Determination of netrin-1 levels and its relationship with neurotoxicity in carbon monoxide poisoning

2019 ◽  
Vol 38 (5) ◽  
pp. 561-566 ◽  
Author(s):  
U Gedikli ◽  
E Emektar ◽  
SK Corbacioglu ◽  
S Dagar ◽  
H Uzunosmanoglu ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Patient Group ◽  
Carbon Monoxide Poisoning ◽  
Neurological Impairment ◽  
Neurological Involvement ◽  
Control Group ◽  
Co Poisoning ◽  
Cross Sectional ◽  
Significant Difference ◽  
Neurological Effects

Objective: The aim of the study was to assess netrin-1 levels in carbon monoxide (CO) poisoning to determine its relationship with poisoning severity and neurotoxicity. Methods: This is a cross-sectional prospective study. The patients older than 18 years with CO poisoning were included. The patients were categorized into two groups on the basis of neurological involvement. Both the patient and the control groups were sampled for netrin-1 at 0th hour, and the patient group only was sampled for netrin-1 at 4th hour. Results: A total of 84 patients and 50 healthy controls were enrolled. The median 0th hour netrin-1 level of the patient group (765.1 pg/mL (619.8-983.1) was significantly higher than the control group (484 pg/mL (376-1031.6)) ( p < 0.001). There was also a significant difference between the 0th hour and 4th hour netrin-1 (888.9 pg/mL (700.3–1175.5)) levels in the patient group ( p < 0.001).There was no significant statistical difference between patients with and without neurological involvement ( p = 0.62) and between those who underwent hyperbaric oxygen therapy (HBOT) and those who did not ( p = 0.76) with respect to 4th hour netrin-1 levels. Conclusion: The significantly higher netrin-1 levels in patients with CO poisoning, suggests that netrin-1 is elevated as a stress marker. Although there is no significant difference in netrin-1 levels in patients with neurological impairment in CO poisonings, netrin-1 may show subclinically neurological effects. Hence, we believe that netrin-1 cannot be used as a marker of poisoning severity.

Evaluation of oxidative stress and antioxidant parameters in children with carbon monoxide poisoning

2019 ◽  
Vol 38 (11) ◽  
pp. 1235-1243
Author(s):  
O Teksam ◽  
S Sabuncuoğlu ◽  
G Girgin ◽  
H Özgüneş
Keyword(s):  
Oxidative Stress ◽  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Venous Blood ◽  
Treatment Modalities ◽  
Control Group ◽  
Co Poisoning ◽  
Erythrocyte Catalase ◽  
Significant Difference ◽  
Before And After

Objective: In this study, we aimed to investigate oxidative stress and antioxidant parameter levels in patients with carbon monoxide (CO) poisoning. Methods: The study was conducted prospectively between March 1, 2015 and April 30, 2016 in the pediatric emergency department. Eligible patients included children aged 0–18 years old with a diagnosis of CO poisoning. To determination of oxidative stress and antioxidant parameter levels, venous blood with heparinized and urine samples were drawn during the admission and after normobaric oxygen (NBO) and hyperbaric oxygen (HBO) treatment. Results: Forty-seven children with CO poisoning for study group and 29 patients as control group were included to the study. Sixteen patients treated with HBO. Basal plasma malondialdehyde levels were found to be significantly higher in the CO poisoning group when compared with the control group ( p = 0.019). There is no significant difference in oxidative stress and antioxidant parameter levels except erythrocyte catalase enzyme levels in patients treated with NBO when comparing before and after NBO treatment ( p > 0.05). Decreasing of basal erythrocyte catalase enzyme levels were found statistically significant after NBO treatment ( p = 0.04). There was no significant difference in oxidative stress and antioxidant parameter levels in patients treated with HBO before and after therapy ( p > 0.05). Conclusions: CO poisoning is associated with increased lipid peroxidation in children immediately after the poisoning. However, both treatment modalities including NBO or HBO do not have a significant effect on oxidative stress or antioxidant parameter levels.

scholarly journals Association of Diabetes Complications With Depression and Suicidality in Hospitalized Patients: a Multicenter Cross-sectional Study

2021 ◽  
Author(s):  
Majid Pakdin ◽  
Alireza Ebrahimi ◽  
Mohammadsaeed Gharaati Jahromi ◽  
Ali Firoozabadi
Keyword(s):  
Beck Depression Inventory ◽  
Patient Group ◽  
Suicide Ideation ◽  
Psychiatric Evaluation ◽  
Mental Health Issue ◽  
Control Group ◽  
Depression Symptoms ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background: Diabetes mellitus and depression are both considered the most prevalent diseases of the recent century. On the other hand, it is estimated that the rate of depression is nearly doubled in diabetic patients compared with the general population.Method: A total of 89 patients, who were admitted to the hospital because of the complications of the disease, were voluntarily and conveniently participated in the study. The participants were given the questionnaires of Beck Depression Inventory-2nd-edition and Beck Scale for Suicide Ideation. They were divided into two age groups: 18-50 years old and 50-75 years old. Control group, consisting of 89 individuals without any underlying disease, were randomly selected from the patients’ visitors, matched with the participants according to the age group and gender. Statistical analysis was performed between the two groups based on scores obtained. Results: Beck Depression Inventory Scale score was significantly higher, regardless of age, in the patient group compared to the control group. However, there was no significant difference between the scores of Beck Scale for Suicide Ideation between the patient group and the control group. In the patient group, it was found that among the variables, female gender, and diabetic foot were associated with higher severity of depression symptoms. Conclusion: It is vitally essential for diabetic patients to undergo periodic psychiatric evaluation. Early diagnosis of depression could help them to better cope with their mental health issue, and as a result, it will decrease risk of suicidal ideation and other consequences.

The impact of hyperthermia after acute carbon monoxide poisoning on neurological sequelae

2018 ◽  
Vol 38 (4) ◽  
pp. 455-465 ◽  
Author(s):  
JM Moon ◽  
BJ Chun ◽  
SD Lee ◽  
MH Shin
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Early Period ◽  
Maximum Temperature ◽  
Co Poisoning ◽  
Neurological Sequelae ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
The Impact

This study investigated whether hyperthermia within the first 24 h after presentation was associated with long-term neurological outcomes after acute carbon monoxide (CO) poisoning. This retrospective study included 200 patients with acute severe CO poisoning. Hyperthermia (≥ 37.5°C) developed during the first 24 h after presentation in 55 (27.5%) patients, and poor long-term neurological sequelae assessed at 23 months after acute CO poisoning developed in 19.5% of the patients. The incidence of poor long-term neurological outcomes was significantly higher in the hyperthermia group than in the normothermia group. Patients with poor long-term neurological outcomes had higher maximum temperatures than patients with good outcomes. No significant difference was found in the time of hyperthermia onset within the first day according to the neurological outcomes. Hyperthermia (adjusted odds ratio (aOR) 5.009 (95% confidence interval (CI) 1.556–16.126)) and maximum temperature (aOR 2.581 (95% CI 1.098–6.063)) within the first 24 h after presentation to the emergency department were independently associated with poor long-term neurological outcomes. Body temperature measurements, which are easily and noninvasively recorded at the bedside in any facility, help to predict the risk for poor long-term neurological outcomes. This study carefully emphasizes fastidious control of pyrexia, particularly during the early period after acute CO poisoning.

Low-Level Carbon-Monoxide Poisoning: Inability of Neuropsychological Testing to Identify Patients Who Benefit from Hyperbaric Oxygen Therapy

1995 ◽  
Vol 10 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Steven J. Rottman ◽  
Nancy Kaser-Boyd ◽  
Timothy Cannis ◽  
John Alexander
Keyword(s):  
Carbon Monoxide ◽  
Hyperbaric Oxygen ◽  
Test Scores ◽  
Carbon Monoxide Poisoning ◽  
Neuropsychological Testing ◽  
Memory Loss ◽  
Control Group ◽  
Co Poisoning ◽  
Low Level ◽  
Before And After

AbstractIntroduction:Although major sequelae of carbon-monoxide (CO) poisoning and its treatment with hyperbaric oxygen (HBO) are well-documented, a syndrome of low-level CO poisoning has received relatively little attention. Subtle symptoms of poor concentration, language difficulty, problems with calculations, and memory loss were noted after an acute exposure of 131 dormitory residents to low levels of CO. The CO Neuropsychological Screening Battery (CONSB), a series of tests reported by others as useful to identify victims of CO poisoning, was performed on a subset of 46 victims. It was hypothesized that their test scores would improve after treatment with HBO.Methods:Testing was performed both before and after HBO on 35 CO-exposed victims. A control group of 20 students residing on the same college campus, but not involved with the CO incident, also were tested on two separate occasions to assess the ability of the test to identify selectively victims of low-level CO poisoning, as well as to evaluate its validity when administered serially.Results:Both CO-exposed and control subjects demonstrated significant performance improvement when completing the testing for the second time. In addition, the baseline test scores were not significantly different for either the CO-exposed or the control groups. Nonetheless, all CO-exposed victims reported immediate subjective improvement of their symptoms after HBO therapy.Conclusion:These observations and a review of the literature suggest that there might exist a syndrome of subtle neurological disturbances in victims of low-level CO poisoning. Whether this is permanent or might regress spontaneously over time is unknown. As a diagnostic adjunct, the CONSB does not appear to be as useful in low-level CO poisoning.

scholarly journals Temporal trends of carbon monoxide poisoning mortality at the global, regional and national levels: a cross-sectional study from the Global Burden of Disease study, 1990 and 2017

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053240
Author(s):  
Jianhai Long ◽  
Yawei Sun ◽  
Junxiu Zhao ◽  
Jie Liu ◽  
Xiaobo Peng
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
National Level ◽  
Temporal Trends ◽  
Global Burden ◽  
Co Poisoning ◽  
Cross Sectional Survey ◽  
Mortality Trends ◽  
Fatal Poisoning ◽  
Cross Sectional

ObjectivesCarbon monoxide (CO) poisoning is one of the most frequent causes of fatal poisoning worldwide. Few studies have explored the mortality trends of CO poisoning grouped by age and gender, at the regional, national and global levels. We therefore aimed to determine the pattern of CO poisoning mortality, as well as temporal trends at all levels.DesignA cross-sectional survey design was used in this study.SettingCO poisoning data collected from the Global Burden of Diseases (GBDs), from 1990 to 2017, was arranged by sex, age, region and country. In addition, we used human development index data at the national level from the World Bank.ParticipantsWe collected over 100 000 information on CO poisoning mortality between 1990 and 2017, derived from the GBD study in 2017.Main outcomes and measuresWe have calculated the estimated annual percentage changes in CO poisoning age-standardised mortality rate (ASR), by sex and age at different regions and countries to quantify the temporal trends in CO poisoning ASR.ResultsGlobally, death cases of CO poisoning decreased 7.2% from 38 210 in 1990 to 35 480 in 2017. The overall ASR decreased by an average of 1.83% (95% CI 2.10% to 1.56%) per year in this period. This decreasing pattern was heterogeneous across ages, regions and countries. The most pronounced decreases were generally observed in countries with a high sociodemographic index, including Estonia, South Korea and Puerto Rico.ConclusionsCurrent prevention strategies should be reoriented, and much more targeted and specific strategies should be established in some countries to forestall CO poisoning.

The relationship among plasma copeptin, carboxyhemoglobin, and lactate levels in carbon monoxide poisoning

2019 ◽  
Vol 39 (3) ◽  
pp. 311-318
Author(s):  
S Ozkan ◽  
O Salt ◽  
P Durukan ◽  
A Sen ◽  
E Bulbul ◽  
...  
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
Plasma Levels ◽  
Carbon Monoxide Poisoning ◽  
Serum Lactate ◽  
Co Poisoning ◽  
Stress Hormone ◽  
Significant Difference ◽  
Lactate Levels ◽  
The Relationship

Objective: The aim of our study is to determine whether there is a change in the plasma levels of copeptin and there is a relationship among the plasma levels of carboxyhemoglobin (COHb), lactate, and copeptin levels in patients presenting to the emergency department with carbon monoxide (CO) poisoning. Methods: Fifty-seven patients admitted to the emergency department with CO poisoning were included in the study. The blood samples of the patients were collected on arrival 0th, 6th, and 12th hours for copeptin, lactate, and COHb levels. Data were analyzed using SPSS-17 statistical software. Results: Arrival serum copeptin levels of the patients were compared to copeptin levels of healthy individuals and a statistically significant difference was found between them ( p = 0.008). There was a statistically significant difference between the arrival levels of copeptin and 6th-hour ( p = 0.006) and 12th-hour ( p = 0.001) levels of copeptin. There was no significant difference between 6th-hour and 12th-hour copeptin levels ( p = 0.51). In terms of serum lactate levels, there was a significant difference between arrival and 6th h ( p < 0.001), arrival and 12th h ( p < 0.001), and 6th and 12th h ( p < 0.001). Likewise, in terms of serum COHb levels, there was a significant difference between arrival and 6th h ( p < 0.001), arrival and 12th h ( p < 0.001), and 6th and 12th h ( p < 0.001). There was a positive correlation between COHb and lactate levels on arrival ( r = 0.52; p = 0.001). Conclusion: Copeptin as a stress hormone can be used in the diagnosis and monitoring of patients with CO poisoning. However, the copeptin level was not superior to COHb and lactate levels.

How much apoptosis does carbon monoxide poisoning cause? Primary clinical soluble TWEAK protein level study

2019 ◽  
Vol 38 (8) ◽  
pp. 974-982 ◽  
Author(s):  
N Dindar Badem ◽  
E Cömertpay ◽  
F Coşkun
Keyword(s):  
Carbon Monoxide ◽  
Peripheral Blood ◽  
Protein Level ◽  
Cell Apoptosis ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Carbon Monoxide Poisoning ◽  
Control Group ◽  
Co Poisoning ◽  
Arterial Blood

Carbon monoxide (CO) is an important cause of deaths via poisoning. CO poisoning causes inhibition of O2 transport and development of tissue hypoxia, which then causes cell apoptosis. A significant indicator of cell apoptosis, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) protein, is important for the stimulation of apoptosis. The primary purpose of this study is to determine whether apoptosis occurs during acute CO poisoning and to show that sTWEAK protein is an indicator of apoptosis that can be analyzed as a marker in the peripheral blood sample. The secondary aim is to determine the diagnostic and prognostic values of sTWEAK protein. The study was performed prospectively on 43 patients with CO poisoning and 30 healthy volunteer control individuals. The anamneses were taken from all patients, who also underwent physical examination. Complete blood count, biochemical markers, cardiac enzymes, and arterial blood gas measurements were analyzed. All the patients’ sTWEAK protein levels were also analyzed. The sTWEAK protein level of patients with CO poisoning was 2278 pg/mL (1197–7234), while the level of the control group was 1609 pg/mL (310–3721). The patients’ sTWEAK levels were significantly higher than the controls (area under the curve: 0.77 (0.66–0.89); p < 0.001), and the cutoff value was determined as 1895.50 pg/mL. The cutoff level had a sensitivity of 74.4%, a specificity of 76.7%, a positive predictive value of 82.0%, and a negative predictive value of 67.6%. sTWEAK is a significant indicator of apoptosis in CO poisoning that can be analyzed in the peripheral blood. However, further clinical trials are needed in terms of prognostic criteria.

Carbon monoxide poisoning cases presenting with non-specific symptoms

2016 ◽  
Vol 33 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Turgut Deniz ◽  
Hayati Kandis ◽  
Oguz Eroglu ◽  
Harun Gunes ◽  
Meral Saygun ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Cross Sectional Study ◽  
Motor Vehicles ◽  
Co Poisoning ◽  
Cross Sectional ◽  
Heating Systems ◽  
Presenting Symptoms ◽  
Non Invasive ◽  
Specific Symptoms

Carbon monoxide (CO) is a colourless and odourless gas appearing as a result of incomplete combustion of carbon-containing fuels. Many domestic or occupational poisonings are caused by CO exposure. Malfunctioning heating systems, improperly ventilated motor vehicles, generators, grills, stoves and residential fires may be listed in the common sources of CO exposure. The aim of this study was to emphasize the significance of early diagnosis of CO poisoning with non-invasive measurement of CO levels of the patients with non-specific symptoms using a pulse oximeter device in the triage. Our study was a cross-sectional study. Patients who presented to the emergency department (ED) due to non-specific symptoms and had a Canadian Triage and Acuity scale level of 4 or 5 were included in the study; 106 (5.9%) of 1788 patients admitted during the study period were diagnosed with CO poisoning. Patients with CO poisoning and the other patients had statistically significant differences in terms of presenting symptoms, namely, headache, dizziness, nausea, and vomiting. More CO poisoning cases were admitted in the fall and winter compared to the spring and summer. The number of CO poisoning victims can be decreased if preventive measures like CO monitoring systems and well-designed ventilation systems are generalized at homes and workplaces. Measurement of carboxyhaemoglobin levels of patients presenting to ED due to non-specific symptoms like headache and dizziness during cold seasons and winter months using a pulse CO-oximeter should be a part of the routine of emergency medicine triage.

The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning

2017 ◽  
Vol 37 (6) ◽  
pp. 587-595 ◽  
Author(s):  
YS Kim ◽  
YS Cha ◽  
MS Kim ◽  
HJ Kim ◽  
YS Lee ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Carbon Monoxide ◽  
Magnetic Resonance ◽  
Carbon Monoxide Poisoning ◽  
Co Poisoning ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Significant Difference ◽  
Delayed Neuropsychiatric Sequelae ◽  
Weighted Magnetic Resonance Imaging

Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). No previous study has determined whether early use of diffusion-weighted magnetic resonance imaging (DWI) can predict which patients will develop DNS in the acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 17-month period. All included patients with acute CO poisoning underwent DWI to evaluate brain injury within 72 h after CO exposure. DWI was evaluated as follows: (1) presence of pathology, (2) number of pathologies, (3) asymmetry, and (4) location of pathology. Patients were divided into two groups. The DNS group was composed of patients with delayed sequelae, while the non-DNS group included patients with no sequelae. A total of 102 patients with acute CO poisoning were finally enrolled in this study. DNS developed in 10 patients (9.8%). Between the DNS group and the non-DNS group, presence of pathology on DWI and initial Glasgow Coma Scale (GCS) showed significant difference. There was also a statistical difference between the non-DNS group and DNS group in terms of CO exposure time, troponin I, rhabdomyolysis, acute kidney injury, and pneumonia. The presence of pathology in DWI and initial GCS (cutoff: <12) at the emergency department served as an early predictors of DNS.

Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning?

2014 ◽  
Vol 34 (3) ◽  
pp. 324-329 ◽  
Author(s):  
NÖ Doğan ◽  
A Savrun ◽  
S Levent ◽  
GP Günaydın ◽  
GK Çelik ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Lactate Level ◽  
Carbon Monoxide Poisoning ◽  
Co Poisoning ◽  
Cross Sectional ◽  
Normobaric Oxygen ◽  
Clinical Criteria ◽  
Oxygen Treatment ◽  
Co Intoxication ◽  
Lactate Levels

Introduction: Accidental carbon monoxide (CO) intoxication is a major cause of unintentional poisoning. This study aimed to determine the value of initial lactate levels in patients with CO poisoning and to evaluate its utilization in the emergency department (ED). Methods: A retrospective cross-sectional study was carried out among patients with CO intoxication, who were admitted to the ED between April 1, 2011 and April 1, 2012. The study data were extracted from a hospital database system using International Classification of Diseases-10 diagnosis codes. The patients were analyzed according to lactate levels, carboxyhemoglobin (COHb) levels, electrocardiographic manifestations, and clinical features at admission to the ED. Results: A total of 74 patients with CO poisoning were enrolled in this study. The average COHb value of the patients was 21.5 ± 13.9%. A total of 50 patients (67.6%) received normobaric oxygen treatment and 24 patients (32.4%) received hyperbaric oxygen (HBO) treatment. The patients who received HBO treatment had increased lactate levels compared with patients receiving normobaric oxygen treatment (2.3 mmol/L vs. 1.0 mmol/L, p < 0.001). The lactate levels were positively correlated with COHb values ( r = 0.738, p < 0.001). We determined that a lactate level of 1.85 mmol/L has a sensitivity of 70.8% and a specificity of 78.0% to predict the HBO treatment needed in CO poisoning. Conclusion: In evaluating patients with CO poisoning, an initial lactate level could be taken into consideration as an adjunctive parameter of severity, together with the clinical criteria and levels of COHb.

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