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1.
Lakartidningen ; 1162019 Nov 01.
Artigo em Sueco | MEDLINE | ID: mdl-31688944

RESUMO

Since the late 1970s N-acetylcystein has been used as an antidote after paracetamol intoxication. The treatment is traditionally given as three consecutive infusions for 20 hours and 15 minutes. The total dose given is 300 mg/kg. Half of this amount is given as a bolus during the first 15 minutes of treatment.  This regime has proven very efficient in avoiding liver injury. However, side effects, caused by histamine release, are common (10-15%). Symptoms as flush, urticaria and, in rare cases, bronchospasm, angioedema and circulatory shock typically appear during the bolus dose and may lead to interrupted and inadequate treatment. In addition, the regime is complicated leading to a risk of administration errors. During the last years several publications have described the use of a model with two infusions instead of three. The first and the second infusions are merged and given over four hours. The third infusion and the total dose are left unchanged. This modified regime has been shown to reduce side effects and seems not to increase the risk of liver injury. As of November 1, 2019, the Swedish Poisons Information Centre will change its recommendations to the new two-infusion protocol.


Assuntos
Acetaminofen/envenenamento , Acetilcisteína/administração & dosagem , Antídotos/administração & dosagem , Overdose de Drogas/tratamento farmacológico , Envenenamento/tratamento farmacológico , Acetilcisteína/efeitos adversos , Acetilcisteína/uso terapêutico , Administração Intravenosa , Antídotos/efeitos adversos , Antídotos/uso terapêutico , Humanos , Centros de Controle de Intoxicações , Guias de Prática Clínica como Assunto
2.
Lakartidningen ; 1162019 Sep 25.
Artigo em Sueco | MEDLINE | ID: mdl-31573667

RESUMO

Sometimes it is suspected that people have been involuntary exposed to drugs, usually by spiked drinks. A young woman was transported to an emergency department by ambulance. Her clinical symptoms (decreased consciousness, mydriasis, confusion, hallucinations and urine retention) indicated anticholinergic syndrome that was effectively treated with the antidote physostigmine. A urine sample tested negative for common narcotic drugs and alcohol, but an extended toxicological analysis of the urine revealed the presence of the alkaloid scopolamine. Scopolamine occurs naturally in Solanaceae plants and is used in some medications. The woman reported that the symptoms had appeared soon after she was offered tea by a male acquaintance. The analytical results along with the woman's story indicated that she had been subjected to a drug-facilitated crime. The results further demonstrate that in suspected cases of involuntary drug exposure, testing should cover a wide panel of relevant drugs, otherwise poisoning may be missed.


Assuntos
Antagonistas Colinérgicos , Escopolamina , Detecção do Abuso de Substâncias , Adolescente , Adulto , Síndrome Anticolinérgica/tratamento farmacológico , Síndrome Anticolinérgica/etiologia , Antídotos/uso terapêutico , Antagonistas Colinérgicos/envenenamento , Antagonistas Colinérgicos/urina , Cromatografia Líquida de Alta Pressão , Vítimas de Crime , Feminino , Humanos , Espectrometria de Massas , Fisostigmina/uso terapêutico , Escopolamina/envenenamento , Escopolamina/urina , Detecção do Abuso de Substâncias/métodos , Detecção do Abuso de Substâncias/normas , Adulto Jovem
3.
Medicine (Baltimore) ; 98(29): e16471, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335706

RESUMO

Thallium is highly toxic and its effects are cumulative. The clinical symptoms of thallium poisoning are non-specific, thereby delaying admission and treatment. This study aimed to summarize the clinical features and treatment experience of patients with delayed admission who experience thallium poisoning.We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had thallium poisoning and experienced a delay in hospital admission. The time from symptom onset to admission was assessed. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory test results, examination findings, treatment methods, outcomes, and follow-up information, were conducted.A total of 34 patients with thallium poisoning were included: 8 were admitted to the hospital early or with mild delay, 9 had a moderate delay, and 17 had a severely delayed admission. The time from illness onset to admission was 13 (interquartile range, 7.5-26) days. Some patients with delayed admission had significant symptoms associated with central nervous system damage, and changes in magnetic resonance images and electroencephalograms were also noted. After admission, all patients received Prussian blue treatment, and some patients with relatively high blood concentration received blood purification treatments. Following treatment, the blood and urine thallium concentrations of all patients decreased significantly, and their symptoms were alleviated.Our results show that delayed patient admission in cases of thallium poisoning is associated with greater risk of central nervous system damage. Use of Prussian blue combined with blood purification treatments might improve patients' conditions.


Assuntos
Diagnóstico Tardio , Intoxicação por Metais Pesados/diagnóstico , Intoxicação por Metais Pesados/terapia , Hospitalização , Tálio/envenenamento , Tempo para o Tratamento , Adolescente , Adulto , Antídotos/uso terapêutico , Feminino , Ferrocianetos/uso terapêutico , Intoxicação por Metais Pesados/sangue , Intoxicação por Metais Pesados/urina , Hemoperfusão , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tálio/sangue , Tálio/urina
6.
Lakartidningen ; 1162019 Jul 29.
Artigo em Sueco | MEDLINE | ID: mdl-31361324

RESUMO

Toxicological analysis is an important part of the acute treatment of various intoxications. Rapid laboratory responses are important for the patient to be assessed and treated correctly, and also to exclude poisoning and thus avoid unjustified and costly overtreatment. In Sweden, paracetamol (acetaminophen) is one of the most common pharmaceuticals in drug poisoning. Paracetamol overdose can cause severe liver damage unless treated early with the antidote acetylcysteine. A nation-wide initiative for improved laboratory measurement of paracetamol in plasma/serum samples has resulted in a marked reduction in the inter-laboratory coefficient of variation to generally below 10%. The introduction of a harmonized national reporting range for plasma/serum paracetamol covering at least 50-5 000 µmol/l was also recommended. This initiative will hopefully contribute to better healthcare from both a patient and health resource perspective in cases of paracetamol poisoning.


Assuntos
Acetaminofen , Analgésicos não Entorpecentes , Serviços de Laboratório Clínico/normas , Acetaminofen/sangue , Acetaminofen/envenenamento , Acetilcisteína/administração & dosagem , Acetilcisteína/uso terapêutico , Analgésicos não Entorpecentes/sangue , Analgésicos não Entorpecentes/envenenamento , Antídotos/administração & dosagem , Antídotos/uso terapêutico , Overdose de Drogas/diagnóstico , Overdose de Drogas/tratamento farmacológico , Humanos , Envenenamento/diagnóstico , Envenenamento/tratamento farmacológico , Guias de Prática Clínica como Assunto , Suécia , Fatores de Tempo
7.
Ann Pharm Fr ; 77(5): 349-362, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31253354

RESUMO

Organophosphorus compounds (OP) are toxic molecules developed as insecticides and chemical warfare nerve agents (CWNAs). Most OP are neurotoxic and act as nervous system disruptors by blocking cholinergic transmission. They are therefore responsible for many poisonings worldwide. OP toxicity may result either from acute or chronic exposure, and their poisoning effect were evaluated using several animal models. These latter were also used for evaluating the efficacy of antidotes. Strategies based on enzymes that can trap (stoichiometric bioscavengers) or degrade (catalytic bioscavengers) OP, were particularly studied since they allow effective decontamination, without toxicity or environmental impact. This review summarizes the results obtained in vivo with enzymes through three levels: prophylaxis, treatment and external decontamination. The efficiency of enzymatic treatments in different animal models is presented and the relevance of these models is also discussed for a better extrapolation to humans.


Assuntos
Substâncias para a Guerra Química , Reativadores da Colinesterase/uso terapêutico , Terapia de Reposição de Enzimas/métodos , Inseticidas/envenenamento , Intoxicação por Organofosfatos/terapia , Animais , Antídotos/uso terapêutico , Humanos , Intoxicação por Organofosfatos/enzimologia
8.
Crit Care ; 23(1): 206, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171018

RESUMO

In light of an aging population with increased cardiovascular comorbidity, the use of oral anticoagulation (OAC) is steadily expanding. A variety of pharmacological alternatives to vitamin K antagonists (VKA) have emerged over recent years (direct oral anticoagulants, DOAC, i.e., dabigatran, rivaroxaban, apixaban, and edoxaban) which show a reduced risk for the occurrence of intracerebral hemorrhage (ICH). Yet, in the event of ICH under OAC (OAC-ICH), hematoma characteristics are similarly severe and clinical outcomes likewise substantially limited in both patients with VKA- and DOAC-ICH, which is why optimal acute hemostatic treatment in all OAC-ICH needs to be guaranteed. Currently, International Guidelines for the hemostatic management of patients with OAC-ICH are updated as several relevant large-sized observational studies and recent trials have established treatment approaches for both VKA- and DOAC-ICH. While the management of VKA-ICH is mainly based on the immediate reversal of elevated levels of international normalized ratio using prothrombin complex concentrates, hemostatic management of DOAC-associated ICH is challenging requiring specific antidotes, notably idarucizumab and andexanet alfa. This review will provide an overview of the latest studies and trials on hemostatic reversal agents and timing and summarizes the effects on hemorrhage progression and clinical outcomes in patients with OAC-ICH.


Assuntos
Anticoagulantes/efeitos adversos , Antídotos/farmacologia , Hemorragia Cerebral/tratamento farmacológico , Administração Oral , Anticoagulantes/uso terapêutico , Antídotos/efeitos adversos , Antídotos/uso terapêutico , Antitrombinas/efeitos adversos , Antitrombinas/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Hemorragia Cerebral/complicações , Fator Xa/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Humanos , Proteínas Recombinantes/uso terapêutico , Ácido Tranexâmico/efeitos adversos , Ácido Tranexâmico/uso terapêutico
9.
Cell Biochem Biophys ; 77(3): 261-272, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31065867

RESUMO

Our early studies have shown that sodium thiosulfate (STS) treatment attenuated the ischemia-reperfusion (IR)-induced injury in an isolated rat heart model by decreasing apoptosis, oxidative stress, and preserving mitochondrial function. Hydrogen sulfide, the precursor molecule is reported to have similar efficacy. This study aims to investigate the role of endogenous hydrogen sulfide in STS-mediated cardioprotection against IR in an isolated rat heart model. D, L-propargylglycine (PAG), an inhibitor of cystathionine γ-lyase was used as endogenous H2S blocker. In addition, we used the hypoxia-reoxygenation (HR) model to study the impact of STS in cardiomyocytes (H9C2) and fibroblast (3T3) cells. STS treatment to animal and cells prior to IR or HR decreased cell injury. The sensitivity of H9C2 and 3T3 cells towards HR (6 h hypoxia followed by 12 h reoxygenation) challenge varies, where, 3T3 cells exhibited higher cell death (54%). Cells treated with PAG prior to STS abrogate the protective effect in 3T3 (cell viability 61%) but not in H9C2 (cell viability 82%). Further evaluation in rat heart model showed partial recovery (46% RPP) of heart from those hearts pretreated with PAG prior to STS condition. In conclusion, we demonstrated that STS-mediated cardioprotection to IR-challenged rat heart is not fully dependent on endogenous H2S level and this dependency may be linked to higher fibroblast content in rat heart.


Assuntos
Antídotos/farmacologia , Apoptose/efeitos dos fármacos , Cistationina gama-Liase/metabolismo , Miocárdio/enzimologia , Tiossulfatos/farmacologia , Alquinos/farmacologia , Animais , Antídotos/uso terapêutico , Antioxidantes/química , Hipóxia Celular , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Cistationina gama-Liase/antagonistas & inibidores , Glicina/análogos & derivados , Glicina/farmacologia , Coração/efeitos dos fármacos , Sulfeto de Hidrogênio/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Camundongos , Mitocôndrias/efeitos dos fármacos , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Ratos , Ratos Wistar , Tiossulfatos/uso terapêutico
10.
Environ Sci Pollut Res Int ; 26(18): 18032-18052, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079302

RESUMO

The global burden of heavy metal especially mercury, arsenic, lead, and cadmium toxicities remains a significant public health challenge. Developing nations are particularly at high risk and carry the highest burden of this hazard. Chelation therapy has been the mainstay for treatment of heavy metal poisoning where the chelating agent binds metal ions to form complex ring-like structures called "chelates" to enhance their elimination from the body. Metal chelators have some drawbacks such as redistribution of some heavy metals from other tissues to the brain thereby increasing its neurotoxicity, causing loss of essential metals such as copper and zinc as well as some serious adverse effects, e.g., hepatotoxicity. The use of natural antidotes, which are easily available, affordable, and with little or no side effects compared to the classic metal chelators, is the focus of this review and suggested as cheaper options for developing nations in the treatment of heavy metal poisoning.


Assuntos
Antídotos/uso terapêutico , Produtos Biológicos/uso terapêutico , Quelantes/uso terapêutico , Terapia por Quelação/métodos , Intoxicação por Metais Pesados/prevenção & controle , Metais Pesados/toxicidade , Antídotos/administração & dosagem , Produtos Biológicos/administração & dosagem , Quelantes/administração & dosagem , Humanos , Inativação Metabólica , Metais Pesados/metabolismo
11.
Mymensingh Med J ; 28(2): 470-473, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086169

RESUMO

Organophosphorus compounds (OPC) are widely used insecticides. Such poisoning is very rare in neonate. A 23 days old infant was admitted with severe respiratory distress, excessive secretion from nose and mouth, bluish discoloration of extremities and poor feeding for 4 hours. He was pale, cyanosed and lethargic with gasping respiration. Frothing was coming through mouth and nose. There was watering of eyes, pupils were pin pointed and light reflex was sluggish. The baby was hypothermic, hypotonic with altered sensorium. Capillary refill time was <3 sec. The neonate was gasping; there was crepitation over lung fields. Precordium and abdomen was normal. An odor of OPC was smelt on clothing and secretions of the infant. The baby was wrapped with a cloth that was ware during pesticide spraying in the field. In addition to general measures, decontamination of skin and clothing and gastric lavage was done. Empirical antibiotic, injection atropine and pralidoxime were given. Patient showed clinical improvement with disappearance of cholinergic signs. The baby was discharged on 7th day of admission after full recovery.


Assuntos
Antídotos/administração & dosagem , Atropina/administração & dosagem , Inseticidas/envenenamento , Intoxicação por Organofosfatos/tratamento farmacológico , Compostos Organofosforados/toxicidade , Compostos de Pralidoxima/administração & dosagem , Antídotos/uso terapêutico , Atropina/uso terapêutico , Humanos , Recém-Nascido , Masculino , Compostos Organofosforados/efeitos adversos , Compostos de Pralidoxima/uso terapêutico , Resultado do Tratamento
12.
Mil Med Res ; 6(1): 10, 2019 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-30961671

RESUMO

Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medical treatments may vary in different countries, and in this paper, we discuss the similarities and differences in the treatments between China and Germany. Carbon monoxide poisoning is treated by 100% oxygen administration and, if available, hyperbaric oxygenation in China as well as in Germany. In addition, antidotes binding the cyanide ions and relieving the respiratory chain are important. Methemoglobin-forming agents (e.g., nitrites, dimethylaminophenol) or hydroxocobalamin (Vitamin B12) are options. The metabolic elimination of cyanide may be enhanced by sodium thiosulfate. In China, sodium nitrite with sodium thiosulfate is the most common combination. The use of dimethylaminophenol instead of sodium nitrite is typical for Germany, and hydroxocobalamin is considered the antidote of choice if available in cases of cyanide intoxications by fire smoke inhalation as it does not further reduce oxygen transport capacity. Systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany. Stable iodine is indicated in the case of radioiodine exposure and must be administered within several hours to be effective. The decorporation of metal radionuclides is possible with Ca (DTPA) or Prussian blue that should be given as soon as possible. These medications are used in both countries, but it seems that Ca (DTPA) is administered at lower dosages in China. Although the details of the treatment of inhalation injury and radionuclide(s) decorporation may vary, the general therapeutic strategy is very similar in China and Germany.


Assuntos
Exposição por Inalação/efeitos adversos , Exposição à Radiação/efeitos adversos , Lesão por Inalação de Fumaça/tratamento farmacológico , Antídotos/uso terapêutico , Monóxido de Carbono/efeitos adversos , Monóxido de Carbono/metabolismo , Monóxido de Carbono/toxicidade , China , Alemanha , Humanos , Cianeto de Hidrogênio/efeitos adversos , Cianeto de Hidrogênio/metabolismo , Cianeto de Hidrogênio/toxicidade , Hidroxocobalamina/uso terapêutico , Oxigenação Hiperbárica/métodos , Radiografia/métodos , Radioisótopos/efeitos adversos , Radioisótopos/metabolismo , Radioisótopos/toxicidade , Lesão por Inalação de Fumaça/complicações , Lesão por Inalação de Fumaça/metabolismo , Nitrito de Sódio/uso terapêutico , Tiossulfatos/uso terapêutico
14.
Toxicol Lett ; 308: 1-6, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30858091

RESUMO

The global use of organophosphorus compounds (OP) for pest control and nerve agents being used in military conflicts and for assassinations renders intoxications by these agents a public health concern. OP-poisoned patients often suffer from dysrhythmias which may ultimately result in death. In this study, human-induced pluripotent stem cells derived cardiomyocytes were exposed to OP compounds in a microelectrode array system (MEA). The MEA system is widely accepted to assess the proarrhythmic properties of (candidate) drugs. The directly acting cholinergic compounds acetylcholine and carbachol and the irreversible acetylcholinesterase inhibitor cyclosarin - a highly toxic nerve agent - were assessed. All three compounds induced a dose-dependent (up to 600 nmol/L) corrected field potential duration (FPDc) prolongation of 9.7 ± 0.6% for carbachol, for 9.7 ± 1.2% acetylcholine and 9.4 ± 0.5% for cyclosarin. Additionally, the electrophysiological alterations of the clinically approved oxime reactivators obidoxime, pralidoxime and the oximes in development HI-6 and MMB-4 were investigated in the absence of OP. Neither of these oximes (up to a concentration of 300 µmol/L) caused dysrhythmia nor beat arrest. The competitive muscarinic receptor antagonist atropine as a cornerstone in the treatment of OP poisoning was also analyzed. Interestingly, atropine caused a drop in the beat rate which might result from a non-receptor action of this substance in the absence of OP. Atropine in combination with the OP nerve agent cyclosarin and the direct cholinergics acetylcholine or carabachol completely reversed the induced FPDc prolongation. However, the oxime HI-6 as potent reactivator of cyclosarin-inhibited AChE was not able to prevent the FPDc prolongation in this model. In conclusion, the current model allows the assessment of FPDc prolongation by the nerve agent cyclosarin, the cholinergic compounds carbachol, acetylcholine and the block of this effect by atropine.


Assuntos
Potenciais de Ação/efeitos dos fármacos , Antídotos/efeitos adversos , Substâncias para a Guerra Química/toxicidade , Células-Tronco Pluripotentes Induzidas/citologia , Miócitos Cardíacos/efeitos dos fármacos , Agentes Neurotóxicos/toxicidade , Compostos Organofosforados/toxicidade , Antídotos/uso terapêutico , Técnicas de Cultura de Células , Células Cultivadas , Humanos , Microeletrodos , Miócitos Cardíacos/fisiologia , Intoxicação por Organofosfatos/fisiopatologia , Intoxicação por Organofosfatos/prevenção & controle
15.
Rev Med Chil ; 147(1): 73-82, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30848768

RESUMO

Direct oral anticoagulants (DOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban have at least comparable efficacy as vitamin K antagonists along with a better safety profile, reflected by a lower incidence of intracranial hemorrhage. Specific reversal agents have been developed in recent years. Namely, idarucizumab, a specific antidote for dabigatran, is currently approved in most countries. Andexanet, which reverses factor Xa inhibitors, has been recently approved by the FDA, and ciraparantag, a universal antidote targeted to reverse all DOACs, is still under investigation. In this review we provide an update on the pharmacology of DOACs, the risk of hemorrhagic complications associated with their use, the measurement of their anticoagulant effect and the reversal strategies in case of DOAC-associated bleeding.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , Fatores de Coagulação Sanguínea/uso terapêutico , Hemorragia/induzido quimicamente , Hemorragia/terapia , Administração Oral , Antídotos/uso terapêutico , Dabigatrana/administração & dosagem , Dabigatrana/efeitos adversos , Humanos , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridinas/administração & dosagem , Piridinas/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Fatores de Risco , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Tiazóis/administração & dosagem , Tiazóis/efeitos adversos
16.
Toxicol Mech Methods ; 29(6): 438-444, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30822191

RESUMO

Formulation optimization and antidotal combination therapy are the two important tools to enhance the antidotal protection of the cyanide (CN) antidote dimethyl trisulfide (DMTS). The focus of this study is to demonstrate how the formulation with polysorbate 80 (Poly80), an excipient used in pharmaceutical technology, and the combinations with other CN antidotes having different mechanisms of action enhance the antidotal efficacy of the unformulated (neat) DMTS. The LD50 for CN was determined by the statistical Dixon up-and-down method on mice. Antidotal efficacy was expressed as antidotal potency ratio (APR). CN was injected subcutaneously one minute prior to the antidotes' injection intramuscularly. The APR values of 1.17 (dose: 25 mg/kg bodyweight) and 1.45 (dose: 50 mg/kg bodyweight) of the neat DMTS were significantly enhanced by the Poly80 formulation at both investigated doses to 2.03 and 2.33, respectively. The combination partners for the Poly80 formulated DMTS (DMTS-Poly80; 25 and 50 mg/kg bodyweight) were 4-nitrocobinamide (4NCbi) (20 mg/kg bodyweight) and aquohydroxocobinamide (AHCbi; 50, 100, and 250 mg/kg bodyweight). When DMTS-Poly80 (25 and 50 mg/kg bodyweight; APR = 2.03 and 2.33, respectively) was combined with 4NCbi (20 mg/kg bodyweight; APR = 1.35), significant increase in the APR values were noted at both DMTS doses (APR = 2.38 and 3.12, respectively). AHCbi enhanced the APR of DMTS-Poly80 (100 mg/kg bodyweight; APR = 3.29) significantly only at the dose of 250 mg/kg bodyweight (APR = 5.86). These studies provided evidence for the importance of the formulation with Poly80 and the combinations with cobinamide derivatives with different mechanisms of action for DMTS as a CN antidote candidate.


Assuntos
Antídotos/uso terapêutico , Cobamidas/uso terapêutico , Cianeto de Potássio/envenenamento , Sulfetos/uso terapêutico , Animais , Antídotos/administração & dosagem , Antídotos/química , Cobamidas/administração & dosagem , Cobamidas/química , Relação Dose-Resposta a Droga , Composição de Medicamentos , Quimioterapia Combinada , Excipientes , Dose Letal Mediana , Masculino , Camundongos Endogâmicos , Polissorbatos , Sulfetos/administração & dosagem , Sulfetos/química
17.
BMJ Case Rep ; 12(2)2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739090

RESUMO

We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly. On second day of admission he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of acute respiratory distress syndrome (ARDS). The patient had to be intubated. Continuous renal replacement therapy (CRRT) was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient succumbed to illness. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on ABG and was corrected accordingly. On second day of admission, he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of ARDS. The patient had to be intubated on day 2. CRRT was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient gradually deteriorated, had cardiac arrest and passed away on day 5 of his hospital stay.


Assuntos
Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Lavagem Gástrica/métodos , Malpighiales , Extratos Vegetais/envenenamento , Envenenamento/terapia , Suicídio , Acidose/induzido quimicamente , Acidose/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/etiologia , Terapia de Substituição Renal , Síndrome do Desconforto Respiratório do Adulto/induzido quimicamente , Síndrome do Desconforto Respiratório do Adulto/terapia
20.
Trends Genet ; 35(3): 175-185, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30685209

RESUMO

Wolbachia bacteria inhabit the cells of about half of all arthropod species, an unparalleled success stemming in large part from selfish invasive strategies. Cytoplasmic incompatibility (CI), whereby the symbiont makes itself essential to embryo viability, is the most common of these and constitutes a promising weapon against vector-borne diseases. After decades of theoretical and experimental struggle, major recent advances have been made toward a molecular understanding of this phenomenon. As pieces of the puzzle come together, from yeast and Drosophila fly transgenesis to CI diversity patterns in natural mosquito populations, it becomes clearer than ever that the CI induction and rescue stem from a toxin-antidote (TA) system. Further, the tight association of the CI genes with prophages provides clues to the possible evolutionary origin of this phenomenon and the levels of selection at play.


Assuntos
Toxinas Bacterianas/genética , Citoplasma/genética , Wolbachia/genética , Animais , Antídotos/química , Antídotos/uso terapêutico , Artrópodes/genética , Artrópodes/microbiologia , Toxinas Bacterianas/química , Culicidae/genética , Culicidae/microbiologia , Citoplasma/microbiologia , Drosophila/genética , Drosophila/microbiologia , Técnicas de Transferência de Genes , Simbiose/genética , Wolbachia/patogenicidade
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