INTRODUCTION:

The study of poisons and their effects, as well as their detection, quantification, toxicity, lethal dosage, interpretation of toxicological data, and treatment, is known as toxicology. Medical and legal considerations about the detrimental effects of substances on humans are the focus of forensic toxicology¹. A poison is any material—solid, liquid, or gas—that, when administered to, or even just coming into touch with, a live organism, may cause sickness or death due to either systemic or localized effects, or both. Toxins are not often thought of as poisons in the common sense, because substances that are innocuous in tiny amounts may have lethal effects when consumed in high doses; moreover, bacterial toxins are not considered poisons in this context. Disorders in humans brought on by or linked to inappropriate exposure to chemicals are the focus of clinical toxicology². The field of toxicology studies harmful substances produced by many living creatures, such as toxic plants, snake, spider, bee, and bacterial and fungal venom.

As a forensic expert looking into a poisoning case, you should know that there are two sides to every criminal inquiry³. First, we need to determine the extent of the harm and the poison's effects; second, we need to identify the offender and understand their motivations. Death is not the only possible outcome of poisoning; the sufferer may also have long-term health effects. Accordingly, a criminal inquiry into poisoning is a lengthy and convoluted process requiring specialists from many walks of life. Medical care is necessary for poisoning survivors, and the course of treatment will vary according to the extent of harm to the body⁴. The time required for healing is directly proportional to the severity of the harm sustained by the organism.

Poisoning Incidence and Adverse Effect:

Exposure to any substance that might cause a negative reaction in a living system is being poisoned. This might lead to mild discomfort, major side effects, or even death. According to several sources, there are multiple criteria that determine whether an object is toxic. Before, we established that every material, when consumed in sufficient quantities, may serve as a poison. In India, like in the rest of the globe, poisoning is widespread, however it may occur for a variety of reasons, including attempts at suicide, murder, and accidents. Because they are naturally curious, don't yet know how to read warning labels, and aren't properly supervised, youngsters are at increased risk of unintentional poisonings⁵.

Most unintentional exposures to pharmaceuticals or household chemicals occur at home, where they may be inhaled by both children and adults. Another source of unintentional poisoning in adults includes ingesting tainted food, toxic plants or animals, or even stings and bites. However, criminal poisoning happens when someone or several people tries to maliciously poison someone else in order to destroy their life. Because it gives the offender plenty of time to flee the scene, poison is a favourite weapon of criminals who want to hurt others. When a human person is poisoned to death, this is known as homicidal poisoning⁶. Because of their availability, tiny lethal dosages, lack of taste or odour, and ease to mix with beverages, many poisons are used for murderous reasons. Possible motives for homicidal poisoning include financial (inheritance, insurance), personal (vengeance), and psychological (a desire for control and power).

The first step in preventing poisoning problems is to get care quickly; however, diagnosing poisoning may be challenging if the sufferer is unconscious or if they have been poisoned by someone else. Medical professionals gather data such as poisoning history and severity to establish hypotheses. They also conduct laboratory tests to identify specific poisons and determine their levels in various bodily fluids, such as blood, urine, or visceral tissues, depending on the kind of poison⁷. Tablets, empty containers, and vomit might help identify the poisonous chemical in the event that the person is unconscious. The patient must have a physical examination in order to confirm the diagnosis of poisoning. Some harmful compounds might produce skin redness, swelling, or even burning. Toxins may often be easily identified by their unique odors and the damage they produce. For example, petroleum compounds have a lighter fluid or kerosene-like stench, and some acids and alkalis can cause burns on the tongue. Despite the high volume of poisoning cases, a definitive diagnosis is still elusive⁸.

Figure 1: A Prospective Observational Study on Pattern Poisoning.³⁹

Table 1: List of poison causing different type of gastrointestinal diseases, ocular diseases and dermal diseases.⁹

Type of Poison (Drug) involved	Sign and Symptoms
Salicylates	Deafness, sweating, hyperventilation, vasodilatation, vomiting, abdominal pain, tinnitus, disorientation, lethargy, metabolic acidosis, nausea.
Acetaminophen	Nausea, abdominal pain, jaundice, confusion, vomiting, coma may develop later
Benzodiazepines	Drowsiness, lethargy, dysarthria, hypotension, hypothermia, ataxia, respiratory depression with overdoses
Sympathomimetics	anxiety, arrhythmias, Agitation, restlessness, convulsions, tachycardia, tremor, mydriasis
Quinine, methanol	Blindness
Cocaine	vomiting, euphoria, hypertension, fever, tachypnea agitation, twitching, confusion, hypotension, Anxiety, nausea, vomiting, abdominal cramps, cardiopulmonary arrest, mydriasis, diaphoresis,
Organophosphate and carbamate insecticides	miosis, bronchorrhoea, Hyper-salivation
Ecstasy (MDMA), amphetamines	tachycardia, mydriasis, hyperthermia, agitation, Delirium
Tricyclic antidepressants, antihistamines	dry mouth, fever, seizures, confusion, hyper-reflexia, myoclonus, tachycardia, arrhythmias, hypotension, coma, myoclonus
Calcium channel blockers	seizures, bradycardia, chest pain, hypotension, bradycardia, peripheral cyanosis, coma, respiratory distress
Narcotics and opioids	drowsiness, reduce respiratory rate, cyanosis, seizures, bradypnea, noncardiac pulmonary edema, vomiting

The kind of poison or poisons implicated in a poisoning may be determined by a physical examination of the affected individual. But there is a wide variety of poisons, and they all have similar side symptoms, which makes identification more challenging(10). Toxic syndromes are groups of symptoms that doctors use to assist diagnose poisoning. These symptoms are often connected with prevalent toxins. In addition to taking careful note of the patient's vital signs—such as those of the eyes, skin, reflexes, and breathing—the doctor should check for signs of dehydration from vomiting or diarrhea, as well as any physical evidence associated with the poisoning, such as changes in urine color or consistency¹¹. It is possible to learn a lot by taking a broad look at the poisoned individual. Because different poisons cause different signs and symptoms to manifest, it is impossible to diagnose poisoning based on a single symptom alone¹². There are, however, a few crucial, drug-specific hints that may be very helpful. These particular poison-related toxicological patterns have been documented.

Table 2: Symptoms and potential vital signs for a chosen list of poisons.¹³

Vital Symptoms	Type of Drugs involved in Poisoning
Tachycardia	Amphetamine, tricyclic antidepressants, Antihistamines, cocaine, anticholinergic drugs, alcohols, cocaine, salicylate
Bradycardia	Beta blockers, digoxin, clonidine, opioid, digitalis, procainamide, calcium channel blockers, cholinergic drugs
Seizures and Convulsions	Lindane caffeine, theophylline, camphor, salicylate, Cocaine, lead, organophosphate, strychnine, tricyclic antidepressants
Tachypnea	Methanol, paracetamol, ethylene glycol, Salicylates, CO
Bradypnea	Opioid, Ethanol
Hypertension	anticholinergic agents, Sympathomimetic agents, thanol, sedative hypnotic drug withdrawal
Hypotension	Calcium channel blockers, heroin, antidepressants, beta blockers, clonidine
Hyperthermia	Dinitrphenol, cocaine, arsenic, cyanide, quinidine, amphetamine, halothane, MAO inhibitors, Acetylsalicylic acid
Hypothermia	Tricyclic antidepressants, barbiturates. antidepressant, CNS depressants, benzodiazepines, Opioid
Peripheral Neuropathy	Chronic poisoning of As, Pb, Hg
Tremors	CO, caffeine, tricyclic antidepressants, phenothiazines, alcohol, mercury
Ataxia	Narcotic, phenytoin, alcohol, antidepressant, barbiturates
Coma	Narcotic, lead, CO, cyclic antidepressants, cyanide, organophosphate
Muscles Rigidity	haloperidol, cyclic antidepressant, Phenothiazines
Blurred Vision	Ethanol, methanol MAOIs, Anticholinergics drug, lithium, botulism,
Corneal Deposits	Chloroquine
Miosis	Nicotine, barbiturates, haloperidol, benzodiazepines, acetone, carbamates, carbolic acid, heroin, morphine,
Nystagmus	Quinine, carbazepine, marijuana, phenytoin, Phencyclidine (PCP), alcohol, lithium, meprobamate, benzodiazepine
Oculogyric Crisis	Metoclopramide, phenothiazines, butyrophenones
Keratopathy	Crack cocaine
Optic Neuritis	Digitalis, disulfiram, penicillamine, quinine, chloroquine, ergot, heavy metals, methanol
Mydriasis	Amphetamine, cocaine, cyanide, ephedrine, antihistamines, ketamine, gelsemium, formic acid, datura, curare
Diplopia	Ethanol, barbiturates, tetracycline, phenytoin, opiates, cannabis
Sluggish or absent pupil response	Alcohol, benzodiazepine, amphetamine, heroin, cocaine
Dry and hot skin	Datura, atropine
Acne brown colour	Chronic poisoning of bromides, iodides, phenytoin, coaltar products
Cyanosis and methemoglobinemia	Nitrates, phenazopridine, aniline dyes, nitrites, ergotamine
Blister	Carbon monoxide, imipramine, methadone, barbiturates
Erythema	Boric acid, mercury, cyanide
Flushing	Clonidine, niacin, theophylline, ergot
Petechiae and purpuric spots	Warfarin
Formication	Cocaine, arsenic

Most poisoning cases include cutaneous evidence from direct skin contact or systematic poisoning. The patient's clothes should be removed to check skin color, warmth, formication, dryness, erytherma, perspiration, and injection marks. Chronic heavy metal exposure may cause dermatitis¹⁴. Hyperkeratosis and melanosis characterize chronic arsenic poisoning. Body injection marks may indicate poisoning route. For poisoning diagnosis, a sample should be taken from the injection site. Carbon monoxide, niacin, cyanide, boric acid, and scromboid poisoning may cause red skin¹⁵. Nitrate, nitrite, phenazopridine, and ergotamine overdose causes cyanosis or methemoglobinemia which turns skin blue. Rash or blisters may also help diagnose. Rashes or blisters usually appear between fingers, knees, and back due to immobility. These are typical of barbiturate intoxication¹⁶. Opioids and fentanyl usage may cause vaginal and scrotal patches. Dry and heated skin is linked with anticholinergic medicines; therefore, it may help distinguish them from sympathomimetic toxicity. Dry and feverish skin may accompany food sickness. Hyperthermia may also develop from drug overdoses and must be treated immediately. Hyperthermia may also be caused by defective thermoregulation, insufficient heat dissipation, muscle hyperactivity or hyperrigidity, and accelerated metabolism¹⁷. In tricyclic antidepressant overdose, seizures and myoclonic jerks cause hyperthermia, which is life-threatening. Cool, clammy, sweating skin indicates sympathomimetic overdose and hypothermia. Most phenothiazines, antibiotics, thiazides, sulfonamides, and NSAIDs cause irritation and dermatitis even at therapeutic levels¹⁸. Thus, cutaneous symptoms are vital for diagnosing poisoning with certain medications or poisons.

Even with blindness, poisoning often affects visual acuity. Chloroquine, quinine, and methanol poisoning impair vision. Drugs and toxins cause miosis, mydriasis, and nystagmus in the pupils. Miosis and mydriasis may be physiological or caused by illness, trauma, or drug/poison ingestion¹⁹. Mydriasis means pupil dilatation and light hypersensitivity. Anticholinergic (tricyclic antidepressants, atropine, cocaine, phenothiazines, benzodiazepines, barbiturates, ethanol) and sympathomimetic medications induce mydiasis. Blindness mydriasis may be caused by retinal, optic nerve, or ocular dysfunctions from quinine and methanol poisoning. In miosis, opioids, cholinergic or anticholinesterase poisoning (e.g., organophosphates, insecticides, phencyclidine, phenothiazines, carbamate pesticides) may constrict the pupil. Uncontrolled, fast, repeated eye movements characterize nystagmus. Chemical, barbiturate, and organophosphate poisoning may cause nystagmus²⁰. The aetiology and ocular signs of poisoning are presented.

Role of Poison Centres:

A poison control centre is a medical supportive care that is cable of providing immediate, free, and expert treatment advice and assistance over the telephone in case of poisonous substrate. An important issue in public health on a worldwide scale is poisoning²¹. The World Health Organisation (WHO) determined that 1,06,683 people died and 6.3 million years of healthy life were lost in 2016 due to accidental poisoning. More than 72% of poison exposure cases are managed simply by phone. Medical professionals in numerous nations see patients in the emergency room due to poisoning²². Like infectious disorders, poisoning is a time-sensitive emergency that may need the aid of an expert in order to get an accurate diagnosis and effective treatment. In response to the reality that general practitioners and other medical professionals simply do not have the training to assess the potential dangers of all consumer products and substances, some nations have set up poison centres to house specialised knowledge and facilitate toxicological studies. Having the ability to monitor, identify, and react to public health incidents caused by chemicals is a requirement of the International Health Regulations (2005), and Poisons Centres play a crucial part in meeting this regulation. A well-equipped poison control facility may make a significant contribution to this capability²³. Details on the services that a poison centre may provide and comprehensive practical advice on how to set one up are both included in the Guidelines for establishing a poison centre. Released in 1997 by the World Health Organisation, this document serves as an updated version of their Guidelines for Poisons Control. This revision takes into account both the resurgence of interest in poison control centres after the IHR's 2005 adoption and the evolution of both technology and poison control centre operations after 1997^24,25.

Figure 2: Applications of poison information centers²⁶

Activities of poison centres are given below:

1. Toxicological information: Poison centres educate the public on how to avoid poisoning by providing information on common compounds, how to store and handle chemicals safely, and how to identify and avoid potentially harmful substances. The risks of some drugs are also taught to the general population and medical professionals²⁷.

2. Toxicological Management: Those who have been poisoned might get information from poison centres about the right first aid measures and medical care for their condition. The management of difficult situations may also be facilitated by them for healthcare practitioners²⁸.

3. Public Health Surveillance: The information that poison centres gather includes not only information on toxic exposures but also epidemiological data, which may be used for the purposes of monitoring. Using this information, new patterns may be identified, the efficacy of public health campaigns can be evaluated, and regulatory actions can be guided effectively²⁹.

4. Professional Consultation: The management and treatment of poisoning is a topic that is covered in training that is provided by poison centres to medical professionals, emergency workers, and other persons that are relevant. There is also the possibility that they may provide consulting services to medical institutions and specialists who are dealing with complicated poisoning situations³⁰.

5. Toxicovigilance: As a part of its role in toxicovigilance, the centre makes recommendations for the development, implementation, and assessment of measures for the prevention and treatment of poisoning, and it also participates in these processes. Include also the primary functions, which are the dissemination of toxicological information, the provision of analytical services, the conduct of research, and the provision of training in the prevention and treatment of poisoning³¹.

6. Emergency Response: Through their participation in disaster preparation and response activities, poison centres provide a contribution to the readiness of emergency situations. They guarantee that emergency services and healthcare personnel are prepared to deal with situations involving chemical injuries or poisonings that affect a large number of people³².

7. Quality Improvement: The services provided by poison centers are continuously evaluated and improved via the implementation of quality assurance and improvement activities. As part of this process, they will be examining cases, revising procedures, and integrating comments in order to improve the efficiency of their response and instructional efforts³³.

Poison Information Source:

There is a significant fatality rate linked with acute poisoning, which is a major health hazard. The identification of the poison that is involved is the most challenging aspect of the management of acute poisoning patients in critical care settings³⁴. This is the greatest obstacle. When it comes to the early identification, treatment, and avoidance of poisoning consequences, having immediate information about the poisoning and how it is being managed is very necessary³⁵. When it comes to the retrieval of up-to-date and speedy information on poisoning, poison information resources, such as the many different poison applications and databases, are fundamental36. Software, mobile applications, and databases all play an important part in the management of poisoning situations because they contribute to the dissemination of information to both the general public and to experts working in the medical field³⁷.

Table 4: Sources for the General Public and Health-Care Professionals, including software.³⁸

	Database/App/Software	Developer
Resources for the General Public and Health-Care Professionals	Poisoning—first aid for children
	Wireless Information System for Emergency Responders (WebWISER)	National Library of Medicine (NLM)
	National Pesticide Information Center (NPIC)	NPIC
	Micromedex	Truven Health Analytics
Resources For Health Care Professionals	Poison Rx	PharmITexpert
	American College of Emergency Physicians (ACEP)	ACEP
	National poison data system (NPDS)	American Association of Poison Control Centers (AAPCC)
	Toxicology Data Network (TOXNET)
	Hazardous Substances Data Bank (HSDB)	Toxicology Data Network (TOXNET)
	CHEMMIDPlus	TOXNET
	Drugs and Lactation Database (LactMed)
	Developmental and Reproductive Toxicology Database (DART)	EPA, NLM
	Haz-Map	ACGIH
	AfriTox	Red Cross Children’s Hospital Poisons Information Centre
	PoisonEXPERT	Toxplanet

Assessment of Poison Exposure and Poisoning Situation:

Various medications, chemicals, venoms, or gasses may cause poisoning, which can result in harm or death. Poisoning can occur when a person swallows, inhales, touches, or injects these substances. It is only at higher concentrations or doses that certain compounds, such as medicines and carbon monoxide, may be declared dangerous. Ingestion is the sole way that some kinds of cleansers may be dangerous^{1, 40}, whereas other types of cleaners can release poisonous gasses or vapours. Due to their heightened sensitivity, children are especially susceptible to even minute quantities of some medications and substances.

Figure 3: Analyzing Process of Poisoning Situation⁴

CONCLUSION:

There have been a number of different ways that have been investigated in order to summarize the information in relation to the diagnosis of poisoning within the field of post-mortem toxicology. Furthermore, comprehensive advice has been given in order to determine the cause of toxicity. When dealing with unconscious patients, the diagnosis of poisoning is of the utmost importance for the treatment of poisoning effects. For the reason that some clinical symptoms may be the consequence of illnesses or subsequent effects such as anoxia, it is necessary to take into consideration other possible diagnoses in addition to poisoning. The clinical characteristics of poisoning with certain compounds are similar to those of illness states. For example, a high dosage of paracetamol, thallium, or paraquat has been linked to hepatitis, paraesthesia, and pneumonitis, respectively. This might lead to a misdiagnosis of poisoning with these compounds. In fatal situations, the diagnosis of poisoning is especially challenging since medications are meant to treat sickness; yet, the usage of these treatments often leads in the death of the patient owing to either an overdose or adverse consequences. It was necessary to conduct this study in order to improve the evidence-based knowledge involved in the process of diagnosing poisoning within the field of forensic toxicology.

CONFLICT OF INTEREST:

None.

REFERENCE:

1. Vijay HM, Priti PD, Priti PD, Vijaya AP. A Prospective Observational Study on Pattern, Severity and Outcome of Different Poisoning Cases in a Tertiary Care Hospital, India. J Basic Clin Pharm. 2017; 8: 154–7.

2. Barani K, Padmavathi R. Two Rare Cases of Malignant Mixed Mullerian Tumor. Int J Path. 2013; 15(1). http://doi.org/10.1097/JU.0000000000003776

3. Beveridge GW, Lawson AAH. Occurrence of Bullous Lesions in Acute Barbiturate Intoxication. BMJ. 1965; Mar 27; 1(5438): 824–37.

4. Mahmood Shahidul Islam S, Laskar N, Afrin RS, Ahmed Mahed RMR, Musarrat Z, Syrmos N. Investigating the awareness of food safety among buyers and sellers in a local market - a taste of safety. Journal of World Science. 2023; 2(12): 2052–63. Available from: https://doi.org/10.58344/jws.v2i12.512.

5. Chakravarthi S and Karikalan B. Molecular Biomarkers for Lung Adenocarcinoma: A Short Review. Current Cancer Therapy Reviews. 2020; 16: 1. https://doi.org/10.2174/1573394716666200724164654.

6. The American Academy of Clinical To, Barceloux DG, Randall Bond G, Krenzelok EP, Cooper H, Allister Vale J. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Methanol Poisoning. J Toxicol Clin Toxicol. 2002; Jan 23; 40(4):415–46.

7. Mackie MA, Davidson J, Clarke J. Quinine — Acute Self-Poisoning and Ocular Toxicity. Scott Med J. 1997 Feb 25;42(1):8–9.

8. Dyson EH, Proudfoot AT, Bateman DN. Quinine Amblyopia: Is Current Management Appropriate? J Toxicol Clin Toxicol. 1986 Jan 25;23(7–8):571–8.

9. Witoonpanich R, Vichayanrat E, Tantisiriwit K, Wongtanate M, Sucharitchan N, Oranrigsupak P, et al. Survival analysis for respiratory failure in patients with food-borne botulism. Clin Toxicol. 2010 Mar 25;48(3):177–83.

10. Leibson T, Lifshitz M. Organophosphate and carbamate poisoning: review of the current literature and summary of clinical and laboratory experience in southern Israel. Isr Med Assoc J. 2008 Nov;10(11):767–70.

11. Reiter CEN, Alayash AI. Effects of carbon monoxide (CO) delivery by a CO donor or hemoglobin on vascular hypoxia inducible factor 1α and mitochondrial respiration. FEBS Open Bio. 2012 Jan 24;2(1):113–8.

12. Hamel J. A Review of Acute Cyanide Poisoning with a Treatment Update. Crit Care Nurse. 2011 Feb 1;31(1):72–82.

13. Heal DJ, Smith SL, Gosden J, Nutt DJ. Amphetamine, past and present – a pharmacological and clinical perspective. J Psycho. 2013 Jun 28;27(6):479–96.

14. Harper SJ, Jones NS. Cocaine: what role does it have in current ENT practice? A review of the current literature. J Laryngol Otol. 2006 Oct 19;120(10):808–11.

15. Nehlig A, Daval JL, Debry G. Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic and psychostimulant effects. Brain Res Rev. 1992 May;17(2):139–70.

16. Bosse GM, Matyunas NJ. Delayed toxidromes. J Emerg Med. 1999;17(4):679–90.

17. Krenzelok EP, Leikin JB. Approach to the poisoned patient. Disease-a-Month. 1996; 42(9): 514–607.

18. Behal N, Wong A, Mantara R, Cantrell FL. Human Poisoning Through Atypical Routes of Exposure. J Community Health. 2016; 41(1):105–8.

19. Atypical manifestations of organophosphorus poisoning following subcutaneous injection of Dichlorvos with suicidal intention. Ind J Cri Care Med. 2014; 18(4):244–6.

20. Martínez MA, Ballesteros S, Sánchez de la Torre C, Almarza E. Investigation of a Fatality Due to Trazodone Poisoning: Case Report and Literature Review. J Anal Toxicol. 2005; 29(4):262–8.

21. Barani K and Pasupati T. Lipoleiomyoma of the uterus. Ind j Path and Micro. 2017, 60(1): 128.

22. Bavanilathamuthiah, Lakshmanan Y, Purnima, Ratnaprabha. Developmental Toxicity of Arsenic and its Underlying Mechanisms in the early Embryonic Development. Res J Pharm Technol. 2016;9(4):340.

23. Islam G, Gahlot K, Mani M, Kumar P, Shukla D. Hepatoprotective Activity of Leucas cephalotes against Paracetamol induced Hepatotoxicity in Rats. Res J Pharm Technol. 2020;13(3):1183.

24. Ahmed Mahedi MdR, Rawat A, Rabbi F, Babu KS, Tasayco ES, Ore Areche F, et al. Understanding the Global Transmission and Demographic Distribution of Nipah Virus (NiV). Res J Pharm Technol. 2023 Aug 31;3588–94.

25. Md. Rezwan Ahmed Mahedi, Kamilia Mounich, Chou-Yi Hsu, Jamilur Rahman Bhuiyan, Ihsan K. Jasim, Othman Mahjoob Khalaf, et al. Cefiderocol (CFDC): A Spy Antibiotic Future Replacement of Carbapenem. Res J Pharm Technol. 2023 Nov;16(11):5492–6.

26. Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief. 2011; (81):1–8.

27. Chandravanshi LP. Assessment and Diagnosis of Poisoning with Characteristics Features in Living or Dead. J Forensic Sci Crim Investig. 2018; 10(5).

28. Reddy K.S. Narayan, Murty O.P. The Essentials of Forensic Medicine and Toxicology. Forensic Medicine. 2017; 34:1–671.

29. Klepac T, Busljeta I, Macan J, Plavec D, Turk R. Household chemicals--common cause of unintentional poisoning. Arh Hig Rada Toksikol. 2000; 51(4):401–7.

30. Majowicz SE, Meyer SB, Kirkpatrick SI, Graham JL, Shaikh A, Elliott SJ, et al. Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action. BMC Public Health. 2016; 16(1):487.

31. Stevenson R, Tuddenham L. Novel psychoactive substance intoxication resulting in attempted murder. J Forensic Leg Med. 2014; 25:60–1.

32. Martens F. Suspected poisoning. What kind of emergency care? MMW Fortschr Med. 2001;143(49–50):28–33.

33. Margie Peden, Kayode Oyegbite, Joan Ozanne-Smith, Adnan A Hyder. World Report on Child Injury Prevention. Geneva: World Health Organization. 2008;

34. Durbar US. Nature’s Cure for the Management of Drug Induced Nephrotoxicity. Res J Pharm Technol. 2015;8(11):1593.

35. Sinha M, Sahu M, Sallawad SS, Ahirwar B, Isukapatla AR. Characteristics and Identifying Features of Various Natural Toxins and Poisonous Plants used as Weapons in Forensic Cases. Res J Pharm Technol. 2017;10(12):4237.

36. Kareem SM, Al-Ezee AMM. Food poisoning (Salmonellosis). Res J Pharm Technol. 2020;13(2):529.

37. Subhashini V, Bhojraj S, Prakash KS, Shalilni T. A Complexity Focus on Nanotoxicology-A Review. Res J Pharm Technol. 2017;10(1):346.

38. Skaria TG, Reddy BS, Vidya RVS, Shetty SM, Pagnis RR, K V, et al. Risk factors for the development of complications in Organophosphate and Carbamate poisoning. Res J Pharm Technol. 2020;13(1):361.

39. Rastogi S, Tripathi S, Ravishanker D. A study of neurologic symptoms on exposure to organophosphate pesticides in the children of agricultural workers. Indian J Occup Environ Med. 2010; 14(2): 54.

40. Mahedi MRA, Mounich K, Hsu CY, Bhuiyan JR, Jasim IK, Khalaf OM, Darshan J C, Wei CR, Mushfique MB, Syrmos N, Afrin S, Singh P. Cefiderocol (CFDC): A Spy Antibiotic Future Replacement of Carbapenem. Res J Pharm Technol. 2023; 16(11): 5492-6. https://doi.org/10.52711/0974-360X.2023.00888

Received on 20.01.2024 Revised on 10.04.2024

Accepted on 15.06.2024 Published on 20.01.2025

Available online from January 27, 2025

Research J. Pharmacy and Technology. 2025;18(1):402-408.

DOI: 10.52711/0974-360X.2025.00062

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