Background Opioid-Induced Constipation (OIC) is one of the most common types of complications affecting patients following opioid treatment for cancer pain. Lactulose has been shown to be an effective drug for managing OIC symptoms in clinics. Acupuncture is a non-invasive approach for relieving constipation and pains. However, the co-applications of Acupuncture and Lactulose for OIC have been rarely evaluated. Materials and methods To confirm the advanced therapy effects of Acupuncture and Lactulose co-application, 80 OIC patients in Hebei Province Hospital of Chinese Medicine are included in the randomised clinical trial. Two groups were assigned, including the co-application group with Manual Acupuncture and oral lactulose (AC-LA group) and the control group of pure oral Lactulose Administration (LA group). Forty patients are allocated into each group randomly. Scores of pain, symptoms, and Quality Of Life (QOL) at Day 0 (the day before treatment), Day 7, and Day 14 of treatments are recorded to evaluate the outcomes of OIC therapy in both the AC-LA and LA group. Results Compared with pure oral lactulose treatment, the combined Manual Acupuncture sessions produced a higher effective rate after seven days (LA 60.53% vs. AC-LA 89.47%, P<0.001) and 14 days (LA 76.32% vs. AC-LA 92.11%, P=0.081) of treatment. The overall symptom scores of the AC-LA group reduced by more than the LA group following one week (LA 18.5% vs. AC-LA 33.6%, P<0.05) or two weeks (LA 39.5% vs. AC-LA 55.8%, P<0.05) of treatment with Manual Acupuncture. Along with the reduced overall symptom scores, the symptoms of defecation straining, harder stool, extended defecation time and intervals, and the feeling of incomplete defecation were relieved in both LA and AC-LA groups. Acupuncture enhanced the remission effects of each constipation sub-symptoms. Though the KPS quality of life scores did not improve significantly, additional acupuncture treatment helped relieve pain in cancer patients (Day 0 6.89 ± 1.66 vs. Day 14 6.05 ± 1.43, P=0.020). Discussion and conclusion As a non-invasive approach, acupuncture put on add-up effects for oral lactulose treatment in relieving Opioid-Induced Constipation symptoms. The co-application of acupuncture and lactulose is a considerably better strategy for pain and constipation management of cancer patients in clinics.
Poisoning is the absorption of chemical, physical, or organic substances into the body by the gastrointestinal tract, skin, mucosa or respiratory tract or by injection, causing toxic effects and cell, tissue and organ damage. Poisoning is an important public health problem that causes a major portion of emergency department admissions and may cause serious consequences to health.
Fluoroacetate poisoning, usually caused by exposure to sodium monofluoroacetate and fluoroacetamide, competitively inhibits aconitase in the tricarboxylic acid cycle. There are no effective antidotes, and treatment is symptomatic and supportive. The effectiveness of hemodialysis in alleviating fluoroacetate poisoning remains unclear, and no study has reported changes in the blood concentration of fluoroacetate after hemodialysis. A 71-year-old man with a history of chronic kidney disease and on maintenance hemodialysis had findings suggestive of acute fluoroacetate poisoning. He presented with tachycardia, tachypnea, renal dysfunction, hyperammonemia, and hyponatremia. He was intubated with a nasogastric tube and administered intravenous fluids, and direct hemoperfusion and hemodialysis were performed on successive days to reduce blood fluoroacetate concentrations. He recovered without organ failure and was transferred for rehabilitation. This is the first study to report a case wherein treatment with hemodialysis reduced fluoroacetate concentrations, suggesting hemodialysis can be an effective treatment strategy for fluoroacetate poisoning.
Background: Povidone Iodine (PVP-I) nasal solutions are effective against the SARS-CoV-2 virus, but are cleared rapidly from the nasal cavity, limiting its use. PVP-I gel forming solutions can circumvent this problem due to their higher viscosity and prolonged clearing time. Objective: Characterize the in vitro virucidal activity of long-acting PVP-I compositions developed using an in situ gel forming technology against the SARS-CoV-2 virus and test its safety using a rat model. Methods: We tested different dilutions of the PVP-I gel forming solution– full concentration, 90%, 50%, 28% and 9% of the original formulation concentration – at varying exposure times to assess virucidal activity against SARSCoV- 2 in VERO76 cells infected. Virucidal activity was recorded as the reduction of virus in formulation-treated test wells compared to virus controls as a log reduction value. We conducted a 28-day toxicity study using Sprague Dawley CD® IGS rats to determine the potential delayed toxicity of a PVP-I formulation. Results: The PVP-I gel-forming nasal spray rapidly inactivated SARS-CoV-2, inhibiting the viral infection of VERO76 cells. No toxicity was observed for the PVP-I formulations. Significant inactivation was noted with preincubation of the virus with this PVP-I formulation at the lowest concentrations tested. No delayed toxicity was observed in our animal model. Conclusions: PVP-I gel forming formulations inactivate SARS-CoV-2 in vitro within 30 seconds of exposure, with increasing effects seen at higher exposure times. These formulations could prove useful in a clinical setting for managing SARS-CoV-2 infected patients.
Background Phytoconstituents from plants provide a huge array of medicinal properties and have been used for many centuries as household medicines in India to treat respiratory illnesses. There are limited studies on comprehensive evaluations of these plant extracts to understand their healing properties. Aim To evaluate the antimicrobial and immunomodulatory properties of the 10 commonly used medicinal plants to treat respiratory illnesses in a comprehensive manner. Materials & Methods The acetone, ethanol and aqueous extracts from the 10 plants were evaluated for antiviral, antifungal and antibacterial activity. Additionally, the aqueous extracts were also evaluated for immunomodulatory properties. Results None of the extracts exhibited antiviral activity against the four influenza viruses, antifungal activity against Candida albicans or antibacterial activity against Gram negative bacilli. Eight acetone extracts, nine ethanol extracts and one aqueous extract (NSAq) exhibited antibacterial activity at concentrations below 1mg/ml against S. pyogenes and/or S. pneumoniae. All the aqueous extracts exhibited dose-dependent anti-inflammatory activity against the innate immunity cytokines, TNF-α and IL-1β, and the Th1 cytokine, IFN-γ, but not against the Th2 cytokine, IL-4. Conclusions Overall the study elucidates that the acetone and ethanol extracts exhibit antibacterial activity, while the commonly consumed aqueous extracts ameliorate respiratory illnesses through immune modulation.
Today toxicology can be characterized as investigation of the multitude of antagonistic impacts coming about because of the connection of synthetic substances or actual specialists with living creatures. Toxicology is a multidisciplinary science that has developed and extended by getting information from a few unique territories. It involves information and strategies from essential sciences like medication, the study of disease transmission, drug store, and surprisingly some designing territories.Toxicological examinations incorporates the location, ID, and measurement of risks resulting from human openness to synthetics (smoke, food, and work environment), general wellbeing parts of poisonous specialists in the climate (air, water, and soil), and testing of novel drug items. Toxicologists are additionally engaged with the advancement of norms and guidelines intended to shield the climate and human wellbeing from the injurious impacts of synthetic poisons.
Paraquat is a quaternary compound used as an herbicide for destroying weed and is highly toxic for humans. Its ingestion leads to multi-organ dysfunction, leading to liver insufficiency and lung fibrosis, which are life-threatening due to respiratory failure. A Pubmed, EMBASE, Ovid, and Cochrane library search was done, all authors reviewed all literature and relevant studies, and data were included in references. Paraquat is available in commercial 20% concentrate form, as 2.5% granules, and 0.2% aerosol. Mortality rates are as high as 65% in patients who ingest concentrated formulation compared to 4% in those who ingest diluted solution (25% w/v). Paraquat undergoes redox-cycling to generate reactive oxygen species leads to its toxic effects. This highly reactive oxygen and nitrite species result in multi-organ toxicity which is maximally seen in the lungs. Absorption occurs primarily through the small intestine. Peak concentration in plasma and maintenance of plasma paraquat levels are the two main factors that decide its concentration in the lungs. The destructive phase is followed by the proliferative phase, in which there is the presence of extensive fibrosis. High dose intake leads to acute respiratory distress syndrome, myocardial necrosis, cerebral edema, and renal failure, which leads to multi-organ failure. The diagnosis of paraquat poisoning is based on history. Simple bedside methods like urine or plasma dithionate tests are used to assess systemic paraquat toxicity. Management stands on four pillars which are reducing absorption, supportive care, antioxidant therapy, and immunosuppression.
Hydroquinone (HQ) is a major benzene metabolite, which is produced after benzene biotransformation mainly in liver, lungs and bone marrow. However, the effects of mechanisms, in particular related to its genotoxicity in humans are not well understood. Argyreia nervosa (AN) is traditionally used in rheumatic, cerebral disorders, syphilis, and wound healing as immunomodulatory agent. The aim of this study was to access the protective effect of quercetin present in hydroalcoholic extract of Argyreia nervosa leaves against HQ-induced genotoxicity in rats and to identify and clarify the mechanisms, using albino rats of wistar strain bone marrow cells. The data suggested that HQ caused DNA strand breaks, DNA protein crosslink’s (DPC) and chromosomal breaks and significant increase in the frequency of micronuclei was found in the Micronucleus test (MNT) and chromosomal aberrations assay. To elucidate the Oxidative DNA damage mechanism, parameters such as antioxidant enzymes like LPO , SOD ,GSH and Catalase levels were choosen to monitor the levels of reactive oxygen species (ROS) and glutathione (GSH ) respectively. The present study showed that HQ induced the increased levels of (ROS) and depletion of GSH in rats ,Quercetin exerted an antigenotoxic effect on HQ- -induced genotoxicity, by significantly reducing the number of structural aberrations in chromosomes. Our results demonstrate that quercetin exerts a Cytoprotective effect against HQ-induced oxidative stress, DNA damage and genotoxicity.
Paraquat is a quaternary compound used as an herbicide for destroying weed and is highly toxic for humans. Its ingestion leads to multi-organ dysfunction, leading to liver insufficiency and lung fibrosis, which are life-threatening due to respiratory failure. A Pubmed, EMBASE, Ovid, and Cochrane library search was done, all authors reviewed all literature and relevant studies, and data were included in references. Paraquat is available in commercial 20% concentrate form, as 2.5% granules, and 0.2% aerosol. Mortality rates are as high as 65% in patients who ingest concentrated formulation compared to 4% in those who ingest diluted solution (25% w/v). Paraquat undergoes redox-cycling to generate reactive oxygen species leads to its toxic effects. This highly reactive oxygen and nitrite species result in multi-organ toxicity which is maximally seen in the lungs. Absorption occurs primarily through the small intestine. Peak concentration in plasma and maintenance of plasma paraquat levels are the two main factors that decide its concentration in the lungs. The destructive phase is followed by the proliferative phase, in which there is the presence of extensive fibrosis. High dose intake leads to acute respiratory distress syndrome, myocardial necrosis, cerebral edema, and renal failure, which leads to multi-organ failure. The diagnosis of paraquat poisoning is based on history. Simple bedside methods like urine or plasma dithionate tests are used to assess systemic paraquat toxicity. Management stands on four pillars which are reducing absorption, supportive care, antioxidant therapy, and immunosuppression.
Elaeocarpus serratus L. (Ceylon olive) fruits in popular medicine are used in the treatment of dysentery and diarrhea. Despite the properties of the fruit, there are no records in Brazil of studies that validate its safe use. The study aimed to evaluate the cytotoxicity, acute toxicity, genotoxicity, mutagenic, and antimutagenic potential of the aqueous extract of the fruits of E. serratus (AEES) through the platelet viability assay (MTT assay), acute toxicity test, micronucleus test and comet assay in rodents, and through the SMART assay with Drosophila melanogaster. It has shown moderate cytotoxic properties, the estimated LD50 of the AEES is greater than 2000 mg/kg and has no genotoxic potential in peripheral blood cells or clastogenic and aneugenic activity in cells from the bone marrow of rats. It is not a mutagenic agent and presents antimutagenic activity, attested by SMART assay.
Ricin poisoning is an exceedingly rare clinical scenario encountered in the field of toxicology. Potential routes of exposure consist of injection, inhalation, or ingestion. The ricin toxin’s mechanism of action involves inhibition of protein synthesis, and the corresponding clinical findings can include nausea, vomiting, shortness of breath, pulmonary edema, cutaneous and visceral necrosis, multi-organ failure, and sepsis. Renal failure is often encountered, and the appropriate management is not currently established in the literature. We report a fatal case of intramuscular ricin injection leading to renal failure in a 37-year-old male. To our knowledge, there has been only one prior confirmed lethal case of intramuscular poisoning. Our case is also the first to evaluate the efficacy of Plasma Exchange (PLEX) in adult ricin poisoning. Although treatment remains supportive, we believe our case provides valuable insight and highlights the need for further investigation.
Background: Liquid cocaine body packing is a novel and rare method for drug smuggling. This new modality of drug trafficking is more difficult to detect by X-ray due to its low density and its purity is higher than powdered cocaine. Methods: We are discussing about a 38-year-old male with clinical and radiological diagnosis of intestinal occlusion secondary to condom filled with liquid cocaine. On abdominal X-ray no foreign body is detected. CT scan reveals a hyperdense image compatible with a cocaine liquid package in distal ileum with retrograde dilatation of small bowel. Results: Laparotomy is performed and after the enterotomy, the liquid cocaine package is carefully “milked” and removed. Postoperative period is uneventful. Conclusion: Drug trafficking has evolved in recent Zmes. Knowing this new variant is crucial to detect mules and provide them adequate treatment. Its ignorance can induce underdiagnosis and fatal consequences for the patient.
We describe a patient presenting multiple organ dysfunction syndrome complicating a refractory cardiogenic shock caused by massive methadone intoxication. Neither ECG changes nor echocardiography abnormalities suggesting the diagnosis of Takotsubo syndrome could be observed at the admission. The QT interval was also normal. An extracorporeal life support (ECLS) was rapidly implanted in bridge to decision. The myocardial failure was fully reversible after 10 days. This case is the first to report multiple organ dysfunction syndrome complicating refractory cardiogenic shock related to methadone poisoning requiring ECLS. It emphasizes that a such diagnosis must be imperatively suspected in patients with history of drug abuse and for whom methadone is rendered available even in absence of typical ECG and/or echocardiography changes.
A 70 year old female was brought to the emergency department with alleged history of ?chest pain/?aphasia/?slurred speech of sudden onset since 6am.She was apparently normal the previous night. The next day morning when she woke up, she had? Slurring of speech with no weakness of limbs. She was initially taken to nearby government hospital where some injection given. On arrival at emergency department, she was conscious, responding to simple commands with GCS-E4V1M6 with blood pressure of 150/90 mmHg, PR-86/min, saturation was 54% in room air and was intubated. Her pre –intubation ABG revealed type 2 respiratory failure and post-intubation ABG showed improvement. She was admitted in ICU. Detailed Neurological examination revealed GCS of E4VTM1 with depressed brain stem reflexes, pupil were 2.5mm reacting to light, doll’s eye absent, cough and gag reflex were absent. She had generalised hypotonia with absent deep tendon reflexes and bilateral plantar was mute. She had normal vesicular breath sounds in all chest areas. Cardiovascular examination revealed ejection click at mitral area and abdominal examination was normal. Differential diagnosis of cerebrovascular accident/hypokalemic paralysis/acute inflammatory demyelinating polyneuropathy/neurotoxic snake bite/acute myasthenic syndrome were considered. Her baseline investigations showed normal hemogram and biochemical parameters. Hence hypokalemic paralysis was ruled out. CT brain done which showed age-related cerebral atrophy. MRI brain done which revealed small vessel ischemic changes. Hence cerebrovascular accident was ruled out. CSF analysis was normal. Hence acute inflammatory demyelinating polyneuropathy was ruled out. She was started on anti-snake venom in view of neurotoxic snake bite as elapid bite would mimic brain death. Her neurological examination of motor system and ophthalmoplegia showed improvement within 24 hours. She was gradually weaned off ventilator and extubated after 72hours. Acetylcholine receptor antibodies were normal. Nerve conduction study of both ulnar nerves revealed symmetrical motor axonal neuropathy. Repetitive nerve stimulation done which was normal. Hence myasthenia was ruled out. She was discharged after 10days with full improvement in clinical status.
Acetaminophen is a common toxic ingestion and the leading cause of acute liver failure in the United States. There exists a relative paucity of evidence in guiding management of acetaminophen Extended-Release ingestions compared to immediate-release ingestions. Many case reports involving Extended-Release acetaminophen ingestion are confounded by co-ingestion, resulting in a delayed peak acetaminophen level. Few reports have been published involving pure acetaminophen Extended-Release ingestion with a late crossing of the Rumack-Matthew nomogram. We present a case of witnessed isolated acetaminophen Extended-Release ingestion in an 18-year-old male, resulting in an acetaminophen level crossing the Rumack-Matthew nomogram treatment threshold at 21 hours post-ingestion.
Caterpillars Glufosinate is a typical herbicide with neurotoxic impacts, prompting seizures, spasms and cognitive decline. Glufosinate in a roundabout way incites glutamate poisonousness by hindering glutamine combination in astrocytes. Here, we considered the intense harmful impacts of a glufosinate-based herbicide in rodent optic nerve at three portions (40, 80 or 120 μM, equivalent to 714 or 21 mg/kg bw/day). Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, glucose, calcium, just as creatinine fixations were broke down after 24, 48 and 72 h treatment. Intraocular pressure (IOP) (communicated as the normal of the two eyes) was estimated with a bounce back tonometer. Interleukin-1β (IL-1β) and c-Fos articulation were controlled by immunohistochemistry. The outcomes set up that the glufosinate-based herbicide fundamentally expanded IL-1β and c-Fos immunopositivity in the optic nerve (p<0.05), associative with expanded IOP. These outcomes recommend that business definitions of glufosinate intensely influence the optic nerve.
Parquet (1, 1’-dimethyl-4-4’-bipyridinium dichloride), an agricultural herbicide, is highly toxic to humans. A 78% mortality rate previously reported for the ingestion of 20% Paraquat commercial preparation. No specific antidote is available; hence cases of poisoning require aggressive decontamination. We report an unintentional ingestion of a 15- months-old male who developed severe neurologic manifestations. Clinical experiences were seen; in vitro and animal models often demonstrate a lack of consistency with clinical response
Congestive cardiac failure or Congestive heart failure is a state at which heart cannot supply blood sufficiently to maintain homeostasis. Heart failure can occur if the center cannot pump (systolic) or fill (diastolic) adequately. Symptoms include shortness of breath, fatigue, swollen legs and rapid heartbeat. Treatments can include eating less salt, limiting fluid intake and taking prescription medication. In some cases a defibrillator or pacemaker could also be implanted.
The term nootropic refers to a group of substances that are used to treat deficits of cognition. Nootropic substances, or cognitive enhancers, have been used therapeutically for the treatment of certain diseases that affect cognition, memory, and mental function. Lately, the use of these substances has been growing widely among young and healthy individuals seeking cognitive enhancement. Some of these substances have been advertised as ‘smart drugs’ or ‘legal highs.’ The safety profile and benefit for those substances are not fully established and mostly are extrapolated from clinical therapeutic use. The wide availability, lack of regulation, and the increasing demand for those enhancers make it important to categorize them, recognize their mechanisms of actions and possible side effects that can be encountered. In this review, we want to emphasize the importance of further studies and clinical trials for the benefit and safety profile of those dietary supplements
Accidental poisoning with Angel’s trumpet (Brugmansia suaveolens) is an uncommon plant poisoning reported in Sri Lanka. Toxic substances like atropine and scopolamine give rise to clinical manifestation of toxicity which is mainly anticholinergic effects. We report a rare case of accidental poisoning of Angel’s trumpet of 73-year-old patient who had clinical manifestations of anticholinergic effects. The patient started his symptoms following consuming leaves of angel’s trumpet accidentally. He developed anticholinergic symptoms such as delirium, altered level of consciousness, dilated pupils and tachycardia. Patient successfully recovered with symptomatic management. We recommend to be aware about uncommon types of plant poisoning and different presentations of their toxic effects, not only for timely diagnosis and treatment of such patients, but also to educate the public about the toxicity of plants in order to prevent morbidity and mortality related to accidental poisoning.
