Gastrointestinal decontamination using oil-based solutions in patients with acute aluminum phosphide poisoning: a systematic review and meta-analysis

Critical Reviews in Toxicology, Год журнала: 2024, Номер 54(4), С. 235 - 251

Опубликована: Апрель 20, 2024

Some studies suggested that gastrointestinal (GIT) decontamination with oil may improve the prognosis of patients who ingested aluminum phosphide (AlP). The aim this study is to compare efficacy and safety gastric lavage oil-based solutions any method not using oils in presenting acute AlP poisoning. literature was searched for English-published randomized controlled trials (RCTs) from inception 16 September 2023. electronic databases included MEDLINE/PubMed, Cochrane Library, Web Science, Egyptian Knowledge Bank, Scopus, Google Scholar. Data were extracted pooled by calculating risk ratio (RR) categorical outcomes standardized mean difference (SMD) numerical outcomes, 95% confidence intervals (CI). Seven RCTs included. Paraffin significantly associated a lower mortality (RR = 0.59 [95% CI: 0.45, 0.76], p < .001), intubation 0.46, .001) vasopressor need 0.71 0.56, 0.91], .006). Survival time prolonged paraffin (SMD 0.72 0.32, 1.13], .001). Coconut survival 0.83 0.06, 1.59], .03) as well decreased requiring 0.78 0.62, 0.99], .04). Oil-based GIT showed benefits over conventional regarding incidence in-hospital endotracheal intubation, time. some terms Decontamination recommended. Future clinical are warranted larger sample sizes focusing on cost-benefit safety.

Язык: Английский

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Development and validation of a nomogram for predicting mechanical ventilation need among acutely intoxicated patients with impaired consciousness

Human & Experimental Toxicology, Год журнала: 2024, Номер 43

Опубликована: Янв. 1, 2024

Background A considerable portion of acutely intoxicated patients is presented with impaired consciousness. Early identification those who require advanced medical care, such as mechanical ventilation (MV), can improve their prognosis. Methods This study included 330 were consciousness and admitted to Tanta University Poison Control Center, Egypt, in the period from January 2021 December 2023. Patients enrolled derivation (257 patients) validation (73 cohorts. Patients’ data analyzed develop validate a predictive nomogram determine probability MV need patients. Results Significant predictors for mean arterial blood pressure (OR = 0.96, p .014), PaO 2 .001), pH 0.00, < . 001), glucose/potassium ratio 1.59, .030). These four parameters used formulate bedside nomogram. Receiver-operating characteristic (ROC) analysis proposed shows that area under curve (AUC) 95.7%, accuracy 93.4%, sensitivity 88.9%, specificity 95.1%. The internal developed was assessed using bootstrapping method calibration curve. Regarding external validation, AUCs 96.5%, predicted 97.8%. Conclusion current provides validated could be reliable tool accurate prediction among It assist early will MV, especially low-income countries limited resources.

Язык: Английский

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Efficacy of Extracorporeal Membrane Oxygenation in Severe Aluminium Phosphide Poisoning Cases: A Real World Experience.

Research Square (Research Square), Год журнала: 2025, Номер unknown

Опубликована: Янв. 23, 2025

Purpose: Aluminium Phosphide poisoning is common among agriculture dominant economies especially southeast Asia. Mitochondrial toxicity caused by AlP leads to hemodynamic collapse without any antidote. Mortality high despite optimum supportive care. In anecdotal studies extra-corporeal membrane oxygenation (ECMO) has been shown reduce mortality. Methods:This was a retrospective single centre study of aluminium phosphide cases managed from 2019 2023. Data all who underwent treatment with ECMO retrieved and analyzed. Results: Of 182 admitted diagnosis 78 VA (veno-arterial) (mean age 34.4years). 60 (76.9%) had multi-organ dysfunction at the time presentation. 74 (94.9%) subjects ECG changes. initiated in emergency room 68 (87.2%) whereas 8 (10.3%) initiate during CPR. Most required concurrent renal replacement therapy initiation (53, 67.9%). Mean 1.48±1.2 hours arrival ER. duration 50.1±23.9 mean ICU length stay 7.17±5.6 days. Out cases- 53 survived 25 expired support. During hospital stay, 15 (19.2%) developed one or other related complications Lactate levels were significantly higher patients died (p=0.026). Conclusion: VA-ECMO found be associated significant survival benefit risk poisoning. Close monitoring blood gas parameters cardiac function variables vital for identifying potentially salvageable cases.

Язык: Английский

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Nomograms applicability in clinical toxicology – enhancing precision in clinical decision-making: a systematic review

Critical Reviews in Toxicology, Год журнала: 2025, Номер unknown, С. 1 - 19

Опубликована: Фев. 13, 2025

Nomograms represent powerful predictive tools that could be easily applied to guide managing acutely intoxicated patients. Thus, several nomograms were developed and validated in the last few decades predict various outcomes following acute poisoning. However, adopted remain sporadic efforts of researchers limited their usefulness clinical settings. We aimed bridge gap between theoretical formulation hands-on application benefit poisoned In this context, systematic review was conducted a reference for implementing these toxicology practice. This included 27 studies published over 60 years. A total 60,883 patients ranging 2 91 years enrolled. These elaborated 38 nomograms; 13 addressed poisoning general, 25 specially designed six poisons/categories, including pesticides (n = 9), psychotropic drugs 5), alcohol 4), analgesics, anti-inflammatory medications 3), carbon monoxide 2), digoxin 2). Despite first nomogram 1960, 81.5% emerged after 2016, with significant increase trend (p < .001). The Glasgow Coma Scale, patient age, poison concentration, bicarbonate level, blood pressure most frequently used predictors. eight outcomes, mortality 14, 36.8%), need intensive care unit (ICU) admission 9, 23.7%), complications 6, 15.8%), optimization therapy 4, 10.5%), severity 2, 5.3%). Also, mechanical ventilation (MV), diagnosis poisoning, suicidal predicted by one each them. nomograms' performances tested using receiver operating characteristic analysis area under curve 26 derived ranged 0.839 0.999. External validation on 16 only; 15 cohorts within same nomograms. only subjected external other studies. externally consist 10 particular and, un-specified poison-specific concerned methanol opioid 1), clozapine 1). Regarding general approach, two mortality. Nevertheless, four separate prediction complications, ICU admission, MV, established ensured performance reliability universal applicability Meanwhile, remaining 22 lacking promising research opportunities.

Язык: Английский

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Prognostic value of PGI score compared to Poison Severity Score and Simplified Acute Physiology Score-II as predictors of mortality and other adverse outcomes in acute poisoning with aluminum phosphide

Toxicology Reports, Год журнала: 2024, Номер 13, С. 101718 - 101718

Опубликована: Авг. 26, 2024

Aluminum phosphide (AlP) poisoning is a life-threatening emergency prevalent in the Middle East region including Egypt. Early prediction of prognosis critical for initiating utmost intensive interventions. Though many scoring systems were studied predicting AlP poisoning, these scores received wide criticism. Complexity and reliability main concerns. Therefore, this retrospective cross-sectional study aimed to evaluate performance recently introduced PGI score as predictor case fatality, need mechanical ventilation vasopressor therapy acute poisoning. Moreover, it compares with known poison severity (PSS), simplified physiology (SAPS) II. Among 144 exposed patients, we reported mortality rate 61.1%. Non-survivors exhibited significantly higher PGI, PSS, SAPS II than survivors. proved their significance predictors and, MV vasopressors, showed area under curve (AUC) (AUC = 0.848) compared PSS 0.731) 0.749). Additively, 2 or more was significant 0.831, sensitivity 65.9%, specificity 89.3 %) (p < 0.001), while 1 another 0.881, 89.0% 79.4%). Given score's high AUCs across all outcomes, coupled its balanced specificity, could be simple, robust tool replacing mortality, clinical decision-making exposure. Adopting seems substantially useful managing notably resource-restricted countries.

Язык: Английский

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Development of a risk-prediction nomogram for in-hospital adverse cardiovascular events in acute cardiotoxic agents poisoning

Toxicology Reports, Год журнала: 2024, Номер 13, С. 101826 - 101826

Опубликована: Ноя. 20, 2024

Adverse cardiovascular events (ACVE) are serious sequelae of acute poisoning with cardiotoxic agents. They include shock, myocardial injury, ventricular dysrhythmias, and cardiac arrest. Early identification high-risk patients could improve their prognosis. Therefore, this study developed a risk-prediction nomogram to assess the risk ACVE in cardiotoxicities. This prospective cohort was conducted at Tanta University Poison Control Center, Tanta, Egypt, from April 2023 March 2024. It included 186 agent poisoning. occurred 36 % were significantly associated ICU admission mortality (

Язык: Английский

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Discovering the most impactful treatments for aluminum phosphide cardiotoxicity gleaned from systematic review of animal studies

Human & Experimental Toxicology, Год журнала: 2024, Номер 43

Опубликована: Янв. 1, 2024

Introduction Aluminum phosphide (AlP) is a chemical compound that can cause death in some countries. AlP inhibits the functioning of cytochrome C oxidase mitochondria cardiomyocytes, leading to toxicity. Oxidative stress and ROS production, as well inflammatory signaling, mediate mechanisms AlP-related toxicity poisoned patient. Unfortunately, there are no approved medicines available treat poisoning yet. To address this issue, researchers have explored various interventions reduce associated with tablets. Methods We systematically searched relevant databases for English articles published between 2013 2024. Results The evaluated treatments included correcting oxidative parameters, enhancing exogenous antioxidant capacity, modifying electrocardiographic abnormalities, improving heart contraction strength. Our evaluation indicated compounds like Triiodothyronine, Vasopressin milrinone, Iron sucrose, Acetyl-l-carnitine, Melatonin, Fresh red blood cell transfusion, Minocycline, Moringa oleifera extract, Dihydroxyacetone, Selegiline, Nanocurcumin, Levosimendan, Exenatide, Taurine, Cannabidiol Edaravone effective lessening AlP-induced cardiotoxicity. Conclusion Based on present study’s findings clinical studies, dihydroxyacetone, fresh infusion, Oil-based disinfection, gastric lavage most potential save patients’ lives acute aluminum phosphide. However, need more research regard.

Язык: Английский

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The effect of educational programs on parents’ knowledge, behavior, and practices regarding aluminum phosphide poisoning and its first-aid measures

BMC Pediatrics, Год журнала: 2024, Номер 24(1)

Опубликована: Дек. 31, 2024

Aluminum phosphide is an excellent insecticide available as a chalky white or brown tablet. traded in the Egyptian market tablets under brand name celphos. To date, no specific antidotes for aluminum poisoning have been identified. Management primarily supportive, to control toxic symptoms and prevent anticipated consequences. Therefore, educating parents about first aid management of utmost importance. This study aimed evaluate knowledge, behavior, practices concerning its first-aid measures. used quasi-experimental research design was conducted inpatient clinical toxicology department ward Menoufia University Hospital between June 2022 May 2023. Children (n = 98) who met inclusion criteria (aged 0 18 years experienced accidental suicidal poisoning) were recruited from ward, intensive care unit emergency department, critical Hospital. Four questionnaires collect data this study: (1) sociodemographics, data, physical examination, laboratory investigations; (2) knowledge parents; (3) practice (4) behavior response scales. analyzed 98 cases acute ALP poisoning, predominantly affecting females (67.3%) aged 16–18 years, with most incidents occurring summer (51.1%) rural areas (80.6%). Suicidal ingestion accounted 86.7% cases, delays hospital arrival noted 65.3%. Clinical findings included vomiting (76.6%), dyspnea (77.5%), cardiogenic shock (84.8%). ECG abnormalities found 82.7% patients, metabolic acidosis present 82.3% patients. An educational program significantly improved participants regarding highlighting need enhanced awareness intervention strategies. Community programs, such education initiatives, can positively influence practices, behaviors mothers terms providing toxicity.

Язык: Английский

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Therapeutic Dilemma of Wheat Pill Poisoning: A Narrative Review and Management Proposal

Medical & Clinical Case Reports Journal, Год журнала: 2024, Номер 2(1), С. 213 - 218

Опубликована: Апрель 26, 2024

million metric tonnes of wheat and 8 rice annually, the use pill, containing aluminium phosphide (ALP), is extensive 1 .To combat rodent damage, a considerable quantity pill required, with an average recommendation ranging from 2 to 5 pills per ton crop .

Язык: Английский

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Efficacy of therapeutic options in patients with aluminum phosphide poisoning

Deleted Journal, Год журнала: 2024, Номер 1(1)

Опубликована: Окт. 30, 2024

Язык: Английский

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