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Case Study: Two Fatal Case Reports of Acute Yohimbine Intoxication. Anderson C et al. J Anal Toxicol 2013;37:611-614.
This paper reports 2 medical examiner cases in which death was attributed to yohimbine overdose on the basis of extremely high post-mortem levels and no other apparent contributing factor. Although the article will be of most interest to forensic pathologists and toxicologists, it does give us the opportunity to review briefly the pharmacology and toxicology of the drug.
Yohimbine is derived from the bark of a West African evergreen. It is an alpha-2 blocker, and thus has actions somewhat opposite to those of clonidine (an alpha-2 agonist). It is available by prescription (Yocon, Aphrodyne, Erex, Testomar) and also over-the-counter in “natural” or health store preparations.
Although benefits have not been proven, yohimbine is used as an aphrodisiac and to treat erectile dysfunction. It increases release of norepinephrine and dopamine, and acts as a CNS stimulant and vasodilator. Its effects are increased by common co-ingestants such as caffeine.
Manifestations of yohimbine overdose include nausea, agitation, anxiety, hypertension, diaphoresis, mydriasis, priapism and bronchospasm. Generally, overdose patients respond to supportive care and benzodiazepines as needed. Clonidine has been used to treat yohimbine-associated hypertension.
Yohimbe and Priapism
Improved survival among HIV-1-infected individuals with the advent of antiretroviral therapy has clearly led to a greater prevalence of noninfectious complications. One of the most devastating sequelae in these individuals is the development of pulmonary arterial hypertension (PAH). Various epidemiological studies suggest worse survival of HIV-PAH patients when compared with other forms of PAH. Given that only a subset and not all HIV-infected individuals develop HIV-PAH, it is suggested that an additional second-hit of genetic or environmental trigger is needed for the development of PAH. In this context, it has been well…
Antiretroviral therapy (ART) has decreased mortality so that increasing numbers of children with HIV are reaching adolescence. However, longstanding HIV infection and/or its treatment in children is associated with noninfectious complications including cardiac disease. We investigated the prevalence, spectrum and risk factors for echocardiographic abnormalities among children established on ART.
HIV-infected children aged 6–16 years, on ART at least 6 months were enrolled into a cross-sectional study from a public-sector paediatric HIV clinic in Harare, Zimbabwe. A standardized examination i…
ConclusionIt was observed that the systemic arterial hypertension group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions, hypertension seems to have the greatest influence on hearing.ResumoIntroduçãoDoenças crônicas podem atuar como fator de aceleração na degeneração do sistema auditivo. Os estudos sobre a associação da presbiacusia com o diabetes mellitus e com a hipertensão arterial sistêmica mostraram conclusões controvers…
Purpose of review
Various neurologically focused monitoring modalities such as processed electroencephalography (pEEG), tissue/brain oxygenation monitors (SbO2), and even somatosensory evoked responses have been suggested as having the potential to improve the well tolerated and effective delivery of care in the setting of outpatient surgery. The present article will discuss the pros and cons of such monitors in this environment.
There is a paucity of evidence from rigorous, well designed clinical trials demonstrating that the routine use of any neuromonitoring technique in an ambulatory surgery settin…
Purpose of review
Ambulatory procedural sedation is used to relieve anxiety, pain and discomfort in a broad spectrum of patients during many types of diagnostic or therapeutic procedures. This review focuses on recent comparative studies of commonly used and new drugs for adult ambulatory sedation.
Midazolam and propofol are commonly used for ambulatory sedation. Their pharmacological properties offer many advantages and there is much experience with their use. Ketamine can be a useful addition to hypnotic drugs but the advantage of the use of ketofol (a mixture of propofol and ketamine) is, although o…
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CONCLUSIONS: The present three cases add further evidence that secukinumab is effective and well tolerated in difficult to treat psoriatic patients with multiple comorbidities, namely HBV, latent TBC infection, and hepatic impairment.
PMID: 30403898 [PubMed – as supplied by publisher]
In this study, we treated SHR and Wistar-Kyoto rats with R568 for 8 weeks. The tail-cuff method was used to assess rat BP weekly. Morphological changes in the thoracic aorta were evaluated with hematoxylin-eosin and Masson staining. Western blotting and immunohistochemistry were used to detect the expression of RAS-related proteins and proliferative remodeling proteins in the thoracic aorta. An enzyme-linked immunosorbent assay was used to detect the content of cAMP, the RAS, and the CaSR in plasma and the thoracic aorta. Finally, we found that treatment with R568 for 8 weeks reduced the BP and inhibited arterial vascular …
Authors: Kwon I, Jun DW, Moon JH
Whether moderate alcohol intake is beneficial remains an unsolved issue. Recent studies have suggested that moderate alcohol consumption is associated with beneficial effects related to the prevention of cardiovascular diseases. Moderate alcohol consumption leads to a higher risk of hepatocellular carcinoma in patients with chronic viral liver diseases. However, the effects of moderate alcohol intake in patients with nonalcoholic fatty liver disease are unclear. In this review, we analyzed, from various perspectives, the effect of moderate alcohol consumption in patients wi…
CONCLUSIONS: Paraquat poisoning still persists in French Guyana despite its withdrawal from the market. It is possible to determine the probability of death on patient admission based on routine clinical and biological parameters. There is an urgent need to request neighboring countries to ban paraquat with the aim of eradicating this dramatically life-threatening poisoning.
PMID: 30402871 [PubMed – in process]