Kambo: Natural drug or potential toxic agent? A literature review of acute poisoning cases.

Kambo is the name of a natural substance derived from the glandular secretions of the amphibian Phyllomedusa bicolor, a species native to regions in South America. The communities living in these areas administer the substance generally transdermally during rituals for religious-purifying purposes, producing small skin burns. The scientific literature has reported some cases of intoxication following the use of Kambo but this aspect is still poorly understood. In fact, no shared therapy protocols exist for these events nor any real legislation on Kambo. The purpose of this work was to examine all cases of acute intoxication resulting from the administration of Kambo and published over the last 10 years, illustrating clinical signs, laboratory findings, instrumental tests, and therapy. The several cases identified in our review confirm that acute Kambo intoxication can occur, with serious and life-threatening effects. We developed a protocol aimed at the early diagnosis of cases of suspected acute intoxication by creating a treatment algorithm. The study aims to investigate the pathophysiology of these events in humans, proposing a protocol for the diagnosis and treatment of these cases that can be used by healthcare professionals.

In vitro cytokine, sCD23 and IgG secretion in multiple sclerosis.

Synthesis of IgG by peripheral blood mononuclear cells from patients with multiple sclerosis (MS) and with other neurological diseases and from healthy controls was induced by Pokeweed mitogen (PWM) in short-term cultures. As expected, MS patients produced more immunoglobulin (Ig) G and had a higher percentage of 'high responders' to PWM stimulation as compared to controls. Interleukin (IL)-4 was undetectable in all samples. IL-6 and tumor necrosis factor (TNF)-alpha synthesis was induced by PWM stimulation in all groups, but MS patients showed the most significant increase of both cytokines. Interestingly, only MS patients showed a significant increase of the soluble form of CD23 receptor (sCD23). Moreover, only sCD23 levels correlated with in vitro IgG production in MS patients. The levels of IL-6, TNF-alpha, sCD23 were greater in high responders compared to low responders in all groups. The mean value of each molecule, however, did not differ significantly among overall groups. A highly significant difference was reported for sCD23 in MS patients. We suggest that sCD23, also known as B cell growth factor, may play a role in the well-documented phenomenon of in vitro IgG hypersynthesis in MS patients, adding support to the concept of B cell up-regulation in the peripheral blood of these patients.

Erectile impotence in multiple sclerosis: a neurophysiological study.

Pudendal evoked potentials, motor evoked potentials of the bulbocavernosus muscle to magnetic stimulation and bulbocavernosus reflex were recorded in 34 patients with multiple sclerosis (MS). Responses were delayed in 26, 20 and 3 cases respectively. No relationship was found between neurophysiological abnormalities and the presence or severity of erectile dysfunction, showing that these tests have little diagnostic usefulness in MS patients with impotence. Nocturnal penile tumescence was assessed in 14 cases: the test result was normal in 10 patients, including 3 severely paraplegic subjects.

A case of myasthenia gravis associated with optic neuritis.

A case of myasthenia gravis is described in association with optic neuritis in which brain-stem auditory and somatosensory evoked potentials were normal. CSF contained alkaline oligoclonal IgG bands. Blood lymphocyte subpopulations showed a decreased number of T-suppressor cells.

Long-term follow-up of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests.

We evaluated the risk of developing clinically definite multiple sclerosis (CDMS) after an acute attack of isolated optic neuritis (ON) in 112 patients, in relation to demographic and paraclinical findings. Patients were examined by brain MRI, CSF analysis, and multiple evoked potentials (EPs); 10 were lost to follow-up, and the other 102 were enrolled in a prospective study (follow-up duration 6. 3 +/- 2.2 years). Of these, 37 (36.3%) developed CDMS after a mean interval of 2.3 +/- 1.6 years. The risk of developing CDMS was 13% after 2 years, 30% after 4, 37% after 6, and 42% after 8 and 10 years. Gender, age, and season of ON onset did not affect the risk. MS occurred in 37 of 71 patients (52.1%) with one MRI lesion or more; no patient with a normal MRI developed the disease. MS developed more frequently in patients with intrathecal IgG synthesis than in those without (43% vs. 28%), but the difference was not statistically significant. Multiple EPs showed a slight predictive value only including somatosensory EPs of the lower limb. Multiple sclerosis was mild in most cases (EDSS 2.2 +/- 1.9). The EDSS was less than 4 in 32 cases (86%), between 4 and 6 in 2 (5%), higher than 6.5 in 3 (8%).

Erythrocyte unsaturated fatty acid test (E-UFA test): a biological test to detect optic neuritis as initial feature of multiple sclerosis.

Retrobulbar optic neuritis, though suspicious is not always considered as a possible onset of MS. For this reason we submitted to the E-UFA (erythrocyte unsaturated fatty acid) test, 41 subjects who suffered from one or several episodes of retrobulbar optic neuritis with no other neurological signs. The test was positive in 14 subjects (34, 1%).

Perineal motor potentials to magnetic stimulation, pudendal evoked potentials and perineal reflex in women.

Motor potentials to transcranial and lumbar magnetic stimulation were recorded from the perineum in 14 healthy women. The response to transcranial stimulation presented an onset at 20.2 +/- 1.3 ms and a negative peak at 25.1 +/- 1.9 ms. Lumbar responses presented an onset at 5.1 +/- 0.8 ms, and the motor central conduction time measured 14.4 +/- 1.5 ms. Perineal reflex, cortical and lumbar pudendal evoked potentials were recorded after electrical stimulation of the labia minora. These tests are of possible clinical use in the evaluation of sphincter disturbances as they investigate the afferent and efferent pathways concerning pudendal nerve function.

[Exploration of the optic and somatosensory pathways with cerebral evoked potentials]. / Esplorazione delle vie ottiche e delle vie somato-sensitive mediante potenziali evocati cerebrali.

Visual and somatosensorial evoked potentials are the electrical response, recorded on the scalp, that follows the presentation of visual and sensorial stimuli. After briefly mentioning the technical premises enabling evoked responses to be obtained from EEC activity, some cases are reported (demyelining, degenerative, compressive, ischaemic, anoxic pathology) where visual or sensory evoked potentials presented changes, proof of the usefulness of these techniques for the purposes of clinical documentation or for diagnosis in different fields of DNS pathology.

[Visual evoked potentials and the E-UFA test. Laboratory contribution to the diagnosis of multiple sclerosis]. / Potenziali evocati visivi ed E-UFA test. Contributi di laboratorio alla diagnosi di sclerosi multipla.

Visual evoked potentials (VEPs) and electrophoretic mobility test of erythrocytes (E-UFA test) were compared in 50 multiple sclerosis (M.S.) patients as diagnostic tests. Abnormal VEPs were recorded in 35 patients. E-UFA test was found positive in 31 cases. With respect to Mc Alpine diagnostic criteria, 26 out of 33 definite M.S., 6 out of 9 probable M.S. and 3 out of 8 possible M.S. cases had abnormal VEPs. A positive response in E-UFA test was observed rispectively in 16, 8, 7 patients. Complessively 48 cases (96%) had an abnormal response to the one and/or to the other of the two tests, which apper complementar in early diagnosis of M.S.

[Neurophysiological tests in the diagnosis of multiple sclerosis. Visual and somatosensory evoked potential studies]. / Test neurofisiologici nella diagnosi di sclerosi multipla. Studio mediante potenziali evocati visivi e somatosenoriali.

Visual evoked potentials were recorded and found abnormal in 44 out of 57 multiple sclerosis (M.S.) patients (77%). Somatosensory evoked potentials were abnormal in 42 cases (73%). Both tests were abnormal in 56 out of 57 cases. The two tests have a complementary role in the assessment of M.S., showing a subclinical involvement of visual or sensory pathways in many cases. The high incidence of abnormal responses in patients with a short duration of the disease and in patients diagnosed as possible or probably M.S. suggests the aid of the tests in diagnosis of M.S.

[A case of Creutzfeldt-Jakob disease. Electroencephalographic and immunobiological aspects]. / A propostio di un caso di malattia di Creutzfeld Jakob. Aspetti elettroencefalografici ed immunobiologici.

A case of Creutzfeld Jakob disease is described from an E.E.G. and immunological point of view. The E.E.G. data at various stages of the disease are described and the presence of intrathecally produced IgG antibodies is pointed out.

[Clinical, immunologic and electrophysiologic correlations in evaluating multiple sclerosis in relation to its development]. / Correlazioni cliniche, immunologiche ed elettrofisiologiche nella valutazione della sclerosi multipla in rapporto all'evoluzione.

49 patients with multiple sclerosis (MS) were evaluated on several lines of investigation: clinical examination with disability rating scale, disease activity staging, multimodal evoked potentials and cerebrospinal fluid analysis. 24 patients were monthly re-examined and T-cell subsets were analysed in the peripheral blood. Evoked potentials were re-evaluated every 3 months in 24 patients. All paramethers were correlated in transversally and longitudinally during a 3 to 18 months follow-up. The results are discussed in the view of a methodological approach to a laboratory evaluation of disease evolution in its natural course and during therapeutic trials.

[Action of trazodone on pyramidal hypertension. Clinical study]. / Azione del trazodone sull'ipertono piramidale. Studio clinico.

18 patients with severe stabilized pyramidal hypertonia were treated with Trazodone for a minimum period of 60 days with a daily oral dose of 200-300 mg. The reduction of hypertonia was assessed using the Ashworth Scale to evaluate symptoms and signs. On the whole 12 patients showed a clinical improvement; eight of them showed an improvement of at least 2 items on the Ashworth Scale. The reduction of hypertonia began on the 4-5th day of therapy, progressing until the 10-12th day of treatment and then remained constant. Tolerance was very good. Despite the low number of patients in the study the authors obtained good results suggesting that Trazodone should be studied further in this field.

E-UFA test in multiple sclerosis.

Field et al. have recently suggested a blood test for multiple sclerosis based on determination of the absolute electrophoretic mobility of erythrocytes alone and in the presence of linoleic acid (LA) or arachidonic acid (AA). We attempted to reinvestigate this phenomenon in an Italian population.