Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Role of the Poison Control Centre of Morocco in the Improvement of Public Health8286166710.22038/apjmt.2013.1667ENNaima RhalemPoison Control and Pharmacovigilance Centre of Morocco, Rabat, Morocco.
Ibn Tofail University, Faculty of Sciences, Kénitra, MoroccoRachida AghandousPoison Control and Pharmacovigilance Centre of Morocco, Rabat, MoroccoHanane ChaouiPoison Control and Pharmacovigilance Centre of Morocco, Rabat, Morocco.
Ibn Tofail University, Faculty of Sciences, Kénitra, MoroccoRhislane EloufirPoison Control and Pharmacovigilance Centre of Morocco, Rabat, MoroccoNarjis BadranePoison Control and Pharmacovigilance Centre of Morocco, Rabat, Morocco.
Ibn Tofail University, Faculty of Sciences, Kénitra, MoroccoMaria WindyPoison Control and Pharmacovigilance Centre of Morocco, Rabat, Morocco.
Ibn Tofail University, Faculty of Sciences, Kénitra, MoroccoHouria HardouzPoison Control and Pharmacovigilance Centre of Morocco, Rabat, Morocco.
Ibn Tofail University, Faculty of Sciences, Kénitra, MoroccoLahcen OuammiPoison Control and Pharmacovigilance Centre of Morocco, Rabat, MoroccoAbdelmjid SoulaymaniIbn Tofail University, Faculty of Sciences, Kénitra, MoroccoRachida Soulaymani-BencheikhPoison Control and Pharmacovigilance Centre of Morocco, Rabat, Morocco.
Mohammed V- Souissi University, Faculty of Medicine, Rabat, MoroccoJournal Article20130704<em>Background:</em> Poison Control Centre of Morocco (MPCC) plays a key role in promoting health. This study was aimed to demonstrate the role of the MPCC in improving public health and poisoning management. <br/><em>Methods:</em> This was a retrospective study of poisoning cases reported to the MPCC between 1980 and 2011. The collected data included number of poisoning cases, profession of interlocutor who called the poison centre, time of poisoning (year), gender of poisoned patient, age of poisoned patient, toxic agent and intention of poisoning. Data were analyzed using Epi Info software. The activities of MPCC were evaluated by three indicators including structural indicators, process indicators and impact indicators <br/><em>Results:</em> Between 1980 and 2011, the MPCC received 401148 notifications which 73.1% of them involved scorpion stings and 26.9% were about other toxic agents. The main causes of poisoning, excluding scorpion stings, were pharmaceuticals (6.1%) followed by food (5.9%) and carbon monoxide (4.5%) poisoning. The MPCC devised five protocols through a consensual method and distributed to practitioners in hospitals around the country considering gastric emptying, management of PPD poisoning, management of scorpion stings, management of carbon monoxide poisoning and the management of snakebite. Gastric emptying decreased from 45% to 4% of cases during this period. A national strategy was set up for the management of scorpion stings leading to a decrease in mortality from 1.54% to 0.22%. <br/><em>Conclusion:</em> During the period of more than two decades, the achievements of the MPCC have not been limited to providing toxicological information, but also activating a proper toxicovigilance system. In fact, a poison control centre is not a luxury structure. It is an integral part of every health system. Its impact on reducing morbidity and mortality is no longer discussed and its observatory role on poisonings should be strengthened.Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Changing Pattern of Epidemic Dropsy in North India8791166810.22038/apjmt.2013.1668ENNavneet SharmaThe Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaNaina MohanKing's College London, Strand, London, United KingdomAshish BhallaThe Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaAman SharmaThe Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSurjit SinghThe Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaJournal Article20130502<em>Background:</em>Epidemic dropsy occurs due to ingestion of mustard oil contaminated with oil from <em>Argemone mexicana</em>, leading to edema and tenderness of the abdomen, upper and lower limbs. In this study, clinical profiles of patients presented with epidemic dropsy in north India are described. <br/><em>Methods:</em> This was a prospective study of patients presented with epidemic dropsy to the emergency department of Nehru Hospital, during the period from March 2004 to December 2011. Inclusion criteria were patients presenting with tender bilateral pitting leg edema and dermal telangiectasia. Clinical and laboratory data of patients were entered into case record forms at the time of presentation until discharge from the hospital. <br/><em>Results:</em> Leg edema was the principal symptom in our series, and was in concurrence with current literature. Erythema has only been reported in 35-82% of published series, though it was present in all of our patients. Similarly, features such as diarrhea, hepatomegaly and anemia were more frequent in our cases compared to the literature. Furthermore, pancytopenia which was documented on peripheral blood counts in 54% of our cases has never been reported before. <br/><em>Conclusion:</em> Epidemic dropsy should be considered in patients presenting with progressive erythema, edema, and tenderness of the limbs who had a history of consumption of mustard oil and confirmation of <em>Argemone</em> oil contamination according to laboratory tests. <br/> Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Toxicologic Laboratory Findings in Cases Reported with Hanging Death: a Two-Year Retrospective Study in Northeast Iran9295166910.22038/apjmt.2013.1669ENMohammad RezaRanjbarAddiction Research Centre, Mashhad university of Medical Sciences, Mashhad, IranAmir RezaLiaghatAddiction Research Centre, Mashhad university of Medical Sciences, Mashhad, IranAmin RanjbarRazavi Khorasan Province-General Office of Iranian Legal Medicine Organization, Mashhad, IranHamid MohabbatiRazavi Khorasan Province-General Office of Iranian Legal Medicine Organization, Mashhad, IranJournal Article20130329<em>Background:</em> Suicide is one of the leading factors of death worldwide. Hanging is one of the most common methods of suicide. This study was designed to evaluate post mortem toxicology laboratory findings of subjects with hanging death in northeast Iran. <br/><em>Methods:</em> This study was carried out on reported cases with hanging death to Razavi Khorasan Province-General Office of Iranian Legal Medicine Organization during 2009 to 2011. In this study, toxicologic investigations were performed on urine samples using thin layer chromatography and gas chromatography mass spectrometry techniques. For cases which required confirmation, another sample was also obtained from blood or the vitreous. Autopsy and scene investigation findings were also studied and entered into a predesigned checklist. <br/><em>Results:</em> In total, 94 men (90.4%) and 10 women (9.6%) were studied. Suicide was proven in one hundred and one (97%) corpses and according to primary scene investigations and autopsy findings three (3%) cases were highly suspicious of non-suicidal events which eventually were clarified with the help of toxicology tests. No drug metabolites, substance or ethanol were noticed in 68 (65%) cases. Among 36 cases with discovered substances, morphine was the most common substance which was found in 27 (75%) cases. Ethanol and codeine came next and were reported in 9 (25%) and 8 (22%) cases, respectively. After plotting discovered substances against age groups, it was found that the presence of ethanol was significantly higher in younger individuals (P = 0.04). <br/><em>Conclusion:</em> Although the nature of hanging death can be clarified by scene investigations, performing postmortem toxicology tests are also crucial to specify suicidal, homicidal or accidental background. In this study morphine was the main substance found in suicidal hanging cases. Hence, the abuse of opioids can be considered as one of the major risk factors of committing suicidal hanging in Iran. <br/> Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Clinical Aspects of Green Pit Viper Bites in Bangladesh: A Study on 40 Patients96100167010.22038/apjmt.2013.1670ENShahnoor SarminDepartment of Anatomy, Dhaka Medical College, Dhaka, BangladeshMohammad RobedAminDepartment of Medicine, Dhaka Medical College, Dhaka, Bangladesh0000-0002-5500-5103Hasan Al-MamunIntensive Care Unit, Metropolitan Hospital, Chittagong, BangladeshRidwanur RahmanDepartment of Medicine, Shaheed Suhrawardy Medical College, Dhaka, BangladeshMohammad AbulFaizDepartment of Medicine, Sir Salimullah Medical College, Dhaka, BangladeshJournal Article20130611<em>Background:</em> Green pit viper bite is an important cause of morbidity in Bangladesh. The objective of this study was to investigate the characteristics and clinical presentations of green pit viper bite in Bangladesh. <br/><em>Methods:</em> This prospective observational study was done in the department of Medicine in Chittagong Medical College Hospital, Bangladesh. A total of 40 patients with history of green pit viper bite presented with local swelling and hematological abnormality were enrolled. Clinical and demographic features of patients were entered into a checklist. A careful assessment of grading of swelling and a 20 minute whole blood clotting test was done for every patient. <br/><em>Results:</em> Patients’ age ranged from 10 to 65 years with majority in 11 to 40 years group. Most bites occurred during daytime while the patients were busy in plantation, gardening and cultivation. Most of the patients received one or more harmful traditional treatments such as multiple tight ligatures (90%). The most common clinical manifestation was local swelling found in 100% of patients followed by incoagulable blood (65%), lymphadenitis (62.5%) and fang marks (60%). All patients received supportive treatments and were rehabilitated. <br/><em>Conclusion:</em> Widely practiced traditional treatments must be discouraged and community education for the people should be arranged for first aid treatments and quick transfer to the nearest hospital. Young and working people should take precautions during agricultural activities. The national guideline for management of snakebite should be encouraged to practice everywhere in Bangladesh. <br/>Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Seizure in Patients with Antiepileptic Drug Overdose: Study on Patients Admitted To Shoushtari Hospital in Shiraz101104167110.22038/apjmt.2013.1671ENNaser SaneDepartment of Medical Toxicology, Shoushtari Hospital, Shiraz University of Medical Sciences, Shiraz, IranFazel GoudarziDepartment of Medical Toxicology, Shoushtari Hospital, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20130521<em>Background:</em> Poisoning with non-barbiturate anti-epileptics (carbamazepine, sodium valproate and phenytoin) shows a growing trend. The objective of this study was to investigate clinical manifestations of poisoned patients with these medications. <br/><em>Methods:</em> This prospective study was conducted in the Shiraz Shoushtari Hospital during a two-year period from 2010 to 2012. Poisoning was confirmed according to patient’s history and clinical examinations. Patients who consumed other anti-epileptics and those who consumed other medications (except anti-epileptics) were excluded from the study. Using the AVPU scale, level of consciousness was graded. Clinical manifestations and demographic features of patients were entered into a predesigned checklist. <br/><em>Results:</em> In total, 200 patients were studied, of which 36% were men. The mean (SD) age of patients was 26.2 (11.7). The most common overdosed medication was sodium valproate, followed by carbamazepine and phenytoin. Decreased consciousness was seen in 34.5% of patients. Sixty-three patients (31.5%) had metabolic acidosis, 15 patients (7.5%) had respiratory alkalosis and 4 patients (2%) had mixed acid-base disorders. Hypercalcemia was the most common electrolyte disorder (49%). Eighty-four patients (42%) had developed seizure. The highest proportion of seizure occurred in patients with multiple drug overdose (100%) followed by phenytoin overdose (60%), carbamazepine overdose (42%) and sodium valproate overdose (33%). <br/><em>Conclusion: </em>This is the first study that shows high rates of seizure in patients poisoned with antiepileptic medications. Due to the growing trend of poisoning with these medications, it is necessary to take appropriate preventive measures include restriction on sale of these medications in pharmacies, psychiatric counseling for the patients and medication safety training to the patients. <br/>Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Comparative Study of Continuous Pralidoxime Infusion versus Intermittent Dosing: Application of High-Performance Liquid Chromatography Method on Serum of Organophosphate Poisoned Patients105110167210.22038/apjmt.2013.1672ENGirish ThungaDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, IndiaSureshwar PandeyThe School of Pharmacy, The University of the West Indies, ST Augustine, Trinidad and TobagoSreedharan NairDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, IndiaRama MylapuriDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, IndiaSudha VidyasagarDepartment of Medicine, Kasturba Hospital, Manipal, Manipal University, Manipal, IndiaVijayanarayana KunhikattaDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, IndiaBhrugu ParitiDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, IndiaMasoom PriyadarshiniDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, IndiaJournal Article20130815<em>Background:</em> The effective therapeutic dose of pralidoxime methylsulphate for organophosphate (OP) poisoning is necessary to be clarified. This study was designed to comparatively assess the blood level of pralidoxime (BPL) and clinical outcomes in OP poisoned patients treated with intermittent dosing and patients treated with continuous infusion. <br/><em>Methods:</em> This was a prospective, open labelled, cross-sectional, nonrandomized observational study which was done from 2009 to 2012 in a tertiary care hospital in Manipal, India. A high-performance liquid chromatography (HPLC) method with prominence diode array (PDA) detector was developed to measure BPL. Patients were categorized into study and control groups. Patients in study group were divided into 3 subgroups as they were treated with (a) intermittent pralidoxime dosing (1 g/q8h) or (b) continuous pralidoxime infusion (500 mg/h) or (c) continuous pralidoxime infusion (1 g/h). Patients who were not treated with pralidoxime were considered as the control group. The level of acetylcholinesterase (AChE) was measured before and pralidoxime therapy. <br/><em>Results:</em> The developed HPLC method was linear over the range of 0.5-50 µg/mL and the correlation coefficient was found to be greater than 0.99. The median (IQR) of BPL in intermittent dosing (4.63 (5.26)) was comparatively lower than patients treated with continuous infusion. The highest BPL was maintained in 1 g/h group with median (IQR) serum level of 38.86 (16.75). The reactivation rate of AChE was higher in continuous infusion groups compared to intermittent dosing. Comparison of AChE before and after pralidoxime therapy showed that higher BPL was associated with greater reactivation of AChE. <br/><em>Conclusion:</em> HPLC can be used as alternative method for measurement of pralidoxime level in blood. Continuous infusion of pralidoxime maintained a steady higher blood concentration compared to intermittent dosing with vast fluctuations. The reactivation rate of AChE was higher in continuous infusion compared to intermittent dosing. Hence, continuous infusion of pralidoxime can more rapidly recover the OP poisoned patients with less morbidity. Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Aluminum Phosphide Poisoning: A Case Series in North Iran111113167410.22038/apjmt.2013.1674ENAnahita NosratiDepartment of Pathology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, IranMohammad KaramiDepartment of Toxico-Pharmacology and Pharmaceutical Sciences Research Center, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, IranMajid EsmaeilniaDepartment of Toxico-Pharmacology and Pharmaceutical Sciences Research Center, School of Pharmacy, Mazandaran University of Medical
Sciences, Sari, IranJournal Article20130522<em>Background:</em> Aluminum phosphide (AlP) poisoning is one of the most life threatening emergencies. In this study, demographic characteristics, clinical profiles and outcomes of a series of patients presented with AlP poisoning in north Iran are described. <br/><em>Methods:</em> The study was a retrospective descriptive medical chart review of AlP poisoned patients who were admitted to internal ward of Imam Khomeini hospital, Sari, Iran, from July 1st 2011 to July 1st 2012. Collected data included gender, age, intention of poisoning, amount of AlP ingested, clinical manifestations at admission, therapeutic interventions, laboratory tests and outcome. <br/><em>Results:</em> During the one-year period, 8 patients which were all men with mean (SD) age of 40.5 (22.5) years were admitted with AlP (rice tablet) poisoning. The most common signs and symptoms at admission were nausea and vomiting (100%), metabolic acidosis (100%) and hemodynamic instability (87.5%). All cases were poisoned as a result of suicidal attempt leading to 5 (62.5.6%) deaths. Compared with the patients who survived, those who died had taken higher doses of AlP, developed hepatic dysfunction in higher rates and had severer metabolic acidosis. All patients were admitted to intensive care unit and received gastric washing with sodium bicarbonate, followed by activated charcoal therapy and intravenous calcium gluconate for decontamination purposes. The median (IQR) of length of hospital stay was 2 (1-4) days. <br/><em>Conclusion:</em> AlP is a low-cost highly-toxic rodenticide. It is easily available and used as a toxic compound for suicide in the Asia region. There has been no effective antidote available for treatment of AlP poisoned patients; thus, symptomatic management should be taken into consideration as soon as possible. <br/> Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature114116167610.22038/apjmt.2013.1676ENNiko GeorgeBekjarovskiUniversity Clinic for Toxicology, Mother Theresa Clinical Center, Skopje, MacedoniaJournal Article20130717<em>Background:</em> High-Dose Insulin Euglycemic Therapy (HIET) and Lipid Rescue Therapy (LRT) are new alternative treatments for acute poisoning with calcium channel blockers. In this report a severely poisoned patient with verapamil and furosemide who was successfully treated with these two treatments is presented. <br/><em>Case report:</em> A 27-year-old woman was brought to “Mother Theresa” Clinical Center in Skopje with a history of consumption of 24 grams (100 pills) sustained-release verapamil and 4 grams (10 pills) furosemide. She was alert and oriented with 60/35 mmHg blood pressure (BP), her respiratory rate was 25 breaths/min and heart rate was 40 beats/min with first degree atrioventricular (AV) block on electrocardiogram (ECG). In the first 90 minutes, she received activated charcoal, 1 liter of 0.9% saline, 60 mL of calcium chloride (CaCl<sub>2</sub>), 40 mg potassium and subsequently dopamine and 100 mg noradrenaline. However, there was no significant improvement in her hemodynamic status (BP = 70/50 mmHg) and she developed second degree AV block. Temporary pace maker was implanted. In the next one hour, the patient had stable vital signs, when she again became hypotensive (BP = 60/35 mmHg) with prolonged QRS complex (20 msec). During this period she was treated with epinephrine (9mg), atropine (2mg), isoprenalin, bicarbonate, CaCl<sub>2</sub> and intravenous fluid. Unsuccessful conventional treatments indicated administration of HIET and LRT. Three hours later, the BP was normalized (110/75mm) and 36 hours later, all ECG disturbances disappeared. She left the Clinic without any sequels, four days later. <br/><em>Conclusion:</em> LRT in addition to HIET are effective treatments for CCB overdose. LRT can be considered as a standard treatment for CCB overdose. Nevertheless, further investigations are necessary to establish the real value of these treatments. <br/> <br/>How to cite this article: Bekjarovski NG. Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature. Asia Pac J Med Toxicol 2013;2:114-6.Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Empowerment of Medical Toxicology in Bangladesh: Inspiration from the APAMT117117169110.22038/apjmt.2013.1691ENFazle RabbiChowdhuryScientific and publication secretary, Toxicology Society of Bangladesh (TSB) Dhaka, Bangladesh.
Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, BangladeshNazia HassanPost graduate trainee, Department of Gastroenterology, Sylhet MAG Osmani Medical College, Sylhet, BangladeshJournal Article20130829<span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">In the last issue of Asia Pacific Journal of Medical Toxicology (APJMT), editor-in-chief, Dr. Reza Afshari focused on an important contemporary issue of empowering toxicology in the Asia pacific region (1). The topic drew our attention and we would like to share the situation of Bangladesh in light of this editorial. Dr. Afshari correctly emphasized on forming national societies of medical toxicology in each country of Asia Pacific region (1). Bangladesh formed its own national society, ‘Toxicology Society of Bangladesh (TSB)’ in the year 2008 under the leadership of Prof. M. Abul Faiz (2). The society has its own website (http://www.tsbbd.org/index.php).</span><br /><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Although in small scale, the society is trying its best to disseminate knowledge of medical toxicology throughout the country. So far, we have arranged two successful national conferences in the year 2011 at Rangpur medical college (northwest of Bangladesh) and in 2013 at Chittagong medical college (southeast of Bangladesh). The society decided to arrange a national gathering at every two years interval, and hence, the next conference is scheduled to be held at Sylhet MAG Osmani medical college (northeast of Bangladesh) in coming 2015. TSB purposefully has arranged the national meetings outside capital (Dhaka), so that medical toxicology as a subject can be ventilated to the remote corners of Bangladesh. Around four hundreds domestic and international participants attended both the conferences and some of the foreign participants were policy makers of the Asia Pacific Association of Medical Toxicology (APAMT). Bangladeshi physicians started to participate APAMT congresses since 2006 (Colombo meeting) and so far TSB sent members to each meeting of the APAMT.</span><br /><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Dr. Afshari mentioned about travel grant as a strong step to motivate young investigators of this region (1). We also support his statement. So far, a number of participants from Bangladesh have received travel grants, and this surely encouraged them for future work. In fact, they are now the core members of the TSB. Undoubtedly, the APAMT is the encouragement behind all of our activities. Introduction of APJMT is clearly a milestone event for us. The young researcher of this region especially those who cannot publish their paper for various technical and linguistic reasons got a hope to see the evolution of APJMT. At least, now they can try their paper for possible publication even though their work needs fine tunes. As a Scientific and publication secretary of the TSB, I specially highlighted the journal to all of the members of TSB and others throughout the country and the journal is now receiving regular papers from Bangladesh. We firmly believe that in the near future, the APJMT will become the representative of the research in medical toxicology in this region.</span>Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901The Achievements of the Poison Control Center of Bach Mai Hospital, Vietnam118118169210.22038/apjmt.2013.1692ENPham DuePoison control center, Bach Mai Hospital, Hanoi, VietnamNguyen TrungNguyenPoison control center, Bach Mai Hospital, Hanoi, VietnamJournal Article20130818<span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Last editorial of the Asia Pacific Journal of Medical Toxicology addressed the important role of poison control centers in the improvement of public health (1). In Vietnam, poison control center (PCC) of Bach Mai Hospital has been the only national one for civilians. The establishment and activities of this center can be considered as one of the pioneers in the East Asia.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;"><em>History and setting (2,4)</em></span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">The PCC is a division of Bach Mai Hospital, a tertiary general hospital with approximately 2000 beds. The hospital is a public teaching hospital. The department of clinical toxicology or poison treatment center (PTC) was separated from the department of emergency and intensive care of Bach Mai Hospital in 1998. From this treatment center, the PCC of Bach Mai Hospital was established in 2003 and has been working as the only national PCC.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;"><em>Organization (2,4)</em></span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">The Bach Mai PCC is directed by 3 physicians who are specialized in critical care medicine and have been working for PTC from its beginning. Other staff members of the PCC include 7 physicians, 2 bachelors of chemistry, 1 technician, 27 nurses and 3 medical assistants. The PCC has a unit of clinical toxicology with 35 patient beds, toxicology laboratory and poison information unit. In this setting, clinical and scientific measures including management of poisoned patients, toxicology analysis, training and education for healthcare workers in the management and prevention of poisoning, toxicologic research, cooperation with domestic and international agencies regarding the poisonings, public education, providing poison information, treatment and prevention advice and participation in regional and international congresses and associations have been tracked.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;"><em>Achievements (2,3,5,6)</em></span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Training and education: (a) For healthcare workers in Vietnam; teaching toxicology module or training courses on the management of poisonings at graduate and postgraduate levels for physicians, residents, medical students, and nurses at the center and in different regions of Vietnam is in progress (7094 students). Moreover, 46 CME courses were organized in 42 provinces nationwide. (b) For international healthcare workers; training course on the diagnosis and management of acute poisonings for 27 physicians from India in cooperation with World Health Organization was performed.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Clinical activities: Approximately 1700-1800 poisoned patients are annually treated in the center which majority of them includes pesticides, snakebite, hymenoptera evenomation and toxic mushrooms. Treatment protocols and regimens for common and life-threatening poisonings have been developed and brought about great successes, especially with regards to organophosphate poisoning, snakebite, hymenoptera evenomation and nereistoxin insecticide poisoning.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Research: Most studies have been focused on devising protocols and application of techniques for decontamination, antidote administration and enhanced elimination of poisons including emulsified charcoal, snake antivenoms, gastric lavage with closed circuit, plasma exchange, continuous veno-venous hemofiltration/hemodialysis and charcoal and resin hemoperfusion.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Mortality rate: The PCC has played an important role in the improvement of death rate. The death rate due to poisonings was reduced from 8.5% to 1.9% after the department of clinical toxicology (PTC) was set up in 1998. The mortality was further reduced to 0.37% in 2005 after the establishment of the PCC. The current death rate (2012) is 1.99% primarily contributed by emerging paraquat poisoning.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Organization of charity activities: A large number of severely poisoned patients who were in poor economical status and had treatment costs exceeding the payment competency of the health insurance benefited from these activities.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Toxicology analysis: Analysis of many common poisons of concern have been carried out including pesticides, pharmaceuticals, drugs of abuse, alkaloids with quick tests, thin layer chromatography and high pressure liquid chromatography.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Publications: Nineteen books (in Vietnamese) on toxicology, emergency medicine and intensive care medicine, nursing, accident and injuries prevention (chief author and co-authors) have been published by the PCC, to date.</span> <br/><span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">International cooperation: The PCC successfully hosted the 9th Scientific Congress of Asia Pacific Association of Medical Toxicology at Bach Mai Hospital in 2010 which was attended by 200 delegates from 19 countries</span>Mashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112320130901Regional Collaboration for Strengthening Medical Toxicology in the Asia Pacific Region119119169310.22038/apjmt.2013.1693ENKenneth YuHartigan-GoFood and Drug Administration, Department of Health, Manila, PhilippinesJournal Article20130902<span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Medical toxicology is somehow a neglected field of medicine. Support for this discipline is necessary as there are many competing interests within a nation's public health priorities (1). In the previous issue of the Asia Pacific Journal of Medical Toxicology, the essentials of the empowerment of medical toxicology in the Asia Pacific region have been discussed (2). Perhaps, there is now an urgent need for some leverage and synergy through more regional collaboration. This means having a strong leadership to communicate and connect with the health sectors (3). I have often adhered to a health system approach when strengthening a discipline was needed. </span>
<span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">In 2007, World Health Organization described six building blocks for strengthening the health system (4). These pillars include health governance, financing, human resources for health, access to products, service delivery and lastly, application of information and communication technologies. These principals can also be applied to empower medical toxicology.</span>
<span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Governance is the strategic management, while we ask where medical toxicology should be positioned. Because toxicology covers many other fields, it is often subsumed under another discipline. Moreover, the leaders of toxicology work in cross disciplines. Hence, it dilutes us and diffuses our goals. So, we need a senior health leader that understands the critical role of toxicology to invest in the regional integration processes. This means strategic health financing. However, financing must be accompanied by good performance indicators (4). Here, lies the challenge; how can performance indicators be developed if the toxicology cases are not always consistently occurring and how can success of preventive toxicology be accurately measured?</span>
<span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">Similar to other professions, the treasure is in the human resource, and this means quality training and a common acceptable accreditation process. Mutual recognition agreement of Association of Southeast Asian Nations (ASEAN) for recognizing and employing health workers is now in discussion. Perhaps, it is time for ASEAN to look into joint needs of the 10 member countries and share the small number of medical toxicologists for more efficiency. With the modern tools of the 21st century, training, consultations and treatment advice can be made cost-efficiently (3). Many antidotes considered as orphan drugs are poorly accessed by patients in need. This problem can be solved by shared regional stockpiling and rapid logistics. This also means strategic governance.</span>
<span style="font-family: tahoma,arial,helvetica,sans-serif; font-size: small;">For improvement of the clinical services delivery, it is a necessity to engage more training at the junior physician level (the next generation) and more research and development, both of which requires recruiting human resource and sourcing of funds. There is; therefore, a unique role for the Asia Pacific Association of Medical Toxicology to play in regional toxicology strengthening.</span>