QTc Prolongation in Acute Methadone Poisoning

 Background:Methadone is considered as a good choice for maintenance treatment program (MMTP) in opioid addicted individuals. QT interval prolongation was reported previously in methadone chronic usersespecially in high dose prescription. QT-interval prolongation predisposes patients to lethal dysrhythmia. This is a report of corrected QT(QTc) prolongation due to acute methadone poisoning. To the best of our knowledge, in review of literatures, there is no previous report of QTc prolongation in cases that are not on chronic methadone therapy. Case Report: The patient was a 20 years old man who has occasionally used opium and ice since 8 month before admission. One night before admission he consumed ice and found psychotic state so he was referred to the addiction treatment center and they put him on methadone maintenance treatment with high dose of methadone. After 40 minutes the patient was drowsy and then hypopnea was started. The patient was referred to the hospital and resuscitation was done after naloxone prescription. After stabilizing general conditions the electrocardiograph shows QTc prolongation which was returned to normal status after 2 days. After 5 days the patient was transferred to psychiatric service with normal sinus rhythm and stable condition. Conclusion:QT interval prolongation in chronic methadone maintenance therapy is defined previously especially in patients on other drugs that interact with the CYP3A4 isoenzyme system and who are on high dose methadone treatment, but it seems that acute methadone intoxication also may prolong the QT interval which should be investigated in future studies.

Electrocardiographic Findings in Patients with Acute Methadone Poisoning

Background:Methadone as a synthetic opioid is widely used for treatment of opioid dependency. One of the causes of methadone related sudden death is cardiac toxicity. This study was aimed to determine the electrocardiographic changes in acute methadone poisoning.Methods: This is a cross sectional study on patients older than 12 years old with acute methadone poisoning who were admitted in Loghman poisoning center at 2010-2011. Data analysis was done by means of SPSS version 16 and appropriate statistical tests at the significant level of P<0.05.Results: In one year period, 51 patients with mean age of 40.59±18.27 (31-51) years, including 39 males, with acute methadone poisoning were included in to the study. Seven patients (13.7%) were acutely poisoned, 29 patients (56.8%) had acute on chronic methadone poisoning and others had not reliable history. The mean time of PR, QRS and QTc were 150.2±34.22, 77.06±13.89 and 421.76±43.04ms, respectively. The prolongation of PR, QRS and QTc were observed in 9.8%, 1.96% and 17.6% of patients, respectively. A significant statistical association was observed between PR prolongation and type of poisoning and QRS prolongation and outcome (P=0.035 and 0.009).Conclusion: The findings of this study indicate the occurrence of cardiac toxicity in patients with acute methadone poisoning. Further studies are required on acute methadone poisoning in patients with known previous cardiac status

Risk Factors for Mortality in Organophosphate Poisoned Patients

Background: Organophosphates (OP) compounds are used as insecticides in agricultural and domestic settings throughout the world. Acute pesticide poisoning has a high morbidity and mortality, especially in developing countries. The purpose of this study was to evaluate the data on acute adult organophosphate poisoning (OPP).Methods: In Descriptive cross sectional study at Loghman Hakim Hospital in Tehran-Iran during March 2010 to June 2013 and identify the risk factors of mortality, patients with the primary diagnosis of OPP who were admitted to Loghman-Hakim Hospital Poison Centre (LHHPC) were the subjects of this prospective study. Cholinesterase (CE) activity and the PR interval was determined for each patient using the Bazett formula and considering >200 msec. as prolonged. Comparative outcomes of the study were respiratory failure, systolic blood pressure, GCS and intentional poisoning, analysis of the PR interval in the primary ECG on admission, and rate of mortality.Results: The study included 201 patients with a diagnosis of OPP. The mean age of the patients was 33.93. The mortality rate was 9%. Nine patients had conductive abnormality (PR prolongation) in ECG. There was no significant difference between two groups (prolonged and normal PR intervals) according to respiratory failure and systolic blood pressure<90mm Hg and GCS and intentional poisoning. The mortality rate in the long PR group was significantly higher than that of the normal PR group.Conclusion: In our study it has been well demonstrated that PR-interval prolongation affects mortality rate. Prolongation of the PR interval is associated with increased risks of mortality in OPP

Electrical Burn Patients According to Electrical Voltage in Shahid Motahari Burn Center

Background: Electrical injuries are rarely happened but it makes more harmful lesions comparing to other thermal injuries. The aim of this study was to report electrical burned patients according to electrical voltage in Shahid Motahari Burn Center.Methods: This Routine data base study was performed on patients with electrical burns which were admitted to Shahid Motahari Burn Center from April 2010 to March 2012. Demographic and clinical data had gathered from medical records. Association between voltage and morbidity or mortality was evaluated used SPSS v. 16.Results: Mean total body surface area of 287 patients (283 (98.60%) male and 4 (1.4%) female) with mean age of 30±0.7 years was 13.56±0.76% (range 1-100). There were 203 patients (70.7%) with low and 84 patients (29.31%) with high voltage injury. There was significant association between voltage and place of injury (p=0.001).Conclusion: High voltage injuries constitute large number of electrical injuries which more of these injuries occurred outdoor and in workplace and need more hospitalization. High voltage injuries are related with more amputation, so people and authorities should pay more attention to such injuries

The Anatomical Position of Appendix in Iranian Cadavers

Background: Vermiform appendix is different in terms of anatomical position, length and mesoappendix.  Knowing the anatomical position of vermiform appendix is important for the surgeons in terms of diagnosis and management. The aim of this study is analysis of length, anatomical position and mesoappendix of vermiform appendix.Methods: This is a cross-sectional study on the 400 randomly selected cadavers (306 male and 94 female) who have been referred to the autopsy hall of legal medicine organization of Tehran province to be autopsied between March 21, 2010 and March, 2011. The cause of death was very heterogeneous among autopsied cadavers.Results:According to our results the anatomical positions were pelvic, subcecal, retroileal, retrocaecal, ectopic and preileal in 55.8%, 19%, 12.5%, 7%, 4.2% and 1.5% respectively. The mean length of vermiform appendix was 91.2 mm and 80.3 mm in men and women, respectively. Mesoappendix was complete in 79.5% and incomplete in 20.5%. No association was seen between sex and anatomical position of vermiform appendix.Conclusion:Anterior anatomical position was the most frequent vermiform appendix position in our population which is in discrepancy with most of the reports from western countries. It might be possible that factors such as race, geographical regions and nutritional regiment play roles in determining the position of vermiform appendix

Causes of Death Accompanying by Soft Tissue Neck Hemorrhage

Background: Generally, soft tissue hemorrhages in anterior part of the neck are attributed to the neck compression or trauma and suspicion goes more to homicidal death than suicide. Although artificial posterior neck hemorrhages are described as Prinsloo-Gordon phenomenon in cadavers with posterior lividity, studies conducted on such hemorrhages in the anterior and lateral compartments are rare. This study intends to investigate causes of death accompanied by soft tissue neck hemorrhages in different compartments of neck. Method: In this retrospective case series, between March 2008 and 2009, cadavers whose autopsies indicated soft tissue neck hemorrhages and the lividity was dominant in posterior, were evaluated according to the cause of death and anatomical and histological locations of hemorrhage. Results: Among 86 cases of neck hemorrhage, 72.1% (n=62) were male. Direct neck trauma, hanging, strangulation, chocking and positional asphyxia constituted 50% (n=43) of them, 40.7% (n=35) were non-asphyxial, non-traumatic deaths such as natural diseases, drug and CO poisoning, electrocution and drowning, and 9.3% (n=8) were unknown. 65.1% (n=28) of non-traumatic, non-asphyxial cases bore anterior or lateral neck hemorrhages. Conclusion: The considerable prevalence of soft neck tissue hemorrhages in non asphyxial deaths with no history of neck trauma and the location of such hemorrhages in anterior and lateral sides of neck, lead the investigators to pay more attention to interpret these hemorrhages and determining the mode and cause of death

Consequences of long-term consumption of water from Nworie River (Owerri, Nigeria) on haematological, hepatic, and renal functions using rat model

The consequences of long term consumption of water from Nworie River (Owerri, Nigeria) on haematological, hepatic, and renal functions using rat model (Wistar albino strain). Twenty-four rats separated into two groups of twelve rats each were kept as test and control for sixty-four days. The test rats were placed on water from Nworie River while those of the control were placed on Eva water (purified Coca-cola bottled water). The rats were sacrificed in two sets: first set was on thirty-second day while the second set was on the sixty-fourth day. Six rats each from each group were sacrificed at each set. The Results obtained revealed that Hb, PCV, WBC, L, N, and ESR were significantly affected (p<0.05) in test rats against the control rats. The functional parameters of liver adequacy; AST, ALT, and ALP were significantly (p<0.05) affected in test rats against those of the control. Also, urea and electrolyte ions (Potassium ion, chloride and bicarbonate) indicating renal sufficiency were significantly (p<0.05) affected in test rats against those of the control. Creatinine, sodium ion, total bilirubin and conjugated bilirubin were not significantly affected (p>0.05) in test rats when compared to those of the control. The induced changes in the parameters investigated in this study have shown that long-term consumption of water from Nworie River has effect on haematological, hepatic, and renal function

Molekulare Integronanalyse und antimikrobielles Resistenzprofil von aus pädiatrischen Patienten mit Diarrhoe isolierten Shigella spp.

Introduction: Shigella spp. is a growing global health concern due to increasing multiple drug resistance, commonly resulting in therapeutic failure. Integrons are gene expression systems run by integrase genes. The aims of this study were detection of class I, II and III integrons and assessment of antimicrobial resistance in Shigella spp. isolated from acute pediatric diarrhea patients.Materials and methods: From January to December 2015, 16 Shigella spp. were isolated from 310 non-duplicative diarrheal stool samples in Children's Medical Center, Tehran, Iran. The isolates were analyzed for their antibiotic susceptibility using CLSI guidelines M100-S14. Multiplex PCR was used for amplification of I, II and III integron-associated integrase (intl ) genes.Results: Of 310 stool samples, 16 (5.2%) were positive for Shigella spp., in 7 of them S. sonnei and in 9 of them S. flexneri were identified. Results of the antimicrobial susceptibility test showed that 6.2%, 50%, 31.2%, 6.2%, 81.2%, 56.2% and 31.2% of the isolates were resistant to gentamicin, chloramphenicol, nalidixic acid, ciprofloxacin, tetracycline, ampicillin and trimethoprim-sulfamethoxazole, respectively. Multiplex PCR results revealed that 6.2% (1/16), 31.2% (5/16), 50% (8/16) of Shigella isolates carried intl I, intl II and both intl I/intl lI genes. No class 3 integrons were detected.Discussion: In this study, multidrug resistance was seen in Shigella isolates similar to that in isolates from other geographical areas. This is possible due to inappropriate use of antimicrobials. Furthermore, prevalence of multidrug resistance was significantly linked to the presence of integrin genes. Conclusion: A class 2 integron plays a role in presence of multidrug resistance in Shigella spp. It is vital to prevent the spread of antibiotic resistance through continuous monitoring.Hintergrund: Die Zunahme multiresistenter Shigella spp. ist ein globales Gesundheitsproblem wachsender Bedeutung. Integrons sind Genexpressionssysteme, die von Integrase-Genen gesteuert werden. Zielsetzung der Studie war die Detektion von Klasse 1, 2 und 3 Integrons und die Bestimmung der antimikrobiellen Resistenz von Shigella spp., die von pädiatrischen Patienten mit Diarrhoe isoliert wurden. Material und Methoden: Von Januar bis Dezember 2015 wurden 16 Shigella spp. aus 310 nicht-duplikativen Durchfall-Stuhlproben im Children's Medical Center, Tehran, gemäß Guideline des Clinical and Laboratory Standards Institute isoliert. Zur Amplifikation der I, II und III Integron-assoziierten Integrase(intl )-Gene wurde die Multiplex PCR eingesetzt.Ergebnisse: In 16 (5,2%) der 310 Stuhlproben wurden 7-mal S. sonnei und 9-mal S. flexneri isoliert. 6,2%, 50%, 31,2%, 6,2%, 81,2%, 56,2% bzw. 31,2% der Isolate waren resistent gegen Gentamicin, Chloramphenicol, Nalidixinsäure, Ciprofloxacin, Tetracycline, Ampicillin und Trimethoprim-Sulfamethoxazol. Mittels Multiplex PCR wurde nachgewiesen, dass 6,2% (1/16), 31,2% (5/16), 50% (8/16) der Shigella Isolate intl I, intl II bzw. beide Gene trugen. Klasse III Integrons wurden nicht detektiert.Diskussion: Bei Shigella -Isolaten wurde ähnlich zu anderen geographischen Regionen Multiresistenz nachgewiesen. Das wird begünstigt durch nicht Leitlinien gerechten Einsatz von Antibiotika. Die Prävalenz der Multiresistenz war signifikant mit dem Vorhandensein von Integrin-Genen assoziiert.Schlussfolgerung: Das Klasse 2 Integron ist von Bedeutung für die Multiresistenz von Shigella spp. Es ist wichtig, die Ausbreitung von Antibiotikaresistenzen durch kontinuierliche Überwachung zu verhindern

Consequences of long-term consumption of water from Nworie River (Owerri, Nigeria) on haematological, hepatic, and renal functions using rat model

The consequences of long term consumption of water from Nworie River (Owerri, Nigeria) on haematological, hepatic, and renal functions using rat model (Wistar albino strain). Twenty-four rats separated into two groups of twelve rats each were kept as test and control for sixty-four days. The test rats were placed on water from Nworie River while those of the control were placed on Eva water (purified Coca-cola bottled water). The rats were sacrificed in two sets: first set was on thirty-second day while the second set was on the sixty-fourth day. Six rats each from each group were sacrificed at each set. The Results obtained revealed that Hb, PCV, WBC, L, N, and ESR were significantly affected (p<0.05) in test rats against the control rats. The functional parameters of liver adequacy; AST, ALT, and ALP were significantly (p<0.05) affected in test rats against those of the control. Also, urea and electrolyte ions (Potassium ion, chloride and bicarbonate) indicating renal sufficiency were significantly (p<0.05) affected in test rats against those of the control. Creatinine, sodium ion, total bilirubin and conjugated bilirubin were not significantly affected (p>0.05) in test rats when compared to those of the control. The induced changes in the parameters investigated in this study have shown that long-term consumption of water from Nworie River has effect on haematological, hepatic, and renal function