Unique coated neusilin pellets with a more distinct and fast visual detection of nerve agents and other cholinesterase inhibitors

Current Perspectives on the Management of Patients Poisoned With Novichok: A Scoping Review

INTRODUCTION

Nerve agents have emerged as a global threat since their discovery in the 1930s, posing severe risks due to their inhibition of acetylcholinesterase and the subsequent accumulation of acetylcholine in nerve synapses. Despite the enforcement of the Chemical Weapon Convention to control chemical weapons, including nerve agents, recent events, such as the Novichok attacks on Sergei Skripal and Alexei Navalny, have highlighted the persistent threat. Novichok, a distinct class of nerve agents, raises specific concerns regarding its management due to limited understanding. This article aims to comprehensively analyze existing literature.

MATERIALS AND METHODS

A scoping review was employed to comprehensively assess the current state of knowledge on managing patients poisoned with Novichok. Following the PRISMA-ScR guidelines, relevant literature was identified in peer-reviewed journals covering symptoms, diagnosis, treatment, decontamination, and long-term effects. Searches were conducted on February 1, 2023, across four electronic databases (PubMed, EMBASE, MEDLINE, and Web of Science) using "Novichok" as a keyword. No restrictions were applied, and additional studies were sought from the references of identified papers. Eligible papers included discussions on Novichok or its specific properties impacting management, regardless of study type, language, or publication date, while those unrelated to the study's conceptual framework were excluded.

RESULTS

A total of 170 records were identified from the initial database search, with 86 studies screened after removing duplicates. Among these, 28 publications met the eligibility criteria and were included in the analysis. An additional relevant study was identified from the citation lists of included studies, bringing the total to 29. The review encompasses studies published from 2018 onwards, indicating the growing interest in this topic. While most studies are reviews on Novichok or nerve agents in general, several theoretical and experimental investigations were also found.

CONCLUSION

This review highlights the significant uncertainties and knowledge gaps surrounding the management of patients poisoned with Novichok. While some aspects align with other nerve agents, limited research likely due to safety and ethical challenges leads to assumptions and uncertainties in patient care. The review identifies areas with ongoing research, such as decontamination and biomarker recognition, while other aspects remain understudied. The possible inefficacy of current treatment options and the need for further research on oximes, bioscavengers, and long-term effects emphasize the necessity for increased research to optimize patient outcomes. More studies are essential to clarify the actual threat and toxicity of Novichok. Moreover, raising awareness among medical staff is crucial for early diagnosis, prompt treatment, and safety. This review offers valuable insights into managing Novichok-poisoned patients and calls for increased research and awareness in this critical area.

Utilization of Pharmaceutical Technology Methods for the Development of Innovative Porous Metasilicate Pellets with a Very High Specific Surface Area for Chemical Warfare Agents Detection

Pharmaceutical technology offers various dosage forms that can be applied interdisciplinary. One of them are spherical pellets which could be utilized as a carrier in emerging second-generation detection tubes. This detection system requires carriers with high specific surface area (SSA), which should allow better adsorption of toxic substances and detection reagents. In this study, a magnesium aluminometasilicate with high SSA was utilized along with various concentrations of volatile substances (menthol, camphor and ammonium bicarbonate) to increase further the carrier SSA after their sublimation. The samples were evaluated in terms of physicochemical parameters, their morphology was assessed by scanning electron microscopy, and the Brunauer–Emmett–Teller (BET) method was utilized to measure SSA. The samples were then impregnated with a detection reagent o-phenylenediamine-pyronine and tested with diphosgene. Only samples prepared using menthol or camphor were found to show red fluorescence under the UV light in addition to the eye-visible red-violet color. This allowed the detection of diphosgene/phosgene at a concentration of only 0.1 mg/m³ in the air for samples M20.0 and C20.0 with their SSA higher than 115 m²/g, thus exceeding the sensitivity of the first-generation DT-12 detection tube.

Second-Generation Phosgene and Diphosgene Detection Tube

We have developed a second-generation detection tube for colorimetric and fluorescence detection of phosgene and diphosgene in air. The tube is packed with pellets made of a mixture of microcrystalline cellulose and magnesium aluminum metasilicate treated with a suitable monoterpene (camphor, menthol) to increase porosity and specific surface area. We impregnated the pellets with a specific o-phenylenediamine-pyronin (PY-OPD) based reagent. The detector with this novel indication charge enables phosgene or diphosgene to be selectively and sensitively detected at concentrations lower than as would those posing acute health risk. Owing to the analytical colorimetric and, at the same time, fluorescence signal, the detector is very robust while featuring good sensitivity and variability. The colorimetric limits of detection were 0.3 mg/m3 (tristimulus colorimeter), resp. 5 mg/m3 (with the naked eye), fluorescence detection limits of 0.3 mg/m3 (with the naked eye), all at an air sample volume of 1 dm3. The response was practically immediate, acid vapors and gases, or diethyl chlorophosphate as a simulant of nerve warfare chemical agents, were disruptive.