Sulfur mustard exposure and non-ischemic central retinal vein occlusion

A 41-year-old man was referred with a complaint of visual loss in his left eye and his best corrected visual acuity was 20/80. Slit lamp examination showed arborizing conjunctival vessels and dry eye. Fundus examination and fluorescein angiography revealed a non-ischemic central retinal vein occlusion. Cardiovascular, rheumatologic, and hematologic work up showed no abnormal findings. An ascertained history of exposure to sulfur mustard during the Iran-Iraq war was documented in his medical history. Four sessions of intravitreal bevacizumab injections were done as needed. After two-year follow-up, visual acuity in his left eye improved to 20/25 and macular edema was resolved without any need for further interventions. We conclude that sulfur mustard gas exposure may be considered as a predisposing factor for central retinal vein occlusion, as was found in our patient [an Iranian war veteran] by excluding all yet known etiologies and predisposing factors

Comparison of Dietary Macro and Micro Nutrient Intake between Iranian Patients with Long-term Complications of Sulphur Mustard Poisoning and Healthy Subjects

Background: Patients with long-term complications of sulfur mustard (SM) poisoning are often less able to undertake optimum levels of physical activity and adequately control their dietary intake. The aim of present study was to investigate the dietary intake of patients with SM poisoning in comparison to a control group. Methods: The study was undertaken on 55 Iranian male veterans, who had > 25% disabilities due to long-term complications of SM poisoning and 55 men age-matched healthy subjects. A previously validated food frequency questionnaire (FFQ) was used for measuring dietary macro/micro nutrient intake for both groups; and the results were analysed using Dietplan6 software. Results: Analysis of macro/micro nutrients in dietary intakes of the patients versus the controls showed a significantly lower intake of several nutrients including selenium and carbohydrate. On the other hand, the dietary intake of trans-fatty acids and iodine were significantly higher in these patients. Conclusion: Long-term complications of SM poisoning in the Iranian veterans induce both chemical and physical disabilities. Macro/micro nutrient intake in these patients was significantly different in comparison with matched, healthy subjects. Dietary advice for these patients should be strongly recommended to these patients in order to prevent other chronic diseases.

Clinical, toxicological, biochemical, and hematologic parameters in lead exposed workers of a car battery industry

Background: Lead is a toxic element which causes acute, subacute or chronic poisoning through environmental and occupational exposure. The aim of this study was to investigate clinical and laboratory abnormalities of chronic lead poisoning among workers of a car battery industry

Methods: Questionnaires and forms were designed and used to record demographic data, past medical histories and clinical manifestations of lead poisoning. Blood samples were taken to determine biochemical [using Auto Analyzer; Model BT3000] and hematologic [using Cell Counter Sysmex; Model KX21N] parameters. An atomic absorption spectrometer [Perkin-Elmer, Model 3030, USA] was used to determine lead concentration in blood and urine by heated graphite atomization technique

Results: A total of 112 men mean age 28.78 +/- 5.17 years, who worked in a car battery industry were recruited in the present study. The most common signs/symptoms of lead poisoning included increased excitability 41.9%, arthralgia 41.0%, fatigue 40.1%, dental grey discoloration 44.6%, lead line 24.1%, increased deep tendon reflexes [DTR] 22.3%, and decreased DTR [18.7%]. Blood lead concentration [BLC] was 398.95 micro g/ L +/- 177.40, which was significantly correlated with duration of work [P=0.044] but not with the clinical manifestations of lead poisoning. However, BLC was significantly correlated with urine lead concentration [83.67 micro g/L +/- 49.78; r[2]=0.711; P<0.001], mean corpuscular hemoglobin [r=-0.280; P=0.011], mean corpuscular hemoglobin concentration [r=-0.304; P=0.006] and fasting blood sugar or FBS [r=-0.258; P=0.010]

Conclusion: Neuropsychiatric and skeletal findings were common manifestations of chronic occupational lead poisoning. BLC was significantly correlated with duration of work, urine lead concentration, two hemoglobin indices and FBS

Recent advances in the treatment of organophosphorous poisonings

Organophosphorous compounds have been employed as pesticides and chemical warfare nerve agents. Toxicity of organophosphorous compounds is a result of excessive cholinergic stimulation through inhibition of acetyl cholinesterase. Clinical manifestations include cholinergic syndromes, central nervous system and cardiovascular disorders. Organophosphorous pesticide poisonings are common in developing worlds including Iran and Sri Lanka. Nerve agents were used during the Iraq-Iran war in 1983-1988 and in a terrorist attack in Japan in 1994-1995. Following decontamination, depending on the severity of intoxication the administration of atropine to counteract muscarinic over-stimulation, and an oxime to reactivate acetyl cholinesterase are indicated. Supportive and intensive care therapy including diazepam to control convulsions and mechanical respiration may be required. Recent investigations have revealed that intravenous infusion of sodium bicarbonate to produce mild to moderate alkalinization is effective. Gacyclidine; an antiglutamatergic compound, was also proved to be beneficial in conjunction with atropine, pralidoxime, and diazepam in nerve agent poisoning. Intravenous magnesium sulfate decreased hospitalization duration and improved outcomes in patients with organophosphorous poisoning. Bio-scavengers including fresh frozen plasma or albumin have recently been suggested as a useful therapy through clearing of free organophosphates. Hemofiltration and antioxidants are also suggested for organophosphorous poisoning. Recombinant bacterial phosphotriesterases and hydrolases that are able to transfer organophosphorous-degrading enzymes are very promising in delayed treatment of organophosphorous poisoning. Recently, encapsulation of drugs or enzymes in nanocarriers has also been proposed. Given the signs and symptoms of organophosphorous poisoning, health professionals should remain updated about the recent advances in treatment of organophosphorous poisoning poisonings

Comparison of maternal and umbilical cord blood selenium levels in term and preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Selenium is an essential trace element and has a main role in cellular antioxidant defense system. In very preterm babies, low selenium is associated with an increased risk of complications such as chronic neonatal lung disease and retinopathy of prematurity. This study was designed to determine and compare maternal and umbilical cord blood selenium levels in term and preterm infants.</p><p><b>METHODS</b>From February 2008 to April 2008, 30 term (gestational age>37 weeks) and 30 preterm infants (gestational age<34 weeks) and their mothers were enrolled. Selenium concentrations in umbilical cord and maternal venous blood were measured by atomic absorption spectrometry.</p><p><b>RESULTS</b>The mean selenium concentration in term infants was higher than in preterm infants (124.80+/-13.72 microg/L vs 100.30+/-11.72 microg/L, P=0.0001). The mean selenium concentration in mothers of term and preterm infants was not significantly different (117.03+/-17.15 microg/L vs 110.56+/-17.49 microg/L, P=0.15). Cord selenium concentrations were strongly correlated with gestational age and birth weight (r=0.66, p<0.0001 and r=0.59, p<0.0001, respectively) when the data of all infants were analyzed together. None of the 60 women had a serum selenium level below the laboratory lower limit of normal (70.0 microg/L). Maternal selenium levels were correlated with cord selenium levels in their infants (r=0.40, p<0.001) when data of all newborn infants and mothers were considered together.</p><p><b>CONCLUSIONS</b>Mothers have a relatively good selenium status and serum selenium is not a significant predictor of preterm delivery in Isfahan. The cord selenium concentration in term infants is significantly higher than in preterm infants, but the cord selenium concentrations in both groups are in a suggested normal range.</p>

Narcotic drug abuse and other risk factors in 100 operated patients for acute cholecystitis in Birjand, Iran

To study narcotic drug abuse, particularly opiate addiction, and other risk factors in patients with acute cholecystitis. In this prospective cross sectional study, variables such as age, gender, weight, narcotics drug abuse, hormone taking, number of pregnancies, and coexistent diseases were recorded in pre-designed forms for 100 consecutive patients who underwent operation for acute cholecystitis between October 2001 and June 2005 in Imam Reza Hospital, Birjand, Iran. Relevant statistical tests were applied, using SPSS version 13.0. From the studied patients 62 females, 38 males with a mean +/- SD of 60.8 +/- 15.9 years, 66 were underweight, 23 were overweight, and only 11 patients had normal weight. Most of the patients 76 had calculous cholecystitis, of which 50 65.8% were female, and 26 34.2%, were male. Seven females 11%, and 14 males 37% revealed jaundice p<0.002. Most 72% had a history of narcotics abuse, of which 69 95.8% abused opiates constantly, and 3 4.2% abused recreationally. A significant p<0.01 relationship was found between acute cholecystitis and opiate addiction. Opiate addiction was more common in patients from rural areas than urban p<0.03. Seventeen female patients 27.4% had a history of taking oral contraceptives. The patients were mostly from low socio-economic populations, and rural areas. The study revealed that narcotic opiate addiction is a major risk factor for occurrence of acute cholecystitis in this area

Comparison of blood lead levels of mothers and cord blood in intrauterine growth retarded neonates and normal term neonates

To compare the blood lead levels of mothers and cord blood in intrauterine growth retarded [IUGR] neonates and normal term neonates. From April to December 2005, we carried out a cross-sectional, prospective study in Isfahan University of Medical Sciences, Isfahan, Iran. Blood lead levels were measured in the umbilical cord and maternal venous blood samples in 32 mother-infant pairs with IUGR full term neonates, and 34 mother-infant pairs with normal full term neonates. Blood-lead levels were analyzed by atomic absorption spectrometry. The mean lead concentration in neonates of IUGR and normal groups was not significantly different [107.47 +/- 16.75 versus 113.08 +/- 19.08 micrometer/L, p=0.2]. The mean lead concentration in mothers of IUGR group was lower than normal groups, but this difference was not significant [124.56 +/- 19.71 versus 135.26 +/- 26.91 micrometer/L, p=0.07]. Maternal lead levels were strongly related with cord blood in both IUGR and normal groups [r=0.8, p<0.0001]. Maternal and cord blood lead levels was not correlated with birth weight of newborns in either group. Overall, 65.6% of IUGR neonates and 76.4% of normal neonates was above the critical level defined for lead poisoning as>100 micrometer/L by the centers for disease control; however, this was not statistically different between the groups. Our results indicate that the mean lead level was not higher in IUGR neonates, and the whole blood lead was not related to the birth weight. In addition, maternal and cord blood lead levels were strongly correlated, and there were remarkable lead burdens on both the mothers and their neonates in this industrial area

Recent advances in treatment of acute organophosphorous nerve agents poisoning

Organophosphorous [OP] chemical warfare nerve agents mainly sarin and tabun were used during the Iran-Iraq war with high mortalities. In addition to atropine and oximes, the followings have recently been used successfully for the treatment of OP poisoning. 1. Sodium Bicarbonate: Infusion of high doses of sodium bicarbonate [5 mEq/kg in 60 min. followed by 5-6 mEq/kg/day to obtain arterial blood pH of 7.45 to 7.55] revealed positive effects in patients with acute OP poisoning in Mashhad. 2. Magnesium Sulfate: Intravenous magnesium sulfate in a dose of 4 g only on the first day after admission was also effective in acute human OP poisoning. 3. Antioxidants: The toxicity of OP compounds is mediated by generation of nitric oxide and other free radicals. These toxic molecules can be counteracted by antioxidants such as vitamins C and E, spin traps, melatonin and low molecule weight thiols. The latter compounds can also increase the synthesis of glutathione, which can both ameliorate the OP-induced oxidative stress and enhance OP detoxification. It is concluded Sodium bicarbonate, Magnesium sulfate and the antioxidants should be added to the standard treatment of OP poisonings