scholarly journals Oxime and atropine failure to prevent intermediate syndrome development in acute organophosphate poisoning

2013 ◽  
Vol 70 (4) ◽  
pp. 420-423 ◽  
Author(s):  
Slavica Vucinic ◽  
Biljana Antonijevic ◽  
Nela Ilic ◽  
Tihomir Ilic
Keyword(s):  
Total Dose ◽  
Key Management ◽  
Cranial Nerves ◽  
Respiratory Muscles ◽  
Organophosphate Poisoning ◽  
Organophosphate Insecticide ◽  
Delayed Treatment ◽  
Medical Institutions ◽  
Exact Etiology ◽  
Pralidoxime Methylsulphate

Introduction. Intermediate syndrome (IMS) was described a few decades ago, however, there is still a controversy regarding its exact etiology, risk factors, diagnostic parameters and required therapy. Considering that acute poisonings are treated in different types of medical institutions this serious complication of organophosphate insecticide (OPI) poisoning is frequently overlooked. The aim of this paper was to present a case of IMS in organophosphate poisoning, which, we believe, provides additional data on the use of oxime or atropine. Case report. After a well-resolved cholinergic crisis, the patient developed clinical presentation of IMS within the first 72 h from deliberate malathion ingestion. The signs of IMS were weakness of proximal limb muscles and muscles innervated by motor cranial nerves, followed by the weakness of respiratory muscles and serious respiratory insufficiency. Malathion and its active metabolite were confirmed by analytical procedure (liquid chromatography-mass spectrometry). Pralidoxime methylsulphate, adiministered as a continuous infusion until day 8 (total dose 38.4 g), and atropine until the day 10 (total dose 922 mg) did not prevent the development of IMS, hence the mechanical ventilation that was stopped after 27 h had to be continued until the day 10. Conclusion. Continuous pralidoxime methylsulphate infusion with atropine did not prevent the development of IMS, most likely due to the delayed treatment and insufficient oxime dose but also because of chemical structure and lipophilicity of ingested OPI. A prolonged intensive care monitoring and respiratory care are the key management for the intermediate syndrome.

Accidental Organophosphate Insecticide Poisoning: a Fatal Child case with Hazards to Emergency Department Staff

2003 ◽  
Vol 10 (4) ◽  
pp. 248-252
Author(s):  
CL Lau ◽  
KL Chung ◽  
CW Kam
Keyword(s):  
Emergency Department ◽  
Healthcare Workers ◽  
Spontaneous Circulation ◽  
Organophosphate Poisoning ◽  
Protective Equipment ◽  
Organophosphate Insecticide ◽  
Secondary Poisoning ◽  
Initial Resuscitation ◽  
Emergency Department Staff ◽  
Department Staff

A 2-year-old boy was accidentally poisoned by one spoonful of organophosphate insecticide and presented in cardiac arrest. Spontaneous circulation was restored after initial resuscitation and antidote therapy (atropine and pralidoxime) but the boy finally succumbed with multiple complications. We reviewed the literature on the clinical features and management of acute organophosphate poisoning, and the appropriate protective equipment for preventing secondary poisoning of healthcare workers.

Two Cases of Organophosphate Poisoning with Development of Intermediate Syndrome

1990 ◽  
Vol 9 (3) ◽  
pp. 187-189 ◽  
Author(s):  
M. Karademir ◽  
F. Ertürk ◽  
R. Koçak
Keyword(s):  
Conventional Therapy ◽  
Respiratory Muscles ◽  
Respiratory Support ◽  
Organophosphate Poisoning ◽  
Delayed Neuropathy ◽  
Organophosphorus Poisoning ◽  
Limb Muscles ◽  
Support Recovery ◽  
Carbamate Pesticide

Two cases of intermediate syndrome caused by organophosphorus poisoning are reported. Trichlorfon, propoxur (a carbamate pesticide) and fenthion were ingested in both attempts at suicide. After successful conventional therapy during the cholinergic phase, but before the time when the onset of delayed neuropathy might be expected, an intermediate syndrome developed. It affected the proximal limb muscles, neck flexors and respiratory muscles 2 d after pesticide ingestion. The two patients needed respiratory support. Recovery from the intermediate syndrome was complete in both patients, although one subsequently developed delayed neuropathy.

Guillain – Barré syndrome associated with SARS-CoV-2 infection

2021 ◽  
Author(s):  
E. I. Tsoma
Keyword(s):  
Cranial Nerves ◽  
Respiratory Muscles ◽  
Guillain Barre Syndrome ◽  
Haemophilus Influenzae Type ◽  
Barr Virus ◽  
Progressive Muscle Weakness ◽  
Fluid Analysis ◽  
Disturbance Of Consciousness ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Neurological manifestations of COVID‑19 infection are caused by its effects on CNS (headache, dizziness, disturbance of consciousness, convulsions, etc.) and PNS (anosmia, ageusia, visual impairment, radiculo‑ and neuropathy). Guillain – Barré syndrome (GBS) is a rare autoimmune disease associated with damage to the peripheral nervous system. 40 — 70 % of cases are associated with a previous infection: cytomegalovirus, Epstein–Barr virus, Haemophilus influenzae type b, Mycoplasma pneumoniae, Campylobacter jejuni etc. The clinical characteristics of this condition are progressive muscle weakness, reduction or loss of tendon reflexes (hyporeflexia and areflexia), paresthesias, paresis of the cranial nerves. The diagnosis is based on clinical data, cerebrospinal fluid analysis (protein level, cytosis, antigangliosid antibodies), as well as electroneuromyography. Most patients with Guillain – Barré syndrome totally recover. However, the most dangerous and severe complication of acute inflammatory demyelinating polyneuropathy is paralysis of the respiratory muscles. About a quarter of patients require urgent treatment at intensive care unit with mechanical ventilation and/or tracheostomy. Mortality in Guillain – Barré syndrome can reach to 10 %. There have been several reports of COVID‑19‑related GBS in the world scientific medical literature during the last year, but more information about this association and its implications is still missing. The aim of this report was to analyze the available information about cases of Guillain – Barré syndrome associated with COVID‑19 infection, to compare different variants of this condition and to share our own experience in clinical management of such patient.

Intermediate myasthenia syndrome following acute organophosphates poisoning-an analysis of 21 cases

1998 ◽  
Vol 17 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Fengsheng He ◽  
Haibing Xu ◽  
Fukuang Qin ◽  
Li Xu ◽  
Jinxiang Huang ◽  
...  
Keyword(s):  
Action Potentials ◽  
Neuromuscular Junctions ◽  
Cranial Nerves ◽  
Respiratory Muscles ◽  
Acetylcholinesterase Activity ◽  
Acute Poisoning ◽  
Muscular Weakness ◽  
Repetitive Nerve Stimulation ◽  
Pesticide Mixtures ◽  
Limb Muscles

1 Twenty-one cases out of 272 patients of acute organophosphates poisoning were diagnosed as intermediate syndrome (IMS) with a prevalence at 7.7%. The responsible OP insecticides included parathion, omethoate and some OP containing pesticide mixtures. IMS occurred mainly in severe OP poisoning patients who recovered from the acute cholinergic crisis at 7-75 h after the onset of acute poisoning. 2 Muscular weakness appeared in the following three categories of muscles: (1) neck flexors and proximal limb muscles; (2) muscles innervated by motor cranial nerves and/or (3) respiratory muscles. Blood acetylcholinesterase activity was persistently inhibited. Electroneuromyography (ENMG) with repetitive nerve stimulation (RNS) at frequencies of 20 Hz or 30 Hz in seven patients showed decrements of common muscle action potentials during the presence of myasthenia in five patients and became normal when their muscle strength recovered. 3 Mild IMS recovered within 2-7 days and had a favorable prognosis. Severe IMS patients with respiratory paralysis needed immediate endotracheal intubation and mechanical ventilation. Recovery of weakness of the respiratory muscles and proximal limb muscles took longer, the slowest being 30 days. Four of the patients died of respiratory paralysis and the fatality rate was 19%. 4 The mechanism of IMS remains to be further investigated. The RNS/ENMG changes indicate a post-synaptic block at the neuromuscular junctions. 5 In order to promote the recognition of this syndrome, we proposed to name the syndrome as Intermediate Myasthenia Syndrome (IMS).

Neurotoxicity of Local Administration of Two Nitrosoureas in Malignant Gliomas

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 794-800 ◽  
Author(s):  
Tetsumori Yamashima ◽  
Junkoh Yamashita ◽  
Katsuo Shoin
Keyword(s):  
Single Dose ◽  
Total Dose ◽  
Nerve Palsy ◽  
Malignant Gliomas ◽  
Cranial Nerves ◽  
Local Administration ◽  
Brain Delivery ◽  
Spongy Degeneration ◽  
Motor Weakness ◽  
Capsule Formation

Abstract The neurotoxicity of local administration of nitrosoureas in malignant gliomas was investigated clinicopathologically, Twenty patients were entered into this study: 13 were treated with 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) and 7 with methyl 6-[3-(2-chloroethyl-3-nitrosoureido]-6-deoxy-α-D-glucopyranoside (MCNU). On the average, a single dose of 20 mg of ACNU was administered 15 times, for a total dose of 295 mg in each case, while a single dose of 11 mg of MCNU was given 2 times, for a total dose of 24 mg. These nitrosoureas provoked greater toxicity when the administration dose was larger or the indwelling multiperforated Silastic basket was in direct continuity with the ventricle or the basal cistern. Usually ACNU was well tolerated, whereas MCNU induced marked brain edema. Side effects consisted of headache, nuchal stiffness, vomiting, motor weakness, and cranial nerve palsy for ACNU, and headache, vomiting, abnormal respiration, and arrhythmia for MCNU. Pathological changes were represented by capsule formation, spongy degeneration and reactive gliosis of adjacent white matter, occlusion of neighboring arteries, and demyelination of cranial nerves in the patients treated with ACNU, while they were represented by focal brain necrosis in two patients treated with MCNU. The differences in neurotoxity of ACNU and MCNU conceivably derive from the different blood-brain delivery of these drugs.

scholarly journals Clinical and epidemiological features and medical and social characteristics of victims with injuries to the maxillofacial bones, according to the department of maxillofacial reconstructive plastic surgery of the national hospital of the ministry of health of the Kyrgyz Republic in 2010–2018

2020 ◽  
Vol 24 (2) ◽  
pp. 109-113
Author(s):  
Bakyt Kubanychbekovich Urgunaliev ◽  
I. M. Yuldashev ◽  
A. T. Rakhmanov ◽  
D. B. Shayahmetov
Keyword(s):  
Rural Areas ◽  
Diagnostic Errors ◽  
Social Characteristics ◽  
Kyrgyz Republic ◽  
Delayed Treatment ◽  
Agricultural Work ◽  
Medical Institutions ◽  
Working Age ◽  
Reconstructive Plastic Surgery ◽  
Permanent Residents

Report. The authors studied the medical and social characteristics of victims with facial bone injuries based on archived data over a long period of time. It was found that the majority of patients were socially active, but not working men of young working age with secondary, higher or incomplete higher education. Most of them were permanent residents of rural areas. The most frequent injuries WERE domestic and seasonal (spring autumn), which was due to an increase in the frequency of street injuries, as well as injuries sustained by rural residents during seasonal agricultural work, as well as an increase in the frequency of road accidents.Analysis of the system of specialized medical care showed that most of the victims were hospitalized, bypassing the stage of clinical diagnosis and treatment, independently in the form of self-treatment.A high frequency of delayed treatment and hospitalization of victims in medical institutions was found, which was associated with the remoteness of the place of permanent residence, material problems, inadequate outpatient treatment at the place of residence , as well as diagnostic errors at the pre-hospital stage.

Uncommon presentation and complications of herpes zoster infection involving the cervical, vagus and accessory nerves which caused a delay in diagnosis and treatment

2021 ◽  
Vol 14 (5) ◽  
pp. e241881
Author(s):  
Ziqi Wang ◽  
Thomas Lotina ◽  
John Malaty
Keyword(s):  
Vocal Cord ◽  
Muscle Atrophy ◽  
Cranial Nerves ◽  
Trapezius Muscle ◽  
Anal Squamous Cell Carcinoma ◽  
Scalene Muscle ◽  
Varicella Zoster ◽  
Delay In Diagnosis ◽  
Delayed Treatment ◽  
Uncommon Presentation

A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient’s symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient’s dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.

scholarly journals Intermediate Syndrome Following Organophosphate Insecticide Poisoning in Emergency Department of Eastern Nepal

2018 ◽  
Vol 5 (3) ◽  
pp. 3588-3590
Author(s):  
Ritesh Chaudhary ◽  
Rabin Bhandari ◽  
Gyanendra Malla ◽  
Masum Poudel
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Early Recognition ◽  
Health Sciences ◽  
Toxic Effects ◽  
Organophosphate Poisoning ◽  
Pesticide Poisoning ◽  
Organophosphate Insecticide ◽  
Organophosphorus Poisoning

Acute organophosphate poisoning is the most common pesticide poisoning which can be manifested in three unique phases of toxic effects e.g. Acute Cholinergic Crisis, Intermediate Syndrome (IMS), Delayed Polyneuropathy. Looking at the previous cases reports the incidence of Intermediate Syndrome has been reported to be as high as 80%.The present study attempted to report a comparable form of incidences encountered in Emergency Department of BP Koirala Institute of Health Sciences (BPKIHS) in Eastern Nepal.  Chlorpyriphos was the commonest compound associated with IMS. Early recognition with plasma acetylcholinesterase level as well as Peradeniya Organophosphorus Poisoning (POP) Scaled score might be useful tool in early diagnosis of Intermediate Syndrome.

Human Neurofibromas in Co-Culture with Mouse Neurons

1982 ◽  
Vol 40 ◽  
pp. 194-195
Author(s):  
R.L. Martuza ◽  
T. Liszczak ◽  
A. Okun ◽  
T-Y Wang
Keyword(s):  
Schwann Cell ◽  
Schwann Cells ◽  
Genetic Disorder ◽  
Cranial Nerves ◽  
Sympathetic Nerves ◽  
Acoustic Neuromas ◽  
Spinal Roots ◽  
Neural Crest Origin ◽  
Multiple Abnormalities ◽  
Other Neoplasms

Neurofibromatosis (NF) is an autosomal dominant genetic disorder with a prevalence of 1/3,000 births. The NF mutation causes multiple abnormalities of various cells of neural crest origin. Schwann cell tumors (neurofibromas, acoustic neuromas) are the most common feature of neurofibromatosis although meningiomas, gliomas, and other neoplasms may be seen. The schwann cell tumors commonly develop from the schwann cells associated with sensory or sympathetic nerves or their ganglia. Schwann cell tumors on ventral spinal roots or motor cranial nerves are much less common. Since the sensory neuron membrane is known to contain a mitogenic factor for schwann cells, we have postulated that neurofibromatosis may be due to an abnormal interaction between the nerve and the schwann cell and that this interaction may be hormonally modulated. To test this possibility a system has been developed in which an enriched schwannoma cell culture can be obtained and co-cultured with pure neurons.

Systems of Oppression in Geriatric Clinical Service Delivery

2021 ◽  
pp. 1-3
Author(s):  
Diane L. Kendall
Keyword(s):  
Higher Education ◽  
Service Delivery ◽  
Clinical Setting ◽  
Service Providers ◽  
Hard Work ◽  
Clinical Service ◽  
Meaningful Change ◽  
Important Work ◽  
Speech Language Pathologists ◽  
Medical Institutions

Purpose The purpose of this article was to extend the concepts of systems of oppression in higher education to the clinical setting where communication and swallowing services are delivered to geriatric persons, and to begin a conversation as to how clinicians can disrupt oppression in their workplace. Conclusions As clinical service providers to geriatric persons, it is imperative to understand systems of oppression to affect meaningful change. As trained speech-language pathologists and audiologists, we hold power and privilege in the medical institutions in which we work and are therefore obligated to do the hard work. Suggestions offered in this article are only the start of this important work.

Sign in / Sign up

Export Citation Format

Share Document