الفهرس 
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Abstract
The use of pesticides is a common practice around the world; yet, pesticides are toxic and capable of interacting with targeted and non-targeted organisms. The consequences of pesticide exposure depend on the type and amount involved. Moreover, the pattern and outcome may vary in different geographic regions across the world with diverse socio-cultural and environmental risk factors. The severity of pesticide poisoning may range from mild to severe or even fatal.
Acute pesticide poisoning is an important and serious public health concern and the health-related issues are increasing. Therefore, this work was aimed to study acute pesticide poisoning among the patients admitted to Alexandria Poison Center and Intensive Care Unit of Alexandria Main University Hospital, as regards demographic data of cases with acute pesticide poisoning, pattern of exposure whether accidental, suicidal or homicidal, as well as severity and outcome of poisoning.
The present study was carried out on 678 patients with acute pesticide poisoning. There were 617 patients admitted to Alexandria Poison Center (APC) and 61 patients admitted to Intensive Care Unit (ICU) of Alexandria Main University Hospital.
The duration of the study was for six months, which started from 1st January until 30th June 2019. A detailed history was taken from every patient or accompanying relatives. A complete physical examination was carried out and management was applied.
The main results of the study revealed that:
• Most of the patients with acute pesticide poisoning admitted to APC and those admitted to ICU were males (51.2 % and 52.5%, respectively) in opposition to females (48.8% and 47.5%, respectively).
• The age of the studied cases ranged from 6 months to 70 years with a mean value of 19.63 ± 15.03 years. The highest percentages of the patients were in the age group 10 – <20 and 1– <10 years (27.7% and 27.1%, respectively). The lowest percentages of the patients were among ≥60 and 0 – <1 group (1.9% and 1.8%, respectively).
• More than half of the patients were from Alexandria (53.8%), followed by 35.8% from Beheira, then 6% from Kafr El-Sheikh, 2.5% from Matrouh and lastly, 1.8% were visitors from other governorates in Egypt.
• In relation to occupation, the highest frequency of the patients (26.8%) were children below the age of six, followed by school/university students (26.7%), then 21.1% were other occupations including governmental employee/ retired, self-employed and unemployed. Agriculture workers and housewives constituted 13.6% and 11.8%, respectively.
• Incidence of acute pesticide poisoning was higher in June (29.2%), followed by May and April (15.9% and 15.6%, respectively). The least incidence was in February (11.5%).
• With regard to the time of exposure, the largest percentage of the patients (47.1%) were exposed to pesticides during the time between 5 pm and <5 am.
• With respect to the time of consultation, 49% of the patients sought medical consultation in less than 2 hours, while 15.2% of the patients took more than 6 hours to seek medical consultation. The mean value for the time of consultation is 3.07 ± 2.92 hours.
• As for the time of admission, 70.9% of the patients were admitted during the evening-night shift (5 PM – <5 AM), followed by the afternoon shift in the time between 12 PM – <5 PM (18.4%), while the least number of the patients were admitted during the morning shift (10.6%) in the time from 5 AM – <12 PM.
• The majority of the patients (85.4%) were exposed to pesticides through ingestion/oral route, followed by inhalation/nasal route (14.5%). Dermal/skin-scalp route represented 7.4% of the patients and the least routes of exposure were injection and eye (0.3% and 0.1%, respectively).
• Accidental poisoning accounted in the majority of the patients (64.9%), while suicidal poisoning presented about 35.1% of the patients. There were no incidents of homicidal poisoning.
• Pre-hospital management was conducted on 26.4% of the patients, while 73.6% did not receive any form of pre-hospital treatment.
• 84.1% of the patients recorded negative past medical history, while 15.9% of the patients had a positive past medical history.
• Regarding the main categories of pesticides, more than half of the patients (55.2%) were exposed to insecticides, followed by rodenticides (28%), then fumigants and insect repellents (15.3% and 1.3%, respectively). At last, herbicides and fungicides (0.9% and 0.4%, respectively).
• Concerning the major chemical classes of pesticides, nearly one-quarter of the patients (23.2%) were exposed to carbamates, followed by zinc phosphide (19.3%), then aluminum phosphide and organophosphates (14.9% and 13.4%, respectively). The least poisoning was from strychnine and chlorothalonil equally (0.1%).
• In Glasgow Coma Scale, the severity score ranged from 3– 15 with a mean value of 14.71 ± 1.38.
• With reference to the size of the pupil, 82.2% of the patients had normal pupil size, while 5.6% had constricted pupils. Pinpoint pupils were observed in 7.4% of the patients, whereas dilated pupils were presented in 4.9% of the patients.
• Electrocardiogram was recorded as follows: 73.5% of the patients had normal sinus rhythm, while 21.5% of the patients had sinus tachycardia. Sinus bradycardia, atrial fibrillation and supraventricular tachycardia recorded 3.1%, 1.8% and 0.1%, respectively.
• Duration of hospital stay was between 6 hours – <24 hour for the largest percentage of the patients (45.4%), followed by less than 6 hours and 1 day – <2 days period (22.6% and 22%, respectively). Four patients (0.6%) were hospitalized for an extended duration of more than 7 days.
• More than half of the patients (52.2%) recovered, one patient (0.1%) developed complications, while the rest of the patients did not complete their management either they discharged on the request of the relatives (33.2%), or escaped (8%).
• In Poisoning Severity Score, more than half of the patients (51.3%) had score minor (1), followed by score none (0) and score moderate (2) (28.5% and 13%, respectively). The least percentage of the patients (7.2%) had score severe (3).
• High scores of Poisoning Severity Score were observed in the majority of the patients who died compared to the patients who recovered.