Acute intoxication with tamsulosin hydrochloride.
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Adrenergic alpha-Antagonists↗
Biomedical subjects
Jacek Sein Anand
Publications and source records attributed to Jacek Sein Anand.
Various clinical aspects of alcohol consumption in trauma patients.
The aim of the study was the evaluation of alcohol consumption pattern, clinical outcome of alcohol misuse patients admitted to traumatology ward as well as estimation of usage of brief intervention strategy. The analyzed group consisted of 137 patients (49 females and 88 males) aged from 17 to 95 (mean 47.8 +/- 21.3) years hospitalized in 2004. All the patients were asked to complete the AUDIT and CAGE tests and were divided into groups according to alcohol consumption. There were analyzed alcohol consumption patterns, patient's medical history and also diagnosis of alcohol misuse. Almost half of the men (45.5%) hospitalized in the traumatology ward had been drinking in hazardous pattern in comparison with 4.1% of women. The most numerous population in this cohort were patients < 35-year-old (38.1%). Both, the group of patients with hazardous alcohol consumption (HAC) (>7 pts. according to AUDIT) and the group of alcohol addicted patients (>1 pts according to CAGE) were mainly represented by males. The anamnesis concerning the alcohol consumption was conducted by the surgeons in only 1 (0.7%) case, but without using any tests. Brief intervention was not used even among those patients who were drunk on admission. There were 45.5% of hazardous drinking males and 4.1% of females among patients admitted to the traumatology ward. None of the surgeons used the screening test to evaluate the drinking misuse of the patients. The brief intervention was not used by the medical staff despite its low cost and high effectiveness.
Adolescent↗
Recreational amitriptyline abuse.
UNLABELLED: Amitriptyline is a potent anticholinergics, rarely used as a drug of abuse. Two cases of amitriptyline dependency lasting for almost twelve months were described. According to the patients the abuse with amitriptyline guarantee them safety not to be uncovered by parents and doctors who systematically checked their urine with typical narcotic tests. CASE REPORT: Two patients with a history of abuse with amphetamine and clonazepam were admitted to the Clinic because of intoxication with amitriptyline. They denied the suicidal attempt and explained that they used amitriptyline in a dosage of 100 to 200 mg per day as a drug of abuse. On the day of admission one of the patients had increased the dosage up to 600 mg which caused an acute intoxication. CONCLUSION: Antidepressants should be treated as a drugs with possible abuse ability.
Adult↗
The social support to patients after suicidal attempts provided by the nurses in Clinic of Acute Poisonings Medical University of Gdańsk.
Nurses and other medical workers have wide ability to provide positive support to patients with low self-esteem. Need of this support is even more important because patients who have tried to attempt suicide are surprisingly less likely to express their needs than other patients. The aim of study was the evaluation of social support provided by nurses working in the Clinic of Acute Poisonings Medical University of Gdańsk to the patients after suicidal attempts. Questionnaire investigation was performed on 40 patients including 32 women and 8 men aged from 14 to 53 (mean 31.4 +/- 13.5) years. Needs and requests of patients after suicidal attempts were mainly limited to getting a proper medical consultation and adequate information. Social support (emotional, valuational, instrumental, informational) provided by nurses proved to be a very important factor in treating patients after suicidal attempts.
Adolescent↗
The relationship between suicidal attempts and menstrual cycle in women.
The purpose of the study was to explore relationship between the menstrual cycle and suicidal attempts. A study was performed on 151 fertile females who were admitted to the Clinic of Internal Diseases and Acute Poisonings Medical University of Gdańsk during the years 2002-2003 because of suicidal attempts. The inclusion criteria were as follows: fertility, regular menstrual cycle, lack of oral contraceptives, willingness to attend the follow up and willingness to see a psychiatrist. Using the anamnesis the patients were also grouped according to the menstrual cycle into menstrual, follicular, midcycle and luteal phase. According to psychiatric investigations every female was classified to the respective category: situational reaction, depression, schizophrenia, alcohol addiction and sociopathy. Severity of intoxication was classified according to Poisoning Severity Score (PSS). Statistical analysis was done with the use of chi-square test with Pearson correction. Suicidal attempts were the most frequent among females during menstrual phase. The most common diagnosis in females who have attempted suicide were situational reactions which dominated in patients aged 14-21 years. Among attempters with the psychiatric diagnosis of depression, schizophrenia and alcohol addiction the degree of poisoning was significantly more severe than in the patients with situational reaction.
Adolescent↗
Acute suicidal self-poisonings during pregnancy.
Selected clinical aspects of suicidal attempts during pregnancy were presented. Nineteen pregnant females, in the age range 17-27 (mean 22 +/- 2.58), were admitted to the Clinic of Acute Poisonings in Gdańsk and Toxicological Ward in Poznań between 2001 and 2004 because of acute suicidal intoxication. The main attention was put on reasons of self-intoxication, the timing of attempted suicide as well as the influence of intoxication on the mother and the child. For most admitted women it was their first pregnancy (12 cases, 63.2%). The week of pregnancy varied from 4 to 37 (mean 19 +/- 9.3) weeks. The most popular drugs for attempting suicide among pregnant females were benzodiazepines (7 cases, 36.8%). The most often reason of suicidal attempts was unplanned pregnancy (9 cases, 47.4%). There were two miscarriages and one premature birth observed in our cases. Acute self-poisonings during pregnancy appeared to be a relatively marginal problem in the analyzed toxicology clinics and occurred in merely 0.38% of all women hospitalized between 2001 and 2004 in both clinics. The main reason of suicidal attempts in pregnant women was unplanned pregnancy (9 cases, 47.4%). None of the studied females admitted that the main reason of suicidal attempt was an abortion induction.
Acute Disease↗
Carbon monoxide--a regulator of vascular tone in hypoxia?
Carbon monoxide is a side product of enzymatic degradation of heme--a reaction catalyzed by heme oxygenase (HO). There are three independent molecular forms (isozymes) of heme oxygenase in man. Isoforms HO-2 and HO-3 are constitutive. More detailed studied isoform HO-2 is especially abundant in the human brain. In contrast to isoforms: HO-2 and HO-3, isoform HO-1 is an inducible species of heme oxygenase. Seen in other tissues, expression of HO-1 is also manifested in the endothelium and smooth muscle of blood vessels. Accumulated experimental data indicate more and more clearly on the possible role of endogenous carbon monoxide in cell cytoprotection, and shows it as a probable factor participating in modulation of the vascular tonus in hypoxia.
Carbon Monoxide↗
Selected clinical aspects of acute intoxication with baclofen.
Baclofen is a lipophilic analogue of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in central nervous system. The aim of the study was to evaluate some clinical aspects of acute intoxication with baclofen. Fifty two patients (37 females and 15 males) aged from 14 to 58 (mean 30.6 +/- 13.7) years were analyzed. Patients were admitted to the Clinic of Internal Diseases and Acute Poisonings Medical University of Gdańsk and the Centre of Acute Poisonings of Praski Hospital in Warszawa during the years 1996-2004 because of suicidal intoxication with baclofen. The doses of baclofen varied from 100 to 1500 (mean 444.8 +/- 317.8) mg. There were twenty eight patients (53.8%) in deep coma (III and IV grade of Matthew scale). Acute respiratory failure which required mechanical ventilation was observed in 18 cases (34.6%). Cardiac abnormalities included bradycardia (36.5%), hypertension (32.7%) and hypotension (3.8%). Toxic psychoses were observed in 6 cases (11.5%). The dosage of baclofen in patients with acute respiratory failure (ARF) was significantly higher than in patients without ARF. Treatment of patients with acute baclofen intoxication should take place in hospitals appropriately equipped which can provide artificial respiration.
Acute Disease↗
Enzymatic examination of potential interaction between statins or fibrates and consumed Tricholoma equestre.
The enzymatic investigations were done in 56 patients, including 30 females and 26 males in the age range 18-76 (mean 52 +/- 12). Thirty two of them (57.1%) suffered from type 2 diabetes. All the patients consumed voluntarily Tricholoma equestre; 43 of them only once from 70 to 150 g, and 13 patients from two to four times for 4 consecutive days (between 300 g and 1200 g). Twenty seven patients, because of hyperlipidemia, took statins (simvastatin á 20 mg--15 patients, lovastatin á 20 mg--6 patients, fluvastatin á 80 mg--3 patients, atorvastatin á 20 mg--3 patients) and seven took fibrates (4 patients-- enofibrate á 267 mg, and 3 patients--ciprofibrate á 100 mg). Two subjects ingested both simvastatin á 20 mg and fenofibrate á 267 mg. Three to six days after the last mushroom dish, blood samples were taken from patients to examine the serum creatine kinase (CK), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities. The biochemical analyses were performed by means of the kinetic spectrophotometry using the autoanalyzer Architect ClI8200 with Abbott proprietary reagents. Statistical analysis was performed by means of t-Student test. Tricholoma equestre taken by patients in a total amount from 70 g to 1200 g for four consecutive days did not cause the significant increase in serum CK, AST, ALT activities. Similar mushroom dishes consumed by patients constantly using statins or fibrates also did not increase significantly the serum CK, AST, ALT activities. Patients treated with statins or fibrates may eat Tricholoma equestre in reasonable amount according to the established tradition.
Adult↗
[Liver albumin dialysis (MARS)--treatment of choice in Amanita phalloides poisoning?].
UNLABELLED: Amanita phalloides is a direct life-threatening poisoning because of acute multiorgan failure. Urgent liver transplantation (LTx) is the last chance to save patient's life in severe cases. In many cases of mushroom poisoning the patient dies because of unavailability of a liver graft. Liver albumin dialysis (MARS) is a promising treatment to bridge the patient to LTx or stabilize his or her condition until spontaneous liver regeneration occurs. CASE REPORT: Four family members (father, mother and two sons) were eating self-collected mushrooms (Russula vesca). Typically for the Amanita phalloides poisoning, the first symptoms appeared in all persons more than 12 hours after mushroom ingestion. Because they did not improve, the whole family was admitted to the Regional Hospital in Ketrzyn (24 hours after mushroom ingestion). Mycological examination of gastric washings was positive only in the mother, in whom the Amanita phalloides spores were found. During the first 48 hours of poisoning the biochemical indexes of liver injury were observed in all persons. The whole family members were sent to centers where liver albumin dialysis could be performed: the mother was admitted to the Department of Nephrology and Dialysis Therapy in Olsztyn, the father and the first son were admitted to the Clinical Toxicology Department in Krak6w, and the second son was admitted to the Department of Internal Medicine and Acute Poisonings in Gdańsk. Three albumin dialysis procedures were performed in the case of mother with complete liver recovery. After the first liver albumin dialysis, the father of the family was disqualified from the following procedures because of severe coagulation disturbances (GI bleeding), and died the fourth day after mushroom ingestion. The first son fulfilled the King's College criteria and was accepted for high urgency liver transplantation. After two albumin dialysis procedures had been able and the patient was urgently sent to the Department of General and Transplantation Surgery in Szczecin, where liver transplantation was successfully performed. The second son was treated conservatively with improvement of general condition and biochemical indexes and no albumin dialysis procedure was necessary. CONCLUSION: Liver albumin dialysis may be effective in severe Amanita phalloides poisoning to stabilize the condition of a patient until spontaneous liver regeneration occurs or as a bridge to LTx. In cases of a family poisoning, proper coordination and cooperation among toxicology departments and transplant centers is required.
Adult↗
Molecular adsorbent recirculating system--MARS as a bridge to liver transplantation in amanita phalloides intoxication.
UNLABELLED: A case of a 46-year-old female intoxicated with Amanita phalloides was presented. Since constant deterioration of her liver function she was put on the waiting list for urgent liver transplantation. To improve her clinical condition two sessions of Molecular Adsorbent Recirculating System were provided with transient good results. About 72 hours after the mushroom ingestion the patient had undergone liver transplantation. CONCLUSIONS: Despite good clinical condition the patients severely poisoned with Amanita phalloides should be placed on a waiting list for liver transplantation as early as possible. The Molecular Adsorbent Recirculating System should be introduced as soon as possible after Amanita phalloides intoxication. Albumin dialysis may be considered as a bridge for the liver transplantation in patients intoxicated with Amanita phalloides.
Amanita↗
[Cocaine smuggling in the gastrointestinal tract--the case report with the review of literature].
Body-packing is the way of psychoactive substances smuggling by swallowing of carefully prepared packages with drugs into the gastrointestinal tract or by insertion them into the vagina or the rectum, especially in order to avoid finding them by the custom service. Cocaine, as well as opiates, is the one of the most often smuggled drugs by so called body-packers. In the present study the first case of the body-packer from Malopolska region in Poland, who was observed in the Toxicology Department of the Collegium Medicum UJ, was described. The 29-year-old man swallowed 60 packages containing cocaine with a total net weight of about 500 grams. The plain abdominal radiography revealed multiple shadows of foreign bodies in the gastrointestinal tract, but the results of blood and urine cocaine measurements were negative. During the 37-hours stay in our department the patient was monitored (blood pressure, heart rate, temperature), laxatives and oral fluids were administered. All the packages were evacuated through the natural way and it was followed up by the control abdominal radiography. No symptoms of acute cocaine intoxication or any other complications were observed. According to the case there is also the thorough review of literature presented including the kinds of body-packing, the diagnostic methods used in recognizing of body-packers and the ways of their treatment taking into consideration the conservative management as well as surgical methods.
Adult↗
Cocaine smuggling in the gastrointestinal tract resulting in mechanical pylorostenosis.
A 45-year-old male, body packer, who confessed to have swallowed 44 packages of cocaine in a total dose of approx. 360 g, was admitted to hospital because of clinical signs of acute intoxication with cocaine followed by ileus. The emergency surgical gastrotomy was initiated, and the conglomerate of Scotch tape and packages with cocaine were removed. Small rupture of one package of cocaine in a body packer stomach caused acute poisoning with cocaine, confirmed additionally by the presence of its metabolites in the urine. Mechanical pylorostenosis provoked by cocaine packages required emergency surgical operation.
Acute Disease↗
Acute suicidal intoxication with tacrolimus in a kidney transplant patient.
A case of a 23-year-old female, after renal transplant, who had tried to commit suicide with 100 mg of Prograf was described. In the presented case despite the relatively high tacrolimus blood concentration level (>30 microg/l) only severe 5-hour lasting headache and short-term mild hyperglycaemia (7.22 mmol/l), hyperkalemia (5.4 mmol/l) and considerable leukocytosis (19.52 x 10(3)) were observed. In this case there was mild clinical course of intoxication despite tacrolimus high blood concentration. It could not be excluded that early administration of gastric lavage and activated carbon was partly responsible for mild course of poisoning.
Acute Disease↗
Acute suicidal intoxication with topiramate.
According to the best of our knowledge this is the first case of intoxication with topiramate in Polish medical literature. A case of a 15-year-old female who tried to commit suicide with 450 mg of Topamax was described. There were no significant changes in the medical examination as well as biochemical results. An agitation which transformed into bradykinesia and bradyphasia and lasted for about 24 hours were the only complaints of the patient.
Acute Disease↗
Multifactorial hypoglycaemic coma in female bodybuilder.
A 31-year-old female bodybuilder who was admitted to the Clinic because of deep coma and hypoglycaemia was presented. For last six weeks she had been preparing for a competition doing aerobic and anaerobic exercises, ingesting rich-protein and low-carbohydrate diet and administering a low dose of somatotropin every day. Even for the regional competitions there is a need for exact doping check among young athletes. Growth hormone in a small dosage taken together with low-carbohydrate and rich-protein diet can provoke deep hypoglicemia among people who use it for doping purposes.
Adult↗
Repeated intensification of lower urinary tract symptoms in the patient with benign prostatic hyperplasia during bisoprolol treatment.
A case of a 60-year-old male patient, suffering from benign prostatic hyperplasia (BPH), with deterioration of lower urinary tract symptoms (LUTS) during antihypertensive treatment with bisoprolol was presented. Discontinuation of beta-blocker resulted in giving a relief whereas the resumption of its use caused repeated deterioration. Bisoprolol deteriorated lower urinary tract symptoms in patient with benign prostatic hyperplasia. Increase of lower urinary tract symptoms caused by beta-blockers can be more significant in elderly men.
Adrenergic beta-Antagonists↗
Regression of long standing anorexia nervosa following acute renal failure caused by gentamicin intoxication.
A female patient aged 22 with fully developed symptoms of anorexia nervosa presented the following metabolic disturbances: persistent hyperuricemia, hyponatruria, (sometimes with sodium lack in urine) as well as frequent hyponatremia and hyper-uricosuria. The patient's low arterial blood pressure (70/40 mm Hg on average) was not improved by pharmacological treatment, and only high oral doses of table salt (20-70 g/24 h) did prove effective in the therapy. The subject passed seven renal calculi composed of sodium urate and uric acid. Numerous urinalyses did not reveal any changes, and bacterial cultures of the urine were also negative. After 14 years of anorexia nervosa, the patient was treated for pneumonia with gentamicin at doses of 2 x 80 mg/24 h. Following third dose of the antibiotic, the patient developed acute renal failure and was treated by haemodialysis for six weeks. The renal function came gradually to the norm. Simultaneously, all the anorexia nervosa symptoms subsided along with sodium metabolism disturbances, while purine metabolism disorders got considerably alleviated. The patient started to have her menstrual cycles again, gained 12 kg in body weight, and one year afterwards bore a son. A further 10-year follow-up period was free of any pathological changes except for a slight hyperuricemia. To the best of our knowledge, the similar case has not been reported in the medical literature and electronic data bases.
Acute Kidney Injury↗