OBJECTIVE: Reliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning. METHODS: Retrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning. RESULTS: Of a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×10⁵; 95% CI, 4.56×10² to 9.00×10¹⁰] in model 1, [AOR, 3.69×10⁵; 95% CI, 2.49×10² to 2.71×10¹¹] in model 2) were independently associated with DNS development. CONCLUSION: Based on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.
Acid-Base Equilibrium ; Biomarkers* ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Emergency Service, Hospital ; Humans ; Interleukin-6* ; Lactic Acid* ; Logistic Models ; Multivariate Analysis ; Neurotoxicity Syndromes ; Odds Ratio ; Osmolar Concentration* ; Poisoning ; Retrospective Studies

PURPOSE: Herbicide-related mortality has decreased since the complete ban of paraquat product sales in 2012, but there still have been other herbicides intoxications with relatively severe complications. Glyphosate and glufosinate herbicides are used widely, and considerable research has been conducted. Chlorophenoxy herbicide is another major herbicide that has shown poor outcomes and mortality without proper management, but research in this area is lacking. Therefore, this study compared the clinical features of chlorophenoxy herbicide with those of other herbicides. METHODS: The medical records of patients exposed to herbicides at a tertiary academic university hospital in Korea from May 2014 to April 2019 were reviewed retrospectively. The demographic and clinical data of 135 patients were then analyzed to identify the recent herbicides intoxication trends after the paraquat sales ban, focusing mainly on chlorophenoxy herbicide poisoning. RESULTS: Of the 135 patients, 13 patients (9.6%) had chlorophenoxy herbicide poisoning. No significant differences in all the variables were observed between the chlorophenoxy herbicide poisoning group and non-chlorophenoxy herbicides poisoning groups. Toxic symptoms after poisoning varied from nothing noticeable to confusion; none of the patients had severe complications after their treatments. CONCLUSION Acute chlorophenoxy poisoning is relatively less severe, with lower mortality rates than glyphosate and glufosinate poisoning.

Objective: This study analyzed patients who visited emergency departments (EDs) following suicide and self-harm attempts to determine the impact of the coronavirus disease 2019 (COVID-19) on suicide and self-harm trends. Methods: This study retrospectively collected the data of patients who visited five EDs following suicide and self-harm attempts before (March to December 2019) and after (March to December 2020) the COVID-19 outbreak using the National Emergency Department Information System database in South Korea. Results: In this study, 2,333 and 2,303 patients visited EDs following suicide and self-harm attempts before and after COVID-19, respectively. The number of females was 1,421 versus 1,490 (P=0.008), and the number of those in their twenties (20s) was 576 versus 705 (P<0.001), respectively. The proportion of patients with suicide attempts increased after the outbreak (1.0 vs. 0.7%; P=0.009). The severity scores on the Korean Triage and Acuity Scale (KTAS) levels 1 and 2 decreased-before 169 (7.2%) and 633 (27.1%); after 144 (6.3%) and 525 (22.8%); P=0.003. The outcomes of patients following hospital admission were significantly different in terms of increased safe discharge numbers, decreased discharges against medical advice and transfers to other hospitals, and fewer deaths during admission. Conclusion During the COVID-19 outbreak, there were notable characteristic changes in the rate of suicide attempts in young adults, with the decreased severity of suicide and self-harm among the patients who visited EDs.