Asia Pacific Journal of Medical Toxicology
Volume:7 Issue: 4, Autumn 2018

Avoidable systematic differences in health status of different population groups are called health inequalities. They cause significant social and economic costs to both individuals and societies (1, 2). For example, life expectancy at birth among Canadian First Nation Population is lower (73 for males and 78 for females) than that of total Canadian population (79 and 83, respectively, projected for 2017) according to Statistics Canada (3). In this commentary, we used Canadian First Nation Population, coastal residents and Native American population who self-harvest as example. Toxicology regulation could be considered as a determinant of health, as policies introduced by regulatory toxicology agencies influence health services and are effective at the community level. These policies, however, could be distributed differently among the subgroups of the populations in a systematic manner, which may be a source of inequality. Consumption of home grown or self-harvested foods can result in exposure to various chemicals but such contaminant levels in these products are often not monitored by inspection agencies (4). To date, many drivers of health inequality have been defined, such as gender, race and economic growth. However, no literature is available on “inequality” and “potential food toxicity”. We argue in this editorial that while all population including Canadian First Nation Population, Coastal Residents and Native American population groups are benefitted from implementing new toxicology regulations, the magnitude of health inequalities might increase for some minority groups. Health Canada has set a maximum level of 0.5 mg/kg (50 ppm) in the edible portion of all retail fish, subject to some exceptions (5). This level is applied to commercial fish and enforced by the inspection agencies. However, fish consumption advisories that reduce the risk borne by the general population might not provide much health benefit to subsistence fishermen, which include First Nation (Native American) populations. In another example, and following an outbreak of amnesic shellfish poisoning (ASP) in Canada in 1987, which is related to high exposure to Domoic acid (DA), a neurotoxin,regulations were put in place in North America, limiting the concentration of Domoic acid to 20 ppm in commercial shellfish products (6, 7). Prior to the promulgation of regulations limiting mercury or DA concentrations in fish and shellfish, the general population consuming commercial products and the Native American-First Nation population, largely consuming self-harvested products, were at similar risk of exposure to these contaminants. Limiting mercury concentration to 50 ppm and DA concentration to 20 ppm in commercial products thus protects the general population, a step that certainly should be celebrated. First Nation population, who mainly self-harvest, did not benefit from this protection, thus increasing the health inequalities with regard to exposure to seafood contaminants (8). These examples show that (i) inequality exists regarding potential food toxicities and (ii) a new regulation can create or exacerbate health inequalities. We suggest the need to consider the impact on potential health inequalities as part of the deliberations on new toxicology regulations. As different subgroups of population might be affected by a new regulation to a different extend, strategies should be considered to insure that increased health inequalities do not result. In case of First Nation populations and subsistence fisherman, and while they are generally benefitted from implementing new regulations on contaminant concentrations of commercial foods, a subset of the population who self-harvest may not be benefitted equally. We would like to suggest including educational materials and guidance for self-harvesters; a recommendation that should go to all new regulatory toxicology guidelines. The proposed dimension adds to the current higher burden of adverse effects from contamination to land and waterways that are caused by industry on First Nations’ territories and coastal areas.

Animal bites and rabies are perceived and managed differently from bites and stings related to envenoms snakes, scorpions and spiders. This study aimed at evaluating knowledge, attitudes and practices (KAP) of local population regarding animal bites and rabies, as a point of comparison for future studies on venomous animals. This cross-sectional KAP study included 1093 subjects from four rural areas of Mashhad. Data gathered through a validated and reliable structured questionnaire. In total, 1093 respondents included in the study consist of 53% male and 42% adults of 20 to 9 years old. Assessing knowledge; 70% of cases were presented with weak and moderate knowledge related to clinical manifestations, but just the opposite, majority of the respondents (83%) were categorised as good or excellent in their knowledge of prevention. Assessing attitudes; almost all (91%) of respondents categorised as good or attitude. Assessing practices; 33% of cases revealed that there are no good practices with regard to animal bites and rabies.
Respondent’s knowledge of prevention was significantly correlated with age (P = 0.01) and educational level (P = 0.002). Both attitudes and practices had significant relations with age. Respondents aged 20- 39 years showed better practices than other age groups (P < 0.01). this study found that while information on prevention is acceptable, clinical findings of bites and rabies are relatively unknown. Preventive measure should include clinical manifestations as well as currently implemented focus on prevention, vaccination and treatment.

Hemiscorpius lepturus envenomation is one of the most important medical issues in tropical regions of Iran, especially Khuzestan Province. Due to lack of reliable data about scorpion sting in Khuzestan Province, this investigation was performed to study the clinical presentation, prognosis factors, complications and mortality rates of Hemiscorpius lepturus sting. this study was a cross-sectional study performed at Sina Hospital, Karoon, Iran during 2011-2013. Required data such as demographic data, complications and outcomes were collected from medical records of all admitted victims of envenomation in this period and then were registered in a propriate checklist. Data were analyzed using SPSS version 16. a total of 311 victims were studied. The highest frequency of sting was in the age range of 15-24 years. Most areas of the sting were the lower extremity. Forty-two patients delayed more than 24 hours to refer to the emergency room. The most common initial symptom in victims was pain in the sting location. Complications such as hematuria, hemoglobinuria, and coagulation disorders were most morbidity occurred in patients. 6 cases died. delay in referring to the hospital, the existence of hemoglobinuria, coagulation disorders and kidney failure were associated with poor prognosis in patients. It seems that patients who refer with delays and with symptoms such as hematuria, need for more medical health care.

Given the growing prevalence of obesity in industrial societies including Iran, there is a growing demand for herbal weight loss drugs. Taking into account the heavy advertisements to sell the capsule as an herbal medicine, the present study was conducted in 2012 to determine the effective substance of prevalent super slim weight loss capsule. Twenty-six super slim capsules were purchased from Tehran-based pharmacies and herbal medicine shops in 2012. Afterwards, 0.5 gram of the samples was solved in 2.5ml methanol. The samples were filtered and brought up to the volume by adding 5ml of ethanol and placed in an ultrasound device for 30min. 50µl zolpidem was then added as an internal standard. From each sample, 30µl was injected into high performance liquid chromatograph at mobile phases including water, methanol, and triethylamine at volumetric ratios of (0.5+79.5+20v/v/v, pH=5.65) and the obtained peaks were analyzed after 30mins. The results showed that prevalent super slim weight loss capsules found in Iran market were not herbal based and the effective substances were synthetic compounds known as sibutramine and mirtazapine. The results of quantitative analysis of the samples showed that pharmaceutical concentration of sibutramine in the capsules ranged from 33.51µg/ml to 286.78µg/ml. In addition, pharmaceutical concentration of sibutramine in the capsules ranged from 33.51µg/ml to 286.78µg/ml – pharmaceutical variables (placebo). Despite the claims and advertisements by the producers, the drug is not herbal based and contains illicit compounds. Therefore, it is essential to improve transparency in the assessments of the damages caused by weight loss drugs.

Niu Huang Jie Du Pian (NHJDP) is a widely used realgar-containing Chinese medicine remedy. Most brands are composed of eight ingredients: Niuhuang (Calculus Bovis), Xionghuang (realgar), gypsum (calcium sulphate), Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae), Jugeng (Platycodon grandiflorum), Bingpian (borneol), and Gancao (Radix Glycyrrhizae uralensis, licorice root). Most users are not aware that Xionghuang (realgar) contains arsenic disulphide [As2S2]. Inorganic arsenic poisoning after therapeutic overdoses has been reported in Chinese literature, but no report of acute, intentional overdose of NHJDP has been published. We report a case of intentional overdose of NHJDP leading to arsenic poisoning. A 33-year-old woman ingested approximately 100 tablets of NHJDP bought over the counter, along with her usual antidepressants. She presented with somnolence, agitation, epigastric pain and repeated vomiting, compatible with clinical toxicities of NHJDP reported in Chinese literature. At presentation, blood and spot urine arsenic levels were 440.9 and 7,495 nmol/L, respectively. The patient’s condition improved rapidly after admission and chelation therapy was not deemed to be necessary. Despite the self-limiting clinical course, the high arsenic level in the patient’s blood and urine raises safety concerns regarding the use of NHJDP in the community. Inconsistencies in the sales regulation of arsenic-containing products, and a lack of product label warning regarding arsenic content, may potentiate inadvertent arsenic poisoning. Clinician should be aware of the possibility of inorganic arsenic poisoning when treating patients with overdose of Chinese medicine remedies that contain Xionghuang (realgar). Proper product labelling may help reduce inadvertent arsenic poisoning.

Herbs can be toxic and may be even life-threatening. The mixture of different plants and herbs made by traditional healer and their canvassing on the street attract general people. Here, we report four cases of severe herbal poisoning. In 2008, four young people rushed to DMC Hospital in the early morning with a history of taking herbal medicine (tonic) on that night for gratification. About 3–4 h after ingestion, they experienced repeated vomiting and abdominal pain. Two patients deteriorated within the hours after admission with restlessness, progressive unconsciousness, and died soon after. The other two patients absconded from the hospital, including the person who prepared the tonic. Screening of the tonic by gas chromatography-mass spectrometry did not reveal toxic components. The suspected herbs used for the preparation of that tonic were Santalum album (Chandan wood) which contains Santalol and other etheric oils; Plantago ovata (Ispaghula Husk) containing diverse alkaloids, phenols, etc.; and Mimosa pudica which is the common Mimosa and contains the alkaloid Mimosine. The nature of the tonic and source of the intoxication could not be finally elucidated. The described cases of unknown herbal poisoning in Bangladesh highlight the need for awareness campaigns targeting the population at risk.

Niyangala poisoning used to be a common method of deliberate self-harm among people living in rural areas of Sri lanka. It is a plant that grows in the wild and has no usage. All parts of this plant are poisonous.The toxic ingredient in Niyangala is Colchicine. Even though Colchicine poisoning is uncommon, it can lead to life threatening complications and be considered a toxicological emergency. It can cause severe gastroenteritis, abdominal pain, hypotension, electrolyte imbalance in the initial phase, as well as granulocytopenia, thrombocytopenia, clotting defects, hepatic insufficiency and renal failure after the first 24 hours. A 62-year-old male presented to our medical unit with several episodes of severe watery diarrhea 6 hours after the ingestion of 3 tubers of Niyangala. He also had epigastric pain, nausea and vomiting. He had eaten Niyangala after consuming alcohol and claimed it was after a dispute with his wife. On admission, the patient was in pain with some dehydration but he was afebrile. SIADH consists of hyponatremia, inappropriately elevated urine osmolality (>100 mOsm/kg), and decreased serum osmolality in a euvolaemic patient. SIADH should be diagnosed when these findings occur in the setting of otherwise normal cardiac, renal, adrenal, hepatic, and thyroid function; in the absence of diuretic therapy; and in the absence of other factors known to stimulate ADH secretion, such as hypotension, severe pain, nausea, and stress. SIADH is a well-recognized complication of colchicine poisoning. We report for the first time SIADH after the ingestion of tubers of Gloriosa superba. Hyponatremia in a patient after poisoning with Gloriosa superba is usually attributed to severe diarrhea which is a common and dominant clinical feature often managed with fluid replacement.