Effect of pulse therapy with glucocorticoid and cyclophosphamide in lung fibrosis due to paraquat poisoning in rats

OBJECTIVE

To evaluate the effectiveness of cyclophosphamide and methylprednisolone pulse therapy in the prevention of pulmonary fibrosis due to paraquat poisoning in rats.

METHODS

This study was carried out in Sina Hospital, Tabriz, Iran, between February and August 2009. Acute poisoning in rats was induced by intraperitoneal injection of Paraquat (15 mg/kg). We planned 2 separate treatment groups (10 rats each), pulse therapy with methylprednisolone (26.5 mg/kg) and cyclophosphamide (15 mg/kg) intraperitoneally for 3 days (PQ+P) and treatment with conventional anti-oxidant drugs including vitamin A, vitamin E, and N-acetylcysteine (PQ+Vit). Prevention of pulmonary fibrosis was evaluated on the fifteenth day. A semi-quantitative determination of lung fibrosis was carried out (Ashcroft staging criteria) on the lung sections and results compared with the paraquat control group (PQ).

RESULTS

The mean score of fibrosis in the PQ was 4.60+/-1.20, in PQ+P was 2.93+/-0.72, and for PQ+Vit groups was 4.25+/-1.08. The score of fibrosis in the PQ+P was significantly lower than the PQ group (p=0.011), while there was no significant difference in the average score of lung fibrosis between the PQ and PQ+Vit groups.

CONCLUSION

Pulse therapy with cyclophosphamide and methylprednisolone significantly prevented pulmonary fibrosis. Therefore, we recommend it along with conventional therapies in the treatment of acute paraquat poisoning.

Respiratory failure in organophosphate insecticide poisoning

OBJECTIVE

Organophosphate compounds (OP) are usual insecticides and may poison human beings in a suicide attempt or accidental exposure. They inhibit activity of cholinesterase. Poisoning may be enough sever for intensive care support. In this paper, we study the prevalence and management of sever cases as well.

METHODS

We studied patients with OP poisoning, from November 2002 to November 2005 in Sina Hospital, Tabriz, Iran, retrospectively and found patients who needed intensive care. During 4 years study, we documented 80 patients who were hospitalized due to OP poisoning and used drugs. Treatment with intravenous atropine and pralidoxime was started as soon as possible. We did not administer pralidoxim for 20 patients due to late admission (5 patients) and unavailability of the medicine (15 patients).

RESULTS

Forty-five male and 35 female patients were enrolled in our study. The majority of the patients used OP for suicide attempt and 4 patients had accidental exposure. The mortality rate was 18% in patients who were treated with pralidoxim and patients without pralidoxim had a mortality rate of 21%. Ten patients were mechanically ventilated and the mortality rate was 50%. In patients without MV the mortality rate was 11.7%. The duration of intensive care stay was 7.1 +/- 2 days.

CONCLUSION

Organophosphate compounds poisoning is a serious and lethal condition and needs early diagnosis and appropriate treatment. In patients with respiratory failure the mortality is very high; therefore we recommended early diagnosis, careful monitoring and appropriate management of complications in reducing the mortality rate.