Acute Myocardial Injury and Electrocardiogram Changes in a Case of Aluminum Phosphide Poisoning

Aluminum phosphide (AIP) poisoning is one of the major causes of mortality among toxic substances. The symptoms and signs of toxicity are nonspecific and related to dose and route of exposure. A 20-year-old woman was admitted to the emergency department due to the consumption of one AIP tablet. ECG was normal at 2 hours post-ingestion and echocardiography revealed LVEF of 55-60% at 4 hours post admission. ECG abnormalities in this patient included VT and VF on the second night. She experienced an unusual rhythm disturbance in term of LBBB and Brugada pattern besides low ejection fraction of left ventricue (about 20-25%) on the third day. The main emphasis for AIP poisoning cases is on a timely, precise and prompt symptomatic treatment

Epidemiological Profile of Snakebite in Iran, 2009-2010 Based on Information of Ministry of Health and Medical Education

Background: Snake bite is one of the significant health problems in the tropical and subtropical regions. It is a common medical emergency in Iran. The current study was conducted to characterize related risk factors for snake bite accidents.Methods: This research was a descriptive retrospective study. Data were collected by gathering snake bite records of 42 Medical Sciences Universities in Iran from March 2009 to March 2010. Information included: age and sex of the victims, region of incident, site of bite and outcome.Results: The results showed that the majority of snake bite patients were male (66.1%). The age distribution of patients indicated that the greatest rate of snake bites occurred among the 25-34 years old. Of 5172 snake bite, 2851 (54.7%) observed on lower limbs, 12019 (38.9%) on upper limbs and 303(5.8%) on head and Trunk and 20 (0.3%) unknown site. The average incidence of snake bite  was estimated 6.9 Per 100,000, however, the highest and the lowest affected cases were observed in Semnan province (with incidence of 111.6 per 100000 individuals) and Rafsanjan, Sabzevar cities  (with incidence of 0 per 100000), respectively. The mortality and recovery rates of cases with and without anti venom, was evaluated (0.12%, 99.88%) and (0.4%, 99.6%) respectively.Conclusion: The high incidence of snake bites in some of provinces of Iran suggests the necessity of preventive programs for minimizing the incidence

Comparative Analysis of the Chemical Composition of Juniperus Excelsa Ssp. Polycarpos Bark and Wood Extracts

In the present study, extracts from the bark and wood of Juniperus excelsa ssp. polycarpos were obtained with acetone solvent. Chemical composition were analyzed and compared by gas chromatography-mass spectrometry (GC-MS). The results showed that the major components identified in the bark acetone extract as trimethylsilyl (TMS) derivatives were β-d-glucofuranose, 1,2,3,5,6-pentakis-O-(TMS) (19.97%), followed by pimaric acid TMS (18.89%), d-mannopyranose, 1,2,3,4,6-pentakis-O-(TMS) (13.90%), d-fructose, 1,3,4,5,6-pentakis-O-(TMS) (12.37%). The major components identified in the wood acetone extract as trimethylsilyl (TMS) derivatives were pimaric acid TMS (24.56%), followed by α-d-glucopyranoside, 1,3,4,6-tetrakis-O-(TMS)-β-d-fructofuranosyl 2,3,4,6-tetrakis-O-(TMS) (21.39%), β-d-galactopyranose, 1,2,3,4,6-pentakis-O-(TMS) (12.10%), d-glucose, 2,3,4,5,6-pentakis-O-(TMS) (9.97%), trifluoromethyl-bis-(TMS)methyl ketone (9.32%). One of the more important components identified both in the bark and wood extracts was pimaric acid TMS. Cedrol as the essential oil was found in the acetone wood extract (0.72%)

Frequency of Electrocardiographic Abnormalities in Tramadol Poisoned Patients; a Brief Report

Introduction: Previous studies have raised the probably of cardiac manifestation in tramadol poisoning. However, conclusive information on electrocardiographic (ECG) abnormalities of tramadol overdose remains to be explained. Therefore, the present study aimed to evaluate the epidemiology of ECG abnormalities in tramadol poisoned patients. Methods: In a prospective cross-sectional study, all patients with tramadol poisoning, who were admitted to the emergency department of Loghman Hospital during 2012 – 2013, were evaluated. Patients’ baseline characteristics and ECG findings including axis, rate, rhythm, PR interval, QRS duration, QTc interval, evidence of Brugada pattern, and evidence of blocks were recorded. Obtained Data were descriptively analyzed using SPSS 21.0 statistical software. Results: 1402 patients with the mean age of 24 ± 6 years were studied (71.1% male). Sinus tachycardia was detected in 463 (33%) patients, sinus bradycardia in one patient (0.07%), right axis deviation in 340 (24.2), QRS widening in 91 (6.5%), long QTc interval in 259 (18.4%), dominant S wave in either I or aVL lead in 395 (28.1%), and right bundle branch block in 73 (5.2%). Increased PR interval was not detected in any cases. The evidence of Brugada pattern was observed in 2 (0.14%) patients (100% male), both symptomatized with seizure. All abnormalities had same sex distribution. Conclusion: Based on the results of the present study, the most common types of ECG changes were sinus tachycardia, a deep S wave in leads I and aVL, right axis deviation, and long QTc interval, respectively. Brugada pattern and sinus bradycardia were rarely presented

Antimicrobial Effects of Gold Nanoparticles Against Gram Positive Coccus spp. and Its Interaction With Bacitracin, Polymyxin B, Gentamicin, Clindamycin and Erythromycin

Introduction: Antibiotic resistance in one of the biggest threats to global health, food security and development today and it has emerged as a medical catastrophe. Antibiotic resistance is also rising to dangerously high levels in all parts of the world. Nanotechnology provides a chance to overcome antibiotic resistance by multiple antibiotic mechanisms. The aim of this study was to examine antibacterial effects of the colloidal gold nanoparticles (GNP) against Staphylococcus aureus, Staphylococcus saprophyticus, Staphylococcus epidermidis, Enterococcus faecalis, and Enterococcus faecium and also the GNP synergistic effects with three antibiotics including Bacitracin, Polymixin B, Gentamicin, Erythromycin and Clindamycin.   Methods and Results: Standard agar diffusion method was used to determine the zone of inhibition of each antimicrobial compound and GNP. Standard broth microdilution method was also used to determine the minimum inhibitory concentration (MIC). The different ratios of each antibiotic and GNPs were then prepared and the antibacterial activities of antibiotic/GNP mixture was assessed one by one. Finally, the results of triplicate examinations were analyzed statistically. the results showed that the combination of gold nanoparticles with the most of the antibiotics with the ratio of 25%-75% had the increased antibacterial effect against the majority of strains with considerable MIC compared with all other antibiotic/GNPs ratio. Therefore, the gold nanoparticles in combination with antibiotics in specific concentrations cab increase the antibacterial effects of the antibiotics. Conclusions: bacterial resistance to available antibiotics is an increasing problem and improved methods to identify and treat pathogenic bacterial strains quickly would be of enormous benefit to public health. Our findings indicated that a combination of antibiotics and gold nanoparticles has considerable efficiency against some gram positive bacteria. The alteration of normal mode of metabolite pathway and the release mechanism could involve in antimicrobial process

Acute Kidney Injury in Poisoned Patients Admitted to ICU

Background: Acute Kidney Injury (AKI) is an abrupt decrease in kidney function, leading to the retention of urea and other nitrogenous waste products. Poisoned patients admitted to the Intensive Care Unit (ICU) may develop AKI due to some reasons. This study was done to evaluate the AKI in poisoned patients admitted to ICU. Methods: 146 patients, admitted to the ICU of Imam Reza Hospital from March 2017 to March 2018 were studied. AKI status was assessed using Acute Kidney Injury Network (AKIN) and Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) classification. Data analysis was done through SPSS V. 22 software.Results: Opioids, organophosphates, aluminum phosphide, multiple drugs, and other types of poisoning were the main five poisoning classes. Opioid toxicity was had the highest frequency with 51 patients; cases in this group experienced longer length of hospitalization stay and higher serum creatinine level than others did. Among 146 patients, 19 patients (12.8%) died, and 97 patients (66%) were transferred to the ICU. Of all cases, 18 patients (12.3%) had renal dysfunction (six patients were at risk, five patient at injury, and seven patients were at failure phase based on the RIFLE criteria). Renal replacement therapy was required in 24 cases (16.4%).Conclusion: It is unlikely to detect a significant difference in the occurrence of AKI between the main poisoning classes. Being the largest group of intoxicated patients admitted to the ICU, the opioid poisoning had the highest rate of AK

Pathological Findings of Tramadol on Liver Tissue in the Cadaver Referred to Legal Medicine Organization of Tehran 2008-2013

Background: Tramadol is a synthetic opioid used to control chronic pain and pain after surgery. However, many cases of poisoning and dangerous side effects have been reported. In order to discover the causes of death in forensic medicine is usually examine tissue samples taken from the body, although the results of toxicology tests generally give us more information, but identifying the pathological effects of Tramadol on the internal organs, especially the livers can be very helpful.Methods: In this cross-sectional study, information on the history, the autopsy report and toxicology testing of patients who died due to poisoning Tramadol were studied. In this study, all of the information already provided by the use of particular forms collected and then analyzed using computer software SPSS.Results: A total of 49 cadavers were examined in this study. There were 39 dead (80%) of men and 10 of (20%) women. Most common age groups in the study were 24 to 34 years old (41%), 15 to 24 years old (39%), were reported. There were significant difference between liver microscopic spread among different ages, history of Tramadol, positive and negative toxicology tests stomach contents, urine, blood, tissue and vitreous. Most common pathological changes were in liver, degenerative changes and inflammatory cell infiltration in patients who under 35 years old.Conclusion: In this study, the majority of patients had acute poisoning with Tramadol, it can be concluded that the majority of changes in tissue obtained was as a result of acute Tramadol, respectively incidence of atelectasis and edema and alveolar bleeding in the liver were most pathological findings. In reviewing toxicology, Tramadol are also present in the stomach contents, urine, gall bladder, liver and blood were positive, the result of stomach contents will be most helpful for us

Mushroom Poisoning in the Northeast of Iran; a Retrospective 6-Year Epidemiologic Study

Introduction: Toxic mushrooms are distributed across the globe with over 5000 species. Among them, 100 species are responsible for most of the cases of mushroom poisoning. This study aimed to evaluate the epidemiologic pattern of mushroom poisoning among patients referred to the main toxicology center of Mashhad province located in North-east of Iran.Method: This cross-sectional study was conducted on patients with final diagnosis of mushroom poisoning referred to the toxicology center of Mashhad, Iran, from February 2005 to 2011. Patients’ demographic characteristics, clinical presentations, laboratory findings, outcomes, and therapeutic measures were collected using a predesigned checklist and searching patient’s profile. Results: 32 cases with the mean age of 24.6 ± 16.7 years were presented to the toxicology center following mushroom poisoning (59% female). Mushroom poisoning accounted for 0.1% of all admitted cases. The mean time elapsed from consumption to referral to poisoning department was 61.9 ± 49.4 hours. 19 (59%) cases were discharged with complete recovery, 7 (22%) expired, and 6 (19%) cases left hospital against medical advice. Mushroom poisoning mortality accounted for 1.5% of deceased cases in the studied center. There was significant relationship between mortality rate and higher values of INR (p = 0.035), PT (p = 0.011) and PTT (p = 0.003). Likewise, there was significant relationship between the need for mechanical ventilation and higher values of INR (p = 0.035), PT (p = 0.006) and PTT (p = 0.014). The relationships between the need for ICU admission, mechanical ventilation, and mortality rate with the rise of hepatic transaminases and serum bilirubin were not significant.Conclusion: Based on the findings, the prevalence of mushroom poisoning among patients referred to Mashhad toxicology center was very low (0.1%), but with a high mortality rate of 22%. Nausea and vomiting were the most common early symptoms of intoxication and higher values of coagulation profile were correlated with poor outcome

Comparison of chilling and heat requirement in some peach and apricot cultivars

Bud Dormancy in deciduous fruit trees of the temperate zones is a phase ofdevelopment that occurs annually and enables trees to survive cold winters. Chilling andheat requirements for breaking dormancy and flowering were studied in five peach (Kosary,Haj Kazemi, Anjiry Asali, Anjiry Zafarany, and Zoud Ras) and four apricot (asgarabad,shamlo, shakarpare, tabarze ghermez) cultivars. Various models (two chilling hour models,the <7C and 0-7C models, and two chilling unit models, the Utah and Low Chill) were usedto measure the accumulation of chilling requirement. The heat requirements were calculatedas the growing degree hours (GDH) accumulated from breaking of dormancy to the F50 (50%of opened flowers). The cultivars studied showed a range of chilling requirements (chillunits, CU), between 746 to 868 CU for peach and 652-826 CU for apricot. The heatrequirements for peaches and apricots were between (4099 to 4543GDH) and (2987 to3465GDH) respectively. Apricot cultivars with lower chilling and heat requirements showedearlier flowering dates. Thus apricot cultivars bloomed between 15 and 16 day before peachcultivars and Heat requirements were found to be more important for regulation offlowering time than were chilling requirement in our climatic condition