[MR imaging late changes of brain after carbon monoxide poisoning--case report]. / Odlegle zmiany w obrazie MR mózgowia po zatruciu tlenkiem wegla--opis przypadku.

We present the case of 28 years old patient hospitalized at the Regional Center of Clinical Toxicology in Lublin after carbon monoxide poisoning. The level of carboxyhemoglobin was 33.3%. Because of neurological symptoms MR of brain was performed with normal result. During hospitalization the progression of clinical symptoms was observed and the patient underwent control MR of brain. The result was abnormal and show changes bilaterally in white matter.

[MR imaging in patients with carbon monoxide poisoning]. / Obrazowanie MR u pacjentów po zatruciu tlenkiem wegla.

UNLABELLED: The aim of the study was to describe MR imaging findings in patients after acute carbon monoxide poisoning. MATERIAL AND METHOD: In the period of 7 months (from October 2011 to April in 2012), 72 patients were hospitalized at the Center of Clinical Toxicology after acute carbon monoxide poisoning. In all patients the level of carboxyhemoglobin (COHb) was determined. Brain MR examination was performed in 14 patients of this group due to persistent neurological symptoms. RESULTS: In 72 patients the mean value of COHb was 21.52%. In 14 patients with persistent neurological symptoms mean value of COHb was 26.14%. In 14 patients who underwent MRI of the brain, in 4 there was no MR change and their COHb average value was 20.45%. In the remaining 10 patients MR brain abnormalities were diagnosed, including changes of basal ganglia, white matter or cortex, and their COHb average value was 26.56%. CONCLUSIONS: In patients with persistent neurological symptoms after acute carbon monoxide poisoning are changes in brain MRI. These changes correlate with the concentration of COHb. MRI seems to be the method of choice for imaging the brain in patients after acute carbon monoxide poisoning.

[Genetically modified food--unnecessary controversy?]. / Zywnosc genetycznie modyfikowana--niepotrzebne kontrowersje?

Fast development of genetic engineering and biotechnology allows use of genetically modified organisms (GMO) more and more in different branches of science and economy. Every year we can see an increase of food amount produced with the use of modification of genetic material. In our supermarkets we can find brand new types of plants, products including genetically modified ingredients or meat from animals fed with food containing GMO. This article presents general information about genetically modified organisms, it also explains the range of genetic manipulation, use of newly developed products and current field area for GMO in the world. Based on scientific data the article presents benefits from development of biotechnology in reference to modified food. It also presents the voice of skeptics who are extremely concerned about the impact of those organisms on human health and natural environment. Problems that appear or can appear as a result of an increase of GMO are very important not only from a toxicologist's or a doctor's point of view but first of all from the point of view of ordinary consumers--all of us.

[Myocardial injury in the course of carbon monoxide poisoning]. / Uszkodzenie miesnia sercowego w przebiegu zatrucia tlenkiem wegla.

Carbon monoxide still remains one of the most common causes of fatal poisonings. Mechanisms of carbon monoxide toxic effects are complex and lead to hypoxia of body tissues. The most sensitive to tissue hypoxia are: the central nervous system and the cardiovascular system.The most characteristic cardiac symptoms of carbon monoxide poisoning are: stenocardial symptoms, hypotonia, myocardial dysfunction and arrhythmia (atrial fibrillation, tachycardia, bradycardia). Carbon monoxide connects with high affinity to metallo-proteins mainly to hemoglobin impairing oxygen transport in the body and to myoglobin, interfering with its function as oxygen reservoir among others in myocardium. Connecting to cytochrome oxidase in mitochondria it blocks the chain of electron transport which results in impairment of cellural respiration and formation of free radicals. Carbon monoxide has also relaxation effect against the smooth muscles of blood vessels, and thrombogenic effect. It is particularly adverse in patients with ischemic heart disease. In case of carbon monoxide poisoning one should always search for features of myocardial injury- as far as screening is concerned the most important ones are ECG and screening for cardiac troponin. Depending on the course of poisoning other laboratory (e.g. BNP) or imaging (echo-cardiography. scintiscanning, coronarography) tests may also prove to be useful.

[Silibinin and its hepatoprotective action from the perspective of a toxicologist]. / Sylibinina i jej dzialanie hepatoprotekcyjne z punktu widzenia toksykologa.

Silibinin is the most active component of a complex of flavonoids -silymarin contained in fruit milk thistle (Sylibum marianum). Its mechanism of action is complex and highly beneficial in protecting hepatocytes. On the one hand this compound blocks the penetration of various toxins (for example amanitin) into the hepatocytes not allowing in this way for the cell death and on the other hand, it prevents apoptosis through intracellular. It protects the liver from oxidative intracellular free radicals by increasing the activity of enzyme superoxide dismutase and peroxidase, as well as by increasing the concentration of glutathione and the activity of the peroxidase. Silibinin strengthens and stabilizes the cell membranes, inhibits the synthesis of prostaglandins associated with the lipid peroxidation and promotes regeneration of liver through the stimulation of protein synthesis and effect on the production of new hepatocytes. A particularly interesting topic from the perspective of a toxicologist is the application of silibinin in Amanita phalloides poisoning. Clinical trials conducted in this respect are very encouraging. The other beneficial application of silibinin is in therapy of the alcoholic liver cirrhosis. The evidence shows that the use of silymarin leads to a significant reduction in liver-related mortality and even reduction in the number of patients with encephalopathy in the course of the disease. Application of silibinin goes beyond liver disease and expands in the direction of cancer and even diabetes. What is interesting is the fact, that the substance of herbal origin occurring in the environment is so strong, favorable, beneficial and multidirectional. Science has contributed to improving the bioavailability of silibinin thus making it more effective.

[Sodium azide poisoning--a rare reason of hospitalization in toxicological units--case report]. / Zatrucie azydkiem sodu--rzadka przyczyna hospitalizacji w osrodkach toksykologicznych--opis przypadku.

Sodium azide poisonings are a rare reason for hospitalization in toxicological units. They are observed as rarely as once within a number of years per hospital. Consequently, an algorithm for the optimum procedure of treating such intoxications does not exist and, as a result, there is a need to describe every single clinical case. A female, aged 55, was directed to the toxicological unit from a county hospital after swallowing four tablets of sodium azide, 150 mg each, in the form of preservative for fresh milk samples. Two hours after the incident a gastric lavage was performed and the tableting blend was retrieved. In the clinical examination higher concentration of lactic acid, ALAT and TSH were observed. In the ECG record unspecific aberrations in the ST segment were noticed. Due to the patient's general good condition and the fact that the tableting blend had been retrieved from the gastric rinse, further use of the antidote indicated in the therapy of cyanide intoxications was abandoned. Symptomatic treatment was used along with the patient's eight-day observation. In the described case the early decontamination prevented the development of acute poisoning.

[Three-fold ethylene glycol poisoning over 3 years--a case report]. / Trzykrotne zatrucie glikolem etylenowym na przestrzeni 3 lat--opis przypadku.

This paper describes a case of now 49-year-old patient with alcohol dependence syndrome, hospitalized three times in the Center of Clinical Toxicology in 2009-2012 due to ethylene glycol poisoning. Twice, the course of poisoning was defined as severe. It was complicated by respiratory failure, severe metabolic acidosis, renal failure, disorders of the central nervous system; once referred to it as a medium, complicated by renal failure. He was treated with ethyl alcohol as an inhibitor of alcohol dehydrogenase, hemodialysess and intensive symptomatic and supportive therapy. This paper shows the great effectiveness of early hemodialysis and intensive therapy even in case of multiple and severe intoxication with toxic alcohols.

[Myocardial infarction in the course of ethylene glycol poisoning--a case report]. / Zawal serca w przebiegu zatrucia glikolem etylenowym--opis przypadku.

The following paper describes the case of the 59-year-old patient moved from Clinical Cardiology to the Centre of Clinical Toxicology because of severe ethylene glycol poisoning, which occurred in the course of myocardial infarction of inferior wall. Ethylene glycol concentration was 85 mg/dl, the blood pH - 6.9, troponin >50 ng/ml, CK-MB 297.1 U/L. ECG current of injury was found at the bottom of the wall cuts reflective reductions in section ST in leads I, aVL and the precordial leads. In the coronarography was RCA occlusion, OM critical stenosis and suspected mouth of LAD stenosis. RCA urgent angioplasty was performed with implantation of bare metal stents 5. In addition, toxicological treatment consisted of mechanical ventilation, hemodialysis, ethanol, and intensive medical care. On 19 day of hospitalization the patient in good general condition was discharged home.

[Tako-tsubo cardiomyopathy in the course of carbon monoxide poisoning]. / Kardiomiopatia tako-tsubo w przebiegu zatrucia tlenkiem wegla.

Tako-tsubo cardiomyopathy is a clinical syndrome induced by a strong mental or physical stress, characterized by a transient hypokinesia, akinesia or dyskinesia middle segments of the left ventricle and apical, with associated electrocardiographic changes of ST-T segment like in acute coronary syndrome, with no significant changes in coronary arteries in coronary angiography. Tako-tsubo cardiomyopathy is mainly found in women in the sixth and seventh decade of life and represents 1-2% of cases originally diagnosed as acute coronary syndrome. We present a case of tako-tsubo syndrome in the course of carbon monoxide poisoning in a 56-year-old patient, with a positive history of ischemic heart disease and hypertension. Moreover, the reasons for its occurrence were considered based on clinical course, laboratory tests and imaging, and available literature.

[Severe digoxin poisoning a case study]. / Ciezkie zatrucie digoksyna--opis przypadku.

Digitalis glycosides are among the oldest drugs used in cardiology. Nowadays, due to the limited indications for their use (advanced heart failure, usually concomitant with atrial fibrillation), cases of poisoning induced by this class of drugs are rarely observed. Digoxin produces a positive inotropic and bathmotropic effect on the heart, but has a negative chronotropic and dromotropic effect. Cardiac glycosides have a narrow therapeutic window, so digitalis treatment can easily lead to symptoms of overdose. In patients taking digoxin, the drug therapeutic level should be maintained at 1-2 ng/ml; the toxic effects occur at concentrations > 2.8 ng/ml and are mainly related to disturbances of cardiac function and of the circulatory system, as well as gastrointestinal symptoms and CNS disturbances. We present, a 45-years-old patient who was hospitalized following the ingestion with suicidal intent of 100 0.25 mg tablets of digoxin. In spite of rapidly applied gastric irrigation and administration of activated charcoal, the drug level in the patient's blood was estimated at 12.0 ng/ml. During her stay on the ward, typical symptoms of severe poisoning were observed: from gastric symptoms (severe nausea, vomiting) to numerous severe arrhythmias and conduction disturbances. Type I, II and III AV blocks were detected, as well as numerous ventricular and supraventricular extrasystoles. These conduction disorders required the use of temporary endocardial pacing. Due to the unavailability of specific antidotes (antidigitalis antibodies) and lack of efficient methods of extracorporeal elimination of the drug, symptomatic treatment comprising the correction of electrolyte disturbances and heart rate control remains the most effective.

Association between 5-hydroxytryptamine 1A receptor gene polymorphism and suicidal behavior.

Suicidal behavior is highly correlated with many emotional disturbances and some psychiatric disorders. The biogenic amine, serotonin, is one of the most important neurotransmitter in the central nervous system believed to play a huge role in pathogenesis of some kind of mental disorders. Drugs targeting serotonin receptors like serotonin reuptake inhibitors (SSRIs) are useful in the present therapy of anxiety and depression. Recent studies have reported that genetic factors are associated with development of some psychiatric disorders. Serotonin receptor single nucleotide polymorphism (SNP) has emerged as the subject of controversial result in correlation with suicide attempt. Further studies should be performed to confirm the influence of allelic variation of serotonin receptor on elevated risk of auto-aggression behavior. The aim of our study was to examine the frequency and genotype distribution of C(-1019)G polymorphism of regulatory region 5-HT1A receptor in the group of 65 suicide attempters and 63 persons in the control group. Using allele specific amplification PCR (ASA-PCR), we found that allele G was higher in suicidal attempters. The genotype frequency was significantly different between hospitalized patients and control subjects. The most common intoxication causes were antidepressants (56.9%), analgesics (18.5%) and cardiologic drugs (10.8%). Our data support hypothesis which indicate role of the 5-HT1A C(-1019)G SNP polymorphism in elevated risk of suicidal attempt.

[Imbalance of oxidoreductive status in suicidal antidepressant drugs poisoning]. / Zachwianie równowagi oksydoredukcyjnej w samobójczych zatruciach lekami przeciwdepresyjnymi.

The aim of this study was to examine the association between suicidal poisoning with antidepressants and the oxidoreductive balance by evaluation of changes in activity of glutathione reductase (GR) and total antioxidative status (TAS) in serum. GR activity and TAS were determined in 29 patients hospitalized after suicidal poisoning with antidepressants and compared with the results of the control group consisting of 16 healthy people. For this purpose, RANDOX diagnostic sets were used. The GR activity and TAS were significantly lower in the examined group, compared with the control group. The results obtained show a significant reduction of GR activity and TAS level in patients with suicidal antidepressants poisoning. It seems, that the oxidoreductive balance is shift towards the oxidative potential and leads to the decrease of the organism's antioxidative potential, which is manifested by the increase of oxygen free radicals and the intensification of the oxidative stress.

[C-reactive protein as a useful prognostic marker in acute poisoning]. / Przydatnosc oznaczenia bialka C-reaktywnego w ostrych zatruciach.

All inflammatory processes or damaging factors affecting human organism increase the levels of pro-inflammatory proteins, i.e. acute phase proteins, in the serum in a statistically significant way. Among these proteins, interleukin-6 and C-reactive protein (CRP) are of the highest prognostic value for the process dynamics. The aim of the present study was to evaluate feasibility of determining the level of the CRP as a diagnostic and prognostic marker in acute poisonings. Out of a group of 132 patients hospitalised in the Lublin Toxicological Centre, 67 patients observed were poisoned with the CNS acting agents, 17 patients were intoxicated with alcohol, 10 patients overdosed cardio-vascular drugs and 6 were exposed to carbon monoxide. In the above mentioned groups, alcohol and CNS acting agents increased CRP values in over 33% of the patients, whereas in the case of patients under the influence of cardiac drugs or carbon monoxide, the same effect was observed in more than 16% of the cases. Moreover, an attempt to evaluate the dynamics of the CRP level changes in time was undertaken; a concentration increase was observed in 65% of the patients during the second day of hospitalisation. Our results suggest that the determination of the C-reactive protein levels can be a cheap prognostic test evaluating severity of acute poisoning cases.

[Analysis of cases of acute poisoning with cardiovascular drugs]. / Analiza przypadków ostrych zatruc lekami dzialajacymi na uklad sercowo-naczyniowy.

A retrospective analysis of cases of acute poisoning with cardiovascular drugs in the period from 1999 to 2002 has been carried out. A total of 72 poisoned patients was treated in the study period in the Lublin Regional Toxicological Centre. The poisoned were mostly women (69%), out of whom 76% were under 30. More than 66% were the cases of mixed poisoning, especially with antidepressant or sedative-hypnotic drugs. Alcohol poisoning was diagnosed in 28% of cases and it was statistically more frequent in men than in women (54.6% and 16.0%, respectively). Cardiovascular drugs were the most frequent cause of suicidal poisoning cases, i.e. beta-blockers were the cause of 40% poisoning cases, ACEI inhibitors--22%, and calcium channel blockers--19%. In 25 cases (in 18 women and 7 men) severe poisoning caused bradyarrhythmia or hypotonia which resulted in the death of 2 patients.

[Is total cholesterol a good predictor of attempting suicide?]. / Czy stezenie cholesterolu calkowitego jest dobrym markerem próby samobójczej?

The aim of the study was to verify a correlation between total cholesterol and a risk of attempting suicide. There has been data suggesting that individuals with low cholesterol are prone to commit a suicide. This could be due to the altered serotonin metabolism that in turn increases the level of aggressiveness, compulsiveness an promotes attempting suicide. We analyzed data from 300 poisonings, also with drugs, which were considered as attempted suicides. There was no evident correlation between cholesterol level and incidence of poisoning with drugs, acute alcohol poisoning and chronic alcohol abuse. Moreover, we did not find a correlation between low cholesterol level and a need of psychiatric treatment, both in hospital and in outpatient clinic. Further study are needed to elucidate the exact role of low cholesterol as a predictor of suicide attempt.

[Psychological analysis of family situation of youthful suicide]. / Psychologiczna analiza sytuacji rodzinnej mlodocianych suicydentów.

The aim of the studies was analysis of youthful suicides family situation. The whole group of being studied was 294 suicides, of women end men, at 15-25 age. The studies was realized in the two centres, were the suicides was hospitalized: in the Lublin Regional Toxicological Centre, and at the Psychiatric Department of the Lublin Medical Academy, in the period from 2000 to 2002 year. The most numerous group was made of suicides at 15-19 age. There were 53% of men, and 47% of women. The most of them are bred in full family. Nearly the half of suicides' families was alcoholic families. 55% of being examined indicate the negative relationship between parents, 25% define them as very negative. More than the half of suicides estimate the homely atmosphere as negative; 25% evaluate them as very negative.

[Cardiovascular drugs poisoning in the elderly patients hospitalized in the Province Poisoning Center in Lublin in the years 1995-2001]. / Analiza zatruc lekami pierwotnie dzialajacymi na uklad sercowo-naczyniowy u pacjentów w wieku podeszlym hospitalizowanych w Wojewódzkim Osrodku Toksykologii w Lublinie w latach 1995-2001.

The aim of our research was retrospective analysis of poisoning with cardiovascular drugs (T46 according to ICD 10 classification) in patients over 59 years old, hospitalized in Province Poisoning Centre in Lublin, in the period from 1995 to 2001. There were hospitalized 288 patients at this time age, over 59 years old. Among this 16 persons were poisoned with cardiovascular drugs (one accidental and 15 suicidal intoxications), and 3 of them died. Different kinds of cardiovascular medications were used e.g. digoxin, nitrates, hypotensive drugs (as single and multiplied drug poisonings). At 3 of the patients depression was diagnosed.