Red-Alarm against Fibers Concentration of Asbestos in Atmospheric Urban Area of Tehran Capital of Iran

Kh Agin

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 4(Autumn) (2014), 5 December 2014, Page 119-121

Asbestos is the natural silicate minerals with attractive physical properties such as; resistant to fire, electrical and chemical solvents. It composes of six types of materials include; Serpentine group; Chrysotile, Amphibole groups; amosite (Brown), Crocidolite (Blue) and other materials. It is popular for low cost favorable properties. All the six types have asbestiform fiber crystal, and can induce carcinogen in human. It was generally used during the boom of the industrial revolution since 1866, and the first publish of the unhealthy effect of asbestos reported nearly 30 years after industrial usage since 1899. The most common usage types of asbestos consist of chrysotile and the crocidolite. All the current types widely use in the building structures, brake pads (1) and clutch disc (2).

Daily inhalation of asbestos occurs in the ambient air of cities which associated with poor air quality control. This event leads to generation of asbestosis disease (3), cancer development and mortality (4) and morbidity among at-risk population, such as asbestos –exposed workers (5), non-occupational subjects, people who living in  the asbestos fibers exposed environment (6).

Corresponding author: Agin Kh, MD. Associated Professor of the Respiratory Medicine. Logman Hakeem General Teaching Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

E-mail: khosrow.agin@yahoo.com    &       Agin@sbmu.ac.ir

Long time exposure with asbestos leads to the development of chronic lung disease. It can be developed as occupational and non-occupational conditions (7, 8). Mesothelioma and lung cancer are the known causes of the asbestos exposure (9). In addition, it produces risk development of esophageal gastric, colorectal cancer (10) and head and neck squamous cell carcinoma (11). Children also are at risk of cancer by asbestos inhalation (12). The accepted threshold for asbestos is 100 fiber/liter that measured by phase-contrast optical microscopy (PCM) (13). There is a direct relationship between high level of asbestos in air and lung cancer (14).

 The first use of asbestos in Iran returns to World War II during the foundation of railroad and beginning product of cement manufacture in 1958 (15). Meanwhile, asbestos is producing up to 55000 tones cement in Iran annually, and near the 94% of produced cement that used in our country. The current output predominantly detected in the manufacture of building material (16), as pipe in the water delivery network (5000 Kilometer), brake pads (17) and pad shoes (15, 18).  The most common types of asbestos observed in the ambient urban area of Tehran, including; Chrysotil (60%), tremolite (10%), antophylline (10%) (19). The rate of asbestos in air of Tehran- Iran was 68 times higher in the USA in 2009 (19). Our ministry of health in 2013 reported that the asbestos levels in the Tehran was 50-100 times more than the standard definition of the world (20).

It seems that the deadline of depreciating has been finalized to the issue of asbestos fibers in our atmospheric cities. It requires a national decision, though the creating practice planes in reducing the level of usage and replacement that with safe materials.

Original Article

Demographic Factors, Duration and Costs of Hospitalization, and Causes of Death in Patients Intoxicated with Opioids and Amphetamines

MR Yazdani, N Tavahen, GR Masoumi, F Gheshlaghi, Z Dana-Siadat, M Setareh, N Eizadi-Mood

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 4(Autumn) (2014), 5 December 2014, Page 122-129

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.

Pre-Interventional Cardiac and ECG Changes in Acute Organophosphate Poisoning Cases Admitted to a Tertiary Hospital in India

H S Gouda, R Kodali, Sasanka P, Mahadeshwara Prasad D.R, Manjula Bai K.H

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 4(Autumn) (2014), 5 December 2014, Page 130-135

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.

Materials and Methods: A total of 151 subjects were sequentially enrolled among public drivers with traffic related respiratory diseases. The total IgE antibodies in serum were measured according to manufacture recommendation.

Results: The mean age recorded 47.66±8.82 standard deviation (SD). The peripheral eosinophil proportion was 3.19±2.16 SD. The mean IgE antibody levels were 205.89±238.67SD. Allergic state was found in 47% of target population. Frequencies of traffic-related air pollution diseases (TRAPD) in chronic obstructive pulmonary disease (COPD) 34%, asthma 25%, rhinitis 21% and bronchitis 21%, respectively. Allergic state distributed high frequency in asthma, rhinitis, COPD and bronchitis diseases, respectively.

Conclusion: Allergic biomarkers of IgE antibody and peripheral eosinophilia were widely distributed among TRAPD. They observed more frequency on the allergic base diseases than non-allergic small airway diseases. It may be reflected the actual role of traffic -related air pollution on the sensitization of all categories of TRAPD.

Case Report

Organophosphate Toxicity Presenting with Cholinergic Crisis, Intermediate Syndrome and Delayed Polyneuropathy in Succession: a Rare Presentation

S Malkarnekar, Naveen L, S Reddy Adam

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 4(Autumn) (2014), 5 December 2014, Page 145-148

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.

Aluminium Phosphide Poisoning: a Case Report

SS Vaghefi, MA Emamhadi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 4(Autumn) (2014), 5 December 2014, Page 149-153

Background: Aluminum phosphide as 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.

Explode Metacarpal Bone by Gunshot: A Case Report

B Mostafazadeh, MA Emamhadi, M Shakeri, N Asadinejad, A Esmaeelzadeh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 4(Autumn) (2014), 5 December 2014, Page 154-157

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.

Accidental Death due to Carbon Monoxide: Case Report

M Chand Meena

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 4(Autumn) (2014), 5 December 2014, Page 158-161

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.