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Levine M, Brent J, Wiegand T, Maguire B, Cohen N, Vaerrier D, Beuhler M, Leikin JB, Ganetsky M, Stellpflug S, Ruha AM, Carey J, Geib AJ, Cao DJ, Kleinschmidt K, Vohra R, Riley BD, Moore P, Schwarz E, Neavyn M, Rusyniak DE, Greene S, Nogar J, Manini A, Wermuth M, Pizon A, Hendrickson RG, Griswold M, Aldy K, Wax P, Spyres MB, Campleman S, Macdonald E, Finkelstein Y. Lipid emulsion therapy during management of the critically-ill poisoned patient: a prospective cohort study. Clin Toxicol (Phila) 2023; 61:584-590. [PMID: 37655788 DOI: 10.1080/15563650.2023.2248372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Despite conflicting data, intravenous lipid emulsion has emerged as a potential antidote. The "lipid sink" theory suggests that following intravenous administration of lipid, lipophilic drugs are sequestered in the vascular compartment, thereby reducing their tissue concentrations. This study sought to determine if survival is associated with the intoxicant's degree of lipophilicity. METHODS We reviewed all cases in the Toxicology Investigators Consortium's lipid sub-registry between May 2012 through December 2018. Information collected included demographics, exposure circumstances, clinical course, management, disposition, and outcome. The primary outcome was survival after lipid emulsion therapy. Survival was stratified by the log of the intoxicant's octanol-water partition coefficient. We also assessed the association between intoxicant lipophilicity and an increase in systolic blood pressure after lipid emulsion administration. RESULTS We identified 134 patients, including 81 (60.4%) females. The median age was 40 years (interquartile range 21-75). One hundred and eight (80.6%) patients survived, including 45 (33.6%) with cardiac arrest during their intoxication. Eighty-two (61.2%) were hypotensive, and 98 (73.1%) received mechanical ventilation. There was no relationship between survival and the log of the partition coefficient of the intoxicant on linear analysis (P = 0.89) or polynomial model (P = 0.10). Systolic blood pressure increased in both groups. The median (interquartile range) systolic blood pressure before lipid administration was 68 (60-78) mmHg for those intoxicants with a log partition coefficient < 3.6 compared with 89 (76-104) mmHg after lipid administration. Among those drugs with a log partition coefficient > 3.6, the median (interquartile range) was 69 (60-84) mmHg before lipid and 89 (80-96) mmHg after lipid administration. CONCLUSION Most patients in this cohort survived. Lipophilicity was not correlated with survival or the observed changes in blood pressure. The study did not address the efficacy of lipid emulsion.
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Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, Los Angeles, CA, USA
| | | | - Timothy Wiegand
- Department of Emergency Medicine, Division of Medical Toxicology, University of Rochester, Rochester, NY, USA
| | - Bryan Maguire
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Neta Cohen
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David Vaerrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Jerrold B Leikin
- Division of Environmental and Occupational Health Science and the Occupational and Environmental Medicine Service of UI Health, University of Illinois Chicago, Chicago, IL, USA
| | - Michael Ganetsky
- Department of Emergency Medicine, Division of Medical Toxicology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samuel Stellpflug
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Anne-Michelle Ruha
- Department of Medical Toxicology, Banner University Medical Center, Phoenix, AZ, USA
| | - Jennifer Carey
- Department of Emergency Medicine, University of Massachusetts, Worchester, MA, USA
| | | | - Dazhe James Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kurt Kleinschmidt
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rais Vohra
- Department of Emergency Medicine, Division of Medical Toxicology, University of California San Francisco-Fresno Medical Center, Fresno, CA, USA
| | - Brad D Riley
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Phillip Moore
- Department of Emergency Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Evan Schwarz
- Department of Emergency Medicine, University of California, Los Angeles, CA, USA
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University, St. Louis, MO, USA
| | - Mark Neavyn
- Department of Emergency Medicine, Hartford Hospital, Hartford, CT, USA
| | - Daniel E Rusyniak
- Department of Emergency Medicine, Division of Medical Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Spencer Greene
- Department of Emergency Medicine, HCA Houston Healthcare - Kingwood, University of Houston College of Medicine, Houston, TX, USA
| | - Joshua Nogar
- Department of Emergency Medicine, North Shore University, Manhasset, NY, USA
| | - Alex Manini
- Department of Emergency Medicine, Division of Medical Toxicology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, NY, USA
| | - Mary Wermuth
- Department of Emergency Medicine, Division of Medical Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anthony Pizon
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Division of Medical Toxicology, Oregon Health Science University, Portland, OR, USA
| | - Matthew Griswold
- Department of Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Kim Aldy
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Paul Wax
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Meghan Beth Spyres
- Department of Medical Toxicology, Banner University Medical Center, Phoenix, AZ, USA
| | | | - Erin Macdonald
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Yaron Finkelstein
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Singh J, Bhatia D, Cao DJ, Brewer J, Roppolo L. Aortic Dissection Presenting as Shortness of Breath from Diffuse Alveolar Hemorrhage. J Emerg Med 2022; 63:e10-e16. [PMID: 35931586 DOI: 10.1016/j.jemermed.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Aortic dissection is a rare but well-known life-threatening disease that classically presents with tearing chest pain radiating to the back yet can have deceiving clinical presentations. CASE REPORT A 54-year-old man with a history of hypertension presented to the emergency department with mild shortness of breath without chest pain. Point-of-care ultrasound (POCUS) detected diffuse B-lines, a dilated aortic root, aortic regurgitation, and pericardial effusion. A computed tomography angiogram confirmed a Stanford type A aortic dissection with diffuse alveolar hemorrhage (DAH), a rare complication of type A aortic dissection involving the posterior aortic wall with extension into the main pulmonary artery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute aortic dissection can present with a wide range of clinical manifestations with a high mortality rate for patients with an untimely diagnosis. Although an intimal flap within the aortic lumen is the characteristic finding on ultrasound, additional POCUS findings of a pericardial effusion, aortic regurgitation, and a dilated aortic root may be seen with proximal dissections. Diffuse B-lines on thoracic POCUS, although commonly associated with pulmonary edema in decompensated heart failure, can be seen in patients with DAH which has a multitude of etiologies, including aortic dissection.
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Affiliation(s)
- Joya Singh
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deven Bhatia
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dazhe James Cao
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Brewer
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lynn Roppolo
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Aldy K, Du T, Weaver MM, Roth B, Cao DJ. Seniors and single-use detergent sacs (SUDS): a review of the National Poison Data System from 2012 to 2020. Clin Toxicol (Phila) 2022; 60:1039-1043. [PMID: 35603994 DOI: 10.1080/15563650.2022.2074856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Exposure to single-use detergent sacs (SUDS), or laundry pods, have declined in the pediatric population between 2015 and 2018. Older adult exposures are less well described, and it is unclear if there is an increased risk of unintentional exposure to SUDS in older adults, especially in those with dementia. This study aims to review SUDS exposures in adults greater than 60-year-old between 2012 and 2020. METHODS Using the National Poison Data System (NPDS), a query was performed for cases involving an acute single substance exposure with substance coded as "laundry detergent unit dose" (Generic code: 0201181, 0201182, and 0201183) in adults greater than 60-years-old between January 1, 2012 and December 31, 2020. Exclusion criteria included unknown age, age less than 60 years, any multi-substance exposure, and chronic or acute-on-chronic acuity. The distribution of cases was analyzed for demographics, exposure circumstances, management, clinical effects, and medical outcome. RESULTS SUDS exposure reported to NPDS increased from 46 cases in 2012 to 219 cases in 2020. Among the 1289 total reported cases, 94.9% (n = 1223) were unintentional exposures with an average age of 75-year-old. The majority of exposures occurred in females (69%, n = 883). More than 1 exposure route was reported in 90 cases (7%), and the most common route of exposure was ingestion (64.9%, n = 836). Major effects were identified in 1% (n = 13) of exposures, and 0.5% (n = 7) of cases resulted in death. CONCLUSIONS Despite a declining incidence of pediatric SUDS exposure, older adult exposures have increased over 400% between 2012 and 2020.
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Affiliation(s)
- Kim Aldy
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony Du
- Baylor College of Medicine, Houston, TX, USA
| | - Mary Madison Weaver
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brett Roth
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - Dazhe James Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
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Aldy K, Cao DJ, Weaver MM, Rao D, Feng S. E-cigarette or vaping product use-associated lung injury (EVALI) features and recognition in the emergency department. J Am Coll Emerg Physicians Open 2020; 1:1090-1096. [PMID: 33145562 PMCID: PMC7593457 DOI: 10.1002/emp2.12112] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022] Open
Abstract
Since August 2019, the pulmonary disease termed e-cigarette or vaping product-use associated lung injury (EVALI), has resulted in 2758 hospitalizations and 64 deaths in the United States. EVALI is considered in patients who have vaped or dabbed within 90 days of symptom onset, and have abnormal lung imaging in the absence of any pulmonary infection. The majority of EVALI patients are otherwise healthy adolescents and young adults. The leading etiology of EVALI is contamination of delta-9-tetrahydrocannabinoid (THC) e-liquids with vitamin E acetate. Although the exact pathophysiology of vitamin E acetate-induced lung injury is unknown, vitamin E acetate may lead to pulmonary lipid accumulation and/or interfere with surfactant functioning. EVALI symptoms are vague but consist of a constellation of constitutional, pulmonary, and gastrointestinal symptoms. Patients often present multiple times to healthcare facilities as their clinical condition worsens with a considerable mortality risk. The diagnosis of EVALI hinges on obtaining history leading to the recognition of vaping/dabbing. Physicians need to be persistent, but nonjudgmental, in obtaining vaping histories, especially in THC-prohibited states. Radiographical findings of nonspecific bilateral ground-glass infiltrates are best detected on computed tomography. Management for EVALI requires a multidisciplinary approach focused on supportive respiratory care and ruling-out infectious causes. Corticosteroids may be of benefit. Most patients who are hypoxic, have comorbidities, or lack appropriate follow-up within 24-48 hours should be admitted for monitoring. Patients may benefit from substance abuse counseling and should be instructed to avoid vaping. As the outbreak continues, cases should be reported to local health departments and poison control centers.
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Affiliation(s)
- Kim Aldy
- Department of Emergency MedicineDivision of Medical ToxicologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- North Texas Poison CenterParkland Health and Hospital SystemDallasTexasUSA
| | - Dazhe James Cao
- Department of Emergency MedicineDivision of Medical ToxicologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- North Texas Poison CenterParkland Health and Hospital SystemDallasTexasUSA
| | - Mary Madison Weaver
- Department of Emergency MedicineDivision of Medical ToxicologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Devika Rao
- Department of PediatricsDivision of Pediatric Pulmonary MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Sing‐Yi Feng
- North Texas Poison CenterParkland Health and Hospital SystemDallasTexasUSA
- Department of PediatricsDivision of Pediatric Emergency MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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Rao DR, Maple KL, Dettori A, Afolabi F, Francis JK, Artunduaga M, Lieu TJ, Aldy K, Cao DJ, Hsu S, Feng SY, Mittal V. Clinical Features of E-cigarette, or Vaping, Product Use-Associated Lung Injury in Teenagers. Pediatrics 2020; 146:peds.2019-4104. [PMID: 32393606 PMCID: PMC7961805 DOI: 10.1542/peds.2019-4104] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the United States in 2019, there was an outbreak of electronic cigarette, or vaping, product use-associated lung injury (EVALI). The manifestations of EVALI in adolescents are not well characterized. We describe the diagnosis, evaluation, and management of EVALI in adolescents hospitalized at a tertiary care, university-affiliated children's hospital. METHODS A multidisciplinary committee developed an EVALI algorithm on the basis of guidelines from the Centers for Disease Control and Prevention. A retrospective chart review was conducted on patients diagnosed with EVALI. Descriptive analyses included sociodemographic characteristics, clinical presentation, laboratory and imaging results, pulmonary function testing, oxygen requirements, and clinic follow-up. RESULTS Thirteen hospitalized adolescents were diagnosed with confirmed or probable EVALI. The majority were female (54%) with a mean age of 15.9 years. Sixty-nine percent of patients presented with respiratory symptoms, whereas gastrointestinal symptoms were prominent in 85% of patients. Vaping Δ-9-tetrahydrocannabinol was reported in 92% of patients, and vaping nicotine was reported in 62% of patients. All had bilateral ground-glass opacities on the chest computed tomography (CT) scan. Treatment with glucocorticoids led to clinical improvement in 11 of 12 patients. Treatment with glucocorticoids led to improvement in both forced expiratory volume in 1 second and forced vital capacity (P < .05). Four patients required home oxygen on the basis of 6-minute walk test results. CONCLUSIONS Diagnosis of EVALI should be suspected on the basis of vaping history and clinical presentation. Glucocorticoid treatment led to an improvement in symptoms and lung function. The 6-minute walk test may help determine oxygen needs at discharge.
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Affiliation(s)
- Devika R. Rao
- Division of Respiratory Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Kendra L. Maple
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Dettori
- Division of Respiratory Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Folashade Afolabi
- Division of Respiratory Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Jenny K.R. Francis
- Division of Developmental-Behavioral Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Maddy Artunduaga
- Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Tiffany J. Lieu
- Division of Pediatric Hospital Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kim Aldy
- Division of Medical Toxicology, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,North Texas Poison Center, Parkland Health and Hospital System, Dallas, Texas
| | - Dazhe James Cao
- Division of Medical Toxicology, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,North Texas Poison Center, Parkland Health and Hospital System, Dallas, Texas
| | - Stephanie Hsu
- Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Sing Yi Feng
- Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,North Texas Poison Center, Parkland Health and Hospital System, Dallas, Texas
| | - Vineeta Mittal
- Division of Pediatric Hospital Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
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Cao DJ, Aldy K, Hsu S, McGetrick M, Verbeck G, De Silva I, Feng SY. Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury. J Med Toxicol 2020; 16:295-310. [PMID: 32301069 PMCID: PMC7320089 DOI: 10.1007/s13181-020-00772-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/11/2022] Open
Abstract
Electronic cigarettes (e-cigarettes) are battery-operated devices to insufflate nicotine or other psychoactive e-liquid aerosols. Despite initial claims of e-cigarettes as a nicotine-cessation device, aggressive marketing of e-cigarettes has led to an explosion in adolescents' and young adults' use over the last few years. Coupled with a lack of adequate investigation and regulation of e-cigarettes, the USA is facing an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) starting in mid-2019. While little long-term health hazard data are available, the components and constituents of e-cigarettes may adversely impact health. Propylene glycol and glycerin are humectants (water-retaining excipients) that generate pulmonary irritants and carcinogenic carbonyl compounds (e.g., formaldehyde, acetaldehyde, and acrolein) when heated in e-cigarettes. Metals contained in heating coils and cartridge casings may leach metals such as aluminum, chromium, iron, lead, manganese, nickel, and tin. Flavoring agents are considered safe for ingestion but lack safety data for inhalational exposures. Diacetyl, a common buttery flavoring agent, has known pulmonary toxicity with inhalational exposures leading to bronchiolitis obliterans. In 2019, clusters of lung injury associated with e-cigarette use were identified in Wisconsin and Illinois. Patients with EVALI present with a constellation of respiratory, gastrointestinal, and constitutional symptoms. Radiographically, patients have bilateral ground glass opacifications. As of February 18, 2020, the Centers for Disease Control has identified 2807 hospitalized patients diagnosed with either "confirmed" or "probable" EVALI in the US. Currently, vitamin E acetate (VEA) used as a diluent in tetrahydrocannabinol vape cartridges is implicated in EVALI. VEA cuts tetrahydrocannabinol oil without changing the appearance or viscosity. When inhaled, pulmonary tissue lacks the mechanism to metabolize and absorb VEA, which may lead to its accumulation. While most EVALI patients were hospitalized, treatment remains largely supportive, and use of corticosteroids has been associated with clinical improvement. The outbreak of EVALI highlights the need for regulation of e-cigarette devices and e-liquids. Clinicians need to be aware of the health hazards of e-cigarettes and be vigilant in asking about vaping.
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Affiliation(s)
- Dazhe James Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA.
| | - Kim Aldy
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - Stephanie Hsu
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Molly McGetrick
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Guido Verbeck
- Department of Chemistry, University of North Texas, Denton, TX, USA
| | - Imesha De Silva
- Department of Chemistry, University of North Texas, Denton, TX, USA
| | - Sing-Yi Feng
- North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Pediatrics, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Chiong M, Wang ZV, Pedrozo Z, Cao DJ, Troncoso R, Ibacache M, Criollo A, Nemchenko A, Hill JA, Lavandero S. Cardiomyocyte death: mechanisms and translational implications. Cell Death Dis 2011; 2:e244. [PMID: 22190003 PMCID: PMC3252742 DOI: 10.1038/cddis.2011.130] [Citation(s) in RCA: 325] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Although treatments have improved, development of novel therapies for patients with CVD remains a major research goal. Apoptosis, necrosis, and autophagy occur in cardiac myocytes, and both gradual and acute cell death are hallmarks of cardiac pathology, including heart failure, myocardial infarction, and ischemia/reperfusion. Pharmacological and genetic inhibition of autophagy, apoptosis, or necrosis diminishes infarct size and improves cardiac function in these disorders. Here, we review recent progress in the fields of autophagy, apoptosis, and necrosis. In addition, we highlight the involvement of these mechanisms in cardiac pathology and discuss potential translational implications.
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Affiliation(s)
- M Chiong
- Centro Estudios Moleculares de la Celula, Departamento de Bioquimica y Biología Molecular, Facultad de Ciencias Quimicas y Farmaceuticas and Facultad de Medicina, Universidad de Chile, Santiago, Chile
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8
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Abstract
Twelve Newcastle disease virus (NDV) strains were isolated from chickens involved in outbreaks of Newcastle disease (ND) in western China (Shaanxi, Gansu, Xinjiang, Qinghai and Guangxi provinces) between 1979 and 1999. All strains were determined to be velogenic by plaque formation, the mean death time (MDT) of embryonated eggs, and the intracerebral pathogenicity index (ICPI). For preparation of virus RNA, the acid guanidinium-thiocyanate method was used. A 908bp fragment of nucleotide was amplified by RT-PCR starting from the N terminal of the F gene and the PCR segments were cloned into the PGEM-T vector and sequenced. The similarities of the nucleotide sequences (1-519bp) and predicted amino acid sequences of the F gene (1-125) were analyzed by comparing the 12 NDV isolates with the NDV vaccine strains Lasota, B1, H1 and V4, with classical NDV strains and recent epizootic strains. Phylogenetic analysis demonstrated that all strains were of two novel genotypes; the NDV strains that caused the outbreak of ND in western China during 1998-1999 was of the genotype VIIa, whereas the strains from the Qinghai province (1979-1985) were of genotype VIII, which has been found predominately in southern Africa.
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Affiliation(s)
- R Liang
- National Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute of CAAS, Harbin 150001, PR China.
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9
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Cao DJ. Investigations of some hereditary eye diseases causing blindness. Chin Med J (Engl) 1984; 97:223-8. [PMID: 6432487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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10
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Cao DJ. [Investigative studies on some blinding hereditary eye diseases (author's transl)]. Zhonghua Yan Ke Za Zhi 1981; 17:233-6. [PMID: 6802615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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