Common Poisons Research Articles

Clinico- etiological profile of acute poisoning and intoxication in children in western Nepal

Background: Pediatric poisoning is a common emergency. The present study was done to assess the incidence, clinico-etiological profile of acute poisoning and intoxication in children.Methods: This study was conducted in the Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Nepal in which children aged less than 18 years, with history of consumption of poison accompanied or unaccompanied by container or poison or with doubtful history of consumption of poison but with definite signs and symptoms of acute poisoning we included. We also included children with history of bites by poisonous creatures like snakes, scorpions, bees and insects or with doubtful history of bites due to poisonous creatures but with definite acute onset of signs and symptoms locally or systemically.Results: In the present study, during the study duration, 68 children were included. The most common age group of included children was 1 to 5 years (59%). Accidental poisoning was reported in 93% of the cases, while the rest had suicidal poisonings. The most common type of poison used were different types of pesticides (46%). We observed that vomiting was the most common clinical presentation (79%). In our study sample, arrival of 46% of the children was delayed by 30 minutes to 2 hours. Majority of the patients arrived in the afternoon to the hospital (51%).Conclusions: The findings of the present study would enable emergency physicians to identify clinical features of common poisonings among children, which would enable manage the cases better.

A retrospective observational study of poisoning and hanging cases during lockdown as a marker of emotional tide of COVID-19 pandemic in a tertiary care center in Northwestern India

Background: In January 2020, WHO declared the outbreak of a new coronavirus disease COVID-19 to be a public health emergency of international concern. Worldwide lockdown led to panic, mass unemployment, poverty and domestic violence. The present study was designed to observe the impact of lockdown on the spectrum of medico-legal cases being admitted with drastic events of poisoning and hanging.Methods:In this retrospective, observational and comparative study, around 131 patients were recruited from the admitted patients in the medicine wards in SMS medical college and hospital during COVID-19 lockdown period from 23 March 2020 to 31 May 2020 after applying inclusion and exclusion criterias. Their clinical profile were noted and comparatively assessed with patients admitted in medicine wards during adjoining pre-lockdown period, that is, from 12 January 2020 to 22 March 2020.Results: Out of 131 cases recruited during lockdown period, hanging cases were 10 (8%) while it was 10 cases out of 213 (5% )during pre-lockdown period. Organophosphorus poisoning was 4.5% and 1.4%, celphos poisoning was 3.8% and 2.3%, rat killer poisoning was 3.05% and 1.4% during lockdown and pre-lockdown period respectively. Cases due to ingestion of other than the major group of poisoning were lower (3.8%) during lockdown period while it was 10.3% during pre-lockdown period.Conclusions:Extreme negative behavioral changes precipitated by corona and this might be aggravated further by complete lockdown, to which people resorted to the means which were easily available to them at home like hanging and common poisonings.

Importance of pesticides for lethal poisoning in India during 1999 to 2018: a systematic review

BackgroundPoisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years.MethodsWe performed a systematic literature review in Medline, Embase and Google Scholar (1999–2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study.ResultsWe identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999–2003), the number of deaths declining thereafter (to n = 1714 in 2014–2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths.ConclusionUse of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter’s lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions.

The rapid SERS detection of succinylcholine chloride in human plasma is based on the high affinity between quaternary ammonium salt structures

Succinylcholine chloride (SCC) is a common poison that threatens human life. At present, there is a lack of research on its on-site rapid detection methods. In this work, the use of gold nanorods as an enhanced substrate based on the high affinity between the quaternary ammonium salt structure can achieve rapid SERS detection of SCC in plasma. The long alkane chain structure of cetyltrimethylammonium bromide (CTAB) and the quaternary ammonium salt structure of SCC have a high molecular affinity, so that the target molecule can show a strong and obvious characteristic signal of SERS. Combined with a simple pretreatment method, acetonitrile is used as a protein precipitation agent to effectively remove matrix interference. The constructed SERS substrate can achieve the sensitive detection of 2 × 10-8 M level of SCC in plasma samples and has high detection reproducibility. The entire pre-processing and testing process can be completed within 7 min, which can be used as an important technical basis for the preliminary identification of on-site SCC-related drug cases. The research results provide an effective solution for the establishment of SCC analysis strategies in complex matrices, and can provide new ideas for solving the problems of difficult identification of common poisons in the field and the lack of rapid detection methods on site.

Cathodic Corrosion of Metal Electrodes-How to Prevent It in Electroorganic Synthesis.

The critical aspects of the corrosion of metal electrodes in cathodic reductions are covered. We discuss the involved mechanisms including alloying with alkali metals, cathodic etching in aqueous and aprotic media, and formation of metal hydrides and organometallics. Successful approaches that have been implemented to suppress cathodic corrosion are reviewed. We present several examples from electroorganic synthesis where the clever use of alloys instead of soft neat heavy metals and the application of protective cationic additives have allowed to successfully exploit these materials as cathodes. Because of the high overpotential for the hydrogen evolution reaction, such cathodes can contribute toward more sustainable green synthetic processes. The reported strategies expand the applications of organic electrosynthesis because a more negative regime is accessible within protic media and common metal poisons, e.g., sulfur-containing substrates, are compatible with these cathodes. The strongly diminished hydrogen evolution side reaction paves the way for more efficient reductive electroorganic conversions.

Assessment of gross mucosal findings of stomach in cases of fatal poisoning

Background: It has been estimated that pesticides were directly or indirectly is responsible for more than 1 million illnesses worldwide annually. The present study was conducted to assess gross mucosal findings of stomach in cases of fatal poisoning.Materials and Methods: 72 suspected cases of poisoning of both genders were selected and autopsies were done by routine autopsy procedure with routine autopsy instruments. Findings of external and internal examination were recorded. After opening of thoracic and abdominal cavity, stomach was dissected. Gross examination stomach was done and mucosa appearance as pale, congestion, haemorrhage, erosion, flatten rugae, edema, colour changes were noted. Results: Common poisoning was organophosphate in 24, organochlorines in 18, aluminium phosphide in 11, carbon monoxide in 8, snakebite in 5, hydrochloric acid in 3 and sulphuric acid in 2 cases. The difference was significant (P< 0.05). Gross findings were congestion seen in 26, hemorrhage in 14, erosion in 10, and flatten rugae in 6, edema in 12 and normal in 4 cases. Conclusion: Most common gross findings were congestion followed by hemorrhage, erosion, flatten rugae and edema.

In-vitro Comparative study on blood clotting time of some Plants Extracts and Heparin when Infected with Snakebite

Around the world, snake bite injuries are still life threatening and require intensive care. The diagnose and treatment to toxic snake bites is the insufficient information, within the management of anti-toxin therapy, is not provided in clinical practice. In this comparative study, water extracts of Allium sativum, Allium cepa and Nigella sativa in different concentrations and heparin powder was used on human blood which is free from diseases. The common desert snake poison was used to compare the anti-coagulation time of the above plant extracts. Among three extracts Nigella sativa extract showed more time of coagulation of blood when treated with the snake poison. The results of the present study confirms the traditional medicinal use of selected plants and evidence for the best substances impact in the delay of blood clotting against snake bites of those plants. Further research is going on to isolate bioactive compounds.

Antidotes for childhood toxidromes.

BackgroundPoisoning causes significant morbidity and sometimes mortality in children worldwide. The clinical skill of toxidrome recognition followed by the timely administration of an antidote specific for the poison is essential for the management of children with suspected poisoning. This is a narrative review on antidotes for toxidromes in paediatric practice.MethodsA literature search was conducted on PubMed with the keywords “antidote”, “poisoning”, “intoxication”, “children” and “pediatric”. The search was customized by applying the appropriate filters (species: humans; age: birth to 18 years) to obtain the most relevant articles for this review article.ResultsToxidrome recognition may offer a rapid guide to possible toxicology diagnosis such that the specific antidote can be administered in a timely manner. This article summarizes toxidromes and their respective antidotes in paediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are discussed. Antidotes are only available for a limited number of poisons responsible for intoxication. Antidotes for common poisonings include N-acetyl cysteine for paracetamol and sodium thiosulphate for poisoning by cyanide.ConclusionPoisoning is a common cause of paediatric injury. Physicians should be familiar with the recognition of common toxidromes and promptly use specific antidotes for the management of childhood toxidromes.

Ultrasensitive and selective detection of Hg2+ using fluorescent phycocyanin in an aqueous system

Hg2+ toxicity is one of the most common chemical poisonings that occurs mainly from drinking polluted water. In the current work, Phycocyanin (PC) was exploited as a fluorescent sensor for sensitive and selective detection of Hg2+ in an aqueous system. PC-Hg2+ interaction was monitored using a spectro-fluorometer under different buffered solutions at pH values of 6,7,8,9, or 10 above the isoelectric point of PC (5.18). A remarkable decrease of PC fluorescence intensity was observed under Tris-buffer at pH 6 upon the addition of increasing Hg2+ concentrations (1–120 nM). Under the maintained experimental conditions, the current sensor showed a good linear relationship with R2 = 0.9971 and a limit of detection as low as 0.7 nM was achieved. In addition, a notable selectivity of Hg2+ over other nine heavy metals (Cu2+, Zn2+, Pb2+, Mg2+, Mn4+, Li+, Fe3+, Co2+, and Al3+) was achieved in the presence of 120 nM of each metal. Moreover, the current fluorescent detection assay was also tested in real samples of pond water, and recoveries as well as relative standard deviations within the acceptable limits were recorded.

Neuropsychiatric sequelae of acute carbon monoxide poisoning: The predictive role of neuron specific enolase and glial fibrillary acidic protein

BackgroundAcute carbon monoxide (CO) poisoning is one of the most common poisons worldwide and neuropsychiatric sequelae (NS) are the most frequent form of its morbidity. ObjectivesThis study aimed to measure the percentage of patients liable to NS, to evaluate the cognitive profile of patients with NS and to assess the role of neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP) in predicting the development of NS after acute CO poisoning. MethodsThis prospective study included 50 patients with acute CO poisoning presented to the Poison Control Center, Ain Shams University Hospitals during the period from beginning of November 2015 till the end of January 2017. Patients’ demographic characteristics, clinical manifestations and blood carboxyhemoglobin levels were recorded. Serum levels of NSE and GFAP were determined on admission. Every patient was invited to participate in a follow-up visit at a dedicated outpatient clinic one month after CO exposure. During the visit, a complete neurological examination, as well as a psychiatric evaluation using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders version 4 Axis-I were performed for detection of neurological and psychiatric disorders. Wechsler memory scale test was administrated for detection of cognitive deficits. The patients were divided into two groups based on the presence or absence of NS. ResultsCognitive impairment was found in 38 % of patients in the NS group. The serum levels of NSE and GFAP were significantly high in the NS group in comparison to the non-NS group. Receiver operating characteristic curves (ROC) determined the cut-off level of NSE at 39 ng/mL achieved 100 % sensitivity with 88.64 % specificity to predict the development of NS after acute CO poisoning while GFAP had 95.24 % sensitivity and 69.23 % specificity at a cut-off value of 2.8 ng/mL. ConclusionNSE and GFAP could be useful in the early identification of patients at risk of developing NS after CO poisoning helping in treatment plans and thus improving quality of care.

Incidence of Pet Intoxications in the Emergency Clinic, Faculty of Veterinary Medicine Cluj-Napoca

Veterinary toxicology is a common field in veterinary medicine, being a science closely related to other clinical and para clinical disciplines. The multitude of toxics and the ability of each organism to respond differently to them, non-specific clinical signs and an inadequate anamnesis can often put the clinician in difficulty when seeking to diagnose. The aim of the study was to highlight the incidence of pet poisoning cases, over a period of 10 years of time at the emergency clinic, faculty of Veterinary Medicine Cluj-Napoca. An epidemiological study was performed with the help of the emergency clinic archive, where the files of the intoxicated patients were selected. The data were centralized in the Microsoft Office Excel. The results obtained revealed the sum of 256 cases of pet poisoning in the last ten years (0.611% of the number of cases registered during this period), of which the predominantly affected species was the dog of mixed breed. Also, within the most common poisonings, the ones with ethylene glycol and anticoagulants rodenticides were observed. In the present study a correlation was established between breed, age, sex and the most frequent incidence of poisoning, common toxins and the connection between the periods of the year.

Lipid Emulsion Treatment in Tricyclic Antidepressant Poisoning in Children: An Observational Cohort Study

Tricyclic antidepressant (TCA) poisonings are among the most common childhood poisonings because of being cheap and readily available. In this manuscript, we aimed to share our experience with Intravenous lipid emulsions (ILE) treatment in addition to basic treatment steps and discussion of effectiveness of treatment in cases of poisoning caused by high-dose TCA intake. From the patients under 18 years of age who admitted to Pediatric Emergency Department due to drug intoxication between January 2014 and December 2019; those who had history of exposure to TCAs were included in our study. In conclusion of examination of six-year patient records, it was determined that there were a total of 619 intoxication cases and 108 (17.4%) of these were TCA poisoning. 21 (19.4%) patients who had hypotension, tachycardia and ECG changes which were refractory to all basic treatment steps were administered ILE. After ILE treatment, a marked improvement was observed in patients’ clinical and ECG findings, as well as vital signs. Early administration of ILE treatment in emergency departments for cases with hypotension, conduction disorder, dysrhythmia or widened QRS which are refractory to sodium bicarbonate is thought to prevent potential cardiovascular complications.

English

BACKGROUND Organo phosphorous compound poisoning is one of the most common suicidal poisonings in India. The various clinical entities that determine the clinical course and outcome in the ICU of OPC poisoning patient are type of the compound and dose of poison. Delayed presentation and multi-organ failure are some of the major factors that decide the outcome of the patient. This study was conducted to assess the clinical outcome of patients with OPC poisoning on assisted ventilation and assess the various factors that determine the outcome. METHODS A prospective observational study was conducted for a period of 6 months at a government tertiary care hospital in Chennai. All patients with history and clinical signs of OPC poisoning requiring mechanical ventilation for respiratory support were included as our study subjects. Outcome of patients was measured in terms of either recovery or death and factors influencing the outcome such as type of OPC compound, amount consumed, onset and duration of respiratory muscle weakness and pseudocholinesterase levels were considered. RESULTS In the 172 subjects, 108 (62.7 %) patients were successfully extubated from mechanical ventilator and 64 (37.2 %) patients expired. Patients aged more than 40 years, patients who consumed methyl parathion with quantity of poison more than 50 ml, patients with serum cholinesterase levels less than 500, patients who were atropinised for more than 3 days and who were on mechanical ventilation for more than 3 days were the factors found to have a statistically significant association (P &lt; .05) for causing death among patients with OPC poisoning. CONCLUSIONS The mortality among the OPC poisoning patients who were on mechanical ventilation was found to be very high. Early resuscitation of patients with OPC poisoning might reduce the morbidity and mortality. KEYWORDS Organo-Phosphorous Compound Poisoning, Mechanical Ventilation, Clinical Outcome

Clinical Profile and Outcome of Patients Presenting to ER with Acute Rodenticide Poisoning

Background: Rodenticide consumption is one of the most common suicidal poisoning. The compounds vary in their chemical composition, mechanism of action, lethal dose and effects. Absence of a specific antidote along with rapid deterioration to multi organ failure has escalated the mortality. This study is intended to predict the clinical profile and the outcome of patients presenting to the ER of a tertiary care center in South India with acute rodenticide poisoning. Methods: A retrospective cross sectional analysis of all acute rodenticide poisoning cases presented to the ER of a tertiary care centre in south India during the period between 1st January 2018 to 1st December 2019 after fulfilling both inclusion and exclusion criteria was done. The clinical profile and outcome of patients presenting with acute rodenticide poisoning were assessed. Results: A total of 39 patients were included in the study population, of which 18(46.2%) were females and 21 (53.8%) were males. The mortality associated with rodenticide poisoning is 33.3%. Out of the 39 patients, 21 patients had acute liver failure , 16 had met the Kings college criteria for liver transplant, but liver transplant was done in only 2 patients and out of which 1 survived. On detailed analysis,two parameters SGOT, SGPT and the presence of hepatic encephalopathy correlate with mortality. Conclusion: The study revealed that, the mortality associated with rodenticide poisoning is high (33.3% ) and certain factors like SGOT, SGPT and the presence of hepatic encephalopathy are strong predictors of mortality in acute rodenticide poisoning.

Descriptive epidemiology of clinically significant occupational poisonings, United States, 2008–2018

Introduction References listing common occupational poisons often include agents that were observed decades prior to the introduction of worker protective laws and regulations. Current causes of work-related acute poisonings have not been characterized. This study’s primary objective was to describe the most common poisons and routes of exposure responsible for clinically significant occupational poisonings. A secondary objective was to determine the crude rate of clinically significant occupational poisonings and occupational poisoning-related deaths over the study period. Methods This was a retrospective cohort study using electronic data from the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS), and open source data from the United States Bureau of Labor Statistics (BLS). The NPDS was queried for all cases with exposure reason coded as “Unintentional-Occupational” for the period 1 January 2008 to 31 December 2018. A case of clinically significant occupational poisoning (CSOP) was defined as a case with moderate or severe clinical effects reported, to include fatal cases. A descriptive analysis was conducted using unadjusted odds ratios to assess the strength of association between main variables of interest and CSOP. Results 329,437 exposure cases were available for analysis. Of these, 54,254 were considered CSOP and included 196 deaths. The top five poisons responsible for occupational fatalities were hydrogen sulfide, ammonia, carbon monoxide, simple asphyxiants, and chlorines. Fatalities were 3.7 times (OR: 3.7; 95% CI: 2.2–6.4) more likely to be men and 5.7 times (OR: 5.7; 95% CI: 4.0–8.1) more likely to have had an inhalational exposure, compared to those workers with CSOP without fatality. The crude rate of occupational fatal poisoning reported to US poison centers was 11.3 deaths per 100,000,000 worker-years during the study period. The crude rate of clinically significant occupational poisoning was 3.1 per 100,000 worker-years. These rates remained generally stable over the study period. Conclusion Occupational poisonings continue to be a significant cause of morbidity and mortality in the workplace despite significant improvements in workplace chemical safety over the last four decades. Workplace education and proper preventive measures devoted to inhalational toxicants and respiratory protection are opportunities for improvement.

Porównanie samobójczych zatruć substancjami chemicznymi i lekami w latach 1930–1939 oraz 2010–2019 w materiale Zakładu Medycyny Sądowej w Krakowie

Comparison of Suicidal Poisonings with Chemicals and Drugs in the Years 1930–1939 and 2010–2019 in the Materials of the Forensic Medicine Institute in Krakow The study aims to compare suicide poisoning and poisons used to commit suicide in the 1930s and today. The focus is on autopsy protocols from 1930–1939 and 2010–2019 collected at the Forensic Medicine Institute in Krakow. In the years 1930–1939, there were 184 cases, 65 of which were among men and 119 among women. The most common poisons were corrosives, accounting for 69 cases, 43 were carbon monoxide, 24 were drugs and narcotics, 17 were heavy metals, and the remaining 31 were other substances. Of the 138 suicide poisonings in modern times, 96 were committed by men and 42 by women. The most common poisoning was multi-drug poisoning – 62 cases. Opioids, benzodiazepines, neuroleptics and antidepressants were the most frequently chosen substances today. Fatal intoxications with drugs/new psychoactive substances (NCAs) were observed in 28 cases, while other substances were used in the remaining 17. The conducted analysis showed a significant decrease in suicidal poisoning with the use of corrosive substances and gases, while the percentage of drug overdoses is systematically growing. Poisons used for suicide purposes in the 1930s left macroscopic changes that could be instantly noticed during the autopsy. The fact that drugs that are currently used most often do not leave such changes may justify the dynamic development of forensic toxicology.

Pesticide poisoning - 10 years retrospective analysis

Background: According to the World Health Organization, the incidence of pesticide poisoning is estimated between 1 and 5 million victims with 300,000 lethal cases annually. Thus, it is recognized as a major public health related problem around the world. Aims and Objectives: The socioeconomic status, religious and cultural influences, and the availability of pesticide poisons determine the pattern of pesticide poisoning, which will help to manage the poisoning cases. Materials and Methods: A retrospective study of deaths due to pesticide poisoning cases was conducted in Forensic medicine and Toxicology department, Government Medical College, Amritsar (Punjab) from January 1, 2006, to December 31, 2015. During this period out of total 10217 autopsies that were conducted that alleged to have died due to pesticide poisoning, 483 cases of pesticide poisoning deaths had been studied. The present study was approved by the institutional ethical committee of Government Medical College, Amritsar. All information has been taken under consideration of medical ethical committee. Results: Young males from rural areas in the age group of 21–40 years are more prone and have high more mortality as a result of pesticide poisoning. The most common fatal pesticide poisons found in the study were aluminum phosphide, organo phosphorus, organo chloro compound, and zinc phosphide, widely used in agriculture. Conclusion: Health education and strict legal intervention regarding storage, handling and transportation of poisonous substances to restrict the easy availability should be mandatory.

Clinical Spectrum and Severity of Poisoning in the Paediatric Intensive Care Unit of a Tertiary Care Centre in Uttarakhand: A Retrospective Cohort Study

Introduction: Acute poisoning causes significant mortality and morbidity among children worldwide. However, the pattern of poisoning and causative substances varies significantly in geo- demographic areas. Aim: To describe admissions due to acute poisoning in the Paediatric Intensive Care Unit (PICU) of a tertiary care centre in terms of demographics, clinical profile, specific agents involved and severity of poisoning. Materials and Methods: This was a retrospective cohort study conducted in PICU of a tertiary care level teaching institute of Uttarakhand, India, over a period of three years on subjects of age group from one month to 18 years. Data was collected and analysed for demography, clinical presentation, substance, management, complications, and outcome. Poison Severity Score (PSS) was used to assess the severity of poisoning. Data was analysed using Statistical Package for the Social sciences (SPSS) software version 21.0. Results: During the study period, out of total 751 PICU admissions, 45 were due to poisoning. Organophosphates 20 (44%) and aluminium phosphide 12 (26%) were the most common substances used. Accidental poisoning was common 6 (46%) among less than five years of age. However, suicidal attempts were noted more frequently 20 (64%) among &gt;15 years of age group. Vomiting 31 (69%), altered sensorium 23 (51%), and pain abdomen 16 (35%) were the most common presentations. Nine (20%) patients required ventilatory support as well. Three (6.6%) patients died; all associated with aluminium phosphide poisoning. Conclusion: The most common poison consumed is organophosphate. Aluminium phosphide is the most lethal poison, accounting for all the deaths in the study. Accidental poisoning is common in children less than five years of age. Suicidal poisoning is common among adolescents which must be prevented by early detection of stress. Primary health care facility hesitates to intervene even for basic poisoning care before referring.

Trends of poisoning in Central India, Indore Region (Madhya Pradesh)

Introduction: In this modern civilization, acute poisoning is one of the leading causes of morbidity and mortality and really becoming a burden for our community. Trends of poisoning are increasing as well as changing day by day due to the introduction of more and more chemicals. This study has been taken to understand the trends of poisoning and will be used to plan how to provide healthcare facility and educate the people. Only those cases that came to the Emergency Department and Mortuary with a history of acute poisoning were included in this study. Materials and Methods: A total of 120 poisoning cases were included from October 2015 to May 2017. The cases were analyzed on various epidemiological, clinical and investigational and postmortem findings through a pre-designed proforma after taking valid consent from the patients or their relatives. Samples were collected and analyzed in Analytical Toxicology lab. Result: Out of 120 acute poisoning cases, 75 were males and 45 were females. Maximum numbers of patients fall in 21-30 years age group. Most common poison was Organophosphorus (OPP) followed by Aluminium phosphide (Celphos). The mortality rate as per this present study was 21.67%. Conclusion: Due to the easy availability of insecticides, pesticides and household poisons; there is more exposure accidently or intentional, which creates a huge burden on hospitals. The government, WHO and other organizations have to make strict rules or to ban highly toxic chemicals. Education camps must be organized to train farmers how to use insecticides and pesticides in a proper way. Keywords: Aluminium Phosphide, Analytical toxicology lab, Insecticides, Mortuary, Organophosphorus, Pesticides, Poisoning.

Seasonal Impact of Heroin on Rabbit Carcass Decomposition and Insect Succession.

This study investigates the succession of insects and the length of the decomposition of rabbit carcasses injected with heroin. In total, 24 rabbits (2-2.5 kg, Oryctolagus cuniculus domesticus L.) were used in the study. Twelve carcasses were exposed to insect activity in winter (January and February) and 12 in summer (July and August) in Riyadh, Saudi Arabia. Three replicate experiments were conducted in each season. For each experiment, three rabbits were injected with varying doses of heroin, and the fourth rabbit was used as a control, being injected only with saline solution. Insects belonging to the order Diptera, Coleoptera, and Hymenoptera were attracted to the carcasses. In both of the investigated seasons, heroin appeared to delay the decomposition process but did not have a significant impact on the number of insects. In general, the number of flies in both seasons was substantially higher than that of beetles and ants. During the summer, flies were more attracted to treated carcasses with a higher dose of heroin. Some flies such as Musca domestica L. (Diptera: Muscidae) and Chrysomya albiceps Wiedemann (Diptera: Calliphoridae) and some beetles such as Pimelia boyeri Solier (Coleoptera: Tenebrionidae) were represented on the carcasses by different developmental instars (larvae, pupae, and adults). Overall, heroin has not potential effects on the insect succession patterns of insect, however, influences the decomposition of rabbit carcasses. These findings are important while using insects in medicolegal investigation, since heroin is one of the common poisons used as an addictive agent.