Capillary leak syndrome: A rare cause of acute respiratory distress syndrome

Capillary leak syndrome (CLS) is a rare clinical syndrome associated with significant morbidity and mortality. Intensive care and supportive therapy constitute the mainstay of the treatment, along with judicious use of crystalloids and colloids such as dextran and starch during the leak phase. The advantages of proning, steroids, and intravenous immunoglobins are worth contemplating in patients with such a presentation. Extracorporeal membrane oxygenation appears to be an excellent strategy to surmount the impediments of the leak and post leak phase of CLS, especially in patients with severe or refractory hypoxemia.     

Successful use of the two-tube approach for the treatment of phenobarbital poisoning without hemodialysis

Half-life of the antipsychotic vegetamin is very long, partially due to the presence of phenobarbital, and mortality due to phenobarbital poisoning is high. Here, we present the case of a 22-year-old female admitted to the emergency department with disturbed consciousness due to vegetamin overdose. Her blood phenobarbital level was elevated to 123 μg/ml. Phenobarbital undergoes enterohepatic circulation, and its retention in the intestine causes its blood levels to remain sustained. The utility of hemodialysis for drug poisoning has been previously reported; however, its efficiency is not yet established and its efficacy is low for drugs with long half-lives such as phenobarbital. Therefore, we performed a two-tube approach to adsorb phenobarbital in the intestines with activated charcoal delivered via a gastric tube and to remove the phenobarbital-adsorbed activated charcoal using whole bowel irrigation via an ileus tube 2 h later. The patient successfully eliminated the charcoal via stool, the blood phenobarbital level decreased drastically without hemodialysis, and the clinical course improved. We propose that this two-tube approach is suitable for treatment of poisoning with drugs that undergo enterohepatic circulation and have long half-lives.     

大剂量细胞色素C在抢救儿童急性磷化氢中毒的临床作用

目的 探讨儿童急性磷化氢中毒的临床特点,及大剂量细胞色素C的临床作用。方法 收集2013年11月—2018年6月本中心救治的急性磷化氢中毒儿童22例临床资料,并回顾性分析。结果 男13例,女9例;年龄29 d~13岁;轻中度磷化氢中毒10例,重度磷化氢中毒12例;轻中度中毒患儿出现症状至就诊时间明显短于重度中毒患儿(P=0.029)。轻中度磷化氢中毒主要表现为头晕、恶心、呕吐、腹痛;重度中毒主要表现为昏迷、口唇紫绀、低血压,甚至心源性休克。实验室检查:脑钠肽异常升高12例;心肌酶异常12例;血乳酸升高10例;心电图异常16例,均表现为快速心律失常,其中1例为尖端扭转型心律失常。除常规治疗外,均给予大剂量细胞色素C治疗,轻中度中毒患儿均治愈,重度中毒患儿治愈6例,死亡6例,22例儿童磷化氢中毒总死亡率为27.3%,重度磷化氢中毒死亡率50%。结论 儿童急性磷化氢中毒死亡率高,在常规治疗的基础上,给予静脉应用大剂量细胞色素C可明显降低儿童急性磷化氢中毒的死亡率。     

一起由两种罕见血清型副溶血性弧菌引起食物中毒事件分析

目的 分析一起由两种罕见血清型混合感染引起的副溶血性弧菌食物中毒病原学的检测结果,为食物中毒病原学检查途径提供依据。方法 对一起在龙门县人民医院就诊食物中毒事件的9例患者采集其肛拭子样本,参照《食品微生物学检验副溶血性弧菌检验》( GB 4789.7—2013) 等标准进行病原学分析鉴定。结果 本次事件出现临床症状者9例,其中≤20岁2例,20~<40岁1例,40~<60岁4例,≥60岁2例;9份肛拭子样本检出8株副溶血性弧菌,血清分型O2:K28构成比占25.00%(2/8);O8:K21构成比占75.00%(6/8);经PFGE分子分型,2株O2∶K28血清型(VP18171、VP18175)相似度为66.7%;3株O8∶K21血清型(VP18172、VP18173、VP18176)相似度为100.0%,与另外3株O8∶K21血清型(VP18177、VP18174、VP18170)相似度为88.4%~95.2%;药敏试验结果显示,除有1株菌株对氨苄西林、头孢唑林二重耐药、1株菌株对氨苄西林耐药、3株菌株对头孢唑林耐药外,其它菌株对所有测试药物均敏感,无多重耐药现象。结论 此次食物中毒是由O2:K28和O8:K21这两种罕见血清型的副溶血性弧菌混合感染引起的。     

Acute liver injury,acute liver failure and acute on chronic liver failure: A clinical spectrum of poisoning due to Gyromitra esculenta

Gyromitra esculenta, also known as “false morel” is one of the most poisonous mushrooms. This species is found all over the world, growing in coniferous forest in early spring time. Common manifestation of poisoning includes gastrointestinal symptoms which include varied degrees of liver impairment.We describe three cases: acute liver injury, acute liver failure and acute-on-chronic liver failure due to G. esculenta poisoning. At admission patients presented with encephalopathy and features of liver failure. Two of them recovered completely following supportive management while the remaining patient who also had preexisting liver disease developed multiorgan failure and subsequently died.Although a rare occurrence, G. esculenta poisoning should be considered in the differential diagnosis of acute liver failure.     

E-cigarettes: Are we renormalizing public smoking? Reversing five decades of tobacco control and revitalizing nicotine dependency in children and youth in Canada

An electronic cigarette (e-cigarette) is a battery attached to a chamber containing liquid that may (or may not) contain nicotine. The battery heats the liquid and converts it into a vapour, which is inhaled, mimicking tobacco smoking. The e-cigarette does not rely on tobacco as a source of nicotine but, rather, vaporizes a liquid for inhalation. E-liquids are often flavoured and may contain nicotine in various concentrations, although actual amounts are seldom accurately reflected in container labelling. The deleterious effects of nicotine on paediatric health are well established. The use of e-cigarettes in the paediatric age group is on the rise in Canada, as are associated nicotine poisonings. E-devices generate substantial amounts of fine particulate matter, toxins and heavy metals at levels that can exceed those observed for conventional cigarettes. Children and youth are particularly susceptible to these atomized products. Action must be taken before these devices become a more established public health hazard. Policies to denormalize tobacco smoking in society and historic reductions in tobacco consumption may be undermined by this new ‘gateway’ product to nicotine dependency.     

急性CO中毒迟发性脑病患者早期血浆HMGB1的表达与预后

目的：探讨急性一氧化碳(CO）中毒迟发性脑病患者血浆高迁移率族蛋白B1(HMGB1）的表达与预后。方法回顾性分析2012年1月—2015年1月该院接收的最终确诊为急性CO中毒迟发性脑病患者10例，另选取同时期内急性CO中毒患者10例以及健康体检者10例作为对照组。分别对各组患者的血浆HMGB1水平进行检测。另外，分别采用日常生活能力量表(ADL）、常识-记忆-注意测验(IMCT）、长谷川痴呆量表(HDS）分析急性CO中毒迟发性脑病患者血浆HMGB1水平变化及与量表评分之间的关系。结果 CO中毒迟发性脑病患者急性期血浆HMGB1水平为(14.23±10.32）ng/mL，明显高于恢复期的(7.93±4.99）ng/mL，差异有统计学意义(t=2.653，P<0.05）；CO中毒迟发性脑病组急性期、恢复期血浆HMGBl水平与HDS以及ADL评分呈现显著正相关(r=0.610；r=0.605；r=0.607；r=0.610,P<0.05）。结论HMGBl参与急性CO中毒迟发性脑病的炎症反应前过程，且与HDS以及ADL评分呈正相关。     

中药肠道灌洗联合血液净化治疗急性农药中毒的临床疗效探讨

目的 探讨中药肠道灌洗联合血液净化治疗急性农药中毒的临床疗效。方法 选取2014年4月～2019年10月本院收治的50例急性农药中毒患者为研究对象,并根据不同的治疗方案将患者分为对照组与观察组,各25例,对照组采用常规治疗联合血液净化治疗,而观察组在对照组的基础上采用中药肠道灌洗治疗,比较两组患者的临床疗效及血压、血气指标情况。结果 治疗后,观察组的临床总有效率为96.00%,对照组为76.00%,两组比较,观察组明显高于对照组;同时观察组的收缩压(SBP)、舒张压(DBP)与酸碱度(pH)高于对照组,动脉血氧分压(PaO2)与动脉血二氧化碳分压(PaCO2)低于对照组,组间比较差异有统计学意义(P0.05)。结论 对急性农药中毒患者实施中药肠道灌洗联合血液净化治疗,能有效改善患者的血压、血气指标,具有显著的临床疗效。