Secuelas neurológicas tardías en la intoxicación por monóxido de carbono. Reporte de un caso pediátrico

Introducción: la intoxicación por monóxido de carbono (CO) es un problema grave de salud. La aparición de secuelas neurológicas tardías incluye trastornos cognitivos, mentales, síntomas piramidales o extrapiramidales. Caso clínico: paciente de 12 años, sexo femenino, luego de 15 días de una intoxicación aguda grave por CO, presenta movimientos coreoatetoideos de miembros superiores, distonías de cuello, discinesias de cara, bradipsiquia y dificultades en la memoria. Resonancia magnética: lesiones isquémicas en globo pálido bilateral, sustancia blanca de hipocampo y cerebelo. Discusión: es fundamental el seguimiento posterior al alta para reconocer las secuelas neurológicas tardías, incluyendo la realización de pruebas neuropsicológicas estandarizadas.

Introduction: Carbon monoxide poisoning is a severe health problem. The appearance of delayed neurological sequelae includes cognitive and mental disorders and pyramidal or extrapyramidal symptoms. Case presentation: A 12-year-old female patient, after 15 days of severe acute CO poisoning, presents choreoathetoid movements of the upper limbs, neck dystonias, face dyskinesias, bradypsychia, and memory difficulties. Magnetic resonance imaging: ischemic lesions in bilateral globus pallidus, the white matter of hippocampus and cerebellum. Discussion: A follow-up visit after discharge is essential to recognize delayed neurological sequelae, including performing standardized neuropsychological tests.

Diagnostic and prognostic value of combined detection of serum Lp-PLA2,NSE and S-100β in patients with carbon monoxide poisoning complicated with acute cerebral infarction / 国际检验医学杂志

Objective To explore the value of combined detection of lipoprotein-associated phospholipase A2(Lp-PLA2),neuron specific enolase(NSE)and S-100 calcium binding protein β(S-100β)in the diagnosis and prognosis evaluation of acute cerebral infarction(ACI)in patients with carbon monoxide poisoning(CMP).Methods A total of 102 patients with CMP complicated with ACI admitted to the hospital from Jan-uary 2020 to November 2021 were selected as the study group,meanwhile,102 patients with simple CMP were enrolled as the control group.Patients in the study group were followed up for 6 months after discharge,ac-cording to the follow-up results,they were grouped into good prognosis group(60 cases)and poor prognosis group(42 cases).The serum levels of Lp-PLA2,NSE and S-100β were detected by enzyme-linked immunosor-bent assay(ELISA).The receiver operating characteristic(ROC)curve was applied to analyze the value of the combination of serum Lp-PLA2,NSE and S-100β in the early diagnosis and prognosis evaluation of patients with CMP and ACI.Results Compared with the control group,the levels of Lp-PLA2,NSE and S-100β in the study group were obviously higher(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of the combined detection of serum Lp-PLA2、NSE、S-100β for the diagnosis of CMP complicat-ed with ACI was greater than the AUC of single detection of each indicator(P<0.001).Compared with the good prognosis group,the levels of Lp-PLA2,NSE and S-100β in the poor prognosis group were obviously higher(P<0.05).The results of ROC curve analysis showed that the AUC of the combined detection of ser-um Lp-PLA2、NSE、S-100β for the prognosis of patients with CMP complicated with ACI was greater than the AUC of single detection of each indicator(P<0.05).Conclusion The expression of Lp-PLA2,NSE and S-100β in serum of patients with CMP complicated with ACI is high,and the combined detection of the three has certain value in the diagnosis and prognosis evaluation for patients with CMP complicated with ACI.

Short-term effects of air pollutants on outpatient volume of respiratory diseases in Guiyang / 环境与职业医学

Background Affected by concentration, composition, and population tolerance of air pollutants, the relationship between air pollutants and population health has regional differences. There is still a research gap in Guiyang. Objective To explore the short-term effects of air pollutant concentrations in low-pollution areas on the outpatient volume of respiratory diseases. Methods Spearman correlation analysis was used to evaluate the correlation between air pollutants, meteorological factors, and respiratory outpatient volume from January 1, 2013 to December 31, 2020 in Guiyang City. A single pollutant distribution lag nonlinear model and a multi-pollutant interaction model were established based on Poisson distribution. A three-dimensional diagram was drawn to display the relationship between air pollutants and respiratory outpatient volume. Quantitative analysis was conducted on the attribution risk and lag effect of air pollutant concentration on outpatient volume of respiratory diseases in Guiyang City. Results The results of the single pollutant model showed that fine particulate matter (PM2.5), nitrogen dioxide (NO2), carbon monoxide (CO), and sulfur dioxide (SO2) elevated the outpatient volume of respiratory diseases. The maximum relative risk (RR) and 95%CI values of PM2.5, NO2,CO, and SO2 appeared on Day 2, 0, 5, and 6, respectively, which were 1.019 (1.015, 1.023), 1.146 (1.122, 1.171), 1.129 (1.116, 1.143), and 1.046(1.040, 1.052), respectively. For every quartile concentration increment of PM2.5, NO2, CO, or SO2, the outpatient volume of respiratory diseases increased by 0.943% (0.111%, 1.782%), 4.050% (3.573%, 4.529%), 0.595% (0.317%, 0.874%), or 0.667% (0.235%, 1.100%), respectively. The maximum RR (95%CI) of O3 was 1.015 (1.007, 1.023) and appeared on Day 0. The results of multi-pollutant model showed that PM2.5, NO2, CO, SO2, and O3 all elevated the outpatient volume of respiratory diseases. The maximum RR values of PM2.5, NO2, CO, SO2 and O3 appeared on Day 14, 0, 5, 7 and 0, respectively, which were 1.027 (1.021, 1.034), 1.213 (1.179, 1.248), 1.059 (1.043, 1.074), 1.016 (1.005, 1.026), and 1.024 (1.015, 1.033), respectively. Compared with the single pollutant model, the RR values of PM2.5, NO2, and O3 on the outpatient volume of respiratory diseases in the multi-pollutant model showed an upward trend, while the RR values of CO and SO2 in the multi-pollutant model showed a downward trend. Conclusion The impact of low concentrations of PM2.5, NO2, CO, and SO2 on human health cannot be ignored.

Intoxicación aguda por monóxido de carbono, un viejo conocido que sigue dando problemas / Acute poisoning with carbon monoxide, an old acquaintance still causing problems / Intoxicação aguda por monóxido de carbono, um velho conhecido que continua a causar problemas

Introducción: la intoxicación por monóxido de carbono (CO) es un tipo de intoxicación aguda frecuente en los meses de invierno y principal causa de muerte y secuelas neurológicas secundarias a un tóxico. La clínica puede variar desde una enfermedad leve hasta una situación crítica con riesgo vital inmediato. Objetivos: describir la presentación clínica de niños y adolescentes que egresaron con diagnóstico de intoxicación por CO asistidos en el Departamento de Emergencia Pediátrica del Centro Hospitalario Pereira Rossell (DEP-CHPR). Metodología: estudio observacional, retrospectivo y descriptivo. Incluyó a pacientes de 0 a 14 años con diagnóstico de intoxicación por CO, entre abril y agosto de 2022. Resultados: se incluyeron 15 pacientes. Presentaron síntomas neurológicos 13 casos, 8 de gravedad (convulsiones, pérdida de conocimiento, coma). La fuente de exposición más frecuente fue el calefón a gas. Discusión: no hubo en todos los casos un reconocimiento inmediato de la exposición y probable intoxicación, resultando en un retraso en el diagnóstico y tratamiento. Mayoritariamente se inició oxigenoterapia al 100% una vez sospechado o confirmado el diagnóstico. Los niveles de carboxihemoglobina (COHb) no se correlacionaron bien con la clínica, valores elevados de lactato sérico y aumento de las enzimas cardíacas fueron identificados en algunos casos. Conclusiones: la intoxicación aguda por CO se manifestó por sintomatología neurológica con un amplio espectro de presentación clínica, en ocasiones con riesgo vital. El calefón a gas fue la causa más común en los casos graves. El nivel elevado de COHb contribuyó al diagnóstico, si bien un valor normal no lo descartó.

Introduction: carbon monoxide (CO) poisoning is a frequent acute poisoning in winter months and the main cause of death and neurological sequelae secondary to an inhaled toxin. Clinical presentation can vary from a mild illness to a critical immediate life-threatening situation. Objectives: describe the clinical presentation of children and adolescents who were discharged with a diagnosis of CO poisoning assisted in the Emergency Pediatric Ward of the Pereira Rossell Pediatric Hospital (CHPR). Methodology: observational, retrospective and descriptive study. It includes patients from 0 to 14 years of age with diagnosis of CO poisoning between April and August 2022. Results: 15 patients were included. Neurological symptoms were present in 13 cases, 8 severe (seizures, loss of consciousness, coma). The most frequent source of exposure was the gas water heaters. Discussion: there was not an immediate recognition of the exposure and probable intoxication in all cases, which resulted in a delay in diagnosis and treatment. Mostly 100% oxygen therapy was started once the diagnosis was suspected or confirmed. Carboxyhemoglobin (COHb) levels did not correlate well with the symptoms, elevated serum lactate values and increased cardiac enzymes were identified in some cases. Conclusions: anexocute CO poisoning was manifested by neurological symptoms, with a wide spectrum of clinical presentation, sometimes life-threatening. Gas water heater was the most common source in severe cases. The elevated level of COHb contributed to the diagnosis, although a normal value did not rule it out.

Introdução: a intoxicação por monóxido de carbono (CO) é um tipo de intoxicação aguda comum nos meses de inverno e a principal causa de morte e sequelas neurológicas secundárias a uma toxina. Os sintomas podem variar desde uma doença leve até uma situação crítica com risco imediato de vida. Objetivos: descrever o quadro clínico de crianças e adolescentes que receberam alta com diagnóstico de intoxicação por CO atendidos no Pronto Socorro Pediátrico do Centro Hospitalar Pereira Rossell (CHPR). Metodologia: estudo observacional, retrospectivo e descritivo. Incluem-se pacientes de 0 a 14 anos com diagnóstico de intoxicação por CO, entre abril e agosto de 2022. Resultados: foram incluídos 15 pacientes. 13 casos apresentaram sintomas neurológicos, sendo 8 graves (convulsões, perda de consciência, coma). A fonte de exposição mais frequente foi o aquecedor a gás. Discussão: não houve reconhecimento imediato da exposição e provável intoxicação em todos os casos, resultando em atraso no diagnóstico e tratamento. Principalmente, a oxigenoterapia a 100% foi iniciada quando o diagnóstico foi suspeito ou confirmado. Os níveis de carboxihemoglobina (COHb) não se correlacionaram bem com os sintomas clínicos, foram identificados valores elevados de lactato sérico e aumento de enzimas cardíacas em alguns casos. Conclusões: a intoxicação aguda por CO manifestou-se por sintomas neurológicos, com amplo espectro de apresentação clínica, por vezes com risco de vida. O aquecedor a gás foi a fonte mais comum nos casos graves. O nível elevado de COHb contribuiu para o diagnóstico, embora um valor normal não o tenha excluído.

Características de las intoxicaciones agudas por monóxido de carbono en un prestador integral de salud pública / Characteristics of acute carbon monoxide poisoning in a comprehensive public health provider / Características das intoxicações agudas por monóxido de carbono em um prestador integral de saúde pública

Introducción: La intoxicación por monóxido de carbono (CO) es una entidad frecuente y prevenible, especialmente en los meses de otoño e invierno. Se debe priorizar la educación pública ambiental sobre las fuentes de CO, su uso adecuado y los potenciales daños tanto en la etapa agua como las posibles secuelas. Objetivo: Describir las características epidemiológicas, clínicas, terapéuticas y evolutivas de los menores de 15 años intoxicados por CO asistidos en un prestador de salud entre abril y diciembre de 2022. Metodología: Estudio observacional retrospectivo. Variables: edad, sexo, fuente de exposición, mes del año, síntomas, severidad, nivel de carboxihemoglobina (COHb), latencia exposición-detección de COHb, paraclínica, tratamiento y evolución. Resultados: Se identificaron 11 casos, de los cuales 6 fueron sexo femenino, con una media de edad de 7,9 años. Fuentes de exposición: calefón a gas 4, braseros 3, estufas 3, caño de escape 1. La intoxicación fue grave en 5 casos, moderada en 4 y leve en 2. Síntomas más frecuentes: neurológicos y gastrointestinales. La media de COHb inicial 5,4% (rango de 0,9-15,6). La latencia media entre el inicio de la sintomatología y la extracción de la muestra fue de 9,8 horas. Siete pacientes recibieron oxigenoterapia previa a la toma de la muestra. La oxigenoterapia fue hiperbárica en 6 casos y normobárica en 5. Ingresaron a cuidados moderados 8 pacientes e intensivos 1. Se dosificaron troponinas en 9 casos (elevadas en 5), CK en 10 (elevada en 4). Se realizó electrocardiograma a 9 pacientes (alterado en 2). La resonancia encefálica se realizó en 8 (alterada en 2). Una paciente reingresó por manifestaciones neurológicas tardías. Ninguno falleció. Conclusiones: El diagnóstico de intoxicación por CO requiere un alto índice de sospecha, dado que las manifestaciones clínicas suelen ser inespecíficas. Los niveles de COHb no siempre son de utilidad para determinar su severidad, ya que se ven afectados por múltiples factores. La realización de resonancia magnética cerebral y el seguimiento posterior al alta son relevantes para la detección de secuelas neurológicas.

Introduction: Carbon monoxide (CO) poisoning is a common and preventable condition, especially during the fall and winter months. Public environmental education on CO sources, proper usage, and potential harms, both during the acute phase and possible long-term effects, should be prioritized. Objective: To describe the epidemiological, clinical, therapeutic, and evolutionary characteristics of children under 15 years of age poisoned by CO and treated at a healthcare provider between April and December 2022. Methodology: Retrospective observational study. Variables: age, sex, source of exposure, month of the year, symptoms, severity, carboxyhemoglobin (COHb) levels, latency between exposure and COHb detection, paraclinical tests, treatment, and evolution. Results: Eleven cases were identified, 6 of which were female, with a mean age of 7.9 years. Sources of exposure: gas water heater 4, stoves 3, braseros 3, exhaust pipe 1. Poisoning was severe in 5 cases, moderate in 4, and mild in 2. Most frequent symptoms: neurological and gastrointestinal. Mean initial COHb was 5.4% (range 0.9­15.6). Mean latency between symptom onset and sample collection was 9.8 hours. Seven patients received oxygen therapy before sample collection. Oxygen therapy was hyperbaric in 6 cases and normobaric in 5. Eight patients were admitted to moderate care and 1 to intensive care. Troponin levels were measured in 9 cases (elevated in 5), CK in 10 (elevated in 4). ECG was performed on 9 patients (altered in 2). Brain MRI was conducted in 8 (altered in 2). One patient was readmitted for late neurological manifestations. No deaths occurred. Conclusions: CO poisoning diagnosis requires a high index of suspicion as clinical manifestations are often nonspecific. COHb levels are not always useful for determining severity, as they are affected by multiple factors. Brain MRI and follow-up after discharge are essential for detecting neurological sequelae.

Introdução: A intoxicação por monóxido de carbono (CO) é uma condição frequente e prevenível, especialmente nos meses de outono e inverno. Deve-se priorizar a educação pública ambiental sobre as fontes de CO, seu uso adequado e os danos potenciais tanto na fase aguda quanto nas possíveis sequelas. Objetivo: Descrever as características epidemiológicas, clínicas, terapêuticas e evolutivas de menores de 15 anos intoxicados por CO atendidos em um prestador de saúde entre abril e dezembro de 2022. Metodologia: Estudo observacional retrospectivo. Variáveis: idade, sexo, fonte de exposição, mês do ano, sintomas, gravidade, nível de carboxihemoglobina (COHb), latência entre exposição e detecção de COHb, exames paraclínicos, tratamento e evolução. Resultados: Foram identificados 11 casos, dos quais 6 eram do sexo feminino, com média de idade de 7,9 anos. Fontes de exposição: aquecedor a gás (4 casos), braseros (3), fogões (3) e escapamento de carro (1). A intoxicação foi grave em 5 casos, moderada em 4 e leve em 2. Sintomas mais frequentes: neurológicos e gastrointestinais. Média de COHb inicial de 5,4% (intervalo de 0,9 a 15,6). A latência média entre o início da sintomatologia e a coleta da amostra foi de 9,8 horas. Sete pacientes receberam oxigenoterapia antes da coleta da amostra. A oxigenoterapia foi hiperbárica em 6 casos e normobárica em 5. Oito pacientes foram internados em cuidados intermediários e 1 em cuidados intensivos. A dosagem de troponinas foi realizada em 9 casos (elevada em 5), CK em 10 (elevada em 4). Foi realizado eletrocardiograma em 9 pacientes (alterado em 2). A ressonância magnética cerebral foi realizada em 8 (alterada em 2). Uma paciente foi readmitida devido a manifestações neurológicas tardias. Nenhum paciente faleceu. Conclusões: O diagnóstico de intoxicação por CO requer um alto índice de suspeição, pois as manifestações clínicas geralmente são inespecíficas. Os níveis de COHb nem sempre são úteis para determinar a gravidade, pois são afetados por múltiplos fatores. A realização de ressonância magnética cerebral e o acompanhamento após a alta são relevantes para a detecção de sequelas neurológicas.

Aspectos por considerar en autopsias por intoxicación aguda con monóxido de carbono, el asesino silente. A propósito de dos casos / Aspects to consider in autopsies for acute carbon monoxide poisoning, the silent killer. About two cases

El monóxido de carbono (CO) es un gas que se produce durante la combustión incompleta de diferentes materiales orgánicos. Una vez que se inhala, se absorbe hacia la sangre, ejerciendo su efecto a nivel sistémico. Se une fuertemente a la hemoglobina, y forma la carboxihemoglobina lo que provoca una disminución del transporte de oxígeno a los tejidos y dependiendo de su concentración puede ser mortal. Los hallazgos comúnmente encontrados en la autopsia son color rojo cereza en la piel y órganos, así como edema pulmonar, entre otros. El diagnóstico de intoxicación por CO se basa en la medición post mortem de carboxihemoglobina en sangre, por lo que se deben tomar muestras para cuantificar estos niveles. Con respecto al manejo en estos casos, se presenta dos casos correspondientes a la autopsia médica legal en las que se estableció como causa de muerte la intoxicación por monóxido de carbono.

Carbon monoxide (CO) is a gas that is produced during the incomplete combustion of different organic materials. Once inhaled, it is absorbed into the blood, exerting its effect at the systemic level. It strongly binds to hemoglobin, and forms carboxyhemoglobin, which causes a decrease in oxygen transport to the tissues and, depending on its concentration, can be fatal. The findings commonly found in the autopsy are cherry red color in the skin and organs, as well as pulmonary edema, among others. The diagnosis of CO poisoning is based on the postmortem measurement of carboxyhemoglobin in the blood, so samples must be taken to quantify these levels. Regarding the handling of these cases, two cases corresponding to the legal medical autopsy are presented in which carbon monoxide poisoning was established as the cause of death.

Ruptura de malformación arteriovenosa en intoxicación por monóxido de carbono / Arteriovenous malformation rupture in carbon monoxide poisoning

Resumen Las malformaciones arteriovenosas son conexiones aberrantes entre los sistemas arterial y venoso que con frecuencia se manifiestan a través de sangrados, los cuales pueden ser espontáneos o tener un factor detonante. Por su parte, el monóxido de carbono es un gas sin olor ni color que debe sus efectos a su afinidad por proteínas indispensables para el metabolismo humano (hemoglobina, mioglobina, citocromos), así como a la formación de óxido nítrico, de especies reactivas de oxígeno, inducción de apop-tosis, peroxidación lipídica, por mecanismos proinflamatorios y al actuar como molécula de señalización, además de otros posibles mecanismos que aun se desconocen. Presentamos el caso de un paciente con una malformación arteriovenosa quien sufrió un infarto cerebral hemorrágico luego de intoxicarse con monóxido de carbono y posteriormente exponemos los posibles mecanismos por los cuales el monóxido de carbono pudo participar como un factor detonante.

Abstract Arteriovenous malformations are aberrant connections between the arterial and venous systems that often manifest them-selves through bleeding, which can be spontaneous or have a trigger. On the other hand, carbon monoxide is an odorless, colorless gas that owes its effects to its affinity for proteins essential for human metabolism (hemoglobin, myoglobin, cytochromes), as well as the formation of nitric oxide, reactive oxygen species, induction of apoptosis, lipid peroxidation, pro-inflammatory mechanisms and by acting as a signaling molecule, in addition to other possible mechanisms that are still unknown. We present the case of a patient with an arteriovenous malformation who suffered a hemorrhagic cerebral infarction after being intoxicated with carbon monoxide and later we expose the possible mechanisms by which carbon monoxide could trigger the hemorrhage.

El rol del laboratorio en los hallazgos de intoxicación y exposición a monóxido de carbono / The role of the laboratory in findings of carbon monoxide poisoning and exposure

El monóxido de carbono es un gas altamente tóxico que se origina principalmente por la combustión incompleta de combustibles fósiles. La intoxicación presenta síntomas inespecíficos que solapan otras patologías y por lo tanto es indispensable la confirmación mediante la medición de la carboxihemoglobina en sangre. El laboratorio incorporó la determinación en el informe del estado ácido base a partir de octubre del 2018, debido a que previamente el médico debía solicitarla frente a la sospecha de una intoxicación. El objetivo del trabajo fue evaluar si esta medida implementada por el laboratorio contribuyó a mejorar el diagnóstico de intoxicación por CO, analizar las características de los pacientes con COHb mayor o igual a 5% y definir un valor de reporte inmediato para la COHb. El 46% de los casos con COHb mayor o igual a 5% no se relacionaban con una intoxicación y/o exposición a CO. De los casos de intoxicación se encontró que el 77% fueron diagnosticados a partir de la sospecha médica y un 23% por hallazgo del laboratorio. Se concluyó que es de mucha utilidad el rol del laboratorio en detectar aquellos casos que no fueron evidentes clínicamente. Existen ciertas patologías como las oncológicas o la enfermedad de Wilson donde se vieron valores elevados de COHb sin presentar intoxicación y se definió finalmente, como valor de reporte inmediato 7% para la COHb. (AU)

Carbon monoxide is a highly toxic gas that originates mainly from incomplete combustion of fossil fuels. Intoxication causes nonspecific symptoms that overlap with other conditions and, therefore, confirmation by measuring blood carboxyhemoglobin is essential. The laboratory incorporated the measurement in the acid-base status report as of October 2018, as it was previously required to be requested by the physician in case of suspected intoxication. The aim of this study was to evaluate whether this measure implemented by the laboratory contributed to the improvement of the diagnosis of CO intoxication, to analyze the characteristics of patients with COHb greater than or equal to 5% and to define an immediate reporting value for COHb. Overall, 46% of the cases with COHb greater than or equal to 5% were not related to CO poisoning and/or exposure. Of the cases of intoxication, 77% were diagnosed based on medical suspicion and 23% on laboratory findings. It was concluded that the laboratory has a useful role in detecting cases that were not clinically evident. There are certain diseases including different types of cancer or Wilson's disease where elevated COHb values were seen without intoxication and finally, 7% for COHb was defined as the immediate reporting value (AU)

Exposición antenatal a contaminantes vehiculares y asociación con parto pretérmino en Colombia / Antenatal exposure to vehicular pollutants and association with preterm birth in Colombia

Objetivo: Determinar la asociación entre parto pretérmino y exposición prenatal de gestantes a emisiones vehiculares de material particulado menor de 10 micras y de monóxido de carbono, en una ciudad de Colombia, entre julio de 2014 y julio de 2015. Métodos: Estudio relacional, retrospectivo, de casos y controles, en el Hospital de Caldas de la ciudad de Manizales; en mujeres que asistieron para atención del parto. La exposición a emisiones vehiculares de material particulado menor de 10 micras y de monóxido de carbono, se determinó usando estimaciones previamente publicadas para la ciudad. El análisis estadístico se realizó en el aplicativo Jamovi ­ Stats Open Now. Se contó con el aval de los comités de ética de las instituciones implicadas. Resultados: Se analizaron 222 pacientes, 74 presentaron parto pretérmino (casos) y 148 parto a término (controles). No se encontró asociación estadísticamente significativa entre el desarrollo de parto pretérmino y los niveles de material particulado menor de 10 micras o de monóxido de carbono; no obstante, podría haber una asociación entre parto pretérmino y aseguramiento en salud, que no pudo establecerse por el tamaño de muestra pequeño. También se obtuvo el patrón espacial de los casos de parto pretérmino en la ciudad con base en la residencia habitual de las pacientes. Conclusión: Los contaminantes ambientales como el material particulado menor de 10 micras y el monóxido de carbono, pueden estar implicados en la presentación de parto pretérmino, sin embargo, se requieren más estudios que analicen esta asociación(AU)

Objective: To determine the association between preterm delivery and prenatal exposure of pregnant women to vehicular emissions of particulate matter smaller than 10 microns and carbon monoxide, in a city in Colombia, between July 2014 and July 2015. Methods: Relational, retrospective, case-control study at the Caldas Hospital in the city of Manizales; in women who attended delivery care. Exposure to vehicular emissions of particulate matter smaller than 10 microns and carbon monoxide was determined using previously published estimates for the city. The statistical analysis was carried out in the Jamovi ­ Stats Open Now application. It had the endorsement of the ethics committees of the institutions involved. Results: A total of 222 patients were analyzed, 74 presented preterm delivery (cases) and 148 term delivery (controls). No statistically significant association was found between the development of preterm labor and levels of particulate matter less than 10 microns or carbon monoxide; however, there could be an association between preterm delivery and health insurance, which could not be established due to the small sample size. The spatial pattern of cases of preterm delivery in the city was also obtained based on the habitual residence of the patients. Conclusion: Environmental pollutants such as particulate matter smaller than 10 microns and carbon monoxide may be involved in the presentation of preterm labor, however, more studies are required to analyze this association(AU)

Carbon Monoxide Poisoning from Heavy Cigarette Smoking Presenting as Delusion in a Patient with a History of Chronic Schizophrenia (Methamphetamine Induced)

We describe a case of carbon monoxide poisoning in a 54-year-old male from heavy cigarette smoking presenting as delusions. The patient has a history of methamphetamine-induced schizophrenia now in remission for 2 years, and not on any psychotropics and is drug-free.

Intoxicación por monóxido de carbono: estudio observacional de pacientes que acudieron a Urgencias durante 2020 / Carbon monoxide poisoning: an observational study of patients admitted to Emergency Department during 2020

El objetivo fue describir las intoxicaciones monóxido de carbono. Se diseñó un corte transversal que incluyó una muestra consecutiva de mediciones de carboxihemoglobina (COHb), realizadas Enero y Diciembre 2020 en la Central de Emergencias del Hospital Italiano de Buenos Aires. Se utilizaron bases secundarias y revisión manual de historias clínicas para recolección de varia-bles de interés. Durante el período de estudio hubo 20 pacientes confirmados, con media de 50 años (DE 20), 55% sexo masculino, 20% tabaquistas, y una única embarazada. El 70% correspondieron al trimestre Junio-Julio-Agosto. La fuente de intoxicación más frecuente se debió a accidentes domésticos (calefón, estufa, brasero, hornalla, salamandra) que representaron el 50% de los casos, 30% por incendios, y el 20% restante explicado por tabaco o factor desconocido. Los estudios de laboratorio más solicitados fueron: 95% recuento de glóbulos blancos, 85% glucemia, 70% CPK, y 55% troponina. Los hallazgos relevantes fueron COHb con mediana de 7.15%, CPK con mediana de 89 U/mL, y troponina con mediana de 8.5 pg/mL. La totalidad se realizó electrocardiograma: 15% presentaron arritmia como hallazgo patológico, y ninguno isquemia. En cuanto la presentación clínica: 30% presentó cefalea, 15% síncope, 15% coma, 10% mareos y 10% convulsiones. Sólo 25% tuvieron tomografía y 15% resonancia de cerebro, sin hallazgos críticos. Sin embargo, 15% fueron derivados para trata-miento con cámara hiperbárica. La mayoría ocurrieron en invierno y explicados por accidentes domésticos. Será necesario un fortalecimiento del rol preventivo que apunte al control de la instalación y el buen funcionamiento de artefactos, como mantener los ambientes bien ventilados (AU)

The objective was to describe carbon monoxide poisoning. A cross sectional was designed, which included a consecutive sample of carboxyhemoglobin (COHb) measurements, carried from January to December 2020 at the Emergency Department of tHospital Italiano de Buenos Aires. Secondary databases and manual review of medical records were used to collect variables of interest. During the study period there were 20 confirmed patients, with a mean age of 50 (SD 20), mostly male (55%), 20% smokers, and only one pregnant woman, 70% corresponded to June-July-August. The most frequent source of poisoning was explained to domestic accidents (water heater, stove, brazier, stove, salamander) which represented 50% of cases, 30% due to fires, and the remaining 20% by tobacco or unknown factor. The most laboratory studies were: 95% white blood cell count, 85% glycemia, 70% CPK, and 55% troponin. Meanwhile, relevant findings were carboxyhemoglobin with a median of 7.15%, CPK with a median of 89 U/mL, and troponin with a median of 8.5 pg/mL. All underwent an electrocardiogram: 15% presented arrhythmia as a pathological finding, and none ischemia. Regarding the clinical presentation: 30% presented headache, 15% syncope, 15% coma, 10% dizziness and 10% seizures. Only 25% had brain tomography and 15% MRI, without pathological findings. However, 15% were referred for treatment with a hyperbaric chamber. Most of the cases occurred in winter and explained by domestic accidents. It will be necessary to strengthen the preventive role that aims to control the installation and the proper functioning of devices, such as keeping rooms well ventilated (AU)

Effect of hyperbaric oxygen on symptoms of dementia in patients with delayed encephalopathy after acute carbon monoxide poisoning / 中南大学学报(医学版)

Objective:Delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)is the most severe complication of carbon monoxide poisoning,which seriously endangers patients'quality of life.This study aims to investigate the efficacy of hyperbaric oxygen(HBO2)on improving dementia symptoms in patients with DEACMP. Methods:A retrospective analysis was performed on DEACMP patients,who visited Xiangya Hospital,Central South University from June 2014 to June 2020.Among them,patients who received conventional drug treatment combined with HBO2 treatment were included in an HBO2 group,while those who only received conventional drug treatment were included in a control group.HBO2 was administered once daily.Patients in the HBO2 group received 6 courses of treatment,with each course consisting of 10 sessions.The Hasegawa Dementia Scale(HDS)was used to diagnose dementia,and the Clinical Dementia Rating(CDR)was used to grade the severity of dementia for DEACMP.The Alzheimer's Disease Assessment Scale-Cognitive Section(ADAS-Cog),the Functional Activities Questionnaire(FAQ),the Neuropsychiatric Inventory(NPI),and the Clinician's Interview-Based Impression of Change-Plus Caregiver Input(CIBIC-Plus)were performed to assess cognitive function,ability to perform activities of daily living(ADL),behavioral and psychological symptoms,and overall function.The study further analyzed the results of objective examinations related to patients'dementia symptoms,including magnetic resonance imaging detection of white matter lesions and abnormal electroencephalogram(EEG).The changes of the above indicators before and after treatment,as well as the differences between the 2 groups after treatment were compared. Results:There was no significant difference in the HDS score and CDR grading between the 2 groups before treatment(both P＞0.05).After treatment,the score of ADAS-Cog,FAQ,NPI,and CIBIC Plus grading of the 2 groups were significantly improved,and the improvement of the above indicators in the HBO2 group was greater than that in the control group(all P＜0.05).The effective rate of the HBO2 group in treating DEACMP was significantly higher than that of the control group(89.47% vs 65.87%,P＜0.05).The objective examination results(white matter lesions and abnormal EEG)showed that the recovery of patients in the HBO2 group was better than that in the control group. Conclusion:Hyperbaric oxygen can significantly relieve the symptoms of dementia in patients with DEACMP.

The bactericidal mechanisms of carbon monoxide and the feasibility of carbon monoxide-releasing molecules as anti-infective drugs / 药学学报

The bactericidal mechanism of carbon monoxide (CO) and the feasibility of CO-releasing molecules as anti-infective drugs were summarized by consulting scientific literature, combined with our own research work. Anaerobic bacteria are usually tolerant to high concentration of CO, and some can even grow with CO as sole carbon or energy source, but most pathogenic bacteria are sensitive to CO. In view of the difficulty of gaseous CO in controlling the applying dose and the action site, CO release molecules were synthesized. CO release molecules not only have higher bactericidal activities against common pathogenic bacteria than gaseous CO, but also have the ability to kill antibiotics-resistant bacteria and destroy their biofilms. CO mainly binds with heme-Fe2+ in cells, interrupting the electron transfer of respiration chains, which would result in the generation of reactive oxygen species. CO can also disturb intracellular ion balance, which further triggers free radical reactions. Due to its diverse acting targets, uneasy to induce drug resistance, and synergistic effect with other antibiotics, CO is expected to be the next generation of anti-infection drugs.

Protective effect and mechanism of hyperbaric oxygen on delayed encephalopathy after carbon monoxide poisoning via the mitochondrial pathway in mice / 中华急诊医学杂志

Objective:To explore the protective effect and underlying mechanism of hyperbaric oxygen (HBO) on delayed encephalopathy after carbon monoxide poisoning (DEACMP) in mice.Methods:Totally 225 adult male Kunming mice were selected to establish CO poisoning model via intraperitoneal injection carbon monoxide (CO), and were randomly divided into the air control group, CO poisoning group, and HBO group. Each group was further divided into five time points group, that was 1, 3, 7, 14 and 21 d. The mice in the air control group were injected intraperitoneally with the same amount of air, and the HBO group received HBO treatment at the same time every day. DEACMP mice model was screened by behaviors using the open field test, new object recognition test and nesting test, and the content of myelin basic protein (MBP) were assayed. The mouse brain tissue and mitochondrial were prepared and malonialdehyde (MDA) and adenosine triphosphate (ATP) content were measured with ultraviolet spectrophotometer. MBP content in brain tissue and cytochrome C (CytC) content in the mitochondrial were measured by ELISA. The mitochondria membrane potential (MMP) was measured by flow cytometry.Results:Compared with the air control group, the content of carboxyhemoglobin (COHB) in blood increased significantly and the content of MBP in brain tissue decreased significantly in CO poisoning mice. CO poisoning mice showed motor ability and cognitive dysfunction. Compared with the air control group, the contents of MMP, CytC and ATP were significantly decreased ( P<0.01) in the CO poisoning group; while the MDA content was significantly increased ( P<0.01). Compared with the CO poisoning group, mice behaviors were improved significantly ( P<0.05), the content of MBP, MMP, CytC and ATP were increased ( P<0.05), while the MDA content decreased significantly ( P<0.01) in the HBO group. Conclusions:The abnormal mitochondrial function might be closely related to the occurrence and development of DEACMP, and HBO therapy plays an effective role in preventing and treating the DEACMP mice model via the mitochondrial pathway.

Correlation analysis of apparent diffusion coefficient combined with C-reactive protein on delayed encephalopathy caused by carbon monoxide poisoning / 中华急诊医学杂志

Objective:To investigate the Correlation between ADC combined with serum C-reactive protein (CRP) and delayed encephalopathy after carbon monoxide poisoning (DEACMP), It provides scientific basis for early prediction of DEACMP.Methods:According to the design principle of case-control study, the data of acute carbon monoxide poisoning (ACOP) patients admitted to Shandong Provincial Hospital from December 2017 to December 2021 were retrospectively selected. Among them, patients with DEACMP were selected as the case group, without DEACMP were used as the control group. Univariate and multivariate analyses were performed on the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of ADC combined with CRP as a combined predictor for disease.Results:A total of 89 patients with ACOP were included, including 33 patients with DEACMP and 56 patients without DEACMP. There were no significant differences in gender, age, smoking, drinking, and underlying diseases (hypertension, coronary heart disease) between groups ( P>0.05). Logistic regression analysis showed that white blood cell count (WBC) ( OR=1.64, 95% CI: 1.19-2.26, P=0.003), CRP ( OR=1.22, 95% CI: 1.03-1.45, P=0.019) and ADC value of central semiovale white matter ( OR=0.99, 95% CI: 0.98-1.00, P=0.010) were associated with DEACMP in patients with ACOP. The ROC curve results showed that the area under the ROC of ADC combined with CRP in the center of semiovale was 0.765 (95% CI: 0.656-0.845), the specificity was 87.9%, the sensitivity was 23.2%, and the cut-off value was 3.5°. Conclusions:WBC, CRP and ADC value of central semiovale are independent factors for DEACMP. ADC value of central semiovale combined with CRP has more clinical value in the early diagnosis of DEACMP. For ACOP patients with DEACMP triggering factors, the diagnosis and treatment awareness of early screening of brain magnetic resonance imaging should be strengthened to avoid DEACMP.

Efficacy of mouse nerve growth factor combined with edaravone in the treatment of carbon monoxide poisoning and its influence on oxygen free radical-related indicators / 中国医师进修杂志

Objective:To investigate the therapeutic effect of the combination of mouse nerve growth factor and edaravone in the treatment of carbon monoxide poisoning and its effect on patients′ cognitive function, lactic acid clearance rate, and related indicators of oxygen free radicals.Methods:A selection of 158 patients with carbon monoxide poisoning in the Huxi Hospital Affilliated Jining Medical College from May 2017 to June 2020 were divided into study group (80 cases) and control group (78 cases) according to the treatment plan. Both groups were given conventional treatment. On this basis, the control group was given edaravone, and the study group was given mouse nerve growth factor combined with edaravone, both of which were treated for 2 weeks. The clinical efficacy of the two groups was compared with those before treatment and 1 week and 2 weeks after treatment. Neurological impairment score (NIHSS), disease severity score (APACHE Ⅱ), cognitive function score (MMSE), serum inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)], oxygen free radical related indicators [lipid peroxide (LPO), superoxide dismutase (SOD), gluten Glutathione peroxidase (GSH-PX), malondialdehyde (MDA)] levels, blood lactic acid levels before treatment and lactic acid clearance rates after 12 h, 24 h, 72 h treatment, and statistics of adverse reactions and 30-day mortality.Results:The total effective rate of the study group was higher than that of the control group after 2 weeks of treatment [95.00% (76/80) vs. 78.21% (61/78)] ( P<0.05); NIHSS and APACHEⅡ scores of the study group after 1 week and 2 weeks of treatment Lower than the control group: (6.08 ± 1.15) points vs. (8.94 ± 1.71) points, (4.58 ± 0.74) points vs. (6.32 ± 0.93) points and (6.79 ± 1.03) points vs. (8.02 ± 1.47) points, (5.94 ± 1.47) points vs. (7.25 ± 0.94) points, the MMSE score was higher than that of the control group: (22.09 ± 4.35) points vs. (19.34 ± 5.32) points, (26.05 ± 2.37) points vs. (22.47 ± 4.64) points ( P<0.05) After 1 and 2 weeks of treatment, the serum TNF-α, IL-6, CRP, LPO and MDA levels in the study group were lower than those in the control group: (22.62 ± 4.12) ng/L vs. (29.43 ± 4.68) ng/L and (18.21 ± 2.09) ng/L vs. (24.37 ± 3.16) ng/L, (39.67 ± 4.35) ng/L vs. (52.14 ± 5.48) ng/L and (34.83 ± 3.75) ng/L vs. (41.07 ± 4.09) ng/L, (12.63 ± 1.85) mg/L vs. (17.02 ± 2.47) mg/L and (8.27 ± 1.16) mg/L vs. (11.05 ± 1.62) mg/L, (11.06 ± 1.28) μmol/L vs. (15.97 ± 1.85) μmol/L and (8.24 ± 1.12) μmol/L vs. (12.97 ± 1.40) μmol/L, (7.15 ± 1.16) μmol/L vs. (9.02 ± 1.47) μmol/L and (6.12 ± 0.96) μmol/L vs. (7.84 ± 1.25) μmol/L, the levels of SOD and GSH-PX were higher than those in the control group ( P<0.05); the lactate clearance rate in the study group was higher than that in the control group after 12, 24 and 72 h of treatment: (18.49 ± 3.63)% vs. (14.62 ± 2.95)%, (23.19 ± 4.20)% vs. (17.42 ± 3.57)%, (29.86 ± 6.37)% vs. (25.38 ± 5.21)% ( P<0.05); the incidence of adverse reactions in the study group during treatment Compared with the control group, there was no significant difference ( P>0.05); there was no significant difference in the 30-day mortality between the study group and the control group ( P>0.05). Conclusions:The combination of mouse nerve growth factor and edaravone in the treatment of carbon monoxide poisoning can reduce the severity of disease and neurological deficits, improve cognitive function and lactate clearance rate, reduce inflammation and oxidative stress, improve efficacy, and have good safety.

Effect of transcranial direct current stimulation on neurological injury markers and prognosis in patients with acute and severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To observe the effects of transcranial direct current stimulation (tDCS) on nerve injury markers and prognosis in patients with acute severe carbon monoxide poisoning (ASCOP) . Methods: In May 2021, 103 ASCOP patients were treated in the emergency department of Harrison International Peace Hospital of Hebei Medical University from November 2020 to January 2021. The patients were divided into two groups according to whether they received tDCS treatment. The control group (50 cases) were given oxygen therapy (hyperbaric oxygen and oxygen inhalation) , reducing cranial pressure, improving brain circulation and cell metabolism, removing oxygen free radicals and symptomatic support, and the observation group (53 cases) was treated with 2 weeks of tDCS intensive treatment on the basis of conventional treatment. All patients underwent at least 24 h bispectral index (BIS) monitoring, BIS value was recorded at the hour and the 24 h mean value was calculated. Neuron-specific enolase (NSE) and serum S100B calcium-binding protein (S100B) were detected after admission, 3 d, 7 d and discharge. Follow-up for 60 days, the incidence and time of onset of delayed encephalopathy (DEACMP) with acute carbon monoxide poisoning in the two groups were recorded. Results: The NSE and S100B proteins of ASCOP patients were significantly increased at admission, but there was no significant difference between the two groups (P=0.711, 0.326) . The NSE and S100B proteins were further increased at 3 and 7 days after admission. The increase in the observation group was slower than that in the control group, and the difference was statistically significant (P(3 d)=0.045, 0.032, P(7 d)=0.021, 0.000) ; After 14 days, it gradually decreased, but the observation group decreased rapidly compared with the control group, with a statistically significant difference (P=0.009, 0.025) . The 60 day follow-up results showed that the incidence of DEACMP in the observation group was 18.87% (10/53) , compared with 38.00% (19/50) in the control group (P=0.048) ; The time of DEACMP in the observation group[ (16.79±5.28) d] was later than that in the control group[ (22.30±5.42) d], and the difference was statistically significant (P=0.013) . Conclusion: The early administration of tDCS in ASCOP patients can prevent the production of NSE and S100B proteins, which are markers of nerve damage. and can improve the incidence and time of DEACMP.

Research progress on head imaging features of carbon monoxide poisoning and delayed encephalopathy / 中华劳动卫生职业病杂志

Acute carbon monoxide poisoning and its delayed encephalopathy have obvious damage to the central nervous system. There are different neuroimaging changes in different stages of the disease, and they are relatively specific. This article reviews the clinical research progress on the imaging changes of carbon monoxide poisoning and delayed encephalopathy, including computed tomography (CT) , conventional magnetic resonance imaging (MRI) , diffusion weighted imaging (DWI) , diffusion tensor imaging (DTI) , diffusion kurtosis imaging (DKI) , magnetic resonance spectroscopy (MRS) and other imaging changes reflecting the function and metabolic state of the brain tissue.

Effect of P2Y1 receptor activation on astrocytes in delayed encephalopathy after acute carbon monoxide poisoning / 中风与神经疾病杂志

@#Objective To investigate the role of P2Y1 receptors and astrocytes in delayed encephalopathy after acute CO poisoning (DEACMP) and the possible pathogenesis of DEACMP.Methods Male SD rats with acceptable cognitive function were screened by water maze test and randomly divided into two groups:the control group and the CO poisoning group.The poisoning group was subjected to DEACMP model.The behavioral changes,neuronal changes and the expressions of P2Y1 receptor and astrocytes in hippocampus of the two groups were compared at 7,14,21 and 28 d after modeling,respectively.Results Compared with the control group,the escape latencies of rats in the poisoning group were significantly prolonged on the 21st and 28th days after modeling (P<0.05).HE staining showed that the hippocampal pyramidal cells and neurons in the model group exhibited obvious necrosis on days 14,21,and 28 after modeling.The water maze indicated that DEACMP occurred on day 21.Compared with the control group,Western blot analysis showed that the expression levels of P2Y1 and GFAP proteins in the hippocampus of the poisoning group were increased at each time point (P<0.05),which increased first and then decreased.Immunofluorescence showed co-expression of P2Y1 and GFAP in hippocampus.Compared with the control group,the expressions of P2Y1 and GFAP in hippocampal CA1 region were up-regulated at each time point after poisoning (P<0.05). Conclusion The activation of astrocytes by P2Y1 receptor may be one of the pathogenesis of DEACMP,and astrocytes may impair learning and memory ability of co-poisoned rats by mediating immune inflammation,leading to DEACMP.

Engineering cannabidiol synergistic carbon monoxide nanocomplexes to enhance cancer therapy via excessive autophagy

Although carbon monoxide (CO)-based treatments have demonstrated the high cancer efficacy by promoting mitochondrial damage and core-region penetrating ability, the efficiency was often compromised by protective autophagy (mitophagy). Herein, cannabidiol (CBD) is integrated into biomimetic carbon monoxide nanocomplexes (HMPOC@M) to address this issue by inducing excessive autophagy. The biomimetic membrane not only prevents premature drugs leakage, but also prolongs blood circulation for tumor enrichment. After entering the acidic tumor microenvironment, carbon monoxide (CO) donors are stimulated by hydrogen oxide (H2O2) to disintegrate into CO and Mn2+. The comprehensive effect of CO/Mn2+ and CBD can induce ROS-mediated cell apoptosis. In addition, HMPOC@M-mediated excessive autophagy can promote cancer cell death by increasing autophagic flux via class III PI3K/BECN1 complex activation and blocking autolysosome degradation via LAMP1 downregulation. Furthermore, in vivo experiments showed that HMPOC@M+ laser strongly inhibited tumor growth and attenuated liver and lung metastases by downregulating VEGF and MMP9 proteins. This strategy may highlight the pro-death role of excessive autophagy in TNBC treatment, providing a novel yet versatile avenue to enhance the efficacy of CO treatments. Importantly, this work also indicated the applicability of CBD for triple-negative breast cancer (TNBC) therapy through excessive autophagy.