Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Kazzi Z [original query] |
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A cluster of tetrodotoxin poisoning in Oman
Alhatali B , Al Lawatia S , Khamis F , Kantur S , Al-Abri S , Kapil V , Thomas J , Johnson R , Hamelin EI , Coleman RM , Kazzi Z . Clin Toxicol (Phila) 2021 60 (2) 1-5 INTRODUCTION: Tetrodotoxin (TTX) is a potent sodium channel blocker, with significant neurotoxicity, found in marine animals like pufferfish and blue-ringed octopus. The severity of toxicity depends on the amount of toxin ingested and the outcome depends on the time-lapse to appropriate medical care. CASES REPORT: We report five patients who presented with tetrodotoxin poisoning after consuming fried internal organs of local pufferfish from the coast of Oman. The patients' clinical manifestations were consistent with the expected TTX toxidrome of perioral and generalized paresthesia, weakness of upper and lower extremities, gastrointestinal manifestations, dyspnea, dysarthria, ascending paralysis, hypotension, bradycardia and coma. The severity varied among the patients who recovered completely except one patient who developed a subarachnoid hemorrhage without underlying aneurysms on computed tomography-angiogram. This complication was potentially related to TTX poisoning and has not been previously reported. In addition to standard supportive management, patients with severe illness should potentially receive the intravenous acetylcholinesterase inhibitor neostigmine, and intermittent dialysis. Urine specimens were sent to CDC in Atlanta, where they were analyzed using online solid phase extraction (SPE) with LC-MS/MS and confirmed the diagnosis in all five cases. DISCUSSION: In general, the patients' clinical manifestations were consistent with the expected TTX toxidrome except patient 3 who developed a subarachnoid hemorrhage early during his clinical course. Two patients received neostigmine and underwent dialysis with complete recovery. |
Early-onset neonatal sepsis 2015 to 2017, the rise of Escherichia coli, and the need for novel prevention strategies
Stoll BJ , Puopolo KM , Hansen NI , Sanchez PJ , Bell EF , Carlo WA , Cotten CM , D'Angio CT , Kazzi SNJ , Poindexter BB , Van Meurs KP , Hale EC , Collins MV , Das A , Baker CJ , Wyckoff MH , Yoder BA , Watterberg KL , Walsh MC , Devaskar U , Laptook AR , Sokol GM , Schrag SJ , Higgins RD . JAMA Pediatr 2020 174 (7) e200593 Importance: Early-onset sepsis (EOS) remains a potentially fatal newborn condition. Ongoing surveillance is critical to optimize prevention and treatment strategies. Objective: To describe the current incidence, microbiology, morbidity, and mortality of EOS among a cohort of term and preterm infants. Design, Setting, and Participants: This prospective surveillance study included a cohort of infants born at a gestational age (GA) of at least 22 weeks and birth weight of greater than 400 g from 18 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from April 1, 2015, to March 31, 2017. Data were analyzed from June 14, 2019, to January 28, 2020. Main Outcomes and Measures: Early-onset sepsis defined by isolation of pathogenic species from blood or cerebrospinal fluid culture within 72 hours of birth and antibiotic treatment for at least 5 days or until death. Results: A total of 235 EOS cases (127 male [54.0%]) were identified among 217480 newborns (1.08 [95% CI, 0.95-1.23] cases per 1000 live births). Incidence varied significantly by GA and was highest among infants with a GA of 22 to 28 weeks (18.47 [95% CI, 14.57-23.38] cases per 1000). No significant differences in EOS incidence were observed by sex, race, or ethnicity. The most frequent pathogens were Escherichia coli (86 [36.6%]) and group B streptococcus (GBS; 71 [30.2%]). E coli disease primarily occurred among preterm infants (68 of 131 [51.9%]); GBS disease primarily occurred among term infants (54 of 104 [51.9%]), with 24 of 45 GBS cases (53.3%) seen in infants born to mothers with negative GBS screening test results. Intrapartum antibiotics were administered to 162 mothers (68.9%; 110 of 131 [84.0%] preterm and 52 of 104 [50.0%] term), most commonly for suspected chorioamnionitis. Neonatal empirical antibiotic treatment most frequently included ampicillin and gentamicin. All GBS isolates were tested, but only 18 of 81 (22.2%) E coli isolates tested were susceptible to ampicillin; 6 of 77 E coli isolates (7.8%) were resistant to both ampicillin and gentamicin. Nearly all newborns with EOS (220 of 235 [93.6%]) displayed signs of illness within 72 hours of birth. Death occurred in 38 of 131 infected infants with GA of less than 37 weeks (29.0%); no term infants died. Compared with earlier surveillance (2006-2009), the rate of E coli infection increased among very low-birth-weight (401-1500 g) infants (8.68 [95% CI, 6.50-11.60] vs 5.07 [95% CI, 3.93-6.53] per 1000 live births; P = .008). Conclusions and Relevance: In this study, EOS incidence and associated mortality disproportionately occurred in preterm infants. Contemporary cases have demonstrated the limitations of current GBS prevention strategies. The increase in E coli infections among very low-birth-weight infants warrants continued study. Ampicillin and gentamicin remained effective antibiotics in most cases, but ongoing surveillance should monitor antibiotic susceptibilities of EOS pathogens. |
All that glitters is not gold: Mercury poisoning in a family mimicking an infectious illness
Atti SK , Silver EM , Chokshi Y , Casteel S , Kiernan E , Dela Cruz R , Kazzi Z , Geller RJ . Curr Probl Pediatr Adolesc Health Care 2020 50 (2) 100758 Three siblings with inhalational elemental mercury toxicity presented with fever, rash, and upper respiratory tract symptoms. The patients were heavily exposed to elemental mercury that was spilled in their home and then vacuumed. Initial whole blood mercury levels were elevated at >200 microg/L, 153 microg/L and 130 microg/L (Mayo Clinic Laboratories lab reference range <9 microg/L) for Cases 1, 2, and 3, respectively. All three required chelation with succimer. Clinically significant elemental mercury toxicity can resemble an infectious illness. Severe morbidity and mortality can be prevented if heavy metal poisoning is considered early, through a detailed history including an environmental exposure history. For elemental mercury spills in the home, safe and effective clean-up steps are needed. Improved public health education is needed to prevent similar household exposures. |
Pediatric considerations before, during, and after radiological or nuclear emergencies
Linet MS , Kazzi Z , Paulson JA . Pediatrics 2018 142 (6) Infants, children, and adolescents can be exposed unexpectedly to ionizing radiation from nuclear power plant events, improvised nuclear or radiologic dispersal device explosions, or inappropriate disposal of radiotherapy equipment. Children are likely to experience higher external and internal radiation exposure levels than adults because of their smaller body and organ size and other physiologic characteristics as well as their tendency to pick up contaminated items and consume contaminated milk or foodstuffs. This technical report accompanies the revision of the 2003 American Academy of Pediatrics policy statement on pediatric radiation emergencies by summarizing newer scientific data from studies of the Chernobyl and the Fukushima Daiichi nuclear power plant events, use of improvised radiologic dispersal devices, exposures from inappropriate disposal of radiotherapy equipment, and potential health effects from residential proximity to nuclear plants. Also included are recommendations from epidemiological studies and biokinetic models to address mitigation efforts. The report includes major emphases on acute radiation syndrome, acute and long-term psychological effects, cancer risks, and other late tissue reactions after low-to-high levels of radiation exposure. Results, along with public health and clinical implications, are described from studies of the Japanese atomic bomb survivors, nuclear plant accidents (eg, Three Mile Island, Chernobyl, and Fukushima), improper disposal of radiotherapy equipment in Goiania, Brazil, and residence in proximity to nuclear plants. Measures to reduce radiation exposure in the immediate aftermath of a radiologic or nuclear disaster are described, including the diagnosis and management of external and internal contamination, use of potassium iodide, and actions in relation to breastfeeding. |
Medical countermeasures for children in radiation and nuclear disasters: Current capabilities and key gaps
Gardner AH , Dziuban EJ , Griese S , Berrios-Cartagena N , Buzzell J , Cobham-Owens K , Peacock G , Kazzi Z , Prasher JM . Disaster Med Public Health Prep 2018 13 (3) 1-8 OBJECTIVE: Despite children's unique vulnerability, clinical guidance and resources are lacking around the use of radiation medical countermeasures (MCMs) available commercially and in the Strategic National Stockpile to support immediate dispensing to pediatric populations. To better understand the current capabilities and shortfalls, a literature review and gap analysis were performed. METHODS: A comprehensive review of the medical literature, Food and Drug Administration (FDA)-approved labeling, FDA summary reviews, medical references, and educational resources related to pediatric radiation MCMs was performed from May 2016 to February 2017. RESULTS: Fifteen gaps related to the use of radiation MCMs in children were identified. The need to address these gaps was prioritized based upon the potential to decrease morbidity and mortality, improve clinical management, strengthen caregiver education, and increase the relevant evidence base. CONCLUSIONS: Key gaps exist in information to support the safe and successful use of MCMs in children during radiation emergencies; failure to address these gaps could have negative consequences for families and communities. There is a clear need for pediatric-specific guidance to ensure clinicians can appropriately identify, triage, and treat children who have been exposed to radiation, and for resources to ensure accurate communication about the safety and utility of radiation MCMs for children. (Disaster Med Public Health Preparedness. 2018;page 1 of 8). |
Emergency department management of patients internally contaminated with radioactive material
Kazzi Z , Buzzell J , Bertelli L , Christensen D . Emerg Med Clin North Am 2015 33 (1) 179-96 After a radiation emergency that involves the dispersal of radioactive material, patients can become externally and internally contaminated with 1 or more radionuclides. Internal contamination can lead to the delivery of harmful ionizing radiation doses to various organs and tissues or the whole body. The clinical consequences can range from acute radiation syndrome to the long-term development of cancer. Estimating the amount of radioactive material absorbed into the body can guide the management of patients. Treatment includes, in addition to supportive care and long term monitoring, certain medical countermeasures like Prussian blue, calcium diethylenetriamine pentaacetic acid (DTPA) and zinc DTPA. |
The role of toxicologists and poison centers during and after a nuclear power plant emergency
Kazzi ZN , Miller CW . Clin Toxicol (Phila) 2013 51 (1) 1-2 The events surrounding the nuclear power plant accident in Fukushima, Japan, uncovered a number of questions and issues that need to be addressed in the United States (US) regarding the preparedness and response to similar potential incidents. A recent commentary discussed some of these issues, including the lack of a sufficient number of radiation subject matter experts that are needed to provide guidance to other public health planners and responders. 1 Indeed, although no health effects from the exposure to radiation were expected to occur in the US, the Emergency Operation Center at the Centers of Disease Control and Prevention (CDC) in Atlanta operated at full capacity to support the needs of State and Federal partners both at home and abroad, particularly in Japan. During such events, the public will seek answers to numerous questions that can overwhelm existing resources like the CDC Info Line and the Radiation Emergency Assistance Center/Training Site (REAC/TS) emergency line. 2 In March and April 2011, a number of CDC toxicologists participated in the Japan Earthquake response in various roles while poison centers provided public health partners with daily updates on radiation exposure and information based on queries relating to radiation exposure and the use of potassium iodide.3 | The role of poison centers in a nuclear power plant or other radiation emergency is well supported by a long and successful record of involvement during other public health incidents that range from infectious disease epidemics like West Nile virus to environmental disasters like the British Petroleum oil spill. In a radiation emergency, poison centers can educate callers about the proper use of medical countermeasures or antidotes, monitor for patterns of use and misuse of these therapies, and detect potential secondary adverse events from their use. Because of their existing technical resources and their experience in operating as a call center, they can assist in communicating important health messages and protective action measures to the public. Currently, the American Association of Poison Control Centers (AAPCC) collaborates closely with CDC in the area of surveillance and belongs to the recently formed National Alliance for Radiation Readiness whose mission is to enhance the Nation’s radiological preparedness. 4 Additionally, the AAPCC participated in the response to the Fukushima and the CardioGen Rubidium-82 contamination incidents. 5 Further steps need to be taken by poison centers and their local and state partners to establish or solidify collaborations and formalize the role of poison centers in radiation preparedness and response alongside other stakeholders like Radiation Control Programs and Emergency Management Agencies. |
Acute radiation syndrome: assessment and management
Donnelly EH , Nemhauser JB , Smith JM , Kazzi ZN , Farfan EB , Chang AS , Naeem SF . South Med J 2010 103 (6) 541-546 Primary care physicians may be unprepared to diagnose and treat rare, yet potentially fatal, illnesses such as acute radiation syndrome (ARS). ARS, also known as radiation sickness, is caused by exposure to a high dose of penetrating, ionizing radiation over a short period of time. The time to onset of ARS is dependent on the dose received, but even at the lowest doses capable of causing illness, this will occur within a matter of hours to days. This article describes the clinical manifestations of ARS, provides guidelines for assessing its severity, and makes recommendations for managing ARS victims. Copyright copyright 2010 by The Southern Medical Association. |
Medical toxicology and public health: update on research and activities at the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry : introduction to activities at the Radiation Studies Branch
Kazzi ZN , Nemhauser JB , Ansari A , McCurley C , Whitcomb R , Miller C . J Med Toxicol 2010 6 (2) 230-3 The Radiation Studies Branch (RSB) was formed in 1989 | as part of the Division of Environmental Hazards and | Health Effects in the Centers for Disease Control and | Prevention’s National Center for Environmental Health | (NCEH) [Fig. 1]. At that time, branch staff focused | primarily on assessing the potential environmental health | effect of radiation released from Department of Energy | Nuclear Weapons Production Facilities. After the events of | September 11, 2001, however, the RSB assumed additional | responsibilities in public health preparedness. This effort is | largely directed toward preparing the nation’s public health | community, healthcare providers, and citizens for various | scenarios. These include intentional (i.e., terrorism-related) | radiological incidents, accidents involving radiation exposure, and unintentional environmental releases of radioactive materials. |
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