Hair Dye poisoning: "An early intervention"

Black stone poisoning with a unique complication of posterior reversible encephalopathy syndrome (PRES)

A 25-year-old woman presented to the emergency department with difficulty in breathing, within 12 hours of intentional black stone ingestion, that is, para-phenylenediamine (p-PD), a chemical component of hair dye. Video laryngoscopy was done which showed laryngeal oedema and got intubated immediately to prevent respiratory failure. She got admitted to the intensive care unit and rigorous fluid resuscitation was done due to acute kidney injury secondary to rhabdomyolysis. On the 5th day, she got extubated after a successful spontaneous breathing trial, and step down to the high dependency unit, where she had four episodes of seizures in a day. After antiepileptic medication initiation, seizures were settled, brain imaging done to rule out stroke showed a finding suggestive of posterior reversible encephalopathy syndrome. Adequate intravenous fluid resuscitation was performed and blood pressure monitored closely. She remained vitally stable and clinically better hence discharge home with clinic follow-up on the 9th day of hospitalisation.

Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades

BACKGROUND

Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan.

AIMS

Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons.

METHOD

We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria.

RESULTS

Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide ('wheat pills') was a preferred agent in North Punjab, whereas paraphenylenediamine ('kala pathar') was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison.

CONCLUSIONS

Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.

Esophagitis Dissecans Superficialis (EDS) Secondary to Hair Dye Ingestion: Case Report and Literature Review

Esophagitis dissecans superficialis (EDS) is a rare and underdiagnosed esophageal lesion characterized by sloughing of the esophageal mucosa that has been associated with medications, various autoimmune disorders, and exposure to some chemical irritants. Anatomically, EDS is most commonly seen in the middle and distal thirds of the esophagus. When present, EDS is best treated by discontinuing the offending agent and initiating pharmacologic therapy with proton pump inhibitors. Steroids may also be effective if the etiology is autoimmune in nature. Our case highlights a 65-year-old female diagnosed with EDS after incidental ingestion of hair dye containing resorcinol and para-phenylenediamine (PPD).

Personal-Care Cosmetic Practices in Pakistan: Current Perspectives and Management

To look superior and acceptable in society, people from all over the world use various types of cosmetic products to enhance or alter their facial appearance and body texture. In recent times, an exponential surge in cosmetic use has been observed in Pakistan, and hence spending money on personal-care products is high. However, there are many reported facts about high loads of lead, mercury, copper, and others hazardous and cancerous elements in local Pakistani cosmetic brands. Consumers of these brands are at high risk of many clinical issues, including cancer. As such, it is a necessity to make people aware of the devastating harmful effects related to cosmetic use. The aim of this study was to provide information for stakeholders and raise awareness in the general public about the use of these local unauthorized personal-care cosmetic products, along with government strategies to stop this cosmetic blight on human health.

Fast-changing life-styles and ecotoxicity of hair dyes drive the emergence of hidden toxicants threatening environmental sustainability in Asia

The practice of hair dyeing is a rapidly expanding industry on a global scale; however, it has become a major concern for Asian countries because they have been undergoing rapid transformations of their environment and lifestyles. While the socio-economic benefits and impacts of this globalization trend are widely understood, the environmental effects are largely unknown. In particular, commonly available oxidative dyes potentially pose specific environmental risks due to their use of a toxic aromatic amine p-Phenylenediamine (PPD). In investigating the environmental impacts of PPD chemicals, we first provide context to the study by setting out the socio-psychological drivers to industrial expansion in Asian countries along with an overview of research into its effects, to show that its environmental impacts are under-researched. We then investigate the environmental toxicity of PPD by focusing on the role of microbes in metabolizing waste products. Results show that Acinetobacter baumannii EB1 isolated from dye effluent prevents autoxidation of PPD under oxygen-enriched (shaking) or oxygen-deficient (static) conditions representing different environmental settings. Microbes transformed PPD into more toxic metabolites, which then significantly reduced plant growth, thereby having a direct bearing on ecosystem services. Based on the findings, we argue that stricter regulatory controls on hair dye wastewater are necessary, particularly in newly industrialising Asian countries where the expansion of commercial practice is most prevalent.

Fluorescence of a Natural Fluorophore as a Key to Improve Fingerprint Contrast Image

The optical and morphological properties of resveratrol were investigated. This nontoxic fluorescent natural material, emitting in the visible blue light, was used as an optical marker, enabling the enhancement of the image contrast coming from relief pictures marked on challenging surfaces. By applying appropriated imaging softwares, this marker was verified to be very useful in the latent fingerprint recognition deposited on different wood surface types, mainly those with high level of roughness, where conventional forensic materials do not allow effective fingerprint image visualization.

Super Vasmol Poisoning: Dangers of Darker Shade

How to cite this article: Senthilkumaran S, Jena NN, Thirumalaikolundusubramanian P. Super Vasmol Poisoning: Dangers of Darker Shade. Indian J Crit Care Med 2019;23(Suppl 4):S287-S289.