V České republice je zneužívání γ-hydroxybutyrátu (GHB) či jeho prekurzoru 1,4-butanediolu (1,4-BD) pro jejich euforizačně sedativní efekt nejspíše okrajovou záležitostí. V dostupné literatuře není evidován počet intoxikací GHB či počet hospitalizací nebo úmrtí po požití GHB. Práce podává základní údaje o farmakokinetických a farmakodynamických vlastnostech GHB a 1,4-BD a klinickém dopadu užívání těchto látek. Připojena je kazuistika mladého muže, který byl dvakrát hospitalizován pro poruchy chování v rámci intoxikace GHB.
In the Czech Republic, the abuse of γ-hydroxybutyrate (GHB), or its precursor 1,4-butanediol (1,4-BD), for euphoric and sedative effects is presumably uncommon. Among existing literature there are no statistics on intoxication, hospitalization, or fatality after ingestion of GHB. This report concerns the pharmacokinetic and pharmacodynamic background of GHB and 1,4-BD, as well as the clinical impact of their abu- se. Also included is a case report documenting a young man who was hospitalized twice for behavioural anomalies due to GHB intoxication.
- MeSH
- Hair Analysis methods MeSH
- Benzodiazepinones administration & dosage MeSH
- Butylene Glycols * administration & dosage pharmacology poisoning adverse effects MeSH
- Hypnotics and Sedatives administration & dosage pharmacology poisoning adverse effects MeSH
- Humans MeSH
- Adolescent MeSH
- Alcoholic Intoxication etiology drug therapy pathology MeSH
- Poisoning etiology drug therapy pathology MeSH
- Sodium Oxybate analysis pharmacology metabolism poisoning MeSH
- Substance-Related Disorders * etiology drug therapy pathology MeSH
- Alcohol-Related Disorders etiology drug therapy pathology MeSH
- Toxicological Phenomena MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
Saxitoxins (STXs) are potent neurotoxins produced by marine dinoflagellates or freshwater cyanobacteria known to cause acute and eventually fatal human intoxications, which are classified as paralytic shellfish poisonings (PSPs). Rapid analysis of STXs in blood plasma can be used for a timely diagnosis and confirmation of PSPs. We developed a fast and simple method of STX extraction based on plasma sample acidification and precipitation by acetonitrile, followed by quantification using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Our approach provides the results ≤30 min, with a limit of detection of 2.8 ng/mL and a lower limit of quantification of 5.0 ng/mL. Within-run and between-run precision experiments showed good reproducibility with ≤15% values. Standard curves for calibration were linear with correlation coefficients ≥0.98 across the assay calibration range (5-200 ng/mL). In an interlaboratory analytical exercise, the method was found to be 100% accurate in determining the presence or absence of STX in human plasma specimens, with recovery values of 86-99%. This simple method for STX determination in animal or human plasma can quickly and reliably diagnose STX exposures and confirm suspected PSP cases to facilitate patient treatment or expedite necessary public health or security actions.
BACKGROUND: Medication poisoning in children is a severe condition that can endanger a child's life. Although drug intoxications are easily preventable, awareness of the proper handling of drugs and their safe storage out of the reach of children is not widespread among the general public. In this work, we investigated the demographic and clinical data of children admitted to the Department of Pediatrics of the University Hospital Olomouc for acute drug-induced intoxication. We also selected several case reports to illustrate the wide range of both presentations and outcomes in individual patients. METHOD: Cases of drug-induced intoxications were selected from a group of patients under the age of 19 years admitted to the hospital for poisoning between January 1, 2010, and December 31, 2019. Medical records of these patients were prospectively evaluated, and overview tables and graphs of predefined research objectives were created. RESULTS: During the given time period, 162 children with suspected drug intoxications were hospitalized at the Department of Pediatrics, University Hospital Olomouc. Of these, 108 cases were reported in girls and 54 in boys (66.7% vs. 33.3%). In 16 cases (9.9%), there was a severe intoxication requiring follow-up intensive care. There was also one case of fatal accidental intoxication. Most poisonings were seen in toddlers (65; 40.1%). Intoxication with suicidal ideation was found in 44 cases (27.2%), with a higher incidence of suicide attempts in girls (40 vs. 4). Repeated intoxication was recorded in nine cases. Analgesics were the most common drug group (61; 37.7%), with paracetamol (28; 17.3%) being the leading drug. In 154 cases (95.1%), the drugs were taken orally, most often in the form of tablets. CONCLUSION: Accidental drug intoxications most frequently occurred in the age group from one to three years old. The second highest incidence was among adolescents most of which were suicide attempts. Analgesics and psychoactive agents accounted for the majority of cases. Medications should be kept in places where children cannot reach them.
- MeSH
- Acute Disease MeSH
- Analgesics MeSH
- Child MeSH
- Adult MeSH
- Hospitalization * MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Hospitals MeSH
- Suicide, Attempted * MeSH
- Child, Preschool MeSH
- Retrospective Studies MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Observational Study MeSH
Introduction:N-2-methoxy-benzylated ("NBOMe") analogues of phenethylamine are a group of new psychoactive substances (NPS) with reported strong psychedelic effects in sub-milligram doses linked to a number of severe intoxications, including fatal ones. In our present work, we provide a detailed investigation of pharmacokinetics and acute behavioural effects of 2C-B-Fly-NBOMe (2-(8-bromo-2,3,6,7-tetrahydrobenzo [1,2-b:4,5-b']difuran-4-yl)-N-[(2-methoxybenzyl]ethan-1-amine), an analogue of popular psychedelic entactogen 2C-B (4-Bromo-2,5-dimethoxyphenethylamine). Methods: All experiments were conducted on adult male Wistar rats. Pharmacokinetic parameters of 2C-B-Fly-NBOMe (1 mg/kg subcutaneously; s. c.) in blood serum and brain tissue were analysed over 24 h using liquid chromatography-mass spectrometry (LC/MS). For examination of behavioural parameters in open field test (OFT) and prepulse inhibition (PPI) of acoustic startle reaction (ASR), 2C-B-Fly-NBOMe (0.2, 1 and 5 mg/kg s. c.) was administered in two temporal onsets: 15 and 60 min after administration. Thermoregulatory changes were evaluated in individually and group-housed animals over 8 h following the highest dose used in behavioural experiments (5 mg/kg s. c.). Results: Peak drug concentrations were detected 30 and 60 min after the drug application in serum (28 ng/ml) and brain tissue (171 ng/g), respectively. The parental compound was still present in the brain 8 h after administration. Locomotor activity was dose-dependently reduced by the drug in both temporal testing onsets. ASR was also strongly disrupted in both temporal onsets, drug's effect on PPI was weaker. 2C-B-Fly-NBOMe did not cause any significant thermoregulatory changes. Discussion: Our results suggest that 2C-B-Fly-NBOMe penetrates animal brain tissue in a relatively slow manner, induces significant inhibitory effects on motor performance, and attenuates sensorimotor gating. Its overall profile is similar to closely related analogue 2C-B and other NBOMe substances.
- Publication type
- Journal Article MeSH
Brain edema is a fatal pathological state in which brain volume increases as a result of abnormal accumulation of fluid within the brain parenchyma. A key attribute of experimentally induced brain edema - increased brain water content (BWC) - needs to be verified. Various methods are used for this purpose: specific gravimetric technique, electron microscopic examination, magnetic resonance imaging (MRI) and dry/wet weight measurement. In this study, the cohort of 40 rats was divided into one control group (CG) and four experimental groups with 8 rats in each group. The procedure for determining BWC using dry/wet weight measurement was initiated 24 h after the completion of edema induction by the water intoxication method (WI group); after the intraperitoneal administration of Methylprednisolone (MP) together with distilled water during edema induction (WI+MP group); 30 min after osmotic blood brain barrier disruption (BBBd group); after injection of MP via the internal carotid artery immediately after BBBd (BBBd + MP group). While induction of brain edema (WI, BBBd) resulted in significantly higher BWC, there was no increase in BWC in the MP groups (WI+MP, BBBd+MP), suggesting a neuroprotective effect of MP in the development of brain edema.
- MeSH
- Brain Edema * chemically induced diagnostic imaging pathology MeSH
- Edema pathology MeSH
- Blood-Brain Barrier MeSH
- Rats MeSH
- Methylprednisolone pharmacology MeSH
- Brain MeSH
- Water MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Junkční náhradní rytmus vzniká pod místem blokády a může pocházet právě z atrioventrikulárního (AV) uzlu, přičemž komorová frekvence dosahuje 40-50/minutu. Ke vzniku rytmu v tomto místě může dojít při narušení funkce sinoatriálního (SA) uzlu. Z klinického hlediska mají velký význam zejména pomalé náhradní rytmy, které bývají důsledkem poškození SA uzlu (např. při ischemii myokardu spodní stěny nebo působením toxické noxy). Naše kazuistika popisuje vznik náhradního srdečního rytmu vlivem toxického působení léku ze skupiny blokátorů kalciových kanálů. Tyto otravy jsou sice vzácné, ale s o to závažnějšími důsledky. Účinek této skupiny léků je antianginózní, antihypertenzní a negativně inotropní. Blokuje pomalé kalciové kanály, které ovlivňují tvorbu a vedení akčního potenciálu ve svalovině myokardu a cév. Tyto vlastnosti mohou při předávkování vést k vazodilataci na periferii a negativně inotropním efektem způsobit kardiogenní šok a smrt. Při včasném zahájení léčby se snahou o eliminaci požité dávky léku, snížení dopadu toxického působení na organismus a zajištění zevní stimulací se zvyšuje naděje na přežití.1,2 V diferenciální diagnostice byla v první řadě vyloučena primární ischemie myokardu a pracováno dále s hypotézou intoxikace, kterou pacient sice negoval, ale která byla nakonec verifikována jako fatální příčina. Pro dlouhou expozici toxické noxe byla terapie intoxikace neúspěšná. Zdravotní stav postupně progredoval do terminální zástavy oběhu a následné smrti po protrahované kardiopulmonální resuscitaci.
Junctional ectopic rhythm emanates from AV node, under the point of present conduction defect, with heart frequency usually between 40-50 beats per minute. Clinically significant SA node injury, which may be the trigger of junctional rhythm, may be inflicted e.g. by myocardial ischemia dominantly of the inferior heart wall or by the effect of some toxic agents. This case report depicts such junctional ectopic rhythm caused by the effect of a calcium channel blocker. Such poisoning is rare, but can have detrimental consequences. Calcium channel blockers function as antihypertensive, antianginal, and negatively inotropic drugs. They block slow calcium channels, which influence the generation and conduction of action potential in the heart and vessel myocytes. Overdose with these drugs may lead to peripheral vasodilation and due to its negatively inotropic effect even to cardiogenic shock and death. Early started treatment with efforts to maximize drug elimination and eventually use of external stimulation may increase the hope of survival. In our case firstly the acute coronary syndrome was excluded. Our suspicion of drug intoxication, even that it was denied by the patient, was ultimately established as the fatal cause. Our therapy was unfortunately unsuccessful possibly because of a long exposition to this toxic substance. The patient deteriorated progressively to cardiac arrest and died in spite of a prolonged cardiopulmonary resuscitation.
- Keywords
- eliminační terapie,
- MeSH
- Alkalosis chemically induced MeSH
- Calcium Channel Blockers poisoning MeSH
- Bradycardia chemically induced MeSH
- Depressive Disorder etiology MeSH
- Diagnosis, Differential MeSH
- Suicide, Completed psychology MeSH
- Electrocardiography MeSH
- Fatal Outcome MeSH
- Hypotension etiology MeSH
- Shock, Cardiogenic chemically induced MeSH
- Cardiopulmonary Resuscitation MeSH
- Family Conflict MeSH
- Middle Aged MeSH
- Humans MeSH
- Treatment Failure MeSH
- Orchiectomy psychology MeSH
- Pulmonary Ventilation MeSH
- Disease Progression MeSH
- Renal Insufficiency chemically induced MeSH
- Sleepiness MeSH
- Cardiac Resynchronization Therapy MeSH
- Heart Arrest MeSH
- Fluid Therapy MeSH
- Testicular Neoplasms psychology MeSH
- Verapamil * poisoning MeSH
- Vomiting chemically induced MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Úvod: Ložiskový proces v terénu chronické pankreatitidy (CHP) je obtížný diagnosticko-terapeutický problém. Cílem práce je: a) na vlastní sestavě stanovit výskyt nemaligních ložisek v terénu CHP, kdy podezření z maligního ložiska je vysoké, b) stanovit skutečný výskyt maligních tumorů v terénu CHP. Metody: Předkládáme retrospektivní analýzu souboru operovaných 2015–2019 pro CHP, ložisko v CHP a podezření na malignitu v ložisku CHP. Součástí je prezentace obtížných případů z pohledu předoperační diagnostiky. Výsledky: Pro některou z forem CHP bylo provedeno 33 ze 340 (9,7 %) resekcí pankreatu (2015–2019). Ložisko v hlavě pankreatu bylo u 16 (48 %), u 10 z nich (62 %) s podezřením na PDAC na základě EUS, CT či PETCT, v 6 případech i na podkladě pozitivní tkáňové diagnostiky využitím EUS-FNA. Spojkovou operaci podstoupilo 59 nemocných (HJA, PJA, Frey). U 8 (13 %) byla předoperačně tkáňová diagnostika, v 25 % podezření na malignitu. Perioperačně malignita byla potvrzena jen u jednoho pacienta, předoperačně nemaligní. Klinický průběh u jiných 3 nemocných po HJA, i když při operaci bez nádoru, ukazuje na PDAC v terénu CHP. Závěr: Prokazatelnost nádorových buněk v ložisku vzniklém v terénu CHP je i při použití všech dostupných sofistikovaných metod nesnadná a o úspěšnosti rozhoduje velmi mnoho proměnných faktorů. Četnost „nepotřebných“ pravostranných resekcí u ložiska v CHP dosahuje v naší sestavě 48 %, zatímco spojkových operací, u nichž měl být proveden resekční výkon, je kolem 7 %. Nadále je nutné očekávat určité procento tzv. nadbytečných resekčních výkonů na pankreatu, stejně jako neprovedených resekčních výkonů pro neprokázaný/nepoznaný tumor pankreatu v terénu CHP.
Introduction: Any mass in chronic pancreatitis (CP) is a difficult diagnostic and therapeutic problem. The aim of the study is a) to use our own group to determine the actual incidence of non-malignant masses in CP where any mass is highly suspected of being malignant; and b) to determine the actual incidence of malignant tumors in CP. Methods: We present a retrospective analysis of our group of patients operated in 2015–2019 for CP, a mass in CP and suspected malignancy in the mass in CP. Additionally, we present difficult cases in terms of preoperative diagnosis. Results: Thirty-three of 340 (9.7%) pancreatic resection were done due to any form of chronic pancreatitis in 2015–2019. A mass in the pancreatic head was present in 16 (48%) patients; of these, pancreatic ductal adenocarcinoma (PDAC) was suspected in 10 (62%) patients based on EUS, CT or PETCT, and also based on positive tissue diagnosis using EUS-FNA in 6 cases. Bypass or Frey procedure were done in 59 patients (HJA, PJA, Frey). Preoperative tissue sampling was done in 8 (13%) patients and malignancy was suspected in 25%. Intraoperatively, malignancy was confirmed only in one patient assessed as non-malignant in the preoperative period. The clinical course in 3 other patients undergoing HJA, although tumor-free at the time of the surgery, indicated PDAC in CP. Conclusion: The ability to detect malignant cells in a mass in CP remains poor even using all of the available sophisticated methods and the success depends on many variable factors. The rate of “unnecessary” right-sided resections of a mass in CP reached 48% in our patient group, while the rate of resections which should have been performed instead of bypass procedures was 7%. A certain percentage of the so-called excessive pancreatic resections, as well as the failure to perform a resection due to an undetected/unrecognized pancreatic tumor in CP should continue to be expected.
- MeSH
- Alcoholism complications MeSH
- Autoimmune Pancreatitis complications MeSH
- Pancreatitis, Chronic * surgery diagnosis etiology MeSH
- Diagnostic Imaging MeSH
- Fatal Outcome MeSH
- Middle Aged MeSH
- Humans MeSH
- Pancreatic Neoplasms * diagnosis etiology drug therapy MeSH
- Pancreatectomy MeSH
- Pancreaticoduodenectomy MeSH
- Postoperative Complications MeSH
- Antineoplastic Agents MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
The review describes fentanyl and its analogs as new synthetic opioids and the possibilities of their identification and determination using electrochemical methods (e.g., voltammetry, potentiometry, electrochemiluminescence) and electrochemical methods combined with various separation methods. The review also covers the analysis of new synthetic opioids, their parent compounds, and corresponding metabolites in body fluids, such as urine, blood, serum, and plasma, necessary for a fast and accurate diagnosis of intoxication. Identifying and quantifying these addictive and illicit substances and their metabolites is necessary for clinical, toxicological, and forensic purposes. As a reaction to the growing number of new synthetic opioid intoxications and increasing fatalities observed over the past ten years, we provide thorough background for developing new biosensors, screen-printed electrodes, or other point-of-care devices.
- MeSH
- Fentanyl * MeSH
- Analgesics, Opioid * MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Brain edema - a frequently fatal pathological state in which brain volume increases resulting in intracranial pressure elevation - can result from almost any insult to the brain, including traumatic brain injury. For many years, the objective of experimental studies was to find a method to prevent the development of brain edema at the onset. From this perspective, the use of methylprednisolone (MP) appears promising. High molecular MP (MW>50 kDa) can be incorporated into the brain - in the conditions of the experimental model - either by osmotic blood-brain barrier disruption (BBBd) or during the induction of cellular edema by water intoxication (WI) - a condition that increases the BBB permeability. The time window for administration of the MP should be at the earliest stages of edema. The neuroprotective effect of MP on the permeability of cytoplasmatic membranes of neuronal populations was proved. MP was administrated in three alternative ways: intraperitoneally during the induction of cytotoxic edema or immediately after finishing cytotoxic edema induction in a dose of 100 mg/kg b.w.; into the internal carotid artery within 2 h after finishing cytotoxic edema induction in a dose of 50 mg/kg b.w.; into internal carotid artery 10 min after edema induction by BBBd in a dose of 50 mg/kg b.w.
- MeSH
- Brain Edema drug therapy metabolism pathology MeSH
- Glucocorticoids pharmacology MeSH
- Blood-Brain Barrier drug effects metabolism pathology MeSH
- Capillary Permeability drug effects MeSH
- Rats MeSH
- Methylprednisolone pharmacology MeSH
- Disease Models, Animal MeSH
- Brain drug effects metabolism pathology MeSH
- Neurons drug effects metabolism pathology MeSH
- Neuroprotective Agents pharmacology MeSH
- Rats, Wistar MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Požití muchomůrky zelené (Amanita phalloides) je nejčastější příčinou smrtelné otravy houbami. Klinický obraz intoxikace kolísá od mírných subklinických projevů až po fulminantní průběh s rozvojem akutního selhání jater. Pro osud pacienta má zásadní význam včasná diagnóza intoxikace muchomůrkou zelenou. Ta je ale často obtížná vzhledem k možnosti záměny za gastroenteritidu nebo za otravu jinými houbami. Diagnóza je založena na anamnéze nedávného požití houby s následnými gastrointestinálními příznaky, typickém časovém průběhu a laboratorních vyšetřeních a potvrzuje se mykologickým a toxikologickým vyšetřením. Specifická léčba spočívá v detoxikačních postupech, podpůrných opatřeních, farmakoterapii a v terapii na specializované jednotce intenzivní péče v případě akutního selhání jater. U vybraných pacientů s akutním selháním jater je jedinou možností záchrany života urgentní transplantace jater.
Ingestion of Amanita phalloides is the most common cause of fatal mushroom poisoning. The clinical picture of intoxication varies from mild subclinical manifestation to lethal fulminant course with the development of acute liver failure. Early diagnosis of Amanita phalloides poisoning is crucial for the outcome but i tis difficult because it is often mistaken as gastroenteritis or due to other mushroom poisoning. The diagnosis is based on the history of recent mushroom ingestion followed by gastrointestinal symptoms, typical time course and laboratory markers and is proven with mycological examination or toxicological examination. Specific treatment consists of detoxification procedures, supportive measures, administration of drugs and therapy in the specialized intensive care unit in the case of acute liver failure. In selected patients with acute liver failure urgent liver transplantation is the only life-saving option.
- MeSH
- Acetylcysteine therapeutic use MeSH
- Liver Failure, Acute chemically induced therapy MeSH
- Amanita * pathogenicity MeSH
- Early Diagnosis MeSH
- Decontamination methods MeSH
- Humans MeSH
- Mycotoxins poisoning toxicity MeSH
- Mushroom Poisoning * diagnosis pathology therapy MeSH
- Silybin therapeutic use MeSH
- Toxicity Tests MeSH
- Toxicological Phenomena MeSH
- Liver Transplantation methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
