Asia Pacific Journal of Medical Toxicology
Volume:8 Issue: 1, Winter 2019

Dental amalgam has been the subject of several studies mainly on the emission of mercury vapor during its handling. The World Health Organization considers that the inhalation of mercury vapor can have adverse effects on the digestive, nervous, immune, pulmonary and renal levels. The aim of this study was to evaluate current practices in the management of dental amalgam waste produced at the level of dental practices in the cities of Rabat and Kenitra in Morocco. A questionnaire has been established to assess the situation of mercury waste management in dental practices and to make these physicians aware of the importance of this management. This study was conducted for a period of three months from April 15 through July 15, 2017. Of the 172 questionnaires submitted to the dentists, 50 completed and usable questionnaires were retrieved. The response rate was 29%. The survey revealed that 68% (17) stated that their dental chair was not equipped with an amalgam separator, the spittoon being connected directly to the sewers. The average amount of dental amalgam used per dental office and per month was 5.6±17.33g. Among the dentists interviewed, 96% had no idea of ​​the Minamata convention. 54% (27) still use dental amalgam. Of these, 42% (21) still throw this waste into public garbage cans. Dentists share the overall responsibility for the reduction and elimination of toxic waste that can harm human health and the environment.

Glasgow coma scale (GCS) was originally designed to be used in standardizing the assessment of conscious level in head trauma patients. However, GCS is now widely used in emergency departments as an indicator of the CNS status in patients regardless of their primary etiology. Alongside with GCS, AVPU scale (an acronym from “alert, verbal, painful and unresponsive”) is a simpler system which can be used to measure and record a patient’s level of consciousness. Therefore, the study investigated the values of admission GCS and AVPU as outcome predictor in mixed poisoned patients. A retrospective study in toxicology unit was performed on patients presented with mixed poisoning. Outcomes were recorded as patient necessity of GI decontamination, length of neurology observation and the length of hospital stay in toxicology unit. There was longer duration of hospital stay in toxicology unit and requirement of neurology observation in patients presented with lower GCS score (whether using cut-off point at 13 or 8). Similar findings were observed in AVPU scale analysis. Majority of patients did not require GI decontamination in both GCS score and AVPU analysis. However, it did not show any statistical significance (P > 0.05) in both group analyses. Admission GCS score and AVPU scale both are not good indicators to predict severity in acute mixed poisoning patients. However, the use of AVPU scale may not be inferior to the use of GCS score in assessing acute poisoning patients.

Medications nowadays have been commonly used items in the world and are sometimes available without prescription. This causes a range of effects on public health. This study evaluated the frequency and the involved factors of uncontrolled prescription drugs consumption. The present study is a cross-sectional study on 1,000 citizens of Tehran between 2016 and 2017. The various factors such as age, gender, and educational background have been carefully surveyed. The questionnaires were presented to interested people in printed form. For analyzing the data, descriptive statistics and analytical statistics were performed using SPSS software version 19. 67% of participants use OTC drugs and 34% of them were between 20 and 30 years old. Although 12% of the OTC pills were used regularly as a pain killer, 95% of the people did not know anything about the side effects of the drugs. Moreover, 45% used the pill to relieve the common and acute pain and 34% of people lived in poverty and 12% suggested lack of adequate time as a reason to refuse visiting a doctor. Self-administered drug is one of the problems in the medical field. Headache is the main reason of self-medication. In the other hand, drug resistance is also rising among repeated drug users. According to the results, public education, the prohibition of the sale of some high-risk drugs and the reduction of drug doses are ways to prevent the development of such high-risk habits.

Organophosphates (OPs) are regularly utilized as pesticides all over the world. Exposures to OPs cause countless cases of poisoning and death annually. Organophosphates inebriation generates a range of muscarinic, nicotinic, and cholinergic side effects including both central and peripheral nervous systems. OP compound’s simple accessibility is responsible for expanding rates of pesticide poisoning and the fact that it is a noteworthy reason for morbidity and mortality that presents general medical issues in a growing district. I performed a review of the published literature. The databases Medline, Embase, Scopus and Google Scholar were searched using the terms intermediate syndrome, organophosphate induces intermediate syndrome and organophosphate poisoning. Databases were merged and a duplicate was removed. In intense organophosphate poisoning, serious and delayed acetylcholinesterase restraint comes with oxidative stress, identified in erythrocyte membranes, that takes place in the initial phases of poisoning and may add to the progress and seriousness of intermediate syndrome (IMS). It normally appears 2-4 days after presentation when the side effects and indications of the intense cholinergic disorder (e.g., muscle fasciculations, muscarinic signs) are not evident anymore. However, IMS has been considered as a noteworthy causative factor of organophosphate-related morbidity and mortality due to its incessant presence and potential occurrence of breathing malfunction. The aim of the article is to bring down the clear idea about the IMS.

One of the side effects of tramadol is seizure. Tramadol is a synthetic analgesic used to treat mild to moderate pain. Tramadol can cause seizures in the range of treatment and toxic doses. This seizure is usually in a generalized tonic-clonic from and usually occurs in the first 24 hours after ingestion. The patient was a 32-year-old man referring to the emergency department with a right shoulder joint dislocation. It was reported that after a tonic-clonic seizure for about 1 minute, it has been followed by foaming at the mouth, eye lifting, urinary incontinence and loss of consciousness for about 5 minutes. He used a combination substance of sildenafil and tramadol to treat an early ejaculation. The patient has referred to the hospital 5 times with shoulder dislocation, without providing a detailed explanation about the use of tramadol and subsequent seizures Tramadol misuse and overdose is a common medical issue in Iran and around the world. Regarding the arbitrary use of tramadol in Iran, especially through the non-scientific prescriptions by apothecaries in some cases such as early ejaculation treatment, attention to patient records along with the cause of referral is essential. Considering the prevalence of tramadol use, the community of physicians is advised to think of tramadol as a common cause for shoulder dislocation.

Aluminum phosphideis a commonly used as a pesticide in Egypt and other agricultural countries to protect grains from pests. Phosphine gas (PH3) is a highly toxic gas, which is released when the tablet is exposed to humidity, causing cardiogenic shock and severe metabolic acidosis. A 22-year-old female patient with history of ingestion of 1 tablet of Aluminum phosphide presented with recurrent vomiting, severe hypotension and metabolic acidosis. Although Aluminum phosphide is considered a highly toxic substance and its rate of death is very high, this case survived even after development of severe toxic manifestations like hypotension and severe metabolic acidosis. Aluminium Phosphide is a highly effective insecticide and rodenticide. However, it is highly toxic with high mortality rate if ingested. It produces severe metabolic acidosis and cardiogenic shock with no available antidote, so management may be the only supportive treatment