Oxygen free radicals and modulation of ileum smooth muscle tone

The results of this study indicate that exogenously-generated oxy-radicals produce relaxation, contraction or contraction/relaxation of rat ileum depending upon the generating system. Xanthine (X) plus xanthine oxidase (XO) produced relaxation of ileum. The relaxation was attenuated by the hydroxyl radical scavengers mannitol and dimethylthiourea (DMTU); and the singlet oxygen scavenger, histidine, supporting the idea that the hydroxyl radical (.OH) and singlet oxygen are involved in X/XO-induced relaxation of ileum. Deferoxamine, an iron chelator, reduced the relaxation of the ileum, indicating that .OH mediates the X/XO-induced relaxation of ileum. Xanthine/xanthine oxidase-induced relaxation is partly mediated through cyclooxygenase metabolites, and partly through nitric oxide and ATP-sensitive potassium channels. Hydrogen peroxide (H2O2) produced a biphasic response (an initial contraction followed by relaxation), which appeared to be due to the generation of .OH. The contraction/relaxation induced by H2O2 is mediated through cyclooxygenase metabolites. The hydrogen peroxide-evoked biphasic response in rat ileum is not mediated through nitric oxide, acetylcholine or histamine. Dihydroxy fumaric acid (DHF) plus ferric chloride (FeCl 3) and adenosine diphosphate (ADP) produced concentration-dependent contraction of ileum. Mannitol, DMTU, and histidine partially inhibited the DHF/FeCl3-ADP-induced contraction, supporting the idea that hydroxyl radicals and singlet oxygen are involved in DHF/FeCl3-ADP-induced contraction of ileum. DHF/FeCl3-ADP-induced contraction is mediated partly through arachidonic acid metabolites and histamine. These results suggest that oxygen radicals play a role in the motility of ileum

Clinico-epidemiological Analysis of Adult Patients With Acute Poisoning

Background: Patients with acute poisoning sometimes require hospitalization in the Intensive Care Unit (ICU). The correct admission of these patients has resulted to lower mortality. This study compared the characteristics of adult patients with acute poisoning who were admitted to the poisoning ward and the ICU. We also determined the relevant outcome predictive factors. Methods: This cross-sectional study was conducted on adult acutely poisoned patients who were admitted to the emergency room of Khorshid Hospital affiliated with Isfahan University of Medical Sciences from October 2018 to 2019. The clinico-epidemiological variables and outcomes were compared between adult patients hospitalized in the ward (n=100) and ICU (n=100). Binary logistic regression was used for predicting the outcome factors.Results: The Mean±SE age of the study patients in the ICU and ward were 36.6±1.62 (median: 34) and 34.20±1.19 years, (median: 33, P=0.23), respectively. There was no significant difference between the study groups respecting substance dependence, alcohol and drug abuse, disease history, and the type of exposure (P>0.05). However, self-mutilation, the kind of substance, the vital signs and level of consciousness at admission, and outcomes were significantly different between the research groups (P<0.05). Variables predicting outcomes (complication/death) were as follows: gender (male) (OR: 4.51; 95%CI: 1.51-13.42; P=0.007), the kind of substance (pesticides) (OR: 8.84; 95%CI: 1.78-44.07; P=0.008), time to admission (OR: 1.04; 95%CI: 1.02-1.08; P=0.002), hypotension (OR: 14.88; 95%CI: 3.01-71.58; P=0.001), and the place of hospitalization (ward) (OR: 2.85; 95%CI: 1.23-6.62; P=0.01).Conclusion: The self-mutilation, kind of substance, vital signs, level of consciousness at admission, and outcomes were significantly different between the study patients hospitalized in the ICU, compared to the ward. Gender (male), the kind of substance (pesticides), delayed arrival times, hypotension, and the place of hospitalization (ward) were essential factors for outcome (complication/death) prediction

The Effects of Succimer and Penicillamine on Acute Lead Poisoning Patients

Background: Lead poisoning was on the rise in recent years. There exists a lack of easy access to some of the main chelator drugs in developing countries. Thus, this study aimed to explore the comparative effects of Succimer and D-Penicillamine on acute lead poisoning patients from 2013 to 2018. Methods: This descriptive study was conducted in the Clinical Toxicology Department of Khorshid Hospital in Isfahan City, Iran. Adult patients with acute lead poisoning were included in the study. Patients in the 3 treatment groups of D-Penicillamine, D-Penicillamine with succimer, and succimer were compared concerning demographic characteristics as well as clinical and laboratory findings at admission time and two weeks later.Results: In total, 163 patients were evaluated in this research. There was no significant difference between the treatment groups respecting improvement in clinical symptoms. The mean blood lead levels during hospitalization and two weeks after the treatment did not significantly differ between the three groups; however, there was a significant reduction in all study groups after two weeks of treatment (P<0.05). The mean white blood cell count was significantly lower only in the D-Penicillamine group two weeks after hospitalization (P<0.05). In the D-Penicillamine group, the mean platelet, hematocrit, and hemoglobin levels were significantly lower two weeks after hospitalization, although within the healthy range.Conclusion: D-Penicillamine may be an acceptable chelator drug for treating patients with acute lead poisoning, especially in communities without access to drugs, like succimer

Electrocardiogram Changes in Patients With Acute Ethanol Poisoning

Background: Alcohol consumption leads to a significant number of deaths, mostly in men, worldwide. Considering the effect of ethanol toxicity on the heart, we studied various Electrocardiographic (ECG) changes in patients with acute ethanol poisoning. Methods: A cross-sectional study was performed on patients admitted to Khorshid Hospital (affiliated to Isfahan University of Medical Sciences) due to ethanol poisoning. All 15- to 50-year-old patients with acute ethanol intoxication were included in the study (N=250). The patients’ information, including the demographic characteristics, clinical manifestations, and ECG changes were recorded and analyzed. Different variables were compared between the patients with or without ECG changes.Results: Most of the research patients (n=208) were men (83.82%). The Mean±SD age of the study patients was 26.8±8.87 years. About 54.8% of the patients presented abnormal ECG. The changes in ECG were not significantly different based on the demographic characteristic and clinical manifestations. The time interval between ethanol consumption and admission was significantly higher in patients with abnormal ECG, compared to those with normal ECG (Mean±SD: 7.09±10.67 vs. 4.77± 4.54 hours, respectively) (P=0.03).Conclusion: ECG changes are common in patients with ethanol poisoning. The time interval between ethanol consumption to hospital admission may be an important factor in the occurrence of ECG changes

Is Admission Serum Sodium Concentration a Clinical Predictor for the Outcome of Therapy in Critically Ill Poisoned Patients?

BACKGROUND Disorders of serum sodium concentration are some of the most electrolyte abnormalities in the intensive care unit (ICU) patients. These disorders adversely affect the function of vital organs and are associated with increased hospital mortality. PURPOSE In the present study we aimed to evaluate the effects of serum sodium concentration abnormalities at the time of hospital admission on the clinical outcome of therapy in a cohort of critically ill poisoned patients. METHODS In this cross-sectional study, 184 critically ill poisoned patients aged >18 years and in the first 8 hours of their poisoning, hospitalized in the ICU of a tertiary care university hospital (Isfahan, Iran) between 2010-2012, were evaluated at the admission time and 24 hours later for serum sodium concentration abnormalities and its relationship with age, gender, consciousness status, ingested drugs and clinical outcome of therapy. The clinical outcome was considered as recovery and mortality. Logistic Regression analysis was performed for predictive variables including serum sodium concentration abnormalities in patients' clinical outcome. FINDINGS On admission, 152 patients (82.6%) were eunatremic, 21 patients (11.4%) were hyponatremic and 11 patients (6%) were hypernatremic. In the second day eunatremia, hyponatremia and hypernatremia was observed in 84.4%, 13% and 2.2% respectively. Age (OR=1.92; CI=1.18-3.12) and severity of toxicity (OR=1.32; CI=1.12-2.41) were predicting factors of mortality in ICU poisoning patients. CONCLUSIONS Serum sodium concentration abnormalities are prevalent in critically ill poisoned patient but do not seem to have a predictive value for the clinical outcome of therapy

Comment on "Medical Management and Outcome of Paraquat Poisoning in Ahvaz, Iran: A Hospital-Based Study"

Dear editor, We read the recent article of Rahmani et al entitled "Medical Management and Outcome of Paraquat Poisoning in Ahvaz, Iran: A Hospital-Based Study" in your journal (1). In their study they performed upper gastrointestinal (GI) endoscopy as a routine for all paraquat poisoned patients, because they considered paraquat a caustic agent and that it may cause severe mucosal injuries in esophagus. This approach seems rather excessive, as Yen et al established that paraquat is a mild caustic agent and produces only grades 1, 2a, and 2b esophageal injury that can be managed with supportive measures (2). In addition, Chen et al ascertained the same implication showing in their study that paraquat is only a weak caustic agent (3). In our experience (4), low rate of GI injury occurs in paraquat poisoning, and moreover, GI tract complications alone do not have any impact on patients’ survival (4).  Taking these facts together, because paraquat poisoning is common in some regions and upper GI endoscopy is an anecdotal routine in some hospitals for this type of poisoning, in our opinion the following comments are better to be considered in day to day practice and for future studies: 1- The relationship between clinical signs and symptoms of mucosal injury (vomiting, odynophagia, dysphagia, retrosternal pain, etc.) with the degree of injury in GI endoscopy in paraquat poisoning has not been determined yet. 2- The association of paraquat serum level with the level of mucosal injury (determined by endoscopy) has not been established in paraquat poisoned patients. 3- As paraquat poisoning may cause severe liver dysfunction and coagulopathy, for performing endoscopy, the optimal time should be considered. In this case, invasive measures may just worsen the patients' condition by exposing them at the risk of uncontrollable bleeding. 4- Comparing the specificity and sensitivity of chest esophageal CT scan (as a possible substitute for GI endoscopy) and GI endoscopy (as a gold standard method) for evaluation of esophageal injury seems to be beneficial. 5- Finally, in order to determine the severity of paraquat poisoning and better define prognosis, severity index of paraquat poisoning (SIPP) is a widely used tool (5). Performing GI endoscopy for patients with SIPP scores less than 10, which are indicative of better prognosis, can be taken into account for follow up purpose (5)

Cyanide poisoning after bitter almond ingestion: “A rare case report”

Key Clinical Message We present a case of a 36‐year‐old woman with a history of three suicide attempts who had ingested approximately 40 bitter almonds in a suicidal act, leading to her admission to the emergency department of a regional hospital due to complaints of vomiting. Upon arrival, she exhibited confusion, and her vital signs were recorded as follows: pulse rate = 117 beats/min, blood pressure = 160/85 mmHg, oxygen saturation = 95%, respiratory rate = 16, temperature = 37°C. The patient venous blood gas analysis manifested severe metabolic acidosis (pH = 6.92, pO2 = 43 mmHg, HCO3 = 8.6 mmol/L, pCO2 = 42.7 mmHg, base excess = −25.9 mmol/L). Four hours later, she became unconscious and she was intubated. Gastric lavage and a single dose of 60 g of activated charcoal and sodium bicarbonate were administered. In the referral hospital, sodium nitrite was given due to the severity of the poisoning, and norepinephrine infusion was initiated to manage hypotension. Within a day, the patient regained consciousness, underwent extubation, and after 72 h was discharged and subsequently transferred to psychiatric care for further treatment. This case underscores the critical, life‐threatening implications of cyanide toxicity following the ingestion of bitter almonds, highlighting the efficacy of supportive measures such as gastric lavage, activated charcoal, and sodium bicarbonate. Furthermore, it emphasizes the successful application of sodium nitrite monotherapy in managing this condition

Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma

Background: Mixed drugs poisoning (MDP) is common in the emergency departments. Because of the limited number of intensive care unit beds, recognition of risk factors to divide the patients into different survival groups is necessary. Poisoning due to ingestion of different medications may have additive or antagonistic effects on different parameters included in the scoring systems; therefore, the aim of the study was to compare applicability of the different scoring systems in outcomes prediction of patients admitted with MDP-induced coma. Methods: This prospective, observational study included 93 patients with MDP-induced coma. Clinical and laboratory data conforming to the Acute Physiology and Chronic Health Evaluation (APACHE II), Modified APACHE II Score (MAS), Mainz Emergency Evaluation Scores (MEES) and Glasgow Coma Scale (GCS) were recorded for all patients on admission (time 0 ) and 24 h later (time 24 ). The outcome was recorded in two categories: Survived with or without complication and non-survived. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC). Results: The mortality rate was 9.7%. Mean of each scoring system was statistically significant between time 0 and time 24 in the survivors. However, it was not significant in non-survivors. Discrimination was excellent for GCS 24 (0.90±0.05), APACHE II 24 (0.89±0.01), MAS 24 (0.86±0.10), and APACHE II 0 (0.83±0.11) AUC. Conclusion: The GCS 24 , APACHE II 24 , MAS 24 , and APACHE II 0 scoring systems seem to predict the outcome in comatose patients due to MDP more accurately. GCS and MAS may have superiority over the others in being easy to perform and not requiring laboratory data