Zamjena pune krvi kao obećavajući način liječenja otrovanja aluminijevim fosfidom

A 37-year-old male was referred to us about one hour after deliberate ingestion of two 3-gram aluminium phosphide (ALP) tablets. Three hours after admission, his blood pressure dropped to 85/55 mmHg, his heart rate increased to 120 bpm, O2 saturation dropped to 82 %, and the electrocardiogram showed junctional rhythm. We started whole blood exchange, and gross haematuria and jaundice ensued. However, his blood pressure increased, arrhythmia resolved itself, and he was extubated two days after the transfusion was completed. He was sent home seven days after admission completely symptom-free. We believe this treatment may be successfully applied in ALP-poisoned patients.Muškarac star 37 godina primljen je u naš centar za otrovanja približno jedan sat nakon što je namjerno progutao dvije 3-gramske tablete aluminijeva fosfida. Tri sata poslije krvni mu je tlak pao na 85/55 mmHg, broj otkucaja srca porastao na 120 u minuti, a zasićenje kisikom palo na 82 %. Nije odgovarao na konvencionalno liječenje. Na elektrokardiogramu se vidio nodalni ritam. Započet je postupak zamjene pune krvi, što je dovelo do pojave krvi u mokraći i do žutice. Krvni je tlak nakon postupka porastao, aritmija je prestala, a pacijent je ekstubiran dva dana nakon svršetka zamjene krvi. Otpušten je kući bez ikakvih simptoma sedam dana nakon prijema. Vjerujemo da bi ovakav način obrade mogao biti uspješan u liječenju otrovanja aluminijevim fosfidom

Parallel Increases in Heterochromatin Variants and Chromosome Damages in Drugs Addicts

Polymorphisms of the size of heterochromatin regions and abnormalities of chromosomes have been well documented in human genome; they consist of DNA sequences that are not transcribed. The prime aim of the present study was to evaluate the heterochromatin polymorphism and numerical and structural abnormalities associated with chromosomes in drug addicts. No data exists in Iran regarding the cytogenetic characteristics of drug addiction lymphocytes. Therefore, cytogenetic investigations were performed in 93 drug addiction lymphocytes and 93 normal controls. This randomized collected study was conducted on 93 consecutive drug addiction individuals and 93 healthy individuals in Loghman and private hospitals, Tehran, Iran between the years 2007-2009. By applying Barium Hydroxide saline Giemsa (BSC) method, the variant heterochromatin polymorphism of chromosomes 1, 9 and 16 on lymphocyte cultures were evaluated. Cytogenetic analysis was performed in drug addicts’ lymphocytes cultures.Constitutive heterochromatin polymorphism of chromosomes 1 in drug addicts revealed statistical significant when compared with chromosome of healthy controls (P=0.004).  The differences were significant for chromosome 9 (P=0.029), it was 94.1%   in drug addiction and 5.9% in the control group (P=0.196). The differences were also significant for chromosome 16: it was 91.9% in addicts and 8.1% in the control group (P=0.052). Also the frequency of partial and complete inversion did not show any significant differences between the drugs addicts and the control group. The occurrence of chromosomal defects including, chromatid break (12 addicts), chromatid gap (8 addicts), dicentric (2 addicts), was higher in our observation. Our constitutive heterochromatin polymorphism blocks and chromosomal abnormalities in drugs addicts’ chromosome may provide an opportunity to serve as a marker for the detection and characterization of the damages chromosomes in drug addicts

Delay-Dependent Impairments in Memory and Motor Functions After Acute Methadone Overdose in Rats

Methadone is used as a substitution drug for the treatment of opioid dependence and chronic pain. Despite its widespread use and availability, there is a serious concern with respect to the relative safety of methadone. The purpose of this study was to characterize how acute methadone overdose affects the cognitive and motor performance of naïve healthy rats. The methadone overdose was induced by administering an acute toxic dose of methadone (15 mg/kg; ip; the equivalent dose of 80% of LD50) to adolescent rats. Resuscitation using a ventilator pump along with a single dose of naloxone (2 mg/kg; ip) was administered following the occurrence of apnea. The animals which were successfully resuscitated divided randomly into three apnea groups that evaluated either on day 1, 5, or 10 post-resuscitation (M/N-Day 1, M/N-Day 5, and M/N-Day 10 groups) in the Y-maze and novel object memory recognition tasks as well as pole and rotarod tests. The data revealed that a single toxic dose of methadone had an adverse effect on spontaneous behavior. In addition, Recognition memory impairment was observed in the M/N-Day 1, 5, and 10 groups after methadone-induced apnea. Further, descending time in the M/N-Day 5 group increased significantly in comparison with its respective Saline control group. The overall results indicate that acute methadone-overdose-induced apnea produced delay-dependent cognitive and motor impairment. We suggest that methadone poisoning should be considered as a possible cause of delayed neurological disorders, which might be transient, in some types of memory or motor performance in naïve healthy rats

The evaluation level of carboxyhemoglobin in children blood with chief complain of headache, nausea, and dizziness referring to pediatric clinics of Loghman hakim hospital in year 2018-2019

Carbon monoxide poisoning is common, challenging and serious poisoning with wide range of non-specific flu-like clinical manifestations that leads to misdiagnosis. This cross-sectional descriptive controlled study conducted in Loghman Hakim Hospital on 3-14 year-old patients presenting with non-specific Flu-like (headache, dizziness, nausea, vomiting, malaise) symptoms from November 2018 to May2019. In all subjects carboxyhemoglobin level measured via noninvasive pulse CO-oximetry (Massimo Company, USA). Demographic data, cigarette, shisha, opium smoke exposure, type of home heater, carboxyhemoglobin level were collected and statistically analyzed via SPSS v16.0. A total of 93 children 3-14 year-old were enrolled the study. Their mean age was 4.6+4.3 years, 46% were male and54% female. Mean carboxyhemoglobin level was 27.8+9.7 %( range 2.7% to 44%). The most frequently encountered symptoms were nausea &vomiting (44%), dizziness (36%), headache (32%) and myalgia (23%). We obtained the COHb levels using noninvasive pulse oximeter for all study patients and their mother, and the levels > 5% for non-smokers were considered as CO poisoning. Of the 93 study patients, 49%had normal carboxyhemoglobin levels (CoHb level< 5%). Of the remaining 51% study patients, 47 patients had CoHb levels between 5% and 10%, and seven patients > 10%. Closer attention to early and nonspecific signs and symptoms of Carbon Monoxide poisoning and higher clinical suspicion could reduce the rate of misdiagnosis and therefore minimize complications in this serious poisoning

Akutni respiratorni distres sindrom uzrokovan sirupom metadona

Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the findings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.Akutni respiratorni distres sindrom (ARDS) uzrokovan toksičnošću metadona (MTD) poznat je ali rijedak fenomen. U većini dosadašnjih slučajeva ARDS-a uzrokovanog MTD-om, MTD je konzumiran u obliku tableta te u velikoj ili nepoznatoj količini. Unatoč nalazima dostupne literature, ovaj prikaz slučaja dokazuje kako čak i mala količina sirupa MTD-a može uzrokovati ARDS, i to ranije nego što bi se očekivalo. Obrađen je slučaj pacijentice koja nije bila ovisnica, a oboljela je od ARDS-a nakon konzumacije tek male količine sirupa MTD-a. Predlažemo pomnije praćenje pacijenata predoziranih MTD-om od najmanje 48 sati do 72 sata usmjereno na detekciju respiratornih komplikacija poput plućnih edema

SELF-POISONING SUICIDE ATTEMPTS AMONG STUDENTS IN TEHRAN, IRAN

Background: This study aim was to describe the epidemiology of intentional self-poisoning among students. Subjects and methods: A cross-sectional study was conducted on self-poisoned students admitted to Loghman-Hakim Hospital in Tehran, Iran. Variables studied included age, sex, substance abuse, personal history, familial history and the immediate precipitant for the suicide attempt. Results: A total of 248 students (200 F and 48 M) studied. The mean age was 16.3±1.42 years. Self poisoning with a pharmaceutical agent was the most common attempt modality (87.5%). The most common precipitant for the suicide attempt was family conflict (54.4%), followed by romantic disappointment (29.4%). The most common psychiatric disorders were adjustment disorder (84.3%). and depression (18.1%). Conclusion: The emphasis in student suicide prevention programs must be on early identification of students at risk, and appropriate treatment of episodes of psychopathology

Methanol mass poisoning in Iran: Role of case finding in outbreak management

Background There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. Methods A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. Results A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. Conclusion In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings. © 2014 The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected]

Acute respiratory distress syndrome caused by methadone syrup

Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the fi ndings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema

Blood lead level and related factors in ADHD patients of Loghman Hakim Hospital in 2016- 2017

Introduction: Lead is a highly neurotoxic metal mainly in early life. In this study we investigate blood lead level (BLL) in children with attention deficit/ hyperactivity disorder (ADHD) and some related factors mainly opium exposure, as a source of lead exposure in recent years in Iran. Materials and Methods: In this cross-sectional descriptive study children & adolescents aged < 18 years in Child Neurology Clinic of Loghman Hakim hospital with ADHD criteria according to DMS-V in Tehran-Iran were studied. Lead Care II checked BLLs using 0.5-milliliter heparinzed venous blood. Demographics characteristic   and some   related factors such as old housing, parents’ job, pica, opium exposure were   asked and analyzed. Results: Fifty-one children and adolescents <18 years, 25.5% female and 74.5% male with mean ages of    71.4+30.3 months entered the study. Mean BLL was 6.34+2.63  µg/dl. The mean BLL in 100 normal children in Loghman Hakim hospital was 3.4 µg/dl. Mean BLL was 57/6 µg/dl in boys and60/6  µg/dl in girls, (p=0.973).  Also, the difference in mean BLLs were not significant in terms of living place, sex, age, pica and parents job.  Totally, 43 patients (84.3%) of the study samples had BLL ≥5 µg/dl. The highest blood lead level in our patient was 20.1 µg/dl. Eighteen (32.7%) of our patients have positive history for opium exposure in their family that BLL in this group was 5.84 µg/dl in comparison 6.95 µg/dl in cases with no opium exposure, that there were not statistically significant. (p=0.148) Conclusion: Based on the results of our study, clinicians are encouraged to take accurately attention about possible lead exposure and to rule out environmental hazards when evaluating for ADHD, particularly in young children and laboratory investigation for this toxin in high-risk cases and further researches recommende

Acute Lidocaine Toxicity: a Case Series

Introduction: Parenteral form of lidocaine is the best-known source of lidocaine poisoning. This study aimed to evaluate the characteristics of acute lidocaine toxicity.Methods: In this retrospective cross-sectional study, demographics, clinical presentation, laboratory findings, and outcome of patients intoxicated with lidocaine (based on  ICD10 codes) admitted to Loghman Hakim Hospital, during April 2007 to March 2014 were analyzed.Results: 30 cases with the mean age of 21.83 ± 6.57 year were studied (60% male). All subjects had used either 6.5% lidocaine spray or 2% topical formulations of lidocaine. The mean consumed dose of lidocaine was 465 ± 318.17 milligrams. The most frequent clinical presentations were nausea and vomiting (50%), seizure (33.3%), and loss of consciousness (16.7%). 22 (73.3%) cases had normal sinus rhythm, 4 (13.3%) bradycardia, 2 (6.7%) ventricular tachycardia, and 2 (6.7%) had left axis deviation. 11 (36.6%) cases were intubated and admitted to intensive care unit (ICU) for 6.91 ± 7.16 days. Three patients experienced status epilepticus that led to cardiac arrest, and death (all cases with suicidal intention).Conclusion: Based on the results of this study, most cases of topical lidocaine toxicity were among < 40-year-old patients with a male to female ratio of 1.2, with suicidal attempt in 90%, need for intensive care in 36.6%, and  mortality rate of 10%