-
[show abstract]
[hide abstract]
ABSTRACT: Aripiprazole is a new drug applied in schizophrenia treatment. There are not strict indications for aripiprazole therapeutic drug monitoring. Despite, serum aripiprazole measuring would help control the drug doses effectiveness. The drug monitoring can eliminate overdosing, adverse effects and let control proper drug ingestion. The aim of the paper was to develop a simple method for aripiprazole determination in serum for therapeutic drug monitoring. High performance liquid chromatography with spectrophotometric detection (HPLC-UV) was used. Resolution was performed on LC-8 column; moving phase was solution 0,025M trimethylammonium buffer: acetonitrile (62:38). Isocratic flow was 1,2 ml/min; internal standard (IS) was promazine; monitored wavelength was lambda=214 nm. The validation parameters were: limits of linearity (LOL) 100-800 ng/ml, limit of detection (LOD) 10 ng/ml, limit of quantity (LOQ) 100 ng/ml. Coefficient of variation (CV) describing accuracy and precision didn't cross 10%. The method was useful for therapeutic drug monitoring in serum of patients treated with aripiprazole.
Przegla̧d lekarski 01/2012; 69(10):1004-6.
-
[show abstract]
[hide abstract]
ABSTRACT: Diagnostics of patients poisoned with psychoactive substances is usually performed by immunoenzymatic methods. The results obtained by the methods are not reliable. A few percent of results can be "false positive" or "false negative". The purpose of the paper was to present cases of "false positive" THC and amphetamine derivatives results obtained in urine of patients treated in Departments of Toxicology in Krakow and in Tarnow. Confirmation tests gave negative results. Interpretation of results obtained by immunoassay methods should include possibility of "false" result. The physician should consider verification of the results and refer confirmation by reference methods.
Przegla̧d lekarski 01/2012; 69(8):629-31.
-
[show abstract]
[hide abstract]
ABSTRACT: Guideline for out - of Hospital triage and initial management of patients with suspected ingestion of dextromethorphan is presented in the study. The guideline was created by the American Association of Control Centers to assist poison center personnel while dealing with poison information service.
Przegla̧d lekarski 01/2011; 68(8):466-7.
-
[show abstract]
[hide abstract]
ABSTRACT: Carboxyhemoglobin is a specific biomarker of carbon monoxide (CO) exposition. The source of CO indoors are most often gas, oil or carbon furnaces and stoves or bathroom gas heaters. CO intoxication during fire or exposition to car fumes are sporadic. The aim of the study was: to present the frequency of CO intoxications diagnosed in Laboratory of Analytical Toxicology UJ Collegium Medicum in years 2002 - 2010, to present the season trends of CO intoxications, show sex and age structure of CO intoxicated patients. Material were Laboratory of Analytical Toxicology and Drug Monitoring data records from years 2002 - 2010. CO intoxication was confirmed and recognized when COHb blood concentration was higher than 10%. Annual number of CO poisonings was stable in the period of time, varied from 209 to 296 (mean 256,2 CO poisonings per year). Sex structure of CO poisoned patients showed little female dominance (54.6%). Carbon monoxide poisonings distribution was seasonal. The season of intensified CO intoxications lasted from October to March, the highest intensity was in December and January. The CO poisoning problem is still actual. Society education about security, recognition, diagnosis and practice in carbon monoxide exposition is still needful.
Przegla̧d lekarski 01/2011; 68(8):413-6.
-
[show abstract]
[hide abstract]
ABSTRACT: 18 patients with acute clozapine poisoning, 6 female and 12 male, were analyzed. The mean age was 42.8 years. Six patients were intoxicated only clozapine. Mixed poisoning (clozapine and other factor) was diagnosed in nine cases. Among the additional factors dominated psychotropic drugs. According to the Poisoning Severity Score (PSS) criteria in the study group was only a one mild intoxication. Acute pneumonia developed in 3 patients, acute bronchitis and rabdomyolysis were reported in one case. The most common symptoms included: agitation, confusion (83.3%), tachycardia (77.8%), CNS depression (66.7%), excessive mucus production in bronchi, hypersalivation (44.4%), miosis (50%). Disordered breathing requiring intubation or mechanical ventilation occurred in 27.7% of poisoned. The average duration of hospitalization was less than 7 days.
Przegla̧d lekarski 01/2011; 68(8):434-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Designer drugs used often by teenagers have simulative, relaxing, hallucinogenic and psychedelic properties. The biological action, addictive potential, diagnostic problems and low regulations related to designer drugs are presented in the study.
Przegla̧d lekarski 01/2010; 67(8):598-601.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of the paper was to present tobacco addiction problem in group of drugs of abuse addicted patients. The structure of abused drugs and addiction to many substances was described. The material was information from patients treated in substitution program in Krakow. There were 64 persons (22 women and 42 men). All of them used illegal drugs of abuse (opiates, amphetamines, cananbinoids) and used other psychoactive substances. The most often was tobacco (93.7%), alcohol (34.4%), drugs (67.2%) and spices (mephedrone). For most of them tobacco was the first abused addicted substance. The mean age of addiction beginning was 17,6 years for tobacco, 19,5 years for drugs of abuse, 21,8 years for alcohol, 25,7 years for medicines. All patients used more than one substance. 25% of them used drugs of abuse, tobacco, alcohol and medicines. The substances can cause different toxicokinetics and toxicodynamics interactions. The problem of addiction to many substances is complex both in patients diagnostics and treatment.
Przegla̧d lekarski 01/2010; 67(10):1000-3.
-
[show abstract]
[hide abstract]
ABSTRACT: There are some serious poisonings with toxic mushroom species in Poland every year. Good prognostics in the cases is correlated to short time from mushroom consumption to hospitalization, correct distinguish not specific gastrointestinal and Amanita phalloides syndrome and immediately specific treatment. The purpose of the paper was to make appraisal of usefulness of amanitin blood and urine determination and transaminases activity determination (ALT, AST) in diagnostics of mushroom poisoned patients up to three days after mushroom consumption. The material was twenty two retrospective histories of mushroom poisoned patients treated in the years 2007-2008. Amanitin blood and urine determinations were made by ELISA method. Urine amanitin results in samples collected within 40 h from mushroom consuming were positive in all Amanita phalloides syndrome cases. Serum amanitin determination was not useful for the diagnostics. Trans-aminases activity determinations let to distinguish Amanita phalloides syndrome on the second and the third day after mushroom consumption. In the first poisoning phase (within 24 h), the ALT and AST activities were in normal ranges and only amanitin urine determination let to confirm or exclude Amanita phalloides poisoning. Amanitin urine determinations were useful to take fast decision about specific treatment and avoid internal organs dysfunctions.
Przegla̧d lekarski 01/2010; 67(8):576-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Laboratory of Analytical Toxicology and Drug Monitoring, Jagiellonian University Medical College in Kraków performs analysis for patients from Kraków and south-east Poland. The determinations are made for intoxicated patients treated in the Toxicology Ward, for addicted patients treated in Detoxification Unit and other hospitals. The most often determined compounds are psychoactive substances (ethanol, drugs of abuse, psychotropic medicines). The purpose of the paper was to study structure of positive results of some psychoactive substances within seven years. In the study archived data of determinations registered in Laboratory of Analytical Toxicology and Drug Monitoring UJ MC in Kraków in the years 2002-2008 were used. The material was blood and urine samples collected for diagnostic of poisoned and addicted patients. There were used methods: EMIT (amphetamines, benzodiazepines, ecstasy, opiates, THC), FPIA (barbiturates, cocaine, tricyclic antidepressants (TCA)), colorimetric test (phenotiazines), thin layer chromatography (tramal). Annual mean numbers of positive results of psychoactive substances in the years 2002-2008 were: 411.7 for benzodiazepines, 234.1--amphetamines, 195.7--phenotiazines 168.4--opiates, 158.3--THC, 149.9 TCA, 87.9--barbiturates, 23.4--tramal 5.0--cocaine, 3.0--ecstasy. The structure and number of abused psychoactive substances determinations in 2002-2008 was studied. The numbers of positive results of benzodiazepines, amphetamines, THC and opiates were stable. The greatest increase of numbers of positive results was observed for cocaine and ecstasy in the studied period of time.
Przegla̧d lekarski 01/2010; 67(8):580-2.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to elaborate on the analytical method for quantitative determination of retinol and alpha-tocopherol in serum of women diagnosed with CIN and cervical cancer. The basic problem in the analysis of the vitamins content in biological material is their low physiological concentration level and instability. Liquid chromatography with diode array detector (DAD) was applied.
The material consisted of serum and urine collected from 12 women diagnosed with cervical intraepithelial neoplasia (CIN) and 16 diagnosed with cervical cancer. The method was evaluated for the following parameters: linearity, recovery, sensitivity, precision, accuracy, selectivity, stability, limit of quantification (LOQ) and limit of detection (LOD).
Results showed good linearity (r2> or =0.99) in the range 0.1 microg/ml-10 mg/ml for retinol and 0.25 microg/ml-15 microg/ml for alpha-tocopherol. The Lower Limit of Detection was 0.15 microg/ml for vitamin E and 0.05 microg/ml for vitamin A. The within-run R.S.Ds were below 5.2% at all concentration levels and the between-run R.S.Ds were below 10.0% at all concentration levels.
The advantage of this method is that it measures both compounds in a more rapid, reproducible and accurate manner when compared to the previous HPLC studies. The compounds (vitamin A and E and internal standards) are measured in the same sample at the same time. Quantitative determination of cotinine may reveal active smokers and subjects exposed to environmental tobacco smoke, which is independent measurable carcinogenetic co-factor. The following study is a part of a project determining non-viral causative agents in cervical carcinogenesis.
Ginekologia polska 04/2009; 80(4):256-62. · 0.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Green tobacco sickness (GTS) is an illness associated with exposure to nicotine originating directly from the growing tobacco plant. The exposure takes place in the course of activities during tobacco farming. Nausea, vomiting, headache and dizziness are the symptoms typical of GTS. The GTS cases have been most commonly reported in the USA, Japan, India and Italy. The first case of GTS in Poland has been diagnosed in a young man working on a Virginia bright tobacco plantation. The patient had symptoms typical of GTS. The toxicological analysis of urine demonstrated the presence of cotinine at the level of 869 ng/ml. Intravenous fluids, anticholinergic agents and potassium supplementation were used in the treatment. Interestingly, diplopia at the initial stage of tobacco poisoning and horizontal nystagmus, which resolved on the 2nd day of hospital stay were observed. We believe that cases of GTS occur in Poland; however patients do not seek medical care. Given that the majority of activities during tobacco farming in Poland are performed manually, it seems necessary to launch a public awareness campaign on GTS and decontamination methods.
Polskie archiwum medycyny wewnȩtrznej 04/2009; 119(3):184-6. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This paper examines the first reported case of Green Tobacco Sickness (GTS) in Poland. A 25-year-old man who worked in a tobacco field for 14 hours with no protective measures experienced symptoms of GTS, and additionally, diplopia, after leaving the field. Upon hospital admission, diplopia was no longer observed. Diplopia was most probably caused by disturbances to the cholinergic neuromuscular transmission, secondary to nicotine. These neurological disturbances, the first of their kind observed in the course of GTS, deserve special attention. The case shows a potential adverse health effect related to tobacco harvest, as most Polish tobacco plantations are not mechanized. Polish farmers should be obligated to protect their workers with protective clothing, shoes, gloves and masks. Recommendations for tobacco harvester health are put forth in the paper.
Journal of Agromedicine 02/2009; 14(1):66-9. · 0.56 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The most popular stimulant drugs in Poland are amphetamine and its analogues: ecstasy (MDMA) and methamphetamine (MA). The substances are usually determined by immunoassays (EMIT, FPIA, Rapid Tests) in medical, toxicological laboratories. The methods are not useful for identification of the substances. Chromatography methods are reference, confirmation methods that identify stimulant drugs in biological samples. The aim of the study was investigation of kinds of amphetamine derivatives abused by poisoned patients treated in the Clinic of Toxicology of the Jagiellonian University Collegium Medicum in Krakow. Materials for the study were urine samples collected from 46 patients. All the samples were positive for amphetamine presence by EMIT (cut off = 300nn/ mL). Amphetamine analogues were identified by high performance liquid chromatography with diode array detector (HPLC-DAD). Amphetamine alone was present in 54.3% samples; amphetamine and it's analogues (MDMA, MDA, MA) were present in 26.0%; MDA and MDMA (no amphetamine) were present in 19.5% samples. In one case no amphetamine neither its analogues were detected in the sample. The positive amphetamine EMIT result was caused by fenfluramine--the substance present in slimming product. Conclusions: the most often determined stimulant drug in the group of poisoned patients was amphetamine. The frequency of MDMA and MA intoxications were occasional and with probably increase. Immunoassay tests are useful for routine analysis in clinic laboratories but in some cases when the history is unreliable, confirmation analysis by reference method should be performed to identify the abused substance.
Przegla̧d lekarski 01/2009; 66(6):323-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Alcohol and tobacco addictions are often joined. There are biological and environmental reasons of the co-addiction. Active compounds present in the substances can interact in different ways, for example in biotransformation reactions. The aim of the paper was to describe differences of ethanol and nicotine metabolites concentrations in biological fluids. The material was blood and urine collected from alcohol and tobacco addicted patients treated in The Detoxication Department, Toxicology Clinic in Krakow. Acetaldehyde and volatile substances were determined in blood by GC-FID. Cotinine was determined in urine by HPLC-UV. Most (91.3%) of alcohol addicted patients were tobacco smokers. In the group 76.3% patients smoked more than 11 cigarettes per day. Tobacco addiction was usually longer or lasted the same time as alcohol addiction. Mean cotinine urine concentrations in the group of alcohol addicted smoking patients were lower than in group of smoking patients not alcohol addicted (p < 0.05). Differences between mean acetaldehyde blood concentrations in group of alcohol addicted smoking patients and alcohol addicted non smoking patients were not significant (p > 0.05).
Przegla̧d lekarski 01/2009; 66(10):624-7.
-
[show abstract]
[hide abstract]
ABSTRACT: The problem of alcohol and nicotine addiction is both social and medical. The substances are often used together and give complex addiction. The knowledge about mechanisms of complex addiction would be useful for creating effective ways of treatment the abused patients. The aim of the paper was to describe the complex ethanol and nicotine addiction phenomenon. The research was made using data from 30 ethanol and nicotine addicted patients treated in Clinic of Toxicology Jagiellonian University Collegium Medicum in Krakow. 90% of them were nicotine addicted. Tobacco was the first abused substance in the group of patients. The mean period of addiction was 29.0 years for tobacco and 22.2 years for alcohol. The majority of the patients (51.9%) smoked more than 20 cigarettes per day; 29.6% smoked 11-20 cigarettes per day. Single patients were narcotics and drugs addicted. Continuation of the research and toxicological determination of the substances and their metabolites concentrations would be useful for the complex addiction problem explanation and description.
Przegla̧d lekarski 02/2008; 65(10):522-3.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this paper is epidemiological analysis of poisonings with amphetamine and tetrahydrocanabinols (THC), particularly in three aspects: (1) co-occurrence of other substances (mixed poisonings); (2) factors shaping dynamics in number of poisonings and 3) average age of patients. The data this paper is based on come from the data set "Duch" which is run by the Department of Analytical Toxicology and Drug Monitoring UJ CM in Kraków. The data were collected between 1 Dec. 2001 and 28 Feb. 2005 (1186 days). Amphetamine and THC were determined in patient's urine in semi-quantitative manner by means of EMIT and FPIA methods. RESULTS: Amphetamine: In the studied period amphetamine was confirmed in 493 patients. Other substances were confirmed in 57.6% of patients: opiates--28.6% THC--14.2%, opiates and THC--5.9%. Since the beginning of the studied period till mid Aug 2003 daily number of cases showed increasing trend (0.062% per day), then the tendency was reversed (-0.074% per day). We observed more males than females (3.24:1). Most cases were poisoned on Mondays, less during the week and least on weekends. At the beginning of the studied period males were older than females (27 vs. 20 years). As the time progressed average age of males was stable but in women average age was increasing at the rate 0.004 year per day. As a consequence of this trend in winter 2004/2005 average age of both sexes was equal. THC: We observed 410 cases with confirmed presence of THC in urine. Other substances were confirmed in 40.2% of patients: amphetamine 17.1% amphetamine and opiates 7.1, opiates 7.1%. There were 17 various substances accompanying THC. In our material the sex ratio was biased toward males (7.8 to 1). Weekly dynamics of poisonings with THC have the same pattern as the one observed in amphetamine. At the beginning of the studied period males were older than females (28 vs. 20 years). Changes in averages followed the same pattern as in amphetamine.
Przegla̧d lekarski 02/2007; 64(4-5):273-6.
-
[show abstract]
[hide abstract]
ABSTRACT: Two cases (woman and man) of the extended suicidal poisonings with carbamazepine and phenothiazine derivatives are presented. Drug's blood concentrations during poisoning were monitored. We examine correlation between patient's general status and the drug's blood concentrations, carbamazepine and phenothiazine derivatives interaction due to young, healthy people who received no earlier treatment. Material and methods: blood samples for toxicological examinations were collected at 0, 12, 24 and 48 hours after admission. Carbamazepine was determined using FPIA method and phenothiazines derivatives by HPLC-DAD. The highest blood concentrations were for carbamazepine: 30.92 mg/l (woman) and 20.95 ng/ml (man); for phenothiazine derivatives: 927 ng/ml (woman) and 733 ng/ ml (man). CONCLUSIONS: In both cases severe central nervous depression was observed due to summed action of the drugs. Sex and individual differences in cytochromes activities should have influence to carbamazepine metabolism and faster elimination time in woman. In the case of phenothiazine derivatives faster elimination time in man was observed. The differences in elimination times between compared drugs confirm their different metabolic routes.
Przegla̧d lekarski 02/2007; 64(4-5):304-7.
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the exposure to tobacco smoke constituents, the biomarkers are used. In most studies conducted among active smokers, the cotinine is usually utilised as such a biomarker. The aim of this study was to estimate an application of determining two nicotine metabolites, cotinine and trans-3'-hydroxycotinine (3-HC) in order to assess cigarette smoking among pregnant women. There were 25 patients (15 smokers, 10 non-smokers) admitted to Delivery Ward in Gynecology and Obstetrics Clinical Hospital of the University of Medical Sciences in Poznan. The free and total form of cotinine and trans-3'-hydroxycotinine in urine were determined by the means of high performance liquid chromatography with spectrometry detection. The results of this studies indicated that in urine both cotinine and trans-3'-hydroxycotinine are conjugated with glucoronide acid in the high degree. The linear correlation between free and conjugated form of cotinine and whole cotinine concentration indicates the possibility of application of all three of them as biomarkers of tobacco smoke exposure. The high conjugation of trans-3'-hydroxycotinine with glucuronic acid (over 80 %), and high correlation between glucuronide and total trans-3'-hydroxycotinine concentration proves necessity of having the urine samples hydrolysed or determining the 3'-hydroxycotinine glucoronide, when application of 3-HC as a biomarker of tobacco smoke exposure is concerned. Our studies confirm other authors' observations that division of 3'-hydroxycotinine and cotinine concentrations might be used as a predictor of differences in cotinine metabolite ratio (polimorphism). The studies shown that using analytical equipment, nowadays available in the most laboratories (HPLC), it is possible to determined two biomarkers which are very useful and give various information, no matter whether they are conjugated with glucuronic acid, or not.
Przegla̧d lekarski 02/2007; 64(10):740-6.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of the study was to measure the concentration of lead and cadmium in urine of women who smoked, were exposed to environmental tobacco smoke (ETS) and were unexposed during pregnancy. The correlations between exposition to tobacco smoke and socioeconomic factors, course of pregnancy and health status of newborns were estimated. The subjects of the study were 231 pregnant women. Information about exposition to tobacco smoke, socioeconomic state, course of pregnancy and health status of newborns was collected from self-created questionnaire. The estimation of tobacco smoke exposition of the women was based on the questionnaire data and their urine cotinine concentration. The urine concentration of lead and cadmium was measured by atomic absorption spectrometry with graphite furnace. The mean urine lead concentration of women who smoked, were exposed to ETS and unexposed to tobacco smoke during pregnancy were respectively: 38.2 +/- 59.1; 36.2 +/- 50.1; 32.7 +/- 53.5 ng/ mg of creatinine, and mean cadmium concentration were respectively: 1.9 +/- 1.6; 1.1 +/- 1.2; 1.3 +/- 1.5 ng/mg of creatinine. The correlation between the urine concentration of cadmium and cotinine was statistically significant. Increased frequency of tobacco smoking was in the group of the women aged less than 25 years, that finished primary or vocational school, had monthly income less tan 500 zł/family member, and have smoking partners. In the group of women who smoked during pregnancy the childbirth was statistically more often by caesarian and supported delivery. The newborns of mothers who smoked and were exposed to ETS had birth weight respectively 348.5 g and 281.1 g smaller than newborns of unexposed mothers. The length of newborns of smoking and ETS exposed mothers were respectively 2.8 cm and 0.7 cm shorter then newborns of unexposed mothers.
Przegla̧d lekarski 02/2006; 63(10):985-92.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to determine relations between the clinical state and the severity of liver damage comparing to the amount of ingested paracetamol, time since ingestion and serum concentration of paracetamol with patients after acute intoxication with this drug. A retrospective analysis of medical records of 95 patients hospitalized in the Toxicology Department in Kraków or treated in the Toxicological Admission Room in 2002-2004 years because of acute paracetamol intoxication was performed. The general clinical state connected with intoxication and the severity of liver damage were determined using the Poisoning Severity Score (PSS). The level of consciousness was determined with the Glasgow Coma Scale and Matthew's scale. The serum concentration of paracetamol during admission to the hospital, levels of biochemical markers of liver damage (AST, ALT), bilirubin and INR index were also performed. We found a statistically significant positive correlation between the ingested dose of paracetamol comparing to the gravity of poisoning, the severity of liver damage, levels of aminotransferases and bilirubin. A positive correlation between time since ingestion of paracetamol to hospitalization and the gravity of poisoning according to PSS scale was also statistically significant. A paracetamol concentration measured during admission to the hospital had no influence on neither the clinical state of patient nor the severity of liver damage. We conclude that the therapeutical approach should consider possibly shortening of the time since drug ingestion to hospitalization and institution of specific treatment (N-acetylcysteine) as well as minimalization of the paracetamol dose, which could be absorbed, by different methods of elimination from the GI tract (eg., gastric lavage, activated charcoal laxatives).
Przegla̧d lekarski 02/2005; 62(6):456-61.
