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

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

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

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

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

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

Evaluation of Pralidoxime Use in an Iranian Teaching Referral Hospital

Background: Organophosphorus (OP) poisonings, a common source of pesticide poisoning, are an important cause of morbidity and mortality in the developing countries. Combination therapy with atropine and oxime is a common practice in the management of OP poisoning. However, the additive benefit of using pralidoxime in addition to atropine remains controversial. Due to inappropriate and widespread use of this relatively expensive and low available antidote, we aimed to evaluate its usage in an Iranian teaching hospital. Methods: Medical files of patients with pesticide poisoning who had been admitted to the poisoning ward between September 2013 and September 2014 were reviewed. Patients with definite diagnosis of OPs poisoning were selected to evaluate rational use of pralidoxime in their treatment regimen. Data were collected using a checklist containing demographic, clinical, and para clinical characteristics, as well as the type of pesticide poisoning. Appropriateness of the pralidoxime therapy was determined based on clinical practice guideline and endorsed by an attending medical toxicologist. Results: 68.8% of patients had been poisoned with insecticides, 27.1% with aluminum phosphide, 2.1% with herbicides, and 2% with rodenticides, respectively. OPs were responsible for 43.8% of all poisoning. All patients with OPs poisoning received pralidoxime after they had been admitted to emergency department, while only 55% of them were eligible to receive pralidoxime. Moreover, pralidoxime had been administered for 59% of patients with non-OPs poisoning, which all of them were clinically inappropriate. Conclusion: The use of pralidoxime in the northwest of Iran is not appropriate and thus, it is highly recommended that a patient-tailored treatment guideline be provided and implemented regionally

An Alliance of Carbapenem-Resistant Klebsiella pneumoniae with Precise Capsular Serotypes and Clinical Determinants: A Disquietude in Hospital Setting

Carbapenemase-resistant Klebsiella pneumoniae (CRKP) is a genuine burden for physicians and researchers. We aimed at carbapenemase resistance and its relation with capsular serotyping in K. pneumoniae and studied some clinical determinants, which may influence the clinical infections. Initially, 61 K. pneumoniae isolates obtained from various clinical specimens were confirmed at the molecular level and then antimicrobial susceptibility test was performed followed by capsular serotyping performed by multiplex PCR. All isolates were subjected to the detection of carbapenemase genes including blaKPC, blaNDM-1, blaOXA-48, blaVIM, and blaIMP. Clinical and demographic data of all patients were reviewed including age, gender, underlying diseases, and the treatment obtained. Multidrug-resistance was a predominant feature in 77% K. pneumoniae strains. Presence of extended-spectrum beta-lactamase was detected phenotypically in 59% K. pneumoniae strains. Carbapenem resistance was noticed phenotypically in 24.6% isolates. blaOXA-48 and blaNDM-1 were the most frequent carbapenemase genes. blaNDM-1 positive isolates correlated with gentamicin, amikacin, imipenem, and meropenem resistance (p<0.05). The nosocomial isolates mostly harbored blaOXA-48 gene (p<0.02). Amongst all the K. pneumoniae isolates, 59% isolates could be typed and serotype K54 had the highest prevalence followed by K20 and K5. Correlation between the carbapenemase genes, serotype and type of infection showed that blaOXA-48 positive strains had a significant association with K20 serotype and urinary tract infections (p=0.2) while, K20 serotype and blaKPC positive strains were significantly associated with wound infections (K20, p=0.3 and blaKPC, and p=0.4). Mucoid phenotype was not found related to presence of specific carbapenemase genes or serotypes except serotype K20 (p<0.001). Patients with monotherapy had treatment failure in comparison to the combination therapy for blaKPC-associated infections. In conclusion, the present investigation exhibited the significant association between K20 serotype with blaOXA-48. The predominance of K54 reveals the possibility of endemicity in our hospital setting. K. pneumoniae isolated from wound specimens significantly harbors K20 serotype and blaKPC gene. Comprehensive clinical information and the distribution of antibiotic resistance genes, and serotypes may play important roles in the treatment process

Successful Treatment of Acute Lethal Dose of Acrylamide Poisoning

Background: Acrylamide (C3H5NO) is a vinyl monomer. This water-soluble crystalline solid is a colorless, odorless agent which is used in scientific laboratories and some industries. Acrylamide has cellular oxidative effects. Acute or chronic poisoning with this agent happens as a result of skin, respiratory, or oral contacts. Clinical manifestations depend on the dose, duration, and frequency of contact. Management of these patients consists of conservative and palliative therapies to reduce the oxidative effects. Case: The case was a 29-year-old girl with a Master of Sciences degree in genetics who worked in a university research center with previous history of depression. She had ingested 100cc of 30% Acrylamide solution for intentional suicide attempt. The patient was successfully managed using N-acetyl cysteine, vitamin C, and melatonin. Conclusion: Early diagnosis and appropriate treatment with recommended agents together with supportive therapies can save the life of patients exposed to potentially lethal doses of acrylamide, although intentional or accidental