Pub Date : 2021-09-01DOI: 10.22038/APJMT.2021.18728
Arezou Mahdavinejad, Peyman Erfan Talab Evini, Mitra Rahimi, S. Shadnia
Background: In acute and chronic phases of severe diseases, endocrine changes occur. Some hormones, such as prolactin (PRL) and thyroid hormones, were considered predictors of ICU patients' outcomes. The present study evaluates thyroid hormone profile, serum PRL level, and their relationship with ICU poisoned patients' mortality rate.Methods: This study included 140 inpatients in the Toxicology Intensive Care Unit (TICU) who enrolled in a prospective study of a single center and observational. After admission to the ICU, the researchers collected venous blood samples from all patients directly. Concurrently, the APACHE II score was calculated. The collected samples analysis was performed based on the entire triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and PRL level.Results: One hundred and forty subjects were studied, of which 109 (75.85%) were male with a mean age of 34.17 ± 14.01. One hundred and eighteen patients were survivors with a mean age of 33.29 ±13.76. In contrast, 22 patients with a mean age of 38.91 ±14.69 died. The model of PRL combined with APACHE II score (OR 1.17, 95% CI 1.06 to 1.28, P-value =0.001) was the best model for predicting post-ICU mortality in our study.Conclusions: This study’s results are consistent with the previous research, indicating a higher incidence of thyroid and PRL hormone changes in patients hospitalized in the ICU. It can be concluded that the presence of PRL based on the APACHE II score can lead us to be more precise in predicting the outcome of poisoning in hospitalized patients.
{"title":"Association of serum prolactin levels and thyroid hormones with poisoned patient outcome","authors":"Arezou Mahdavinejad, Peyman Erfan Talab Evini, Mitra Rahimi, S. Shadnia","doi":"10.22038/APJMT.2021.18728","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18728","url":null,"abstract":"Background: In acute and chronic phases of severe diseases, endocrine changes occur. Some hormones, such as prolactin (PRL) and thyroid hormones, were considered predictors of ICU patients' outcomes. The present study evaluates thyroid hormone profile, serum PRL level, and their relationship with ICU poisoned patients' mortality rate.Methods: This study included 140 inpatients in the Toxicology Intensive Care Unit (TICU) who enrolled in a prospective study of a single center and observational. After admission to the ICU, the researchers collected venous blood samples from all patients directly. Concurrently, the APACHE II score was calculated. The collected samples analysis was performed based on the entire triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and PRL level.Results: One hundred and forty subjects were studied, of which 109 (75.85%) were male with a mean age of 34.17 ± 14.01. One hundred and eighteen patients were survivors with a mean age of 33.29 ±13.76. In contrast, 22 patients with a mean age of 38.91 ±14.69 died. The model of PRL combined with APACHE II score (OR 1.17, 95% CI 1.06 to 1.28, P-value =0.001) was the best model for predicting post-ICU mortality in our study.Conclusions: This study’s results are consistent with the previous research, indicating a higher incidence of thyroid and PRL hormone changes in patients hospitalized in the ICU. It can be concluded that the presence of PRL based on the APACHE II score can lead us to be more precise in predicting the outcome of poisoning in hospitalized patients.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43642163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.22038/APJMT.2021.18818
R. Rathnayaka, P. Ranathunga, S. Kularatne
Background: Russell’s viper (Daboia russelii) of Family Viperidae is a highly venomous snake in Sri Lanka and is responsible for the most snakebite deaths. It commonly causes coagulopathy and neuroparalysis. Thrombotic microangiopathy (TMA) including the triad of acute kidney injury (AKI), thrombocytopenia and microangiopathic hemolysis is a rare complication of its bites. There are two clinical entities of TMA including hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) of which, only few records of TMA and HUS following Russell’s viper bites are available in literature.Case presentation: Two patients presented with TMA following Russell’s viper bites. A 36-year-old male who got coagulopathy, respiratory failure, AKI, signs of HUS, and he completely recovered with antivenom and 8 cycles of hemodialysis and discharged on day 19 of snakebite. The other patient was a 66-year-old female who had delayed coagulopathy and persistent drowsiness, the signs of TTP. She required antivenom with 9 cycles of hemodialysis and 6 cycles of therapeutic plasma exchange and got recovered after 30 days in hospital that included intensive care treatments.Discussion: Russell’s viper venom causes activation of Factor V and X which results venom induced consumption coagulopathy and bleeding. The venom also blocks neuromuscular junction and causes neuroparalysis, which are commonly manifested as ptosis and external ophthalmoplegia. It also has direct nephrotoxic effects and there are fibrin depositions in renal microvasculature thereby, causing renal ischemia. In the spectrum of HUS-TTP of TMA, HUS is suggested when there is a severe renal involvement, and TTP is diagnosed when neurological impairment is prominent.Conclusion: Atypical presentations like TMA and HUS may rarely occur following Russell’s viper bites. Further evidence of similar observations is needed to confirm the clinical entity of TTP following Daboia russelii bites.
{"title":"Thrombotic microangiopathy, hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: Rare manifestations of Russell’s viper (Daboia russelii) envenoming in Sri Lanka","authors":"R. Rathnayaka, P. Ranathunga, S. Kularatne","doi":"10.22038/APJMT.2021.18818","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18818","url":null,"abstract":"Background: Russell’s viper (Daboia russelii) of Family Viperidae is a highly venomous snake in Sri Lanka and is responsible for the most snakebite deaths. It commonly causes coagulopathy and neuroparalysis. Thrombotic microangiopathy (TMA) including the triad of acute kidney injury (AKI), thrombocytopenia and microangiopathic hemolysis is a rare complication of its bites. There are two clinical entities of TMA including hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) of which, only few records of TMA and HUS following Russell’s viper bites are available in literature.Case presentation: Two patients presented with TMA following Russell’s viper bites. A 36-year-old male who got coagulopathy, respiratory failure, AKI, signs of HUS, and he completely recovered with antivenom and 8 cycles of hemodialysis and discharged on day 19 of snakebite. The other patient was a 66-year-old female who had delayed coagulopathy and persistent drowsiness, the signs of TTP. She required antivenom with 9 cycles of hemodialysis and 6 cycles of therapeutic plasma exchange and got recovered after 30 days in hospital that included intensive care treatments.Discussion: Russell’s viper venom causes activation of Factor V and X which results venom induced consumption coagulopathy and bleeding. The venom also blocks neuromuscular junction and causes neuroparalysis, which are commonly manifested as ptosis and external ophthalmoplegia. It also has direct nephrotoxic effects and there are fibrin depositions in renal microvasculature thereby, causing renal ischemia. In the spectrum of HUS-TTP of TMA, HUS is suggested when there is a severe renal involvement, and TTP is diagnosed when neurological impairment is prominent.Conclusion: Atypical presentations like TMA and HUS may rarely occur following Russell’s viper bites. Further evidence of similar observations is needed to confirm the clinical entity of TTP following Daboia russelii bites.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45532138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.22038/APJMT.2021.18715
M. Linus, Manojan Kk, A. KannanMuthuraman, Sivam Roopasree, M. P. George
Background: Emergency physicians must be updated about the variations in poisoning pattern during Covid19 pandemic. Limited data exist on the incidence and characteristics of patients presenting with poisoning in Indian Emergency Departments (ED) during the COVID 19 pandemic. Hence, we aimed to explore the impact of Covid19 pandemic on poisoning cases presenting to the ED.Methods: This cross-sectional retrospective study was conducted on poisoning patients presenting to ED during the pandemic period (April 1-October 30, 2020 (period 2)), and a matching period before the pandemic (September 1,2019 to March 31, 2020 (period 1)). The rate of prevalence and clinical profile were compared between period 1 and 2 using appropriate statistical test.Results: A total of 111 (periods 1 = 57, and periods 2 = 54) cases were analysed. Poisoning prevalence rates had slightly increased by 2.7% before the pandemic (51.33%) in comparison to during the pandemic (48.6%) period (p=0.3). Females were predominant in both periods, and the mean age of 32.5 years. The predominant (57%) patient age group was 15-34 years. 36.9% (n=41) patients consumed multiple poisons, 19.8% (n=22) consumed paracetamol, and 14.4% (n=16) patients consumed psychiatric medications. Before lockdown, 27.02% (n=30) patients presented within 3 hours ingestion, and 21.6% (n=24) presented after 3 hours ingestion (p=0.12). A significant delay in arrival of poisoning cases during lockdown (p= 0.12) with increased hospital admission (p=0.03) was observed. A psychiatric disorder was observed in 36.03% cases. Majority of the cases were admitted in the ICU, and 0.9%(n=1) death was recorded.Conclusions: This is the first Indian study that describes the incidence of poisoning cases and their pattern during the COVID 19pandemic period, study revealed that increased mental health crisis in low resource settings in rural Kerala affects predominantly young population. Study implies the importance of priming the mental health care professionals to initiate their mental health screening programmes.
{"title":"Clinical profile and Prevalence of poisoning patients presenting to the emergency department of a teaching hospital in Kerala: A retrospective comparative study before and during COVID-19 pandemic","authors":"M. Linus, Manojan Kk, A. KannanMuthuraman, Sivam Roopasree, M. P. George","doi":"10.22038/APJMT.2021.18715","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18715","url":null,"abstract":"Background: Emergency physicians must be updated about the variations in poisoning pattern during Covid19 pandemic. Limited data exist on the incidence and characteristics of patients presenting with poisoning in Indian Emergency Departments (ED) during the COVID 19 pandemic. Hence, we aimed to explore the impact of Covid19 pandemic on poisoning cases presenting to the ED.Methods: This cross-sectional retrospective study was conducted on poisoning patients presenting to ED during the pandemic period (April 1-October 30, 2020 (period 2)), and a matching period before the pandemic (September 1,2019 to March 31, 2020 (period 1)). The rate of prevalence and clinical profile were compared between period 1 and 2 using appropriate statistical test.Results: A total of 111 (periods 1 = 57, and periods 2 = 54) cases were analysed. Poisoning prevalence rates had slightly increased by 2.7% before the pandemic (51.33%) in comparison to during the pandemic (48.6%) period (p=0.3). Females were predominant in both periods, and the mean age of 32.5 years. The predominant (57%) patient age group was 15-34 years. 36.9% (n=41) patients consumed multiple poisons, 19.8% (n=22) consumed paracetamol, and 14.4% (n=16) patients consumed psychiatric medications. Before lockdown, 27.02% (n=30) patients presented within 3 hours ingestion, and 21.6% (n=24) presented after 3 hours ingestion (p=0.12). A significant delay in arrival of poisoning cases during lockdown (p= 0.12) with increased hospital admission (p=0.03) was observed. A psychiatric disorder was observed in 36.03% cases. Majority of the cases were admitted in the ICU, and 0.9%(n=1) death was recorded.Conclusions: This is the first Indian study that describes the incidence of poisoning cases and their pattern during the COVID 19pandemic period, study revealed that increased mental health crisis in low resource settings in rural Kerala affects predominantly young population. Study implies the importance of priming the mental health care professionals to initiate their mental health screening programmes.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49464226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.22038/APJMT.2021.18823
Sareh Dortaj
Background: The venom of different snake species has a distinctive composition. This composition can be also affected by other factors such as age, sex, geographical, and seasonal variations. Generally, snake venom is composed of small molecules such as inorganic cations as well as enzymatic and non-enzymatic peptides, and proteins. Although snake bite poisoning is highly associated with death after systemic absorption of the venom, some studies report on snake venom’s composition, toxicodynamic, and potential therapeutic.Methods: Using electronic databases like ISI Web of Knowledge, PubMed, and Scopus, this review aims to point to some components of snake venom and how these components can be used for therapeutic and diagnostic purposes.Results: Snake venom was used for the treatment of different pathophysiological conditions in ancient times and is now being used in both modern and folk medicine. These have created the opportunity for scientists to discover new drugs that are more targeted to the site of action and have fewer adverse effects.Conclusion: Today, using special techniques of isolation and formulation, some purified snake venom components are being used for the treatment of acute and chronic conditions, while some others are under further clinical trials. This is due to their potential to produce antitumor, antimicrobial, analgesic, antiplatelet, hypotensive, and other activities.
背景：不同蛇种的毒液具有独特的成分。这种组成也可能受到其他因素的影响，如年龄、性别、地理和季节变化。一般来说，蛇毒由小分子组成，如无机阳离子、酶和非酶肽以及蛋白质。尽管蛇咬伤中毒与全身吸收毒液后的死亡高度相关，但一些研究报道了蛇毒的成分、毒代动力学和潜在的治疗方法。方法：使用ISI Web of Knowledge、PubMed和Scopus等电子数据库，本综述旨在指出蛇毒的一些成分，以及这些成分如何用于治疗和诊断目的。结果：蛇毒在古代被用于治疗不同的病理生理条件，目前已被用于现代医学和民间医学。这些为科学家们创造了机会，发现更针对作用部位、不良反应更少的新药。结论：目前，通过特殊的分离和配制技术，一些纯化的蛇毒成分正在用于治疗急慢性疾病，而另一些成分正在进一步的临床试验中。这是由于它们具有产生抗肿瘤、抗菌、镇痛、抗血小板、降压和其他活性的潜力。
{"title":"The Toxic Components and the Clinical Uses of Snake Venom: A Review","authors":"Sareh Dortaj","doi":"10.22038/APJMT.2021.18823","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18823","url":null,"abstract":"Background: The venom of different snake species has a distinctive composition. This composition can be also affected by other factors such as age, sex, geographical, and seasonal variations. Generally, snake venom is composed of small molecules such as inorganic cations as well as enzymatic and non-enzymatic peptides, and proteins. Although snake bite poisoning is highly associated with death after systemic absorption of the venom, some studies report on snake venom’s composition, toxicodynamic, and potential therapeutic.Methods: Using electronic databases like ISI Web of Knowledge, PubMed, and Scopus, this review aims to point to some components of snake venom and how these components can be used for therapeutic and diagnostic purposes.Results: Snake venom was used for the treatment of different pathophysiological conditions in ancient times and is now being used in both modern and folk medicine. These have created the opportunity for scientists to discover new drugs that are more targeted to the site of action and have fewer adverse effects.Conclusion: Today, using special techniques of isolation and formulation, some purified snake venom components are being used for the treatment of acute and chronic conditions, while some others are under further clinical trials. This is due to their potential to produce antitumor, antimicrobial, analgesic, antiplatelet, hypotensive, and other activities.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47890493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.22038/APJMT.2021.18229
A. Nsonwu-Anyanwu, M. C. Nsonwu, Dibang Parchely Bebia, U. A. Fabian, S. J. Offor, PRECIOUS-UBU David Egete, C. Usoro
Background: 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. Methods: 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. Results: 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. Conclusion: 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.
{"title":"Chronic Exposure to Toluene and Heavy Metals and Changes in Indices of Liver Function, Inflammation and Oxidative DNA Damage among Automobile Workers","authors":"A. Nsonwu-Anyanwu, M. C. Nsonwu, Dibang Parchely Bebia, U. A. Fabian, S. J. Offor, PRECIOUS-UBU David Egete, C. Usoro","doi":"10.22038/APJMT.2021.18229","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18229","url":null,"abstract":"Background: 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. Methods: 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. Results: 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. Conclusion: 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.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42412279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.22038/APJMT.2021.18232
G. VikramReddy, Akash Chetan Geet, Sagar Dhupaji Sonone
Background: 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. Case Presentation: 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. Conclusion: 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.
{"title":"Vasculotoxic snake bite induced multi-organ dysfunction- A case report","authors":"G. VikramReddy, Akash Chetan Geet, Sagar Dhupaji Sonone","doi":"10.22038/APJMT.2021.18232","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18232","url":null,"abstract":"Background: 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. Case Presentation: 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. Conclusion: 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.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44954417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.22038/APJMT.2021.18228
A. Acharya, Abinash Panda
Background: 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. Methodology: 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. Result: 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+1.39 days. The recovery rate was 100% without any major sequel. Conclusion: 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.
{"title":"Clinical epidemiology and treatment outcome of Hexaconazole poisoning – A prospective six year study","authors":"A. Acharya, Abinash Panda","doi":"10.22038/APJMT.2021.18228","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18228","url":null,"abstract":"Background: 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. Methodology: 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. Result: 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+1.39 days. The recovery rate was 100% without any major sequel. Conclusion: 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.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43907552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.22038/APJMT.2021.18231
R. Surendar, A. Rangaswamy, Manu Ayyan, N. Balamurugan, V. Pillai
Introduction: The Kodo Millet crop is known by different names in different regions such as Varagu, Harka and Arikelu. It is predominantly grown in India and commonly consumed. When infected by certain fungus species, the compound cyclopiazonic acid causes the crop to be toxic to humans. Case Report: 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. Discussion: 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. Conclusion: 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.
{"title":"Sinus Bradyarrhythmia in Accidental Kodo Millet (Paspalum scrobiculatum) Poisoning – A Case Report","authors":"R. Surendar, A. Rangaswamy, Manu Ayyan, N. Balamurugan, V. Pillai","doi":"10.22038/APJMT.2021.18231","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18231","url":null,"abstract":"Introduction: The Kodo Millet crop is known by different names in different regions such as Varagu, Harka and Arikelu. It is predominantly grown in India and commonly consumed. When infected by certain fungus species, the compound cyclopiazonic acid causes the crop to be toxic to humans. Case Report: 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. Discussion: 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. Conclusion: 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.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46327812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.22038/APJMT.2021.18230
R. Mathew, J. J. Fleming, J. Bondu, A. Jose
Abstract 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. 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. 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. 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
{"title":"Measurement of concentrations of six metals in Indian traditional medicine preparations and Sindoor powders","authors":"R. Mathew, J. J. Fleming, J. Bondu, A. Jose","doi":"10.22038/APJMT.2021.18230","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18230","url":null,"abstract":"Abstract 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. 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. 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. 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","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49518948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.22038/APJMT.2021.18222
Zahra Nafei, Nasrin Sabouhi, F. Ferdosian, F. Shamsi
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. 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. 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.
{"title":"The pattern of acute poisoning in hospitalized children under 18 years old of Yazd, Iran","authors":"Zahra Nafei, Nasrin Sabouhi, F. Ferdosian, F. Shamsi","doi":"10.22038/APJMT.2021.18222","DOIUrl":"https://doi.org/10.22038/APJMT.2021.18222","url":null,"abstract":"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. 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. 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.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43738282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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