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El-Sarnagawy GN, Ghonem MM, Abdelhameid MA, Ali OM, Ismail AM, Shehaby DME. Answer to comments on "Accuracy of Rapid Emergency Medicine Score and Sequential Organ Failure Assessment Score in predicting acute paraphenylenediamine poisoning adverse outcomes". ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024:10.1007/s11356-024-33898-3. [PMID: 38837028 DOI: 10.1007/s11356-024-33898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Al‑Geish Street, Tanta City, Gharbia, 31527, Egypt.
| | - Mona M Ghonem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Al‑Geish Street, Tanta City, Gharbia, 31527, Egypt
| | - Marwa A Abdelhameid
- Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan City, Egypt
| | - Omaima M Ali
- Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan City, Egypt
| | - Asmaa M Ismail
- Department of Pediatrics, Faculty of Medicine, Aswan University, Aswan City, Egypt
| | - Doaa M El Shehaby
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Assiut City, Egypt
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Shokry Zaghary MM, Abd ElKader MM, Mousa REA, Said AM. Patterns and outcomes of acute toxicological cases before, during, and after COVID-19 lockdown in Sohag University hospitals, Egypt. Toxicol Res (Camb) 2024; 13:tfae061. [PMID: 38623093 PMCID: PMC11015990 DOI: 10.1093/toxres/tfae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/13/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024] Open
Abstract
Background Toxicologists manage poisoning by preventing, detecting, and treating it, which requires continuous data collection and analysis of toxicological hazards. Aim of the work The study aims to report and compare the pattern and outcome of acute toxicological cases admitted to Sohag University Hospitals during the COVID-19 lockdown (2020-2021) with the year before (2019) and the year after (2022). Methods This comparative study reviewed the sociodemographic and clinical data in the medical records. The study showed that Sohag University Hospitals received 670 toxicological cases between 2019 and 2022; 105 cases in 2019, 347 cases in 2020-2021, and 218 cases in 2022. Results Most of patients were below seven years with no sex differences. Accidental poisoning was the most frequent toxicity. The oral route was the most common in the three studied periods. During the lockdown, metal phosphide was the most frequent (19.0%), while therapeutic agents were the most reported after the lockdown (23.9%). The delay time showed a significant difference between the studied periods (p-value < 0.001). In the three studied periods, complete recovery was achieved in more than 70% of cases; however, the mortality rate and the rate of complications during the lockdown period (10.4% and 9.5%, respectively) were almost twice those of the year before and the year after the pandemic with significant odds ratio of mortality during pandemic (OR) 0.07 CI 95% (0.02, 0.11). Conclusion The pandemic had a bad impact on outcomes as showed the highest percentage of mortality compared to before and after COVID-19 periods.
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Affiliation(s)
- Meray Medhat Shokry Zaghary
- Department of Forensict Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Mai M Abd ElKader
- Department of Forensict Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Rasha Elhaddad Ali Mousa
- Department of Forensict Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Ahmed M Said
- Department of Forensict Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt
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Elhawary AE, Lashin HI, Fnoon NF, Sagah GA. Evaluation of the rate and pattern of suicide attempts and deaths by self-poisoning among Egyptians before and during the COVID-19 pandemic. Toxicol Res (Camb) 2023; 12:1113-1125. [PMID: 38145090 PMCID: PMC10734599 DOI: 10.1093/toxres/tfad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 12/26/2023] Open
Abstract
Background Concerns about increased suicidal attempts, especially by self-poisoning as a consequence of Coronavirus disease 2019 (COVID-19) pandemic have been raised worldwide. Aim of the study This study aimed to evaluate the rate and pattern of suicide attempts and deaths by self-poisoning among patients admitted to Tanta University Poisoning Control Center one year before and following COVID-19 pandemic declaration in Egypt. It was conducted on the medical records of 3,200 poisoned patients, from March 2019 to February 2021. Demographic, toxicological data and patients' outcomes were collected. Results During the pandemic year, 63.8% of total admitted patients alleged suicidal self-poisoning. Adults significantly decreased from 59% to 52.3%, while adolescents significantly increased from 34.6% to 41.7%. Monthly numbers of admitted suicidal self-poisoned patients significantly decreased during the lockdown but significantly increased from 7% to 26.5%, during the peak of the second wave of the pandemic as well as suicidal deaths (increased from 1.9% to 21.2%). Suicidal self-poisoning in females increased late in the pandemic year and suicidal self-poisoning deaths were significantly reported from rural areas (P = 0.025). The delay time was significantly longer, length of hospital stay was significantly shorter, intensive care unit admission rates and suicidal deaths were significantly increased during the pandemic year (P < 0.001, 0.026, <0.001, <0.001, respectively). Phosphides were the most commonly used poison for committing suicide and suicidal deaths during this year. Conclusion Psychological support should be directed to females and adolescents, especially from rural areas in Egypt to help reduce suicidal attempts and deaths by self-poisoning during any future pandemics and lockdowns.
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Affiliation(s)
- Amira Elsayed Elhawary
- Forensic Medicine and Clinical Toxicology Department, 6 floor, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
| | - Heba Ibrahim Lashin
- Forensic Medicine and Clinical Toxicology Department, 6 floor, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
| | - Noha Fawzy Fnoon
- Neuropsychiatry Department, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
| | - Ghada Attia Sagah
- Forensic Medicine and Clinical Toxicology Department, 6 floor, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
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El-Gharbawy DM, Kabbash IA, Ghonem MM. A nomogram proposal for early prediction of intensive care unit admission in patients with acute antipsychotic poisoning. Toxicol Res (Camb) 2023; 12:873-883. [PMID: 37915484 PMCID: PMC10615807 DOI: 10.1093/toxres/tfad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 11/03/2023] Open
Abstract
Background Early identification of antipsychotic poisoned patients who may have a potential risk for intensive care unit (ICU) admission is crucial especially when resources are limited. Nomograms were previously used as a practical tool to predict prognosis and planning the treatment of some diseases including some poisoning conditions. However, they were not previously investigated in antipsychotic poisoning. Aim The current study aimed to construct a nomogram to predict the need for ICU admission in acute antipsychotic poisoning. Patients and methods: This 2-year study included 140 patients acutely intoxicated with antipsychotics and admitted at Tanta University Poison Control Centre throughout July 2019 to June 2021. Personal and toxicological data, findings of clinical examination and electrocardiography, as well as, results of laboratory investigations at time of admission were recorded. According to the outcome, patients were divided into ICU-admitted and ICU-not admitted groups. Results The results of this study provided a proposed nomogram that included five significant independent predictors for ICU admission in acute antipsychotic intoxications; the presence of seizures (OR: 31132.26[108.97-Inf]), corrected QT interval (OR: 1.04[1.01-1.09]), mean arterial blood pressure (OR: 0.83[0.70-0.92]), oxygen saturation (OR: 0.62[0.40 to 0.83)], and Glasgow Coma Scale (OR: 0.25 [0.06-0.56]). Conclusion It could be concluded that the developed nomogram is a promising tool for easy and rapid decision making to predict the need for ICU admission in acute antipsychotic poisoning.
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Affiliation(s)
- Doaa M El-Gharbawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ibrahim Ali Kabbash
- Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mona M Ghonem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Lashin HI, Sharif AF. Evaluation of various scoring systems as predictors of the need for intensive care unit admission and other adverse outcomes among patients with acute clozapine poisoning. Toxicol Res (Camb) 2023; 12:468-479. [PMID: 37397925 PMCID: PMC10311143 DOI: 10.1093/toxres/tfad029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/25/2023] [Accepted: 04/06/2023] [Indexed: 07/04/2023] Open
Abstract
Acute clozapine poisoning (ACP) is frequently reported worldwide. We evaluated the efficacy of the Poison Severity Score (PSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS) as predictors for intensive care unit (ICU) admission, mechanical ventilation (MV), mortality, and length of hospital stay in patients with ACP. A retrospective cohort study was conducted using records of patients diagnosed with ACP from January 2017 to June 2022 and admitted to an Egyptian poison control center. Analyzing 156 records showed that all assessed scores were significant predictors of the studied outcomes. The PSS and APACHE II score showed the highest area under the curve (AUC) as ICU admission predictors with insignificant variations. The APACHE II score showed the best discriminatory power in predicting MV and mortality. Nevertheless, MEWS exhibited the highest odds ratio (OR) as an ICU predictor (OR = 2.39, and 95% confidence interval = 1.86-3.27) and as a mortality predictor (OR = 1.98, and 95% confidence interval = 1.16-4.41). REMS and MEWS were better predictors of length of hospital stay compared with the APACHE II score. The simpler, lab-independent nature and the comparable discrimination but higher odds ratio of MEWS compared with APACHE II score justify MEWS' superior utility as an outcome predictor in ACP. We recommend using either the APACHE II score or MEWS, depending on the availability of laboratory investigations, resources, and the case's urgency. Otherwise, the MEWS is a substantially feasible, economical, and bedside alternative outcome predictor in ACP.
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Affiliation(s)
- Heba I Lashin
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Asmaa F Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
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Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Sharif AF, Kasemy ZA, Mabrouk HA, Shoeib O, Fayed MM. Could the serum glucose/potassium ratio offer an early reliable predictor of life-threatening events in acute methylxanthine intoxication? Toxicol Res (Camb) 2023; 12:310-320. [PMID: 37125326 PMCID: PMC10141764 DOI: 10.1093/toxres/tfad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Methylxanthines are widely used to manage pulmonary disorders, particularly in developing countries. Methylxanthines are unsafe due to their narrow therapeutic index and associated morbidity and mortality. The current study aimed to investigate the role of glucose/potassium ratio as a substantially useful early predictor of life-threatening events (LTEs) in the form of cardiovascular and neurological complications among methylxanthine users. A retrospective cohort study was conducted using medical records of patients diagnosed with acute methylxanthine intoxications and presented to an Egyptian Poison Control Center for 2 years. A total of 366 patients were enrolled. Of them, 59 patients (16.1%) were complicated with LTEs. The most frequent serious arrhythmia was T wave inversion (45.6% of patients with LTEs). Laboratory investigations that could significantly predict LTEs were the random blood glucose and potassium levels, glucose/potassium ratio, pH, liver transaminases, HCO3 level, hemoglobin, and platelet count (P < 0.05). The glucose/potassium ratio was the best predictor of LTEs (odds ratio = 2.92, and 95% confidence interval = 2.02-4.23). With an excellent area under the curve (0.906) and at a cutoff of 2.44, that ratio could correctly classify the patients based on their risk of LTEs with an overall accuracy of 73% (sensitivity of 88% and specificity of 70%). The current study endorsed an important, feasible, and easily obtainable ratio that could predictor stratify the patients according to severity and risk of LTEs, which guides the decision-making and prioritizes the treatment lines in methylxanthine intoxicated patients.
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Affiliation(s)
- Asmaa F Sharif
- Faculty of Medicine, Forensic Medicine and Clinical Toxicology Department, Tanta University, Tanta 31527, Egypt
| | - Zeinab A Kasemy
- Faculty of Medicine, Department of Public Health and Community Medicine, Menoufia University, Shiben Elkom 6132720, Egypt
| | - Heba A Mabrouk
- Faculty of Medicine, Forensic Medicine and Clinical Toxicology Department, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Osama Shoeib
- Faculty of Medicine, Cardiology Department, Tanta University, Tanta 31527, Egypt
| | - Manar M Fayed
- Faculty of Medicine, Forensic Medicine and Clinical Toxicology Department, Tanta University, Tanta 31527, Egypt
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Severity of emergency department presentations due to acute drug toxicity in Europe: a longitudinal analysis over a 6-year period (2014-2019) stratified by sex. Eur J Emerg Med 2023; 30:21-31. [PMID: 36350710 DOI: 10.1097/mej.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether the severity of acute recreation drug toxicity presentations to emergency departments (EDs) in Europe has changed in recent years and to uncover potential sex differences. DESIGN We analysed presentations to 36 EDs in 24 European countries relating to acute recreational drug toxicity, with separate analysis for presentations involving lone use of cannabis, cocaine, and heroin. As severity markers, we calculated rates of hospitalization, admission to ICU, intubation, and death by annual quarters between 2014 and 2019. Trends on severity over time were estimated by logistic regression. Differences between men and women were assessed by interaction. Sensitivity analysis was performed including only EDs that provided data for all 24 quarters. Analyses of intoxications taken altogether were adjusted by age and sex, while of lone intoxications being also adjusted by ethanol co-ingestion. RESULTS There were 43 633 presentations (median age = 31 years, interquartile range = 25-40 years, men = 76.5%) resulting in 10 344 hospitalizations (23.9%), 2568 ICU admissions (5.9%), 1391 intubations (3.2%), and 171 deaths (0.39%). Hospitalization, ICU admission and death did not differ by sex, but intubation was more frequent in men (3.4% vs. 2.3%, P < 0.001). No significant changes in the severity of drug intoxications over time were found when considered altogether, neither for lone cannabis (n = 4264) nor cocaine (n = 3562). Conversely, significant increases in hospitalization [odds ratios (OR) = 1.023, 95% confidence interval (CI) = 1.004-1.041], ICU admission (OR = 1.080, 95% CI = 1.042-1.118) and in intubation (OR = 1.049, 95% CI = 1.001-1.099) were detected for lone heroin presentations (n = 1997). Sensitivity analysis (32 245 presentations, 14 EDs, 9 countries) confirmed the overall absence of changes in severity markers (except for death rate, which significantly decreased by quarter: OR = 0.968, 95% CI = 0.943-0.994). Additionally, it suggested an increased risk over time of intubation for cocaine (OR = 1.068, 95% CI = 1.009-1.130) and confirmed the increased risk of ICU admission for heroin (OR = 1.058, 95% CI = 1.013-1.105). Changes in severity over time did not differ according to sex in the main analysis of the whole cohort, while a significantly higher decrease in risk of death in men was found in the sensitivity analysis (OR = 0.894, 95% CI = 0.825-969 vs. OR = 0.949, 95% CI = 0.860-1.048; P interaction = 0.042). CONCLUSIONS The severity of presentations to European EDs remained mainly unchanged during 2014-2019, but the risk of death may have decreased. Conversely, intubation in lone cocaine and ICU admission in lone heroin intoxications have increased. Although men and women exhibited a similar pattern over the period for the majority of comparisons, our data suggest that women exhibited a smaller decrease of the overall risk of death.
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Assessment of severity and outcome of poisoning before and during the era of COVID-19 pandemic. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2023. [PMCID: PMC9812360 DOI: 10.1016/j.toxac.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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El-Sarnagawy G, Hafez A, Amer R. Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:138. [DOI: 10.1186/s41983-022-00577-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Suicidal poisoning is a major concern during the COVID-19 pandemic that has several physical and mental hazards. This study aimed to evaluate the characteristics of suicidal poisoned patients admitted to a tertiary poison control center during the pandemic lockdown and assess COVID-related knowledge and attitude among those patients to identify the high-risk group for suicide. This cross-sectional study was conducted on acutely poisoned patients admitted to Tanta University Poison Control Center from June to December 2020. Upon admission, socio-demographic data, causative poisoning agents, COVID-related knowledge and attitude, Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) were collected from all participants.
Results
A total of 254 poisoned patients were categorized into suicidal (85.04%) and accidental (14.96%) poisoning groups. The former was caused mainly by phosphides and was significantly associated with a history of using psychotropic medications and high HAM-A and HAM-D results. Logistic regression analysis showed that a history of psychiatric illness, low attitude scores, and high HAM-D scores were significant risk factors for suicidal poisoning.
Conclusions
Considerable number of suicidal poisoned patients had moderate-to-severe depressive symptoms, highlighting the importance of providing specialized psychiatric services in poisoning centers, particularly among vulnerable populations, to prevent the overwhelming repeated suicidal attempts.
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Seydou A, Hachelaf M, Thiébaud D, Barondeau-Leuret A. Évolution du nombre de passages aux urgences pour intoxications aiguës lors des périodes de confinement de Covid-19 en Bourgogne-Franche-Comté. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Estimer l’évolution du nombre de passages aux urgences pour intoxications aiguës (IA) lors des périodes de confinement en 2020 par rapport à l’année précédente.
Matériels et méthode : Une étude rétrospective multicentrique de type transversale a été menée en utilisant les données des résumés de passages aux urgences. Deux périodes ont été étudiées en 2020 : période 1 = 1er confinement et période 2 = 2e confinement et ont été comparées aux mêmes périodes en 2019. Les diagnostics pour IA volontaires ou accidentelles toutes causes ont été définis à partir du code CIM-10. Le critère de jugement principal a été la variation du nombre de passages aux urgences pour IA entre les périodes de confinement en 2020 et les périodes de référence en 2019.
Résultats : Comparé à la même période en 2019, le nombre de passages aux urgences pour IA a baissé de 31 % (p = 0,001) pendant le premier confinement et de 18 % (p = 0,07) pendant le deuxième confinement. Le nombre de passages pour IA médicamenteuse a baissé de 3 % (p = 0,035) pendant le deuxième confinement en comparaison à 2019. Les caractéristiques des patients consultant pour IA étaient comparables dans chacune des périodes.
Conclusion : Dans cette étude, une diminution du nombre de passages aux urgences pour IA a été observée pendant les périodes de confinement en 2020 par rapport aux mêmes périodes l’année précédente.
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Crescioli G, Lanzi C, Gambassi F, Ieri A, Ercolini A, Borgioli G, Bettiol A, Vannacci A, Mannaioni G, Lombardi N. Exposures and suspected intoxications during SARS-CoV-2 pandemic: preliminary results from an Italian poison control centre. Intern Emerg Med 2022; 17:535-540. [PMID: 34091841 PMCID: PMC8180185 DOI: 10.1007/s11739-021-02774-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/22/2021] [Indexed: 12/26/2022]
Abstract
Data on cleaner and disinfectant exposure and misuse-related acute intoxications in Italy during SARS-CoV-2 pandemic are still lacking. The aim of the present study was to analyse and describe cleaner and disinfectant-related intoxications during SARS-CoV-2 pandemic in an Italian poison control centre. Data were obtained from the toxicological consultations requested to the Toxicology Unit and Poison Centre, Careggi University Hospital, Florence (Italy). We compared data from January 1st to April 30th of 2019 and 2020. Data concerning probable or acute intoxication from any causative agent in the general population (all age groups), from private individuals or from Regional and National health structures, were included in the analysis. A toxicological evaluation was also performed to calculate the Poisoning Severity Score.In 2019, 451 phone counselling sessions were performed and compared to a total of 410 calls received during the same period of 2020. In both periods, the majority of events occurred in paediatric (0-17 years) and adult (18-65 years) patients, who were mainly exposed to one toxic agent, and intoxications took place principally at home due to domestic accidents. The oral route of intoxication was the most frequently observed one, followed by inhalation of toxic agents, which increased by 4.7% in 2020. In 2020, sanitizers and cleaners were reported in 21.6% of cases compared to 12.5% in 2019. This is the first study describing cleaner and disinfectant-related intoxications in Italy. Our results suggested a possible misuse of these products during the SARS-CoV-2 pandemic, underling the effects of home isolation on mental health and unintentional toxic exposures.
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Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6-50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Cecilia Lanzi
- Toxicology Unit and Poison Center, Careggi University Hospital, Florence, Italy
| | - Francesco Gambassi
- Toxicology Unit and Poison Center, Careggi University Hospital, Florence, Italy
| | - Alessandra Ieri
- Toxicology Unit and Poison Center, Careggi University Hospital, Florence, Italy
| | - Anita Ercolini
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6-50139, Florence, Italy
| | - Giulia Borgioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6-50139, Florence, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6-50139, Florence, Italy.
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.
| | - Guido Mannaioni
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6-50139, Florence, Italy
- Toxicology Unit and Poison Center, Careggi University Hospital, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6-50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
- Toxicology Unit and Poison Center, Careggi University Hospital, Florence, Italy
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13
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Singla N, Behera A, Sharma N, Sharma N. Paradigm shift in pattern and prevalence of poisoning during COVID-19 pandemic. J Family Med Prim Care 2022; 11:208-214. [PMID: 35309638 PMCID: PMC8930117 DOI: 10.4103/jfmpc.jfmpc_916_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022] Open
Abstract
Objective: Material and Methods: Results: Conclusions:
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14
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Sharif AF, Gameel DEGE, Abdo SAEF, Elgebally EI, Fayed MM. Evaluation of Pediatric Early Warning System and Drooling Reluctance Oropharynx Others Leukocytosis scores as prognostic tools for pediatric caustic ingestion: a two-center, cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:5378-5395. [PMID: 34420162 PMCID: PMC8380116 DOI: 10.1007/s11356-021-15988-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
Caustic chemicals are widely distributed in our environment. Exposure to caustic agents is a lifelong problem associated with severe tissue and mucous membrane injuries. In pediatrics, corrosive exposure is the most common cause of nonpharmaceutical exposure presenting to poison control centers. Therefore, this study evaluated the role of the Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) scores as early in-hospital outcome predictors following corrosive ingestion. The current study was a two-center, retrospective, cross-sectional study carried out among pediatric patients diagnosed with acute caustic ingestion during the past 4 years. Most exposure occurred accidentally among boys (59.4%) living in rural areas (51.9%) of preschool age (50% were 2-4 years old). Residence, body temperature, respiratory rate, vomiting, skin and mucosal burns, retrosternal pain, respiratory distress, Oxygen (O2) saturation, Glasgow Coma Scale score, HCO3 level, total bilirubin level, anemia, leukocytosis, and presence of free peritoneal fluid were significant predictors of esophageal injuries (p < 0.05). DROOL and PEWS scoring were the most significant predictors of esophageal injuries with worthy predictive power, where odds ratio (95% confidence interval (CI)) was 1.76 (0.97-3.17) and 0.47 (0.21-0.99) for PEWS and DROOL, respectively. At a cutoff of < 6.5, the DROOL score could predict esophageal injuries excellently, with AUC = 0.931; sensitivity, 91.7%; specificity, 72.5%; and overall accuracy, 91.3%. At a cutoff of > 6.5, PEWS could significantly predict unfavorable outcomes, with AUC = 0.893; sensitivity, 94.4%; specificity, 71.9%; and overall accuracy, 89.3%. However, PEWS better predicted the need for admittance to the intensive care unit (ICU). Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) are potentially useful accurate scorings that could predict the esophageal injuries and ICU admission following corrosive ingestion in pediatrics.
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Affiliation(s)
- Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina El Gameel El Gameel
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Poison Control Center, Aseer, Saudi Arabia
| | - Sanaa Abd El-Fatah Abdo
- Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elsayed Ibrahim Elgebally
- Department of Pediatric, Menoufia University, Shebeen Al-kom, Egypt
- Pediatric Department, Saudi German Hospital, Aseer, Saudi Arabia
| | - Manar Maher Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
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15
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Spinelli A, Willeman T, Roustit M, Stanke-Labesque F. COVID-19 lockdowns and incidence of psychoactive substance exposure according to age and sex. Clin Toxicol (Phila) 2021; 60:596-601. [PMID: 34904494 DOI: 10.1080/15563650.2021.2013494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The lockdown periods imposed in 2020 by governments had deleterious consequences on population mental health. Several studies based on declarative data have suggested that the lockdown periods were associated with changes in psychoactive substance use but few relied on toxicological analyses. AIMS We studied the impact of lockdowns on the pattern of routine care toxicological screening performed on patients hospitalized at the emergency ward (EW) and intensive care units (ICU) at the Grenoble University Hospital. METHOD This was a retrospective, monocentric study comparing routine care toxicology biological tests performed in children older than 12 years of age and adults hospitalized at the ICU and EW in 2018, 2019, and 2020. Alcohol, illicit drugs, and medications were screened. Generalized linear models were generated to evaluate the effect of the lockdown periods on toxicology results, considering age and sex. RESULTS The study included 13,910 samples from 11,786 patients. There was no significant difference in the repartition of sex or age over the three years. The frequency of positive toxicological tests increased during the lockdown periods (adjusted odds ratio (OR) 95% confidence interval (CI): 1.14, (1.01-1.28), p = .026). The frequency of poly-exposures also rose during these periods (OR 1.43 (1.11-1.82), p = .004) mostly among men (OR 1.54 (1.02-2.04), p = .022), 12-25-year-old patients (OR 1.69 (1.07-2.31), p = .016), and seniors (>56 years) (OR 1.54 (1.00-1.97), p = .032). CONCLUSIONS This study suggests that lockdown episodes were associated with increased incidence of psychoactive substance poly-exposures, highlighting the need for preventive strategies for high-risk populations.
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Affiliation(s)
- Aurélien Spinelli
- University Grenoble Alpes, Grenoble, France.,Pharmacology, Pharmacogenetics and Toxicology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Theo Willeman
- Pharmacology, Pharmacogenetics and Toxicology Laboratory, Grenoble Alpes University Hospital, Grenoble, France.,Forensic Medicine Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Matthieu Roustit
- University Grenoble Alpes, Grenoble, France.,Clinical Investigation Center, Grenoble Alpes University Hospital, Grenoble, France
| | - Françoise Stanke-Labesque
- University Grenoble Alpes, Grenoble, France.,Pharmacology, Pharmacogenetics and Toxicology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
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16
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Naguib YM, Sherif HA, Elbalshy AT, Edrees EA, Sabry AE, Sharif AF, Aloshari SHA, Kasemy ZA. Prevalence and associated risk factors of cannabinoid abuse among Egyptian university students: a cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:68706-68716. [PMID: 34273073 PMCID: PMC8285707 DOI: 10.1007/s11356-021-15412-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Global surveys have highlighted rise in consumption of cannabinoids among residents of both developed and developing countries. Cannabinoids cause severe damage to the cardiovascular, nervous, respiratory, and renal systems, and have been linked with several deaths. Despite these adverse health effects, the use of cannabinoids has rapidly increased. This work seeks to estimate the prevalence of cannabinoid abuse among Egyptian university students and explore the associated risk factors. A cross-sectional study was carried out over 3 months (1st of July-1st of October 2020) and included 2380 students. Participants were subjected to a pre-designed self-administered questionnaire that included demographic data, Addiction Severity Index, and Depression Anxiety Stress Scale. Among the participating students, 4.9% of them reported cannabinoid abuse and 41% reported smoking cigarettes. The most used substances were hashish (96.5%), Strox (41.3%), Bhang (34.4%), voodoo (34.4%), and Tramadol (31.1%). Gender and social status were also significantly related to rates of substances abuse; most illicit drug users were males (93.1%), and the majority was of low (41.3%) or moderate (50.8%) socioeconomic status. The most significant risk factors associated with substance use were positive history of family conflict (OR=6.48; CI95%: 5.08-8.64, p<0.001), encouragement by peers (OR=2.95; CI95%: 1.73-5.05, p<0.001), male gender (OR=5.46; CI95%: 2.40-12.44, p=0.001), positive history of child abuse (OR=2.85; CI95%: 1.96-3.04, p=0.001), having a stay-at-home mother (OR= 1.56, CI95%: 1.19-2.04, p=0.001), living in an urban area (OR=2.22; CI95%: 1.53-5.0, p=0.002), and positive family history of substance use (OR=1.98; CI95%: 1.48-2.08, p=0.045). This study emphasizes the possible significant rise in substance use among university students. Awareness campaigns should target both students and student families.
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Affiliation(s)
- Yahya M Naguib
- Physiology Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Department of Medical Physiology, Faculty of Medicine, Menoufia University, Shibin El Kom, Menoufia, Egypt
| | - Huda A Sherif
- Medical Student at Faculty of Medicine, Menoufia University, Shibin El Kom, Menoufia, Egypt
| | - Amr T Elbalshy
- Medical Student at Faculty of Medicine, KasrAlainy, Cairo University, Giza, Egypt
| | - Eslam A Edrees
- Medical Student at Faculty of Medicine, Menoufia University, Shibin El Kom, Menoufia, Egypt
| | - Ahmed E Sabry
- Medical Student at Faculty of Medicine, Menoufia University, Shibin El Kom, Menoufia, Egypt
| | - Asmaa F Sharif
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Clinical Medical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Samar H A Aloshari
- Department of Public Health and Community Medicine Faculty of Medicine, Taiz University, Taiz, Yemen
| | - Zeinab A Kasemy
- Department of Public Health and Community Medicine Faculty of Medicine, Menoufia University, Shibin El Kom, Menoufia, Egypt.
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Sharif AF, AlAmeer MR, AlSubaie DS, Alarfaj NH, AlDawsari MK, AlAslai KM, BuSaleh MJ, AlSabr AI, Al-Mulhim KA. Predictors of poor outcomes among patients of acute methanol intoxication with particular reference to Sequential Organ Failure Assessment (SOFA) score. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:60511-60525. [PMID: 34156622 DOI: 10.1007/s11356-021-14998-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Methanol intoxication is a global problem with serious morbidities and mortalities. Apart from the lifelong disabilities experienced by methanol intoxication survivors, mortality rates of up to 44% of exposed patients have been reported. The aim of the current study was to outline the early findings that could be utilized as effective in-hospital outcome predictors among cases of methanol exposure. Furthermore, the role of the Sequential Organ Failure Assessment (SOFA) score was evaluated as an early in-hospital outcome indicator among patients presented with acute methanol intoxication. A multicenter study including 37 patients diagnosed with acute methanol intoxication and referred to three major poison control centers in Saudi Arabia during the past 3 years (January 1, 2018-January 1, 2021) was conducted. Data including demographics, exposure history, presenting complaints, clinical findings, and laboratory investigation were collected. The patients were scored on Glasgow Coma Scale (GCS), Poison Severity Score (PSS), and SOFA score on admission. Out of the presented patients, 83.8% were alcoholic men. No deaths have been reported, and 51.4% were discharged with unfavorable outcomes, including 29.7% suffered optic neuropathy and blindness, 18.9% showed acute renal impairment, and 10.8% were complicated with respiratory failure. The diastolic blood pressure, anion gap, visual acuity, number of hemodialysis sessions, PSS, duration of Intensive Care Unit (ICU) stay, and SOFA score were all significant organ failure predictors (P < 0.05). However, only the SOFA score showed the best significant prediction on multivariate analysis, with an odds ratio (95% confidence interval) of 0.10 (0.04-0.17) and P = 0.003. At a cutoff of greater than 4.5, the SOFA score could significantly predict unfavorable outcomes with area under curve (AUC) = 0.955, accuracy 89.2%, specificity 94.4%, and sensitivity 84.2%. Early identification of methanol exposed patients at risk is critical and lifesaving. The SOFA score is a substantially useful and early inclusive unfavorable outcome predictor.
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Affiliation(s)
- Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, El Geish Street, Tanta, Gharbia, 31527, Egypt.
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia.
| | - Mahdi Riyadh AlAmeer
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Respiratory Care Department, Riyadh Care Hospital, Riyadh, Saudi Arabia
| | - Duhaim Saad AlSubaie
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Emergency Medicine Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Naser Husam Alarfaj
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Administartion of Radiology Department, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - Mubarak Khalifah AlDawsari
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Diagnostic Radiology Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Khalid Mansour AlAslai
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Emergency Medicine Department, Prince Mohammed Bin Abdulaziz Hospital (PMAH), Riyadh, Saudi Arabia
| | - Mahmoud Jawad BuSaleh
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Abdulaziz Ibrahim AlSabr
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
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Sharif AF, Fayed MM. Evaluation of Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA) score as in-hospital outcome predictors among cases of hydrogen cyanamide exposure: a cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:42161-42176. [PMID: 33797718 DOI: 10.1007/s11356-021-13655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
Dormex is widely used as a plant growth regulator in developing countries such as Egypt as well as worldwide. Despite the widespread use of Dormex, little is known about the exact mechanism of action and toxic profile. The current study aims to outline the factors that predict in-hospital outcome and the need for intensive care unit (ICU) admission among the patients who presented with acute hydrogen cyanamide exposure as well as to evaluate the roles of the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA) score as unfavorable outcome predictors. This is a retrospective cross-sectional study including all cases diagnosed with acute hydrogen cyanamide exposure who presented to the Tanta Poison Control Center during the past 6 years (January 1, 2015-January 1, 2020). Patient data were collected in a case report form, including the history of exposure, clinical data, laboratory investigations, and radiologic studies. Four scoring systems were carried out upon presentation: the Glasgow Coma Scale, poison severity score, MODS, and SOFA score. Thirty-five patients were enrolled in the current study. Most of the presented cases were males exposed unintentionally in an occupational setting. The mean participant age was 34.1 ± 15.51 years. The most common presenting complaints were throat irritation in all cases, vomiting and hallucinations presented equally in 68.6%, and headache occurred in 51.4%, whereas skin and mucous membrane burn was present in 40% of cases. Patients showing one or more of the following criteria were expected to have an urgent need for ICU admission: MODS >3.5, SOFA >4.5, length of hospital stay >30 hours, prothrombin time >14.75 seconds, serum glutamic pyruvic transaminase >67.5 U/L, and serum glutamic oxaloacetic transaminase >58.5 U/L. When the length of hospital stay was combined with the four scoring systems, only MODS yielded a significant prediction. Study results indicate that MODS and SOFA scores are considered excellent outcome predictors; MODS is more accurate, specific, and treatment independent, whereas the use of the SOFA score is more feasible with simple cardiovascular function assessment.
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Affiliation(s)
- Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, El Geish Street, Tanta, Gharbia, 31527, Egypt.
- Clinical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia.
| | - Manar Maher Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, El Geish Street, Tanta, Gharbia, 31527, Egypt
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