Acarbose protects from central and peripheral metabolic imbalance induced by benzene exposure.

Benzene is a well-known human carcinogen that is one of the major components of air pollution. Sources of benzene in ambient air include cigarette smoke, e-cigarettes vaping, and evaporation of benzene containing petrol processes. While the carcinogenic effects of benzene exposure have been well studied, less is known about the metabolic effects of benzene exposure. We show that chronic exposure to benzene at low levels induces a severe metabolic imbalance in a sex-specific manner, and is associated with hypothalamic inflammation and endoplasmic reticulum (ER) stress. Benzene exposure rapidly activates hypothalamic ER stress and neuroinflammatory responses in male mice, while pharmacological inhibition of ER stress response by inhibiting IRE1α-XBP1 pathway significantly alleviates benzene-induced glial inflammatory responses. Additionally, feeding mice with Acarbose, a clinically available anti-diabetes drug, protected against benzene induced central and peripheral metabolic imbalance. Acarbose imitates the slowing of dietary carbohydrate digestion, suggesting that choosing a diet with a low glycemic index might be a potential strategy for reducing the negative metabolic effect of chronic exposure to benzene for smokers or people living/working in urban environments with high concentrations of exposure to automobile exhausts.

Phenytoin Intoxication: Burden and risk factors.

OBJECTIVE: The aim of the study is to determine: 1) the frequency of patients admitted for phenytoin toxicity and their economic burden; 2) the clinical symptoms and signs of intoxication; 3) the causes or risk factors of intoxication, and 4) the ways to prevent phenytoin toxicity. METHODS: Retrospective review of hospital ICD coded database between 1987 and 1998. All patients with phenytoin intoxication were reviewed. RESULTS: Thirty-one patients were admitted 35 times for phenytoin toxicity. Phenytoin intoxication accounted for 1/5,000 admissions. Ataxia, confusion, dysarthria and nystagmus were the most common signs. The outcome was benign except for one patient who remained with a residual cerebellar syndrome. Unawareness of phenytoin pharmacokinetics, lack of clinic follow-up visits, infrequent serum level monitoring following drug dosage change and using wrong doses accounted for most of the cases. CONCLUSION: Phenytoin intoxication rarely leaves any permanent sequelae but can be a cause of significant transient morbidity and prolonged hospitalization. As the major causes were related to poor follow-up or were iatrogenic, a better patient education and a stepwise dose increase based on serum level, together with drug level monitoring 2-4 weeks after dose change could decrease the incidence and severity of phenytoin intoxication.

Complications of carbon monoxide poisoning.

OBJECTIVE: Acute carbon monoxide poisoning is a common problem that occurs during winter and leads to serious complications. METHODS: We retrospectively studied 24 consecutive cases admitted with the aim of finding the causes and outcome of acute carbon monoxide poisoning. RESULTS: The source of poisoning was charcoal in 71% of patients, motor gasoline in 21%, and other causes in 8%. Immediate complications included altered consciousness level in 54% of patients, metabolic acidosis in 46%, pneumonia in 42%, cardiac arrhythmia in 29% and rhabdomyolysis in 25%. Late neurological complications occurred in 17% of patients. All the patients received 100% oxygen. Eleven patients (46%) required mechanical ventilation. Ultimately, 19 patients (79%) recovered completely, 4 (17%) had neurological or cardiac disorders, and 1 (4%) died. CONCLUSION: Immediate and late complications are common in carbon monoxide poisoning cases admitted to the hospital especially when they arrive late. Time lapse between exposure and presentation may have a role in predicting the outcome.

Carpal Tunnel Syndrome in type 2 diabetic patients.

OBJECTIVE: To determine the frequency of carpal tunnel syndrome in type 2 diabetic patients, its clinical profile and its other predisposing factors. METHODS: One hundred and forty six consecutive patients (57 male, 89 female) with type 2 diabetes mellitus seen in the diabetic clinic were examined prospectively and submitted to comprehensive electrophysiological studies to detect carpal tunnel syndrome and sensorimotor neuropathy. Those with carpal tunnel syndrome were compared to others to determine the additional predisposing factors for carpal tunnel syndrome in diabetic patients. RESULTS: The mean duration of diabetes was 11.5 years. Carpal tunnel syndrome was diagnosed in 39% of the patients (28% of the males and 46% of females). Numbness of the hands, Tinel`s sign and Phalen`s sign had poor sensitivity (61%, 54% and 37% respectively) but high specificity (75%, 85% and 91%). The main risk factor for carpal tunnel syndrome in diabetics was the duration of diabetes (p<0.001) and to a lesser degree female gender and obesity (p<0.05). CONCLUSION: Carpal tunnel syndrome is quite frequent in type 2 diabetic patients. Its clinical diagnosis may be difficult because of the poor sensitivity of its classical symptoms and signs. It should be suspected mainly in obese women with long-standing diabetes mellitus. Electrodiagnostic studies should be done in these patients because the earlier the diagnosis, the sooner consideration can be given to the need for surgical decompression.

Abdominal muscle paralysis in herpes zoster.

Herpes zoster or Shingles, an inflammatory viral disease caused by varicella has classical clinical presentation with herpetic morphological pattern exhibited along one or more dermatomes. The self limiting skin disease is accompanied by pain and burning sensations leading to post herpetic neuralgia. The sensory component of the disease is so prominent that the motor involvement is often overlooked. It was not known till recently that profound muscle weakness can be a part of this syndrome. We report 2 cases of herpes zoster who had prominent appreciable motor weakness of the abdominal muscles following the disease. The weakness however has a better prognosis and the lesions in both of our patients healed in 6 months without leaving any residual paralysis.