Search

Butane, an aliphatic hydrocarbon with explosive and flammable properties, is widely misused especially by young people. Acting as an asphyxiant gas, butane mainly targets the central nervous and cardiovascular systems. We aimed to review butane-attributed toxicities due to its harmful use or misuse reported in a two-decade period. We searched English-language publications reporting butane toxicities from 2000 up to 2021 and collected data on age, gender, route and source of exposure, country of origin, clinical presentation and outcome. Among 54 butane's harmful use/misuse cases identified in the literature, there were 11 survivors successfully discharged from the hospital. Patients were predominantly males with a mean age ± SD of 23 ± 13 years. The main route of exposure was inhalation. Manifestations were mainly cardiac and neurological. Majority of the cases were reported from Europe and Japan. To conclude, butane exposure is at risk of severe central nervous system and cardiac toxicities, which may result in a fatal outcome. Therefore, in the event of a sudden or suspicious death in a young individual, our findings suggest that butane's harmful use/misuse should be considered as a potential differential diagnosis.

PURPOSE: Lead Poisoning is a major health problem in Iran. We aimed to compare efficacy of a standard regimen (Succimer) with that of a low-priced combination of D-penicillamine and Garlic in outpatients with lead poisoning. METHODS: In this retrospective cross-sectional study, year-long clinical files of outpatients with lead poisoning in two referral toxicology clinics in Mashhad, Iran were reviewed. A total of 79 patients (all men), received either Succimer or a combination of D-penicillamen plus garlic (DPN + Gar), for 19 and 30 days, respectively. Clinical and laboratory data, including blood lead level (BLL), were analyzed and treatment expanses were compared between the two regimens. RESULTS: Of 79 male patients, 42 were treated by DPN + Gar and 37 received Succimer. Mean BLL of DPN + Gar group before treatment (965.73 ± 62.54 µg/L) was higher than that of the Succimer group (827.59 ± 24.41) (p

Background : Peganum harmala is a medicinal plant used in Iran and other countries. Many therapeutic effects have been described for this plant; it is insect repellant, disinfectant, antimicrobial, sedative, analgesic, anti-inflammatory, emetic, and abortifacient. Roots and seeds are medicinally-active parts of the plant containing some β-carboline and quinazoline alkaloids, which are responsible for its pharmacological and toxicological effects. Poisoning with high doses of Peganum harmala can be life-threatening. Case Report : We reported a 31-year old woman with an unwanted pregnancy, who ingested 1 glass of Peganum harmala seeds to induce abortion. On admission, she had severe nausea and vomiting, mild abdominal pain, and stable vital signs. Physical examination was unremarkable, and the leukocytosis was the only abnormal laboratory finding. The patient underwent nasogastric tube insertion, gastric lavage, as well as the administration of activated charcoal. Although she left the hospital on self-consent, further follow-up revealed that she had a spontaneous abortion without any complications. Conclusion : Although most cases of Peganum harmala intoxication can be managed successfully, this poisoning led to abortion in our case. Physicians working in Iran and other regions, where Peganum harmala is used as traditional medicine, must be aware of its toxicity for the early diagnosis and management.

Background : Amphetamines constitute a group of central nervous system stimulators with an increasing frequency of usage and destructive outcomes on the metabolism, perfusion, and structure of the brain. This study aimed at evaluating the structural brain changes following amphetamines abuse, using Magnetic Resonance Imaging (MRI). Methods : This cross sectional study was conducted on the individuals, who were admitted to the toxicology Emergency Room (ER) with continuous amphetamines abuse for at least six months and a positive methamphetamine urine test. Positive Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for dependency and addiction to methamphetamine were also considered as the inclusion criteria. Following informed consent, the demographic information, and data on methamphetamine use were collected. An MRI was performed for all participants as soon as relative recovery. A matched control group also underwent MRI simultaneously. Results : Forty male (20 cases of methamphetamine addicts and 20 healthy individuals) with a mean±SD age of 28.1±5.11 years were investigated. The mean±SD age of starting methamphetamine abuse was 25.6±10 years. About (75%), (n=15) of the patients abused methamphetamine 6-9 months, while others had abused it for more than 10 months. All cases used to abuse methamphetamine at least once a week, with (85%) of them inhaling it. The results showed that the only change in the brain MRI of methamphetamine abusers was hyperintensities increase in deep and periventricular white matter (only positive MRI in 3 cases, P=0.231). Oral consumption and higher doses had induced greater changes in the brain structure. Conclusion : Methamphetamine dependency may increase deep and periventricular white matter hyperintensities.

Background: Along with the COVID-19 pandemic, a new problem has appeared in the healthcare facilities: toxicities and poisonings caused by medications and home remedies, by which people have been trying to protect themselves from acquiring the virus. The authors of this paper aim to notify the global scientific society of several substances and medications that either have led to poisonings thus far or have the potential for an outbreak. Methods: Medical English literature reporting cases of poisonings during this pandemic between January and December 2020. Substances and drugs that could be a potential concern to public health are also reviewed. Results: Alcohols and chemical substances have been the main causes of poisonings during this pandemic. Opioids, household products and herbal remedies were partly to blame. Global spread of incorrect information related to the COVID-19 prevention and treatment is a major risk to human lives, particularly in this difficult situation where healthcare systems are overwhelms with high rate of COVID-19 morbidity and mortality. Conclusion: As additional waves of the coronaviruses may hit countries in the upcoming winter, confinements may as well continue. Therefore, emergency physicians must be prepared for possible outbreaks of poisonings and be able to predict any unusual pattern of toxicities.

Metabolic syndrome is one of the rising global health problems and medical challenges due to several clinical complications it may cause, for example increasing the risk of myocardial infarction and hypertension. However, great attention has been directed toward determining the worthiness of herbal medicines. There are emerging studies on preventive and therapeutic effects of silymarin on different components of metabolic syndrome. Extracted from the dried seeds of milk thistle plant (Silybum marianum L.), silymarin has been used in the treatment of different diseases for many years. Several protective effects have been identified for this herb such as decreasing insulin resistance, regulating blood pressure and lipid profile, as well as antioxidant and cytoprotective effects. This review aims to discuss available human and experimental researches into the promising effects of silymarin on different elements of metabolic syndrome. All related human and experimental papers published from 2012 to date were included in this review. Reviewing different human and experimental studies into the effects of silymarin on metabolic syndrome, we deduced that silymarin possesses promising effects on different components of this syndrome. Although the complete mechanism of action and target organs for silymarin require further verification and investigation, high-risk individuals may benefit from supplementation with this herbal medicine. © 2018 Society of Chemical Industry.

International audience; Lead may contaminate opium, heroin and illicit opiates and is particularly observed in Iran. Lead, a natural heavy metal is able to interfere with several organ functions after ingestion or inhalation. Lead poisoning manifestations are non-specific and thus lead poisoning remains difficult to diagnose. Among the manifestations, abdominal pain is almost the most frequent symptom causing patients to seek medical care. In patients with a history of opium addiction presenting with moderate-to-severe abdominal pain, lack of diagnosis of lead toxicity may thus result in time-consuming and unnecessary medical work-ups that can end up in invasive surgery. This paper aims to briefly review abdominal pain as an emergency issue and the leading symptom of lead poisoning that brings most of the patients to healthcare facilities. All published adult cases and case series of opium addicts admitted with abdominal pain due to lead-adulterated opium consumption have been reviewed. A trend of increasing numbers of lead poisoning cases has recently emerged among opium addicts in Iran. Due to the non-specific manifestations and hazardous effects, psychiatrists and emergency physicians should consider lead poisoning in patients with a past or present history of opium addiction referred for acute abdominal pain, particularly in case of colicky abdominal pain.

Occupational exposure to elemental mercury vapor usually occurs through inhalation during its utilizations. This leads to a variety of adverse health effects. In some Islamic cities, this type of poisoning may occur during gilding of shrines using elemental mercury with gold. Herein, we report on three male patients aged 20–53 years, who were diagnosed with occupational metallic mercury poisoning due to gilding of a shrine. All patients presented with neuro-psychiatric disorders such as anxiety, loss of memory and concentration, and sleep disorders with high urinary mercury concentrations of 326–760 μg/L upon referring, 3–10 days after cessation of elemental mercury exposure. Following chelating therapy, the patients recovered clinically and their mercury concentrations declined to non-toxic level (

Background: Arrhythmia is the foremost cause of sudden death after myocardial infarction (MI). Animal models have recently shown that erythropoietin (EPO) can reduce the incidence of arrhythmia after MI. Methods: We investigated the effects of administrating 33,000 IU EPO on the occurrence of post-MI arrhythmia in 40 patients with ST-elevation MI who were randomly assigned in either EPO or placebo groups. Arrhythmias were blindly documented using full 12-lead configuration during 24 hours after percutaneous coronary intervention (PCI) by a cardiologist. Afterward, CK-MB, hematologic, and hemodynamic data were examined within 2 weeks after MI. Results: A comparison made between the 2 groups showed significant differences in the incidence of arrhythmias (20% in EPO group and 35% in placebo group, P = 0.043). However, no significant differences in type of arrhythmias were observed between the groups. There was no significant difference between levels of CK-MB in the 2 groups during 24 hours (P = 0.186). Hematologic and hemodynamic data showed no significant changes 2 weeks after PCI. Conclusion: High-dose administration of EPO in patients with ST-elevation MI who have been treated by primary PCI and standard antiplatelet therapy reduces the occurrence of arrhythmias. For clinical interpretation of the results, further well-designed trials are required.

Metabolic syndrome is one of the rising global health problems and medical challenges due to several clinical complications it may cause, for example increasing the risk of myocardial infarction and hypertension. However, great attention has been directed toward determining the worthiness of herbal medicines. There are emerging studies on preventive and therapeutic effects of silymarin on different components of metabolic syndrome. Extracted from the dried seeds of milk thistle plant (Silybum marianum L.), silymarin has been used in the treatment of different diseases for many years. Several protective effects have been identified for this herb such as decreasing insulin resistance, regulating blood pressure and lipid profile, as well as antioxidant and cytoprotective effects. This review aims to discuss available human and experimental researches into the promising effects of silymarin on different elements of metabolic syndrome. All related human and experimental papers published from 2012 to date were included in this review. Reviewing different human and experimental studies into the effects of silymarin on metabolic syndrome, we deduced that silymarin possesses promising effects on different components of this syndrome. Although the complete mechanism of action and target organs for silymarin require further verification and investigation, high-risk individuals may benefit from supplementation with this herbal medicine. © 2018 Society of Chemical Industry.

Sesame seed is one of the main nutrient substances which is used in the food industries of Khorasan Razavi, Iran. Because it is likely that stored sesame seeds are contaminated with mycotoxins, the levels of aflatoxins (AF) in five lots of imported sesame seeds before their distribution to the market were studied during one year. A total of 269 sub-samples were obtained from a total of 9,321 tons of sesame seeds from five importing companies. Aflatoxins at >1 μg/kg were found in 50 % of all samples, but at low levels in most cases, which is illustrated by mean AFB1 and total AF levels of 1.25 ± 3.70 and 1.43 ± 4.38 μg/kg, respectively. A few (1.9 %) samples exceeded the National Iranian Standard maximum accepted level for AFB1 (5 μg/kg) or total AF (15 μg/kg); the maximum total AF level found in one sample was 48 μg/kg. The results indicate that the risk of a violative AF contamination in imported sesame seeds is not negligible but is currently relatively low.

Diabetes mellitus (DM) is a complicated endocrine disorder that can clinically impair tissues and organs due to hyperglycemia. One of the areas of concern in diabetes would be the higher amount of medications being consumed by diabetes sufferers that is the corollary of its inevitable complications such as micro-and macro-vascular damages to various organs. Different metabolic pathways are involved in the biotransformation of drugs and toxins, thus their pharmacokinetic/toxicokinetic can be affected by DM primarily due to changes in enzymes and drug transporters. On the other hand, different enzymatic pathways are involved in the metabolic processes of substances. While not many human studies are available, several investigations have been carried out in animal models of diabetes, the majority of them being rodents. Given the high prevalence of DM and its important complications, the effect of this disease on the metabolism of some of the toxins and drugs is discussed herein.

Commonly known as saffron, Crocus sativus L and its active components have shown several useful pharmacological effects such as anticonvulsant, antidepressant, anti-inflammatory, antitumor, radical scavenger effects, learning and memory improving effects, etc. There has been an increasing body of data on saffron use in medical databases within the last 20 years. In the current review, the strengths and weaknesses of some of the clinical trials about different pharmacological effects of saffron will be discussed C. sativus extract has been studied in 8 anti-depressant clinical trials in comparison to placebo or some antidepressant drugs, in which saffron showed effectiveness as an antidepressant drug. Clinical trials on anti-Alzheimer effect of saffron demonstrated that it was more effective than the placebo, and as effective as donepezil. 2 clinical trials on antipruritic and complexion promoter in skin care effects of saffron both confirmed that saffron was more efficient than the placebo. In another clinical trial, it was proved that in addition to the weight loss treatment, saffron could reduce snacking frequency. Clinical trials conducted on women with premenstrual syndrome showed that saffron could reduce suffering symptoms more than the placebo and similar to standard treatments. Furthermore, additional clinical trials on effects of saffron on erection dysfunction, allergies, cardiovascular and immune system as well as its safety, toxicity and human pharmacokinetics are reviewed herein.

There are many reports on the effects of intravenous lipid emulsion (ILE) as an antidote in drug toxicity. Haloperidol (HAL) is a butyrophenone antipsychotic agent which is highly lipophilic. Hypotension is an important adverse effect of HAL administration and overdose. The aim of this study was to investigate the beneficial hemodynamic effects of ILE on acute HAL poisoning. We used six groups of five male rabbits. Two groups received aseptic distilled water intravenously followed by infusion of 18.6 ml/kg normal saline, as negative control group, or ILE 20% after 0.5 h. The third group received 18.6 ml/kg normal saline after HAL infusion (2.6 mg/kg). The other three groups received ILE 20% solution (6, 12, and 18.6 ml/kg) following HAL (2.6 mg/kg) administration. We measured blood pressure at 0, 0.5, 1, 2, 3, 4, 8, and 24 h after starting HAL administration, from left forelimb using a noninvasive method that was carried out automatically with a neonatal intensive care unit bedside monitor. ILE 20% at the dose of 18 ml/kg could return the reduced mean arterial pressure and diastolic blood pressure sooner than the other doses and normal saline. In conclusion, ILE could reverse HAL-induced hypotension same as the other lipophilic drugs. However, the clinical use of ILE for this purpose needs more evaluation to determine its exact indication and safety.

In recent years, research has provided experimental and subjective evidence that intravenous lipid emulsions (ILEs) reverse some hemodynamically considerable poisonings with various drugs. The aim of this study was to investigate the possible antidotal effect of ILE on acute tramadol poisoning.Thirty male New Zealand rabbits weighing 2.5 to 3 kg were divided into 6 groups, 5 in each. Two groups were considered controls, and the rest were treated intravenously with a dose of 50 mg/kg of tramadol. Thirty minutes later, infusions of either ILE 20% (3 doses of 6, 12, and 18 mL/kg) or normal saline (dose of 18 mL/kg) were administered. The survival of animals, total seizure time, and hemodynamic parameters were monitored immediately after infusions and subsequently for 3 observations during 24 hours.Survival percentages at doses of 6 and 12 mL/kg of ILE were both 100% (P0.001), and 80% at a dose of 18 mL/kg (P0.01). Intravenous lipid emulsion reduced tramadol-induced tachycardia when administered within 30 minutes of poisoning (P0.01) and showed positive effects on normalizing mean arterial pressure and diastolic blood pressure (P0.05). However, ILE did not have major effect on systolic blood pressure. Intravenous lipid emulsion also prevented tramadol-related seizures in doses of 6 and 12 mL/kg (P0.001) and reduced elevated creatine phosphokinase levels with the 2 higher doses (P0.001).Intravenous lipid emulsion significantly reduced mortality due to acute toxicity with tramadol in rabbits, although increasing the ILE dose may cause reverse effects.

Fish and shrimp are common healthy sources of protein to a large percentage of the world's population. Hence, it is vital to evaluate the content of possible contamination of these marine-foods. Six species of fishes and two species of shrimps were collected from the local markets of Mashhad, Iran. The mercury (Hg) concentration of samples was determined by atomic absorption spectrophotometry using a mercuric hydride system (MHS 10). High concentration of total Hg was found in Clupeonella cultriventris caspia (0.93 ± 0.14 μg/g) while the lowest level was detected in Penaeus indicus (0.37 ± 0.03 μg/g). Mean Hg levels in fish and shrimp samples were 0.77 ± 0.08 μg/g and 0.51 ± 0.05 μg/g, respectively. Farmed species (except for P. indicus) and all samples from Persian Gulf and the Caspian Sea had mean mercury concentrations above 0.5 μg/g, which is the maximum standard level recommended by Joint FAO/WHO/Expert Committee on Food Additives (JECFA). All samples had also mean Hg concentrations that exceeded EPA's established safety level of 0.3 μg/g. A little more extensive analysis of data showed that weekly intake of mercury for the proportion of the Iranian population consuming Hg contaminated fish and shrimp is not predicted to exceed the respective provisional tolerable weekly intakes recommended by JECFA. However, the Iranian health and environmental authorities should monitor Hg contamination of the fishes and shrimps before marketing.