فهرست مطالب

Asia Pacific Journal of Medical Toxicology
Volume:2 Issue: 4, Autumn 2013

  • تاریخ انتشار: 1392/08/10
  • تعداد عناوین: 12
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  • Mahadevaiah Mahesh, Mohan Gowdar, Chilkunda Raviprakash Venkatesh Pages 121-125
    Background
    The role and proper dose of pralidoxime in the treatment of Organophosphorus (OP) compounds poisoning is an unresolved issue. This study was designed to compare the regimen recommended by the World Health Organization (WHO) with the commonly used standard regimen of pralidoxime.
    Methods
    This was a randomized open labeled prospective study on OP poisoned patients admitted to JSS Hospital, Mysore, India during November 2009 to January 2012. WHO regimen of 2 g pralidoxime bolus followed by 8mg/kg/h infusion (study group) compared with standard regimen of 2 g pralidoxime bolus followed by 1g 6 hourly (control group).
    Results
    In total, 82 patients were studied. Thirty-seven patients were randomized into the study group and 45 patients to the control group. All patients had moderate clinical severity. Although fewer patients in the study group required mechanical ventilation in comparison to the controls (12 vs. 22), the difference was not significant (P = 0.13). The death rate was lower in the study group though the difference was not also significant (P = 0.17). Mean (SD) duration of mechanical ventilation in the study group was significantly lower than controls (4.1 (1.6) vs. 6.6 (1.7) days; P = 0.01). Mean dosage of atropine administered was significantly lower in the study group compared to controls (345.0 (90.6) vs. 933.1 (162.3) mg; P = 0.001). Furthermore, 15 controls (33.3%) developed intermediate syndrome whereas no patient (0%) in the study group had such complication, which showed a significant difference (P < 0.001).
    Conclusion
    A dose regimen of pralidoxime consisting of 2 g pralidoxime bolus followed by 8mg/kg/h infusion reduces morbidity and mortality in moderate cases of OP poisoning. The WHO dose regimen had significantly better outcomes compared to the standard dose regimen.
    Keywords: Cholinesterase Reactivators, Clinical Trial, Organophosphate Poisoning, Oximes, Pralidoxime Compounds
  • Yunes Panahi, Zohreh Poursaleh, Ali Amini, Harandi, Amin Saburi, Majid Shohrati, Mostafa Ghanei Pages 126-130
    Background
    Theophylline may reverse steroid resistance and decrease inflammation in patients with chronic pulmonary disease and sulfur mustard (SM) induced bronchiolitis. This study was designed to assess the effects of low-dose theophylline on improvement of pulmonary function tests (PFTs) of SM exposed patients.
    Methods
    In this comparative observational study, a group of SM-exposed victims during the Iraq-Iran war who were treated with oral slow releasing (SR) theophylline, salmetrol, fluxitide, omeprazole and NAC (study group) were compared to a group of age and gender matched SM-exposed patients who received same medications except oral SR theophylline (historical control group). PFTs were measured at the beginning of the study and after 8 weeks of the treatment.
    Results
    In total, 33 subjects in the study group and 27 subjects in the control group were studied. Mean (SD) age of all subjects was 51 (14.1) years. In the study group, on the 8th week post-treatment, PFTs decreased, though the differences of tests between before and after treatment were not significant. In the control group, all the tests decreased in the same period and these reductions were not also significant. However, the changes in PFTs were significantly different between the two groups. The results of most PFTs in the controls decreased in greater extents compared to theophylline treated patients. This shows that despite theophylline was unable to improve the patients; it was partially able to decelerate the reductions in PFTs.
    Conclusion
    Theophylline may not improve PFTs of SM exposed patients but it may decelerate the progress of the underlying respiratory disease. Further studies in this setting with higher doses of theophylline and longer term of evaluation are needed to better understand the pathophysiological mechanism of SM induced bronchiolitis and the effectiveness of the treatment with theophylline.
    Keywords: Bronchiolitis, Mustard gas, Spirometry, Steroids, Theophylline
  • Awatef Tahouri, Badiaa Lyoussi, Sanae Achour Pages 131-134
    Background
    Carbon monoxide (CO) poisoning has remained a common, serious and often unrecognized event and constitutes a public health problem in Morocco. The objective of this study is to describe the epidemiological and clinical profile and risk factors of CO poisoning in the region of Fez-Boulemane, Morocco.
    Methods
    This is a retrospective study on CO poisoning cases occurred in the region of Fez-Boulemane between January 2009 and December 2012. Data were retrieved from medical records of patients who were admitted to 7 referral hospitals in the study catchment area. The patient's clinical status was classified according to the Poisoning Severity Score. By comparing critical (grade 3 or 4) and non-critical (grade 1 or 2) cases, a univariate analysis was performed to identify the factors associated with life-threatening consequences.
    Results
    During the study period, 2332 cases were included. Most patients were women (68%). The mean (SD) age of patients was 26.4 (16.1) years. Most cases occurred during winter (45.1%). The source of poisoning was water heaters in majority of cases (53%). The most common manifestations were headache in 86%, nausea in 79%, dizziness in 76%, vomiting in 63% and dyspnea in 63% of cases. The majority of patients had grade 2 or grade 1 poisoning severity. Univariate analysis demonstrated that gender (P = 0.03) and the location of event (P = 0.005) had significant impacts on the prognosis while age did not have any influence on the severity of poisoning (P = 0.15). The impact of season of event on the prognosis approached the level of significance but its significance was questionable (P = 0.09).
    Conclusion
    This study showed that CO poisoning is common but probably underestimated in the region. Strengthening the role of the morocco poison control center in the region would be the most effective preventive measure to decrease morbidity and mortality secondary to CO poisoning.
    Keywords: Carbon monoxide poisoning, Epidemiology, Morocco, Risk factors, Prognosis
  • Seyed Seifollah Beladi Mousavi, Mehran Hossainzadeh, Abdullah Khanzadeh, Fatemeh Hayati, Marzieh Beladi Mousavi, Abbas Ali Zeraati, Azam Anvari Pages 136-138
    Background
    Nephrotoxicity is one of the major side-effects of cisplatin that has been seen in about 20% of treated patients. The aim of this study was to assess the effectiveness of a forced hydration protocol comprised of isotonic saline, potassium chloride (KCl) and magnesium sulfate (MgSO4) on prevention of cisplatin nephrotoxicity.
    Methods
    This cross sectional prospective study was performed on cancer patients treated in Shafa Hospital, Ahvaz, Iran from November 2009 to March 2010. The patients were under at least 50 mg/m2 cisplatin. All patients received 1000 mL isotonic saline plus 20 mEq of KCl and 2 g of MgSO4 during 2-3 hours before, and 500 mL of the same solution over the two hours after administration of cisplatin. The prescribed dose of the solution was to the extent facilitating a urine flow of at least 100 mL/h for two hours prior to chemotherapy and 2 hours post-chemotherapy. Cisplatin nephrotoxicity was defined as an increase in the SCr equal or over 0.5 mg/dL during the 5 day follow-up post-chemotherapy.
    Results
    A total of 76 patients (48 men and 28 women with mean (SD) age of 51.0 (17.6) years) were studied. Mean cumulative cisplatin dose was 86.7 (43.1) mg/m2. Hypokalemia and hypomagnesemia were not observed in any patient. Cisplatin nephrotoxicity (increase of creatinine) was developed in 5 patients (6.6%). The mean dose of cisplatin in patients with and without nephrotoxicity was 83 and 86.97 mg respectively which showed no significant difference between them (P = 0.8).
    Conclusion
    The new protocol was able to decrease the rate of cisplatin nephrotoxicity from about 20% to 6.6%. Further case control studies with larger sample sizes are recommended to evaluate the effectiveness of this protocol.
    Keywords: Cisplatin, Chemotherapy, Forced Fluid Therapy, Nephrotoxicity
  • Hamid Khosrojerdi, Mozhgan Amini Pages 140-142
    Background
    Overwhelming life experiences can trigger stress disorders including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The objective of this study was to investigate the frequency of and predictive factors for ASD and PTSD in snakebite victims.
    Methods
    In this study, snakebite victims who were admitted to Mashhad Medical Toxicology Centre, Imam Reza Hospital, Iran, from 1st November 2010 to 30th April 2012 were enrolled. Psychiatric symptoms of patients were evaluated after stabilization of patients’ clinical condition. Structured Clinical Interview for DSM-IV Axis I Disorder questionnaire was used for interviewing the patients. Patients underwent 4 scheduled psychiatric interviews on admission, 3 weeks post-bite, 6 weeks post-bite and 6 months post-bite.
    Results
    Fifty-three patients (74% men) were included in the study with mean (SD) age of 33.6 (15.0) years. Patients were given psychological consultations during the study while they received no psychiatric medication. The set of efforts to avoid activities, places, or people that arouse recollections of the trauma was the most common symptom found in all visits. Re-experience was the most common class of symptoms in all visits. On admission and the 3rd week post-bite, 36% and 15% of patients had ASD. Moreover, 8% of patients developed PTSD and only 4% of patients developed chronic PTSD. ASD on admission (P < 0.001), ASD in 3rd week (P = 0.02) and PTSD (P = 0.01) were developed in patients with significantly younger ages. In addition, the presence of ASD on admission (P < 0.001), ASD in 3rd week (P = 0.003) and PTSD (P = 0.003) was significantly higher in female gender.
    Conclusion
    Snakebite is not only an emergency medical problem, but also is a traumatic event that can cause stress disorders. It is prudent to refer all snakebite victims, especially women in younger ages, to psychiatric specialist for better evaluation and psychological treatments.
    Keywords: Acute Stress Disorder, Iran, Post, Traumatic Stress Disorder, Psychiatry, Snake Bite
  • Moch Sahri, Noeroel Widajati Pages 145-149
    Background
    Toluene is a harmful substance still being used as a solvent and catalyst in many industries that can increase the level of urinary hippuric acid (UHA). This study was designed to examine the level of toluene and UHA among workers of industrial site in seven companies in Sidoarjo, Indonesia and to analyze the risk factors for abnormal UHA.
    Methods
    This study was an analytical cross-sectional study conducted during August to September 2008. The locations were selected based on the fact that toluene was utilized in the production process of these companies. Urinary hippuric acid was analyzed with screen spectrophotometer 3000 on obtained urine samples from workers. Urinary hippuric acid of higher than 1.6 g/g creatinine was considered as abnormal. Workers’ characteristics were collected via questionnaires completed by the workers. Toluene in workplace air was obtained with the reagent tube and the samples were analyzed using gas chromatography.
    Results
    In total, 96 subjects were studied. Workers examined in this study suffered from watery eyes, shortness of breath, cough, runny nose, fatigue, and skin irritation. Urinary hippuric acid level was normal in 91 workers (95%). Five subjects had abnormal levels of urinary hippuric acid. Levels of toluene in workplace air at all companies were below the ratified governmental regulatory threshold value (< 50 ppm) with the maximum level of 28.1 ppm. Abnormal HPA was higher in workers with older ages, lower educational attainments and not using the personal protective equipment (PPE).
    Conclusion
    Toluene concentration in the air of the ink, paint and printing companies in Sidoarjo, Indonesia was within ratified limit. Workers with older ages, lower educational attainment and not using the PPEs are probably more vulnerable to toluene toxicity.
    Keywords: Hippuric Acid, Indonesia, Occupational exposure, Toluene
  • Ahmadshah Farhat, Ashraf Mohammadzadeh, Mahdi Balali, Mood, Morteza Aghajanpoor, Yalda Ravanshad Pages 150-152
    Background
    It has been shown that there is a partial correlation between blood lead level (BLL) of infants and their mothers. This study was designed to evaluate the BLL of exclusively breast-fed infants less than 6 months of age and their mothers.
    Methods
    This was a cross-sectional study on infants below 6 months of age and their mothers who were referred to Mashhad Imam Reza Hospital, Iran. BLL was determined by atomic absorption spectroscopy method. Demographic features and economic status of the subjects were also collected.
    Results
    Sixty infants and their mothers in total were studied and 76.7% of the infants were boy. Mean (SD) age of children was 24.6 (31.8) days. Economic status of 16.7% of subjects was evaluated to be "poor", 38.3% "middle" and 45% "good". All of the mothers were housewives. Most subjects (88.3%) were living in the urban areas, and the remainder (11.7%) in rural areas. Mean (SD) of mothers’ BLL was 75.9 (31.1) mg/L. Mean (SD) of BLL in infants was 63.6 (26.8) mg/L. In 8 mothers (13.3%) and 4 infants (6.7%) BLL was higher than 100 mg/L. There was a significant relationship between BLL of infants and mothers (P < 0.001, r = 0.64). No significant correlation between maternal BLL and infants’ age, infant birth weight and current infant weight was established. Mean BLL in male infants was 73.4 (25.4) mg/L and in female infants was 84.8 (45.3) mg/L which was not significantly different from each other. The relationship between economic status and infants’ BLL was close to the level of significance (P = 0.08). Mean BLL in infants living in urban areas was 65.2 (27.1) mg/L, while in infants living in rural areas was 51.9 (23.3) mg/L; nonetheless, it was not significantly different between them (P = 0.22).
    Conclusion
    There was a direct relationship between BLL in exclusively breastfed infants and their mothers. This may ascertain that lead can be excreted to the breast milk. Also, it may also suggest that both mothers and children were exposed to same level of air lead pollution.
    Keywords: Atomic Absorption Spectrophotometry, Exclusive breastfeeding, Infants, Lead, Mothers
  • Timothy J. Wiegand, Rachel M. Gorodetsky, Tamas R. Peredy Pages 153-156
    Background
    Skin lesions and blistering in the overdose patient, most notably associated with barbiturate overdoses, are commonly referred to as coma blisters, ‘barb blisters’, or ‘barb burns’. We present a patient who was noted to have skin lesions including bullae and blistering following a prolonged coma after quetiapine overdose. Case report: A 27 year old male presented to our institution with the history of having ingested 7,200 mg of quetiapine in a suicide attempt up to 35 hours prior to being discovered. The patient was found comatose, and was noted to have multiple vesicles on his right ankle and a firm, erythematous plaque and bullae on his right thigh.
    Discussion
    Sequelae related to prolonged immobility of any cause may include injury to muscle, vascular, microvascular and cutaneous structures. Coma blisters differ from pressure ulcers in many ways and cannot be graded using the typical staging system. Histopathologic analysis suggests an array of microvascular injuries which are secondary to direct pressure injury as well as specific drug effect.
    Conclusion
    This is the first description of a dermatologic manifestation attributed to coma from isolated quetiapine overdose. Blister formation can be considered as a possible complication of quetiapine overdose.
    Keywords: Blister, Coma, Quetiapine, Overdose
  • Mukta Rani, Mahesh Chand Meena Pages 157-159
    Background
    Boric acid (BA) is commonly used as pesticide, disinfectant and wood preservative. Its ingestion can cause serious organ damages resulting in death. Case report: A 19 year old man was found dead with two empty packs of BA tablets in vicinity of his body. On autopsy examination, brownish stains along with right angle of mouth and right nostril were found. Stomach was damaged with hemorrhagic gastritis. All internal organs including liver, kidney, spleen and brain were congested. The toxicological analysis of viscera confirmed boron ion toxicity.
    Discussion
    Boric acid is a moderately toxic compound that is a mucosal corrosive agent affecting upper respiratory and gastrointestinal tracts. It can also act as a generalized cellular poison, and thus all end organs including liver, kidneys, brain and gastrointestinal tract are prone to its toxicity. Massive BA poisoning mostly occurs in adults as a result of suicide attempt. Early aggressive hydration and hemodialysis can prevent its mortality.
    Conclusion
    A dead body with erythematous rash, redness of skin, bluish green color of vomitus and fecal matter, corrosive changes in oral and nasal cavity and multiple organ damages can be highly suggestive of BA poisoning.
    Keywords: Boric Acids, Boron toxicity, Gastritis, Multiple Organ Failure, Suicide
  • Jinwoo Jeong Page 161