Rhabdomyolysis and Acute Poisoning; a Brief Report

Introduction: Some studies have reported creatinine phosphokinase (CPK) as a new emerging way in predicting the outcomes of poisoned patients. This study aimed to evaluate the association of serum CPK level in the first 24 hours with outcomes of poisoned patients.Methods: This retrospective cross-sectional study was performed using the medical profiles of poisoned patients aged between 13 and 70 years old who were referred to the emergency department of a big referral medical toxicology center during 6 years and whose necessary data for this study was available.Results: 318 patients with the mean age of 34.9±14.5 years were studied (77.1% male). The mean serum CPK level of patients was 4693.1 ± 10303.8 (35–89480) IU/L. There was no significant correlation between serum CPK level and cause of poisoning (r= 0.16; p=0.51), age (r = -0.021; p = 0.651), sex (r = 0.131; p = 0.281), seizure (r = -0.022; p = 0.193), level of consciences (r = -0.138; p = 0.167), and duration of hospital stay (r= 0.242, p = 0.437). The mean serum CPK level was significantly higher in ICU admitted (p<0.0001), AKI (p<0.0001), hyperkalemia (p<0.0001), hypophosphatemia (p=0.045), and hypocalcaemia (p=0.008) cases.  The best cut off point of serum CPK level in predicting acute kidney injury (AKI) was estimated to be 10000 IU/L (sensitivity = 83.8% and specificity = 68.8%).Conclusion: It seems that CPK could be considered as a candidate tool for screening the intoxicated patients in need for ICU admission and at risk for AKI

Predictive Factors of Mortality in Acute Amphetamine Type Stimulants Poisoning; a Review of 226 Cases

Introduction: Amphetamine type stimulants (ATS) such as amphetamine and methamphetamine (MA) are one of the most important causes of poisoning in the world.  In this study we aimed to define the predictive factors of mortality in acute ATS poisoning patients. Methods: This is a retrospective cross-sectional study on all cases with acute ATS poisoning who were referred to a referral center for poisoning, Tehran, Iran, from April 2011 to March 2014. Using patients’ medical records, demographic data, route of exposure, type and amount of ATS, the cause of poisoning, clinical presentations, and electrocardiogram (ECG) and laboratory findings, as well as patient’s outcomes were collected and analyzed regarding the independent predictive factors of mortality. Results: 226 cases with the mean age of 32.9 ± 10.9 years were studied (77% male). MA was the most abused ATS (97.4%) and the most frequent route of exposure was oral (55.3%). The mortality rate was 5.4%. There was a significant association between agitation (p = 0.002), seizure (p = 0.001), loss of consciousness (p < 0.001), creatine phosphokinase level (p = 0.002), serum pH (p = 0.002), serum HCO3 (p = 0.02), and PCO2 (p = 0.01) with mortality. However, serum HCO3 [OR=1.27 (95% CI: 1.07-1.50); p value=0.005], PCO2 [OR=0.89 (95% CI: 0.84-0.96); p value=0.002], and loss of consciousness [OR=0.019 (95% CI: 0.003-0.106); p value=0.000] were the only independent predictive factors of mortality. Conclusion: PCO2 ≥ 51 mmHg, serum bicarbonate ≤ 22.6 mEq/L, and loss of consciousness on admission could be considered as prognostic factors of mortality in acute ATS poisoning cases presenting to emergency department

Frequency of Influenza-A-H1N1 in Patients with Community-Acquired Pneumonia Admitted to Loghman Hakim Hospital

Background: Here we assessed the incidence of Influenza-A-H1N1-related pneumonia in community-acquired pneumonia (CAP) at Loghman Hakim Hospital, Tehran, Iran.Materials and Methods: In this prospective study from November 22, 2016, to June 21, 2017, patients with CAP and suspected to seasonal influenza were included. Rapid Antigen test and quantitative real-time PCR assay were performed on samples. P-value < 0.05 was considered significant. In addition, radiologic patterns of them were evaluated.Results: a total of 29 admitted CAP patients were suspected of seasonal influenza. Two cases out of them were positive for influenza by real-time PCR, similar to result of influenza rapid test. The most common finding in their chest X ray was consolidation in one lobe. None of them vaccinated against influenza. Only nine patients received empiric Oseltamivir treatment. The amount of irrational antibiotic administration was significant.Conclusion: Despite low statistical numbers, admitted influenza CAP patients did not have unusual symptoms and radiologic patterns. Other results in this study showed need for antibiotic stewardship program and better training about necessity of vaccination

Puzzling Situation of Acetaminophen Toxicity in a Referral Hospital, Tehran, Iran: Acetaminophen toxicity in a referral hospital

Acetaminophen carries a higher risk of overdose. A puzzling situation of acetaminophen toxicity was encouraging enough to explore the epidemiologic situation of acetaminophen toxicity and its outcomes among patients acquired poisoning. This cross-sectional study retrospectively reviewed the medical records of 185 patients with acetaminophen poisoning referred to Loghman Hakim Hospital. Toxicity determined by acetaminophen serum concentration and time elapsed after drug ingestion. Demographics, laboratory markers, toxic hepatitis, renal failures, and liver enzyme elevations were compared between toxic and non-toxic patients. Twelve cases belonged to the former group and 173 patients fitted with the latter one. Having a mean age of 24.27±7.19 and 21.58±3.47 years, respectively, females were predominant. The average serum acetaminophen level was 70.37±61.92 and 24.90±26.36 within toxic and nontoxic patients, respectively. Median of consumed tablets were estimated as 40 for non-toxic and 18 for toxic patients (p=0.017). Mean hospital stay was 1.75±1.05 days for toxic patients and 1.35±3.25 days for the non-toxic group (p-value<0.001), and of whom 92.4 % were discharged within the first day. The laboratory assessments revealed no significant difference between groups. No death was recorded. Whereas hepatotoxicity was present in three toxic patients, renal failure was predominant in non-toxic patients. Rarely, a rise in liver enzyme was noticed; however, 33.33 % of toxic and 2.31 % of the non-toxic group had elevated AST; and 33.33 % of toxic versus 1.73 % percent of non-toxic patients had increased ALT. Acetaminophen toxicity is a worldwide noteworthy cause of poisoning which has distinct mortality and morbidity rates and showed an amazing and undebatable poisoning effect in the present study. A comprehensive study is required to examine the possible reasons for the difference between Iranian acetaminophen products with other non-Iranian company products

Determining the Topics and Content of CME Programs in Five Selected Subjects: Comparing the View Points of Experts and Target Group a Tehran University of Medical Sciences Experience

Introduction: One of the most appropriate methods for needs assessment is to assess learners' needs and arrange the educational programs based on their viewpoints. The aim of this study was to determine the topics and content of Continuing Medical Education (CME) programs in five selected subjects by medical education experts and target group, based on the real needs of General Practitioners (GPs) in order to revise CME national programs. Methods: In this cross-sectional applied study, 700 GPs covered by Medical Sciences Universities in Tehran province were studied. A questionnaire consisting of two parts of demographic features and 80 scientific questions regarding their knowledge in five domains of clinical pharmacology, skin diseases, toxicology, emergencies, and forensic medicine was used. The questionnaires were delivered to physicians' offices by trained personnel using a list or by direct referral to offices and then gathered. Three topics in each subject and 15 standard educational contents in total were developed for the target group. Results: There was almost a complete relationship between the opinion of experts and target group in forensic medicine. Some of the first five priorities of the two groups overlapped in skin diseases, forensic medicine, and emergencies. No common viewpoints were observed between experts and target group in pharmacology. In toxicology, there was no common viewpoint in the first three selections of the two groups. Conclusion: Real educational needs of GPs in receiving new information in order to promote their competencies and knowledge were different from those considered by experts. It is recommended to design the educational content for the target groups in the health care field based on their real deficiencies in knowledge and practice and by assessing their views and knowledge