فهرست مطالب

  • Volume:7 Issue:4, 2013
  • تاریخ انتشار: 1392/09/17
  • تعداد عناوین: 8
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  • Behnam Behnoush, Fakhredin Taghadosinejad, Babak Salahshour *, ? Vahid ? Yousefinejad Pages 932-939
    Background
    To 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. ‎
    Methods
    This 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. ‎
    Results
    Overall، 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). ‎
    Conclusion
    Based 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
  • Reza Ghafari, Jaber Gharehdaghi, Hassan? Solhi? * Pages 940-943
    Background
    Iron 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. ‎
    Methods
    In 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.‎
    Results
    The 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.‎
    Conclusion
    It 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
  • Seyed Ali Hashemi, Abdolamir ? Allameh *, Bahram Daraei, Kamran Moradi Peynevandi, Ramin Pashazadeh? Pages 944-951
    Background
    Acetaminophen (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. ‎
    Methods
    Oxidative 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.‎
    Results
    GSH 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.‎
    Conclusion
    Rebadioside 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
  • Nahid Kazemzadeh, Saeed Mohammadi *, Mohammadali Emamhadi, Abdollah Amirfarhangi, Hossein Sanaei, Zadeh Pages 952-955
    Background
    The aim of this study was to evaluate and compare the clinical and ‎electrocardiographic (ECG) manifestations of benzodiazepines (BZs).‎
    Methods
    In 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.‎
    Results
    Oxazepam, 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. ‎
    Conclusion
    Diazepam 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
  • Asma Mohammad Karami, Alireza Riyahi Bakhtiari *, Ali Kazemi, Kheirabadi Kheirabadi Pages 956-961
    Background
    Persian 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.‎
    Methods
    The 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.‎
    Results
    Higher 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.‎
    Conclusion
    The 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
  • Alireza Salimi, Sepideh ? Kamalbeik?, Arezou Mahdavinejad, ? Shahram? Sabeti, ? Haleh? Talaie * Pages 962-966
    Background
    Methicillin 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.
    Methods
    This 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.‎
    Results
    MRSA 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)‎.
    Conclusion
    In 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
  • Hossein Sarmadyan, Hassan Solhi, ? Tahereh Hajimir, Negin Najarian, Araghi, Ehsanollah Ghaznavi, Rad * Pages 967-972
    Background
    The 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.‎
    Methods
    Clinical 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).‎
    Results
    First, 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.‎
    Conclusion
    The 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
  • Martin Nnoli *, Nwidu Lucky Lebgbosi, ? Innocent Ijezie Chukwuonye, Collins Ogbonna Nwabuko Pages 973-976
    Background
    This 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.‎
    Methods
    Autopsy 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. ‎
    Results
    The 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.‎
    Conclusion
    The 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