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Schmoll S, Heier EC, Böll R, Zellner T, Romanek K, Eyer F, Rabe C, Geith S. Independent validation of the Tanta University Risk Model for intensive care requirement in acutely poisoned adults. Clin Toxicol (Phila) 2023; 61:266-269. [PMID: 37129221 DOI: 10.1080/15563650.2023.2188142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To independently validate the predictive value of the Tanta University Risk Model for intensive care requirement in unselected poisoned patients. METHOD Retrospective chart review of 293 poisoned patients. The Tanta University Risk Model was calculated as follows: Tanta University Risk Model = -1.966*Glasgow Coma Scale - 0.329*oxygen saturation - 0.212*diastolic blood pressure + 0.27*respiratory rate - 0.33*standard bicarbonate. It was then compared to a composite endpoint indicating an intensive care unit requirement (death in hospital, vasopressors, need for intubation). RESULTS Nineteen of 293 patients had a complicated clinical course as defined by meeting the primary endpoint definition. Receiver operating characteristic analysis revealed the area under the curve to be 0.79 (95% confidence interval 0.73-0.83). A positive Tanta University Risk Model was defined >-73.46. Fifteen out of 84 patients with a positive Tanta University Risk Model had a complicated course, while four of 209 patients with a negative Tanta University risk model had a complicated course (P<0.0001, Fisher's exact test). The negative predictive value of the Tanta University Risk Model was 0.98 (95% confidence interval 0.95-0.99), the sensitivity was 0.79 and that specificity was 0.75. CONCLUSION Poisoned patients with a negative Tanta University Risk Model score are unlikely to need an intensive care unit level of care.
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Affiliation(s)
- Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Eva-Carina Heier
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Regina Böll
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Zellner
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katrin Romanek
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Zellner T, Romanek K, Rabe C, Schmoll S, Geith S, Heier EC, Stich R, Burwinkel H, Keicher M, Bani-Harouni D, Navab N, Ahmadi SA, Eyer F. ToxNet: an artificial intelligence designed for decision support for toxin prediction. Clin Toxicol (Phila) 2023; 61:56-63. [PMID: 36373611 DOI: 10.1080/15563650.2022.2144345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Artificial intelligences (AIs) are emerging in the field of medical informatics in many areas. They are mostly used for diagnosis support in medical imaging but have potential uses in many other fields of medicine where large datasets are available. AIM To develop an artificial intelligence (AI) "ToxNet", a machine-learning based computer-aided diagnosis (CADx) system, which aims to predict poisons based on patient's symptoms and metadata from our Poison Control Center (PCC) data. To prove its accuracy and compare it against medical doctors (MDs). METHODS The CADx system was developed and trained using data from 781,278 calls recorded in our PCC database from 2001 to 2019. All cases were mono-intoxications. Patient symptoms and meta-information (e.g., age group, sex, etiology, toxin point of entry, weekday, etc.) were provided. In the pilot phase, the AI was trained on 10 substances, the AI's prediction was compared to naïve matching, literature matching, a multi-layer perceptron (MLP), and the graph attention network (GAT). The trained AI's accuracy was then compared to 10 medical doctors in an individual and in an identical dataset. The dataset was then expanded to 28 substances and the predictions and comparisons repeated. RESULTS In the pilot, the prediction performance in a set of 8995 patients with 10 substances was 0.66 ± 0.01 (F1 micro score). Our CADx system was significantly superior to naïve matching, literature matching, MLP, and GAT (p < 0.005). It outperformed our physicians experienced in clinical toxicology in the individual and identical dataset. In the extended dataset, our CADx system was able to predict the correct toxin in a set of 36,033 patients with 28 substances with an overall performance of 0.27 ± 0.01 (F1 micro score), also significantly superior to naïve matching, literature matching, MLP, and GAT. It also outperformed our MDs. CONCLUSION Our AI trained on a large PCC database works well for poison prediction in these experiments. With further research, it might become a valuable aid for physicians in predicting unknown substances and might be the first step into AI use in PCCs.
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Affiliation(s)
- Tobias Zellner
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Katrin Romanek
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Sabrina Schmoll
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Eva-Carina Heier
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Raphael Stich
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Hendrik Burwinkel
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | - Matthias Keicher
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | - David Bani-Harouni
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | | | - Florian Eyer
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Schmoll S, Romanek K, Zorn G, Eiglmeier H, Eyer F. Anticholinergic syndrome after atropine overdose in a supposedly homeopathic solution: a case report. Clin Toxicol (Phila) 2021; 60:252-254. [PMID: 33988064 DOI: 10.1080/15563650.2021.1918704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A 53-year-old male with no pre-existing conditions and no permanent medication presented to our emergency department with an anticholinergic syndrome including confusion, anxiety, ataxia and dysarthria after ingestion of a homeopathic solution containing Atropa belladonna extract supposedly in a D4 dilution. METHODS Atropine sulphate was quantitatively analysed in serum and the homeopathic preparation via liquid chromatography/mass spectrometry. RESULTS Analysis revealed concentrations of approximately 3 mg/mL atropine sulphate in the homeopathic solution and a serum level of 5.7 ng/mL (±1.4) in the patient's blood proving a 600-fold overdose of atropine due to a production error of the homeopathic dilution. The patient was observed and recovered without further intervention. CONCLUSION Rare but possibly dangerous manufacturing errors should be considered when faced with symptoms occurring after ingestion of homeopathic or holistic remedies.
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Affiliation(s)
- Sabrina Schmoll
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Katrin Romanek
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Gabriel Zorn
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Hans Eiglmeier
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Romanek K, Fels H, Dame T, Skopp G, Musshoff F, Eiglmeier H, Eyer F. Return of the Quaaludes? Prolonged agitated delirium after intentional ingestion of the methaqualone analog SL-164 - a case report. Subst Abus 2021; 42:503-505. [PMID: 33760714 DOI: 10.1080/08897077.2021.1903648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: A 22-year-old male with a known history of drug abuse presented to our department with prolonged agitated delirium, myocloni, tachycardia and subfebrile temperature after the deliberate ingestion of opium poppy tea (Papaver somniferum L.) together with the methaqualone analog SL-164 (5-chloro-3-(4-chloro-2-methylphenyl)-2-methyl-4(3H)-quinazolinone) which is sold online as a designer drug. Methods: SL-164 and its hydroxy metabolites were detected in serum and urine via liquid chromatography-quadrupole-time-of-flight mass spectrometry (LC-QTOF-MS). Results: The pronounced delirium was treated with benzodiazepines and neuroleptics; temporary medical restraint had to be applied. Symptoms completely resolved over the next 72 h and the patient was discharged on day three able to give consent. Conclusions: Although methaqualone was a popular and widespread sedative in the 1950s and 60 s before its discontinuation in the USA in 1985, derivatives of the methaqualone class have not previously played a large role as drugs of abuse in the rapidly growing market of new psychoactive substances. To our knowledge, this is the first case of agitated delirium with detection of SL-164 and hydroxylated metabolites in a patient's serum and urine.
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Affiliation(s)
- Katrin Romanek
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Helena Fels
- Forensic Toxicological Centre (FTC) Munich, Munich, Germany
| | - Torsten Dame
- Forensic Toxicological Centre (FTC) Munich, Munich, Germany
| | - Gisela Skopp
- Forensic Toxicological Centre (FTC) Munich, Munich, Germany
| | - Frank Musshoff
- Forensic Toxicological Centre (FTC) Munich, Munich, Germany
| | - Hans Eiglmeier
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Internal Medicine II, Division of Clinical Toxicology and Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Böll R, Romanek K, Schmoll S, Stich R, Ott A, Stenzel J, Geith S, Eyer F, Rabe C. Independent validation of the ICU requirement score in a cohort of acutely poisoned adults. Clin Toxicol (Phila) 2017; 56:664-666. [DOI: 10.1080/15563650.2017.1401635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Regina Böll
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katrin Romanek
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Raphael Stich
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Armin Ott
- Institute of Medical Informatics, Statistics, and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jochen Stenzel
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Schmoll S, Romanek K, Stich R, Bekka E, Stenzel J, Geith S, Eyer F, Rabe C. An internet-based survey of 96 German-speaking users of "bath salts": frequent complications, risky sexual behavior, violence, and delinquency. Clin Toxicol (Phila) 2017; 56:219-222. [PMID: 28753045 DOI: 10.1080/15563650.2017.1353094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To define the demographics of German-speaking "bath salt" users. DESIGN Prospective web-based survey of volunteer users of "bath salts". Subject recruitment/exclusion: Participation was solicited by posts in web forums frequented by users of synthetic cathinones. An invitation to participate was also disseminated via regional drug information centers. Responses were discarded if participants refused data analysis, provided incomplete surveys, were under 18 years of age (five cases), and in case of clearly improbable answers (i.e., two cases with profanity typed in free-form input fields). Overall 96 out of 180 participants provided complete questionnaires. These were further analyzed. RESULTS AND CONCLUSIONS 74% of respondents were male. 41% were under the age of 30 and a further 38% between 30 and 39 years old. Cathinones were used on more than 10 days in the preceding year by 62% of study subjects. The nasal and intravenous routes of administration were most often used. About 80% of respondents reported binge use. There were frequent co-administrations of opioids and opiates. The most common complication was prolonged confusion (47%). 16% had been involuntarily confined. One third had thoughts of violence and 16% acted on these thoughts either against themselves or others. About 44% reported high-risk sexual activity under the influence of cathinones. About 31% had driven or ridden a bike while intoxicated. About 6% had problems with law-enforcement for selling cathinones and 16% for crimes committed under the influence of cathinones. In conclusion, cathinone users are typically young males in their twenties and thirties. Most are experienced drug users, particularly of alcohol and opiates/opioids. The impact on society is tremendous as evidenced by high rates of self-reported violence, high-risk sexual activity, crimes, and traffic violations.
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Affiliation(s)
- Sabrina Schmoll
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Katrin Romanek
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Raphael Stich
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Elias Bekka
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Jochen Stenzel
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Stefanie Geith
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Florian Eyer
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Christian Rabe
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
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Romanek K, Stenzel J, Schmoll S, Schrettl V, Geith S, Eyer F, Rabe C. Synthetic cathinones in Southern Germany – characteristics of users, substance-patterns, co-ingestions, and complications. Clin Toxicol (Phila) 2017; 55:573-578. [DOI: 10.1080/15563650.2017.1301463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katrin Romanek
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jochen Stenzel
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Verena Schrettl
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Rose K, Van de Venne M, Abakke A, Romanek K, Redecha M. Is 48 hours enough for Obstetrics and Gynaecology training in Europe? Facts Views Vis Obgyn 2012; 4:88-92. [PMID: 24753895 PMCID: PMC3987495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The European Working Time Directive, implemented by the European Union (EU) in 1993, was adopted in the medical profession to improve patient safety as well as the working lives of doctors. The Directive reduced the average amount of hours trainee doctors worked to 48 hours per week. However, its adoption has varied throughout the EU. Its potential effect on both the quality and total amount of hours of -training has caused concern. This monograph presents data on Obstetrics and Gynaecology training in Europe obtained from several of the European Network of Trainees in Obstetrics & Gynaecology's (ENTOG) surveys. The monograph demonstrates large variations in training and explains the difficulties in ascertaining whether 48 hours of training a week is sufficient to become an Obstetrics and Gynaecology specialist in Europe.
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Affiliation(s)
- K. Rose
- Department of Obstetrics and Gynaecology, James Cook University Hospital, Middlesbrough, United Kingdom.
| | - M. Van de Venne
- Department of Obstetrics and Gynaecology, Royal United Hospital, Bath, United Kingdom.
| | - A.J.M. Abakke
- Department of Obstetrics and Gynaecology, University of Copenhagen, Holbæk Hospital, Denmark.
| | - K. Romanek
- II Department of Gynecology, Medical University of Lubin, Poland.
| | - M. Redecha
- II Department of Gynecology and Obstetrics, Comenius University, Bratislava, Slovak Republic.
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