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The efficient processing of hypereutectic Al–Si alloys depends on controlling the microstructure of the primary Si phase during solidification. This study investigates the effects of electric current and phosphorus (P) addition on the refinement of primary Si, with the results confirming that applying electric current during solidification refines the primary Si phase; introducing P further enhances this refinement. Notably, when 10 ppm of P is added (below the identified critical amount of 20 ppm), an improved refinement effect is observed compared with the application of either electric current or P alone. Applying an electric current generates a circulating flow within the melt, resulting in an increased cooling rate, which leads to improved nucleation behavior for the primary Si phase. In addition, the circulating flow generated within the melt influences the dispersion of aluminum phosphide during nucleation. Adding P at concentrations above 40 ppm does not yield further benefits, suggesting a saturation point for its efficacy. This study demonstrates that the concurrent electric current application and minimal P addition can significantly enhance the refinement of primary Si phases, offering a potent approach for optimizing the microstructural properties of hypereutectic Al–Si alloys. [ABSTRACT FROM AUTHOR]

Background: Various fumigant products containing aluminium phosphide, known as rice pills, are widely used to kill insects in many parts of Iran, including the northern provinces. Poisoning with zinc phosphide as a rat poison also has the same side effects as aluminium phosphide. This poisoning has no specific antidote, and the treatment is auxiliary, and one of the effective auxiliary treatments is L-carnitine. This review study aimed to determine the prevalence of aluminium phosphide poisoning and treatment with intravenous L-carnitine. Materials and Methods: This study was a narrative review conducted in 2023. Search keywords aluminium phosphide, zinc phosphide, intravenous L-carnitine, and poisoning in Persian and English languages in databases including Magiran, PubMed, Wiley, Science Direct, web of Sciences, SID, Scopus, and Google Scholar were done from 1970 to 2022. Relevant articles were identified, and the most important and valuable points were presented after review. Results: According to the findings of most studies, aluminium phosphide pills had the most adverse effects as toxic substances. Conclusion: Due to the prevalence of its consumption among young people with low education levels, there was a need for physicians to treat these patients as quickly as possible accurately. It is also necessary to raise awareness about its potentially dangerous side effects and to monitor closely the distribution of this poisonous pill in its distribution centers. Moreover, the quick start of supportive treatment with antioxidants and L-carnitine can help in this poisoning that does not have a specific antidote. Very effective and useful. [ABSTRACT FROM AUTHOR]

Background: In Egypt, aluminum phosphide (ALP) is a known lethal poison due to its cardiotoxicity. This study aimed to evaluate the predictive ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for mortality in ALP-poisoned patients. Methods: This prospective study was conducted on patients with ALP poisoning admitted to the Poison Control Center Ain Shams University Hospitals between July and December 2022. Upon admission, all patients were followed up and had their levels of NT-proBNP, troponin I (cTnI), and creatine kinase myocardial band (CK-MB) analyzed. Results: Thirty patients were enrolled in the study and were divided into survivors and non-survivors. The initial NT-proBNP levels were significantly higher among non-survivors in contrast to the initial cTnI and CK-MB levels. The study identified that the best cutoff point of NT-proBNP for predicting mortality was ≥72 pg/ml, with AUC (0.869). Conclusion: It can be concluded that NT-proBNP can serve as an early predictor of mortality in ALP poisoning. [ABSTRACT FROM AUTHOR]

The hallmark of aluminum phosphide (AlP) poisoning is heart failure in victims which is associated with reactive oxygen species (ROS), mitochondrial dysfunction, oxidative stress, alteration in antioxidant defense system and depletion of ATP in cardiomyocytes. In the present study, we hypothesized that the injection of isolated mitochondria into blood or mitochondrial transplantation can likely create a primary target for phosphine released from AlP and inhibit AlP-induced mortality and cardiotoxicity in rat. Male, Wistar, healthy and adult rats were randomly divided into 5 groups as control, AlP (12.5 mg/kg, orally), AlP + mitochondria (125 µg/kg), AlP + mitochondria (250 µg/kg) and mitochondria (250 µg/kg) alone. Functional and intact mitochondria isolated from rat heart and transplantation was carried out via tail vein, 30 min after exposure to AlP. Survival rate, histopathological alterations, cardiac biochemical markers, oxidative stress and mitochondrial toxicity parameters were monitored and analyzed during 30 days. We found that injection of healthy mitochondria into blood at concentrations of 125 and 250 125 µg/ml significantly increased the survival of rats up to 40% and 56.25% respectively, during 30 days. Moreover, we observed that mitochondria injection into blood decreased histopathological damages, cardiac biochemical markers, oxidative stress and mitochondrial toxicity parameters. To our knowledge, the current study is the first report in the literature that demonstrated good therapeutic effects of mitochondrial transplantation in AlP-induced mortality and cardiotoxicity. The findings of the present study suggests that injection of exogenous mitochondria into blood could be an effective therapeutic strategy in treating AlP poisoning. [ABSTRACT FROM AUTHOR]

Aluminum phosphide (AlP) is the main component of rice tablets (a pesticide), which produces phosphine gas (PH3) when exposed to stomach acid. The most important symptoms of PH3 toxicity include, lethargy, tachycardia, hypotension, and cardiac shock. It was shown that Iodine can chemically react with PH3, and the purpose of this study is to investigate the protective effects of Lugol solution in poisoning with rice tablets. Five doses (12, 15, 21, 23, and 25 mg/kg) of AlP were selected, for calculating its lethal dose (LD50). Then, the rats were divided into 4 groups: AlP, Lugol, AlP + Lugol, and Almond oil (as a control). After 4 h, the blood pressure and electrocardiogram (ECG) were recorded, and blood samples were obtained for biochemical tests, then liver, lung, kidney, heart, and brain tissues were removed for histopathological examination. The results of the blood pressure showed no significant changes (P > 0.05). In ECG, the PR interval showed a significant decrease in the AlP + Lugol group (P < 0.05). In biochemical tests, LDH, Ca2+, Creatinine, ALP, Mg2+, and K+ represented significant decreases in AlP + Lugol compared to the AlP group (P < 0.05). Also, the administration of Lugol's solution to AlP-poisoned rats resulted in a significant decrease in malondialdehyde levels and a significant increase in catalase activity (P < 0.05). Histopathological evaluation indicates that Lugol improves changes in the lungs, kidneys, brain, and heart. Our results showed that the Lugol solution could reduce tissue damage and oxidative stress in AlP-poisoned rats. We assume that the positive effects of Lugol on pulmonary and cardiac tissues are due to its ability to react directly with PH3. [ABSTRACT FROM AUTHOR]

Aluminum Phosphide (AlP), a potent rodenticide and fumigant pesticide, poses a significant health threat, especially in agricultural communities. This study aimed to investigate demographic trends and predictive factors influencing outcomes in AlP poisoning patients presenting to the Emergency Department (ED). With an alarming mortality rate of 80.4%, identifying predictors of mortality became imperative. Non-survivors tended to be older and presented with distinct vital signs, such as tachycardia and shock upon ED arrival. Prognostic scoring systems like the Modified Early Warning Score (MEWS), Shock Index (SI), Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS), and serum lactate emerged as robust mortality predictors, with good accuracy (Area Under the Curve, AUC, MEWS=0.904, SI=0.914, MAP=0.869, GCS=0.829, lactate=0.962). This study favors integrating these predictors into routine ED practices, particularly in Low- and Middle-Income Countries (LMICs), to prognosticate and enhance management outcomes in patients with AlP poisoning, offering essential guidance for emergency physicians. [ABSTRACT FROM AUTHOR]

Background: Phosphide metal poisoning results in tens of thousands of fatalities per year worldwide. The mortality in critically ill patients often exceeds 50%. The available treatment is supportive and there is no antidote. Dialysis is recommended to treat advanced complications but has not been prescribed early in the process. In this study we report our experience in using dialysis in the early hours of presentation of the patients and suggest it can favorably improve the prognosis. We also draw attention to the risk of suicide under conditions of chronic conflict such as those in northwestern Syria, and to the lack of necessary mental health support for patients after suicide attempts. Methods: Retrospective review of records of patients poisoned with aluminum phosphide and admitted to critical care facilities in northwestern Syria between July 2022 and June 2023. Results: During the observation period 16 cases were encountered. Suicide was the reason of the poisoning in 15 patients, the median patient age was 18 years and over two thirds of the patients were female. Early dialysis was used in 11 patients who were critically ill and their mortality rate was 18%. Conclusions: Phosphide metal poisoning is common in the disasters stricken area of northwestern Syria. Most cases are suicidal and impact young females. Early dialytic interventions may favorably impact the outcomes. [ABSTRACT FROM AUTHOR]

The agricultural fumigant pesticide aluminum phosphide (AlP) is cardiotoxic. Water causes AlP to emit phosphine gas, a cardiac toxin that affects heart function and causes cardiogenic shock. AlP poisoning's high fatality rate is due to cardiotoxicity. This study examines how resveratrol reduces oxidative stress, mitochondrial activity, and apoptosis in human cardiac myocyte (HCM) cells. After determining the optimal doses of resveratrol using the MTT test, HCM cells were subjected to a 24-h treatment of resveratrol following exposure to AlP (2.36 μM). The levels of reactive oxygen species (ROS), superoxide dismutase (SOD) activity, mitochondrial swelling, mitochondrial cytochrome c release, and mitochondrial membrane potential (MMP) in HCM cells were investigated. Also, the expression of Bax and Bcl-2, caspace-3 activity, and apoptosis were assessed. The present investigation revealed that AlP substantially increased the level of ROS and decreased SOD activation, which were significantly modulated by resveratrol in a dose-dependent manner. Moreover, AlP induced an elevation of mitochondrial swelling, cytochrome c release, and MMP collapse. Co-administration of resveratrol significantly reduced above mitochondrial markers. AlP also significantly upregulated BAX and downregulated Bcl-2 expression, elevated caspace-3 activity, and apoptosis. Resveratrol co-administration was able to meaningfully modulate the mentioned parameters and finally reduce apoptosis. In conclusion, resveratrol, via its pleotropic properties, significantly demonstrated cytoprotective effects on HCM cytotoxicity induced by AlP. [ABSTRACT FROM AUTHOR]

Background: The assessment of the postmortem interval (PMI) represents one of the major challenges in forensic pathology. Because of their stability miRNAs, are anticipated to be helpful in forensic research. Objective: to see if estimation of PMI is possible using miRNA-122 expression levels in the heart samples from aluminum phosphide toxicity (Alpt). Methods: This was a cross sectional study on 60 postmortem samples (heart tissues) collected at different intervals during forensic autopsies. The two groups were allocated equally according to the cause of death into Group I (control, n꓿30): Deaths caused by other than toxicity, and Group II (cases, n꓿30): Deaths due to Alpt. miRNA-122 expression levels were measured in heart tissues at different PMI using RT-Q PCR. Results: miRNA-122 level in Alp deaths was up regulated with statistically significant difference. There was positive correlation between miRNA-122 with PMI. Conclusion: The results of this study concluded that the PMI can be calculated using the degree to which particular miRNA-122. [ABSTRACT FROM AUTHOR]

Background: Para-suicide by self-poisoning is a major public health concern throughout the world, especially in developing countries. It is a cause of considerable morbidity and mortality as well as consuming scarce medical resources which would have been used otherwise. The survival of such patients to a considerable extent depends on the competence of the attending doctors, nature of toxic agent consumed and the availability of specific antidote. Objective: The sole purpose of this study is to provide proper knowledge and awareness of health professionals on the common toxic agents used for self-poisoning. Material and methods: This prospective study was conducted by identifying and reviewing all self-poisoning cases that were presented at the emergency department of JNMCH, A.M.U Aligarh, over a span of 2 years. A total of 375 cases of self-poisoning were entered into the emergency department register, but only 315 files were considered for this study. Results: In this study majority patients belong to 15-24 years' age group i.e. 153(48.57%) with male dominance. The most ingested substance for non-fatal self-poisoning was a pharmaceutical drug 71(22.54%) followed by agrochemicals like rat poison 60 (19.05%), Aluminium phosphide 46(14.60%) and organophosphate 33(10.48%). There were significant (p<0.01) gender differences noted in type of substance used. Conclusion: Accessibility has been noted as a factor affecting the choice of drug used. Implementing the pesticide act strictly will allow the government to have control over the production, sale, distribution, storage, and use of pesticides. [ABSTRACT FROM AUTHOR]

Totally 300 demonstrations were initiated in four districts (Dharwad, Belagavi, Bagalkot and Vijayapur) of northern Karnataka, but 50 farmers terminated the demonstrations half way due to use of the produce for consumption or marketing of produce. Hence, the inferences were drawn from 250 successful demonstrations. Immediately after the harvest, the seeds should be dried properly and stored. For cereals, as a preventive measure, to reduce the pest infestation, mix sweet flag rhizome powder @ 1 per cent (100 g/q) or neem seed powder @ 2 per cent (200 g/q) in case of cereals such as sorghum, maize, wheat and paddy. For pulses, as a preventive measure, to reduce the pest infestation, mix sweet flag rhizome powder @ 1 per cent (100 g/q) or smear groundnut oil @ 5 per cent (500 ml/q) in case of pulses such as bengal gram, red gram, cowpea and green gram. For oilseeds, as a preventive measure, to reduce the pest infestation, mix sweet flag rhizome powder @ 1 per cent (100 g/q) in oilseeds such as groundnut, sunflower and soybean. These give protection against storage pests for a period of six months. As curative measure, in the infested seeds/grains of cereals or pulses, place Aluminium Phosphide tablets (@ 3 tablets per tonne tied in the muslin cloth) in the middle of the stack in the storage structures under airtight conditions for seven days. After this, open the gunny bags and air dry for 48 hours and sieve the produce to remove dead insects and store/use further. [ABSTRACT FROM AUTHOR]

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.

Aluminum phosphide (AlP) poisoning is a life-threatening emergency prevalent in the Middle East region including Egypt. Early prediction of prognosis is critical for initiating the utmost intensive interventions. Though many scoring systems were studied for predicting the prognosis of AlP poisoning, these scores received wide criticism. Complexity and reliability were the main concerns. Therefore, this retrospective cross-sectional study aimed to evaluate the performance of the recently introduced PGI score as a predictor of case fatality, the need for mechanical ventilation and vasopressor therapy in acute AlP poisoning. Moreover, it compares the performance of PGI with the known poison severity score (PSS), and the simplified acute physiology score (SAPS) II. Among 144 exposed patients, we reported a mortality rate of 61.1%. Non-survivors exhibited significantly higher PGI, PSS, and SAPS II than survivors. Though the PGI, PSS, and SAPS II proved their significance as predictors of mortality and, the need for MV and vasopressors, the PGI score showed a significantly higher area under the curve (AUC) as a predictor of MV (AUC = 0.848) compared to PSS (AUC = 0.731) and SAPS II (AUC = 0.749). Additively, PGI of 2 or more was a significant predictor of mortality (AUC = 0.831, sensitivity = 65.9%, and specificity = 89.3 %) and MV (p < 0.001), while PGI of 1 or more was another predictor of vasopressor need (AUC = 0.881, sensitivity = 89.0% and specificity = 79.4%). Given the PGI score's high AUCs across all outcomes, coupled with its balanced sensitivity and specificity, the PGI score could be a simple, and robust tool replacing the PSS and SAPS II for predicting mortality, clinical decision-making including the need for MV and vasopressor therapy in acute AlP exposure. Adopting the PGI score seems substantially useful in managing acute AlP poisoning, notably in resource-restricted countries.

Introduction Aluminum phosphide (ALP) is a highly toxic rodenticide and the mortality rates caused by it have been demonstrated up to 70–100% in various studies. Unfortunately, there is no specific antidote to manage its toxic effects. This study aimed to assess the biochemical and clinical efficacy and safety of intravenous lipid emulsion as an adjuvant therapy in acute aluminum phosphide poisoning. Patients and methods Sixty-four cases with acute ALP poisoning were stratified according to severity by the Poison Severity Score into severe and moderate groups (32 patients each). Patients were then randomly allocated into either receiving intravenous lipid emulsion in addition to the conventional treatment or receiving the conventional treatment only by using block randomization. Results Treatment by ILE resulted in a significant improvement in the survival time, the mean arterial blood pressure, arterial blood gases, and a significant reduction in serum lactate levels. The need for intubation and mechanical ventilation was insignificantly lower in the intervention groups compared to control groups. However, the reduction in mortality rate in the patients of intervention groups compared with control groups was found to be non-significant. Intravenous lipid emulsion use in acute ALP poisoning significantly prolonged the survival time, improved the metabolic acidosis, decreased the serum lactate levels and increased the mean arterial blood pressure and hospital stay in the intervention groups. And insignificantly decreased the mortality rate, need of intubation and mechanical ventilation, and the total dose of vasopressors. [ABSTRACT FROM AUTHOR]

Background: Nowadays, therapeutic plasma exchange (TPE) is considered a novel and promising treatment in cases of poisoning. However, few studies have been conducted on the use of TPE as a treatment in various toxicity cases, especially aluminum phosphide (AlP) poisoning. Therefore, the present study aimed to investigate the efficacy of plasmapheresis in the treatment and clinical outcome of patients with AlP poisoning. Methods: We conducted this randomized controlled clinical trial on 80 patients poisoned with AlP. The control patients (n=58) received only the routine treatment, whereas those in the experimental group (n=22) underwent plasmapheresis in addition to the routine treatment. The plasmapheresis was given to these patients immediately after they had received the routine treatment, within the first six hours of their hospital admission. Results: The study results revealed that the mean hematocrit level in the plasmapheresis group (34.31±3.31%) was significantly lower than that of patients in the control group (38.05±4.80%) 12 h after the plasmapheresis treatment (P=0.046). Moreover, there were six (27.3%) and 14 (24.1%) cases of mortality in the plasmapheresis group and the control group, respectively. There was no significant difference in the mortality rates between the two groups (P=0.778). Conclusion: Based on the results of this study, plasmapheresis had a significant effect on increasing the blood HCO3 level within 12 h after the intervention. Therefore, it had a significant role in reducing the resultant acidosis in patients with AlP poisoning; however, this effect did not reduce the mortality rate after plasmapheresis. [ABSTRACT FROM AUTHOR]

Background: In Bundelkhand region, 15-18% patients who are attended in the emergency setting comprises poisoning and 60-70% of which are agriculture-based poisons due to its easy accessibility. Aims and Objectives: The aim of this study was to see spectrum of poisoning in Bundelkhand region. Materials and Methods: The prospective non-randomized study was done in Maharani Laxmi Bai Medical College, Jhansi, between December 2020 and October 2022, including 500 patients applied for treatment of different poisoning. Results: In our study, total 500 cases of poisoning were taken. As per found data, majority of patients were found in 17-30 years of age group 202 (40.4%) followed by 31-40 years of age group 157 (31.4%). Minimum 19 (3.8%) cases were found in 61-70 years of age group and 0 case in >70 years of age group. Majority of patients were found male, i.e., 281 (56.2%) and the rest 219 (43.8%) were females. According to finding of our study, maximum mortality rate was found due to Stone hair dye, i.e., 100% followed by Celphos 35.54%, Insecticidal 26.92%, and Alcoholic intoxication 22.22%. As per our study, major cause of taking poison, maximum number of patients were found in marital discord 108 (21.6%) followed by family problems, i.e., 75 (15%), which is similar to separation/death of family member, that is, 74 (14.8%). Conclusion: Concerned authorities should think about substitute of aluminum phosphide, which would be less toxic for human being and concerned authority should ban availability of aluminum phosphide (Celphos) in market. [ABSTRACT FROM AUTHOR]

Some studies suggested that gastrointestinal (GIT) decontamination with oil may improve the prognosis of patients who ingested aluminum phosphide (AlP). The aim of this study is to compare the efficacy and safety of gastric lavage with oil-based solutions to any method of gastric decontamination not using oils in patients presenting with acute AlP poisoning. The literature was searched for English-published randomized controlled trials (RCTs) from inception to 16 September 2023. The searched electronic databases included MEDLINE/PubMed, Cochrane Library, Web of Science, Egyptian Knowledge Bank, Scopus, and Google Scholar. Data were extracted and pooled by calculating the risk ratio (RR) for categorical outcomes and standardized mean difference (SMD) for numerical outcomes, with 95% confidence intervals (CI). Seven RCTs were included. Paraffin oil was significantly associated with a lower risk of mortality (RR = 0.59 [95% CI: 0.45, 0.76], p <.001), intubation (RR = 0.59 [95% CI: 0.46, 0.76], p <.001) and vasopressor need (RR = 0.71 [95% CI: 0.56, 0.91], p =.006). Survival time was significantly prolonged with paraffin oil (SMD = 0.72 [95% CI: 0.32, 1.13], p <.001). Coconut oil was significantly associated with prolonged survival time (SMD = 0.83 [95% CI: 0.06, 1.59], p =.03) as well as decreased risk of requiring intubation (RR = 0.78 [95% CI: 0.62, 0.99], p =.04). Oil-based GIT decontamination using paraffin oil showed benefits over conventional lavage regarding the incidence of in-hospital mortality and endotracheal intubation, and survival time. Coconut oil showed some benefits in terms of the intubation incidence and survival time. Decontamination using paraffin oil is recommended. Future clinical trials are warranted with larger sample sizes and focusing on cost-benefit and safety. [ABSTRACT FROM AUTHOR]

Brugada phenocopy is considered when a Brugada-type ECG pattern is present but with a low likelihood of true Brugada syndrome, as indicated by negative family history, genetic testing, or provocative testing with drugs, or ECG normalization after the removal of precipitants. Brugada phenocopy has been reported due to various causes such as fever and electrolyte imbalance. We describe a 22-year-old man who presented with aluminum phosphide poisoning, resulting in severe metabolic acidosis, myocarditis, and profound myocardial depression. He developed transient Brugada-like ECG changes and multiorgan dysfunction, requiring intensive management, including mechanical ventilation and inotropes. Brugada phenocopy is a rare manifestation of aluminum phosphide-associated toxic myocarditis. After a week of treatment, there was a significant improvement in cardiac function and overall clinical status. [ABSTRACT FROM AUTHOR]

Background: Poison is defined as any substance that harms, endangers, or even kills a person irrespective of the quality or quantity. Pakistan is a developing country and farming is the major occupation of most of the population. Due to the easy availability and increased use of pesticides, accidental and suicidal poisoning is very common. The objective of the study is to find out the most common poison used by people in the general population and its frequency in our setup. Methods: Casualty Department of the Ayub Teaching Hospital in Abbottabad, served as the site of this retrospective investigation. Registrations between January 1st and December 31st, 2023, provided the data. All cases with a history of poisoning were included. Using SPSS 22, the data was analyzed. Sample was limited to those who were admitted when they were still alive. Ethical permission was taken from hospital administration. Results: The study revealed that poisoning was more common among females and the most common age group affected was 16-22years. 57.8% (52) cases were of suicidal intent while 40% (36) were accidental. Conclusion: Female and young people are more prone to Aluminium Phosphide (wheat pill) poison. It is a dangerous and lethal poison, so healthcare workers at emergency department ought to be prepared for such cases. Furthermore, its routine use as a domestic pesticide has to be strictly prohibited by creating awareness among the public. [ABSTRACT FROM AUTHOR]

The most common pesticide agents are organophosphates and phosphides, aluminum phosphide (ALP) in particular. ALP is a major cause of suicidal poisoning in many countries. In other countries, the problem of accidental, mainly occupational-related, poisoning is also real and actual. Almost two thirds of individuals in poisoning cases have died. This case report describes a case of a patient with accidental ALP intoxication. The origin of the poisoning was the fumigation of stored grain in an agricultural building adjacent to the building in which patient was temporarily housed, while both buildings were connected by an underground corridor, through which the released poison gas penetrated. The case was originally presented by the rescuers as well as healthcare professionals of the local hospital as carbon monoxide intoxication, which has a similar symptomatology as ALP intoxication. The patient was treated comprehensively, including using the HBOT method, which is very unique in the case of phosphine intoxication in human medicine, with an excellent final clinical outcome. This was the first described case of HBOT for ALP intoxication in clinical medicine, although the HBOT indication itself became a coincidence in this case. Further studies must be undertaken to demonstrate the effectiveness of HBOT in treating patients with ALP poisoning. [ABSTRACT FROM AUTHOR]

Introduction Aluminum Phosphide (AlP) poisoning constituted the most common cause of poisoning death in some low- and middle-income countries (LMICs). This study aimed to evaluate the safety and efficacy of oil-based gastric lavage (GL) compared with standard therapy for the treatment of AlP poisoning. Materials and methods. This systematic review complied with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) Protocols. A comprehensive search was carried out, identifying randomized controlled trials (RCTs), including anyone presenting within 6 h of exposure to AlP, and the administration of GL with oils, including liquid paraffin or coconut oil. Results We identified 7 RCTs. The evidence from 4 RCTs indicates that GL with paraffin oil is an effective treatment for acute AlP poisoning, decreasing the mortality rate (RR = 0.62; 95% CI = 0.48 to 0.81; participants = 226; I 2 = 10%; low-quality evidence). We estimate the Number Needed to Treat of 4. Likewise, this intervention reduces the need for intubation and mechanical ventilation (RR = 0.62; 95% CI = 0.40 to 0.79; I2 = 0%; low-quality evidence). Regarding GL with coconut oil, the evidence from 4 RCTs, indicates a slight reduction in mortality (RR = 0.82; 95% CI = 0.69 to 0.98; participants = 112; I2 = 0%; very low-quality evidence). Conclusions Limited evidence suggests that GL with paraffin oil is effective in reducing the mortality rate. Likewise, limited evidence showed in favor of paraffin oil concerning the need for intubation and mechanical ventilation. Very limited evidence suggests that GL with coconut oil could reduce mortality. Both interventions would have a benign safety profile. [ABSTRACT FROM AUTHOR]

Aluminum Phosphide (AlP), a potent rodenticide and fumigant pesticide, poses a significant health threat, especially in agricultural communities. This study aimed to investigate demographic trends and predictive factors influencing outcomes in AlP poisoning patients presenting to the Emergency Department (ED). With an alarming mortality rate of 80.4%, identifying predictors of mortality became imperative. Non-survivors tended to be older and presented with distinct vital signs, such as tachycardia and shock upon ED arrival. Prognostic scoring systems like the Modified Early Warning Score (MEWS), Shock Index (SI), Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS), and serum lactate emerged as robust mortality predictors, with good accuracy (Area Under the Curve, AUC, MEWS=0.904, SI=0.914, MAP=0.869, GCS=0.829, lactate=0.962). This study favors integrating these predictors into routine ED practices, particularly in Low- and Middle-Income Countries (LMICs), to prognosticate and enhance management outcomes in patients with AlP poisoning, offering essential guidance for emergency physicians.

Abstract Background Aluminum phosphide is a commonly used pesticide, particularly in developing countries where uncontrolled insecticides and pesticides are commonly prevalent. Mortalities have been reported due to accidental and suicidal exposures to aluminum phosphide. To date, there has been no reported mortality case of aluminum phosphide in Lebanon. In addition, there is no specific antidote for aluminum phosphide toxicity and the treatment is mainly supportive. This is why awareness should be spread about this case to include it in the differential diagnoses and enhance prompt management and response in future encounters. Case presentation A previously healthy 37-year-old male, presented to the emergency department of Notre Dame des Secours University Hospital Center for a suicidal attempt after ingesting 5 tablets of pesticide containing 56% aluminum phosphide an hour prior to presentation. Shortly after the presentation, the patient began deteriorating and became clinically unstable. The patient was then intubated and was started on sodium bicarbonate along with aggressive fluid resuscitation. The patient remained hypotensive even after giving vasopressors. He was then later admitted to the intensive care unit for further management. However, the patient further decompensated and developed multiorgan failure. This is the first case of mortality in Lebanon from aluminum phosphide toxicity. Conclusions Emergency physicians should include aluminum phosphide toxicity in the differential diagnosis when dealing with patients ingesting unknown pesticides especially when they smell the characteristic garlic-like odor. The toxicity from ALP leads to multiorgan failure and death rapidly. Thus, it is of utmost importance to start early, and aggressive resuscitation given that there is no specific antidote.

Background: Severe refractory hypotension and cardiogenic shock are the main contributors to death in acute aluminum phosphide (ALP) poisoning. Shock index (SI) and modified shock index (MSI) are easily obtained parameters that reflect shock at an early stage. Aim: This study aimed to evaluate the role of SI and MSI in the prediction of the severity and outcomes of acute ALP poisoned patients. Patients and methods: This cross sectional study was conducted on patients admitted to Tanta University Poison Control Centre with acute ALP poisoning from April 2022 to March 2023. Socio-demographics and toxicological data were taken, findings of clinical examination and laboratory investigations were recoded, SI was calculated by dividing heart rate over systolic blood pressure, and MSI was obtained by dividing heart rate over mean arterial pressure. Poisoning severity was assessed using poisoning severity score (PSS). Patients were divided into groups according to intensive care unit (ICU) admission and mortality. Results: The study enrolled 94 patients. The median values of SI and MSI were significantly higher in ICU-admitted patients and non-survivors rather than their comparable groups. Significant positive correlations were observed between each of SI and MSI and PSS. At cut-off >1.14, SI conveyed fair performance to predict ICU admission and mortality (AUC = 0.710 and 0.739, respectively). Similarly, MSI had fair performance to predict ICU admission (AUC = 0.731) and mortality (AUC = 0.744) at cut-off >1.47 and >1.5, respectively. Conclusion: Both SI and MSI could be considered simple bedside adjuncts to predict ICU admission and mortality in acute ALP poisoning. [ABSTRACT FROM AUTHOR]

The formaldehyde (HCHO) is produced from building materials and it can cause illness and cancer in human. The oxidation of HCHO is acceptable pathway for HCHO purification to protect the human health. The catalytic activity of Manganese (Mn) doped carbon nanocage (Mn-C60), Mn doped silicon nanocage (Mn-Si60) and Mn doped aluminum phosphide nanocage (Mn-Al30P30) as effective catalysts for oxidation of HCHO to carbon dioxide (CO2) are investigated. The acceptable mechanisms for oxidation of HCHO to CO2 on surfaces of Mn-C60, Mn-Si60 and Mn-Al30P30 nanocages as catalysts are examined. Results shown HCHO is oxidized to CO2 on Mn-C60, Mn-Si60 and Mn-Al30P30 nanocage surfaces thought two acceptable mechanisms: (1) HCHO → HHCOO → HCOO → HCO → CO → CO2 and (2) HCHO → HHCOO → HCOO → CO2. The rate-limiting steps of pathways 1 and 2 are HCOO → HCO and HCHO → HHCOO. The metal doped nanocages (Mn-C60, Mn-Si60 and Mn-Al30P30) have excellent potential to development the patheways of HCHO oxidation with high performance. The results have proposed that the new strategy to increase enhance the catalytic ability of metal doped nanocages (Mn-C60, Mn-Si60 and Mn-Al30P30) for HCHO oxidation. [ABSTRACT FROM AUTHOR]

Chrysomya megacephala and C. rufifacies are globally predominant species of blowflies that are amongst the primary colonisers of decomposing carcasses. The development of blowflies has been studied extensively to estimate the minimum postmortem interval (PMImin). This article evaluates the effect of aluminium phosphide (AlP) on the larval morphometry and life cycles of C. megacephala and C. rufifacies. The rabbits were given different dosages of AlP and their livers were excised to rear C. megacephala and C. rufifacies. Through multiple-regression analysis, we assessed the overall impact of varying dosages of AlP on larvae of both species. AlP accelerated development until pupation, whilst the time until emergence remained the same. At higher concentrations, AlP had a positive effect on the development of these species. Since both species are abundant, forensic entomology studies examining the effect of AlP on morphometry and developmental stages would provide valuable information to investigators assessing PMImin. [ABSTRACT FROM AUTHOR]

The applicant Detia Freyberg GmbH submitted to the competent national authority in Germany two requests to evaluate the confirmatory data that were identified for tree nuts, oilseeds, cereals and commodities of animal origin in the framework of the maximum residue level (MRL) review under Article 12 of Regulation (EC) No 396/2005 as not available and two requests in accordance with Article 6 of Regulation (EC) No 396/2005 to increase the existing MRL for the active substance aluminium phosphide in peanuts, barley, oat, rye, rice and wheat, roots of herbal infusions, cocoa beans and seed spices and for the active substance magnesium phosphide in oilseeds (except peanuts) and pistachios. The four applications were combined by EFSA under the current assessment. To address the data gaps, validation data for the method of analysis for enforcement of phosphide in high‐oil content commodities and new residue trials were submitted. The data gaps on additional residue trials supporting authorisations on oilseeds and cereal grains, on clarifications regarding the discrepancies observed in the residue trial results for pistachios, and on data confirming the negligible occurrence of phosphane and its oxidation products in livestock products were considered addressed. The data gap on independent laboratory validation (ILV) and a confirmatory method for monitoring of phosphide in high‐oil content commodities was considered not fully addressed. The information provided justified a lowering of the current tentative MRLs for the whole group of cereals (except rice and 'others'), an increase of the current tentative MRLs for pistachios, the whole group of oilseeds, rice and 'other' cereals, herbal infusions from roots, cocoa beans and seed spices, and a revision of the risk assessment performed for phosphane and its phosphide salts. Based on the risk assessment results, EFSA concluded that the short‐term and long‐term intake of residues resulting from the use of AlP and Mg3P2 according to the reported agricultural practices is unlikely to present a risk to consumer health. Further risk management considerations are required. [ABSTRACT FROM AUTHOR]

The formaldehyde (HCHO) is produced from building materials and it can cause illness and cancer in human. The oxidation of HCHO is acceptable pathway for HCHO purification to protect the human health. The catalytic activity of Manganese (Mn) doped carbon nanocage (Mn-C60), Mn doped silicon nanocage (Mn-Si60) and Mn doped aluminum phosphide nanocage (Mn-Al30P30) as effective catalysts for oxidation of HCHO to carbon dioxide (CO2) are investigated. The acceptable mechanisms for oxidation of HCHO to CO2 on surfaces of Mn-C60, Mn-Si60 and Mn-Al30P30 nanocages as catalysts are examined. Results shown HCHO is oxidized to CO2 on Mn-C60, Mn-Si60 and Mn-Al30P30 nanocage surfaces thought two acceptable mechanisms: (1) HCHO → HHCOO → HCOO → HCO → CO → CO2 and (2) HCHO → HHCOO → HCOO → CO2. The rate-limiting steps of pathways 1 and 2 are HCOO → HCO and HCHO → HHCOO. The metal doped nanocages (Mn-C60, Mn-Si60 and Mn-Al30P30) have excellent potential to development the patheways of HCHO oxidation with high performance. The results have proposed that the new strategy to increase enhance the catalytic ability of metal doped nanocages (Mn-C60, Mn-Si60 and Mn-Al30P30) for HCHO oxidation. [ABSTRACT FROM AUTHOR]

Background and Aim: Aluminum phosphide poisoning is one of the fatal poisonings in Asian countries, including Pakistan and India, which requires urgent treatment. Since one of the most important symptoms in patients poisoned with aluminum phosphide is cardiovascular manifestations; it seems that electrocardiogram and echocardiographic changes are one of the important things that need to be measured in patients poisoned with this substance. Therefore, the study was designed to investigate electrocardiogram and echocardiographic changes in patients poisoned with aluminum phosphide. Materials and Methods: The present study was conducted cross-sectionally 2019-2021 on 107 patients poisoned with aluminum phosphide who referred to the poisoning emergency of Baharloo Hospital in Tehran. All patients were included in the study due to taking tablets, solution or inhalation of aluminum phosphide. Finally, the patients› information was collected based on the variables investigated in this study including age, gender, poisoning dose, time interval between taking pills and admission to the hospital, systolic blood pressure level, electrocardiogram and echocardiography changes. Results: The mean systolic blood pressure was 107 mmHg at the beginning of the study that changed to 103 mmHg after 24 hours. In addition, the mean diastolic blood pressure was 71.19 mmHg at the beginning of the study that changed to 68.66 mmHg after 24 hours. The blood pH of the patients at the beginning of the study and after 24 hours, was 6.99 and 7.39, respectively (P-value= 0.081). The mean EF was 40.68at the beginning of the study which, on average, changed to 46.57 mmHg after 24 hours (%5.21 increase, P-value= 0.029). Conclusion: The results of the present study showed that extensive changes in the echocardiography of the heart, especially the left ventricular ejection fraction, as well as the patient›s ECG could indicate the severity of heart poisoning in patients poisoned with aluminum phosphide.

Introduction: Aluminum phosphide (AlP) poisoning, commonly known as rice tablet poisoning, is a lethal method of suicide with no known antidotes. Thyroid hormones have inotropic effects that can potentially reverse hemodynamic instability and improve cardiac output. This study investigated the effects of Triiodothyronine (T3) on the cardiac function of patients with aluminum phosphide poisoning.Methods: In this randomized clinical trial, 24 patients with confirmed ALP poisoning were recruited. The intervention group received T3 treatment in addition to standard treatment, while the control group received only standard treatment. Demographic variables, cardiac parameters, biochemical markers, and oxidative stress tests were evaluated.Results: The majority of participants were men (60%) in their thirties (intervention: 32±17.4 years; control: 30±11.6 years). Following treatment, both systolic and diastolic blood pressures had significantly higher mean differences in the T3 group compared to the control group (18.7±9.3, P=0.05 and 14.1±5.9, P=0.03 respectively). While both groups showed improvement in mean arterial pH, the intervention group exhibited a significantly greater improvement 12 hours after the administration of T3, which was significantly different from both the baseline and control groups (p=0.04, 0.009 respectively). Additionally, the intervention group had a lower QRS and QTc interval compared to admission time.Conclusion: Triiodothyronine administration has been shown to maintain a higher range of SBP, control cardiogenic shock, regulate metabolism, improve acidosis and blood pressure, and ultimately enhance recovery in patients with aluminum phosphide poisoning. Furthermore, it may have cardio-protective effects on these patients.

Background and Aim: Aluminum phosphide poisoning is one of the fatal poisonings in Asian countries, including Pakistan and India, which requires urgent treatment. Since one of the most important symptoms in patients poisoned with aluminum phosphide is c ardiovascular manifestations; it seems that electrocardiogram and echocardiographic changes are one of the important things that need to be measured in patients poisoned with this substance. Therefore, the study was designed to investigate electrocardiogram and echocardiographic changes in patients poisoned with aluminum phosphide. Materials and Methods: The present study was conducted cross-sectionally 20192021- on 107 patients poisoned with aluminum phosphide who referred to the poisoning emergency of Baharloo Hospital in Tehran. All patients were included in the study due to taking tablets, solution or inhalation of aluminum phosphide. Finally, the patients› information was collected based on the variables investigated in this study including age, gender, poisoning dose, time interval between taking pills and admission to the hospital, systolic blood pressure level, electrocardiogram and echocardiography changes. Results: The mean systolic blood pressure was 107 mmHg at the beginning of the study that changed to 103 mmHg after 24 hours. In addition, the mean diastolic blood pressure was 71.19 mmHg at the beginning of the study that changed to 68.66 mmHg after 24 hours. The blood pH of the patients at the beginning of the study and after 24 hours, was 6.99 and 7.39, respectively (P-value= 0.081). The mean EF was 40.68at the beginning of the study which, on average, changed to 46.57 mmHg after 24 hours (%5.21 increase, P-value= 0.029). Conclusion: The results of the present study showed that extensive changes in the echocardiography of the heart, especially the left ventricular ejection fraction, as well as the patient›s ECG could indicate the severity of heart poisoning in patients poisoned with aluminum phosphide. [ABSTRACT FROM AUTHOR]

Introduction: Aluminum phosphide is a pesticide that is used in developing countries. Aluminum phosphide poisoning has a high mortality rate and there is no known antidote. This study aimed to evaluate the safety and efficacy of insulin-euglycemia therapy in the management of patients with acute aluminum phosphide poisoning. Methods: This trial was prospectively registered in the Pan African Clinical Trials Registry (PACTR202008534546951). A total of 108 patients were randomly allocated to two groups. The intervention group received insulin-euglycemia therapy in addition to standard treatment (norepinephrine and supportive care); the control group received standard treatment plus placebo. The main outcome measures were survival, blood pressure, and laboratory investigations. Results: The two groups had similar baseline parameters. Insulin-euglycemia therapy was associated with a significant reduction in mortality compared with that in the control group (64.8 percent and 96.3 percent, respectively; P value <0.001). Patients randomized to insulin-euglycemia also required lower doses of vasopressors (median was 7 mg versus 26 mg in control group; P value 0.006) and fewer patients needed intubation (61.1 percent versus 81.5 percent in the control group; P value 0.019). Insulin-euglycemia therapy significantly improved blood pressure (systolic, diastolic, and mean arterial pressure) (median at 6h post-admission was 80 mmHg, 55 mmHg and 65 mmHg compared with 20 mmHg, 10 mmHg and 13 mmHg in the control group respectively; P value <0.001) and bicarbonate and lactate concentrations. Conclusion: Insulin-euglycemia therapy appears to be a safe and effective treatment option for patients with aluminum phosphide poisoning. Vasopressor only therapy was associated with very poor outcomes in acute aluminum phosphide poisoning. [ABSTRACT FROM AUTHOR]

Large‐scale fumigation of grain silos is a strategy to mitigate infestation of the bulk material. A common fumigant precursor for grain processes is aluminum phosphide, which exothermically decomposes in the presence of moisture (from the grain or air) to the toxic fumigant: phosphine gas. To overcome the hazards of exothermic decomposition and phosphine exposure, aluminum phosphide pellets can be metered into the silo's grain feed to distribute them throughout the grain more evenly. This approach decreases the decomposition rate of aluminum phosphide, better distributes heat generation to avoid igniting grain, and sustains a phosphine gas concentration well below the pyrophoric concentration—all while achieving the fumigation objectives. During a fumigation activity, a large explosion occurred within a group of silos at a grain elevator complex. Dust explosions are a common hazard for grain handling facilities, but this incident was caused by the autoignition of a phosphine gas cloud inside the conveyor tunnels. It was only through post‐incident evaluations of the grain flow dynamics and pellet addition activities that a gap between the desired pellet distribution and the incident conditions was identified. As a result, a new insight into bulk grain handling and safe fumigation was developed. [ABSTRACT FROM AUTHOR]

Background: Aluminum phosphide toxicity is a serious problem in many countries. Unfortunately, there is no specific antidote. N-acetylcysteine has been used in some studies as adjuvant therapy depending on to its antioxidant properties. We hypothesized that IV N-acetylcysteine is effective in reducing mortality rate compared to supportive treatment alone. Methods: We searched in PubMed, Scopus, Web of Science, and Cochrane Library databases. We only included randomized controlled trials that assessed the efficacy of IV N-acetylcysteine and supportive treatment versus supportive treatment alone in acute aluminum phosphide poisoning. Four investigators independently screened the studies' results and designed the data extraction sheet. The primary and secondary outcomes were mortality and the need for mechanical ventilation rates. Random effects estimators with weights were used to result in the pooled risk ratios. Results: We included four randomized controlled trials with 177 patients. 91 patients were distributed in N-acetylcysteine group and 86 patients in the control group. Mortality rates in N-acetylcysteine group and in the control group were 43.95% 66.27% respectively. There was a statistically significant reduction in mortality rate after leave out test (pooled risk ratio, 0.5; 95% confidence interval, 0.32–0.77). Regarding the need for mechanical ventilation, it was measured only in three RCTs. It was assessed in 67 patients in N-acetylcysteine group and 60 patients in the control group. 24 patients were ventilated in N-acetylcysteine group (35.8%) and 29 patients in the control group (48.3%). But it was statistically nonsignificant (pooled risk ratio, 0.71; 95% confidence interval, 0.48–1.04). Conclusion: Our meta-analysis revealed that IV N-acetylcysteine may be effective in reducing mortality of severe aluminum phosphide poisoning cases. Trial registration: Registration number in Prospero CRD42022375344 on 25 NOVEMBER 2022, retrospectively registered. [ABSTRACT FROM AUTHOR]

Background. Due to the high lethality of aluminum phosphide as well as the lack of antidote for its treatment, this study aimed to determine the effect of intravenous lipid emulsion on the outcome of hospitalization in the patients poisoned by rice pill . Methods. In this cross-sectional study, 19 patients aged over 18 years and poisoned by rice pill were investigated to determine the characteristics and outcomes of the patients as well as to detect the effect of intravenous lipid emulsion on the patients’ outcome in a six-year period. A data collection form was used to collect research data. Patients were treated with two types of standard treatment regimen (first group) and standard regimen+intravenous fat (second group). ECG changes, heart ejection fraction (EF), and the patients’ outcomes (death or discharge) were evaluated. Results. In the first group, 16 patients and 3 patients received treatment regimen in second group. Also, 89.5% of the patients had sinus tachycardia in ECG. There was no significant difference between two groups except in terms of diastolic blood pressure (P=0.012). All cases of ECG changes were sinus tachycardia in the second group, while sinus tachycardia (87.4%), V-tach (6.3%), and PAC (6.3%) were observed in the first group. The mortality rate in first and second groups were 87.5% and 100%, respectively. Conclusion. Application of lipid emulsion was a relatively new therapeutic approach to clinical treatment of rice pill poisoning, and the studies on given issue were limited. Therefore, it was recommended that prospective studies should be carried out based on clinical trials to further investigate its application. Practical Implications. It was necessary to develop an effective antidote for Aluminum phosphide Poisoning since it had a high mortality rate as well as a high prevalence in Iran. Unfortunately, there was no antidote for dealing with this poison. Application of intravenous lipid emulsion may have been effective in reducing the hospital mortality.

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.

Rodenticide is widely used around the word. It contains various toxic components such as zinc or aluminum phosphide, yellow phosphorus, arsenic, thallium, sodium monofluroacetate. Rodenticide is easily available. Toxic effects may be produced by inhalation or ingestion. It may be accidental or intentional. The rodenticide in this case contains 38 percent zinc phosphide. Zinc phosphide produces phosphine gas when hydrolyzed by gastric acid. Phosphine gas is highly toxic. It produces toxicity within 30 minutes. It may produce symptoms such as nausea, vomiting, abdominal pain, hematemesis, arrhythmias, acute respiratory syndrome, respiratory failure, cardiac failure, liver failure and renal failure. Phosphine gas is highly toxic to respiratory system it inhibits cytochrome C oxidase. Poisoning from metal phosphide is prevalent, particularly in tropical nations. Through the phosphine gas-mediated effects on cellular respiration, aluminum and zinc phosphide poisoning have harmful effects. Majority of deaths are due to acute pulmonary edema, metabolic acidosis or distal renal tubular acidosis. [ABSTRACT FROM AUTHOR]

Background and objectives: Aluminum phosphide (AlP), known as “rice tablet,” is widely used as an effective pesticide. However, AlP poisoning is a common cause of mortality in many countries, such as Iran. Unfortunately, there is no specific antidote for AlP toxicity to date. AlP releases phosphine gas when it is exposed to moisture or acid. Phosphine is a potent mitochondrial toxin that could significantly inhibit cellular energy metabolism. AlP poisoning is an emergency condition that needs instant and effective intervention. Dihydroxyacetone (DHA) is a simple saccharide used for several pharmacological as well as cosmetic purposes. Previously, we found that DHA could significantly prevent mitochondrial impairment induced by toxic agents such as cyanide and phosphine in various in vitro and in vivo experimental models. Methods: Hospitalized patients (n = 111) were evaluated for eligibility criteria. Among these patients, n = 35 cases were excluded due to incomplete data (n = 11) and suspicion of poisoning with poisons other than AlP (n = 24). Meanwhile, n = 76 cases with confirmed AlP poisoning were included in the study. AlP-poisoned patients who did not receive DHA (n = 18) were used as the control group.Patients (n = 58) received at least one dose of DHA (500 ml of 5 % DHA solution w/v, i.v.) as an adjuvant therapy in addition to the routine treatment of AlP poisoning. Arterial blood gas (ABG), blood pH, bicarbonate levels, and other vital signs and biochemical measurements were monitored. Moreover, the mortality rate and hospitalization time were evaluated in DHA-treated and AlP-poisoned patients without DHA administration. Several biomarkers were assessed before (upon hospitalization) and after DHA treatment. The routine tests for AlP-poisoned patients in this study were the measurement of electrolytes (K+ and Na+), WBC, RBC, hemoglobin, INR, carbonate (HCO3), blood pH, PaCO2, and PaO2 and SGPT, SGOT, BUN, Cr. Results: Upon patients' admission, significant decreases in blood pH (acidosis), blood PaO2, and HCO3 levels were the hallmarks of AlP poisoning. It was found that DHA significantly alleviated biomarkers of AlP poisoning and tremendously enhanced patients’ survival rate (65.52 % in DHA-treated vs 33.34 % in the control group) compared to patients treated based on hospital routine AlP poisoning protocols (no DHA). No significant adverse effects were evident in DHA-treated patients in the current study. Interpretation and conclusions: These data suggest that parenteral DHA is a novel and effective antidote against AlP poisoning to be used as an adjuvant in addition to routine supportive treatment. Trial registration: IR.SUMS.REC.1394.102.

Introduction: The WHO 2021 data estimate that 2 million lives and 53 million disability-adjusted life-years were lost in 2019 due to exposures to selected chemicals. It is important to know the pattern and outcome of acute poisoning cases for proper planning, prevention and management. Knowing the pattern will also help in designing training modules for primary care physicians to make them aware about newer poisons and their management. Awareness regarding newer poisons consumed is necessary for early identification, initial management and timely referral to higher centres by primary care physicians. This study was performed to see the pattern and outcome of acute poisoning cases in North Indian population and various factors related to outcome. Materials and Methods: This study was conducted in department of medicine of a teaching institute in North India after approval by the Institutional Review Board. Patients admitted in the department during the study and fulfilling the inclusion criteria were enrolled in the study after obtaining consent. Results: A total of 417 patients with poisoning were recruited in the study. Out of 417 patients, majority were males (59.5%). Maximum number of patients were in the age group of 21-30 years (33.8%), and rural population (79.9%) was found to be more affected. Most of the patients were students and private employees. Most common types of poisoning were snakebite (n = 109, 26.1%), organophosphate (n = 49, 11.8%) and aluminium phosphide (n = 39, 9.3%). Out of 417 patients, 349 (83.69%) improved, while 68 (16.3%) expired. Requirement of ventilatory support was most commonly associated with aluminium phosphide poisoning (30.12%) followed by organophosphate poisoning (24.1%). Conclusion: Poisoning was more common in young males and more prevalent in rural population. Pesticides and snakebite were major causes of poisoning. Among suicidal cases, family conflict (problem/altercation with family members/marital discord) was main reason for the consumption of poison. There is need for creation of poison information centre along with separate toxicological units in tertiary care hospitals. [ABSTRACT FROM AUTHOR]

Phosphine, as per several reports, is considered to be an ideal and effective alternative to methyl bromide (MB) fumigant, phased out globally honouring 'Montreal Protocol'. The food grains fumigated with phosphine are perceived to be residue-free; however, estimation of its residues is imperative. In the present study, the phosphine residues were estimated in grains of wheat, rice, green gram, chickpea and yellow pea fumigated with different formulations of phosphine under 7 and 10 days exposure periods at various locations in India. For efficacy studies, the conventional aluminium phosphide (AlP) tablet (56% @2 and 3 tablet/MT) and granular AlP (77.5% @1.0 and 1.5 g phosphine/m3) formulations were applied. Each treatment including untreated control was replicated thrice. The concentration was monitored every 24 h until the end of exposure periods. Food grain samples were drawn before and post fumigation following a certain waiting period for estimation of phosphine residues using gas chromatography equipped with FPD detector. Residues in fumigated food grains were observed in traces in all the experimental stacks, but below the MRL (0.1 ppm), fixed by Codex Alimentarius Commission (CAC). Phosphine can be considered safe for use as an alternate fumigant in quarantine and long-term storage of food grains leaving residues below MRL. [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. [ABSTRACT FROM AUTHOR]

Preservatives are most often used to maintain the quality of foods for longer time periods. It has been reported that chemicals, which are used as preservatives have some effects (positive or negative) on the nutritive indices of foods. This research was carried out to investigate the effect of some selected preservatives on the nutritive indices of kidney beans (Phaseolus vulgaris). The matured P. vulgaris used for this research were collected in bags from the area of cultivation. Following the established research guidelines, the seeds were prepared and sent to laboratory for analysis prior to storage with selected preservatives. The selected preservatives were procured and prepared for the experimental purpose under standard protocols. The kidney beans were divided into airtight containers and labeled in group 1 to 5, which were preserved with selected preservatives; (DDVP) (sniper), birds eye pepper and Aluminium phosphide, while the fourth group was mixed with ash and the fifth group was left without mixing with any preservative to serve as control. The beans mixed with preservative were left to stay on standard research procedure for 6 months. Standard procedures were used to assess the effect of the preservatives on the proximate compositions, mineral contents, and amino acid concentrations, respectively compared with the control group, which was not mixed with the preservatives. Results of the research showed varying effects of the different preservatives on the beans mixed with preservatives when compared with the control group. There was an observed improvement on the proximate composition of the beans preserved with some of the selected preservatives while some beans were negatively affected as the preservative affected the nutritive quality as compared to control groups; same results were observed for the mineral nutrient constituents and amino acid concentrations. The observed improvements in the experimental parameters showed that the chemicals in some groups were more effective for some aspects while natural preservatives were better for other measured criteria. The effectiveness of the preservatives for a longer shelf life and stop or delay the growth of bacteria, suppress the reaction when food comes in contact with oxygen or heat, they also prevent the loss of some essential amino-acids and some vitamins enhance the food flavors and colors. The results of this study showed that some of the selected preservatives used on the kidney beans suggested that kidney beans could improve the shelf life and improve nutritive value. [ABSTRACT FROM AUTHOR]

Introduction: Aluminum phosphide (AlP) poisoning, commonly known as rice tablet poisoning, is a lethal method of suicide with no known antidotes. Thyroid hormones have inotropic effects that can potentially reverse hemodynamic instability and improve cardiac output. This study investigated the effects of Triiodothyronine (T3) on the cardiac function of patients with aluminum phosphide poisoning. Methods: In this randomized clinical trial, 24 patients with confirmed ALP poisoning were recruited. The intervention group received T3 treatment in addition to standard treatment, while the control group received only standard treatment. Demographic variables, cardiac parameters, biochemical markers, and oxidative stress tests were evaluated. Results: The majority of participants were men (60%) in their thirties (intervention: 32±17.4 years; control: 30±11.6 years). Following treatment, both systolic and diastolic blood pressures had significantly higher mean differences in the T3 group compared to the control group (18.7±9.3, P=0.05 and 14.1±5.9, P=0.03 respectively). While both groups showed improvement in mean arterial pH, the intervention group exhibited a significantly greater improvement 12 hours after the administration of T3, which was significantly different from both the baseline and control groups (p=0.04, 0.009 respectively). Additionally, the intervention group had a lower QRS and QTc interval compared to admission time. Conclusion: Triiodothyronine administration has been shown to maintain a higher range of SBP, control cardiogenic shock, regulate metabolism, improve acidosis and blood pressure, and ultimately enhance recovery in patients with aluminum phosphide poisoning. Furthermore, it may have cardio-protective effects on these patients. [ABSTRACT FROM AUTHOR]

Context: Hydrogen fluoride (HF) is extensively present in environmental and industrial pollutants. It may harm the health of humans and animals. This work evaluated the adsorption of an (HF)n linear chain (n = 1, 2, 3, and 4) onto an AlP nanocage through ab initio calculations for the evaluation of its performance in sensing and monitoring (HF)n within aqueous and gaseous media. Methods: The present work adopted density functional theory (DFT) at the 6–311 G (d, p) basis set to analyze (HF)n linear chain adsorption onto AlP nanocages with the B3LYP functional. This paper examined the adsorption energy, configuration optimization, work function, and charge transfer. In addition, the contributions of the HF linear chain size to electronic properties and adsorption energy were measured. The dimer form of HF on the surface of AlP nanocages was found to have the highest stability based on the adsorption energy values. Once (HF)n was adsorbed onto the nanocage, the HOMO-LUMO energy gap experienced a large reduction from 3.87 to 3.03 eV, enhancing electrical conductivity. In addition, AlP nanocages may serve in the sensing of (HF)n under multiple environmental pollutants. [ABSTRACT FROM AUTHOR]

Background: According to World Health Organization report, poisoning with phosphides is the most common fatal poisoning in most of the world, especially developing countries. One of the leading causes of morbidity and mortality in these patients is cardiovascular complications; therefore, the researchers aimed to study the prevalence and type of electrocardiographic changes, especially life-threatening electrocardiographic changes observed in poisoned patients with aluminum Phosphide. Methods: This retrospective cohort study was carried out on all the individuals poisoned with aluminum phosphide tablet and were admitted to the toxicology center in northwest Iran and met the inclusion criteria and no exclusion criteria. After categorization, the data were entered into SPSS (SPSS Inc, Chicago, USA) software, and appropriate statistical analyses were done. In all the tests, p<0.05 was considered statistically significant. Results: Our findings pointed out that the majority of the patients were in the 20-40 age group and male-to-female ratio was 2.00. Electrocardiographic changes were prevalent in 86.1 percent of the patients who consumed aluminum phosphide. The most common change was sinus bradycardia. The mean consumed aluminum phosphide was 1.93±1.88 tablets, and the mean interval from consumption to medical care was 3.67±2.05 hr which did not have significant correlations with electrocardiographic changes. Conclusion: The most common electrocardiographic change is bradycardia, but the most lethal is ventricular tachycardia; therefore, taking repeated electrocardiograms and echocardiography could help the decision making in the process of patient management. Definitive conclusions need further studies. [ABSTRACT FROM AUTHOR]