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Prospective study of long-term neurological sequelae of acute methanol poisoning
Kotíková, Kateřina ; Zacharov, Sergej (advisor) ; Pohanka, Miroslav (referee) ; Ehler, Edvard (referee)
Background: Methanol is widely industrially used alcohol with known neurotoxic properties. Bilateral necrosis of basal ganglia is a typical finding detected on MRI or CT scan of the brain in acute methanol poisoning. The impact of methanol exposure on peripheral nervous system is unknown. Aim: To study the prevalence and predisposing factors of haemorrhagic and non-haemorrhagic brain lesions in survivors of acute methanol poisoning; to investigate whether 123 I-ioflupane SPECT (DaT SPECT) has the potential as a marker of basal ganglia damage in acute methanol poisoning; to investigate the role of acute methanol exposure in the development of peripheral polyneuropathy (PNP) during the years following discharge from the hospital. Methods: A six year prospective, single-centre, cohort study of patients with confirmed methanol poisoning was conducted. The examination protocol consisted of neurological examination, including magnetic resonance imaging (MRI) of the brain, DaT SPECT and electromyographic examination, further, visual evoked potentials, ocular examination with retinal nerve fiber layer thickness measurement, series of biochemical and toxicological tests. In 46 patients, follow-up examinations including brain MRI were performed 3-8 and 24-28 months after discharge from the hospital, in 42...
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Role of therapeutic approach in the treatment outcome, hospital costs, one-year post-hospital medical costs and quality of life in the patients who survived acute methanol poisoning.
Rulíšek, Jan ; Zacharov, Sergej (advisor) ; Máca, Jan (referee) ; Kieslichová, Eva (referee)
(English) Background: Methanol poisoning is severe medical condition with a need of urgent intensive treatment. Mass poisoning outbreak took place in the Czech Republic in 2012-2013. Costs of hospital treatment of methanol poisoning present significant financial burden to healthcare systems. The effect of treatment modality choice on clinical outcome and healthcare costs is not known, as well as its impact on the quality of life of methanol poisoning survivors after hospital discharge. Aim: To compare different therapeutic methods, choice of antidote (fomepizole versus ethanol) and extracorporeal elimination method (intermittent vs. continuous dialysis) for optimizing clinical outcome, cost-effectiveness, hospital costs, post-discharge costs, and the quality of life in survivors. Methods: For prospective cohort study, all patients hospitalized with acute methanol poisoning were included (n=106); for hospital and one-year healthcare costs study, all survivors of acute methanol poisoning (n=83) were included. For longitudinal quality of life study all survivors with informed consent (n=54) and control group of chronic alcohol abusers, age- and gender-balanced, without history of methanol poisoning (n=23), were included. Results: Comparative data of clinical effectiveness of elimination techniques...
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Prospective study of the role of oxidative stress in acute methanol poisonings.
Hlušička, Jiří ; Zacharov, Sergej (advisor) ; Lambert, Lukáš (referee) ; Pohanka, Miroslav (referee)
5 SUMMARY Context: Acute methanol poisoning is a life-threatening condition. Methanol is metabolized in the organism to formaldehyde and than to formic acid, which inhibits cytochrome c oxidase in mitochondria and thus contributes to the development of oxidative stress. Aim: To study the role of oxidative stress in the pathogenesis of acute neuronal damage to the central nervous system (CNS), in the development of long-term sequelae of methanol poisoning and chronic neurodegenerative processes in the years following acute methanol exposure. Material and Methods: Methanol intoxication was confirmed analytically in 55 patients included in he d ; hei age a he ime f i ning a 46.7 3.6 ea (9 female and 46 male ). All a ien , together with 41 control subjects, were examined in a prospective longitudinal cohort study. At admission, during hospitalisation, and at regular intervals after discharge during the follow-up, the patients were sampled for serum concentrations of lipid oxidative damage markers 4-hydroxy-trans-2- hexenal (HHE), 4-hydroxynonenal (HNE), malondialdehyde (MDA), and 8-isoprostane, for nucleic acids oxidative damage markers 8-hydroxy-2 -deoxyguanosine (8-OHdG), 8-hydroxyguanosine (8- OHG), 5- (hydroxymethyl) uracil (5-OHMU), for proteins oxidative damage markers ortho-tyrosine (o- Tyr),...
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Prospective study of long-term visual sequelae of acute methanol poisonings
Nurieva, Olga ; Zacharov, Sergej (advisor) ; Lišková, Petra (referee) ; Pohanka, Miroslav (referee)
Background: Methanol poisoning is a life-threatening condition which induces acute toxic optic neuropathy with possible long-term visual sequelae in survivors. Aim: To study the prevalence, character, dynamics, and key determinants of chronic morphological and functional visual pathway changes during 4 years after methanol-induced optic neuropathy. Methods: A total of 55 patients with confirmed methanol poisoning with mean age 46.7 ± 3.6 years (46 males and 9 females), and 41 controls were included in this prospective longitudinal cohort study. The patients were examined 4.9 ± 0.6, 25.0 ± 0.6, and 49.9 ± 0.5 months after discharge. The following tests were performed: visual evoked potential (VEP), optical coherence tomography with retinal nerve fiber layer (RNFL) measurement, brain magnetic resonance imaging (MRI), complete ocular examination, biochemical tests, and apolipoprotein E (ApoE) genotyping. Results: Of 42/55 patients with all three consecutive examinations, abnormal RNFL thickness was registered in 13 (31%) and chronic axonal loss during the observation period was found in 10 (24%) patients. The risk estimate of chronic global RNFL loss for arterial blood pH<7.3 at admission was: 11.65 (1.91-71.12; 95% CI) after adjusting for age and sex. The patients with chronic axonal degeneration demonstrated...
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Pharmacovigilance in the Toxicological Information Centre
Urban, Michal ; Pelclová, Daniela (advisor) ; Benešová, Veronika (referee) ; Zacharov, Sergej (referee)
1 ABSTRACT Background The annual drug overdose rates have been increasing exponentially since the 90's worldwide. Toxicological information centre (TIC) represents a valuable source of information for evaluating the trends in the drug poisonings in Czech Republic. Aim of the study The purpose was to analyze the number and trends in the calls concerning poisonings due to central nervous system (CNS) affecting drugs, identify the reasons of medication errors caused by laymen, frequency and consequences of these errors across all age groups and also to analyze the numbers, causes, symptoms and severity of the paracetamol intoxications. Methods During the reference period the data from the enquiries were extracted from the TIC electronic database, discharge reports from the hospital were studied or phone call follow-ups with the patients were carried out to be able to evaluate the outcome of the poisonings. Results In the years 1997-2002 the number of calls caused by poisoning with tricyclic antidepressants and barbiturates decreased (by 366.7 % and 340,0 %, respectively) whereas the calls due to selective serotonin reuptake inhibitors and benzodiazepines overdose increased (by 1347.4 % and 359.8 %). The 0-5 years old children are at the highest risk of experiencing medication errors or accidental poisonings...
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