الفهرس 
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Abstract
Pesticide self-poisoning is a major problem, it accounts for 14–20% of global suicides, which is about 110,000–168,000 deaths each year down from an estimated 371,000 in the late 1990s. In Egypt, anticholinesterase and phosphide poisoning constitute the majority of pesticides suicidal cases due to their easy availability and low price. Phosphide poisoning is a serious medical emergency needs rapid and effective management. Its rate increases in the last years with high rates of mortality due to its very rapid onset of action and no available antidote. Determination of prognosis may allow more intensive monitoring and favorable outcome in pesticides poisoned patients. Previous studies suggested that cortisol and thyroid stimulating hormone (TSH) may have prognostic role in patients poisoned by organophosphates and phosphides. Changes in thyroid profile may occur in critical illnesses through different mechanisms such as the inhibition of thyroxine uptake by the hepatocytes and limiting its conversion to triiodothyronine in the periphery, also circulating cytokines can influence hormones levels. These alterations in thyroid hormones levels are called sick euthyroid syndrome. This syndrome may result from severe illness, physical trauma, physiologic stress and large number of drugs and chemical compounds as some pesticides. Upon exposure to stressful conditions or in cases of critical illness, activation of hypothalamic-pituitary-adrenal axis (HPA) occurs with subsequent increase in cortisol level .However in some patients, their cortisol • production is not sufficiently increased in response to stress conditions which is known as critical illness-related corticosteroid insufficiency (CIRCI). In addition, Anticholinesterase pesticides can affect the endocrine system through hormone receptors, hormone synthesis, and transcription factors. Also, phosphides may causes damage to adrenal glands which may increase or decrease blood cortisol level. The aim of the present study is to evaluate the prognostic role of cortisol and TSH in acute pesticides poisoned patients (phosphide and cholinesterase inhibitors) admitted to Tanta Poison Control Center. Patients and methods: This prospective cohort study was conducted on 60 cases of acute pesticides poisoning who were admitted to Tanta Poison Control Center in Emergency Hospital of Tanta University between beginig of August 2019 and end of July 2020. The patients were divided into two groups: • group I: Twenty nine patients with acute anticholinesterase pesticides poisoning. • group II: Thirty one patients with acute aluminum phosphide poisoning. This study was designed to include toxicity with zinc phosphide cases also, but these cases were mild and didn`t coincide with the inclusion criteria during this period The included cases were subjected to: • History taking: • Sociodemographic data including age and sex - Toxicological history include: f) Route of administration: inhalation, ingestion or dermal exposure. • g) Amount of pesticide taken (in case of ingestion). h) Mode of poisoning either suicidal or accidental. i) Delay time between pesticide exposure and hospital admission. j) Any prehospital intervention. - History of medical diseases - Clinical examination: • Vital signs (pulse, blood pressure, respiratory rate and temperature). • Level of consciousness (Glasgow coma scale). • Respiratory examination. • Cardiovascular examination. • Abdominal examination. - Laboratory investigations: • Arterial blood gases. • Sodium and potassium level. • Liver function tests. • Renal function tests. • Complete blood count. • Random blood sugar. • Assessment of serum cortisol level by ELISA technique (serial measurements at admission, after 6 hours and after 12 hours). • Assessment of serum thyroid stimulating hormone (TSH) level by ELISA technique. - Electrocardiogram (ECG) - Outcome measures (prognosis): • Improved or died. • Need for ICU admission. • Need for intubation &mechanical ventilation. • ICU admission duration. • Total needed amount of antidote therapy (in cholinesterase inhibitors). • Total hospital admission duration. These data were statistically analyzed and results revealed that: Majority of cases was in age group (1-19) years and from rural areas in both groups anticholinesterase (group Ι)& phosphide (group II). The predominant sex was female in group Ι and male in group II. Majority of patients in both groups had ingested the pesticide orally as suicidal attempt; only 2 cases in group II inhaled phosphine gas accidentally. The mean delay time between pesticides exposure and hospital admission was 3.2, 1.7 hours in group I and II respectively. Majority of cases in this study had moderate toxicity as regards poison severity score. Chest examination in group I showed that only 4 patients had chest crepitaions and 2 patients had chest wheeze. While cardiovascular and abdominal examination were normal in all cases in both groups. Majority of patients were fully conscious in both groups. Regarding heart rate, it was normal in majority of patients with percentage of 65.5%, 61.3% in group I & II respectively. Blood pressure was normal in all patients in group I, but in group II, 25.8% of cases were hypotensive and other 25.8% had undetected blood pressure. Concerning respiratory rate, majority of cases in group Ι had normal respiratory rate.