الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
I
LIMITATION
n the current study, the role of troponin I and CK-MB in predicting the mortality in acute theophylline toxicity could not be investigated as there was only one mortality case. Additionally small sample size of the current study is considered another limitation. Further studies on larger samples and in different poison control centers are recommended.
T
CONCLUSION
roponin I could predict the severity and the requirement of ICU admission and haemodialysis in patients with acute theophylline toxicity either with early or delayed presentation. On the other hand, CK-MB could be considered for patients with delayed presentation. Depending on time of admission, proper choosing of the biomarker to be investigated will allow for better evaluation of patients with saving extra cost.
RECOMMENDATIONS
It is recommended to use troponin as a predictor of severity in acute theophylline intoxicated patients in early and delayed presentation.
CKMB as a predictor of severity in acute theophylline intoxicated patients in delayed presentation.
Further prospective study involving large sample size should be conducted to verify the findings of the present study and to evaluate the usefulness of these prognostic parameters on large scale.
Raising public awareness about hazards and complications of theophylline toxicity.
Psychiatric referral is a must for all cases of suicidal attempts.
Regulations to ban suicide.
SUMMARY
T
heophylline is a methylxanthine used for the treatment of respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD) and apnea of prematurity, due to its pharmacological action in smooth muscle relaxation, anti-inflammatory properties and powerful stimulation of the central nervous system (CNS) respiratory center (Kong et al., 2021).
Theophylline use is extremely lowered in developed countries because of its narrow therapeutic index and relatively high frequency of side effects along with production of safer and more effective bronchodilator drugs. Nevertheless, it is still widely used and considered a preferred drug in the majority of the developing countries due to its low cost (Hodeib and Ghonem, 2019).
Acute theophylline poisoning involves gastrointestinal symptoms, neurologic effects like seizures, musculoskeletal manifestations such as muscle contractions, and cardiovascular complications including tachycardia and arrhythmias, cardiac ischemia. These symptoms can increase rapidly, leading to life-threatening events like refractory seizures and cardiac arrest that may be resistant to standard treatments. There is a high need to predict the severity and outcomes of patients with acute theophylline poisoning, in order to guide its treatment properly (Khalifa and Lashin, 2018).
Methylxanthine cardiotoxicity is based on diverse, complex mechanisms. PDE inhibition and blocking adenosine receptors which cannot explain all the cardiotoxic effects of methylxanthine (Sharif et al., 2023). In addition, methylxanthines are cardiac stimulants and result in positive inotropy and chronotropy even with therapeutic dosing (Hoffman R.J., 2019). Theophylline and its derivatives have been associated with elevated troponin as well as myocardial infarction in patients without coronary artery disease (Cashy et al., 2020).
This study aimed to Investigate the potential benefit of troponin I and CK-MB as early markers of severity and outcomes induced by Theophylline toxicity and to Correlate between troponin I and CK-MB plasma concentration and theophylline level, ABG, and ECG and some clinical data.
The current study was case control study conducted on 34 patients admitted to PCC-ASUH for 6 months duration from January 2022 to June 2022 with history of acute exposure to theophylline toxicity and history collection was conducted for all patients including sociodemographic data, intoxication data which Included type and amount of ingested theophylline, mode of poisoning, delay time, pre-hospitalization period and past medical history which included the presence of pre-existing diseases as cardiac diseases and hypertension, diabetes mellitus, hepatic, renal diseases, and respiratory diseases especially bronchial asthma.
Detailed clinical examination (including general and local) done on admission and 6 hours after and repeated every 12 hours for ICU patients and every 24 hours for those in the inpatient ward until discharge.
Laboratory parameters collected, were all biological samples withdrawn 6 hours post ingestion; troponin I and CKMB repeated 12 hours post ingestion and immediate analysis done to the following parameter (Theophylline level, Troponin I, CK-MB, ABG, Serum Potassium level, Random Blood Glucose and ECG).
Treatment done included Decontamination and Elimination with activated charcoal or gastric lavage, Specific treatment according to symptoms, supportive treatment to complications and Enhancement of elimination if required included MDAC or hemodialysis.
In our study, 34 patients were included and classified into three distinct groups based on their serum theophylline levels as outlined by Murray et al., (2011), mild theophylline toxicity had serum theophylline levels ranging from 20 to 40 mg/L and represent 35.5% of cases, while moderate theophylline toxicity had serum theophylline levels between 40 and 80 mg/L and about 41.2% and severe theophylline toxicity ranging from 80 to 100 mg/L and calculated 23.5% of total patient.
In the present study, patients ages ranged from 18 to 76 years with mean 25.44 ± 11.8. Moreover, females had higher incidence of acute theophylline toxicity than males.
In this present study, suicide was the most common manner of poisoning and acute toxicity was more common than acute on top of chronic toxicity among studied patient, the study also revealed that sustained-release preparations is more common than conventional theophylline preparations.
In this study, nearly all patients were tachycardiac and tachypneic and most of patients were normotensive.
Sinus tachycardia was the most common finding in ECG with statistically significant differences among the three groups and significant positive correlation with troponin I level at 6- and 12-hours post ingestion as troponin I levels increase there is a corresponding increase in heart rate. Also, corrected QT showed a significant difference among the mild, moderate, and severe groups and a moderate positive correlation with troponin I levels at 12 hours post-ingestion.
Concerning CK-MB and troponin I levels at 6- and 12-hours post-ingestion both showed a statistically significant among the three studied groups (mild, moderate, and severe).
Also, CK-MB and troponin I levels at 6- and 12-hours post-ingestion showed a statistically significant among ICU admission, hemodialysis and hospital stay.
There is absence of a significant difference in CKMB levels at 6 hours post-ingestion between the patient and control groups indicates that CKMB levels at 6 hours post-ingestion cannot effectively distinguish between patient with toxicity and those without it. In other words, CKMB lacks the ability to serve as a reliable marker in acute theophylline toxicity.
While troponin I level at 6- hours post ingestion is a strong predictor for identifying severe cases with early manifestations that need ICU admission and hemodialysis with notable sensitivity and specificity.
Troponin I level at 12 hours and a CKMB level at 12 hours post-ingestion appear to exhibit efficacy as promising predictors for severe cases with delayed manifestations. However, troponin I appears to be a stronger indicator for identifying severe cases of acute theophylline toxicity, striking a balance between sensitivity and specificity, while CKMB, while specific, may not be as sensitive in capturing all cases of severe theophylline toxicity as troponin I.