Respiratory complications from acute corrosive poisonings in adults.

INTRODUCTION: Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient. OBJECTIVE: The aim of the study is to show the incidence of respiratory complications in acute corrosive poisonings, the need of various clinical investigations and also the treatment and final outcome of these kind of poisoning. METHODS: We retrospectively analyzed clinical records of 415 patients hospitalized and treated at the University clinic for toxicology and urgent internal medicine, in Skopje, Republic of Macedonia, in the period between 2007 and 2011. The protocol consisted of methods for analyzing the systemic complications, with an accent on the post-corrosive respiratory complications. RESULTS: From the total number of patients even 98 (23.61%) exhibited systemic complications, from which 51 (52.04%) are respiratory complications. The majority of patients are female (n=40, 78.43%) and the most common complication is pneumonia (n=47). The youngest patient in this study was 14 and the oldest was 87 years old. CONCLUSION: Besides the gastrointestinal complications in the acute corrosive poisonings respiratory complications are also very often. They complicate the clinical state of patient and very often lead to fatal endings.

Heroin dependence duration influences the metabolic parameters: mechanisms and consequences of impaired insulin sensitivity in hepatitis C virus seronegative heroin dependents.

OBJECTIVE: Carbohydrate metabolism disorder in heroin dependence is an issue with long history and contradicting results. The aim of the study was to evaluate basal insulin sensitivity in hepatitis C virus seronegative heroin dependents with normal body mass index, taking into consideration the duration of heroin dependence. METHOD: 78 heroin dependents and 32 healthy controls were enrolled in the cross-sectional, prospective study. The dependents were observed in 2 groups: group 1 with dependence duration less than or equal to 3 years and group 2 with more than 3 years. Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and ß-cell function (HOMA-B%) were used to define basal glucose-insulin homeostasis. RESULTS: The group with longer dependence duration had HOMA-IR (2.23 ± 3.15) significantly higher compared with the control group (1.23 ± 0.53, P = 0.016) but lower compared with the group with the shorter dependence duration (2.65 ± 2.66, P = 0.024), after adjustment for HOMA-B%, waist circumference, and aspartate aminotransferase. The decrease in HOMA-IR during prolonged heroin addiction was significantly associated with the reduced ß-cell function (P < 0.001) and waist circumference (P = 0.004). CONCLUSIONS: Heroin dependence is associated with increased insulin resistance in hepatitis C virus seronegative heroin dependents. Prolonged heroin use is associated with reduction of basal ß-cell pancreatic function with decreased insulin resistance controlled for waist circumference, but still inducing significantly decreased basal insulin sensitivity.

Plasma apo/lipoproteins disturbances as a precondition for metabolic syndrome in HCV seronegative heroin addicts.

BACKGROUND: Dyslipidemia in heroin addicts is considered to be a precondition for developing metabolic syndrome. OBJECTIVES: The aim was to evaluate the frequency in serum lipid disturbances of hepatitis C virus (HCV) seronegative heroin addicts; the capacity of high-density lipoprotein (HDL)-C and apolipoprotein B (apoB)/apolipoprotein A-I (apoA-I) for predicting hypertriglyceridemia/low HDL-C profile; correlation of HDL-C with the apoB/apoA-I and their correlation to plasma apo/lipoproteins. MATERIALS AND METHODS: Sixty-six heroin addicts, seronegative for HCV and HIV, without liver morphological changes were divided into two groups according to their decreased/normal HDL-C concentrations. RESULTS: We registered decreased HDL-C in 58.8% of the addicts; decreased apoA-I in 50.9%, increased triglyceride (TGL) in 35.9%, and increased apoB/apoA-I in 3.8% of the patients; and 25.7% had hypertriglyceridemia/low HDL profile. Addicts with low HDL-C had higher TGL (1.73 ± .91 vs. 1.31 ± .71, pр = .02) compared with addicts with normal HDL-C and the controls. Low HDL-C group had higher apoB/apoA-I compared with addicts with normal HDL-C (.62 ± .28 vs. .42 ± .11, pр = .000). HDL-C inversely correlated to apoB/apoA-I (p = -.452, pр = .001). ApoB/apoA-I showed stronger correlation with the observed apo/lipoproteins than the HDL-C. The logistic regression model showed that apoB/apoA-I index (OR 89.1, 95% CI 1.3-5971.2) is more significant predictor in developing hypertriglyceridemia/low HDL profile than HDL-C. CONCLUSION: Heroin addiction is associated with decreased plasma concentrations of HDL-C, apoA-I, apoB, and increased TGL concentrations. In heroin addicts, HDL-C concentrations are significantly associated with the apoB/apoA-I index, which correlates to all lipid fractions and is a stronger predictor of metabolic syndrome lipid profile in heroin addicts.

Evaluation of circulating immune complexes and antiphospholipid antibodies (anti beta 2 glycoprotein 1) in heroin addicts and their clinical significance.

INTRODUCTION: Earlier studies have reported that heroin might cause the structural and antigen changes on numerous tissues, organs and subsequent development of autoimmune reactions (production of antibodies and creation of immune complexes) as a result the immunotoxic effect of heroin. The aims of our study were to: a) Evaluate CIC and antibeta2GP1 in heroin addicts; b) Correlate between the values of the obtained CIC and antibeta2GP1 (stratified by the duration and route of heroin application); c) Compare the CIC and antibeta2GP1 in heroin addicts and the control group and d) Assess the clinical importance of CIC and antibeta2GP1 in heroin addicts. PATIENTS AND METHODS: This was a cross-sectional study performed at the University Clinic of Toxicology and the Institute of Transfusiology, Skopje, Republic of Macedonia. Patients referred to the Clinic for clinical examinations who met the inclusion criteria were analyzed. Protocol for work was the following: 1.) detailed anamnestic data, 2.) a whole set of laboratory biochemical blood and urine analyses, 3.) examination with the Schiller's twelve-channel ECG; 4.) toxicological analyses for opioids in a urine sample; circulating immune complexes and 5.) antiphospholipid antibodies (antibeta2GP1, fractions: IgA, IgG, IgM). The obtained results were statistically analyzed. RESULTS: We included 37 heroin addicts and a control group of 27 healthy subjects. Male abusers predominated over female in--28 (76%) subjects; mean age being 26 +/- 5.06. The results which refer to the increased values of circulating immune complexes have shown a high statistically significant dominance of heroin addicts, in comparison with the control group (p < 0.01) and increased values above the reference ones of IgG antibeta2GP1, alone in the group of intravenous heroin abusers (p < 0.025). The mean duration of the heroin use in intravenous abusers was 6.21 +/- 3.25 years, whereas in those snorting heroin was 5.15 +/- 2.26 years. Duration of heroin application was in a positive correlation with IgG antibeta2GP1 (p = 0.35). CONCLUSIONS: Our data showed that heroin-dependent patients in our study had increased values of circulating immune complexes and changes in IgG and IgM antibeta2GP1 with significantly increased values of IgG antibeta2GP1 in the intravenous heroin abusers. The duration of heroin application is in direct proportional relationship with IgG antibeta2GP1. Heroin addicts had significantly higher values of circulating immune complexes and statistically significant difference in IgG antibeta2GP1, in comparison with the control group. Changes in the fractions of antibeta2GP1 and CIC suggest a possible relation with the somatic changes found in heroin addicts (i.e. thrombocytopenia, reduced renal clearance, etc).