Intoxication par tortue de mer vue au Centre Hospitalier Universitaire Antanambao, Toliara, Madagascar / Poisoning by sea turtle at the Antanambao University Hospital, Toliara, Madagasca

Le chélonitoxisme est une intoxication collective par consommation de la chair, de la peau et des viscères de la tortue marine. Elle est peu fréquente. Notre objectif était de décrire l'aspect épidémio-clinique et thérapeutique de l'intoxication par tortue de mer. Méthodes : Il s'agit d'un rapport de cas effectué au Centre Hospitalier Universitaire (CHU) Antanambao Toliara, Madagascar après une intoxication collective dans la commune rurale de Soalara Sud, Toliara. Résultats : Nous avons colligé 70 patients qui ont ingéré une tortue adulte du genre Eretmochelys imbricata. Les signes cliniques étaient du type chélonitoxisme. Parmi les 70 cas, 8 patients ont été hospitalisés. L'âge des patients intoxiqués variait de 2 ans à 65 ans avec un âge moyen de 20 ± 14 ans. La tranche d'âge entre 10-20 ans était la plus touchée (44%). Les hommes représentaient 54% des patients avec un sex ratio de 1,18. Cinquante-huit pourcent ont eu leurs premiers signes 24 heures après l'intoxication et 81% des patients ont été vus au CHU entre 24 et 48 heures. Les signes cliniques du chélonitoxisme sont polymorphes : 86% ont présenté une asthénie, 91% des nausées, 25% des vomissements, 71% des céphalées et 21% des stomatites. A l'issue de l'hospitalisation, 99% des malades ont été guéris et un patient est décédé. Les traitements étaient symptomatiques. Conclusion : L'intoxication par tortue de mer est généralement bénigne. La prise en charge est symptomatique.

Intoxication à la réglisse révélée par une hypokaliémie sévère associée à une HTA Labile: à propos d'une observation et revue de la littérature / Licorice intoxication revealed by severe hypokalemia and labile hypertension: a case report with review of the literature

Cette observation illustre un tableau de pseudo-hyperaldostéronisme primaire par intoxication à la réglisse révélé par une hypokaliémie sévère chez un monsieur de 56 ans dans un contexte d'HTA de découverte récente. L'interrogatoire a retrouvé une notion de consommation régulière quotidienne de pastis sans alcool d'environ un litre et le bilan endocrinien a trouvé une activité rénine plasmatique effondrée et une hypoaldostéronémie. L'hypokaliémie et l'HTA ont régressé au bout de trois mois avec l'arrêt de la consommation du pastis et à distance de tout traitement antihypertenseur. Les abus de la réglisse sont rarement mentionnés spontanément par les patients ou sont ignorés d'eux, d'où l'intérêt d'une anamnèse minutieuse

This patient illustrates a case of primary pseudo-hyperaldosteronism due to licorice intoxication revealed by severe hypokalemia in a 56-year-old man with newly discovered hypertension. Past medical history revealed a notion of regular consumption of pastis without alcohol (about one liter per day) and hormonal assessment showed a collapsed plasma renin activity and hypoaldosteronemia. Hypokalaemia and hypertension resolved three months after cessation of pastis consumption, without any antihypertensive treatment. The abuse of licorice is rarely mentioned spontaneously by patients or is ignored by them, hence the interest of a careful medical history.

Les métaux lourds plus polluant dans la malnutrition chez l'enfant de moins de 5 ans à Lubumbashi / NA

Introduction : Lubumbashi, première ville du Katanga et deuxième grande ville de la République Démocratique du Congo, est une zone minière et le poumon économique du pays. De ce fait, elle constitue le siège d'une effervescence d'activités minières artisanales et industrielles. Ce travail vise à évaluer la bioaccumulation ou l'intoxication des métaux lourds dans la population des enfants malnutris. Matériel et méthodes : Le cobalt, le chrome, l'antimoine et le Plomb ont été dosés dans le sérum chez les enfants de moins de 5ans (n = 311). L'ICP OES ou le spectrophotomètre d'absorption atomique couplé à un spectrophotomètre à émission optique ont été utilisés pour le dosage. Trois cent onze enfants ont été colligés au cours de la période allant du 1 Juillet 2013 au 31 décembre 2014. Les analyses statistiques ont été réalisées au moyen du logiciel Epi Info 7.1.1.0. Résultats : Parmi les métaux lourds, l'antimoine s'est révélé moins toxique que les autres, tandis que les prévalences et risques de pollution significatifs suivants ont été observés chez les enfants malnutris : 76 % (OR [IC 95 %] : 1,5[1,04-2,25]) pour le chrome, 58 % (OR [IC 95 %] : 1,7[1,18-2,59]) pour le cobalt et 58 % pour le Plomb (OR [IC 95 %] : 1,7[1,15-2,65]). Conclusion : L'intoxication aux métaux lourds reste un problème de santé à Lubumbashi dans la population en général, particulièrement chez les malnutris. Plus l'enfant est jeune, de sexe féminin plus, il était exposé à l'intoxication aux métaux lourds plus polluants dans la majorité des cas. Pour la plupart les zscores PPA et TPA étaient au-delà de 2 avec une différence statistique hautement significative.

The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa

Introduction:Intentional self-poisoning is a significant part of the toxicological burden experienced by emergency centres. The aim of this study was to describe all adults presenting with intentional self-poisoning over a six-month period to the resuscitation unit of Khayelitsha Hospital, Cape Town.Methods:Adult patients with a diagnosis of intentional self-poisoning between 1 November 2014 and 30 April 2015 were retrospectively analysed after eligible patients were obtained from the Khayelitsha Hospital Emergency Centre database. Missing data and variables not initially captured in the database were retrospectively collected by means of a chart review. Summary statistics were used to describe all variables.Results:A total of 192 patients were included in the analysis. The mean age was 27.3 years with the majority being female (n = 132, 68.8%). HIV-infection was a comorbidity in 39 (20.3%) patients, while 13 (6.8%) previously attempted suicide. Presentations per day of the week were almost equally distributed while most patients presented after conventional office hours (n = 152, 79.2%), were transported from home (n = 124, 64.6%) and arrived by ambulance (n = 126, 65.6%). Patients spend a median time of 3h37m in the resuscitation unit (interquartile range 1 h 45 m­7 h 00 m; maximum 65 h 49 m). Patient acuity on admission was mostly low according to both the Triage Early Warning Score (non-urgent n = 100, 52.1%) and the Poison Severity Score (minor severity n = 107, 55.7%). Pharmaceuticals were the most common type of toxin ingested (261/343, 76.1%), with paracetamol the most frequently ingested toxin (n = 48, 25.0%). Eleven patients (5.7%) were intubated, 27 (14.1%) received N-acetylcysteine, and 18 (9.4%) received benzodiazepines. Fourteen (7.3%) patients were transferred to a higher level of care and four deaths (2%) were reported.Discussion:Intentional self-poisoning patients place a significant burden on emergency centres. The high percentage of low-grade acuity patients managed in a high-acuity area is of concern and should be investigated further

Accidental Childhood Poisoning in Enugu; South-East; Nigeria

Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time.Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu.Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South­East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted.Results: Sixty­five cases of childhood poisoning were recorded during the 10­year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65).Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications

Epidemiology of paediatric poisoning reporting to a tertiary hospital in Ghana

Background. Childhood poisoning is an important cause of morbidity in both developed and developing countries. Epidemiological studies on accidental poisoning in children show a consistent pattern regarding age and gender. Childhood poisoning is predominant in children 6 years of age and has a male preponderance; as boys are more active with a drive to explore the environment. Objective. To document the epidemiology of home poisonings in Kumasi and its environs. Methods. We conducted a retrospective study from January 2007 to January 2012 at the Komfo Anokye Teaching Hospital; a tertiary hospital in Ghana.Results. Poisoning is a significant health problem in the study area. A total of 253 children reported to the hospital with poisoning over the 61-month period; with an average of four cases per month. The male to female ratio was 1.58:1. The median age of the children was 24 months (interquartile range 24 - 48 months). Kerosene was the leading cause of poisoning (39.5%). Conclusion. Paediatric poisoning is a major health hazard in children living in Kumasi and its environs. This can possibly be attributed to a lack of adequate supervision of children and poor storage of harmful substances in homes. Multidisciplinary interventions are needed to reduce the occurrence of the condition in the population at risk

Management and control of agri-chemical pesticides: any progress?

Issues related to agri-chemical pesticides usage and poisonings in South Africa have been well documented. Under-reporting of information required to determine the size of the problem complicates current surveillance and prevention programmes. The study aimed to determine: the procedure for reporting and follow-up of cases of agricultural pesticide poisonings; which factors contributed to the poisoning cases; and whether a biological monitoring programme was in place at the time of 110 reported cases of agri-chemical poisonings on farms in the Boland Health District between 1997 and 2000. A retrospective descriptive survey design involving a record review was applied. The study found that the cases were poorly reported. The follow up system at the local level between local government officials and the farmers was not efficient for the prevention of agrichemical poisonings. The contributory factors were insufficient information and training; the incorrect use of personal protective equipment; the lack of safety of the agri-chemical store; and the absence of a monitoring system on the majority of farms. This study demonstrated that the notification of agricultural chemical poisoning was applied in a fragmentary manner between the different governmental levels and departments

epidemiologie des patients suicidants dans le service de Reanimation medicale du Centre Hospitalier Universitaire d'Antananarivo

Introduction. Decrire l'epidemiologie hospitaliere des patients suicidants; et connaitre les differents facteurs de risque sur un echantillon de population malgache. Methode. Il s'agit d'une etude prospective; allant du mois de Janvier 2009 au mois de Decembre 2009; des suicidants hospitalises dans le service de Reanimation medicale du CHU Antananarivo. Resultats. Cent soixante quatorze cas (14;83) sur les 1173 patients hospitalises ont ete retenus pour cette etude. L'age moyen etait de 26;20 ans et le sex ratio de 0;74. La majorite (52;29) de nos patients etait celibataire. Cinquante quatre patients (31;03) ont des antecedents medico-chirurgicaux; dont 8 avec des antecedents psychiatriques (4;60); et 26 patients (15) avec des antecedents de tentative de suicide. Le contexte de depression a ete retrouve dans 36;78; les troubles psychotiques dans 6;32et l'impulsivite dans 56;89. Le moyen le plus frequemment utilise etait l'intoxication aux organo-phosphores (55;17); et l'intoxication aux antipaludiques de synthese (16;67). Conclusion. La tentative de suicide est une realite et une actualite qu'il ne faut pas negliger a Madagascar. Les plus vulnerables sont ceux qui presentent des comorbidites psychiatriques; et ceux qui vivent dans un environnement pathologique. Il serait souhaitable que tous patients suicidants recoivent une evaluation psychiatrique approfondie pour eviter la recidive

Intoxicatrion accidentelle par ingestion de fer chez l'enfant : a propos de deux cas a Dakar

Introduction : L'intoxication au fer est un motif exceptionnel d'hospitalisation en pediatrie au centre hospitalier universitaire de Dakar.Observations : Nous rapportons les observations de deux enfants de 3 ans et 20 mois admis au service d'urgence pediatrique de l'hopital Aristide Le Dantec pour une intoxication de moderee a severe apres l'absorption d'une quantite importante de sulfate de fer. Les manifestations cliniques etaient dominees par les troubles digestifs et les troubles neurologiques a type de convulsions tonico-cloniques et de coma stade I. Le dosage sanguin du fer montrait des taux au dessus des limites normales. L'evolution clinique etait satisfaisante apres le lavage gastrique et les mesures de reanimation. Conclusion : Un diagnostic precoce et une prise en charge diligente des cas d'intoxication au fer permet d'en reduire la morbidite et la mortalite. Nous insistons egalement sur l'information des familles pour une meilleure securisation des comprimes de fer prescrits aux adultes

Profile of acute poisoning in three health districts of Botswana

Background: This study sought to characterise acute poisoning cases seen in three health districts of Botswana. Methods: A retrospective review of patients' records was conducted and included patients treated from January 2004 to December 2005. Data on the demographic status of the patients; information about the poisonous agent(s) involved; and the circumstances and outcomes of the poisoning incidents were recorded on a pre-tested data collection form. Results: A total of 590 cases of acute poisoning were included in the analysis. The most affected age category was that of children aged less than six years; who constituted 33.4of the cases. Most incidents were recorded in the urban district of Gaborone. Seventy-eight percent (78) of the incidents were accidental; with the remainder being intentional. The poisonous agents involved were pharmaceuticals (26.6); natural toxins (25.6); household products (14.6); foods (14.4); alcohol (6.9); traditional medicines (4.7); unspecified agents (3.2); and agrochemicals (2.7). The most common route of poison exposure was by oral (82.2); followed by dermal contact (16.5); while the inhalation of gases occurred in 1.2of cases. An incidence rate of 4.7/1000; a case fatality rate of 3.8/100; and 1.5of deaths were recorded over the two-year period. Conclusions: In conclusion; it can be stated that acute poisoning involved mainly young children and resulted in an incidence rate of 4.7/1000; a case fatality rate of 3.8/100; and 1.5of deaths over the two-year period. There were differences based on age category; gender and residence of the victims; the types of toxic agents involved; as well as the circumstances and the outcomes of the poisoning incidents. Given the fact that pharmaceuticals; natural toxins; household products and foods were the agents most commonly involved; targeted interventions should take these differences into account in addressing the problem of acute poisoning

A Profile of Acute Poisoning at Selected Hospitals in South Africa

The aim of this study was to characterise acute poisoning cases admitted to a number of selected hospitals in South Africa. All cases admitted to eight hospitals; from January 2005 to June 2005; were evaluated retrospectively. Data obtained from the hospital medical records included the following: demographic characteristics; toxic agents; length of hospital stay; circumstances of poisoning; morbidity and mortality information on the poisoned patients. From a total of 424 patients admitted for treatment; whose median age was 17.6 years; 57.8were females; and 89.6black Africans. Fifty-nine percent of the poisonings were accidental; and the involved toxic agents were; in descending order: household chemicals (45.7); modern medicines (17.5); animal/insect bites (15.8); agrochemical chemicals (9.7); food poisoning (5.4); drugs of abuse (3.3); traditional medicines (2.4); and plants (0.2). Poisoning by drugs of abuse was commoner in males than females; but the percentage of females poisoned by all other toxic agents was higher than in males. Most patients spent less than two days in hospital; but more females (70.1) than males (29.9) stayed for more than two days. The overall case fatality rate was 2.4. Of those who died; 80were black Africans; aged 13 to 19 years and it was deliberate poisoning through drugs of abuse; carbon monoxide and agricultural chemicals. Acute poisoning reviewed in some selected hospitals in South Africa revealed that more black African females were involved; who spent more than two days hospitalised. The case fatality rate was 2.4; mainly due to drugs of abuse; carbon monoxide and agricultural chemicals. These findings suggest that further studies are needed to understand the motivation(s) for this emerging problem and that these should focus primarily on the female black African

A Seven - Year Review of Accidental Kerosene Poisoning in Children at Aminu Kano Teaching Hospital

Background: Accidental ingestion of kerosene is a potential source of morbidity and mortality in children. The objectives of the study are to determine to magnitude of the problem and proffer feasible solutions to reduce the frequency of occurrence. Methodology: The medical records of all cases of kerosene poisoning admitted into Paediatric Medical Ward and Emergency Paediatric Unit were identified and relevant data extracted and analysed. Results: Kerosene poisoning constituted 55 (1.2) of cases of all paediatric admissions within the period (Jan 1999 Dec 2005). The study showed that children 4 months to 8 years were affected with peak age of 18 months. Thirty-four (61.8) of the cases were aged below 2 years which conforms to findings in earlier studies in Nigeria. Main clinical feature was cough with difficulty in breathing in 52 (94.5) of cases. Others features noted were central nervous system involvement (14.5); vomiting (20); and fever 16 (29.1). There were 3 deaths giving the mortality of 5.5. Conclusion: The study has revealed that kerosene poisoning is a significant cause of morbidity and mortality. Government policies that will enhance the standard of living of people and education of parents/care givers are the identified imperatives for reduction of the problem

Hydrogen sulphide gas poisoning aboard a fishing trawler: A report of four fishermen

Hydrogen sulphide is a colourless; foul-smelling gas that results from the decay of organic material. It is a by-product of various industrial processes; including the processing of fish; and is an important cause of work-related sudden death. Its toxicity is mainly due to its inhibition of oxidative phosphorylation in human metabolic pathways. Although there is some anecdotal evidence to suggest that the early use of amyl nitrate and hyperbaric oxygen is beneficial; supportive care remains the mainstay of therapy. This report highlights an incident during which four anchovy fishermen exposed to this gas; resulted in one fatality; two Intensive Care Unit admissions for pulmonary oedema and one minor case of bronchial irritation. This incident illustrates the need for more stringent enforcement of health and safety regulations in the fishing and seafood processing industry

In-Vitro Adsorption of Fluoroquinolones on Some Pharmaceutical Adsorbents

PURPOSE: Drug overdose and poisoning are common clinical problems and could occur with the fluoroquinolones -a new series of synthetic antimicrobial agents. It therefore becomes important to study the adsorption of the fluoroquinolones on pharmaceutical adsorbents which could serve as possible antidotes for the emergency treatment of fluoroquinolone overdose or poisoning when they occur. METHOD: The rate and extent of adsorption of the fluoroquinolones on some pharmaceutical adsorbents; namely activated charcoal; kaolin and bentonite were investigated spectrophotometrically RESULTS: The fluoroquinolones adsorbed on activated charcoal rapidly and attained equilibrium within fifteen minutes. The fluoroquinolones however adsorbed on kaolin and bentonite less rapidly and attained equilibrium within two hours. Activated charcoal and bentonite had high adsorption capacities for the fluoroquinolones while kaolin had low adsorption capacities for them. CONCLUSION: Because of the rapid rate of adsorption and high binding capacities exhibited by activated charcoal for the fluoroquinolones; it could be an effective antidote for the fluoroquinolones in cases of overdose or poisoning. Activated charcoal has shown a superior behaviour to both bentonite and kaolin in the adsorption of the fluoroquinolones

Organophosphate poisoning in Jimma

A prospective study was done to assess the frequency of Organophosphate Poisoning (OPP) among patients admitted to the Jimma hospital between January; 1996 and January; 1997. The study also aimed to determine the different causes of Organophosphate poisoning and the common behavioral factors associated with increased risk for poisoning. A total of 23 cases of OPP were admitted during the one year period. The M:F ratio was 1:2.83. Most were Oromo; Orthodox Christian and single with a monthly income below 300 Birr. In four; the attempt was for at least the second time. The reason for poisoning cited by most was quarrel with parents. The most common clinical findings were vomiting and abdominal pain. Only four had an abnormal mental status and there were no deaths. The average time to reach the hospital was 18 hours and the mean atropine requirement was 12.3 mg. Results are compared to other studies