Pub Date : 2019-09-01DOI: 10.22038/APJMT.2019.13797
Hooi Li Chen, Ying Qi Chuah, K. L. Eng, Yenn Yeoh Lynn Michelle, Roziana Ahmad
Backgrounds: Snake antivenom (SAV) is the definitive treatment for snake envenomation. But SAVs are specific, expensive and limited in supply. SAVs also come with risk of adverse reactions. Hence, this study was conducted to assess the use of SAV, adverse reactions to SAV and its clinical outcomes in snakebite patients. Methods: This was a retrospective study. Medical records of snakebite patients for the period from January 2014 to September 2017 were reviewed and study data was extracted. Clinical outcomes were measured by mortality rate in those receiving SAV. Results: Among 165 subjects, only 9 patients (5%) were treated with SAV after presenting with envenomation symptoms in which five cases with identified snakes were given monovalent SAV namely pit viper (two cases), king cobra, sea snake and cobra with one case each. Meanwhile, three cases of unidentified snake received polyvalent SAV and one case received pit viper SAV. Most of the patients (8/9, 88.9%) received SAV within 24 hours after snakebite. The average time gap to first administration was 7.23 hours. In patients receiving SAV, six out of 9 cases required two to four vials of SAV. All the patients receiving SAV did not encounter any adverse effects except a child who had pyrogenic reaction. All patients survived without significant morbidity at discharge. The total cost of SAV for the 9 patients was US$ 24,082.68. Conclusion: From this study, the incidence of snakebites requiring SAV was low. Low incidences of adverse effects and no mortality were observed in patients receiving SAV.
{"title":"Use of Snake Antivenom and Clinical Outcomes in Snake Envenomation: A Retrospective Study in a Tertiary Hospital in Penang, Malaysia","authors":"Hooi Li Chen, Ying Qi Chuah, K. L. Eng, Yenn Yeoh Lynn Michelle, Roziana Ahmad","doi":"10.22038/APJMT.2019.13797","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13797","url":null,"abstract":"Backgrounds: Snake antivenom (SAV) is the definitive treatment for snake envenomation. But SAVs are specific, expensive and limited in supply. SAVs also come with risk of adverse reactions. Hence, this study was conducted to assess the use of SAV, adverse reactions to SAV and its clinical outcomes in snakebite patients. Methods: This was a retrospective study. Medical records of snakebite patients for the period from January 2014 to September 2017 were reviewed and study data was extracted. Clinical outcomes were measured by mortality rate in those receiving SAV. Results: Among 165 subjects, only 9 patients (5%) were treated with SAV after presenting with envenomation symptoms in which five cases with identified snakes were given monovalent SAV namely pit viper (two cases), king cobra, sea snake and cobra with one case each. Meanwhile, three cases of unidentified snake received polyvalent SAV and one case received pit viper SAV. Most of the patients (8/9, 88.9%) received SAV within 24 hours after snakebite. The average time gap to first administration was 7.23 hours. In patients receiving SAV, six out of 9 cases required two to four vials of SAV. All the patients receiving SAV did not encounter any adverse effects except a child who had pyrogenic reaction. All patients survived without significant morbidity at discharge. The total cost of SAV for the 9 patients was US$ 24,082.68. Conclusion: From this study, the incidence of snakebites requiring SAV was low. Low incidences of adverse effects and no mortality were observed in patients receiving SAV.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48913430","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.2019.13792
L. A. Irogbeyi, I. Nweke, G. Akuodor, U. Prince, A. Ebere
Background: 32 different brands of bread with 12 different brands of wheat-flour sold in Aba metropolis, South Eastern Nigeria were selected and evaluated for both potassium bromate and some heavy metals contents to determine their safety level of consumption. Methods:Bromate determination was carried out using spectrophotometric method while heavy metals were done by the flame atomic absorption spectrophotometer. Results:The results of the analysis revealed that all the bread samples contained potassium bromate at concentrations above the permissible limit allowed by the US FDA while the concentrations in wheat flour samples were within the acceptable limit with ranges from 0.27±0.04 – 3.78±0.26 mg/kg and 00 – 1.52±0.28 mg/kg, respectively. The values of heavy metals in bread ranged as follows: Zn (3.22±0.05 – 7.25±0.24 mg/kg), Pb (0.05±0.01 – 0.45±0.02 mg/kg), Mn (44.28±0.5 – 78.25±1.24 mg/kg), Cu (0.31±0.04 – 0.49±0.12 mg/kg) and Co (0.04±0.01 – 0.24±0.03 mg/kg) while in wheat flour, the ranges were as follows: Zn (3.85±0.04 – 5.03±0.10 mg/kg), Pb (0.06±0.02 – 0.15±0.04 mg/kg), Mn (47.30±0.38 – 70.20±1.02 mg/kg), Cu (0.36±0.02 – 0.46±0.13 mg/kg) and Co (0.07±0.01 – 0.21±0.03 mg/kg). Conclusion:The values of these metals are within the permissible limits except Pb and Mn which were above the normal limits that can be detrimental to human health.
{"title":"Evaluation of Levels of Potassium Bromate and Some Heavy Metals in Bread and Wheat Flour Sold in Aba Metropolis, South Eastern Nigeria","authors":"L. A. Irogbeyi, I. Nweke, G. Akuodor, U. Prince, A. Ebere","doi":"10.22038/APJMT.2019.13792","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13792","url":null,"abstract":"Background: 32 different brands of bread with 12 different brands of wheat-flour sold in Aba metropolis, South Eastern Nigeria were selected and evaluated for both potassium bromate and some heavy metals contents to determine their safety level of consumption. Methods:Bromate determination was carried out using spectrophotometric method while heavy metals were done by the flame atomic absorption spectrophotometer. Results:The results of the analysis revealed that all the bread samples contained potassium bromate at concentrations above the permissible limit allowed by the US FDA while the concentrations in wheat flour samples were within the acceptable limit with ranges from 0.27±0.04 – 3.78±0.26 mg/kg and 00 – 1.52±0.28 mg/kg, respectively. The values of heavy metals in bread ranged as follows: Zn (3.22±0.05 – 7.25±0.24 mg/kg), Pb (0.05±0.01 – 0.45±0.02 mg/kg), Mn (44.28±0.5 – 78.25±1.24 mg/kg), Cu (0.31±0.04 – 0.49±0.12 mg/kg) and Co (0.04±0.01 – 0.24±0.03 mg/kg) while in wheat flour, the ranges were as follows: Zn (3.85±0.04 – 5.03±0.10 mg/kg), Pb (0.06±0.02 – 0.15±0.04 mg/kg), Mn (47.30±0.38 – 70.20±1.02 mg/kg), Cu (0.36±0.02 – 0.46±0.13 mg/kg) and Co (0.07±0.01 – 0.21±0.03 mg/kg). Conclusion:The values of these metals are within the permissible limits except Pb and Mn which were above the normal limits that can be detrimental to human health.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48026331","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 : 2019-06-01DOI: 10.22038/APJMT.2019.13175
Indira Madhavan, R. Balan, Balaram Neeratty Asokan, A. Andrews, Aswin Valliot
Background:The National Crime Records Bureau of India reported a decline in suicide rate from 2010 through 2014. We conducted this study to know whether our hospital data reflects the national data and to know the age and gender specific differences in selecting methods of suicide. Methods: We conducted a retrospective analysis of autopsied cases in Department of Forensic Medicine in a tertiary care hospital in central Kerala, India. Data on age, gender, cause of death of autopsied cases with alleged history of deliberate self-harm (DSH) were noted. Results: Mean age of study population was 43.4±24.4. There were 59.3% males and 40.7% females, but young females outnumbered young males. Majority of cases were hanging (n=1325), followed by poisoning (n=1169), burns (n=809), drowning (n=626) and others (n=401). Hanging and poisoning were the common methods chosen by males while burns and poisoning were the common methods by females. The number of DSH cases was 1,040, 866, 771, 837 and 826 in each year from 2010 to 2014, respectively. Number of poisoning cases was declining steadily from 350 to 163 while non-poisoning suicide was not showing any steady changes (690, 578, 514, 657, and 663). Pesticides were the most common agent recorded in the autopsy sheet while corrosives, plant toxins, cyanide, toxic alcohol and drug overdose were less common. Quinalfos, chlorpyrifos and carbofuran were the commonly identified pesticides on chemical analysis. Conclusion: There is a decrease trend in the number of suicides over the 5 years from 2010 through 2014 with a decrease in suicide due to poisoning. Though there is minimal increase in suicide due to hanging, it did not affect the total number of suicides.
{"title":"A Retrospective Analysis of Pattern of Suicide in Autopsied Cases in a Tertiary Care Hospital","authors":"Indira Madhavan, R. Balan, Balaram Neeratty Asokan, A. Andrews, Aswin Valliot","doi":"10.22038/APJMT.2019.13175","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13175","url":null,"abstract":"Background:The National Crime Records Bureau of India reported a decline in suicide rate from 2010 through 2014. We conducted this study to know whether our hospital data reflects the national data and to know the age and gender specific differences in selecting methods of suicide. Methods: We conducted a retrospective analysis of autopsied cases in Department of Forensic Medicine in a tertiary care hospital in central Kerala, India. Data on age, gender, cause of death of autopsied cases with alleged history of deliberate self-harm (DSH) were noted. Results: Mean age of study population was 43.4±24.4. There were 59.3% males and 40.7% females, but young females outnumbered young males. Majority of cases were hanging (n=1325), followed by poisoning (n=1169), burns (n=809), drowning (n=626) and others (n=401). Hanging and poisoning were the common methods chosen by males while burns and poisoning were the common methods by females. The number of DSH cases was 1,040, 866, 771, 837 and 826 in each year from 2010 to 2014, respectively. Number of poisoning cases was declining steadily from 350 to 163 while non-poisoning suicide was not showing any steady changes (690, 578, 514, 657, and 663). Pesticides were the most common agent recorded in the autopsy sheet while corrosives, plant toxins, cyanide, toxic alcohol and drug overdose were less common. Quinalfos, chlorpyrifos and carbofuran were the commonly identified pesticides on chemical analysis. Conclusion: There is a decrease trend in the number of suicides over the 5 years from 2010 through 2014 with a decrease in suicide due to poisoning. Though there is minimal increase in suicide due to hanging, it did not affect the total number of suicides.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42300059","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 : 2019-06-01DOI: 10.22038/APJMT.2019.13177
marjan emzhik, Pouran Makhdoumi, Nasrin Milani, Bita Dadpour
Background: Rhabdomyolysis is a clinical syndrome that results in releasing myoglobin content from damaged muscle cells into circulation and often causes acute kidney injury (1). Different mechanisms are considered to be responsible in rhabdomyolysis and renal failure. However, free radical generation is the most important mechanism resulting in kidney injury. Thus, the effect of various antioxidants has been investigated. Acetaminophen, with antioxidant ability in therapeutic dose, has shown a considerable protective effect on kidney after muscle injury. The investigations have shown that acetaminophen enhances renal function, decreases renal damage and reduces oxidant injury. The aim of this review was to summarize proven evidences for etiology to renal injury and abilities of acetaminophen in reducing it. Methods: Articles published from 2010 to 2017 in PubMed and Google Scholar were covered in this review. The articles investigating the role of free radical in renal injury following Rhabdomylosis were searched using the keywords Rhabdomyolysis, kidney and oxidative stress. The keywords used to find articles regarding antioxidant ability of acetaminophen were antioxidant and acetaminophen. Conclusion: With assessment of evidences form antioxidant capacity of acetaminophen and mechanism of renal failure in Rhabdomyolysis, this drug can be useful for prevention and treatment of kidney injury especially following rhabdomyolysis.
{"title":"Role of acetaminophen in reducing risk of kidney injury from Rhabdomyolysis: A Narrative Review","authors":"marjan emzhik, Pouran Makhdoumi, Nasrin Milani, Bita Dadpour","doi":"10.22038/APJMT.2019.13177","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13177","url":null,"abstract":"Background: Rhabdomyolysis is a clinical syndrome that results in releasing myoglobin content from damaged muscle cells into circulation and often causes acute kidney injury (1). Different mechanisms are considered to be responsible in rhabdomyolysis and renal failure. However, free radical generation is the most important mechanism resulting in kidney injury. Thus, the effect of various antioxidants has been investigated. Acetaminophen, with antioxidant ability in therapeutic dose, has shown a considerable protective effect on kidney after muscle injury. The investigations have shown that acetaminophen enhances renal function, decreases renal damage and reduces oxidant injury. The aim of this review was to summarize proven evidences for etiology to renal injury and abilities of acetaminophen in reducing it. Methods: Articles published from 2010 to 2017 in PubMed and Google Scholar were covered in this review. The articles investigating the role of free radical in renal injury following Rhabdomylosis were searched using the keywords Rhabdomyolysis, kidney and oxidative stress. The keywords used to find articles regarding antioxidant ability of acetaminophen were antioxidant and acetaminophen. Conclusion: With assessment of evidences form antioxidant capacity of acetaminophen and mechanism of renal failure in Rhabdomyolysis, this drug can be useful for prevention and treatment of kidney injury especially following rhabdomyolysis.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48479204","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 : 2019-06-01DOI: 10.22038/APJMT.2019.12398
A. Turk, A. Kalkan, Ş. Atiş, M. Topal, B. Çekmen, Ö. Bozan, H. Topacoglu
Background: Several drug intoxications can affect both pulmonary and cellular respiration. We therefore think that assessing blood lactate levels can provide information about prognosis. Blood lactate levels have provided information about prognosis in several diseases involving hypoxia at the cellular level, such as sepsis and trauma. The purpose of this study was to determine whether there is any relation between blood lactate levels and mortality, morbidity, and prognosis in patients presenting to the emergency department with drug intoxication. Methods: This retrospective cross-sectional study involved patients admitted to the emergency department due to suicidal drug intoxication over a one-year period (January to December 2016). The primary outcome measure was the relationship between serum lactate concentrations and patient discharge or hospitalization, and if hospitalized, the duration of stay. The secondary outcome measure was the relationship between serum lactate concentrations and toxic dose intake in single-drug intoxication. Results: We enrolled 372 patients, of whom 192 were analyzed after exclusion criteria application. The mean blood lactate level in the total patient group was 2.6±1.46, and 2.7±1.9 in the single drug group and 2.5±1.3 in the multidrug group. Also, blood lactate levels in the overdose group and toxic dose group were 3.4±3.0 and 2.4±0.9, respectively. No significant differences were determined in the lactate level, discharge, hospitalization and the length of hospital stay between the single drug and multidrug groups. In the toxic dose group, patient ages and number of admissions to intensive care unit were significantly higher than in the overdose group. The number of discharges was significantly lower in the toxic dose group. No correlation was determined between the serum lactate level and the length of hospital stay. Conclusion: Lactate level is not a useful parameter for predicting hospitalization in drug intoxication patients.
{"title":"Correlation Between Blood Lactate Level and Hospitalization and Prognosis in Drug Intoxication Patients in Emergency Medicine Department","authors":"A. Turk, A. Kalkan, Ş. Atiş, M. Topal, B. Çekmen, Ö. Bozan, H. Topacoglu","doi":"10.22038/APJMT.2019.12398","DOIUrl":"https://doi.org/10.22038/APJMT.2019.12398","url":null,"abstract":"Background: Several drug intoxications can affect both pulmonary and cellular respiration. We therefore think that assessing blood lactate levels can provide information about prognosis. Blood lactate levels have provided information about prognosis in several diseases involving hypoxia at the cellular level, such as sepsis and trauma. The purpose of this study was to determine whether there is any relation between blood lactate levels and mortality, morbidity, and prognosis in patients presenting to the emergency department with drug intoxication. Methods: This retrospective cross-sectional study involved patients admitted to the emergency department due to suicidal drug intoxication over a one-year period (January to December 2016). The primary outcome measure was the relationship between serum lactate concentrations and patient discharge or hospitalization, and if hospitalized, the duration of stay. The secondary outcome measure was the relationship between serum lactate concentrations and toxic dose intake in single-drug intoxication. Results: We enrolled 372 patients, of whom 192 were analyzed after exclusion criteria application. The mean blood lactate level in the total patient group was 2.6±1.46, and 2.7±1.9 in the single drug group and 2.5±1.3 in the multidrug group. Also, blood lactate levels in the overdose group and toxic dose group were 3.4±3.0 and 2.4±0.9, respectively. No significant differences were determined in the lactate level, discharge, hospitalization and the length of hospital stay between the single drug and multidrug groups. In the toxic dose group, patient ages and number of admissions to intensive care unit were significantly higher than in the overdose group. The number of discharges was significantly lower in the toxic dose group. No correlation was determined between the serum lactate level and the length of hospital stay. Conclusion: Lactate level is not a useful parameter for predicting hospitalization in drug intoxication patients.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48866311","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 : 2019-06-01DOI: 10.22038/APJMT.2019.13173
N. Khan, Naveed Ahmed, Faysal Subhani, S. Kerai, N. Zia
Abstract: Introduction: Poisoning is an important public health issue globally. There are very few poison control centers in Pakistan with a very limited capacity to deal with poisoning emergencies. The aim of this study was to identify non-governmental organizations (NGOs) working for poison control and prevention in Pakistan and to assess their capacity and role in control of poisoning in Pakistan. Methods: A cross-sectional study was conducted between October and December 2017. NGOs were identified through web-based search. They were contacted through telephone and emails. The data was recorded on a predesigned structured questionnaire. The questions were related to major areas including poison information, advice service, infrastructure, human resource and availability of clinical services. Results: We found 408 healthcare NGOs, of which 168 responded either via phone call or email. Eight out of 168 were found to have some role in the field of prevention and control of poisoning. Of these, complete information was available for only six organizations. All were involved in some aspect of environmental poisoning with a focus on pesticide poisoning mostly for farmers. Almost all organization referred cases to local hospitals when necessary. However, they did not have any official referral system in place and links with any tertiary level facilities. Conclusion: The study highlights that very few NGOs have some focus on the poisoning control and prevention. There is a window of opportunity for non-governmental sector to strengthen poisoning prevention and control for other forms of environmental poisoning for example caused by medicines, household chemicals, drug misuse, etc.
{"title":"Role of Non-Governmental Organizations in the Prevention and Control of Poisoning in Pakistan","authors":"N. Khan, Naveed Ahmed, Faysal Subhani, S. Kerai, N. Zia","doi":"10.22038/APJMT.2019.13173","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13173","url":null,"abstract":"Abstract: \u0000Introduction: \u0000Poisoning is an important public health issue globally. There are very few poison control centers in Pakistan with a very limited capacity to deal with poisoning emergencies. The aim of this study was to identify non-governmental organizations (NGOs) working for poison control and prevention in Pakistan and to assess their capacity and role in control of poisoning in Pakistan. \u0000 Methods: \u0000A cross-sectional study was conducted between October and December 2017. NGOs were identified through web-based search. They were contacted through telephone and emails. The data was recorded on a predesigned structured questionnaire. The questions were related to major areas including poison information, advice service, infrastructure, human resource and availability of clinical services. \u0000Results: \u0000We found 408 healthcare NGOs, of which 168 responded either via phone call or email. Eight out of 168 were found to have some role in the field of prevention and control of poisoning. Of these, complete information was available for only six organizations. All were involved in some aspect of environmental poisoning with a focus on pesticide poisoning mostly for farmers. Almost all organization referred cases to local hospitals when necessary. However, they did not have any official referral system in place and links with any tertiary level facilities. \u0000Conclusion: \u0000The study highlights that very few NGOs have some focus on the poisoning control and prevention. There is a window of opportunity for non-governmental sector to strengthen poisoning prevention and control for other forms of environmental poisoning for example caused by medicines, household chemicals, drug misuse, etc.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41631233","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 : 2019-06-01DOI: 10.22038/APJMT.2019.13176
Lincy Juliet Kolandai Samy, P. Adole, V. Pandit, K. Vinod
Background: Human serum paraoxonase 1 (PON1) hydrolyzes organophosphate (OP) compounds and so significantly alters an individual’s susceptibility to the toxicity of these chemicals. The study was designed to assess the serum PON1 activity in a series of patients with OP poisoning. Methods: Suspected OP poisoning patients presented within 6 hours of consumption at emergency department were recruited. Demographic information of patients, clinical findings, treatments given, complications, length of hospital stay and clinical outcome were collected into datasheets. Patients were graded into moderate and severe poisoning. Serum PON1 was measured by ELISA method and serum cholinesterase by butyrylthiocholine method. Results: Mean serum PON1 level in patients with severe poisoning was significantly lower than those with moderate poisoning (426 ± 179 U/L vs. 868 ± 79 U/L, P < 0.001). Serum PON1 significantly correlated with serum cholinesterase levels (r = 0.400, P < 0.001) and negatively associated with total length of hospital stay (r = -0.338, P < 0.001), total atropine dose (r = -0.826, P < 0.001), serum amylase (r = -0.331, P < 0.001), lipase (r = 0.260, P = 0.011) and total creatinine kinase (r = -0.456, P < 0.001). Serum PON1 and cholinesterase levels were significantly lower in expired patients and those who required ventilation assistance as compared to recovered patients who did not require ventilation assistance. Conclusion: Lower PON1 activity was significantly associated with lower serum cholinesterase and poorer outcomes. PON1 activity may be considered as an indicator of prognosis in OP poisoning.
背景:人血清对氧磷酶1 (PON1)水解有机磷(OP)化合物，因此显著改变个体对这些化学物质毒性的易感性。本研究旨在评估一系列OP中毒患者的血清PON1活性。方法:选取急诊就诊6小时内就诊的疑似OP中毒患者。患者的人口统计信息、临床表现、给予的治疗、并发症、住院时间和临床结果收集到数据表中。患者被分为中度和重度中毒。ELISA法测定血清PON1，丁基硫代胆碱法测定血清胆碱酯酶。结果:重度中毒患者的平均血清PON1水平显著低于中度中毒患者(426±179 U/L∶868±79 U/L, P < 0.001)。血清PON1与血清胆碱酯酶水平显著相关(r = 0.400, P < 0.001)，与总住院时间(r = -0.338, P < 0.001)、阿托品总剂量(r = -0.826, P < 0.001)、血清淀粉酶(r = -0.331, P < 0.001)、脂肪酶(r = 0.260, P = 0.011)、总肌酐激酶(r = -0.456, P < 0.001)呈负相关。与不需要通气辅助的康复患者相比，过期患者和需要通气辅助的患者血清PON1和胆碱酯酶水平显著降低。结论:PON1活性降低与血清胆碱酯酶降低和预后不良显著相关。PON1活性可作为OP中毒预后的一个指标。
{"title":"Serum Paraoxonase 1 Activity in Patients with Organophosphate Poisoning: A Potential Indicator of Prognosis","authors":"Lincy Juliet Kolandai Samy, P. Adole, V. Pandit, K. Vinod","doi":"10.22038/APJMT.2019.13176","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13176","url":null,"abstract":"Background: Human serum paraoxonase 1 (PON1) hydrolyzes organophosphate (OP) compounds and so significantly alters an individual’s susceptibility to the toxicity of these chemicals. The study was designed to assess the serum PON1 activity in a series of patients with OP poisoning. Methods: Suspected OP poisoning patients presented within 6 hours of consumption at emergency department were recruited. Demographic information of patients, clinical findings, treatments given, complications, length of hospital stay and clinical outcome were collected into datasheets. Patients were graded into moderate and severe poisoning. Serum PON1 was measured by ELISA method and serum cholinesterase by butyrylthiocholine method. Results: Mean serum PON1 level in patients with severe poisoning was significantly lower than those with moderate poisoning (426 ± 179 U/L vs. 868 ± 79 U/L, P < 0.001). Serum PON1 significantly correlated with serum cholinesterase levels (r = 0.400, P < 0.001) and negatively associated with total length of hospital stay (r = -0.338, P < 0.001), total atropine dose (r = -0.826, P < 0.001), serum amylase (r = -0.331, P < 0.001), lipase (r = 0.260, P = 0.011) and total creatinine kinase (r = -0.456, P < 0.001). Serum PON1 and cholinesterase levels were significantly lower in expired patients and those who required ventilation assistance as compared to recovered patients who did not require ventilation assistance. Conclusion: Lower PON1 activity was significantly associated with lower serum cholinesterase and poorer outcomes. PON1 activity may be considered as an indicator of prognosis in OP poisoning.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47900141","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 : 2019-06-01DOI: 10.22038/APJMT.2019.13178
Belasinti Saroj Kumar Prusty, K. Ramineni, Gangireddy Krishna Mohan Reddy, Majedabdulbasit Momin, S. Perveen
Background: Organophosphorus compound ingestion is one of the most common modes of deliberate self-harm in developing countries like India. Neurological complications are known in acute, intermediate and delayed phases following organophosphate poisoning. However, extrapyramidal manifestations are rarely reported. Case presentation: A 30-year-old male patient was brought to the emergency department with history of consumption of unknown amount of monocrotophos 36%. At the time of presentation, he was in cholinergic crisis. He was managed with intravenous satropine, pralidoxime and mechanical ventilatory support. By day six, he improved significantly and was extubated. On day eight of illness, he developed extrapyramidal syndrome (EPS) characterized by reduced facial expression, tremors of all four limbs, rigidity and intermittent opisthotonic posturing. In addition to supportive care, he was treated with oral amantadine and trihexyphenidyl. He was discharged on day fifteen and by eight weeks improved significantly and became independent for all activities of daily living. Discussion: Organophosphorus compounds are cholinesterase inhibitors which act primarily by blocking active site on the cholinesterase enzyme by forming a covalent bond. Extrapyramidal syndrome is a rare complication during intermediate phase. Increased susceptibility of the basal ganglia nuclei to the toxic products in the absence of efficient detoxification pathways may be responsible. Brain imaging may reveal characteristic signal changes or can be completely normal. Conclusion: This case highlights the importance of careful observation and meticulous neurological examination for the diagnosis and appropriate management of the rare extrapyramidal syndrome due to acute organophosphate poisoning.
{"title":"Acute Organophosphate Poisoning Induced Extrapyramidal Syndrome: A Case Report","authors":"Belasinti Saroj Kumar Prusty, K. Ramineni, Gangireddy Krishna Mohan Reddy, Majedabdulbasit Momin, S. Perveen","doi":"10.22038/APJMT.2019.13178","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13178","url":null,"abstract":"Background: Organophosphorus compound ingestion is one of the most common modes of deliberate self-harm in developing countries like India. Neurological complications are known in acute, intermediate and delayed phases following organophosphate poisoning. However, extrapyramidal manifestations are rarely reported. Case presentation: A 30-year-old male patient was brought to the emergency department with history of consumption of unknown amount of monocrotophos 36%. At the time of presentation, he was in cholinergic crisis. He was managed with intravenous satropine, pralidoxime and mechanical ventilatory support. By day six, he improved significantly and was extubated. On day eight of illness, he developed extrapyramidal syndrome (EPS) characterized by reduced facial expression, tremors of all four limbs, rigidity and intermittent opisthotonic posturing. In addition to supportive care, he was treated with oral amantadine and trihexyphenidyl. He was discharged on day fifteen and by eight weeks improved significantly and became independent for all activities of daily living. Discussion: Organophosphorus compounds are cholinesterase inhibitors which act primarily by blocking active site on the cholinesterase enzyme by forming a covalent bond. Extrapyramidal syndrome is a rare complication during intermediate phase. Increased susceptibility of the basal ganglia nuclei to the toxic products in the absence of efficient detoxification pathways may be responsible. Brain imaging may reveal characteristic signal changes or can be completely normal. Conclusion: This case highlights the importance of careful observation and meticulous neurological examination for the diagnosis and appropriate management of the rare extrapyramidal syndrome due to acute organophosphate poisoning.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45366245","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 : 2019-06-01DOI: 10.22038/APJMT.2019.13171
R. Afshari, D. Bellinger
{"title":"Chemical Risk without Concurrent External Exposure","authors":"R. Afshari, D. Bellinger","doi":"10.22038/APJMT.2019.13171","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13171","url":null,"abstract":"","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44073666","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 : 2019-06-01DOI: 10.22038/APJMT.2019.13431
A. Vanani, A. Rahmani, Samaneh Parsa Payam
Background: Drug abuse is one of the major socio-medical problems of our time with a global scope. Abusing street drugs is on the rise among adults and is considered as a public health concern. In addition, limited studies are available in this regard. The aim of this study was to investigate the frequency of street drug poisoning in the Razi Hospital of Ahvaz in Iran during 2008-2013. Methods: This is an epidemiological cross-sectional study based on hospital information. All admitted cases with street drug poisoning were included during 2008 to 2013 (70 patients). Data were analyzed by SPSS software using descriptive statistics and Chi-square. Results: In the current study, out of 70 cases aged 13-53 years old, the highest frequency of abusers was related to 30 years of age, and male/female ratio was 4 to 1. Among the drugs used, methamphetamine accounted for the highest rate. In this study, 55.7% of the cases needed to be admitted to the intensive care unit and 2 deaths were observed. The most common symptom among poisoned patients includes loss of consciousness and the least common symptom is respiratory distress. Conclusion: According to the results, it can be concluded that the poisoning will be rarely fatal in case of dangerous exposure, if they are under supervision of emergency medical attentions, including the careful management of airways and respiratory failure, hypotension monitoring, seizure and impaired management of body temperature.
{"title":"An Investigation of the Clinical Signs, and Frequency of Street Drug Poisoning in Patients Referred to Razi Hospital of Ahvaz City, 2008-2013","authors":"A. Vanani, A. Rahmani, Samaneh Parsa Payam","doi":"10.22038/APJMT.2019.13431","DOIUrl":"https://doi.org/10.22038/APJMT.2019.13431","url":null,"abstract":"Background: Drug abuse is one of the major socio-medical problems of our time with a global scope. Abusing street drugs is on the rise among adults and is considered as a public health concern. In addition, limited studies are available in this regard. The aim of this study was to investigate the frequency of street drug poisoning in the Razi Hospital of Ahvaz in Iran during 2008-2013. Methods: This is an epidemiological cross-sectional study based on hospital information. All admitted cases with street drug poisoning were included during 2008 to 2013 (70 patients). Data were analyzed by SPSS software using descriptive statistics and Chi-square. Results: In the current study, out of 70 cases aged 13-53 years old, the highest frequency of abusers was related to 30 years of age, and male/female ratio was 4 to 1. Among the drugs used, methamphetamine accounted for the highest rate. In this study, 55.7% of the cases needed to be admitted to the intensive care unit and 2 deaths were observed. The most common symptom among poisoned patients includes loss of consciousness and the least common symptom is respiratory distress. Conclusion: According to the results, it can be concluded that the poisoning will be rarely fatal in case of dangerous exposure, if they are under supervision of emergency medical attentions, including the careful management of airways and respiratory failure, hypotension monitoring, seizure and impaired management of body temperature.","PeriodicalId":30463,"journal":{"name":"Asia Pacific Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46256087","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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