Heroin dependents are insulin resistant

Background. Fasting insulin levels, HOMA-IR and HOMA-%B are precise methods for determining insulin resistance and can be used in assessing the insulin sensitivity in heroin dependents (HD). Heroin dependents are expected to be insulin resistant. To determine the heroin influence on insulin sensitivity in male heroin dependents compared to control healthy male (K). Materials. Fasting insulin levels (I), HOMA-IR, HOMA-%B, fasting glucose levels (gl) and C-peptide (C) were determined in both groups, group K with mean age (28.1±4.2 yr) and mean BMI (22.8±2.5 kg/m2), not different compared to group HD with mean age (27.9±5.4 yr) and BMI (22.3±3.1 kg/m2),which were HCV negative. Methods. I and C were determined with hemiluminiscentmethod on Immunology Analyzer Immulate2000, HOMA-IR was calculated [(FIxFgl)/22.5], as well as HOMA-%B [(20xFI)/(Fgl-3.5)]. Results. I values in HD group were 15.24±27.6 IU/L, significantly higher compared to K (4.58±3.23) (p0.05). HOMA-IR in HD (2.52±3.29) and HOMA-%B (111.56±58.14) were significantly higher compared to the correspondent values in K (1.02±0.8) (p<0.016) and (68.83±46.57) (p<0.05). I values correlated highly significantly positively with HOMA-IR, HOMA-%B and C-peptide (p<0.0001) in HD. Conclusions. HD were characterized with significantly higher I, HOMA-IR, HOMA-%B values, which correlated highly significantly between themselves, confirming insulin resistance in HD

Respiratory Complications from Acute Corrosive Poisonings in Adults

Introduction: Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient. Objective: The aim of the study is to show the incidence of respiratory complications in acute corrosive poisonings, the need of various clinical investigations and also the treatment and final outcome of these kind of poisoning. Methods: We retrospectively analyzed clinical records of 415 patients hospitalized and treated at the University clinic for toxicology and urgent internal medicine, in Skopje, Republic of Macedonia, in the period between 2007 and 2011. The protocol consisted of methods for analyzing the systemic complications, with an accent on the post-corrosive respiratory complications. Results: From the total number of patients even 98 (23.61%) exhibited systemic complications, from which 51 (52.04%) are respiratory complications. The majority of patients are female (n=40, 78.43%) and the most common complication is pneumonia (n=47). The youngest patient in this study was 14 and the oldest was 87 years old. Conclusion: Besides the gastrointestinal complications in the acute corrosive poisonings respiratory complications are also very often. They complicate the clinical state of patient and very often lead to fatal endings

Differences in red blood cells distribution (RDW) at patients with ACS

Background: Considering the fact that the formation of the atheromatous plaque entails a series of changes at the vascular level, monitoring the number, shape and representation of blood elements has proven to be an important evidence for the further treatment of patients with ACS. This statement is due the evidence that RDW can provide information for higher heterogeneity in cell size (anisocytosis) as a result of maturation or degradation of RBC. Several studies have indicated the relationship of the relative distribution of erythrocytes with deterioration and mortality in such patients. Methods: Our study, among others, examined the percentage of erythrocyte variation or RDW in patients with symptoms and confirmed AMI and AP/NSAP admitted in the EU with aim to reveal or add more laboratory results for prognosis at patients with ACS. Overall, 95 patients with AMI of which 7 with fatal outcome, 42 patients with AP and 22 with NSAP were selected for statistical processing for the level of RDW. Measurements were made according to the IFCC recommendation for laboratory tests. Results: The results show that in patients with a confirmed AMI that ends with fatal outcome, average value for RDW was 13.3 %, except one patient, female, with RDW value 25.1 % that is not included in statistics. Mean value of the RDW of the rest of the patients diagnosed with AMI was 14.6%. As for patients with stable and unstable angina pectoris, we found a difference in favor of patients with unstable AP 15.6% vs. stable AP 14.2%. RDW percentage was higher at the female patients with NSAP, 16.6 % vs male with mean of 15,5% RDW. Conclusion: Our results and assumptions, prompted and supported by other significant data indicate the importance of determining this parameter in addition to the treatment of patients, especially at female patients with NSAP, due to already known pathology at this stage, increased risk factors and possible outcomes

Determination of Hsp 70 as one of the important inputs in the detection and definition of the degree of myocardial ischemic events

Background: Atherosclerosis induced myocardial ischemia should be as soon as possible confirmed in aim of further protocols. Oxidative stress, through various inflammatory events induces processes involved in repairing the damage. Determination of Heat shock proteins(Hsp)70, involved in this issue give useful data since they induce mechanisms that take part in protein remodeling so can repair the impaired myocardium integrity. Hypoxia and re-oxygenation alter the distribution of cardiac proteins through changes in mRNA so, cardiac myocytes try to protect themselves by regulating antioxidant proteins and stress proteins. Therefore, the determinations of Hsp70 antibodies indicate necrosis, but also witness the initiation of the repair processes of damage. Methods: Study involves group (200) patients suspected for AMI. Standard laboratory protocol was carried out for confirming or dismiss the AMI diagnosis including, photometric determination of cardiac enzymes, (CK, CKMB), MEIA principle for estimation of cardiac markers. Determination of concentration of Hsp70Ab was performed with ELISA technique. Results: Standard statistical analysis showed a positive correlation of Hsp 70 level and CRP with increase cTnT and cTnI values at patients with confirmed AMI (67% of patients). Also, we found an elevated level of Hsp70 in the majority of patients with AP/NSAP (96.7%) and in patients with pulmonary disease (100%). Level of Hsp 70 vs control group shows 15 fold increases at the patients with AP/NSAP, but more important is even 26fold increase at the patients with AMI. Results are significant in aspect of estimation of level of damage, according to some previous data that which detected the path of activation and transduction of the signals through different protein kinase pathological processes. Conclusion: Our results and the prevalence of detected increased Hsp 70Ab at 67 % of patients with AMI testify of engagement of this proteins in cardiac proteins recovering processes. The higher prevalence in patients with AP speaks about the chronic condition at the patients and therefore our recommendation, supported by other data, is to monitor the level of these proteins in patients with AP in order to avoid unwanted, unfavorable outcomes for such patients

Инсулинска резистенција и метаболичен синдром кај хепатитис Ц вирус серонегативни хероински зависници

Initial studies on impaired glucose-insulin homeostasis in heroin dependents have not defined the impact of concomitant hepatitis C infection (HCV), which has been&nbsp; strongly associated with the development of insulin resistanceand metabolic syndrome (MS). The aim of our study was to evaluate the association of heroin dependence with glucose-insulin homeostasis and MS in heroin dependents with HCV seronegativity. Materials and methods: The study was prospective and cross-sectional, including 160 heroin dependents compared to a control group of 60 participants.MS was diagnosed using International Diabetes Federation criteria. The homeostatic model assessment for insulin resistance (HOMA-IR) and pancreatic β-cell function (HOMA-%B) were used for assessing insulin resistance and β-cell function of pancreas. Results: MS was detected in 9.32% of heroin addicts. Heroin dependents with MS compared to dependents without MS were older, had higher BMI, waist circumference and significantly higher systolic and diastolic blood pressure, increased triglycerides (F=8.233, df=2, p&lt;0.001), apoB (F=8.154, df=2, p=0.001), and reduced HDL-C (F=25.926, df=2, p&lt;0.001) and apoA-I (F=16.406, df=2, p&lt;0.001), significantly increased inuslinemia (F=4.928, df=2, p&lt;0.05), insulin resistance-HOMA-IR (F=4,928, df=2, p&lt;0,05) and insignificantly increased pancreatic β-cell function (194.66 ±224.05) (F=2.461, df=2, p&gt;0.05). Conclusions: Insulin resistance and МS, independent of HCV, was also registered in heroin dependence. Timely recognition will enable more successful treatment of comorbidities and illicit drug dependence.Првичните студии за нарушена глукозно-инсулинска хомеостаза кај хероински зависници не го дефинираа и влијанието на&nbsp; хепатитис Ц инфекцијата (ХЦВ), којa е силно поврзана со развој на инсулинска резистенција и метаболичен синдром (МС). Целта на нашата студија беше да ја процени поврзаноста на зависноста од хероин со глукозно-инсулинската хомеостаза и МС кај хероински зависници кои се ХЦВ серонегативни. Материјали и методи: Студијата беше проспективна и пресечна, вклучувајќи 160 хероински зависници и контролна група од 60 испитаници. МС беше дијагностициран според критериумите на Меѓународната федерација за дијабетес. За проценка на инсулинската резистенција и функцијата на β-клетките на панкреасот беше користен хомеостатскиот модел за инсулинска резистенција (HOMA-IR) и функцијата на β-клетките на панкреасот (HOMA-%B). Резултати: МС беше детектиран кај 9,32% од хероинските зависници и тие во споредба со зависниците без МС беа постари, со повисок БМИ, обем на половината и значително повисок систолен и дијастолен крвен притисок, покачени триглицериди (F=8, 233, df=2, p&lt;0,001), apoB (F=8,154, df=2, p=0,001), и намалени HDL-C (F=25,926, df=2, p&lt;0,001) и apoA-I (F=16,406, df=2, p&lt;0,001), со значително зголемена инсулинемија (F=4,928, df =2, p&lt;0,05), инсулинска резистенција – HOMA-IR (F=4,928, df=2, p&lt;0,05) и незначително зголемена функција на β-клетките на панкреасот (194,66 ±224,05) (F=2,461, df=2, p&gt;0,05). Заклучок: Инсулинската резистенција и МС, независно од ХЦВ инфекција, се регистрира и кај хероинската зависност. Навременото препознавање ќе овозможи поуспешен третман на коморбидитетите и на болеста на зависноста од илегални дроги

Teško oštećenje bubrežne funkcije u odraslih bolesnika s akutnim trovanjem octenom kiselinom

Acetic acid is a widely used organic acid with corrosive properties that depend on its concentration. If acetic acid is ingested in concentrations above 30 % it may severely damage the upper gastrointestinal tract and cause intravascular haemolysis, which can result in severe kidney and liver disorders and disseminated intravascular coagulation. In this retrospective study, we analysed acetic acid ingestion data collected at the University Clinic for Toxicology of Skopje, Macedonia from 1 January 2002 to 31 December 2011. The analysis included systemic complications, kidney damage, and the outcomes in particular. Over the ten years, 84 patients were reported at the Clinic to have ingested highly concentrated acetic acid. Twenty-eight developed kidney disorders, while the remaining 56 had no complications. Fatal outcome was reported for 11 patients, seven of whom had systemic complications and four severe gastrointestinal complications.Octena kiselina organska je kiselina s korozivnim svojstvima koja ovise o njezinoj koncentraciji. Ako se unese u koncentracijama iznad 30 %, može teško oštetiti gornji dio gastrointestinalnog sustava i izazvati intravaskularnu hemolizu, što može dovesti do teških oštećenja bubrega i jetara te do diseminirane intravaskularne koagulacije. U ovome retrospektivnom ispitivanju analizirani su slučajevi gutanja octene kiseline prikupljeni u Sveučilišnoj klinici za toksikologiju u Skopju od 1. siječnja 2002. do 31. prosinca 2011. Analize su obuhvatile sistemske komplikacije, oštećenja bubrega i ishode. Tijekom deset godina, u Kliniku su se javila 84 bolesnika zbog gutanja visokokoncentrirane octene kiseline. Njih 28 dobilo je bolest bubrega, a preostalih 56 nije imalo komplikacije. Smrtni je ishod bio zabilježen u 11 bolesnika, od kojih je sedam imalo sustavne komplikacije, a četiri teške gastrointestinalne komplikacije

Insulin resistance and metabolic syndrome in hepatitis C virus seronegative heroin dependents

Initial studies on impaired glucose-insulin homeostasis in heroin dependents have not defined the impact of concomitant hepatitis C infection (HCV), which has been strongly associated with the development of insulin resistance and metabolic syndrome (MS). The aim of our study was to evaluate the association of heroin dependence with glucose-insulin homeostasis disturbances and MS in heroin dependents with HCV seronegativity. Materials and methods: The study was prospective and cross-sectional, including 160 heroin dependents compared to a control group of 60 participants. MS was diagnosed using International Diabetes Federation criteria. The homeostatic model assessment for insulin resistance (HOMA-IR) and pancreatic β-cell function (HOMA-%B) were used for assessing insulin resistance and β-cell function of pancreas. Results: MS was detected in 9.32% of heroin addicts. Heroin dependents with MS compared to dependents without MS were older, had higher BMI, waist circumference and significantly higher systolic and diastolic blood pressure, increased triglycerides (F=8.233, df=2, p0.05). Conclusions: Insulin resistance and МS, independent of HCV, was also registered in heroin dependence. Timely recognition will enable more successful treatment of comorbidities and illicit drug dependenc

Artifitial nutrition in therapeutic approach of acute caustic poisoning

Acutes corrosive poisonings can cause serious chemical injuries of the upper gastrointestinal tract, and they are localized most frequently in the esophagus and the stomach because the poison remains there a long time. Treatment of the acute corrosive intoxications include: neutralization of corrosive agents, antibiotics, corticosteroids, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery.The damaged mucosa, submucosa and muscle layer regenerate with great difficulty because of the surrounding inflammation, necrosis and secondary complications. Tissue fibrosis, adhesions or circular stenosis appear, which greatly disturb the normal functioning (impeded peristaltic, impeded passage). All these complicate the entire general condition of the patient, including inadequate normal food intake, loss of body weight, prostration, cachexia. These patients are also into a severe general condition due to hypercatabolic state and negative alkali balance. Therefore, early nutritional support is of substantial importance in treatment of these patients. Nutritional support can be given by parenteral way in peripheral or central vein and by enteral way through specially designed tubes inserted in the stomach or intestines, prepyloric or postpyloric. The type of artificial nutritional support will depend on the grade of esophageal or gastric damage determined by endoscopy

Heroin dependents are insulin resistant

Background. Fasting insulin levels, HOMA-IR and HOMA-%B are precise methods for determining insulin resistance and can be used in assessing the insulin sensitivity in heroin dependents (HD). Heroin dependents are expected to be insulin resistant. To determine the heroin influence on insulin sensitivity in male heroin dependents compared to control healthy male (K). Materials. Fasting insulin levels (I), HOMA-IR, HOMA-%B, fasting glucose levels (gl) and C-peptide (C) were determined in both groups, group K with mean age (28.1±4.2 yr) and mean BMI (22.8±2.5 kg/m2), not different compared to group HD with mean age (27.9±5.4 yr) and BMI (22.3±3.1 kg/m2),which were HCV negative. Methods. I and C were determined with hemiluminiscentmethod on Immunology Analyzer Immulate2000, HOMA-IR was calculated [(FIxFgl)/22.5], as well as HOMA-%B [(20xFI)/(Fgl-3.5)]. Results. I values in HD group were 15.24±27.6 IU/L, significantly higher compared to K (4.58±3.23) (p0.05). HOMA-IR in HD (2.52±3.29) and HOMA-%B (111.56±58.14) were significantly higher compared to the correspondent values in K (1.02±0.8) (p<0.016) and (68.83±46.57) (p<0.05). I values correlated highly significantly positively with HOMA-IR, HOMA-%B and C-peptide (p<0.0001) in HD. Conclusions. HD were characterized with significantly higher I, HOMA-IR, HOMA-%B values, which correlated highly significantly between themselves, confirming insulin resistance in HD

Acute venlafaxine overdose with positive urine immunoassay for tramadol – clinical and diagnostic overlap - case report and literature overview

Objective. The overlapping of pharmacokinetics and/or the pharmacodynamics of medicines causes the occurrence of overlapping clinical syndromes and diagnostic issues, potentiated in overdoses. We report a case of severe venlafaxine poisoning where the clinical presentation and the results of rapid immunoassay test overlapped with tramadol intoxication. Case presentation. An unconscious women with recurrent seizers, hypertension and supposed acute medication poisoning in suicidal attempt was transported to our clinic. Previously, she had been lavaged, rehydrated and treated with 20 mg diazepam iv, 40 mg furosemide at the local general hospital. Her regular tablet therapy consisted of losartan, levothyroxine, venlafaxine, occasionally tramadol. At admission she was comatose, with isochoric normal pupils, BP 130/80 mm Hg, SaO2 86%, and recurrent episodes of seizures treated with 10mg diazepam iv, ocular clonus, hypertonus, temperature 38.9C, diaphoresis, facial hyperaemia, dark coloured urine, hyponatremia and rhabdomyolisis. The lateral flow immunoassay (AbuGnostR) was positive for tramadol, but the homogeneous enzyme immunoassay did not confirm it. After 36 hours of intensive treatment she became somnolent and reported ingestion of 2250 mg tbl Venlafaxine. The AbuGnost R test detects tramadol at cut off urine values 200ng/ml, but present cross reactivity with O-desmethyl-venlafaxine at cut off values up to 25000ng/ml. The following days she complained of muscular weakness, headaches and cognitive impairment, which lasted for more then one month after release from hospital. Conclusion. High concentrations of venlafaxine metabolites induce false positive tramadol immunoassay (AbuGnostR) test. Overlapping clinical presentations and metabolic pathways of venlafaxine and tramadol should alert physicians when interpret rapid immunoassay test. The mandatory principle when making medical decisions should cover synthesis of critically interpreted toxicology analysis, interview data and clinical features of the poisoning, which may help to avoid misleading conclusions and improve the diagnostic and therapy decisions