Faculty of Medicine
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Item type:Publication, Ingestion of corrosive substances and the endoscopic role in assessing the severity of caustic injury(2023); ; ; ; Irena JurukovIntroduction: The ingestion of caustic substances into the upper gastrointestinal tract is an unusual but potentially life-threatening problem. Aim: To evaluate the most commonly ingested corrosive substances, and the endoscopic findings, complications, and final outcomes of caustic intake. Material and methods: This cross-sectional study included 220 inpatient participants with corrosive poisonings during a 3-year period (2017–2019). Data from the national patient electronic system “My term” and from the “Poisoning information centre” at the University Clinic for Toxicology, Skopje were used. Demographic characteristics, type of corrosive substance, endoscopic findings by Kikendall classification, emerging complications, fatal outcome, and hospitalization were analysed. Data obtained were analysed with the SPSS software package, version 22.0 for Windows. Results: During the period 2017–2019, out of 220 hospitalized cases with corrosive substance intake, 132 (60%) were with ingestion of acids, 19 (8.6%) with bases, 32 (14.6%) with bleaches, and 37 (16.8%) with other household products (p = 0.3469). The mean age of patients was 49.89 ±19.86 years. The most severe endoscopy findings (high-grade injury) were significantly more often associated with acid and base ingestion (p = 0.00001). Out of all strictures, 25 (64.1%) were on one location (either oesophagus or stomach), and 12 (30.8%) were on 2 locations. Conclusions: Upper gastrointestinal endoscopy is very important procedure for rapid assessment of severity of caustic injury, early appropriate therapy, as well as the potential development of strictures. The obtained data are very important for the development of a national program for the prevention of corrosive poisoning in our country. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FATAL ACUTE SELF-POISONING WITH ONE PHOSTOXIN TABLET – A CASE REPORT(2023-05); ; Aluminum phosphide (AlP) is well known as an effective pesticide for grain preservation, but also as a suicidal agent due to its high human toxicity. Phosphine gas (PH3), which is released in contact with stomach acid, is responsible for systemic toxicity and high mortality. We report the first case of severe intentional AlP poisoning treated in our clinic with a fatal outcome and review the therapeutic modalities. A 35-year-old woman with a history of epilepsy was admitted to the University Clinic for Toxicology two hours after the intentional ingestion of a phostoxin (AlP) tablet. She presented with vomiting, abdominal pain, leukocytosis, ECG changes (prolonged PT interval, inverted T waves in D3, AVF, and left precordial leads), hypotension (80/40 mmHg, heart rate 120/min) and respiratory failure, after which she was transferred to the ICU. Signs of hepatic lesion, rhabdomyolysis, renal failure and metabolic acidosis (pO2 9.6 kPa, pCO2 4.14 kPa, pH 7.15, bicarbonate 11 mmol/L, BE -15) were noted. Despite the application of mechanical ventilation, fluid supplementation and inotropic support, hemodynamic instability worsened. Cardiopulmonary resuscitation was performed three times, but unfortunately the patient had a fatal outcome on the fourth day of hospitalization. Freshly opened phostoxin tablets (3 g) are very toxic, and the dose of AlP they contain is sufficient to cause progressive life-threatening symptoms and a fatal outcome. In the absence of antidote, consensus on treatment and elucidated mechanisms of toxicity, the key to treatment is rapid decontamination and initiation of resuscitation measures. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, TROPONIN I VISOKE OSETLJIVOSTI I DUŽINA BORAVKA U BOLNICI KOD AKUTNO OTROVANIH PACIJENATA SA RABDOMIOLIZOM(2023-05); ;