Asia Pacific Journal of Medical Toxicology
Volume:4 Issue: 3, Summer 2015

Evaluation of scientists working in a specific area of science is necessary, as they may strive for same limited resources, grants and academic promotions. One of the most common and accepted methods of assessing the performance and impact of a scientist is calculating the number of citations for their publications. However, such method suffer from certain shortcomings. It has become more and more obvious that evaluation of scientists should be qualitative in addition to quantitative. Moreover, the evaluation process should be pragmatic and reflective of the priorities of an institution, a country or an intended population. In this context, a scoring scale called "360-degree researcher evaluation score" is proposed in this paper. Accordingly, scientists are evaluated in 5 independent domains including (I) science development, (II) economic impact, (III) policy impact, (IV) societal impact and (V) stewardship of research. This scale is designed for evaluation of impacts resulted from research activities and thus it excludes the educational programs done by a scientist. In general, it seems necessary that the evaluation process of a scientist’s impact moves from only scintometric indices to a combination of quantitative and qualitative indices.

The annual statistics of Drug and Poison Information Centers (DPICs) have critical role in public health planning. The objective of this study was to provide annual epidemiologic profile of drug inquiry and poisoning-related phone calls to Iran’s DPICs during 2014-2015. This was a descriptive retrospective study by reviewing reported phone calls of Iranian DPICs to central division in Tehran (NDPIC) during one Iranian solar year (1393 A.H. equivalent to March 20th 2014 to 20th March 2015 A.D). During the study period, 250368 phone calls were registered in 36 DPICs across the country. The majority of callers were women (145917, 58.28%). The most frequent calls were made by the individuals in the age group of 31 to 40 years (48795, 19.49%). Most of the calls were made by the patients (134322, 53.64%) followed by patients’ relatives (105646, 42.2%). The most common subject of calls was adverse drug reactions (42682, 19.4%), followed by therapeutic use (37114, 16.9%) and drug administration (30091, 13.7%) inquiries. Micromedex (54324, 21.70%) was the most commonly used reference to answer the inquiries. Given that 223482 calls were related to drug information inquiries, the most common drugs questioned about were antibiotics (24274, 10.86%); whereas 4548 calls were made about poisonings and the majority of them were due to pharmaceutical agents (2556, 56.20%). Iranian people seems to have numerous unmet drug information needs. This may especially be the case for antibiotics, nutrients and anti-depressants. Pharmaceutical products are the main subjects of poisoning-related calls to DPICs in Iran. Public education on usage, safety and storage of drugs as well as strict terms of sale should be implemented.

Methotrexate (MTX) is one of the most commonly used disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis (RA) which can be associated with toxic effects on different organs. This study was designed to investigate the hepatotoxic effects in RA patients treated with MTX. In this cross-sectional observational study, RA patients who received standard dose regimen of methotrexate (7.5-15 mg/week) for a minimum of 3 months were included. Liver function parameters including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin as well as prothrombin time (PT) were assessed for all patients. The patients were divided into two groups according to the MTX dose received: (1) low-dose group (≤ 7.5 mg/week) and (2) high-dose group (> 7.5 mg/week). One-hundred patients (64% women) with mean age of 45.8 ± 7.5 years were studied. Eighty patients (80%) received low-dose MTX and the rest received high-dose MTX. Mean values of AST (P = 0.004), ALT (P = 0.001) and PT (P = 0.014) were significantly higher in patients receiving high-dose MTX compared with those who received low-dose MTX. Mean serum albumin was significantly lower in high-dose MTX receiving patients (P = 0.014). Moreover, elevated AST (RR (95% CI): 4.3 (2.1-8.7), P < 0.001), increased ALT (RR (95% CI): 4.9 (2.4-9.9), P < 0.001), and hypoalbuminemia (RR (95% CI): 2.3 (1.1-4.7), P = 0.030) were significantly more common in patients treated with high-dose MTX. The liver parameters restored to normal values after discontinuation of the treatment. MTX therapy especially in doses higher than 7.5 mg/week can be associated with increased risk for hepatotoxic effects. Regular monitoring for patients under MTX treatment is necessary.

Research on poisoning epidemiology in different regions is highly important for evidence-informed health planning. The present study was conducted with the aim of evaluating the two-year epidemiologic pattern of acute poisoning cases treated at Adama Hospital Medical College (AHMC) in Adama, Ethiopia. In this retrospective descriptive study, medical records of emergency department patients with diagnosis of acute poisoning from the beginning of April 2013 to the beginning of April 2015 were reviewed. Data of 292 patients with acute poisoning were retrieved, of which 50.3% were women. The majority of the patients (83.6%) were below 30 years of age. There most common affected patients were in the 21-30 year age-group (39.5%). The highest number of patients were farmers (18.8%) followed closely by unemployed individuals (18.2%). Considering the location of residence, the majority of the patients lived in rural areas (68.8%). Organophosphates were the most commonly used toxic agents (52.1%), followed by household cleaning products (12.7%) and alcohols (10.3%). Four patients died (case fatality rate = 1.37 %) and all of them were due to complications of OP poisoning. Data analyses showed significant correlations between age-groups and intention of poisoning (P < 0.001), poison types and patients’ gender (P = 0.011), and poison types and place of residence (P = 0.010). In Adama, poisonings are more common in rural residents and young adults, and organophosphates are the leading cause of poisoning. These findings warrant social empowerment actions as well as educational programs on poisonings and their outcomes, which should be especially targeted on this stratum of the society (young adult rural residents).

The Persian Gulf is a suitable habitat for various types of marine species. This study was conducted with the aim of determining the epidemiology and clinical findings of injuries inflicted by marine creatures in the Persian Gulf, south Iran. In this retrospective cross-sectional study, medical records of patients with diagnosis of marine animal exposures treated at 6 referral clinics in Bushehr province, south Iran, during 2009-2014 were studied. Ninety-eight patients were studied whose mean (SD, Min - Max) age was 23.6 (7.0, 14-57) years. The majority of patients (91, 92.9%) were men. Scorpionfish stings were the most common cause of injuries (56.1%) followed by jellyfish stings (22.4%), stingray stings (13.3%) and sea urchin stings (8.2%). In most cases (60.2%), the location of injury was on lower limbs. The most common symptom was pain. Marked local swelling was detected in 69.1% of scorpionfish stings and 100% of stingray stings. Itching and hives were seen in 100% and 36.3% of jellyfish stung patients. Gastrointestinal manifestations were the most common systemic effects. Muscle cramps and transient local paralysis were reported in 38.7 % and 23 % of stingray patients, respectively. Serious systemic effects were rare except for symptomatic hypotension in a scorpionfish sting patient and syncope in a stingray sting patient. The vast majority of patients (93.9%) recovered without notable sequels. Secondary dermal infections were only observed in 1 stingray inflicted victim and 4 sea urchin stung victim. No death occurred. Scorpionfish attacks are the common cause of marine animal exposures in south Iran and should be taken seriously. Men at young ages are the victims of this environmental and occupational hazard.

Organophosphate (OP) compounds are frequently used agorchemicals for deliberate self-harm in some parts of the world resulting in high mortality and morbidity. Pralidoxime (2PAM) is the most widely used and trialed oxime for treatment of OP poisoning. There have been variations over the results of trials using 2PAM for OP poisoning. 2PAM therapy has led to favorable outcomes in some studies, whereas it has been associated with unfavorable outcomes or without benefit in the others. Why 2PAM works in some trials and why it does not in the others, has been a key question for medical toxicologists with no definite answer. In this systematic review, we sought to investigate possibilities of the variations in the results of different studies conducted on the effectiveness of 2PAM therapy for OP poisoning and we tried to provide solutions for future studies.

Organophosphates are commercially available agrochemicals for pest control, but may be abused for deliberate self-poisoning. We report a case of suicidal ingestion of dimethoate, a moderately toxic organophosphate insecticide, which can cause refractory hemodynamic instability, and the successful use of methylene blue (MB) for counteracting this complication. An unconscious 47-year-old man was referred to emergency department with history of dimethoate ingestion. He rapidly developed hypotension that was refractory to antidotes, resuscitative hydration and multiple vasopressors including norepinephrine, epinephrine and vasopressin. Pulmonary artery catheterization revealed high cardiac output and low peripheral vascular resistance consistent with distributive shock, a complication previously reported in the setting of acute dimethoate toxicity. MB was initiated for the patient and improved hemodynamic status (increased MAP, systolic and diastolic blood pressures) and seized vasopressor requirement. Laboratory tests revealed that on-admission plasma cholinesterase level and dimethoate serum level were 2247 U and 56 μg/mL, respectively. The patient required 2 week ICU course with eventual tracheotomy for ventilation and later transferred to step down level of care. Although MB therapy has been reported to be useful in managing sepsis-induced hypotension, there has been no similar report of its use in organophosphate poisoning. Our patient had no objective evidence for sepsis, and MB infusion improved hemodynamics within 6 hours and the effect was continued even after discontinuation of the therapy. The underlying mechanism of dimethoate-induced hypotension might be related to increase in nitric oxide (NO) formation. MB is effective to inhibit NO synthase. MB treatment was effective to reverse hypotension and restore hemodynamic instability caused by dimethoate poisoning. This index case may pave way to further investigation of MB therapy for OP-induced hemodynamic instabilities.

Potassium permanganate (PP) is a highly corrosive and deadly agent with a reported lethal dose of 10 g in adults. In this report, successful treatment of a patient poisoned with three times the lethal dose of PP is presented, and effective and early approach to such emergency toxicologic condition is discussed. A 24-year-old woman presented to emergency room of our hospital following PP ingestion (30 g) one hour earlier. She had swollen and stained (dark brown / black) oral cavity, tongue, face, neck and palms. As the patient had stridor, labored respiration, and obstructive swollen upper airways in the emergency room; surgical bedside tracheotomy was performed and later she was transferred to intensive care unit for further treatments. Later, a 20-hour regimen of intravenous N-acetyl cysteine injection was started for her. The patient was also treated with proton pump inhibitor, broad spectrum antibiotics, steroid, analgesic and IV fluids. She was decannulated on the 7th day and discharged home on the 13th day post-admission. No specific antidote is available for this poisoning and so the mainstay of treatment is supportive. Airway management is of utmost importance since PP exposure can cause upper airway edema leading to respiratory compromise. Intensivists should be prepared for difficult intubation, emergency cricothyrodotomy or surgical tracheostomy to secure airway. Steroids might be useful for reversing airway This case report mainly emphasizes the significance of early management of difficult airway during resuscitation of patients with ingestion of highly caustic agents, namely PP in this report, and timely supportive care for the improved ultimate outcome.