Does organophosphate poisoning cause cardiac injury?

Organophosphates are insecticides which are widely used as a suicidal agent in Iran. They are associated with different types of cardiac complications including cardiac arrest and arrhythmia, however their role in cardiac injury is not known yet. The aim of this study was to investigate the presence of myocardial damage in patients with cholinesterase poisoning. It was a prospective study conducted from January 2008 to March 2010. Cohorts of patients with cholinesterase poisoning due to suicidal attempt who have been referred to Loghman hospital were selected. Patients who have taken more than one poison or were used concomitant drugs were excluded. Physical examination was performed on admission to discover warning sign. Peripheral arterial blood gases, creatine kinase, creatine kinase-myocardial band, troponin-T measurements were performed in all cases. There were 24 patients, 7 of them women, with the mean age of 41.2 +/- 15.05 who were included in this study. Non-survivors had significantly higher levels of systolic blood pressure, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide, bicarbonate Glasgow Coma Scale scoring and longer duration of mechanical ventilation. Our findings showed that cardiac injury is an important cause of death in organophosphate poisoning. It could be hypothesized that cardiac injury is a strong predictor of death in patients with organophosphate poisoning

Mercury exposure of gold mining workers in the northwest of Iran

Mercury exposure is a health concern in the occupational settings like gold mining and chloralkali industries and blood and urine levels of mercury are used as exposure indicators. In this study, blood and urine concentrations of mercury were determined using hydride generation atomic absorption spectrophotometery [HGAAS] in sixteen gold miners with neuropsychiatric symptoms. The patients treated with two chelating agents, dimercaprol and D-penicillamine. The mean serum mercury levels before and after chelation therapy were 208.14 Micro g/L[-1] and 10.50 Micro g/L[-1], respectively. The mean urinary mercury levels before and after chelation therapy were 134.70 Micro g/L[-1] and 17.23 Micro g/L[-1], respectively. The results of this study showed that there are significant differences between concentration of blood and urine mercury before and after intervention [p<0.005]. There were no significant differences between in the biochemistry parameters of patients before and after treatment. This study indicated that the gold miners in the northwest of Iran had been exposed to high levels of mercury vapors [Hg[0]]

novel protocol for gastric lavage in patients with aluminum phosphide poisoning: a double-blind study

Aluminum phosphide poisoning [ALPP] still has no efficient and approved antidote. Supportive care and hemodynamic monitoring are the only choices of treatment. We proposed a new lavage formulation in addition to evaluation of its efficacy and defining the impact of clinical characteristics of patients on their prognosis. During eight months period of time, 120 patients were enrolled to the study and randomly received two different gastric lavage protocols. Our new lavage protocol had positive impact on patients' survival and the P-value in comparison with the classic gastric lavage method was close to significant level [P=0.054]. On hospital arrival indication for intubation-ventilation as well as sense of thirst, sore throat and absence of nausea indicate worse outcome. Using our novel approach, indication for intubation-ventilation as well as sense of thirst, sore throat and absence of nausea can be considered as applicable prognostic factors in survival of ALPP patients. Further studies are required to set this approach as preferred treatment.

Suicide epidemiology and characteristics among young iranians at poison ward, Loghman-Hakim Hospital [1997-2007]

Suicide is a critical public health problem. In developing countries, the highest suicide rate is found in young adults with remarkable increasing rate. In this study, we have evaluated the epidemiology and characteristics of 8-16-year-old individuals who attempted suicide and were hospitalized in Loghman-Hakim Hospital, Tehran, Iran from 1997 to 2007. A total of 6414 hospitalized patients, ages 8-16, who attempted suicide and were residents of Loghman-Hakim Hospital were investigated. We performed a retrospective chart review to study the characteristics of cases in a 10-year period by review of psychiatric and medical records. Out of 6414 patients 22.6% were male, 5978 patients were 12-16 years old and the rest were aged 8-12 years. During the 10-year period, suicides showed a rising trend among adults, while in children no significant increase was detected. Communicative disorders were the most common underlying risk factors, particularly in females. One patient out of five cases had psychiatric disorders, of which adjustment disorders were the most predominant. A remarkable peak in suicides was observed in May and July, while winter had the highest suicide rate among seasons. Suicide due to drug overdose is higher in females than males in young population. This increasing trend is a psychiatric concern and should be resolved by improving mental and public health

fatal case of Metformin intoxication

Metformin is an oral antidiabetic drug in the biguanide class. It is the first-line drug of choice for the treatment of type 2 diabetes. The most common symptoms following overdose appear to include vomiting, diarrhea, abdominal pain, tachycardia, drowsiness, and, rarely, hypoglycemia. The major potentially life-threatening complication of Metformin overdose is metabolic acidosis. We report a case of fatal Metformin toxicity following an acute intentional Metformin intoxication. Our patient 21-year-old girl who was asymptomatic when she came to Emergency department developed severe metabolic acidosis, cardiovascular compromise, hypoglycemia, and death following an acute intentional Metformin intoxication. Dysrhythmia developed later due to refractory metabolic acidosis. Severe metformin overdose could be lethal despite the patient being asymptomatic at the time of arrival. Thus the patient with severe metformin toxicity could be asymptomatic for a few hours and in the lack of any symptoms or signs of overdose he or she must be treated with early intensive sodium bicarbonate [alkalization] and hemodialysis

Incidence of hepatitis B and HIV virus at cadaver of IV drug abusers in Tehran

Injection drug use has been the most growing route of drug abuse in Iran in the past decade and it has been responsible for the transmission of HIV virus in more than two third of cases. The aim of the present study was to determine the prevalence of HIV and hepatitis B in a group of IDU cadavers and to compare the results to a group of cadavers of the normal population. In a case-control study the blood samples of the cadavers of 400 randomly chosen IDUS and 400 other cadavers as control group were checked for HBS antigen and Anti HIV antibody in the forensic medicine center of Tehran. The prevalence of HIV and HBV infection was compared in two groups according to their demographic characteristics. The number of HIV and HBV positive cadavers was significantly higher in the IDU group than the controls [6.25% vs 0.5%, P<0.001, 27.5% vs 3%, P<0.001]. The risk of getting infected by HIV virus was 13.27 times greater in the IDU group and the risk of HBV infection was 12.26 times greater in this group as compared to the control group. The age distribution of IDU cadavers indicated that the percentage of IDU cadavers in the reproductive [21-40 years old] age was 80%. The greater prevalence of the HIV and HBV infection especially in the reproductive age of IDUS indicates a greater concern to the authorities for more attention to prevention and harm reduction programs

[Assessment the role of effective variables in repeated suicidal attempts]

Repeated suicidal attempts are common in patients with drug and chemical poisoning. This study was conducted at poisoning referral hospitals in Tehran to determine the role of different factors in repeated suicide attempts with drug and chemical agents. In this case-control study, 19 subjects with a history of previous suicidal attempts, [cases] and 54 individuals without this history, [controls] were selected from patients admitted with drug poisoning in the poisoning referral hospitals in Tehran, from August to October 2009. We matched the two groups regarding age, gender and level of consciousness. Demographics, poisoning characteristics, past medical history and substance use history of the patients were recorded. SPSS version 16, variable bit SD indicators, qualitative variables and frequency tables for the comparison between the two groups Chi-square test were used for statistical analysis. History of mental illness, [100%, 0.01> P], mean of number of tablets ingested [N=40], interval between drug consumption and emergency forces to reach the place [4 +/- 2.1 h], history of deliberate self poisoning [100%, P =0.001], failed resuscitation efforts in comatose patients, [51%, P =0.02] and the need for intensive care and follow-up,[37%, P=0.013] were higher in patients with a history of previous suicide attempts compared with the control group. Also, previous history of attempted suicide with drugs was associated with decreased level of consciousness, [P =0.04]. Patients with drug poisoning and a history of previous attempted suicide are at high risk for morbidity and mortality, needing special management strategies