[THE COMPARATIVE STRUCTURE OF ACUTE POISONINGS IN TWO CAPITAL CITIES OF THE SOUTH CAUCASUS REGION].

Objective - according to WHO, acute poisoning is one of the important public health global problems. At the same time, each geographic region is characterized by a unique epidemiological situation on acute poisoning. The aim of this study was to investigate and compare the main toxic-epidemiological parameters of the two largest cities of the South Caucasus - Baku and Tbilisi, and on the basis of the obtained data to develop a program on chemical safety and prevention of acute poisoning among population of the region. Data on all acute poisoned patients undergoing in-patient treatment in the hospitals of Baku and Tbilisi in 2009-2016 were placed in the standard forms and subjected to a comparative analysis. Diagnoses of toxicological patients were unified in accordance with ICD-10 (T36-T65). The total number of patients in this study was 13,292 in Baku and 14,229 in Tbilisi. The results of the study showed that in the both cities among toxicological hospitalizations dominated by cases of toxic effects of substances chiefly nonmedicinal as to source (62.13% in Tbilisi and 53.75% in Baku). However, with a detailed analysis of individual nosological units, we found significant and fundamental differences in the toxic-epidemiological profile of non-medicinal chemical poisoning in two capitals. For example, acute alcohol poisoning in Tbilisi was accounted for 24.26% of all intoxications, or 39,865 cases per 100,000 population. At the same time, alcohol intoxications in Baku were significantly less frequent, amounting to 4,454 hospitalizations per 100,000 population or 5.73% of all poisoning cases. Corrosive substances poisoning in Baku amounted 10.77% of all intoxication, while in Tbilisi it was significantly less - 3.86%. In Baku, the hospitalizations rate of acetic acid poisoning was 5.724 cases per 100.000 population, while in Tbilisi it was only 0.023 cases per 100.000 inhabitants. Toxic effects of carbon monoxide in Baku occupied 24.36% and in Tbilisi - 4.53% of all poisoning cases, which was 18.951 and 7.449 hospitalizations per 100.000 population, respectively. According to pesticide poisoning, hospitalization rates in Baku was 2,710 and in Tbilisi 6,906 cases per 100,000 population. Hospitalization of patients with envenomation in Tbilisi amounted to 5,901; and in Baku - 2,622 cases per 100,000 residents, respectively. In general, the hospitalization rate of intoxication with substances chiefly nonmedicinal as to source use in Tbilisi was 102,088 cases per 100,000 population, and in Baku - 41,817 cases per 100,000 residents respectively. This prospective toxic-epidemiological study revealed a significant incidence of acute intoxication in the two largest cities in the South Caucasus. However, there are considerable differences in the comparative profile and frequency of hospitalizations in patients with acute poisoning in Baku and Tbilisi over the period 2009-2016. The observed cases of mass and unusual intoxication during the study period make it necessary to create the unified network for the monitoring toxic-epidemiological situation and rapid information exchange on emerging toxicological risks in the South Caucasus region.

Clinical manifestation and management of intravenous mercury injection: a case report.

Intentional self-injection of metallic mercury case report is presented. A 22 year old man with a past medical history of ethylene glycol suicidal poisoning was admitted to a Acad. N. Kipshidze Central University Clinic in Tbilisi, four months after deliberate intravenous injection of an unknown quantity of metallic mercury from several thermometers into his antecubital vein. After 2 months of asymptomatic period, the patient began to complain of pain and tremor in limbs, fatigue and skin rash. CT scan of the thorax and the abdomen confirmed multiple small opacities of metallic density in both lungs, liver and right kidney. After the procedure the patient was transferred to the toxicology center in Baku, Azerbaijan for chelation therapy. On arrival no biochemical abnormalities in hepatic or renal function or clinical pulmonary malfunction were detected, despite presence of slight symptoms of erethism, tremor mercuralis, knee joints arthralgia and lower extremities weakness. Chelation therapy with intramuscular injection of Unithiol (DMPS) was started in dose of 20mg/kg/day. After one month of chelation therapy, mercury blood concentration slowly decreased from initially 134 microgram/L to 105 microgram/L. This case report demonstrates mild acute toxicity following intravenous administration of unknown amounts of elemental mercury. Because of chelation therapy can remove approximately 1 mg of mercury per day the patient was recommended further long-term DMPS treatments under the control blood mercury levels. It is concluded that clinical manifestations of intravenous elemental mercury intoxication may be delayed despite significant increase in blood mercury level.

[Regional features of acute chemical trauma in Azerbaijan and Georgia].

Epidemiologic data on acute chemical poisonings in South Caucasus region are extremely limited. The purpose of this joint prospective study was evaluation and analyzes the rate and characteristics of acute chemical poisoning cases in Azerbaijan and Georgia. This investigation was performed on data of poisoned patients admitted to Republican Toxicology Center of Ministry of Health of Azerbaijan in Baku city and poisoned patients admitted to medical hospitals in Tbilisi (Georgia) from 1st January to 31st December, 2007. Total were 1182 hospitalizations in Republican Toxicology Center's (RTC) intensive care unit and 1646 poisoned patients admitted to medical hospitals in Tbilisi (Georgia). The mean lengths of hospitalization were 3.2 days in Azerbaijan and 1.2 days in Georgia. Acute intoxications were more frequent amount males (51% in Azerbaijan to 67% in Georgia) and in 20-40 age group. Among the pharmaceuticals poisonings by antiepileptic, sedative-hypnotic and antiparkinsonism drugs (T42) and poisonings by psychotropic drugs (T43) were the most frequent. The other cases of poisonings were inhalation of carbon monoxide (T58) - 173 hospitalization in Azerbaijan and 77 hospitalization in Georgia; toxic effect of alcohol (T51) - 50 admissions in Azerbaijan and 697 admissions in Georgia; poisoning by narcotics and psychodysleptics (T40) - 50 cases in Azerbaijan and 36 cases in Georgia; toxic effect of corrosive substances (T54) 176 patients in Azerbaijan to 56 patients in Georgia; toxic effect of pesticides (T60) - 39 patients in Azerbaijan to 11 patients in Georgia; toxic effect of contact with venomous animals (T63) - 70 patients in Azerbaijan to 23 patients in Georgia and toxic effect of other noxious substances eaten as food (T62) - 7 patients in Azerbaijan to 85 patients in Georgia The mortality rates were 3.1% in Azerbaijan and 0.74% in Georgia. Corrosive liquids (especially - concentrated acetic acid) poisonings were most often fatal (41% of total mortality) in Azerbaijan and alcohol poisonings were most often fatal (38% of total mortality) in Georgia. These data provide important preliminary information about toxicoepidemiological situation in South Caucasus countries and could help to develop program of chemical safety and prevention of acute chemical poisonings in this region.

Most common poisonings and their management--data from Tbilisi.

The purpose of the present study was to evaluate the toxicological aid and efficiency of preventive measures and methods in treatment of acute exogenous intoxications in hospitals in Tbilisi in 1990-2005. Structure of poisoning accidents in Tbilisi, its trends in last decade is analyzed and explained. The data were obtained in Georgian National Center for Disease Control and Medical statistics in Tbilisi. The study revealed that total number of hospitalizations due to acute poisoning in Tbilisi exceeded the number of hospitalizations due to acute myocardial infarction. In 1992-1994 Georgia was in severe social-economic crisis: the cases of acute poisoning increased and the number of hospitalizations had been reduced with concomitant longer hospital stay (in 1992--10.7 hospital days; in 1993-1994--13.7 hospital days), and higher mortality (in 1992--4%; in 1993--5.5%; 1994--5.2%). Low hospitalization rates in 1992-1994 should be explained by late patient referral to hospitals. Longer hospital stay was available due to free hospital care at that time. In 1995 with termination of free medical care number of hospitalized patients with acute intoxication raised annually; hospital stay shortened and mortality rate decreased. In 2003 mortality was reduced by 0.74% in Tbilisi. The prevalence of acute alcoholic intoxication incidence was noticed. Therefore hospital stay decreases. High prevalence of acute alcoholic intoxication was explained by the growth of alcohol consumption; lack of quality control of beverage production resulting in huge amount of unconditioned and counterfeit substances in the market, etc. As to poisonings due to medical substances 42% of cases were intoxications with anticonvulsants, sedative and psychotropic preparations; 17% with cardiovascular drugs; and 10% with narcotic substances. It was found, that poisoning incidence and their outcome significantly depend on social-economical conditions in Georgia. Measures to improve toxicology care in the country are outlined and the ways are ushered to reach it soon.