Aluminum Phosphide Poisoning Research Articles

The potential role of N-acetylcysteine as an adjuvant therapy in acute aluminum phosphide poisoning: a randomized clinical trial.

Aluminum phosphide (AP) intoxication is a life-threatening emergency with no available effective antidote. This study evaluated the efficacy and safety of N-acetylcysteine (NAC) infusion in cases of acute AP poisoning. This randomized, single-blinded, parallel-group, controlled, clinical trial enrolled 96 patients with acute AP poisoning. The patients were allocated to two groups and received either conventional treatment (control group) or conventional treatment plus NAC infusion (NAC group). The patients were subjected to full clinical evaluation, routine laboratory investigations, silver nitrate test, and evaluation of the oxidative markers, malondialdehyde (MDA) and total antioxidant capacity (TAC), at admission and after 24h treatment. The primary outcome was mortality, and the secondary outcomes were the arterial blood pressure, the length of hospital stay, and the need for intubation or mechanical ventilation. Compared to the control group, the NAC group showed significantly lower MDA (median [interquartile range (IQR)]: 4.6 [1.9-10.6] vs. 6.8 [3.5-17.4] nmol/mL, P=0.014) and higher TAC levels (median [IQR]: 0.7 [0.6-0.7] vs. 0.6 [0.6-06] mM/L, P<0.001). The mortality rate and the need for mechanical ventilation were comparable in both groups (P=0.601 and 0.505, respectively). However, the NAC group showed significant improvements of both systolic and diastolic blood pressure values (both P=0.030). The duration of hospitalization was significantly shorter in the NAC group (P=0.017). No adverse events were reported in patients who received NAC infusion. In patients with acute AP poisoning, the use of NAC mitigates oxidative stress and partially enhances clinical manifestations without inducing noticeable adverse effects.

A rare advantage of G6PD deficiency in resistance to aluminum phosphide poisoning: A rare case report

A rare advantage of G6PD deficiency in resistance to aluminum phosphide poisoning: A rare case report

Predictive value of arterial blood gases in Patients with Acute Aluminium Phosphide Poisoning Admitted to Poison Control Centre –Ain Shams University Hospitals

Predictive value of arterial blood gases in Patients with Acute Aluminium Phosphide Poisoning Admitted to Poison Control Centre –Ain Shams University Hospitals

The National Early Warning Score 2 versus the New-Poisoning Mortality Score System for Predicting Clinical Outcomes After Acute Aluminum Phosphide Poisoning.

Acute aluminum phosphide (AlP) poisoning is one of the leading causes of suicide, particularly in the developing world. In cases of scarce and/or high-cost resources, it is advisable to prioritize critically ill patients who will benefit from available resources and improve their prognosis. Despite numerous scores, a dependable, easy-to-use, and quick approach to assessing the degree of poisoning is lacking. This study is designed to compare the prognostic performance of the National Early Warning Score 2 (NEWS2) versus the new-poisoning mortality score system (new-PMS) for predicting the clinical outcomes, including in-hospital mortality, vasopressor use, and mechanical ventilation placement after acute AlP poisoning. This study was a retrospective observational study that included patients with acute AlP poisoning with retrieving the required data from the patients' medical records. A total of 90 acutely AlP-intoxicated patients were enrolled in the study. The in-hospital mortality rate was 42.2%. Additionally, in-hospital mortality, vasopressor use, and mechanical ventilation placement were significantly higher in patients with higher NEWS2 and new-PMS scores. The new-PMS showed excellent prognostic performance, particularly in-hospital mortality prediction; however, NEWS2 demonstrated a more helpful predictive performance compared to the new-PMS particularly for the need for mechanical ventilation and in-hospital mortality, with an area under the curve of 0.991 versus 0.851 and 0.949 versus 0.874, respectively. We concluded that NEWS2 and new-PMS are simple, easily calculated, and lab-independent scoring systems. The NEWS2 is a more effective tracking and triggering tool than the new-PMS in the evaluation of AlP acutely intoxicated patients.

The performance of ejection fraction as a predictor of mortality and morbidity in acute aluminium phosphide poisoning.

Aluminium phosphide poison become an alarming, well-known, effective suicidal poison with a high mortality rate. There is a need for a simple tool that can triage patients with bad prognosis. The study aimed to assess the accuracy of ejection fraction as a predictor of mortality and morbidity in acute aluminium phosphide toxicity cases. The study involved 70 cases of acutely aluminium phosphide-poisoned patients in our hospital from January 2021 to January 2024. The study found that 54.3% of the cases were males and 45.7% were females, with a mean age of 22.4 ± 11.8years old. The oral route was the route of administration of all cases, and the intention of poisoning was intentional in 84.3% of cases. Regarding the outcome of patients, 62.9% of the cases recovered, and 37.1% died. The Receiver Operating Characteristic Curve found that the ejection fraction below 37.5% had an accuracy rate of 96.8% with excellent discrimination for mortality, sensitivity of 100%, specificity of 93.2%, positive predictive value of 89.6%, and negative predictive value of 100%. The ejection fraction below 52.5% had an accuracy rate of 89% with good discrimination for complications, sensitivity of 83.3%, specificity of 96.8%, positive predictive value of 90.9%, and negative predictive value of 93.7%. So, the ejection fraction plays an essential tool in predicting mortality and complications in acute aluminium phosphide toxicity and should be assessed on every patient in the first 24h of admission to facilitate the triage of these patients.

Can Intravenous Lipid Emulsion Reduce Mortality Rate in Cases of Acute Aluminium Phosphide Poisoning? A Systematic Review

Background: Acute pesticide poisoning has remained a significant public health concern for decades. Supportive care has been the mainstay of treatment. Intravenous lipid emulsion (ILE) therapy offers a potential new strategy. Objectives: This systematic review aimed to evaluate the current research on the efficacy of ILE in treating aluminum phosphide (AlP) poisoning. Methods: A comprehensive electronic search was conducted across various databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Campbell Systematic Reviews, Scopus, Web of Science, Springer Nature, Elsevier, Google Scholar, and regional databases encompassing Mansoura, Zagazig, Ain Shams universities, and Indian publications. Studies published in English language were considered for inclusion (from 2015 to 2023). Inclusion criteria focused on human studies evaluating the use of ILE for AlP intoxication. Results: Five studies met the inclusion criteria, three studies were randomized controlled trials, one was observational cross sectional study, and one was case report encompassing a total of 224 patients. Of these, 102 patients received ILE, with all studies utilizing 20% ILE. Three studies administered ILE as a continuous intravenous infusion at a rate of 10 mL/h. Two other studies employed a bolus dose regimen, ranging from 1-3 mL/kg delivered over one minute, followed by continuous infusion. The overall mortality rate was 68.6% in the ILE group compared to 76.2% in the control group and the need for mechanical ventilation was lower in the ILE group with clinical improvement in the ILE group. Conclusion: Intravenous lipid emulsion represents a novel therapeutic approach in toxicology with the potential to improve patient outcomes. This review suggests ILE may reduce mortality associated with AlP poisoning. Additionally, ILE use might be associated with decreased, need for mechanical ventilation, hospital stay and discharge time among survivors.

Insulin in aluminum phosphide poisoning: A systematic review of the current literature.

Aluminum phosphide (AlP) is a commonly used fumigant in agriculture and grain preservation because of its high potency and low cost. Due to the absence of a specific antidote and promising treatment modality, poisoning with this substance is deadly. Amid multiple studies in different parts of the world, each exploring options like lavage, inotropes, antioxidants, etc, we conducted a systematic review to find the possible role of exogenous insulin in treating symptomatic cases of AlP poisoning. Experimental studies released before February 15, 2024, that reported the use of exogenous insulin were systematically reviewed following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The search was done on PubMed Central, Cochrane Library, and Google Scholar. After applying the inclusion and exclusion criteria, we finalized a few scientific papers for the review. Studying data from 4 scientific papers (3 quasi-experimental studies and 1 randomized controlled trial), we could postulate the significant improvement in survivability after the inclusion of exogenous insulin in the treatment of poisoned cases of AlP. Studies showed divergent results for the blood pressure, blood gases, and need for mechanical ventilation. Hypoglycemia, hyperglycemia, and hypokalemia were the reported adverse effects of this therapy. Our review found that the use of exogenous insulin in AlP poisoning reduced mortality rates, which was consistent across all studies. With available knowledge, its inclusion as a part of therapy might be beneficial in AlP poisoning, but to put it forward confidently, we still need high-quality randomized control trials. It is indeed a subject of interest for future research.

Clinico-Epidemiological Profile and Outcome of Acute Poisoning Patients admitted to Intensive Care Unit in A Tertiary Level Private Hospital in Bangladesh

Background: Acute poisoning is a prevalent health issue necessitating Intensive Care Unit (ICU) admission in developing countries. This study evaluates the socio-demographic characteristics, clinical parameters, and outcomes of acute poisoning patients admitted to the ICU in a tertiary level private hospital in Bangladesh. Method: This retrospective cohort study was conducted at tertiary care private hospital in Narayanganj, Bangladesh. Data was collected from ICU medical records from January 2023 to April 2024, enrolling a total of 57 patients aged 18 years or more who presented with acute poisoning. Data analysis was performed using Stata (Statistical Software for Data Science) 17.0(p &lt; 0.05) Results: Out of 57 patients, 52.63% were females, with mean age of 27.84 years. Suicidal intent accounted for 84.21% of cases, and the primary reasons for poisoning included marital (61.40%) and familial disharmony (15.79%). The predominant type of poisoning was due to sedatives (17.54%) followed by aluminium phosphide (14.04%), and stupefying agents (14.04%). Aluminium phosphide poisoning had a 100% fatality rate, while sedatives and several other agents had 100% recovery rate. Statistical analysis showed a significant association between the type of poison and the final outcome (χ2(15) = 38.7996, p = 0.001). Conclusion: The study highlights the prevalence of intentional poisoning among young adults, especially females, with sedatives, aluminium phosphide, and stupefying agents being the most common. The high mortality rate from aluminium phosphide underscores the need for strict regulations and public awareness to control access to these substances. Bangladesh Crit Care J September 2024; 12 (2): 89-95

Incidental detection of aluminum phosphide in abdominal subcutaneous fat- a rare reporting of chemical analysis findings in poisoning cases.

Aluminum phosphide (AlP) poses a significant health challenge in developing countries, primarily because of its accessibility to the unregulated market and the absence of specific antidotes. Although chemical analysis of routine viscera can provide valuable information regarding the type of poison present in the body during poisoning incidents, numerous factors can alter the test results of chemical analysis, such as decomposition changes, postmortem redistribution, and the chemical nature of drugs. Analytical methods are frequently impeded by the interference caused by coextracted putrefactive compounds, which can mask or alter the detection of drugs. This series of three cases is particularly noteworthy because it involves the postmortem detection of AlP in the abdominal subcutaneous fat of the deceased, a previously unreported occurrence. In the first case, the body showed findings of late postmortem changes, with stomach mucosa being congested and hemorrhagic, along with routine viscera, and abdominal subcutaneous fat was sent for toxicological analysis. To confirm these findings, in two further cases of suspected AlP poisoning, subcutaneous fat was sent along with routine viscera. Stomach mucosa in the other two cases showed findings similar to those in the first. In the third case, black paste-like material was noted as stomach content. All the cases revealed the presence of AlP in routine viscera samples and abdominal subcutaneous fat on gas chromatography-mass spectrometry (GC‒MS) analysis. Therefore, abdominal fat can serve as a suitable sample for toxicological analysis to identify the presence of AlP, even in cases with advanced putrefactive changes.

Construction of a Crucial Score to Predict the Outcome of Patients with Aluminum Phosphide Poisoning at the Poison Control Center, Ain Shams University Hospitals (PCC-ASUH)

Abstract Introduction Acute aluminum phosphide (ALP) poisoning has become a major toxicological challenge in developing countries due to increasing mortality rate and absence of specific antidote. The aim of this study was to “Evaluate the value of APACHE II and SOFA scores in the prediction of outcome in patients with acute ALP poisoning and construct a predictive model for ALP poisoning”. Subjects and Methods A prospective cross sectional study of acute ALP poisoned patients admitted to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) during the period from August 2022 to April 2023. Patients’ data were collected in a patient sheet and included sociodemographic data, clinical and laboratory data of APACHE II and SOFA scores, ECG evaluation and the outcome. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression analysis have been applied for data analysis. Results A total of 110 ALP poisoned patients were evaluated with 52 survivors and 58 non-survivors. Evaluating the predictive value of APACHE II and SOFA scores, the cut off point of APACHE II score was &amp;gt; 6 and AUC was 0.969 achieved 98.28% sensitivity and 86.54% specificity. The cut off point of SOFA score was &amp;gt; 2 and AUC was 0.983 achieved 100% sensitivity and 86.54% specificity. Univariate and multivariate regression analysis revealed that six factors were the most significant predictive factors of mortality: PO2, PH value, Glasgow coma scale (GCS), Mean arterial pressure (MAP), HCO3 level and abnormal ECG. They were valid to construct the predictive new score at cut off value of PO2 &amp;lt; 90% mmHg, PH &amp;lt; = 7.28, GCS &amp;lt; =12, MAP &amp;lt;70 mmHg, HCO3 &amp;lt; = 12.6 mEq/L. Scoring system was constructed of these six parameters each take a constant logistic score to give a total score of 33. The power of the predictive new score to discriminate between survivors and non-survivors at cut off &amp;gt; 19 was excellent (AUC: 0.999) that achieved 96.55% sensitivity and 100% specificity. Conclusion High sensitivity and specificity values with excellent AUC reflect the usefulness of the new predictive score and recommended its use at emergency room as it is simple, quick, easy to use and appliciable even in small hospitals to predict the outcome of acute ALP poisoned patients.

Glycogen Phosphorylase-BB and Corrected QT Interval in Early Prediction of Cardiotoxicity in Patients with Acute Aluminum Phosphide Poisoning

Abstract Background Aluminum phosphide (ALP) is a highly toxic pesticide that cause multi-organ affection. Cardiovascular affection accounts for high mortality. So, early prediction of myocardial injury and arrhythmias are important in the management. Aim This study aimed at investigating the role of Glycogen phosphorylase BB (GPBB) and corrected QT interval (QTc) in early prediction of ALP induced cardiotoxicity. Methods and Results The current study was a prospective study carried at Poison Control Center of Ain Shams University on thirty ALP intoxicated adults and thirty age and sex matched healthy controls. Patients were subjected to history taking, clinical examination, grading of severity according to Poison Severity Score (PSS) and on admission investigations including electrocardiogram (ECG) and GPBB. Outcome was also recorded. The results revealed that GPBB was higher in intoxicated patients than controls and there was significant difference among outcome groups. GPBB also was able to detect cardiotoxicity and predict mortality. QTc interval was longer in intoxicated patients than healthy controls and was able to predict occurrence of arrhythmias. Conclusion It was concluded that GPBB is a promising biomarker to predict myocardial injury following aluminum phosphide intoxication and on admission corrected QT interval is simple bed side tool to predict arrhythmias. Recommendations The present study recommended the use of GPBB and corrected QT interval as useful markers for prediction of ALP cardiotoxicity.

Analysis of Acute Poisoning Cases Presenting to the Medical Emergency Department

Abstract Introduction: Acute poisoning cases are always a medical emergency. Immediate management with proper identification of the poisoning agent is very much important. This study aimed to estimate the sociodemographic pattern and outcome of acute poisoning cases so that the emergency health-care provider can decide on a suitable management procedure as well as effective preventive measures as early as possible when they receive a patient. Materials and Methods: A retrospective observational study was carried out for a 1-year duration after getting approval from the Institutional Ethical Committee. Patients of either gender with acute poisoning were collected from the records of the medical emergency department of the hospital with the details of age, gender, occupation, type of poisoning, route of administration, and outcome. Analysis was done with suitable software. Results: We got a total of 91 acute poisoning cases, where 61 (67.03%) patients survived and 30 (32.96%) patients succumbed to death. The highest cases were seen due to aluminum phosphide (ALP) and it was about 47 (51.64%), followed by organophosphorus (OP) 21 (23.07%). The most common age group was early adulthood (20–30 years) followed by the adolescence (10–19 years) age group. Male cases were 50 (54.94%) compared to females 41 (45.05%) and married cases were 51 (56.04%) compared to unmarried cases 40 (43.95%). Conclusions: ALP poisoning was highest followed by OP, and all cases were suicidal in intention. Male cases were higher than female cases. Delayed reporting to the hospital significantly increased the death rate.

An Oxidative Stress Study on Curcumin and NanoCurcumin against Aluminum Phosphide-induced Kidney Injury in Rats: The Role of SIRT1/FOXO3 Signaling Pathway in Nephrotoxicity.

In this study, we have investigated the aluminium phosphide (ALP) toxicity on Renal Function and oxidative stress in kidney tissue of male rats and the possible protective role of Curcumin and nanoCurcumin against ALP-induced nephrotoxicity. Thirty-six adult male rats were divided into 6 groups (n=6). ALP (2 mg/kg oral administration) and control groups received Curcumin and nanoCurcumin (oral administration 100 mg/kg) or without it. After seven days of treatment, kidney parameters, oxidative stress biomarkers, and expression level of sirtuins1 (SIRT1)/Forkhead box protein O1 (FoxO1) pathway genes were evaluated in kidney tissue. In addition, histopathological changes in the kidney tissues were assayed. In the ALP group, compared to the control group, lipid peroxidation levels, urea, and creatinine were increased, and total antioxidant capacity and thiol groups decreased significantly p < 0.05. In Curcumin and nanoCurcumin groups compared to the ALP group, lipid peroxidation and creatinine decreased significantly p < 0.05. Also, Curcumin and nanoCurcumin improved the tissue damage caused by ALP. NanoCurcumin modulated the effect of ALP on the gene expression levels in SIRT1/FoxO1. The present study showed that ALP intoxication in kidney tissue can induce oxidative damage. Moreover, Curcumin and nanocurcumin, as potential antioxidants, can be effective therapeutics in ALP-induced nephrotoxicity.

Prognostic value of PGI score compared to poison severity score (PSS) and simplified acute physiology score (SAPS) II as predictors of mortality and other adverse outcomes in acute poisoning with aluminum phosphide

Aluminum phosphide (AlP) poisoning is a life-threatening emergency prevalent in the Middle East region including Egypt. Early prediction of prognosis is critical for initiating the utmost intensive interventions. Though many scoring systems were studied for predicting the prognosis of AlP poisoning, these scores received wide criticism. Complexity and reliability were the main concerns. Therefore, this retrospective cross-sectional study aimed to evaluate the performance of the recently introduced PGI score as a predictor of case fatality, the need for mechanical ventilation and vasopressor therapy in acute AlP poisoning. Moreover, it compares the performance of PGI with the known poison severity score (PSS), and the simplified acute physiology score (SAPS) II. Among 144 exposed patients, we reported a mortality rate of 61.1%. Non-survivors exhibited significantly higher PGI, PSS, and SAPS II than survivors. Though the PGI, PSS, and SAPS II proved their significance as predictors of mortality and, the need for MV and vasopressors, the PGI score showed a significantly higher area under the curve (AUC) as a predictor of MV (AUC = 0.848) compared to PSS (AUC = 0.731) and SAPS II (AUC = 0.749). Additively, PGI of 2 or more was a significant predictor of mortality (AUC = 0.831, sensitivity = 65.9%, and specificity = 89.3 %) and MV (p < 0.001), while PGI of 1 or more was another predictor of vasopressor need (AUC = 0.881, sensitivity = 89.0% and specificity = 79.4%). Given the PGI score's high AUCs across all outcomes, coupled with its balanced sensitivity and specificity, the PGI score could be a simple, and robust tool replacing the PSS and SAPS II for predicting mortality, clinical decision-making including the need for MV and vasopressor therapy in acute AlP exposure. Adopting the PGI score seems substantially useful in managing acute AlP poisoning, notably in resource-restricted countries.

Toxic Myocarditis with Brugada Phenocopy in a Case of Aluminum Phosphide Poisoning

Brugada phenocopy is considered when a Brugada-type ECG pattern is present but with a low likelihood of true Brugada syndrome, as indicated by negative family history, genetic testing, or provocative testing with drugs, or ECG normalization after the removal of precipitants. Brugada phenocopy has been reported due to various causes such as fever and electrolyte imbalance. We describe a 22-year-old man who presented with aluminum phosphide poisoning, resulting in severe metabolic acidosis, myocarditis, and profound myocardial depression. He developed transient Brugada-like ECG changes and multiorgan dysfunction, requiring intensive management, including mechanical ventilation and inotropes. Brugada phenocopy is a rare manifestation of aluminum phosphide-associated toxic myocarditis. After a week of treatment, there was a significant improvement in cardiac function and overall clinical status.

Effectiveness of Plasmapheresis in the Treatment and Clinical Outcome of Patients with Aluminum Phosphide Poisoning: A Randomized Controlled Clinical Trial

Background: Nowadays, therapeutic plasma exchange (TPE) is considered a novel and promising treatment in cases of poisoning. However, few studies have been conducted on the use of TPE as a treatment in various toxicity cases, especially aluminum phosphide (AlP) poisoning. Therefore, the present study aimed to investigate the efficacy of plasmapheresis in the treatment and clinical outcome of patients with AlP poisoning. Methods: We conducted this randomized controlled clinical trial on 80 patients poisoned with AlP. The control patients (n=58) received only the routine treatment, whereas those in the experimental group (n=22) underwent plasmapheresis in addition to the routine treatment. The plasmapheresis was given to these patients immediately after they had received the routine treatment, within the first six hours of their hospital admission. Results: The study results revealed that the mean hematocrit level in the plasmapheresis group (34.31±3.31%) was significantly lower than that of patients in the control group (38.05±4.80%) 12 h after the plasmapheresis treatment (P=0.046). Moreover, there were six (27.3%) and 14 (24.1%) cases of mortality in the plasmapheresis group and the control group, respectively. There was no significant difference in the mortality rates between the two groups (P=0.778). Conclusion: Based on the results of this study, plasmapheresis had a significant effect on increasing the blood HCO3 level within 12 h after the intervention. Therefore, it had a significant role in reducing the resultant acidosis in patients with AlP poisoning; however, this effect did not reduce the mortality rate after plasmapheresis.

The Protective Effect of Ethanolic Extract of Olive Leaf on Aluminum Phosphide-Induced Cardiac Toxicity in Rats

Background: The purpose of this study is to evaluate a treatment for aluminum phosphide (ALP) poisoning, which is known as “rice tablet”. Methods: In the present study, the impact of different doses of ethanolic extract of olive leaves (100, 200, and 400 mg/kg) on ALP (120 mg/kg)-induced cardiotoxicity was evaluated in anesthetized-gastrotomized adult male Wistar rats. Thirty-five rats were randomly assigned into five groups (n=7) as follows: control (AC) and treatment groups [ALP+Olea100 (AO100), ALP+Olea 200 (AO200), and ALP+Olea 400 (AO400)]. Physiological data including blood pressure, heart rate, electrocardiogram (ECG), as well as oxidative stress markers were measured in heart tissues. Results: ALP-intoxication led to perturbed normal ECG and increased oxidative stress. Administration of olive leaf extract at various concentrations, however, mitigated bradycardia after 90 minutes, following ALP-intoxication (in AO200), hypotension (in AO100), and cardiac conduction disturbances (decreased QTC in the AO200 30 (P&lt;0.05), 60 (P&lt;0.001), and 90 (P&lt;0.05) minutes after intoxication) and decreased PR 60 (P&lt;0.05) and 90 minutes (P&lt;0.01) after intoxication. This was compared with baseline as well as detrimental changes in cardiac electrophysiology [mitigated ST-segment elevation in AO200 and depressed T-wave in the AO200 (P&lt;0.05) and AO400 (P&lt;0.01) groups 90 minutes after intoxication] Conclusion: Based on these authentic results, it seems that olive leaf extracts can be useful in reducing the severity of symptoms in ALP-poisoned individuals and could be utilized in a poisoning emergency.

Examining the effectiveness of prognostic scoring systems and mortality predictors in aluminum phosphide poisoning: insights from emergency department settings

Aluminum Phosphide (AlP), a potent rodenticide and fumigant pesticide, poses a significant health threat, especially in agricultural communities. This study aimed to investigate demographic trends and predictive factors influencing outcomes in AlP poisoning patients presenting to the Emergency Department (ED). With an alarming mortality rate of 80.4%, identifying predictors of mortality became imperative. Non-survivors tended to be older and presented with distinct vital signs, such as tachycardia and shock upon ED arrival. Prognostic scoring systems like the Modified Early Warning Score (MEWS), Shock Index (SI), Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS), and serum lactate emerged as robust mortality predictors, with good accuracy (Area Under the Curve, AUC, MEWS=0.904, SI=0.914, MAP=0.869, GCS=0.829, lactate=0.962). This study favors integrating these predictors into routine ED practices, particularly in Low- and Middle-Income Countries (LMICs), to prognosticate and enhance management outcomes in patients with AlP poisoning, offering essential guidance for emergency physicians.

Pattern of poisoning cases in Bir Hospital

Background: Poisoning is one of the major causes of hospitalization through emergency and is a major public health problem in the country. For starting preventive measures, information on nature and extent of poisoning is required. For some years, there has been no study on poisoning at Bir hospital. Objectives: To find out the patient profile, the common poisons and outcome of poisoning cases. Materials and Methods: A retrospective analysis of all acute poisoning cases admitted to the emergency department of Bir Hospital from January 2005 to June 2005 was done to study the pattern of acute poisoning. Data on age, sex, time elapsed after intake, circumstances of poisoning, name of the poisonous substance, actual use, chemical type, hospitalization days, severity and outcome were collected and analyzed. Results: The age of the patients varied from 16 to 65 years. The male female ratio was 1:1.3. More than three-fourth (76.8%) of the female patients were from 16 to 25 years age group. Similarly, 46.5% of the male patients were from 16 to 25 years age group. In more than 25 years of age, there was malepredominance in all the age group. The common insecticides used for poisoning were organophosphorus compounds mainly Methyl Parathion (Metacid) and Dichlorovos (Nuvan). Paracetamol alone or combination preparations with antihistamines were the most common analgesic used. Benzodiazepines were the most commonly used anxiolytics. Ninety-seven percent of caseswere intentional poisoning for suicidal attempt. Most of the cases (61.6%) had arrived hospital within 3 hours after exposure to the poison. The hospital stay of the admitted patients with poisoningranged from one to sixteen days. The mean hospital stay was 5.9 days. During the hospital stay, six (6.0%) cases were managed in Intensive Care Unit (ICU) service. In this study, only 3% cases had mortality. There were 5 cases of Aluminium Phosphide poisoning but surprisingly, none of them died from this highly toxic poison. Conclusion: Suicide among adolescents and young adults is a common public health problem. Patients with intentional poisoning must undergo psychiatric consultation during their stay in the hospital for the treatment poisoning. This will minimize the risk of next attempt of self harm. In addition, strict rules must be followed regarding sale of psychotropic medicines and pesticides. Effective clinical management of poisoning can minimize the mortality.

Mitotherapy with Fresh Isolated Cardiac Mitochondria Via Injection Into Blood Reduces Aluminum Phosphide-Induced Mortality and Protects Cardiac Tissue Against Oxidative Stress and Mitochondrial Damages.

The hallmark of aluminum phosphide (AlP) poisoning is heart failure in victims which is associated with reactive oxygen species (ROS), mitochondrial dysfunction, oxidative stress, alteration in antioxidant defense system and depletion of ATP in cardiomyocytes. In the present study, we hypothesized that the injection of isolated mitochondria into blood or mitochondrial transplantation can likely create a primary target for phosphine released from AlP and inhibit AlP-induced mortality and cardiotoxicity in rat. Male, Wistar, healthy and adult rats were randomly divided into 5 groups as control, AlP (12.5 mg/kg, orally), AlP + mitochondria (125 µg/kg), AlP + mitochondria (250 µg/kg) and mitochondria (250 µg/kg) alone. Functional and intact mitochondria isolated from rat heart and transplantation was carried out via tail vein, 30 min after exposure to AlP. Survival rate, histopathological alterations, cardiac biochemical markers, oxidative stress and mitochondrial toxicity parameters were monitored and analyzed during 30 days. We found that injection of healthy mitochondria into blood at concentrations of 125 and 250 125 µg/ml significantly increased the survival of rats up to 40% and 56.25% respectively, during 30 days. Moreover, we observed that mitochondria injection into blood decreased histopathological damages, cardiac biochemical markers, oxidative stress and mitochondrial toxicity parameters. To our knowledge, the current study is the first report in the literature that demonstrated good therapeutic effects of mitochondrial transplantation in AlP-induced mortality and cardiotoxicity. The findings of the present study suggests that injection of exogenous mitochondria into blood could be an effective therapeutic strategy in treating AlP poisoning.