The arteriovenous fistula (AVF) has long been considered the optimal vascular access. However, the evolving characteristics of the ageing dialysis population limit the creation of an AVF in all patients. Thus, more patients start hemodialysis (HD) with a central venous catheter (CVC) rather than an AVF, and the supremacy of the AVF has recently been questioned. The aim of this study was to analyze the incidence and rate of access complications in 100 patients between 2010 and 2015. A total of 63 patients started HD with an AVF, while 37 began HD with a CVC. We found no differences in patient survival according to the vascular access in use at the beginning of dialysis, but patients were more likely to die while undergoing dialysis by means of a CVC than an AVF. Patients started on dialysis with a CVC had more cardiovascular disease, while patients who began dialysis with an AVF presented more hypertension. Fistulas presented a longer survival time despite more hospital admissions, but CVCs bore a higher risk of infections. Our results suggest that starting dialysis with a CVC does not confer a greater risk of death.

Introduction: Most of the molybdenum (Mo) is used in metallurgical applications, the tetrathiomolybdate form is an experimental chelating agent for Wilson's disease. Human data of acute Mo exposure are lacking and, no report of no-observed-adverse-effect level (NOAEL) has been described until now. Case-study: We report a case of acute occupational exposure to molybdenum, with the related plasma and urine molybdenum concentrations, caused by an accidental ingestion of a sip of an anti-corrosion liquid for metal containing sodium molybdate. Our purpose was to evaluate potential systemic toxicity of molybdenum and to evaluate the dose-response/dose-effect relationship. We estimated the amount of ingested molybdenum to make a mg/kg relationship and performed repeated urine and plasma molybdenum determinations. The patient was hospitalized for three days to monitor possible development of acute symptoms/biochemical alterations. Discussion: We estimated the amount of the sip around 50 ml, with an estimation of a total of 5 gr of sodium molybdate that, for the patient bodyweight of 80 kg, would mean 62,5 mg/kg of ingested Mo. Blood and urine samples collected 2 hours after ingestion showed 50 mcg/L (reference range: 0.43 – 1.8 mcg/L) and 630 mcg/L (refence range: up to 116 mcg/L) of Mo respectively, confirming acute exposure. The patients remained asymptomatic confirming that an estimated oral dose of Mo of 62.5 mg/kg was not associated with adverse effects. Conclusions: Our value, being extrapolated by a single case, will require further confirmations from other studies to allow a full evaluation of a NOAEL. Nevertheless, it does not preclude its use in evaluating the probable absence of adverse effect in the context of acute Mo exposure.

Although bupropion is known to be associated with pharmacobezoar formation, it remains understudied in this context. Upper gastrointestinal endoscopy has emerged as a potential adjunctive decontamination technique for managing acute overdoses associated with pharmacobezoar formation. We aim to evaluate its role in acute bupropion overdoses. We retrospectively analysed intentional bupropion overdoses referred to the Pavia Poison Control Centre (2015-2024) in which upper endoscopy was performed. Data on patient characteristics, overdose details, co-ingestants, decontamination procedures, endoscopy indications, and findings were collected. Endoscopy outcomes were classified as positive (pharmacobezoars, intact tablets, or paste-like residues) or negative. In parallel, an in vitro model was used to assess the propensity of bupropion to form pharmacobezoars. Forty-seven patients were included (median age 44 years, IQR 27-55; 75% female). The median ingested bupropion dose was 4,500 mg (IQR 4,500-6,750 mg). The median ingested tablets count was 59 (IQR 29-100 mg), and co-ingestants were present in 79% of cases. Upper gastrointestinal decontamination endoscopy was positive in 28 cases (60%). Pharmacobezoars or tablet residues were identified even in patients who had undergone prior decontamination, including orogastric lavage (60%). The only variable significantly associated with positive endoscopic findings was the total number of ingested tablets (P <0.05). In our cohort, nearly three-quarters of patients ingesting ≥30 tablets showed a substantial rate of positive endoscopy 73%, compared to 33% of those ingesting <30 tablets. All positive cases resulted in successful endoscopic removal without complications. The in vitro experiment showed early pharmacobezoar formation within four hours of incubation, persisting for up to 72 hours. Acute bupropion overdoses, alone or with co-ingestants, can cause gastric pharmacobezoars and retained tablets/residues despite standard decontamination. Upper gastrointestinal decontamination endoscopy is effective early post-ingestion and may complement or replace conventional methods. Gastric pharmacobezoars and tablet residues are frequently observed in bupropion overdoses, particularly with ingestions of ≥30 tablets, making these patients potential candidates for early endoscopic removal.