Neuropsychiatric manifestations due to anticholinergic agents and anabolic steroids ingestion: A case series and literature review.

Anticholinergic toxicity is a common occurrence in the emergency room, making it crucial for emergency clinicians to have a good understanding of this toxidrome. The neuropsychiatric effects of anticholinergic agents and anabolic steroids (ASs) can manifest as symptoms like anxiety, agitation, dysarthria, confusion, seizures, visual hallucinations, bizarre behavior, delirium, psychosis, and coma. When dealing with a conscious patient who has ingested an anticholinergic substance, a detailed history of ingestion can aid clinicians in making an accurate diagnosis. However, the lack of information about the substances consumed can complicate diagnosis. In cases where the exposure is unknown, clinicians should consider anticholinergic poisoning in patients showing signs of altered mental status and physical examination findings consistent with anticholinergic toxicity. We report four cases presenting a range of symptoms, including neuropsychiatric manifestations, following the ingestion of the same bodybuilding powders with anticholinergic properties. All four patients consumed yellow and white powders at the same time and in the same place. Laboratory analysis revealed that yellow powder and white powder contained ASs and cyproheptadine, respectively.

Adult nondysraphic cervicomedullary intramedullary lipoma: A case report and literature review.

Intra-dural perimedullary lipomas involving craniovertebral region are rare. There is no clear tumor-cord border and patients are at high risk of neurological deficits after surgery. Partial resection of the mass and neural decompression are the main surgical strategies in symptomatic patients.

The Relationship Between Hemodialysis and the Echocardiographic Findings in Patients with Chronic Kidney Disease.

BACKGROUND: The incidence of cardiac morbidity and mortality is high in patients treated with hemodialysis (HD). The aim of this study was to evaluate the relationship between HD and the echocardiographic findings in patients with chronic kidney disease (CKD). METHODS: Between 2012 and 2014, 150 patients with CKD. The echocardiographic data were done based on American Society of Cardiology (ASE). Measurement method for Ejection Fraction was E balling and for Diastolic Function was Tissue Doppler. Anemia, thyroid conditions and dialysis through an arteriovenous fistula or permanent catheter of dialysis for the patients are not considered. RESULTS: The mean age at diagnosis for the patients was 57.8 years, 52.7% were males. Out of 150 patients, 112 patients (74.7%) had diabetes and 117 patients (78%) had a history of hypertension. The prevalence of all echocardiographic findings was more after the first dialysis compared with before the first dialysis in diabetic patients (P<0.05), but in non-diabetic patients, was not for the tricuspid valve stenosis, impaired right ventricular volume, systolic dysfunction and pulmonary hypertension (P>0.05). CONCLUSIONS: According to the findings of this study, seems that more accurate selection of patients for dialysis, paying special attention to hemodynamic change during dialysis, patient education about diet and better control of uremia and diabetes is essential.

Application of hollow fiber liquid phase microextraction and dispersive liquid-liquid microextraction techniques in analytical toxicology.

The recent developments in hollow fiber liquid phase microextraction and dispersive liquid-liquid microextraction are reviewed. Applications of these newly emerging developments in extraction and preconcentration of a vast category of compounds including heavy metals, pesticides, pharmaceuticals and abused drugs in complex matrices (environmental and biological matrices) are reviewed and discussed. The new developments in these techniques including the use of solvents lighter than water, ionic liquids and supramolecular solvents are also considered. Applications of these new solvents reduce the use of toxic solvents and eliminate the centrifugation step, which reduces the extraction time.

Professionalism in residents of physical medicine and rehabilitation in Iran.

Professionalism is the foundation of trust on which the doctor-patient relationship is built. This study was performed to measure professionalism in Iranian physical medicine and rehabilitation residents as a baseline assessment tool for future studies. This was a descriptive study. The Persian version of the American Board of Internal Medicine (ABIM) questionnaire was distributed among all the second and third-year residents of the medical state universities of Iran (n=43). Data were summarized as mean (SD), and independent samples t-test was used for comparison of means between genders, and also between the second and third-year residents. Forty questionnaires were analyzed. The mean (± SD) age of respondents was 29.95 (± 2.37) years. The mean score (SD) for the overall score was 115.15 (± 17.36) out of 150, and the mean score (± SD) for all items was 7.67 (± 1.15) out of 10. The respondents averaged 5.88 (± 1.69) for items forming the 'excellence' factor, 7.98 (± 1.48) for items in 'altruism/respect' and 8.92 (± 1.26) for items in the 'honor/integrity' subscale. These data may serve as a baseline for future research in this field. The lowest score pertained to excellence, which needs more focus in future studies.

Hollow fibre-based liquid phase microextraction combined with high-performance liquid chromatography for the analysis of flavonoids in Echinophora platyloba DC. and Mentha piperita.

A simple, inexpensive and efficient three phase hollow fibre liquid phase microextraction (HF-LPME) technique combined with HPLC was used for the simultaneous determination of flavonoids in Echinophora platyloba DC. and Mentha piperita. Different factors affecting the HF-LPME procedure were investigated and optimised. The optimised extraction conditions were as follows: 1-octanol as an organic solvent, pHdonor=2, pHacceptor=9.75, stirring rate of 1000rpm, extraction time of 80min, without addition of salt. Under these conditions, the enrichment factors ranged between 146 and 311. The values of intra and inter-day relative standard deviations (RSD) were in the range of 3.18-6.00% and 7.25-11.00%, respectively. The limits of detection (LODs) ranged between 0.5 and 7.0ngmL(-1). Among the investigated flavonoids quercetin was found in E. platyloba DC. and luteolin was found in M. piperita. Concentration of quercetin and luteolin was 0.015 and 0.025mgg(-1) respectively.

Use of hollow fiber liquid phase microextraction and HPLC for extraction and determination of apigenin in human urine after consumption of Satureja sahendica Bornm.

The applicability of hollow fiber liquid phase microextraction (HF-LPME) was evaluated for extraction and preconcentration of apigenin prior to its determination by HPLC. Different parameters affecting the HF-LPME recovery such as nature of organic solvent, pH of donor and acceptor phases, extraction time, stirring speed, salt addition were optimized. Under optimum conditions (1-octanol as organic solvent, pH of the donor phase=3 and pH of acceptor phase=11.5, extraction time of 75 min, stirring speed of 1000 rpm) limit of detection (LOD) of 0.1 ng/mL, linear range of 0.5-300 ng/mL and correlation of determination (R(2)) of 0.9956 were obtained. The relative intra and inter-day standard deviations (RSD%) based on five replicate measurement were 3.5% and 10.7% respectively. Enrichment factor of 315 and recovery 85% were achieved. Finally, the applicability of the proposed method was evaluated by extraction and determination of apigenin in urine sample after consumption of Satureja sahendica Bornm. which is a native medicinal plant from Iran. Concentration of apigenin in urine sample was found to be 6.20 ng/mL.

Simultaneous optimization of the resolution and analysis time of flavonoids in reverse phase liquid chromatography using Derringer's desirability function.

The chemometrics approach was applied for simultaneous optimization of resolution and analysis time of seven flavonoids in reverse phase liquid chromatography. Derringer's desirability function, a multi-criteria decision making method, was used for the evaluation of two different chromatographic performance goals including resolution and analysis time. The selected flavonoids belong to different classes of flavonoids including: flavonols (myricetin, morin, quercetin and kaempferol) flavones (apigenin and luteolin) and flavanones (naringenin). The effect of five experimental factors on a chromatographic response function, formed using two sigmoidal desirability functions, was investigated. The sigmoidal functions were used to transform the optimization criteria, resolution and analysis time, into the desirability values. The factors studied were percentages of methanol, phosphoric acid and THF in mobile phase as well as flow rate and temperature. A rotatable, orthogonal central composite design was used to map the chromatographic response surface and then calculated chromatographic response functions were fitted to a polynomial model. The obtained regression model was characterized by both descriptive and predictive ability (R(2)=0.96). The model was verified, as good agreement was observed between the predicted and experimental values of the chromatographic response function in the optimal condition. The most effective factor on retention of flavonoids was percentage of methanol in mobile phase followed by temperature, flow rate, THF and H(3)PO(4) percentages. Optimum condition for separation of flavonoids was as follows: methanol:0.4% phosphoric acid in water:THF (45.3:54.4:0.3, v/v/v) as mobile phase with flow rate of 1 mL min(-1) at 30°C. The optimum condition was applied for separation of flavonoids of Satureja sahendica Bornm. which is an endemic medicinal plant of Iran.