Child cyanide poisoning after ingestion of bitter almonds

Hong Kong poison information centre: Annual report 2020

Background:

The Hong Kong Poison Information Centre has provided consultation service to healthcare professionals and collected epidemiological data on poisoning in Hong Kong since 2005.

Objective:

To analyse and report the poisoning data of Hong Kong Poison Information Centre in 2020 during the COVID-19 pandemic.

Methods:

A retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2020.

Results:

A total of 3633 poisoning cases were analysed. Compared to 2019 (pre-COVID era), there was a reduction of ~10% of total poisoning cases recorded (383 cases), with a majority (> 90%) of reduction from poisoning cases with no clinical effect (353 cases). A greater proportion of reduction was observed among the children (0–12 years), patients with general unintentional poisoning, poisoning due to therapeutic error and food poisoning. An increased number of cases was noted from abusive use, adverse herb/proprietary Chinese medicine reaction and poisoning related to household bleaches. Teenage (13–19 years) poisoning seemed to be unaffected by the COVID-19 pandemic and the previously observed increasing trend continued (up to 11.8% of total poisoning cases this year). Despite a total reduction in poisoning cases recorded, the number of deaths increased by 37% from 35 in 2019 to 48 in 2020 (mortality rate 1.5%). A total of seven interesting cases were discussed.

Conclusion:

This 15th annual report provides updated epidemiological information on poisoning patterns in Hong Kong during the COVID-19 pandemic. It also highlighted important changes and possible effects of the COVID-19 pandemic on poisoning in Hong Kong in comparison with our previous reports.

Almond oil: A comprehensive review of chemical composition, extraction methods, preservation conditions, potential health benefits, and safety

Almond oil, a rich source of macronutrients and micronutrients, is extracted for food flavorings and the cosmetics industry. In recent years, the need for high-quality and high-quantity production of almond oil for human consumption has been increased. The present review examines the chemical composition of almond oil, storage conditions, and clinical evidence supporting the health benefits of almond oil. From the reviewed studies, it appears that almond oil contains a significant proportion of poly and monounsaturated fatty acids, with oleic acid as the main compound, and an important amount of tocopherol and phytosterol content. Some variations in almond oil composition can be found depending on the kernel's origin and the extraction system used. Some new technologies such as ultrasonic-assisted extraction, supercritical fluid extraction, subcritical fluid extraction, and salt-assisted aqueous extraction have emerged as the most promising extraction techniques that allow eco-friendly and effective recovery of almond oil. This safe oil was reported by several clinical studies to have potential roles in cardiovascular risk management, glucose homeostasis, oxidative stress reduction, neuroprotection, and many dermatologic and cosmetic applications. However, the anticarcinogenic and fertility benefits of almond oil have yet to be experimentally verified.

Amygdalin - A pharmacological and toxicological review

ETHNOPHARMACOLOGICAL RELEVANCE

Amygdalin is commonly distributed in plants of the Rosaceae, such as peach, plum, loquat, apple and bayberry, but most notably in the seeds (kernels) of apricot almonds. As a naturally aromatic cyanogenic compound, it has long been used in Asia, Europe and other regions for the treatment of various diseases including cough, asthma, nausea, leprosy and leukoderma. Importantly, in recent years, an increasing attention has been paid to its antitumor effect.

AIM OF THE STUDY

The paper aims to review the pharmacological activities and toxicological effects of amygdalin and provide a reference and perspective for its further investigation.

METHODS

Electronic databases including the Web of Science, Cochrane Library, PubMed, EMBASE, the Chinese Biological Medicine Database, China National Knowledge Infrastructure, Wanfang database and VIP information database were searched up to November 2019 to identify eligible studies. A meticulous review was performed, an in-depth analysis on the pharmacological activity and toxicology of amygdalin was conducted, and perspectives for future research were also discussed.

RESULTS

A total of 110 papers about in vitro/in vivo studies on amygdalin have been reviewed. Analysis on the data suggested that this compound presented pharmacological activities of anti-tumor, anti-fibrotic, anti-inflammatory, analgesic, immunomodulatory, anti-atherosclerosis, ameliorating digestive system and reproductive system, improving neurodegeneration and myocardial hypertrophy, as well as reducing blood glucose. In addition, studies revealed that amygdalin's toxicity was caused by its poisonous decomposite product of benzaldehyde and hydrogen cyanide after oral ingestion, toxicity of intravenous administration route was far less than the oral route, and it can be avoidable with an oral dose ranging from 0.6 to 1 g per day.

CONCLUSION

This paper has systematically reviewed the pharmacology and toxicology of amygdalin and provided comprehensive information on this compound. We hope this review highlights some perspectives for the future research and development of amygdalin.

Evaluation of the health risks related to the presence of cyanogenic glycosides in foods other than raw apricot kernels

In 2016, the EFSA Panel on Contaminants in the Food Chain (CONTAM) published a scientific opinion on the acute health risks related to the presence of cyanogenic glycosides (CNGs) in raw apricot kernels in which an acute reference dose (ARfD) of 20 μg/kg body weight (bw) was established for cyanide (CN). In the present opinion, the CONTAM Panel concluded that this ARfD is applicable for acute effects of CN regardless the dietary source. To account for differences in cyanide bioavailability after ingestion of certain food items, specific factors were used. Estimated mean acute dietary exposures to cyanide from foods containing CNGs did not exceed the ARfD in any age group. At the 95th percentile, the ARfD was exceeded up to about 2.5-fold in some surveys for children and adolescent age groups. The main contributors to exposures were biscuits, juice or nectar and pastries and cakes that could potentially contain CNGs. Taking into account the conservatism in the exposure assessment and in derivation of the ARfD, it is unlikely that this estimated exceedance would result in adverse effects. The limited data from animal and human studies do not allow the derivation of a chronic health-based guidance value (HBGV) for cyanide, and thus, chronic risks could not be assessed.

Plant toxins and acute medicinal plant poisoning in children: A systematic literature review

BACKGROUND

For many years, medicinal plants and herbal therapy have been widely used in different societies for the treatment of various diseases. Besides their therapeutic potency, some of the medicinal plants have strong toxicity in human, especially in children and elderly. Despite common beliefs that natural products are safe, there have been few reports on their toxicities.

MATERIALS AND METHODS

In the present study, we aimed to systematically review the literature wherein acute plant poisoning and herbal intoxication have been reported in pediatric patients. After literature search and selection of the appropriate documents, the desired data were extracted and described qualitatively.

RESULTS

A total of 127 articles with overall 1453 intoxicated cases were collected. The results of this study showed that some medicinal plants can cause acute poisoning and complications such as hepatic and renal failure in children.

CONCLUSION

The findings of this survey showed that acute plant poisoning can be life?threatening in children, and since a single?ingested dose of toxic plants can cause acute poisoning, parents should be aware of these toxic effects and compare the side effects of self?medication with its potential benefits.