Toad Intoxication in the Dog by Rhinella marina : The Clinical Syndrome and Current Treatment Recommendations.

Oral exposure to the secretions of Rhinella marina (formerly Bufo marinus ) can carry a high fatality rate without early and appropriate treatment. In dogs, the clinical syndrome, which is evident almost immediately, manifests in profuse ptyalism along with gastrointestinal, respiratory, and neurologic signs. Severe cardiac arrhythmias develop less frequently. This review will cover the history, toxicology, and clinical syndrome of Rhinella marina intoxication, and will discuss the recommended therapies for stabilization.

[Overall principles of treatment in case of toxicological threats]. / Ogólne zasady postepowania w przypadku zagrozen toksykologicznych.

Toxins and venoms are silent weapons capable of killing people secretly. All around the world, there are a lot of such substances produced by bacteria, fungi, plants and animals. The threat to health and life, which are caused by toxins and venoms, meant that they are seen as a biological weapon. In the rescue proceedings with the victims the mechanism of toxin action is imported, because in some cases the antitoxins are known. However, in the most cases, the primary consideration is the symptomatic treatment. Conducted research on the usefulness of oxime and autofages in eliminating the effects of toxins are advanced, but not yet implemented into therapy. In each case the toxin action the victims must be evacuated to a safe location. It is also necessary to protect teams providing assistance in suitable protective clothing.

Cyanobacteria and algae blooms: Review of health and environmental data from the Harmful Algal Bloom-Related Illness Surveillance System (HABISS) 2007-2011.

Algae and cyanobacteria are present in all aquatic environments. We do not have a good sense of the extent of human and animal exposures to cyanobacteria or their toxins, nor do we understand the public health impacts from acute exposures associated with recreational activities or chronic exposures associated with drinking water. We describe the Harmful Algal Bloom-related Illness Surveillance System (HABISS) and summarize the collected reports describing bloom events and associated adverse human and animal health events. For the period of 2007-2011, Departments of Health and/or Environment from 11 states funded by the National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention contributed reports for 4534 events. For 2007, states contributed 173 reports from historical data. The states participating in the HABISS program built response capacity through targeted public outreach and prevention activities, including supporting routine cyanobacteria monitoring for public recreation waters. During 2007-2010, states used monitoring data to support196 public health advisories or beach closures. The information recorded in HABISS and the application of these data to develop a wide range of public health prevention and response activities indicate that cyanobacteria and algae blooms are an environmental public health issue that needs continuing attention.

Type 2 myocardial infarction after ingestion of mad honey in a patient with normal coronary arteries

No abstract available.

Update on uncertain etiology of chronic kidney disease in Sri Lanka's north-central dry zone.

INTRODUCTION: This manuscript updates a review previously published in a local journal in 2012, about a new form of chronic kidney disease that has emerged over the past two decades in the north-central dry zone of Sri Lanka, where the underlying causes remain undetermined. Disease burden is higher in this area, particularly North Central Province, and affects a rural and disadvantaged population involved in rice-paddy farming. Over the last decade several studies have been carried out to estimate prevalence and identify determinants of this chronic kidney disease of uncertain etiology. OBJECTIVE: Summarize the available evidence on prevalence, clinical profile and risk factors of chronic kidney disease of uncertain etiology in the north-central region of Sri Lanka. METHODS: PubMed search located 16 manuscripts published in peer-reviewed journals. Three peer-reviewed abstracts of presentations at national scientific conferences were also included in the review. RESULTS: Disease prevalence was 5.1%-16.9% with more severe disease seen in men than in women. Patients with mild to moderate stages of disease were asymptomatic or had nonspecific symptoms; urinary sediments were bland; 24-hour urine protein excretion was <1 g; and ultrasound demonstrated bilateral small kidneys. Interstitial fibrosis was the main pathological feature on renal biopsy. The possibility of environmental toxins affecting vulnerable population groups in a specific geographic area was considered in evaluating etiological factors. Pesticide residues were detected in affected patients' urine, and mycotoxins detected in foods were below maximum statutory limits. Calcium-bicarbonate-type water with high levels of fluoride was predominant in endemic regions. Significantly high levels of cadmium in urine of cases compared to controls, as well as the disease's dose-related response to these levels, has drawn attention to this element as a possible contributing factor. Familial clustering of patients is suggestive of a polygenic inheritance pattern comparable to that associated with diseases of multifactorial etiology. CONCLUSIONS: Available data suggest that chronic kidney disease of uncertain etiology is an environmentally acquired disease, but to date no definitive causal factor has been identified. Geographic distribution and research findings suggest a multifactorial etiology.

Medical honey and its role in paediatric patients.

BACKGROUND: The use of complementary medical treatment in wound management has continued to grow throughout the world. There is a large body of evidence that supports the use of honey as a wound dressing for a wide range of wound types. The authors present an update of present knowledge about honey as a form of complementary medicine in paediatric wound management. METHODS: The literature cited was found by searching the PubMed, BIOSIS and ISI Web of Science databases for the phrase 'honey and wound'. Papers where honey was used in a mixture with other therapeutic substances were excluded. Randomised controlled trials as well as case studies were taken into consideration. RESULTS: This paper reviews data on the effectiveness of honey in wound healing; 80 citations or references were found that matched the criteria. Furthermore, the wound-healing properties of honey are described and the mechanism of action discussed. The authors' data show that honey induced enhanced epithelialisation, minimised scar formations and had an anti-microbiotic effect. CONCLUSION: These results should encourage the use of medical honey in the field of paediatrics. It is a safe and natural substance that induces wound healing at a greater rate than conventional methods.

Poisoning in Israel: annual report of the Israel Poison Information Center, 2012.

BACKGROUND: The Israel National Poison Information Center (IPIC), Rambam Health Care Campus, provides 24 hour telephone consultations in clinical toxicology as well as drug and teratogen information. It participates in research, teaching and regulatory activities, and also provides laboratory services. OBJECTIVES: To report data on the epidemiology of poisonings and poison exposures in Israel. METHODS: We made computerized queries and descriptive analyses of the medical records database of the IPIC during 2012. RESULTS: A total of 31,519 poison exposure cases were recorded, a 157.6% increase compared with 1995. Children < 6 years of age were involved in 43.1% of cases; 74.0% of calls were made by the public and 23.7% by physicians; 74.8% of exposures were unintentional and 9.1% intentional. Chemicals were involved in 35.8% of all cases (single and multiple substances), pharmaceuticals in 48.8%, bites and stings in 3.8%, and plants and mushrooms in 1.6%. Substances most frequently involved were analgesics, cleaning products and antimicrobials. Clinical severity was moderate/major in 3.4%. Substances most frequently involved in moderate/major exposures were corrosives, insecticides and snake venom. Four fatalities were recorded; all were intentional exposures in adults (corrosive, medications, energy drink). CONCLUSIONS: Poison exposures and poisonings have increased significantly and have contributed substantially to morbidity and mortality in Israel. The IPIC database is a valuable national resource for the collection and monitoring of poisoning exposure cases. It can be used as a real-time surveillance system for the benefit of public health. It is recommended that reporting to the IPIC become mandatory and its activities be adequately supported by national resources.

Biowarfare and bioterrorism.

Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequately prepared to manage a mass casualty situation. This article reviews the epidemiology, diagnosis, and treatment of the most likely agents of biowarfare and bioterrorism.

[Natural toxin poisoning].

Natural toxin poisoning often occurs when amateur who has no expert knowledge of food collects and cooks the wrong material. In many cases, the symptoms of natural toxin poisoning are mild and the patients recover from illness within a day. However, if the patients have respiratory or neurological symptoms after several hours of intake, the patients must go to hospital immediately. Mushroom poisoning is often reported and puffer fish poisoning is sometimes reported in Japan.

[Trends of food poisonings caused by natural toxins in Japan, 1989-2011].

In order to reduce the health risk associated with food poisonings caused by natural toxins, it is necessary to implement risk management strategies based on previous poisoning data and risk factors. In present study, we statistically analyzed natural toxin food poisoning (NTFP) data published by the Ministry of Health, Labour and Welfare from 1989 to 2010 in Japan and reviewed the trends of NTFP for each natural toxin hazard. Since 1989, the number of incidents of NTFP in each year has not been reduced. Prevention and control are needed to reduce the risk of NTFP. The major site for all hazards was "at home". This result suggested that consumer education is critically important to inform about NTFP occurrence, preventive measures and emergency treatments. Furthermore, countermeasures for NTFPs which have never occurred in the past in Japan should be considered, because of the increasing variety of imported foods and changes resulting from the inerease of sea temperature with global warming.

Nairobi fly (Paederus) dermatitis in South Sudan: a case report.

A 28-year-old nursing student working in Juba, South Sudan, suddenly developed a rash over her mid-right clavicle. Beginning as a 10-cm-diameter erythematous patch with an irregular border, within 24 hours it had developed an increasingly gray, necrotic center, appearing similar to a burn. The patient was seen by 2 local physicians without a diagnosis being made. Ultimately, it was diagnosed as being caused by the toxic hemolymph, pederin, from the Nairobi fly (Paederus). The rash usually affects body parts not covered by clothing; healing time ranges from 7 to 28 days, usually with permanent skin discoloration. Preventive measures include typical antivector precautions, including bed nets, long-sleeve clothing, and avoiding fluorescent lights. If the beetles are found on the skin, brushing them off, rather than crushing them, avoids producing dermatitis. Treatment includes rapidly washing the affected area, applying cold, wet compresses, and possibly treating with antibiotics, steroids, and antihistamines.

Grayanotoxin poisoning: 'mad honey disease' and beyond.

Many plants of the Ericaceae family, Rhododendron, Pieris, Agarista and Kalmia, contain diterpene grayanotoxins. Consumption of grayanotoxin containing leaves, flowers or secondary products as honey may result in intoxication specifically characterized by dizziness, hypotension and atrial-ventricular block. Symptoms are caused by an inability to inactivate neural sodium ion channels resulting in continuous increased vagal tone. Grayanotoxin containing products are currently sold online, which may pose an increasing risk. In humans, intoxication is rarely lethal, in contrast to cattle and pet poisoning cases. Scientific evidence for the medicinal properties of grayanotoxin containing preparations, such as honey or herbal preparation in use in folk medicine, is scarce, and such use may even be harmful.

Mad-honey sexual activity and acute inferior myocardial infarctions in a married couple.

Mad-honey poisoning can occur after the eating of honey that contains grayanotoxin. Mad honey is intentionally produced from the nectar of Rhododendron ponticum, which grows in Japan, Nepal, Brazil, parts of North America and Europe, and the eastern Black Sea region of Turkey. Low doses of grayanotoxin can cause dizziness, hypotension, and bradycardia, and high doses can cause impaired consciousness, syncope, atrioventricular block, and asystole due to vagal stimulation. Reports of acute coronary syndrome are very rare. Herein, we present the case of a 50-year-old husband and 42-year-old wife who, to improve sexual performance, intentionally ate honey from the Black Sea area of Turkey for 1 week. Within 3 hours of consuming increased amounts of the honey, they presented at our emergency department with acute inferior myocardial infarctions. Coronary angiography revealed normal coronary arteries in both patients. Supportive treatment with atropine rapidly resolved the clinical symptoms and electrocardiographic irregularities. Grayanotoxin-containing rhododendron pollen was detected in the honey.In patients from geographic regions where mad honey can be obtained, mad-honey poisoning should be considered in the differential diagnosis of chest pain, particularly in the presence of unexplained bradyarrhythmia and hypotension. Sexual performance is a chief reason for the purchase of mad honey and self-treatment with it by persons of our patients' ages.