The objective of this study is to describe the clinical status, procedural interventions, and outcomes of critically ill patients with poisoning and snake bite injuries presenting to a tertiary-care emergency department for treatment with therapeutic plasmapheresis. Records of 20 patients who presented to our academic emergency department over a 2-year period and who underwent plasmapheresis for poisoning or snake bite were retrospectively reviewed. Plasmapheresis was performed using centrifugation technology via an intravenous antecubital venous or subclavian vein catheter access. Human albumin or fresh frozen plasma were used as replacement fluids. Data extracted from the patient record included demographic data, clinical status, and outcome measures. Sixteen patients underwent plasmapheresis because of toxicity from snake bite. Three patients were treated for drug poisoning (phenytoin, theophylline, bipyridene HCl) and one patient for mushroom poisoning. Haematologic parameters such as platelet count, PT, and INR resolved rapidly in victims of snake bite injuries after treatment with plasmapheresis. Loss of limbs did not occur in these cases. Seven patients required admission to the intensive care unit. One patient with mushroom poisoning died. Mean length of hospital stay was 14.3 days (range 3-28 days) for all cases. Plasmapheresis was a clinically effective and safe approach in the treatment of snake bite envenomation and other drug poisoning victims especially in the management of hematologic problems and in limb preservation/salvage strategies. In addition to established conventional therapies, emergency physicians should consider plasmapheresis among the therapeutic options in treatment strategies for selected toxicologic emergencies.

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In 432 school children aged 7-15 years we investigated the following parameters; body mass index, blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Only 2.8% of children were considered to be obese. Of the children, 3.5% had systolic, 4.9% had diastolic and 3.9% had both blood pressures higher than the acceptable age- and sex-stratified values. The mean total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels were 3.37, 1.93 and 1.33 mmoll-1, respectively. In 31 (7.1%) of the children, total cholesterol levels were found to be above the risk cut-off level of 4.4 mmoll-1; in 39 (9%) of the children, low-density lipoprotein cholesterol levels were elevated above an acceptable upper limit of 2.84 mmoll-1. Significantly reduced high-density lipoprotein cholesterol values were observed in 8.8%. Mean total cholesterol and low-density lipoprotein cholesterol values were elevated significantly in hypertensive cases, while high-density lipoprotein cholesterol levels showed no difference. Sensitivity and the positive predictive value for selected total cholesterol cut-off points for determining elevated low-density lipoprotein cholesterol were 67% and 54%, respectively. These levels of risk are considerably lower than those found in studies in Western countries.

In recent years, an increase in the prevalence of allergic diseases has been reported, in industrialised countries. It is also a problem in non-industrialised countries, but its extent is less well documented. In this study, inhalant screening allergens (AlaTOP), food screening allergens (FP5E), and total and specific IgE were measured in 237 allergic patients (164 adults and 73 children) in order to examine the distribution of common allergens, the percentage of atopy/non-atopy among allergic children and adults in a developing country, Turkey, which has different environments and societies from western countries. We also evaluated the efficiency of automatic allergy screening tests in both groups. The sensitivity and specificity of AlaTOP in adults were 83% and 86%, respectively; these were 70% and 84%, respectively for FP5E, and the sensitivity and specificity of AlaTOP in children were 79% and 82%, while sensitivity and specificity of FP5E were 72% and 85%, respectively. The percentages of atopic male children (31%) were higher than in adults (21%). The reverse is true in adults. The most frequent allergens in childhood were Lolium perenne and cow milk, while in adults it was Lolium perenne. Total IgE levels were found to be statistically different between atopic and non-atopic subjects in adults (p < 0.001). This relationship was not found in children (p > 0.05). The sensitivity and specificity of total IgE in children were 57% and 67%, and in adults 84% and 67%, respectively. The lower specificity and sensitivity of total IgE level in children than in adults suggests that it is less useful for the diagnosis of allergy.

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