https://apjmt.mums.ac.ir/ Asia Pacific Journal of Medical Toxicology en daily 1 Mon, 01 Dec 2025 00:00:00 +0330 Mon, 01 Dec 2025 00:00:00 +0330 https://apjmt.mums.ac.ir/article_27241.html Background: Gas station attendants (GSA) are at risk of adverse health outcomes due to chronic occupational exposure to petroleum hydrocarbons and poor occupational safety practices. In Sri Lanka, extended working hours, minimal use of personal protective equipment (PPE), and limited health surveillance exacerbate these risks. This study aimed to evaluate oxidative stress biomarkers and associated health risks among GSA in the Gampaha District.Methods: A cross-sectional study was conducted among 25 exposed workers and 25 age-matched unexposed controls. Data on sociodemographic characteristics, occupational exposure history, lifestyle factors, and self-reported health symptoms were collected using a structured questionnaire. Blood samples were analyzed for oxidative stress biomarkers, including glutathione (GSH), 8-hydroxydeoxyguanosine (8-OHdG), and total antioxidant capacity (TAC), using enzyme-linked immunosorbent assay (ELISA).Results: GSH levels were significantly higher among GSA (p = 0.043), indicating a potential early-phase compensatory antioxidant response to chronic petroleum vapor exposure. However, no statistically significant differences were found in TAC (p = 0.101) or 8-OHdG (p = 0.770) between exposed and control groups. Self-reported symptoms such as headaches, fatigue, memory disturbances, and respiratory complaints were more prevalent among the GSA. Alarmingly, PPE usage was extremely limited, with only 4% reporting access to masks and none to gloves, indicating a critical gap in occupational health protection.Conclusion: The findings indicate early biochemical signs of oxidative stress among gas station attendees, alongside poor adherence to occupational safety practices. Immediate implementation of regulatory interventions, including mandatory PPE provision and health education, is essential to reduce long-term health risks in this vulnerable workforce. https://apjmt.mums.ac.ir/article_27242.html Background: Generative artificial intelligence (AI) holds promise for medical education, yet the realism and contextual relevance of AI-generated toxicology vignettes in Southeast Asia are not well established. This study evaluated the face and content validity of vignettes produced by ChatGPT-4.0, to assess their plausibility and relevance for use in Singaporean emergency medicine education, training, and clinical decision support.Methods: Ten vignettes were generated using ChatGPT-4.0 in March 2025 and independently evaluated by five Singapore-based clinical toxicologists from four public hospitals. A six-domain rubric, adapted from established validity frameworks, scored presentation realism, typicality of exposure, toxidrome representation, clinical progression, appropriateness for toxicology consultation, and alignment with local practice. Inter-rater reliability was calculated using a two-way random-effects intraclass correlation coefficient [ICC (2, k)].Results: The mean total score was 20.1/24 (SD = 1.8). Inter-rater agreement was excellent (ICC = 0.87; 95% CI: 0.80–0.94). Face validity averaged 4.4/5 (SD = 0.5) and content validity averaged 4.2/5 (SD = 0.6). Most vignettes reflected common regional poisoning patterns, with some depicting rare but plausible exposures relevant to local practice.Conclusion: ChatGPT-4.0 can generate toxicology vignettes with high expert-rated realism and contextual relevance when tailored to Singaporean practice. These findings support its potential role in medical education, simulation, and decision-support tools. Further research should compare AI-generated and clinician-authored materials to determine educational impact and applicability in real-world clinical settings. https://apjmt.mums.ac.ir/article_27243.html Background: This study investigated the relationship between environmental particulate matter and electrocardiographic parameters, SpO2, creatine kinase-MB, and cardiac troponin in cardiovascular patients with COVID-19.Methods: This cross-sectional analytical study obtained information about the concentration of environmental particulate matter (PM10, PM2.5) from March 20, 2020, to March 20, 2023, from the Abadan Environmental Department. Clinical and laboratory information of cardiovascular patients with COVID-19 who were hospitalized at Ayatollah Taleghani Hospital in Abadan during this period was collected. The relationship between environmental particulate matter and SpO2, ECG parameters, troponin, and creatine kinase MB in these patients was investigated.Results: 58.5% of patients were female, with a mean age of 63.03 ± 15.21. The mean ejection fraction (EF) was 30.41 ± 22.69, and the mean peripheral capillary oxygen saturation (SpO2) was 87.56 ± 11.28, which were lower than normal. The study of the association of environmental particulate matter with clinical and laboratory diagnostic factors in cardiovascular patients with COVID-19 showed that the association between disease progression and troponin T with PM2.5 was significant, and no significant association with environmental particulate matter was observed in other factors. Also, mean PM2.5 was significantly higher on days when patients died, and it was significantly higher in patients with positive troponin T.Conclusion: These findings suggest that exposure to higher levels of PM2.5 may be associated with an increased mortality risk compared to recovery. However, further studies controlling for confounding variables must confirm the causal relationship. https://apjmt.mums.ac.ir/article_27244.html Background: Gentamicin is a commonly used antibiotic in neonatal intensive care units with known renal and auditory toxic effects. Several studies have aimed to reduce these adverse effects, which are mainly related to dosage and infusion rate. Reducing the frequency of gentamicin injections may save time, money, and human resources. This study aimed to compare the toxic effects of gentamicin administered once daily versus twice daily in neonates.  Methods: All neonates hospitalized in the NICU who met eligibility criteria and were receiving gentamicin therapy were recruited using a non-random, target-based sampling method. Participants were randomly assigned to two groups: group A received gentamicin once daily,   and group B twice daily. Therapeutic efficacy, nephrotoxicity, ototoxicity, and mortality rates were compared between the groups based on clinical evaluation, laboratory data, and  audiometric tests. Serum urea and creatinine levels were assessed to evaluate nephrotoxicity, while otoacoustic emissions (OAE) and automated auditory brainstem response (AABR) tests were used to assess ototoxicity.Results: Therapeutic effectiveness and nephrotoxicity were similar between the groups. Audiometric tests were normal in group A, whereas 6 patients in group B showed abnormal OAE and AABR results, which was statistically significant (P=0.012). No neonatal deaths occurred in either group.Conclusion: Once-daily gentamicin administration results in fewer audiological side effects compared to twice-daily dosing, highlighting its importance in reducing toxicity and conserving resources. https://apjmt.mums.ac.ir/article_27245.html Background: Heavy metals toxicities have been implicated in many biochemical, physiological, and hematological changes, some leading to the development of many organ pathologies. Miners, and even non-miners living in mining areas, are constantly exposed to these toxicities and therefore, possible sufferers of organ failures. Some mechanisms involved in the development of these changes are already elucidated, while some are not.  Methods: This review brings together many findings on the effects of these heavy metals on both occupationally and environmentally exposed individuals, and attempts to suggest some modes of action of these metals in bringing about the adverse effects. Published articles on the effects of heavy metals and priority heavy metals were randomly sourced from the internet using search terms like “toxicity of priority heavy metals”, “effects of heavy metals on miners”, biochemical changes in liver, kidney, heart of heavy metal miners”, “hematological changes in occupationally and non-occupationally exposed lead miners”, “priority heavy metals in ethno-medicinal plants. Also, unpublished work and personal experiences were used but not referenced.Results: The results showed wide adverse effects of heavy metals on internal organs, especially the kidney, liver, and heart, of both occupationally and environmentally exposed subjects.Conclusion: Artisanal system of mining in developing and underdeveloped countries can be a major culprit in the development of these organ pathologies. Therefore, government regulation and legislation will be a saving grace to the miners and other occupants of mining areas. https://apjmt.mums.ac.ir/article_27246.html Background: Tramadol is a synthetic opioid analgesic prescribed for moderate pain. Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) is a naturally occurring psychoactive compound found in certain mushrooms, often referred to as "magic mushrooms" and is classified as a Schedule I substance. This case report aimed to present the unexpected detection of psilocybin in a 100 mg tramadol tablet.Case Presentation: This case report presents the forensic identification of psilocybin in a tablet labeled as tramadol 100 mg. Analysis was conducted using Gas Chromatography–Mass Spectrometry (GC-MS). A high concentration of psilocybin was confirmed, and additionally, 60 mg of tramadol was detected in the analyzed tablet.Discussion: Active compounds of some mushrooms, such as Psilocybe cubensis and Paneolus, have psychotropic agents with hallucinogenic effects. Psilocybin is a prodrug of psilocin, meaning it's converted into psilocin in the body, and Psilocin then acts as a serotonin receptor agonist, particularly on the 5-HT2A receptor, leading to visual hallucinations, euphoria, and altered cognition. These effects can be particularly dangerous when combined with other opioids and psychoactive substances that do not have a determined dosage and intensify each other's effects.Conclusion: This case underscores the importance of drug monitoring and advanced toxicological analysis in combating the public health threat posed by drug adulteration. https://apjmt.mums.ac.ir/article_27247.html Background: Recognized by the World Health Organization as a neglected tropical disease in 2009, snake bites continue to contribute substantially to morbidity and mortality in tropical countries. Maharashtra, experiences high incidence of snake bites due to its extensive agricultural activity. Based on clinical manifestations, snake bite envenomation is broadly classified as neurotoxic, vasculotoxic, or myotoxic.Case presentation: This case series reports on 60 snakebite patients presenting to a district hospital in Bhandara, Northern Maharashtra, between May and July 2024. Cases were evaluated by clinical features, time to presentation, and offending snake species, with outcomes measured in terms of complication rates and mortality.Discussion: In this series of 60 snakebite cases, mostly involving young rural males, early hospital presentation and prompt antivenom administration were linked to markedly better outcomes, achieving 85% complete recovery with a mortality rate of 1.6%. Neurotoxic bites (cobra, krait) and vasculotoxic bites (Russell’s viper) demonstrated distinct symptom profiles, with viper bites causing the highest complication rates. Delayed medical care, often due to traditional practices, significantly increased the risk of adverse outcomes.Conclusion: This study highlights the significant impact of early intervention, species-specific envenomation patterns on the outcomes of victims. Timely presentation and prompt administration of antivenom were strongly associated with favorable clinical outcomes, while delays were linked to increased complications. https://apjmt.mums.ac.ir/article_27248.html Background: Paraquat ingestion is associated with multi-organ failure and high mortality. The lack of management guidelines and an appropriate antidote is concerning. This report discusses the successful treatment and management of four patients at our tertiary hospital using a novel combination protocol.Methods: We treated four patients with paraquat ingestion who presented to our center with a novel combination protocol, which included administration of intravenous Methylprednisolone, N-acetylcysteine, Cyclophosphamide, oral Vitamin C and Vitamin E, and an antifibrotic agent. We followed up with these patients in the hospital, monitoring their clinical outcome.Results: The ingested volume of paraquat ranged from 10 ml to 50 ml of 24% paraquat. Three patients had paraquat tongue with corrosive injury. We noted a serial rise in creatinine levels in all patients, which returned to baseline on follow-up. Three patients had ground-glass opacifications on a high-resolution Chest computerized tomography scan. At follow-up, we noted normal renal and liver function, with no delayed effects or complications in these patients.Conclusion: A combination therapy with immunosuppression, high-dose antioxidants, and antifibrotics has demonstrated potential in treating paraquat (PQ) poisoning, preventing progressive pulmonary fibrosis, and improving survival. This protocol has shown progress in PQ poisoning management and has laid the groundwork for future research. https://apjmt.mums.ac.ir/article_27249.html Traditional toxicity studies rely on laboratory animal experimentations to estimate the median lethal dose (LD50) of chemicals such as pesticides and medications. This scientific letter highlights the importance of using artificial intelligence (AI) tools (ChatGPT, Deep Seek and Perplexity) to calculate the LD50 values of diazinon in chicks and cadmium chloride in mice. The data of diazinon and cadmium LD50 experiments in animals were separately presented to each of the three AI tools to estimate LD50 values of both toxicants, which were then compared to those of already published results. By following optimal instructions and providing experimental data, the three AI tools (ChatGPT, Deep Seek and Perplexity) accurately determined the LD50 values of diazinon (6.32 mg/kg, orally) in chicks and cadmium chloride (8.6 mg/kg, intraperitoneally) in mice using the up-and-down method. However, when the AI tools were provided with limited information but the same data, inaccuracies arose in calculating the LD50 values for both diazinon and cadmium. A word of caution is, therefore in place herewith, when AI tools are used for estimation of toxicity output (LD50) that might simulate an in silico approach, even in case of availability of some experimental data, as presented currently in the form of doses used and animal survival and death.