ABSTRACT
Background: The agricultural industry has experienced beneficial outcomes by implementing contemporary synthetic pesticides, specifically, the mixture of acetamiprid and pyridaben. However, concerns regarding public health have arisen due to the increased number of suicides caused by insecticide poisoning. Nevertheless, limited reports of human exposure to these pesticides have reported various adverse clinical effects. In this study, we present the case of an individual who consumed the acetamiprid and pyridaben mixture for suicidal purposes, and subsequently developed central nervous system depression, hyperlactacidemia, and metabolic acid poisoning, which thus required clinical management. Case report: A 74-year-old woman was transported to our hospital after ingesting a combination of 30 mL of acetamiprid 5 % and pyridaben 5 %. The patient displayed nausea and vomiting symptoms, followed by confusion. An arterial blood gas analysis revealed metabolic acidosis and hyperlactacidemia. The patient was carefully monitored for vital signs and treated with gastric lavage, purgation, and proton pump inhibitors to reduce gastric acid, blood volume, and electrolyte resuscitation. In addition, the patient received 24 h of hemoperfusion (HP) and continuous renal replacement therapy (CRRT). As a result of these interventions, the patient had a speedy recovery and was discharged 10 days later. Conclusion: This case report provided the details of a rare instance of acute poisoning in humans resulting from exposure to newer synthetic pesticides, specifically acetamiprid and pyridaben. The report described the clinical manifestations and effective supportive therapy management. Future clinicians may find the results of this report valuable for identifying clinical symptoms and treating acute poisoning caused by newer synthetic pesticides.
ABSTRACT
Critical clinical forms of COVID-19 infection often include Acute Kidney Injury (AKI), requiring kidney replacement therapy (KRT) in up to 20% of patients, further worsening the outcome of the disease. No specific medical therapies are available for the treatment of COVID-19, while supportive care remains the standard treatment with the control of systemic inflammation playing a pivotal role, avoiding the disease progression and improving organ function. Extracorporeal blood purification (EBP) has been proposed for cytokines removal in sepsis and could be beneficial in COVID-19, preventing the cytokines release syndrome (CRS) and providing Extra-corporeal organ support (ECOS) in critical patients. Different EBP procedures for COVID-19 patients have been proposed including hemoperfusion (HP) on sorbent, continuous kidney replacement therapy (CRRT) with adsorbing capacity, or the use of high cut-off (HCO) membranes. Depending on the local experience, the multidisciplinary capabilities, the hardware, and the available devices, EBP can be combined sequentially or in parallel. The purpose of this paper is to illustrate how to perform EBPs, providing practical support to extracorporeal therapies in COVID-19 patients with AKI.
ABSTRACT
BACKGROUND: This study evaluates the cost-effectiveness of hemodialysis (HD) plus hemoperfusion (HP) with HD alone in adult patients with end-stage renal disease (ESRD) in China. METHODS: A Markov model was constructed to assess the cost-effectiveness of interventions over a lifetime horizon. Model parameters were informed by the HD/HP trial, the first randomized, open-label multicenter trial comparing survival outcomes and incidence of cardiovascular disease (CVD) for HD + HP versus HD alone, and supplemented by published literature and expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) with respect to quality adjusted life-years (QALY). The robustness of the results was examined in extensive sensitivity analyses. Analyses were conducted from a healthcare perspective. Costs were reported in both Chinese Renminbi (RMB) and US Dollars (USD) in 2019 values. RESULTS: The base case ICER of HD + HP is RMB 174,486 (USD 25,251) per QALY, which is lower than the RMB 212,676 (USD 30,778) willingness-to-pay threshold of three times Gross Domestic Product. This conclusion is sensitive to the mortality for patients with no severe CVD events, the incidence of CVD events, and the cost of HP and HD. At a willingness-to-pay threshold of RMB 212,676 (USD 30,778) per QALY gained, the probability that HD + HP is cost-effective is 58%. CONCLUSIONS: Our results indicate a potential for HD + HP to be cost-effective for patients with ESRD. Further evidence on the longer-term impact of HD + HP on CVD event rates and mortality unrelated to CVD is needed to robustly demonstrate the cost-effectiveness of HD + HP. TRIAL REGISTRATION: The HD/HP trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-16009332).
ABSTRACT
Objective:To investigate the effects of hemodialysis (HD) and hemoperfusion (HP) combination treatment on maintenance hemodialysis (MHD) patients. Methods:A total of 80 MHD patients in Chongming Branch of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from July 2017 to July 2018 were randomly divided into two groups, i.e., HD+HP group (n=40) and HD group (n=40). The patients were followed up every 3 months for 1 year. The changes of laboratory indexes, dialysis adequacy indicators and quality of life scores of Kidney Disease Quality of Life-Short Form (KDQOL-SF) were compared between the two groups, and the prognosis, causes of death and adverse events were recorded. Results:At the end of one-year treatment, levels of parathyroid hormone (PTH), β2-microglobulin (β2-MG), high sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and left ventricular mass index (LVMI) were significantly lower in HD+HP group than those in HD group (P0.05). The overall mortality rates of HD+HP group and HD group were 12.5% and 32.5%, respectively. No significant adverse events were observed during the follow-up. Conclusion:The effects of HD combined with HP on clearing middle and large molecular toxins, reducing microinflammation status, and improving renal anemia and left ventricular hypertrophy are better than those of only HD. There may be potential advantages of HD and HP combination in improving quality of life in MHD patients as well.
ABSTRACT
Objective:To investigate the therapeutic effect of sequential blood purification on rescuing acute grave intoxication.Methods:Twenty eight patients with acute intoxication were treated by HP+CVVH during 2002 and compared them with thirty patients without hemopurgation from 1998 to 2002.Results:The group of hemopurgation was better than non-hemopurgation group in the time of revive,the rate of recovery and death,and the total dose of atropine.Conclusion:Hemopurgation has decisively effect on rescuing all kinds of intoxication with toxins and drugs.It could quickly ameliorate symptom,raise success rate and reduce mortality;Hp combining with CVVH are suitable for the patients with toxicsis who had cardiac and respiratory failure,brain edema,and dielectric disorder.
