Asia Pacific Journal of Medical Toxicology
Volume:3 Issue: 4, Autumn 2014

Evaluation of scientists working in a specific area of science is necessary, as they may strive for same limited resources, grants and academic promotions. One of the most common and accepted methods of assessing the performance and impact of a scientist is calculating the number of citations for their publications. However, such method suffer from certain shortcomings. It has become more and more obvious that evaluation of scientists should be qualitative in addition to quantitative. Moreover, the evaluation process should be pragmatic and reflective of the priorities of an institution, a country or an intended population. In this context, a scoring scale called «360-degree researcher evaluation score» is proposed in this paper. Accordingly, scientists are evaluated in 5 independent domains including (I) science development, (II) economic impact, (III) policy impact, (IV) societal impact and (V) stewardship of research. This scale is designed for evaluation of impacts resulted from research activities and thus it excludes the educational programs done by a scientist. In general, it seems necessary that the evaluation process of a scientist’s impact moves from only scintometric indices to a combination of quantitative and qualitative indices.

Poisoning with paraquat (PQ) is highly fatal. In this study; demographic and clinical characteristics of a series of patients with acute PQ poisoning treated at two university hospitals in Shiraz, Iran are presented and predictive factors for mortality are analyzed. This was an analytical cross-sectional study on consecutive PQ poisoned patients admitted to Shoushtari and Ali Asghar hospitals in Shiraz, Iran during 21st March 2012 to 20th March 2013. To find out predictive factors for mortality, independent variables were compared between death and survival using Fisher’s exact test. To determine the factors that had the strongest impact on mortality, logistic regression analysis was done. Fifty-two patients (73.1% men) were included with mean age of 28.2 ± 10.3 years. The most common clinical findings were nausea and vomiting (88.5%), pharyngeal congestion (82.7%), epigastric pain (80.8%), increased creatinine (57.7%), increased liver enzymes (53.8%) and metabolic acidosis (53.8%). The volume of poison ingested was significantly higher in deceased compared to survived patients (P < 0.001). Death was significantly higher in patients with pharyngeal congestion (P = 0.001), respiratory distress (P < 0.001), loss of consciousness (P = 0.025), increased creatinine (P < 0.001), increased liver enzymes (P < 0.001), metabolic acidosis (P < 0.001), increased bilirubin (P < 0.001), respiratory acidosis (P = 0.001), increased INR (P = 0.023), suicidal intention (P < 0.001), and oral exposure (P = 0.047). After putting these factors to logistic regression model, only respiratory distress, increased bilirubin, increased liver enzymes and increased creatinine continued to be significantly associated with mortality. Conlcusion: PQ poisoning is associated with high mortality requiring an immediate assessment of patients and prediction of prognosis. Renal and hepatic failure in addition to respiratory distress can be the strongest risk factors for poor prognosis in acute PQ poisoning.

Gastric lavage (GL) is one of the most commonly used decontamination method for cholinergic insecticide ingestion in developing countries despite lack of supporting evidence. This study was designed to evaluate the outcome of patients with cholinergic insecticide poisoning treated with GL in regards to timing and frequency of the procedure.

In this prospective observational cohort study, GL was planned to be administered to patients with cholinergic insecticide poisoning after initial stabilization irrespective of lavage given in peripheral hospitals. Therefore, some patients received one procedure (single GL) and some received more than one procedure (multiple GL). Early GL was defined as GL given within one hour of poison exposure and late GL was referred to performing the procedure after one hour.

During the study period, 238 patients with cholinergic insecticide poisoning received GL comprising of 93 who received early, 145 who received late, 127 who received single and 111 who received multiple GL. Seventy-six GL treated patients (31.9%) died. Mortality, early RF and duration of assisted ventilation were not significantly different between patients receiving early and late, or single and multiple GL. Patients receiving multiple GL compared to those who received single GL developed late RF (9.0% vs. 20.5%, P = 0.01) and IMS (9.9% vs. 23.6%, P = 0.005) in significantly lesser extents. In multiple logistic regression analysis, effect of multiple GL on IMS and late RF remained significant (P = 0.04).

Number or timing of GL does not show any association with mortality while multiple GL had protective effect against development of late RF and IMS. Hence, GL might be beneficial in cholinergic insecticide poisoning.

The pattern of poisoning has a regional variability. This study was carried out to describe the epidemiological profile of acute poisoning in northeastern Bangladesh and to evaluate the mortality. In this retrospective cross-sectional study, medical records of poisoned patients treated at department of medicine of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh during 1st January 2008 to 31st December 2011 were reviewed. Patients aged 10 years and above with diagnosis of acute poisoning were included. Data collected were gender, age, place of residence, type of poison and intention of poisoning. A total of 4435 (58.7% men) were included. Patients aged 21 to 30 years were the most common age group involved with poisoning (41.6%). The majority of patients (55.4%) lived in rural areas. Commuter poisoning (43.3%) was the most frequently occurring type of poisoning in both men and women in all 4 years followed by OP poisoning (25.7%). Men were found to be significantly more affected in commuter, organophosphate and alcohol poisoning (P < 0.001). Intention of poisoning in the greatest number of patients (54.5%) was suicidal followed by 1919 patients (43.3%) who were poisoned by homicidal/stupefying intents. Among the homicidal cases, men were significantly more victimized (67% vs. 33%, P < 0.001). Overall, 224 patients (5.1%) died. The highest number of deaths was due to OP poisoning (46.9%) followed by commuter poisoning (45.5%). Case fatality rate was the highest in the snakebite victims (23.3%) followed by alcohol poisoning (11.4%). Commuter or travel-related poisoning is an emerging public health threat in this part of Bangladesh. Public awareness should be raised and school-based educational programs should be emphasized regarding the commuter poisoning and the consequence of accepting and eating food from strangers.

Tobacco use has toxic effects on different organs. This study was carried out to assess the effect of indigenous tobacco both in smoking (bidi) and smokeless (gutkha, zarda and khaini) forms on buccal cells at chromosomal level, through assessment of different nuclear anomalies as biomarker. This study was done on people living in Durgapur and its adjacent areas, West Bengal, India during January to July 2011. The samples were collected from 50 smokers (case group), 50 smokeless tobacco consumers or chewers (case group) and 50 non-tobacco consumers (control group). Micronucleus assay was used to assess buccal cell nuclear changes. Buccal smears collected from study subjects were prepared on a grease free slide. Prepared slides were observed under light microscope and 2 to 5 fields were observed randomly for counting the different anomalies. In each field, the frequency of each anomaly was assessed in 100 cells and reported with percentage. Chewers had significantly the highest frequency of all nuclear anomalies compared to smokers and healthy controls (HCs). Smokers also had significantly more anomalies compared to HCs. Condensed chromatin (CC), karyolysis (KL) and bi-nucleation (BN) in chewers and CC, pyknosis and BN in smokers were the most frequent anomalies. KL was significantly more frequent in chewers compared to smokers (59.8 ± 6.4 vs. 24.2 ± 12.4%, P < 0.001), however, the frequency of other nuclear anomalies were not significantly different in these two study groups. Presence of each nuclear anomaly was significantly greater in older ages in all study groups. Tobacco can cause and increase the rate of nuclear anomalies in both smoking and smokeless forms compared to HCs. The genotoxic effects of tobacco on buccal cells are partly age-related. Cell nuclear anomalies in buccal tissue can be used as biomarker indicating the detrimental effects of tobacco.

Ecstasy, mainly composed of 3,4-methylenedioxymethamphetamine (MDMA), is one of the most popular addictive synthetic drugs. This study was aimed to investigate the amount of MDMA in the ecstasy tablets seized in West Azerbaijan province, northwest Iran and also to assess the relationship between the physicochemical and morphological characteristics of the tablets. MDMA content of ecstasy tablets was analyzed using high-performance liquid chromatography method. Flow rate was 3 mL/min and mobile phase consisted of a mixture of acetonitrile and water containing triethylamine (pH = 3.2). The fluorescence spectrophotometer detector set at an excitation and emission wavelength of 220 and 306 nm, respectively. The retention time of ecstasy on this system was 2.2 minutes. The calibration curve was linear (R2= 0.999) over the concentrations ranging from 0.2 to 2 µg/ml. The limit of detection and the limit of quantitation were found to be 0.06 µg/L and 0.19 µg/L, respectively with six times repetition. In this study, 85 ecstasy tablets were analyzed. Mean weight of the tablets was 275.6 ± 70.4 (range: 158.5-403.3) mg. Mean MDMA content of the tablets was 30.53 ± 23.23 (range: 0.05-70.7) mg. The tablets were classified into 8 groups based on their morphological features (color and logo). Considering the tablet groups, physicochemical features of the tablets (weight, MDMA content, and MDMA to weight ratio) were significantly different (P < 0.001). Correlation analysis showed that the MDMA content and weight of tablets were significantly correlated (P = 0.04). There is variability in the physicochemical properties of ecstasy tablets available in the black market for illicit drugs in northwest Iran. This variability may potentially put abusers at increased risk of overdose due to inadvertent excess ingestion of the tablets to achieve desired effects and also experiencing more harm due to tablets adulterants.

Cardiac toxicity is one of the life-threatening effects of severe organophosphate (OP) poisoning. We presented a patient with severe OP poisoning, in cardiovascular shock poorly responsive to conventional treatments, who could be resuscitated successfully with intravenous lipid emulsion (ILE) therapy. Case report: A 26-year-old female was admitted to our emergency department who had ingested unquantifiable amount of parathion. On admission, she was tachycardic, tachypneic and hypotensive with pin-point pupils. Neurological examination revealed Glasgow coma scale (GCS) of 6. Immediately, she was admitted to intensive care unit, and was intubated and put under mechanical ventilation. Standard treatments including atropine and pralidoxime (according to WHO protocol) were given to the patient. However, the patient did not show favorable response to antidotes and supportive treatments and her condition continued to deteriorate. Because of bradycardia and hypotension, she was given noradrenaline vasopressor support. Due to failure of treatments in improvement of the patient''s condition, a single 100 mL bolus (1.5 mL/kg) of 20% intralipid was administered intravenously and the same dose repeated 2 minutes later. Over 15 minutes, cardiovascular condition of the patient noticeably improved. ILE was continued up to a total dose of 300 mL when extrasystoles disappeared. The patient could be extubated from ventilator with GCS score of 15 on the 5th day of admission. OPs are lipid soluble and ILE can move these kinds of compounds away from the site of toxicity and dissolve them in the plasma which will alleviate their toxic effects. This is the first human case report of OP poisoning which showed efficacy of intralipids as antidotal therapy outside the accepted setting of local anesthetic toxicity.

Closantel is a veterinary drug used as anthelmintic for ruminants while it is contraindicated for humans. This report describes a rare case of blindness, increased liver enzymes and coagulopathy following closantel poisoning. Case report: A 5-year-old girl was presented with acute blindness following closantel poisoning. She was given mistakenly a dose of 500 mg/day (25mg/kg/day) for 8 days. Clinical examination revealed a well-appearing child with bilateral mydriasis, loss of pupillary light reflex and absence of blinking to threat. Fundoscopic exam revealed bilateral pre-atrophic papilledema. Electroretinogram showed a highly significant decrease in retinal activity. Laboratory examinations revealed 52% increase in prothrombin time, prolongation of activated partial thromboplastin time to 1.3 times the normal and rise of aspartate aminotransferase to 120 IU/L. In addition, creatine kinase peaked at 904 IU/L. Moreover, normocytic normochromic anemia with hemoglobin at 10.7 mg/L and leukocytosis with lymphocytic predominance was noted. The patient received glucocorticoids, vitamin B12 and vitamin K and was discharged after correction of blood and coagulation parameters and normalization of liver enzymes. Partial recovery in visual acuity was found two months after ingestion of the last dose. Closantel can cause significant spongiform change (intra-myelin vacuolation) in the white matter of the cerebrum and the cerebellum. It can also induce optic nerve damage as a result of Wallerian degeneration, fibrosis and atrophy. On the retina, closantel leads to papilledema, necrosis of the outer layers, and retinal detachment. It can also cause fatty change and hydropic degeneration in the liver and hepatocellular degeneration. Closantel is a toxic drug for humans causing blindness, hematologic and hepatic disorders. Public awareness should be raised regarding the risks of use of unapproved drugs for human.