To What Extent Vital Signs Are Important to Medical Toxicologists When Conflicts Arise in Defining Toxidroms
Reza
Afshari
Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
author
text
article
2017
eng
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
104
104
https://apjmt.mums.ac.ir/article_10643_d41d8cd98f00b204e9800998ecf8427e.pdf
dx.doi.org/10.22038/apjmt.2017.10643
Brain MRI Findings in Tramadol Poisoning
Parvaneh
Layegh
Assistant professor of radiology, department of radiology, Mashhad university of medical sciences, Mashhad, Iran
author
Zakieh
Ghorbanpour
Mashhad University of Medical Sciences, Mashhad, Iran
author
Bita
Dadpour
Assistant Professor, Toxicology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
author
text
article
2017
eng
Introduction: Recently tramadol intoxication and non-therapeutical abuse have been prevalent in Iran. in this study we aimed at evaluating possible central neural system lesions in patients with tramadol induced seizure by using MRI imaging.Methods & Materials: a cross-sectional study was conducted with age- and sex-matched case and control groups. The case group included oral tramadol intoxication cases with loss of consciousness and/or tramadol induced seizure. The control group included patients with seizure without tramadol consumption. In the first post seizure 24-hour, brain MRI was done and the images were interpreted by a radiologist. Finally all data were collected and they were recorded and analyzed using SPSS software.Results: 15 patients (7 females and 8 males) were in the control group and 15 patients (3 females and 12 males) were in the case group with mean age of 22.27±6.54 and 21.93±4.57 years, respectively. 8 patients of case group and 3 patients of control group had abnormal evidences (hyper signal foci in white mtter) in brain MRI images; there were no significant difference between two groups (p=0.128). Lesions depth in MRI images of case group were equally in Subcortical and Deep parts of white matter (37.5%) and in 2 cases (25%) were observed in both parts. There was no difference between two groups in this way (p=0.721). The most common involved lobe in both groups was frontal lobe which was observed in 62.5% (5 patients) of case group and 100% (3 patients) of control group. In comparison between two groups there was no significant difference in involved lobe (p=0.509).Conclusion: In our study, over half of case group patients had hypersignal evidences in MRI imaging. However no specific pattern was seen in these lesions. Also no significant difference was observed between case and control groups in lesions pattern.
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
105
108
https://apjmt.mums.ac.ir/article_10086_e7888d24f1186a27d97cf570a5d5a791.pdf
dx.doi.org/10.22038/apjmt.2017.10086
Non-Accidental Poisoning among Children in Rural Sri Lanka: A Two-Year Cross Sectional Study
MB Kavinda Chandimal
Dayasiri
Clinical Fellow in Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
author
Shaluka F
Jayamanne
Senior lecturer in Clinical Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
author
Chamilka Y
Jayasinghe
Senior lecturer in Pediatrics, Faculty of Medicine, University of Kelaniya, Sri Lanka
author
text
article
2017
eng
Background:Non-accidental poisoning in the paediatric age group is uncommon and international literature on this subject is limited. There are no Sri Lankan paediatric studies on non-accidental poisoning to date. The objective of the current study was to explore the predisposing factors and profile of children less than 12 years in rural Sri Lanka who had non-accidental poisoning.Method:This cross-sectional study was conducted at Anuradhapura teaching hospital for two years (from February 2012 to January 2014) involving all children below 12 years and presented with either a history of acute non-accidental self-poisoning or non-accidental poisoning by another person. Quantitative data were collected using a structured questionnaire and qualitative data to explore the background socio-cultural factors were collected using focused group discussions. Both quantitative and qualitative data were analysed separately in the two groups.Results:Nineteen children with non-accidental poisoning were recruited among 383 acute poisoning admissions over two years. The majority of children were male – 13 (68.4%). All children who had non-accidental self-poisoning were at least eight years of age while the mean age of children poisoned by another person was 4.6 years. Children mostly ingested pesticides (9/14- 64.3%) followed by plant poisons and medicinal poisons. No child was reported to have ingested household chemicals including kerosene oil or miscellaneous substances intentionally. Children with non-accidental self-poisoning often had acute psychological distress and an immediate preceding event which resulted in the poisoning event. Verbal abuse by parents, poor family relationships, psychiatric disorders in children and emotional disturbances were often predisposing factors. Four children had morbidity secondary to aspiration pneumonia, respiratory arrest, and cardiac arrhythmias. Case fatality rate was 14.3% among children with non-accidental self-poisoning. Children with non-accidental poisoning by another person often did not have acute psychological distress prior to the poisoning event. When the perpetrator was one of the parents, those families had major disruptions in family relationships and functioning.Conclusion:Non-accidental poisoning in paediatric age could be either non-accidental self-poisoning or non-accidental poisoning by another person. The risk factors for the two types of non-accidental poisonings are different and multitudinous. These predisposing factors need to be further evaluated through community-based studies.
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
109
114
https://apjmt.mums.ac.ir/article_10598_b5960c599b20fb7e6f48f0b2afa312e3.pdf
dx.doi.org/10.22038/apjmt.2017.10598
Prevalence of Organophosphate Poisoning In Batticaloa, Sri Lanka
Maheswaran
Umakanth
Senior lecturer in medicine, department of clinical sciences, faculty of health care sciences, eastern university, Sri Lanka
author
text
article
2017
eng
Background: Deliberate self-harm (DSH) is a global problem which has steadily increased over the past few years in developing countries and has become as one of the major causes of morbidity and mortality in these countries. The aim of this prospective study was to analyze the prevalence of organophosphate poisoning among other acute DSH cases admitted to the medical ward at Batticaloa Teaching Hospital, Sri Lanka. We report the socio-demographic, and outcome of organophosphate poisoning. Method: The prospective study comprises of 121 cases of acute poisoning admitted at Batticaloa Teaching Hospital (BTH), Sri Lanka. This study was conducted for a period of three months from April 12 through July 12, 2017. Results: Among the subjects, 119 (98.34%) cases had intentional poisoning and only two cases (1.65%) accidental poisoning. Poisoning with organophosphate compounds (OP) 23 (19%) was the second leading type. There were 13 (56.5%) males and 10 (43.5%) females. Most of the patients were under the age group of 20-29 years old. 21 cases lived in rural areas and 2 in urban areas. Out of 23 patients, there were 2 (8.7%) deaths, 18 (78.3%) were discharged without any complications. Conclusion: DSH in Sri Lanka is reported to be associated with interpersonal conflict, short premeditation, as well as alcohol misuse among males.
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
115
117
https://apjmt.mums.ac.ir/article_10599_7c7911b234d2e1ead074eb7a96b418c9.pdf
dx.doi.org/10.22038/apjmt.2017.10599
The Clinical Spectrum of Plumbism; an Experience from a Tertiary Care Hospital in Karachi, Pakistan
Lena
Jafri
Assistant Professor at Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
author
Nadeem
Ullah Khan
Associate Professor and Consultant, Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
author
Muhammad Akbar
Baig
Senior Instructor at Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
author
Noman
Ali
Resident year V, Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
author
Hafsa
Majid
Senior Instructor at Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
author
Ayesha
Habib Khan
Associate Professor and Head at section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
author
text
article
2017
eng
Background:Lead toxicity continues to remain a concerning health problem for developing nations like Pakistan. Due to the lack of studies, we aim to highlight the clinical spectrum of lead poisoning in patients presenting to an urban-based tertiary care hospital in Pakistan. Method:This is a retrospective review of patients admitted form January 2011 to December 2014 using a structured questionnaire for recording demographics, comorbidities, clinical findings, biochemical abnormalities, clinical findings and treatment provided. Patients were categorized as children (≤18yrs) and adults (>18yrs), further divided into three groups; desired blood lead levels (BLLs) [lead levels <2ug/dl in children and <10ug/dl in adults], high but non-toxic [children 2-10ug/dl, adults 10-70ug/dl] and toxic [children >10ug/dl, adults >70ug/dl]. Result: A total of 86 patients were included in the final analysis, majority (69.6%) of whom were adult males with median age of 35 yrs. Median (IQR) BLL was 6.3 ug/dl (12.8-2.7) in all age groups with BLL in children and adults of 4.2 ug/dl (3.1-5.7) and 6.5 ug/dl (2.6-14.7), respectively. 72% of the children had complaints related to the central nervous system with majority complaining of irritability. The gastrointestinal system was most commonly implicated in adults (93%) with most common complaint of abdominal pain. The commonest risk factor showing a positive correlation with BLLs was battery handling in adults [median (IQR) BLL 18.4ug/dl (8.35-36.1)] and pica eating in children with BLLs in high but non-toxic range [median (IQR) BLL 5.2ug/dl (2.7-5.7)]. The highest BLLs were observed to lie within the high but non-toxic range group in one adult herbal medicine user (54.4 ug/dl) and in children observed in the toxic range group (>10ug/dl) due to occupational battery work exposure and residence in a congested zone. Conclusion:Lead toxicity continues to be hazardous due to unchecked environmental and occupational exposure. Increasing awareness is tantamount in order to find a solution.
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
118
122
https://apjmt.mums.ac.ir/article_10601_fe6702c51b12d052400e88340679fe46.pdf
dx.doi.org/10.22038/apjmt.2017.10601
Evaluation of Oxidative Stress in Combination Therapy with D-penicillamine and N-Acetylcysteine (NAC) in Lead Poisoning in Opium Addicts
Saeedeh
Shojaeepour
Department of Pharmacology & Toxicology, Faculty of Veterinary Medicine, Shiraz University, Shiraz, Iran
author
Mehdi
Fazeli
Department of Pharmacology & Toxicology, Faculty of Veterinary Medicine, Shiraz University, Shiraz, Iran
author
Ali
Mandegary
Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
author
Seyed-Mehdi
Sayed-Mirzaei
Departmrnt of Internal Medicine, Kerman University of Medical Sciences, Kerman, Iran
author
Nahid
Ahmadi
Department of Toxicology & Pharmacology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
author
Arastoo
Saeedi
Fars NIOC Health Organization, Shiraz, Iran
author
Zohreh
Oghabian
Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
author
text
article
2017
eng
Background: N-acetylcysteine (NAC) is a putative antioxidant and has gained attention as a promising agent for chelating heavy metals including lead. Considering the animal studies results, we hypothesized that adding NAC to the treatment regimen may improve the success of treatment with lead chelators. Methods: A total of 46 patients who were lead-poisoned opioid addicts were divided into two groups randomly and treated with d-penicillamine (DP, 1g/day in four equal divided doses) and NAC+DP (1 g/day + 150 mg/kg/day). The efficacy of treatment was evaluated by hospitalization period. Meanwhile, the oxidative stress parameters including lipid peroxidation, protein carbonyl, total antioxidant capacity (TAC), glutathione concentration and super oxide dismutase (SOD) activity were determined on admission and discharge and compared with healthy normal controls. Results: Hospitalization period was not different between the two groups. Treatment with DP and DP+NAC significantly decreased oxidative stress in patients. On the discharge day, the SOD activity and TAC were significantly higher in DP+NAC group in comparison with the DP group. Conclusion: Although NAC recovers antioxidant capacity, the advantages of NAC in improvement of DP efficacy in lead poisoning is questionable. Further studies with larger sample size and combination with other chelators are recommended.
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
123
128
https://apjmt.mums.ac.ir/article_10602_3f05b623d401e256028be10985d1ac22.pdf
dx.doi.org/10.22038/apjmt.2017.10602
Lisdexamfetamine Toxicity with Delayed Hypertensive Emergency
Rachel
Schult
Toxicology Clinical Pharmacy Specialist
Department of Pharmacy
University of Rochester Medical Center
601 Elmwood Ave, Box 638
Rochester, NY 14642 USA
author
Domenique N
Ciriello
2. John Fisher College Wegmans School of Pharmacy, Rochester, New York, USA
author
Emily K
Schranz
John Fisher College Wegmans School of Pharmacy, Rochester, New York, USA
author
Michelle
Malnoske
University of Rochester Medical Center, Rochester, New York, USA
author
Timothy J
Wiegand
University of Rochester Medical Center, Rochester, New York, USA
author
text
article
2017
eng
Background: Lisdexamfetamine is a stimulant used for the treatment of attention-deficit/hyperactivity disorder. Limited data exist regarding the presentation and management of patients with lisdexamfetamine toxicity. Case Presentation: A 17-year-old female with history of prior suicide attempt presented to the emergency department after ingestion of 50 lisdexamfetamine 40 mg capsules which belonged to a friend. The patient was asymptomatic until approximately seven hours post-ingestion when she developed hypertension, mydriasis and complained of severe headache, blurred vision, chest pain, nausea, and vomiting. The patient was diagnosed with drug-induced hypertensive emergency and phentolamine was administered after lorazepam failed to adequately control her symptoms. Discussion: While lisdexamfetamine is a pro-drug, onset of clinical effects after ingestion is typically quicker and often consistent with amphetamine intoxication including many sympathomimetic symptoms, not simply those related to vasoconstriction alone. Benzodiazepines are frequently utilized in the management of stimulant toxicity; however, they were insufficient for our patient. This case highlights a unique presentation of lisdexamfetamine toxicity with primarily alpha adrenergic stimulant effects in addition to altered pharmacokinetics observed in overdose. Phentolamine was effective for management of hypertensive emergency in this patient. Conclusion: Lisdexamfetamine toxicity may present with delayed onset of clinical effects. Phentolamine may be useful for treating hypertensive emergency resulting from overdose in addition to standard care.
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
129
131
https://apjmt.mums.ac.ir/article_10603_ee922d4d42611ae2d638243d9162fff6.pdf
dx.doi.org/10.22038/apjmt.2017.10603
Rhabdomyolysis and Acute Respiratory Distress Syndrome Secondary to Multiple Wasp Stings
Uraiporn
Sirithep
Trauma Intensive Care Unit, Department of Surgery and Orthopaedic Nursing, Siriraj Hospital, Mahidol University, Bangkok, Thailand
author
Kusuma
Chinaroonchai
Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
author
text
article
2017
eng
Background: Wasp stings usually cause local reactions such as itching, urticaria, angioedema and anaphylaxis. Life-threatening complications following multiple wasp stings are relatively rare and unexpected. However, rhabdomyolysis and acute respiratory distress syndrome following wasp stings are possible. Case presentation: A middle-aged male worker was stung by a swarm of wasps all over his body while attacking a wasp’s nest. He had pain, a swollen face and multiple blisters on his entire body. He initially received the standard treatment of intravenous antihistamine, anesthetic and steroid medications. On admission day, his urine output progressively decreased in volume and turned from clear to bloody in appearance, with the color tending to become progressively darker. A serum creatinine of 0.87 mg/dL and a creatinine phosphokinase of 1403 IU/L at admission confirmed rhabdomyolysis. The following day, his serum creatinine and creatinine phosphokinase rose, with the development of tachypnea with desaturation; a chest radiograph showed bilateral diffuse lung infiltration. He was subsequently diagnosed with acute respiratory distress syndrome (ARDS). A medical record review revealed that he had received only 1150 ml of intravenous fluid in 8 hours. Consequently, his ARDS may have been caused by an anaphylactic reaction to the wasp toxin rather than by a cardiogenic cause or volume overload. He was intubated and transferred from the general ward to the intensive care unit for close clinical monitoring. Mechanical ventilation and intravenous fluid support were given to achieve a minimum urine output of 1 ml/kg/hr. His clinical and biochemical pictures started to improve and normalize from the fourth day after ICU admission. Conclusions:Wasp stings may cause both rhabdomyolysis and acute respiratory distress syndrome. Early detection and immediate supportive treatment is the mainstay to reduce morbidity and mortality in such cases.
Asia Pacific Journal of Medical Toxicology
Mashhad University of Medical Sciences
2322-2611
6
v.
4
no.
2017
132
135
https://apjmt.mums.ac.ir/article_10090_90150dbef31188a3c67ffb04ad6d7785.pdf
dx.doi.org/10.22038/apjmt.2017.10090