Analysis of risk factors for prognosis of patients with acute paraquat intoxication / 中华危重病急救医学

Objective To explore the risk factors influencing the prognosis by analyzing clinical data of patients with acute paraquat intoxication, and to assess the prognostic values of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, and Acute Kidney Injury Network (AKIN) stage.Methods The clinical data of patients with acute paraquat intoxication admitted into the First People's Hospital of Xianyang City during October 2005 to May 2015 were retrospectively analyzed.The patients were divided into death group and survival group according to 28-day outcome after poisoning.The gender, age, body weight index, toxin dose, time elapsed from poisoning to gastric lavage, time elapsed from poisoning to hemoperfusion (HP), times of HP treatment, white blood cell count (WBC), alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), serum creatinine (SCr), blood urea nitrogen (BUN), creatine kinase (CK) were determined at admission.Arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), arterial lactate (Lac), and APACHE Ⅱ score, SOFA score and AKIN stage were recorded and compared between two groups.The receiver operating characteristic (ROC) curve was plotted for APACHE Ⅱ score, SOFA score and AKIN stage to analyze the prognostic value for patients with acute paraquat intoxication.Results There were 118 cases in total,with 64 survivors and 54 deaths in 28 days, and the fatality rate was 45.76％.Compared with survival group, the toxic dose (mL: 66.29 ± 27.40 vs.29.16 ± 19.40), time elapsed from poisoning to gastric lavage (minutes: 60.37 ± 26.68 vs.41.17± 14.82), WBC count (× 109/L: 16.86±2.77 vs.10.25 ± 2.60), ALT (U/L: 53.94± 10.85 vs.36.40±9.21),SCr (μmol/L: 159.69±42.85 vs.81.73±34.40) at admission as well as Lac (mmol/L: 3.06± 1.33 vs.1.71 ±0.88),APACHE Ⅱ score (6.46±2.38 vs.3.31 ± 1.51), SOFA score (3.31 ± 1.06 vs.2.21±0.76) 48 hours after admission were significantly higher in the death group (all P ＜ 0.01).PaO2 and PaCO2 48 hours after admission were significantly lower in death group than those in the survival group [PaO2 (mmHg, 1 mmHg =0.133 kPa): 64.07± 13.04 vs.75.40 ± 13.27, PaCO2 (mmHg): 26.20 ± 8.89 vs.31.25 ± 6.29, both P ＜ 0.01].There were 18, 15, 11 and 10 patients in AKIN 0, 1, 2, 3 stage 48 hours after admission respectively in death group, and 38, 15, 7, 4 in survival group.The difference between two groups was statistically significant (P ＜ 0.01).There were no statistically significant differences in gender, age, body mass index, time elapsed from poisoning to HP, levels of HP, and AST, TBil, BUN and CK at admission between the two groups.At 48 hours after admission, the area under the ROC curve (AUC) of APACHE Ⅱ score predicting the prognosis of patients with acute paraquat poisoning was 0.875 [95％ confidence interval (95％CI) =0.814-0.935, P =0.000].When the cut-off point of APACHE Ⅱ score was 4, the sensitivity and specificity were 79.6％ and 79.7％, and the best Youden index was 0.593.The AUC of SOFA score was 0.776 (95％CI=0.692-0.859, P =0.000).When the cut-off point of FOFA score was 3, the sensitivity was 72.2％, the specificity 67.2％, and the best Youden index 0.394.The AKIN stage of ROC curve had an area of 0.656 (95％CI =0.556-0.755, P =0.004).When the cut-off point of AKIN stage was 1, the sensitivity was 66.7％, the specificity was 59.4％, and the best Youden index was 0.261.Conclusions Amount of the poison, time elapsed from poisoning to gastric lavage, and WBC, ALT, SCr at admission as well as PaO2, PaCO2 and Lac 48 hours after admission are the risk factors for prediction of the prognosis of acute paraquat intoxication.APACHE Ⅱ score, SOFA score and AKIN stage can be used to assess the prognosis of acute paraquat poisoning, and APACHE Ⅱ score is better than SOFA score and AKIN stage.

Analysis of risk factors for prognoses of 176 patients with acute paraquat intoxication / 中国中西医结合急救杂志

Objective To explore the risk factors influencing the prognoses by analyzing clinical data of patients with acute paraquat intoxication,and provide a basis for clinical prevention and treatment of the disease. Methods The clinical data of 176 patients with acute paraquat intoxication admitted into our Hospital were retrospectively collected during the period from January 2012 to February 2013. After admission,the conventional medical treatment was given to all the patients,and according to the prognoses of 28 days after poisoning,the patients were divided into death group and survival group. The gender,age,toxic dose,time elapsed from poisoning to admission,time elapsed from poisoning to gastric lavage,number of cases treated with drug lavage,white blood cell count(WBC),alanine amino-transferase(ALT),aspartate amino-transferase(AST),blood urea nitrogen(BUN), serum creatinine(SCr),acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ)score,carbon dioxide combining power(CO2CP),number and time of cases revealing arterial blood oxygen saturation(SaO2)0.05〕.③Multivariate logistic regression revealed poisoning doses>30 ml〔odds ratio(OR)=6.455,95% confidence interval(95%CI)3.177-13.113,P30 minutes(OR=8.639, 95%CI 4.043-18.461, P12×109/L (OR=2.745,95%CI 1.388-5.426, P=0.004),BUN>8 mmol/L(OR=6.713,95%CI 2.650-17.006,P<0.001)and CO2CP≤22 mmol/L(OR=4.737,95%CI 2.389-9.394, P<0.001) were the risk factors correlated with the prognosis of patients with acute paraquat intoxicationl. Conclusion Poisoning doses,time elapsed from poisoning to admission,BUN,CO2CP and WBC are the independent risk factors for predicting prognosis of acute paraquat intoxication.

Hepatoprotective effect of lingzhi extract on chronic hepatic toxication by diethyl-nitrosamine and carbon tetrachloride

The experimental trial was conducted on bull white mice, ddY strain, weight of 18-20g, were randomly assigned to different lots, with 8-15 mice in each lot. Experimental product was total dry lingzhi extract produced by OPC Company which reached standards at basic level. Lingzhi dry powder was prepared with distilled water to make liquid extract with concentration of 15% (15g dry extract/100ml water), 30% and 75%. These liquid extracts were used to test hepatoprotective effect effect of Lingzhi extract on chronic hepatic toxication by DEN and CCl4. The results showed that lingzhi extract did not show microprotective effects. However, lingzhi extract can inhibit hyperplastic nodule formation. On the other hand, lingzhi extract also reduced abnormal cells formation

Hepatoprotective effect of Lingzhi extract on CCl4-induced hepatic lesion

Study on hepatoprotective effects of lingzhi extract on CCl4-induced hepatic lesion, lingzhi formulation produced by OPC Company which reached standards at basic level. Lingzhi dry powder was prepared with distilled water to make liquid extract with concentrations of 15% (15g dry extract/100ml water), 30% and 75%. These liquid extracts were used to test hepatoprotective effects. With low dose CCl4 (0,25%) induced hepatic toxication, 15%, 30% and 75% lingzhi extracts showed hepatoprotective effect. However, with high dose CCl4 (1%), only 30% lingzhi extract showed clear and stable hepatoprotective effects. Experimental trials on hepatic diseases as well as on hepatoprotective medications should provide necessary information on physiopathological characteristics and medicinal therapies

Electrophysiological characteristics of chronic alcoholic myopathy / 第三军医大学学报

Objective To investigate the electrophysiological characteristics of chronic alcoholic myopathy. Methods Muscle fiber conduction velocity, peripheral nerve conduction velocity, and induced potentials in 26 patients with chronic alcoholic myopathy, 13 patients with chronic alcoholic peripheral neuropathy, 21 patients with chronic alcoholic neuromuscular damage, and 20 normal subjects were detected by electromyography and single fiber electromyography. Results Electromyography revealed myogenic changes in 9 cases in the myopathy group, neurogenic changes in 7 cases in the peripheral neuropathy group, and both kind of changes in 4 cases in the neuromuscular damage group. Compared with the normal subjects, neuromuscular jitter and fiber density increased in all patients ( P 0.05). Slowed sensory nerve conduction velocity was found in 28 patients (82.35%) with peripheral neuropathy or neuromuscular damage. Conclusion Electromyography and determination of nerve conduction velocity can be used to differentiate the alcoholic myopathy from peripheral neuropathy. The abnormal muscle fiber conduction velocity can be helpful for the confirmation of myopathy.

Study on some alterations of biochemical indicators in rabbit suffered the toxicity due to the single diclodietyl or clovininyl diclorasin or their combination

Concentration of SGOT, SGPT, ure and creatinine was increased in serum of rabbits, exposed to diclodietylsulfid and clovinyldiclorasin. We realized that there were synergic effects between diclodietylsulfid and clovinyldiclorasin, caused increase of ure and creatinie in rabbits higher than effect of single agent. Concentration of glucose was increased at the third day and decreased at the 7th day in rabbits exposed to mix of clovinyldiclorasin and diclodietylsulfid.

Efficacy of unithiol and naturenze in the treatment of rabbits suffered toxicity of mixture of yperite and lewisit through some biochemical indicators

Treatment of rabbits, exposed to mix of yperite and lewisite with unithiol and naturenze showed that unithol reduced concentration of SGOT (serum glutamat-oxaloacetat-transaminase), SGPT (serum glutamat-pyruvat-transaminase), urea and creatinine in serum but concentration of these components was still high. Using unithiol in combination with naturenze for treatment, concentration of SGOT, SGPT, urea and creatinine was decreased lower than treatment of single unithiol.

The correlation of serum cholinesterase and clinical signs in acute organophosphate poisoning

30 acute organophosphate poisoning patients admitted in our department were classified into three groups of severity based on serum cholinesterase level and clinical syndromes of cholinergic crisis. Atropine was given at dose of 2-5mg every 10-15 minutes until the atropinisation reached then the doses of atropine were adjusted to maintain it. Pralidoxime was administered according to severity and its dosages were titrated as serum cholinesterase levels and clinical changes. Data was analyzed by SPSS for Windows. (1) The patients had good outcome with short duration of hospitalization (5.73.8) and low mortality (3.3%). (2) Serum cholinesterase was correlated with number of clinical symptoms (r=-0.613); clinical score (r=-0.580); number clinical syndromes (r=-0.515); total dose of atropine (-.714) severity of poisoning (r=-0.928) and total dose of PAM (r=-0.721). All correlation was significantly at the 0.01 level. (3) Total dose of PAM was correlated with clinical symptoms (r=0.625); clinical score (r=0.596); clinical syndromes (r=0.658); severity of poisoning (0.695); duration of hospitalization (0.889)

Study on utilization of gel activated charcoal in the management of acute poisoning

The combinations of gel activated charcoal and sorbitol in rational proportion (product name: Antipois- Bachmai) were given for 91 patients with ingestion-induced poisoning as protocol of Bachmai Poison Control Center. 76 cases (83.5%) were admitted before 6 hours and 85 cases (93.4%) before 12 hours. 66 patients (72.5%) were given 1 dose, 93.4% were given less than 3 doses, and in 2 patients (2.2%), 6 doses have been used. Antipois-Bachmai was used conveniently. Deposit was not observed in gastric sonde, so this drug prevented from obstruction due to charcoal. Almost patients had charcoal loose stool within first 12 hours.

Improved gastric lavage with close system

Method: 73 patients were performed gastric lavage by an improved technique with new equipment. All of the patients were monitored clinical signs (pulse rate, blood pressure, respiratory rate, SpO2, lung sound...) and tested (blood count, electrolyte, ECG, chest X-ray, toxic screening...) before and after doing gastric lavage. The results were compared to a retrospective study in 1998-2000 we found that complications are reduced significantly from 6.21% to 2.74%. In addition, there was not any severity complication; we only met two cases hypokalemia after doing gastric lavage. Conclusion: the improved technique with new equipment of gastric lavage would be safe for the patients, reduce significantly complication, and easy to implement.

Titrate pam dosage according to serum cholinesterase level in the management of acute organophosphate poisoning

20 patients hospitalized from 1998 to 2000 due to acute organophosphate poisoning were treated by intravenous infusion of PAM at dose of 0.25g - 1g per hour. The dosage of PAM was adjusted according to concentrations of serum cholinesterase tested every 12 hours. The results of study showed that the clinical status was significantly improved: in-hospital stay time was shorter, dose of atropine was lower, severe complications such as paralysis, respiratory failure were decreased in comparison to previous studies. Thus, the level of serum cholinesterase is correlated to poisoning severity and is good indicator for adjustment of PAM dosage in the management of acute organophosphate poisoning.

Contribution to study on pregnancy intervention in severe pregnancy toxicity

A restrospective study on the 30 patients with severe pregnancy toxicity in Hanoi hospital of Gynaecology and Obstetrics during 1995-1996 was implemented aiming to determination of the time for pregnancy intervention which prevent the pregnant women from the bad complications and finding the experiences in the diagnosis and management. Conclusions: the indication depends on the condition of eclampsia such as blood pressure; nervous symptoms and evaluation of renal functions (with or without complication in the process of treatment). The edema is reference symptom

Changes of morphological structure and ability of regeneration of the rat's kidney after poisoning the pesticide Bassa

A study on 41 white male rats with ages of 2 - 2.5 months, weight of 130-150g was carried out. Materials included the sun oil and Bassa 50EC of Novatis. The authors found that renal lesions occurred in some positions and become more severe after 7 days of poison. The lesions included early and long lasting vasodilative congestion in the glomerular and interstitial tissues, cellular proliferation, basement tissular proliferation in glomeruli of kidney cavity and plasma surrounding the cellular nuclear in the renal tubular cells. The images of regeneration of the parenchyma appeared after 7 days of poison

Intoxication in workers at a pesticide company in Tien Giang province between 1995-1999

In our retrospective study on the contamination of pesticides during 1995-1999, mainly depending on cholinesterase index in blood, 101 workers were interviewed directly by available questionnaire. The results showed that 60 cases of contamination were discovered, this prevalence decreased gradually every year, there were 4 cases (3.96%) in 1999. The types of intoxication were changed little by little from the organic phosphorum to perythroid. The protection and occupational safe and hygiene had been given much attention and brought into play of the preventive effects

The treatment of opiod intoxication by naloxon and respiratory resuscitation

62 patients with opiod poisoning involved our study were treated by naloxon and respiratory supportive therapies as united protocol. Because of aggressive using naloxon, the ratio of patients requiring intubations and mechanical ventilation was significantly decreased, 29% and 17.7% respectively. The manifestation of opiod overdose were rapidly improved and almost of the patients (95.5%) were treated successfully. The side effects of naxolon were minor. We observed only 2 cases having vomiting after Iv injection of naloxon. Ambuballon bagging with 100% oxygen was mainly respiratory supportive therapy. The mechanical ventilation indicated for the patients suffering from life-threatening respiratory failure. Heroin-induced pulmonary edema accounted for 82% of these cases. PEEP was used in 7 patients. The mean of PEEP levels was 5.31.3 cmH2O. Our protocol was success in 95.5%.

A five year - survey (1997-2001) on food poisoning in Yen Bai province

Retrospective study on the food poisoning during 5 years (1997-2001) in Yen Bai province showed that: the morbility rate was 0.06%. The highest rate was in Van Yen distric (26%). The adults affected by the food poisoning was higher than children. The mortality rate of food poisoning during 5 years was 5.3%. The cause of microorganism was 41%; pesticide 30%; poisonous food as mushroom, toad egg 22.6%; wild vegetables and fruids 2%; unknown causes 4.2%. Food poisoning occoured in family meals were 58%, in crowed meals 24%. Food poisoning happened throughout the year, the highest found during April, May, June and July. The statistics was insufficient.

Complication of endotracheal intubation inpatients suffered acute intoxication

A study on 112 patients with acute experienced endotracheal intubations in lariboisiere hospital, France of which 67 patients received tracheoscopy within 24 hours after removal of intubation has shown that the major causes of intoxication were due to benzodiazepine, alcohol and psychotic agents and multidrugs (67%). The lesions in ear, nose and throat was common complication in-patients with acute intoxication, mainly edema, swollen, ulceration. These lesions related closely with the duration of intubation and duration of treatment. There was no relation between complication and causes of intoxication.

The food intoxication - situation and solution

The food intoxication has impacted badly on the human health and economy. Every year, the rate of the food intoxication was very high such as in America (175/1000 rehabitant), England and New Zealand (190/1000), Australia (220/1000). In Vietnam, there are about 7,000 cases suffered the food intoxication with 46 deaths in 60/61 provinces in 1997. This paper introduced the concerns and solution for management of the food intoxication.

Personal sample and risk assessment of lead poisoning in foundry workers

Recently, air-borne lead sampling by acids and impinge was not reasonable for the personal sample, neither was it for risk assessment of lead poisoning. The application of NMAM for lead exposure dose evaluation deduces that: the personal samples describe well the risk of lead poisoning of the foundry workers. Personal lead samples give mean of 0.012 to 3.460 mg per shift (air borne lead from 0.001 mg/m3 to 0.330 mg/m3). So, the samples are needed and useful for better risk assessment and occupational health care here

Cloning of human ScFv against digoxin from a semi-synthetic phage antibody library / 中国免疫学杂志

Objective:To clone human anti digoxin ScFv from a human semi synthetic phage antibody library.Methods:①Digoxin BSA conjugate(Dig BSA) was preparaed by a modified periodate oxidation method.②A semi synthetic phage antibody library was panned against immobilized Dig BSA.Collected clones were analysed by ELISA,inhibition ELISA and DNA Sequencing.Results:①During the four rounds panning against Dig BSA,the enrichment of the eluted phage particles was observed;②Analysis of the eluted clones identified one clone that could bind Dig as well as other digitalis.③Sequencing analysis showed that the variable genes of the positive clone belonged to VH5 and V?1 subgroup respectively.Conclusion:Human Dig specific ScFv that could bind Dig and other digitalis has been cloned from a semi synthetic phage antibody library which may provide a potential reagent for the diagnosis and therapy of Dig toxication.