Pub Date : 2018-12-01DOI: 10.22038/APJMT.2018.11986
R. Lam, E. Chan, J. Leung, M. Tse, Z. Lin
Background: Niu Huang Jie Du Pian (NHJDP) is a widely used realgar-containing Chinese medicine remedy. Most brands are composed of eight ingredients: Niuhuang (Calculus Bovis), Xionghuang (realgar), gypsum (calcium sulphate), Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae), Jugeng (Platycodon grandiflorum), Bingpian (borneol), and Gancao (Radix Glycyrrhizae uralensis, licorice root). Most users are not aware that Xionghuang (realgar) contains arsenic disulphide [As2S2]. Inorganic arsenic poisoning after therapeutic overdoses has been reported in Chinese literature, but no report of acute, intentional overdose of NHJDP has been published. We report a case of intentional overdose of NHJDP leading to arsenic poisoning. Case Presentation: A 33-year-old woman ingested approximately 100 tablets of NHJDP bought over the counter, along with her usual antidepressants. She presented with somnolence, agitation, epigastric pain and repeated vomiting, compatible with clinical toxicities of NHJDP reported in Chinese literature. At presentation, blood and spot urine arsenic levels were 440.9 and 7,495 nmol/L, respectively. The patient’s condition improved rapidly after admission and chelation therapy was not deemed to be necessary. Discussion: Despite the self-limiting clinical course, the high arsenic level in the patient’s blood and urine raises safety concerns regarding the use of NHJDP in the community. Inconsistencies in the sales regulation of arsenic-containing products, and a lack of product label warning regarding arsenic content, may potentiate inadvertent arsenic poisoning. Conclusion: Clinician should be aware of the possibility of inorganic arsenic poisoning when treating patients with overdose of Chinese medicine remedies that contain Xionghuang (realgar). Proper product labelling may help reduce inadvertent arsenic poisoning.
{"title":"Inorganic Arsenic Poisoning Following An Intentional Overdose Of Realgar-Containing Niu Huang Jie Du Pian: A Case report and Literature Review","authors":"R. Lam, E. Chan, J. Leung, M. Tse, Z. Lin","doi":"10.22038/APJMT.2018.11986","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11986","url":null,"abstract":"Background: Niu Huang Jie Du Pian (NHJDP) is a widely used realgar-containing Chinese medicine remedy. Most brands are composed of eight ingredients: Niuhuang (Calculus Bovis), Xionghuang (realgar), gypsum (calcium sulphate), Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae), Jugeng (Platycodon grandiflorum), Bingpian (borneol), and Gancao (Radix Glycyrrhizae uralensis, licorice root). Most users are not aware that Xionghuang (realgar) contains arsenic disulphide [As2S2]. Inorganic arsenic poisoning after therapeutic overdoses has been reported in Chinese literature, but no report of acute, intentional overdose of NHJDP has been published. We report a case of intentional overdose of NHJDP leading to arsenic poisoning. Case Presentation: A 33-year-old woman ingested approximately 100 tablets of NHJDP bought over the counter, along with her usual antidepressants. She presented with somnolence, agitation, epigastric pain and repeated vomiting, compatible with clinical toxicities of NHJDP reported in Chinese literature. At presentation, blood and spot urine arsenic levels were 440.9 and 7,495 nmol/L, respectively. The patient’s condition improved rapidly after admission and chelation therapy was not deemed to be necessary. Discussion: Despite the self-limiting clinical course, the high arsenic level in the patient’s blood and urine raises safety concerns regarding the use of NHJDP in the community. Inconsistencies in the sales regulation of arsenic-containing products, and a lack of product label warning regarding arsenic content, may potentiate inadvertent arsenic poisoning. Conclusion: Clinician should be aware of the possibility of inorganic arsenic poisoning when treating patients with overdose of Chinese medicine remedies that contain Xionghuang (realgar). Proper product labelling may help reduce inadvertent arsenic poisoning.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49340591","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 : 2018-12-01DOI: 10.22038/APJMT.2018.11980
H. Bagherian, A. Taghipour, M. Bazaz, F. Nezamdoost, R. Afshari, F. Abedi
Introduction: Animal bites and rabies are perceived and managed differently from bites and stings related to envenoms snakes, scorpions and spiders. This study aimed at evaluating knowledge, attitudes and practices (KAP) of local population regarding animal bites and rabies, as a point of comparison for future studies on venomous animals. Methods: This cross-sectional KAP study included 1093 subjects from four rural areas of Mashhad. Data gathered through a validated and reliable structured questionnaire. Results: In total, 1093 respondents included in the study consist of 53% male and 42% adults of 20 to 9 years old. Assessing knowledge; 70% of cases were presented with weak and moderate knowledge related to clinical manifestations, but just the opposite, majority of the respondents (83%) were categorised as good or excellent in their knowledge of prevention. Assessing attitudes; almost all (91%) of respondents categorised as good or attitude. Assessing practices; 33% of cases revealed that there are no good practices with regard to animal bites and rabies. Respondent’s knowledge of prevention was significantly correlated with age (P = 0.01) and educational level (P = 0.002). Both attitudes and practices had significant relations with age. Respondents aged 20- 39 years showed better practices than other age groups (P < 0.01). Conclusion: this study found that while information on prevention is acceptable, clinical findings of bites and rabies are relatively unknown. Preventive measure should include clinical manifestations as well as currently implemented focus on prevention, vaccination and treatment.
{"title":"Knowledge, Attitudes and Practices Regarding animal Bites and Rabies; a Multi-Center Study","authors":"H. Bagherian, A. Taghipour, M. Bazaz, F. Nezamdoost, R. Afshari, F. Abedi","doi":"10.22038/APJMT.2018.11980","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11980","url":null,"abstract":"Introduction: Animal bites and rabies are perceived and managed differently from bites and stings related to envenoms snakes, scorpions and spiders. This study aimed at evaluating knowledge, attitudes and practices (KAP) of local population regarding animal bites and rabies, as a point of comparison for future studies on venomous animals. Methods: This cross-sectional KAP study included 1093 subjects from four rural areas of Mashhad. Data gathered through a validated and reliable structured questionnaire. Results: In total, 1093 respondents included in the study consist of 53% male and 42% adults of 20 to 9 years old. Assessing knowledge; 70% of cases were presented with weak and moderate knowledge related to clinical manifestations, but just the opposite, majority of the respondents (83%) were categorised as good or excellent in their knowledge of prevention. Assessing attitudes; almost all (91%) of respondents categorised as good or attitude. Assessing practices; 33% of cases revealed that there are no good practices with regard to animal bites and rabies. Respondent’s knowledge of prevention was significantly correlated with age (P = 0.01) and educational level (P = 0.002). Both attitudes and practices had significant relations with age. Respondents aged 20- 39 years showed better practices than other age groups (P < 0.01). Conclusion: this study found that while information on prevention is acceptable, clinical findings of bites and rabies are relatively unknown. Preventive measure should include clinical manifestations as well as currently implemented focus on prevention, vaccination and treatment.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42344136","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 : 2018-12-01DOI: 10.22038/APJMT.2018.11999
R. Afshari, D. Bellinger
Avoidable systematic differences in health status of different population groups are called health inequalities. They cause significant social and economic costs to both individuals and societies (1, 2). For example, life expectancy at birth among Canadian First Nation Population is lower (73 for males and 78 for females) than that of total Canadian population (79 and 83, respectively, projected for 2017) according to Statistics Canada (3). In this commentary, we used Canadian First Nation Population, coastal residents and Native American population who self-harvest as example. Toxicology regulation could be considered as a determinant of health, as policies introduced by regulatory toxicology agencies influence health services and are effective at the community level. These policies, however, could be distributed differently among the subgroups of the populations in a systematic manner, which may be a source of inequality. Consumption of home grown or self-harvested foods can result in exposure to various chemicals but such contaminant levels in these products are often not monitored by inspection agencies (4). To date, many drivers of health inequality have been defined, such as gender, race and economic growth. However, no literature is available on “inequality” and “potential food toxicity”. We argue in this editorial that while all population including Canadian First Nation Population, Coastal Residents and Native American population groups are benefitted from implementing new toxicology regulations, the magnitude of health inequalities might increase for some minority groups. Health Canada has set a maximum level of 0.5 mg/kg (50 ppm) in the edible portion of all retail fish, subject to some exceptions (5). This level is applied to commercial fish and enforced by the inspection agencies. However, fish consumption advisories that reduce the risk borne by the general population might not provide much health benefit to subsistence fishermen, which include First Nation (Native American) populations. In another example, and following an outbreak of amnesic shellfish poisoning (ASP) in Canada in 1987, which is ___________________ ORIGINAL ARTICLE EDITORIAL
{"title":"Implementing New Regulation Promotes Health but May Increase Inequality","authors":"R. Afshari, D. Bellinger","doi":"10.22038/APJMT.2018.11999","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11999","url":null,"abstract":"Avoidable systematic differences in health status of different population groups are called health inequalities. They cause significant social and economic costs to both individuals and societies (1, 2). For example, life expectancy at birth among Canadian First Nation Population is lower (73 for males and 78 for females) than that of total Canadian population (79 and 83, respectively, projected for 2017) according to Statistics Canada (3). In this commentary, we used Canadian First Nation Population, coastal residents and Native American population who self-harvest as example. Toxicology regulation could be considered as a determinant of health, as policies introduced by regulatory toxicology agencies influence health services and are effective at the community level. These policies, however, could be distributed differently among the subgroups of the populations in a systematic manner, which may be a source of inequality. Consumption of home grown or self-harvested foods can result in exposure to various chemicals but such contaminant levels in these products are often not monitored by inspection agencies (4). To date, many drivers of health inequality have been defined, such as gender, race and economic growth. However, no literature is available on “inequality” and “potential food toxicity”. We argue in this editorial that while all population including Canadian First Nation Population, Coastal Residents and Native American population groups are benefitted from implementing new toxicology regulations, the magnitude of health inequalities might increase for some minority groups. Health Canada has set a maximum level of 0.5 mg/kg (50 ppm) in the edible portion of all retail fish, subject to some exceptions (5). This level is applied to commercial fish and enforced by the inspection agencies. However, fish consumption advisories that reduce the risk borne by the general population might not provide much health benefit to subsistence fishermen, which include First Nation (Native American) populations. In another example, and following an outbreak of amnesic shellfish poisoning (ASP) in Canada in 1987, which is ___________________ ORIGINAL ARTICLE EDITORIAL","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44097104","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 : 2018-12-01DOI: 10.22038/APJMT.2018.11982
Bahare Hedayat, A. Rahmani, M. Matinrad, Pedram Nazari
Background: Hemiscorpius lepturus envenomation is one of the most important medical issues in tropical regions of Iran, especially Khuzestan Province. Due to lack of reliable data about scorpion sting in Khuzestan Province, this investigation was performed to study the clinical presentation, prognosis factors, complications and mortality rates of Hemiscorpius lepturus sting. Methods: this study was a cross-sectional study performed at Sina Hospital, Karoon, Iran during 2011-2013. Required data such as demographic data, complications and outcomes were collected from medical records of all admitted victims of envenomation in this period and then were registered in a propriate checklist. Data were analyzed using SPSS version 16. Results: a total of 311 victims were studied. The highest frequency of sting was in the age range of 15-24 years. Most areas of the sting were the lower extremity. Forty-two patients delayed more than 24 hours to refer to the emergency room. The most common initial symptom in victims was pain in the sting location. Complications such as hematuria, hemoglobinuria, and coagulation disorders were most morbidity occurred in patients. 6 cases died. Conclusion: delay in referring to the hospital, the existence of hemoglobinuria, coagulation disorders and kidney failure were associated with poor prognosis in patients. It seems that patients who refer with delays and with symptoms such as hematuria, need for more medical health care.
背景:在伊朗的热带地区，尤其是胡齐斯坦省，猪角锥虫中毒是最重要的医学问题之一。由于胡齐斯坦省缺乏可靠的蝎子蜇伤资料，本文对半角蝎蜇伤的临床表现、预后因素、并发症及死亡率进行了调查。方法:本研究是2011-2013年在伊朗Karoon Sina医院进行的横断面研究。从这一时期所有入院的中毒受害者的医疗记录中收集了必要的数据，如人口数据、并发症和结果，然后在适当的核对表中登记。数据分析使用SPSS version 16。结果:共对311名患者进行了研究。蜇伤发生率最高的年龄段为15 ~ 24岁。刺痛的大部分区域在下肢。42名患者延误24小时以上才转诊到急诊室。受害者最常见的最初症状是刺痛部位的疼痛。血尿、血红蛋白尿、凝血功能障碍等并发症在患者中发生率最高。死亡6例。结论:延迟转诊、存在血红蛋白尿、凝血功能障碍及肾功能衰竭与患者预后不良有关。似乎有延迟和血尿等症状的患者需要更多的医疗保健。
{"title":"The Epidemiologic and Clinical Study on Hemiscorpius Lepturus (Gadim) Envenomation with Focus on Clinical Manifestations, Prognosis Factors, and Outcomes","authors":"Bahare Hedayat, A. Rahmani, M. Matinrad, Pedram Nazari","doi":"10.22038/APJMT.2018.11982","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11982","url":null,"abstract":"Background: Hemiscorpius lepturus envenomation is one of the most important medical issues in tropical regions of Iran, especially Khuzestan Province. Due to lack of reliable data about scorpion sting in Khuzestan Province, this investigation was performed to study the clinical presentation, prognosis factors, complications and mortality rates of Hemiscorpius lepturus sting. Methods: this study was a cross-sectional study performed at Sina Hospital, Karoon, Iran during 2011-2013. Required data such as demographic data, complications and outcomes were collected from medical records of all admitted victims of envenomation in this period and then were registered in a propriate checklist. Data were analyzed using SPSS version 16. Results: a total of 311 victims were studied. The highest frequency of sting was in the age range of 15-24 years. Most areas of the sting were the lower extremity. Forty-two patients delayed more than 24 hours to refer to the emergency room. The most common initial symptom in victims was pain in the sting location. Complications such as hematuria, hemoglobinuria, and coagulation disorders were most morbidity occurred in patients. 6 cases died. Conclusion: delay in referring to the hospital, the existence of hemoglobinuria, coagulation disorders and kidney failure were associated with poor prognosis in patients. It seems that patients who refer with delays and with symptoms such as hematuria, need for more medical health care.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44261478","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 : 2018-12-01DOI: 10.22038/APJMT.2018.11985
A. Basher, kamruzzaman Khokon, U. Kuch, S. Toennes, M. Faiz
Background: Herbs can be toxic and may be even life-threatening. The mixture of different plants and herbs made by traditional healer and their canvassing on the street attract general people. Here, we report four cases of severe herbal poisoning. Case presentation: In 2008, four young people rushed to DMC Hospital in the early morning with a history of taking herbal medicine (tonic) on that night for gratification. About 3–4 h after ingestion, they experienced repeated vomiting and abdominal pain. Two patients deteriorated within the hours after admission with restlessness, progressive unconsciousness, and died soon after. The other two patients absconded from the hospital, including the person who prepared the tonic. Screening of the tonic by gas chromatography-mass spectrometry did not reveal toxic components. Discussion: The suspected herbs used for the preparation of that tonic were Santalum album (Chandan wood) which contains Santalol and other etheric oils; Plantago ovata (Ispaghula Husk) containing diverse alkaloids, phenols, etc.; and Mimosa pudica which is the common Mimosa and contains the alkaloid Mimosine. The nature of the tonic and source of the intoxication could not be finally elucidated. Conclusion: The described cases of unknown herbal poisoning in Bangladesh highlight the need for awareness campaigns targeting the population at risk.
{"title":"Unknown Herbal Poisoning with Fatal Outcome","authors":"A. Basher, kamruzzaman Khokon, U. Kuch, S. Toennes, M. Faiz","doi":"10.22038/APJMT.2018.11985","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11985","url":null,"abstract":"Background: Herbs can be toxic and may be even life-threatening. The mixture of different plants and herbs made by traditional healer and their canvassing on the street attract general people. Here, we report four cases of severe herbal poisoning. Case presentation: In 2008, four young people rushed to DMC Hospital in the early morning with a history of taking herbal medicine (tonic) on that night for gratification. About 3–4 h after ingestion, they experienced repeated vomiting and abdominal pain. Two patients deteriorated within the hours after admission with restlessness, progressive unconsciousness, and died soon after. The other two patients absconded from the hospital, including the person who prepared the tonic. Screening of the tonic by gas chromatography-mass spectrometry did not reveal toxic components. Discussion: The suspected herbs used for the preparation of that tonic were Santalum album (Chandan wood) which contains Santalol and other etheric oils; Plantago ovata (Ispaghula Husk) containing diverse alkaloids, phenols, etc.; and Mimosa pudica which is the common Mimosa and contains the alkaloid Mimosine. The nature of the tonic and source of the intoxication could not be finally elucidated. Conclusion: The described cases of unknown herbal poisoning in Bangladesh highlight the need for awareness campaigns targeting the population at risk.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45645974","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 : 2018-09-20DOI: 10.22038/APJMT.2018.11346
Simasadat Noorbakhsh, J. Shams, Reza Lotfi-Lelahloo, P. Wennberg, H. Källmén
Background: AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients. Methods: Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment. Results: A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88. Conclusions: Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.
{"title":"An Empirical Study of the Cut-Off Point for the Iranian Version of Alcohol Use Disorders Identification Test (AUDIT)","authors":"Simasadat Noorbakhsh, J. Shams, Reza Lotfi-Lelahloo, P. Wennberg, H. Källmén","doi":"10.22038/APJMT.2018.11346","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11346","url":null,"abstract":"Background: AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients. Methods: Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment. Results: A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88. Conclusions: Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47998029","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 : 2018-09-20DOI: 10.22038/APJMT.2018.11983
Francis Chu, A. Yim, S. Ng
Background: MDMA (3,4-methylenedioxymethamphetamine), which is also known as Ecstasy or Molly, is a commonly found abusive agent in Hong Kong. MDMA abuse is widely reported in electronic dance music (EDM) festivals all over the world. It brings about uncommon mortality and serious morbidity with recreational use, which are believed to be related to serotonin toxicity. Cyproheptadine has anti-histamine and 5-HT antagonist property which are reported to be an effective agent in managing serotonin syndrome of moderate severity. However, there is not much information concerning whether it is useful in life-threatening situations. Case Presentation: Four victims who collapsed while attending an EDM festival were sent to our Emergency Department (ED). They showed clinical symptoms compatible with life-threatening serotonin toxicity. One patient died 30 minutes after arrival to the ED. Aggressive attempts were made to resuscitate the other three; cyproheptadine was administrated to them from 0.75 to 10 hours after arrival. They were all admitted to intensive care unit (ICU) for further management. Their urine showed a presence of MDMA. Discussion: Except for the one who died on arrival, the other three survived, who were later discharged. An early use of cyproheptadine (0.75 vs 3.5 vs 10 hours) results in better outcome as well as a shorter ICU stay (3 vs 10 vs 53 days) and total hospital stay (11 vs 37 vs 98 days). Results: Supportive treatments as well as early use of cyproheptadine might have some beneficial effects in reducing the severity and hospital stay in patients presented with life-threatening serotonin syndrome related to MDMA.
背景：MDMA（3,4-亚甲二氧基甲基苯丙胺），也被称为摇头丸或Molly，是香港常见的滥用药物。MDMA滥用在世界各地的电子舞曲节上被广泛报道。娱乐性使用会导致罕见的死亡率和严重的发病率，这被认为与血清素毒性有关。赛庚啶具有抗组胺和5-HT拮抗剂的特性，据报道，这是治疗中度血清素综合征的有效药物。然而，关于它在危及生命的情况下是否有用，目前还没有太多信息。案例介绍：四名在参加EDM音乐节时晕倒的受害者被送往我们的急诊科。他们的临床症状与危及生命的血清素毒性相一致。一名患者在到达急诊室30分钟后死亡。其他三名患者积极尝试复苏；在到达后0.75至10小时给药赛庚啶。他们都被送入重症监护室（ICU）接受进一步治疗。他们的尿液显示存在MDMA。讨论：除了一人在抵达时死亡外，其他三人幸存下来，后来出院。早期使用赛庚啶（0.75 vs 3.5 vs 10小时）可获得更好的结果，缩短ICU住院时间（3 vs 10 vs 53天）和总住院时间（11 vs 37 vs 98天）。结果：支持性治疗以及早期使用赛庚啶可能对降低与MDMA相关的危及生命的血清素综合征患者的严重程度和住院时间有一些有益的效果。
{"title":"A Case Series of Life-Threatening MDMA Poisoning in An Electronic Dance Music Party in Hong Kong","authors":"Francis Chu, A. Yim, S. Ng","doi":"10.22038/APJMT.2018.11983","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11983","url":null,"abstract":"Background: MDMA (3,4-methylenedioxymethamphetamine), which is also known as Ecstasy or Molly, is a commonly found abusive agent in Hong Kong. MDMA abuse is widely reported in electronic dance music (EDM) festivals all over the world. It brings about uncommon mortality and serious morbidity with recreational use, which are believed to be related to serotonin toxicity. Cyproheptadine has anti-histamine and 5-HT antagonist property which are reported to be an effective agent in managing serotonin syndrome of moderate severity. However, there is not much information concerning whether it is useful in life-threatening situations. Case Presentation: Four victims who collapsed while attending an EDM festival were sent to our Emergency Department (ED). They showed clinical symptoms compatible with life-threatening serotonin toxicity. One patient died 30 minutes after arrival to the ED. Aggressive attempts were made to resuscitate the other three; cyproheptadine was administrated to them from 0.75 to 10 hours after arrival. They were all admitted to intensive care unit (ICU) for further management. Their urine showed a presence of MDMA. Discussion: Except for the one who died on arrival, the other three survived, who were later discharged. An early use of cyproheptadine (0.75 vs 3.5 vs 10 hours) results in better outcome as well as a shorter ICU stay (3 vs 10 vs 53 days) and total hospital stay (11 vs 37 vs 98 days). Results: Supportive treatments as well as early use of cyproheptadine might have some beneficial effects in reducing the severity and hospital stay in patients presented with life-threatening serotonin syndrome related to MDMA.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48854058","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 : 2018-09-20DOI: 10.22038/APJMT.2018.11973
R. Afshari
Background: Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein’s regime in 1980s and more recently in Syria. The use of CWA is banned under the international law. Methods: Ancient uses of CWA are not well studied. Recently, their use during the Persian siege of the Roman-held Dura-Europos (Salihiyah) in modern Syria in 256 C.E. has been theorized by revisiting the archaeological findings from Dura-Europos from the 1930s. Case study: The paper describes the history of Persia (Iran) and Rome in that era and particularly Shapur I, the second King (Shah) of the [Sasanian] Persian Empire (215 - 270 C.E.) and Valerian, Publius Licinius Valerianus Augustus, the Roman Emperor (193/200 - 264 C.E.). In addition, composition of the potentially applied CWA and clinical findings related to the exposure are postulated through a medical toxicology lens taking into account archeological evidence (carbonized top of the tunnels and bodies and yellow crystals found in the tunnel), recent research and contemporary historical notes. Conclusion: It is plausible that a combination of fire accelerant or so called pitch (oil based substance, naphtha, bitumen or crude oil) and Sulphur dioxide (SO2) were used in this occasion. SO2 in combination with water on the body membranes creates highly toxic sulphurous acid (H2SO3) which is life threatening in a small enclosed space. As a result, a burning sensation in the nasopharynx and eyes, coughing, dyspnea, choking that led to pulmonary edema and death would have shortly followed. Severe clinical manifestations, panic and consequent mass hysteria of the toxic exposure should have prevented any organized retreat. In this incident, nineteen Roman and one Persian soldier were killed.
{"title":"Use of Chemical Warfare Agents in Ancient History. A Case of Persians and Romans in Dura-Europos, Modern Syria in 256 C.E.","authors":"R. Afshari","doi":"10.22038/APJMT.2018.11973","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11973","url":null,"abstract":"Background: Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein’s regime in 1980s and more recently in Syria. The use of CWA is banned under the international law. Methods: Ancient uses of CWA are not well studied. Recently, their use during the Persian siege of the Roman-held Dura-Europos (Salihiyah) in modern Syria in 256 C.E. has been theorized by revisiting the archaeological findings from Dura-Europos from the 1930s. Case study: The paper describes the history of Persia (Iran) and Rome in that era and particularly Shapur I, the second King (Shah) of the [Sasanian] Persian Empire (215 - 270 C.E.) and Valerian, Publius Licinius Valerianus Augustus, the Roman Emperor (193/200 - 264 C.E.). In addition, composition of the potentially applied CWA and clinical findings related to the exposure are postulated through a medical toxicology lens taking into account archeological evidence (carbonized top of the tunnels and bodies and yellow crystals found in the tunnel), recent research and contemporary historical notes. Conclusion: It is plausible that a combination of fire accelerant or so called pitch (oil based substance, naphtha, bitumen or crude oil) and Sulphur dioxide (SO2) were used in this occasion. SO2 in combination with water on the body membranes creates highly toxic sulphurous acid (H2SO3) which is life threatening in a small enclosed space. As a result, a burning sensation in the nasopharynx and eyes, coughing, dyspnea, choking that led to pulmonary edema and death would have shortly followed. Severe clinical manifestations, panic and consequent mass hysteria of the toxic exposure should have prevented any organized retreat. In this incident, nineteen Roman and one Persian soldier were killed.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43551436","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 : 2018-09-20DOI: 10.22038/APJMT.2018.11977
Kavinda Chandimal Dayasiri, S. Jayamanne, C. Jayasinghe
Background: This qualitative study presents an in-depth evaluation of the contributory psycho-socio-cultural and physical-economic factors related to paediatric poisoning in rural Sri Lanka. Method: The study was conducted at paediatric wards of Anuradhapura teaching hospital (THA) over a period of two years (2012 – 2014). Main methods of data collection were participants’ narrative and focus group discussions (FGDs). All parents of children with acute poisoning were recruited to FGDs. The structure of phenomena was developed based on descriptive phenomenological inquiries and key themes were identified at data analysis stage. Results: 383 parents participated in focus group discussions. Data were categorized to four domains; (1) parental awareness of poisoning risks, (2) presence of child, parent and environment related risk factors, (3) issues related to first aid care and provision of care until child was brought to emergency care unit, and (4) possible measures to prevent further poisoning. Interaction of multiple risk factors was observed in children with both intentional and unintentional poisoning. Accidental poisonings were associated with certain cultural practices, unsafe environment and unsafe storage of poisons. Children with intentional poisoning frequently had disrupted family relationships. Harmful first aid measures and delayed presentation at the primary care unit had negative impact on poisoning related outcomes. Parents believed community education, safe storage of poisons, and safe environment would likely bring down poison related morbidity. Conclusion: Person, poison and environment related risk factors can lead to acute poisoning emergencies in children in rural Sri Lanka. Often multiple risk factors interact to bring about the poisoning event. Avoidance of harmful first aid measures and early presentation at the primary care unit would bring down poisoning related morbidity. Effect of community education, safe storage of poisons and safe environment should be evaluated in the view of preventing poisoning.
{"title":"A Qualitative Study of Acute Poisoning related Emergencies in the Paediatric Age Group","authors":"Kavinda Chandimal Dayasiri, S. Jayamanne, C. Jayasinghe","doi":"10.22038/APJMT.2018.11977","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11977","url":null,"abstract":"Background: This qualitative study presents an in-depth evaluation of the contributory psycho-socio-cultural and physical-economic factors related to paediatric poisoning in rural Sri Lanka. Method: The study was conducted at paediatric wards of Anuradhapura teaching hospital (THA) over a period of two years (2012 – 2014). Main methods of data collection were participants’ narrative and focus group discussions (FGDs). All parents of children with acute poisoning were recruited to FGDs. The structure of phenomena was developed based on descriptive phenomenological inquiries and key themes were identified at data analysis stage. Results: 383 parents participated in focus group discussions. Data were categorized to four domains; (1) parental awareness of poisoning risks, (2) presence of child, parent and environment related risk factors, (3) issues related to first aid care and provision of care until child was brought to emergency care unit, and (4) possible measures to prevent further poisoning. Interaction of multiple risk factors was observed in children with both intentional and unintentional poisoning. Accidental poisonings were associated with certain cultural practices, unsafe environment and unsafe storage of poisons. Children with intentional poisoning frequently had disrupted family relationships. Harmful first aid measures and delayed presentation at the primary care unit had negative impact on poisoning related outcomes. Parents believed community education, safe storage of poisons, and safe environment would likely bring down poison related morbidity. Conclusion: Person, poison and environment related risk factors can lead to acute poisoning emergencies in children in rural Sri Lanka. Often multiple risk factors interact to bring about the poisoning event. Avoidance of harmful first aid measures and early presentation at the primary care unit would bring down poisoning related morbidity. Effect of community education, safe storage of poisons and safe environment should be evaluated in the view of preventing poisoning.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42095998","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}
Background: Dichloromethane (a chlorinated hydrocarbon) is normally used as a solvent. Dichloromethane poisoning has been reported from occupational exposure and the common routes of dichloromethane poisoning are ingestion and inhalation. Case presentation: We described a case of 51-year-old man who received subcutaneous injection of dichloromethane and presented with local wound necrosis at his forearm, but carboxyhemoglobin levels were normal. Discussion: The corrosive property of dichloromethane result in venous thrombosis formation at his wound that might prevent systemic absorption of dichloromethane leads to reduced hepatic converted dichloromethane to the carbon monoxide. Conclusion: Symptomatic treatment and monitoring of CO production remain the mainstay in the treatment of patients with subcutaneous injection of dichloromethane.
{"title":"Dichloromethane Injection: Case Report","authors":"Kitisak Sanprasert, Thunyaporn Tangtrongchitr, Nat Krairojananan","doi":"10.22038/APJMT.2018.11981","DOIUrl":"https://doi.org/10.22038/APJMT.2018.11981","url":null,"abstract":"Background: Dichloromethane (a chlorinated hydrocarbon) is normally used as a solvent. Dichloromethane poisoning has been reported from occupational exposure and the common routes of dichloromethane poisoning are ingestion and inhalation. Case presentation: We described a case of 51-year-old man who received subcutaneous injection of dichloromethane and presented with local wound necrosis at his forearm, but carboxyhemoglobin levels were normal. Discussion: The corrosive property of dichloromethane result in venous thrombosis formation at his wound that might prevent systemic absorption of dichloromethane leads to reduced hepatic converted dichloromethane to the carbon monoxide. Conclusion: Symptomatic treatment and monitoring of CO production remain the mainstay in the treatment of patients with subcutaneous injection of dichloromethane.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43942755","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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