Moderate Poisoning Research Articles

Assessment of the pattern, severity, and outcomes of acute mood stabilizer drug poisoning.

Mood-stabilizer drugs are associated with a considerable incidence of morbidity and mortality. This study aimed to assess the pattern, severity, and outcomes of poisoning with acute mood stabilizer drugs among admitted patients to Tanta University Poison Control Center, Egypt between January 2021 and September 2023. This cross-sectional study was conducted in patients with acute mood stabilizer drug poisoning. Data from electronic medical records were observed. The poison severity score (PSS) assessed the severity of the patients. Primary outcomes were the pattern and severity assessment. Secondary outcomes included the incidence of mortality, the need for intensive care unit (ICU) admission, the need for intubation and mechanical ventilation, the incidence of complications, and the duration of hospital stay. A total of 67 patients with acute poisoning of mood stabilizers were included. Poisoning with carbamazepine accounted for 58.2% of all mood stabilizers, followed by valproic acid (29.8%), lithium (7.5%), and lamotrigine (4.5%). The highest proportion of patients were young, females, with intentional poisoning and were classified as mild to moderate poisoning based on PSS. There were significant statistical associations between PSS and the need for ICU admission, development of complications, and length of hospital stay among poisoned patients with carbamazepine or valproic acid. Carbamazepine poisoning and valproic acid poisoning were the most common mood stabilizers compared to lithium and lamotrigine poisoning. In acute carbamazepine and valproic acid poisoning, the PSS is a relevant score that could predict the need for ICU admission, the development of complications, and the duration of hospital stays.

Correlation of Pseudocholinesterase Level with Clinical, Biochemical Parameters Including Cardiac Profile and the Outcome in Organophosphorus Poisoning.

Poisoning is a significant health hazard and a leading cause of morbidity and mortality worldwide. India, being a predominantly agrarian country, routinely employs organophosphate (OP) pesticides in farming, and they are readily available "over the counter." OPs exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous systems. Due to the limited availability of facilities and resources in health-care systems, and economically restraining patients, it is necessary to rely more on clinical features to assess the severity of poisoning and manage the condition properly. It was a hospital-based prospective observational study that included patients aged >13 years in a tertiary care hospital. All patients were clinically evaluated based on their history and examination. The diagnosis was made based on characteristic clinical manifestations or evidence of exposure to organophosphorus compounds (corroborative evidence such as empty containers and the odor of gastric aspirates). Clinical severity was assessed and categorized according to the Peradeniya Organophosphorus Poisoning Scale (POP scale). A score of 0-3 is considered mild poisoning, 4-7 as moderate poisoning, and 8-11 as severe poisoning. Out of the 50 patients enrolled in the study, 17 (34.00%) were aged <20 years, 19 (38%) were in the 20-30 years age group, and 14 (28%) were aged >30 years. Ingestion is the only mode of exposure to poisoning. None of the patients had history of contact or inhalational exposure. Of the 50 cases, 12 (24.0%) were in the mild category, 26 (52.0%) in the moderate category, and 12 (24%) in the severe category on the POP grading. A comparison of the mean serum pseudocholinesterase, troponin-T, and pro-BNP levels with severity was performed. In mild OP poisoning, the mean serum PChE level was 2766.58 ± 1120.44; in moderate, it was 1969.35 ± 1330.07, and in severe, it was 701.83 ± 961.17. Pseudocholinesterase levels decreased progressively with increasing clinical severity from mild-to-severe cases, and this association was statistically significant (P < 0.001). Two-dimensional echocardiography screening done in all patients did not show any significant abnormalities. This study shows that serum PCE is reduced in OP poisoning and correlates with the clinical severity grading done by the POP scale and is also associated with an increase in the duration of intensive care unit stay. No significant evidence of direct cardiac injury was observed in this study. A low Glasgow Coma Scale score and an increased respiratory rate at presentation are associated with poor outcomes.

A CROSS SECTIONAL STUDY TO ASSESS THE SEVERITY OF ORGANOPHOSPHORUS POISONING AND ITS CORRELATION WITH PSEUDOCHOLINESTERASE ESTIMATION

Background &amp; objectives Organophosphorus (OP) compounds is the most common poisoning. Serum pseudocholinesterase enzymes levels are routinely measured in OP compound poisoning. The Peradeniya Organophosphorus Poisoning (POP) scale is used to assess the severity of the poisoning. So this study was conducted to assess the severity using POP scoring system and to estimate serum pseudocholinesterase values in OP compound poisoning patient. Methods A cross sectional study was conducted on 100 patients admitted under Department of General medicine , Adichuchunchanagiri hospital and research centre, B.G. Nagara. Results Among the patients, 47% had mild poisoning, 48% had moderate poisoning and 5% had severe poisoning according to POP Scale. Patients who had lower level of serum pseudocholinesterase had increased mortality. ConclusionThere was good association between POPScale and serum pseudocholinesterase levels and severity of poisoning. Our study shows that the severity of poisoning had a direct relation with the pseudocholinesterase levels.

Prediction of acute organophosphate poisoning severity using machine learning techniques

Poisoning with organophosphate compounds is a significant public health risk, especially in developing countries. Considering the importance of early and accurate prediction of organophosphate poisoning prognosis, the aim of this study was to develop a machine learning-based prediction model to predict the severity of organophosphate poisoning. The data of patients with organophosphate poisoning were retrospectively extracted and split into training and test sets in a ratio of 70:30. The feature selection was done by least absolute shrinkage and selection operator method. Selected features were fed into five machine learning techniques, including Histogram Boosting Gradient, eXtreme Gradient Boosting, K-Nearest Neighborhood, Support Vector Machine (SVM) (kernel = linear), and Random Forest. The Scikit-learn library in Python programming language was used to implement the models. Finally, the performance of developed models was measured using ten-fold cross-validation methods and some evaluation criteria with 95 % confidence intervals. A total of 1237 patients were used to train and test the machine learning models. According to the criteria determining severe organophosphate poisoning, 732 patients were assigned to group 1 (patients with mild to moderate poisoning) and 505 patients were assigned to group 2 (patients with severe poisoning). With an AUC value of 0.907 (95 % CI 0.89–0.92), the model developed using XGBoost outperformed other models. Feature importance evaluation found that venous blood gas-pH, white blood cells, and plasma cholinesterase activity were the top three variables that contribute the most to the prediction performance of the prognosis in patients with organophosphate poisoning. XGBoost model yield an accuracy of 90.1 % (95 % CI 0.891–0.918), specificity of 91.4 % (95 % CI 0.90–0.92), a sensitivity of 89.5 % (95 % CI 0.87–0.91), F-measure of 91.2 % (95 % CI 0.90–0.921), and Kappa statistic of 91.2 % (95 % CI 0.90–0.92). The machine learning-based prediction models can accurately predict the severity of organophosphate poisoning. Based on feature selection techniques, the most important predictors of organophosphate poisoning were VBG-pH, white blood cell count, plasma cholinesterase activity, VBG-BE, and age. The best algorithm with the highest predictive performance was the XGBoost classifier.

Acute poisoning in children: a retrospective case study

Introduction. Acute exposure to chemicals is the most common cause of poisoning in pediatric practice and one of the leading causes of morbidity and mortality worldwide [1]. In the available domestic literature, we have not found publications concerning up-to-date data on the etiological structure, clinical characteristics of patients and outcomes of acute poisoning in children. Knowledge of clinical manifestations and prognosis for various poisoning in children will help doctors of the outpatient level and the reception department of hospitals to quickly determine the tactics of patient management and prevent serious consequences. Material and methods. In this retrospective study, the case histories of 300 children aged 0 to 18 years who were admitted to the emergency department of the third - level hospital - the Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan with acute poisoning for the period from 2018 to 2020 were studied. Results. The study included 176 boys (58.6%) and 124 girls (41.4%). Poisoning was most common in the age periods from 1 to 3 years - 127 (42.3%) and from 12 to 18 years - 76 (25.3%). 67% of poisoning were unintentional, and in 33% of cases - intentional. The largest number of poisonings - 248 (82.7%) occurred at home, and 52 (17.3%) were poisoned outside the home. Of the 300 cases of poisoning, 70 (23.3%) were of mild severity, 151 (50.3%) of moderate severity, 79 (26.3%) of severe severity. The most common toxic substances were: chemical detergents, carbon monoxide, vasoconstrictor drugs, nonsteroidal anti-inflammatory drugs. All 300 patients survived. Limitations of the study. The data of patients living in the Republic of Tatarstan who were admitted to the emergency department of the DRKB for the time period from 2018 to 2020 were studied. Conclusion. Over the past 2 years, there has been an increase in the frequency of poisoning in the city of Kazan. Most patients had mild to moderate poisoning, more often unintentional. A serious condition was observed in adolescents when the cause of poisoning was a suicide attempt. The increase in the number of poisonings can be associated with the over-the-counter sale of a large number of drugs, their aggressive advertising, as well as improper storage at home.

Organophosphorus poisoning: study of evaluation of clinically relevant indicators

Background: POP scale and serum cholinesterase estimation are purported to be meaningful indicators for mortality prediction in the cases of organophosphorus poisoning. The present study was undertaken to substantiate the correlation of POP scale score and serum cholinesterase levels in acute OP poisoning with mechanical ventilation requirement and mortality in our setting.Methods: Data of 150 eligible participants was collected, with POP scale and serum cholinesterase levels being assessed during initial presentation in each of them. Clinical course of the cases was monitored and documented.Results: The observed case fatality rate was 32.7%. POP scale scoring revealed 30 out of 75 patients to be from moderate group and 19 out of 22 patients to be from severe group. Forty nine out of 75 in moderate group &amp; all patients in severe group required ventilator support. With respect to Serum Cholinesterase level; 20 out of 23 and 29 out of 77 patients died in the severe &amp; moderate poisoning categories respectively. Forty eight out of 77 in moderate poisoning and all patients in severe poisoning required ventilator support.Conclusions: POP scale scoring and serum Cholinesterase level assessments are clinically relevant indicators in acute OP poisoning cases and are of great utility towards assessment of mechanical ventilation requirement and mortality prediction.

3-Methylmethcathinone (3-MMC) Poisonings: Acute Clinical Toxicity and Time Trend Between 2013 and 2021 in the Netherlands

The synthetic cathinone 3-methylmethcathinone (3-MMC, or metaphedrone) has recently gained popularity. We studied the numbers of 3-MMC poisonings over time and the clinical effects following poisonings with 3-MMC. We performed a retrospective study on the numbers of self-reported 3-MMC poisonings to the Dutch Poisons Information Center (DPIC) from 2013 to June 2021. For poisonings reporting 3-MMC only, the symptoms were extracted and the Poisoning Severity Score (PSS) was determined. From 2016 to June 2019, a prospective cohort study on poisonings reporting only 3-MMC was performed, in which details on the clinical courses were collected through telephone interviews. From 2013 to June 2021, the DPIC was consulted on 184 3-MMC poisonings. The number of poisonings increased from 1 in 2013 to 70 in the first half of 2021. In 84 poisonings with only 3-MMC (46%), sympathomimetic symptoms were commonly reported, including tachycardia (n=29, 35%), hypertension (n=17, 20%), and agitation (n=16, 19%). The initial PSS was usually minor (n=37, 44%) to moderate (n=39, 46%). Five patients (6%) experienced severe effects, including 3 patients experienced severe hypertension (systolic blood pressure >180 mmHg; n=3) and nonfatal cardiac arrest (n=1). Sympathomimetic symptoms (n=8) were also reported in the prospective cohort study. The percentage of moderate poisonings increased (n=6, 75%), and 1 (13%) severe poisoning was observed. Analytical confirmation of 3-MMC exposure was performed in 2 cases. The number of 3-MMC poisonings reported to the DPIC has increased over time. Most poisonings with 3-MMC resulted in moderate toxicity and involved sympathomimetic effects, while severe effects were observed in 5 cases.

Different lead species deactivation on Mn-Ce activated carbon supported catalyst for low-temperature SCR of NO with NH3: Comparison of PbCl2, Pb (NO3)2 and PbSO4

Due to the accumulation of heavy metal compounds produced by the sintering process in steel industry, the catalysts used for low-temperature selective catalytic reduction of NO with NH3 (NH3-SCR) might be seriously deactivated. In this work, the deactivation effect of PbCl2, Pb(NO3)2, and PbSO4 on Mn-Ce activated carbon supported catalyst for low-temperature NH3-SCR of NO was investigated and compared. Poisoned catalysts were provided by impregnating fresh catalysts with Pb(NO3)2, PbSO4 and PbCl2 aqueous solutions, respectively. Deactivation could be observed on the poisoned samples, and the deactivation degree was following PbCl2 > PbSO4 > Pb(NO3)2. The catalytic activities of all samples were tested, and the physicochemical properties of fresh and poisoned catalysts were assessed. PbCl2 caused the most severe deactivation of the catalyst, owing to its poor redox property and surface acidity. Cl- could also react with Mn active sites to form -O-Mn-Cl bonds, resulting in additional acid sites, although these newly generated sites were not reactive in NH3-SCR reaction process. PbSO4 exhibited moderate poisoning effect due to the addition of SO42-, which created new Brønsted acid sites, facilitating the NH3 adsorption and NO reduction. Pb(NO3)2 had the least poisoning impact on the catalyst due to the NO3–, promoting the NH3 activation. The in situ DRIFTS results revealed that NH3-SCR reaction over all samples was governed by Eley-Rideal (E-R) and Langmuir-Hinshelwood (L-H) mechanism, and did not change due to the lead poisoning. Finally, a possible mechanistic model for different lead salts poisoning over Mn-Ce/AC catalyst was proposed.

Emergency psychological intervention of acute ammonia leakage event

Objective: To analyze the situation of emergency psychological intervention in an acute ammonia leakage event, and to provide reference for emergency response. Methods: In August 2020, the emergency treatment of 65 patients admitted by Zhangqiu District People's Hospital Affiliated to Jining Medical College of Shandong Province in June 2019 in the ammonia tank car leakage incident was analyzed, the psychological intervention in emergency after the incident was collected, the anxiety and depression were evaluated by symptom checklist 90 (SCL-90) , and targeted psychological intervention was implemented according to the psychological evaluation results, And analyze the intervention efficiency. Results: Among the 65 patients, there were 52 cases of ammonia stimulation reaction, 11 cases of mild poisoning and 2 cases of moderate poisoning. There were 60 cases of chest tightness and dyspnea, 11 cases of bloody sputum, 58 cases of sore throat, 43 cases of hoarseness, 28 cases of photophobia and tears, 13 cases of blurred vision, 18 cases of nausea and vomiting, and 2 cases of dry and wet rales in the lungs. The scores of somatization, depression, anxiety, hostility, phobia, paranoia and negative coping in patients with mild and moderate poisoning were higher than those in patients with stimulus response (P<0.05) . The effective rate of intervention was 98.7%. Conclusion: Emergency psychological evaluation and intervention in mass public health events are helpful to the treatment of patients.

Investigation and case analysis of an occupational chronic benzene poisoning accident

This article investigated an occupational chronic benzene poisoning incident that occurred in a sealing material factory in Hebei Province in September 2019, analyzed the clinical data of workers, to explore the causes of occupational chronic benzene poisoning, and summarize the diagnosis and treatment characteristics and treatment outcome. According to GBZ 68-2013 "Diagnosis of Occupational Benzene Poisoning", a total of 12 cases of occupational chronic benzene poisoning were diagnosed among the 20 workers, including 2 cases of occupational chronic mild benzene poisoning, 7 cases of moderate benzene poisoning, and 3 cases of severe benzene poisoning. Both mild and moderate poisoning patients had recovered after treatment. Severely poisoned patients had recovered more slowly, and the white blood cell count was still 2.0×10(9)-3.0×10(9)/L during the 1-year follow-up. This benzene poisoning incident was caused by illegal operations. The responsibility of the employer, the supervision of the administrative agency, and the awareness of personal protection of employees should be strengthened to avoid or reduce the occurrence of poisoning incidents and ensure the health of workers.

Dosage of Lipid Emulsions as an Antidoteto Lipid-Soluble Substances.

Lipid emulsions are increasingly used as an antidote to lipophilic drug intoxications. The dose recommended by the American Society of Regional Anesthesia is used primarily for the treatment of local anesthetic systemic toxicity. There is insufficient information about what the dose of lipid emulsions (LE) should be in other intoxications depending on their severity. To determine the LE dose in a shock or haemodynamic instability in patients with acute exogenous intoxications treated with LE. Forty-nine patients with acute lipophilic drug intoxications were treated with LE in the Clinic of Toxicology at the Naval Hospital in Varna.Statistical analysis was performed using the statistical functions of Excel 2016 and the Statistica 7.0 software package. The percentage of patients receiving a low dose of LE of 0.3 ml/kg (93.87%) was significantly higher than the percentage of patients treated with a medium (2.04%) and a high dose (4.08%) of LF. The high dose of LE of 1.5 ml/kg recommended by the American Society of Regional Anesthesia was administered to two patients (4.08%). In severe intoxications with exotoxic shock, the rate of LE administration varies from 20 ml/h to 40 ml/h. In severe intoxications with cardiotoxic syndrome and haemodynamic instability, LE should be used in the dose as suggested by the American Society of Regional Anesthesia. It is possible to use lower doses of LE in the range of 0.3-0.6 ml/kg in all moderate poisonings administered by continuous intravenous infusion for 12-24-48 hours. No side effects were observed at these doses.

Crown Ether-Immobilized Cellulose Acetate Membranes for the Retention of Gd (III).

This study presents a new, revolutionary, and easy method of separating Gd (III). For this purpose, a cellulose acetate membrane surface was modified in three steps, as follows: firstly, with aminopropyl triethoxysylene; then with glutaraldehyde; and at the end, by immobilization of crown ethers. The obtained membranes were characterized by Fourier transform infrared spectroscopy (FT-IR) and X-ray photoelectron spectroscopy (XPS), through which the synthesis of membranes with Gd (III) separation properties is demonstrated. In addition, for the Gd (III) separating process, a gadolinium nitrate solution, with applications of moderator poison in nuclear reactors, was used. The membranes retention performance has been demonstrated by inductively coupled plasma mass spectrometry (ICP-MS), showing a separation efficiency of up to 91%, compared with the initial feed solution.

CT Imaging in the Diagnosis of Lung Injury of Organophosphorus Poisoning and Analysis of Its Correlation with Procalcitonin and C-Reactive Protein Levels

This study focused on the application value of CT images of patients with organophosphorus poisoning lung injury. Specifically, 50 patients diagnosed with organophosphorus pesticide poisoning lung injury in the hospital were selected as research subjects. They all had chest CT examinations. Patients were classified according to different degrees of poisoning, and different groups were compared for the levels of C-reactive protein (CRP) and procalcitonin (PCT) in the serum. The results showed that, of the 50 patients, 25 patients had mild organophosphorus poisoning, accounting for 50%, 14 patients had moderate poisoning, accounting for 28%, and 11 patients suffered from severe organophosphorus poisoning. It was found that, in AOPP patients, cascade effect was exerted by stimulating the secretion of inflammatory mediators such as CRP, causing systemic inflammatory response syndrome, and multiorgan failure appeared in the early stage of the disease. After the histogram equalization treatment, the image was clearer than that processed by the other three methods. In terms of CT image smoothing, the effect of the Gaussian filtering was better than the mean filtering effect, and the effect of the median filtering was better than that of the Gaussian filtering. Therefore, the structure of the lungs became clearer, and the lung texture was also clearly displayed, and CT images after histogram equalization have an important value in the diagnosis of lung injury caused by organophosphorus poisoning.

Обоснование мероприятий интенсивной терапии и экстракорпоральной детоксикации при комбинированных отравлениях метадоном

Актуальность. Острые отравления метадоном в сочетании с другими психоактивными веществами, в частности этанолом, нередко осложняются синдромом компрессии мягких тканей и острым повреждением почек, что требует использования методов экстракорпоральной детоксикации. Цель исследования — изучение эффективности раннего применения гемодиализа с ультрафильтрацией, мембранного плазмафереза и озонирования крови в комплексной терапии острых отравлений метадоном тяжелой степени. Материалы и методы. Проведен анализ результатов лечения 186 пациентов с отравлением метадоном в возрасте от 21 до 43 лет обоих полов, которые составляли три группы исследования. Лечение проводилось на базе отделении интенсивной терапии и экстракорпоральной детоксикации Киевской городской клинической больницы скорой медицинской помощи в 2018–2019 гг. Использованы клинические, биохимические, функциональные, химико-аналитические, статистические методы исследования. Показатели в группах сравнивали с помощью t-критерия Стьюдента для независимых выборок; различия считали статистически значимыми при р ≤ 0,05. Результаты. По результатам проведенного клинического, функционального и лабораторного обследования пациентов с комбинированными отравлениями метадоном выявлена токсическая гепатонефропатия у 34,3 % пациентов, синдром ишемии мягких тканей и олигурия/анурия — у 22,9 %. Причинами развития почечной недостаточности были как преренальные (гиповолемия, низкий сердечный выброс, снижение тонуса почечных сосудов), так и ренальные факторы (токсическое поражение паренхимы почек). Показанием для гемодиализа был симптомокомплекс: олигурия/анурия в течение 24 часов, повышение уровня КФК плазмы крови, увеличение уровня креатинина, мочевины, лактата, АСАТ, АЛАТ, ЛДГ, водно-электролитный дисбаланс, ишемия мягких тканей (≥ 5 % площади тела), отек мозга, угроза сосудистого тромбоза вследствие усиления компрессии в зоне ишемии мягких тканей. Применены вено-венозный гемодиализ и ультрафильтрация (CVVHD) у 86 пациентов с острым повреждением почек. Выводы. Разнообразие нарушений гомеостаза при комбинированном отравлении метадоном, в частности с наличием синдрома ишемии мягких тканей, требует раннего использования (в течение 24–48 часов) методов экстракорпоральной терапии. Среди таких методов эффективными являются пролонгированный вено-венозный гемодиализ с ультрафильтрацией, мембранный плазмаферез и озонотерапия (внутривенное введение физиологического раствора и аутогемотрансфузия озонированной крови).

Clinical Characteristics of Visual Dysfunction in Carbon Monoxide Poisoning Patients.

Purpose The aim of the present study was to analyze the clinical characteristics of visual dysfunction in patients with carbon monoxide (CO) poisoning. Methods A total of 436 patients with CO poisoning were enrolled in our hospital from October 2012 to December 2018, including 193 patients with moderate poisoning (MP group), 165 with severe poisoning (SP group), and 78 with delayed encephalopathy (DE group). The clinical characteristics of visual dysfunction in patients with CO poisoning were analyzed through the collection of medical history, regular physical examination, brain magnetic resonance imaging (MRI), ophthalmological examination, the National Eye Institute Visual Function Questionnaire (NEI-VFQ), and its influencing factors. Results Some patients in the three groups had visual dysfunction. The main ocular symptoms were local pain, eye movement disorder, and visual field defect. The key pathological factors were keratopathy, retinal nerve cell damage, optic nerve damage, retinal vascular disease, macular disease, and occipital visual center damage. The clinical symptoms of visual dysfunction after CO poisoning lasted for a long time (>12 months) and were not completely consistent with the positive results of the ophthalmological examination. A few sequelae of ophthalmology were still left after the help of medicine. Conclusion The incidence of visual dysfunction in patients with CO poisoning was high, the clinical symptoms were rich and diverse, the duration of disease was long, and the prognosis was poor. Thus, the relevant ophthalmological examination and intervention treatment should be perfected as soon as possible.

A comparative study of reactivity feedback effects for a HALEU molybdenum-producing PHWR fuel bundle and a standard PHWR fuel bundle

A new 37-element PHWR fuel bundle, which can produce Molybdenum-99 (99Mo) when irradiated inside a PHWR, has recently been proposed (Nichita and Haroon, 2016). The modified 37-element fuel bundle uses High-Assay Low-Enriched Uranium (HALEU) at the periphery of fuel pellets and has been shown to be neutronically and thermal-hydraulically equivalent to the standard CANDU bundle for steady-state conditions.The first step towards comparing the behavior of the molybdenum-producing bundle (MPB) and the standard CANDU bundle (SCB) under transient conditions is a comparison of their reactivity feedback effects. This study calculates and compares the reactivity effects of the two bundles over a wide range of perturbations in coolant density, moderator density, coolant temperature, moderator temperature, fuel temperature and moderator poison concentration (boron and gadolinium), for burnups ranging from zero to 7500 MWd/t(U) (discharge burnup). An analysis of reactivity coefficients based on linear perturbation theory is also included.The study concludes that the reactivity effects of the MPB are very similar (within 1 mk) to those of the SCB over a wide range of perturbations at all burnups (zero to discharge burnup).

Clinical significance of serum amylase and glucose level in organophosphorus poisoning

Background: Organophosphorous (OP) poisoning is a common problem in country like Nepal where agriculture is the backbone of the economy. The primary mechanism of action is inhibition of acetylcholinesterase (ACHE). Organophosphorus poisoning is a possible cause of acute pancreatitis along with alternation of glucose metabolism.&#x0D; Materials and Method: This was a hospital based cross-sectional comparative study. The level of serum amylase and glucose were measured in thirty-eight OP poisoned patients at the time of admission, before discharge and were compared.&#x0D; Results: Amongst 38 patients, Majority had mild OP poisoning 27(71.1%) as per Peradeniya Organophosphorus Poisoning (POP) score whereas 9(23.7%) had moderate and 2(5.2%) had severe poisoning. The mean initial serum amylase level in patients with mild poisoning was 152±73.92 (IU/L)(p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22(IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (Mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (Mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (Mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis.&#x0D; Conclusion: Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.

A new ecotoxicity tolerance index of macrobenthos associated with Zoanthus sansibaricus in the littoral zone of Hormuz Island, Persian Gulf, Iran.

Palytoxin (PTX), one of the most potent marine natural products, which has been produced in zoanthids, also occurred in various other marine macrobenthos living in close association with zoanthid colonies, e.g. molluscs, accumulate high toxin concentrations in their organs, where PTX is stored in its active form. In littoral of Hormuz Island, among identified zoanthids, the highest number of toxic colonies per unit area is related to Zoanthus sansibaricus which can have a significant impact on assossiated macrobenthos with it. The purpose of this study was to collect more information on the toxicity of PTX in Z. sansibaricus and the consequences of exposure to PTX on associated macrobenthos with it using aqatic snails and the calculation of ecotoxicity tolerance index (ETI). Hence, zoanthid colonies were collected during reef walk at low tide in April 2016. Also, among assossiated gastropods, Planaxis sulcatus, were collected from the rock for experimental purpose as they are very abundant on and around Hormuz Island reef. In this model for each transect, 36 snails were divided into 4 set, each set had 3 replicates and working mucus solution, as PTX exist in the mucus of zoanthids, was injected in 2 different doses. Results showed that no snails were dead during the study period. However, calculation of Dara index (DI) was indicated that PTX accumulate in high toxin concentrations in snail’s foot and thus snail can be introduced as an indicator of ecotoxicity conditions. Results of ETI, also were shown moderate poisoning in all transects. Hence, tolerance of marine animals to the toxin may enable it to enter food chains and to be followed by potential exposure for humans. However, due to lack of data on PTX of zoanthids research for the entire Persian Gulf, further investigation is needed to clearly ascertain this matter.

Serum Paraoxonase 1 Activity in Patients with Organophosphate Poisoning: A Potential Indicator of Prognosis

Background: Human serum paraoxonase 1 (PON1) hydrolyzes organophosphate (OP) compounds and so significantly alters an individual’s susceptibility to the toxicity of these chemicals. The study was designed to assess the serum PON1 activity in a series of patients with OP poisoning. Methods: Suspected OP poisoning patients presented within 6 hours of consumption at emergency department were recruited. Demographic information of patients, clinical findings, treatments given, complications, length of hospital stay and clinical outcome were collected into datasheets. Patients were graded into moderate and severe poisoning. Serum PON1 was measured by ELISA method and serum cholinesterase by butyrylthiocholine method. Results: Mean serum PON1 level in patients with severe poisoning was significantly lower than those with moderate poisoning (426 ± 179 U/L vs. 868 ± 79 U/L, P < 0.001). Serum PON1 significantly correlated with serum cholinesterase levels (r = 0.400, P < 0.001) and negatively associated with total length of hospital stay (r = -0.338, P < 0.001), total atropine dose (r = -0.826, P < 0.001), serum amylase (r = -0.331, P < 0.001), lipase (r = 0.260, P = 0.011) and total creatinine kinase (r = -0.456, P < 0.001). Serum PON1 and cholinesterase levels were significantly lower in expired patients and those who required ventilation assistance as compared to recovered patients who did not require ventilation assistance. Conclusion: Lower PON1 activity was significantly associated with lower serum cholinesterase and poorer outcomes. PON1 activity may be considered as an indicator of prognosis in OP poisoning.

Clinical analysis of sequelae of acute trimethyltin oxide poisoning

Objective: Clinical analysis of sequelae of 16 patients with trimethyltin chloride (TMT) poisoning after 2 years. Methods: Sixteen patients with TMT poisoning from a waste recycling company in Ganzhou City in August 2016 were enrolled. They were investigated by questionnaires and assessed by various scales after two years. 6 cases of severe poisoning were examined by head MRI. The scale includes Hamilton Anxiety Scale (HAMA) , Depression Scale (HAMD) , Simple Mental State Examination Scale (MMSE) , Activity of Daily Living (ADL) , International Cooperative Ataxia Rating Scale (ICARS) . Results: 16 cases of TMT poisoning still have headache, dizziness and other symptoms. Instability of walking in 4 patients with severe poisoning, and the brain MRI manifestations included obvious atrophy of temporal lobe, hippocampus, insula lobe, cerebellum and ventricle enlargement. Two patients were rated as severe mixed anxiety and depression, one as moderate mixed anxiety and depression, and one as mild anxiety. 3 cases were diagnosed as dementia and 1 case as mild cognitive impairment. Two cases were totally dependent on living ability. ICARS scores were 66 points and 63 points respectively. Two cases were mildly dependent on living ability. ICARS scores were 28 points and 6 points respectively. There were 2 cases of mild mixed anxiety and depression in mild and moderate poisoning patients, and 1 case of mild cognitive impairment in each patient. They could live independently. ICARS scores were 0. Conclusion: After 2 years of TMT poisoning, some patients still have general clinical symptoms such as dizziness, headache and so on. There are also mental and intellectual symptoms such as anxiety, depression and cognitive impairment. Some of patients with severe poisoning presented with dementia and cerebellar ataxia, and even lost independent living ability.