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Richmond woman, 20, experienced hallucinations from 'laughing gas' misuse: report – Richmond News

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A Richmond ER doctor is warning about the dangers of inhaling nitrous oxide (N2O) after treating a 20-year-old woman who experienced hallucinations stemming from daily use of “whippits.”

According to a report published this month in the B.C. Medical Journal, Dr. Matthew Mo Kin Kwok — one of the report’s authors — treated a young Asian woman who came to emergency at Richmond Hospital because she was worried for her safety.

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The woman was experiencing auditory and visual hallucinations, agitation and had issues walking, according to the report.

The high from whippits, which produces a dissociative state, typically lasts one to two minutes, according to the report.

As a result of her hallucinations, she was also concerned about an imaginary “transmitting” device in her throat, which she believed was making her legs weak and from which she heard voices telling her to kill herself.

N2O easily accessible

Commonly known as “laughing gas,” N2O is used in a medical setting for purposes such as anaesthesia or sedation.

It’s also commercially available in canisters known as whippits, which are used as a foaming agent in whipped cream dispensers. Whippets can be purchased over-the-counter or online regardless of age, medical history or intended use.

The N2O in over-the-counter whippits is the exact same as what’s used for medicinal purposes.

The woman had no history of psychiatric or medical illness, according to the report, had stable vital signs and showed no sign of head trauma. Other medical tests came back normal.

However, said the report, she told doctors that she inhaled nitrous oxide on a daily basis.

“She had increased her use recently and was inhaling gas from approximately 100 whippits per day,” reads the report.

The patient told doctors she bought the canisters legally using a shopping app and showed the physician the website she used when making the purchases. She did not report any other prescription or recreational drug use.

“A psychiatrist, a neurologist and an addiction medicine physician assessed the patient in consultation and agreed that she was psychotic as a result of N2O use,” reads the report.

And according to the report, the authors found that a package of 100 canisters could be purchased online for less than $100, or $1 per canister.

Lack of reporting a concern

According to the report, there were multiple barriers when it came to reporting the woman’s case.

First, it was difficult to determine which authority to report the case to. For example, if the use of the chemical was medicinal, health care providers would need to report to the Canada Vigilance Program.

But if the chemical comes from a product used for whipped cream, the case should be reported to Health Canada Consumer Products and Cosmetics.

But the response from those authorities was also an issue.

“In response to our report, a Health Canada representative explained that consumer products and cosmetics would document the misuse but only take further action if the (nitrous oxide) canister had faults or hazards regarding its intended use, which is making whipped cream,” reads the report.

The report’s authors were “surprised” to learn that no cases of nitrous oxide misuse had been reported to Health Canada and only one case of substance abuse was reported to the Canada Vigilance Program.

The authors also contacted the B.C. Drug and Poison Information Centre, which informed them that the organization had received 14 calls about nitrous oxide toxicity from misuse of whippets or similar commercial products between 2015 and 2019.

“Since our investigation determined that Health Canada received only one report of N2O misuse in this period, many incidents appear to have gone unreported,” reads the report.

In 2017, the News reported how a 23-year-old Richmond man was almost paralyzed after overdosing on N2O, having bought the gas on WeChat.

At the height of his addiction, the man inhaled more than 1,000 eight-gram cartridges of nitrous oxide every day for two months.

He also said he experienced delusions, such as someone chasing him while he was driving or someone was going to hurt him.

According to Kwok’s report, Health Canada considers N2O to be an “unscheduled non-prescription professional use” product.

“This raises an important question,” reads the report. “If N2O used medicinally is deemed to require health care provider involvement, why is the purchase of N2O used commercially not restricted in any way given the potential impact on consumers?”

Some possible solutions to a lack of awareness around N2O toxicity and its possible serious effects, according to the report, are adding safeguards to minimize harm and encouraging intervention from authorities to prevent misuse.

In a release from Vancouver Coastal Health, Kwok also said both doctors and the public need to be more aware of the possible outcomes of inhaling whippits. 

“When people present at the emergency department with unexplained neurological symptoms it’s important for clinicians to consider nitrous oxide as a possible cause,” said Kwok.

“It’s also important for users to know that using this product outside a supervised medical setting can cause serious health effects.”

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Worldwide coronavirus cases cross 161.42 million, death toll at 3,488,751

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More than 161.42 million people have been reported to be infected by the novel coronavirus globally and 3,488,751​ have died, according to a Reuters tally.

Infections have been reported in more than 210 countries and territories since the first cases were identified in China in December 2019.

Interactive graphic tracking global spread of coronavirus: open https://tmsnrt.rs/2FThSv7 in an external browser.

Eikon users can click  for a case tracker.

The following table lists the top 50 countries by the number of reported cases. A complete list is available with the above links.

COUNTRIES AND TOTAL DEATHS CONFIRMED DEATHS PER

TERRITORIES CASES 10,000

INHABITANTS

United States 584,768 32,926,288 17.9

India 262,317 24,046,809 1.94

Brazil 430,417 15,433,989 20.55

France 107,423 5,848,154 16.04

Turkey 44,301 5,095,390 5.38

Russia 254,590 4,922,901 17.62

United Kingdom 127,668 4,446,824 19.21

Italy 123,927 4,146,722 20.51

Spain 79,339 3,604,799 16.95

Germany 85,903 3,579,871 10.36

Argentina 69,254 3,242,103 15.56

Colombia 79,760 3,067,879 16.06

Poland 71,311 2,849,014 18.78

Iran 76,433 2,732,152 9.34

Mexico 219,901 2,375,115 17.43

Ukraine 47,620 2,143,448 10.67

Peru 65,316 1,873,316 20.02

Indonesia 47,823 1,734,285 1.79

Czech Republic 29,857 1,651,178 28.09

South Africa 55,012 1,605,252 9.52

Netherlands 17,423 1,589,282 10.11

Canada 24,825 1,312,408 6.7

Chile 27,520 1,266,601 14.69

Iraq 15,910 1,134,859 4.14

Philippines 18,958 1,131,467 1.78

Romania 29,413 1,070,605 15.11

Sweden 14,275 1,037,126 14.03

Belgium 24,645 1,026,473 21.56

Pakistan 19,384 873,220 0.91

Portugal 16,999 841,379 16.53

Israel 6,379 839,076 7.18

Hungary 29,041 796,390 29.71

Bangladesh 12,102 779,535 0.75

Jordan 9,203 722,754 9.24

Serbia 6,646 705,185 9.52

Switzerland 10,179 679,510 11.96

Japan 11,396 673,821 0.9

Austria 10,455 635,780 11.83

United Arab Emirates 1,626 543,610 1.69

Lebanon 7,569 534,968 11.05

Morocco 9,091 514,670 2.52

Malaysia 1,822 462,190 0.58

Nepal 4,669 439,658 1.66

Saudi Arabia 7,134 431,432 2.12

Bulgaria 17,194 413,320 24.48

Ecuador 19,442 405,783 11.38

Slovakia 12,168 387,162 22.34

Greece 11,322 373,881 10.55

Belarus 2,681 373,351 2.83

Panama 6,288 369,455 15.05

Source: Reuters tally based on statements from health ministries and government officials

Generated at 10:00 GMT.

 

(Editing by David Clarke)

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Canada plots course to fully vaccinated return to gatherings in fall

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Canada on Friday said there would be a gradual return to a world with indoor sports and family gatherings as more people get vaccinated, but it did not go as far as the United States in telling people they could eventually ditch their masks.

Canada has administered one dose of a COVID-19 vaccine to just over half its adult population, and the country may be over the worst of its current third wave of infections, Chief Public Health Officer Theresa Tam said.

On Thursday, the U.S. Centers for Disease Control and Prevention (CDC) advised that fully vaccinated people do not need to wear masks outdoors and can avoid wearing them indoors in most places, guidance the agency said will allow life to begin to return to normal.

On Friday, Canada‘s public health agency offered guidelines to the 10 provinces, which are responsible for public health restrictions.

The agency says once 75% of Canadians have had a single dose and 20% are fully vaccinated, some restrictions can be relaxed to allow small, outdoor gatherings with family and friends, camping, and picnics.

Once 75% of those eligible are fully vaccinated in the fall, indoor sports and family gatherings can be allowed again.

“I think masks might be the last layer of that multi-layer protection that we’ll advise people to remove,” Tam told reporters, noting that in Canada colder temperatures meant people would start spending more time indoors in the fall.

“We are taking a bit of a different approach to the United States,” she added. While in most of Canada masks are not required outdoors, they are mandatory indoors.

Less than 4% of Canada‘s adult population has been fully vaccinated compared to more than 36% of Americans.

Prime Minister Justin Trudeau, who has promised that everyone who wants to can be fully vaccinated by September, this week spoke of a “one-dose summer” and a “two-dose fall” without explaining what that might look like.

 

(Reporting by Steve Scherer and David Ljunggren; Editing by Hugh Lawson)

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Delayed 2nd Pfizer/BioNTech shot boosts antibodies in elderly; COVID-19 obesity risk higher for men

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The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Delaying second Pfizer/BioNTech dose boosts antibodies in elderly

Delaying the second dose of the Pfizer/BioNTech COVID-19 vaccine beyond the originally recommended three-week gap used by the companies in clinical trials appears to induce a stronger antibody response in the elderly, UK researchers found. Shortly after the vaccine became available, UK health officials advised that the second dose should be given 12 weeks after the first to allow more people to get protected by a first dose early on. In a new paper seen by Reuters and expected to appear on medRxiv on Friday ahead of peer review, researchers found that among 175 people ages 80 to 99, those who got their second dose at 12 weeks had antibody responses that were 3.5 times higher than those who got it after three weeks. Antibodies are only one part of the immune system, and vaccines also generate T cells that fight infections. The peak T cell responses were higher in the group with a three-week interval between doses, and the authors cautioned against drawing conclusions on how protected individuals were based on which dosing schedule they received. (https://reut.rs/3wjPK9B)

Impact of obesity on COVID-19 risks may be greater in men

The known increased risk of severe COVID-19 and death linked to obesity may be even more pronounced for men than women, new data suggest. Researchers studied 3,530 hospitalized COVID-19 patients with an average age of 65, including 1,469 who were obese. In men, moderate obesity was associated with a significantly higher risk of developing severe disease, needing mechanical breathing assistance and dying from COVID-19. (The threshold for moderate obesity is a body mass index (BMI) of 35. In an 5-foot, five-inch tall (1.65 m) adult, that would correspond to a weight of 210 pounds (95 kg). In women, however, only a BMI of 40 or higher, indicating severe obesity, was linked with the increased risks. In a report published in European Journal of Clinical Microbiology & Infectious Diseases, the researchers note that while obesity is known to be linked with body-wide inflammation, patients’ levels of inflammatory proteins did not appear to explain the association between obesity and severe illness. For now, they conclude, “particular attention should be paid” to protecting patients with obesity from the coronavirus, “with priority to vaccination access, remote work, telemedicine, and other measures given the higher risk of adverse outcomes once they are diagnosed with COVID-19.” (https://bit.ly/3eO6GiA)

COVID-19 testing rates low among symptomatic Americans

Sick Americans appear to be passing up opportunities to get tested for coronavirus and thus are likely unknowingly spreading the infection throughout their communities, new research shows. Among 37,000 adults across the United States who participated in a smartphone app survey between March and October 2020, nearly 2,700 reported at least one episode of fever and chills. But according to a report published in JAMA Network Open, only a small fraction reported receiving a COVID-19 test result within seven days of the onset of illness. At first, as tests became more accessible, the numbers improved. In early April 2020, less than 10% of survey participants reporting illness with fever received test results within a week. By late July, that proportion had increased to 24.1%. Throughout the summer and fall, as tests became easier to find, the number of sick participants who reported getting tested remained flat. By late October, only 26% reported receiving a test result within a week of febrile illness. “It’s shocking to me that when people have a fever they’re still not getting tested,” said coauthor Dr. Mark Pletcher of the University of California, San Francisco. “Tests are easy to come by. People might have coronavirus, might be spreading it to their friends and neighbors, and they’re not getting tested.” (https://bit.ly/2QUyMzf)

Open  in an external browser for a Reuters graphic on vaccines in development.

 

(Reporting by Nancy Lapid, Alistair Smout and Ronnie Cohen; Editing by Bill Berkrot

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