Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
Severity and Management of patients with Snake and Scorpion Envenomation Admitted to an Intensive Care Unit in Southeastern Turkey: A retrospective study
38
43
EN
Firdevs Tugba
Bozkurt
0000-0002-1461-5933
Department of Intensive Care Medicine University of Health Sciences, Mehmet Akif İnan Research and Training Hospital Şanlıurfa, Turkey
drtugbaicu@gmail.com
Burc
Aydin
Department of Medical Pharmacology University of Health Sciences, Mehmet Akif İnan Research and Training Hospital Şanlıurfa, Turkey
burcaydin@gmail.com
Tugba
Bingol
Tanrıverdi
Department of Anesthesiology and Reanimation University of Health Sciences, Mehmet Akif İnan Research and Training Hospital Şanlıurfa, Turkey
tuggbabingol@gmail.com
Gulcin
Patmano
Department of Anesthesiology and Reanimation University of Health Sciences, Mehmet Akif İnan Research and Training Hospital Şanlıurfa, Turkey
gulcinpatmano@gmail.com
Mehmet
Tercan
Department of Anesthesiology and Reanimation University of Health Sciences, Mehmet Akif İnan Research and Training Hospital Şanlıurfa, Turkey
drmtercan@gmail.com
Ahmet
Kaya
Department of Anesthesiology and Reanimation University of Health Sciences, Mehmet Akif İnan Research and Training Hospital Şanlıurfa, Turkey
ahmetkayamd@yahoo.com
10.22038/apjmt.2021.18221
<em>Background: </em>Snake and scorpion envenomation is a common public health problem in many regions of the world. Life-threatening emergencies may occur in patients with snake and scorpion envenomation; therefore, these patients may be required intensive care unit (ICU) follow-up. Our objective was to present the demographic and clinical characteristics, treatment modalities and short term outcomes of patients with snake and scorpion envenomation who followed up in our tertiary hospital ICU.<br /> <em>Methods: </em>Patient records were retrospectively searched and snake or scorpion envenomation patients with ICU stay were identified with relevant keywords and ICD-10 codes between January 2010 and September 2019. All cases with ICU stay were included for study analysis, regardless of patient age. Scorpion and snake envenomation managed in outpatient clinic were excluded from our data. Poisoning severity score (PSS) system was used to present signs and symptoms and PSS was calculated. Primary and critical care treatment modalities were identified and analyzed.<br /> <em>Results: </em>Forty patients (25 with snake bites [62.5%] and 15 with scorpion sting [37.5%]) were included in this retrospective study. Local and systemic effects have been reported in 33 (82.5%) and in 27 patients (67.5%), respectively. Majority of patients suffered from pain or disturbances in sensory neural, hematological, cardiovascular or metabolic systems. Median PSS was 2 (0-4) and median length of stay in ICU was 2 days (1-12). Mortality rate was 2.5%. Antivenom immunoglobulins (n=32, %80.0), systemic antibacterial agents (n=24, 60%), and paracetamol (n=21, 52.5%) were the most common systemically administered treatments. Surgical interventions were performed in 4 patients (10%)<br /> <em>Conclusions: </em>We reported that snake and scorpion envenomation were mostly admitted to the ICU with local and/or systemic symptoms for advanced monitoring and observation. Although life treating emergencies and mortality was uncommon in our study, we think that these patients should be closely followed up in ICU.
Venom,Poisoning,Critical care,Middle East,scorpions,snakes,Envenomation
https://apjmt.mums.ac.ir/article_18221.html
https://apjmt.mums.ac.ir/article_18221_ee89bb5c9a9c27adb79add8df74a9fee.pdf
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
The pattern of acute poisoning in hospitalized children under 18 years old of Yazd, Iran
44
47
EN
Zahra
Nafei
0000-0001-8714-2201
Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
nafeiy@yahoo.com
Nasrin
Sabouhi
0000-0002-2815-7902
Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
nasrin.sabouhi71@gmail.com
Farzad
Ferdosian
0000-0002-2763-7859
Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
ferdosian@ssu.ac.ir
Farimah
Shamsi
0000-0002-8812-0765
Center of Healthcare Data Modelling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
farimah.shamsi1982@gmail.com
10.22038/apjmt.2021.18222
Acute poisoning is a common cause of emergency department visits in childhood and can increase children’s morbidity and mortality. Since the causes of child poisoning in different parts of Iran may differ due to cultural differences, this study was conducted to evaluate the most common causes of poisoning in Yazd.<br /> This retrospective cross-sectional study is based on the medical records of children less than 18 years of age admitted to the pediatric emergency department at Shahid Sadoughi Hospital in Yazd during 2018. The collected data included demographic information, the cause, and the outcome of acute poisoning. Out of 105 cases, 61.9% were boys. The highest poisoning rates were in the age group of 1 to 4 years (55.2%). In 50% of the participants, the family size was five or more, and 91% had Iranian nationality. Drugs were identified as the most common causes of poisoning (51.4%), and opioid analgesics were the most frequent drugs. The most common complaint at the time of referral in patients was the loss of consciousness (33%). The mean hospital stay was 56 hours, and no death was reported.<br /> According to the findings of this study in Yazd, the probability of accidental poisoning in boys under four years and due to different types of drugs, especially opioids, was higher than others. It seems that increasing parents’ awareness about keeping drugs used by family members in a safe place and out of children’s reach is essential in preventing poisoning.<br />
Poisoning,Pediatrics,Hospitalization,Iran
https://apjmt.mums.ac.ir/article_18222.html
https://apjmt.mums.ac.ir/article_18222_83df039b337f64db24162cf644591465.pdf
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
Clinical epidemiology and treatment outcome of Hexaconazole poisoning – A prospective six year study
48
52
EN
Anand
Acharya
DEPARTMENT OF PHARMACOLOGY, Konaseema Institute of Medical Sciences & Research Foundation
anand_kims@yahoo.co.in
Abinash
Panda
0000-0002-4191-8104
DEPARTMENT OF PHARMACOLOGY,
M.K.C.G. MEDICAL COLLEGE
BERHANPUR, ODISHA - 760004
drabinashpanda@rediffmail.com
10.22038/apjmt.2021.18228
<em>Background: </em>Hexaconazole is a category 3/4 of poison as per the W.H.O Expert Group on Pesticide Residues. Hexaconazole is used to control infection by fungi in paddy and other crops. Apart from destroying the target species, it can also cause damage to humans. There have been discrete reports of instances of human poisoning due to hexaconazole.<br /> <em>Methodology: </em>A patient record-based cross-sectional study was carried out in Konaseema Institute of Medical Science & Research Foundation, Amalapuram, Andhra Pradesh, India during a period from March 2014 to April 2020 on 26 confirmed cases of hexaconazole poisoning. The clinic-demographic data, hematological, and biochemical parameters at the time of admission and at 72 hrs as well as the outcome were recorded and analyzed using descriptive statistics and paired t test.<br /> <em>Result:</em> The prevalence of hexaconazole poisoning was 4.79% of all poisoning cases. The major clinical presentation was gastrointestinal symptoms with vomiting being commonest. There was no significant change in the biochemical and hematological parameters. The mean duration of hospitalization was 4.93<span style="text-decoration: underline;">+</span>1.39 days. The recovery rate was 100% without any major sequel.<br /> <em>Conclusion: </em>Poisoning due to hexaconazole is uncommon in comparison to poisoning by other pesticides in the agricultural community. The clinical manifestations of hexaconazole poisoning indicated that it is of non-serious nature and its recovery was without any sequel.
Hexaconazole,clinical-epidemiology,Treatment outcome
https://apjmt.mums.ac.ir/article_18228.html
https://apjmt.mums.ac.ir/article_18228_44744246f9dafb9863552d4de379f76b.pdf
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
Chronic Exposure to Toluene and Heavy Metals and Changes in Indices of Liver Function, Inflammation and Oxidative DNA Damage among Automobile Workers
53
60
EN
Augusta
Chinyere
Nsonwu-Anyanwu
https://orcid.org/0000-0003-1141-5992
University of Calabar
austadechic@yahoo.com
Magnus
Chininye
Nsonwu
Department Optometry,
Imo state University, Owerri Nigeria
magnusdegreat@yahoo.com
Dibang
Parchely
Bebia
Department of Medical Laboratory Science, University of Calabar, Nigeria.
dibangparchely@gmail.com
Unyime
Aniekpon
Fabian
Department of Medical Laboratory Science, University of Calabar, Nigeria
unyumoh@yahoo.com
Sunday
Jeremiah
Offor
Department of Medical Laboratory Science, University of Calabar, Nigeria
jerryoffor@gmail.com
Precious-Ubu
David
Egete
Department of Medical Laboratory Science, University of Calabar, Nigeria
uegete@gmail.com
Chinyere
Adanna Opara
Usoro
Department of Medical Laboratory Science, University of Calabar, Nigeria.
chioparausoro@yahoo.com
10.22038/apjmt.2021.18229
<em>Background:</em> Oxidative stress (OS), oxidative DNA damage and inflammatory response induced by chronic exposure to volatile organic compounds and heavy metals (HM) have been implicated in multiple organ dysfunction. The liver enzymes (alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT)), biomarkers of OS (nitric oxide (NO), glutathione (GSH), total antioxidant capacity (TAC), total plasma peroxides (TPP), malondialdehyde (MDA)) oxidative stress index (OSI)), oxidative DNA damage (8-hydroxy-2-deoxyguanosine (8-OHdG)), and inflammation marker (tumor necrosis factor alpha (TNF-α)); heavy metals (cadmium (Cd), lead (Pb)) and urine hippuric acid (uHA) levels were assessed in automobile workers.<br /> <em>Methods:</em> Fifty automobile workers and 50 controls aged 18-60 years were enrolled into this study. The MDA, GSH, NO, TAC, TPP, ALT, ALP and GGT were estimated by colorimetry, 8-OHdG and TNF-α by enzyme linked immunosorbent assay, Cd, Pb by atomic absorption spectrophotometry and uHA by high performance liquid chromatography. Data were analyzed using t-test and correlation analysis at p <0.05.<br /> <em>Results:</em> Automobile workers had significantly higher liver enzymes, lipid peroxidation, oxidative stress, oxidative DNA damage, nitric oxide, HM, uHA and lower total antioxidants relative to controls. Heavy metals were positively associated with MDA, TPP and OSI; TPP with duration of exposure; ALP with number of working hours; and liver enzymes with OSI only in automobile workers.<br /> <em>Conclusion:</em> Association of exposure to toluene and heavy metals with increased liver enzymes activity, lipid peroxidation, oxidative stress, oxidative DNA damage, and depressed antioxidants in automobile workers suggest increased risk of hepatotoxicity and hepatocellular carcinogenesis. <br /> <strong> </strong>
Antioxidants,Heavy metals,Liver enzymes,Lipid Peroxidation,Toluene
https://apjmt.mums.ac.ir/article_18229.html
https://apjmt.mums.ac.ir/article_18229_7e6de9e61fb3cc2b33412924d075d613.pdf
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
Measurement of concentrations of six metals in Indian traditional medicine preparations and Sindoor powders
61
64
EN
Rosa
Mariam
Mathew
0000-0001-9270-0001
Department of Clinical Biochemistry, Christian Medical College Vellore, Vellore, 632004
leyzmathew@gmail.com
Jude
Joseph
Fleming
Visting Professor, Department of Clinical Biochemistry, Christian Medical College Vellore, Vellore, Tamil Nadu,632004
jjdhfleming@gmail.com
Joseph
Dian
Bondu
Lecturere, Department of Clinical Biochemistry, Christian Medical College Vellore, Tamil Nadu, India, 632004
bjdian@yahoo.co.in
Arun
Jose
Associate Professor, Department of Clinical Biochemistry, Christian Medical College Vellore, Tamil Nadu, India, 632004
arunjoseaj@yahoo.com
10.22038/apjmt.2021.18230
<strong>Abstract<br /> </strong>Background: Ayurveda is one of the traditional medical practices that is originated from India where it is still widely practiced. This study is an attempt to determine the concentration of 6 selected metals, namely chromium, cobalt, nickel, arsenic, mercury, and lead in 19 samples of Ayurvedic herbal medicines and 7 Sindoor powders sent by physicians for analysis.<br /> <br /> Methods: In this study, ICP-MS as direct analysis of a 1 in 100 dilution of the tested materials was employed which gives an estimate of the solubility of the metal constituents of the materials tested in 0.5% nitric acid. <br /> <br /> Results: The highest individual metal values found per gram in the tested materials were: chromium 3.2 microgram/g, cobalt 3.1microgram/g, arsenic 2811 microgram/g, mercury 1320 microgram/g, and lead 8329 microgram/g. Assuming only a 1 g intake/day of any single material tested, lead content exceeded in 10/26 (38%) of the preparations above the ANSI 173 oral permitted daily limit (PDE). Likewise, mercury and arsenic contents exceeded the oral PDE in 6/26 (23%). Some of these folk medicines had high levels of more than one element in it. The lead content in 3 of the 7 Sindoor powders surpassed the guideline. However, the nickel content did not exceed the PDE in the 19 samples tested. <br /> <br /> Conclusions: Our data shows that, many of Ayurvedic medicine preparations tested still contain toxic amounts of arsenic, mercury, and lead. Sindoor powder which is traditionally and religiously used by many Indian women at their forehead also contains heavy metals like lead. All these materials can pose serious health risks to their users
Herbal Medicine,Heavy metal poisoning,lead poisoning
https://apjmt.mums.ac.ir/article_18230.html
https://apjmt.mums.ac.ir/article_18230_e80aa5ea48242b4fe997ef586b011aeb.pdf
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
Sinus Bradyarrhythmia in Accidental Kodo Millet (Paspalum scrobiculatum) Poisoning – A Case Report
65
68
EN
Surendar
R
0000-0002-7760-0210
Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
drsurendar18@gmail.com
Ajay
Rangaswamy
Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India,
aj.ai.inn@gmail.com
Manu
Ayyan
Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India,
manuayyan@hotmail.com
Balamurugan
N
Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India,
muruganbala2006@gmail.com
Vivekanandan
Pillai
Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India,
drvivekvivek@gmail.com
10.22038/apjmt.2021.18231
<em>Introduction:</em> The Kodo Millet crop is known by different names in different regions such as <em>Varagu, Harka and Arikelu. It is predominantly grown in India and commonly consumed. </em>When infected by certain fungus species, the compound cyclopiazonic acid causes the crop to be toxic to humans.<br /> <em>Case Report:</em> The following article discusses a case of Kodo Millet poisoning, which is presented with episodes of vomiting, sweating, giddiness and dysphagia. Upon examination, Sinus bradycardia and hypotension were the major findings. The electrocardiograph (ECG) showed sinus brady arrhythmia, which is rarely presented in Kodo Millet poisoning. The emergency physician team treated the patient symptomatically and he was discharged after 24 hours as the symptoms and the ECG findings were reverted.<br /> <em>Discussion:</em> Kodo Millet poisoning often occurs due to accidental consumption of infected crops. Its occurrence is rare and the treatment involves only supportive care and monitoring. However, it is important to rule it out as a possible differential diagnosis in similar cases due to other causes. <br /> <em>Conclusion:</em> Sinus bradyarrhythmia is a rare condition associated with Kodo Millet poisoning. Emergency physicians should be aware of this toxicity to rule out all other possible differential diagnoses and to provide patients with early treatment.<br />
Kodo Millet,Varagu poisoning,India
https://apjmt.mums.ac.ir/article_18231.html
https://apjmt.mums.ac.ir/article_18231_cd878fcd7802445982562d96f6a3be9e.pdf
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
Vasculotoxic snake bite induced multi-organ dysfunction- A case report
69
73
EN
Vikram
Reddy
G
0000-0001-7770-4258
SETH GS MEDICAL COLLEGE AND KEM HOSPITAL
vikky1992@gmail.com
Akash
Chetan
Geet
Seth GS medical college and KEM hospital
akashgeet.geet68@gmail.com
Sagar
Dhupaji
Sonone
SETH GS MEDICAL COLLEGE AND KEM HOSPITAL
sagar31051991@gmail.com
10.22038/apjmt.2021.18232
<em>Background: </em>A WHO report included snake envenomation in the list of most important Neglected Tropical Diseases (NTD) and 95% of these cases were reported within developing countries. The reason behind this given importance is the high morbidity and mortality rates of snake envenomation as well as the challenges in availability and affordability of anti-snake venom [1]. Vasculotoxic snake bites has a myriad of manifestations ranging from local complications like necrosis and cellulitis to systemic complications such as coagulopathy, acute renal failure, acute respiratory failure, and hemolysis. <br /> <em>Case Presentation: </em>We report a case of a young male patient who was bitten by a Russell viper snake and developed cellulitis and blackish discolorations of the local site. The patient developed altered sensorium and subsequent loss of consciousness with a CT scan of the brain showing intra-parenchymal and subarachnoid hemorrhage. The coagulation profile demonstrated disseminated intravascular coagulation. He was treated for the above complications with polyvalent anti-snake venom, fresh frozen plasma, and cryoprecipitate units. Three days later, the patient developed breathlessness and hemoptysis with a drop in haemoglobin level with bilateral parenchymal infiltrates and left lower lobe consolidation indicative of diffuse alveolar hemorrhage with acute respiratory distress syndrome. On the fifth day, the patient reduced urine output with raised serum and creatinine levels. The patient’s clinical status rapidly worsened despite mechanical ventilatory and inotropic support and unfortunately succumbed to death on the 7th day of admission.<br /> <em>Conclusion: </em>Although there are case reports of snake bite induced isolated organ involvement, little is known about multi-organ dysfunction due to snake envenomation. The widespread multi-systemic involvement of snake envenomation resulting in fatal intracranial hemorrhage, acute lung, and kidney injury in our patient has been illustrated in this case report.<br />
snake envenomation,disseminated intravascular coagulation,acute respiratory distress syndrome,Acute renal failure,Intracranial Hemorrhage
https://apjmt.mums.ac.ir/article_18232.html
https://apjmt.mums.ac.ir/article_18232_048aafdc96c7e82871863ea58be2f5d3.pdf
Mashhad University of Medical Sciences
Asia Pacific Journal of Medical Toxicology
2322-2611
2322-4320
10
2
2021
06
01
A Case Report of Putaminal Hemorrhage Due to Methanol Toxicity; is Hemodialysis the Offender?
74
76
EN
Marjan
Zeinali
0000-0003-0094-9032
Neurology resident at neurology department, Firoozgar hospital, Iran University of Medical Science, Tehran, Iran
mar.zeinali.neuro@gmail.com
Mohammad Reza
Motamed
Associate professor of neurology, Neurology department, Firoozgar hospital, Iran University of Medical Science, Tehran, Iran
a_mostafa108@yahoo.com
Mostafa
Almasi Dooghaee
0000-0002-3244-1615
Assistant professor of neurology, Neurology department, Firoozgar hospital, Iran University of Medical Science, Tehran, Iran
hrabie33@gmail.com
10.22038/apjmt.2021.18235
<em>Introduction:</em> Methanol toxicity is a life-threatening condition which is rare in developed countries but common in developing countries. Bilateral putaminal necrosis and hemorrhage are potentially two lethal consequences of methanol toxicity which may be due to direct neurotoxicity of methanol metabolites, especially formic acid, or the consequences of acidosis and hypoxemia in the course of poisoning. Hemodialysis is an important part of the treatment of methanol toxicity and some researchers believe that heparin which is administrated during the hemodialysis may be the cause of putaminal hemorrhage<br /> <em>Case report:</em> We report a-32-year old man who presented with acute symptoms of methanol toxicity. A day after hemodialysis he suffered from seizure and Parkinsonism, and the neuroimaging revealed bilateral putaminal hemorrhage. Treatment with Levodopa-carbidopa was introduced for the management of Parkinsonism and finally the patient was discharged with marked improvement of symptoms and relative independency in daily activities<br /> <em>Discussion and Conclusion:</em> Our patient suffered from a late manifestation of methanol intoxication, bilateral putaminal hemorrhage, and necrosis. This appearance along with subcortical white matter involvement are the most common abnormalities of methanol toxicity in the brain imaging which can be associated with peripheral enhancement. Based on the reported case and review of present evidences, it is suggested that putaminal hemorrhage in methanol toxicity can be due to anticoagulant agents used in hemodialysis<br /> <strong> </strong>
Putamen hemorrhage,Toxicity,hemodialysis,Methanol
https://apjmt.mums.ac.ir/article_18235.html
https://apjmt.mums.ac.ir/article_18235_59cca45097cd49f13ff9b8d4e3f09f80.pdf