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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Public health,acute toxicity,Herbal Drug,Fatal Poisoning,Intensive care
- چکیده:
- چکیده انگلیسی: Background: 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.
Case presentation: 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.
Discussion: 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.
Conclusion: The described cases of unknown herbal poisoning in Bangladesh highlight the need for awareness campaigns targeting the population at risk.- انتشار مقاله: 13-12-1396
- نویسندگان: Ariful Basher,Kamruzzaman Khokon,Ulrich Kuch,SW Toennes,M Abul Faiz
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Benzodiazepine,Commuters,Poisonings
- چکیده:
- چکیده انگلیسی: Introduction: Drug-facilitated robberies, primarily of public transport passengers, are a massively increasing public health emergency and law enforcement challenge in Dhaka, the capital city of Bangladesh.
Methods:We conducted a prospective clinical and toxicological study of 38 patients with acute poisoning who had been admitted to Dhaka Medical College Hospital between October 2008 and December 2008 and suspected to be victims of drug-facilitated crimes. Blood samples were obtained on admission and one hour later to identify changing concentrations of the drugs used by the perpetrators. Toxicological screening was performed by LC-TOF/MS and LC-MS/MS analysis of the blood samples of 22 of these patients.
Results:All of the patients in our series were male, 17-60 years of age, and none had any memory of the time between the ingestion of the drug and the onset of unconsciousness. All had lost the valuables they had been carrying at the time of the incident. On admission, 50% of the patients had a Glasgow Coma Score (GCS) of 5-10. Most of them were poisoned while travelling (79%), most frequently by bus (70%). They had been offered tea (21%), other drinks (26%), prickles (18%), herbal medicines (10%) or cigarettes (5%) by the suspected perpetrators. Screening by LC-TOF/MS and LC-MS/MS revealed pharmacologically active concentrations of lorazepam in the blood samples of all 22 cases (191±138 µg/l, mean±SD); midazolam in 12 (149±99 µg/l); diazepam in 3 (217±144 µg/l) and nordiazepam in 6 cases (364±186 µg/l). In five cases the lorazepam concentration of the second blood sample was at least 15% higher than in the sample drawn on admission one hour earlier, indicating continuing absorption. This suggests that only these five patients had been admitted within the 1-2 hour long absorption phase. Almost all of the patients left the hospital unnoticed after clearing up, two likely prematurely within 12 hours of admission, and no mortality was observed.
Conclusions:This study reveals flexibility of the criminals in Dhaka in using different mixtures of benzodiazepines to incapacitate and then rob their victims.The findings of our study have important implications for the clinical management of drug-facilitated crime victims. In particular, they highlight an urgent need to widely deploy rapid diagnostic and analytical forensic and clinical toxicology facilities in Bangladesh, introduce and implement modifications to emergency department protocols, and provide post-recovery psychological support for victims who often suffer existentially threatening economic losses in addition to the poisoning.- انتشار مقاله: 18-12-1395
- نویسندگان: Ariful Basher,M Abul Faiz,Syed M Arif,MAK Khandaker,Ulrich Kuch,SW Toennes
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Bangladesh,Organophosphate Poisoning,Atropine,Clinical Protocols
- چکیده:
- چکیده انگلیسی: Background:Acute poisoning with organophosphorus (OP) pesticides is a common method of suicide and entails considerable mortality in Bangladesh. The objective of this study was to evaluate the effects and outcomes of a protocol for treatment of OP poisoning that included titrated incremental atropine as loading dose and slow infusion for maintenance.
Methods:In this prospective descriptive case series, definitive OP poisoned patients were enrolled in an adult medicine unit of Dhaka Medical College Hospital from April 2006 to April 2007. Clinical examinations were done as soon as the patient entered the ward. Patient’s demographics, comorbid conditions and the occurrence of specific clinical outcomes including death, need for assisted ventilation and clinical complications were recorded. The patients were treated according to the protocol.
Results: A total of 56 patients were enrolled over the study period. The median age of the study population was 22.5 years. Most patients were men (67.8%). The most common clinical presentation was miosis (58.9%). In total, 11 patients died (19.6%). Intermediate syndrome developed in 12 patients (21.4%) and 6 of them died. Assisted ventilation was required in 16 cases (28.5). Patients with diastolic blood pressure ≤ 70 mmHg and/or GCS ≤ 10 were significantly less likely to survive (P = 0.02, 0.006, respectively). Moreover, early respiratory failure (P < 0.001) and the need for assisted ventilation (P < 0.001) were significantly higher among deceased cases. The mortality rate in this study was similar to previous studies. The frequency of atropine toxicity in the present study (1.8%) was considerably lower than conventional regimen used in previous studies.
Conclusion:Using the new protocol, lower rate of atropine toxicity developed in victims. Hence, the new protocol appears to be safer and its effectiveness should be further evaluated in case control studies in Bangladesh.
How to cite this article: Ahmed AS, Basher A, Amin MR, Faiz MA. Effect of Intensive Atropine Doses (Rapid Incremental Loading and Titration) for Management of Organophosphorus Pesticide Poisoning: a Case Series. Asia Pac J Med Toxicol 2014;3:23-6.- انتشار مقاله: 01-12-1391
- نویسندگان: Abu Saleh Ahmed,Ariful Basher,Mohammad Robed Amin,Mohammad Abul Faiz
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Bangladesh,Acute poisoning,Pharmaceutical,Chemical,Suicide
- چکیده:
- چکیده انگلیسی: Background: Acute poisoning is a major public health problem in Bangladesh. It is a common method for suicide. A clear picture regarding clinical presentation, most commonly used toxic agents, background factors and outcome of poisoned patients is necessary in every region. The aim of this study was to investigate frequency and outcome of acute pharmaceutical and chemical poisoning cases in Northern Bangladesh.
Methods: This was a retrospective descriptive study on poisoned patients with 18 years of age and above who were admitted to Rangpur Medical College Hospital during 1st December 2011 to 30th November 2012.
Results: During the study period, a total of 956 patients were investigated. Males slightly outnumbered females (51.6%). The majority of patients (92%) were in the 18-40 year age-group. Regarding occupation, housewives were the most frequent (33.6%) followed by farmers (31.7%) and students (20.9%). Organophosphate compounds (OPC) were the most commonly used toxic agents (73.5%). Most of poisoning cases occurred following suicidal attempts (88%). Familial disharmony was the main cause of suicidal attempts (92.3%). Univariate Analysis showed that age less than 40 years, being married, living in rural areas and educational attainment below secondary level were significantly associated with an increased risk of poisoning (P<0.001).
Conclusion: All tertiary hospitals should be well equipped with antidotes of OPCs and other supportive treatments in Bangladesh. Furthermore, strong rules must be applied to prevent the distribution of benzodiazepines without prescription. In addition, people with age of less than 40 years, housewives and farmers, rural residents and those with less educational attainment should be targeted for prevention and educational programs against deliberate self-poisoning.- انتشار مقاله: 08-11-1391
- نویسندگان: Devendranath Sarkar,Mohammad Shaheduzzaman,Mohammad Ismail Hossain,Mainuddin Ahmed,Nur Mohammad,Ariful Basher
- مشاهده