Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000393
A. Pesce, Kevin Krock, D. Ritz, A. Cua, Richard Thomas, J. Nickley
Heroin (diacetylmorphine) is made by acetylation of the 3 and 6 positions of the morphine molecule allowing it to rapidly cross the blood brain barrier. Once taken, it is rapidly de-acylated in two steps. First, the acetyl group from the 3 position is removed, forming 6-monoacetylmorphine (6-MAM). Second, the acetyl group on the 6 position is hydrolyzed, forming morphine. Although the major excreted products of heroin metabolism are morphine and morphine glucuronide, detection of heroin use is achieved by monitoring the presence of the intermediate metabolite 6-MAM in urine. The only source of this metabolite is heroin. The testing logic being that because of its short half-life there would only be minimal amounts of 6-MAM excreted. Workplace testing guidelines set the cut-off for 6-MAM at 10 ng/ml, implying that only 0.5% of the excreted morphine would be 6-MAM. Reviews of our urine samples positive for 6-MAM showed a significant number were above 1000 ng/mL. We attempted to determine the possible reason for the high 6-MAM urine concentrations.
{"title":"Observations on 6-MAM (6-Monoacetylmorphine) in Urine","authors":"A. Pesce, Kevin Krock, D. Ritz, A. Cua, Richard Thomas, J. Nickley","doi":"10.4172/2161-0495.1000393","DOIUrl":"https://doi.org/10.4172/2161-0495.1000393","url":null,"abstract":"Heroin (diacetylmorphine) is made by acetylation of the 3 and 6 positions of the morphine molecule allowing it to rapidly cross the blood brain barrier. Once taken, it is rapidly de-acylated in two steps. First, the acetyl group from the 3 position is removed, forming 6-monoacetylmorphine (6-MAM). Second, the acetyl group on the 6 position is hydrolyzed, forming morphine. Although the major excreted products of heroin metabolism are morphine and morphine glucuronide, detection of heroin use is achieved by monitoring the presence of the intermediate metabolite 6-MAM in urine. The only source of this metabolite is heroin. The testing logic being that because of its short half-life there would only be minimal amounts of 6-MAM excreted. Workplace testing guidelines set the cut-off for 6-MAM at 10 ng/ml, implying that only 0.5% of the excreted morphine would be 6-MAM. Reviews of our urine samples positive for 6-MAM showed a significant number were above 1000 ng/mL. We attempted to determine the possible reason for the high 6-MAM urine concentrations.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"95 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74957845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000i102
D. Garg, D. Vibha, Varun Reddy, Parthiban Balasundaram, Leve Joseph, A. Pandit, R. Rajan, A. Srivastava, G. Shukla, K. Prasad
Figure 1: A 40-year-old male with chronic alcohol dependence presented to us with acute bilateral visual diminution, epigastric discomfort, and altered sensorium after a binge involving illicit liquor. Examination revealed a dehydrated male in encephalopathy without meningeal irritation, focal deficits or extrapyramidal involvement. Fundus showed bilateral papilledema. Non-contrast CT scan (Figure 1a) showed hypodensities involving putamen (black arrows) and subcortical white matter (red arrows), which were hypointense on T1-weighted (T1W) MRI (Figure 1b), hyperintense on T2 weighted image (Figure 1c) and FLAIR (Figure 1d). Diffusion restriction and microhemorrhages were seen on diffusion-weighted imaging (DWI) (Figures 1f, g) and susceptibility weighted imaging (SWI) (Figure 1g (yellow arrows)). T1W postgadolinium images showed peripheral putaminal enhancement (Figure 1h, (green arrows)). Ethanol supplementation led to gradual resolution of encephalopathy but not visual loss, over a period of two weeks. Accumulation of methanol metabolite formate leads to specific endorgan damage [1]. Fomepizole and ethanol are useful antidotes [2].
{"title":"Typical Clinical and Neuroimaging Features in Methanol Intoxication","authors":"D. Garg, D. Vibha, Varun Reddy, Parthiban Balasundaram, Leve Joseph, A. Pandit, R. Rajan, A. Srivastava, G. Shukla, K. Prasad","doi":"10.4172/2161-0495.1000i102","DOIUrl":"https://doi.org/10.4172/2161-0495.1000i102","url":null,"abstract":"Figure 1: A 40-year-old male with chronic alcohol dependence presented to us with acute bilateral visual diminution, epigastric discomfort, and altered sensorium after a binge involving illicit liquor. Examination revealed a dehydrated male in encephalopathy without meningeal irritation, focal deficits or extrapyramidal involvement. Fundus showed bilateral papilledema. Non-contrast CT scan (Figure 1a) showed hypodensities involving putamen (black arrows) and subcortical white matter (red arrows), which were hypointense on T1-weighted (T1W) MRI (Figure 1b), hyperintense on T2 weighted image (Figure 1c) and FLAIR (Figure 1d). Diffusion restriction and microhemorrhages were seen on diffusion-weighted imaging (DWI) (Figures 1f, g) and susceptibility weighted imaging (SWI) (Figure 1g (yellow arrows)). T1W postgadolinium images showed peripheral putaminal enhancement (Figure 1h, (green arrows)). Ethanol supplementation led to gradual resolution of encephalopathy but not visual loss, over a period of two weeks. Accumulation of methanol metabolite formate leads to specific endorgan damage [1]. Fomepizole and ethanol are useful antidotes [2].","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89443263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000377
L. Magro, Giovanna Stoppa, M. Venegoni, C. Pistorelli, G. Ricci, U. Moretti, C. Bovo, R. Leone
Objectives: The aims of this cross-sectional study were to describe the incidence of haemorrhages and adverse drug events related to different classes of drugs as cause of emergency department admission. Methods: Adult patients (≥ 18 years) visiting two emergency departments of the University Hospital in Verona (Italy) over a twelve-month period in 2015-2016 were included. The study takes into consideration non-traumatic haemorrhages defined through an International Classification of Diseases, Clinical Modification (ICD-9 CM) diagnosis code and classified into five groups (cerebral haemorrhage, gastrointestinal bleeding, epistaxis, haematuria and other haemorrhages). Demographic data, clinical data and outcome of hospitalization were extrapolated from computerized medical records. Drugs were grouped into six categories and linked to the prescription data of the Verona population during the study period. Results: Overall, 117,019 admissions to emergency departments related to 101,053 patients occurred. According to selection criteria, 1,614 admissions for bleeding, which concerned 1,391 patients (1.4% of the total patients, 59.6% male, 45.7% ≥ 75 years old) were analysed. Out of 1,391 patients, 873 had taken at least one drug (62.8%). Patients were admitted more frequently for epistaxis and gastrointestinal bleeding (27.5% and 23.9%, respectively), and the most reported drugs were antiplatelet (38.8% and 37.7%, respectively) followed by anticoagulants (23.5%), heparins (8.4%), corticosteroids (6.2%), SSRI (5.6%) and NSAIDs (3.0%). About 37% of the visiting patients were subsequently hospitalized, and death was the outcome in 4.2% of cases. Conclusion: In emergency department about 1.4% of admitted patients had an haemorrhage, of these 37% have been hospitalized and 4.2% died during hospitalization. About one third of patients with haemorrhages did not use any drugs. The majority of hospitalized patients had gastrointestinal bleedings and cerebral haemorrhages. To the best of our knowledge, this study is new in the literature, since it takes into consideration all non-traumatic bleedings, and also all drugs known to be associated with haemorrhagic events mentioned on the clinical records.
{"title":"Non-traumatic Haemorrhagic Adverse Events: A Cross-sectional Study in Emergency Departments","authors":"L. Magro, Giovanna Stoppa, M. Venegoni, C. Pistorelli, G. Ricci, U. Moretti, C. Bovo, R. Leone","doi":"10.4172/2161-0495.1000377","DOIUrl":"https://doi.org/10.4172/2161-0495.1000377","url":null,"abstract":"Objectives: The aims of this cross-sectional study were to describe the incidence of haemorrhages and adverse drug events related to different classes of drugs as cause of emergency department admission. Methods: Adult patients (≥ 18 years) visiting two emergency departments of the University Hospital in Verona (Italy) over a twelve-month period in 2015-2016 were included. The study takes into consideration non-traumatic haemorrhages defined through an International Classification of Diseases, Clinical Modification (ICD-9 CM) diagnosis code and classified into five groups (cerebral haemorrhage, gastrointestinal bleeding, epistaxis, haematuria and other haemorrhages). Demographic data, clinical data and outcome of hospitalization were extrapolated from computerized medical records. Drugs were grouped into six categories and linked to the prescription data of the Verona population during the study period. Results: Overall, 117,019 admissions to emergency departments related to 101,053 patients occurred. According to selection criteria, 1,614 admissions for bleeding, which concerned 1,391 patients (1.4% of the total patients, 59.6% male, 45.7% ≥ 75 years old) were analysed. Out of 1,391 patients, 873 had taken at least one drug (62.8%). Patients were admitted more frequently for epistaxis and gastrointestinal bleeding (27.5% and 23.9%, respectively), and the most reported drugs were antiplatelet (38.8% and 37.7%, respectively) followed by anticoagulants (23.5%), heparins (8.4%), corticosteroids (6.2%), SSRI (5.6%) and NSAIDs (3.0%). About 37% of the visiting patients were subsequently hospitalized, and death was the outcome in 4.2% of cases. Conclusion: In emergency department about 1.4% of admitted patients had an haemorrhage, of these 37% have been hospitalized and 4.2% died during hospitalization. About one third of patients with haemorrhages did not use any drugs. The majority of hospitalized patients had gastrointestinal bleedings and cerebral haemorrhages. To the best of our knowledge, this study is new in the literature, since it takes into consideration all non-traumatic bleedings, and also all drugs known to be associated with haemorrhagic events mentioned on the clinical records.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"15 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78327758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495-c2-029
G. Drevenšek, A. Plut, M. Drevenšek
{"title":"Antihistaminic drugs affect bone metabolism in orthodontic tooth movement in rats","authors":"G. Drevenšek, A. Plut, M. Drevenšek","doi":"10.4172/2161-0495-c2-029","DOIUrl":"https://doi.org/10.4172/2161-0495-c2-029","url":null,"abstract":"","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83537857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000387
Richard Thomas, N. Chandler, A. Pesce
Methamphetamine is a commonly used illegal drug and the use of the d form of methamphetamine (MAMP) can have serious implications for a patient’s treatment. Thus, correct identification of d methamphetamine is critical when releasing methamphetamine results although most reported positives are the result of illicit use, a small but significant number of MAMP positive findings can be from the use of medications that either contain or can be metabolized to MAMP. Neither common immunoassay screens nor routine mass spectral confirmatory methods can distinguish between the two forms of the drug because both forms have the same elemental composition and only differ in their orientation at the drug’s asymmetric carbon. Chromatographic chiral analysis which is a separation technique based upon the asymmetric carbon is used to resolve the drug into its enantiomeric forms. Historically, the test to differentiate the enantiomers has been time consuming requiring derivatization of the MAMP and a separate analytical system. The advent of newer chiral columns eliminates the need for derivatization and makes the analytical process simpler to automate. Federal workplace drug testing programs have established a threshold of 20% d-MAMP to distinguish between the legal and illegal use. The purpose of this study was to characterize positive MAMP results in the population of our test patients using both the derivatized and non-derivatized analytical procedures. The test population consisted of specimens collected from pain clinics and rehabilitation facilities. Of the 252,800 specimens tested between 3/28/16 and 2/3/17, we observed 11,264 specimens above our lower limit of quantitation of 50 ng/ml for methamphetamine. The average MAMP concentration was 32,530 ng/mL, while the median concentration was 27,882 ng/mL. There were 198 specimens in with 20% to 60% of the d enantiomer while 142 specimens contained greater than 99% of the l isomer. The average concentration of the d isomer value was 2074 ng/mL. The median concentration of the l isomer specimens was 166 ng/mL. However, 5 of these specimens contained MAMP concentrations greater than 20,000 ng/mL. Both methods of isomer analysis gave similar results with the d isomer measured to being 99% or greater in purity.
{"title":"Observations on Methamphetamine Enantiomers","authors":"Richard Thomas, N. Chandler, A. Pesce","doi":"10.4172/2161-0495.1000387","DOIUrl":"https://doi.org/10.4172/2161-0495.1000387","url":null,"abstract":"Methamphetamine is a commonly used illegal drug and the use of the d form of methamphetamine (MAMP) can have serious implications for a patient’s treatment. Thus, correct identification of d methamphetamine is critical when releasing methamphetamine results although most reported positives are the result of illicit use, a small but significant number of MAMP positive findings can be from the use of medications that either contain or can be metabolized to MAMP. Neither common immunoassay screens nor routine mass spectral confirmatory methods can distinguish between the two forms of the drug because both forms have the same elemental composition and only differ in their orientation at the drug’s asymmetric carbon. Chromatographic chiral analysis which is a separation technique based upon the asymmetric carbon is used to resolve the drug into its enantiomeric forms. Historically, the test to differentiate the enantiomers has been time consuming requiring derivatization of the MAMP and a separate analytical system. The advent of newer chiral columns eliminates the need for derivatization and makes the analytical process simpler to automate. Federal workplace drug testing programs have established a threshold of 20% d-MAMP to distinguish between the legal and illegal use. The purpose of this study was to characterize positive MAMP results in the population of our test patients using both the derivatized and non-derivatized analytical procedures. The test population consisted of specimens collected from pain clinics and rehabilitation facilities. Of the 252,800 specimens tested between 3/28/16 and 2/3/17, we observed 11,264 specimens above our lower limit of quantitation of 50 ng/ml for methamphetamine. The average MAMP concentration was 32,530 ng/mL, while the median concentration was 27,882 ng/mL. There were 198 specimens in with 20% to 60% of the d enantiomer while 142 specimens contained greater than 99% of the l isomer. The average concentration of the d isomer value was 2074 ng/mL. The median concentration of the l isomer specimens was 166 ng/mL. However, 5 of these specimens contained MAMP concentrations greater than 20,000 ng/mL. Both methods of isomer analysis gave similar results with the d isomer measured to being 99% or greater in purity.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"19 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87773958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000389
Y. Kohda
The prevalence of obesity is rapidly increasing worldwide. Obesity greatly increases health care costs because of associated complications. Illnesses related to obesity include impaired glucose tolerance, hypertension, and cardiovascular disease. Obesity also increases the risk of developing type II diabetes. Mild obesity, as well as severe obesity, may result in development of obesity associated diseases, where a person suffers from health problems that are caused by or related to obesity. Obesity disease is differentiated from obesity, which is not accompanied by health problems that represent risk factors for various diseases. Development of obesity disease needs to be prevented or mitigated through a reduction in weight. For individuals who are obese, awareness of the concept of obesity disease could help in selecting appropriate treatment. The Japan Society for the Study of Obesity recommends that researchers and physicians fully comprehend the concepts of obesity and obesity disease. Treatment paradigms and therapeutic focuses are constantly changing, and this knowledge needs to be disseminated to individuals with obesity, regardless of whether they have health problems. This review discusses the concepts of obesity and obesity disease. The role of adipose tissue in metabolic complications due to obesity, as well as prevention and treatment of metabolic complications are also discussed with respect to improving health. The main aim of this review is to assist reader to determine the level of risk associated with obesity disease and obesity-related complications.
{"title":"Paradigm Change to Future Health Enhancement through Comprehending the Concept of Obesity Disease in Japan","authors":"Y. Kohda","doi":"10.4172/2161-0495.1000389","DOIUrl":"https://doi.org/10.4172/2161-0495.1000389","url":null,"abstract":"The prevalence of obesity is rapidly increasing worldwide. Obesity greatly increases health care costs because of associated complications. Illnesses related to obesity include impaired glucose tolerance, hypertension, and cardiovascular disease. Obesity also increases the risk of developing type II diabetes. Mild obesity, as well as severe obesity, may result in development of obesity associated diseases, where a person suffers from health problems that are caused by or related to obesity. Obesity disease is differentiated from obesity, which is not accompanied by health problems that represent risk factors for various diseases. Development of obesity disease needs to be prevented or mitigated through a reduction in weight. For individuals who are obese, awareness of the concept of obesity disease could help in selecting appropriate treatment. The Japan Society for the Study of Obesity recommends that researchers and physicians fully comprehend the concepts of obesity and obesity disease. Treatment paradigms and therapeutic focuses are constantly changing, and this knowledge needs to be disseminated to individuals with obesity, regardless of whether they have health problems. This review discusses the concepts of obesity and obesity disease. The role of adipose tissue in metabolic complications due to obesity, as well as prevention and treatment of metabolic complications are also discussed with respect to improving health. The main aim of this review is to assist reader to determine the level of risk associated with obesity disease and obesity-related complications.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81251874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000374
A. El-Wakf, E. El-Habibi, N. Barakat, A. Attia, Abdelaziz M. Hussein, I. Ali
Objectives: Present study aimed to investigate if prolonged intake of either pomegranate peel methanolic extract (PPME) or pomegranate juice (PJ) could protect against CPF-induced cardiotoxicity and restore cardiac functions up to normal status. Methods: Thirty six male albino rats (170-180 g) were equally allocated into 6 groups, the first four ones were used as control, PJ (3 ml/kg), PPME (200 mg/kg) and CPF (6.75 mg/kg) groups, while the two last groups were given CPF+PJ and CPF+PPME at the same mentioned doses, daily for 60 successive days. Results: CPF-exposed group showed electrocardiograph (ECG) alterations, manifested as ST segment elevation, prolonged corrected QTc interval and shortened RR interval, along with elevation in heart rate and blood pressure. Further elevation in cardiac marker enzymes (CK-MB, LDH) and myocardium specific troponin isoform (cTn 1) were noticed. Results also showed decreased cardiac antioxidants (GSH, SOD), and increased malondialdhyde (MDA) level with induction of apoptosis and cell cycle arrest, evidenced by increased cardiac p53, caspase-3, Bax and G0/G1 phase% with decreased Bcl-2, S- and G2/M phases%. Cardiac histopathological changes characterized by disorganization and degeneration in myocardial fibers with cytoplasmic vacuolization and separation of cardiac myofibrils were observed. Congested thickened arteries with extravasation of the blood in between the cardiac myofibrils were also noticed following CPF exposure. On contrast, co-administration of CPF and either PJ or PPME tended to protect against CPF-induced cardiotoxicity, as manifested by improved ECG alterations, oxidative status apoptotic biomarkers and histological characters. Conclusion: Thus, administration of PPME or PJ seems to offer a greater protective effect against CPF-induced myocardial injury, probably through the synergism between their antioxidant and anti-apoptotic properties.
{"title":"Cardiovascular Toxic Effects of Chlorpyrifos: A Possible Protective Role for Pomegranate Extracts","authors":"A. El-Wakf, E. El-Habibi, N. Barakat, A. Attia, Abdelaziz M. Hussein, I. Ali","doi":"10.4172/2161-0495.1000374","DOIUrl":"https://doi.org/10.4172/2161-0495.1000374","url":null,"abstract":"Objectives: Present study aimed to investigate if prolonged intake of either pomegranate peel methanolic extract (PPME) or pomegranate juice (PJ) could protect against CPF-induced cardiotoxicity and restore cardiac functions up to normal status. Methods: Thirty six male albino rats (170-180 g) were equally allocated into 6 groups, the first four ones were used as control, PJ (3 ml/kg), PPME (200 mg/kg) and CPF (6.75 mg/kg) groups, while the two last groups were given CPF+PJ and CPF+PPME at the same mentioned doses, daily for 60 successive days. Results: CPF-exposed group showed electrocardiograph (ECG) alterations, manifested as ST segment elevation, prolonged corrected QTc interval and shortened RR interval, along with elevation in heart rate and blood pressure. Further elevation in cardiac marker enzymes (CK-MB, LDH) and myocardium specific troponin isoform (cTn 1) were noticed. Results also showed decreased cardiac antioxidants (GSH, SOD), and increased malondialdhyde (MDA) level with induction of apoptosis and cell cycle arrest, evidenced by increased cardiac p53, caspase-3, Bax and G0/G1 phase% with decreased Bcl-2, S- and G2/M phases%. Cardiac histopathological changes characterized by disorganization and degeneration in myocardial fibers with cytoplasmic vacuolization and separation of cardiac myofibrils were observed. Congested thickened arteries with extravasation of the blood in between the cardiac myofibrils were also noticed following CPF exposure. On contrast, co-administration of CPF and either PJ or PPME tended to protect against CPF-induced cardiotoxicity, as manifested by improved ECG alterations, oxidative status apoptotic biomarkers and histological characters. Conclusion: Thus, administration of PPME or PJ seems to offer a greater protective effect against CPF-induced myocardial injury, probably through the synergism between their antioxidant and anti-apoptotic properties.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"43 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80997871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000378
R. Sivaganabalan, Z. MohdJamin, Loke Ky, N. Z'aba, S. Periathamby, Mohd Abdul Kader Jailani Mf
Objectives: The objective of this study is to determine treatment interventions that provided the best outcome for patients. Initial treatment interventions performed in the emergency department such as decontamination, antidote administration and intubation will be analysed. Subsequent management in the intensive care unit with complications related to invasive ventilation will be analysed. The risks of aspiration pneumonia for patients who underwent gastric lavage with or without administration of activated charcoal will also be analysed.Methods: A retrospective observational study was conducted. Study population included all patients presenting to the emergency department of Hospital Tengku Ampuan Rahimah with history of having consumed an organophosphate from the 1st April 2013 to 31st March 2016. The inclusion criteria was all patients with history of ingesting an insecticide containing a suspected organophosphate. The exclusion criteria was patients confirmed not to have ingested an organophosphate from clinical inference and confirmation of actual poison.Results: A total of 84 patients were sampled with 75 patients fulfilling criteria for study inclusion. A total of 22 cases developed complications during their hospital stay with 13 cases of nosocomial infection, 8 cases of aspiration pneumonia, 2 cases with in hospital cardiac arrest and 1 case of atropine toxicity.Malathion and chlorpyrifos were the only two identified organophosphates with the remaining 38 having consumed an unidentified organophosphate. Using chi-square test, there appears to be a significant difference between chlorpyrifos and malathion in terms of need for intubation with a p value of 0.017.Conclusion: Resuscitation of airway, breathing and circulation with close observation for early signs of proximal muscle weakness or paralysis countered with judicious atropine administration is sufficient to ensure good outcome for cases of malathion and chlorpyrifos poisoning which present early to the emergency department.The risk of aspiration pneumonia is high in patients with organophosphate poisoning outweighing the benefits of performing a gastric lavage. Aspiration of stomach contents with a ryle's tube after endotracheal intubation is an acceptable method of gastrointestinal decontamination for patients who have consumed a large quantity of organophosphate.Pralidoxime may be beneficial in reducing the period of respiratory paralysis or weakness for chlorpyrifos poisoning but shows no clear benefit for malathion poisoning. The prolonged muscle paralysis seen in malathion poisoning weighs heavily on intensive care resources. Banning the sale of malathion may help reduce morbidity from prolonged ventilation as well as reduce the burden on intensive care resources.
{"title":"Retrospective Observational Study of Organophosphate Poisoning in an Urban Malaysian Hospital","authors":"R. Sivaganabalan, Z. MohdJamin, Loke Ky, N. Z'aba, S. Periathamby, Mohd Abdul Kader Jailani Mf","doi":"10.4172/2161-0495.1000378","DOIUrl":"https://doi.org/10.4172/2161-0495.1000378","url":null,"abstract":"Objectives: The objective of this study is to determine treatment interventions that provided the best outcome for patients. Initial treatment interventions performed in the emergency department such as decontamination, antidote administration and intubation will be analysed. Subsequent management in the intensive care unit with complications related to invasive ventilation will be analysed. The risks of aspiration pneumonia for patients who underwent gastric lavage with or without administration of activated charcoal will also be analysed.Methods: A retrospective observational study was conducted. Study population included all patients presenting to the emergency department of Hospital Tengku Ampuan Rahimah with history of having consumed an organophosphate from the 1st April 2013 to 31st March 2016. The inclusion criteria was all patients with history of ingesting an insecticide containing a suspected organophosphate. The exclusion criteria was patients confirmed not to have ingested an organophosphate from clinical inference and confirmation of actual poison.Results: A total of 84 patients were sampled with 75 patients fulfilling criteria for study inclusion. A total of 22 cases developed complications during their hospital stay with 13 cases of nosocomial infection, 8 cases of aspiration pneumonia, 2 cases with in hospital cardiac arrest and 1 case of atropine toxicity.Malathion and chlorpyrifos were the only two identified organophosphates with the remaining 38 having consumed an unidentified organophosphate. Using chi-square test, there appears to be a significant difference between chlorpyrifos and malathion in terms of need for intubation with a p value of 0.017.Conclusion: Resuscitation of airway, breathing and circulation with close observation for early signs of proximal muscle weakness or paralysis countered with judicious atropine administration is sufficient to ensure good outcome for cases of malathion and chlorpyrifos poisoning which present early to the emergency department.The risk of aspiration pneumonia is high in patients with organophosphate poisoning outweighing the benefits of performing a gastric lavage. Aspiration of stomach contents with a ryle's tube after endotracheal intubation is an acceptable method of gastrointestinal decontamination for patients who have consumed a large quantity of organophosphate.Pralidoxime may be beneficial in reducing the period of respiratory paralysis or weakness for chlorpyrifos poisoning but shows no clear benefit for malathion poisoning. The prolonged muscle paralysis seen in malathion poisoning weighs heavily on intensive care resources. Banning the sale of malathion may help reduce morbidity from prolonged ventilation as well as reduce the burden on intensive care resources.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"20 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86685699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000388
Juan José Gorgojo Martínez, Frédéric Mollard, F. Baud, K. Bendjelid
Overdose with calcium channel blockers is often a life-threating condition that is frequently exacerbated by the availability of extended-release preparations with slow drug clearances. In the annual report of the American Association of Poison Control Centers, calcium channel inhibitor overdose is one of the most deadly poisonings. In addition, calcium channel blockers are highly bound to proteins, making them difficult to remove using standard dialysis techniques. We describe two cases of amlodipine overdose that presented with profound circulatory shock and were treated with the Molecular Adsorbent Recirculating System™ (MARS™). In this regard, the authors reviewed other cases reported in the literature to discuss the rationale for using albumin dialysis techniques in the setting of highly protein-bound drug intoxication.
{"title":"Intoxication with Calcium Channel Blockers and Other Highly Protein-Bound Drugs: Why Use MARS? Two Clinical Case Reports","authors":"Juan José Gorgojo Martínez, Frédéric Mollard, F. Baud, K. Bendjelid","doi":"10.4172/2161-0495.1000388","DOIUrl":"https://doi.org/10.4172/2161-0495.1000388","url":null,"abstract":"Overdose with calcium channel blockers is often a life-threating condition that is frequently exacerbated by the availability of extended-release preparations with slow drug clearances. In the annual report of the American Association of Poison Control Centers, calcium channel inhibitor overdose is one of the most deadly poisonings. In addition, calcium channel blockers are highly bound to proteins, making them difficult to remove using standard dialysis techniques. We describe two cases of amlodipine overdose that presented with profound circulatory shock and were treated with the Molecular Adsorbent Recirculating System™ (MARS™). In this regard, the authors reviewed other cases reported in the literature to discuss the rationale for using albumin dialysis techniques in the setting of highly protein-bound drug intoxication.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"12 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91260950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2161-0495.1000384
H. A. El-Atta, Esam R. Ahmed
Many environmental pollutants are considered to be obsogenes that are encountered to be one of the major nontraditional risk factors for induction of obesity. The aim of the present study is to determine role of malaoxon, malathion dicarboxylic acid (MDCA), cadmium chloride (CdCl2) and bisphenol-A (BPA); as prevalent pollutants in our locality, Egypt. In vitro study was conducted on pre-adipocytes PCS-210-010 cell line, cells were divided into 5 groups: (I) treated with malaoxon, (II) treated with MDCA, (III) treated with CdCl2, (IV) treated with BPA, (V) served as control group. LC50 were determined for treated cells, at different concentrations, using MTT assay, expression of PPARγ, PPIA and aP2 genes were estimated using RT-PCR; and adiponectin (ADP) levels were measured spectrophotometrically. Results showed that the studied pollutants significantly upregulated all the studied genes (p<.001) compared to the control group, as well as, ADP levels were significantly increased in treated cells compared to control cells (p<.001). In conclusion, malaoxon, MDCA, CdCl2 and BPA epigenetically increased the expression of studied genes that play a key role in the process of adipogensis. These results warranted more depth mechanistic studies for each toxicant to elucidate the main pathway of action.
{"title":"Study of the In-vitro Epigenetic Toxicity Effects of Malaoxon, Malathion Dicarboxylic Acid, Cadmium Chloride and Bisphenol-A on PPAR γ, PPIA and aP2 gene Expressions","authors":"H. A. El-Atta, Esam R. Ahmed","doi":"10.4172/2161-0495.1000384","DOIUrl":"https://doi.org/10.4172/2161-0495.1000384","url":null,"abstract":"Many environmental pollutants are considered to be obsogenes that are encountered to be one of the major nontraditional risk factors for induction of obesity. The aim of the present study is to determine role of malaoxon, malathion dicarboxylic acid (MDCA), cadmium chloride (CdCl2) and bisphenol-A (BPA); as prevalent pollutants in our locality, Egypt. In vitro study was conducted on pre-adipocytes PCS-210-010 cell line, cells were divided into 5 groups: (I) treated with malaoxon, (II) treated with MDCA, (III) treated with CdCl2, (IV) treated with BPA, (V) served as control group. LC50 were determined for treated cells, at different concentrations, using MTT assay, expression of PPARγ, PPIA and aP2 genes were estimated using RT-PCR; and adiponectin (ADP) levels were measured spectrophotometrically. Results showed that the studied pollutants significantly upregulated all the studied genes (p<.001) compared to the control group, as well as, ADP levels were significantly increased in treated cells compared to control cells (p<.001). In conclusion, malaoxon, MDCA, CdCl2 and BPA epigenetically increased the expression of studied genes that play a key role in the process of adipogensis. These results warranted more depth mechanistic studies for each toxicant to elucidate the main pathway of action.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"16 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78308517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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