فهرست مطالب
International Journal of Medical Toxicology and Forensic Medicine
Volume:11 Issue: 3, Summer 2021
- تاریخ انتشار: 1400/07/14
- تعداد عناوین: 15
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Page 1Background
Lead poisoning was on the rise in recent years. There exists a lack of easy access to some of the main chelator drugs in developing countries. Thus, this study aimed to explore the comparative effects of Succimer and D-Penicillamine on acute lead poisoning patients from 2013 to 2018.
MethodsThis descriptive study was conducted in the Clinical Toxicology Department of Khorshid Hospital in Isfahan City, Iran. Adult patients with acute lead poisoning were included in the study. Patients in the 3 treatment groups of D-Penicillamine, D-Penicillamine with succimer, and succimer were compared concerning demographic characteristics as well as clinical and laboratory findings at admission time and two weeks later.
ResultsIn total, 163 patients were evaluated in this research. There was no significant difference between the treatment groups respecting improvement in clinical symptoms. The mean blood lead levels during hospitalization and two weeks after the treatment did not significantly differ between the three groups; however, there was a significant reduction in all study groups after two weeks of treatment (P<0.05). The mean white blood cell count was significantly lower only in the D-Penicillamine group two weeks after hospitalization (P<0.05). In the D-Penicillamine group, the mean platelet, hematocrit, and hemoglobin levels were significantly lower two weeks after hospitalization, although within the healthy range.
ConclusionD-Penicillamine may be an acceptable chelator drug for treating patients with acute lead poisoning, especially in communities without access to drugs, like succimer.
Keywords: D-Penicillamine, Succimer, Poisoning, Lead, Treatment -
Page 2Background
Patients with acute poisoning sometimes require hospitalization in the Intensive Care Unit (ICU). The correct admission of these patients has resulted to lower mortality. This study compared the characteristics of adult patients with acute poisoning who were admitted to the poisoning ward and the ICU. We also determined the relevant outcome predictive factors.
MethodsThis cross-sectional study was conducted on adult acutely poisoned patients who were admitted to the emergency room of Khorshid Hospital affiliated with Isfahan University of Medical Sciences from October 2018 to 2019. The clinico-epidemiological variables and outcomes were compared between adult patients hospitalized in the ward (n=100) and ICU (n=100). Binary logistic regression was used for predicting the outcome factors.
ResultsThe Mean±SE age of the study patients in the ICU and ward were 36.6±1.62 (median: 34) and 34.20±1.19 years, (median: 33, P=0.23), respectively. There was no significant difference between the study groups respecting substance dependence, alcohol and drug abuse, disease history, and the type of exposure (P>0.05). However, self-mutilation, the kind of substance, the vital signs and level of consciousness at admission, and outcomes were significantly different between the research groups (P<0.05). Variables predicting outcomes (complication/death) were as follows: gender (male) (OR: 4.51; 95%CI: 1.51-13.42; P=0.007), the kind of substance (pesticides) (OR: 8.84; 95%CI: 1.78-44.07; P=0.008), time to admission (OR: 1.04; 95%CI: 1.02-1.08; P=0.002), hypotension (OR: 14.88; 95%CI: 3.01-71.58; P=0.001), and the place of hospitalization (ward) (OR: 2.85; 95%CI: 1.23-6.62; P=0.01).
ConclusionThe self-mutilation, kind of substance, vital signs, level of consciousness at admission, and outcomes were significantly different between the study patients hospitalized in the ICU, compared to the ward. Gender (male), the kind of substance (pesticides), delayed arrival times, hypotension, and the place of hospitalization (ward) were essential factors for outcome (complication/death) prediction.
Keywords: Poisoning, Intensive care unit, Outcomes, Pesticides -
Page 3Background
Methanol poisoning is a serious problem in public health, especially in developing countries. The present study aimed to evaluate the incidence of visual disturbances in patients with acute methanol poisoning in the south of Iran.
MethodsThis cross-sectional study (from 21/March/2014 to 21/March/2019) was conducted on all adult patients’ medical records who were referred to Ali-Asghar Hospital in Shiraz City, Iran, with acute methanol poisoning. The required data were collected using a data-gathering form and were then analyzed.
ResultsTwenty male patients were enrolled in this research, with Mean±SD age of 33.15±10.40 years. Visual disturbances were observed in 15(75%) of the study subjects, as the most common clinical manifestations. Blurred vision (40%) and blindness (35%) were the most frequent visual disturbances in the study participants. None of the study subjects reported photophobia. The explored variables did not differ between patients with visual disturbances and those without visual disturbances. Only one patient who encountered blindness was expired.
ConclusionThe incidence of visual disturbances in the study patients with acute methanol poisoning was higher than that of similar studies
Keywords: Methanol, Poisoning, Epidemiology, Toxicity, Iran -
Page 4Background
Hypovitaminosis D, low bone mineral density, non-specific musculoskeletal pain, increased risk of fracture, and periodontal disease were reported in most subjects recruited from the Methadone Maintenance Treatment (MMT) program. This study aimed to determine the relationship between vitamin D levels and the severity of anxiety and depression in patients under MMT.
MethodsIn a cross-sectional study, serum vitamin D levels were measured among 500 patients under MMT from Kashan Province, Iran. Correlation tests were used to assess the association of vitamin D levels with the severity of anxiety and depression in the explored patients.
ResultsWe found that serum vitamin D levels were positively correlated with the scores of the Beck Depression Inventory (BDI) (r=0.107, P=0.017) and the Beck Anxiety Inventory (BAI) (r=0.129, P=0.004). Additionally, there was a negative correlation between serum vitamin D levels, MMT dosage (r=-0.011, P=0.8), and the duration of MMT (r=-0.017, P=0.7).
ConclusionOur findings demonstrated that serum vitamin D levels were independently correlated with the BDI and BAI scores. Further studies are required to confirm our findings.
Keywords: Vitamin D, Anxiety, Depression, Methadone -
Page 5Background
Poisoning is a common condition worldwide that requires precise evaluation of the quality and rapid management. Registry plays an essential role in the management of toxins. This study aimed to examine the features and processes of poisoning registries.
MethodsThis review study was conducted in 2020. Several searches were conducted in the following scientific databases: PubMed, Scopus, Embase, and Web of Science using a combination of keywords, such as “data management, registry, poison, and toxic”. The review of titles, abstracts, and full-text of the selected articles was independently performed by two researchers. Besides, the obtained data were analyzed based on the research objectives by the content analysis method.
ResultsSome critical features of registries were considered the confidentiality of patients’ information, i.e., equipped with various technologies, such as Geographical Information System (GIS), warning systems, searches, and text retrieval tools. The most common sources of case findings were self-reported contacts by individuals and healthcare professionals to poison control centers. Moreover, the main tool for data collection was electronic forms. The major indices of data quality were the accuracy, completeness, and consistency of the data. Phone calls were usually made at follow-ups.
ConclusionThe registry’s features and processes are an essential and fundamental step to achieve the registry goals, as well as designing and developing these systems. It is recommended that the registries be equipped with various technologies to better manage the exposure cases. It is recommended to use educational, incentive, competitive, participatory, and motivational mechanisms among all organizations and individuals involved in poisoning registry programs.
Keywords: Registry, Data management, Poisons, Information management -
Page 6Background
According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran.
MethodsIn this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation.
ResultsSome of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for >24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level.
ConclusionTramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults.
Keywords: Poisoning, Tramadol, Hospitals, Mortality -
Page 7Background
Vaccination is a fundamental strategy in public health for controlling and eradicating infectious diseases. However, the undesirable Adverse Events Following Immunization (AEFI) should be effectively monitored, prevented, and managed in societies. Previously, Sudden Infant Death (SID) has been reported as a serious AEFI. We present a rare case of SID in an 18-month-old girl due to severe myocarditis following vaccination.
Case PresentationAn 18-month-old girl presented to the Emergency Department (ED) with a history of the injection of Diphtheria-Tetanus-Whole Cell Pertussis (DTwP); Measles, Mumps, and Rubella (MMR), and oral poliovirus vaccines. She expired one-hour post ED admission after the episodes of vomiting and cardiopulmonary arrest. Postmortem histopathological examination signified marked congestion and the destruction of muscle fibers in the myocardium with inflammatory cells infiltration predominantly eosinophils. Given the postmortem histopathological findings, the cause of death was concluded as severe myocarditis following vaccination. Finally, the causality assessment was performed according to the Naranjo scale; the relevant data revealed a probable association in this regard (Naranjo score 6).
ConclusionMyocarditis is a rare and probable AEFI; thus, cardiac monitoring should be recommended as a diagnostic measure in managing postvaccinal adverse effects.
Keywords: Vaccine, Death, Myocarditis, Histopathology, Case report -
Page 8Background
Fear, anxiety, and stress are natural reactions of the human body to unpredictable and potentially threatening conditions. Currently, individuals are encountering Coronavirus Disease 2019 (COVID-19) pandemic; it is caused by a virulent, partially unknown pathogen with high transmissibility, recognized as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is conceivable to experience anxiety, stress, and subsequent mental health disorders during the pandemic. This narrative review provided a brief overview of mechanisms involved in COVID-19 and mental health disorders as well as the bidirectional association between them.
MethodsScientific electronic databases, such as PubMed, Scopus, Web of Science, and Google Scholar were thoroughly searched, based on different keywords in this study.
ResultsLifestyle changes and isolation for breaking the chain of infection facilitate mental health disorders development more than before. Since the onset of the pandemic, the prevalence of mental health disorders has significantly increased. Moreover, studies suggested that the incidence of COVID-19 and the progression of the disease to a severe and life-threatening stage is higher in individuals with a history of mental health disorders. Inflammation is caused by, also may cause mental health disorders. Besides, COVID-19 is associated with cytokine storm and subsequent inflammation.
ConclusionThere seems to be a bidirectional association between COVID-19 and mental health disorders, in which inflammation acts as an adaptor.
Keywords: Coronavirus Disease 2019 (COVID-19), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV- 2), Mental disorders, Cytokine release syndrome, Inflammation -
Page 10Background
Cancer is among the leading causes of mortality in India. Studies have reported antineoplastic agents as the common class of drugs causing Adverse Drug Reactions (ADRs). The present study aimed to conduct active surveillance of ADRs of anticancer drugs in the hematology department.
MethodsA prospective observational study was conducted in 136 patients with cancer and the incidence and frequency of ADRs were assessed. The study was conducted in 6 months in a multispecialty hospital.
ResultsAmong 136 cancer patients, All was more prevalent (39.70%); CLL, Non- Hodgkin’s Lymphoma were less prevalent (0.73%). ADRs were more prevalent in the Pediatrics department, i.e., 18.53% of ADRs were observed in patients aged <10 years. ADRs in male patients constituted 54.39%, whereas it was 45.60% in female patients. Cytarabine caused the highest number of ADRs (34.48%). The most prevalent ADR was anemia (25.60%).
ConclusionMultiple ADRs were detected in cancer patients. We found that hematological ADRs were more prevalent. Most of the ADRs were possible reactions according to Naranjo and the World Health Organization (WHO) scales
Keywords: Adverse drug reaction, Anticanceragents, Active surveillance, AcuteLeukemic Leukemia -
Page 11Background
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.
MethodsIn 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.
ResultsIn 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.
ConclusionBased 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.
Keywords: Hand sanitizer, Poisoning, Children -
Page 12Background
Paraquat is an extremely toxic herbicide that causes such severe adverse effects as acute lung injury, pulmonary fibrosis, metabolic acidosis, cardiogenic shock, acute renal failure, and even death. Regarding the high prevalence and mortality rate without a specific antidote in paraquat poisoning, we explored managing acute paraquat poisoning.
MethodsIn this study, required articles were searched using the following keywords: “paraquat poisoning” and “treatment” on an electronic database, such as Pubmed and Google Scholar from January 2013 to December 2020.
ResultsThis article examined pharmacokinetic, clinical, and laboratory findings, complications, diagnosis, prognostic factors, and the treatment of paraquat poisoning. Then, the medical management and therapeutic procedures of paraquat poisoning were discussed.
ConclusionAlthough there exists no antidote for paraquat poisoning, numerous therapeutic methods have been suggested for treating paraquat poisoning. However, their efficacy remains undiscovered.An interesting finding in one study indicating that endotracheal intubation is an inappropriate procedure for managing paraquat poisoning; further studies are required in this regard. For these reasons, preventing poisoning and using other herbicides with less toxicity than paraquat are recommended.
Keywords: Herbicides, Paraquat, Poisoning, Therapeutics -
Page 14Background
The term phytobezoar refers to a trapped mass in the gastrointestinal tract caused by the agglomeration of indigestible ingested plant materials, including fibers, skins, and seeds. A persimmon phytobezoar is formed after the frequent consumption of persimmons. The clinical manifestations of persimmon phytobezoars are similar to other phytobezoars and depend on the localization and size of the trapped mass.
Case PresentationHere, we presented a 57-year-old male with persimmon phytobezoars, which finally led to small bowel obstruction. The patient was referred to the emergency room with complaints of severe abdominal pain and frequent vomiting.The patient underwent laparotomy surgery that led to the removal of a portion of his ileum.
ConclusionOverindulgence in taking persimmon can lead to formation of phytobezoar and subsequent obstruction of small intestinal. Persimmon phytobezoars are difficult to break up into pieces because of containing tannins, cellulose, hemicellulose, and lignin.
Keywords: Bezoar, Persimmon, Persimmon phytobezoar, Small bowel obstruction, Surgery -
Page 16Background
Alcohol intoxication is among the leading and preventable causes of death, disability, and injury in numerous societies. Ethanol and methanol are the most commonly used types of alcohol. Increasing nurses’ awareness about the difference between intoxication with these two alcohol types will prevent the occurrence of dangerous and deadly complications of intoxication. We investigated the awareness of the nurses respecting the difference between acute methanol and ethanol intoxication in clinical manifestations, diagnosis, and treatment.
MethodsA cross-sectional study was performed in 2020 on the emergency nurses from two educational hospitals. A total of 100 nurses participated in this study. The data collection tool was a researcher-made questionnaire, including demographic characteristics and questions concerning the identification and differentiation of acute methanol from ethanol intoxication. Moreover, the obtained data were analyzed using SPSS v. 20 at the significance level of P<0.05.
ResultsThe present research results suggested that 21% of the examined nurses had a low level of awareness (<7) and 79% had a moderate level of awareness (8-13). The mean score of awareness was measured as 8.71 (range: 2-12). Nurses’ awareness was not related to age, gender, the duration of working experience, and educational level (P>0.05).
ConclusionThe awareness of nurses regarding alcohol poisoning is moderate. Due to the importance of differentiating ethanol from methanol toxicity, considering the outcomes of the patients, nurses’ awareness should be increased.
Keywords: Alcohol intoxication, Emergency service, Hospitals, Methanol, Ethanol