Microplastic and nanoplastic exposure and risk of diabetes mellitus.

The issue of plastic pollutants has become a growing concern. Both microplastics (MPs) (particle size < 5 mm) and nanoplastics (NPs) (particle size < 1 µm) can cause DNA damage, cytotoxicity, and oxidative stress in various organisms. The primary known impacts of microplastic/nanoplastic are observed in the liver and respiratory system, leading to hepatotoxicity and chronic obstructive pulmonary disease.

Should digoxin immune fab be administered based solely on reported ingested amount in acute digoxin poisoning?

Acute digoxin poisoning is increasingly uncommon in emergency medicine. Furthermore, controversy exists regarding indications for antidotal digoxin immune fab in acute poisoning. In healthy adults, the fab prescribing information recommends administration based on "known consumption of fatal doses of digoxin: ≥10mg," while many emergency medicine textbooks suggest fab administration be driven by clinical features or potassium concentration.

Therapeutic Errors Associated With Antithrombotic Medications Reported to United States Poison Centers.

The objective of this study was to investigate the characteristics and trends of therapeutic errors in non-healthcare facility settings associated with antithrombotic medications reported to United States Poison Centers by analyzing data from the National Poison Data System from 2000 to 2021. There were 57 288 reported therapeutic error-related exposures involving antithrombotic medications as the primary substance. The rate of therapeutic errors increased by 590.

Street Pharmacology: Toxico-Dermatology of Injection Drug Use.

Street medicine is a point-of-care, mobile approach that services the needs of unhoused individuals who are otherwise unable to access medical care in traditional settings. The prevalence of injection drug use combines with the pipeline of illicit substances, to produce a constellation of severe, potentially life-threatening dermatological disorders unique to this population. This review applies principles of clinical pharmacology to clarify the mechanisms underlying the dermatological toxicity of xylazine, desomorphine, and 3,4-methylenedioxymethamphetamine (MDMA).

Environmental PM Exposure: An Ignored Factor Associated with Blood Cadmium Level in Hemodialysis Patients.

Background: The negative impacts of particulate matter with an aerodynamic diameter of 2.5 μm or less (PM) are well known. Patients undergoing maintenance hemodialysis (HD) have significantly higher blood cadmium levels (BCLs) than healthy individuals.

Regional readiness for sodium nitrite-induced methemoglobinemia: availability of methemoglobin testing and methylthioninium chloride (methylene blue) stocking in the Upper Midwestern United States.

Introduction: Sodium nitrite is a potent oxidizer, which may precipitate rapidly lethal methemoglobinemia. Prompt diagnosis and treatment may salvage otherwise fatal cases. It is unclear if emergency departments are prepared for increasing cases.

Identifying the sources of mercury exposure in dental workers.

Dental professionals who handle dental amalgam are at risk of mercury exposure, though the prevalence and severity of elevated mercury levels from non-occupational sources are not well characterized. We report two dental workers who had elevated urinary mercury levels (37 and 25.6 mcg/L) during routine health screenings.

Tianeptine Exposures Reported to United States Poison Centers, 2015-2023.

Introduction: Tianeptine is an atypical tricyclic antidepressant not approved for medical use in the US but is found in dietary supplements. This study investigates single-substance tianeptine exposures reported to US poison centers.

Methods: We analyzed cases involving tianeptine reported to the National Poison Data System from 2015 to 2023.

National Poison Data System Annual Report: under the hood.

Introduction: The 41st National Poison Data System Annual Report from America's Poison Centers is published in this issue of This Commentary focuses on comparing the different poisoning-related surveillance systems in the United States while highlighting some of the strengths and weaknesses of the National Poison Data System. It also reviews the process underlying the fatality review section of the Annual Report.

Comparison Of Poisoning Surveillance Systems: In order to place the data reported by the National Poison Data System in context, the National Poison Data System was compared to other available poisoning surveillance systems in the United States: the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, the Centers for Disease Control and Prevention Injury Prevention and Control Web-based Injury Statistics Query and Reporting System (WISQARS) which partners with the Consumer Products Safety Commission's National Electronic Injury Surveillance System - All Injury Program (NEISS-AIP), and the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database.

Does the time between doses in an unintentional double dose bupropion exposure affect the incidence of adverse effects? A retrospective cohort study.

Introduction: Unintentional therapeutic errors with bupropion are common. The impact of the timing of the second dose in a double dose exposure on adverse effects is not well studied. This study aims to compare adverse effects between double doses separated by <720 min and ≥720 min.

Consensus Guideline for Care of Patients in the Prehospital and Aerospace Settings with Exposures to Hydrazine and Hydrazine Derivatives.

Objectives: Hydrazine (HZ) and Hydrazine Derivative (HZ-D) exposures pose health risks to people in industrial and aerospace settings. Several recent systematic reviews and case series have highlighted common clinical presentations and management strategies. Given the low frequency at which HZ and HZ-D exposures occur, a strong evidence base on which to develop an evidence-based guideline does not exist at this time.

Coma and confirmed epileptiform activity induced by Amanita pantherina poisoning.

Amanita pantherina poisoning is a rare event poorly described. The clinical picture is usually associated with the one of A. muscaria, but A.

Pediatric exposure to illicit fentanyl is associated with drug availability in the community.

Introduction: Fentanyl has replaced diacetylmorphine (heroin) as the primary illicit opioid in the United States. Over the last several years, exposures to illicit fentanyl in small children have increased nationally. We hypothesized that the increase in illicit fentanyl in the community, as measured by regional drug seizures, would be associated with the number of pediatric exposures to illicit fentanyl.

Human stromal cell-based protocol to generate astrocytes: a straightforward predictive strategy in neurotoxicology.

The inherent adaptability of human mesenchymal stromal cells (hMSCs) to differentiate into neural lineages provides a valuable resource for investigating potential neurotoxicity in humans. By harnessing the ability of hMSCs to transform into astrocytes, we can evaluate the effects of various agents on these vital cells. Our protocol employs hMSCs sourced from umbilical cord tissue, ensuring a readily available supply of high-quality cells.

Acute kidney failure from ingestion of "wood bleach" beekeeping miticide.

Wood bleach is >95 % oxalic acid formulation used off-label as a miticide for Varroa mites by hobbyist beekeepers. Wood bleach (oxalic acid) ingestions are poorly documented in the medical literature. A 46-year-old man presented to the emergency department nauseated and vomiting after accidentally ingesting "bleach and grain ethanol intended for use in beekeeping.

Characteristics of Fentanyl Toxicity in Very Young Children.

Children exposed to illicit fentanyl often experience severe toxicity and receive repeated naloxone doses and prolonged airway support. This retrospective study presents the clinical course and management of 4 cases, emphasizing the urgent need for prompt recognition and intervention to address the severe, extended effects of illicit fentanyl exposure in very young children.

A ZnO-nanorod/PEDOT:PSS nanocomposite functionalized bridge-like membrane type nanomechanical sensing device for ultrasensitive blood lead detection.

Lead (Pb) ion detection poses a critical problem, particularly in environmental monitoring, industrial operations, and public health, especially for young children and expecting women. Determining lead levels in blood early on is essential to minimizing the long-term consequences of lead exposure. Several sophisticated detection instruments, such as mass spectrometers which perform with high sensitivity, specificity and accuracy, but require a lab-based setting, multi-step sample preparation, expensive payment and professional operation.

Utility of iron concentration two to four hours post ingestion in predicting toxicity.

Introduction: Iron products are widely available over the counter and have the potential to cause serious toxicity. Iron concentrations can be used to prognosticate and guide treatment during acute ingestions. Traditionally, a concentration of 350 μg/dL with symptoms, or 500 μg/dL without symptoms, is considered toxic and will likely need treatment to prevent decompensation.

Developments in the epidemiology of calcium channel blocker poisoning and implications for management.

Purpose Of Review: The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents.

Recent Findings: Amlodipine is now the most common CCB involved in poisoning.

Gabapentin and pregabalin exposures reported to United States poison centers, 2012-2022.

Background: Gabapentin and pregabalin were originally introduced as anticonvulsant medications but are now also prescribed on- and off-label for multiple medical disorders, especially for pain management. The national opioid crisis has led to increased use of non-opioid pain medications, including gabapentinoids, which has been associated with changing patterns of adverse events associated with these medications. This study investigated the characteristics and trends of gabapentin and pregabalin exposures reported to US poison centers from 2012 to 2022.