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Biomedical subjects

M R Daya

Publications and source records attributed to M R Daya.

9 recordsLinked to original sources
PubMed1998

Prognostic factors in patients with methanol poisoning.

OBJECTIVE: To identify prognostic factors in methanol poisoning and determine the effect of medical interventions on clinical outcome. METHODS: Retrospective review of all patients treated for methanol poisoning from 1982 through 1992 at The Toronto Hospital. Presenting history, physical examination, results of laboratory tests, medical interventions, and final outcomes after hemodialysis were abstracted. RESULTS: Of 50 patients treated for methanol poisoning, 18 (36%) died, 32 (64%) survived. Seven of the 32 survivors sustained visual sequelae (22%), the remaining 25 (78%) recovered completely. Patients presenting with coma or seizure had 84% (16/19) mortality compared to 6% (2/31) in those without (p < 0.001). Initial arterial pH < 7 was also associated with significantly higher mortality (17/19, 89% vs 1/31, 3%, p < 0.001). There were no differences in time from presentation to dialysis between survivors and fatalities (8.4 +/- 3.6 vs 7.6 +/- 3.5 hours, p = 0.47). The deceased patients had higher mean methanol concentration than the survivors (83 +/- 53 vs 41 +/- 25 mmol/L, p = 0.004). Subgroup analysis of 19 patients presenting with visual symptoms who survived showed prolonged acidosis (5.4 +/- 2.3 vs 3.0 +/- 2.1 hours, p = 0.06) in those with persistent visual sequelae. CONCLUSIONS: Coma or seizure on presentation and severe metabolic acidosis, in particular initial arterial pH < 7, are poor prognostic indicators in methanol poisoning. Survivors presented with lower methanol concentrations. Patients with residual visual sequelae had more prolonged acidosis than those with complete recovery. Future studies will be needed to confirm the effect of correction of acidosis on final clinical outcome.

Acidosis↗
PubMed1995

Sotalol-induced bradycardia reversed by glucagon.

Glucagon is considered the drug of choice for treating bradycardia and hypotension encountered during beta-blocker poisoning. Its potential usefulness in reversing adverse effects encountered during therapeutic dosing with beta-blockers has not been well characterized. We present a case of sotalol-induced bradycardia reversed by glucagon.

Aged↗
PubMed1994

Emergency department patients who leave without seeing a physician: the Toronto Hospital experience.

STUDY OBJECTIVES: To determine why emergency department patients leave without being seen by a physician and whether they receive alternate medical care. DESIGN: A prospective, cross-sectional study of patients who left without being seen. Charts were reviewed for population demographics, presenting complaints, and clinical acuity rating. Follow-up was achieved within 6 weeks through mailed survey questionnaires and telephone interviews. SETTING: Two inner-city EDs of the Toronto Hospital, a quaternary care facility. PARTICIPANTS: All 423 patients who registered for care and left without being seen during a 16-week period from January to May 1991. RESULTS: Of 23,933 registered patients, 423 (1.4%) left without being seen. Follow-up was achieved on 39% of patients (165 of 423). Sixty-seven percent of those who left (284 of 423) had low acuity ratings. Of the 165 survey respondents, 107 (65%) left between 30 minutes and 2 hours after registration. The major reasons cited for leaving included prolonged waiting time (99 of 165, 60%), perceived difficulties with hospital staff (46 of 165, 28%), and pressing commitments elsewhere (45 of 165, 27%). Ninety-two percent (152 of 165) believed they should be evaluated by a physician within 1 hour of presentation. Forty-eight percent (80 of 165) sought further medical attention within 24 hours. Personal physicians (65 of 165, 39%) and other EDs (29 of 165, 18%) were the most common sources of further medical care. CONCLUSION: The majority of survey respondents had a low acuity rating and left because of prolonged waiting times. Most of these patients sought alternate medical care through their personal physician or other EDs.

Adolescent↗
PubMed1994

A roller coaster headache: case report.

There are few reports of adverse outcomes associated with roller coaster rides. We present the case of a 26-year-old man who complained of a gradually worsening headache following a roller coaster ride. A computed tomographic scan of the head demonstrated bilateral chronic subdural hematomas. The clinical course and probable mechanism of injury are reviewed.

Adult↗
PubMed1992

Massive strychnine intoxication: serial blood levels in a fatal case.

A fatal case of strychnine intoxication is reported. The patient expired despite early aggressive management and prevention of metabolic complications. Serial blood levels are reported. In contrast to a previous report describing first order elimination kinetics, our data suggest that strychnine follows Michaelis-Menton elimination kinetics. The case illustrates the rapid, dramatic course of severe strychnine ingestions. A review of the toxicokinetics, mechanism of action and treatment of strychnine intoxication follows.

Autopsy↗
PubMed1990

Liver transplantation for severe Amanita phalloides mushroom poisoning.

Amanita phalloides mushroom poisoning is an increasingly common and potentially lethal problem for which liver transplantation offers definitive therapy in selected patients. When significant liver dysfunction appears, early transfer to a liver transplant center is important to identify appropriate candidates and to begin the search for a donor organ. The clinical course of five severely poisoned patients, four of whom underwent liver transplantation, is reviewed. Indications for transplantation included primarily a markedly prolonged prothrombin time that was only partially correctable and a constellation of findings including metabolic acidosis, hypoglycemia, hypofibrinogenemia, and increased serum ammonia, following a marked elevation in serum aminotransferase levels. Unlike viral fulminant hepatic failure, grade III or IV hepatic encephalopathy, marked elevation of the serum bilirubin level, and azotemia were not indications for transplantation. Resected livers demonstrated hepatocyte viability of 0% to 30%. Manifestations of Amanita poisoning complicating preoperative and/or postoperative care included severe diarrhea, gastrointestinal hemorrhage, hypophosphatemia, bowel edema, and marrow suppression with lymphopenia, thrombocytopenia, and neutropenia. All five patients are well 1 year later. This largest experience with liver transplantation for Amanita poisoning further defines the early clinical and laboratory indications for, and the unique complicating features of, transplantation in this setting.

Acute Disease↗
PubMed1988

Recurrent seizures following mucosal application of TAC.

A 5-year-old 20-kg boy developed grand mal seizures following application of 2 mL of tetracaine-adrenalin-cocaine to an oral mucosa laceration. Diazepam 6 mg IV followed by 195 mg phenobarbital was required to terminate the seizures. The patient was transferred to a pediatric intensive care unit for further evaluation and treatment. A toxicology screen obtained after transfer was positive only for diazepam and phenobarbital. The child remained lethargic for several hours but otherwise had a normal neurological examination. Brain computed tomography was normal. Anticonvulsant medication was discontinued prior to discharge and the child had no subsequent seizures.

Administration, Buccal↗
PubMedDate not supplied

Occupational infectious disease exposures in EMS personnel.

Reports of occupationally transmitted hepatitis B virus (HBV) and human immunodeficiency virus (HIV) prompted the Portland Bureau of Fire Rescue and Emergency Services (PFB) to institute a comprehensive program for handling and tracking on-the-job infectious disease exposures. Data were collected for a 2-year period beginning January 1, 1988, and ending December 31, 1989, utilizing verbal and written exposure reports, prehospital care reports, and PFB statistical information. Two hundred and fifty-six (256) exposures were categorized. The overall incidence of reported exposure was 4.4/1,000 emergency medical service (EMS) calls. Of these exposures, 14 (5.5%) were needle sticks, 15 (5.9%) were eye splashes, 8 (3.1%) were mucous membrane exposures, 38 (14.8%) were exposure to nonintact skin, 120 (46.9%) were exposures to intact skin, and 61 (23.8%) involved respiratory exposure only. The incidence of exposure of nonintact skin or mucous membranes to blood or body fluids and needle sticks was 1.3/1,000 EMS calls. Forty-eight individuals (64% of those incurring needle sticks, or exposure of non-intact skin or mucous membranes to blood or body fluids) were treated and followed for signs of infection. Of this group, 11 individuals (26%) previously vaccinated against hepatitis B demonstrated inadequate HBsAb titers at the time of exposure. Requests for HIV and HBV information on source patients were made for needle sticks or exposure of nonintact skin or mucous membranes to blood or high-risk body fluids. Information on the source patient's HIV status was obtained for 57% of these requests.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗