Comparison of rhabdomyolysis in acutely intoxicated patients with psychotropic and chemical substances.

INTRODUCTION: Rhabdomyolysis is characterized by a muscle injury that leads to the release of intracellular muscle contents/constituents into the systemic circulation.

The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury.

BACKGROUND: Elderly population (≥ 65) are more prone to develop acute kidney injury (AKI) compared to younger, also elderly with AKI have an increased requirement for dialysis treatment and an elevated risk of short-term and long-term mortality. AIM: The objectives of this study were to examine the effect of treatment of short-term outcomes and mortality in elderly patients with AKI. MATERIAL AND METHODS: Seventy elderly AKI patients, that filled one of the criteria of AKI definition and had hospitalization over 24 hours, were enrolled in the study. RESULTS: The median age of patients was 74.28 ± 6.64, with mean CCI (Charlson Comorbidity Index) score of 6.94 ± 1.94. The majority of patients (70%) were classified at stage 3 of AKIN, 20% of patients were classified at stage 2 and 10% at stage 1. In the groups of patients with death outcome, the chronic cardiomyopathy was more frequently present (p = 0.034). Regarding treatment, 58.6% of the AKI patients underwent hemodialysis while 41.4% received conservative treatment. Mortality rate was 52.8%, out of which 28.6% was in-hospital mortality, while in 24.3% of patients death occurred in the follow-up period of 90 days. CONCLUSION: In our study, short- term survival is not related to different treatment options. Applied treatment in elderly patients with AKI should be assessed by measuring the long term outcome.

Multi-System Complications after Intravenous Cocaine Abuse.

BACKGROUND: Use and abuse of cocaine are associated with numerous adverse effects, independent of the route of administration. More severe conditions of poisoning, however, are observed after cocaine intravenous administration. AIM: We present a case of severe poisoning after violent intravenous injection of cocaine, but with a good outcome. CASE PRESENTATION: Cocaine was intravenously (i.v.) administered in 16-years old female patient as a homicide attempt. Shortly after that, patient experienced series of generalised tonic-clonic seizures, was highly febrile (40°C), somnolent, agitated, presenting with tachycardia, tachypnea and with increased blood pressure 150/90 mmHg. Neurologic status, lumbar puncture and computerised tomography (CT) of the brain were without remarks. Electroencephalogram (EEG) was characterised with signs of diffuse encephalopathy, and acid-base analyses resulted in metabolic acidosis. Urine screening revealed the presence of cocaine and benzodiazepines. The patient presented with signs of the hepatic lesion, acute renal insufficiency (ARI), and increased D-dimers resulting from activated fibrinolysis. The patient was discharged in stable general condition after being hospitalised for 23 days. CONCLUSION: Intravenous abuse of cocaine results in overdose and serous multi-system complications requiring multidisciplinary diagnostic and intensive therapeutic approach.

The role of hemodialysis in treatment of acute acetic acid poisonings.

INTRODUCTION: The aim of this study is to show the importance of hemodialysis as an active method in treatment of acute acetic acid poisonings. Its main role is to support the renal function during the state of the intoxication when patients develop acute renal failure. METHODS: We analyzed data from a 10-year period, a total of 71 patients who ingested acetic acid, either intentionally or accidentally. Patients with a need of hemodialysis (HD) treatment underwent 3- to 4-hour HD sessions every day or every second day, according to clinical assessment, as needed, until recovery of kidney function. RESULTS: In the period between 2006 and 2015 at the university clinic for toxicology and urgent internal medicine, we hospitalized 6,106 patients with different kinds of intoxication, of which 1.162% ingested concentrated acetic acid; 47 patients were female and 24 were male. The minimal age of patients was 18 and the maximal 74 years. A total of 28 (39.43%) of the patients developed acute renal failure and in 10 patients (14.08%) we used hemodialysis as a part of the treatment. The maximum number of performed sessions in one patient was five and the minimal number of performed sessions in one patents was only one session. The use of heparin led to fatal bleeding in 4 patients. The mortality rate was 7% and most of the cases resulted in fatalities during the first 96 hours after ingestion. CONCLUSIONS: Acetic acid poisonings are one of the most dangerous intoxications seen in clinical toxicology. The use of hemodialysis in some of the patients who develop acute renal failure can be of great importance and it should be put into official treatment protocols due to its great number of advantages in renal function support.

Severe mushroom poisoning in one Macedonian family.

BACKGROUND: Collecting and consuming wild mushrooms is a historical tradition in many European countries, including The Republic of Macedonia. This activity is predominantly performed in the period between June and October, when the weather is warm and humidity in the air and soil is at higher levels.The Amanita genus consists of 500 different species of mushrooms; among these, Amanita phaloides, Amanita virosa and Amanita verna are most commonly found in oak forests in our country. These species are highly poisonous and because they can be similar to some edible mushrooms, they have often been misidentified. Their consumption causes severe intoxication. PURPOSE: The aim of this case series report is to demonstrate a severe poisoning with Amanita mushrooms (A. verna) that occurred in 8 patients, all from 1 Macedonian family. RESULTS: We show the differences in the clinical appearance and status of these patients, the wide spectrum of symptoms as well as the treatment and outcome of this rare poisoning. One patient, an 8-month-old baby, was excluded from the study because the infant was immediately transferred to the pediatric clinic after admission to our clinic. CONCLUSIONS: Despite modern therapy, poisoning due to ingestion of Amanita mushrooms is a serious clinical and health problem that may even be potentially lethal. The most efficient way for the general public to protect itself against potential poisoning is to avoid ingesting mushrooms that may not be edible.

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.