exudates and Poisoning

We retrospectively reviewed poisoning admissions to all government health facilities from 1999 to 2001, in an effort to expand our current knowledge on poisoning in Malaysia to a level that better reflects a nationwide burden. There were 21 714 admissions reported with 779 deaths. The case-fatality rate was 35.88/1000 admissions. The majority of admissions (89.7%) and deaths (98.9%) occurred in adults. Some 55.1% of all admissions were female, mostly involving pharmaceutical agents. Male poisoning admissions were more often due to chemical substances. The prevalence of poisoning and death was highest among Indians compared to all other races in Malaysia. Overall, the majority of poisoning admissions were due to pharmaceutical agents, with agents classified as non-opioid analgesics, anti-pyretics and anti-rheumatics the most common. Pesticides accounted for the largest number of fatalities. It was also the commonest substance reported in cases of intentional self-harm. Most cases of poisoning admissions occurred due to accidental exposure (47%), followed by cases of intentional self-harm (20.7%). Overall, this study has managed to contribute substantial additional information regarding the epidemiology of poisoning in Malaysia, highlighting important issues, such as the rampant poisonings involving pesticides and analgesics, as well as the high prevalence of poisoning among Indians in Malaysia.

Topics: Drug-Related Side Effects and Adverse Reactions; Hospitalization; Hospitals, Public; Humans; Malaysia; Pesticides; Poisoning; Solvents

Pesticide poisoning is a global health problem, and its progressive deterioration is a major cause of concern. The objective of this study is to assess epidemiological characteristics and identify risk factors of pesticide poisoning in Malaysia.. Pesticide poisoning database of Malaysia National Poison Centre (NPC) from 2006 to 2015.. Telephone enquiries regarding pesticide poisoning were made by healthcare professionals. Information received by the NPC was entered into a retrievable database of standardised Poison Case Report Form, as adapted from the World Health Organization (WHO).. The outcome of the study is to provide an overview of national epidemiological profile of pesticide poisoning. High-risk groups of people and their circumstances were also identified to ensure that appropriate measures are strategised.. Within the study period, a total of 11 087 pesticide poisoning cases were recorded. Sixty per cent of these cases were intentional in nature and most were found among male individuals (57%) of the Indian race (36.4%) aged between 20 and 29 years (25.5%), which occurred at home (90%) through the route of ingestion (94%). The highest number of poisoning was due to herbicides (44%) followed by agricultural insecticides (34%), rodenticides (9.9%), household insecticides (9.5%) and fungicides (0.5%). In addition, 93.6% of intentional pesticide poisoning cases were caused by suicide attempts. The results of this study show that there was an increasing trend in pesticide poisoning incidents over the 10-year duration. This indicates that pesticide poisoning is a prevalent public health problem in Malaysia, resulting in an average incidence rate of 3.8 per 100 000 population.. Deliberate pesticide ingestion as a method of suicide has become a disturbing trend among Malaysians. Therefore, regulation of highly hazardous pesticides must be enforced to ensure controlled and limited access to these chemicals by the public.

Topics: Adult; Humans; Malaysia; Male; Pesticides; Poisoning; Poisons; Retrospective Studies; Risk Factors; Young Adult

There are increasing reports of methanol poisoning (MP) incidence worldwide. In Malaysia, the largest first methanol poisoning was reported in Selangor in 2013 with a total of 41 patients and cluster of cases been reported from the country since then. Often MP involved adulterated alcohol containing more than the legal permissible concentration of methanol. Methanol is rapidly absorbed and metabolised into formic acid which causes variable symptoms of the central nervous system such as blindness, seizure, coma and gastrointestinal disturbances. Mortality could reach up to 83% as reported using the coma state, pH and pCO2 level in the worst-case scenario.

Topics: Adult; Fatal Outcome; Hospitals, District; Humans; Malaysia; Male; Methanol; Poisoning; Treatment Outcome

A methanol outbreak occurred in the district of Hulu Langat on 16 September 2018. The Hulu Langat District Health Office received 25 notifications of a suspected methanol poisoning from Kajang and Ampang Hospital. An outbreak investigation was done to determine the source followed by a preventive and control measure.. Active case detection was done on cases living quarters and workplaces. Patients were interviewed, and their blood and urine samples were sent for methanol analysis. Samples of suspected alcoholic beverages were also sent for analysis. A suspected case was defined as any person presented with clinical symptoms with a history of consuming alcoholic beverages within five days before symptoms and high anion gap metabolic acidosis. A confirmed case was defined as a suspected case with positive blood and urine methanol.. In total, there were 25 suspected cases, of which 12 cases were confirmed. The calculated attack rate was 48%. There were six mortalities (50%) secondary to severe metabolic acidosis. The most common presenting symptom was vomiting (75%) and abdominal pain (41.7%). These cases were linked to consumption of illicitly produced alcohol. Samples of the alcoholic drinks were positive containing high level of methanol.. The methanol outbreak in the Hulu Langat was successfully managed. Appropriate control and prevention measures were taken, including health promotion and joint enforcement activities. Steps were taken successfully through collaborations with multiple agencies and cooperation with Selangor Health Departments and the Ministry of Health. Continuous surveillance on the product of liquor, and health promotion are essential to prevent a similar outbreak from happening again in future.

Topics: Adult; Disease Outbreaks; Female; Humans; Malaysia; Male; Methanol; Middle Aged; Poisoning; Retrospective Studies; Young Adult

This study analyses the incidences and patterns of paraquat poisoning from calls received at the Malaysia National Poison Centre (NPC) since 2004 following the ban of the herbicide (2004-2006) and subsequent restriction up to year 2015. Related reported cases to the centre over twelve years (2004-2015) were retrieved and studied in respect to socio-demographic characteristics, mode and type of poisonings, exposure routes and location of incident. Ages of poisoned victims range from 10 months old to 98 years with males being intoxicated more frequently than females (ratio male to female = 2.7). The age group mainly involved in the poisoning was 20-39 years. The most common mode was intentional (62.8%) followed by unintentional (36.9%). Among the 1232 reported cases, suicidal poisoning was the highest (57.2%); accidental poisoning (30.8%) and occupational poisoning (3.3%). The findings showed an upward trend of suicidal poisoning over the years, clearly emphasizing the need for more stringent and effective enforcement to ensure the safe use of paraquat.

Topics: Accidents; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Herbicides; Humans; Infant; Malaysia; Male; Middle Aged; Paraquat; Poison Control Centers; Poisoning; Retrospective Studies; Sex Distribution; Suicide; Young Adult

Accidental or intentional poisoning is a public health concern requiring intervention. The current study designs to evaluate the types of poisoning exposure calls received by the Malaysia National Poison Centre (NPC) over a 10-year period.. The poisoning enquiries database (2006-2015) from the Malaysia NPC was used for the analysis.. The NPC records all telephone calls that it manages using a validated and standardised form. Demographics and types of the poisoning exposure calls were extracted and descriptive analysis was applied.. The primary outcome of this study is to evaluate NPC data for trends in the poisoning exposure calls based on the types and modes of poisoning over a 10-year period. The secondary outcome is to evaluate the characteristics of human exposure cases based on the calls received by the NPC.. There was a notable increase in the number of poisoning exposure calls noticed during the 10-year period but dropped significantly in 2012. The highest number of poisoning exposure calls came from Selangor (21.0%), Perak (18.0%) and Negeri Sembilan (9.8%). More than half of the exposure was intentional (53.8%) involving more women (50.3%) as compared with men (41.9%), and in the 20-29 years age group category (33.5%). Exposure mostly occurred at home (96%) through the ingestion route (94.1%). Pharmaceutical products (40.5%), pesticides (31.7%) and household products (20.1%) were the common agents implicated for intentional exposure.. There is an increasing trend in enquiries on poisoning exposure calls made to the NPC. Most of the intentional poisoning exposures occurred among younger women and involved pharmaceuticals, pesticides or household products. Poisoning safety education and other interventions are needed to curb poisoning incidents.

Topics: Accidents; Adult; Drug Overdose; Female; Household Products; Humans; Incidence; Intention; Malaysia; Male; Needs Assessment; Pesticides; Poisoning; Poisons; Retrospective Studies; Sex Distribution

Two freshwater fish, Rasbora sumatrana (Cyprinidae) and Poecilia reticulata (guppy; Poeciliidae), were exposed to a range of eight heavy metals (copper (Cu), cadmium (Cd), zinc (Zn), lead (Pb), nickel (Ni), iron (Fe), aluminium (Al), and manganese (Mn)) at varied concentrations for 96 h in the laboratory. Mortality was assessed and median lethal concentrations (LC50) were calculated. It was observed that the LC50 values increased with a decrease in mean exposure times, for all metals and for both fish types. The 96-h LC50 values for Cu, Cd, Zn, Pb, Ni, Fe, Al, and Mn were 0.006, 0.10, 0.46, 0.63, 0.83, 1.71, 1.53, and 5.71 mg/L for R. sumatrana and 0.038, 0.17, 1.06, 1.99, 15.62, 1.46, 6.76, and 23.91 mg/L for P. reticulata, respectively. The metal toxicity trend for R. sumatrana and P. reticulata from most to least toxic was Cu > Cd > Zn > Pb > Ni > Al > Fe > Mn and Cu > Cd > Zn > Fe > Pb > Al > Ni > Mn, respectively. Results indicated that Cu was the most toxic metal on both fish, and R. sumatrana was more sensitive than P. reticulata to all the eight metals.

Topics: Animals; Biological Assay; Cadmium; Copper; Environmental Monitoring; Fishes; Fresh Water; Heavy Metal Poisoning; Iron; Lead; Malaysia; Manganese; Metals, Heavy; Nickel; Poecilia; Poisoning; Water Pollutants, Chemical; Zinc

The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes.. The purpose of this study was to determine the availability of antidote stocking at hospitals, based on published guidelines for antidote stocking, and to evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia.. A questionnaire on the availability of antidotes was sent to all government accident and emergency departments in Malaysia. The list of commonly required antidotes and essential drugs was compiled from published guidelines. Collected data were analysed in SPSS version 16 using descriptive and comparative analysis.. The response rate was 59.06%. None of the responding hospitals stocked all of the antidotes on the lists. In relation to hospital type, there was great variability in the availability of antidotes (there were significant differences between hospitals for 13 antidotes). The availabilities of most antidotes were far better in the General Hospitals and the District Hospitals with specialists compared to District Hospitals without specialists. Calcium gluconate, sodium bicarbonate, atropine sulphate, naloxone, flumazenil, vitamin K, and pyridoxine were available at all general hospitals. Atropine sulphate and naloxone were available at all district hospitals with specialists.. Most Malaysian government hospitals stocked some important antidotes. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions. Coordination between Malaysian hospitals and the National Poison Centre at Universiti Sains Malaysia is also important.

Topics: Antidotes; Cross-Sectional Studies; Emergency Service, Hospital; Emergency Treatment; Health Care Surveys; Health Services Accessibility; Humans; Malaysia; Poison Control Centers; Poisoning

This study aimed to find the association between urinary aflatoxin M(1) level and milk and dairy products consumption. Of 160 morning urine samples collected, aflatoxin M(1) was detected in 61.3 % samples (n = 98) [mean ± SD = 0.0234 ± 0.0177 ng/mL; range = 0-0.0747 ng/mL]. Of these positive samples, 67.3 % (n = 66) had levels above the limit of detection. Respondents with intake of milk and dairy products above median (67.79 g/day) had significantly high level of AFM(1) compared to those with low intake. A significant and positive association (φ = 0.286) was found between milk and dairy products consumption and urinary aflatoxin M(1) level.

Topics: Adult; Aflatoxin M1; Animals; Cattle; Dairy Products; Diet; Female; Food Contamination; Goats; Humans; Malaysia; Male; Middle Aged; Poisoning; Poisons; Sheep; Young Adult

Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.

Topics: Acute Disease; Cross-Sectional Studies; Decontamination; Emergency Service, Hospital; Emergency Treatment; Humans; Malaysia; Poisoning; Surveys and Questionnaires; Therapeutic Irrigation

This article highlights methods of ending life in different ethnic groups. This inference is drawn from analysis of data from suicidal cases from the University Malaya Medical Centre mortuary. This study also looked at sex, age, social, and employment factors. Kuala Lumpur has sizeable populations of Muslims, Chinese, Indians and Indonesian, etc. This study is based on 251 cases of suicide that were reported at the University Malaya Medical Centre from 2000 to 2004. Malaysia has a population of 22,662,365 people with 3 major ethnic groups: Malay (58%), Chinese (24%), and Indians (8%) with a minority of "others" (10%), which includes foreigners, Sabahan, and Sarawakian. This research found suicides of 164 male (65%) and 87 female (35%) victims. Their age ranged from 15 to 80 years. The age group from 21 to 30 had the highest total cases of suicide (83 of 251; 33.1%). Among ethnic groups highest rate of suicide was among Chinese with a total of 120 cases (120 of 251; 47.8%). As far as lone method of suicide is concerned, hangings accounted for the highest proportion of cases (108 of 251; 43%). Among ethnic groups, jumping from height was the commonest method used by Chinese (49 of 120; 41%), Malay (9 of 16; 56%), and others (15 of 28; 53.4%); whereas, hanging was the commonest method of committing suicide by Indians (49 of 87); Muslims showed the lowest cases of suicide (18 of 251; 7.2%). In poisoning group Indian was the highest ethnic group who used this method (20 of 37; 54.1%).

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Asphyxia; Ethnicity; Female; Forensic Pathology; Humans; Malaysia; Male; Middle Aged; Neck Injuries; Poisoning; Retrospective Studies; Sex Distribution; Suicide; Young Adult

Data on adult risk factors associated with drug or chemical poisonings in Malaysia are scarce. The objective of the study was to identify possible risk factors associated with adult admissions to the Penang General Hospital (PGH) due to chemical poisoning and/or drug overdose. The present study was a case-control study, conducted over 18 weeks. One hundred acutely poisoned adult patients admitted to PGH during the period from September 2003 to February 2004 were considered as cases. Two hundred patients admitted to the same medical wards for other illnesses, during the same period, were matched for age and gender with the poisoned cases and thus selected as controls. McNemar test and binary logistic were used for univariate analysis and logistic regression analysis for multivariate analyses. The odds ratio (OR) and its 95% confidence interval (95% CI) were calculated for each predictor variable. Positive histories of psychiatric illness and previous poisoning, problems in boy/girl friend relationships, family problems, marital problems, Indian ethnicity, Chinese ethnicity, living in rented houses and living in a household with less than five people were significant risk factors associated with adult admissions due to poisoning.

Topics: Adolescent; Adult; Aged; Case-Control Studies; China; Drug Overdose; Ethnicity; Family Relations; Female; Health Status; Household Products; Humans; India; Malaysia; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Poisoning; Regression Analysis; Risk Factors; Socioeconomic Factors

Acute poisoning is a significant health problem all over the world. In Malaysia, nationwide data on poisoning pattern is scarce and incomplete. The objectives of our study were to determine the pattern of acute drug and chemical poisoning at Penang General Hospital (PGH), in the northern region of Malaysia, and to compare poisoning characteristics between different ethnic groups. The study was a retrospective case review of all poisoned patients admitted to PGH during the years 2000-2002. We collected data concerning demographic parameters of patients, information about the agent(s) implicated, and circumstances surrounding the event. There were 493 poisoning incidents. Nearly two-thirds of the poisoned cases involved female patients. The predominant mode of poisoning was intentional (51.5%). The age group 15.1-30 years ranked at the top, constituting 55.2% of all cases. Drugs were the predominant agents implicated. Among cases associated with drugs, paracetamol was the main causative agent (44.7%). Chinese patients constituted 37.7% of all poisoning cases, followed by the Indians (31.6%) and Malays (26.6%). Between ethnic groups, Indian patients were found to have the highest rate of poisoning admission of 75.2 per 100,000 persons.

Topics: Accidents; Acetaminophen; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Asian People; Demography; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Female; Household Products; Humans; Malaysia; Male; Middle Aged; Pesticides; Poisoning; Retrospective Studies; Sex Factors; Suicide, Attempted

A retrospective review of medical records was carried out to determine the pattern of drug and chemical poisoning cases admitted to a teaching hospital in Malaysia. Medical records of patients admitted during the period January 1987 to December 1995 were reviewed. They accounted for 0.2% of total admissions during the period. While all ages were represented, there was predominance of children, which showed little change throughout the nine-year period. Of all cases of poisoning, 77.8% were unintentional, 12.6% intentional and 9.6% were undetermined. Kerosene, pesticides and medicinal substances remained the common agents associated with poisoning. A significant number of patients sought treatment elsewhere before being admitted to the hospital. Of those who came directly to the hospital, many were presented late in the course of their poisoning. Only seven patients died and none were children. This study supports the need for greater emphasis on prevention of poisoning in children and among farmers in the state.

Topics: Adolescent; Adult; Age Distribution; Child; Child, Preschool; Female; Hospitalization; Hospitals, Teaching; Humans; Incidence; Infant; Malaysia; Male; Middle Aged; Poisoning; Retrospective Studies; Sex Distribution

In 1997, the Ministry of Health Malaysia introduced a surveillance programme for occupational and work-related diseases including poisonings for cases seen in government health facilities. Between June 1997 and November 1998, there were 36 cases of respiratory disease and 95 cases of poisoning by chemicals and pesticides notified while skin diseases were 108 cases. Respiratory diseases reported were predominantly occupational asthma (25%), pneumoconiosis (17%) and infections (39%). The commonest reported skin disease was contact dermatitis (87%). The commonest causes of occupational poisonings were paraquat (19%), organo-phosphates (16%), agro-chemicals excluding pesticides (15%) and gases (10%). The number of cases reported is still relatively few compared to data from other countries, suggesting that there is still considerable under reporting.

Topics: Adult; Aged; Female; Humans; Lung Diseases; Malaysia; Male; Middle Aged; Occupational Diseases; Poisoning; Skin Diseases; Time Factors

In a case control study, 70 children consecutively hospitalized for acute ingestion of poisons were compared with 140 other hospitalized children matched for age. Children aged less than 3 years and boys were most often the victims. Univariate analysis identified Indian race, having a parent younger than 21 years, residing at present address for less than 1 year and living in a household with more than five occupants as significant risk factors. Experience of a recent stressful event in the family barely failed to reach the level of significance. Logistic regression analysis confirmed that Indian race, having a parent younger than 21 years and residing less than 1 year at the present address were independent predictors of acute poisoning. Positive interactions were noted between Indian race and duration of residence and between parental age and duration of residence. Knowledge of risk factors and their interactions may be useful in planning preventive measures against childhood poisoning.

Topics: Age Factors; Case-Control Studies; Child; Child, Preschool; Female; Humans; India; Infant; Logistic Models; Malaysia; Male; Poisoning; Population Dynamics; Risk Factors; Urban Population

Topics: Humans; Malaysia; Poisoning

Topics: History, Modern 1601-; Malaysia; Pharmaceutical Preparations; Poisoning; Religion and Medicine

Topics: Humans; Malaysia; Poisoning; Poisons; Statistics as Topic; Suicide

Topics: Adolescent; Adult; Aged; Child; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Length of Stay; Malaysia; Male; Middle Aged; Poisoning; Prospective Studies; Self Medication

Topics: Adolescent; Adult; Atropine; Cholinesterases; Female; Humans; Insecticides; Malaysia; Male; Phosphates; Poisoning; Positive-Pressure Respiration; Pralidoxime Compounds; Suicide

Topics: Acids; Adolescent; Adult; Alkalies; Arsenic Poisoning; Barbiturates; Child; Child, Preschool; Female; Humans; Infant; Insecticides; Malaysia; Male; Middle Aged; Poisoning; Suicide