ORIGINAL_ARTICLE
Chemical Risk without Concurrent External Exposure!
https://apjmt.mums.ac.ir/article_13171_50d97dcbc88ffde1292c38a06c07c1a7.pdf
2019-06-01
30
33
10.22038/apjmt.2019.13171
Reza
Afshari
afsharireza@yahoo.com
1
Environmental Health Services, BC Centre for Disease Control, BC, Canada- School of Population and Public Health, University of British Columbia, Canada
LEAD_AUTHOR
David
Bellinger
2
Boston Children’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
AUTHOR
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2.Afshari R, Bellinger DC. Implementing New Regulation Promotes Health but May Increase Inequality. Asia Pac J Med Toxicol 2018;7:90-1.
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3.Vandenberg LN, Colborn T, Hayes TB, Heindel JJ, Jacobs DR Jr, Lee DH, et al. Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses. Endocr Rev 2012;33:378-455.
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4.Lanphear BP. Low-level toxicity of chemicals: No acceptable levels? PLoS Biol 2017;15:e2003066.
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6.Oulhote Y, Mergler D, Barbeau B, Bellinger DC, Bouffard T, Brodeur MÈ, et al. Neurobehavioral function in school-age children exposed to manganese in drinking water. Environ Health Perspect 2014;122:1343-50.
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7.Wang B, Du Y. Cadmium and its neurotoxic effects. Oxid Med Cell Longev 2013;2013:898034.
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9.Afshari R, Emadzadeh A. Short communication: case report on adulterated opium-induced severe lead toxicity. Drug Chem Toxicol 2010;33:48-9.
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17.Zafarghandi MR1, Soroush MR, Mahmoodi M, Naieni KH, Ardalan A, Dolatyari A, et al. Incidence of cancer in Iranian sulfur mustard exposed veterans: a long-term follow-up cohort study. Cancer Causes Control 2013;24:99-105.
17
18.Balali-Mood M, Afshari R, Zojaji R, Kahrom H, Kamrani M, Attaran D, et al. Delayed toxic effects of sulfur mustard on respiratory tract of Iranian veterans. Hum Exp Toxicol 2011;30:1141-9.
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19.Castro BB, Freches AR, Rodrigues M, Nunes B, Antunes SC. Transgenerational Effects of Toxicants: An Extension of the Daphnia 21-day Chronic Assay? Arch Environ Contam Toxicol 2018;74:616-26.
19
20.Xu C, Niu L, Liu J, Sun X3, Zhang C4, Ye J, et al. Maternal exposure to fipronil results in sulfone metabolite enrichment and transgenerational toxicity in zebrafish offspring: Indication for an overlooked risk in maternal transfer? Environ Pollut 2019;246:876-84.
20
21.Alfonso S, Blanc M, Joassard L, Keiter SH, Munschy C, Loizeau V, et al. Examining multi- and transgenerational behavioral and molecular alterations resulting from parental exposure to an environmental PCB and PBDE mixture. Aquat Toxicol 2019;208:29-38.
21
22.Skinner MK, Manikkam M, Tracey R, Guerrero-Bosagna C, Haque M, Nilsson EE. Ancestral dichlorodiphenyltrichloroethane (DDT) exposure promotes epigenetic transgenerational inheritance of obesity. BMC Med 2013;11:228.
22
23.Vizuete J, Perez-Lopez M, Miguez-Santiyan MP, Hernández- Moreno D. Mercury (Hg), Lead (Pb), Cadmium (Cd), Selenium (Se), and Arsenic (As) in Liver, Kidney, and Feathers of Gulls: A Review. Rev Environ Contam Toxicol 2019;247:85-146.
23
24.Kitowski I, Jakubas D, Wiacek D, Sujak A. Concentrations of lead and other elements in the liver of the white-tailed eagle (Haliaeetus albicilla), a European flagship species, wintering in Eastern Poland. Ambio 2017;46:825-41.
24
25.Has-Schon E, Bogut I, Vukovic R, Galović D, Bogut A, Horvatić J. Distribution and age-related bioaccumulation of lead (Pb), mercury (Hg), cadmium (Cd), and arsenic (As) in tissues of common carp (Cyprinus carpio) and European catfish (Sylurus glanis) from the Busko Blato reservoir (Bosnia and Herzegovina). Chemosphere 2015;135:289-96.
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26.Lu J, Petroianu G, Widjaja B, Rüfer R. Transplacental kinetics o f lead in pregnant mini-pigs. Arch Toxicol 1997;71:187-92.
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27.Maximum levels for various chemical contaminants in specified foods sold in Canada. Health Canada's Maximum Levels for Chemical Contaminants in Foods. Health Canada. Available from https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/chemical-contaminants/maximum-levels-chemical-contaminants-foods.html
27
ORIGINAL_ARTICLE
Correlation Between Blood Lactate Level and Hospitalization and Prognosis in Drug Intoxication Patients in Emergency Medicine Department
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
2019-06-01
34
38
10.22038/apjmt.2019.12398
Drug Toxicity
Hospitalization
Lactic Acid
Adnan
Turk
dradnanturk@gmail.com
1
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
LEAD_AUTHOR
Asım
Kalkan
drasimkalkan@hotmail.com
2
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
AUTHOR
Şeref Emre
ATİŞ
3
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
AUTHOR
Mehmet Ali
Topal
4
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
AUTHOR
Bora
Çekmen
ebrosrian@gmail.com
5
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
AUTHOR
Öner
Bozan
onerbozan@gmail.com
6
University of Health Sciences, Okmeydani Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
AUTHOR
Hakan
Topacoglu
7
Düzce University Faculty of Medicine Department of Emergency Medicine, Düzce, Turkey
AUTHOR
Wax PM. History. In: Toxicologic Emergencies. eds. Goldfrank LR, Flomenbaum NE, et al. 6th ed. New York, Mc Graw-Hill; 1998: 1-14.
1
Mégarbane B. Toxidrome-based approach to common poisonings. Asia Pac J Med Toxicol 2014; 3: 2-12.
2
Akköse Ş, Fedakar R, Bulut M, Çebicci H, Zehirlenme Olgularının Beş Yıllık Analizi. Acil Tıp Dergisi 2003; 3: 8-10
3
Manini AF, Stimmel B, Hoffman RS, Vlahov D. Utility of cardiac troponin to predict drug overdose mortality. Cardiovasc Toxicol 2016; 16: 355-60.
4
Cheung R, Hoffman RS, Vlahov D, Manini AF. Prognostic Utility of Initial Lactate in Patient with Acute Drug Overdose: A Validation Cohort. Ann Emerg Med 2018; 72: 16-23.
5
Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med 2005; 20: 255-71.
6
Mankis P, Jankowski S, Zhang H, Kahn RJ, Vincent JL. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med 1995; 13: 619-22.
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Thomsen MT, Lefevre S, Nilsson GE, Wang T, Bayley M. The effects of lactate ions on the cardiorespiratory system in rainbow trout ( Oncorhynchus mykiss). Am J Physiol Regul Integr Comp Physiol 2019;316:R607-R620.
8
Prasad M, Murthy DR, Kumar S, Malini SS. Effects of Diesel Combustion Nanoparticles on Oxidative Stress Markers among the Exposures. Asia Pac J Med Toxicol 2018; 7:7-12.
9
Shojaeepour S, Mandegary A, Fazeli M, Sayed-Mirzaei SM, Ahmadi N, Saeediet A, et al. Evaluation of Oxidative Stress in Combination Therapy with D-penicillamine and N-Acetylcysteine (NAC) in Lead Poisoning in Opium Addicts. Asia Pac J Med Toxicol 2017; 6: 128-32.
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O’Donovan FC, Owens J, Tracey JA. Self-poisoning: admission to intensive care over a one-year period. Ir Med J 1993; 86: 64-5.
11
Burillo-Putze G, Munne P, Dueñas A, Pinillos MA, Naveiro JM, Cobo J, et al. National multicentre study of acute intoxication in emergency departments of Spain. Eur J Emerg Med 2003;10:101-4.
12
Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 2005;45:524-8.
13
Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009; 66:1040–4.
14
Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001; 27:74–83.
15
Serinken M, Yanturalı S. Acil serviste intihar amaçlı zehirlenmelerin geriye dönük analizi. Toksikoloji Dergisi 2003; 1: 15-9.
16
Buchanan WJ. A year of intentional self-poisoning in Christchurch. N Z Med J 1991; 104: 470-2
17
Lionte C, Sorodoc V, Tuchilus C, Cimpoiesu D, Jaba E. Biomarkers, lactate, and clinical scores as outcome predictors in systemic poisons exposures. Hum Exp Toxicol 2017; 36: 651–62
18
Flomenbaum NE, Goldfrank LR, Kulberg AG, et al. General management of the poisoned or overdosed patient. In: Toxicologic Emergencies. Eds. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Kulberg AG. 3rd ed. Appleton-Century-Crofts Connecticut, USA, 1986:5-28.
19
Bertolote JM, Fleischmann A. A global perspective in the epidemiology of suicide. Suicidol 2002; 7:6–8
20
WHO. Global Health Estimates Disease burden and mortality estimates [Internet]. Available from: http://www.who.int/healthinfo/global_burden_disease/estimate
21
Cervellin G, Comelli I, Rastelli G, Picanza A, Lippi G. Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients. Clin Biochem 2014; 47: 298–301
22
Megarbane B, Deye N, Malissin I, Baud FJ. Usefulness of the serum lactate concentration for predicting mortality in acute beta-blocker poisoning. Clin Toxicol (Phila) 2010; 48: 974–8
23
ORIGINAL_ARTICLE
Role of Non-Governmental Organizations in the Prevention and Control of Poisoning in Pakistan
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
2019-06-01
39
44
10.22038/apjmt.2019.13173
Non-Governmental Organizations (NGOs)
Pakistan
Poisoning
Nadeemullah
Khan
nadeemullah.khan@aku.edu
1
Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
LEAD_AUTHOR
Naveed
Ahmed
naveed.hpm501156@gmail.com
2
Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
AUTHOR
Faysal
Subhani
faysal.subhani@aku.edu
3
Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
AUTHOR
Salima
Kerai
salima.kerai@aku.edu
4
Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
AUTHOR
Nukhba
Zia
nukhba.zia@jhu.edu
5
Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
AUTHOR
1. World Health Organization. Chemicals of public health concern in the African Region and their management: Regional Assessment Report. available from: https://www.afro.who.int/publications/chemicals-public-health-concern-african-region-and-their-management-regional
1
2. Evaluation IfHMa. Global poisonings: University of Washington. Available from: https://hvizhub.healthdata.org/gbd-compare/#.
2
3. Das RK. Epidemiology of Insecticide poisoning at AIIMS Emergency Services and role of its detection by gas liquid chromatography in diagnosis. Medico-Legal Update Int J 2007;7:49-60.
3
4. Centers for Disease Control and Prevention (CDC). Unintentional poisoning deaths--United States, 1999-2004. MMWR Morb Mortal Wkly Rep 2007;56:93-6.
4
5. World Health Organisation. Poisoning Prevention and Management Geneva2019. Available from: https://who.int/ipcs/poisons/en/
5
6. Khaliq A, Sayed SA. Drug and poison information centres: An emergent need for health care professionals in Pakistan. J Pak Med Assoc 2016;66:639-43.
6
7. Mohiuddin H, Siddiqi R, Aijaz P. Pesticide poisoning in Pakistan: the need for public health reforms. Public health 2016;141:185.
7
8. ul Hassan O, Qadri H, Mir U, Ahmed B. Unintentional childhood poisoning, epidemiology and strategies for the prevention and policy change in Pakistan. J Ayub Med Coll Abbottabad 2013;25:90-3.
8
9. Howlader M, Sardar M, Amin M, Morshed M, Islam M, Uddin M, et al. Clinico-epidemiological pattern of poisoning in a tertiary level hospital. J Dhaka Med Coll 2008;17:111-5.
9
10. Hettiarachchi J, Kodithuwakku G. Pattern of poisoning in rural Sri Lanka. Int J Epidemiol 1989;18:418-22.
10
11. Khadem-Rezaiyan M, Afshari R. Epidemiology of poisoning in northeast of Iran (2004-2013). Int J Med Toxicol Forensic Med 2017;7:54-8.
11
12. Khadem-Rezaiyan M, Afshari R. Carbon monoxide poisoning in Northeast of Iran. J forensic legal med 2016;41:1-4.
12
13. Jan A, Khan MJ, Khan MTH, Khan MTM, Fatima S. Poisons implicated in homicidal, suicidal and accidental cases in North-West Pakistan. J Ayub Med Coll Abbottabad 2016;28:308-11.
13
14. Khan NU, Khan UR, Feroze A, Khan SA, Ali N, Ejaz K, et al. Trends of acute poisoning: 22 years experience from a tertiary care hospital in Karachi, Pakistan. J Pak Med Assoc 2016;66:1237.
14
15. Khan NU, Pérez-Núñez R, Shamim N, Khan UR, Naseer N, Feroze A, et al. Intentional and unintentional poisoning in Pakistan: a pilot study using the Emergency Departments surveillance project. BMC emerg med 2015;15:S2.
15
16. Khan NU, Mir MU, Khan UR, Khan AR, Ara J, Raja K, et al. The Current State of Poison Control Centers in Pakistan and the Need for Capacity Building. Asia Pac J Med Toxicol 2014;3:31.
16
17. World Health Organisation. Improving the availability of poisons centre services in Eastern Africa: highlights from a feasibility study for a subregional poison centre in the Eastern Africa Subregion, including a toolkit on setting up a poisons information service. Available from: https://apps.who.int/iris/handle/10665/183149
17
18. World Health Organisation. Guidelines on the prevention of toxic exposures : education and public awareness activities / International Programme on Chemical Safety . Available from: https://apps.who.int/iris/handle/10665/42714
18
19. Laborde A. New roles for poison control centres in the developing countries. Toxicol 2004;198:273-7.
19
20. Mancini F, Jiggins JL, O'Malley M. Reducing the incidence of acute pesticide poisoning by educating farmers on integrated pest management in South India. Int J Occup Environ Health 2009;15:143-51.
20
21. Slavica V, Dubravko B, Milan J. Acute organophosphate poisoning: 17 years of experience of the National Poison Control Center in Serbia. Toxicol 2018;409:73-9.
21
22. World Health Organization. Public health action for the prevention of suicide: a framework. Available from: https://apps.who.int/iris/handle/10665/75166
22
ORIGINAL_ARTICLE
A Retrospective Analysis of Pattern of Suicide in Autopsied Cases in a Tertiary Care Hospital
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
2019-06-01
45
49
10.22038/apjmt.2019.13175
Burns
Drowning
Pesticides
Poisoning
Suicide
Indira
Madhavan
drindirarun76@gmail.com
1
Assistant Professor, Dept of Medicine, GMC, Thrissur, Kerala, India
LEAD_AUTHOR
Rakhin
Kareparambil Balan
drrakhinkb@gmail.com
2
Department of Forensic Medicine, GMC, Kozhikode, Kerala, India
AUTHOR
Balaram
Neeratty Asokan
drindirarun@yahoo.com
3
Professsor, Department of Forensic Medicine, GMC, Thrissur, Kerala, India
AUTHOR
Andrews
Mekkattukunnel Andrews
anjulioness@gmail.com
4
Professsor, Department of Medicine, GMC, Thrissur, Kerala, Pakistan
AUTHOR
Aswin
Valliot
5
Junior resident, Department of Medicine, GMC, Thrissur, Kerala, India
AUTHOR
Wasserman D, Cheng Q, Jiang G-X. Global suicide rates among young people aged 15-19. World Psychiatry 2005;4:114-120.
1
Mathers C, Boerma T, Fat DM. The global burden of disease 2004 Updat. Available from: https://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf
2
Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003;32:902-909.
3
Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: a nationally representative survey. Lancet 2012;379:2343-51.
4
Afshari R, Bellinger D.C. Implementing New Regulation Promotes Health but May Increase Inequality. Asia Pac J Med Toxicol 2018;7:90-1.
5
Gunnell D, Knipe D, Chang S-S, Pearson M, Konradsen F, Lee WJ, et al. Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence. Lancet Glob Heal 2017;5:e1026-e1037.
6
Knipe DW, Metcalfe C, Fernando R, Pearson M, Konradsen F, Eddleston M, et al. Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data. BMC Public Health. 2014;14:839.
7
National Crime Records Bureau.Available from: http://ncrb.nic.in/.
8
Madhavan I, K. SL, Thomas V. Clinical Profile and Outcome of Deliberate Self Poisoning Cases in Medical Wards. Am J Intern Med 2015;3:5.
9
Andrews MA, Madhavan I, Parakadavathu RT, Sankaranarayanan HST. Outcome of Patients with Cholinergic Insecticide Poisoning Treated with Gastric Lavage: A Prospective Observational Cohort Study. Asia Pac J Med Toxicol 2014;3:146-51
10
Eddleston M, Bateman DN. Major reductions in global suicide numbers can be made rapidly through pesticide regulation without the need for psychosocial interventions. Soc Sci Med 2011;72:1-2.
11
Joseph A, Abraham S, Muliyil JP, George K, Prasad J, Minz S, et al. Evaluation of suicide rates in rural India using verbal autopsies, 1994-9. BMJ 2003;326:1121-2.
12
Gajalakshmi V, Peto R. Suicide rates in rural Tamil Nadu, South India: Verbal autopsy of 39 000 deaths in 1997–98. Int J Epidemiol 2007;36:203-207.
13
Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, et al. Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ 2008;86:726-32.
14
Vijayakumar L. Suicide in women. Indian J Psychiatry 2015;57:S233-8.
15
Davis AT, Schrueder C. The prediction of suicide. Med J Aust 1990;153:552-4.
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Indian pest control association. Pesticide Regulations. Available from: https://ipca.org.in/rescources/pesticide-regulations/
17
Chowdhury FR, Dewan G, Verma VR, Knipe DW, Isha IT, Faiz MA, et al. Bans of WHO Class I Pesticides in Bangladesh—Suicide Prevention without Hampering Agricultural Output. Int J Epidemiol 2018;47:175-84.
18
Roberts DM, Karunarathna A, Buckley NA, Manuweera G, Sheriff MHR, Eddleston M. Influence of pesticide regulation on acute poisoning deaths in Sri Lanka. Bull World Health Organ 2003;81:789-98.
19
Cha ES, Chang S-S, Gunnell D, Eddleston M, Khang Y-H, Lee WJ. Impact of paraquat regulation on suicide in South Korea. Int J Epidemiol 2016;45:470-9.
20
Indira M, Andrews MA, Rakesh TP. Incidence , predectors and outcome of intermediate syndrome in cholinergic insecticide poisoning – a prospective cohort study. Clin Toxicol (Phila) 2013;51:838-45.
21
Srinivas Rao C, Venkateswarlu V, Surender T, Eddleston M, Buckley NA. Pesticide poisoning in south India: opportunities for prevention and improved medical management. Trop Med Int Health 2005;10:581-8.
22
ORIGINAL_ARTICLE
Serum Paraoxonase 1 Activity in Patients with Organophosphate Poisoning: A Potential Indicator of Prognosis
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
2019-06-01
50
55
10.22038/apjmt.2019.13176
Cholinesterase
Organophosphate Poisoning
Pesticides
Paraoxonase 1
Lincy Juliet
Kolandai Samy
k.lincy8@gmail.com
1
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, India.
AUTHOR
Prashant
Adole
prashant.adole@gmail.com
2
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, India
LEAD_AUTHOR
Vinay
Pandit
vinayrpandit@gmail.com
3
Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, India.
AUTHOR
Kolar
Vinod
drkvv@rediffmail.com
4
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, India
AUTHOR
Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Chang SS, Phillips MR, et al. The global burden of fatal self-poisoning with pesticides 2006-15: Systematic review. J Affect Disord 2017;219:93-104.
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Dewan G. Analysis of Recent Situation of Pesticide Poisoning in Bangladesh: Is There a Proper Estimate? Asia Pac J Med Toxicol 2014;3:76-83.
2
Sen R, Nayak J, Khadanga S. Study of serum cholinesterase, CPK and LDH as prognostic biomarkers in organophosphorus poisoning. Int J Med Res Rev 2014;2:176-7.
3
Goel A, Aggarwal P. Pesticide poisoning. Natl Med J India 2007;20:182-91.
4
Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: a nationally representative survey. Lancet 2012;379:2343-51.
5
China SE, Mohamed Ali S, Yap PH, Gan L, Ong YB, Chia KS. Distribution of PON1 polymorphisms PON1Q192R and PON1L55M among Chinese, Malay and Indian males in Singapore and possible susceptibility to organophosphate exposure. Neurotoxicolgy 2009;30(2):214-19.
6
Prajapati T, Prajapati K, Tandon R, Merchant S. Acute Chemical and Pharmaceutical Poisoning Cases Treated in Civil Hospital, Ahmedabad: One year study. Asia Pac J Med Toxicol 2013;2:63-7.
7
Ahmed SM, Das B, Nadeem A, Samal RK. Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital. Indian J Anaesth 2014;58:11-7.
8
Muley A, Shah C, Lakhani J, Bapna M, Mehta J. To identify morbidity and mortality predictors in acute organophosphate poisoning. Indian J Crit Care Med 2014;18:297-300.
9
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Batra AK, Keoliya AN, Jadhav GU. Poisoning: an unnatural cause of morbidity and mortality in rural India. J Assoc Physicians India 2003;51:955-9.
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Akgür SA, Öztürk P, Solak I, Moral AR, Ege B. Human serum paraoxonase (PON1) activity in acute organophosphorous insecticide poisoning. Forensic Sci Int 2003;133:136-40.
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Kumar CU, Kishan PV, Chandrasekhar E, Usharani P. The utility of serial serum cholinesterase as a prognostic marker in organophosphorus compound poisoning. Int J Basic Clin Pharmacol 2014;3:529-33.
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18
La Du BN, Billecke S, Hsu C, Haley RW, Broomfield CA. Serum paraoxonase (PON1) isozymes: the quantitative analysis of isozymes affecting individual sensitivity to environmental chemicals. Drug Metab Dispos 2001;29:566-9.
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Prasad DRMM, Jirli P, Mahesh M., Mamatha, S. Relevance of Plasma Cholinesterase to Clinical Findings in Acute Organophosphorous Poisoning. Asia Pac J Med Toxicol 2013;2:23-7.
21
Kumara A, Margekar LS, Margekar P, Margekar V. Recent advances in management of organophosphate & carbamate poisoning. Indian J Med Spec. 2018;9:154-9.
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Androutsopoulos VP, Kanavouras K, Tsatsakis AM. Role of paraoxonase 1 (PON1) in organophosphate metabolism: implications in neurodegenerative diseases. Toxicol Appl Pharmacol 2011;256:418-24.
23
Costa LG, Giordano G, Cole TB, Marsillach J, Furlong CE. Paraoxonase 1 (PON1) as a genetic determinant of susceptibility to organophosphate toxicity. Toxicology 2013;307:115-22.
24
Hofmann JN, Keifer MC, Furlong CE, De Roos AJ, Farin FM, Fenske RA, et al. Serum cholinesterase inhibition in relation to paraoxonase-1 (PON1) status among organophosphate-exposed agricultural pesticide handlers. Environ Health Perspect 2009;117:1402-8.
25
Laudari S, Patowary BS, Sharma SK, Dhungel S, Subedi K, Bhattacharya R, et al. Cardiovascular Effects of Acute Organophosphate Poisoning. Asia Pac J Med Toxicol 2014;3:64-7.
26
Umakanth, M. Clinical profile of Intermediate Syndrome following Organophosphate Poisoning. Asia Pac J Med Toxicol 2018;7:42-5.
27
Singh S, Bhardwaj U, Verma SK, Bhalla A, Gill K. Hyperamylasemia and acute pancreatitis following anticholinesterase poisoning. Hum Exp Toxicol 2007;26:467-71.
28
Lin CL, Yang CT, Pan KY, Huang CC. Most common intoxication in nephrology ward organophosphate poisoning. Ren Fail 2004;26:349–54.
29
Singh S, Bhardwaj U, Verma SK, Bhalla A, Gill K. Hyperamylasemia and acute pancreatitis following anticholinesterase poisoning. Hum Exp Toxicol 2007;26:467–71.
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Hassan NAM, Madboly AG. Correlation between serum creatine phosphokinase and severity of acute organophosphorus poisoning: A prospective clinical study. J Environ Sci Toxico Food Tech 2013;4:18-29.
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Bhattacharya K, Phaujdar S, Sarkar R, Mullick OS. Serum creatine phosphokinase: A probable marker of severity in organophosphorus poisoning. Toxicol Int 2011;18:117–23.
32
ORIGINAL_ARTICLE
An Investigation of the Clinical Signs, and Frequency of Street Drug Poisoning in Patients Referred to Razi Hospital of Ahvaz City, 2008-2013
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
2019-06-01
56
60
10.22038/apjmt.2019.13431
Addiction
Drug abuse
Methamphetamine
Marijuana
Poisoning
Atefeh
Raesi Vanani
atefehraisi1393@gmail.com
1
Department of Pharmacology and Toxicology, Pharmacy School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
Alihassan
Rahmani
alir884@yahoo.com
2
Department of Clinical Toxicology, Razi Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
LEAD_AUTHOR
Samaneh
Parsa Payam
3
Medical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
1. Paulozzi LJ. Prescription drug overdoses: a review. J Safety Res 2012;43:283-9
1
2. Rahmani A, Zeidooni L, Samimi A. Prevalence of symptoms in patients poisoned with Iranian crack in Ahvaz Razi Hospital in 2008-2013. Asia Pac J Med Toxicol 2017;6:88-91.
2
3. Javad Hashemi AN. Effectiveness of Acceptance and Commitment Therapy (ACT) of Admission of Treatment Plan in Marijuana, Phencyclidine and Ketamine Abusers. J Police Med 2017;6:189-95.
3
4. Khadem Rezayian M, Afshari R. Alcohol intoxication: An emerging public health problem. Asia Pac J Med Toxicol 2017;6:1-5.
4
5. Salehi H, Sayadi A, Zare R, Soltanpour N, Hoseinpor A. Comparison of serum lead level in oral opium dependent men with healthy control group. Med J Mashhad Univ Med Sci 2009;52:129-32.
5
6. Bahrami F, Moazedian A, Hosseini SA. The effectiveness of the training of problem-solving and decision-making skills on the reduction of addicts’ positive attitudes to narcotics. Res Addiction 2013;7:57-72.
6
7. Moitra E, Christopher PP, Anderson BJ, Stein MD. Coping-motivated marijuana use correlates with DSM-5 cannabis use disorder and psychological distress among emerging adults. Psychol Addict Behav 2015;29:627.
7
8. Banes KE, Stephens RS, Blevins CE, Walker DD, Roffman RA. Changing motives for use: Outcomes from a cognitive-behavioral intervention for marijuana-dependent adults. Drug Alcohol Depend 2014;139:41-6.
8
9. Rehm J, Room R, van den Brinkt W, Kraus L. Problematic drug use and drug use disorders in EU countries and Norway: an overview of the epidemiology. Eur Neuropsychopharmacol 2005;15:389-97.
9
10. Ho EL, Josephson SA, Lee HS, Smith WS. Cerebrovascular complications of methamphetamine abuse. Neurocrit Care 2009;10(3):295-305.
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11. Esse K, Fossati-Bellani M, Traylor A, Martin-Schild S. Epidemic of illicit drug use, mechanisms of action/addiction and stroke as a health hazard. Brain Behav 2011;1:44-54.
11
12. Lankenau SE, Schrager SM, Silva K, Kecojevic A, Bloom JJ, Wong C, et al. Misuse of prescription and illicit drugs among high-risk young adults in Los Angeles and New York. J Public Health Res 2012;1:22-30.
12
13. Yazdani MR, Tavahen N, Masoumi GR, Gheshlaghi F, Dana-Siadat ZSetareh M, et al. Demographic Factors, Duration of Hospitalization, Costs of Hospitalization, and Cause of Death in Patients Intoxicated with Amphetamines and Opioids. Int J Med Toxicol Forensic Med 2014;4:122-9.
13
14. Darke S, Kaye S, Duflou J. Rates, characteristics and circumstances of methamphetamine‐related death in Australia: a national 7‐year study. Addiction 2017;112:2191-201.
14
15. Singleton J, Degenhardt L, Hall W, Zabransky T. Mortality among amphetamine users: a systematic review of cohort studies. Drug Alcohol Depend 2009;105:1-8.
15
16. Kobeissy F, Mouhieddine TH, Nokkari A, Itani M, Mouhieddine M, Zhang Z, et al. Recent updates on drug abuse analyzed by neuroproteomics studies: Cocaine, Methamphetamine and MDMA. Translational Proteomics 2014;3:38-52.
16
17. Winslow BT, Voorhees KI, Pehl KA. Methamphetamine abuse. Am Fam Physician 2007;76:1169-74.
17
18. Cheng WS, Garfein RS, Semple SJ, Strathdee SA, Zians JK, Patterson TL. Differences in sexual risk behaviors among male and female HIV-seronegative heterosexual methamphetamine users. Am J Drug Alcohol Abuse 2009;35:295-300.
18
19. Khadem Rezaiyan M, Afshari R. Epidemiology of poisoning in northeast of Iran (2004-2013). Int J Med Toxicol Forensic Med 2017;7:54-8.
19
20. Greenfield SF, Back SE, Lawson K, Brady KT. Substance abuse in women. Psychiatr Clin North Am 2010;33:339-55.
20
21. Colliver J, Kroutil L, Dai L, Gfroerer J. Misuse of prescription drugs: Data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2006.
21
22. Daneshparvar HR, Sardari F, Esfahanizadeh N. A survey on substance abuse related deaths referred to Tehran's Legal Medicine Organization during 2007 and 2008. Acta Med Iran 2011;49:383-9.
22
23. Compton WM, Thomas YF, Stinson FS, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2007;64:566-76.
23
24. Qorbani M, Mansorian M, Rahmani Anaraki H, Asayesh H, Rezapour A, Yeganeh M, et al. The Relationship Between Criminal Background and Substance Abuse Tendency. J Urmia Nurs Midwifery Faculty 2014;12:11-7.
24
25. Simonsen KW, Hansen AC, Rollmann D, Kringsholm B, Muller IB, Johansen SS, et al. Drug-related death in Denmark in 2007. Dan Med Bull 2011;58:A4307.
25
26. Hossein Hosseinian Moghadam AP. One year follow up of adolescent and adolescent poisoning in Loghman Hakim Hospital in Tehran in 2005. Pajoohande J 2007;12:169-76.
26
27. Kozel NJ, Lund J, Douglas J, McKetin R. Patterns and Trends of Amphetamine-Type Stimulants (ATS) and Other Drugs of Abuse in East Asia and the Pacific 2006. United Nations Office on Drugs and Crime; USA: 2007.
27
ORIGINAL_ARTICLE
Role of acetaminophen in reducing risk of kidney injury from Rhabdomyolysis: A Narrative Review
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
2019-06-01
61
64
10.22038/apjmt.2019.13177
Acetaminophen
Kidney Injury
rhabdomyolysis
Marjan
Emzhik
emzhik@hotmail.com
1
Graduated from MSD (toxicology) Medical toxicology center, Mashhad University of Medical Science, Mashhad, Iran
AUTHOR
Pouran
Makhdoumi
makhdoumip921@mums.ac.ir
2
Phd student (toxicology) Dep. of Environmental Health Engineering, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
AUTHOR
Nasrin
Milani
nasrinmilani@yahoo.com
3
Internal medicine specialist. Mashhad University of Medical Sciences Department of internal medicine ,Mashhad, Iran
AUTHOR
Bita
Dadpour
dadpourb@mums.ac.ir
4
Assistant professor of clinical toxicology Mashhad University of Medical Sciences Department of medical toxicology Mashhad, Iran
LEAD_AUTHOR
1. Kadowaki D, Sumikawa S, Arimizu K, Taguchi K, Kitamura K, Ishitsuka Y, et al. Effect of acetaminophen on the progression of renal damage in adenine induced renal failure model rats. Life sci 2012;91:1304-8.
1
2. Panizo N, Rubio-Navarro A, Amaro-Villalobos JM, Egido J, Moreno JA. Molecular mechanisms and novel therapeutic approaches to rhabdomyolysis-induced acute kidney injury. Kidney Blood Press Res 2015;40:520-32.
2
3. Tang W-X, Wu W-H, Qiu H-Y, Bo H, Huang S-M. Amelioration of rhabdomyolysis-induced renal mitochondrial injury and apoptosis through suppression of Drp-1 translocation. J Nephrol 2013;26:1073-82.
3
4. El-Ashker MR. Acute kidney injury mediated by oxidative stress in Egyptian horses with exertional rhabdomyolysis. Vet Res Commun 2011;35:311-20.
4
5. Billings FT, Ball SK, Roberts LJ, Pretorius M. Postoperative acute kidney injury is associated with hemoglobinemia and an enhanced oxidative stress response. Free Radic Biol Med 2011;50:1480-7.
5
6. Plotnikov E, Chupyrkina A, Jankauskas S, Pevzner I, Silachev D, Skulachev V, et al. Mechanisms of nephroprotective effect of mitochondria-targeted antioxidants under rhabdomyolysis and ischemia/reperfusion. Biochim Biophys Acta 2011;1812:77-86.
6
7. Gu H, Yang M, Zhao X, Zhao B, Sun X, Gao X. Pretreatment with hydrogen-rich saline reduces the damage caused by glycerol-induced rhabdomyolysis and acute kidney injury in rats. J Surg Res 2014;188:243-9.
7
8. Janz DR, Ware LB. The role of red blood cells and cell-free hemoglobin in the pathogenesis of ARDS. J Intensive Care 2015;3:20.
8
9. Boutaud O, Moore KP, Reeder BJ, Harry D, Howie AJ, Wang S, et al. Acetaminophen inhibits hemoprotein-catalyzed lipid peroxidation and attenuates rhabdomyolysis-induced renal failure. Proc Natl Acad Sci U S A 2010;107:2699-704.
9
10. Nair PK, Revi NG. One-year study on pattern of acute pharmaceutical and chemical poisoning cases admitted to a tertiary care hospital in Thrissur, India. Asia Pac J Med Toxicol 2015;4:79-82.
10
11. Fan AY, Che AH, Pan B, Yang C, Coulter CV, Shieffelbien L, et al. Investigating Childhood and Adolescence Poisoning Exposures in New Zealand Reported to the National Poisons Centre during 2000-2009. Asia Pac J Med Toxicol 2013;2:52-7.
11
12. Blough ER, Wu M. Acetaminophen: beyond pain and fever-relieving. Front Pharmacol 2011;2:72.
12
13. Better OS, Abassi ZA. Early fluid resuscitation in patients with rhabdomyolysis. Nat Rev Nephrol 2011;7:416-22.
13
14. Oates JA, Roberts LJ, Porter NA, Boutaud O. Inhibitors of hemeprotein-catalyzed lipid peroxidation. Google Patents; 2015.
14
15. Zhong H, Lu J, Xia L, Zhu M, Yin H. Formation of electrophilic oxidation products from mitochondrial cardiolipin in vitro and in vivo in the context of apoptosis and atherosclerosis. Redox biol 2014;2:878-83.
15
16. Yin H, Vergeade A, Shi Q, Zackert WE, Gruenberg KC, Bokiej M, et al. Acetaminophen inhibits cytochrome c redox cycling induced lipid peroxidation. Biochem Biophys Res Commun 2012;423:224-8.
16
17. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care 2016;20:187.
17
18. Simpson SA, Zaccagni H, Bichell DP, Christian KG, Mettler BA, Donahue BS, et al. Acetaminophen attenuates lipid peroxidation in children undergoing cardiopulmonary bypass. Pediatr Crit Care Med 2014;15:503-10.
18
19. Billings IV FT, Petracek MR, Roberts II LJ, Pretorius M. Perioperative intravenous acetaminophen attenuates lipid peroxidation in adults undergoing cardiopulmonary bypass: a randomized clinical trial. PloS one 2015;10:e0117625.
19
20. Wang C, Blough E, Arvapalli R, Dai X, Triest WE, Leidy JW, et al. Acetaminophen attenuates glomerulosclerosis in obese Zucker rats via reactive oxygen species/p38MAPK signaling pathways. Free Radic Biol Med 2015;81:47-57.
20
21. Janz DR, Bastarache JA, Peterson JF, Sills G, Wickersham N, May AK, et al. Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study. Crit Care med 2013;41:784.
21
22. Janz DR, Bastarache JA, Rice TW, Bernard GR, Warren MA, Wickersham N, et al. Randomized, Placebo-controlled Trial of Acetaminophen for the Reduction of Oxidative Injury in Severe Sepsis: The ACROSS Trial. Crit Care Med 2015;43:534.
22
23. Zhao W-X, Zhang J-H, Cao J-B, Wang W, Wang D-X, Zhang X-Y, et al. Acetaminophen attenuates lipopolysaccharide-induced cognitive impairment through antioxidant activity. J Neuroinflammation 2017;14:17.
23
24. Zhang T, Zhang Q, Guo J, Yuan H, Peng H, Cui L, et al. Non-cytotoxic concentrations of acetaminophen induced mitochondrial biogenesis and antioxidant response in HepG2 cells. Environ Toxicol Pharmacol 2016;46:71-9.
24
25. Oliver J. Acetaminophen attenuates rhabdomyolysis-induced renal failure. Kidney Int 2010;77:941-2.
25
26. Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Crit Care 2014;18:224.
26
27. Cil O, Ertunc M, Gucer KS, Ozaltin F, Iskit AB, Onur R. Endothelial dysfunction and increased responses to renal nerve stimulation in rat kidneys during rhabdomyolysis-induced acute renal failure: role of hydroxyl radical. Ren Fail 2012;34:211-20.
27
28. Oliveira SF, Pinho L, Rocha H, Nogueira C, Vilarinho L, Dinis MJ, et al. Rhabdomyolysis as a presenting manifestation of very long-chain acyl-coenzyme A dehydrogenase deficiency. Clin Pract 2013; 3:e22.
28
ORIGINAL_ARTICLE
Acute Organophosphate Poisoning Induced Extrapyramidal Syndrome: A Case Report
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
2019-06-01
65
67
10.22038/apjmt.2019.13178
Extra Pyramidal Syndrome (EPS)
Intermediate Syndrome
Organophosphorus Compound
B Saroj
Prusty
sarojprusty1@gmail.com
1
Department of Critical Care, Yashoda Hospital, Malakpet, Hyderabad, India
AUTHOR
Kiran Kumar
Ramineni
ram.kirankumar.dm@gmail.com
2
Yashoda Hospital, Malakpet, Hyderabad, India
AUTHOR
Majed
Momin
majedmomin878@yahoo.co.in
3
Department of lab medicine, Yashoda Hospitals, Malakpet, Hyderabad, Telangana state, India
LEAD_AUTHOR
Krishna mohan
Reddy
gcvreddy@gmail.com
4
Yashoda Hospital, Malakpet, Hyderabad, India
AUTHOR
Safina
Perveen
drsafinaperveen@gmail.com
5
Department of Critical Care, Yashoda Hospitals, Malakpet, Hyderabad,India
AUTHOR
Singh S, Sharma N. Neurological syndromes following organophosphate poisoning. Neurol India 2000; 48: 308.
1
Umakanth M. Intermediate Syndrome Following Organophosphate Poisoning; Review Article. Asia Pac J Med Toxicol 2019 ; 8 : 19 – 24.
2
Jain V, Singh V, Limbapure A. Organophosphorus Induced Hemiparesis and Chorieform Movements: Rare Neurological Sequelae. Ann Med Health Sci Res. 2018; 8: 236-238
3
Rosenstock L, Keifer M, Daniell WE, McConnell R, Claypoole K. Chronic central nervous system effects of acute organophosphate pesticide intoxication. The Pesticide Health Effects Study Group. Lancet 1991 ; 338: 223–227.
4
Senanayake N, Sanmuganathan PS. Extrapyramidal manifestation complicating organophosphorus insecticide poisoning. Hum Exp Toxicol 1995; 14: 600-4.
5
Sedgwick EM, Senanayake N. Pathophysiology of the intermediate syndrome of organophosphorus poisoning. J Neurol Neurosurg Psychiatry 1997; 62: 201–2.
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Steventon GB, Heafield MT, Waring RH, Williams AC. Xenobiotic metabolism in Parkinson's disease. Neurol 1989; 39: 883–7.
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Muller-Vahl KR, Kolbe H, Dengler R. Transient severe parkinsonism after acute organophosphate poisoning. J Neurol Neurosurg Psychiatry 1999; 66: 253-254.
8
Teke E, Sungurtekin H, Sahiner T, Atalay H, Gur S. Organophosphate poisoning case with atypical clinical survey and magnetic resonance imaging findings. J Neurol Neurosurg Psychiatr 2004; 75: 936-7.
9
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