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1.
Toxins (Basel) ; 11(8)2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31349685

RESUMO

Oleander (Nerium oleander) is an ornamental plant common in tropical and sub-tropical regions that is becoming increasingly widespread, even in temperate regions. Oleander poisoning may occur in animals and humans. The main active components contained in the plant are cardiac glycosides belonging to the class of cardenolides that are toxic to many species, from human to insects. This work describes a case of oleander poisoning that occurred on a small cattle farm and resulted in the fatality of all six resident animals. Furthermore, the investigation of the poisonous agent is described, with particular focus on the characterization of the oleandrin toxin that was recovered from the forage and rumen contents. The innovation of this study is the first description of the detection and quantification of the oleandrin toxin by liquid chromatography-high resolution mass spectrometry (LC-HRMS) in rumen.

2.
J Anal Toxicol ; 43(5): e1-e7, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30843073

RESUMO

4-Fluoromethylphenidate (4F-MPH) is an halogenated derivative of methylphenidate (MPH), a re-uptake inhibitor for dopamine and norepinephrine used for the treatment of attention deficit hyperactivity disorders. In the last few years, several compounds structurally related to MPH have been marked as new psychoactive substances (NPS) with stimulating and euphoric effects similar to the parent drug, but with more dopaminergic activity. This report represents the first case of an analytically confirmed non-fatal intoxication by 4F-MPH. A 26-year-old female was admitted to the emergency department with neuropsychiatric and cardiologic symptoms that lasted for a week, during which she sniffed a powder named 4F-MPH acquired as entactogen on the Internet. The patient required sedation with intravenous diazepam and was discharged two days later with a prescription of promazine and quetiapine. The seized product was analytically characterized by gas chromatography-mass spectrometry, liquid chromatography high-resolution mass spectrometry and nuclear magnetic resonance. These analyses confirmed the composition of the product as a 4F-MPH diastereomeric (±)-threo and (±)-erythro mixture, with a large preponderance of the active (±)-threo isomer. A minimal validation, intended for rare analytes, was performed for the quantification of 4F-MPH in the biological samples by liquid chromatography-tandem mass spectrometry. Accuracy (bias) and precision were within ±15% for both blood and urine. The blood and urine concentration of (±)-threo 4F-MPH were 32 ng/mL and 827 ng/mL, respectively. Analyses for classic drugs (opiates, methadone, cocaine, cannabis metabolites, amphetamines, ecstasy and LSD), ethanol, qualitative full screen by gas chromatography-mass spectrometry and targeted analysis for 50 NPS by liquid chromatography-tandem mass spectrometry tested negative; comorbidities were excluded, too. Based on these data, it can be assumed that the clinical manifestations were due to 4F-MPH only.


Assuntos
Acatisia Induzida por Medicamentos/diagnóstico , Estimulantes do Sistema Nervoso Central/toxicidade , Metilfenidato/análogos & derivados , Metilfenidato/toxicidade , Taquicardia/diagnóstico , Adulto , Acatisia Induzida por Medicamentos/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/sangue , Estimulantes do Sistema Nervoso Central/urina , Diazepam/uso terapêutico , Feminino , Humanos , Metilfenidato/sangue , Metilfenidato/urina , Taquicardia/induzido quimicamente , Taquicardia/tratamento farmacológico , Resultado do Tratamento
3.
Sci Rep ; 8(1): 9818, 2018 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-29959358

RESUMO

Medically relevant cases of snakebite in Europe are predominately caused by European vipers of the genus Vipera. Systemic envenoming by European vipers can cause severe pathology in humans and different clinical manifestations are associated with different members of this genus. The most representative vipers in Europe are V. aspis and V. berus and neurological symptoms have been reported in humans envenomed by the former but not by the latter species. In this study we determined the toxicological profile of V. aspis and V. berus venoms in vivo in mice and we tested the effectiveness of two antivenoms, commonly used as antidotes, in counteracting the specific activities of the two venoms. We found that V. aspis, but not V. berus, is neurotoxic and that this effect is due to the degeneration of peripheral nerve terminals at the NMJ and is not neutralized by the two tested antisera. Differently, V. berus causes a haemorrhagic effect, which is efficiently contrasted by the same antivenoms. These results indicate that the effectiveness of different antisera is strongly influenced by the variable composition of the venoms and reinforce the arguments supporting the use polyvalent antivenoms.


Assuntos
Antivenenos/farmacologia , Reações Cruzadas/imunologia , Junção Neuromuscular/patologia , Paralisia/patologia , Mordeduras de Serpentes/prevenção & controle , Venenos de Víboras/antagonistas & inibidores , Viperidae/classificação , Animais , Cerebelo/efeitos dos fármacos , Cerebelo/patologia , Reações Cruzadas/efeitos dos fármacos , Feminino , Soros Imunes/farmacologia , Camundongos , Neurônios Motores/efeitos dos fármacos , Neurônios Motores/patologia , Junção Neuromuscular/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Neurônios/patologia , Paralisia/induzido quimicamente , Fosfolipases A2 , Ratos , Mordeduras de Serpentes/induzido quimicamente , Mordeduras de Serpentes/patologia , Venenos de Víboras/toxicidade , Viperidae/fisiologia
4.
Toxins (Basel) ; 10(3)2018 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-29495579

RESUMO

Ciguatera fish poisoning (CFP) is the most prevalent non-bacterial food-borne form of poisoning in French Polynesia, which results from the consumption of coral reef fish naturally contaminated with ciguatoxins produced by dinoflagellates in the genus Gambierdiscus. Since the early 2000s, this French territory has also witnessed the emergence of atypical forms of ciguatera, known as ciguatera shellfish poisoning (CSP), associated with the consumption of marine invertebrates. In June 2014, nine tourists simultaneously developed a major and persistent poisoning syndrome following the consumption of the gastropod Tectus niloticus collected in Anaho, a secluded bay of Nuku Hiva Island (Marquesas Archipelago, French Polynesia). The unusual nature and severity of this event prompted a multidisciplinary investigation in order to characterize the etiology and document the short/long-term health consequences of this mass-poisoning event. This paper presents the results of clinical investigations based on hospital medical records, medical follow-up conducted six and 20 months post-poisoning, including a case description. This study is the first to describe the medical signature of T. niloticus poisoning in French Polynesia and contributed to alerting local authorities about the potential health hazards associated with the consumption of this gastropod, which is highly prized by local communities in Pacific island countries and territories.


Assuntos
Intoxicação por Ciguatera/epidemiologia , Gastrópodes , Intoxicação por Frutos do Mar/epidemiologia , Adulto , Idoso , Animais , Ciguatoxinas/análise , Surtos de Doenças , Feminino , Contaminação de Alimentos/análise , Gastrópodes/química , Humanos , Masculino , Pessoa de Meia-Idade , Polinésia/epidemiologia
5.
J Addict Med ; 12(3): 247-251, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29401155

RESUMO

: Novel psychoactive substance use is a major social concern. Their use may elicit or uncover unpredictably as yet undescribed clinical pictures. We aimed to illustrate a multisubstance use case indistinguishable from paranoid schizophrenia, so to alert clinicians on possibly misdiagnosing substance-induced psychotic disorders. CASE REPORT: We describe a case of a 32-year-old man who started at 18 years with cannabinoids and ketamine, and is currently using N-methyl-D-aspartate (NMDA) antagonists. At age 23, he developed social withdrawal after being assaulted by a stranger, but did not consult psychiatrists until age 26; during this period, he was using internet-purchased methoxetamine and ketamine, and was persecutory, irritable, suspicious, and insomniac and discontinued all received medical prescriptions. He added dextromethorphan to his list of used substances. At age 31, while using phencyclidine, and, for the first time, methoxphenidine, he developed a religious delusion, involving God calling him to reach Him, and the near-death experiences ensured by NMDA antagonists backed his purpose. He received Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of multisubstance-induced psychotic disorder and was hospitalized 8 times, 6 of which after visiting the emergency room due to the development of extreme anguish, verbal and physical aggression, and paranoia. He reportedly used methoxphenidine, methoxyphencyclidine, ethylnorketamine, norketamine, and deschlorketamine, to achieve near-death experiences, and eventually to reach God in heavens. CONCLUSIONS: This case points to the need for better control of drugs sold on the internet. It also illustrates that people using NMDA antagonists may present clinical pictures indistinguishable from those of major psychoses and are likely to be misdiagnosed.


Assuntos
N-Metilaspartato/antagonistas & inibidores , Psicoses Induzidas por Substâncias/tratamento farmacológico , Adulto , Cicloexanonas/efeitos adversos , Cicloexilaminas/efeitos adversos , Morte , Delusões/induzido quimicamente , Dextrometorfano/efeitos adversos , Diagnóstico Diferencial , Humanos , Ketamina/efeitos adversos , Ketamina/análogos & derivados , Masculino , N-Metilaspartato/efeitos adversos , Disponibilidade de Medicamentos Via Internet , Piperidinas/efeitos adversos , Psicoses Induzidas por Substâncias/diagnóstico , Esquizofrenia Paranoide
6.
Euro Surveill ; 22(24)2017 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-28661393

RESUMO

Botulism is a rare but severe neuroparalytic disease caused by botulinum toxins. Because of its high potential impact on public health, botulism is a closely monitored communicable disease in Europe. In Italy, which has one of the highest incidence rates in Europe (0.03 cases per 100,000 population), botulism is monitored through a case-based passive surveillance system: the front-line physician who diagnoses a suspected case must notify the Local Health Units immediately, and the Ministry of Health's office within 12 hours. From 1986 to 2015, 466 confirmed cases of botulism were recorded in Italy (of 1,257 suspected cases). Of these, 421 were food-borne (the most frequently seen form of botulism due to the consumption of improperly home-canned foods), 36 were infant botulism, which accounts for ca 50% of all these types of cases registered in Europe, six were wound-related and three were due to adult intestinal colonisation. This scenario suggests that stronger efforts should be made towards raising public awareness of the risk of food-borne botulism, especially with respect to home-preserved foods, as well as improving the training of front-line medical personnel, to ensure that a quick and accurate diagnosis of botulism can be made.


Assuntos
Botulismo/epidemiologia , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População/métodos , Saúde Pública , Adulto , Distribuição por Idade , Toxinas Botulínicas , Botulismo/diagnóstico , Clostridium botulinum/isolamento & purificação , Notificação de Doenças , Alimentos em Conserva , Doenças Transmitidas por Alimentos/diagnóstico , Humanos , Incidência , Lactente , Itália/epidemiologia , Masculino , Distribuição por Sexo
8.
Case Rep Orthop ; 2016: 8682737, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27148463

RESUMO

Systemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014). After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL) are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable.

10.
Addict Behav ; 60: 53-7, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27088514

RESUMO

A 24-year old woman with multisubstance use since the age of 13, including opioids and cocaine, and long-standing HIV/HCV seropositivity status, presented with psychosis, agitation, and insomnia at the emergency department of a university hospital. She had been abusive and physically aggressive frequently without specific reasons and was involved in criminal legal cases. She was hospitalized twice. During her first hospital stay she experienced a brief episode of detachment from her environment, similar to episodes reportedly suffered at home. Psychosis had developed following heavy polysubstance abuse. Her mother provided sachets containing benzylglycinamide, a substance with no known psychotropic effects, which were also present in the patient's urine. She was occasionally positive for cannabinoids. She used to buy various novel psychoactive substances (NPSs) from the internet and used experimentally various substances freely made available to her by drug suppliers/dealers. She was unable to explain clearly why she was taking any of the identified NPS. She stated she was taking benzylglycinamide to calm her when smoking synthetic cannabinoids. While it appears that benzylglycinamide is not likely to constitute a novel drug of abuse, her polysubstance use exemplifies trends in NPS use patterns among the youths in the Western world and should alert mental health workers as to the possible dangers of such behavior and its reflection on social behavior and psychopathology.


Assuntos
Glicina/análogos & derivados , Infecções por HIV/complicações , Psicoses Induzidas por Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Ansiolíticos/uso terapêutico , Antirretrovirais/uso terapêutico , Antipsicóticos/uso terapêutico , Feminino , Glicina/sangue , Glicina/urina , Infecções por HIV/tratamento farmacológico , Humanos , /urina , Itália , Lorazepam/uso terapêutico , Palmitato de Paliperidona/uso terapêutico , Promazina/uso terapêutico , Psicoses Induzidas por Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Adulto Jovem
11.
Dermatology ; 229(4): 319-23, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25359191

RESUMO

BACKGROUND: Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) may develop in susceptible patients after administration of different drugs. Only mild cutaneous reactions have been related to lomefloxacin. A correlation between human leucocyte antigen (HLA) and cutaneous adverse reaction has been identified. CASE REPORT: Twenty-four hours after intake of lomefloxacin, a 30-year-old Caucasian woman developed a severe skin reaction with symptoms suggesting SJS/TEN. The fast onset reaction worsened with skin blisters and 20% body surface area skin detachment within 48 h. Burn unit admittance was required; corticosteroids and human immunoglobulins were administered. Complete recovery occurred within 3 months, except for epidermal discoloration. Molecular studies showed a peculiar profile characterized by HLA class I genotype rich of ligands for natural killer cell immunoglobulin-like receptors (KIR) and HLA class II haplotype, HLA-DRB1*03:01,DQB1*02:01, prone to autoimmunity. CONCLUSION: While the HLA profile approaches our case to other well-documented drug-induced SJS/TEN, KIR involvement still remains puzzling.


Assuntos
Antibacterianos/efeitos adversos , Fluoroquinolonas/efeitos adversos , Síndrome de Stevens-Johnson/genética , Adulto , Feminino , Genes MHC Classe I , Genes MHC da Classe II , Genótipo , Antígenos HLA-G/genética , Humanos , Tipagem Molecular , Polimorfismo Genético , Receptores KIR/genética , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/terapia
12.
Expert Rev Anti Infect Ther ; 12(9): 1075-86, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25089560

RESUMO

Botulism is a severe neuroparalytic disease resulting from exposure to one of the most poisonous toxins to humans. Because of this high potency and the use of toxins as biological weapons, botulism is a public health concern and each case represents an emergency. Current therapy involves respiratory supportive care and anti-toxins administration. As a preventive measure, vaccination against toxins represents an effective strategy but is undesirable due the rarity of botulism and the effectiveness of toxins in treating several neuromuscular disorders. This paper summarizes the current issues in botulism treatment and prevention, highlighting the challenge for future researches.


Assuntos
Vacinas Bacterianas/imunologia , Antitoxina Botulínica/uso terapêutico , Botulismo/tratamento farmacológico , Botulismo/prevenção & controle , Descoberta de Drogas , Antitoxina Botulínica/administração & dosagem , Toxinas Botulínicas/antagonistas & inibidores , Toxinas Botulínicas/imunologia , Botulismo/imunologia , Botulismo/microbiologia , Clostridium botulinum/efeitos dos fármacos , Clostridium botulinum/imunologia , Humanos , Vacinas Sintéticas/imunologia
14.
Ann Emerg Med ; 64(6): 629-32, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24530110

RESUMO

Excitatory behavior, xerostomia, chest pain, severe dyspnea, tachycardia (150 beats/min), and mild hypertension (160/80 mm Hg) without ECG abnormalities were observed in a 20-year-old subject 6 hours after nasal insufflation (snorting) of a "legally" obtained white powdered substance sold as Synthacaine. A serum sample was found to contain MAM-2201 (11 ng/mL), a synthetic cannabinoid receptor agonist, and benzocaine. The patient's symptoms improved after administration of diazepam and intravenous fluids. Synthacaine was sold as legal cocaine, suggesting the user can expect an effect like that of cocaine. The pharmacologic receptor profile and chemical structure of MAM-2201 is similar to the synthetic cannabinoid receptor agonists AM-2201 and JWH-122 (2 potent synthetic cannabinoid receptor agonists with high affinity to cannabinoid receptors).


Assuntos
Agonistas de Receptores de Canabinoides/efeitos adversos , Indóis/efeitos adversos , Naftalenos/efeitos adversos , Benzocaína/efeitos adversos , Benzocaína/análise , Agonistas de Receptores de Canabinoides/análise , Humanos , Indóis/análise , Masculino , Naftalenos/análise , Adulto Jovem
15.
16.
Clin Toxicol (Phila) ; 50(2): 149-50, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22224932

RESUMO

A 74-year-old female with a 5-year medical history of breast infiltrating lobular carcinoma was admitted to our Rehabilitation Unit ward for left hemiparesis secondary to neurosurgical removal of frontal and right parietal metastatic lesions. After the intervention, prophylactic treatment with the antiepileptic diphenylhydantoin 100 mg/tid was started. On 38th day of drug administration an erythema without itch appeared in jugular and parasternal region and absent in the clothing covered areas, suggesting a contact dermatitis. Next day, the erythema extended to the neck with poorly delineated red plaques. During the following 4 days the patient presented oral stomatitis with fetid breath, atypical targetoid and erythematous confluenced macules. The clinical picture rapidly worsened with vesiculate, bullate lesions and frank skin erosions. The patient was sent to a Dermatology Burn Unit where a therapy with corticosteroids, antibiotics, fluids, albumin and immunoglobulins was administrated. Complete clinical resolution was observed after 1 month without long-term sequelae. Toxic epidermal necrolysis (TEN) is a rare (incidence about 0.01%) adverse drug reaction related to idiosyncratic mechanism, burdened by a mortality rate ranging from 3.2 to 90%. In our patient, TEN covered 63% of body surface, a condition associated with a death risk of 58.3% according to the specific severity illness scale SCORTEN. The disease onset may be insidious, and it could appear as a skin rash without itch; the cutaneous manifestations appear quite lately, then the disease quickly progresses. Early recognition of the disease, especially in oncologic patients, is critical for effective management of this condition in terms of mortality reduction.


Assuntos
Anticonvulsivantes/efeitos adversos , Exantema/induzido quimicamente , Fenitoína/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Idoso , Feminino , Humanos , Prurido/induzido quimicamente
18.
Clin Toxicol (Phila) ; 49(3): 191-2, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21495890

RESUMO

A young man with abdominal pain who had radiopaque tablets in his gut is described. Investigations showed the diagnosis of lead poisoning from ayurvedic medicines.


Assuntos
Dor Abdominal/diagnóstico , Intoxicação por Chumbo/diagnóstico , Medicina Ayurvédica , Fitoterapia/efeitos adversos , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Humanos , Intoxicação por Chumbo/etiologia , Masculino , Radiografia , Adulto Jovem
19.
Pediatr Rep ; 3(4): e31, 2011 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-22355516

RESUMO

An 8-month old girl, weighing 9 kg, was brought by her parents at 8.15 am to the Emergency Department (ED) for a progressive worsening of weakness and acute respiratory failure. On admission, the baby presented with poor oral intake, a weak cry and extremely weak muscular body control. Poor gag and suck, unreactive mydriasis, hypotonia, lethargy and absence of peristalsis were noted. Laboratory data showed severe respiratory acidosis. Chest X-ray, electroencephalography, encephalic CT scan and MRI were all normal, as were cerebrospinal fluid analysis and viral tests. Orotracheal intubation and continuous mechanical ventilation were applied. The patient received fluids, corticosteroids, aerosol therapy, large-spectrum antibiotics and enteral-nutrition. Further investigation revealed ingestion of an improperly prepared home-canned homogenized turkey meal. Type A botulinum neurotoxin was identified. Trivalent botulinum antitoxin, prostigmine and oral activated charcoal were administered. Generalized flaccid paralysis, areflexic bilateral mydriasis, gastric stasis and deep coma persisted for the duration of the hospital stay, and the patient died of severe respiratory failure and cardiac arrest 12 days after ED admission. Botulism poisoning should be suspected in any infant presenting with feeding difficulties, constipation, descendent paralysis or acute respiratory failure. Supportive treatment and antidotal therapy should be performed as soon as a clinical diagnosis is made. We describe a case of foodborne botulism in an 8-month old infant caused by ingestion of an improperly prepared home-canned homogenized turkey meal, representing the youngest fatal case reported in medical literature.

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