A retrospective 7-years study of aluminum phosphide poisoning in Tehran: opportunities for prevention

The objective of this study was to survey aluminum phosphide (AIP) poisoning in a referral poisoning hospital in Tehran servicing an estimation of 10,000,000 populations. Records of all patients admitted and hospitalized during a period of 7 years from January 2000 to January 2007 were collected and analyzed according to gender, age, cause of intoxication, amount of AIP consumed, route of exposure, time between exposure and onset of treatment, signs and symptoms of intoxication at admission, therapeutic intervention, laboratory tests, and outcome. During the studied years, 471 patients were admitted to the hospital with AIP poisoning; 50% of them were men. The overall case fatality ratio was 31%. The mean age was 27.1 years, and most of the patients were between 20 and 40 years old. Self-poisoning was observed in 93% of cases. The average ingested dose was 5.1 g, and most of the patients (73%) consumed 1–3 tablets of AIP. A wide range of symptoms and signs was seen on admission, but the most common one was cardiovascular manifestations (78.12%). The majority (65%) of patients were from Tehran. Poisoning in spring and winter (34% and 24%, respectively) was more common than other seasons. Gastric decontamination with potassium permanganate, and administration of calcium gluconate, magnesium sulfate, sodium bicarbonate, and charcoal were considered for most of the patients. Mean arterial blood pH was 7.23 and bicarbonate concentration was 12.7 mEq/L. One-hundred percent of patients with blood pH <7 died and 100% of patients with blood pH ≥ 7.35 survived. Electrocardiogram (EKG) abnormalities were noted in 65.6% of cases. There was a significant difference between survival and non-survival according to pH, HCO3 concentration, and EKG abnormality. Even without an increase in resources, there appears to be significant opportunities for reducing mortality by better medical management and further restrictions on the AIP tablets usage. Arterial blood pH seems to be a prognostic factor for the outcome of AIP-poisoned patients.

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Rice tablet (Aluminum Phosphide) poisoning

International Journal of Bioassays ◽

10.21746/ijbio.2016.11.008 ◽

2016 ◽

Vol 5 (11) ◽

pp. 5041

Author(s):

Farkhondeh Jamshidi ◽

Ahmad Ghorbani ◽

Sina Darvishi*

Keyword(s):

Medical Records ◽

Statistical Tests ◽

Patient Records ◽

Demographic Information ◽

Aluminum Phosphide ◽

Men And Women ◽

Significant Difference ◽

The Mean ◽

Aluminum Phosphide Poisoning ◽

Commit Suicide

The abuse of some pesticides especially to suicide is one of the current problems of pesticides. Aluminum phosphide induced poisoning usually happens to suicide and sometimes it is due to accidental occupational exposure and in a few cases it has some criminal intensions. This study is conducted to evaluate patients poisoned with aluminum phosphide. In the present study the medical records of cases of poisoning with rice tablets (aluminum phosphide) hospitalized in Ahvaz Razi hospital is studied. Accordingly, a checklist is prepared that included demographic information of patients (age, gender) and information on patient records (information on poisoning) are completed using the patients’ medical records. The analysis of data is done by SPSS V22. 18 patients poisoned with rice tablet (aluminum phosphide) are studied. Results of the study show that 11 patients are male and seven are female. The mean patient age is 27.06 ±8.04 years that is 28 ±9 and 25 ±6.02 in men and women respectively. Statistical tests show no statistically significant difference in mean age in both genders (P> 0.05). Among patients, 11 subjects took aluminum phosphide to attempt suicide and 3 cases took it unintentionally and of course the reason is not mentioned in four cases. Among the patients who tried to commit suicide by taking aluminum phosphide, 6 cases are male and 5 cases are female that no statistically significant difference is observed between the genders in this respect (P> 0.05). In addition to the study of the complications caused by this poisoning and its mortality, it is recommended to responsible authorities to provide the necessary educations and treatments to prevent this type of poisoning.

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DIGITALIS TOLERANCE IN YOUNG PUPPIES

PEDIATRICS ◽

10.1542/peds.46.5.730 ◽

1970 ◽

Vol 46 (5) ◽

pp. 730-736

Author(s):

Katherine H. Halloran ◽

Steven C. Schimpff ◽

Jean G. Nicolas ◽

Norman S. Talner

Keyword(s):

Blood Gases ◽

Acid Base Balance ◽

Acid Base ◽

Littermate Control ◽

Premature Ventricular Contractions ◽

Toxic Dose ◽

Arterial Blood ◽

Wide Range ◽

Base Balance ◽

The Mean

Tolerance to acetyl strophanthidin, a rapid-acting cardiac aglycone, was determined in 28 anesthetized mongrel puppies, ages 16 to 56 days, and compared to tolerance in 16 littermate puppies in whom acute hypercapnic acidemia was produced. The tolerance was also compared to that of four adult mongrel dogs. The toxic dose was defined as the intravenous amount required to produce four consecutive premature ventricular contractions. A marked variation in the toxic dose was found in the 28 control puppies (range 83 to 353 µg/kg, mean 169 µg/kg) which could not be correlated with age, arterial blood gases or pH, serum potassium or sodium, arterial pressure, or heart rate. The toxic dose was significantly greater in the puppies than in the adult dogs, in whom the mean toxic dose was 64 µg/kg (range 50 to 89 µg/kg). A significant increase in tolerance was also observed in the puppies with hypercapnic acidemia (mean toxic dose 220 µg/kg, range 93 to 375 µg/kg) in comparison to tolerance in the control puppies and despite the wide range of tolerance, each of the puppies with hypercapnic acidemia showed greater tolerance than its littermate control puppy. Assessment of the clinical implications of these findings will require study of the effects of alterations in acid-base balance on the inotropic effect of acetyl strophanthidin in addition to the toxic electrophysiologic effects.

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Therapeutic effects of oral liothyronine on aluminum phosphide poisoning as an adjuvant therapy

Human & Experimental Toxicology ◽

10.1177/0960327117694074 ◽

2017 ◽

Vol 37 (2) ◽

pp. 107-117 ◽

Cited By ~ 4

Author(s):

MH Goharbari ◽

F Taghaddosinejad ◽

M Arefi ◽

M Sharifzadeh ◽

M Mojtahedzadeh ◽

...

Keyword(s):

Gastric Lavage ◽

Case Group ◽

Therapeutic Effects ◽

Aluminum Phosphide ◽

Cardiovascular Failure ◽

Arterial Blood ◽

Total Antioxidant ◽

Cardioprotective Effects ◽

Aluminum Phosphide Poisoning ◽

Decrease Lipid Peroxidation

Background: In aluminum phosphide (AlP) poisoning, death is mainly due to cardiovascular failure and refractory acute heart failure. There is a lot of evidence showing thyroid hormones have cardioprotective effects. Objective: The purpose of this study was to evaluate the effect of oral liothyronine in the treatment of AlP poisoning. Methods: Twenty-four patients from intensive care unit of Baharloo Hospital, Tehran, Iran, were included based on the inclusion and exclusion criteria. They were randomly divided into two parallel groups of 12 cases and 12 controls. Intervention in the case group was administration of 50 µg liothyronine via nasogastric tube after gastric lavage, in the first 6 h of poisoning. In both groups, the routine treatment of AlP poisoning was performed. Blood samples were prepared at the beginning of the study and after 12 h. Patients were followed up till discharge from the hospital or death. Results: The findings demonstrated that oral liothyronine was able to significantly improve systolic blood pressure, arterial blood pH, and total thiol molecules and also could decrease lipid peroxidation, increase catalase activity, and prevent further decline in total antioxidant capacity. Conclusion: Liothyronine administration is effective in controlling AlP poisoning and can improve patients’ outcome.

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Consumer Prices for Surgical Management of End-Stage Hallux Rigidus

Foot & Ankle Specialist ◽

10.1177/1938640019846966 ◽

2019 ◽

Vol 13 (4) ◽

pp. 276-280

Author(s):

Niall A. Smyth ◽

Vaishnavi Krishnan ◽

Johnathon R. McCormick ◽

Jonathan R. Kaplan ◽

Amiethab A. Aiyer

Keyword(s):

Health Care ◽

Hallux Rigidus ◽

Treatment Modalities ◽

Potential Cost ◽

First Metatarsophalangeal Joint ◽

Consumer Prices ◽

Wide Range ◽

Significant Difference ◽

The Mean ◽

End Stage

Background. Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis; however, the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, health care consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods. Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to 3 times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results. Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21 767 (range $8417 to $39 265). The mean bundled price for synthetic cartilage implantation was $21 546 (range $4903 to $74 145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusions. There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, thus impeding health care consumers’ decision making. There was a wide range of quotes for both procedures, indicating potential cost savings. Levels of Evidence: IV, basic science

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The duration of pubertal growth peak among three skeletal classes

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.21.5.067-074.oar ◽

2016 ◽

Vol 21 (5) ◽

pp. 67-74 ◽

Cited By ~ 3

Author(s):

Waqar Jeelani ◽

◽

Mubassar Fida ◽

Attiya Shaikh ◽

◽

...

Keyword(s):

Class Ii ◽

Growth Potential ◽

Class I ◽

Maturation Stage ◽

Class Iii ◽

Pubertal Growth ◽

Lateral Cephalograms ◽

Wide Range ◽

Significant Difference ◽

The Mean

ABSTRACT Introduction: Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability. Objective: The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes. Methods: A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes. Results: Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls). Conclusions: Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.0.8877 ◽

2020 ◽

pp. 1-6

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidine before induction of anesthesia. In the second group (GR), 100 μg of remifentanil was slowly injected intravenously.In addition, we collected demographic information such as respiratory rate, heart pulse rate, seizure time, mean of arterial blood pressure, recovery duration and the oxygen arterial saturation recorded after recovery. Data obtained were analysed by use of statistical software, SPSS-23. The mean age of both groups was approximately 37 years with the majority being men. There was no significant difference between the two groups in terms of age and sex, blood pressure, heart rate, duration of seizures and arterial oxygen saturation before ECT. The mean blood pressure and heart rate in the recovery group were lower in the dexmedetomidine group than in the remifentanil group and the hemodynamics in the dexmedetomidine group were more stable. The recovery time in the dexmedetomidine group was longer than that of the remifentanil group (p = 0.001). Both groups had approximately the same satisfaction and the rate of agitation after ECT was the same. Both remifentanil and dexmedetomidine as adjuvants lead to a decrease in patients' post-ECT hyperdynamic responses. In our study, we demonstrated that the effect of dexmedetomidine is greater than remifentanil. On the other hand, neither dexmedetomidine nor remifentanil had a negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time, when compared to remifentanil.

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Dosimetry of Critical Organs in Maxillofacial Imaging with Cone-beam Computed Tomography

Journal of Biomedical Physics and Engineering ◽

10.31661/jbpe.v9i1feb.691 ◽

2019 ◽

Vol 9 (1Feb) ◽

Author(s):

R Ghanbarnezhad Farshi ◽

A Mesbahi ◽

M Johari ◽

Ü Kara ◽

N Gharehaghaji

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Cone Beam ◽

Radiation Doses ◽

Parotid Glands ◽

Thermoluminescent Dosimeters ◽

Wide Range ◽

Significant Difference ◽

The Mean ◽

Selection Of

Background: While the benefits of cone-beam computed tomography (CBCT) are well known in maxillofacial imaging, the use of this modality is not risk-free.Objective: The aim of this study was to evaluate the exposure doses received by patients during maxillofacial imaging with CBCT.Methods: Entrance surface dose (ESD) was measured by using thermoluminescent dosimeters (TLDs) attached to the eyes lids, parotid glands and thyroid of 64 patients in two imaging centers (A and B). Phantom dosimetry was performed by a cylindrical poly-methyl methacrylate (PMMA) head-size phantom and an ionization chamber for different exposure parameters. NewTom VGi and Planmeca Promax 3D CBCT scanners were used at centers A and B, respectively.Results: The mean ESD of the eyes, parotid glands and thyroid were 2.57, 2.33 and 0.28 mGy in center A, 0.35, 2.11 and 0.37 mGy in center B, respectively. ESD of the eyes revealed a significant difference in two centers; in center B, it was 86.4% lower than center A. In the phantom dosimetry, the measured doses of NewTom VGi were 2.63 and 2.08 mGy, respectively by changing field of view (FOV) size from 8×8 cm2 (height × diameter) to 6×6 cm2. For Planmeca Promax 3D, it ranged from 0.98 to 3.24 mGy depending on exposure parameters.Conclusion: There is a wide range of radiation doses dependent on the units, patients and selected scan parameters. Inappropriate selection of exposure settings, especially FOV size, can seriously increase patient dose.

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Evaluation of Iodine in Distributed Salts in Abarkouh City in 2017-2018

Journal of Environmental Health and Sustainable Development ◽

10.18502/jehsd.v3i4.227 ◽

2018 ◽

pp. 659-665

Author(s):

Mahrokh Mahrokh Jalili ◽

Ali Asghar Ebrahimi ◽

Mohammad Hassan Ehrampoush ◽

Fariba Abbasi ◽

Eslami Hadi Eslami ◽

...

Keyword(s):

Iodine Deficiency ◽

Random Sampling ◽

Clinical Manifestations ◽

Iodine Concentration ◽

T Test ◽

British Pharmacopoeia ◽

Wide Range ◽

Significant Difference ◽

The Mean ◽

The City

Introduction: Iodine deficiency and associated disorders, which lead to a wide range of clinical manifestations, have been raised as one of the health and nutritional problems in Iran. Therefore, this study was aimed to investigate the amount of iodine in distributed salts in Abarkouh city in 2017-2018. Materials and Methods: Random sampling was done by census on all 30 distributed brands in Abarkouh city in the different stores across the city. Sixty samples (30 samples after one month from the production date and 30 samples after 6 months from the production date) were collected and transferred to the laboratory. The measurement of iodine was done according to the British Pharmacopoeia recommended method. T-test was used to analyze the data. Results: The Mean iodine concentration in the salts supplied in the Abarkouh was 29.83 ± 19.9 ppm, which was 50% less than the Iran's standard, with a statistically significant difference (P ≤ 0.001). 66.6% of the studied brands did not contain adequate iodine. Six months after production date, the average iodine amount in salts was reduced to 24.26 ± 16.94 ppm, but the reduction was not statistically significant (P = 0.224). Conclusion: Average iodine amount in most of the salts supplied across the Abarkouh city was not acceptable and some salts lacked iodine. Therefore, careful and continuous supervision and monitoring the process of iodized salts production in factories is recommended.

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L-Malate’s Plasma and Excretion Profile in the Treatment of Moderate and Severe Hemorrhagic Shock in Rats

BioMed Research International ◽

10.1155/2016/5237148 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Indra N. Waack ◽

Stephan Himmen ◽

Friederike Mueller ◽

Ricarda Rohrig ◽

Friederike Roehrborn ◽

...

Keyword(s):

Hemorrhagic Shock ◽

Renal Excretion ◽

Crystalloid Solution ◽

Arterial Blood ◽

Plasma Distribution ◽

Wide Range ◽

Male Wistar Rats ◽

The Mean ◽

Urinary Citrate ◽

Observation Period

Introduction. Malate is a standard component in fluid therapy within a wide range of medical applications. To date, there are insufficient data regarding its plasma distribution, renal excretion, and metabolism after infusion. This study aimed to investigate these three aspects in a rat model of moderate and severe hemorrhagic shock (HS).Methods. Male Wistar rats were subjected to HS by dropping the mean arterial blood pressure to 25–30 mmHg (severe) and 40–45 mmHg (moderate), respectively, for 60 minutes. Subsequently, reperfusion with Ringer-saline or a malate containing crystalloid solution (7 mM, 13.6 mM, and 21 mM, resp.) was performed within 30 minutes, followed by an observation period of 150 minutes.Results. In the present experiments, malate rapidly disappeared from the blood, while only 5% of the infused malate was renally excreted. In the resuscitation interval the urinary citrate and succinate amounts significantly increased compared to control.Conclusion. Malate’s half-life is between 30 and 60 minutes in both, moderate and severe HS. Thus, even under traumatic conditions malate seems to be subjected to rapid metabolism with participation of the kidneys.

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