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Emergency Toxicology

Jeff Lapoint, Seth Meyer, Charles K Yu, Kristi L Koenig, Roneet Lev, Sayone Thihalolipavan, Katherine Staats, Christopher A Kahn
Introduction: Cannabinoid hyperemesis syndrome (CHS) is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED) repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful...
March 2018: Western Journal of Emergency Medicine
Michelle Hershman, Raymond Carmody, Unni K Udayasankar
History A 19-year-old woman with no pertinent medical history was brought to the emergency department after being found unconscious on her bathroom floor by her roommate. In the preceding weeks, she had reported intractable nausea and vomiting, for which she had been taking ondansetron. No other medications had been prescribed. The day prior to presentation, she had contacted her mother and described increasing confusion. Glasgow coma scale score on arrival in the emergency department was 4. Intravenous naloxone was administered, without immediate response...
April 2018: Radiology
Antonella Sorrentino, Silvia Trotta, Anna Pia Colucci, Lucia Aventaggiato, Andrea Marzullo, Biagio Solarino
"Krokodil" is a home-made opioid drug obtained by synthesizing desomorphine from codeine and combining it with other low-cost additives. Initially introduced in the former Soviet countries, it was then imported to Western Europe as a heroin substitute. To our knowledge, this is the first report of an Italian case of lethal krokodil abuse, that occurred in a 39-year-old man, who died suddenly after transportation to the Emergency Department (ED) for hyperthermia associated with sweating, dyspnoea and tachycardia...
March 19, 2018: Forensic Science, Medicine, and Pathology
Adi L Tarca, Xiaofeng Gong, Roberto Romero, Wenxin Yang, Zhongqu Duan, Hao Yang, Chengfang Zhang, Peixuan Wang
Crowdsourcing has emerged as a framework to address methodological challenges in omics data analysis and assess the extent to which omics data are predictive of phenotypes of interest. The sbv IMPROVER Systems Toxicology Challenge was designed to leverage crowdsourcing to determine whether human blood gene expression levels are informative of current and past smoking. Participating teams were invited to use a training gene expression dataset to derive parsimonious models (up to 40 genes) that can accurately classify subjects into exposure groups: smokers, former smokers that quit for at least one year, and never-smokers...
February 2018: Computational Toxicology
Alex J Krotulski, Amanda L A Mohr, Donna M Papsun, Barry K Logan
The number of emerging novel stimulants modified based on beta-keto variations of amphetamine-like substances continues to rise. Dibutylone reports described in the medical and toxicological literature are limited, therefore little information is available in terms of quantitative confirmation or metabolism. During this study, authentic human specimens, including blood, urine, vitreous humor, oral fluid and liver were quantitatively and qualitatively analyzed for the presence of dibutylone and butylone, with paired case history and demographic information...
March 15, 2018: Journal of Analytical Toxicology
Guillermo Benítez, Martí March-Salas, Alberto Villa-Kamel, Ulises Cháves-Jiménez, Javier Hernández, Nuria Montes-Osuna, Joaquín Moreno-Chocano, Paloma Cariñanos
ETHNOPHARMACOLOGICAL RELEVANCE: The different species of the genus Datura have been used traditionally by some pre-Columbian civilizations, as well as in medieval rituals linked to magic and witchcraft in both Mexico and Europe. It is also noteworthy the use of different alkaloids obtained from the plants for medicinal purposes in the treatment of various groups of diseases, especially of the respiratory and muscularskeletal systems. AIM OF THE STUDY: A review of the ethnobotanical uses of the genus Datura in Mexico and Spain has been conducted...
March 15, 2018: Journal of Ethnopharmacology
Geraldine Dowling, Pierce V Kavanagh, Hans-Georg Eckhardt, Brendan Twamley, Gary Hessman, Gavin McLaughlin, John O' Brien, Simon D Brandt
Nitrazolam and clonazolam are two designer benzodiazepines that are available from internet retailers and there is growing evidence suggesting that such compounds have the potential to cause severe adverse events. Information about tolerability in humans is scarce but typically, low doses can be difficult to administer for users when handling bulk material and variability of the active ingredient in tablet formulations can also be of a concern. Customs, toxicology and forensic laboratories are increasingly encountering designer benzodiazepines, both in tablet and powdered forms, and the unavailability of reference standards can impact on the ability to identify these compounds...
March 15, 2018: Drug Testing and Analysis
Beatriz Silva Lima, Mafalda Ascensão Videira
Since the human genome decoding, understanding and identification of genetic disturbances behind many diseases, including cancer, are intensively increasing. Scientific and technological advances in this area trigger the search for therapeutic (curative) approaches targeting the correction of gene disturbances. Gene therapy medicinal products (GTMPs) emerge in this context, bringing new challenges for their characterization. Compared to small molecules, biodistribution is fundamental to identifying target organs and anticipating safety and efficacy, may be integrated into safety and pharmacology studies, and may eventually be anticipated based on specificities of vectors and constructs...
March 16, 2018: Molecular Therapy. Methods & Clinical Development
Meghan Gilley, Jeffrey Brent, Diane P Calello, Paul Wax, Yaron Finkelstein
OBJECTIVE: The objective of this study was to characterize the clinical picture and management of synthetic cannabinoid exposure in a cohort of adolescents. METHODS: Using the 45 participating sites of the Toxicology Investigators Consortium Registry, a North American database, we conducted an observational study of a prospectively collected cohort. We identified all adolescent (12-19 years) cases of synthetic cannabinoid exposure who have received medical toxicology consultation between January 2012 and December 2016...
March 12, 2018: Pediatric Emergency Care
Ivo Iavicoli, Veruscka Leso, Luca Fontana, Edward J Calabrese
The concept of hormesis, as an adaptive response of biological systems to moderate environmental challenges, has raised considerable nano-toxicological interests in view of the rapid pace of production and application of even more innovative nanomaterials and the expected increasing likelihood of environmental and human exposure to low-dose concentrations. Therefore, the aim of this review is to provide an update of the current knowledge concerning the biphasic dose-responses induced by nanoparticle exposure...
March 10, 2018: International Journal of Molecular Sciences
Apurva Patange, Daniela Boehm, Michelle Giltrap, Peng Lu, P J Cullen, Paula Bourke
Generation of wastewater is one of the main environmental sustainability issues across food sector industries. The constituents of food process effluents are often complex and require high energy and processing for regulatory compliance. Wastewater streams are the subject of microbiological and chemical criteria, and can have a significant eco-toxicological impact on the aquatic life. Thus, innovative treatment approaches are required to mitigate environmental impact in an energy efficient manner. Here, dielectric barrier discharge atmospheric cold plasma (ACP) was evaluated for control of key microbial indicators encountered in food industry effluent...
March 8, 2018: Science of the Total Environment
Yongwen Jiang, Megan L Ranney, Brian Sullivan, Dennis Hilliard, Samara Viner-Brown, Nicole Alexander-Scott
CONTEXT: National data on the epidemiology of firearm injuries and circumstances of firearm deaths are difficult to obtain and often are nonreliable. Since firearm injury and death rates and causes can vary substantially between states, it is critical to consider state-specific data sources. OBJECTIVE: In this study, we illustrate how states can systematically examine demographic characteristics, firearm information, type of wound, toxicology tests, precipitating circumstances, and costs to provide a comprehensive picture of firearm injuries and deaths using data sets from a single state with relatively low rates of firearm injury and death...
March 7, 2018: Journal of Public Health Management and Practice: JPHMP
Zulfiqar Qutrio Baloch, Muhammad Hussain, Shabber Agha Abbas, Jorge L Perez, Muhammad Ayyaz
The development of methamphetamine-associated cardiomyopathy (MACM) represents a severe complication of chronic methamphetamine abuse. MACM-induced irreversible structural and functional changes in the heart can eventually lead to decompensated heart failure, ultimately requiring heart transplantation. In this case report we present a 47-year old male with a previous history of chronic amphetamine abuse who presented to the emergency room with severe dyspnea at rest associated with mild substernal non-radiating chest pain...
2018: Emergency (Tehran, Iran)
A H Piersma, T Burgdorf, K Louekari, B Desprez, R Taalman, R Landsiedel, J Barroso, V Rogiers, C Eskes, M Oelgeschläger, M Whelan, A Braeuning, A M Vinggaard, A Kienhuis, J van Benthem, J Ezendam
This report describes the proceedings of the BfR-RIVM workshop on validation of alternative methods which was held 23 and 24 March 2017 in Berlin, Germany. Stakeholders from. governmental agencies, regulatory authorities, universities, industry and the OECD were invited to discuss current problems concerning the regulatory acceptance and implementation of alternative test methods and testing strategies, with the aim to develop feasible solutions. Classical validation of alternative methods usually involves one to one comparison with the gold standard animal study...
March 1, 2018: Toxicology in Vitro: An International Journal Published in Association with BIBRA
Joana C Prata, Beatriz R B O Lavorante, Maria da Conceição B S M Montenegro, Lúcia Guilhermino
Microplastics and pharmaceuticals are considered ubiquitous and emergent pollutants of high concern but the knowledge on their effects on primary producers is still limited, especially those caused by mixtures. Thus, the goal of the present study was to investigate if the presence of microplastics (1-5 μm diameter) influences the toxicity of the pharmaceuticals procainamide and doxycycline to the marine microalga Tetraselmis chuii. Bioassays (96 h) to investigate the toxicity of those substances individually and in mixtures (i...
February 21, 2018: Aquatic Toxicology
Daniel L Villeneuve, Michelle M Angrish, Marie C Fortin, Ioanna Katsiadaki, Marc Leonard, Luigi Margiotta-Casaluci, Sharon Munn, Jason M O'Brien, Nathan L Pollesch, L Cody Smith, Xiaowei Zhang, Dries Knapen
Toxicological responses to stressors are more complex than the simple one biological perturbation to one adverse outcome model portrayed by individual adverse outcome pathways (AOPs). Consequently, the AOP framework was designed to facilitate de facto development of AOP networks that can aid understanding and prediction of pleiotropic and interactive effects more common to environmentally realistic, complex exposure scenarios. The present paper introduces nascent concepts related to the qualitative analysis of AOP networks...
February 28, 2018: Environmental Toxicology and Chemistry
Tyra Dark, George Rust, Heather A Flynn, Heidi Kinsell, Jeffrey S Harman
This study examines variations in content of care for anxiety-related emergency department (ED) visits in the USA across various sociodemographic strata. The 2009-2012 National Hospital Ambulatory Medical Care Survey was used to identify all visits to general hospital EDs in which an anxiety diagnosis was recorded (n = 1930). Content and equitability of care was assessed utilizing logistic regression models. There were an estimated 1,856,000 ED visits with anxiety-related discharge diagnoses in the USA annually...
February 28, 2018: Journal of Behavioral Health Services & Research
Timothy B Legare, Oteni Hamilton, Sarah Dhannoon, Sayed Ali
Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic condition caused most commonly by metastatic mesenchymal tumors. A 74-year-old non-diabetic male with an eight-year history of metastatic sarcomatoid lung cancer presented with altered mental status. His previous treatment included a lobectomy and radiation. Laboratory investigations were significant for blood glucose of 28 mg/dL, confirming hypoglycemia. He was hypokalemic, a condition seen in approximately 50% of patients with NICTH, at 2...
December 20, 2017: Curēus
Gurjot Kaur, Thivanka Muthumalage, Irfan Rahman
Tobacco products containing flavorings, such as electronic nicotine delivery devices (ENDS) or e-cigarettes, cigars/cigarillos, waterpipes, and heat-not-burn devices (iQOS) are continuously evolving. In addition to increasing the exposure of teenagers and adults to nicotine containing flavoring products and flavoring enhancers, chances of nicotine addiction through chronic use and abuse also increase. These flavorings are believed to be safe for ingestion, but little information is available about their effects on the lungs...
February 23, 2018: Toxicology Letters
Anna-Liina Rahikainen, Jukka U Palo, Jari Haukka, Antti Sajantila
BACKGROUND: Genetic variation in efflux transporter, permeability glycoprotein (P-gp), has recently been associated with completed violent suicides and also violent suicide attempts. As depression is known to be a risk factor for suicide and many antidepressants are P-gp substrates, it has been speculated that inadequate antidepressant treatment response or adverse side effects could be involved. OBJECTIVES: The aim of this study was to investigate whether there is an association between the P-gp coding ABCB1 gene and completed suicides in citalopram users...
February 23, 2018: Pharmacogenetics and Genomics
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