Iron; Benefits or threatens (with emphasis on mechanism and treatment of its poisoning).

Iron is a necessary biological element and one of the richest in the human body, but it can cause changes in cell function and activity control. Iron is involved in a wide range of oxidation - reduction activities. Whenever iron exceeds the cellular metabolic needs, its excess causes changes in the products of cellular respiration, such as superoxide, hydrogen peroxide and hydroxyl. The formation of these compounds causes cellular toxicity. Lack of control over reactive oxygen species causes damages to DNA, proteins, and lipids. Conversely, superoxide, hydrogen peroxide and hydroxyl are reactive oxygen species, using antioxidants, restoring DNA function, and controlling iron stores lead to natural conditions. Iron poisoning causes clinical manifestations in the gastrointestinal tract, liver, heart, kidneys, and hematopoietic system. When serum iron is elevated, serum iron concentrations, total iron-binding capacity (TIBC) and ferritin will also increase. Supportive care is provided by whole bowel irrigation (WBI), esophagogastroduodenoscopy is required to evaluate mucosal injury and remove undissolved iron tablets. The use of chelator agents such as deferoxamine mesylate, deferasirox, deferiprone, deferitrin are very effective in removing excess iron. Of course, the combined treatment of these chelators plays an important role in increasing iron excretion, and reducing side effects.

Ophthalmological aspects of mustard gas poisoning (focus on management).

Background: Amongst the chemical warfare agents, blistering (vesicant) agents can be significant materials. The most important agent in this group is sulfur mustard (mustard gas) which is known as "King of chemical warfare (CW) agents ". Exposure to this agent, seriously causes damages in several organs, such as the eyes. This article reviews the ophthalmological aspects of sulfur mustard with reference of its management. Methods: A wide-ranging search in PubMed databases, Thomson Reuters and Scopus was done and different aspects of chemical properties of sulfur mustard, its mechanism of action and effects on eyes, clinical finding, diagnostic evaluation, initiate actions, pharmaceutical and surgical interventions was reported. Results: Sulfur mustard can alkylate DNA and RNA strands and break down structures of protein and lipid of cell membrane. This may impair cell energy production, and leads to cell death. Exposure to sulfur mustard, therefore, causes such problems for organs, including irreversible damage to the eyes. Conclusion: Understanding the mechanism of the sulfur mustard effect and the early training in prevention injuries will cause fewer complications and damage to organs, including the eyes. Washing the eyes with tap water or eyewash solutions, using mydriatic drops, anti- inflammatory drugs, matrix metalloproteinase inhibitors and antibiotics may help to the management of poisoning. Surgical interventions including tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation and corneal transplantation could reduce the harm to the victims.

Vascular deformation in human atherosclerotic carotid artery evaluated by 2D analysis of ultrasonography.

OBJECTIVES: Common carotid artery (CCA) remodelling in the atherosclerosis process is an inherent necessary element that decreases the progress of significant lumen compromise. The present study used a semi-automated method to assess relationships of intima-media thickness (IMT), lumen diameter (LD) and inter-adventitial diameter (IAD) using ultrasound B-mode images of atherosclerotic carotid artery. METHODS: In the cross-sectional study, 120 male subjects (age range: 40-60 years) were classified into four research groups namely control, mild, moderate, and severe stenosis. The maximum near and far wall IMT, mean of both walls' IMT and IAD, and also LD of the left CCA were extracted for all participants. Pearson correlation coefficient was utilized to investigate relationships of IMT, LD, and IAD. RESULTS: Results revealed that the maximum far and near wall IMT, mean of both walls' IMT and IAD in the CCA were significantly different in stenosis patients and the control group (p< 0.001). However, there were no significant differences among the four studied groups in terms of LD of CCA (p = 0.65). There was a stronger correlation between mean of both walls' IMT and IAD in comparison with mean far wall IMT and IAD (p < 0.001). CONCLUSIONS: Results indicated that changes of IAD in the left CCA were associated with carotid deformation, and thus it can be considered as a predictor of atherosclerosis process.

Therapeutic options to treat mustard gas poisoning - Review.

Among the blistering (vesicant) chemical warfare agents (CWA), sulfur mustard is the most important since it is known as the "King of chemical warfare agents". The use of sulfur mustard has caused serious damages in several organs, especially the eyes, skin, respiratory, central and peripheral nervous systems after short and long term exposure, incapacitating and even killing people and troops. In this review, chemical properties, mechanism of actions and their effects on each organ, clinical manifestations, diagnostic evaluation of the actions triage, and treatment of injuries have been described.

New formulation of ibuprofen on absorption-rate: A comparative bioavailability study in healthy volunteers.

BACKGROUND: Enteric-coated capsules are solid dosage forms which are designed to bypass the stomach and release the drug in the small intestine. This study was done to compare pharmacokinetics of ibuprofen tablet and ibuprofen as enteric-coated capsule using sodium alginate beads. METHODS: A crossover randomized study was performed on 12 healthy volunteers receiving a single dose of regular ibuprofen tablet (200 mg) and enteric-coated capsule (200 mg). The washout time between the periods was one month. Pharmacokinetic and pharmacodynamic blood samples were collected for 16 hours following treatment. High-performance liquid chromatography (HPLC) method used the following specifications: C18 column with 4.6 mm diameter & 25 mm length, the fluorescent detector of excitation and emission wavelengths were 224 and 290 nm, respectively. RESULTS: After a single oral dose of ibuprofen formulations, the median times to maximum concentration were 60 and 240 minutes in ibuprofen tablet (200 mg) and enteric-coated capsule, respectively. The maximum levels for the participants receiving ibuprofen tablet and enteric-coated capsule were 11.71±1.3 and 10.32±4.19 µg/mL, respectively. The pharmacokinetic (PK) modeling data showed the area under curve (AUC) to be 61.51 hours & 86.62 hours for the group receiving the tablet and the capsule, respectively. CONCLUSION: According to the results, in is concluded that enteric coating may delay the onset of ibuprofen effect and increases the duration of action. This formulation has advantages over the conventional drug delivery systems as it lengthens the dosing intervals and also increases patient compliance for chronic pain.

Cadmium toxicity and treatment: An update.

Cadmium poisoning has been reported from many parts of the world. It is one of the global health problems that affect many organs and in some cases it can cause deaths annually. Long-term exposure to cadmium through air, water, soil, and food leads to cancer and organ system toxicity such as skeletal, urinary, reproductive, cardiovascular, central and peripheral nervous, and respiratory systems. Cadmium levels can be measured in the blood, urine, hair, nail and saliva samples. Patients with cadmium toxicity need gastrointestinal tract irrigation, supportive care, and chemical decontamination traditional-based chelation therapy with appropriate new chelating agents and nanoparticle-based antidotes. Furthermore it has been likewise recommended to determine the level of food contamination and suspicious areas, consider public education and awareness programs for the exposed people to prevent cadmium poisoning.

A New 2D-Based Method for Carotid Intima-Media Thickness Quantification From Ultrasound Sequences.

BACKGROUND: Ultrasound measurement of carotid Intima-Media Thickness (IMT) is a suitable method to evaluate subclinical arteriosclerosis. OBJECTIVES: The current study aimed to present a new computerized algorithm to detect instantaneous changes of the IMT to Common Carotid Artery (CCA) of IMT in sequential ultrasound images by applying the maximum gradient and the dynamic programming. PATIENTS AND METHODS: In a cross-sectional design, an examination was performed on thirty healthy human subjects with the mean age of 44 ± 6 years from April 2013 to June 2013 in Beheshti Hospital, Kashan, Iran. In all individuals, the instantaneous changes of the far wall IMT on the CCA were extracted. Local measurements of vessel intensity, intensity gradient, and boundary continuity were extracted for all of the sequential ultrasonic 2D-frames throughout three cardiac cycles. The Pearson correlation coefficients and Bland-Altman analysis were performed to assess the relationship and agreement between IMT measured by the proposed and conventional manual methods. RESULTS: There was no significant difference between the proposed and manual methods with paired t-test analysis (in systole: 0.57 ± 0.10 vs. 0.56 ± 0.10 mm; P = 0.188 and in diastole: 0.63 ± 0.16 vs. 0.62 ± 0.10 mm; P = 0.122 for the manual and proposed methods, respectively). The Pearson correlation coefficients were r = 0.94 and r = 0.93 for IMTs and IMTd, respectively (both P < 0.001). Limit of agreements were narrow and considerable agreement was found between the two methods. CONCLUSIONS: The present study demonstrated that the proposed computerized analyzing method can provide accurate measurements of the IMT of the CCA in sequential 2D ultrasonic images.

A comparative study of three speckle reducing methods for intima-media thickness ultrasound images.

BACKGROUND: Ultrasonic evaluation of intima-media thickness (IMT) is an early marker of assessing the development of atherosclerosis and determining cardiovascular risk. To attain the best possible diagnosis, it is essential that medical images be clear, sharp and without noise and artifacts. OBJECTIVES: Comparison of speckle reducing anisotropic diffusion (SRAD), discrete (DTD) and continuum topological derivative (CTD) on B-mode ultrasound images of common carotid and brachial arteries throughout the cardiac cycle. PATIENTS AND METHODS: In a cross-sectional design, an examination was performed on forty-two human subjects with a mean age of 44 ± 6 years from April 2013 to June 2013. This study was approved by the ethics committees of Kashan University of Medical Sciences and Beheshti Hospital. An ultrasonic examination of common carotid and brachial arteries of forty-two human subjects was performed. The program was designed in MATLAB software to extract consecutive B-mode images and apply region of interest (ROI) on the IMT of the common carotid and brachial arteries. Then, three different noise reduction filters with the Canny edge detection were used in ROI separately. Finally, the program measured the image quality metrics. RESULTS: According to values of eleven different image quality metrics (mentioned in the main text), there was a significant difference between CTD, DTD and SRAD filters with the Canny edge detection status in the common carotid and brachial arteries throughout the cardiac cycle (all P values < 0.001). For example, peak signal to noise ratios (PSNR) using CTD, DTD and SRAD filters were 95.43 ± 0.64, 88.86 ± 0.82 and 73.02 ± 0.20 in common carotid and 96.39 ± 1.25, 92.58 ± 0.11 and 88.27 ± 0.63 in brachial arteries, respectively (both P values < 0.001). CONCLUSIONS: By measuring image quality metrics, this study showed that DTD and CTD filters with the Canny edge detection respectively, are better than SRAD filter with the Canny detection for speckle suppression and details preservation in both arteries in the ultrasound images.

Current approaches of the management of mercury poisoning: need of the hour.

Mercury poisoning cases have been reported in many parts of the world, resulting in many deaths every year. Mercury compounds are classified in different chemical types such as elemental, inorganic and organic forms. Long term exposure to mercury compounds from different sources e.g. water, food, soil and air lead to toxic effects on cardiovascular, pulmonary, urinary, gastrointestinal, neurological systems and skin. Mercury level can be measured in plasma, urine, feces and hair samples. Urinary concentration is a good indicator of poisoning of elemental and inorganic mercury, but organic mercury (e.g. methyl mercury) can be detected easily in feces. Gold nanoparticles (AuNPs) are a rapid, cheap and sensitive method for detection of thymine bound mercuric ions. Silver nanoparticles are used as a sensitive detector of low concentration Hg2+ ions in homogeneous aqueous solutions. Besides supportive therapy, British anti lewisite, dimercaprol (BAL), 2,3-dimercaptosuccinic acid (DMSA. succimer) and dimercaptopropanesulfoxid acid (DMPS) are currently used as chelating agents in mercury poisoning. Natural biologic scavengers such as algae, azolla and other aquatic plants possess the ability to uptake mercury traces from the environment.

Comparison of different edge detections and noise reduction on ultrasound images of carotid and brachial arteries using a speckle reducing anisotropic diffusion filter.

BACKGROUND: Common carotid artery (CCA) ultrasound with measurement of intima-media thickness (IMT) is a safe and noninvasive technique for assessing subclinical atherosclerosis and determining cardiovascular risks. Moreover, the pattern of wall thickening in the brachial artery (BA) is rather diffuse compared to the carotid artery and may be a more sensitive indicator of long-term systemic exposure to risk factors. Therefore noninvasive evaluation of mechanical parameters changes of both arteries has gained the attention of researchers. OBJECTIVES: The aim of this study was to compare different edge detection techniques with speckle reducing anisotropic diffusion (SRAD) de-noising filter in ultrasound images of both arteries. PATIENTS AND METHODS: In a cross-sectional design, an examination was performed on ten men with mean age of 40 ± 5 years from September 2012 to March 2013 through random sampling. An ultrasonic examination of the left CCA and BA was performed. The program was designed in the MATLAB software to extract consecutive images in JPEG format from the AVI. Another program was designed in the MATLAB software to apply regions of interest (ROI) on the IMT of the posterior wall of common carotid and brachial arteries. Next, different edge detections and SRAD filter were applied to the ROI, separately. Finally, the program measured mean-squared error (MSE) and peak signal to noise ratio (PSNR). RESULTS: The lowest values of MSE and highest values of PSNR were achieved by Canny edge detection with de-noising SRAD filter for IMT of left CCA and BA in 90 frames. CONCLUSIONS: Based on the result, by measuring the MSE and PSNR, this study showed Canny edge detection with SRAD filter is better than other edge detections in terms of speckle suppression and details preservation in CCA and BA ultrasound images.