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Journal of Postgraduate Medicine Apr 2024Arsenic compounds are colorless and odorless and toxicity can occur either acutely following ingestion of arsenicals with gastrointestinal disturbances or due to chronic...
Arsenic compounds are colorless and odorless and toxicity can occur either acutely following ingestion of arsenicals with gastrointestinal disturbances or due to chronic exposure usually presenting with dermatologic lesions and peripheral neuropathy. We report a young couple who presented with signs and symptoms of painful sensorimotor peripheral neuropathy in a typical "stocking and glove" pattern. They had raised urinary arsenic levels with normal blood levels and thus, a diagnosis of chronic arsenic poisoning due to contaminated water intake was made after detecting elevated arsenic levels in their home water supply. Both patients underwent chelation therapy with dimercaprol for 14 days and reported subjective and objective improvement in symptoms with the reduction in urinary arsenic levels at the end of therapy.
Topics: Humans; Arsenic Poisoning; Peripheral Nervous System Diseases; Male; Female; Adult; Dimercaprol; Chelating Agents; Arsenic; Treatment Outcome; Chronic Disease; Chelation Therapy
PubMed: 38629272
DOI: 10.4103/jpgm.jpgm_708_23 -
Zhongguo Dang Dai Er Ke Za Zhi =... Jan 2024To study the efficacy of bronchoalveolar lavage (BAL) combined with prone positioning in children with pneumonia (MPP) and atelectasis and its effect on pulmonary... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To study the efficacy of bronchoalveolar lavage (BAL) combined with prone positioning in children with pneumonia (MPP) and atelectasis and its effect on pulmonary function.
METHODS
A prospective study was conducted on 94 children with MPP and atelectasis who were hospitalized in Ordos Central Hospital of Inner Mongolia from November 2020 to May 2023. The children were randomly divided into a treatment group and a control group, with 47 children in each group. The children in the treatment group were given conventional treatment, BAL, and prone positioning, and those in the control group were given conventional treatment and BAL. The two groups were compared in terms of fever, pulmonary signs, length of hospital stay, lung recruitment, and improvement in pulmonary function.
RESULTS
Compared with the control group, the treatment group had significantly shorter time to improvement in pulmonary signs and length of hospital stay and a significantly higher rate of lung recruitment on day 7 of hospitalization, on the day of discharge, and at 1 week after discharge (<0.05). Compared with the control group, the treatment group had significantly higher levels of forced vital capacity (FVC) as a percentage of the predicted value, forced expiratory volume (FEV) in 1 second as a percentage of the predicted value, ratio of FEV in 1 second to FVC, forced expiratory flow at 50% of FVC as a percentage of the predicted value, forced expiratory flow at 75% of FVC as a percentage of the predicted value, and maximal mid-expiratory flow as a percentage of the predicted value on the day of discharge and at 1 week after discharge (<0.05). There was no significant difference in the time for body temperature to return to normal between the two groups (>0.05).
CONCLUSIONS
In the treatment of children with MPP and atelectasis, BAL combined with prone positioning can help to shorten the time to improvement in pulmonary signs and the length of hospital stay and promote lung recruitment and improvement in pulmonary function.
Topics: Child; Humans; Prospective Studies; Mycoplasma pneumoniae; Prone Position; Pulmonary Atelectasis; Pneumonia, Mycoplasma; Bronchoalveolar Lavage; Dimercaprol
PubMed: 38269456
DOI: 10.7499/j.issn.1008-8830.2308013 -
Intensive Care Medicine Feb 2024
Topics: Humans; Animals; Strongyloides stercoralis; Bronchoalveolar Lavage; Dimercaprol; Respiratory Distress Syndrome
PubMed: 38224349
DOI: 10.1007/s00134-023-07315-1 -
The Veterinary Record Feb 2024Cytology of airway samples is sensitive for diagnosis of exercise-induced pulmonary haemorrhage (EIPH), but the association between tracheal wash (TW) and...
BACKGROUND
Cytology of airway samples is sensitive for diagnosis of exercise-induced pulmonary haemorrhage (EIPH), but the association between tracheal wash (TW) and bronchoalveolar lavage fluid (BALF) is unknown. The objective of this study was to determine whether diagnosis of EIPH, using haemosiderophages/macrophages (H/M) ratio, differs when based on TW or BALF.
METHODS
A prospective cross-sectional study was conducted on 102 standardbred horses in training. TW and BALF were collected concomitantly from all horses at rest (at least 24 hours after their last training or race), and their H/M ratios were calculated. Spearman's correlation, Cohen's kappa and Gwet's coefficient tests were performed to evaluate the association between TW and BALF samples.
RESULTS
With BALF, 21 horses met the cytological inclusion criteria for an EIPH diagnosis from individual and/or pooled samples. With TW, 20 horses had occasional (H/M < 10%) haemosiderophages, and nine, one and three horses had small (10%-25%), moderate (25%-50%) and large (>50%) proportions, respectively. Poor correlations and inconsistent concordances between TW and BALF were found for H/M ratio.
LIMITATIONS
Limitations include the use of a single staining method and the absence of a total haemosiderin score.
CONCLUSION
No association between TW and BALF was found for the cytological diagnosis of EIPH. Based on H/M ratio, BALF remains the sample type of choice for cytological diagnosis of EIPH.
Topics: Horses; Animals; Cross-Sectional Studies; Prospective Studies; Horse Diseases; Physical Conditioning, Animal; Bronchoalveolar Lavage; Lung Diseases; Bronchoalveolar Lavage Fluid; Hemorrhage; Dimercaprol
PubMed: 38291664
DOI: 10.1002/vetr.3826 -
Journal of Medical Toxicology :... Jan 2024For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNaEDTA. We present a...
INTRODUCTION
For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNaEDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNaEDTA was unavailable.
CASE REPORT
A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNaEDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits.
DISCUSSION
The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.
Topics: Humans; Male; Child; Child, Preschool; Lead; Edetic Acid; Chelating Agents; Succimer; Lead Poisoning; Brain Diseases; Heart Arrest
PubMed: 37843802
DOI: 10.1007/s13181-023-00970-2 -
Frontiers in Immunology 2024Influenza A viruses (IAVs) infect the respiratory tract of mainly humans, poultry, and pigs. Co-infections with pathogenic lung bacteria are a common event and...
INTRODUCTION
Influenza A viruses (IAVs) infect the respiratory tract of mainly humans, poultry, and pigs. Co-infections with pathogenic lung bacteria are a common event and contribute to the severity of disease progression. Neutrophils are a major cell type of the innate immune system and are rapidly recruited to the site of infection. They have several effector functions to fight invading pathogens such as the secretion of reactive oxygen species (ROS) or the release of neutrophil extracellular traps (NETs). NETs are known to promote the growth of bacteria, especially if degraded by nucleases.
METHODS
In this study, bronchoalveolar lavage fluid (BALF) from 45 field-infected pigs was analyzed for 1) NET markers, 2) influence on growth of lung bacteria, and 3) impact on neutrophil functions. BALF samples from 21 IAV-positive pigs and 24 lung diseased but IAV-negative pigs were compared.
RESULTS
Here, we show that neutrophils in the lungs of IAV-positive pigs release vesicular NETs. Several NET markers were increased in the BALF of IAV-positive pigs compared with the BALF from IAV-negative pigs. The amount of NET markers positively correlated with the viral load of the IAV infection. Interestingly, the BALF of IAV-positive pigs enhanced the growth of bacteria belonging to the family of Pasteurellaceae as potential coinfecting bacteria. These effects were weaker with the BALF derived from IAV-negative pigs with other lung infections. The intensity of oxidative burst in neutrophils was significantly decreased by BALF from IAVpositive pigs, indicating impaired antimicrobial activity of neutrophils. Finally, the lung milieu reflected by IAV-positive BALF does not enable neutrophils to kill but rather enhances its growth.
DISCUSSION
In summary, our data show that an IAV infection is affecting neutrophil functions, in particular the release of NETs and ROS. Furthermore, IAV infection seems to provide growth-enhancing factors for especially coinfecting Pasteurellaceae and reduces the killing efficiency of neutrophils.
Topics: Humans; Animals; Swine; Neutrophils; Reactive Oxygen Species; Bronchoalveolar Lavage; Bacteria; Dimercaprol; Influenza A virus
PubMed: 38449874
DOI: 10.3389/fimmu.2024.1325269