35 results on '"Grenc, Damjan"'
Search Results
2. Clinical effect of ethanol co-use in patients with acute drug toxicity involving the use of central nervous system depressant recreational drugs
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Heier, Eva-Carina, Eyer, Florian, Rabe, Christian, Geith, Stefanie, Dargan, Paul I., Wood, David M., Heyerdahl, Fridtjof, Dines, Alison M., Giraudon, Isabelle, Erik Hovda, Knut, Yates, Chris, Vallersnes, Odd Martin, Miró, Òscar, Liechti, Matthias E., Zellner, Tobias, Anand, Lukasz, Waldman, Wojciech, Anseeuw, Kurt, Gillebeert, Johan, Badaras, Robertas, Laubner, Gabija, Bonnici, Jeffrey, Brvar, Miran, Grenc, Damjan, Burke, Rachel, Moughty, Adrian, Caganova, Blazena, Galicia, Miguel, Gorozia, Ketevan, Kutubidze, Soso, Jaffal, Karim, Mégarbane, Bruno, Jürgens, Gesche, Konstari, Jutta, Liguts, Viesturs, Stašinskis, Roberts, Lyphout, Cathelijne, Toth, Ibolya, Noseda, Roberta, Ceschi, Alessandro, O’Connor, Niall, Sopirala, Radhika, Paasma, Raido, Perez, Juan Ortega, Puiguriguer, Jordi, Perminas, Marius, Surkus, Jonas, Persett, Per Sverre, Põld, Kristiina, Radenkova-Saeva, Julia, Rulisek, Jan, Vigorita, Federico, Waldman, Wojciech, Waring, W. Stephen, Zacharov, Sergej, Schmid, Yasmin, Liakoni, Evangelia, Scholz, Irene, Gesnigt, Femke MJ., Sandel, Maro H., Nitescu, Gabriela Viorela, Calýskan, Feriyde, Hengel-Koot, Irma van den, and Hondebrink, Laura
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- 2022
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3. Cholinergic syndrome: a case report of acute organophosphate and carbamate poisoning
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Petreski Tadej, Kit Barbara, Strnad Matej, Grenc Damjan, and Svenšek Franc
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carbofuran ,chlormephos ,critical care ,obidoxime ,karbofuran ,klormefos ,intenzivna medicina ,obidoksim ,Toxicology. Poisons ,RA1190-1270 - Abstract
Cholinergic syndrome is a common topic at western medical universities yet rarely observed in clinical practice. The treatment involves muscarinic antagonists, acetylcholinesterase reactivation, seizure control, and supportive measures. Here we report a case of a 52-year old Caucasian male who attempted suicide by ingesting a purple crystal powder that turned out to be a mixture of carbofuran and chlormephos. At clinical examination, the patient presented with salivation, perspiration, diarrhoea, bradypnoea, loss of consciousness, and epileptic seizures. Laboratory tests showed low plasma cholinesterase, and we started obidoxime along with supportive intensive care treatment. He was later transferred to the psychiatry department for further diagnostics and treatment.
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- 2020
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4. Viper envenomation in Central and Southeastern Europe: a multicentre study
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Dobaja Borak, Mojca, primary, Babić, Željka, additional, Caganova, Blažena, additional, Grenc, Damjan, additional, Karabuva, Svjetlana, additional, Kolpach, Zuzana, additional, Krakowiak, Anna, additional, Kolesnikova, Viktoriia, additional, Lukšić, Boris, additional, Pap, Csaba, additional, Puljiz, Ivan, additional, Piekarska-Wijatkowska, Anna, additional, Radenkova-Saeva, Julia, additional, Vučinić, Slavica, additional, Zacharov, Sergej, additional, Eddleston, Michael, additional, and Brvar, Miran, additional
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- 2023
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5. Inadvertent Intoxication with Salbutamol, Treated with Hemodialysis: A Case Report and Brief Review of the Literature.
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Bezeljak, Neva, Jerman, Alexander, Grenc, Damjan, and Krzisnik Zorman, Simona
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LITERATURE reviews ,ALBUTEROL ,CHRONIC obstructive pulmonary disease ,NONINVASIVE ventilation ,SEPTIC shock - Abstract
Introduction: Salbutamol is a moderately selective beta-2-adrenergic agonist. Various side effects can occur because of beta-1 and beta-2 receptor activation. Due to the large volume of distribution, it is not considered dialyzable. Case Presentation: A patient with salbutamol intoxication, which developed as a result of a medical error in a patient with sepsis, Down syndrome, and liver cirrhosis, is presented. Initial treatment was partially successful and antibiotic adjustments were made. After his respiratory failure worsened, the patient needed non-invasive ventilation, and previously undiagnosed chronic obstructive pulmonary disease was suspected. He was prescribed intravenous methylprednisolone but accidently received 5 mg of salbutamol (albuterol), which led to immediate severe arrhythmic tachycardia with hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was commenced to decrease suspectedly highly elevated serum salbutamol levels. After 30 min, sinus rhythm with normocardia was observed. After the hemodialysis termination, no rebound tachycardia was noted, but due to severe septic shock, the hypotension was ongoing and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol and data from literature do not support the view that hemodialysis was the cause of the described improvement: the total amount of the drug cleared was very small (2.8% of total dose). Conclusion: Our results confirm a large volume of salbutamol distribution; the measured levels are within observed therapeutic levels; and the measured half-life time during hemodialysis (3.1 h) is comparable to observed half-life times in therapeutic settings. The observed favorable clinical benefit associated with dialysis may be fortuitous, highlighting potential bias toward positive clinical outcomes and unproven ("salvage") therapies. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Reversible and transient thrombocytopenia of functional platelets induced by nose-horned viper venom
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Dobaja Borak, Mojca, Grenc, Damjan, Reberšek, Katarina, Podgornik, Helena, Leonardi, Adrijana, Kurtović, Tihana, Halassy, Beata, Križaj, Igor, and Brvar, Miran
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- 2023
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7. Yellow sac spider (Cheiracanthium punctorium) bites in Slovenia: case series and review
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Varl, Tanja, Grenc, Damjan, Kostanjšek, Rok, and Brvar, Miran
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- 2017
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8. MDMA-related presentations to the emergency departments of the European Drug Emergencies Network plus (Euro-DEN Plus) over the four-year period 2014–2017
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Noseda, Roberta, Schmid, Yasmin, Scholz, Irene, Liakoni, Evangelia, Liechti, Matthias E., Dargan, Paul I., Wood, David M., Dines, Alison M., Yates, Christopher, Heyerdahl, Fridtjof, Hovda, Knut E., Giraudon, Isabelle, Ceschi, Alessandro, Lukasz Anand, Anseeuw, Kurt, Badaras, Robertas, Bonnici, Jeffrey, Brvar, Miran, Burke, Rachel, Blazena Caganova, Eyer, Florian, Galicia, Miguel, Geith, Stefanie, Gillebeert, Johan, Grenc, Damjan, Gorozia, Ketevan, Jaffal, Karim, Jürgens, Gesche, Konstari, Jutta, Kutubidze, Soso, Gabija Laubner, Liguts, Viesturs, Lyphout, Cathelijne, Mégarbane, Bruno, Òscar Miró, Moughty, Adrian, O'Connor, Niall, Paasma, Raido, Perez, Juan Ortega, Perminas, Marius, Persett, Per Sverre, Põld, Kristiina, Puiguriguer, Jordi, Radenkova-Saeva, Julia, Rulisek, Jan, Sopirala, Radhika, Stašinskis, Roberts, Surkus, Jonas, Toth, Ibolya, Vallersnes, Odd Martin, Vigorita, Federico, Waldman, Wojciech, W. Stephen Waring, and Zacharov, Sergej
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3,4-Methylenedioxymethamphetamine (MDMA) remains one of the most commonly used recreational drugs in Europe. Monitoring of Emergency Department (ED) presentations with acute toxicity associated with MDMA is important to determine trends in MDMA use and harms. Data were extracted from the European Drug Emergencies Network (Euro-DEN) Plus database for all ED presentations with acute toxicity involving MDMA use, alone or in combination with other substances, between 1 January 2014 and 31 December 2017. Geographical distribution, time trends, patient demographics, clinical features, management and outcome were analysed. Out of 23,947 presentations, 2013 (8.4%) involved MDMA, used alone (88, 4.4%) or with other substances (1925, 95.6%). The proportion of MDMA presentations varied by country, from over 15% in France to less than 5% in Norway. For the 15 sentinel centres where data were available for all four years, MDMA-related presentations peaked in 2016 (10.4% versus 8.1% in 2015, p p = 0.0002). 1436 (71.3%) presentations involved males. Females were significantly younger than males (median 23 years, interquartile range, IQR, 20–27 years, versus median 25 years, IQR 21–30 years, p versus 43.9%, p = 0.02), were more frequently medically discharged directly from the ED (74.7% versus 62.4%, p = 0.03), and less frequently received sedation (43.5% versus 66.5%, p = 0.003). This large multicentre series of MDMA presentations to EDs showed geographical variation and changes in time trends and in patient demographics. Triangulation with data from complementary sources including seizures, prevalence of use and wastewater analysis, will enable a greater understanding of the public health implications of MDMA use in Europe.
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- 2021
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9. Intravenous Vipera berus Venom-Specific Fab Fragments and Intramuscular Vipera ammodytes Venom-Specific F(ab’)2 Fragments in Vipera ammodytes-Envenomed Patients
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Kurtović, Tihana, primary, Karabuva, Svjetlana, additional, Grenc, Damjan, additional, Dobaja Borak, Mojca, additional, Križaj, Igor, additional, Lukšić, Boris, additional, Halassy, Beata, additional, and Brvar, Miran, additional
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- 2021
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10. Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus
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Layne, Kerry, Dargan, Paul, Dines, Alison, Leaper, Craig, Yates, Christopher, Hovda, Knut Erik, Heyerdahl, Fridtjof, Archer, John R.H., Giraudon, Isabelle, Wood, David, Anand, Lukasz, Anseeuw, Kurt, Badaras, Robertas, Bonnici, Jeffrey, Brvar, Miran, Burke, Rachel, Caganova, Blazena, Ceschi, Alessandro, Eyer, Florian, Galicia, Miguel, Geith, Stefanie, Gillebeert, Johan, Grenc, Damjan, Gorozia, Ketevan, Jaffal, Karim, Jürgens, Gesche, Konstari, Jutta, Kutubidze, Soso, Laubner, Gabija, Liakoni, Evangelia, Liechti, Matthias, Liguts, Viesturs, Lyphout, Cathelijne, Mégarbane, Bruno, Miró, Òscar, Moughty, Adrian, Noseda, Roberta, O'Connor, Niall, Paasma, Raido, Perez, Juan Ortega, Perminas, Marius, Persett, Per Sverre, Põld, Kristiina, Puiguriguer, Jordi, Radenkova-Saeva, Julia, Rulisek, Jan, Schmid, Yasmin, Scholz, Irene, Sopirala, Radhika, Stašinskis, Roberts, Surkus, Jonas, Toth, Ibolya, Vallersnes, Odd Martin, Vigorita, Federico, Waldman, Wojciech, Waring, W. Stephen, Zacharov, Sergej, Guy's and St Thomas' Hospital [London], King‘s College London, Hospital Universitari Son Espases, Oslo University Hospital [Oslo], European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Observatoire Européen des Drogues et des Toxicomanies, Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Euro-DEN Plus Research Group, and Mégarbane, Bruno
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medicine.medical_specialty ,030226 pharmacology & pharmacy ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Germany ,Medicine ,Humans ,Pharmacology (medical) ,In patient ,030212 general & internal medicine ,Tramadol ,Pharmacology ,Coma ,[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,business.industry ,Glasgow Coma Scale ,Emergency department ,humanities ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.TOX] Life Sciences [q-bio]/Toxicology ,Analgesics, Opioid ,Europe ,Pharmaceutical Preparations ,[SDV.TOX]Life Sciences [q-bio]/Toxicology ,Emergency medicine ,Africa ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,[SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,medicine.symptom ,Emergencies ,business ,Emergency Service, Hospital ,medicine.drug - Abstract
International audience; Following the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro-DEN Plus database for the 4-year period from 1 January 2014 to 31 December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia; n = 11, 7.5% of all presentations to this centre), Riga (Latvia; n = 4, 4.9%) and Munich (Germany; n = 17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/Glasgow coma score ≤ 8 and 9 of these had a respiratory rate
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- 2020
11. Accidental poisoning with autumn crocus ( Colchicum autumnale ): a case series
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Razinger, Gasper, primary, Kozelj, Gordana, additional, Gorjup, Vojka, additional, Grenc, Damjan, additional, and Brvar, Miran, additional
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- 2020
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12. Cholinergic syndrome: a case report of acute organophosphate and carbamate poisoning
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Petreski, Tadej, primary, Kit, Barbara, additional, Strnad, Matej, additional, Grenc, Damjan, additional, and Svenšek, Franc, additional
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- 2020
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13. Pharmacokinetic evaluation of V. ammodytes snakebites treated with currently available antivenoms
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Kurtović, Tihana, Brvar, Miran, Karabuva, Svjetlana, Lang Balija, Maja, Grenc, Damjan, Križaj, Igor, Lukšić, Boris, and Halassy, Beata
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Zagreb antivenom ,ViperaTAb ,Viperfav ,immunotherapy ,venom pharmacokinetics ,antivenom pharmacokinetics ,complex mixtures - Abstract
Objective: Due to shortage in Zagreb antivenom availability, in Slovenia V. ammodytes bites have been treated with French and UK antivenoms in the recent years. In Croatia, for therapeutic purposes the remaining doses of Zagreb antivenom have still been used. Composition differences between these three antivenoms exist. First, they differ in specificity. Zagreb antivenom (Croatia) is raised against V. ammodytes venom, but is clinically effective and used against all European venomous snakes. Viperfav (France) is raised against the mixture of V. aspis, V. berus and V. ammodytes venoms, but was mostly used against V. aspis and V. berus. ViperaTAb (UK) is raised against V. berus venom solely, and used so far only to treat envenomations caused by V. berus until recently. Second, they differ in type of the active drug component, since Zagreb antivenom and Viperfav are F(ab')2-based, while ViperaTAb is Fab-based preparation. And third, investigated antivenoms have differently prescribed administration routes - intravenous for ViperaTAb and Viperfav or intramuscular for Zagreb antivenom. Aim was to reveal pharmacokinetic profiles of currently available antivenoms in V. ammodytes envenomations and their influence on venom level decrement. Methods: The study represents prospective case series of consecutive patients envenomed by V. ammodytes snakebite and mostly treated with Zagreb antivenom or ViperaTAb in University Hospital of Split or Ljubljana since 2015. In serum samples concentrations of F(ab’)2 or Fab fragments, venom and neurotoxic ammodytoxins were determined. Pharmacokinetic parameters of antivenoms were evaluated whenever possible. Results: Nine patients were treated with Zagreb antivenom and six with ViperaTAb, one of which received Viperfav also. Pharmacokinetic profile differences were revealed. Systemic clearance of ViperaTAb was between 4.3 and 23.2 (mL h-1) / kg. Its distribution and elimination half- lives were in range of 0.4-3.2 h and 12.9-55.9 h, respectively. In the case of Zagreb antivenom, due to prolonged residence time, even the sampling period of 96 h post-treatment was not sufficient for estimation of pharmacokinetic parameters. The exception was 8 days hospitalized patient, revealing systemic clearance of 0.42 (mL h-1) / kg and half-life of 317.2 h. Venom was detected in serum of all patients, in contrary to ammodytoxins. Measured concentrations correlated with the F(ab')2/Fab level, revealing inverse trend in venom- antivenom circulation behavior. Conclusion: Antivenom level was highly dependent on the fabotherapics type and administration route, significantly affecting reappereance and systemic clearance of V. ammodytes venom and its neurotoxic component as well.
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- 2019
14. Epidemiology of Viperidae snake envenoming in central and southeastern Europe: CEE Viper Study
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Dobaja Borak, Mojca, Babić, Željka, Bekjarovski, Niko, Cagáňová, Blažena, Grenc, Damjan, Gruzdyte, Laima, Kabata, Piotr M, Kastanje, Ruth, Kolpach, Zuzana, Krakowiak, Anna, Pap, Csaba, Radenkova-Saeva, Julia, Sein-Anand, Jacek, Vučinić, Slavica, Zacharov, Sergey, Eddleston, Michael, and Brvar, Miran
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Viperidae, envenoming, Europe - Abstract
The study was a prospective multicentre survey of Viperidae snakebites and use of antivenoms in poison control centres and toxicology departments in Estonia, Lithuania, Poland, Czech Republic, Slovakia, Hungary, Slovenia, Croatia, Macedonia and Bulgaria. The incidence of Viperidae snakebites in central and south-eastern Europe is at least 2.9/million populations ; but is likely more, since not all snakebites would have been treated in toxicology departments or reported to local poison control centers. V. berus bites were most common, and although V. ammodytes bites had a higher median severity score it was not significant (2 compared to 1 for V. berus bites ; p = 0.18). Antivenom was used in half of the reported V. ammodytes bites (compared to 13% of V. berus bites). Three different antiViperidae antivenoms were used, none of which is European Medicines Agency (EMA)- approved. Only ViperaTab was used in both V. berus and V. ammodytes bites.
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- 2019
15. Accidental poisoning with autumn crocus (Colchicum autumnale): a case series.
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Razinger, Gasper, Kozelj, Gordana, Gorjup, Vojka, Grenc, Damjan, and Brvar, Miran
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TROPONIN I ,POISONING ,MYELOSUPPRESSION ,INTRA-aortic balloon counterpulsation ,SELF-poisoning ,POISONS ,CARDIOGENIC shock ,CARDIAC output - Abstract
Colchicum autumnale (autumn crocus) is a plant that contains highly toxic alkaloid colchicine. The aim was to evaluate accidental C autumnale poisoning and assess serum troponin as a prognostic parameter. In this study, we retrospectively included all adult patients with a history of accidental C autumnale ingestion and serum colchicine confirmation during the study period from 2000 to 2019. The medical files of enrolled patients were reviewed. Literature search of accidental ingestions of C autumnale was done. Over the study period of 20 years, 16 adult patients were admitted to the University Medical Centre Ljubljana due to acute colchicine poisoning after ingestion of C autumnale. They all mistakenly ingested C autumnale's leaves instead of Allium ursinum in the spring and had confirmed colchicine in serum by GC–MS or LC–MS/MS (15.5 µg/L (0.5–80 µg/L)). They developed vomiting and diarrhoea within 1–9 h after the meal. Vomiting within 2 h was associated with lethality (p=.04). Bone marrow suppression developed in 15 patients (94%). Acute myocardial injury with positive troponin I (>0.10 µg/L) developed in five patients; lethal cardiogenic shock with decreased cardiac output and hypotension occurred in four of these patients despite supportive therapy. Positive troponin I ultra (>0.10 µg/L) was associated with need for intensive support therapy (p=.01), decreased cardiac output (p=.01) and death (p=.01). The mortality was 4/16 (25%). On review, we found 58 cases; 95% cases accidently ingested leaves of C autumnale instead of A ursinum. Troponin I was reported in 3% cases. The lethality of this and reviewed cases was 35% (26/74). In unexplained gastroenterocolitis after ingestion of wild plants as a salad or spice in the spring, especially when wild garlic is mentioned, we should always consider C autumnale poisoning. Cardiogenic shock can be predicted by a positive serum troponin I measurement. [ABSTRACT FROM AUTHOR]
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- 2021
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16. Insight in differences in venom and antivenom pharmacokinetics in sera of V. ammodytes bitten patients treated by currently available therapies
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Kurtović, Tihana, Brvar, Miran, Karabuva, Svjetlana, Lang Balija, Maja, Grenc, Damjan, Križaj, Igor, Lukšić, Boris, and Halassy, Beata
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Antivenom ,Venom ,Pharmacokinetics ,complex mixtures - Abstract
Due to current shortage in Zagreb antivenom availability, in Slovenia V. ammodytes venomous bites have recently been treated with antivenoms of French and UK producers. In Croatia, for therapeutic purposes the remaining doses of Zagreb antivenom have still been used. Composition differences between these three antivenoms exist. First, they differ slightly in specificity. Zagreb antivenom has been raised against V. a. ammodytes venom, but is clinically effective and used against all European venomous snakes (V. ammodytes, V. berus, V. aspis, V. lebetina and V. xanthina). Viperfav from the French producer has been raised against the mixture of V. aspis, V. berus and V. ammodytes venoms, but was mostly used against V. aspis and V. berus. ViperaTAb from the UK has been raised against V. berus venom solely, and used so far only to treat envenomations caused by V. berus. Second, they differ in type of the active drug component. Namely, Zagreb antivenom and Viperfav are F(ab')2-based preparations, while ViperaTAb is formulated of Fab fragments. And third, investigated antivenoms have differently prescribed administration routes - intravenous for ViperaTAb and Viperfav or intramuscular for Zagreb antivenom. Since ViperaTAb’s and Viperfav’s therapeutical suitability for use against V. ammodytes venom-induced toxicity lately has been reported as poorer in comparison to that of Zagreb antivenom, we aimed for elucidation of their distinct clinical efficiency. In serum samples of V. ammodytes-envenomed and treated patients, collected during the few days long hospitalization, concentrations of venom, neurotoxic ammodytoxins and F(ab’)2 or Fab fragments were determined. Differences in pharmokinetic profiles of investigated antivenoms were revealed. Antivenom level in circulation was highly dependent on the active principle type and route of administration, significantly affecting venom systemic clearance and consequently, clinical status of the patient. Overall, the treatment of patients with Zagreb antivenom did not required additional doses, in contrast to particularly ViperaTAb treatment. This effect might be due to higher specificity of Zagreb antivenom for V. ammodytes venom, but also due to differences in administration route and antivenom pharmacokinetics.
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- 2018
17. Seizures as a complication of recreational drug use: Analysis of the Euro-DEN Plus data-set
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Wolfe, Caitlin E., primary, Wood, David M., additional, Dines, Alison, additional, Whatley, Benjamin P., additional, Yates, Christopher, additional, Heyerdahl, Fridtjof, additional, Hovda, Knut Erik, additional, Giraudon, Isabelle, additional, Dargan, Paul I., additional, Anseeuw, Kurt, additional, Badaras, Robertas, additional, Bonnici, Jeffrey, additional, Brvar, Miran, additional, Caganova, Blazena, additional, Ceschi, Alessandro, additional, Eyer, Florian, additional, Galicia, Miguel, additional, Geith, Stefanie, additional, Gillebeert, Johan, additional, Grenc, Damjan, additional, Gorozia, Ketevan, additional, Jaffal, Karim, additional, Jürgens, Gesche, additional, Kabata, Piotr Maciej, additional, Kennedy, Iarlaith, additional, Konstari, Jutta, additional, Kutubidze, Soso, additional, Laubner, Gabija, additional, Liakoni, Evangelia, additional, Liechti, Matthias E., additional, Lyphout, Cathelijne, additional, Mégarbane, Bruno, additional, Miró, Òscar, additional, Moughty, Adrian, additional, Müller, Laura, additional, O'Connor, Niall, additional, Paasma, Raido, additional, Perez, Juan Ortega, additional, Perminas, Marius, additional, Persett, Per Sverre, additional, Põld, Kristiina, additional, Puiguriguer, Jordi, additional, Radenkova-Saeva, Julia, additional, Rulisek, Jan, additional, Schmid, Yasmin, additional, Scholz, Irene, additional, Sopirala, Radhika, additional, Surkus, Jonas, additional, Toth, Ibolya, additional, Vallersnes, Odd Martin, additional, Vigorita, Federico, additional, Waldman, Wojciech, additional, Waring, W. Stephen, additional, and Zacharov, Sergej, additional
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- 2019
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18. Vipera ammodytes bites treated with antivenoms Viperfav® and ViperaTAb®
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Brvar, Miran, Kurtović, Tihana, Grenc, Damjan, Lang Balija, Maja, Križaj, Igor, and Halassy, Beata
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Vipera ammodytes ammodytes envenomation ,Viperfav™ ,ViperaTab™ ,F(ab’)2 antivenom pharmacokinetics - Abstract
Objective: Clinically Vipera berus and Vipera ammodytes envenomation are difficult to differentiate. In the past this was not a concern, but due to the current shortage in European viper venom antiserum availability, V. ammodytes venomous bites have recently been treated with ViperfavTM and ViperaTAb®. Viperfav contains polyvalent equine F(ab')2 fragments as an active principle against V. aspis, V. berus and V. ammodytes, while ViperaTAb contains monospecific ovine Fab fragments against V. berus. ViperaTAb’s and Viperfav’s therapeutic convenience for use against V. ammodytes venom- induced toxicity in humans has not been described, although protective efficacy has been proved preclinically. The aim of this study was to evaluate Viperfav and ViperaTAb in V. ammodytes envenomations. Methods: A prospective case series of consecutive patients envenomed by V. ammodytes treated with Viperfav and/or ViperaTAb in the University Medical Centre Ljubljana in 2015 and 2016. V. ammodytes venom, neurotoxic ammodytoxins, and F(ab')2 and/or Fab fragments concentrations were determined in serum samples with a pharmacokinetic analysis of the antivenoms. Results: Ten patients bitten by V. ammodytes were treated using Viperfav and/or ViperaTAb ; 5 received Viperfav, 4 ViperaTAb, and 1 patient received both. V. ammodytes venom and antivenom concentrations were measured in 5 patients. V. ammodytes venom was detected in serum of all 5 patients, but ammodytoxins were detected in only the most severely envenomed patient who developed neurological symptoms. Viperfav (4 mL) promptly reduced local swelling and improved systemic pathological signs, except recurrent thrombocytopenia. ViperaTAb (8 mL) reduced moderate swelling and temporarily improved systemic effects as well. However, this dose of ViperaTAb had no effect on neurological signs. ViperaTAb and Viperfav administration induced a decrease in V. ammodytes venom serum concentrations, but only Viperfav affected the serum ammodytoxins concentration. Viperfav’s systemic clearance and elimination half-life were 1.64 (mL/h)/kg and 97 hours, while ViperaTAb’s were 4.3–13.4 (mL/h)/kg and 14.1– 55.4 hours, respectively. Conclusion: In patients bitten by V. ammodytes, both Viperfav and ViperaTAb reduce local swelling and temporarily improve systemic effects. ViperaTAb did not affect neurological symptoms or the serum concentration of neurotoxic ammodytoxins. The recommended dose of Viperfav and ViperaTAb may be inadequate in serious cases of V. ammodytes bites, therefore duplication and repetition of the treatment, with an adjustment of administration timing, should be considered. However, it should be pointed out that this study was the result of V. ammodytes antivenom shortage and it emphasises the importance of the specific antivenom availability.
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- 2017
19. Zastrupitve z gama-hidroksibutiratom v Ljubljani med letoma 2000 in 2014: Gamma-hydroxybutirate poisoning in Ljubljana between the years 2000 and 2014
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Brvar, Miran, Grenc, Damjan, Koželj, Gordana, and Škafar, Mojca
- Abstract
depression. The aim of this study was to evaluate the clinical presentation and treatment in patients admitted to the University Medical Centre Ljubljana (UMCL). Methods: In this study we included all retrospectively reviewed cases of GHB-poisoning admitted to the UMCL between 2000 and 2014. We collected all data regarding the overdose circumstances, clinical presentation, treatment and toxicological analysis of blood and urine. Results: In the previous 15 years a total of 74 patients were admitted to the UMCL due to GHBpoisoning. The first case of GHB-poisoning was observed in 2002 and the numbers have largely increased since 2012. 86 % of all the patients ingested the drug intentionally, 82 % were male and the median age of admitted patients was 27 years. We recorded 6 mass GHB-poisonings in which 2%4 patients were admitted simultaneously. The most common presenting symptom of GHB-poisoning was a diminished level of consciousness (95 %), with 53 % being unresponsive to pain. Vomiting (30 %), bradycardia (28 %), hypotension (26 %), hypoventilation with respiratory insufficiency (19 %) and agitation upon awakening (31 %) were common as well. Concomitant alcohol and illicit drug use was recorded in 61 % of cases. 80 % of all the patients were treated symptomatically, 14 % were mechanically ventilated. Conclusions: The number of GHB-poisoned patients admitted to UMCL has increased in recent years. GHB-poisoned patients are predominantly male, often admitted in groups, who ingest the drug intentionally at parties during weekends. The most common presenting symptom of GHBpoisoning is unconsciousness. Treatment is symptomatic.
- Published
- 2016
20. Vipera ammodites bites treated with antivenom ViperaTAb®: a case series and pharmacokinetic evaluation
- Author
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Kurtović, Tihana, Brvar, Miran, Grenc, Damjan, Lang Balija, Maja, Križaj, Igor, Halassy, Beata, Kelava, Tomislav, Markotić, Antonio, and Šućur, Alan
- Subjects
V. a. ammodytes ,nose-horned viper ,ViperaTAb ,Fab fragments ,pharmacokinetics - Abstract
In the southeastern parts of Europe Vipera a. ammodytes and Vipera berus are the only medically important poisonous snakes. Differentiation of their bites based on clinical presentation is very difficult and unreliable. In the past this was not a concern, since snakebites were successfully treated with Viperfav™ (Aventis Pasteur, France) or European viper venom antiserum (Zagreb antivenom) (Institute of Immunology, Croatia) as formulations containing equine F(ab’)2 fragments that are either specific for both venoms, either clinically proved to be safe and effective for the treatment of V. a. ammodytes and V. berus envenomings. However, due to current shortage in ViperfavTM and Zagreb antivenom availability, V. a. ammodytes and V. berus bites have recently been treated with ViperaTAb® (MicroPharm Limited, United Kingdom) composed of ovine Fab fragments as active principle against the venom of V. berus only. Its therapeutical convenience for use against V. a. ammodytes venom-induced toxicity in human has not been described yet, although neutralisation efficacy has been proved preclinically. In view of this for the first time we present cases of several V. a. ammodytes snakebites treated with ViperaTAb® whose pharmacokinetics has been measured and correlated with clinical picture.
- Published
- 2016
21. Vipera ammodytes bites treated with antivenom ViperaTAb: a case series with pharmacokinetic evaluation
- Author
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Brvar, Miran, primary, Kurtović, Tihana, additional, Grenc, Damjan, additional, Lang Balija, Maja, additional, Križaj, Igor, additional, and Halassy, Beata, additional
- Published
- 2017
- Full Text
- View/download PDF
22. Occupational transdermal poisoning with synthetic cannabinoid cumyl-PINACA
- Author
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Dobaja, Mojca, primary, Grenc, Damjan, additional, Kozelj, Gordana, additional, and Brvar, Miran, additional
- Published
- 2017
- Full Text
- View/download PDF
23. Smernice za zdravljenje zastrupitev s paracetamolom: Guidelines for paracetamol poisoning treatment
- Author
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Brvar, Miran, Grenc, Damjan, Jamšek, Marija, and Šarc, Lucija
- Subjects
organic chemicals ,digestive, oral, and skin physiology - Abstract
Paracetamol overdose results in an accumulation of the reactive, hepatotoxic metabolite N-acetyl-p-benzoquinoneimin (NAPKQI) which can cause serious liver injury. Recognition of paracetamol overdose, hepatotoxicity risk estimation and early treatment are crutial in paracetamol poisoniong management. In ingestion of potential hepatotoxic dose of paracetamol decontamination and early treatment with N-acetylcysteine (NAC) are indicated. Both, 20-hours intravenous and 72-hurs oral regimes of NAC administration are successful. By antidote regime selection we should consider patient condition and time after paracetamol overdose. In severe hepatotoxicity, criteria for liver transplantation should be regularly evaluated and mechanisms for liver transplantation must be activated in time.
- Published
- 2014
24. Smernice zdravljenja zastrupitev z ogljikovim monoksidom: Carbon monoxide treatment guidelines
- Author
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Brvar, Miran, Finderle, Žarko, Grenc, Damjan, Jamšek, Marija, and Šarc, Lucija
- Abstract
Carbon monoxide is the leading cause of unintentional poisoning-related death in Slovenia. It is an odorless, colorless gas that usually remains undetectable until exposures result in injury or death. Exposure to carbon monoxide is most commonly accompanied by headache, nausea, vomiting, dizziness, confusion, drowsiness, fatigue and collapse. Carbon monoxide poisoning management includes normobaric oxygen therapy. Hyperbaric-oxygen treatments reduce the risk of cognitive sequelae after carbon monoxide poisoning.
- Published
- 2014
25. A Single Dose of ViperfavTM May Be Inadequate for Vipera ammodytes Snake Bite: A Case Report and Pharmacokinetic Evaluation
- Author
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Kurtović, Tihana, primary, Brvar, Miran, additional, Grenc, Damjan, additional, Lang Balija, Maja, additional, Križaj, Igor, additional, and Halassy, Beata, additional
- Published
- 2016
- Full Text
- View/download PDF
26. Low-dose intravenous lipid emulsion for the treatment of severe quetiapine and citalopram poisoning
- Author
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Purg, Darinka, primary, Markota, Andrej, additional, Grenc, Damjan, additional, and Sinkovič, Andreja, additional
- Published
- 2016
- Full Text
- View/download PDF
27. Zastrupitve z gama-hidroksibutiratom v Ljubljani med letoma 2000 in 2014
- Author
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Škafar, Mojca, primary, Grenc, Damjan, additional, Koželj, Gordana, additional, and Brvar, Miran, additional
- Published
- 2016
- Full Text
- View/download PDF
28. Antidoti: Antidotes
- Author
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Grenc, Damjan and Možina, Martin
- Abstract
In addition to symptomatic and supportive treatment, decontamination of the digestive tract is frequently the only therapeutic measure in the case of poison ingestion. Decontamination of the skin and eyes can also be performed, and if corrosive substances are ingested, dilution may be attempted. Decontamination methods for the digestive tract include: induction of vomiting, gastric lavage, administration of activated charcoal, intestinal lavage, forced diarrhea as well as high enema, gastroscopy and gastrotomy. Generally, decontamination of the digestive tract is most effective during thefirst hour after poison ingestion. Elimination methods are used to promote the poison's excretion from the body following its absorption. Elimination of poisons is also accelerated by administering repeated doses of activated charcoal, forced diuresis, alkalinisation and acidification of urine and extracorporeal techniques (peritoneal dialysis, hemodialysis, hemoperfusion, hemofiltration, plasmapheresis) and exchange transfusion. The decision on the need for and method of decontamination or poison elimination should be based on prior assessment of the severity of poisoning and time of poisoning, as well as the assessment of the poison's dangerousness in cooperation with the Centre for Intoxications, and the possibility of safe performance of procedures. No method should be used routinely without taking into account itsindications, contraindications and possible complications.
- Published
- 2009
29. Ugrizi strupenih kač: Bites by venomous snakes
- Author
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Grenc, Damjan
- Abstract
Eight different species of non-venomous snakes of the Colubridae family, and three different species of poisonous snakes of the Viperidae family are native in Slovenia. In the period between 1999 and October of 2008, 39 snake bites were reported to the Poison Control Centre. The most common clinical findings in snake bite victims are discernible fang marks, rapidly progressive swelling, pain, ecchymosis, lymphangitis, and regional lymphadenitis. Systemic signs of envenomation can be delayed and include gastrointestinal symptoms, hypotension, shock, respiratory distress, as well as other cardiovascular, respiratory and neurologic symptoms and signs. First aid treatment involves immobilization of the limb, reassurance and rapid transportation to a health care facility. Good symptomatic and supportive care represents the mainstay oftreatment of snake bite victims. Use of antivenom (e.g. Viper venom antiserum, European (equine)) is indicated in the case of severe local and pronounced or prolonged systemic signs of poisoning. V Sloveniji živi osem vrst nestrupenih kač iz družine gožev (lat. Colubridae) in tri avtohtone vrste strupenih kač iz družine gadov (lat. Viperidae). Po podatkih iz Registra posvetov Centra za zastrupitve je bilo v Sloveniji v letih od 1999 do oktobra 2008 zabeleženih skupno 39 ugrizov kač. Najpogostejši lokalni znaki zastrupitve po ugrizu kač so ugrizna rana, hitro napredujoča oteklina, bolečina, podplutba, limfangiitis in področni limfadenitis. Sistemska prizadetost se lahko pokaže z zakasnitvijo, najpogosteje kot prebavne težave in padec krvnega tlaka, šok, dihalna stiska ter moteno delovanje srca in obtočil, dihal in živčevja. Prva pomoč po ugrizu strupenih kač je omejena na imobilizacijo prizadetega, pomiritev bolnika in hiter transport v zdravstveno ustanovo. Bolnike po ugrizu strupene kače zdravimo simptomatsko in podporno. Indikacije za uporabo protiseruma (t. j. Viper venom antiserum, European (equine)) so hudi lokalni ali izraziti sistemski znaki zastrupitve.
- Published
- 2009
30. Zastrupitve s psihotropnimi zdravili: Poisoning with psychotropic drugs
- Author
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Grenc, Damjan
- Abstract
The article deals with the pharmacodynamics, pharmacokinetics, clinical presentation, diagnosis and treatment of selected groups of psychotropic drugs, namely benzodiazepines, monoamin oxidase inhibitors, cyclic antidepressants and second generation serotonergic antidepressants. Epidemiologically speaking, poisonings with benzodiazepines are the commonest type of poisoning among the aforementioned groups in Slovenia. The clinical presentation of benzodiazepine poisoning is usually dominated by a decreased level of consciousness, without cardiovascular or respiratory depression. Poisonings with monoamin oxidase inhibitors show distinct characteristics of adrenergic toxidrome, and the serotonin syndrome is also a possible entity. Poisonings with cyclic antidepressants are the most dramatic from this group of drugs; they present as a combination of anticholinergic toxidrome, cardiovascular depression and/or convulsions. In recent years, poisonings withserotonergic antidepressants are becoming more common epidemiologicallv, with a somewhat less dramatic clinical presentation consisting mainly of central nervous system depression, while respiratory depression is present very rarely. Treatment of poisoning is mainly symptomatic; a specific antidotecan be administered only in benzodiazepine poisoning.
- Published
- 2009
31. Mass Poisoning with Carbon Monoxide
- Author
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Grenc, Damjan, primary, Sarc, Lucija, additional, Brvar, Miran, additional, Jamsek, Marija, additional, and Mozina, Martin, additional
- Published
- 2003
- Full Text
- View/download PDF
32. Intravenous Vipera berus Venom-Specific Fab Fragments and Intramuscular Vipera ammodytes Venom-Specific F(ab') 2 Fragments in Vipera ammodytes -Envenomed Patients.
- Author
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Kurtović, Tihana, Karabuva, Svjetlana, Grenc, Damjan, Dobaja Borak, Mojca, Križaj, Igor, Lukšić, Boris, Halassy, Beata, and Brvar, Miran
- Subjects
ANTIVENINS ,VENOM ,IMMUNE serums ,LENGTH of stay in hospitals - Abstract
Vipera ammodytes (V. ammodytes) is the most venomous European viper. The aim of this study was to compare the clinical efficacy and pharmacokinetic values of intravenous Vipera berus venom-specific (paraspecific) Fab fragments (ViperaTAb) and intramuscular V. ammodytes venom-specific F(ab')
2 fragments (European viper venom antiserum, also called "Zagreb" antivenom) in V.ammodytes-envenomed patients. This was a prospective study of V.ammodytes-envenomed patients that were treated intravenously with ViperaTAb or intramuscularly with European viper venom antiserum that was feasible only due to the unique situation of an antivenom shortage. The highest venom concentration, survival, length of hospital stay and adverse reactions did not differ between the groups. Patients treated with intravenous Fab fragments were sicker, with significantly more rhabdomyolysis and neurotoxicity. The kinetics of Fab fragments after one or more intravenous applications matched better with the venom concentration in the early phase of envenomation compared to F(ab')2 fragments that were given intramuscularly only on admission. F(ab')2 fragments given intramuscularly had 25-fold longer apparent total body clearance and 14-fold longer elimination half-time compared to Fab fragments given intravenously (2 weeks vs. 24 h, respectively). In V.ammodytes-envenomed patients, the intramuscular use of specific F(ab')2 fragments resulted in a slow rise of antivenom serum concentration that demanded their early administration but without the need for additional doses for complete resolution of all clinical signs of envenomation. Intravenous use of paraspecific Fab fragments resulted in the immediate rise of antivenom serum concentration that enabled their use according to the clinical progress, but multiple doses might be needed for efficient therapy of thrombocytopenia due to venom recurrence, while the progression of rhabdomyolysis and neurotoxic effects of the venom could not be prevented. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
33. Fatal colchicine poisoning in babies due to sound-alike drugs: a call for a common European poisoning database
- Author
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Borak, Mojca Dobaja, Grenc, Damjan, Lonati, Davide, Locatelli, Carlo A., valeria margherita petrolini, and Brvar, Miran
34. Clinical effects of cannabis compared to synthetic cannabinoid receptor agonists (SCRAs): a retrospective cohort study of presentations with acute toxicity to European hospitals between 2013 and 2020.
- Author
-
Waters ML, Dargan PI, Yates C, Dines AM, Eyer F, Giraudon I, Heyerdahl F, Hovda KE, Liechti ME, Miró Ò, Vallersnes OM, Anseeuw K, Badaras R, Bitel M, Bonnici J, Brvar M, Caganova B, Calýskan F, Ceschi A, Chamoun K, Daveloose L, Galicia M, Gartner B, Gorozia K, Grenc D, Gresnigt FMJ, Hondebrink L, Jürgens G, Konstari J, Kutubidze S, Laubner G, Liakoni E, Liguts V, Lyphout C, McKenna R, Mégarbane B, Moughty A, Nitescu GV, Noseda R, O'Connor N, Paasma R, Ortega Perez J, Perminas M, Persett PS, Põld K, Puchon E, Puiguriguer J, Radenkova-Saeva J, Rulisek J, Samer C, Schmid Y, Scholz I, Stašinskis R, Surkus J, Van den Hengel-Koot I, Vigorita F, Vogt S, Waldman W, Waring WS, Zacharov S, Zellner T, and Wood DM
- Subjects
- Humans, Retrospective Studies, Male, Female, Europe epidemiology, Adult, Middle Aged, Young Adult, Cannabis toxicity, Cannabinoids toxicity, Adolescent, Cannabinoid Receptor Agonists toxicity, Emergency Service, Hospital
- Abstract
Introduction: Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020., Methods: Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a P value of <0.05., Results: Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache., Discussion: Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity., Conclusion: This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use.
- Published
- 2024
- Full Text
- View/download PDF
35. Low-dose intravenous lipid emulsion for the treatment of severe quetiapine and citalopram poisoning.
- Author
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Purg D, Markota A, Grenc D, and Sinkovič A
- Subjects
- Female, Humans, Slovenia, Suicide, Attempted, Treatment Outcome, Young Adult, Antidepressive Agents, Second-Generation poisoning, Antipsychotic Agents poisoning, Bromazepam poisoning, Citalopram poisoning, Drug Overdose drug therapy, Fat Emulsions, Intravenous therapeutic use, Quetiapine Fumarate poisoning
- Abstract
The treatment of quetiapine and/or citalopram poisoning is mainly supportive and involves gastric lavage, activated charcoal, intubation, and mechanical ventilation. Recently, however, there were reports of successful treatment with intravenous lipid emulsion. Here we report a case of a 19-year-old Caucasian girl who ingested approximately 6000 mg of quetiapine, 400 mg of citalopram, and 45 mg of bromazepam in a suicide attempt. The patient developed ventricular tachycardia and epileptic seizures 12 h after admission to the hospital. As the patient's condition deteriorated, we combined standard therapy (intubation, mechanical ventilation, and vasopressors) with low-dose intravenous lipid emulsion (ILE) (a total of 300 mL of 20 % lipid emulsion) and normalised her heart rhythm and stopped the seizures. She was discharged to the psychiatric ward after 48 h and home after a prolonged (2-month) psychiatric rehabilitation. Intravenous lipid emulsion turned out to be effective even in the lower dose range than previously reported for quetiapine poisoning in patients presenting with seizure and ventricular arrhythmia. To our knowledge, there are no case reports describing the use of ILE in treating citalopram poisoning.
- Published
- 2016
- Full Text
- View/download PDF
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