Search Results (222)

Autobrewery syndrome is a rare condition characterized by the endogenous fermentation of carbohydrates by gut microbiota, which exceeds the liver’s detoxification capacity and leads to signs and symptoms of acute alcohol intoxication. This condition has significant clinical, social, and legal implications. Beyond the acute effects, the role of excessive endogenous ethanol production in the progression of chronic diseases—particularly liver disease—is still under investigation. In this review, we aim to describe the key clinical features of autobrewery syndrome, identify the main microbial pathogens involved, and explore the potential impact of endogenous ethanol production on the development and progression of chronic liver disease. Although robust data and standardized treatment protocols are currently lacking, we discuss the general principles of management and outline possible therapeutic strategies and future perspectives. Full article

The discovery that human beings may endogenously produce ethanol is not new and dates back at the end of the 19th century; recently, however, it has become clear that through the proliferation of gut microorganisms that produce ethanol from sugars or other substrates, blood alcohol level may be greater than 0, despite Homo sapiens sapiens lacking the enzymatic pathways to produce it. Very rarely this can lead to symptoms and/or to a disease, named gut fermentation syndrome or auto-brewery syndrome (ABS). The list of microorganisms (mostly bacteria and fungi) is very long and contains almost 100 different strains, and many metabolic pathways are involved. Endogenous ethanol production is a neglected entity, but it may be suspected in patients in whom ethanol consumption may be firmly excluded. Nevertheless, due to the growing prevalence of NAFLD (now renamed as MAFLD) worldwide, an ethanol-producing microorganism responsible for endogenous ethanol production such as Klebsiella pneumoniae or Saccharomices cerevisiae is increasingly sought in NAFLD patients, or in patients with metabolic diseases such as diabetes mellitus, obesity, or metabolic syndrome, at least in selected instances. In the absence of standard diagnostic and therapeutic guidelines, ABS requires a detailed patient history, including dietary habits, alcohol consumption, and gastrointestinal symptoms, and a comprehensive physical examination to detect unexplained ethanol intoxication. It has been proposed to start the diagnostic protocol with a standardized carbohydrate challenge test, followed, if positive, by the use of antifungal agents or antibiotics; indeed, fecal microbiota transplantation might be the only way to cure a patient with refractory ABS. Scientific societies should produce internationally agreed recommendations for ABS and other conditions linked to excessive endogenous ethanol production. Full article

Background: Severe traumatic brain injury (TBI) remains a leading cause of mortality and long-term morbidity, particularly in high-acuity trauma settings. We aim to evaluate the clinical, physiologic, and socioeconomic factors associated with outcomes in patients with severe traumatic brain injury (TBI) at a single urban Level 1 trauma center. Method: This is a single-center, retrospective study of patients presenting with severe TBI between 1 January 2020 and 31 December 2023 at Elmhurst Hospital Center in Queens, New York. Patients were identified using ICD trauma codes and an Abbreviated Injury Severity (AIS) Head score of ≥3. Demographic data, injury characteristics, vital signs, airway interventions, alcohol level, and insurance status were analyzed. Result: A total of 1130 patients met the inclusion criteria. The cohort was predominantly male (76.1%) with a mean age of 52.7 years. Blunt trauma accounted for 97.8% of cases, with a mortality rate of 13.8%, while penetrating trauma comprised 2.2%, with a markedly higher mortality rate of 48%. Patients who died as full code had lower mean systolic blood pressure (82.5 mmHg), oxygen saturation (63%), and shorter emergency department stays (~3.7 h). The mean Glasgow Coma Scale (GCS) score was 12.6, dropping to 6.0 in patients who died. Moreover, higher AIS Head and Injury Severity Score (ISS) values were correlated with worse outcomes. Severely intoxicated patients had higher TBI incidence, with no clear difference observed when compared to normal BAC levels. Self-pay patients exhibited the highest mortality (40%). All associations were statistically significant (p < 0.0001). Conclusions: Severe TBI outcomes are significantly influenced by injury mechanisms, physiologic parameters, and socioeconomic status. These findings emphasize the need for targeted prognostic tools and improved trauma system preparedness for TBI patients at risk of poor outcomes. Full article

Salinomycin is a polyether ionophorous antibiotic with promising antineoplastic properties. Published studies have revealed that the compound also exerts pronounced antidotal activity against cadmium (Cd) and lead (Pb) intoxications. It has been proven that salinomycin with Cd(II) forms a coordination compound of a composition [Cd(C₄₂H₆₉O₁₁)₂(H₂O)₂] and an octahedral molecular geometry, while the coordination compound of the antibiotic with Pb(II) has a square pyramidal structure and composition [Pb(C₄₂H₆₉O₁₁)(NO₃)]. To date, there is no published information about the ability of salinomycin to form complexes with the mercury ion (Hg(II)). Herein, we report, for the first time, a synthetic procedure for a complex compound of salinomycin with Hg(II). The coordination compound was characterized by a variety of methods, such as elemental analysis, attenuated total reflectance–Fourier transform infrared spectroscopy (ATR-FTIR), electrospray ionization–mass spectrometry (ESI-MS), powder X-ray diffraction, nuclear magnetic resonance spectroscopy (NMR), thermogravimetry with differential thermal analysis (TG-DTA), and thermogravimetry with mass spectrometry (TG-MS). The elemental analysis data revealed that the new compound is of the chemical composition [Hg(C₄₂H₆₉O₁₁)(H₂O)(OH)]. Based on the results from the spectral analyses, the most probable structure of the complex was proposed. Full article

Cultivated pasture grasses contribute forage to more than 40% of cattle produced in 11 southern states in the USA. In recent years the increasing intoxication of cattle feeding on pasture grasses raised serious concerns about their palatability. While molecular and metagenomics techniques have revealed the great diversity of microbial composition and functional richness of the grass endosphere microbiome, meta-sequencing techniques enable us to gain a bird’s-eye view of all plant-associated microbiomes as a ‘holobiont’. Plant holobionts provide a more comprehensive approach where one can define the functions of microbial communities and feedback between the core and satellite microbiomes of a targeted host. In the near future we will be able to tailor our grasses and their endosphere microbiomes through the host-directed selection of a ‘modular microbiome’, leading to ‘plant enhanced holobionts’ as a microbiome-driven solution to managing the intoxication of pasture grasses in livestock. The present review aims to understand the potential co-relation between the endosphere microbiome community composition and mycotoxin production in forage grasses in the southern United States. Full article

The administration of nutraceutical substances to fish diet can help to control disease outbreaks in aquaculture practices, thereby promoting sustainability and food safety. In particular, some substances have the potential to alleviate the effects of trace metals toxicity in fish also by reducing metal accumulation in tissues. This study evaluates, for the first time, the effect of nutraceutical substances on bioaccumulation mechanisms of mercury (Hg) in tissues and organs of farmed gilthead seabream (Sparus aurata) by mesocosm experimentation. The kinetics of bioaccumulation in muscle, gills, gut, liver and kidney and the detoxification efficiency were also assessed. Fish were fed with three different diets: a commercial diet used as control (CD); a diet enriched with short chain fatty acids (SCFA) and extract of Castanea sativa (D1); a diet enriched with yeast Saccharomyces cerevisiae and extract of Schinopsis balansae (D2). All groups were exposed to sub-lethal concentrations of mercury. After 20 days of exposure, mercury levels in different organs and tissues clearly revealed the effectiveness of yeast and plant extracts in limiting the metal bioaccumulation in fish fed with D2 through mercury absorption and then elimination by feces. In contrast, the D1 seems to not reduce the Hg bioaccumulation in fish tissues. This can be attributed to the high affinity of SCFA for mercury, leading to the formation of organometallic compounds absorbed by the fish tissues. This mechanism potentially counteracts the efficiency of tannins contained in the extract plant on mercury removal. This study clearly demonstrates that the use of diets enriched with yeast and/or plant extracts rich in tannins are a useful bioremediation strategy to reduce trace metals bioaccumulation in farmed fish, thus preserving their health status from intoxication, their commercial values, and consequently the health of consumers. Full article

Staphylococcus aureus is a leading cause of foodborne intoxication globally, driven by its heat-stable enterotoxins (SEs), which pose significant public health risks. This review critically evaluates modern and traditional methodologies for detecting S. aureus and its enterotoxins in food matrices, emphasizing their principles, applications, and limitations. The review includes a dedicated section on sample preparation and pretreatment methods for diverse food substrates, addressing a critical gap in practical applications. Immunological techniques, including ELISA and lateral flow assays, offer rapid on-site screening but face matrix interference and variable sensitivity challenges. Molecular methods, such as PCR and isothermal amplification, provide high specificity and speed for bacterial and toxin gene detection but cannot confirm functional toxin production. Sequencing-based approaches (e.g., WGS and MLST) deliver unparalleled genetic resolution for outbreak tracing but require advanced infrastructure. Emerging biosensor technologies leverage nanomaterials and biorecognition elements for ultra-sensitive real-time detection, although scalability and matrix effects remain hurdles. Mass spectrometry (MALDI-TOF MS) ensures rapid species identification but depends on pre-isolated colonies. Traditional microbiological methods, while foundational, lack the precision and speed of molecular alternatives. The review underscores the necessity of context-driven method selection, balancing speed, sensitivity, and resource availability. Innovations in multiplexing, automation, AI-based methods, and integration of complementary techniques are highlighted as pivotal for advancing food safety surveillance. Standardized validation protocols and improved reporting of performance metrics are urgently needed to enhance cross-method comparability and reliability in outbreak settings. Full article

Ricin is a highly potent toxin that causes severe lung injury upon inhalation by initiating a complex cascade of cellular responses that ultimately leads to cell death. The low-density lipoprotein receptor-related protein 1 (LRP1) is a multifunctional receptor involved in various physiological processes, including ricin-mediated toxicity. This study explores the role of LRP1 shedding in the development of ricin-induced lung injury. Analysis of bronchoalveolar lavage fluid (BALF) from ricin-intoxicated mice and swine showed a significant increase in soluble LRP1 (sLRP1) levels, whereas serum LRP1 levels remained largely unchanged, suggesting the lungs are the primary source of sLRP1 release. In vitro assays demonstrated the formation of ricin-sLRP1 complexes, indicating that sLRP1 in BALF retained ricin-binding capability. Flow cytometric analysis of lung cells revealed a reduction in both the percentage and total number of LRP1-expressing cells following ricin exposure. Further investigation of specific lung cell populations showed that alveolar epithelial type II (AT-II) cells, despite experiencing significant injury, exhibited minimal LRP1 shedding. No shedding of LRP1 occurred in neutrophils. In contrast, fibroblasts, which were resistant to ricin-induced cell death, exhibited increased shedding of LRP1 and a corresponding decrease in membrane-bound LRP1 expression. This shedding of the LRP1 ectodomain was mediated by metalloproteinases. Immunohistochemical staining further confirmed decreased LRP1 expression in fibroblasts from ricin-exposed mice. Macrophages also showed substantial LRP1 shedding, despite undergoing significant depletion. These findings highlight the complex cell-specific nature of LRP1 shedding in response to ricin intoxication and suggests the potential role of LRP1 in modulation of cellular susceptibility and resistance to ricin-induced lung injury. Full article

Lead contamination in the environment affects both humans and animals. Even with the decrease in manufactured items containing lead, contaminants persist in the landscape and may enter the food supply through animal products. In cattle, lead poisoning is associated with economic losses due to mortality and treatment costs and poses a health risk to consumers. A dairy herd was exposed to lead through feed that was contaminated with a 12-volt battery from a mixer wagon. Lead concentrations in blood and milk samples were examined over 289 days. A 2 ng/mL threshold for lead in milk was utilized to release affected cows back into the milking herd. After 289 days of surveillance, one of the five cows under milk surveillance was yet to meet this threshold. Milk lead concentrations greater than 2 ng/mL can result in lead intakes exceeding 2.2 µg/day limits for young children in the highest milk consumption group. Lead is not routinely assessed in fluid milk as a quality control step prior to processing in the United States, yet interstate commerce justifies a need for harmonized protocols for routine lead surveillance of the general milk supply and enhanced surveillance and quarantine for known food-animal exposures. Full article

Driving under the influence of alcohol (DUI) remains a leading cause of accidents globally, with accident risk rising exponentially with blood alcohol concentration (BAC). This study aims to distinguish between sober and intoxicated drivers using driving behavior analysis and driver monitoring system (DMS), technologies that align with emerging EU regulations. In a driving simulator, twenty-three participants (average age: 32) completed five drives (one practice and two each while sober and intoxicated) on separate days across city, rural, and highway settings. Each 30-minute drive was analyzed using eye-tracking and driving behavior data. We applied significance testing and classification models to assess the data. Our study goes beyond the state of the art by a) combining data from various sensors and b) not only examining the effects of alcohol on driving behavior but also using these data to classify driver impairment. Fusing gaze and driving behavior data improved classification accuracy, with models achieving over 70% accuracy in city and rural conditions and a Long Short-Term Memory (LSTM) network reaching up to 80% on rural roads. Although the detection rate is, of course, still far too low for a productive system, the results nevertheless provide valuable insights for improving DUI detection technologies and enhancing road safety. Full article

Studies analyzing the prevalence of associated substance use are limited. Currently, the World Health Organization (WHO) defines polydrug use as the concurrent (simultaneous use) or sequential (use of one drug followed by another) abuse of more than one drug or type of drug, with dependence on at least one. Associated drug consumption can exacerbate the adverse effects and complicate the clinical management of patients. This study aimed to investigate the prevalence of polydrug use, excluding tobacco, in patients presenting with acute intoxication in the Emergency Department (ED) of the Clinical University Hospital Virgen de la Arrixaca (Murcia, Spain) in the year 2023. To this end, a retrospective analysis of 2562 patients was conducted, examining demographic variables, substance use patterns, reasons for presenting to the ED, and the substances consumed by each patient. The study reveals an average patient age of 41 ± 0.5 (SD = 11.96) composed of predominantly male patients (74.4%). A high prevalence of benzodiazepines and cocaine use, often in combination, was observed. The main reasons for attendance included symptoms such as palpitations, dyspnea, vomiting, diarrhea, behavioral disturbances, and self-harm. Only 25.5% of patients admitted to consuming all substances detected in their analyses. Polydrug use is frequent in our environment, which can lead to added complexity in diagnosis and treatment. Consumption patterns show a profile strongly related to the age of the subject. Among the youngest subjects, tetrahydrocannabinol (THC) and benzodiazepines predominate, whilst among older subjects, alcohol and benzodiazepines, and sometimes cocaine, predominate. This study highlights the need to design specific intervention and prevention strategies to address patterns of substance abuse, the importance of family and community support, and the need to tackle challenges in identifying and treating cases of polysubstance abuse. Moreover, cooperation between the healthcare system and law enforcement is also important to obtain up-to-date knowledge of new drugs and their consumption patterns in an emergency context. Full article

Background: Farmers are continuously exposed to pesticides during crop production, which can lead to both acute and chronic poisoning. This exposure poses a significant global public health concern. In response, this study aims to achieve two primary objectives: (1) to identify the correlation between pesticide intoxication cases among farmers and their potential causes and (2) to assess the relationship between risk–control measures, hygiene practices, and resulting health effects. Methods: This study employed a cross-sectional mixed-methods observational design, sampling 112 farmers from Bogotá’s rural areas. Data were analyzed using logistic regression in R (version 4.2.1), examining eight associated variables. Results: The use of personal protective equipment (PPE) ranged from approximately 62% to 92%. Additionally, 82% of participants reported changing their workwear and 76% practiced bodily hygiene after exposure. Nevertheless, health complaints persisted—particularly affecting vision (46%), the respiratory system (38%), and the skin (32%). Notably, two out of every three farmers reported experiencing some form of systemic illness associated with pesticide exposure. Conclusion: A strong association was observed between the use of facemasks and changing workwear and the prevention of pesticide-related intoxication. These practices appear to be key in reducing chemical exposure during fumigation activities. Full article

Background: Cytoreductive surgery (CRS), in combination with chemotherapy, is the main treatment for advanced-stage ovarian cancer. In vulnerable patients, this extensive surgery has a high complication risk and may lead to clinical decline. There is emerging evidence that prehabilitation could be valuable in optimizing the patient’s condition prior to cytoreductive surgery, as is shown in colorectal surgery. However, there is limited evidence in gynecologic oncology. The objective of this study is to evaluate the feasibility and effects of implementing multimodal prehabilitation before cytoreductive surgery in patients with ovarian cancer. Methods: In two Dutch hospitals, 46 patients with ovarian cancer were included during the study period, of whom 32 participated in a multimodal prehabilitation program before CRS. The programs included at least physiotherapy, dietary advice and intoxication cessation. The timing, extent and content of the programs differed. Feasibility was assessed by eligibility and participation rates and adherence to the physiotherapy program. Effectiveness was measured by differences in functional capacity, postoperative outcomes and tolerance to adjuvant chemotherapy. Results: Eligibility rates in both hospitals were 83% and 89%, and participation rates were 68% and 72%. Adherence to the physiotherapy program was moderate and only satisfactory in 55% and 63% of the patients. All fitness endpoint measurements improved compared to the baseline. No significant differences in postoperative outcomes were found between prehabilitation and control patients. Prehabilitation patients appeared to have better tolerance to adjuvant chemotherapy, with fewer dose reductions (21% vs. 73%, p = 0.017) and dose deferrals (39% vs. 46%, not significant) compared to the control group. Conclusions: The implementation of multimodal prehabilitation before CRS is feasible and effective in patients with ovarian cancer with respectable eligibility and participation rates, along with improved functional capacity, even during neoadjuvant chemotherapy. Full article

Botulinum neurotoxin (BoNT) intoxication is a rare but severe condition that is characterized by autonomic and neuromuscular dysfunction. This study aimed to evaluate autonomic impairment and blood pressure variability in patients with botulinum intoxication during an outbreak, compared to healthy controls, and to assess their progression over a six-month follow-up period. Methods: Twenty (n = 20) male patients diagnosed with BoNT intoxication and 34 age- and sex-matched healthy controls were enrolled. At baseline, all subjects underwent 24 h ambulatory blood pressure monitoring (ABPM), and clinostatic and orthostatic blood pressure measurements. Autonomic function parameters, including mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), SBP and DBP variability, SBP and DBP load, pulse pressure (PP), blood pressure variability ratio (BPVR), and morning surge, were analyzed. Follow-up assessments were conducted after six months. Results: Patients with botulinum intoxication exhibited significantly lower SBP, DBP, and blood pressure variability parameters compared to healthy controls. Orthostatic hypotension was present in 55% of patients at baseline, improving to 5% at follow-up. Respiratory failure occurred in 40% of cases, necessitating non-invasive ventilation in 35% and intubation in 20%. At six-month follow-up, mean SBP, DBP, heart rate, and blood pressure variability parameters increased significantly, indicating partial recovery of autonomic control. However, residual abnormalities in autonomic regulation persisted. Conclusions: BoNT intoxication leads to notable autonomic dysfunction, marked by impaired blood pressure regulation and a high prevalence of orthostatic hypotension. Although partial recovery occurs, long-term autonomic impairment persists, highlighting the necessity for ongoing cardiovascular monitoring and further research to accelerate autonomic recovery through targeted therapeutic interventions. Full article

All parts of Alocasia × amazonica (A. amazonica, Araceae) pose a toxicological risk due to oxalate production. Ingestion of the plant extract may cause multi-organ damage and fatal outcomes. Given the rarity of poisoning cases, its toxicological profile and systemic effects remain insufficiently characterized. This study aimed to investigate and report an appropriate approach to managing a patient intoxicated with A. amazonica (Araceae). A case of intentional self-poisoning with A. amazonica is presented. The patient, a 63-year-old woman, ingested approximately 200–300 mL of liquid prepared from the grated root of the plant. The initial clinical presentation involved localized injuries to the oral cavity and gastrointestinal tract, including severe pain, hoarseness, aphonia, dysphagia, mucosal erosions, and necrosis. Additional symptoms included hematinic vomiting, hemorrhagic diarrhea, and abdominal discomfort. These superficial and mucosal lesions resolved without the development of adhesions. Systemic effects comprised impaired consciousness indicative of encephalopathy, early metabolic acidosis, pulmonary edema with acute respiratory insufficiency, mild liver dysfunction, and hematuria. The therapeutic protocol for oral poisoning management was appropriate, leading to the patient’s discharge after 20 days of hospitalization. Full article