Clinical characteristics and treatment of mixed-pesticide poisoning in a patient: reflections on a particular case

Patients who commit suicide often deliberately hide their medical history. Given that taking pesticides is one of the most common methods of suicide, other forms of poisoning may be neglected in clinical practice. We report here a case of mixed-pesticide poisoning. The patient was poisoned by oral administration of a coumarin rodenticide in combination with an intramuscular injection of organophosphorus (OP) pesticide. The patient was treated with vitamin K1, cholinesterase reactivators, atropine, ventilator-assisted ventilation, and bedside debridement. Her condition gradually stabilized and she eventually recovered and was discharged. Assessment of the causes of delayed diagnosis and treatment suggests that we need to improve early detection and treatment of acute poisoning. It is especially important to ask about the patient’s medical history, conduct a careful physical examination, and track the clinical symptoms and differential diagnosis of common poisoning. In addition to the three common routes of poisoning—oral, inhalation, and cutaneous mucosal contact—intramuscular injection of OP can also lead to severe poisoning, which manifests as respiratory failure.

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Clonidine as an adjuvant in the management of acute poisoning by anticholinesterase pesticides

Human & Experimental Toxicology ◽

10.1177/0960327115586822 ◽

2015 ◽

Vol 35 (4) ◽

pp. 371-376 ◽

Cited By ~ 2

Author(s):

AA El-Ebiary ◽

SA Gad ◽

AA Wahdan ◽

IH El-Mehallawi

Keyword(s):

Clinical Outcomes ◽

Length Of Hospital Stay ◽

Acute Poisoning ◽

Assisted Ventilation ◽

Serum Cholinesterase ◽

Pesticide Poisoning ◽

Open Label ◽

Routine Treatment ◽

Group I ◽

Open Label Phase

Introduction: Anticholinesterase pesticides are widely used in agriculture and domestic settings throughout the world, and they are responsible for great morbidity and mortality. In Egypt and other developing countries, there is a pressing need for new affordable antidotes to treat anticholinesterase pesticide poisoning. Hence, this study was conducted to evaluate the safety and effectiveness of moderate doses of clonidine in the management of adult patients with acute anticholinesterase pesticide poisoning. Methodology: This study was an open-label, phase II pilot clinical trial. Sixty patients with acute anticholinesterase pesticide poisoning gave consent to participate in the study. They were divided into 2 equal groups, with 30 patients in each group. Group I received clonidine plus the routine treatment, while group II received only the routine treatment. Patients were subjected to full history taking, and their vital and clinical data were recorded. Serum cholinesterase levels and routine laboratory investigations were measured. The different outcomes of the patients were assessed. Results: The baseline characteristics of both groups were similar. Thirteen (43.3%) patients developed significant hypotension during clonidine treatment. The clinical outcomes (including mortality, need for assisted ventilation, length of hospital stay, and total doses of atropine) showed no significant differences between the two groups. Conclusion: The use of clonidine in acute anticholinesterase pesticide poisoning may be associated with a high incidence of hypotension requiring intervention. The clinical outcomes may not significantly improve in clonidine-treated patients.

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Chilaiditi Syndrome: A Case Report Highlighting the Intermittent Nature of the Disease

Case Reports in Medicine ◽

10.1155/2018/3515370 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Esha M. Kapania ◽

Christina Link ◽

Joshua M. Eberhardt

Keyword(s):

Case Report ◽

Complete Resolution ◽

Clinical Symptoms ◽

Case Reports ◽

Delayed Diagnosis ◽

Spontaneous Resolution ◽

Radiographic Evidence ◽

Case Presentation ◽

Chilaiditi Syndrome

Background. Chilaiditi syndrome is a phenomenon where there is an interposition of the colon between the liver and the abdominal wall leading to clinical symptoms. This is distinct from Chilaiditi sign for which there is radiographic evidence of the interposition, but is asymptomatic. Case Presentation. Here, we present the case of a patient who, despite having clinical symptoms for a decade, had a delayed diagnosis presumably due to the interposition being intermittent and episodic. Conclusions. This case highlights the fact that Chilaiditi syndrome may be intermittent and episodic in nature. This raises an interesting question of whether previous case reports, which describe complete resolution of the syndrome after nonsurgical intervention, are perhaps just capturing periods of resolution that may have occurred spontaneously. Because the syndrome may be intermittent with spontaneous resolution and then recurrence, patients should have episodic follow-up after nonsurgical intervention.

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Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

Hormone and Metabolic Research ◽

10.1055/a-1033-7524 ◽

2019 ◽

Vol 52 (01) ◽

pp. 32-38 ◽

Cited By ~ 1

Author(s):

Magdalena Stasiak ◽

Renata Michalak ◽

Bartłomiej Stasiak ◽

Andrzej Lewiński

Keyword(s):

Antibiotic Treatment ◽

Clinical Symptoms ◽

Time Lag ◽

Delayed Diagnosis ◽

Simple Algorithm ◽

Antibiotic Use ◽

Treated Group ◽

Subacute Thyroiditis ◽

Reactive Protein ◽

Laboratory Test Results

AbstractClinical symptoms of subacute thyroiditis (SAT) may be misleading and the proper diagnosis is significantly delayed, and many unnecessary therapeutic methods are used, including application of antibiotics. The purpose of the study is to analyze the reasons and frequency of delayed SAT diagnosis and unnecessary antibiotic treatment and to propose a simple algorithm to facilitate the diagnosis and prevent antibiotic abuse. Sixty-four SAT patients were divided into groups depending on the period of time from the first symptoms of SAT to diagnosis and on the unnecessary use of antibiotics. Data from medical history and laboratory test results were analyzed for individual groups to determine the reasons for delayed diagnosis and incorrect treatment. In 73% of patients, the diagnosis was delayed from over two weeks up to six months. Among 62 patients who provided data on antibiotic use, 29 (46.77%) were treated with one or more antibiotics due to SAT symptoms. Fever, preceding infection, increased C-reactive protein (CRP), and WBC were characteristic for the antibiotic treated group. Fever, preceding infection, increased CRP and WBC are typical for both SAT and infection and are the main symptoms leading to misdiagnosis and unnecessary antibiotic treatment in SAT. Thus, in all patients with neck pain or other SAT-like symptoms, thorough clinical examination of the neck is mandatory. When firm and/or tender thyroid nodule/goitre is present and erythrocyte sedimentation rate /CRP is increased, patient should be promptly referred to an endocrinologist, and antibiotics are not recommended.

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A Case of Acute Poisoning with Fenitrothion (Sumithion)

Human Toxicology ◽

10.1177/096032718700600511 ◽

1987 ◽

Vol 6 (5) ◽

pp. 403-406 ◽

Cited By ~ 22

Author(s):

M. Yoshida ◽

E. Shimada ◽

S. Yamanaka ◽

H. Aoyama ◽

Y. Yamamura ◽

...

Keyword(s):

Respiratory Insufficiency ◽

Attempted Suicide ◽

Clinical Symptoms ◽

Acute Poisoning ◽

Lipid Solubility ◽

Fat Tissue ◽

High Lipid ◽

High Lipid Solubility

A 56-year-old male attempted suicide by ingestion of about 60 ml of 50% fenitrothion (Sumithion) emulsion. Five hours later, combined hemoperfusion and hemodialysis (HP-HD) treatment was performed for 60 min and consequently the toxic symptoms improved gradually. However, cholinergic symptoms recurred 4 days after ingestion. Although HP-HD was immediately performed for 180 min, it had no effect on the clinical symptoms. He died of respiratory insufficiency 6 days after the ingestion of fenitrothion. Fenitrothion concentration in the organs and tissues showed the highest values in the fat tissue, followed in decreasing order by the pancreas, muscle, lung and brain. The results indicate that fenitrothion has high lipid solubility and deposits in the fat tissue. Furthermore, we believe that when HP-HD therapy is used in the treatment of acute insecticide poisoning it is important that it be performed continuously and in as early a stage as possible.

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Delayed diagnosis of Sheehan's syndrome in a developed country: a retrospective cohort study

Acta Endocrinologica ◽

10.1530/eje-13-0279 ◽

2013 ◽

Vol 169 (4) ◽

pp. 431-438 ◽

Cited By ~ 20

Author(s):

Cynthia Ramiandrasoa ◽

Frédéric Castinetti ◽

Isabelle Raingeard ◽

Patrick Fenichel ◽

Olivier Chabre ◽

...

Keyword(s):

Clinical Symptoms ◽

Diagnostic Delay ◽

Delayed Diagnosis ◽

Study Data ◽

Sheehan’S Syndrome ◽

Developed Country ◽

Mean Delay ◽

Early Signs ◽

Acute Adrenal Insufficiency ◽

Sheehan's Syndrome

BackgroundLittle is known about Sheehan's syndrome (SS), even though it is believed that its incidence is low. The aims of this study were to determine the clinical features and diagnostic delay of SS and to ascertain whether early signs could have allowed earlier diagnosis.Subjects and methodsAll patients with SS diagnosed in reference units in the southeast of France between 1980 and 2011 were recruited for this study. Data on obstetrical history, clinical symptoms suggestive of hypopituitarism, early signs, hormone analysis, and magnetic resonance imaging were collected.ResultsOf the 40 women found to have SS, 39 were studied. Mean delay in the diagnosis of SS was 9±9.7 years. We found that four of the 35 assessable patients were diagnosed with agalactia, 16 of the 29 assessable ones with amenorrhea, 19 of the 39 with hypothyroidism, eight with acute adrenal insufficiency, and 15 with asthenia. Among the patients for whom there was a diagnostic delay of more than 1 year (n=28), seven had headaches during the postpartum period, all assessable patients had agalactia, six of the 22 assessable ones had amenorrhea, seven of 28 had hypothyroidism, and 12 of 28 had asthenia.ConclusionMost signs of SS are aspecific and classical signs such as agalactia and amenorrhea are often difficult to detect, which can explain the long diagnostic delay. We suggest that all women failing to lactate after postpartum hemorrhage (PPH) should be evaluated by measuring prolactin levels and women with signs such as amenorrhea and asthenia, even several years after PPH, should undergo a blood test including assessment of thyroxine, TSH, 0800 h ACTH–cortisol, and IGF1 levels.

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Hodgkin disease through symptoms of paraneoplastic nephrotic syndrome by the case of a 13-year old boy – case study

Health Promotion & Physical Activity ◽

10.5604/01.3001.0013.2656 ◽

2019 ◽

Vol 7 (2) ◽

pp. 5-8

Author(s):

Maciej Walczak

Keyword(s):

Nephrotic Syndrome ◽

Physical Examination ◽

Lymph Nodes ◽

Medical History ◽

Paraneoplastic Syndrome ◽

Clinical Symptoms ◽

The State ◽

Hodgkin Disease

Idiopathic nephrotic based on medical history, physical examination supplemented by ultrasound check. It does not often happen that a medical sign characteristic of nephrotic syndrome with generalized enlargement of lymph nodes (lymphadenopathy), liver and spleen may indicate an occurrence of lymphoma. A paraneoplastic syndrome is the state of clinical symptoms related to tumors, not being a close implication of a local neoplastic and metastatic infiltration. The objective of this article is drawing attention to the possibility of concealment of Hodgkin disease through symptoms of nephrotic syndrome by the case of a 13-year old boy.

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Total Joint Arthroplasty during Coronavirus Disease-2019 COVID-19 Pandemic

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v6i2.4783 ◽

2020 ◽

Author(s):

Seyed Mohammad Javad Mortazavi ◽

Seyed Hadi Kalantar ◽

Alireza Moharrami ◽

Mohammad Zarei ◽

Nima Hoseini Zare

Keyword(s):

Physical Examination ◽

Total Joint Arthroplasty ◽

Clinical Symptoms ◽

Joint Arthroplasty ◽

The Novel ◽

History Taking ◽

The World ◽

Total Knee ◽

Novel Coronavirus ◽

Careful Physical Examination

Background: Since the outbreak of the novel coronavirus disease-2019 (COVID-19) pandemics many orthopedic elective surgeries have been postponed all over the world. There are several guidelines for resuming elective surgeries during this crisis. In our center (Imam Khomeini hospital, Tehran, Iran), we resumed total joint arthroplasty (TJAs) surgeries using preoperative history taking and physical examination. Here, we report our experience. Methods: From February 2020 to August 2020, we included 165 patients who underwent TJA [70 total hip arthroplasty (THA) and 95 total knee arthroplasty (TKA)] in Imam Khomeini hospital, a referral center for COVID-19. We followed each patient from the day of hospitalization to two weeks after discharge by telephone for clinical symptoms of COVID-19. Results: Only one patient became infected with COVID-19 a week after discharge from the hospital, and other patients did not show any sign or symptoms within two weeks after the discharge. Conclusion: We recommend resuming the elective surgeries using a careful physical examination and medical history for all patients, and in suspicious cases, referring to a specialized COVID-19 clinic for further investigation.

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Plasma cholinesterase: double-edged parameter in the diagnosis of acute organophosphorus poisoning

Medicine Science and the Law ◽

10.1258/msl.2010.100015 ◽

2010 ◽

Vol 50 (3) ◽

pp. 159-160 ◽

Cited By ~ 4

Author(s):

D R Mahadeshwara Prasad ◽

Hareesh S Gouda ◽

Vinay R Hallikeri

Keyword(s):

Biochemical Marker ◽

Organophosphorus Pesticides ◽

Clinical Signs ◽

Organophosphorus Pesticide ◽

Signs And Symptoms ◽

Acute Poisoning ◽

Plasma Cholinesterase ◽

Pesticide Poisoning ◽

Organophosphorus Poisoning ◽

Clinical Signs And Symptoms

Biochemical markers are one of the mainstays in the diagnosis of ill health. Plasma cholinesterase is one such marker of the ill health caused by acute organophosphorus pesticide poisoning. Organophosphorus pesticides are powerful inhibitors of plasma cholinesterase; consequently, the reduced level of this biochemical marker has been used in the diagnosis of cases of acute poisoning. But how dependable is this biochemical marker in the diagnosis of suspected organophosphorus pesticide poisoning without adequate clinical signs and symptoms? In the case reported here, the low level of plasma cholinesterase which was suspected to be due to organophosphorus poisoning was found to be caused by pulmonary Koch's and hepatitis B with associated malnutrition.

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Emergence of Lassa Fever Disease in Northern Togo: Report of Two Cases in Oti District in 2016

Case Reports in Infectious Diseases ◽

10.1155/2017/8242313 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Akouda Akessiwe Patassi ◽

Dadja Essoya Landoh ◽

Agballa Mebiny-Essoh Tchalla ◽

Wemboo Afiwa Halatoko ◽

Hamadi Assane ◽

...

Keyword(s):

Health Professionals ◽

Ebola Virus ◽

Clinical Symptoms ◽

Fatal Outcome ◽

Delayed Diagnosis ◽

Hemorrhagic Fever ◽

Lassa Fever ◽

Control Measures ◽

Infection Prevention And Control ◽

First Case

Background. Lassa fever belongs to the group of potentially fatal hemorrhagic fevers, never reported in Togo. The aim of this paper is to report the first two cases of Lassa fever infection in Togo. Case Presentation. The two first Lassa fever cases occurred in two expatriate’s health professionals working in Togo for more than two years. The symptoms appeared among two health professionals of a clinic located in Oti district in the north of the country. The absence of clinical improvement after antimalarial treatment and the worsening of clinical symptoms led to the medical evacuation. The delayed diagnosis of the first case led to a fatal outcome. The second case recovered under ribavirin treatment. Conclusion. The emergence of this hemorrhagic fever confirms the existence of Lassa fever virus in Togo. After a period of intensive Ebola virus transmission from 2013 to 2015, this is an additional call for the establishment and enhancement of infection prevention and control measures in the health care setting in West Africa.

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TUBERCULOSTATICS ACUTE POISONING: DIAGNOSTIC AND TREATMENT

Romanian Journal of Pediatrics ◽

10.37897/rjp.2015.3.8 ◽

2015 ◽

Vol 64 (3) ◽

pp. 277-281

Author(s):

Dora Andreea Boghitoiu ◽

◽

Coriolan Emil Ulmeanu ◽

◽

...

Keyword(s):

Metabolic Acidosis ◽

Medical History ◽

Vitamin B6 ◽

Clinical Manifestations ◽

Gastric Fluid ◽

Acute Poisoning ◽

Emergency Admissions ◽

Verbal Stimuli ◽

Generalized Seizures ◽

Life Threatening

Introduction. Although the frequency of isoniazid poisoning is not very high, there are life threatening conditions which require a swift diagnosis and treatment. Material and method. We present the case of a female patient, aged 15 admitted in our clinic, by means of transfer, from another medical unit, due to tonic-clonic generalized seizures, followed by emesis and coma. The patient arrived at the Emergency Admissions Unit of our hospital, in coma, Glasgow 8, orotracheally intubated. She did not respond to verbal stimuli, but she did respond to deep, painful stimuli with marked agitation. The patient has a nasogastric tube, on which an orange liquid is visible on the outside and on the urinary catheter – orange colored urine. From the patient’s medical history, which was obtained from the patient’s mother, we noticed that the patient had been, for the past 4 months, under treatment with tuberculostatic drugs (Isoniazid, Rifampicin and vitamin B6). The patient administered the medication herself. Results. Based on clinical manifestations, i.e. tonic-clonic generalized seizures, incoercible emesis and coma, reddish-orange color of the gastric fluid and urine, at over 6 hours after the onset, on the patient’s medical history and based on laboratory results which revealed metabolic acidosis the suspicion of acute tuberculo-static poisoning arose. We started antidotal therapy with vitamin B6 with favorable clinical evolution. Conclusion. Acute isoniazid poisoning must be suspected in the case of any patient who presents the classic triad: refractory seizures, severe metabolic acidosis and coma and the treatment with the specific antidote-pyridoxine, must be available at any emergency unit.

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