eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-09-20
7
3
54
59
10.22038/apjmt.2018.11973
11973
Use of Chemical Warfare Agents in Ancient History. A Case of Persians and Romans in Dura-Europos, Modern Syria in 256 C.E.
Reza Afshari
afsharireza@yahoo.com
1
Professor of Clinical Toxicology, Addiction Research Centre (ADRC), Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran.
Background: Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein’s regime in 1980s and more recently in Syria. The use of CWA is banned under the international law. Methods: Ancient uses of CWA are not well studied. Recently, their use during the Persian siege of the Roman-held Dura-Europos (Salihiyah) in modern Syria in 256 C.E. has been theorized by revisiting the archaeological findings from Dura-Europos from the 1930s. Case study: The paper describes the history of Persia (Iran) and Rome in that era and particularly Shapur I, the second King (Shah) of the [Sasanian] Persian Empire (215 - 270 C.E.) and Valerian, Publius Licinius Valerianus Augustus, the Roman Emperor (193/200 - 264 C.E.). In addition, composition of the potentially applied CWA and clinical findings related to the exposure are postulated through a medical toxicology lens taking into account archeological evidence (carbonized top of the tunnels and bodies and yellow crystals found in the tunnel), recent research and contemporary historical notes. Conclusion: It is plausible that a combination of fire accelerant or so called pitch (oil based substance, naphtha, bitumen or crude oil) and Sulphur dioxide (SO2) were used in this occasion. SO2 in combination with water on the body membranes creates highly toxic sulphurous acid (H2SO3) which is life threatening in a small enclosed space. As a result, a burning sensation in the nasopharynx and eyes, coughing, dyspnea, choking that led to pulmonary edema and death would have shortly followed. Severe clinical manifestations, panic and consequent mass hysteria of the toxic exposure should have prevented any organized retreat. In this incident, nineteen Roman and one Persian soldier were killed.
https://apjmt.mums.ac.ir/article_11973_c27d6a3392273b6f1cb6a90ed748f4cc.pdf
Chemical warfare agents
Dura-Europos
Persian
Roman
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-09-01
7
3
60
67
10.22038/apjmt.2018.11975
11975
Association of Long Term Antibiotic Use and Diagnosis of Chronic Disease
Sean Wachtel
sean.wachtel@gmail.com
1
Uy Hoang
uy@hoang.co.uk
2
Julian Sherlock
3
Chris Mcgee
4
Rachel Byford
5
Simon de Lusignan
6
Department of Experimental Medicine University of Surrey, UK
Research Fellow, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom
SQL Programmer, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom
Research Assistant, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom
Database Manager, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom
Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom
Background: There has recently been increasing interest in the role of the human microbiome in disease. Antibiotic use is known to disrupt the intestinal microbial environment and cause acute disease, for example pseudomembranous colitis. This study aimed to investigate the hypothesis that long-term antibiotic use is associated with the development of chronic diseases, i.e., Asthma, Rheumatoid Arthritis, Inflammatory Bowel Disease, Colorectal Cancer, and Dementia. Methods:The study is a retrospective observational study using ontologically defined cases recorded by primary care physicians covering the period 2004 to 2015 combined with prescribing data. The study is primary care based, utilizing records held by the Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) database, representative of all English General Practices, over the period 2004 to 2015 inclusive. All patients registered with practices subscribing to the RCGP RSC database, with 10 years of prescribing history and other full demographic information required for the study recorded, numbering 644,273 were utilized. All records were analyzed for demographic data, diagnoses of study, known risk factors, and prescribing history of antibiotics. Exclusion criteria included incomplete data for known risk factors or demographics. The main outcome measures are the odds ratios (OR) of being diagnosed with one of the diseases of the study per antibiotic prescription issued over the preceding decade before diagnosis, adjusted for demographics and known risk factors. Results: The OR (2.5% CI, 97.5% CI) of being diagnosed with Asthma was 1.004 (1.002, 1.006), Rheumatoid Arthritis 1.006 (1.003, 1.008), Inflammatory Bowel Disease 1.007 (1.006, 1.008), Colorectal Cancer 1.001 (0.999, 1.002), and Dementia 1.001 (0.998, 1.001). Conclusions: The long-term use of antibiotics is associated with a statistically significant dose related increase in the odds of being diagnosed with asthma, rheumatoid arthritis and inflammatory bowel disease, but not all forms of dementia or colorectal cancer. Potential mechanisms include chronic disruption of the microbiome. This finding has implications for practitioners who prescribe antibiotics, the pharmaceutical industry, policy makers, and researchers involved in studying chronic disease mechanisms.
https://apjmt.mums.ac.ir/article_11975_eebcec7394197cacc92c435c5f59b975.pdf
Antibiotics
chronic disease
Microbiome
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-09-20
7
3
68
74
10.22038/apjmt.2018.11977
11977
A Qualitative Study of Acute Poisoning related Emergencies in the Paediatric Age Group
Kavinda Dayasiri
kavindadayasiri@gmail.com
1
Shaluka Jayamanne
shalukajaya@yahoo.com
2
Chamilka Jayasinghe
chamilkajayasinghe@yahoo.com
3
Clinical Fellow in Paediatrics, Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, United Kingdom
Senior lecturer in Clinical Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
Senior lecturer in Paediatics, Faculty of Medicine, University of Kelaniya, Sri Lanka
Background: This qualitative study presents an in-depth evaluation of the contributory psycho-socio-cultural and physical-economic factors related to paediatric poisoning in rural Sri Lanka. Method: The study was conducted at paediatric wards of Anuradhapura teaching hospital (THA) over a period of two years (2012 – 2014). Main methods of data collection were participants’ narrative and focus group discussions (FGDs). All parents of children with acute poisoning were recruited to FGDs. The structure of phenomena was developed based on descriptive phenomenological inquiries and key themes were identified at data analysis stage. Results: 383 parents participated in focus group discussions. Data were categorized to four domains; (1) parental awareness of poisoning risks, (2) presence of child, parent and environment related risk factors, (3) issues related to first aid care and provision of care until child was brought to emergency care unit, and (4) possible measures to prevent further poisoning. Interaction of multiple risk factors was observed in children with both intentional and unintentional poisoning. Accidental poisonings were associated with certain cultural practices, unsafe environment and unsafe storage of poisons. Children with intentional poisoning frequently had disrupted family relationships. Harmful first aid measures and delayed presentation at the primary care unit had negative impact on poisoning related outcomes. Parents believed community education, safe storage of poisons, and safe environment would likely bring down poison related morbidity. Conclusion: Person, poison and environment related risk factors can lead to acute poisoning emergencies in children in rural Sri Lanka. Often multiple risk factors interact to bring about the poisoning event. Avoidance of harmful first aid measures and early presentation at the primary care unit would bring down poisoning related morbidity. Effect of community education, safe storage of poisons and safe environment should be evaluated in the view of preventing poisoning.
https://apjmt.mums.ac.ir/article_11977_17ee761f92244c02df2e96122e25425c.pdf
Children
Emergencies
Poisoning
Rural
Sri Lanka
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-09-20
7
3
75
78
10.22038/apjmt.2018.11346
11346
An Empirical Study of the Cut-Off Point for the Iranian Version of Alcohol Use Disorders Identification Test (AUDIT)
Simasadat Noorbakhsh
s.noorbakhsh@umontreal.ca
1
Jamal Shams
j_shams@sbmu.ac.ir
2
Reza Lotfi-Lelahloo
tr1900.tr@gmail.com
3
Peter Wennberg,
peter.wennberg@ki.se
4
Hakan Kallmen
hakan.kallmen@ki.se
5
Department of Psychiatry, Universite de Montreal, CHU Ste Justine Hospital, Montreal, Canada (Behavioral Sciences Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran)
Behavioral Sciences Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Psychology and Educational, Faculty of Psychology, Islamic Azad University of the South Branch, Tehran, Iran
Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
Associate professor, STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Sweden
Background: AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients. Methods: Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment. Results: A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88. Conclusions: Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.
https://apjmt.mums.ac.ir/article_11346_46cfe1ca26f5e2f3d7cf73e115d44146.pdf
Alcohol Use Disorder
Alcohol Use Disorders Identification Test (AUDIT)
Cut-off Point
Iranian version
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-09-20
7
3
79
83
10.22038/apjmt.2018.11983
11983
A Case Series of Life-Threatening MDMA Poisoning in An Electronic Dance Music Party in Hong Kong
Francis Chu
chufrancis0429@gmail.com
1
Anfernee Yim
anferneeyim@gmail.com
2
Sau Wah Ng
ngsw2@ha.org.hk
3
Accident & Emergency Department, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
Accident & Emergency Department, Intensive Care Unit, Queen Elizabeth Hospital, China
Toxicology Reference Laboratory, Princess Margaret Hospital, Princess Margaret Hospital Road, Kowloon, Hong Kong, China
Background: MDMA (3,4-methylenedioxymethamphetamine), which is also known as Ecstasy or Molly, is a commonly found abusive agent in Hong Kong. MDMA abuse is widely reported in electronic dance music (EDM) festivals all over the world. It brings about uncommon mortality and serious morbidity with recreational use, which are believed to be related to serotonin toxicity. Cyproheptadine has anti-histamine and 5-HT antagonist property which are reported to be an effective agent in managing serotonin syndrome of moderate severity. However, there is not much information concerning whether it is useful in life-threatening situations. Case Presentation: Four victims who collapsed while attending an EDM festival were sent to our Emergency Department (ED). They showed clinical symptoms compatible with life-threatening serotonin toxicity. One patient died 30 minutes after arrival to the ED. Aggressive attempts were made to resuscitate the other three; cyproheptadine was administrated to them from 0.75 to 10 hours after arrival. They were all admitted to intensive care unit (ICU) for further management. Their urine showed a presence of MDMA. Discussion: Except for the one who died on arrival, the other three survived, who were later discharged. An early use of cyproheptadine (0.75 vs 3.5 vs 10 hours) results in better outcome as well as a shorter ICU stay (3 vs 10 vs 53 days) and total hospital stay (11 vs 37 vs 98 days). Results: Supportive treatments as well as early use of cyproheptadine might have some beneficial effects in reducing the severity and hospital stay in patients presented with life-threatening serotonin syndrome related to MDMA.
https://apjmt.mums.ac.ir/article_11983_89ca5bf9a4e92a6f875ea0ae7bcedf92.pdf
Cyproheptadine
MDMA
Poisoning
Serotonin Syndrome
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-09-01
7
3
84
85
10.22038/apjmt.2018.11981
11981
Dichloromethane Injection: Case Report
Kitisak Sanprasert
oligulia@gmail.com
1
Thunyaporn Tangtrongchitr
thun_tang@hotmail.com
2
Nat Krairojananan
natmd@hotmail.com
3
Department of trauma and emergency medicine, Pharmongkutklao hospital, Thailand
Department of Trauma and Emergency Medicine, Phramongkutklao hospital, thailand
Department of trauma and emergency medicine, Pharmongkutklao Hospital, Thailand
Background: Dichloromethane (a chlorinated hydrocarbon) is normally used as a solvent. Dichloromethane poisoning has been reported from occupational exposure and the common routes of dichloromethane poisoning are ingestion and inhalation. Case presentation: We described a case of 51-year-old man who received subcutaneous injection of dichloromethane and presented with local wound necrosis at his forearm, but carboxyhemoglobin levels were normal. Discussion: The corrosive property of dichloromethane result in venous thrombosis formation at his wound that might prevent systemic absorption of dichloromethane leads to reduced hepatic converted dichloromethane to the carbon monoxide. Conclusion: Symptomatic treatment and monitoring of CO production remain the mainstay in the treatment of patients with subcutaneous injection of dichloromethane.
https://apjmt.mums.ac.ir/article_11981_0ce4bda17545231376fe5959548be474.pdf
Carbon Monoxide
Methylene Chloride
Subcutaneous Injection
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-09-20
7
3
86
88
10.22038/apjmt.2018.11984
11984
Glyphosate Poisoning with Acute Fulminant Hepatic Failure
Rajashree Khot
rajashree.s.khot@gmail.com
1
Amey Bhise
ameybhise07@gmail.com
2
Rakhee Joshi
drrakheetrivedi@gmail.com
3
Nilima Patil Ambade
nilimaambade2302@gmail.com
4
Medicine, Associate Professor, Indira Gandhi Govt Medical College,Nagpur, Maharashtra University of Health Sciences, Nashik, India
Medicine, Indira Gandhi Govt Medical College, Nagpur, Maharashtra University of Health Sciences, Nashik, India
Medicine, Indira Gandhi Govt Medical College, Nagpur, Maharashtra University of Health Sciences, Nashik, India
Medicine, Indira Gandhi Govt Medical College, Nagpur, Maharashtra University of Health Sciences, Nashik, India
Background: Glyphosate containing herbicides are widely used the world over. They are marketed as nontoxic to humans, but numerous studies have showed that these glyphosate-based herbicides (GlySH) can cause multiorgan damage.1 Recent reports of animal studies on rats have raised a doubt of liver damage after long term exposure to GlySH. Case Presentation: a young male had chronic exposure to Glyphosate for 5 years in the form of spraying GlySH in farm and eating cereals sprayed with GlySH. He developed fulminant liver failure after accidental consumption of glyphosate containing herbicide. His liver function deteriorated in spite of supportive treatment. He developed hepatorenal syndrome later and died. Discussion: Studies done on rats have showed that chronic consumption of extremely low levels of a GlySH formulation (Roundup), at admissible glyphosate-equivalent concentrations, is associated with marked alterations of the liver proteome and metabolome.2 It has been reported that chronic exposure to Glyphosate of more than 5 years’ duration due to consumption of food grains sprayed with this herbicide or inhalation of particles results in development of Fatty Liver, i.e., non-alcoholic fatty liver disease. Any acute insult can result in decompensation and development of fulminant liver failure. Although this herbicide is relatively safe, other complications like Acute renal failure, Acute pulmonary edema with respiratory distress and shock can also occur. Conclusion: Chronic as well as acute exposure to GlySH can lead to NAFLD and fulminant liver failure. As there is no antidote to glyphosate, clinicians must depend only on intensive supportive management which might not always be fruitful as in our case. It is important to be aware of systemic complications of this commonly used herbicide so that appropriate preventive measures can be taken.
https://apjmt.mums.ac.ir/article_11984_40e922ca100bf493686f39379c87913a.pdf
Cumulative Effect
Glyphosate Poisoning
Hepatic Failure
NAFLD