The impact of several chemical poisons on the absorbing 45Caby the Arca granosa

-The impact of several chemical poisons on the Arca granosa absorbing 45Ca was studied. The results showed that the absorption of 45Ca in the blood and the soft tissue by Arca granosa was inhibited by the inorganic compounds of Cu, Zn, Pd, Cd, Hg and so on, among which the inhibition of Cd was the strongest, next was that of Cu and Hg. But the inhibition of the absorption of 45Ca in the shell of Arca granosa was little. The impact of three kinds of energy metabolism inhibitory substances on the absorption of 45Ca by the Area granosa showed that the absorption was an active transfer process.

nsect poisons in museums

Since natural history museums existed, there have been problems concerning how to protect the collections from damages caused by insects. In 1740s＇, French Chemist Becoeur started to use arsenic-soap to protect his taxidermy specimens against insects. But in the years of 1770s＇, it was discovered the terrible strong arsenic poison which was dangerous to human beings. Finally taxidermy specimens leave the use of ar- senic and borax to history and use Eulan in their place.

The Conidae Family (Snails Producers of Poisons) Associated with the Rocky Intertidal Zone of Acapulco, Mexico

Acapulco, Mexico has a coastline of 62 km where large areas of rocky substrate inhabited by organisms such as the GASTROPODA Class can be found. Conidae (Fleming, 1822) Family is among the members of this Class, which has been poorly studied in the Mexican Pacific, despite their biomedical potential. This research was carried out in the rocky intertidal of nine sites in Acapulco. The objectives were: 1) Prepare an inventory of species associated with rocky intertidal of Conidae family, 2) examine the composition of the family based on two criteria: a) species richness and b) abundance, 3) determine the geographical distribution and 4) analyze the size composition. The unit sampled was 1 m2 and the sampled area was 10 m2 persite. A total of 97 organisms were analyzed, corresponding to two subfamilies, five genera and five species. The Puncticuliinae (Tucker & Tenorio, 2009) subfamily had higher species richness, abundance and frequency of occurrence. The most abundant and most common species were Harmoniconus nux (Broderip, 1833) and Gladioconus gladiator (Broderip, 1833) both showed regular distribution. The size structure found for Conidae family is similar to what has been reported in other research. For the first time G. gladiator is being reported for the state of Guerrero.

A Transcriptome Analysis of Neural Tissue of Litopenaeus vannamei After Acute Exposure to Alexandrium pacificum

Alexandrium pacificum(A.pacificum)is a typical paralytic shellfish poisonous dinoflagellate.Harmful algal blooms(HABs)caused by this species can bring serious environmental problems and economic losses to the aquaculture industry.In this study,transcriptome sequencing and analyses were performed on the neural tissue of Litopenaeus vannamei(L.vannamei)after acute exposure to A.pacificum disrupted solution for 72 h,and differentially expressed genes(DEGs)were identified.The results showed that,compared with the control samples,300 DEGs were identified in the experimental group,of which 194 were up-regulated,and 106 down-regulated.The gene ontology(GO)functional enrichment analysis showed that DEGs were significantly enriched in the cortical cytoskeleton organization,troponin complex,amylo-alpha-1,6-glucosidase and thymidine phosphorylase.Kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis found that DEGs were mainly enriched in the oxidative phosphorylation process,intercellular tight junctions and mitophagy.The results showed that the proteoglycans,signaling pathways,and various metabolic processes that regulate cell proliferation,differentiation,and apoptosis all played an essential role in the response of L.vannamei to A.pacificum toxins.

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.

Privacy-Preserving Large-Scale AI Models for Intelligent Railway Transportation Systems:Hierarchical Poisoning Attacks and Defenses in Federated Learning

The development of Intelligent Railway Transportation Systems necessitates incorporating privacy-preserving mechanisms into AI models to protect sensitive information and enhance system efficiency.Federated learning offers a promising solution by allowing multiple clients to train models collaboratively without sharing private data.However,despite its privacy benefits,federated learning systems are vulnerable to poisoning attacks,where adversaries alter local model parameters on compromised clients and send malicious updates to the server,potentially compromising the global model’s accuracy.In this study,we introduce PMM(Perturbation coefficient Multiplied by Maximum value),a new poisoning attack method that perturbs model updates layer by layer,demonstrating the threat of poisoning attacks faced by federated learning.Extensive experiments across three distinct datasets have demonstrated PMM’s ability to significantly reduce the global model’s accuracy.Additionally,we propose an effective defense method,namely CLBL(Cluster Layer By Layer).Experiment results on three datasets have confirmed CLBL’s effectiveness.

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.

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.

Data complexity-based batch sanitization method against poison in distributed learning

The security of Federated Learning(FL)/Distributed Machine Learning(DML)is gravely threatened by data poisoning attacks,which destroy the usability of the model by contaminating training samples,so such attacks are called causative availability indiscriminate attacks.Facing the problem that existing data sanitization methods are hard to apply to real-time applications due to their tedious process and heavy computations,we propose a new supervised batch detection method for poison,which can fleetly sanitize the training dataset before the local model training.We design a training dataset generation method that helps to enhance accuracy and uses data complexity features to train a detection model,which will be used in an efficient batch hierarchical detection process.Our model stockpiles knowledge about poison,which can be expanded by retraining to adapt to new attacks.Being neither attack-specific nor scenario-specific,our method is applicable to FL/DML or other online or offline scenarios.

Severe liver injury and clinical characteristics of occupational exposure to 2-amino-5-chloro-N,3-dimethylbenzamide: A case series

Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals.However,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in humans.This study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.Methods:This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July 2022.The entire course of the incidents was described in detail.Blood 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass spectrometer.Hema-toxylin and eosin staining was performed to assess liver injury,and immunofluorescence was used to evaluate hepatic mitophagy.Results:The 2-amino-5-chloro-N,3-dimethylbenzamide powder(99%purity)entered the human body mainly via the skin and respiratory tract due to poor personal protective measures.The typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency,rash,fever,organic dam-age,and recovery phases in accordance with the clinical evolution.Rash and fever may be the important premonitory symptoms for further organ injuries.The chemical was detected in the blood of all patients and caused multiple organ injuries,predominantly liver injury,including kidney,myocardium,and micro-circulation.Three patients recovered smoothly after comprehensive treatments,including artificial liver therapy,continuous renal replacement therapy,glucocorticoids,and other symptomatic and supportive treatments.One patient survived by liver transplantation.The postoperative pathological findings of the removed liver showed acute liver failure,and immunofluorescence staining confirmed the abundance of mitophagy in residual hepatocytes.Conclusions:This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.The chemical enters the body through the respiratory tract and skin during industrial production.The 2-amino-5-chloro-N,3-dimethylbenzamide poisoning causes multiple-organ dysfunction with a predominance of liver injury.Liver transplantation may be an effective option for patients with severe liver failure.The mechanisms of liver injury induced by 2-amino-5-chloro-N,3-dimethylbenzamide might involve abnormal mitochondrial function and mitophagy.

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.

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.

Vascular endothelium,a promising target for effectively treating fulminant diquat intoxication?

Following the withdrawal of paraquat,diquat(DQ)has emerged as the predominant herbicide.When people come into contact with or ingest DQ,may lead to poisoning and potentially fatal outcomes.Reports suggest that the mortality of DQ poisoning can be as high as 50%.DQ poisoning can be categorized as mild,moderate to severe or fulminant.In cases of fulminant poisoning,victims often succumb to multiple organ failure within 48 h.This presents a significant challenge in the clinical management.Scholars have discovered that oxidative stress,inflammatory injury,and cell apoptosis play crucial roles in the DQ poisoning.However,the underlying connection of the extensive organ damage remains unknown.The abnormal function and activity of endothelial cells(EC)should play a crucial role in tissue damage caused by DQ due to rich microcirculation and high sensitivity to perfusion in the vulnerable organs.However,reports on DQ-induced EC injury is rare.We made a preliminary discovery-the presence of severe vascular endothelial damage in the kidneys and lungs affected by DQ.Therefore,we hypothesize that DQ poisoning may be attributed to EC damage,ultimately resulting in multiple organ failure.

Poisonous Plants of the Karakalpak Part of the Ustyurt Plateau (Uzbekistan)

The article presents the composition and current state of poisonous plants distributed on the Ustyurt plateau. Ustyurt is one of the largest deserts in Central Asia, differing from other deserts of the world in geographical location, relief, flora and fauna and other features. The territory of Ustyurt occupies 21.3 million hectares, of which the Karakalpak part accounts for 7.2 million hectares. Poisonous alkaloid-bearing plants of the Karakalpak part of the Ustyurt plateau Anabasis aphylla, Atriplex flabellum, Kalidium capsicum, Salsola arbusculaeformis, Salsola foliosa, Aellenia subaphylla, Anabasis brachiata, Rheum tataricum, Capparis spinosa, Glycyrrhiza aspera. Alkaloid-bearing plants that are not eaten or poorly eaten by cattle Ephedra distachya, Delphinium songaricum, Anabasis salsa, alkaloid-bearing plants eaten by animals without harm Carex physodes, Eremopyrum orientale, Agrophyllum repens, Astragalus amodendron, Astragalus villosissimus, species of the genera Calligonum, Salsola. Poisonous plants of the Karakalpak part of the Ustyurt plateau. An analysis of the pasture flora of the Karakalpak part of the Ustyurt plateau shows that 62 species of wild poisonous plants belonging to 49 genera and 19 families grow here. Although these plants are considered poisonous, but in modern pharmaceutics and medicine, they are used as medicinal.

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.

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.

Death from caustic ingestion:A case report

Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system derangements.Patient’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning solution.Diagnosis:Poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and atropine.The patient then underwent urgent hemodialysis.Outcomes:The patient suffered gastrointestinal bleeding as a result of local caustic injury.In addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually demised.Lessons:The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion.These patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.

以鼻出血为首发症状的溴鼠隆中毒1例

1临床资料患者,男,52岁,因“左侧鼻腔反复出血5 d”于2021-02-25来安徽省阜阳市人民医院就诊。患者5d前无明显诱因出现左侧鼻腔出血,无恶心呕吐,无咳嗽咳血,无头晕头痛,在当地县医院给予左侧鼻腔填塞后出血症状好转。3 d前患者拔除左侧鼻腔填塞物后再次出血。

Spectrum of delayed post-hypoxic leukoencephalopathy syndrome:A systematic review

BACKGROUND Delayed post hypoxic leukoencephalopathy syndrome(DPHLS),also known as Grinker’s myelinopathy,is a rare but significant neurological condition that manifests days to weeks after a hypoxic event.Characterized by delayed onset of neurological and cognitive deficits,DPHLS presents substantial diagnostic and therapeutic challenges.AIM To consolidate current knowledge on pathophysiology,clinical features,diagnostic approaches,and management strategies for DPHLS,providing a comprehensive overview and highlighting gaps for future research.METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines,we systematically searched PubMed,ScienceDirect and Hinari databases using terms related to delayed post-hypoxic leukoencephalopathy.Inclusion criteria were original research articles,case reports,and case series involving human subjects with detailed clinical,neuroimaging,or pathological data on DPHLS.Data were extracted on study characteristics,participant demographics,clinical features,neuroimaging findings,pathological findings,treatment,and outcomes.The quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist.RESULTS A total of 73 cases were reviewed.Common comorbidities included schizoaffective disorder,bipolar disorder,hypertension,and substance use disorder.The primary causes of hypoxia were benzodiazepine overdose,opioid overdose,polysubstance overdose,and carbon monoxide(CO)poisoning.Symptoms frequently include decreased level of consciousness,psychomotor agitation,cognitive decline,parkinsonism,and encephalopathy.Neuroimaging commonly revealed diffuse T2 hyperintensities in cerebral white matter,sometimes involving the basal ganglia and the globus pallidus.Magnetic resonance spectroscopy often showed decreased N-acetylaspartate,elevated choline,choline-to-creatinine ratio,and normal or elevated lactate.Treatment is often supportive,including amantadine,an antioxidant cocktail,and steroids.Hyperbaric oxygen therapy may be beneficial in those with CO poisoning.Parkinsonism was often treated with levodopa.Most of the patients had substantial recovery over the course of months and many cases had some residual neurocognitive deficits.CONCLUSION DPHLS remains a complex and multifaceted condition with various etiologies and clinical manifestations.Early recognition and appropriate management are crucial to improving patient outcomes.Future research should focus on standardizing diagnostic criteria,using advanced imaging techniques,and exploring therapeutic interventions to improve understanding and treatment of DPHLS.Conducting prospective cohort studies and developing biomarkers for early diagnosis and monitoring will be essential to advance patient care.