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Background: Aluminum phosphate (ALP) poisoning has a high mortality rate (MR) secondary to cardiogenic shock. Recently, extracorporeal membrane oxygenation (ECMO) showed a successful result in this issue. We conducted a systematic review and meta-analysis to compare the MR of patients with ALP poisoning who underwent ECMO versus those with conventional treatment. Materials and Methods: Two parallel databases’ reviews were done to find the ECMO treatment-applied studies or conventional treatment-applied studies according to the PRISMA protocol. All studies in any languages and English conference abstracts were included for ECMO treatment-applied studies. Only English-language human observational studies, which reported MR, were included in conventional treatment-applied studies. All ETAS case reports were summarized and used as a newly generated cross-sectional study (NGCSS) for inclusion in the meta-analysis. Results: Out of 167 and 1043 records, 17 case reports (24 cases), 3 cross-sectional studies, and 9 conventional treatment-applied studies were selected. In meta-analysis NGCSS applied as the fourth cross-sectional ECMO treatment-applied studies. The overall MR of ECMO-treated cases (23% [95% confidence interval (CI): 7%–39%]) was significantly less than conventionally treated cases (60% [95% CI: 39%–63%]; P < 0.001). In ECMO-treated cases, the weighted mean difference (WMD) for age, blood pH, ALP dose, hospitalization, ECMO lag time, and ECMO duration were not statistically significant between survived and nonsurvived cases. However, WMD of cardiac ejection fraction (4.6%; 95% CI: 2.76%–6.39%; P < 0.0001), exposure to hospitalization lag time (−2.05; 95% CI: −4.05–0.14 h; P = 0.06), and length of hospital stay (16; 95% CI: 12.0–20.5 days; P < 0.0001) between survived and nonsurvived ETC were significant. Conclusion: ECMO reduced the MR of ALP-poisoned patients; however, it is a highly invasive and complicated procedure.

Background: There is a high prevalence of intentional paraquat poisoning especially for suicide reported from many part of the world, with its negative effects on the lungs, kidneys, heart, and digestive system. This study was planned, aimed at investigating the efficacy of sucralfate in the treatment of oral paraquat poisoning with respect to its clinical outcomes. Methods: A randomized double-blind clinical trial was conducted on 70 patients, suffering from oral paraquat poisoning. These patients were divided into two groups of 35 each. Subsequently, gastric lavage was performed for each patient in the control and treatment groups with 5g sucralfate mixed in tap water in the treatment group, but with tap water alone in the controls. The patients’ hemodynamic and laboratory parameters were evaluated and recorded, on admission and the hospital discharge dates. In addition, the patients’ final clinical outcome, including survival or death was also recorded. Results: The results of the present study revealed that the patients’ hemodynamic parameters, coagulation factors, renal and liver laboratory findings did not differ significantly between the two groups (P>0.05). Moreover, 45.7% and 31.4% of the patients died in the control and treatment groups, respectively (P>0.05). Conclusions: The sucralfate administration did not have a significant effect on the patients’ hemodynamic and laboratory parameters. The survival of patients in the treatment group was slightly higher than those in the control group. Also the patients in the treatment group had less pulmonary and renal complications in the long-term than those in the control group.

Background. Beta‐blockers carry a high risk of potentially causing fatal poisoning if overdosed. We aimed to assess the clinical and epidemiological characteristics of patients with beta-blocker poisoning. Methods. Patients were categorized based on the type of drug poisoning into propranolol, other beta-blockers, and the combination of beta-blocker groups, respectively. Demographic data, drug toxicity, and clinical, laboratory, and treatment information of different groups were compared. Results. During the study period, 5086 poisoned patients were hospitalized, of whom 255 (5.1%) had beta-blocker poisoning. Most patients were women (80.8%), married (50.6%), with a history of psychiatric disorders (36.5%), previous suicide attempts (34.6%), and intentional type of exposure (95.3%). The mean ± SD age of the patients was 28.94 ± 11.08 years. Propranolol toxicity was the most common among different beta-blockers (84.4%). There was a significant difference in age, occupation, education level, and history of psychiatric diseases with respect to the type of beta-blocker poisoning (P

Organophosphate (OP) poisoning is prevalent in developing countries. Toxicity occurs by voluntary injection, inhalation, and absorption. Self-injection is rare. The current case report describes a 61-y/o male with subcutaneous self-injected one cc OP poisoning presenting with delayed drowsiness, nausea, and vomiting. He was treated and presented a good clinical response to treatment with pralidoxime and had a successful recovery. Diagnosis of OP compound toxicity by the parenteral route is a challenge. By observing patients, the dose, and the time between poisoning until the time to start treatment, we can conclude different presentations and outcomes of OP poisoning.

Dear editor, We read the recent article of Rahmani et al entitled "Medical Management and Outcome of Paraquat Poisoning in Ahvaz, Iran: A Hospital-Based Study" in your journal (1). In their study they performed upper gastrointestinal (GI) endoscopy as a routine for all paraquat poisoned patients, because they considered paraquat a caustic agent and that it may cause severe mucosal injuries in esophagus. This approach seems rather excessive, as Yen et al established that paraquat is a mild caustic agent and produces only grades 1, 2a, and 2b esophageal injury that can be managed with supportive measures (2). In addition, Chen et al ascertained the same implication showing in their study that paraquat is only a weak caustic agent (3). In our experience (4), low rate of GI injury occurs in paraquat poisoning, and moreover, GI tract complications alone do not have any impact on patients’ survival (4). Taking these facts together, because paraquat poisoning is common in some regions and upper GI endoscopy is an anecdotal routine in some hospitals for this type of poisoning, in our opinion the following comments are better to be considered in day to day practice and for future studies: 1- The relationship between clinical signs and symptoms of mucosal injury (vomiting, odynophagia, dysphagia, retrosternal pain, etc.) with the degree of injury in GI endoscopy in paraquat poisoning has not been determined yet. 2- The association of paraquat serum level with the level of mucosal injury (determined by endoscopy) has not been established in paraquat poisoned patients. 3- As paraquat poisoning may cause severe liver dysfunction and coagulopathy, for performing endoscopy, the optimal time should be considered. In this case, invasive measures may just worsen the patients' condition by exposing them at the risk of uncontrollable bleeding. 4- Comparing the specificity and sensitivity of chest esophageal CT scan (as a possible substitute for GI endoscopy) and GI endoscopy (as a gold standard method) for evaluation of esophageal injury seems to be beneficial. 5- Finally, in order to determine the severity of paraquat poisoning and better define prognosis, severity index of paraquat poisoning (SIPP) is a widely used tool (5). Performing GI endoscopy for patients with SIPP scores less than 10, which are indicative of better prognosis, can be taken into account for follow up purpose (5).