Frequency of Electrocardiographic Abnormalities in Tramadol Poisoned Patients; a Brief Report

Introduction: Previous studies have raised the probably of cardiac manifestation in tramadol poisoning. However, conclusive information on electrocardiographic (ECG) abnormalities of tramadol overdose remains to be explained. Therefore, the present study aimed to evaluate the epidemiology of ECG abnormalities in tramadol poisoned patients. Methods: In a prospective cross-sectional study, all patients with tramadol poisoning, who were admitted to the emergency department of Loghman Hospital during 2012 – 2013, were evaluated. Patients’ baseline characteristics and ECG findings including axis, rate, rhythm, PR interval, QRS duration, QTc interval, evidence of Brugada pattern, and evidence of blocks were recorded. Obtained Data were descriptively analyzed using SPSS 21.0 statistical software. Results: 1402 patients with the mean age of 24 ± 6 years were studied (71.1% male). Sinus tachycardia was detected in 463 (33%) patients, sinus bradycardia in one patient (0.07%), right axis deviation in 340 (24.2), QRS widening in 91 (6.5%), long QTc interval in 259 (18.4%), dominant S wave in either I or aVL lead in 395 (28.1%), and right bundle branch block in 73 (5.2%). Increased PR interval was not detected in any cases. The evidence of Brugada pattern was observed in 2 (0.14%) patients (100% male), both symptomatized with seizure. All abnormalities had same sex distribution. Conclusion: Based on the results of the present study, the most common types of ECG changes were sinus tachycardia, a deep S wave in leads I and aVL, right axis deviation, and long QTc interval, respectively. Brugada pattern and sinus bradycardia were rarely presented

Weakness and diplopia in a 4-year old boy. An unusual Diagnosis

Abstract Ptosis, diplopia, and overall weakness in children may have serious underlying causes such as myasthenia, botulism, Guillain-Barré syndrome, and poisoning, which require a systematic and timely evaluation and proper management.(1,2,3) In pediatrics, clinical presentations may be atypical, and diagnostic overlap sometimesmakes the final diagnosis challenging. This can be addressed through taking accurate history, performing a physical exam, conducting a comprehensive assessment, and using appropriate diagnosticalgorithms &nbsp

The Outcomes of Accidental Ingestion of Hand Sanitizer

Background: children are exposed to numerous chemicals, such as hand sanitizers and their associated poisoning. Awareness of such poisoning symptoms and their management is critical for healthcare providers, as it can induce dangerous conditions. This study evaluated the clinical and paraclinical parameters of children who ingested hand sanitizers.Methods: In the first 6 months of 2020, the cases of children who accidentally ingested hand sanitizer and were referred to Akbar Hospital in Mashhad City, Iran (Referral pediatric poisoning center) were evaluated in this cross-sectional study. The relevant medical information and laboratory parameters were recorded.Results: In total, 20 patients were evaluated; of whom, 80% were male. The Mean±SD age of the study subjects was 4.9±4.2 years (2-15y). The ingestion was accidental in the study participants. The amount of ingestion approximately equaled a sip (3-7cc). All clinical and laboratory parameters were normal according to their age. Only 1(5%) case presented metabolic acidosis. No study subject manifested hypoglycemia or the loss of consciousness. Thus, they only received supportive care and were observed for ≥12 hours.Conclusion: Based on the present study results and absence of symptoms in the explored cases of hand sanitizer ingestion, the suitability of hand sanitizer solutions. Therefore, the formulation of these products should be carefully evaluated

Learning Styles and Toxicology Knowledge of Medical Students of Mashhad University of Medical Sciences

Background: Considering the breadth of medical knowledge, it is very important to study medical students’ learning and ways to facilitate it. One of the key areas in learning is studying methods. This study aimed to determine the preferred learning style in medical students and the level of learning in a medical discipline (Toxicology) as well as its correlates. Methods: Thirty-seven medical students who were admitted to an internship course, completed a questionnaire about their preferred learning style using the VARK (Visual, Auditory, Read/Write and Kinesthetic) method. Then, a standardized test was applied to measure the students’ score for each level of learning and the total score of learning. Results: The study participants included 20 males and 17 females. The preferred style of learning was mostly (32%) aural. Thirteen (35%) students preferred single-style of learning, and 24 (65%) preferred more than one style. No significant relationship was found between the learning style and the score on each learning level. No significant relationship was found between the preferred learning style and the total score of the final test (P>0.05). There was also no significant difference between persons with regard to single style and multiple styles of learning (P=0.46). The scores of theoretical knowledge was higher than the practical knowledge in all styles and among those with a multiple style of learning.Conclusion: Learning style is just one of the effective factors in medical education and it has no significant relationship with the level of learning. The current training method in some areas (toxicology training) for medical students, is more successful in transferring knowledge than skills to apply that knowledge

A Review on Complications and Management of Aluminium Phosphide (Rice Pill) and Zinc Phosphide Poisoning

Background: Various fumigant products containing aluminium  phosphide, known as rice pills, are widely used to kill insects in many parts of Iran, including the northern provinces. Poisoning with zinc phosphide as a rat poison also has the same side effects as aluminium  phosphide. This poisoning has no specific antidote, and the treatment is auxiliary, and one of the effective auxiliary treatments is L-carnitine. This review study aimed to determine the prevalence of aluminium  phosphide poisoning and treatment with intravenous L-carnitine. Materials and Methods: This study was a narrative review conducted in 2023. Search keywords aluminium  phosphide, zinc phosphide, intravenous L-carnitine, and poisoning in Persian and English languages in databases including Magiran, PubMed, Wiley, Science Direct, web of Sciences, SID, Scopus, and Google Scholar were done from 1970 to 2022. Relevant articles were identified, and the most important and valuable points were presented after review. Results: According to the findings of most studies, aluminium  phosphide pills had the most adverse effects as toxic substances. Conclusion: Due to the prevalence of its consumption among young people with low education levels, there was a need for physicians to treat these patients as quickly as possible accurately. It is also necessary to raise awareness about its potentially dangerous side effects and to monitor closely the distribution of this poisonous pill in its distribution centers. Moreover, the quick start of supportive treatment with antioxidants and L-carnitine can help in this poisoning that does not have a specific antidote. Very effective and useful

Cardiovascular Conditions in Patients With Aluminum Phosphide Poisoning

Background: Aluminum Phosphide (AlP) is a well-known rodenticide and insecticide, used as a fumigant to control pests and rodents in grain-storage facilities. Its intoxication presents a medical emergency that requires early rigorous management. This study aimed to investigate cardiac function by Electrocardiogram (ECG) changes in patients with AlP intoxication. We also explored the potential relationship between low bicarbonate and cardiac function.Methods: This cross-sectional study investigated 42 patients in the age range of 17-47 years, with a history of orally-administered AlP poisoning, known as “rice tablet”, admitted to the toxicology ward of Imam Reza Hospital from March 2019 to March 2021. The study patients’ demographic data were collected by trained interviewers, using pretested questionnaires. Systolic and diastolic blood pressure, as well as blood samples, were measured 12 hours from admission. Echocardiography was performed during the first 12 hours and on the fifth-day post-admission. All statistical analysis was performed using R 3.6.1. The significance level was set at 0.05 for all statistical tests.Results: In total, 48.78% of patients presented normal bicarbonate levels, and 24.39% and 26.83% had moderate and severe acidity, respectively. Moderately and severely decreased Left Ventricular Ejection Fraction (LVEF) was observed among 21 (51.2%) and 10 (24.4%) patients, respectively. Furthermore, mild Right Ventricular (RV) function was observed among 11 (26.8%) patients. A statistically significant association was observed between bicarbonate level and RV function (P<0.001) and LVEF (P<0.001). Besides, 19.5% of the explored patients expired. The proportion of expired patients was significantly higher in patients with mild RV function, compared to the other patients (P<0.001).Conclusion: Acute AlP intoxication is a worldwide serious problem. Severe metabolic acidosis and ECG abnormalities are associated with poor outcomes in this respect. Thus, conducting early ECG and echocardiography could be desirable instruments to predict prognosis. There is no antidote for AlP poisoning; thus, the replacement of a safer agent for in-store grain protection is strongly suggested

characteristic Findings of primary sclerosing cholangitis on endoscopic Retrograde cholangiography: Which is the Most common Finding?

Abstract Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease and one of the most common indications for cholangiography (ERCP). We undertook this study to clarify whether there is a specific pattern of involvement of the biliary tract in patients with PSC and to evaluate features of PSC disease on ERCP in order to be able to manage this disease better. Methods: This retrospective study included 45 patients admitted to Taleghani Hospital in 2004–2010 and diagnosed to have PSC on the basis of typical cholangiographic findings in combination with clinical and laboratory data. Patients suspected to have secondary sclerosing cholangitis were excluded. Demographic and clinical data were recorded, along with cholangiographic findings and the frequency of large duct and small duct PSC. Results: Forty-five patients of mean age 34.8 (range 15–66) years were included. Twenty-nine patients (64.4%) had inflammatory bowel disease, and the frequency of large duct PSC and small duct PSC was 93.4% and 6.6%, respectively. The intrahepatic ducts alone were involved in 11 (24.4%) patients and the extrahepatic ducts were involved in 14 (31.1%), with 17 (37.7%) patients having both intrahepatic and extrahepatic PSC. Three (6.6%) patients did not have bile duct involvement on ERCP, and their disease was diagnosed by liver biopsy as small duct PSC. The most common type of cholangiographic feature of intrahepatic duct involvement was type 2, found in 15 (33.3%) patients, with type 3 being the most common type of extrahepatic duct involvement and detected in 16 (35.5%) patients. Conclusion: Our study demonstrates that the most common PSC finding on ERCP is involvement of both the extrahepatic and intrahepatic bile ducts, with small duct PSC being less common than large duct PSC

Assessment of the Blood Lead Level in Children with Unexplained Failure to Thrive (FTT) admitted to Pediatrics Emergency Ward of Ghaem Hospital, Mashhad, Iran

BackgroundLead is a strong and stable toxin, harmful especially to children, pregnant women, and the elderly. Nearly 27% of children aged under 5 years suffer from failure to thrive (FTT). Due to the probable harmful effects of lead poisoning on children’s growth, in this study we aimed to assess the blood lead level in children with unexplained failure to thrive.MethodsThis analytic cross-sectional study was performed on 200 children under 2 years of age who were referred to Ghaem hospital, a referral hospital in Mashhad city-Iran. The participants were divided into two equal groups, one with unexplained FTT (group A), and children with normal weight (group B). Baseline characteristics were obtained by a research-made questionnaire. Blood samples were taken by the hospital nurses who were blind to the study groups. Blood lead level was measured by atomic absorption spectrophotometric method (Perkin Elmer 3030). ResultsThe mean ± standard deviation (SD) of blood lead level in FTT group and control group were 7.3±3.32 µg/dL and 6.37±5.93 µg/dL, respectively. Blood lead level was significantly higher in FTT group than control group (P=0.001). Baseline Charactistics (such as hgender, parental educational level, gestational age, and socio-economic status of the family) were not significantly different between the two groups (P>0.05).ConclusionThe results of our study revealed that blood lead level was higher in children with FTT. So Lead poisoning may be a potential cause of unexplained FTT. So, measuring blood lead level can be useful in diagnostic workup of patients with FTT

Interactions of Colorectal Cancer, Dietary Fats, and Polymorphisms of Arachidonate Lipoxygenase and Cyclooxygenase Genes: A Literature Review

ObjectiveGenetics and dietary factors play important roles in the development of colorectal cancer (CRC). However, the underlying mechanisms of the interactions between CRC, gene polymorphisms, and dietary fat are unclear. This review study investigated the effects of polymorphisms of arachidonate lipoxygenase (ALOX) and cyclooxygenase (COX) genes in the association between CRC and dietary fat.MethodsAll the related papers published from 2000 to 2022 were collected from different databases such as PubMed, Science Direct, Scopus, and Cochran using related keywords such as colorectal cancer, ALOX, COX, polymorphism, and dietary fat. Non-English and unrelated documents were excluded.ResultsSome single-nucleotide polymorphisms (SNPs) in the ALOX and COX genes, such as rs2228065, rs6413416, and rs4986832 in the ALOX gene, and rs689465 in the COX gene may play significant roles in the association between the risk of CRC and dietary fats. SNPs of ALOX and COX genes may influence the effects of dietary fatty acids on the risk of CRC.ConclusionSome polymorphisms of the ALOX and COX genes may have important roles in the effects of dietary fat on the risk of CRC. If future studies confirm these results, dietary recommendations for preventing colorectal cancer may be personalized based on the genotype of the ALOX and COX genes