Pub Date : 2019-12-01DOI: 10.22038/APJMT.2019.14808
S. Weerasinghe, I. Gawarammana, Anuradha Colambage
Background: Substituted urea herbicide is widely used in the agricultural industry and is accessible to most people around the globe. Accidental or deliberate poisoning is an anticipated complication of these agrochemical products. Case presentation: We present a 15-year-old girl following deliberate self-ingestion of substituted urea herbicide (Diuron). She was diagnosed with Diuron induced methemoglobinemia and treated with intra venous methylene blue. Later she developed hemolytic anemia and needed 3 units of blood transfusions. Her haemolysis was thought to be due to methylene blue with concomitant Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency as no other possible cause was found for haemolysis. But on follow-up visits, G6PD deficiency was excluded by screening test and enzyme level assay. Conclusion: Heamolytic anemia is a possible rare complication that should be anticipated in patients presented with the significant amount of substituted urea herbicide poisoning. Studies have found the possibility of reactive oxygen species accumulation in cells leading to oxidative damage. But we were unable to find any reported cases of haemolysis in humans. We postulate that the inhibition of NADPH production like G6PD deficiency may be the key mechanism that causes haemolysis in humans by creating an acquired G6PD deficiency status in red blood cells. However, further studies are needed to identify the exact mechanism of hemolysis in humans.
{"title":"Substituted Urea Herbicide (Diuron) Induced Haemolytic Anemia: A Case of Unknown Complication in Humans","authors":"S. Weerasinghe, I. Gawarammana, Anuradha Colambage","doi":"10.22038/APJMT.2019.14808","DOIUrl":"https://doi.org/10.22038/APJMT.2019.14808","url":null,"abstract":"Background: Substituted urea herbicide is widely used in the agricultural industry and is accessible to most people around the globe. Accidental or deliberate poisoning is an anticipated complication of these agrochemical products. Case presentation: We present a 15-year-old girl following deliberate self-ingestion of substituted urea herbicide (Diuron). She was diagnosed with Diuron induced methemoglobinemia and treated with intra venous methylene blue. Later she developed hemolytic anemia and needed 3 units of blood transfusions. Her haemolysis was thought to be due to methylene blue with concomitant Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency as no other possible cause was found for haemolysis. But on follow-up visits, G6PD deficiency was excluded by screening test and enzyme level assay. Conclusion: Heamolytic anemia is a possible rare complication that should be anticipated in patients presented with the significant amount of substituted urea herbicide poisoning. Studies have found the possibility of reactive oxygen species accumulation in cells leading to oxidative damage. But we were unable to find any reported cases of haemolysis in humans. We postulate that the inhibition of NADPH production like G6PD deficiency may be the key mechanism that causes haemolysis in humans by creating an acquired G6PD deficiency status in red blood cells. However, further studies are needed to identify the exact mechanism of hemolysis in humans.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"134-139"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44661684","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 : 2019-12-01DOI: 10.22038/APJMT.2019.14810
Sadaf Sheikh, M. Baig
Background: Loperamide is an insoluble meperidine analog that is commonly used for diarrhea. It is an inexpensive and frequently available over the counter drug. While physicians are aware of its opioid effects, Loperamide use is also linked to cardiac conduction disturbances. Case presentation: We present a case of Loperamide toxicity with QRS, Corrected QT interval (QTc) prolongation and ventricular arrhythmias such as ventricular tachycardia leading to cardiopulmonary resuscitation (CPR). The patient survived and was evaluated to have prolonged QT interval. He later disclosed over the counter (OTC) and continued a regular use of Loperamide as an anti-diarrheal agent. During the rest of hospital stay, serial Electrocardiograms (ECGs) showed improvement in QT interval and patient was successfully discharged. Conclusion: Loperamide inhibits intestinal peristalsis through its peripheral µ-opioid receptor agonism, as well as calcium channel blockade. Loperamide abuse is increasing, as patients use it either to experience euphoric effects or to attenuate the effects of opioid withdrawal.At high doses, Loperamide blocks cardiac sodium and potassium channels, resulting in prolonged QRS and QT intervals which can proceed to cardiac rhythm disturbances. Our case shows the acute and delayed cardiac effects of Loperamide toxicity which the treating physician should be made well aware of.
{"title":"A Heart-Wrenching Case of Loperamide Toxicity","authors":"Sadaf Sheikh, M. Baig","doi":"10.22038/APJMT.2019.14810","DOIUrl":"https://doi.org/10.22038/APJMT.2019.14810","url":null,"abstract":"Background: Loperamide is an insoluble meperidine analog that is commonly used for diarrhea. It is an inexpensive and frequently available over the counter drug. While physicians are aware of its opioid effects, Loperamide use is also linked to cardiac conduction disturbances. Case presentation: We present a case of Loperamide toxicity with QRS, Corrected QT interval (QTc) prolongation and ventricular arrhythmias such as ventricular tachycardia leading to cardiopulmonary resuscitation (CPR). The patient survived and was evaluated to have prolonged QT interval. He later disclosed over the counter (OTC) and continued a regular use of Loperamide as an anti-diarrheal agent. During the rest of hospital stay, serial Electrocardiograms (ECGs) showed improvement in QT interval and patient was successfully discharged. Conclusion: Loperamide inhibits intestinal peristalsis through its peripheral µ-opioid receptor agonism, as well as calcium channel blockade. Loperamide abuse is increasing, as patients use it either to experience euphoric effects or to attenuate the effects of opioid withdrawal.At high doses, Loperamide blocks cardiac sodium and potassium channels, resulting in prolonged QRS and QT intervals which can proceed to cardiac rhythm disturbances. Our case shows the acute and delayed cardiac effects of Loperamide toxicity which the treating physician should be made well aware of.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"141-143"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43332818","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 : 2019-12-01DOI: 10.22038/APJMT.2019.14809
F. Bozkurt, S. Izdes, H. Demir, Duygu Kayar Calili, D. Hosgun
Background: Calcium channel blockers (CCBs) are widely used for various indications such as hypertension, coronary artery disease, and certain cardiac arrhythmias. As they are frequently prescribed, overdoses are common. Our aim in this paper was to present a case of intoxication with amlodipine, captopril, and doxazosin where ILE treatment proved unsuccessful and to review literature for effectiveness of ILE therapy in amlodipine poisonings. Case Presentation: A 54-year-old female patient presented to the emergency department after taking 300 mg of amlodipine, 1000 mg of captopril, and 120 mg of doxazosin with suicidal intention. The patient was treated with gastric lavage, activated charcoal, calcium gluconate, hydration, vasopressor, inotrope, insulin and glucose, and intravenous lipid emulsion and transferred to intensive care unit at the 8th hour. Hemodynamics did not improve and the patient underwent plasmapheresis at the 10th hour. Patient was extubated and discharged without sequelae. Considering the pharmacokinetics of captopril and doxazosin, worsening of hemodynamics after 8 hours was related to amlodipine. Conclusion: While verapamil and diltiazem poisonings were generally reported to be successfully treated with intravenous lipid emulsion, salvage treatment with intravenous lipid emulsion was reported to be unsuccessful in the literature for amlodipine intakes of 280 mg or more.
{"title":"Intravenous Lipid Emulsion Treatment and High-Dose Amlodipine Intoxication: A Case Report","authors":"F. Bozkurt, S. Izdes, H. Demir, Duygu Kayar Calili, D. Hosgun","doi":"10.22038/APJMT.2019.14809","DOIUrl":"https://doi.org/10.22038/APJMT.2019.14809","url":null,"abstract":"Background: Calcium channel blockers (CCBs) are widely used for various indications such as hypertension, coronary artery disease, and certain cardiac arrhythmias. As they are frequently prescribed, overdoses are common. Our aim in this paper was to present a case of intoxication with amlodipine, captopril, and doxazosin where ILE treatment proved unsuccessful and to review literature for effectiveness of ILE therapy in amlodipine poisonings. Case Presentation: A 54-year-old female patient presented to the emergency department after taking 300 mg of amlodipine, 1000 mg of captopril, and 120 mg of doxazosin with suicidal intention. The patient was treated with gastric lavage, activated charcoal, calcium gluconate, hydration, vasopressor, inotrope, insulin and glucose, and intravenous lipid emulsion and transferred to intensive care unit at the 8th hour. Hemodynamics did not improve and the patient underwent plasmapheresis at the 10th hour. Patient was extubated and discharged without sequelae. Considering the pharmacokinetics of captopril and doxazosin, worsening of hemodynamics after 8 hours was related to amlodipine. Conclusion: While verapamil and diltiazem poisonings were generally reported to be successfully treated with intravenous lipid emulsion, salvage treatment with intravenous lipid emulsion was reported to be unsuccessful in the literature for amlodipine intakes of 280 mg or more.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"140-143"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42088361","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 : 2019-12-01DOI: 10.22038/APJMT.2019.14806
N. Rezaei, Pouyan Alinia, A. Aghabiklooei, S. Izadi
Background: During the recent years, risk of lead poisoning has increased in Iranian’s opium users. A few researches showed that the most common route was ingestion of lead contaminated opium in these patients. However, data on lead poisoning through inhalation route in opium smokers is scarce. The aim of the current study was to determine lead poisoning in opium smokers. Method: In this case-controlled study, blood lead level (BLL) and clinical lead poisoning were assessed and compared between pure inhalational and pure ingestionally chronic opium users and healthy controls. Results: There were totally 90 cases, 30 patients in each group (pure inhaler opium users, pure oral opium users, and control group). In chronic opium users (case group), mean age of the patients was 48.91±13.14 yeas (range; 22 to 79 years). Eighty-four (85%) patients were male (male to female ratio: 5.6/1). Mean BLL was 10.6±4.2 and 126.1±52µg/dL in opium smokers and ingestional users, respectively (P=0.001). The mean of BLL in healthy control group was 4.78 µg/dL±1.83. Conclusion: In contrast to chronic ingestion of opium, the probability of absorption of lead via lungs is low when opium used by smoking and inhalation route. So, lead toxicity is not common in acute or chronic inhalational users of lead-contaminated opium.
{"title":"Blood Lead Level in Opium Abuse; Which Is More Dangerous? Opium Smoking or Opium Ingestion?","authors":"N. Rezaei, Pouyan Alinia, A. Aghabiklooei, S. Izadi","doi":"10.22038/APJMT.2019.14806","DOIUrl":"https://doi.org/10.22038/APJMT.2019.14806","url":null,"abstract":"Background: During the recent years, risk of lead poisoning has increased in Iranian’s opium users. A few researches showed that the most common route was ingestion of lead contaminated opium in these patients. However, data on lead poisoning through inhalation route in opium smokers is scarce. The aim of the current study was to determine lead poisoning in opium smokers. Method: In this case-controlled study, blood lead level (BLL) and clinical lead poisoning were assessed and compared between pure inhalational and pure ingestionally chronic opium users and healthy controls. Results: There were totally 90 cases, 30 patients in each group (pure inhaler opium users, pure oral opium users, and control group). In chronic opium users (case group), mean age of the patients was 48.91±13.14 yeas (range; 22 to 79 years). Eighty-four (85%) patients were male (male to female ratio: 5.6/1). Mean BLL was 10.6±4.2 and 126.1±52µg/dL in opium smokers and ingestional users, respectively (P=0.001). The mean of BLL in healthy control group was 4.78 µg/dL±1.83. Conclusion: In contrast to chronic ingestion of opium, the probability of absorption of lead via lungs is low when opium used by smoking and inhalation route. So, lead toxicity is not common in acute or chronic inhalational users of lead-contaminated opium.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"124-129"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43030273","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 : 2019-12-01DOI: 10.22038/APJMT.2019.14328
S. M. Monzavi, R. Afshari, A. Khoshdel, A. Salarian, H. Khosrojerdi, Azam Mihandoust
Background: Despite sharing common evolutionary features, Viperidae species including Echis carinatus and Macrovipera lebetina possess venoms with different proportions of toxic agents, thereby causing clinical effects with potentially variable severity. This study was an effort to differentiate the clinical effects and outcomes of E. c. sochureki and M. l. obtusa victims. Methods: In this prospective cross-sectional study, snakebite patients treated at a reference poisoning center in northeast of Iran in 2012 were enrolled. The features of snakebite event, demographic and clinical data of patients were recorded in checklists. Results: Twenty-seven patients (63% male) with mean age of 34.8 ± 18.1 years were included. The offending snakes were recorded as "E. c. sochureki" in 63%, "M. l. obtusa" in 25.9% and "unknown" in 11.1% of cases. The most common clinical findings were fang mark in 100%, local pain in 81.5% and local edema in 74% of patients. Although the victims of both species showed classic features of viper envenoming syndrome including marked local effect and hemostatic disturbances, the victims of M. l. obtusa had significantly higher creatine kinase levels (P = 0.031) and lower platelet counts (P = 0.043), whereas marked edema (> 15cm) was significantly more common in E. c. sochureki victims (P = 0.028). Envenomation severity, other clinical effects and outcomes did not differ between the two species. Patients with delayed presentation to hospital had greater envenomation severity and edema extent and higher rate of coagulopathy. Conclusions: Species-specific description of clinical effects following snakebite envenoming is useful for syndromic approach to human victims. The clinical envenoming syndromes by E. c. sochureki and M. l. obtusa show many common similarities despite the difference in severity of some effects. The delay in hospital admission and antivenom therapy is a risk for increased severity of envenomation and development of poorer clinical outcomes.
{"title":"Interspecies Variations in Clinical Envenoming Effects of Viper Snakes Evolutionized in a Common Habitat: A Comparative Study on Echis carinatus sochureki and Macrovipera lebetina obtusa Victims in Iran","authors":"S. M. Monzavi, R. Afshari, A. Khoshdel, A. Salarian, H. Khosrojerdi, Azam Mihandoust","doi":"10.22038/APJMT.2019.14328","DOIUrl":"https://doi.org/10.22038/APJMT.2019.14328","url":null,"abstract":"Background: Despite sharing common evolutionary features, Viperidae species including Echis carinatus and Macrovipera lebetina possess venoms with different proportions of toxic agents, thereby causing clinical effects with potentially variable severity. This study was an effort to differentiate the clinical effects and outcomes of E. c. sochureki and M. l. obtusa victims. Methods: In this prospective cross-sectional study, snakebite patients treated at a reference poisoning center in northeast of Iran in 2012 were enrolled. The features of snakebite event, demographic and clinical data of patients were recorded in checklists. Results: Twenty-seven patients (63% male) with mean age of 34.8 ± 18.1 years were included. The offending snakes were recorded as \"E. c. sochureki\" in 63%, \"M. l. obtusa\" in 25.9% and \"unknown\" in 11.1% of cases. The most common clinical findings were fang mark in 100%, local pain in 81.5% and local edema in 74% of patients. Although the victims of both species showed classic features of viper envenoming syndrome including marked local effect and hemostatic disturbances, the victims of M. l. obtusa had significantly higher creatine kinase levels (P = 0.031) and lower platelet counts (P = 0.043), whereas marked edema (> 15cm) was significantly more common in E. c. sochureki victims (P = 0.028). Envenomation severity, other clinical effects and outcomes did not differ between the two species. Patients with delayed presentation to hospital had greater envenomation severity and edema extent and higher rate of coagulopathy. Conclusions: Species-specific description of clinical effects following snakebite envenoming is useful for syndromic approach to human victims. The clinical envenoming syndromes by E. c. sochureki and M. l. obtusa show many common similarities despite the difference in severity of some effects. The delay in hospital admission and antivenom therapy is a risk for increased severity of envenomation and development of poorer clinical outcomes.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"107-114"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45299583","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 : 2019-09-01DOI: 10.22038/APJMT.2019.13826
O. Nafea, M. Aziz, Fatma Saptan, A. R. Abdalla, H. Ibrahim
Background:Organophosphate (OP) poisoning is still a major health concern in both developed and developing countries. The standard treatment approaches of (OP) poisoning are not always available as well so they may show a limited success rate. Fresh frozen plasma (FFP) is one of Bio-scavengers that have been suggested as a useful therapy through elimination of free organophosphates. Therefore, this systematic review and meta-analysis was conducted to update the present evidence about the efficacy of FFP in management of acute OP-intoxicated patients. Method:A computer literature search of PubMed and Scopus was conducted to identify the relevant randomized controlled trials (RCTs). In addition, a manual search of reference lists of the retrieved articles was conducted. Relevant outcomes were pooled as mean difference (MD) risk ratio (RR) by RevMan version 5.3 for Windows. Results:Pooled data from 3 RCTs (169 patients) showed that adding FFP to conventional therapy to acutely OP intoxicated patients did not improve clinical outcomes regarding total atropine (MD = 35.05, 95% CI = [-41.14 to 111.24], P-value = 0.37) and pralidoxime dosages (MD = -0.41, 95% CI = [-2.34 to 1.51], P-value = 0.67), length of hospital stay (MD = -2.08, 95% CI = [-4.51 to 0.35], P-value = 0.09) and mortality (RR = 0.42, 95% CI = [0.14 to 1.27], P-value = 0.12). Conclusion: Fresh frozen plasma did not provide any additional benefit in acutely-OP intoxicated patients compared to the conventional therapy. The limited number and sizes of the included trials are the most probable cause of such effects.
{"title":"Effectiveness of Fresh Frozen Plasma in Management of Acute Organophosphate Intoxicated Patients: An Updated Systematic Review and Meta-Analysis","authors":"O. Nafea, M. Aziz, Fatma Saptan, A. R. Abdalla, H. Ibrahim","doi":"10.22038/APJMT.2019.13826","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13826","url":null,"abstract":"Background:Organophosphate (OP) poisoning is still a major health concern in both developed and developing countries. The standard treatment approaches of (OP) poisoning are not always available as well so they may show a limited success rate. Fresh frozen plasma (FFP) is one of Bio-scavengers that have been suggested as a useful therapy through elimination of free organophosphates. Therefore, this systematic review and meta-analysis was conducted to update the present evidence about the efficacy of FFP in management of acute OP-intoxicated patients. Method:A computer literature search of PubMed and Scopus was conducted to identify the relevant randomized controlled trials (RCTs). In addition, a manual search of reference lists of the retrieved articles was conducted. Relevant outcomes were pooled as mean difference (MD) risk ratio (RR) by RevMan version 5.3 for Windows. Results:Pooled data from 3 RCTs (169 patients) showed that adding FFP to conventional therapy to acutely OP intoxicated patients did not improve clinical outcomes regarding total atropine (MD = 35.05, 95% CI = [-41.14 to 111.24], P-value = 0.37) and pralidoxime dosages (MD = -0.41, 95% CI = [-2.34 to 1.51], P-value = 0.67), length of hospital stay (MD = -2.08, 95% CI = [-4.51 to 0.35], P-value = 0.09) and mortality (RR = 0.42, 95% CI = [0.14 to 1.27], P-value = 0.12). Conclusion: Fresh frozen plasma did not provide any additional benefit in acutely-OP intoxicated patients compared to the conventional therapy. The limited number and sizes of the included trials are the most probable cause of such effects.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"95-100"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49259276","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 : 2019-09-01DOI: 10.22038/APJMT.2019.13823
R. Afshari
{"title":"Environmental and Ecological Extra Challenges in Minority Populations; a Tale of Toxic Exposures among First Nation Populations","authors":"R. Afshari","doi":"10.22038/APJMT.2019.13823","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13823","url":null,"abstract":"","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"68-70"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43804404","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 : 2019-09-01DOI: 10.22038/APJMT.2019.13828
A. Bazi, S. Ghasempouri, A. Sahebnasagh, F. Saghafi
Background: The vast territory of Iran, due to climate diversity, is a host for various animal species. Snakes may be considered a significant threat to health of the rural regions of Iran. Sheltopusik (Pseudopus apodus), the largest member of the family Anguida, is one of the species of lizard that is considered to be a harmless animal species. This lizard is often mistaken for a faunistic community of reptiles in the area and is well-known as Petilus Snake. To the best of our knowledge, no reports of injury from bites or attacks of this species have previously been published. Case presentation: The present case report is the first report of describing the attack of a sheltopusik to a 40-year-old white female farmer. Due to the lack of primary identification of the damaging animal, it was initially confused with the snakebite, leading to unnecessary administration of anti-venom and tetanus prophylaxis. Discussion: The main reason for this event was the lack of reporting a similar medical harm in the area and the snake-like appearance of the lizard. Acquaintance with this kind of damage to the human health and tissue contusion by the hit can help rational management of such patients without conventional modalities for snakebite like antivenom. Conclusion: The physicians practicing in emergency wards and rural clinics in the area, as the first place of referral, should be trained on proper management of this group of patients to achieve the best clinical outcome.
{"title":"Snakebites by the Sheltopusik (Pseudopus Apodus) Locally Called Petilus Snake to Humans: a Case Report","authors":"A. Bazi, S. Ghasempouri, A. Sahebnasagh, F. Saghafi","doi":"10.22038/APJMT.2019.13828","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13828","url":null,"abstract":"Background: The vast territory of Iran, due to climate diversity, is a host for various animal species. Snakes may be considered a significant threat to health of the rural regions of Iran. Sheltopusik (Pseudopus apodus), the largest member of the family Anguida, is one of the species of lizard that is considered to be a harmless animal species. This lizard is often mistaken for a faunistic community of reptiles in the area and is well-known as Petilus Snake. To the best of our knowledge, no reports of injury from bites or attacks of this species have previously been published. Case presentation: The present case report is the first report of describing the attack of a sheltopusik to a 40-year-old white female farmer. Due to the lack of primary identification of the damaging animal, it was initially confused with the snakebite, leading to unnecessary administration of anti-venom and tetanus prophylaxis. Discussion: The main reason for this event was the lack of reporting a similar medical harm in the area and the snake-like appearance of the lizard. Acquaintance with this kind of damage to the human health and tissue contusion by the hit can help rational management of such patients without conventional modalities for snakebite like antivenom. Conclusion: The physicians practicing in emergency wards and rural clinics in the area, as the first place of referral, should be trained on proper management of this group of patients to achieve the best clinical outcome.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"104-106"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43611916","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 : 2019-09-01DOI: 10.22038/APJMT.2019.13827
Faiz Ahmad, Mohd. Kaleem Khan, A. Mahmood, Jamal Azmat
Background: Suicide by poisoning is the second most common cause of death by suicide (27.9%) as per The National Crime Records Bureau (NCRB) India in 2015. Aluminum phosphide (ALP) is the leading agricultural poison used to commit suicide as where its availability is not properly regulated. ALP is a highly toxic solid fumigant pesticide, rodenticide and insecticide. Case presentation: A 40-year-old woman was brought by the police to the emergency section. Her extremities were cold and hypotonic, and her skin was pale. Patient’s vitals were unstable with pulse rate 112/minute irregularities, blood pressure 68/54 mm of Hg, respiratory rate 22/minute shallow and body temperature 30.1 oC and characteristicly strong garlicky odor on her breath. During the suction of gastric contents, spontaneous ignition of gas with flames and white fumes with sound like a blast was observed by resident doctors and para-clinical staff. Gastric aspirate along with Ryle’s tube were immediately sent to the forensic department where the Silver Nitrate test was performed and it was found strongly positive for phosphine gas. Discussion: Aluminum phosphide readily reacts with water and hydrochloric acid in the stomach to produce phosphine (hydrogen phosphide, PH3) and a small amount of diphosphine. Conclusion: The present case report stresses on the need that the emergency physicians need to be highly alert and adequately prepared while handling such patients. Spontaneous ignition with the release of phosphine from ALP poisoned patients can not only affect the patient, but also pose a health hazard to emergency physicians and medical staff.
{"title":"Aluminum Phosphide Poisoning and Blast in Gastric Tube: A Case Report","authors":"Faiz Ahmad, Mohd. Kaleem Khan, A. Mahmood, Jamal Azmat","doi":"10.22038/APJMT.2019.13827","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13827","url":null,"abstract":"Background: Suicide by poisoning is the second most common cause of death by suicide (27.9%) as per The National Crime Records Bureau (NCRB) India in 2015. Aluminum phosphide (ALP) is the leading agricultural poison used to commit suicide as where its availability is not properly regulated. ALP is a highly toxic solid fumigant pesticide, rodenticide and insecticide. Case presentation: A 40-year-old woman was brought by the police to the emergency section. Her extremities were cold and hypotonic, and her skin was pale. Patient’s vitals were unstable with pulse rate 112/minute irregularities, blood pressure 68/54 mm of Hg, respiratory rate 22/minute shallow and body temperature 30.1 oC and characteristicly strong garlicky odor on her breath. During the suction of gastric contents, spontaneous ignition of gas with flames and white fumes with sound like a blast was observed by resident doctors and para-clinical staff. Gastric aspirate along with Ryle’s tube were immediately sent to the forensic department where the Silver Nitrate test was performed and it was found strongly positive for phosphine gas. Discussion: Aluminum phosphide readily reacts with water and hydrochloric acid in the stomach to produce phosphine (hydrogen phosphide, PH3) and a small amount of diphosphine. Conclusion: The present case report stresses on the need that the emergency physicians need to be highly alert and adequately prepared while handling such patients. Spontaneous ignition with the release of phosphine from ALP poisoned patients can not only affect the patient, but also pose a health hazard to emergency physicians and medical staff.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"101-103"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47516553","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 : 2019-09-01DOI: 10.22038/APJMT.2020.41172.1259
B. Masihipour, A. Z. Mirakabadi, Mehdi Kheirollahpour, H. Rabiei, A. Hedayat
Abstract :Scorpion sting is a significant health problem in southern provinces of Iran. Many thousands of people are stung by different species of scorpions annually. More than 60 scorpion species have been reported to be present in Iran. However razi Institute manufactures polyvalent antivenom against only six species of scorpions, excluding Buthacus macrocentrus , Apistobuthus susanae and Vachoniolus iranus, wide spread scorpion species in south region of Iran. In this research, after collecting scorpions (at night),milking by elctroshock method, the venom of its lyophilized and the LD50 was determined. The fractions were then separated by gel chromatography and HPLC. Using SDS page electrophoresis, the fractional molecular weight was determined. At the end, potency test of these scorpion venoms was carried out in the vicinity of the antiserum produced by the Razi Institute on the animal.In the present work we tried to investigate the cross reactivity of present antivenom against these excluded scorpion species. The antisera production of the Razi Institute was able to neutralize the 33 LD50 of Apistobuthus susanae venom. This antivenom could neutralize Buthacus macrocentrus as well as Vachoniolus iranus scorpion venoms by 41 LD50 and 15 LD50 respectively . According to the World Health Organization (WHO) , antiserums should be made locally and against animal species.Therefore based on the results obtained in the present study it can be concluded that although the venom of these scorpion species are not included in the antivenom production but the present polyvalent antivenom is able to be used in patients stung by these 3 species of scopions too. The powerity of anti-serum neutralizing against the venom of other species of scorpions is based on the constructional similarity and cross-reactivity of different species of venom scorpions
{"title":"Cross-Reactivity and Neutralization Capacity of Polyspecific Antivenom Produced by Razi Institute against Three Species of Buthidea Family Scorpions","authors":"B. Masihipour, A. Z. Mirakabadi, Mehdi Kheirollahpour, H. Rabiei, A. Hedayat","doi":"10.22038/APJMT.2020.41172.1259","DOIUrl":"https://doi.org/10.22038/APJMT.2020.41172.1259","url":null,"abstract":"Abstract :Scorpion sting is a significant health problem in southern provinces of Iran. Many thousands of people are stung by different species of scorpions annually. More than 60 scorpion species have been reported to be present in Iran. However razi Institute manufactures polyvalent antivenom against only six species of scorpions, excluding Buthacus macrocentrus , Apistobuthus susanae and Vachoniolus iranus, wide spread scorpion species in south region of Iran. In this research, after collecting scorpions (at night),milking by elctroshock method, the venom of its lyophilized and the LD50 was determined. The fractions were then separated by gel chromatography and HPLC. Using SDS page electrophoresis, the fractional molecular weight was determined. At the end, potency test of these scorpion venoms was carried out in the vicinity of the antiserum produced by the Razi Institute on the animal.In the present work we tried to investigate the cross reactivity of present antivenom against these excluded scorpion species. The antisera production of the Razi Institute was able to neutralize the 33 LD50 of Apistobuthus susanae venom. This antivenom could neutralize Buthacus macrocentrus as well as Vachoniolus iranus scorpion venoms by 41 LD50 and 15 LD50 respectively . According to the World Health Organization (WHO) , antiserums should be made locally and against animal species.Therefore based on the results obtained in the present study it can be concluded that although the venom of these scorpion species are not included in the antivenom production but the present polyvalent antivenom is able to be used in patients stung by these 3 species of scopions too. The powerity of anti-serum neutralizing against the venom of other species of scorpions is based on the constructional similarity and cross-reactivity of different species of venom scorpions","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":"8 1","pages":"90-94"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41490030","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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