Hepatotoxicity Due To Mushroom Poisoning: A Case Report

Background: Although the majority of mushroom ingestions are benign, some result in significant toxicity and death. Of greatest concern is the hepatotoxic amatoxin-containing mushroom, which may be fatal even small ingestions. Identification of amatoxin poisoning can prove to be difficult due to delay in onset of symptoms and difficulty with identification of mushrooms.Case Report: We present one case of mushroom ingestion in Kerman, province what according to clinical course and laboratory finding, we believe to be an amanita species, treated with multiple dose of activated charcoal, N-acetylcysteine, high-dose penicillin and liver Gol (silymarin).Conclusion: We present the successful treatment a patient who ingested hepato-toxicity induced mushrooms, further, this case is evidence of a mushroom variety responsible for toxicity never previously implicated in the southeastern Iran

Treatment of 2, 4-Dichlorophenoxyacetic Acid (2, 4-D) Poisoning; a Case Study

Background: 2, 4-Dichlorophenoxyacetic Acid (2, 4-D) is an herbicide in chlorophenoxy group that use as a weed killer. Acute poisoning with 2, 4-D may be fatal in large ingestion. There is no specific antidote for 2, 4-D herbicide poisoning. We report here a case of 2, 4-D toxicity with rhabdomyolysis.Case Report: In this case study we present a case of intentional consumption of 2, 4-D herbicide with main gastrointestinal complain that became toward   rhabdomyolysis and liver damage during hospital course. Successful treatment with sodium bicarbonate and other conservative therapies was performed.Conclusion: In cases of 2, 4-dichlorophenoxyacetic acid poisoning, rhabdomyolysis should be in mind and an alkaline diuresis can increase herbicide elimination as well as treatment of rhabdomyolysis should be considered

Role of pharmacists in reducing antibiotic prescribing errors in an emergency department

Background: Clinical pharmacists and clinically trained pharmacists can detect and correct prescribing errors by reviewing physicians' orders. In addition, prescribing errors related to antibiotics occur frequently in emergency departments (EDs). Aim: This study evaluated the role of pharmacists in reducing antibiotic prescribing errors in an ED. Methods: One clinically trained pharmacist spent 4 h/day in the ED for 30 days. The pharmacist attended the ward rounds and reviewed medical records to identify prescribing errors related to antibiotics, and corrected these errors in consultation with emergency physicians. The types and severity of antibiotic prescribing errors were determined. The corrected errors were also classified. Results: Antibiotics had been prescribed for 110 of 267 patients (41.20). In all, 180 antibiotic prescriptions were identified for 57 patients, of which 78 had prescribing errors. The most common types of errors were incorrect drug selection (48/78; 61.50) and wrong dose (19/78; 24.40), and the most common actual severities were Type B (30/78; 38.46) and Type C (35/78; (44.87). In addition, 41 of 78 antibiotic prescribing errors were accepted as errors by emergency physicians. The corrected prescribing errors were categorised as two (4.88) intercepted potential adverse drug events (ADEs), 35 (85.36) mitigated ADEs and four (9.76) ameliorated ADEs. Conclusion: Pharmacists have a significant role in the identification and correction of antibiotic prescribing errors. In addition, collaboration between physicians and pharmacists can lead to more appropriate antibiotic use in hospitals. © 2020 The Society of Hospital Pharmacists of Australi

Thallium exists in opioid poisoned patients

BACKGROUND: Thallium (Tl) is a toxic heavy metal that exists in nature. Tl poisoning (thallotoxicosis) may occur in opioid addicts. This study was designed to evaluate the frequency and level of urinary Tl in opioid abusers. In addition, clinical findings were evaluated. METHODS: A total of 150 subjects were examined. Cases with a history of at least 3 years of abuse were admitted in the Imam Reza Hospital as the case group; 50 non-opioid abusers from the target population were included as the control group. Twenty-four hour urinary qualitative and quantitative Tl analyses were performed on both groups. RESULTS: Out of the 150 subjects, 128 (85 %) were negative for qualitative urinary Tl, followed by 5 % (trace), 7 % (1+), 2 % (2+), and 1 % (3+). Mean (standard error (SE), Min-Max) quantitative urinary Tl level was 14 μg/L (3.5 μg/L, 0-346 μg/L). Mean urinary Tl level in the case group was 21 μg/L (5 μg/L, 0-346 μg/L) and that in the controls was 1 μg/L (0.14 μg/L, 0-26 μg/L), which were significantly different (P = 0.001). The most frequent clinical findings were ataxia (86 %), sweating (81 %), and constipation (54 %). In all cases (n = 150), the mean (SE) value for cases with positive qualitative urinary Tl was 26.8 μg/L (0.9 μg/L) and that in the negative cases was 2.3 μg/L (0.2 μg/L), which were significantly different (P = 0.002). CONCLUSIONS: This study showed that long-term opioid abuse may lead to Tl exposure. In opioid abusers with the clinical manifestation of thallotoxicosis, urinary Tl should be determined

Successful treatment of aluminium phosphide poisoning by dihydroxyacetone: A two-case report study

What is known and objective: Aluminium phosphide (AlP) is an agricultural fumigant which produces phosphine gas in the presence of moisture. Phosphine inhibits oxidative phosphorylation and causes cell death by inhibiting cytochrome C oxidase. Clinical manifestations of AlP poisoning are refractory hypotension, tachycardia, low oxygen saturation and severe metabolic acidosis. Case summary: Two cases received dihydroxyacetone (DHA) in addition to routine management of AlP poisoning. Administration of DHA (7 gr in 50 mL sodium bicarbonate, gavage) 2 times at a 1-hour interval improved the clinical signs. What is new and conclusion: This is the first case report to highlight the safe and successful treatment of AlP poisoning with DHA. However, more clinical studies are recommended to determine the precise mechanism of DHA action. © 2020 John Wiley & Sons Lt

Studying angiogenesis in autochthonous xenograft models of glioblastoma multiforme by MVD-CD34 technique in Iranian patients

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Despite advances in cancer diagnosis and treatment, survival rate of patients suffering from glioblastoma multiform (GBM) has not been significantly improved. Therefore, novel therapeutic adjuncts to routine therapies have been suggested over time. Inhibition of angiogenesis by antiangiogenic drugs is one of the new approaches to inhibit the growth of malignant cells. Microvessel density (MVD) assay is a technique performed by counting immunohistochemically-stained blood vessels. Nowadays, athymic nude mice are widely used for the establishment of xenograft tumor models in cancer research. The aim of this study was to evaluate the MVD of autochthonous xenograft models of GBM isolated from Iranian patients for use in pharmaceutical research on antiangiogenic drugs."n"nMethods: Fresh tumor samples of GBM were obtained from three patients in Cancer Institute of Tehran University of Medical Sciences in Fall of 2010 and Winter of 2011. After preliminary processing, minced tumor samples were implanted heterotopically on flanks of athymic nude mice. Two months later, the animals were sacrificed and the xenograft tumor samples were sent to the pathology laboratory. After establishing the proof of the xenograft tumor type, MVD-CD34, an endothelial cell marker, was assessed by counting hot spot areas in 22 samples."n"nResults: The mean number of microvessels in these xenograft tumor models was 30±2.1."n"nConclusion: These autochthonous xenograft models of GBM can be used in preclinical settings for research on antiangiogenic drugs regarding a pharmacogenomics-based treatment regimen for the Iranian population. Moreover, such models can be used in future studies for determining the sensitivity or resistance to antiangiogenic drugs in individualized cancer therapy

Evaluation of multimodal MR imaging for differentiating infiltrative versus reactive edema in brain gliomas

Objective: To determine the border of glial tumors by diffusion weighted imaging (DWI), apparent diffusion co-efficient (ADC), magnetic resonance spectroscopy (MRS) and perfusion brain MRI. Patients and methods: Ten patients with brain gliomas were enrolled mean age: 35.3 ± 13.2, range: 20�62. Conventional MRI was performed for all patients. Besides, tumor mapping based on Choline (Cho)/Creatine (Cr) color map in MRS, perfusion and diffusion color maps, were gathered. Different tumoral and peritumoral regions normal tissue, reactive edema, infiltrative edema, and tumor core were defined. MRI criteria were evaluated in areas targeted for biopsy and histopathologic evaluation was determined. Results: Tumor cell positive samples one necrosis, 26 infiltrative and nine tumor cores composed 36 (75%) of the 48 samples. Seven (19.4%) of the positive samples were interpreted as not tumor on MRI. Five were identified as reactive edema and two as normal tissue kappa:.67, p-value <.001. Mean of ADC, median of N-acetylaspartate (NAA) and NAA/Cho were statistically different between positive and negative samples (p =.02 and p <.001, respectively). Mean ADC and median Cho/NAA were statistically different in missed tumor containing tissue presented as reactive edema compared to normal and correctly diagnosed reactive edema samples together (p-values <.05). Conclusions: Multimodal MRI could define infiltrated borders of brain gliomas. © 2020 The Neurosurgical Foundation