@article { author = {Monzavi, Seyed Mostafa and Afshari, Reza and Rehman, Nadeem}, title = {Alcohol Related Disorders in Asia Pacific Region: Prevalence, Health Consequences and Impacts on the Nations}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {1-8}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {}, abstract = {Background: In Asia Pacific (AP) region, the exact picture of the alcohol use problems has remained relatively obscure. In this study, the profile of alcohol consumption and alcohol related disorders in AP countries are presented.     Methods: Official statistics on average alcohol consumption (alcohol per capita consumption, APC), alcohol related health variables, income group and alcohol policy of countries geographically related to Asia and Oceania continents were extracted from the 2014 edition of World Health Organization report on global status of alcohol and health. Results: The data of 57 AP countries were analyzed. Two-third of the countries did not establish comprehensive national monitoring systems (NMSs). Median of total APC in people aged 15 years and older was 2.4 (1-4.6) L during 2003 to 2005, while this indicator was 2.8 (1-5.5) L during 2008 to 2010 which accounts for about 0.4 L (in median) increase in consumption. In 13 countries which were mostly located in South-east Asia and the Pacific region, APC was higher than average global consumption. Comparing the countries with and without total ban policy, the countries with total ban policy had significantly lower APC (P = 0.003), higher rate of abstainers (P = 0.002) and lower rate of alcohol related disorders (P < 0.001). Higher APC and higher rates of alcohol related disorders were observed in higher income countries. Conclusion: Alcohol consumption in AP region is comparatively lower than global average. However, the status of some countries in Southeast Asia and Pacific region is alarming and needs serious attention. Moreover, establishment of comprehensive NMSs, proper data registry and holistic harm reduction and rehabilitation programs for users should receive meaningful governmental and public support.}, keywords = {Alcohol Drinking,Alcohol-Related Disorders,Asia,Oceania}, url = {https://apjmt.mums.ac.ir/article_4158.html}, eprint = {https://apjmt.mums.ac.ir/article_4158_090fd8d65e80de1fef44d7cbbc4aca16.pdf} } @article { author = {Brent, Jeffrey}, title = {Translational Antidote Research: A Bedside to Bench Tale}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {9-12}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.4159}, abstract = {Although antidote development should proceed in an orderly fashion from observation, to experimental and safety studies, to clinical trials, this sequence is not always precisely followed. The development of fomepizole as an antidote for toxic alcohol and glycol poisoning is an example of how this may not be the case. Interest in the development of fomepizole was spurred in the 1960s. Shortly thereafter studies characterized by administration to humans commenced. The potential value of fomepizole as an antidote for methanol poisoning was highlighted by primate experiments. Simultaneously, the utility of fomepizole was shown in an experimental model of ethylene glycol poisoning. Further studies on humans showed effectiveness of fomepizole in the treatment of disulfiram-alcohol reactions and ethylene glycol poisoning. In addition, in primate experiments, the safety of fomepizole was established as the subjects tolerated serum fomepizole concentrations over 150 times higher than therapeutic target levels. Subsequent studies have validated the efficacy of fomepizole in the treatment of ethylene glycol and methanol poisonings. Fomepizole has been found to be associated with fewer complications than the alternative alcohol dehydrogenase inhibitor, ethanol. In serious cases of methanol toxicity, fomepizole has been shown to improve survival compared to that obtained with ethanol.}, keywords = {antidote,Fomepizole,Methanol,Poisoning,Translational Medical Research}, url = {https://apjmt.mums.ac.ir/article_4159.html}, eprint = {https://apjmt.mums.ac.ir/article_4159_4ba53d5dabdedfd34ade93d0b1342cde.pdf} } @article { author = {McDonough, Michael}, title = {Alcohol Use Disorders: Implications for the Clinical Toxicologist}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {13-24}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.4160}, abstract = {Alcohol use disorders (AUDs) are a health problem of high prevalence in most communities and such problems account for 5% of the total burden of disease worldwide. Clinical toxicologists are commonly required to treat patients having AUDs and associated drug/alcohol-related harm. There have been recent changes to some of the diagnostic criteria (notably in DSM V) relevant to AUDs, with older terms “alcohol abuse” and “alcohol dependence” no longer being classified. AUDs may sometimes not be clearly recognizable and use of evidence-based screening interventions can help identify such conditions and lead to effective brief interventions (e.g. SBIRT programs in emergency departments). AUDs are viewed as chronic disorders of alcohol consumption occurring across a spectrum of severity. While most AUDs are mild to moderate in severity and usually self-limiting conditions, more severe presentations are more commonly encountered by physicians in emergency settings. Hence, clinical toxicologists are more likely to see patients within the more severe form of disorder, at end of the spectrum of AUDs. Among this group of patients, multi-morbidity and particularly high mortality risk exists, and thus they usually require management collaboration with specialist services. Patients with AUDs are most likely to be recognized by a clinical toxicologist in the following scenarios: following acute heavy alcohol ingestion and subsequently developing acute alcohol intoxication (ethanol toxidrome), following accidental or intentional drug overdosage where alcohol has also been consumed, following acute alcohol consumption that has been associated with behavioral risk-taking and/or self-harming (e.g. poisoning, envenomation, etc.), when alcohol withdrawal reactions are severe requiring hospitalization and possibly following an adverse drug reaction.}, keywords = {Alcohol Related Disorders,Alcohol Deterrents,Alcoholism,Substance Withdrawal Syndrome,Toxicologist}, url = {https://apjmt.mums.ac.ir/article_4160.html}, eprint = {https://apjmt.mums.ac.ir/article_4160_94171a217c95d4feb07a814237e11c58.pdf} } @article { author = {Rahimi, Hamid Reza and Jaafari, Mahmoud Reza and Mohammadpour, Amir Hooshang and Abnous, Khalil and Ghayour Mobarhan, Majid and Ramezanzadeh, Elahe and Mousavi, Fateme and Kazemi Oskuee, Reza}, title = {Curcumin: Reintroduced Therapeutic Agent from Traditional Medicine for Alcoholic Liver Disease}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {25-30}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.3983}, abstract = {Alcoholic liver disease (ALD) is the main cause of chronic liver disease across the world and can lead to fibrosis and cirrhosis. The etiopathogenesis of ALD is related to ethanol-induced oxidative stress, glutathione reduction, abnormal methionine metabolism, malnutrition, and production of endotoxins that activate Kupffer cells. Curcumin is an active ingredient of the rhizome of turmeric. The substance is shown to have minor adverse effects. As the substance possess low bioavailability in free formulation, different strategies has been conducted to improve its bioavailability which resulted in production of nanomiscels and nanoparticles. Curcumin can provide protection for the liver against toxic effects of alcohol use. Several studies showed curcumin blocks endotoxin-mediated activation of NF-κB and suppresses the expression of cytokines, chemokines, COX-2, and iNOS in Kupffer cells. According to the molecular studies, curcumin inhibits NF-κB signaling pathway, regulates cytokines production and modulates immune response. It has been shown that curcumin can suppress gene expression, especially cytokines genes resulting in down-regulation of tumor necrosis factor-α (TNF-α), interleukin 1 (IL-1), IL-6, IL-8, adhesion molecules (ICAM, VCAM) and C-reactive protein. Hence, curcumin can have therapeutic effects on the majority of chronic inflammatory diseases such as asthma, bronchitis, inflammatory bowel disease, rheumatoid arthritis, ALD, fatty liver, and allergy.}, keywords = {Alcoholic Liver Diseases,Curcumin,Kupffer Cells,NF-kappa B}, url = {https://apjmt.mums.ac.ir/article_3983.html}, eprint = {https://apjmt.mums.ac.ir/article_3983_892a347394e8bba8e28bd927930a55af.pdf} } @article { author = {Gashlin, Lauren Z. and Groth, Christine M. and Wiegand, Timothy J. and Ashley, Elizabeth}, title = {Comparison of Alcohol Withdrawal Outcomes in Patients Treated with Benzodiazepines Alone versus Adjunctive Phenobarbital: a Retrospective Cohort Study}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {31-36}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.3984}, abstract = {Background: For treatment of severe alcohol withdrawal syndrome, high dose benzodiazepines (BZDs) may cause delirium and over-sedation. Phenobarbital (PBT) is a long-acting barbiturate effective for the treatment of alcohol withdrawal. Given the potential benefits of PBT, we sought to investigate the effectiveness of PBT as adjunctive treatment for alcohol withdrawal. Methods: This was a retrospective cohort study on patients with a diagnosis of alcohol withdrawal who had a CIWA-Ar score > 10 treated with either BZDs alone (BZD alone group) or BZDs with adjunctive PBT (PBT-adjunct group). The patients received at least one dose of PBT in addition to BZDs (variable doses) in the PBT-adjunct group, and three doses of 20 mg diazepam equivalents within 6 hours in the BZD alone group. The primary endpoint was the proportion of patients with a CIWA-Ar score < 10 at 24 hours after initial treatment. Duration of withdrawal and cumulative dose of BZDs were also assessed. Results: Seven subjects in the adjunctive phenobarbital and 21 in the benzodiazepine group were included in the final analysis. Two patients (28.6%) in the PBT-adjunct group and 5 patients (23.8%) in the BZD only group achieved the primary endpoint, though the difference between the two groups was not statistically significant (P = 0.588). The median (IQR) duration of withdrawal symptoms was 44 (12-62) hours in the PBT-adjunct group compared to 53 (37-87) hours in the BZD only group, with no significant difference between the groups (P = 0.249). The median (IQR) cumulative BZD dose requirement (diazepam equivalent) in the PBT-adjunct group was significantly lower than BZD alone group (25 (20-226) vs. 326 (160-550) mg, P = 0.02). Conclusion: PBT appears to be a safe and effective alternative to BZDs for the treatment of alcohol withdrawal in non-critically ill patients and may be BZD sparing.}, keywords = {Alcohol Withdrawal Delirium,Alcoholism,Benzodiazepines,Comparative Effectiveness Research,Phenobarbital}, url = {https://apjmt.mums.ac.ir/article_3984.html}, eprint = {https://apjmt.mums.ac.ir/article_3984_9b8c792e9ad16a0cb0368c75459e4155.pdf} } @article { author = {Zavar, Abbas and Jarahi, Lida and Alimoradi, Bahman and Khosravi, Nafiseh}, title = {The Alcohol Use Disorders Identification Test (AUDIT): Reliability and Validity of the Persian version}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {37-42}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.4161}, abstract = {Background: Alcohol Use Disorders (AUDs) has been recently prioritized as a health problem in Iran. The Alcohol Use Disorders Identification Test (AUDIT) is an easy-to-use diagnostic tool for excessive drinking. This study was designed to assess the validity and reliability of the Persian version of AUDIT questionnaire. Methods: Participants were 70 individuals with AUD (study group) and 70 non-alcoholic individuals (control group). Persian AUDIT was completed for all participants. Explanatory factor analysis was used for construct validity; and the reliability of AUDIT was determined by examining internal consistency and test-retest reliability. ROC curve was applied for calculation of specificity and sensitivity. Results: Using Cronbach’s alpha, the internal reliability of the Persian AUDIT was estimated to be 0.77. The internal consistency coefficient of the Persian AUDIT was calculated to be 0.78 by the split-half method in the total population. The correlation of the test-retest results was statistically significant (r = 0.711, P = 0.020). Using the ROC curve at the cutoff point of 8, a specificity and sensitivity of 89% and 99% was achieved for the test and the accuracy of the area under the curve was achieved to be 99% (P < 0.001). The cutoff value of 8 in AUDIT questionnaire was specified as the best cutoff point. Control subjects obtained significantly lower mean scores compared to alcoholic subjects (P < 0.001). Conclusion: Given the acceptable reliability and validity of the Persian AUDIT and its high sensitivity and specificity, it can be used as an effective instrument for identification of AUDs, risky drinkers and early detection of ulterior cases of alcohol addiction in the Persian speaking population.}, keywords = {Alcohol-Related Disorders,Alcoholism,Iran,Questionnaires,Reproducibility of Results}, url = {https://apjmt.mums.ac.ir/article_4161.html}, eprint = {https://apjmt.mums.ac.ir/article_4161_8cd8e5143a23bc591e5cb778ab44da3b.pdf} } @article { author = {Brusin, Konstantin M. and Nekhoroshkov, Roman O.}, title = {A 13-Year Retrospective Study on Toxic Alcohol Poisoning in Middle Urals, Russia}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {43-46}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.4162}, abstract = {Background: Toxic alcohol poisonings are responsible for high mortality and morbidity in Russia. This study was aimed to evaluate the trends of harmful ethanol (EtOH) drinking as well as methanol (MeOH), isopropanol (IPA) and ethylene glycol (EG) poisonings in the Middle Urals region of Russia. Methods: In this retrospective study, the medical records of patients poisoned with MeOH, IPA and EG as well as those with harmful heavy EtOH drinking admitted to Regional Poison Treatment Center in Yekaterinburg during the period of 2002 to 2014 were reviewed. Results: During this 13-year period, 17482 patients with acute poisoning (due to various toxic agents) were admitted, which 2244 of them (12.8%) were due to alcohol poisoning. Of all patients with acute poisoning, 502 cases died which 61 of them (12.2%) were due to alcohol poisoning. Most of the alcohol poisoned patients were men (1658, 73.9%). The male proportion of EG poisoned patients was higher than poisoned patients with other types of alcohol. Harmful EtOH drinking constituted the majority of alcohol poisoning cases (2076, 92.5%). Patients with EG poisoning were relatively older while patients with heavy EtOH intake were significantly younger (P < 0.001). The highest mortality rate (35.9%) was seen in patients with EG poisoning. During this period, heavy EtOH drinking had a slight increasing trend and MeOH poisoning had a sharp increasing trend. On the other hand, IPA poisoning had a constant trend and the trend of EG poisoning was decreasing. The majority of MeOH and IPA poisonings were due to ingestion of surrogate alcohols. Conclusion: Particular attention of health authorities should be directed towards alcohol drinking prevention measures as well as production and availability of surrogate alcohols in the community.}, keywords = {Ethanol,Ethylene glycol,Methanol,Poisoning,Russia}, url = {https://apjmt.mums.ac.ir/article_4162.html}, eprint = {https://apjmt.mums.ac.ir/article_4162_3113f68472eeb44743187a4560bc9e40.pdf} } @article { author = {Eghbali, Hakimeh and Mostafazadeh, Babak and Ghorbani, Mazaher and Behnoush, Behnam}, title = {Neurologic Complications of Methanol Poisoning: A Clinicoepidemiological Report from Poisoning Treatment Centers in Tehran, Iran}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {47-50}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.4163}, abstract = {Background: In this study we sought to investigate clinical findings (with a focus on neurologic effects) and also to analyze outcomes of a series of patients with methanol poisoning admitted to two poisoning treatment centers in Tehran, Iran. Methods: In this prospective cross-sectional study, methanol-poisoned patients admitted to departments of forensic medicine and toxicology of Loghman Hakim and Baharloo hospitals in Tehran during October 2010 to October 2011 were included; and their data were recorded in predesigned checklists. Results: Twenty-eight methanol poisoned patients (82.1% men) with mean age of 29.3±4.6 years were studied. Most patients (67.9%) had metabolic acidosis at presentation. On admission, all patients had different degrees of decrease in consciousness, who the majority of them (57.1%) were admitted with mildly reduced consciousness (grade I of Grady coma scale). Headache and vertigo were observed in 7.1% and 17.9% of patients, respectively. Most patients (53.6%) had no ocular effects, while 46.6% of patients developed impaired vision. All patients received sodium bicarbonate. Ethanol as antidote and folic acid were given to 18 patients (64.2%) and 16 patients (57.1%), respectively. Six patients (21.4%) underwent hemodialysis. Over half of the patients (53.6%) fully recovered and were discharged without complications. Four patients (14.3%) developed total blindness. Four patients (14.3%) left the hospital against medical advice by self-discharge (they had no significant complication at the time of discharge). Five patients (17.9%) died; who compared to survived cases had significantly lower blood pH (P=0.028), higher coma grade (P<0.001) and more delayed presentation to hospital (P=0.004). Age had no significant impact on mortality.    Conclusion: Methanol poisoning causes major neurologic effects such as coma and blindness. It is also responsible for high mortality.}, keywords = {blindness,Methanol,Mortality,Neurologic manifestations,Poisoning}, url = {https://apjmt.mums.ac.ir/article_4163.html}, eprint = {https://apjmt.mums.ac.ir/article_4163_a00b4487e040cf7eec5688030b8c298e.pdf} } @article { author = {Band, Rahul Mohanrao and Meena, Mahesh Chand and Kandpal, Alok and Mittal, Sachin}, title = {Rapid Death Due to Alcohol Withdrawal Syndrome: Case Report and Review of Literature}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {51-54}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.4164}, abstract = {Background: Alcohol withdrawal syndrome (AWS) is one of the most serious complications associated with chronic alcoholism. Sudden deaths are not uncommon in AWS. In severe stages of AWS, delirium tremens (DT) occurs, which is characterized with agitation, global confusion, disorientation, visual and auditory hallucinations in addition to autonomic hyperactivity. Case report: A 30-year old man, chronic and heavy alcohol drinker for 10 years, abstained from alcohol for 3 days. Consequently, he started having palpitations, sweating and tremors. A day later, he was found having hallucinations and delirium. The patient was immediately transferred to the hospital. On admission, he was stuporous and had difficulty in breathing. He developed generalized seizures later on. He was successfully intubated, but there was bleeding through it. The patient’s condition deteriorated very rapidly and he died within two hours. After death, his body was transferred to forensic department. In autopsy, gastrointestinal tract was found to be intact. Massive pulmonary hemorrhage was present on cut section. Liver was found to be with yellowish discoloration and early cirrhotic changes. In heart, left ventricular hypertrophy with narrowed lumen was present and coronary arteries were patent. Discussion: Alcoholism is associated with liver dysfunction and especially in final phases with cirrhosis. Hence and due to resultant coagulopathy, patients are vulnerable to internal bleedings. Hypertrophic cardiomyopathy also occurs in chronic alcoholics. Therefore, we can speculate that our patient developed pulmonary hemorrhage as a result of combined effect of coagulopathy secondary to cirrhosis, alveolar damage (seizure and artificial ventilation) and congestive heart failure. Conclusion: For a patient with delirium, convulsions, respiratory distress and coagulopathy, diagnosis of DT should be kept in mind.}, keywords = {Alcohol Withdrawal Delirium,Alcoholism,Hemoptysis,Liver Cirrhosis,Sudden Death}, url = {https://apjmt.mums.ac.ir/article_4164.html}, eprint = {https://apjmt.mums.ac.ir/article_4164_5c6806f848c9dd2f5f6174793616d256.pdf} } @article { author = {Kunnummal Madathodi, Abdul Raoof and Andrews, Mekkattukunnel A. and Madhavan, Indira}, title = {Ethylene Glycol Poisoning; an Unusual Cause of Hyperglycemia: A Case Report}, journal = {Asia Pacific Journal of Medical Toxicology}, volume = {4}, number = {1}, pages = {55-57}, year = {2015}, publisher = {Mashhad University of Medical Sciences}, issn = {2322-2611}, eissn = {2322-4320}, doi = {10.22038/apjmt.2015.4165}, abstract = {Background:Poisoning with ethylene glycol (EG) can be fatal even if appropriate treatments are delivered. EG poisoning usually causes central nervous system depression, cardiovascular dysfunction, metabolic acidosis and acute renal failure (ARF). Case Report:A 33-year-old man was referred to the emergency department with reduced consciousness and dyspnea of four-hour duration due to unknown reason. The patient had no history of diabetes, hypertension, cardiac disease or asthma. He was tachycardic, tachypneic and hypertensive. Laboratory investigations revealed hyperglycemia, high serum creatinine, hyponatremia, hyperkalemia, leukocytosis and high anion gap metabolic acidosis (HAGMA). He was initially managed as diabetic ketoacidosis (DKA). Alternative diagnoses of toxic alcohols poisoning was considered as there was no improvement. EG ingestion was confirmed when the relatives found an empty bottle of automotive brake oil, a poly glycol-based product, in the patient’s room. Although he was treated with ethanol and hemodialysis, renal failure worsened and finally he succumbed to death due to severe sepsis on the seventh day of EG ingestion. Discussion: This case illustrates the difficulties posed by high toxicity as well as unraveled and delayed diagnosis of EG poisoning. High anion gap and high osmolal gap are characteristics of EG poisoning. Transient pancreatitis caused by EG and insulin resistance due to ARF are the possible explanations for hyperglycemia secondary to EG poisoning. Conclusion:EG poisoning may manifest with hyperglycemia and HAGMA resembling DKA. It is important for the clinician to have high degree of suspicion for EG poisoning in case of HAGMA and ARF refractory to common treatments.}, keywords = {Acidosis,Ethylene Glycol, Hyperglycemia, Poisoning,Renal Insufficiency}, url = {https://apjmt.mums.ac.ir/article_4165.html}, eprint = {https://apjmt.mums.ac.ir/article_4165_df187ca5d9955bc83404bded26b6ea57.pdf} }