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1.
Forensic Sci Int ; 306: 110063, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31790891

RESUMO

Diagnosis of carbon monoxide (CO) poisonings has always been a challenging task due to the susceptibility to alterations of the optical state and degradation of blood samples during sampling, transport and storage, which highly affects the analysis with spectrophotometric methods. Methodological improvements are then required urgently because of increased reports of cases with discrepancies between results of the measured biomarker carboxyhemoglobin (COHb) and reported symptoms. Total blood CO (TBCO) measured chromatographically was thus proposed in a previous study as alternative biomarker to COHb. This approach was investigated in this study by comparing the two biomarkers and assessing the effects of various storage parameters (temperature, preservative, time, tube headspace (HS) volume, initial saturation level, freeze- and thaw- and reopening-cycles) over a period of one month. Results show that while for TBCO, concentrations are relatively stable over the observation period regardless of parameters such as temperature, time and HS volume, for COHb, concentrations are altered significantly during storage. Therefore, the use of TBCO as alternative biomarker for CO poisonings has been proposed, since it provides more valid results and is more stable even under non-optimal storage conditions. Additionally, it can be used to predict COHb in cases where sample degradation hinders optical measurement. Furthermore, a correction formula for COHb and TBCO is provided to be used in laboratories or circumstances where optimal storage or analysis is not possible, to obtain more accurate results.


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico , Monóxido de Carbono/sangue , Carboxihemoglobina/análise , Medicina Legal/métodos , Biomarcadores/sangue , Cromatografia Gasosa , Interpretação Estatística de Dados , Humanos , Oximetria , Manejo de Espécimes , Espectrofotometria
2.
Forensic Sci Int ; 306: 110073, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31812818

RESUMO

Suicides involving more than one suicide method are termed "complex suicides" and need to be differentiated from murders. Self-immolation is the action of setting fire to oneself and is an infrequent method of suicide method in Western countries. However, burned corpses must be carefully examined because setting fire to a body after death can be a way of covering up a crime. Complex suicides involving self-immolation are rare, but careful analysis is necessary if we are to identify the manner of death. A systematic search of the literature concerning self-incineration in cases of complex suicides was carried out. This covered the age, gender and psychiatric condition of the victims, any history of previous suicide attempts, the existence of suicide notes, evidence of fire accelerants, signs of vital exposure to the fire, toxicology, the other suicide methods used in combination with burning and the characteristics of the burns. 46 cases were found in 22 papers published since 1985, but few of these studies provide any detailed analysis and in several cases many important data were missing. There is, therefore, a need to study this topic and to use an approach based on careful examination of the corpse, detailed investigation of the scene, toxicological examination and an evaluation of the victim's physical and psychiatric state.


Assuntos
Fogo , Patologia Legal , Distribuição por Idade , Queimaduras/patologia , Carboxihemoglobina/análise , Humanos , Transtornos Mentais/psicologia , Publicações Periódicas como Assunto/estatística & dados numéricos , Mucosa Respiratória/patologia , Distribuição por Sexo , Fuligem , Detecção do Abuso de Substâncias
3.
Undersea Hyperb Med ; 46(5): 655-658, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683364

RESUMO

Background: Carboxyhemoglobin (COHb) levels are obtained when there is suspicion for carbon monoxide (CO) exposure. Serial COHb levels are sometimes obtained despite the well-established half-life of COHb with oxygen supplementation. We sought to evaluate the trends and characteristics associated with obtaining serial carboxyhemoglobin levels. Methods: A retrospective review was performed at an academic medical center for all inpatient and emergency department cases with either single COHb or serial COHb levels from 1 April 2010 through 31 March 2015. Data collected included age, gender, pregnancy status, smoking history, encounter month, admission status, oxygen administration, fire or burn history, vital signs, presenting symptoms, hyperbaric oxygen (HBO2) therapy use, initial pH, troponin, lactate, and COHb levels. The time and change in values between serial levels were also obtained. Results: 624 cases were identified, with 106 (17%) having multiple carboxyhemoglobin levels. A mean of 2.6 (range 2 - 9) serial COHb levels were obtained. The average initial COHb was 8.9%. Subsequent serial levels were obtained on average at 353, 663 and 1,095 minutes and averaged 2.8%, 1.8% and 1.1% respectively. Serial COHb levels were obtained more commonly in burn patients, those admitted to the ICU and those who had HBO2 therapy. Four patients had an increase in COHb level on serial testing. The largest increase of these was from 2.0% to 3.9%. Conclusion: Serial COHb levels were not infrequent in this study. No clinically significant increase in COHb was identified by serial testing. Further studies should examine the clinical utility of such practices.


Assuntos
Intoxicação por Monóxido de Carbono/sangue , Carboxihemoglobina/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Monitorização Transcutânea dos Gases Sanguíneos/instrumentação , Queimaduras/sangue , Intoxicação por Monóxido de Carbono/diagnóstico , Criança , Cuidados Críticos , Feminino , Humanos , Oxigenação Hiperbárica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
4.
J Perinat Med ; 47(7): 780-784, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31421045

RESUMO

Background Smoking during pregnancy still exists in daily life but the effect on the newborn in the early stage of life is still unclear. This study investigates the normal reference range of carboxyhemoglobin (HbCO) in umbilical cord blood gas (UBG). Methods A single center retrospective cross-sectional cohort study was performed with 1172 cases. We analyzed HbCO values in umbilical cord blood, maternal smoking, birth weight percentiles, duration of amenorrhea and maternal admission duration prior to delivery. Results HbCO levels in newborns range from 0 to 7.7% with a mean of 0.6% (standard deviation 0.6). Newborns from women who smoked during pregnancy have a significant higher HbCO value compared to newborns from women who did not smoke. Birth weight is negatively correlated with HbCO (P = 0.001). Conclusion Our results show the normal reference range in this study is 0-1.2% for HbCO in the umbilical blood of newborns. Smoking prior to delivery leads to a higher HbCO value in the UBG sample of the newborn, a lower birth weight and may be potential harmful.


Assuntos
Peso ao Nascer/efeitos dos fármacos , Monóxido de Carbono/efeitos adversos , Carboxihemoglobina/análise , Sangue Fetal/química , Recém-Nascido de Baixo Peso/sangue , Gestantes/psicologia , Fumar , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Países Baixos , Gravidez , Estudos Retrospectivos , Fumar/efeitos adversos , Fumar/sangue , Fumar/epidemiologia
5.
Hum Exp Toxicol ; 38(11): 1235-1243, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31423839

RESUMO

OBJECTIVE: In this study, we aimed to investigate oxidative stress and antioxidant parameter levels in patients with carbon monoxide (CO) poisoning. METHODS: The study was conducted prospectively between March 1, 2015 and April 30, 2016 in the pediatric emergency department. Eligible patients included children aged 0-18 years old with a diagnosis of CO poisoning. To determination of oxidative stress and antioxidant parameter levels, venous blood with heparinized and urine samples were drawn during the admission and after normobaric oxygen (NBO) and hyperbaric oxygen (HBO) treatment. RESULTS: Forty-seven children with CO poisoning for study group and 29 patients as control group were included to the study. Sixteen patients treated with HBO. Basal plasma malondialdehyde levels were found to be significantly higher in the CO poisoning group when compared with the control group (p = 0.019). There is no significant difference in oxidative stress and antioxidant parameter levels except erythrocyte catalase enzyme levels in patients treated with NBO when comparing before and after NBO treatment (p > 0.05). Decreasing of basal erythrocyte catalase enzyme levels were found statistically significant after NBO treatment (p = 0.04). There was no significant difference in oxidative stress and antioxidant parameter levels in patients treated with HBO before and after therapy (p > 0.05). CONCLUSIONS: CO poisoning is associated with increased lipid peroxidation in children immediately after the poisoning. However, both treatment modalities including NBO or HBO do not have a significant effect on oxidative stress or antioxidant parameter levels.


Assuntos
Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/terapia , Estresse Oxidativo , Oxigenoterapia , Adolescente , Carboxihemoglobina/análise , Catalase/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Peroxidação de Lipídeos , Masculino , Malondialdeído/sangue , Superóxido Dismutase/sangue
6.
Prehosp Disaster Med ; 34(4): 454-455, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31239002

RESUMO

Oxygen is the main treatment of carbon monoxide (CO) poisoning. In two simultaneous cases, the efficacy of conventional and continuous positive airway pressure (CPAP)-administered oxygen therapy was compared. A 63-year-old man and his 58-year-old wife were brought to the emergency department with complaints of dizziness, headache, and nausea. The man had a history of congestive heart failure and additionally had shortness of breath. Initial carboxyhemoglobin (COHb) values were 26% in the male patient and 24% in his wife. For the female patient, oxygen therapy was performed with a reservoir balloon mask; a CPAP device was used for the male patient. The COHb levels decreased below five percent after approximately two hours in the male patient and at the end of five hours in his wife. In follow-up, symptomatic relief was achieved in both patients and no additional complications were observed. According to our experience, CPAP ventilation can be a new and effective method for oxygen therapy in CO poisoning.


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/análise , Pressão Positiva Contínua nas Vias Aéreas/métodos , Doença Aguda , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Medição de Risco , Resultado do Tratamento
7.
Undersea Hyperb Med ; 46(1): 63-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154686

RESUMO

Introduction: Carbon monoxide (CO) poisoning causes hypoxia and inflammation, which could adversely affect muscle. We could find no published information about CO poisoning causing myositis. Case report: A 53-year-old previously healthy female semi truck driver had CO poisoning from a faulty diesel engine exhaust intermittently over three months, culminating in an episode of acute CO poisoning, with syncope after exiting the truck at the end of the three-month period. Neuropsychological symptoms immediately after the acute poisoning event were followed by the development of fatigue, weakness and myalgias within two months and a diagnosis of "polymyositis" within four months. C-reactive protein and creatine kinase were elevated. Electromyogram showed pure myopathy without sensory abnormalities. Occult malignancy was ruled out. Thigh muscle biopsy revealed severe inflammatory myopathy and myonecrosis. Muscle specialist pathologists interpreted the biopsy as toxic or viral inflammatory myopathy, not polymyositis, with CO poisoning as the likely etiology. She received steroids and mycophenolate. Nineteen months later, a repeat biopsy was negative for inflammation or myopathic process. Alternative diagnoses were ruled out by clinical investigation and her course over the next five years. Conclusion: This patient's presentation and clinical course support a diagnosis of myositis from CO poisoning, although it is possible that the myositis was either idiopathic or post-viral (without evidence of a causative virus).


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Miosite/etiologia , Doenças Profissionais/complicações , Condução de Veículo , Intoxicação por Monóxido de Carbono/sangue , Carboxihemoglobina/análise , Feminino , Humanos , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Síncope/etiologia
8.
J Forensic Odontostomatol ; 37(1): 26-31, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31187740

RESUMO

Burned bodies raise relevant issues for forensic patologist and odontologist both for the identification and the cause of death and possible vital burning.. The tongue protrusion is regularly investigated for the death caused by strangulation or hanging, whilst seems to be overlooked in case of charred remains as the significance of this sign is still discussed. Different mechanims are hypothized in literature to explain the toungue protrusion both for vital and non-vital burning. This paper retrospectively evaluates some cases of carbonized corpses examined at the Forensic Pathology service of the University of Florence. The tongue protrusion shows a high occurrence both in vital (100%) and non-vital fires (66%). The involvement of a forensic odontologist in the cadaver examination result to be limited to one third of the cases. In two non-vital cases the tongue was described as protruded and clenched between the dental arches. The rigor of the genioglossus induced by the heat could explain the phenomenon. Further research on fire fatalities is required to analyze the tongue bleeding as a possible parameter to discriminate the vital by the non-vital tongue protrusion. Moreover, the mechanism at the origin of vital and non-vital tongue protrusion, the different position of the tongue (protruded from an open mouth, protruded and clenched between the dental arches, etc.) in different death circumstances, should be furtherly investigated with a meaningful collaboration between forensic pathologists and odontologists for a complete registration and interpretation of all the mouth originated evidence.


Assuntos
Fogo , Odontologia Legal , Patologia Legal , Língua/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/patologia , Carboxihemoglobina/análise , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema Respiratório/patologia , Fuligem , Adulto Jovem
9.
Undersea Hyperb Med ; 46: 203-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051066

RESUMO

Carbon monoxide intoxication occurs usually via inhalation of carbon monoxide that is emitted as a result of a fire, furnace, space heater, generator, motor vehicle. A 37-year-old male patient was admitted to the emergency department at about 5:00 a.m., with complaints of nausea, vomiting and headache. He was accompanied by his wife and children. His venous blood gas measures were: pH was 7.29, partial pressure of carbon dioxide (pCO2) was 42 mmHg, partial pressure of oxygen (pO2) was 28 mmHg, carboxyhemoglobin (COHb) was 12.7% (reference interval: 0.5%-2.5%) and oxygen saturation was 52.4%. Electro-cardiogram (ECG) examination showed that the patient was not in sinus rhythm but had atrial fibrillation. After three hours the laboratory examination was repeated: Troponin was 1.2 pg/ml and in the arterial blood gas COHb was 3%. The examination of the findings on the monitor showed that the sinus rhythm was re-established. The repeated ECG examination confirmed the conversion to sinus rhythm. He was monitored with the normobaric oxygen administration.


Assuntos
Fibrilação Atrial/etiologia , Intoxicação por Monóxido de Carbono/complicações , Adulto , Fibrilação Atrial/diagnóstico , Carboxihemoglobina/análise , Eletrocardiografia , Humanos , Masculino
10.
Forensic Sci Int ; 299: 1-5, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30952069

RESUMO

The presented manuscript describes the carbon monoxide (CO) related deaths in Portugal over a period of 3 years, based on autopsies carried out at the National Institute of Legal Medicine and Forensic Sciences, from January 2012 to December 2014. Three hundred and forty-seven forensic autopsy reports with carboxyhaemoglobin (COHb) analysis requests were analysed and subdivided into three main groups: (1) improbable CO intoxication; (2) possible CO intoxication; (3) highly probable CO intoxication. In group 1, COHb analysis was negative, and the death circumstances, as well as the post mortem findings, didn't corroborate an exposition to CO. In group 2, with COHb positive in 1/3 of the cases, the death circumstances corroborated an exposition to CO, but the post mortem findings weren't enough to confirm an exposition to this substance. In group 3, the results of COHb were positive, and both circumstances of death and post mortem findings corroborated an exposition to CO. The first group (113 cases) had no specific suspicion of a CO intoxication and, thus, the request of a COHb analysis had no particular basis, reflected in the low COHb achieved percentage (between 0 and 12). In the second group (164 cases), 29% of the cases were directly or indirectly related to CO exposure (between 0% and 94%). In the third group (70 cases), 56 deaths were due to CO intoxication and 14 due to burns after CO inhalation (between 18% and 91%). This study intended to do, not only a 3-year assessment of CO poisoning, but also to enhance the fact that circumstantial information, as well as a correct evaluation at the forensic autopsy data are crucial, and allow an enhanced diagnosis of possible intoxication, as well as a better guidance for the consequent toxicological analysis requests.


Assuntos
Intoxicação por Monóxido de Carbono/mortalidade , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Queimaduras/patologia , Monóxido de Carbono/sangue , Carboxihemoglobina/análise , Criança , Esôfago/patologia , Feminino , Fogo , Medicina Legal , Utensílios Domésticos , Humanos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Estações do Ano , Distribuição por Sexo , Fuligem , Suicídio/estatística & dados numéricos , Emissões de Veículos , Adulto Jovem
11.
Environ Toxicol Pharmacol ; 67: 117-123, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30818178

RESUMO

This study was designed to investigate the neuroprotective effect of hyperoxygenate hydrogen-rich saline (HOHS) against brain injury induced by carbon monoxide (CO) poisoning in rats. A rat model of CO poisoning was established by administering CO via intraperitoneal injection to male Sprague-Dawley rats. Forty-eight adult male rats were randomly divided into the following groups: normal control group (NG), CO poisoning group (CO), HOS treatment group (hyperoxygenated solution, HOS) and HOHS treatment group (HOHS). After CO poisoning, the carboxyhemoglobin (COHb) contents in the blood of rats in all the CO poisoning groups were increased significantly. However, HOS and HOHS significantly decreased COHb contents, furthermore, the HOHS group had lower COHb contents than the HOS group. Arterial oxygen partial pressure (PaO2) and arterial oxygen saturation (SaO2) results showed that HOS and HOHS could improve the oxygenation of the rats with CO poisoning. Compared with the CO group, the HOS group and the HOHS group had persistently neuroprotective effect on CO-induced brain injury, as assessed by modified neurological severity score (mNSS), furthermore, the HOHS group had better neurological functional recovery than the HOS group. The neuronal apoptosis induced by CO was also evaluated. Except the NG group, all the CO-poisoning groups had varying degrees of neuronal apoptosis. There was lesser degree of neuronal apoptosis in both the HOS group and the HOHS group than that in the CO group. Moreover, the HOHS group had more minor degree of neuronal apoptosis than the HOS group. Compared with the CO group, the free radicals production in the HOS group and the HOHS group were significantly inhibited. In addition, there were significantly difference in the free radicals production between the HOS group and the HOHS group. We could conclude that HOHS exerted a stronger neuroprotective effect against CO-induced brain injury than HOS, and the neuroprotective mechanism of HOHS may be related with inhibition of both neuronal apoptosis and free radicals.


Assuntos
Lesões Encefálicas/tratamento farmacológico , Intoxicação por Monóxido de Carbono/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Solução Salina/uso terapêutico , Soluções/uso terapêutico , Animais , Apoptose/efeitos dos fármacos , Lesões Encefálicas/etiologia , Lesões Encefálicas/metabolismo , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/metabolismo , Carboxihemoglobina/análise , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/metabolismo , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Masculino , Neurônios/efeitos dos fármacos , Ratos Sprague-Dawley
12.
Pediatr Emerg Care ; 35(3): 226-230, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30747788

RESUMO

OBJECTIVE: Carbon monoxide poisoning (COP) is the leading cause of mortality and morbidity due to poisoning worldwide. Because children are affected more quick and severely from COP, they may require a longer treatment period, even if carboxyhemoglobin (CO-Hb) and/or lactate levels return to normal. Therefore, a new marker that predicts the duration of treatment and the final outcomes of COP is needed. METHODS: This case control study was conducted on 32 carbon monoxide-poisoned patients younger than 18 years who had been admitted to pediatric emergency department. The control group included age- and sex-matched 30 healthy children. Blood samples were obtained for analysis of arterial blood gases, CO-Hb percent, methemoglobine, lactate, and asymmetric dimethylarginine (ADMA). RESULTS: Asymmetric dimethylarginine levels were significantly increased (P < 0.05) in patients with COP on admission and after the treatment when compared with controls (1.36 [0.89-6.94], 1.69 [0.76-7.81], 1.21 [0.73-3.18] nmol/L, respectively). There was no positive correlation between CO-Hb and ADMA levels on admission and at 6 hours (P = 0.903, r = 0.218, P = 0.231, r = 0.022, respectively). Positive correlation was found between lactate and CO-Hb levels on admission (P = 0.018, r = 0.423). CONCLUSIONS: This study showed that ADMA levels were still high after 6 hours of 100% oxygen therapy in children with COP, even CO-Hb and/or lactate levels return to normal range. On the basis of these results, we consider that ADMA may be a useful biomarker in patient with COP.


Assuntos
Arginina/análogos & derivados , Biomarcadores/sangue , Intoxicação por Monóxido de Carbono/sangue , Adolescente , Arginina/sangue , Gasometria/métodos , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/análise , Estudos de Casos e Controles , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Metemoglobina/análise
13.
Med Sci Monit ; 25: 605-609, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30663634

RESUMO

BACKGROUND High-flow nasal cannula (HFNC) is an alternative to conventional normobaric oxygen therapy (NBO) for hypoxemic patients. Since nothing is known about its effect on carbon monoxide (CO) poisoning, we hypothesized that HFNC might be a useful device in the treatment of CO poisoning victims. MATERIAL AND METHODS We retrospectively reviewed the medical records of patients who were admitted consecutively to the emergency department with CO intoxication. Patients were divided into 2 groups: patients treated with HFNC and patients treated with conventional face mask (CFM). Demographic data, pretreatment, and control (after 1 hour) arterial blood gas analyses values of the patients were evaluated. RESULTS Sixty-eight patients (mean age 35.8±18.7 years) were included in this study. NBO was given via HFNC to 38 patients (55.9%), and via CFM to 30 patients (44.1%). The demographic characteristics and pretreatment values of carboxy-hemoglobin (COHb) were similar in the 2 groups. The mean COHb value of the HFNC group at the first hour was found significantly lower than the CFM group: 9.5±4.7 and 12.0±5.1, respectively (P=0.041). Improvement of COHb level was significantly higher in the HFNC group compared to the CFM group: 12.5±4.5 versus 6.7±3.7, respectively (P=0.001). CONCLUSIONS HFNC was superior than CFM in alleviating COHb levels in the victims of CO poisoning. We believe that using HFNC will increase patient comfort by shortening the duration of treatment in emergency department settings, especially in patients who have mild clinical findings of CO poisoning.


Assuntos
Intoxicação por Monóxido de Carbono/terapia , Oxigenoterapia/métodos , Oxigênio/uso terapêutico , Adulto , Gasometria , Cânula , Carboxihemoglobina/análise , Serviço Hospitalar de Emergência , Feminino , Humanos , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Oxigênio/administração & dosagem , Oxigênio/sangue , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Resultado do Tratamento
14.
Forensic Sci Med Pathol ; 15(1): 133-135, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29796749

RESUMO

A 47-year-old previously-well woman was found dead on the floor of a shower cubicle on a property in rural South Australia. The impression of the attending doctor and police was of collapse due to natural disease. Although there was significant stenosing coronary artery atherosclerosis found at autopsy, cherry pink discoloration of tissues prompted measurement of the blood carboxyhemoglobin level which was found to be 55%. The source of the gas was a poorly-maintained hot water heater that was mounted on the inside wall of the shower. Construction of the shower using an impermeable concrete rain water tank had caused gas accumulation when the water heater malfunctioned. Had lethal carbon monoxide exposure not been identified others using the same shower unit would also have been at risk.


Assuntos
Intoxicação por Monóxido de Carbono/etiologia , Utensílios Domésticos , Intoxicação por Monóxido de Carbono/diagnóstico , Carboxihemoglobina/análise , Doença da Artéria Coronariana/patologia , Estenose Coronária/patologia , Falha de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade
15.
Hum Exp Toxicol ; 38(1): 148-154, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29998771

RESUMO

Carbon monoxide (CO) poisoning is a significant cause of death especially in developing countries. The current study investigated cardioprotective effects of insulin in CO-poisoned rats. Male rats were exposed to 3000 ppm CO for 1 h. Insulin (100 and 120 U/kg intraperitoneally) was immediately administered after CO exposure and on the next 4 days, on a daily basis (a total of 5 doses). On day 5, animals were euthanized, and the hearts were harvested for Western blotting and histopathological studies. The electrocardiograms (ECG) were recorded postexposure to CO and after the completion of insulin treatment period. Histopathological evaluations showed reduction of myocardial necrosis in insulin-treated animals compared to controls. BAX/BCL2 ratio, as a proapoptotic index, was significantly reduced in treatment groups ( p < 0.01). The ECG findings showed no differences among groups; also, compared to control animals, myocardial Akt levels were not markedly affected by insulin. The current study showed that insulin significantly reduces myocardial necrotic and apoptotic indices in CO-poisoned rats.


Assuntos
Intoxicação por Monóxido de Carbono/tratamento farmacológico , Cardiotônicos/uso terapêutico , Insulina/uso terapêutico , Animais , Apoptose/efeitos dos fármacos , Intoxicação por Monóxido de Carbono/metabolismo , Intoxicação por Monóxido de Carbono/patologia , Intoxicação por Monóxido de Carbono/fisiopatologia , Carboxihemoglobina/análise , Eletrocardiografia , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos Wistar
16.
Am J Emerg Med ; 37(7): 1254-1259, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30268441

RESUMO

OBJECTIVE: Carbon monoxide (CO) poisoning is very common worldwide. In this study, we aimed to evaluate the predictivity of neuro psychosis in carbon monoxide poisoning by the admission levels of red cell distribution (RDW), mean platelet volume (MPV) and troponin I levels which can be measured quickly and easily in the emergency department (ED). PATIENTS AND METHODS: This single center observational study included a total of 216 consecutive patients who presented to the ED due to CO poisoning between January 2009 and December 2013. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. According to the carboxyhemoglobin levels, the patients were classified as mildly (COHb < 20%) and severely poisoned (COHb > 20%). In addition, patients were divided into 2 groups, i.e., those with positive (>0.05 ng/mL for our laboratory) and negative (<0.05 ng/mL for our laboratory) troponin levels. RESULTS: Patients mean age was 52.58 ±â€¯10.58. 57.9% of the patients had high troponin levels and 51.9% were poisoned severely according to COHb levels. Patients with positive troponin and COHb had longer CO exposure time and higher neutrophil, lymphocyte, mean platelet volume (MPV), COHb and red cell distribution width (RDW) levels at the index admission following CO poisoning than patients with negative troponin (p < 0.05). Age, COHb level, CO exposure time, MPV and RDW (p = 0.001, p < 0.05) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant. CONCLUSIONS: In patients presenting to the ED with CO poisoning, RDW and MPV can be helpful for risk stratification of neuropsychosis.


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Psicoses Induzidas por Substâncias/etiologia , Adulto , Idoso , Carboxihemoglobina/análise , Índices de Eritrócitos , Feminino , Humanos , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Troponina I/sangue
17.
J Formos Med Assoc ; 118(4): 821-827, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30293927

RESUMO

BACKGROUND: Carbon monoxide (CO), a colorless and odorless gas, is one of the common causes of poisoning-related deaths worldwide. CO poisoning can result in hypoxic brain damage and death, but intensive care can improve the likely outcome for critically ill patients. However, there is a paucity of clinical data regarding the prognostic factors and association between organ dysfunction and clinical outcome of patients treated for CO poisoning in the intensive care unit (ICU). METHODS: We performed a retrospective study of patients admitted to a university affiliated hospital ICU between July 2001 and December 2010 following CO poisoning. Outcomes were survival to ICU discharge and to hospital discharge. RESULTS: Seven hundred and eighty-seven patients were admitted to the university hospital following CO poisoning, of which 140 (17.8%) were admitted to the hospital ICU. The overall mortality rate of the patients admitted to the ICU was 14.3% (20/140). Univariate analysis indicated that non-surviving patients with CO poisoning were more likely to have initial blood carboxyhemoglobin (COHb) level > 30%, shock, acute respiratory failure, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 25, Glasgow coma scale (GCS) score of 3, acute renal failure, dysfunction or failure of more than 3 organs, low blood pH, low HCO3- level, high potassium level, and high glucose level. They were also more likely to have not received hyperbaric oxygen (HBO) intervention. Multivariate logistical regression analysis indicated that the mortality rate of patients treated in the ICU for CO poisoning was higher if their initial APACHE II score was ≥25, GCS was 3, and more than 3 organs were dysfunctional. Moreover, HBO intervention in ICU significantly decreased patients' risk of mortality due to CO poisoning. CONCLUSION: In conclusion, we observed that APACHE II score >25, GCS 3, and dysfunction of more than 3 organ systems on admission to emergency department was associated with a significant mortality risk in patients treated in the ICU for CO poisoning. Moreover, HBO therapy could reduce the risk of mortality in patients with CO poisoning in ICU.


Assuntos
Intoxicação por Monóxido de Carbono/mortalidade , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , APACHE , Lesão Renal Aguda/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/análise , Feminino , Escala de Coma de Glasgow , Hospitais Universitários , Humanos , Oxigenação Hiperbárica , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Taiwan/epidemiologia , Adulto Jovem
18.
Balkan Med J ; 36(2): 106-112, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30396875

RESUMO

Background: Although water-pipe smoking is a great public health problem, data regarding the acute and chronic effects and the degree of toxin exposure are limited. While water pipe-related malignancy, pulmonary, infectious, cardiac effects, infertility, and biological effects have been described in a meta-analysis, there are no studies in the literature about its neurologic effects. Aims: To evaluate water pipe-related acute neurological effects and cerebral blood flow through transcranial Doppler ultrasonography and serum S100 calcium binding protein calcium binding protein level measurements. Study Design: Prospective observational study. Methods: Vital signs and baseline carboxyhemoglobin and S100 calcium binding protein levels, cerebral flood changes with transcranial Doppler ultrasound were evaluated and recorded before and after water-pipe smoking. Results: The mean age of the 31 volunteers was 30.61 (±5.67) years, and 24 of them (77.42%) were male. A statistically significant difference was determined in heart rate, oxygen saturation, systolic and diastolic arterial pressure values before and after water-pipe smoking (p<0.001, p=0.035, p=0.009, p=0.021, respectively). Mean carboxyhemoglobin level was 2.68% (±1.68) before, 14.97% (±4.83) after water-pipe smoking (p<0.001). The S100 calcium binding protein level was 25.05 µ/mL (±8.34) at the beginning, 40.71 µ/mL (±14.06) after water-pipe smoking (p<0.001). An increase was determined in peak, and median middle, anterior and posterior cerebral artery blood flow rates, and a decrease was determined in both the pulsatility index and resistivity index values after water-pipe smoking using transcranial Doppler ultrasound. Conclusion: Cerebral vasodilation develops due to the increase in cerebral blood flow rate and the decrease in pulsatility index, resistivity index values, and the elevation in carboxyhemoglobin, S100 calcium binding protein level indicates that water-pipe smoking leads to neuronal damage in the acute period.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Fumar Cachimbo de Água/efeitos adversos , Adulto , Carboxihemoglobina/análise , Circulação Cerebrovascular/fisiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Estudos Prospectivos , Proteínas S100/análise , Proteínas S100/sangue , Ultrassonografia Doppler/métodos
19.
J Anal Toxicol ; 43(2): 79-87, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30371866

RESUMO

As one of the most abundant toxic contaminants in the atmosphere, carbon monoxide (CO) plays a significant role in toxicology and public health. Every year, around half of the accidental non-fire-related poisoning deaths are attributed to CO in the USA, UK and many other countries. However, due to the non-specificity of the symptoms and often encountered inconsistency of these with the results obtained from measurements of the biomarker for CO poisonings, carboxyhemoglobin (COHb), there is a high rate of misdiagnoses. The mechanism of toxicity of CO includes not only the reduced transport of oxygen caused by COHb but also the impairment of cellular respiration and activation of oxidative metabolism by binding to other proteins. Therefore, in this study we propose the measurement of the total amount of CO in blood (TBCO) by airtight gas syringe-gas chromatography-mass spectrometry (AGS-GC-MS) as an alternative to COHb for the determination of CO exposures. The method is validated for a clinical range with TBCO concentrations of 1.63-104 nmol/mL of headspace (HS) (0.65-41.6 µmol/mL blood). The limit of quantification was found between 2 and 5 nmol/mL HS (0.8 and 2 µmol/mL blood). The method is applied to a cohort of 13 patients, who were exposed to CO under controlled conditions, and the results are compared to those obtained by CO-oximetry. Furthermore, samples were compared before and after a "flushing" step to remove excess CO. Results showed a significant decrease in TBCO when samples were flushed (10-60%), whereas no constant trend was observed for COHb. Therefore, measurement of TBCO by AGS-GC-MS suggests the presence of more dissolved CO than previously known. This constitutes a first step into the acknowledgment of a possibly significant amount of CO present not in the form of COHb, but as free CO, which might help explain the incongruences with symptoms and decrease misdiagnoses.


Assuntos
Gasometria/métodos , Intoxicação por Monóxido de Carbono/sangue , Monóxido de Carbono/sangue , Carboxihemoglobina/análise , Cromatografia Gasosa-Espectrometria de Massas/métodos , Biomarcadores/sangue , Calibragem , Humanos , Limite de Detecção , Reprodutibilidade dos Testes
20.
J Public Health Policy ; 40(1): 17-34, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30377300

RESUMO

Because of air quality management and control, traffic-related air pollution has declined in Quito, Ecuador. We evaluated the effect of a city-wide 5-year air pollution control program on the occurrence of acute respiratory illness (ARI). We compared two studies conducted at the same location in Quito: in 2000, 2 years before the policy to control vehicle emission was introduced, and in 2007. Each study involved ~ 730 children aged 6-12 years, observed for 15 weeks. We examined associations between carboxyhemoglobin (COHb) serum concentration-an exposure proxy for carbon monoxide (CO)-ambient CO, and ARI in both cohorts. In 2007, we found a 48% reduction in the ARI incidence (RR 0.52; 95% CI 0.45-0.62, p < 0.0001), and 92% decrease in the percentage of children with COHb > 2.5% as compared to the 2000 study. We found no association between COHb concentrations above the safe level of 2.5% and the ARI incidence (p = 0.736). The decline in air pollution due to vehicle emissions control was associated with a lower incidence of respiratory illness in school children.


Assuntos
Poluição do Ar/prevenção & controle , Doenças Respiratórias/epidemiologia , Doença Aguda , Poluição do Ar/efeitos adversos , Carboxihemoglobina/análise , Criança , Equador/epidemiologia , Feminino , Política de Saúde , Humanos , Incidência , Masculino , Prevalência , Doenças Respiratórias/etiologia , População Urbana/estatística & dados numéricos , Emissões de Veículos/prevenção & controle
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