eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-12-01
7
4
90
91
10.22038/apjmt.2018.11999
11999
Implementing New Regulation Promotes Health but May Increase Inequality
Reza Afshari
afsharireza@yahoo.com
1
David C. Bellinger
2
School of Population and Public Health, University of British Columbia, Canada
Boston Children’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
https://apjmt.mums.ac.ir/article_11999_081cc1d14cdaede19d23d11120c53794.pdf
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-12-01
7
4
92
95
10.22038/apjmt.2018.11980
11980
Knowledge, Attitudes and Practices Regarding animal Bites and Rabies; a Multi-Center Study
HR Bagherian
1
A Taghipour
2
M Mousavi Bazaz
3
F Nezamdoost
4
Reza Afshari
afsharireza@yahoo.com
5
Farshid abedi
abedif@mums.ac.ir
6
Kenebist Rural Health Centre, Mashhad University of Medical Sciences, Mashhad, Iran
Health Sciences Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
General Practitioner, Mashhad University of Medical Sciences, Mashhad, Iran
BC Centre for Disease Control, Vancouver, Canada
Infectious Disease of Research Centre, Birjand University of Medical Sciences, Birjand, Iran/ Family Medicine Department, Mashhad university of Medical Sciences, Mashhad, Iran
Introduction: Animal bites and rabies are perceived and managed differently from bites and stings related to envenoms snakes, scorpions and spiders. This study aimed at evaluating knowledge, attitudes and practices (KAP) of local population regarding animal bites and rabies, as a point of comparison for future studies on venomous animals. Methods: This cross-sectional KAP study included 1093 subjects from four rural areas of Mashhad. Data gathered through a validated and reliable structured questionnaire. Results: In total, 1093 respondents included in the study consist of 53% male and 42% adults of 20 to 9 years old. Assessing knowledge; 70% of cases were presented with weak and moderate knowledge related to clinical manifestations, but just the opposite, majority of the respondents (83%) were categorised as good or excellent in their knowledge of prevention. Assessing attitudes; almost all (91%) of respondents categorised as good or attitude. Assessing practices; 33% of cases revealed that there are no good practices with regard to animal bites and rabies. Respondent’s knowledge of prevention was significantly correlated with age (P = 0.01) and educational level (P = 0.002). Both attitudes and practices had significant relations with age. Respondents aged 20- 39 years showed better practices than other age groups (P < 0.01). Conclusion: this study found that while information on prevention is acceptable, clinical findings of bites and rabies are relatively unknown. Preventive measure should include clinical manifestations as well as currently implemented focus on prevention, vaccination and treatment.
https://apjmt.mums.ac.ir/article_11980_be6d743b7c0d0a3ad769efcb680970a7.pdf
Animal Bite
Attitude
Iran
Knowledge
Practice
rabies
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-12-01
7
4
96
99
10.22038/apjmt.2018.11982
11982
The Epidemiologic and Clinical Study on Hemiscorpius Lepturus (Gadim) Envenomation with Focus on Clinical Manifestations, Prognosis Factors, and Outcomes
Bahare Hedayat
baharehhedaiat@ajums.ac.ir
1
Ali Hasan Rahmani
alir884@yahoo.com
2
Mohammad Matinrad
matinradmohammad@ajums.ac.ir
3
Pedram Nazari
nazari.p@ajums.ac.ir
4
Department of Clinical Toxicology, Razi Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Clinical Toxicology, Razi Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Clinical Toxicology, Razi Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Clinical Toxicology, Razi Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Background: Hemiscorpius lepturus envenomation is one of the most important medical issues in tropical regions of Iran, especially Khuzestan Province. Due to lack of reliable data about scorpion sting in Khuzestan Province, this investigation was performed to study the clinical presentation, prognosis factors, complications and mortality rates of Hemiscorpius lepturus sting. Methods: this study was a cross-sectional study performed at Sina Hospital, Karoon, Iran during 2011-2013. Required data such as demographic data, complications and outcomes were collected from medical records of all admitted victims of envenomation in this period and then were registered in a propriate checklist. Data were analyzed using SPSS version 16. Results: a total of 311 victims were studied. The highest frequency of sting was in the age range of 15-24 years. Most areas of the sting were the lower extremity. Forty-two patients delayed more than 24 hours to refer to the emergency room. The most common initial symptom in victims was pain in the sting location. Complications such as hematuria, hemoglobinuria, and coagulation disorders were most morbidity occurred in patients. 6 cases died. Conclusion: delay in referring to the hospital, the existence of hemoglobinuria, coagulation disorders and kidney failure were associated with poor prognosis in patients. It seems that patients who refer with delays and with symptoms such as hematuria, need for more medical health care.
https://apjmt.mums.ac.ir/article_11982_3e9fcc945fb88c7fc6036275698c0fef.pdf
Clinical manifestations
Epidemiology
Karoon city
Hemiscorpius lepturus
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-12-20
7
4
100
106
10.22038/apjmt.2018.12283
12283
Determining the Effective Substance of Prevalent Super Slim Weight Loss Capsule
Maryam Akhgari
1
Bahman Haj Mohammadi
bhph_1388@yahoo.com
2
Farzaneh Jokar
3
Zahra Mousavi
mosavi50@yahoo.com
4
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad university, Tehran, Iran
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad university, Tehran, Iran
Introduction: Given the growing prevalence of obesity in industrial societies including Iran, there is a growing demand for herbal weight loss drugs. Taking into account the heavy advertisements to sell the capsule as an herbal medicine, the present study was conducted in 2012 to determine the effective substance of prevalent super slim weight loss capsule. Methodology: Twenty-six super slim capsules were purchased from Tehran-based pharmacies and herbal medicine shops in 2012. Afterwards, 0.5 gram of the samples was solved in 2.5ml methanol. The samples were filtered and brought up to the volume by adding 5ml of ethanol and placed in an ultrasound device for 30min. 50µl zolpidem was then added as an internal standard. From each sample, 30µl was injected into high performance liquid chromatograph at mobile phases including water, methanol, and triethylamine at volumetric ratios of (0.5+79.5+20v/v/v, pH=5.65) and the obtained peaks were analyzed after 30mins. Findings:The results showed that prevalent super slim weight loss capsules found in Iran market were not herbal based and the effective substances were synthetic compounds known as sibutramine and mirtazapine. The results of quantitative analysis of the samples showed that pharmaceutical concentration of sibutramine in the capsules ranged from 33.51µg/ml to 286.78µg/ml. In addition, pharmaceutical concentration of sibutramine in the capsules ranged from 33.51µg/ml to 286.78µg/ml – pharmaceutical variables (placebo). Conclusion:Despite the claims and advertisements by the producers, the drug is not herbal based and contains illicit compounds. Therefore, it is essential to improve transparency in the assessments of the damages caused by weight loss drugs.
https://apjmt.mums.ac.ir/article_12283_249da012222cdf9a291c7ed880f69f06.pdf
Gas Chromatography
Illicit Drugs
Mass Spectroscopy
Obesity
Weight loss
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-12-01
7
4
107
110
10.22038/apjmt.2018.11986
11986
Inorganic Arsenic Poisoning Following An Intentional Overdose Of Realgar-Containing Niu Huang Jie Du Pian: A Case report and Literature Review
Rex Pui Kin LAM
lampkrex@hku.hk
1
Ella Chan
duchessella@gmail.com
2
Joe Kai Shing Leung
emilyjoe@netvigator.com
3
Man Li Tse
tseml@ha.org.hk
4
Zhi Xiu Lin
linzx@eservices.cuhk.edu.hk
5
Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong
Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
Department of Accident and Emergency, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
Hong Kong Poison Information Centre, Hospital Authority, Hong Kong Special Administrative Region, China
School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
Background: Niu Huang Jie Du Pian (NHJDP) is a widely used realgar-containing Chinese medicine remedy. Most brands are composed of eight ingredients: Niuhuang (Calculus Bovis), Xionghuang (realgar), gypsum (calcium sulphate), Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae), Jugeng (Platycodon grandiflorum), Bingpian (borneol), and Gancao (Radix Glycyrrhizae uralensis, licorice root). Most users are not aware that Xionghuang (realgar) contains arsenic disulphide [As2S2]. Inorganic arsenic poisoning after therapeutic overdoses has been reported in Chinese literature, but no report of acute, intentional overdose of NHJDP has been published. We report a case of intentional overdose of NHJDP leading to arsenic poisoning. Case Presentation: A 33-year-old woman ingested approximately 100 tablets of NHJDP bought over the counter, along with her usual antidepressants. She presented with somnolence, agitation, epigastric pain and repeated vomiting, compatible with clinical toxicities of NHJDP reported in Chinese literature. At presentation, blood and spot urine arsenic levels were 440.9 and 7,495 nmol/L, respectively. The patient’s condition improved rapidly after admission and chelation therapy was not deemed to be necessary. Discussion: Despite the self-limiting clinical course, the high arsenic level in the patient’s blood and urine raises safety concerns regarding the use of NHJDP in the community. Inconsistencies in the sales regulation of arsenic-containing products, and a lack of product label warning regarding arsenic content, may potentiate inadvertent arsenic poisoning. Conclusion: Clinician should be aware of the possibility of inorganic arsenic poisoning when treating patients with overdose of Chinese medicine remedies that contain Xionghuang (realgar). Proper product labelling may help reduce inadvertent arsenic poisoning.
https://apjmt.mums.ac.ir/article_11986_528d92ab339bf05e862dbd0a1257f31a.pdf
Acute poisoning
Arsenic
Drug Overdose
Herbal Medicine
Realgar
Traditional Chinese Medicine
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-12-01
7
4
111
113
10.22038/apjmt.2018.11985
11985
Unknown Herbal Poisoning with Fatal Outcome
Ariful Basher
arifulbasher@yahoo.com
1
kamruzzaman Khokon
khokon_cmc@yahoo.com
2
Ulrich Kuch
u.kuch@em.uni-frankfurt.de
3
SW Toennes
toennes@em.uni-frankfurt.de
4
M Faiz
drmafaiz@gmail.com
5
Registrar
department of medicine, Comilla Medical College, Comilla , Bangladesh
Biodiversity and Climate Research Centre, Frankfurt am Main, Germany
Institute of Forensic Toxicology, Centre for Legal Medicine, Goethe University, Frankfurt am Main, Germany
Professor & Former Director General of Health Services, Dhaka, Bangladesh
Background: Herbs can be toxic and may be even life-threatening. The mixture of different plants and herbs made by traditional healer and their canvassing on the street attract general people. Here, we report four cases of severe herbal poisoning. Case presentation: In 2008, four young people rushed to DMC Hospital in the early morning with a history of taking herbal medicine (tonic) on that night for gratification. About 3–4 h after ingestion, they experienced repeated vomiting and abdominal pain. Two patients deteriorated within the hours after admission with restlessness, progressive unconsciousness, and died soon after. The other two patients absconded from the hospital, including the person who prepared the tonic. Screening of the tonic by gas chromatography-mass spectrometry did not reveal toxic components. Discussion: The suspected herbs used for the preparation of that tonic were Santalum album (Chandan wood) which contains Santalol and other etheric oils; Plantago ovata (Ispaghula Husk) containing diverse alkaloids, phenols, etc.; and Mimosa pudica which is the common Mimosa and contains the alkaloid Mimosine. The nature of the tonic and source of the intoxication could not be finally elucidated. Conclusion: The described cases of unknown herbal poisoning in Bangladesh highlight the need for awareness campaigns targeting the population at risk.
https://apjmt.mums.ac.ir/article_11985_90274a7ab0e8f00ff4dfcecc215ade7c.pdf
acute toxicity
Herbal Drug
Fatal Poisoning
Intensive care
Public health
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2018-12-20
7
4
114
116
10.22038/apjmt.2018.12293
12293
Niyangala (Gloriosa Superba) Poisoning Complicated with SIADH
Tharindu Ruwanpathiranage
intercstc@gmail.com
1
Kolitha Sellahewa
kolithah@gmail.com
2
Sabaratnam Sivakumaran
sivakumaran17@gmail.com
3
Shane Halpe
shanehalpe@gmail.com
4
Manjula Thampoe
manju010191@gmail.com
5
Department of Internal Medicine, Neville Fernando Teaching Hospital, Malabe, Sri Lanka
Department of Internal Medicine, Neville Fernando Teaching Hospital, Malabe, Sri Lanka
Department of Internal Medicine, Neville Fernando Teaching Hospital, Malabe, Sri Lanka
Department of Internal Medicine, Neville Fernando Teaching Hospital, Malabe, Sri Lanka
Department of Internal Medicine, Neville Fernando Teaching Hospital, Malabe, Sri Lanka
Abstract Background: Niyangala poisoning used to be a common method of deliberate self-harm among people living in rural areas of Sri lanka. It is a plant that grows in the wild and has no usage. All parts of this plant are poisonous.The toxic ingredient in Niyangala is Colchicine. Even though Colchicine poisoning is uncommon, it can lead to life threatening complications and be considered a toxicological emergency. It can cause severe gastroenteritis, abdominal pain, hypotension, electrolyte imbalance in the initial phase, as well as granulocytopenia, thrombocytopenia, clotting defects, hepatic insufficiency and renal failure after the first 24 hours. Case presentation: A 62-year-old male presented to our medical unit with several episodes of severe watery diarrhea 6 hours after the ingestion of 3 tubers of Niyangala. He also had epigastric pain, nausea and vomiting. He had eaten Niyangala after consuming alcohol and claimed it was after a dispute with his wife. On admission, the patient was in pain with some dehydration but he was afebrile. Discussion: SIADH consists of hyponatremia, inappropriately elevated urine osmolality (>100 mOsm/kg), and decreased serum osmolality in a euvolaemic patient. SIADH should be diagnosed when these findings occur in the setting of otherwise normal cardiac, renal, adrenal, hepatic, and thyroid function; in the absence of diuretic therapy; and in the absence of other factors known to stimulate ADH secretion, such as hypotension, severe pain, nausea, and stress. Conclusion: SIADH is a well-recognized complication of colchicine poisoning. We report for the first time SIADH after the ingestion of tubers of Gloriosa superba. Hyponatremia in a patient after poisoning with Gloriosa superba is usually attributed to severe diarrhea which is a common and dominant clinical feature often managed with fluid replacement.
https://apjmt.mums.ac.ir/article_12293_8b16bca056c96e4d6ed9116828bb8937.pdf
Gloriosa superba
Niyangala
Poisoning
SIADH