The Tokyo subway sarin attack has long-term effects on survivors: A 10-year study started 5 years after the terrorist incident.

OBJECTIVES: The Tokyo subway sarin attack in 1995 was an unprecedented act of terrorism that killed 13 people and sickened more than 6,000. The long-term somatic and psychological effects on its victims remain unknown. METHODS: We conducted analyses on the self-rating questionnaire collected annually by the Recovery Support Center (RSC) during the period from 2000 to 2009. The RSC is the only organization that has large-scale follow-up data about sarin attack victims. The prevalence of self-reported symptoms was calculated over 10 years. We also evaluated the prevalence of posttraumatic stress response (PTSR), defined as a score ≥ 25 on the Japanese-language version of the Impact of Event Scale-Revised. The multivariate Poisson regression model was applied to estimate the risk ratios of age, gender, and year factor on the prevalence of PTSR. RESULTS: Subjects were 747 survivors (12% of the total) who responded to the annual questionnaire once or more during the study period. The prevalence of somatic symptoms, especially eye symptoms, was 60-80% and has not decreased. PTSR prevalence was 35.1%, and again there was no change with time. The multivariate Poisson regression model results revealed "old age" and "female" as independent risk factors, but the passage of time did not decrease the risk of PTSR. CONCLUSIONS: Although symptoms in most victims of the Tokyo subway sarin were transient, this large-scale follow-up data analysis revealed that survivors have been suffering from somatic and psychological long-term effects.

OCCUPATIONAL CARBAMATE POISONING IN THAILAND.

Carbamate insecticide is a leading cause of poisoning in Thailand. The objective of this study was to characterize the clinical manifestations and modes of occupational exposure in carbamate poisoning cases. We retrospectively studied all the cases of carbamate poisoning due to occupational exposure recorded in the Ramathibodi Poison Center Toxic Exposure Surveillance system during 2005 to 2010. Demographic data, clinical manifestations and severity were analyzed statistically. During the study period, 3,183 cases were identified, of which 170 (5.3%) were deemed to be due to occupational exposure. Ninety-six cases (56.5%) and 35 cases (20.6%) were poisoned by carbofuran and methomyl, respectively. Carbofuran is sold as a 3% grain and applied by sowing; methomyl is sold as a liquid and is applied by spraying. The majority of poisoned patients did not wear personal protective equipment (PPE) while applying the carbamates. The clinical manifestations of occupational carbofuran poisoning recorded were nausea and vomiting (82.3%), headaches (56.3%) and miosis (19.8%). The clinical manifestations of methomyl poisoning were nausea and vomiting (74.3%), headaches (57.1%) and palpitations (11.4%). Most patients in both groups had mild symptoms. Only one case in each group required endotracheal intubation and mechanical ventilation support. There were no deaths and the lengths of hospitalization ranged from 2 hours to 2 days. Occupational carbamate poisoning cases in our series were mostly mild and the patients recovered quickly. There were only rare cases of serious symptoms. Lack of knowledge and inadequate PPE were the major factors contributing to occupational poisoning. Educating agricultural workers about correct precautions and pesticide use could minimize this type of poisoning.

Common ocular effects reported to a poison control center after systemic absorption of drugs in therapeutic and toxic doses.

PURPOSE OF REVIEW: Ocular effects resulting from medications assist toxicologists in determining substances involved when treating a poisoned patient. The intention of this review is to discuss the most common ocular effects, the medications that cause them, and the mechanisms by which they occur. RECENT FINDINGS: According to National Poison Data System, the most common reported ocular effects following a drug ingestion/injection/inhalation are mydriasis, miosis, and nystagmus. The most common drug/drug classes reported to a regional poison control center causing these ocular effects include the following: first, mydriasis - amphetamines and diphenhydramine; second, miosis - clonidine and opioids; third, nystagmus - dextromethorphan. However, many other drugs/substances can cause these effects along with other systemic effects. SUMMARY: Ocular findings are a pertinent component of any patient assessment involving therapeutic and/or toxic exposure to medications and other substances.

Obtained mydriasis in long-term type 2 diabetic patients.

PURPOSE: The purpose of this study was to evaluate obtained mydriasis and prevalence of small pupil in long-term type 2 diabetic patients. METHODS: A prospective observational cross-sectional study was carried out. We included 107 eyes from 107 patients (mean age: 60.8) with long-term (≥10 years) type 2 diabetes mellitus. Patients were divided into 2 groups: no apparent diabetic retinopathy (group 1, n=33) and diabetic retinopathy (group 2, n=74). Exclusion criteria were eyes with prior intraocular surgeries, presence of other ocular disorders that may affect iris, or any other condition that precludes the precise measurement of pupil size. Sixty eyes in 60 age-matched nondiabetic patients (mean age: 61.0) scheduled for routine fundoscopy exam were enrolled as control. We measured pupil diameter by pupil gauges at 40 min after instillation of eye drops (phenylephrine 10% and tropicamide 1%). Small pupil was defined as pupil diameter of 6 mm or less. RESULTS: Mean pupil diameter was 8.07 mm [standard deviation (SD): 0.59 mm] in the control group, 7.46 mm (SD: 0.71 mm) in group 1, and 7.24 mm (SD: 0.83 mm) in group 2. Both group 1 (P<0.001) and group 2 (P<0.001) showed significant difference when compared with the control group. The incidences of small pupil were 1.9% in the control group, 6.1% in group 1, and 13.5% in group 2. When compared with control, group 2 showed significantly higher incidence of small pupil (P=0.023). CONCLUSIONS: Long-term diabetic patients showed poorer response to pharmacological mydriasis than nondiabetic patients. Higher prevalence of small pupil size was found in patients with diabetic retinopathy.

Sarin poisoning in Matsumoto, Japan.

A presumed terrorist attack with sarin occurred in a residential area of the city of Matsumoto, Japan, on June 27, 1994. About 600 residents and rescue staff were poisoned; 58 were admitted to hospitals, and 7 died. We examined clinical and laboratory findings of 264 people who sought treatment and the results of health examinations on 155 residents done 3 weeks after the poisoning. Findings for severely poisoned people were decreases in serum cholinesterase, acetylcholinesterase in erythrocytes, serum triglyceride, serum potassium and chloride; and increases in serum creatine kinase, leucocytes, and ketones in urine. Slight fever and epileptiform abnormalities on electroencephalogram were present for up to 30 days. Examination revealed no persisting abnormal physical findings in any individual. Acetylcholinesterase returned to normal within 3 months in all people examined. Although subclinical miosis and neuropathy were present 30 days after exposure, almost all symptoms of sarin exposure disappeared rapidly and left no sequelae in most people.