Tropical fresh water stingrays have become quite popular among amateur and professional aquarists due to their attractive appearance. However, the species may have a high life-threatening potential. Stingray intoxication is rare in Eastern Europe and there is no specific antivenin available. We present the first case of “rayism” - envenomation caused by sp. Reticulatus in Eastern Europe. The patient was a 63-year-old amateur aquarist, with a history of ischaemic heart disease and allergy to NSAIDs. He got stung while cleaning a stingray fish tank and was admitted to the department of clinical toxicology 40min following the incident, with symptoms of moderate intoxication: accentuated local toxic syndrome - mild bleeding at the sting site, worsening and excruciating (8- 9/10) pain in his left hand and forearm, feeling of “burning” in the arm, accompanying toxic symptoms - vertigo, malaise, fatigue, sweating and tightness in the chest. No antitoxin was available and the treatment plan included local aseptic treatment of the wound, anti- tetanus prophylaxis, fluoroquinolone-type antibiotic prophylaxis, antihistamine, a corticosteroid and i.v. infusions. Thermal therapy (immersing the arm in hot, 45℃ tap water) completely reduced the pain within 5 hours. Full recovery was achieved on the 3rd day after the exposure. A toxicologist should react adequately in the setting of a rare intoxication even when a specific antidote is not available. Thermal therapy proved to be effective in the case of stingray envenomation.
Yanko T. Iliev, Stoilka G. Tufkova, Marin Y. Zagorov and Stanka M. Nikolova
INTRODUCTION: Envenomation by poisons of biological origin is very common globally in the tropical and subtropical areas mainly, where the biological diversity of the species clearly leads to evolution of highly toxic species. The weather warming trend in Bulgaria, whether cyclic or permanent, allows for a change in the biological response of reptiles and insects inhabiting the temperate zone by a possible migration of biological species from the subtropical zone towards the temperate zone because of the new environmental conditions. There are very few studies on snake bite envenoming in Bulgaria. The AIM of the study was to find the incidence of the acute accidental intoxication (AAI) caused by snake venom in adult individuals in a large region of Bulgaria between 2004 and 2012 and characterises it by number, type, main clinical features, course and socio-demographic parameters of the victims so that preventive measures can be taken, wherever necessary. MATERIALS AND METHODS: We studied retrospectively all 68 cases of AAI caused by snake venom in adult individuals (> 18 years old) hospitalized in the Clinic of Toxicology in St. George University Hospital, Plovdiv over the period from 2004 to 2012 by 23 quantitative and qualitative parameters. RESULTS: We found that the average annual incidence of snake venom AAI in adult population in the region of Plovdiv was relatively low for the specified period (9.5 per 100000 residents); the snake venom AAI increases or decreases every other year, with no clearly delineated trend for now. The prevalence of envenomation by poisons of biological origin increased from 2.3% in 1990-1998 to 9.5-10.33% between 2007 and 2012. The main sociodemographic characteristics of snake bite victims are similar to those in other Balkan and Central European countries. The clinical response to poisons of biological origin is generally identical with the response to the viper (Vipera ammodytes) - mild to medium intensity with predominantly local toxic syndrome. CONCLUSIONS: The algorithm of Clinical Pathway 293 (CP) is effective and conducive to the reduction of duration of the morbid condition. There are, however, still aspects of it that can be optimised
Yanko T. Iliev, Marin Y. Zagorov and Janet G. Grudeva-Popova
Dapsone is a drug commonly used in the treatment of leprosy. In Europe it is rarely prescribed, mostly for the treatment of skin diseases such as dermatitis herpetiformis. Poisoning with dapsone is rare and reports of such cases are of interest for toxicological practice. We describe the only acute dapsone poisoning in a caseload series of 21000 intoxications treated in the Clinical Toxicology Clinic at St George University Hospital in Plovdiv, Bulgaria between 1999 and 2013.
We report on a 36-year-old woman who attempted deliberate self-poisoning with an ingestion of approximately 4.5 g of dapsone and 0.3 g of olanzapine. On admission, the patient was in a state of severe intoxication and comatose. On admission to hospital 9 hours after the ingestion, the methemoglobin level was 51.7%. The patient recovered 8 days later. She received complex treatment including intubation, ventilation, repeated gastric lavage, hemodialysis, blood exchange transfusion and antidote treatment with methylene blue. She was discharged in good clinical condition with minimal organ damage such as mild toxic hepatitis.
Yanko T. Iliev, Sasha A. Kristeva and Maria G. Prancheva
The rattlesnake (Crotalus adamanteus) is a venomous viper inhabiting the southeastern parts of the United States. It is not found in the Balkans and Europe habitats. Subjects of the species are grown and seen in museums, exhibitions and terrariums, and sometimes in private collections. This may generate potentially toxic exposures to the venom in accidental contact. Acute poisoning with rattlesnake poison in Bulgaria is exotic, rare and even casuistic.
The venom of the rattlesnake exhibits neuropathic, proteolytic and hemolytic activities. Antivenom is not currently easily available in Bulgaria - it is not usually stored in hospitals because it is very rarely used and therefore rather expensive. We present a case of multiple envenomation (two different occasions) of one and the same person who kept rattlesnakes in a private terrarium. Local toxic syndrome was observed with burning and stinging pain at bite site combined with limited hemorrhage and necrosis. The hemolytic reaction and the local toxic results were successfully managed without resorting to any specific antidotal therapy.
Sava V. Petrov, Maria M. Orbetzova, Yanko T. Iliev and Doychin T. Boyadzhiev
Introduction: Drug addictions to psychoactive substances are disorders with a complex bio-psycho-social genesis, which are characterized with chronic relapses. Substance addiction causes multifactorial damage to the normal functioning of individuals and requires a multicenter approach for the treatment process.
Aim: The aim of the study was to assess the quality of life of patients undergoing chronic treatment with the opiate agonist methadone using a standardized questionnaire method in Bulgarian.
Material and methods: The study included patients aged 18 to 40 years undergoing chronic treatment with methadone for at least six months. The study included 100 subjects. Seventy-six patients were from 5 clinical programs in Bulgaria; twenty- four clinically healthy age-matched subjects with no history of drug abuse, psychiatric and somatic diseases were the control group.
Results: We found significant differences between patients and controls in all components of the survey (P<0.05). The patients had lower scores than the control group in the SF-36 in terms of all eight components and both the physical and mental component summaries of the SF-36-survey. Patients compared between the groups by dose, duration of treatment with methadone and period of heroin abuse before initiating treatment did not show significant differences. There were no significant differences between patients with and without hepatitis C virus.
Conclusions: Opiate addiction is a state associated with poor quality of life. The duration of treatment, the methadone dose, period of heroin abuse before initiating treatment and illness of hepatitis C virus does not correlate with lower results.
Stefan P. Popov, Nonka G. Mateva, Yanko T. Iliev, Ivan D. Dechev and Rositsa V. Karalilova
Sexual fears, sometimes in the form of phobias, lead to aversive or sexually avoidant behavior blocking sexual closeness and resulting in deep personal and interpersonal distress. OBJECTIVE: To determine the types of sexual fears and aversive behavior in young people of reproductive age (students) and their degree of markedness as to encourage a further implementation of prevention programs and interventions. MATERIALS AND METHODS: The study included 116 fifth-year medical students in Plovdiv Medical University. Of these, 55 men and 61 women were assessed with the Sexual Aversion Scale, a 30-item self-rating questionnaire. The Diagnostic and Statistical Manual of Mental Disorders criteria of sexual aversion were used. The statistical analyses used were descriptive statistics and independent samples t-test. RESULTS: Sexual fears and aversive or blocking behavior are mild to moderate, mean score of 1.54 ± 0.04, without statistically significant gender differences. Both sexes have established fear-related sexual aversive motives of sexual behavior related to the risk of unwanted pregnancy and HIV infection. Women have significantly higher average scores for the following statements: fear of sexual intercourse (1.61 vs 1.25), avoidance of situations in which they may be involved sexually (1.95 vs 1.51), avoidance of genital sexual contact (1.44 vs 1.16), fear of catching a sexually transmitted disease (2.46 vs 2.09 ), fear of pregnancy (2.61 vs 2.15) and concerns what other people think of them (2.34 vs 1.93 ). CONCLUSIONS: Sexual fears and aversive or blocking behavior were mild to moderate. In both sexes similar fears - aversive or blocking patterns of sexual behavior were found, mainly associated with the fear of unwanted pregnancy and the risk of HIV infection, more expressed in women.