Clinical characteristics and follow-up analysis of 12 patients of acute phosphine poisoning / 中华劳动卫生职业病杂志

Objective: To investigate the clinical characteristics of patients with acute phosphine poisoning, and to follow up and evaluate the prognosis of patients. Methods: In May 2022, 12 patients with phosphine poisoning by respiratory inhalation in Beijing Chao-Yang Hospital of Capital Medical University were analyzed. The patients were treated with symptomatic support therapy. Three months later, patients were re-evaluated the symptoms of poisoning, pulmonary function and magnetic resonance imaging (MRI) of the brain to understand the prognosis of the phosphine poisoning. Results: The main symptoms of 12 patients were respiratory and central nervous system symptoms with hypoxia. The symptoms of poisoning improved after treatment. Follow-up found that the patients had different degrees of residual symptoms. Pulmonary function showed increased airway resistance. Airway challenge test was positive in some patients. MRI of the head of some patients showed small ischemic focus in bilateral frontal lobes. Conclusion: Acute phosphine poisoning may cause persistent damage to the respiratory system and central system, and residual symptoms after 3 months.

Analysis of the Distribution of Total Phosphine and the Characteristics of Phosphine Poisoning in 29 Victims / 法医学杂志

OBJECTIVES@#To study the distribution of total phosphine in phosphine poisoning victims and summarize the characteristics of phosphine poisoning cases.@*METHODS@#The phosphine and its metabolites in the biological samples of 29 victims in 16 phosphine poisoning cases were qualified and quantified by headspace gas chromatography-mass spectrometry.@*RESULTS@#Five victims among 29 were poisoned by ingestion of aluminium phosphide and 24 by inhalation of phosphine gas. Phosphine metabolites were detected in the biological samples of 23 victims, and the concentrations of total phosphine in blood ranged 0.5-34.0 μg/mL. The total concentration of phosphine in liver tissue was up to 71.0 μg/g. Phosphine was not detected in the blood of the other six survived victims, which may be related to the small amount of phosphine exposure and the delay in blood sampling.@*CONCLUSIONS@#The total concentration of phosphine in blood and tissues caused by aluminum phosphine ingestion is higher than that caused by phosphine gas inhalation. The death cases of phosphine inhalation are characterized by long exposure time, repeated exposures and age susceptibility.

Effects of radiant exposure values using second and third generation light curing units on the degree of conversion of a lucirin-based resin composite

Abstract Alternative photoinitiators with different absorption wavelengths have been used in resin composites (RCs), so it is crucial to evaluate the effectiveness of light-curing units (LCUs) on these products. Objective Using Fourier transform infrared analysis (FTIR) in vitro, the effects of varying radiant exposure (RE) values generated by second and third generation LED LCUs on the degree of conversion (DC) and maximum rate of polymerization (Rpmax) of an experimental Lucirin TPO-based RC were evaluated. Material and Methods 1 mm or 2 mm thick silicon molds were positioned on a horizontal attenuated total reflectance (ATR) unit attached to an infrared spectroscope. The RC was inserted into the molds and exposed to varying REs (18, 36 and 56 J/cm2) using second (Radii Plus, SDI) and third generation LED LCUs (Bluephase G2/Ivoclar Vivadent) or a quartz tungsten based LCU (Optilux 501/SDS Kerr). FTIR spectra (n=7) were recorded for 10 min (1 spectrum/s, 16 scans/spectrum, resolution 4 cm-1) immediately after their application to the ATR. The DC was calculated using standard techniques for observing changes in aliphatic to aromatic peak ratios both prior to, and 10 min after curing, as well as during each 1 second interval. DC and Rpmax data were analyzed using 3-way ANOVA and Tukey’s post-hoc test (p=0.05). Results No significant difference in DC or Rpmax was observed between the 1 mm or 2 mm thick specimens when RE values were delivered by Optilux 501 or when the 1 mm thick composites were exposed to light emitted by Bluephase G2, which in turn promoted a lower DC when 18 J/cm2 (13 s) were delivered to the 2 mm thick specimens. Radii Plus promoted DC and Rpmax values close to zero under most conditions, while the delivery of 56 J/cm2 (40 s) resulted in low DC values. Conclusions The third generation LCU provided an optimal polymerization of Lucirin TPO-based RC under most tested conditions, whereas the second generation LED-curing unit was useless regardless of the RE.

Serie de casos de intoxicación fatal por ingesta intencional de fosfuro de aluminio: case reports with fatal evolution / Aluminium phosphide poisonings: case reports with fatal evolution

El fosfuro de aluminio (AlP) es un plaguicida fumigante de bajo costo, cuyo único uso permitido es el control de plagas en granos almacenados. En contacto con la humedad del aire libera gas fosfina (PH3), altamente tóxico, inflamable y explosivo, pero que se disipa rápidamente. En todas las presentaciones, 3 g de la formulación genera 1 g de gas fosfina. La exposición a 1000 ppm durante 30 minutos es fatal. Presentamos una serie de casos de intoxicación severa por ingesta intencional de fosfuro de aluminio, con desenlace fatal, con el objetivo de asesorar e informar sobre los mecanismos de intoxicación y el manejo adecuado del paciente intoxicado.

Aluminium phosphide (AlP) is a fumigant pesticide inexpensive; whose only permitted use is for stored grain pest control. On contact with moisty air, it releases phosphine gas (PH3), highly toxic, flammable and explosive, but that quickly dissipates. For all presentations, a 3 g formulation generates 1 g of phosphine gas. Exposure to 1000 ppm for 30 minutes is lethal. We present a series of cases of severe poisoning with AlP, in order to advise and inform on the mechanisms of toxicity and proper management of the poisoned patient.

Aluminium Phosphide Poisoning.

Aluminium phosphide poisoning is a major cause of morbidity and mortality in northwest and central India. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. The mechanism of toxicity includes cellular hypoxia due to the effect on mitochondria, inhibition of cytochrome C oxidase and formation of highly reactive hydroxyl radicals. In India, most of the patients who come with Celphos poisoning succumb to its toxicity because of the considerable time gap between the ingestion of the poison and the initiation of proper treatment. This has led to widely prevalent scepticism among physicians while managing cases of Celphos poisoning. Due to no known specific antidote, management remains primarily supportive care. In most of the studies, poor prognostic factors were presence of acidosis and shock. The overall outcome improved in the last decade due to better and advanced intensive care management.

Acute anterolateral myocardial infarction due to aluminum phosphide poisoning

Aluminum phosphide [AlP] is a highly effective rodenticide which is used as a suicide poison. Herein, a 24-year-old man who'd intentionally ingested about 1 liter of alcohol and one tablet of AlP is reported. Acute myocardial infarction due to AlP poisoning has been occurred secondary to AIP poisoning. Cardiovascular complications are poor prognostic factors in AlP poisoning

Efficacy of high dose of magnesium sulphate for cardiac arrhythmias in patients of wheat pill poisoning

To study the prophylactic effects of High Dose Magnesium Sulphate on Cardiac Arrhythmias, Cardiogenic shock and associated mortality in Cases of Aluminum Phosphide Poisoning. Seventy One patients of wheat pill poisoning were randomly selected. Thirty seven were given high dose of Magnesium Sulphate [study group] and 34 were given low dose of magnesium sulphate [control group] through intravenous route along with other supportive measures. Patients were observed for cardiac arrhythmias and mortality in both groups. Study end point was safe discharge from the hospital or death. The mean age of the sample was 25.27 +/- 7.48 years. Frequency of cardiac arrhythmias was 40.54%[n=15] in study group versus 55.88% [n=19] in the control group. Average length of stay and frequency of cardiogenic shock was slightly lower in the study group, i.e., 1.42 +/- 0.65 days while it was 1.78 +/- 1.38 days for the control group. Overall, mortality in both the groups was 66.20% [n=47], which remained almost equal in both groups or slightly favored study group with 64.86% [n=24] in the study and 67.65% [n=23] in the control group. High dose magnesium sulphate administration was found to be helpful for cardiac arrhythmia and shock but mortality remained unchanged

Influence of different light sources on the conversion of composite resins.

Aims: The purpose of this paper was to evaluate the influence of different light curing units on the conversion of four composite resins with different compositions (Durafill VS® - Heraeus-Kulzer, Tetric Ceram® - Ivoclar/Vivadent, Filtek™ Supreme XT - 3M ESPE™ e Aelite™ LS Packable - Bisco), using differential scanning calorimetry. Materials and Methods: A stainless steel matrix was used to prepare 48 cylindrical composite test samples (n=6), measuring 3 mm in diameter and 1 mm in thickness. The samples were photoactivated using a halogen lamp (Optilux™ 500 - Demetron/Kerr) and three different generations of light-emitting diodes (LEDs) (LEC-470 I - MMOptics, Radii Plus - SDI and Ultra-Lume™ LED 5 - Ultradent). After removal of the matrix, each sample was weighed and hermetically sealed in an aluminum pan and analyzed. The amount of heat liberated by thermopolymerisation of residual monomers after photoactivation was measured in Joules/gram (J/g). The data were submitted to Analysis of Variance (ANOVA) test (P ≤ 0.002) and the Tukey test (P < 0.05). Results: The Ultra-Lume™ LED 5 was superior on degree of conversion for all resins. The Radii Plus was equal to the Ultra-Lume™ LED 5, except for the resin Tetric Ceram® , were the Optilux™ 500 was superior. The LEC-470 I was inferior for the conversion of all resins. Conclusion: The study proves the importance of the compatibility of the different photoinitiators in resin composites with the different light sources.

The study of aluminium phosphide poisoning in a Tertiary Care Hospital - Amritsar.

Trend of poisoning had been constantly changing throughout the world, as the advent of new agents, has always replaced the older one due to their innumerable merits and demerits. Similarly in India, the pattern of ingested poisons has also changed. A number of chemical substances which are developed to save the agricultural product from rodents and pests are in fact themselves proving to be disastrous for mankind. Recently in the last two decades aluminium phosphide [Alphos] used as pesticide, rodenticide, fumigant for storage of food grains has created havoc with the human lives differently i.e. suicidal, accidental and very rarely homicidal poisoning agent. Alphos, a solid fumigant used for storage of food grains, freely accessible in the market is commonly used suicidal agent with high mortality rate as no antidote or specific treatment is available. The present study of 50 cases of aluminium phosphide poisoning showed male dominance, common in sikhs and educated persons. Heart is the first organ to be affected. Shock was present in majority of cases. Sufficient time was available for recording dying declaration.

Forensic view on aluminium phosphide poisoning.

In India, acute aluminium phosphide poisoning (AAlPP) is a serious health care problem. This study aimed to determine the characteristics of AAlPP and the predictors of mortality at the time of patients' admission. We studied consecutive admissions of patients with AAlPP admitted to the intensive care unit (ICU). We noted 38 parameters at admission to the hospital and the ICU and compared survivor and non-survivor groups. A total of 54 patients were enrolled comprising 10 females and 44 males and the mean ingested dose of poison was 0.75 ± 0.745 grams. The mortality from AAlPP was 59.3%. We found the following factors to be associated with an increased risk of mortality: a serum creatinine concentration of more than 1.0 mg % (P = 0.01), pH value less than 7.2 (P = 0.014), serum bicarbonate value less than 15 mmol/L (P = 0.048), need for mechanical ventilation (P = 0.045), need for vasoactive drugs like dobutamine (P = 0.027) and nor adrenaline (P = 0.048) AAlPP causes high mortality primarily due to early haemodynamic failure and multi-organ dysfunction.

Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran.

Background: Aluminum phosphide (ALP) is a highly effective insecticide and rodenticide used frequently to protect stored grain. Acute poisoning with this compound is common in some countries including India and Iran, and is a serious health problem. Aim: The objective of this study was to survey ALP poisoning locally known as "Rice Tablet" and the outcome in a referral poisoning hospital in Mazandaran province, northern part of Iran. Materials and Methods: The study was a cross-sectional study from March 2007 to February 2008. Records of all patients admitted and hospitalized to a referral teaching hospital during the 2 year period were collected. Information including gender, age, cause of toxicity, amount of AIP consumed, route of exposure, time between exposure and hospital admission, signs and symptoms of toxicity at admission, therapeutic intervention, laboratory tests, and outcome were extracted from the patients' notes. Patients who died and survived were compared using appropriate statistical tests. Results: During the two-year period, 102 patients, 46 men and 56 women with mean (±SD) age 28.5 ± 12.4 year were admitted with ALP poisoning. The most common signs and symptoms at admission were nausea (79.4%), vomiting (76.5%), and abdominal pain (31.4%). 41.1% of the patients showed metabolic acidosis. Suicidal intention was the most common cause of poisoning (97%) leading to 19 (18.6%) deaths. Compared with the patients who survived, those who died had taken higher amount of ALP tablet (2.2 ± 2.4 vs. 1.4 ± 1.0, P < 0.05), had poor liver function test (P < 0.0001) and severe metabolic acidosis (pH: 7.17 ± 0.19 vs. 7.33 ± 0.08, P < 0.0001). Conclusion: ALP poisoning is a common toxicity in Iran causing high morality. This is a serious health problem in agricultural region where ALP is readily available. Withdrawal of ALP tablet from the market and introduction of safer products as rodenticides and insecticides is recommended.

[Survey the histopathological findings in autopsy of poisoned patients with rice tablet [aluminium phosphide]]

Aluminium Phosphide [ALP] or rice tablet is one of the most commonly used pesticides in agriculture. Exposure of ALP with water, moisture and gastric acid produced phosphine gas [PH3] that caused to poisoning. Several histopathogical researches have shown edema, congestion, and leukocyte infiltration in different organs. More pathological researches are obviously required to describe the mechanism of poison effects on cells. To determine the histopathological findings in autopsy of liver, myocardium, and lungs of poisoned patients with rice tablet. This retrospective descriptive study was conducted on 80 poisoned patients with phosphine in the histopathology department of the legal medicine organization of Guilan in the years of 2001-2006. Stained sections of the liver, myocardium and lungs of poisoned patients were reviewed and histopathological findings were recorded. Data were analyzed by SPSS Ver.15 software. According to the data analysis, 60% of patients were male and the rest [40%] were female. Mean age was 31.45 years. Histopathological findings in liver were: Sinusoidal congestion [45%], fatty liver changes [20%], congestion of central vein [15%], fine cytoplasmic vacuoles [10%], PMN leukocyte clusters in Sinusoids [7%], nuclear fragmentation [2%], centri lobular necrosis [1%]. Histopathological findings in myocardium were: congestion [86%], necrosis [7%] and leukocyte infiltration [7%]. Histopathological findings in lungs were: edema [42%], congestion [33%], hemorrhage [11%], atelectasia [11%], capillary dilatation [2%], and thickening of alveolar septae [1%]. In this study, it was discovered that the most common histopathological finding in liver of poisoned patients with phosphine were sinusoidal congestion and fatty liver changes. Meanwhile, edema and congestion were the most common in autopsy of lungs. Congestion was the mostly-observed histopathological finding of myocardium

Wheat pill: clinical characterisitcs and outcome

To determine the clinical characteristics and outcome in patients presenting with wheat pill poisoning. Retrospective study. Department of medicine, Combined Military Hospital, Kharian from 1st July 2009 to 30 December 2010. Fifty two patients with wheat pill ingestion were included in the study. All patients' history, symptoms, signs and management data was collected on a pre-designed data collection form. Mean age was 25.10 +/- 5.35 years with 51.9% females. Time interval between ingestion of pills and presentation to hospital was 2.5 +/- 1.27 hours. Numbers of pills consumed were 2.73 +/- 20. Most common symptom seen in patients was vomiting seen in 88.5% of the patients. Other common symptoms were irritability in 63.5% and confusion in 55.8% patients. Most common clinical sign hypoxia in 75% patients. Overall mortality was 86.5 percent. Wheat pills are highly toxic with rapid and high mortality rate. These patients develop refractory hypotension and metabolic acidosis which progresses to death. More research is required to develop antidote and to minimize toxicity. Strict legislations are required to control sale of aluminium phosphide over the counter

Quantitative Exposure Assessment of Various Chemical Substances in a Wafer Fabrication Industry Facility

OBJECTIVES: This study was designed to evaluate exposure levels of various chemicals used in wafer fabrication product lines in the semiconductor industry where work-related leukemia has occurred. METHODS: The research focused on 9 representative wafer fabrication bays among a total of 25 bays in a semiconductor product line. We monitored the chemical substances categorized as human carcinogens with respect to leukemia as well as harmful chemicals used in the bays and substances with hematologic and reproductive toxicities to evaluate the overall health effect for semiconductor industry workers. With respect to monitoring, active and passive sampling techniques were introduced. Eight-hour long-term and 15-minute short-term sampling was conducted for the area as well as on personal samples. RESULTS: The results of the measurements for each substance showed that benzene, toluene, xylene, n-butyl acetate, 2-methoxyethanol, 2-heptanone, ethylene glycol, sulfuric acid, and phosphoric acid were non-detectable (ND) in all samples. Arsine was either "ND" or it existed only in trace form in the bay air. The maximum exposure concentration of fluorides was approximately 0.17% of the Korea occupational exposure limits, with hydrofluoric acid at about 0.2%, hydrochloric acid 0.06%, nitric acid 0.05%, isopropyl alcohol 0.4%, and phosphine at about 2%. The maximum exposure concentration of propylene glycol monomethyl ether acetate (PGMEA) was 0.0870 ppm, representing only 0.1% or less than the American Industrial Hygiene Association recommended standard (100 ppm). CONCLUSION: Benzene, a known human carcinogen for leukemia, and arsine, a hematologic toxin, were not detected in wafer fabrication sites in this study. Among reproductive toxic substances, n-butyl acetate was not detected, but fluorides and PGMEA existed in small amounts in the air. This investigation was focused on the air-borne chemical concentrations only in regular working conditions. Unconditional exposures during spills and/or maintenance tasks and by-product chemicals were not included. Supplementary studies might be required.

A Case of Aluminum Phosphide Poisoning

Aluminum phosphide is commonly used as a rodenticidal agent in agricultural workplaces. However, reported cases of aluminum phosphide poisoning in Korea are rare. Upon contact with moisture in the air, aluminum phosphide releases highly toxic phosphine gas (PH3). PH3 is readily absorbed through lung epithelium and into the bloodstream. Phosphine may cause denaturing of oxyhemoglobin and enzymes important to respiration and metabolism, and also may effect cellular membranes. There are numerous complications associated with acute aluminum phosphide poisoning including gastrointestinal, respiratory, and cardiac toxicities. We report the case of a 46-year-old man who suffered from respiratory and cardiac toxicities after unintentional aluminum phosphide exposure. More intensive education for prevention is recommended.

A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome.

Background : Aluminum phosphide (AlP) is used as a fumigant. It produces phosphine gas, which is a mitochondrial poison. Unfortunately, there is no known antidote for AlP intoxication, and also, there are few data about its prognostic factors. AIMS: The aim of this study was to determine the impact of the Simplified Acute Physiology Score II (SAPS II ) in the prediction of outcome in patients with acute AlP poisoning requiring admission to the Intensive Care Unit (ICU). Materials and Methods : This was a prospective study in patients with acute AlP poisoning, admitted to the ICU over a period of 12 months. The demographic data were collected and SAPSII was recorded. The patients were divided into survival and non-survival groups due to outcome. Statistical Analysis : The data were expressed as mean ± SD for continuous or discrete variables and as frequency and percentage for categorical variables. The results were compared between the two groups using SPSS software. Results : During the study period, 39 subjects were admitted to the ICU with acute AlP poisoning. All 39 patients required endotracheal intubation and mechanical ventilation in addition to gastric decontamination with sodium bicarbonate, permanganate potassium, and activated charcoal, therapy with MgSO 4 and calcium gluconate and adequate hydration. Among these patients, 26 (66.7%) died. SAPSII was significantly higher in the non-survival group than in the survival group (11.88 ± 4.22 vs. 4.31 ± 2.06, respectively) (P < 0.001). Conclusion : SAPSII calculated within the first 24 hours was recognized as a good prognostic indicator among patients with acute AlP poisoning requiring ICU admission.

Aluminium phosphide poisoning: management and prevention.

Death by Aluminium phosphide (AIP) and organo-phosphide poisoning are the commonest forms of poisoning in India. Aluminium phosphide is used as rodenticide and pesticide in grain storage facilities. It produces phosphine gas, which results in mitochondrial poisoning. There is no known antidote for AIP poisoning. The effects of AIP poisoning, mediated by phosphine and mechanism of action have not been established.The information related to this poisoning is available in the literature and substantiated by practical experience. Liberated phosphine cannot be detoxified but Magnesium sulphate has been reported to be effective. Another remedy can be rapid absorption by coconut oil which might be helpful. Treatment consists of gastric lavage with potassium permanganate solution, oral administration of charcoal and sorbitol suspension, intravenous administration of sodium bicarbonate, magnesium sulphate and calcium gluconate, and oral administration of sodium bicarbonate and coconut oil. Use of coconut oil for treatment in this poisoning is suggested, although clinical trials and scientific approval is still awaited. Every suggestion, news regarding new modality of treatment for this poisoning needs to be shared in the interest of saving precious human lives. It is with this aim the present paper is written.

Spread of phosphine resistance among brazilian populations of three species of stored product insects

The resistance to fumigant insecticides in stored-products insects is often recorded. Several factors influence the evolution of insecticide resistance. Among these, the frequency of applications and the migration of resistant populations are of primary importance for the stored-product insects. The aim of this study was to characterize the spectrum and investigate the status of phosphine resistance in Brazil, in 13 populations of the Coleoptera Tribolium castaneum Herbst (Tenebrionidae), ten populations of Rhyzopertha dominica (Fabr.) (Bostrichidae), and eight populations of Oryzaephilus surinamensis (L.) (Silvanidae). The pattern of resistance dispersion in the populations of these species was also verified. The bioassays for the detection of phosphine resistance followed the FAO standard method. To test the influence of migration in the evolution of the phosphine resistance, the difference of mortality in the discriminating concentration and the geographical distance among each pair wise combination of collection sites were correlated. None of the populations exhibited mortality above 90 percent in the discriminating concentration, for the three species. Mortality in the discriminating concentration increased with the geographical distance for R.dominica and O.surinamensis. However, no significant linear response was observed among the variables for T.castaneum populations. These results suggest that the dispersion of insects and the local selection are relevant in the evolution of the phosphine resistance in populations of R.dominica and O.surinamensis. In contrast, grain trade and local selection are probably the factors that determine the evolution of the phosphine resistance in populations of T. castaneum.

Trends of poisoning in Faridkot region of Punjab- A retrospective study of one year.

Since immemorial times, poisonous substances have been reported to be adversely affecting human life, both in terms of morbidity and mortality. Evolution in fields like agriculture, industry etc has made wide and easy availability of various poisonous substances. The present study is a retrospective study of one year which is related to poisoning cases that were admitted in the emergency department of G.G. S. Medical College, Faridkot from 1st January 1996 to 31st December 1996. The analysis of the data revealed that out of 78 patients admitted in the hospital, 31 patients died. The maxi-mum incidence was seen in the age group of 21-30 years with males outnumbering the females. The commonest poison used was organophosphorus group of compounds.

Aluminium phosphide poisoning: a case report

This paper reports the case of a family in which three children were presented at Emergency Room [ER] with poisoning after the use of a pesticide at home. Initially, the cases were managed as routine cases of organophosphorus poisoning; however, the death of two children made the health team members realise that the poison's effects were delayed and devastating. Later, the compound was identified as Aluminium Phosphide [ALP], and the life of the last surviving child in the family was saved