BACKGROUND: Medication poisoning in children is a severe condition that can endanger a child's life. Although drug intoxications are easily preventable, awareness of the proper handling of drugs and their safe storage out of the reach of children is not widespread among the general public. In this work, we investigated the demographic and clinical data of children admitted to the Department of Pediatrics of the University Hospital Olomouc for acute drug-induced intoxication. We also selected several case reports to illustrate the wide range of both presentations and outcomes in individual patients. METHOD: Cases of drug-induced intoxications were selected from a group of patients under the age of 19 years admitted to the hospital for poisoning between January 1, 2010, and December 31, 2019. Medical records of these patients were prospectively evaluated, and overview tables and graphs of predefined research objectives were created. RESULTS: During the given time period, 162 children with suspected drug intoxications were hospitalized at the Department of Pediatrics, University Hospital Olomouc. Of these, 108 cases were reported in girls and 54 in boys (66.7% vs. 33.3%). In 16 cases (9.9%), there was a severe intoxication requiring follow-up intensive care. There was also one case of fatal accidental intoxication. Most poisonings were seen in toddlers (65; 40.1%). Intoxication with suicidal ideation was found in 44 cases (27.2%), with a higher incidence of suicide attempts in girls (40 vs. 4). Repeated intoxication was recorded in nine cases. Analgesics were the most common drug group (61; 37.7%), with paracetamol (28; 17.3%) being the leading drug. In 154 cases (95.1%), the drugs were taken orally, most often in the form of tablets. CONCLUSION: Accidental drug intoxications most frequently occurred in the age group from one to three years old. The second highest incidence was among adolescents most of which were suicide attempts. Analgesics and psychoactive agents accounted for the majority of cases. Medications should be kept in places where children cannot reach them.

• MeSH
• akutní nemoc MeSH
• analgetika MeSH
• dítě MeSH
• dospělí MeSH
• hospitalizace * MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nemocnice MeSH
• pokus o sebevraždu * MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• pozorovací studie MeSH

• MeSH
• dospělí MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu MeSH
• pokus o sebevraždu MeSH
• tukové emulze intravenózní terapeutické užití   MeSH
• venlafaxin hydrochlorid * otrava   MeSH
• výsledek terapie MeSH
• zneužívání léků na předpis MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

OBJECTIVE: The impact of the coronavirus disease 2019 (COVID-19) pandemic on suicidal thoughts and behavior has been widely hypothesized but remains largely unexplored at the population-level. We aimed to assess changes in suicide risk (SR) in people with and without mental disorders, before and during the COVID-19 pandemic in Czechia. METHODS: We analyzed data from three nationwide cross-sectional surveys of Czech adults (November 2017, May and November 2020). For the 2017 data collection, we employed paper and pencil interviewing, while for the two 2020 data collections, we used a mixed computer-assisted web interviewing and computer-assisted telephone interviewing approach. All samples were representative in terms of age, gender, education, and area of residence for the Czech adult population (18+). We used the Mini International Neuropsychiatric Interview to screen for mental disorders and SR. We calculated weighted prevalence rates with 95% confidence intervals (95% CI). RESULTS: When compared to baseline, we found a 4% and 6% increase in SR in individuals without mental disorders in pandemic surveys (1.95% (1.45%; 2.44%) vs. 6.29% (5.28%; 7.30%) and 8.42% (7.19%; 9.65%)). Relative to baseline, SR in people with major depressive episode or anxiety disorders was elevated in May and November 2020 (22.35% (17.64%; 27.06%) vs. 36.68% (32.45%; 40.91%) and 38.88% (34.51%; 43.25%)). CONCLUSIONS: We found substantially increased SR in both people with and without mental disorders, however, these changes could be partially related to differing data collection methods used in the baseline and subsequent surveys. Ongoing prevention, monitoring and evaluation of nationwide suicidality is warranted.HIGHLIGHTSWe found that suicide risk substantially increased during the pandemicSuicide risk was elevated in both individuals with and without mental disordersOur findings support increased suicide monitoring and prevention.

• MeSH
• COVID-19 * MeSH
• depresivní porucha unipolární * epidemiologie   MeSH
• dospělí MeSH
• duševní poruchy * epidemiologie   MeSH
• lidé MeSH
• pandemie MeSH
• pokus o sebevraždu psychologie   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• rizikové faktory MeSH
• sebevražda * psychologie   MeSH
• sebevražedné myšlenky MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Ecstasy (methylendioxymethamphetamine, MDMA) is the second most frequently used drug, following cannabis. Ecstasy is an illegal substance, and its acute intoxication risks being the development of serotonin syndrome, severe hyperthermia and malignant arrhythmias. Suicidal overdose with MDMA, which is described in this article, is rare but scarcely occurs. The authors presents a case report of ecstasy - induced serotonin syndrome and fulminant hepatic failure requiring liver transplantation following a suicidal attempt in a 16-year-old girl.

Extáze (methylendioxymethamfetamin, MDMA) je po marihuaně v České republice druhou nejčastěji vyzkoušenou drogou. Její užívání je ilegální, hlavním akutním rizikem při intoxikaci nebo netoleranci je rozvoj serotoninového syndromu, hypertermie a vznik významných arytmií. Suicidální užití, dokumentované v uvedené kazuistice, je vzácné, ale možné. Při extrémních hladinách látky v krvi byl v uvedeném případě dominantním klinickým projevem serotoninový syndrom s diseminovanou intravaskulární koagulací a významné renální a hepatální selhání s nutností transplantace jater.

• MeSH
• akutní selhání jater * chemicky indukované   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• N-methyl-3,4-methylendioxyamfetamin * otrava   toxicita   MeSH
• pokus o sebevraždu MeSH
• transplantace jater MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Intoxikácie u detí predstavujú stále závažný problém v Slovenskej republike a tvoria 50 % zo všetkých intoxikácií konzultovaných s Národným toxikologickým informačným centrom (NTIC) v Bratislave. Akútna intoxikácia železom je závažný stav, ktorý môže rýchlo progredovať až do multiorgánového zlyhania a smrti. V článku prezentujeme prípad intoxikácie 16-ročnej pacientky s úmyselným požitím 50 tabliet prípravku s obsahom železa. Celková dávka zodpovedala 5000 mg elementárneho železa, čo pri hmotnosti pacientky 50 kg predstavovalo dávku 100 mg/kg. Vzhľadom na známky závažnej intoxikácie a vysokú požitú dávku železa sme indikovali podanie antidota do úpravy klinického stavu a sérových hladín železa. Pacientka sa aj napriek vysokej požitej dávke železa, vďaka promptnému zahájeniu detoxikačnej liečby, zotavila bez následkov. Vzhľadom na to, že otrava železom môže viesť k závažným komplikáciám, máme touto kazuistikou snahu poukázať na dôležitosť poznania klinického obrazu, priebehu a včasného začatia liečby u pacienta s akútnou intoxikáciou.

Intoxications in children still represent a serious problem in the Slovak Republic and account for 50 % of all intoxications consulted with the National Toxicological Information Center (NTIC) in Bratislava. Acute iron intoxication is a serious condition that can progress rapidly to multiorgan failure and death. In this article, we present a case of intoxication of a 16-year-old patient who intentionally ingested 50 tablets of an iron-containing preparation. The total dose corresponded to 5000 mg of elemental iron, which at a patient weight of 50 kg was 100 mg/kg. Due to signs of severe intoxication and high ingested iron dose, we indicated the administration of an antidote to adjust the clinical condition and serum iron levels. Patient recovered without sequelae due to the prompt initiation of detoxification treatment. Given that iron poisoning can lead to serious complications, we use this case report to point out the importance of knowing the clinical picture, course and early initiation of treatment in a patient with acute intoxication.

• MeSH
• lidé MeSH
• mladiství MeSH
• otrava patologie   terapie   MeSH
• pokus o sebevraždu MeSH
• výsledek terapie MeSH
• železo škodlivé účinky   toxicita   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• fibrilace komor etiologie   terapie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• multiorgánové selhání etiologie   MeSH
• otrava rostlinami * patofyziologie   terapie   MeSH
• pokus o sebevraždu MeSH
• taxoidy otrava   MeSH
• tis * otrava   MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• Publikační typ
• kazuistiky MeSH

V kazuistice je popsán případ otravy lerkanidipinem, který patří mezi často předepisované léky ze skupiny blokátorů vápníkových kanálů. Prezentovaná práce popisuje případ 31letého muže, který v sebevražedném pokusu užil 90-100 tablet lerkanidipinu, což odpovídá 900-1 000 mg účinné látky. Jde o zatím nejvyšší dávku, jaká byla v literatuře popsána. V rámci léčby byl pacientovi proveden výplach žaludku, podáváno aktivní uhlí a na podporu vyloučení Fortrans (makrogol). Následně byl za sledování hladin ionizovaného vápníku podáván CaCl2. Po třech dnech hospitalizace na JIP byl pacient přeložen na psychiatrické oddělení, ze kterého byl po necelém týdnu propuštěn do domácí péče.

The case report describes a case of poisoning with lercanidipine, a widely prescribed drug from the group of calcium channel blockers. It follows the case of a 31-year-old man who took 90-100 tablets, equivalent to 900-1000 mg, in a suicide attempt. This is the highest administered dose known yet. The patient was given a gastric lavage, administered activated charcoal and Fortrans (macrogol) to speed up drug elimination. Subsequently, CaCl2 was administered while ionized calcium levels were monitored. After 3 days in the ICU, the patient could be transferred to the psychiatric ward and discharged to home care after less than a week.

• Klíčová slova
• lerkanidipin,
• MeSH
• blokátory kalciových kanálů terapeutické užití   toxicita   MeSH
• chromatografie kapalinová MeSH
• dihydropyridiny * krev   otrava   terapeutické užití   MeSH
• dospělí MeSH
• dřevěné a živočišné uhlí aplikace a dávkování   terapeutické užití   MeSH
• lidé MeSH
• pokus o sebevraždu MeSH
• předávkování léky na předpis * MeSH
• žaludeční výplach MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

OBJECTIVES: We decided to compare the incidence and spectrum of pelvic fractures in 2020 affected by the anti-pandemic measures due to COVID-19 with previous years 2018 and 2019. METHODS: This retrospective study included 391 patients treated at the author’s clinic for pelvic fractures. From the medical records we recorded gender, age, mechanism of injury, trauma energy, fracture type based on the AO classification and severity of injury. RESULTS: As expected, we observed no difference in the number of fractures caused by simple falls. However, we failed to prove a reduction in the number of high-energy injuries. In contrary, we observed an increase in the number of high-energy injuries in the period between lockdowns (p=0.0375). A surprising result was a dramatic increase in suicide attempts as a cause of pelvic fractures, with 6 (2.2 %) in 2018 and 2019 compared to 13 (10 %) in 2020 alone (p=0.0017). CONCLUSION: We observed the increased number of suicidal attempts only on a limited number of specific patients with pelvic fractures; therefore, we cannot formulate any general conclusions regarding the incidence of suicide during the COVID-19 pandemic. Nevertheless, we consider this to be a warning signal highlighting the worsened population mental health due to COVID-19 pandemic (Tab. 2, Fig. 1, Ref. 34).

• MeSH
• COVID-19 * prevence a kontrola   psychologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pánev zranění   MeSH
• pokus o sebevraždu * psychologie   MeSH
• rány a poranění epidemiologie   etiologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH
• práce podpořená grantem MeSH

BACKGROUND: Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. METHODS: We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. RESULTS: Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. CONCLUSIONS: Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

• MeSH
• celogenomová asociační studie MeSH
• depresivní porucha unipolární * genetika   MeSH
• duševní poruchy * genetika   MeSH
• jednonukleotidový polymorfismus MeSH
• lidé MeSH
• pokus o sebevraždu MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

INTRODUCTION: Zolpidem is one of the most commonly prescribed nonbenzodiazepine hypnotic drugs for insomnia. Published epidemiological studies linked zolpidem with the risk of suicide. However, to date, no meta-analysis investigated this association. Hence, we systematically reviewed and meta-analysed the current evidence from real-world studies reporting the risk of suicide with the use of zolpidem. METHODS: Medline (Ovid), Embase (Ovid), and PsycINFO databases were searched from inception till June 2021 for real-world evidence studies reporting the risk of suicide with the use of zolpidem. The quality assessment of included studies was assessed using the New-Castle Ottawa Scale (NOS). Random-effect meta-analysis was performed using a generic inverse variance method. RESULTS: This meta-analysis was based on four studies with 344,753 participants, of which 42,279 were zolpidem users. The methodological quality of all the included studies was of high quality. A significantly increased risk of suicide or suicide attempt was found in zolpidem users compared to non-users, with a pooled relative risk of 1.88 (95% CI: 1.54 - 2.30). Furthermore, an increased risk of suicidal death was observed in zolpidem users compared to non-users, with a pooled relative risk of 1.82 (95% CI: 1.43 - 2.30). Dose-response analysis also revealed a significantly increased risk of suicide in patients receiving ≥ 180cDDD (cumulative defined daily doses) of zolpidem (124 times), followed by 90-179cDDD (113 times) and <90cDDD (93 times) of zolpidem compared to non-users. CONCLUSION: In conclusion, zolpidem use was associated with an increased risk of suicide or suicide attempt and suicidal death. Therefore, careful prescribing practices must be followed by considering the risk-benefit profile.

• MeSH
• hodnocení rizik MeSH
• lidé MeSH
• pokus o sebevraždu * MeSH
• poruchy iniciace a udržování spánku * farmakoterapie   MeSH
• sebevražedné myšlenky MeSH
• zolpidem škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH