Heart Rate-Corrected QT Interval Helps Predict Mortality after Intentional Organophosphate Poisoning

INTRODUCTION: In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. METHODS: We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (<0.44 s) or prolonged (>0.44 s). Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS: The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019). By the end of the study, 18 of 118 (15.2%) patients had died, including 3 of 75 (4.0%) patients with normal QTc intervals and 15 of 43 (34.9%) patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961-40.345, P = 0.000), respiratory failure (OR = 4.867, 95% CI = 1.062-22.301, P = 0.042), coma (OR = 3.482, 95% CI = 1.184-10.238, P = 0.023), and QTc prolongation (OR = 7.459, 95% CI = 2.053-27.099, P = 0.002) were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002), but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000), shortness of breath (64 versus 94.4%, P = 0.010), bronchorrhea (55 versus 94.4%, P = 0.002), bronchospasm (50.0 versus 94.4%, P = 0.000), respiratory failure (94.4 versus 43.0%, P = 0.000) and coma (66.7 versus 11.0%, P = 0.000) than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals (Log-rank test, Chi-square test = 20.36, P<0.001). CONCLUSIONS: QTc interval helps predict mortality after intentional organophosphate poisoning

A rare complication of chlorine gas inhalation: pneumomediastinum

Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tract

The effect of exercise to P wave dispersion and its evaluation as a predictor of atrial fibrillation

Aim: Prolongation of P wave time and increase of its dispersion as an independent predictor of atrial fibrillation. In patients with paroxysmal atrial fibrillation (PAF) as in healthy people, exercise augments sympathetic activity and therefore can cause the development of atrial fibrillation. The aim of this study is to evaluate the effect of exercise on P wave dispersion and to predict the development of atrial fibrillation

Acute amitraz poisoning in adults: Clinical features, laboratory findings, and management

Background . Amitraz is a formamidine pesticide widely used in agriculture and veterinary medicine as an insecticide and acaricide. Reports on amitraz poisoning in humans are not as prevalent as those in animals. Of human intoxications in the medical literature, the majority of intoxications are in children. The number of adult intoxications with amitraz is limited. Methods . In this study, we discuss the clinical features, laboratory findings, and management of 23 adults with amitraz poisoning cared for in our center. Data were extracted from the charts retrospectively, and included age, gender, mode of poisoning, initial symptoms, time to appearance of initial symptoms, clinical and laboratory findings, management, and prognosis. Results . Fourteen of 23 patients were female (61%). Ages ranged from 16 and 78 years (mean 38.6 19.8 years). Twenty-one patients ingested amitraz orally while one was exposed through skin contact and one probably through skin contact and/or inhalation. Seven patients ingested amitraz with intent to commit suicide and 11 patients accidentally. Vomiting, altered consciousness, and drowsiness were the predominant initial symptoms. Initially, hypotension was present in seven patients (30%), bradycardia in two (8.7%), myosis in six (26%), and mydriasis (without atropine administration) in three (13%). Time to appearance of the initial symptoms ranged from 5 to 120 minutes. Laboratory findings included an initial blood glucose level higher than 120 mg/dL in 62% of patients (mean 191 70 mg/dL) and elevations in AST levels in four patients (81 28 U/L) and ALT levels in three (60 14 U/L). Ten patients had central nervous system depression, which resolved spontaneously. Five patients required mechanical ventilation for respiratory depression (mean duration of mechanical ventilatory support: 50 16 hours). Six patients were thought to have been poisoned with an organophosphate and three with a carbamate pesticide due to confusing clinical picture; four of these nine patients received pralidoxim. Conclusions . In spite of a rapidly progressing and life-threatening clinical picture, amitraz intoxication in humans carries a low morbidity and mortality when appropriate supportive treatment is given. No antidote has been developed for use in more serious cases. To prevent accidental ingestions, prominent and clear warning labels should be placed on its containers

Educational intervention for the awareness improvement and control programme design on Echinococcosis in Izmir, Turkey

In Turkey, cyst hydatid disease (CHD) or cystic echinococcosis (CE) is publicly known as “dog cyst”, a fatal and serious disease not only affects livestock husbandry and human health but also brings about economic loss to our country. According to the data of the Ministry of Health; number of annual cases was 408 in 2008, and this number reached 1,867 by the end of 2019. Cystic echinococcosis is especially taken up during childhood and emerged at an older age. They become exposed to the eggs of the tapeworm after close contact with an infected dog or its contaminated environment. The infected dogs also pass in their feces E. granulosus eggs that adhere to the dogs’ hairs, and pass on to the children who are in the course of playful and intimate contact with the infected dogs. This study was to create the awareness of risk factors of CE among 10 different districts of Izmir province. Awareness raising seminars are essential component of this study because local people living in CE endemic areas, are crucial to continue and sustain the long-time effort that is needed to tackle this disease. In each district, 3 awareness raising seminars were held to the target groups: (a) in schools for students, teachers, administrators, (b) for general public, (c) for healthcare professionals. 4090 students attended to the trainings, 242 administrators and teachers who attended to the presentations together with the students, 524 people were attended to the trainings and 327 health workers attended to the trainings from different institutions. This study helped improving this situation by organising educational events for the rural populations for preventing transmission of the disease. This is the first educational intervention study regarding creating awareness on CE in Izmir Province which includes 10 districts between January 2019 to January 2020

BNP shows myocardial injury earlier than Troponin-I in experimental carbon monoxide poisoning

CONCLUSIONS: It was found that BNP levels increased earlier than cTnI levels in acute severe CO poisoning. BNP levels of the cases which were determined to have increased cTnI levels showing myocardial injury increased as well. BNP can show myocardial injury and its severity in acute CO poisoning