Discrimination between drug abuse and medical therapy - case report of a tranylcypromine overdose-related fatality

Tranylcypromine is an effective antidepressant from the class of monoamine oxidase inhibitors and is structurally related to amphetamine. However, reports differ regarding the potential metabolism of tranylcypromine to amphetamine and methamphetamine within the human body. We report a 25-year-old woman with severe depression who died due to a fatal tranylcypromine overdose in 2016. She had been prescribed tranylcypromine one day previously and had no history of previous suicide attempts or substance abuse. The body was transferred to a forensic medicine department in Tehran, Iran for the autopsy. A urine sample was positive for tranylcypromine, amphetamine and methamphetamine using gas chromatography/mass spectrometry after derivatisation with heptafluorobutyric acid. As amphetamines were present in the urine sample, it was assumed that the tranylcypromine had been converted to amphetamines metabolically. As such, it is possible that the legitimate use of certain prescription drugs may complicate the interpretation of test results for illegal drugs

[ changes of some antioxidant enzymes activity after six-week of glycogen depletion training with glucose and glutamine supplementation in healthy nonactive males]

Background and Objectives: the aim of the present study was to investigate the effect of glucose and glutamine supplementation on two erythrocyte antioxidants enzymes, glutathione peroxidase and glutathione reductase activity in nonactive men during six-week glycogen depletion training

Materials and Methods: for this purpose, 24 non-athlete healthy men were selected and randomly divided into four groups including: glucose supplementation with glycogen depletion training group [n=6], glutamine supplementation with glycogen depletion training group [n=6], placebo with glycogen depletion training group [n=6] and a control group [n=6] without any treatment. The blood samples were collected from anticubital venous at the onset of training protocol period and 48 hours after final training session. For determining significant between groups One-way ANOVA, compeleted with Tukey post-hoc test. The significant level was chosen as [proportional to]

Results: the results showed there was significant increases in glutathione peroxidase enzyme activity of erythrocyte [p<0.05]. Post-hoc test showed the significant difference between glucose- traine with placebo-traine and control groups [p<0.001], glutamine-traine with placebo-traine and control groups [p<0.01] and placebo-traine group with control group [p<0.001]. Also, there was significant increases in glutathione reductase enzyme activity of erythrocyte [p<0.001]. Post-hoc test showed the significant difference between, glutamine-traine with placebo-traine group [p<0.05] and glutamine-traine with control group [p<0.001] and glucose- traine with control group [p<0.001]

Conclusion: in summary, the results suggested that glucose and glutamine supplementation cause adaptation erythrocyte glutathione peroxidase and glutathione reductase enzymes activity in glycogen depletion training condition. Therefore, ingestion glucose or glutamine supplementation cause decrease harmful effects free radicals and increase in anti-oxidatives enzymes, during longterm activities

Epidermoid/Dermoid cysts mimicking odontogenic infections: review of literature

Introduction: Dermoid/Epidermoid cysts are rare pathologic lesions that may involve the floor of the mouth. Infection and inflammation of the cyst can produce a clinical picture very similar to the submandibular and submental abscesses with odontogenic origin. Dermoid/epidermoid cysts are on the floor of the mouth with submental or submandibular component can be mistaken for odontogenic infections

Methods: Four biopsy proven dermoid/epidermoid cysts operated in the Mashhad University of Medical Sciences, Ghaem hospital [2012-2013], were reviewed

Results: Four patients, including two classic cases and two infected dermoid/epidermoid cysts, were erroneously diagnosed as odontogenic infection

Discussion: The lesions located solely below mylohyoid muscle need to be removed through anextraoral approach but the lesions above the mylohyoid muscle or those that have both supra- and infra-mylohyoid components can be removed through an intraoral incision

Conclusion: Dermoid/epidermoid cysts should be considered in the differential diagnosis of submental/submandibular swellings. In the absence of an odontogenic cause of infection, fine-needle aspiration biopsy and appropriate imaging evaluation techniques with sonography, CT or MRI are mandatory for correct diagnosis and surgical treatment planning. The clinicians should be very cautious to differentiate odontogenic infections from infected dermoid/epidermoid cysts

[Post treatment thyroid dysfunction and obesity in children with acute lymphoblastic leukemia and non-hodgkin's lymphoma: a brief report]

In most children with Acute Lymphoblastic Leukemia [ALL] and Non Hodgkin's Lymphoma [NHL] who have received chemotherapy with and without radiotherapy, some late effects due to treatment may occur such as endocrinopathies. We evaluated growth criteria [including short stature, obesity] and thyroid test function in 50 children with ALL [n=25] and NHL [n=25] 3-17 year-old in remission period who randomly received chemotherapy with [n=25] or without [n=25] radiation such as our treatment groups. The values for height, weight and BMI in less than 5[th] or more than 95[th] percentile considers abnormal. Six [12%] patients were in less than 5[th] percentile height [short stature]. Two patients [4.0%] had over-weight and 48 [96%] were in normal range of BMI. Six [12%] patients were in less than 5[th] and 3 [6%] were in more than 95[th] weight percentile. There was no significant difference between two different treatment groups for TSH [P=0.662] but there was a significant difference between these groups in case of T4 [P=0.049]. Mean and SD for T4 in patients with chemotherapy alone was less than in whom received chemotherapy plus radiotherapy. There was no significant difference between ALL and NHL groups for TSH, T4 [P=0.567, 0.528 respectively]. Two boys with ALL without history of radiation had hypothyroidism that had based on their laboratory data. Regarding to effects of thyroid dysfunction on short stature and obesity in adolescent with ALL and NHL, we suggest to have more attention about growth, thyroid test to avoid late side effect of malignancy treatment

Association of cytogenetics and immunophenotype in prognosis of children with acute lymphoblastic leukemia: literature review

Acute lymphoblastic leukemia [ALL] is the most common type of neoplastic disorder diagnosed in childhood. It is the cause of one third of all pediatric malignancies. ALL is characterized by the abnormal production and proliferation of immature lymphoblasts in bone marrow [BM]. It seems that ALL occurs due to a genetic mutation in DNA structure producing white blood cell [WBC] stem cells. Because ALL is a systemic disease, its primary management is based on chemotherapy. There are important risk factors responsible for the poor prognosis of ALL in children less than 1 year old and greater than 10 years old, such as: high WBC, mature T cell ,mature B cell, central nervous system [CNS] involvement, DNA index < 1 [hypodiploid], triploidy, tetraploidy, Mixed-Lineage Leukemia [MLL] gene re-arrangement on 11q23, the Philadelphia chromosome t[9;22], reduction in platelet count, hemoglobin>10 at diagnosis, no remission at the end of induction therapy and Minimal residual disease at the end of consolidation therapy. Complications might appear during the treatment including tumor lysis syndrome, bleeding, renal failure, sepsis, seizure, thrombosis, etc. Some consequences might identify after a long-term follow-up such as learning impairment, growth retardation, and secondary malignancies. It is estimated that up to 90% of pediatric ALL cases are curable

Comparison of dexamethasone and Anti-D Immune globulin for immune thrombocytopenia purpura in children

Different therapeutic options in children with immune thrombocytopenic purpura include observation alone, periodic treatment with corticosteroids, intravenous immunoglobulin [IVIG] or anti-D, chronic administration of immunosuppressive agents, and splenectomy. Preference of the type of therapy depends on the degree of thrombocytopenia and clinical bleeding manifestations. Dexamethasone is safe but its side effects are the main disadvantages for its usage. Anti-D is more expensive than dexamethason but the side effect is rare and not dangerous and response to treatment is assessed in approximately 3 days after infusion

Unusual presentation of a patient with hemoglobin constant spring and immune hemolytic anemia

Hemoglobin Constant Spring [Hb CS], an abnormal Hb characterized by elongated alpha -globin chain resulting from mutations of the termination codon in the alpha 2 - globin gene, is the most common nondelitional alpha -thalassemic mutation and is an important cause of HbH like disease in Southeast Asia. Case Report: A 9- years-old female with immune hemolytic anemia and splenomegally and abnormal hemoglobin in Hb electrophoresis is reported. The first presentation of our patient was weakness and dark urine. She had a hemolytic anemia with normal MCV and positive direct coombs. In Hb electrophoresis, she had abnormal hemoglobin near the A2 region and slow moving component. PCR testing showed homozygous mutation in codon 142. Hb CS-containing RBCs have membrane pathology and these pathology lead to destruction of her RBCs in reticuloendotelial system and she had a RBC sick syndrome resemble thalassemia intermedia. Our study showed that the five-day massage therapy is a safe technique mothers can perform for stable preterm infants to facilitate weight gain in neonate