The Critical Assessment of Oxidative Stress Parameters as Potential Biomarkers of Carbon Monoxide Poisoning.

In conventional clinical toxicology practice, the blood level of carboxyhemoglobin is a biomarker of carbon monoxide (CO) poisoning but does not correspond to the complete clinical picture and the severity of the poisoning. Taking into account articles suggesting the relationship between oxidative stress parameters and CO poisoning, it seems reasonable to consider this topic more broadly, including experimental biochemical data (oxidative stress parameters) and patients poisoned with CO. This article aimed to critically assess oxidative-stress-related parameters as potential biomarkers to evaluate the severity of CO poisoning and their possible role in the decision to treat. The critically set parameters were antioxidative, including catalase, 2,2-diphenyl-1-picryl-hydrazyl, glutathione, thiol and carbonyl groups. Our preliminary studies involved patients (n = 82) admitted to the Toxicology Clinical Department of the University Hospital of Jagiellonian University Medical College (Kraków, Poland) during 2015-2020. The poisoning was diagnosed based on medical history, clinical symptoms, and carboxyhemoglobin blood level. Blood samples for carboxyhemoglobin and antioxidative parameters were collected immediately after admission to the emergency department. To evaluate the severity of the poisoning, the Pach scale was applied. The final analysis included a significant decrease in catalase activity and a reduction in glutathione level in all poisoned patients based on the severity of the Pach scale: I°-III° compared to the control group. It follows from the experimental data that the poisoned patients had a significant increase in level due to thiol groups and the 2,2-diphenyl-1-picryl-hydrazyl radical, with no significant differences according to the severity of poisoning. The catalase-to-glutathione and thiol-to-glutathione ratios showed the most important differences between the poisoned patients and the control group, with a significant increase in the poisoned group. The ratios did not differentiate the severity of the poisoning. The carbonyl level was highest in the control group compared to the poisoned group but was not statistically significant. Our critical assessment shows that using oxidative-stress-related parameters to evaluate the severity of CO poisoning, the outcome, and treatment options is challenging.

Occupational Exposure to Polycyclic Aromatic Hydrocarbons in Polish Coke Plant Workers.

Assessment of occupational exposure to polycyclic aromatic hydrocarbons (PAHs) is an urgent and important task to prevent workers' illnesses. 1-Hydroxypyrene is one of the most commonly used biomarkers. The presented study assessed exposure to PAHs molecules among 619 individuals, men working in coke plant. Average number of years spent on working posts in exposition to PAHs was 31.5 years with standard deviation = 5.3. About 35% were smokers with 14.7 cigarettes per day. For each individual, 1-hydroxypyrene concentration in urine samples was measured. Urine 1-hydroxypyrene concentration correlated with air PAHs concentration. Difference between smokers and non-smokers was statistically significant. The median value for post-shift samples was 1.3 µg g-1 and for pre-shift sample concentration reached 0.3 µg g-1 Maximal assessed concentration was 7.6 µg g-1 among pre-shift samples and 27.8 µg g-1 among post-shift samples. The most exposed working posts were coke oven workers and coal derivatives production workers. Results obtained in presented study are relatively low in comparison to other countries or other Polish results but for further improvement a regular measurement of any PAHs' biomarker should be included to standard periodic health examinations for coke plant workers.

SERUM ANTIOXIDANT PARAMETERS IN PATIENTS POISONED BY DIFFERENT XENOBIOTICS.

There is a great diversity of the acute drugs overdose cases in clinical toxicology. Clinical situation is complicated by the coexistence of factors predisposing to the development of adverse drug reactions (chronic use of drugs, polypharmacy, alcohol or drugs dependence, nutritional disorders) and by the presence of chronic organ damage, especially the liver and the kidney. The aim of this study was to evaluate whether there are sensitive plasma markers belonging to the antioxidant system in patients exposed to various xenobiotics. We measured the activity of antioxidant parameters: catalase (CAT), glutathione peroxidase (GPX3), glutathione (GSH), sulfhydryl groups (-SH), carbonyl groups (=CO) and free radicals (2,2-diphenyl-1-picrylhydrazyl, DPPH, assay) in serum of 49 patients with acute intoxication caused by carbamazepine (CBZ, n = 9), mixed drug intoxication (MDI) (n = 9), alcohol withdrawal syndrome (AWS, n = 9), acetaminophen (APAP, n = 7), tricyclic antidepressants (TCAs) (n = 5), valproic acids (VA, n = 4), narcotics (N, n = 3), and three others (benzodiazepines, BZD, n = 2; barbiturates, n = 1). The results were compared with the parameters of not intoxicated patients (n = 39). All patients had lower catalase activity in comparison to the control group (41.9 ± 16.5 vs. 196.0 ± 82.2 U/mg protein, p = 0.000), while the increase of GSH level was particularly apparent only in patients with AWS (391.3 ± 257.9 µmol/mg protein) compared to the control group (171.4 ± 88.4 µmol/mg protein, p = 0.034) and to patients intoxicated with carbamazepine (152.8 ± 102.5 µmol/mg protein, p = 0.027). Some differences, but without statistical significance, were also observed in GPX3 activity between different groups of poisoned patients.

[Poisonings with paracetamol, salicylates and dextromethorphan ­ problem evaluation based on data from Toxicological Laboratory and Poison Information Center in Krakow in 2010-2015].

The aim of the paper was to study frequency of laboratory determinations and toxicological information related to over-the-counter drugs (OTC): paracetamol (acetaminophen), salicylates and dextromethorphan. The research was based on data from Toxicological Laboratory and Poison Information Center UJ CM in Krakow in years 2010-2015. Paracetamol was determined averagely 102 times a year, more than 50% (57 cases) were positive with confirmation of poisoning. The least number of paracetamol poisoning was noted in 2011 (35 cases), the most were in 2015 (98 cases). In the time span there were averagely 40 salicylates check measurements a year, less than 50% (15 cases) were positive. Dextromethorphane was confirmed averagely in 31 patients a year, decrease of the drug intoxications was noted in 2013-2015. Paracetamol and dextromethorphan were the most often the cause of poisoning in group of patients 13-18 years old, salicylates ­ more than 30 years. In the group of small children there were only a few poisonings with paracetamol. Toxicological information data related to paracetamol, salicylates and dextromethorphan were similar to data from toxicological laboratory. Mean year numbers of drug poisoning information were: 90 (paracetamol), 14 (salicylates), 30 (dextromethorphan). The differences were in patients age distribution. Acute poisonings with OTC were related mainly to paracetamol, young patients (13- 18 years) and young adults (19-29 years). Salicylates poisoning information were related mainly to the group of adult patients (> 30 years), dextromethorphan was abused mainly by oung patients (13-18 years). There were no observed poisonings with salicylates and dextromethorphan in children, but there were toxicological information about paracetamol and salicylates poisoning and overdose in group of children (1-6 years).

[Acute poisoning with e-cigarette liquid ­ case report].

Spreading e-cigarettes popularity comes from relief, the products are safe. They don't contain carcinogenic substances, that are present in tobacco smoke. But nicotine present in e-liquid is a very toxic alkaloid, highly addictive. A case of acute, oral intoxication with e-liquid was described. A patient, 42-years old woman, e-cigarettes addicted, health thus far, by accident drunk a swig of e-liquid containing nicotine at concentration 6 mg/ml. At admission to Toxicology Department she was conscious, with symptoms: dizziness, flushed cheeks, dry skin, dry conjunctivas, medium-wide pupils, nervous twitch, tachycardia, elevated blood pressure. Concentration of cotinine ­ nicotine metabolite, in serum and urine were respectively 2077 and 10236 ng/ml. Applied treatment was: infusive liquids, intravenous alkalization, administration of electrolytes and propranolol. Gradually improvement was reached and on the third day of hospitalization, after psychiatric consultation she was deinstitutionalized in good medical condition to continue treatment in Neurology Clinic. E-fluid intoxications are rare, poisoning course depends on nicotine dose, way of absorption, patient's health state and age.

[Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) blood levels in patients with acute carbon monoxide poisoning - a preliminary observations].

Background: Neurotrophins are the family of proteins which stimulate and regulate the process of neurogenesis. Several factors belong to the family, mainly nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT 3), and neurotrophin-4/5 (NT-4/5). Acute poisoning with carbon monoxide (CO), which usually is accompanied by neurologic symptoms, can potentially change the secretion profile of neurotrophins. Aim of the study. The main goal of the study is to assess the changes of NGF and BDNF plasma levels during an acute phase of CO poisoning as well as immediately after recovery. Additionally, the relationship among neurotrophin levels and selected aspects of clinical course of CO poisoning were studied. Materials and Methods: The study group consisted of 18 patients (mean age: 31.8±10.3 years) hospitalized in Toxicology Department of University Hospital in Cracow because of acute CO poisoning. There were 10 women (mean age: 30.2±6.9 years) and 8 men (mean age 33.9±13.7 years) in the group. The levels of NGF and BDNF were evaluated using immunoenzymatic method (ELISA) in plasma samples taken thrice in each patient. The sample 1. was taken during hospital admission, the sample 2. about 12-36 hours after admission, and the sample 3. just before the hospital discharging (usually, on the 3rd-4th day). The clinical data were collected from patients' anamnesis, physical examination and neuropsychological evaluation. The statistical analysis were performed using tools comprised in STATISTICA 12.0 PL (StatSoft Polska, Cracow, Poland) software. Results: The majority of NGF plasma levels were less than 14 pg/mL (values below the limit of quantification), contrary to the sole case of 34.3 pg/mL. BDNF plasma levels ranged from 4.8 ng/mL to above 48 ng/mL, i.e. they were higher than the upper limit of measurement range for the plasma dilution which had been used. The comparison of NGF and BDNF plasma levels in the study group with their analogues in healthy volunteers taken from the literature indicates that NGF level declines and BDNF level rises in patients with CO poisoning. The profile of BDNF concentrations in the majority of patients formed the characteristic pattern: BDNF sample 1. > BDNF sample 2. < BDNF sample 3. Taking all the values of BDNF higher than 48 ng/mL as equal to 48 ng/ mL, the statistically significant difference among 3 sample series was found according to BDNF levels. Maintaining the above mentioned assumption, the statistically significant negative correlation between the number of higher cognitive functions disturbed in one patient at the same time and the BDNF levels in sample series 2 was discovered, as well as the weak correlations between BDNF level in sample series 1 and carboxyhaemoglobin or lactate level. Moreover, weak but statistically significant correlations were present between the duration of CO exposure and BDNF levels in each sample series. Conclusions: The NGF plasma level is probably declined, while the BDNF plasma level is increased in patients with acute CO poisoning. The concentration­time curve for the plasma BDNF may sometimes undergo fluctuations with two peaks on its course. Plasma BDNF level may serve as a biological marker of disturbed higher cognitive functions in acute CO poisoning. Some clinical aspects of CO poisoning (duration of exposure, HbCO and lactate blood levels) may influence BDNF level.

[Structure of poison xenobiotic based on results of toxicological analysis from Toxicological Laboratory in Krakow in years 2003 and 2013]. / Struktura zatruc ksenobiotykami w oparciu o oznaczenia toksykologiczne wykonane w Pracowni Toksykologii w Krakowie w latach 2003 i 2013.

The aim of the study was to present changes in structure of toxicological analysis performed for hospitals in south-east Poland in last decennium. Material for the study were data from Toxicological Laboratory in Krakow in years 2003 and 2013. Total number of toxicological analysis decreased by about 30% in the period. The decline was related to analysis of ethanol, drugs of abuse (amphetamines, opiates, THC) and medicines. The number of determinations of acetylocholinoesterase activity (AChE)--marker of exposition to organophosphate and carbamate pesticides and carboxyhemoglobin (COHb)--marker of exposition to carbon monoxide also declined. The number of analysis of toxic alcohols (methanol and ethylene glycol) raised. The demand for determinations of new toxic substances (new drugs of abuse, "spices") appeared in the studied period. Advanced analytical methods (gas chromatography (GC), high performance liquid chromatography (HPLC), atomic absorption spectrometry (AAS) came into use in day-to-day routine. Changes in structure and numbers of determinations performed in regional toxicology laboratory reflects different trends. Prevalence of rapid tests for determination of drugs of abuse and alcohol in general medical laboratories caused decrease of number of the analysis in specialized toxicology laboratory. On the other hand growing demand for specialized analysis: new drugs of abuse, spices, new drugs, toxic alcohols and heavy metals was observed in last decennium.

[Exposure to environmental tobacco smoke in pre-school children--a comparative study]. / Narazenie dzieci w wieku przedszkolnym na dym tytoniowy--badanie porównawcze.

The objective of the work was to compare the socioeconomic situation and the structure of tobacco use in the families of children attending preschools in Bialystok in 2004 and 2012 in terms of 3-year-olds' exposure to environmental tobacco smoke (ETS). The study involved 313 children out of 1,200 3-year-olds attending 51 pre-schools in Bialystok in 2004 (Gr I) and 273 children out of 1,100 attending 49 pre-schools in 2012 (Gr I). Information on environmental conditions and the use of tobacco in the families of the studied 3-year-olds was obtained through anonymous questionnaires filled in by their parents or caregivers. The exposure of children to ETS was evaluated using the questionnaire and by determining the cotinine/creatinine ratio in urine. The children from Gr I had better educated (p<0.001) and wealthier (p=0.005) parents, and better living conditions (p=0.008). In 47.3% of the homes of children from Gr I and 31.1% of homes of children from Gr II there was at least one smoking person (p<0.001). Both in 2004 and in 2012, fathers prevailed among the smokers, but in 2012 their number was significantly lower (p<0.001). As for mothers, 23.6% of them in Gr I and 10.3% in Gr I admitted smoking every day (p<0.001). More children from Gr I than from Gr I lived with smoking grandparents. The declared number of cigarettes smoked a day by the people living with the children was similar in both Groups The Groups did not differ significantly regarding the rules of tobacco smoke applying to the family members and guests (p=0.639). The mean cotinine/ creatinine concentration [ng/mg] in the urine of children from Gr I (60.78) was significantly higher than in those from Gr II (22.75) (p<0.001). According to the survey data, in 2012 fewer three-year-olds were exposed to ETS out of home (p<0.001). The mean cotinine/ creatinine concentrations [ng/mg] depending on the declared exposure to tobacco smoke out of home: no exposure, existing exposure, unknown exposure, were for Gr I and Gr II, respectively: 51.31 vs. 35.67; (p<0.001), 76.10 vs. 38.65; (p=0.002), 76.92 vs. 47.04; (p=0.460). In 2012, as compared to 2004, the number of smokers among young parents decreased, but despite education activities in the community, only 1/4 of homes with children had the "no smoking" rule.

Proteins as biomarkers of carbon monoxide neurotoxicity.

CONTEXT: Carbon monoxide (CO) poisoning is the most common form of accidental lethal poisoning and is associated with a risk of brain damage in survivors. OBJECTIVE: The goal of this study was to examine whether Tau protein or S100B protein may be used as a biomarker for acute brain dysfunction. MATERIALS AND METHODS: The determination of Tau and S100B proteins was performed in serum samples collected from 27 CO-poisoned patients and 12 healthy volunteers. RESULTS: The level of Tau protein in the serum of patients (444 ± 227 ng L(-1)) differed significantly compared with those in the healthy controls (240 ± 61 ng L(-1)) and correlated with the level of carboxyhemoglobin. A higher concentration of Tau protein was found in patients who had lost consciousness during CO exposure. The concentration of S100B in the serum of CO-poisoned subjects (0.08 ± 0.03 µg L(-1)) was not statistically different from values obtained for the controls (0.07 ± 0.02 µg L(-1)). CONCLUSION: CO poisoning appears to be associated with an elevated level of Tau and S100B proteins in the serum of patients who had suffered a loss of consciousness. The study has shown that Tau protein is a more sensitive biomarker than S100B protein for the earlier stage of neurotoxic effects of CO intoxication.

Acute caffeine poisoning resulting in atrial fibrillation after guarana extract overdose.

UNLABELLED: Guarana (Paullinia cupana) is the climbing vine native to Amazon Basin, characterized by high caffeine content in its seeds. Guarana extract is a common ingredient of energy drinks used in order to boost energy and physical endurance and increase alertness. Severe caffeine intoxication is rare, but may be life-threatening mostly due to supraventricular and ventricular dysrhythmias. OBJECTIVES: We present the case of intentional caffeine poisoning after ingestion of tablets containing guarana extract, complicated by atrial fibrillation. CASE REPORT: A44-year-old man with no significant medical history was admitted to hospital about 21 h after ingestion of guarana extract containing 1.6 g of caffeine. Typical symptoms of caffeine toxicity, i.e. nausea, vomiting, anxiety and palpitaions, occurred shortly after ingestion. On admission, he was conscious, with blood pressure of 136/86 mmHg, heart rate of 106-113 beats per minute, fever of 37.8 °C, and symmetrically increased deep tendon reflexes. QTc interval in electrocardiogram was prolonged to 0.542 s. Laboratory tests revealed hypokalemia, hyperglycemia, leukocytosis, as well as elevated creatinine and creatine phosphokinase levels. Approximately 45 h post ingestion, the patient developed atrial fibrillation with fast ventricular rhythm. Tachydysrythmia subsided after infusion of amiodarone and restoration of electrolyte balance. Echocardiogram revealed presence of asymmetrical hypertrophy of the left ventricle with the systolic anterior motion of the mitral valve and normal left ventricular outflow tract gradient suggesting non-obstructive hypertrophic cardiomyopathy. CONCLUSION: Acute caffeine poisoning may result in atrial fibrillation, especially in predisposed patients with underlying hypertrophic cardiomyopathy.

[Patterns of drinking alcohol tobacco smoking among 6th year students of the faculty of medicine in Bialstok]. / Wzorce picia alkoholu i palenie tytoniu wsród studentów VI roku Wydzialu Lekarskiego Uniwersytetu Medycznego w Bialymstoku.

INTRODUCTION: Alcohol and tobacco are legal, easily available addictive substances. There are no universal criteria of safe alcohol consumption but some scientific studies have allowed for determination of consumption levels helpful in evaluation of the pattern of drinking and evoking readiness to limit the amount of consumed alcohol. THE AIM: The aim of the work was to evaluate and compare the knowledge of 6th year students of the Faculty of Medicine of the Medical University of Biatystok in the academic years 2011/12 and 2012/13 concerning the effects of alcohol abuse, as well as to determine their drinking patterns and tobacco smoking structure. MATERIALS AND METHODS: The study material was collected by means of anonymous voluntary surveys carried out before classes concerning the issues of addictions within the framework of family medicine subject block. RESULTS: 356 students took part in the study: 226 (63.5%) women and 130 (36.5%) men (p<0.000). 4.86% of the respondents displayed a high level of knowledge on the harmfulness of alcohol abuse; 63.43% had an average level of knowledge and 31.71% - a low one. 51,32% women and 62,3% men drank alcohol in a hazardous way. A relation was found between a low level of knowledge and the amount of alcohol consumed on a typical drinking day (rS=-0.15, p=0.03) as well as between a low level of knowledge and hazardous drinking (rS=-0.13, p=0.03). Among the respondents, 18,58% women and 14,63% men smoked cigarettes regularly. Those who are 6th year students in the academic year 2012/13 usually had started smoking within the first three years of study at the Medical University and drank greater amounts of alcohol on a typical drinking day than students surveyed in the 2011/12 year. A correlation was found between tobacco smoking and a greater frequency of getting drunk occasionally (rS=-0.18, p=0.002) among students of both years. CONCLUSION: Insufficient knowledge on the effects of alcohol abuse and smoking coexist with a higher risk of drinking alcohol.

[Confirmed poisonings with ethylene glycol and methanol in south Poland in the years 2010-2012 based on results from toxicological laboratories in Kraków and Sosnowiec]. / Potwierdzone zatrucia glikolem etylenowym i alkoholem metylowym w Polsce poludniowej w latach 2010-2012 na podstawie wyników oznaczen laboratoriów toksykologicznych w Krakowie i Sosnowcu.

The purpose of the research was to present the number of ethylene glycol and methanol poisonings in south Poland in the years 2010-2012, based on data from toxicological laboratories in Kraków and Sosnowiec. Total numbers of positive determinations of the toxic alcohols were 380-ethylene glycol and 152-methanol. Most of the patients poisoned with the toxic alcohols were men (87.4%), the mean age of the patients was 48.1 years. Mean ethylene glycol concentration in samples from poisoned patients was 57.5 mg/dl in serum and 286.2 mg/dl in urine; mean blood methanol concentration was 1.4 g/l. Samples collected from poisoned patients treated on the area of whole voivodeship were determined in toxicology laboratories. According to information about orderers of ethylene glycol and methanol tests, positive results of the toxic alcohols were the most often in big cities and in cities, where department of toxicology were located (Kraków and Sosnowiec). In many cases patients were treated in hospitals in small cities, and samples collected from patients were transported to perform toxicological determination. The study shows, that intoxications with ethylene glycol and methanol are a big problem in Poland and the number of methanol poisonings markedly increased in the years 2010-2012.

[Children and adolescents toxic exposure in 2010-2012--data of Poison Information Centre and Laboratory of Analytical Toxicology and Drug Monitoring Jagiellonian University Medical College]. / Narazenie na substancje toksyczne wsród dzieci i mlodocianych w latach 2010-2012 w materiale Osrodka Informacji Toksykologicznej oraz Pracowni Toksykologii Analitycznej i Terapii Monitorowanej Katedry Toksykologii Klinicznej i Chorób Srodowiskowych UJ CM.

A telephone inquires to Poison Information Centre and data from toxicological laboratory of Jagiellonian University Medical College related to cases below 19 years of age in 2010 -2012 were analyzed. 37.3% of 3692 information given were related to children and adolescent toxic exposure. Most telephone inquires concerned youngest children (below 6 years); toxicological analysis were ordered in the oldest group (13-19 years) mostly.

[Osteopontin level in the serum of patients with alcoholic liver disease, treated for alcohol withdrawal syndrome--a preliminary report]. / Poziom osteopontyny w surowicy krwi u pacjentów z alkoholowa choroba watroby, leczonych z powodu alkoholowego zespolu odstawiennego--doniesienie wstepne.

Alcoholic liver disease (ALD) is consequence of alcohol addiction, that increase morbidity and mortality of those group of patients. Induction of the inflammatory process in alcohol injured liver is a turning point in ALD, can cause acute liver damage symptoms or cirrhosis with increase of hepatic fibrosis intensity and portal hypertension. Osteopontin (OPN)--a protein associated with early inflammatory process and remodeling of damaged tissues with intensification of hepatic fibrogenesis process, is considered to be a biomarker of hepatic inflammation and fibrosis. A group of 12 patients with mean age--44 years, mean alcohol addiction time--16 years, hospitalized because of alcohol withdrawal symptoms were examined in the preliminary report. ALD was diagnosed in all patients, steatosis--in 4, inflammatory--in 3, cirrhosis--in 5. Control group were 19 healthy patients with no alcohol addiction and liver disease in medical history. Serum OPN level was measured by ELISA method using reagents from Raybiotech. Serum OPN level in control group ranged 0-35,955 pg/ml, in examined group ranged 0-338,280 pg/ml. OPN levels in serum of patients with hepatic steatosis were under limit of detection (< 50 pg/ml). OPN serum level increase was correlated to ALD progression. The highest OPN levels (> 100,000 pg/ml) were observed in patients with symptoms of the liver decompensation due to severe hepatitis and advanced cirrhosis.

[Kindergartners' indoor exposition to tobacco smoke and its influence on cotinine concentration in children's urine]. / Narazenie dzieci w wieku przedszkolnym na dym tytoniowy i jego wplyw na stezenie kotyniny w moczu.

The purpose of the research was to study kindergarteners' exposition to environmental tobacco smoke (ETS) in houses. Social and economical factors were checked for the improper behavior of grown-up household. Material for the research were data collected from questionnaires filled by children's parents. 272 three years old children were studied (57.7% boys and 42.3% girls). Cotinine--marker of exposition to ETS was measured in the children's urine. In 32.4% houses at least one resident was a tobacco smoker. The most often it was father (22.3%) or mother (10.6%). Most of them (78.7%) affirmed tobacco smoking out of houses. Tobacco smoking correlated to parents education (mothers--college graduate and fathers--high-school graduate smoked tobacco the most often). Tobacco smoking by the parents correlated to low household income (less than 1000 zl), many house occupants (4-5 persons), small house area (less than 15 m2/person). A part of studied group of children (11%) was exposed to ETS out of house. Mean cotinine concentration in urine of children exposed and unexposed to ETS in house were not significantly different an were respectively: 25.60 and 21.22 ng/mg creatinine. Propagation of right behavior among people smoking tobacco in houses and education of small children parents is important.

[Determination of ethylene glycol in biological fluids--propylene glycol interferences]. / Oznaczanie glikolu etylenowego w materiale biologicznym--interferencja glikolu propylenowego.

Many laboratories in Poland do not use gas chromatography (GC) method for determination of ethylene glycol (EG) and methanol in blood of poisoned patients, they use non specific spectrophotometry methods. One of the interfering substances is propylene glycol (PG)--compound present in many medical and cosmetic products: drops, air freshens, disinfectants, electronic cigarettes and others. In Laboratory of Analytical Toxicology and Drug Monitoring in Krakow determination of EG is made by GC method. The method enables to distinguish and make resolution of (EG) and (PG) in biological samples. In the years 2011-2012 in several serum samples from diagnosed patients PG was present in concentration from several to higher than 100 mg/dL. The aim of the study was to estimate PG interferences of serum EG determination by spectrophotometry method. Serum samples containing PG and EG were used in the study. The samples were analyzed by two methods: GC and spectrophotometry. Results of serum samples spiked with PG with no EG analysed by spectrophotometry method were improper ("false positive"). The results were correlated to PG concentration in samples. Calculated cross-reactivity of PG in the method was 42%. Positive results of EG measured by spectrophotometry method must be confirmed by reference GC method. Spectrophotometry method shouldn't be used for diagnostics and monitoring of patients poisoned by EG.

[Medical analytical toxicology in Poland in year 2012]. / Kliniczna analityka toksykologiczna w Polsce w 2012 roku.

There are 12 centers of acute poisoning treatment and 9 round the clock toxicological laboratories. Most of the laboratories access evidence of activity run by National Clinical Toxicology Consultant. The paper presents actual status of medical toxicology laboratories in Poland and summarizes activity of the laboratories in the year 2012. In 2012 toxicological laboratories reported 113,719 assays. There were diagnosed 63.8% men and 34.8% women. The toxicological laboratories determine most substances and markers of exposition to chemical compounds important for diagnosis and treatment of acute poisonings (i.e. ethanol, methanol, ethylene glycol, acetaminophen, salicylates, anticonvulsants, carboxyhemoglobin, methemoglobin). There is not possible to determine heavy metals, all medicines and "designed" drugs of abuse in all laboratories. Limited access to reference methods, that enable to confirm results obtained by screening methods (immunological cassette and strip tests) is also a problem.

[Immunoassay methods used to diagnose patients poisoned with psychoactive substances--analytical and interpretation problems]. / Metody immunoenzymatyczne w diagnostyce zatruc substancjami psychoaktywnymi--problemy analityczne i interpretacyjne.

Diagnostics of patients poisoned with psychoactive substances is usually performed by immunoenzymatic methods. The results obtained by the methods are not reliable. A few percent of results can be "false positive" or "false negative". The purpose of the paper was to present cases of "false positive" THC and amphetamine derivatives results obtained in urine of patients treated in Departments of Toxicology in Krakow and in Tarnow. Confirmation tests gave negative results. Interpretation of results obtained by immunoassay methods should include possibility of "false" result. The physician should consider verification of the results and refer confirmation by reference methods.

[Application of HPLC-UV method for aripiprazole determination in serum]. / Zastosowanie metody HPLC-UV do oznaczania arypiprazolu w surowicy.

Aripiprazole is a new drug applied in schizophrenia treatment. There are not strict indications for aripiprazole therapeutic drug monitoring. Despite, serum aripiprazole measuring would help control the drug doses effectiveness. The drug monitoring can eliminate overdosing, adverse effects and let control proper drug ingestion. The aim of the paper was to develop a simple method for aripiprazole determination in serum for therapeutic drug monitoring. High performance liquid chromatography with spectrophotometric detection (HPLC-UV) was used. Resolution was performed on LC-8 column; moving phase was solution 0,025M trimethylammonium buffer: acetonitrile (62:38). Isocratic flow was 1,2 ml/min; internal standard (IS) was promazine; monitored wavelength was lambda=214 nm. The validation parameters were: limits of linearity (LOL) 100-800 ng/ml, limit of detection (LOD) 10 ng/ml, limit of quantity (LOQ) 100 ng/ml. Coefficient of variation (CV) describing accuracy and precision didn't cross 10%. The method was useful for therapeutic drug monitoring in serum of patients treated with aripiprazole.

[Estimation of carbon monoxide poisonings frequency, based on carboxyhemoglobin determinations performed in Toxicology Laboratory in Krakow in years 2002-2010]. / Ocena czestosci zatruc tlenkiem wegla na podstawie wyników oznaczen karboksyhemoglobiny przeprowadzonych w Pracowni Toksykologii w Krakowie w latach 2002-2010.

Carboxyhemoglobin is a specific biomarker of carbon monoxide (CO) exposition. The source of CO indoors are most often gas, oil or carbon furnaces and stoves or bathroom gas heaters. CO intoxication during fire or exposition to car fumes are sporadic. The aim of the study was: to present the frequency of CO intoxications diagnosed in Laboratory of Analytical Toxicology UJ Collegium Medicum in years 2002 - 2010, to present the season trends of CO intoxications, show sex and age structure of CO intoxicated patients. Material were Laboratory of Analytical Toxicology and Drug Monitoring data records from years 2002 - 2010. CO intoxication was confirmed and recognized when COHb blood concentration was higher than 10%. Annual number of CO poisonings was stable in the period of time, varied from 209 to 296 (mean 256,2 CO poisonings per year). Sex structure of CO poisoned patients showed little female dominance (54.6%). Carbon monoxide poisonings distribution was seasonal. The season of intensified CO intoxications lasted from October to March, the highest intensity was in December and January. The CO poisoning problem is still actual. Society education about security, recognition, diagnosis and practice in carbon monoxide exposition is still needful.