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Fremer C, Szejko N, Pisarenko A, Haas M, Laudenbach L, Wegener C, Müller-Vahl KR. Mass social media-induced illness presenting with Tourette-like behavior. Front Psychiatry 2022; 13:963769. [PMID: 36203825 PMCID: PMC9530444 DOI: 10.3389/fpsyt.2022.963769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022] Open
Abstract
Currently, we are facing a new manifestation of functional neurological disorder presenting with functional Tourette-like behavior (FTB). This study aimed to show characteristics of this phenotype presenting as an outbreak of "mass social media-induced illness" (MSMI) and to explore predisposing factors. Between 5-9/2021, we prospectively investigated 32 patients (mean/median age: 20.1/18 years, range: 11-53 years, n = 16 females) with MSMI-FTB using a neuro-psychiatric examination, a comprehensive semi-structured interview and aspects of the Operationalized Psychodynamic Diagnostic System. In contrast to tics, numbers of complex movements and vocalizations were nine times greater than of "simple" symptoms, and of vocalizations one and a half times greater than of movements. In line with our hypothesis of MSMI, symptoms largely overlapped with those presented by German YouTuber Jan Zimmermann justifying his role as "virtual" index case in current outbreak. Typically, symptoms started abruptly at a mean age of 19 years and deteriorated gradually with no differences between males and females. In all patients, we identified timely-related psychological stressors, unconscious intrapsychic conflicts, and/or structural deficits. Nearly all patients (94%) suffered from further psychiatric symptoms including abnormalities in social behavior (81%), obsessive-compulsive behavior (OCB) (47%), Tourette syndrome (TS) (47%), anxiety (41%), and depression (31%), about half (47%) had experienced bullying, and 75% suffered from coexisting somatic diseases. Our data suggest that pre-existing abnormalities in social behavior and psychiatric symptoms (OCB, anxiety, and depression), but also TS in combination with timely-related psychological stressors, unconscious intrapsychic conflicts, and structural deficits predispose to contagion with MSMI-FTB.
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Affiliation(s)
- Carolin Fremer
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Anna Pisarenko
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Martina Haas
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Luise Laudenbach
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Claudia Wegener
- Department of Audiovisual Media Studies, Film University Babelsberg, Potsdam, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Moghaddam ET, Tafazoli A. Cola Beverages: Clinical Uses versus Adverse Effects. CURRENT NUTRITION & FOOD SCIENCE 2019. [DOI: 10.2174/1573401313666170821130225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Excessive consumption of cola beverages is accompanied by numerous public health risks. But besides these well-known adverse effects, recently, several medical articles have been published that show some indications for cola beverages in clinical practice like resolution of gastrointestinal or feeding tube obstructions, increasing bioavailability and palatability of other medications, rehydration and other uses in healthcare settings. These approaches are not without shortcomings and complications.Methods:In this systematic review we tried to explore these new uses for practitioners and also reemphasize on the most evidence-based complications of cola consumption like bone loss and metabolic and cardiovascular adverse effects in cases of misuse and overuse from both clinical and nutritional points of view via searching the PubMed database.Results:We chose 145 journal articles from the most relevant ones plus 30 extra references and categorized their topics in two classes of medical uses and adverse effects.Conclusion:It could be stated that cola beverages have demonstrated interesting uses and benefits in medicine but their use should be regulated as strict as possible.
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Affiliation(s)
- Ehsan T. Moghaddam
- Orthodontics Department, School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ali Tafazoli
- School of Pharmacy, International Campus, Iran University of Medical Sciences, Tehran, Iran
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In Vivo and In Vitro Genotoxic and Epigenetic Effects of Two Types of Cola Beverages and Caffeine: A Multiassay Approach. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7574843. [PMID: 27471731 PMCID: PMC4947684 DOI: 10.1155/2016/7574843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/14/2016] [Accepted: 06/05/2016] [Indexed: 12/25/2022]
Abstract
The aim of this work was to assess the biological and food safety of two different beverages: Classic Coca Cola™ (CCC) and Caffeine-Free Coca Cola (CFCC). To this end, we determined the genotoxicological and biological effects of different doses of lyophilised CCC and CFCC and Caffeine (CAF), the main distinctive constituent. Their toxic/antitoxic, genotoxic/antigenotoxic, and chronic toxicity (lifespan assay) effects were determined in vivo using the Drosophila model. Their cytotoxic activities were determined using the HL-60 in vitro cancer model. In addition, clastogenic DNA toxicity was measured using internucleosomal fragmentation and SCGE assays. Their epigenetic effects were assessed on the HL-60 methylation status using some repetitive elements. The experimental results showed a slight chemopreventive effect of the two cola beverages against HL-60 leukaemia cells, probably mediated by nonapoptotic mechanisms. Finally, CCC and CAF induced a global genome hypomethylation evaluated in LINE-1 and Alu M1 repetitive elements. Overall, we demonstrated for the first time the safety of this famous beverage in in vivo and in vitro models.
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Simons K, De Smedt T, Stove C, De Paepe P, Bader M, Nemery B, Vleminckx C, De Cremer K, Van Overmeire I, Fierens S, Mertens B, Göen T, Schettgen T, Van Oyen H, Van Loco J, Van Nieuwenhuyse A. Short-term health effects in the general population following a major train accident with acrylonitrile in Belgium. ENVIRONMENTAL RESEARCH 2016; 148:256-263. [PMID: 27085497 DOI: 10.1016/j.envres.2016.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N-2-cyanoethylvaline (CEV) was carried out days 14-21 after the accident. OBJECTIVES (1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects. METHODS Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs). RESULTS The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose. DISCUSSION AND CONCLUSION The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure.
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Affiliation(s)
- K Simons
- Scientific Institute of Public Health, Brussels, Belgium.
| | - T De Smedt
- Scientific Institute of Public Health, Brussels, Belgium.
| | - C Stove
- Ghent University, Laboratory of Toxicology, Department of Bioanalysis, Ghent, Belgium.
| | - P De Paepe
- Ghent University Hospital, Department of Emergency Medicine, Ghent, Belgium.
| | - M Bader
- BASF SE, Occupational Medicine & Health Protection, Ludwigshafen, Germany.
| | - B Nemery
- Katholieke Universiteit Leuven, Department of Public Health and Primary Care, Centre for Environment and Health, Leuven, Belgium.
| | - C Vleminckx
- Scientific Institute of Public Health, Brussels, Belgium.
| | - K De Cremer
- Scientific Institute of Public Health, Brussels, Belgium.
| | | | - S Fierens
- Scientific Institute of Public Health, Brussels, Belgium.
| | - B Mertens
- Scientific Institute of Public Health, Brussels, Belgium.
| | - T Göen
- University of Erlangen-Nuremberg, Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Erlangen, Germany.
| | - T Schettgen
- RWTH Aachen University, Institute for Occupational and Social Medicine, Medical Faculty, Aachen, Germany.
| | - H Van Oyen
- Scientific Institute of Public Health, Brussels, Belgium.
| | - J Van Loco
- Scientific Institute of Public Health, Brussels, Belgium.
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Abstract
Hydrogen sulfide (H2S) is a hazard primarily in the oil and gas industry, agriculture, sewage and animal waste handling, construction (asphalt operations and disturbing marshy terrain), and other settings where organic material decomposes under reducing conditions, and in geothermal operations. It is an insoluble gas, heavier than air, with a very low odor threshold and high toxicity, driven by concentration more than duration of exposure. Toxicity presents in a unique, reliable, and characteristic toxidrome consisting, in ascending order of exposure, of mucosal irritation, especially of the eye ("gas eye"), olfactory paralysis (not to be confused with olfactory fatigue), sudden but reversible loss of consciousness ("knockdown"), pulmonary edema (with an unusually favorable prognosis), and death (probably with apnea contributing). The risk of chronic neurcognitive changes is controversial, with the best evidence at high exposure levels and after knockdowns, which are frequently accompanied by head injury or oxygen deprivation. Treatment cannot be initiated promptly in the prehospital phase, and currently rests primarily on supportive care, hyperbaric oxygen, and nitrite administration. The mechanism of action for sublethal neurotoxicity and knockdown is clearly not inhibition of cytochrome oxidase c, as generally assumed, although this may play a role in overwhelming exposures. High levels of endogenous sulfide are found in the brain, presumably relating to the function of hydrogen sulfide as a gaseous neurotransmitter and immunomodulator. Prevention requires control of exposure and rigorous training to stop doomed rescue attempts attempted without self-contained breathing apparatus, especially in confined spaces, and in sudden release in the oil and gas sector, which result in multiple avoidable deaths.
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Haque F, Kundu SK, Islam MS, Hasan SMM, Khatun A, Gope PS, Mahmud ZH, Alamgir ASM, Islam MS, Rahman M, Luby SP. Outbreak of mass sociogenic illness in a school feeding program in northwest Bangladesh, 2010. PLoS One 2013; 8:e80420. [PMID: 24244685 PMCID: PMC3828262 DOI: 10.1371/journal.pone.0080420] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/02/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2010, an acute illness outbreak was reported in school students eating high-energy biscuits supplied by the school feeding programme in northwest Bangladesh. We investigated this outbreak to describe the illness in terms of person, place and time, develop the timeline of events, and determine the cause and community perceptions regarding the outbreak. METHODS We defined case-patients as students from affected schools reporting any two symptoms including abdominal pain, heartburn, bitter taste, and headache after eating biscuits on the day of illness. We conducted in-depth interviews and group discussions with students, teachers, parents and community members to explore symptoms, exposures, and community perceptions. We conducted a questionnaire survey among case-patients to determine the symptoms and ascertain food items eaten 12 hours before illness onset, and microbiological and environmental investigations. RESULTS Among 142 students seeking hospital care, 44 students from four schools qualified as case-patients. Of these, we surveyed 30 who had a mean age of 9 years; 70% (21/30) were females. Predominant symptoms included abdominal pain (93%), heartburn (90%), and bitter taste (57%). All students recovered within a few hours. No pathogenic Vibrio cholerae, Shigella or Salmonella spp. were isolated from collected stool samples. We found no rancid biscuits in schools and storage sites. The female index case perceived the unusually darker packet label as a "devil's deed" that made the biscuits poisonous. Many students, parents and community members reported concerns about rumors of students dying from biscuit poisoning. CONCLUSIONS Rapid onset, followed by rapid recovery of symptoms; female preponderance; inconsistent physical, microbiological and environmental findings suggested mass sociogenic illness rather than a foodborne or toxic cause. Rumours of student deaths heightening community anxiety apparently propagated this outbreak. Sharing investigation results and reassuring students and parents through health communication campaigns could limit similar future outbreaks and help retain beneficiaries' trust on nutrition supplementation initiatives.
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Affiliation(s)
- Farhana Haque
- Centre for Communicable Diseases (CCD), icddr,b, Dhaka, Bangladesh
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Subodh Kumar Kundu
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Md Saiful Islam
- Centre for Communicable Diseases (CCD), icddr,b, Dhaka, Bangladesh
| | | | - Asma Khatun
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | - A. S. M. Alamgir
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - M. Sirajul Islam
- Centre for Food and Waterborne Diseases, icddr,b, Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Stephen P. Luby
- Centre for Communicable Diseases (CCD), icddr,b, Dhaka, Bangladesh
- Global Disease Detection Program, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Mass Sociogenic Illness Initially Reported as Carbon Monoxide Poisoning. J Emerg Med 2012; 42:159-61. [DOI: 10.1016/j.jemermed.2011.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 11/10/2010] [Accepted: 01/03/2011] [Indexed: 11/16/2022]
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Abstract
Hydrogen sulfide is a relatively common, frequently lethal, and unique occupational hazard for which research since 1990 has uncovered many anomalies and subtleties and a previously unsuspected physiological role for the endogenous agent. The result has been uncertainty and misunderstanding, particularly for persons new to the literature. This review addresses evidence that settles past controversies, guides practical issues in evaluating human toxicity, addresses unresolved issues involving chronic exposure, and points the way to a deeper understanding of the agent and its effects.
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Affiliation(s)
- Tee L. Guidotti
- Tee L. Guidotti, Medical Advisory Services, PO Box 7479, Gaithersburg, MD 20898, USA
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Relativism, regulation and the dangers of indifferent science: the Sir Roy Cameron lecture of the Royal College of Pathologists. Toxicology 2009; 267:7-13. [PMID: 19903509 DOI: 10.1016/j.tox.2009.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 10/09/2009] [Accepted: 11/03/2009] [Indexed: 01/19/2023]
Abstract
The evaluation of data obtained from scientific investigations is not easy and the process often seems counterintuitive to the uninformed. Some commentators hold the conviction that ideological motives colour all deliberations-this makes it easy to suggest that in any scientific debate an opponent's reason for holding a particular viewpoint or belief depends on his or her motives, rather than their knowledge base. This position may be useful in providing the grounds on which to mount a polemic against any perceived threat (drugs in modern medicine, pesticides in intensive agriculture or genetically modified organisms). However, its existence is not a reason to ignore the fact that the data obtained by use of the scientific method may be of a different kind from that which depends on opinions, honed by prejudices. Here I use prejudice to mean a bias that may be favourable or unfavourable to a particular viewpoint, rather than to a willful disregard of fact or an unreasoning predilection to arrive at a particular answer--the Precautionary Principle is a good example of only considering results that fit a preconceived viewpoint. The conviction that opinions cannot be based on independent thought has led to a disregard of professionalism and the development of the view that who pays you determines your opinion--not your science. This is relativism, which embodies the assertion that knowledge is relative and that ethical truths depend on the individuals and groups holding them-there are no absolutes. This compounds the problems of regulatory toxicology which is always beset by unavoidable uncertainties and suffers from being based on the use of the results of testing procedures many decades old which have themselves failed to incorporate new knowledge about the processes we investigate (see Hartung, 2009). A more vigorous assertion of the particular values of the scientific viewpoint and a willingness to incorporate new knowledge into regulatory decision making is necessary.
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Page LA, Petrie KJ, Wessely SC. Psychosocial responses to environmental incidents: a review and a proposed typology. J Psychosom Res 2006; 60:413-22. [PMID: 16581367 DOI: 10.1016/j.jpsychores.2005.11.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this review was to propose a typology for understanding the diversity of psychosocial reactions to environmental incidents. METHODOLOGY The first section provides an introduction and background to the topic; we then attempt to provide a typology of psychosocial responses to environmental incidents. RESULTS Response to an environmental incident can be usefully considered in terms of the exposure, the response of the individual, the action of professionals, the response of the community, and the influence of the society in which the incident occurs. We reviewed each of these factors. CONCLUSIONS By examining incidents in an ordered framework, we suggest that a more comprehensive understanding is possible. We also suggest some basic ways in which the psychosocial management of such difficult and diverse incidents could be improved.
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Affiliation(s)
- Lisa A Page
- Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
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Vasterman P, Yzermans CJ, Dirkzwager AJE. The role of the media and media hypes in the aftermath of disasters. Epidemiol Rev 2005; 27:107-14. [PMID: 15958431 DOI: 10.1093/epirev/mxi002] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Vasterman
- Faculty of Humanities, Department of Media Studies, University of Amsterdam, The Netherlands
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Nemery B, Fischler B, Boogaerts M, Lison D, Willems J. The Coca-Cola incident in Belgium, June 1999. Food Chem Toxicol 2002; 40:1657-67. [PMID: 12176091 DOI: 10.1016/s0278-6915(02)00135-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present paper describes the outbreak of health complaints that occurred in Belgium, in June 1999, among schoolchildren and members of the general public in relation to the consumption of Coca-Cola and other soft drinks. The outbreak took place in the wake of a major food crisis, caused by PCB/dioxin contamination of animal feed, that had erupted shortly before. The clinical features (absence of serious poisoning) and epidemiological characteristics of the Coca-Cola outbreak pointed to mass sociogenic illness, and no subsequent toxicological or other data have refuted this hypothesis.
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Affiliation(s)
- B Nemery
- Department of Pneumology, Katholieke Universiteit Leuven, Leuven, Belgium.
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