جستجوی مقالات مرتبط با کلیدواژه « Intoxication » در نشریات گروه « پزشکی »

This study evaluates the role of oral melatonin in improving vision in methanol toxicity since vision disorders are one of the side effects related to methanol toxicity and assumes the potential effects of melatonin in protecting neurons and optic nerves. Meanwhile, little attention has been paid by researchers to the effect of melatonin in these patients.

A double-blind randomized controlled clinical trial study was conducted on 40 patients diagnosed with methanol toxicity who were referred to Khorshid Hospital of Isfahan City, Iran, from May 2022 to May 2023. These patients were randomly divided into two groups. In the first group (the intervention group), in addition to the usual treatment, the patients were prescribed orally 3 mg of melatonin every morning and 6 mg of melatonin every night for 10 days. In the second group (the control group), in addition to the usual treatment, a placebo was administered similar to the intervention group protocol. Then, the clinical and vision parameters of the patients were evaluated before, during, and after the intervention.

The mean pH, PCO2 and HCO3 increased significantly after the intervention compared to the pre-intervention in both groups (P<0.05); however, no significant difference was found between the two groups in any of the two follow-up times (P>0.05). The most common visual complication caused by methadone toxicity was blurred vision with 71.4% and 90% in the melatonin and non-melatonin groups, respectively. Visual complications improved significantly after the intervention compared to the pre-intervention; accordingly, the complete improvement of vision complications in the melatonin group (76.2%) was significantly more than the non-melatonin group (53.3%) (P=0.040).

Melatonin improves blurred or snowfield vision in methanol poisoning. Therefore, the administration of melatonin plus routine treatment can be effective in improving vision disorders (blurred or snowfield vision) caused by methanol poisoning.

There are only rare case reports that revealed the efavirenz (EFV) toxicity.

Case Report: 

This study presents an acute intoxication with 12 g of efavirenz in a 16-year-old healthy girl whose main problem was dose-dependent neurotoxicity. No other serious EFV-related side effects were seen. Previous serious side effects of EFV were observed in HIV-infected patients who underwent long-term combination drug therapy. 

Accordingly, in terms of the key clinical messages, serious adverse effects of efavirenz are expected to be observed in long-term use in combination with other antiretroviral drugs.

Today, methanol intoxication is increasing. Identifying mortality predictors has a significant correlation with poisoning progress. This meta-analysis study aimed to identify and evaluate mortality predictors for methanol poisoning.

In this study, we searched electronic databases for case-control and cohort studies related to methanol poisoning. The quality of the studies was evaluated using the STROBE checklist. Comprehensive meta-analysis 3 was used to calculate the odds ratio (OR) and 95% CI of the factors present, as well as to perform heterogeneity, sensitivity, and publication bias assessments.

In this meta-analysis study, 14 out of 945 initial studies were included. The results identified 15 mortality predictors of methanol poisoning. The risk factors were ranked by the integrated OR values and included venous blood pH (OR=3.79, 95% CI, 2.42%, 5.19%), methanol concentration (OR=1.64, 95% CI, 1.05%, 2.55%), venous carbon dioxide pressure (PCO2) (OR=9.993, 95% CI, 5.80%, 17.18%), base deficit (OR=2.943, 95% CI, 1.20%, 7.165%), hemodialysis time (OR=2.69, 95% CI, 1.35%, 5.35%), blood sugar (OR=9.84, 95% CI=3.86, 25.09), venous bicarbonate (HCO3) (OR=2.97, 95% CI, 1.68%, 5.26%), creatinine (OR=13.10, 95% CI, 2.68%, 64.04%), potassium (K) (OR=3.51, 95% CI, 1.66%, 7.43%), alanine aminotransferase (OR=7.57, 95% CI, 1.03%, 55.57%), sodium (OR=6.69, 95% CI, 1.78%, 25.12%), white blood cells (OR=7.16, 95% CI, 1.42%, 36.16%), coma (OR=32.73, 95% CI, 18.59%, 56.70%), visual disturbances (OR=3.37, 95% CI, 1.59%, 7.16%), and gastrointestinal symptoms (OR=1.94, 95% CI, 1.16%, 3.22%).

Identifying mortality predictors and disease progression in methanol intoxication patients can help doctors diagnose patients at risk better and faster to provide effective treatment interventions for them.

This study intended to investigate blood lead and serum total antioxidant capacity and oxidative stress marker levels of subjects in a lead-zinc mining community of Ebonyi State, Nigeria. Sixty-eight (68) occupationally-exposed (OE) and 62 environmentally-exposed (EE) to lead in Enyigba community and 70 non-inhabitants (controls), were recruited for this study. Blood samples were collected from them for blood lead (BL), malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX), assays using standard methods. Data were analyzed with the IBM SPSS software and means were compared using One Way ANOVA and t-test. Statistical differences was considered significant at p<0.05. Mean BL significantly rose in the OE and EE groups (p<0.0001 respectively) than the controls. TAC decreased significantly in the OE (p<0.01), but increased in EE (p<0.05) compared with the control groups, while SOD, CAT, and MDA decreased significantly in the OE (p<0.01 respectively) and EE (p<0.01 each) versus control group. Significant higher TAC and lower CAT were recorded in the EE compared with the OE (p<0.05) subjects. GPx significantly increased (p<0.05) in the OE compared with the control group. Only CAT correlated significantly with lead in the EE subjects. BL, MDA, and CAT differed significantly (<0.0001 respectively), and SOD (<0.05) varied with age. Children <10 years recorded the highest BL concentration (34.77±12.46) b young adults aged 21-30 the lowest, which was significantly lower than in the other age categories. The elevated MDA concentration and reduced antioxidant activities indicated some oxidative stress damage resulting from lead toxicity.

Bacillus cereus is widely distributed in different food products and causes a variety of symptoms associated with food poisoning. Rice has been suggested as a vehicle for contamination and being involved in B. cereus intoxication. Based on the aforementioned risks, studies of Bacillus cereus incidence along with its isolation and characterization are essential to establishing the safety of cooked rice. Using the selective culture technique, pure isolates of Bacillus cereus strains were characterized and identified based on cultural, and biochemical features. Characterization was done on the ability of the bacterial strains to hydrolyse casein and starch, ferment lactose, and lyse red blood cells (haemolysis). Out of the 47 samples screened, 45 isolates were detected in 14 samples. Antibiotic susceptibility testing revealed that all isolates showed resistance to Ampicillin (10 μg), but were susceptible to Erythromycin (15 μg), Vancomycin (30 μg), Tetracycline (30 μg), Ampicillin (10 μg), Gentamicin (10 μg), and Chloramphenicol (30 μg). 62.2%, 64.4%, 0% and 46.7% were capable of producing amylase, protease, ferment lactose and lyse red blood cells respectively. This study shows that 14 samples out of 47 samples of cooked rice in this work have the possible risk of foodborne infections/ intoxication that occurs as a result of the possibility of the development of B. cereus in favourable conditions and consumption of these products. Basically, prevention is by proper handling of raw materials, controlling the temperature of cooking and storing rice, and personal hygiene of food handlers.

paraquat is a cheap and easy access herbicide which its intoxication is limited in Iran. The current study aims to provide some epidemiologic data within paraquat poisoning from the most crowded referral center of clinical toxicology in Iran.

We investigated the paraquat poisoning patients who were admitted to Loghman-Hakim Hospital in Tehran, Iran from 2008 to 2016.

A total of 12 patients participated in this study, 50% of these patients were between 10-20 years old, 41.7% were between 26-40 years old, and 8.3% were above 55 years old. About 83.3% were male, and 16.7% were female. Treatments which were given in the hospital include cyclophosphamide (58.3%), cortisol (75%), vitamin C (50%), vitamin E (83.3%), N-acetyl cysteine (83.3%).  66.6 percent of hospitalized patients required invasive measures to preserve their airways, with 3.33 percent undergoing tracheostomy and the same percentage undergoing intubation. There were five fatalities among the patients, three of which were related to pulmonary and renal failure.

This study indicates that the majority are younger than 40 years and males. Prevention and limited access to this substance is necessary in terms of the lack of antidote.

The epidemiology of pediatric poisoning differs from one country to another. Due to the scarcity of reviews on this issue in Iran, we performed a systematic review and meta-analysis of studies providing data on Iranian pediatric poisoning epidemiology.

PubMed, Web of Sciences, Science direct, Embase, Scopus and the Persian databases Magiran, Scientific Information Database (SID), and Iranmedex were searched. Twenty-seven studies published between 2002 and 2019 were included, based on the inclusion and exclusion criteria.

54.7% of the participants in the reviewed studies were male, and 88.1% of them were unintentional. Most of the children were in the age range of 3-5 years. Non-pharmaceutical agents were the most common causes of poisonings (n=7175, 59.2%) and among them, illicit drugs (19.3%) followed by hydrocarbons (16.4%) constituted the most common non-pharmaceutical poisonings. Illicit drugs, especially opioids, showed an upward trend from 2002 to 2019. Among pharmaceuticals, central nervous system (CNS) drugs (50.4%), especially benzodiazepines (BZDs) (25.8%) and analgesics (14.5%), were the most frequent agents implicated. CNS complaints (51.8%), followed by gastrointestinal complaints (27.6%), were the most common symptoms. Ingestion was the most common route of poisoning (22.1%). Most of the poisoning cases occurred in summer (28.2%). 21.7% of the cases were hospitalized and the mortality rate was 0.8%. A remarkable downward trend in both hospitalization and death rates occurred over time.

Overall, non-pharmaceutical toxicity was found to be the most common cause of poisoning. However, considering the agents separately, pharmaceuticals, illicit drugs, and hydrocarbons were the most common causes of poisoning, respectively. In contrast to the decreasing trend in hydrocarbons, pesticides, and pharmaceutical poisonings, we found an increase in opioid poisoning during our study period.

The overdose of selective serotonin reuptake inhibitor rarely causes death or serious sequelae. While it may be mildlysymptomatic or asymptomatic at doses up to 30 times the daily therapeutic dose, higher doses may cause drowsiness, tremor,gastrointestinal distress, and serotonin syndrome. Serotonin syndrome is a life-threatening condition associated with increasedserotonergic activity in the central nervous system. We presented a case who used fluoxetine with the diagnosis of unipolar depressionand developed serotonin syndrome as a result of overdose for suicide.

 A 14-year-old female patient, who was followed up by psychiatry for unipolar depression, ingested 30 tablet fluoxetinefor a suicide attempt. Afterwards, serotonin syndrome was observed. As a result of cyproheptadine treatment for signs that developedduring the patient's follow-up in the pediatric emergency department, the symptoms started to regress at the 24th hour.

In the literature, no similar case study has pointed to a developed serotonin syndrome after suicide with fluoxetine inchildren. The present study discusses a case in which a side effect resulting in serotonin syndrome occurred after a suicide attemptwith fluoxetine.

Although it is stated that fluoxetine overdose is benign, pediatric emergency physicians should be aware that serotoninsyndrome may develop in suicidal, high-dose fluoxetine intakes.

Acetone or propanone is a volatile liquid that can be absorbed by ingestion, inhalation, and dermal routes, and is distributed throughout the body. 

This study presented a case of an employee of the Emergency Medical Center of North Khorasan Province, Iran, who died due to acetone poisoning. He was last seen alive approximately 4 hours before his body was found. Thus, the deceased was found 4 hours after death. He was a 25-year-old unmarried male nurse. He had a history of smoking for the last 4 years and reported diarrhea and nausea on the day before death. There was no history of diabetes or alcoholism as well as no other definite causes. According to interviews with his colleagues and family, he had no history of depression. A postmortem examination was performed to define the cause of death. Postmortem quantitative toxicological analysis with Gas Chromatography with Flame-Ionization Detection (GC-FID) presented acetone in the vitreous (35 mg/dL), blood (28 mg/dL), and urine (77 mg/dL) samples. Furthermore, in postmortem pathological analysis, highly microvascular changes and the diffuse necrosis of hepatocytes were reported. Other pathological changes in the brain and lungs were observed. No other definite medical cause of death was found. The cause of death was determined to be acute acetone intoxication. 

Contrary to public opinion, acetone is a toxic and dangerous substance; thus, it is necessary to improve and implement public safeguards concerning acetone usage, as well as its handling, and disposal. Organ toxicity due to acetone can be a major cause of death. Other alcohol-related poisoning deaths, such as acetone and other metabolites, should be considered.

Organophosphate (OP) insecticides are important compounds as the most probable common cause of acute poisonings in developing countries. OP intoxication often presents as medical emergencies, and its related morbidity and mortality have not decreased despite major advances in critical care. This study aims to determine the impact of serum amylase level for estimation of prognosis in patients with acute OP poisoning.

This observational case-control study was done during two years on 332 consecutive patients with acute OP poisoning.Clinical and demographic data, serum amylase level on early admission time, morbidity, and outcome were determined. Data were analyzed in the form of a frequency distribution table by using SPSS 11.0 version software.

The mean age of patients with acute OP poisoning was 28.9 ± 23.95 with slightly female dominance. All patients were intoxicated via the gastrointestinal route. The mean amylase level of patients with deterioration of mental status, tachycardia, ICU admission, and death was significantly higher.

Among patients with OP poisoning, higher serum amylase than normal was associated with severe clinical course and increased risk for mortality. Determination of serum amylase can be effective in the quick prediction of the outcome

Paraquat has been recognized as a highly toxic agent for pest removal and is used worldwide.In adults, paraquat poisoning for suicidal attempts is much more common than accidental exposure poisoning. Approximately 20% of patients with paraquat poisoning develop pneumomediastonium as a complication with a mortality rate of approximately 100%. A 19‑year‑old man patient was admitted to the poisoning emergency department of Khorshid hospital, who had ingested paraquat. He had nausea and vomiting and had normal vital signs and examination in admission. Initial treatment for the patient was done. The patient signs got worsened on the 21st day of hospitalization and had severe emphysema of the superficial and deep spaces of the neck, followed by bilateral pneumothorax, and severe pneumomediastinum. Unfortunately, the patient died on the 27th day of hospitalization. Purpose of the current study is to raise awareness of rare paraquat toxicity complications, treatment, and especially its lethal complications, including pneumomomediastonium.

Poisoning is a major public health problem that constitutes a significant share of the global burden of disease. Previous studies conducted in this area indicated the importance of such epidemiological studies. The most critical impact of these studies is their effect on changing current regulations and, therefore, decreasing poisoning cases. We aimed to evaluate all poisoning cases with regard to the patients’ demographics and the involved intoxicants.

The present study was conducted to investigate all poisoning cases who were admitted during a three-year period. Causes of poisoning, hospitalization, management procedures and outcome of the cases were surveyed.  A total of 1448 patients referred to Shahid Beheshti Hospital (Babol, Iran) from 2015 to 2018.

More than half of the patients were females (51.7%), and the majority of poisoning cases were seen in patients aged between 15 to 25 years (34.2%). It was found that suicide made a large part of poisoning cases (65.6%), and females tend to attempt suicide more than males (64.3% vs. 35.7%, respectively). Also, regular drugs followed by club drugs were the most abundant toxic agents (52.1% and 23.3%, respectively). Aluminum phosphide (AlP) was the most lethal intoxicant in our study, accounting for 68.2% of all deaths.

According to the results, it is concluded that the existing regulations for drug control and suicide prevention have not been efficient enough and further actions yet to be made to reduce the consequences of drug- and non-drug-related toxicities.

Superwarfarin toxicity may be a serious problem. It needs high clinical suspicious in patients with bleeding diathesis without hematologic or liver diseases even in patients with apparent negative history of warfarin or other anticoagulant accessibility. Here we reported a patient with a negative history of any medical diseases or drug administration who was referred with generalized ecchymosis. Increased international normalized ratio and decreased vitamin K‑dependent coagulation factors were detected in this patient. His hematologic and liver evaluations were normal. Clinical pharmacist emphasis in taking history revealed using anticoagulant rodenticide all over the farm the patient lived in that might result in unaware intoxication in this patient who suffered dementia.

Calcium channel blockers (CCBs) are widely used for various indications such as hypertension, coronary artery disease, and certain cardiac arrhythmias. As they are frequently prescribed, overdoses are common. Our aim in this paper was to present a case of intoxication with amlodipine, captopril, and doxazosin where ILE treatment proved unsuccessful and to review literature for effectiveness of ILE therapy in amlodipine poisonings.

A 54-year-old female patient presented to the emergency department after taking 300 mg of amlodipine, 1000 mg of captopril, and 120 mg of doxazosin with suicidal intention. The patient was treated with gastric lavage, activated charcoal, calcium gluconate, hydration, vasopressor, inotrope, insulin and glucose, and intravenous lipid emulsion and transferred to intensive care unit at the 8th hour. Hemodynamics did not improve and the patient underwent plasmapheresis at the 10th hour. Patient was extubated and discharged without sequelae. Considering the pharmacokinetics of captopril and doxazosin, worsening of hemodynamics after 8 hours was related to amlodipine.

While verapamil and diltiazem poisonings were generally reported to be successfully treated with intravenous lipid emulsion, salvage treatment with intravenous lipid emulsion was reported to be unsuccessful in the literature for amlodipine intakes of 280 mg or more.

Methanol is a clear liquid with high toxicity. Methanol intoxication may result from accidental exposure, overconsumption of compounds containing methanol with suicidal intent, or following consumption of distilled and contaminated alcoholic beverages. This report describes a case of transdermal methanol intoxication, which is a rare condition. A 58-year-old woman presented with nausea, vomiting, weakness, diplopia and dizziness. On neurological examination, she only had diplopia. On physical examination, a hyperemic lesion with clear borders was found over the right knee. The patient’s recent medical history revealed that four days prior to the onset of symptoms, she had covered her knee with a methanol-soaked bandage in an attempt to alleviate her knee pain. She had a high osmolar gap as well as high anion-gap metabolic acidosis (HAGMA). Methanol intoxication was suspected due to HAGMA and high osmolar gap. Serum methanol levels were subsequently measured and found to be 37.9 mg/ dL. The patient was treated with intravenous (IV) bicarbonate, IV ethyl alcohol and hemodialysis. She was discharged with no central nervous system or ophthalmologic sequelae. Methanol poisoning should be kept in mind in patients with diplopia and unexplained metabolic acidosis. Although most methanol intoxication cases occur after oral ingestion, it should be considered that methanol poisoning may occur transdermally.