Source Of Intoxication Research Articles

Foodborne Botulism: Clinical Diagnosis and Medical Treatment.

Botulinum neurotoxins (BoNTs) produced by Clostridia species are the most potent identified natural toxins. Classically, the toxic neurological syndrome is characterized by an (afebrile) acute symmetric descending flaccid paralysis. The most know typical clinical syndrome of botulism refers to the foodborne form. All different forms are characterized by the same symptoms, caused by toxin-induced neuromuscular paralysis. The diagnosis of botulism is essentially clinical, as well as the decision to apply the specific antidotal treatment. The role of the laboratory is mandatory to confirm the clinical suspicion in relation to regulatory agencies, to identify the BoNTs involved and the source of intoxication. The laboratory diagnosis of foodborne botulism is based on the detection of BoNTs in clinical specimens/food samples and the isolation of BoNT from stools. Foodborne botulism intoxication is often underdiagnosed; the initial symptoms can be confused with more common clinical conditions (i.e., stroke, myasthenia gravis, Guillain–Barré syndrome—Miller–Fisher variant, Eaton–Lambert syndrome, tick paralysis and shellfish or tetrodotoxin poisoning). The treatment includes procedures for decontamination, antidote administration and, when required, support of respiratory function; few differences are related to the different way of exposure.

Environmental exposure to cadmium—a risk for health of the general population in industrialized countries and preventive strategies

Cadmium (Cd) is a heavy metal belonging to the group of the main chemical pollutants of the natural and occupational environment in economically developed countries. The forecasts indicate that contamination of the environment with this toxic metal, and thus the exposure of the general population, will increase. Food (particularly plant products) is the main source of the general population exposure to this element. Moreover, an important, and often the main, source of intoxication with Cd is habitual tobacco smoking. Recent epidemiological studies have provided numerous evidence that even low-level environmental exposure to this toxic metal, nowadays occurring in numerous economically developed countries, creates a risk for health of the general population. The low-level lifetime exposure to this metal may lead to the damage to the kidneys, liver, skeletal system, and cardiovascular system, as well as to the deterioration of the sight and hearing. Moreover, it has been suggested that environmental exposure to this xenobiotic may contribute to the development of cancer of the lung, breast, prostate, pancreas, urinary bladder, and nasopharynx. Taking the above into account, the aim of this review article is to draw more attention to Cd as an environmental risk factor for the health of the general population and the need to undertake preventive actions allowing to reduce the risk of health damage due to a lifetime exposure to this toxic metal.

Experimental pathology of arsenic toxicity and its alleviation by Moringa oleifera in Japanese quails

Arsenic occurs naturally in water and soil and can be source of intoxication. The present experiment was carried out to explore the medicinal property of Moringa oleifera in restoration of toxic effects of arsenic in Japanese quails. Group T1 birds were fed with commercial diet and served as control while group T2 was treated with arsenic trioxide @ 300 ppm in the feed. The birds in group T3 and T4 were fed with Moringa oleifera seed powder at 5% and 10% level, respectively. The T5 and T6 group birds were fed with arsenic trioxide @ 300 ppm with Moringa oleifera powder at 5% and 10% level, respectively. Lowest carcass and organ weight was recorded in T2 group. Grossly, testes and ovary of T2 and T5 group birds were smaller in size compared to other groups. Microscopically, hydropic degeneration and fatty changes of liver, reduced numbers of glomeruli in kidneys, increased Virchow Robin space and neuronophagia in brain, severe destruction of mucosal villi of duodenum, arrest of spermatogenesis in testesand irregular sized ova in ovaries were observed in T2 group birds. The birds of T3 and T4 group and those fed arsenic with Moringa oleifera seeds powder (group T5 and T6) showed normal histological architecture of various organs and active spermatogenesis. Arsenic residual level in plasma as well as in the liver, kidneys, muscles and tibia bone was significantly higher in T2 group compared to the control group.

Recovery surgery for extracapsular extension of squamous cell cancer metastasizing to the lymph nodes in the neck

Metastatic neck lymph nodes in massive lesion of their tissue with tumor cells are accompanied by extracapsular extension to the adjacent structures in a number of cases. The greatest problem in clinical oncology is when even extended radical neck dissection fails to completely remove tumor tissue that is macroscopically detectable after surgical resection. In this situation, there is a continued growth of tissue mass that is left on the neck. Thus, the unresectable extracapsular spread of neck lymph node metastases to the adjacent tissues reduces the duration of life in the patients and worsens its quality. The basis for this investigation is clinical observations of patients who have been operated on at the Nizhny Novgorod Regional Clinical Oncology Dispensary (Hospital Two) in the period 2005 to 2016. Histologically, the tumors were squamous cell carcinomas. In this period, there have been 24 Crile operations (radical neck dissection) that are cytoreductive. A primary tumor has been (n = 15) or has not been (n = 9) previously excised. The extracapsular spread of metastatic lymph nodes corresponded to levels IIa, IIb, and III. Cytoreductive cervical lymphadenectomy with the pectoralis musculocutaneous flap covering an unresectable tumor for extracapsular unresectable squamous cell carcinoma metastasizing to the neck lymph nodes should be considered the operation of recovery. This type of surgery is warranted, as tumor mass reduction by eliminating the source of intoxication allows further antitumor treatment (radiotherapy or chemotherapy or their combination) that is contraindicated in patients with tumor lysis in the neck. When the cause of death is the exceedingly continued growth of an unresectable component of radio- and chemoresistant variants of tumor tissue on the neck, the covering of the component with a pectoralis major flap delays a fatal outcome in incurable patients to improve a number of quality-of-life indicators.

Orale ivermectine-intoxicatie op een vleeskalverbedrijf

In deze casus wordt een vermoedelijk kwaadwillige, orale ivermectine-intoxicatie op een Vlaams vleeskalverbedrijf besproken. Alle 330 kalveren van twee tot vier weken oud werden in de eerste week na aankomst op het bedrijf getroffen. De symptomen waren ernstige depressie, het neerliggen in laterale of sternale positie, tremor en kopschudden. Uiteindelijk stierf 13,6% van de kalveren. De overige dieren herstelden gradueel met ondersteunende orale rehydratatietherapie over een termijn van vijf tot zeven dagen. In de kunstmelk kon een ivermectinegehalte van 35 mg/kg aangetoond worden. In het serum van drie kalveren werden ivermectinegehaltes van 0,75 mg/kg tot 1,1 mg/kg gevonden. De vermoedelijk toegediende dosering was 1,75 mg/kg lichaamsgewicht voor een gemiddeld kalf (40 kg). In deze casus wordt aangetoond dat orale toxiciteitsverschijnselen van ivermectine bij kalveren van twee tot vier weken oud kunnen optreden aan een dosis die 8,75 keer hoger is dan de geregistreerde therapeutische dosis voor subcutane toediening bij rundvee.

Simultaneous presentation of squamous cell carcinoma and basal cell carcinoma in a patient of chronic arsenic poisoning: a case report

“Arsenicosis” is a known health hazard in certain areas of our country, contaminated drinking water being the chief source of intoxication. Common manifestations include typical pigmentation, keratosis with or without involvement of internal organs. The worst consequence is development of malignancies, typically squamous cell carcinoma and basal cell carcinoma among others. We report a case of a 50-year-old farmer from N-24 Paraganas (West Bengal, India) found to consume water with more than permissible arsenic level for almost 10 years, presenting with aforesaid cutaneous malignancies simultaneously. Chronic arsenic exposure is known to cause cutaneous malignancies in people. However, a simultaneous occurrence of both squamous and basal cell carcinomas in the same subject is rarely seen.

Assessment of effectiveness of complex treatment of apical and marginal periodontitis with thiotriazoline and chloramphenicol ointment

Introduction. Chronic combined periodontal and periapical lesions have a negative impact on the human organism, since they are a source of intoxication and sensitization causing progression of infection, development of focal sequelae and secondary immunodeficiency. Problem of successful treatment of apical and marginal periodontitis is associated with a significant prevalence of these diseases, a complexity of medical procedures, a substantial proportion of failures and complications, and with a lack of long-term stability of gained results.Aim. The aim of this work was to investigate clinical effectiveness of drug formulation with thiotriazoline and chloramphenicol in the integrated treatment of combined apical and marginal periodontitis.Meterial and methods. The condition of oral cavity of the 65 patients with combined lesions of periodontal and endodontic tissues before and after treatment was studied. Outcomes measured were X-ray examination, probing depth, OHI-S, PMA, PI, SBI indices. The complex treatment has been worked out in the patients of main group and the ointment with thiotriazoline and chloramphenicol was introduced in the scheme of periodontal treatment Results and conclusions. Results of applied treatment indicated to the acceleration of healing process, reduction of exudation period and decrease of exacerbations frequency in the patients of main group. Clinical experience also demonstrated positive dynamic in changes of periodontal indices after the conducted treatment.

Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children.

The aim of our study was to investigate the relation of blood carboxyhemoglobin level with presentation finding and clinical properties and to demonstrate neurological and cardiological findings which are indicators of tissue hypoxia in patients followed up because of carbonmonoxide (CO) poisoning. Three hundred and twenty-five patients who were followed up because of carbonmonoxide poisoning between 2011 and 2013 in our pediatric emergency department were evaluated prospectively. Ethics committee approval was obtained for the study on 10.19.2011 (number: 0437). The carbonmonoxide levels, source of intoxication, neurological and cardiological findings and treatment methods were recorded. Blood gases and cardiac enzymes were studied and electrocardiography (ECG) was performed. The data were analysed using SPSS for windows 16.0 package program. One hundred and sixty-eight (51.7%) of the patients were female and the median age was 9 years (11 days-17 years). Two hundred and twenty-eight (70.2%) of the patients were poisoned while using heater and 78.1% presented during winter months. The median carbonmonoxide level of the patients was found to be 24.8%. Cardiac enzymes were found to be increased in 10.5% of the patients, first degree A-V block was found in 0.6% and negative T wave was found in 0.3%. Glasgow coma score was found to be below 14 in 4.6% of the patients. A significant correlation was found between the carboxyhemoglobin levels and neurological findings, cardiological findings and lactate (p<0.05). Normobaric oxygen treatment was given to 76.3% of the patients and hyperbaric oxygen treatment was given to 23.7%. We think that neurological disorders and cardiac findings may be closely related, since systemic involvement may be easier in carbonmonoxide poisoning in children, Glasgow coma score should be assessed in the follow-up of the patients and cardiac enzymes and serum lactate levels should be monitored closely from the time of presentation.

English

The incidences of intoxication due to the consumption of marine foods have been increasing in recent years. This is due to the presence of biotoxins in foods of marine origin. The biotoxins will be accumulated in the marine foods due to the consumption of toxic biota of marine origin. When this contaminated food is taken by the humans or animals, those toxins will be transferred to them causing intoxication and lethality. Among these intoxications, most of them are caused by the harmful algal blooms (HAB). In order to avoid the harmful effects from marine biotoxins, it is necessary to have the proper knowledge. In this manuscript, the different types of biotoxins, source of intoxication, characteristics of toxins, detection and control measures are discussed in detail.

Foodborne outbreak associated with consumption of ultrapasteurized milk in the Republic of Paraguay

During March 2007 there was an epidemic outbreak associated with the consumption of ultrapasteurized milk. Four hundred people were affected and 60 required hospitalization. S. aureus subspecies aureus was isolated from 5 patients, 3 operators and 3 milk samples. All strains produced enterotoxins. Strains isolated from 3 patients, one operator and all the milk samples carried the genes encoding enterotoxins C (sec) and D (sed), and showed an indistinguishable macrorestriction pattern (SmaI-PFGE). Milk was identified as the source of intoxication and a production line operator as the source of contamination. This is the first foodborne outbreak reported in Paraguay whose agent was isolated, characterized and subtypified in the production plant, the food and the affected people.

Industrial Copper Intoxication of Iranian Fat-Tailed Sheep in Kerman Province, Iran

An outbreak of industrial chronic copper poisoning in Iranian fat-tailed sheep in a region of southeast Iran is described. At least 10,000 out of 75,000 sheep (13.3%) originating from 50 flocks died over a period of 3 years in the Khatoon Abad region in Kerman province, Iran. The diagnosis was based on epidemiological, clinical, hematological, serum biochemical, urinalysis, necropsy and histopathological evaluations. Then findings were confirmed by toxicological analysis of liver and kidney samples. The details of epidemiological, clinical, laboratory and pathologic findings are described in the manuscript. These findings were indicative of chronic copper poisoning in affected sheep. Toxicological analysis showed an exceeding of the permitted limit (150 mg/kg w.w.) of copper in liver samples by 7.97 times (1196.9 ± 20.6 mg/kg) (wet weight-w.w.). In kidney samples the excess was by 9.14 times (137.2 ± 8.96 mg/kg) (w.w.). The copper concentrations in water and pasture plant samples around the factory were very high, suggesting that water and pasture plants were the sources of intoxication. In conclusion, the environmental pollution by a copper smelter factory in the region was the source of intoxication. Chronic copper intoxication through inhalation and ingestion may result in severe economic losses and a public health hazard. Thus it is necessary to determine copper concentrations in the organs (liver, kidney, muscle, and lung) of sheep in the influence area of chemical units.

Acute yew ( Taxus) poisoning in moose ( Alces alces)

Acute yew ( Taxus) intoxication in a free-ranging moose ( Alces alces) is reported. The moose was found dead without any signs of struggle and post mortem examination revealed general congestion, bilateral heart dilatation, and the presence of yew in rumen. The animal was found adjacent to a housing estate with unfenced gardens, surrounded by woods and open fields without native yew. The vast majority of the gardens contained cultivars of yew that had frequently been browsed upon. These were the most likely source of intoxication. This is believed to be the first report of yew intoxication in a wild animal species. It is concluded that yew intoxication may be an overlooked diagnosis in wild deer, and the general opinion that deer species are naturally resistant to many plant-associated toxins is discussed.

Irreversible color vision losses in patients with chronic mercury vapor intoxication

This longitudinal study addresses the reversibility of color vision losses in subjects who had been occupationally exposed to mercury vapor. Color discrimination was assessed in 20 Hg-exposed patients (mean age = 42.4 +/- 6.5 years; 6 females and 14 males) with exposure to Hg vapor during 10.5 +/- 5.3 years and away from the work place (relative to 2002) for 6.8 +/- 4.2 years. During the Hg exposure or up to one year after ceasing it, mean urinary Hg concentration was 47 +/- 35.4 mug/g creatinine. There was no information on Hg urinary concentration at the time of the first tests, in 2002 (Ventura et al., 2005), but at the time of the follow-up tests, in 2005, this value was 1.4 +/- 1.4 microg/g creatinine for patients compared with 0.5 +/- 0.5 microg/g creatinine for controls (different group from the one in Ventura et al. (2005)). Color vision was monocularly assessed using the Cambridge Colour Test (CCT). Hg-exposed patients had significantly worse color discrimination (p < 0.02) than controls, as evaluated by the size of MacAdam's color discrimination ellipses and color discrimination thresholds along protan, deutan, and tritan confusion axes. There were no significant differences between the results of the study in Ventura et al. (2005) and in the present follow-up measurements, in 2005, except for worsening of the tritan thresholds in the best eye in 2005. Both chromatic systems, blue-yellow and red-green, were affected in the first evaluation (Ventura et al., 2005) and remained impaired in the follow-up testing, in 2005. These findings indicate that following a long-term occupational exposure to Hg vapor, even several years away from the source of intoxication, color vision impairment remains irreversible.

Castor bean ( Ricinus communis) toxicosis in a sheep flock

This paper describes clinical, laboratory and pathological findings of sheep, which is intoxicated with castor bean. The source of intoxication was a miscellaneous garden waste. Forty-five animals showed clinical toxicosis and 17 died. The clinical signs included weakness, salivation, profuse watery diarrhoea, dehydration, mydriasis, teeth grinding, hypothermia and recumbency. The most significant haematological and biochemical findings were a high haematocrit, high concentration of serum BUN, creatinine and phosphorus and high activity of serum CK and AST. Pathology revealed severe gastroenteritis, cardiac haemorrhage and necrosis, hepatic necrosis and acute tubular necrosis in kidneys. Treatment included symptomatic and supportive care with fluid therapy and cathartic administration.

Severe hypervitaminosis A in siblings: Evidence of variable tolerance to retinol intake

A 2-year-old boy had signs and symptoms of chronic hypervitaminosis A. A course of increasing severity led to eventual death. A younger brother later had similar clinical features. Chicken liver spread containing up to 420 IU/g vitamin A was the likely source of intoxication. Markedly elevated circulating retinyl ester levels have persisted in the surviving sibling for 3 subsequent years despite severe restriction of vitamin A intake. A therapeutic trial of the carbohydrate-derived complexing agent 2-hydroxypropyl-beta-cyclodextrin was initiated. Circulating retinyl esters transiently increased during the infusion (from 407 to 4791 micrograms/dL), and urinary total vitamin A excretion, undetectable before infusion, increased to 23 micrograms/dL after infusion. The frequency of hypervitaminotic episodes has decreased somewhat in the 2 years since the infusion, probably related to dietary vitamin A restriction. The occurrence of this syndrome in two brothers, while a sister ingesting the same diet remains completely healthy, suggests an inherited variance in tolerance to vitamin A intake.

Epidemiology and toxicology of arsenic poisoning in domestic animals.

Arsenic poisoning is one of the more important causes of heavy metal poisoning in domestic animals. Two species--dogs and cattle--are intoxicated more frequently than other animals; yet sporadic instances of poisoning have been observed in cats, horses, and pigs. Cases observed by veterinary clinicians are either peracute, acute, or chronic intoxications. Frequently the initial and only indication that a severe problem exists with peracute poisoning in a cattle herd is dead animals. Chronic intoxications are also observed in cattle. Acute intoxication is the most common form of arsenic poisoning observed and documented in the dog. Also intoxicated dogs were younger, i.e., 2-6 months of age. Arsenic is a severe alimentary tract irritant in domestic animals, and treatment in most instances consists mainly of symptomatic and supportive treatment. The source of intoxication, when it can be determined, is usually dips, sprays, powders, or vegetation contaminated by pesticides containing arsenic.