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Bupropion is a popular antidepressant due to its favorable side effect profile and indications for smoking cessation and weight loss. Due to the possibility of delayed onset seizure and other adverse outcomes after bupropion overdose, patients are often observed for periods of 12-24 hours following suspected ingestion. Tachycardia is a clinical predictor that holds promise in differentiating cases at risk for seizures from low-risk cases that do not require prolonged observation. This study assessed whether heart rate within the first eight hours of presentation can identify cases that do not require extended observation. This is a retrospective cohort study of all supra-therapeutic bupropion cases from two hospital systems between 2010 and 2022. Data from 216 charts were included. Seizures, hypotension, and dysrhythmias occurred in 19 percent (n = 41), 1.4 percent (n = 3), 0.9 percent (n = 2) respectively. One patient died. Delayed adverse effects were rare (n = 4); they occurred from 14 hours to 28 hours post-ingestion. Maximum heart rate in eight hours was associated with a risk of adverse outcomes. (odds ratio, 1.07; 95 percent confidence interval: 1.05 to 1.09; P < 0.001). An eight hour maximum heart rate threshold of 104 beats/minute had a negative predictive value of 100 percent (95 percent confidence interval: 96.7 percent to 100 percent) for the occurrence of delayed adverse effects. All patients with delayed effects had tachycardia within five hours of emergency department arrival. Delayed adverse outcomes of seizures, hypotension, dysrhythmia, and death were uncommon in this cohort. Heart rate during the first eight hours of observation performs reliably as a screening test to identify patients at low risk for delayed adverse outcomes. This study is limited by its retrospective nature, the inability to ascertain time of ingestion for most cases and the lack of confirmatory laboratory testing. This study supports the use of an eight hour observation period when there are no other clinical signs of toxicity to warrant admission and if no co-ingestion or administration of substances that mask tachycardia are present. [ABSTRACT FROM AUTHOR]

Introduction: For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa2EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNa2EDTA was unavailable. Case Report: A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa2EDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits. Discussion: The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses a case of delayed peak methemoglobinemia after intentional ingestion of sodium nitrate. The patient, a 63-year-old male with a history of chronic kidney disease and diabetes, ingested a large amount of sodium nitrate and experienced severe diarrhea. The peak methemoglobin percentage did not occur until at least 16 hours after ingestion. The letter highlights the need for more reports on the time course of toxicity after nitrate salt ingestions and emphasizes the importance of monitoring patients until peak methemoglobin levels are observed. [Extracted from the article]

This study evaluated the hepatoprotective effect of oral administration of aqueous fraction of methanolic extract of Costus afer leaves (CALAF) during induction of hepatocellular carcinoma (HCC) with diethylnitrosamine (DEN) in rats. The methanolic leaf extract was fractionated into hexane, ethyl acetate, butanol, and aqueous fractions. The in vitro antioxidant potential of the fractions were estimated by the assays of 2,2-diphenyl-1-picrylhydrazine and nitric oxide radical scavenging activity, ferric-reducing antioxidant potential, and total antioxidant capacity. CALAF had the most antioxidant effect. Rats were orally pretreated daily with CALAF at 100, 200, and 400 mg/kg or silymarin (hepatoprotective drug) at 50 mg/kg from 2 weeks prior to HCC induction and through 6 weeks of HCC induction. The HCC induction was by a single intraperitoneal injection of DEN at 200 mg/kg as an initiator, followed 2 weeks later by daily oral administration of 2-acetylaminofluorene at 30 mg/kg as promoter. At the end of HCC induction, levels of alpha-fetoprotein (AFP), liver function and antioxidants, gamma histone 2A family member X (γH2AX), and O6-methylguanine-DNA methyltransferase (MGMT) expressions were determined. HCC rats treated with CALAF at all doses had significantly (p < 0.05) reduced levels of AFP, aspartate aminotransferase, alanine aminotransferase, superoxide dismutase, glutathione peroxidase, reduced glutathione, and γH2AX protein expression, whereas MGMT protein expression was elevated when compared with untreated HCC rats. Thus, CALAF could be effective in protecting against DEN-induced HCC in rats by ameliorating hepatic injury and genotoxicity. [ABSTRACT FROM AUTHOR]

Objectives: Prevention methods for carbon monoxide (CO) poisoning in Wisconsin address occupational and nonoccupational exposures together, but differences between the settings could inform new approaches to preventing occupational CO poisonings. We described occupational CO poisonings in Wisconsin from July 1, 2018, through July 1, 2021, using surveillance data from the Wisconsin Electronic Disease Surveillance System and Wisconsin Poison Center. Methods: We identified cases of CO poisoning from the Wisconsin Electronic Disease Surveillance System and Wisconsin Poison Center. Occupational CO poisonings were records where "workplace" was recorded as the location of exposure. We excluded records classified as suspect/not a case, those missing laboratory results or information on exposure source/location, and intentional poisonings. We compared characteristics between occupational and nonoccupational settings using odds ratios (ORs), and we estimated crude incidence rates of occupational exposures by occupation. Results: We identified 614 cases of CO poisoning, of which 168 (27.4%) were occupational exposures. When compared with patients with nonoccupational exposures, patients with occupational exposures were more likely to be male (OR = 3.8; 95% CI, 2.4-6.1), Hispanic (OR = 2.4; 95% CI, 1.4-4.2), and younger (mean difference [SD] = 6.6 [20.9]). Several CO sources were significantly associated with occupational poisonings: forklifts (OR = 58.4; 95% CI, 13.9-246.1; P <.001), pressure sprayers (OR = 2.4; 95% CI, 1.3-4.4; P =.003), and other gasoline-powered tools (OR = 3.8; 95% CI, 2.3-6.3; P <.001). The natural resources, construction, and maintenance occupation group had the highest crude incidence rate—45.0 poisonings per 100 000 full-time equivalent employees. Conclusions: Incorporating data from the Wisconsin Poison Center improved data quality, but surveillance is limited by underreporting. Creating strategies to increase reporting would allow for a more comprehensive understanding of occupational CO poisoning. [ABSTRACT FROM AUTHOR]

• Mechanism of photo-catalytic degradation of BTEX pollutants by emerging nanosemiconductors was pragmatically explained. • Photo-catalytic degradation pathways of BTEX pollutants was mechanistically discussed. • The negative impact and ecological risk assessment of BTEX on eco-system and eco-networking was highlighted. Climate change and environmental pollution are unequivocally real and poses an instantaneous, direct, grievous and inescapable existential menace to all terrestrial and aquatic inhabitants and thus must be continuously addressed. Among the silent but salient pollutants that causes this climate and environmental damages is mono-aromatic volatile organic compounds (VOC) known as BTEX whose usage is unavoidable across all major important industries globally. As nanosemiconductor variants of nano matrials show substantial potential for wastewater treatment owing to their long service life, better chemical reactivity, wide band gap energy, resistance to photocorrosion, superlative surface property, remarkable mechanical profile, and low cost, this review holistically discusses current trends and state-of-the-art work utilizing various nanosemiconductors for photodegradation of BTEX in aquatic environment in order to bridge knowledge gap. This review paper further detail the heterogeneous photocatalytic mechanism of nanosemiconductor photocatalysts for the degradation of BTEX pollutants which was pragmatically taking into account of .OH and .O 2 radicals largely, and juxtapose photocatalytic performance of various nanosemiconductors which was revealed to be ≥70% for most photocatalysts reported, especially the popular TiO 2 with admirable visible light absorption capacity. This review also underscore future prospects exploiting the feasible uses of nanosemiconductor, and identifies the frontiers, dilemmas and challenges to be overcome for the pragmatic implementation of nanocatalysts for monoaromatic VOC wastewater treatment. This review can spark fresh thoughts and offer useful insights into the designing of improved nanosemenconductor as a nanocatalyst for more efficacious photodegradation practical applications in marine pollution management especially. [Display omitted] [ABSTRACT FROM AUTHOR]