Asia Pacific Journal of Medical Toxicology
Volume:12 Issue: 3, Summer 2023

Poisoning is a major public health problem and due to industrialization and urbanization, its incidence is on a major rise and it may be poisoning, suicidal, accidental, or homicidal. It is extremely important for physicians to have the knowledge of common suicidal poisons in a particular locality as it may help in the early diagnosis and management of acute poisoning cases. Therefore, this study was conducted to know the clinical spectrum of acute poisoning cases in and around Mangaluru and the effectiveness of decontamination procedures.

100 patients admitted in the intensive care units and wards of the General Medicine department were observed in this study. Details of each of these patients like presenting complaints, time of onset of the symptoms, addictive habits, and the nature of poisons consumed were noted. Clinical parameters such as whether stomach wash was given or not, the time lapse between the consumption of poison and stomach wash, the time lapse between the consumption of poison and stomach wash and death of the patients, duration of hospital stay, psychiatric condition of the patient and overall mortality rate of poisoning cases, were observed in this study.

The present study shows that organophosphate poisoning is the commonest type of poisoning. Nausea or vomiting is the most common symptom. There is a significant correlation between the time elapsed between the consumption of poison and stomach wash and mortality. Mortality was highest in patients with paraquat poisoning followed by rat poisoning.

The prevalence of drug abuse has been one of the most serious challenges to the healthcare system resulting in several psychological, medical, and social complications. The present study examines the effect of educational intervention based on the theory of planned behavior on the prevention and risk reduction behavior of substance abuse in patients referred to drug addiction treatment centers in the southern region of Iran This quasi-experimental study was conducted on 130 addicts referred to Fasa Drug Addiction Treatment Center in 2020. A random sampling method was adopted to divide the samples into the control and experimental groups (n=65). Educational Intervention based on the Theory of Planned Behavior was followed in six forty-minute sessions in the experimental group. Data were analyzed by the paired t-test, independent t-test, and Chi-squared test using SPSS-22 software.  There was no significant difference between the experimental and control groups in terms of attitude, subjective norms, perceived behavioral control, intention toward substance abuse preventive behavior before the educational intervention (P>0.05); however, there was a significant growth of attitude (53.06±4.48), subjective norms (35.34±3.65), perceived behavioral control (34.37±4.6), intention (7.38±1.92) toward substance abuse preventive behavior in the experimental group three months after the educational intervention (P<0.05). Educational intervention based on the theory of planned behavior has effectively reduced substance abuse in the addicts treated with methadone. Accordingly, health system policymakers and managers can use the results of this study for planning and educational interventions in the prevention and risk reduction behavior of substance abuse.

Unrecorded alcoholic beverage consumption is a health problem in Iran. Extensive use of pesticides in agricultural products may lead to the presence of residues of these compounds in hand-made alcoholic beverages. There are claims that the producer of hand-made alcoholic beverages adds some drugs to increase efficiency. The objective of this study was to assess the presence of methamphetamine, methadone, tramadol, diazinon, phosalone, trichlorfon, mancozeb, and penconazole in homemade alcoholic drinks. Thirty hand-made alcoholic beverages were analyzed in this study. Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) and liquid-liquid extraction (LLE) were selected for samples' pretreatment. Gas chromatography-mass spectrometry (GC-MS) was used to identify diazinon, phosalone, trichlorfon, mancozeb, and penconazole and high-performance liquid chromatography (HPLC) was used to identify tramadol, methadone, and methamphetamine. This study showed that diazinon was detected in three samples (10% of the total samples) at 10.8 to 16.5 μg/L and Penconazole was detected in two samples (6% of the whole samples) at a range of 78.5 to 810.6 μg/L. However, Mancozeb, trichlorfon, and phosalone were not in alcoholic beverages. In addition, methadone, tramadol, and methamphetamine were not detected in any samples. The results of our research showed that hand-made alcoholic beverages contain pesticide residues, and the use of these beverages causes diseases in the body.

Aluminum Phosphide toxicity is a common deliberate toxicity, and due to no specific antidote available for its treatment, most toxicity leads to death. The present study aimed to evaluate the efficacy of Hyper Insulin Euglycemia protocol in combination with vitamin E and N-Acetyl Cysteine in patients with acute ALP poisoning treatment. In this incidental prospective clinical trial, 76 individuals with toxicity were enrolled and assigned into two groups: One treatment group undergoing by glucose, insulin, and potassium() administration in combination with vitamin E and N-Acetyl Cysteine,  and one control group who were mainly managed by supportive treatments. Signs and symptoms at arrival and during hospitalization, complications, and outcomes were recorded and compared between these two groups to find any possible effect of, vitamin E, and protocol for toxicity treatment. This study investigated the mortality and safety of therapy in 76 poisoning patients with an average age of 28. The mortality rate in the group was 26% lower than in the control group (p-value: 0.058). Furthermore, this research detected a significant rise in systolic blood pressure during hospitalization in the treatment group. Regarding pH and bicarbonate levels, the group showed less metabolic acidosis. In contrast to the case group, the therapy group's bicarbonate levels significantly increased throughout hospitalization. Using the, vitamin E, and protocol accompanied by Symptomatic and supportive treatments in acute ALP toxicity among the treatment group of this study resulted in a significant increase in systolic blood pressure,  longer hospitalization duration, and lower death rates.

Cadmium is a toxic metal that affects many organ systems in the body. Medetomidine is an alpha-2 adrenoceptor agonist reported to reduce glutathione (GSH) levels in tissues. We used the effect of medetomidine to determine GSH levels and turnover rates in the brain and liver of mice acutely treated with cadmium. Female mice  were treated with either saline (control) or cadmium chloride at 2 mg cadmium/5 ml saline/kg of body weight, itraperitoneally (ip), followed one hour later with medetomidine at 0.2 mg/kg of body weight, ip. Five hours after the medetomidine administration, the mice were sacrificed using terminal ether anesthesia to obtain the whole brain and liver. GSH level was determined in the homogenized brain or liver spectrophotometrically. Turnover parameters (efflux rate constant-k, turnover time, and turnover rate) of GSH were estimated by a steady state kinetic relationship. The levels of GSH after medetomidine or cadmium + medetomidine treatments were reduced in the brain (12.4% and 11.4%, respectively) and liver (3.8% and 15.1%, respectively) of mice in comparison with respective control values. Cadmium reduced GSH trunover rate in the brain of mice by 8% with a corresponding decrease in k value by 8% and an increase of 9%  in the turnover time. In the liver, it increased the turnover rate by 320% with a corresponding increase in k value by 319% and a reduction of turnover time by 76%. In conclusion, cadmium differentially affected GSH levels and turnover rates in the brain and liver of mice. Medetomidine administration was found to be a potential simple tool to determine GSH turnover and related parameters in tissues.

The World Health Organization (WHO) defines human health as the optimal state of balance and well-being encompassing physical, mental, and social dimensions. The execution of any activity or work induces alteration in the work environment, rendering it a potential source of adverse stimuli, impacting the health of  involved workers.Contaminants, whether inert or living matter, manifest in the work environment, giving rise to what is commonly recognised as hygienic risk.

This paper conducts a targeted review, utilizing databases such as Medline/PubMed, Google Scholar, Web of Science, Cochrane and Ovid®, encompassing publications in all languages. The selection of articles is based on scientific relevance, considering the impact and visibility of the journal.  All articles undergo thorough scrutiny during the selection process.

The review delineates diverse categories of contaminants within the work environment, elucidating the routes of entry into the body, the duration of exposure, and their associated risks to the worker's health.It explicates the influence of working conditions and the susceptibility of individuals to environmental contaminant exposure. Additionally, measures are outlined to eliminate polluting agents from the work environment.

This comprehensive examination of current knowledge on contaminants in the work environment underscores the necessity for actions to diminish the concentration of contaminants to which workers are exposed.These measures must be tailored to address the emission source, transmission modalities, and protective actions directed toward workers. Endeavours to eradicate such contamination significantly contribute to improving workers' overall health.

Urea agricultural products normally have low toxicity. However, most of the severe poisoning occurs after urea ingestion, which causes gastrointestinal symptoms. There is no robust evidence about inhalation or topical exposure; however, in animals, it has been documented dyspnea, methemoglobinemia, carboxyhemoglobin, hemorrhages, and brain degenerative changes. Case report: A 31-year-old male without medical history had a fainting episode prior to the use of urea fertilizer. Laboratory tests showed a progressive increase in renal function, from 1.47 mg/dl up to 10 mg/dl requiring renal replacement therapy, and remarkably high aminotransferase levels. Also an aspartate aminotransferase and alanine aminotransferase at 10150 U/L and 2150 U/L, were reported respectively. The clinical manifestations progressed to respiratory failure, requiring invasive mechanical ventilation for 10 days with successful extubation and a return to normal saturation without supplemental oxygen.

Urea poisoning due to agricultural product use is a rare condition. In this exceptional case, our patient presented with a life-threatening condition. Even though it is not well-established as a standard treatment, management with intravenous methylene blue can improve the symptoms associated with methemoglobinemia, provide breathing support, and prevent renal damage or the use of renal replacement therapy in cases of acute renal failure.

Reports of urea herbicide poisoning are extremely rare, and little is known about how to effectively manage urea poisoning as it normally presents mild symptoms. Correct identification of the agricultural product causing the poisoning is crucial to direct therapeutic efforts.

The concentration of heroin in street drugs is highly uncertain. This uncertainty of drug purity is the major cause of overdose. If it is used with a combination of other drugs, it can be fatal. The route of administration and drug tolerance is also important in this prospect.

This article represents a case study, in which the person was found dead in a hotel room. During the investigation by the Law Enforcement agencies, two pieces of forensic evidence, i.e., currency notes, cigarette butts and postmortem specimens were submitted to the author’s laboratory for investigation about the cause of death. The aliquot from pieces of evidence was analyzed using a gas chromatography-mass spectrometer (GC-MS), gas chromatography-flame ionization detector (GC-FID), and FTIR.

The GC-MS analysis showed a high concentration of heroin along with dextromethorphan and phenobarbital on currency notes, while analysis of cigarette butts showed the presence of phenobarbital mixed with cannabis constituents in Tobacco leaves. The purity of the heroin sample was found to be 65.5 %. Toxicological analysis of postmortem blood sample showed above the lethal levels of morphine (0.619 mg/L). Moreover, the synergistic effects of the other drugs may have caused the morbidity of the victim.