Asia Pacific Journal of Medical Toxicology
Volume:10 Issue: 1, Winter 2021

Gasoline poses a threat to the public health, in general, and gasoline station workers, in particular. Cardiometabolic syndrome is a very common health problem among gasoline station workers throughout the world. In spite of its significance, few health assessments studies (if any) are available exploring the health risk effects of gasoline in relation to occupational exposure in Iraq. Trying to fill this gap, the present study aimed to evaluate health risk effects of gasoline on gasoline station workers in Iraq.

The study population (N=134) was composed of randomly selected male gasoline pump workers (N=83) in Basrah, Iraq. Unexposed healthy individuals (N=51) without any systemic or mental illness were used as a control group. Body mass index (BMI), blood pressure, and blood glucose level were measured in both groups.

The results indicated that the BMI, blood pressure, and blood glucose levels were significantly higher among gasoline station workers in comparison to those in the control group.

Based on the results, it can be claimed that exposure to gasoline could increase the potential risk of many disorders such as metabolic syndrome, high blood pressure, and elevated blood glucose level. It is highly recommended to consider preventive measures that protect gasoline station workers from such health threats. In addition, learning about the importance of wearing gloves, special coats, and face mask is believed to considerably reduce the risk of getting involved with such health problems.

In several countries, suicide is one of the leading causes of mortality and morbidity among adolescents, making it a major public health problem. Suicide can be prevented with accurate and prompt evaluation of mental illness and successful care, as well as informed media reporting of suicide and environmental monitoring of risk factors. This study was designed to assess the predictive value of the Poisoning Severity Score ((PSS) IPCS/EAPCCT)) in the outcome of suicide by pesticides in adolescents and provide data on risk/precipitating factors. Observational prospective surveys were conducted on 100 adolescent patients presented with acute suicidal pesticides poisoning within a six-month period and met the inclusion criteria. Most of the patients (96.0%) reported adverse life events and recent stressors, 77.0% of the patients were diagnosed with anxiety, 52.0% were diagnosed with depression, and 29.0% were diagnosed with personality disorders. Significant higher total PSS was found in patients who died (2.22 ± 0.24) compared to those admitted to ICU (1.47 ± 0.23); p=0.001 and the total PSS for the patients admitted to ICU(1.47 ± 0.23) was significantly higher than those admitted to Alexandria Poison Center (0.64 ± 0.26) p 2 and P-value was highly significant (p <0.001). Aluminum phosphide, organophosphorus, and zinc phosphide are the most used pesticides for committing suicide in adolescence by this order in Alexandria. In the present study, the presence of major life events, recent stressors, diagnosis with depression, and diagnosis of anxiety were associated with the suicide event. Finally, Poisoning Severity Score can be used as a predictor to provide the families with the possible outcome/prognosis for their patients and to have the medical team prepared for specific medical attention needed by the patients, especially in PSS 3 and 4.

There is limited data on refined opium extract (Shireh) abuse, especially the magnitude of its complications and its mortality rates. To bridge such a gap, in this study, we aimed to investigate the frequency of pure refined opium extract poisoning and its consequences in a sample of our patients. This retrospective study was conducted on all the patients presented to our center with pure refined opium extract poisoning. Patients’ demographics, clinical and laboratory data, and outcome were collected during a ten-year period between 2006 and 2016. The included patients were divided into two groups: those who remained conscious and those who developed loss of consciousness. However, they were compared subsequently. A total of 227 patients were evaluated. Most (75.8 %) of them were male. Mean age was 38.26±25.91 years. We found a significant correlation between educational (.038), marital (<.001), and occupational status (<.001) and age-gender groups of the patients. The mean amount of refined opium extract consumed was 4400 mg which had significant correlation with hospitalization period (<.001) and on-arrival rhabdomyolysis (<.001). We also found a correlation in vomiting (<.001), dizziness (.015), respiratory distress (.001), and apnea (<.001) between the two groups. The mean hospitalization period was 2.3 days and the mortality rate was 1.76%. Naloxone therapy use effective in most cases of pure poisoning with refined opium extract. There were four deaths incidences three of which happened due to cardiopulmonary arrest following body packing. Further studies in this type of poisoning are recommended.

Neurotoxic Snake bite is an important health hazard that may lead to fatality in Bangladesh, particularly in rural areas. Epidemiological data point to 700000 incidences of snake bite resulting in 6000 deaths in a year. Despite the criticality of this issue, limited studies are available in the pertinent literature. Consequently, to bridge the gap and offer fresh insights into this domain, the present study was an effort to observe the clinical and demographic profile of neurotoxic snake bite in tertiary care hospital of Bangladesh.

This research was a hospital based observational study which was conducted at the inpatient department of Medicine in Dhaka Medical College Hospital (DMCH). Thirty five patients admitted in DMCH for neurotoxic snake bite were examined according to the inclusion and exclusion criteria. Ethical issues were ensured properly throughout the study. After obtaining a written informed consent, patents’ history was taken and physical examination was done and data were recorded in structured case record form. In the end, the collected data was analysed by computer via SPSS 22.

Neurotoxic snake bite was most frequent (34.3%) in age group 21-30 years. The mean age of the subjects was 32.31 ±14.33 SD. Total 11 Neurotoxic snake was identified and 7 were Cobras and 4 were Kraits. Difficulty in swallowing, difficulty in speech, double vision, and difficulty in breathing were found in 11.4%, 28.6%, 5.7%, and 37.1% of the cases, respectively.  Moreover, all the subjects had Ptosis (100%), 14.3% had external ophthalmoplegia, 57.1% had broken neck sign. Furthermore 60% of the cases recovered completely, 17.1% recovered with complications, but unfortunately 22.9% of the patients died.

Ptosis and broken neck signs are the most frequent neurotoxic signs. However, a larger study is needed to validate and approve this finding.

Acute poisoning is an important medical emergency. Depending on the socioeconomic factors and cultural diversity, the nature of poison varies throughout the world even in different parts of the same country. Hence, the management of these patients can improve if the common causes of poisoning are properly defined. Pesticide poisoning is globally the single most important means of suicide. It is a major public health problem in rural Asia, where it has led to a very high-case fatality ratio in comparison to the developed world. Case Series: we report four cases of extremely rare poisoning with 2-4-D, Sodium Salt, all of which were due to suicidal attempt. In this case series, we attempt to describe the clinical and biochemical profile of this rare poison. The presenting symptoms were nausea,vomiting, abdominal pain, and altered behavior/sensorium. All cases had hypernatremia/ high anion gap metabolic acidosis, yet the degree of which varied across cases. Two of them had only Hypernatremia and acidosis, and improved with conservative treatment. One of them developed severe renal, hepatic and respiratory failure and succumbed. Another case had hypernatremia, acidosis, AKI. He improved drastically after dialysis. We would like to highlight in our case series that timely management, could alter the outcomes in this poisoning.

Ayurvedic and Herbal medicine induced liver injury is rarely reported in children. The injury can range from mild asymptomatic elevation of liver enzymes to severe presentation with acute liver failure leading to death. The diagnosis is by exclusion and relies on accurate history and clinical examination supported by laboratory investigations.  Various causality assessments such as council for international organizations of medical sciences (CIOMS) and Roussel Uclaf Causality Assessment Method (RUCAM) have been reported to be useful in reaching the diagnosis of Herbal Induced Liver Injury (HILI). However, these scales have not been validated specifically for pediatric age group. In this report, we present a case of a child who was presented to our department with acute liver failure after taking unlabeled ayurvedic medicine for jaundice and loss of appetite. The child was examined for age specific causes of hepatic injury and acute liver failure and he was managed conservatively. Despite extensive search, we did not find any etiology and suspected herbal medicine induced hepatic injury. She recovered completely after stopping the offending medicines. This case highlights the paradoxical hepatotoxic effect of such medications, widely considered safe and natural by the masses. Pediatric hepatologists and general practitioners should be well aware about such adverse effects of herbal medications when encountered with patients with abnormal liver functions. The health authorities need to establish strict quality check and regulations both in the production and sale of ayurvedic medications.

Clonidine is among the drugs that are in a list of ‘one pill can kill’ drugs. We are reporting a child with clonidine toxicity with classical manifestations who recovered completely.

Case Report: 

A 3 year and 2 months old ADHD girl presented with drowsiness for 30 minutes.  Her mother gave the history of accidental consumption of 3/4th clonidine 100 mcg tablet 45 minutes prior. On the examination, the child was drowsy with Glasgow Coma Score (GCS) 12/15. Her heart rate was 82 /minute with low volume pulse, respiratory rate 22 /minute, systolic blood pressure was 80 mm of Hg, and diastolic BP was not recordable. Immediately normal saline bolus was administered and her pulse volume improved and BP was 94/60 mm of Hg. After an hour, GCS was 9/15 and the respiration was shallow. After 4 hours, her sensorium improved (GCS 15/15). By 6 hours of ingestion, the child showed complete recovery.

Most of the clonidine poisoning children were younger than 6 years according to the NSWPIC database. Among them, 60% developed symptoms, most commonly lethargy (80%), bradycardia (17%), hypotension (15%), and respiratory depression (5%). Symptoms usually develop within 30-60 minutes and resolve within 24-48 hours. In our case, classical symptoms like drowsiness, hypotension, meiosis occurred within 30 minutes of ingestion and her consciousness deteriorated along with shallow respiration by the next 2 hours. By 6 hours of ingestion, the child showed complete recovery.

While prescribing clonidine caution should be exercised regarding the side-effects. When calculating the dose, extra vigilance should be ensured and drug needs to be kept out of the reach of children.

Organophosphate compound poisoning is one of the most common causes for admission to the Medical Intensive Care Unit. Parkinsonism is a primary neurotoxic manifestation of organophosphate intoxication. In this case report, we present the case of a 26 year old man who had the experience of organothiophosphate poisoning.

A 26 year old man was admitted with tremors in upper and lower limbs together with the rigidity of all 4 limbs as well as difficulty in swallowing and in daily activities like walking, rising from chair, and turning on bed. He had consumed organophosphorus compound quinalphos, 15 days before. The basal ganglia changes were documented radiologically by Magnetic Resonance Imaging (MRI). Gradual recovery was observed by treatment with dopaminergic agents and central anticholinergics over few weeks. Only 0.5% of organophosphate poisoning patients develop neurotoxic manifestations in the form of extrapyramidal syndromes such as Parkinsonism.

The occurrence of Parkinsonism as a complication of organophosphate poisoning raises safety concerns, especially in developing countries. Yet, this study is the first case report on Organothiophospahate induced Parkinsonism.

Clinicians should be aware of the possibility of extrapyramidal manifestations following organophosphate poisoning and the patients should be asked for regular follow-ups as the symptoms may appear even 1 month after the poisoning.