Ingestion Of Chemicals Research Articles

English

BACKGROUND: Organophophorous poisoning constitutes one of the most frequent poisoning in clinical practice all over the country and especially in this area where agriculture is the chief economic occupation. Acute organophophorous poisoning ranks foremost in the list of agents which causes acute pesticide poisoning in the developing countries. Acute poisoning, accidental or due to deliberate ingestion or inhalation of these organophosphate chemicals is an important and one of the most common medical emergencies. Hence the present study is undertaken to assess severity of poisoning, management and outcome of organophosphorous poisoning cases admitted in Government General Hospital, Kakinada, A. P. AIMS/OBJECTIVES: 1. Assessment of severity of Organophosphorous poisoning according to Driesbach's criteria 2. To study the morbidity and mortality in these patients. MATERIALS AND METHODS: In this descriptive study fifty patients with organophosphorous insecticide poisoning were evaluated by clinical examination. They were investigated, treated and their treatment outcome were analyzed. RESULTS: 1. Chlorpyriphos and monocrotophos(together 66%) were the most commonly used pesticides. 2. 82% cases reached the hospital within 6 hours for commencement of treatment and were mostly of moderate to severe degree of OP poisoning while mild cases of accidental poisoning reached after 12 hours. Hence the mortality is high in the former group only. 3. When the severity of poisoning was graded by applying Dreisbach's criteria at the time of admission 34% had severe degree of poisoning, 26% had moderate poisoning while 40% of cases presented with mild degree of poisoning. (Most of the cases were accidental inhalation and skin contact exposure.) 4. Among the patients belonging to moderate to severe degree of poisoning 30% of patients were put on assisted mechanical ventilation, indications being uncontrolled pulmonary secretions, continuing hypoxia, not relieved with routine Oxygen therapy and respiratory paralysis. 5. The mortality rate in the present study is 14% (7 cases out of 50). All of them expired despite good ventilatory support and intensive medical care. 6. In this study among 17 cases of severe degree poisoning, 5 patients expired and the remaining 12 cases recovered with Intensive medical care and mechanical ventilatory support.

Is human immunodeficiency virus (HIV) a risk factor to development of dental caries and molar incisor hypomineralization (MIH) in children?

Introduction: HIV-positive children are susceptible to various infections, and they are often placed on long-term medications to control and/or prevent these infections. It is possible that the ingestion of these medications by the children could result in some form of dental conditions, like dental caries that possibly results from the intake of sugar-containing medications and poor oral hygiene, and or molar incisor hypomineralization (MIH) ensuing from the febrile conditions, ingestion of certain medications and/or other chemicals at the time the dentition is developing. Case Series: Two cases of HIV-positive children have been described in this paper, both of which suffered from severe dental caries and MIH. The treatment included extractions and extensive dental restorative procedures to improve their masticatory function and aesthetics. Conclusion: HIV-positive children may be at a greater risk of developing dental caries and MIH.

The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study: assessment of environmental exposures.

The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3–4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set.

Possible Health Implications Associated with Cosmetics: A Review

Cosmetics are products applied to the body or face to improve appearance. Theycleanse, beautify, promote attractiveness and alter appearance of the body. The concept of beauty and cosmetics is as old as mankind and civilization. Assorted beauty products such as skincare products, hair products, fragrances, oral hygiene, and nail products, which may contain toxic chemicals that can be harmful to health are used especially by women. Most cosmetic products contain hazardous chemicals like Sodium Laureth Sulphate, Talcum, Parabens, Coal tar dye, Phthalates, Fragrance, Mineral oil, Triethanolamine and some heavy metals eg, Lead, Arsenic, Nickel, Cadmium, and Mercury. The bioaccumulation of theseharmful chemicals andmetals in the body over time has been associatedwith cancer, reproductive and developmental disorders, contact dermatitis, hair loss, lung damage, ageing, skin disease and reaction, allergies, and damage of nails. The deleterious chemicals and metals can enter into the body by inhalation of perfumes, deodorant, nail polish, scented powder, etc; by absorption through penetration of harmful chemicals from body creams, moisturizers, cleanser, eye shadow, etc. It can also be by ingestion of chemicals and metals in lip sticks, lip balm, lip gloss, etc. through the mouth.

Speech-language pathology services in Australian and New Zealand pediatric burn units and chemical ingestion injury

To date, little is known regarding the extent and nature of involvement of speech-language pathology (SLP) services within pediatric burn settings. The aim of this clinical service study was to investigate the role of SLP services within burn teams across Australia and New Zealand. Eleven pediatric burn units were identified as members of the Australian and New Zealand Burn Association Bi National Burns Registry. Representatives from both burn units and SLP departments at each setting were sent a link to a purpose-built online questionnaire. Seven responses from eight centers were received, with paired responses (burn units and SLP departments) being obtained from six centers. Pediatric burn units and SLP departments were found to differ in perceptions of SLP involvement in burn care. No burn units reported utilization of a protocol for referral to SLP. Dysphagia, followed by orofacial contracture management was the most frequently reported areas of SLP involvement, and multidisciplinary contribution within these areas was recognized. A majority (71%) of SLP departments reported involvement with chemical ingestion injury; however, referral rates were low. This study confirms that SLP services are utilized within Australian and New Zealand pediatric burn units, and SLPs are involved with pediatric patients with chemical ingestion injuries. However, potential exists for increased SLP input. There is also evident need for established guidelines surrounding referrals and greater education regarding the role of SLPs within pediatric burn care.

Tissue communication in regenerative inflammatory signaling: lessons from the fly gut.

The intestine, as a barrier epithelium, serves in the first line of defense against invading pathogens and damaging agents that enter the body via food ingestion. Maintenance of intestinal homeostasis is therefore key to organismal health. To maintain homeostasis, intestinal stem cells (ISCs) continuously replace lost or damaged intestinal epithelial cells in organisms ranging from Drosophila to humans. Interestingly, intestinal damage upon ingestion of chemicals or pathogenic bacteria leads to an inflammatory response in the Drosophila intestine, which promotes regeneration and predisposes to tumorigenesis. This regenerative inflammatory signaling culminates in proliferation and differentiation of ISCs that replenish the damaged intestinal cells and is regulated by the interplay of conserved cell-cell communication pathways, such as the JNK, JAK/STAT, Wnt/Wingless, Notch, InR, PVR, EGFR, and Hippo. These pathways are induced by signals emanating not only from the damaged intestinal epithelial cells, but also from neighboring tissues associated with the intestinal epithelium, such as the muscles and the trachea, or distant tissues, such as the wounded epidermis and the brain. Here we review tissue communication during homeostasis and regenerative inflammatory signaling in Drosophila focusing on the signals that emanate from non-intestinal epithelial tissues to ensure intestinal integrity.

Respiratory complications from acute corrosive poisonings in adults.

Introduction:Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient.Objective:The aim of the study is to show the incidence of respiratory complications in acute corrosive poisonings, the need of various clinical investigations and also the treatment and final outcome of these kind of poisoning. Methods: We retrospectively analyzed clinical records of 415 patients hospitalized and treated at the University clinic for toxicology and urgent internal medicine, in Skopje, Republic of Macedonia, in the period between 2007 and 2011. The protocol consisted of methods for analyzing the systemic complications, with an accent on the post-corrosive respiratory complications.Results:From the total number of patients even 98 (23.61%) exhibited systemic complications, from which 51 (52.04%) are respiratory complications. The majority of patients are female (n=40, 78.43%) and the most common complication is pneumonia (n=47). The youngest patient in this study was 14 and the oldest was 87 years old.Conclusion:Besides the gastrointestinal complications in the acute corrosive poisonings respiratory complications are also very often. They complicate the clinical state of patient and very often lead to fatal endings.

Common Causes of Poisoning

In 2011, German hospitals treated approximately 205 000 patients suffering from acute poisoning. Change is seen over time both in the types of poisoning that occur and in the indications for specific treatment. This article is based on a selective review of the literature, with special attention to the health reports of the German federal government, the annual reports of the GIZ-Nord Poisons Center (the poison information center for the four northwestern states of Germany, i.e. Bremen, Hamburg, Lower Saxony and Schleswig-Holstein), and the recommendations of international medical associations. From 1996 to 2011, the GIZ-Nord Poisons Center answered more than 450 000 inquiries, most of which involved exposures to medical drugs, chemicals, plants, foods, or cosmetics. Poisoning was clinically manifest in only a fraction of these cases. Ethanol intoxication is the commonest type of acute poisoning and suicide by medical drug overdose is the commonest type of suicide by poisoning. Death from acute poisoning is most commonly the result of either smoke inhalation or illegal drug use. Severe poisoning is only rarely due to the ingestion of chemicals (particularly detergents and cleaning products), cosmetics, or plant matter. Medical procedures that are intended to reduce the absorption of a poison or enhance its elimination are now only rarely indicated. Antidotes (e.g., atropine, 4-dimethylaminophenol, naloxone, toluidine blue) are available for only a few kinds of poisoning. Randomized clinical trials of treatment have been carried out for only a few substances. Most exposures to poisons can be treated with general emergency care and, if necessary, with symptomatic intensive-care measures. Poison information centers help ensure that cases of poisoning are dealt with efficiently. The data they collect are a useful aid to toxicological assessment and can serve as a point of departure for research projects.

Endocrine disruptors found in food contaminants enhance allergic sensitization through an oxidative stress that promotes the development of allergic airway inflammation

In the past few decades, there has been a significant increase in incidence of allergic diseases. The hygiene hypothesis may provide some clues to explain this rising trend, but it may also be attributable to other environmental factors that exert a proallergic adjuvant effects. However, there is limited information on the risks of developing allergic asthma and related diseases through the ingestion of environmental chemicals found in food contaminants. In the present study, we have shown that oral administration of tributyltin, used as a model environmental chemical, induced oxidative-stress status in the bronchial lymph node, mesenteric lymph node and spleen, but not in the lung, where the initial step of allergic asthma pathogenesis takes place. Mice exposed to tributyltin exhibited heightened Th2 immunity to the allergen with more severe airway inflammation. Tributyltin also induced Treg cells apoptosis preferentially over non-Treg cells. All these effects of tributyltin exposure were canceled by the administration of glutathione monoethyl ester. Meanwhile, tributyltin did not affect airway inflammation of mice transferred with allergen-specific Th2 cells. Collectively, these results suggest that tributyltin exerts its pathological effect during the sensitization phase through oxidative stress that enhances the development of allergic diseases. The current study dissects the pathogenic role of oxidative stress induced by oral exposure to an environmental chemical during the sensitization phase of allergic airway inflammation and would be important for developing therapeutics for prevention of allergic diseases.

Profile of suicide in rural Cameroon: are health systems doing enough?

To describe the characteristics of suicide and assess the capacity of health services at the district level in Cameroon to deliver quality mental health care. The study covered the period between 1999 and 2008 and was carried out in Guidiguis health district which had a population of 145700 inhabitants in 2008. Data collection was based on psychological autopsy methods. To collect data, we used documentary review of medical archives, semi-structured interviews of relatives of suicide completers, a focus group discussion of health committee members and a survey to consulting nurses working at the primary health care level. Forty-seven suicides were recorded from 1999 to 2008: 37 (78.7%) males and 10 (21.3%) females, yielding rates of reported suicides that ranged from 0.89 to 6.54 per 100000 inhabitants. The most frequently used suicide method was the ingestion of toxic agricultural chemicals (in 76.6% of cases). According to the relatives, the suicides were due to an ongoing chronic illness (31.9%), sexual and marital conflicts (25.5%), witchcraft (14.9%), financial problems (8.5%) or unknown cause (25.5%). In 25 (53.2%) cases, suicide victims exhibited symptoms suggestive of a mental disorder but only six of the suicide committers who presented behavioural symptoms sought health care. Only two of the 15 consulting nurses were able to cite at least three symptoms of depression and were aware that depression can lead to suicide. All of the nurses acknowledged that they had never received any specific training or supervision in mental health care. Suicides are not a rare event in rural settings in Cameroon. The health district capacity to provide quality mental care is almost insignificant. The integration of minimal mental health care services at the community and primary health care levels should be considered a priority in sub-Saharan Africa.

The WHO START Study

The World Health Organization (WHO) study entitled Suicide Trends in At-Risk Territories (START) is an international multisite initiative that aims to stimulate suicide research and prevention across different areas of the globe. A central component of the study is the development of registration systems for fatal and nonfatal suicidal behaviors. This paper provides an overview of the data collected on suicidal behaviors from the participating locations in the START study. Descriptive statistics on the data are presented in terms of age, sex, and method. A greater proportion of suicide deaths occurred among males. In all areas except the Philippines more females than males engaged in nonfatal suicidal behaviors. Compared to Australia, Italy, New Zealand, the Philippines, and Hong Kong SAR, in the Pacific Islands suicide most often occurs in younger age groups. Results indicate notable variations between countries in choice of method. A greater proportion of suicides occurred by hanging in Pacific Islands, while inhalation of carbon monoxide, use of firearms, ingestion of chemicals and poisons, and drug overdose were the most frequent methods of choice in other areas. The information drawn from this study demonstrates the enormous variation in suicidal behavior across the areas involved in the START Study. Further research is needed to assess the reliability of the established data-recording systems for suicidal behaviors. The baseline data established in START may allow the development of suicide prevention initiatives sensitive to variation in the profile of suicide across different locations.

English

Nitrobenzene, a pale yellow oily liquid with an odour of bitter almonds is used as intermediate in the synthesis of aniline dyes, and as a solvent for the manufacture of cellulose ethers and acetate, as a flavouring agent and in rubber industry. Nitrobenzene induces methemoglobinemia and this is responsible for the manifestations. It is important to take care of the secondary cycling of nitrobenzene from body stores in patients presenting late, after heavy exposure. Clues for diagnosis are a history of chemical ingestion. The characteristic smell of almonds, central cyanosis with no apparent respiratory distress, low pulse oximeter (observed) oxygen saturation with normal ABG (calculated) oxygen saturation and persisting cyanosis on oxygen therapy, without severe cardiopulmonary disease. Dark brown blood that fails to turn bright red on shaking suggests methemoglobinemia and this is supported by chocolate red colour of dried blood. To manage chemically induced methemoglobinemia properly, a clinician must be aware of its pathophysiology, be skilled with the use of reducing agents such as methylene blue, and understand specific physiochemical properties of the toxin. Acute poisoning with nitrobenzene is presented where clinical evaluation and timely management, with repeated intravenous methylene blue helped to save a life.

Community-acquired acute kidney injury in tropical countries

Community-acquired acute kidney injury (AKI) in developing tropical countries is markedly different from AKI in developed countries with a temperate climate, which exemplifies the influence that environment can have on the epidemiology of human diseases. The aetiology and presentation of AKI reflect the ethnicity, socioeconomic factors, climatic and ecological characteristics in tropical countries. Tropical zones are characterized by high year-round temperatures and the absence of frost, which supports the propagation of infections that can cause AKI, including malaria, leptospirosis, HIV and diarrhoeal diseases. Other major causes of AKI in tropical countries are envenomation; ingestion of toxic herbs or chemicals; poisoning; and obstetric complications. These factors are associated with low levels of income, poor access to treatment, and social or cultural practices (such as the use of traditional herbal medicines and treatments) that contribute to poor outcomes of patients with AKI. Most causes of AKI in developing tropical countries are preventable, but strategies to improve the outcomes and reduce the burden of tropical AKI require both improvements in basic public health, achieved through effective interventions, and increased access to effective medical care (especially for patients with established AKI).

Role of a Poison Center in Reducing Unintentional Childhood Ingestion by Targeting Pre-Event Risk Factors

Unintentional poisoning is a frequent presentation in the pediatric emergency care settings. We sought to determine the current incidence of unintentional poison ingestions in children who present to the emergency care in the city of Al Ain in United Arab Emirates, to create a profile of the products ingested, and to compare our data with a previous study conducted before the inception of a poison and drug information center. We reviewed all cases of unintentional poisoning in children 10 years or younger, who presented at 2 tertiary level emergency care centers during January-December 2010. Two hundred cases met our inclusion criteria. Data on demographics, type and amount of noxious substance ingested, time of presentation, and outcomes were collected. Annual incidence was estimated, and data were compared with the previous study. The annual incidence of unintentional poisoning in the UAE is 2.35 per 1000 children 10 years or younger. The incidence is decreasing, especially for household chemical ingestions. The incidence is twice as high among native Emirati children compared with expatriate children. There was an increase in cosmetics- and synthetic hormone-related poisonings, as well as in the involvement of younger infants. The incidence of unintentional pediatric poisoning in the UAE is decreasing particularly in household chemical ingestions. Targeted health promotion campaigns by the poison center may have led to this drop. The sociological, environmental, and cultural factors that might be contributing to the greater use of emergency care in native children should be investigated.

Validation of SOS-lux Microbial Biosensors for Mutagenicity Assessment: Mitomycin-C as a Model Compound

Human health protection requires relating the bioaccessible concentration of a mutagen with the corresponding likely harm that could be caused through exposure. This requires designating the target receptor in need of protection, and a quantitative understanding of the likely pathways for mutagen availability. In this study, young children were selected as target receptors because of their tendency to directly ingest soils. Most data used to characterise a chemical mutagenicity has been extrapolated from rat-based assays using chemical ingestion or direct injection procedures. Mitomycin C was selected as a relevant model compound and extracted using an established in vitro digestion technique. A range of mutagenic bioassays (i.e. SOS-lux based microbial biosensors and Salmonella mutagenicity assay) were calibrated and optimised in aqueous samples, before being applied to soil extracts. The biosensors were consistently as sensitive and responsive as the traditional Salmonella assay, however, the use of microbial biosensors offered speed and ease of analysis. The data presented confirm that the in vitro digestion bioassay enabled a rapid and inexpensive technique for deriving critical values for the protection of humans exposed to soil borne mutagenic pollutants.

Childhood self-poisoning: a one-year review

Self-poisoning in children is a serious health concern accounting for 2% and 5% of childhood deaths in the developed and developing world, respectively. Type of poison and intent varies between age groups, with alcohol poisoning becoming increasingly common in teenagers. The aim of the study was to identify the characteristics of paediatric self-poisoning at Ninewells Hospital, Dundee, as a function of age, sex, intent and type of poison. Data from patients under the age of 17 presenting to Ninewells Hospital's Emergency Department with self-poisoning from 1 December 2008 to 30 November 2009 inclusive were identified, classified and analysed using chi-square testing. Overall there was no significant difference in gender. However, females significantly dominated in the ≥12<17 years age group, with older females also significantly more likely to deliberately self-poison. Alcohol was the sole cause of accidental self-poisoning in this age group while paracetamol was used in the majority of cases of deliberate self-poisoning. In the <6 years age group, household chemical ingestion and over-the-counter medications were the most common poisons. The findings reflect previous published data and national trends. The prevalence of alcohol abuse in the ≥12<17 years age group is a major public health issue that must be addressed.

Biosensor recording of extracellular potentials in the taste epithelium for bitter detection

The sense of bitter taste provides critical information about ingestion of toxic and noxious chemicals. In this study, a novel biosensor, mimicking biological responses to bitter compounds, was developed to measure and evaluate bitters. We used 32-channel microelectrode arrays (MEAs) with the diameter of 30 μm as a multi-channel recording platform, and employed intact taste epithelium of rats as a biological sensing element. Electrophysiological activities of epithelium which preserved native state of taste cell population were measured and analyzed through the multirecording system. We found that administrations of different bitter stimuli such as quinine, denatonium and cycloheximide significantly evoked specific responses respectively, and electrophysiological signal characteristics, such as firing rates, amplitudes and power spectrum, have a visible increase with concentrations of bitternesses. The investigation of taste epithelium with cellular potential measurement based on MEAs represents a fast and reliable biosensor for recognizing and distinguishing bitter tastants.

Severe Chlorate Poisoning Successfully Treated with Methylene Blue

BackgroundChlorate poisoning as a cause of methemoglobinemia is regarded in current literature to be resistant to treatment by methylene blue due to the oxidizing and denaturing properties of the chlorate anion, and often leads to severe renal and hematological complications with a high mortality rate. Recent case studies suggest practitioners have eschewed the use of methylene blue in such situations. ObjectivesThis report describes a case of chlorate poisoning presenting as severe methemoglobinemia successfully treated with methylene blue alone, believed to be a first in reported literature. Case ReportA 34-year-old male construction worker presented 4 h after accidental ingestion of an industrial chemical, with giddiness and breathlessness. Physical examination did not reveal any abnormal cardiorespiratory findings, although arterial blood gas analysis and pulse oximetry revealed an “oxygen saturation gap.” Methemoglobin levels were found to be severely elevated at 66.8% 6 h after ingestion, and the patient was promptly treated with methylene blue. Clinical examination and laboratory tests suggested the absence of hemolysis at the time of treatment. The patient was discharged after a brief and uneventful hospital stay. Subsequent tests revealed the chemical ingested to be sodium chlorate. ConclusionThe successful outcome in our case suggests that a window of opportunity as long as 6 h may exist during which treatment of chlorate poisoning with methylene blue may be of clinical value. We postulate that the absence of significant hemolysis and hematological alterations at the time of antidote administration may be a necessary prerequisite for treatment success.

The New Danger of Thirdhand Smoke: Why Passive Smoking Does Not Stop at Secondhand Smoke

Passive smoking exposure is a topic of great concern for public health because of its well-known adverse effects on human health (International Agency for Research on Cancer 2004). Two news articles on this topic were published in the February 2011 issue of Environmental Health Perspectives (Burton 2011; Lubick 2011). Lubick (2011) discussed the global health burden of secondhand smoke, and Burton (2011) emphasized a new and alarming consequence of smoking in indoor environments—“thirdhand smoke”—a term first coined in 2006 (Szabo 2006). Secondhand smoke is defined as “the combination of smoke emitted from the burning end of a cigarette or other tobacco products and smoke exhaled by the smoker” (World Health Organization 2007). Thus, secondhand smoke exposure consists of an unintentional inhalation of smoke that occurs close to people smoking and/or in indoor environments where tobacco was recently used. Thirdhand smoke is a complex phenomenon resulting from residual tobacco smoke pollutants that adhere to the clothing and hair of smokers and to surfaces, furnishings, and dust in indoor environments. These pollutants persist long after the clearing of secondhand smoke. They are reemitted into the gas phase or react with oxidants or other compounds present in the environment to form secondary contaminants, some of which are carcinogenic or otherwise toxic for human health (Matt et al. 2011). Thus, thirdhand smoke exposure consists of unintentional intake (mainly through inhalation but also via ingestion and dermal routes) of tobacco smoke and other related chemicals that occurs in the absence of concurrent smoking. Exposure can even take place long after smoking has ceased, through close contact with smokers and in indoor environments in which tobacco is regularly smoked. Lubick (2011) considers secondhand smoke synonymous with passive smoking, as do the majority of the authors publishing on this topic. However, in light of new evidence about thirdhand smoke (Matt et al. 2011), it is no longer appropriate to use the term “secondhand smoke” as a synonym for passive smoking or environmental tobacco smoke, because it represents a pars pro toto. In other words, using the term “secondhand smoke” mistakes one part of the problem for the whole. Instead, we propose that “passive smoking” or “environmental tobacco smoke” be used as a more inclusive term to describe any tobacco smoke exposure outside of active smoking. This question of terminology is of particular concern for researchers evaluating passive smoking exposure in indoor settings, especially in domestic environments. Since numerous countries have introduced smoking bans in enclosed public places, domestic environments have become the main sources of passive smoking exposure (World Health Organization 2007). We believe researchers should determine the independent contributions of secondhand and thirdhand smoke when they assess the magnitude of pollutant intake due to passive smoking exposure.

Pneumatosis Intestinalis: A Benign Finding in Two Stable Patients

Purpose: Case One: An 86-year-old male with gastroesophageal reflux and a history of prostate cancer status post transurethral resection, open cholecystectomy, and history of umbilical and inguinal hernias repair presented to the emergency department with several days of nausea, vomiting and abdominal pain. He appeared non-toxic. Examination revealed a distended, soft, non-tender abdomen with reducible hernias and normal bowel sounds. Abdominal x-ray showed no free air. Vital signs and initial laboratory tests were unremarkable with the exception of mildly elevated lactate (2.7, normal <2.2). Computer tomography (CT) of the abdomen revealed pneumatosis intestinalis of the jejunum and portal venous air suspicious for mesenteric ischemia with underlying infection. Blood cultures were obtained and empiric intravenous antibiotics were started. He was admitted to the intensive care unit for monitoring. He remained clinically stable. Cultures were negative. On hospital day three, a repeat CT showed resolution of venous gas and pneumatosis intestinalis. The patient was dismissed home on oral antibiotics with follow-up in the Gastrointestinal (GI) clinic in two weeks. Case Two: A 91-year-old male with a history of gastrointestinal bleeding, diverticulosis, and atrial fibrillation status post inferior vena cava filter on oral anticoagulation presented to the ED complaining of cough, sore throat and retching after cleaning with standard household products. He denied chemical ingestion, gastrointestinal pain or bloody stools. Vital signs were normal. He appeared in no distress. Nose, throat, cardiac, pulmonary, and abdominal exams were unremarkable. Basic laboratory evaluations including troponins were within normal limits. Fecal occult blood tests were negative. A chest x-ray revealed pneumoperitoneum and a follow-up flat abdominal x-ray confirmed free air. CT of the abdomen with oral contrast showed pneumatosis intestinalis of the small bowel with no extravasation of contrast. The patient was admitted for observation. An intravenous proton-pump inhibitor (PPI) was initiated. His throat pain and cough resolved overnight. Serial exams and laboratory studies were unchanged. On hospital day three, a follow-up abdominal flat plate with contrast showed resolution of free air. The patient was dismissed on an oral PPI with follow-up in the GI clinic in one week. Discussion: Pneumatosis intestinalis is generally related to high morbidity and mortality, historically necessitating emergent surgical intervention. In these cases, pneumatosis intestinalis proved to have a benign, self-limited course. As imaging studies become higher quality, further investigation as to the significance of this finding may be warranted.