Giulia Scaravaggi

Although bupropion is known to be associated with pharmacobezoar formation, it remains understudied in this context. Upper gastrointestinal endoscopy has emerged as a potential adjunctive decontamination technique for managing acute overdoses associated with pharmacobezoar formation. We aim to evaluate its role in acute bupropion overdoses. We retrospectively analysed intentional bupropion overdoses referred to the Pavia Poison Control Centre (2015-2024) in which upper endoscopy was performed. Data on patient characteristics, overdose details, co-ingestants, decontamination procedures, endoscopy indications, and findings were collected. Endoscopy outcomes were classified as positive (pharmacobezoars, intact tablets, or paste-like residues) or negative. In parallel, an in vitro model was used to assess the propensity of bupropion to form pharmacobezoars. Forty-seven patients were included (median age 44 years, IQR 27-55; 75% female). The median ingested bupropion dose was 4,500 mg (IQR 4,500-6,750 mg). The median ingested tablets count was 59 (IQR 29-100 mg), and co-ingestants were present in 79% of cases. Upper gastrointestinal decontamination endoscopy was positive in 28 cases (60%). Pharmacobezoars or tablet residues were identified even in patients who had undergone prior decontamination, including orogastric lavage (60%). The only variable significantly associated with positive endoscopic findings was the total number of ingested tablets (P in vitro experiment showed early pharmacobezoar formation within four hours of incubation, persisting for up to 72 hours. Acute bupropion overdoses, alone or with co-ingestants, can cause gastric pharmacobezoars and retained tablets/residues despite standard decontamination. Upper gastrointestinal decontamination endoscopy is effective early post-ingestion and may complement or replace conventional methods. Gastric pharmacobezoars and tablet residues are frequently observed in bupropion overdoses, particularly with ingestions of ≥30 tablets, making these patients potential candidates for early endoscopic removal.

Aims To study the predictive factors for the development of clinical manifestations in poisoning due to the erroneous taking of low-dose methotrexate (MTX). Methods A retrospective observational study was performed. Only cases of erroneous administration in non-oncologic outpatients were included (July 2008-March 2020). Results Forty-one cases were included. All patients were taking MTX for the first time. In 36 cases, patients took MTX daily instead of weekly. In the other five patients, MTX was sold instead of methylergometrine. Clinical manifestations were absent in 12/41 patients (29.3%). All 29 (70.7%) symptomatic patients recognized the medication error when they developed clinical manifestations: dermatological, haematological and gastrointestinal symptoms. Statistical results showed that symptomatic patients were older, received a higher amount of total dose and were treated for longer. Moreover, the probability of being symptomatic increases as a function of age and of total dose. Asymptomatic patients were treated with folinic acid (30 mg/m(2)/day) for 5 days. Symptomatic patients were treated with folinic acid together with treatments for the specific clinical manifestations. No patients were treated with glucarpidase. All patients fully recovered. Conclusions When MTX is prescribed for the first time, it is important to clearly communicate with patients to avoid therapeutic errors. In our experience, age, total dose taken and number of days of assumption are predictive for the presence/absence of clinical manifestations. These parameters must be evaluated together to identify patients needing maximum starting treatment with folinic acid and closer monitoring.

Botulinum neurotoxins (BoNTs) produced by Clostridia species are the most potent identified natural toxins. Classically, the toxic neurological syndrome is characterized by an (afebrile) acute symmetric descending flaccid paralysis. The most know typical clinical syndrome of botulism refers to the foodborne form. All different forms are characterized by the same symptoms, caused by toxin-induced neuromuscular paralysis. The diagnosis of botulism is essentially clinical, as well as the decision to apply the specific antidotal treatment. The role of the laboratory is mandatory to confirm the clinical suspicion in relation to regulatory agencies, to identify the BoNTs involved and the source of intoxication. The laboratory diagnosis of foodborne botulism is based on the detection of BoNTs in clinical specimens/food samples and the isolation of BoNT from stools. Foodborne botulism intoxication is often underdiagnosed; the initial symptoms can be confused with more common clinical conditions (i.e., stroke, myasthenia gravis, Guillain–Barré syndrome—Miller–Fisher variant, Eaton–Lambert syndrome, tick paralysis and shellfish or tetrodotoxin poisoning). The treatment includes procedures for decontamination, antidote administration and, when required, support of respiratory function; few differences are related to the different way of exposure.

The use of artificial nail tips in professional manicure services and the application of false eyelashes are a growing trend among young women. Often, this “beauty routine” is performed at home without the supervision of an expert beautician, raising health problems due to either the spillage of these products or to accidental exposure to children. The aim of this study is to review the Pavia Poison Control Centre clinical records to identify the frequency, the most common route of exposure, and the possible risks associated to these events to support the decision-making process in emergency departments. The Pavia Poison Control Centre database was retrospectively searched for records reporting nail or false eyelash glue exposure from January 2007 to April 2020, and 42 patients were identified. Among the patients, 76% presented symptoms from mild to severe, while 24% were asymptomatic. The most common route of exposure was dermal, through cutaneous contact, as determined for 19 patients involved. Among these, seven patients presented with second-degree chemical burns, cutaneous erythema, and ocular symptoms. The most dangerous glue component was cyanoacrylate, leading to symptoms in 16 out of 22 patients, while three cases remained asymptomatic. Even if this exposure is relatively rare, nail and false eyelash glue can be seriously harmful, especially when exposure occurs via dermal or ocular routes. In the case of emergency, it is important to treat the patient as fast as possible to limit the damage caused by a burn. Moreover, even though these products are often perceived as harmless, safety precautions should be taken to prevent children from accidental contact.