Ferulic acid grafted into ß-cyclodextrin nanosponges ameliorates Paraquat-induced human MRC-5 fibroblast injury.

Paraquat (PQ) is a commercially important and effective herbicide in the world. Nevertheless, it has higher toxicity causing acute organ damage and different complications, mainly in the lungs and kidneys. Ferulic acid (FA), 4-hydroxy-3-methoxycinnamic acid imposes multiple pharmacological impacts. No protective effect of FA on PQ poisoning-caused human embryonic lung fibroblast damage has not been reported. Despite their many beneficial effects, FA is characterized by poor water solubility, low bioavailability, and phytochemical instability. To solve the problem, ß-cyclodextrin nanosponge (ß-CD NSs) was utilized to increase the solubility of FA so that it was grafted into ß-CD NSs to establish ß-CD@FA NSs. The purpose of this work was to examine for the first time the protective effect of ß-CD@FA NS on MRC-5 human lung cells damages induced by PQ poisoning. MTS assay was performed to investigate the viability of MRC-5 cells at different concentrations of FA/ß-CD@FA NSs when cells were co-cultured with 0.2 µg/mL PQ. The flow cytometry study was carried out to determine apoptosis. Malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) levels were detected using appropriate biochemistry kits. Compared with the PQ group, the cell activity, CAT, and SOD levels were significantly increased in the FA and chiefly in ß-CD@FA NSs intervention groups, whereas apoptosis and MDA levels were markedly decreased. The inflammatory factors tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), and interleukin 22 (IL-22) were detected. The results demonstrate that ß-CD@FA NSs can inhibit PQ-induced cell damage by enhancing antioxidant stress capacity and regulation of inflammatory responses.

Protective effects of natural compounds against paraquat-induced pulmonary toxicity: the role of the Nrf2/ARE signaling pathway.

Paraquat (PQ) is a toxic herbicide to humans. Once absorbed, it accumulates in the lungs. PQ has been well documented that the generation of reactive oxygen species (ROS) is the main mechanism of its toxicity. Oxidative damage of PQ in lungs is represented as generation of cytotoxic and fibrotic mediators, interruption of epithelial and endothelial barriers, and inflammatory cell infiltration. No effective treatment for PQ toxicity is currently available. Several studies have shown that natural compounds (NCs) have the potential to alleviate PQ-induced pulmonary toxicity, due to their antioxidant and anti-inflammatory effects. NCs function as protective agents through stimulation of nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathways. Elevation of Nrf2 levels leads to the expression of its downstream enzymes such as SOD, CAT, and HO-1. The hypothesized role of the Nrf2/ARE signaling pathway as the protective mechanism of NCs against PQ-induced pulmonary toxicity is reviewed.

Technology-based suicide prevention: An umbrella review.

Background: The objective is to summarize evidence from systematic reviews, scoping reviews, and meta-analyses evaluating the effects of any format of Internet-based, mobile-, or telephone-based intervention as a technology-based intervention in suicide prevention. Materials and Methods: This is an umbrella review, that followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines. An electronic search was done on September 29, 2022. Data were extracted by reviewers and then methodological quality and risk of bias were assessed by A Measurement Tool to Assess Systematic Reviews-2. Statistical analysis was done by STATA version 17. Standard mean difference was extracted from these studies and by random effect model, the overall pooled effect size (ES) was calculated. I2 statistic was used to assess the heterogeneity between studies. For publication bias, the Egger test was used. Results: Six reviews were included in our study, all with moderate quality. The overall sample size was 24631. The ES for standard mean differences of the studies is calculated as - 0.20 with a confidence interval of (-0.26, -0.14). The heterogeneity is found as 58.14%, indicating a moderate-to-substantial one. The Egger test shows publication bias. Conclusion: Our results show that technology-based interventions are effective. We propose more rigorous randomized controlled trials with different control groups to assess the effectiveness of these interventions.

The efficacy of hemodialysis on paraquat poisoning mortality: A systematic review and meta-analysis.

Background: Paraquat (PQ) poisoning is a serious public health concern, especially in developing countries, due to its easy access and lack of awareness of potential harms. No effective treatment has been reported yet. Conventional hemodialysis (HD) is still used in many centers for excreting PQ or reducing acute kidney injury, but there is no consensus on its efficacy. Therefore, we aimed to review the HD efficacy in PQ poisoning mortality. Materials and Methods: We searched Web of Science, PubMed, Excerpta Medical Database, Google Scholar, Scopus, Cochrane, Web of Knowledge, Pro-Quest, ScienceDirect, Springer, Clinical Key, Scientific Information Database, Magiran, and Iran-doc, in publications before January 1, 2020. We compared patients who underwent HD (Group 1) with those who did not (Group 2). The outcome was considered mortality/survival. The data were analyzed by Comprehensive Meta-analysis Software. Results: This systematic review and meta-analysis included five studies with a combined total of 203 patients. The patients in the Group 1 had higher mortality than Group 2 (odds ratio, 2.84; 95% confidence interval: 1.22-6.64; P = 0.02). There was no evidence of publication bias (P value for Egger's test = 0.833). Conclusion: Although HD did not affect the survival of patients, other variables such as the amount of ingested PQ, poisoning severity, the time between PQ ingestion and the start of HD, duration, and times of HD sessions may influence the results regarding mortality.

Efficacy of fresh frozen plasma transfusion in comparison with conventional regimen in organophosphate poisoning treatment: a meta-analysis study.

OBJECTIVE: To evaluating the efficacy of fresh frozen plasma (FFP) in comparison with conventional regimen in the treatment of organophosphate (OP) poisoning. METHODS: PubMed, ScopeMed, Cochrane, Scopus, and Google Scholar databases were searched. The search strategy used the following key words "organophosphate" and "poisoning or toxicity", "(atropine and oxime)", "fresh frozen plasma", "clinical trial", "outcome". The treatment with atropine or/and oxime was considered conventional therapy. The length of hospitalization, the length of ICU admission, need for mechanical ventilation and its duration, clinical recovery point, choline esterase level, mortality rate, and intermediate syndrome (IMS) occurrence were the key outcomes of interest. Databases were searched during the period of 2003-2019. Five studies were included in the analysis. RESULTS: Pooling of data showed that the relative risk (RR) of mortality in OP poisoning for five included trials comparing FFP-treated group with conventional regimen therapy was [0.563 (95% CI (0.252, 1.255)]. The summary of RR for IMS in two studies was [RR: 1.34, 95% CI (0.655, 2.742)]. In addition, there was a non-significant mean difference (MD) in hospital stay [MD: -0.106, 95% CI (-0.434, 0.223)] in three included trials. A significant MD was observed in the length of ICU admission in two trials between FFP-treated group compared to the conventional treatment group [MD: -2.672, 95% CI (-4.189, -1.154)], but after random effects meta-analysis, the changes were not significant [MD: -2.015, 95% CI (-6.308, 2.277)]. The summary of fixed-effect meta-analysis for choline esterase level in three trails was [MD: -0.117, 95% CI (-0.468, 0.234)]. The RR of ventilation requirement for two included trials in the FFP-treated group comparing to the conventional regimen therapy was [0.84, 95% CI (0.691, 1.022)] while for ventilation duration in two studies was [MD: -0.183, 95% CI (-0.567, 0.201)]. CONCLUSION: The addition of FFP to conventional therapy did not improve the outcomes of mortality, IMS, hospital length of stay, cholinesterase levels, need or duration of mechanical ventilation, and only the length of ICU stay could affect in the treated group.

Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis.

BACKGROUND: Paraquat (PQ) poisoning is a serious public health problem in many countries. In spite of different treatments, the mortality is still high. We performed a meta-analysis to see whether hemoperfusion (HP) in combination with other treatments reduces the mortality more than HP alone in patients with PQ poisoning. MATERIALS AND METHODS: We searched EMBASE, PubMed, Google Scholar, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials, Scopus, Springer, TRIP, ProQuest, and references of the included studies from January 2000 to August 2017. Two reviewers independently searched and extracted data. We measured I 2 to determine variance contributed by heterogeneity. To investigate the publication bias, Begg's and Egger's tests were used along with funnel plot analysis. RESULTS: Ultimately 12 articles were included in the meta-analysis. Five articles compared HP with conventional therapy with a total of 1311 patients, and seven articles compared mortality of patients received HP versus those received HP in combination with an additional treatment. HP alone reduced the odds of death (odds ratio [OR] = 0.20; 95% confidence interval [CI]: 0.11-0.40, P < 0.0001) compared to conventional therapy. Furthermore, the odds of death was higher in HP group compared to those received HP in combination of additional treatments (OR = 1.24; 95% CI: 1.05-1.46, P = 0.01). CONCLUSION: The mortality was less in HP-treated group compared to those received only conventional therapy. Addition of other treatments with HP reduced the mortality more than HP alone.

Is Admission Serum Sodium Concentration a Clinical Predictor for the Outcome of Therapy in Critically Ill Poisoned Patients?

BACKGROUND: Disorders of serum sodium concentration are some of the most electrolyte abnormalities in the intensive care unit (ICU) patients. These disorders adversely affect the function of vital organs and are associated with increased hospital mortality. PURPOSE: In the present study we aimed to evaluate the effects of serum sodium concentration abnormalities at the time of hospital admission on the clinical outcome of therapy in a cohort of critically ill poisoned patients. METHODS: In this cross-sectional study, 184 critically ill poisoned patients aged >18 years and in the first 8 hours of their poisoning, hospitalized in the ICU of a tertiary care university hospital (Isfahan, Iran) between 2010-2012, were evaluated at the admission time and 24 hours later for serum sodium concentration abnormalities and its relationship with age, gender, consciousness status, ingested drugs and clinical outcome of therapy. The clinical outcome was considered as recovery and mortality. Logistic Regression analysis was performed for predictive variables including serum sodium concentration abnormalities in patients' clinical outcome. FINDINGS: On admission, 152 patients (82.6%) were eunatremic, 21 patients (11.4%) were hyponatremic and 11 patients (6%) were hypernatremic. In the second day eunatremia, hyponatremia and hypernatremia was observed in 84.4%, 13% and 2.2% respectively. Age (OR=1.92; CI=1.18-3.12) and severity of toxicity (OR=1.32; CI=1.12-2.41) were predicting factors of mortality in ICU poisoning patients. CONCLUSIONS: Serum sodium concentration abnormalities are prevalent in critically ill poisoned patient but do not seem to have a predictive value for the clinical outcome of therapy.

Prediction of endotracheal intubation outcome in opioid-poisoned patients: A clinical approach to bispectral monitoring.

BACKGROUND: Some opioid-poisoned patients do not respond appropriately to naloxone; consequently, intubation is required. Although various measures have been used to evaluate the level of consciousness of poisoned patients, no study has assessed the role of the bispectral index (BIS) to ascertain the depth of anesthesia in opioid-poisoned patients who require endotracheal intubation. OBJECTIVE: To compare BIS scores between opioid-poisoned patients with and without intubation, and to determine the BIS cut-off point for endotracheal intubation in these patients. METHODS: In the present cross-sectional study, conducted in an Iranian university referral hospital for poisoning emergencies between 2012 and 2013, opioid-poisoned patients (n=41) were divided into two groups according to their requirement for endotracheal intubation. BIS analyses were performed at the time of admission and at the time of intubation for those who required it. In addition, electromyography and signal quality index were evaluated for all patients at the time of admission, and cardiorespiratory monitoring was performed during the hospitalization period. Using ROC curves, and sensitivity and specificity analyses, the optimal BIS cut-off point for prediction of intubation of these patients was determined. RESULTS: The optimal cut-off point for prediction of intubation was BIS ≤78, which had a sensitivity of 86.7% (95% CI 66.1 to 98.8) and specificity of 88.5% (95% CI 73.9% to 98.8%); the positive and negative predictive values were 81.2 % and 92%, respectively. CONCLUSIONS: BIS may be considered an acceptable index to determine the need for intubation in opioid-poisoned patients whose response to naloxone is inadequate.

HISTORIQUE: Certains patients empoisonnés par des opioïdes ne répondent pas bien au naloxone et doivent être intubés. Diverses mesures sont utilisées pour évaluer le niveau de conscience des patients empoisonnés, mais aucune étude n'a porté sur le rôle de l'index bispectral (IBS) pour déterminer la profondeur de l'anesthésie chez les patients empoisonnés par des opioïdes qui doivent subir une intubation trachéale. OBJECTIF: Comparer les indices de l'IBS entre les patients empoisonnés par des opioïdes intubés ou non et déterminer le seuil d'IBS pour l'intubation trachéale de ces patients. MÉTHODOLOGIE: Dans la présente étude transversale menée entre 2012 et 2013 dans un hôpital universitaire iranien spécialisé dans les urgences causées par des empoisonnements, les patients empoisonnés par des opioïdes (n=41) ont été divisés en deux groupes, en fonction de la nécessité qu'ils subissent une intubation trachéale. Les chercheurs ont analysé l'IBS au moment de l'admission et de l'intubation des patients qui devaient la subir. Ils ont aussi évalué l'électromyographie et l'indice de qualité du signal chez tous les patients au moment de l'admission et assuré un monitorage cardiorespiratoire pendant la période d'hospitalisation. À l'aide des courbes ROC et des analyses de sensibilité et de spécificité, ils ont déterminé le seuil d'IBS optimal pour prédire l'intubation de ces patients. RÉSULTATS: Un IBS de 78 ou moins, d'une sensibilité de 86,7 % (95 % IC 66,1 à 98,8) et d'une spécificité de 88,5 % (95 % IC 73,9 % à 98,8 %), était le seuil optimal pour prédire l'intubation. Les valeurs prédictives positives et négatives s'établissaient à 81,2 % et 92 %, respectivement. CONCLUSIONS: L'IBS peut être considéré comme un index acceptable pour déterminer la nécessité d'intuber les patients empoisonnés par des opioïdes qui répondent peu au naloxone.

Cyanide poisoning after bitter almond ingestion: "A rare case report".

We present a case of a 36-year-old woman with a history of three suicide attempts who had ingested approximately 40 bitter almonds in a suicidal act, leading to her admission to the emergency department of a regional hospital due to complaints of vomiting. Upon arrival, she exhibited confusion, and her vital signs were recorded as follows: pulse rate = 117 beats/min, blood pressure = 160/85 mmHg, oxygen saturation = 95%, respiratory rate = 16, temperature = 37°C. The patient venous blood gas analysis manifested severe metabolic acidosis (pH = 6.92, pO2 = 43 mmHg, HCO3 = 8.6 mmol/L, pCO2 = 42.7 mmHg, base excess = -25.9 mmol/L). Four hours later, she became unconscious and she was intubated. Gastric lavage and a single dose of 60 g of activated charcoal and sodium bicarbonate were administered. In the referral hospital, sodium nitrite was given due to the severity of the poisoning, and norepinephrine infusion was initiated to manage hypotension. Within a day, the patient regained consciousness, underwent extubation, and after 72 h was discharged and subsequently transferred to psychiatric care for further treatment. This case underscores the critical, life-threatening implications of cyanide toxicity following the ingestion of bitter almonds, highlighting the efficacy of supportive measures such as gastric lavage, activated charcoal, and sodium bicarbonate. Furthermore, it emphasizes the successful application of sodium nitrite monotherapy in managing this condition.

Effect of methadone maintenance therapy on sexual disorders in males: a systematic review and meta-analysis.

INTRODUCTION: Methadone maintenance treatment (MMT) is a popular method of treating opioid use disorder. However, the majority of drug-using males experience sexual dysfunction. OBJECTIVES: This systematic review and meta-analysis examined the possible impact of MMT on sexual dysfunction in drug-using males. METHODS: Cochrane, Web of Science, ProQuest, PubMed, and Google Scholar are the international databases that we used in this study. There were neither temporal nor regional limitations on the search. Stata version 14 (StataCorp) was used for data analysis. RESULTS: When compared with the control group, the MMT group, as measured by the International Index of Erectile Function (IIEF), exhibited significantly greater levels of intercourse satisfaction disorders (standardized mean difference [SMD], -0.52; 95% CI, -0.71 to -0.32), decreased sexual desire/drive (SMD, -0.44; 95% CI, -0.87 to -0.01), lower overall satisfaction (SMD, -0.27; 95% CI, -0.43 to -0.11), and reduced total IIEF score (SMD, -0.69; 95% CI, -0.92 to -0.47). According to the Arizona Sexual Experiences Scale, the MMT group was substantially more satisfied with orgasm than the control group (SMD, 0.58; 95% CI, 0.31-0.86). As determined by the Sexual History Form, MMT was linked to a statistically significant increase in orgasmic dysfunction in comparison with the control group (SMD, 0.65; 95% CI, 0.10-1.20). The Arizona Sexual Experiences Scale revealed a significant decrease in men reporting sexual disorder following MMT as compared with their pretreatment levels. CONCLUSION: As compared with control, MMT increased disorders of intercourse satisfaction, sexual desire/drive, and overall satisfaction according to the IIEF. MMT was also associated with a statistically significant decrease in various aspects of male sexual function as compared with pretreatment levels-including erectile function, intercourse satisfaction, orgasmic function, sexual desire/drive, and overall satisfaction. These findings highlight the importance of including sexual dysfunction screening in the routine care of male patients undergoing MMT.

Clinico-epidemiological evaluation of pharmaceutical/non-pharmaceutical poisoning in a referral poisoning emergency in the Central part of Iran.

The pattern of poisoning varies in different societies. In this study, we investigated the clinical-epidemiological features and outcomes of poisoned patients based on the substances involved, whether pharmaceutical or non- pharmaceutical toxins. This cross-sectional study involved a retrospective chart review of all poisoned patients who presented to the poisoning emergency hospital in the center of Iran between January 2015 and December 2019. We collected data on socio-demographics, the nature of the poisoning, and the outcomes. Backward stepwise binary regression analysis was conducted to predict the mortality. Throughout the study period, 5777 patients with acute poisoning met the inclusion criteria. Of these, 3524 cases (61%) were attributed to pharmaceutical, and 2253 cases (39%) were due to non-pharmaceutical poisoning. The majority of pharmaceutical poisonings (82.9%) were intentional, whereas non-pharmaceutical poisonings accounted for 46.2% of intentional exposures (P < 0.001). Patients with non-pharmaceutical poisoning were predominantly men, older in age, and had a history of addiction compared to those with pharmaceutical poisoning (P < 0.001). In binary logistic regression analysis, patients poisoned by non-pharmaceutical substances had a significantly higher risk of mortality [Odds ratio, 3.14; (95% CI 1.39-7.10); P = 0.006] compared to those poisoned by pharmaceutical substances (P < 0.001). The pattern of poisoning differs in terms of age and gender when comparing pharmaceutical to non-pharmaceutical poisoning. Patients poisoned by non-pharmaceutical may have a worse outcome compared to those poisoned by pharmaceutical substances.

Investigating the Effect of Substance Desire and Child Abuse in Adolescent Suicide Attempt.

Background: This study aimed to investigate the impact of child abuse and substance desire on adolescent suicide. Methods: This cross-sectional analytical study was conducted on all adolescents aged 12 to 19 who attempted suicide in 2018 at Khorshid Hospital, Isfahan, Iran. A checklist of the patients' demographic information, toxicological data, and 2 standard questionnaires, including substance desire (family, personal, social) and child abuse questionnaire (emotional abuse, physical abuse, and neglect abuse), were collected. The data were analyzed using SPSS version 15. Comparisons between the 2 groups were performed using t tests, chi-square tests, regression analysis, and crude model analysis. Odds ratio (OR) and 95% confidence interval were calculated based on logistic regression. Findings: A total of 196 teenagers were included in the study, with a mean age of 16.48±1.6 years. Out of these, 155 individuals (79.1%) were female, resulting in a female-to-male ratio of 3.78. There was a significant relationship between gender and alcohol consumption in the personal aspect, as well as between the history of psychiatric diseases and alcohol consumption in the physical aspect (P<0.005). The previous history of suicide was the only variable that showed significance in all aspects of both the substance desire and child abuse questionnaires. History of neglect abuse (OR: 1.2, 95% CI [1.07-1.41]; P=0.009) was a predictive factor for suicide attempt. However, being male (OR: 0.12, 95% CI [0.039-0.37], P=0.000), having no psychiatric history (OR: 0.23, 95% CI [0.10-0.52], P<0.001) and not consuming alcohol (OR 0.33, 95% CI 0.15-0.71, P=0.005) were identified as protective factors for attempted suicide. Conclusion: A public health strategy for suicide prevention includes implementing prevention strategies aimed at reducing risk factors, such as alcohol consumption and the risk of neglect abuse.

Comparative Study of Demographic and Toxico-Clinical Factors of Patients with Acute Poisoning Admitted to General Intensive Care Unit versus Specific Intensive Care Unit for Poisoning Cases.

Background: There is no dedicated specific intensive care unit (ICU) for poisoning cases due to the small number of poisoned patients in some poisoning centers and patients may hospitalized in the general ICU. In this study, we compared the outcome of hospitalization in poisoning and general ICU, in matched patients to demographical and toxico-clinical factors. Materials and Methods: This historical cohort study was conducted from September 2020 to January 2022 in the general and poisoning ICUs of Khorshid Hospital affiliated to the University of Medical Sciences, Isfahan, Iran. Patient characteristics, clinical, and toxicological information as well as the therapeutic measures and outcome were collected from hospital medical records and analyzed. Results: Totally, 178 (60.1% male and 39.9% female) patients met inclusion criteria. Medicines (56.2%) and opioids (25.3%) followed by pesticides (14%) were the most common substances. Suicide was the type of exposure in 78.7% of the cases. Most patients suffered from lung (19.1%) and kidney (15.2%) injuries. The mortality rate was 23.6%. The median length of hospital stay (P-value < 0.001) and duration of ventilator usage was higher (P-value < 0.001) in general ICU compared to specific ICU for poisoning cases. No significant difference with respect to demographic, toxico-clinical variables and mortality rate was found between the two groups. Conclusion: Among poisoned patients admitted to ICU, reported mortality rate was relatively high. Patients who hospitalized in the specific ICU for poisoning cases have lower length of hospital stay and duration of mechanical ventilation compared to general ICU.

Gastrointestinal Manifestations of Lead Poisoning: A Brief Report.

Gastrointestinal (GI) manifestations of lead poisoning include abdominal pain, constipation, and diarrhea. Depending on the severity of a symptom, surgical consultation is required. The present study aimed to make a comparison between the mean blood lead levels of patients hospitalized for lead toxicity and the various Gl symptoms. A retrospective cross-sectional study was performed in 2020 at Khorshid Hospital, the main regional referral center for poisoned patients (Isfahan, Iran). A total of 82 patients aged ≥18 years who were hospitalized for lead poisoning during 2017-2018 were included in the study. Patients' information was extracted from hospital medical records, including demographic information, clinical manifestations, blood lead levels, and treatment outcome. The mean age of the patients was 48.18±11.9 years, 91.5% were men, and 62.2% suffered from multiple GI symptoms, with abdominal pain being predominant (31.7%). Blood lead levels in patients with multiple GI symptoms were higher than those with only one symptom (P=0.01). Surgical consultation was required in 14.6% of the patients. Multiple GI symptoms were the main predictive factor for blood lead levels above 70 mg/dL (P=0.03, Odds ratio=3.06, 95% CI=1.09-8.61). Given the prevalence of abdominal pain and its association with elevated blood lead levels, differential diagnosis of abdominal pain should include lead toxicity.

A Clinical-Epidemiological Study on Beta-Blocker Poisonings Based on the Type of Drug Overdose.

Background: Beta-blockers carry a high risk of potentially causing fatal poisoning if overdosed. We aimed to assess the clinical and epidemiological characteristics of patients with beta-blocker poisoning. Methods: Patients were categorized based on the type of drug poisoning into propranolol, other beta-blockers, and the combination of beta-blocker groups, respectively. Demographic data, drug toxicity, and clinical, laboratory, and treatment information of different groups were compared. Results: During the study period, 5086 poisoned patients were hospitalized, of whom 255 (5.1%) had beta-blocker poisoning. Most patients were women (80.8%), married (50.6%), with a history of psychiatric disorders (36.5%), previous suicide attempts (34.6%), and intentional type of exposure (95.3%). The mean ± SD age of the patients was 28.94 ± 11.08 years. Propranolol toxicity was the most common among different beta-blockers (84.4%). There was a significant difference in age, occupation, education level, and history of psychiatric diseases with respect to the type of beta-blocker poisoning (P < 0.05). We observed changes in the consciousness level and need for endotracheal intubation only in the third group (combination of beta-blockers). Only 1 (0.4%) patient had a fatal outcome in toxicity with the combination of beta-blockers. Conclusion: Beta-blocker poisoning is not common in our poisoning referral center. Propranolol toxicity was most common among different beta-blockers. Although symptoms are not different among defined beta-blocker groups, more severe symptoms are observed in the combination of the beta-blocker group. Only one patient had a fatal outcome in the toxicity with the combination of the beta-blocker group. Therefore, poisoning circumstances have to investigate thoroughly to screen coexposure with combined drugs.

Follow-up of Methanol-related Visual Defects in a Cohort Study: Initial Severity Predicts Long-term Outcome.

Objective: Methanol poisoning can occur either intentionally through the consumption of methanol-containing products or accidentally through ingestion, resulting in visual impairment. We assessed the long-term visual sequelae in patients with methanol poisoning. Methods: This prospective cohort study was conducted at referral centers, Khorshid and Alzahra University Hospitals, affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. The study included patients hospitalized for methanol poisoning from June 22, 2018, to June 21, 2020, with follow-up extended until June 2021. Toxico-clinical and ophthalmologic examination data were collected from patients upon hospital admission, discharge, and during follow-up. Findings: Thirty-nine patients were assessed in this study. The majority of them (94.9%) were male, with an average age of 34 years. Patients who presented with reduced visual acuity (VA) upon admission subsequently showed abnormalities (in acuity and visual fields) during follow-up (n = 13). Among the patients who displayed visual field defects on admission, bilateral optic disc atrophy was observed in follow-up (n = 13). Conversely, patients who reported blurred vision, with or without photophobia upon admission, had normal results in their follow-up eye examinations. Among the 36 patients who underwent dialysis, 14 (38.9%) exhibited visual impairment during follow-up examinations. Additionally, 38 patients received sodium bicarbonate, and 14 of them (36.85%) also presented ocular abnormalities. Conclusion: Patients who demonstrated VA deficits upon admission are more likely to experience long-term VA and visual field defects, as well as optic disc atrophy. Patients who solely complained of blurred vision, with or without photophobia, during admission were less likely to develop long-term visual defects.

Toxicoepidemiology of Phosphide Poisoning in the Central Part of Iran.

Objective: Aluminum phosphide (ALP) and zinc phosphide (ZnP) are toxic agrochemical pesticides, which are commonly used as an agent of self-harm in developing countries. Because of high toxicity of phosphides, we evaluated toxico-epidemiology ALP and ZnP poisoning in with respect to outcome. Methods: We performed a cross-sectional study with retrospective chart review including the records for patients admitted due to phosphide poisoning (ALP, ZnP) in a poisoning referral center in Khorshid Hospital, affiliated with Isfahan University of Medial Sciences, Isfahan, Iran. Demographic characteristics, clinical manifestations, outcome (survived or death), and length of hospital stay for the patients were recorded in a data collecting form. Binary backward stepwise logistic regression was used for outcome prediction. Findings: Sixty patients were evaluated in the study. The mean age of patients was 27.61. Thirty-nine patients were men. 96.7% of the patients ingested it intentionally. Most of the patients on admission were conscious (66.7%). Abnormality of EKG was noted in 8.3%. The mortality in ALP and ZnP poisoning was 39.2% and 22.2%, respectively. Serum bicarbonate and base excess in the venous blood gas analysis, systolic blood pressure, and serum sodium level were significantly different between patients with ALP and ZnP poisoning on admission time (P < 0.05). On admission, systolic blood pressure was an important predictive factor for mortality (odds ratio 4.87; 95% confidence interval: 1.5-15.45; P = 0.007). Conclusion: The rate of mortality in phosphide poisoning is high. Knowing predictive factors for mortality help physicians for selecting patients in intensive care unit admission and aggressive treatment.

Comparing Sequential Organ Failure Assessment Score, Acute Physiology and Chronic Health Evaluation II, Modified Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Poisoning Severity Score for Outcome Prediction of Pesticide Poisoned Patients Admitted to the Intensive Care Unit.

Objective: This study aimed to assess the severity of poisoning, various scoring systems, including Sequential Organ Failure Assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II), Simplified Acute Physiology Score (SAPS II), Modified APACHE II, and poisoning severity score (PSS) were used. In this study, we compared the predictive value of these scoring systems on the outcome of pesticide-poisoned patients. Methods: This is a cross-sectional study of pesticide-poisoned patients (140 patients) who were admitted to the intensive care unit (ICU) of Khorshid Hospital, Isfahan, Iran, between January 2015 and 2019. The area under the receiver operating characteristic (AUC) curve and the predictive value of scoring systems were compared. Findings: Poisoning was higher in the male population (72.8%). The causes of poisoning were paraquat, (38.6%), aluminum phosphide, (32.1%), and organophosphate, (29.3%). The mean age of the patients was 33.9 years. Most patients (79.3%) attempted suicide. The mortality rate was 46.43%. The mean of "SOFA score," "APACHE II," "SAPS II," "Modified APACHE II," and "PSS" was 5.9; 15.7; 30.02; 15.8; and 1.9, respectively. There was a significant difference in the mean of all scoring systems for outcome prediction. Among all scoring systems, the SAPS II score with the cutoff point (16.5) had the best criteria for outcome prediction (AUC (0.831 ± 0.037), sensitivity (83.1%, 95% confidence interval [CI]: [71.7-91.2]), specificity (75.7%, 95% CI: [64.3-84.9]), positive predictive values (75.0%, 95% CI: [66.4-82.0]), negative predictive values (83.6%, 95% CI: [74.5-89.9]). Conclusion: The SAPS II scoring system may be a suitable indicator for outcome predictions in pesticide-poisoned patients in the ICU.