International Journal of Medical Toxicology and Forensic Medicine
Year:2014 | Volume:4 | Issue:4 |Papers Count:8

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Background: Intoxications are medical emergencies and among the significant causes of morbidity and mortality worldwide. In recent years, prevalence of intoxication with opioids and stimulants, such as amphetamines, is increasing particularly among young people. In this study, we investigated demographic factors, duration of hospitalization, costs of hospitalization, and cause of death in patients intoxicated with amphetamines and opioids.Materials and Methods: This study was a prospective descriptive–analytic study. Sampling method was census, and Subjects were patients intoxicated with amphetamines and opioids, alone or combined, who referred to toxicology ward of Ali-Asghar hospital in Isfahan, from October 2009 to April 2010.Results: During 6 months, among 2325 subjects, 419 patients used opioids, 98 patients used amphetamines, and 25 patients used both of them. The mean age of patients in the three groups was not significantly different. Most patients were male in all groups. The most common route of intoxication was orally in opioid group and inhalation in amphetamine group. The most common cause of intoxication was intentional attempt. Vital signs at admission were normal in three groups, but the average of heart rate, body temperature, respiratory rate and blood pressure, was slightly higher in the amphetamine group than the opioid group. Duration and cost of hospitalization were not significantly different between groups. Four patients were died totally and the outcome was not significantly different between groups. The mean age and duration of hospitalization were significantly higher in died compared to living patients.Conclusion: Opioids and amphetamines accounted for high percentages of intoxication, especially in young single men with self-employed job. Therefore, control and prevention of opioids and amphetamines consumption are important ways to reduce this kind of intoxication in this group.

Background: Cardiac complications are the less common fatal effect of acute organophosphate poisoning. This study was undertaken to analyze the pre-interventional cardiac and Electrocardiographic (ECG) changes in acute organophosphate poisoning cases.Materials and Methods: Clinical records of acute organophosphate poisoning patients of age less than 50 years admitted to KLE’s Dr. Prabhakar Kore Hospital, Belgaum, Karnataka, from 01-01-2010 to 31-12-2010 were analyzed. Cases of organophosphate poisonings referred from other hospitals, poisoning with multiple agents, patients with history of previous cardiac diseases and coexisting medical conditions were excluded from the study. Poisoning Severity Score was calculated as per International Programme on Chemical Safety and patients were grouped into 3 grades.Results: In this study, 50 cases of acute organophosphate poisoning (male - 32; female - 18) were analyzed. Sinus tachycardia was present in 45 patients (90%), hypertension in 13 (26%) and hypotension in 12 (24%). Prolonged corrected QT interval was observed in 14 patients (28%), elevated ST segment in 2 (4%), inverted T wave in 13 (26%) and conduction defects in 1 (2%). Among 14 patients with prolonged corrected QT interval, 12 were in grade III and 2 in grade II severity; and, among 13 patients who had inverted T wave, 2 were in grade I, 4 in grade II and 7 in grade III severity. Acidosis, as assessed by blood pH and HCO3, was observed in 22 patients (44%).Conclusion: Fatal cardiac complications do occur in acute organophosphate poisoning, which are overlooked at times as the most common complications expected are respiratory complications. Higher incidence of ECG changes in Grade III cases suggests that if the cardiac complications develop, the patient should be immediately transferred to an intensive cardiac care unit.

Background: Traffic air pollution can be induced or developed the different respiratory diseases. Megacity has potential magnitude in the production of high density and large- volume traffic triggering factors in the outdoor environment. High concentrations of Formaldehyde and polycyclic aromatic hydrocarbons (PAHs) are found in traffic density of ambient air in urban area. It can be stimulated both allergic state and diseases. The PAHs originates from the motor engine are as pro-inflammatory compounds which can enhance Immunoglobulin E (IgE) responses. The purpose of the study was evaluation of allergic markers among public drivers in Tehran, to assess the respiratory diseases.

Background: Organophosphate (OP) self poisoning is a major health hazard in a predominantly agrarian country like India. Acute cholinergic crisis and intermediate syndrome are well recognized manifestations of OP toxicity, delayed polyneuropathy being an unusual clinical event.Case Report: We describe a 30-year-old male with suicidal chlorpyrifos poisoning who presented with cholinergic crisis; developed intermediate syndrome subsequently and ultimately three weeks later landed up with OP induced delayed polyneuropathy (OPIDPN).Conclusion: This reported case emphasizes on the importance of strict vigilance and follow up in patients with OP toxicity in order to recognise and appropriately treat chronic toxicities like OPIDPN.

Background: Aluminum phosphideas pesticide commonly used to protect crops from pests. Despite the limited number of cases of poisoning with this substance, it is important due to the high risk of being fatal. The major cause of the poisoning is suicide attempt. Due to the lack of specific treatment in poisoning, taking more than 500 mg is fatal.Case Report: The patient was a 16-year-old woman who attempted suicide by consuming some 4.5gram aluminum phosphide tablets. Within half an hour after consumption she had vomiting and nausea then smoking cigar, followed closely by smoking in her mouth flames around his mouth is created which will burn (grade II). Subsequently she had argument with her husband and injured her right ear. During the admission she was alert, 2nd degree burn were observed on the upper lip and around the mouth and nose and ears areas. Physical examination was normal, when she arrived she had severe hypotension and her oxygen saturation was 69% with tachycardia. The patient was immediately intubated and received mechanical ventilation. After installing Nasogastric tube, gastric lavage was done with potassium permanganate and bicarbonate. At Arterial Blood Gas (ABG), severe metabolic acidosis (pH 6.9) and a chest X-ray, diffuse lung opacities was seen. Blood test showed that there was a leukocytosis (22, 000). Treatment was given Saline, high dose inotrope drugs (norepinephrine and dopamine), bicarbonate, calcium gluconate, magnesium sulfate hydrocortisone. Burns around the mouth was dressing after admission. On the third day the patient was alert and complained of pain in the right ear and hearing loss.9 days after admission, the patient was discharged well with complication of sensory neural hearing loss (unrelated to slap injury).Conclusion: Despite the extreme virulence of the Aluminum phosphide (rice tablets), especially in high doses, conventional therapeutic measures can sometimes unexpected ways leading to improved patient. The patient's well general condition was discharged with remained hearing loss in her right ear, despite the very poor prognosis. It is recommended that phosphine gas research on the possible impact of hearing loss further.

Background: The incidence of firearm related non-fatal and fatal accidents has been increased worldwide. Most of the unintentional or intentional nonfatal gunshot injuries involve an extremity.Case Report: A 33-year-old man was admitted to emergency department with a complaint of injury related to 5th metacarpal area of right hand. The patient reported that he is a police officer who suffered gunshot injury during crashes with smugglers in himself right hand. At arriving time into hospital, hand was neurologically intact and no vascular injury was noted. There was a distractive entrance wound in the 5th metacarpal hypothenar palmar area and a distractive exit wound on the dorsal side. The wound was irrigated and debrided. All lose bone fragments were removed. The lose area covered by distant flap of skin from the abdomen. All of the wounds were healed on postoperative 15th day.Conclusion: This report is an attempt to present the problem of firearm injury and appeal to a wide range of disciplines working to expand their knowledge and redirect new energy to address the urgent problem of firearm injury.

Background: Carbon monoxide (CO) is a colorless, odorless gas produced as a by-product of incomplete combustion of hydrocarbons. CO binds rapidly to Haemoglobin (Hb), leading to the formation of carboxyhemoglobin (COHb), so the oxygen carrying capacity of the blood will be decreased and causing tissue hypoxia.Case Report: A 35-years-old male mechanic was found unconscious at automobile garage and he was dead after hospitalization on same day after one hour. On external examination, Rigor mortis had occurred all over the body. Cherry red postmortem lividity was present over back. Hypostasis, sub-scalpel tissue, muscles of chest and abdominal wall were cherry red in color suggestive of carbon monoxide toxicity. The chemical analysis report of blood and viscera confirmed toxicity due to carbon monoxide poisoning.Conclusion: Accidental carbon monoxide poisoning in vehicles can occur due to leaking exhausts and inadequate ventilation, but some cases in fatal concentration of CO was found even with garage door had opened or in the absence of defective exhaust systems. Each of the CO poisoning hazard scenarios reflects either product malfunction resulting in high CO emissions and/or some failure to adequately remove CO from the living or recreational environment. Use of catalytic converters in vehicles has reduced carbon monoxide emission considerably. The sudden death of a mechanic due to excessive inhalation of the carbon monoxide gas due to defective exhaust systems and poorly ventilated in automobile garage.