eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
30
33
10.22038/apjmt.2019.13171
13171
Chemical Risk without Concurrent External Exposure!
Reza Afshari
afsharireza@yahoo.com
1
David Bellinger
2
Environmental Health Services, BC Centre for Disease Control, BC, Canada- 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_13171_50d97dcbc88ffde1292c38a06c07c1a7.pdf
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
34
38
10.22038/apjmt.2019.12398
12398
Correlation Between Blood Lactate Level and Hospitalization and Prognosis in Drug Intoxication Patients in Emergency Medicine Department
Adnan Turk
dradnanturk@gmail.com
1
Asım Kalkan
drasimkalkan@hotmail.com
2
Şeref Emre ATİŞ
3
Mehmet Ali Topal
4
Bora Çekmen
ebrosrian@gmail.com
5
Öner Bozan
onerbozan@gmail.com
6
Hakan Topacoglu
7
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
Düzce University Faculty of Medicine Department of Emergency Medicine, Düzce, Turkey
Background: Several drug intoxications can affect both pulmonary and cellular respiration. We therefore think that assessing blood lactate levels can provide information about prognosis. Blood lactate levels have provided information about prognosis in several diseases involving hypoxia at the cellular level, such as sepsis and trauma. The purpose of this study was to determine whether there is any relation between blood lactate levels and mortality, morbidity, and prognosis in patients presenting to the emergency department with drug intoxication. Methods: This retrospective cross-sectional study involved patients admitted to the emergency department due to suicidal drug intoxication over a one-year period (January to December 2016). The primary outcome measure was the relationship between serum lactate concentrations and patient discharge or hospitalization, and if hospitalized, the duration of stay. The secondary outcome measure was the relationship between serum lactate concentrations and toxic dose intake in single-drug intoxication. Results: We enrolled 372 patients, of whom 192 were analyzed after exclusion criteria application. The mean blood lactate level in the total patient group was 2.6±1.46, and 2.7±1.9 in the single drug group and 2.5±1.3 in the multidrug group. Also, blood lactate levels in the overdose group and toxic dose group were 3.4±3.0 and 2.4±0.9, respectively. No significant differences were determined in the lactate level, discharge, hospitalization and the length of hospital stay between the single drug and multidrug groups. In the toxic dose group, patient ages and number of admissions to intensive care unit were significantly higher than in the overdose group. The number of discharges was significantly lower in the toxic dose group. No correlation was determined between the serum lactate level and the length of hospital stay. Conclusion: Lactate level is not a useful parameter for predicting hospitalization in drug intoxication patients.
https://apjmt.mums.ac.ir/article_12398_9d0c9ca1bddb1905a37f70464e50207b.pdf
Drug Toxicity
Hospitalization
Lactic Acid
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
39
44
10.22038/apjmt.2019.13173
13173
Role of Non-Governmental Organizations in the Prevention and Control of Poisoning in Pakistan
Nadeemullah Khan
nadeemullah.khan@aku.edu
1
Naveed Ahmed
naveed.hpm501156@gmail.com
2
Faysal Subhani
faysal.subhani@aku.edu
3
Salima Kerai
salima.kerai@aku.edu
4
Nukhba Zia
nukhba.zia@jhu.edu
5
Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Abstract:
Introduction:
Poisoning is an important public health issue globally. There are very few poison control centers in Pakistan with a very limited capacity to deal with poisoning emergencies. The aim of this study was to identify non-governmental organizations (NGOs) working for poison control and prevention in Pakistan and to assess their capacity and role in control of poisoning in Pakistan.
Methods:
A cross-sectional study was conducted between October and December 2017. NGOs were identified through web-based search. They were contacted through telephone and emails. The data was recorded on a predesigned structured questionnaire. The questions were related to major areas including poison information, advice service, infrastructure, human resource and availability of clinical services.
Results:
We found 408 healthcare NGOs, of which 168 responded either via phone call or email. Eight out of 168 were found to have some role in the field of prevention and control of poisoning. Of these, complete information was available for only six organizations. All were involved in some aspect of environmental poisoning with a focus on pesticide poisoning mostly for farmers. Almost all organization referred cases to local hospitals when necessary. However, they did not have any official referral system in place and links with any tertiary level facilities.
Conclusion:
The study highlights that very few NGOs have some focus on the poisoning control and prevention. There is a window of opportunity for non-governmental sector to strengthen poisoning prevention and control for other forms of environmental poisoning for example caused by medicines, household chemicals, drug misuse, etc.
https://apjmt.mums.ac.ir/article_13173_f669cb00351db51267d7060d7d89937b.pdf
Non-Governmental Organizations (NGOs)
Pakistan
Poisoning
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
45
49
10.22038/apjmt.2019.13175
13175
A Retrospective Analysis of Pattern of Suicide in Autopsied Cases in a Tertiary Care Hospital
Indira Madhavan
drindirarun76@gmail.com
1
Rakhin Kareparambil Balan
drrakhinkb@gmail.com
2
Balaram Neeratty Asokan
drindirarun@yahoo.com
3
Andrews Mekkattukunnel Andrews
anjulioness@gmail.com
4
Aswin Valliot
5
Assistant Professor, Dept of Medicine, GMC, Thrissur, Kerala, India
Department of Forensic Medicine, GMC, Kozhikode, Kerala, India
Professsor, Department of Forensic Medicine, GMC, Thrissur, Kerala, India
Professsor, Department of Medicine, GMC, Thrissur, Kerala, Pakistan
Junior resident, Department of Medicine, GMC, Thrissur, Kerala, India
Background:The National Crime Records Bureau of India reported a decline in suicide rate from 2010 through 2014. We conducted this study to know whether our hospital data reflects the national data and to know the age and gender specific differences in selecting methods of suicide. Methods: We conducted a retrospective analysis of autopsied cases in Department of Forensic Medicine in a tertiary care hospital in central Kerala, India. Data on age, gender, cause of death of autopsied cases with alleged history of deliberate self-harm (DSH) were noted. Results: Mean age of study population was 43.4±24.4. There were 59.3% males and 40.7% females, but young females outnumbered young males. Majority of cases were hanging (n=1325), followed by poisoning (n=1169), burns (n=809), drowning (n=626) and others (n=401). Hanging and poisoning were the common methods chosen by males while burns and poisoning were the common methods by females. The number of DSH cases was 1,040, 866, 771, 837 and 826 in each year from 2010 to 2014, respectively. Number of poisoning cases was declining steadily from 350 to 163 while non-poisoning suicide was not showing any steady changes (690, 578, 514, 657, and 663). Pesticides were the most common agent recorded in the autopsy sheet while corrosives, plant toxins, cyanide, toxic alcohol and drug overdose were less common. Quinalfos, chlorpyrifos and carbofuran were the commonly identified pesticides on chemical analysis. Conclusion: There is a decrease trend in the number of suicides over the 5 years from 2010 through 2014 with a decrease in suicide due to poisoning. Though there is minimal increase in suicide due to hanging, it did not affect the total number of suicides.
https://apjmt.mums.ac.ir/article_13175_0bd555c7dc74f2f59de26e7466b466e2.pdf
Burns
Drowning
Pesticides
Poisoning
Suicide
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
50
55
10.22038/apjmt.2019.13176
13176
Serum Paraoxonase 1 Activity in Patients with Organophosphate Poisoning: A Potential Indicator of Prognosis
Lincy Juliet Kolandai Samy
k.lincy8@gmail.com
1
Prashant Adole
prashant.adole@gmail.com
2
Vinay Pandit
vinayrpandit@gmail.com
3
Kolar Vinod
drkvv@rediffmail.com
4
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, India.
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, India
Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, India.
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, India
Background: Human serum paraoxonase 1 (PON1) hydrolyzes organophosphate (OP) compounds and so significantly alters an individual’s susceptibility to the toxicity of these chemicals. The study was designed to assess the serum PON1 activity in a series of patients with OP poisoning. Methods: Suspected OP poisoning patients presented within 6 hours of consumption at emergency department were recruited. Demographic information of patients, clinical findings, treatments given, complications, length of hospital stay and clinical outcome were collected into datasheets. Patients were graded into moderate and severe poisoning. Serum PON1 was measured by ELISA method and serum cholinesterase by butyrylthiocholine method. Results: Mean serum PON1 level in patients with severe poisoning was significantly lower than those with moderate poisoning (426 ± 179 U/L vs. 868 ± 79 U/L, P < 0.001). Serum PON1 significantly correlated with serum cholinesterase levels (r = 0.400, P < 0.001) and negatively associated with total length of hospital stay (r = -0.338, P < 0.001), total atropine dose (r = -0.826, P < 0.001), serum amylase (r = -0.331, P < 0.001), lipase (r = 0.260, P = 0.011) and total creatinine kinase (r = -0.456, P < 0.001). Serum PON1 and cholinesterase levels were significantly lower in expired patients and those who required ventilation assistance as compared to recovered patients who did not require ventilation assistance. Conclusion: Lower PON1 activity was significantly associated with lower serum cholinesterase and poorer outcomes. PON1 activity may be considered as an indicator of prognosis in OP poisoning.
https://apjmt.mums.ac.ir/article_13176_21d3b2198e8867cd0cc421d567a25fc6.pdf
Cholinesterase
Organophosphate Poisoning
Pesticides
Paraoxonase 1
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
56
60
10.22038/apjmt.2019.13431
13431
An Investigation of the Clinical Signs, and Frequency of Street Drug Poisoning in Patients Referred to Razi Hospital of Ahvaz City, 2008-2013
Atefeh Raesi Vanani
atefehraisi1393@gmail.com
1
Alihassan Rahmani
alir884@yahoo.com
2
Samaneh Parsa Payam
3
Department of Pharmacology and Toxicology, Pharmacy School, 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
Medical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Background: Drug abuse is one of the major socio-medical problems of our time with a global scope. Abusing street drugs is on the rise among adults and is considered as a public health concern. In addition, limited studies are available in this regard. The aim of this study was to investigate the frequency of street drug poisoning in the Razi Hospital of Ahvaz in Iran during 2008-2013. Methods: This is an epidemiological cross-sectional study based on hospital information. All admitted cases with street drug poisoning were included during 2008 to 2013 (70 patients). Data were analyzed by SPSS software using descriptive statistics and Chi-square. Results: In the current study, out of 70 cases aged 13-53 years old, the highest frequency of abusers was related to 30 years of age, and male/female ratio was 4 to 1. Among the drugs used, methamphetamine accounted for the highest rate. In this study, 55.7% of the cases needed to be admitted to the intensive care unit and 2 deaths were observed. The most common symptom among poisoned patients includes loss of consciousness and the least common symptom is respiratory distress. Conclusion: According to the results, it can be concluded that the poisoning will be rarely fatal in case of dangerous exposure, if they are under supervision of emergency medical attentions, including the careful management of airways and respiratory failure, hypotension monitoring, seizure and impaired management of body temperature.
https://apjmt.mums.ac.ir/article_13431_3cbea0ab52adab53114bc218c58ca237.pdf
Addiction
Drug abuse
Methamphetamine
Marijuana
Poisoning
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
61
64
10.22038/apjmt.2019.13177
13177
Role of acetaminophen in reducing risk of kidney injury from Rhabdomyolysis: A Narrative Review
Marjan Emzhik
emzhik@hotmail.com
1
Pouran Makhdoumi
makhdoumip921@mums.ac.ir
2
Nasrin Milani
nasrinmilani@yahoo.com
3
Bita Dadpour
dadpourb@mums.ac.ir
4
Graduated from MSD (toxicology) Medical toxicology center, Mashhad University of Medical Science, Mashhad, Iran
Phd student (toxicology) Dep. of Environmental Health Engineering, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
Internal medicine specialist. Mashhad University of Medical Sciences Department of internal medicine ,Mashhad, Iran
Assistant professor of clinical toxicology Mashhad University of Medical Sciences Department of medical toxicology Mashhad, Iran
Background: Rhabdomyolysis is a clinical syndrome that results in releasing myoglobin content from damaged muscle cells into circulation and often causes acute kidney injury (1). Different mechanisms are considered to be responsible in rhabdomyolysis and renal failure. However, free radical generation is the most important mechanism resulting in kidney injury. Thus, the effect of various antioxidants has been investigated. Acetaminophen, with antioxidant ability in therapeutic dose, has shown a considerable protective effect on kidney after muscle injury. The investigations have shown that acetaminophen enhances renal function, decreases renal damage and reduces oxidant injury. The aim of this review was to summarize proven evidences for etiology to renal injury and abilities of acetaminophen in reducing it. Methods: Articles published from 2010 to 2017 in PubMed and Google Scholar were covered in this review. The articles investigating the role of free radical in renal injury following Rhabdomylosis were searched using the keywords Rhabdomyolysis, kidney and oxidative stress. The keywords used to find articles regarding antioxidant ability of acetaminophen were antioxidant and acetaminophen. Conclusion: With assessment of evidences form antioxidant capacity of acetaminophen and mechanism of renal failure in Rhabdomyolysis, this drug can be useful for prevention and treatment of kidney injury especially following rhabdomyolysis.
https://apjmt.mums.ac.ir/article_13177_6c7770978e76ff57873258e6cb7a0170.pdf
Acetaminophen
Kidney Injury
rhabdomyolysis
eng
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
2019-06-01
8
2
65
67
10.22038/apjmt.2019.13178
13178
Acute Organophosphate Poisoning Induced Extrapyramidal Syndrome: A Case Report
B Saroj Prusty
sarojprusty1@gmail.com
1
Kiran Kumar Ramineni
ram.kirankumar.dm@gmail.com
2
Majed Momin
majedmomin878@yahoo.co.in
3
Krishna mohan Reddy
gcvreddy@gmail.com
4
Safina Perveen
drsafinaperveen@gmail.com
5
Department of Critical Care, Yashoda Hospital, Malakpet, Hyderabad, India
Yashoda Hospital, Malakpet, Hyderabad, India
Department of lab medicine, Yashoda Hospitals, Malakpet, Hyderabad, Telangana state, India
Yashoda Hospital, Malakpet, Hyderabad, India
Department of Critical Care, Yashoda Hospitals, Malakpet, Hyderabad,India
Background: Organophosphorus compound ingestion is one of the most common modes of deliberate self-harm in developing countries like India. Neurological complications are known in acute, intermediate and delayed phases following organophosphate poisoning. However, extrapyramidal manifestations are rarely reported. Case presentation: A 30-year-old male patient was brought to the emergency department with history of consumption of unknown amount of monocrotophos 36%. At the time of presentation, he was in cholinergic crisis. He was managed with intravenous satropine, pralidoxime and mechanical ventilatory support. By day six, he improved significantly and was extubated. On day eight of illness, he developed extrapyramidal syndrome (EPS) characterized by reduced facial expression, tremors of all four limbs, rigidity and intermittent opisthotonic posturing. In addition to supportive care, he was treated with oral amantadine and trihexyphenidyl. He was discharged on day fifteen and by eight weeks improved significantly and became independent for all activities of daily living. Discussion: Organophosphorus compounds are cholinesterase inhibitors which act primarily by blocking active site on the cholinesterase enzyme by forming a covalent bond. Extrapyramidal syndrome is a rare complication during intermediate phase. Increased susceptibility of the basal ganglia nuclei to the toxic products in the absence of efficient detoxification pathways may be responsible. Brain imaging may reveal characteristic signal changes or can be completely normal. Conclusion: This case highlights the importance of careful observation and meticulous neurological examination for the diagnosis and appropriate management of the rare extrapyramidal syndrome due to acute organophosphate poisoning.
https://apjmt.mums.ac.ir/article_13178_041a9ca7ccefa1e2b181377c46217edb.pdf
Extra Pyramidal Syndrome (EPS)
Intermediate Syndrome
Organophosphorus Compound