Inhalation Of Toxic Substances Research Articles

Clinical and diagnostic substantiation for computed tomography of internal organs in acute lung injury in intensive care unit

Objective. To conduct a clinical and diagnostic substantiation of computed tomography (CT) of internal organs in acute lung injury (ALI) in intensive care.Methods. 96 patients of the intensive care unit of the Clinical hospital No 1(Smolensk) were examined. CT scans of the lungs, liver, and brain were performed using a tomograph GE Revolution EVO64. Clinical structure of the patients: 49 – with pneumonia, 15 – septic condition, 12 – Inhalation of toxic substances, 8 – aspiration of toxic liquids, 3 – aspiration of disosmolar liquids, 3 – disseminated intravascular coagulation, 3 – pulmonary contusion, 3 – shock condition. Statistical processing of the results was carried out in the Statistica 6.0 program.Results. Of the 15 patients without changes of the lungs on CT scan, in 12 patients’ attenuation value of liver parenchyma was 14–28HU, brain attenuation value was 24–30HU. In patients with established changes in lung tissue (n=81), the density of liver tissue less than 54HU, brain density less than 32HU in 80.2 % of cases allowed us to predict an unfavorable course of ALI. 10 deaths were recorded, 6 patients were in critical condition for a long period of time. Treatment of hemostasis disorders, normalization of water-electrolyte homeostasis, elimination of hypoxemia, prescription of hepatoprotective, antibacterial, detoxification therapy helped to avoid an unfavorable outcome.Conclusions. 1. It is recommended to consider of criteria for an unfavorable course in patients with acute lung injury the attenuation value of liver parenchyma less than 54HU and brain tissue attenuation value less than 32HU on CT (r=0.969 and r=0.988). 2. CT scan of the liver and brain allows the resuscitator to correct therapy and decide whether it is necessary to involve other specialists. 3. Diagnostic and prognostic significance of a complex CT scan in patients with acute lung injury, at the patient’s admitting AUROC 0.998; CI 0.901–0.999; at follow-up AUROC 0.835; CI 0.822–0.847.

Prehospital Care of Severely Intoxicated Patients by a Dutch Physician-Staffed Helicopter Emergency Medical Services: A Retrospective Study

ObjectiveIntoxicated patients are often encountered by emergency medical services (eg, in cases of recreational drug use, accidental ingestion, or inhalation of toxic substances or [attempted] suicide). Earlier research showed that a physician-staffed helicopter emergency medical service (P-HEMS) is regularly dispatched for intoxicated patients. However, it is still unclear if there is added value of P-HEMS compared with standard care provided by an ambulance crew. The aim of this study was to analyze the contribution of additional expertise and equipment that P-HEMS brings to the prehospital scene. MethodsIn this retrospective study, we searched the database of the helicopter emergency medical service Lifeliner 1 serving the northwestern quadrant of the Netherlands for cases that involved intoxications from January 2013 to July 2020. Patients were included in this study if the primary reason for P-HEMS dispatch was intoxication. The types of intoxication were categorized as (illicit/recreational) drug related, suicide attempt, or accidental. The agents were categorized as stimulants, depressants, hallucinogenic, cannabinoids, and other substances such as bleach or insulin. Patient characteristics, vital signs, and the therapeutic interventions performed were recorded for analysis. ResultsIn our study period, P-HEMS was dispatched 23,878 times. Of these dispatches, a total of 259 cases were included for further analysis. The majority of patients were male (64.5%). Sixty-six patients (25.5%) had an intoxication of depressant agents alone, whereas 60 patients (23.2%) had an intoxication with a combination of agents. With 159 (61.4%) patients, the majority of cases involved recreational drug intoxications. Unintentional intoxications were treated in 27 (10.4%) patients, whereas 73 (28.2%) cases involved suicide attempts. In 159 patients (61.4%), prehospital endotracheal intubation was required; the vast majority was performed by the helicopter emergency medical service physician. Specific antidotes were administered in 56 (21.6%) of the cases. ConclusionIn this study, we found that P-HEMS crews might complement usual prehospital care by ambulance crews for patients with severe intoxications by bringing advanced skills (eg, airway management and specific antidotes) to the scene.

Inhaled aptamer therapy: A hopeful therapy for lung disease

Inhaled aptamer therapy: A hopeful therapy for lung disease

Une forme sévère de pneumopathie aiguë à éosinophiles liée à l’amoxicilline

Acute eosinophilic pneumonia (AEP) is a rare and potentially severe disorder, characterized by an acute febrile respiratory illness with diffuse pulmonary infiltrates, pleural effusions and an eosinophilic alveolitis identified on broncho-alveolar lavage or lung biopsy. The condition can be idiopathic, or induced by the inhalation of toxic substances, by infections or by medications. The condition tends to respond rapidly to treatment with systemic steroids. We report the case of a 16-year old patient who presented severe acute interstitial pneumonia with eosinophilia (1.17g/L). They had taken a seven-day course of amoxicillin treatment two weeks previously for a dental abscess. The patient initially required respiratory support by mechanical ventilation followed by extracorporeal membrane oxygenation due to severe refractory hypoxemia. After exhaustive investigation a diagnosis of amoxicillin-induced acute eosinophilic pneumonia was made. After steroid treatment was initiated the clinical response was rapidly favorable and remission was achieved. The patient has been advised to avoid beta lactam antibiotics for life. This case illustrates a rare case of severe acute eosinophilic pneumonia induced by amoxicillin.

Health and Safety Hazard Identification and Evaluation in Sun Air Reaserch Institiute of Ferdowsi University of Mashhad Using the FMEA Approach

Introduction: Renewable energies, such as wind and solar energy have attracted the attention of scientific, research, and industrial communities due to its fewer threats to the environment and human health. The purpose of this study was to identify and assess the safety and health risks of the Sun Air research institute of Ferdowsi University of Mashhad.
 Methods: In this descriptive cross-sectional study, the failure mode and effect analysis (FMEA) technique was used to identify and assess the risks of all Sun Air Research Institute of Ferdowsi University of Mashhad units in the second half of 2019. The HSE management team identified the risks of each unit separately and assessed the risks. All risks were prioritized following identification based on the range of priority numbers (RPN) method resulting from multiplication of the Occupancy, Severity, and Detectability components as well as the control measures.
 Results: The RPN ranged from 18 cases related to repetitive work in inspection operations to RPN=180 related to electric current leakage. Among the risks, three potential risks had higher priority, which included electric current leakage (RPN=180), inhalation of toxic substances (RPN=162), and falling from a height (RPN=150). Other risks were ranked next in priority.
 Conclusion: The results showed that use of FMEA technique was appropriate to identify and assess occupational risks in research and renewable energy production environments that lead to identification of risks at different levels. This helps the HSE team to eliminate or reduce the level of risks by providing control solutions with the priority of unacceptable risks.

Impact du sevrage des corticostéroïdes inhalés dans la BPCO

The key pathophysiological feature of chronic obstructive pulmonary disease (COPD) is an abnormal inflammatory bronchial reaction after inhalation of toxic substances. The priority is the avoidance of such toxic inhalations, but the use of anti-inflammatory drugs also seems appropriate, especially corticosteroids that are the sole anti-inflammatory drug available for this purpose in France. The risks associated with the prolonged use of these parenteral drugs are well known. Inhalation is therefore the optimal route, but inhaled drugs may also lead to adverse consequences. In COPD, there is an inhaled corticosteroids overuse, and a non-satisfactory respect of the guidelines. Consequently, their withdrawal should be considered. We reviewed seven clinical studies dealing with inhaled corticosteroids withdrawal in patients with COPD and found that included populations were heterogenous with different concomitant treatments. In non-frequent exacerbators receiving inhaled corticosteroids outside the recommendations, withdrawal appears to be safe under a well-managed bronchodilator treatment. In patients with severe COPD and frequent exacerbations, the risk of acute respiratory event is low when they receive concomitant optimal inhaled bronchodilators. However, other risks may be observed (declining lung function, quality of life) and a discussion of each case should be performed, especially in case of COPD and asthma overlap.

Flame Transfer through the External Walls Insulation of the Building During a Fire

The article contains a description of the problems of the risk associated with flammable insulation of the building external walls. According to fire statistics, 80% of lives are taken because of the smoke presence. The smoke as a basic heat conveyor in a fire poses a major threat to people because of: inhalation of toxic substances which are integral part of it and attenuation of fire spaces and adjacent spaces. Both threats simultaneously cause problems with orientation to occupants and consequently render evacuation more difficult. Fire research on insulated elevations, conducted both in Poland and abroad have shown, that wall after insulating has not changed in a significant way its behavior during the fire and it has not constituted the additional risk to people.

The Role of ROS in COPD Progression and Therapeutic Strategies

The atmosphere is replete with a mixture of toxic substances. Inhalation of toxic substances produces a variety of insults on the pulmonary system. Lung poisons include industrial materials and a large number of environmental contaminants. This review will give an in-depth knowledge of how the development and progression of chronic obstructive pulmonary disease (COPD) are associated with increased oxidative stress or reduced antioxidant resources. It has been documented that several indicators of oxidative stress, such as hydrogen peroxide exhalation, lipid peroxidation products, and degraded proteins, are indeed elevated in COPD patients, and as a result, the antioxidant capacity decreases. The fall in antioxidant capacity of blood from COPD patients should not only be regarded as a reflection of the occurrence of oxidative stress but also as evidence that oxidative stress spreads out to the circulation and can therefore generate a systemic effect. An effective wide-spectrum antioxidant therapy that has good bioavailability and potency is a good approach to redressing the lungs antioxidant capacity to control the localized oxidative and inflammatory processes that occur in the pathogenesis of COPD.

Evaluation of Diffuse Reflection Infrared Spectrometry for End-of-Shift Measurement of α-quartz in Coal Dust Samples

The inhalation of toxic substances is a major threat to the health of miners, and dust containing respirable crystalline silica (α-quartz) is of particular concern, due to the recent rise in cases of coal workers’ pneumoconiosis and silicosis in some U.S. mining regions. Currently, there is no field-portable instrument that can measure airborne α-quartz and give miners timely feedback on their exposure. The U.S. National Institute for Occupational Safety and Health (NIOSH) is therefore conducting studies to investigate technologies capable of end-of-shift or real-time measurement of airborne quartz. The present study focuses on the potential application of Fourier transform infrared (FT-IR) spectrometry conducted in the diffuse reflection (DR) mode as a technique for measuring α-quartz in respirable mine dust. A DR accessory was used to analyze lab-generated respirable samples of Min-U-Sil 5 (which contains more than 90% α-quartz) and coal dust, at mass loadings in the ranges of 100–600 μg and 600–5300 μg, respectively. The dust samples were deposited onto three different types of filters, borosilicate fiberglass, nylon, and polyvinyl chloride (PVC). The reflectance, R, was calculated by the ratio of a blank filter and a filter with deposited mine dust. Results suggest that for coal and pure quartz dusts deposited on 37 mm PVC filters, measurements of -log R correlate linearly with known amounts of quartz on filters, with R2 values of approximately 0.99 and 0.94, respectively, for samples loaded up to ∼4000 μg. Additional tests were conducted to measure quartz in coal dusts deposited onto the borosilicate fiberglass and nylon filter media used in the NIOSH-developed Personal Dust Monitor (PDM). The nylon filter was shown to be amenable to DR analysis, but quantification of quartz is more accurate when the filter is “free,” as opposed to being mounted in the PDM filter holder. The borosilicate fiberglass filters were shown to produce excessive interference, making quartz quantification impossible. It was concluded that, while the DR/FT-IR method is potentially useful for on-filter measurement of quartz in dust samples, the use of PVC filters produced the most accurate results.

Where There Is Smoke… Inhalation Injuries, Carbon Monoxide, and Cyanide Poisoning

Structure fires are a common occurrence; however most deaths from them are not the result of burns, but inhalation of toxic substances. The process of combustion frequently results in the production of hydrogen cyanide and carbon monoxide along with other gases. The result can be wide ranging and understanding the effects and suspecting toxic exposure can aid with treatment decisions.

Six medical papyri describe the effects of Santorini’s volcanic ash, and provide Egyptian parallels to the so-called biblical plagues

Six medical papyri document how Santorini's volcanic ash from the Bronze Age biphasic eruption, otherwise attested by material retrieved at the bottom of lakes at the edge of the Nile Delta, severely affected the health of the inhabitants of Egypt as well as their society as a whole. Treatments for burns caused by particulate and dissolved acids are documented in the London Medical Papyrus as well as in the Ebers Papyrus, and are compatible with ash fallout and ash in rain, respectively. Furthermore, both instances of ash correlate to the first eight biblical plagues. Moreover, the latter text also presents a series of ailments coherent with serious inhalation of toxic substances in aerosol form. This scenario is confirmed by the Hearst Medical Papyrus, the Carlsberg Papyrus 8, and the Ramesseum Papyrus III, and fits a volcanic plume, which is also coherent with the ninth biblical plague of palpable obscurity as well as Santorini's second phase of its Bronze Age eruption. Finally, a sixth contemporary medical text, the Edwin Smith Surgical Papyrus, a manual to practice on wounded soldiers, supplies an insight into the collapse of the sociopolitical system of the time. The text appears to provide an insight into the sociopolitical climate in the aftermath of the Santorini eruption, possibly describing conditions that would have led to the tenth and final biblical plague of the massacre of firstborn as well as the escape of slaves from local labor camps.

Roflumilast: the evidence for its clinical potential in the treatment of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD), characterized by a progressive deterioration of lung function caused primarily by the inhalation of toxic substances, is a leading cause of morbidity and mortality worldwide. Current treatment options for the management of its symptoms include the use of bronchodilators and glucocorticoid agents that are not universally beneficial and which are associated with limitations. Phosphodiesterase-4 (PDE4) inhibitors are a novel class of antiinflammatory agents being developed for COPD treatment. The purpose of this article is to review the clinical potential of roflumilast, a PDE4 inhibitor currently in phase III clinical trials, in the management of patients with COPD. Phase II studies indicate that roflumilast can be given orally once daily. Preliminary evidence from two phase III, randomized, double-blind, placebo-controlled studies suggest that roflumilast improves or stabilizes lung function, as measured by forced expiratory volume in 1 s and 6 s (FEV(1) and FEV(6)), forced vital capacity (FVC), and peak expiratory flow (PEF) in patients with COPD. Improvements in COPD exacerbation rate were also reported in these trials. Quality of life, as measured by the St George's Respiratory Questionnaire, also improved with roflumilast treatment. Clinical studies to date suggest that roflumilast is well tolerated. Current evidence supports the use of roflumilast in the management of COPD as shown by improvements in patients' symptoms and quality of life, and good tolerability profile. Its once-daily oral dosing regimen is unique among current therapies for COPD. This potential and the place of roflumilast in the stepwise management of the disease need to be confirmed as further evidence is published. Additional evidence will also be welcome to determine if its mechanism of action moderates the progression of lung function deterioration.

Bronchiolitis Obliterans from Exposure to Incinerator Fly Ash

Inhalation of toxic substances in the workplace can result in a variety of respiratory disorders. One relatively rare sequela of the inhalation of toxic fumes is bronchiolitis obliterans, a condition characterized by fibrosis and narrowing of the small airways. Several substances have been reported to cause bronchiolitis obliterans, including ammonia, chlorine, hydrogen fluoride, hydrogen sulfide, nitrogen dioxide, ozone, phosgene, and other irritant fumes. Little has been reported on the pulmonary effects of fly ash produced by the incineration of coal and oil. We report a case of bronchiolitis obliterans with a component of partially reversible airway obstruction in a 39-year-old male occupationally exposed to incinerator fly ash.

Identification of Epithelial Cells in Bronchoalveolar Lavage

1. Damage to the bronchial epithelium occurs after the inhalation of toxic substances and allergens, and through virus infections and it may lead to increased desquamation of epithelial cells in bronchoalveolar lavage (BAL). 2. In this study we compared two methods of staining the epithelial cells of BAL, the conventional cytochemical May Grunwald-Giemsa stain (MGG) and an immunocytochemical technique using a monoclonal antibody anti-human cytokeratin (CK) detected with APAAP immuno-alkaline phosphatase. BAL was obtained from 13 subjects and the epithelial cells were cytocentrifuged either immediately after collection (fraction A) or after washing (fraction B). 3. Higher percentages of epithelial cells were identified in fraction A with CK (20.0 +/- 5.1%) than in fraction A with MGG (11.2 +/- 2.3%), which recognized only ciliated epithelial cells. In fact a proportion of CK-positive cells (34%) in fraction A were not ciliated. Underestimation of epithelial cells by MGG compared to CK was more pronounced in fraction B (8.0 +/- 2.9% and 22.9 +/- 3.0%, respectively) as there was a relative loss of ciliated CK+ cells after washings. 4. These results suggest that immunocytochemical staining with an anti-cytokeratin monoclonal antibody is more sensitive than using the MGG stain in detecting epithelial cells in BAL.

Cancer risk by inhalation of toxic substances

Cancer risk by inhalation of toxic substances