Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran

Background: Coronary slow flow phenomenon (CSFP) represents a clinical entity with recurrent chest pain leading to living impairment. The present study aimed to investigate whether opium use correlates with primary CSFP. Methods: This study included Iranian patients with suspected coronary artery disease who underwent myocardial perfusion imaging. Coronary blood flow was measured quantitatively using the thrombolysis in myocardial infarction (TIMI) frame count and slow flow was defined as TIMI grade 2 standard deviations. Age and clinical conditions including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), history of chest pain, and opium use were recorded. First, the characteristics of the two groups were compared and then the main analyses were conducted to examine the relationship between CSFP and opium use. Data were analyzed using t test and chi-square test via SPSS 25.0. The significance level was set at P<0.05. Findings: This study was conducted on 44 male patients with documented CSFP who had no stenotic lesions and 134 control group male patients who had normal coronary arteries with normal flow. The mean age was similar in the two groups (54.25 vs.52.69, P=0.474). Two groups were significantly different in terms of history of chest pain (P=0.003), but there was no significant difference in HTN (P=0.084), DM (P=0.284), HLP (P=0.183), smoking (P=0.696), and opium use (P=0.107).  Conclusion: This study indicated that opium use is not associated with primary CSFP

Hot charcoal vomitus in aluminum phosphide poisoning - A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature

Aluminium phosphide (ALP) poisoning is a commonly encountered poisoning in emergency departments in most developing countries. Many papers have revealed metabolic derangements in this poisoning and also examined contributing factors leading to death, but only few have reported physical damage. Some case reports have described a complication that has been frequently termed ′ignition′. The exact mechanism of this phenomenon has not been fully elucidated. An exothermic reaction during therapeutic administration of chemicals may contribute to this problem, but the incidence has occurred in the absence of treatment or drug administration. Here, we report a 34-year-old woman with ALP poisoning who presented with hot charcoal vomitus, a sign of internal thermal event, leading to the thermal burning of the patient′s face and internal damage resulting in death. We reviewed all reported cases with similar complication to demonstrate varied characteristics of patients and to propose the possible mechanisms leading to this event

Comparison of elevated troponin I with APACHE II score and SAPS II score in predicting mortality rate and major adverse outcomes in critically ill intoxicated patients

ABSTRACT Objective: Scoring the severity of the disease and predicting the mortality rate in each patient can be done with the clinical evaluation of the patient by a specialist physician so that a more accurate chance of survival can be assessed. Due to the limited research done especially in Iran regarding the scoring of severity of disease in patients with acute poisoning, this study aimed to compare of elevated troponin I with Acute Physiologic and Chronic Health Evaluation 2 (APACHE II) score and Simplified Acute Physiology Score 2 (SAPS II) score in predicting mortality rate and major adverse outcomes in critically ill intoxicated patients Materials and Methods: This descriptive-analytic cross-sectional study was performed on all patients who were referred to Booali hospital affiliated to Qazvin University of Medical Sciences in 2017 due to acute poisoning. In the first 24 hours, APACHE II and SAPS II scores and also level of troponin I were assessed and their relation with complications and death as well as the number of admission days were evaluated using SPSS 24 software. In addition, the diagnostic value of these three indicators to predict mortality due to poisoning was examined using the ROC curve. Results: 55 patients were enrolled in the study. The results of this study showed that the mean score of APACHE II and SAPS II and troponin I was significantly higher in patients who eventually died or had complications due to poisoning than uncomplicated patients. Based on the ROC curve, the SAPS II, APACHE II and troponin I sensitivity were 100%, 100% and 87%, respectively, and their specifity were 81%, 66% and 60%, respectively, and the cutoff points were 38, 13.5 and 0.009 ng/ml respectively. Conclusion: It seems that troponin I is not superior to SAPS II and APACHE II to predict the mortality in critically ill intoxicated patients. To achieve more reliable results, further studies on the predictive role of troponin I in intoxicated patients are recommended. Keywords: Troponin I, Acute Physiologic and Chronic Health Evaluation 2, Simplified Acute Physiology Score 2, Prediction, Mortality, Poisonin

Determination of blood lead level (BLL) in oral opium addict people and evaluation of its correlation with acute abdominal pain at cardiology ward of Bualisina hospital at Qazvin province (97-98)

Abstract Introduction: Substance abuse and its consequences are major health problems in Middle-East countries including Iran. Opium addiction is a common form of addiction in Iran. The country has a long border with Afghanistan which remains as the main producer of illicit opium in the world. Adulteration of opium with lead is a new source of lead poisoning in Iran in which the opium abuse is frequent and it could be a new health problem in the future. In this study, we evaluated the patients with oral opium use and assessed blood lead level (BLL) to elaborate its correlation with acute abdominal pain at Bu Ali Sina hospital affiliated with Qazvin University of Medical Sciences located in Qazvin, Iran. (97-98) Methods: This is a case-control study of 40 opium addict patients at Bualisina hospital at Qazvin province that have had chosen randomly (20 patient with abdominal pain & 20 without). We recorded their demographic information such as sex, age, duration of use. Also we recorded blood Hb levels, blood lead levels, retic count , basophilic stippling in PBS (with 5 cc vein blood sample). We also divided patients according to their Hb level into 2 groups: Anemic & non Anemic. Findings: First of all, we detected a negative significant correlation between abdominal pain and BLL (p=0.000,r=-0.6) Then, in divided groups (with or without abdominal pain), it didn’t show any significant correlation between BLL & the variables except Hb level. The analysis showed a negative significant correlation in group with abdominal pain. (p=0.000,r=-0.723) When we divided patients into Anemic & non anemic, the analysis showed a positive significant correlation between abdominal pain & BLL in anemic patients. Between the patients, we had people without abdominal pain and with high BLL. it was noticeable that what the cause of high BLL is. So we collected those with high BLL and evaluated the correlation of variables with BLL in 2 groups(with or without abdominal pain) for finding the factor that probably causes the high BLL. it showed a negative significant correlation just with Hb level in the group without abdominal pain.(p =0.01 , r=-79.0). Conclusion: First, raised BLL would increase the severity of abdominal pain among oral opium users, particularly in those who suffer anemia, Second, in those without abdominal pain & high BLL, Hb levels effect the BLL and increase it. So we should consider Hb levels and anemia in opium addicts and treat anemia to reach a better outcome of managing gastrointestinal symptoms in addicts with lead toxicity. Keywords: Oral opium, abdominal pain, BLL, Hb levels, anemi