A Study on Incidence, Clinical Profile and Outcome of Cardiac Dysrhythmias in Yellow Oleander Poisoning

Background: Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is a common toxicological emergencyin South India.Objectives: The objectives of this study were to identify the various cardiac arrhythmias and electrolyte abnormalities in yellowoleander poisoning. This study was also designed to identify the clinical and biochemical parameters at presentation whichcan predict serious arrhythmias.Materials and Methods: This was a observational study among 111 patients who attended our emergency department afterconsuming yellow oleander seeds. Clinical, biochemical, electrocardiographic, and treatment details were collected from thepatients and recorded. Patients were monitored with serial electrocardiograms (ECGs).Results: Oleander seed poison was most prevalent in the 20–40 years of age. Incidence was more among the young females.ECG abnormalities were found in majority of the individuals. More the crushed seeds consumed and delay to admission to thehospital, poorer was the outcome. All symptomatic patients had conduction defects affecting the sinus node, atrioventricularnode, or both. Patients showing cardiac arrhythmias that required specific management had significantly higher serumpotassium concentrations. At presentation, 21 patients had serious arrhythmias, and on follow-up, 4 developed new-onsetserious arrhythmia. Sinus bradycardia (41.8%) was the most common arrhythmia followed by segment-wave changes (33%).Mortality rate was 1.9%.Conclusions: The arrhythmias produced by this poisoning might range from sinus bradycardia to complete heart block andventricular tachycardia. Although serum potassium correlated significantly with serious dysrhythmias, it did not predict thedevelopment of new-onset serious arrhythmia. On the whole, serious dysrhythmias were significantly associated with ingestionof crushed seeds, delay in admission, hyperkalemia.

Correlation study on chemical constitutes of cardiac glycosides in Taxillus chinensis and its Nerium indicum host by UPLC-Q-TOF-MS/MS / 中国中药杂志

To build up an identification method on cardiac glycosides in Taxillus chinensis and its Nerium indicum host, and evaluate the influence on medicine quality from host to T. chinensis, ultra-performance liquid chromatography coupled with quadrupole-time-of-flight tandem mass-mass spectrometry(UPLC-Q-TOF-MS/MS)was applied. The samples of T. chinensis(harvested from N. indicum)and its N. indicum host were collected in field. The samples of T. chinensis(harvested from Morus alba)and its M. alba host was taken as control substance. All samples were extracted by ultrasonic extraction in 70% ethanol. Chromatographic separation was performed on an ACQUITY UPLC HSS T3 C_(18)(2.1 mm×100 mm,1.8 μm)column at 40 ℃. Gradient elution was applied, and the mobile phase was consisted of 0.1% formic acid water and acetonitrile. The 0.5 μL of sample solution was injected and the flow rate of the mobile phase was kept at 0.6 mL·min~(-1) in each run. It was done to identify cardiac glycosides and explore the chemical composition correlation in T. chinensis and its N. indicum host by analyzing positive and negative ion mode mass spectrometry data, elemental composition, cardiac glycoside reference substance and searching related literatures. A total of 29 cardiac glycosides were identified, 28 of it belonged to N. indicum host, 5 belonged to T. chinensis(harvested from N. indicum host), none of cardiac glycoside was identified in T. chinensis(harvested from M. alba host). The result could provide a reference in evaluating the influence in T. chinensis medicine quality from host. It was rapid, accurate, and comprehensive to identify cardiac glycosides in T. chinensis and its N. indicum host by UPLC-Q-TOF-MS/MS.

Chemical Constitutes of Cardiac Glycosides in Scurrula parasitica and Its Nerium indicum by UPLC-Q-TOF-MS/MS / 中国实验方剂学杂志

Objective: To establish a method for identifying cardiac glycosides in Scurrula parasitica and its Nerium indicum host by UPLC-Q-TOF-MS/MS. With safflower parasitoids with sweet-scented osmanthus trees as the host and their host osmanthus tree samples used for control, the chemical constituents of the cardiac glycosides were identified by comparison between the cardiac glycoside reference substances and literatures, so as to analyze the correlation between the safflower parasitoid and its host oleander glycoside components,and evaluate the host' s impact on the quality of Taxilli Herba. Method: Samples of S. parasitica (parasitic on N. indicum and Osmanthus fragrans),N. indicum and O. fragrans were collected. Samples of S. parasitica and its O. fragrans host were taken for control. All of the samples were extracted through ultrasonic extraction with 70%ethanol. ACQUITY UPLC HSS T3 C18(2.1 mm×100 mm,1.8 μm) column was adopted with mobile phase A comprising 0.1%formic acid water and mobile phase B comprising acetonitrile for gradient elution. The sample size was 0.5 μL. The flow rate was 0.6 mL·min-1. The column temperature was maintained at 40℃. MassLynx V4.1 software was used to analyze the data. Identification and correlation of chemical constitute of cardiac glycosides in S. parasitica and its N. indicum host were performed through analysis on cardiac glycosides reference substances,relevant literatures,elemental composition of compounds and positive and negative ion mode mass spectrometry data. Result: A total of 26 compounds of cardiac glycoside were identified,including 25 compounds of cardiac glycoside from N. indicum host,and 5 compounds of cardiac glycoside from S. parasitic(parasitic on N. indicum). none of cardiac glycosides were found in S. parasitica (parasitic on O. fragrans ) and its O. fragrans host. Conclusion: It was rapid,accurate and comprehensive to identify cardiac glycosides in S. parasitica (parasitic on N. indicum) and its N. indicum host by UPLC-Q-TOF-MS/MS. S. parasitica itself does not contain cardiac glycosides,its host may impact the quality of S. parasitica by delivering cardiac glycosides, a kind of its characteristic compound.

Study on analysis of socio-demographic aspects, clinical profile, ECG changes, electrolyte status and outcome with acute yellow oleander seed poison patients in GDMCH, Dharmapuri

Background: Patients with diabetes mellitus (DM) are at an increased risk of dying from cardiovascular diseases, the reason for which is not completely understood. Aim: To study the clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy (CAN). Materials and methods: This was a cross sectional study involving 100 patients attending the diabetic clinic of a tertiary care hospital. Demographic data was collected and autonomic function testing was done with Ewing and Clark’s tests. Results: The prevalence of CAN was 58 %. CAN had statistically significant association with increasing duration of diabetes (p < 0.00001), increasing values of HbA1c (p < 0.00001), and with combined use of insulin and oral medications (p < 0.05). Conclusion: There is a high prevalence of CAN in the diabetic population providing a large pool of patients awaiting effective interventions.

Chemical constituents in fruits of mangrove plant Cerbera manghas L / 中国药学杂志

OBJECTIVE: To investigate the chemical constituents in the fruits of Cerbera manghas Linn. METHODS: Silica gel column, HPTLC, and Sephadex LH-20 chromatography were applied to isolate the chemical constituents. The structures of the isolated compounds were elucidated by spectroscopic techniques and physicochemical properties. RESULTS: Fifteen compounds were isolated and identified including eleven phenolic acids, i.e., benzoic acid(1), vanillic acid(2), vanillin(3), p-hydroxybenzaldehyde(4), isophthalaldehydic acid(5), β-hydroxygpropiovanillone(6), ficusol(7), evofolin B(8), 3, 4'-dihydroxypropiophenone(9), p-hydroxybenzoic acid(10), protocatechuic acid(11), one monoterpene, i.e., cerbinal(12), two cardiac glycosides, i.e., 17-β-neriifolin(13) and cerberin(14), and one triterpenoid, i.e., ursolic acid(15). CONCLUSION: All the compounds except compound 13 and 14 are obtained from the fruits for the first time. Compound 5 is a new natural product, and compounds 1, 3, 6-9, and 15 are obtained from genus Cerbera for the first time.

A new compound from roots and rhizomes of Helleborus thibetanus / 中草药

Objective: To study the chemical constituents in the ethanol extract from the roots and rhizomes of Helleborus thibetanus. Methods: The compounds were isolated and purified by silica gel column chromatography and recrystallization. The structures of the compounds were identified on the basis of chemical and spectral methods. Results: A new compound was isolated from the ethanol extract in the roots and rhizomes of H. thibetanus and identified as 14β-hydroxy-3β - [(β-D-glucopyranosyl)oxy]-5α-bufa-20, 22-dienolide (1). Conclusion: Compound 1 is a new compound named as hellebocoside A, which belongs to bufadienolide of cardiac glycosides.

Digoxin toxicity: crucial to diagnose.

Digoxin is mainly used for heart failure and arrhythmias like atrial flutter and fibrillation. Digoxin is like double edged sword because of its potency to cause life threatening complications like various arrhythmias. Furthermore, it is difficult and important to recognize cardio toxicity caused by digoxin to prevent threat to life. We report a case which was initially diagnosed as arrhythmia and later turned as digoxin toxicity.

Curiosity almost killed the cat: A case of accidental yellow oleander poisoning in school children.

Seven schoolchildren (9–12 years) accidentally ingested the seeds of yellow oleander (Cerbera thevetia or Thevetia neriifolia) while playing outdoors. Yellow oleander is an evergreen ornamental shrub that grows wild in most parts of India. The whole plant, including its sap, is toxic, containing several cardiac glycosides. All parts of the plant are dangerous, especially the seeds. After repeated vomiting by one child, all seven children were taken to hospital by their schoolteacher. On admission most of the victims appeared normal, though a few were drowsy or irritable. A few hours later, some of them developed hypotension, for which they were successfully treated and discharged after 18 hours. All children were followed up periodically over the next week, but did not display evidence of any sequelae or complications.