دورية أكاديمية
Radiological findings in poisoning by synthetic cannabinoids adulterated with brodifacoum.
| العنوان: | Radiological findings in poisoning by synthetic cannabinoids adulterated with brodifacoum. |
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| المؤلفون: | Bar N; Department of Radiology, Rambam Health Care Campus, Haifa, Israel. yourfriendnitai@gmail.com., Lopez-Alonso R; Department of Radiology, Rambam Health Care Campus, Haifa, Israel., Merhav G; Department of Radiology, Rambam Health Care Campus, Haifa, Israel., Naaman E; Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel., Leiderman M; Department of Radiology, Rambam Health Care Campus, Haifa, Israel., Ilivitzki A; Department of Radiology, Rambam Health Care Campus, Haifa, Israel.; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel., Lurie Y; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.; Israel Poison Information Center, Rambam Health Care Campus, Haifa, Israel.; Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel., Kurnik D; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.; Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel., Abadi S; Department of Radiology, Rambam Health Care Campus, Haifa, Israel.; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. |
| المصدر: | European radiology [Eur Radiol] 2024 Jul; Vol. 34 (7), pp. 4540-4549. Date of Electronic Publication: 2023 Dec 21. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer International Country of Publication: Germany NLM ID: 9114774 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1084 (Electronic) Linking ISSN: 09387994 NLM ISO Abbreviation: Eur Radiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Berlin : Springer International, c1991- |
| مواضيع طبية MeSH: | Cannabinoids*/poisoning , 4-Hydroxycoumarins*/poisoning, Humans ; Male ; Adult ; Female ; Retrospective Studies ; Israel/epidemiology ; Middle Aged ; Tomography, X-Ray Computed ; Drug Contamination ; Anticoagulants/poisoning ; Blood Coagulation Disorders/chemically induced |
| مستخلص: | Objectives: Severe coagulopathy due to consumption of synthetic cannabinoids adulterated with brodifacoum, a long-acting anticoagulant, is an emerging worldwide hazard. Here, we review the spectrum of imaging findings in adulterated cannabinoid poisoning. Materials and Methods: In this retrospective study, we used the Israeli Poison Information Center database to identify patients with cannabinoid-associated coagulopathy who presented to the Rambam Health Care Campus, where most patients were treated during an outbreak in northern Israel between September 2021 and June 2022. All relevant imaging studies for these patients were reviewed. We estimated the sensitivity of findings for cannabinoid-associated coagulopathy. Associations between a continuous variable and a dichotomous outcome were assessed with the Mann-Whitney U test. Results: We identified 48 patients (mean age 40 years ± 9 [SD], 43 males) with 54 hospitalizations due to cannabinoid-associated coagulopathy. Symptomatic hemorrhage was documented in 50 (93%) cases at presentation, most of whom (78%) had hemorrhage from multiple systems. The most common bleeding site was the genitourinary collecting system, with a characteristic sign of suburothelial bleeding in 16/18 of performed abdominal CTs (sensitivity 89% [CI 65-99%] for cannabinoid-associated coagulopathy). Intramural bowel hematomas were noted in 70% (7/10) of CTs of patients with gastrointestinal bleeding. Incidental bleeding sites were identified on imaging in 24% of patients. An increased number of bleeding sites was associated with need for vasopressors (difference in bleeding sites 3.00 [95% CI 0.99-4.00], p = 0.026). Conclusion: CT plays a key role in the diagnosis and work-up of adulterated cannabinoid-associated coagulopathy. Characteristic signs include suburothelial hemorrhage and intramural bowel hematomas. Clinical Relevance Statement: Recognition of radiological signs of adulterated synthetic cannabinoid-associated coagulopathy is critical for optimizing outbreak control on the public health level and ensuring timely treatment on the individual patient level. Key Points: • Severe coagulopathy due to consumption of synthetic cannabinoids adulterated with brodifacoum, a long-acting anticoagulant, is an emerging worldwide threat. • Characteristic imaging signs include suburothelial bleeding, intramural bowel hematomas, and rare incidental bleeding sites. • Imaging has a pivotal role in optimizing outbreak control and ensuring timely and appropriate treatment. (© 2023. The Author(s), under exclusive licence to European Society of Radiology.) |
| التعليقات: | Comment in: Eur Radiol. 2024 Jul;34(7):4538-4539. doi: 10.1007/s00330-023-10532-3. (PMID: 38133676) |
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| فهرسة مساهمة: | Keywords: Anticoagulants; Cannabinoids; Hemorrhage; Poisoning |
| المشرفين على المادة: | 0 (Cannabinoids) A25P3CP5S7 (bromfenacoum) 0 (4-Hydroxycoumarins) 0 (Anticoagulants) |
| تواريخ الأحداث: | Date Created: 20231221 Date Completed: 20240628 Latest Revision: 20240712 |
| رمز التحديث: | 20240712 |
| DOI: | 10.1007/s00330-023-10496-4 |
| PMID: | 38127072 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1432-1084 |
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| DOI: | 10.1007/s00330-023-10496-4 |