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Introduction: Recent research has revealed that exposure to toxins and substances like cannabis, opium, heroin, and tramadol can inhibit the growth of lymphocytes. One of the key factors identified is the impact of probiotics on decreasing and managing inflammation in individuals affected by poisoning. This study examined the impact of probiotic treatment on interleukin-6 (IL-6) and IL-10 levels in opioid-poisoned patients. Methods: This randomized clinical trial included 70 patients with opioid poisoning who were admitted to the poisoned intensive care unit for 6 months. Patients were randomly assigned to two intervention groups that received oral probiotics or a control group that received placebo. Data collected were analyzed using IBM SPSS version 22 software. Results: The intervention group had methadone (28.6%) and tramadol as the most common causes of poisoning, whereas the control group had tramadol (45.7%) and methadone (28.6%). There was a noticeable decrease in Acute Physiology and Chronic Health Evaluation scores in the intervention group before and after the intervention, whereas no significant difference was observed in the control group. Significantly, the levels of IL-6 and IL-10 were lower in the probiotic group than in the control group. Conclusion: Probiotic use improved the condition of patients and decreased IL-6 and IL-10. This shows the positive effect of probiotics as an adjunctive treatment in opioid-poisoned patients, improving the condition of the patients' immune system. [ABSTRACT FROM AUTHOR]

Background: The use of hemodialysis is a prevalent extracorporeal technique for managing the poisoning of certain patients. Objectives: In this study, we examined the frequency of extracorporeal methods and the prognosis of using these methods in various poisonings. Methods: This retrospective study was conducted at Loghman Hakim hospital in Tehran between 2016 and 2020. The study investigated all patients who were hospitalized and underwent hemodialysis at the poisoning center. The study analyzed demographic data, clinical information, and certain laboratory findings from a sample size of 980 cases. The data obtained from the study were analyzed using SPSS 22. Results: 793 (80.9%) males and 187 (19.1%) females were investigated. The mean age of the subjects was 36.5±14 years. Methanol consumption was the highest cause of poisoning (858 cases, 87.6%). Hemodialysis was the most widely used extracorporeal method (971 cases, 99.1%). The median number of hemodialysis was 1 times and the maximum was 18. The mortality rate was 13.3%. Metabolic acidosis was observed in 823 cases (84%). Acute kidney injury (AKI) was present in 536 cases (54.7%). Conclusions: Although there have been some published studies and conferences on extracorporeal methods for treating poisonings, the lack of cases treated with these methods has resulted in weak evidence. To address this issue and provide more widely applicable data, studies like this can help to improve the treatment of poisoned patients. [ABSTRACT FROM AUTHOR]

Background: The following case report discusses a person who experienced vision loss after consuming a homemade alcoholic beverage for 14 days. Case presentation: A 32-year-old Iranian man with a chief complaint of blindness was referred to Loghman Hakim Hospital. Results: The patient's visual acuity was limited to light perception, meaning he could only identify the direction of the light. He had a history of purchasing a 20-liter batch of homemade alcoholic beverages, which he consumed over 14 days with various groups of friends. The day after he finished the drink and stopped consuming it, his vision started to deteriorate. By the end of the second day, he was nearly blind. None of his other friends who drank from the same alcohol were showing any visual or other symptoms of methanol poisoning problems. The liquor he purchased contained a small amount of methanol. While folinic acid detoxified it in his friends, it accumulated in him over two weeks of constant drinking. Because ethanol is a competitive inhibitor of methanol for the alcohol dehydrogenase (ADH) enzyme, the methanol was not converted. Discussion: Methanol toxicity, a leading cause of blindness in developing nations, damages the optic nerve and retina by disrupting mitochondrial function through formic acid’s effect on cytochrome oxidase. ADH isoenzyme variations affect methanol elimination rates and delayed neurological syndromes, including vision problems. Conclusion: Formic acid led to blindness. However, as his blood ethanol levels decreased, he began showing symptoms of methanol toxicity. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Aluminum phosphide poisoning may cause rare visual impairment. In a case, a 31‐year‐old female, visual loss was linked to shock‐induced hypoperfusion, causing oxygen lack and cerebral atrophy, emphasizing the need for identifying atypical symptoms. This case report describes the multidisciplinary evaluation of a 31‐year‐old female patient who suffered from visual impairment as a result of aluminum phosphide (AlP) poisoning. Phosphine, which is formed in the body when AlP reacts with water, cannot cross the blood–brain barrier; therefore, visual impairment seems unlikely to be the direct result of phosphine. To our knowledge, it is the first documented report of such impairment due to AlP. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted to determine the prevalence of acute iron poisoning among patients in a referral poison control center located in Tehran. It also studied their clinical profile, treatment, and outcome. Methods: This retrospective cross-sectional study was conducted on acute iron poisoned patients, who were admitted to the poison center from March 21, 2015 to March 19, 2020. Some background variables such as age, gender, ingested dose, time interval between onset of poisoning to hospital admission, the need for antidote, clinical presentations, paraclinical findings and outcome of poisoning were extracted from patients' medical records. Data analysis was carried out using SPSS software. Results: A total of 74 patients with acute iron poisoning with a mean age of 16.85 ± 11.97 years included in this study. Sixty-one (82.4%) patients were female and the most affected age group was 19-30 years (35.1%). The ingestion dose median in patients under 18 years old was 2450 (IQR=5600, Min= 120, Max= 30000) mg and in the group over 18 years old it was 9000 (IQR= 11125, Min= 600, Max= 30000) mg. Vomiting (66.2%) and lethargy (24.3%) were the most common clinical presentations on admission. Metabolic acidosis was the most common abnormality in blood gas analysis (43.2%). Positive findings in abdominal radiography have been observed in 4 (5.4%) cases. The serum iron concentration in the patients were 259.54 ± 153.96 µg/dL. Moreover, mortality was reported in one case (1.3%). There was a significant difference between the age of the patients whom received deferoxamine and more patients under 18 years of age received the antidotal therapy (p=0.003). Conclusion: The present study showed a low mortality rate among the acute iron poisoning patients. From this view, it can be concluded that adults have lower mortality rates than children. [ABSTRACT FROM AUTHOR]

Introduction: Acute accidental and deliberate poisoning by medications and pharmaceuticals is the third cause of death in suicides after hanging and self-immolation. To determine the common pattern of intentional drug poisoning in Tehran, this descriptive and retrospective study has reviewed and analyzed the data related to the records of patients admitted due to intentional drug poisoning, 2018-2019 at Loghman-Hakim-Hospital-Poison-Center (LHHPC). Methods: This is an epidemiological, cross-sectional investigation based on the medical profile of 9245 patients who were admitted to LHHPC for intentional drug poisoning from May 2018 to May 2019. The verified variables included: age, gender, type of drug used, previous history of mental health problems, presence or absence of a previous history of suicide, the outcome of hospitalization and time of emergency visit. All inquiry data were coded and statistically analyzed using SPSS Version 26 software. Results: The average age of the admitted cases was 29.3±12.4, with a minimum age of 12 years. The greatest proportion of poisoning occurred between the ages of 21-30 years. About 17.10% of patients had a previous history of self-harm and 57.77% had mental disorders. The most common pharmaceuticals for deliberate poisoning were anti-epileptics-sedativehypnotics, antipyretics-non-opioid-analgesics, narcotics- hallucinogens and antidepressantantipsychotic. Mortality was significantly higher in men and also following methadone and benzodiazepines. Conclusion: The high prevalence of intentional poisoning and its resulting mortality among young adults requires considerable attention and further studies to understand the underlying causes. Besides, strict rules need to be enforced regarding the sale of central nervous system drugs and opioids. [ABSTRACT FROM AUTHOR]

Background: Tracheal intubation is a life-saving measure in patients poisoned acutely with opioid, and when naloxone treatment is inadequate. This study determined the risk factors for early unplanned extubation in these patients and evaluated the effects on the clinical outcomes. Methods: At a poisoning center in Tehran, Iran, 165 opioid overdose patients who were admitted to the intensive care unit and intubated between September 2019 and March 2020 were enrolled into this study. Patients were categorized in two groups: a) those extubated based on the physicians' decision, and b) those who were extubated by self or were accidentally. The two groups were compared regarding their clinical outcomes and complications during hospitalization. In addition, the re-intubated patients in both groups were compared to those with successful intubation regarding the predisposing factors and mortality. Results: Of these patients, 36 (21.8%) died before extubation, and planned extubation was performed in 109 of them (84.5%). Unplanned extubation occurred in 20 patients (15.5%). Agitation, elevated temperature (>38.5°C), and insufficient nursing care were the independent risk factors for the unplanned extubation. 6(5.5%) and 3(15%) patients died following the planned and unplanned extubation, respectively, and 24 patients required reintubation. Patient transfer, succinylcholine use, aspiration pneumonia, presence of brain injury, and insufficient nursing care were independent risk factors for re-intubation. Conclusion: Among the patients with high drug dependency, higher doses of sedatives were needed to avoid self-extubation. Infection control and sufficient nursing care were factors that led to better clinical outcomes for extubation in these patients. [ABSTRACT FROM AUTHOR]

Introduction: paraquat is a cheap and easy access herbicide which its intoxication is limited in Iran. The current study aims to provide some epidemiologic data within paraquat poisoning from the most crowded referral center of clinical toxicology in Iran. Methods: We investigated the paraquat poisoning patients who were admitted to Loghman-Hakim Hospital in Tehran, Iran from 2008 to 2016. Results: A total of 12 patients participated in this study, %50 of these patients were between 20-10 years old, %41.7 were between 40-26 years old, and %8.3 were above 55 years old. About %83.3 were male, and %16.7 were female. Treatments which were given in the hospital include cyclophosphamide (%58.3), cortisol (%75), vitamin C (%50), vitamin E (%83.3), N-acetyl cysteine (66.6 .)%83.3 percent of hospitalized patients required invasive measures to preserve their airways, with 3.33 percent undergoing tracheostomy and the same percentage undergoing intubation. There were five fatalities among the patients, three of which were related to pulmonary and renal failure. Conclusions: This study indicates that the majority are younger than 40 years and males. Prevention and limited access to this substance is necessary in terms of the lack of antidote. [ABSTRACT FROM AUTHOR]

Introduction: Aluminum phosphide (AlP) is an effective fumigant and rodenticide which is a commonly used agent for suicide in parts of developing countries. AlP poisoning results in serious manifestations involving many vital organs and it has high mortality. Electrolyte and metabolic abnormalities including metabol ic acidosis is a common problem in AlP poisoning. Case report: Here, we report two cases of AlP poisoning who take AlP tablets intentionally. The therapeutic intervention initiated for both of them including glucose, insulin, and potassium ( GIK) protocol, antioxidants agents, intravenous magnesium, intravenous calcium, and norepinephrine. The arterial blood samples obtained in a serial manner and interestingly it showed no abnormality. Conclusion: This is first cases of AlP poisoning with normal acid base balance which emphasis the importance the early initiation of therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background: Digoxin poisoning leads to the development of cardiac and noncardiac complications. Digoxin immune fab is a safe and effective antidote, but clinical trials have not been performed in this regard, and most of the evidence is based on prospective studies. Understanding the toxicoepidemiology pattern of digoxin poisoning could provide valuable context for better managing its acute poisoning. Objectives: This study aimed to assess the toxicoepidemiology pattern of acute digoxin poisoning through a 5-year assessment in Iran. Methodology: In this observational study, the records of 97 patients who were referred with acute digoxin poisoning between 2010 and 2015 were evaluated. Demographic characteristics, past medical history, drug history, chief complaints, vital signs, paraclinical findings, digoxin immune fab administration, and clinical outcomes recorded. Results: The mean age of patients was 34.02 ± 17.87 years old. About 24.7% of patients had underlying diseases, and among them, heart failure was the most prevalent disease (29.2%) 42.3% of patients needed intensive care unit (ICU) admission. The mean duration of ICU stay was 4.00 ± 2.29 days. Digoxin immune fab was administered for 4.1% of patients, and an average of 6.2 ± 2.2 vials were used for them. All patients survived, and no mortality was reported. Conclusions: Digoxin immune fab administration did not alter the mortality rate. Hence, it can be concluded digoxin immune fab is not appropriate in acute poisoning, but it may be considered in chronic poisoning. Furthermore, acute digoxin poisoning is more common in Iran, and it responds appropriately to conventional treatment. [ABSTRACT FROM AUTHOR]

Background: In acute and chronic phases of severe diseases, endocrine changes occur. Some hormones, such as prolactin (PRL) and thyroid hormones, were considered predictors of ICU patients' outcomes. The present study evaluates thyroid hormone profile, serum PRL level, and their relationship with ICU poisoned patients' mortality rate. Methods: This study included 140 inpatients in the Toxicology Intensive Care Unit (TICU) who enrolled in a prospective study of a single center and observational. After admission to the ICU, the researchers collected venous blood samples from all patients directly. Concurrently, the APACHE II score was calculated. The collected samples analysis was performed based on the entire triiodothyronine (T3), thyroxine (T4), thyroidstimulating hormone (TSH), and PRL level. Results: One hundred and forty subjects were studied, of which 109 (75.85%) were male with a mean age of 34.17 ± 14.01. One hundred and eighteen patients were survivors with a mean age of 33.29 ±13.76. In contrast, 22 patients with a mean age of 38.91 ±14.69 died. The model of PRL combined with APACHE II score (OR 1.17, 95% CI 1.06 to 1.28, P-value =0.001) was the best model for predicting post-ICU mortality in our study. Conclusions: This study's results are consistent with the previous research, indicating a higher incidence of thyroid and PRL hormone changes in patients hospitalized in the ICU. It can be concluded that the presence of PRL based on the APACHE II score can lead us to be more precise in predicting the outcome of poisoning in hospitalized patients. [ABSTRACT FROM AUTHOR]

Background: There is limited data on refined opium extract (Shireh) abuse, especially the magnitude of its complications and its mortality rates. To bridge such a gap, in this study, we aimed to investigate the frequency of pure refined opium extract poisoning and its consequences in a sample of our patients. Methods: This retrospective study was conducted on all the patients presented to our center with pure refined opium extract poisoning. Patients' demographics, clinical and laboratory data, and outcome were collected during a ten-year period between 2006 and 2016. The included patients were divided into two groups: those who remained conscious and those who developed loss of consciousness. However, they were compared subsequently. Results: A total of 227 patients were evaluated. Most (75.8 %) of them were male. Mean age was 38.26±25.91 years. We found a significant correlation between educational (.038), marital (<.001), and occupational status (<.001) and age-gender groups of the patients. The mean amount of refined opium extract consumed was 4400 mg which had significant correlation with hospitalization period (<.001) and on-arrival rhabdomyolysis (<.001). We also found a correlation in vomiting (<.001), dizziness (.015), respiratory distress (.001), and apnea (<.001) between the two groups. The mean hospitalization period was 2.3 days and the mortality rate was 1.76%. Conclusion: Naloxone therapy use effective in most cases of pure poisoning with refined opium extract. There were four deaths incidences three of which happened due to cardiopulmonary arrest following body packing. Further studies in this type of poisoning are recommended. [ABSTRACT FROM AUTHOR]