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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Organophosphate Poisoning,Pralidoxime Compounds,Atropine,Clinical Protocols,Therapeutic Human Experimentation
- چکیده:
- چکیده انگلیسی: Background: For effective treatment of organophosphate (OP) poisoning, development of a standardized protocol with flexible dose regimen for atropine and pralidoxime is an essential step. In this study, we aimed to assess the protocol devised in our setting; Bach Mai Hospital Poison Treatment Center, for treatment of OP poisoning that included a higher dose regimen of pralidoxime (2PAM).
Methods: A protocol for treatment of OP poisoning was developed during 1995 to 1996, which included an atropinization scoring scale and a modification of 2PAM dose regimen. In this study, OP poisoned patients who were treated during 1997 to 2002 with the new protocol (study group or cases) were compared with historical control group which included OP poisoned patients treated between 1993 and 1994 prior to establishment of the new protocol.
Results: One-hundred and eight cases and 54 controls were included. The cases and controls were not significantly different according to age, gender and plasma cholinesterase activity on admission from each other. There was no significant difference of mean duration of 2PAM therapy between the two groups. The controls received mean total 2PAM dose of 7.2±4.1 g, while the patients in the study group received 20.0±12.7 g which was 2.77 times higher than the dose for control group (P<0.001). Patients in the study group received significantly lower doses of atropine (100.2±119.1 vs. 231.8±225.5, P<0.001). Patients in the study group required a shorter duration of hospital stay compared to controls (6.2±4.8 vs. 8.2±5.8, P=0.035). In addition, morality rate decreased significantly (P=0.004) from 13% to 1.9% by application of the new protocol.
Conclusion: The new protocol was more effective for patients with OP toxicity as it reduced the morbidities and mortality. A flexible regimen of 2PAM therapy for OP poisoning is recommended to be implemented.- انتشار مقاله: 09-03-1393
- نویسندگان: Pham Due,Pham Due,Pham Due
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: toxicology,Poison Control Centers,Vietnam
- چکیده:
- چکیده انگلیسی: Last editorial of the Asia Pacific Journal of Medical Toxicology addressed the important role of poison control centers in the improvement of public health (1). In Vietnam, poison control center (PCC) of Bach Mai Hospital has been the only national one for civilians. The establishment and activities of this center can be considered as one of the pioneers in the East Asia.
History and setting (2,4)
The PCC is a division of Bach Mai Hospital, a tertiary general hospital with approximately 2000 beds. The hospital is a public teaching hospital. The department of clinical toxicology or poison treatment center (PTC) was separated from the department of emergency and intensive care of Bach Mai Hospital in 1998. From this treatment center, the PCC of Bach Mai Hospital was established in 2003 and has been working as the only national PCC.
Organization (2,4)
The Bach Mai PCC is directed by 3 physicians who are specialized in critical care medicine and have been working for PTC from its beginning. Other staff members of the PCC include 7 physicians, 2 bachelors of chemistry, 1 technician, 27 nurses and 3 medical assistants. The PCC has a unit of clinical toxicology with 35 patient beds, toxicology laboratory and poison information unit. In this setting, clinical and scientific measures including management of poisoned patients, toxicology analysis, training and education for healthcare workers in the management and prevention of poisoning, toxicologic research, cooperation with domestic and international agencies regarding the poisonings, public education, providing poison information, treatment and prevention advice and participation in regional and international congresses and associations have been tracked.
Achievements (2,3,5,6)
Training and education: (a) For healthcare workers in Vietnam; teaching toxicology module or training courses on the management of poisonings at graduate and postgraduate levels for physicians, residents, medical students, and nurses at the center and in different regions of Vietnam is in progress (7094 students). Moreover, 46 CME courses were organized in 42 provinces nationwide. (b) For international healthcare workers; training course on the diagnosis and management of acute poisonings for 27 physicians from India in cooperation with World Health Organization was performed.
Clinical activities: Approximately 1700-1800 poisoned patients are annually treated in the center which majority of them includes pesticides, snakebite, hymenoptera evenomation and toxic mushrooms. Treatment protocols and regimens for common and life-threatening poisonings have been developed and brought about great successes, especially with regards to organophosphate poisoning, snakebite, hymenoptera evenomation and nereistoxin insecticide poisoning.
Research: Most studies have been focused on devising protocols and application of techniques for decontamination, antidote administration and enhanced elimination of poisons including emulsified charcoal, snake antivenoms, gastric lavage with closed circuit, plasma exchange, continuous veno-venous hemofiltration/hemodialysis and charcoal and resin hemoperfusion.
Mortality rate: The PCC has played an important role in the improvement of death rate. The death rate due to poisonings was reduced from 8.5% to 1.9% after the department of clinical toxicology (PTC) was set up in 1998. The mortality was further reduced to 0.37% in 2005 after the establishment of the PCC. The current death rate (2012) is 1.99% primarily contributed by emerging paraquat poisoning.
Organization of charity activities: A large number of severely poisoned patients who were in poor economical status and had treatment costs exceeding the payment competency of the health insurance benefited from these activities.
Toxicology analysis: Analysis of many common poisons of concern have been carried out including pesticides, pharmaceuticals, drugs of abuse, alkaloids with quick tests, thin layer chromatography and high pressure liquid chromatography.
Publications: Nineteen books (in Vietnamese) on toxicology, emergency medicine and intensive care medicine, nursing, accident and injuries prevention (chief author and co-authors) have been published by the PCC, to date.
International cooperation: The PCC successfully hosted the 9th Scientific Congress of Asia Pacific Association of Medical Toxicology at Bach Mai Hospital in 2010 which was attended by 200 delegates from 19 countries- انتشار مقاله: 27-05-1392
- نویسندگان: Pham Due,Nguyen Trung Nguyen
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Poisoning,Phenobarbital,Continuous Veno-Venous Hemofiltration (CVVH),Hemodialysis (HD)
- چکیده:
- چکیده انگلیسی: Background: Phenobarbital poisoning is common in Vietnam. The aim of this study was to compare the effectiveness of continuous veno-venous hemofiltration (CVVH) and hemodialysis (HD) on clinical outcomes in the treatment of severe acute phenobarbital poisoning.
Methods: This was a retrospective observational historically controlled study. 42 patients with severe phenobarbital poisoning were enrolled. 21 patients were treated with HD and 21 with CVVH. Both groups received similar supportive therapies consisting of mechanical ventilation, forced alkaline diuresis and multiple-dose activated charcoal.
Results: Following one course of treatment with HD (4 hours) or CVVH (~19.5 hours) the mean (SD) blood phenobarbital concentration (BPC) had decreased to 3.9 (2.5) and 3.2 (2.3) mg/dL respectively (P=0.232). Mean percentage decrease in BPC after HD and CVVH were 62.7 (12.4) and 61.5 (22.0) % respectively, showing no significant difference (P=0.782). Mean duration of coma and mechanical ventilation in CVVH group was 31.9 (26.6) and 39.7 (27.9) hours, significantly shorter than those in HD group with 66.1 (32.5) and 66.7 (32.2) hours (P=0.002; 0.001) respectively.
Conclusion: One course of treatment with CVVH and HD decreased the BPC to a similar extent but this was not associated with similar clinical outcomes. Although, CVVH was not associated with rapid fall in blood phenobarbital level, it clearly had clinical advantages by shortening the duration of coma and mechanical ventilation and with lack of coma recurrence in severe phenobarbital poisoning.- انتشار مقاله: 23-10-1391
- نویسندگان: Le Quang Thuan,Ngo Duc Ngoc,Pham Due
- مشاهده