[THE COMPARATIVE STRUCTURE OF ACUTE POISONINGS IN TWO CAPITAL CITIES OF THE SOUTH CAUCASUS REGION].

Objective - according to WHO, acute poisoning is one of the important public health global problems. At the same time, each geographic region is characterized by a unique epidemiological situation on acute poisoning. The aim of this study was to investigate and compare the main toxic-epidemiological parameters of the two largest cities of the South Caucasus - Baku and Tbilisi, and on the basis of the obtained data to develop a program on chemical safety and prevention of acute poisoning among population of the region. Data on all acute poisoned patients undergoing in-patient treatment in the hospitals of Baku and Tbilisi in 2009-2016 were placed in the standard forms and subjected to a comparative analysis. Diagnoses of toxicological patients were unified in accordance with ICD-10 (T36-T65). The total number of patients in this study was 13,292 in Baku and 14,229 in Tbilisi. The results of the study showed that in the both cities among toxicological hospitalizations dominated by cases of toxic effects of substances chiefly nonmedicinal as to source (62.13% in Tbilisi and 53.75% in Baku). However, with a detailed analysis of individual nosological units, we found significant and fundamental differences in the toxic-epidemiological profile of non-medicinal chemical poisoning in two capitals. For example, acute alcohol poisoning in Tbilisi was accounted for 24.26% of all intoxications, or 39,865 cases per 100,000 population. At the same time, alcohol intoxications in Baku were significantly less frequent, amounting to 4,454 hospitalizations per 100,000 population or 5.73% of all poisoning cases. Corrosive substances poisoning in Baku amounted 10.77% of all intoxication, while in Tbilisi it was significantly less - 3.86%. In Baku, the hospitalizations rate of acetic acid poisoning was 5.724 cases per 100.000 population, while in Tbilisi it was only 0.023 cases per 100.000 inhabitants. Toxic effects of carbon monoxide in Baku occupied 24.36% and in Tbilisi - 4.53% of all poisoning cases, which was 18.951 and 7.449 hospitalizations per 100.000 population, respectively. According to pesticide poisoning, hospitalization rates in Baku was 2,710 and in Tbilisi 6,906 cases per 100,000 population. Hospitalization of patients with envenomation in Tbilisi amounted to 5,901; and in Baku - 2,622 cases per 100,000 residents, respectively. In general, the hospitalization rate of intoxication with substances chiefly nonmedicinal as to source use in Tbilisi was 102,088 cases per 100,000 population, and in Baku - 41,817 cases per 100,000 residents respectively. This prospective toxic-epidemiological study revealed a significant incidence of acute intoxication in the two largest cities in the South Caucasus. However, there are considerable differences in the comparative profile and frequency of hospitalizations in patients with acute poisoning in Baku and Tbilisi over the period 2009-2016. The observed cases of mass and unusual intoxication during the study period make it necessary to create the unified network for the monitoring toxic-epidemiological situation and rapid information exchange on emerging toxicological risks in the South Caucasus region.

[POISONING BY PSYCHOPHARMACOLOGICAL DRUGS IN AZERBAIJAN: THE RESULTS OF 8-YEAR PROSPECTIVE OBSERVATION].

Acute poisoning of chemical etiology is a significant global public health problem. The aim of this study was the analysis of the toxicoepidemiological structure of psychopharmacological drugs poisoning in Azerbaijan. We collected and analyzed the data on all cases of acute poisoning by psychopharmacological drugs (codes of categories T42/T43 ICD-10) undergoing inpatient treatment at the Center of Clinical Toxicology in Baku, Azerbaijan in 2009-2016. The total number of patients with acute intoxication by psychopharmacological drugs was 3,413, which was 48.3% of all cases of poisoning by drugs, medicaments and biological substances (T36-T50). The predominance of women was registered in all age groups. 1114 patients or 32.6% were in 15-24 years old age group. The highest percentage of poisonings at category T42 of ICD-10 were benzodiazepine-type drugs (35.8%), and at category T43 - antipsychotic and neuroleptic drugs (19.2%). In the structure of benzodiazepine poisoning, the first and second ranked places belonged to phenazepam (71.0%) and clonazepam - 16.6%. In addition, another 120 cases (5.5%) of poisonings in the T42 cohort were caused by "Z drugs", which have similar therapeutic effect to benzodiazepines (zolpidem and zopiclone). Among the antipsychotic and neuroleptic poisonings, thioridazine, trifluoperazine, levomepromazine, chlorpromazine, and periciazine accounted for 91% of all cases of intoxication in this cohort. Barbiturates, in view of their toxicity and narrow range of therapeutic dosages, now lost their importance as antiepileptic and hypnotic drugs. Only 4.9% of all cases of poisoning, classified under category T42, was due to the use of barbiturates (mainly phenobarbital). Poisonings with iminostilbenes were presented by carbamazepine poisoning only. Most patients in this cohort received this anticonvulsant drug as prescribed by a doctor. Acute intoxications by tricyclic antidepressants in 91.5% were presented by cases of amitriptyline poisoning. Intoxication by serotonin reuptake inhibitors antidepressants, were relatively rare (3.8% of all cases of poisoning in T43). Among the poisonings with butyrophenone and thioxanthene neuroleptics, the first ranked place was occupied by cases of haloperidol poisoning, which accounted for 82.6% in this cohort. In the group of intoxications with other antipsychotic and neuroleptic drugs, the first ranked place belonged to the poisoning with clozapine - a total of 83 cases or 47.2% in cohort. Poisonings by psychopharmacological drugs occupy the first ranking place among poisoning by drugs, medicaments and biological substances (T36-T50). Increased control over the prescription and sale of psychopharmacological drugs, a reduction the number of tablets in one package, as well as increased attention to vulnerable groups of the population could be help to reduce the percentage of these poisonings in Azerbaijan.

Clinical manifestation and management of intravenous mercury injection: a case report.

Intentional self-injection of metallic mercury case report is presented. A 22 year old man with a past medical history of ethylene glycol suicidal poisoning was admitted to a Acad. N. Kipshidze Central University Clinic in Tbilisi, four months after deliberate intravenous injection of an unknown quantity of metallic mercury from several thermometers into his antecubital vein. After 2 months of asymptomatic period, the patient began to complain of pain and tremor in limbs, fatigue and skin rash. CT scan of the thorax and the abdomen confirmed multiple small opacities of metallic density in both lungs, liver and right kidney. After the procedure the patient was transferred to the toxicology center in Baku, Azerbaijan for chelation therapy. On arrival no biochemical abnormalities in hepatic or renal function or clinical pulmonary malfunction were detected, despite presence of slight symptoms of erethism, tremor mercuralis, knee joints arthralgia and lower extremities weakness. Chelation therapy with intramuscular injection of Unithiol (DMPS) was started in dose of 20mg/kg/day. After one month of chelation therapy, mercury blood concentration slowly decreased from initially 134 microgram/L to 105 microgram/L. This case report demonstrates mild acute toxicity following intravenous administration of unknown amounts of elemental mercury. Because of chelation therapy can remove approximately 1 mg of mercury per day the patient was recommended further long-term DMPS treatments under the control blood mercury levels. It is concluded that clinical manifestations of intravenous elemental mercury intoxication may be delayed despite significant increase in blood mercury level.