Evaluation of Common Non-pharmacological Chemical Substance Poisonings in Childhood

Acute intoxications in adolescents and adults are mostly associated with intentional or accidental ingestions. Intoxications are commonly seen in children aged between 1 and 5 years and most of the cases are associated with accidental intake. In most of the children, no clinical symptoms related to intoxication are observed or only mild effects can develop. The main route of drug elimination is through kidneys. Absolute clearance in children is often lower than in adults but weight-adjusted clearance is higher. Depending on more rapid elimination in children the plasma half-life of the drug might be shorter in children than in adults. A shorter elimination half-life means that plasma steady-state is achieved with repeated doses. It is important to prevent childhood intoxications, and the use of child-resistant packaging and adequate supervision together with the secure storage of household substances are the basis of prevention of accidental childhood intoxications. Intoxications represent one of the most common medical emergencies in children, and epidemiological characteristics vary in different countries. Therefore, special epidemiological surveillance is necessary for each country to determine the problem according to which preventive measures should be taken. Early awareness and taking appropriate therapeutic measures seems to be effective in the reduction of mortality rate. The major and most common non-pharmacological chemical intoxications in childhood have been reviewed here with the intent of helping health-care professionals, particularly pediatricians to recognize and reduce the risk of harmful childhood intoxications

Determination of 5-hydroxymethylfurfural (5-HMF) in Expired Pharmaceutical Syrups by Using HPLC-DAD Method

The Maillard reaction product 5-hydroxymethylfurfural (5-HMF) is formed under acidic conditions by the dehydration of sugars in carbohydrate-based food and pharmaceutical products during heating and storage. As pharmaceutical syrup formulations contain sugar and are stored under room temperature, they provide favorable conditions for the formation of 5-HMF. The long-term storage of syrup bottles after their cap has been opened and the unintentional use of expired syrups can lead to the formation of undesirable products such as 5-HMF in medications. Although legal limits have been established for 5-HMF content in pharmaceutical preparations, these levels may exceed those limits in hot climates or under inappropriate storage conditions. The present study detects and measures 5-HMF levels in expired pharmaceutical syrups through the HPLC-DAD (High Performance Liquid Chromatography with Diode Array Detection) method, and investigates the effects on 5-HMF levels of the 72-hour storage of syrups at temperatures of 40˚C. The 5-HMF level in syrups stored at room temperature varied between 1.34 μg/mL to 15.63 μg/mL, while in syrups stored at higher temperatures, the levels ranged from 2.24 μg/mL to 18.24 μg/mL. This indicated that 5-HMF content in syrups stored at 40 ˚C was higher than those measured in syrups stored at room temperature, although the increase was not found to be statistically significant (p>0.05). In addition to measuring the amount of 5-HMF in pharmaceutical syrups, this study also examined the changes in the levels of this dehydration product in syrup formulations under hot climates and according to storage conditions

Yaşlılarda çoklu ilaç kullanımının değerlendirilmesi

Amaç: Çoklu ilaç kullanımı, polifarmasi olarak ta adlandırılmaktadır. Hastanın aynı anda veya belli aralıklarla, çoğu zaman endikasyon olmadan birden fazla ilacı bir arada kullanmasıdır. Polifarmasi en sık, birden fazla kronik hastalığın bir arada görüldüğü yaşlı hastalarda gözlenmektedir. Yaşlı hastalarda polifarmasiye bağlı en önemli sorun ise ilaç uyuncunun sağlanamamasıdır. Çalışmamızda bir grup yaşlı hastada çoklu ilaç kullanımı sonrasında ilaç uyuncu değerlendirilmiştir.Gereç ve Yöntem: Çalışma 55 yaş üstü, 70 hasta ile yürütülmüştür. Hastalarla yüz yüze görüşülerek çoklu ilaç kullanımları değerlendirilmiştir. Bulgular: İlaç uyuncu ve eğitim düzeyi arasında bir ilişki bulunmamıştır. Kadınların ilaçları doğru kullanım oranı, erkeklerden daha fazla bulunmuştur. Yaşlıların %19'unun alternatif tedavileri tercih ettikleri, geleneksel ve alternatif tedaviyi birlikte uygulayanların ise %22.9 olduğu bulunmuştur. Katılımcıların % 1.4'ünün hekim önerisi dışında ilaç kullandığı bulunmuştur.Sonuç: Yaşlanma süreci, tüm organ sistemlerini etkileyen yapısal ve fonksiyonel değişikliklerle karakterize, homeostatik kapasitenin azalmasına neden olan bir süreçtir. Vücut kompozisyonundaki değişiklikler, hepatik ve böbrek fonksiyonlarını etkileyerek yağda çözünen ilaçların dağılım hacminde artış ve suda çözünen ilaçların klerensinde azalmayla sonuçlanmaktadır. İlaçların plazma yarılanma ömrü genel olarak artmaktadır. Yaşlanmaya bağlı farmakokinetik ve farmakodinamik değişikliklerin terapötik rejimler üzerindeki etkisini iyi anlamak, tedavi etkinliğini artıracaktı

The relationship between neopterin and hepatitis B surface antigen positivity

Hepatitis B is a life-threatening viral liver infection caused by the hepatitis B virus. Neopterin is regarded as an immunologic biomarker of several diseases related to activation of the cellular immune system. Hepatitis B infection is associated with increased production of cellular immune system markers. We aimed to investigate whether there is a relationship between hepatitis B surface antigen-positivity (HBsAg +) and neopterin to determine the role of neopterin in the early diagnosis of hepatitis B infections. Seventy-two HBsAg (+) patients with normal liver function tests and forty-three controls were included in the study. Neopterin levels were 17.6 ± 0.13 nmol/L in HBsAg (+) patients; and 9.12 ± 0.09 nmol/L in infection-free controls, respectively. Compared to the control group, a statistically significant increase (p 0.05). With overstimulation of interferon-gamma, the production of neopterin increases by monocytes/macrophages. Likewise with other diseases associated with an activated cellular immune system, this study shows that neopterin can be a predictive biomarker for persistent carriers of hepatitis B infection

Tryptophan Degradation and Antioxidant Status in Patients With Thyroid Disorders.

The aim of this study was to evaluate the degradation of tryptophan (Trp), neopterin production and antioxidant capacity in patients with benign and malignant thyroid disease

Drug-Drug Interaction of Aldehyde Oxidase Inhibitor and Xanthine Oxidase Inhibitor with Favipiravir

Aim: Favipiravir is an effective antiviral used in the treatment of COVID-19. It is metabolized by aldehyde oxidase (AO) and xanthine oxidase (XO). This study investigated drug-drug interactions between favipiravir with both AO substrate and XO enzyme inhibitor, allopurinol, and an XO inhibitor, verapamil. Material and Methods: 25 Sprague-Dawley female rats, 250-300 g, were divided into five equal groups. Blood samples were taken from the jugular vein at the end of 0, 15, 30, and 45 minutes, and at the end of the 1st, 2nd, 4th, 6th, and 8th hours after the drugs were administered. The drug-blood concentration was determined in the HPLC-UV device using plasma. The ELISA method measured AO and XO enzyme activities in rat liver tissue. Results: Allopurinol prolonged the time taken for favipiravir to reach Cmax (Tmax), decreased maximum serum concentration (Cmax), elimination half-life (T1/2), area under the curve (AUC), and mean residence time (MRT). Allopurinol significantly reduced clearance per unit time (Cl/f) when co-administered with favipiravir. Verapamil accelerated the elimination of favipiravir, significantly reducing T1/2, MRT, and AUC. On the other hand, Favipiravir decreased the absorption of verapamil and slowed its elimination. Cmax, AUC, and Cl values of verapamil decreased. In addition, T1/2, MRT, and volume of distribution (Vd) increased. Conclusion: In conclusion, the concomitant use of favipiravir with other drugs that affect AO and/or XO enzyme activities may cause changes in the pharmacokinetic profiles of drugs and the levels of enzymes that metabolize drugs

Neopterin Levels And Indoleamine 2,3-Dioxygenase Activity As Biomarkers Of Immune System Activation And Childhood Allergic Diseases

Background Although Th2 immune activation is predominant in allergic diseases, neopterinlevels and indoleamine 2,3-dioxygenase (IDO)-1 activity (kynurenine:tryptophan ratio), which reflect Th1 immune activity, increase with interferon-gamma (IFN-γ) stimulation. We investigated neopterin, tryptophan, and kynurenine levels as biomarkersof the Th1 immune system activation and changes in IDO-1 activityin children with asthma, allergic rhinitis, and atopic dermatitis, as well as the relationship between these biomarkers and the total IgE level, age, and disease severity. Methods We divided 205 children (80 girls and 125 boys, four months to 17 years old) into four groups: controls, patients with asthma, patients with allergic rhinitis, and patients with atopic dermatitis. Peripheral venous blood samples were collected. Neopterin levels were determined by an enzyme immunoassay. Tryptophan and kynurenine levels were analyzed using HPLC. IDO-1 enzyme activity was calculated using tryptophan and kynurenine levels. IgE levels were measured. The Mann-Whitney U test, Kruskal-Wallis test, and Conover post-hoc method were used for statistical analysis. Results Neopterin, tryptophan, and kynurenine levels were higher and IgE levels and IDO-1 enzyme activity were lower in patients with asthma and allergic rhinitis than in controls (P<0.05). Patients with atopic dermatitis showed higher neopterin, tryptophan, and kynurenine levels, higher IDO-1 activity, and lower IgE levels thancontrols (P<0.05). Conclusions The Th1/Th2 balance is disrupted in children with allergic diseases, concomitant with increased Th1-mediated immune response activation and reduced IgEproduction, which is promoted by Th2-type cytokines.PubMedWoSScopu