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Abstract Introduction Datura stramonium poisoning, resulting from the ingestion of seeds, leaves, or flowers of Datura stramonium, is a severe condition with significant risks, particularly for young children. Most documented cases of Datura stramonium poisoning in the literature involve teenagers who intentionally ingest the plant to induce hallucinogenic and euphoric experiences. This report presents a rare instance of unintentional Datura stramonium poisoning in a 3year-old Ethiopian toddler. Case presentation He presented with symptoms consistent with anticholinergic toxidrome, including altered mental status, agitation, seizures, dilated pupils, and tachycardia. Laboratory tests, including complete blood count, liver function test, renal function test, electrolyte levels and cerebrospinal fluid analysis were normal. Results of blood toxicology screen were negative. Timely recognition and supportive care lead to a positive outcome. Conclusion Through this report, we aim to add to the limited body of literature on Datura stramonium poisoning in toddlers and offer insights into its clinical course and management in paediatric patients.

Abstract This paper reports on a 22-year-old male presenting with persistent chest pain accompanied by mediastinal emphysema. We firstly considered mediastinal emphysema induced by community acquired pneumonia. Pathogen detection was performed but no positive results were found. Based on the results of a subsequent lung CT scan, paraquat poisoning was suspected. Although there was no trace of paraquat in the blood, the nebulizer masks used by patient at home was found to be positive for paraquat. The diagnosis was ultimately established as paraquat poisoning via inhalation with mediastinal emphysema. This case report explores the clinical manifestations, diagnostic challenges, and treatment complexities of inhaled paraquat poisoning, emphasizing the importance of recognizing this rare poisoning route and its atypical symptoms.

Abstract Background Recurrent depressive disorder (RDD) is mainly manifested as a low mood, negative and pessimistic mood, and often presents suicidal tendencies when severe. This study reports on a patient with RDD who experienced rat poison poisoning occurring tongue biting. The patient’s psychiatric symptoms improved after receiving emergency management and subsequent combined medical care. Case presentation The patient was a 51-year-old female with RDD complicated with rat poison poisoning. Tongue bite occurred on the third day of hospitalization. She received emergency treatment. Depression, anxiety and suicide risk assessment, safety management and caregiver-health education were conducted on the day of admission and before discharge. At the follow-up after discharge, the risk of suicide was reduced. Conclusions Suicide in patients with RDD is characterized by repetition and complexity. The occurrence of clinical cases involving tongue bite after gastric lavage is rare. Suicide assessment and emergency management play an auxiliary role in the treatment of patients with recurrent depressive disorder.

Purpose Acetaminophen overdose accounts for the largest proportion of pediatric poisoning reported in South Korea. We investigated the characteristics and prognosis of pediatric acetaminophen overdose. Methods We retrospectively reviewed medical records of patients younger than 19 years with acetaminophen overdose who visited the emergency department (ED) of Pusan National University Children’s Hospital from January 2009 through December 2022. We investigated age, sex, dose, clinical findings, and treatment, and compared the differences in the variables according to the intentionality of ingestion and the presence of hepatotoxicity. Results Among the 132,691 pediatric patients who visited the ED during the period, 555 did for drug intoxication, of whom 51 with acetaminophen overdose were included in this study. The overdose was intentional in 43 patients (the intentional group; median age, 15.4 years [interquartile range, 13.9-16.8]) and accidental in 8 patients (the accidental group; 7.7 years [2.3-15.4]). The mean ingested dose was higher in the intentional group than in the accidental group (170.3 ± 129.0 vs. 105.3 ± 37.5 mg/kg; P = 0.016). Hospitalization tended to be implemented more frequently in the intentional group (53.5% vs. 12.5%; P = 0.081). All patients with hepatotoxicity (n = 10) belonged to the same group, and showed a higher or longer median age (15.9 [14.6-17.1] vs. 13.8 years [13.7-16.4]; P = 0.030), mean ingested dose (13,230.0 ± 10,544.8 vs. 7,654.0 ± 6,752.3 mg; P = 0.043), mean time from ingestion to arrival at the ED (22.6 ± 23.4 vs. 5.5 ± 6.4 hours; P = 0.048), and frequency of hospitalization (80.0% vs. 39.0%; P = 0.048). Conclusion It is necessary to track the occurrence of hepatotoxicity in patients who intentionally ingest acetaminophen.

Doxylamine is an over-the-counter first-generation antihistamine used in the treatment of allergies and insomnia. Intentional ingestion is common due to its wide availability. Toxicity most frequently presents as an anticholinergic toxidrome with central effects leading to delirium, psychosis, or seizures, and peripheral effects manifested as tachycardia, dry and warm skin, mydriasis, or urinary retention. First-generation antihistamines can have antagonistic properties against the sodium channels on the cardiac myocytes in supratherapeutic doses. This article reports a polysubstance ingestion of 2 antihistaminergic agents with development of QRS complex widening and a right bundle branch block, which has not been well described in the literature.

Abstract Background Chronic abdominal pain is a potential symptom of lead poisoning, which is often challenging to diagnose. This case–control study aimed to evaluate blood lead levels in pediatric patients with chronic abdominal pain. Methods The case–control study was conducted on 190 pediatrics who presented to the Children's Medical Center Hospital clinics, Tehran between April 2021- 2023. The children were divided into two groups: the case group, consisting of 81 patients with chronic abdominal pain, and the matched control group; 109 children without any gastrointestinal symptoms. The statistical analysis of the data was performed using STATA 16. A multiple logistic regression model was used to assess the association of different independent variables with chronic abdominal pain. Results There was no significant difference between mean (± standard deviation [SD]) of age (8.80(2.7) years vs. control group: 9.23(3.9) years), sex, and BMI (16.55(4.6) vs. 17.32(4.7)) of the patients with chronic abdominal pain (case group) and the control group, whereas the mean weight was remarkably low in patients with chronic abdominal pain: 27.25(± 12.1) kg vs. 31.70(± 14.7) kg (P value = 0.028). Fifty-nine percent of children with chronic abdominal pain had serum lead levels ≥ 10 µg/dL. The mean (SD) of blood lead levels was statistically high in the case group: 11.09 (± 5.35) µg/dL vs. control group: 8.26 (± 5.01) µg/dL) (P value ≤ 0.05). The appetite level was significantly low in the case group: 3.8 (± 2.5) vs. control group 5.4 (± 1.3). Conclusions Lead poisoning could be a possible cause of children's chronic abdominal pain. Regarding the high rate of lead poisoning in children exerting appropriate measures to reduce their exposure to lead is necessary.

The current study was conducted to detect Listeria monocytogenes, associated antibiotic resistance and virulence genes possessed by these strains, and the genotype of identified isolates from milk, cheese, beef, and chicken. Accordingly, 203 samples (53 milk samples, 52 cheese samples, 48 beef samples, and 50 chicken samples) were collected from local markets in Al-Qadisiyah Province, Iraq. These samples were used for conventional and selective cultivation and biochemical studies. Eight isolates were molecularly detected using the PCR and sequencing based on the 16S rRNA gene. All the physically detected isolates were recruited for antibiotic resistance tests. Furthermore, all isolates were exposed to the detection of virulence genes, which included actin assembly inducing protein (actA), listeriolysin (hlyA), invasive associated protein (iap), internalin A (inlA), and phospholipase C (plcA). Random amplified polymorphism DND-polymerase chain reaction (RAPD-PCR) was utilized to genotype these isolates. The cultivation revealed the identity of 63 isolates (16 milk, 14 cheese, 16 beef, and 17 chicken). The molecular detection confirms the identity of the eight tested isolates. Various antibiotic and pattern resistance profiles were detected for the isolates, which included the highest resistance rates, which reached up to 100% and 94% in penicillin and ampicillin, respectively. The virulence genes that reached up to 94% were identified in all isolates. The sequencing findings demonstrated strong alignment with world isolates from the GeneBank. The data here reveal the vital presence of Listeria monocytogenes in food products, which pose high health risks to consumers.

Abstract Background The opioid crisis is a serious public health issue in Canada. There have been many surveillance programs and research studies on opioid-related emergency department (ED) visits at a national, provincial, regional or municipal level. However, no published studies have investigated the in-depth contexts surrounding opioid-related ED visits. In addition, few studies have examined injuries other than poisonings in those visits. The objective of this study is to investigate the contextual factors and co-occurrence of poisonings and injuries among the opioid-related ED visits in a Canadian sentinel surveillance system on injuries and poisonings from 2011 to 2022. Methods This study used a mixed methods design. The data source was the Canadian Hospitals Injury Reporting and Prevention Program. We first selected all opioid-related ED visits during our study period and then identified the contextual factors through a content analysis of the combination of the narrative description and other variables in the patients’ records. The contextual factors were organized into themes as opioid use context, social resource utilization, bystander involvement, and prior naloxone use. The opioid use context was used as a co-variable to examine the other themes and ED presentations (poisonings and other injuries). Quantitative descriptive approach was used to analyze all the contexts and ED presentations. Results The most common opioid use context was non-prescribed opioid use without intention to cause harm, followed by self-poisoning, children’s exposure, and medication error. Various rare contexts occurred. Paramedics participated in 27.9% of visits. Police and security guards were involved in 5.1% and 2.3% of visits, respectively. Child welfare or social workers were involved in 0.4% of visits. Bystanders initiated 18.9% of the ED visits. Naloxone use before arriving at the ED occurred in 23.4% of the visits with a variety of administrators. The majority of patients presented with poisoning effects, either with poisoning effects only or with other injuries or conditions. Conclusions Our study has provided an in-depth analysis of contextual factors and co-occurrence of poisonings and injuries among opioid-related ED visits in Canada. This information is important for ED programming and opioid-related poisoning and injury intervention and prevention.

Background/Objectives: Poisonings among children are a major cause of morbidity and mortality worldwide and present a significant challenge for emergency medical services (EMS). The aim of this study was to analyze the types of substances causing poisonings and the intention of poisonings in children, providing detailed information on the most common causes of poisonings in different age groups. Methods: A retrospective study was conducted analyzing medical records of pediatric patients under the care of emergency medical services (EMS) in Wroclaw, Poland, between 2015 and 2017. The study included all patients under 18 years old diagnosed with poisoning. Data collected included age, sex, cause of poisoning, location of the incident, neurological status (GCS), and the type of healthcare facility. Results: The study included 484 patients, with a mean age of 13 years. The largest age group was 16–18 years (44%), and the majority were female (58%). The most common causes of poisonings were alcohol (29.3%), medications (26%), and intoxicants (24.8%). Over half of the incidents occurred at home (52.5%). Intentional poisonings constituted 75% of cases, particularly involving alcohol (38.6%), intoxicants (32%), and medications (26.7%). Accidental poisonings were mainly due to household chemicals (28.7%) and carbon monoxide (27%). The differences in causes and locations of poisonings were statistically significant (p < 0.001). Conclusions: Our study showed that the most common causes of poisonings among children were alcohol, medications, and intoxicants. Poisonings most frequently occurred at home, especially with medications, while outside the home, alcohol and intoxicants were predominant. This study was not registered.

Objective: The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/ECLS therapies to drug-intoxicated patients.Methods: From inception until April 30, 2024, an extensive search was performed on four main databases:PubMed, Web of Science, Cochrane Library, and EMBASE. There was no restriction on the search period. Onlythe studies that reported survival to hospital discharge rates, adverse events, and the utilization of ECMO/ECLSin the treatment of intoxicated patients were included. On the other hand, articles that did not report adverseevents or hospital discharge rates as outcomes, as well as studies published in languages other than English,were excluded. The evaluated outcomes were the rate of survival to hospital discharge rate and the incidenceof adverse events associated with ECMO therapy. The Newcastle Ottawa scale was employed to appraise eachstudy to determine its methodological quality. The Comprehensive Meta-Analysis (CMA) software (version3.0) for statistical analysis was used, with the random effects model (due to high heterogeneity among thestudies) and a 95% confidence interval.Results: From a total search of 2216 search results, only 10 studies were included. The pooled analysis from10 studies indicated that ECMO therapies among drug-overdosed/poisoned patients were associated witha significant survival to hospital discharge rate of 65.6% ([95% CI: 51.5%-77.4%], p=0.030). However, theoutcomes were highly heterogeneous (I2=83.47%), which could be attributed to the use of several medicinesby different studies. In contrast, ECMO therapies among drug-overdosed patients were associated with asignificant incidence rate of adverse events of 23.1% ([95% CI: 12.3%-39.2%], p=0.002). However, the pooledanalysis had a significant heterogeneity (I2=70.27%).Conclusion: Despite various health complications, extracorporeal membrane treatment enhanced survival tohospital discharge with good neurological outcomes. Hence, it was a viable, effective, and feasible alternativefor managing drug-induced intoxication in patients.

Summary: Accidental poisoning is common in children. Potassium bromate is a commonly used additive and raising agent in many edibles particularly bread, a staple food worldwide, yet its accidental poisoning has hitherto, not been documented in Nigeria. We report an unusual case of acute renal failure following accidental ingestion of potassium bromate tablets.

Background: Childhood poisoning is an important cause of childhood morbidity and mortality, especially in children below five years of age. There is an increase in the range of household poisoning agents, particularly cheap hydrocarbon domestic fuel such as kerosene (paraffin). Objective: To describe the epidemiology of poisoning in the paediatric age group in a tertiary facility in Southwest Nigeria. Materials and Methods: This was a retrospective study covering the period from January 2013 to December 2018 at the Olabisi Onabanjo University Teaching Hospital, Sagamu Ogun State, Nigeria. Relevant data were extracted from patient’s records for analysis. Results: Out of the 2,881 admissions into the Children’s Emergency Room during the study period, 40 (1.4%) reported on account of poisoning but only the records of 31 were available for analysis. The male to female ratio was 2.1:1.The median age was 7.8 years. The case fatality rate was 3.2%. Kerosene was the leading agent of poisoning (17; 54.8%) and palm oil was the most frequently administered home remedy. Dyspnea was the most common presenting symptom. Only one death (3.2%) was recorded. Conclusion: Poisoning is a problem of young children and it frequently occurs in the home setting. Therefore, efforts should be targeted at educating caregivers about the dangers of poisoning in young children.

Background: The young child can be at risk of accidental poisoning because of its being very inquisitive to mouth objects. The prevalence and types of poisoning vary within Nigeria and different parts of the world. Aim: To describe the socio- demographics, clinical features and outcome in childhood poisoning seen at the National hospital Abuja (NHA) Nigeria. Subjects and Methods: A descriptive prospective study on children admitted for acute poisoning from September 2014 -August 2016. Consecutive children with a history of poisoning were recruited during the study period. The children were examined, and poison severity scores were recorded into a proforma, and followed up till discharge or demise. Results: Twenty-two children were admitted for acute poisoning, out of the 2336 children seen during the study period, with a prevalence rate of 0.94%. Fourteen (63.6%) were of upper social class, with 12 (54. 5%) mothers having tertiary level education. The mean time (±SD) of presentation was 11.9 ± 23.9 hours, while the mean (SD) duration of hospital stay was 4.8 ± 6.2 days; hospital stay was significant with types of poisoning (Fisher exact test 22.062, p

Abstract Bed bugs are pervasive global pests that have reemerged in the last 20 years as a significant public health concern, especially in densely populated urban areas. Beyond financial losses, expenses, inconvenience, and psychological distress, bed bug infestations often necessitate chemical management, posing poisoning risks to those with an infestation. The French Poison Control Centers recorded 1056 cases of exposure to bed bug insecticide products between 1999 and 2021. This study followed cases over 2007–2021, with a notable surge in reports of adverse reactions from 2016 onwards. Data revealed an increased recurrent misuse of insecticides, including substances banned or not approved for this use. Our findings underscore the growing public reliance on chemical insecticides for home bed bug management. With this is the concern of increased poisoning risks, and potential long-term health consequences from non-professional efforts by the public to manage bed bugs in their homes. This escalating trend emphasizes the need for safer and more sustainable pest management strategies in urban environments.

Abstract Background Detergent packets are common household products; however, they pose a risk of injuries and poisonings, especially among children. This study examined the epidemiological characteristics of pediatric injuries and poisonings related to all types of detergent packets in Canada using emergency department (ED) data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. Methods The CHIRPP database was searched for ED visit records for injuries and poisonings related to all types of detergent packets between April 1, 2011 and October 12, 2023 (N = 2,021,814) using variable codes and narratives. Data for individuals aged 17 years and younger were analyzed descriptively. Temporal trends in the number of detergent packet-related injuries and poisonings per 100,000 CHIRPP cases were assessed using Joinpoint regression and annual percent change (APC). A proportion ratio and 95% confidence intervals (CI) were calculated to compare the proportion of detergent packet-related cases in CHIRPP during two 34-months periods, pre-COVID-19 pandemic and after the beginning of the pandemic. Results There were 904 detergent packet-related cases among children and youth aged 17 years and younger identified in CHIRPP between April 1, 2011 and October 12, 2023, representing 59.9 cases per 100,000 CHIRPP cases. The majority (86.5%) of cases were among children aged 4 years and younger. Poisonings (58.8%) and eye injuries (30.6%) were the most frequent primary diagnoses. Unintentional ingestion (56.9%) and squeezing/breaking a detergent packet (32.3%) were the most frequent exposure mechanisms. Sixty-five patients (7.2%) were admitted to hospital. The number of detergent packet-related cases per 100,000 CHIRPP cases increased by 5.0% (95% CI 0.8, 10.2) annually between 2012 and 2022. The number of detergent packet-related poisonings per 100,000 CHIRPP cases decreased by 15.3% (95% CI − 22.3, − 10.6) annually between 2015 and 2022, whereas eye injuries showed an average annual percent increase of 16.6% (95% CI 11.2, 23.0) between 2012 and 2022. The proportion of detergent packet-related cases in CHIRPP after the beginning of the pandemic (79.9/100,000 CHIRPP cases) was 1.43 (95% CI 1.20, 1.71) times greater than pre-pandemic (55.7/100,000 CHIRPP cases). Conclusions Detergent packet-related injuries and poisonings are a persisting issue. Continued surveillance and prevention efforts are needed to reduce detergent packet-related injuries and poisonings in Canada, particularly among children and youth.

Research objectives: To find out the real causes of death of the Mongolian khans Yesugei-baatur, Ogedei, and Guyuk, as well as the circumstances of the emergence of ideas about their poisoning, reflected in a number of narrative sources. Research materials: The work used the Mongolian historical and literary works “Mongol un-niucha tobchiyan” (“The Secret History of the Mongols”) and “Altan Tobchi” (“Golden Legend”), the Mongolian-Chinese dynastic chronicle “Yuan Shi”, as well as the works of the Hulaguid “chroniclers” Rashid al-Din (“Jami at-tawarih”) and Juveini ata-Malik (“Tarikh-i-jehangusha”). In addition, the information contained in the travel notes of the head of the papal embassy to the court of Guyuk Khagan – Giovanni del Plano Carpini – and the ambassador of the French King Louis IX, Guillaume Rubruk, were involved. Results and novelty of the study: the topic of reflection and interpretation in medieval written sources of the sudden deaths of Mongolian rulers has been beyond the attention of nomadic historians up to the present time. Because of this circumstance, the relevance of the problem raised in the study lies in considering one of the least studied aspects of the mental history of Eurasian nomads. The article examines several episodes related to the sudden death of three Mongolian khans (Yesugei-baatur, Ogedei, Guyuk) and the interpretation of these tragic events in narrative sources. Based on a critical analysis of the information presented in written sources, as well as the use of data from natural science disciplines (medicine, geography), the authors conclude that the misconceptions common in historical science about the violent nature of the deaths of the above-mentioned Mongolian rulers are false. According to the authors of the study, the causes of the sudden and premature deaths of Yesugei-baatur, Ogedei, and Guyuk were, respectively, food toxicological poisoning, the consequences of excessive alcohol consumption, and the progressive development of a chronic, incurable disease. It should be noted that the presented work is in the nature of an interdisciplinary study and is a thematic continuation of the article published in the journal “Golden Horde Review” in 2023 [8].

Background: This is a descriptive cross-sectional study to investigate the severity of acute baclofen poisoning and length of hospital stay (LOS) Methods: The documents of cases with baclofen poisoning diagnosis; Baclofen alone intoxication (BAI) and multidrug intoxication (MDI) (March 2015-2019) were evaluated. Clinical and paraclinical findings, LOS, APACHE, and Poison Severity Scores (PSS) were extracted. Results: From 46 collected cases 10 cases were BAI and all of them were women. The adult cases who attempted suicide were younger (26.09±9.62 years) than those accidentally poisoned (58.29±22.06 years) (PV=0.008). Two BAI (20%) and one MDI (2.7%) were apnotic. None of BAI had hypotension, hypertension, bradycardia, or tachycardia. Past medical history of depression has no statistically significant effect on the clinical manifestation. There were correlations between adult diastolic and mean arterial blood pressures with baclofen ingested dose and renal function test results. MDI and BAI had similar ingested baclofen doses (152.63±67.0 and 130±90.3 mg). All BAI had GCS

Background: The increasing mortality and morbidity rates associated with poisoning in India have become a major public health concern. This short review paper discusses the urgent need for a comprehensive poisoning incident reporting and monitoring system to address data gaps and combat this threat at the national level. A national poisoning incident registry would not only provide traditional uses of data like aiding in the processes of planning, resource allocation, design of health programs, and public health research in the field of toxicology but also serve as a valuable tool for researchers investigating the scientific validity of using organs salvaged from poisoning cases for transplantation purposes. Discussion: With the emergence of biocrime as a stark reality in the post-COVID-19 era, the need for rigorous documentation of all poisoning incidents has become even more critical. Given the potential for molecular and genetic level threats, including bioterrorism, a strong public health surveillance system in the field of toxicology is essential in the future. Conclusion: The data on healthcare events is crucial for the proper implementation of healthcare programs, disease/issue control, and clinical decision-making. The Health Management Information System (HMIS) shows great promise in supporting decision-makers and healthcare professionals in providing high-quality care and reducing illness burden. The integration of toxicology event-related data in a registry on the lines of HMIS has a huge potential in improving the quality of health care in clinical toxicology scenarios in India. In conclusion, the implementation of a national toxicology incident registry is a categorical imperative to address the growing threat of poisoning fatalities in India.

Abstract Background The aim of the study was to develop a technique for quantitative determination of rat urine metabolites by HPLC–MS/MS, which can be used to search for biomarkers of acute intoxication with organophosphates (OPs). Results The content of metabolites in the urine of rats exposed to a single dose of paraoxon (POX1x); interval, twice daily administration of paraoxon (POX2x); exposure to 2-(o-cresyl)-4H-1, 3, 2-benzodioxaphosphorin-2-oxide and paraoxon (CBPOX) was investigated. New data were obtained on the content in the urine of intact rats as well as rats in 3 models of OP poisoning: 3-methylhistidine, threonine, creatine, creatinine, lactic acid, acetylcarnitine, inosine, hypoxanthine, adenine, 3-hydroxymethyl-butyrate and 2-hydroxymethyl-butyrate. Conclusions The proposed assay procedure is a simple and reliable tool for urine metabolomic studies. Within 1–3 days after OP exposure in all three models of acute intoxication, the concentration of metabolites in rat urine, with the exception of adenine, changes similarly and symmetrically, regardless of the method of poisoning modeling, in all three models of acute intoxication. Further studies are needed to determine the specificity and reliability of using urinary metabolite concentration changes as potential biomarkers of acute organophosphate intoxication. Graphical Abstract

Background: In a developing country such as India, intentional poisoning is associated with a high degree of morbidity and mortality. Historically, the use of agricultural poisons for attempted deliberate self-harm (DSH) has taken precedence. However, urbanization and stringent laws governing sale of agricultural chemicals, in recent years, may have shifted the focus of seekers toward commercially available therapeutic medications. Further, urbanization, high health-care seeking behavior, and poor regulation on sale of medicines, in Kerala, provide a conducive environment for such attempts. Aims and Objectives: The objective of this study was to determine the contribution of therapeutic medication toward acute poisoning as a means of DSH and the factors contributing to the same. Materials and Methods: Patients who obtained treatment for acute poisoning after DSH, between 2017 and 2023, were screened, those who employed therapeutic medication for the same were further determined. Sociodemographic details, clinical profile, and history of previous such attempts and treatment history including toxicological screening report were gathered and analyzed. Results: In our study of 154 patients arriving at the emergency department with history of DSH, 41% used therapeutic medicines for the same. Majority were women (75%) and most had a high school education (64%) or above. The most common agents were determined as paracetamol (23%) and benzodiazepine (10.6%). Tox screen was performed for 45% of patients. Organ failure developed in 36% patients with drug levels above and 42% of those with levels below the therapeutic range. However, 48% of those who did not undergo toxicological screening developed organ failure. Organ failure developed in 42% of patients, with acute liver injury being the most common culprit (25%). Management was symptomatic unless an antidote was available. Conclusion: Prescription drugs utilization for DSH was common in women and patients with higher educational status. Over-the-counter drugs and psychiatric medication were frequently used. Lack of prompt access to healthcare may contribute to organ failure. Tox-screen is recommended for drug detection.

Introduction: Acute accidental poisoning in children remains a significant public health issue and a predictable cause of morbidity around the world. To take preventive measures, it is necessary to identify the pattern of this problem. Objective: To determine the extent and characteristics of paediatric poisoning, an epidemiological investigation specific to each country is required. The goal of our research was to determine the current pattern of acute poisoning in children between (0−5) years old in Jordan. Methods: This retrospective study performs a descriptive analysis of the Jordan University Hospital’s National Poison Information Center (NPIC) database and describes the epidemiology of acute poisoning in children between (0−5) years old during a period of two years (2018–2019). Results: Paediatric poisoning (0−5) years old accounts for approximately 88% of poisoning cases in Jordan between 2018 and 2019.Out of 3531 paediatric poisoning cases, 44.9% of cases were in children between (2−3) years old, 63.4% of subjects were male. 40.9% of calls were from governmental hospitals. Most cases occurred at home (98.7%) and were unintentional (98.6%). Medication poisoning was the commonest among cases (71.0%). Besides, 89.4% were asymptomatic at the time of call, and Central Nervous System (CNS) symptoms being the most common (3.6%) among the symptomatic cases. Conclusions: Most cases of paediatric poisoning handled by the NPIC was due to medications. To prevent or minimize these cases, it is necessary to educate parents and other caregivers about proper medication storage and use, and in case of poisoning, urgent referral to health facilities is required.

Background: Acute poisoning is a major medical emergency that translates into morbidity and mortality across all age groups, it is a potentially preventable cause of illness and death. This study was carried out to assess the epidemiological information of acute poisoning among the general population presented to the three campuses of a private tertiary care teaching hospital in Karachi, Pakistan. Method: The cross-sectional study was conducted at three campuses of a private tertiary care teaching hospital, Dr. Ziauddin Hospital in Karachi, comprising of records from January 1, 2018, to December 31, 2022, of patients reporting acute poisoning. These records were accessed after getting approval from the Ethical review committee. Consecutive sampling technique was applied while data was collected. All cases of acute poisoning reporting to the emergency department with complete records were included. While data of those with any other diagnosis or incomplete record were excluded. Descriptive analysis was performed for quantitative variables. For categorical data frequency and percentages were extracted. The chi-square test was used to associate categorical variables. P value less than 0.05 was taken as statistically significant. Results: The total number of cases was n=518 out of which n=235 (45.4%) were males while n=283 (54.6%) were females and the maximum number of cases n=111 (21.4%) were associated with Benzodiazepines followed by insecticide poisoning and ingestion of rodenticides. Conclusions: The most susceptible groups to acute poisoning were found to be women and children. A prevalent agent that caused toxicity was benzodiazepines; the biggest number of cases occurred in April, while the lowest number occurred in December. The year 2020 was linked to the highest number of cases.

IntroductionHydrofluoric and nitric acids are strongly acidic substances with strong oxidation and are widely used in industrial production. Chemical pneumonia caused by the inhalation of strong acids has occasionally been reported. Severe chemical pneumonia can lead to acute pulmonary edema and life-threatening acute respiratory distress syndrome. The treatment of chemical pneumonia mainly relies on symptomatic and supportive treatment such as anti-inflammatory and anti-infection.Case descriptionThis study reports three cases of chemical pneumonia caused by the inhalation of a mixed hydrofluoric and nitric acid mist during an occupational exposure accident. After appropriate emergency symptomatic treatment, such as oxygenation and excretion promotion, cough, and difficulty in breathing were alleviated but not completely cleared.DiscussionMost of the literature reports damage caused by hydrogen fluoride on the skin and mucosal burns, and reports on lung damage caused by the inhalation of large amounts of hydrogen fluoride gas are relatively rare. Usually in the early stage of this kind of patients can have elevated blood picture, hypoxemia, pulmonary CT inflammatory plaque changes, so as to have obvious respiratory irritation symptoms. When inhaling a large amount of hydrofluorine mixed nitric acid mist, in addition to considering the occurrence of severe pneumonia, we should also be alert to the occurrence of other organ damage and electrolyte disorder.ConclusionAs occupational hydrogen fluoride gas inhalation poisoning often occurs in groups, improving the safety facilities and standard operations of small- and medium-sized enterprises is necessary. For medical workers, it is necessary to be alert to the occurrence of severe toxic pneumonia and severe fluorosis.

Background: Maduramicin (MAD) is an anticoccidial veterinary drug, but it frequently causes fatal poisonings in poultry, livestock, or humans. However, there is no specific antidote or guidance on first aid for MAD poisoning. Aim: The aim of the present study is to evaluate the acute toxicity and toxicokinetics of MAD after oral exposure, so as to make a foundation for developing diagnostic and therapeutic protocols for human intoxication. Methods: Five groups of rats (eight-to-nine-week-old male Wistar rats) were orally administered MAD via gavage at doses of 0, 4.64, 10.0, 21.5, or 46.4 mg/kg bw for only one time. The survival rates of the rats were observed over the following 14 days to assess acute toxicity. To evaluate the toxic effects of MAD, two doses (4.8 mg/kg bw and 10 mg/kg bw) were orally administered via gavage. Biochemical parameters including creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, serum myoglobin, and urinary myoglobin were measured. Liver, kidney, heart, and hind limb skeletal muscle samples from severely poisoned rats were obtained for pathological examination. For toxicokinetic analysis, samples of serum, urine, and feces from the 4.8 mg/kg bw dose group were analyzed using high-performance liquid chromatography-tandem mass spectrometry. Results: The LD50 of MAD in male Wistar rats was determined to be 6.81 mg/kg bw. In the 10 mg/kg bw group, elevated serum urea levels and increased myoglobin levels in both serum and urine indicated renal injury and potential muscle damage. Toxicokinetics in serum revealed that following oral administration of 4.8 mg/kg bw MAD, peak serum concentration of 59.8 ± 8.9 μg/L was achieved at 30.0 ± 13.9 h. MAD exhibited a slow elimination from the blood with an elimination half-life of 72.9 ± 36.8 h and a mean residence time of 79.6 ± 25.5 h. Additionally, fecal excretion of MAD was found to be greater than urinary excretion. Conclusion: MAD is a highly toxic veterinary drug which requires careful handling. The primary effects of poisoning include kidney injury and suspected rhabdomyolysis. It is excreted very slowly after oral administration. Promoting toxin excretion in individuals poisoned by MAD could potentially serve as an effective treatment method until a specific antidote is identified.

ABSTRACT The aim was to report two cases of accidental Brodifacum poisoning in calves on a dairy farm. The animals presented a variable clinical picture of bleeding disorders with melena, epistaxis, orthopneic position, severe dyspnea, productive cough, coarse lung crackles, and expiratory groans. The male died, the female was euthanized, and both were sent for necropsy. The anatomopathological findings revealed a predominantly bleeding diathesis in the animals. During the investigation, blood serum, liver and kidney samples were collected for toxicologic measurement, which revealed concentrations of coumarin derivatives < 0.100µg/kg in all samples. The combination of history, clinical-pathologic findings, and toxicologic results confirmed the diagnosis.

Self-poisoning with paracetamol is the most frequently used overdose method in the UK. Psychosocial assessments were conducted by mental health clinicians with 127 consecutive individuals who presented with pure paracetamol overdoses to a large general hospital over 8 months, including asking about the source of the tablets and scoring the patients’ acts on the Beck Suicide Intent scale (BSI). Patients were predominantly female (86%) and young (79% aged 12–24 years). Most had used paracetamol which was available in the home (77%). Those who purchased paracetamol for the act took double the number of tablets compared with those who used paracetamol available in the home (37 v. 18), had higher suicidal intent (mean BSI: 11 v. 7) and more often required treatment with N-acetyl cysteine (71% v. 43%). These results highlight the need for safer home storage of paracetamol and consideration of reducing pack size limits on paracetamol that can be purchased.

Abstract Selenium is an essential micronutrient for ruminants, which participates in the optimal functioning of proteins and enzymes that can combat oxidative stress in the body; however, its toxicity is documented in different species. The objective of this work was to describe macroscopic and microscopic lesions in lambs intoxicated with selenium administered through intraruminal boluses. The main lesions at necropsy were pulmonary oedema; the myocardial surface presented multifocal pale areas; the thyroid and thymus glands were decreased in size, and areas of necrosis, haemorrhage and hyperkeratosis were observed in the reticulum and rumen. At the microscopic level, congestion, haemorrhage, oedema and hyaline membranes were observed in the lung; hepatic congestion, haemorrhage, degeneration and necrosis; degeneration and necrosis of the reticulum mucosa, as well as areas of hyperplasia and hyperkeratosis; myocardial degeneration, necrosis and fibrosis; congestion, haemorrhage, degeneration and renal tubular necrosis; thyroid follicular atrophy and thymic cortical atrophy. This study evidenced the main lesions related to selenium poisoning in lambs supplemented with the mineral through intraruminal boluses.

Cyproheptadine is an antihistamine that is also used as appetite stimulant in children. We report a three-year old who developed anticholinergic syndrome following accidental ingestion of a large dose of cyproheptadine. The child was conservatively managed, CC –BY 4.0 and he recovered fully with no immediate sequelae. We report this case to create awareness on the harmful effects of cyproheptadine ingestion.

Background and aims: Ongoing methadone intoxication parallels the generalization of the implemented addiction cession programs, as well as the necessity to sustain an effectively durable addiction treatment course. This study aimed to investigate the predisposing factors and clinical features of methadone intoxication. Methods: During a one-year period (March 2018 to March 2019), patients admitted for methadone intoxication were investigated retrospectively. Demographic data, the consumed methadone dose, electrocardiogram findings, and the level of creatinine phosphokinase (CPK) at admission were collected and entered into a statistical analyzing platform (SPSS version 22) for further statistical testing. Results: Seventy-five eligible patients were investigated. The mean age was 23.63±16.66, 66.7% were male, and 15 patients were children. The unemployment status led to an increased methadone poisoning (MP) incidence (P

Abstract Paraquat (PQ) is a widely used herbicide and a common cause of poisoning that leads to pulmonary fibrosis with a high mortality rate. However, the underlying mechanisms of PQ-induced pulmonary fibrosis and whether pulmonary epithelial cell senescence is involved in the process remain elusive. In this study, PQ-induced pulmonary epithelial cell senescence and Hippo-YAP/TAZ activation were observed in both C57BL/6 mice and human epithelial cells. PQ-induced senescent pulmonary epithelial cells promoted lung fibroblast transformation through secreting senescence-associated secretory phenotype (SASP) factors. Yap/Taz knockdown in mice lungs significantly decreased the expression of downstream profibrotic protein Ctgf and senescent markers p16 and p21, and alleviated PQ-induced pulmonary fibrosis. Interfering YAP/TAZ in senescent human pulmonary epithelial cells resulted in decreased expression of the anti-apoptosis protein survivin and elevated level of apoptosis. In conclusion, our findings reveal a novel mechanism by which the involvement of Hippo-YAP/TAZ activation in pulmonary epithelial cell senescence mediates the pathogenesis of PQ-induced pulmonary fibrosis, thereby offering novel insights and potential targets for the clinical management of PQ poisoning as well as providing the mechanistic insight of the involvement of Yap/Taz activation in cell senescence in pulmonary fibrosis and its related pulmonary disorders. The YIN YANG balance between cell senescence and apoptosis is important to maintain the homeostasis of the lung, the disruption of which will lead to disease.

Abstract The pattern of poisoning varies in different societies. In this study, we investigated the clinical-epidemiological features and outcomes of poisoned patients based on the substances involved, whether pharmaceutical or non- pharmaceutical toxins. This cross-sectional study involved a retrospective chart review of all poisoned patients who presented to the poisoning emergency hospital in the center of Iran between January 2015 and December 2019. We collected data on socio-demographics, the nature of the poisoning, and the outcomes. Backward stepwise binary regression analysis was conducted to predict the mortality. Throughout the study period, 5777 patients with acute poisoning met the inclusion criteria. Of these, 3524 cases (61%) were attributed to pharmaceutical, and 2253 cases (39%) were due to non-pharmaceutical poisoning. The majority of pharmaceutical poisonings (82.9%) were intentional, whereas non-pharmaceutical poisonings accounted for 46.2% of intentional exposures (P

Abstract Background Carbon monoxide (CO) poisoning is now one of the leading causes of poisoning-related mortality worldwide. The central nervous system is the most vulnerable structure in acute CO poisoning. MRI is of great significance in the diagnosis and prognosis of CO toxic encephalopathy. The imaging features of CO poisoning are diverse. We report atypical hippocampal lesions observed on MRI in four patients after acute CO exposure. Case presentations We report four patients who presented to the emergency department with loss of consciousness. The diagnosis of CO poisoning was confirmed on the basis of their detailed history, physical examination and laboratory tests. Brain MRI in all of these patients revealed abnormal signal intensity in hippocampi bilaterally. They all received hyperbaric oxygen therapy. The prognosis of all four patients was poor. Conclusion Hippocampi, as a relatively rare lesion on MRI of CO poisoning, is of important significance both in the early and delayed stages of acute CO poisoning. In this article, we summarize the case reports of hippocampal lesions on MRI in patients with CO poisoning in recent years, in order to provide reference for the diagnosis and prognosis of CO poisoning.

Objective: Methanol poisoning can occur either intentionally through the consumption of methanol-containing products or accidentally through ingestion, resulting in visual impairment. We assessed the long-term visual sequelae in patients with methanol poisoning. Methods: This prospective cohort study was conducted at referral centers, Khorshid and Alzahra University Hospitals, affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. The study included patients hospitalized for methanol poisoning from June 22, 2018, to June 21, 2020, with follow-up extended until June 2021. Toxico-clinical and ophthalmologic examination data were collected from patients upon hospital admission, discharge, and during follow-up. Findings: Thirty-nine patients were assessed in this study. The majority of them (94.9%) were male, with an average age of 34 years. Patients who presented with reduced visual acuity (VA) upon admission subsequently showed abnormalities (in acuity and visual fields) during follow-up (n = 13). Among the patients who displayed visual field defects on admission, bilateral optic disc atrophy was observed in follow-up (n = 13). Conversely, patients who reported blurred vision, with or without photophobia upon admission, had normal results in their follow-up eye examinations. Among the 36 patients who underwent dialysis, 14 (38.9%) exhibited visual impairment during follow-up examinations. Additionally, 38 patients received sodium bicarbonate, and 14 of them (36.85%) also presented ocular abnormalities. Conclusion: Patients who demonstrated VA deficits upon admission are more likely to experience long-term VA and visual field defects, as well as optic disc atrophy. Patients who solely complained of blurred vision, with or without photophobia, during admission were less likely to develop long-term visual defects.

Abstract Background Guanfacine is an alpha-2 adrenergic agonist that decreases norepinephrine release and sympathetic outflow. With the increased use of guanfacine for attention-deficit hyperactivity disorder (ADHD), reports of guanfacine poisoning have also risen. Case presentation A 15-year-old male (height: 170 cm, weight: 48 kg), who was taking 2 mg/day of guanfacine for ADHD, was brought to our emergency department after ingesting 40 tablets of guanfacine due to poor exam results. He presented with impaired consciousness and sinus bradycardia on an electrocardiogram (ECG), leading to diagnosis of guanfacine poisoning. Gastric lavage (5 L) was performed, and activated charcoal was administered. Although his consciousness gradually recovered, he developed ST-segment elevation on the ECG. Despite the absence of chest pain and elevated myocardial enzymes, coronary artery stenosis was not observed on coronary artery computed tomography. As his blood guanfacine level decreased, his ECG returned to normal. Conclusions This case highlights the need for careful monitoring of guanfacine poisoning patients due to the potential for various cardiovascular events.

Introduction: Intoxication with non-pharmaceutical substances within household environment is an important group of pediatric injuries seen in pediatric emergency departments. Our objective was to study clinical characteristics and outcomes of these exposures and compare them with pharmaceutical intoxications. Methods: The study was designed as a retrospective cohort study. All patients between 0 and 18 years old presented to 3rd level teaching hospital pediatric emergency unit between May 1st 2016 and April 30th 2017 with a complaint of acute toxic exposure were included. Results: Over one-year period, 0.52% of all patients presented to pediatric emergency department were toxic exposures. 44% of them were non-pharmaceutical exposures, most commonly cleaning products (49.5%), followed by carbon monoxide (19.2%) and hydrocarbon products (5.5%). Most common route of exposure was oral route (73.2%) and most of exposures were unintentional (97.9%). Respiratory symptoms were the most common manifestation (4.8%), followed by neurologic and cardiac manifestations (2.4%). 57% of patients were hospitalized, one patient admitted to pediatric intensive care unit (PICU). None of the patients died. When compared with pharmaceutical exposures, patients in non-pharmaceutical group were younger, accidental exposures and non-oral routes of exposure were more in this group. Less patients in household group were admitted to PICU. Cardiac manifestations were seen more in household group. Conclusion: Household toxic exposures to non-pharmaceutical substances are common in childhood. Although mortality risk of pharmaceutical exposures is higher, household non-pharmaceutical exposures can also result in significant clinical manifestations therefore every effort should be taken to prevent accidental toxic exposures within household environment.

Bird crime is a serious problem in many countries around the world. This study focuses on the situation in Slovakia, summarising data on bird crime in the country between 2016 and 2022. Over the course of that period, 92 cases were recorded in 27 districts involving 33 animal species. At least 249 protected birds and 78 mammals fell victim to illegal activities, and 61 poisoned baits were discovered. Social value is the monetary value which state institutions use to quantify the damage incurred to wildlife. Slovak law determines whether an illegal act is an offence or a criminal act based on the value of the incurred damage. The total social value of all of the protected animals as a result of illegal activities was estimated at € 696,250. Intentional poisoning, typically using carbofuran, was the most common of illegal act identified in the recorded cases, followed by shooting and trapping. An analysis of the recorded cases of bird crime was also used to assess the risk in each of Slovakia’s districts in relation to landscape structure variables. The percentage share of arable land was found to be a reliable predictor of bird crime, regardless of whether the birds had been poisoned or shot. These findings can help to develop better preventive inspections to detect bird crime incidents. We also recommended several management measures to help tackle bird crime more quickly and effectively.

Background: Poisoning is a significant public health concern, encompassing a broad range of sudden and severe health issues resulting from the ingestion, inhalation, or contact with toxic substances. The potential for injury or fatality necessitates urgent medical attention and care. With the ongoing advancements in artificial intelligence (AI) and its increasing integration into medical and pharmaceutical domains, there is a growing interest in exploring the role of AI in the context of poisonings. This study aims to investigate the potential applications of AI in the management and treatment of poisoning.Materials and methods: This research is a review by searching the keywords ("Artificial intelligence") [TIAB] AND (poisoning [TIAB] OR toxicity[TIAB] OR intoxication[TIAB] OR Toxin[TIAB] OR poison[TIAB]) was searched in the internet databases PubMed, Scopus, and Google Scholar search engine in 2016-2024.Conclusion: Enhancing system management and treatment approaches is crucial in preventing accidental and intentional poisoning. This can be achieved by incorporating cutting-edge medical equipment, such as those equipped with AI. AI technology can recognize complex patterns beyond predefined rules and process large amounts of data, exceeding human capabilities. In the future, more progress in AI will likely affect various areas of healthcare, including poison prevention and treatment, to improve patient outcomes and reduce the burden of poisoning on healthcare systems.

Abstract Background Anticoagulant rodenticide (AR) poisoning was diagnosed in 3 Patagonian maras (Dolichotis patagonum) raised in the mara farm in Thailand. To date, there have been no reports of maras with diagnosed AR poisoning. Case presentation The first clinical sign of the sickening maras was anorexia. Fifteen from 50 maras were dead over a 3–5 day period after the clinical signs had occurred. Positive results to AR were detected in all of the maras’ liver specimens by screening test using thin layer chromatography and spectrophotometry methods. Supportive therapy was selected for the treatment of the 35 surviving maras. During the follow – up observation period of 12 months, all of the surviving maras were healthy and no reproductive loss. Conclusions This is the first report on suspected AR poisoning in maras in Thailand based on history taking, clinical signs, gross pathology lesions and chemical analysis. AR poisoning in the present report is possibly from contaminated animal food. Therefore, quality control of food should be fastidious when feeding maras.

Background: Poisoning is a critical health issue caused by exposure to harmful substances, leading to a range of biological effects from mild irritation to severe organ damage and death. Acute poisoning is particularly prevalent in developing countries reliant on agriculture, where agricultural poisons such as organophosphates, carbamates, pyrethroids, and aluminum/zinc phosphide are common. This study aims to analyze the histopathological changes in various organs in autopsy of poisoning cases to understand the extent and nature of organ damage. Methods: Autopsies were performed on cases with an established or suspected history of poison ingestion. Tissue samples from the stomach, intestine, liver, spleen, kidneys, brain, and lungs were examined for histopathological changes. Results: Out of 52 cases analyzed, aluminum phosphide was the predominant poison, accounting for 76.92 % of cases. Histopathological findings in poisoning cases included significant pulmonary edema (55.77 %), intra-alveolar hemorrhage (48.08 %), liver ballooning degeneration (48.08 %), acute tubular necrosis (51.92 %) in kidney, and universal brain and spleen congestion (100 %). Stomach findings showed partial loss of rugosity (80.77 %), congestion (51.92 %), necrosis of the mucosa (30.77 %), congestion (71.15 %), denudation of the epithelium (48.08 %), and mucosal inflammation (48.08 %) as predominant findings. Aluminum phosphide caused severe histopathological changes across all examined organs. Conclusion: The study highlights the critical role of histopathological examination in diagnosing and understanding organ damage in poisoning cases. Forensic pathologists can use these histopathological patterns as reference points to differentiate poisoning from other causes of death, aiding in accurate diagnosis and targeted treatment.

Background Endothall is a protein phosphatase 5 inhibitor used as an herbicide however scant reports of human exposure are associated with high lethality.Case series: We describe two cases of endothall toxicity in Melbourne, Victoria. Case 1 was a 75‐year‐old male who had died following an accidental ingestion of a mouthful of endothall (175 g/L). He developed a severe metabolic acidosis with cardiac arrest following a gastroscopy demonstrating severe haemorrhagic gastritis and oesophagitis. Case 2 was a 29‐year‐old male, who was presented after ingesting 100 mL of endothall (175 g/L) with suicidal intent and who died in less than 24 h despite intensive treatment including continuous renal replacement therapy.Discussion Endothall is a rare but lethal poisoning in humans post ingestion that causes both corrosion and multi‐organ failure. Whilst there are limited data, early intensive care management appears necessary, no published cases have survived longer than 24 h.Conclusion Endothall is highly lethal in small quantities despite current best measures; therefore, public health measures to restrict access are strongly recommended.

Objective To evaluate the clinical efficacy and safety of fractionated plasma separation and adsorption combined with continuous veno-venous hemofiltration (FPSA-CVVH) treatment in patients with acute bipyridine herbicide poisoning.Methods A retrospective analysis of 18 patients with acute bipyridine herbicide poisoning was conducted, of which 9 patients were poisoned by diquat and 9 patients by paraquat. All patients underwent FPSA-CVVH treatment. The serum cytokine levels in pesticide-poisoned patients were assessed. The efficacy of FPSA-CVVH in eliminating cytokines, the 90-d survival rate of poisoned patients, and adverse reactions to the treatment were observed.Results Fourteen patients (77.8%) had acute kidney injuries and 10 (55.6%) had acute liver injuries. The serum cytokine levels of high mobility group protein B-1 (HMGB-1), interleukin-6 (IL-6), IL-8, interferon-inducible protein-10 (IP-10), monocyte chemotactic protein-1 (MCP-1), and macrophage inflammatory protein-1β (MIP-1β) were significantly elevated. A total of 41 FPSA-CVVH treatment sessions were administered. After a single 8-h FPSA-CVVH treatment, the decreases in HMGB-1, IL-6, IL-8, IP-10, MCP-1, and MIP-1β were 66.0%, 63.5%, 73.3%, 63.7%, 53.9%, and 54.1%, respectively. During FPSA-CVVH treatment, one patient required a filter change due to coagulation in the plasma component separator, and one experienced a bleeding adverse reaction. The 90-d patient survival rate was 50%, with 4 patients with diquat poisoning and 5 patients with paraquat poisoning, and both liver and kidney functions were restored to normal.Conclusion Cytokine storms may play a significant role in the progression of multiorgan dysfunction in patients with acute bipyridine herbicide poisoning. FPSA-CVVH can effectively reduce cytokine levels, increase the survival rate of patients with acute bipyridine herbicide poisoning, and decrease the incidence of adverse events.

AbstractPerforming head CT in intoxicated patients presenting to the emergency department (ED) is common, yet low yield. In our previous study, acute findings were found only in patients with at least one of: neurological Deficits, Intubation, Trauma, Convulsions or Headache. We hypothesise that the absence of these DITCH clinical features rules out the need for immediate CT. We collected data for intoxicated patients attending EDs in our district from March 2021 to May 2022 inclusive. We recorded clinical presentation features, agents, disposition and head CT results. There were 1,308 intoxicated patients out of a total of 219,273 ED presentations. Median age was 38 years. Common ingestions were ethanol, stimulants, GABA-ergics and opioids. 407 patients (31%) had head CT, with 31 patients (7.6%) having 36 acute findings: 19 intracranial haemorrhages, 8 fractures, 2 cerebral oedema and 7 haematomas. All patients with acute CT findings had one of the DITCH features, and all had trauma. The sensitivity and NPV of the hypothesis were 100%. In patients that were not scanned, there were no re-presentations.Our internal validation study is further evidence that acute findings on head CT in intoxicated patients presenting to the ED are only found in those who had one of the DITCH features.

Background: Glyphosate is a widely used herbicide. Clinical presentations of glyphosate intoxication show variation, but hepatic portal venous gas(HPVG) caused by glyphosate poisoning is rarely reported. Herein, we report a rare case of ominous HPVG after ingesting glyphosate. HPVG, which used to be an ominous abdominal radiologic sign, is associated with numerous underlying abdominal pathologies, ranging from benign conditions that require no invasive treatment to potentially lethal diseases that necessitate prompt surgical intervention. Case summary: A young woman who ingested 100 mL glyphosate 6-h prior was admitted to the emergency intensive care unit. Before admission to our hospital, the patient was administered gastric lavage treatment with 10000 mL of normal saline in the local hospital. After 14 h, her laboratory examinations showed systemic inflammatory response syndrome and multiple organ dysfunction syndrome, while the condition deteriorated. Computed tomography of the abdomen showed multilinear air densities in the portal vein, hepatic branches, and mesenteric vessels, intestinal obstruction, and intestinal necrosis. Septic shock and a severe abdominal infection were diagnosed. The patient was treated conservatively as they could not tolerate surgery and, after 20 h died of septic shock. Conclusion: We reviewed 289 cases of ''hepatic portal venous gas'' in PUBMED and analyzed the etiology and treatment of HPVG accompanied by the underlying pathology. We concluded that HPVG is a radiological sign associated with various diseases, and the prognosis mainly depends on the underlying cause and clinical condition. As glyphosate may erode the digestive tract, attention should be paid to the volume, pressure, and speed of gastric lavage in treating glyphosate poisoning to avoid fatal complications such as HPVG. Abdominal symptoms need to be closely observed, and changes in the early onset of the condition in clinical practice need to be responded to promptly.

Abstract Iron phthalocyanine (FePc) was penta‐coordinated with pyridine ligand (Py) grafted on carbon nanotube (CNT), to form (FePc‐Py‐CNT). The complex was studied as a catalyst for the oxygen reduction reaction ORR in seven different supporting electrolytes: OH− (0.1 M), OH− (1 M), NO3− (1 M), HSO4− (1 M), ClO4− (1 M), Br− (1 M), Cl− (1 M), to unveil anion‐poisoning effects and mechanism. Through cyclic voltammetry and polarization curves in N2 and O2 saturated atmospheres, thermodynamic and kinetic data were acquired. In acid media, the formal potential Fe(III)/(II) (E0’Fe(III)/(II)) of the complex is biased to more negative potentials by the anion presence. Similar effects were observed for the onset potential (Eonset) during polarization curves for the ORR. When the ORR was performed in the presence of either ClO4−, or HSO4−, anions, Tafel analysis showed different values depending if were derived from the low or from the high overpotential regions, revealing an inner‐sphere electron transfer mechanism (ISET). The Tafel values derived from measurements in the presence of Cl− and Br− anions do not change when extracted at low or at high overpotentials evidencing an outer‐sphere reaction mechanism (OSET). Gibbs free energies were derived from poisoning tests confirming the ISET and OSET mechanisms. The poisoning effect is responsible for the immediate loss of performance for these catalysts during the ORR in acidic media.

Background: Each year, a significant number of fatalities caused by drug poisoning are documented globally. Analyzing the pattern of poisonings is crucial for prevention, particularly in decreasing the incidence of suicides. This research aimed to investigate the trend of poisonings from 2019 to 2023 at Loghman Hakim Hospital, Tehran, Iran. Methods: The present study collected data on gender, age, reasons for poisoning and patient outcomes from the archived records of Loghman Hakim Hospital Poison Center, Tehran, Iran, using the ICD- 10 coding system. Patients were categorized into medication groups following the guidelines in Goldfrank’s book and with input from clinical toxicology specialists. All records underwent a thorough review. The data were analyzed using SPSS software, version 24, incorporating statistical analyses, such as Fisher’s exact and chi-square tests. Result: A comprehensive analysis was performed on 81,689 patients who had experienced poisoning, with 41336(50.6%) being male and 40353(49.4%) being female. The mortality rate over five years stood at 2.01%. The highest number of fatalities occurred in 2023 and 2022, with 359 cases (21.82%) and 358 cases (21.76%), respectively. Opioid and narcotic poisoning was identified as the primary cause of death, representing 30.33% of the cases. Conclusion: It is crucial to restrict access to methadone and alcohol. Additionally, the increasing instances of poisonings underscore the societal requirement for government support to alleviate the psychological and economic burdens induced by the coronavirus pandemic.

Drug poisoning is an important area of study in South Africa as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in South Africa. The objectives of this study were to assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors’ experiences of antidote supply. The availability of antidotes in the emergency departments (EDs) and pharmacies was assessed and recorded using a data sheet that was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Our results indicate that N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol, and pyridoxine were present in all EDs; activated charcoal was present in 80%; lorazepam, glycopyrrolate, and calcium chloride in 60%; freeze-dried plasma in 40%; glucagon and desferrioxamine in 20%; and fresh frozen plasma, hydroxocobalamin, sodium nitrite, sodium thiosulfate, sodium calcium edetate, and intralipid were not present in any of the EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents, respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate, or pyridoxine (85.7%, 83.3%, 87.3%, and 75.4% of 126 respondents, respectively). The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply, which will be an important avenue for further research. Significance: • These findings highlight the lack of uniform availability of antidotes to common and critical drug poisonings in emergency departments. • The experiences of doctors in Gauteng concerning the most commonly encountered poisonings contrast with existing literature from South Africa, suggesting regional differences within the country.

ABSTRACT: The state of Santa Catarina is the largest national producer of onions. The consumption of onion (Allium cepa) by domestic animals can cause hemolytic anemia and hyperhemoglobinemia of Heinz bodies in erythrocytes. The epidemiological data and the pathological clinical picture were obtained during a visit to the property where the disease occurred. A herd of 54 beef cattle from a property in the municipality of Bom Retiro/SC, was placed in an onion crop, which had not been completely harvested because it was outside the desired standard for trade. The animals remained in this field for eight days. At the end of this period, all of them presented apathy, anorexia, brown urine and mucous membranes and an onion odor on expiration. The macroscopic changes observed were pale mucous membranes, blood with decreased viscosity and increased clotting time, liver with an evident lobular pattern and remains of onion in the rumen. The carcass gave off a strong onion odor. By histological analysis, there was central lobular coagulation necrosis in bridging in the liver. In the kidneys, there were intracytoplasmic hyaline droplets in tubular epithelial cells and a deposit of eosinophilic material in the lumen of the tubules. For the diagnosis of onion poisoning, epidemiological data associated with clinical signs, such as pale mucous membranes with evidence of hemoglobin pigmentation (brown mucosa) and hemoglobinuria, should be taken into account. This article seems to be the first report of onion poisoning in cattle in Brazil.

Xylazine is used in veterinary medicine as a sedative, analgesic, and muscle relaxant. However, in recent decades, it has frequently been detected in illicit drugs. Xylazine poisoning is characterized by depression of the central nervous and cardiovascular systems. Herein, we present a case of a 41-year-old man who not only had severe depression of the central nervous and cardiovascular systems, but also developed hyperpyrexia during the treatment of xylazine poisoning, which led to his death 3 days after poisoning. This case indicates that, in addition to its other effects, xylazine may also cause hyperthermia, which has not yet been reported in humans.