Symptoms Of Intoxication Research Articles

How does pharmacological and toxicological knowledge evolve? A case study on hydrogen cyanide in German pharmacology and toxicology textbooks from 1878 to 2020

Little is known about how pharmacological and toxicological knowledge evolves. The aim of this study was to investigate the changes in the presentation of the poison hydrogen cyanide in sixteen German-language pharmacology and toxicology textbooks from 1878 to 2020. The categories of structure, molecular mechanism of action, occurrence, effects, resorption, areas of application, lethal dose, acute symptoms of intoxication, treatment of hydrogen cyanide poisoning, and recommended therapeutic preparations were evaluated. The knowledge on the structure, lethal dosage, and occurrence of hydrogen cyanide has remained constant. In contrast, knowledge on molecular mechanism of action and recommended preparations of the poison has changed dramatically. Until 1944, the binding of hydrogen cyanide to hemoglobin was considered the mechanism of action, whereas from 1951 onwards, the interaction of hydrogen cyanide with the Fe3+ of cytochrome oxidase was described. The number of preparations containing hydrogen cyanide decreased into obsolescence until 1951. The areas of application of hydrogen cyanide also show a change, as from 1919 onwards, mainly industrial areas of application of the poison are described instead of medical ones, and from 1951 onwards, criminalistic areas of application are also mentioned. Thus, pharmacological and toxicological knowledge develops non-linearly, molecular mechanism and uses being the most dynamic areas, whereas the knowledge about hydrogen cyanide’s chemical structure, lethal dose, and occurrence remained constant. Older pharmacology and toxicology textbooks were better than newer ones at discussing changes in scientific concepts. Pharmacology and toxicology textbooks also mostly failed to discuss the misuse of hydrogen cyanide (Zyklon B) during the Nazi regime, missing an important opportunity to showcase the ethical responsibility of pharmacology and toxicology. Thus, future pharmacology and toxicology textbooks should improve on discussing the development of pharmacological and toxicological concepts and the ethical responsibility of the discipline.

Evaluation of some toxicological parameters of Oxantel-, Pyrantel- and Praziquantel-based anthelmintic in tablet formulation for dogs and cats

The purpose of the research is to evaluate some toxicological parameters of a new combined anthelmintic based on oxantel pamoate, pyrantel pamoate and praziquantel in tablet formulation for dogs and cats.Materials and methods. The studies used 70 outbred male rats and 50 outbred male mice. Acute oral toxicity was studied in male mice and male rats weighing 14–16 and 160–180 g, respectively. The subchronic toxicity study with the drug administered repeatedly, orally for 14 days was conducted on male rats weighing 180–200 g. The study monitored the laboratory animals’ overall health status, behavior and possible death, and any intoxication symptoms were recorded. All studies were performed using conventional techniques for experimental (preclinical) studies of new pharmacological substances using the guidelines edited by R. U. Khabriev (2005) and A. I. Mironov et al. (2012). Additionally, the experiments assessed clinical toxicological, biochemical, and morphological parameters of the laboratory animals.Results and discussion. In evaluation of the drug acute toxicity in the male mice and the female rats, the LD50 exceeded the dose of 6000 mg/kg; the animals showed no signs of intoxication during the entire study. Thus, the drug was classified as substance hazard category 4. Doses 600, 300 and 120 mg/kg of the drug had no negative effect on the organism of the laboratory animals in the subchronic experiment on the male rats; the doses were ineffective (safe). The threshold or toxic dose could not be determined.

Epidemiological Study of the Causes of Alcohol Drinks in Cases of Alcohol Poisoning among Patients who Referred to Amir Al-Momenin Hospital in Zabol in 2016-2019

Background: Abuse of substances such as alcohol as a social issue affects the health of human life. In this study, we decided to address the prevalence of alcohol poisoning and its effective factors among patients referred to Amir Al-Momenin Hospital in Zabol. Methods: In this cross-sectional study, 110 patients with alcohol poisoning who had referred to Amir Al-Momenin Hospital in Zabol in 2016-2019 participated. Necessary information was collected through a questionnaire. Finally, the obtained data were statistically analyzed by T-test, Chi-square and Fisher's exact tests. Results: In the present study, 110 patients with alcohol poisoning were included in the study, of which 91 (82.72%) had ethanol poisoning and 19 (17.27%) had methanol poisoning. The mean age of patients was 27.08 ± 3.2 years and 95.45% of them were male. Unemployment and lack of entertainment, mental disorders, alcoholic friends, psychological dependence were the most common causes of alcohol consumption in patients. In this study, decreased level of consciousness (57.27%) and gastrointestinal complications (43.63%) were the most common symptoms of alcohol poisoning in the studied patients. Conclusion: In the present study, male gender was significantly associated with alcohol poisoning (P). While the variables of age, sex and marital status were not significantly associated with the type of ethanol or methanol poisoning. The results of the study showed that male gender, social status and low education of parents, psychological problems and alcohol friends were risk factors and influential factors in alcohol poisoning.

Evaluating and Enhancing an Educational Intervention to Reduce Smallholder Farmers' Exposure to Pesticides in Uganda Through a Digital, Systematic Approach to Behavior Change: Protocol for a Cluster-Randomized Controlled Trial.

Smallholder farmers receive educational interventions on safe pesticide handling by governmental agencies, industries, or nongovernmental organizations to reduce exposure risks. However, existing educational interventions have limited effects on changing behaviors. Targeting psychosocial determinants of behavior change in educational interventions through theory- and evidence-based approaches may enhance their effectiveness. We aim at describing the intervention development and study design of a 3-arm cluster-randomized controlled trial to assess the effects in improving safe pesticide handling and reducing pesticide exposure of (1) an existing educational intervention and (2) a newly developed SMS text messaging intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) behavior change approach. We enrolled 539 Ugandan smallholder farmers in 12 clusters (subcounties). The clusters, each with 45 farmers, were randomly allocated to one of the three arms: (1) educational intervention, (2) educational intervention+RANAS-based SMS text messages, or (3) control group. The educational intervention comprised a 2-day workshop that targeted multiple aspects of safe pesticide handling, whereas the SMS text messages targeted the use of personal protective equipment (PPE) and were based on the RANAS approach. For intervention development in this study, this approach includes identifying psychosocial determinants of PPE use at baseline and selecting behavior change techniques to target them in SMS text messages. The primary outcomes of the study are (1) pesticide knowledge, attitude, and practice scores indicating performance throughout the educational intervention; and (2) frequency of PPE use. Secondary outcomes are the RANAS-based behavioral determinants of PPE use, the frequency of glove use, algorithm-based pesticide exposure intensity scores, and signs and symptoms of pesticide poisoning. The outcomes were assessed in structured interviews before the intervention (baseline) and at the 12-month follow-up. The effect of the interventions among the arms will be analyzed using the intervention arms and baseline measures as predictors and the follow-up measures as outcomes in linear multivariable mixed models including the clusters as random effects. The mediating psychosocial determinants of the interventions will be assessed in multiple mediation models. The study was conducted from 2020 to 2021-baseline interviews were conducted in October 2020, and the educational intervention was delivered in November 2020. The RANAS-based SMS text messages were developed based on the baseline data for relevant behavioral determinants of PPE use and sent between February 2021 and September 2021. Follow-up interviews were conducted in October 2021. Overall, 539 farmers were enrolled in the study at baseline; 8.3% (45/539) were lost to follow-up by the end of the study. This study will contribute to a better understanding of the effectiveness and behavior change mechanisms of educational interventions by using an experimental, cluster-randomized study design to improve pesticide handling among smallholder farmers. International Standard Randomised Controlled Trial Number (ISRCTN) 18237656; https://doi.org/10.1186/ISRCTN18237656. DERR1-10.2196/55238.

HYPERTENSION AND DEXTROMETHORPHAN POISONING IN PATIENTS AGED BETWEEN 0 TO 18 YEARS- A 7 YEAR RETROSPECTIVE CASE SERIES

Objective: Coughing is a common symptom in the pediatric population. The wide variety of preparations available in pharmacies allows easy access to over-the-counter use. Dextromethorphan inhibits the cough reflex through an antagonistic mechanism at the NMDA-glutamate opioid receptor. Its effects are similar to those of drugs of abuse (phencyclidine and ketamine). In high doses, it produces tachycardia, hypertension, altered consciousness to coma, and neurological symptoms (agitation, hallucinations, seizures). According to the literature, patients between the ages of 12 and 20 years account for 50% of all dextromethorphan poisoning emergencies. The aim of our study is to determine the presence of arterial hypertension, its characteristics and the course of its development in dextromethorphan intoxication. Design and method: We present a series of 18 cases of acute dextromethorphan poisoning that were admitted to the Pediatric Antitoxic Center in Bucharest between January 2017 and November 2023. Results: The age range in the series of 18 patients is from 1 to 17 years. Voluntary intoxication was recorded in 13 cases (72.22%) Hypertension was noted in 15 cases (83.33%). Hypertension was present at the onset of symptoms. The poisoning severity score(PSS) showed that most of the cases were moderate (77.77%) Conclusions: Hypertension is a common symptom of dextromethorphan intoxication in patients between 0 and 18 years of age and may be accompanied by palpitations and precordialgia. It is mild to moderate in severity and does not require any specific treatment, as general management of the intoxication is sufficient. Severe cases or death are a rare event, while moderate cases are the most common.

Evaluation of antihypoxic effects of therapeutic breathing mixtures with high argon content on the example of acute blood loss in laboratory animals: a preclinical randomized experimental study

Background. According to the hypothesis of the study, the therapeutic efficacy of measures to treat hypoxic (ischemic) emergencies can be significantly increased by using an artificial gas mixture with normal or increased oxygen content and a high content of argon, being bioactive despite its chemical inertness.Objective. To experimentally evaluate the antihypoxic effects of argon on the example of acute massive blood loss in experimental animals.Methods. The study was carried out on 72 albino male gray rats with a baseline body weight of 220–250 g. The experiments were performed at the premises of the Konstantinov St. Petersburg Nuclear Physics Institute of the Kurchatov Institute and the Smorodintsev Research Institute of Influenza (Russia). Prior to the experiment, the animals were quarantined for 2 weeks in the vivariums of the performing organizations. Acute massive blood loss in rats was formed by taking blood (12 ± 1% of body weight on average) using syringe method by transcutaneous cardiac puncture. Rats were randomized into 3 groups (24 individuals each) depending on the gaseous medium where the animal was placed after artificial blood loss. Composition of the applied gaseous medium in the comparison groups: medium No. 1 — oxygen 21% vol.; argon — 30% vol.; nitrogen — the rest; medium No. 2 — oxygen 21% vol.; argon — the rest; medium No. 3 (control) — air. The postoperative follow-up (post-conditioning) for 8 hours involved assessing and recording the following indicators: survival/lethality rates; recovery rates (anesthesia recovery, somatic mobilization); clinical symptoms of possible intoxication with the gas mixture during inhalation exposure. The surviving animals were then monitored for 4 days to evaluate their health and behavioral performance. Upon completing the observation period, the animals were euthanized.Results. After artificially-induced blood loss, all the non-survivors died within 1.5–8 hours after the operation. In group 1 (post-conditioning in medium No. 1), the lethality of laboratory animals amounted to 4 individuals out of 24 (16%); in group 2 (post-conditioning in medium No. 2) — 2 individuals out of 24 (8%). In the control group, the lethality rate was significantly higher — 10 animals out of 24 (42%). The surviving animals demonstrated no lethality or morbidity within 4 days after the exposure. Analysis of outcomes between experimental groups and controls revealed that the significance of differences in the lethality index between group 1 and control (by Fisher’s two-sided criterion) comprised p = 0.06; between group 2 and control — p = 0.017. When the statistical “power” of the experimental group was increased (by combining samples 1 and 2), the significance of differences in outcomes in this group compared to the control accounted for p < 0.001.Conclusion. The conducted studies confirmed the hypothesis about the pronounced antihypoxic effect of argon, which significantly increased the survival rate of experimental animals after massive artificially-induced blood loss.

Relationship between the outcomes of intensive phase therapy in patients with newly diagnosed infiltrative pulmonary tuberculosis and activity of purine metabolism enzymes as well as CD3+CD8+ lymphocyte level

Monitoring activity of inflammatory process and lymphocyte subsets can help assess the effectiveness of intensive phase therapy (IPT) already in the early stages of treatment. The goal is to evaluate changes in the concentration and activity of enzymes associated with purine metabolism and peripheral blood lymphocyte subset composition, and to determine their relationship with IPT effectiveness in patients with newly diagnosed infiltrative pulmonary tuberculosis (IPTb). Materials and methods. In 141 IPTb patients, the IPT data were presented as follows: “significant improvement” (SI) — disappearance of intoxication symptoms, abacillation, closure of decay cavities; “less pronounced improvement” (LMI) — eliminated symptoms of intoxication, abacillation, pronounced resorption of focal and infiltrative changes, reduction of decay cavities. We assessed the activity of adenosine deaminase in blood serum (eADA-1, 2), mononuclear cells and neutrophils, the concentration of blood serum ecto-5'-nucleotidase (eHT5E), CD26 (DPPV) in blood serum (s, soluble form) and mononuclear cells (m, membrane form), subpopulation composition. Results. Patients exhibit increased concentrations of eNT5E, mCD26 (DPPIV) and eADA-2 activity, and decreased intracellular ADA-1 activity. In the “LMI” group, after IPT, an increased sCD26 (DPPV) level was noted. The groups differed in lymphocyte counts and percentage of CD3+CD8+ cells. eADA-2 activity was higher in the LMI group and increased after IPT, in contrast to comparison group. mCD26 (DPPIV) concentrations are higher in PD patients before therapy and after IPT. Conclusion. Thus, the outcome of IPT in IPTb patients is associated with altered T-lymphocyte populations and severity of the inflammatory process. Studying the activity of membrane and soluble eADA-2, CD26 (DPPIV) and percentage of CD3+CD8+ T-lymphocytes in the early stages of therapy can provide the necessary information for correcting personalized pathogenetic therapy of patients with newly diagnosed IPTb.

Negative Impacts of the High-Tech Implementation in the Russian Higher Education Sector

Introduction. The institute of education in modern society is currently in the process of serious transformation associated with the large-scale introduction of high technologies, which is due to a similar process in post-industrial society as a whole. There is a growing understanding of the negative consequences of digitalization of society and education along with the understanding of the objective necessity of such transformation. The article contains an analysis of the negative consequences and problems arising in the course of the spread of digitalization of higher education in Russia. Methodology and sources. The methodology of the research is based on the methods of comparative analysis and extrapolation of transformations of social environment and anthropological factors under the influence of technological progress in the field of higher education. The signs of “high technology poisoning” considered by J. Naisbitt in his book “High Tech – High Touch: Technology and Our Search for Meaning” and the concept of extensive and intensive types of creativity formulated by A.I. Stoletov are a conceptual basis for analyzing the impact of high technology on education. Results and Discussion. Seven symptoms of technological poisoning in higher education, representing the main risks of the modern educational system, their manifestations in the educational process and prospects in case the existing trend persists, have been considered. One of the sources of manifestation of these symptoms is the extensive character of creativity inherent in scientific and technological activity of the society, which stakes on innovative development and mastering of material aspects of nature. The technogenic character of the emerging innovation process levels out the activities associated with the intensive type of creativity, aimed at the meaning-creating and existential aspects of human existence. Conclusion. Minimization of negative consequences presupposes the strengthening of the humanitarian component in education, allowing to form a culture of “pause of contemplation” (Grigory Pomerantz), in which technology will acquire, as it was suggested by J. Naisbitt himself, a fullness of meaning that goes beyond instrumental values into the realm of ethical and existential ones.

Perception of the use and exposure to pesticides among farmers in Santana do Livramento, Rio Grande do Sul state - Brazil

The majority of farmers in Brazil have a low level of education, which makes it difficult for them to read and understand pesticide labels and can result in poisoning during field applications. The aim of this study was to verify the perception of farmers and rural workers in the district of Santana do Livramento, Rio Grande do Sul - Brazil, concerning the use of and exposure to pesticides, as well as the damage caused to their health and the environment. Thirty-one farmers who make use of pesticides on their property were interviewed, together with the people that apply the pesticides. The profile of those interviewed showed that the majority were male (87.5%), with a professional occupation characterised as rural worker (29.2%) and a high school education (29.15%). When reading the labels and pictograms, none of the respondents correctly defined the figures on the labels or knew their meaning, the conclusion being that comprehension is still a problem. The perception of the farmers concerning the use of and exposure to pesticides was considered low despite claiming to know the risks that exposure entails. However, their partial use of PPE and their difficulty in understanding the product labels would contradict this claim. In addition, a proportion of those interviewed had already experienced some symptoms of poisoning.

Treatment with Digoxin – is it a clinical challenge? A Retrospective Analysis of Hospitalizations due to Digoxin intoxication

Introduction and purpose: Digoxin, a cardiac glycoside derived from Digitalis lanata, has stood as a cornerstone in the treatment of various cardiovascular disorders for centuries. This study aims to delve into the demographic aspects, clinical characteristics, and outcomes associated with Digoxin poisoning. By drawing upon a dataset involving 22 patients hospitalized for Digoxin intoxication at the Clinical Department of Toxicology and Cardiology in Lublin, Poland, spanning from April 2014 to December 2023, our investigation seeks to provide an understanding of this issue.Brief description of the state of knowledge: Despite the efficacy of Digoxin, the potential risk of intoxication, especially in the elderly, necessitate a comprehensive examination. Age-related changes, such as declining renal function, electrolyte imbalances, comorbidities and polypharmacy affect how drugs like Digoxin work. The symptoms of Digoxin poisoning can manifest in various organ systems such as cardiovascular, gastrointestinal, nervous system, highlighting the importance of prompt recognition to seek medical attention.Methods and results: In our study, we analyzed data from 22 patients hospitalized due to Digoxin intoxication, focusing on demographic aspects, clinical characteristics and outcomes. The cases of Digoxin poisoning were categorized according to several factors, including the quantity and nature of substances consumed, the cause of intoxication, gender, age brackets, health conditions, peak serum Digoxin levels, length and outcomes of hospitalization.Conclusions: Our study provides insights into the characteristics and outcomes of patients hospitalized due to Digoxin intoxication. The findings underscore the association of Digoxin poisoning, and emphasize the importance of monitoring serum levels to prevent adverse outcomes. As Digoxin continues to be relevant in treating cardiovascular conditions, our study calls for careful management and monitoring.

You Code It! Cannabis Poisoning in a 4-Year-Old

There has been a significant increase in the number of patients evaluated and treated for exposure to edible cannabis products. This coding challenge asks you to determine the correct procedure and diagnosis codes for services to a patient who presents with symptoms of cannabis poisoning.

Current situation regarding psychedelics and magic mushroom in Korea

IntroductionRecently, the pros and cons have been debating in Korea even before the approval of use of medical marijuana with very strict limitations. And the next controversial topic is psychedelics. In 1890, when mescaline was first isolated from peyote cactus, clinical researches began, but due to its harmful effects, it was thereafter legally prohibited in 1970 in USA. However, a pernicious debate over the medical efficacy of psychedelic drugs has begun again with the release of a study that uses psychedelic mushrooms to be effective against treatment-resistant depression, alcohol dependence, and depression and anxiety in terminal cancer patient.ObjectivesTo make a consensus on the medical use of these, we reviewed wild mushrooms containing hallucinogenic ingredients living in Korea.MethodsTo make a consensus on the medical use of these, we reviewed wild mushrooms containing hallucinogenic ingredients living in Korea.ResultsMushrooms have long been popular as a food ingredient in Korea. Psilocybin, a classical psychedelic, can be obtained from magic mushroom (Psilocybe cubensis). The psilocybin on the CNS and causes hallucinations. Intoxication symptoms include pleasant or nervousness, sudden laughter, hallucinations, visual impairment, tachycardia and hypertension, reflexes, agitation, cognitive impairment, confusion, and aggressive behavior. These symptoms last for 2-4 hours after ingestion, and most disappear within six hours.Among 114 species of Psilocybe containing psilocybin around the world, only five wild mushrooms found in Korea that cause nervous system hallucinations are as follows: P. argentipes, P. coprophila, P. perdaria, and P. subcarulipes.In Korea, there is acute poisoning case suffering with GI symptoms caused by mushrooms, but it is difficult to find records of abuse or dependences case caused by psychedelic mushrooms. In addition, although oriental medicine treatment is relatively active, it is not used as an herbal medicine.ConclusionsCurrently, the Korean government classifies psychedelic mushroom-derived substances, Psilocybin and Psilocin, as psychotropic drugs by law. If researcher intends to clinical trial with eve very small amount of it for academic purpose, it is only possible after obtaining approval from Korean FDA. In order to determine the usefulness of psychedelics, many clinical studies are needed in Korea.Disclosure of InterestNone Declared

Bifenthrin induces changes in clinical poisoning symptoms, oxidative stress, DNA damage, histological characteristics, and transcriptome in Chinese giant salamander (Andrias davidianus) larvae

Bifenthrin (BF) is a broad-spectrum insecticide that has gained widespread use due to its high effectiveness. However, there is limited research on the potential toxic effects of bifenthrin pollution on amphibians. This study aimed to investigate the 50 % lethal concentration (LC50) and safety concentration of Chinese giant salamanders (CGS) exposed to BF (at 0, 6.25,12.5,25 and 50 μg/L BF) for 96 h. Subsequently, CGS were exposed to BF (at 0, 0.04, and 4 μg/L BF) for one week to investigate its toxic effects. Clinical poisoning symptoms, liver pathology, oxidative stress factors, DNA damage, and transcriptome differences were observed and analyzed. The results indicate that exposure to BF at 4 μg/L significantly decreased the adenosine-triphosphate (ATP), superoxide dismutase (SOD), glutathione (GSH), and catalase (CAT) contents in the brain, liver, and kidney of CGS. Additionally, the study found that the malondialdehyde (MDA), reactive oxygen species (ROS), and 8-hydroxydeoxyguanosine (8-OHdG) contents were increased. The liver tissue exhibited significant inflammatory reactions and structural malformations. RNA-seq analysis of the liver showed that BF caused abnormal antioxidant indices of CGS. This affected molecular function genes such as catalytic activity, ATP-dependent activity, metabolic processes, signaling and immune system processes, behavior, and detoxification, which were significantly upregulated, resulting in the differential genes significantly enriched in the calcium signaling pathway, PPARα signaling pathway and NF-kB signaling pathway. The results suggest that BF induces the abnormal production of free radicals, which overwhelms the body's self-defense system, leading to varying degrees of oxidative stress. This can result in oxidative damage, DNA damage, abnormal lipid metabolism, autoimmune diseases, clinical poisoning symptoms, and tissue inflammation. This work provides a theoretical basis for the rational application of bifenthrin and environmental risk assessment, as well as scientific guidance for the conservation of amphibian populations.

Harmful blooms caused by dinoflagellates in the Pacific of Guatemala (2019–2022)

Plankton studies in Guatemala are associated with the history of harmful algal blooms (HAB). An important event was observed in 1987, with 193 human poisonings due to shellfish consumption, of which 22 were lethal. The causative organism was Pyrodinium bahamense var. compressum. This species was reported again in November 2019 in the coastal Guatemalan Pacific. The species reached an abundance of 1 × 104 cells/L. In September 2020, the abundance of the Margalefidinium polykrikoides vegetative stage reached 1.24 × 106 cells/L, and its cysts 1.5 × 106 cells/L. Noctiluca scintillans proliferated (the first quantitatively estimated bloom of this species in Guatemala) in November 2020 and March 2021 (up to 1.2 × 106 cells/L). From January to December 2021, monthly monitoring was carried out in front of the Port of Quetzal at three sites (bottle and 25 μm mesh net samples). In April 2022, 11 cases of humans presenting symptoms of paralytic shellfish poisoning (PSP) were recorded in the western sector of the Guatemalan Pacific, in particular, in the municipality of Tiquisate in the department of Escuintla. From May 3 to 27, 2022, a HAB event caused the death of 4 and the poisoning of 34 humans in the departments near Mexico: Retalhuleu (Champerico), San Marcos (Tilapa) and Escuintla (Tiquisate, Buena Vista and Iztapa). The maximum saxitoxin (STX) concentration was determined in Retalhuleu (14,099 MU/100 g); until 7 July 2022, STX continued to be detected in Tilapa and Tiquisate (1,021 MU/100 g). The P. bahamense cells were observed in the stomach contents of the clam Tagelus sp. (Bivalvia: Solecurtidae).

Metapneumovirus infection in children in modern conditions: clinical and immunological parallels

Aim. The study of metapneumovirus infection clinical and immunological features in children of different ages. Patients and methods. An analysis of 22 patients with mono-metapneumovirus infection is presented. There were 7 (31.8%) children under the age of 1 year, 8 (36.4%) — 1—3 years old, 7 (31.8%) — 4—7 years old. Diagnosis of metapneumovirus infection was based on clinical data and on PCR analysis of nasopharyngeal mucus. Immunological studies in 10 patients included immunophenotype of patient's blood lymphocytes and analysis of the interferon system. Results. Among children under the age of 1 year 71.4 ± 17.1% were diagnosed with obstructive bronchitis and 28.6 ± 17.1% had pneumonia. In patients aged 1—3 years pneumonia was observed more often (55.6 ± 17.6%), obstructive bronchitis — less often (33.3 ± 16.7%), and in 11.1 ± 11.1% bronchitis occurred without symptoms of bronchial obstruction. In children aged 4—7 years only the upper respiratory tract was affected in 14.3 ± 13.2% of cases, 57.1 ± 18.7% developed bronchitis and 28.6 ± 17.1% — pneumonia. The immune system state was characterized by a low content of T-helpers (CD3 + CD4 + ) and NK-cells (CD3-CD16 + CD56 + ) detected in 7 (70%) and 5 (50%) patients respectively. IFNγ production was reduced in 70% of children and IFNα in 80%. Conclusion. Metapneumovirus infection in children in modern conditions is characterized by the frequent development of inflammatory changes in the bronchopulmonary system in the early stages of the disease. The disease severity was due to both manifestations of respiratory failure and severe symptoms of intoxication. Immunological studies revealed changes in the cellular link and the interferon system in all age groups.

Children Intoxicated with Psychoactive Substances: The Health Status on Admission to Hospital Based on Medical Records.

Introduction: Alcohol is the most common psychoactive substance among young people. The use of psychoactive substances gives rise to a number of health, social, moral and economic problems. The aim of the study was to characterise the symptoms reported by children and adolescents presenting with psychoactive substance intoxication on admission to hospital. Methods: The study included a group of 303 patients aged 0 to 18 years, diagnosed with psychoactive substance intoxication. This retrospective study assessed medical records of patients hospitalised at the Provincial Specialist Children's Hospital in Olsztyn between 2016 and 2018. Results: Body temperature on admission varied depending on the type of psychoactive substance taken (χ2 = 14.12, p < 0.006). Girls were more likely to have an increased heart rate than boys. An analysis of the symptoms of intoxication over the years 2016-2018 showed significant differences in the incidence of the following symptoms: disturbed consciousness (χ2 = 8.75, p < 0.01), visual disorders (χ2 = 8.02, p < 0.02), loss of consciousness (χ2 = 37.71, p < 0.000001), drowsiness (χ2 = 7.33, p < 0.03), hypothermia (χ2 = 18.95, p < 0.00008) and gait disturbances (χ2 = 13.08, p < 0.002). Conclusions: Girls are more likely to use stimulants such as alcohol and cigarettes, while boys are more likely to opt for designer drugs. The number of patients hospitalised more than once increases every year. Gastrointestinal intoxication with psychoactive substances was most common. The most severe intoxication was associated with alcohol intake, while the most intense pain was reported by patients poisoned with other psychoactive substances.

Indoxacarb poisoning causing methemoglobinemia treated with parenteral vitamin C: a case report

IntroductionThis case study reports on a suicide attempt involving indoxacarb and vitamin C. Indoxacarb is a neurotoxic insecticide used in agriculture and as a flea controller in pets. Cotton, vegetables, and fruits are treated with indoxacarb, an insecticide that can be applied both indoors and outdoors. It causes skin allergies, methemoglobinemia, and hemolytic anemia. It is also attributed to allergic reactions through ingestion, inhalation, physical contact, and translaminar action. This case report highlights use of vitamin C in methemoglobinemia caused by indoxacarb poisoning. Indoxacarb poisoning has the potential to be extremely serious and even lethal. In this instance, the patient initially had no symptoms after ingesting a substance containing indoxacarb in an attempt at suicide. However, further tests revealed methemoglobinemia and low oxygen levels.Case presentationA 28-year-old south-east Asian female patient ingested an insecticide containing 5.25% novaluron, 4.5% indoxacarb, and 25% thiamethoxam, and reported that she noticed muddy brown urine but presented with no active signs or symptoms of poisoning. Upon examination, the patient was fully conscious, alert, and hemodynamically stable, but had an oxygen saturation of 84%. Gastric lavage was performed, and blood investigations revealed a muddy-brown-colored blood sample and methemoglobin levels of 12%. The patient was treated with high-dose vitamin C and showed significant improvement, with a drop in methemoglobin levels to 1.2% and an increase in oxygen saturation to 97%.DiscussionIndoxacarb poisoning can cause severe methemoglobinemia. Vitamin C may be a useful treatment option for methemoglobinemia caused by indoxacarb, particularly in cases in which traditional treatment with methylene blue is contraindicated or not tolerated. Hence high doses of ascorbic acid, that is, vitamin C, were administered to the patient, which lowered their methemoglobin levels and improved oxygen levels without much safety concerns.ConclusionThis example emphasizes the significance of early indoxacarb poisoning detection and treatment as well as the possible advantages of utilizing ascorbic acid in the management of methemoglobinemia, and highlights the use of vitamin C in the treatment of methemoglobinemia caused by indoxacarb poisoning. Therefore, it is important for healthcare professionals to be aware of the potential for indoxacarb to cause methemoglobinemia and to consider vitamin C as a treatment option.

Metaphedrone (3-Methylmethcathinone): Pharmacological, Clinical, and Toxicological Profile.

Introduction: Synthetic cathinones are a group of novel psychoactive substances used as an alternative to classical recreational drugs. As a result of legal prohibitions on older generations of these compounds, new formulations appeared on the drug market. One of them is metaphedrone (3-methylmethcathinone, 3-MMC), a structural isomer of 4-methylmethcathinone and a psychostimulant drug. Metaphedrone became popular in a large number of countries in a short period of time. The aim: The collection, analysis, and review of relevant research on the subject of metaphedrone in order to present information about the pharmacological, clinical, and toxicological profile of this compound. An assessment of the significance and role of metaphedrone in consumption patterns of novel psychoactive substances among recreational drug users. Methodology: By using search engines like Google Scholar and PubMed, the relevant literature on metaphedrone was looked for and analyzed. The search was not limited to a specific period of time. All information regarding the compound of interest was analyzed and presented. Key results and discussion: All novel psychoactive substances are abused due to their pronounced stimulatory, hallucinogenic, dissociative, and euphoric and/or relaxing characteristics. Users of 3-methylmethcathinone usually opt for this substance for recreational purposes and/or sexual stimulation. Metaphedrone has the potential to cause a psychological dependence to the users. It was determined in relevant studies that most users are from 17 to 50 years of age. Older users usually administer metaphedrone intravenously, while younger ones usually choose snorting and oral ingestion of the drug. In Serbia, metaphedrone is a legally controlled substance. The pharmacodynamic properties make metaphedrone similar to classical recreational drugs. The method of administration, mainly repeated administration in a single session, could be explained using the pharmacokinetic profile of the drug. The most reported symptoms of intoxication were those of a sympathomimetic nature, such as tachycardia, chest pain, hypertension, diaphoresis, and agitation. Most intoxications and fatal outcomes occurred to users who combined several psychoactive substances. The correlation between measured blood concentrations of the drug and outcomes of intoxication was not found. The mechanisms of metaphedrone's toxicity are not fully understood. Conclusions: There is an increasing trend of abuse of metaphedrone among recreational drugs users. Future studies should focus on pharmacological and toxicological effects of metaphedrone on animals and humans.

A case of a combined course of typhoid fever and leptospirosis

Coinfections are becoming increasingly relevant and urgently require research. The development of international tourism has caused the rapid spread of infectious diseases from countries with unfavorable sanitary and hygienic conditions. This article analyzes the clinical case of a patient who recently returned from India and developed a combined course of typhoid fever and leptospirosis due to astrovirus infection and blastocystosis. The disease was characterized by symptoms of enteritis, low-grade fever, and mild intoxication. The patient repeatedly sought medical help. Diagnoses of “acute respiratory viral infection” and “intestinal infection of unknown etiology” were established. Symptomatic therapy was performed without a positive effect; fever and severe asthenic syndrome persisted. The patient was hospitalized on the 18th day of illness with moderate severity. Taking into account clinical, anamnestic, and epidemiological data and laboratory examination results, typhoid fever was diagnosed. A polymerase chain reaction (PCR) test identified astrovirus RNA in the stool, and Blastocystis hominis was detected during stool examination. Despite the ongoing pathogenetic and antibacterial therapy, considering the determination of the pathogen’s sensitivity to antibiotics, the patient’s condition worsened. On day 23 of the illness, jaundice, hemorrhagic syndrome, and signs of acute renal failure were noted. Through in-depth analysis of changes in the clinical and laboratory findings, considering epidemiological history data (stay in a region endemic for leptospirosis), leptospirosis was diagnosed and treated with antibacterial therapy. Complex intensive therapy using extracorporeal treatment methods helped prevent the development of unfavorable outcomes of combined pathology. This clinical case emphasizes that doctors must be wary of imported infections and conduct additional comprehensive investigations of suspected cases.

Hemoadsorption Combined with Hemodialysis and the “Inflammation Mitigation Hypothesis”

ABSTRACT Clinical outcomes are still unsatisfactory in patients undergoing chronic maintenance dialysis. Signs and symptoms of uremic intoxication are often present even in presence of an adequate dialysis delivery. These along with cardiovascular and skeletal complications, have been correlated to the accumulation of inflammatory chemical mediators, beta-2 microglobulin (β2M), parathyroid hormone (PTH) and other middle to large molecular weight toxins that are insufficiently cleared by current dialysis techniques. Such condition determines a vicious loop where a subclinical status of inflammation causes a disruption of the immunological response affecting outcomes by accelerated atherosclerosis, anemia, and frequent infections. The overall picture can be described as a systemic inflammatory syndrome with simultaneous activation of the innate and the adaptive immunity. In such condition, new options and techniques are required to achieve a more effective blood purification and to correct the altered immuno-homeostasis. New efficient and biocompatible sorbents are today available (HA 130 Cartridge, Jafron Medical, Zhuhai, China) and they can be advantageously coupled in series with the hemodialyzer to perform hemoadsorption combined with hemodialysis (HA-HD). This technique has been already studied in at least two randomized trials demonstrating an effective improvement of clinical and biochemical outcomes. We have calculated the kinetics of β2M in a single session, in a series of three consecutive sessions of a week and in a period of three months using different frequencies of application (first month: Three sessions per week; second month: Two sessions per week; third month: One session per week). In the single session the reduction ratio was superior to other techniques such as hemodialysis (HD), high-flux hemodialysis (HFD) or hemodiafiltration (HDF). In the thrice weekly regime, the time average concentration (TAC) of β2M resulted inferior to HD and HDF. In the long period, a lower concentration of β2M was maintained even with a once-a-week regime. Considering the parallel reduction of inflammatory parameters, we could hypothesize that the enhanced removal of uremic toxins and chemical mediators led to a mitigation of the systemic inflammation with a progressive reduction in the generation of β2M. This “inflammation mitigation hypothesis (IMH)” supports the prescription of HA-HD once a week, possibly after a month of thrice weekly regime.