A Three-Year Study on Acute Poisoning Cases Brought for Medico-Legal Autopsy in a North-Eastern City of India

GC-MS/MS analysis of chlorpyrifos in forensic samples with varied survival time

Organophosphorus pesticides are extensively used in the agricultural sector to kill insects, worms, and other pests. Many people may be poisoned by chlorpyrifos either accidentally or intentionally, including accidental, suicidal, and homicidal poisoning cases in India. The effect of chlorpyrifos on human health depends on factors such as the time, amount and frequency of exposure, the individual's health, and certain environmental conditions. The main objective of this investigation is to identify the post-mortem biological sample that shows the longest detection window, enabling precise chlorpyrifos detection in cases of acute poisoning with varying survival durations. Our research focuses on the detection and distribution of chlorpyrifos in cases of acute poisoning using a simple liquid-liquid extraction and GC-MS/MS analysis. We validated the method, which proved to be effective and reliable. Upon examining various organs, we detected the presence of chlorpyrifos in the stomach tissue, liver tissue, kidney tissue, and blood samples of individuals who consumed chlorpyrifos and passed away immediately, as well as in those who survived for the first 3 days following ingestion. Analysing urine, blood, and liver tissue from individuals who survived for 3 days provided more precise results compared to stomach tissue. Additionally, urine samples played a crucial role in detecting chlorpyrifos in individuals who survived for 4 and 5 days. A blood sample is the most suitable post-mortem biological sample for detecting chlorpyrifos in individuals who survived for a duration of 2 to 4 days. This finding highlights the significance of analysing urine as a valuable sample type, particularly in determining the presence of chlorpyrifos in cases where individuals have survived for a long period of time before their demise. The experimental data and information provided in this study will serve as a valuable resource for forensic toxicologists.

Knowledge, Attitude, and Practice of Nurses Toward the Initial Managements of Acute Poisoning in Public Hospitals of Bahir Dar City, Northwest Ethiopia 2022: Cross-Sectional Study

Introduction

Poisoning is a common cause of medical visits and hospitalizations around the world. The knowledge, attitude, and practice of nurses in the management of acute poisoning are very poor in developing countries, such as Ethiopia. According to the previous study, 75% and 45% of nurses had unsatisfactory knowledge and practice, respectively.

Objectives

This study aimed to assess the knowledge, attitude, and practice of nurses toward the initial management of acute poisoning.

Method

An institution-based cross-sectional study design was used to recruit 422 nurses from public hospitals of Bahir Dar city in Ethiopia. A systematic random sampling method and an English version of self-administered questionnaires were used to collect the data. The data were entered into Epi Data and analyzed using SPSS version 25.

Results

The study recruited 422 nurses, with a response rate of 100%; 248 (58.8%) and 264 (62.2%) of the nurses had good knowledge and practice, respectively. Slightly more than half (57.6%) of the nurses had a positive attitude. Nurses who worked in an emergency and intensive care unit had twice the odds of having more knowledge and practice than those who worked in an outpatient department (AOR = 2.1, CI: (1.019, 4.540), p = 0.001). Nurses who have MSc degree were twice (AOR = 2.1, CI: (1.019, 4.540), p = 0.001) and three times (AOR = 3.1, CI: (1.012, 7.140), p = 0.002) to have good knowledge and practice than those who have a diploma.

Conclusion

Slightly more than half of nurses had good knowledge, practice, and a positive attitude. Educational status, working in an emergency department, and having training in poison management have been significantly associated with the knowledge and practice of nurses. The authors recommended that there is a need to empower the attitude, knowledge, and practice of nurses through consistent training, accessing, and updating guidelines (poisoning management protocol). The author also suggested that the poison management protocol be incorporated into the Ethiopian nursing curriculum (certificates).

Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries

The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.

Acute poisoning in children: Etiology, structure, treatment tactics and outcomes

Introduction: Acute poisoning is often observed in children and can have serious consequences since it is characterized by rapid development of symptoms and obvious disfunction of vital organs.

Materials and methods: Retrospective analysis of the case histories of the children with acute poisoning admitted to Voronezh Regional Children’s Clinical Hospital No. 1 in 2016–2019 was carried out. Anamnesis, clinical and laboratory studies and effective treatment criteria were entered into electronic spreadsheets and served as the basis for a database on children’s poisoning.

Results and discussion: Analysis of 183 case histories of children with intoxication aged 4 months to 17 years old was performed. Distribution per age showed bimodal peaks at 1–2 years and 13–14 years. Poisoning was accidental in 96.2% of the cases, and 3.8% of the adolescents reported suicide cases. In the group of young children, acute drug poisoning is more frequent in girls (P < 0.05). In the older groups, there is no gender difference in frequency of poisoning cases.

Early call for medical help is typical for the adolescent age group. Correlation between time of help-seeking and children’s age is statistically significant (correlation coefficient r = 0.38, P < 0.05).

Conclusion: Study of poisoning issue in children will allow to carry out targeted preventive measures to reduce the number of poisoning cases, prevent their consequences and to determine the most rational modus operandi for medical personnel for effective and safe pharmacotherapy.

Graphical abstract

In pediatric practice, intoxication by poisons and drugs is among the most common reasons for seeking medical help and hospitalization in intensive care units. It is important to study and record dynamics, structure and frequency of acute poisoning with subsequent development of prevention and treatment methods.