الفهرس 
Physical and chemical propertiesOnly 14 pages are availabe for public view
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Abstract
Summary
Carbon monoxide (CO) poisoning is a major cause of morbidity and
mortality worldwide. It is still a vital clinical issue of great concern to public
health and toxicology. Early non-specific presentation makes diagnosis of CO
poisoning difficult issue, therefore high level of suspicion and considering
circumstances of poisoning is of crucial role.
Acute CO toxicity is the result of a combination of tissue hypoxia secondary
to carboxyhemoglobin formation that has > 250 times affinity to hemoglobin
than oxygen together with direct CO-mediated damage at a cellular level.
Delayed neurological sequelae (DNS) are the most frequent form of COrelated
morbidity. They include cognitive impairments, memory disturbances,
affective disorders and abnormal neurological signs that developed between 2-
40 days CO poisoning. Therefore, its prevention and early prediction after
acute CO is now the main goal of treatment.
There are limited studies in the literature that aimed to assess the role of
pentraxin 3, ischemia-modified albumin and myeloperoxidase enzyme in
prediction of outcome and severity of acute CO poisoning. Therefore, there is
an insisting need for novel promising biomarkers that can access the severity
and outcome of CO poisoning.
This study aimed to assess the role of pentraxin 3, ischemia-modified
albumin and myeloperoxidase in predicting acute CO poisoning-related
outcome.
The study herein is a prospective observational cohort study that was carried
out following approval of the medical research ethical committee of Faculty of
Medicine, Tanta University on 55 acutely CO-poisoned patients admitted to the Tanta Poison Control center (Emergency Hospital, Tanta University) and 55
non-exposed healthy volunteers (control group) during the period from the start
of December 2016 to the end of November 2017. Moreover, patients were
followed up at 3 and 6 months following discharge from hospital at
neuropsychiatry hospital for detection of delayed neuropsychological sequelae
(DNS). Written informed consent was obtained from patients or from their
guardians.
Patients with the following criteria were excluded from the study:
When diagnosis of carbon monoxide (CO) poisoning is not definite.
Expected rise in levels of the studied markers as presence of co ingestion,
ischemic heart diseases, chronic obstructive pulmonary diseases, smoking
history (current or smoking cessation since less than 2 months), pregnancy and
previous history of recent CO exposure.
Patients with hypoproteinemia (The normal range is 3.5 to 5.5 g/dL).
Patients with chronic disease such as: diabetes, hypertension, bronchial asthma,
hepatic, renal, cardiovascular diseases that may affect the oucome.
Patients who received medical treatment in another health institution before
admission.
Patients aged less than 18 years.
The enrolled subjects were subjected to the following:
Personal history taking: including (Age, gender, residence, occupation and
education) is obtained including.
Full medical history: Smoking, chronic diseases, medications and allergy.
Full toxicological history: Including (source, duration and place of exposure t
CO, delay time before arrival to medical facility, number of persons involved
and presenting symptoms of CO poisoning.Clinical assessment:
All patients were generally examined on admission to obtain vital data
(blood pressure, pulse, respiratory rate and temperature) and oxygen saturation.
Consciousness level by the Glasgow Coma Scale and pupil size were assessed
immediately at presentation. Cardiovascular, respiratory and genitourinary
systems and skin were also examined and any abnormalities were recorded.
Follow up:
Assessment of patient’s neurological and psychological outcome was done
initially after patient regain stable level of consciousness and then at 3 and 6
weeks after carbon monoxide (CO) poisoning as all patients were invited for
follow up visits at neuropsychiatry hospital for detection of delayed
neuropsychiatric syndrome.
Laboratory investigations:
Blood samples underwent analysis for routine laboratory measurement of
arterial blood gases, serum electrolytes (Na and k), random blood glucose,
urea, creatinine and liver enzymes ALT and AST. Carboxyhemoglobin level on
admission was also measured by Rad.57 Signal Extraction Pulse CO-Oximeter
device.
On admission levels of Pentraxin 3 (ng/ml) in plasma and myeloperoxidase
(pg/ml) in serum were measured using ELISA Kit purchased from (Chongqing
Biospes company). Spectrophotometric assay of on admission serum levels of
ischemia-modified albumin (ABSU) was done.
The twelve-lead ECGs were recorded for each of the patient on admission.
Two-dimensional echocardiography was done to patients suspected withmyocardial injury in ECG as soon as possible after admission It was done at
Cardiovascular Medicine Department, Tanta University Hospitals.
Outcome assessment:
Duration of hospital stay, number of hyperbaric oxygen sessions and need
for assisted or mechanical ventilation were also recorded.
The current study revealed that delayed neurological sequelae (DNS) were
common complications after acute carbon monoxide (CO) poisoning as they
were developed in 49.1% of the studied cases, whereas 41.8% of patients
developed no complications and 9.1% died. The occurrence of memory
disturbances was the most common DNS after acute CO intoxication (12.7%),
followed by speech difficulties (10.9%), while the least recorded complication
was depression (1.8%).
It was observed that, the age group (18 - 28 years) was the commonest
involved in all studied groups. There were insignificant differences between
the studied CO-poisoned patients and their control group as regards their
demographic data.