Vol.21 Issue No.01 (2025): Journal of Indian Society of Toxicology <p style="padding-left: 120px;"><strong>The Role of a Toxicology Garden in the Department of Forensic Medicine and Toxicology</strong></p> <p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Anand Mugadlimath&nbsp; &nbsp; &nbsp; &nbsp;Mandar R Sane&nbsp;</p> <p><strong>Introduction</strong> : In the subject of forensic medicine and toxicology, real-time exposure to toxic plants offers unparalleled learning that no textbook or virtual simulator can replicate. The establishment of a Toxicology Garden within the Department of Forensic Medicine and Toxicology is a vital, yet often overlooked, academic and research infrastructure. With the National Medical Commission (NMC) placing increased emphasis on competency-based learning and practical skill acquisition, such a garden has found renewed importance in undergraduate and postgraduate training. A Toxicology Garden is a curated botanical space containing poisonous plants, primarily those relevant to human toxicity and of some medicolegal importance. This initiative not only aids in the visual and tactile learning of plant identification but also helps students appreciate the dual nature of botanical substances&mdash;as remedies and as poisons.</p> <p><strong>Educational Utility and CBME Integration</strong></p> <p>The introduction of the Competency-Based Medical Education (CBME) curriculum by the NMC underlines the need for hands-on learning. The Toxicology Garden directly supports the following CBME competencies outlined in Forensic Medicine and Toxicology:</p> <p>- FM 3.9: Identify and describe common toxic plants and their active principles.</p> <p>- FM 3.10: Demonstrate knowledge of signs, symptoms, treatment, and medico-legal aspects of plant-based poisoning.</p> <p>The garden allows students to observe plant morphology, smell and feel textures, and understand seasonal changes&mdash;all of which are crucial for accurate identification during the actual case scenarios during practice.</p> <p><strong>Use of QR code: </strong></p> <p>QR-code-based digital descriptions, interactive signage, and field-guided quizzes enhance engagement. Additionally, regular plant walks, case-based discussions, and problemsolving exercises conducted in this open-air setting contribute to active learning.</p> <p><strong>Medicolegal Significance and Interdisciplinary Research </strong></p> <p>Poisonous plants are widespread, and completely removing them from a specific area is often impractical. Instead, it is better to learn how to identify the most significant ones and understand how they can cause harm. The likelihood of poisoning generally depends more on human behavior and animal management practices than on the mere presence of a poisonous plant. Toxic plants such as Abrus precatorius (rosary pea), Datura stramonium, Calotropis gigantea, Ricinus communis, Nerium oleander, and Gloriosa superba are frequently involved in accidental, suicidal, or homicidal poisonings in India. A clinician's or forensic expert's ability to identify these plants can assist in early diagnosis, informed treatment, and prompt medico-legal reporting. Similarly, requirement of recognizing the plant species producing health problems is generally devoted to specialized structures such as the poison centres. To accomplish their mission, poison centres need to maintain a comprehensive collection of information about poisonous plants. Furthermore, plant species which are locally prevalent must be identified and catalogued in toxicology garden.</p> <p>In forensic investigations, plant remnants from the stomach or vomitus can be compared with living specimens in the garden, bridging the gap between toxicological reports and field evidence. Moreover, the garden is a hub for interdisciplinary research&mdash;linking forensic toxicologists, pharmacognosists, botanists, and pharmacologists. Studies on plant phytochemistry, toxic dose estimation, regional variations in toxicity, and ethnobotanical use of poisons can be undertaken by postgraduate students, thus contributing to bothacademic literature and public health knowledge. However, toxicology garden must be decoupled from 'Herbal Garden', which serves as a living repository of medicinal plants for academia purpose and awareness of public at large.&nbsp;</p> <p><strong>NMC Norms and Institutional Requirements </strong></p> <p>The NMC Minimum Requirements for Medical Colleges (2023) emphasize the need for innovative teaching-learning methods and practical exposure, especially in subjects like forensic medicine, which often face a disconnect between classroom and real-life situations.</p> <p>While the toxicology museum is a prescribed requirement, a Toxicology Garden is a recommended best practice, aligned with the NMC's spirit of experiential learning. Several newer institutions, especially AIIMS and centrally funded medical colleges, have begun integrating such gardens as model teaching units.To establish a garden that meets both academic and regulatory expectations, the following infrastructure is recommended:</p> <p>- Minimum 25&ndash;30 species of toxicological importance, well-labeled with local and botanical names.</p> <p>- Advice regarding type of plants, soil conditions and horticultural requirements should be sought from Agricultural university/Botanical department of university or institutes like Indian Council of Agricultural Research.</p> <p>- Digital cataloging with QR codes linked to pharmacological and toxicological profiles.</p> <p>- Seating and discussion spaces for guided sessions.</p> <p>- It should be securely fenced, and all visitor access should be continuously monitored.</p> <p>- Annual updating and periodic maintenance.</p> <p>Institutions planning for NAAC or NMC assessments can also present the garden as evidence of curriculum enrichment and innovation under &ldquo;Best Practices&rdquo; or &ldquo;Extension Activities.&rdquo;</p> <p><strong>Community and Public Health Outreach</strong></p> <p>Beyond academic use, the garden serves a community awareness function. School outreach programs, public exhibitions on World Poison Prevention Day, or collaborations with agriculture and forest departments can raise awareness about the dangers of local poisonous flora. For example, in rural India, knowledge of the lethality of Thevetia peruviana (yellow oleander) or Cleistanthuscollinus (Oduvanthalai) can be lifesaving.</p> <p>Such gardens can also integrate modules on natural toxins in child poisoning, pesticide safety, and household plant toxicity, aligning with national poison control strategies.</p> <p><strong>Challenges and the Way Forward </strong></p> <p>Creating and sustaining a toxicology garden is not without challenges&mdash;land allocation, interdepartmental coordination, plant upkeep, and faculty involvement require consistent institutional support. Additionally, handling certain toxic plants necessitates biosecurity and safety protocols.</p> <p>Despite these challenges, the benefits far outweigh the difficulties. A well-maintained Toxicology Garden becomes a living laboratory, a teaching aid, and a research platform. It reflects the institution's commitment to excellence in medical education and forensic awareness.</p> <p><strong>Conclusion</strong></p> <p>In an age where digital learning dominates, the humble toxicology garden offers a refreshing, effective, and necessary tactile learning space. It aligns with the NMC's CBME objectives, supports interdisciplinary education, and has vast public health relevance. Departments of Forensic Medicine and Toxicology must take the lead in promoting such innovative educational ecosystems. By cultivating these spaces, we do not merely grow plants&mdash;we grow awareness, vigilance, and lifesaving knowledge.&nbsp;</p> <p>&nbsp;</p> 41 2026-01-15 19:32:01 Prognostic Markers of Insecticidal Poisoning : A One Year Institution Based Cross Sectional Study in Bundelkhand Region 473 2026-01-15 19:32:01 <p><strong>Background</strong> : Organophosphorus compounds (OPC) are widely used as pesticides and are a leading cause of poisoning in rural India. This study aimed to identify clinical and biochemical parameters inuencing prognosis and duration of hospital stay in OPC poisoning cases.</p> <p><strong>Materials and Methods: </strong>A cross-sectional study was conducted over one year on patients with acute OPC poisoning admitted to the emergency ward and ICU of a tertiary hospital in Bundelkhand. Demographic, clinical, and laboratory parameters were collected retrospectively. Severity was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale. Statistical analysis was performed using SPSS 26.0.</p> <p><strong>Results</strong>: Of 106 patients, 97 met inclusion criteria. Mean age was 34.2 &plusmn; 11.4 years; 59.8% were male. Mean ingestion-to-presentation interval was 3.8 &plusmn; 2.7 hours, and mean POP score was 2.8 &plusmn; 1.9. Longer hospital stay was significantly associated with low pH (p = 0.014), high lactate (p = 0.020), elevated serum sodium (p = 0.004), higher POP score (p = 0.002), and need for invasive ventilation (p = 0.005). Mortality occurred in 11 patients (11.3%) and was significantly linked to low pH (p = 0.039), hypokalemia (p = 0.015), elevated total leukocyte count (p = 0.021), raised SGOT (p = 0.016), SGPT (p = 0.012), and blood urea (p = 0.001). Blood urea had the strongest predictive value for mortality (AUROC 0.811).&nbsp;</p>

<p><strong>Background</strong> : Organophosphorus compounds (OPC) are widely used as pesticides and are a leading cause of poisoning in rural India. This study aimed to identify clinical and biochemical parameters inuencing prognosis and duration of hospital stay in OPC poisoning cases.</p> <p><strong>Materials and Methods: </strong>A cross-sectional study was conducted over one year on patients with acute OPC poisoning admitted to the emergency ward and ICU of a tertiary hospital in Bundelkhand. Demographic, clinical, and laboratory parameters were collected retrospectively. Severity was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale. Statistical analysis was performed using SPSS 26.0.</p> <p><strong>Results</strong>: Of 106 patients, 97 met inclusion criteria. Mean age was 34.2 &plusmn; 11.4 years; 59.8% were male. Mean ingestion-to-presentation interval was 3.8 &plusmn; 2.7 hours, and mean POP score was 2.8 &plusmn; 1.9. Longer hospital stay was significantly associated with low pH (p = 0.014), high lactate (p = 0.020), elevated serum sodium (p = 0.004), higher POP score (p = 0.002), and need for invasive ventilation (p = 0.005). Mortality occurred in 11 patients (11.3%) and was significantly linked to low pH (p = 0.039), hypokalemia (p = 0.015), elevated total leukocyte count (p = 0.021), raised SGOT (p = 0.016), SGPT (p = 0.012), and blood urea (p = 0.001). Blood urea had the strongest predictive value for mortality (AUROC 0.811).&nbsp;</p>

 Zaki Siddiqui Shashank Shekhar Swarna Tripathi Aditya Singh Development and Validation of a Presumptive Colour Test for Diagnosing Hair Dye Poisoning 474 2026-01-15 19:32:01 <p><strong>Aim</strong>: To develop and validate a modified Simon's test as a simple, rapid, and cost-effective method for detecting paraphenylenediamine (PPD) in hair dyes and biological samples.</p> <p><strong>Materials and Methods</strong>:Twelve commercial hair dye formulations (black and dark brown) and natural controls (henna, indigo) were obtained from the local market in Kochi, Kerala. Urine samples spiked with PPD (50 ppm) were also tested. The modified Simon's test involved adding sodium nitroprusside (10%) and sodium carbonate (2%) to prepared dye or urine solutions and observing color changes. The appearance of a deep blue color was interpreted as a positive result for PPD.</p> <p><strong>Results:</strong> All 12 commercial hair dye products tested positive for PPD at both 50 ppm and 100 ppm. Natural henna and indigo controls were consistently negative. Spiked urine samples also yielded positive results, confirming the test's sensitivity to detect PPD at 50 ppm.</p> <p><strong>Conclusion:</strong> The modified Simon's test is a rapid, inexpensive, and sensitive presumptive screening tool for PPD detection in cosmetic formulations and biological samples. Although qualitative in nature and limited by sample diversity, the method holds promise for application in clinical toxicology and forensic practice where advanced instrumentation is unavailable</p>

<p><strong>Aim</strong>: To develop and validate a modified Simon's test as a simple, rapid, and cost-effective method for detecting paraphenylenediamine (PPD) in hair dyes and biological samples.</p> <p><strong>Materials and Methods</strong>:Twelve commercial hair dye formulations (black and dark brown) and natural controls (henna, indigo) were obtained from the local market in Kochi, Kerala. Urine samples spiked with PPD (50 ppm) were also tested. The modified Simon's test involved adding sodium nitroprusside (10%) and sodium carbonate (2%) to prepared dye or urine solutions and observing color changes. The appearance of a deep blue color was interpreted as a positive result for PPD.</p> <p><strong>Results:</strong> All 12 commercial hair dye products tested positive for PPD at both 50 ppm and 100 ppm. Natural henna and indigo controls were consistently negative. Spiked urine samples also yielded positive results, confirming the test's sensitivity to detect PPD at 50 ppm.</p> <p><strong>Conclusion:</strong> The modified Simon's test is a rapid, inexpensive, and sensitive presumptive screening tool for PPD detection in cosmetic formulations and biological samples. Although qualitative in nature and limited by sample diversity, the method holds promise for application in clinical toxicology and forensic practice where advanced instrumentation is unavailable</p>

 Vaishnavi Vinu Arathy SL Anagha Chandran Devika Rajeev Poisoning Cases in Bangalore South : A Retrospective One-Year Study from a Tertiary Care Poison Information Centre 475 2026-01-15 19:32:01 <p><strong>Objective:</strong> To analyse the epidemiological profile, classes of poisoning agents, and manner of poisoning incidents reported to an early-stage Poison Information Centre (PIC)Bangalore South District, for targeted public health interventions.</p> <p><strong>Methods:</strong> A retrospective descriptive study analysed 197 poisoning cases reported to a tertiary care PIC (September 2023 - September 2024). Data extracted from telephone-based consultation logs included patient demographics, class of poisoning agent, and reported intent. Descriptive statistics (frequencies, percentages) were used. Fatal outcomes documented via follow-up calls.</p> <p><strong>Results:</strong> Among 197 cases, 52.7% were female. Age groups 21&ndash;30 years (25.4%) and 11&ndash;20 years (24.9%) were most affected. Intent was largely undetermined (47.2%, n=93); however, intentional cases (36.5%, n=72) showed strong female preponderance. Accidental poisonings accounted for 16.2% (n=32). Pesticides predominated (43.7%, n=86), notably Pyrethroids (n=33) and Organophosphates (n=15). Unknown compounds (26.9%, n=53) and pharmaceutical agents (13.7%, n=27) were also significant. Paediatric cases (&le;17 years) constituted 29.4% (n=58), mainly involving pesticides (n=18) and unknown substances (n=15). Thirteen fatalities (6.6% CFR) recorded, primarily from pesticides (n=7) and unknown compounds (n=4); an accidental atropine fatality involved a 3-year-old.</p> <p><strong>Conclusion:</strong> This early-stage registry highlights intentional self-poisoning with easily accessible pesticides, particularly among young females, as a significant burden in Bangalore South. High undetermined intent and unknown agents, coupled with paediatric vulnerability to accidental exposures, present critical challenges. Findings emphasize an urgent, multi-faceted public health response: integrating enhanced toxicovigilance, targeted prevention, improved clinical/forensic toxicology, and sustained inter-sectoral collaboration to mitigate this crisis.</p>

<p><strong>Objective:</strong> To analyse the epidemiological profile, classes of poisoning agents, and manner of poisoning incidents reported to an early-stage Poison Information Centre (PIC)Bangalore South District, for targeted public health interventions.</p> <p><strong>Methods:</strong> A retrospective descriptive study analysed 197 poisoning cases reported to a tertiary care PIC (September 2023 - September 2024). Data extracted from telephone-based consultation logs included patient demographics, class of poisoning agent, and reported intent. Descriptive statistics (frequencies, percentages) were used. Fatal outcomes documented via follow-up calls.</p> <p><strong>Results:</strong> Among 197 cases, 52.7% were female. Age groups 21&ndash;30 years (25.4%) and 11&ndash;20 years (24.9%) were most affected. Intent was largely undetermined (47.2%, n=93); however, intentional cases (36.5%, n=72) showed strong female preponderance. Accidental poisonings accounted for 16.2% (n=32). Pesticides predominated (43.7%, n=86), notably Pyrethroids (n=33) and Organophosphates (n=15). Unknown compounds (26.9%, n=53) and pharmaceutical agents (13.7%, n=27) were also significant. Paediatric cases (&le;17 years) constituted 29.4% (n=58), mainly involving pesticides (n=18) and unknown substances (n=15). Thirteen fatalities (6.6% CFR) recorded, primarily from pesticides (n=7) and unknown compounds (n=4); an accidental atropine fatality involved a 3-year-old.</p> <p><strong>Conclusion:</strong> This early-stage registry highlights intentional self-poisoning with easily accessible pesticides, particularly among young females, as a significant burden in Bangalore South. High undetermined intent and unknown agents, coupled with paediatric vulnerability to accidental exposures, present critical challenges. Findings emphasize an urgent, multi-faceted public health response: integrating enhanced toxicovigilance, targeted prevention, improved clinical/forensic toxicology, and sustained inter-sectoral collaboration to mitigate this crisis.</p>

 Sylia Sara Thomas Aishwarya C Rabiya Shaikh Subhanali Accidental Formaldehyde Poisoning in an Alcohol-Dependent 476 2026-01-15 19:32:01 <p>Formaldehyde is a colourless, volatile chemical with a strong, pungent odour. In aqueous solution, it is known as formalin and is widely used as a disinfectant, embalming agent, and in industries such as plastics and sericulture. Formalin is a protoplasmic poison with potent caustic and xative properties, leading to extensive tissue damage upon ingestion or inhalation. Due to its strong odour and unpleasant taste, both suicidal and accidental formalin poisoning are uncommon. We report a case of a 42-year-old male who died following accidental ingestion of formalin while under the inuence of alcohol. Clinical history, autopsy ndings, and toxicological analysis were consistent with formalin poisoning. This case highlights the medicolegal importance of secure chemical storage &amp; the potential risks of occupational exposure in rural and agricultural settings.</p>

<p>Formaldehyde is a colourless, volatile chemical with a strong, pungent odour. In aqueous solution, it is known as formalin and is widely used as a disinfectant, embalming agent, and in industries such as plastics and sericulture. Formalin is a protoplasmic poison with potent caustic and xative properties, leading to extensive tissue damage upon ingestion or inhalation. Due to its strong odour and unpleasant taste, both suicidal and accidental formalin poisoning are uncommon. We report a case of a 42-year-old male who died following accidental ingestion of formalin while under the inuence of alcohol. Clinical history, autopsy ndings, and toxicological analysis were consistent with formalin poisoning. This case highlights the medicolegal importance of secure chemical storage &amp; the potential risks of occupational exposure in rural and agricultural settings.</p>

 Rabiya Shaikh Subhanali Sylia Sara Thomas Aishwarya C The Clinical Profle of Cerbera Odollam Poisoning and the Effect of Early Pacemaker Initiation Therapy - A Case Series 477 2026-01-15 19:32:01 <p><strong>Background :</strong> Cerbera odollam is a highly toxic plant found in South India, particularly Kerala. Its seeds contain cardiac glycosides, notably cerber in, which can cause life-threatening arrhythmias by inhibiting the Na⁺/K⁺-ATPase pump. Poisoning often presents with gastrointestinal and cardiac manifestations, and early intervention is essential.</p> <p><strong>Case series:</strong> We report three cases of Cerbera odollam poisoning presenting to atertiary care center in Kerala, between January and June 2019. The first case involved a 38-year-old male who ingested one fruit and presented with vomiting and oliguria; his ECG showed sinus bradycardia and atrioventricular (AV) block. He was successfully treated with temporary pacemaker insertion and recovered fully. The second case was a 56-year-old male who consumed one seed and developed bradyarrhythmias accompanied by hyperkalemia. Despite supportive care, pacemaker therapy was not initiated, and the patient unfortunately succumbed to the poisoning. The third case described a 42-year-old male who ingested three seeds and presented with altered consciousness and significant bradyarrhythmias, including conduction blocks. He was managed with temporary pacing and supportive treatment, leading to clinical recovery.</p> <p><strong>Conclusion:</strong> This case series emphasizes the critical role of temporary cardiac pacing in managing Cerbera odollam poisoning. Early diagnosis and timely intervention, particularly in the presence of conduction abnormalities, can be lifesaving.</p>

<p><strong>Background :</strong> Cerbera odollam is a highly toxic plant found in South India, particularly Kerala. Its seeds contain cardiac glycosides, notably cerber in, which can cause life-threatening arrhythmias by inhibiting the Na⁺/K⁺-ATPase pump. Poisoning often presents with gastrointestinal and cardiac manifestations, and early intervention is essential.</p> <p><strong>Case series:</strong> We report three cases of Cerbera odollam poisoning presenting to atertiary care center in Kerala, between January and June 2019. The first case involved a 38-year-old male who ingested one fruit and presented with vomiting and oliguria; his ECG showed sinus bradycardia and atrioventricular (AV) block. He was successfully treated with temporary pacemaker insertion and recovered fully. The second case was a 56-year-old male who consumed one seed and developed bradyarrhythmias accompanied by hyperkalemia. Despite supportive care, pacemaker therapy was not initiated, and the patient unfortunately succumbed to the poisoning. The third case described a 42-year-old male who ingested three seeds and presented with altered consciousness and significant bradyarrhythmias, including conduction blocks. He was managed with temporary pacing and supportive treatment, leading to clinical recovery.</p> <p><strong>Conclusion:</strong> This case series emphasizes the critical role of temporary cardiac pacing in managing Cerbera odollam poisoning. Early diagnosis and timely intervention, particularly in the presence of conduction abnormalities, can be lifesaving.</p>

 Nikhil Paul Keerthana Manoharan K K Ramu R J Linu S M Archu M J