Exercise-induced hematuria exacerbated by improper hydration, low RBC MCV and dapagliflozin use.

BACKGROUND: Dapagliflozin is a reversible, highly potent, and selective Sodium-Glucose Co-Transporter-2 inhibitor indicated for the treatment of type 2 diabetes. It is generally well tolerated, with a low risk of hypoglycaemia and diabetic ketoacidosis. CASE PRESENTATION: We report a new adverse effect of dapagliflozin in a form of a transient hematuria, presenting in a 54-years-old male patient with type 2 diabetes after exercise and insufficient hydration. The process of hematuria in the patient is strongly linked with initial period of treatment. CONCLUSION: Dapagliflozin appears to have a rare adverse effect in the form of transient hematuria. Exercise, insufficient hydration, and low RBC MCV may play a role in such episodes.

Self-poisonings before and during the initial year of the COVID-19 pandemic in northern Poland.

OBJECTIVES: The objectives of this study included evaluating and reporting on the initial impact of the COVID-19 pandemic and preventive measures in the form of a lockdown on self-poisoning tendencies in northern Poland. MATERIAL AND METHODS: The authors retrospectively analyzed medical records of all patients (N = 2990) admitted to the Pomeranian Center of Toxicology in 2018-2020. Of those, further analysis included 2140 patients who had been admitted because of a suicide attempt by self-poisoning. The authors also selected a group of 40 patients on the basis of a self-reported direct relationship of the suicide attempt with the COVID-19 pandemic or the imposed lockdown. RESULTS: The rates of suicide attempts in toxicological patients over the years ranged 68.18-75.3%. The patients were predominantly female, with age between M±SD 33.2±16.9 and 36.0±16.4. Each year, over 60% of patients were admitted during their first attempt and were treated psychiatrically prior to their attempt, with differences observed in the COVID-19-related group. The alcohol intoxication during the suicide attempt was confirmed in 37.40-43.53% of the patients, with a higher rate of 52.50% observed in the COVID-19-related group. The main self-reported reason for the suicide was a romantic relationship conflict or breakup, and a conflict and/or violence in the family. The most frequent agents were over-the-counter painkillers, antidepressants, antipsychotics and benzodiazepines or Z-drugs. CONCLUSIONS: During the initial year of the COVID-19 pandemic, there was a fall of suicide attempts by self-poisonings in northern Poland, significant only in the case of women. The self-reported reasons were similar in all years, with mainly minor changes. There was also an increase in attempts made using benzodiazepines or Z-drugs seen in 2020 and in the COVID-19-related group. The authors believe that there is a need for multi-center, large-scale prospective studies that would provide better insight into the pandemic-related suicidal trends. Int J Occup Med Environ Health. 2022;35(5):527-35.

Tachykinin antagonists ameliorate surgically induced impairment of gastrointestinal motility in rats.

The protective effects of tachykinin receptor antagonists: SR140333 (NK1 receptor), SR48968 (NK2 receptor), and SB222200 (NK3 receptor) were tested in rats against a surgically induced postoperative inhibition of gut motility, a common complication of abdominal surgery. The small intestinal transit of Evans blue was measured 24-h post-surgery in untreated rats and animals subjected to skin incision, laparotomy, or laparotomy followed by gut evisceration and manipulation. Surgical procedures were conducted under diethyl ether anesthesia. In comparison to untreated and ether-anesthetized rats, animals undergoing skin incision, laparotomy, or laparotomy with gut evisceration and manipulation showed a significant decrease in the intestinal transit of Evans blue. The pretreatment with NK1 (3-100 µg/kg), NK2 (3-30 µg/kg), and NK3 (10-300 µg/kg) blockers before surgery ameliorated the inhibitory effects of gut manipulation in a dose-dependent manner. Moreover, the submaximal and maximal doses of NK3 antagonists showed a trend toward reversing not only the inhibition caused by gut manipulation but also laparotomy. An additive effect of combining submaximal doses of NK1-3 blockers was observed in animals pretreated with NK1  + NK2 compared to single-agent NK1 and NK2 . Additionally, doublets: NK1  + NK3 or NK2  + NK3 and a triplet: NK1  + NK2  + NK3 proved to be more effective than NK2 antagonist alone. In contrast, NK1-3 blockers have not markedly affected the intestinal propulsion in untreated rats or animals subjected to skin incision or laparotomy. NK1-3 blockers ameliorated the suppressed small-bowel gut motility 24 post-surgery. Combined pretreatment with NK1-3 antagonists provided selective, additive benefits compared to single agents.

Cardiogenic shock induced by a high dose of intravenous morphine.

Morphine is an opiate alkaloid characterized by various clinical effects, among which the most prominent are its analgesic and psychoactive effects. It also has a prominent depressive effect on the respiratory and cardiovascular system. Because of its psychoactive effect, morphine is very addictive and often used as a recreational narcotic. As a medication, it has found its use as an analgesic agent in chronic pain treatment, in hemorrhagic shock, and in acute heart failure with pulmonary edema. Albeit, morphine use in heart failure is controversial, based on many observational studies showing the negative effect on the outcomes of the patients treated with morphine during acute cardiovascular incidents. In this report, the authors present a case of cardiogenic shock (CS) with transient left ventricular ejection fraction reduction, occurring in a patient attempting suicide using a high dose of intravenous morphine sulphate administration. Other CS causes were ruled out. To the best of the authors' knowledge, this is the second case of a morphine-related CS reported in literature. Int J Occup Med Environ Health. 2021;34(1):133-8.

Tachykinin Antagonists Reverse Ischemia/Reperfusion Gastrointestinal Motility Impairment in Rats.

BACKGROUND: Supraceliac aortic clamping and unclamping produces ischemia-reperfusion (I/R) injury of the splanchnic organs. The protective effects of tachykinin receptor antagonists, SR140333 (NK1 receptor), SR48968 (NK2 receptor), and SB222200 (NK3 receptor), against I/R-induced inhibition of intestinal motility were tested in rats. MATERIAL AND METHODS: The intestinal transit of Evans blue was measured in untreated rats and animals subjected to skin incision, I/R (1 h superior mesenteric artery occlusion followed by 24 h reperfusion) or sham operation. Surgical procedures were conducted under diethyl ether anesthesia. RESULTS: The gastrointestinal transit has not been markedly affected in rats, which were anesthetized or subjected to skin incision in comparison with untreated animals. In contrast, a sham operation and I/R have significantly reduced the intestinal motility. Pretreatment with NK1-3 blockers (SR140333 [3-30 µg/kg]; SR48968 [3-100 µg/kg]; and SB222200 [10-100 µg/kg]) reversed dose dependently the effects of I/R to the level observed after sham operation only. A combination of NK1+NK2+NK3 inhibitors exerted an additive effect compared with NK1 and NK2 antagonists used as single agents. Similarly, combined NK1+NK2 were more effective than NK2 alone. Sham operation and I/R have shifted the in vitro carbachol concentration-response curves to the right in comparison with untreated animals, a phenomenon partially reversed by NK1-NK3 pretreatment. CONCLUSIONS: Single-agent and combined treatment with NK1-3 antagonists markedly attenuated the gastrointestinal dysmotility evoked by I/R injury. The pretreatment with NK3 blocker proved to be the most active in this experimental setting.

Sonographic appearance of rhabdomyolysis - a systematic review of the literature.

Rhabdomyolysis is the process of striated muscle cell lysis, during which proteins and microelements such as myoglobin are released into the bloodstream. It is important to diagnose rhabdomyolysis as soon as possible and start the treatment according to severity, as it is a state that significantly increases the mortality of the patients. The current gold standard of rhabdomyolysis diagnosis is the creatine kinase plasma concentration test, but it can be also diagnosed with imaging techniques, such as ultrasound (US). This review aims to gather previously published information regarding sonographic appearance of rhabdomyolysis. We searched through PubMed and ScienceDirect databases for studies using designed queries. After the selection process we were left with 13 studies containing a description of US appearance of rhabdomyolysis confirmed with a CK plasma level test. Findings described in the majority of the cases were muscle thickening, ground glass opacity, traits of edema and anechoic areas. Other than these, there were several less often reported findings. As a conclusion, rhabdomyolysis seems to have its own US appearance, but for now it cannot be precisely specified and needs further research for clarification.

The protective effect of endothelin receptor antagonists against surgically induced impairment of gastrointestinal motility in rats.

Endothelin (ET) receptor antagonists: BQ-123 (ETA), BQ-788 (ETB), tezosentan (dual ET receptor antagonist) protect against the development of postoperative ileus (POI) evoked by ischemia-reperfusion (I/R). The current experiments explored whether ET antagonists prevent the occurrence of POI evoked by surgical gut manipulation. Intestinal transit was assessed by measuring the rate of dye migration subsequent to skin incision (SI), laparotomy (L), or laparotomy and surgical gut handling (L+M) in diethyl ether anaesthesized rats (E). Experimental animals were randomly sub-divided into two groups depending on the time of recovery following surgery: viz. either 2 or 24 h (early or late phase POI). E and SI did not affect the gastrointestinal (GI) transit. In contrast, L and L+M significantly reduced GI motility in comparison to untreated group (UN). Tezosentan (10 mg/kg), BQ-123 and BQ-788 (1 mg/kg) protected against development of L+M evoked inhibition of intestinal motility in the course of late phase, but not early phase POI. Furthermore, tezosentan alleviated the decrease in the contractile response of the longitudinal jejunal smooth muscle strips to carbachol in vitro induced by L+M. The serum ET(1-21) concentration was not increased in either the early or the late phase POI groups after surgery compared to control animals. This study indicates that delay in the intestinal transit in late phase of surgically induced POI involves an ET-dependent mechanism.