Biomedical evaluation of antioxidant properties of lamb meat enriched with iodine and selenium.

The article presents a study of the antioxidant properties of meat from lambs that received organic forms of iodine and selenium during growth. This meat was included in diets of laboratory animals using a model of acute toxic hepatitis. The experiments resulted in developing and testing a technique that was effective in enriching lamb with bioorganic elements of iodine and selenium and contributed to the activation metabolism in the bodies of animals consuming the meat. The purpose of the presented investigation was to compare the roles of bioorganic iodine and selenium and their combination as antioxidants in rat rations using a model of acute toxic hepatitis induced by carbon tetrachloride. The experimental studies have established a hepatoprotective effect of lamb meat enriched with selenium and iodine on rats suffering from toxic xenobiotic effects. This was confirmed by normalized hematological and biochemical measures in the blood of the experimental rats.

Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis.

BACKGROUND AND OBJECTIVES: Acute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure. MATERIALS AND METHODS: A total of 335 patients who received TPE between 2010-2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22-84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE. RESULTS: Acute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed. CONCLUSION: TPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.

Novel Score-based Decision Approach in Chronic Myeloid Leukemia Patients After Acute Toxic Imatinib-induced Liver Injury.

The tyrosine kinase inhibitor (TKI) imatinib in rare cases can cause acute toxic hepatitis, hepatic failure, and death. Currently, the choice of further chronic myeloid leukemia (CML) therapy in patients after acute hepatotoxicity is still a difficult question, which requires a complex individual approach based on the clinical guidelines of adverse event management. Data about the further follow-up strategy approach in patients with CML after acute toxic imatinib-induced liver injury are of concern, and at times controversial. In addition, one of the questions is about the necessity and safety of the imatinib therapy resumption after acute hepatotoxicity. In some publications, imatinib resumption without the recurrence of hepatotoxicity has been discussed; in others, imatinib resumption with the recurrence of imatinib hepatotoxicity has been mentioned. There are a few publications about the experience of administration of the second-line TKIs after acute imatinib hepatotoxicity. There are no clear data on which factors the physician's decision should be based on in patients with CML after acute toxic imatinib-induced liver injury. Imatinib should be restarted or withdrawn, when and for whom second-line therapy should be started. The physician's decision is usually based on the published data of similar cases, personal experience, and the severity of hepatotoxicity. We have discussed the clinical guidelines devoted to the peculiarities of the patient's management after acute toxic imatinib-induced hepatitis and main strategy approaches. A complex score-based decision algorithm for choosing the further strategy approach after acute toxic imatinib-induced hepatitis in patients with CML has been presented. The following parameters should be assessed: the grade of hepatotoxicity reaction, the presence of liver transplantation or imatinib-induced liver cirrhosis and its possible pathogenetic mechanism, the presence of early molecular response (EMR) to imatinib therapy defined as three-month BCR-ABL1 ≤10% according to the international scale (BCR-ABL1IS ) or/and six-month BCR-ABL1 IS <1%; and the presence of the offender concomitant drug that probably caused the drug interaction with imatinib and the presence of viral hepatitis reactivation identified by polymerase chain reaction (PCR).

Сase Report of Acute Toxic Imatinib-induced Hepatitis in a Patient with Chronic Myeloid Leukemia, Sulfa Allergy, and Rheumatoid Arthritis.

The introduction of imatinib has substantially changed the approaches to the therapy of chronic myeloid leukemia. However, this drug can cause hepatic failure and death in rare cases. This report describes a clinical case of acute, toxic imatinib-induced hepatitis in a 56-year-old woman with chronic myeloid leukemia and concomitant sulfa allergy and rheumatoid arthritis. The patient developed acute imatinib-induced hepatitis after three months of treatment with imatinib and three days after increasing the imatinib dosage from 400 mg per day to 600 mg per day, resolving within three months after imatinib discontinuation and prednisolone administration. This confirms the necessity of great caution during imatinib therapy and the monitoring of liver tests. Approximately 25 reports about clinical cases of imatinib-induced hepatitis have been published up to the present.

Exposure Assessment for Toxic Hepatitis Caused by HCFC-123.

This case report attempts to present a case of acute toxic hepatitis in fire extinguisher manufacturing workers exposed to 2,2-dichloro-1,1,1-trifluoro-ethane (HCFC-123) in August 2017 in Korea. Twenty-two-year-old male workers were exposed to HCFC-123 for 1.5 hours one day and for 2.5 hours the other day, after which one worker died, and the other recovered after treatment. The workers were diagnosed with acute toxicity of hepatitis. However, exposure levels of HCFC-123 were not known with no work environment measurement done. Therefore, this study was conducted to estimate the exposure concentration of HCFC-123 via a job simulation experiment. In the simulation, the HCFC-123 exposure concentration was measured with the same working practice and working time as with the workers aforementioned. As a result, the workers who infused HCFC-123 into storage tanks were estimated to be exposed to HCFC-123 at a concentration of 20.65 ± 10.81 ppm, and a mean concentration of area samples within a working radius were estimated as 70.30 ± 18.10 ppm. Valve assembly workers working on valves of a fire extinguisher filled with HCFC-123 were exposed to HCFC-123 at concentrations of 91.65 ± 4.03 ppm and 115.55 ± 7.28 ppm, respectively, in the simulation, and area samples simulated within the working radius were also found to be high with concentrations of 122.75 ± 91.15 ppm and 126.80 ± 60.25 ppm, respectively. Nitrogen gas packing workers, who did not handle HCFC-123 directly, were exposed to the agent at a concentration of 71.80 ± 8.49 ppm. These results suggest that exposure to HCFC-123 at high concentrations for 1.5-2.5 hours caused acute toxic hepatitis in two workers.

Exposure Assessment for Toxic Hepatitis Caused by HCFC-123

This case report attempts to present a case of acute toxic hepatitis in fire extinguisher manufacturing workers exposed to 2,2-dichloro-1,1,1-trifluoro-ethane (HCFC-123) in August 2017 in Korea. Twenty-two-year-old male workers were exposed to HCFC-123 for 1.5 hours one day and for 2.5 hours the other day, after which one worker died, and the other recovered after treatment. The workers were diagnosed with acute toxicity of hepatitis. However, exposure levels of HCFC-123 were not known with no work environment measurement done. Therefore, this study was conducted to estimate the exposure concentration of HCFC-123 via a job simulation experiment. In the simulation, the HCFC-123 exposure concentration was measured with the same working practice and working time as with the workers aforementioned. As a result, the workers who infused HCFC-123 into storage tanks were estimated to be exposed to HCFC-123 at a concentration of 20.65±10.81 ppm, and a mean concentration of area samples within a working radius were estimated as 70.30±18.10ppm. Valve assembly workers working on valves of a fire extinguisher filled with HCFC-123 were exposed to HCFC-123 at concentrations of 91.65±4.03ppm and 115.55±7.28 ppm, respectively, in the simulation, and area samples simulated within the working radius were also found to be high with concentrations of 122.75±91.15 ppm and 126.80±60.25 ppm, respectively. Nitrogen gas packing workers, who did not handle HCFC-123 directly, were exposed to the agent at a concentration of 71.80±8.49 ppm. These results suggest that exposure to HCFC-123 at high concentrations for 1.5–2.5 hours caused acute toxic hepatitis in two workers.

Acute interstitial nephritis, toxic hepatitis and toxic myocarditis following multiple Asian giant hornet stings in Shaanxi Province, China.

OBJECTIVES: During July to October 2013, the Asian giant hornet has killed 42 and injured 1,675 people in the southern part of Shaanxi Province, China. This study investigated this unusual and frequent public health event. METHODS: During the 3 months, 103 patients with severe Asian hornet stings were hospitalized in our hospital. Clinical data were collected using a standardized data collection form which included sex, age, length of hospital stay and medical recorder. RESULTS: After physical examination and laboratory investigation, 25.2, 46.6 and 44.7 % of the patients were found with varying degrees of acute interstitial nephritis, acute toxic hepatitis and acute toxic myocarditis, respectively. After timely and appropriate treatment including removal of the stings and the use of intravenous methylprednisolone and antihistamines, the kidney function, liver function and heart function of 99 patients recovered within 1 month, while four patients died. CONCLUSIONS: This study provided a good opportunity for recognizing the effect of Asian giant hornet stings and evaluating this serious public health event.

Liver Transplantation for Acute Toxic Hepatitis due to Herbal Medicines and Preparations

PURPOSE: Acute toxic hepatitis is a common cause of acute liver failure (ALF). We investigated the causes, clinical manifestation, and outcomes of ALF patients who underwent liver transplantation due to acute toxic hepatitis caused by herbal medicines and preparations. METHODS: Between January 1992 and May 2008, we retrospectively reviewed the medical records of 24 patients who were transplanted due to acute toxic hepatitis caused by herbal medicines and preparations. We applied the RUCAM score to patients with acute toxic hepatitis and assessed the relationship between herbal preparations and liver injury. We studied the patients' medication history, liver function tests, and clinical outcomes. RESULTS: The type of liver injury was divided into three groups: hepatocellular type, 14 patients (58.3%); cholestatic type, 4 patients (16.7%); and mixed type, 6 patients (25%). Polygonum multiflorum Thunberg (3 cases) was the most common cause of acute toxic hepatitis, followed by Acanthopanax senticosus (2 cases), pumpkin juice (2 cases), Dictamnus dasycarpus Turcz (2 cases), Hovenia dulcis (1 case), Phellinus linteus (1 case), and Artemisia capillaries (1 case). One year survival after liver transplantation was 76%. CONCLUSION: We identified the herbal preparations leading to acute liver failure. Many patients consider herbal remedies to be completely free of unwanted side effects. However, we found that many herbal products have biological activities that can lead to severe hepatotoxicity.

Two cases of acute toxic hepatitis and renal failure after ingestion of the extract of elm bark in lung cancer patients / 대한내과학회지

Traditional remedies, especially the extract of elm bark, are frequently used in Korea. But the exact efficacy and adverse effects are not known. Cancer patients are frequently recommended various traditional remedies by family members. However such remedies may lead to life-threatening complications. We observed two cases of severe hepatic and renal toxicities that developed after ingestion of elm extract. One patient was a 67-year-old man diagnosed with stage IV non-small cell lung cancer (NSCLC). He ingested the bark extract of elm for 2 weeks during routine work-up prior to chemotherapy. He abruptly showed acute toxic hepatitis with cardiac tamponade. The other patient was a 57-year-old woman diagnosed with extensive disease-small cell lung cancer (ED-SCLC). She consumed the extract of root bark of elm for 5 months during complete remission status and developed acute renal failure. These cases suggest that use of the extract of elm bark in cancer patients must be more careful.