ORIGINAL_ARTICLE
Asian Implications of Aflatoxin and Dioxin Foodborne Chemical Exposures Based on World Health Organization Estimates
All people need food. Unsafe foods; however, may cause diseases ranging from diarrhea to cancer. Chemicals in food are a worldwide health concern. In 2006, the World Health Organization (WHO) organized a consultation on the global burden of foodborne diseases. Work to estimate this burden began in 2007 and was carried out by the WHO Foodborne Disease Burden Epidemiology Reference Group (FERG), which included a Chemical and Toxins Disease Task Force. The results of 8 years of work were released in December 2015.
https://apjmt.mums.ac.ir/article_6358_770957946505ecfc753db2a75c249be4.pdf
2015-12-01
131
133
10.22038/apjmt.2015.6358
Aflatoxins
Chemical Hazard Release
Dioxins
Disease Burden
Foodborne Diseases
Herman
Gibb
herman.gibb@gibbepi.com
1
Gibb Epidemiology Consulting LLC, Arlington, VA, USA
AUTHOR
Brecht
Devleesschauwer
2
Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
AUTHOR
P. Michael
Bolger
3
Exponent, Center for Chemical Regulation and Food Safety, Washington, DC, USA
AUTHOR
Felicia
Wu
4
Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
AUTHOR
Janine
Ezendam
5
National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
AUTHOR
Julie
Cliff
6
Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
AUTHOR
Marco
Zeilmaker
7
National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
AUTHOR
Philippe Jean-Paul
Verger
8
Department of Food Safety and Zoonoses, World Health Organization, Geneva, Switzerland
AUTHOR
John
Pitt
9
CSIRO Food and Nutrition Flagship, North Ryde, Australia
AUTHOR
Janis
Baines
10
Food Data Analysis Section, Food Standards Australia New Zealand, Canberra, Australia
AUTHOR
Gabriel
Adegoke
11
Department of Food Technology, University of Ibadan, Ibadan, Nigeria
AUTHOR
Reza
Afshari
afsharireza@yahoo.com
12
Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
LEAD_AUTHOR
Yan
Liu
13
INTERTEK, Oak Brook, IL, USA
AUTHOR
Bas
Bokkers
14
National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
AUTHOR
Henk
van Loveren
15
National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
AUTHOR
Marcel
Mengelers
16
National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
AUTHOR
Esther
Brandon
17
National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
AUTHOR
Arie Hendrik
Havelaar
18
Emerging Pathogens Institute and Animal Sciences Department, University of Florida, Gainesville, FL, USA
AUTHOR
David C.
Bellinger
david.bellinger@childrens.harvard.edu
19
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
AUTHOR
World Health Organization. Food Safety; All people need food, each and every day [Internet]. 2015 [Cited 8 Dec 2015]. Available from: http://www.who.int/foodsafety/en/
1
World health organization. Food Safety; Chemical Risks [Internet]. 2015 [Cited 8 Dec 2015]. Available from: http://www.who.int/foodsafety/areas_work/chemical-risks/en/
2
World Health Organization (WHO). Department of Food Safety, Zoonoses and Foodborne Diseases Sustainable Development and Healthy Environments. WHO Consultation to Develop a Strategy to Estimate the Global Burden of Foodborne Diseases. Taking Stock and Charting the Way Forward. Geneva, Switzerland: WHO Press; 2007.
3
Gibb H, Devleesschauwer B, Bolger PM, Wu F, Ezendam J, Cliff J, et al. World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010: a data synthesis [version 1; referees: 2 approved, 1 approved with reservations]. F1000Research 2015;4:1393.
4
World Health Organization. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. Geneva, Switzerland: WHO Press; 2015.
5
World Health Organisation. WHO regional offices [Internet]. 2015 [Cited 8 Dec 2015]. Available from: http://www.who.int/about/regions/en/
6
Liu Y, Wu F. Global burden of aflatoxin-induced hepatocellular carcinoma: a risk assessment. Environ Health Perspect 2010;118:818-24.
7
Kana JR, Gnonlonfin BG, Harvey J, Wainaina J, Wanjuki I, Skilton RA, et al. Assessment of aflatoxin contamination of maize, peanut meal and poultry feed mixtures from different agroecological zones in Cameroon. Toxins (Basel) 2013;5:884-94.
8
Utsumi T, Lusida MI. Viral hepatitis and human immunodeficiency virus co-infections in Asia. World J Virol 2015;4:96-104.
9
Moudgil V, Redhu D, Dhanda S, Singh J. A review of molecular mechanisms in the development of hepatocellular carcinoma by aflatoxin and hepatitis B and C viruses. J Environ Pathol Toxicol Oncol 2013;32:165-75.
10
The World Bank. World Development Indicators 2008. Washington, USA: The World Bank Publications; 2008.
11
Engstrom PF, Sigurdson E, Evans AA, Pingpank JF. Primary neoplasms of the liver. In: Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF, et al., editors. Holland-Frei Cancer Medicine. 6th ed. Hamilton (ON), Canada: BC Decker; 2003. p.1542-53.
12
Kogevinas M. Human health effects of dioxins: cancer, reproductive and endocrine system effects. Hum Reprod Update 2001;7:331-9.
13
Afshari R, Bellinger DC. Socially Responsive Toxicology; Looking outside the Windows of Medical Wards: A Tale of Lead Exposure. Asia Pac J Med Toxicol 2015;4:95-6.
14
ORIGINAL_ARTICLE
Pulmonary Scintiscan Findings in Sulfur Mustard Injured Patients Suspected for Gastroesophageal Reflux; a Descriptive Cross-Sectional Study
Background:Gastroesophageal reflux disease (GERD) prevalence in patients with sulfur mustard (SM)-induced bronchiolitis obliterans (BO) is higher than exposed cases with mild lung injuries. In this study, we aimed to evaluate the prevalence of microaspirations using nuclear scintiscan among BO patients with SM exposure.Methods: This was a prospective cross-sectional study conducted on patients with SM-induced BO and pulmonary symptom exacerbation referred to the Baqiyatallah Hospital, Tehran, Iran during the year 2009. Following the endoscopy-based diagnosis of GERD by a gastroenterologist, anti-reflux medications were withdrawn for 72 hours and then the patients underwent nuclear scintigraphy scan following 12 hour ingestion of fat containing food as radionuclide dinner. High resolution computed tomography (HRCT), spirometry and bronchoscopy were also performed for all patients.Results: In this study, 39 patients (94.9% men) with mean (± SD) age of 45.1 ± 6.2 years were enrolled. The most common clinical complaints of the patients were thick sputum (97.4%) and dyspepsia (94.7%), followed by chest tightness (89.7%), nocturnal cough (82.1%), and nocturnal dyspnea (66.7%). In HRCT, air-trapping was the most common pulmonary finding (92.1%). In spirometry, mean (±SD) FEV1 and FEV1/FVC were 52.7 ± 22.4% and 70.4 ± 13.9%, respectively. In bronchoscopy, the most common finding was airway remodeling (62.2%), followed by false vocal cord hypertrophy (24.3%). In scintigraphic imaging, only 1 patient had a remarkable finding, in whom, the radionuclide material was seen in the pharynx (proximal GERD), but did not produce marked microaspiration of gastric substances into the airways.Conclusion:Although previous reports demonstrated high prevalence of GERD and microaspiration in patients with SM-induced BO, we did not find remarkable evidence for microaspiration in scintiscan in patients included in this study.
https://apjmt.mums.ac.ir/article_6258_b992d110f346abf7a7c21f9dfdd8bdac.pdf
2015-12-01
134
138
10.22038/apjmt.2015.6258
Bronchiolitis Obliterans
Gastroesophageal reflux
Mustard Gas
Poisoning
Radionuclide Imaging
Ali
Ghazvini
1
Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Ashraf
Karbasi
2
Baqiyatallah Research Center of Gastroenterology and Hepatology, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Amin
Saburi
aminsaburi@gmail.com
3
Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Rasoul
Aliannejad
4
Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Mostafa
Ghanei
mghaneister@gmail.com
5
Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Sontag SJ. Gastroesophageal reflux disease and asthma. J Clin Gastroenterol 2000;30:S9-30.
1
Ghanei M, A S. Gastro-Esophageal Reflux and Pulmonary Medicine; Where Are We and What Should We Do? J Pulmonar Respirat Med 2012;2:107.
2
Emilsson OI, Bengtsson A, Franklin KA, Toren K, Benediktsdottir B, Farkhooy A, et al. Nocturnal gastroesophageal reflux, asthma and symptoms of obstructive sleep apnoea: a longitudinal, general population study. Eur Respir J 2013;41:1347-54.
3
Blake K, Teague WG. Gastroesophageal reflux disease and childhood asthma. Curr Opin Pulm Med 2013;19:24-9.
4
Hartwig MG, Davis RD. Gastroesophageal reflux disease-induced aspiration injury following lung transplantation. Curr Opin Organ Transplant 2012;17:474-8.
5
Ghanei M, Harandi AA. Long term consequences from exposure to sulfur mustard: a review. Inhal Toxicol 2007;19:451-6.
6
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;24:900-6.
7
Panahi Y, Poursaleh Z, Amini-Harandi A, Saburi A, Shohrati M, Ghanei M. Study on Effectiveness of Low Dose Theophylline as Add-on to Inhaled Corticosteroid for Patients with Sulfur Mustard Induced Bronchiolitis. Asia Pac J Med Toxicol 2013;2:126-30.
8
Amini M, Oghabian Z. Late-onset Radiologic Findings of Respiratory System Following Sulfur Mustard Exposure. Asia Pac J Med Toxicol 2013;2:58-62.
9
Ghanei M, Hosseini AR, Arabbaferani Z, Shahkarami E. Evaluation of chronic cough in chemical chronic bronchitis patients. Environ Toxicol Pharmacol 2005;20:6-10.
10
Ghanei M, Khedmat H, Mardi F, Hosseini A. Distal esophagitis in patients with mustard-gas induced chronic cough. Dis Esophagus 2006;19:285-8.
11
Hartwig MG, Appel JZ, Davis RD. Antireflux surgery in the setting of lung transplantation: strategies for treating gastroesophageal reflux disease in a high-risk population. Thorac Surg Clin 2005;15:417-27.
12
Patra S, Singh V, Chandra J, Kumar P, Tripathi M. Diagnostic modalities for gastro-esophageal reflux in infantile wheezers. J Trop Pediatr 2011;57:99-103.
13
Aliannejad R, Hashemi-Bajgani S-M, Karbasi A, Jafari M, Aslani J, Salehi M, et al. GERD related micro-aspiration in chronic mustard-induced pulmonary disorder. J Res Med Sci. 2012;17:777-81.
14
Decalmer S, Stovold R, Houghton LA, Pearson J, Ward C, Kelsall A, et al. Chronic cough: relationship between microaspiration, gastroesophageal reflux, and cough frequency. Chest 2012;142:958-64.
15
Ervine E, McMaster C, McCallion W, Shields MD. Pepsin measured in induced sputum--a test for pulmonary aspiration in children? J Pediatr Surg 2009;44:1938-41.
16
Farhath S, He Z, Nakhla T, Saslow J, Soundar S, Camacho J, et al. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics 2008;121:e253-9.
17
Fiorucci S, Distrutti E, Di Matteo F, Brunori P, Santucci L, Mallozzi E, et al. Circadian variations in gastric acid and pepsin secretion and intragastric bile acid in patients with reflux esophagitis and in healthy controls. Am J Gastroenterol 1995;90:270-6.
18
Fujimoto K, Yamaguchi S, Urushibata K, Koizumi T, Kubo K. Sputum eosinophilia and bronchial responsiveness in patients with chronic non-productive cough responsive to anti-asthma therapy. Respirology 2003;8:168-74.
19
Grabowski M, Kasran A, Seys S, Pauwels A, Medrala W, Dupont L, et al. Pepsin and bile acids in induced sputum of chronic cough patients. Respir Med 2011;105:1257-61.
20
Pierson DJ. Clinical practice guidelines for chronic obstructive pulmonary disease: a review and comparison of current resources. Respir Care 2006;51:277-88.
21
Tutuian R, Mainie I, Agrawal A, Adams D, Castell DO. Nonacid reflux in patients with chronic cough on acid-suppressive therapy. Chest 2006;130:386-91.
22
Tutuian R, Vela MF, Hill EG, Mainie I, Agrawal A, Castell DO. Characteristics of symptomatic reflux episodes on Acid suppressive therapy. Am J Gastroenterol 2008;103:1090-6.
23
Holbrook JT, Wise RA, Gold BD, Blake K, Brown ED, Castro M, et al. Lansoprazole for children with poorly controlled asthma: a randomized controlled trial. JAMA 2012;307:373-81.
24
Littner MR, Leung FW, Ballard ED 2nd, Huang B, Samra NK, Lansoprazole Asthma Study Group. Effects of 24 weeks of lansoprazole therapy on asthma symptoms, exacerbations, quality of life, and pulmonary function in adult asthmatic patients with acid reflux symptoms. Chest 2005;128:1128-35.
25
Sharma B, Sharma M, Daga MK, Sachdev GK, Bondi E. Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux. World J Gastroenterol 2007;13:1706-10.
26
Knight J, Lively MO, Johnston N, Dettmar PW, Koufman JA. Sensitive pepsin immunoassay for detection of laryngopharyngeal reflux. Laryngoscope 2005;115:1473-8.
27
Karbasi A, Goosheh H, Aliannejad R, Saber H, Salehi M, Jafari M, et al. Pepsin and bile acid concentrations in sputum of mustard gas exposed patients. Saudi J Gastroenterol 2013;19:121-5.
28
Patterson RN, Johnston BT, Ardill JE, Heaney LG, McGarvey LP. Increased tachykinin levels in induced sputum from asthmatic and cough patients with acid reflux. Thorax 2007;62:491-5.
29
Ruth M, Carlsson S, Mansson I, Bengtsson U, Sandberg N. Scintigraphic detection of gastro-pulmonary aspiration in patients with respiratory disorders. Clin Physiol 1993;13:19-33.
30
Jadcherla SR. Upstream effect of esophageal distention: effect on airway. Curr Gastroenterol Rep 2006;8:190-4.
31
Mansfield LE, Hameister HH, Spaulding HS, Smith NJ, Glab N. The role of the vague nerve in airway narrowing caused by intraesophageal hydrochloric acid provocation and esophageal distention. Ann Allergy 1981;47:431-4.
32
Bingol Boz A, Aydn F, Celmeli F, Boz A, Artan R, Gungor F. Does gastroesophageal reflux scintigraphy correlate with clinical findings in children with chronic cough? Nucl Med Commun 2009;30:802-6.
33
Saber H, Ghanei M. Extra-esophageal manifestations of gastroesophageal reflux disease: controversies between epidemiology and clinic. Open Respir Med J 2012;6:121-6.
34
ORIGINAL_ARTICLE
Outcome of Paraquat Poisoned Patients Treated with a Commonly Used Therapeutic Flowchart: A Case Series
Background: Paraquat poisoning is a medical emergency challenge due to its inherent severe toxicity and unavailability of specific antidote for it. In this paper, a series of patients who were treated according to a commonly used treatment flowchart are presented.Methods: This prospective observational study was carried out on paraquat poisoned patients admitted to District Hospital, Chamarajanagar and Shimoga institute of Medical Sciences, Shimoga, Karnataka, India, during January 2013 to December 2014.Results: Six patients (4 women and 2 men) with median age of 23 [min-max: 18-42] years were studied. The majority of patients had respiratory distress (with an average SpO2 of 60%), i.e. 4 out of 6 cases manifested with respiratory distress associated with dryness and burning sensation in mouth, throat and chest. Oxygen therapy with mask in one case and by ventilator in rest of cases was required. Except one patient who died on the first day and no further measurement of serum creatinine could be taken from her, all other patients developed increased creatinine. Five out of 6 patients died mainly due to pulmonary sequels. In the only survived patient, gastrointestinal symptoms were predominant followed by acute renal failure and pulmonary congestion which were reverted with medical care indicated in the therapeutic flowchart. In post-mortem investigations, inflammatory infiltration in lungs was noted in all cases and acute tubular necrosis was seen in 3 cases.Conclusion: Renal insufficiency and pulmonary damage following severe paraquat poisoning are indicators of poor prognosis and may not be reversible with commonly used treatment approaches.
https://apjmt.mums.ac.ir/article_6359_ba701f9cc149b68d2b2e38b593e4dca9.pdf
2015-12-01
139
142
10.22038/apjmt.2015.6359
Clinical Protocols
Paraquat
Poisoning
Renal Insufficiency
Respiratory insufficiency
Devanur Rajashekhara Murthy Mahadeshwara
Prasad
manudrp@gmail.com
1
Department of Forensic Medicine and Toxicology, District Hospital and Chamarajanagar Institute of Medical Sciences, Chamarajanagar, Karnataka, India
LEAD_AUTHOR
Abhilash
Chennabasappa
2
Shimoga Institute of Medical Science, Shimoga, Karnataka, India
AUTHOR
[1]. Denizbaşı A. Zehirlenmiş Hastaya Acil Yaklaşım. In: Kekeç Z, editor. Tüm Yönleriyle Acil Tıp Tanı Tedavi ve Uygulama Kitabı. 2. Baskı. Adana: Nobel Kitabevi; 2011.p.421-430.
1
[2]. Rosner MH. Hemodialysis for the non-nephrologist. South Med J. 2005;98(8):785-91.
2
[3]. Shadnia S, Esmaily H, Sasanian G, Pajoumand A, Hassanian-Moghaddam H. Pattern of acute poisoning in Tehran-Iran. Hum Exp Toxicol 2007; 26(9): 753-6.
3
[4]. Satar S, Alpay NR, Sebe A, Gokel Y. Emergency hemodialysis in the management of intoxication. Am J Ther. 2006;13(5):404-10.
4
[5]. Jha VK, Padmaprakash KV. Extracorporeal Treatment in the Management of Acute Poisoning: What an Intensivist Should Know? Indian J Crit Care Med. 2018;22(12):862-869.
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[6]. Schreiner GE. The Role of Hemodialysis (Artificial Kidney) in Acute Poisoning. AMA Arch Intern Med. 1958;102(6):896–913.
6
[7]. King JD, Kern MH, Jaar BG. Extracorporeal Removal of Poisons and Toxins. Clin J Am Soc Nephrol. 2019;14(9):1408-1415.
7
[8]. Güngörer B, Katı C, Köse F. Evaluation of Hemodialysis and Hemoperfusion in Poisoned Patients. Eurasian J Emerg Med. 2019;18(4): 218-22.
8
[9]. Holubek WJ, Hoffman RS, Goldfarb DS, Nelson LS. Use of hemodialysis and hemoperfusion in poisoned patients, Kidney Int. 2008;74:1327-34.
9
[10]. Darracq MA, Cantrell FL. Hemodialysis and extracorporeal removal after pediatric and adolescent poisoning reported to a state poison center. J Emerg Med. 2013;44(6):1101-7.
10
[11]. Thuan L, Ngoc N, Due P. Effectiveness of Continuous Veno-Venous Hemofiltration and Intermittent Hemodialysis in the Treatment of Severe Acute Phenobarbital Poisoning. APJMT, 2013; 2(1): 10-13.
11
[12]. Zeinali M, Motamed M, Almasi Dooghaee M. A Case Report of Putaminal Hemorrhage Due to Methanol Toxicity; is Hemodialysis the Offender? APJMT, 2021; 10(2): 74-76.
12
[13]. Park S, Lee S, Park S, Gil H, Lee E, Yang J, et al. Concurrent Hemoperfusion and Hemodialysis in Patients with Acute Pesticide Intoxication. Blood Purif. 2016;42(4):329-336.
13
[14]. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017;55(10):1072-1252.
14
[15]. Hassanian-Moghaddam H, Zamani N, Roberts DM, Brent J, McMartin K, Aaron C et al. Consensus statements on the approach to patients in a methanol poisoning outbreak. Clin Toxicol (Phila). 2019;57(12):1129-1136.
15
[16]. Mowry JB, Spyker DA, Cantilena LR Jr, Bailey JE, Ford M. 2012 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th Annual Report. Clin Toxicol (Phila). 2013; 51:949-1229.
16
[17]. Güngörer B, Katı C, Köse F. Evaluation of Hemodialysis and Hemoperfusion in Poisoned Patients. Eurasian J Emerg Med. 2019;18(4): 218-22.
17
[18]. El-Sheikh AA, Khayal EE-S, Allam R. Human kidney injury molecule-1 and interleukin-18 as predictive markers of nephrotoxicity in acute organophosphorus poisoned patients in Zagazig University hospitals. J Toxicol Environ Health Sci. 2018;10 (5):34-43.
18
ORIGINAL_ARTICLE
Acute Poisoning in Elderly; a Five-Year Study (2008-2013) in Hamadan, Iran
Background: A good proportion of poisoned patients treated at poisoning wards are elderly. This study was designed to evaluate the epidemiologic pattern of acute poisoning in elderly in Hamadan, western Iran.Methods: In this retrospective cross-sectional study, poisoned patients aged 60 years and older treated at department of poisoning of Farshchian Hospital from March 2008 to March 2013 were included.Results: In this 5-year period, 7951 poisoned patients were treated at Farshchian Hospital in Hamadan, Iran. Among them, 418 (5.3%) patients were 60 years old or older, with mean age of 71.6 ± 5.1 years. Narcotics and recreational substances were the most common type of poisons responsible for poisoning (46.4%), which among them, methadone was the most commonly used drug (20.3%). Neurologic medicines were the most commonly used pharmaceutical products (16%), among which, benzodiazepines (8.9%) were responsible for the highest number of poisonings due to pharmaceuticals. Fifteen patients (3.6%) including 13 men and 2 women died. The toxic agents used by cases with fatal outcome were opioids (8 patients), organophosphates (5 patients) and aluminum phosphide (2 patients). Men were found to be significantly more affected with recreational substances (P < 0.001) and pesticides (P < 0.001), while poisoning with pharmaceutical products (P = 0.017) was significantly more common in women. Regarding the intention of poisoning, accidental poisoning (P = 0.025) and overdose (P < 0.001) were significantly more common in men while deliberate self-poisoning was significantly more frequent in women (P < 0.001).Conclusion: Deliberate self-harm and poisoning with opioids especially methadone showed a high prevalence in elderly poisoned patients in Hamadan, Iran. It seems that drug trafficking control, addiction rehabilitation therapies and suicide prevention programs for elderly can be helpful in poisoning reduction in this age group in this part of the country.
https://apjmt.mums.ac.ir/article_6360_90d0878a3f37ab5121bc910c867de606.pdf
2015-12-01
143
146
10.22038/apjmt.2015.6360
Aged
Iran
methadone
Opioid-Related Disorders
Poisoning
Saeed
Afzali
afzali691@yahoo.com
1
Department of Forensic Medicine and Toxicology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
LEAD_AUTHOR
Mohammad Ali
Seifrabiei
seifrabiei@yahoo.com
2
Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
AUTHOR
Seyed Kazem
Taheri
saeid_tm@yahoo.com
3
Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
AUTHOR
Jahangir
Pourabdollah
4
School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
AUTHOR
Ameri GF, Govari F, Nazari T, Rashidinejad M, Afsharzadeh P. The adult age theories and definition. J Hayat. 2002;8:4-13. (In Persian)
1
World Health Organization. Health statistics and information systems: Definition of an older or elderly person [Internet]. 2015 [cited 3 Aug 2015]. Available from: http://www.who.int/healthinfo/survey/ageingdefnolder/en/
2
United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2013. Herndon, VA, USA: United Nations publication; 2013.
3
Bolton S, Brunier A. First WHO report on suicide prevention [Internet]. 2014 [updated 4 Sep 2014, cited 14 Oct 2015]. Available from:http://www.who.int/mediacentre/news/releases/2014/suicide-prevention-report/en
4
Moradi S, Khademi A. Evaluation of suicides resulting in death in Iran, comparing with the world rates. J Legal Med 2002;27:16-21. (In Persian)
5
Mortazavi SM, Haaji Y, Khonche A, Jamilian H. Epidemiology and Causes of Poisoning in patients Referred to Loqman Hospital, Tehran, Iran during summer 2010. Iran J Toxicol 2012;6:642-8.
6
Mühlberg W, Becher K, Heppner HJ. Wicklein S, Sieber C. Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriatr 2005;38:182-9.
7
Hu YH, Chou HL, Lu WH, Huang HH, Yang CC, Yen DH et al . Features and prognostic factors for elderly with acute poisoning in the emergency department. J Chin Med Assoc 2010;73:78-87.
8
Karbakhsh M, Zandi NS. Pattern of poisoning in the elderly: an experience from Tehran. Clin Toxicol (Phila) 2008;46:211-7.
9
Klein-Schwartz W, Oderda GM. Poisoning in the elderly. Epidemiological, clinical and management considerations. Drugs Aging. 1991;1:67-89.
10
Miranda Arto P, Ferrer Dufol A, Ruiz Ruiz F, Menao Guillén S, Civeira Murillo E. Acute poisoning in patients over 65 years of age. An Sist Sanit Navar 2014;37:99-108. (In Spanish)
11
Khodabandeh F, Noorbala AA, Kahani S, Bagher A. A Study on the Factors Associated with Attempting Suicide in Middle and Old Age Patients Referred to Loghman Hospital Poison Center in 2009. Health Psychol 2012;11:1-11. (In Persian)
12
Zhang J, Jiang C, Jia S, Wieczorek WF. An Overview of Suicide Research in China. Arch Suicide Res 2002;6:167-184.
13
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;2:2-5.
14
Soltaninejad K, Hassanian-Moghaddam H, Shadnia S. Methadone Related Poisoning on the Rise in Tehran, Iran. Asia Pac J Med Toxicol 2014;3:104-9.
15
Calabrese J. Iran’s war on drugs: holding the line. Washington, USA: The Middle East Institute; 2007.
16
ORIGINAL_ARTICLE
Frequency of Cardiac Arrhythmias in Patients with Aluminum Phosphide Poisoning
Background: Cardiac failure is the major lethal consequence of aluminum phosphide (AlP) poisoning. This study was designed to determine the frequency of cardiac arrhythmias in patients with AlP poisoning. Methods: In this prospective cross-sectional study, patients with definitive history of AlP poisoning treated at emergency department of Allied Hospital Faisalabad, Faisalabad, Pakistan, from July 2013 to November 2014 were included. On admission, twelve-lead electrocardiogram (ECG) was performed for all patients. During admission, all patients underwent continuous cardiac monitoring using a cardiac monitor. If an arrhythmia was suspected on the cardiac monitor, another ECG was obtained immediately. Results: During the study period, 100 patients with AlP poisoning (63% men) were treated at Allied Hospital Faisalabad. Mean age of the patients was 26.7 ± 7.9 years ranging from 16 to 54 years. Tachycardia was detected in 68 patients and bradycardia in 12 patients. Hypotension was observed in 75 patients. Eighty patients developed cardiac arrhythmia. The most frequent arrhythmia was atrial fibrillation (31% of patients) followed by ventricular fibrillation (20%), ventricular tachycardia (17%), 3rd degree AV block (7%) and 2nd degree AV block (5%). In total, 78 patients died, depicting a 78% mortality rate following wheat pill poisoning. Among those who died, seventy-one patients had cardiac arrhythmia. Comparison of death rate between patients with and without cardiac arrhythmia showed a significant difference (71/80 (88.8%) vs. 7/20 (35%); P < 0.001). Conclusion: Wheat pill poisoning causes a very high mortality, and circulatory collapse is the major cause of death among these patients. Most of the patients with AlP poisoning develop cardiac arrhythmias which are invariably life threatening. Early detection of cardiac disorders and proper management of arrhythmias may reduce mortalities.
https://apjmt.mums.ac.ir/article_6257_ea7312632036c42221302a1621bb82e1.pdf
2015-12-01
147
150
10.22038/apjmt.2015.6257
Aluminum phosphide
Cardiac Arrhythmias
Cardiogenic Shock
Poisoning
Umair
Aziz
eaglezown@gmail.com
1
University Medical and Dental College Faisalabad, Faisalabad, Pakistan
LEAD_AUTHOR
Aamir
Husain
aahusain2014@gmail.com
2
Allied Hospital, Punjab Medical College, Faisalabad, Pakistan
AUTHOR
Saeed A, Bashir Z, Khan D, Iqbal J, Raja KS, Rehman A. Epidemiology of suicide in Faisalabad. J Ayub Med Coll Abottabad 2002;14:34-7.
1
Ranjbar R, Liaghat AR, Ranjbar A, Mohabbati H. Toxicologic Laboratory Findings in Cases Reported with Hanging Death: a Two-Year Retrospective Study in Northeast Iran. Asia Pac J Med Toxicol 2013;2:92-5.
2
Mostafazadeh B, Farzaneh E. Risks and risk factors of repeated suicidal attempt: Study on unconscious poisoned patients. Asia Pac J Med Toxicol 2013;2:28-31.
3
Abidi M, Zia W, Waqas M. Deliberate self harm: A local perspective. J Pak Psychiatry Soc 2010;7:67.
4
Rathore R, Khan MZ. Morbidity, mortality and management of wheat pill poisoning. Esculapio J Services Inst Med Sci. Jan - Mar 2007;2(4):14-8.
5
Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2012; 63:61-73.
6
Nosrati A, Karami M, Esmaeilnia M. Aluminum phosphide poisoning: A case series in north Iran. Asia Pac J Med Toxicol 2013;2:111-3.
7
Anand R, Sharma DR, Verma D, Bhalla A, Gill KD, Singh S. Mitochondrial electron transport chain complexes, catalase and markers of oxidative stress in platelets of patients with severe aluminum phosphide poisoning. Hum ExpToxicol 2013;32:807-16.
8
Bhalla A, Mahi S, Sharma N, Singh S. Polyserositis: An unusual complication of aluminum phosphide poisoning. Asia Pac J Med Toxicol 2012;1:14-7.
9
Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci 2009; 63:227-34.
10
Proudfoot AT. Aluminium and zinc phosphide poisoning. ClinToxicol (Phila) 2009; 47:89-100.
11
Dewan G. Analysis of Recent Situation of Pesticide Poisoning in Bangladesh: Is There a Proper Estimate? Asia Pac J Med Toxicol 2014;3:76-83.
12
Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock 2011;4:378-84.
13
Moghadamnia AA. An update on toxicology of aluminum phosphide. Daru 2012;20:25.
14
Mehrpour O, Amouzeshi A, Dadpour B, Oghabian Z, Zamani N, Amini S, et al. Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Arh Hig Rada Toksikol 2014;65:121-6.
15
Camm AJ, Bunce NH. Cardiovascular diseases In: Kumar P, Clark M. Kumar and Clark’s clinical medicine. 8th ed. Edinburgh, UK: Saunders; 2012: 669-790.
16
Farooqi AN, Tariq S, Asad F, Abid F, Tariq O. Epidemiological profile of suicidal poisoning at Abbasi Shaheed Hospital. Annal Abbasi Shaheed Hosp Karachi Med Dent Coll 2004;9:502-5.
17
Khurram M, Mahmood N. Deliberate self-poisoning: experience at a medical unit. J Pak Med Assoc 2008;58:455-6.
18
Iftikhar R, Tariq KM, Saeed F, Khan MB, Babar NF. Wheat pill: clinical characteristics and outcome. Pak Armed Forces Med J 2011;61:350-3.
19
Soltaninejad K, Beyranvand MR, Momenzadeh SA, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. J Forensic Leg Med 2012;19:291-3.
20
Mehrpour O, Farzaneh E, Abdollahi M. Successful treatment of aluminum phosphide poisoning with digoxin: a case report and review of literature. Int J pharmacol 2011;7:761-4.
21
Reyna-Medina M, Vázquez-de Anda GF, García-Monroy J, Valdespino-Salinas EA, Vicente-Cruz DC. Suicide attempt with aluminum phosphide poisoning. Rev Med Inst Mex Seguro Soc. 2013;51:212-7. (In Spanish)
22
Hosseinian A, Pakravan N, Rafiei A, Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran. Indian J Med Sci 2011;65:143-50.
23
ORIGINAL_ARTICLE
Investigation of Lethal Poisonings among Dead Bodies Referred to Regional Office of Iranian Legal Medicine Organization in Shiraz
Background:Death due to acute poisoning is of medical, legal and social significance. This study was designed to investigate lethal poisonings among dead bodies referred to a regional office of Iranian Legal Medicine Organization (ILMO). Methods:This was a retrospective descriptive-analytical study on dead bodies referred to Fars province regional office of ILMO in Shiraz, Iran, during April 2013 to the end of March 2014. For data analysis, only subjects with poisoning as the definitive cause of death were included. Results:During the study period, 2,594 autopsies were conducted in Fars province office of ILMO, among which poisoning was found to be the cause of death in 147 autopsies (5.7%). Eighty-eight cases (59.9%) were men. The majority of subjects aged 20 to 30 years (50.3%). The greatest number of subjects (73.5%) was unmarried persons. Regarding the occupation, most subjects were unemployed (49.7%) followed by housewives (19.7%). Over half of the cases (54.42%) had died within less than 6 hours after the poisoning. The majority of cases were found dead at home (73.5%), while the rest had died in outpatient department or hospital wards. Suicide cases were far more common than unintentional cases (75.5% vs. 24.5%). Suicidal intention was significantly higher in subjects with lower educational status (P = 0.033). The most common causes of poisoning were pharmaceutical products (66.7%) followed by aluminum phosphide (10.9%) and other types of pesticides (7.2%). Conclusion:Lethal poisonings is mostly seen in young adults, and those with lower educational level and unemployment. Suicidal intention is the main cause of lethal poisonings.
https://apjmt.mums.ac.ir/article_6361_ce28cf0169baecadcc27578e493a7f9c.pdf
2015-12-01
151
155
10.22038/apjmt.2015.6361
Forensic Toxicology
Iran
Mortality
Suicide
Poisoning
Mahmoud
Montazeri
1
Director, Autopsy Department, Fars Province General Office, Legal Medicine Organization, Shiraz, Iran
AUTHOR
Nahid
Najafi
najafi_n@sums.ac.ir
2
Department of Toxicology and Pharmacology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
LEAD_AUTHOR
Negar
Azarpira
3
Organ Transplant Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
AUTHOR
Fatemeh
Zahedipour
4
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
AUTHOR
Asadi R, Afshari R. Applying Global Burden of Diseases in Medical Toxicology. Asia Pac J Med Toxicol 2014;3:1.
1
Akbari ME, Naghavi M, Soori H. Epidemiology of deaths from injuries in the Islamic Republic of Iran. East Mediterr Health J 2006;12:382-90.
2
Bailey RK, Patel TC, Avenido J, Patel M, Jaleel M, Barker NC, et al. Suicide: current trends. J Natl Med Assoc 2011;103:614-7.
3
Lund C, Teige B, Drottning P, Stiksrud B, Rui TO, Lyngra M, et al. A one-year observational study of all hospitalized and fatal acute poisonings in Oslo: epidemiology, intention and follow-up. BMC Public Health 2012;12:858.
4
Patil A, Peddawad R, Verma VCS, Gandhi H. Profile of Acute Poisoning Cases Treated in a Tertiary Care Hospital: a Study in Navi Mumbai. Asia Pac J Med Toxicol 2014;3:36-40.
5
Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM. 2000;93:715-31.
6
Chala TS, Gebramariam H, Hussen M. Two-Year Epidemiologic Pattern of Acute Pharmaceutical and Chemical Poisoning Cases Admitted to Adama Hospital Medical College, Adama, Ethiopia. Asia Pac J Med Toxicol 2015;4:106-11.
7
Rhalem N, Aghandous R, Chaoui H, Eloufir R, Badrane N, Windy M, et al. Role of the poison control centre of Morocco in the improvement of public health. Asia Pac J Med Toxicol 2013;2:82-6.
8
Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poisonings in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol 2004;42:965-75.
9
Ghane T, Behmanesh Y, Khazaei F. Annual Report of Recorded Phone Calls to Iran's Drug and Poison Information Centers (2014-2015). Asia Pac J Med Toxicol 2015;4:97-101.
10
Rajapakse T, Griffiths KM, Christensen H, Cotton S. A comparison of non-fatal self-poisoning among males and females, in Sri Lanka. BMC Psychiatry 2014;14:221.
11
Mostafazadeh B, Farzaneh E. Risks and risk factors of repeated suicidal attempt: Study on unconscious poisoned patients. Asia Pac J Med Toxicol 2013;2:28-31.
12
Mauri MC, Cerveri G, Volonteri LS, Fiorentini A, Colasanti A, Manfré S, et al. Parasuicide and drug self-poisoning: analysis of the epidemiological and clinical variables of the patients admitted to the Poisoning Treatment Centre (CAV), Niguarda General Hospital, Milan. Clin Pract Epidemiol Ment Health 2005;1:5.
13
Yartire H, Hashemian AH, Saleh E. A View to Mortality Due to Poisoning Cases in Forensics Center of Kermanshah in 2006-2012. Adv Biol Res 2014;8:157-61.
14
Akhgari M, Jokar F, Etemadi Aleagha A. Drug related deaths in Tehran, Iran: toxicological, death and crime scene investigations. Iran J Toxicol 2011;5:402-9.
15
Najjari F, Afshar M. Deaths Due to Poisoning Referred to Legal Medicine Organization of Iran. Razi J Med Sci 2004;11:309-16. (In Persian)
16
Varma NM, Kalele SD. Study of profile of deaths due to poisoning in Bhavnagar region. J Indian Acad Forensic Med 2011;33:313-8.
17
Radhakrishnan R, Andrade C. Suicide: An Indian perspective. Indian J Psychiatry 2012;54:304-19.
18
Pires MC, Silva Tde P, Passos MP, Sougey EB, Bastos Filho OC. Risk factors of suicide attempts by poisoning: review. Trends Psychiatry Psychother 2014;36:63-74.
19
Ghazinour M, Emami H, Richter J, Abdollahi M, Pazhumand A. Age and gender differences in the use of various poisoning methods for deliberate parasuicide cases admitted to loghman hospital in Tehran (2000-2004). Suicide Life Threat Behav 2009;39:231-9.
20
Shojaei A, Moradi S, Alaeddini F, Khodadoost M, Abdizadeh A, Khademi A. Evaluating the temporal trend of completed suicides referred to the Iranian Forensic Medicine Organization during 2006-2010. J Forensic Leg Med 2016;39:104-8.
21
Curtin SC, Warner M, Hedegaard H. Increase in Suicide in the United States, 1999-2014. NCHS Data Brief 2016;(241):1-8.
22
Dewan G. Analysis of Recent Situation of Pesticide Poisoning in Bangladesh: Is There a Proper Estimate? Asia Pac J Med Toxicol 2014;3:76-83.
23
Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: systematic review. BMC Public Health 2007;7:357.
24
Townsend E, Hawton K, Harriss L, Bale E, Bond A. Substances used in deliberate self-poisoning 1985-1997: trends and associations with age, gender, repetition and suicide intent. Soc Psychiatry Psychiatr Epidemiol 2001;36:228-34.
25
Nair PK, Revi NG. One-Year Study on Pattern of Acute Pharmaceutical and Chemical
26
Azin SA, Shahidzadeh Mahani A, Abadi M, Omidvari S, Montazeri A. Substances Involved in Human Poisoning a Comparison between Intentional and Accidental Poisoning Cases. Iran J Epidemiol 2008;4:7-17.
27
Senanayake N, Peiris H. Mortality due to poisoning in a Poisoning Cases Admitted to a Tertiary Care Hospital in Thrissur, India. Asia Pac J Med Toxicol 2015;4:79-82.
28
developing agricultural country: trends over 20 years. Hum Exp Toxicol 1995;14:808-11.
29
Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2012; 63:61-73.
30
ORIGINAL_ARTICLE
A Hospital-Based Epidemiologic Study on Acute Pediatric Poisonings in Chennai, India
Background: Toxic exposures in childhood are major health concern. In this hospital-based study, we sought to investigate socio-epidemiological factors contributing to acute pediatric poisoning in Chennai, Tamil Nadu, India.Methods: This prospective cross-sectional study was conducted at the Kanchi Kamakoti CHILDS Trust Hospital (KKCTH), a tertiary care hospital for children in Chennai. Children and adolescents less than 18 years of age with diagnosis of acute poisoning during June 2014 to January 2015 were included in the study.Results: During the study period, 10500 children were admitted to emergency department of the hospital; among which, 34 children presented with diagnosis of acute poisoning (0.32% of admissions). Eighteen patients (52.9%) were boys. The greatest proportion of patients (52.9%) aged 1 to 3 years. Regarding the intention of poisoning, 27 cases (79.4%) occurred following unintentional ingestion by children, 5 cases (14.7%) following inadvertent administration of medication(s) by a caregiver and 2 cases (5.9%) following inadvertent administration by a sibling. Children had relatively equal chance of being poisoned with medications (n = 18, 52.9%) and common household agents (n = 16, 47.1%). The most common medicines responsible for the poisonings were neuropsychiatric medicines (n = 6, 17.6%). None of the medications responsible for poisoning had childproof containers. On admission, only 14 children (41.2%) were symptomatic. Fifteen patients (44.1%) required admission to hospital wards and 4 patients (11.8%) required intensive care. The remaining patients only needed close observation for a few hours. All children made complete recovery and there was no mortality.Conclusion:Children especially toddlers of either gender are vulnerable to unintentional exposures and need constant supervision by an adult. Educating caregivers about the fatalities associated with unprotected storage of medications, and dangers of placing hazardous chemicals in the reach of children will reduce a great number of poisoning in children.
https://apjmt.mums.ac.ir/article_6362_14f7792a050d808375851528f4628c44.pdf
2015-12-01
156
160
10.22038/apjmt.2015.6362
Epidemiology
India
Pediatrics
Poisoning
Senthil
Kumar
senthilkmrdoc@gmail.com
1
Kanchi Kamakoti CHILDS Trust Hospital, The CHILDS Trust Medical Research Foundation, Chennai, India
AUTHOR
Radhika
Raman
doc.rads15@gmail.com
2
Kanchi Kamakoti CHILDS Trust Hospital, The CHILDS Trust Medical Research Foundation, Chennai, India
LEAD_AUTHOR
Lakshmi
Muthukrishnan
vcmlck@yahoo.co.in
3
Kanchi Kamakoti CHILDS Trust Hospital, The CHILDS Trust Medical Research Foundation, Chennai, India
AUTHOR
Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur-Rahman AKM, et al. World Report on Child Injury Prevention. World Health Organization (WHO) Press; 2008.
1
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;1:10-3.
2
Kumar SV, Venkateswarlu B, Sasikala M, Kumar GV. A study on poisoning cases in a tertiary care hospital. J Nat Sci Biol Med 2010; 1:35-9.
3
Roy RN, Shrivastava P, Das DK, Saha I, Sarkar AP. Burden of hospitalized pediatric morbidity and utilization of beds in a tertiary care hospital of kolkata, India. Indian J Community Med 2012;37:252-5.
4
Gupta SK, Peshin SS, Srivastava A, Kaleekal T. A study of childhood poisoning at National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. J Occup Health 2003;45:191-6.
5
Fan AY, Che AH, Pan B, Yang C, Coulter CV, Shieffelbien L, et al. Investigating Childhood and Adolescence Poisoning Exposures in New Zealand Reported to the National Poisons Centre during 2000-2009. Asia Pac J Med Toxicol 2013;2:52-7.
6
Krenzelok EP, Mrvos R. Toxic Christmas and New Year Holiday Plants...or Are They? Asia Pac J Med Toxicol 2015;4:64-7.
7
Schmertmann M, Williamson A, Black D. Stable age pattern supports role of development in unintentional childhood poisoning. Inj Prev 2008;14:30-3.
8
Azemi M, Berisha M, Kolgeci S, Bejiqi R. Frequency, etiology and several sociodemographic characteristics of acute poisoning in children treated in the intensive care unit. Mater Sociomed. 2012;24:76-80.
9
Shuba S, Chacko B. House Hold Material Poisoning. Indian J Pract Pediatr 2009;11:41-52.
10
Osaghae DO, Sule G. Socio-demographic factors in accidental poisoning in children. J Med Med Sci 2013;4:13-6.
11
Ahmed B, Fatmi Z, Siddiqui AR, Sheikh AL. Predictors of unintentional poisoning among children under 5 years of age in Karachi: a matched case-control study. Inj Prev 2011;17:27-32.
12
Kohli U, Kuttait VS, Lodha R, Kabra SK. Profile of Childhood Poisoningat a Tertiary Care Centre in North India. Indian J Pediatr2008;75:791-4 .
13
Yaqoob M, Yar M, Farooq M, Butt AR, Izhar RW. Acute Poisoning in Children: Etiological Agents, Risk Factors and Outcomes. Pak J Med Health Sci 2007;1:42-4.
14
Manzar N, Saad SM, Manzar B, Fatima SS. The study of etiological and demographic characteristics of acute household accidental poisoning in children--a consecutive case series study from Pakistan. BMC Pediatr 2010;10:28
15
Bhat NK, Dhar M, Ahmad S, Chandar V. Profile of poisoning in children and adolescents at a North Indian tertiary care centre. J Indian Acad Clin Med 2011;13:37-42.
16
Ramos CL, Barros HM, Stein AT, Costa JS. Risk factors contributing to childhood poisoning. J Pediatr (Rio J) 2010;86:435-40.
17
Krishnakumar P, Geeta MG, Gopalan AV. Deliberate self-poisoning in children. Indian Pediatr 2005;42:582-6.
18
Chala TS, Gebramariam H, Hussen M. Two-Year Epidemiologic Pattern of Acute Pharmaceutical and Chemical Poisoning Cases Admitted to Adama Hospital Medical College, Adama, Ethiopia. Asia Pac J Med Toxicol 2015;4:106-11.
19
Siddiqui E, Ejaz K, Kazi SG, Siddiqui S, Raza SJ. Mothers’ education and working status; do they contribute to corrosive poisoning among paediatric patients of Karachi, Pakistan? J Pak Med Assoc 2013;63:992-6.
20
Khosrojerdi H, Amini M. Change in methadone syrups needs to consider different aspects. Clin Toxicol (Phila) 2014;52:152.
21
Alazab RM, Elmougy MT, Fayad RA, Abdelsalam HF, Mohamed AS. Risk factors of acute poisoning among children: A study at a poisoning unit of a university hospital in Egypt. South East Asia J Public Health 2013;2:41-7.
22
Ulmeanu C, Nitescu Girnita VG. Mortality rate in acute poisoning in a pediatric toxicology department. Przegl Lek 2005;62:453-5.
23
Brusin KM, Krayeva YV. Highly Concentrated Acetic Acid Poisoning: 400 Cases Reviewed. Asia Pac J Med Toxicol 2012;1:3-9.
24
Sahin S, Carman KB, Dinleyici EC. Acute poisoning in children; data of a pediatric emergency unit. Iran J Pediatr 2011;21:479-84.
25
Ahmed A, AlJamal AN, Mohamed Ibrahim MI, Salameh K, AlYafei K, Zaineh SA, et al. Poisoning emergency visits among children: a 3-year retrospective study in Qatar. BMC Pediatr 2015;15:104.
26
ORIGINAL_ARTICLE
Demyelinating Polyneuropathy Following Scorpion Sting Envenomation; a Case Report and Review of Literature
Background: Scorpion sting envenomation generally causes treatable local and systemic effects; however, in rare cases, the victims might experience sequels in end organs such as central nervous system. In the present paper, a case of relatively self-limiting demyelinating polyneuropathy following a Butidae sting is presented and the possible mechanisms are discussed. Case Presentation: A 19-year-old man presented to emergency department of Sultan Qaboos University Hospital, Oman with severe throbbing pain at the base of his right big toe after a scorpion sting. His initial examination revealed normal vital signs and the systemic examinations were unremarkable. Few minutes later, he developed profuse sweating, slurred speech, blurred vision, increased salivation and restlessness. Repetition of measurement of vital signs showed a blood pressure of 160/100 mmHg, heart rate of 140 beat per minute and a respiratory rate of 18 per minute. The patients received scorpion antivenom and cholinergic hyperactivity manifestations. Shortly after, the patient developed involuntary jerky movements in both lower associated with fasciculation. Nerve conduction study was suggestive of demyelinating polyneuropathy. In later days, involuntary jerky movements of lower limbs improved gradually but fasciculation remained. On a follow-up visit after four months, the patient still complained of occasional fasciculation.Discussion: One explanation for the development of peripheral nerves demyelination in our patient is the inflammatory response triggered by scorpion venom. In addition, this complication can be attributed to direct cytotoxic effects of scorpion venom toxins. Antimicrobial peptides in scorpion venoms are shown to be highly toxic to human cells, which in our case might have damaged the nerve sheet.Conclusion: Severe scorpion sting envenomation may lead to severe systemic effects and end organ damage. Medical toxicologists should be prepared to diagnose and treat such sequels.
https://apjmt.mums.ac.ir/article_6259_bf2e48080f6721d917e2c5a55265212d.pdf
2015-12-01
161
164
10.22038/apjmt.2015.6259
Fasciculation
Myoclonus
Oman
Polyneuropathies
Scorpion Stings
Faisal Abdullah
Alsawafi
fasawafi@yahoo.com
1
Ministry of Health, Muscat, Oman
LEAD_AUTHOR
Humaid
Alhinai
qasra2001@hotmail.com
2
Ministry of Health, Muscat, Oman
AUTHOR
Badriyah
Alhattali
dr.b.h@hotmail.com
3
Ministry of Health, Muscat, Oman
AUTHOR
Sabah
Awad
sabahawad14@yahoo.com
4
Sultan Qaboos University Hospital, Muscat, Oman
AUTHOR
Abdullah
Alreesi
aalreesi@live.com
5
Sultan Qaboos University Hospital, Muscat, Oman
AUTHOR
Mohammed
Alshamsi
malshamsi@hotmail.com
6
Armed Forces Hospital, Muscat, Oman
AUTHOR
Warrell DA. Venomous bites, stings, and poisoning. Infect Dis Clin North Am 2012;26:207-23.
1
Rhalem N, Aghandous R, Chaoui H, Eloufir R, Badrane N, Windy M, et al. Role of the Poison Control Centre of Morocco in the Improvement of Public Health. Asia Pac J Med Toxicol 2013;2:82-6.
2
Lall SB, Al-Wahaibi SS, Al-Riyami MM, Al-Kharusi K. Profile of acute poisoning cases presenting to health centres and hospitals in Oman. East Mediterr Health J 2003;9:944-54.
3
Scrimgeour EM, Alexander PC, Rafay A, Al-Riyami K. Antibiotic Handbook. 7th ed. Muscat, Oman: Sultan Qaboos University; 2006. (In Arabic)
4
Al-Asmari AK, Al-Saif AA, Abdo NM. Morphological identification of scorpion species from Jazan and Al-Medina Al-Munawara regions, Saudi Arabia. J Venom Anim Toxins Incl Trop Dis 2007;13:821-43.
5
Oman’s Ministry of Health. National Guidelines on Poisoning Management. 1st ed. Muscat, Oman: Ministry of Health; 2009.
6
Mégarbane B. Toxidrome-based Approach to Common Poisonings. Asia Pac J Med Toxicol 2014;3:2-12.
7
Bawaskar HS, Bawaskar PH. Scorpion sting: update. J Assoc Physicians India 2012;60:46-55.
8
Ortiz E, Gurrola GB, Schwartz EF, Possani LD. Scorpion venom components as potential candidates for drug development. Toxicon 2015;93:125-35.
9
Petricevich VL. Scorpion venom and the inflammatory response. Mediators Inflamm 2010;2010:903295.
10
Almaaytah A, Tarazi S, Mhaidat NM, Al-Balas Q, Mukattash TL. Mauriporin, a novel cationic a-helical peptide with selective cytotoxic activity against prostate cancer cell lines from the venom of the scorpion Androctonus mauritanicus. Int J Pept Res Ther 2013;19:281-93.
11
Annane D, Sanquer S, Sébille V, Faye A, Djuranovic D, Raphaël JC, et al. Compartmentalised inducible nitric-oxide synthase activity in septic shock. Lancet 2000;355:1143-8.
12
Alpay NR, Satar S, Sebe A, Demir M, Topal M. Unusual presentations of scorpion envenomation. Hum Exp Toxicol 2008;27:81-5.
13
Mohamad IL, Elsayh KI, Mohammad HA, Saad K, Zahran AM, Abdallah AM, et al. Clinical characteristics and outcome of children stung by scorpion. Eur J Pediatr 2014;173:815-8.
14
Uluğ M, Yaman Y, Yapici F, Can-Uluğ N. Scorpion envenomation in children: an analysis of 99 cases. Turk J Pediatr 2012;54:119-27.
15
Kishore D, Misra S. Atypical systemic manifestation of scorpion envenomation. J Assoc Physicians India 2009;57:344.
16
Cavari Y, Lazar I, Shelef I, Sofer S. Lethal brain edema, shock, and coagulopathy after scorpion envenomation. Wilderness Environ Med 2013;24:23-7.
17
Udayakumar N, Rajendiran C, Srinivasan AV. Cerebrovascular manifestations in scorpion sting: a case series. Indian J Med Sci 2006;60:241-4.
18
Bosnak M, Ece A, Yolbas I, Bosnak V, Kaplan M, Gurkan F. Scorpion sting envenomation in children in southeast Turkey. Wilderness Environ Med 2009;20:118-24.
19
National Antivenom and Vaccine Production Center. Polyvalent Scorpion Antivenom [Internet]. 2015 [Cited 23 Jul 2015]. Available from: http://www.antivenom-center.com/navpc-products/polyvalent-scorpion-antivenom/
20
ORIGINAL_ARTICLE
Comment on the Newly Developed Consciousness Assessment Scale; AVPU Plus
I read with interest a recent paper in your journal, in which three consciousness assessment scales were compared in poisoned patients and finally a new scale "AVPU plus" was proposed (1). The study was very interesting with a worthy objective. I would like to admire the authors for exploring how the Alert/Verbal/Painful/Unresponsive (AVPU) responsive scale corresponds with the Glasgow Coma Scale (GCS) and Richmond Agitation-Sedation Scale (RASS) scores in drug-poisoned patients, and for proposing an augmented AVPU scale.
The GCS was developed by Teasdale and Jennet in 1974 (2), aimed at standardizing assessment of level of consciousness in head trauma victims (3). The AVPU scale has been developed for rapid neurologic assessment of
traumatic patients and for those in need of advanced life support (1,4). RASS has been developed to assess agitation-sedation status of critical patients in intensive care unit (5,6).
Because there has been no standardized unified method for assessment of consciousness impairment in patients with drug and chemical poisoning, physicians have used different methods or scales in different medical settings. Therefore, developing a research-based scale that is agreed among most medical toxicologists seems necessary. My colleagues and I usually use the AVPU scale in our routine practice. Nonetheless, looking at this newly proposed scale, we believe using AVPU plus for poisoned patients in emergency setting or clinical toxicology ward would be helpful and practical. As a recommendation, I think if the grading of AVPU plus is scaled in numerical instead of alphabetical, it would be easier to use.
https://apjmt.mums.ac.ir/article_6363_170470eb20dbd598d15af661fff3185c.pdf
2015-12-01
165
165
10.22038/apjmt.2015.6363
Glasgow Coma Scale
Psychomotor agitation
Sedation
Unconsciousness
Weights and Measures
Babak
Mostafazadeh
mstzbmd@sbmu.ac.ir
1
Department of Forensic Medicine and Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Rajabi Kheirabadi A, Tabeshpour J, Afshari R. Comparison of Three Consciousness Assessment Scales in Poisoned Patients and Recommendation of a New Scale: AVPU Plus. Asia Pac J Med Toxicol 2015;4:58-63.
1
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-4.
2
Matis G, Birbilis T. The Glasgow Coma Scale--a brief review. Past, present, future. Acta Neurol Belg 2008;108:75-89.
3
Mostafazadeh B, Farzaneh E. Risks and risk factors of repeated suicidal attempt: Study on unconscious poisoned patients. Asia Pac J Med Toxicol 2013;2:28-31.
4
Sessler CN, Grap MJ, Brophy GM. Multidisciplinary management of sedation and analgesia in critical care. Semin Respir Crit Care Med 2001;22:211-26.
5
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-44.
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