Asia Pacific Journal of Medical Toxicology
Volume:11 Issue: 1, Winter 2022

Archaeologists, historians, and physicians have frequently examined historical pieces including images or sculptures (visual arts) and found evidence that allow them to make interpretations under certain assumptions. Iconography examines archaeological evidence and provides clues and symbols for more information about the past.This manuscript aims to highlight "iconography" as another source for studying the history of health literacy. We hope to persuade professional readers of health and medicine to begin researching and reporting the rich iconographic figures, particularly in Iran, attributed to health and medicine across the country.

We have evaluated a pre-Columbian ceramic mask from the Olmec civilization (1500-400 BCE, south-central Mexico) discovered in 1955 by the famous archaeologist Matthew Williams Stirling and is kept at the Museo Internazionale delle Ceramiche in Faenza, Italy.

This mask consists of two halves (earth jaguar and divine human). It looks like the skull that is transforming from an anxious jaguar earthly creature into a perfect and holy figure of the human face. First, this hybrid deity mask manifests auditory and visual hallucinations from a medical and psychological perspective. The jaguar's ear is small with no hole. However, its human ear is shaped like a horn with a large hole which could symbolize a relatively more remarkable hearing ability. The jaguar's eye is just an empty and presumably blind hole. Yet, the celestial eye is anatomically intact, suggesting the ability to see beyond the eyeless earth creature.Additionally, the human (holy) half of the figurine has a skull and nose that resembles the cap and stem of a mushroom. Enhanced visual and auditory abilities, today classified as hallucinations, provide evidence of psychoactive chemicals such as the effects of magic mushrooms containig psilocybin.

The pre-Columbian Olmec civilization ichnographically documented magic mushrooms' medical and psychological effects long before any medical texts described their manifestation.

There is no consensus on the usefulness of toxicological analysis in the management of cases presenting to the Emergency Department (ED) with acute recreational toxicity. While in some centers urine samples are routinely analyzed, in others management is based on clinical interpretation and patient self-report on the drug(s) used. Most of the studies that investigated the role of toxicological analysis in this cohort have used urine for the drug testing. The aim of this study was to compare the drug(s) detected in blood samples analyzed by immunoassay (IA) with those self-reported by patients presenting to the ED with acute recreational drug toxicity. The data were collected from self-reported drug(s) in patients presenting to the ED with acute recreational drug toxicity and compared to the results of a serum Immunoassay which includes 20 different tests. There was weak agreement (kappa 0.2 - 0.5) with significant disagreement between IA self-report for most of the drug assays, including cocaine, pregabalin, cannabis, and methadone. The poorest agreement was seen for synthetic cannabinoids (kappa 0.04) and benzodiazepines (kappa 0.13). The only exceptions with good agreement and insignificant disagreement between self-report and IA were methamphetamines (kappa = 0.65) and opiates (kappa = 0.60). Poor agreement existed between the IA test results in blood and the self-reported data. Further studies comparing IA/self-report data to a gold-standard confirmatory mass spectrometry (MS)-based test are required to definitively address the role of analytical screening in the assessment of patients with acute recreational drug toxicity.

The role of fluorescein in detecting dental plaque has been introduced recently. However, the effect of adding fluorescein to toothpastes and its cytotoxic effects on gingival cells are still unknown. The aim of the present study was to evaluate the cytotoxic effects of fluorescein on human gingival fibroblasts using MTT assay.

 In this in-vitro study, 0.1% fluorescein was added to three different toothpastes including Sensodyne ProNamel, Signal Complete 8, and Darougar 1. Next, different concentrations of each toothpaste (3%, 25% and 50%) were prepared. The same concentrations of each toothpaste without fluorescein were served as controls. Human gingival fibroblast cells in contact with various concentrations of toothpastes were incubated for 2, 5 and 10 minutes. The mean cell viability was evaluated by MTT assay.

The mean cell viability of toothpastes with and without fluorescein was reported to be 40.88% ± 31.62% and 47.18% ± 31.82%, respectively. No significant difference was found between the cell viability of these groups (P=0.73). There was a significant difference in cell viability between the three different concentrations of each toothpaste (P<0.0001). A significant difference in cell viability was also found between the three different types of toothpastes (P<0.0001). Pronamel and Darougar1 toothpastes had the highest and lowest cell viability, respectively. As the exposure time increased, the mean cell viability decreased. However, the difference was not statistically significant. 

It seems that the addition of fluorescein to toothpastes did not increase their cytotoxic effects on gingival fibroblasts.

This research was carried out to investigate the potential bioaccumulation and translocation of heavy metals in plantain cultivation-consumption chain using the serum and vitreous humour as the final reservoirs. Soil, plantain, serum and vitreous humour were analyzed for heavy metals (HM) (Cr, Pb, Cd, As, Hg).   Twelve male albino rabbits were divided into two groups to constitute the sample size as validated by Mead’s formula. The control group was fed with normal rabbit meal void of detectable HM sourced from the market, whereas the treatment group was fed with same normal meal along with plantain sourced from Awka Etiti Anambra State for ninety days. The heavy metal concentrations were analyzed using AAS. Data analysis was carried out using t-test through SPSS (version 22). The findings showed that soil and plantain cadmium concentrations in Awka Etiti were higher than World Health Organization (WHO) permissible limits. Similarly, heavy metals in the soil were higher than those found in plantain. Vitreous cadmium, chromium, and lead were higher in concentrations in the treatment group compared with the control, whereas arsenic concentration was the opposite. Similarly, serum cadmium and lead were lower in the treatment group, whereas chromium and arsenic were higher when compared with the control group.  Heavy metals bioaccumulation and translocation along cultivation-consumption chain is a reality and could be potentially disruptive to physiological processes in the body and the ecology in general.

There is insufficient evidence on the effectiveness of gastric lavage in organophosphorus poisoning. This study was done to quantitate the level of chlorpyrifos and quinalphos retrieved in gastric lavage fluid. Patients presenting within six hours of ingesting quinalphos or chlorpyrifos with International Program on Chemical Safety Poison Severity Score (IPCS PSS) grade 2 or more were included in the study. After the stabilisation of patients, gastric lavage was performed with alliquotes of 200 ml of normal saline till aspirate became clear. Quantification of the pesticide was done in the first 10 ml of lavage fluid aspirated out and in blood with gas chromatography with triple quadruple mass spectrometer (GC-MSMS). There were six patients in each pesticide group. Mean time for reaching hospital after the ingestion of pesticide was 2.8 ± 1.1(range 1.25-6) hours. Median quantity of chlorpyrifos in the lavage fluid was 10.24 (IQR 14.36) µg/L and in quinalphos, it was 1360.62 (IQR 1691.2) µg/L. Other compounds detected in lavage fluid and confirmed in blood were endosulfan, diazinon, pirimiphos, pyridafenthion, pyrazophos, pirimiphos ethyl, and azinphos. Chlorpyrifos and quinalphos are detected in lavage fluid after one hour of ingestion and few milligrams are retrieved by gastric lavage. The presence of other pesticides including endosulfan were confirmed in lavage fluid.

In this scientific letter, a modified electrometric method is clarified for rapid and accurate determination of blood cholinesterase (ChE) activity in man and various animal species. Our electrometric method for ChE determination is a modified one that we refined and developed after several years of research and validations in various animal species as well as in man. The developed method has been applied in many research projects on poisoning with organophosphate and carbamate insecticides. Given the importance of the subject of ChE biomonitoring, and to further clarify the assay technique of the modified electrometric method, a brief and a concise description of the procedure would be beneficial for researchers of limited resources. The enzymatic (ChE) reaction mixture consisted of 3 ml of distilled water, 0.2 ml of plasma, erythrocytes or whole blood, and 3 ml of barbital-phosphate buffer (pH 8.1). The initial pH (pH1) of the mixture is measured with a pH meter, and thereafter 0.1 ml of the substrate acetylcholine iodide (7.1%) or acetylthiocholine iodide (7.5%) is added. The mixture is incubated at 37 ºC for 30 min in most animal species or for 20 min in man; the pH2 of the reaction mixture is measured again. The activity of blood ChE is calculated as follows:ChE activity (D pH/20 min-in man) = (pH1 – pH2) - D pH of blank (no blood sample).

Potassium chloride is extensively used as a potassium supplement, both by physicians as a therapeutic modality and by the general public, mostly in the form of salt substitute. In the oral formulation, the overdose of potassium is not frequently encountered as homeostasis is maintained by daily consumption and renal excretion mechanisms. Lethal injection of potassium chloride (KCl) is yet used either for suicide or homicide, particularly by the healthcare professionals.

We report a case of a medical professional, found dead in a hotel’s bathroom with intravenous drip set connected to an intravenous cannula, present in situ. The autopsy did not reveal any significant finding except hypo-calcemic tetany in both hands and multiple horizontally placed incised wounds on front of both forearms suggestive of suicidal tendency.

Fatal intravenous injection of potassium produces subtle or no specific anatomic changes at all thereby posing a challenge to the autopsy surgeon to unpack the cause and manner of death. Since, it is only the extracellular potassium that can be measured in the laboratory, attributing death due to potassium poisoning becomes difficult.

In such cases when the post-mortem biological tests are unable to differentiate endogenous from exogenous substances, decisions can only be substantiated by history and circumstantial evidence.

The overdose of selective serotonin reuptake inhibitor rarely causes death or serious sequelae. While it may be mildlysymptomatic or asymptomatic at doses up to 30 times the daily therapeutic dose, higher doses may cause drowsiness, tremor,gastrointestinal distress, and serotonin syndrome. Serotonin syndrome is a life-threatening condition associated with increasedserotonergic activity in the central nervous system. We presented a case who used fluoxetine with the diagnosis of unipolar depressionand developed serotonin syndrome as a result of overdose for suicide.

 A 14-year-old female patient, who was followed up by psychiatry for unipolar depression, ingested 30 tablet fluoxetinefor a suicide attempt. Afterwards, serotonin syndrome was observed. As a result of cyproheptadine treatment for signs that developedduring the patient's follow-up in the pediatric emergency department, the symptoms started to regress at the 24th hour.

In the literature, no similar case study has pointed to a developed serotonin syndrome after suicide with fluoxetine inchildren. The present study discusses a case in which a side effect resulting in serotonin syndrome occurred after a suicide attemptwith fluoxetine.

Although it is stated that fluoxetine overdose is benign, pediatric emergency physicians should be aware that serotoninsyndrome may develop in suicidal, high-dose fluoxetine intakes.