ABSTRACT
Acute anticholinesterase pesticide poisoning is a serious clinical problem, particularly in developing countries. Atropine is the most acceptable treatment for acute anticholinesterase poisoning. However, it only stops fluid production. Albuterol is a beta-2 receptor agonist that can increase fluid removal and speed the return of effective oxygen exchange. This study aims to evaluate the safety and efficacy of nebulized albuterol as an adjuvant therapy in patients with acute anticholinesterase poisoning. This stratified block randomized, single-blinded, placebo-controlled, parallel-group clinical trial was conducted between November 2020 and October 2021. It enrolled 80 patients with acute anticholinesterase pesticide poisoning who were admitted to Tanta University Poison Control Center. Patients were allocated into two groups (40 patients each). The strata were based on the severity of poisoning (moderate and severe). Patients in group I received 10 mg of nebulized albuterol. Group II received an equivalent volume of nebulized normal saline. Additionally, standard treatment was provided to both groups. Outcomes included oxygenation, mortality, need for endotracheal intubation and mechanical ventilation, hospital stay duration, time to atropinization, and total doses of atropine and oxime. We found insignificant differences in sociodemographics, exposure characteristics, clinical manifestations, or routine laboratory tests between the studied groups. The median values of oxygen saturation by pulse oximetry were 99% in the albuterol moderate toxicity group and 98% in the control moderate toxicity group. Albuterol significantly improved oxygen saturation in moderate intoxicated patients (P = 0.039). Therefore, nebulized albuterol is a safe drug. Moreover, it may improve oxygenation in acute anticholinesterase pesticide poisoning.
ABSTRACT
The immune and hematological systems can be a target for environmental contaminants with potential adverse effects, so the purpose of this study is to provide documentation on immunotoxicity and hematotoxicity of tetrachloroethylene, which is widely used in dry cleaning in Egypt. This study was carried out on 80 adult males. Subjects designated as controls (n = 40) were healthy persons and others were tetrachloroethylene-exposed dry-cleaning workers (n = 40). The controls and tetrachloroethylene-exposed workers were then divided into four equal groups (20 individuals/group): group I, control group never smoking; group II, smoking control group; and groups III and IV, tetrachloroethylene-exposed nonsmoking and smoking workers, respectively. Blood level of tetrachloroethylene, complete blood count, immunoglobulins (IgA, IgM, IgG, and IgE), the total numbers of white blood cells (WBC), and leukocyte differential counts, as well as interferon gamma (IFN-gamma) and interleukin-4 (IL-4), were measured. The immunotoxicity of tetrachloroethylene appeared in the form of an increase in serum immunoglobulin E in nonsmoking and smoking tetrachloroethylene-exposed workers, while the serum immunoglobulins A, M, and G levels showed no significant change in all studied groups. In addition, our results demonstrated a significant increase in white cell count, lymphocytes, natural killer (NK; CD3+CD16CD56+) cells, and B (CD19+) lymphocytes. The increase in WBC and lymphocytes may be attributed to allergic reaction. Moreover, serum and lymphocytic interlukin-4 levels were significantly increased in nonsmoking and smoking tetrachloroethylene-exposed workers. Tetrachloroethylene exposure is associated with immunotoxicity, which may lead to the augmentation of allergic diseases or appearance of autoimmune reaction.
