Evaluation of Cardioprotective action of Suvarna gairik (Redochre) in Indian Cobra Envenomation, Aluminium Phosphide Poisoning and Doxorubicin Cardiotoxicity in Albino Rats- A Protocol

Background: Poisoning is major health issue all over the world. Poisoning is one of basic causes for Out Hospital cardiac arrest (OHCA). P-OHCA (Poison induced Out Hospital cardiac arrest) can be prevented by immediate primary management. The agent for poisoning is unknown in most cases, which leads to difficulty deciding the emergency antidote. In Ayurveda Hridyavaranchikitsa (Cardio protection) is one of the treatment modalities mentioned in all types of poisoning as first aid treatment. Suvarna Gairik (Red ochre) is one of drugs mentioned for the cardioprotection. Snake bite and organophosphate poisoning are the threats to life in India. Doxorubicin is commonly used drug for Chemotherapy in malignancies, and its major side effect is cardiotoxicity. Hence these poisonings are included in study. Aim and Objective: Evaluation of cardioprotective activity of Suvarna Gairik (Red ochre) in cardiac biomarker like Lactate dehydrogenase, Creatinine phosphokinase, Alkaline transferase, Cardiac Troponins and Survival Time in Indian Cobra Envenomation, Aluminium phosphide poisoning and Doxorubicin cardiotoxicity in Albino Rats. Methodology: Animal study is designed. 56 wistar rats will be divided in 7 groups as Vehicle Control Group, Disease control Group -1 Indian Cobra envenomation, Disease control Group -2Aluminium Phosphide poisoning, Disease control Group -3 Inj. Doxorubicin induced cardiotoxicity, Test Group -1 Indian Cobra Envenomation and Suvarna gairik Test Group -2 Aluminium Phosphide poisoning and Suvarna gairik Test control Group 3- Inj. Doxorubicin cardiotoxicity and Suvarna gairik. Results: Outcome will be assessed in between groups and among groups. Conclusion: Suvarna Gairik (Red ochre) may show statistical significant cardioprotective activity.

Unexpected survival after deliberate phosphine gas poisoning: An Australian experience of extracorporeal membrane oxygenation rescue in this setting

Phosphine poisoning is responsible for hundreds of thousands of deaths per year in countries where access to this pesticide is unrestricted. Metal phosphides release phosphine gas on contact with moisture, and ingestion of these tablets most often results in death despite intensive support. A 36-year-old woman presented to a regional hospital after ingesting multiple aluminium phosphide pesticide tablets and rapidly developed severe cardiogenic shock. In this case, serendipitous access to an untested Extracorporeal Membrane Oxygenation (ECMO) service of a regional hospital effected a successful rescue and prevented the predicted death. We discuss the toxicology, management and the evidence for and against using ECMO in this acute poisoning.

Determination of Organochlorine Residues in Cowpea (Vigna unguiculata L. WALP) From Selected Markets in Ibadan, Oyo State, Nigeria

Cowpea (Vigna unguiculata(L.) Walp) is one of the major stale plant protein food crops in Nigeria, but constantly being attacked by insects especially during storage. This has been a major production constraint which usually necessitated the use of synthetic pesticides and chemicals, but comes with the problems of high pesticides residues. In cowpea, only few information or research has been made as regarding the level of pesticides residues, therefore the objective of this study was to identify the awareness level and organochlorine insecticides residue presence trendy to cowpea grains. This study was carried out using a multiple choice questionnaire, in which three markets in Ibadan were selected as the case study due to their population and patronisation. The multiple choice questionnaire was used in getting information as regarding the pesticide used, method of application, duration of storage after pesticide application and level of awareness on the possible side effects of pesticides. Thirty samples of cowpea were collected from the selected three markets for residue analysis which was determined in an analytical laboratory using standard procedures. Data collected were analysed using descriptive statistics. Results showed that Fumigation, spraying and baiting were the mostly used method of application of pesticides and Aluminium phosphide, Betoxin and Quickphos were the mostly used pesticides during application. Higher percentage (56.67%) of the respondent store the food stuff for less than a month before exposing it to the market for sales, about 53.3% of the respondents shows their ignorance about the health hazard associated with pesticides. Organochlorine pesticide residues were detected in all the samples of cowpea grains examined with highest mean concentration of Endosulfan (0.7500 mg/kg 0.3508).

Blocking vicious cycle of cardiac dysfunction by external cardiopulmonary resuscitation is the key to rescue acute aluminium phosphide poisoning

Aluminium phosphide (ALP) and aluminium zinc phosphide (ZnP), the two main ingredients of fumigation drugs, are commonly used to kill insects or rodents in grain. When exposed to water, highly toxic phosphine gas is released and absorbed through the respiratory or digestive tract. Phosphine gas could non-selectively block cytochrome oxidase, inhibit electron transfer and suppress oxidative phosphorylation, leading to cellular hypoxia and organ dysfunction. The characteristic clinical manifestations are refractory shock and metabolic acidosis with high mortality. However, patients with ALP poisoning have a chance to be cured. Here, we report a case of oral ALP poisoning that was successfully treated by extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) during frequent ventricular fibrillation and cardiac dysfunction.

Preclinical Evaluation of Antidotal Property of Mritasanjeevana agada in Poisoning- A Study Protocol

Background: As the poisoning is becoming a threat to rural India, it is necessary to increase the survival time to avail the primary treatment. For the treatment of poisoning, Agada is described in Ayurveda as an antidote. Agada is a polyherbal or herbomineral formulation constituted with combination antitoxic drugs along with some antioxidant, immunomodulator or hepatoprotective drugs. But they need to be revalidated for their efficacy and safety on the basis of contemporary assessment parameters Aim: Evaluation of antidotal property of Mritasanjivana Agada in poisoning. Objectives: To increase the survival time after the administration of Mritasanjivana Agada in snake venom and aluminium phosphide poisoning in albino mice. To compare the efficacy of Mritasanjivana Agada and Anti-snake venom as an antidote. To standardize the Mritasanjivana Agada. Methodology: Mritasanjeevana Agada will be prepared and standardized. Cobra venom poisoning and aluminium phosphide poisoning have been selected as the representative for the animate poison and artificial/ synthetic poison. After inducing poisoning in mice, one group will receive its standard antidote and other will receive standard antidote with Mritasanjivana Agada. The third group will receive only Mritasanjivana Agada without its standard antidote. All the groups will be assessed on the basis of hematology, biochemistry, Superoxide dismutase (SOD) level, Malondialdehyde (MDA) level and histopathology in case of death of the animals. Results: Mritasanjeevana agada is expected to increase the survival time in the treatment of snake venom and aluminium phosphide poisoning in albino mice. Conclusion: Mritasanjeevana agada may be as efficacious as Anti-snake venom as an antidote.

Importance of pesticides for lethal poisoning in India during 1999 to 2018: a systematic review

Background Poisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years. Methods We performed a systematic literature review in Medline, Embase and Google Scholar (1999–2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study. Results We identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999–2003), the number of deaths declining thereafter (to n = 1714 in 2014–2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths. Conclusion Use of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter’s lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions.

An Audit Of Wheat Pill Poisoning In A Tertiary Care Hospital: A Retroscpective Study

Background: Wheatpill is a commonly used suicide drug in developing countries. Due to the easy availability, this drug has played a great role for those people who commit suicide due to various reasons. Aim: To investigate different features such as (Age, Gender, Education, Marital status, Treatment, Location) of all those people who deliberately self-harm by using aluminium phosphide. Study design: Retrospective study. Methodology: Patients (n=83) were enrolled at Teaching Medical Unit, DHQ Teaching Hospital, Sargodha, Pakistan from January 2019 to December 2019 in present study and study tools were age, gender, marital status, educational status, time of arrival, number of days stayed in a hospital, treatment and outcome. Cases were included irrespective of gender. Data analyzed by SPSS 22.0v. Results: Among them 42 are men and 41 were women. 77% of the patients were under 40 years of age and despite taking advantage of all available treatment options, the mortality rate was up to 83% which indicates severe consequences after taking Aluminium Phosphide. Conclusion: This study concluded that this particular aspect of pesticide poisoning was almost exclusively a concern of the developing world where aluminum phosphide was a commonly used and easily available rodenticide. Agricultural activities were undertaken in remote rural areas, which most often lack health-care facilities. Death resulted from cardiogenic shock and hypotension. Keywords: Gender, educational status, time of arrival and treatment efficacy.