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Although it is rarely seen in Turkey and developed countries, aluminum phosphide poisoning is an important heath problem because of its high mortality rate. Aluminum phosphate tablets in 3 g weight which are sold in the market under the trade name "57% Fumiphos" include 57% aluminum phosphide and 43% ammonium carbonate. In the present report, it was aimed to define clinical, crime scene investigation and autopsy findings of a case of aluminum phosphide poisoning that was rarely seen in Turkey and comparatively discuss data of our case and literature knowledge. 20 years old male patient, hospitalized with an ambulance following intake of aluminum phosphide while he was in military service and he was accepted as exitus after intense cardio-pulmonary resuscitation efforts. From witness statements, it was learned that patient taken orally a poison; a pill box written "Fumiphos 57% aluminum phosphide" on it, was found in patient's jacket pocket; and it was learned that patient shared some words about death in social media before the event. In the performed medico-legal autopsy, macroscopic findings were defined and the tissue samples which obtained in autopsy were examined microscopically. In the results of toxicological analysis of samples which obtained in autopsy, it was reported the presence of 14184 ng/g aluminum in stomach contents and p-toluene sulfonic acid in visceral organ and muscle samples. Macroscopic and microscopic findings which obtained at autopsy was found compatible with non-specific findings which defined in the literature. In the result of evaluation of crime scene, autopsy and toxicological analysis findings, it was decided that the person's death occurred due to aluminum phosphide poisoning. In this case report, forensic-medicine procedures in cases died due to intoxications was emphasized, and a case who died due to aluminum phosphide poisoning that was a condition commonly seen in developing countries, but rarely seen in Turkey and developed countries was presented and precautions against aluminum phosphide poisoning were defined. Additionally, we suggest that macroscopic and microscopic autopsy findings of the present case which is rarely defined in classical literature will be a guide to medico-legal examiners for aluminum phosphide poisoning. [ABSTRACT FROM AUTHOR]

In this work, we have studied the interaction of NH3, NH2CH3, NH2CH2OCH3, and NH2CH2COOH with aluminum nitride (AlN) and aluminum phosphide (AlP) nanotubes (NT) by means of the B3LYP hybrid density functional method using 6-31G(d) basis set. The results show that these molecules can be chemically adsorbed on the top of the aluminum atom of AlNNTs and AlPNTs. Also, the AlP nanotubes are the most energetically favorable candidates for adsorption of these molecules. It was found that the interaction these molecules with nanotubes results in changes in the electronic properties of NTs. Based on the NBO analysis, in all complexes charge transfer occurs from these molecules to nanotubes. The AIM results show that, the Al…N interaction has a partial covalent nature. Also, this interaction in the AlP complexes is stronger than that in the AlN complexes. In both types of complexes, the results obtained for complexes containing electron-donating molecules are better than complexes containing electron-withdrawing ones. [ABSTRACT FROM AUTHOR]

Background:-poisoning cases are increasing as epidemiological, social and medicolegal problem in all over the world. Aims & objective:- our aim of the study is to develop the statistical profile of poisoning cases in relation to their medico-legal aspect. Method:- this is a retrospective and cross-sectional study on the 142 poisoning cases noted in the Department of Forensic Medicine & Toxicology, J.L.N. Medical College, Ajmer, in the period starts from Jan. 2013 to December 2015. Result:- The incidence of poisoning, males being common victim and male : female ratio of 2.1:1. Maximum cases were observed in Hindu community. Evening time encountered maximum cases with common place of exposure being home. Maximum involvement of married males with Present study shows, married people (100 cases, 70.43%) are commonly involved as compared to unmarried (41 cases, 28.87%). Majority of victims (112 cases, 78.88%) consumed the poisons to commit suicide as per history followed by Accidental nature (22 cases, 15.49%). Aluminium phosphide is most commonly encountered poison (28 cases, 19.71%) leading to maximum fatalities, very closely followed by Organophosphorus compounds (25 cases, 17.61%) and corrosive substance (18 cases, 12.68%). Conclusion:- male cases predominant in poisoning cases and suicidal nature most commonly found. [ABSTRACT FROM AUTHOR]

Background: Aluminum phosphide is a highly toxic pesticide that results in high mortality. To date, there is neither a definitive antidote nor a unified protocol for managing acute aluminum phosphide poisoning., Objectives: This cross-sectional questionnaire-based study aims to explore different management approaches and rely on the expertise of Egyptian medical professionals to enhance the prognosis for acute aluminum phosphide poisoning., Subjects and Methods: A self-administered questionnaire was formulated and electronically distributed according to published literature and experience of senior physicians., Results and Conclusions: Responses were received from 151 physicians from 10 governorates. Management modalities were variable among respondents. Noradrenaline was used by 90.7% of respondents with no fixed-dose regimen. In all, 84.1% of participants utilized oil in gastrointestinal decontamination; paraffin oil was the most used solution. Overall, 92.1, 61.6, 46.4, and 34.4% of participants used sodium bicarbonate, proton pump inhibitors, IV magnesium sulfate, and antioxidants, respectively. Regarding the frequency of acute aluminum phosphide poisoning, 47% of participants managed these cases daily or a few times a week. Participants' responses denoted a poor prognosis of acute aluminum phosphide poisoning, and high percentages attributed the prognosis to exposure factors rather than treatment modalities. Statistical analysis revealed that using oil in gastrointestinal decontamination improved the outcome by 4.62-fold. Clinical toxicologists were more likely to rescue ≥ 30% of the cases about 3-fold (2.97) than other specialties. Clinical toxicologists used oil in gastrointestinal decontamination, magnesium sulfate, and antioxidant therapy and calculated base deficit before administration of sodium bicarbonate by 7.70-, 5.30-, 3.26-, and 2.08-fold than other specialties., Competing Interests: None declared., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Acute intoxication with ALP is extremely lethal. The present study was conducted to determine the range of serum cortisol levels in ALP poisoning and its correlation with patient outcome. Methods: This study was carried out on patients who were intoxicated with ALP. Their demographic data and pertinent findings in their history and physical examination were recorded at the time of arrival and also when shock and severe metabolic acidosis emerged. 5cc blood was taken from the patients to measure blood cortisol level, when shock and severe metabolic acidosis developed. Blood cortisol level analysis was performed using ELISA method. Data analysis was done using SPSS software version 16.0. Results: The average ingested dose was 1.98+1.79 tablets each containing 3 grams of ALP. Overall, 77% of the patients presented tachycardia and hypotension. Blood cortisol level less than 15 µg/dl, 15-33 µg/dl, and more than 34 µg/dl were regarded as adrenal insufficiency, critical illness-related corticosteroid insufficiency, and adequate adrenal response, respectively. Eventually, 3 patients fell within the first category, 24 patients matched with the second category, and 3 patients corresponded to the last category. Conclusion: Blood cortisol concentration is satisfactory only in 10% of the patients. In majority of the patients although it is not apparently low, it has not shown the expected rise comparable to the shock and stress state of such patients. It defines a role for corticosteroids therapy in management of ALP poisoning, particularly if it does not respond to conventional treatments.

Objective: To analyze the clinical characteristics, treatment methods and cause of death of aluminium phosphide poisoning in children. Methods: The clinical data of 55 cases of children with accidental inhalation of aluminum phosphide poisoning in our hospital from 2014 to 2018 (31 cases of mild poisoning and 14 cases of severe poisoning ) were analyzed, including the age, gender, onset seasons, poisoning inhalation time, visit time and examination results. Results: In the 55 cases, 10 cases died. The average inhalation time of mild poisoning was 25.1 hours, of which the severe poisoning was 185.4 hours, and the average visit time were 14.6 hours and 38.5 hours separately. The clinical manifestations were nausea and vomiting in 55 cases (100%), dizziness and pale in 14 cases (25%), palpitation in 16 cases (29%), respiratory failure in 14 cases (25%), severe arrhythmia in 8 cases (14.5%), hypotension and cardiogenic shock in 10 cases (18%). Electrocardiogram examination were analyzed: 1 case of supraventricular tachycardia, 4 cases of ventricular tachycardia, 1 case of grade 2 II atrioventricular block, 5 cases of sinus arrhythmia, and 26 cases of sinus tachycardia. Laboratory results followed: myocardial enzymes were elevated in 19 cases (34.5%), liver function were abnormal in 12 cases (21.8%), 6 cases (10.9%) had abnormal renal function and 14 cases (25%) had metabolic acidosis. Treatment is mainly symptomatic support treatment. All of them were severe poisoned and died from circulatory failure. Conclusion: The mortality of aluminium phosphide poisoning is very high and the cause of death is circulatory failure. There are no special detoxification drugs now, so it is important to diagnose early and treatment comprehensively. [ABSTRACT FROM AUTHOR]

Background: Suicide by poisoning is the second most common cause of death by suicide (27.9%) as per The National Crime Records Bureau (NCRB) India in 2015. Aluminum phosphide (ALP) is the leading agricultural poison used to commit suicide as where its availability is not properly regulated. ALP is a highly toxic solid fumigant pesticide, rodenticide and insecticide. Case presentation: A 40-year-old woman was brought by the police to the emergency section. Her extremities were cold and hypotonic, and her skin was pale. Patient’s vitals were unstable with pulse rate 112/minute irregularities, blood pressure 68/54 mm of Hg, respiratory rate 22/minute shallow and body temperature 30.1 ºC and characteristicly strong garlicky odor on her breath. During the suction of gastric contents, spontaneous ignition of gas with flames and white fumes with sound like a blast was observed by resident doctors and para-clinical staff. Gastric aspirate along with Ryle’s tube were immediately sent to the forensic department where the Silver Nitrate test was performed and it was found strongly positive for phosphine gas. Discussion: Aluminum phosphide readily reacts with water and hydrochloric acid in the stomach to produce phosphine (hydrogen phosphide, PH3) and a small amount of diphosphine. Conclusion: The present case report stresses on the need that the emergency physicians need to be highly alert and adequately prepared while handling such patients. Spontaneous ignition with the release of phosphine from ALP poisoned patients can not only affect the patient, but also pose a health hazard to emergency physicians and medical staff. [ABSTRACT FROM AUTHOR]

Background: Aluminum phosphide is the common cause of poisoning in adults in India, with a very high case fatality ratio. We studied five patients of aluminum phosphide poisoning with polyserositis. Methods: We enrolled all patients with aluminum phosphide poisoning presenting to emergency medical department, at a tertiary care hospital in northwestern India from January to July 2006. These patients were managed according to a standard treatment protocol and their complications were recorded. Results: During the study period, total of 35 patients were admitted with 57.5% mortality in the first 12 hours. Among the rest, 5 patients were found to develop polyserositis. All these patients had severe hypotension at presentation and developed respiratory distress requiring mechanical ventilation after an average stay of 3.8 days post-ingestion. They were managed conservatively and four of them were discharged from the hospital after the average stay of 10 days. Conclusion: In this case series, features of polyserositis (pleural effusion, ascites and pericardial effusion) were found in 15% patients of severe aluminum phosphide poisoning. We postulate systemic capillary leak syndrome, secondary to mitochondrial damage in the endothelium, as a possible mechanism.

Aluminum phosphide (AlP) as 3 g tablet is widely used in Iran to protect stored food grains from pests. Hyperglycemia following its ingestion has been already reported in the recent years but severe hypoglycemia is uncommon. Here, we report a 19 year old male who attempted suicide with one tablet of AlP and demonstrated severe hypoglycemia. Despite restoration of blood glucose concentration to normal, he failed to respond to supportive treatment and died. The possible mechanisms leading to severe hypoglycemia are discussed. Though severe hypoglycemia is rare following AlP poisoning, physicians managing such patients should be aware of it.

Aluminum phosphide poisoning (ALPP) still has no efficient and approved antidote. Supportive care and hemodynamic monitoring are the only choices of treatment. We proposed a new lavage formulation in addition to evaluation of its efficacy and defining the impact of clinical characteristics of patients on their prognosis. During eight months period of time, 120 patients were enrolled to the study and randomly received two different gastric lavage protocols. Our new lavage protocol had positive impact on patients' survival and the P-value in comparison with the classic gastric lavage method was close to significant level (P=0.054). On hospital arrival indication for intubation-ventilation as well as sense of thirst, sore throat and absence of nausea indicate worse outcome. Using our novel approach, indication for intubation-ventilation as well as sense of thirst, sore throat and absence of nausea can be considered as applicable prognostic factors in survival of ALPP patients. Further studies are required to set this approach as preferred treatment.

Background: Aluminum phosphide as a fumigant is extensively used for wheat preservation from rodents and bugs especially in silos worldwide. There is increasing number of acute intoxication with this potentially lethal compound because of its easy availability. We have tried to locate predictors of poor prognosis in patients with aluminum phosphide intoxication in order to find patients who need more strict medical cares. Methods: All cases of aluminum phosphide intoxication that had been referred to our hospital during April 2008 to March 2010 were studied by their medical dossiers. Pertinent data including vital signs, demographic features, clinical and lab findings, and incidence of any complication were collected and analyzed by the relevant statistical methods. Results: Sixty seven cases of aluminum phosphide intoxication were included in the study. 44.8% of them were male. 97% of cases were suicidal. Mean amount of ingestion was 1.23+/- 0.71 tablets. Mortality rate was 41.8%. ECG abnormality and need for mechanical ventilation had negative relation with outcome. Conclusion: Correlation between some findings and complications with outcome in aluminum phosphide intoxication can be used as guidance for risk assessment and treatment planning in the patients.

Background and objectives : In recent decades, aluminum phosphide pills are used for suicide attempts in Tehran and other parts of the country. Aluminum phosphide is a solid inorganic phosphide that because of its involvement in entire the body organs right after the use, it causes different clinical signs and symptoms. In this research, we studied the epidemiological factors of poisoned patients with aluminum phosphide who were admitted in Tehran Baharloo hospital over the two years. Material and Methods : In this retrospective case series study, we surveyed the poisoned patients with aluminum phosphide who were admitted in Tehran Baharloo hospital. After recording data in pre-designed data collection forms, the collected data were analyzed using SPSS software. Results : Seventy one cases of poisoned patients with aluminum phosphide with an average age of 26.18 ± 11.29 years were included in this study. The average number of ingested pills was 1.27±0.73. Sixty eight (95.8%) patients had a suicidal and deliberate attempt. In this study, the fatality rate of fresh aluminum phosphide tablets was 51.6%. Conclusion : Based on the fatality rate of aluminum phosphide pills, preventive health care actions, increasing the awareness and training of health and medical management personnel at medical universities seem necessary to reduce the tendency and access to aluminum phosphides.

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Aluminum phosphide (ALP) poisoning is one of the fatal poisonings in the world. Hemolysis is a rare presentation of this poisoning. Here, we report an episode of hemolysis due to G6PD deficiency after ingestion of ALP and also the patient survived.

Introduction: The phosphine gas, which is released by the contact of aluminum phosphide with moisture, with the pathophysiology of toxicity is not fully understood. Since there is no specific antidote, the treatment is symptomatic. Case: Forty-three-year-old patient was referred to our hospital intubated after aluminum phosphide inhalation from the emergency department of the external center. It was discovered in his history that powdered aluminum phosphide was found in the vehicle he drove. He was intubated during the intensive care unit follow-up due to the increasing severity of his unconsciousness. He was admitted to the anesthesia and reanimation intensive care unit 13 hours after his exposure. On physical examination, GCS was 3, bilateral pupils were mid-dilated and light reflex was minimal. Vital signs; BP under norepinephrine and dopamine infusions 63/42 mmHg, HR 42/min, SpO2 90% were measured. Treatment was started to the patient with metabolic acidosis (pH: 6.8, pO2 : 104 mmHg, pCO2 : 32.9 mmHg, HCO3-: 6.1, BE: -26.7, lactate: 19.2 mmol/L). Ventricular fibrillation developed and defibrillated after 15 minutes of his hospitalization, and then cardiopulmonary resuscitation was started after cardiac arrest. Hemodialysis could not be performed because hemodynamic stabilization could not be achieved. After 3 hours of his hospitalization the patient was considered as exitus. Discussion: Mohan et al. and Hassanian-Moghaddam et al. applied in their case series ECMO to patients poisoned with highly toxic aluminum phosphide, which is used as a pesticide. Survival of patients who underwent ECMO was found to be higher. We deduced that ECMO treatment should be considered in addition to symptomatic treatment, hemodialysis, or continuous renal replacement therapy to prevent mortality due to metabolic acidosis, dysrhythmia, pulmonary edema, and cardiovascular shock. There are cases treated with CRRT in the early period for hemodynamically unstable patients in the absence of ECMO. Keywords: Aluminum, phosphide, poisoning, treatment, ECMO [OP-051] Efficiency of Plasmapheresis in COVID-19 Patients with Hyperinflamation Sevil Tultak, Osman Özcan Aydın, Ebru Karakoç, Birgül Büyükkıdan Yelken Eskişehir Osmangazi University Faculty of Medicine, Department of Anesthesiology and Reanimation, Eskişehir, Turkey Introduction: COVID-19 causes sitokin induced acute respiratory distress syndrome (ARDS) and multiple organ dysfunction. For reducing burden of cytokines, abnormal coagulation agents and the virus in blood, plasmapheresis have been performed as a therapotic method of severe COVID-19. We aimed to evaluate the efficacy of therapeutic plasmapheresis at COVID-19 cases with hyperinflamation in ICU. Materials and Methods: Respiratory, inflamatory and prognostic markers of 29 COVID-19 patients who had been treated with plasmapheresis were evaluated retrospectively and analyzed statistically. Critirea of COVID-19 associated hyperinflammatory syndrome such as hyperferritinaemia, neutrophil to lymphocyte ratio, lactate dehydrogenase or asparate aminotransferase, D-dimer, C-reactive protein, fibrinogen, platelet count and progression in oxygenation such GOCA score, PaO2 /FiO2, PaO2, SpO2 were evalueted at admission, before and after plasmaspheres. Results: Increase in PaO2, SpO2 (p<0.05) and clinical improvement in the oxygenation was observed while the GOCA score increased and the worst PaO2 /FiO2 ratio decreased after plasmapheresis (p<0.05). Increased leukocyte count,neutrophil lymphocyte ratio, D-dimer after plasmapheresis compared to admission and before plasmapheresis (p<0.05) were recorded in terms of worsening disease progression. Statistically significant decrease in ferritin (p<0.05) and clinically significant decrease of CRP, AST and LDH (p>0.05) after plasmapheresis as improving prognostic results in terms of reducing hyperinflammation. Conclusion: In the lights of our results that were consistent with the literature it should be considered that plasmapheresis improves oxygenation and alleviating the hyperinflammation, while there was not statistically and clinically significant improving effect on disease progression [ABSTRACT FROM AUTHOR]

[Display omitted] • Sensing response of AlP nano-sheet to the cathinone (CA) drug is 9.0 at 298 K. • By Ir decoration on AlP nano-sheet, the sensing response increased to 69.1. • A short recovery time of 18.6 s was predicted for CA desorption from the Ir-decorated AlP surface. Within this work, B3LYP, B97D and M06-2X are employed as density functionals to scrutinize the impact of Co–, Rh-, and Ir-decoration upon the capability of an aluminum phosphide nano-sheet (AlP-NS) in the detection of cathinone (CA). The interaction between the pristine AlP-NS and CA was a physical adsorption with the sensing response (SR) of roughly 9.0. Decorating the metals Co, Rh, and Ir into the surface of AlPNS changed the adsorption energy of CA from −6.1 to –22.2, –23.0, and –23.7 kcal/mol respectively. In addition, there was a substantial rise in the corresponding to 38.8, 51.3, and 69.1, respectively, indicating that the sensitiveness of the metal-decorated AlP-NS (MAlP-NS) raised by raising the atomic number of metals. So, it was found that Ir-decoration improved the sensitiveness of the AlP-NS to the CA molecule more in contrast to the other metals. Based on the energy decomposition analysis results, the interaction nature between CA and the MAlP-NS was mostly a cation-lone pair interaction. There was a slight decrease in the SR of the MAlP-NS in the water solvent. The theoretical results achieved in this study further supported the practical applications of MAlP nano-structures. [ABSTRACT FROM AUTHOR]

The experimental studies of Aluminum Phosphide (AP) poisoning in rats revealed several clinical and pathological signs such as hemorrhage, sinusoidal dilatation, bile stasis, centrilobular necrosis, Kupffer cell hyperplasia, infiltration by mononuclear cells, and fatty infiltration in the liver tissues. This paper aimed to show the impact of carrots on the toxic effect of AP on the livers of adult rats (female). To investigate some biochemical and histopathological changes effects of AP in rats, sixty white female rats were equally divided into four groups, the first group (G1) was administered orally with 3mg/kg/ body weight of AP, the second group (G2) was orally treated with AP and 10% carrot extract at the same time. The third group (G3) administrated 10% carrot extract only. The fourth (G4) group was the negative control and was treated with distilled water only. The experiments continued for a month at the animal house of the Veterinary Medicine College of Baghdad University. The results revealed that high levels of liver enzymes and bilirubin were induced in G1 with decreasing total protein levels. The pathological examination revealed the presence of marked proliferation of Kupffer cells in G1 livers. However, the G2 group showed slight infiltration of lymphocytes in sinusoids. The pathological changes in the livers of G3 group showed slight cloudy swelling in hepatocytes compared with the normal texture of hepatocytes in G4. The data of this experiment showed that treatment with carrot extract significantly decreases the elevation in the level of liver function enzymes in animal poisoned with AP. In addition, treatment with carrot extract reduces the severe damage in the hepatic tissue that occurred in rats treated with AP only. In general, it could be concluded that treatment with carrot extract provides a remedial effect against the hepatotoxicity that is resulted from exposure to AP.

Aluminum phosphide (ALP)-induced cardiotoxicity is a major cause of high mortality rates. As there is no specific antidote, restoring cardiac hemodynamics is the cornerstone for saving patients. Based on oxidative stress theory in acute ALP poisoning, we examined the cardioprotective role of coconut oil and Coenzyme Q10 (COQ10) in ALP poisoning, focusing on their antioxidant capacity. This study was a randomized, controlled, single-blind, phase II clinical trial conducted at Tanta Poison Control Center over 1 year. Eighty-four ALP poisoned patients received supportive treatment and were randomly allocated to three equal groups. Gastric lavage was performed using sodium bicarbonate 8.4% with saline in group I. Alternatively, group II received 50 ml coconut oil, and group III initially received 600 mg CoQ10 dissolved in 50 ml coconut oil; and repeated 12 hours later. In addition to patient characteristics, clinical, laboratory, electrocardiography (ECG), and total antioxidant capacity (TAC) data were recorded and repeated 12 hours later. Patient outcomes were evaluated. There was no significant difference among groups considering patient characteristics, initial cardiotoxicity severity, vital, laboratory data, ECG changes, and TAC. However, 12 hours post-admissions, group III was significantly improved in all clinical, laboratory, and ECG parameters than comparable groups. Significant correlations were observed between elevated TAC in groups II and III with hemodynamic, serum troponin, and ECG variables. Accordingly, the need for intubation, mechanical ventilation, and the total vasopressor dose was significantly decreased in group III compared with other groups. Therefore, coconut oil and COQ10 are promising cardioprotective adjuvant therapy ameliorating the ALP-induced cardiotoxicity., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Aluminum phosphide (ALP) is among the most significant causes of brain toxicity and death in many countries. Curcumin (CUR), a major turmeric component, is a potent protective agent against many diseases, including brain toxicity. This study aimed to examine the probable protection potential of nanomicelle curcumin (nanomicelle-CUR) and its underlying mechanism in a rat model of ALP-induced brain toxicity. A total of 36 Wistar rats were randomly divided into six groups (n = 6) and exposed to ALP (2 mg/kg/day, orally) + CUR or nanomicelle-CUR (100 mg/kg/day, orally) for 7 days. Then, they were anesthetized, and brain tissue samples were dissected to evaluate histopathological alterations, oxidative stress biomarkers, gene expression of SIRT1, FOXO1a, FOXO3a, CAT and GPX in brain tissue via hematoxylin and eosin (H&E) staining, biochemical and enzyme-linked immunosorbent assay (ELISA) methods and Real-Time PCR analysis. CUR and nanomicelle-CUR caused significant improvement in ALP-induced brain damage by reducing the MDA levels and induction of antioxidant capacity (TTG, TAC and SOD levels) and antioxidant enzymes (CAT, GPX), modulation of histopathological changes and up-regulation of gene expression of SIRT1 in brain tissue. It was concluded that nanomicelle-CUR treatment ameliorated the harmful effects of ALP-induced brain toxicity by reducing oxidative stress. Therefore, it could be considered a suitable therapeutic choice for ALP poisoning., Competing Interests: Conflict of interest: The authors reported no potential conflict of interest., (© 2023 the Author(s), licensee AIMS Press.)

The red palm weevil, Rhynchophorus ferrugineus, is a palm borer native to South Asia which has spread mainly due to the unintended movement of infested planting material. As a result, this species has become the most destructive palm pest in the world. The difficulty of detecting the early stages of infestation due to its cryptic life cycle has led many countries to implement, strict pre- and post-entry quarantine regulations to prevent further spread. However, there are no quarantine protocols to ensure that palm material for planting is free of R. ferrugineus. The aim of this study has been to determine the efficacy of aluminium phosphide as a safe quarantine treatment against different stages of R. ferrugineus and the possible phytotoxic effects on live Phoenix canariensis palms. Our results confirm that a dose of 1.14 g/m3 for 2 days is enough to kill all stages of R. ferrugineus in live palms with no phytotoxic effects on treated palms for up to one year after the treatment. This procedure, which could be easily applied in sealed containers used for palm trade, could drastically reduce risks associated to palm movement worldwide.

The majority of aluminum phosphide (ALP) toxicity cases are suicidal attempts. Despite advances in critical care medicine, the mortality rate of ALP remains very high. Unfortunately, knowledge on the toxicokinetics of ALP is very low. An obsolete idea was proposed that inhibition of complex IV of cytochrome C oxidase is responsible for multiorgan dysfunction. However, based on human studies, this effect might be insignificant. Thus, a novel idea proposes that the main mechanism might be vascular wall integrity disruption. The low frequency of acute toxicity and unanswered questions about the toxicokinetics and toxicodynamics has led to leaden advances of novel treatments. The aim of this review was to evaluate problems regarding current treatment protocols and propose new ideas based on updated information. For this purpose, we reviewed all available articles on the management of ALP poisoning published to date. Considering failure of conventional therapies on maintaining systolic blood pressure, correcting acid-base disturbances, and support cardiac function, the previous treatment protocols have been overruled. However, repudiate of conventional treatments in this deadly condition is not without penalties for the health-care provider. The introduction of new therapies including refuse of gastric lavage with water-soluble compounds, administration of a high molecular weight colloidal solution for fluid resuscitation and termination using sodium bicarbonate, and vasoactive agents has been prospected to improve patient survival. This protocol is in early clinical evaluation; nevertheless, it appears to improve patient's survival; hence, future randomized trials should be performed to support their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Aluminum phosphide (AlP) is a very effective indoor and outdoor pesticide. We investigated the effects of N-acetyl cysteine (NAC) on the survival time, hemodynamics, and cardiac biochemical parameters at various time intervals in some cases of AlP poisoning. Methods: This research was a case-control study to evaluate 63 AlP poisoned patients during 2010-2012. Patients with cardiovascular complications of AlP to be treated with intravenous NAC plus conventional treatment were considered as the case group and compared with patients who did not receive NAC. NAC infusion was administered to the case group at 300 mg/kg for 20 h. The data gathered included age, sex, heart rate, Systolic blood pressure (SBP), creatine phosphokinase (CPK), creatine kinase MB (CK-MB), and ECG at the admission time and 12, 18, and 24 h after admission. Analysis of repeated measures was performed to check the variability of parameters over time. Results: The mean ages in the case and control groups were 26.65 ± 1.06 (19-37 years) and 28.39 ± 1.11 (18-37 years), respectively (P = 0.266). Most of the patients were female (56.5%). CK-MB means were significantly different between the two groups, but no differences between the other variables were observed. Also, CK-MB, CPK, heart rate, and systolic blood pressure means became significantly different over time (0, 12, 18, and 24 h) in both groups (P < 0.001). NAC prevented sharp heart rate fluctuations in AlP patients in the case group. Regarding the outcomes, 17 patients died (10 patients in the control and 7 patients in the case groups). No side-effects of NAC were observed. Conclusion: Our patients could be managed by the positive role of NAC as the biochemical index of cardiotoxicity was found to elevate in both the case and control groups. Therefore, for the management protocol optimization, NAC evaluation should be done in further cases. [ABSTRACT FROM AUTHOR]

Density functional theory (DFT) calculations have been performed to evaluate the geometries and electronic properties of nickel decorated aluminum phosphide (AlP) nano-cages. At the lowest coverage of our system (one Ni per one Al 12 P 12 ), four adsorption sites (P 1 P 4 ) of Ni on AlP nano-cage are studied. Band structures, binding energies, total density of states, natural bond orbital (NBO) charges, and electron density differences of Ni-adsorbed Al 12 P 12 nano-cages are studied for each adsorption site. We found that three orientations (P 1 , P 2 , and P 3 ) show electron transfer from the Ni to Al 12 P 12 whereas one orientation (P 4 ) has reverse direction of electron transfer. The adsorption energies of Ni on AlP nano-cage are −136.7, −108.5, −102.7, and −99.4 kcal mol −1 for P4, P3, P1 and P2, respectively. Formation of new Al Ni and P Ni bonds is observed concomitant with the dissociation of some Al P bonds of the nano-cage. [ABSTRACT FROM AUTHOR]

In pulse CO-oximetry of aluminium phosphide ( ALP)-poisoned patients, we discovered that carboxyhaemoglobin ( CO-Hb) level was elevated. We aimed to determine whether a higher CO level was detected in patients with severe ALP poisoning and if this could be used as a prognostic factor in these patients. In a prospective case -control study, 96 suspected cases of ALP poisoning were evaluated. In the ALP-poisoned group, demographic characteristics, gastric and exhalation silver nitrate test results, average CO-Hb saturation, methaemoglobin saturation, and blood pressure and blood gas analysis until death/discharge were recorded. Severely poisoned patients were defined as those with systolic blood pressure ≤80 mmHg, pH ≤7.2, or HCO3 ≤15 meq/L or those who died, while patients with minor poisoning were those without any of these signs/symptoms. A control group (37 patients) was taken from other medically ill patients to detect probable effects of hypotension and metabolic acidosis on CO-Hb and methaemoglobin saturations. Of 96 patients, 27 died and 37 fulfilled the criteria for severe poisoning. All patients with carbon monoxide saturation >18% met the criteria to be included in the severe poisoning group and all with a Sp CO >25% died. Concerning all significant variables in univariate analysis of severe ALP toxicity, the only significant variable which could independently predict death was carbon monoxide saturation. Due to high mortality rate and need for intensive care support, early prediction of outcome is vital for choosing an appropriate setting ( ICU or ordinary ward). CO-oximetry is a good diagnostic and prognostic factor in patients with ALP poisoning even before any clinical evidence of toxicity will develop. [ABSTRACT FROM AUTHOR]

The use of pesticides such as aluminium phosphide (AlP) has increased in the recent years and improved the quantity and quality of agricultural products in a number of developing countries. The downside is that AlP causes severe chronic and acute health effects that have reached major proportions in countries such as India, Iran, Bangladesh, and Jordan. Nearly 300,000 people die due to pesticide poisoning in the world every year. Poisoning with AlP accounts for many of these deaths. Unfortunately, at the same time, there is no standard treatment for it. The aim of this article is to give a brief review of AlP poisoning and propose a treatment flowchart based on the knowledge gained so far. For this purpose we reviewed all articles on the management of AlP poisoning published from 2000 till now. Using a modified Delphi design, we have designed a handy flowchart that could be used as a guide for AlP poisoning management of patients in emergency centres. [ABSTRACT FROM AUTHOR]

Aluminium phosphide (AlP) is used to protect stored grains from rodents. It produces phosphine gas (PH3), a mitochondrial poison thought to cause toxicity by blocking the cytochrome c oxidase enzyme and inhibiting oxidative phosphorylation, which results in cell death. AlP poisoning has a high mortality rate among humans due to the rapid onset of cardiogenic shock and metabolic acidosis, despite aggressive treatment. We report a 21-yearold male who was referred to the Afzalipour Hospital, Kerman, Iran, in 2015 after having intentionally ingested a 3 g AlP tablet. He was successfully treated with crystalloid fluids, vasopressors, sodium bicarbonate, digoxin, glucagon and antioxidant agents and was discharged from the hospital six days after admission in good clinical condition. For the treatment of AlP poisoning, the combination of glucagon and digoxin with antioxidant agents should be considered. However, evaluation of further cases is necessary to optimise treatment protocols. [ABSTRACT FROM AUTHOR]

Objectives: Aluminium phosphide (AlP) is a fumigant pesticide which protects stored grains from insects and rodents. When it comes into contact with moisture, AlP releases phosphine (PH3), a highly toxic gas. No efficient antidote has been found for AlP poisoning so far and most people who are poisoned do not survive. Boric acid is a Lewis acid with an empty porbital which accepts electrons. This study aimed to investigate the neutralisation of PH3 gas with boric acid. Methods: This study was carried out at the Baharlou Hospital, Tehran University of Medical Sciences, Tehran, Iran, between December 2013 and February 2014. The volume of released gas, rate of gas evolution and changes in pH were measured during reactions of AlP tablets with water, acidified water, saturated boric acid solution, acidified saturated boric acid solution, activated charcoal and acidified activated charcoal. Infrared spectroscopy was used to study the resulting probable adduct between PH3 and boric acid. Results: Activated charcoal significantly reduced the volume of released gas (P <0.01). Although boric acid did not significantly reduce the volume of released gas, it significantly reduced the rate of gas evolution (P <0.01). A gaseous adduct was formed in the reaction between pure AlP and boric acid. Conclusion: These findings indicate that boric acid may be an efficient and non-toxic antidote for PH3 poisoning. [ABSTRACT FROM AUTHOR]

Background: Acute poisoning including drug overdose is responsible for significant morbidity and mortality. The objectives of this study were to determine the frequency and distribution of acute poisoning in set up of a medical intensive care unit. Material & Methods: This was a record based, cross-sectional study conducted at Medical ICU of Khyber Teaching Hospital, Peshawar, Pakistan from Feb. 1, 2015 to March 15, 2015. Ninty two patients with acute poisoning admitted to medical ICU between March 2009 and October 2014 were included. The demographic variables were; gender, age in years and marital status. The research variables were; the type of poisons, the number of poisons, route of poisons, mode of poisons, the need for ventilatory, inotropic and renal support, duration of stay, and outcome of patients. Counts and percentages were calculated for the nominal and means and SDs for numeric variables. Chi-square goodness of fit test was applied. Results: Out of total of 92 patients, 55 (59.8%) were females and 37 (40.2%) were males with female to male ratio of 1.49:1. The mean age of the sample was 26.8±13.9 years. The mean duration of stay for the sample was 3.14±0.52 days. The differences of counts (frequencies) among different attributes of all the ten nominal variables except gender were statistically significant, assuming that all attributes have equal expected counts. Conclusion: Acute poisoning is a common medical emergency. These patients commonly need ventilatory and inotropic support, and have high mortality rates. Proper triage and timely admission to intensive care unit may improve outcome of these patients. [ABSTRACT FROM AUTHOR]