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Rutchik J, Bowler RM, Ratner MH. A rare case of Holmes tremor in a worker with occupational carbon monoxide poisoning. Am J Ind Med 2021; 64:435-449. [PMID: 33616228 DOI: 10.1002/ajim.23235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/04/2021] [Accepted: 01/29/2021] [Indexed: 01/27/2023]
Abstract
Parkinsonism and encephalopathy are frequently seen in patients who survive carbon monoxide (CO) poisoning. Neurological findings associated with CO poisoning can emerge immediately after cessation of exposure or following a brief period of pseudo-recovery. When present, the tremor associated with CO poisoning is typical of the postural/intention type. Here, we report on a rare case of toxic encephalopathy with a dominant-hand Holmes-type tremor, characterized by resting, as well as postural and kinetic/intentional components, in a previously healthy 53-year-old man exposed to CO while actively engaged in the process of performing a physically demanding skilled labor task. The unique neuropathological and functional changes that give rise to Holmes-type tremor and how this relates to the selective vulnerability of the inhibitory indirect pathway of the basal ganglia to glutamatergic excitotoxicity mediated by tissue hypoxia are discussed.
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Affiliation(s)
- Jonathan Rutchik
- Department of Medicine, Division of Occupational and Environmental Medicine University of California San Francisco San Francisco California USA
- Neurology, Environmental and Occupational Medicine Associates Mill Valley California USA
| | - Rosemarie M. Bowler
- Department of Psychology San Francisco State University San Francisco California USA
| | - Marcia H. Ratner
- Department of Pharmacology and Experimental Therapeutics Boston University School of Medicine Boston Massachusetts USA
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2
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Nakamura T, Setsu K, Takahashi T, Miyashita M, Sugiyama N, Washizuka S, Murata S, Hanihara T, Amano N. Chronic exposure to carbon monoxide in two elderly patients using a kotatsu, a traditional Japanese charcoal-based heater. Psychogeriatrics 2016; 16:323-6. [PMID: 26551791 DOI: 10.1111/psyg.12164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 07/17/2015] [Accepted: 09/25/2015] [Indexed: 11/30/2022]
Abstract
We report on two elderly patients with cognitive impairments, for whom chronic carbon monoxide (CO) exposure was suspected based on elevated carboxyhaemoglobin levels in their serum. On their initial visits, cognitive impairment and brain magnetic resonance imaging findings in both patients were compatible with the diagnosis of Alzheimer's-type dementia. However, after discontinuation of the use of a kotatsu, a charcoal-based heater, their serum carboxyhaemoglobin levels normalized and their physical symptoms resolved. Their cognitive function also slightly improved. The causal relationship between physical symptoms and cognitive impairment after chronic CO poisoning is uncertain; however, it is possible that chronic exposure to low CO levels exacerbated the clinical manifestation in our patients.
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Affiliation(s)
- Toshinori Nakamura
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan.
| | | | - Tohru Takahashi
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuhiro Miyashita
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nobuhiro Sugiyama
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shinsuke Washizuka
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Tokiji Hanihara
- School of Health Sciences, Shinshu University, Matsumoto, Japan
| | - Naoji Amano
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
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3
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Hopkins RO, Woon FLM. Neuroimaging, Cognitive, and Neurobehavioral Outcomes Following Carbon Monoxide Poisoning. ACTA ACUST UNITED AC 2016; 5:141-55. [PMID: 16891556 DOI: 10.1177/1534582306289730] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Carbon monoxide is a colorless, odorless gas produced as a byproduct of combustion. Carbon monoxide is the leading cause of poisoning injury and death worldwide. Morbidity following CO poisoning includes neurologic sequelae, neuropathologic abnormalities on brain imaging, neurobehavioral changes, and cognitive impairments. It is estimated that as high as 50% of individuals with carbon monoxide poisoning will develop neurologic, neurobehavioral, or cognitive sequelae. Carbon monoxide related cognitive impairments included impaired memory, attention, executive function, motor, visual spatial, and slow mental processing speed. Given the high rate of brain related morbidity and the fact that the majority of carbon monoxide is avoidable, awareness and prevention of carbon monoxide poisoning is warranted.
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Hampson NB. Myth busting in carbon monoxide poisoning. Am J Emerg Med 2016; 34:295-7. [DOI: 10.1016/j.ajem.2015.10.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/26/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022] Open
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Gara E, Gesztes É, Doroszlai R, Zacher G. [Urgent cesarean section in a pregnant woman with carbon monoxide poisoning]. Orv Hetil 2014; 155:871-5. [PMID: 24860052 DOI: 10.1556/oh.2014.29911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recognition of carbon monoxide is difficult due to its plain physical-chemical properties. Carbon and gas operating heating systems may cause severe poisoning. Carbon-monoxide intoxication may generate severe hypoxic damage and it may cause death. The authors present the case of severe carbon monoxide poisoning affecting one young child and five adults, including a pregnant woman. Because the availability of hyperbaric oxygen therapy is limited in Hungary, urgent cesarean section was performed to avoid intrauterine hypoxic damage. The authors note that there are no standardized non-invasive methods for measuring fetal carbon-monoxide level and that the level of carbon monoxide accumulation is higher and the clearance is longer in the fetus than in the mother. The pathophysiology of carbon monoxide intoxication and therapeutic options in pregnancy are discussed.
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Affiliation(s)
- Edit Gara
- Országos Mentőszolgálat Közép-Magyarországi Régió Budapest Magyar Gyermekmentő Alapítvány Budapest Semmelweis Egyetem, Általános Orvostudományi Kar Városmajori Szív- és Érgyógyászati Klinika Budapest Városmajor u. 68. 1122
| | - Éva Gesztes
- Országos Mentőszolgálat Közép-Magyarországi Régió Budapest Magyar Gyermekmentő Alapítvány Budapest
| | - Richárd Doroszlai
- Országos Mentőszolgálat Közép-Magyarországi Régió Budapest Magyar Gyermekmentő Alapítvány Budapest
| | - Gábor Zacher
- Péterfy Sándor utcai Kórház Sürgősségi Belgyógyászat és Klinikai Toxikológiai Osztály Budapest
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Janulewicz PA, Killiany RJ, White RF, Martin BM, Winter MR, Weinberg JM, Aschengrau A. Structural Magnetic Resonance Imaging in an adult cohort following prenatal and early postnatal exposure to tetrachloroethylene (PCE)-contaminated drinking water. Neurotoxicol Teratol 2013; 38:13-20. [PMID: 23571160 DOI: 10.1016/j.ntt.2013.03.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 03/21/2013] [Accepted: 03/22/2013] [Indexed: 10/27/2022]
Abstract
This population-based retrospective cohort study examined Structural Magnetic Resonance Imaging (MRI) of the brain in relation to prenatal and early postnatal exposure to tetrachloroethylene (PCE)-contaminated drinking water on Cape Cod, Massachusetts. Subjects were identified through birth records from 1969 through 1983. Exposure was modeled using pipe network information from town water departments, a PCE leaching and transport algorithm, EPANet water flow modeling software, and Geographic Information System (GIS) methodology. Brain imaging was performed on 26 exposed and 16 unexposed subjects. Scans were acquired on a Philips 3T whole body scanner using the ADNI T1-weighted MP-RAGE scan. The scans were processed by FreeSurfer version 4.3.1 software to obtain measurements of specific brain regions. There were no statistically significant differences between exposed and unexposed subjects on the measures of white matter hypointensities (β: 127.5mm(3), 95% CI: -259.1, 1514.0), white matter volumes (e.g. total cerebral white matter: β: 21230.0mm(3), 95% CI: -4512.6, 46971.7) or gray matter volumes (e.g. total cerebral gray matter: β: 11976.0mm(3), 95% CI: -13657.2, 37609.3). The results of this study suggest that exposure to PCE during gestation and early childhood, at the levels observed in this population, is not associated with alterations in the brain structures studied.
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Affiliation(s)
- Patricia A Janulewicz
- Department of Epidemiology, Boston University Schools of Public Health and Medicine, Boston, MA 02118, USA.
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Ghorbani M, Moallem SA, Abnous K, Tabatabaee Yazdi SA, Movassaghi AR, Azizzadeh M, Mohamadpour AH. The effect of granulocyte colony-stimulating factor administration on carbon monoxide neurotoxicity in rats. Drug Chem Toxicol 2012; 36:102-8. [DOI: 10.3109/01480545.2012.737802] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mihaylova S, Killian A, Mayer K, Pullamsetti SS, Schermuly R, Rosengarten B. Effects of anti-inflammatory vagus nerve stimulation on the cerebral microcirculation in endotoxinemic rats. J Neuroinflammation 2012; 9:183. [PMID: 22830560 PMCID: PMC3425315 DOI: 10.1186/1742-2094-9-183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 06/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sepsis syndromes the severity of the inflammation triggers microvascular dysfunction and early organ failure. We studied the effects of anti-inflammatory vagus nerve stimulation on the cerebral microcirculatory integrity in an endotoxinemic rat model. METHODS In both control and endotoxinemic (5 mg/kg lipopolysaccharide i.v.) rats, the effect of cervical bilateral vagotomy with or without left-sided distal vagus nerve stimulation were compared to non-vagotomized, nonstimulated group (sham). Neurovascular coupling was analyzed by electrical forepaw stimulation, EEG, and cortical laser-Doppler flow recording. Resting cerebral blood flow, evoked potentials and hemodynamic responses, were obtained over a period of 4.5 hours. Regulation of the nitric oxide system (iNOS expression and nitrite/nitrate measurements), cytokines (IFN-γ, TNF-α, IL-6, IL-10), hypoxic and apoptosis signaling molecules (HIF-2α, Bax) were measured at the end of experiments. RESULTS In endotoxinemic rats, vagus nerve stimulation tended to increase anti-inflammatory cytokine levels and resulted in a stabile hemodynamic response (28 ± 13%; versus baseline). Vagotomized animals incurred a pro-inflammatory response (7 ± 4%; P < 0.0001 versus baseline) and produced more HIF-2α than vagotomized vagus nerve stimulated (VNS) animals. Evoked potential amplitudes were stabilized in VNS (15 ± 7 μV; n.s. versus baseline) as compared to vagotomised rats (8 ± 5 μV; P < 0.001 versus baseline). However, no effects were observed on apoptosis markers or nitric oxide levels. CONCLUSIONS Vagus nerve stimulation in endotoxinemic rats had a positive effect on neurovascular coupling and stabilized evoked potentials.
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Affiliation(s)
- Stanka Mihaylova
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, D-35392, Giessen, Germany
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Karakurum B, Karataş M, Giray S, Tan M, Yildirim T. Partial Recovery from Cortical Blindness Following Monoxide Intoxication. Int J Neurosci 2009; 115:143-7. [PMID: 15768859 DOI: 10.1080/00207450490512722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with carbon monoxide (CO) intoxication may show neurological signs such as headache, seizures, extrapyramidal findings, and coma. However, cortical blindness is rare in these cases. This study describes a woman exhibiting confusion and axial rigidity after CO intoxication. Ten days after intoxication, her pupils were isonormocoric and reactive to light. A fundoscopic examination was normal, but visual acuity was light-perception in both eyes. There were diffuse EEG slow waves. Magnetic resonance imaging (MRI) demonstrated bilateral hyperintensity in the basal ganglia. The P100 latencies of visual evoked potentials (VEP) were increased and dispersed. One year later, the patient's visual acuity was almost normal and VEPs showed mild dispersion in P100 latencies. The authors found this case of interest because cortical blindness due to CO intoxication is only rarely seen with a relatively good outcome.
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Affiliation(s)
- Başak Karakurum
- Department of Neurology, Başkent University Medical School, Adana Teaching and Medical Research Center, Adana, Turkey.
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Lo CP, Chen SY, Chou MC, Wang CY, Lee KW, Hsueh CJ, Chen CY, Huang KL, Huang GS. Diffusion-tensor MR imaging for evaluation of the efficacy of hyperbaric oxygen therapy in patients with delayed neuropsychiatric syndrome caused by carbon monoxide inhalation. Eur J Neurol 2007; 14:777-82. [PMID: 17594334 DOI: 10.1111/j.1468-1331.2007.01854.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study is to assess the efficacy of hyperbaric oxygen therapy (HBOT) in patients with delayed neuropsychiatric syndrome (DNS) caused by carbon monoxide (CO) inhalation using diffusion tensor magnetic resonance (MR) imaging and neuropsychological test. Conventional and diffusion tensor brain MR imaging exams were performed in six patients with DNS immediately before and 3 months after the HBOT to obtain fractional anisotropy (FA) values. Six age- and sex-matched normal control subjects also received MR exams for comparison. Mini-Mental State Examination (MMSE) was also performed in patients immediately before and 3 months after the HBOT. A significantly higher mean FA value was found in control subjects as compared with the patients both before and 3 months after the HBOT (P < 0.001). The mean FA value 3 months after the HBOT was also significantly higher than that before the HBOT in the patient group (P < 0.001). All of the patients regained full scores in the MMSE 3 months after the HBOT. Diffusion tensor MR imaging can be a quantitative method for the assessment of the white matter change and monitor the treatment response in patients of CO-induced DNS with a good clinical correlation. HBO may be an effective therapy for DNS.
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Affiliation(s)
- C-P Lo
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, China.
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Hopkins RO, Fearing MA, Weaver LK, Foley JF. Basal ganglia lesions following carbon monoxide poisoning. Brain Inj 2006; 20:273-81. [PMID: 16537269 DOI: 10.1080/02699050500488181] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVES Carbon monoxide (CO) is the most common cause of poisoning and may result in basal ganglia lesions. This study reviewed the literature of carbon monoxide poisoning and basal ganglia lesions and prospectively assessed the prevalence of basal ganglia lesions in a cohort of patients with CO poisoning. RESEARCH DESIGN Literature review and prospective cohort study. METHODS This study conducted a comprehensive review of the literature and assessed 73 CO-poisoned patients for basal ganglia lesions on sequential MR scans. Magnetic resonance scans were obtained on day 1, 2 weeks and 6 months post-CO poisoning. RESULTS The literature review found basal ganglia lesions occur in 4-88% of subjects. Only one patient was found with globus pallidus lesions at 2 weeks and 6 months following CO poisoning, that were not present on the initial day 1 MR scan. CONCLUSIONS Basal ganglia lesions, including lesions of the globus pallidus, may be less common than previously reported.
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Affiliation(s)
- Ramona O Hopkins
- Pyschology Department, Brigham Young University, Provo, Utah 84602-5543, USA.
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Abstract
Carbon monoxide is an insidious poison that accounts for thousands of deaths each year in North America. Clinical effects maybe diverse and include headache, dizziness, nausea, vomiting,syn-cope, seizures, coma, dysrhythmias, and cardiac ischemia. Children, pregnant women, and patients who have underlying cardiovascular disease are particularly at risk for adverse out-comes. Treatment consists of oxygen therapy, supportive care, and, in selected cases, hyperbaric oxygen therapy.
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Affiliation(s)
- Louise W Kao
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA.
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13
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Abstract
CO is an ubiquitous poison with many sources of exposure. CO poisoning produces diverse signs and symptoms that are often subtle and may be easily misdiagnosed. Failure to diagnose CO poisoning may result insignificant morbidity and mortality and permit continued exposure to a dangerous environment. Treatment of CO poisoning begins with inhalation of supplemental oxygen and aggressive supportive care. HBOT accelerates dissociation of CO from hemoglobin and may also prevent DNS. Absolute indications forHBOT for CO poisoning remain controversial, although most authors would agree that HBOT is indicated in patients who are comatose or neurologically abnormal, have a history of LOC with their exposure, or have cardiac dysfunction. Pregnancy with an elevated CO-Hgb level(>15%-20%) is also widely, considered an indication for treatment.HBOT may be considered in patients who have persistent symptoms despite NBO, metabolic acidosis, abnormalities on neuropsychometric testing, or significantly elevated levels. The ideal regimen of oxygen therapy has yet to be determined, and significant controversy exists regarding HBOTtreatment protocols. Often the local medical toxicologist, poison control center, or hyperbaric unit may assist the treating physician with decisions regarding therapy.
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Affiliation(s)
- Louise W Kao
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA.
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Labana S, Pandey G, Paul D, Sharma NK, Basu A, Jain RK. Pot and field studies on bioremediation of p-nitrophenol contaminated soil using Arthrobacter protophormiae RKJ100. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2005; 39:3330-7. [PMID: 15926586 DOI: 10.1021/es0489801] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Biodegradation of p-nitrophenol (PNP), a priority pollutant, was studied as a model system for bioremediation of sites contaminated with nitroaromatic/organic compounds. Bioremediation of PNP-containing soil was first carried out in pots using immobilized and free cells of Arthrobacter protophormiae RKJ100 in order to ascertain the role of a suitable carrier material. Results showed that stability of the introduced strain was enhanced upon immobilization and that the rate of PNP depletion decreased with increasing depth of soil. Small-scale field studies (in one square meter plots) were then conducted in which PNP-contaminated soil from an agricultural field was bioaugmented with strain RKJ100 under natural environmental conditions. PNP was totally depleted in 5 days by immobilized cells, whereas free cells were able to deplete 75% of PNP in the same time period. The fate of the released strain as monitored by plate counts, hybridization studies, and real-time polymerase chain reaction revealed fairly stable population of the cells upon immobilization on corncob powder throughout the period of study.
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Affiliation(s)
- Sumeet Labana
- Institute of Microbial Technology, Sector 39-A, Chandigarh-160036, India
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Erdogan MS, Islam SS, Chaudhari A, Ducatman AM. Occupational Carbon Monoxide Poisoning Among West Virginia Workers’ Compensation Claims: Diagnosis, Treatment Duration, and Utilization. J Occup Environ Med 2004; 46:577-83. [PMID: 15213520 DOI: 10.1097/01.jom.0000128157.24767.5b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Incidence rates and characterizations of occupational carbon monoxide (CO) poisoning in terms of sources of exposures, diagnosis, treatment, and health care utilization are critical for public health planning. We identified 182 CO poisoning cases occurring over a 6-year period (IR = 4.3/100000 worker-years) in the West Virginia workers' compensation data. Frequent sources of poisoning were gas-powered engines (28%) and furnaces (20%). Minimum treatment duration ranged from 1 day to 8 years with significant differences in mental health comorbidities between cases treated within 1 year compared with cases treated for more than 1 year (OR = 20.75; 95% CI = 3.5-128.4). The average cost (medical and wage loss replacement) for CO claims was dollars 2130 and median lost time was 45 days. CO poisoning could lead to prolonged disability and treatment in patients with mental health comorbidities, suggesting a possible role for early intervention.
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Affiliation(s)
- M Sarper Erdogan
- Kocaeli University Medical Faculty, Department of Public Health, Kocaeli, Turkey
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