ORIGINAL_ARTICLE
An Outbreak of Carbon Monoxide Poisoning in Yamagata Prefecture Following the Great East Japan Earthquake
Background: In the aftermath of the Great East Japan Earthquake, most of the areas in Yamagata prefecture experienced a serious power failure lasting for approximately 24 hours. A number of households were subsequently poisoned with carbon monoxide (CO) due to various causes. In this study, we conducted a survey of CO poisoning during the disaster. Methods: A questionnaire regarding CO poisoning associated with the disaster was sent to 37 emergency hospitals in Yamagata prefecture. Results: A total of 51 patients were treated for unintentional CO poisoning in 7 hospitals (hyperbaric oxygen chambers were present in 3 of the hospitals). The patients (18 men, 33 women) ranged in age from 0 to 90 years. The source of CO exposure was charcoal briquettes (23 cases; 45%), gasoline-powered electric generators (18 cases; 35%), electric generators together with oil stoves (8 cases; 16%), oil stoves (1 cases; 2%), and automobile exhaust (1 cases; 2%). Blood carboxyhemoglobin levels ranged from 0.5% to 41.6% in 49 cases. Of these, 41 patients were treated by normobaric oxygen therapy, while one was intubated for artificial respiration. Additionally, 5 patients (10%) were treated by hyperbaric oxygen therapy, and 3 patients (6%) experienced delayed neuropsychiatric sequelae. Conclusion: CO sources included gasoline-powered electric generators and charcoal briquettes during the disaster. Storm-related CO poisoning is well recognized as a disaster-associated accident in the United States, but not in Japan. We emphasize that public education is needed to make people aware of the dangers of CO poisoning after a disaster. In addition, a pulse CO-oximeter should be set up in hospitals.
https://apjmt.mums.ac.ir/article_857_57b08f8acaf50d4ce957b337bd3ef1c9.pdf
2013-06-01
37
41
10.22038/apjmt.2013.857
Carbon Monoxide
the Great East Japan Earthquake
Electric generator
Charcoal briquette
Poisoning
Ken
Iseki
ken@fmu.ac.jp
1
Department of Regional Emergency Medicine, Fukushima Medical University School of medicine, Fukushima, Japan. Department of Emergency and Critical Care Medicine, Yamagata University School of Medicine, Yamagata, Japan.
LEAD_AUTHOR
Akiko
Hayashida
2
Department of Regional Emergency Medicine, Fukushima Medical University School of medicine, Fukushima, Japan. Department of Emergency and Critical Care Medicine, Yamagata University School of Medicine, Yamagata, Japan.
AUTHOR
Yukihiro
Shikama
3
Department of Neurology, Yamagata Prefectural Kahoku Hospital, Yamagata, Japan
AUTHOR
Kaoru
Goto
4
Department of Anatomy and Cell Biology, Yamagata University School of Medicine, Yamagata, Japan
AUTHOR
Choichiro
Tase
5
Department of Emergency and Critical Care Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
AUTHOR
Normile D. Devastating earthquake defied expectations. Science 2011 Mar 18; 331(6023):1375-6.
1
Iseki K, Hayashida A, Seino K, Iwashita Y, Shinozaki K. Clinical services in the emergency department of Yamagata University Hospital after the Great Eastern Japan Earthquake. (In Japanese) Yamagata Med J 2012 Feb; 30(1):1-7.
2
Tamiya N, Noguchi H, Nishi A, Reich MR, Ikegami N, Hashimoto H, et al. Population ageing and wellbeing: lessons from Japan's long-term care insurance policy. Lancet 2011 Sep 24; 378(9797):1183-92.
3
Osaki Y, Minowa M. Factors associated with earthquake deaths in the great Hanshin-Awaji earthquake, 1995. Am J Epidemiol 2001 Jan 15; 153(2):153-6.
4
Hampson NB, Stock AL. Storm-related carbon monoxide poisoning: lessons learned from recent epidemics. Undersea Hyperb Med 2006 Jul-Aug; 33(4):257-63.
5
Houck PM, Hampson NB. Epidemic carbon monoxide poisoning following a winter storm. J Emerg Med 1997 Jul-Aug; 15(4):469-73.
6
Guzman JA. Carbon monoxide poisoning. Crit Care Clin 2012 Oct; 28(4):537-48.
7
Iqbal S, Clower JH, King M, Bell J, Yip FY. National carbon monoxide poisoning surveillance framework and recent estimates. Public Health Rep 2012 Sep-Oct; 127(5):486-96.
8
Iqbal S, Clower JH, Hernandez SA, Damon SA, Yip FY. A review of disaster-related carbon monoxide poisoning: surveillance, epidemiology, and opportunities for prevention. Am J Public Health 2012 Oct; 102(10):1957-63.
9
Fife CE, Smith LA, Maus EA, McCarthy JJ, Koehler MZ, Hawkins T, et al. Dying to play video games: carbon monoxide poisoning from electrical generators used after hurricane Ike. Pediatrics 2009 Jun; 123(6):e1035-8.
10
Wrenn K, Conners GP. Carbon monoxide poisoning during ice storms: a tale of two cities. J Emerg Med 1997 Jul-Aug;15(4):465-7.
11
Lutterloh EC, Iqbal S, Clower JH, Spiller HA, Riggs MA, Sugg TJ, Humbaugh KE, Cadwell BL, Thoroughman DA. Carbon monoxide poisoning after an ice storm in Kentucky, 2009. Public Health Rep 2011 May-Jun; 126 (Suppl 1):108-15.
12
Hampson NB2, Zmaeff JL. Carbon monoxide poisoning from portable electric generators. Am J Prev Med 2005 Jan; 28(1):123-5.
13
Cukor J, Restuccia M. Carbon monoxide poisoning during natural disasters: the Hurricane Rita experience. J Emerg Med 2007 Oct; 33(3):261-4.
14
Scott T, Theresa F. Assessing carbon monoxide poisoning. Emerg Nurse 2013 Mar; 20(10):14-9.
15
Hampson NB, Dunn SL, Yip FY, Clower JH, Weaver LK. The UHMS/CDC carbon monoxide poisoning surveillance program: three-year data. Undersea Hyperb Med 2012 Mar-Apr; 39(2):667-85.
16
Yari M, Fouladi N, Ahmadi H, Najafi F. Profile of acute carbon monoxide poisoning in the west province of Iran J Coll Physicians Surg Pak 2012 Jun; 22(6):381-4.
17
Daley WR, Shireley L, Gilmore R. A flood-related outbreak of carbon monoxide poisoning--Grand Forks, North Dakota. J Emerg Med 2001 Oct; 21(3):249-53.
18
Chen L, HuiLai M. Risk factors of nonoccupational carbon monoxide poisoning during the 2008 ice storm in Guiyang County, Hunan Province, China. Public Health Rep 2010 Jul-Aug; 125(4):605-10.
19
ORIGINAL_ARTICLE
Estonian Experience on Establishment of a Modern National Poison Information Centre: One-year Profile of Phone Calls in 2012
Background: Initiating a National Poisoning Information Centre (PIC) in Estonia took about 12 years of challenging work on research, training and attracting governmental support and funding. In this study we described the establishment process and the profile of phone calls in the first year which the PIC started to be available full time (24h/day 7days/week). Methods: This was a descriptive retrospective study. Relevant documents from 2000-2012 were reviewed. The documents were categorized into 5 main issues against establishment of PIC. Data of all inquiries related to toxic agent exposures regarding patient’s demographic, intention of poisoning and type of toxic substances in 2012 were collected. The data were reported with frequency and percentage. Results: During establishment process, 386 documents including governmental regulations and contracts, memorandums from meetings, professional e-mails, newspaper articles, interviews, annual reports and program sheets of other poison centres and conference presentations were collected. Funding was provided form PHARE and BTox projects (2000-2003), and government of Estonia (2004-2012). Educational programs were held to train specialists in clinical toxicology and poisoning information to direct the PIC. The active phase of establishment started in 2004; however, the services of PIC became available at the beginning of 2008. In 2012, total number of calls was 1118. 20% of calls were related to general questions about pharmaceuticals and non-toxic agents. 894 calls were related to acute poisoning cases. Most of them (87.9%) were due to accidental poisoning. The most common types of substances responsible for poisoning were pharmaceutical products (30.2%), household products (29.5%) and plant toxins (11.1%). Conclusion: To establish a stable PIC, it is crucial to have a wide range data backbone, clear support and direct funding from the government, assistance from collaborative PICs, active international/domestic collaboration and experienced committed specialists in clinical toxicology. A well-established PIC improves public health surveillance and reduces health-care costs. These effects should be investigated in future studies about the National PIC of Estonia.
https://apjmt.mums.ac.ir/article_858_2bd3dcf7f5e90775195d5bdaf43f8064.pdf
2013-06-01
42
47
10.22038/apjmt.2013.858
Poisoning
Poison information centre
Estonia
Mare
Oder
mare.oder@16662.ee
1
Poisoning Information Centre, Tallinn, Estonia
LEAD_AUTHOR
Kristiina
Põld
2
Department of Emergency Medicine, North Estonian Medical Centre, Tallinn, Estonia
AUTHOR
Tuusov J, Vals K, Tõnisson M, Riikoja A, Denissov G, Väli M. Fatal poisoning in Estonia 2000-2009. Trends in illegal drug-related deaths. J Forensic Leg Med 2013 Jan;20(1): 51-6.
1
Koppel A, Kahur K, Habicht T, Saar P, Habicht J and van Ginneken E. Estonia: Health system review. Health Systems in Transition 2008; 10(1): 1-230.
2
World Health Organization (WHO). Guidelines for poison control. Geneva: WHO Press; 1997.
3
Nikfar S, Abdollahi M, and Cheraghali A. Going from strength to strength; a drug and poison information centre. Essent Drugs Monit 2000; 28-29: 30-1.
4
Persson H, Tempowski J. Developing and maintaining quality in poisons information centers. Toxicology 2004 May 20;198(1-3):263-6.
5
Kastanje R. Poisoning information centre’s call responder - An Additional Competency for Emergency Medicine Nurses. Abstracts of the 2012 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, 25 May–1 June 2012, London, UK. Clin Toxicol (Phila) 2012 Apr; 50(4):310. [Abstract].
6
Põld K, Oder M. The Effect of Active Poison Information Education on the Call Volume and Structure. Abstracts of the 2011 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, 24–27 May 2011, Dubrovnik, Croatia. Clin Toxicol (Phila) 2011 Mar; 49(3):241. [Abstract].
7
Wananukul W, Sriapha C, Tongpoo A, Sadabthammarak U, Wongvisawakorn S, Kaojarern S. Human poisoning in Thailand: The Ramathibodi Poison Center's experience (2001-2004). Clin Toxicol (Phila) 2007 Jun-Aug;45(5):582-8.
8
Yang CC, Wu JF, Ong HC, Hung SC, Kuo YP, Sa CH, Chen SS, Deng JF. Taiwan National Poison Center: epidemiologic data 1985-1993. J Toxicol Clin Toxicol 1996;34(6):651-63.
9
Hung HT, Du Nguyen T, Höjer J. The first poison control center in Vietnam: experiences of its initial years. Southeast Asian J Trop Med Public Health 2008 Mar;39(2):310-8.
10
Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol 2005 Jun;24(6):279-85.
11
Warrell DA. Snake bite. Lancet 2010 Jan 2;375(9708):77-88.
12
Dadpour B, Shafahi A, Monzavi SM, Zavar A, Afshari R, Khoshdel AR. Snakebite Prognostic Factors: Leading Factors of Weak Therapeutic Response Following Snakebite Envenomation. Asia Pac J Med Toxicol 2012 Dec;1(1):27-33.
13
Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003 Dec;32(6):902-9.
14
Kliegman RM, Stanton BF, St. Geme JW III, Schor NF, Behrman RE. Nelson textbook of pediatrics. 19th edition. Philadelphia: Elsevier Saunders; 2011.
15
Spiller HA, Griffith JR. The value and evolving role of the U.S. Poison Control Center System. Public Health Rep 2009 May-Jun;124(3):359-63.
16
ORIGINAL_ARTICLE
Descriptive Analysis of Recorded Phone Calls to Iran Drug and Poison Information Centers during 2011-2012
Background: Poisoning is one of the main causes of visits to emergency departments and hospitals in Iran. Drug and Poison Information Centers (DPIC) are reliable sources to guide poisoned patients and provide information about pharmaceutical agents. This study was designed to analyze recorded phone calls to Iran DPICs during 2011-2012. Methods: This was a retrospective study on phone calls to DPIC in Tehran between January 2011 and November 2012. Data including demographic features, type of poison (in case of poisoning) and intention of poisoning were collected by reviewing the reported phone calls to central division of Iran DPICs in Tehran. Results: It was found that 98.5% of the phone calls were inquiries about pharmaceutical products and only 1.5% of them were associated with poisoning. 49% of poisonings reported from the DPICs in 2011was intentional, while this rate increased to 67% in 2012. Regarding toxic agents responsible for poisonings, pharmaceuticals were the most common consisting of 68.6% and 70.9% of cases in 2011 and 2012, respectively. Conclusion: Pharmaceutical products are the main causes of poisonings in Iran. Public education on safety and storage issues and also strict terms of sale should be implemented. In addition, the majority of poisonings occurred intentionally while the rate showed an increasing trend. Predisposing factors of this high rate should be studied.
https://apjmt.mums.ac.ir/article_859_1f654e71df1374a5917d12b87fb600d5.pdf
2013-06-01
48
51
10.22038/apjmt.2013.859
Drug and poison information center
Poisoning
Pharmaceutical products
Iran
Talat
Ghane
t_ghane@yahoo.com
1
Central Division of Iran Drug and Poison Information Centers, Tehran, Iran
LEAD_AUTHOR
Soheila
Saberi
2
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Masoomeh
Davoodabadi
3
Central Division of Iran Drug and Poison Information Centers, Tehran, Iran
AUTHOR
Peden M, McGree K, Krug E. Injury: A Leading Cause of the Global Burden of Disease, 2000. Geneva: World Health Organization (WHO) Press; 2002.
1
Bunn TL, Slavova S, Spiller HA, Colvin J, Bathke A, Nicholson VJ. The effect of poison control center consultation on accidental poisoning inpatient hospitalizations with preexisting medical conditions. J Toxicol Environ Health A. 2008;71(4):283-8.
2
Vassilev ZP, Marcus SM. The impact of a poison control center on the length of hospital stay for patients with poisoning. J Toxicol Environ Health A. 2007 Jan 15;70(2):107-10.
3
Spiller HA, Griffith JR. The value and evolving role of the U.S. Poison Control Center System. Public Health Rep 2009 May-Jun;124(3):359-63.
4
Krenzelok E, Mrvos R, Mazo E. Combining primary and secondary poison prevention in one initiative. Clin Toxicol (Phila). 2008 Feb;46(2):101-4.
5
De Silva WDAS. Effectiveness of Tobacco Control Measures in Reducing Tobacco Use among Adolescents and Young Adults in Anuradhapura, Sri Lanka. Asia Pac J Med Toxicol 2012 Dec; 1(1): 22-6.
6
Sarkar D, Shaheduzzaman M, Hossain MI, Ahmed M, Mohammad N, Basher A. Spectrum of Acute Pharmaceutical and Chemical Poisoning in Northern Bangladesh. Asia Pac J Med Toxicol 2013 Mar; 2(1): 2-5.
7
Centers for Disease Control and Prevention (CDC). Unintentional Poisoning in the United States. Atlanta: CDC Publications; 2010.
8
Grossman S, Zerilli T. Health and medication information resources on the world wide web. J Pharm Pract 2013 Apr;26(2):85-94.
9
Pourmand A, Wang J, Mazer M. A survey of poison control centers worldwide. Daru 2012 Aug 28;20(1):13.
10
Nikfar S, Abdollahi M, Cheraghali A. Going from strength to strength; a drug and poison information center. Essent Drugs Monit 2000;28-29:30-1.
11
Mehrpour O, Abdollahi M. Poison treatment centers in Iran. Hum Exp Toxicol 2012 Mar;31(3):303-4.
12
Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila) 2011 Dec;49(10):910-41.
13
Bronstein AC, Spyker DA, Cantilena LR Jr, Rumack BH, Dart RC. 2011 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol (Phila) 2012 Dec;50(10):911-1164.
14
Wananukul W, Sriapha C, Tongpoo A, Sadabthammarak U, Wongvisawakorn S, Kaojarern S. Human poisoning in Thailand: The Ramathibodi Poison Center's experience (2001-2004). Clin Toxicol (Phila) 2007 Jun-Aug;45(5):582-8.
15
ORIGINAL_ARTICLE
Investigating Childhood and Adolescence Poisoning Exposures in New Zealand Reported to the National Poisons Centre during 2000-2009
Background: Poisoning incidents, in both children and adolescents, are known to occur in New Zealand but little is known about the agents implicated. Methods: All the calls received over the ten years between 2000 and 2009, by the National Poison Centre in New Zealand, were retrospectively reviewed. Calls related to cases involving those less than 19 years were included. The data were analyzed according to age and gender of cases, the toxic agent implicated in the poisoning and the year of the incident. Results: Most poisonings occurred in children less than five years of age (86%), with these being further concentrated in children aged one to two years (57%). The most frequently implicated agents were therapeutic agents (39%) and then household products (36%). In adolescents, an increase in drug misuse or abuse was seen from 12 years old – with those aged 13 and 18 years being most frequently exposed to agents with psychotropic properties. Conclusion: This study showed that accidental (and intentional) ingestion is still an issue for children and adolescents in New Zealand. Specific strategies are needed to be targeted to the 1) products implicated in a high number of poisonings and 2) to children at the different ages.
https://apjmt.mums.ac.ir/article_860_61c6c63cab79af3fd30c5cbb08d51f7e.pdf
2013-06-01
52
57
10.22038/apjmt.2013.860
Poisoning
Children
Adolescent
Poison information centre
Anny
Fan
1
School of Pharmacy, University of Otago, New Zealand
AUTHOR
Arthur
Che
2
School of Pharmacy, University of Otago, New Zealand
AUTHOR
Benny
Pan
3
School of Pharmacy, University of Otago, New Zealand
AUTHOR
Cindy
Yang
4
School of Pharmacy, University of Otago, New Zealand
AUTHOR
Carolyn
Coulter
5
School of Pharmacy, University of Otago, New Zealand
AUTHOR
Lucy
Shieffelbien
6
National Poisons Centre, University of Otago, New Zealand
AUTHOR
Wayne
Temple
7
National Poisons Centre, University of Otago, New Zealand
AUTHOR
Rhiannon
Braund
rhiannon.braund@otago.ac.nz
8
School of Pharmacy, University of Otago, New Zealand
LEAD_AUTHOR
Braund R, Pan B, Shieffelbien L, Temple W. What Can We Learn from 21 Years of School Poisonings in New Zealand? Asia Pac J Med Toxicol 2012 Dec;1(1):10-3.
1
Holder Y, Matzopoulos R, Smith N. Poisons. In: Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur-Rahman AKM, et al., editors. World Report on Child Injury Prevention. Geneva: World Health Organization (WHO) press; 2008.
2
Yates KM. Accidental poisoning in New Zealand. Emerg Med (Fremantle) 2003 Jun;15(3):244-9.
3
Kypri K, Chalmers DJ, Langley JD, Wright CS. Child injury morbidity in New Zealand, 1987-1996. J Paediatr Child Health 2001 Jun; 37(3):227-34.
4
Safekids New Zealand. Unintentional Childhood Poisoning. Auckland: Safekids New Zealand; 2006.
5
Reith DM, Pitt WR, Hockey R. Childhood poisoning in Queensland: an analysis of presentation and admission rates. J Paediatr Child Health 2001 Oct;37(5):446-50.
6
Chien C, Marriott JL, Ashby K, Ozanne-Smith J. Unintentional ingestion of over the counter medications in children less than 5 years old. J Paediatr Child Health 2003 May-Jun;39(4):264-9.
7
Lam LT. Childhood and adolescence poisoning in NSW, Australia: an analysis of age, sex, geographic, and poison types. Inj Prev. 2003 Dec;9(4):338-42.
8
Rajka T, Heyerdahl F, Hovda KE, Stiksrud B, Jacobsen D. Acute child poisonings in Oslo: a 2-year prospective study. Acta Paediatr 2007 Sep;96(9):1355-9.
9
Ozanne-Smith J, Day L, Parsons B, Tibballs J, Dobbin M. Childhood poisoning: access and prevention. J Paediatr Child Health 2001 Jun;37(3):262-5.
10
Gulliver P, Dow N, Simpson J. The epidemiology of home injuries to children under five years in New Zealand. Aust N Z J Public Health 2005 Feb;29(1):29-34.
11
Leather NC. Risk-taking behaviour in adolescence: a literature review. J Child Health Care 2009 Sep;13(3):295-304.
12
Yamamoto LG, Wiebe RA, Matthews WJ Jr. Toxic exposures and ingestions in Honolulu: I. A prospective pediatric ED cohort; II. A prospective poison center cohort. Pediatr Emerg Care. 1991 Jun;7(3):141-8.
13
Bushby SK, Anderson RJ, Braund R. New Zealand parent's perceptions of the use and safety of over the counter liquid analgesics. Pharmacy Practice 2010;8(4):238-42.
14
Hoffman RS. Understanding the limitations of retrospective analyses of poison center data. Clin Toxicol (Phila) 2007 Dec;45(8):943-5.
15
Alatini M. Analysis of Unintentional Child Injury Data in New Zealand: Mortality (2001-2005) and Morbidity (2003-2007). Auckland: Safekids New Zealand; 2009.
16
ORIGINAL_ARTICLE
Late-onset Radiologic Findings of Respiratory System Following Sulfur Mustard Exposure
Background: Sulfur mustard (SM) as a chemical warfare agent, increases permeability of bronchial vessels and damages airway epithelium. SM exposure causes debilitating respiratory complications. This study was designed to evaluate clinical respiratory manifestations, and to compare chest X ray (CXR) and high resolution computed tomography (HRCT) scan of chest in SM exposed patients with respiratory complaints. Methods:All patients with history of SM exposure who visited Imam Reza Specialized Clinic of Respiratory Diseases from September 2001 to March 2011 were included. Patients with other comorbidities which affect respiratory system were excluded. CXR and chest HRCT scan were performed on the same day and were repeated after 5 years. Clinical and radiologic findings were collected and were compared with each other. Results: In total, 62 male patients with mean age of 53 (6.9, 41-65) were studied. Dyspnea (61 cases; 100%), dry cough (40 cases; 66%), hemoptysis (21 cases; 35%) and productive cough (20 cases; 33%) were the most common respiratory manifestations. Pulmonary infiltration (51; 83%), pleural thickening (25; 40%) and emphysema (16; 26%) were the most common findings on CXR. According to HRCT scan, pulmonary infiltration (53; 85%), bronchiolitis obliterans (38; 61%) and pleural thickening (36; 58%) were the most common findings (Table 2). Repeated radiologic assessments after 5 years showed a few additional findings in HRCT scan, while in about one fifth of CXRs, new pathologic findings were found. Conclusion: Patients with SM exposure experience debilitating respiratory disorders in long term. Repeating CXR in patients who present with subjective symptoms may show new findings; however, repeating HRCT scan is probably not necessary.
https://apjmt.mums.ac.ir/article_868_b23bd552d51764253a18c73f64931c9f.pdf
2013-06-01
58
62
10.22038/apjmt.2013.868
Sulfur mustard
Respiratory disorder
Chemical warfare agents
Poisoning
Radiology
Mahnaz
Amini
aminim@mums.ac.ir
1
Chronic Obstructive Pulmonary Disease Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Zohreh
Oghabian
zoghabian@yahoo.com
2
Department of Forensic Medicine and Clinical Toxicology, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
Ghabili K, Agutter PS, Ghanei M, Ansarin K, Panahi Y, Shoja MM. Sulfur mustard toxicity: history, chemistry, pharmacokinetics, and pharmacodynamics. Crit Rev Toxicol 2011 May; 41(5):384-403.
1
United Nations Security Council. Report of the mission dispatched by the Secretary General to investigate allegations of the use of chemical weapons in the conflict between the Islamic Republic of Iran and Iraq, 1987. New York, USA: United Nations; 1987. Report No.: S/18953.
2
Shohrati M, Peyman M, Peyman A, Davoudi M, Ghanei M. Cutaneous and ocular late complications of sulfur mustard in Iranian veterans. Cutan Ocul Toxicol 2007;26(2):73-81.
3
Steinritz D, Emmler J, Hintz M, Worek F, Kreppel H, Szinicz L, et al. Apoptosis in sulfur mustard treated A549 cell cultures. Life Sci 2007 May 30;80(24-25):2199-201.
4
Tang FR, Loke WK. Sulfur mustard and respiratory diseases. Crit Rev Toxicol 2012 Sep;42(8):688-702.
5
Saber H, Saburi A, Ghanei M. Clinical and paraclinical guidelines for management of sulfur mustard induced bronchiolitis obliterans; from bench to bedside. Inhal Toxicol 2012 Nov; 24(13):900-6
6
Doi M, Hattori N, Yokoyama A, Onari Y, Kanehara M, Masuda K, Tonda T. Effect of mustard gas exposure on incidence of lung cancer: a longitudinal study. Am J Epidemiol 2011 Mar 15; 173(6):659-66.
7
Angelini DJ, Dorsey RM, Willis KL, Hong C, Moyer RA, Oyler J, et al. Chemical warfare agent and biological toxin-induced pulmonary toxicity: could stem cells provide potential therapies? Inhal Toxicol 2013 Jan; 25(1):37-62.
8
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 Sep; 30(9):1141-9.
9
Vahedi E, Taheri S, Alaedini F, Poursaleh Z, Ameli J, Ghanei M. Correlations of sleep disorders with severity of obstructive airway disease in mustard gas-injured patients. Sleep Breath 2012 Jun; 16(2):443-51.
10
Ghanei M, Sheyacy M, Abbasi MA, Ani A, Aslani J. Correlation between the degree of air trapping in chest HRCT and cardiopulmonary exercise test parameters: could HRCT be a predictor of disease severity? Arch Iran Med 2011 Mar;14(2):86-90.
11
Taghaddosinejad F, Fayyaz AF, Behnoush B. Pulmonary complications of mustard gas exposure: a study on cadavers. Acta Med Iran 2011; 49(4):233-6.
12
Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM, et al. An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. Respir Med 2008 Jun;102(6):825-30.
13
Beheshti J, Mark EJ, Akbaei HM, Aslani J, Ghanei M. Mustard lung secrets: long term clinicopathological study following mustard gas exposure. Pathol Res Pract 2006; 202(10):739-44.
14
Zarchi K, Akbar A, Naieni KH. Long-term pulmonary complications in combatants exposed to mustard gas: a historical cohort study. Int J Epidemiol 2004 Jun;33(3):579-81.
15
ORIGINAL_ARTICLE
Acute Chemical and Pharmaceutical Poisoning Cases Treated in Civil Hospital, Ahmedabad: One year study
Background: To study the pattern of acute chemical and pharmaceutical poisoning in Ahmadabad, Gujarat, India. Methods: This was a prospective study of patients with chemical and pharmaceutical poisoning who were admitted to the emergency department of Civil Hospital Ahmadabad, from 1st October 2006 to 30th September 2007. Socio-demographic details, intention of poisoning, type of poison, duration of hospitalization and outcome were recorded in a data checklist. Results: In total, 366 cases were studied over one year. Of these, 70.8% were male. The majority (45.08%) of cases had 21 to 30 years of age. 71.6% of cases lived in rural area and 28.4% of cases lived in urban area. The most common type of poison was pesticides in 33.9% of cases, followed by household chemicals in 26.8% of cases. In 74.6% of cases, intention of poisoning was self-harm. Case fatality rate among the patients was 18.6% while this index in patients poisoned with household chemicals was the highest (19.9%) followed by pesticides (17.7%). Conclusion: The prevention and treatment of poisoning with pesticides and household chemicals should merit high priority in the health care of Gujarat population. A specific concern should be raised toward pesticides availability and terms of sale. A national concern should be raised toward providing more laboratory and diagnostic facilities in hospitals in India.
https://apjmt.mums.ac.ir/article_869_c01ab2f512d41190f880e069d3adba83.pdf
2013-06-01
63
67
10.22038/apjmt.2013.869
Acute poisoning
Pesticide
Household chemicals
Pharmaceutical agents
Emergency Department
Tejas
Prajapati
drtejasforensic@yahoo.com
1
Department of Forensic Medicine and Toxicology, Ahmedabad Municipal Corporation Medical Education Trust, Medical College, Ahmedabad, India
LEAD_AUTHOR
Kartik
Prajapati
2
Department of Forensic Medicine and Toxicology, Ahmedabad Municipal Corporation Medical Education Trust, Medical College, Ahmedabad, India
AUTHOR
Rakesh
Tandon
3
Department of Forensic Medicine and Toxicology, B.J Medical College, Ahmedabad, India
AUTHOR
Saumil
Merchant
4
Department of Forensic Medicine and Toxicology, Ahmedabad Municipal Corporation Medical Education Trust, Medical College, Ahmedabad, India
AUTHOR
United Nations Environment Programme (UNEP), International Labour Organization (ILO), World Health Organization (WHO). Guidelines for poison control. Geneva: WHO press; 1997.
1
International Programme on Chemical Safety, World Health Organization (WHO). Epidemiology of pesticide poisoning: harmonized collection of data on human pesticide exposure in selected countries. Geneva: WHO press; 2004.
2
Kora SA, Doddamani GB, Halagali GR, Vijayamahantesh SN, Boke Umakanth. Sociodemographic Profile of the Organophosphorus Poisoning Cases in Southern India. J Clin Diagn Res 2011 Oct;5(5).953-6.
3
Sarkar D, Shaheduzzaman M, Hossain MI, Ahmed M, Mohammad N, Basher A. Spectrum of Acute Pharmaceutical and Chemical Poisoning in Northern Bangladesh. Asia Pac J Med Toxicol 2013 Mar; 2(1): 2-5.
4
Prasad DRMM, Jirli PS, Mahesh M, Mamatha S. Relevance of Plasma Cholinesterase to Clinical Findings in Acute Organophosphorous Poisoning. Asia Pac J Med Toxicol 2013 Mar; 2(1): 23-7.
5
Singh D, Jit I, Tyagi S. Changing trends in acute poisoning in Chandigarh zone: a 25-year autopsy experience from a tertiary care hospital in northern India. Am J Forensic Med Pathol 1999 Jun;20(2):203-10.
6
Singh B, Unnikrishnan B. A profile of acute poisoning at Mangalore (South India). J Clin Forensic Med 2006 Apr;13(3):112-6.
7
World Health Organization (WHO). The WHO recommended classification of pesticides by hazard and guidelines to classification: 2009. Geneva: WHO Press; 2010.
8
Minton NA, Murray VS. A review of organophosphate poisoning. Med Toxicol Adverse Drug Exp 1988 Sep-Oct;3(5):350-75.
9
Thunga G, Sam KG, Khera K, Pandey S, Sagar SV. Evaluation of incidence, clinical characteristics and management in organophosphorus poisoning patients in a tertiary care hospital. J Toxicol Environ Health Sci 2010 Oct;2(5):73-6.
10
Kanchan T, Menezes RG, Kumar TS, Bakkannavar SM, Bukelo MJ, Sharma PS, et al. Toxicoepidemiology of fatal poisonings in Southern India. J Forensic Leg Med 2010 Aug;17(6):344-7.
11
Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003 Dec;32(6):902-9.
12
Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poisonings in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol 2004;42(7):965-75.
13
Hovda KE, Bjornaas MA, Skog K, Opdahl A, Drottning P, Ekeberg O, et al. Acute poisonings treated in hospitals in Oslo: a one-year prospective study (I): pattern of poisoning. Clin Toxicol (Phila) 2008 Jan;46(1):35-41.
14
Townsend E, Hawton K, Harriss L, Bale E, Bond A. Substances used in deliberate self-poisoning 1985-1997: trends and
15
associations with age, gender, repetition and suicide intent. Soc Psychiatry Psychiatr Epidemiol 2001 May;36(5):228-34.
16
Brusin KM, Krayeva YV. Highly Concentrated Acetic Acid Poisoning: 400 Cases Reviewed. Asia Pac J Med Toxicol 2012 Dec;1(1):3-9.
17
Quingking CG, Dioquino C, Pascual J. Predictive Factors of Gastrointestinal Caustic Injury According to Clinical and Endoscopic Findings. Asia Pac J Med Toxicol 2013 Mar;2(1):19-22.
18
Srinivas Rao Ch, 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 Jun;10(6):581-8.
19
Hoberman HM, Garfinkel BD. Completed suicide in children and adolescents. J Am Acad Child Adolesc Psychiatry 1988 Nov;27(6):689-95.
20
Chien WC, Lin JD, Lai CH, Chung CH, Hung YC. Trends in poisoning hospitalization and mortality in Taiwan, 1999-2008: a retrospective analysis. BMC Public Health 2011 Sep 16;11:703. doi: 10.1186/1471-2458-11-703.
21
Bohnert AS, Fudalej S, Ilgen MA. Increasing poisoning mortality rates in the United States, 1999-2006. Public Health Rep 2010 Jul-Aug;125(4):542-7.
22
ORIGINAL_ARTICLE
Low Molecular Weight Heparin Overdose: A 10 Year Case Series
Background: Low molecular weight heparin (LMWH) is used for the treatment and prevention of coagulative disorders. Few patients receiving therapeutic doses of LMWH develop major hemorrhage. Currently there are few reports in the literature on acute overdose on adults. In this study, clinical profile, treatment and outcome of 21 patients who acutely overdosed enoxaparin are described. Methods: A retrospective chart review of California Poison Control System (CPCS) database: Visual Dot Lab during 1997 to 2007 was obtained. All patients with a definite reported overdose of subcutaneous injection of LMWH were included. Results: In total, 21 patients who were all exposed to enoxaparin were studied. The reasons for overdose included medical miscalculation (3 cases, all infants), intentional misuse (2 patients), accidental overdose (7 cases), suicidal attempt (7 cases) and unknown in 2 patients. 7 cases were documented to have overdosed more than 2 times the therapeutic dose. The overdose ranged from 50 mg to 1300mg (0.1-80 times the therapeutic range). No patients were documented to experience bleeding or have thrombocytopenia although complete follow-up was only available for 11 patients. Reassurance was given to patients with less than 0.14 times the therapeutic dose. The 2 patients who received protamine were overdosed with more than 2.5 times the therapeutic dose of enoxaparin. Conclusion: Most patients had no complications and were not treated with protamine. This study suggests that a large dosage of LMWH is unlikely to result in any life threatening complications, though further studies are needed to certainly conclude about this. The use of protamine in LMWH overdose seems to remain controversial.
https://apjmt.mums.ac.ir/article_870_d78be1bbea9247d5ab04a5868cacb456.pdf
2013-06-01
68
70
10.22038/apjmt.2013.870
Low molecular weight heparin
Enoxaparin
Protamine
Overdose
Adeline
Ngo
angosy@gmail.com
1
Department of Emergency Medicine, Alexandra Hospital, Jurong Health Services, Singapore California Poison Control System, San Francisco Division, San Francisco, USA
LEAD_AUTHOR
Daryl
Tan
tan_daryl@rafflesmedical.com
2
Raffles Cancer Centre, Singapore
AUTHOR
Kent
Olson
olson@calpoison.org
3
California Poison Control System, San Francisco Division, San Francisco, USA Department of Clinical Pharmacy and Division of Clinical Pharmacology, University of California, San Francisco, USA
AUTHOR
Hirsh J, Warkentin TE, Shaughnessy SG, Anand SS, Halperin JL, Raschke R, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001 Jan;119(1 Suppl):64S-94S.
1
Weitz JI. Low-molecular-weight heparins. N Engl J Med. 1997 Sep 4;337(10):688-98.
2
Levine MN, Raskob G, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulant treatment. Chest 2001 Jan;119(1 Suppl):108S-121S.
3
Ellis MH, Hadari R, Tchuvrero N, Shapira S, Kovlenko I, Kozmiakova M, et al. Hemorrhagic complications in patients treated with anticoagulant doses of a low molecular weight heparin (enoxaparin) in routine hospital practice. Clin Appl Thromb Hemost 2006 Apr;12(2):199-204.
4
Gurfinkel EP, Manos EJ, Mejaíl RI, Cerdá MA, Duronto EA, García CN, et al. Low molecular weight heparin versus regular heparin or aspirin in the treatment of unstable angina and silent ischemia. J Am Coll Cardiol 1995 Aug;26(2):313-8.
5
Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med 1999 May 18;130(10):800-9.
6
Gouin-Thibault I, Pautas E, Siguret V. Safety profile of different low-molecular weight heparins used at therapeutic dose. Drug Saf 2005;28(4):333-49.
7
Dose-ranging trial of enoxaparin for unstable angina: results of TIMI 11A. The Thrombolysis in Myocardial Infarction (TIMI) 11A Trial Investigators. J Am Coll Cardiol 1997 Jun;29(7):1474-82.
8
Bratt G, Törnebohm E, Granqvist S, Aberg W, Lockner D. A comparison between low molecular weight heparin (KABI 2165) and standard heparin in the intravenous treatment of deep venous thrombosis. Thromb Haemost 1985 Dec 17;54(4):813-7.
9
Chawla LS, Moore G, Seneff MG. Incomplete reversal of enoxaparin toxicity by protamine: implications of renal insufficiency, obesity, and low molecular weight heparin sulfate content. Obes Surg 2004 May;14(5):695-8.
10
Massonnet-Castel S, Pelissier E, Bara L, Terrier E, Abry B, Guibourt P, et al. Partial reversal of low molecular weight heparin (PK 10169) anti-Xa activity by protamine sulfate: in vitro and in vivo study during cardiac surgery with extracorporeal circulation. Haemostasis 1986;16(2): 139-46.
11
Bang CJ, Berstad A, Talstad I. Incomplete reversal of enoxaparin-induced bleeding by protamine sulfate. Haemostasis 1991;21(3):155-60.
12
Wiernikowski JT, Chan A, Lo G. Reversal of anti-thrombin activity using protamine sulfate. Experience in a neonate with a 10-fold overdose of enoxaparin. Thromb Res 2007;120(2):303-5.
13
Byrne M, Zumberg M. Intentional low-molecular-weight heparin overdose: a case report and review. Blood Coagul Fibrinolysis 2012 Dec;23(8):772-4.
14
Monte AA, Bodmer M, Schaeffer TH. Low-molecular-weight heparin overdose: management by observation. Ann Pharmacother 2010 Nov;44(11):1836-9.
15
Spinler SA, Inverso SM, Cohen M, Goodman SG, Stringer KA, Antman EM, et al. Safety and efficacy of unfractionated heparin versus enoxaparin in patients who are obese and patients with severe renal impairment: analysis from the ESSENCE and TIMI 11B studies. Am Heart J 2003 Jul;146(1):33-41.
16
ORIGINAL_ARTICLE
Methamphetamine Related Radiculopathy: Case Series and Review of Literature
Background: Peripheral nervous injury and neuromuscular complications from methamphetamine abuse has not been reported. The mechanism is not yet identified. Methods: Eight patients with lower extremity weakness following methamphetamine abuse were reported during December 2009 to May 2010. Results: Patients presented with lower extremity weakness. All patients were co-abusers of methamphetamine and opioids. Other clinical manifestations comprised of distal paresthesia of the lower extremities with progression to proximal portions, with minimal sensory involvement in the distal of the lower extremities. Electrodiagnostic findings were consistent with lumbosacral Radiculopathy. Vital signs were unremarkable and all laboratory tests were within normal limits. Follow-up examination after three months showed improvement of weakness in 3 patients. Conclusion: For patients with a history of illicit drug abuse and acute neuromuscular weakness, methamphetamine or heroin toxicity should be taken into account. Hence, urine morphine and amphetamine/ methamphetamine tests should be performed and serum lead and thallium levels should be evaluated. In addition, rhabdomyolysis and myoglobinuria should be worked up.
https://apjmt.mums.ac.ir/article_894_c713c64e1230353e47d1d71865bebf95.pdf
2013-06-01
71
75
10.22038/apjmt.2013.894
Methamphetamine
Heroin
Radiculopathy
Neuropathy
Mohsen
Foroughipour
foroughipourm@mums.ac.ir
1
Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mohammad
Farzadfard
farzadfardmt@mums.ac.ir
2
Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Meisam
Aghaee
3
Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Ali
Ghabeli-Juibary
4
Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Fariborz
Rezaietalab
5
Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Lineberry TW, Bostwick JM. Methamphetamine abuse: a perfect storm of complications. Mayo Clin Proc 2006 Jan;81(1):77-84.
1
Afshari R, Monzavi SM. Illicit Drug Overdose. In: Afshari R, Monzavi SM, editors. Afshari’s Clinical Toxicology and Poisoning Emergency Care. 2nd ed. Mashhad: Mashhad University of Medical Sciences Publication; 2012. p.137-74.
2
Brust JC. Acute neurologic complications of drug and alcohol abuse. Neurol Clin 1998 May;16(2):503-19.
3
Davidson C, Gow AJ, Lee TH, Ellinwood EH. Methamphetamine neurotoxicity: necrotic and apoptotic mechanisms and relevance to human abuse and treatment. Brain Res Brain Res Rev 2001 Aug;36(1):1-22.
4
Rusyniak DE. Neurologic manifestations of chronic methamphetamine abuse. Neurol Clin 2011 Aug;29(3):641-55.
5
Itzhak Y, Achat-Mendes C. Methamphetamine and MDMA (ecstasy) neurotoxicity: 'of mice and men'. IUBMB Life 2004 May;56(5):249-55.
6
Neiman J, Haapaniemi HM, Hillbom M. Neurological complications of drug abuse: pathophysiological mechanisms. Eur J Neurol 2000 Nov;7(6):595-606.
7
Enevoldson TP. Recreational drugs and their neurological consequences. J Neurol Neurosurg Psychiatry 2004 Sep;75Suppl 3:iii9-15.
8
Büttner A. Review: The neuropathology of drug abuse. Neuropathol Appl Neurobiol 2011 Feb;37(2):118-34.
9
Ho EL, Josephson SA, Lee HS, Smith WS. Cerebrovascular complications of methamphetamine abuse. Neurocrit Care 2009;10(3):295-305.
10
Yen DJ, Wang SJ, Ju TH, Chen CC, Liao KK, Fuh JL, et al. Stroke associated with methamphetamine inhalation. Eur Neurol 1994;34(1):16-22.
11
Ohta K, Mori M, Yoritaka A, Okamoto K, Kishida S. Delayed ischemic stroke associated with methamphetamine use. J Emerg Med 2005 Feb;28(2):165-7.
12
Perez JA Jr, Arsura EL, Strategos S. Methamphetamine-related stroke: four cases. J Emerg Med 1999 May-Jun;17(3):469-71.
13
Rothrock JF, Rubenstein R, Lyden PD. Ischemic stroke associated with methamphetamine inhalation. Neurology 1988 Apr;38(4):589-92.
14
McGee SM, McGee DN, McGee MB. Spontaneous intracerebral hemorrhage related to methamphetamine abuse: autopsy findings and clinical correlation. Am J Forensic Med Pathol 2004 Dec;25(4):334-7.
15
Ener RA, Meglathery SB, Van Decker WA, Gallagher RM. Serotonin syndrome and other serotonergic disorders. Pain Med 2003 Mar;4(1):63-74.
16
Wijaya J, Salu P, Leblanc A, Bervoets S. Acute unilateral visual loss due to a single intranasal methamphetamine abuse. Bull Soc Belge Ophtalmol 1999;271:19-25.
17
Ehealthme. Could Carboplatin, Methamphetamine Hydrochloride together cause Radiculopathy? [Internet]. 2013 [Cited 2013 Apr 1]. Available from: http://www.ehealthme.com/carboplatin-and-methamphetamine-hydrochloride/radiculopathy
18
Ehealthme. Could Advair Diskus 250/50, Methamphetamine Hydrochloride together cause Radiculopathy? [Internet]. 2013 [Cited 2013 Apr 1]. Available from: http://www.ehealthme.com/ advair- diskus-250-50-and-methamphetamine-hydrochloride/radiculopathy
19
Sim T, Simon SL, Domier CP, Richardson K, Rawson RA, Ling W. Cognitive deficits among methamphetamine users with attention deficit hyperactivity disorder symptomatology. J Addict Dis 2002;21(1):75-89.
20
Kalechstein AD, Newton TF, Green M. Methamphetamine dependence is associated with neurocognitive impairment in the initial phases of abstinence. J Neuropsychiatry Clin Neurosci 2003 Spring;15(2):215-20.
21
Scott JC, Woods SP, Matt GE, Meyer RA, Heaton RK, Atkinson JH, et al. Neurocognitive effects of methamphetamine: a critical review and meta-analysis. Neuropsychol Rev 2007 Sep;17(3):275-97.
22
Salo R, Ursu S, Buonocore MH, Leamon MH, Carter C. Impaired prefrontal cortical function and disrupted adaptive cognitive control in methamphetamine abusers: a functional magnetic resonance imaging study. Biol Psychiatry 2009 Apr 15;65(8):706-9.
23
Thrash B, Thiruchelvan K, Ahuja M, Suppiramaniam V, Dhanasekaran M. Methamphetamine-induced neurotoxicity: the road to Parkinson's disease. Pharmacol Rep 2009 Nov-Dec;61(6):966-77.
24
Kuehn BM. Meth use linked to risk of Parkinson disease. JAMA 2011 Aug 24;306(8):814.
25
Callaghan RC, Cunningham JK, Sykes J, Kish SJ. Increased risk of Parkinson's disease in individuals hospitalized with conditions related to the use of methamphetamine or other amphetamine-type drugs. Drug Alcohol Depend 2012 Jan 1;120(1-3):35-40.
26
Tarulli AW, Raynor EM. Lumbosacral radiculopathy. NeurolClin 2007 May;25(2):387-405.
27
Davidson C, Gow AJ, Lee TH, Ellinwood EH. Methamphetamine neurotoxicity: necrotic and apoptotic mechanisms and relevance to human abuse and treatment. Brain Res Brain Res Rev 2001 Aug;36(1):1-22.
28
Dabby R, Djaldetti R, Gilad R, Herman O, Frand J, Sadeh M, et al. Acute heroin-related neuropathy. J Peripher Nerv Syst 2006 Dec;11(4):304-9.
29
Evans PA, Millington HT. Atraumatic brachial plexopathy following intravenous heroin use. Arch Emerg Med 1993 Sep;10(3):209-11.
30
Diaz Guzman J, Pastor Valverde C, Gil Grande R, Alonso Ortiz A, Trueba Gutierrez JL. Rhabdomyolysis and lumbosacral plexopathy in intravenous drug addict: report of a case. (Article in Spanish) An Med Interna 1996 Feb;13(2):84-6.
31
Hecker E, Friedli WG. Plexus lesions, rhabdomyolysis and heroin. (Article in German) Schweiz Med Wochenschr 1988 Dec 31;118(52):1982-8.
32
Riggs JE, Schochet SS Jr, Hogg JP. Focal rhabdomyolysis and brachial plexopathy: an association with heroin and chronic ethanol use. Mil Med 1999 Mar;164(3):228-9.
33
Stamboulis E, Psimaras A, Malliara-Loulakaki S. Brachial and lumbar plexitis as a reaction to heroin. Drug Alcohol Depend 1988 Dec;22(3):205-7.
34
Bernasconi A, Kuntzer T, Ladbon N, Janzer RC, Yersin B, Regli F. Peripheral nerve and spinal cord complication in intravenous heroin addiction. (Article in French) Rev Neurol (Paris) 1996 Nov;152(11):688-94.
35
Delcker A, Dux R, Diener HC. Acute plexus lesions in heroin dependence. (Article in German) Nervenarzt 1992 Apr;63(4):240-3.
36
deGans J, Stam J, van Wijngaarden GK. Rhabdomyolysis and concomitant neurological lesions after intravenous heroin abuse. J Neurol Neurosurg Psychiatry 1985 Oct;48(10):1057-9.
37
Goodhart LC, Loizou LA, Anderson M. Heroin myelopathy. J Neurol Neurosurg Psychiatry 1982 Jun;45(6):562-3.
38
Warner-Smith M, Darke S, Day C. Morbidity associated with non-fatal heroin overdose. Addiction 2002 Aug;97(8):963-7.
39
Gille M, Delbecq J, Depré A, van den Bergh P. Painful sciatic neuropathy after heroin overdose. J Neurol 1995 Jul;242(7):478-80.
40
Beniczky S, Tfelt-Hansen P, Fabricius M, Andersen KV. Multiple mononeuropathy following cocaine abuse. BMJ Case Rep 2009;2009. pii: bcr07.2008.0446. doi: 10.1136/bcr.07.2008.0446.
41
Richter RW, Pearson J, Bruun B, Challenor YB, Brust JC, Baden MM. Neurological complications of addiction to heroin. Bull N Y Acad Med 1973 Jan;49(1):3-21.
42
Amnueilaph R, Boongird P, Leechawengwongs M, Vejjajiva A. Heroin neuropathy. Lancet 1973 Jun 30;1(7818):1517-8.
43
Kaku DA, So YT. Acute femoral neuropathy and iliopsoas infarction in intravenous drug abusers. Neurology 1990 Aug;40(8):1317-8.
44
Hall JH 3rd, Karp HR. Acute progressive ventral pontine disease in heroin abuse. Neurology 1973 Jan;23(1):6-7.
45
Afshari R, Mégarbane B, Zavar A. Thallium poisoning: one additional and unexpected risk of heroin abuse. Clin Toxicol (Phila) 2012 Sep;50(8):791-2.
46
Afshari R, Emadzadeh A. Short communication: case report on adulterated opium-induced severe lead toxicity. Drug Chem Toxicol 2010 Jan;33(1):48-9.
47
Khosrojerdi H, Sarabadani J. Bluish Discoloration of Periodontal Tissue. Asia Pac J Med Toxicol 2012 Dec;1(1):38-40.
48
Nora DB, Gomes I, Said G, Carvalho FM, Melo A. Modifications of the sympathetic skin response in workers chronically exposed to lead. Braz J Med Biol Res 2007Jan;40(1):81-7.
49
Nicholas PK, Voss JG, Corless IB, Lindgren TG, Wantland DJ, Kemppainen JK, et al. Unhealthy behaviours for self-management of HIV-related peripheral neuropathy. AIDS Care 2007 Nov;19(10):1266-73.
50
ORIGINAL_ARTICLE
Comment on Editorial; Best Research for Low Income Countries
Achieving a practical and productive balance in collaborative research between partners from high and lower income countries (North-South Collaborations) requires seeking win-win solutions. This issue requires time to engage each other and to understand each participant’s research priorities and to identify areas of mutual interest. In SACTRC’s experience, key elements include; building research capacity that is closely linked to the research being conducted by the partners, establishing a clear research identity for the group that facilitates further funding and publishing in accessible (open access) high impact journals (1). The preparation of any research paper requires a significant effort and time. Publishing in high impact journals allows both young researchers to be more competitive in career advancement and established researchers to be able to get further funding to support collaborative research. The challenge for any new journal such as the APJMT is to build a reputation that will impress both readers and funders (2). While the flaws of publication metrics such as h-index and journal impact factors are recognised, they remain important factors when seeking competitive grants. Although the importance of translational research is increasingly recognised by granting bodies in funding decisions, the metrics for measuring this are not well defined (3).
https://apjmt.mums.ac.ir/article_1001_1c34430e8c9359a87a2c76680200ad0e.pdf
2013-06-01
76
76
10.22038/apjmt.2013.1001
Research
Translational
H-index
Impact factor
Andrew
Dawson
ahdawson@sactrc.org
1
South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka. Central Clinical School, Royal Prince Alfred Hospital, Sydney, Australia
LEAD_AUTHOR
Dawson AH, Buckley NA. Toxicologists in public health--Following the path of Louis Roche (based on the Louis Roche lecture "An accidental toxicologist in public health", Bordeaux, 2010). Clin Toxicol (Phila) 2011 Feb;49(2):94-101.
1
Afshari R. What is the “Best Research” for Low Income Countries? Asia Pac J Med Toxicol 2013 Mar;2(1):1.
2
Lean ME, Mann JI, Hoek JA, Elliot RM, Schofield G. Translational research. BMJ 2008 Aug 28;337:a863.
3
ORIGINAL_ARTICLE
Knowledge, Not Funding is the Most Important Research Resource
In the last issue of the Asia Pacific Journal of Medical Toxicology, Dr. Reza Afshari raised the question of what are the best scientific areas of focus of toxicology for “low income countries and how such research might be achieved (1). South-south collaboration, in which developing countries share resources, was one of the proposed solutions.
Rather than limit discussion to “low income” countries, the issue of research agenda might be better framed within the perspective of “developed” and “developing” countries. Two of the largest Asia Pacific Association of Medical Toxicology member countries, Iran and India lay almost within visual distance of the United Arab Emirates. Despite its wealth, the United Arab Emirates has a general lack of high-quality medical research, and toxicology research is virtually non-existent. In contrast, Iran and India, with far less economic strength, have a vast network of highly trained and expert clinicians in medical toxicology and most other medical specialties. This is helpful to consider, and to understand that high income does not equal quality in research.
Outstanding medical research, applicable to both developing and developed countries, may be conducted in resource-poor settings. An example of collaborative research that comes to mind is the World Health Organization (WHO) Pediatric Hydrocarbon Study Group clinical decision rule for young children with possible hydrocarbon aspiration (2). The results of this research, that was supported by the WHO, conducted in Egypt, and led by an American toxicologist, have clinical applicability and utility in developing and developed countries. Conducting this study in a developed country, such as the USA, would have been extraordinarily difficult or impossible.
In addition to South-South collaborations, tapping research expertise of other countries, developed or developing, is another key factor for facilitating relevant and translatable research in countries that historically lack such. Finding mutually relevant research questions that are shared by developed and developing countries can also avail research opportunities.
Lastly, developing a culture of research led by clinicians and persons with expertise in biostatistics and epidemiology, who may be based in clinical sciences or academia, is an important key to having a sustained productive research effort in any country.
This letter can be easily summarized: “The most important resource for quality research is not funding, it is knowledge”.
https://apjmt.mums.ac.ir/article_1002_29c55a7ff50e456bcf2fa9ac96d58423.pdf
2013-06-01
77
77
10.22038/apjmt.2013.1002
toxicology
Research
Funding
Collaboration
Robert
Hoffman
rjhoffmanmd@gmail.com
1
Albert Einstein College of Medicine, Bronx, New York
LEAD_AUTHOR
Afshari R. What is the “Best Research” for Low Income Countries? Asia Pac J Med Toxicol 2013 Mar;2(1):1.
1
WHO EMRO Pediatric Hydrocarbon Study Group, Cairo, Egypt, Bond GR, Pièche S, Sonicki Z, Gamaluddin H, El Guindi M, et al. A clinical decision rule for triage of children under 5 years of age with hydrocarbon (kerosene) aspiration in developing countries. Clin Toxicol (Phila) 2008 Mar;46(3):222-9.
2
ORIGINAL_ARTICLE
Research Priorities for Medical Toxicology in Low and Middle Income Countries
In the editorial by Dr. Reza Afshari “What is the best research for low income countries” (1), some important issues have been raised, highly relevant to developing countries. In most developing countries including India, emergency medicine is not well established and clinical toxicology is even further a low priority in view of both research and clinical management. The number of poison control and treatment centers is few and if they exist, they are mainly in metro cities. Moreover, we are faced with lack of required resources for such research.
Dr. Afshari’s suggestion about the need for epidemiological studies should be regarded as highly important (1). These studies should be prospective and community-based rather than hospital or poison centre based. Unless we know the pattern of poisonings, it will not be possible to formulate the guidelines for treatment and research as poisonings vary in different countries and in different areas of a country (2). Depending on pattern, the treatment and research guidelines can be devised and scarce resources can be allocated. The acute poisonings in developing countries are very often due to toxic chemicals. This is because there is a lack of control on availability of chemicals as laws do exist but implementation is lacking (2). Although specific antidote is available for majority of them, mortality remains high because treatment is often delayed due to non-availability of proper centres and lack of antidotes. Therefore, it is necessary to train health care professionals and to provide better awareness in general public regarding risks of poisonings. Furthermore, not only resources are lacking, western textbooks or literature is only available for management of poisonings and local guidelines are limited. In high income countries, both knowledge and money are available but poisoned patients are in limited number while in developing countries it is other way round.
We must pay the most careful attention to the role of gastric lavage which due to legal reasons in some countries such as India, it is mandatory (3).
It is also crucial to carefully investigate the venomous snakes where more species are required to be identified and antivenoms should be developed. There is a great need to develop low-priced diagnostic kits and cheaper analytic methods for poisons.
More access to information in developing world and South-South collaboration is a highly welcomed idea. We need a standardized format to record, uniform protocols to manage poisonings and low cost healthcare technologies such as self-inflating bag in saving patients with respiratory arrest following snakebite or OPC poisoning or where short term ventilation is required.
https://apjmt.mums.ac.ir/article_1003_464ff1bc486927cbc49e8dace7298b2a.pdf
2013-06-01
78
78
10.22038/apjmt.2013.1003
Developing countries
Acute poisoning
Research
Medical toxicology
Surjit
Singh
surjit51@hotmail.com
1
Department of internal medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
LEAD_AUTHOR
Afshari R. What is the “Best Research” for Low Income Countries? Asia Pac J Med Toxicol 2013 Mar;2(1):1.
1
Murali R, Bhalla A, Singh D, Singh S. Acute pesticide poisoning: 15 years experience of a large North-West Indian hospital. Clin Toxicol (Phila) 2009 Jan;47(1):35-8.
2
Bhardwaj UB, Anand S, Bhalla A, Sharma N, Singh S. Safety of gastric lavage using nasogastric ryle’s tube in pesticide poisoning. Health 2011 Jul;3(7):401-5.
3
ORIGINAL_ARTICLE
Changing the Insight of Scientists in High Income Countries: A Solution for Collaborative Research with Lower Income Countries
The recent issue of Asia Pacific Journal of Medical Toxicology made an important and interesting theme “What is the Best Research for Low Income Countries?” (1). We enjoyed reading the paper; nevertheless we hope to find a chance to share our idea.
It was mentioned that some, for sure not all, researchers from the developed countries might not have enough motivation to contribute to the scientific production in the developing countries. Sadly, we agree with this idea and in practice most of the researchers in the less developed countries face these barriers. But the question is why such subtle discrimination exists in the scientific environment of the world despite its dominant moral concepts?
Usually, scientists are working very hard to progress in their fields. Many indicators including H-index have been developed to measure the scientific level of experts. However, all of these indicators have their own limitations (2). Dr. Afshari mentioned in his paper that some scientists from north countries might not contribute since these contributions decelerate their progress. However, we did not find any strong logic for such explanation. There are many opportunities in the developing countries for scientific progress. Some of these opportunities are lower competition in scientific fields, more available International resources, many crucial questions for research, and the hospitality of the developing countries (including researchers, universities, and journals) to scientists of developed countries.
Despite the above positive points, there are some barriers as well. The scientific gaps in some fields, less effective organizations, political, and financial obstacles are some examples. However, we would like to highlight one more important issue; a considerable portion of scientists in the developed countries do not have a deep and comprehensive view about the real situation in the developing countries. Honestly, we think they might have a distorted view about the capacities and the level of works in less developed countries. As a result of such a view, it would be difficult to establish a real scientific communication and collaboration between them.
Therefore, it seems that a multi-dimensional strategy has to be taken by the scientific organizations in the developing countries with the following components:
Improving their capacities in order to minimize their gaps with the developed countries.
Working as a network and support each other efficiently by creating south-south links.
Changing the attitude of scientists in the developed countries and change their insight about the existing capacities in the developing countries.
https://apjmt.mums.ac.ir/article_1004_144ebfd0122221710f7402fdbef73228.pdf
2013-06-01
79
79
10.22038/apjmt.2013.1004
Collaboration
Research
Developing countries
Developed Countries
Hamid
Sharifi
hamidsharifi@uk.ac.ir
1
Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
AUTHOR
Ali
Haghdoost
ahaghdoost@gmail.com
2
Research Center for Modeling in Health, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
Afshari R. What is the “Best Research” for Low Income Countries? Asia Pac J Med Toxicol 2013 Mar;2(1):1.
1
Bornmann L, Daniel HD. What do we know about the h index? J Am Soc Inf Sci 2007;58(9): 1381-5.
2
ORIGINAL_ARTICLE
What Is the Best Research Globally?
Dr. Afshari’s editorial gives insight on human nature (1). Collaborative willingness usually occurs when different sides perceive personal benefit, or when institutions mandate collaboration. This is not unique between higher and lower income countries; many working in global emergency medicine (EM) observe this within wealthier countries. It exists among collaborators in low resource settings. Yes, pride and status are globally universal. Convincing others to engage altruistically is challenging. Camaraderie and “brotherhood” is created from shared experiences. Many global health practitioners work for extended times overseas, returning to their own countries with new perspectives and gratitude, if the experience was positive. As mentors, we must identify young physicians and investigators with these attributes, and create positive outcomes. Then, it is imperative to continue the relationship. Commitment is therefore needed. The Global Network of Emergency Medicine had its second meeting in Dubai in May 2013, in order to promote this idea, without making one country adhere to the system of EM of another country-in other words, EM and research is set according to autochthonous needs (2). Project funding remains difficult. In the US, the National Institutes of Health grant 5% of their budget to EM research. Yet the NIH will claim that 23% of their funding goes to emergency medicine research. Why the disparity? Occasionally, primary investigators from other specialties use our departments as their “laboratories”, leaving EM specialists outside of a given large, prospective, randomized study (much of the cardiology literature published in the New England Journal of Medicine has few of our specialists included) (3,4). Furthermore, our research methodology may be lacking, since the majority of designs are case controlled, and fewer studies overlooked by powerful funding agencies. Many funding agencies don’t understand EM priorities. Donors may be non EM trained philanthropists, or bureaucrats. Decision maker physicians are also rarely EM (5), let alone toxicology trained. Either change funding demographics, or look southward. In Mexico, PACE (http://www.pace-medspanish.org) monies come from those personally affected by emergencies or from governments wishing to improve health statistics (example: decreasing infant-maternal mortality). These community-based programs help funders reach their goals, and fund us to spread EM rurally. A Latin-American “southern” alliance exists, with the “brotherhood” of US EM organizations (ACEP). With global economic uncertainty looming, well-developed regions can benefit from programs originating from limited resource settings. Many of us believe altruism, a communal bond or desperate needs, is able to link the North and South together.
https://apjmt.mums.ac.ir/article_1005_bc0df6c3185b12359d2b47f8fc7fd051.pdf
2013-06-01
80
80
10.22038/apjmt.2013.1005
Collaboration
Emergency Medicine
Budget
Research
Darryl
Macias
dmacias@salud.unm.edu
1
Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
LEAD_AUTHOR
Afshari R. What is the “Best Research” for Low Income Countries? Asia Pac J Med Toxicol 2013 Mar;2(1):1.
1
Macias D. Emergencies in extreme conditions. Paper presented at: The 2nd Global Network Conference on Emergency Medicine; 2013 May 2-6; Dubai, United Arab Emirates.
2
Bebarta VS, Cairns CB. Emergency Care Research - A Primer. Dallas: American College of Emergency Physicians, 2012.
3
Bounes V, Dehours E, Houze-Cerfon V, Vallé B, Lipton R, Ducassé JL. Quality of publications in emergency medicine. Am J Emerg Med 2013 Feb;31(2):297-301.
4
Wilson MP, Itagaki MW. Characteristics and trends of published emergency medicine research. Acad Emerg Med 2007 Jul;14(7):635-40.
5