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2.
Leg Med (Tokyo) ; 47: 101782, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32916471

RESUMO

Chlorine gas exposure occurs in chemical warfare, industrial and household accidents. In forensic science, the generation of chlorine gas by mixing sodium hypochlorite detergent and strong acid detergent cannot be overlooked because of the possibility of suicide method (NaClO + 2HCl â†’ NaCl + H2O + Cl2). Though typical autopsy findings are obtained in chlorine exposure, such as pulmonary edema, useful biomarkers don't exist. In this research, we developed an analytical method of 3-chloro-l-tyrosine (Cl-Tyr) in blood as a novel marker of chlorine poisoning utilizing gas chromatography-mass spectrometry (GC-MS). Cl-Tyr was purified using protein precipitation and cation-exchange solid phase extraction, derivatized by the silylation agent and subjected to GC-MS. The quantification range was 10-200 ng/mL and good reproducibility was obtained. We applied the developed method to analyze Cl-Tyr in autopsy sample, which is suspected of chlorine poisoning, and detected 59.7 ng/mL Cl-Tyr in left heart blood. To our knowledge, this is the first report of determination of the chlorinated biomolecule in the human autopsy sample from chlorine poisoning.


Assuntos
Autopsia , Cloro/envenenamento , Ciências Forenses , Envenenamento/diagnóstico , Tirosina/análogos & derivados , Biomarcadores/sangue , Transtorno Depressivo , Cromatografia Gasosa-Espectrometria de Massas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/etiologia , Suicídio , Tirosina/sangue
3.
Artigo em Chinês | MEDLINE | ID: mdl-32746578

RESUMO

To analyze the clinical data of a case of acute emamectin·chlorfenapyr poisoning in Guangzhou 12th People's Hospital in 2019. The patient developed high fever and night sweats, and gradually became unconscious. The patient died after 5 days of treatment. The toxicity and mortality of emamectin·chlorfenapyr were high. For acute poisoning patients, in addition to conventional symptomatic treatment, early blood purification treatment should be actively carried out.


Assuntos
Dissacarídeos/envenenamento , Inseticidas/envenenamento , Ivermectina/análogos & derivados , Envenenamento/diagnóstico , Piretrinas/envenenamento , Humanos , Ivermectina/envenenamento
5.
Artigo em Chinês | MEDLINE | ID: mdl-32746581

RESUMO

From August 21 to December 13, 2018, a tetramine poisoning incident in Wenzhou, Zhejiang Province was investigated, and the clinical diagnosis and treatment of tetramine poisoning was analyzed. There were 6 cases of poisoning caused by artificial tetramine poisoning. The diagnosis was delayed, coma and convulsions were severe manifestations continuous renal replacement therapy (CRRT) was effective in the treatment of severe cases, and all 6 cases were cured. The possibility of poisoning should be considered for unexplained coma and/or convulsions. Although tetramine is banned, it still needs to be highly vigilant and avoids the recurrence of delayed diagnosis and treatment.


Assuntos
Hidrocarbonetos Aromáticos com Pontes/envenenamento , Envenenamento/diagnóstico , Acidentes , Coma , Toxicologia Forense , Humanos , Envenenamento/terapia , Convulsões/induzido quimicamente
7.
Medicine (Baltimore) ; 99(31): e21351, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756123

RESUMO

Paraquat (PQ) poisoning is associated with high mortality rate. Therefore, an accurate method for predicting the survival of patients with PQ poisoning is required. This study evaluated the value of serum anion gap (AG) at admission in predicting the survival of such patients.Cases of patients with PQ poisoning admitted to Cangzhou Central Hospital between May 2012 and March 2019 were retrospectively analyzed. The patients were classified into survival and nonsurvival groups on the basis of their 90-day prognosis. Correlation analysis, Cox regression analysis, and receiver operating characteristic and Kaplan-Meier curve analyses were performed to assess the value of AG in predicting the 90-day survival of patients with PQ poisoning.Only 44 of the 108 patients with PQ poisoning survived; thus, the 90-day survival was 40.74%. AG levels at admission were significantly higher in nonsurvivors (26.53 ±â€Š4.93 mmol/L) than in survivors (20.88 ±â€Š2.74 mmol/L) (P < .001) and negatively correlated with 90-day survival (r = -0.557; P < .001). Cox regression analysis revealed that AG at admission is an independent prognostic marker of the 90-day survival of patients with PQ poisoning. AG level at admission had an area under the receiver operating characteristic curve of 0.836 (95% confidence interval: 0.763-0.909) and an optimal cut-off value of 25.5 mmol/L (59.4% sensitivity and 95.5% specificity).AG level at admission may serve as a candidate marker for predicting the survival of patients with PQ poisoning.


Assuntos
Desequilíbrio Ácido-Base/sangue , Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos
8.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
12.
Sud Med Ekspert ; 63(4): 17-21, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32686385

RESUMO

The purpose of this work is an in-depth study of main morphological features and pathogenesis of acute lung injury in cases of acute fatal poisoning with ethanol; assessment of microcirculation disorders in the respiratory system; details of the mechanisms of development of non-cardiogenic pulmonary edema. An analysis of 160 deaths of men and women aged 19 to 85 years from acute ethanol poisoning was made. Histological preparations were colored with hematoxylin and eosin according to the Van Gieson method, elastic fibers - according to Weigert. It was established that the first reaction in response to the effect of ethanol is hemodynamic disorders, then interstitial and alveolar edema develops; pronounced changes occur in endothelial cells, which lead to plasmorrhagia and hyalinosis.


Assuntos
Células Endoteliais , Etanol , Pulmão , Adulto , Idoso , Idoso de 80 Anos ou mais , Etanol/envenenamento , Feminino , Humanos , Masculino , Microvasos , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Adulto Jovem
13.
Sud Med Ekspert ; 63(4): 22-26, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32686386

RESUMO

We studied the morphological criteria that allow us to assess the need to send biological material to a forensic chemical study based on the results of a forensic medical study of a corpse in cases of suspected acute drug poisoning. According to a statistical analysis, it was determined that under the condition of death with a fast agonal period, the most characteristic prognostic signs of acute drug poisoning are young age, the presence of traces of injections and/or «wells¼, lung mass more than 1050 g, the sum of the size of the spleen exceeding 25. The use of a combination of the three indicated characteristic signs encountered in acute drug poisoning can increase the likelihood of detecting acute poisoning with psychoactive substances. Taking into account the tendency of recent years to increase the age of drug users, the possibility of using exclusively morphological characters has been objectively proven while maintaining the specificity of the diagnosis of acute drug poisoning.


Assuntos
Envenenamento , Transtornos Relacionados ao Uso de Substâncias , Cadáver , Humanos , Envenenamento/diagnóstico , Prognóstico , Projetos de Pesquisa , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
14.
Sud Med Ekspert ; 63(4): 34-38, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32686389

RESUMO

The problem of laboratory diagnosis of acute and fatal poisoning by hellebore, which is possible when used in traditional medicine, the erroneous use of hellebore preparations orally or use of various types of this plant for food, remains relevant. Currently, in the practice of chemical-toxicological laboratories and the bureau of forensic medical examination there is no single approach to the laboratory diagnosis of such poisoning. The diagnosis is most often based on anamnesis. In this regard, the development and validation of a legally significant methodology for the determination of hellebore alkaloids in various biological objects seems relevant. The physicochemical and toxic properties of alkaloids of various types of hellebore are characterized. It was shown that for the identification of hellebore alkaloids, it is advisable to use HPLC-MS/MS as the most sensitive and specific instrumental method corresponding to the characteristics of hellebore alkaloids (high molecular weight, high thermal lability, high polarity).


Assuntos
Helleborus , Envenenamento , Veratrum , Envenenamento/diagnóstico , Espectrometria de Massas em Tandem , Veratrum/envenenamento , Alcaloides de Veratrum
16.
J Zoo Wildl Med ; 51(2): 407-415, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32549572

RESUMO

Over a period of 5 mo, seven out of eight American white pelicans (Pelecanus erythrorhynchos) housed on a spring-fed pond at a zoo died or were euthanized. Clinical signs included inability to stand, anorexia, and weight loss. Clinicopathologic findings included heterophilic leukocytosis and elevated creatine kinase and aspartate aminotransferase. Histopathologic findings on all pelicans demonstrated severe, chronic, diffuse rhabdomyofiber degeneration and necrosis, making vitamin E deficiency a differential diagnosis despite routine supplementation. Based on tissue and pond water assays for the cyanobacterial toxin, microcystin, toxicosis is suspected as the inciting cause of death in these cases. We hypothesize that vitamin E exhaustion and resultant rhabdomyodegeneration and cardiomyopathy were sequelae to this toxicosis.


Assuntos
Doenças das Aves/diagnóstico , Aves , Microcistinas/envenenamento , Necrose/veterinária , Envenenamento/mortalidade , Envenenamento/veterinária , Alabama/epidemiologia , Animais , Doenças das Aves/microbiologia , Doenças das Aves/mortalidade , Diagnóstico Diferencial , Feminino , Masculino , Necrose/diagnóstico , Necrose/microbiologia , Necrose/mortalidade , Envenenamento/complicações , Envenenamento/diagnóstico
17.
Emergencias (Sant Vicenç dels Horts) ; 32(3): 185-187, jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-189731

RESUMO

OBJETIVO: La suspensión líquida de carbón activado (CA) contiene como excipiente 600 mg/mL de sacarosa. Se eva¬lúa el impacto glucémico de la administración de CA en pacientes con intoxicación medicamentosa aguda (IMA). MÉTODO: Se identificaron pacientes con IMA y determinación de la glucemia antes y después de haber recibido CA. Se compararon estos cambios de glucemia con los generados por el desayuno en un grupo control de no intoxicados. RESULTADOS: Se incluyeron 55 IMA. En el 82% de los casos la glucemia aumentó tras administrar CA. La media de las glucemias previas al carbón fue de 98,2 mg/dL y a la hora posterior de 124,2 mg/dL (p < 0,001). El cambio glucémico no condicionó eventos clínicos adversos. En el grupo control (n = 23) la glucemia aumentó en el 82,6% de los casos. La media de las glucemias antes del desayuno fue de 117,1 mg/dL y la posterior de 152,0 mg/dL (p < 0,001). CONCLUSIÓN: La administración de CA induce un aumento estadísticamente significativo de la glucemia, pero sin rele¬vancia clínica y equiparable al producido por un desayuno


OBJECTIVE: Activated charcoal in suspension contains 600 mg/mL of sucrose. We aimed to assess the impact of an activated charcoal suspension on blood glucose levels in patients with acute medication poisoning. METHODS: We identified drug patients whose blood glucose levels were measured before and after administration of activated charcoal to treat poisoning. The impact on blood glucose level was compared to changes after breakfast in a control group not receiving treatment for poisoning. RESULTS: Fifty-five poisoned patients were included. Eighty-two percent had higher blood glucose levels after activated charcoal administration. The mean glucose levels before and 1 hour after treatment were 98.2 mg/dL and 124.2 mg/dL, respectively (P<.001). The increase did not translate to adverse clinical events. Glucose levels increased in 82.6% of the 23 patients in the control group. Mean glucose levels before breakfast and 1 hour later were 117.1 mg/dL and 152.0 mg/dL (P<.001). CONCLUSION: Activated charcoal induces an increase in blood glucose level that is statistically but not clinically significant. The increase is comparable to the increase after breakfast


Assuntos
Humanos , Masculino , Feminino , Adulto , Índice Glicêmico/efeitos dos fármacos , Carvão Vegetal/toxicidade , Envenenamento/diagnóstico , Envenenamento/tratamento farmacológico , Carvão Vegetal/metabolismo , Carvão Vegetal/administração & dosagem , Sacarose/administração & dosagem , Serviços Médicos de Emergência
20.
Ann Emerg Med ; 76(3): 303-317, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32507489

RESUMO

STUDY OBJECTIVE: We studied the severity of poisoning after exposure to low to moderate and high doses of 4-bromo-2,5-dimethoxyphenethylamine (2C-B). METHODS: Patients for whom the Dutch Poisons Information Centre was consulted for 2C-B exposure from 2016 to 2018 were included in a prospective cohort study. Data were collected through telephone interviews with the physician or patient. Patients were categorized according to the reported 2C-B dose: low to moderate (up to 20 mg), high (greater than 20 mg), or unknown. Presence of 2C-B was analyzed in leftover drug and biological samples with liquid/gas chromatography-mass spectrometry. The severity of poisoning was graded with the Poisoning Severity Score. RESULTS: We included 59 patients, of whom 32 could be followed up. Low to moderate 2C-B doses were reported by 9 patients (28%), high doses by 17 (53%), and unknown doses by 6 (19%). Poisoning was moderate in the majority of patients in both the low- to moderate-dose and high-dose groups. Frequently reported symptoms included mydriasis, agitation or aggression, hallucinations, confusion, anxiety, hypertension, and tachycardia. The presence of 2C-B was confirmed in 5 patients in urine (n=3) or drug samples (n=4). CONCLUSION: In this study, most 2C-B poisonings resulted in moderate toxicity even at high reported doses up to 192 mg. No severe cases were observed. The clinical course was usually short-lived (up to 24 hours) and typically involved hallucinations in addition to mild somatic effects.


Assuntos
Dimetoxifeniletilamina/análogos & derivados , Envenenamento/diagnóstico , Índice de Gravidade de Doença , Adolescente , Adulto , Estudos de Coortes , Dimetoxifeniletilamina/administração & dosagem , Dimetoxifeniletilamina/envenenamento , Relação Dose-Resposta a Droga , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Adulto Jovem
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