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Peng H, Shahidi F. Metabolic, toxicological, chemical, and commercial perspectives on esterification of dietary polyphenols: a review. Crit Rev Food Sci Nutr 2024; 64:7465-7504. [PMID: 36908213 DOI: 10.1080/10408398.2023.2185589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Molecular modifications have been practiced for more than a century and nowadays they are widely applied in food, pharmaceutical, or other industries to manipulate the physicochemical, bioactivity, metabolic/catabolic, and pharmacokinetic properties. Among various structural modifications, the esterification/O-acylation has been well-established in altering lipophilicity and bioactivity of parent bioactive compounds, especially natural polyphenolics, while maintaining their high biocompatibility. Meanwhile, various classic chemical and enzymatic protocols and other recently emerged cell factory technology are being employed as viable esterification strategies. In this contribution, the main motivations of phenolic esterification, including the tendency to replace synthetic alkyl phenolics with safer alternatives in the food industry to improve the bioavailability of phenolics as dietary supplements/pharmaceuticals, are discussed. In addition, the toxicity, metabolism, and commercial application of synthetic and natural phenolics are briefly introduced. Under these contexts, the mechanisms and reaction features of several most prevalent chemical and enzymatic esterification pathways are demonstrated. In addition, insights into the studies of esterification modification of natural phenolic compounds and specific pros/cons of various reaction systems with regard to their practical application are provided.
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Affiliation(s)
- Han Peng
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Fereidoon Shahidi
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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2
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van den Berg MM, Wong AB, Houtak G, Williamson RS, Borst JGG. Sodium salicylate improves detection of amplitude-modulated sound in mice. iScience 2024; 27:109691. [PMID: 38736549 PMCID: PMC11088340 DOI: 10.1016/j.isci.2024.109691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/14/2024] [Accepted: 04/05/2024] [Indexed: 05/14/2024] Open
Abstract
Salicylate is commonly used to induce tinnitus in animals, but its underlying mechanism of action is still debated. We therefore tested its effects on the firing properties of neurons in the mouse inferior colliculus (IC). Salicylate induced a large decrease in the spontaneous activity and an increase of ∼20 dB SPL in the minimum threshold of single units. In response to sinusoidally modulated noise (SAM noise) single units showed both an increase in phase locking and improved rate coding. Mice also became better at detecting amplitude modulations, and a simple threshold model based on the IC population response could reproduce this improvement. The responses to dynamic random chords (DRCs) suggested that the improved AM encoding was due to a linearization of the cochlear output, resulting in larger contrasts during SAM noise. These effects of salicylate are not consistent with the presence of tinnitus, but should be taken into account when studying hyperacusis.
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Affiliation(s)
- Maurits M. van den Berg
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, NL-3015 GD Rotterdam, the Netherlands
| | - Aaron B. Wong
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, NL-3015 GD Rotterdam, the Netherlands
| | - Ghais Houtak
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, NL-3015 GD Rotterdam, the Netherlands
| | - Ross S. Williamson
- Pittsburgh Hearing Research Center, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - J. Gerard G. Borst
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, NL-3015 GD Rotterdam, the Netherlands
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3
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Peketi SH, Upadrista PK, Cadet B, Cadet J, Cadet N. Salicylate Poisoning and Rebound Toxicity. Cureus 2024; 16:e60241. [PMID: 38746490 PMCID: PMC11093619 DOI: 10.7759/cureus.60241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/16/2024] Open
Abstract
Salicylate exposure and toxicity are associated with a myriad of symptoms and signs, and a comprehensive knowledge of diagnosing and treating salicylate poisoning is needed. Here, we present a case of a 29-year-old female with a past medical history of schizoaffective disorder and bipolar disorder with multiple suicide attempts brought to our hospital, Nassau University Medical Center, East Meadow, by the Emergency Medical Service (EMS) due to an intentional overdose of 300 pills of acetylsalicylic acid. She had mixed acid-base disturbance with respiratory alkalosis and metabolic acidosis. She was started on bicarbonate infusion in the emergency department to maintain a blood pH of 7.5 and to maintain a urine pH of more than 7.5. As her salicylate levels were 98.2 at admission with altered mental status, she was started on slow, low-efficiency hemodialysis. A few hours later, she developed a rebound increase in salicylate levels to 129, associated with a change in mental status and the patient was more confused. She was started on regular hemodialysis with improvement in mental status and elimination of salicylate steadily. Given the extensive nature of toxic effects, a patient with severe salicylate toxicity can deteriorate rapidly and can be challenging to manage. As there is no specific antidote for aspirin, the goals of therapy depend primarily on limiting the absorption of salicylate, enhancing elimination, and providing supportive care. Monitoring the acid-base status and serum salicylate levels closely and monitoring for rebound increase in salicylate levels is of paramount importance. Aggressive hydration to maintain euvolemia, alkalinization, aggressive replenishment of potassium and magnesium, activated charcoal to decrease absorption, and hemodialysis remain the cornerstones of treatment.
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Affiliation(s)
| | | | - Bair Cadet
- Nephrology, Nassau University Medical Center, East Meadow, USA
| | - Johanne Cadet
- Nursing, New York City (NYC) Health Plus Hospitals South Brooklyn Health, New York, USA
| | - Noonkee Cadet
- Nursing, Texas Department Criminal Justice Hospital, Galveston, USA
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Onyango DO, Selman BG, Rose JL, Ellison CA, Nash JF. Comparison between endocrine activity assessed using ToxCast/Tox21 database and human plasma concentration of sunscreen active ingredients/UV filters. Toxicol Sci 2023; 196:25-37. [PMID: 37561120 PMCID: PMC10613966 DOI: 10.1093/toxsci/kfad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Sunscreen products are composed of ultraviolet (UV) filters and formulated to reduce exposure to sunlight thereby lessening skin damage. Concerns have been raised regarding the toxicity and potential endocrine disrupting (ED) effects of UV filters. The ToxCast/Tox21 program, that is, CompTox, is a high-throughput in vitro screening database of chemicals that identify adverse outcome pathways, key events, and ED potential of chemicals. Using the ToxCast/Tox21 database, octisalate, homosalate, octocrylene, oxybenzone, octinoxate, and avobenzone, 6 commonly used organic UV filters, were found to have been evaluated. These UV filters showed low potency in these bioassays with most activity detected above the range of the cytotoxic burst. The pathways that were most affected were the cell cycle and the nuclear receptor pathways. Most activity was observed in liver and kidney-based bioassays. These organic filters and their metabolites showed relatively weak ED activity when tested in bioassays measuring estrogen receptor (ER), androgen receptor (AR), thyroid receptor, and steroidogenesis activity. Except for oxybenzone, all activity in the endocrine assays occurred at concentrations greater than the cytotoxic burst. Moreover, except for oxybenzone, plasma concentrations (Cmax) measured in humans were at least 100× lower than bioactive (AC50/ACC) concentrations that produced a response in ToxCast/Tox21 assays. These data are consistent with in vivo animal/human studies showing weak or negligible endocrine activity. In sum, when considered as part of a weight-of-evidence assessment and compared with measured plasma concentrations, the results show these organic UV filters have low intrinsic biological activity and risk of toxicity including endocrine disruption in humans.
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Affiliation(s)
- David O Onyango
- Global Product Stewardship, The Procter & Gamble Company, Mason, Ohio 45040, USA
| | - Bastian G Selman
- Global Product Stewardship, The Procter & Gamble Company, Mason, Ohio 45040, USA
| | - Jane L Rose
- Global Product Stewardship, The Procter & Gamble Company, Mason, Ohio 45040, USA
| | - Corie A Ellison
- Global Product Stewardship, The Procter & Gamble Company, Mason, Ohio 45040, USA
| | - J F Nash
- Global Product Stewardship, The Procter & Gamble Company, Mason, Ohio 45040, USA
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Cecone C, Iudici M, Ginepro M, Zanetti M, Trotta F, Bracco P. Dextrin-Based Adsorbents Synthesized via a Sustainable Approach for the Removal of Salicylic Acid from Water. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:2805. [PMID: 37887955 PMCID: PMC10609289 DOI: 10.3390/nano13202805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
Pharmaceuticals such as salicylic acid are commonly detected in wastewater and surface waters, increasing concern for possible harmful effects on humans and the environment. Their difficult removal via conventional treatments raised the need for improved strategies, among which the development of bioderived adsorbents gained interest because of their sustainability and circularity. In this work, biobased cross-linked adsorbents, synthesized via a sustainable approach from starch derivatives, namely beta-cyclodextrins and maltodextrins, were at first characterized via FTIR-ATR, TGA, SEM, and elemental analysis, showing hydrophilic granular morphologies endowed with specific interaction sites and thermal stabilities higher than 300 °C. Subsequently, adsorption tests were carried out, aiming to assess the capabilities of such polymers on the removal of salicylic acid, as a case study, from water. Batch tests showed rapid kinetics of adsorption with a removal of salicylic acid higher than 90% and a maximum adsorption capacity of 17 mg/g. Accordingly, continuous fixed bed adsorption tests confirmed the good interaction between the polymers and salicylic acid, while the recycling of the adsorbents was successfully performed up to four cycles of use.
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Affiliation(s)
- Claudio Cecone
- Department of Chemistry, Nis Interdepartmental Centre, University of Turin, Via P. Giuria 7, 10125 Turin, Italy (M.G.); (M.Z.); (P.B.)
| | - Mario Iudici
- Department of Chemistry, Nis Interdepartmental Centre, University of Turin, Via P. Giuria 7, 10125 Turin, Italy (M.G.); (M.Z.); (P.B.)
| | - Marco Ginepro
- Department of Chemistry, Nis Interdepartmental Centre, University of Turin, Via P. Giuria 7, 10125 Turin, Italy (M.G.); (M.Z.); (P.B.)
| | - Marco Zanetti
- Department of Chemistry, Nis Interdepartmental Centre, University of Turin, Via P. Giuria 7, 10125 Turin, Italy (M.G.); (M.Z.); (P.B.)
- INSTM Reference Centre, University of Turin, Via G. Quarello 15A, 10135 Turin, Italy
- ICxT Interdepartmental Centre, University of Turin, Via Lungo Dora Siena 100, 10153 Turin, Italy
| | - Francesco Trotta
- Department of Chemistry, Nis Interdepartmental Centre, University of Turin, Via P. Giuria 7, 10125 Turin, Italy (M.G.); (M.Z.); (P.B.)
| | - Pierangiola Bracco
- Department of Chemistry, Nis Interdepartmental Centre, University of Turin, Via P. Giuria 7, 10125 Turin, Italy (M.G.); (M.Z.); (P.B.)
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Lee SH, Shin C, Hwang I, Kim H, Kim Y, Park HS, Park CW, Yang CW, Chung BH, Ko EJ, Lee H. Case 12: A 84-Year-Old Man With Decreased Consciousness and Hyperpnea. J Korean Med Sci 2023; 38:e222. [PMID: 37431545 DOI: 10.3346/jkms.2023.38.e222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 07/12/2023] Open
Affiliation(s)
- Seung-Hwan Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Changyong Shin
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Injoon Hwang
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunglae Kim
- Division of Nephrology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yaeni Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hoon Suk Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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7
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Tzima CS, Banti CN, Hatzidimitriou AG, Hadjikakou SK. Possible implementation of salicylate anions in lead detoxification. J Inorg Biochem 2023; 244:112225. [PMID: 37075542 DOI: 10.1016/j.jinorgbio.2023.112225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
The water-soluble coordination polymer of formula {[Pb(Sal)2(H2O)]n} (SaLead), was obtained from the reaction between Pb(NO3)2 and the potassium salt of salicylic acid (SalH), an anti-inflammatory drug, which is also use as food preservation, in cosmetics etc. The compound was characterized by melting point, Attenuated Total Reflectance-Fourier Transform Infra-Red (ATR-FTIR) spectroscopy and X-ray diffraction crystallography (XRD) in solid state and in solution by Ultra Violet (UV) and 1H NMR spectroscopies. The binding affinity of SalK to Pb(II) ions towards SaLead was determined in order to examine its possible implementation in lead detoxification. The in vitro non-toxic behaviour of SalK and its complex SaLead was evaluated against normal human fetal lung fibroblast cells (MRC-5). The corresponding IC50 values are 260 ± 13 and > 1600 μM respectively. The non-genotoxic in vitro activity of SaLead was confirmed with the micronucleus (MN) assay, while its in vivo non-toxicity behaviour was evaluated with Allium cepa and Artemia salina assays.
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Affiliation(s)
- Chrysoula S Tzima
- Section of Inorganic and Analytical Chemistry, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece
| | - Christina N Banti
- Section of Inorganic and Analytical Chemistry, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece.
| | | | - Sotiris K Hadjikakou
- Section of Inorganic and Analytical Chemistry, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece; University Research Center of Ioannina (URCI), Institute of Materials Science and Computing, Ioannina, Greece.
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8
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Granfone A, Applewhite BP, Palmer BF, Jobbagy S. Case 2-2023: A 76-Year-Old Man with Dizziness and Altered Mental Status. N Engl J Med 2023; 388:264-272. [PMID: 36652358 DOI: 10.1056/nejmcpc2201240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Antonio Granfone
- From the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Massachusetts General Hospital, and the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Harvard Medical School - both in Boston; and the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (B.F.P.)
| | - Brooks P Applewhite
- From the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Massachusetts General Hospital, and the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Harvard Medical School - both in Boston; and the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (B.F.P.)
| | - Biff F Palmer
- From the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Massachusetts General Hospital, and the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Harvard Medical School - both in Boston; and the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (B.F.P.)
| | - Soma Jobbagy
- From the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Massachusetts General Hospital, and the Departments of Medicine (A.G.), Radiology (B.P.A.), and Pathology (S.J.), Harvard Medical School - both in Boston; and the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (B.F.P.)
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9
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Protective Effect of Resveratrol in an Experimental Model of Salicylate-Induced Tinnitus. Int J Mol Sci 2022; 23:ijms232214183. [PMID: 36430660 PMCID: PMC9692321 DOI: 10.3390/ijms232214183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
To date, the effect of resveratrol on tinnitus has not been reported. The attenuative effects of resveratrol (RSV) on a salicylate-induced tinnitus model were evaluated by in vitro and in vivo experiments. The gene expression of the activity-regulated cytoskeleton-associated protein (ARC), tumor necrosis factor-alpha (TNFα), and NMDA receptor subunit 2B (NR2B) in SH-SY5Y cells was examined using qPCR. Phosphorylated cAMP response element-binding protein (p-CREB), apoptosis markers, and reactive oxygen species (ROS) were evaluated by in vitro experiments. The in vivo experiment evaluated the gap-prepulse inhibition of the acoustic startle reflex (GPIAS) and auditory brainstem response (ABR) level. The NR2B expression in the auditory cortex (AC) was determined by immunohistochemistry. RSV significantly reduced the salicylate-induced expression of NR2B, ARC, and TNFα in neuronal cells; the GPIAS and ABR thresholds altered by salicylate in rats were recovered close to their normal range. RSV also reduced the salicylate-induced NR2B overexpression of the AC. These results confirmed that resveratrol exerted an attenuative effect on salicylate-induced tinnitus and may have a therapeutic potential.
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Dorfman JD. Near Hanging: Evaluation and Management. Chest 2022; 163:855-860. [PMID: 36372303 PMCID: PMC9647002 DOI: 10.1016/j.chest.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
Prior to the COVID-19 pandemic, the incidence of self-harm was already on the rise. Hanging/suffocation accounted for 50% of the increase in suicide attempts and remains the second leading cause of death from self-harm in the United States. Studies on the management of near-hanging patients are lacking, and most published literature is retrospective. Following airway and circulation assessment, clinical examination and imaging, namely CT angiography, remain the standard for identifying the injuries associated with near hanging: cervical spine fracture, blunt cerebrovascular injury, laryngeal injury, and injury to the trachea and oropharynx. These injuries, however, are uncommon, and each occur in < 5% of patients in most series. In a large series of critically ill near-hanging patients, > 50% survived to hospital discharge; however, cardiac arrest predicted a poor outcome. The management of asphyxia-related arrest remains controversial. Targeted temperature management has only been studied in a single large multicenter trial, which was retrospective. Given the significant selection bias of targeted temperature management in the treatment of the most ill patients, no firm recommendations can be made. Finally, for survivors, the underlying mental health issues must be addressed to avoid recurrent suicide attempts. Thirty percent of patients in a large near-hanging series were admitted for their second suicide attempt.
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Affiliation(s)
- Jon D Dorfman
- Division of Trauma and Surgical Critical Care, UMass Memorial, Worcester, MA.
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Chen N, Wang XC, Fan LL, Zhu YH, Wang Q, Chen YB. Berberine ameliorates lipopolysaccharide-induced cognitive impairment through Sirt1/Nrf2/NF-κB signaling pathway in C57BL/6J mice. Rejuvenation Res 2022; 25:233-242. [PMID: 36029207 DOI: 10.1089/rej.2022.0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The inflammatory response is the stress reactions to infection or injury so as to help the body return to normal as soon as possible. In central nervous system, the over activated immune system causes irreversible damage to neurons and synapses,which results in cognitive impairment. Berberine,an isoquinoline alkaloid extracted from Coptidis Rhizoma,plays a powerful role in anti-inflammation.It has been reported that berberine significantly improved the decline of cognitive ability.Therefore,we carried out this work to find out the specific mechanism.We tested behaviourally that berberine administration did improve lipopolysaccharide (LPS)-induced cognitive impairment in C57BL/6J mice. We found that berberine reduced neuronal damage in the hippocampus by Nissl staining, and verified by Western blot and immunofluorescence that berberine improved LPS-induced cognitive impairment through the SIRT1/NRF2/NF-κB signaling pathway.The results showed that berberine plays an anti-inflammatory and antioxidant role by targeting SIRT1/NRF2/NFκB signaling pathway so as to reduce the cognitive impairment and neuronal damage caused by lipopolysaccharide in C57BL/6J mice.Berberine pre-protection increased the expression of heme oxygenase-1 (HO-1) after activating nuclear factor E2 related factor 2 (NRF2), and inhibited the activation of NF-κB and the release of iNOS, which may be related to berberine activating SIRT1. However,the effect of reducing inflammatory response was inhibited after using SIRT1 inhibitor EX527 in vitro.This research explains the significance of anti-inflammatory in the treatment of cognitive impairment from different angles. Key words: berberine;lipopolysaccharide;cognitive impairment; neuroinflammation; SIRT1.
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Affiliation(s)
- Nan Chen
- Guangzhou University of Chinese Medicine Science and Technology Innovation Center, Guangzhou, Guangzhou, China, 510006;
| | | | - Ling-Ling Fan
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China;
| | - Yu-Huang Zhu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China;
| | - Qi Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China;
| | - Yun-Bo Chen
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China;
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Horseman M, Panahi L, Udeani G, Tenpas AS, Verduzco Jr. R, Patel PH, Bazan DZ, Mora A, Samuel N, Mingle AC, Leon LR, Varon J, Surani S. Drug-Induced Hyperthermia Review. Cureus 2022; 14:e27278. [PMID: 36039261 PMCID: PMC9403255 DOI: 10.7759/cureus.27278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
Humans maintain core body temperature via a complicated system of physiologic mechanisms that counteract heat/cold fluctuations from metabolism, exertion, and the environment. Overextension of these mechanisms or disruption of body temperature homeostasis leads to bodily dysfunction, culminating in a syndrome analogous to exertional heat stroke (EHS). The inability of this thermoregulatory process to maintain the body temperature is caused by either thermal stress or certain drugs. EHS is a syndrome characterized by hyperthermia and the activation of systemic inflammation. Several drug-induced hyperthermic syndromes may resemble EHS and share common mechanisms. The purpose of this article is to review the current literature and compare exertional heat stroke (EHS) to three of the most widely studied drug-induced hyperthermic syndromes: malignant hyperthermia (MH), neuroleptic malignant syndrome (NMS), and serotonin syndrome (SS). Drugs and drug classes that have been implicated in these conditions include amphetamines, diuretics, cocaine, antipsychotics, metoclopramide, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and many more. Observations suggest that severe or fulminant cases of drug-induced hyperthermia may evolve into an inflammatory syndrome best described as heat stroke. Their underlying mechanisms, symptoms, and treatment approaches will be reviewed to assist in accurate diagnosis, which will impact the management of potentially life-threatening complications.
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Andrade del Olmo J, Pérez-Álvarez L, Sáez-Martínez V, Benito-Cid S, Ruiz-Rubio L, Pérez-González R, Vilas-Vilela JL, Alonso JM. Wound healing and antibacterial chitosan-genipin hydrogels with controlled drug delivery for synergistic anti-inflammatory activity. Int J Biol Macromol 2022; 203:679-694. [DOI: 10.1016/j.ijbiomac.2022.01.193] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/15/2022] [Accepted: 01/30/2022] [Indexed: 02/08/2023]
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14
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Isoardi KZ, Henry C, Harris K, Isbister GK. Activated Charcoal and Bicarbonate for Aspirin Toxicity: a Retrospective Series. J Med Toxicol 2022; 18:30-37. [PMID: 34845647 PMCID: PMC8758842 DOI: 10.1007/s13181-021-00865-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Aspirin overdose causes acid-base disturbances and organ dysfunction. Management is guided by research reported over 50 years ago when chronic aspirin toxicity was common and accounted for significant morbidity. We investigate our experience of aspirin overdose and the effectiveness of charcoal and bicarbonate administration over 20 years. METHODS This is a retrospective series of acute aspirin overdose from two toxicology units from January 2000 to September 2019. Acute aspirin ingestions > 3000 mg were identified in each unit's database. Excluded were cases of chronic exposure, hospital presentation > 24 hours after ingestion, and cases without a salicylate concentration. Included in our analysis was demographic data, clinical effects, investigations, complications, and treatment. RESULTS There were 132 presentations in 108 patients (79 females (73%)). The median age was 28 years (range: 13-93 years). The median dose ingested was 7750 mg (IQR: 6000-14,400 mg). There were 44 aspirin-only ingestions. Mild toxicity (nausea, vomiting, tinnitus or hyperventilation) occurred in 22 with a median dose of 160 mg/kg. Moderate toxicity (acid-base disturbance, confusion) occurred in 16 with a median ingested dose of 297 mg/kg. There were no cases of severe toxicity (coma or seizures) due to aspirin alone. The median peak salicylate concentration was 276 mg/L (IQR: 175-400 mg/L, range: 14-814 mg/L). There was a moderate association between dose ingested and peak concentration (Pearson r = 0.58; 95% CI 0.45-0.68). Activated charcoal was administered in 36 (27%) cases, which decreased the median peak salicylate concentration (34.2 to 24.8 mg/L/g (difference: 9.4, 95% CI: 1.0-13.1)). Bicarbonate was administered in 34 (26%) presentations, decreasing the median apparent elimination half-life from 13.4 to 9.3 h (difference: 4.2 h, 95% CI: 1.0-6.5 h). CONCLUSIONS Acute aspirin overdose caused only mild to moderate effects in this series. Early administration of activated charcoal decreased absorption and use of bicarbonate enhanced elimination.
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Affiliation(s)
- K Z Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia.
| | - C Henry
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - K Harris
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - G K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia
- Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, NSW, Australia
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15
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Posen AK, Paloucek FP, Gimbar RP. Anion gap physiology and faults of the correction formula. Am J Health Syst Pharm 2021; 79:446-451. [PMID: 34788391 DOI: 10.1093/ajhp/zxab423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The anion gap is a calculated fundamental laboratory parameter used to identify and monitor acid-base disturbances. A recently popularized correction formula transforms the resulting integer to compensate for hypoalbuminemia and improve diagnostic yield. Clinical pharmacists should be aware of the underlying biochemistry, interpretation, and limitations of this formula to discern drug- and disease-related etiologies. SUMMARY The anion gap is utilized in most care settings, ranging from outpatient monitoring to inpatient intensive care units. Supported by decades of experience, the original anion gap derives its value from its simplicity. Applying the anion gap in metabolic acidosis can help narrow differential diagnosis and detect concomitant acid-base disorders. To account for hypoalbuminemia and potential missed diagnoses, a correction formula was developed to improve sensitivity. Yet, the law of electroneutrality ensures that hypoalbuminemia is already accounted for in the original anion gap, and the proposed correction formula was derived from samples unrepresentative of human physiology. Evidence from clinical trials shows no benefit from applying the correction formula. CONCLUSION There is no advantage to correcting the anion gap, and such correction may increase the risk of misinterpretation or error. Clinicians should understand these limitations when diagnosing or trending acid-base disturbances.
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Affiliation(s)
- Andrew K Posen
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Frank P Paloucek
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Renee Petzel Gimbar
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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16
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Neumann NR, Thompson DC, Vasiliou V. AMPK activators for the prevention and treatment of neurodegenerative diseases. Expert Opin Drug Metab Toxicol 2021; 17:1199-1210. [PMID: 34632898 DOI: 10.1080/17425255.2021.1991308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION As the global population ages at an unprecedented rate, the burden of neurodegenerative diseases is expected to grow. Given the profound impact illness like dementia exert on individuals and society writ large, researchers, physicians, and scientific organizations have called for increased investigation into their treatment and prevention. Both metformin and aspirin have been associated with improved cognitive outcomes. These agents are related in their ability to stimulate AMP kinase (AMPK). Momordica charantia, another AMPK activator, is a component of traditional medicines and a novel agent for the treatment of cancer. It is also being evaluated as a nootropic agent. AREAS COVERED This article is a comprehensive review which examines the role of AMPK activation in neuroprotection and the role that AMPK activators may have in the management of dementia and cognitive impairment. It evaluates the interaction of metformin, aspirin, and Momordica charantia, with AMPK, and reviews the literature characterizing these agents' impact on neurodegeneration. EXPERT OPINION We suggest that AMPK activators should be considered for the treatment and prevention of neurodegenerative diseases. We identify multiple areas of future investigation which may have a profound impact on patients worldwide.
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Affiliation(s)
- Natalie R Neumann
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David C Thompson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA
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17
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Wiederkehr MR, Benevides R, Santa Ana CA, Emmett M. Pseudohyperchloremia and Negative Anion Gap - Think Salicylate! Am J Med 2021; 134:1170-1174. [PMID: 33864761 DOI: 10.1016/j.amjmed.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pseudohyperchloremia results in a very low or negative anion gap. Historically, the most common cause of this artifact was bromide poisoning. Bromide salts have been removed from most medications and bromism has become very uncommon. More recently, the introduction of chloride ion selective sensing electrodes (Cl-ISE) has generated a new cause of pseudohyperchloremia-salicylate poisoning. We describe 5 such patients and quantitate the error generated by this measurement artifact. METHODS The magnitude of artifactual hyperchloremia generated by high salicylate levels was quantified in 5 patients by measuring chloride concentration with several Cl-ISEs from different manufacturers and with Cl-ISEs of different "ages," and comparing these results to measurements with a chloridometer (coulometric titration), which is free of the salicylate artifact. RESULTS Cl-ISEs from different manufacturers generated a wide range of artifactual chloride concentration elevation. Furthermore, the same Cl-ISE generated increasingly severe pseudohyperchloremia as it was repeatedly reused over time and "aged." CONCLUSIONS Salicylate interferes with measurement of the blood chloride concentration when a Cl-ISE is used. The severity of this artifact is related to the salicylate level, the specific Cl-ISE, and the "age" of the electrode. Toxic blood salicylate levels can generate marked pseudohyperchloremia, and consequently, an artifactual very small or negative anion gap. The large anion gap metabolic acidosis typical of salicylate poisoning is masked by this artifact. Salicylate has become the most common cause of pseudohyperchloremia, and physicians should immediately consider salicylate poisoning whenever the combination of hyperchloremia and a very small or negative anion gap is reported by the laboratory.
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Affiliation(s)
- Michael R Wiederkehr
- Nephrology Division, Baylor University Medical Center, Dallas, Texas; Texas A&M School of Medicine, Bryan
| | - Raul Benevides
- Department of Pathology, Baylor University Medical Center, Dallas Texas
| | | | - Michael Emmett
- Texas A&M School of Medicine, Bryan; Internal Medicine, Baylor University Medical Center, Dallas, Texas; Internal Medicine, UT Southwestern School of Medicine, Dallas, Texas.
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18
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Aga Z, Matthews N, Delaney S, Wong N, Poley R, Perl J. Finding the source of intoxication: better salicylate than never. Kidney Int 2021; 100:711-712. [PMID: 34420669 DOI: 10.1016/j.kint.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Zeenia Aga
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicola Matthews
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Sarah Delaney
- Division of Biochemistry, Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Natalie Wong
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Critical Care, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Poley
- Division of Emergency Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Perl
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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19
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Abstract
Anticoagulant and antiplatelet drugs target a specific portion of the coagulation cascade or the platelet activation and aggregation pathway. The primary toxicity associated with these agents is hemorrhage. Understanding the pharmacology of these drugs allows the treating clinician to choose the correct antidotal therapy. Reversal agents exist for some of these drugs; however, not all have proven patient-centered outcomes. The anticoagulants covered in this review are vitamin K antagonists, heparins, fondaparinux, hirudin derivatives, argatroban, oral factor Xa antagonists, and dabigatran. The antiplatelet agents reviewed are aspirin, adenosine diphosphate antagonists, dipyridamole, and glycoprotein IIb/IIIa antagonists. Additional notable toxicities are also reviewed.
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Affiliation(s)
- David B Liss
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University in St. Louis, 660 South Euclid Avenue, CB 8072, St Louis, MO 63110, USA.
| | - Michael E Mullins
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University in St. Louis, 660 South Euclid Avenue, CB 8072, St Louis, MO 63110, USA
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20
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Palmer BF, Clegg DJ. Euglycemic Ketoacidosis as a Complication of SGLT2 Inhibitor Therapy. Clin J Am Soc Nephrol 2021; 16:1284-1291. [PMID: 33563658 PMCID: PMC8455044 DOI: 10.2215/cjn.17621120] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are drugs designed to lower plasma glucose concentration by inhibiting Na+-glucose-coupled transport in the proximal tubule. Clinical trials demonstrate these drugs have favorable effects on cardiovascular outcomes to include slowing the progression of CKD. Although most patients tolerate these drugs, a potential complication is development of ketoacidosis, often with a normal or only a minimally elevated plasma glucose concentration. Inhibition of sodium-glucose cotransporter-2 in the proximal tubule alters kidney ATP turnover so that filtered ketoacids are preferentially excreted as Na+ or K+ salts, leading to indirect loss of bicarbonate from the body and systemic acidosis under conditions of increased ketogenesis. Risk factors include reductions in insulin dose, increased insulin demand, metabolic stress, low carbohydrate intake, women, and latent autoimmune diabetes of adulthood. The lack of hyperglycemia and nonspecific symptoms of ketoacidosis can lead to delays in diagnosis. Treatment strategies and various precautions are discussed that can decrease the likelihood of this complication.
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Affiliation(s)
- Biff F. Palmer
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deborah J. Clegg
- Associate Dean for Research, College of Nursing and Health Professionals, Drexel University, Philadelphia, Pennsylvania
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21
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Palmer BF, Clegg DJ. Starvation Ketosis and the Kidney. Am J Nephrol 2021; 52:467-478. [PMID: 34350876 DOI: 10.1159/000517305] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The remarkable ability of the body to adapt to long-term starvation has been critical for survival of primitive man. An appreciation of these processes can provide the clinician better insight into many clinical conditions characterized by ketoacidosis. SUMMARY The body adapts to long-term fasting by conserving nitrogen, as the brain increasingly utilizes keto acids, sparing the need for glucose. This shift in fuel utilization decreases the need for mobilization of amino acids from the muscle for purposes of gluconeogenesis. Loss of urinary nitrogen is initially in the form of urea when hepatic gluconeogenesis is dominant and later as ammonia reflecting increased glutamine uptake by the kidney. The carbon skeleton of glutamine is utilized for glucose production and regeneration of consumed HCO3-. The replacement of urea with NH4+ provides the osmoles needed for urine flow and waste product excretion. Over time, the urinary loss of nitrogen is minimized as kidney uptake of filtered ketone bodies becomes more complete. Adjustments in urine Na+ serve to minimize kidney K+ wasting and, along with changes in urine pH, minimize the likelihood of uric acid precipitation. There is a sexual dimorphism in response to starvation. Key Message: Ketoacidosis is a major feature of common clinical conditions to include diabetic ketoacidosis, alcoholic ketoacidosis, salicylate intoxication, SGLT2 inhibitor therapy, and calorie sufficient but carbohydrate-restricted diets. Familiarity with the pathophysiology and metabolic consequences of ketogenesis is critical, given the potential for the clinician to encounter one of these conditions.
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Affiliation(s)
- Biff F Palmer
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, El Paso, Texas, USA
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22
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Hon KL, Hui WF, Leung AK. Antidotes for childhood toxidromes. Drugs Context 2021; 10:dic-2020-11-4. [PMID: 34122588 PMCID: PMC8177957 DOI: 10.7573/dic.2020-11-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background Poisoning causes significant morbidity and sometimes mortality in children worldwide. The clinical skill of toxidrome recognition followed by the timely administration of an antidote specific for the poison is essential for the management of children with suspected poisoning. This is a narrative review on antidotes for toxidromes in paediatric practice. Methods A literature search was conducted on PubMed with the keywords “antidote”, “poisoning”, “intoxication”, “children” and “pediatric”. The search was customized by applying the appropriate filters (species: humans; age: birth to 18 years) to obtain the most relevant articles for this review article. Results Toxidrome recognition may offer a rapid guide to possible toxicology diagnosis such that the specific antidote can be administered in a timely manner. This article summarizes toxidromes and their respective antidotes in paediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are discussed. Antidotes are only available for a limited number of poisons responsible for intoxication. Antidotes for common poisonings include N-acetyl cysteine for paracetamol and sodium thiosulphate for poisoning by cyanide. Conclusion Poisoning is a common cause of paediatric injury. Physicians should be familiar with the recognition of common toxidromes and promptly use specific antidotes for the management of childhood toxidromes.
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Affiliation(s)
- Kam Lun Hon
- Department of a Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
| | - Wun Fung Hui
- Department of a Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
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Thongprayoon C, Lapumnuaypol K, Kaewput W, Petnak T, Qureshi F, Mao MA, Boonpheng B, Bathini T, Choudhury A, Vallabhajosyula S, Cheungpasitporn W. Gastrointestinal bleeding among hospitalizations for salicylate poisoning in the United States. QJM 2021; 114:190-195. [PMID: 33599273 DOI: 10.1093/qjmed/hcab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to determine the incidence, as well as evaluate risk factors, and impact of gastrointestinal bleeding on outcomes and resource use in patients admitted for salicylate poisoning. METHODS We used the National Inpatient Sample to construct a cohort of patients hospitalized primarily for salicylate poisoning from 2003 to 2014. We compared clinical characteristics, in-hospital treatments, outcomes and resource use between salicylate poisoning patients with and without gastrointestinal bleeding. RESULTS Of 13 805 hospital admissions for salicylate poisoning, gastrointestinal bleeding occurred in 482 (3.5%) admissions. The risk factors for gastrointestinal bleeding included older age, history of atrial fibrillation and cirrhosis. After adjusting for difference in baseline characteristics, patients with gastrointestinal bleeding required more gastric lavage, gastrointestinal endoscopy, invasive mechanical ventilation and red blood cell transfusion. Gastrointestinal bleeding was significantly associated with increased risk of anemia, circulatory, liver and hematological failure but was not significantly associated with increased in-hospital mortality. The length of hospital stay and hospitalization cost was significantly higher in patients with gastrointestinal bleeding. CONCLUSION Gastrointestinal bleeding occurred in about 4% of patients admitted for salicylate poisoning. Gastrointestinal bleeding was associated with higher morbidity and resource use but not mortality.
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Affiliation(s)
- C Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - K Lapumnuaypol
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - W Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - T Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - F Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - B Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - T Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - A Choudhury
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - S Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - W Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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24
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Evaluation and Management of Toxicological Causes of Delirium. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40138-021-00230-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Rhabdomyolysis among hospitalized patients for salicylate intoxication in the United States: Nationwide inpatient sample 2003-2014. PLoS One 2021; 16:e0248242. [PMID: 33684174 PMCID: PMC7939294 DOI: 10.1371/journal.pone.0248242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction This study aimed to assess the risk factors and impact of rhabdomyolysis on treatments, outcomes, and resource utilization in hospitalized patients for salicylate intoxication in the United States. Materials and methods The National Inpatient Sample was utilized to identify hospitalized patients with a primary diagnosis of salicylate intoxication from 2003–2014. Rhabdomyolysis was identified using hospital diagnosis code. We compared the clinical characteristics, in-hospital treatment, outcomes, and resource utilization between patients with and without rhabdomyolysis. Results A total of 13,805 hospital admissions for salicylate intoxication were studied. Of these, rhabdomyolysis developed in 258 (1.9%) admissions. The risk factors for rhabdomyolysis were age>20 years, male sex, volume depletion, hypokalemia, sepsis, and seizure. After adjustment for baseline clinical characteristics, salicylate intoxication patients with rhabdomyolysis required more invasive mechanical ventilation, and renal replacement therapy. Rhabdomyolysis was significantly associated with higher risk of failure of any organ systems, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher when rhabdomyolysis occurred during hospital stay. Conclusions Rhabdomyolysis was not common in hospitalized patients for salicylate intoxication but it was associated with increased morbidity, mortality, and resource utilization.
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Thongprayoon C, Petnak T, Kaewput W, Qureshi F, Mao MA, Pivovarova AI, Boonpheng B, Bathini T, Vallabhajosyula S, Medaura J, Cheungpasitporn W. Acute kidney injury among salicylate intoxication hospitalisations in the United States. Int J Clin Pract 2021; 75:e13745. [PMID: 32991024 DOI: 10.1111/ijcp.13745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/12/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the risk factors and the association of acute kidney injury (AKI) with outcomes, and resource utilisation in patients hospitalised because of salicylate intoxication in the United States. METHODS Hospitalised patients with a primary diagnosis of salicylate intoxication from 2003 to 2014 were identified in the National Inpatient Sample (NIS) database. End-stage kidney disease patients were excluded. The occurrence of AKI was identified using hospital diagnosis code. Clinical characteristics, in-hospital treatment, outcomes and resource utilisation were compared between patients with and without AKI. RESULTS A total of 13 787 eligible hospital admissions were included in the analysis. AKI occurred in 1279 (9.3%) admissions. Older age, male sex, more recent year of hospitalisation, anaemia, hypertension, congestive heart failure, chronic kidney disease, volume depletion, sepsis and ventricular arrhythmia/cardiac arrest were significantly associated with increased risk of AKI, whereas Hispanic race was associated with decreased risk. AKI was significantly associated with increased risk of organ failure, and in-hospital mortality. In addition, the need for ventilation support, blood component transfusion, renal replacement therapy, length of hospital stay and hospitalisation cost were higher in AKI patients. CONCLUSION Approximately one tenth of salicylate intoxication patients developed AKI during hospitalisation. AKI was associated with higher morbidity, mortality and resource utilisations.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Aleksandra I Pivovarova
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan Medaura
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Sodium Salicylate Influences the Pseudomonas aeruginosa Biofilm Structure and Susceptibility Towards Silver. Int J Mol Sci 2021; 22:ijms22031060. [PMID: 33494399 PMCID: PMC7865925 DOI: 10.3390/ijms22031060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 01/30/2023] Open
Abstract
Hard-to-heal wounds are typically infected with biofilm-producing microorganisms, such as Pseudomonas aeruginosa, which strongly contribute to delayed healing. Due to the global challenge of antimicrobial resistance, alternative treatment strategies are needed. Here, we investigated whether inhibition of quorum sensing (QS) by sodium salicylate in different P. aeruginosa strains (QS-competent, QS-mutant, and chronic wound strains) influences biofilm formation and tolerance to silver. Biofilm formation was evaluated in simulated serum-containing wound fluid in the presence or absence of sodium salicylate (NaSa). Biofilms were established using a 3D collagen-based biofilm model, collagen coated glass, and the Calgary biofilm device. Furthermore, the susceptibility of 48-h-old biofilms formed by laboratory and clinical strains in the presence or absence of NaSa towards silver was evaluated by assessing cell viability. Biofilms formed in the presence of NaSa were more susceptible to silver and contained reduced levels of virulence factors associated with biofilm development than those formed in the absence of NaSa. Biofilm aggregates formed by the wild-type but not the QS mutant strain, were smaller and less heterogenous in size when grown in cultures with NaSa compared to control. These data suggest that NaSa, via a reduction of cell aggregation in biofilms, allows the antiseptic to become more readily available to cells.
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Petnak T, Thongprayoon C, Kaewput W, Qureshi F, Boonpheng B, Vallabhajosyula S, Bathini T, Mao MA, Lertjitbanjong P, Cheungpasitporn W. Circulatory Shock among Hospitalized Patients for Salicylate Intoxication. Diseases 2021; 9:diseases9010007. [PMID: 33445533 PMCID: PMC7839009 DOI: 10.3390/diseases9010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/01/2021] [Accepted: 01/09/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the risk factors for circulatory shock and its impact on outcomes in patients hospitalized for salicylate intoxication. METHODS We used the National Inpatient Sample to identify patients hospitalized primarily for salicylate intoxication from 2003-2014. Circulatory shock was identified based on hospital diagnosis code for any type of shock or hypotension. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between patients with and without circulatory shock associated with salicylate intoxication. RESULTS Of 13,805 hospital admissions for salicylate intoxication, circulatory shock developed in 484 (4%) admissions. Risk factors for development of circulatory shock included older age, female sex, concurrent psychotropic medication overdose, anemia, congestive heart failure, volume depletion, rhabdomyolysis, seizure, gastrointestinal bleeding, and sepsis. Circulatory shock was significantly associated with increased odds of any organ failure and in-hospital mortality. Length of hospital stay and hospitalization cost was significantly higher in patients with circulatory shock. CONCLUSION Approximately 4% of patients admitted for salicylate intoxication developed circulatory shock. Circulatory shock was associated with worse clinical outcomes and increased resource use.
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Affiliation(s)
- Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA;
- Correspondence: (C.T.); (W.K.); (W.C.)
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Correspondence: (C.T.); (W.K.); (W.C.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA;
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85724, USA;
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Ploypin Lertjitbanjong
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA;
- Correspondence: (C.T.); (W.K.); (W.C.)
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Hospitalizations for Acute Salicylate Intoxication in the United States. J Clin Med 2020; 9:jcm9082638. [PMID: 32823834 PMCID: PMC7465677 DOI: 10.3390/jcm9082638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/26/2023] Open
Abstract
Background: The objective of this study was to describe inpatient prevalence, characteristics, outcomes, and resource use for acute salicylate intoxication hospitalizations in the United States. Methods: A total of 13,805 admissions with a primary diagnosis of salicylate intoxication from 2003 to 2014 in the National Inpatient Sample database were analyzed. Prognostic factors for in-hospital mortality were determined using multivariable logistic regression. Results: The overall inpatient prevalence of salicylate intoxication among hospitalized patients was 147.8 cases per 1,000,000 admissions in the United States. The average age was 34 ± 19 years. Of these, 35.0% were male and 65.4% used salicylate for suicidal attempts. Overall, 6% required renal replacement therapy. The most common complications of salicylate intoxication were electrolyte and acid-base disorders, including hypokalemia (25.4%), acidosis (19.1%), and alkalosis (11.1%). Kidney failure (9.3%) was the most common observed organ dysfunction. In-hospital mortality was 1.0%. Increased in-hospital mortality was associated with age ≥30, Asian/Pacific Islander race, diabetes mellitus, hyponatremia, ventricular arrhythmia, kidney failure, respiratory failure, and neurological failure, while decreased in-hospital mortality was associated with African American and Hispanic race. Conclusion: hospitalization for salicylate intoxication occurred in 148 per 1,000,000 admissions in the United States. Several factors were associated with in-hospital mortality.
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Fiala C, Pasic MD. Aspirin: Bitter pill or miracle drug? Clin Biochem 2020; 85:1-4. [PMID: 32721423 DOI: 10.1016/j.clinbiochem.2020.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022]
Abstract
Acetylsalicylic acid (ASA) or brand name Aspirin is a widely available medication used to relieve inflammation, fever and pain. It has also been frequently prescribed as prevention for cardiovascular disease due to its anti-thrombotic qualities. However, ASA is also connected to increased internal bleeding, leading to concerns that this harmful side effect may outweigh its cardioprotective properties in some populations. In this review, we summarize data from several recent, large-scale clinical trials that put into the question the long-standing recommendations about prescribing ASA for primary cardiovascular disease. We also provide a detailed overview of the role of ASA in cancer, surgery and female reproductive health. Finally, we discuss the ASA prescription guidelines of several major medical organizations and suggest that this new evidence may lead to updates to these influential and longstanding recommendations.
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Affiliation(s)
- Clare Fiala
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Maria D Pasic
- Department of Laboratory Medicine, Unity Health Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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