Status of Total Antioxidant Capacity and Malondialdehyde Level in Methamphetamine Addicts: A Cross Sectional Study

Background: Methamphetamine (MA) is an illegal amphetamine-like which stimulate the central nervous system. In recent years, MA has been widely abused worldwide. Previous studies have suggested that oxidative stress (OS) plays an important role in MA-induced toxicity. From this view, antioxidant therapy could be considered as a potential drug therapy in MA abusers. Therefore, the objective of this study was to evaluate OS status in MA abusers.Methods: This was a cross-sectional study conducted on 21 MA abusers who referred to Iranian National Center for Addiction Studies and Congress 60 Humane Revivification Society, and 15 healthy males as a control group. The demographic data and peripheral blood sampling was obtained from both groups. The serum malondialdehyde (MDA) level as a marker of plasma lipid peroxidation and total antioxidant capacity (TAC) of plasma were analyzed.Results: Significant decrease in plasma TAC in case group was observed (101.85±12.5 vs. 130.7±16.12 mmol/L). No significant increase in MDA serum level was detected in case group in comparison with control (27.35±2.6 vs. 26.67±2.22 µmol/L, respectively). Neither the serum MDA levels nor the plasma TAC were significantly correlated with the duration and amount of MA abuse.Conclusion: It seems that, MA abuse is associated with prooxidant-antioxidant imbalance, which suggests evaluation the role of antioxidants administration for the prevention and treatment of MA-induced toxicity

Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5) were male. VAP was detected in 24 of 43 (55.8) patients in the case group and 23 of 48 (47.9) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10) and Acinetobacter spp. (19.68). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients. © 2016 Ahmad Ghoochani Khorasani et al

Late extensive intravenous administration of N-acetylcysteine can reverse hepatic failure in acetaminophen overdose

Acetaminophen is a commonly used analgesic and has been shown to be a main cause of drug-induced liver failure. N-acetylcysteine (NAC) should be employed as the antidote in case of acetaminophen poisoning within the first 8-10 hours. Oral administration of NAC is universally recommended and due to the adverse effects, the intravenous administration of the agent is reserved for patients with oral intolerance and severe complications. We here report an 18-year-old man with severe liver failure due to a huge ingestion of acetaminophen, who was taken into the Loghman Hakim Hospital Poison Center 72 hours after attempted suicide. Regarding the poor prognostic clues as his level of consciousness and impaired liver functions, an extensive intravenous regimen of NAC was started. The patient survived the condition with an additional intravenous administration of NAC past the first 72 hours of treatment. We discuss that even in late phases of intoxication; high-dose intravenous NAC can serve a substantial improvement. © The Author(s) 2011

Favorable results after conservative management of 316 valproate intoxicated patients

Valproic acid (VPA) is an effective antiepileptic drug widely used worldwide. Despite several studies indicating the usefulness of intravenous L-carnitine in the treatment of VPA poisoning, this drug is not readily available in Iran. The aim of this study was to determine whether supportive care without antidote would result in acceptable outcomes in VPA poisoned patients. Materials and Methods: In an observational, retrospective, single-center case series, all patients >12-year-old with VPA overdose who had referred to a tertiary center between 2009 and 2013 were consecutively enrolled. Patients� demographic and presenting features, physical examinations, clinical management, laboratory data, and outcomes were recorded. Results: A total of 316 patients were enrolled with pure VPA toxicity. The most common presenting signs/symptoms were drowsiness, nausea and vomiting, vertigo, and headache. In the course of the disease, 14 patients (4.4) were intubated and three (0.9) required hemodialysis with mean dialysis sessions of two. Fourteen patients were admitted to Intensive Care Unit, and seizures occurred in five. The initial level of consciousness was lower in patients with poor outcome. The median ingested dose of VPA in patients who required dialysis was significantly higher (20 vs. 6 g; P = 0.006). Multivariate analyses revealed that coma on presentation was associated with a worse outcome (P = 0.001; odds ratio = 61.5, 95 CI = 5.8-646.7). Conclusion: Prognosis of VPA poisoned patients appears to be good even with supportive care. According to our study, older age, ingestion of higher amounts of VPA and lower PCO2, HCO3, base excess, and CPK levels prone the patients to more severe toxicities in univariate analysis, but the main poor prognostic factor is coma on presentation in multivariate analysis. © 2015 Journal of Research in Medical Sciences

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

Effectiveness of naltrexone in the prevention of delayed respiratory arrest in opioid-naive methadone-intoxicated patients

Acute methadone toxicity is a major public health concern in Iran. Methadone-intoxicated patients are in a great risk of recurrent or delayed respiratory arrest despite the prescription of initial doses of naloxone. This study aimed to evaluate the effectiveness of oral naltrexone in the management of acute methadone overdose in opioid-naive patients and check if it could be a substitute of continuous infusion of naloxone in maintaining adequate ventilation. In a randomized, double-blind, placebo-controlled study, a total of 54 opioid-naive patients with acute methadone toxicity were enrolled. The patients received either oral naltrexone or placebo capsules after awakening by naloxone. All patients underwent close monitoring of respiration. Frequency of respiratory depression or arrest, need for another dose of naloxone, duration of hospital stay, and adverse outcomes compared between the two groups. The incidence of respiratory depression was significantly less in those who had received naltrexone. Our results show that single oral dose of naltrexone is quite efficient in the prevention of recurrent or delayed respiratory arrest in opioid-naive methadone-intoxicated patients. It can shorten the duration of hospitalization and, as a consequence, decreased the risk of complications. Further studies are warranted before the generalization of this approach to other patient populations. © 2013 Abbas Aghabiklooei et al

Effectiveness of naltrexone in the prevention of delayed respiratory arrest in opioid-naive methadone-intoxicated patients

Acute methadone toxicity is a major public health concern in Iran. Methadone-intoxicated patients are in a great risk of recurrent or delayed respiratory arrest despite the prescription of initial doses of naloxone. This study aimed to evaluate the effectiveness of oral naltrexone in the management of acute methadone overdose in opioid-naive patients and check if it could be a substitute of continuous infusion of naloxone in maintaining adequate ventilation. In a randomized, double-blind, placebo-controlled study, a total of 54 opioid-naive patients with acute methadone toxicity were enrolled. The patients received either oral naltrexone or placebo capsules after awakening by naloxone. All patients underwent close monitoring of respiration. Frequency of respiratory depression or arrest, need for another dose of naloxone, duration of hospital stay, and adverse outcomes compared between the two groups. The incidence of respiratory depression was significantly less in those who had received naltrexone. Our results show that single oral dose of naltrexone is quite efficient in the prevention of recurrent or delayed respiratory arrest in opioid-naive methadone-intoxicated patients. It can shorten the duration of hospitalization and, as a consequence, decreased the risk of complications. Further studies are warranted before the generalization of this approach to other patient populations. © 2013 Abbas Aghabiklooei et al

Usporedba djelovanja blokatora kalcijevih kanala, blokatora autonomnoga živčanog sustava te inhibitora slobodnih radikala na hiposekreciju inzulin iz izolirnih langerhansovih otočića štakora uzrokovanu diazinonom

Hyperglycaemia has been observed with exposure to organophosphate insecticides. This study was designed to compare the effects of calcium channel blockers, alpha-adrenergic, beta-adrenergic, and muscarinic receptor blockers, and of free radical scavengers on insulin secretion from diazinon-treated islets of Langerhans isolated from the pancreas of rats using standard collagenase digestion, separation by centrifugation, and hand-picking technique. The islets were then cultured in an incubator at 37 °C and 5 % CO2. In each experimental set 1 mL of 8 mmol L-1 glucose plus 125 µg mL-1 or 625 µg mL-1 of diazinon were added, except for the control group, which received 8 mmol L-1 glucose alone. The cultures were then treated with one of the following: 30 µmol L-1 atropine, 100 µmol L-1 ACh + 10 µmol L-1 neostigmine, 0.1 µmol L-1 propranolol, 2 µmol L-1 nifedipine, 50 µmol L-1 phenoxybenzamine, or 10 µmol L-1 alphatocopherol. In all experiments, diazinon significantly reduced glucose-stimulated insulin secretion at both doses, showing no dose dependency, as the average inhibition for the lower dose was 62.20 % and for the higher dose 64.38 %. Acetylcholine and alpha-tocopherol restored, whereas atropine potentiated diazinoninduced hyposecretion of insulin. Alpha-, beta- and calcium channel blockers did not change diazinoninduced effects. These findings suggest that diazinon affects insulin secretion mainly by disturbing the balance between free radicals and antioxidants in the islets of Langerhans and by inducing toxic stress.U osoba izloženih organofosfatnim insekticidima zamijećen je nastanak hiperglikemije. Svrha je ovo istraživanja bila usporediti djelovanje blokatora kalcijevih kanala, alfa i beta-adrenergičkih i muskarinskih receptora te inhibicije slobodnih radikala na lučenje inzulina iz Langerhansovih otočića izoliranih iz štakora tretiranih diazinonom. Otočići su izolirani iz gušterače štakora s pomoću standardnog postupka digestije kolagenazom, odvajanja centrifugiranjem i metodom ručnog probira (engl. hand-picking) te su kultivirani u inkubatoru pri 37 °C i 5 % CO2. Pokusne su kulture inkubirane s 1 mL glukoze u koncentraciji od 8 mmol L-1 te diazinonom u dozi od 125 μg mL-1, odnosno 625 μg mL-1. U kontrolu je dodana samo glukoza u koncentraciji od 8 mmol L-1. Nakon toga je u kulture dodan jedan od sljedećih agenasa: 30 µmol L-1 atropin, 100 µmol L-1 ACh + 10 µmol L-1 neostigmin, 0,1 µmol L-1 propranolol, 2 µmol L-1 nifedipin, 50 µmol L-1 fenoksibenzamin, odnosno 10 µmol L-1 alfa-tokoferol. U svim je pokusima diazinon značajno smanjio lučenje inzulina, s time da je doza od 125 μg mL-1 dovela do 62,2 %-tne inhibicije, a doza od 625 μg mL-1 do 64,38 %-tne inhibicije lučenja inzulina, što upućuje na djelovanje neovisno o dozi. Acetilkolin i alfa-tokoferol su ponovno potaknuli lučenje inzulina, za razliku od atropina koji ga je dodatno smanjio. Primjena blokatora alfa i beta-adrenergičkih receptora te blokatora kalcijevih kanala nije utjecala na djelovanje diazinona. Autori zaključuju da diazinon utječe na lučenje inzulina ponajviše narušavanjem ravnoteže između slobodnih radikala i antioksidansa u Langerhansovim otočićima te dovodi do toksičnoga stresa

Heart Rate-Corrected QT Interval Helps Predict Mortality after Intentional Organophosphate Poisoning

INTRODUCTION: In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. METHODS: We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (<0.44 s) or prolonged (>0.44 s). Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS: The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019). By the end of the study, 18 of 118 (15.2%) patients had died, including 3 of 75 (4.0%) patients with normal QTc intervals and 15 of 43 (34.9%) patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961-40.345, P = 0.000), respiratory failure (OR = 4.867, 95% CI = 1.062-22.301, P = 0.042), coma (OR = 3.482, 95% CI = 1.184-10.238, P = 0.023), and QTc prolongation (OR = 7.459, 95% CI = 2.053-27.099, P = 0.002) were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002), but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000), shortness of breath (64 versus 94.4%, P = 0.010), bronchorrhea (55 versus 94.4%, P = 0.002), bronchospasm (50.0 versus 94.4%, P = 0.000), respiratory failure (94.4 versus 43.0%, P = 0.000) and coma (66.7 versus 11.0%, P = 0.000) than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals (Log-rank test, Chi-square test = 20.36, P<0.001). CONCLUSIONS: QTc interval helps predict mortality after intentional organophosphate poisoning