Discipline - Clinical Toxicology

Associate Professor Tudosie Mihail-Silviu, PhD tenured
Associate Professor Tincu Radu-Ciprian, PhD tenured
Head of works Avram Oana-Ruxandra, PhD tenured
Assistant Professor Oprita Bogdan-Mihai, PhD tenured
Assistant Professor Constantinescu Laura Georgiana, PhD fixed term

The toxicology section AIT II treats an impressive number of patients (approx. 1500 each year) and covers an extremely large geographic area, due to its unique medical capabilities. Within the toxicology section AIT II, acute intoxications are given priority, but patients with chronic intoxications are also admitted. The section comprises 25 beds.

The intensive care equipment permits treatment of the most serious cases of intoxication (requiring mechanical ventilation, renal replacement therapy, plasmapheresis, advanced cardiovascular support, and specific antidote administration).

The section includes a toxicological analysis laboratory, which is equipped to identify a vast array of chemical substances, both qualitatively and quantitatively.

The range of intoxications treate at the section is extremely large, including: acute drug intoxications (benzodiazepine, barbiturates, neuroleptics, antidepressants, etc.), acute intoxications with chemical substances (pesticides, insecticides), acute alcoholic intoxications (methylic and ethylic alcohol), heavy metal intoxications (lead, mercury, arsenic), acute carbon monoxide and smoke intoxications and acute intoxications with substances of abuse (marijuana, LSD, cocaine, heroin, chemical compounds).

The toxicology section provides an interdisciplinary team for the benefit of patients when they are ready to be released, as well as throughout their stay, comprising a medical psychiatrist and psychologist.

Toxicological research comprises observation of the toxic phenomenon, detection of poisons, experiments designed to explain the mechanisms which initiate and maintain toxicity and the establishment of diagnostic protocol and treatment adapted to the evolution of toxic substances.

The first book about toxicology "Treatise on poisons and their antidotes" was written in the 2nd century B.C. by Nicandru of Colofan. Toxicology became a precise medical science in the year 1836, when James Marsh identified arsenic. The founder of analytical toxicology was Matthieu Joseph Bonaventura, the royal medic of Louis the 17th. In Romania, the first book about toxicology was written by professor Nicolae Ioanid in 1965.

The toxicology section AIT II conducts both clinical and fundamental research. Due to the wide range of toxic substances in existence and the benefit of having its own laboratory, the section is able to conduct numerous research projects. The Toxicology Section AIT II has worked in collaboration with the Ministry of Health on a project, with the aim of establishing the first National Register of Toxicology – ReTox. The Register will permit the immediate identification of toxic substances circulating in the European community, as well as the statistical evaluation of intoxications in Romania.

The clinical research conducted by the toxicology section AIT II has resulted in the elaboration of scientific studies and works that have been presented at prestigious international manifestations. A large part of these received awards of recognition. The study "Early digestive decontamination in mercury poisoning" (C. Cobilinschi, Z. Ghiorghiu, R.C. Tincu, R.A. Macovei) – a case report, received 3rd place at the 42nd National Congress of Anesthesiology and Intensive Therapy, which took place in Sinaia in 2015. It was published as an article in the Romanian Journal of Intensive Therapy. Clinical nutrition and antioxidant nutrition research on patients with intoxications were presented at national congresses on clinical nutrition, as well as the European Congress of Clinical Nutrition (ESPEN). The development of new treatment protocols for intoxications is the main preoccupation of medics that are part of the didactic personnel; they have implemented the newest European treatment protocols within the section.

Furthermore, toxicology section AIT II has elaborated its own protocols, which were presented at prestigious scientific manifestations. The medics of toxicology section AIT II as well as the didactic personnel are affiliated with renowned European societies (Eurotox, ISICEM, EAPCT, Societatea Romana de Anestezie si Terapie Intensiva, Societatea Romana de Nutritie Clinica, Societatea Europeana de Hipertermie Maligna).

Students will attend theoretical lectures and practical lessons/seminars that will take place in the Toxicology Section AIT II, as well as the toxicological laboratory.

After completing the course, students are expected to be able to:

  • describe the general mechanisms of acute intoxications and types of intoxications;
  • know the parameters of acute intoxication, phase I and phase II reactions, receptors and specific interactions with toxicodynamic receptors;
  • master notions related to general measures for stabilization in acute intoxication;
  • retain notions regarding measures to increase the elimination of toxic substances;
  • know specifics about the main antidotes and their mechanisms of action;
  • describe the main toxidromes;
  • master notions about acute intoxication with psychotropic substances, alcohols and glycols, metals and opioids;
  • know the main measures used to monitor and support patients in toxicological intensive therapy;
  • make an effort to practice and improve their clinical thinking skills;
  • demonstrate their implication in scientific activities, for example by writing an article or participating in studies within this specialty;
  • participate in scientific projects that are compatible with european academic guidelines.

After completing the course, students are expected to have the following communication abilities:

 Professional conduct

  • to demonstrate a professional attitude towards the patients and their colleagues
  • to coordinate the activities of the toxicological intensive therapy unit in close collaboration with the available medical personnel
  • to promote and maintain a safe workplace environment, taking into consideration the risk of contamination or injury with the medical equipment and instruments necessary in this specialty
  • to understand the importance of continuous medical education and training, allowing them to develop their professional abilities based on current scientific data

Ethical conduct

  • to apply the ethical principals related to medical practice
  • to respect patients’ rights
  • to give priority to treatment options that correspond to the individual needs of the patients
  • to respect the patients and their fellow colleagues without discrimination
  • to respect juridic, legal and administrative procedures, as well as the rules of conduct for medical practitioners

Goals of the discipline:

General objectives:

  • To provide students with the knowledge required to establish the etiopathogenesis and diagnosis of acute intoxications.
  • To train students in various aptitudes, behaviors, attitudes and abilities, as well as to impart the values necessary for their medical clinical practice and intensive therapy.
  • To promote medical and human ethical values, teach the ethical norms of care for intoxicated patients and the appropriate way to interact with patients and their families.
  • To make connections between notions taught in Clinical Toxicology courses and students’ previous medical experiences.
  • The evaluation of student performance is based on periodic and final evaluations, testing their level of knowledge and aptitudes.
  • Being familiar with the course objectives, in order to assume any related responsibilities.

Specific Objectives:

After completing these courses, students are expected to:

  • understand and be able to define the mechanisms of acute intoxication;
  • know the clinical and paraclinical aspects of acute intoxications;
  • comprehend notions about the therapeutic methods used for acute intoxications;
  • retain some notions regarding the methods used in a toxicological analytic laboratory;
  • gain some notions related to antidotes and their mechanisms of action.

Student Bibliography:

  • 2006 - „Diagnostic si tratament in intoxicatiile acute", autori: Victor A. Voicu, Radu Macovei, Liviu Miclea.
  • 2012 editie revizuita si adaugita a „Ghidului de Toxicologie Clinica", editura Brumar Timisoara. Colectivul de autori: Victor A. Voicu, Radu Macovei, Liviu Miclea; colaboratori - Mihail Silviu Tudosie; Bogdan OpriALAL; Mihai IonicAL.
  • acute intoxications
  • toxicovigilence
  • clinical toxicology
  • toxicological intensive therapy
  • 2004-2006: Proiectului de cercetare-dezvoltare si stimulare a inovãrii „Modificãri neuropsihice induse de consumul de droguri (Studiu de caz: heroina), cu finantare de cãtre Bugetul de stat – Ministerul Educatiei si Cercetãrii, PNCDI, Programul VIASAN.
  • 2005:  Proiectului de cercetare “Monitorizarea variatiilor psihosomatice la pacienti toxicodependenti în timpul terapiei de substitutie.“ cu finantare de la Bugetul de Stat, Ministerul Educatiei si Cercetãrii – Autoritatea Nationalã pentru Cercetare Stiintificã, Programul de Cercetare de Excelentã.
  • 2006: Studiul multicentric international intitulat „A prospective, Randomized, Double-blind, Placebo Controlled, Dose Ranging, Multi-center Study of the Safety and Efficacy of Three Days Continuous Intravenous Infusion of GR270773 in the Treatment of Suspected or Confirmed Gram-negative Severe Sepsis in Adults.”, Protocol EMD20001.
  • 2006: Studiul multicentric international intitulat „A Multicenter, Randomized, Double-Blind, Comparative Study to Evaluate the Safety, Tolerability and Efficacy of 2 Dosing Regimens of Caspofungin in the Treatment of Invasive Candidiasis in Adults.”, Protocol MK-0991-801-00
  • 2010: Programul Operaţional Sectorial Dezvoltarea Resurselor Umane 2007 – 2013; 1.5 Programe doctorale şi post-doctorale în sprijinul cercetării; Titlul proiectului: „Sustinerea cercetarii postdoctorale in domeniul chirurgiei reconstructive de transplant Contract nr  POSDRU/89/1.5/S/64153; Manager proiect Prof. Dr. Ioan Lascãr

Article: "Tincu Radu Ciprian, Dana Tomescu, LaurenALiu Coman, Radu Alexandru Macovei Biochemical paramete/rs changes induced by lead exposure  Farmacia, 2016, Vol. 64, 2, pag 278-282"

Scientific publications:

  1. Diagnosis challenge: a coincidence between benzodiazepine intoxication and prion disease Radu Macovei, Radu Tincu, Zoie Ghiorghiu 50th Congress of the European Societies of Toxicology (EUROTOX), 07-10 octombrie 2014,  Edinburgh, UK Toxicology letters, vol. 229S, pages 598-599, ISSN 0378-4274; 229S S1-S252 (2014)
  2. “Ventilator associated pneumonia: do silver-coated endotracheal tubes really work? Radu Ciprian Tincu, Cristian Cobilinschi, Radu Alexandru Macovei Euroanaesthesia 2015, The annual meeting of the European Society of Anaesthesiology (ESA), Berlin, Germany. May-June 2015 European Journal of Anaesthesiology, vol 32, e-Supplement 53, pag 369, June 2015
  3. Rare cerebral lesions in acute carbon monoxide poisoning – A case report R.C. Tincu, C. Cobilinschi, Z. Ghiorghiu, R.A. Macovei 51st Congress of the European Societies of Toxicology, Porto, Portugal, September 2015 Toxicology Letters, Volume 238, Issue 2, Supplement, 16 October 2015, Pages S143-S144
  1. Stevens–Johnson-TEN overlap syndrome induced by mushroom poisoning 51st Congress of the European Societies of Toxicology, Porto, Portugal, September 2015 R.C. Tincu, R.A. Macovei, Z. Ghiorghiu, C. Cobilinschi Toxicology Letters, Volume 238, Issue 2, Supplement, 16 October 2015, Page S144
  1. Methadone-induced torsades de pointes – A case report 51st Congress of the European Societies of Toxicology, Porto, Portugal, September 2015 R.C. Tincu, C. Cobilinschi, Z. Ghiorghiu, R.A. Macovei Toxicology Letters, Volume 238, Issue 2, Supplement, 16 October 2015, Page S144
  1. Long term cholinesterase inhibition after skin exposure to organophosphates 51st Congress of the European Societies of Toxicology, Porto, Portugal, September 2015 R.C. Tincu, C. Cobilinschi, Z. Ghiorghiu, R.A. Macovei Toxicology Letters, Volume 238, Issue 2, Supplement, 16 October 2015, Pages S144-S145
  1. Benefits of L-carnitine in valproic acid induced encephalopathy Radu Ciprian Ţincu, Cristian Cobilinschi, Dana Tomescu, Zoie Ghiorghiu, Radu Alexandru Macovei 36th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, 15-18 March 2016 Critical Care 2016, Volume 20, Suppl 2, 2016, pag 26
  1. Vasodilatory plant extracts gel as an alternative treatment for fever in critically ill patients Radu Ciprian Ţincu, Cristian Cobilinschi, Dana Tomescu, Zoie Ghiorghiu, Radu Alexandru Macovei 36th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, 15-18 March 2016 Critical Care 2016, Volume 20, Suppl 2, 2016, pag 26
  1. Can 5-hydroxytriptophan prevent post-traumatic stress disorder in critically ill patients? Radu Ciprian Ţincu, Cristian Cobilinschi, Dana Tomescu, Zoie Ghiorghiu, Radu Alexandru Macovei 36th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, 15-18 March 2016 Critical Care 2016, Volume 20, Suppl 2, 2016, pag 26
  1. Unusual chronic arsenic poisoning Radu Ciprian Ţincu, Cristian Cobilinschi, Dana Tomescu, Zoie Ghiorghiu, Radu Alexandru Macovei Toxicology Letters, 2016,Volume 258, Supplement S1-S324 .
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