Asia Pacific Journal of Medical Toxicology
Volume:5 Issue: 2, Spring 2016

Globally, smoking is one of the main causes of morbidity and mortality. It is also an important social determinant of health and the largest contributor to health inequalities. While several prevalence studies are conducted on special groups such as physicians, less such studies have been focused on deprived areas (areas with lacking adequate food, shelter, education, etc). The aim of this study is to evaluate the prevalence of smoking in the outskirts of Mashhad, Iran.
This analytical cross-sectional study was performed on 500 residents of sub-urban areas of Mashhad, Iran. Subjects were included and were interviewed using a multi-stage random sampling method.

Composition of subjects, 40% (200) were male. Mean age was 35±11 years. Twenty-four percent (117) of subjects were smokers (18% women and 33% of men). Hookah was used twice as much as cigarettes (18% vs. 9%, respectively). Smoking was most prevalent between 25 and 34 years old for both genders. More than 75% of smokers had low grade education.
Smoking is of high prevalence in suburban areas of Mashhad. Target oriented interventions are needed to effectively lower this major health risk factor.

Acetaminophen (N-Acetyl-p aminophenol; APAP) is one of the most common types of analgesics. It is also the most common xneobitic reported to poison centers. This study investigates if therapeutic doses of NAC can falsely increase coagulation tests, prothrombin time (PT) and bleeding time (BT). ​​
Thirty-six APAP poisoned patients whose acetaminophen serum concentration were in toxic zone in the Rummak-Matheiw graph were treated by NAC according to standard intravenous 21 hours protocol. Prothrombin time (PT) and bleeding time (BT) in all cases were measured before the start of the NAC and at the 8th and 16th hour of the treatment.
The mean age of the cases was 21.5 ± 5.12 years old. Among them, 31 cases (86%) were female. The mean dose of ingested APAP was 9.6 ±2.0 grams (7.8 – 16.1 g). Mean of SLA was 196.0±37.7. The means of BT were nor significantly different at all evolution times (2.6±0.64, 2.6±0.62 and 2.6± 0.6. The means of PT rose at 16th hour of NAC treatment in as compared 8th hour (16.1± 1.1 s 12.3±0.6 s, respectively) (P With specific reference to our study results, a low level of rising PT resulting from an NAC treatment is not a reliable indicator of liver damage. Further investigation on the effect of NAC on clotting factors is recommended.

Envenomation by Macrovipera lebetina (M. lebetina) is characterized by prominent local tissue damage, hemorrhage, abnormalities in the blood coagulation system, necrosis, and edema. However, the main cause of death after a bite by M. lebetina has been attributed to acute renal failure (ARF). It is unclear whether the venom components have a direct or indirect action in causing ARF. To investigate this point, we looked at the in vitro effect of M. lebetina crude venom, using cultured human embryonic kidney (HEK-293) mono layers as a model.
The effect of M. lebetina snake venom on HEK-293 growth inhibition was determined by the MTT assay and the neutral red uptake assay. The integrity of the cell membrane through LDH release was measured with the Cytotoxicity Detection Kit. Morphological changes in HEK-293 cells were also evaluated using an inverted microscope.
In the MTT assay, crude venom showed a significant cytotoxic effect on HEK-293 cells at 24 hours of exposure and was confirmed by the neutral red assay. Also, at 24 hours exposure, crude venom caused a non-significant increase in LDH activity of the culture medium at concentrations above 20 μg/ml. Various morphological abnormalities were observed in cells exposed to the venom and showed loss of their common polygonal shape, appearing as several roughly rounded cells of variable size. The M. lebetina crude venom induced detachment of cells from the plate.
Based on the results obtained in this study, it can be concluded that the Iranian snake M. lebetina venom causes a cytotoxic effect on kidney tissue not by necrotic mechanism but rather by secondary effects, including hypotension, hemolysis, hemoglobinuria, rhabdomyolysis, myoglobinuria and disseminated intravascular coagulation (DIC), which may lead to ARF.

Acute poisonings are common presentations to emergency departments (EDs) worldwide and require rapid assessment. Consultant emergency physicians (EPs) faced with various toxicological presentations must initiate rapid investigations and empirical management. This study aimed to determine emergency department doctors’ level of knowledge and confidence in toxicological presentations, and factors that predicted these outcomes.
Target participants included members of the Australasian College for Emergency Medicine (ACEM) and readers of the emergency medicine website, “Life in the Fast Lane”. The survey was distributed electronically via the ACEM bulletin and posted on Life in the Fast Lane. A survey was designed based on toxicology multiple choice questions (MCQs). The questionnaire comprised 59 items: 10 demographic items; 20 items about confidence; 28 MCQs assessing knowledge of common and serious toxicological presentations.
There were 467 consenting respondents from 31 countries, with most residing in Australia (306/467, 66%). Respondents comprised similar proportions of consultant emergency physicians (196/467, 42.0%), and trainees (197/467, 42.2%). Almost two-thirds (292/467; 62.1%) had received formal training in toxicological emergencies, while a third (166/467, 35.5%) had participated in a relevant conference or workshop. A total of 284/339 (83.8%) participants completing all items achieved a knowledge test score >50%. More than 65% incorrectly answered questions on pharmacology of serotonin syndrome and lithium toxicity, and more than half incorrectly answered questions on use of 12 lead ECG in toxicology, calcium channel antagonist or tricyclic antidepressant toxicities. Predictors of overall knowledge for toxicology were receipt of formal toxicology education, and clinicians’ experience and seniority.
The knowledge and confidence of doctors working in emergency departments is varied, yet correlated. Emergency medicine training programs should consider the benefit of reviewing current toxicological education, including the provision of further educational support to regional and rural hospitals.