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.

Metabolomics Profile in Acute Respiratory Distress Syndrome By Nuclear Magnetic Resonance Spectroscopy In Patients With Community-Acquired Pneumonia

Background: Acute respiratory distress syndrome (ARDS) is a challenging clinical problem. To date, no standardized diagnostic biomarker has been validated for community-acquired pneumonia (CAP)-induced ARDS. An integrated analysis of changes in the metabolic profile could help detect biomarkers for early prediction of ARDS development and evaluation of treatment efficacy.Methods: A total of 88 patients were enrolled for the final analysis and divided into two groups: the ARDS group (n = 43) and the no-ARDS group (n = 45). We examined differences in serum and urine metabolites and explored dynamic changes with nuclear magnetic resonance (NMR) spectroscopy.Results: A total of 20 serum and 42 urine metabolites were identified using NMR spectroscopy. Serum metabolites, including leucine, 3-hydroxybutyrate, lactate, acetone, citrate, and choline, and urine metabolites, including creatine and creatinine, could distinguish patients with CAP with and without ARDS, with areas under the receiver operating characteristic curve (AUC) values of 0.790 and 0.747, respectively. The treatment efficacy of patients with ARDS was achieved at an AUC of 0.862 with serum metabolites 3-hydroxybutyrate, lactate, acetone, acetoacetate, citrate, and choline, and of 0.691 with urine metabolites taurine and glucose. The treatment efficacy of patients without ARDS was achieved at an AUC of 0.845 with serum metabolites alanine, acetate, acetoacetate, glutamine, creatine, and glucose and 0.891 with urine metabolites choline, tryptamine, and 3-indoxyl sulfate. We also proposed a combined biomarker of associated serum and urine metabolites to predict ARDS in patients with CAP (AUC = 0.865) and evaluate treatment efficacy for patients with and without ARDS (AUC = 0.921 and 0.893, respectively).Conclusions: Serum and urine analyses showed that metabolomics provides potential circulatory markers for early prediction and evaluation of treatment efficacy in patients with CAP with and without ARDS.

Achievements of Mesoporous Carbon Solution and Single-Walled Carbon Nanotube Composite on the Sensitive Electrochemical Assay of Ivabradine

In this study, the electrochemical determination of Ivabradine hydrochloride (IH) was studied in detail using a glassy carbon electrode (GCE) modified with mesoporous carbon solution (MCS) and carboxylated group linked single-walled carbon nanotube (SWCNT-COOH). The developed nanosensor showed a significant effect by remarkably increasing the IH signal compared with the bare GCE. Cyclic (CV) and differential pulse voltammetric (DPV) methods were applied to perform electrochemical analysis of IH in pH 3.0 BRB solutions. The calibration plot for IH with a detection limit of 1.47 × 10−7 M was obtained using the DPV technique in the range of 1–10 µM under optimum experimental conditions. The proposed method has been validated and applied for the detection of the IH tablet. The produced nanosensor was also performed for the determination of IH in serum and urine. Excellent recoveries of 98.4%, 98.0%, and 100.2% were achieved for tablet, serum, and urine analysis, respectively.

Mechanisms for Cardiac Troponin Increase in Arterial Hypertension

Despite the fact that cardiac troponins (cTnI and cTnT) are cardiospecific, they can be elevated in many systemic and non-cardiac physiological and pathological conditions. The diagnostic value of cTnI and cTnT significantly depends on the method of their determination. Thus, previously used low- and moderate-sensitivity immunoassays detected only serious myocardial damage and did not determine troponins in patients suffering from certain chronic pathologies. High-sensitivity troponin assays can detect minor damage to cardiac muscle cells in many pathological conditions, and troponin levels have a high predictive value. Among the early pathological conditions requiring the attention of clinicians is arterial hypertension (AH), which is also accompanied by an increase in the levels of hsTn in serum and urine. Currently, mechanisms responsible for increased levels of cardiac troponins in the blood serum and urine in hypertension are not well covered in the scientific literature. This article discusses in detail the presumptive mechanisms that cause increased levels of cTnI and cTnT in AH.

Overdose of Quetiapine—A Case Report with QT Prolongation

Quetiapine is an atypical antipsychotic drug used to treat bipolar disorder, schizophrenia, and major depressive disorder. Although several studies describe the adverse effects of intoxication with Quetiapine, only a few report an extreme overdose without comedications that lead to a life threat. We present a case of a 75-year-old male who tried to attempt suicide by ingesting 28 g of Quetiapine. During the management in the emergency department, both serum and urine samples were collected, allowing a complete pharmacokinetic analysis to be conducted, from the admission to the discharge.