@article { author = {Vaghela, Snehal and Afshari, Reza}, title = {Comparative Cancer Risk Assessment to Estimate Risk of Hepatocellular Carcinoma Attributable to Dietary Exposure of Aflatoxin through a Surrogate (Maize) in Eastern Mediterranean Region (Iran) as Compared to East (Canada) and West Pacific (China) Regions}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {6}, number = {3}, pages = {67-73}, year = {2017}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2017.9395}, abstract = {Background:Hepatocellular Carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer related deaths worldwide. Chronic infection with Hepatitis B (HBV) and Hepatitis C (HCV) virus are significant risk factors of HCC. Aflatoxins, type of mycotoxin, produced by fungi Aspergillus flavus and Aspergillus parasiticus are potent liver carcinogen. This cancer risk assessment was conducted with aim to compare risk of aflatoxin attributable HCC in the countries of Eastern Mediterranean region with countries of region of Americas (East) and Western Pacific region (West).Methods:Cancer risk assessment was conducted using data on maize consumption for select countries from food balance sheets (FBS) database of the Food and Agriculture Organization of the United Nations (FAO), aflatoxin contamination level of the maize and chronic HBV infection prevalence from 37 publications retrieved from literature review.Results:Risk of HCC attributable to aflatoxin exposure in Iran is 0.02 (0.0001 – 0.095) HCC cases per 100,000 chronic HBV negative population which reflects in 15-75 HCC cases per year. Among the select WHO regions, most cases occur in China and Philippines from Western Pacific region and Mexico from region of Americas.Conclusion:Risk of aflatoxin related HCC in Iran is comparable to high income countries from region of Americas and Western Pacific region.}, keywords = {Hepatocellular carcinoma,Aflatoxins,Hepatitis}, url = {https://apjmt.mums.ac.ir/article_9395.html}, eprint = {https://apjmt.mums.ac.ir/article_9395_fec4bf2ee69603a37d739204bee6555a.pdf} } @article { author = {Salameh, Rawan and Salem, Waleed Awad and Qureshi, ISMA and Al-Bukari, Asma and Shaat, Eman and Moinudheen, Jibin and Aleassi, Galal and Hoffman, Robert}, title = {Appropriate Utilization and Stocking of Antidotes in Qatar Public Hospitals}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {6}, number = {3}, pages = {74-80}, year = {2017}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2017.9401}, abstract = {Background: There are a few studies that evaluate preparedness and availability of antidotes in the emergency setting and none have been conducted in Qatar. Published studies show that timely availability of antidotes in the emergency department setting is a common issue. To address this, we conducted a study to evaluate antidote stocking and utilization in Qatar hospital pharmacies and emergency departments. Methods: In order to evaluate the appropriate use and timely administration of antidotes, research assistants prospectively collected data on ED patients. All ED patients who received any key antidote over the 6-month study period were identified through both ED and pharmacy records. In order to evaluate the stocking of the 31 most important antidotes in our main public hospitals, a survey assessing the stocking of these key antidotes was sent to the four general hospitals in Qatar, to determine their availability and whether they are stocked in the ED or only in the main pharmacy. Results: Poison exposure was evaluated in 471 cases. Antidotes were given within 30 minutes in 73% of cases, which included atropine, calcium, dextrose, flumazenil, naloxone, pralidoxime, sodium bicarbonate, thiamine, vitamin K and scorpion and snake antivenoms. Administration occurred later than 60 minutes in 2% of cases, exclusively with N-acetylcysteine and activated charcoal. Atropine, calcium, dextrose, naloxone, pralidoxime (2-PAM), sodium bicarbonate, and anti-venoms were clinically indicated 92% of the times they were ordered. N-acetylcysteine was indicated in only 51.5% of administrations. Significant variation in antidote stocking existed between hospitals, and there was no stocked hydroxocobalamin as antidotes for cyanide poisoning or fomepizole for toxic alcohol poisoning. Conclusion: Antidote stocking varied significantly between hospitals, and antidotes necessary for cyanide and toxic alcohol poisoning were deficient in all public hospitals. The implication of this research indicates the need for the development of national guidelines to standardize the stocking and administration protocols of the antidotes among the country’s public hospitals.}, keywords = {Acetylcysteine,antidote,Poisons,stocking}, url = {https://apjmt.mums.ac.ir/article_9401.html}, eprint = {https://apjmt.mums.ac.ir/article_9401_5331e2c701cfc1271c1bad51af678551.pdf} } @article { author = {Salimiasl, Seyed Majid and Khodayar, Mohammad javad and Mousavi, Zahra and Akhgari, Maryam}, title = {Comparison of the Modified QuEChERS Method and the Conventional Method of Extraction in Forensic Medicine to Detect Methadone in Post-Mortem Urine by GCMS}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {6}, number = {3}, pages = {81-87}, year = {2017}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2017.9402}, abstract = {Background:Extraction of drugs is one of the biggest concerns and the most important part of preparation and determination in forensic medicine. The lack of an easy, efficient and fast extraction method is the most important and most difficult problem despite the development of forensic centers and their being equipped with new diagnostic devices. In the present study, a comparison was conducted between extraction of methadone in post-mortem urine (Autopsy), using modified QuEChERS method and conventional liquid-liquid extraction method in forensic medicine. Method: Methadone extraction from the Post-Mortem urine sample was performed using QuEChERS extraction method, which is a simple and fast micro-extraction method in tube. In this method, the analyte was extracted using MgSO4, NaCl salts and ethyl acetate solvent, and detected by Gas Chromatography-Mass Spectrometry (GCMS). Results: The recovery level of methadone analyte in the urine sample obtained was equal to 67% (N = 15) in QuEChERS method, and 49% (N =1 5) in LLE method. In this center, the LOD and LOQ of the methadone were determined, using GC-MS device, to be equal to 29.1ng/mL and 97ng/mL, respectively. According to the results obtained, there was a significant difference between QuEChERS and LLE methods, in terms of methadone test in post-mortem urine. Conclusion: Cheap, fast, effective, and green QuEChERS, improved with better recovery, could replace the LLE method in detecting methadone in Post-Mortem urine.}, keywords = {How to cite this article: Salimiasl SM, Khodayar MJ, Mousavi Z, Akhgari M. Comparison of the Modified QuEChERS Method and the Conventional Method of Extraction in Forensic Medicine to Detect Methadone in Post-Mortem Urine by GCMS. Asia Pac J Med Toxi,6(3):79-85}, url = {https://apjmt.mums.ac.ir/article_9402.html}, eprint = {https://apjmt.mums.ac.ir/article_9402_a7461d88dc65174f4601ec94178e9572.pdf} } @article { author = {Rahmani, Alihasan and Zeidooni, Leila and Samimi, Azin}, title = {Prevalence of Symptoms in Patients Poisoned with Iranian Crack in Ahvaz Razi Hospital in 2008-2013}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {6}, number = {3}, pages = {88-91}, year = {2017}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2017.9403}, abstract = {Background: Crack is a strong and smoking form of cocaine, but Iranian crack is different from common crack cocaine, having symptoms and side effects similar to those of heroin. This study was to investigate the prevalence and clinical symptoms in patients poisoned with Iranian crack poisoning hospitalized in Ahvaz Razi Hospital in the years 2008-2013. Methods: In this study, 63 subjects with Iranian crack poisoning referred to the poisonings center of Ahvaz Razi Hospital, Khuzestan Province, Iran, between 2008 and 2013. The information collected from their records based on hospital data includes reference data, demographic data, prevalence and clinical symptoms and treatment. Results: Of 63 subjects, 88.9% were male. The mean age of the subjects was 25 years. The majority of the subjects were single. Most of them used another substance along with Iranian crack. The first clinical symptoms of more than half of them were loss of consciousness. 54% of them needed antidote; 69.8% admitted to ICU. 6.3% of the subjects died. Conclusion:We concluded that the most prevalent pattern and the first signs of Iranian crack overdose are similar to heroin consumption and not crack cocaine. Therefore, more studies are required for clinical management of acute or chronic toxicity of this illicit drug and to reduce further damages.}, keywords = {Crack,Crack Cocaine,Heroin,Iran}, url = {https://apjmt.mums.ac.ir/article_9403.html}, eprint = {https://apjmt.mums.ac.ir/article_9403_ec23a5ded9b59d0267b6acb99fac86f3.pdf} } @article { author = {Ghasemi Tousi, Alireza}, title = {Successful Treatment of Aluminium Phosphide, is it possible?}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {6}, number = {3}, pages = {92-98}, year = {2017}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2017.9405}, abstract = {Background: The utilization of pesticides like AlP has expanded in the current years and enhanced the amount and nature of horticultural items in various developing nations. Considering that in addiction research centers, many cases of suicide with rice tablet have been observed and various methods have been proposed for the treatment, it was decided to examine different methods and to finally compare the effectiveness of these methods with experiences and observations in the present study. Methods: 30 articles were compiled from prestigious scientific databases such as PubMed, Scopus and Elsevier, from 2010 to 2017. The search was carried out in English, using “aluminum phosphide,” “treatment” and “rice tablet” as the keywords. Results: Phosphine creates free oxygen radicals in body tissues, it has been demonstrated that organs with a higher requirement for oxygen (heart, lung, kidney, and liver) show higher sensitivity to the harm prompted by phosphine gas, which is consistent with the histopathological changes in these organs after death. In vitro experiences recommend that phosphides are retained as too tiny particles of unhydrolysed salt that for all time associate with free hemoglobin and hemoglobin in untouched erythrocytes (rat and human) to create a haemichrome. Conclusion: Many articles refer to successful treatment of rice tablets. While some factors are not considered. Considering these issues and the importance of obtaining the patient's history and taking into account clinical affairs as well as mere research, the effectiveness of the treatment methods mentioned in the study requires further consideration and investigation of all factors.}, keywords = {Aluminum phosphide,Rice tablet,Treatment}, url = {https://apjmt.mums.ac.ir/article_9405.html}, eprint = {https://apjmt.mums.ac.ir/article_9405_2d8e59d1e717ca27e47cb5e5beb1ca97.pdf} } @article { author = {Midha, Naresh and Misra, Arup and Chhabra, Vivek and Bohra, Gopal}, title = {Olanzapine Overdose in a Pin Point Pupil with Altered Sensorium}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {6}, number = {3}, pages = {99-100}, year = {2017}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2017.9404}, abstract = {Background:Olanzapine is a highly tolerable and easily affordable atypical antipsychotic drug which has been commonly prescribed in both inpatient and outpatient settings for several mental disorders. Olanzapine overdose is commonly seen in psychiatric patients, who attempt suicide by intoxicating themselves with their own prescribed medications. Increased olanzapine use is associated with increased incidence of overdosing. Case Presentation:We are reporting a case of olanzapine overdosage as a cause of pinpoint pupils and altered sensorium with exclusion of other differentials. The mainstay of managementof olanzapine overdose is general supportive and symptomatic measures. Discussion: Pinpoint pupils with altered sensorium and agitation are always an alarming situation for a clinician, because of differentials like organophosphorus poisoning, pontine hemorrhage and opium overdosing. Due to olanzapine overdosage, similar clinical picture can be confusing in the emergency department and early identification of such cases is helpful to decrease the risk of fatality. Conclusion: This case highlights the significance of olanzapine overdosing as a differential diagnosis for patients presented with altered sensorium and pinpoint pupils in the emergency department. Olanzapine overdosage is associated with high morbidity and mortality. Although there is no specific antidote for olanzapine overdose, appropriate history, assessment and early diagnosis are very useful for the better outcome.}, keywords = {Agitation,Antipsychotics,Pontine hemorrhage}, url = {https://apjmt.mums.ac.ir/article_9404.html}, eprint = {https://apjmt.mums.ac.ir/article_9404_6c86aa2184b9aa5768d32dfdc8b74787.pdf} } @article { author = {Shamim, Khusro and Ullah Khan, Nadem and Baig, Muhammad Akbar and Waheed, Shahan and Iqbal, Arshad}, title = {A Case of a Contraband Body Packer Requiring High-Dose Naloxone}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {6}, number = {3}, pages = {101-103}, year = {2017}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2017.9406}, abstract = {Background:Body packers occasionally refer to the Emergency Department (ED), after leakage of package contents within intestinal lumen, resulting in life-threatening toxicities, depending upon the nature of the chemical product. Case Presentation: We present a case report of a patient presented with sudden onset of drowsiness while he was on board a flight. He was brought in by the airport security staff. On arrival to the ED, his Glasgow Coma Scale (GCS) was 3/15 and pupils were pinpoint bilaterally. He was empirically treated with Naloxone on clinical suspicion of narcotic overdose. He required a cumulative dose of 12 mg of Naloxone for reversal of respiratory depression and coma. On subsequent investigation in the ED, he was identified to be a body packer. Discussion: This case represents a rare clinical example of narcotic overdose which resulted in a life-threatening opioid toxicity due to leakage of the package contents into his bowels. In this case, a dosage greater than 10 mg of the maximum recommended dose of Naloxone is required for reversal of toxicity. Conclusion:It is imperative to have a high level of suspicion for managing possible opioid intoxication as immediate treatment can be diagnostic and lifesaving. Our case required more than the recommended dosage of Naloxone, highlighting the possible suggestion of further studies to look into the maximum threshold of this reversal agent.}, keywords = {Body Packer,Coma,Overdose,Narcotic,Naloxone}, url = {https://apjmt.mums.ac.ir/article_9406.html}, eprint = {https://apjmt.mums.ac.ir/article_9406_dc8894fc82e6f4cee49b4039288c2934.pdf} }