Current Concepts in Management of Organophosphorus Poisoning. Treatment of organophosphate poisoning: - Insight into the Management of Organophosphate Poisoning Dr R M Sugathadasa MBBS, MD Senior Registrar in Medicine University Medical Unit CNTH Ragama. The intermediate syndrome (IMS) following organophosphorus (OP) insecticide poisoning was first described in the mid-1980s. Organophosphate poisoning is a serious condition that requires medical attention even in the mildest cases. - PESTICIDE POISONING Shiromini Nissanka Research Officer National Poisons and Drug Information Centre, Diagnosis & Management of Insecticide Poisoning. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. They are used primarily in pest control as an alternative to chlorinated hydrocarbons that persist in the environment. See our Privacy Policy and User Agreement for details. Fetal period of organophosphate poisoning: It means when the signs and symptoms of poisoning appear within 1/2 an hour and individual dies in 1/2-3 hours but if the poison is not fatal the signs and symptoms may remain for 30 hours and finishes away in next 48-75 hours but may be present for 3 weeks. Bird SB, Krajacic P, Sawamoto K, Bunya N, Loro E, Khurana TS. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. 1. Severe intoxication incontinence, convulsion, Chronic intermediate dose exposure manifested as, Hypersecretion of salivary, lacrimal, and, Nausea, vomiting, diarrhea, urine and fecal. See Full report: https://goo.gl/SXgwdG. Organophosphates cause the inhibition of acetylcholinesterase which leads to the accumulation of acetylcholine in the body. Acute Effects of Organophosphate Poisoning Nervous System Affected Organs Clinical Presentations Autonomic nervous system Muscarinic Gastrointestinal system Emesis, increased motility, Diarrhea Genitourinary system Urinary incontinence Eyes Lacrimation, Miosis, blurred vision Bronchial tree Bronchorrhea, bronchospasm, wheezing, cough, cyanosis Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. PowerShow.com is a leading presentation/slideshow sharing website. TO X I D R O M E A N D C U R R E N T C O N C E P T S O F Lancet 2006; 368:2136-2141 In addition, the specific antidotes atropine and pralidoxime (2-PAM) are employed. There are no accurate figures kept about the incidence of OP poisoning. If you continue browsing the site, you agree to the use of cookies on this website. • Examples of organophosphates include insecticides (malathion, parathion, dichlorvos, and diazinon) • Worldwide mortality studies report mortality rates … 5.Poisoning - therapy. By the end of this module, the learner will be able to: Background Concerns about the safety of paralytics such as succinylcholine to facilitate endotracheal intubation limit their use in prehospital and emergency department settings. Organophosphorus poisoning is often diagnosed based on characteristic symptoms and signs such as a pungent garlic-like odor, small pupil size, slow heart rate and increased secretions. - Pesticide Hazards and First Aid Chapter 5 National Pesticide Applicator Certification Core Manual * If you re working with organophosphate or carbamate insecticides ... Gosreports researh:Data Book Asia Pacific Ultrasound Devices Market (2016 – 2022), - Gosreports researh:Data Book Asia Pacific Ultrasound Devices Market (2016 – 2022). Gawarammana, S. Sayed, - Title: Pesticide Poisoning in Sri Lanka: Integrating Clinical Science with Social Responsibility Author: A Dawson Last modified by: Dr Mark Perera, - Toxicology Case Presentation Ng Fu A&E, QMH. Clipping is a handy way to collect important slides you want to go back to later. Associate Professor, Department of Environmental and Occupational Health Sciences, University of. - Oximes, atropine and diazepam in organophosphate and carbamate poisoning ... R2 = aromatic or aliphatic. View and Download PowerPoint Presentations on Organophosphate Poisoning PPT. Specific agents linked to human … FORENSIC MEDICINE , ORGANOPHOSPHORUS POISONING Rajeev Ranjan Gupta. Organophosphate poisoning is poisoning due to organophosphates (OPs). There is a much higher incidence in rural areas of the third world. The vast majority of cases are accidental from the use of pesticides. 7 ... | PowerPoint PPT presentation | free to view, Organophosphate and Carbonate Poisoning - Pipeline Review, H1 2017: Aarkstore, - The report provides an overview of the Organophosphate and Carbonate Poisoning pipeline landscape. PPT – Organophosphate and Carbamate poisoning PowerPoint presentation | free to view - id: b9cd8-YzRhM, The Adobe Flash plugin is needed to view this content. If you continue browsing the site, you agree to the use of cookies on this website. 6.Suicide - prevention and control. Boasting an impressive range of designs, they will support your presentations with inspiring background photos or videos that support your themes, set the right mood, enhance your credibility and inspire your audiences. If so, share your PPT presentation slides online with PowerShow.com. The most common group are OP and one of the most deadly, next to paraquat which is also seen in high numbers. - Beautifully designed chart and diagram s for PowerPoint with visually stunning graphics and animation effects. Most of these pesticide poisoning … Or use it to create really cool photo slideshows - with 2D and 3D transitions, animation, and your choice of music - that you can share with your Facebook friends or Google+ circles. But large doses of organophosphates can also harm people and other animals. Organophosphorus (OP) compounds constitute a heterogeneous category of chemicals specifically designed for the control of pests, weeds or plant diseases. In mild cases, people should should … following recognised poisoning incidents, the evidence relating to chronic low-level exposure to OPs, insufficient to cause overt acute toxicity, is less convincing. Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. 33(6):683-6. . DNB Trainee, Emergency Medicine INITIAL EVALUATION OF THE PATIENT WITH POISONING OR DRUG OVERDOSE. Mild to moderate poison alert and oriented. - For hypotension caused by overdoses of tricyclic antidepressants or related drugs, administer sodium bicarbonate, 1 2 meq/kg by intravenous bolus injection. PIMS & RC. Other potential causes of organophosphate or carbamate toxicity include ingestion of contaminated fruit, flour, or cooking oil, and wearing contaminated clothing [ 6,7 ]. Organophosphorus compounds are organic compounds containing phosphorus. - Title: Pediatric Poisoning Author: Preferred Customer Last modified by: FLJ3 Created Date: 5/8/2007 12:13:43 AM Document presentation format: On-screen Show, Measurement of chlorpyrifos adducts to plasma cholinesterase: A new tool for monitoring exposures to organophosphate pesticides Christopher Simpson, Ph.D. ORGANOPHOSPHORUS group. Concentrations as high as 2.5% in sprays have failed to produce poisoning of cattle, young dairy calves, or sheep. Loading... Unsubscribe from Rajeev Ranjan Gupta? Poisoning is a process in which an organism becomes chemically wound grievously by a toxic substance. Ramathibodi Poison Center & Department of Medicine Ramathibodi Hospital Epidemiology of Toxic ... - Oximes, atropine and diazepam in organophosphate and carbamate poisoning Dr Martin Wilks, Syngenta Crop Protection AG, Basel, Switzerland, Pesticide Poisoning Symptoms and Other Health Issues, - Pesticide Poisoning Symptoms and Other Health Issues Joanne Kick-Raack State Coordinator, Pesticide Education Programs The Ohio State University Extension. 2008 Feb 16;371(9612):597-607. Organophosphate. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. diazepam). 2. Pharmacotherapy to protect the neuromuscular junction after acute organophosphorus pesticide poisoning. THE BEGINNING • Lassaigne - first synthesized in the early 1800s by reaction of alcohol with phosphoric acid. - Diagnosis & Management of Insecticide Poisoning Winai Wananukul, M.D. Intentional self-harm tends to involve much higher doses than accidental exposure. Poisoning usually occurs in … While onset of symptoms is often within minutes to hours, some symptoms can take weeks to appear. - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Pawar KS et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors. Ronnel produces mild signs of poisoning in cattle at 132 mg/kg, but severe signs do not appear until the dosage is >400 mg/kg. The minimum toxic dose in sheep is 400 mg/kg. 7.Drug and narcotic control - legislation and jurisprudence. As … The intermediate syndrome in organophosphate poisoning: an overview of experimental and clinical observations. Poisoning Global Clinical Trials Review, H1, 2018. Fellow, Pediatric Neurology ... - Every poisoned patient should have an EKG, ABG, ASA, and ... You wisely call the Poison Centre and they tell you that the liquid contains a carbamate. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. The result is a loss of available AChE so that the effector organ becomes overstimulated by the excess acetylcholine (ACh, the impulse-transmitting substance) in the nerve ending. Organophosphates are used as insecticides, medications, and nerve agents. Organophosphorus (OP) nerve agent poisoning made the headlines in 2018 with the nerve agent ‘Novichok’ poisonings in Salisbury, England. presentations for free. 86 ... Meperidine/propoxyphene (Dilated pupil / seizures), Tramadol, Dextromethorphan ... - -blocker and Organophosphate Toxicity Mark Wahba Preceptor Dr. - TREATMENT OF OP POISONING First aid: -remove patient from the scene of exposure -remove contaminated clothing - skin, eyes washed thoroughly ... How to Identify the Products Your Patients Are Exposed To. Dr. Anoop James Emergency Medicine Australasia 2004; 16:456-458. found that atropine rev ersed the early muscarinic effects of acute organophosphorus poisoning. Symptoms can last for days to weeks. Management of Mental and Brain Disorders Team. Organophosphate Poisoning - Free download as Powerpoint Presentation (.ppt / .pptx), PDF File (.pdf), Text File (.txt) or view presentation slides online. Introduction: • Organophosphate (OP) compounds are a diverse group of chemicals used in both domestic and industrial settings. Poisoning and Toxidromes: Definitions, Types & … Organophosphates poison insects and mammals primarily by phosphory- lation of the acetylcholinesterase enzyme (AChE) at nerve endings. Organophosphate poisoning. Educational Objectives. Which patient has nerve agent poisoning? Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. 33(6):683-6. . They are all artistically enhanced with visually stunning color, shadow and lighting effects. Oximes, atropine and diazepam in organophosphate and carbamate poisoning. after severe poisoning due to sarin, a weaponized organophosphate compound struc-turally similar to the insecticides.28 Some of the most commonly reported early symptoms include headache, nausea, dizziness and hypersecretion, the latter of which is manifested by … CrystalGraphics 3D Character Slides for PowerPoint, - CrystalGraphics 3D Character Slides for PowerPoint. Known ... Management of specific poisons: Organophosphates and carbamate Alcohol. Insight into the Management of Organophosphate Poisoning. Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Start with 1-2 g (20-40 mg/kg) IV in 100 mL isotonic sodium chloride over 15-30 min; repeat in 1 h if muscle weakness is not relieved; then repeat q3-8h if signs of poisoning recur; other dosing regimens have been used, including continuous drip. You can change your ad preferences anytime. Do you have PowerPoint slides to share? And, best of all, most of its cool features are free and easy to use. Pharmacotherapy to protect the neuromuscular junction after acute organophosphorus pesticide poisoning. Our new CrystalGraphics Chart and Diagram Slides for PowerPoint is a collection of over 1000 impressively designed data-driven chart and editable diagram s guaranteed to impress any audience. Some organophosphorus compounds are highly effective insecticides, although some are extremely toxic to humans, including sarin and VX nerve agents.. Organophosphorus chemistry is the corresponding … The syndrome described comprised characteristic symptoms and signs occurring after apparent recovery from the acute cholinergic syndrome. - Poisoning is a vital problem all over the world; its type and mortality regarding poisoning vary from country to country. This event highlighted a gap in the knowledge of most clinicians in the UK. The ability to rapidly reverse paralysis and restore respiratory drive would increase the safety margin of an agent, thus permitting the pursuit of alternative intubation strategies. The PowerPoint PPT presentation: "Organophosphate and Carbamate poisoning" is the property of its rightful owner. Find PowerPoint Presentations and Slides using the power of XPowerPoint.com, find free presentations research about Organophosphate Poisoning PPT Little M, Murray L. Consensus statement: risk of nosocomial organophosphate poisoning in emergency departments. PMC1065055. World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. M A N A G E M E N T Remove clothing and wash skin with soap and water SLUDGE (salivation, lacrimation, urination, Muscle fasciculations, cramping and muscle, Cause of death respiratory failure combined with, Routine lab finding nonspecific nonketotic, CVS tachycardia is more common due to both, Arrhythmia first transient phase of intense, Classic presentation of serious OP poisoning, Increase oral and bronchial secretions with urine, Decreased cholinesterase activity in the blood, RBC cholinesterase is more accurate but less, Mild case deceased cholinesterase lever to, Some chronic, lowgrade intoxication may show, Carbamate poisoning is less useful due to, Initial objective treatment establishment of, Usually patient presents with respiratory, Atropine is competitively blocking the action of, Use repeat dose of atropine until atropinization, After initial stabilization, the patient should, Remove exposure clothing and vigorous washing of, Patient ingested OP should use gastric emptying, Use Ipecac induced emesis for gastric lavage, Pralidoxime (PAM) is antidote for primary OP, PAM reverse the cholinergic nicotinic effects, reactivation of cholinesterase by cleavage of, Pediatric dose 20-50 mg/Kg over 15-30 min, Subsequent dose may repeated 1-2 hr after initial, Reversal of muscle weakness and fasciculation. 4.Poisoning - prevention and control. Aged acetylcholinesterase cannot be reactivated by oximes, 1. - SUICIDE AND EXPOSURE TO ORGANOPHOSPHATE INSECTICIDES: CAUSE OR EFFECT? Looks like you’ve clipped this slide to already. [14] Atropine versus glycopyrr onium bromide: See benefits of glycopyrronium bromide, p 4 . 2004 Dec;8(6):R391-7. Muscarinic overstimulation: -increase parasympathetic tone. J Toxicol Clin Toxicol. Many of them are also animated. Neuropsychological outcomes 1.18 Although some studies suggest impairment in the same tests that are affected after acute poisoning… I. Vicas Core rounds March 25th, 2004 -blockers Teaching points Recognize an overdose Toxidrome ... P.M.S. - 2003, it was reported more that 1.582 million poisoning exposures. See our User Agreement and Privacy Policy. Eddleston M, Buckley NA, Eyer P, Dawson AH. Miosis ... Reversal of muscle weakness and fasciculation usually begins within 10-40 min ... – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: b9cd8-YzRhM. Management of acute organophosphorus pesticide poisoning. Perera, A.H. Dawson, I.B. Poisoning Unintentional Overdose Intentional. Our review article mainly focused on OP poisoning, especially with pesticides, its severity and management of toxic exposure. It's FREE! Cause agricultural use, accidental exposure, Intoxication onset of symptoms and signs vary, Carbamate less toxic and poor CNS penetration. POISONING - Pediatric Poisoning Dana Ramirez, ... dysphagia, dysphonia, mouth pain, oral burns (note: esophageal burns can occur in absence of mouth lesions). Organophosphate poisoning is an uncommon clinical presentation, and simulation will provide a safe way for participants to learn how to manage this toxicological emergency. Abstract Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, with thousands of deaths occurring every year. mm http://www.gosreports.com/asthma-pipeline-review-h2-2016/ http://www.gosreports.com/organophosphate-and-carbamate-poisoning-pipeline-review-h2-2016/, SUICIDE AND EXPOSURE TO ORGANOPHOSPHATE INSECTICIDES: CAUSE OR EFFECT Implications for pesticide pol. Hospital admissions for intentional OP poisoning are twice as numerous as for accidental poisoning. ... Josh Rotenberg MD MMS. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 3 ER Cases. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Acetylecholinesterate Poisoning: Treatment. Unintentional poisoning kills far fewer people but is a problem in places where highly toxic organophosphorus pesticides are available. Sari… Crit Care. Organophosphorous Poisoning Pain Free Partha PPT Presentation Summary : Out of 5 lakh self inflicted deaths. Organophosphate Poisoning - Update on Management 1. Customer Code: Creating a Company Customers Love, Be A Great Product Leader (Amplify, Oct 2019), Trillion Dollar Coach Book (Bill Campbell). 1. Organophosphate poisoning is common, often as a result of suicidal ingestion (acute high-level exposure) or occupational exposure to pesticides (chronic low-level exposure) 1. Acetylcholinesterase and OP. 6. Organophosphate poisoning results from exposure to organophosphates - chemical compounds found in insecticides and nerve agents. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. After you enable Flash, refresh this page and the presentation should play. PMC2493390. And they’re ready for you to use in your PowerPoint presentations the moment you need them. It is thought that worldwide, approximately 3 million people are exposed to toxic levels of organophosphates, including approximately 2 million hospitalizations for suicidal ingestion 1. Organophosphorus pesticide self-poisoning is a major clinical and public-health problem across much of rural Asia.. J Toxicol Clin Toxicol. - Measurement of chlorpyrifos adducts to plasma cholinesterase: A new tool for monitoring exposures to organophosphate pesticides Christopher Simpson, Ph.D. - Joshua Rotenberg MD MMS, Pediatric Neurology. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. APIdays Paris 2019 - Innovation @ scale, APIs as Digital Factories' New Machi... No public clipboards found for this slide, Organophosphate Poisoning - Update on Management, Jubilee Mission Medical College and Research Centre, Thrissur. PPT – Organophosphate and Carbamate poisoning PowerPoint presentation | free to view - id: b9cd8-YzRhM. 1995. Bird SB, Krajacic P, Sawamoto K, Bunya N, Loro E, Khurana TS. 3. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.com is a great resource. Lancet. That's all free as well! Organophosphates are a common class of insecticides. 2. Fortunately, terrorist or warfare use of OP is rare but the potential exists to expose a great many people at once. I.World Health Organization. ORGANOPHOSPHORUS POISONING TO X I D R O M E A N D C U R R E N T C O N C E P T S O F M A N A G E M E N T Dr. Anoop James DNB Trainee, Emergency Medicine PIMS & RC 2. To view this presentation, you'll need to allow Flash. Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion. Now customize the name of a clipboard to store your clips. Treatment of acute organophosphate poisoning consists of non-specific measures of decontamination, cardiorespiratory support, and seizure control where applicable (e.g. The intermediate syndrome in organophosphate poisoning: an overview of experimental and clinical observations. ORGANOPHOSPHATE POISONING By: Nandinii Ramasenderan. ... - Title: Slide 1 Author: Geetesh Bajaj Last modified by: Jon Cole Created Date: 9/17/2008 8:57:51 PM Document presentation format: On-screen Show (4:3), 2 major classes of insecticides organophosphates, Organophosphate more common use in agricultural, Organophosphate (OP) insecticides permanently, Carbamate is reversible bind with cholinesterase, OP irreversible binding cholinesterase as, Acetylcholine (Ach) is present throughout the, Normally, Ach rapidly hydrolyze into inactive, Serum cholinesterase (pseudocholinesterase) in, Inhibition of cholinesterase lead to excessive, Intoxication produce central and peripheral, Nicotinic receptor (autonomic and muscular. 1995. To allow Flash intermediate syndrome in organophosphate and carbamate alcohol Insecticide poisoning Dr M. Carbamate alcohol of acetylcholine in the knowledge of most clinicians in the.. 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Dr R M Sugathadasa MBBS, MD Senior Registrar in MEDICINE University medical CNTH. - for hypotension caused by overdoses of tricyclic antidepressants or related drugs, administer sodium bicarbonate,.... 16 ; 371 ( 9612 ):597-607 4.Poisoning - prevention and control from. Preceptor Dr versus repeated bolus injection Health Organization recommends use of pralidoxime this... More that 1.582 million poisoning exposures OP and one of the PATIENT with poisoning Drug! In mild cases, people should should … 4.Poisoning - prevention and control,... 8 ( 6 ): R391-7 Rajeev Ranjan Gupta occurring after apparent recovery from the acute cholinergic syndrome to. Grievously by a toxic substance from country to country recovery from the use OP., you agree to the accumulation of acetylcholine in the UK than anyone else in the knowledge most! Award for “ Best PowerPoint Templates than anyone else in the UK: FORENSIC,. Of its cool features are free and easy to use Senior Registrar in MEDICINE University medical Unit CNTH.! 5 lakh self inflicted deaths in MEDICINE University medical Unit CNTH Ragama are twice numerous... Of organophosphate poisoning PPT treatment of acute organophosphate poisoning PPT versus repeated bolus injection to treat organophosphorus pesticide poisoning Lassaigne... Especially with pesticides, its severity and Management of specific Poisons: organophosphates and carbamate alcohol antidepressants or related,... Highlighted a gap in the mildest cases tricyclic antidepressants or related drugs, administer organophosphorus poisoning ppt... Self inflicted deaths can also harm people and other animals its rightful owner Insight into the of. - Beautifully designed chart and diagram s for PowerPoint, - CrystalGraphics offers more PowerPoint ”! Reported more that 1.582 million poisoning exposures, 2004 -blockers Teaching points an. People and other animals first synthesized in the environment paraquat which is also seen in numbers. In organophosphate and carbamate poisoning '' is the property of its rightful owner poisoning Rajeev Ranjan.! Less toxic and poor CNS penetration 's effectiveness remains unclear in addition the. Symptoms and signs vary, carbamate less toxic and poor CNS penetration figures kept about the of! Most clinicians in the mildest cases slides online with PowerShow.com to store clips! Cause the inhibition of acetylcholinesterase which leads to the accumulation of acetylcholine in the UK Environmental and Health! Junction after acute organophosphorus pesticide poisoning: an overview of experimental and clinical observations Drug! Cause or EFFECT Implications for pesticide pol to paraquat which is also seen in high.. Grievously by a toxic substance neuromuscular junction after acute organophosphorus pesticide poisoning … organophosphates are a common class insecticides... Organophosphates ( OPs ) clipping is a much higher incidence in rural areas of the Standing Ovation for... Carbamate pesticide – a treatment protocol for junior doctors to protect the neuromuscular junction after acute organophosphorus pesticide.. People and other animals clinicians in the early 1800s by reaction of alcohol phosphoric... Ranjan Gupta cardiorespiratory support, and confusion in emergency departments Officer National Poisons and Drug Centre! Insecticides and nerve agents • organophosphate ( OP ) compounds are a diverse group of chemicals used in both and... Cns penetration of organophosphates can also harm people and other animals although world. Higher doses than accidental exposure, Intoxication onset of symptoms and signs after! Toxicity Mark Wahba Preceptor Dr aromatic or aliphatic insecticides: cause or EFFECT poisoning especially. Recovery from the acute cholinergic syndrome or warfare use of pralidoxime, antidote. The early 1800s by reaction of alcohol with phosphoric acid poisoning exposures reported that. People but is a handy way to collect important slides you want to go back to.. 'Ll give your Presentations a professional, memorable appearance - the kind of sophisticated look that today 's expect. Initial EVALUATION of the most common group are OP and one of the PATIENT with poisoning Drug. Wound grievously by a toxic substance the inhibition of acetylcholinesterase which leads to the use of OP,. Ppt – organophosphate and carbamate alcohol Tramadol, Dextromethorphan... - -blocker and organophosphate Toxicity Mark Wahba Preceptor.! Cattle, young dairy calves, or sheep, M.D professional, memorable appearance the... Of 5 lakh self inflicted deaths Presentations a professional, memorable appearance - the kind of sophisticated look that 's. Crystalgraphics offers more PowerPoint Templates than anyone else in the world ; its type and mortality poisoning...