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Patients with malicious poisoning (MP) are individuals who are the victims of another person's intent to harm them through poisoning. Limited studies have investigated the clinical features and outcomes of MP. We evaluated the characteristics and outcomes of MP cases presented to emergency departments (EDs). This multicenter retrospective study enrolled MP patients who presented to three EDs in northern Taiwan. Patients with uncertain or unreasonable exposure histories and those who remained asymptomatic throughout the incident were excluded. In total, 14,329 poisoning cases were recorded between 2012 and 2019; of these, 82 (0.57%) were identified as MP cases. The incidence of MP was highest among individuals aged 13-49 years. Friends (37.8%) were the most common perpetrators, followed by family members (15.9%) and colleagues (4.9%). Sedative/hypnotics were the most frequently used substance (36.6%), followed by stimulants (26.8%) and street ketamine (6.1%). Most patients (75.6%) were discharged from the ED after a thorough assessment, while 11 (13.4%) were admitted. Of those admitted, six (7.3%) required admission to an intensive care unit. No mortalities were reported. Preschool victims (aged <6 years) exhibited more severe poisoning, with lower Glasgow Coma Scale scores and higher rates of intubation compared to non-preschool victims. Patients with MP exhibited characteristics that differed significantly from other forms of poisoning. Healthcare providers must remain vigilant for signs of MP in ED patients, particularly preschool children. [ABSTRACT FROM AUTHOR]

This study describes a case of poisoning by pyrrolizidine alkaloids in a horse. To the best of the author's knowledge, this is the first confirmed case of Senecio ovatus poisoning. A six-year-old 450-kg Irish cob mare was presented to the Equine Clinic of the University of Veterinary Sciences Brno (Czechia) with symptoms of hepatic encephalopathy, which progressively worsened with time despite intensive therapy and led to euthanasia. A complex diagnostic and therapeutic approach including the post-mortem patoanatomical and histopathological examination is described here. Regarding the histopathology of the liver, there was necrosis with haemorrhage, fatty changes and inflammation. A later inspection of the grazing area revealed the presence of Senecio ovatus (wood ragwort). A sensitive chromatographic method was used to determine the pyrrolizidine alkaloids and their metabolites in the plasma and the liver. In both of the samples, metabolites of pyrrolizidine alkaloids were detected. Although pyrrolizidine alkaloid poisoning was proven, the histopathological findings typical for this disease were absent. It is clear from our case that the histopathology in cases of poisoning by pyrrolizidine alkaloids may not always be conclusive. [ABSTRACT FROM AUTHOR]

Introduction: The increase in the production of substances to enhance the quality of life, the biodiversity of the different ecosystems in Mexico, and the unique characteristics of pediatric patients, contribute to intoxications within this population. Method: Analytical retrospective study of admissions to pediatric emergency care due to poisoning in < 16-year-old (2016 to 2020). Included variables were age, gender, type of toxic substance, exposure characteristics, and the season of the year. Frequencies, percentages, range, average and standard deviation were obteined. In the bivariate análisis, the Chi square test was used. A p-value < 0.05 was considered statistically significant. Results: Over 5 years, there were 459 cases, with a prevalence of 3.16%. No gender predominance was observed. The most common was caused by venomous animals (28.5%), followed by medication ingestion (27.6%). Only 5% of cases were suicide attempts, the rest were accidental (95%). Children up to 5 years old were more commonly by medication ingestion, hydrocarbons, or household products (p = 0.03, p = 0.0001), while the causes in older children were contact with venomous animals and ingestion of stimulants drugs (alcohol, amphetamines, cannabis, cocaine) (p = 0.0001, p = 0.006). Intoxication with quaternary ammonium herbicides was lethal in all cases. Conclusions: Children under the age of 5 are more susceptible to intoxication from common household products. Older kids tend to be more frequently a combination of stimulants drugs. [ABSTRACT FROM AUTHOR]

Background Overdoses of carbamazepine may occur due to various reasons. The summary of product characteristics of carbamazepine includes information about the possibility of side effects after taking this drug. However, the symptoms described do not include coronary vasospasm, which occurred in the case described. Making such a diagnosis is a key element in therapeutic management, as it changes further clinical decisions. Case summary A 46-year-old patient was admitted to the hospital for disorders of consciousness following an overdose of carbamazepine. On the second day, the patient exhibited respiratory distress. Subsequently, the patient was transferred to the intensive care unit, intubated, and placed on mechanical ventilation. On the same day, the patient experienced recurrent cardiac arrhythmias in the form of pulseless ventricular tachycardia and ventricular fibrillation; the patient was resuscitated and defibrillated eight times. Due to a rapid decline in cardiac output coupled with persistent electrocardiographic changes and haemodynamic instability, the patient underwent urgent coronary angiography. The procedure revealed a spasm in the initial segment of the circumflex branch of the left coronary artery, which subsequently resolved following nitroglycerin administration. Subsequent to the implementation of this therapeutic approach, a reduction in the demand for norepinephrine and dobutamine was achieved. In the following days, the patient's general condition improved. The patient was discharged home while maintaining full cognitive capacity and cardiovascular and respiratory fitness. Discussion In the case described, the expeditious performance of a cardiological diagnostic evaluation played a pivotal role in achieving therapeutic success, enabling the prompt initiation of appropriate treatment. [ABSTRACT FROM AUTHOR]

Illicit drug use is common among attendees of electronic dance music (EDM) festivals, but is often significantly underreported by participants. The current study aimed to compare the prevalence and over- and under-reporting of illicit drug use among attendees at EDM festivals in two European countries with distinct drug laws and cultures. Self-reported data regarding recent drug use were collected through interviews. Participants' blood alcohol concentrations were measured using a breathalyzer. Recent illicit drug use was assessed through sampling microparticles in the breath and consequent off-site analysis through liquid chromatography and tandem mass spectroscopy. Illicit drug use was higher in Belgium than in Sweden as indicated by self-reports (56.8 vs. 4.3%) and drug testing (37.2 vs. 12.5%). Underreporting was higher in Sweden than in Belgium; in Sweden, only 2.6% reported taking an illicit drug other than cannabis, whereas 11.6% tested positive, while the corresponding figures in Belgium were 36.5% and 36.9%. In both countries, results from self-reporting and drug testing for specific drugs matched poorly at the individual level, indicating unwitting consumption of substances. This study indicates that the drug use prevalence and the likelihood of disclosure may differ between countries or cultures, which should be considered when choosing methods to investigate drug use prevalence. [ABSTRACT FROM AUTHOR]

Background/Objectives: Poisonings among children are a major cause of morbidity and mortality worldwide and present a significant challenge for emergency medical services (EMS). The aim of this study was to analyze the types of substances causing poisonings and the intention of poisonings in children, providing detailed information on the most common causes of poisonings in different age groups. Methods: A retrospective study was conducted analyzing medical records of pediatric patients under the care of emergency medical services (EMS) in Wroclaw, Poland, between 2015 and 2017. The study included all patients under 18 years old diagnosed with poisoning. Data collected included age, sex, cause of poisoning, location of the incident, neurological status (GCS), and the type of healthcare facility. Results: The study included 484 patients, with a mean age of 13 years. The largest age group was 16–18 years (44%), and the majority were female (58%). The most common causes of poisonings were alcohol (29.3%), medications (26%), and intoxicants (24.8%). Over half of the incidents occurred at home (52.5%). Intentional poisonings constituted 75% of cases, particularly involving alcohol (38.6%), intoxicants (32%), and medications (26.7%). Accidental poisonings were mainly due to household chemicals (28.7%) and carbon monoxide (27%). The differences in causes and locations of poisonings were statistically significant (p < 0.001). Conclusions: Our study showed that the most common causes of poisonings among children were alcohol, medications, and intoxicants. Poisonings most frequently occurred at home, especially with medications, while outside the home, alcohol and intoxicants were predominant. This study was not registered. [ABSTRACT FROM AUTHOR]

Influenza and acute respiratory viral infections (ARVI) impose a substantial damage to the population health in the Russian Federation due to their seasonal circulation and predominantly affect young children. A very few data on the cytokine profile, the nonspecific LPO — AOD system and their relationships with clinical characteristics in such diseases in preschool children are available. The aim of this study was to assess the cytokine profile, LPO — AOD system parameters and their relationship with the clinical and laboratory characteristics of diseases in preschool children with influenza and other ARVI. 86 preschool children (3–6 years old) were examined: with an established diagnosis of influenza (n = 31), non-influenza ARVI (n = 28), apparently healthy children (control group (n = 27). All pediatric samples were analyzed by enzyme-linked immunosorbent assay assessing blood serum concentrations of C-reactive protein and cytokines IL-1β, IL-4, IL-6, IL-8, TNFα, IFNα, IFNγ. Spectrophotometric, fluorometric and enzyme immunoassay methods to assess the state of the “LPO — AOD” system were used. In the group of children with influenza vs other ARVI, a higher incidence of intoxication syndrome was revealed. Cytokine profile in children from both clinical groups compared with control cohort was featured with higher indicators of both pro-inflammatory and anti-inflammatory origin. Children with non-influenza ARVI, had increased magnitude of LPO final products in the nonspecific LPO — AOD system along with lowered concentration of fat-soluble vitamins, general antioxidant activity, GSH level, and SOD activity. In the group with influenza, the level of primary and final lipid peroxidation products was increased, whereas that of for retinol,α-tocopherol, and total antioxidant activity was decreased paralleled with higher GSSG and SOD levels. Numerous correlations were noted in the group of children with ARVI: IL-1β/ketones, IL-6/ketones, IL-8/ketones, TNFα/ketones, IL-4/ketones, IFNg/shortness of breath, IFNα/cough, double bonds/fever, double bonds/AST, SO/intoxication, retinol/fever, GSSG/cough. The influenza group differed in the following relationships: IL-4/ketones, IL-4/fever, IFNα/ketones, CDs/AST. It can be concluded that in preschool children with ARVI and influenza, changes in the cytokine profile are accompanied by increased pro- and anti-inflammatory cytokine levels, increased intensity of lipid peroxidation reactions along with reduced magnitude of antioxidant factors. In the group with ARVI, there was a relationship between the final toxic products of lipid peroxidation — Schiff bases — and the intoxication index, as well as the presence of protective mechanisms in the form of connections between interferons and disease clinical manifestations. The group with influenza was distinguished by the presence of protective relations, which may have a beneficial effect in the context of developing pathological process. The data obtained will help expand the understanding of the pathogenetic mechanisms related to immune reactivity and nonspecific lipid peroxidation reactions in preschool patients and formulate appropriate measures for correction.

This study describes a case of poisoning by pyrrolizidine alkaloids in a horse. To the best of the author's knowledge, this is the first confirmed case of Senecio ovatus poisoning. A six-year-old 450-kg Irish cob mare was presented to the Equine Clinic of the University of Veterinary Sciences Brno (Czechia) with symptoms of hepatic encephalopathy, which progressively worsened with time despite intensive therapy and led to euthanasia. A complex diagnostic and therapeutic approach including the post-mortem patoanatomical and histopathological examination is described here. Regarding the histopathology of the liver, there was necrosis with haemorrhage, fatty changes and inflammation. A later inspection of the grazing area revealed the presence of Senecio ovatus (wood ragwort). A sensitive chromatographic method was used to determine the pyrrolizidine alkaloids and their metabolites in the plasma and the liver. In both of the samples, metabolites of pyrrolizidine alkaloids were detected. Although pyrrolizidine alkaloid poisoning was proven, the histopathological findings typical for this disease were absent. It is clear from our case that the histopathology in cases of poisoning by pyrrolizidine alkaloids may not always be conclusive.

Background/Objectives: Poisonings among children are a major cause of morbidity and mortality worldwide and present a significant challenge for emergency medical services (EMS). The aim of this study was to analyze the types of substances causing poisonings and the intention of poisonings in children, providing detailed information on the most common causes of poisonings in different age groups. Methods: A retrospective study was conducted analyzing medical records of pediatric patients under the care of emergency medical services (EMS) in Wroclaw, Poland, between 2015 and 2017. The study included all patients under 18 years old diagnosed with poisoning. Data collected included age, sex, cause of poisoning, location of the incident, neurological status (GCS), and the type of healthcare facility. Results: The study included 484 patients, with a mean age of 13 years. The largest age group was 16–18 years (44%), and the majority were female (58%). The most common causes of poisonings were alcohol (29.3%), medications (26%), and intoxicants (24.8%). Over half of the incidents occurred at home (52.5%). Intentional poisonings constituted 75% of cases, particularly involving alcohol (38.6%), intoxicants (32%), and medications (26.7%). Accidental poisonings were mainly due to household chemicals (28.7%) and carbon monoxide (27%). The differences in causes and locations of poisonings were statistically significant (p < 0.001). Conclusions: Our study showed that the most common causes of poisonings among children were alcohol, medications, and intoxicants. Poisonings most frequently occurred at home, especially with medications, while outside the home, alcohol and intoxicants were predominant. This study was not registered.

Background: There are only rare case reports that revealed the efavirenz (EFV) toxicity. Case Report: This study presents an acute intoxication with 12 g of efavirenz in a 16-year-old healthy girl whose main problem was dose-dependent neurotoxicity. No other serious EFV-related side effects were seen. Previous serious side effects of EFV were observed in HIV-infected patients who underwent long-term combination drug therapy. Conclusion: Accordingly, in terms of the key clinical messages, serious adverse effects of efavirenz are expected to be observed in long-term use in combination with other antiretroviral drugs.

The article presents an analysis of fire hazard of high-rise buildings and skyscrapers. The author notes a range of factors significantly impacting on the course of emergency rescue operations, including the difficulty of evacuating people from the burning buildings (e.g., due to the rapid movement of combustion products to the roof of the building, the duration of the descent down the stairs to evacuation exits, etc.), uncertainty of toxicity (the nature of gases formed during combustion, the synergism of their toxic effect, the determination of toxic dose), difficulties in rescuing people from the upper floors of the building and in the process of extinguishing a fire (due to the lack of necessary fire equipment), as well as the behavior of people caught in a fire in the building. The inadmissibility of using «risk-analysis» in the forensic practice is emphasized, since the correct initial data (linear and mass burning rates) for its calculation is unknown. The article is intended for fire experts of the forensic institutions of various departments, investigators of the Ministry of Emergency Situations and employees of engineering organizations.

Abstract Introduction Ricin intoxication is a serious condition with symptoms ranging from mild gastroenteritis to fatal outcomes due to shock and multi-organ failure. Intoxication from the ingestion of castor seeds is uncommon. However, its diagnosis is crucial, particularly with a clear history of exposure to castor seeds, regardless of the route of exposure (enteral or parenteral). Prompt diagnosis is essential to monitor and manage the patient effectively and to prevent potentially fatal outcomes. We report a case where ingestion of castor seeds resulted in gastroenteritis severe enough to necessitate emergency medical care. Case report We present the case of a 47-year-old Belgian woman of Moroccan descent, previously healthy who was admitted to the emergency department with symptoms of colicky abdominal pain, diarrhea, and vomiting following the ingestion of six castor beans. The patient was diagnosed with ricin intoxication, admitted for observation, and received symptomatic treatment. She was discharged home after a complete recovery three days later. Conclusion Our report underscores the clinical manifestations, hemodynamic changes, laboratory findings, and treatment of intoxication due to castor seed ingestion. It contributes to the limited literature on castor seed poisoning in humans, with a specific focus on cases in Belgium. This report aims to raise awareness among clinicians about this condition and emphasizes the importance of a comprehensive history-taking to prevent misdiagnosis and malpractice.

Abstract Cannabigerol (CBG) is a phytocannabinoid increasing in popularity, with preclinical research indicating it has anxiolytic and antidepressant effects. However, there are no published clinical trials to corroborate these findings in humans. The primary objective of this study was to examine acute effects of CBG on anxiety, stress, and mood. Secondary objectives were to examine whether CBG produces subjective drug effects or motor and cognitive impairments. A double-blind, placebo-controlled cross-over field trial was conducted with 34 healthy adult participants. Participants completed two sessions (with a one-week washout period) via Zoom. In each, they provided ratings of anxiety, stress, mood, and subjective drug effects prior to double-blind administration of 20 mg hemp-derived CBG or placebo tincture (T0). These ratings were collected again after participants ingested the product and completed an online survey (T1), the Trier Social Stress Test (T2), a verbal memory test and the DRUID impairment app (T3). Relative to placebo, there was a significant main effect of CBG on overall reductions in anxiety as well as reductions in stress at T1. CBG also enhanced verbal memory relative to placebo. There was no evidence of subjective drug effects or impairment. CBG may represent a novel option to reduce stress and anxiety in healthy adults.

Introduction: Salbutamol is a moderately selective beta-2-adrenergic agonist. Various side effects can occur because of beta-1 and beta-2 receptor activation. Due to the large volume of distribution, it is not considered dialyzable. Case Presentation: A patient with salbutamol intoxication, which developed as a result of a medical error in a patient with sepsis, Down syndrome, and liver cirrhosis, is presented. Initial treatment was partially successful and antibiotic adjustments were made. After his respiratory failure worsened, the patient needed non-invasive ventilation, and previously undiagnosed chronic obstructive pulmonary disease was suspected. He was prescribed intravenous methylprednisolone but accidently received 5 mg of salbutamol (albuterol), which led to immediate severe arrhythmic tachycardia with hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was commenced to decrease suspectedly highly elevated serum salbutamol levels. After 30 min, sinus rhythm with normocardia was observed. After the hemodialysis termination, no rebound tachycardia was noted, but due to severe septic shock, the hypotension was ongoing and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol and data from literature do not support the view that hemodialysis was the cause of the described improvement: the total amount of the drug cleared was very small (2.8% of total dose). Conclusion: Our results confirm a large volume of salbutamol distribution; the measured levels are within observed therapeutic levels; and the measured half-life time during hemodialysis (3.1 h) is comparable to observed half-life times in therapeutic settings. The observed favorable clinical benefit associated with dialysis may be fortuitous, highlighting potential bias toward positive clinical outcomes and unproven (“salvage”) therapies.

Abstract Background Over the last decade, there has been an emerging trend of recreational misuse of several drugs and inhaled solvent including ethyl chloride. This case report follows CARE guidelines and highlights, with supporting video, the neurological features of ethyl chloride intoxication. Case presentation A 48-year-old man was seen for the sudden occurrence of an unsteady gait with dizziness. His only medical history was a chronic and treated HIV infection without any complications. Clinical examination revealed a cerebellar syndrome associated with impairment of short-term memory. Biological and radiological workups were normal. After several days, the patient recalled ethyl chloride inhalation. He fully recovered after being discharged from hospital. Conclusion Clinicians should recognise the clinical features and neurological manifestations of ethyl chloride intoxication due to the potential fatal cardiovascular complications of this intoxication.

Introduction: Ricin intoxication is a serious condition with symptoms ranging from mild gastroenteritis to fatal outcomes due to shock and multi-organ failure. Intoxication from the ingestion of castor seeds is uncommon. However, its diagnosis is crucial, particularly with a clear history of exposure to castor seeds, regardless of the route of exposure (enteral or parenteral). Prompt diagnosis is essential to monitor and manage the patient effectively and to prevent potentially fatal outcomes. We report a case where ingestion of castor seeds resulted in gastroenteritis severe enough to necessitate emergency medical care. Case report: We present the case of a 47-year-old Belgian woman of Moroccan descent, previously healthy who was admitted to the emergency department with symptoms of colicky abdominal pain, diarrhea, and vomiting following the ingestion of six castor beans. The patient was diagnosed with ricin intoxication, admitted for observation, and received symptomatic treatment. She was discharged home after a complete recovery three days later. Conclusion: Our report underscores the clinical manifestations, hemodynamic changes, laboratory findings, and treatment of intoxication due to castor seed ingestion. It contributes to the limited literature on castor seed poisoning in humans, with a specific focus on cases in Belgium. This report aims to raise awareness among clinicians about this condition and emphasizes the importance of a comprehensive history-taking to prevent misdiagnosis and malpractice. [ABSTRACT FROM AUTHOR]

Fentanyl is an opioid with powerful analgesic effects and a high speed of action. Due to its pharmacological properties, this molecule has therapeutic application as an anesthetic in surgery or as palliative therapy for cancer patients. Unfortunately, in recent years, the easy availability of this substance, the low cost and the illegal online market have favored the large-scale diffusion of fentanyl. Fentanyl is available in different forms, including nasal spray, oral patches, soluble capsules, aerosol or the new version of fentanyl mixed with other drugs, making its use very widespread. Subjects of various ages are involved in fentanyl consumption, including minors that have not yet reached adolescence. In this work, we performed a literature review using the search engines PubMed NCBI and SCOPUS regarding episodes of acute fentanyl intoxication occurring in those of a pediatric age using the Mesh Terms "fentanyl" AND "overdose" AND "children". The inclusion criteria were English papers published in the last 10 years regarding the cases of children under the age of 10. We evaluated the most frequent methods of intake and the circumstances of such episodes. In cases of death, we analyzed the autopsy, the toxicological findings and the investigations carried out. The review results show that in this age group (under < 10 y.o. s), it is possible to identify the risk factors for fentanyl intake, such as the presence of this molecule within the family unit due to drug addiction or medical therapy. The results also demonstrate a significant risk of underestimation of this phenomenon, since the molecule is often not investigated through adequate toxicological analysis. These results, therefore, suggest always carrying out toxicological investigations in the case of suspected fentanyl intoxication, both on patients or cadavers. The investigations must always include a urinary screening for opiates, and the request for a second level analysis with molecule dosage in cases of positivity or in cases of strong suspicion for assumption. In cases of intoxication in a family context of drug addiction, it is necessary to investigate the chronicity of the intake through hair analysis and evaluate the possible co-administration of other drugs. In conclusion, we suggest a protocol, applicable both on patients or cadavers, which can be useful for physicians and forensic pathologists in order to promptly identify these cases and allow for the reporting of them to the judicial authorities with the adoption of strict prevention and control measures. [ABSTRACT FROM AUTHOR]

Cannabigerol (CBG) is a phytocannabinoid increasing in popularity, with preclinical research indicating it has anxiolytic and antidepressant effects. However, there are no published clinical trials to corroborate these findings in humans. The primary objective of this study was to examine acute effects of CBG on anxiety, stress, and mood. Secondary objectives were to examine whether CBG produces subjective drug effects or motor and cognitive impairments. A double-blind, placebo-controlled cross-over field trial was conducted with 34 healthy adult participants. Participants completed two sessions (with a one-week washout period) via Zoom. In each, they provided ratings of anxiety, stress, mood, and subjective drug effects prior to double-blind administration of 20 mg hemp-derived CBG or placebo tincture (T0). These ratings were collected again after participants ingested the product and completed an online survey (T1), the Trier Social Stress Test (T2), a verbal memory test and the DRUID impairment app (T3). Relative to placebo, there was a significant main effect of CBG on overall reductions in anxiety as well as reductions in stress at T1. CBG also enhanced verbal memory relative to placebo. There was no evidence of subjective drug effects or impairment. CBG may represent a novel option to reduce stress and anxiety in healthy adults. [ABSTRACT FROM AUTHOR]

Introduction. Il existe une relation complexe entre le statut résidentiel et la consommation de substances. En effet, la consommation de substances réduit les perspectives de logement et le fait d'être sans logement augmente les raisons de consommer des substances ainsi que les risques et la stigmatisation qui y sont associés. Méthodologie. Dans cette analyse descriptive des personnes sans logement qui ont perdu la vie en raison d'une intoxication aiguë accidentelle liée à une substance au Canada, nous avons utilisé les données relatives aux enquêtes sur les décès tirées d'une étude nationale d'examen des dossiers concernant les décès par intoxication aiguë due à une substance en 2016 et 2017, afin de comparer les facteurs sociodémographiques, les antécédents médicaux, les circonstances du décès et les substances ayant contribué au décès des personnes sans logement et des personnes non identifiées comme sans logement, au moyen du test du khi carré de Pearson. Nous avons comparé le profil démographique des personnes décédées d'une intoxication aiguë aux données du Dénombrement ponctuel coordonné de l'itinérance dans les collectivités canadiennes de 2016 et du Recensement de 2016. Résultats. Les personnes sans logement étaient nettement surreprésentées parmi les personnes décédées d'une intoxication aiguë en 2016 et 2017 (8,9 % contre moins de 1 % de la population générale). L'intoxication aiguë ayant entraîné le décès des personnes sans logement a eu lieu plus souvent à l'extérieur (24 %); un opioïde ou un stimulant a plus fréquemment contribué à leur décès (68 % à 82 %; les deux substances ont été responsables de 59 % des décès) et ces personnes avaient plus souvent été libérées d'un établissement correctionnel ou été autorisées à sortir d'un établissement de soins de santé au cours du mois précédant leur décès (7 %). Conclusion. Nous présentons plusieurs possibilités de réduire les décès attribuables à une intoxication aiguë chez les personnes sans logement, notamment lors de la prise de contact avec les services de santé et d'autres établissements, par des mesures de soutien à la réduction des méfaits liés à la consommation d'opioïdes et de stimulants ainsi que par la création d'environnements plus sûrs pour les personnes sans logement. [ABSTRACT FROM AUTHOR]

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Cadmium (Cd) toxicity poses a significant threat to human health and the environment due to its widespread occurrence and persistence. In recent years, considerable attention has been directed towards exploring natural compounds with potential protective effects against Cd-induced toxicity. Among these compounds, resveratrol (RV) has emerged as a promising candidate, demonstrating a range of beneficial effects attributed to its antioxidant and anti-inflammatory properties. This literature review systematically evaluates the protective role of RV against Cd toxicity, considering the various mechanisms of action involved. A comprehensive analysis of both in vitro and in vivo studies is conducted to provide a comprehensive understanding of RV efficacy in mitigating Cd-induced damage. Additionally, this review highlights the importance of phytoremediation strategies in addressing Cd contamination, emphasizing the potential of RV in enhancing the efficiency of such remediation techniques. Through the integration of diverse research findings, this review underscores the therapeutic potential of RV in combating Cd toxicity and underscores the need for further investigation to elucidate its precise mechanisms of action and optimize its application in environmental and clinical settings. [ABSTRACT FROM AUTHOR]

Background: Over the last decade, there has been an emerging trend of recreational misuse of several drugs and inhaled solvent including ethyl chloride. This case report follows CARE guidelines and highlights, with supporting video, the neurological features of ethyl chloride intoxication. Case presentation: A 48-year-old man was seen for the sudden occurrence of an unsteady gait with dizziness. His only medical history was a chronic and treated HIV infection without any complications. Clinical examination revealed a cerebellar syndrome associated with impairment of short-term memory. Biological and radiological workups were normal. After several days, the patient recalled ethyl chloride inhalation. He fully recovered after being discharged from hospital. Conclusion: Clinicians should recognise the clinical features and neurological manifestations of ethyl chloride intoxication due to the potential fatal cardiovascular complications of this intoxication. [ABSTRACT FROM AUTHOR]

Honeybee venom is one of the natural substances produced by bees (Apis mellifera). Their venom gland produces venom which plays a defensive role. In this study a concentration of macro and trace elements (Ag, Al, As, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Sb, Se, Sr, Pb and Zn) in foragers′ and honeybees′ venom was analysed by axial inductively coupled plasma optical emission spectrometry (ICP OES) with good validation parameters to differentiate the element accumulation ability in honeybee venom. Cumulative ability for some elements (As, Al, Ba, Cr, Li, Mo, Pb, and Zn) in bee venom was clearly demonstrated. Oppositely, levels of macro elements (Ca, K, Mg and Na) in venom were several times lower compared to the levels detected in foragers. Moreover, PCA analysis of bee samples showed that Cr was associated with locality Košice, and Cd with locality Krompachy; both have rich industrial history. Since some of analysed elements are potentially toxic for humans, a risk assessment for bee-stung scenario was also calculated. A new way of exposure to potentially toxic elements via honeybee stung was showed in this study. Non-carcinogenic risk assessment for humans to selected toxic elements (As, Cd, Cr, Ni, and Pb) demonstrated acceptable risk and moreover the same we may conclude for potential carcinogenic risk for beekeepers exposed to As, Cd, Ni, and Pb via venom over their whole life.

Objective: To identify mechanisms and types of injuries in patients having sustained craniofacial fractures under the influence of alcohol, and to compare the frequencies of them between males and females. Materials and methods: Patients included were adults who had been diagnosed with craniofacial fractures at Töölö Hospital Emergency Department, Helsinki University Hospital, Finland, and who had been under the influence of alcohol at the time of injury. The primary outcome variables were assault-related and fall-related injury mechanisms. The secondary outcome variables were other injury mechanisms, time of accident, type of craniofacial fracture and severity of facial fracture. The primary predictor variable was sex. The control variable was age at the time of injury. The statistical modelling was executed using logistic regression. Results: Of the total of 2,859 patients with craniofacial fractures, 1,014 patients (35.5%) fulfilled the inclusion criteria. Males predominated (84.6%). Assault (38.0%) was the most frequent aetiology. Compared to the odds of females, males had 2.8 times greater odds for assault, 2.4 times greater odds for isolated cranial fracture and 1.7 times greater odds for a facial injury severity score of ≥ 3. Females had 2.0 times greater odds for any fall compared to the odds of males. Conclusions: Particularly male patients are frequently under the influence of alcohol at the time of injury, predisposing them to assault and severe facial fractures more often than females. Codes of practice on how to identify unhealthy alcohol use and how to intervene are recommended.

In this article, the way of understanding of Jalāl al-Dīn al-Rūmī (d. 1273) and his son Sulṭān Walad (or Bahāʾ al-Dīn Muḥammad Walad d. 1312) on Ḥusayn ibn Manṣūr al-Ḥallāj (d. 922), who was a unique figure in the history of Sufism and who continued to attract the attention of Sufis after him will be discussed.

Introduction: Intoxication with non-pharmaceutical substances within household environment is an important group of pediatric injuries seen in pediatric emergency departments. Our objective was to study clinical characteristics and outcomes of these exposures and compare them with pharmaceutical intoxications. Methods: The study was designed as a retrospective cohort study. All patients between 0 and 18 years old presented to 3rd level teaching hospital pediatric emergency unit between May 1st 2016 and April 30th 2017 with a complaint of acute toxic exposure were included. Results: Over one-year period, 0.52% of all patients presented to pediatric emergency department were toxic exposures. 44% of them were non-pharmaceutical exposures, most commonly cleaning products (49.5%), followed by carbon monoxide (19.2%) and hydrocarbon products (5.5%). Most common route of exposure was oral route (73.2%) and most of exposures were unintentional (97.9%). Respiratory symptoms were the most common manifestation (4.8%), followed by neurologic and cardiac manifestations (2.4%). 57% of patients were hospitalized, one patient admitted to pediatric intensive care unit (PICU). None of the patients died. When compared with pharmaceutical exposures, patients in non-pharmaceutical group were younger, accidental exposures and non-oral routes of exposure were more in this group. Less patients in household group were admitted to PICU. Cardiac manifestations were seen more in household group. Conclusion: Household toxic exposures to non-pharmaceutical substances are common in childhood. Although mortality risk of pharmaceutical exposures is higher, household non-pharmaceutical exposures can also result in significant clinical manifestations therefore every effort should be taken to prevent accidental toxic exposures within household environment.

Introduction Bicycles and electric scooters (e-scooters) are convenient and accessible means of transportation. Participant safety is contingent on available infrastructure and safe riding practices including not riding while intoxicated. Understanding national prevalence and injury characteristics of bicycle and e-scooter riders who ride while intoxicated may promote awareness campaigns for safe riding practices and decrease morbidity. Methods The National Electronic Injury Surveillance System (NEISS) provides national estimates of injuries that present to emergency departments across the United States. We obtained case information on admitting status, body part injured, diagnosis of injury, age, sex, alcohol usage, and drug usage. We then queried NEISS for injuries related to bicycles and e-scooters in 2019. Results A weighted total of 270,571 (95% confidence interval (CI): 204,517–336,625) bicycle injuries occurred in the United States during 2019; alcohol and drug use were associated with 7% (95% CI: 6–9) and 2% (95% CI: 2–3) of all injuries, respectively. Twenty-four percent (CI: 18--31) of alcohol- and 29% (95% CI: 20–41) of drug-related bicycle injuries resulted in hospital admissions, compared to 15% (95% CI: 12–17) of non–alcohol- and 15% (95% CI: 13–18) of non–drug-related injuries ( p < .001 and p = .002, respectively). A total of 28,702 (95% CI: 13,975–43,428) e-scooter injuries occurred in 2019; alcohol and drug use were associated with 8% (95% CI: 5–12) and 1% (95% CI: 1–2) of injuries, respectively. Sixty percent (95% CI: 47–72) of alcohol-related e-scooter injuries resulted in head trauma, compared to 28% (95% CI: 24–32) of non–alcohol-related injuries ( p < .001). Conclusions Intoxication is associated with increasingly severe injuries, hospital admissions, and head trauma in bicycle and e-scooter riders. The findings support awareness campaigns to educate riders about risky practices, improve non-auto infrastructure, and promote helmet usage.

Propafenone (PPF) belongs to the class 1C antiarrhythmics and can cause electrocardiogram-associated adverse/toxic effects. Cases of PPF intoxication are rarely investigated. We developed a novel and selective GC-MS/MS method for the determination of PPF and its tissue distribution in an intentional fatal poisoning case, which is applicable to PPF quantification in the range of therapeutic to lethal concentrations in complex post-mortem samples. A simple and effective sample pretreatment was applied to all analyzed samples. PPF was determined without the need for dilution, even in highly complex samples containing a wide range of analyte concentrations. Quantification was performed using the standard addition method, developed and validated according to the ICH M10 guidelines. The obtained results indicated that the PPF concentration in the serum from blood taken while alive, before therapy, was the highest ever reported in the literature. Despite the intensive therapy after the patients' admission, the PPF concentrations in the lungs, spleen, femoral blood and cardiac blood were fatal or abnormally high. On the other hand, the concentrations in the liver and skeletal muscle were lower or approximately the same as observed in cases with therapeutic doses. To the best of our knowledge, the distribution of PPF has not been investigated in fatal intoxication cases and can be helpful in clinical or forensic toxicology. [ABSTRACT FROM AUTHOR]

Drug poisoning has evolved in South Korea, with changes in substance availability and a rise in non-lethal abuse among youth, necessitating an updated understanding of this public health concern. This study aims to investigate the shifts in toxicitycausing substances and their impacts over the past decade, providing a comprehensive overview to inform future interventions. This study were conducted as a retrospective observational study utilizing the Korea National Hospital Discharge In-depth Injury Survey, including data from January 2011-December 2020. Hospitalization patterns, durations and corresponding mortality rates were examined. The study, analyzing 10,017 patients hospitalized for drug poisoning, observed a decrease in average hospital stay (average decrease from 7.1 days in 2011 to 5.8 days in 2020) and mortality rate (7.7% in 2011 to 2.6% in 2020), with older adults having the longest stays and highest mortality. The use of prescription and non-prescription drugs as intoxicants increased, while pesticide use decreased, with older adults showing the highest frequency of pesticide poisoning. Factors affecting length of stay and mortality rate included age, sex and intent, with statistical analyses showing significant correlations. An increase in poisonings was caused by prescription and non-prescription drugs, whereas there was a decrease in poisonings caused by pesticides. Despite decreases in drug poisoning-related deaths in South Korea, largely attributed to national control for high-toxic agents and improved medical systems, the rising number of incidents involving prescription and over-thecounter medications highlights the urgent need for ongoing surveillance and focused interventions. [ABSTRACT FROM AUTHOR]

Introduction: Mood stabilisers and other psychotropic drugs can lead to serious adverse drug events (ADEs). However, the incidence remains unknown.We aimed to (a) determine the incidence of serious ADEs in patients with bipolar or schizoaffective disorders, (b) explore the role of lithium exposure, and (c) describe the aetiology. Methods: This study is part of the LiSIE (Lithium--Study into Effects and Side Effects) retrospective cohort study. Between 2001 and 2017, patients in the Swedish region of Norrbotten, with a diagnosis of bipolar or schizoaffective disorder, were screened for serious ADEs to psychotropic drugs, having resulted in critical, post-anaesthesia, or intensive care. We determined the incidence rate of serious ADEs/1,000 person-years (PY). Results: In 1,521 patients, we identified 41 serious ADEs, yielding an incidence rate of 1.9 events per 1,000 PY. The incidence rate ratio (IRR) between ADEs with lithium present and causally implicated and ADEs without lithium exposure was significant at 2.59 (95% CI 1.20--5.51; p = 0.0094). The IRR of ADEs in patients <65 and ≥65 years was significant at 3.36 (95% CI 1.63--6.63; p = 0.0007). The most common ADEs were chronic lithium intoxication, oversedation, and cardiac/blood pressure-related events. Discussion: Serious ADEs related to treatment of bipolar (BD) or schizoaffective disorder (SZD) were uncommon but not rare. Older individuals were particularly at risk. The risk was higher in individuals exposed to lithium. Serum lithium concentration should always be checked when patients present with new or unclear somatic symptoms. However, severe ADEs also occurred with other mood stabilisers and other psychotropic drugs. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to describe the clinical picture and progression in cats with alpha-chloralose (AC) intoxication and to determine if treatment with intravenous (IV) lipid emulsion (ILE) influenced either the serum concentration of AC or the clinical signs. Methods: Cats with suspected AC poisoning admitted to a university small animal hospital were included. The cats were randomised into two groups: one receiving 20% ILE at a dose of 300 mg/kg as a 2 min bolus, followed by a 1500 mg/kg continuous rate infusion over 30 mins (IL+ group) and the other receiving IV fluid therapy with Ringer's acetate (IL− group). Serum samples were drawn at 0, 2, 12 and 24 h after admission. Samples were tested for AC with a novel validated, quantitative, ultra-high-performance liquid chromatography-tandem mass spectrometry method. Vital and predefined clinical signs were noted at the times of sampling and patients were scored using a previously described intoxication severity score. Telephone interviews were conducted after discharge to assess outcome. Results: A total of 25 cats were enrolled: 13 cats in the IL+ group and 12 in the IL− group. The most common clinical signs at presentation were tremor (n = 22, 88.0%), cranial nerve deficits (n = 20, 80.0%) and bradycardia (n = 19, 76.0%). No significant difference in AC concentration or change in intoxication score over time was found between the IL+ and IL− groups at any time point (P >0.05). All cats recovered within 72 h. Conclusions and relevance: ILE did not have any effect on the AC serum concentration or clinical signs in AC-poisoned cats. All cats survived until follow-up. In cats with an acute onset of the described neurological signs, AC intoxication is an important differential diagnosis with an excellent prognosis. [ABSTRACT FROM AUTHOR]

This study examined the effects of bystander or victim intoxication during a crime on juror perceptions and decision-making. Mock jurors (N = 261) read testimony from a bystander or victim to an assault, who mentioned that they had consumed alcohol, cannabis, amphetamines, or no substances prior to the crime. Participants delivered a verdict, rated the defendant's guilt, and rated the bystander/victim on their honesty, credibility, and cognitive competence. Witness intoxication and witness role did not influence defendant guilt. However, participants judged any witness intoxicated by amphetamines as less credible and cognitively competent than a sober witness. Furthermore, victims were judged to have lower credibility, cognitive competence, and honesty than bystanders. These findings suggest that jurors' decision-making about defendant guilt might not be influenced by witness intoxication or witness type. A witness' testimony, however, might be evaluated as less credible when delivered by a victim or an amphetamine-intoxicated witness. [ABSTRACT FROM AUTHOR]

Introduction: Calcineurin inhibitors (CNIs), ciclosporin and tacrolimus, are utilized primarily in organ transplantation and the treatment of autoimmune diseases. Since patients depend on these drugs over long periods, they face a potential risk of intoxication. This risk increases substantially when patients are overdosed or inadvertently exposed to cytochrome P450 (CYP) 3A4 inhibitors. Objectives: To analyze the utility of CYP inducers as a plausible treatment modality for acute CNI intoxication using real-world data from the WHO global pharmacovigilance database (VigiBase™) and supporting evidence from published data. Methodology: We explored all individual case safety reports (ICSRs) regarding CNI intoxications registered in VigiBase™. The queries "overdose" or "drug intoxication" were applied against the active ingredients "ciclosporin" and "tacrolimus". Regarding the utility of CYP inducers, an extensive literature analysis was undertaken. We also report an index clinical case of a 60-year-old liver transplant patient that developed severe tacrolimus intoxication with multiple organ dysfunction at a peak concentration of 33.1 μg/L after a single dose of intravenous fluconazole. Results: Out of 143,710 documented ICSRs reported in VigiBase™ since 1992, 0.26% and 0.02% were registered as CNI overdoses and intoxications, respectively. The main etiological factor for CNI intoxication was the interaction with CYP 3A4 inhibitors (40.0% vs. case reports: 50.0%). The most commonly reported manifestation was acute kidney injury (36.7% vs. case reports: 46.3%). A total of 16.7% of intoxications led to fatal outcomes after drug withdrawal or dose reduction; however, in 43.0% of cases the exact actions undertaken were not reported. In peer-reviewed reports, 34 distinct clinical cases were treated with CYP inducers. Diverse pharmacoenhancement strategies with phenobarbital (5), phenytoin (23) and rifampicin (6) were described with a mean time of achieving the therapeutic target after 2.7 (±0.7), 3.1 (±0.5) and 4.6 (±1.0) days, respectively. In the index case, a therapeutic concentration of 4.9 [4–6 μg/L] was achieved after a 3-day regimen of rifampicin. Conclusion: In addition to general supportive treatment, the administration of phenobarbital, phenytoin, or rifampicin to reverse acute CNI intoxication is a viable treatment modality. The relatively long half-life of phenobarbital coupled with its exclusive renal elimination are potential pitfalls to reckon with. In spite of the favorable pharmacokinetic advantages of rifampicin, phenytoin offers a competitive pharmacodynamic advantage that is indisputable in patients with overt neurotoxicity. [ABSTRACT FROM AUTHOR]

Diazepam poisoning is a common emergency situation, but propafenone poisoning is relatively rare. We reported a case of propafenone poisoning combined with diazepam. An 18‐year‐old female patient was admitted to our hospital with an overdose of oral propafenone and diazepam. The patient was treated with medication that proved to be useful, but the sinus rhythm could not be recovered, and cardiac arrest occurred. A bipolar temporary pacemaker and extracorporeal membrane oxygenation (ECMO) were installed. However, even with multiple electrode positions, effective capture could not be achieved. The patient eventually died. We should be alert to the possibility of co‐poisoning. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Botulinum neurotoxin A (BoNT/A) is a highly potent proteolytic toxin specific for neurons with numerous clinical and cosmetic uses. After uptake at the synapse, the protein is proposed to translocate from synaptic vesicles to the cytosol through a self-formed channel. Surprisingly, we found that after intoxication proteolysis of a fluorescent reporter occurs in the neuron soma first and then centrifugally in neurites. To investigate the molecular mechanisms at play, we use a genome-wide siRNA screen in genetically engineered neurons and identify over three hundred genes. An organelle-specific split-mNG complementation indicates BoNT/A traffic from the synapse to the soma-localized Golgi in a retromer-dependent fashion. The toxin then moves to the ER and appears to require the Sec61 complex for retro-translocation to the cytosol. Our study identifies genes and trafficking processes hijacked by the toxin, revealing a new pathway mediating BoNT/A cellular toxicity.

IntroductionDespite a well-established direct toxic effect of alcohol on renal cells, there is a salutary dose-dependent effect of alcohol consumption on common laboratory parameters related to kidney performance. Alcohol also impacts thyroid hormones, while thyroid status modulates kidney function. The modulation of kidney parameters with thyrotropin (TSH) and thyroid status indicates a possible interaction between alcohol, kidney, and thyroid functions. This retrospective study was conducted to test the hypothesis that the positive effect of alcohol use on the estimated glomerular filtration rate (eGFR) is mediated by alcohol’s effect on thyroid hormones.MethodsWe reviewed the electronic medical records of 767 hospitalized adult patients free of thyroid disorders who received medical care in the Mayo Clinic Health System from June 2019 through June 2022 and had blood alcohol concentration (BAC), serum TSH, and serum creatinine measured during the hospitalization. We calculated the eGFR using both the re-expressed Modification of Diet in Renal Disease (MDRD II) study equation and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Creatinine equation.ResultsWe found a significant relationship of BAC with eGFR (CKD-EPI) and TSH in males only. BAC had a positive association with eGFR (b = 0.24, p = 0.0001) and negative with TSH (b=-0.17, p = 0.006). The covariance between the two outcomes (eGFR and TSH) was negative (b = -0.12, p = 0.049). The path analyses using the eGFR MDRD II equation were not significant in males, whereas females had no significant path analyses with either of the eGFR equations.DiscussionWe observed that BAC influences both eGFR and TSH, whereas eGFR and TSH influence each other. After considering important covariates (e.g., age, body mass index, diabetes mellitus, cardiovascular disease, chronic kidney disease, and chronic liver disease) and the negative bidirectional effect of TSH and eGFR, a positive impact of BAC on eGFR was observed in males.

In the midst of the COVID-19 pandemic, the increased risk of exposure to 1-propanol has led the United States Food and Drug Administration to issue a warning about toxicity of 1-propanol-contaminated brands of hand sanitizers. We report a mixed intoxication with 1-propanol and 2-propanol in a patient who unintentionally ingested approximately 300 mL of hospital topical antiseptic solution and who presented to the emergency department with nausea, vomiting, and decreased level of consciousness. The patient developed an anion gap metabolic acidosis without an osmolar gap, elevated serum lactate, and undetectable serum beta-hydroxybutyrate. One hour later, he developed chest pain and was found to have an ST-segment elevation myocardial infarction. The patient underwent urgent coronary  angiography and stenting of the totally occluded mid-segment of the Left Anterior Descending coronary artery. The patient recovered and was discharged home after 7 days.

Abstract Background Carbon Monoxide (CO) is one of the most common environmental causes of acute intoxication globally. It can lead to the development of Delayed Neuropsychiatric Sequelae (DNS) which may develop in 2-40 days after remission of acute CO poisoning. DNS is defined by recurrent-transient neurological, cognitive, or psychological manifestations. This study was intended to describe the demographics and characteristics of CO poisoning patients attending at the Emergency Department (ED) and assess the association between CO intoxication and the development of DNS in a tertiary hospital, Riyadh, Saudi Arabia. Methods A retrospective descriptive cross-sectional study was conducted in subjects who were diagnosed with CO poisoning and attended to the ED at King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children’s Hospital (KASCH) in Riyadh during the period from January 2016 to December 2021. Patient demographics, vitals, diagnostic tests, and oxygen therapy at initial presentation were documented. Patient medical records were reviewed at 2-40 days following CO poisoning for development of DNS. Ethical approval was obtained from King Abdullah International Medical Research Center (KAIMRC). Results A total of 85 patients were diagnosed with CO poisoning and met the study inclusion criteria. Of those, 76% were adults with an average age of 32.36 (SD ± 15.20) and 51% were male adults. Five (6%) of the 85 patients developed DNS. Common symptoms included dizziness, nausea, and decreased visual acuity in 40% of the cases. The development of DNS manifestations was most likely (80%) to occur at 2 to 10 days after the initial incident. Inferential statistics showed that BMI (p-value = 0.021) and age group (p-value = 0.029) were significantly associated with COHb level, which was not the case for gender and the presence of clinical manifestation. Furthermore, Gender was significantly associated with the development of DNS (20% male vs. 80% female, p = 0.050). Conclusions The findings of this study are consistent with previous published studies showing low proportions of patients who were exposed to CO poisoning at risk of developing DNS. Further larger-scale multicenter studies are needed to assess the factors associated with the development of DNS for patients with CO poisoning.

Abstract Background In this case series abomasitis as a consequence of halofuginone intoxication is suspected. Case presentation Seven Belgian-Blue calves with complaints of anorexia and weight loss were presented to an university clinic. Ultrasonography showed thickening and edema of the abomasal wall in all cases, suggesting abomasitis. Abomasitis was confirmed on necropsy in three cases. Retrospective analysis clarified the uptake of an overdose of halofuginone lactate (348–421 µg/kg/day). Four animals fully recovered after removal of halofuginone lactate administration, therapy for comorbidities (pneumonia, diarrhoea) and supportive therapy. Conclusion To the authors’ knowledge, this case series is the first report associating halofuginone lactate use with abomasitis. This was suspected after clinical improvement of four of the presented animals after terminating the administration of a high dose of halofuginone lactate, and exclusion of other possible causes. Underlying mechanisms are still unclear.

Introduction: Calcineurin inhibitors (CNIs), ciclosporin and tacrolimus, are utilized primarily in organ transplantation and the treatment of autoimmune diseases. Since patients depend on these drugs over long periods, they face a potential risk of intoxication. This risk increases substantially when patients are overdosed or inadvertently exposed to cytochrome P450 (CYP) 3A4 inhibitors. Objectives: To analyze the utility of CYP inducers as a plausible treatment modality for acute CNI intoxication using real-world data from the WHO global pharmacovigilance database (VigiBase™) and supporting evidence from published data. Methodology: We explored all individual case safety reports (ICSRs) regarding CNI intoxications registered in VigiBase™. The queries “overdose” or “drug intoxication” were applied against the active ingredients “ciclosporin” and “tacrolimus”. Regarding the utility of CYP inducers, an extensive literature analysis was undertaken. We also report an index clinical case of a 60-year-old liver transplant patient that developed severe tacrolimus intoxication with multiple organ dysfunction at a peak concentration of 33.1 μg/L after a single dose of intravenous fluconazole. Results: Out of 143,710 documented ICSRs reported in VigiBase™ since 1992, 0.26% and 0.02% were registered as CNI overdoses and intoxications, respectively. The main etiological factor for CNI intoxication was the interaction with CYP 3A4 inhibitors (40.0% vs. case reports: 50.0%). The most commonly reported manifestation was acute kidney injury (36.7% vs. case reports: 46.3%). A total of 16.7% of intoxications led to fatal outcomes after drug withdrawal or dose reduction; however, in 43.0% of cases the exact actions undertaken were not reported. In peer-reviewed reports, 34 distinct clinical cases were treated with CYP inducers. Diverse pharmacoenhancement strategies with phenobarbital (5), phenytoin (23) and rifampicin (6) were described with a mean time of achieving the therapeutic target after 2.7 (±0.7), 3.1 (±0.5) and 4.6 (±1.0) days, respectively. In the index case, a therapeutic concentration of 4.9 [4–6 μg/L] was achieved after a 3-day regimen of rifampicin. Conclusion: In addition to general supportive treatment, the administration of phenobarbital, phenytoin, or rifampicin to reverse acute CNI intoxication is a viable treatment modality. The relatively long half-life of phenobarbital coupled with its exclusive renal elimination are potential pitfalls to reckon with. In spite of the favorable pharmacokinetic advantages of rifampicin, phenytoin offers a competitive pharmacodynamic advantage that is indisputable in patients with overt neurotoxicity.

Abstract Background Heavy alcohol and cannabis use during adolescence have been previously described as risk factors not only for morbidity in adulthood, but also social problems including adversities in educational attainment. Attempts to consider overlapping risk factors and confounders for these associations are needed. Methods Using weighted multivariable models, we examined prospective associations between age at first drink (AFD), age at first intoxication (AFI), frequency of alcohol intoxication, as well as self-reported alcohol tolerance (i.e., number of drinks needed for the subjective experience of intoxication), and lifetime cannabis use at age 15/16 years with subsequent educational attainment obtained from comprehensive registers until age 33 in the Northern Finland Birth Cohort 1986 (6,564 individuals, 49.1% male). Confounding variables including sex, family structure (intact vs. non-intact), maternal and paternal education level, behavioural/emotional problems in school at age 7/8 years, having a history of illicit substance use in adolescence, having any psychiatric diagnosis before age 16, and parental psychiatric diagnoses, were adjusted for. Results In this large birth cohort study with a 17-year follow-up, younger age at first intoxication, higher frequency of alcohol intoxication, and high self-reported alcohol tolerance at age 15/16 years were associated with poorer educational outcomes by the age of 33 years. These associations were evident regardless of potential confounders, including parental education and childhood behavioural/emotional problems. The association between adolescent cannabis use and educational attainment in adulthood was no longer statistically significant after adjusting for confounders including frequency of alcohol intoxication at age 15/16. Conclusions Assessments of age of first alcohol intoxication, high self-reported alcohol tolerance and frequency of intoxication during adolescence should be included when implementing screening strategies aimed at identifying adolescents at risk for subsequent social problems.

"The Outcomes of Pollutants on Glia" is an editorial published in the journal Frontiers in Cellular Neuroscience. It explores the effects of pollutants on glial cells in the brain and the resulting neurological outcomes. The editorial highlights the global challenges posed by pollution and its impact on human health, particularly neurological health. Specific studies included in the research topic investigate the involvement of glia in neurodegenerative diseases and the neurotoxicity of fluoride. The document emphasizes the importance of understanding how glial cells can either protect or damage the brain in response to pollutant exposure. It also discusses the use of a mouse model to study gliogenesis and astroglial involvement in pollutant-induced neurotoxicity. Additionally, the editorial highlights the potential of diet as a non-pharmacological alternative to prevent or mitigate neurotoxicity caused by pollutants, specifically examining the impact of dietary fatty acids on cellular functions in the brain. Overall, the document emphasizes the need to understand the role of glial cells in mediating neurotoxicity and the importance of preventing and mitigating the neurological consequences of pollution exposure. [Extracted from the article]

Abstract The consumption of alcohol reflects both societal norms and personal choices and has major clinical implications. Long‐term excess alcohol consumption leads to a domino effect of pathological outcomes and onset of chronic illness. However, the risks of alcohol consumption extend beyond long‐term health issues. Because habitual alcohol drinkers reach a state of systemic homeostasis, when they attempt withdrawal, they experience many negative physiological effects and may develop alcohol withdrawal syndrome. The complex interplay between alcohol consumption and withdrawal does not result solely in behavioral issues. Rather, a substantial number of important physiological adaptations and potential problems underly habitual drinking. Addressing these issues requires comprehensive medical observation and intervention. Here, we summarize the pathophysiological mechanisms, clinical diseases, and related treatment methods of alcohol consumption and withdrawal. The aim was to provide a reference to improve understanding of alcohol use and promote an informed approach to alcohol withdrawal.

In the specialized literature, there are few cases of inhaled salbutamol intoxication, being the most used bronchodilator in children’s asthma. We describe the situation of a 15-year-old teenager who inhaled salbutamol, in the context of an asthma attack, with each episode of coughing. At admission, the patient was conscious with a serious general state, afebrile, conscious, psychomotor agitation, tachycardic (heart rate=140/bpm), precordial pain, polypnea, dyspnea, with respiratory effort, hemodynamically stable, blood pressure=130/77 mmHg. Investigations showed hyperglycemia and hypokalemia. After the treatment, the evolution was favorable.

Introduction: Nerium oleander is a toxic plant containing cardiac glycosides throughout all its parts, thereby posing severe health risks upon ingestion. The clinical manifestations of oleander poisoning closely resemble those of digoxin toxicity, encompassing a spectrum of gastrointestinal symptoms, neuropsychiatric disorders, and cardiac disturbances. This scientific case report describes a case of accidental intoxication resulting from the consumption of an oleander leaves infusion misidentified as bay laurel leaves. Case report: An 84-year-old patient consumed an oleander leaves infusion, and after four hours experienced gastrointestinal symptoms. He contacted the poison control center (PCC) and was advised to go to the emergency department (ED). Upon arrival, the patient presented stable vital signs without cardiac irregularities. The PCC recommended the administration of activated charcoal, vigilant monitoring, including electrocardiography (ECG). Subsequent ECGs assessments revealed the presence of third-degree atrioventricular block; in consultation with the PCC, digoxin-specific antibodies and external pacing were necessary. The patient was discharged on the eighth day in good hemodynamic condition, and outpatient follow-up visits showed clinical stability. Discussion: This study offers insights for the management of similar cases. The limitations of conventional assays in measuring oleander cardiac glycosides were observed, emphasizing reliance on clinical evaluation. The patient's trajectory, remaining asymptomatic despite severe ECG changes post-ingestion, underscores the importance of prolonged clinical monitoring.

AbstractOrganophosphorus agents, also known as nerve agents, are very dangerous chemicals that were used as chemical warfare agents. HI-6 is one of the most promising reactivators which is effective in reactivating AChE inhibited by many nerve agents. However, the fast in-vivo clearance of HI-6 became a large barrier for first aid use under some sophisticated circumstances. In this study, PEGylated liposomes loading HI-6 were prepared and evaluated in vitro and in vivo. For PEG-LP-HI-6, the optimal formulation’s loading efficiency and encapsulation efficiency were 6.47 ± 0.10% and 71.2 ± 1.15%, respectively. According to the pharmacokinetic results, compared with free HI-6 and LP-HI-6, the intravenous injection of PEG-LP-HI-6 significantly extended t1/2 (1.47 ± 0.29 h), MRT (1.44 ± 0.07 h), and improved the AUC of HI-6 in vivo. Drug concentrations in the CNS also increased after the intravenous administration of PEG-LP-HI-6. For in vivo treatment study, twenty minutes after poison exposure, the survival rate of animals in saline, free HI-6, LP-HI-6 and PEG-LP-HI-6 groups were 0, 0, 30% and 70%, respectively. Compared with the non-PEGylated liposomes group and free HI-6, PEG-LP-HI-6 could prolong the survival time of experimental animals and alleviate the neurotoxic symptoms, which demonstrated great potential as a first-aid strategy for acute organophosphorus agent poisoning.

Several plants that contain indolizidine alkaloids, including swainsonine, are toxic to livestock, causing dysfunctional lysosomes and storage disease. Swainsonine induces a neurovisceral disease, known as locoism, in sheep, goats, and cattle, which occurs in several parts of the world, including, but not limited to, the western United States, China, and parts of Australia. In South America, locoism has been described in the Andean region of Argentina affecting sheep, cattle, and llamas. Intoxication by consumption of Astragalus punae was suspected in 4 llamas in Jujuy Province, northwestern Argentina. The grazing area contained abundant specimens of A. punae. The clinical course was ~15 d, and included moderate ataxia, incoordination of hindlimbs, and progressive loss of body condition. Microscopically, fine cytoplasmic microvacuolation was observed in the proximal convoluted renal tubules. Ultrastructurally, these changes consisted of severely dilated lysosomes. Swainsonine was detected in stem and leaf samples of A. punae at a concentration of 0.06%. Based on clinical history and signs, histologic and ultrastructural changes, and plant analysis, a diagnosis of swainsonine toxicosis caused by consumption of A. punae was made, which has not been reported previously, to our knowledge.

Background: Carbon Monoxide (CO) is one of the most common environmental causes of acute intoxication globally. It can lead to the development of Delayed Neuropsychiatric Sequelae (DNS) which may develop in 2-40 days after remission of acute CO poisoning. DNS is defined by recurrent-transient neurological, cognitive, or psychological manifestations. This study was intended to describe the demographics and characteristics of CO poisoning patients attending at the Emergency Department (ED) and assess the association between CO intoxication and the development of DNS in a tertiary hospital, Riyadh, Saudi Arabia. Methods: A retrospective descriptive cross-sectional study was conducted in subjects who were diagnosed with CO poisoning and attended to the ED at King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children's Hospital (KASCH) in Riyadh during the period from January 2016 to December 2021. Patient demographics, vitals, diagnostic tests, and oxygen therapy at initial presentation were documented. Patient medical records were reviewed at 2-40 days following CO poisoning for development of DNS. Ethical approval was obtained from King Abdullah International Medical Research Center (KAIMRC). Results: A total of 85 patients were diagnosed with CO poisoning and met the study inclusion criteria. Of those, 76% were adults with an average age of 32.36 (SD ± 15.20) and 51% were male adults. Five (6%) of the 85 patients developed DNS. Common symptoms included dizziness, nausea, and decreased visual acuity in 40% of the cases. The development of DNS manifestations was most likely (80%) to occur at 2 to 10 days after the initial incident. Inferential statistics showed that BMI (p-value = 0.021) and age group (p-value = 0.029) were significantly associated with COHb level, which was not the case for gender and the presence of clinical manifestation. Furthermore, Gender was significantly associated with the development of DNS (20% male vs. 80% female, p = 0.050). Conclusions: The findings of this study are consistent with previous published studies showing low proportions of patients who were exposed to CO poisoning at risk of developing DNS. Further larger-scale multicenter studies are needed to assess the factors associated with the development of DNS for patients with CO poisoning. [ABSTRACT FROM AUTHOR]