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Background: Acute organophosphorus poisoning (AOPP) is one of the important causes of morbidity and mortality especially in developing countries. Exposure to organophosphorus (OP) compounds leads to inhibition of cholinesterase enzyme, resulting in overstimulation of muscarinic and nicotinic receptors. Hence, central, peripheral and autonomic manifestations may lead to death. The lack of valid scoring systems for classification of AOPP severity, render difficult outcome prediction and inaccurate potential complication incidence. There are emerging options for new biochemical markers in AOPP that may facilitate the prediction of severity and/ or outcome. Aim of the work: Evaluation and correlation of the role of serum Copeptin level and Peradeniya organophosphorus poisoning (POP) scale in predicting AOPP severity and outcome in 90 AOPP patients admitted to the Poison Control Center-Ain Shams University Hospitals (PCC-ASUHs). Subjects and Methods: A prospective cross sectional, hospital-based study carried out on 90 AOPP patients admitted to PCC-ASUHs. The diagnosis was verified by history of OP exposure, initial assessment of clinical manifestations and serum Pseudocholinestrase level measurement. Results: In the current study, according to POP scale 48% of the patients were mild, 42% were moderate and 10% were severe cases. Deaths were reported among 11% of the cases. Serum Copeptin level was positively associated with the severity and outcome, with cut off level ≥ 3.9 ng/ml for mortality prediction. POP score was directly proportional with hospital stay duration, serum Copeptin level and the outcome. Hospital disposition, mechanical ventilation and coma were positively associated with the degree of severity. Conclusion: Our study concluded that POP scale can be used as a reliable scoring system for AOPP classification of severity and early detector of hospital disposition either ICU or in-patient, hospital stay duration, total atropine dose, incidence of mechanical ventilation and mortality. Serum Copeptin level is positively associated with AOPP severity and had a role in outcome prediction. Recommendation: Early assessment of AOPP severity by POP score can facilitate categorization of the patient's severity state and predict morbidity and mortality. Serum Copeptin level can be used as a tool for evaluation of severity and prognostic marker for the outcome of AOPP.

Phosphides are common pesticides widely used as a grain preservative. Zinc phosphide toxicity is a major health problem with a high mortality rate especially in developing countries. Cardiotoxicity is the main cause of death in phosphide poisonings. Aim of study: This prospective study aimed to evaluate the cardiovascular affection among zinc phosphide intoxicated patients admitted to the Poison Control Center, Ain Shams University Hospitals (PCC-ASUH) during the period from 1 st June 2013 to 1 st June 2014 and to determine factors predicting the outcome of patients with zinc phosphide cardiotoxicity with special reference to determination of serum troponin I. Methods: Clinical characteristics (systolic blood pressure and central venous pressure), laboratory parameters (liver enzymes, renal function, serum electrolytes: (sodium and potassium), random blood sugar, serum bicarbonate and qualitative assessment of cardiac troponin I, electrocardiographic (ECG) findings and treatment characteristics were all recorded. Results: Cardiotoxicity was evident in 18 patients out of 144 (12.5%) with zinc phosphide intoxication, twelve of them died. Systolic blood pressure was significantly lower among non survivors (60 ± 7 mmHg) compared to survivors (75 ± 5 mmHg). Central venous pressure was elevated in 6 patients, all of them died. Serum cardiac troponin I was positive in 67% (12 patients) and it did not predict mortality. Eight patients out of the 18 patients had dysrhythmias which found to be a predictor of mortality. Conclusion: The statistically significant factors useful in predicting mortality in our study were shock (which required vasoactive drugs), increased central venous pressure and ventricular arrhythmias.

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Toxicity following acute ingestion of large amount of methotrexate is rarely reported, yet accidental daily dosing of methotrexate can result in life-threatening toxicity. This study aims to evaluate the outcome of cases of methotrexate toxicity reported to the Poison Control Center of Ain Shams University Hospitals, Egypt with highlight on causes of mortality, frequency of adverse effect and treatment offered. A prospective study conducted on patients suffering from methotrexate toxicity admitted to the Poison Control Center from beginning of January 2015 till the end of December 2018. Twenty-seven patients were included and were classified into two groups: Survivors and non-survivors. The following variables were studied: presence or absence of vomiting, diarrhea, stomatitis, dysphagia, melena, rash, respiratory distress and treatment given to the patients. Venous samples were drawn for complete blood picture, renal function test and liver enzymes. Electrocardiogram and chest X-ray were performed for all patients on admission and repeated if needed. Our results revealed that 41% of patients had no effect, minor effect (7%), moderate effect (4%), and major effect (22%). Death was reported in 26% of the cases. The majority of patients (63%) were due to therapeutic errors. Accidental and suicidal patients were asymptomatic. Major manifestations and death were reported in cases of therapeutic error. Death was mainly due to respiratory complications. Errors with methotrexate treatment were the main cause of toxicity and respiratory complication was the most common cause of mortality. Strategies to reduce these harms are highly required.

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