Kratom: History, pharmacology, current user trends, adverse health effects and potential benefits.

Kratom (Mitragyna speciosa Korth.) is a tree native to Southeast Asia with dose-dependent stimulant and opioid-like effects. Dried, powdered leaf material is among the kratom products most commonly consumed in the US and Europe, but other formulations also exist including enriched extracts, resins, tinctures, and edibles.

The 2021 Core Content of Medical Toxicology.

The Medical Toxicology Subboard approved modifications to the Core Content of Medical Toxicology in March 2021. The document outlines the areas of knowledge considered essential for the practice of medical toxicology. The Core Content provides the organizational framework for the development of the Medical Toxicology Certification and Cognitive Expertise Examinations and serves as a template for the development of curricula for medical toxicology fellowship training programs.

Nicotine Content from Cigarettes Submerged in Soda.

Introduction: Cigarettes and other tobacco products may be extinguished by submersion in liquids in beverage cans or bottles. Cases of nicotine poisoning in children have been reported following ingestion of such liquids. The aim of this study is to analyze the variability of nicotine concentrations with respect to number of cigarettes immersed and the duration of immersion in a soda can METHODS: One unsmoked cigarette was immersed in a cola containing soda can.

Regeneration of a Pediatric Alveolar Cleft Model Using Three-Dimensionally Printed Bioceramic Scaffolds and Osteogenic Agents: Comparison of Dipyridamole and rhBMP-2.

Background: Alveolar clefts are traditionally treated with secondary bone grafting, but this is associated with morbidity and graft resorption. Although recombinant human bone morphogenetic protein-2 (rhBMP-2) is under investigation for alveolar cleft repair, safety concerns remain. Dipyridamole is an adenosine receptor indirect agonist with known osteogenic potential.

Opioid Toxidrome Following Grapefruit Juice Consumption in the Setting of Methadone Maintenance.

Background: Methadone is a synthetic mu-opioid receptor agonist used in the treatment of chronic pain and opioid dependence. Methadone is metabolized by several cytochrome P450 isoenzymes; primarily CYP3A4, CYP2B6, and CYP2D6 before renal and fecal elimination. Exposure to substances like grapefruit juice, that inhibit these isoenzymes may result in increased blood levels of methadone, and thus may manifest clinically as unexpected opioid toxicity.

Gadolinium Aspiration Following Inadvertent Endotracheal Tube Cuff Injection in a Pediatric Patient.

Introduction: Gadolinium-based contrast agents (GBCA) are frequently used for MRI contrast studies. We report a case of pulmonary aspiration secondary to inadvertent GBCA injection.

Case Report: A 12-year-old female with a past medical history significant for mitochondrial disorder, bronchial asthma, autism, recurrent urinary tract infection, epilepsy, developmental delay, dysautonomia, and thrombocytopenia was scheduled for a contrast-enhanced MRI study using gadoterate meglumine for urinary incontinence.

The implementation of medical monitoring programs following potentially hazardous exposures: a medico-legal perspective.

Context: Clinical toxicologists may be called upon to determine the appropriateness of medical monitoring following documented or purported exposures to toxicants in the occupational, environmental, and medical settings.

Methods: We searched the MEDLINE database using the Ovid search engine for the following terms cross-referenced to the MeSH database: ("occupational exposures" OR "environmental exposures") AND ("physiologic monitoring" OR "population surveillance"). The titles and abstracts of the resulted articles were reviewed for relevance.

Urine uranium concentrations and renal function in residents of the United States--2001 to 2010.

Context: Animal model studies have demonstrated that subchronic oral uranium exposure is associated with renal dysfunction. Little is known about the effects of environmental exposure to uranium in humans.

Objective: To determine whether environmental exposure to uranium is associated with alterations in renal function among residents of the United States.

Metal fume fever and polymer fume fever.

Introduction: Inhalational exposure to metal-containing fumes generated by welding and related processes may result in the development of the clinical syndrome known as "metal fume fever." Polymer fume fever is a separate and distinct but related disorder that has been associated with inhalational exposure to specific fluorinated polymer products, such as polytetrafluoroethylene or Teflon(®). We undertook a review of the peer-reviewed medical literature as it relates to these two disease entities in order to describe their epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, prevention, and prognosis.

Change in perceived risk associated with marijuana use in the United States from 2002 to 2012.

Context: The role of a dynamic legal, medical, and social setting in affecting the perceived risk associated with smoking marijuana has not been well studied. We sought to determine whether there has been a change in the perceived risk associated with marijuana use over time.

Methods: A cross-sectional study was conducted using the 2002-2012 National Survey on Drug Use and Health.

Effect of single-dose Ginkgo biloba and Panax ginseng on driving performance.

Context: Panax ginseng and Gingko biloba are commonly used herbal supplements in the United States that have been reported to increase alertness and cognitive function.

Objective: The objective of this study was to investigate the effects of these specific herbals on driving performance.

Materials And Methods: 30 volunteers were tested using the STISIM3® Driving Simulator (Systems Technology Inc.

Phenol Toxicity Following Cutaneous Exposure to Creolin®: A Case Report.

Introduction: Phenol is a caustic that may cause cutaneous or gastrointestinal burns depending on the route of exposure. Significant absorption may result in systemic toxicity. We present a case of topical phenol exposure resulting in cutaneous burns and systemic phenol toxicity.

K2--not the spice of life; synthetic cannabinoids and ST elevation myocardial infarction: a case report.

Introduction: The adverse effects of synthetic cannabinoids are not well-described nor have they been thoroughly studied.

Case Report: A 16-year-old male with a past medical history of asthma and attention deficit hyperactivity disorder (ADHD) presented to the emergency department (ED) complaining of 24 h of substernal pressure associated with dyspnea, nausea, and vomiting. He reported smoking tobacco cigarettes daily and occasional marijuana use but denied recent use of marijuana.

The perception of odor is not a surrogate marker for chemical exposure: a review of factors influencing human odor perception.

Context: Clinical toxicologists perform risk assessments and clinical evaluations for patients with potential exposure to airborne toxicants in which the patient's self-reported perception of odor may be the only indicator that an exposure may have taken place.

Objective: To review the factors that may affect the human ability to perceive chemical odors and relate those odors to specific chemical exposures.

Methods: The medical literature, from 1950 through 2012, was searched using the OVID database and the PUBMED database.

Blood lead levels in the United States "oldest-old" population.

Context: Previous studies have suggested significant endogenous lead release from bony stores in the elderly raising the concern for elevated blood lead levels in that population.

Objective: We undertook to determine the range of blood lead levels in the "oldest-old" population, a demographic category that includes persons aged 80 years and older.

Materials And Methods: We analyzed blood lead level data from the National Health and Nutrition Examination Survey (NHANES) for the years 1999-2010 for persons aged 80 years and older.

FMCSA's medical review board: five years of progress in commercial driver medical examinations.

Objective: To revise and update guidance recommendations to the Federal Motor Carrier Safety Administration for evaluating commercial drivers.

Methods: The Federal Motor Carrier Safety Administration's medical review board has addressed guidance for commercial drivers for the past 5 years. The processes for most topics involve comprehensive literature searches, evidence reports, medical expert panel reports, critique of the literature, testimony, and decision making.

Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance.

Context: Mining operations conducted at high altitudes provide health challenges for workers as well as for medical personnel.

Objective: To review the literature regarding adverse health effects and toxic exposures that may be associated with mining operations conducted at altitude and to discuss pre-placement screening, acclimatization issues, and on-site surveillance strategies.

Methods: We used the Ovid ( http://ovidsp.