فهرست مطالب

Asia Pacific Journal of Medical Toxicology - Volume:7 Issue: 3, 2018
  • Volume:7 Issue: 3, 2018
  • تاریخ انتشار: 1397/06/03
  • تعداد عناوین: 7
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  • Reza Afshari * Pages 54-59
    Background
    Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein’s regime in 1980s and more recently in Syria. The use of CWA is banned under the international law.
    Methods
    Ancient uses of CWA are not well studied. Recently, their use during the Persian siege of the Roman-held Dura-Europos (Salihiyah) in modern Syria in 256 C.E. has been theorized by revisiting the archaeological findings from Dura-Europos from the 1930s. Case study: The paper describes the history of Persia (Iran) and Rome in that era and particularly Shapur I, the second King (Shah) of the [Sasanian] Persian Empire (215 - 270 C.E.) and Valerian, Publius Licinius Valerianus Augustus, the Roman Emperor (193/200 - 264 C.E.). In addition, composition of the potentially applied CWA and clinical findings related to the exposure are postulated through a medical toxicology lens taking into account archeological evidence (carbonized top of the tunnels and bodies and yellow crystals found in the tunnel), recent research and contemporary historical notes.
    Conclusion
    It is plausible that a combination of fire accelerant or so called pitch (oil based substance, naphtha, bitumen or crude oil) and Sulphur dioxide (SO2) were used in this occasion. SO2 in combination with water on the body membranes creates highly toxic sulphurous acid (H2SO3) which is life threatening in a small enclosed space. As a result, a burning sensation in the nasopharynx and eyes, coughing, dyspnea, choking that led to pulmonary edema and death would have shortly followed. Severe clinical manifestations, panic and consequent mass hysteria of the toxic exposure should have prevented any organized retreat. In this incident, nineteen Roman and one Persian soldier were killed.
    Keywords: Chemical warfare agents, Dura-Europos, Persian, Roman
  • Sean Wachtel *, Uy Hoang, Julian Sherlock, Chris Mcgee, Rachel Byford, Simon de Lusignan Pages 60-67
    Background
    There has recently been increasing interest in the role of the human microbiome in disease. Antibiotic use is known to disrupt the intestinal microbial environment and cause acute disease, for example pseudomembranous colitis. This study aimed to investigate the hypothesis that long-term antibiotic use is associated with the development of chronic diseases, i.e., Asthma, Rheumatoid Arthritis, Inflammatory Bowel Disease, Colorectal Cancer, and Dementia.
    Methods
    The study is a retrospective observational study using ontologically defined cases recorded by primary care physicians covering the period 2004 to 2015 combined with prescribing data. The study is primary care based, utilizing records held by the Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) database, representative of all English General Practices, over the period 2004 to 2015 inclusive. All patients registered with practices subscribing to the RCGP RSC database, with 10 years of prescribing history and other full demographic information required for the study recorded, numbering 644,273 were utilized. All records were analyzed for demographic data, diagnoses of study, known risk factors, and prescribing history of antibiotics. Exclusion criteria included incomplete data for known risk factors or demographics. The main outcome measures are the odds ratios (OR) of being diagnosed with one of the diseases of the study per antibiotic prescription issued over the preceding decade before diagnosis, adjusted for demographics and known risk factors.
    Results
    The OR (2.5% CI, 97.5% CI) of being diagnosed with Asthma was 1.004 (1.002, 1.006), Rheumatoid Arthritis 1.006 (1.003, 1.008), Inflammatory Bowel Disease 1.007 (1.006, 1.008), Colorectal Cancer 1.001 (0.999, 1.002), and Dementia 1.001 (0.998, 1.001).
    Conclusions
    The long-term use of antibiotics is associated with a statistically significant dose related increase in the odds of being diagnosed with asthma, rheumatoid arthritis and inflammatory bowel disease, but not all forms of dementia or colorectal cancer. Potential mechanisms include chronic disruption of the microbiome. This finding has implications for practitioners who prescribe antibiotics, the pharmaceutical industry, policy makers, and researchers involved in studying chronic disease mechanisms.
    Keywords: Antibiotics, chronic disease, Microbiome
  • Kavinda Chandimal Dayasiri *, Shaluka Jayamanne, Chamilka Jayasinghe Pages 68-74
    Background
    This qualitative study presents an in-depth evaluation of the contributory psycho-socio-cultural and physical-economic factors related to paediatric poisoning in rural Sri Lanka.
    Method
    The study was conducted at paediatric wards of Anuradhapura teaching hospital (THA) over a period of two years (2012 – 2014). Main methods of data collection were participants’ narrative and focus group discussions (FGDs). All parents of children with acute poisoning were recruited to FGDs. The structure of phenomena was developed based on descriptive phenomenological inquiries and key themes were identified at data analysis stage.
    Results
    383 parents participated in focus group discussions. Data were categorized to four domains; (1) parental awareness of poisoning risks, (2) presence of child, parent and environment related risk factors, (3) issues related to first aid care and provision of care until child was brought to emergency care unit, and (4) possible measures to prevent further poisoning. Interaction of multiple risk factors was observed in children with both intentional and unintentional poisoning. Accidental poisonings were associated with certain cultural practices, unsafe environment and unsafe storage of poisons. Children with intentional poisoning frequently had disrupted family relationships. Harmful first aid measures and delayed presentation at the primary care unit had negative impact on poisoning related outcomes. Parents believed community education, safe storage of poisons, and safe environment would likely bring down poison related morbidity.
    Conclusion
    Person, poison and environment related risk factors can lead to acute poisoning emergencies in children in rural Sri Lanka. Often multiple risk factors interact to bring about the poisoning event. Avoidance of harmful first aid measures and early presentation at the primary care unit would bring down poisoning related morbidity. Effect of community education, safe storage of poisons and safe environment should be evaluated in the view of preventing poisoning.
    Keywords: Children, Emergencies, Poisoning, Rural, Sri Lanka
  • Simasadat Noorbakhsh , Jamal Shams, Reza Lotfi, Lelahloo, Peter Wennberg, , Hakan Kallmen * Pages 75-78
    Background
    AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients.
    Methods
    Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment.
    Results
    A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88.
    Conclusions
    Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.
    Keywords: Alcohol Use Disorder, Alcohol Use Disorders Identification Test (AUDIT), Cut-off Point, Iranian version
  • Francis Chu *, Anfernee Kin Ming Yim, Sau Wah Ng Pages 79-83
    Background
    MDMA (3,4-methylenedioxymethamphetamine), which is also known as Ecstasy or Molly, is a commonly found abusive agent in Hong Kong. MDMA abuse is widely reported in electronic dance music (EDM) festivals all over the world. It brings about uncommon mortality and serious morbidity with recreational use, which are believed to be related to serotonin toxicity. Cyproheptadine has anti-histamine and 5-HT antagonist property which are reported to be an effective agent in managing serotonin syndrome of moderate severity. However, there is not much information concerning whether it is useful in life-threatening situations.
    Case Presentation
    Four victims who collapsed while attending an EDM festival were sent to our Emergency Department (ED). They showed clinical symptoms compatible with life-threatening serotonin toxicity. One patient died 30 minutes after arrival to the ED. Aggressive attempts were made to resuscitate the other three; cyproheptadine was administrated to them from 0.75 to 10 hours after arrival. They were all admitted to intensive care unit (ICU) for further management. Their urine showed a presence of MDMA.
    Discussion
    Except for the one who died on arrival, the other three survived, who were later discharged. An early use of cyproheptadine (0.75 vs 3.5 vs 10 hours) results in better outcome as well as a shorter ICU stay (3 vs 10 vs 53 days) and total hospital stay (11 vs 37 vs 98 days).
    Results
    Supportive treatments as well as early use of cyproheptadine might have some beneficial effects in reducing the severity and hospital stay in patients presented with life-threatening serotonin syndrome related to MDMA.
    Keywords: Cyproheptadine, MDMA, Poisoning, Serotonin Syndrome
  • kitisak sanprasert *, Thunyaporn Tangtrongchitr, Nat Krairojananan Pages 84-85
    Background
    Dichloromethane (a chlorinated hydrocarbon) is normally used as a solvent. Dichloromethane poisoning has been reported from occupational exposure and the common routes of dichloromethane poisoning are ingestion and inhalation.
    Case presentation
    We described a case of 51-year-old man who received subcutaneous injection of dichloromethane and presented with local wound necrosis at his forearm, but carboxyhemoglobin levels were normal.
    Discussion
    The corrosive property of dichloromethane result in venous thrombosis formation at his wound that might prevent systemic absorption of dichloromethane leads to reduced hepatic converted dichloromethane to the carbon monoxide.
    Conclusion
    Symptomatic treatment and monitoring of CO production remain the mainstay in the treatment of patients with subcutaneous injection of dichloromethane.
    Keywords: Carbon Monoxide, Methylene Chloride, Subcutaneous Injection
  • Rajashree Sanjay Khot *, Amey Bhise, Rakhee Joshi, Nilima Patil Ambade Pages 86-88
    Background
    Glyphosate containing herbicides are widely used the world over. They are marketed as nontoxic to humans, but numerous studies have showed that these glyphosate-based herbicides (GlySH) can cause multiorgan damage.1 Recent reports of animal studies on rats have raised a doubt of liver damage after long term exposure to GlySH.
    Case Presentation
    a young male had chronic exposure to Glyphosate for 5 years in the form of spraying GlySH in farm and eating cereals sprayed with GlySH. He developed fulminant liver failure after accidental consumption of glyphosate containing herbicide. His liver function deteriorated in spite of supportive treatment. He developed hepatorenal syndrome later and died.
    Discussion
    Studies done on rats have showed that chronic consumption of extremely low levels of a GlySH formulation (Roundup), at admissible glyphosate-equivalent concentrations, is associated with marked alterations of the liver proteome and metabolome.2 It has been reported that chronic exposure to Glyphosate of more than 5 years’ duration due to consumption of food grains sprayed with this herbicide or inhalation of particles results in development of Fatty Liver, i.e., non-alcoholic fatty liver disease. Any acute insult can result in decompensation and development of fulminant liver failure. Although this herbicide is relatively safe, other complications like Acute renal failure, Acute pulmonary edema with respiratory distress and shock can also occur.
    Conclusion
    Chronic as well as acute exposure to GlySH can lead to NAFLD and fulminant liver failure. As there is no antidote to glyphosate, clinicians must depend only on intensive supportive management which might not always be fruitful as in our case. It is important to be aware of systemic complications of this commonly used herbicide so that appropriate preventive measures can be taken.
    Keywords: Cumulative Effect, Glyphosate Poisoning, Hepatic Failure, NAFLD