Metabolic acidosis in an infant associated with permethrin toxicity.

Pyrethroids are broad-spectrum insecticides. Permethrin intoxication due to topical application has not been documented in humans. We report a 20-month-old infant who had used 5% permethrin lotion topically for scabies treatment. Approximately 60 mL (20 mL/day) was used and after the third application he developed agitation, nausea, vomiting, respiratory distress, tachycardia, and metabolic acidosis. His clinical symptoms and metabolic acidosis normalized within 20 hours. His follow-up was unremarkable. Toxicity of permethrin is rare, and although permethrin is a widely and safely used topical agent in the treatment of scabies and lice, inappropriate use may rarely cause toxicity. Moreover, in cases of unexplained metabolic acidosis, topically applied medications should be carefully investigated.

Neutrophil/lymphocyte and C-reactive protein/mean platelet volume ratios in differentiating between viral and bacterial pneumonias and diagnosing early complications in children.

OBJECTIVE: To test the usability of neutrophil/lymphocyte (N/L) and C-reactive protein/mean platelet volume (CRP/MPV) ratios for the differential diagnosis of bacterial versus viral pneumonia, and the early diagnosis of complications related to pneumonia. METHODS: This retrospective study was conducted on 31 patients diagnosed with bacterial pneumonia and 21 patients diagnosed with viral pneumonia from January 2011 to December 2012 in the Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey. We investigated the clinical characteristics, radiological, and laboratory findings of patients from their medical records. RESULTS: The female/male ratio of patients with bacterial was 1.0/1.8, and with viral pneumonias was 1.0/2.0. The mean patient age was 59+/-51 months. There was a statistically significant difference in the neutrophil/lymphocyte ratio (2.7 versus 0.6, p<0.001) and CRP/MPV ratio (11.0 versus 9.3, p<0.001) in the cases with bacterial pneumonia versus those who had viral pneumonia. Nine of the patients were identified as having complications. There was a statistically significant difference in the N/L ratio (3.5 versus 1.2, p=0.01) and CRP/MPV ratio (11.1 versus 3.9, p=0.001) in the cases that developed complications compared with those that did not. When the neutrophil/lymphocyte and CRP/MPV ratios were used jointly, the diagnosis of bacterial pneumonia could be correctly estimated in 28 (90.3%) cases (odds ratio [OR]=0.06, 95% confidence interval [CI]: 0.01-0.29, p<0.001) and pneumonia-related complications were predicted in 8 (88.9%) cases (OR=13.5, 95% CI: 1.5-118.1, p=0.005). CONCLUSION: It was observed that the combined use of N/L and CRP/MPV ratios might be used in both the differential diagnosis of bacterial versus viral pneumonia, and the prediction of complications.

Bicuspid aortic valve and severe aortic stenosis in a newborn exposed to carbamazapine during pregnancy.

The use of antiepileptic drugs increases the risk of major congenital malformations during pregnancy. Here, we report an infant who had a history of in-utero carbamazepine exposure and who was born with a cardiac malformation. The infant was born at 39 weeks of gestation vaginally to an epileptic mother who had been treated with carbamazepine throughout her pregnancy. He was referred due to cardiac murmur in the second week of his life. The mother had not received folic acid supplementation. Transthoracic echocardiography revealed bicuspid aortic valve, mild aortic stenosis, patent ductus arteriosus, patent foramen ovale and the renal ultrasound revealed mild left hydronephrosis. Follow-up echocardiography performed 14 weeks later showed increased severity of aortic stenosis and percutaneous balloon aortic valvuloplasty was performed. To our knowledge, there is only one case report in the literature mentioning the association of a bicuspid aortic valve and aortic stenosis with oxcarbazepine exposure, which is a structural derivative of carbamazepine. However, there are no reports for association with carbamazepine itself. Bicuspid aorta and aortic stenosis may be among the cardiac malformations that result from the teratogenic effect of carbamazepine.

Is chemotherapy-induced nausea and vomiting lower in smokers?

AIM: Chemotherapy-induced nausea and vomiting (CINV) is not understood completely. The aim of this study is to investigate the effects of smoking on CINV. METHODS: 121 consecutive patients who received cisplatin (≥ 50 mg/m²) based chemotherapy were included in the study. The patients who reported motion sickness, pain, emesis during past pregnancy, emesis history of previous chemotherapy, with Karnofsky score < 70, peptic ulcer, gastroesophageal reflux, migraine, central nervous system metastasis and patients scheduled to receive radiation therapy were excluded from the study. A standard antiemetic treatment was given to all patients. The nausea and vomiting was assessed by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. After first cycle of chemotherapy, Grade 2 - 3 nausea and vomiting were questioned. RESULTS: Grade 2 - 3 nausea and vomiting was higher in non-smokers (p < 0.001). We found that nausea and vomiting in women is more frequent than in men (p < 0.001). CONCLUSION: In our study we found that smokers had a lower incidence of CINV. Further investigations are needed to confirm the findings of this pilot study.

The use of the glial fibrillary acidic protein (GFAP) biomarker as an early detection model of chemically induced cancer.

Due to the massive industrial development during recent decades, the general population today is exposed to numerous environmental chemicals not only through occupational exposure but also through the daily handling and consumption of products. In our study, we developed a carcinogenesis bioassay for industrial solvents and other pollutants by measuring the gliosis produced by these toxins. We investigated the morphological changes produced by some pollutants in astroglial rat cultures and the increase in GFAP-positive cells. Astroglial primary cultures were obtained from the cerebral hemispheres of neonatal rats. The nutrient medium consisted of Waymouth's medium supplemented with 20% fetal calf serum and antibiotics. The cultures were incubated at 37 degrees C in a humidified particle-filtered room containing an atmosphere of 5% CO2 in air. After being cultured for 22 days, toluene and a mixture of solvents (toluene, carbon tetrachloride, and 1,1,1-trichloroethylene) were applied in concentrations between 10(-4) M and 10(-6) M. Immunofluorescence staining for glial fibrillary acidic protein (GFAP), a specific marker for fibrillary astrocytes, was only occasionally positive in the monolayer of the control cultures; however, it was markedly positive in most cells maintained for 3 or 9 days and exposed to toluene and mixed solvents. This study provides a rapid in vitro assay by which cells exposed to chemicals can be examined.

Induction of cytochrome P4501A1 and P4504A1 activities and peroxisomal proliferation by fumonisin B1.

The effects of repeated exposure to fumonisin B1 (FB1) on hepatic and renal mixed function oxidase activities and peroxisomal proliferation has been examined in rats following intraperitoneal administration at three dose levels (0.125, 0.25, and 2.5 mg/kg) once a day for 6 days. At the two highest doses, FB1 increased the renal and hepatic N-demethylation of erythromycin (CYP3A1) and the hepatic O-deethylation of ethoxyresorufin (CYP1A1). FB1, at the highest dose of 2.5 mg/kg, also increased the renal O-deethylation of ethoxyresorufin. The liver, but not the kidney, was also susceptible to FB1-dependent induction of the 12- and 11-hydroxylation of lauric acid, suggesting induction of the CYP4A subfamily. Immunoblot studies employing solubilized microsomes from FB1-treated rats revealed that FB1, at the two highest doses, increased the apoprotein levels of CYP1A1 and CYP4A1. The same treatment with FB1 increased the beta-oxidation of palmitoyl-coenzyme A (CoA) in liver homogenates, and immunoblot analysis showed an increase in the apoprotein levels of the trans-2-enoyl-CoA hydratase trifunctional protein. The possible implications of these findings to the hepatocarcinogenicity of this mycotoxin are discussed.

In vitro neuronal changes induced by beta-aminopropionitrile.

beta-Aminopropionitrile (beta APN), a peptide found in leguminous plants, is a multifunctional aminonitrile because it has some action on collagen, elastin, and nervous cells. Due to its action on the nervous system, it is very interesting to show its inhibitory effect on cultures of neurons. In the present study, we have demonstrated that beta APN can produce progressive degeneration of neurons and that this effect is dose-dependant. Neuronal cultures were prepared from 14-day-old rat embryos with a cell density of 10(4) cells/cm2 in the control plates. Progressive concentrations of beta APN (from 10(-7) M to 10(-3) M) were added and a 50 Inhibitory Dose (ID50) of 10(-5) M was found. At concentrations of 10(-5) M of beta APN, the neurons showed a loss of synapsis and thinning of neuronal prolongations. Based on the morphological changes observed, we think that beta APN may be used as a neurodegeneration model similar to that obtained with acrylamide, carbon disulfide, beta-beta'-iminodipropionitrile, or aluminum salts.