The Role of Abdominal CT in the Assessment of the Effectiveness of Gastric Lavage after Pesticide Poisoning

Pesticide poisoning is one of the most common diseases in the emergency department, characterized by rapid changes in condition, a high misdiagnosis rate, and a poor prognosis. Measures for early removal of poisons are crucial, and gastric lavage is one of the important measures. Regarding the post-gastric lavage effect, abdominal CT scanning has an important application value in the assessment of the gastric lavage effect after pesticide poisoning.

Acute Pesticide Poisoning in Jiangsu Province, China, from 2006 to 2015

This study aimed to investigate the characteristics of pesticide poisoning in Jiangsu Province, China, and to provide a scientific basis for developing effective interventional measures and preventive strategies. From 2006 to 2015, a total of 35,308 cases of pesticide poisoning were reported in Jiangsu Province. Non‐occupational poisoning accounted for 73.79% of all poisoning cases. A comparison of the data collected before（2006） and after（2015） this study showed a decrease in non‐occupational pesticide poisoning. Pesticide poisoning showed an age central tendency of 30 to 44 years, area central tendency for northern Jiangsu, and seasonal central tendency of occupational pesticide poisoning in autumn. Pesticide poisoning remains a major health concern in China. Government agencies together with scientists should focus their efforts on the prevention of potential threats to vulnerable groups such as the elderly, women, and children.

The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning:A meta-analysis

Background:Penehyclidine hydrochloride(PHC)has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning(AOPP).The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP.Methods:We searched Scopus,Embase,Cochrane,PubMed,ProQuest,Ovid,Web of Science,China Science and Technology Journal Database(VIP),Duxiu,Chinese Biomedical literature(CBM),WanFang,and Chinese National Knowledge Infrastructure(CNKI),from inception to March 2022.After all qualified randomized controlled trials(RCTs)were included,we conducted quality evaluation,data extraction,and statistical analysis.Statistics using risk ratios(RR),weighted mean difference(WMD),and standard mean difference(SMD).Results:Our meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China.Compared with the atropine group,the PHC group showed decreased mortality rate(RR=0.20,95%confidence intervals[CI]:0.16–0.25,P<0.001),hospitalization time(WMD=-3.89,95%CI:-4.37 to-3.41,P<0.001),overall incidence rate of complications(RR=0.35,95%CI:0.28–0.43,P<0.001),overall incidence of adverse reactions(RR=0.19,95%CI:0.17–0.22,P<0.001),total symptom disappearance time(SMD=-2.13,95%CI:-2.35 to-1.90,P<0.001),time for cholinesterase activity to return to normal value 50–60%(SMD=-1.87,95%CI:-2.03 to-1.70,P<0.001),coma time(WMD=-5.57,95%CI:-7.20 to-3.95,P<0.001),and mechanical ventilation time(WMD=-2.16,95%CI:-2.79 to-1.53,P<0.001).Conclusion:PHC has several advantages over atropine as an anticholinergic drug in AOPP.

Role of hemoperfusion combined with hemodialysis in acute severe organophosphorus pesticide poisoning:a meta-analysis

Background:Acute severe organophosphorus pesticide poisoning is a common severe emergency in developing countries.Our meta-analysis aimed to clarify the efficacy of hemoperfusion combined with hemodialysis on acute severe organophosphorus pesticide poisoning.Methods:Several databases were searched.After formulating relevant inclusion and exclusion criteria,qualified studies were included,and the data were extracted.The outcome indicators were the success rate of rescue,the time of hospitalization,the incidence of com-plications,the time for the cholinesterase level to return to normal,the coma time,and the atropine dosage.The results were analyzed using risk ratios,weighted mean difference,standard mean difference,and 95%confidence interval.The Cochrane Collaboration tool was used to assess the risk of bias in all the included studies.In terms of statistical methods,we used RevMan software(version 5.3;The Nordic Cochrane Centre,The Cochrane Collaboration,Copenhagen,Denmark)and Stata(versions 14 and 16;StataCorp,College Station,TX,USA)for the data analysis.Results:We included 92 randomized controlled trials with 6899 participants.Compared with the conventional emergency treatment group(CET group),the hemoperfusion group(HP+CET group),and the hemodialysis group(HD+CET group),the use of hemoperfusion combined with hemodialysis based on CET(HP+HD+CET group)significantly increased the success rate of rescue and reduced hos-pitalization time,the incidence of complications,time for cholinesterase level to return to normal,coma time,and atropine dosage.Conclusion:Hemoperfusion combined with hemodialysis is effective in the treatment of acute severe organophosphorus pesticide poi-soning.In the future,more scientifically designed,large-scale,high-quality,multicenter randomized controlled trials are needed to validate this study further.

Serum amylase as a novel prognostic marker of organophosphorus poisoning:a retrospective study

Background:This study aims to explore the significance of serum amylase levels in patients with organophosphorus pesticide(OP)poisoning and to provide a new perspective for evaluating the severity and prognosis of OP poisoning.Methods:The clinical data of 67 patients with acute OP poisoning,who had been treated in the emergency department of the General Hospital of Ningxia Medical University between September 2020 and August 2022,were retrospectively analyzed.Using Spearman rank correlation,serum amylase levels during admission and severity of poisoning correlated with discharge outcomes.Based on serum amylase levels,receiver operating characteristic curves were plotted to predict the severity and mortality of patients who experience organophosphate poisoning.The optimal threshold serum amylase level at admission was determined based on the maximum Youden index.Results:Using Spearman rank correlation analysis,serum amylase levels at admission positively correlated with the severity of poisoning and discharge outcomes,but the degree of correlation was weak(r_(s):0.344;0.264;P<0.05).The patients’serum amylase levels at admission had receiver operating characteristic area under the curve values of 0.726 and 0.735 to predict the degree of severe poisoning and death,respectively.Based on the maximum Youden index,the optimal threshold of serum amylase were 97.8 and 194.1 U/L when the degree of poisoning was severe and the discharge outcome of patients was died.In comparison to patients with serum amylase levels≤194.1 U/L at admission,the OR values of death in patients with serum amylase levels>194.1 U/L at admission was 15.944(95%CI:1.825-139.274).Conclusion:Serum amylase levels in patients with organophosphate poisoning correlate with the degree of poisoning and discharge outcomes.Higher serum amylase level was a risk factor for organophosphorus poisoning death.

Veno-venous-extracorporeal membrane oxygenation treatment for severe capillary leakage syndrome: A case report

BACKGROUND Capillary leak syndrome(CLS)is characterized by the leakage of large amounts of fluid and plasma proteins into the interstitial space,resulting in hypoalbuminemia,hypovolemic shock,elevated blood concentration,systemic progressive edema,and multiple serosal cavity effusion.Clinical syndromes such as cavity effusion pose a grave threat to the life and health of the patient.CASE SUMMARY A 58-year-old female patient was admitted to the hospital after being in a coma for 6 h following accidental ingestion of a pesticide.She was treated with phencyclidine hydrochloride and pralidoxime iodide for detoxification,mechanical ventilation to maintain oxygen supply,continuous renal replacement therapy to maintain the internal environment,and hemoperfusion to promote the excretion of toxins.She also received a transfusion of red blood cells and massive fluid resuscitation.However,her blood pressure was not maintained.The patient was diagnosed with CLS due to pesticide poisoning.Oxygenation was difficult to maintain under full ventilator support;therefore,veno-venous-extracorporeal membrane oxygenation(VV-ECMO)treatment was given 13 h after admission.Her oxygenation level improved,but a large amount of ascites and pleural effusion soon became apparent.We continued drainage with an indwelling drainage tube,and the ECMO flow stabilized.The leakage gradually decreased,and ECMO was discontinued 3 d later.On the 6th day,the patient recovered from unconsciousness,but on gastroscopic evaluation,severe erosions were found in her entire stomach.With the family’s consent,treatment was stopped,and the patient was discharged from the hospital on the 7th day.CONCLUSION ECMO,liquid resuscitation and management,and improvement in plasma colloidal osmotic pressure,circulation,and tissue oxygen supply are crucial in treating CLS.