Accidental monensin poisoning in buffaloes in Bahia, Brazil

ABSTRACT: Monensin is an ionophore antibiotic (IA) widely used for growth promotion and weight gain in the production of ruminants. However, it has caused intoxication in several species, including buffaloes, mainly because of the ignorance or disrespect of the recommendations for use in each animal species. The objective of this study was to describe, for the first time, clinical-epidemiological and anatomopathological data of an outbreak of accidental poisoning by monensin in buffalos and rediscuss the recommendation of the use of IA in the production of this species. The outbreak affected 21 adult buffaloes after consumption of remains from a feed formulated on the farm and whose constituents were mixed by hand. Clinical and first death signs were observed 24 hours after ingestion of this food. In general, the clinical picture was characterized by muscle weakness, tremors, difficulty in locomotion, and decubitus. Fifteen buffaloes presented clinical signs of poisoning (71.5% morbidity), followed by death (100% lethality), after acute to subacute evolution (<24h to 96h). Laboratory tests indicated elevated serum activity of creatine phosphokinase and aspartate aminotransferase enzymes. Three buffaloes underwent necropsy, and samples from several organs were collected for histopathological examination. The main injuries found were hyaline degeneration and multifocal segmental necrosis in the skeletal and cardiac striated muscles (myopathy and degenerative-necrotic multifocal multifocal-necrotic cardiopathy). The diagnosis was confirmed by the toxicological evaluation of suspected ration remains, which detected 461.67mg/kg of monensin. The death of 71.5% buffaloes in this lot occurred due to a succession of errors, which included faults in the formulation of the ration and, above all, due to the use of monensin in a highly sensitive species. Despite the possible beneficial effects of IA use as a dietary supplement for buffaloes, we are of the opinion that IAs should never be used in bubalinoculture since any increment in production does not compensate for the imminent risk of death due to a small safety margin for this species and the absence of antidotes.

Incidence, Distribution, and Determinants of Suicide by Self-Poisoning in two Egyptian Provinces

Objectives: Suicide by self-poisoning is a serious public health problem that accounts for global morbidities and mortalities. This work aims to study the incidence, trend, and determinants of suicide by self-poisoning in two Egyptian provinces. Methods: The current study is a bi-designed two-phases observational study carried out in two Egyptian poison control centers including Menoufia Poison Control Center (MPCC) and Tanta Poison Control Center (TPCC). A total of 7,802 patients were enrolled. The first phase of the current study was conducted retrospectively to show the trend of suicide attempts over 2016, 2017, and 2018 when the cases diagnosed as suicide by self-poisoning were extracted from medical record. The second part was conducted prospectively (January 2019-Januaray 2020) among cases of suicide by self-poisoning and accidental poisoning. Results: The current study revealed that incidence of poisoning exposure no matter what its type represented 34.99/100,000 (CI95%: 33.84–36.20) distributed as 28.18/100,000 (CI95%: 27.14–29.26) for suicide by self-poisoning and 6.82/100,000 (6.32–7.36) for accidental poisoning. The suicide by self-poisoning death rate represented 2.08/100,000 (1.90–2.49). The suicide by self-poisoning was significantly associated with young age <25years, low socioeconomic status, being a student or not working. Conclusion: Suicide by self-poisoning shows a continuous increase across time raising a serious concern. Collaborative Efforts are required by to conduct health education and enforce legislation to overcome this serious condition. Keywords: Aluminum phosphide; Egypt; pesticides; self-poisoning; suicide

Breaking the dry ice: A case of accidental carbon dioxide poisoning due to dry ice inhalation

Background: Solid dry ice undergoes sublimation to gaseous carbondioxide (CO2 ) at room temperature. Symptoms of exposure include headache, dizziness, unconsciousness, seizures, even coma and death based on concentrations of CO2 inhaled. We present a case of accidental poisoning due to dry ice inhalation. Case: 35-year-old Caucasian male with a history of depression and tobacco use was brought into the emergency department after he was found unconscious in the walk-in freezer at the fast-food center he was working at. On contacting his coworkers, we were told that the walk-in freezer was out of order, and they had packed it with dry ice. On examination, the patient was tachypneic, tachycardic and was saturating at 89% on room air. Physical examination was normal. Blood work showed acute hypoxic respiratory failure with metabolic acidosis with lactic acid 13.1 mmol/l. Carboxyhemoglobin level was elevated at 5.3% (normal level and smokers 3 to 5%). The patient significantly improved with supplemental oxygen and fluid boluses and was discharged in the next 24 hours. Conclusion: Exposure to dry ice in confined spaces and warm temperatures can lead to carbon dioxide poisoning. Accurate and detailed history taking helps recognize this potentially fatal medical emergency Keywords: dry ice poisoning; carbon dioxide poisoning; accidental poisoning; inhalation toxicity.

An Accidental Emamectin Benzoate Poisoning In Child: A Case Report

Background: Emamectin Benzoate has high GABA (Gamma Amino Butyric Acid) receptor affinity and increase chloride membrane permeability. It is the 4'-deoxy-4'-epi-methyl-amino benzoate salt of avermectin B1 (abamectin), obtained from natural fermentation products of Streptomyces Avermitilis.Report: This case report describes the accidental poisoning of Emamectin Benzoate 5% w/ws in a female child. The child was brought to the emergency department(ED) with complaints of nausea, vomiting and abdominal pain. She consumed a packet of “LURA” (5% w/w Soluble Granule (SG) Emamectin Benzoate) supposing it as a packet of “JALJEERA” (a commonly used beverage) since there was no proper labelling. The patient was hemodynamically stable and underwent vigorous gastric lavage with normal saline, activated charcoal and coconut oil. Her blood report was normal for serum electrolytes and renal function. She was admitted in medical ward for symptomatic management and observation. She was given antiemetics, IV fluids and antacids and discharged in 2 days. In follow up after 1 week, she did not have any complain, her gastrointestinal symptoms had completely resolved and she was doing very well.Conclusion: In absence of specific antidote, vigorous gastric lavage with both activated charcoal and coconut oil improves the outcome in Emamectin Benzoate poisoning.

Drug and Chemical Poisoning Patterns in Makkah Region, Saudi Arabia

This research reveals that drugs and chemicals poisoning have been reported to have severe and fetal side effects on health provided by doctors in statistics and periodical records. This work aimed to explore the interaction among drug and chemical poisoning patterns concerning risk factors, especially gender, age, exposure circumstances, and outcomes in the Makkah region. A retrospective analysis was of clinical drug and chemical poisoning cases (2014–2015). The data were retrieved from the Department of Environmental and Occupational Health, Ministry of Health, Makkah, Saudi Arabia. The Saudi Arabia Ministry of Health received 1216 reports of drug and chemical poisoning during 2014–2015 in Makkah. This study has found that, the most affected gender was that of males (65%). The most affected age category with drug poisoning was over 15 years old (67%), but under 5 years for chemical poisoning (60%). The majority of drug poisoning cases are unknown drugs (42%), which accidental poisoning was a minority compared with other drug causes (27%). Chemical poisoning accidents were the majority causes of the recorded cases (63%). We reported healthy recovered without complications for most patients from drug and chemical poisoning (85–95%). Antidotes were administered in only (5%) of cases, and fatalities were reported (0.5% of cases). We have shown a flagrant increase in the number of people poisoned by drugs and chemical agents during 2015. Increases poisoning cases involved both genders and all studied age categories, especially males over 15 years up to 25 (drugs) and < 5 years (chemicals). Most cases were accidental (chemicals) and reported healthy recovery for most patients.

Clinico- etiological profile of acute poisoning and intoxication in children in western Nepal

Background: Pediatric poisoning is a common emergency. The present study was done to assess the incidence, clinico-etiological profile of acute poisoning and intoxication in children.Methods: This study was conducted in the Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Nepal in which children aged less than 18 years, with history of consumption of poison accompanied or unaccompanied by container or poison or with doubtful history of consumption of poison but with definite signs and symptoms of acute poisoning we included. We also included children with history of bites by poisonous creatures like snakes, scorpions, bees and insects or with doubtful history of bites due to poisonous creatures but with definite acute onset of signs and symptoms locally or systemically.Results: In the present study, during the study duration, 68 children were included. The most common age group of included children was 1 to 5 years (59%). Accidental poisoning was reported in 93% of the cases, while the rest had suicidal poisonings. The most common type of poison used were different types of pesticides (46%). We observed that vomiting was the most common clinical presentation (79%). In our study sample, arrival of 46% of the children was delayed by 30 minutes to 2 hours. Majority of the patients arrived in the afternoon to the hospital (51%).Conclusions: The findings of the present study would enable emergency physicians to identify clinical features of common poisonings among children, which would enable manage the cases better.

Thallium Use, Toxicity, and Detoxification Therapy: An Overview

Thallium (Tl) is released into the environment, where is present at very low levels, from both natural and anthropogenic sources. Tl is considered as one of the most toxic heavy metals; it is a non-essential metal, present in low concentrations in humans. Tl toxicity causes dermatological and gastrointestinal diseases and disorders of the nervous system, and may even result in death. Many isotopes of Tl exist, with different uses. One of the isotopes of this metal (201Tl) is used in cardiovascular scintigraphy and for the diagnosis of malignant tumors such as breast or lung cancer and osteosarcoma bone cancer. Many Tl compounds are tasteless, colorless, and odorless. Due to these characteristics and their high toxicity, they have been used as poisons in suicides and murders for criminal purposes, as well as instances of accidental poisoning. Impaired glutathione metabolism, oxidative stress, and disruption of potassium-regulated homeostasis may play a role in the mechanism of Tl toxicity. Solanum nigrum L. and Callitriche cophocarpa have been suggested as promising agents for the phytoremediation of Tl. In addition, macrocyclic compounds such as crown ethers (18-crown-6) are good candidates to absorb Tl from wastewater. Through this review, we present an update to general information about the uses and toxicity of Tl. Furthermore, the attention is focused on detoxification therapies.

Accidental household poisoning in children: shedding light on the common agents and risk factors

Background: Household poisoning is one of the leading causes of accidental injuries in children. The cause may vary between different countries. The aim of the study was to identify the causative agents as well as risk factors pertaining to our country such as social, demographic, cultural factors and local customs.Methods: This was a descriptive cross-sectional study. All children in the age group of 6 months to 12 years with established diagnosis of acute accidental known household poisoning were included in the study group.Results: Most of the children with accidental poisoning were in the age group of less than 2 years (56.8%), with male preponderance (66.7%). The commonest poisoning agent was kerosene in 45% of the children followed by detergents (9%), drugs (8.1%), paint thinner (7.1%) and ant chalk (4.5%). In 62.2% of cases poisons were not in original container. Socio-demographic factors such as parents’ education status, mother’s employment or type of family did not show significant correlation.Conclusions: Accidental poisoning is a preventable cause of morbidity and rarely even mortality in children. Awareness needs to be generated amongst parents about simple but effective measures in the household to prevent such incidents. Given the pandemic, the presence of children at home constantly increases the importance of vigilance regarding this public health issue.

Risk Factors and Outcome of Acute Poisoning in Childrens

Objective: To determine the risk factors and outcome of acute poisoning in children at a tertiary care hospital of Karachi. Study design: Cross sectional study Place and duration of study: Department of Emergency Medicine, Dr Ziauddin Hospital, Karachi, Pakistan. From January 2019 to January 2021 Methodology: The patients (n=136) were selected of either gender with the precise age group of twelve years. All the patients selected were meeting the inclusion criteria and enrolled with a history of poisoning exposure within 24 hours of arriving at the hospital's emergency department. The name of the toxin, the time since ingestion of the toxic substance, factors prompting coincidental harming like age, ill-advised capacity of hurtful specialists, for example, lamp oil and blanch in soda bottles, simple access of kids to meds utilized by different individuals from the family, mother's schooling, working moms, financial status were completely assembled from the guardians or orderlies as referenced in the Performa. In general, people were poisoned primarily from within their own homes. Non-accidental poisoning cases were omitted. SPSS version 22 was used to analyze the data. Results: Out of 136 patient enrolled in this study mean age was 5.2+2.9 years, 77(56.6%) were male and 59(43.4%) were female and mean time of presentation was 2.3+1.7 hours. Most common risk factor was unsafe storage of chemicals (n=98) (72.1%), followed by education level of mother (n=)65 (47.8%), inadequate supervision of child (n=60) (44.1%), non authorative parenting (n=51) (37.5%), working mothers (n=41) (30.1%), lack of family support (n=30) (22.1%), developmental delay (n=11) (8.1%) and poisonous plant in home garden (n=6) (4.4%). Outcome mainly depends upon type of poisoning and time interval between poisoning and presentation to the hospital, 26 (19.11%) were discharged safely from ER, while 45 (33.08%) admit in wards and 48 (35.29%) were admitted in Intensive Care and 17 (12.5%) were expired in ER. Conclusion: In this study we have concluded that number of accidental poisoning are often occur in toddler and school going children. The major risk factor of acute poisoning found was unsafe storage or easy accessibility of house hold chemicals, second one was low level of education of parents, than non-authorative parenting, and working mothers and lack of family support. The outcome mainly depend upon time interval from ingestion of poison to presentation at hospital and type poisonous agent taken, that can lead to the need of specialized care, prolong hospital stay and sometimes results in death of a child.