Iranian Journal of Toxicology
Volume:6 Issue: 4, Winter 2013

Ingestion of caustic agents can cause serious damages of the upper gastrointestinal tract and in some cases this kind of poisoning may have fatal outcomes.Acute caustic intoxications are one of the main problems in the modern clinical toxicology since they mainly affect young people with psychic disorders, suicidal intent, and alcohol addiction. Text: In diagnostic evaluation of this kind of poisoning, different procedures are used. Today’s golden standard for determination of the grade and extent of the lesion is esophagogastroduodenoscopy (EGD) performed in the first 12-24 hours following corrosive ingestion.In some patients, some late complications, such as esophageal stenosis and gastric stenosis, which are the most common, as well as carcinoma of the upper gastrointestinal tract, which is rarely seen, can be detected. Acute caustic poisonings are treated with specific kinds of protocols. According to them, first, an attempt is made to neutralize the poison. Combinations of antibiotics, anti-secretory drugs, and collagen synthesis inhibitors are used. As a support therapy, nutritional liquids can be utilized, and in the most unmanageable cases, esophageal dilatation, stent placement and surgery are used. In the future, caustic poisonings will remain a serious socio-medical issue, due to the difficult clinical presentation, expensive diagnostic protocol, extended hospitalization, and possible permanent disability.

Web of Science (WoS) is an online academic citation index provided by Thomson Reuters which supplies valuable bibliometric information for comparing impact of specific author, organization, or country in science production. The aim of this study was to compare toxicology publications of Iran and Turkey indexed in WoS from bibliometric point of view. The WoS database was queried based on keywords “Iran” and “Turkey” separately in the “Address” field and refined by “Toxicology” as a category. All records were transferred to Microsoft Excel® application. The dataset were analyzed from different perspectives, such as publication years, number of references and citations, authorship pattern, publications types, affiliated organizations, core subject areas and journals. There were 1178 and 2240 publications that met the criteria during 1993-2011 for Iran and Turkey, respectively. Less than 2% of authors had published more than 25% of all toxicology papers in both countries. The average number of citation per article was about 3.48 for Iranian and 6.73 for Turkish papers. By the time of the analysis, 54.3% of Iranian and 31.6% of Turkish articles had not received any citation. This analysis reveals that top Iranian toxicologists had a better performance than their Turkish counterparts but overall authorship pattern was well-distributed among Turkish researchers and organizations. If Iranian authors desire to achieve first rank of toxicology articles in the Middle East region by 2025, they must try to increase the quantity and quality of their international publications.

Acute intoxication with ALP is extremely lethal. The present study was conducted to determine the range of serum cortisol levels in ALP poisoning and its correlation with patient outcome. This study was carried out on patients who were intoxicated with ALP. Their demographic data and pertinent findings in their history and physical examination were recorded at the time of arrival and also when shock and severe metabolic acidosis emerged. 5cc blood was taken from the patients to measure blood cortisol level, when shock and severe metabolic acidosis developed. Blood cortisol level analysis was performed using ELISA method. Data analysis was done using SPSS software version 16.0. The average ingested dose was 1.98+1.79 tablets each containing 3 grams of ALP. Overall, 77% of the patients presented tachycardia and hypotension. Blood cortisol level less than 15 µg/dl, 15-33 µg/dl, and more than 34 µg/dl were regarded as adrenal insufficiency, critical illness-related corticosteroid insufficiency, and adequate adrenal response, respectively. Eventually, 3 patients fell within the first category, 24 patients matched with the second category, and 3 patients corresponded to the last category. Blood cortisol concentration is satisfactory only in 10% of the patients. In majority of the patients although it is not apparently low, it has not shown the expected rise comparable to the shock and stress state of such patients. It defines a role for corticosteroids therapy in management of ALP poisoning, particularly if it does not respond to conventional treatments.

Cardiac manifestations that occur in a majority of patients with organophosphate (OP) poisoning may range from innocuous electrocardiographic manifestations, such as sinus tachycardia, to life-threatening complications, including cardiogenic pulmonary edema and myocardial necrosis. In this study, we evaluated the various electrocardiographic manifestations in patients with OP poisoning. This retrospective-descriptive study was performed by reviewing the medical records from all patients poisoned with organophosphate admitted to Razi Educational Hospital, Rasht, Iran, from April 2008 to March 2011. Patients with incomplete records were excluded from the study. Histories of all patients were collected and ECG analysis was conducted including the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals by a cardiologist. Descriptive statistical analysis was conducted by SPSS software version18. Of the total 100 patients (75 were male) with OP poisoning that referred to the Emergency Ward of Razi Hospital, 63 patients presented ECG abnormalities. The mean age of the patients was 35.78 ± 12.91 years. The causes of poisoning were occupational in 71 patients, suicidal in 26 patients, and accidental in 3 patients. Sinus tachycardia (31%) was the most common ECG abnormality, followed by non-specific ST-T changes (24%). Overall, mortality rate was 5% and all of the deceased patients presented changes in ECG. OP poisoning is associated with significant ECG abnormalities, especially tachycardia and non-specific ST-T changes.

Poly chlorinated biphenyls (PCBs) are a class of chlorinated organic chemicals that do not easily degrade in the environment. This study was conducted to determine the effect of microwave rays, hydrogen peroxide, dioxide titanium and ethanol solvent on the degradation of PCBs. A 900w domestic MW oven with a fixed frequency of 2450 MHZ was used to provide MW irradiation. Ray powers were used in 540, 720, and 900w. A hole was made on the top portion of the oven and a Pyrex vessel reactor (250ml volume) was connected to condensing system with a Pyrex tube connector. The PCBs were analyzed by GC-ECD. The degradation of total PCBs was 54.62%, 79.71%, and 95.76% in terms of their ratio to solvent with transformer oil at 1:1, 2:1, and 3:1, respectively. The degradation of total PCBs was 84.27%, 89.18%, and 96.1% when using 540, 720, and 900W microwave radiation, respectively. The degradation of total PCBs was 70.72%, 93.02%, 94.16, 95.23% and 96.1% when not using H2O2/ Tio2 and using 20% H2O2 and 0.05, 0.1, 0.15, and 0.2g Tio2, respectively. In the present study, the optimum conditions to decompose PCBs efficiently included 50 ml volume of ratio to solvent with transformer oil (3:1), sodium hydroxide solution (0.2N) 1 cc, use of 20% hydrogen peroxide of total volume of samples, dioxide titanium (0.2g), and irradiation for 9 minutes. Under these optimum conditions, efficiency of PCBs decomposition increased.

Blood hemoglobin can be damaged by toxins such as lead. Thus, this study was carried out to assess its blood hemoglobin concentration in the staff of Kermanshah Oil Refinery that had been exposed to lead components. In this study, 150 workers at Kermanshah Oil Refinery were selected as the case group and 70 workers of textile industry factory were chosen as the control group. Informed written consent was obtained from them for participation in the study and blood sampling. Blood hemoglobin level was assessed by SAHLI method and serum lead concentration was assayed by atomic absorption spectrophotometery at 217.4 nm. The results were analyzed by statistical procedures, such as correlation test, and P-values less than 0.05 were considered significant. The results showed that the presence of a statistically significant difference between hemoglobin levels (P<0.05). Mean hemoglobin level was 15.96gr/100cc in the control group and 12.51gr/100cc in the case group. There was a significant relationship between lead exposure and hemoglobin level. Lead is a toxin that its chronic exposure decreases hemoglobin level. Protective measures should be anticipated to save the workers from harms of lead exposure.

The development of toxicity tests regarding toxic responses of different fish species could be more effectively used in predictive toxicology and risk assessment. In this study lethal concentrations (LC50-96 h) values of copper sulphate; an important toxic industrial pollutant, on Capoeta fusca were determined. Behavioral changes at different concentrations of CuSO4 were determined for the C.fusca. The sample fishes were collected from Qanat in Birjand and were transported to the laboratory in polythene bags. The exposure time of fish to CuSO4 was 96 hours. Mortalities were recorded at 24, 48, 72, and 96 hours of exposure, and the dead fish were removed regularly from the test aquariums. Physicochemical parameters, such as dissolved oxygen, pH and Total hardness of aquaria were monitored daily. The LC50 values for CuSO4 at 24, 48, 72, and 96 h of exposure, were 43.62, 12.6, 7.66, and 6.85 mg/L, respectively. The median LC50 value of CuSO4 for C.fusca was found to be 6.928 mg/L by EPA method and estimated to be 6.787 mg/L with SPSS statistical software. The mortality decreased with time, and most of the deaths occurred during the first 24 h. In addition, behavioural changes increased with increased concentration. This metal is an important constituent in industrial effluents discharged into freshwaters. The results obtained in this study clearly revealed the fact that it is necessary to control the use of a heavy metal such as copper.

Metabolic acidosis is a fatal finding in trauma patients that complicates the process of resuscitation. Case: The case was a 37-year-old man with open fracture in both legs and fracture in second lumbar vertebral (L2). The serial arterial blood gas (ABG) test results showed a pH value of 6.7 indicating a very severe and special case of metabolic acidosis. The rate of mortality for such a case was very high. The patient was treated with sodium bicarbonate and successfully revived after four hours post treatment and metabolic acidosis was resolved. This indicated that bicarbonate administration is useful for very severe cases. The good condition of the patient after survival from the severe academia allowed for extubation.