Effectiveness of therapeutic plasma exchange in patients with intermediate syndrome due to organophosphate intoxication.

OBJECTIVE: We aimed to determine effectiveness of therapeutic plasma exchange (TPE) in patients with intermediate syndrome (IMS) due to organophosphate (OP) intoxication. METHODS: Patients diagnosed with IMS due to OP intoxication were included in this prospective study. Therapeutic plasma exchange procedure was performed with fresh frozen plasma as a replacement fluid via Fresenius-AS-TEC 204 device by Therapeutic Apheresis Unit to patients who developed IMS during follow-up. Samples were taken from patient's blood and waste plasma collected in the device before and after TPE procedure to be studied in laboratory for detection of organic phosphate and pseudocholinesterase (PChE) levels. In this study, SPSS 18.0 software package was used for statistical analysis of the data obtained. Level of statistical significance was taken as P < .05 for all tests. RESULTS: Of all 17 patients, 4 (23.5%) were female, and 13 (76.5%) were male. A statistically significant decrease was detected in organic phosphate levels in the plasma of patients after TPE procedure (P = .012). A statistically significant increase was detected in PChE levels in the plasma of patients after TPE procedure (P = .014). Of 17 patients included in the study, 13 patients showed clinical improvement and were discharged after the TPE process. CONCLUSION: In our study, it was observed that a significant decrease in the level of blood plasma OP and a significant increase in the level of PChE were achieved with TPE process in the early period of IMS due to OP poisoning. This study indicates that TPE is one of the effective treatment options for IMS due to OP intoxication.

Unintentional endosulfan poisoning.

Endosulfan is an organochloride insecticide, widely used in insect control. It is responsible for many severe intoxication and several deaths. We present a case series of endosulfan poisoning, admitted to our emergency department with different clinical courses. Two patients presented with status epilepticus and were successfully treated with thiopental sodium to control seizures. One patient required also hemodialysis. All patients were discharged following a complete recovery of their health. Endosulfan is a highly toxic insecticide that produces tonic-clonic convulsions, headache, dizziness and ataxia. It can cause also life threatening metabolic disturbances. Treatment is symptomatic and supportive (Tab. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome.

AIM: The aim of this study was to evaluate the trends in acute adult poisoning data during ten years in university emergency department and determine the factors of hazardous outcome such as severe clinical status, prolonged hospital stay and mortality. MATERIAL AND METHODS: Medical records of 4569 poisoned patients admitted to Emergency Department (ED) of Qukurova University, School of Medicine in Adana. RESULTS: The mean age of 2988 females (65.4% of the patients) was 24.5+/-10.1 years, whilst the mean age of 1581 male patients (34.6%) was 29.5+/-13.2 years (p=0.001). Of the poisonings 80.0% were suicidal; 69.4% of the women and 30.6% of the men committed suicide. The most common types of poisonings were ingestion of drugs (58.4%), organophosphates (23.9%) corrosives (3.4%), mushrooms (1.7%), methanol (2.4%), carbon monoxide (2.1%) and unknown (8.1%). Of the total 96.0% were discharged from emergency department, 1.4% transferred to IC and 2.6% died. CONCLUSIONS: Young people and women are high-risk groups for acute poisoning and drug poisoning was found to be the most common type of poisoning. The poisoning by psychoactive drugs is increasinging in the recent years and organophosphates poisoning seems to be still a serious problem in such an agricultural area. However, while the ratios of prolonged hospitalization and mortality are decreasing, suicidal poisoning is seriously increasing (Tab. 4, Fig. 2, Ref. 34). Full Text (Free, PDF) www.bmj.sk.

The association between apelin-12 levels and paroxysmal supraventricular tachycardia.

AIMS: Our aim was to investigate the apelin-12 levels in patients with atrioventricular tachyarrhythmias and compare with those in patients with lone atrial fibrillation. METHODS: Forty four patients with supraventricular tachycardia as atrial fibrillation, 44 patients with paroxysmal supraventricular tachycardia (P-SVT) as atrioventricular tachyarrhythmias, including atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia, and 30 age- and sex-matched healthy individuals were included in the study. RESULTS: The apelin-12 levels were significantly lower in both atrial fibrillation and P-SVT groups than control group. In post-hoc analysis, there was no significant difference in apelin-12 levels between atrial fibrillation and P-SVT groups (P = 0.9). Patients in atrial fibrillation group and patients in P-SVT group had significantly lower apelin-12 levels than control group, separately (P < 0.001 and P < 0.001, respectively). The sensitivity and specificity values of the apelin-12 levels for predicting SVT, including both atrial fibrillation and atrioventricular reentrant tachycardia or atrioventricular nodal reentrant tachycardia were 64.77 and 90%, respectively (cut-off value was 0.87). The area under the receiver operator characteristic curve was 0.834 for the apelin-12 levels (P = 0.0001). CONCLUSION: Apelin-12 levels are lower in patients with atrial fibrillation and P-SVT than control groups. Lower apelin levels in patients with atrial fibrillation and P-SVT would be expected to result in a decrease in the conduction velocity.

The effect of nesfatin-1 levels on paroxysmal supraventricular tachycardia.

BACKGROUND: Nesfatin-1 was originally identified as a neuropeptide of the hypothalamus, which is a key integration area of the brain, where numerous neuropeptides and transmitters are released to participate in the control of essential body functions. In the literature, there are no studies showing the relationship between the nesfatin-1 level and paroxysmal supraventricular tachycardia. We hypothesize that the circulating levels of nesfatin-1 may increase during supraventricular tachycardia, to engage the vagal stimulation to terminate by the inhibition of neuropeptide-Y, and may activate oxytocin and the corticotropin-releasing hormone. MATERIALS AND METHODS: This study includes 120 cases (80 patients and 40 controls). Patients with paroxysmal supraventricular tachycardia were compared with the control group with regard to sex, nesfatin-1 level, comorbid diseases, serum renal function values, and patients' vital findings. RESULTS: The nesfatin-1 levels were significantly higher in the paroxysmal supraventricular tachycardia group than in the control group and positively correlated highly with heart rate (r = 0.634; P < 0.001). The area under the receiver operating characteristic curve was 0.644 for the nesfatin-1 levels (P = 0.0051). The sensitivity and specificity values of the nesfatin-1 levels were 41.2% and 95%, respectively (cutoff value >1743.7 pg/mL). CONCLUSION: At the end of this study, a statistically significant correlation was found between the serum nesfatin-1 level and supraventricular tachycardia. Although multifactorial causes may explain the relationship, we based our hypothesis on the relationship of the antagonistic effects of nesfatin-1 on the neuropeptide-Y and activated oxytocin.