Clinical Poisonings Imposed by the COVID-19 Pandemic

Background: Along with the COVID-19 pandemic, a new problem has appeared in the healthcare facilities: toxicities and poisonings caused by medications and home remedies, by which people have been trying to protect themselves from acquiring the virus. The authors of this paper aim to notify the global scientific society of several substances and medications that either have led to poisonings thus far or have the potential for an outbreak.Methods: Medical English literature reporting cases of poisonings during this pandemic between January and December 2020. Substances and drugs that could be a potential concern to public health are also reviewed.Results: Alcohols and chemical substances have been the main causes of poisonings during this pandemic. Opioids, household products and herbal remedies were partly to blame. Global spread of incorrect information related to the COVID-19 prevention and treatment is a major risk to human lives, particularly in this difficult situation where healthcare systems are overwhelms with high rate of COVID-19 morbidity and mortality.Conclusion: As additional waves of the coronaviruses may hit countries in the upcoming winter, confinements may as well continue. Therefore, emergency physicians must be prepared for possible outbreaks of poisonings and be able to predict any unusual pattern of toxicities

Assessing the Clinical Features and Blood Biochemistries of Acute Organophosphorus Chemical Warfare Agents in Iranian Veterans

Background: Nerve Agents (NAs) are a chemical weapons, and their use is prohibited. They were used for numerous-times in the warfare of Iraq against Iran. The present study aimed to assess the clinical features and laboratory findings of the acute poisoning manifestations of organophosphorus chemical warfare agents (NAs) in Iranian veterans early after exposure.Methods: A total of 25 male NAs-exposed cases were enrolled in the present study. We used the medical records of early combat in 1990 for data collection. The data of the exposed-victims were unavailable for a long time. Clinical features were evaluated and fasting blood glucose, sodium, potassium, insulin level, and protein electrophoresis were measured on the first day of exposure. Results: Potassium, sodium, fasting blood glucose, and protein electrophoresis were abnormally noticeable on the first day post-exposure. The clinical features of the studied cases were manifested in the muscarinic and nicotinic systems, and Central Nervous Systems (CNS). Miosis, cramp, restlessness, and respiratory symptoms were dominant features in the study subjects.Conclusion: The investigated exposed-victims of NAs indicated hypokalemia, hyperkalemia, hypoglycemia, normal insulin levels, and abnormal protein electrophoresis. The clinical features of the cholinergic crisis were markedly significant in three levels of the muscarinic, nicotinic, and CNS manifestations. Our findings suggested that the exposed cases were against a significant dose of NAs

Epidemiological Assessment of acute poisoning Death–One year Survey

Background: Acute poisoning by drugs and chemical agents is a medical emergency and carries a high morbidity and mortality rate. The epidemiology of acute poisoning varies between countries and different regions. Method: In this one year retrospective study, we reviewed the epidemiology of patients with acute poisoning (intentionally or unintentionally) who died during hospitalization at Loghman Hakim hospital, Tehran, Iran. Results: Of the 280 cases of completed suicide by self-poisoning 69 (24.6%) cases were female and 211(75.4%) cases were male, between 15-78 years old with mean±SD of 39±17.5. Most of them were conscious (69.6%) on admission to Emergency Department (ED). Past history of any self- harm were positive in 82 (29.3) cases of subjects. Multiple drug toxicity and opioid poisoning were the most common causes of acute poisoning death in 27.5% and 27.1% respectively. Conclusion: Differences based on age category, sex, the types of toxic agents involved and the outcomes of the poisoning death incidents were noted. Future interventions should take these differences into account

Radiological Features of Paraquat Herbicide Poisoning: A Case Report

Paraquat (PQ) is a herbicide with potent toxicity. The most frequent human poisoning occurs by ingestion and inhalation. Its clinical feature includes pulmonary edema in the first 48 hours post-toxicity with progression to acute respiratory distress syndrome. A 50-year-old male poisoned patient referred to the emergency department with the complaint of shortness of breath. His companions had an herbicide poison bottle. Respiratory failure gradually intensified. The patient was intubated and under mechanical ventilation for one month. kidney and liver insufficiency were gradually added to the patient’s clinical feature in the following days. He died with multiorgan failures one month later. Standard chest X-ray is not beneficial for assessing PQ intoxication. High resolution computed tomography scan is recommended at day 7 post-ingestion for evaluating PQ poisoning

The study of brain death in Chaharmahal and Bakhtiari province in Iran from 2003 to 2013

Background and aims: There are different causes for brain death including head trauma, cerebrovascular accidents and intracranial space-occupying lesions. The present study was aimed to determine the causes of brain death in Chahar Mahal and Bakhtiari province due to high turnover of trauma in this area during 2003 to 2013. Methods: This study was based on routine data and was conducted on all brain death cases of Ayatollah Kashani Hospital in Shahrekord city, the capital of province, from 2003 to 2013. Necessary data was collected using retrospective method and completion of the questionnaire. Results: The results of the study showed that 95 patients were brain dead in Chahar Mahal and Bakhtiari province over a ten-year study. The mean age of these brain dead patients was 31±15.4 years with the age range of 5 to 78 years. 35.8 (33 patients) of the patients were female. The most common cause of brain death was driving accidents with 44.2 (42 cases). Most of brain deaths were occurred in the summer season with 41.1 (39 patients). Conclusion: The most common causes of brain death in adults and children were trauma due to car accidents. The limited use of safety devices among the population may pose more attention of managers to build the culture of using the safety devices during driving

Complications of Laparoscopic and Laparotomy Surgeries in the Department of Tehran Legal Medical Committee in 2011-2016

Background: A major challenge in medicine is patients’ dissatisfaction and complaints against doctors. Medical complaints in Iran, similar to the other countries, have a growing trend. Over the past two decades, the implementation of laparoscopic surgery rapidly grew in many countries. The current study aimed to investigate complaints against surgeons in laparoscopic surgeries, compared to open surgeries. Methods: The current cross-sectional study was conducted on all laparotomy and laparoscopic surgery complaint cases. The medical records were extracted based on the study variables, using a researcher-made questionnaire. To analyze the obtained data, frequency tables were used and to investigate the relationship between variables, Chi-Squared and Fisher’s Exact tests were employed.Results: A total of 369 medical complaint cases were brought to the Department of Tehran Legal Medical Committee, Tehran, Iran, from 2011 to 1016. The Mean±SD age of studied patients was 45.8±13.4 years. The most frequent medical complaint cases were against physicians working at private hospitals. In addition, most complaints were after laparotomy cases. More than half of the cases were voted on the malpractice of physicians. The frequency of postoperative infections was significantly higher in laparoscopic surgeries. The frequency of sentence for malpractice was significantly higher in laparoscopic surgeons, compared to laparotomy ones.Conclusion: Physicians’ knowledge about legal medical issues and building intimate and trustful relationship with patients along with the provision of desirable healthcare services can be effective in reducing medical error complaints

Determining the Cause of Death Among Drug Addicts in Residential Rehab Campuses in Tehran

Background: Determining the cause of death among drug addicts in Residential Rehab Campuses (RRCs) is of paramount importance, since it may prevent and reduce morbidity and mortality rates. Therefore, the present study was done to investigate the cause of death among drug addicts in RRCs in Kahrizak Dissection Hall, Tehran Province, Iran, from September 2011 to September 2019.Methods: In this descriptive cross-sectional study, a total number of 166 drug addicts, who had died in the RRCs located in Tehran, Iran were examined, and the findings were analyzed using the SPSS v. 26. Moreover, the Chi-square test was utilized to compare the results.Results: In this study, the most important causes of death, were infections, drug side effects, Myocardial Infarction (MI), and drowning, respectively. The highest frequency of death had occurred in the 31-40-year-old age group and was mostly observed in unmarried individuals. The most common causes of death were infection among the single and divorced ones and were MI for married cases. Toxicological results were generally negative in 60.84% of the cases. Also, 86.74% of the cases were non-pathological with regard to the brain tissue samples and 65.66% of the individuals had no pathological cardiac lesions. Besides, the most common microscopic findings of the lungs were associated with pulmonary edema. In the trauma group and also drug side effects and drowning groups, the most frequent pathological findings were pulmonary hemorrhage and pulmonary edema, respectively. As a whole, 69.87% of the deaths had occurred in the RRCs and 55.42% of them were assumed natural in terms of mode of occurrence.Conclusion: The majority of the deaths in the RRCs should not have occurred if the given centers were authorized and the illegal centers were closed. Moreover, these centers should have proper management with the presence of resident physicians and trained medical staff as well as necessary medical equipment, proper nutrition, no access to drugs and other illicit substances, along with adherence to hygienic principles to minimize mortality rates among the drug addicts living in the RRCs

The Outcomes of Accidental Ingestion of Hand Sanitizer

Background: children are exposed to numerous chemicals, such as hand sanitizers and their associated poisoning. Awareness of such poisoning symptoms and their management is critical for healthcare providers, as it can induce dangerous conditions. This study evaluated the clinical and paraclinical parameters of children who ingested hand sanitizers.Methods: In the first 6 months of 2020, the cases of children who accidentally ingested hand sanitizer and were referred to Akbar Hospital in Mashhad City, Iran (Referral pediatric poisoning center) were evaluated in this cross-sectional study. The relevant medical information and laboratory parameters were recorded.Results: In total, 20 patients were evaluated; of whom, 80% were male. The Mean±SD age of the study subjects was 4.9±4.2 years (2-15y). The ingestion was accidental in the study participants. The amount of ingestion approximately equaled a sip (3-7cc). All clinical and laboratory parameters were normal according to their age. Only 1(5%) case presented metabolic acidosis. No study subject manifested hypoglycemia or the loss of consciousness. Thus, they only received supportive care and were observed for ≥12 hours.Conclusion: Based on the present study results and absence of symptoms in the explored cases of hand sanitizer ingestion, the suitability of hand sanitizer solutions. Therefore, the formulation of these products should be carefully evaluated

Guillain-Barre Syndrome Due to Tramadol

Tramadol is a powerful prescription medication used for pain relief of varying intensities. Tramadol was initially produced in Germany to alleviate postsurgical and chronic pains. We describe a case of a 22-year-old male with no past medical history who took tramadol for the second time and then had a tonic-clonic seizure episode that worsened the weakness of his inferior limbs and followed by loss of consciousness. According to physical examination, clinical and paraclinical tests, he was diagnosed with Guillain-Barre syndrome. After treatment with intravenous immunoglobulin, he was improved and discharged 9 days after treatment. He was recommended to continue physiotherapy. The relation between tramadol using and Guillain-Barre syndrome development is unknown but it can be due to reactive oxygen species generation. &nbsp