Asia Pacific Journal of Medical Toxicology
Volume:8 Issue: 4, Autumn 2019

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.   

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.

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.

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.

Chitosan as an organic constituent has widely been researched as biodegradable bone scaffold. However, some hesitation in some studies has intrigued to be observed. This study is aimed at observing the cytotoxicity of chitosan material with Adipose Tissue-Derived Mesenchymal Stem Cells (ASCs) obtained from human. The material was served in 2 varieties among other raw and scaffold chitosans to prepare the bone scaffold candidate. Cytotoxicity was tested in vitro, using MTT(3-(4.5-Dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromidefor) assay standard protocol with ASCs as the cultured cell. The chitosan material was obtained from shrimps and processed into granules as raw chitosan. The raw chitosan was then processed into bone scaffold using frozen dried method. ASCs was gotten from the human tissue of a patient in a hospital with several criteria and certain indications. It was then cultured and put into the microplate. Afterwards, both scaffold and raw chitosan were added with Dulbecco’s modified Eagle medium as the medium, and MTT solution as the reagent test. Both varieties of chitosan were later compared to the control cell which contained ASCs and the control medium which had blanks filled with cells. The result indicated that scaffold chitosan comes with no toxic effect, unlike raw chitosan. Although the raw chitosan displayed remarkably higher levels of cytotoxicity (P<0,01) than the control medium and control cell, the results also indicated that raw chitosan has a low-level cytotoxicity leading to the effect on ASCs and the cytotoxicity of chitosan depends on its properties. This study indicated that raw chitosan gives more citotoxicity on ASCs compared to scaffold chitosan which has no citotoxicity against stem cells derived from human tissue.

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. 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. 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. 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.

Breast cancer is now the most important type of cancer in women around the globe and accounts for 25% of all types of cancer. Prevention and treatment of cancer are essential.

The main methods for treating cancer include chemotherapy, surgery, radiotherapy, gene therapy, and hormone therapy. Chemopreventive test programmes began in 1987, when over 1,000 agents and agent combinations were selected and evaluated in preclinical studies of chemopreventive activity against various types of cancers.

An important feature of anticancer drugs is a cytotoxic effect on cancer cells; these drugs have some cytotoxic agents found in animal venom. The ICD-85 is a combination of three peptides, ranging from 10,000 to 30,000 Da, and derived from the venom of the Iranian brown snake (Gloydius halys) and the yellow scorpion (Hemiscorpius lepturus).

ICD-85 has an anti-proliferative effect and anti-angiogenesis activity on cancer cells. The side effects of chemotherapy are multiple drug resistance and effects on natural tissues, among others. Therefore, cytotoxic anticancer drugs are useful in treating cancer. The present work investigates the effects of ICD-85 on in vivo and in vitro studies.

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.

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.

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.

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.

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.

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.

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.

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. 

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.