The possible therapeutic role of intravenous lipid emulsion in acute aluminium phosphide poisoning: a randomized controlled clinical trial.

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.

Evaluation of pelvic inflammatory disease potential in cholinesterase inhibitor pesticide-exposed females.

Cholinesterase inhibitor pesticides, mainly organophosphates and carbamates, are commonly used in Egypt. Chronic exposure of males and females working in agriculture is expected. The study aimed to relate exposure to cholinesterase inhibitor pesticides to the development of pelvic inflammatory disease (PID). This is a case-control study that was conducted among 84 females. Seventy patients complained of pelvic inflammatory disease visited the outpatient Gynecology and Obstetrics Clinic. Fourteen females were not suffering from PID and were chosen as a control group. Red blood cells' cholinesterase activity was measured in blood. Cervical swaps were collected, and cultures were submitted for microbiological examination. The results showed that cholinesterase activities were significantly depressed in exposed females (6.36 ± 0.8 µmoles/min/ml red cells) when compared to non-exposed (7.5 ± 1.2 µmoles/min/ml red cells), and both were significantly depressed when compared with healthy females (9.17 ± 0.7 µmoles/min/ml red cells). The correlation coefficient (r) between previous exposure and the laboratory confirmed cervical infection was 0.31, with a P value of 0.009. The study concluded that exposure to cholinesterase inhibitor pesticides could increase the occurrence of pelvic inflammatory disease.

Marijuana use in acute coronary syndromes.

BACKGROUND: Cannabis is one of the most widely used illicit substances worldwide, and it has the highest prevalence among drugs used in Egypt. OBJECTIVES: The aims were to evaluate whether the use of cannabis is a risk factor of acute coronary heart disease in low-risk, young males and to compare the cardiac pathological changes between cannabis exposed and non-exposed ischemic patients. METHODS: This was a cross-sectional study that was performed on 138 male patients, aged ≤ 40 years, with acute myocardial infarction who were admitted to the Cardiac Care Unit at the University Hospital. Urine samples were submitted for toxicological analysis using a homogenous enzyme immunoassay technique to determine the substance of use. The patients were divided into three groups: group 1 (n = 23), cannabis-positive only patients; group 2 (n = 28), patients positive for any other substance of use; and group 3 (n = 34), patients negative for any substance of use. RESULTS: Smoking was prominent, whereas group 1 had no other risk factors. In groups 1 and 2, ST-segment elevation myocardial infarction (STEMI) was dominant, whereas no ST-segment elevation myocardial infarction (NSTEMI) was prominent in group 3. Ischemic resting wall motion abnormalities were presented in 47.8% of group 1 and in only 11.8% of group 3. None of group 1 had normal coronaries, whereas 14.3% of group 3 had normal coronaries. Significant changes in echocardiography and angiography were observed between group 1 and other groups. CONCLUSION: Cannabis smoking could be a potential risk factor for the development of cardiac ischemia.

Neurotrophic and antioxidant effects of silymarin comparable to 4-methylcatechol in protection against gentamicin-induced ototoxicity in guinea pigs.

BACKGROUND: Despite that gentamicin is a very effective aminoglycoside, its potential ototoxicity which is of irreversible nature makes a challenge and limitation for its use. This study was designed to investigate possible neurotrophic and antioxidant effects of silymarin comparable to 4-methylcatechol in protection against gentamicin-induced ototoxicity. METHODS AND RESULTS: Twenty pigmented guinea pigs were divided into four equal groups, where group I served as normal control group. The other groups received gentamicin (120 mg/kg/day, ip) for 19 days where group II given vehicle of 1% CMC, group III and group IV were pre-treated 2h before gentamicin by 4-methylcatechol (10 µg/kg, ip) and silymarin (100mg/kg, oral gavage), respectively. The main findings indicated that silymarin exhibited restoration of nerve growth factor (NGF) levels and increased tropomyosin-related kinase receptors-A (Trk-A) m-RNA expression in cochlear tissue and preservation of hair cells of organ of Corti by scanning electron microscopy (SEM) with significant decrease in auditory brainstem response (ABR) threshold compared to 4-methylcatechol. Only silymarin caused significant amelioration in oxidative stress state by reducing malondialdehyde (MDA) levels and increasing catalase activity. CONCLUSIONS: Silymarin exerts superiority over 4-methylcatechol when recommended as protective agent against gentamicin ototoxicity based on its efficient neurotrophic and antioxidant activities.

Immunotoxicological study of one of the most common over-the-counter pyrethroid insecticide products in Egypt.

A commonly available aerosolized pyrethroid insecticide containing deltamethrin and imiprothrin is widely used for hygienic control in Egypt. The immunotoxic effects after inhalation exposures to the preparation of each for 2, 10, and 30 days were investigated in rats. For each exposure, the insecticide (containing 0.2% imiprothrin and 2.5% deltamethrin) was sprayed in all directions in a room (using a special attachment located in the ceiling in the center of the room) for 30 s each minute for 15 min; the room was then kept closed for 15 min. After each spray interval, the rats were introduced for 30 min and then removed to a clean room. The exposure process was repeated a total of three times on each day of the respective regimens. The interval between the 15-min spray/15-min pause/30-min rat exposure cycles was 120 min. Twenty-four hours after the final exposure in each particular regimen, the cohort rats in the regimen (air and exposed) were weighed, sacrificed, and their tissues were removed for analyses. Immunological tests performed included assessments of potential changes in immunopathology (determined from body and splenic weights), humoral-mediated immunity (based on plaque-forming activity of spleen cells), cell-mediated immunity (determined from splenic lymphocyte responsiveness to stimulation with phytohemagglutinin and immune cell (sub)type profile analyses), and nonspecific immunity (based on phagocytic activity of peritoneal macrophages). The results indicated that of all the endpoints examined, among the rats exposed over a 2-day period to the imiprothrin- and deltamethrin-containing insecticide aerosol, the only significant change noted (relative to values from time-matched controls) was in the levels of splenic CD4+CD8- and CD4+ CD8+ cells. In contrast, exposures on each day of a 10-day period led to significant decreases in several endpoints; exceptions to this were values for body and spleen weight (unaffected), splenic OX12-OX19+ levels (significant increase), and CD4+CD8- levels (unaffected, relative to control). Rats exposed for 30 days displayed significant decreases in each test applied, except for increases in both splenic OX12-OX19+ and CD4+CD8- cell levels relative to corresponding control rat values. The present study findings indicate that repeated noncontinuous inhalation of a commonly utilized insecticide that contains imiprothrin and deltamethrin can cause a variety of immunotoxic effects in sites distal to the lungs.