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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
I would request a urine dipstick to look for haematuria and proteinuria, as a screen for any renal disease. I would check the FBC, urea and electrolytes to look for signs of anaemia, raised WCC, neutrophils and deranged renal function. This may represent occult or active bleeding, as well as reactions to foreign material in the patient. I would also consider faecal occult blood testing as an adjunct to PR examination for foreign bodies potentially in the colorectal system. I would next request chest and abdominal radiographs to look for any obvious signs of foreign bodies. Although the patient denies any symptoms of ingestion, if missed this can be fatal and difficult to manage. I would also wish to further explore the abdomen, as there is an obvious superficial injury which may have caused underlying visceral damage.
Neurotoxicology
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Sean D. McCann, Trevonne M. Thompson
Strychnine is a naturally occurring alkaloid derived from the Strychnos nux-vomica tree, with the highest concentrations of the toxin found in the seeds and blossoms. Strychnine can be used as a rodenticide, although it has largely been replaced by products with less potential for human toxicity. Strychnine is an antagonist of glycine and acetylcholine (ACh) receptors in the central and peripheral nervous systems. Signs and symptoms are the result of decreased inhibitory tone and present as severe, painful muscle contractions similar to those seen in tetanus, which can then progress to seizure. The diagnosis is based on a history of ingestion, and treatment consists of aggressive supportive care with no available specific antidote.
Paediatric Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Refer patients to the paediatric team for admission and observation if: Symptomatic following significant ingestion.Potentially toxic ingestion.Presenting late at night and require overnight observation.Deliberate self-harm is suspected, for psychiatric assessment.
Insecticide potential of two saliva components of the predatory bug Podisus nigrispinus (Heteroptera: Pentatomidae) against Spodoptera frugiperda (Lepidoptera: Noctuidae) caterpillars
Published in Toxin Reviews, 2022
Juliana Mendonça Campos, Luis Carlos Martínez, Angelica Plata-Rueda, Wolfgang Weigand, José Cola Zanuncio, José Eduardo Serrão
Prey death associated with extra-oral digestion has been reported for the predatory heteropterans Belostoma anurum Herrich-Schäffer (Belostomatidae), Podisus maculiventris Say (Pentatomidae), and Rhynocoris marginatus Fabricius (Reduviidae) (Bell et al. 2005, Silva-Cardoso et al. 2010, Sahayaraj and Muthukumar 2011). Extra-oral digestion begins with the injection of saliva, which contains proteins that break down prey tissues and facilitate their ingestion (Cohen 1998, Fialho et al. 2012, Martínez et al. 2014, 2015). The presence of proteins (of hydrolyzing enzymes) such as amino-peptidase, amylase, cathepsin, chymotrypsin, α-glucosidase, lipase, phospholipase, and trypsin in the saliva has been found but collagenase act on the collagen present in intercellular space, contributes to toxic degradation and liquefaction of prey’s tissues (Fialho et al. 2012). During feeding, predatory bugs insert the stylet into the prey body and release saliva, leading to prey paralysis and death (Schmidt 1982, Cohen 1998, Martínez et al. 2016), which suggest that some components in the saliva of heteropteran are venoms toxic for preys (Martínez et al. 2016, Walker et al. 2016).
Poisoning of glutaraldehyde-containing products: clinical characteristics and outcomes
Published in Clinical Toxicology, 2021
Suthimon Thumtecho, Charuwan Sriapha, Achara Tongpoo, Umaporn Udomsubpayakul, Winai Wananukul, Satariya Trakulsrichai
The most common symptoms found in this study were mild local irritation of acutely exposed areas. Chemical cross-linking with proteins may result in the direct cytotoxic effects, although the precise mechanism by which this occurs is not known [26]. Ingestion was the most frequent route of exposure found in our study, while data on acute oral toxicity are limited to a few individual case reports and are mostly extrapolated from animal studies. In animal studies, aqueous solutions of >5% GA cause moderate acute peroral toxicity [8], and concentrated GA solutions may corrode the upper alimentary tract [27]. Most of our patients were exposed to GA concentrations greater than those in this animal study, and they experienced symptoms ranging from local irritation to GI necrosis. Moreover, ingestion can involve the respiratory tract and cause systemic effects, consistent with previous reports [7,11]. In one case report, an 8-year-old child was diagnosed with chemical pneumonitis after accidental GA inhalation with/without aspiration of GA [7].
Brain activity and connectivity changes in response to nutritive natural sugars, non-nutritive natural sugar replacements and artificial sweeteners
Published in Nutritional Neuroscience, 2021
Anna M. Van Opstal, Anne Hafkemeijer, Annette A. van den Berg-Huysmans, Marco Hoeksma, Theo. P. J. Mulder, Hanno Pijl, Serge A. R. B. Rombouts, Jeroen van der Grond
ECM is an assumption- and parameter-free method to determine the level and quality of connectivity on a voxel-wise level which has been shown to be modulated by the physiological state of the subject and could thus be used to investigate states of hunger satiety and changes in response to nutrient ingestion [44,45]. For the ECM connectivity analysis, the data-driven ICA-based Automatic Removal of Motion Artifacts (ICA-AROMA) was used to identify components in the data related to head motion and to remove these using linear regression [48,49]. Voxel-based connectivity eigenvector centrality maps were calculated on the ICA-AROMA preprocessed data for each participant using fast-ECM software, which estimates voxel-wise eigenvector centralities from fMRI time series [45]. Pre- and post-ingestion eigenvector centrality maps were compared in a voxel-wise approach in the masked gray matter using the Randomize tool with a paired samples approach and using TFCE [47]. Pre- and post-ingestion scans were compared per condition with paired two-sided contrasts. The same family wise error (FWE) correction at p < 0.05 as for the whole brain BOLD analysis was used. The average Quantitative Eigenvector centrality value was determined in the voxels/clusters showing significant changes per study stimulus by using the thresholded statistical maps as a total mask to determine the mean Eigenvector values per subject.