الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Aluminum phosphide is a potent pesticide. It is used for crop protection during storage and transportation. However, it has currently aroused interest with increasing number of cases in the past four decades due to increased use in agricultural and non-agricultural purposes. As well as its misuse to commit suicide due to its cheapness, easy availability and known high mortality rate. Death rates caused by ALP poisoning have been demonstrated as high as 70–100%. The increased incidence of acute ALP poisoning and its high mortality is a real challenge for health professional staff in developing countries. Unfortunately, there is no specific antidote or effective drug to manage the cardiotoxic effects of ALP and the treatment is mainly supportive. Hence, evaluation of new treatment modalities is necessary, in order to decrease the rate of mortality and/or morbidity. Melatonin possesses antioxidant, anti-apoptosis, anti-inflammatory, and antiarrhythmic properties and recently, it is recommended to be used as adjuvant therapy in pandemic covid 19. Thus these properties give rise to the opinion that it can be highly potential in counteracting the mechanisms of ALP-induced cardiotoxicity The aim of this study was to evaluate the protective effect of melatonin on the cardiotoxicity induced in cases of acute aluminum phosphide poisoning. This study was a randomized controlled trial that was conducted on 60 patients presented with acute ALP poisoning. The study participants were recruited from Tanta university Poison Control center of Tanta University Emergency Hospital in the period from the 1st of October 2018 to the end of October 2019. Sixty patients were randomly allocated using the sequentially numbered, opaque sealed envelopes method into 2 equal groups (30 cases in each); the first group is the group I (melatonin group) (receive single dose of 20mg melatonin plus the conventional treatment of ALP poisoning) and the second group is group II (control) (received the conventional treatment only). The patients’ personal and medical data, clinical characteristics, investigations and, treatment data until outcome measures were recorded in a special observation sheet for every patient. Data were statistically analyzed and revealed the following results: The age of patients included in this study ranged between 18 and 62 years. The highest percentage of intoxication in both groups was in the age group < 20 years. The majority of the studied patients were females (66.6 %), single (61.7%), students (53.3%), educated to secondary level (48.3%) and from rural regions (71.7%). The median ingested amount was one tablet (three grams), and the median time passing between exposure and the hospital admission in both groups was 2.25 hours with no statistically significant difference. All patients in both groups were fully conscious with GCS=15, only one patient in melatonin group had a GCS=13. The main clinical findings at the time of admission were vomiting, hypotension, tachycardia and metabolic acidosis in both the melatonin and control group, with no statistically significant difference. More than half of the patients in control (53.3%) and melatonin (60%) groups were in severe toxicity. About one third of them (30%) were in moderate toxicity. Only 10% and 16.7% of melatonin and control groups had minor toxicity. Many patients in the study had two or more abnormal ECG finding at the same time. The most prominent ECG abnormality in melatonin and control groups was sinus tachycardia (56.7% and 40 % respectively). This was followed by depressed ST segment (53.3%) in the melatonin group whereas; it was only 26.7 % in control group. Concerning baseline laboratory investigations, there was no significant difference between the studied groups regarding serum levels of sodium, potassium, magnesium, kidney function tests, liver enzymes, random blood sugar, or troponin I at the time of admission. Regarding oxidative stress biomarker, there were no statistically significant differences in lipid peroxide and total antioxidant capacity level between both groups. Laboratory investigations obtained 6hrs post-admission revealed significant improvement in the following; metabolic acidosis, and troponin I, lipid peroxide, TAC levels in melatonin group compared to control group. In addition, there was absence of any significant differences between both groups regarding other routine investigations obtained 6 hrs after admission. A significant negative moderate correlation was detected between troponin I obtained 6hrs post-admission and mean arterial blood pressure in the control group. Also, a significant negative correlation was detected between lipid peroxide level and mean arterial blood pressure in both groups at the time of admission and within control group 6hrs after admission. A significant positive correlation between MAP and TAC in melatonin group at admission and control group at admission as well as 6hrs post-admission was evident. Troponin I and serum lipid peroxide level were higher and TAC level was lower in patients who developed ECG abnormalities when compared with patients who had normal ECG findings in both groups at admission and 6hrs post-admission. Patients with severe toxicity showed a statistically significant increase in the oxidative stress in the form of significant decrease in values of TAC associated with significant increase in lipid peroxide level in comparison with patients in mild or moderate toxicity in both groups with significant negative correlation between TAC and PSS and significant positive correlation between lipid peroxide and PSS. Also, a significant positive correlation was noticed between troponin I and PSS. Its level significantly increased in severely toxic patients in comparison with patients with mild and moderate toxicity. Regarding the outcome measures, melatonin in the current study insignificantly reduced the mortality rate in melatonin group compared to control group (43.3% versus 66.7 % respectively). Whereas, the need for intubation and mechanical ventilation was significantly lower in the melatonin group compared to the control group (46.7% versus 76.7% respectively). The ICU admission and the median duration of mechanical ventilation were non-significantly higher in melatonin group compared to the control group (48 hours versus 8.5 hours respectively). The mean arterial blood pressure assessed 6 hours post-admission and the total amount of norepinephrine administered showed non-significant difference between both groups. Concerning the length of hospital stay, patients in melatonin group stayed in hospital a significantly longer duration compared to patients in control group. In contrast, a significant lowering of the duration of hospital stay among survivors in group I than in group II was observed.