فهرست مطالب
Iranian Journal of Toxicology
Volume:7 Issue: 4, Winter 2014
- تاریخ انتشار: 1392/09/17
- تعداد عناوین: 8
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Pages 932-939BackgroundTo date، studies on methadone overdose in adults have not been reported in Iran. Hence، this study was performed to determine the frequency of methadone overdose and its associated complications in Baharloo Hospital of Tehran between August 2011 and August 2012.MethodsThis cross-sectional study was done on 390 cases. All patients with methadone overdoses and positive urine screen test for methadone were included in this case study through census method. Demographic data and overdose complications، such as loss of consciousness، respiratory complications، arrhythmia، hemodynamic disturbances، and QTC interval، were recorded in the questionnaire. Data were analyzed by SPSS software and Kolmogorov Smirnov، t-test، and Chi-square tests were used for data analysis. ResultsOverall، 84. 1% of the samples were male and the mean age of the samples was 35. 53±11. 25 years (range: 15-84 years). Mean of the methadone dose used in current admissions was 96. 13±52. 34 mg. Concomitant drug abuse and concomitant uses of medications were seen in 25. 9% and 36. 9% of the patients، respectively. Respiratory depression، pulmonary edema، pneumonia، aspiration، and arrhythmia were seen in 87. 9%، 26. 2%، 3. 3%، 7. 4%، and 15. 4% of the patients، respectively. There were significant differences between concomitant medications، duration of methadone use، and QTc interval prolongation and arrhythmia (P<0. 05).ConclusionBased on the findings of the present study، initial screening of ECG changes and QT interval prolongation as well as arrhythmias should be considered in patients on methadone therapy and concurrent drug abuse and co-administration of medications that lead to QT prolongation should be avoided in them. Keywords: Arrhythmia, Complications, Methadone, Overdose, Qtc Interval
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Pages 940-943BackgroundIron is an essential mineral for normal cellular physiology but its overload can lead to cell injury. For many years, deferoxamine injection has been used as an iron chelator for treatment of iron overload. The aim of this study is to compare oral deferoxamine, activated charcoal, and vitamin C, as an absorbent factor of Fe, in changing the serum level of iron in iron overload rats.MethodsIn this experimental study, all groups were administered 150 mg iron dextran orally by gavage. After eight hours, rats in the first group received oral deferoxamine while those in the second and third groups received oral activated charcoal 1 mg/kg and oral vitamin C 150 mg, respectively. Then, serum levels of iron ware measured in all rats.ResultsThe mean serum level of iron in rats that received oral deferoxamine was 258.11±10.49 µg/dl, whereas mean levels of iron in charcoal and vitamin C groups were 380.88±11.21 µg/dl and 401.22±13.28 µg/dl, respectively. None of the measurements were within safety limits of serum iron.ConclusionIt seems that oral deferoxamine per se may not help physicians in the management of cases presented with iron toxicity. Activated charcoal did not reduce serum iron significantly in this study and further investigations may be warranted to assess the potential clinical utility of its mixture with oral deferoxamine as an adjunct in the clinical management of iron ingestions. Keywords: Ascorbic Acid, Charcoal, Deferoxamine, Iron, Poisoning, Rats
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Pages 944-951BackgroundAcetaminophen (APAP) overdose causes renal and hepatic injury. It is also believed that oxidative stress has a pivotal role in APAP-induced renal injury. Therefore, protective effects of different antioxidants have been examined in APAP-induced renal and hepatic toxicity models. Stevia rebadiana is a plant with a high degree of natural antioxidant activity in its leaf extract. The aim of this study was to investigate the possible protective effects of rebadioside A; one of the main components of stevia extract, on APAP-induced oxidative stress in kidney of mice.MethodsOxidative stress was induced in kidney of BALB/c mice by the intraperitoneal (i.p.) administration of a single dose of 300 mg/kg APAP. Some of these mice also received rebadioside A (700 mg/kg) (i.p.) 30 minutes after APAP injection. Two and six hours after APAP injection, all mice were sacrificed and malondialdehyde (MDA), glutathione (GSH), free APAP, and glutathione conjugated of APAP (APAP-GSH) were determined in the kidney tissue.ResultsGSH depletion and MDA levels significantly (P<0.05) increased in mice treated with either APAP or APAP plus Rebadioside A, respectively in 2 and 6 hours intervals after APAP administration. Significantly (P<0.05) higher levels of free APAP and APAP-GSH levels detected in kidney of mice administrated with APAP plus rebadioside A compared to APAP treated ones.ConclusionRebadioside A may be a potential compound in alleviation of APAP-induced oxidative stress in kidney of mice after APAP overdoses. Keywords: Acetaminophen, Oxidative Stress, Rebadioside A
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Pages 952-955BackgroundThe aim of this study was to evaluate and compare the clinical and electrocardiographic (ECG) manifestations of benzodiazepines (BZs).MethodsIn this retrospective study, all BZ-poisoned patients hospitalized at Loghman Hakim Hospital between September 2010 and March 2011 were evaluated. Patients’ information including age, sex, time elapsed between the ingestion and presentation, and type of the BZ used were extracted from the patients'' charts and recorded. ECGs on presentation to the emergency department (ED) were evaluated and parameters such as PR interval, QRS duration, corrected QT, amplitude of S wave in lead I, height of R wave and R/S ratio in the lead aVR were also measured and recorded.ResultsOxazepam, chlordiazepoxide, lorazepam, alprazolam, diazepam, and clonazepam were ingested by 9 (3%), 13 (4.4%), 29 (9.9%), 105 (35.8%), 65 (22.2%), and 72 (24.6%) patients, respectively. Mean PR interval was reported to be 0.16 ± 0.03 sec and PR interval of greater than 200 msec was detected in 12 (4.5%) patients. Mean QRS duration was 0.07 ± 0.01sec and QRS≥120 msec was observed in 7 (2.6%) cases.ConclusionDiazepam is the only BZ that does not cause QRS widening and oxazepam is the only one not causing PR prolongation. It can be concluded that if a patient refers with a decreased level of consciousness and accompanying signs of BZ toxicity, QRS widening in ECG rules out diazepam, whereas PR prolongation rules out oxazepam toxicity.Keywords: Benzodiazepines, Electrocardiogram, Manifestations, Poisoning
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Pages 956-961BackgroundPersian Gulf is a semi-closed environment which is affected by pollution from heavy metals. Entrance of heavy metals to the water column and binding to sediment particles can affect the benthic organisms that can accumulate these materials in their body. Noticing this ability, mussels are considered as bio-monitoring agents.MethodsThe pearl oyster, Pinctada radiate, and sediment samples were collected from Lengeh Port and Qeshm Island. For measuring heavy metals, 0.5g of soft tissue and 1g of shell and sediment were digested by HNO3 (69%) and hot block digester. The prepared samples were evaluated for Cd, Cu, and Zn using a flame AAS Model 67OG while for Pb a graphite furnace AAS was used.ResultsHigher metal accumulations were observed in soft tissues. Positive correlations between Cd, Pb, Zn, and Cu concentrations in sediments and soft tissues of oyster were observed. The use of soft tissue of P. radiata as an indicator showed the highest accumulations of Cd (9.76±0.59) and Zn (3142.60±477.10) in Lengeh Port, but there were no significant differences in Cu and Pb concentrations between the two stations.ConclusionThe higher concentrations of heavy metals in P. radiata’ soft tissue in comparison to shell suggested this material as a better heavy metals indicator than shell. Also, the correlation between heavy metals concentration in soft tissue and sediment improve this idea that soft tissue of Pinctada radiata can be considered as a biomonitoring agent for toxic metals pollutions. Hence, using this bioindicator showed Lengeh Port as more polluted station than Qeshm Island.Keywords: Bioindicator, Heavy Metals, Persian Gulf, Pinctada Radiata, Shell, Soft ?Tissue
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Pages 962-966BackgroundMethicillin resistant Staphylococus Aureus (MRSA) is a cause of nosocomial infections at intensive care unit (ICU), which imposes a high mortality and morbidity on the health care systems. The objective of this study was to evaluate the role of MRSA in patients with clinically suspected ventilator associated pneumonia (VAP) in toxicological ICU admitted patients.MethodsThis cross-sectional study was performed over a period of six months from August 2009 to February 2010. A total of 84 patients with clinically suspected VAP were selected from all 381 ICU admitted patients under mechanical ventilation for more than 48 hours. MRSA Screen Agar was used to detect resistance in Staph aureus specimens. MRSA was determined as the main outcome.ResultsMRSA was the cause in 54% of Staph aureus infected VAPs. Although MRSA infection was not significantly associated with age, gender, cause of poisoning, chronic disease, paraclinical findings, length of hospital stay, and antibiotic prescription (P>0.05 for all comparisons), it was reported higher in those who expired than those who survived (66.7% vs. 31.9%, P<0.012).ConclusionIn the main referral toxicological ICU in Tehran, in more than 1 of 3 clinically suspected VAP cases, MRSA was seen which was associated with the poorer outcome, higher inpatient mortality.Keywords: Intensive Care Unit, Methicillin Resistance, Pneumonia, Staphylococus ?Aureus, Ventilator
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Pages 967-972BackgroundThe science of identification and employment of medicinal plants dates back to the early days of man on earth. Cannabis (hashish) is the most common illegal substance used in the United States and was subjected to extensive research as a powerful local disinfecting agent for mouth cavity and skin and an anti-tubercular agent in 1950.MethodsClinical strains were isolated from hospitalized patients in Vali-e-Asr Hospital of Arak. The hydro-alcoholic extract of cannabis (5 g) was prepared following liquid-liquid method and drying in 45˚C. The antimicrobial properties of the extract were determined through disk diffusion and determination of MIC (Minimum Inhibitory Concentration).ResultsFirst, the sensitivity of bacteria was detected based on disk diffusion method and the zone of inhibition was obtained for MRSA (12 mm), S.aureus 25923 (14 mm), E. coli ESBL+: (10 mm), and Klebsiella pneumoniae (7 mm). Disk diffusion for Pseudomonas and Acinetobacter demonstrated no inhibitory zones. Through Broth dilution method, MIC of cannabis extract on the bacteria was determined: E.coli 25922: 50µg/ml, E.coli ESBL+:100 µg/ml, S.aureus 25923:25 µg/ml, MRSA: 50 µg/ml, Pseudomona aeroginosaESBL+> 100 µg/ml, Pseudomonas: 100 µg/ml, Klebsiella pneumoniae: 100 µg/ml, and Acinetobacter baumannii> 1000.ConclusionThe maximum anti-microbial effect of the hydro-alcoholic extract of cannabis was seen for gram positive cocci, especially S. aureus, whereas non-fermentative gram negatives presented resistance to the extract. This extract had intermediate effect on Enterobacteriacae family. Cannabis components extracted through chemical analysis can perhaps be effective in treatment of nosocomial infections.Keywords: Antibiotic resistance, Cannabis, Nosocomial Infections
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Pages 973-976BackgroundThis toxicological investigation involves a report on the death of four occupants of a sport utility vehicle on one of the major busy Federal roads of Nigeria where they were held for up to three hours in a traffic jam while the car was steaming.MethodsAutopsy was executed using the standard procedure and toxicological analysis was done using simple spectrophotometric method to establish the level of carboxyhaemoglobin (HbCO) in peripheral blood in the four occupants.ResultsThe autopsy report indicated generalized cyanosis, sub-conjuctival hemorrhages, marked laryngo-trachea edema with severe hyperemia with frothy fluid discharges characteristic of carbon monoxide poisoning. Toxicological report of the level of HbCO in part per million (ppm) in the peripheral blood of the four occupants was A= 650 ppm; B= 500 ppm; C= 480 ppm, and D= 495 ppm against the maximum permissible level of 50 ppm.ConclusionThe sudden death of the four occupants was due to excessive inhalation of the carbon monoxide gas from the exhaust fumes leaking into the cabin of the car. The poor road network, numerous potholes, and traffic jam in most of roads in Nigeria could have exacerbated a leaky exhaust of the smoky second hand SUV car leading to the acute carbon monoxide poisoning. Keywords: Acute Poisoning, Autopsy, Carbon Monoxide, Toxicological Studies