فهرست مطالب

Asia Pacific Journal of Medical Toxicology - Volume:6 Issue: 2, Spring 2017

Asia Pacific Journal of Medical Toxicology
Volume:6 Issue: 2, Spring 2017

  • تاریخ انتشار: 1396/03/22
  • تعداد عناوین: 7
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  • Angela Randall, Jane A. Buxton, Reza Afshari * Pages 38-41
    Background
    The prevalence of reported allergic diseases is higher in North-America than in other countries around the world. Further, certain types of allergies are more common in some geographic regions or amongst different ethnic populations. This phenomenon has not been well studied amongst the Persian population in the Canadian context; therefore, the current study aimed to compare the prevalence of perceived and diagnosed non-food and food allergies, and food intolerance between Canadians of Persian descent (CPD) and Canadians of European descent (CED), within a sample population of British Columbia residents, their family members and close friends.
    Methods
    Participants were recruited via convenience and snowball sampling, and information about allergy history was collected through in-person and telephone interviews. The prevalence of perceived and diagnosed allergies and food intolerances were compared between CPD and CED. In total, data was reported about 4,404 individuals.
    Results
    The prevalence of all perceived allergies was significantly higher amongst CED compared to CPD [RR (95%CI) = 2.33 (1.6, 3.3)]. A similar pattern was observed for diagnosed food and nut allergy. As well, no cases of perceived or diagnosed food intolerance were reported amongst Persians in the study population.
    Conclusion
    In conclusion, these findings have clinical implications for the treatment and prevention of allergies and food intolerance in BC and Canada. The disproportionate effect of allergies and food intolerance on Canadians of European descent warrants the implementation of targeted public health prevention measures. The genitival and environmental reasons for lack of food intolerance in Canadians of Persian descent should also be investigated.
    Keywords: Allergy, Food, Intolerance, Non-Food, Nut
  • Marjan Emzhik, Danial Zarif, Shahrad Tajoddini, Amir Baniasad, Bita Dadpour * Pages 42-46
    Background
    Methadone maintenance therapy (MMT) is considered as an efficient and effective treatment in management of high risk opioids addiction; although, concomitant use of other drugs may interfere with treatment course and outcome in MMT cases. This study aimed at evaluating patterns of drug use along with methadone based on self reported and urine analysis data in two MMT clinics.
    Methods
    135 patients on MMT recruited for this cross-sectional study which was conducted from March to September 2014. Data were obtained of MMT clinic of Imam Reza (p) hospital, Mashhad, Iran. After completing a written informed consent, a questionnaire including demographic information, duration of MMT, methadone dose, concomitant medication and other related information was fulfilled. Data were analyzed by SPSS software version 16.
    Results
    Mean (SD) age of patients was 42.8 (12.2). All patients were taking medication along with methadone. The most prevalent drug classes were antidepressants (32%) and benzodiazepines (BNZD) (25%). The next three drug groups were analgesics, GI and cardiovascular drugs respectively. Antidepressant and benzodiazepine use was more prevalent in patients who were on MMT for at least 7 months compared with shorter courses. Antidepressant use was more common in patients on maximum dose of 30 mg/day methadone while BNZD use was more frequent in patients on doses higher than 30 mg/d.
    Conclusion
    Psychiatric drug use is common in opioid addicted cases. BNZD and antidepressant drugs were two most consumed drugs in cases on MMT based on our study. Psychiatric drug consumption was more common in patients on higher length of methadone use. Dosage of methadone may affect kind of concomitant drug use. Physicians should be aware of interactions between psychiatric medications and opioids.
    Keywords: Concomitant Drug Use, Opioid, Psychotropic Drugs, MMT
  • Ariful Basher *, M. Abul Faiz, Syed M. Arif, Mak Khandaker, Ulrich Kuch, Sw Toennes Pages 47-49
    Introduction
    Drug-facilitated robberies, primarily of public transport passengers, are a massively increasing public health emergency and law enforcement challenge in Dhaka, the capital city of Bangladesh.
    Methods
    We conducted a prospective clinical and toxicological study of 38 patients with acute poisoning who had been admitted to Dhaka Medical College Hospital between October 2008 and December 2008 and suspected to be victims of drug-facilitated crimes. Blood samples were obtained on admission and one hour later to identify changing concentrations of the drugs used by the perpetrators. Toxicological screening was performed by LC-TOF/MS and LC-MS/MS analysis of the blood samples of 22 of these patients.
    Results
    All of the patients in our series were male, 17-60 years of age, and none had any memory of the time between the ingestion of the drug and the onset of unconsciousness. All had lost the valuables they had been carrying at the time of the incident. On admission, 50% of the patients had a Glasgow Coma Score (GCS) of 5-10. Most of them were poisoned while travelling (79%), most frequently by bus (70%). They had been offered tea (21%), other drinks (26%), prickles (18%), herbal medicines (10%) or cigarettes (5%) by the suspected perpetrators. Screening by LC-TOF/MS and LC-MS/MS revealed pharmacologically active concentrations of lorazepam in the blood samples of all 22 cases (191±138 µg/l, mean±SD); midazolam in 12 (149±99 µg/l); diazepam in 3 (217±144 µg/l) and nordiazepam in 6 cases (364±186 µg/l). In five cases the lorazepam concentration of the second blood sample was at least 15% higher than in the sample drawn on admission one hour earlier, indicating continuing absorption. This suggests that only these five patients had been admitted within the 1-2 hour long absorption phase. Almost all of the patients left the hospital unnoticed after clearing up, two likely prematurely within 12 hours of admission, and no mortality was observed.
    Conclusions
    This study reveals flexibility of the criminals in Dhaka in using different mixtures of benzodiazepines to incapacitate and then rob their victims.The findings of our study have important implications for the clinical management of drug-facilitated crime victims. In particular, they highlight an urgent need to widely deploy rapid diagnostic and analytical forensic and clinical toxicology facilities in Bangladesh, introduce and implement modifications to emergency department protocols, and provide post-recovery psychological support for victims who often suffer existentially threatening economic losses in addition to the poisoning.
    Keywords: Benzodiazepine, Commuters, Poisonings
  • Abuzar Durrani, Osamah Shahid, Asadullah Sabir, Muneeba Faisal * Pages 50-54
    Background
    The choice of poisoning agent depends on a number of factors like the geographic area, socioeconomic status, educational status and easy availability of a specific kind of poison. Thereby, the sound knowledge of the type and clinical picture of the poison is very important for its proper diagnosis and prompt treatment on emergency basis. To assess the types of poisoning agents used by patients admitted to Medical Department of Holy Family Hospital, Rawalpindi.
    Methods
    This is a descriptive cross-sectional study which was done on 285 patients who were admitted to Medical Department of Holy Family Hospital, Rawalpindi with history of poison ingestion from 1st January 2011 to 31st December 2015. Data was collected retrospectively and variables such as age, gender, year of reporting to hospital, residence, and type of poison were entered on a predesigned Performa. Data was analyzed by using Statistical Package for Social Sciences (SPSS) version 23.
    Results
    The study showed that organophosphate compounds are the most frequent cause of poisoning (40.4%), followed by corrosives (15.8%) and wheat pill (14%). 67.7% of the population belonged to younger age group (11 to 30 years) while 52.6% of the population admitted consisted of males.
    Conclusion
    Organophosphate poisoning is the most frequently used poisoning type and their use is largest in the younger population. The situation can be improved by decreasing the chances of occupational exposure, addressing the reasons of self-poisoning, and improving the training of medical and paramedical staff in poisoning management at the primary, secondary and tertiary levels of hospitals.
    Keywords: Epidemiology, Organophosphate, Pakistan, Poisoning
  • Saeed Afzali *, Saadat Torabian, Seyed Kazem Taheri Pages 55-58
    Background
    Raw opium is a kind of drug, abused a lot in Iran. In a vast majority of cases, various impurities including lead are added to raw opium. This study aimed to evaluate Blood Lead Level (BLL) and probable clinical symptoms triggered by it among opium abusers.
    Methods
    This study was case control and conducted on 40 patients addicted to raw opium (case group) and 40 patients without any kind of addiction (control group) who were hospitalized in the poisoning ward of Farshchian hospital, Hamadan, Iran. BLL was measured by Atomic Absorption Spectroscopy (AAS) and compared between the two groups. Para clinical tests and peripheral blood smear were also assessed to check basophilic erythrocytes.
    Results
    The patients’ mean age was 51.9±15.8 years in the control group and 53.2±15 years in the case group. Besides, the mean of BLL was 4.02±3.16 µg/dl in the control group and 22.41±21.14 µg/dl in the case group, and the difference was statistically significant (p
    Conclusion
    With regard to the high BLL in raw opium abuser, it seems that poisoning with lead should be considered if patients with a history of raw opium addiction refer to physicians.
    Keywords: Addiction, Blood Lead level, Opium
  • Thunyaporn Tangtrongchitr, Nat Krairojananan, Kitisak Sanprasert * Pages 59-61
    Background
    Jatropha curcas,commonly known as “Saboo Dum,” is the most common plant poisoning in Thailand. Saboo Dum seeds are used as raw material for biodiesel fuel manufacture, especially in Royal Thai Military units. The seed contains a toxin called curcin which can cause hepatotoxicity in humans.
    Case Presentation
    We reported twenty-eight private soldiers who were brought to the emergency department with gastrointestinal symptoms after having been ingested Saboo Dum. Four patients had mild elevated liver function test (56.25±7.38). In our case series, gastrointestinal symptoms were predominant symptoms (nausea and vomiting 96.4%, diarrhea 78.6% and abdominal pain 50%). All patients discharged from hospital without any complications.
    Discussion
    Curcin can cause hepatotoxicity similar to ricin but less potent than ricin which may explain the clinical manifestations in our patients.
    Conclusion
    As the lack of awareness of Saboo Dum poisoning is the major cause of intoxication, knowledge of this seed may play an important role in the reduced incidence of curcin poisoning.
    Keywords: Jatropha Curcas, Saboo Dum, Thailand
  • Rathnayaka Mudiyanselage Mithun Kaushika Namal Rathnayaka *, Panwilahene Ellawatte Anusha Nishanthi Ranathunga Pages 62-65
    Background
    Ethylene glycol is a toxic alcohol which is used in brake fluid, antifreeze, coolants, preservatives and chemical solvents. Ethylene glycol poisoning usually results in depression of the central nervous system, renal insufficiency and cardiopulmonary compromise, while laboratory findings include metabolic acidosis, increased anion gap, increased osmolar gap and calcium oxalate crystalluria.
    Case Presentation
    A 24-year-old previously healthy person died 13 days after self-ingestion of brake fluid (ethylene glycol). He developed multi-organ failure including acute kidney injury, metabolic acidosis, respiratory failure, myocardial infarction, low Glasgow coma scale, and elevation of liver enzymes. He also developed hypotension for which 3 inotropes were started. He had ST elevation myocardial infarction (STEMI) on day 4 of the poisoning associated with a reduction of ejection fraction of up to 25% with septal anterior wall hypokinesia. He needed intensive care treatment via ventilator and inotropic support. Five cycles of hemodialysis were carried out for acute kidney injury. His autopsy examination revealed sub-endocardial hemorrhages.
    Discussion
    Acute kidney injury and metabolic acidosis are frequently seen following ethylene glycol poisoning from brake fluid ingestion. The cardiotoxic effect of its poisoning could be due to multiple microcalcifications of the myocardium. This clinical report highlights the severity and the sequence of events following ethylene glycol poisoning.
    Conclusion
    STEMI may result following ethylene glycol poisoning in addition to other cardiac effects such as hypotension, tachycardia, myocarditis and ischemic changes in ECG.
    Keywords: Acute Kidney Injury, Brake Fluid, Ethylene glycol, Metabolic acidosis, Myocardial Infarction