Acute intoxication following massive bupropion sniffing: A case report

Bupropion intranasal misuse potential should be considered in the suspect of sympathomimetic syndrome for illicit drug or medication intoxication. A 31-year-old man was admitted for intranasal misuse of 30 crushed tablets of bupropion with adrenergic mild presentation. Lorazepam infusion was started with complete clinical resolution. Further forensic investigations detected a bupropion serum and urine concentration levels at 18 hours from intake of 1905.26 ng/mL and 2001.57 ng/mL, respectively. This case of intranasal bupropion misuse shared only some features with oral overdose, despite a plasma concentration five times higher than the lowest toxic level. Nasal bupropion snorting in chronic users could have lower toxicity compared to other snorted stimulants but symptomatic treatment remains the gold standard for preventing complications. Bupropion misuse might rapidly become a concerning issue and monitoring by healthcare professionals is needed.

The Role of Vasopressin V2 Receptor in Drug-Induced Hyponatremia

Hyponatremia is frequently encountered in clinical practice and usually induced by renal water retention. Many medications are considered to be among the various causes of hyponatremia, because they either stimulate the release of arginine vasopressin (AVP) or potentiate its action in the kidney. Antidepressants, anticonvulsants, antipsychotics, diuretics, and cytotoxic agents are the major causes of drug-induced hyponatremia. However, studies addressing the potential of these drugs to increase AVP release from the posterior pituitary gland or enhance urine concentration through intrarenal mechanisms are lacking. We previously showed that in the absence of AVP, sertraline, carbamazepine, haloperidol, and cyclophosphamide each increased vasopressin V2 receptor (V2R) mRNA and aquaporin-2 (AQP2) protein and mRNA expression in primary cultured inner medullary collecting duct cells. The upregulation of AQP2 was blocked by the V2R antagonist tolvaptan or protein kinase A (PKA) inhibitors. These findings led us to conclude that the nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is the main mechanism of drug-induced hyponatremia. Previous studies have also shown that the V2R has a role in chlorpropamide-induced hyponatremia. Several other agents, including metformin and statins, have been found to induce antidiuresis and AQP2 upregulation through various V2R-independent pathways in animal experiments but are not associated with hyponatremia despite being frequently used clinically. In brief, drug-induced hyponatremia can be largely explained by AQP2 upregulation from V2R-cAMP-PKA signaling in the absence of AVP stimulation. This paper reviews the central and nephrogenic mechanisms of drug-induced hyponatremia and discusses the importance of the canonical pathway of AQP2 upregulation in drug-induced NSIAD.

Concentration of urine samples improves sensitivity in detection of Strongyloides -specific IgG antibody in urine for diagnosis of strongyloidiasis

Detection of IgG in urine is an efficient method comparable to that in serum for diagnosis of strongyloidiasis but effects of daily variation in urine dilution on diagnostic accuracy is not clearly known. This study evaluated effects of urine concentration on detection of parasite-specific IgG by urine enzyme-linked immunosorbent assay (ELISA), particularly in individuals with border-line results or false-negative diagnosis. Optimal concentration conditions were established by comparing Strongyloides -specific IgG antibody levels between unconcentrated and concentrated urine in participants with different infection intensities, namely healthy control (HC), low-negative (LN), high-negative (HN) and low-positive (LP) groups. The optimal condition was selected and validated in a field-trial study. The final urine concentration protocol required centrifugation at 4,000 g at 4°C for 10 mins using the Amicon® concentrator tube. This protocol was validated in groups of participants with varying diagnoses according to urine ELISA and fecal examination (n=148). The concentrated-urine ELISA increased the proportion of positive results in the LN group by 68.2% and by 100% in the HN group. Significantly elevated IgG antibody levels were seen in the LP group. In the group that was false negative by urine ELISA but positive by fecal examination (n=28), concentrated-urine ELISA yielded 100% positive results. Overall, the frequency estimates of S. stercoralis were 23.6% by fecal culture, 27% by standard urine ELISA and 90.5% by concentrated-urine ELISA. Concentration of urine samples prior to analysis by ELISA improved the sensitivity for diagnosis and is potentially useful in diagnosis of strongyloidiasis in immunocompromised individuals or in low-prevalence areas.

Assessment of Zinc-alfa2 Glycoprotein (ZAG) and Lipase Maturation Factor 1 (LMF1) concentration in children with chronic kidney disease

ZAG (zinc-α2-glycoprotein) - adipokine, may participate in the mechanism of malnutrition in chronic kidney disease (CKD) as cachexia factor. The transmembrane protein of the endoplasmic reticulum - lipase maturation factor 1 (LMF1) is necessary for the secretion and enzymatic activity of lipases and lowering triglycerides level. The aim of the study was to evaluate these markers - ZAG and LMF1, their potential importance in CKD in children. The study included 59 children and adolescents aged 10.7±5.0 years with CKD. Compared with healthy children, serum and urine ZAG levels were higher in children with CKD. A similar relationship was obtained in the comparison of girls and boys between the above groups. We showed a reduced serum and urine concentration of LMF1 in children with CKD. Additionally, ZAG and LMF1 levels in children below 10 years of age and above 10 were no different. There was also no correlation between these markers and serum creatinine (except negative correlation of urinary ZAG), albumin, cholesterol, triglycerides. LMF1 concentration correlated positively with vitamin D level in dialyzed patients. To conclude, elevated serum ZAG levels in children with CKD document that selective kidney damage results in the rise of ZAG concentration, however the specific role of this marker in malnutrition was not documented. Reduced serum LMF1 concentration in children with CKD, did not correlate with standard parameters used to assess lipid metabolism and severity of CKD. The usefulness of LMF1 as the marker of the lipid metabolism disturbances in children with CKD was not proven.

Effect of glutathione supplementation on swimmers’ performance

Background and Study Aim. Continuously increasing the volume and intensity of the training sessions often leads to overtraining. It has been demonstrated that glutathione supplementation might improve the aerobic metabolism in skeletal muscle and reduce exercise-induced muscle fatigue. The aim of the study was to assess the effect of glutathione supplementation on fatigue, recovery processes, and competitive results of elite swimmers during a six-week training period. Material and Methods. Twenty-four elite swimmers (10 women and 14 men) from the Bulgarian national swimming team, with a mean age of 18.7±3.78 years, took part in this double-blind placebo control study. The swimmers from the experimental group were supplemented once a day with a capsule of 250mg glutathione, whilst the swimmers from the control group took a placebo once a day. The urine concentration levels of cortisol and cortisone, as well as the degree of overtraining, were evaluated on the 1st(T1), 14th(T2), 28th(T3), and 42nd(T4) days. Anthropometric measurements and a nutritional assessment were performed at T1 and T4. Results. The swimmers showed a gradual decrease of cortisol and cortisone during the study, with significantly lower concentrations in the experimental vs the control group at T4 (19.4 vs 42.5 ng/mL, p < 0.05). At the end of the study, the swimmers from the experimental group showed improvements in their time in 41 out of the 43 swimming events, whilst those from the control group had significantly smaller improvements (-1.66 vs -0.97%, p < 0.05). Conclusions. In conclusion, glutathione supplementation at a dose of 250mg/day for six weeks improves the adaptation of elite swimmers towards training schedules, which is likely to lead to better sports results.

PENGARUH UMUR PANEN PUCUK DAN KONSENTRASI POC URINE KELINCI TERHADAP PERTUMBUHAN DAN PRODUKSI PUCUK KENIKIR (Cosmos caudatus)

Kenikir is an indigenous plant that has the potential to be cultivated, but there are still many people who do not know the potential of kenikir. This research aims to study the effect of shoots harvest on the results of kenikir and to find the best concentration of liquid organic fertilizer rabbit urine for the growth of kenikir. This research was conducted in January - April 2020 in the experimentation field of Perjuangan University of Tasikmalaya at an altitude of 359 m asl. The design used was a two factor Randomized Complete Block Design (RCBD). The first factor is the age of harvest, consisting of 3 levels ie 7 WAP (Weeks after planting), 8 WAP and 9 WAP. The second factor is urine concentration consisting of 4 levels ie 0 ml.L-1, 10 ml.L-1, 20 ml.L-1 and 30 ml.L-1. The results showed that 10 ml of L-1 U2 treatment produced higher kenikir plants and thicker diameters. U2P3 treatment gave the best response to plant height variables. All treatment combinations gave the same response to the number of leaves harvested and the weight of fresh shoots

Regulated exocytosis: Renal Aquaporin-2 3D Vesicular Network Organization and Association with F-actin

Regulated vesicle exocytosis is a key response to extracellular stimuli in diverse physiological processes; including hormone regulated short-term urine concentration. In the renal collecting duct, the water channel aquaporin-2 localizes to the apical plasma membrane as well as small, sub-apical vesicles. In response to stimulation with the antidiuretic hormone, arginine vasopressin, aquaporin-2 containing vesicles fuse with the plasma membrane, which increases collecting duct water reabsorption and thus, urine concentration. The nano-scale size of these vesicles has limited analysis of their 3D organization. Using a cell system combined with 3D super resolution microscopy, we provide the first direct analysis of the 3D network of aquaporin-2 containing exocytic vesicles in a cell culture system. We show that aquaporin-2 vesicles are 43 ± 3nm in diameter, a size similar to synaptic vesicles, and that one fraction of AQP2 vesicles localized with the sub-cortical F-actin layer and the other localized in between the F-actin layer and the plasma membrane. Aquaporin-2 vesicles associated with F-actin and this association was enhanced in a serine 256 phospho-mimic of aquaporin-2, whose phosphorylation is a key event in antidiuretic hormone-mediated aquaporin-2 vesicle exocytosis.

The validity urine color scoring at different light conditions to assess low versus high urine concentration

Context: Urine color (Uc) is used to asses urine concentration when lab techniques are not feasible. Objective: To compare the accuracy of Uc scoring using four different light conditions and two different scoring techniques with a 7-color Uc chart. Additionally to assess the results' generalizability, a subsample was compared to scores obtained from fresh samples. Design: Descriptive laboratory study. Samples: 178 previously frozen urine samples were scored and n=78 samples were compared to its own fresh outcomes. Main outcome measure: Urine color and accuracy for classifying urine samples were calculated using receiver operating characteristics (ROC) analysis, allowing to compare the diagnostic capacity against a 1.020 urine specific gravity (USG) cut-off and defining optimal Uc cut-off value. Results: Uc was significantly different between light conditions (P&lt;0.01), with the highest accuracy (80.3%) of correctly classifications of low or high urine concentrations occurring at the brightest light condition. Lower light intensity scored 1.5–2 shades darker on a 7-color Uc scale than bright conditions (P&lt;0.001), with urine color but no further practical differences for accuracy between scoring techniques. Frozen was 0.5–1 shade darker than freshly measured Uc (P&lt;0.004), but they were moderately correlated (r=0.64). A Bland-Altman plot showed that reporting bias mainly affects darker Uc without impacting the diagnostic ability of the method. Conclusions: Uc scoring, accuracy and Uc cut-off values are affected by lighting condition but not by scoring technique, with higher accuracy and a one-shade lower Uc cut-off value at the brightest light (i.e. LED flashlight).