Incidence, Distribution, and Determinants of Suicide by Self-Poisoning in two Egyptian Provinces

Objectives: Suicide by self-poisoning is a serious public health problem that accounts for global morbidities and mortalities. This work aims to study the incidence, trend, and determinants of suicide by self-poisoning in two Egyptian provinces. Methods: The current study is a bi-designed two-phases observational study carried out in two Egyptian poison control centers including Menoufia Poison Control Center (MPCC) and Tanta Poison Control Center (TPCC). A total of 7,802 patients were enrolled. The first phase of the current study was conducted retrospectively to show the trend of suicide attempts over 2016, 2017, and 2018 when the cases diagnosed as suicide by self-poisoning were extracted from medical record. The second part was conducted prospectively (January 2019-Januaray 2020) among cases of suicide by self-poisoning and accidental poisoning. Results: The current study revealed that incidence of poisoning exposure no matter what its type represented 34.99/100,000 (CI95%: 33.84–36.20) distributed as 28.18/100,000 (CI95%: 27.14–29.26) for suicide by self-poisoning and 6.82/100,000 (6.32–7.36) for accidental poisoning. The suicide by self-poisoning death rate represented 2.08/100,000 (1.90–2.49). The suicide by self-poisoning was significantly associated with young age <25years, low socioeconomic status, being a student or not working. Conclusion: Suicide by self-poisoning shows a continuous increase across time raising a serious concern. Collaborative Efforts are required by to conduct health education and enforce legislation to overcome this serious condition. Keywords: Aluminum phosphide; Egypt; pesticides; self-poisoning; suicide

Prognostic Factors of In-Hospital Mortality in Adult Patients With Aluminum Phosphide (ALP) Poisoning in Southern Iran (2014-2018)

Background: The suicide with aluminum phosphide, known as rice tablet, has increased significantly. This study aimed to investigate the epidemiology of Aluminum Phosphide (ALP) poisoning and determine the in-hospital mortality prognostic factors in adult people referring to ALP poisoning to one of the main poisoning centers in southern Iran. Methods: This retrospective cross-sectional study (March 21, 2014, to March 21, 2018) was conducted on all adult patients (>16 years) with ALP poisoning who were referred to Ali-Asghar Hospital (affiliated with Shiraz University of Medical Sciences). All data were extracted from the patients’ medical files. The patients were categorized into two groups of survived and non-survived. Univariate and multivariate logistic regression analyses were conducted to determine prognostic factors for in-hospital mortality, and Odds Ratios (ORs) were reported. Results: Totally, 97 patients were enrolled in this study. The patients’ Mean±SD age was 29.3±12.2 years. Both study groups (survived and non-survived) were matched in most demographic and poisoning characteristics. Nausea (62.9%) and vomiting (49.5%) were the most symptoms at the time of admission. Castor oil (66%), N-acetyl cysteine (56.7%), and magnesium sulfate (52.6%) were the most frequent treatment in these patients. The multivariate analysis showed that age (OR=1.12, 95%CI: 1.03-1.22), body temperature (OR=0.02, 95%CI: 0.01-0.48), resistant acidosis (OR=77.10, 95%CI: 5.05-1176.86), and taking sodium bicarbonate (OR=12.35, 95%CI: 1.25-122.10) were the prognostic factors of in-hospital mortality. Conclusion: The in-hospital mortality rate in patients with ALP poisoning was 29.9%. Age, illiteracy, body temperature, resistant acidosis, and taking sodium bicarbonate were the prognostic factors of in-hospital mortality in these patients.

Fatal Fulminant Hepatic Failure in a Case of Zinc Phosphide Poisoning: A Case Report

Rodenticide is the term given for the compounds that are used in the killing of rats. The commonest compounds that are available as rodenticides are Aluminum phosphide, Zinc Phosphide, Yellow Phosphorus and Coumarins. Due to their easy availability in the general stores, these also have been used as a source of inflicting self-harm by the patients in order to commit suicide. Most of the patients escape the poisonous side effects with a mild course, but some cases progress to a state of Acute liver failure or fulminant liver failure. Due to the broad range of symptoms that can occur with the compounds, it is important to discuss the course of progression of symptoms from mild to severe in order to understand the treatment protocols to treat the patient appropriately. Some patients progress to such a severe form of symptoms that there is an urgent indication of liver transplantation. Here we report a case of rodenticide poisoning in a young female which started off with a mild course and ultimately progressed to fulminant liver failure leading to a fatal outcome.

Acute Poisoning Cases Presented to the Addis Ababa Burn, Emergency, and Trauma Hospital Emergency Department, Addis Ababa, Ethiopia: A Cross-Sectional Study

Background. Acute poisoning is a common reason for visits to the emergency room and hospitalization across the world, as well as a possible cause of morbidity and death. This study aimed to assess acute poisonings at Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital. Methodology. A one-year cross-sectional study was conducted at AaBET Hospital from February 1, 2018, to January 31, 2019. Data were collected using a structured and pretested questionnaire by the Emergency Medicine and Critical Care residents from acutely poisoned patients’ interviews and patient charts. Results. Data were collected from 98 acute poisoning cases, and 52% were males and 48% were females. 85 (86.7%) were less than 45 years. 52 (55.1%) were unemployed, and 33 (33.7%) were farmers. 96 (98%) cases were due to intentional poisoning, and 96 (98%) had oral ingestion. Organophosphates poisoning (27.5%) was the commonest cause, followed by 26.5% of unknown poisons and 16.3% prescribed drugs. Sixty-six percent of the patients presented to the hospital after 2 hours of ingestion. The case fatalities were 10.2% of which 40% of the cases were due to 2,4-dichlorophenoxyacetic (2, 4-D) poisoning, followed by aluminum phosphide (20%). Conclusion. This study showed farmers and the unemployed were more affected. The most common mode of poisoning was intentional poisoning, oral ingestion being the primary route. The common poisons used by the victims were organophosphates. 2, 4-D poisoning was the major cause of death.

The Effect of Levosimendan on Phosphine-Induced Nephrotoxicity: Biochemical and Histopathological Assessment

Background Aluminum phosphide (AlP) toxicity is associated with a high risk of death due to heart, liver, and kidney failure as the target organs. Phosphine gas released due to the ingestion is the main factor involved in the multi-organ failure with various mechanisms. Levosimendan (LEV) is a calcium sensitizer with a pleiotropic effect on multiple organs. This study aimed to investigate whether LEV can alleviate AlP-induced nephrotoxicity in the rat model. Method Six groups included control group (almond oil only), sole LEV group (48 µg/kg), AlP group (LD50=10 µg/kg), and the poisoned groups treated with LEV at doses of 12, 24, and 48 µg/kg 30 min after AlP gavage. After 24 hours of treatment, serum and kidney samples were taken for biochemical and histopathological analyses. Result Biochemical analysis of the AlP group showed that the activity of complexes I, II, and IV was significantly reduced, while the levels of lipid peroxidation (LPO) and reactive oxygen species (ROS), lactate, and myeloperoxidase (MPO) activity significantly increased. Also, AlP reduced live renal cells and elevated necrosis. However, the levels of serum creatinine and blood urea nitrogen were not affected by the poisoning. LEV co-treatment could increase mitochondrial complex activity and reduce MPO activity, LPO, ROS, and lactate levels. Additionally, the histopathological analysis showed the detrimental effects of AlP on kidney tissue, which was mitigated by LEV administration. Conclusion Our findings showed that LEV can potentially improve oxidative stress, imbalance in the redox status, necrosis, and pathological injuries in kidney tissue following AlP-poisoning.