Medical Confidentiality: Legal and Ethical Challenges in Iran

Being a matter of confidentiality, medical "secret" is an issue that physicians are aware of due to nature of their profession. Breach of confidentiality is defined as giving away a patient’s medical records by any means such as writing, telling, implying etc. According to law in Iran, medical confidentiality is one of the principles of medical profession and if anyone breaches it, they can be imprisoned up to one year. It is imperative that medical professionals make every effort to protect their patients’ secrets from being divulged even to their next of kin. Disclosure of patients' secret without their consent also results in public distrust in the healthcare system so that individuals either refuse to see the doctor or give incomplete and inaccurate information in the future, which per se can cause serious health risks

Abortion Induced by Peganum Harmala Ingestion in a Pregnant Woman: A Case Report and Literature Review

Background: Peganum harmala is a medicinal plant used in Iran and other countries. Many therapeutic effects have been described for this plant; it is insect repellant, disinfectant, antimicrobial, sedative, analgesic, anti-inflammatory, emetic, and abortifacient. Roots and seeds are medicinally-active parts of the plant containing some β-carboline and quinazoline alkaloids, which are responsible for its pharmacological and toxicological effects. Poisoning with high doses of Peganum harmala can be life-threatening.Case Report: We reported a 31-year old woman with an unwanted pregnancy, who ingested 1 glass of Peganum harmala seeds to induce abortion. On admission, she had severe nausea and vomiting, mild abdominal pain, and stable vital signs. Physical examination was unremarkable, and the leukocytosis was the only abnormal laboratory finding. The patient underwent nasogastric tube insertion, gastric lavage, as well as the administration of activated charcoal. Although she left the hospital on self-consent, further follow-up revealed that she had a spontaneous abortion without any complications.Conclusion: Although most cases of Peganum harmala intoxication can be managed successfully, this poisoning led to abortion in our case. Physicians working in Iran and other regions, where Peganum harmala is used as traditional medicine, must be aware of its toxicity for the early diagnosis and management.

The Successful Treatment of High Lethal Dose Paraquat Poisoning With Hemoperfusion

Paraquat (PQ), as an herbicide, is mostly used by farmers, especially in the north-west of Iran. Easy access to PQ is the reason for PQ intoxication in farm­ers. However, poisoning with PQ is rare. Most of the PQ-poisoned patients ingest it deliberately and following a suicidal attempt. PQ poisoning treatment has a poor outcome; only a small dose of slightly more than 10 mL PQ could be harmful and damage lungs forever. Under the conditions of no specific clinical feature, proper history, and diagnostic test, diagnosis is usually difficult. The ingestion of PQ in toxic doses could be fatal, destroying the lungs, kidney, heart, gastrointestinal tract, liver, and other organs. To remove PQ from the blood and intoxicants, one of the best recommendations is Hemo­perfusion (HP), as an extracorporeal method. In this case report, according to our treatments, early management of high lethal dose PQ poisoning, especially with HP could reduce the morbidity and mortality rates

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

Serum Klotho Level and its Related Factors Among Male Opioids Addicts With Normal Renal Function Compared to Healthy Male Non-smokers and Smokers in Tabriz, Iran

Background: Klotho is an aging-suppressor gene that encodes a single-pass transmembrane protein and acts as a hormone. In this study, we aim to investigate the serum α-Klotho level in male opioids addicts with normal kidney function compared to healthy male non-smokers and smokers in Tabriz, Iran. Methods: Participnts were 87 men with normal kidney function referred to Sina Educational Research and Treatment Center in Tabriz, Iran (29 opioids addicts, 29 healthy non-smokers, and 29 healthy smokers). Blood samples were collected to measure the soluble a-Klotho level using an ELISA kit. Furthermore, blood creatinine (Cr) and hemoglobin (Hb) levels was measured. Body mass index (BMI) was also calculated for all participants.Results: In addicts, BMI, Hb, and Cr levels were significantly lower than in healthy non-smokers and smokers, but their Klotho level was higher (P>0.05). The Klotho level in healthy smokers was significantly lower than in healthy non-smokers and addicts. The Klotho level of healthy smokers decreased as the pack year increased, but the duration of opioid addiction had no significant association with the Klotho level. There was no significant difference in the Klotho level between control groups (non-smokers and smokers) and men with addiction to different types of opioids. Conclusion: The Klotho level in male opioid addicts is significantly higher than in smokers. There is a significant negative correlation between BMI and Klotho levels among men with normal BMI and overweight. Further studies are recommended in these fields

Role of medical toxicology educational programs in improvement of the maternal health

letterMothers’ health and life is constantly exposed to different risks such as the risk of accidents, injuries and poisoning, so some of mothers may lose their health and lives which is understood as social damage. Various studies have found that in vulnerable groups of the society, women at the age of childbearing are the most susceptible group to deliberate suicidal poisonin

Attitudes of Patients and Their Families Towards Medical Privacy and Competence of Bearer or Receiver of Bad News

Background: Based on the patients’ and relatives’ views on the level of preservation of privacy rights of individuals, we propose a way to reduce problems and disagreements about the competence of the provider and recipient of bad news.Methods: In the current cross-sectional study, the participants were recruited from the main northwest hospital of Iran. It was also conducted to study the scope of medical privacy and competence of bearers or receivers of bad news. After the literature review, two questionnaires were designed and administered. They contained items pertinent to the scope of medical privacy and competence of bearers and receivers of bad news. Each item of the original questionnaire was scored on a 5-point Likert scale.Results: The model quality and significance level were obtained using KMO and Bartlett tests. The results (patient’s attitudes questionnaire: KMO=0729 and P<0.05 in the Bartlett test; family attitudes questionnaire: KMO=0.764 and P<0.05 in the Bartlett test) confirmed the model efficiency. According to the results from factor variance and their cumulative rate, the predictive power of the model was obtained as 62.019%, based on the overall factor variance rate. The majority of patients wanted to be informed about their disease conditions. They also considered bad news to be medical privacy and disagreed that their medical information should be opened up with others without permission.Conclusion: To preserve medical privacy, it is recommended that a system be designed that allows patients at the admission to the medical center to enlist their eligible family members to whom medical information can be delivered

Successful Management of an Aluminum Phosphide Poisoned Patient Following Ventricular Tachycardia

Aluminum Phosphide (ALP) poisoning is regarded as fatal; however, it is commonly used indeveloping countries. In some countries, such as India and Iran, it is still being used to protectgrain against pests at home. As yet, no known antidote is reported to be effective against ALPpoisoning. ALP acts through blockage of cell respiration, alteration of cell permeability, andinduction of oxidative stress. Some factors can worsen the prognosis of its intoxication, whichinclude hyperglycemia on admission, ingestion of fresh tablets, cardiac abnormality, especiallyVentricular Tachycardia (VT), severe metabolic acidosis, cardiogenic shock and other typesof shocks, electrolyte disturbances, end-organ damage, and a need for mechanical ventilation.ALP kills its victims by induction of multi-organ failure.In this study, we controlled the patient’s VT using MgSO4, electric shock, amiodarone, andlidocaine. We also encountered the cardiogenic shock using norepinephrine, High-Dose Insulin(HDI), antioxidants, sodium bicarbonate, and normal saline. Moreover, myocardial ischemia,recurrent VTs, and adverse cardiac effects were protected via tight control of magnesium andother electrolytes

Factors Affecting Tramadol-Associated Seizure

Background: Tramadol is a widely prescribed analgesic and due to its opioid-like effects, the potential for abuse of tramadol is noticeable. Besides, the complications of tramadol abuse have become a public health concern. This study aimed to investigate the affecting factors on the seizure, as one of the most common complications of tramadol consumption.Methods: A total number of 64 patients from 315 patients who were referred to Sina Hospital, Tabriz, Iran because of tramadol toxicity were included in this 9 months cross-sectional retrospective study.Results: There were 52 males and 12 females in the study. The seizure happened in 53.1% of the subjects and the Mean±SD time between tramadol consumption and seizure was 5.9±7.36 hours. There was no significant association between seizure and sex, age, the dose of tramadol, and previous tramadol consumption history. A significant association was seen between the dose of tramadol and the time of seizure.Conclusion: Seizure that happens due to tramadol overdose is not dependent on sex, age, and previous history of tramadol consumption. As the dose of tramadol is higher, the seizure happens later. More research is needed to understand why the seizure occurs later in higher doses

Letter to the Editor: Alarming Level of Tramadol Intoxication in Iran

This article has no abstract