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Biomedical subjects

James H Diaz

Publications and source records attributed to James H Diaz.

At least 19 recordsLinked to original sources
PubMed2005

Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings.

OBJECTIVE: To assess the evolving global epidemiology of mushroom poisoning and to identify new and emerging mushroom poisonings and their treatments, a descriptive analysis and review of the world's salient scientific literature on mushroom poisoning was conducted. DATA SOURCE: Data sources from observation studies conducted over the period 1959-2002 and describing 28,018 mushroom poisonings since 1951 were collected from case reports, case series, regional descriptive studies, meta-analyses, and laboratory studies of mushroom poisonings and the toxicokinetics of mycotoxins. STUDY SELECTION: Studies included in the review were selected by a MEDLINE search, 1966-2004, an Ovid OLDMEDLINE search, 1951-1965, and a medical library search for sources published before 1951. DATA EXTRACTION: To better guide clinicians in establishing diagnoses and implementing therapies, despite confusing ingestion histories, data were extracted to permit an expanded syndromic classification of mushroom poisoning based on presentation timing and target organ systemic toxicity. DATA SYNTHESIS: The final 14 major syndromes of mushroom poisoning were stratified first by presentation timing and then by target organ systemic toxicity and included early (<6 hrs), late (6-24 hrs), and delayed syndromes (> or =1 day). There were eight early syndromes (four neurotoxic, two gastrointestinal, two allergic); three late syndromes (hepatotoxic, accelerated nephrotoxic, erythromelalgia); and three delayed syndromes (delayed nephrotoxic, delayed neurotoxic, rhabdomyolysis). Four new mushroom poisoning syndromes were classified including accelerated nephrotoxicity (Amanita proxima, Amanita smithiana), rhabdomyolysis (Tricholoma equestre, Russula subnigricans), erythromelalgia (Clitocybe amoenolens, Clitocybe acromelalgia), and delayed neurotoxicity (Hapalopilus rutilans). In addition, data sources were stratified by three chronological time periods with >1,000 confirmed mushroom ingestions reported and tested for any statistically significant secular trends in case fatalities from mushroom ingestions over the entire study period, 1951-2002. CONCLUSIONS: Since the 1950s, reports of severe and fatal mushroom poisonings have increased worldwide. Clinicians must consider mushroom poisoning in the evaluation of all patients who may be intoxicated by natural substances. Since information on natural exposures is often insufficient and incorrect, a new syndromic classification of mushroom poisoning is recommended to guide clinicians in making earlier diagnoses, especially in cases where only advanced critical care, including organ transplantation, may be life saving.

Diagnosis, Differential↗
PubMed2005

Syndromic diagnosis and management of confirmed mushroom poisonings.

OBJECTIVE: To assess the evolving global epidemiology of mushroom poisoning and to identify new and emerging mushroom poisonings and their treatments, a descriptive analysis and review of the world's salient scientific literature on mushroom poisoning was conducted. DATA SOURCE: Data sources from observation studies conducted over the period 1959-2002, and describing 28,018 mushroom poisonings since 1951, were collected from case reports, case series, regional descriptive studies, meta-analyses, and laboratory studies of mushroom poisonings and the toxicokinetics of mycotoxins. STUDY SELECTION: Studies included in the review were selected by a MEDLINE search, 1966-2004, an Ovid OLDMEDLINE search, 1951-1965, and a medical library search for sources published before 1951. DATA EXTRACTION: To better guide clinicians in establishing diagnoses and implementing therapies, despite confusing ingestion histories, data were extracted to permit an expanded syndromic classification of mushroom poisoning based on presentation timing and target organ systemic toxicity. DATA SYNTHESIS: The final 14 major syndromes of mushroom poisoning were stratified first by presentation timing and then by target organ systemic toxicity and included early (<6 hrs), late (6-24 hrs), and delayed syndromes (> or =1 day). There were eight early syndromes (four neurotoxic, two gastrointestinal, two allergic); three late syndromes (hepatotoxic, accelerated nephrotoxic, erythromelalgia); and three delayed syndromes (delayed nephrotoxic, delayed neurotoxic, rhabdomyolysis). Four new mushroom poisoning syndromes were classified including accelerated nephrotoxicity (Amanita proxima, Amanita smithiana), rhabdomyolysis (Tricholoma equestre, Russula subnigricans), erythromelalgia (Clitocybe amoenolens, Clitocybe acromelalgia), and delayed neurotoxicity (Hapalopilus rutilans). In addition, data sources were stratified by three chronological time periods with >1,000 confirmed mushroom ingestions reported and tested for any statistically significant secular trends in case fatalities from mushroom ingestions over the entire study period, 1951-2002. CONCLUSIONS: Since the 1950s, reports of severe and fatal mushroom poisonings have increased worldwide. Clinicians must consider mushroom poisoning in the evaluation of all patients who may be intoxicated by natural substances. Since information on natural exposures is often insufficient and incorrect, a new syndromic classification of mushroom poisoning is recommended to guide clinicians in making earlier diagnoses, especially in cases where only advanced critical care, including organ transplantation, may be life saving.

Agaricales↗
PubMed2005

Correlation of adverse neurological outcomes with increasing volumes and delayed administration of autologous epidural blood patches for postdural puncture headaches.

INTRODUCTION: Epidural blood patches (EBPs) usually afford rapid and successful treatment outcomes for postdural puncture headaches (PDPH) with few adverse sequelae. PATIENTS AND METHODS: In order to identify potential risk factors for any adverse outcomes of EBP, a Medline search, 1966 to the present, of case reports and series of any adverse outcomes following EBP for PDPH was conducted. The literature search identified 26 patient cases with 21 cases defined as adverse neurological outcomes, and further stratified as compression or noncompression syndromes, and five cases defined as persistent cranial nerve (CN) palsies. Cases were also stratified by age, sex, and blood volumes of EBP or delays in administration, and compared for statistically significant differences in continuous variables by unpaired, two-tailed t-tests and for significant correlations between predictor variables, including EBP volumes and delays in administration, and adverse neurological outcomes, by simple linear regression analysis. RESULTS: There were no statistically significant sex differences in the mean ages or weights of the study population, or in the total volumes of autologous blood injected in EBPs. When the study population was compared for adverse neurological outcomes by compression or noncompression syndromes, patients experiencing compression syndromes received significantly more EBP volumes (35.36 mL) than patients experiencing noncompression (17.46 mL) syndromes (P = 0.025). Regression analysis confirmed a significant direct linear relationship between increasing EBP volumes and worsening adverse neurological outcomes (P = 0.008). In patients with CN palsies associated with PDPH and unrelieved by EBP, regression analysis again confirmed significant direct linear relationships between increasing days waited to perform EBP and increasing duration of CN palsies in months (P = 0.001). CONCLUSIONS: Epidural blood patches for the management of PDPH, especially PDPH associated with CN palsies, should be administered as soon as the diagnosis of PDPH is made with lower volumes of autologous blood (< or =20 mL) to assure the best treatment outcomes.

Journal Article↗
PubMed2005

The evolving global epidemiology, syndromic classification, management, and prevention of caterpillar envenoming.

Caterpillars are the wormlike, larval forms of butterflies and moths of the insect order Lepidoptera. Next to flies, lepidopterans are the most abundant arthropods with more than 165,000 species worldwide, and with most species posing no human threats. However, caterpillar species from approximately 12 families of moths or butterflies worldwide can inflict serious human injuries ranging from urticarial dermatitis and atopic asthma to osteochondritis, consumption coagulopathy, renal failure, and intracerebral hemorrhage. Unlike bees and wasps, envenoming or stinging caterpillars do not possess stingers or modified ovipositors attached to venom glands, but instead bear highly specialized external nettling or urticating hairs and breakaway spines or setae to defend against attacks by predators and enemies. Since the 1970s, there have been increasing reports of mass dermatolgic, pulmonary, and systemic reactions following caterpillar encounters throughout the world.

Animals↗
PubMed2004

Permanent neurologic symptoms after prolonged epidural analgesia.

OBJECTIVE: Although transient neurologic symptoms may occur after neuraxial anesthetics with lidocaine, permanent neurologic symptoms (PNS) are unusual after uncomplicated continuous epidural analgesia (CEA). This report demonstrates that PNS may follow CEA uncomplicated by paresthesias, dural puncture, spinal hemorrhage, or intravascular local anesthetic injection; and performed with bupivacaine alone administered at high dosages with vasoconstrictors over a prolonged time period. CASE REPORT: An obstetrical patient developed fixed left L5-S1 sensorimotor radiculopathy following L5-S1 level CEA with bupivacaine alone administered at high doses (270 mg) with a vasoconstrictor (epinephrine, 225 mg) over a prolonged time period (62 hours). CONCLUSIONS: CEA should be administered at higher lumbar levels for labor analgesia rather than at lumbosacral levels that may require higher volumes and concentrations of local anesthetics with greater potential for local anesthetic neurotoxicity. Local anesthetics with vasoconstrictors should only be used as sentinel markers of unrecognized intravascular entry, rather than as primary local anesthetics during CEA to avoid any potential for ischemic neuropathy.

Journal Article↗
PubMed2004

Treatment outcomes in spontaneous intracranial hypotension: do epidural blood patches stop the leaks?

Spontaneous intracranial hypotension (SIH) is a postural headache syndrome unrelated to dural puncture. Because of the increasing failure of epidural blood patch (EBP) to relieve headache in SIH, we retrospectively investigated the epidemiological features and treatment outcomes in 55 cases of SIH. The study population was stratified by age and sex; continuous variables were compared for differences by t-tests; categorical variables were compared by Chi-squared analysis or Fisher exact tests. Significant differences were identified by P values of 0.05 or less. The mean age of the study population was 44 +/- 12 years with a female to male ratio of 1.3:1.0. Men presented with subdural hematomas (P = 0.001) more often than women. Meningeal enhancement on contrast magnetic resonance imaging (MRI) was the most consistent radiographic finding. Radionuclide cisternography (RC) demonstrated thoracolumbar dural leaks in 16 of 22 patients. EBP failures were more common in patients aged 40 and younger than in older patients (P = 0.003). Postural headache from SIH was not uniformly responsive to EBP, and had significant comorbidities, especially in men. The management of postural headache in SIH by other techniques to restore brain position and cerebrospinal fluid dynamics should be investigated.

Journal Article↗
PubMed2004

The global epidemiology, syndromic classification, management, and prevention of spider bites.

Spiders are carnivorous arthropods that coexist with humans and ambush or ensnare prey. Unlike other arthropods, spiders rarely transmit communicable diseases, and play a critical role in the ecosystem by consuming other arthropods that frequently transmit human diseases, such as mosquitoes and flies. There are more than 30,000 species of spiders, most of which are venomous, but they cannot inflict serious bites due to delicate mouthparts and short fangs. The differential diagnosis of spider bites is extensive and includes other arthropod bites, skin infections, and exposure to chemical or physical agents. However, approximately 200 species from 20 genera of spiders worldwide can cause severe human envenomings, with dermonecrosis, systemic toxicity, and death. Spider bites can usually be prevented by simple personal and domestic measures. Early species identification and specific management may help prevent serious sequelae of spider bites.

Animals↗
PubMed2002

A possible role for zonisamide in treating neuropathic pain: a case of idiopathic polyneuropathy.

Anti-epilepsy medications have frequently been used in the treatment of neuropathic pain to reduce the transmission of nociceptive signals.(1,2) Zonisamide is a sulfonamide drug that was approved in 2000 for the adjunctive treatment of partial seizures in adults. Because of the unique combination of mechanisms through which zonisamide functions, it has potential to be a useful option in the treatment of refractory neuropathic pain. We present the case of a patient with refractory neuropathic pain related to idiopathic polyneuropathy, who responded to adjunctive treatment with zonisamide.

Journal Article↗
PubMed2002

Chronic postoperative epidural abscess with ascending neuromyotonia.

IMPLICATIONS: Clinicians are reminded that epidural abscesses may not follow epidural space violation, may present a confusing constellation of back pain and paraparesis, and may have serious consequences if not diagnosed accurately and managed aggressively with spinal decompression.

Aged↗
PubMedDate not supplied

The public health impact of global climate change.

Accurate predictions of the public health impact of global climatic changes are hampered by the absence of a dose-response relationship between climate change and human health and imprecise, often conflicting, meteorological models of climate change. Public health officials are obligated to educate policy makers and the public about the significant threats posed to population health and quality of life by the inexorable progression of global climate change. Only an enlightened public consciousness can muster the political will required to press for policy changes and to support new technologies to conserve energy and to protect the environment from manmade agents of destruction.

Animals↗
PubMedDate not supplied

The epidemiology, diagnosis, management, and prevention of ectoparasitic diseases in travelers.

Ectoparasitic diseases have been reported in travelers returning from both developed and developing nations.(1-3) Ectoparasitic diseases afflict the skin and its appendages and orifices, especially the scalp, facial, and pubic hairs; external ears; nares; orbits and eyelids; and genitourinary and rectal orifices. Like endoparasites, ectoparasites may be either obligatory parasites, which need to feed on human hosts to complete their life cycles, or facultative parasites, which prefer to feed on nonhuman hosts and infest humans only as accidental or dead-end hosts.(4,5).

Diagnosis, Differential↗
PubMedDate not supplied

Global climate changes, natural disasters, and travel health risks.

Whether the result of cyclical atmospheric changes, anthropogenic activities, or combinations of both, authorities now agree that the earth is warming from a variety of climatic effects, including the cascading effects of greenhouse gas emissions to support human activities. To date, most reports of the public health outcomes of global warming have been anecdotal and retrospective in design and have focused on heat stroke deaths following heat waves, drowning deaths in floods and tsunamis, and mosquito-borne infectious disease outbreaks following tropical storms and cyclones. Accurate predictions of the true public health outcomes of global climate change are confounded by several effect modifiers including human acclimatization and adaptation, the contributions of natural climatic changes, and many conflicting atmospheric models of climate change. Nevertheless, temporal relationships between environmental factors and human health outcomes have been identified and may be used as criteria to judge the causality of associations between the human health outcomes of climate changes and climate-driven natural disasters. Travel medicine physicians are obligated to educate their patients about the known public health outcomes of climate changes, about the disease and injury risk factors their patients may face from climate-spawned natural disasters, and about the best preventive measures to reduce infectious diseases and injuries following natural disasters throughout the world.

Disasters↗
PubMedDate not supplied

Is fish consumption safe?

Louisiana's vital seafood industry provides nearly 40% of domestic seafood production. Unlike Louisianans, most Americans do not enjoy fresh seafood, yet manage to eat over 4 billion pounds of seafood annually, most of it foreign, frozen, and fried! America's commercial fisheries now face crippling economic and environmental pressures from seafood imports, over-fishing, urban and agricultural wastewater runoff, harmful algal blooms, and coastal wetlands loss. As a result of these ecosystem stresses, seafood-borne disease now causes 37% of all foodborne illness in the United States. Despite recent advisories on high mercury-containing finfish consumption, seafood provides more than a third of the world with essential dietary protein, rich in cardiovascular-protective omega-3 polyunsaturated fatty acids. Louisiana and other coastal-state physicians can effectively curtail the rising threat of local seafood-borne disease outbreaks by supporting responsible coastal restoration and regulation of commercial fishing, and by recommending careful inspection, selection, and preparation of seafood.

Botulism↗
PubMedDate not supplied

The public health impact of hurricanes and major flooding.

Accurate predictions of the public health impact of hurricanes and major flooding are hampered by the absence of a dose-response relationship between hurricane-associated flooding and human health and the imprecise, often conflicting, meteorological models of climate change and hurricane landfall. Flooding is now the most common type of disaster worldwide, and flash flooding, usually associated with tropical storms, is the leading cause of weather-related deaths in the United States. As a result of climate changes and more frequently alternating ocean oscillations, hurricanes of category 3 or greater now strike the continental US approximately every 18 months. Public health officials are obligated to educate policymakers and the public about the significant threats posed to population health and quality of life by the inexorable progression of global climate change, including more water-centered disasters, such as tropical storms and hurricanes.

Disasters↗
PubMedDate not supplied

Is shellfish consumption safe?

Louisiana provides nearly 40% of domestic seafood production. America's commercial fisheries, especially coastal shellfish fisheries, now face crippling economic and environmental pressures from seafood imports, over-fishing, urban and agricultural wastewater runoff, harmful algal blooms, and coastal wetlands loss. As a result of these ecosystem stresses, seafood-borne disease now causes 37% of all foodborne illness in the United States. Louisiana and other coastal-state physicians can effectively curtail the rising threat of local shellfish-borne disease outbreaks by supporting responsible coastal restoration and regulation of commercial shell-fishing, especially oyster fishing, and by recommending careful selection and preparation of all shellfish and crustaceans.

Arsenic Poisoning↗