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.

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.

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.

Assessment of Acute Poisoning Cases in Emergency Department of the Provincial General Reference Hospital in Bukavu, DR-Congo

Background: Acute intoxications result from intentionally or accidentally taking a relatively significant amount of a chemical substance which triggers disturbances in the level of psychophysiological functions, the complications of which may lead to mental disorders, physical causalities, and death. Any acute intoxication mostly requires emergency care. Objective: To highlight the prevalence, history, clinical features, emergency treatment, and prediction of acute intoxication cases referred to the emergency services at the Provincial General Reference Hospital in Bukavu, DR-Congo. Methods: A retrospective cross-sectional study was conducted from January 2021 to October 2022 based on an analysis of patients’ medical files. Triage was performed among all-type of patient files recorded in the computerized hospital database Ebale-Sante to sort cases of intoxication. Results: During the observational period, 3966 emergency admissions were counted, of which 321 (8.09%) patients were identified as having acute intoxication. Among these, 100 files that containing sufficient information fit the quality criteria for this study’s analysis. The victims were infants, adolescents and adults aged 1 - 45 years, and 52% were female and 48% were male. Most cases were accidental and, occurred at home, and the victims were driven to the hospital within 2 - 24 hours. The substances consumed included household products, drugs, and herbs. Resuscitation care, antidotes and supportive symptomatic medications ensured that 85% were healed and 10% experienced sequelae;however, 5% died. Conclusion: Acute intoxication occurs in infants mostly accidentally though the ingestion of household products and medicines. Furthermore, suicide cases may occur in traumatized adolescents and discordant couples. People should be informed about how to store hazardous products (e.g.: drugs, household products and pesticides), which should not be available to children, to avoid unintentional poisoning. Special training in clinical toxicology is required to reduce treatment failure.

Role of penehyclidine in acute organophosphorus pesticide poisoning

BACKGROUND:Penehyclidine is a newly developed anticholinergic agent.We aimed to investigate the role of penehyclidine in acute organophosphorus pesticide poisoning(OP)patients.METHODS:We searched the Pubmed,Cochrane library,EMBASE,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical literature(CBM)and Wanfang databases.Randomized controlled trials(RCTs)recruiting acute OP patients were identifi ed for meta-analysis.Main outcomes included cure rate,mortality rate,time to atropinization,time to 60%normal acetylcholinesterase(AchE)level,rate of intermediate syndrome(IMS)and rate of adverse drug reactions(ADR).RESULTS:Sixteen RCTs involving 1,334 patients were identifi ed.Compared with the atropineor penehyclidine-alone groups,atropine combined with penehyclidine significantly increased the cure rate(penehyclidine+atropine vs.atropine,0.97 vs.0.86,RR 1.13,95%CI[1.07–1.19];penehyclidine+atropine vs.penehyclidine,0.93 vs.0.80,RR 1.08,95%CI[1.01–1.15])and reduced the mortality rate(penehyclidine+atropine vs.atropine,0.015 vs.0.11,RR 0.17,95%CI[0.06–0.49];penehyclidine+atropine vs.penehyclidine,0.13 vs.0.08,RR 0.23,95%CI[0.04–1.28]).Atropine combined with penehyclidine in OP patients also helped reduce the time to atropinization and AchE recovery,the rate of IMS and the rate of ADR.Compared with a single dose of atropine,a single dose of penehyclidine also signifi cantly elevated the cure rate,reduced times to atropinization,AchE recovery,and rate of IMS.CONCLUSION:Atropine combined with penehyclidine benefi ts OP patients by enhancing the cure rate,mortality rate,time to atropinization,AchE recovery,IMS rate,total ADR and duration of hospitalization.Penehyclidine combined with atropine is likely a better initial therapy for OP patients than atropine alone.

Oxidative Stress and Free Radical Damage in Patients With Acute Dipterex Poisoning

Objective To investigate whether acute dipterex poisoning (ADP) may cause oxidative stress and free radical damage in the bodies of acute dipterex poisoning patients (ADPPs), and to explore the mechanisms by which ADP may cause oxidative stress and free radical damage. Methods Fifty ADPPs and fifty healthy adult volunteers (HAVs) whose ages, gender and others were matched with the ADPPs were enrolled in a randomized controlled study, in which concentrations of nitric oxide (NO), vitamin C (VC), vitamin E (VE) and P-carotene (P-CAR) in plasma as well as concentration of lipoperoxide (LPO), and activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX) and acetylcholinesterase (AChE) in erythrocytes were determined by spectrophotometric analytical methods. Results Compared with the average values of experimental parameters in the HAVs group, the average values of plasma NO and erythrocyte LPO in the ADPPs group were significantly increased (P<0.0001), while those of plasma VC, VE and P-CAR as well as erythrocyte SOD, CAT, GPX and AChE in the ADPPs group were significantly decreased (P<0.0001). Bivariate correlation analysis and partial correlation analysis suggested that when NO and LPO values were increased, and VC, VE, β-CAR, SOD, CAT and GPX values were decreased in the ADPPs, AChE value was decreased gradually in the ADPPs (P<0.001-0.0001). Reliability analysis of experimental parameters reflecting oxidative stress and free radical damage in the ADPPs showed that the reliability coefficient (8 items) alpha=0.6909, and the standardized item alpha=0.8574. Conclusion The findings in the present study suggest that ADP can cause oxidative stress and free radical damage, and inhibit markedly erythrocyte acetylcholinesterase activity in ADPPs.

Ulinastatin suppresses endoplasmic reticulum stress and apoptosis in the hippocampus of rats with acute paraquat poisoning

Lung injury is the main manifestation of paraquat poisoning. Few studies have addressed brain damage after paraquat poisoning. Ulinastatin is a protease inhibitor that can effectively stabilize lysosomal membranes, prevent cell damage, and reduce the production of free radicals. This study assumed that ulinastatin would exert these effects on brain tissues that had been poisoned with paraquat. Rat models of paraquat poisoning were intraperitoneally injected with ulinastatin. Simultaneously, rats in the control group were administered normal saline. Hematoxylin-eosin staining showed that most hippocampal cells were contracted and nucleoli had disappeared in the paraquat group. Fewer cells in the hippocampus were concentrated and nucleoli had dis- appeared in the ulinastatin group. Western blot assay showed that expressions of GRP78 and cleaved-caspase-3 were significantly lower in the ulinastatin group than in the paraquat group. Immunohistochemical findings showed that CHOP immunoreactivity was significantly lower in the ulinastatin group than in the paraquat group. Terminal deoxynucleotidyl transferase-medi- ated dUTP nick end labeling staining showed that the number of apoptotic cells was reduced in the paraquat and ulinastatin groups. These data confirmed that endoplasmic reticular stress can be induced by acute paraqnat poisoning. Ulinastatin can effectively inhibit this stress as well as cell apoptosis, thereby exerting a neuroprotective effect.

Early Biomarkers in 1H Nuclear Magnetic Resonance Spectroscopy of Striatal Pathological Mechanisms after Acute Carbon Monoxide Poisoning in Rats

Objective In vivo Proton Magnetic Resonance Spectroscopy （1H-MRS） can be used to evaluate the levels of specific neurochemical biomarkers of pathological mechanisms in the brain. Methods We conducted T2-Weighted Magnetic Resonance Imaging （MRI） and 1H-MRS with a 3.0-Tesla animal MRI system to investigate the early microstructural and metabolic profiles in vivo in the striatum of rats following carbon monoxide （CO） poisoning. Results Compared to baseline, we found significant cortical surface deformation, cerebral edema changes, which were indicated by the unclear gray/white matter border, and lateral ventricular volume changes in the brain. A significant reduction in the metabolite to total creatine （Cr） ratios of N-acetylaspartate （NAA） was observed as early as 1 h after the last CO administration, while the lactate （Lac） levels increased marginally. Both the Lac/Cr and NAA/Cr ratios leveled off at 6 h and showed no subsequent significant changes. In addition, compared to the control, the choline （Cho）/Cr ratio was slightly reduced in the early stages and significantly increased after 6 h. In addition, a pathological examination revealed mild cerebral edema on cessation of the insult and more severe cerebral injury after additional CO poisoning. Conclusion The present study demonstrated that 1H-MRS of the brain identified early metabolic changes after CO poisoning. Notably, the relationship between the increased Cho/Cr ratio in the striatum and delayed neuropsychologic sequelae requires further research.

Clinical correlates of hypotension in patients with acute organophosphorus poisoning

BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort study,we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals.Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension.We also evaluated the association between clinical parameters(including hypotension)and in-hospital mortality.RESULTS:The incidence of hypotension in AOPP patients was 16.4%.Hypotensive patients showed signifi cantly higher in-hospital mortality(1.1%vs.39.9%,P<0.001).Advanced age(odds ratio[OR]1.25,95%confi dence interval[CI]1.08–1.44),history of diabetes(OR 2.65,95%CI 1.14–5.96),and increased white blood cell count(OR 1.06,95%CI 1.03–1.09),plasma cholinesterase(OR 0.91,95%CI 0.84–0.94),plasma albumin(OR 0.88,95%CI 0.85–0.92),serum amylase(OR 1.01,95%CI 1.01–1.02),and blood pH(OR 0.64,95%CI 0.54–0.75)were signifi cantly associated with hypotension.After adjusting for potential confounders,hypotension was associated with increased in-hospital mortality(hazard ratio 8.77–37.06,depending on the controlled variables).CONCLUSIONS:Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality.Advanced age,history of diabetes,and changes in laboratory parameters were associated with hypotension in AOPP patients.

Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning

BACKGROUND There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication(APP).AIM To optimize a predictive scoring system for mortality in children with APP.METHODS A total of 113 children with APP from January 1,2010 to January 1,2020 were enrolled in this study.These patients were divided into survivors and nonsurvivors.We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors.The survival rates of patients with different values of the pediatric critical illness score(PCIS)were assessed using kaplan-meier survival analysis.The best scoring system was established by using the area under the receiver operating characteristic curve analysis.RESULTS The overall mortality rate was 23.4%.All non-survivors died within 20 days;48.1%(13/27)died within 3 days,and 70.3%(19/27)died within 7 days.Compared to survivors,the non-survivors were older,had higher white blood cell count,alanine aminotransferase(ALT),aspartate aminotransferase,serum creatinine,blood urea nitrogen,glucose,and pediatric early warning score,and had lower platelet count,albumin,Serum sodium(Na+)and PCIS.ALT and PCIS were the independent prognostic risk factors for children with APP.The survival rate of children classified as extremely critical patients(100%)was lower than that of children classified as critical(60%)or noncritical(6.7%)patients.The specificity of ALT was high(96.51%),but the sensitivity was low(59.26%).The sensitivity and specificity of ALT combined with PCIS were high,92.59%and 87.21%,respectively.The difference in mortality was significantly higher for ALT combined with PCIS(area under the receiver operating characteristic:0.937;95%CI:0.875-0.974;P<0.05).CONCLUSION In our study,ALT and PCIS were independent prognostic risk factors for children with APP.ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.

A cross-sectional study of children with acute poisoning:A three-year retrospective analysis

BACKGROUND： There is a lack of evidence on description of burden and cases of childhood poisoning in developing countries. This study aimed to assess the characteristics of children with acute poisoning, and factors for time of presentation to health facility and nature of poisoning.METHODS： A cross-sectional study was conducted at three major pediatric referral hospitals in Addis Ababa, Ethiopia. Description of demographics of children with acute poisoning and factors associated with time to presentation and nature of poisoning were analyzed. Data were entered to Epi info 3.5.3 and analyzed with SPSS version 20.RESULTS： Over three years, we retrieved records of a total of 128 children admitted for acute poisoning. The mean age of victims was 5.46 （SD, standard deviation=4.48） years. The majority （29.7%） were poisoned by prescribed drugs. Most poisoning incidents （73.5%） were unintentional in nature. The median time to health facility visit was 15.5 hours. Age less than 2 years was related to earlier presentation to health facility （P=0.010, OR=0.28, 95%CI=0.10–0.74）. Children with age more than 5 years was more likely to have intentional poisoning （χ2=25.06, P〈0.0001）. None of the victims was provided psychosocial evaluation and counseling.CONCLUSION： Most poisoning incidents are unintentional. Prescribed drugs are the commonest causes. Psychosocial counseling and care for the affected children is lacking. Family and community education should be given on prevention of poisoning. We recommend that caregivers take the required action in keeping prescribed drugs at home. Psychosocial support should be part of care and treatment of children with poisoning.

Trend of blood lactate level in acute aluminum phosphide poisoning

BACKGROUND: Aluminum phosphide(Al P) poisoning is common in the developing countries. There is no specifi c antidote for the treatment of acute Al P poisoning. Early diagnosis of poisoning and outcome predictors may facilitate treatment decisions. The objective of this study was to determine the trend of blood lactate level in acute Al P poisoning to evaluate its role as a prognostic factor.METHODS: This was a prospective study on acute Al P intoxicated patients during one year. Demographic data, clinical and laboratory data on admission, and outcome were recorded in a selfmade questionnaire. Blood lactate levels were analyzed every two hours for 24 hours.RESULTS: Thirty-nine(27 male, 12 female) patients were included in the study. The mortality rate was 38.5%. The mean blood pressure, pulse rate, blood p H and serum bicarbonate level were significantly different between the survivors and non-survivors groups. Blood lactate level was signifi cantly higher in the non-survivors group during 8 to 16 hours post ingestion.CONCLUSION: Blood lactate level could be used as an index of severity of acute Al P poisoning.

Brain injury due to acute organophosphate poisoning Magnetic resonance imaging manifestation and pathological characteristics

BACKGROUND： Acute organophosphate poisoning can cause injuries of multiple visceras; especially,central nervous system injury can increase risk factors of patients with severe acute organophosphate poisoning. An application of modem image may increase diagnostic rate of brain injury in an earlier period and provide evidences for clinical treatment.OBJECTIVE： To reveal imaging manifestations, pathological characteristics and multi-ways injured mechanism of brain injury due to acute organophosphate poisoning.DESIGN： Contrast observational study.SETTING： Department of Medical Image, the Second Hospital of Hebei Medical University.MATERIALS： The experiment was carried out in the Department of Nerve Molecule Imaging Medicine and Laboratory of Neurology, the Second Hospital of Hebei Medical University from August 2003 to February 2004. A total of 30 healthy cats weighing 2.8 - 3.5 g and of both genders were selected from Animal Experimental Center of Hebei Medical University.METHODS： Thirty healthy cats were randomly divided into control group （n =5） and intoxication group （n=25）. Cats in the control group were subcutaneously injected with 0.3 mL/kg saline at four points; while, cats in the intoxication group were subcutaneously injected with 400 g/L 0.3 mL/kg O,O-dimethyl-S-（methoxycarbonylmethyl） thiophosphate at four points. Two minutes after intoxication, cats received muscular injection with 0.5 mg/kg atropine sulfate, and then, brain tissues were collected from parietal lobe, basal ganglia, hippocampus, cerebellum and brain stem were observed at 3, 6, 24 hours, 3 and 7 days after intoxication respectively under optic microscope and electron microscope and expressions of acetylcholinesterase （AChE）, choline acetyltransferase （ChAT）, glial fibrillary acidic protein （GFAP）,glutamic acid （Glu） and γ-amino butyric acid after immunohistochemical staining.MAIN OUTCOME MEASURES： Results of MRI examinations; histological changes under optic microscope and electron microscope; expressions of AChE, ChAT, GFAP, Glu and γ -amino butyric acid after immunohistochemical staining.MAIN OUTCOME MEASURES： Results of MRI examinations; histological changes under optic microscope and electron microscope; expressions of AChE, ChAT, GFAP, Glu and γ -amino butyric acid after immunohistochemical staining.RESULTS： All 30 healthy cats were involved in the final analysis. ① Imaging and pathological observation： Image manifestations of brain injury induced by acute organophosphate poisoning showed as cerebral edema and symmetry signal abnormality of bilateral basal ganglia; while, pathological manifestations also showed as cerebral edema. ② Observation of immunohistochemical staining： As compared with the control group, after organophosphate poisoning, area of AChE immune-positive cells was decreased obviously （P〈0.01）, but area of ChAT immune-positive cells was not changed （P〉0.05）; in addition, positive cells of GFAP were increased remarkably （P〈0.01）, positive cells of γ -amino butyric acid in cerebral cortex were increased obviously （P〈0.05）, but numbers of positive cells of Glu were not changed （P〈0.05）.CONCLUSION： Multi-ways injured mechanism invovled in acute organophosphate poisoning. An application of modern image can increase diagnostic rate of brain injury in an earlier period and provide evidences for clinical treatment.

Analysis of Nine Cases of Acute Thallium Poisoning

In this study nine cases of thallium poisoning in a series of homicidal poisoning were analyzed in order to provide more information concerning thallium poisoning. It was found that the most common clinical feature of thallium poisoning was peripheral neuropathy and paraesthesia was more common than amyasthenia. Understanding of these clinical characteristics of thallium poisoning was helpful to early identification and differential diagnosis. Since the early administration of Prussian Blue, as a specific antidote for thallium poisoning, can substantially improve the prognosis, it is of great importance to establish a correct and early diagnosis.

Early diagnosis, treatment, and outcomes of five patients with acute thallium poisoning

BACKGROUND Thallium poisoning is rare and difficult to recognize.Early diagnosis and treatment of thallium-poisoned patients are essential to prevent morbidity and mortality.AIM To evaluate the efficacy of treatments and outcomes of five patients with early diagnosis of acute thallium poisoning.METHODS Five patients who consumed a thallium-contaminated meal were hospitalized in succession,and underwent clinical examinations such as blood tests and electromyography tests.Urine and blood tests confirmed the diagnosis of thallotoxicosis,revealing the occurrence of food poisoning.All patients underwent detoxification treatment,including hemoperfusion(HP)and treatment with Prussian blue(PB).A 24-mo follow-up was performed to evaluate the long-term outcomes on the patients after discharge.RESULTS Initially,the patients presented with symptoms of acute thallium poisoning including hyperalgesia of the limbs and abdominalgia,which may differ from common peripheral neuropathy.Accompanying symptoms such as hepatic damage and alopecia were observed in all the patients,which further confirmed the diagnosis of poisoning.Treatment with chelating agents was ineffective,while HP and treatment with PB drastically decreased the thallium concentration in the urine and blood.With early diagnosis and intervention,four patients had a good prognosis and no permanent sequelae.One patient developed blindness and disability during the 24-mo follow-up period.CONCLUSION Identification of incident cluster and characteristic symptoms is extremely important for early diagnosis of acute thallium poisoning.HP plus PB is essential to improve the prognosis of thallium-poisoned patients.

Pattern of acute poisoning in Jimma University Specialized Hospital,South West Ethiopia

BACKGROUND:Poisoning is a common cause of morbidity and mortality worldwide.People can be exposed to poisons either intentionally or accidentally.Designing appropriate treatment or prevention approaches depends on understanding of the nature and pattern of poisoning in a specific place.Information on the patterns of acute poisoning in Ethiopian hospitals is limited.This study was,therefore,conducted to evaluate the patterns of acute poisoning in Jimma University Specialized Hospital(JUSH),South West Ethiopia.METHODS:A record based retrospective analysis of acute poisoning cases presented to JUSH from January 1,2012 to December 31,2013 was conducted.The collected data was analyzed using SPSS version 16.RESULTS:Of the 103 patients,49(47.6%) were male and 54(52.4%) were female.The highest prevalence of poisoning was observed in persons aged 12-20 years(70,67.96%).Majority of the cases were intentional poisoning(52,50.5%),and 28(27.2%) of the cases were accidental.The common causes of poisoning were house hold cleansing agents(43,41.7%),organophosphates(28,27.2%) and drugs(13,12.6%).Diarrhea and vomiting(49.5%),altered consciousness(16.5%) and epigastric pain(13.6%) were the common presenting symptoms.CONCLUSION:Majority of the victims of the acute poisoning in this study were aged 12-20 years.The most common mode of poisoning was intentional poisoning resulting from temporary quarrel.The common poisons used by the victims were found to be household cleansing agents.

Effects of Changtuoning and Xuebijing combined with hemoperfusion on serum inflammatory factors and myocardial enzymes in patients with acute severe organophosphorus poisoning

Objective:To investigate the effects of Changtuogning and Xuebijing combined with hemoperfusion on serum inflammatory factors and myocardial enzymes in patients with acute severe organophosphorus pesticide poisoning (AOPP).Methods: A total of 92 patients with acute severe AOPP who were admitted to our hospital from July 2015 to June 2018 were enrolled. All patients were divided into the observation group and the control group by randomized block method (n=46). The control group was treated with Changtuoning and Xuebijing, and the observation group was treated with Changtuoning and Xuebijing combined with blood perfusion. The clinical indexes, serum inflammatory factors, myocardial enzyme indexes, complications and adverse reactions were compared between the two groups.Results:The doses of atropine, recovery waking time, ChE recovery time and hospital stay in the observation group were significantly lower than those in the control group. The cure rate in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference between the two groups (P>0.05). The levels of TNF-α, IL-8 and IL-18 in the observation group were significantly lower than those in the control group (P<0.05). The levels of CK, CK-MB, LDH and AST in the observation group were significantly lower than those in the control group (P<0.05). The incidence of complications (intermediate syndrome, respiratory failure, pulmonary infection, pulmonary edema) in the observation group was significantly lower than that in the control group (P<0.05). The incidence of adverse reactions (myalgia, fatigue, digestive tract reaction, abnormal liver function) in the observation group was significantly lower than that in the control group (P<0.05).Conclusion:Changtuoning and Xuebijing combined with hemoperfusion have significant effects on patients with acute severe organophosphorus poisoning, which can effectively reduce inflammatory factors and improve myocardial enzyme index.

Brainstem auditory evoked potentials in patients with delayed encephalopathy after acute carbon monoxide poisoning

Objective:To evaluate the changes of brainstem auditory evoked potential (BAEP) in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods: BAEPs were performed in 32 controls and 40 patients. Wave Ⅰ , Ⅱ , Ⅲ ,Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies were measured, respectively. Results: Abnormalities of BAEPs in 13 patients (13/40, 32 ％). Among the13 abnormal BAEPs, 3 displayed prolongation of latency to waves in one side, no potential in another side; 5 displayed a similar abnormality which was bilateral prolongation of latency to waves ;and another 5 displayed unilateral latency delay. Compared wave Ⅰ , Ⅱ , Ⅲ , Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies in the patients and the controls, there were no significant differences (P＞0.05). Conclusion: BAEPs can be used for evaluating the diagnostic and prognostic values in the cases of delayed encephalopathy after acute carbon monoxide poisoning.

Nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties: Study at Kenyatta National Hospital, Kenya

The purpose of this study was to determine nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta National Hospital (KNH). The study was cross sectional. Both qualitative and quantitative methods of data collection were employed. The target population were all nurses working at AED, KNH. Purposive sampling was used to select study subjects. Sample size included all Accident and Emergency (A&E) nurses who met subject’s inclusion criteria. Structured questionnaires, observation checklist and interview were used to collect the data. Sixty eight (82%) of A&E nurses participated in this study. The study found out that with higher nursing qualification and training on courses related to emergency care, knowledge and skills of A&E nurses on the initial management of acute poisoning is enhanced. A&E nurses with lower education level had a higher mean score of positive attitude compared with nurses with higher nursing qualification. Majority 60 (88.2%) of the A&E nurses indicated that, they required more training on the initial management of acute poisoning. Study recommends that A&E nurses should be trained on various types of poisoning including;assessment, clinical presentations and management to include gut decontaminations. In addition, refresher courses should be organised for those already trained. Flowcharts that will enhance easy identification and management of poisoned casualties should be put in place and utilized accordingly.