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Rising incidence and high mortality in intentional sodium nitrite exposures reported to US poison centers. To the Editor, We read with interest the article by McCann et al. "Rising incidence and high mortality in intentional sodium nitrite exposures reported to US poison centers" reporting an increasing trend in severe intentional sodium nitrite exposures in the US [[1]]. [Extracted from the article]

Context: Today, immunotherapy with Fab or F(ab′)2 fragments is considered as a gold standard treatment for patients bitten by vipers. We compared the efficiency of two antivenoms, Viperfav® and Viperatab®, in mainland France in 2017–2018 with data provided by the French poison control centre (PCC). Methods: Patients with a moderate (2a and 2b) or severe (3) envenomation after a European viper bite and treated with immunotherapy were included and the markers chosen were the risk of post-antivenom treatment worsening, duration of hospital stay and persistent functional discomfort on day 15. Statistical studies were based on multivariate data analysis. Results: Two hundred and ninety-seven cases were recorded. One hundred and eighty-two (61.3%) patients received Viperfav® and 115 (38.7%) received Viperatab®. Compared to Viperfav®, use of Viperatab® significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p <.001). No significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15. Viperfav® and Viperatab® have a similar tolerance (p >.21). Otherwise, duration of hospitalisation was significantly increased by a delay of immunotherapy infusion of more than 12 h (OR 2.70; 95%CI [1.45–5.06]; p =.002) or a preventive administration of LMWH (OR 6.55; 95%CI [1.58–27.13]; p=.02). Discussion: While Viperfav® and Viperatab® have a similar tolerance, our data show that Viperatab® was associated with a higher risk of post-antivenom treatment worsening compared to Viperfav®. Furthermore, this study confirms that the antivenom should be used as soon as possible. Indeed, patients receiving the immunotherapy infusion from the grade 2b presented significantly more frequent exacerbated symptoms (OR 3.99; 95%CI [1.16–13.73]; p=.028) after the antivenom infusion compared to grade 2a group. Conclusions: Whereas no significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15, use of Viperatab®, compared to Viperfav®, significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p <.001). Taken together, these data show that Viperfav® is the treatment of choice for the management of snake bites in France. [ABSTRACT FROM AUTHOR]

Context: During the re-approval process of glyphosate in Europe, it was mentioned that glyphosate-based products (GBF) were more toxic than glyphosate alone. This phenomenon was attributed to the surfactants and among them, polyethoxylated tallowamine (POEA) has been suspected to significantly contribute to the toxicity of glyphosate products. In animal data acute oral toxicity of POEA has been suggested to be greater than glyphosate toxicity in animal studies. There are no data, however, comparing the clinical signs and severity of acute human poisoning with tallowamine-containing GBF (TA) and non-tallowamine-containing GBF (NTA). The aim of this study was to compare the severity of oral poisoning between TA and NTA cases, reported to the French Poison Control Centres (PCC) over 7 years. Methods: This is a retrospective study of cases of oral exposure to GBF reported to French PCCs between January 1st, 2008 and December 12th, 2014. The formulation of every GBF was reviewed using the PCC national database of products and compositions, to identify cases involving TA, NTA, or GBF with unknown co-formulants. Results: Between 2008 and 2014, 1362 cases of GBF ingestion were registered in the PCC national database of poisoning cases. Among them, 429 were symptomatic acute cases of ingestion of GBF. There were 235 exposures to TA, 105 to NTA, and 89 to unknown GBF. There were more severe cases in the TA group than in the NTA group (p = 0.037). Discussion: The present study shows that POEA rather than other co-formulants leads to more severe symptoms in those patients ingesting GBF. The acute toxicity of POEA might be explained by its irritating properties; in experimental studies, it caused skin irritation and severe eye and mucous membranes irritation. Conclusion: In this study, severe respiratory symptoms were also more frequently reported in the TA group. The surfactant properties of POEA are likely to cause aspiration pneumonitis which is a plausible explanation for the respiratory failure complicating severe GBF poisoning cases. [ABSTRACT FROM AUTHOR]

Context: Today, immunotherapy with Fab or F(ab′)2 fragments is considered as a gold standard treatment for patients bitten by vipers. We compared the efficiency of two antivenoms, Viperfav® and Viperatab®, in mainland France in 2017–2018 with data provided by the French poison control centre (PCC). Methods: Patients with a moderate (2a and 2b) or severe (3) envenomation after a European viper bite and treated with immunotherapy were included and the markers chosen were the risk of post-antivenom treatment worsening, duration of hospital stay and persistent functional discomfort on day 15. Statistical studies were based on multivariate data analysis. Results: Two hundred and ninety-seven cases were recorded. One hundred and eighty-two (61.3%) patients received Viperfav® and 115 (38.7%) received Viperatab®. Compared to Viperfav®, use of Viperatab® significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p <.001). No significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15. Viperfav® and Viperatab® have a similar tolerance (p >.21). Otherwise, duration of hospitalisation was significantly increased by a delay of immunotherapy infusion of more than 12 h (OR 2.70; 95%CI [1.45–5.06]; p =.002) or a preventive administration of LMWH (OR 6.55; 95%CI [1.58–27.13]; p=.02). Discussion: While Viperfav® and Viperatab® have a similar tolerance, our data show that Viperatab® was associated with a higher risk of post-antivenom treatment worsening compared to Viperfav®. Furthermore, this study confirms that the antivenom should be used as soon as possible. Indeed, patients receiving the immunotherapy infusion from the grade 2b presented significantly more frequent exacerbated symptoms (OR 3.99; 95%CI [1.16–13.73]; p=.028) after the antivenom infusion compared to grade 2a group. Conclusions: Whereas no significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15, use of Viperatab®, compared to Viperfav®, significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p <.001). Taken together, these data show that Viperfav® is the treatment of choice for the management of snake bites in France. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, the number of patients managed by poison control centres (PCCs) has increased without a proportional increase in the number of physicians. To improve efficiency without neglecting patient follow-up, some PCCs have begun using text messages. We evaluated the difference in response rates between text messaging and traditional telephone follow-up., Materials and Methods: This retrospective, monocentric, non-randomised cohort study was conducted using data from calls made by the New Aquitaine PCC between February 27, 2019, and March 31, 2019. Patients were contacted up to three times by a phone call or short message service (SMS)., Results: For the analysis, 823 patients were included. At the end of follow-up, the response rates were similar in the phone call and SMS group (94 vs. 94%; p  = 0.76) with median [interquartile range] response times of 0 min [0; 27 min] and 29 min [6; 120 min], respectively. The response rates did not differ in subgroups stratified according to sex, self-poisoning vs. relative response, age class, and solicitation during working hours vs. outside of working hours (all p  > 0.5). Moreover, health practitioners required 2.4-fold more time to call than to send text messages ( p  < 0.001), and all practitioners were satisfied or very satisfied with text messaging implementation., Conclusion: Patients had good adherence to text messages. Text messages are easy to use, rapid, and allow the physician to easily prioritise follow-up without occupying the emergency line. Additionally, the costs of installation and maintenance are low for text message systems; these low costs facilitate the implementation of such services in various medical situations.

Introduction: The aim was to assess the impact of the COVID-19 pandemic on French Poison Control Centre (PCC) call characteristics., Methods: Reported cases of xenobiotic exposures from 1 March to 30 April in 2018, 2019, and 2020 were extracted from the French National Database of Poisonings. The collected data included call, patient, and exposure characteristics for both general calls and for calls involving sentinel xenobiotic categories related to the COVID-19 pandemic. The 2020 exposures were compared to 2018-2019 exposures by using simple logistic models in order to provide effect size with odds ratios., Results: From March to April 2020, 32,182 exposures were reported to French PCCs with an overall increase of 5.6% compared to exposures in the same time frame in 2018-2019. A similar increase in calls was observed in non-epidemic and epidemic COVID-19 areas with an increase in calls from the public (+13.6%) while calls from health-professionals decreased (-7.5%). Despite the increase in exposures, the incidence of symptomatic exposures remained stable (-0.4%) with a decrease in severity (moderate/severe -17.2%). A significant increase in exposures to home cleaning products containing biocides, essential oils, and alcohol-based hand sanitizers (odds ratio >1.3, p  < .0001) was observed., Discussion and Conclusion: The COVID-19 pandemic altered calls to French PCCs with a small increase in calls during the study period and changes in the pattern of exposure. These changes possibly reflected the indirect consequences of the COVID-19 pandemic i.e., limited access to primary care, fear of contracting COVID-19 and anxiety related to home isolation.

Context: Today, immunotherapy with Fab or F(ab') 2 fragments is considered as a gold standard treatment for patients bitten by vipers. We compared the efficiency of two antivenoms, Viperfav ® and Viperatab ® , in mainland France in 2017-2018 with data provided by the French poison control centre (PCC). Methods: Patients with a moderate (2a and 2b) or severe (3) envenomation after a European viper bite and treated with immunotherapy were included and the markers chosen were the risk of post-antivenom treatment worsening, duration of hospital stay and persistent functional discomfort on day 15. Statistical studies were based on multivariate data analysis. Results: Two hundred and ninety-seven cases were recorded. One hundred and eighty-two (61.3%) patients received Viperfav ® and 115 (38.7%) received Viperatab ® . Compared to Viperfav ® , use of Viperatab ® significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p  < .001). No significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15. Viperfav ® and Viperatab ® have a similar tolerance ( p  > .21). Otherwise, duration of hospitalisation was significantly increased by a delay of immunotherapy infusion of more than 12 h (OR 2.70; 95%CI [1.45-5.06]; p  = .002) or a preventive administration of LMWH (OR 6.55; 95%CI [1.58-27.13]; p =.02). Discussion: While Viperfav ® and Viperatab ® have a similar tolerance, our data show that Viperatab ® was associated with a higher risk of post-antivenom treatment worsening compared to Viperfav ® . Furthermore, this study confirms that the antivenom should be used as soon as possible. Indeed, patients receiving the immunotherapy infusion from the grade 2b presented significantly more frequent exacerbated symptoms (OR 3.99; 95%CI [1.16-13.73]; p =.028) after the antivenom infusion compared to grade 2a group. Conclusions: Whereas no significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15, use of Viperatab ® , compared to Viperfav ® , significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p  < .001). Taken together, these data show that Viperfav ® is the treatment of choice for the management of snake bites in France.