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A specific biological vulnerability underlies suicidal behavior. Recent findings have suggested a possible role of inflammation and neuroaxonal injury. However, the relationship between inflammation and clinical symptoms in this disorder is still unclear. The objective of this study is applying novel blood markers of neuroaxonal integrity such as neurofilament light chain (NfL) and comparing the results with the healthy control subjects.

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]

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]

During the COVID-19 pandemic, methanol-containing beverages' consumption has risen because people mistakenly believed that alcohol might protect them against the virus. This study aimed to evaluate the prevalence and predisposing factors of brain lesions in patients with methanol toxicity and its outcome. A total of 516 patients with confirmed methanol poisoning were enrolled in this retrospective study, of which 40 patients underwent spiral brain computed tomography (CT) scan. The presence of unilateral or bilateral brain necrosis was significantly higher in the non-survival group (p = 0.001). Also, intracerebral hemorrhage (ICH) and brain edema were prevalent among patients that subsequently died (p = 0.004 and p = 0.002, respectively). Lower Glasgow Coma Scale (GCS) was related to a higher mortality rate (p = 0.001). The mortality rate in chronic alcohol consumption was lower than the patients who drank alcohol for the first time (p = 0.014). In conclusion, increasing the number of methanol poisoning and its associated mortality and morbidity should be considered a threat during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]