Multiple Fatalities

Interleukin-12, an immunomodulatory cytokine, has potential effects in several cancer and infectious diseases. Although interleukin-12 was considered to be reasonably safe in early clinical trials, severe and sometimes fatal multiple organ adverse effects have been described in subsequent studies (SEDA-20, 336). This unexpected profile of toxicity was later shown to result from schedule-dependent toxicity, which occurred only in patients with cancer who received multiple high doses without an initial single dose of interleukin-12 (1). This severe toxicity has since been avoided. 

An isolated report describes a fatal multiple drug intoxication involving citalopram and cocaine. Animal studies have suggested that SSRIs may potentiate the pro-convulsive effects of cocaine. 

An isolated report describes a fatal multiple drug intoxication involving citalopram and cocaine. It was suggested that SSRIs and cocaine bind to the same receptor site and their concurrent use may have an additive effect through inhibition of serotonin reuptake. The patient also took other drugs including omeprazole, which may have further potentiated the effects of citalopram. ... 

British Petroleum Texas City, Texas, United States Isomerization startup resulting in a hydrocarbon release that ignited Fifteen fatalities multiple injuries significant property damage Ineffective organizational structure 6... 

The extent of the loss should not determine who should carry out the investigation. Past experience has shown that once there are fatalities, multiple fatalities, or great financial loss as a result of an accident, only then does top management get involved. What should determine participation in the near miss incident or accident investigation procedure is the potential for loss of the event, or what could have happened under slightly different circumstances ... 

One or more acute or chronic fatalities. Multiple permanent injuries or irreversible health effects... 

Basic requirement. Within eight (8) hours after the death of any employee from a work-related incident or the in-patient hospitalization of three or more employees as a result of a work-related incident, you must orally report the fatality/multiple hospitalization by telephone or in person to the Area Office of the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor, that is nearest to the site of the incident. Yon may also use the OSHA toU-free central telephone number, 800-321-OSHA (800-321-6742). 

This step takes the information from Steps 6 and 8. The frequency of an accident multiplied by the consequences is the risk. The consequences need to be in common units to get a measure of the risk. Of course, multiple consequence measures may be used and give multiple risk measures frequency of fatalities, frequency of injuries, frequency of fishkill, frequency of monetary loss. Judgment must be used to rank there relative significance. 

In this study detailed fault trees with probability and failure rate calculations were generated for the events (1) Fatality due to Explosion, Fire, Toxic Release or Asphyxiation at the Process Development Unit (PDU) Coal Gasification Process and (2) Loss of Availability of the PDU. The fault trees for the PDU were synthesized by Design Sciences, Inc., and then subjected to multiple reviews by Combustion Engineering. The steps involved in hazard identification and evaluation, fault tree generation, probability assessment, and design alteration are presented in the main body of this report. The fault trees, cut sets, failure rate data and unavailability calculations are included as attachments to this report. Although both safety and reliability trees have been constructed for the PDU, the verification and analysis of these trees were not completed as a result of the curtailment of the demonstration plant project. Certain items not completed for the PDU risk and reliability assessment are listed. 

Tlie reader should also note that tlie risk to people can be defined in terms of injury or fatality. The use of injuries as a basis of risk evaluation may be less disturbing tlian tlie use of fatalities. However, tliis introduces problems associated with degree of injury and comparability between different types of injuries. Further complications am arise in a risk assessment when dealing witli multiple hazards. For example, how are second-degree bums, fragment injuries, and injuries due to toxic gas e.xposure combined Even where only one type of effect (e.g., tlueshold to.xic exposure) is being evaluated, different durations of e.xposure can markedly affect tlie severity of injury. 

Fatal infantile cytochrome c oxidase (CCO) deficiency is characterized by total absence of catalytic activity in skeletal muscle. This often occurs within the context of the Fanconi syndrome, or less commonly in association with a cardiomyopathy. Although the deficiency is global in skeletal muscle, with all fibers affected, only isolated scattered fibers show abnormal aggregations of mitochondria (ragged-red fibers). Multiple affected siblings within one family are frequently encountered and suggest autosomal recessive inheritance. The condition normally proves fatal before the age of six months and is characterized by worsening intractable lactic acidemia. 

Each antidepressant has a response rate of approximately 60% to 80%, and no antidepressant medication or class has been reliably shown to be more efficacious than another 22 MAOIs may be the most effective therapy for atypical depression, but MAOI use continues to wane because of problematic adverse effects, dietary restrictions, and possibility of fatal drug interactions.22,28 There is some evidence that dual-action antidepressants, such as TCAs and SNRIs, may be more effective for inpatients with severe depression than are the single-action drugs such as SSRIs,22,28 but the more general assertion that multiple mechanisms of action confer efficacy advantages is quite controversial.33... 

Societal Risk measures the potential for incidents to affect many people. It has historically been applied as a measure of risk to the general public exposed to the same event or events. Societal risk is often presented as a frequency distribution of multiple-casualty events, called an F-N curve, showing the frequency of events F) leading to N or more fatalities. 

Perez-Moreno, J., Perez-Moreno, A. and Ferrera-Cerrato, R. (1994). Multiple fatal mycetism caused by Amanita virosa in Mexico, Mycopathologia, 125, 3-5. 

Benzyl alcohol The multiple-dose vials of dalteparin, enoxaparin, and tinzaparin contain benzyl alcohol as a preservative. Benzyl alcohol has been associated with a fatal gasping syndrome in premature infants. Because benzyl alcohol may cross the placenta, do not use LMWHs preserved with benzyl alcohol in pregnant women. Thromboembolic events If thromboembolic events occur despite LMWH prophylaxis, discontinue and initiate appropriate therapy. 

Hypersensitivity reactions Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving therapy with -lactams. These reactions are more likely to occur with a history of sensitivity to multiple allergens. 

Hepatic injury Fluconazole has been associated with rare cases of serious hepatic toxicity. Instances of fatal hepatic reactions occurred primarily in patients with serious underlying medical conditions (predominantly AIDS or malignancy) and often while taking multiple concomitant medications. 

Skin reactions Severe, occasionally fatal skin reactions have been reported following single or multiple doses of methotrexate. Reactions have occurred within days of oral, IM, IV, or intrathecal methotrexate administration. Recovery has been reported with discontinuation of therapy. 

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