Vol.19 Issue No.1 (2023): Journal of Indian Society of Toxicology

Hazard Identification and Risk Assessment (HIRA) in the Autopsy Activity: An Observational Study

2023-11-14 04:05:15

Occupational Health & Safety measures are well comprehended in the industrial sector due to the Factories Act and local legislation. Such measures are not percolated in the health sector due to the lack of awareness, and very few studies available in this area. The range of services offered by a tertiary healthcare facility includes mortuary services. The medical staff and the relatives of the deceased may be at risk in mortuaries or post-mortemrooms. The study aimed to analyze existent practices and Occupational Health and Safety (OSH) measures in autopsy activity and to identify inherent hazards and associated risks. This is an observational study conducted at the mortuary of the Forensic Medicine Department, in a Government tertiary care hospital in Patna, Bihar (India). Standard Methodology of Hazard Identification and Risk Assessment followed from ILO publication. Biological risks include coming into contact with the deceased's bodily fluids and splashes, spills, and aerosols as a result of post-mortem room activities for the staff members involved in moving the body to the mortuary. The physical risks include slip-and-fall accidents and related injuries. Potential chemical risks include contact dermatitis and allergic asthma caused by exposure to formalin vapours during embalming processes and medications/chemicals used by the deceased. The personnel are susceptible to a number of illnesses, including hepatitis, lung TB, hepatitis C, HIV, and COVID-19. exposure to radiation a possibility for the X-ray technician and assistance. Musculo skeletal conditions and injuries brought on by repeated action in the shoulder, small joints of the hand, and elbow are examples of ergonomic dangers. PPEs were rarely used consistently in most mortuary areas. The use of risk reduction techniques like replacement, engineering controls, administrative controls, and personal protective equipment (PPE) is necessary, as is periodic occupational health surveillance.

Clinical Outcome in snake bite envenomation patients based on their time of presentation

2023-11-14 04:05:15

Snake bite is a medical emergency requiring timely intervention. Apart from the panic attack and the local injury, snake bites have no adverse effects on the patient. The common cobra (Najanaja), Russell's viper, saw-scaled viper, and common krait are four of the 13 poisonous species that are known to exist. This was a cross-sectional study of patients who presented with snake bite envenomation admitted to a tertiary care centre in central Karnataka between July and December 2022. The objective of the study was to assess the clinical outcome in patients with snake bite envenomation based on their time of presentation after the snake bite to a tertiary care centre. The subjects were stratified into two groups based on their time of presentation as early and late presentation groups and the need for ASV (anti-snake venom), FFP (fresh frozen plasma), development of cellulitis, conservative or surgical measures required for cellulitis, development of other complications like AKI (acute kidney injury) and need for hemodialysis was compared in these two groups. Pregnant women and patients with less than 18 years of age were excluded from the study. After a primary and secondary survey, WBCT20 mins along with coagulation factors was noted in two groups, need for ASV, need for FFP, development of complications like cellulitis, AKI is compared in both groups along with management measures whether conservative or surgical, need for hemodialysis was compared in two groups. In this study, of 30 patients 76.6 % were males 26.6% ofthepatientswerebetween30-39 years of age.23 patients (76.6%) presented within 6h (early presentation).7 patients (23.4%) were in the delayed presentation group. WBCT 20 mins and coagulation profile was prolonged in all patients who presented late (more than 6h). 85.7% of patients who presented late required more than 20 vials of ASV whereas 30% of patients who presented early did not even require ASV. 57 % of patients who presented late required 12or more pints of FFP whereas 60% of the patients who presented early did not require FFP transfusion. 57% of patients (4 patients) who presented late died during the course of treatment whereas 86.9%of patients who presented early were conservatively managed. AKI developed in all patients who presented late and hemodialysis was required in all those patients who developed AKI. Snakebite is a medical emergency. Patients if brought early within a few hours of snake bite can be conservatively managed and those patients are less likely to develop complications like cellulitis and AKI and even death.

Methemoglobinemia Induced by Dermal Exposure to Aniline Dye

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We report a case of severe methemoglobinemia induced by dermally absorbed aniline dye in a young adult.The purpose of this case report is to increase awareness among healthcare providers about the occurrence of such cases in the industrial beltin the Delhi NCR region which has textile units using aniline compounds as fabric dyes.

Death Due to Accidental Diesel Poisoning

2023-11-14 04:05:15

Hydrocarbons are a group of organic substances made up of hydrogen and carbon molecules. Among the various groups of hydrocarbons, the commonly used fuels like petrol and diesel are classified under aliphatic hydrocarbons. Diesel is fuel for engines in automobiles and for electricity generators.

We present a case of a 55-year-old male, an auto driver by occupation who accidentally ingested diesel and got admitted to GGH, Nizamabad. He developed aspiration pneumonia and expired, following which an autopsy was conducted in this case. In this case, viscera were preserved for chemical analysis & lungs were preserved for histopathological examination. The chemical analysis of viscera revealed traces of inflammable hydrocarbons and on histopathological examination of the lungs indicated aspiration pneumonia. On HPE of the lungs, it was observed that there was intra-alveolar serous accumulation and lymphomono nuclear inflammatory cell infiltrates. Additionally, the alveolar septa showed thickening and congestion, indicating the presence of aspiration pneumonia.

Hydrocarbon exposure leads to a spectrum of manifestations like pneumonitis, myocarditis, skin lesions, mediastinitis, and Parkinson's disease. Diesel is considered to have a relatively low aspiration potential compared to other substances, and fatal cases of diesel poisoning due to aspiration are uncommon.

In cases of chemical pneumonitis caused by hydrocarbon poisoning, the respiratory rate serves as a crucial prognostic factor for determining mortality. A high respiratory rate at the time of presentation is associated with poor outcomes and an increased risk of fatality. The development of Acute Respiratory Distress Syndrome (ARDS) is the ultimate pathway of toxicity in these cases, as observed during autopsy examinations.

Deliberate Use of Ketamine by A Healthcare Professional

2023-11-14 04:05:15

Suicidal tendencies among healthcare professionals are one of the significant problems. Data on suicide among healthcare professionals are alarmingly increasing globally. India is home to approximately 1 million doctors, the largest globally. Medical Students and trainees often commit suicide. Suicide among healthcare professionals occurs due to improper balancing of personal and professional lives. The methods used for suicide vary from violent methods (hanging, falls) to drug overdose. Due to easy access to controlled drugs, non-medical use leads to addiction, disease, and mental disorders in the impaired healthcare professional. For both recreational and self-harm, commonly used are anaesthetic drugs. Ketamine is one of the easily accessible drugs available for healthcare professionals working in the ICU and CCU. It is increasingly gaining popularity as a recreational drug due to its hallucinatory effects and feelings of disconnect. We present a case of a healthcare worker working in an ICU who deliberately used ketamine for self-harm.

Chronic Agrochemical Substance-Induced Axonal Neuropathy (CASIAN): A Focused Review of the Literature

2023-11-14 04:05:15

Chronic Agrochemical Substance-Induced Axonal Neuropathy (CASIAN) has emerged as a tnacfi ingisconcern in India due to the substantial number of individuals involved in agricultural activities. This article aims to provide a comprehensive review of the association between long-term exposure to pesticides and peripheral neuropathy in pesticide applicators and farmers which was established in several clinical and preclinical studies so far. While the exact molecular mechanisms underlying chronic toxic peripheral neuropathy caused by these substances remain unclear, there is a consensus that it primarily involves axonopathy. Toxic Peripheral neuropathy is characterized by a range of challenging clinical features that can yltnacfiingis affect an individual's quality of life, especially in the Indian geriatric rural population. These features include but are not limited to, chronic pain, numbness, tingling, burning sensations, muscle weakness, muscle cramps, and difficulty with balance and coordination. Moreover, it is imperative to develop quality biomarkers for chronic exposure to agrochemical substances and validate them for routine use. Genetic factors responsible for chronic toxicity should also be given due consideration by researchers. Ultimately, a national-wide multicentric cohort study is required to comprehensively investigate peripheral neuropathy caused by agrochemical substances and provide valuable insights into effective prevention and treatment strategies.

Pocketbook of Poisoning Protocols

2023-11-14 04:05:15

This book entitled “Pocketbook of Poisoning Protocols” edited by V.V. Pillay, Devendra Richhariya, S. Senthilkumaran and other authors is a very handy book for the practicing physicians. This is very specially designed for the management protocols on the common poisoning cases encountered in India.

The information regarding the diagnostic clues, clinical management and forensic issues about the poisons, drugs and toxins is elaborated in a very concise manner in the form of tables and bullet formats.

Most of the outdated concepts regarding the treatment of poisoning are eliminated. The information regarding each poisoning is incorporated in a straightforward, lucid language with regard to their common names, physical appearance, active principles, clinical features, diagnosis, management and forensic aspects. And because of this common format, it will attract the attention of many readers. This has also covered very precisely meticulously preserving and dispatching the viscera, formation of final opinion in poisoning cases, and giving evidence in the court of law in poisoning cases.

Finally in my opinion this book is very handy (Hence the name Pocketbook), crispy, concept concept-based. Practicing physicians in emergency medicine should keep this book on hand for quick reference.