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Biomedical subjects

J B Leikin

Publications and source records attributed to J B Leikin.

At least 19 recordsLinked to original sources
PubMed2001

Trends in a decade of drug abuse presentation to an inner city ED.

Temporal factors on the periodic presentations has been described for many diseased states (ie, asthma, seizures, coronary attacks). We now report an analysis of factors that could affect the periodic character regarding emergency department (ED) presentation of drugs of abuse. All drugs presentations consistent with the Drug Abuse Warning Network (DAWN) reporting program from January 1988 through December 1997 were categorized. Data collection was based on daily chart review of ED medical records from Rush-Presbyterian-St. Luke's Hospital (Chicago, IL). Data were computer analyzed using SPSS and Pharmfit programs and analyzed for time, age, disposition, sex, and reasons for presentation and taking the drugs. During the above period, the Rush ED saw 369,770 patients of which 2,561 (0.7%) presented with a drug-related problem. The average age of men was 33. 7 + 0.29 and women 30.5 + 0.37 years. One hundred thirty-nine patients (5.4%) were under 17 years of age whereas only 72 patients (2.8%) were over 55 years of age. Cocaine was the most common drug presentation with a total of 859 visits. Seven hundred sixty-one (29. 7%) presented with an unexpected reaction, 754 (29.4%) experienced an over dosage, 135 (5.3%) had a drug withdrawal, 546 (21.3%) experienced chronic effects, 1,380 (53.9%) were drug dependent, 218 (8.5%) were suicide attempts, and the remaining 2.7% were unknown. There were 1,078 (42.2%) patients who were treated and released, 1, 394 (54.6%) who were admitted into the hospital, 74 (2.9%) left against medical advice whereas 9 patients (0.4%) died. Peak time for presentation was 5:03 PM (P =.00002). Suicide intent presentations were more likely to be women (P <.0001), older (P <.001), and present at a later time that of recreational drug use (acrophase 18:49 versus 16:39; P =.00011). Almost 90% of patients presenting to our urban ED over past 10 years with drug-related problems arrive because of drug abuse or dependency issues. ED staff should be most prepared to deal with these issues in the late afternoon.

Adolescent↗
PubMed2001

Surveillance for carbon monoxide poisoning using a national media clipping service.

Using a novel method to review carbon monoxide (CO) exposures in the US, the role of CO detectors in prevention of CO-related deaths was studied. Using a national media clipping service, CO poisonings reported in the US were analyzed. The impact of CO detectors was investigated through nonfatal outcomes attributable to the presence of CO detectors and case fatality rate comparison among cities with and without CO detector ordinances. There were 4,564 CO exposures resulting in 406 (8.9%) fatalities. Of the exposures 2,617 (57.3%) occurred in the home, accounting for 374 (92.1%) deaths. Faulty heating systems constituted 2,540 (55.6%) exposures and 186 (45.8%) deaths, with alternate heating sources responsible for 389 (8.5%) exposures and 104 (25.6%) deaths. Cities with CO detector ordinances showed lower case fatality rates as reported in the media than those cities without ordinances (P <.001). There were 1,008 (24.2%) survivors who attributed their survival to the presence of a CO detector. A media clipping service provided insight into CO poisoning demographics. Despite its limitations, this tool may calibrate the positive impact of CO detectors on the prevention of CO-related deaths.

Carbon Monoxide Poisoning↗
PubMed2001

Atypical presentation of risperidone toxicity.

A new class of antipsychotic medication, the "atypical antipsychotics" are gaining popularity. We report 2 cases of toxicity associated with 1 of these new antipsychotics, risperidone. Both patients presented with fatigue, orthostasis, dry mucous membranes, and the unusual finding of miosis. The pathophysiology and clinical presentation of overdose with this agent are discussed.

Administration, Oral↗
PubMed2001

Relative safety of mirtazapine overdose.

A 43-y-o male with a history of AIDS, atrial fibrillation, and alcohol abuse presented to the emergency department 2 h after ingestion of 25 tablets of 15 mg mirtazapine (total 375 mg) with ethanol in a suicide attempt (no other coingestion). Vital signs were normal except for a mild tachycardia (rate 112). Physical examination was unremarkable except for lethargy. Fifty grams of activated charcoal with sorbitol was given. Electrocardiogram showed sinus tachycardia, left ventricular hypertrophy, and non-specific ST-segment changes. Serum mirtazapine on admission was 530 ng/mL (therapeutic level 20-50 ng/mL). Overnight monitoring revealed no tachyarrythmias, and discharge occurred after psychiatric evaluation. It appears that ingestions of mirtazapine approximately 10-fold of therapeutic exhibit minimal acute toxicity. From this and other cases in the literature exhibiting a 10-fold overdose, we conclude that isolated mirtazapine ingestions of this magnitude require no acute intervention other than short term (about 6 h) observation.

Adult↗
PubMed2000

Selected topics related to occupational exposures.

The auditory and nonauditory effects of noise can be quite profound, affecting approximately 15 to 20 million Americans. As with most occupational toxins, recognition and careful assessment of noise exposure are the foundation on which preventive measures and treatment are based. Dosimeters can measure noise exposure over specific time periods. Pure tone air conduction audiometric monitoring should be performed on an annual basis in workers at risk for significant noise exposure. Occupational infectious disease involves far more than hepatitis and tuberculosis. Periodic fever, dermatologic manifestations and other symptoms peculiar to a specific disease may be important clues to an occupationally related exposure. Whereas strict attention to hand washing and isolation are cornerstones of prevention, use of protective gear is mandated in certain situations. Zoonotic disease, agriculture exposure, water transmission, and biologic contaminants in buildings can be important but subtle exposures sources. Recognition of these infections often depends on the alertness of the primary care giver.

Cardiovascular Diseases↗
PubMed2000

Serious toxicity in a young child due to ibuprofen.

An 18-month-old male presented to the emergency department (ED) for evaluation of lethargy and apnea. Four hours before presentation, the patient was found with an empty bottle of ibuprofen, an ingestion of as much as 7.2 grams (600 mg/kg). The ED course was remarkable for a 30-second tonic-clonic seizure. Laboratory analysis was notable for metabolic acidosis. Four-hour and 7.5-hour serum ibuprofen levels were 640 and 39 microg/mL, respectively. Following treatment, the patient improved and was extubated the next morning. While metabolic acidosis has been frequently described at doses exceeding 400 mg/kg, seizures occurring early in the course of ibuprofen toxicity have been rarely noted.

Accidents, Home↗
PubMed1999

Use of subcutaneous terbutaline to reverse peripheral ischemia.

Four cases are presented, one involving extravasation of a dopamine and dobutamine solution in the arm and three involving accidental digital injection of epinephrine into the thumb. In three cases, local infiltration of terbutaline resulted in dramatic reversal of vasospasm and ischemia. In the remaining case the use of terbutaline resulted in minor clinical improvement. These are the first reported cases involving the successful treatment of peripheral ischemia with subcutaneous terbutaline. This experience suggests that terbutaline may be an effective alternative for treatment of peripheral ischemia when phentolamine is not available.

Adolescent↗
PubMed1999

Hypersensitivity myocarditis associated with ephedra use.

BACKGROUND: Ephedrine has previously been described as a causative factor of vasculitis but myocarditis has not yet been associated with either ephedrine or its plant derivative ephedra. CASE REPORT: A 39-year-old African American male with hypertension presented to Rush Presbyterian St. Luke's Medical Center with a 1-month history of progressive dyspnea on exertion, orthopnea, and dependent edema. He was taking Ma Huang (Herbalife) 1-3 tablets twice daily for 3 months along with other vitamin supplements, pravastatin, and furosemide. Physical examination revealed a male in mild respiratory distress. The lung fields had rales at both bases without audible wheezes. Internal jugular venous pulsations were 5 cm above the sternal notch. Medical therapy with intravenous furosemide and oral enalapril was initiated upon admission. Cardiac catheterization with coronary angiography revealed normal coronary arteries, a dilated left ventricle, moderate pulmonary hypertension, and a pulmonary capillary wedge pressure of 34 mm Hg. The patient had right ventricular biopsy performed demonstrating mild myocyte hypertrophy and an infiltrate consisting predominantly of lymphocytes with eosinophils present in significantly increased numbers. Treatment for myocarditis was initiated with azothioprine 200 mg daily and prednisone 60 mg per day with a tapering course over 6 months. Anticoagulation with warfarin and diuretics was initiated and angiotensin-converting enzyme inhibition was continued. Hydralazine was added later. One month into therapy, an echocardiogram demonstrated improved left ventricular function with only mild global hypokinesis. A repeat right ventricular biopsy 2 months after the first admission showed no evidence of myocarditis. At 6 months, left ventricular ejection fraction was normal (EFN 50%) and the patient asymptomatic. CONCLUSION: Ephedra (Ma Huang) is the suspected cause of hypersensitivity myocarditis in this patient due to the temporal course of disease and its propensity to induce vasculitis.

Adult↗