الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Aluminum phosphide is a highly popular indoor and outdoor pesticide used in many developing countries. Even 500 mg of this compound can be fatal for humans with mortality rates as high as 70–100%. The toxicity of aluminium phosphides is due to production of deadly phosphine gas in contact with water or diluted acids. The main mechanisms of toxicity are electron transfer blockage and non-competitive inhibition of cytochrome oxidase c, which inhibits oxidative phosphorylation and, in turn, cellular respiration resulting in activation of peroxide radicals. In addition, phosphine can inhibit catalase and deplete glutathione, resulting in cellular wall dysfunction.
N-acetylcysteine (NAC) is a precursor of L- cysteine and reduced glutathione (GSH). In addition, NAC is a source of sulfhydryl groups in cells and free radical scavenger as it interacts with reactive oxygen species (ROS) such as OH and H2O2. Many studies were done to evaluate NAC effect in treatment of acute aluminium phosphide poisoning either animal or human studies and the majority show positive role of NAC in treatment such lethal poison.
The current study is a systematic review and meta-analysis study, including all randomized controlled trials (RCTs) and observational studies (OSs) comparing acute aluminium phosphide (AlP) poisoning outcomes between groups receiving or not receiving N-acetylcysteine (NAC) those published in English and fulfilled the inclusion criteria. It aimed at providing evidence based systematic review about the role of NAC in treatment of acute aluminium phosphide poisoning which may help in developing clear guidelines for treatment of such lethal poison.
We followed PRISMA guidelines during preparation of this study. PubMed, EKB, ScienceDirect and Cochrane CENTRAL were searched to identify the published literature from inception to June 2022. In addition, we searched for ongoing studies, reference lists, attending conferences, and asking experts for additional studies
This systematic review of NAC usage in acute AlP poisoning included four RCTs and two OSs with total 286 participants. The current study revealed that there was significant reduction in mortality rate (OR 0.38, 95% CI [0,23 to 0.66]), duration of hospital stay in survivors (SMD -1.73 days, 95% CI [-2.35, -01.11]). Significant increase in survival time in non survivors in patients received NAC, compared with those did not (SMD 0.87 day, 95% CI [0.37, 1.37]). There was no significant difference between NAC and control groups regarding need for mechanical ventilation (OR 0.51, 95% CI [0,23 to 1.10]).
Morbidity rate could not be assessed because it was not clearly mentioned in all included studies.