Asia Pacific Journal of Medical Toxicology
Volume:8 Issue: 3, Summer 2019

32 different brands of bread with 12 different brands of wheat-flour sold in Aba metropolis, South Eastern Nigeria were selected and evaluated for both potassium bromate and some heavy metals contents to determine their safety level of consumption. Bromate determination was carried out using spectrophotometric method while heavy metals were done by the flame atomic absorption spectrophotometer. The results of the analysis revealed that all the bread samples contained potassium bromate at concentrations above the permissible limit allowed by the US FDA while the concentrations in wheat flour samples were within the acceptable limit with ranges from 0.27±0.04 – 3.78±0.26 mg/kg and 00 – 1.52±0.28 mg/kg, respectively. The values of heavy metals in bread ranged as follows: Zn (3.22±0.05 – 7.25±0.24 mg/kg), Pb (0.05±0.01 – 0.45±0.02 mg/kg), Mn (44.28±0.5 – 78.25±1.24 mg/kg), Cu (0.31±0.04 – 0.49±0.12 mg/kg) and Co (0.04±0.01 – 0.24±0.03 mg/kg) while in wheat flour, the ranges were as follows: Zn (3.85±0.04 – 5.03±0.10 mg/kg), Pb (0.06±0.02 – 0.15±0.04 mg/kg), Mn (47.30±0.38 – 70.20±1.02 mg/kg), Cu (0.36±0.02 – 0.46±0.13 mg/kg) and Co (0.07±0.01 – 0.21±0.03 mg/kg). The values of these metals are within the permissible limits except Pb and Mn which were above the normal limits that can be detrimental to human health.

Snake antivenom (SAV) is the definitive treatment for snake envenomation. But SAVs are specific, expensive and limited in supply. SAVs also come with risk of adverse reactions. Hence, this study was conducted to assess the use of SAV, adverse reactions to SAV and its clinical outcomes in snakebite patients. This was a retrospective study. Medical records of snakebite patients for the period from January 2014 to September 2017 were reviewed and study data was extracted. Clinical outcomes were measured by mortality rate in those receiving SAV. Among 165 subjects, only 9 patients (5%) were treated with SAV after presenting with envenomation symptoms in which five cases with identified snakes were given monovalent SAV namely pit viper (two cases), king cobra, sea snake and cobra with one case each. Meanwhile, three cases of unidentified snake received polyvalent SAV and one case received pit viper SAV. Most of the patients (8/9, 88.9%) received SAV within 24 hours after snakebite. The average time gap to first administration was 7.23 hours. In patients receiving SAV, six out of 9 cases required two to four vials of SAV. All the patients receiving SAV did not encounter any adverse effects except a child who had pyrogenic reaction. All patients survived without significant morbidity at discharge. The total cost of SAV for the 9 patients was US$ 24,082.68. From this study, the incidence of snakebites requiring SAV was low. Low incidence of adverse effects and no mortality were observed in patients receiving SAV.

Geospatial distribution analysis is a highly useful tool, especially in the field of health research and health economics. We aimed to study the geospatial distribution of poisoned patients and the risk factors in Mashhad, Iran.

This was a retrospective cross-sectional study of patients treated at the Medical Toxicology Center, Imam Reza Hospital, Mashhad, Iran, which is the only referral center in northeast of Iran, in 2013. Negative binomial and Poisson approach via generalized linear mixed models were performed to investigate the association between socio-demographic characteristics with the number of reported cases of poisoning.

A total of 5064 poisoned patients (52% females) were included. Most of the poisoned patients were within the age group of 20-29 years old (41.4%). Pharmaceutical agents were the most common cause of poisonings (64.6%). The local test of spatial autocorrelation (Moran’s I) confirms that the poisoning had cluster pattern in Mashhad. Number of poisoning events were found to be associated with population density (RR= 1.00011; 95% CI 1.0001-1.00013), and the frequency of people with less than high school education (RR=1.49; 95% CI 1.32-1.68).

The geospatial factors may have impact on the number of acute poisoning events in a city. Some parts of a city may exhibit spatial clustering in poisoning events. Once clusters are found, interventions can be focused to specific geographic locations and would be helpful for healthcare policymakers to focus on prevention programs.

Scorpion sting is a significant health problem in southern provinces of Iran. Many thousands of people are stung by different species of scorpions annually. More than 60 scorpion species have been reported to be present in Iran. However, Razi Institute manufactures polyvalent antivenom against only six species of scorpions, excluding Buthacus macrocentrus, Apistobuthus susanae and Vachoniolus iranus, wide spread scorpion species in the south region of Iran. Since the venom of these scorpion species is not included in the production of Razi polyvalent antivenom, the aim of this study was to check the neutralization capacity of our antivenom against these species.  

In this research, after collecting scorpions (at night), milking by the electroshock method, the venom was lyophilized and the LD50 was determined. The fractions were then separated by gel chromatography and HPLC. Using SDS page electrophoresis, the fractional molecular weight was determined. At the end, the potency test of these scorpion venoms was carried out in the vicinity of the antiserum produced by Razi Institute on the animal. In the present work, we tried to investigate the cross reactivity of present antivenom against these excluded scorpion species.

The antisera production of Razi Institute was able to neutralize the 33 LD50 of Apistobuthus susanae venom.This antivenom could neutralize Buthacus macrocentrus as well as Vachoniolus iranus scorpion venoms by 41 LD50 and 15 LD50, respectively.

Based on the results obtained in the present study that indicate the neutralization of the three species of scorpions’ venom, not included in antivenom production, the present Razi polyvalent antivenom is able to be used in patients stung by these 3 species of scorpions.

Organophosphate (OP) poisoning is still a major health concern in both developed and developing countries. The standard treatment approaches of (OP) poisoning are not always available as well so they may show a limited success rate. Fresh frozen plasma (FFP) is one of Bio-scavengers that have been suggested as a useful therapy through elimination of free organophosphates. Therefore, this systematic review and meta-analysis was conducted to update the present evidence about the efficacy of FFP in management of acute OP-intoxicated patients. A computer literature search of PubMed and Scopus was conducted to identify the relevant randomized controlled trials (RCTs). In addition, a manual search of reference lists of the retrieved articles was conducted. Relevant outcomes were pooled as mean difference (MD) risk ratio (RR) by RevMan version 5.3 for Windows. Pooled data from 3 RCTs (169 patients) showed that adding FFP to conventional therapy to acutely OP intoxicated patients did not improve clinical outcomes regarding total atropine (MD = 35.05, 95% CI = [-41.14 to 111.24], P-value = 0.37) and pralidoxime dosages (MD = -0.41, 95% CI = [-2.34 to 1.51], P-value = 0.67), length of hospital stay (MD = -2.08, 95% CI = [-4.51 to 0.35], P-value = 0.09) and mortality (RR = 0.42, 95% CI = [0.14 to 1.27], P-value = 0.12). Fresh frozen plasma did not provide any additional benefit in acutely-OP intoxicated patients compared to the conventional therapy. The limited number and sizes of the included trials are the most probable cause of such effects.

Suicide by poisoning is the second most common cause of death by suicide (27.9%) as per The National Crime Records Bureau (NCRB) India in 2015. Aluminum phosphide (ALP) is the leading agricultural poison used to commit suicide as where its availability is not properly regulated. ALP is a highly toxic solid fumigant pesticide, rodenticide and insecticide. A 40-year-old woman was brought by the police to the emergency section. Her extremities were cold and hypotonic, and her skin was pale. Patient’s vitals were unstable with pulse rate 112/minute irregularities, blood pressure 68/54 mm of Hg, respiratory rate 22/minute shallow and body temperature 30.1 ºC and characteristicly strong garlicky odor on her breath. During the suction of gastric contents, spontaneous ignition of gas with flames and white fumes with sound like a blast was observed by resident doctors and para-clinical staff. Gastric aspirate along with Ryle’s tube were immediately sent to the forensic department where the Silver Nitrate test was performed and it was found strongly positive for phosphine gas. Aluminum phosphide readily reacts with water and hydrochloric acid in the stomach to produce phosphine (hydrogen phosphide, PH3) and a small amount of diphosphine. The present case report stresses on the need that the emergency physicians need to be highly alert and adequately prepared while handling such patients. Spontaneous ignition with the release of phosphine from ALP poisoned patients can not only affect the patient, but also pose a health hazard to emergency physicians and medical staff.

The vast territory of Iran, due to climate diversity, is a host for various animal species. Snakes may be considered a significant threat to health of the rural regions of Iran. Sheltopusik (Pseudopus apodus), the largest member of the family Anguida, is one of the species of lizard that is considered to be a harmless animal species. This lizard is often mistaken for a faunistic community of reptiles in the area and is well-known as Petilus Snake. To the best of our knowledge, no reports of injury from bites or attacks of this species have previously been published. The present case report is the first report of describing the attack of a sheltopusik to a 40-year-old white female farmer. Due to the lack of primary identification of the damaging animal, it was initially confused with the snakebite, leading to unnecessary administration of anti-venom and tetanus prophylaxis. The main reason for this event was the lack of reporting a similar medical harm in the area and the snake-like appearance of the lizard. Acquaintance with this kind of damage to the human health and tissue contusion by the hit can help rational management of such patients without conventional modalities for snakebite like antivenom. The physicians practicing in emergency wards and rural clinics in the area, as the first place of referral, should be trained on proper management of this group of patients to achieve the best clinical outcome.