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Mohan S, Mahonski S, Koziatek C, Cohen ET, Smith S, Su MK. Induction of Labor at Term for Severe Antenatal Lead Poisoning. J Med Toxicol 2023; 19:401-404. [PMID: 37365427 PMCID: PMC10522539 DOI: 10.1007/s13181-023-00955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Antenatal lead exposure is associated with multiple adverse maternal and fetal consequences. Maternal blood lead concentrations as low as 10 µg/dL have been associated with gestational hypertension, spontaneous abortion, growth retardation, and impaired neurobehavioral development. Current treatment recommendations for pregnant women with a blood lead level (BLL) ≥ 45 µg/dL include chelation. We report a successful case of a mother with severe gestational lead poisoning treated with induction of labor in a term infant. CASE REPORT A 22-year-old G2P1001 female, at 38 weeks and 5 days gestation, was referred to the emergency department for an outpatient venous BLL of 53 µg/dL. The decision was made to limit ongoing prenatal lead exposure by emergent induction as opposed to chelation. Maternal BLL just prior to induction increased to 70 µg/dL. A 3510 g infant was delivered with APGAR scores of 9 and 9 at 1 and 5 min. Cord BLL at delivery returned at 41 µg/dL. The mother was instructed to avoid breastfeeding until her BLLs decreased to below 40 µg/dL, consistent with federal and local guidelines. The neonate was empirically chelated with dimercaptosuccinic acid. On postpartum day 2, maternal BLL decreased to 36 µg/dL, and the neonatal BLL was found to be 33 µg/mL. Both the mother and neonate were discharged to an alternative lead-free household on postpartum day 4.
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Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Department of Emergency Medicine, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 270-05 76th Avenue, Queens, NY, 11040, USA.
| | - Sarah Mahonski
- Department of Emergency Medicine, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Christian Koziatek
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York City, NY, USA
| | - Emily T Cohen
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Silas Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Mahonski S, Mohan S, Howland MA, Biary R. Antimuscarinic toxicity secondary to moist towelettes containing glycopyrronium tosylate: a case report. Toxicology Communications 2022. [DOI: 10.1080/24734306.2022.2077584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Sarah Mahonski
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sanjay Mohan
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mary Ann Howland
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
- College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, USA
| | - Rana Biary
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Mahonski S, DiSalvo P, Hoffman RS. Comment on: "validation of a nomogram used to predict lithium concentration in overdose". Clin Toxicol (Phila) 2022; 60:1082-1083. [PMID: 35471136 DOI: 10.1080/15563650.2022.2066541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sarah Mahonski
- Ronald O. Perelman Department of Emergency Medicine, Division of Medical Toxicology, NYU Grossman School of Medicine, New York, NY, USA
| | - Phil DiSalvo
- Department of Emergency Medicine, Carle Foundation Hospital, Urbana, IL, USA
| | - Robert S Hoffman
- Ronald O. Perelman Department of Emergency Medicine, Division of Medical Toxicology, NYU Grossman School of Medicine, New York, NY, USA
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Mahonski S, Furlano E, Chiang W. Validation of a Plant Identification Application Using Digital Images of Toxic Plants. J Med Toxicol 2022; 18:159-162. [PMID: 35084709 PMCID: PMC8938528 DOI: 10.1007/s13181-022-00877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022] Open
Affiliation(s)
- Sarah Mahonski
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA.
| | - Emma Furlano
- Division of Medical Toxicology, Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - William Chiang
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Mohan S, Mahonski S, Hoffman RS. Comment on Fomepizole as an adjunct in acetylcysteine treated acetaminophen overdose patients: a case series. Clin Toxicol (Phila) 2021; 60:666. [PMID: 34937479 DOI: 10.1080/15563650.2021.2009848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sarah Mahonski
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Woods PS, Morin AA, Chen PJ, Mahonski S, Xiao L, Hurley M, Yadav S, Schmidt TA. Automated Indentation Demonstrates Structural Stiffness of Femoral Articular Cartilage and Temporomandibular Joint Mandibular Condylar Cartilage Is Altered in FgF2KO Mice. Cartilage 2021; 13:1513S-1521S. [PMID: 33012179 PMCID: PMC8804844 DOI: 10.1177/1947603520962565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Employ an automated indentation technique, using a commercially available machine, to assess the effect of fibroblast growth factor 2 (FGF2) expression on structural stiffness over the surface of both murine femoral articular cartilage (AC) and temporomandibular joint (TMJ) mandibular condylar cartilage (MCC). DESIGN Experiments were performed using 3-month-old female homozygote Fgf2KO mice with wild type (WT) littermates. After euthanization, isolated mandibles and hindlimbs were either processed for histology or subjected to automated indentation on a Biomomentum Mach-1 v500csst with a 3-axis motion controller in a phosphate buffered saline bath using a 0.3 mm spherical tip indenter. The effect of indentation depth on normal force was characterized, then structural stiffness was calculated and mapped at multiple positions on the AC and MCC. RESULTS Automated indentation of the AC and TMJ MCC was successfully completed and was able to demonstrate both regional variation in structural stiffness and differences between WT and Fgf2KO mice. Structural stiffness values for Fgf2KO AC were significantly smaller than WT at both the medial/anterior (P < 0.05) and medial/posterior (P < 0.05) positions. Global Fgf2KO also lead to a decrease in MCC thickness of the TMJ compared with WT (P < 0.05) and increased structural stiffness values for Fgf2KO at both the posterior and anterior location (P < 0.05). CONCLUSIONS Automated indentation spatially resolved differences in structural stiffness between WT and Fgf2KO tissue, demonstrating FGF2 expression affects femoral AC and TMJ MCC. This quantitative method will provide a valuable approach for functional characterization of cartilage tissues in murine models relevant to knee joint and TMJ health and disease.
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Affiliation(s)
- Paige S. Woods
- Biomedical Engineering Department,
School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - Alyssa A. Morin
- Biomedical Engineering Department,
School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - Po-Jung Chen
- Division of Orthodontics, School of
Dental Medicine, UConn Health, Farmington, CT, USA
| | - Sarah Mahonski
- Department of Medicine, School of
Medicine, UConn Health, Farmington, CT, USA
| | - Liping Xiao
- Department of Medicine, School of
Medicine, UConn Health, Farmington, CT, USA
| | - Marja Hurley
- Department of Medicine, School of
Medicine, UConn Health, Farmington, CT, USA
| | - Sumit Yadav
- Division of Orthodontics, School of
Dental Medicine, UConn Health, Farmington, CT, USA
| | - Tannin A. Schmidt
- Biomedical Engineering Department,
School of Dental Medicine, UConn Health, Farmington, CT, USA,Tannin A. Schmidt, Biomedical Engineering
Department, UConn Health, 263 Farmington Avenue, MC 17121, Farmington, CT 06001,
USA.
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Mahonski S, Howland MA, Su MK. Comment on: clinical experience with titrating doses of digoxin antibodies in acute digoxin poisoning. Clin Toxicol (Phila) 2021; 60:547. [PMID: 34709957 DOI: 10.1080/15563650.2021.1994986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sarah Mahonski
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mary Ann Howland
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA.,College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA.,New York City Poison Control Center, Department of Health and Mental Hygiene, New York, NY, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA.,New York City Poison Control Center, Department of Health and Mental Hygiene, New York, NY, USA
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Mahonski S, Su MK. Comment on Treatment of carbon monoxide poisoning: high-flow nasal cannula versus non-rebreather face mask. Clin Toxicol (Phila) 2021; 59:768. [PMID: 33448901 DOI: 10.1080/15563650.2020.1862144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah Mahonski
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA.,Department of Health and Mental Hygiene, New York City Poison Control Center, New York, NY, USA
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Abstract
The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.
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Affiliation(s)
- Sarah Mahonski
- Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009, USA
| | - Kami M Hu
- Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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