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  1. Article ; Online: Sublethal toxicities of 2,4-dinitrophenol as inferred from online self-reports.

    Abdelati, Ali / Burns, Michele M / Chary, Michael

    PloS one

    2023  Volume 18, Issue 9, Page(s) e0290630

    Abstract: Introduction: 2,4-dinitrophenol (DNP) is a mitochondrial toxin sometimes used as a weight loss agent. Reports of fatalities from DNP have been increasing since 2000, suggesting an increase in use. Our understanding of DNP toxicity in humans comes from ... ...

    Abstract Introduction: 2,4-dinitrophenol (DNP) is a mitochondrial toxin sometimes used as a weight loss agent. Reports of fatalities from DNP have been increasing since 2000, suggesting an increase in use. Our understanding of DNP toxicity in humans comes from reports to Poison Control and postmortem analyses, sources that are biased to more extreme presentations. This leads to a gap in our knowledge about the adverse effects of DNP at nonlethal doses. Here we investigate the doses and effects of DNP as reported online.
    Methods: We analyzed publicly available Internet posts that we collected from 2017-2019. The posts came from anonymous users or users who voluntarily self-identified. We collected data from websites whose terms of use allow for the secondary analysis of data that their users agree to make public. We used natural language processing techniques that we had previously developed to extract doses, effects, and substances mentioned in each post.
    Results: We collected 1,630 posts across 5 online forums and the Reddit forum r/DNP. The posts were from 1,234 unique usernames. The most commonly reported doses were between 150 to 300 mg each day followed by 300 to 450 mg each day. At those doses, the most reported adverse effects were profuse sweating and fatigue. Reports of thermoregulatory (sweating, feeling hot flashes or flushed), fatigue-related, and neurologically related symptoms were statistically significantly more frequent at reported daily doses greater than 150 mg than doses below 150 mg (post-hoc χ2-test with Bonferroni correction). The effects were judged as plausible by two board-certified medical toxicologists. Triiodothyronine, clenbuterol, testosterone, and trenbolone, an androgenic anabolic steroid were the most significantly co-mentioned substances.
    Conclusions: Fatigue, increased body temperature, and paresthesias from DNP are reported more frequently at doses greater than 150 mg each day than at doses less than 150 mg each day. Online discussions of DNP frequently mention androgenic anabolic steroids and other weight loss agents.
    MeSH term(s) Humans ; Self Report ; 2,4-Dinitrophenol/toxicity ; Androstanes ; Anti-Obesity Agents ; Dinitrophenols ; Drug-Related Side Effects and Adverse Reactions ; Fatigue
    Chemical Substances 2,4-Dinitrophenol (Q13SKS21MN) ; Androstanes ; Anti-Obesity Agents ; Dinitrophenols
    Language English
    Publishing date 2023-09-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0290630
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Authors' reply to comment on "Efficacy of lipid emulsion therapy in treating cardiotoxicity from diphenhydramine ingestion".

    Clemons, Joseph / Jandu, Arvinder / Stein, Brandon / Chary, Michael

    Clinical toxicology (Philadelphia, Pa.)

    2022  Volume 60, Issue 8, Page(s) 993–994

    MeSH term(s) Cardiotoxicity/etiology ; Diphenhydramine/therapeutic use ; Eating ; Fat Emulsions, Intravenous/therapeutic use ; Humans ; Lipids
    Chemical Substances Fat Emulsions, Intravenous ; Lipids ; Diphenhydramine (8GTS82S83M)
    Language English
    Publishing date 2022-04-27
    Publishing country England
    Document type Letter
    ZDB-ID 204476-6
    ISSN 1556-9519 ; 0009-9309 ; 0731-3810 ; 1556-3650
    ISSN (online) 1556-9519
    ISSN 0009-9309 ; 0731-3810 ; 1556-3650
    DOI 10.1080/15563650.2022.2066543
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Tweetchats, Disseminating Information, and Sparking Further Scientific Discussion with Social Media.

    Chary, Michael A / Chai, Peter R

    Journal of medical toxicology : official journal of the American College of Medical Toxicology

    2020  Volume 16, Issue 2, Page(s) 109–111

    MeSH term(s) Editorial Policies ; Group Processes ; Humans ; Information Dissemination ; Periodicals as Topic ; Scholarly Communication ; Social Media ; Toxicology
    Language English
    Publishing date 2020-02-24
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2435016-3
    ISSN 1937-6995 ; 1556-9039
    ISSN (online) 1937-6995
    ISSN 1556-9039
    DOI 10.1007/s13181-020-00760-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Efficacy of lipid emulsion therapy in treating cardiotoxicity from diphenhydramine ingestion: a review and analysis of case reports.

    Clemons, Joseph / Jandu, Arvinder / Stein, Brandon / Chary, Michael

    Clinical toxicology (Philadelphia, Pa.)

    2022  Volume 60, Issue 5, Page(s) 550–558

    Abstract: Introduction: Lipid emulsion therapy (LET) has been most thoroughly studied to reverse local anesthetic systemic toxicity (LAST). Case reports suggest that LET can successfully rescue cardiovascular collapse from bupropion, amitriptyline, and ... ...

    Abstract Introduction: Lipid emulsion therapy (LET) has been most thoroughly studied to reverse local anesthetic systemic toxicity (LAST). Case reports suggest that LET can successfully rescue cardiovascular collapse from bupropion, amitriptyline, and propranolol. The efficacy of LET against refractory hypotension and dysrhythmias from diphenhydramine, a commonly ingested lipophilic cardiotoxic agent, is less well described.
    Objective: Summarize the evidence that LET rescues cardiac ion channel blockade (QRS, QTc widening) or hypotension attributable to diphenhydramine overdose.
    Methods: We searched MEDLINE, EMBASE, and Google Scholar for English-language full-length case reports of diphenhydramine (DPH) intoxication in patients 17 years of age or older. We extracted data with a PRISMA-compliant protocol, dividing the case reports into two groups, one that received LET and one that did not. We performed a pooled analysis to compare the change in mean arterial pressure (MAP), QRS duration, and QTc duration between the two groups.
    Results: We identified 23 reports (25 patients). Lipid emulsion therapy (LET) was used in 6 cases because the patient suffered from hypotension refractory to traditional resuscitation. Those who received LET and those who did not were comparable in age, gender, amount ingested, and frequency of seizures. The mean arterial pressure (MAP) decreased by 4.5 ± 11.5 mm Hg in those who did not receive LET compared to an increase in MAP 37 ± 17.5 mm Hg in those who did receive LET. The QRS narrowed by 29 ± 33.9 ms (no LET group) vs 68 ± 49.5 ms (LET group) and QTc by 168.5 ± 126.75 ms (no LET group) vs 134 ± 88 ms (LET group). All values are expressed as median ± interquartile range. One out of the 6 patients who received LET died after withdrawal of care. In the group that did not receive LET 4 out of 19 died and 3 had no outcome reported.
    Discussion: LET may improve MAP in patients with hypotension refractory to vasopressors due to diphenhydramine toxicity. We found no significant effect of LET on QRS or QTc duration. These results are limited by a small sample size, reporting bias of case reports, incomplete data, and heterogeneity.
    Conclusion: An analysis of pooled case reports suggests that LET may rescue hypotension when other methods have failed in patients with hypotension attributable to diphenhydramine overdose.
    MeSH term(s) Cardiotoxicity/drug therapy ; Cardiotoxicity/therapy ; Diphenhydramine/therapeutic use ; Drug Overdose/drug therapy ; Eating ; Fat Emulsions, Intravenous/therapeutic use ; Humans ; Lipids/therapeutic use
    Chemical Substances Fat Emulsions, Intravenous ; Lipids ; Diphenhydramine (8GTS82S83M)
    Language English
    Publishing date 2022-02-16
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 204476-6
    ISSN 1556-9519 ; 0009-9309 ; 0731-3810 ; 1556-3650
    ISSN (online) 1556-9519
    ISSN 0009-9309 ; 0731-3810 ; 1556-3650
    DOI 10.1080/15563650.2022.2038187
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Translator use not associated with longer time to pain medication in initial evaluation of low-severity geriatric trauma.

    Gong, Jing Jing / Chen, Chun-Cheng / Lebaron, Johnathan / Chary, Michael A

    The American journal of emergency medicine

    2022  Volume 60, Page(s) 62–64

    Abstract: Objectives: Determine whether geriatric victims of blunt trauma who preferred to communicate in a language other than English waited longer for pain medication or received more imaging studies than English-speaking patients with the same age and ... ...

    Abstract Objectives: Determine whether geriatric victims of blunt trauma who preferred to communicate in a language other than English waited longer for pain medication or received more imaging studies than English-speaking patients with the same age and injuries. Secondary outcomes were the type of medication administered and number of imaging studies.
    Methods: We conducted a retrospective analysis of all trauma activations to a single academic urban medical center from January 2019 to October 2019. We included all hemodynamically stable patients older than 65, with head or torso trauma after a low energy injury, and on at least one medication that was an anti-coagulant, anti-platelet, or chemotherapeutic.
    Results: We identified 1,153 unique patients (17, 379 radiologic studies) performed from January 2019 to October 2019, with a median of 5 (4-6) radiologic studies per patient. We excluded 419 patients for whom the language used was not reported (n = 7), no imaging was not reported (n = 16), or no medication was recorded as given (n = 409), leaving 734 patients for further analysis. Of those 734 patients, 460 preferred to communicate in English, 84 in Mandarin Chinese, 64 in Spanish, 37 in Cantonese Chinese, and 35 in Korean, and 29 in Russian. Across all languages patient age and Injury Severity Score (ISS) were comparable. Those who preferred to communicate in Spanish, Russian, or Korean were more likely to be female than those who preferred English, Mandarin, or Cantonese, but this tendency was not statistically significant (χ
    Conclusions: A retrospective analysis of patients with low-risk blunt trauma found no relationship between preferred language, time to pain medication, use of opioids or number of imaging studies.
    MeSH term(s) Acetaminophen ; Aged ; Analgesics, Opioid ; Female ; Humans ; Lidocaine ; Male ; Pain/complications ; Pain/etiology ; Retrospective Studies ; Wounds, Nonpenetrating/complications ; Wounds, Nonpenetrating/diagnostic imaging ; Wounds, Nonpenetrating/drug therapy
    Chemical Substances Analgesics, Opioid ; Acetaminophen (362O9ITL9D) ; Lidocaine (98PI200987)
    Language English
    Publishing date 2022-07-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2022.06.057
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: COVID-19 Therapeutics: Use, Mechanism of Action, and Toxicity (Xenobiotics).

    Chary, Michael A / Barbuto, Alexander F / Izadmehr, Sudeh / Tarsillo, Marc / Fleischer, Eduardo / Burns, Michele M

    Journal of medical toxicology : official journal of the American College of Medical Toxicology

    2022  Volume 19, Issue 1, Page(s) 26–36

    Abstract: SARS-CoV-2 emerged in 2019 and led to the COVID-19 pandemic. Efforts to develop therapeutics against SARS-Cov-2 led to both new treatments and attempts to repurpose existing medications. Here, we provide a narrative review of the xenobiotics and ... ...

    Abstract SARS-CoV-2 emerged in 2019 and led to the COVID-19 pandemic. Efforts to develop therapeutics against SARS-Cov-2 led to both new treatments and attempts to repurpose existing medications. Here, we provide a narrative review of the xenobiotics and alternative remedies used or proposed to treat COVID-19. Most repositioned xenobiotics have had neither the feared toxicity nor the anticipated efficacy. Repurposed viral replication inhibitors are not efficacious and frequently associated with nausea, vomiting, and diarrhea. Antiviral medications designed specifically against SARS-CoV-2 may prevent progression to severe disease in at-risk individuals and appear to have a wide therapeutic index. Colloidal silver, zinc, and ivermectin have no demonstrated efficacy. Ivermectin has a wide therapeutic index but is not efficacious and acquiring it from veterinary sources poses additional danger. Chloroquine has a narrow therapeutic index and no efficacy. A companion review covers vaccines, monoclonal antibodies, and immunotherapies. Together, these two reviews form an update to our 2020 review.
    MeSH term(s) Humans ; COVID-19 ; SARS-CoV-2 ; Xenobiotics ; Pandemics/prevention & control ; Ivermectin/therapeutic use ; Antiviral Agents/therapeutic use
    Chemical Substances Xenobiotics ; Ivermectin (70288-86-7) ; Antiviral Agents
    Language English
    Publishing date 2022-12-16
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ZDB-ID 2435016-3
    ISSN 1937-6995 ; 1556-9039
    ISSN (online) 1937-6995
    ISSN 1556-9039
    DOI 10.1007/s13181-022-00918-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Fostering the Next Generation of Researchers: a Sustainable Mentoring Program for Early Career Toxicologists in Scientific Abstract Review.

    Mycyk, Mark B / Murphy, Christine M / Chary, Michael / Chai, Peter R / Dunavin, Adrienne / Meyn, Alison / Mazer-Amirshahi, Maryann

    Journal of medical toxicology : official journal of the American College of Medical Toxicology

    2023  Volume 19, Issue 2, Page(s) 224–227

    Abstract: The presentation of abstracts at scientific meetings is an important step in the dissemination of scientific discovery. Most scientific meetings recruit volunteer experts to evaluate and score submitted abstracts to determine which ones qualify for ... ...

    Abstract The presentation of abstracts at scientific meetings is an important step in the dissemination of scientific discovery. Most scientific meetings recruit volunteer experts to evaluate and score submitted abstracts to determine which ones qualify for presentation. Reviewing an abstract is an important service to one's specialty, but there is typically no formal training or required instruction during medical toxicology fellowship on scientific abstract scoring. In order to provide structured training in abstract review, the American College of Medical Toxicology (ACMT) Research Committee launched the Annual Scientific Meeting (ASM) Abstract Review Mentor program in 2021. The goals of this program were to train fellows how to score scientific abstracts and provide them with new mentor connections to toxicologists outside of their training program. After evaluating 3 years of data from participating fellows-in-training and faculty mentors, we conclude that ACMT's Abstract Review Mentor program was successful in training future reviewers and fostering external mentorship relationships. All participants reported their experience in this program will change how they submit future abstracts to scientific meetings, help their future service as an abstract reviewer, and motivate their involvement in other specialty-related research activities. Implementing an abstract review training program is sustainable and a vital strategy for enhancing the dissemination of scientific discovery and training the next generation of medical toxicology researchers.
    MeSH term(s) Humans ; United States ; Mentors/education ; Mentoring ; Biomedical Research ; Research Personnel/education ; Health Personnel/education
    Language English
    Publishing date 2023-03-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2435016-3
    ISSN 1937-6995 ; 1556-9039
    ISSN (online) 1937-6995
    ISSN 1556-9039
    DOI 10.1007/s13181-023-00938-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: A case of a pediatric patient after a large ingestion of buspirone.

    Krenz, James R / Chary, Anita / Schwartz, Kevin R / Hayes, Bryan D / O'Brien, Michael E

    Clinical toxicology (Philadelphia, Pa.)

    2021  Volume 59, Issue 9, Page(s) 848–849

    MeSH term(s) Adolescent ; Anti-Anxiety Agents/blood ; Anti-Anxiety Agents/toxicity ; Buspirone/blood ; Buspirone/toxicity ; Dose-Response Relationship, Drug ; Female ; Humans ; Nausea/chemically induced ; Nausea/therapy ; Sleepiness ; Suicide, Attempted ; Treatment Outcome ; United States
    Chemical Substances Anti-Anxiety Agents ; Buspirone (TK65WKS8HL)
    Language English
    Publishing date 2021-01-15
    Publishing country England
    Document type Case Reports ; Letter
    ZDB-ID 204476-6
    ISSN 1556-9519 ; 0009-9309 ; 0731-3810 ; 1556-3650
    ISSN (online) 1556-9519
    ISSN 0009-9309 ; 0731-3810 ; 1556-3650
    DOI 10.1080/15563650.2020.1868492
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The Role and Promise of Artificial Intelligence in Medical Toxicology.

    Chary, Michael A / Manini, Alex F / Boyer, Edward W / Burns, Michele

    Journal of medical toxicology : official journal of the American College of Medical Toxicology

    2020  Volume 16, Issue 4, Page(s) 458–464

    Abstract: Artificial intelligence (AI) refers to machines or software that process information and interact with the world as understanding beings. Examples of AI in medicine include the automated reading of chest X-rays and the detection of heart dysrhythmias ... ...

    Abstract Artificial intelligence (AI) refers to machines or software that process information and interact with the world as understanding beings. Examples of AI in medicine include the automated reading of chest X-rays and the detection of heart dysrhythmias from wearables. A key promise of AI is its potential to apply logical reasoning at the scale of data too vast for the human mind to comprehend. This scaling up of logical reasoning may allow clinicians to bring the entire breadth of current medical knowledge to bear on each patient in real time. It may also unearth otherwise unreachable knowledge in the attempt to integrate knowledge and research across disciplines. In this review, we discuss two complementary aspects of artificial intelligence: deep learning and knowledge representation. Deep learning recognizes and predicts patterns. Knowledge representation structures and interprets those patterns or predictions. We frame this review around how deep learning and knowledge representation might expand the reach of Poison Control Centers and enhance syndromic surveillance from social media.
    MeSH term(s) Artificial Intelligence ; Big Data ; Data Mining ; Deep Learning ; Humans ; Knowledge Bases ; Markov Chains ; Neural Networks, Computer ; Psychotropic Drugs/poisoning ; Toxicology ; Vocabulary, Controlled
    Chemical Substances Psychotropic Drugs
    Language English
    Publishing date 2020-03-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 2435016-3
    ISSN 1937-6995 ; 1556-9039
    ISSN (online) 1937-6995
    ISSN 1556-9039
    DOI 10.1007/s13181-020-00769-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Combination of Extended Antivirals With Antiretrovirals for Severe Mpox in Advanced Human Immunodeficiency Virus Infection: Case Series of 4 Patients.

    Duong, Michael T / Tebas, Pablo / Ancha, Bhavya / Baron, Jillian / Chary, Pallavi / Isaacs, Stuart N / Szep, Zsofia

    Open forum infectious diseases

    2024  Volume 11, Issue 3, Page(s) ofae110

    Abstract: To gauge the safety and utility of extended tecovirimat/cidofovir for severe mpox, here we report our experience caring for 4 patients with mpox and advanced human immunodeficiency virus (HIV) at the Hospitals of the University of Pennsylvania during the ...

    Abstract To gauge the safety and utility of extended tecovirimat/cidofovir for severe mpox, here we report our experience caring for 4 patients with mpox and advanced human immunodeficiency virus (HIV) at the Hospitals of the University of Pennsylvania during the 2022 global outbreak. Three patients had recurrent courses complicated by superinfections, coinfections and insufficient nutrition/housing, requiring extended tecovirimat (5-16 weeks) and cidofovir (1-12 doses) with probenecid and fluids. At follow-up, patients had undetectable HIV RNA on antiretrovirals, improved ulcers and stable renal function on antivirals. Serology guided cessation for one 7-month cidofovir course. Overall findings support a comprehensive approach of prolonged tecovirimat/cidofovir with antiretrovirals for severe mpox, while addressing social factors.
    Language English
    Publishing date 2024-02-27
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofae110
    Database MEDical Literature Analysis and Retrieval System OnLINE

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