Chlorfenapyr poisoning:mechanisms,clinical presentations,and treatment strategies

BACKGROUND:Chlorfenapyr is used to kill insects that are resistant to organophosphorus insecticides.Chlorfenapyr poisoning has a high mortality rate and is difficult to treat.This article aims to review the mechanisms,clinical presentations,and treatment strategies for chlorfenapyr poisoning.DATA RESOURCES:We conducted a review of the literature using PubMed,Web of Science,and SpringerLink from their beginnings to the end of October 2023.The inclusion criteria were systematic reviews,clinical guidelines,retrospective studies,and case reports on chlorfenapyr poisoning that focused on its mechanisms,clinical presentations,and treatment strategies.The references in the included studies were also examined to identify additional sources.RESULTS:We included 57 studies in this review.Chlorfenapyr can be degraded into tralopyril,which is more toxic and reduces energy production by inhibiting the conversion of adenosine diphosphate to adenosine triphosphate.High fever and altered mental status are characteristic clinical presentations of chlorfenapyr poisoning.Once it occurs,respiratory failure occurs immediately,ultimately leading to cardiac arrest and death.Chlorfenapyr poisoning is diflcult to treat,and there is no specific antidote.CONCLUSION:Chlorfenapyr is a new pyrrole pesticide.Although it has been identified as a moderately toxic pesticide by the World Health Organization(WHO),the mortality rate of poisoned patients is extremely high.There is no specific antidote for chlorfenapyr poisoning.Therefore,based on the literature review,future efforts to explore rapid and effective detoxification methods,reconstitute intracellular oxidative phosphorylation couplings,identify early biomarkers of chlorfenapyr poisoning,and block the conversion of chlorfenapyr to tralopyril may be helpful for emergency physicians in the diagnosis and treatment of this disease.

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories:a retrospective and descriptive study from an institute of poisoning

BACKGROUND:In clinical practice,some patients might not be able or unwilling to provide a thorough history of medication and poison exposure.The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.METHODS:This was a retrospective and descriptive study from an institute of poisoning.Patient registration information and test reports spanning the period from April 1,2020 to March 31,2022,were obtained.Patients with uncertain exposure histories and who underwent toxicological analysis were included.Clinical manifestations and categories of toxics were analyzed.RESULTS:Among the 195 patients with positive toxicological analysis results,the main causes of uncertain exposure history was disturbance of consciousness(62.6%),unawareness(23.6%)and unwillingness or lack of cooperation(13.8%).The predominant clinical manifestations were disturbed consciousness(62.6%),followed by vomiting and nausea(14.4%)and liver function abnormalities(8.7%).A comparison of clinical manifestations between patients with positive and negative(n=99)toxicological analyses results revealed significantly different proportions of disturbances in consciousness(63%vs.21%),dizziness(1.5%vs.5.1%),multi-organ failure(1.5%vs.7.1%),and local pain(0 vs 4%).The main categories of substances involved were psychiatric medications(23.1%),sedatives(20.5%),insecticides(13.8%),and herbicides(12.8%).CONCLUSION:The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific,and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

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.

Laboratory evaluation of toxicity of selected insecticides against egg and larval stages of cotton pink bollworm, Pectinophora gossypiella (Saunders) (Lepidoptera: Gelechiidae)

Background The cryptic nature of pink bollworm Pectinophora gossypiella(Saunders)larvae enables its reduced vul-nerability to insecticidal control.Further,the development of resistance against Bacillus thuringiensis(Bt)toxins posed a serious threat to transgenic cotton cultivation.This necessitated determining the critical timing of spray applications on the control effectiveness.This study assessed the influence of egg age(freshly laid vs.three-day-old)and the loca-tion of larvae(directly exposed to the insecticide residues on the boll rind vs.burrowed inside the bolls)on insecticide control efficacy.Results The results revealed a significant decrease in the ovicidal activity of tested insecticides with an increase in the age of eggs from one day old to three days old(paired t-test,P<0.05).The larvae directly exposed to the insec-ticide residues on the boll rind were more susceptible(>80%mortality)than the larvae exposed after they had bur-rowed inside the bolls(<49%mortality).The inhibitory effects of tested insecticides on developmental biology were more pronounced in the experiment on pre-larval release insecticide treatment compared with insecticide treatment given post-larval release and entry inside the bolls.Conclusion Egg age influences the insecticide susceptibility,as does the larval location,directly exposed vs bur-rowed inside the bolls.Older eggs and the larvae that had burrowed inside the green bolls of cotton were relatively less susceptible to the insecticide treatments.The toxic effects of insecticides on egg and larval stages were primar-ily ephemeral.These findings are significant for devising a comprehensive strategy for pink bollworm management on a sustainable basis.

Evaluating the Efficacy of Latent Variables in Mitigating Data Poisoning Attacks in the Context of Bayesian Networks:An Empirical Study

Bayesian networks are a powerful class of graphical decision models used to represent causal relationships among variables.However,the reliability and integrity of learned Bayesian network models are highly dependent on the quality of incoming data streams.One of the primary challenges with Bayesian networks is their vulnerability to adversarial data poisoning attacks,wherein malicious data is injected into the training dataset to negatively influence the Bayesian network models and impair their performance.In this research paper,we propose an efficient framework for detecting data poisoning attacks against Bayesian network structure learning algorithms.Our framework utilizes latent variables to quantify the amount of belief between every two nodes in each causal model over time.We use our innovative methodology to tackle an important issue with data poisoning assaults in the context of Bayesian networks.With regard to four different forms of data poisoning attacks,we specifically aim to strengthen the security and dependability of Bayesian network structure learning techniques,such as the PC algorithm.By doing this,we explore the complexity of this area and offer workablemethods for identifying and reducing these sneaky dangers.Additionally,our research investigates one particular use case,the“Visit to Asia Network.”The practical consequences of using uncertainty as a way to spot cases of data poisoning are explored in this inquiry,which is of utmost relevance.Our results demonstrate the promising efficacy of latent variables in detecting and mitigating the threat of data poisoning attacks.Additionally,our proposed latent-based framework proves to be sensitive in detecting malicious data poisoning attacks in the context of stream data.

Treatment of a patient with aconitine poisoning using veno-arterial membrane oxygenation:A case report

BACKGROUND Aconitine poisoning is highly prone to causing malignant arrhythmias.The elimination of aconitine from the body takes a considerable amount of time,and during this period,patients are at a significant risk of death due to malignant arrhythmias associated with aconitine poisoning.CASE SUMMARY A 30-year-old male patient was admitted due to accidental ingestion of aconitinecontaining drugs.Upon arrival at the emergency department,the patient intermittently experienced malignant arrhythmias including ventricular tachycardia,ventricular fibrillation,ventricular premature beats,and cardiac arrest.Emergency interventions such as cardiopulmonary resuscitation and defibrillation were promptly administered.Additionally,veno-arterial extracorporeal membrane oxygenation(VA-ECMO)therapy was initiated.Successful resuscitation was achieved before ECMO placement,but upon initiation of ECMO,the patient experienced recurrent malignant arrhythmias.ECMO was utilized to maintain hemodynamics and respiration,while continuous blood purification therapy for toxin clearance,mechanical ventilation,and hypothermic brain protection therapy were concurrently administered.On the third day of VA-ECMO support,the patient’s respiratory and hemodynamic status stabilized,with only frequent ventricular premature beats observed on electrocardiographic monitoring,and echocardiography indicated recovery of cardiac contractile function.On the fourth day,a significant reduction in toxin levels was observed,along with stable hemodynamic and respiratory functions.Following a successful pump-controlled retrograde trial occlusion test,ECMO assistance was terminated.The patient gradually improved postoperatively and achieved recovery.He was discharged 11 days later.CONCLUSION VA-ECMO can serve as a bridging resuscitation technique for patients with reversible malignant arrhythmias.

Severe aconite poisoning successfully treated with veno-arterial extracorporeal membrane oxygenation:A case report

BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.

Paradoxical systemic toxicity by inhaled paraquat poisoning: A case report

Rationale:Multi-organ failure is a symptom of paraquat poisoning,resulting in high mortality and morbidity rates.Though paraquat is widely available,poisoning through inhalation is rare.Patient’s Concern:A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work.Diagnosis:Paraquat poisoning.Interventions:Supportive management along with multiple sessions of hemodialysis.Outcomes:Renal complications caused by paraquat were improved after multiple sessions of hemodialysis.However,the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy,he succumbed to his illness.Lessons:Acute kidney injury is a complication of paraquat poisoning.However,kidney involvement with the inhalational mode is rare.It is caused by reduction and oxidation cycles,as well as the formation of reactive oxygen species,necessitating hemodialysis as the treatment.Without a clear history,a specific clinical trait,or a diagnostic test,diagnosis can be difficult.Our case thus highlights the inhaled paraquat poisoning,presenting with acute kidney injury with late respiratory impairment as a consequence.

Multiorgan dysfunction syndrome due to high-dose cantharidin poisoning:A case report

BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with high-dose cantharidin poisoning and multiorgan dysfunction syndrome(MODS).Particular emphasis is placed on the comprehensive elucidation of the clinical manifestations of high-dose cantharidin poisoning,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A patient taking 10 g of cantharidin powder orally subsequently developed MODS.The patient was treated with supportive care,fluid hydration and antibiotics,and hemoperfusion and hemofiltration therapy for 24 h and successfully recovered 8 d after hospital admission.Cantharidin poisoning can cause lifethreatening MODS and is rare clinically.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of high-dose cantharidin poisoning resulting in MODS and reviewed the relevant literature to improve the clinical understanding of this rare condition.

Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning:A case report

BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Clinical Case Report of Acute Heart Injury and Acute Rhabdomyolysis Due to Cyanide Poisoning

Cyanide poisoning is one of the most dangerous poisonings, and it can be absorbed into the body through the mouth, inhalation and through the skin. A 32-year-old female patient was admitted to our poison control center because of high fever, severe vomiting, and seizures. Physical examination found that the patient was drowsy, had a high fever of 40 degrees Celsius, pulse of 140 beats/minute, and increased tendon and bone reflexes. Exploiting the patient’s information, it was discovered that the patient bought Cyanide to drink with the intention of committing suicide. The patient was quickly treated with gastric lavage and activated charcoal. Echocardiography recorded EF: 35%, reduced movement of the entire myocardium. CK blood test: 4562 U/L. The patient’s condition rapidly deteriorated and the patient was made ECMO, IHD and CVVHDF. After 3 days of treatment, the patient’s condition did not improve, so the family asked for the patient to go home. This article aims to describe the rapidly progressing and severe damage to the heart and muscles of patients with cyanide poisoning.

A Comparison of Hydrothermal Aging, SO2 and Propene Poisoning Effects on NH3-SCR over Cu-ZSM-5 and Cu-SAPO-34 Catalysts

This study was aimed to investigate the effects of hydrothermal aging, propene and SO2 poisoning on the ammonia-selective catalytic reduction (NH3-SCR) performance of both Cu-SAPO-34 and Cu-ZSM-5. The catalytic activities of fresh, aged and poisoned samples were tested in ammonia-selective catalytic reduction (NH3-SCR) of NOx conditions. The XRD, TG and N2-desorption results showed that the structures of the Cu-SAPO-34 and Cu-ZSM-5 remained intact after 750˚C hydrothermally aged, SO2 and propene poisoned. After hydrothermal aging at 750˚C for 12 h, the NO reduction performance of Cu-ZSM-5 was significantly reduced at lower temperatures, while that of Cu-SAPO-34 was less affected. Moreover, Cu-SAPO-34 catalyst showed high NO conversion with SO2 or propene compared to Cu-ZSM-5. However, Cu-ZSM-5 showed a larger drop in catalytic activity with SO2 or propene compared to Cu-SAPO-34 catalyst. The H2-TPR results showed that Cu2 ions could be reduced to Cu and Cu0 for Cu-ZSM-5, while no significant transformation of copper species was observed for Cu-SAPO-34. Meanwhile, the UV-vis DRS results showed that CuO species were formed in Cu-ZSM-5, while little changes were observed for the Cu-SAPO-34. Cu-SAPO-34 showed high sulfur and hydrocarbon poison resistance compared to Cu-ZSM-5. In summary, Cu-SAPO-34 with small-pore zeolite showed higher hydrothermal stability and better hydrocarbon and sulfur poison resistant than Cu-ZSM-5 with medium-pore.

基于符号执行的Tcache Poisoning堆漏洞自动验证方法研究

Tcache Poisoning是面向堆管理机制的一种堆漏洞利用方法,现有的堆漏洞自动验证工作未考虑Tcache带来的影响,无法适用于高版本Glibc堆漏洞自动验证。分析Tcache机制以及Tcache Poisoning验证方法的原理,提出一种基于符号执行的Tcache Poisoning堆漏洞自动验证方法。定义多元组对堆块的状态进行形式化描述,通过对关键API函数的挂钩,在程序运行过程中收集堆块的状态信息,并引入符号变元将外部输入数据符号化,实现关键信息的获取。通过状态监控检测堆漏洞触发,依据Tcache Poisoning堆漏洞自动验证模型,逐步生成Tcache Poisoning攻击约束和攻击载荷约束,最后通过约束求解生成漏洞验证代码。基于S2E符号执行平台实现自动验证系统TPAEG,并对10个测试程序进行测试,其中在Tcache Poisoning方法的7个测试程序中有5个生成了验证代码。实验结果表明,TPAEG可有效地检测堆溢出漏洞和释放后重用漏洞,并能够针对符合Tcache Poisoning攻击特征的场景实现自动验证,完成控制流的劫持并生成验证代码。

Influence of element substitutions on poisoning behavior of ZrV_(2)alloy:theoretical and experimental investigations

A ZrV_(2)alloy is typically susceptible to poisoning by impurity gases,which causes a considerable reduction in the hydrogen storage properties of the alloy.In this study,the adsorption characteristics of oxygen on ZrV_(2)surfaces doped with Hf,Ti,and Pd are investigated,and the effect of oxygen on the hydrogen storage performance of the alloy was discussed.Subsequently,the adsorption energy,bond-length change,density of states,and differential charge density of the alloy before and after doping are analyzed using the first-principles method.The theoretical results show that Ti doping has a limited effect on the adsorption of oxygen atoms on the ZrV_(2)surface,whereas Hf doping decreases the adsorption energy of oxygen on the ZrV_(2)surface.Oxygen atoms are more difficult to adsorb at most adsorption sites on Pd-substituting surfaces,which indicates that Pd has the best anti-poisoning properties,followed by Hf.The analysis of the differential charge density and partial density of states show that the electron interaction between the oxygen atom and surface atom of the alloys is weakened,and the total energy is reduced after Hf and Pd doping.Based on theoretical calculations,the hydrogen absorption kinetics of ZrV_(2),Zr_(0.9)Hf_(0.1)V_(2),and Zr(V_(0.9)Pd_(0.1))_(2) alloys are studied in a hydrogen-oxygen mixture of 0.5 vol%O_(2) at 25℃.The experimental results show that the hydrogen storage capacities of ZrV_(2),Zr_(0.9)Hf_(0.1)V_(2),and Zr(V_(0.9)Pd_(0.1))_(2) decrease to 19%,69%,and 80%of their original values,respectively.The order of alloy resistance to 0.5 vol%O_(2) poisoning is Zr(V_(0.9)Pd_(0.1))_(2)>Zr_(0.9)Hf_(0.1)V_(2)>ZrV_(2).Pd retains its original hydrogen absorption performance to a greater extent than undoped surfaces,and it has the strongest resistance to poisoning,which is consistent with previous theoretical calculations.

Antipoisoning catalysts for the selective oxygen reduction reaction at the interface between metal nanoparticles and the electrolyte

One of the primary challenges in relation to phosphoric acid fuel cells is catalyst poisoning by phosphate anions that occurs at the interface between metal nanoparticles and the electrolyte.The strong adsorption of phosphate anions on the catalyst surface limits the active sites for the oxygen reduction reaction(ORR),significantly deteriorating fuel cell performance.Here,antipoisoning catalysts consisting of Pt-based nanoparticles encapsulated in an ultrathin carbon shell that can be used as a molecular sieve layer are rationally designed.The pore structure of the carbon shells is systematically regulated at the atomic level by high-temperature gas treatment,allowing O_(2) molecules to selectively react on the active sites of the metal nanoparticles through the molecular sieves.Besides,the carbon shell,as a protective layer,effectively prevents metal dissolution from the catalyst during a long-term operation.Consequently,the defect-controlled carbon shell leads to outstanding ORR activity and durability of the hybrid catalyst even in phosphoric acid electrolytes.

Management of acute carbamazepine poisoning:A narrative review

Standard management protocols are lacking and specific antidotes are unavailable for acute carbamazepine(CBZ)poisoning.The objective of this review is to provide currently available information on acute CBZ poisoning,including its management,by describing and summarizing various therapeutic methods for its treatment according to previously published studies.Several treatment methods for CBZ poisoning will be briefly introduced,their advantages and disadvantages will be analyzed and compared,and suggestions for the clinical treatment of CBZ poisoning will be provided.A literature search was performed in various English and Chinese databases.In addition,the reference lists of identified articles were screened for additional relevant studies,including non-indexed reports.Nonpeer-reviewed sources were also included.In the present review,154 articles met the inclusion criteria including case reports,case series,descriptive cohorts,pharmacokinetic studies,and in vitro studies.Data on 67 patients,including 4 fatalities,were reviewed.Based on the summary of cases reported in the included articles,the cure rate of CBZ poisoning after symptomatic treatment was 82%and the efficiency of hemoperfusion was 58.2%.Based on the literature review,CBZ is moderately dialyzable and the recommendation for CBZ poisoning is supportive management and gastric lavage.In severe cases,extracorporeal treatment is recommended,with hemodialysis as the first choice.

Twelve family members with tetramine poisoning after consumption of vegetables grown in polluted soils

The main toxic component of tetramine is tetramethylenedisulfotetramine(TETS).It is a sulfonamide derivative without special antidote,tasteless and tasteless,with high toxicity and high mortality.[1]It was first discovered by a German scientist Hagen in 1949.Although its use has been banned worldwide due to its high toxicity and mortality rate,it is still available in certain countries and has led to cases of intentional and unintentional poisoning.Tetramine blocksγ-neurons,leading to dizziness,fatigue,nausea,vomiting,convulsions,and other symptoms.[2-4]Due to the lack of recognized effective antidotes,many poisoned people suff ocate and die as a result of continuous spasms of the respiratory muscles.[5-7]Tetramine poisoning sometimes occurs,but it is rare for vegetables grown in tetraminecontaminated soil to cause group poisoning after being eaten.

Biochemical indicators and the Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning:An observational prospective study

Objective:To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning.Methods:This was a hospital-based prospective,observational study.Various biochemical tests viz.complete blood count,random blood sugar,liver and renal function tests,creatine phosphokinase,and electrolytes were performed.Patients were assessed based on the Peradeniya Organophosphate Poisoning scale.All the patients were followed till the end point like recovery/death.Results:Out of the 100 patients,72%were males and 28%were females.The majority of the patients were farmers and 21 to 30 years of age.Suicidal was the most common manner(92,92%).Based on the Peradeniya Organophosphate Poisoning scale,47%were mild,34%moderate,and 19%severe.Serum creatinine,creatine phosphokinase,serum glutamic-oxaloacetic transaminase,serum glutamic pyruvic transaminase,and alkaline phosphatase levels showed a significant correlation with severity.Conclusions:Some biochemical indicators such as creatine phosphokinase,alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning.The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning.

Intracardiac Thrombosis Secondary to the Silent Killer: A Case Report about Monoxide Carbon Poisoning in a Child

Carbon monoxide (CO) poisoning is a frequent cause of emergency room admissions, especially during winter days, the symptoms are varied ranging from a simple headache to a serious cardiac and neurological impairment that can be deadly. Diagnosis is based on the circumstances of occurrence as well as the dosage of carboxyhemoglobin in the blood. Exposure to CO has serious consequences, neurological and cardiac manifestations are not negligible and vary from repolarization disorders to heart attack. Treatment is urgent with normobaric or hyperbaric oxygen therapy. We report a case of a 2-year male child admitted to the emergency room for CO intoxication with an intracardiac thrombus subsequently complicated by an ischemic stroke with a fatal outcome in order to highlight this complication rarely described in literature.

Unintentional Carbon Monoxide Poisoning Outbreak from 2 to 9 October 2019 in Ulaanbaatar, Mongolia

Carbon monoxide poisoning (COP) from 2 to 9 October 2019 was a major public health concern in Ulaanbaatar, Mongolia, after a transition from consumption of raw coal to upgraded briquette fuel. During the period, a total of 186 residents, which is 16 times more than the previous years, were exposed to COP and 6 persons died at home. We conduct a cross-sectional study by using registration data and medical history of all hospitalized patients with a diagnosis of COP from 2 to 9 October 2019 and had an in-depth interview. 144 (77.4%) people from 85 households registered as potential cases and 124 (86.1%) people were diagnosed with COP. All households used upgraded briquettes, and 41 households (48.2%) used them for the first time. In 50% of cases, the stove was broken, the chimney was short, not heated, and the clay joint connecting the wall stove was broken. The majority of interviewees were unaware of COP and improperly used briquettes, and the safety of chimneys and stoves was insufficient which caused unintentional COP. It is necessary to provide information to the local population about the potential risks of COP, install CO alarms in households, and educate the population. In further, a well-established poisoning surveillance system is an important aspect of public health emergency preparedness in Mongolia.