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1.
Nano Lett ; 23(4): 1350-1354, 2023 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-36763516

RESUMO

Thioether polymers are fundamental for a variety of applications. Their synthesis is, however, more challenging than that of other metal-catalyzed reactions due to the reported detachment of the S atom during thermal activation. In this study, it has been demonstrated unambiguously that thermal annealing results in the thioetherification of the 4-bromo-4-mercaptobiphenyl molecule (Br-MBP) adsorbed on the surface of Au(111). Through complementary techniques, such as scanning tunneling microscopy, spectroscopy, and first-principle calculations, we have identified four reaction steps, involving sulfhydryl or bromine molecular functional groups and leading to the formation of intermolecular C-S bonds. To form the thioether polymer and to overcome the competitive formation of C-C bonds, two reaction steps, the dehalogenation, and dissociation of the S-Au bond, must occur simultaneously. We detail the electronic properties of the phenyl-sulfur bond and the polymer as a function of the ligand length. This result suggests a wider perspective of this chemical synthesis.

2.
Sensors (Basel) ; 23(17)2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37688015

RESUMO

In recent years, the application of artificial intelligence (AI) in the automotive industry has led to the development of intelligent systems focused on road safety, aiming to improve protection for drivers and pedestrians worldwide to reduce the number of accidents yearly. One of the most critical functions of these systems is pedestrian detection, as it is crucial for the safety of everyone involved in road traffic. However, pedestrian detection goes beyond the front of the vehicle; it is also essential to consider the vehicle's rear since pedestrian collisions occur when the car is in reverse drive. To contribute to the solution of this problem, this research proposes a model based on convolutional neural networks (CNN) using a proposed one-dimensional architecture and the Inception V3 architecture to fuse the information from the backup camera and the distance measured by the ultrasonic sensors, to detect pedestrians when the vehicle is reversing. In addition, specific data collection was performed to build a database for the research. The proposed model showed outstanding results with 99.85% accuracy and 99.86% correct classification performance, demonstrating that it is possible to achieve the goal of pedestrian detection using CNN by fusing two types of data.

3.
Nano Lett ; 22(10): 4176-4181, 2022 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-35512394

RESUMO

Electron paramagnetic resonance (EPR) can provide unique insight into the chemical structure and magnetic properties of dopants in oxide and semiconducting materials that are of interest for applications in electronics, catalysis, and quantum sensing. Here, we demonstrate that EPR in combination with scanning tunneling microscopy (STM) allows for probing the bonding and charge state of alkali metal atoms on an ultrathin magnesium oxide layer on a Ag substrate. We observe a magnetic moment of 1 µB for Li2, LiNa, and Na2 dimers corresponding to spin radicals with a charge state of +1e. Single alkali atoms have the same charge state and no magnetic moment. The ionization of the adsorbates is attributed to charge transfer through the oxide to the metal substrate. Our work highlights the potential of EPR-STM to provide insight into dopant atoms that are relevant for the control of the electrical properties of surfaces and nanodevices.

4.
Nano Lett ; 21(19): 8317-8323, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34520215

RESUMO

Starting from a long aza-starphene neutral and nonmagnetic organic molecule, a single-molecule magnet is on-surface constructed using up to 3 light nonmagnetic aluminum (Al) atoms. Seldom observed in solution with transition-metal atoms and going from 1 to 3 Al coordinated atoms, the doublet-singlet-doublet transition is easily on-surface accessible using the scanning tunneling microscope single-atom and single-molecule manipulations on a gold(111) surface. With 3 coordinated Al atoms, the lateral vibration modes of the Al3-aza-starphene molecule magnet are largely frozen. Using the Kondo states, this opens the observation of the in-phase Al vertical atom vibrations and out-of-phase central phenyl vibrations.

5.
Phys Chem Chem Phys ; 23(18): 10845-10851, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33908516

RESUMO

The on-surface synthesis of non-planar nanographenes is a challenging task. Herein, with the aid of bond-resolving scanning tunneling microscopy (BRSTM) and density functional theory (DFT) calculations, we present a systematic study aiming at the fabrication of corannulene-based nanographenes via intramolecular cyclodehydrogenation on a Au(111) surface. The formation of non-planar targeted products is confirmed to be energetically unfavorable compared to the formation of planar/quasi-planar undesired competing monomer products. In addition, the activation of intermolecular coupling further inhibits the formation of the final targeted product. Although it was not possible to access the corannulene moiety by means of on-surface synthesis, partial cyclodehydrogenation of the molecular precursors was demonstrated.

6.
Nano Lett ; 20(1): 384-388, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31846337

RESUMO

The Kondo effect results from the interactions of the conduction electrons in a metal bulk with localized magnetic impurities. While adsorbed atop a metallic surface, the on-surface nanoscale version of this effect is observed when a single magnetic atom or a single magnetic molecule (SMM) is interacting with the conduction electrons. SMMs are commonly organometallic complexes incorporating transition-metal atoms in different oxidation states. We demonstrate how a single nonmagnetic neutral tetrabenzo[a,c,j,h]phenazine molecule can be on-surface-coordinated with exactly two aluminum metal atoms (between Al(I) and Al(II) oxidation state on the Au(111) surface) by low-temperature scanning tunneling microscope (LT-STM) single-atom manipulation. It results in a Kondo measurable localized molecular magnetic moment. This opens a new way to design SMM complexes without the need for heavy transition-metal atoms and complex ligands to stabilize the molecular coordination sphere.

7.
Angew Chem Int Ed Engl ; 60(29): 16208-16214, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-33960097

RESUMO

Porphyrin nanotapes (Por NTs) are promising structures for their use as molecular wires thanks to a high degree of π-conjugation, low HOMO-LUMO gaps, and exceptional conductance. Such structures have been prepared in solution, but their on-surface synthesis remains unreported. Here, meso-meso triply fused Por NTs have been prepared through a two-step synthesis on Au(111). The diradical character of the on-surface formed building block PorA2 , a phenalenyl π-extended ZnII Por, facilitates intermolecular homocoupling and allows for the formation of laterally π-extended tapes. The structural and electronic properties of individual Por NTs are addressed, both on Au(111) and on a thin insulating NaCl layer, by high-resolution scanning probe microscopy/spectroscopy complemented by DFT calculations. These Por NTs carry one unpaired electron at each end, which leads to magnetic end states. Our study provides a versatile route towards Por NTs and the atomic-scale characterization of such tapes.

8.
J Am Chem Soc ; 142(42): 18109-18117, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-32985889

RESUMO

Organic open-shell compounds are extraordinarily attractive materials for their use in molecular spintronics thanks to their long spin-relaxation times and structural flexibility. Porphyrins (Pors) have widely been used as molecular platforms to craft persistent open-shell structures through solution-based redox chemistry. However, very few examples of inherently open-shell Pors have been reported, which are typically obtained through the fusion of non-Kekulé polyaromatic hydrocarbon moieties to the Por core. The inherent instability and low solubility of these radical species, however, requires the use of bulky substituents and multistep synthetic approaches. On-surface synthesis has emerged as a powerful tool to overcome such limitations, giving access to structures that cannot be obtained through classical methods. Herein, we present a simple and straightforward method for the on-surface synthesis of phenalenyl-fused Pors using readily available molecular precursors. In a systematic study, we examine the structural and electronic properties of three surface-supported Pors, bearing zero, two (PorA2), and four (PorA4) meso-fused phenalenyl moieties. Through atomically resolved real-space imaging by scanning probe microscopy and high-resolution scanning tunneling spectroscopy combined with density functional theory calculations, we unambiguously demonstrate a triplet ground state for PorA2 and a charge-transfer-induced open-shell character for the intrinsically closed-shell PorA4.

9.
Phys Chem Chem Phys ; 22(27): 15208-15213, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32427237

RESUMO

On a gold surface, supramolecules composed of 4-acetylbiphenyl molecules show structural directionality, reproducibility and robustness to external perturbations. We investigate the assembly of those molecules on the Au(111) surface and analyze how the observed supramolecular structures are the result of weak long-range dispersive forces stabilizing the 4-acetylbiphenyl molecules together. Metallic adatoms serve as stabilizing agents. Our analysis suggests new ways of creating complex molecular nano-objects that can eventually be used as devices or as seeds for extended hierarchical structures.

10.
J Chem Phys ; 152(20): 204108, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32486661

RESUMO

A review of the present status, recent enhancements, and applicability of the Siesta program is presented. Since its debut in the mid-1990s, Siesta's flexibility, efficiency, and free distribution have given advanced materials simulation capabilities to many groups worldwide. The core methodological scheme of Siesta combines finite-support pseudo-atomic orbitals as basis sets, norm-conserving pseudopotentials, and a real-space grid for the representation of charge density and potentials and the computation of their associated matrix elements. Here, we describe the more recent implementations on top of that core scheme, which include full spin-orbit interaction, non-repeated and multiple-contact ballistic electron transport, density functional theory (DFT)+U and hybrid functionals, time-dependent DFT, novel reduced-scaling solvers, density-functional perturbation theory, efficient van der Waals non-local density functionals, and enhanced molecular-dynamics options. In addition, a substantial effort has been made in enhancing interoperability and interfacing with other codes and utilities, such as wannier90 and the second-principles modeling it can be used for, an AiiDA plugin for workflow automatization, interface to Lua for steering Siesta runs, and various post-processing utilities. Siesta has also been engaged in the Electronic Structure Library effort from its inception, which has allowed the sharing of various low-level libraries, as well as data standards and support for them, particularly the PSeudopotential Markup Language definition and library for transferable pseudopotentials, and the interface to the ELectronic Structure Infrastructure library of solvers. Code sharing is made easier by the new open-source licensing model of the program. This review also presents examples of application of the capabilities of the code, as well as a view of on-going and future developments.

11.
Nano Lett ; 19(5): 3027-3032, 2019 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-30998364

RESUMO

Bulk and single-layer 2 H-NbSe2 exhibit identical charge density wave order (CDW) with a quasi-commensurate 3 × 3 superlattice periodicity. Here we combine scanning tunnelling microscopy (STM) imaging at T = 1 K of 2 H-NbSe2 with first-principles density functional theory (DFT) calculations to investigate the structural atomic rearrangement of this CDW phase. Our calculations for single-layers reveal that six different atomic structures are compatible with the 3 × 3 CDW distortion, although all of them lie on a very narrow energy range of at most 3 meV per formula unit, suggesting the coexistence of such structures. Our atomically resolved STM images of bulk 2 H-NbSe2 unambiguously confirm this by identifying two of these structures. Remarkably, these structures differ from the X-ray crystal structure reported for the bulk 3 × 3 CDW which in fact is also one of the six DFT structures located for the single-layer. Our calculations also show that due to the minute energy difference between the different phases, the ground state of the 3 × 3 CDW could be extremely sensitive to doping, external strain or internal pressure within the crystal. The presence of multiphase CDW order in 2 H-NbSe2 may provide further understanding of its low temperature state and the competition between different instabilities.

12.
Nano Lett ; 18(3): 2033-2039, 2018 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-29481087

RESUMO

Enhancing the spin-orbit interaction in graphene, via proximity effects with topological insulators, could create a novel 2D system that combines nontrivial spin textures with high electron mobility. To engineer practical spintronics applications with such graphene/topological insulator (Gr/TI) heterostructures, an understanding of the hybrid spin-dependent properties is essential. However, to date, despite the large number of experimental studies on Gr/TI heterostructures reporting a great variety of remarkable (spin) transport phenomena, little is known about the true nature of the spin texture of the interface states as well as their role on the measured properties. Here, we use ab initio simulations and tight-binding models to determine the precise spin texture of electronic states in graphene interfaced with a Bi2Se3 topological insulator. Our calculations predict the emergence of a giant spin lifetime anisotropy in the graphene layer, which should be a measurable hallmark of spin transport in Gr/TI heterostructures and suggest novel types of spin devices.

13.
Ann Hepatol ; 17(1): 125-133, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29311398

RESUMO

BACKGROUND: Current guidelines do not differentiate in the utilization of vasoactive drugs in patients with cirrhosis and acute variceal bleeding (AVB) depending on liver disease severity. MATERIAL AND METHODS: In this retrospective study, clinical outcomes in 100 patients receiving octreotide plus endoscopic therapy (ET) and 216 patients with ET alone were compared in terms of failure to control bleeding, in-hospital mortality, and transfusion requirements stratifying the results according to liver disease severity by Child-Pugh (CP) score and MELD. RESULTS: In patients with CP-A or those with MELD < 10 octreotide was not associated with a better outcome compared to ET alone in terms of hospital mortality (CP-A: 0.0 vs. 0.0%; MELD < 10: 0.0 vs. 2.9%, p = 1.00), failure to control bleeding (CP-A: 8.7 vs. 3.7%, p = 0.58; MELD < 10: 5.3 vs. 4.3%, p = 1.00) and need for transfusion (CP-A: 39.1 vs. 61.1%, p = 0.09; MELD < 10: 63.2 vs. 62.9%, p = 1.00). Those with severe liver dysfunction in the octreotide group showed better outcomes compared to the non-octreotide group in terms of hospital mortality (CP-B/C: 3.9 vs. 13.0%, p = 0.04; MELD ≥ 10: 3.9 vs. 13.3%, p = 0.03) and need for transfusion (CP-B/C: 58.4 vs. 71.6%, p = 0.05; MELD ≥ 10: 50.6 vs. 72.7%, p < 0.01). In multivariate analysis, octreotide was independently associated with in-hospital mortality (p = 0.028) and need for transfusion (p = 0.008) only in patients with severe liver dysfunction (CP-B/C or MELD ≥ 10). CONCLUSION: Patients with cirrhosis and AVB categorized as CP-A or MELD < 10 had similar clinical outcomes during hospitalization whether or not they received octreotide.


Assuntos
Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/etiologia , Fármacos Gastrointestinais/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/etiologia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Octreotida/uso terapêutico , Adulto , Idoso , Transfusão de Sangue , Terapia Combinada , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Fármacos Gastrointestinais/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Hemostase Endoscópica , Mortalidade Hospitalar , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/mortalidade , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Testes de Função Hepática , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Octreotida/efeitos adversos , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
14.
Nano Lett ; 17(10): 6203-6209, 2017 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-28872317

RESUMO

The creation of molecule-like structures in which magnetic atoms interact controllably is full of potential for the study of complex or strongly correlated systems. Here, we create spin chains in which a strongly correlated Kondo state emerges from magnetic coupling of transition-metal atoms. We build chains up to ten atoms in length by placing Fe and Mn atoms on a Cu2N surface with a scanning tunneling microscope. The atoms couple antiferromagnetically via superexchange interaction through the nitrogen atom network of the surface. The emergent Kondo resonance is spatially distributed along the chain. Its strength can be controlled by mixing atoms of different transition metal elements and manipulating their spatial distribution. We show that the Kondo screening of the full chain by the electrons of the nonmagnetic substrate depends on the interatomic entanglement of the spins in the chain, demonstrating the prerequisites to build and probe spatially extended strongly correlated nanostructures.

15.
Ann Hepatol ; 16(5): 788-796, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28809735

RESUMO

INTRODUCTION AND AIMS: Adrenal insufficiency (AI) is common in patients with cirrhosis. We aimed to assess the presence of AI in stable patients with cirrhosis using the gold-standard insulin tolerance test (ITT) and to propose an algorithm for screening AI in these patients. MATERIAL AND METHODS: We studied 40 stable patients with cirrhosis. We determined the basal total (BTC) and peak cortisol (PTC) levels. Using the ITT, we defined AI as a serum PTC < 18 µg/dL at 30 min after insulin-induced hypoglycemia. We assessed the diagnostic accuracy of BTC in different stages of liver disease to discriminate between those with NAF and AI. RESULTS: Of the 40 patients, 24 (60%) presented with AI. Child-Pugh and MELD scores differed between the NAF and AI groups (Child-Pugh: NAF 7.2 ± 1.7 vs. AI 8.8 ± 2.4, p = 0.024 and MELD: NAF 9.9 ± 2.5 vs. AI 14.9 ± 6.3, p = 0.001). The BTC level was lower in patients with AI than in those with NAF (7.2 ± 2.4 vs. 12.5 ± 5.2, p < 0.001). A BTC value ≤ 10.0 µg/dL had a 96% sensitivity (negative predictive value: 90%) for identifying AI. This cutoff value (BTC ≤ 10.0 µg/dL) provided 100% specificity (positive predictive value: 100%) in patients with advanced liver disease (Child-Pugh ≥ 9 or MELD ≥ 12). CONCLUSION: An algorithm including the use of BTC and the severity of liver disease may be a useful and simple method for assessing adrenal function in stable patients with cirrhosis.


Assuntos
Testes de Função do Córtex Suprarrenal , Glândulas Suprarrenais/fisiopatologia , Insuficiência Adrenal/diagnóstico , Algoritmos , Técnicas de Apoio para a Decisão , Cirrose Hepática/diagnóstico , Administração Intravenosa , Glândulas Suprarrenais/metabolismo , Insuficiência Adrenal/sangue , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/fisiopatologia , Adulto , Área Sob a Curva , Biomarcadores/sangue , Glicemia/metabolismo , Procedimentos Clínicos , Estudos Transversais , Feminino , Humanos , Hidrocortisona/sangue , Hipoglicemia/sangue , Hipoglicemia/fisiopatologia , Insulina/administração & dosagem , Cirrose Hepática/sangue , Cirrose Hepática/epidemiologia , Cirrose Hepática/fisiopatologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Curva ROC , Reprodutibilidade dos Testes
16.
Nano Lett ; 16(1): 588-93, 2016 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-26650920

RESUMO

The manipulation of the molecular spin state by atom doping is an attractive strategy to confer desirable magnetic properties to molecules. Here, we present the formation of novel magnetic metallocenes by following this approach. In particular, two different on-surface procedures to build isolated and layer-integrated Co-ferrocene (CoFc) molecules on a metallic substrate via atomic manipulation and atom deposition are shown. The structure as well as the electronic properties of the so-formed molecule are investigated combining scanning tunneling microscopy and spectroscopy with density functional theory calculations. It is found that unlike single ferrocene a CoFc molecule possesses a magnetic moment as revealed by the Kondo effect. These results correspond to the first controlled procedure toward the development of tailored metallocene-based nanowires with a desired chemical composition, which are predicted to be promising materials for molecular spintronics.

17.
Rev Esp Enferm Dig ; 109(4): 313, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28240036

RESUMO

We thank Dr. Dib for his interest in our prospective study, in which we assessed the accuracy of the American Society for Gastrointestinal Endoscopy guidelines for the prediction of choledocholithiasis (CL). The guidelines suggest the option of using a less-invasive initial test including endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) in patients with intermediate probability of CL. However, there is a paucity of published literature supporting this recommendation. Furthermore, in the study by Adams et al. (3) such a recommendation is not supported by their data. Additionally, because the prevalence of CL varies among ethnic groups, we did not consider performing pre-ERCP (endoscopic retrograde cholangiopancreatography) imaging studies in our study.


Assuntos
Coledocolitíase , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Endossonografia , Humanos , Probabilidade , Estudos Prospectivos
18.
J Am Chem Soc ; 138(24): 7544-50, 2016 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-27233351

RESUMO

Adding ligands to molecules can have drastic and unforeseen consequences in the final products of a reaction. Recently a surface trans effect due to the weakening of a molecule-surface bond was reported. Here, we show a surface cis effect where an axial ligand at adsorbed transition-metal complexes enables lateral bonding among the molecules. In the absence of this ligand, the intermolecular interaction is repulsive and supramolecular patterns are not observed. Fe-tetramethyl-tetraazaannulene on Au(111) was investigated using low-temperature scanning tunneling microscopy and spectroscopy along with density functional theory calculations. At low coverages, the molecules remain isolated. Exposure to CO leads to axial CO bonding and induces reordering into extended clusters of chiral molecular trimers. The changed self-assembly pattern is due to a CO-induced modification of the molecular structure and the corresponding charge transfer between the molecule and the substrate, which in turn changes the lateral intermolecular forces.

19.
Rev Esp Enferm Dig ; 108(6): 309-14, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27063334

RESUMO

BACKGROUND/AIMS: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL. METHODS: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL. RESULTS: A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/sludge. The performance of ASGE high- and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI, 0.17-0.55). CONCLUSIONS: Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.


Assuntos
Coledocolitíase/diagnóstico por imagem , Endoscopia Gastrointestinal/métodos , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes
20.
BMC Emerg Med ; 15: 19, 2015 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-26282250

RESUMO

BACKGROUND: Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication. METHODS: We prospectively assessed 20 patients that were admitted to a single center's emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication. RESULTS: The main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80% of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities. CONCLUSION: The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.


Assuntos
Drogas Ilícitas/intoxicação , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Tolueno/intoxicação , Acidose/induzido quimicamente , Doença Aguda , Adolescente , Adulto , Doenças Biliares/induzido quimicamente , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Cuidados Críticos , Feminino , Humanos , Hipopotassemia/induzido quimicamente , Modelos Logísticos , Masculino , Paralisia/induzido quimicamente , Prognóstico , Estudos Prospectivos , Proteinúria/induzido quimicamente , Rabdomiólise/induzido quimicamente , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto Jovem
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