[A significance of measurement of breathing nervous regulation, respiratory resistance and spirometry in clinical toxicology - retrospective review].

The exogenous central nervous system depressants such opioides, alcohol and carbon monoxide may affect nervous respiratory regulation and lead to disturbances in respiratory system efficiency. The aim of this study was to evaluate the breathing nervous regulation and ventilatory efficiency in patients treated in Clinical Toxicology, UJCM in Krakow in the period 1994- 2000. Methods: There were 385 persons under examination: 144 alcohol abusers and 70 opiate abusers (group I), 91 persons treated because of acute carbon monoxide poisoning (group II) and 80 healthy persons - control group. The examinations performed before and after treatment included measurements of respiratory pattern parameters, occlusion pressure and evaluation of ventilatory efficiency determined on the basis of "flow-volume" loop results, spirometry and the measurements of respiratory tract resistance. Results: The central respiratory drive (VT/T(in) index) and the parasympathetic control of breathing cycle (T(in)/ T(tot) index) were similar in alcohol and opiate abusers in the initial examination but in abusers classified to methadone maintenance treatment programme the VT/T(in) index was elevated. After treatment the values of both indices were similar. In the group of acute CO poisoned patients the disturbances in breathing regulation were connected with increased value of the VT/Tin parameter and the diminished of T(in)/T(tot) value. After treatment in the slightly CO poisoned patients the both respiratory pattern components were comparable to the healthy control group but in the moderately and severely poisoned group the VT/T(in) index was elevated and the T(in)/T(tot) index was lessened compared to the controls. The values of respiratory resistance were higher than upper level of normal values (except participants of methadone programme). The bronchial obturation was most often stated disturbance in respiratory system efficiency, especially in alcohol abusers. Ventilatory parameters in moderate and severe CO poisoned were significantly lower than in the slightly poisoned patients. Conclusion: Presented methods of evaluation of respiratory system efficiency and nervous breathing regulation are of special value and should be implemented in clinical toxicology as essential to diagnosis and monitoring, especially in case of alcohol and drug dependent patients and in patients poisoned with central nervous system depressants.

[Clinical practice guidelines in dextromethorphan poisoning pre-hospital management]. / Wytyczne postepowania w przypadku zatrucia dekstrometorfanem - postepowanie przedszpitalne.

Guideline for out - of Hospital triage and initial management of patients with suspected ingestion of dextromethorphan is presented in the study. The guideline was created by the American Association of Control Centers to assist poison center personnel while dealing with poison information service.

[Isocyanates and formaldehyde--low molecular weight xenobiotics]. / Izocyjaniany i formaldehyd--maloczasteczkowe ksenobiotyki.

Isocyanates and formaldehyde are a low molecular weight environmental xenobiotics. Acute poisonings are relatively rare, chronic exposure not enough recognized. A source, mechanism of toxicity and ability of those low molecular weight compounds to stimulation of different types of immune response are presented in the study.

[Students knowledge on carbon monoxide toxicity]. / Poziom wiedzy studentów na temat toksycznosci tlenku wegla.

The results of questionnaire research on carbon monoxide (CO) poisoning in students of State Higher Vocational School in Nowy Sacz (Institutes of Economy, Pedagogic, Technical and Health) are presented in the study. The mean age of the group examined, with a female predomination (77.6%) was 22.7 +/- 4.94 years. The questionnaire covered demographic data and knowledge on CO source, exposure, most frequent and most severe symptoms, most severe sequels, risky behavior and risk groups in CO poisoning. The results obtained indicate on inadequate knowledge on CO poisoning even in young students population. The proper education and prophylaxis activity is necessary to avoid accidental CO poisoning, especially that they also occur in spring-summer season.

[Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the material of Poison Information Centre]. / Niesteroidowe leki przeciwzapalne (NLPZ) dostepne bez recepty w materiale Osrodka Informacji Toksykologicznej.

There were 10 636 toxicological information given in 2004-2008 by the Poison Information Center Jagiellonian University Medical College. 538 of them concerned NonSteroidal Anti-Inflammatory Drugs (NSAIDs); 336 cases of NSAIDs ingested alone and 202 co-ingested with other drugs and/or with ethanol. 58,9% of them were intentional and 29,6% were accidental. Children (1-6 years) and adolescents (15-19 years) were mostly involved.

[System of biocide products control in Poland]. / System kontroli zatruc biocydami w Polsce.

In this article we presented actual legislation concerning biocide products in Poland. Rules of reporting and archiving of biocide products exposure were discussed. We presented the first results of monitoring of biocide poisoning cases in Poland from July 2007 to June 2008.

[The usage of psychoactive substances among secondary school students in Nowy Sacz]. / Uzywanie substancji psychoaktywnych przez uczniów szkól srednich w Nowym Saczu.

The results of anonymous questionnaire research on psychoactive substances in two last classes of high school pupils in Nowy Sacz are presented in the study. Only 1.7% of the examined students do not perceive the psychoactive substances as a real problem existing at school, 9.6% have no opinion. The rest (88.7%) perceive it as an already existing problem, where 36% as a very serious one. Alcohol, cigarette smoking, marijuana, hashish or crack and medical drugs are the most common substances, being used mostly for fun and relaxation. Pupils opinions were evaluated on addictive properties of the substances. The essential difference between those who initiated drugs vs. those who did not has was also evaluated. Tobacco, cocaine, heroine and crack have been considered the most addictive. Health consequences followed by moral and ethical principles are the main rules against taking drugs. Only 4.1% of examined individuals question the fact that schools should take involvement in whether students take drugs the rest expect some punishment for a school drug dealers and prophylaxis (proposal of interesting work-shops, lectures).

[Evaluation of cardiovascular autonomic nervous system in ethanol withdrawal]. / Ocena ukladu autonomicznego sercowo-naczyniowego w zespole odstawiennym u chorych przewlekle uzaleznionych od alkoholu.

UNLABELLED: The aim of the study was to assess the risk factors and state of cardiovascular autonomic nervous system injury in ethanol dependent patients. The group examined consisted of 85 alcoholics (17 females and 68 males) aged from 27 to 68 y (45.7 +/- 8.82) hospitalized at the Ward of Toxicology and Environmental Diseases because of alcohol withdrawal. Ethanol dependence was diagnosed according to ICD -10 criteria, withdrawal syndrome was scored according to CIWA - A scale. A blood ethanol concentration, creatinine, urine, coagulation parameters and liver enzymes activity were measured on admission. Cardiovascular autonomic nervous system was evaluated by standard Ewing battery tests using VariaCardio TF5 system. The parasympathetic system was assessed by the heart rate response to forced breathing, the heart rate response to standing up, and to heart response to the Valsalva maneuver. The sympathetic system was evaluated by the blood pressure response to standing up. The original Ewing normal values were used. RESULTS: The mean duration of ethanol dependence was 13.7 +/- 8.2 y. In 92% of examined patients heavy and in 8% moderate ethanol withdrawal syndrome was diagnosed. The mean blood ethanol concentration was 1.07 +/- 1.21g/l. Liver injury was diagnosed in 43.5% of the examined group. No changes in autonomic battery tests were found only in 28.2% of the examined subjects. Early parasympathetic damage was stated in 23.5%, definite parasympa-thetic damage in 44.7%, combined para-sympathetic and sympathetic damage was diagnosed in 3.5% of patients examined. The relative risk for parasympathetic and sympathetic system injury rose together with CIWA - scoring, blood ethanol concentration on admission (OR = 1,4 95% CI: 0,81 +/- 2,4), and when GTP activity was three times greater than normal (OR = 1.2 95% CI: 0.92 +/- 1.7).

[Clinical practice guidelines in acetaminophen poisoning--pre-hospital management]. / Wytyczne postepowania w przypadku zatrucia acetaminofenem--postepowanie przedszpitalne.

We described guidelines for personel working in poison information service in case of acute paracetamol overdose. The guidelines were created with respect to EBM (Evidence Based Medicine) by the American Association of Control Centers.

[Evaluation of regional cerebral blood flow using 99mTc-ECD SPECT in ethanol dependent patients: pilot study]. / Ocena zaburzen regionalnego przeplywu mózgowego metoda tomografii emisyjnej Pojedynczego Fotonu z uiyciem 99mtc-ECD u pacjentów uzaleinionych od alkoholu: doniesienie wstepne.

UNLABELLED: The depressant actions of ethanol in the brain is known. SPECT is non invasive method to measure the regional cerebral blood flow (rCBF) and to evaluate indirectly the brain metabolism. The aim of the study is to evaluate morphologic and functional status of CNS using 99mTc-ECD SPECT in chronic alcoholics. MATERIAL AND METHODS: Examined group consisted of 18 male alcoholic patients aged from 28 to 52 years (x = 42.1 +/- 5.4) treated at the Ward of Toxicology and Environmental Diseaes (Detoxification Unit). Only patients without prior head injury, CNS inflammatory changes, epilepsy, migraine, diabetes mellitus or other systemic injury were included. Alcohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. The regional cerebral blood flow (rCBF) was measured using 99mTc-ECD SPECT with the double head E.CAM Siemens gamma camera. The reference group, necessary to obtain a normal values for the gamma camera applied, consisted of 31 healthy subjects (33.32 +/- 10.99 y). RESULTS: The mean values of rCBF in all examined region of frontal and temporal lobes, and in basal ganglia bothsided were significantly lower in the group of alcoholic patients than in the control group. No significant difference between rCBF in occipital lobes except the occipital inferior region, and in parietal lobes except the parietal superior region. Symetrical hypoperfusion (rCBF-2SD) in the frontal lobes was stated in 11 (61.1%), in temporal lobes in 4 (22.2%), in parietal and occipital lobes in 3 (16.7%) of the patients examined. In 7 the patients examined rCBF disturbances in basal ganglia were found (bothsided in 4, leftsided in 2, and rightsided in 2 the patients). Focal rCBF changes in the parietal, frontal and temporal lobes localised mostly on the left hemisphere were stated in 27.8% of the alcoholics examined. In concusion, the metabolic disturbances and the brain morphological changes mostly in frontal and temporal lobes due to chronic alcoholism were detected in the pilot study. A further investigation on more numerous group of ethanol dependent patients and monitoring of the changes in alcoholics who maintain a long-term abstinence from alcohol is needed.

[Alcohol consumption and the risk of insulin resistance--population based study]. / Spozywanie alkoholu i ryzyko wystqpienia insulinoopornosci--badanie populacyjne.

UNLABELLED: The aim of the study was to assess the relationship between alcohol consumption and insulin resistance in the adult Kraków's inhabitants. MATERIALS AND METHODS: 6000 subjects at age 35-75, participants of the Polish Multicenter Study on Diabetes Epidemiology, were randomized and invited to the study. Finally in 2838 participants the standardized questionnaire examination of the life style especially alcohol consumption was performed. In all persons anthropometric and blood pressure examination was performed. Fasting lipids, fasting and after glucose load glucose and insulin were determined. Glucose tolerance was determined in all study participants according WHO 1999 criteria. Insulin-resistance was defined as the highest quartile of the distribution of the HOMA-IR index assessed for population with normal glucose tolerance (NGT). RESULTS: In examined group 472 (29.2%) women and 150 (12.2%) men were abstainers. Alcohol consumption below 10 glday declared 68.4% of women and 54.9% of men, between 10 and 30 g/day--2.0% of women and 24.7% of men, above 30 g/day--8.2% of men and 0.4% of women. In men with normal glucose tolerance the lowest HOMA-IR we observed in the group drinking daily above 30 g of alcohol (2.05 +/- 1.3). In men with impaired glucose tolerance the lowest HOMA-IR was observed in the group drinking daily below 10 g of alcohol, the highest in the group of abstainers (2.81 +/- 2.04 vs. 3.23 +/- 1.72; ns). For men drinking between 10 and 30 g of alcohol daily decreased the risk of insulin resistance at 40% (OR = 0.6; 95% CI: 0.37-0.96), drinking above 30 g daily decreased the risk at 49% (OR = 0.51; 95% CI: 0.27-0.96). We didn't observed this relationship in the group of women. CONCLUSION: Our results confirm positive impact of daily alcohol intake above 10 g for the risk of insulin resistance in the group of men.

[Evaluation of ventilation disorders in alcohol addicted males]. / Ocena zaburzen wentylacji u mezczyzn uzaleinionych od alkoholu.

The aim of the study was to evaluate the ventilatory disturbances in alcohol addicted males. The examined group consisted of 59 alcoholics acutely poisoned with ethanol. 30 healthy individuals, occasionally drinkers, were the control group. The acetaldehyde concentration in relation to results of spirometric examination was analyzed. It's serum concentration in alcoholics was higher then in the coi* trol group. The frequency of central bronchi obstruction in ethanol dependent patients was significantly higher compared with the control. In examined group negative correlation between serum acetaldehyde concentration and spirometric parameters was noted and statistically significant for FEV1 and VC ones.

[Evaluation of pituitary-gonadal axis in alcohol dependent males]. / Ocena osi przysadkowo-gonadalnej u mezczyzn uzaleinionych od alkoholu.

UNLABELLED: Chronic alcoholism leads to organic damages of nervous system, the liver and the endocrine system. The aim of the study is to evaluate pituitary-gonadal axis in males chronically dependent with alcohol. MATERIAL AND METHODS: The study group consisted of 50 alcohol dependent men aged 27 to 53 years (40.7 +/- 6.6) treated at the Ward of Toxicology and Environmental Diseases (Detoxification Unit). Al-cohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. In all the patients anthropometrical measurements and abdominal ultrasonography were performed as well as blood pressure was measured. Levels of gonadotropin, total testosteron, PRL were determined, thyroid and adrenal gland function were assessed and oral glucose tolerance test (OGTT) was performed in all patients. Activity of the liver enzymes, urea and creatine concentration were determined. Erectile dysfunction was assessed using IIEF. 5 questionnaire: in those patients who received < or =21 points an incidence of diabetes mellitus, thyroid gland and cardiovascular diseases was assessed using standardized questionnaire. RESULTS: Alcohol dependency longer than 15 years was stated in 25, longer than 10 years in 9, and longer than 5 years in 16 of examined patients. The moderate withdrawal syndrome was diagnosed in 22, severe withdrawal syndrome in 26 and very severe withdrawal syndrome in 2 of the patients. BMI ranged from 15.8 to 33.8 kg/m2 (mediane 24.67; +/- 0.54 kg/m2). In 24 men erectile dysfunction was diagnosed using IIEF5 questionnaire. No significant difference was noted between level of total testosterone and PRL in the group with or without erectile dysfunction (testosterone: 5.07 +/- 2.41 vs. 4.54 +/- 2.74; PRL: 330.2 +/- 214.2 vs. 307.4 +/- 258.2). Gonadropine level in the group of men with erectile dysfunction was significantly higher than that without erectile dysfunction (LH: 7.4 +/- 5.2 vs. 4.38 +/- 2.23, p < 0.01; FSH: 13.3 +/- 29.3 vs. 4.59 +/- 19.92, p < 0.05). CONCLUSION: The results obtained confirm that secondary stimulation of pituitary-gonadal axis in alcoholic men depends on liver function and ethanol toxic effect on gonads.

[Carbohydrate metabolism in acute poisoning with xenobiotics]. / Zaburzenia gospodarki weglowodanowej w ostrych zatruciach ksenobiotykami.

UNLABELLED: The aim of the study was to evaluate carbohydrate metabolism in patients hospitalised because of acute intoxication with xenobiotics. MATERIAL AND METHODS: An analysis of 3628 patients (1553 females and 2075 males; age: 40.6 +/- 15.9 y) hospitalized at the Ward of Toxicology and Environmental Diseases because of acute poisoning in 2004-2006 was done. The patients with diabetes mellitus diagnosed prior to hospitalisation were excluded from the analysis. The blood ethanol concentration was measured, medication drugs and/or psychoactive substance screening test were performed in all patients on admission. Fasting glucose level on admission and control level on second or third day of hospitalisation were determined. Risk ratio of hyperglycaemia according to toxic agent was assessed using multiple regression model considering age, gender, and the patient education. RESULTS: In 18.2% (398 males and 254 females) of the patients the blood glucose level on admission was > or = 7.8 mmol/l; in u 3.6% (78 males and 50 females) > or = 11.1 mmol/l. In 24 (0.6%) of the patients glycaemia on admission was < or = 3.5 mmol/l. Control fasting glucose level of > or = 7.0 mmol/l was determined in 115 males and 76 female patients. 42% elevation in risk of hyperglycaemia was noted in acute carbon monoxide poisoning (OR = 1.42; 95% PU: 1.11-1.82). In ethanol intoxicated patients 12% drop in risk of hyperglycaemia was noted (OR = 0.88; 95% PU: 0.72-1.07). Benzodiazepine poisoning diminished risk of hyperglycaemia in 36% (OR=0.64; 95%PU: 0.48-0.84). Risk of hyperglycaemia in poisoning by medicines co-ingested with ethanol was always lower compared to poisoning with the single agent. CONCLUSION: A higher risk of hyperglycaemia was related to acute carbon monoxide poisoning whereas lower risk of hyperglycaemia was attributed to benzodiazepines and alcohol. A frequency of hypoglycaemia in the group of poisoned patients was much more lower compared to hyperglycaemia.

Drug free universities--trends in illicit drugs use among Kraków university students.

Social survey by questioning people is a significant source of information, valuable for planning and developing of prophylactic strategies. An illicit drugs use among a first-year students of Kraków's universities and factors determining the usage were analysed. The research by completing the questionnaire designed by National Bureau for Drug Prevention, Poland was performed in 725 a first-year students of six Kraków's universities. The students were asked to complete the questionnaire confidentially, while the lecture on psychoactive substances. 83.6% of those polled know some students who use a drugs, 38.3% already initiated into drugs, 61.9% reported that they needed at least one day to get drugs. The male students reach for drugs more often then females, and those first-year students being already 20 years old compared to the younger. The greater risk was also noted among students who rent apartments or when a parents earned together more than 3500 PLN. The medical students reached for drugs more rarely than the others. Our survey is one of the first source of information about trends in the drugs usage by Kraków's students. The results will help to develop a preventive standards and creation of effective anti-drugs campaign to be accomplished by college authorities and the Kraków Environmental Diseases Out-patient Clinic for students and academic teachers. The clinic was organised in 2004.

Frequency and pattern of poisoning in adult and adolescent Kraków population in 2003 and 1983.

The pattern (frequency, type of exposure, toxic substance) of adolescent and adult poisonings in Kraków in 2003 is compared with 1983. The analysis includes data for poisoned patients treated at the Kraków Department of Clinical Toxicology and all on the spot fatal cases subjected to post-mortem autopsy and toxicological examinations at the Department of Forensic Medicine Jagiellonian University Medical College in both the years. As much as 4341 poisoning cases (2852 males; 1489 females) were treated in 2003 compared with 2132 (1078 males; 1054 females) in 1983. In 1983 in group of 154 poisoned persons who died at the place of accident there were 138 (89.6%) men and 16 (10.4%) women. In 2003 among 121 deaths at the scene there were 93 (76.9%) males and 28 (23.1%) females. Poisonings due to suicidal attempts decreased significantly from 53.6% in 1983 to 19% in 2003. Incidence of poisoning per 10 000 of general Kraków population increased from 36.17 in 1983 to 57 in 2003 or up to 65.7 if the population of adults and teenagers (above 15 years old) was only considered. Pharmaceuticals (40.6%) followed in frequency by ethanol (25%) and ethanol co-ingested with pharmaceuticals (12.2%) and carbon monoxide (10.6%) were the most common reasons for poisoning in 1983. In 2003 the most common cause of poisonings was ethanol (46.2%) followed by pharmaceuticals alone (25%) or co-ingested with ethanol (6.4%) and carbon monoxide (6.2%). An ingestion of mixed pharmaceuticals (55.1%) followed In frequency by non-barbiturate hypnotics and psychotropic drugs (26.3%) were a most common in 1983 whereas a non-barbiturate hypnotics and psychotropic drugs (34.4%) followed by mixed pharmaceuticals (32.9%) in 2003. A mortality both concerning only the people who died in hospital and also those who died on the spot (prior to any treatment) was significantly higher in 1983 compared with 2003.

B-type natriuretic peptide plasma concentration in acutely poisoned patients.

B-type natriuretic peptide (BNP) is synthesized in the cardiac ventricles upon ventricular myocyte stretch. BNP plasma concentration is useful in cardiology especially for identifying patients with congestive heart failure (CHF), as a prognostic marker of acute coronary syndromes and independent predictor of sudden cardiac death. Its value in clinical toxicology is unclear. As toxins frequently produce deleterious effects on the cardiovascular system we have decided to carry out the pilot study on BNP plasma levels in acutely poisoned patients. The 117 patients (65 males and 52 females) treated at the Department of Clinical Toxicology Jagiellonian University Medical College in Kraków in 2004 were included. 42 of them were intoxicated with ethanol, 35 with pharmaceuticals (mostly tricyclic antidepressants), 13 with CO. The mean age of examined group was 34.07 +/- 12.08 year. The control group consisted of 54 healthy volunteers and employees of the Department (mean age; 32.7 +/- 11.74). A significantly higher BNP concentration was found in poisoned patients than in the control group. The highest BNP plasma concentration was noted in pharmaceutical poisoned patients. Mean BNP concentration in poisonings of minor severity (grade 1) was significantly lower then in moderate (grade 2) or severe (grade 3) poisonings. BNP plasma measurement as an additional marker of cardiac disturbances in clinical toxicology practice may be suggested.

[The role of poison information center in the health service structures]. / Miejsce Osrodka informacji Toksykologicznej w strukturach sluzby zdrowia.

Poison information centres (PIC) provide telephone advice on the treatment of poisonings to the lay public and medical professionals. The number of inquiries increases every year. Poison Information Centre of Collegium Medicum of Jagiellonian University in Krakow provided 1611 items of advice in 1999 and 2263--five years later--in 2004. Each incoming call is recorded and documented by standardized protocol. Another aspect of PIC activity of is prevention and education. Inquiries protocols' analysis shows the most frequent reasons and circumstances of poisonings. Thus, it is possible to conduct appropriate prophylactic campaigns. The above aspects of activity of PIC do not bring direct financial benefit. There is one index which shows that PIC saves the money. There were 335 cases in 2004 (above 50% consulted lay public) when unnecessary hospital admissions were prevent. It should be noted that the others were refer to proper specialist. This aspect of PIC's activity significantly decreases the costs which should be paid in any medical intervention.

Toxic exposure of children in 2004--telephone service of toxicology.

509 toxicological telephone inquiries concerning children under 15 years have been provided by Kraków Poison Information Centre (PIC) in the year 2004. Medication drugs were involved in almost one half (n=208) the cases noted. 63.7% of calls concerned children under 4 years with a two-year-old group predominance. The main reason for poisoning in children under 4 were pharmaceuticals (42.6%), followed by pesticides (9.8%), corrosives (8.8%), hydrocarbons (8.1%), plants (5.5%) and detergents (3.7%); all exposure were accidental. Suicide attempts reached 32.3% in the 12-14 age group. In that group also a cases of psychoactive substances overdosing were noted. Most exposures in children reported to poison centre were accidental (87.2%). Thus, it is absolutely necessary to intensify prevention and education activity both for parents and primary school children to avoid the poisoning.

[Dangerous aquaria]. / Niebezpieczne akwaria.

World trends for a home breeding of exotic freshwater and marine fishes did not miss Poland. There are almost all species of aquarium fishes available in Polish pet shops, but there is not enough information about threat given to customers. In some fish, there are masses of one-cell glands, mainly serous, in the proximity of the spines. In others, those one-cell glands may be grouped in larger aggregates of cells called venom glands, that may form organs resembling multicellular glands of terrestrial animals. They are usually located around the spines or hard rays of the fins. Even if covered with a connective tissue sheath, the aggregates of the venom cells do not have any common outlet; they are not, therefore, proper multicellular glands. The venom glands of the catfish are covered with a thin sheath and they release their contents when the fin ray is pressed. Spines are derived from fin rays. When the spine penetrates the body of its prey, it presses its base against the cells, squashes them and squeezes the venomous contents into the wound. Catfish, lionfish and stonefish have the venom glands producing secretion which could be dangerous. The eels and morays blood is also dangerous, as well as slime of reduced squamae. Poison information centers noted several cases of fishes' stings in Poland.