Acute psychosis and serotonin syndrome in the setting of "Triple-C" overdose: a case report

BACKGROUND: Over-the-counter medication overdose is a difficult diagnostic challenge for many physicians as common drug screening assays cannot detect these substances. We present a case of acute psychosis, serotonin syndrome, and anticholinergic overdose-like properties in the setting of Coricidin HBP Cough & Cold tablets, known by their street name Triple-C. This is the first case report we are aware of involving a patient presenting with these symptoms and requiring critical-care-level support. CASE PRESENTATION: A 31-year-old African American female with a past medical history of anxiety, childhood asthma, previous methamphetamine abuse, and coronavirus disease 2019 infection in August 2020 was brought to the emergency department by the local police department with altered mental status. Initial blood work, including extended drug screens, were unremarkable for a definitive diagnosis. This patient required critical-care-level support and high sedation because of her symptoms. Collateral history revealed the patient regularly consumed Triple-C daily for the 6 weeks prior to admission. A trial off sedation was attempted after 24 hours with no complications. The patient admitted to regular Triple-C consumption and auditory hallucinations since adolescence. She was discharged safely after 48 hours back into the community. She was lost to follow-up with psychiatry and internal medicine; however, she was evaluated in the emergency room 1 month later with a similar psychiatric presentation. CONCLUSION: Overdose of Triple-C should be kept in the differential diagnosis of patients presenting with a triad of psychosis, serotonin syndrome, and anticholinergic overdose, in the setting of unknown substance ingestion

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Microbial decontamination of urea formaldehyde bonded medium density fiberboard

ix, 91, IV leaves : ill. (some col.) ; 29 cm.Includes abstract.Includes bibliographical references (leaves 82-91).Urea-formaldehyde (UF) is a resin commonly used as an adhesive for medium density fiberboard (MDF). Diverting MDF from Canadian landfills is important to decrease annual methane emissions. The use of anaerobic digestion and aerobic fungi were investigated as potential decontamination methods for the decontamination of toxic UF resins; specifically the formaldehyde (FA) component. For anaerobic digestion batch reactors with three inoculum types were used; diluted cow manure (DCM) inocula and decaying sea weed (DSW). FA concentration, gas production, and reactor conditions were measured. Reactors with 10 g L[superscript -1] MDF (1.1 – 1.4 g UF) were used with retention times of 38 days. Thermophilic (55 °C) reactors with fresh DCM as an inoculum had the greatest UF decontamination and gas production. Final FA concentration was 5.523 (SD = 1.516) ppm. GC-FID suggested partial UF resin un-hydrolyzed still in solution. The aerobic fungus Paecilomyces variotii was tested at various temperatures for its FA degrading potential. At 40 °C P. variotii could decontaminate autoclaved MDF with FA concentrations dropping from 400 ppm to 3.970 ppm (SD 3.832) ppm in 7 days, but pH rapidly increased and fungal death occurred

Glutathione dependent NADP+ linked enzymatic pathway as a possible pathway used by microorganisms in the detoxification of formaldehyde resins

1 online resource (vii, 43 p.) : ill.Includes abstract.Includes bibliographical references (p. 41-43).Urea-formaldehyde polymers undergo hydrolysis to break into their monomeric components; one of which is formaldehyde. When resin containing wood chips are put into anaerobic bioreactors it is suspected that formaldehyde breaks down into carbon dioxide and methane gas, by microbes present in the system; this shares common characteristics with the MixAlco® fermentation process. The biochemical pathway with which this is achieved is unknown in this system, however throughout nature with respect to microbes, both eukaryotes and prokaryotes; their metabolic pathways are intensely studied and characterized. The purpose of this experiment was to determine if a glutathione (GSH) dependent NADP+ linked pathway was used by microbes for this process. Custom primers for use with polymerase chain reactions (PCR) were created to detect the presence of a gene responsible for the synthesis of a key intermediate enzyme in this pathway; S-(hydroxymethyl) glutathione dehydrogenase (S-GSHDH). Agarose Gel electrophoresis determined a greater intensity of S-GSHDH gene PCR product in samples with urea formaldehyde resins as a primary carbon source. These findings correlate with the resource ratio competition models and support the hypothesis that this pathway may be one of the main pathways used in this system

Students' participation in collaborative research should be recognised

Letter to the editor