The role of serum cholinesterase activity and S100B protein in the evaluation of organophosphate poisoning.

The aim of this study was to investigate the role of serum cholinesterase (SChE) activity and S100B protein in the evaluation of patients with acute organophosphate (OP) poisoning. Patients with acute OP poisoning admitted to the emergency department were included in this cross-sectional study. Twenty healthy volunteers served as controls. The SChE activity and serum S100B were determined on admission. Patients were divided into two groups (low severity and high severity). Thirty-six patients diagnosed with acute OP poisoning were enrolled. Serum S100B concentrations were higher in patients than in the control group (p < 0.05). In the high-severity group, the SChE levels were lower and the S100Bs levels were higher than in the low-severity group. The SChE level was not different between survivors and nonsurvivors. S100B levels were higher in nonsurvivors than in survivors. According to receiver-operating characteristic curve analysis, the optimal cutoff value of serum S100B level to predict mortality was 236.5 pg/mL, with 71.4% sensitivity and 89.7% specificity. Our data suggest that initial SChE level is related to the clinical severity but not with mortality. S100B may be a useful marker in the assessment of clinical severity and prediction of mortality in acute OP poisoning.

Toxicity of non-steroidal anti-inflammatory drugs: a review of melatonin and diclofenac sodium association.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the purpose of anti-inflammation, antipyretic, and analgesia. For this aim, they are used for the alleviation of pain, fever, and inflammation associated with rheumatoid arthritis, sports injuries, and temporary pain. However, treatment with NSAIDs may be accompanied by adverse effects such as gastrointestinal damage and platelet dysfunction. As with the other NSAIDs, diclofenac sodium (sodium-(o-((2,6-dichlorophenyl)-amino)-phenyl)-acetate) (DS), an NSAID, has potent anti-inflammatory, analgesic, and antipyretic effects. However, treatment with DS may cause some adverse cerebral and cerebellar effects such as convulsions, disorientation, hallucination, and loss of consciousness. Melatonin (MLT) is a free-radical scavenger and possesses antioxidant properties. It has been reported to easily cross the blood-brain barrier, and is found in high concentrations in the brain after exogenous administration. It is also a neuroprotector in a wide range of conditions affecting the central nervous system CNS due to its free-radical scavenging activities and lipophilic-hydrophilic properties. Neuroprotective actions of MLT have been discovered in both in vitro and in vivo, and are a powerful scavenger of oxygen and nitrogen free radicals. Thus, MLT can protect the cell membrane, organelles, and core against free-radical damage. Therefore, it has been postulated that exogenous MLT acts as a neuroprotector contrary to DS neurotoxicity. In this review, we aimed to discuss the possible neuroprotective effects of MLT on DS toxicity.

Antipyretic effect of ketoprofen.

OBJECTIVE: The aim of this study was to investigate the efficacy and side effect profile of ketoprofen as well as compliance with respect to the taste of the drug and compare these parameters with those of acetaminophen and ibuprofen. METHODS: A total of 301 patients between 1-14 years of age who applied to emergency rooms of three medical centers with the complaint of fever that required antipyretic therapy were included in the study. Fever was measured with the aid of a tympanic thermometer (Braun Kronberg 6014) and followed for 4-6 hours. The measurement was repeated at 30, 60, 120 minutes, and again 4-6 hours after the initial assessment. RESULTS: The mean age of the patients was 47.8+/-41.1 months. The patients randomly received 15 mg/kg/dose of acetaminophen (n=112 group 1), 0.5 mg/kg/dose of ketoprofen (n=105, group 2), or 10 mg/kg/dose of ibuprofen (n=84, group 3). Fever was 38.4+/-0.7 degrees C, 38.4+/-0.7 degrees C, and 38.5+/-0.5 degrees C at 30 minutes; 38.0+/-0.7 degrees C, 37.9+/-0.7 degrees C, and 38.0+/-0.6 degrees C at 60 minutes (p>0.05), 37.7+/-0.6 degrees C, 37.6+/-0.7 degrees C, and 37.7+/-0.5 degrees C at 120 minutes (p>0.05); 37.5+/-0.7 degrees C, 37.3+/-0.6 degrees C, and 37.4+/-0.6 degrees C at 4-6 hours after admission (p>0.05). The fever was significantly lower at 30, 60, and 120 minutes in all group s (p<0.05). Early vomiting after medication (<6 hours) was observed in 3.8%, 13.5%, and 9.6% whereas late vomiting (6-48 hours) occurred in 1.3%, 2.7%, and 5.8% respectively (p>0.05). Bad taste was expressed by 5.1%, 12.2%, and 5.8% early (<6 hours), and 3.9%, 8.1%, and 3.8% late (6-48 hours) (p>0.05). There were no differences between age groups for antipyretic effect, taste and adverse effect in three drugs (p>0.05). CONCLUSION: All three drugs were similar in terms of efficacy, adverse effects, and compliance within 48 hours of therapy. These results suggest that ketoprofen may be used for antipyresis as an alternative to acetaminophen and ibuprofen.

Is there a relationship between the blood cholinesterase and QTc interval in the patients with acute organophosphate poisoning?

Organophosphates cause poisoning as a result of the excessive accumulation of acetylcholine at the cholinergic synapses due to inhibition of acetylcholinesterase (ChE). In the literature, it has been reported that there have been electrocardiographic abnormalities, including QT-interval prolongation in most patients with acute organophosphate poisoning (OPP), and a relation between blood ChE level and clinical severity in acute OPP. The aim of this study is to assess the relationship between blood ChE level and QTc interval in the patients with acute OPP. This retrospective study consists of 20 patients admitted to the emergency intensive care unit. A total of 93 QTc interval and blood ChE measures obtained on the same day from 20 cases were compared for their correlation. There were prolonged QTc intervals in 35.4% of the ECGs. There was a negative correlation between QTc interval and blood ChE measures. In following up the patients with acute OPP, QTc interval may be useful when blood ChE levels are low and may provide complementary information concerning the severity of poisoning. However, further prospective studies, supporting the present results, are needed.

Characteristics of endosulfan poisoning: a study of 23 cases.

INTRODUCTION: Organochloride insecticides are chlorinated cyclic hydrocarbons having molecular weights in the range of 300-550 Da. Case series of endosulfan poisoning are extremely rare in the literature. We report 23 cases of endosulfan poisoning. METHODS: This retrospective study enrolled patients with endosulfan poisoning presenting to our emergency department from January to December 2005. The data were collected from clinical records and laboratory files. RESULTS: On admission, initial symptoms were nausea and vomiting in 17 patients (73.9 percent), seizures in five patients (21.7 percent), and dizziness in one patient (4.3 percent). Symptoms began within one hour after ingestion in 12 patients (52.2 percent), in the second hour in nine patients (39.1 percent), and in the third hour in two patients (8.7 percent). Seizure types were generalised tonic-clonic in 16 patients (84.2 percent), and focal seizures in three patients (15.8 percent). 19 patients were observed for one day, two patients were observed for two days, and one patient was followed-up for ten days in the emergency department. One patient was transferred for liver transplantation on the fifth day to another centre. All patients were treated symptomatically by intravenous diazepam for controlling seizures. CONCLUSION: Endosulfan poisoning can be suspected in the presence of primary central nervous system manifestations including seizures, with or without clinical or laboratory evidence of other organ dysfunction such as liver failure.

Fibrous dysplasia of the frontal sinus: an uncommon cause of frontal lobe abscess.

Fibrous dysplasia of the cranial air sinuses is rarely reported in the literature. This is the first report of frontal lobe abscess (FLA) associated with fibrous dysplasia of the frontal sinus (FDFS). A 29-year-old female presented with seizures and acute confusion. Cranial computed tomography (CT) revealed fibrous dysplasia of the left frontal sinus and associated FLA. She was referred to the neurosurgical service and the abscess and dysplastic tissue were removed. Histological examination confirmed fibrous dysplasia. We review the radiological appearance of FDFS with FLA. Clinicians should be aware of the association between these two conditions.

Neurological soft signs in obsessive-compulsive disorder.

BACKGROUND: Neurological soft signs (NSSs) are defined as abnormal motor or sensory findings, including involuntary movements, a variety of dispraxia, difficulties in performing rapid alternating movements, difficulties in two-point discrimination, and graphesthesia in a person without a neurological disorder which can be determined as its focus. AIMS: to investigate the relationship of NSSs with obsessive-compulsive disorder (OCD). SETTINGS AND DESIGN: This study was designed in the Psychiatry Polyclinic of Ondokuz Mayis University Hospital. After signing an informed consent form, all the subjects were divided into 2 groups: (1) the patient group and (2) the control group. MATERIAL AND METHODS: Thirty consecutive patients presenting with DSM-IV OCD were included in this study. The control group consisted of 30 healthy subjects without a psychiatric/neurological disorder. All subjects underwent a physical and neurological examination for soft signs (PANESS). STATISTICAL ANALYSIS USED: The Mann-Whitney U test was used for statistical analysis of data. RESULTS: It was seen that graphesthesia, two-point discrimination, and total PANESS scores were significantly higher in the group with OCD than the control group. In other NSSs, there was no significant difference between the patient and control groups. CONCLUSIONS: Unlike some studies, in the present study, the difference between the groups in graphesthesia compared to other NSSs was significant. The results of this preliminary study suggest that there is a relationship between NSSs and OCD. We think that NSSs may point to a structural brain abnormality in patients with OCD.

The clinical and electrophysiological features of a delayed polyneuropathy developing subsequently after acute organophosphate poisoning and it's correlation with the serum acetylcholinesterase.

INTRODUCTION: Organophosphorus-induced delayed polyneuropathy (OPIDP) characterised with cramping pain, paresthesias in the lower extremities and occasionally in the hands, followed by weakness of the distal limb muscles, especially in the legs, and partial denervation of affected muscles often develops within first 3 weeks following acute poisoning. OBJECTIVES: To determine the incidence of development of subsequent polyneuropathy among patients with acute organophosphate poisoning (OPP), to assess whether there was a difference between patient groups with severe poisoning and mild poisoning for the development of polyneuropathy, to determine whether there was a correlation between the serum AChE levels and the development of OPIDP, and to define the clinical and electrophysiological features of OPIDP. METHODS: Forty-one patients with acute OPP admitted to the Emergency department were included in this retrospective study. On days 1, 2, 3, and 7, each patient was assessed clinically, with the measurement of serum AChE, and results were recorded on special forms. RESULTS: OPIDP was diagnosed clinically in 14 patients (34.15%) during the 14th to 22nd days after poisoning. Twelve (85.7%) of 14 patients had a severe clinical status on day 1 after poisoning. The frequency of development of OPIDP was higher in the patients with severe poisoning than the patients with mild poisoning (p = 0.041). There was no significant correlation between the serum AChE levels and the development of OPIDP. CONCLUSION: We conclude that the serum AChE levels measured on the first day and consecutive several days can not be the predictive of the development of subsequent OPIDP.

Electrocardiographic changes during migraine attacks.

OBJECTIVES: To clarify whether electrocardiographic (ECG) changes can be identified during a migraine attack and to determine whether there are ECG differences between periods with and without headache. BACKGROUND: The clinical signs and symptoms of migraine point to involvement of the autonomic nervous system, and especially to disrupted regulation of the circulatory system and autonomic balance. This disruption may be more marked during a migraine attack. During a migraine attack, autonomic imbalance within the heart and its vessels conceivably may result in ECG abnormalities. METHODS: In 30 patients with migraine, the ECG variables of heart rate, abnormalities of rhythm, PR interval, QRS duration, corrected QT interval, T inversion, and ST-segment changes were recorded during migraine attacks and pain-free periods. RESULTS: Of the 30 patients studied during a migraine attack, 9 (30%) had one or more abnormalities of rhythm (including sinus arrhythmia, atrial premature contraction, and ventricular premature contraction), 20% had PR intervals greater than 0.20 seconds, 40% had corrected QT intervals greater than 0.44 seconds, 66% had T inversion, and 40% had ST-segment abnormalities. No patient had arrhythmia, PR intervals greater than 0.20 seconds, or corrected QT intervals greater than 0.44 seconds during a pain-free period. No differences were noted for ST-segment changes, T inversion, and total ECG changes between periods with and without headache, but both PR and corrected QT intervals were significantly longer during migraine attacks than during pain-free periods. CONCLUSIONS: We conclude that ECG abnormalities often are present during a migraine attack, and for most of these, particularly PR and corrected QT interval lengthening, these abnormalities will be absent or less prominent during pain-free intervals.

Clinical warning criteria in evaluation by computed tomography the secondary neurological headaches in adults.

Our aims were to investigate the frequency of intracranial lesions detected by cranial computed tomography (CT-scan) amongst adult patients who had clinical warning criteria (CWC) for secondary neurological headaches and to determine the importance of CWC in predicting a possible lesion on CT-scan. Seventy consecutive patients with headache exhibiting CWC were included in this prospective study. The CWC included: (i) increase in the intensity and frequency of headache; (ii) abrupt onset of headache; (iii) persistence of headache despite analgesics; (iv) alteration of the characteristics of headache; and (v) presence of focal neurological symptoms or findings. The mean age of the patients was 46.5 years; the female-to-male ratio was 1.5. Of the patients, 35.7% had a neurological cause identified by CT-scan, and 64.3% had normal CT-scan. In the patients without lesion, of headaches, 64.4% were primary, and 35.6% were from undefined headache group. Although, of the above criteria, only the 5th was different markedly in the patients with lesion than the patients without lesion, in evaluation by CT-scan the secondary neurological headaches in adults, all CWC should look for absolutely in their history and physical examination.

Basic toxicological approach has been effective in two poisoned patients with amitraz ingestion: case reports.

Amitraz, a formamidine insecticide and acaricide used in veterinary practice, presents side effects in humans related to its pharmacological activity on alpha 2-adrenergic receptors. There is little information available in the literature about the toxicology of the product in man and the treatment of this poisoning. In this report, the clinical and laboratory features of amitraz poisoning in two patients by a veterinary formulation also containing xylene are presented. The major clinical findings were unconsciousness, drowsiness, respiratory failure requiring mechanical ventilation, miosis, hypothermia and bradycardia. The laboratory findings were hyperglycemia, hypertransaminasemia and increased urinary output. Supportive management of this poisoning in humans is suggested in only a few articles and there is no specific antidote for the subsequent possible pharmacological effects of amitraz. In our two cases, we performed supportive treatment such as mechanical ventilation, atropine, gastric lavage, active carbon, oxygen and fluid administration. We concluded that the basic approach to the patient with amitraz poisoning, including initial stabilization to correct immediate life-threatening problems, treatment to reduce absorption and measures to improve elimination of the toxin, is effective.

Carpenter syndrome: report of two siblings.

Carpenter syndrome consists of acrocephaly, soft tissue syndactyly, short fingers, preaxial polydactyly, congenital heart disease, hypogenitalism, cryptorchidism, obesity, umbilical hernia and mental retardation. Here we report two affected sibs (IQs were 80 and 93) presenting various cerebrospinal malformations, i.e. frontal lobe deformity, narrowed foramen magnum, hypoplastic posterior fossa, kinked spinal cord, and syrinx cavitation demonstrated by magnetic resonance imaging.