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Serotonin toxicity results from serotonin excess in the central nervous system from serotonergic drugs. Previous studies suggest an association between T102C polymorphism of the serotonin 2A (5-hydroxytryptamine 2A) receptor gene and serotonergic adverse effects with serotonergic drugs. We aimed to determine whether there is an association between the T102C polymorphism and serotonin toxicity in patients taking serotonergic drug overdoses. Ninety-five patients presenting with serotonergic drug overdoses were examined for serotonin toxicity and had blood collected for DNA analysis. A diagnosis of serotonin toxicity was made in 14 patients (15%) based on the Hunter Serotonin Toxicology Criteria. Four of the 14 patients (29%) with serotonin toxicity had the C/C genotype compared with 20/81 (25%) without serotonin toxicity. There were no differences in age or sex, but the median defined daily dose taken by patients with serotonin toxicity was 27 (14-84) compared with 18 (2-136) in patients without serotonin toxicity (P=0.06). There was no association between serotonin toxicity and the T102C polymorphism in patients taking a serotonergic drug overdose. [ABSTRACT FROM AUTHOR]

Introduction. The United Kingdom has recently changed the indications for N-acetylcysteine treatment for acetaminophen intoxication. Any ingestion over 75 mg/kg is now referred to the hospital. A model based on pharmacokinetic parameters was developed to predict 4-h acetaminophen concentration for this and other ingested doses. Methodology. EMBASE and Medline were searched to obtain values for volume of distribution, absorption, and elimination constants and bioavailability for acetaminophen. Four-hour concentrations were calculated for ingestion doses currently recommended for hospital referral in different countries. Calculated plasma concentrations at 4 h for several doses were plotted against the Rumack-Matthew and the United Kingdom treatment lines. Results. Six articles were used for the calculations (4 adult and 2 pediatric). In order to achieve a 4-h acetaminophen concentration of 100 mg/L, doses (mg/kg ± 99.9CI) of 180.5 ± 43.2 for adults and 396.1 ± 115.5 for children were calculated. Discussion. A dose of 75 mg/kg would likely yield a 4-h acetaminophen concentrations well below 100 mg/L. Medical toxicologists and poison information specialists are left without evidence-based guidance for which patients or which ingestion history would now warrant referral to hospital for acetaminophen concentration measurement. Larger toxicokinetic studies in acetaminophen overdose are needed to define ingestion dose for referral to hospital. [ABSTRACT FROM AUTHOR]

The United Kingdom's Medicines and Healthcare Products Regulatory Agency (MHRA) modified the indications for N-acetylcysteine therapy of acetaminophen (paracetamol) overdose in September 2012. The new treatment threshold line was lowered to 100 mg/L (662 μmol/L) for a 4 hours acetaminophen concentration from the previous 200 mg/L (1325 μmol/L). This decision has the potential to substantially increase overall costs associated with acetaminophen overdose with unclear benefits from a marginal increase in patients protected from hepatotoxicity, fulminant hepatic failure, death, or transplant. Changing the treatment threshold for acetaminophen overdose also implies that ingestion amounts previously thought not to require acetaminophen concentration measurements would need to be revised. As a result, more individuals will be sent to hospitals in order that everyone with a predicted 4 hours concentration above the 100 mg/L line will have concentrations measured and potentially be treated with N-acetylcysteine. Before others consider adopting this new treatment guideline, formal cost-effectiveness analyses need to be performed to define the appropriate thresholds for referral and treatment. [ABSTRACT FROM AUTHOR]

In a recent paper we demonstrated that elephant bull groups and mixed herds exhibited spatial and resource segregation across the Kruger National Park. It was found, inter alia, that both bull groups and mixed herds occurred more frequently closer to rivers than expected if they were randomly distributed, but that only bull groups occurred more frequently closer to the artificial waterholes. Although Chamaillé-Jammes et al. (2007 ) accepted these results, they disagreed with our interpretation regarding the potential effect that closure of artificial waterholes might have. Here we address some of the specific concerns expressed and provide a broader context regarding water provision and elephant management. Although water provision can influence elephant density and distribution, we argue that the effectiveness of surface-water manipulation as a management tool will depend on (1) natural surface-water availability, (2) forage quality, (3) elephant densities, (4) position of a population on its growth trajectory, and (5) management objectives. Even though elephants are water-dependent, the effectiveness of water provision as a management tool will therefore be area- and population-specific and will depend on management objectives. [ABSTRACT FROM AUTHOR]

This study compared the dry season distribution of elephant bull groups and mixed herds and the resources driving these distributions within Kruger National Park, South Africa. It is important to understand what resources drive the distribution of elephants as this may be of relevance to understanding and managing their impact. It is also important to distinguish between resource use by bull groups and mixed herds because their impact on the habitat may differ. Our results indicated that sexual segregation, both in space and in resource selection, did occur in Kruger Park. Bulls roamed more widely in the park, and although their distribution and resource use overlapped with mixed herds, they also occurred in areas that mixed herds apparently did not, or could not, utilize in the dry season. This gave rise to areas used exclusively by bulls but no areas used exclusively by mixed herds. Lower collective feeding requirements as a result of smaller group size, wider habitat tolerance, and increased mobility as a result of bigger body size, as well as conflict avoidance with musth bulls in areas with mixed herds, might have been some of the reasons for bull groups roaming more widely and for the establishment of separate bull areas. Rivers were an important resource driving both the distribution of the mixed herds and bull groups, but with the mixed herds occurring closer to these resource hot spots than the bull groups. Tree cover proved important for mixed herds, probably because of the importance of shade and the higher nutritional requirements of the smaller-sized cows and calves. Artificial waterholes might have opened up previously unutilized areas for bulls in the dry season, especially on the grassy basaltic plains in the north of the park. However, the distribution of the mixed herds suggested that they did not occur in higher densities in areas surrounding waterholes. [ABSTRACT FROM AUTHOR]

AimTo assess the effect of mobile telephone electromagnetic interference on electronic ophthalmic equipment.MethodsProspective audit with mobile telephones placed at distances of 3 m, 1 m, and 30 cm from, and in contact with, electronic ophthalmic equipment. Any interruption or cessation of the function of the ophthalmic device was assessed with the mobile telephones in standby, and in dialling or receiving modes. Any alterations of displayed digital figures or numbers were also assessed.ResultsA total of 23 electronic ophthalmic devices in two hospital ophthalmology outpatient departments were evaluated. All six mobile telephones used, and 22 (95.7%) of the 23 ophthalmic equipment evaluated had the Conformité Européene (CE) mark. No device showed any interruption or cessation of function. There were no alterations of displayed digital figures or numbers. The only effect of any kind was found with four instruments (1 non-CE marked), where there was temporary flickering on the screen, and only occurred when the mobile telephones were dialling or receiving at a distance of 30 cm or less from the instruments.ConclusionThis study shows that among the electronic ophthalmic devices tested, none suffered failure or interruption of function, from mobile telephone interference. Although not comprehensive for all ophthalmic equipment, the results question the need for a complete ban of mobile telephones in ophthalmic departments. It highlights the need for a controlled, objectively measured study of the clinically relevant effects of mobile telephones in the ophthalmology outpatient setting.Eye (2007) 21, 29–32. doi:10.1038/sj.eye.6702110; published online 30 September 2005 [ABSTRACT FROM AUTHOR]

Since the Newcastle Diabetes Centre opened in 1997, the three podiatrists working in the centre have established specialised ulcer clinics to see patients with foot ulcers at least twice per week. As this was a new service, a baseline audit was proposed to provide a level with which to compare future developments. The standard was set at 80% of diabetic foot ulcers to be healed within six months of referral to the podiatry team. All patients with diabetes presenting at the Podiatry Department, Newcastle Diabetes Centre, with a new foot ulcer during the period from 1 December 1997 to 31 May 1998 were entered into the audit. The ulcers were then monitored for up to six months until the end of the audit period on 30 November 1998. The result was that 85% of diabetic foot ulcers healed within six months, which exceeds the standard set at 80%. The average time taken to heal diabetic foot ulcers was eight weeks. [ABSTRACT FROM AUTHOR]