All rights reserved. AbstractPhosphides poisoning is a commonly encountered poisoning in most developing countries and is emerging as a common self-poisoning agent. Over the past 20 years, biochemical markers of brain damage have been increasingly studied as potential tools for prognostic evaluation. S-100β protein is the β-subunit of a calcium binding protein present mainly in glial and Schwann cells. The current study was conducted to evaluate central nervous system affection and the prognostic value of S-100β protein for prediction of mortality after acute phosphides intoxication. Twenty nine patients admitted to Poison Control Unit (Emergency Hospital, Tanta University) suffering from acute phosphide poisoning in nine months period were included in this study. For all patients sociodemographic, clinical and toxicological data were explored. One milliliter venous blood was withdrawn for analysis of S-100β protein level. Primary outcome included mortality. Meanwhile, secondary outcomes included GCS, hypotension and length of hospital stay. There was statistical significant difference between survivor patients and non-survivor patients regarding blood pressure. Meanwhile, no statistical significant difference was noticed between survivors and non-survivors in either GCS, pulse or duration of hospital stay. Toxicological data of the participant patients revealed that (96.6%) of patients were in suicidal attempts by oral route. Zink phosphide was identified in (75.9%) of patients, while, aluminum phosphide was recognized in (24.1%) patients. Serum level of S-100β concentrations was significantly increased in phosphide intoxicated patients compared to the reference value for detection of injury to neural tissue (0.1 µg/L). There was significant negative statistical correlation between serum S-100β concentrations and GCS. Analysis of (ROC) curve of serum S-100β level as a predictor of mortality showed (AUC) = 0.956, P <0.0001* at a cut off value > 1.762 ug/l, serum S100β had a sensitivity of 100% and a specificity 95%. (PPV) was 95%, while (NPV) was 100%.

Early identification of cholinesterase inhibitor (AChEI)-poisoned patients who are at risk of respiratory insufficiency or death is crucial to initiate proper interventions. The present study aimed to compare Glasgow Coma Scale (GCS), acute physiology and chronic health evaluation (APACHE II), rapid acute physiology score (RAPS), rapid emergency medicine score (REMS) and simple clinical score (SCS) in order to predict the need of mechanical ventilation (MV) and the risk of mortality in AChEIs poisoning. A retrospective study was conducted on 118 patients with acute AChEIs poisoning. The patients' data were collected from their hospital records. The studied scoring systems were evaluated on admission. Statistical analysis revealed that the median APACHE II, GCS, REMS, RAPS, and SCS differed significantly between MV patients and non-MV as well as between non-survivors and survivors. RAPS and REMS scores showed the highest discriminatory power in prediction of MV and mortality. No significant differences were detected between the studied scores as predictors of MV and mortality except for SCS which was significantly inferior to RAPS and REMS in prediction of MV. In conclusion, the admission REMS or RAPS seem to have valuable prognostic abilities in AChEIs poisoning for identification of patients who require MV or at increased risk of mortality.

No abstract

All right received. Introduction icin toxin (RT) is considered one of the most potent and lethal naturally-occurring substances that ever known; in humans, the median lethal dose of ricin (LD50) after injection or inhalation is about 22 µg/kg of body weight, meanwhile, the estimated lethal oral dose is 1 mg/kg. Hence, some of orally administered ricin is inactivated in the stomach therefore, it becomes less toxic. Meanwhile, ricin toxicity is very limited through intact skin because of its large molecular size and high charge. Ricin is a water-soluble glycoprotein which was firstly extracted from the seeds of castor bean plant (Ricinus communis) by the researcher Peter Hermann Stillmark. Because of its high toxicity, wide availability and the ease of its manufacture, ricin has been considered as one of the biological warfare agents (EFSA, 2008; Moshiri et al., 2016 and Zhou et al., 2017).

Acute theophylline toxicity is still an important cause of intoxication with major consequences; significant morbidity and mortality. Conflicting reports about both age and serum theophylline concentrations as predictors for development of major toxic effects were suggested by many authors. However, little is known about electrocardiography (ECG) as predictor of mortality and major outcome events in acute theophylline poisoned patients. The current observational cross sectional study was conducted to evaluate electrocardiographic findings as predictor of mortality and major outcome events [intensive care unit (ICU) admission, need for mechanical ventilation and need for hemodialysis] in acute theophylline toxicity. Twenty eight adult patients acutely exposed to theophylline have participated in the study. The severity of symptoms and signs of acute theophylline poisoning was graded into mild, moderate and severe grade theophylline poisoning. Electrocardiography was recorded and analyzed for rate, rhythm, axis, voltage, ST and T wave abnormalities, conduction defects, PR interval. The ECG changes induced by acute theophylline poisoning were graded into minor, moderate and severe. Corrected QT interval (QTc) was estimated according to Bazett's formula; QTc= QT/ √RR. Both normal and severe ECG changes were recorded in seven (25%) patients each. Meanwhile, moderate ECG changes were verified in 14 (50%) of patients. Fourteen patients (50 %) showed a prolonged QTc interval. Grading of ECG changes revealed significant statistical association with theophylline poisoning severity, theophylline level and major outcome events (ICU admission and need for hemodialysis). Meanwhile, no significant statistical association was perceived between QTc interval and any of sociodemographic, toxicological & clinical data, mortality and major outcome events.