Treatment of symptomatic hyponatremia with hypertonic saline – a real-life observational study

Objective: Treatment of symptomatic hyponatremia is not well established. European guidelines recommend bolus-wise administration of 150ml of 3% hypertonic saline. This recommendation is based, however, on low level of evidence. Design: Observational study Methods: Sixty-two consecutive hyponatremic patients admitted to the emergency department or intensive care unit of the University Hospital Wuerzburg were divided in subgroups according to treatment (150ml bolus of 3% hypertonic saline or conventional treatment), and symptom severity. Treatment target was defined as an increase in serum sodium by 5-10mEq/L within first 24h and maximum 8mEq/L during subsequent 24h. Results: 33/62 patients (53%) presented with moderate and 29/62 (47%) with severe symptoms. 36 were treated with hypertonic saline and 26 conventionally. In the hypertonic saline group serum sodium increased from 116±7 to 123±6 (24h) and 127±6mEq/L (48h) and from 121±6 to 126±5 and 129±4mEq/L in the conventional group, respectively. Overcorrection at 24h occurred more frequent in patients with severe than moderate symptoms (38% vs. 6%, p<0.05). Diuresis correlated positively with the degree of sodium overcorrection at 24h (r=0.6, p<0.01). Conventional therapies exposed patients to higher degrees of sodium fluctuations and an increased risk for insufficient sodium correction at 24h compared to hypertonic saline (RR 2.8, 95% CI 1.4-5.5). Conclusion: Sodium increase was more constant with hypertonic saline, but overcorrection rate was high, especially in severely symptomatic patients. Reducing bolus-volume and reevaluation before repeating bolus infusion might prevent overcorrection. Symptoms caused by exsiccosis can be misinterpreted as severely symptomatic hyponatremia and diuresis should be monitored.

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Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

Frontiers in Medicine ◽

10.3389/fmed.2021.639970 ◽

2021 ◽

Vol 8 ◽

Author(s):

Augusto Di Castelnuovo ◽

Simona Costanzo ◽

Andrea Antinori ◽

Nausicaa Berselli ◽

Lorenzo Blandi ◽

...

Keyword(s):

Observational Study ◽

Propensity Scores ◽

Proportional Hazards ◽

Real Life ◽

Cox Proportional Hazards ◽

Event Analysis ◽

Multicenter Observational Study ◽

Protein Levels ◽

Cox Proportional Hazards Models ◽

Increased Risk

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients.Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients.Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores.Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs.Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients.

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Clinical Application of Trans-Arterial Radioembolization in Hepatic Malignancies in Europe: First Results from the Prospective Multicentre Observational Study CIRSE Registry for SIR-Spheres Therapy (CIRT)

CardioVascular and Interventional Radiology ◽

10.1007/s00270-020-02642-y ◽

2020 ◽

Vol 44 (1) ◽

pp. 21-35 ◽

Cited By ~ 1

Author(s):

Thomas Helmberger ◽

◽

Rita Golfieri ◽

Maciej Pech ◽

Thomas Pfammatter ◽

...

Keyword(s):

Overall Survival ◽

Observational Study ◽

Clinical Application ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Disease Patient ◽

Real Life ◽

Level Of Evidence ◽

Liver Tumours ◽

The Real

Abstract Purpose To address the lack of prospective data on the real-life clinical application of trans-arterial radioembolization (TARE) in Europe, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) initiated the prospective observational study CIRSE Registry for SIR-Spheres® Therapy (CIRT). Materials and Methods Patients were enrolled from 1 January 2015 till 31 December 2017. Eligible patients were adult patients treated with TARE with Y90 resin microspheres for primary or metastatic liver tumours. Patients were followed up for 24 months after treatment, whereas data on the clinical context of TARE, overall survival (OS) and safety were collected. Results Totally, 1027 patients were analysed. 68.2% of the intention of treatment was palliative. Up to half of the patients received systemic therapy and/or locoregional treatments prior to TARE (53.1%; 38.3%). Median overall survival (OS) was reported per cohort and was 16.5 months (95% confidence interval (CI) 14.2–19.3) for hepatocellular carcinoma, 14.6 months (95% CI 10.9–17.9) for intrahepatic cholangiocarcinoma. For liver metastases, median OS for colorectal cancer was 9.8 months (95% CI 8.3–12.9), 5.6 months for pancreatic cancer (95% CI 4.1–6.6), 10.6 months (95% CI 7.3–14.4) for breast cancer, 14.6 months (95% CI 7.3–21.4) for melanoma and 33.1 months (95% CI 22.1–nr) for neuroendocrine tumours. Statistically significant prognostic factors in terms of OS include the presence of ascites, cirrhosis, extra-hepatic disease, patient performance status (Eastern Cooperative Oncology Group), number of chemotherapy lines prior to TARE and tumour burden. Thirty-day mortality rate was 1.0%. 2.5% experienced adverse events grade 3 or 4 within 30 days after TARE. Conclusion In the real-life clinical setting, TARE is largely considered to be a part of a palliative treatment strategy across indications and provides an excellent safety profile. Level of evidence Level 3. Trial registration ClinicalTrials.gov NCT02305459.

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Acute Pulmonary Embolism at Tanta University Hospital: Single Centre Registry

Cardiology and Angiology An International Journal ◽

10.9734/ca/2021/v10i130160 ◽

2021 ◽

pp. 23-32

Author(s):

Alaa Raafat Elesawi Elkhateeb ◽

Ahmed Farouk Alarag ◽

Taymoor Mostafa Abdallah ◽

Seham Fahmy Badr

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

High Risk ◽

Acute Pulmonary Embolism ◽

Previous History ◽

Real Life ◽

University Hospital ◽

Treatment Modalities ◽

Increased Risk ◽

Active Cancer

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality worldwide, and has significant negative impacts on quality of life, healthcare costs, and longevity. Registries have been created to record ‘real-life’ clinical features and management of patients with PE. Aim: We aimed to describe a comprehensive view of the clinical presentation, demographic data, treatment modalities and short-term outcome at hospital discharge and 3 months after discharge for patients presented with acute pulmonary embolism at Tanta university hospital to improve the level of care of those patients. Methods: This study was conducted on 150 patients with confirmed acute PE presented to Tanta university hospitals. The study duration was 1 year from April 2019 to May 2020. Results: We focused on a group of common risk factors for PE and determined prevelance of each in our enrolled patients, we found increase some risk factors obesity and bed rest > 3 days were the most prevalent risk factors followed by active cancer, estrogen use and lower limb fracture. Symptoms in this study are near to other registries and ESC guidelines 2019 with the commonest symptom was dyspnea and chest pain and the least symptom was hemoptysis. Certain ECG signs more prevalent in our patients and these signs related to RV strain with sinus tachycardia the commonest sign followed by S1Q3T3 sign and the least was right axis deviation. Conclusion: Presence of active cancer and patients with high risk stratification were independent predictors of mortality. Other factors associated with increased mortality were impaired RV systolic function, high PESI score, presence of RBBB in ECG and presence of congestive heart failure. Increased risk of bleeding in male patients with intermediate high or high risk category especially those received UFH and fibrinolytic therapy. Previous history of VTE was independent predictors of VTE recurrence.

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Osmotic Demyelination Syndrome Following Correction of Hyponatremia by ≤10 mEq/L per day

Kidney360 ◽

10.34067/kid.0004402021 ◽

2021 ◽

pp. 10.34067/KID.0004402021

Author(s):

Srijan Tandukar ◽

Richard H. Sterns ◽

Helbert Rondon-Berrios

Keyword(s):

Risk Factors ◽

Serum Sodium ◽

Alcohol Use Disorder ◽

Neurological Deficits ◽

Osmotic Demyelination Syndrome ◽

European Guidelines ◽

Osmotic Demyelination ◽

Chronic Hyponatremia ◽

The Mean ◽

Sodium Correction

Background: Overly rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. European guidelines recommend a correction to ≤10 mEq/L in 24 hours to prevent this complication. However, osmotic demyelination syndrome may occur despite adherence to these guidelines. Methods: We searched the literature for reports of osmotic demyelination syndrome with rates of correction of hyponatremia <10 mEq/L in 24 hours. The reports were reviewed to identify specific risk factors for this complication. Results: We identified 19 publications with a total of 21 patients that were included in our analysis. The mean age was 52 years of which 67% were male. All of the patients had community acquired chronic hyponatremia. Twelve patients had an initial serum sodium <115 mEq/L, of which seven had an initial serum sodium ≤105 mEq/L. Other risk factors identified included alcohol use disorder (n=11), hypokalemia (n=5), liver disease (n=6), and malnutrition (n=11). The maximum rate of correction in patients with serum sodium <115 mEq/L was at least 8 mEq/L in all but 1 patient. In contrast, correction was <8 mEq/L in all but 2 patients with serum sodium >115 mEq/L. Among the latter group, osmotic demyelination syndrome developed before hospital admission or was unrelated to hyponatremia overcorrection. Four patients died (19%), 5 had full recovery (24%) and 9 (42%) had varying degrees of residual neurological deficits. Conclusions: Osmotic demyelination syndrome can occur in patients with chronic hyponatremia with a serum sodium <115 mEq/L despite rates of serum sodium correction <10 mEq/L in 24 hours. In patients with severe hyponatremia and high risk features, especially those with serum sodium <115 mEq/L, we recommend limiting serum sodium correction to <8 mEq/L. Thiamine supplementation is advisable for any hyponatremic patient whose dietary intake has been poor.

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Hepatocellular Carcinoma in Hepatitis C-Associated Cirrhotic Patients Treated with Different Combinations of Direct-Acting Antiviral Agents Available in Pakistan: A Prospective Observational Study

10.53350/pjmhs2115103157 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3157-3160

Author(s):

Irshad Batool Abro ◽

Prem Kumar ◽

Imran Arshad ◽

Shagufta Memon ◽

Ali Akbar Siddiqui

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Hepatitis C ◽

Observational Study ◽

Prospective Observational Study ◽

Treatment Time ◽

University Hospital ◽

Increased Risk ◽

Pugh Class ◽

Direct Acting

Background: The hepatitis C virus (HCV) is a leading cause of chronic liver disease, including hepatic cirrhosis and hepatocellular cancer (HCC). Drugs that act directly on the virus, like as direct-acting antivirals (DAAs), are associated with improved long-term virologic responses and reduced treatment time. Pakistani patients with HCV-related cirrhosis receiving DAA medication were studied to see if they had an increased risk of hepatocellular carcinoma (HCC). Material and Methods: We conducted a prospective observational study at Isra University Hospital Hyderabad from July 2019 to August 2020. Three hundred fourteen patients met the inclusion criteria and were included. We recorded baseline demographic characteristics, Child-Pugh class, model for end-stage liver disease (MELD) score, alpha-fetoprotein level, and abdominal ultrasound/computed tomography (CT) scan before and after treatment. Results: Three hundred-fourteen individuals took part in the research. The average age of participant with hepatocellular carcinoma was 46.7 years. Twenty (sixty-nine) of the participants developing hepatocellular carcinoma were men, while nine (thirty-one percent) were women (p=0.221). Five (17.2%) of the HCC participants were diabetics, and seventeen (58.6%) were tobacco users (p=0.001). Twenty individuals (69%) developed HCC after receiving a combination of sofosbuvir and daclatasvir. A sofosbuvir/velpatasvir combination led to the development of HCC in nine (31%) of individuals (p=0.1). HCC was diagnosed in eight individuals under the age of forty (27.6%), but in 21 patients beyond the age of forty (72.6%) (p=0.55). HCC was found in 65.6 percent of Child-Turcotte-Pugh class A participants. Conclusion: DAAs have been linked to a higher risk of HCC. Participants receiving a combo of sofosbuvir/daclatasvir were more likely to develop HCC than those who received sofosbuvir/velpatasvir alone. Keywords: Velpatasvir, Hepatocellular carcinoma, Sofosbuvir, Cirrhosis,

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Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01425-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Andreas Andersen ◽

Jonatan I. Bagger ◽

Samuel K. Sørensen ◽

Maria P. A. Baldassarre ◽

Ulrik Pedersen-Bjergaard ◽

...

Keyword(s):

Type 2 Diabetes ◽

Observational Study ◽

Cardiac Arrhythmias ◽

Real Life ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Absolute Increase ◽

Increased Risk ◽

Subject Specific

Abstract Background Insulin-treated patients with type 2 diabetes (T2D) are at risk of hypoglycemia, which is associated with an increased risk of cardiovascular disease and mortality. Using a long-term monitoring approach, we investigated the association between episodes of hypoglycemia, glycemic variability and cardiac arrhythmias in a real-life setting. Methods Insulin-treated patients with T2D (N = 21, [mean ± SD] age 66.8 ± 9.6 years, BMI 30.1 ± 4.5 kg/m2, HbA1c 6.8 ± 0.4% [51.0 ± 4.8 mmol/mol]) were included for a one-year observational study. Patients were monitored with continuous glucose monitoring ([mean ± SD] 118 ± 6 days) and an implantable cardiac monitor (ICM) during the study period. Results Time spend in hypoglycemia was higher during nighttime than during daytime ([median and interquartile range] 0.7% [0.7–2.7] vs. 0.4% [0.2–0.8]). The ICMs detected 724 episodes of potentially clinically significant arrhythmias in 12 (57%) participants, with atrial fibrillation and pauses accounting for 99% of the episodes. No association between hypoglycemia and cardiac arrhythmia was found during daytime. During nighttime, subject-specific hourly incidence of cardiac arrhythmias tended to increase with the occurrence of hypoglycemia (incident rate ratio [IRR] 1.70 [95% CI 0.36–8.01]) but only slightly with increasing time in hypoglycemia (IRR 1.04 [95% CI 0.89–1.22] per 5 min). Subject-specific incidence of cardiac arrhythmias during nighttime increased with increasing glycemic variability as estimated by coefficient of variation whereas it decreased during daytime (IRR 1.33 [95% CI 1.05–1.67] and IRR 0.77 [95% CI 0.59–0.99] per 5% absolute increase, respectively). Conclusions Cardiac arrhythmias were common in insulin-treated patients with T2D and were associated with glycemic variability, whereas arrhythmias were not strongly associated with hypoglycemia. Trial registration: NCT03150030, ClinicalTrials.gov, registered May 11, 2017. https://clinicaltrials.gov/ct2/show/NCT03150030

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Single Use of Rasburicase (rasb) Leads to Insufficient Tumor Lysis Syndrome (TLS) Control in Adults: Outcome and Resource Utilization in a One Year Real-Life Observational Study

Blood ◽

10.1182/blood.v112.11.4694.4694 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4694-4694

Author(s):

Matthaeus Krych ◽

Julia Ostermann ◽

Wolfgang Hiddemann ◽

Helmut Ostermann

Keyword(s):

Single Dose ◽

Observational Study ◽

Tumor Lysis Syndrome ◽

Real Life ◽

Treatment Costs ◽

University Hospital ◽

Urate Oxidase ◽

Tumor Lysis ◽

The Mean ◽

One Year

Abstract TLS due to the rapid lysis of tumor cells following initiation of chemotherapy can lead to the release of intracellular components into the extracellular space. Among these hyperuricemia might exceed the excretory capacity of the kidneys and lead to renal failure. Rasb is a recombinant urate oxidase given during the first 3–5 days of chemotherapy to effectively lower uric acid serum levels. Limited data suggest that a single prechemotherapy dose of rasb might be sufficiently efficacious and this single dose regimen is widely used to reduce treatment costs. We analyzed the clinical and economical data of all adults who received rasb for prophylaxis or treatment of TLS at a university hospital during a one year period. The goal was to describe treatment patterns and outcome outside of clinical trials and to verify whether patients with TLS can be treated cost-effectively. 38 patients (pts) received rasb, however 1/3 of the pts were treated off-label for other reasons then TLS. 24 pts (median age 66 yrs, 21 male) received rasb for malignancy-associated hyperuricemia and were eligible for further clinical and economical evaluation. 2/3 of these pts were treated for hematological malignancies (acute leukemia 6pts, lymphoma 8 pts) and 8 pts for solid tumors. Apart from hydration (mean volume 2 l per day; all pts), furosemide (mean dose 80 mg/day; all pts) and urinary alkalinization with sodium bicarbonate (pH > 7; 7 pts), 20 patients received a single 7,5 mg dose of rasb and 4 pts received multi dose. In 14 pts a tumor lysis was observed. 6 pts died, three fatalities were directly associated with TLS. Mortality was higher among pts with single dose rasb vs. multi dose rasb (30% vs. 0 %) and higher among patients with urinary alkalinization (71% vs. 5%). No anaphylaxis, hemolysis or methemoglobinemia was observed in this cohort. The mean duration of hospitalisation was 23 days, the mean treatment costs were 16.200 €. The costs exceeded the revenues based on diagnosis related groups for Germany (G-DRG) in 18 pts and resulted in a 7% funding gap. 107.000 € were spent for drugs for these patients, 10% of these for rasb. We conclude from this observational study that TLS is a menacing disease, resulted in a 12,5 % mortality and should therefore be cautiously monitored and treated, single dose rasb was associated with a higher mortality rate then multi dose, urinary alkalinization cannot be recommended when rasb is used, TLS leads to a 7 % underfunding in the respective G-DRGs, for TLS pts. the usage of rasb elevates the total drug expenses by 10%.

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MELISSE, a large multicentric observational study to determine risk factors of venous thromboembolism in patients with multiple myeloma treated with immunomodulatory drugs

Thrombosis and Haemostasis ◽

10.1160/th13-02-0140 ◽

2013 ◽

Vol 110 (10) ◽

pp. 844-851 ◽

Cited By ~ 33

Author(s):

Philippe Rodon ◽

Cyrille Hulin ◽

Laurent Daley ◽

Charles Dauriac ◽

Maya Hacini ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Multiple Myeloma ◽

Venous Thromboembolism ◽

Observational Study ◽

Vitamin K Antagonists ◽

Real Life ◽

Immunomodulatory Drugs ◽

Vte Prophylaxis ◽

Increased Risk

SummaryImmunomodulatory drugs (IMiDs) are associated with an increased risk of venous thromboembolism (VTE) in multiple myeloma (MM) patients. We designed MELISSE, a multicentre prospective observational study, to evaluate VTE incidence and identify risk factors in IMiDstreated MM. Our objective was to determine the real-life practice of VTE prophylaxis strategy. A total of 524 MM patients were included, and we planned to collect information at baseline, at four and at 12 months, on MM therapy, on VTE risk factors and management. VTE incidence was 7% (n=31), including 2.5% pulmonary embolism (PE) (n=11), similar at four or 12 months. VTE was observed at all risk assessment levels, although the increased risk assessment level correlated to a lower rate of VTE, maybe due to the implemented thromboprophylaxis strategy. VTE occurred in 7% on aspirin vs 3% on lowmolecular- weight heparin (LMWH) prophylaxis, and none on vitamin K antagonists (VKA). New risk factors for VTE in IMiDs-treated MM were identified. In conclusion, VTE prophylaxis is compulsory in IMiDstreated MM, based on individualised VTE risk assessment. Anticoagulation prophylaxis with LMWH should clearly be prioritised in MM patients with high VTE risk, along with VKA. Further prospective studies will identify most relevant VTE risk factors in IMiDs-treated MM to select accurately which MM patients should receive LMWH prophylaxis and for which duration to optimise VTE risk reduction.

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Knee arthroscopy in patients over 64 years suffering from primary gonarthrosis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00177 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0017

Author(s):

Alejandro Alvarez Lopez

Keyword(s):

Observational Study ◽

Knee Arthroscopy ◽

Statistical Significance ◽

Surgical Techniques ◽

Partial Meniscectomy ◽

University Hospital ◽

Level Of Evidence ◽

Before And After ◽

The City ◽

Meniscus Injuries

Objectives: to evaluate the results of the arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years. Methods: an analytical observational study was carried out in 40 patients older than 64 years treated arthroscopically with the diagnosis of primary gonarthrosis, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from October 2012 to May 2019. The research has a level of evidence IV recommendation D. Results: the average age of the 40 patients studied was 69,6 years, with a predominance of female to male, with a ratio of 3 to 1. Tricompartmental disease predominated in most patients as well as grade IV according to the Outerbridge RE classification. The cartilage and associated meniscus injuries predominate. Grades III and IV of the Kellgram JH and Lawrence JS classification were the most found. The most commonly used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance between a before and after was detected. Conclusion: the results of the investigation show that the procedures performed through the arthroscopic route for patients with primary gonarthrosis over 64 years of age are effective in more than half of the patients.

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Epidemiological Trends in Attempted Suicide in Adolescents and Young Adults Between 1996 and 2004

Crisis ◽

10.1027/0227-5910.30.3.115 ◽

2009 ◽

Vol 30 (3) ◽

pp. 115-119 ◽

Cited By ~ 10

Author(s):

Stephanie De Munck ◽

Gwendolyn Portzky ◽

Kees Van Heeringen

Keyword(s):

Young Adults ◽

Attempted Suicide ◽

Suicide Attempts ◽

Epidemiological Studies ◽

Adolescents And Young Adults ◽

University Hospital ◽

International Studies ◽

Suicide Attempters ◽

Increased Risk ◽

Epidemiological Trends

Background: Notwithstanding the epidemiological studies indicating an increased risk of attempted suicide among adolescents and young adults, there is a scarcity of international studies that examine long-term epidemiological trends in rates and characteristics of this vulnerable group. Aims: This article describes the results of a 9-year monitoring study of suicide attempts in adolescents and young adults referred to the Accident and Emergency Department of the Gent University Hospital (Belgium). Methods: Between January 1996 and December 2004, trends, sociodemographic, and methodrelated characteristics of suicide attempts were assessed by a psychiatrist on data sheets. Results: Attempted suicide rates declined from 1996 to 2001 and then rose until 2004, but did not exceed previous rates. During the 9 years of monitoring, there was a preponderance of female suicide attempters, except for 1997. Rates of attempts and of fatal suicide were negatively correlated. Significantly more males than females deliberately injured themselves. Younger attempters, especially females, significantly more often poisoned themselves with analgesics. In nearly one in five attempts, alcohol was used in combination with other methods, and alcohol intake was more commonly observed in older suicide attempters. Nearly half of the adolescents were identified as repeaters. Conclusions: The results of this study warrant further monitoring of trends and characteristics of young suicide attempters.

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