Unilateral Visual loss Due to Methanol Intoxication: A Case Report

Methanol is a toxic alcohol which can cause severe bilateral visual impairment. In this study we report a case of unilateral visual loss due to methanol intoxication. A 45-year-old man referred to toxicology department of Loghman Hakim Hospital complaining of bilateral blurred vision, vomiting, nausea. He was oriented and he had drunk about 500 cc alcohol two days ago, he underwent 4 hours of emergency hemodialysis and we also prescribed erythropoietin, Methylprednisolone, Amp folinic acid, Na/HCO3. then he was referred to ophthalmologist that reported: right eye’s acuity 7/10, left eye’s acuity 3m, RADP positive, left eye’s abducent movement and its color was disturbed and retinal examination was consistent with methanol intoxication. Visual impairment due to methanol poisoning usually occurs bilaterally, but rare cases of unilateral vision damage have also been reported in two studies which they stated may be due to anatomical or structural variation

Development of Professional Ethics Curriculum in the Operating Room for the Current Era of Surgery: A Mixed Method Study

Introduction: The rapid advancement of intricate technologies and the emergence of novel surgical methodologies necessitate nuanced ethical decision-making under high-stress scenarios. Consequently, cultivating an understanding of professional ethics within the surgical environment is crucial for all practitioners involved in patient care. This study was initiated with the aim of designing a comprehensive curriculum for Iranian medical schools, focusing on professional ethics within the operating room. Methods: This mixed-method exploratory research was executed in distinct qualitative and quantitative phases. The first stage involved conducting 12 structured interviews with Iranian faculty members who were experts in education of professional ethics and operating room staffs for assessing the current needs and reviewing extant curricula. The subsequent quantitative phase entailed evaluating the elements of each curriculum axis via the Delphi method. Results: The qualitative phase led to the identification of 45 primary codes, 14 subcategories, and 5 primary categories. The quantitative phase confirmed 3 instructional goal domains, 12 instructional content areas, 8 teaching methodologies, and 10 evaluation methods through the Delphi process. These confirmed components were eventually incorporated into various theoretical and clinical courses as longitudinal integration themes. Conclusion: Based on our findings, we recommend the development of educational objectives targeting cognitive, affective, and psychomotor domains and the longitudinal integration of a professional ethics course

Methotrexate as a safe immunosuppressive agent during the COVID-19 pandemic

Background: During the ongoing COVID-19 pandemic, immunocompromised patients are at a higher risk of severe infection, since the immune system has an important role in defeating this disease. This study compares the severity of COVID-19 in patients taking methotrexate with the severity of their family members' illness as patients with normal immune system function. Methods: A total of 35 participants, including 14 patients taking methotrexate and 21 patients with normal immune function, entered this study, and the indicators of COVID-19 severity were compared between these two groups. Results: The case group, who were on methotrexate therapy, had significantly less severe COVID-19 based on their symptoms, including fever (p = 0.000) and cough and dyspnea (p = 0.01) as well as in terms of COVID-19 severity indicators such as pulmonary involvement (p = 0.001), ferritin level (p = 0.001), white blood cell count (p = 0.008) and CRP level (p = 0.006), compared to the control group. There was a significant correlation between taking methotrexate and lower severity in COVID-19 disease. Conclusion: The present findings demonstrated that methotrexate does not predispose patients to severe COVID19; on the contrary, patients taking methotrexate may experience a milder disease, possibly due to their reduced severe inflammatory reactions as a result of inhibited TNF alpha, lowered IL6, and increased T regulatory cells. According to these findings, methotrexate appears to be a suitable treatment option for patients who need immunosuppressive medications during the COVID-19 pandemic

Evaluation of Prognostic Factors of Methanol Poisoning in Patients Referred to Shahid Rajaei Hospital in Karaj

Background: Methanol poisoning is a life-threatening condition that requires accurate prognosis and treatment. This study aims to evaluate the predictive value of laboratory and clinical variables in methanol poisoning.Methods: This was an observational retrospective study performed on patients with methanol poisoning. Variables were determined based on the literature review, and patient data were extracted from the patient’s file. The data was analyzed by SPSS software.Results: There were significant differences between survived group and the dead group in GCS, heart rate, PH and HCO3, serum potassium, serum creatinine, and blood sugar levels, neurological symptoms, requiring intubation, and hemodialysis. Significant differences were not observed in the number of hemodialysis sessions, respiratory rate, age, gastrointestinal symptoms, and PCO2 levels between survived and non-survived groups.Conclusion: In our study, mortality was significantly associated with low GCS, high heart rate, low PH and HCO3, high potassium, creatinine, blood sugar levels, neurological symptoms, intubation, and hemodialysis. Despite other studies in this study, there was no association between the number of hemodialysis sessions, respiratory rate, age, gastrointestinal symptoms, and PCO2 levels with mortality

Assessment of Risk Factors and the Effect of Drug Abuse on the Incidence of Ischemic Heart Disease in Patients Less Than 40 Years Old

Background: in this study, we examined the risk factors and the effects of substance abuse on the incidence of ischemic heart disease in patients less than 40 years old in Shahid Rajaei Hospital in Karaj from 2019-2020.Methods: This case-control study was done on 70 patients in the cases and 70 cases in the control groups. All demographic data, including age, gender, place of residence, weight, height, body mass index, cardiovascular (CVD) risk factors, including hypertension, high levels of blood fats, diabetes, a history of smoking cigarettes, tobacco, crystal meth, and cocaine, alcohol consumption, as well as a history of taking supplements for bodybuilding, and sex-enhancing drugs were obtained. Afterward, blood levels of glucose and fats were evaluated and urine analysis for the presence of drugs, such as amphetamine, methamphetamine, buprenorphine, benzodiazepines, cannabinoids, cocaine, morphine, methadone, tramadol, and tricyclic antidepressants (TCA) was done. SPSS software v. 22 was used for data analysis.Results: Among the studied underlying factors and drugs, family history, high blood pressure, diabetes, smoking, and low-density lipoprotein (LDL) levels above 130 mg/dL were significantly associated with a higher risk of acute myocardial infarction (MI) (P<0.05). Interestingly, alcohol consumption and the use of tobacco, opium, methadone, heroin, cocaine, cannabis, amphetamines, methamphetamine, tramadol, benzodiazepines, TCA, buprenorphine, and anabolic steroids were not significantly associated with acute MI under 40 years (P>0.05).Conclusion: according to the results of the present study, it seems that a positive family history of MI under the age of 55, hypertension, diabetes, smoking, and LDL levels above 130 mg/dL are more significant risk factors for acute MI in patients under 40 years of age in comparison with the consumption of alcohol and the use of hookah, opium, methadone, heroin, cocaine, cannabis, amphetamine, methamphetamine, tramadol, benzodiazepines, TCA, buprenorphine, and anabolic steroids. It should be noted that further studies in this area are recommended

Prognostic Factors in Metformin Intoxication; A Case Control Study

Background: Metformin is one of the most orally used antidiabetic agents. Intentional and unintentional overdose of metformin can be associated with life threatening condition. In this study we evaluate prognostic factors for metformin intoxication. Methods: This case-control study was performed on patients referred to Loghman Hakim toxicology emergency department due to metformin intoxication. The patient’s information and lab data were subsequently extracted from their medical file and data processing and analysis performed. Results: There was a significant difference between two groups in multiple items, patients in died group had higher age, blood sugar, BUN, Cr, PT, INR, WBC, on the other hand this group had lower blood pressure, O2 saturation, pH, HCO3 and PTT. Receiver operating characteristic curve showed that five items including: Bp, O2sat, pH, HCO3 and Cr had ability to predict the risk of mortality in patients with metformin poisoning. Univariate as well as multivariate analysis showed, factors including: BP<95 (P=0.0184), O2sat<93 (P=0.0094), pH<6.94 (P0.0032), HCO3<17.25 (P=0.0302), and Cr>1.15 (P=0.0216) were related to patient’s mortality. Discussion and conclusion: Our study showed that mentioned clinical and laboratory findings may have an important role in determining the prognosis of patients with metformin poisoning. Extracorporeal treatments may be considered sooner in those who have poorer prognostic factors since admission