Cases Of Acute Toxicity Research Articles

Tramadol: repeated prescriptions and repeated warnings

Tramadol is a widely prescribed opioid agonist that can cause addiction and can cause fatal respiratory depression. We describe two reports to prevent future deaths (PFDs) that emphasize the dangers...

MRI-guided stereotactic radiation therapy for hepatocellular carcinoma: a feasible and safe innovative treatment approach.

Hepatocellular carcinoma (HCC) in early stages benefits from local ablative treatments such as radiofrequency ablation (RFA) or transarterial chemoembolization (TACE). In this context, radiotherapy (RT) has shown promising results but has not been thoroughly evaluated. Magnetic resonance-guided RT (MRgRT) may represent a paradigm shifting improvement in stereotactic body radiotherapy (SBRT) for liver tumors. We retrospectively evaluated HCC patients treated on a hybrid low-tesla MRgRT unit. A total biologically effective dose (BED) > 100Gy was delivered in 5 consecutive fractions, respecting the appropriate organs-at-risk constraints. Hybrid MR scans were used for treatment planning and cine MR was used for delivery gating. Patients were followed up for toxicity and treatment-response assessment. Ten patients were enrolled, with a total of 12 lesions. All the lesions were irradiated with no interruptions. Six patients had already performed previous local therapies. Median follow-up after SBRT was 6.5months (1-25). Two cases of acute toxicity were reported (G ≤ 2 according to CTCAE v4.0). At the time of the analysis, 90% of the population presented local control. Child-Pugh before and after treatment remained unchanged in all but one patient. MRgRT is a feasible and safe option showing favorable toxicity profile for HCC treatment.

Intractable nausea and vomiting in na\xefve ingestion of kratom for analgesia

BackgroundKratom is a habit-forming opioid-like substance with an acute toxidrome of various symptoms such as diaphoresis, dizziness, nausea, and vomiting. Chronic users require increasing dosages for the analgesic effects. Although kratom use dates back to the 1800s in Asia, kratom intoxication is still a novel (but increasing) toxidrome in the Western world. Here, we present a novel case of acute toxicity from overdose in a kratom-naïve patient, taking place through recommendation by a family member who chronically takes this substance.Case presentationWe present the case of a 62-year-old woman arriving to the emergency department (ED) with a chief complaint of intractable vomiting after ingestion of kratom. After a day of yard work, she was in pain, secondary to her osteoporotic joints. She was recommended kratom from a family member, who stated he was using kratom to transition away from opioid dependence. She took two “scoops.” She proceeded to have multiple episodes of vomiting at home. She came to the ED, where she required multiple rounds of anti-emetic medication for resolution of her symptoms.DiscussionWe present a classic case of a novel acute toxicity: kratom. A unique aspect of this case is the circumstance by which this toxicity took place: a family member who chronically takes this substance (that requires increasing dosages to remain effective) recommended a dosage to this kratom-naïve patient, leading to overdose. This opioid family alternative substance is gaining popularity across the USA in the era of the opioid crisis. Further documentation of case reports and research is required to learn the associated risks of the use of this substance.

Inoperable early-stage primary and early recurrent non-small cell lung cancer: outcomes of a mono-institutional experience using a moderate hypofractionated schedule

Patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) may beneficiate of a hypofractionated radiation therapy in order to intensificate the treatment and to reduce the number of hospital access. From 2007 to 2015, 27 patients with early-stage primary or limited loco-regional recurrent (T2a > 4cm, T2b N0 or T1-2 N1M0) NSCLC were treated. All patients were medically inoperable or refused surgery and were treated with 60Gy in 20 fractions, 5 times per week. Thirteen (48.1%) presented limited recurrence after surgery and 14 (51.9%) primary disease. Median follow-up was 34months. Twelve patients achieved a CR (44.4%) and 8 a PR (29.6%) with a tumour response rate of 74%. Median overall survival (OS) and 2-year OS were 34months and 63.0%, respectively. Median and 2-year loco-regional progression-free survival (LR-PFS) were 31months and 51.4%, respectively. Survival outcomes were statistically favourable in patients with partial or complete response with respect to patients with stable or progressive disease, whereas stage (N0 vs N1) and primary or relapse/recurrent disease not. No cases of acute toxicity > grade 2 were observed. Seven patients (25.9%) presented grade 2 late toxicities. Sixty Gy in 20 fractions is well tolerated and achieves good clinical outcomes in early primary or recurrent NSCLC patients. A greater number of patients and a longer follow-up are necessary to confirm the results obtained with our treatment.

A 16-Year-Old Lady with Transformer Oil Poisoning in Intensive Care Unit of Enam Medical College Hospital

Transformer oil is one kind of highly refined oil which is used as coolant and heat exchanger in different electronic equipments. Poisoning with this oil is a rare type of chemical poisoning as it is not easily available for household purpose. The main constituent of transformer oil is polychlorinated biphenyl (PCB) which is responsible for producing toxicity in humans. Chronic exposure with PCB may cause some toxicity such as hepatotoxicity and neurotoxicity. Here we present a case of acute toxicity with transformer oil of a rural woman in Bangladesh who ingested this oil as suicidal attempt. She was managed efficiently through conservative treatment along with artificial ventilation.J Enam Med Col 2016; 6(2): 110-113

A systematic review on the safety and efficacy of yttrium-90 radioembolization for unresectable, chemorefractory colorectal cancer liver metastases

The management of unresectable, chemorefractory colorectal cancer liver metastases (CRCLM) is a clinical dilemma. Yttrium-90 (Y90) radioembolization is a potentially safe and effective treatment for patients with CRCLM who have failed conventional chemotherapy regimens. A systematic review of clinical studies before November 2012 was performed to examine the radiological response, overall survival and progression-free survival of patients who underwent Y90 radioembolization of unresectable CRCLM refractory to systemic therapy. The secondary objectives were to evaluate the safety profile of this treatment and identify prognostic factors for overall survival. Twenty studies comprising 979 patients were examined. Patients had failed a median of 3 lines of chemotherapy (range 2-5). After treatment, the average reported value of patients with complete radiological response, partial response and stable disease was 0% (range 0-6%), 31% (range 0-73%) and 40.5% (range 17-76%), respectively. The median time to intra-hepatic progression was 9 months (range 6-16). The median overall survival was 12 months (range 8.3-36). The overall acute toxicity rate ranged from 11 to 100% (median 40.5 %). Most cases of acute toxicity were mild (Grade I or II) (median 39%; range 7-100%) which resolved without intervention. The number of previous lines of chemotherapy (≥ 3), poor radiological response to treatment, extra-hepatic disease and extensive liver disease (≥ 25%) were the factors most commonly associated with poorer overall survival. Y90 radioembolization is a safe and effective treatment of CRCLM in the salvage setting and should be more widely utilized.

Bitter lupine beans ingestion in a child: a disregarded cause of acute anticholinergic toxicity

We describe the case of a 6-year-old girl brought to the emergency department for the sudden onset of anticholinergic syndrome after the ingestion of a few home-made partially debittered lupine beans. She complained of blurry vision, headache, photophobia and nausea. No specific treatment was needed, and the symptoms resolved about 12h after the exposure. Lupine beans are a popular and worldwide-diffused food. The bitter variety is rich in alkaloids harbouring anticholinergic activity and thus requires a debittering process before lupines can be eaten. Only four cases of acute toxicity, due to the ingestion of incompletely detoxified bitter lupines, have been reported in children so far; notwithstanding the small amount of lupines ingested, three of these cases were lethal. Acute anticholinergic syndrome can arise after the consumption of a wide range of exogenous substances including partially debittered lupine beans. Paediatricians should be aware of bitter lupine toxicity, recognize possible cases of intoxication, ensure a prompt and appropriate supportive treatment and provide appropriate information about their danger.

Acute toxicity associated with the recreational use of the ketamine derivative methoxetamine

Long-term regular use of ketamine has been reported to be associated with severe symptomatic urinary tract problems. Methoxetamine, an arylcyclohexylamine derivative of ketamine, is marketed as a "bladder safe" derivative of ketamine, and no cases of acute toxicity following analytically confirmed methoxetamine use have been reported to date. We report here a case series of three individuals with acute toxicity related to the analytically confirmed use of methoxetamine. Three patients aged between 28 and 42 years presented to the Emergency Department (ED) on unrelated occasions having used methoxetamine. Clinical features were suggestive of a "dissociative/catatonic" state similar to that seen with ketamine; in addition, they had clinical features of acute sympathomimetic toxicity with significant tachycardia and hypertension. All were managed with low-dose benzodiazepines and discharged home once their symptoms/signs had settled. TOXICOLOGICAL SCREENING: Serum collected at the time of presentation to the ED was analysed qualitatively and quantitatively by gas chromatography-mass spectrometry. Serum concentrations ranged from 0.09 to 0.2 mg/L; in addition, detectable levels of 6-APB/5-APB were found in one of the patients. These three analytically confirmed cases demonstrate that acute methoxetamine-related toxicity is associated with both "dissociative" and "sympathomimetic" clinical features. The information from these three cases is useful to clinical pharmacologists, not only in managing individuals with acute methoxetamine toxicity but also in advising the appropriate legislative authorities on the risk of acute harm related to methoxetamine use. Further work is needed to determine whether methoxetamine is more "bladder friendly" than ketamine, as has been suggested by those marketing methoxetamine.

The safety of misoprostol

TITLE: The Safety of Misoprostol AUTHOR: Anke Hemmerling, MD, MPH Bixby Fellow of Population and International Health University of California, Berkeley School of Public Health 513 Warren Hall Berkeley, CA 94720-6390 Email: anke@berkeley.edu Misoprostol, Safety, Post Partum Hemorrhage KEYWORDS: Misoprostol is currently on the WHO Essential Drug List for treatment of gastric ulcers, for induced abortion in combination with mifepristone, and more recently for induction of labor. The WHO will review its role as an essential drug for control of post partum hemorrhage (PPH) in early 2007. Relevant data on the safety of misoprostol has been accumulated since the introduction of the drug in the late 1980s. Since then, millions of individuals worldwide have used up to four tablets (800 mcg) daily for treatment and prevention of gastric ulcer. Multi-center trials following thousands of users [1, 2], as well as a review of the worldwide safety data [3] and a Cochrane Review in 2002 [4] failed to report any misoprostol related deaths or side effects severe enough to demand the cessation of treatment. Common side effects for long term misoprostol users with gastric ulcers were the same as seen in some women treated for PPH – and include chills, fever, diarrhea and nausea. Four cases of acute toxicity after accidental or intentional overdose with misoprostol are described in the peer-reviewed literature, two of them in women beyond 30 weeks of pregnancy. [5-8] After ingesting a large number of misoprostol tablets, sometimes mixed with other medication, tachycardia, nausea and abdominal pain and, in some cases, hyperthermia was reported, although the authors of these reports emphasize the complete resolution with supportive care within 12 hours. Bentov [7] concludes that his case of overdose with 42 tablets (8.4 mg) over three days “illustrates the relative safety of the drug”. The literature also reports one case of severe hyperthermia post partum reaching 41.9 C following a normal dose of 800 mcg of oral misoprostol and requiring intensive supportive care. [9] Although no other extreme cases of severe hyperpyrexia are reported, several studies on PPH using oral misoprostol of 400-600 mcg describe transient pyrexia of 38 degrees Celsius

Acute lindane poisoning in three children

Lindane has been reported to cause central nervous system (CNS) toxicity including seizures after prolonged dermal contact and also after acute ingestions. Despite safer alternatives, lindane still remains a commonly used agent in the treatment of scabies and pediculosis. We present three cases of acute toxicity after the inadvertent oral administration of lindane in three siblings. A 17-month-old female suffered a single seizure. A 3-year-old male was listless, nauseated, pale, and had decreased responsiveness to verbal and tactile stimulation. A 4-year-old female became nauseated and required bag-valve-mask ventilation for hypoventilation. The three patients all recovered without sequelae.

Impact potentiel du flottage du bois sur le milieu aquatique

Some aspects are discussed of the consequences of logging operations on natural waters. The release into the aquatic environment of certain types of organic substances from logs can result in an increase in the colour and odour of the water. It appears that bark in particular is responsible for the deterioration of the water quality. Factors such as age and species of the tree and the environmental conditions of the water do mainly determine the nature and effectiveness of the microbial degradation of the tree trunk. Different constituents such as simple sugars, polysaccharides, cellulose, hemicellulose, pectins, lignins, amino acids, peptides, proteins, fatty and other organic acids, as well as phenols can, each to a different degree, be degraded by various types of microbes, in particular by fungi. Substances liberated from the bark and the wood, as well as their products of degradation could exert a stress on several types of organisms in the aquatic environment. Although no specific case of acute toxicity has as yet been reported, some laboratory studies have indicated sub-lethal effects involving fish (blockage of their respiratory system), fish eggs (reduction in the number of hatchings) and algae (reduction in growth rate). In certain instances these effects could be ascribed either to the presence of toxic organic substances or to low oxygen levels.