Charejoo Amirhosein, Arabfard Masoud, Jafari Amir, Nourian Yazdan Hasani
Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Front Toxicol. 2023 Jan 25;4:1004705. doi: 10.3389/ftox.2022.1004705. eCollection 2022.
The whole world has learned about the existence of a highly toxic neuro-paralytic substance called Novichok. A wide range of neuro-paralytic toxins were used during the wars of decades ago, which also had harmful and irreversible effects. Fortunately, the establishment of conventions prohibiting the use of these weapons prevented the adverse clinical consequences of these compounds. What we did in the present study was to evaluate the clinical features of Novichok, how to manage exposure to it, and to evaluate the prognostic aspects associated with this poisoning agent. The manuscript especial databases including Medline, Web of knowledge, Google scholar, and Scopus were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords. Initially 98 articles were initially collected by database searching that considering eligibility criteria, 83 articles were finally eligible for the final assessment. There is a lack of clinical trials and case-cohort studies on general population about treatment and side effects when it comes to human nerve agents and most of the data in our search is based on animal studies. In evaluating various clinical, auto physiological and prognostic aspects of exposure to these substances, special attention was necessary to the following points. First, Novichok agents are considered more potent than other toxic agents. Pathophysiologically, these agents irreversibly bind acetylcholinesterase and produce a rapid cholinergic toxidrome which is responsible for the clinical manifestations as well as the potential dangerous and life threatening side effects caused by these agents. Uniquely, these agents are thought to also target every neuron in the central and peripheral nervous system. As a managerial and therapeutic approach, early and timely treatment of its related complication along with prevents massive exposure and decontamination in addition to rapid resuscitation can prohibit debilitating neuropathy and death due to facing it. The present review highlights the importance of recognizing the potential acute toxic effects of Novichok agents, diagnostic and therapeutic approaches (life-saving antidotal therapy) to complications and ultimately the application of guidelines to improve the prognosis of exposure to these agents for both victims and medical community.
全世界都已了解到一种名为“诺维乔克”的剧毒神经麻痹性物质的存在。几十年前的战争中曾使用过多种神经麻痹性毒素，这些毒素也会产生有害且不可逆转的影响。幸运的是，禁止使用此类武器的公约的制定避免了这些化合物带来的不良临床后果。我们在本研究中所做的是评估诺维乔克的临床特征、如何处理对其的接触，以及评估与这种中毒剂相关的预后情况。两位盲法研究者基于所考虑的关键词，对包括Medline、Web of knowledge、谷歌学术和Scopus在内的手稿特别数据库进行了深入检索，以查找所有符合条件的研究。最初通过数据库检索收集了98篇文章，根据纳入标准，最终有83篇文章符合最终评估要求。在涉及人类神经毒剂的治疗和副作用方面，针对普通人群缺乏临床试验和病例队列研究，我们检索到的大多数数据都基于动物研究。在评估接触这些物质的各种临床、自身生理和预后情况时，需要特别关注以下几点。首先，诺维乔克制剂被认为比其他有毒制剂更具毒性。从病理生理学角度来看，这些制剂会不可逆地结合乙酰胆碱酯酶，并产生快速的胆碱能中毒综合征，这是这些制剂所致临床表现以及潜在危险和危及生命的副作用的原因。独特的是，这些制剂还被认为会靶向中枢和外周神经系统中的每一个神经元。作为一种管理和治疗方法，除了快速复苏外，早期及时治疗其相关并发症以及防止大规模接触和去污，可以避免因接触诺维乔克而导致使人衰弱的神经病变和死亡。本综述强调了认识诺维乔克制剂潜在急性毒性作用、针对并发症的诊断和治疗方法（挽救生命的解毒治疗）以及最终应用指南以改善受害者和医学界接触这些制剂后的预后的重要性。
