Asia Pacific Journal of Medical Toxicology
Volume:10 Issue: 3, Summer 2021

Knowledge of chronopharmacology and disease rhythms may provide additional therapeutic options for diabeticcomplications. The present research investigates the effect of chronomodulated alpha-lipoic acid/ nifedipine/ glimepiride combinationin oxidative stress-mediated testicular toxicity in diabetic rats. A total of seven rat groups were used for the following study. A group of non-diabetic rats and a group of diabetic rats were treated with 1 mL/kg of water to serve as normal and diabeticcontrols respectively. All other groups were diabetic and received 10 mg/kg glimepiride at 20:00h. Additionally, groups four to sevenwere treated with 20 mg/kg nifedipine at 08:00h while groups five to seven received additional treatments with alpha-lipoic acid(ALA) at 08:00h, 14:00h and 20:00h respectively. Rats were euthanized after four weeks of oral treatment and the epididymis andtestis were excised for assessment of fertility markers. Serum testosterone and relative testes weights were measured. The right testeswere preserved in phosphate buffer for cholesterol and antioxidant assay while the left testes were fixed in formalin for histologicalstudies. All rat groups treated with ALA showed significantly (p ≤ 0.01) better prognostic values for all markers assessed comparedto the diabetic control group. Those treated with ALA at 20:00h showed better prognosis (p ≤ 0.05) than treatment at other time points,showing values similar to the normal. Time-dependent triple therapy with alpha-lipoic acid, nifedipine and glimepiride mitigates oxidative stress-mediatedtesticular injury in diabetic rats and its clinical benefits may be explored using equivalent circadian timing in men.

Opium abuse has become a major and growing problem in most countries of the world, including Iran. The Central Nervous System (CNS) is the most affected system by opium, although the cardiovascular and respiratory systems can be affected too. The aim of this study was to compare coronary angiographic data in patients admitted with and without opioid addiction in Imam Reza (p) Hospital for six months (October 2017 to March 2018). The following cross-sectional study, patients with stable ischemic heart disease who were admitted to Imam Reza (p) Hospital for coronary angiography were studied. Risk factors for cardiovascular disease such as age, body mass index (BMI), diabetes mellitus, hyperlipidemia, hypertension, past evidence of heart problems (CVD), physical inactivity, history of heart disease in first-degree relatives and past or present cigarette smoking. Information on the history of opioid addiction was also collected for the above individuals. Coronary angiographic findings were recorded for each patient and the results were compared. Group 1 consisted of cases with minimal stenosis or without stenosis. Group 2 consisted cases with equal or more than 70% stenosis in single, 2 or 3 vessels or more than 50% stenosis in left main. Finally, the two groups of addicted and non-addicted people were compared in terms of angiographic findings. No significant difference was observed among the two groups In terms of BMI, diabetes mellitus, hyperlipidemia, hypertension, past evidence of heart problems (CVD), physical inactivity, history of heart disease in first-degree relatives and smoking. Additionally, No significant difference in the incidence of angiographic problems was found between opioid addicts and non-addict cases. The adverse effects of opioid addiction on different organs such as the cardiovascular system is a challenging subject In term of probable protective effects of these compounds against cardiac problems or their inductive effects on heart problems The current study found no significant relationship between opioid addiction and coronary angiographic findings. Further investigation with larger sample size is recommended.

A prescription containing five or more drugs is likely to result in adverse consequences that may involve hospital admission, falls & many other complications. Increasing incidence of Polypharmacy among patients visiting ED calls for a more judicious and cautious approach to prescribing with a focus on long term as well as short term health care issues. To estimate the incidence and current trend of poly-pharmacy among patients (pediatric and adults) visiting emergency department (ED) of a at a tertiary care hospital. It was retrospective study in which those patients’ data who visited the emergency department of Aga Khan University Hospital (AKUH) was reviewed & analyzed. The duration of study is between January, 2012 to December, 2012. The detailed clinical records of randomly selected patient through a simple random sampling method were retrieved out of 51,000 patients visited ED during the period. Total 51,000 patients visited ED during study period, out of those 372 patients were randomly selected. Polypharmacy was common in 69.9% (251) of patients with elderly population were most effected age group P < 0.05. Male were 51.9 % (193) & adults were 80.4% (295). The most common triage category was P1 40.2% (100). Top most diagnosis was respiratory tract infection with antibiotic was the most prescribed drugs in ED 91% (340). The perils and problems associated with Poly pharmacy are a subject of interest as polypharmacy found to be significant finding among all ED patients

Emergency physicians must be updated about the variations in poisoning pattern during Covid19 pandemic. Limited data exist on the incidence and characteristics of patients presenting with poisoning in Indian Emergency Departments (ED) during the COVID 19 pandemic. Hence, we aimed to explore the impact of Covid19 pandemic on poisoning cases presenting to the ED. This cross-sectional retrospective study was conducted on poisoning patients presenting to ED during the pandemic period (April 1-October 30, 2020 (period 2)), and a matching period before the pandemic (September 1,2019 to March 31, 2020 (period 1)). The rate of prevalence and clinical profile were compared between period 1 and 2 using appropriate statistical test. A total of 111 (periods 1 = 57, and periods 2 = 54) cases were analysed. Poisoning prevalence rates had slightly increased by 2.7% before the pandemic (51.33%) in comparison to during the pandemic (48.6%) period (p=0.3). Females were predominant in both periods, and the mean age of 32.5 years. The predominant (57%) patient age group was 15-34 years. 36.9% (n=41) patients consumed multiple poisons, 19.8% (n=22) consumed paracetamol, and 14.4% (n=16) patients consumed psychiatric medications. Before lockdown, 27.02% (n=30) patients presented within 3 hours ingestion, and 21.6% (n=24) presented after 3 hours ingestion (p=0.12). A significant delay in arrival of poisoning cases during lockdown (p= 0.12) with increased hospital admission (p=0.03) was observed.  A psychiatric disorder was observed in 36.03% cases. Majority of the cases were admitted in the ICU, and 0.9%(n=1) death was recorded. This is the first Indian study that describes the incidence of poisoning cases and their pattern during the COVID 19pandemic period, study revealed that increased mental health crisis in low resource settings in rural Kerala affects predominantly young population. Study implies the importance of priming the mental health care professionals to initiate their mental health screening programmes.

In acute and chronic phases of severe diseases, endocrine changes occur. Some hormones, such as prolactin (PRL) and thyroid hormones, were considered predictors of ICU patients' outcomes. The present study evaluates thyroid hormone profile, serum PRL level, and their relationship with ICU poisoned patients' mortality rate. This study included 140 inpatients in the Toxicology Intensive Care Unit (TICU) who enrolled in a prospective study of a single center and observational. After admission to the ICU, the researchers collected venous blood samples from all patients directly. Concurrently, the APACHE II score was calculated. The collected samples analysis was performed based on the entire triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and PRL level. One hundred and forty subjects were studied, of which 109 (75.85%) were male with a mean age of 34.17 ± 14.01. One hundred and eighteen patients were survivors with a mean age of 33.29 ±13.76. In contrast, 22 patients with a mean age of 38.91 ±14.69 died. The model of PRL combined with APACHE II score (OR 1.17, 95% CI 1.06 to 1.28, P-value =0.001) was the best model for predicting post-ICU mortality in our study. This study’s results are consistent with the previous research, indicating a higher incidence of thyroid and PRL hormone changes in patients hospitalized in the ICU.   It can be concluded that the presence of PRL based on the APACHE II score can lead us to be more precise in predicting the outcome of poisoning in hospitalized patients.

The venom of different snake species has a distinctive composition. This composition can be also affected by other factors such as age, sex, geographical, and seasonal variations. Generally, snake venom is composed of small molecules such as inorganic cations as well as enzymatic and non-enzymatic peptides, and proteins. Although snake bite poisoning is highly associated with death after systemic absorption of the venom, some studies report on snake venom’s composition, toxicodynamic, and potential therapeutic.

Using electronic databases like ISI Web of Knowledge, PubMed, and Scopus, this review aims to point to some components of snake venom and how these components can be used for therapeutic and diagnostic purposes.

Snake venom was used for the treatment of different pathophysiological conditions in ancient times and is now being used in both modern and folk medicine. These have created the opportunity for scientists to discover new drugs that are more targeted to the site of action and have fewer adverse effects.

Today, using special techniques of isolation and formulation, some purified snake venom components are being used for the treatment of acute and chronic conditions, while some others are under further clinical trials. This is due to their potential to produce antitumor, antimicrobial, analgesic, antiplatelet, hypotensive, and other activities.

Foodborne botulism (FB) is a potentially fatal and paralytic disease which can be prevented by the application of simple measures. FB outbreaks are usually the results of consuming contaminated canned vegetables or meat. However, in rare cases, dairy products can be their source of occurrence.

We report on nine cases of confirmed botulism who referred to our center on December 2019 with a common history of exposure to a type of traditional yogurt called “Poost yogurt” in local language. Patients presented with various combination of symptoms, 5 of them required ICU admission. All hospitalized patients fully recovered and discharged at a median of 14.5 days. In addition to these 9 cases, 60 patients were admitted and treated at Neyshabour University of Medical Sciences, as well. Totally, 69 patients in the area were diagnosed with FB with a definite history of “Poost yogurt” consumption and telltale symptoms of botulism.

Dairy products are a relatively uncommon source of FB. However, home-prepared cheese, and rarely yogurt, could bear contamination with clostridium botulinum, leading to intoxication due to improper refrigeration or incomplete heating. In this outbreak, the source of toxin was tracked down to a home-prepared Poost yogurt being sold at a dairy shop in Neyshabour. It is conceivable that improper refrigeration or incomplete heating of the milk, before fermentation, has led to spore vegetation and toxin production.

It is necessary to increase public awareness about traditional dairy products as a potential source of FB.

Russell’s viper (Daboia russelii) of Family Viperidae is a highly venomous snake in Sri Lanka and is responsible for the most snakebite deaths. It commonly causes coagulopathy and neuroparalysis. Thrombotic microangiopathy (TMA) including the triad of acute kidney injury (AKI), thrombocytopenia and microangiopathic hemolysis is a rare complication of its bites. There are two clinical entities of TMA including hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) of which, only few records of TMA and HUS following Russell’s viper bites are available in literature.

Two patients presented with TMA following Russell’s viper bites. A 36-year-old male who got coagulopathy, respiratory failure, AKI, signs of HUS, and he completely recovered with antivenom and 8 cycles of hemodialysis and discharged on day 19 of snakebite. The other patient was a 66-year-old female who had delayed coagulopathy and persistent drowsiness, the signs of TTP. She required antivenom with 9 cycles of hemodialysis and 6 cycles of therapeutic plasma exchange and got recovered after 30 days in hospital that included intensive care treatments.

Russell’s viper venom causes activation of Factor V and X which results venom induced consumption coagulopathy and bleeding. The venom also blocks neuromuscular junction and causes neuroparalysis, which are commonly manifested as ptosis and external ophthalmoplegia. It also has direct nephrotoxic effects and there are fibrin depositions in renal microvasculature thereby, causing renal ischemia. In the spectrum of HUS-TTP of TMA, HUS is suggested when there is a severe renal involvement, and TTP is diagnosed when neurological impairment is prominent.

Atypical presentations like TMA and HUS may rarely occur following Russell’s viper bites. Further evidence of similar observations is needed to confirm the clinical entity of TTP following Daboia russelii bites.