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Safari H, Ajudani R, Savaie M, Babadi AJ, Alizadeh P. Intracerebral hemorrhage in methanol toxicity patients during COVID-19 pandemic: case report and review of literature. Forensic Toxicol 2024; 42:242-247. [PMID: 38334843 DOI: 10.1007/s11419-023-00680-y] [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: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The aim of this study is to examine the clinical and imaging manifestations of methanol toxicity during the COVID-19 pandemic, as well as to review existing studies on this topic. The most common cause of methanol intoxication is methanol-adulterated liquor. The primary metabolite of methanol, formic acid, is responsible for pathological changes. Symptoms typically present within 6-24 h of consumption and can include visual disturbances, acute neurological symptoms, and gastrointestinal issues. During the initial year of the COVID-19 pandemic, methanol poisoning cases increased significantly. METHODS In this study, We present six different patients with methanol intoxication and their clinical and imaging features. RESULTS In the literature review, the most common clinical presentation was loss of consciousness and obtundation and the other was vision loss. CT scan findings showed bilateral putaminal necrosis and hemorrhage in 55% of methanol toxicity patients. CONCLUSION Methanol intoxication, causing bilateral putaminal involvement and a 50% mortality rate in intracerebral hemorrhage patients, warrants urgent toxicological analysis due to potential putaminal hemorrhage.
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Affiliation(s)
- Hosein Safari
- Pain Research Center, Neurosurgery department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Reza Ajudani
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Savaie
- Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Pooyan Alizadeh
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Tartarin H, Morotti A, Van Etten ES, Hausman-Kedem M, Charidimou A, Jouvent E, Susen S, Cordonnier C, Pasi M, Boulouis G. Uncommon Causes of Nontraumatic Intracerebral Hemorrhage. Stroke 2024; 55:1416-1427. [PMID: 38572651 DOI: 10.1161/strokeaha.123.043917] [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: 04/05/2024]
Abstract
Nontraumatic intracerebral hemorrhage is an important health issue. Although common causes such as hypertension and cerebral amyloid angiopathy predominantly affect the elderly, there exists a spectrum of uncommon etiologies that contribute to the overall incidence of intracerebral hemorrhage. The identification of these rare causes is essential for targeted clinical management, informed prognostication, and strategic secondary prevention where relevant. This topical review explores the uncommon intracerebral hemorrhage causes and provides practical clues for their clinical and imaging identification. By expanding the clinician's differential diagnosis, this review aims to bridge the gap between standard intracerebral hemorrhage classification systems and the nuanced reality of clinical practice.
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Affiliation(s)
- Hugo Tartarin
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy (A.M.)
| | - Ellis S Van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.S.V.E.)
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dewk Children's Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv Unisversity, Israel (M.H.-K.)
| | | | - Eric Jouvent
- Neurology Department, Lariboisière Hosp, APHP and Université Paris Cité, France (E.J.)
| | - Sophie Susen
- Hematology and Transfusion Department, Centre Hospitalier Universitaire de Lille, France (S.S.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, France (C.C.)
| | - Marco Pasi
- Stroke unit, CHU Tours, Centre Val de Loire, France (M.P.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
- INSERM 1253 iBrain, Tours, Centre Val de Loire, France (G.B.)
- CIC-IT 14.15, Tours, Centre Val de Loire, France (G.B.)
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3
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Takahashi M, Kondo T, Yamasaki G, Sugimoto M, Yoshida H, Harada K, Matsumoto H, Asano M, Ueno Y. An Autopsy Case Report of Homicide by Methanol Intoxication With Pinkish Bilateral Putamina. Am J Forensic Med Pathol 2023; 44:55-58. [PMID: 36037297 DOI: 10.1097/paf.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Many deaths caused by methanol occur as a result of intentional suicide attempts or accidental ingestion, and several investigators have quantified methanol and formic acid in blood and organs. However, to the best of our knowledge, no reports have described regional differences in the concentration of methanol in the brain. A man in his 50s drank alcohol that had been deliberately contaminated with methanol by his wife, and he died of multiple-organ failure after 4 days of intensive medical treatment including hemodialysis. On medicolegal autopsy, cross sections of the brain showed scattered petechial hemorrhage in the brain stem and microscopic hemorrhage with congestion in the bilateral putamina, which showed pinkish discoloration. The concentrations of methanol, formic acid, and ethanol in autopsy samples were measured by headspace gas chromatography, revealing relatively high concentrations of residual methanol and formic acid in the brain (especially in the basal ganglia), although methanol had been eliminated from the blood. Even after 4 days of medical treatment, postmortem toxicological analysis of the brain tissue indicated methanol ingestion. The accumulation of formic acid and the consequent local metabolic acidosis may cause brain lesions.
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Affiliation(s)
- Motonori Takahashi
- From the Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, Hyogo
| | - Takeshi Kondo
- From the Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, Hyogo
| | - Gentaro Yamasaki
- From the Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, Hyogo
| | - Marie Sugimoto
- From the Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, Hyogo
| | | | | | - Hiroshi Matsumoto
- Department of Legal Medicine, Osaka University Graduate School of Medicine
| | - Migiwa Asano
- Department of Legal Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasuhiro Ueno
- From the Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, Hyogo
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Cejnar P, Smirnova TA, Kuckova S, Prochazka A, Zak I, Harant K, Zakharov S. Acute and chronic blood serum proteome changes in patients with methanol poisoning. Sci Rep 2022; 12:21379. [PMID: 36494437 PMCID: PMC9734099 DOI: 10.1038/s41598-022-25492-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Twenty-four blood serum samples from patients with acute methanol poisoning (M) from the mass methanol poisoning outbreak in the Czech Republic in 2012 were compared with 46 patient samples taken four years after poisoning (S) (overlap of 10 people with group M) and with a control group (C) of 24 samples of patients with a similar proportion of chronic alcohol abuse. When comparing any two groups, tens to hundreds of proteins with a significant change in concentration were identified. Fifteen proteins showed significant changes when compared between any two groups. The group with acute methanol poisoning showed significant changes in protein concentrations for at least 64 proteins compared to the other groups. Among the most important identified proteins closely related to intoxication are mainly those involved in blood coagulation, metabolism of vitamin A (increased retinol-binding protein), immune response (e.g., increased complement factor I, complement factors C3 and C5), and lipid transport (increased apolipoprotein A I, apolipoprotein A II, adiponectin). For blood coagulation, the most affected proteins with significant changes in the methanol poisoning group were von Willebrand factor, carboxypeptidase N, alpha-2-antiplasmin (all increased), inter-alpha-trypsin inhibitor heavy chain H4, kininogen-1, plasma serine protease inhibitor, plasminogen (all decreased). However, heparin administration used for the methanol poisoning group could have interfered with some of the changes in their concentrations. Data are available via ProteomeXchange with the identifier PXD035726.
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Affiliation(s)
- Pavel Cejnar
- grid.448072.d0000 0004 0635 6059Department of Computing and Control Engineering, University of Chemistry and Technology, Prague, Technicka 5, 166 28 Prague 6, Czech Republic ,grid.412539.80000 0004 0609 2284University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Tatiana Anatolievna Smirnova
- grid.448072.d0000 0004 0635 6059Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Technicka 5, 166 28 Prague 6, Czech Republic
| | - Stepanka Kuckova
- grid.448072.d0000 0004 0635 6059Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Technicka 5, 166 28 Prague 6, Czech Republic
| | - Ales Prochazka
- grid.448072.d0000 0004 0635 6059Department of Computing and Control Engineering, University of Chemistry and Technology, Prague, Technicka 5, 166 28 Prague 6, Czech Republic
| | - Ivan Zak
- grid.4491.80000 0004 1937 116XDepartment of Occupational Medicine, First Faculty of Medicine, Charles University, Na Bojisti 1, 12000 Prague, Czech Republic ,grid.411798.20000 0000 9100 9940Toxicological Information Centre, General University Hospital, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Karel Harant
- grid.4491.80000 0004 1937 116XProteomics Core Facility, Faculty of Science, BIOCEV, Charles University, Prumyslova 595, 252 42 Vestec, Czech Republic
| | - Sergey Zakharov
- grid.4491.80000 0004 1937 116XDepartment of Occupational Medicine, First Faculty of Medicine, Charles University, Na Bojisti 1, 12000 Prague, Czech Republic ,grid.411798.20000 0000 9100 9940Toxicological Information Centre, General University Hospital, Na Bojisti 1, 120 00 Prague 2, Czech Republic
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Yaşgüçlükal MA, Eyüpoğlu S, Kaya B. Late hemorrhagic transformation of brain lesions in case with methanol intoxication. Neuroradiol J 2022; 35:658-661. [PMID: 35487801 PMCID: PMC9513911 DOI: 10.1177/19714009221096822] [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: 11/15/2022] Open
Abstract
Methanol intoxication can be occurred as accidental or suicidal ingestion or intentional ingestion through abuse. Formic acid is the primary toxic metabolite which causes high anion gap metabolic acidosis and end-organ damage in the human body. Here we presented a 46-year-old man who loss of consciousness on the 23rd day of hospitalization and his cranial computed tomography revealed bilateral subcortical hemorrhages. This case indicates us an example of late appearance of hemorrhagic transformation in methanol intoxication.
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Affiliation(s)
- Miray A Yaşgüçlükal
- Giresun Training and Research
Hospital, Neurology Department, Giresun, Turkey
| | - Selin Eyüpoğlu
- Giresun Training and Research
Hospital, Department of Intensive Care, Turkey
| | - Bahar Kaya
- Giresun Training and Research
Hospital, Neurology Department, Giresun, Turkey
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6
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Di YL, Yu Y, Zhao SJ, Huang N, Fei XC, Yao DD, Ai L, Lyu JH, He RQ, Li JJ, Tong ZQ. Formic acid induces hypertension-related hemorrhage in hSSAO TG in mice and human. Exp Neurol 2022; 358:114208. [PMID: 35988700 DOI: 10.1016/j.expneurol.2022.114208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/04/2022]
Abstract
Hypertension is a confirmed risk factor for cerebral hemorrhage in humans. Which endogenous factor directly induces hypertension-related hemorrhage is unclear. In this study, 42 hemorrhagic patients with hypertension and hyperlipidemia and 42 age-matched healthy controls were enrolled. The contents of serum semicarbazide-sensitive amine oxidase (SSAO) and formic acid (FC, FC is a final product of SSAO through the oxidation of endogenous formaldehyde, which results from the enzymatic oxidative deamination of the SSAO substrate, methylamine) were examined in the patients after stroke. Hemorrhagic areas were quantified by computer tomography. In the animal study, hemorrhagic degree was assessed by hemotoxylin & eosin or tissue hemoglobin kits. The relationship between FC and blood pressure/hemorrhagic degree was examined in wild-type mice and hSSAOTG mice fed with high-fat diets or high-fat and -salt diets. The results showed that the levels of serum FC were positively correlated with blood pressure and hemorrhagic areas in hemorrhagic patients. Transfection of microRNA-134 could enhance SSAO expression in human vascular smooth muscle cells. Consistently, after treatment with high-fat and -salt diets, hSSAOTG mice exhibited higher levels of miR134 and FC, higher blood pressure, and more severe hemorrhage than wild-type mice. Interestingly, folic acid reduced hypertension and hemorrhage in hSSAOTG mice fed with high-fat diets. These findings suggest that FC is a crucial endogenous factor for hypertension and hemorrhage.
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Affiliation(s)
- Ya-Lan Di
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, School of Mental Health, Oujiang Laboratory, Wenzhou Medical University, Wenzhou, China
| | - Yan Yu
- Chinese institute of Rehabilitation Science, China Rehabilitation Research Center, Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing Boai Hospital, Beijing, China
| | - Sheng-Jie Zhao
- Chinese institute of Rehabilitation Science, China Rehabilitation Research Center, Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing Boai Hospital, Beijing, China
| | - Nayan Huang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Xue-Chao Fei
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Dan-Dan Yao
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Li Ai
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Ji-Hui Lyu
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Rong-Qiao He
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Jian-Jun Li
- Chinese institute of Rehabilitation Science, China Rehabilitation Research Center, Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing Boai Hospital, Beijing, China
| | - Zhi-Qian Tong
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, School of Mental Health, Oujiang Laboratory, Wenzhou Medical University, Wenzhou, China.
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7
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Li J, Feng ZJ, Liu L, Ma YJ. Acute methanol poisoning with bilateral diffuse cerebral hemorrhage: A case report. World J Clin Cases 2022; 10:6571-6579. [PMID: 35979299 PMCID: PMC9294890 DOI: 10.12998/wjcc.v10.i19.6571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/04/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute methanol poisoning (AMP) is a systemic disease that mainly affects the central nervous system and is characterized by ocular damage and metabolic acidosis. If appropriate treatments are inadequate or delayed, the mortality can exceed 40%. As the most serious complication, cerebral hemorrhage is rare with reported prevalence of 7%-19%.
CASE SUMMARY A 62-year-old man drank liquor mixed with 45% methanol and 35% alcohol. His vision blurred 10 h later and he fell into coma in another 9 h. Serum toxicological tests were performed immediately, and continuous renal replacement therapy (CRRT) was carried out as the lactic acid exceeded 15 mmol/L and blood pH was 6.78. In addition, the toxicological report revealed 1300.5 μg/mL of methanol in serum and 1500.2 μg/mL in urine. After 59 h of CRRT, the methanol level decreased to 126.0 μg/mL in serum and 151.0 μg/mL in urine. However, the patient was still unconscious and his pupillary light reflex was slow. Computed tomography showed hemorrhage in the left putamen. After 16 d of life support treatment, putamen hemorrhage developed into diffuse symmetric intracerebral hemorrhage. In the end, his family gave up and the patient was discharged, and died in a local hospital.
CONCLUSION Cerebral hemorrhage requires constant vigilance during the full course of treatment for severe cases of AMP.
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Affiliation(s)
- Jin Li
- Department of Critical Care Medicine, Air Force Medical Center, PLA, Beijing 100142, China
| | - Zhi-Juan Feng
- Department of Critical Care Medicine, Air Force Medical Center, PLA, Beijing 100142, China
| | - Lei Liu
- Department of Critical Care Medicine, Air Force Medical Center, PLA, Beijing 100142, China
| | - Yu-Jie Ma
- Department of Critical Care Medicine, Air Force Medical Center, PLA, Beijing 100142, China
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Biochemical mechanism underlying the pathogenesis of diabetic retinopathy and other diabetic complications in humans: the methanol-formaldehyde-formic acid hypothesis. Acta Biochim Biophys Sin (Shanghai) 2022; 54:415-451. [PMID: 35607958 PMCID: PMC9828688 DOI: 10.3724/abbs.2022012] [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] [Indexed: 11/25/2022] Open
Abstract
Hyperglycemia in diabetic patients is associated with abnormally-elevated cellular glucose levels. It is hypothesized that increased cellular glucose will lead to increased formation of endogenous methanol and/or formaldehyde, both of which are then metabolically converted to formic acid. These one-carbon metabolites are known to be present naturally in humans, and their levels are increased under diabetic conditions. Mechanistically, while formaldehyde is a cross-linking agent capable of causing extensive cytotoxicity, formic acid is an inhibitor of mitochondrial cytochrome oxidase, capable of inducing histotoxic hypoxia, ATP deficiency and cytotoxicity. Chronic increase in the production and accumulation of these toxic one-carbon metabolites in diabetic patients can drive the pathogenesis of ocular as well as other diabetic complications. This hypothesis is supported by a large body of experimental and clinical observations scattered in the literature. For instance, methanol is known to have organ- and species-selective toxicities, including the characteristic ocular lesions commonly seen in humans and non-human primates, but not in rodents. Similarly, some of the diabetic complications (such as ocular lesions) also have a characteristic species-selective pattern, closely resembling methanol intoxication. Moreover, while alcohol consumption or combined use of folic acid plus vitamin B is beneficial for mitigating acute methanol toxicity in humans, their use also improves the outcomes of diabetic complications. In addition, there is also a large body of evidence from biochemical and cellular studies. Together, there is considerable experimental support for the proposed hypothesis that increased metabolic formation of toxic one-carbon metabolites in diabetic patients contributes importantly to the development of various clinical complications.
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Tian M, He H, Liu Y, Li R, Zhu B, Cao Z. Fatal methanol poisoning with different clinical and autopsy findings: Case report and literature review. Leg Med (Tokyo) 2021; 54:101995. [PMID: 34844153 DOI: 10.1016/j.legalmed.2021.101995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 12/24/2022]
Abstract
Methanol poisoning is responsible for high morbidity and mortality, and the elevated concentration of methanol in the body is the major criteria for forensic diagnosis of methanol poisoning. However, in cases with lower methanol concentrations, diagnosis is mainly dependent on highly variable postmortem manifestations.Herein, we report a fatal methanol poisoning cases that two subjects ingested the same amount of methanol simultaneously, yet the subject one presented only non-specific gastrointestinal and mild central nervous system symptoms, while the other subject exhibited typical toxic manifestations with the exception of visual compromise. In autopsy, subject number 1 did not show typical pathological changes caused by methanol poisoning, except for the elevated levels of methanol in body fluids. On the contrary, bilateral basal ganglia hemorrhage and necrosis caused by methanol-induced brain lesion was observed in case number 2. Due to the complex and multifactorial process of methanol intoxication, many factors, including comprehensive autopsy, quantitative detection of methanol and formic acid, and genotype analysis, participate in its metabolism and toxicity, and can impact the clinical symptoms, prognosis and postmortem manifestations. Therefore, a combination of multiple diagnosis methods may more accurately contribute to the forensic diagnosis of methanol poisoning and should be tailored on an individual basis. This case report also reviews forensic diagnosis literature on methanol poisoning to provide a reference for forensic pathologists.
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Affiliation(s)
- Meihui Tian
- School of Forensic Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110122, PR China
| | - Hongyu He
- The Department of Pathology, the General Hospital of Northern Theater Command of Chinese People's Liberation Army, No.83 Wenhua road, Shenhe Area, Shenyang 110016, PR China
| | - Ye Liu
- Forensic Science Service of the Yingkou Public Security Bureau, No.12 Riyue Road, Bayuquan District, Yingkou 115007, PR China
| | - Rubo Li
- School of Forensic Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110122, PR China
| | - Baoli Zhu
- School of Forensic Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110122, PR China.
| | - Zhipeng Cao
- School of Forensic Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110122, PR China.
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Barták M, Rogalewicz V, Doubek J, Šejvl J, Petruželka B, Zakharov S, Miovský M. Estimation of long-term costs of postacute care in survivors of the methanol poisoning outbreak. BMJ Open 2021; 11:e043037. [PMID: 34011582 PMCID: PMC8137204 DOI: 10.1136/bmjopen-2020-043037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To fill the existing research gap related to long-term costs of postacute care in methanol poisoning survivors, healthcare cost for 6 years after the outbreak has been modelled and estimated. DESIGN In a prospective longitudinal cohort study, data collected from 55 survivors of the Czech methanol mass poisoning outbreak in 2012 were collected in four rounds (5 months, then 2, 4 and 6 years after the discharge) in the General University Hospital in Prague according to the same predefined study protocol. The collected data were used to inform the cost model. SETTING AND PARTICIPANTS All 83 patients discharged from a hospital poisoning treatment after the 2012 methanol outbreak were informed about the study and invited to participate. Fifty-five patients (66%) gave their written informed consent and were followed until their death or the last follow-up 6 years later. The costs were modelled from the Czech healthcare service (general health insurance) perspective. MAIN OUTCOME MEASURES Long-term national budget impact of the methanol poisoning outbreak, frequencies of sequelae and their average costs. RESULTS The postacute cost analysis concentrated on visual and neurological sequelae that were shown to be dominant. Collected data were used to create process maps portraying gradual changes in long-term sequelae over time. Individual process maps were created for the central nervous system, peripheral nervous system, sequelae detected during eye examinations and sequelae concerning the visual evoked potentials. Based on the process maps the costs of the postacute outpatient care were estimated. CONCLUSIONS In 2013-2019 the highest costs per patient related to postacute care were found in the first year; the average costs decreased afterwards, and remained almost constant for the rest of the studied period of time. These costs per patient ranged from CZK4142 in 2013 to CZK1845 in 2018, when they raised to CZK2519 in 2019 again.
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Affiliation(s)
- Miroslav Barták
- Department of Addictology, Charles University, First Faculty of Medicine, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
| | - Vladimír Rogalewicz
- Department of Addictology, Charles University, First Faculty of Medicine, Praha, Czech Republic
| | - Jaroslav Doubek
- Department of Biomedical Technology, Czech Technical University in Prague, Faculty of Biomedical Engineering, Kladno, Czech Republic
| | - Jaroslav Šejvl
- Department of Addictology, Charles University, First Faculty of Medicine, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
| | - Benjamin Petruželka
- Department of Addictology, Charles University, First Faculty of Medicine, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine with Toxicological Information Centre, General University Hospital in Prague, Praha, Czech Republic
- Department of Occupational Medicine with Toxicological Information Centre, Charles University, First Faculty of Medicine, Praha, Czech Republic
| | - Michal Miovský
- Department of Addictology, Charles University, First Faculty of Medicine, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
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11
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Gulen M, Satar S, Avci A, Acehan S, Orhan U, Nazik H. Methanol poisoning in Turkey: Two outbreaks, a single center experience. Alcohol 2020; 88:83-90. [PMID: 32702502 DOI: 10.1016/j.alcohol.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Methanol poisoning is still one of the major causes of mortality due to intoxication because of the challenging diagnosis and late hospital admissions. We aimed to evaluate epidemiological data, clinical characteristics, laboratory findings, treatment protocols, and prognosis of patients in a tertiary hospital in two different methanol outbreaks occurring in a three-year interval. METHODS The study was planned as a single-center and retrospective observational case series study. Patients ≥18 years of age who were admitted to the hospital between 1 September 2016 and 1 September 2019 and diagnosed with methanol poisoning were included in the study. RESULTS Sixty-seven patients whose data were sufficient and accessible were included in the study. Thirty-five (52.2%) patients were discharged without sequelae, 14 (20.9%) patients were discharged with sequelae (both central nervous system sequelae and visual sequelae in 3 patients, only visual sequelae in 11 patients) and 18 (26.9%) patients died. High anion gap (AG) metabolic acidosis (pH < 7.07, AG > 26.7), low Glasgow Coma Score, and increased lactate (lactate > 2.55 mmol/L) levels were found to be associated with poor outcome. Folate use in treatment did not have a statistically significant effect (p = 0.087) on the prevention of visual sequelae development, but it had a statistically significant effect on mortality (p = 0.041). CONCLUSIONS State of consciousness and the severity of metabolic acidosis were significant parameters associated with mortality. In addition to antidote and elimination therapies, given the benefit on mortality and low risk of adverse events, folate therapy should be considered for all patients with significant toxic methanol exposures.
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Affiliation(s)
- Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Salim Satar
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Akkan Avci
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Ugur Orhan
- Bitlis State Hospital, Department of Emergency Medicine, Bitlis, Turkey
| | - Hakan Nazik
- Adana City Training and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
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12
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Kaewput W, Thongprayoon C, Petnak T, Chewcharat A, Boonpheng B, Bathini T, Vallabhajosyula S, Cheungpasitporn W. Inpatient Burden and Mortality of Methanol Intoxication in the United States. Am J Med Sci 2020; 361:69-74. [PMID: 32958166 DOI: 10.1016/j.amjms.2020.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/22/2020] [Accepted: 08/08/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilization of hospitalization for methanol intoxication in the United States. MATERIALS AND METHODS A total of 603 hospitalized patients with a primary diagnosis of methanol intoxication from 2003 to 2014 were identified in the National Inpatient Sample database. The inpatient prevalence, clinical characteristics, treatments, outcomes, resource utilization, were investigated. Multivariable logistic regression was performed to identify factors independently associated with in-hospital mortality. RESULTS The overall inpatient prevalence of methanol intoxication among hospitalized patients was 6.4 cases per 1,000,000 admissions in the United States. The mean age was 38±18 (range 0-86) years. 44% used methanol for suicidal attempts. 20% of admissions required mechanical ventilation, and 40% required renal replacement therapy. The three most common complications were metabolic acidosis (44%), hypokalemia (18%), and visual impairment or optic neuritis (8%). The three most common end-organ failures were renal failure (22%), respiratory failure (21%), and neurological failure (17%). 6.5% died in the hospital. Factors associated with increased in-hospital mortality included alcohol drinking, hypernatremia, renal failure, respiratory failure, circulatory failure, and neurological failure. The mean length of hospital stay was 4.0 days. The mean hospitalization cost per patient was $43,222 CONCLUSION: The inpatient prevalence of methanol intoxication in the United States was 6.4 cases per 1,000,000 admissions. The risk of in-hospital mortality mainly depended on the number of end-organ failures.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tuscon, AZ, United States
| | | | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States
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13
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Kotikova K, Zogala D, Ptacnik V, Trnka J, Kupka K, Vaneckova M, Seidl Z, Diblik P, Heissigerova J, Navratil T, Komarc M, Zak I, Polakova K, Brozova H, Zakharov S. Efficiency of 123I-ioflupane SPECT as the marker of basal ganglia damage in acute methanol poisoning: 6-year prospective study. Clin Toxicol (Phila) 2020; 59:235-245. [PMID: 32762574 DOI: 10.1080/15563650.2020.1802033] [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: 10/23/2022]
Abstract
CONTEXT Investigate whether 123I-ioflupane SPECT (DaT SPECT) has the potential as a marker of basal ganglia damage in acute methanol poisoning. METHODS Prospective, single-centre, cohort study of patients with confirmed methanol poisoning was conducted. DaT SPECT was performed twice with semi-quantification using DaTQUANTTM and MRI-based volumetry was calculated. Specific binding ratios (SBR) of striatum, caudate nucleus, and putamen were correlated with laboratory parameters of outcome, volumetric data, and retinal nerve fibres layer (RNFL) thickness measurements. RESULTS Forty-two patients (mean age 46.3 ± 4.2 years; 8 females), including 15 with MRI-detected putamen lesions (group I) and 27 patients with intact putamen (group II), underwent DaT SPECT. Volumetry was calculated in 35 of the patients assessed. SBR values for the left putamen correlated with putamen volume (r = 0.665; p < 0.001). Decreased bilateral SBR values were determined for the striatum and the putamen, but not for the nucleus caudate, in group I (p < 0.05). Significant correlation was observed between the SBR of the posterior putamen and arterial blood pH (r = 0.574; p < 0.001) and other toxicological parameters of severity of poisoning/outcome including serum lactate, glucose, and creatinine concentrations (p < 0.05). The SBR of the posterior putamen positively correlated with the global RNFL thickness (p < 0.05). ROC analysis demonstrated a significant discriminatory ability of SBR of the posterior putamen with AUC = 0.753 (95%CI 0.604-0.902; p = 0.007). The multivariate regression model demonstrated that arterial blood pH, age, and gender were the most significant factors associated with SBR of the posterior putamen. CONCLUSION DaT SPECT demonstrates significant potential for the diagnosis of methanol-induced basal ganglia damage.
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Affiliation(s)
- Katerina Kotikova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - David Zogala
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Vaclav Ptacnik
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Trnka
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Kupka
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Electrochemistry at the Nanoscale, J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Ivan Zak
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Kamila Polakova
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Brozova
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
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14
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Van Cauter S, Severino M, Ammendola R, Van Berkel B, Vavro H, van den Hauwe L, Rumboldt Z. Bilateral lesions of the basal ganglia and thalami (central grey matter)-pictorial review. Neuroradiology 2020; 62:1565-1605. [PMID: 32761278 PMCID: PMC7405775 DOI: 10.1007/s00234-020-02511-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
The basal ganglia and thalami are paired deep grey matter structures with extensive metabolic activity that renders them susceptible to injury by various diseases. Most pathological processes lead to bilateral lesions, which may be symmetric or asymmetric, frequently showing characteristic patterns on imaging studies. In this comprehensive pictorial review, the most common and/or typical genetic, acquired metabolic/toxic, infectious, inflammatory, vascular and neoplastic pathologies affecting the central grey matter are subdivided according to the preferential location of the lesions: in the basal ganglia, in the thalami or both. The characteristic imaging findings are described with emphasis on the differential diagnosis and clinical context.
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Affiliation(s)
- Sofie Van Cauter
- Department of Medical Imaging, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. .,Department of Radiology, University Hospitals Leuven, Herestraat 39, 3000, Leuven, Belgium.
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Instituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Rosamaria Ammendola
- Neuroradiology Unit, IRCCS Instituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Brecht Van Berkel
- Department of Medical Imaging, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Department of Radiology, University Hospitals Leuven, Herestraat 39, 3000, Leuven, Belgium
| | - Hrvoje Vavro
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, Croatia
| | - Luc van den Hauwe
- Department of Radiology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.,Department of Medical Imaging, AZ KLINA, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Zoran Rumboldt
- Department of Radiology, University of Rijeka School of Medicine, Ulica Braće Branchetta 20, 51000, Rijeka, Croatia.,Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
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15
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Kotikova K, Klepis P, Ridzon P, Hlusicka J, Navratil T, Rulisek J, Zak I, Zakharov S. Peripheral polyneuropathy after acute methanol poisoning: Six-year prospective cohort study. Neurotoxicology 2020; 79:67-74. [DOI: 10.1016/j.neuro.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
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16
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Hlusicka J, Mana J, Vaneckova M, Kotikova K, Diblik P, Urban P, Navratil T, Marechal B, Kober T, Zakharov S. MRI-based brain volumetry and retinal optical coherence tomography as the biomarkers of outcome in acute methanol poisoning. Neurotoxicology 2020; 80:12-19. [PMID: 32554081 DOI: 10.1016/j.neuro.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/15/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Basal ganglia lesions are typical findings on magnetic resonance imaging (MRI) of the brain in survivors of acute methanol poisoning. However, no data are available on the association between the magnitude of damaged brain regions, serum concentrations of markers of acute methanol toxicity, oxidative stress, neuroinflammation, and the rate of retinal nerve ganglion cell loss. OBJECTIVES To investigate the association between MRI-based volumetry of the basal ganglia, retinal nerve fibre layer (RNFL) thickness and prognostic laboratory markers of outcomes in acute methanol poisoning. METHODS MRI-based volumetry of putamen, nucleus caudatus and globus pallidus was performed and compared with laboratory parameters of severity of poisoning and acute serum markers of oxidative damage of lipids (8-isoprostan, MDA, HHE, HNE), nucleic acids (8-OHdG, 8-OHG, 5-OHMU), proteins (o-Thyr, NO-Thyr, Cl-Thyr) and leukotrienes (LTC4, LTD4, LTE4, LTB4), as well as with the results of RNFL measurements by optic coherence tomography (OCT) in 16 patients with acute methanol poisoning (Group I) and in 28 survivors of poisoning two years after discharge with the same markers measured within the follow-up examination (Group II). The control group consisted of 28 healthy subjects without methanol poisoning. RESULTS The survivors of acute methanol poisoning had significantly lower volumes of basal ganglia than the controls. The patients with MRI signs of methanol-induced toxic brain damage had significantly lower volumes of basal ganglia than those without these signs. A positive correlation was found between the volume of putamen and arterial blood pH on admission (r = 0.45; p = 0.02 and r = 0.44; p = 0.02 for left and right putamen, correspondingly). A negative correlation was present between the volumes of putamen and acute serum lactate (r = -0.63; p < 0.001 and r = -0.59; p = 0.01), creatinine (r = -0.53; p = 0.01 and r = -0.47; p = 0.01) and glucose (r = -0.55; p < 0.001 and r = -0.50; p = 0.01) concentrations. The volume of basal ganglia positively correlated with acute concentrations of markers of lipoperoxidation (8-isoprostan: r = 0.61; p < 0.05 and r = 0.59; p < 0.05 for left and right putamen, correspondingly) and inflammation (leukotriene LTB4: r = 0.61; p < 0.05 and r = 0.61; p < 0.05 for left and right putamen, correspondingly). The higher the volume of the basal ganglia, the higher the thickness of the RNFL, with the strongest positive association between global RNFL and the volume of putamen bilaterally (all p < 0.01). In the follow-up markers of oxidative stress and inflammation, only o-Thyr concentration negatively correlated with the volume of putamen bilaterally (r = -0.39; p < 0.05 and r = -0.37; p < 0.05 for left and right putamen, correspondingly). CONCLUSION In survivors of acute methanol poisoning with signs of toxic brain damage, the magnitude of affected areas correlated with acute parameters of severity of poisoning, markers of oxidative stress and neuroinflammation. There was a positive association between the basal ganglia volume and the thickness of RNFL, making OCT an important screening test and MRI-based volumetry the confirmative diagnostic method for the detection of CNS sequelae of methanol poisoning.
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Affiliation(s)
- Jiri Hlusicka
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic; Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Katerina Kotikova
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic; Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centre for Industrial Hygiene and Occupational Medicine, National Institute of Public Health, Prague, Czech Republic
| | - Tomas Navratil
- J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Benedicte Marechal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sergey Zakharov
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic; Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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17
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Owolabi LF, Enwere OO, Ahmed Reda A, Sayed Sayd RE, Elrazek H, Adamu B, AlGhamdi M. Methanol induced stroke: report of cases occurring simultaneously in two biological brothers. J Community Hosp Intern Med Perspect 2020; 10:265-268. [PMID: 32864054 PMCID: PMC7431918 DOI: 10.1080/20009666.2020.1766840] [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] [Indexed: 11/21/2022] Open
Abstract
Methanol bears semblance to ethanol in smell and taste, thus, individuals who indulge in alcohol may fall back on it in societies where alcohol consumption is illegal or difficult to come by despite the life-threatening neurologic sequelae of methanol toxicity. Stroke is an uncommon outcome of methanol poisoning. We presented two cases of methanol-induced infarctive and hemorrhagic stroke in biological brothers who were simultaneously involved in an illicit ingestion of methanol. One of them developed infarctive stroke while the other had infarctive stroke with hemorrhagic transformation. We have highlighted the differences and similarity in the course of their illnesses.
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Affiliation(s)
| | | | | | | | - Hanem Elrazek
- Department of medicine, King Abdullah Hospital, Bisha, Saudi Arabia
| | - Bappa Adamu
- College of Medicine, University of Bisha, Bisha, Saudi Arabia
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18
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Rulisek J, Waldauf P, Belohlavek J, Balik M, Kotikova K, Hlusicka J, Vaneckova M, Seidl Z, Diblik P, Bydzovsky J, Heissigerova J, Urban P, Miovsky M, Sejvl J, Pelclova D, Zakharov S. Health-related quality of life determinants in survivors of a mass methanol poisoning outbreak: six-year prospective cohort study. Clin Toxicol (Phila) 2020; 58:870-880. [PMID: 31913708 DOI: 10.1080/15563650.2019.1702994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose: The effect of acute methanol poisoning on the follow-up quality of life of survivors in mass poisoning outbreaks is not known. The objective of this is to study the impact of visual and central nervous system (CNS) sequelae of methanol poisoning on long-term health-related quality of life (QoL) of survivors, its clinical determinants, and dynamics.Materials and methods: A total of 54 patients with confirmed methanol poisoning (mean age 46.7 ± 13.4 years, 9 females) were examined consequently three times within six-year prospective cohort study and compared to 23 controls with the history of chronic alcohol abuse. The following tests were performed: SF-36 QoL questionnaire, visual evoked potentials (VEP) of optic nerve, ocular examination with retinal nerve fiber layer (RNFL) thickness measurement, brain magnetic resonance imaging (MRI), and biochemical and toxicological tests.Results: Acute methanol poisoning led to significant decrease in physical component summary (PCS) compared to PCS of age-adjusted controls (mean score with SD 46.8 ± 11.0 versus 52.3 ± 9.4 points; p = .003). In 17/40 (42.5%) patients with three rounds of examination, signs of severe disability (≤30 points in at least one score) were present six years after discharge, with negative dynamics of PCS score during the observation period. The patients with abnormal RNFL thickness had lower PCS (mean difference 10.5 points; 95%CI 3.5-17.5, p = .004) and mental component summary score (9.5 points; 95%CI 1.9-17.1, p = .015) compared to the patients with normal RNFL. Signs of physical and mental adaptation to long-term visual sequelae were registered with gradual reduction of difference in most of physical and mental components scores compared to the patients with normal RNFL during six years of observation. Signs of hemorrhagic brain lesions were associated with permanent decrease of PCS score (mean difference 7.4 points; 95%CI 0.6-14.0; p = .033), bodily pain (8.7 points; 95%CI 1.6-17.6; p = .018), and social functioning (8.2 points; 95%CI 3.0-17.4; p = .005) six years after discharge. No effect of type of antidote (fomepizole versus ethanol) and extracorporeal enhanced elimination modality (intermittent hemodialysis versus continuous renal replacement therapy) applied in hospital on long-term QoL was found (all p > .05).Conclusion: Acute methanol poisoning was associated with a significant decrease of health-related quality of life of survivors persisting for at least six years after discharge. The more pronounced decrease in QoL scores was observed in the patients with hemorrhagic brain lesions and visual sequelae of poisoning with abnormal RNFL thickness.
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Affiliation(s)
- Jan Rulisek
- Department of Anesthesia and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and Royal Vinohrady Teaching Hospital, Prague, Czech Republic
| | - Jan Belohlavek
- Department of Cardiology and Angiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Balik
- Department of Anesthesia and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Jiri Hlusicka
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Bydzovsky
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Michal Miovsky
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaroslav Sejvl
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
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Kumar M, Kaeley N, Nagasubramanyam V, Bhardwaj BB, Kumar S, Kabi A, Arora P, Dhar M. Single center experience of managing methanol poisoning in the hilly state of Uttarakhand: A cross sectional study. Int J Crit Illn Inj Sci 2019; 9:172-176. [PMID: 31879603 PMCID: PMC6927134 DOI: 10.4103/ijciis.ijciis_49_19] [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: 06/10/2019] [Revised: 09/05/2019] [Accepted: 10/07/2019] [Indexed: 11/04/2022] Open
Abstract
Background In this article, we describe our experience in managing one of the worst tragedies of an outbreak of methanol poisoning in the state of Uttarakhand in February 2019. It was reported that more than 100 people of Uttarakhand and neighboring districts of Uttar Pradesh succumbed to death after consuming this toxic alcohol laced with methanol. Materials and Methods Demographic, clinical, and biochemical data were collected retrospectively from the hospital record section of the tertiary care hospital in the state of Uttarakhand. Results Ninety-three patients of methanol poisoning were attended by the emergency medicine department of our hospital. The mean age of the patients was 38.9 ± 10.3 years. Majority of the patients were males (92/93). The most common clinical symptoms were gastrointestinal (56; 60.2%) followed by neurological (21; 22.6%) and respiratory (18; 19.3%). Most of the patients presented within 12-24 h after consumption of methanol. The mean of latent time of presentation was 4.8 ± 2.6 h. The mean values of pH, bicarbonate levels, lactate, and base deficit were 7.13 ± 0.6, 12.3 ± 6.4, 2.6 ± 0.8, and 15.6 ± 3.8 mmol/l, respectively. Acute kidney injury (26; 27.9%), blurring of vision (9; 9.6%), and sepsis (6, 6.4%) were common complications. Seven patients (7.5%) succumbed to death. Intensive alkali therapy was the main modality of treatment. Ethanol therapy was useful in patients resistant to alkali therapy. Sixteen (17.2%) patients with acute methanol poisoning were dialyzed once. Conclusion Patients with acute methanol poisoning have varied presentations. Gastrointestinal symptoms are the most common presentation. Such outbreaks account for the heavy toll of mortality and morbidity in the society. Prompt diagnosis and a protocol based treatment can have a significant impact on the outcome of these patients. Thus, public health warning should be immediately issued with initial presentation of the casualties.
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Affiliation(s)
- Manish Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nidhi Kaeley
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vempalli Nagasubramanyam
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharat Bhushan Bhardwaj
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Subodh Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankita Kabi
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Arora
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mridul Dhar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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20
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Jaffe TA, Boyer EW, Erickson TB, Studley H, Hayes BD, Chai PR. Acute and delayed toxicity from co-ingestion of methylene chloride and methanol. TOXICOLOGY COMMUNICATIONS 2019; 3:79-84. [PMID: 31745533 PMCID: PMC6863342 DOI: 10.1080/24734306.2019.1685222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Methylene chloride is a volatile, chlorinated hydrocarbon and colorless solvent found in multiple industrial products including paint strippers, metal cleaners, automotive products, pesticides and aerosol containers. Occupational exposure to methylene chloride is reported in automotive technicians, painters, and other industrial workers with adverse health effects including gastrointestinal, neurological, as well as hepato-renal injuries. International Agency for Research on Cancer (IARC) classifies methylene chloride as a 2 A carcinogen. Through a series of reactions catalyzed by cytochrome P450 2E1 (CYP2E1), metabolism of methylene chloride leads to the formation of formyl chloride, and ultimately carbon monoxide (CO). Most reports of methylene chloride toxicity are due to dermal and inhalational exposure in occupational settings. Ingestion of methylene chloride is uncommon, yet can lead to significant toxicity and prolonged CO toxicity. Methylene chloride is frequently formulated with methanol; individuals who intentionally ingest methylene chloride can experience concomitant methanol toxicity. We present a case of acute ingestion of paint stripper containing methanol and methylene chloride. We discuss the clinical presentation, key management decisions, relevant pathophysiology and biochemistry, as well as the clinical course and management.
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Affiliation(s)
- Todd A Jaffe
- Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Edward W Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Behavioral Science Research Program, The Fenway Institute, Boston, MA, USA
| | - Timothy B Erickson
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | - Heather Studley
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bryan D Hayes
- Clinical Pharmacist, Emergency Medicine and Toxicology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Behavioral Science Research Program, The Fenway Institute, Boston, MA, USA.,Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, USA
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21
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Hlusicka J, Loster T, Lischkova L, Vaneckova M, Diblik P, Urban P, Navratil T, Kacer P, Kacerova T, Zakharov S. Reactive carbonyl compounds, carbonyl stress, and neuroinflammation in methyl alcohol intoxication. MONATSHEFTE FUR CHEMIE 2019. [DOI: 10.1007/s00706-019-02429-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Zakharov S, Rulisek J, Hlusicka J, Kotikova K, Navratil T, Komarc M, Vaneckova M, Seidl Z, Diblik P, Bydzovsky J, Heissigerova J, Zogala D, Hubacek JA, Miovsky M, Sejvl J, Vojtova L, Pelclova D. The impact of co-morbidities on a 6-year survival after methanol mass poisoning outbreak: possible role of metabolic formaldehyde. Clin Toxicol (Phila) 2019; 58:241-253. [PMID: 31298045 DOI: 10.1080/15563650.2019.1637525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Context: The influence of co-morbid conditions on the outcome of acute methanol poisoning in mass poisoning outbreaks is not known.Objective: The objective of this is to study the impact of burden of co-morbidities, complications, and methanol-induced brain lesions on hospital, follow-up, and total mortality.Methods: All patients hospitalized with methanol poisoning during a mass poisoning outbreak were followed in a prospective cohort study until death or final follow-up after 6 years. The age-adjusted Charlson co-morbidity index (ACCI) score was calculated for each patient. A multivariate Cox regression model was used to calculate the adjusted hazards ratio (HR) for death. The survival was modeled using the Kaplan-Meier method.Results: Of 108 patients (mean age with SD 50.9 ± 2.6 years), 24 (54.4 ± 5.9 years) died during hospitalization (mean survival with SD 8 ± 4 days) and 84 (49.9 ± 3.0 years; p = .159) were discharged, including 27 with methanol-induced brain lesions. Of the discharged patients, 15 (56.3 ± 6.8 years) died during the follow-up (mean survival 37 ± 11 months) and 69 (48.5 ± 3.3 years; p = .044) survived. The hospital mortality was 22%, the follow-up mortality was 18%; the total mortality was 36%. Cardiac/respiratory arrest, acute respiratory failure, multiorgan failure syndrome, and arterial hypotension increased the HR for hospital and total (but not follow-up) mortality after adjustment for age, sex, and arterial pH (all p < .05). All patients who died in the hospital had at least one complication. A higher ACCI score was associated with greater total mortality (HR 1.22; 1.00-1.48 95% CI; p = .046). Of those who died, 35 (90%) had a moderate-to-high ACCI. The Kaplan-Meier curve demonstrated that patients with a high ACCI had greater follow-up mortality compared to ones with low (p = .027) or moderate (p = .020) scores. For the patients who died during follow-up, cancers of different localizations were responsible for 7/15 (47%) of the deaths.Conclusions: The character and number of complications affected hospital but not follow-up mortality, while the burden of co-morbidities affected follow-up mortality. Methanol-induced brain lesions did not affect follow-up mortality. Relatively high cancer mortality rate may be associated with acute exposure to metabolic formaldehyde produced by methanol oxidation.
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Affiliation(s)
- Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Jan Rulisek
- Department of Anesthesia and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Hlusicka
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Biomimetic Electrochemistry, J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Bydzovsky
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Zogala
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaroslav A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michal Miovsky
- Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Jaroslav Sejvl
- Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Lucie Vojtova
- Institute of Clinical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
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Hlusicka J, Loster T, Lischkova L, Vaneckova M, Diblik P, Urban P, Navratil T, Kacer P, Kacerova T, Zakharov S. Markers of nucleic acids and proteins oxidative damage in acute methanol poisoning. MONATSHEFTE FUR CHEMIE 2019. [DOI: 10.1007/s00706-019-2370-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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24
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Exogenous Toxins and CNS Injuries. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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26
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Zakharov S, Hlusicka J, Nurieva O, Kotikova K, Lischkova L, Kacer P, Kacerova T, Urban P, Vaneckova M, Seidl Z, Diblik P, Kuthan P, Heissigerova J, Lesovsky J, Rulisek J, Vojtova L, Hubacek JA, Navratil T. Neuroinflammation markers and methyl alcohol induced toxic brain damage. Toxicol Lett 2018; 298:60-69. [DOI: 10.1016/j.toxlet.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/22/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
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27
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Nurieva O, Hubacek JA, Urban P, Hlusicka J, Diblik P, Kuthan P, Sklenka P, Meliska M, Bydzovsky J, Heissigerova J, Kotikova K, Navratil T, Komarc M, Seidl Z, Vaneckova M, Vojtova L, Zakharov S. Clinical and genetic determinants of chronic visual pathway changes after methanol - induced optic neuropathy: four-year follow-up study. Clin Toxicol (Phila) 2018; 57:387-397. [PMID: 30451020 DOI: 10.1080/15563650.2018.1532083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Methanol poisoning induces acute optic neuropathy with possible long-term visual damage. OBJECTIVE To study the dynamics and key determinants of visual pathway functional changes during 4 years after acute methanol poisoning. METHODS A total of 42 patients with confirmed methanol poisoning (mean age 45.7 ± 4.4 years) were examined 4.9 ± 0.6, 25.0 ± 0.6, and 49.9 ± 0.5 months after discharge. The following tests were performed: visual evoked potential (VEP), retinal nerve fiber layer (RNFL) measurement, brain magnetic resonance imaging (MRI), complete ocular examination, biochemical tests, and apolipoprotein E (ApoE) genotyping. RESULTS Abnormal VEP P1 latency was registered in 18/42 right eyes (OD) and 21/42 left eyes (OS), abnormal N1P1 amplitude in 10/42 OD and OS. Mean P1 latency shortening during the follow-up was 15.0 ± 2.0 ms for 36/42 (86%) OD and 14.9 ± 2.4 ms for 35/42 (83%) OS, with maximum shortening up to 35.0 ms. No significant change of mean N1P1 amplitude was registered during follow-up. A further decrease in N1P1 amplitude ≥1.0 mcV in at least one eye was observed in 17 of 36 patients (47%) with measurable amplitude (mean decrease -1.11 ± 0.83 (OD)/-2.37 ± 0.66 (OS) mcV versus -0.06 ± 0.56 (OD)/-0.83 ± 0.64 (OS) mcV in the study population; both p < .001). ApoE4 allele carriers had lower global and temporal RNFL thickness and longer initial P1 latency compared to the non-carriers (all p < .05). The odds ratio for abnormal visual function was 8.92 (3.00-36.50; 95%CI) for ApoE4 allele carriers (p < .001). The presence of ApoE4 allele was further associated with brain necrotic lesions (r = 0.384; p = .013) and brain hemorrhages (r = 0.395; p = .011). CONCLUSIONS Improvement of optic nerve conductivity occurred in more than 80% of patients, but evoked potential amplitude tended to decrease during the 4 years of observation. ApoE4 allele carriers demonstrated lower RNFL thickness, longer P1 latency, and more frequent methanol-induced brain damage compared to non-carriers.
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Affiliation(s)
- Olga Nurieva
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Jaroslav A Hubacek
- b Center for Experimental Medicine , Institute for Clinical and Experimental Medicine , Prague , Czech Republic
| | - Pavel Urban
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic.,c Centre for Industrial Hygiene and Occupational Medicine , National Institute of Public Health , Prague , Czech Republic
| | - Jiri Hlusicka
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Pavel Diblik
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Pavel Kuthan
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Petr Sklenka
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Martin Meliska
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Jan Bydzovsky
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Jarmila Heissigerova
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Katerina Kotikova
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Tomas Navratil
- e Department of Biomimetic Electrochemistry , J. Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences , Prague , Czech Republic.,f Institute of Medical Biochemistry and Laboratory Medicine, First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic
| | - Martin Komarc
- g Department of Methodology, Faculty of Physical Education and Sport , Charles University , Prague , Czech Republic
| | - Zdenek Seidl
- h Department of Radiology, First Faculty of Medicine , Charles University in Prague and General University Hospital , Prague , Czech Republic
| | - Manuela Vaneckova
- h Department of Radiology, First Faculty of Medicine , Charles University in Prague and General University Hospital , Prague , Czech Republic
| | - Lucie Vojtova
- i First Faculty of Medicine, Institute of Clinical Biochemistry and Laboratory Diagnostics , Charles University and General University Hospital , Prague , Czech Republic
| | - Sergey Zakharov
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
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Hubacek J, Jirsa M, Bobak M, Pelclova D, Zakharov S. Aldehyde dehydrogenase 2 polymorphism affects the outcome of methanol poisoning in exposed humans. Clin Genet 2018; 94:445-449. [DOI: 10.1111/cge.13411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 12/23/2022]
Affiliation(s)
- J.A. Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - M. Jirsa
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - M. Bobak
- International Institute for Health and Society, Department of Epidemiology and Public Health; University College London; London UK
| | - D. Pelclova
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - S. Zakharov
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
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Nurieva O, Diblik P, Kuthan P, Sklenka P, Meliska M, Bydzovsky J, Heissigerova J, Urban P, Kotikova K, Navratil T, Komarc M, Seidl Z, Vaneckova M, Pelclova D, Zakharov S. Progressive Chronic Retinal Axonal Loss Following Acute Methanol-induced Optic Neuropathy: Four-Year Prospective Cohort Study. Am J Ophthalmol 2018; 191:100-115. [PMID: 29709459 DOI: 10.1016/j.ajo.2018.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/03/2018] [Accepted: 04/19/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE To study the dynamics and clinical determinants of chronic retinal nerve fiber layer thickness (RNFL) loss after methanol-induced optic neuropathy. DESIGN Prospective cohort study. METHODS All patients underwent complete ophthalmic evaluation including spectral-domain optical coherence tomography 3 times during 4 years of observation: 4.9 (±0.6), 25.0 (±0.6), and 49.9 (±0.5) months after discharge. PARTICIPANTS Eighty-four eyes of 42 survivors of methanol poisoning, mean age (standard deviation) of 45.7 (±4.4) years; and 82 eyes of 41 controls, mean age 44.0 (±4.2) years. MAIN OUTCOME MEASURES Global and temporal RNFL loss. RESULTS Abnormal RNFL thickness was registered in 13 of 42 (31%) survivors of methanol poisoning and chronic axonal loss in 10 of 42 (24%) patients. Significant decrease of global/temporal RNFL thickness during the observation period was found in the study population compared to the controls (P < .001). The risk estimate of chronic global RNFL loss for arterial blood pH < 7.3 at admission was 11.65 (95% confidence interval 1.91-71.12) after adjusting for age and sex. The patients with chronic axonal degeneration demonstrated progressive visual loss in 7 of 10 cases. The patients with abnormal RNFL thickness had magnetic resonance signs of brain damage in 10 of 13 vs 8 of 29 cases with normal RNFL thickness (P = .003). Signs of brain hemorrhages were present in 7 of 13 patients with abnormal RNFL thickness vs 5 of 29 cases with normal RNFL thickness (P = .015). CONCLUSIONS Methanol-induced optic neuropathy may lead to chronic retinal axonal loss during the following years. Arterial blood pH on admission is the strongest predictor of chronic RNFL thickness decrease. Chronic retinal neurodegeneration is associated with the progressive loss of visual functions and necrotic brain lesions.
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Affiliation(s)
- Olga Nurieva
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Kuthan
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Sklenka
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Meliska
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Bydzovsky
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Urban
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Department of Biomimetic Electrochemistry, J. Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Medical Biochemistry and Laboratory Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Sergey Zakharov
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
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Hlusicka J, Loster T, Lischkova L, Vaneckova M, Seidl Z, Diblik P, Kuthan P, Urban P, Navratil T, Kacer P, Zakharov S. Role of activation of lipid peroxidation in the mechanisms of acute methanol poisoning. Clin Toxicol (Phila) 2018; 56:893-903. [DOI: 10.1080/15563650.2018.1455980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jiri Hlusicka
- Toxicological Information Centre, General University Hospital in Prague, Prague, Czech Republic
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Loster
- Faculty of Informatics and Statistics, Department of Statistics and Probability, University of Economics, Prague, Czech Republic
| | - Lucie Lischkova
- Toxicological Information Centre, General University Hospital in Prague, Prague, Czech Republic
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Kuthan
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Centre for Industrial Hygiene and Occupational Medicine, National Institute of Public Health, Prague, Czech Republic
| | - Tomas Navratil
- J. Heyrovsky Institute of Physical Chemistry, Czech Academy of Sciences, Prague, Czech Republic
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Kacer
- Biocev, First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Sergey Zakharov
- Toxicological Information Centre, General University Hospital in Prague, Prague, Czech Republic
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Peterová K, Brožová H, Klempíř J, Lišková I, Bezdicek O, Ridzoň P, Vaněčková M, Zakharov S, Pelclová D, Miovský M, Růžička E. Gait and Balance Impairment after Acute Methanol Poisoning. Basic Clin Pharmacol Toxicol 2017; 122:176-182. [DOI: 10.1111/bcpt.12853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Kamila Peterová
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Hana Brožová
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Jiří Klempíř
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Irena Lišková
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Ondřej Bezdicek
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Petr Ridzoň
- Department of Occupational Medicine; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
- Department of Neurology; Thomayer Hospital; Prague Czech Republic
| | - Manuela Vaněčková
- Department of Radiology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Sergej Zakharov
- Department of Occupational Medicine; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Daniela Pelclová
- Department of Occupational Medicine; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Michal Miovský
- Department of Addictology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Evžen Růžička
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
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Zakharov S, Rulisek J, Nurieva O, Kotikova K, Navratil T, Komarc M, Pelclova D, Hovda KE. Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks. Ann Intensive Care 2017; 7:77. [PMID: 28730555 PMCID: PMC5519513 DOI: 10.1186/s13613-017-0300-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Intermittent hemodialysis (IHD) is the modality of choice in the extracorporeal treatment (ECTR) of acute methanol poisoning. However, the comparative clinical effectiveness of intermittent versus continuous modalities (CRRT) is unknown. During an outbreak of mass methanol poisoning, we therefore studied the effect of IHD versus CRRT on mortality and the prevalence of visual/central nervous system (CNS) sequelae in survivors. METHODS The study was designed as prospective observational cohort study. Patients hospitalized with a diagnosis of acute methanol poisoning were identified for the study. Exploratory factor analysis and multivariate logistic regression were applied to determine the effect of ECTR modality on the outcome. RESULTS Data were obtained from 41 patients treated with IHD and 40 patients with CRRT. The follow-up time in survivors was two years. Both groups of patients were comparable by age, time to presentation, laboratory data, clinical features, and other treatment applied. The CRRT group was more acidemic (arterial blood pH 6.96 ± 0.08 vs. 7.17 ± 0.07; p < 0.001) and more severely poisoned (25/40 vs. 9/41 patients with Glasgow Coma Scale (GCS) ≤ 8; p < 0.001). The median intensive care unit length of stay (4 (range 1-16) days vs. 4 (1-22) days; p = 0.703) and the number of patients with complications during the treatment (11/41 vs. 13/40 patients; p = 0.576) did not differ between the groups. The mortality was higher in the CRRT group (15/40 vs. 5/41; p = 0.008). The number of survivors without sequelae of poisoning was higher in the IHD group (23/41 vs. 10/40; p = 0.004). There was a significant association of ECTR modality with both mortality and the number of survivors with visual and CNS sequelae of poisoning, but this association was not present after adjustment for arterial blood pH and GCS on admission (all p > 0.05). CONCLUSIONS In spite of the faster correction of the acidosis and the quicker removal of the toxic metabolite in intermittent dialysis, we did not find significant differences in the treatment outcomes between the two groups after adjusting for the degree of acidemia and the severity of poisoning on admission. These findings support the strategy of "use what you have" in situations with large outbreaks and limited dialysis capacity.
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Affiliation(s)
- Sergey Zakharov
- Department of Occupational Medicine, Toxicological Information Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Jan Rulisek
- Department of Anesthesia and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Olga Nurieva
- Department of Occupational Medicine, Toxicological Information Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Department of Occupational Medicine, Toxicological Information Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Department of Occupational Medicine, Toxicological Information Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Biomimetic Electrochemistry, J. Heyrovský Institute of Physical Chemistry of CAS, v.v.i, Prague, Czech Republic
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine, Toxicological Information Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Knut Erik Hovda
- The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Cost-effectiveness of hospital treatment and outcomes of acute methanol poisoning during the Czech Republic mass poisoning outbreak. J Crit Care 2017; 39:190-198. [DOI: 10.1016/j.jcrc.2017.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 02/25/2017] [Accepted: 03/03/2017] [Indexed: 12/21/2022]
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34
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Bezdicek O, Michalec J, Vaneckova M, Klempir J, Liskova I, Seidl Z, Janikova B, Miovsky M, Hubacek J, Diblik P, Kuthan P, Pilin A, Kurcova I, Fenclova Z, Petrik V, Navratil T, Pelclova D, Zakharov S, Ruzicka E. Cognitive sequelae of methanol poisoning involve executive dysfunction and memory impairment in cross-sectional and long-term perspective. Alcohol 2017; 59:27-35. [PMID: 28262185 DOI: 10.1016/j.alcohol.2016.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 11/25/2016] [Accepted: 12/09/2016] [Indexed: 11/24/2022]
Abstract
Methanol poisoning leads to lesions in the basal ganglia and subcortical white matter, as well as to demyelination and atrophy of the optic nerve. However, information regarding cognitive deficits in a large methanol sample is lacking. The principal aim of the present study was to identify the cognitive sequelae of methanol poisoning and their morphological correlates. A sample of 50 patients (METH; age 48 ± 13 years), 3-8 months after methanol poisoning, and 57 control subjects (CS; age 49 ± 13 years) were administered a neuropsychological battery. Forty-six patients were followed in 2 years' perspective. Patients additionally underwent 1.5T magnetic resonance imaging (MRI). Three biochemical and toxicological metabolic markers and a questionnaire regarding alcohol abuse facilitated the classification of 24 patients with methanol poisoning without alcohol abuse (METHna) and 22 patients with methanol poisoning and alcohol abuse (METHa). All groups were compared to a control group of similar size, and matched for age, education, premorbid intelligence level, global cognitive performance, and level of depressive symptoms. Using hierarchical multiple regression we found significant differences between METH and CS, especially in executive and memory domains. METHa showed a similar pattern of cognitive impairment with generally more severe executive dysfunction. Moreover, all METH patients with extensive involvement on brain MRI (lesions in ≥2 anatomical regions) had a more severe cognitive impairment. From a longitudinal perspective, we did not find any changes in their cognitive functioning after 2 years' follow-up. Our findings suggest that methanol poisoning is associated with executive dysfunction and explicit memory impairment, supposedly due to basal ganglia dysfunction and disruption of frontostriatal circuitry proportional to the number of brain lesions, and that these changes are persistent after 2 years' follow-up.
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Zakharov S, Kotikova K, Nurieva O, Hlusicka J, Kacer P, Urban P, Vaneckova M, Seidl Z, Diblik P, Kuthan P, Navratil T, Pelclova D. Leukotriene-mediated neuroinflammation, toxic brain damage, and neurodegeneration in acute methanol poisoning. Clin Toxicol (Phila) 2017; 55:249-259. [DOI: 10.1080/15563650.2017.1284332] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Nurieva
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Hlusicka
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Petr Kacer
- Institute of Chemical Technology, Prague, Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Centre for Industrial Hygiene and Occupational Medicine, National Institute of Public Health, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Kuthan
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic
- Department of Biomimetic Electrochemistry, J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i, Prague, Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic
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Hassanian-Moghaddam H, Bahrami-Motlagh H, Zamani N, Fazeli SA, Behnam B. Intracranial Hemorrhage in Methanol Toxicity: Challenging the Probable Heparin Effect during Hemodialysis. J Res Pharm Pract 2017; 6:186-189. [PMID: 29026846 PMCID: PMC5632941 DOI: 10.4103/jrpp.jrpp_17_39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Brain hemorrhages are rare complications of acute methanol poisoning. There is a debate on association of brain hemorrhage in methanol toxicity and application of systemic anticoagulation during hemodialysis (HD). A 70-year-old male presented to us with severe metabolic acidosis and a methanol level of 7.6 mg/dL. Ethanol and folinic acid were administered, and HD was performed. Brain computed tomography (CT) scan which was normal on presentation showed extensive bilateral subcortical supratentorial hypodensities on the 3rd day after commencing the treatment. However, the next CT scan performed 2 weeks later revealed expanding hemorrhagic transformation in previous hypodensities. Hemorrhagic changes could not be explained by patient's coagulation profile on the 3rd day. Anticoagulation agents such as heparin are used routinely during a dialysis session to prevent clot formation in dialysis circuits. This case is possibly questioning the role of heparin in hemorrhagic brain lesions of methanol intoxication.
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Affiliation(s)
- Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hooman Bahrami-Motlagh
- Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Behdad Behnam
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zakharov S, Pelclova D, Navratil T, Belacek J, Latta J, Pisar M, Rulisek J, Leps J, Zidek P, Kucera C, Bocek R, Mazur M, Belik Z, Chalupa J, Talafa V, Kodras K, Nalos D, Sedlak C, Senkyrik M, Smid J, Salek T, Roberts DM, Hovda KE. Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning. Clin Toxicol (Phila) 2016; 55:123-132. [DOI: 10.1080/15563650.2016.1250901] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Toxicological Information Centre, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine, First Faculty of Medicine, Toxicological Information Centre, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Department of Occupational Medicine, First Faculty of Medicine, Toxicological Information Centre, Charles University and General University Hospital, Prague, Czech Republic
- First Faculty of Medicine, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University and General University Hospital, Prague, Czech Republic
- J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i, Prague, Czech Republic
| | - Jaromir Belacek
- First Faculty of Medicine, Institute of Biophysics and Informatics, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Latta
- Department of Internal Medicine, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Michal Pisar
- Department of Internal Medicine, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Jan Rulisek
- Department of Anesthesiology, Resuscitation, and Intensive Medicine, General University Hospital, Prague, Czech Republic
| | - Jiri Leps
- Department of Anesthesiology and Resuscitation, Znojmo City Hospital, Znojmo, Czech Republic
| | - Pavel Zidek
- Department of Anesthesiology and Resuscitation, Benešov City Hospital, Benešov, Czech Republic
| | - Cyril Kucera
- Department of Anesthesiology and Resuscitation, Ostrava City Hospital, Ostrava, Czech Republic
| | - Robert Bocek
- Department of Anesthesiology and Intensive Medicine, Havířov Hospital, Havířov, Czech Republic
| | - Miroslav Mazur
- Department of Anesthesiology and Intensive Medicine, Havířov Hospital, Havířov, Czech Republic
| | - Zdenek Belik
- Department of Anesthesiology and Intensive Medicine, Karvina-Raj Hospital, Orlova, Czech Republic
| | - Josef Chalupa
- Department of Anesthesiology and Resuscitation, Frydek-Mistek City Hospital, Frydek-Mistek, Czech Republic
| | - Viktor Talafa
- Department of Internal Medicine, Frydek-Mistek City Hospital, Frydek-Mistek, Czech Republic
| | - Kamil Kodras
- Department of Anesthesiology and Resuscitation, Kladno City Hospital, Kladno, Czech Republic
| | - Daniel Nalos
- Department of Anesthesiology and Resuscitation, Masaryk Hospital, Ústínad Labem, Czech Republic
| | - Ctirad Sedlak
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Michal Senkyrik
- Department of Internal Medicine, Faculty Hospital Brno, Brno, Czech Republic
| | - Jan Smid
- Department of Internal Medicine, Ostrava City Hospital, Ostrava, Czech Republic
| | - Tomas Salek
- Department of Clinical Biochemistry, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | | | - Knut Erik Hovda
- Department of Acute Medicine, The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
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Zakharov S, Nurieva O, Kotikova K, Belacek J, Navratil T, Pelclova D. Positive serum ethanol concentration on admission to hospital as the factor predictive of treatment outcome in acute methanol poisoning. MONATSHEFTE FUR CHEMIE 2016; 148:409-419. [PMID: 28344362 PMCID: PMC5346122 DOI: 10.1007/s00706-016-1846-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022]
Abstract
ABSTRACT Mass methanol poisonings present a serious problem for health systems worldwide, with poor outcome associated with delayed treatment. Positive pre-hospital serum ethanol concentration may have predictive value as the prognostic factor of the treatment outcome. We studied the effect of positive serum ethanol level on admission to hospital on survival in patients treated during the Czech methanol outbreak during 2012-2014. Cross-sectional cohort study was performed in 100 hospitalized patients with confirmed methanol poisoning. Pre-hospital ethanol was administered in 42 patients (by paramedic/medical staff to 30 patients and self-administered by 12 patients before admission); 58 patients did not receive pre-hospital ethanol. Forty-two patients had detectable serum ethanol concentration on admission to hospital [median 18.3 (IQR 6.6-32.2) mmol dm-3]. Pre-hospital ethanol administration by paramedic/medical staff had a significant effect on survival without visual and CNS sequelae when adjusted for arterial blood pH on admission (OR 8.73; 95 % CI 3.57-21.34; p < 0.001). No patients receiving pre-hospital ethanol died compared with 21 not receiving (p < 0.001). Positive serum ethanol concentration on admission to hospital was a predictor for survival without health sequelae when adjusted for arterial blood pH (OR 8.10; 95 % CI 2.85-23.02; p < 0.001). The probability of visual and CNS sequelae in survivors reduced with increasing serum ethanol concentration on admission. GRAPHICAL ABSTRACT
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Affiliation(s)
- Sergey Zakharov
- Toxicological Information Centre, General University Hospital in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Olga Nurieva
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Katerina Kotikova
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Jaromir Belacek
- First Faculty of Medicine, Institute of Biophysics and Informatics, Charles University in Prague, Salmovska 1, 120 00 Prague, Czech Republic
| | - Tomas Navratil
- J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i., Dolejškova 3, 182 23 Prague 8, Czech Republic
- First Faculty of Medicine, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Daniela Pelclova
- Toxicological Information Centre, General University Hospital in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
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