@article { author = {Afshari, Reza}, title = {Fall of Easter Island Civilization and Toxic Prion Exposures}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {7}, number = {2}, pages = {29-32}, year = {2018}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2018.11744}, abstract = {}, keywords = {}, url = {https://apjmt.mums.ac.ir/article_11744.html}, eprint = {https://apjmt.mums.ac.ir/article_11744_bc455edbf686246144d4d057028a81ff.pdf} } @article { author = {Silakhori, Samaneh and Dadpour, Bita and Najaf Najafi, Mona}, title = {A 3-Year Survey of Mushroom-Poisoned Patients: Clinical Features, Management and Outcomes}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {7}, number = {2}, pages = {33-37}, year = {2018}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2018.11340}, abstract = {Background:Besides their nutritional value, mushrooms have shown beneficial effects on human body organs; thus, people are interested in consumption of mushrooms regardless of their safety. In this report, we present patients with suspected mushroom poisoning, who were admitted to the Medical Toxicology Department of Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Method:Seventeen mushroom-poisoned patients were admitted to our department from April 2012 to May 2015. Following the evaluation of the vital signs, biochemical analysis was done and in parallel, treatment was initiated based on the laboratory tests results and clinical manifestations. Results:In this period, 17 mushroom-poisoned individuals (11 males (64.7%) and 6 females (35.3%) with mean age of 28.26±18.05 years old) were referred to our department. Subjects presenting the signs of intoxication within 6 hours post-ingestion comprised 58.8% of our patients. The rate of mortality was zero but 3 patients presented with some levels of unconsciousness. Only one patient had augmented levels of AST with no evidence of hepatic failure. Coagulopathy as reflected by increased INR was observed in 2 patients. Regarding the season in which the poisoning occurred, the majority of cases happened in spring and autumn. Conclusion:Similar to other reports on mushroom-poisoned patients, we observed gastrointestinal disturbances as the major symptom. Since the majority of mushroom poisoning cases occur following the ingestion of accidentally picked mushrooms, risk communication practices should be improved to increase the public awareness of mushrooms toxic effects.}, keywords = {Amatoxin,Epidemiology,Mushroom poisoning,Survey}, url = {https://apjmt.mums.ac.ir/article_11340.html}, eprint = {https://apjmt.mums.ac.ir/article_11340_c2926856a4a447a359867228800833d9.pdf} } @article { author = {Erfan Uddin, Rabiul Alam and Ghose, Aniruddha and Hassan, Mahtab and Dutta, Asok and Zahed, Abu Sahed and Jabed, Syed}, title = {A Clinico-Epidemiological Study on Poisoning among Commuters: Is There any Substance Abuse?}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {7}, number = {2}, pages = {38-41}, year = {2018}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2018.11341}, abstract = {Background: Poisoning among commuters is becoming a major health hazards day by day in Bangladesh. Few studies were done in Bangladesh regarding this problem. To describe the clinico-epidemiological features of patients with suspected intentional poisoning during travel for robbery. Method:This was a prospective observational study, conducted in medicine department of Chittagong Medical College Hospital, Bangladesh during March 2010 to September 2010. 40 patients were selected. Out of whom, 15 who had GCS < 8 at presentation were selected for urine analysis by detection kits for a few substances in the urine. Detailed demographic data were collected from the informant in a structured case report form. Clinical examination of the patient was done at presentation and urine was collected in selected patients. Routine patient follow-ups were carried out and the outcome was recorded. Results: Victims being males of 31.23 ± 7.6 years of age, most of whom were married (80%), and businessmen (40%). Most of them were brought to hospital by their relatives (80%). Their financial loss by the incidence did not exceed 50,000 tk (i.e., 18937 Tk). They were mainly from middle class family, usually poisoned by beverage (55%), food (30%), and inhalation (5%). Most of them presented with unconsciousness (75%), having GCS 10 on average. Their pupils usually remained constricted bilaterally (75%) with intact light reflex in 35% of the cases. There was no papilledema, and cranial nerves were usually intact in those who could be examined (25%). Patients were usually depressed with absent planter reflex (70%) or flexor (30%). Within 2.5 days, most of them could walk without support and could be discharged. There was neither any case fatality reported or any long term disability recorded. Only 7.5% of the patients had substance examined by kit in their urine. Conclusion: We can come to the conclusion that money bearing people were victimized by the miscreant and they usually used a substance which has short onset of action and which can sedate people for a short time with depressive neurological findings.  }, keywords = {Commuter Poisoning,Epidemiology,Substance of Abuse}, url = {https://apjmt.mums.ac.ir/article_11341.html}, eprint = {https://apjmt.mums.ac.ir/article_11341_a49f53e367cd5375c617d42c2053ac54.pdf} } @article { author = {Umakanth, Maheswaran}, title = {Clinical profile of Intermediate Syndrome following Organophosphate Poisoning}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {7}, number = {2}, pages = {42-45}, year = {2018}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2018.11342}, abstract = {Background: Organophosphate (OP) poisoning is a global issue, causing over 200,000 deaths annually especially in developing countries, such as Sri Lanka and India. Clinical presentation of a typical OP poisoning may follow three well-defined phases. The initial phase is an acute cholinergic crisis, after that Intermediate Syndrome (IMS) may develop within 24-96 hours, and lastly, Organophosphate-Induced Delayed Polyneuropathy (OPIDPN) may present after 2-3 weeks. The signs and symptoms of the IMS are weakness of the respiratory muscles, including the diaphragm, intercostal, accessory, neck, and proximal limbs muscles. The aim of this study was to highlight the clinical profile of the IMS following organophosphate poisoning. Methods: This descriptive, prospective, and cross-sectional study was conducted at the Teaching Hospital, Batticaloa, Sri Lanka, over a period of 6 months from March 1, 2017 to August 31, 2017.  Results: Of the total 65 enrolled patients, 60% (n=39) were male. All patients ingested OP pesticide for deliberate self-harm and all of them had some degrees of initial cholinergic crises. The prevalence of IMS in the studied patients was 5.88%. All 5 patients with IMS had neck, facial and proximal limbs muscle weakness from whom, two cases (40%) had extra-ocular muscle paralysis. There was no in-hospital fatality among IMS patients. Conclusion: IMS is a rare and life-threatening problem in OP intoxication. Early diagnosis and intensive care management can prevent further complications and mortality. Prevalence of IMS in this study was lower than previous reports with almost similar clinical features.}, keywords = {Intermediate Syndrome,Organophosphate Poisoning}, url = {https://apjmt.mums.ac.ir/article_11342.html}, eprint = {https://apjmt.mums.ac.ir/article_11342_85ba6995156804f2198f91ba566df75e.pdf} } @article { author = {De Silva, Rukshanie and Sumanadasa, Hasitha and Wijekoon, Sanjeewa and Wanigasuriya, Kamani}, title = {Two Cases of Ethylene Glycol Poisoning Treated Successfully with Haemodialysis}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {7}, number = {2}, pages = {46-48}, year = {2018}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2018.11343}, abstract = {Introduction: Ethylene glycol is an organic toxic compound found in many household items including radiator coolants and brake oil. Toxic effects of ethylene glycol are due to its metabolites glycolic acid and oxalic acid which cause potentially fatal metabolic acidosis and renal failure. Here we discuss two cases of ethylene glycol poisoning with literature review on pathophysiology, clues in diagnosis and therapy. Case presentations: First case is of a teenage girl presenting with unexplained persistent drowsiness. She went on to develop acidotic breathing and anuria. Unexplained metabolic acidosis and acute kidney injury inclined us towards ethylene glycol poisoning. On further questioning, she confirmed taking radiator coolant 5 hours before admission. The second case is of a young automobile serviceman who presented with unexplained markedly reduced level of consciousness. He had high anion gap metabolic acidosis, calcium oxalate crystals in urine and basal ganglia hypodensities in non-contrast CT. He later developed acute kidney injury. Ethylene glycol poisoning was suspected which was later confirmed when the patient regained consciousness. Both patients responded well to haemodialysis and recovered without complications. Discussion: Ethylene glycol is an easily accessible toxic compound that can be used as a suicidal agent. High anion gap metabolic acidosis, acute kidney injury, calcium oxalate crystalluria and altered sensorium are highly suggestive. Conclusions: A high degree of suspicion is needed for early diagnosis. Haemodialysis can be used effectively to remove the toxic metabolites and treat the renal impairment. Early recognition will save lives without long term renal or neurologic complications.  }, keywords = {Acute kidney injury,Ethylene glycol,haemodialysis,Metabolic acidosis}, url = {https://apjmt.mums.ac.ir/article_11343.html}, eprint = {https://apjmt.mums.ac.ir/article_11343_65b33f38211f32e9955f0c806a6cc958.pdf} } @article { author = {Ali, Maria and Mansoori, Huma and Ali, Sidra}, title = {A Pragmatic Approach to Superwarfarin Intoxication in a Resource Constraint Setting; a Case Report}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {7}, number = {2}, pages = {49-51}, year = {2018}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2018.11344}, abstract = {  Introduction: Superwarfarins are highly lethal rodenticides which are much more potent than the warfarin owing to various structural changes in the parent compound that confers high half-life and increase affinity to vitamin K epoxide. Case Presentation: We report a case of a 19 years old female who presented bleeding prolonged PT and APTT. Factor assay showed significantly lower levels vitamin K dependent coagulation factors. She was given conventional doses of FFP and vitamin K for two consecutive days, although she responded clinically but her coagulation profile failed to show any improvement. Hence superwarfarin poisoning was considered. Based on this assumption patient was cross questioned repeatedly, and subsequently she admitted that she had ingested rodenticide with the suicidal intent. Hence she was given higher doses of vitamin K and FFP for several days after which her PT and APTT shortened significantly. Discussion: Superwarfarin toxicity clinically presents with bleeding and deranged coagulation profile. Differentiating it from other causes is challenging but very crucial, as it does not responds to usual doses of vitamin K and plasma. Conclusion: This case highlights the importance of maintaining high index of suspicion of superwarfarin toxicity in coagulopathy of unknown etiology that fails to respond to conventional doses of treatment. Detailed history with interrogation of leading questions in such cases is of integral importance.}, keywords = {FFP,Superwarfarin,Toxicity}, url = {https://apjmt.mums.ac.ir/article_11344.html}, eprint = {https://apjmt.mums.ac.ir/article_11344_0fad8888a61a58292f2e92425c137f5e.pdf} } @article { author = {Manohar, Tanuja and Khobragade, Harshal}, title = {Organophosphorus Compound Induced 'Intermediate Syndrome'}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {7}, number = {2}, pages = {52-53}, year = {2018}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2018.11347}, abstract = {Background: Organophosphate compound (OPC) poisoning with suicidal intent is common in Indian ICUs. These compounds are the organic derivatives of phosphorous containing acids and their effect on neuromuscular junction and autonomic synapses is clinically important. Organophosphate poisoning can present as acute cholinergic syndrome, intermediate syndrome and delayed neuropathy. Case Presentation: Intermediate syndrome secondary to organophosphate poisoning is a serious health problem leading to increased morbidity and mortality. The incidence of problem varies and ranges from 8%-84% of OPC poisoning cases. After initial recovery from cholinergic crisis, some patients have resurgence of respiratory muscle paralysis requiring continued ventilatory support. This is termed intermediate syndrome (IMS). The factors accounting for this difference is the nature of organophosphate compound, severity of poisoning and inadequate oxime therapy. The recognition of this syndrome is important as if this entity is overlooked it can have disastrous effects. Discussion: Our patient had developed respiratory muscle weakness as evidenced by inadequate respiratory efforts, drop in oxygen saturation, retention of CO2 and need for ventilatory support. There was no evidence of weakness in ocular, neck, bulbar muscles but he had weakness in all 4 limbs more pronounced in proximal muscles. Conclusion: We presented this case of OPC poisoning with intermediate syndrome, which remained for a prolonged time and required mechanical ventilation for 16 days. This case highlights how the timely intervention can save the patient’s life.}, keywords = {Intermediate Syndrome,OP Poisoning}, url = {https://apjmt.mums.ac.ir/article_11347.html}, eprint = {https://apjmt.mums.ac.ir/article_11347_b00e75f02ce01f3c5f1604fa5c890650.pdf} }