BACKGROUND: Limited research exists on substance-related acute toxicity deaths (ATDs) in older adults (≥60 years) in Canada. This study aims to examine and describe the sociodemographic characteristics, health histories and circumstances of death for accidental ATDs among older adults.
METHODS: Following a retrospective descriptive analysis of all coroner and medical examiner files on accidental substance-related ATDs in older adults in Canada from 2016 to 2017, proportions and mortality rates for coroner and medical examiner data were compared with general population data on older adults from the 2016 Census. Chisquare tests were conducted for categorical variables where possible.
RESULTS: From 2016 to 2017, there were 705 documented accidental ATDs in older adults. Multiple substances contributed to 61% of these deaths. Fentanyl, cocaine and ethanol (alcohol) were the most common substances contributing to death. Heart disease (33%), chronic pain (27%) and depression (26%) were commonly documented. Approximately 84% of older adults had contact with health care services in the year preceding their death. Only 14% were confirmed as having their deaths witnessed.
CONCLUSIONS: Findings provide insight into the demographic, contextual and medical history factors that may influence substance-related ATDs in older adults and suggest key areas for prevention.
BACKGROUND: Il existe peu de recherches sur les décès liés à une intoxication aiguë due à une substance chez les aînés (60 ans et plus) au Canada. Cette étude vise à explorer et à décrire les caractéristiques sociodémographiques, les antécédents en matière de santé et les circonstances des décès en ce qui concerne les décès accidentels liés à une intoxication aiguë chez les aînés.
UNASSIGNED: À la suite d’une analyse descriptive rétrospective de tous les dossiers des coroners et des médecins légistes sur les décès accidentels liés à une intoxication aiguë due à une substance chez les aînés au Canada de 2016 à 2017, les pourcentages de décès et les taux de mortalité issus des données des coroners et des médecins légistes ont été comparés aux données sur les aînés de la population générale tirées du recensement de 2016. Dans la mesure du possible, nous avons réalisé des tests du chi carré pour les variables nominales.
UNASSIGNED: En 2016 et 2017, 705 décès accidentels liés à une intoxication aiguë chez les aînés ont été documentés. Dans 61 % des cas, ce sont plusieurs substances qui ont contribué au décès. Le fentanyl, la cocaïne et l’éthanol (alcool) sont les substances les plus souvent en cause. Les maladies du cœur (33 %), la douleur chronique (27 %) et la dépression (26 %) ont souvent été documentées. Environ 84 % des aînés avaient pris contact avec des services de soins de santé au cours de l’année précédant leur décès. Le décès a eu lieu en présence d’un témoin dans 14 % des cas seulement.
CONCLUSIONS: Nos constatations permettent de mettre en lumière les facteurs sociodémographiques, contextuels et les antécédents médicaux pouvant avoir une incidence sur les décès liés à une intoxication aiguë due à une substance chez les aînés et d’ainsi proposer des aires clés de prévention.
Males 60 years or older had a higher mortality rate due to accidental acute toxicity than females. When a pharmaceutical substance contributed to accidental acute toxicity death, 61% of older adults had a prescription for the substance. At least one nonpharmaceutical substance contributed to 43% of accidental older adult acute toxicity deaths. Multiple substances contributed to most of the accidental deaths (61%), with fentanyl, cocaine and ethanol (alcohol) most often contributing to death. Almost three-quarters of the older adults who died of acute toxicity had accessed health care in the year preceding death.
Les hommes de 60 ans et plus ont un taux plus élevé de décès lié à une intoxication aiguë accidentelle que les femmes. Dans les cas où une substance pharmaceutique a contribué au décès accidentel par intoxication aiguë, 61 % des aînés avaient obtenu une ordonnance pour cette substance. Au moins une substance non pharmaceutique a contribué au décès dans 43 % des décès accidentels par intoxication aiguë chez les aînés. Une combinaison de substances a contribué à la plupart des décès accidentels (61 %), le fentanyl, la cocaïne et l’éthanol (alcool) étant les substances les plus souvent en cause. Près des trois quarts des aînés décédés d’une intoxication aiguë avaient eu accès à des soins de santé au cours de l’année précédant leur décès.

Plastic products are extensively used worldwide, but inadequate management of plastic waste results in significant plastic pollution. Biodegradable plastic (BPs) offers an alternative to traditional plastics, however, not all BPs can fully degrade under natural conditions. Instead, they may deteriorate into biodegradable microplastic (BMPs) at a faster rate than conventional plastic, thereby posing an additional hazard to aquatic environments. This study provides a comprehensive overview of the fate of BPs in aquatic systems and their eco-toxicological effects on aquatic organisms such as algae, invertebrates, and fish. The findings highlight that BMPs have comparable or heightened effects compared to conventional microplastics (MPs) which physiochemical characteristic of the polymer itself or by the chemical leached from the polymeric matrix can affect aquatic organisms. While BPs is not a flawless solution to address plastic pollution, future research should prioritize investigating their production, environmental behavior, ecological impact, and whether BMPs inflict greater harm than conventional MPs.

Despite advances in head and neck cancer treatment, virtually all patients experience chemoradiation-induced toxicities. Oral mucositis (OM) and dysphagia are among the most prevalent and have a systemic impact on patients, hampering treatment outcome and harming quality of life. Accurate prediction of severe cases is crucial for improving management strategies and, ultimately, patient outcomes. This scoping review comprehensively maps the reported predictors and critically evaluates the performance, methodology, and reporting of predictive models for these conditions. A total of 174 studies were identified from database searches, with 73 reporting OM predictors, 97 reporting dysphagia predictors, and 4 reporting both OM and dysphagia predictors. These predictors included patient demographics, tumor classification, chemoradiotherapy regimen, radiation dose to organs-at-risk, genetic factors, and results of clinical laboratory tests. Notably, many studies only conducted univariate analysis or focused exclusively on certain predictor types. Among the included studies, numerous predictive models were reported: eight for acute OM, five for acute dysphagia, and nine for late dysphagia. The area under the receiver operating characteristic curve (AUC) ranged between 0.65 and 0.81, 0.60 and 0.82, and 0.70 and 0.85 for acute oral mucositis, acute dysphagia, and late dysphagia predictive models, respectively. Several areas for improvement were identified, including the need for external validation with sufficiently large sample sizes, further standardization of predictor and outcome definitions, and more comprehensive reporting to facilitate reproducibility.

Unsymmetrical dimethylhydrazine (UDMH) is a widely used rocket propellant, which oxidizes to different compounds. The determination of UDMH transformation products in the environment is of great importance since many of them are highly toxic. Along with well-known transformation products, researchers report new compounds, and establishing their structures is difficult and may be unreliable, and data on their properties, such as toxicity, are often not available. Moreover, the available information on the existence of various UDMH transformation products is quite scattered, many compounds are mentioned in the literature only once and/or without satisfactory confirmation of the structure, and labeled as assumed compounds. All this complicates the identification of new UDMH transformation products and obfuscates the search for already known compounds. This review aimed to summarize and systematize the UDMH oxidation pathways and its transformation products. The attention was paid to in which environmental compartment or only in the laboratory study UDMH transformation products were detected, as well as their formation under conditions of combustion and generating by engines. Schemes for the transformation of confirmed UDMH products were summarized; required conditions for the relevant chemical reactions were described. A group of assumed UDMH transformation products - those substances found in contaminated compartments, but without full structure confirmation - is shown in a separate table. Data on the UDMH and its transformation products acute toxicity are presented. Predicting the transformation products properties, including acute toxicity, cannot be the primary determination method, as the results obtained often do not reflect real values and, when dealing with unknown substances, may lead to using false results. Improved understanding of the UDMH transformation pathways in environmental compartments potentially can lead to more accurate identification of new transformation products with future use in developing approaches to reduce the toxic effects of UDMH and its transformation products.

Industries such as unconventional natural gas have seen increased global expansion to meet the increasing energy needs of our increasing global population. Unconventional gas uses hydraulic fracturing that produces significant volumes of produced waters, which can be highly saline and pose a toxic threat to freshwater invertebrates if exposure via discharges, spills, leaks, or runoff were to occur. The primary aim of the present review was to determine the sodium (Na+ ) and chloride (Cl- ) content of these waters as an approximate measure of salinity and how these values compare to the NaCl or synthetic marine salt acute toxicity values of freshwater invertebrate taxa. Shale gas produced waters are much more saline with 78 900 ± 10 200 NaCl mg/L and total dissolved solids (TDS) of 83 200 ± 12 200 mg/L compared to coal bed methane (CBM) produced waters with 4300 ± 1100 NaCl mg/L and TDS of 5900 ± 1300 mg/L and pose a far greater toxicity risk from NaCl to freshwater invertebrates. In addition, the toxicity of other major ions (Ca2+ , K+ , Mg2+ , CO 3 2 - , HCO3 - , and SO 4 2 - ) and their influence on the toxicity of Na+ and Cl- were evaluated. Exposure of untreated and undiluted shale gas produced waters to freshwater invertebrates is likely to result in significant or complete mortality. Shale gas produced waters have higher concentrations of various metals compared with CBM produced waters and are more acidic. We recommend future research to increase the reporting and consistency of water quality parameters, metals, and particularly organics of produced waters to provide a better baseline and help in further investigations. Environ Toxicol Chem 2022;41:2928-2949. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

We report the case of a 46-year-old woman with Bloom-like syndrome affected with locally advanced cervical cancer. She was treated with induction chemotherapy and radical radiation therapy concurrent with chemotherapy (carboplatin and paclitaxel). She was able to complete treatment, but grade III toxicities were observed. The limited relevant literature is presented. We conclude that the management of patients with DNA repair deficiency is challenging for the team in charge because of the potentially high sensitivity to treatment and the lack of clear recommendations in the literature. The main objective remains to deliver the optimal treatment while reducing toxicities.

Glyphosate [N-(phosphonomethyl) glycine] is currently the most widely used herbicide worldwide. Its application in agricultural and urban areas can lead to the dispersion and arrival to aquatic systems causing environmental deterioration with detrimental effects on the inhabiting biota. This is triggered not only by the herbicide per se but also its metabolite aminomethyl-phosphonic acid (AMPA), which can be highly toxic to many aquatic organisms. Water fleas are some of the key components in aquatic food webs, being one of the most sensitive groups to pollutants. Although being often used in standardized toxicity tests, they are comparatively less studied in relation to glyphosate exposition. Here we examine the current scientific literature regarding the acute and sublethal toxicity of glyphosate in the Cladocera taxonomic group, with special comparisons between the active ingredient (A.I) and formulations. Our results document a high variation in the lethal concentrations reported for different cladoceran species, due to the high diversity of products used in the toxicity tests. Most articles accounting for sublethal effects were performed on the standard Daphnia magna species. Reproduction, including decreased fecundity and delayed age of first reproduction, is usually one of the most severely affected individual traits. Although still scarce, studies documenting metabolic and genetic alterations might provide accurate information on the mechanisms of action of the herbicide.

Plant-based products such as essential oils and other extracts have been used for centuries due to their beneficial properties. Currently, their use is widely disseminated through a variety of industries and new applications are continuously emerging. For these reasons, they are produced industrially in large quantities and consequently they have the potential to reach the environment. However, the potential effects that these products have on the ecosystems\' health are mostly unknown. In recent years, the scientific community started to focus on the possible toxic effects of essential oils and plant extracts towards non-target organisms. As a result, an increasing body of knowledge has emerged. This review describes the current state of the art on the toxic effects that essential oils and plant extracts have towards organisms from different trophic levels, including producers, primary consumers, and secondary consumers. The majority of the studies (76.5%) focuses on the aquatic environment, particularly in aquatic invertebrates (45.1%) with only 23.5% of the studies focusing on the potential toxicity of plant-derived products on terrestrial ecosystems. While some essential oils and extracts have been described to have no toxic effects to the selected organisms or the toxic effects were only observable at high concentrations, others were reported to be toxic at concentrations below the limit set by international regulations, some of them at very low concentrations. In fact, L(E)C50 values as low as 0.0336 mg.L-1, 0.0005 mg.L-1 and 0.0053 mg.L-1 were described for microalgae, crustaceans and fish, respectively. Generally, essential oils exhibit higher toxicity than extracts. However, when the extracts are obtained from plants that are known to produce toxic metabolites, the extracts can be more toxic than essential oils. Overall, and despite being generally considered \"eco-friendly\" products and safer than they synthetic counterparts, some essential oils and plant extracts are toxic towards non-target organisms. Given the increasing interest from industry on these plant-based products further research using international standardized protocols is mandatory.

Phorate is a systemic organophosphorus pesticide (OP) that acts by inhibiting cholinesterases. Recent studies have reported that long-term low/moderate exposure to OP could be correlated with impaired cardiovascular and pulmonary function and other neurological effects. A 70-year-old farmer died after an intention ingestion of a granular powder mixed with water. He was employed on a farm for over 50 years producing fruit and vegetables, and for about 20 years, he had also applied pesticides. In the last 15 years, he used phorate predominantly. The Phorate concentration detected in gastric contents was 3.29 µg/mL. Chronic exposure to phorate is experimentally studied by histopathological changes observed in the kidney. In the light of current literature, our case confirms that there is an association between renal damage and chronic exposure to phorate in a subject exposed for years to the pesticide. Autopsies and toxicological analyses play a key role in the reconstruction of the dynamics, including the cause of the death.

BACKGROUND: Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality.
OBJECTIVE: This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population.
CONCLUSIONS: Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10-30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention.
CONCLUSIONS: An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.