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Vlcek P, Monkova I, Nerandzic Z, Lippert-Grüner M. Delayed encephalopathy after acute carbon monoxide poisoning: a case study. Brain Inj 2024; 38:331-336. [PMID: 38308510 DOI: 10.1080/02699052.2024.2311339] [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] [Received: 07/12/2022] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a relatively rare inflammatory-associated neurometabolic complication. In this article, we present a case report of a 50-year-old male patient with a history of carbon monoxide poisoning. This acute poisoning, although successfully controlled during a stay in the intensive care unit of a local hospital, later led to persistent neurological symptoms. The patient was then treated in the inpatient unit of the rehabilitation clinic, where cognitive deterioration began to develop 20 days after admission. Subsequent examination using EEG and magnetic resonance imaging confirmed severe encephalopathy later complicated by SARS-CoV-2 infection with fatal consequences due to bronchopneumonia. Because currently there are no approved guidelines for the management of DEACMP, we briefly discuss the existing challenges for future studies, especially the application of rational immunosuppressive therapy already in the acute treatment phase of CO poisoning, which could prevent the development of a severe form of DEACMP.
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Affiliation(s)
- Premysl Vlcek
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ivana Monkova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zoran Nerandzic
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marcela Lippert-Grüner
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Cho DH, Thom SR, Son JW, Ko SM, Cha YS. Practical Recommendations for the Evaluation and Management of Cardiac Injury Due to Carbon Monoxide Poisoning. JACC. HEART FAILURE 2024:S2213-1779(24)00051-9. [PMID: 38385937 DOI: 10.1016/j.jchf.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 02/23/2024]
Abstract
Carbon monoxide (CO) is a relatively frequent cause of poisoning evaluated in emergency departments. The risk of neurologic injuries, such as cognitive, psychological, vestibular, and motor deficits, is 25% to 50%. However, the risk of cardiac injuries should also be considered. Among patients with CO poisoning, the mortality in patients with myocardial injury is approximately 3 times greater than that in patients without myocardial injury. In large-scale studies, up to 69.2% of patients with acute CO poisoning exhibiting elevated troponin I levels and no underlying cardiovascular illnesses had late gadolinium enhancement on cardiac magnetic resonance, suggesting covert CO-induced myocardial fibrosis. Myocardial damage can be evaluated using electrocardiography, echocardiography, computed tomography, and cardiac magnetic resonance. This paper offers recommendations for cardiac evaluations based on our collective experience of managing >2,000 cases of acute CO poisoning with supporting information taken from peer-reviewed published reports on CO poisoning.
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Affiliation(s)
- Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea; Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Patel B, Omeh J, Tackling G, Gupta R, Sahadeo T, Villcant V, Dussie T, Atnas M, Hai O, Zeltser R, Makaryus AN. The Clinical Association between Carbon Monoxide Poisoning and Myocardial Injury as Measured by Elevated Troponin I Levels. J Clin Med 2023; 12:5529. [PMID: 37685595 PMCID: PMC10488441 DOI: 10.3390/jcm12175529] [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: 05/26/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Carbon monoxide (CO) poisoning accounts for over 50,000 estimated emergency room visits and approximately 1200 deaths per year in the US. Despite the high prevalence, there is a paucity of data looking at the association between laboratory biomarkers and clinical outcomes. Our study investigates the association between myocardial injury as assessed by increased troponin levels and its effect on in-hospital outcomes in CO poisoning. A total of 900 sequential charts of patients presenting with CO poisoning between 1 January 2012, and 31 August 2019, at our tertiary center with regional hyperbaric chamber and burn unit, were reviewed. Of the 900, a total of 488 patients had elevated carboxyhemoglobin levels. Of these 488 patients, 119 (24.4%) also had blood troponin levels measured. Patients were stratified based on the presence or absence of myocardial injury as evidenced by highly sensitive serum troponin I (TnI) level > 0.5 ng/mL to determine if a correlation exists relating to myocardial injury and risk of major adverse events. Mean age was 51.2 years, 58.8% were males, 35.3% were non-White, and 10.1% were intentional CO poisonings. Comorbidities included hypertension: 37%, diabetes: 21%, smoking: 21%, hyperlipidemia: 17.6%, coronary artery disease: 11.8%, asthma: 5.9%, heart failure: 5%, atrial fibrillation: 4.2%, and chronic obstructive pulmonary disease: 4.2%. Myocardial injury occurred in 22 patients (18.5%) and was associated with increased likelihood of requiring intensive care admission (54.5% vs. 20.6%, p = 0.002) and intubation (40.9% vs. 14.4%, p = 0.008). TnI elevation was associated with higher in-hospital mortality (p = 0.008, OR 21.3) compared to patients without TnI elevation. Older age was independently associated with increased in-hospital mortality (p = 0.03, OR 1.08). When controlling for age, in-hospital mortality remained statistically significant (p = 0.01, OR 21.37). No significant difference was found with respect to age, comorbidities, gender, race, ethnicity, or hospital length of stay in patients with and without myocardial injury. Myocardial injury induced by CO exposure occurs frequently and adversely affects clinical outcomes. Further research is needed to help guide physicians in the management of CO poisoning and associated myocardial injury to improve patient outcomes.
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Affiliation(s)
- Bhakti Patel
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Jideofor Omeh
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Gary Tackling
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Rohun Gupta
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Tiffany Sahadeo
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Viliane Villcant
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Tashina Dussie
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Mirette Atnas
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Ofek Hai
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Roman Zeltser
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Amgad N. Makaryus
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
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Rose JJ, Zhang MS, Pan J, Gauthier MC, Pizon AF, Saul MI, Nouraie SM. Heart-Brain 346-7 Score: the development and validation of a simple mortality prediction score for carbon monoxide poisoning utilizing deep learning. Clin Toxicol (Phila) 2023; 61:492-499. [PMID: 37417305 PMCID: PMC10529057 DOI: 10.1080/15563650.2023.2226817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Acute mortality from carbon monoxide poisoning is 1-3%. The long-term mortality risk of survivors of carbon monoxide poisoning is doubled compared to age-matched controls. Cardiac involvement also increases mortality risk. We built a clinical risk score to identify carbon monoxide-poisoned patients at risk for acute and long-term mortality. METHODS We performed a retrospective analysis. We identified 811 adult carbon monoxide-poisoned patients in the derivation cohort, and 462 adult patients in the validation cohort. We utilized baseline demographics, laboratory values, hospital charge transactions, discharge disposition, and clinical charting information in the electronic medical record in Stepwise Akaike's Information Criteria with Firth logistic regression to determine optimal parameters to create a prediction model. RESULTS In the derivation cohort, 5% had inpatient or 1-year mortality. Three variables following the final Firth logistic regression minimized Stepwise Akaike's Information Criteria: altered mental status, age, and cardiac complications. The following predict inpatient or 1-year mortality: age > 67, age > 37 with cardiac complications, age > 47 with altered mental status, or any age with cardiac complications and altered mental status. The sensitivity of the score was 82% (95% confidence interval: 65-92%), the specificity was 80% (95% confidence interval: 77-83%), negative predictive value was 99% (95% confidence interval: 98-100%), positive predictive value 17% (95% confidence interval: 12-23%), and the area under the receiver operating characteristic curve was 0.81 (95% confidence interval: 0.74-0.87). A score above the cut-off point of -2.9 was associated with an odds ratio of 18 (95% confidence interval: 8-40). In the validation cohort (462 patients), 4% had inpatient death or 1-year mortality. The score performed similarly in the validation cohort: sensitivity was 72% (95% confidence interval: 47-90%), specificity was 69% (95% confidence interval: 63-73%), negative predictive value was 98% (95% confidence interval: 96-99%), positive predictive value was 9% (95% confidence interval: 5-15%) and the area under the receiver operating characteristic curve was 0.70 (95% confidence interval: 60%-81%). CONCLUSIONS We developed and validated a simple, clinical-based scoring system, the Heart-Brain 346-7 Score to predict inpatient and long-term mortality based on the following: age > 67, age > 37 with cardiac complications, age > 47 with altered mental status, or any age with cardiac complications and altered mental status. With further validation, this score will hopefully aid decision-making to identify carbon monoxide-poisoned patients with higher mortality risk.
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Affiliation(s)
- Jason J. Rose
- University of Maryland School of Medicine, University of Maryland; Baltimore, MA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA
| | - Michael S. Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA
| | - Jerry Pan
- Department of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
| | - Marc C. Gauthier
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA
| | - Anthony F. Pizon
- Department of Emergency Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA
- Division of Medical Toxicology, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA
| | - Melissa I. Saul
- Department of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
| | - Seyed M. Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA
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Yankova A, Georgiev K, Dimitrova D, Dimitrova-Kirilova V, Nestorova V. A patient with toxic encephalopathy associated with acute carbon monoxide poisoning–A clinical case. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Carbon monoxide (CO) is a colorless, odorless, and lacking in irritative properties gas. It has a higher affinity towards hemoglobin than oxygen and thus the complex carboxyhemoglobin develops. Acute CO poisoning leads to poly-organic insufficiency and the organs that suffer the most are the ones with higher oxygen needs- the brain, the heart and the kidneys. We present a clinical case of 49-year-old woman with a sudden appearance of complaints of dizziness, stiffness throughout the entire body, inability to move. Subsequently she was found by her relatives with disorientated and “foaming around her mouth”. Earlier she had been using a gasoline generator because of a power outage. Her laboratory results came out with higher carboxyhemoglobin (40%), nitrogen waste products and mixed type acidosis. From the conducted brain MRI there were changes, correlating to toxic encephalopathy after acute CO poisoning.
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Affiliation(s)
- Alexandra Yankova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University Varna, Varna, BULGARIA
| | - Kristiyan Georgiev
- Department of Neurological Diseases and Neuroscience, Faculty of Medicine, Medical University Varna, Varna, BULGARIA
| | - Dimitrinka Dimitrova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University Varna, Varna, BULGARIA
| | - Vladina Dimitrova-Kirilova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University Varna, Varna, BULGARIA
| | - Veselinka Nestorova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University Varna, Varna, BULGARIA
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Feng SY, Li Y. Incidence, timing, location, risk factors, and nomogram of lower extremity deep venous thrombosis after acute carbon monoxide poisoning. Ir J Med Sci 2023; 192:417-422. [PMID: 35396674 DOI: 10.1007/s11845-022-02992-1] [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] [Received: 12/15/2021] [Accepted: 03/29/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Data on lower extremity deep venous thrombosis (DVT) following acute carbon monoxide (CO) poisoning are lacking. This study aimed to identify the incidence rate, timing, locations, risk factors, and nomogram of lower extremity DVT after acute CO poisoning. METHODS A total of 203 patients with acute CO poisoning from October 2019 to April 2021 were included in this retrospective study. Multivariate logistic regression analysis was performed to identify the independent risk factors associated with lower extremity DVT. Nomogram was drawn and area under the curve (AUC) was calculated to predict lower extremity DVT. RESULTS Overall, 14.3% (29/203) had lower extremity DVT, with incidence rates of 2.5% (5/203) for proximal DVT and 11.8% (24/203) for distal DVT. The lower extremity DVTs involved intermuscular vein in 28 patients, popliteal vein in 5 patients, and posterior tibial vein in 3 patients. The mean time from end of exposure to diagnosis of lower extremity DVT was 1.24 days. Among 29 lower extremity DVT cases, 6 (23.1%) DVT cases had thrombolysis. Multivariate logistic regression analysis revealed that long coma duration (P < 0.001) and high D-dimer levels (P < 0.001) were significantly associated with lower extremity DVT. The discrimination of nomogram was good with AUC of 0.93 (95% CI, 0.89-0.98). CONCLUSION Clinicians should be aware of and concerned with lower extremity DVT after acute CO poisoning, especially in patients with long coma duration and high D-dimer levels.
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Affiliation(s)
- Shun Yi Feng
- Emergency Department, Cangzhou Central Hospital, No.16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China
| | - Yong Li
- Emergency Department, Cangzhou Central Hospital, No.16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China.
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Exercise-induced myocardial ischemia presenting as exercise intolerance after carbon monoxide intoxication and smoke inhalation Injury: case report. BMC Cardiovasc Disord 2022; 22:570. [PMID: 36575398 PMCID: PMC9795777 DOI: 10.1186/s12872-022-03019-4] [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: 02/08/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Carbon monoxide intoxication and smoke inhalation injury can lead to severe disorders, and the current literature has elaborated on the importance of major cardiopulmonary impairment. Exercise intolerance has seldom been discussed, particular in patient with low cardiovascular risk. CASE PRESENTATION Two young male fire survivors who presented with exercise intolerance after CO intoxication and smoke inhalation injury. Both received bronchodilator and glucocorticoid therapy, high-flow oxygen therapy, and hyperbaric oxygen therapy for airway edema and CO intoxication during acute care. Serum carboxyhemoglobin levels improved after treatment (8.2-3.9% in Case A and 14.8-0.8% in Case B). However, subjective exercise intolerance was noted after discharge. Cardiopulmonary exercise testing revealed exercise-induced myocardial ischemia during peak exercise (significant ST-segment depression on exercise electrocardiogram). They were instructed to exercise with precaution by setting the intensity threshold according to the ischemic threshold. Their symptoms improved, and no cardiopulmonary events were reported in the 6-month follow-up. CONCLUSION The present case report raised the attention that exercise intolerance after carbon monoxide intoxication and smoke inhalation injury in low cardiovascular risk population may be underestimated. Cardiopulmonary exercise testing help physician to discover exercise-induced myocardial ischemia and set up the cardiac rehabilitation program accordingly.
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Ito H, Ogawa R, Shimojo N. Rhabdomyolysis secondary to carbon monoxide poisoning: A retrospective cohort study. Am J Emerg Med 2022; 60:207-208. [PMID: 35773173 DOI: 10.1016/j.ajem.2022.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Hiroshi Ito
- Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
| | - Ryoko Ogawa
- Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Nobutake Shimojo
- Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
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Chebli A, Mimoun S, Brahimi B, Zebbiche Y, Seleymi S, Cheradi S, Hamzaoui F. Évaluation de l’exposition au plomb et au monoxyde de carbone des travailleurs de parking de la région d’Alger. ARCH MAL PROF ENVIRO 2022. [DOI: 10.1016/j.admp.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li B, Gao X, Wang W, Zhu B, Xiao Q. Effect of early intervention on short-term prognosis of patients with myocardial injury induced by acute carbon monoxide poisoning. ESC Heart Fail 2022; 9:1090-1097. [PMID: 35019239 PMCID: PMC8934989 DOI: 10.1002/ehf2.13777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 11/05/2021] [Accepted: 12/05/2021] [Indexed: 11/08/2022] Open
Abstract
AIM This study aimed to investigate the effect of early intervention on the short-term prognosis of patients with myocardial injury induced by acute carbon monoxide poisoning (ACOP). METHODS AND RESULTS We performed a retrospective cohort study of 139 patients admitted to the hospital for ACOP-induced acute toxic cardiopathy. Compared with the mild and moderate toxic cardiopathy group, the severe toxic cardiopathy group has significantly increased coma time, acute physiology and chronic health status (APACHE) II score, and the length of hospital stay and significantly reduced proportion of patients with immediate endotracheal intubation and early admission to intensive care unit (ICU) (all P < 0.05). The cardiac troponin I (cTnI) levels and corrected QT dispersion (QTcd) duration in three patient groups were significantly higher (all P < 0.05) than those in the control group, with the highest in the severely toxic heart disease group. Serum cTnI level and QTcd duration were two independent predictors of myocardial injury in ACOP patients. There was a positive correlation between the APACHE II score and serum cTnI level/QTcd duration at admission. The sensitivities of cTnI and QTcd at admission to diagnose serious cardiovascular events were 78.6% and 85.7%, respectively, and the specificities were both 75%. CONCLUSIONS Acute carbon monoxide poisoning patients with myocardial injury need to be admitted to the hospital as early as possible. For patients with severe hypoxia, an artificial airway should be established as early as possible, and patients should be admitted to the monitoring ward to stabilize their condition at the early stage of poisoning. Meanwhile, changes in QTcd, serum cTnI, and creatine kinase-MB (CK-MB) should be closely observed.
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Affiliation(s)
- Baiyan Li
- Department of Emergency, Harrison International Peace hospital Affiliated to Hebei Medical University, 180 East Renmin Road, Hengshui, Hebei, 053000, China
| | - Xun Gao
- Department of Emergency, Harrison International Peace hospital Affiliated to Hebei Medical University, 180 East Renmin Road, Hengshui, Hebei, 053000, China
| | - Weizhan Wang
- Department of Emergency, Harrison International Peace hospital Affiliated to Hebei Medical University, 180 East Renmin Road, Hengshui, Hebei, 053000, China
| | - Baoyue Zhu
- Department of Emergency, Harrison International Peace hospital Affiliated to Hebei Medical University, 180 East Renmin Road, Hengshui, Hebei, 053000, China
| | - Qingmian Xiao
- Department of Emergency, Harrison International Peace hospital Affiliated to Hebei Medical University, 180 East Renmin Road, Hengshui, Hebei, 053000, China
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Zhang S, Lu W, Wei Z, Zhang H. Air Pollution and Cardiac Arrhythmias: From Epidemiological and Clinical Evidences to Cellular Electrophysiological Mechanisms. Front Cardiovasc Med 2021; 8:736151. [PMID: 34778399 PMCID: PMC8581215 DOI: 10.3389/fcvm.2021.736151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Cardiovascular disease is the leading cause of death worldwide and kills over 17 million people per year. In the recent decade, growing epidemiological evidence links air pollution and cardiac arrhythmias, suggesting a detrimental influence of air pollution on cardiac electrophysiological functionality. However, the proarrhythmic mechanisms underlying the air pollution-induced cardiac arrhythmias are not fully understood. The purpose of this work is to provide recent advances in air pollution-induced arrhythmias with a comprehensive review of the literature on the common air pollutants and arrhythmias. Six common air pollutants of widespread concern are discussed, namely particulate matter, carbon monoxide, hydrogen sulfide, sulfur dioxide, nitrogen dioxide, and ozone. The epidemiological and clinical reports in recent years are reviewed by pollutant type, and the recently identified mechanisms including both the general pathways and the direct influences of air pollutants on the cellular electrophysiology are summarized. Particularly, this review focuses on the impaired ion channel functionality underlying the air pollution-induced arrhythmias. Alterations of ionic currents directly by the air pollutants, as well as the alterations mediated by intracellular signaling or other more general pathways are reviewed in this work. Finally, areas for future research are suggested to address several remaining scientific questions.
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Affiliation(s)
- Shugang Zhang
- Computational Cardiology Group, College of Computer Science and Technology, Ocean University of China, Qingdao, China.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Weigang Lu
- Computational Cardiology Group, College of Computer Science and Technology, Ocean University of China, Qingdao, China.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Zhiqiang Wei
- Computational Cardiology Group, College of Computer Science and Technology, Ocean University of China, Qingdao, China
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
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Positive Association between Indoor Gaseous Air Pollution and Obesity: An Observational Study in 60 Households. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111447. [PMID: 34769965 PMCID: PMC8582717 DOI: 10.3390/ijerph182111447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 01/02/2023]
Abstract
This study aims to analyze whether exposure to indoor air pollution affects obesity. In our research, we recruited 127 participants, with an average age of 43.30 ± 15.38 years old, residing in 60 households. We monitored indoor air quality for 24 h, and conducted both questionnaire surveys and collected serum samples for analysis, to assess the relationship between indoor air pollutant exposure and obesity. After adjusting for demographic characteristics, the results showed that CO2 exposure is positively associated with being overweight and with a higher risk of being abdominally obese. Exposures to CO and formaldehyde were also positively associated with being overweight. IQR increase in TVOC was positively associated with increases in the risk of a high BMI, being abdominally obese and having a high body fat percentage. Two-pollutant models demonstrate that TVOCs presented the strongest risks associated with overweightness. We concluded that persistent exposure to indoor gaseous pollutants increases the risk of overweightness and obesity, as indicated by the positive association with BMI, abdominal obesity, and percentage body fat. TVOCs display the strongest contribution to obesity.
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Liu Y, Gao X, Xiao Q, Wang W, Zhu B. Correlation Between QTc Dispersion and Soluble Growth-stimulating Gene 2 Protein on the Early Prognosis of Acute Carbon Monoxide Poisoning Heart Disease. J Cardiovasc Pharmacol 2021; 78:572-580. [PMID: 34166304 DOI: 10.1097/fjc.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study aimed to explore the correlation between QTc dispersion (QTcd) and soluble growth-stimulating gene 2 protein (sST2) after heart rate correction in patients with acute carbon monoxide poisoning heart disease. Among the 150 patients, 35 cases had severe toxic heart disease. The concentrations of sST2, cardiac troponin I, and creatine kinase-MB in the severe group began to increase from admission, 24 hours, and 2 days, respectively, and their detected values were all higher than those in the nonsevere group and the normal control group. There were statistically significant differences in sST2 and QTcd between the poisoning, nonsevere, and normal control groups before the treatment. There was a statistically significant difference between the indexes of the poisoning groups at different degrees 2 and 3 days after poisoning. Receiver operating characteristic curve analysis confirmed the sensitivity and specificity of sST2 and QTcd. The correlation analysis showed that sST2 and QTcd levels were positively correlated with the incidence of severe heart disease at admission. Generally, the combined observation of sST2 and QTcd improved the prediction sensitivity and were early predictor indexes of toxic heart disease.
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Affiliation(s)
- Yongjian Liu
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hebei, China
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15
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Bussienne F, Betello M. Cardiogenic Shock Related to Carbon Monoxide Poisoning. CASE REPORTS IN ACUTE MEDICINE 2021. [DOI: 10.1159/000514303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Carbon monoxide (CO) poisoning is one of the leading causes of death by poisoning in occidental countries. We report the presentation and management of a patient who developed a severe cardiac dysfunction, leading to profound cardiogenic shock after CO poisoning despite an initial low CO blood level.
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Lakhani M, Alkhero M, Bains N, Steele R, Abdelmalik R. The Poisoned Heart: A Case of Takotsubo Cardiomyopathy Induced by Carbon Monoxide Poisoning. J Emerg Med 2021; 60:651-654. [PMID: 33674139 DOI: 10.1016/j.jemermed.2021.01.017] [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] [Received: 07/19/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Carbon monoxide is a common environmental toxin, and some patients present with features of cardiac injury in addition to the noxious effects of carbon monoxide poisoning. A very small fraction of those have a transient left ventricular apical ballooning syndrome or Takotsubo cardiomyopathy, both terms are used to define a syndrome that affects the systolic function of the heart. It usually presents with elevated troponin levels with or without electrocardiographic changes. Cardiac angiograms generally illustrate coronary arteries without significant obstruction. CASE REPORT Here we report the curious case of a 37-year-old Hispanic man brought in for carbon monoxide poisoning, but found to have significantly elevated troponin levels. Echocardiogram demonstrated decreased ejection fraction of 35%. Left heart catheterization 2 days after admission revealed patent coronary arteries, improved ejection fraction to 45%, and wall motion abnormalities plus apical ballooning compatible with Takotsubo cardiomyopathy. The case is unusual because our patient differs from the classically defined elderly, postmenopausal female demographic, and did not experience an emotional crisis that could have provoked this series of events. It is also noteworthy for the fact that the only identifiable trigger was exposure to carbon monoxide. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Carbon monoxide poisoning is a common occurrence resulting in a multitude of annual emergency department visits. Given the known toxic effects of carbon monoxide poisoning on the heart, prompt cardiac workup is important to prevent overlooking a major, although rare, manifestation of carbon monoxide exposure.
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Affiliation(s)
- Midhat Lakhani
- UHS Southern California Medical Education Consortium, Temecula, California
| | - Mohammed Alkhero
- UHS Southern California Medical Education Consortium, Temecula, California
| | - Nainjot Bains
- UHS Southern California Medical Education Consortium, Temecula, California
| | - Robert Steele
- UHS Southern California Medical Education Consortium, Temecula, California
| | - Robin Abdelmalik
- UHS Southern California Medical Education Consortium, Temecula, California
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Wang Y, Li J, Wang L, Lin Y, Zhou M, Yin P, Yao S. The impact of carbon monoxide on years of life lost and modified effect by individual- and city-level characteristics: Evidence from a nationwide time-series study in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 210:111884. [PMID: 33421716 DOI: 10.1016/j.ecoenv.2020.111884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
Ambient carbon monoxide (CO) has been linked with mortality and morbidity. Little evidence is available regarding the relation between CO and years of life lost (YLL). Using data from 48 major cities in China from 2013 to 2017, we applied generalized additive models and random effects meta-analyses to explore the effects of CO on YLL from various diseases. Stratified analyses and meta-regression were performed to estimate potential effect modifications of demographic factors, regions, meteorological factors, co-pollutants, urbanization rate, economic level and health service level. Additional life gains due to avoidable YLL under certain scenario were also evaluated. Results indicated that a 1-mg/m³ increase of CO concentrations (lagged over 0-3 d), was associated with 2.08% (95% confidence interval [CI], 1.35%, 2.80%), 2.35% (95% CI: 1.39%, 3.30%), 1.47% (95% CI: -0.01%, 2.93%), 2.28% (95% CI: 1.09%, 3.47%), 2.42% (95% CI: 1.31%, 3.54%), 2.09% (95% CI: 0.47%, 3.72%) increments in daily YLL from non-accidental causes, cardiovascular diseases, respiratory diseases, coronary heart disease, stroke and chronic obstructive pulmonary disease, respectively. These associations were robust to the adjustment of co-pollutants and varied substantially by geography and demographic characteristics. Associations were stronger in the elder people (≥65 years), females, population with low education attainment, and lived in south region, than younger people, males, high educated populations and those lived in north region. Moreover, the harmful impact of increasing CO concentration could be attenuated by city-level characteristics, including the growth of urbanization rate, gross domestic product (GDP), GDP per capita, number of hospital beds, doctors and hospitals. Finally, an estimated life of 0.081 (95% CI: -0.027, 0.190) years would be gained per deceased people if CO concentration could fall to 1 mg/m3. In conclusions, this nationwide analysis showed significant associations between short-term CO exposure and cause-specific YLL. The heterogeneity of both individual- and city-level characteristics should be considered for relevant intervention. These findings may have significant public health implications for the reduction of CO-attributed disease burden in China.
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Affiliation(s)
- Yu Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jie Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yun Lin
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Shanglong Yao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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18
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Chen RJ, Lee YH, Chen TH, Chen YY, Yeh YL, Chang CP, Huang CC, Guo HR, Wang YJ. Carbon monoxide-triggered health effects: the important role of the inflammasome and its possible crosstalk with autophagy and exosomes. Arch Toxicol 2021; 95:1141-1159. [PMID: 33554280 DOI: 10.1007/s00204-021-02976-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022]
Abstract
Carbon monoxide (CO) has long been known as a "silent killer" because of its ability to bind hemoglobin (Hb), leading to reduced oxygen carrying capacity of Hb, which is the main cause of CO poisoning (COP) in humans. Emerging studies suggest that mitochondria is a key target of CO action that can impact key biological processes, including apoptosis, cellular proliferation, inflammation, and autophagy. Despite its toxicity at high concentrations, CO also exhibits cyto- and tissue-protective effects at low concentrations in animal models of organ injury and disease. Specifically, CO modulates the production of pro- or anti-inflammatory cytokines and mediators by regulating the NLRP3 inflammasome. Given that human diseases are strongly associated with inflammation, a deep understanding of the exact mechanism is helpful for treatment. Autophagic factors and inflammasomes interact in various situations, including inflammatory disease, and exosomes might function as the bridge between the inflammasome and autophagy activation. Thus, the interplay among autophagy, mitochondrial dysfunction, exosomes, and the inflammasome may play pivotal roles in the health effects of CO. In this review, we summarize the latest research on the beneficial and toxic effects of CO and their underlying mechanisms, focusing on the important role of the inflammasome and its possible crosstalk with autophagy and exosomes. This knowledge may lead to the development of new therapies for inflammation-related diseases and is essential for the development of new therapeutic strategies and biomarkers of COP.
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Affiliation(s)
- Rong-Jane Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Hsuan Lee
- Department of Cosmeceutics, China Medical University, Taichung, Taiwan
| | - Tzu-Hao Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Ying Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ya-Ling Yeh
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ching-Ping Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan.,Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan. .,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. .,Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Ying-Jan Wang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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19
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Liu Q, Gao X, Xiao Q, Zhu B, Liu Y, Han Y, Wang W. A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning. Clin Cardiol 2021; 44:401-406. [PMID: 33496356 PMCID: PMC7943905 DOI: 10.1002/clc.23550] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background Indicators of adverse cardiovascular events in patients with acute carbon monoxide (CO) poisoning‐induced myocardial injury have not yet been elucidated. Hypothesis This study aimed at determining the risk factors for adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Methods We enrolled patients with moderate‐to‐severe acute CO poisoning‐induced myocardial injury. Based on the occurrence of adverse cardiovascular events, the patients were assigned into event and non‐event group. Binary logistic regression analysis was performed to analyze the potential risk factors for cardiovascular adverse events. Results A total of 413 eligible patients were enrolled. Among them, 61 (14.8%) patients presented adverse cardiovascular events and were assigned to the event group while 352 patients were assigned to the non‐event group. Univariate analysis revealed that cTnI, Lac, and NLR levels at admission and sST2 at day 3 in the event group were significantly higher compared to those in the non‐event group. Subsequent multivariate analysis revealed that sST2 at day 3 and NLR at admission were independent risk factors for adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Finally, the sensitivity, specificity, and AUC of sST2 at day 3 combined with NLR for event prediction were 79.5%, 82.8%, and 0.858, respectively. Conclusion A combination of sST2 at day 3 and NLR is a potential predictor for the occurrence of adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Therefore, cardiovascular risk stratification should be taken into consideration, especially in patients with acute CO poisoning‐induced myocardial injury.
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Affiliation(s)
- Qian Liu
- Department of EICU, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Xun Gao
- Department of EICU, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Qingmian Xiao
- Department of Emergency General Ward, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Baoyue Zhu
- Department of EICU, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Yongjian Liu
- Department of Emergency Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Yongyan Han
- Department of Emergency General Ward, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Weizhan Wang
- Department of Emergency Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
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20
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Park JH, Heo R, Kang H, Oh J, Lim TH, Ko BS. Diagnostic performance and optimal cut-off values of cardiac biomarkers for predicting cardiac injury in carbon monoxide poisoning. Clin Exp Emerg Med 2020; 7:183-189. [PMID: 33028061 PMCID: PMC7550812 DOI: 10.15441/ceem.19.072] [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: 08/27/2019] [Accepted: 10/11/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to compare the diagnostic performance of cardiac biomarkers and to evaluate the optimal cut-off values for echocardiographic cardiac injury prediction in patients with carbon monoxide (CO) poisoning. METHODS This retrospective observational cohort study included adult patients with acute CO poisoning. Patients who did not undergo transthoracic echocardiography, which was used to define patients with cardiac injury (ejection fraction <55%), were excluded. The area under the curve was used to evaluate diagnostic performance for cardiac injury prediction. Mann-Whitney U, chi-square, and Fisher exact tests were used to analyze data. RESULTS After excluding the 27 patients who did not undergo echocardiography, 114 patients were included in the study. Fifteen (13.2%) patients had cardiac injury. The area under the curve values for the B-type natriuretic peptide, creatine kinase-myocardial band, and troponin I were 0.711 (95% confidence interval [CI], 0.527-0.895; P=0.011), 0.766 (95% CI, 0.607-0.926; P=0.001), and 0.801 (95% CI, 0.647-0.955; P<0.001), respectively, with optimal cut-off values of 330 pg/mL, 10.1 ng/mL, and 0.455 ng/mL, respectively. The sensitivity, specificity, and positive and negative predictive values of troponin I were 67%, 91%, 53%, and 95%, respectively. CONCLUSION Troponin I showed the best diagnostic performance for predicting cardiac injury in patients with CO poisoning. A cut-off value of 0.455 ng/mL appeared optimal for cardiac injury prediction. However, further studies on cardiac biomarkers and other diagnostic tools in CO poisoning are needed given the low sensitivity of troponin I.
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Affiliation(s)
- Jun Hwan Park
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
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21
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Myocardial Repolarization Parameters and Neutrophil-to-Lymphocyte Ratio are Associated with Cardiotoxicity in Carbon Monoxide Poisoning. Cardiovasc Toxicol 2020; 20:190-196. [PMID: 31863276 DOI: 10.1007/s12012-019-09560-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The present study aims to examine the clinical values of complete blood count (CBC) bioindicators and corrected QT (QTc), Tpeak - Tend interval (Tp-e), Tpeak dispersion (Tp disp), and Tp-e/QT ratio that are the parameters of myocardial repolarization (M-rep) for cardiotoxicity, which develops due to acute carbon monoxide (CO) intoxication in patients admitted to the emergency service. This retrospective, cross-sectional, observational, and single-center study was conducted between April and June 2019. Statistical analysis was performed using the SPSS 23.0 software. Data of 234 participants were analyzed. Of these, 54.9% (n = 129) were female. Neutrophil-to-lymphocyte ratio (NLR), QTc, Tp-e values were significantly high in the CO intoxication group (p < 0.001, p < 0.001, and p < 0.001, respectively), whereas Tp-e/QTc ratio was significantly lower in the CO intoxication group than that in the control group (p < 0.001). NLR, Tp-e, Tp disp values were significantly high in the myocardial injury (M-inj) group (p < 0.001, p = 0.003, and p = 0.018, respectively). Furthermore, Tp-e/QTc ratio was significantly low in the M-inj group (p = 0.002). M-rep parameters and NLR are associated with CO intoxication and the development of M-inj. Moreover, these bioindicators and can provide clinicians an early indication of M-inj.
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22
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Kim YM, Shin HJ, Choi DW, Kim JM, Lee SW, Jeong SH, Kim H. Comparison of high-flow nasal cannula oxygen therapy and conventional reserve-bag oxygen therapy in carbon monoxide intoxication: A pilot study. Am J Emerg Med 2020; 38:1621-1626. [DOI: 10.1016/j.ajem.2019.158451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/11/2019] [Accepted: 09/14/2019] [Indexed: 01/11/2023] Open
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23
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Geng S, Hao X, Xu H, Yao J, He D, Xin H, Gong X, Zhang R. Cardiac injury after acute carbon monoxide poisoning and its clinical treatment scheme. Exp Ther Med 2020; 20:1098-1104. [PMID: 32742349 PMCID: PMC7388256 DOI: 10.3892/etm.2020.8801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/11/2019] [Indexed: 01/28/2023] Open
Abstract
This study was designed to investigate cardiac injury after acute carbon monoxide poisoning and its clinical treatment scheme. Seventy patients with moderate and severe acute carbon monoxide poisoning (ACOP) admitted from January 2017 to December 2018 into The Affiliated Hospital of Qingdao University were regarded as a research group (RG), and another 30 healthy adults undergoing physical examination in the hospital during the same period were selected as a control group (CG). Thirty-five patients in the RG who received hyperbaric oxygen therapy were considered as group A, and 35 patients who received extracorporeal membrane oxygenation therapy were considered as group B. The effective rates and complications of the two groups after treatment were compared. The concentrations of creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) of myocardial enzymes at different time points before and after treatment were detected. Expression of miR-30a in the blood of experimental subjects was detected by time-fluorescence quantitative PCR, and the relationship between miR-30a expression and ACOP patients was analyzed. Patients in groups A and B achieved obvious efficacy, but the effective rate and incidence rate of complications in the extracorporeal membrane oxygenation (ECMO) group were better than those in the hyperbaric oxygen group. The concentrations of CK-MB and LDH in group A and group B were significantly higher than those in control group (P<0.01). The expression level of miR-30a in the RG was significantly higher than that in the control group (P<0.05). Both hyperbaric oxygen therapy and ECMO therapy have obvious efficacy on ACOP patients, but the latter is better than the former. The expression level of miR-30a in blood of ACOP patients increased significantly, which is positively correlated with myocardial injury, and it decreased after treatment. It is believed that miR-30a can provide a reference index for early diagnosis and prediction of disease progression and prognosis in cardiac injury of ACOP.
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Affiliation(s)
- Shoumeng Geng
- Department of Emergency, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xiaoyan Hao
- Department of Emergency, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| | - Haicang Xu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Jian Yao
- Department of Emergency, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Dongyong He
- Department of Emergency, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Hui Xin
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xingji Gong
- Department of Emergency, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Rui Zhang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
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24
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Du JJ, Liu ZQ, Yan Y, Xiong J, Jia XT, Di ZL, Ren JJ. The Cannabinoid WIN 55,212-2 Reduces Delayed Neurologic Sequelae After Carbon Monoxide Poisoning by Promoting Microglial M2 Polarization Through ST2 Signaling. J Mol Neurosci 2019; 70:422-432. [PMID: 31732924 DOI: 10.1007/s12031-019-01429-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/03/2019] [Indexed: 12/27/2022]
Abstract
Delayed neurologic sequelae (DNS) are among the most serious complications of carbon monoxide (CO) poisoning caused partly by elevated neuroinflammation. WIN 55,212-2, a non-selective agonist of cannabinoid receptors, has been demonstrated to have anti-inflammatory properties in various brain disorders. The anti-inflammatory action of WIN 55,212-2 is potentially associated with driving microglial M2 polarization. ST2 signaling is important in regulating inflammatory responses and microglial polarization. Therefore, we aimed to investigate the neuroprotective effect of WIN 55,212-2 on DNS after CO poisoning and elucidate its relationship with ST2-mediated microglial M2 polarization. The behavioral tests showed that treatment with WIN 55,212-2 significantly ameliorates the cognitive impairment induced by CO poisoning. This behavioral improvement was accompanied by reduced neuron loss, decreased production of pro-inflammatory cytokines, and a limited number of microglia in the hippocampus. Moreover, WIN 55,212-2 elevated the protein expression of IL-33 (the ligand of ST2) and ST2, increased the ratio of CD206-positive (M2 phenotype) and ST2-positive microglia, and augmented production of M2 microglia-associated cytokines in the hippocampus of CO-exposed rats. Furthermore, we observed that the WIN 55,212-2-mediated increases in ST2 protein expression, CD206-positive and ST2-positive microglia, and microglia-associated cytokines were blocked by the cannabinoid receptor 2 (CB2R) antagonist AM630 but not by the cannabinoid receptor 1 (CB1R) antagonist AM251. In contrast, the WIN 55,212-2-induced upregulation of the IL-33 protein expression was inhibited by AM251 but not by AM630. Altogether, these findings reveal cannabinoid receptors as promising therapeutic agents for CO poisoning and identify ST2 signaling-related microglial M2 polarization as a new mechanism of cannabinoid-induced neuroprotection.
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Affiliation(s)
- Jing-Jing Du
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Zhi-Qin Liu
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Yue Yan
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Jing Xiong
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Xiao-Tao Jia
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Zheng-Li Di
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Jing-Jing Ren
- Department of Hematology, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
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25
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Wang W, Cheng J, Zhang J, Wang K. Effect of Hyperbaric Oxygen on Neurologic Sequelae and All-Cause Mortality in Patients with Carbon Monoxide Poisoning: A Meta-Analysis of Randomized Controlled Trials. Med Sci Monit 2019; 25:7684-7693. [PMID: 31606731 PMCID: PMC6807531 DOI: 10.12659/msm.917065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Hyperbaric oxygen (HBO) is used in patients with carbon monoxide (CO) poisoning to prevent the occurrence of delayed neurological sequelae. However, inconsistent results were obtained regarding the treatment effects of HBO. Therefore, the current meta-analysis was conducted based on published randomized controlled trials (RCTs) to determine the effect of HBO on neurologic sequelae and all-cause mortality in patients with CO poisoning. Material/Methods Electronic databases MedLine, EmBase, and the Cochrane Library were searched for relevant RCTs from inception to March 1, 2019. The pooled relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the outcomes by using a random-effects model. Sensitivity, subgroup, and publication bias analyses were also conducted. Results Seven RCTs, including 9 cohorts and a total of 2023 patients with CO poisoning, were enrolled in this study. The summary results revealed that HBO showed an association with lower risk of memory impairment compared to patients receiving normobaric oxygen (NBO), whereas 2 sessions of HBO showed an association with higher risk of memory impairment compared to those who received 1 session of HBO. Moreover, HBO was associated with increased neuropsychologic scores of block design and trail making when compared with NBO. No other significant differences regarding the treatment effects of HBO were observed. Conclusions These results indicate that HBO therapy significantly reduces the risk of memory impairment compared to NBO, but 2 sessions of HBO might not be better for memory impairment than 1 session of HBO.
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Affiliation(s)
- Weiqiang Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Department of General Practice, Suzhou Hospital of Anhui Medical University/Suzhou Municipal Hospital, Suzhou, Anhui, China (mainland)
| | - Jincheng Cheng
- Department of Neurology, No. 123 Hospital of Nanjing Military Command, Chinese People's Liberation Army (CPLA), Bengbu, Anhui, China (mainland)
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
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26
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Rezaee R, Sheidary A, Jangjoo S, Ekhtiary S, Bagheri S, Kohkan Z, Dadres M, Oana Docea A, Tsarouhas K, Sarigiannis DA, Karakitsios S, Tsatsakis A, Kovatsi L, Hashemzaei M. Cardioprotective effects of hesperidin on carbon monoxide poisoned in rats. Drug Chem Toxicol 2019; 44:668-673. [DOI: 10.1080/01480545.2019.1650753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
- HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Thessaloniki, Greece
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sheidary
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
- Students Research Committee, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Saeedeh Jangjoo
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
- Students Research Committee, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Sarvenaz Ekhtiary
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
- Students Research Committee, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Somayeh Bagheri
- Department of Biostatistics, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Zahra Kohkan
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
- Students Research Committee, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Madjid Dadres
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Anca Oana Docea
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Dimosthenis A. Sarigiannis
- Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
- HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Thessaloniki, Greece
| | - Spyros Karakitsios
- Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
- HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Thessaloniki, Greece
| | - Aristidis Tsatsakis
- Center of Toxicology Science & Research, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Leda Kovatsi
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Mahmoud Hashemzaei
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
- Students Research Committee, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
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27
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Risk of Myocardial Infarction After Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study. Cardiovasc Toxicol 2018; 19:147-155. [DOI: 10.1007/s12012-018-9484-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Rezaee MA, Moallem SA, Mohammadpour AH, Mahmoudi M, Sankian M, Farzadnia M, Alavi H, Imenshahidi M. Histopathological study of erythropoietin protective effect on carbon monoxide-induced cardiotoxicity in rat. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2018; 20:1189-1193. [PMID: 29299194 PMCID: PMC5749351 DOI: 10.22038/ijbms.2017.9471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective(s): Cardiotoxicity is one of the major consequences in carbon monoxide poisoning. Following our previous work, in this study we aimed to define the myocardium changes induced by carbon monoxide (CO) intoxication and evaluate erythropoietin (EPO) effect on CO cardiotoxicity in rat. Materials and Methods: Severe carbon monoxide toxicity induced by 3000 ppm CO in Wistar rat. EPO was administrated (5000 IU/Kg, intraperitoneal injection) at the end of CO exposure and then the animals were re-oxygenated with the ambient air. Subsequently heart was removed and assessed by histopathology and electron microscopy examinations. Results: 3000 ppm CO induced significant myocardium injury; multiple foci of necrosis and lymphocyte infiltration compare with the control (P<0.05). Electron microscopy examination showed myofibril lysis and mitochondrial swelling in myocardium due to 3000 ppm CO poisoning. However EPO administration after CO exposure resulted in significant reduction in cardiomyocytes injury (P<0.05). Conclusion: Our results represented protective effect of EPO on cardiac injury induced by CO intoxication in rat.
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Affiliation(s)
- Mitra Asgharian Rezaee
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.,Pharmaceutical Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Adel Moallem
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Sankian
- Immunobiochemistry Laboratory, Immunology Research Center, Bu-Ali research Institute, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Farzadnia
- Department of Pathology, School of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Alavi
- Electron Microscope Unit, Bu-Ali Research Institute, Mashhad University of Medical Science, Mashhad, Iran.,School of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Mohsen Imenshahidi
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Saritas A, Gunes H, Colakoglu S, Eroz R, Akoz A, Oktay M, Buyukkaya A, Kandis H, Ozkan A. Are there any effects of chronic carbon monoxide exposure on argyrophilic nucleolar-organizing region–associated protein synthesis in rat myocardium? Hum Exp Toxicol 2016; 35:921-8. [DOI: 10.1177/0960327115608929] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of the study are to detect whether there are any possible effects of chronic carbon monoxide (CO) exposure on the argyrophilic nucleolar-organizing region (AgNOR)–associated protein synthesis and evaluate any possible relationship between the amount of AgNOR protein and the level of myocardial injury also and between AgNOR and histopathological evaluation methods. Adult male albino Wistar rats ( n = 18) were randomly divided into three groups (groups A, B, and C). Group A served as control, while groups B and C were rats exposed to CO gas chronically (1000 and 3000 ppm CO concentration with a flow rate of 4 L/min for 30 min/day for 7 days, respectively). Total AgNOR area/nuclear area (TAA/NA) and the mean AgNOR numbers for each myocyte nucleus were determined. There were significant differences among all groups for TAA/NA ratio. These differences were not significant for mean AgNOR numbers. According to the histopathological evaluation scores, there were significant differences between the groups. The differences were significant among the groups for loss of sarcomere pattern. A strong positive correlation between histopathological injury scores and TAA/NA ratio was found ( Rsq = 0.48; p = 0.002), however, the correlation was not significant for mean AgNOR numbers ( Rsq = 0.08; p = 0.25). In conclusion, TAA/NA ratio can be used as an indicator for obtaining information about the level of myocardial damage instead of histopathological evaluation scores.
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Affiliation(s)
- A Saritas
- Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - H Gunes
- Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - S Colakoglu
- Department of Anatomy, Duzce University School of Medicine, Duzce, Turkey
| | - R Eroz
- Department of Medical Genetics, Duzce University School of Medicine, Duzce, Turkey
| | - A Akoz
- Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey
| | - M Oktay
- Department of Pathology, Duzce University School of Medicine, Duzce, Turkey
| | - A Buyukkaya
- Department of Radiology, Duzce State Hospital, Duzce, Turkey
| | - H Kandis
- Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - A Ozkan
- Department of Pediatric Surgery, Duzce University School of Medicine, Duzce, Turkey
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Akyol S, Yuksel S, Pehlivan S, Erdemli HK, Gulec MA, Adam B, Akyol O. Possible role of antioxidants and nitric oxide inhibitors against carbon monoxide poisoning: Having a clear conscience because of their potential benefits. Med Hypotheses 2016; 92:3-6. [PMID: 27241244 DOI: 10.1016/j.mehy.2016.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/19/2016] [Accepted: 04/08/2016] [Indexed: 01/09/2023]
Abstract
Carbon monoxide poisoning is one of the important emergency situations manifested by primarily acute and chronic anoxic central nervous system (CNS) injuries and other organ damages. Current descriptions and therapeutic approaches have been focused on the anoxic pathophysiology. However, this point of view incompletely explains some of the outcomes and needs to be investigated extensively. Considering this, we propose that reactive oxygen species (ROS) including especially nitric oxide (NO) are likely to be a key concept to understand the emergency related to CO poisoning and to discover new therapeutic modalities in CO toxicity. If we consider the hypothesis that ROS is involved greatly in acute and chronic toxic effects of CO on CNS and some other vital organs such as heart, it follows that the antioxidant and anti-NO therapies might give the clinicians more opportunities to prevent deep CNS injury. In support of this, we review the subject in essence and summarize clinical and experimental studies that support a key role of ROS in the explanation of pathophysiology of CO toxicity as well as new treatment modalities after CO poisoning.
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Affiliation(s)
- Sumeyya Akyol
- Department of Medical Biology, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey.
| | - Sevda Yuksel
- Department of Child Development, School of Health, Turgut Ozal University, Ankara, Turkey
| | - Sultan Pehlivan
- Ankara Regional Office of Council of Forensic Medicine, Morgue Department, Ankara, Turkey
| | - Haci Kemal Erdemli
- Department of Biochemistry Laboratory, Corum Training and Research Hospital, Corum, Turkey
| | - Mehmet Akif Gulec
- Department of Medical Biochemistry, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Bahattin Adam
- Department of Biochemistry & Molecular Medicine, University of California, Davis, California, United States
| | - Omer Akyol
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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31
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Protective effect of erythropoietin on myocardial apoptosis in rats exposed to carbon monoxide. Life Sci 2016; 148:118-24. [PMID: 26855001 DOI: 10.1016/j.lfs.2016.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/21/2022]
Abstract
AIMS Cardiac complications are common in carbon monoxide (CO) poisoning and associated with high morbidity and mortality. We have previously shown that erythropoietin (EPO) could reduce CO-induced cardiac ischemia in rat. In the current study, the anti-apoptotic effect of EPO during CO cardiotoxicity was investigated in order to elucidate the mechanism of EPO anti-ischemic action. MAIN METHODS Wistar rats were exposed to CO (250, 1000 and 3000ppm). EPO (5000IU/kg) was administered to all groups by intraperitoneal injection at the end of CO exposure period. TUNEL and caspase-3 activity levels were assessed to investigate the effects of CO exposure and subsequent EPO administration on myocardial apoptosis. The changes of mitochondrial membrane potential (MMP) were also assessed with sensitive lipophilic dye JC-1 by flow cytometry. The roles of Bcl2 and Bax in EPO protective effect were investigated by Western blotting. KEY FINDINGS Myocardial apoptosis was observed following CO exposure. Moreover, mitochondrial membrane depolarization and significant reduction in Bcl2/Bax ratio were shown following CO poisoning especially at 3000ppm. On the other hand, EPO administration could effectively suppress apoptosis in myocardial cells. Also, EPO significantly prevented the CO-induced depolarization of MMP (p<0.001) and preserved Bcl2/Bax ratio (p<0.01). SIGNIFICANCE EPO reduces myocardial injury due to CO intoxication. Thus EPO could be suggested as a possible candidate for the management of CO cardiotoxicity with clinical applications.
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Huysal K, Ustundag Budak Y, Aydin U, Demirci H, Turk T, Karadag M. COHb Level and High-Sensitivity Cardiac Troponin T in 2012 in Bursa, Turkey: A Retrospective Single-Center Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27061. [PMID: 27437130 PMCID: PMC4939414 DOI: 10.5812/ircmj.27061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 08/18/2015] [Accepted: 09/16/2015] [Indexed: 12/13/2022]
Abstract
Background Intoxication due to carbon monoxide (CO) is one of the most common types of poisoning. Cardiac effects of carboxyhemoglobin (COHb) range from simple arrhythmias to myocardial infarction. Objectives The current study aimed to investigate the relationship between blood carboxyhemoglobin and high-sensitivity cardiac troponin T (hs-cTnT) level with a highly sensitive assay in patients with acute carbon monoxide poisoning. Patients and Methods This retrospective study was conducted on 141 (54 males and 87 females) patients, with acute CO intoxication, admitted to the Sevket Yilmaz research and education hospital emergency unit during a one-year period (January 2012 - January 2013). The patients were divided into three groups based on COHb levels: Group I, mild COHb level < 15%; Group II, COHb between 15% and 25%; Group III, severe acute CO intoxication COHb levels > 25%. COHb, hs-cTnT (Stat), creatine kinase (CK) and creatine kinase-myocardial band (CK-MB) levels were measured on admission. Results The mean age of the patients was 38 ± 16 years. COHb levels ranged from 8 to 35. hs-cTnT levels on inclusion in this study were slightly different between the groups (P = 0.05). COHb levels with hs-cTnT values were weakly correlated (r = 0.173, P = 0.041); on the other hand, CK-MB levels were not correlated with COHb (r = 0.013, P = 0.883). Conclusions In patients without clear signs of myocardial infarction, even mild CO poisoning was associated with quantifiable circulating levels of hs-cTnT when TnT was measured using a highly sensitive assay in the current study patients. Plasma levels of the hs-TnT and CK-MB assays were not correlated with the COHb levels in the current study patients.
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Affiliation(s)
- Kagan Huysal
- Sevket Yilmaz Education and Research Hospital, Clinical Laboratory Section, Bursa, Turkey
| | - Yasemin Ustundag Budak
- Sevket Yilmaz Education and Research Hospital, Clinical Laboratory Section, Bursa, Turkey
| | - Ufuk Aydin
- Sevket Yilmaz Education and Research Hospital, Cardiovasculer Surgery Section, Bursa, Turkey
- Corresponding Author: Ufuk Aydin, Sevket Yilmaz Education and Research Hospital, Cardiovasculer Surgery Section, Bursa, Turkey. Tel: +90-5322211458, Fax: +90-2243605055, E-mail:
| | - Hakan Demirci
- Sevket Yilmaz Education and Research Hospital, Family Medicine Section, Bursa, Turkey
| | - Tamer Turk
- Sevket Yilmaz Education and Research Hospital, Cardiovasculer Surgery Section, Bursa, Turkey
| | - Mehmet Karadag
- Sevket Yilmaz Education and Research Hospital, Pulmonary Medicine Section, Bursa, Turkey
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Lee FY, Chen WK, Lin CL, Kao CH. Carbon monoxide poisoning and subsequent cardiovascular disease risk: a nationwide population-based cohort study. Medicine (Baltimore) 2015; 94:e624. [PMID: 25761191 PMCID: PMC4602477 DOI: 10.1097/md.0000000000000624] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Carbon monoxide (CO) poisoning is considered one of the most crucial health concerns. Few studies have investigated the correlation between CO poisoning and the risk of developing cardiovascular diseases (CVDs). Therefore, we conducted a population-based, longitudinal cohort study in Taiwan to determine whether patients with CO poisoning are associated with higher risk of developing subsequent CVDs, including arrhythmia, coronary artery disease (CAD) and congestive heart failure (CHF). This retrospective study used the National Health Insurance Research Database. The study cohort comprised all patients aged ≥20 years with a diagnosis of CO poisoning and hospitalized during 2000 to 2011 (N = 8381), and the comparison cohort comprised randomly selected non-CO-poisoned patients (N = 33,524) frequency-matched with the study cohort by age, sex, and the year of index date. Each patient was individually tracked to identify those who develop CVD events during the follow-up period. Cox proportional hazards regression model was performed to calculate the hazard ratios of CVDs after adjusting for possible confounders. The overall incidences of arrhythmia, CAD, and CHF were higher in the patients with CO poisoning than in the controls (2.57 vs 1.25/1000 person-years, 3.28 vs 2.25/1000 person-years, and 1.32 vs 1.05/1000 person-years, respectively). After adjusting for age, sex, and comorbidities, the patients with CO poisoning were associated with a 1.83-fold higher risk of arrhythmia compared with the comparison cohort, and nonsignificantly associated with risk of CAD and CHF. CO-poisoned patients with coexisting comorbidity or in high severity were associated with significantly and substantially increased risk of all 3 CVDs. CO poisoning is associated with increased risk of subsequent development of arrhythmia. Future studies are required to explore the long-term effects of CO poisoning on the cardiovascular system.
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Affiliation(s)
- Feng-You Lee
- From the Department of Health Services Administration, College of Management, China Medical University (F-YL); Department of Emergency Medicine, Trauma and Emergency Center (W-KC); Management Office for Health Data, China Medical University Hospital (C-LL); College of Medicine (C-LL); Graduate Institute of Clinical Medical Science, China Medical University (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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