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Objective To describe an outbreak of lead poisoning among opium users in the Islamic Republic of Iran and estimate the number of affected people in the country. Methods We used data from the country's largest poison treatment centre to illustrate the epidemiology of an outbreak of lead poisoning in oral opium users. We describe the government's referral and treatment guidelines in response to the outbreak. Based on the number of individuals treated and previous studies on the prevalence of oral opium use we estimated the total number of people at risk of lead-contaminated opium nationwide. Findings In February 2016, we noticed a steep increase in the numbers of oral opium users referred to our poison treatment centre with abdominal pain, anaemia and constipation. Numbers peaked in June 2016 but the outbreak was ongoing in August 2017. The mean blood lead level in a sample of 80 patients was 140.3 [micro]g/dL (standard deviation: 122.6). Analysis of an illegal opium sample showed 3.55 mg lead in 1 g opium. Treatment was exposure reduction with opioid substitutes and laxatives, or chelation therapy if indicated. Over 7 months, 4294 poison cases were seen at main referral hospitals in Tehran out of an estimated 31 914 oral opium users in the city. We estimate more than 260000 out of 773 800 users nationwide remain untreated and at risk of poisoning. Conclusion Lead-contaminated opium and heroin that has transited through the Iranian markets is a global risk and highlights a need for better monitoring of illegal drug supplies. Objectif Decrire la vague d'intoxications au plomb survenue chez les consommateurs d'opium en Republique Islamique d'Iran et estimer le nombre de personnes concernees dans le pays. Methodes Nous avons utilise les donnees du plus grand centre antipoison du pays pour illustrer l'epidemlologie d'une vague d'intoxications au plomb survenue chez les consommateurs d'opium par vole orale. Nous decrivons les directives du gouvernement en matiere de traitement et d'orientation vers des services specialises suite a cette flambee. A partir du nombre de personnes traitees et de precedentes etudes sur la prevalence de la consommation d'opium par vole orale, nous avons estime le nombre total de personnes susceptibles de consommer de l'opium contamine au plomb dans le pays. Resultats En fevrier 2016, nous avons constate une forte augmentation du nombre de consommateurs d'opium par voie orale orientes vers notre centre antipoison avec des douleurs abdominales, une anemie et une constipation. Cette hausse a culmine au mois de juin 2016 mais la vague se poursuivait en aout 2017. La plombemie moyenne, sur un echantillon de 80 patients, etait de 140,3 pg/dL (ecart type: 122,6). L'analyse d'un echantillon d'opium illicite a revele la presence de 3,55 mg de plomb dans 1 g d'opium. Le traitement a consiste a reduire l'exposition et a prendre des substituts aux opiaces et des laxatifs, ou des agents chelateurs lorsque cela etait indique. Sur 7 mois, 4294 personnes intoxiquees ont ete recues dans les principaux hopitaux centraux de Teheran, sur un total estime de 31 914 consommateurs d'opium par vole orale dans la ville. Nous estimons que plus de 260 000 consommateurs sur 773 800 dans le pays n'ont, a ce jour, pas recu de traitement et courent un risque d'Intoxication. Conclusion L'opium contamine au plomb et l'heroine qui ont transite sur les marches iraniens representent un risque mondial et mettent en avant la necessite de mieux controler l'offre de drogues illicites. Objetivo Describir un brote de intoxicacion con plomo entre consumidores de opio en la Republica Islamica del Iran y estimar la cantidad de personas afectadas en el pais. Metodos Utilizamos datos del centro de tratamiento de Intoxicaciones mas grande del pais para ilustrar la epidemiologia de un brote de intoxicacion con plomo en consumidores de opio por via oral. Describimos la referencia y orientaciones de tratamiento del gobierno en respuesta al brote. Basado en el numero de individuos tratados y estudios anteriores sobre la prevalencia del uso de opio por via oral, estimamos el numero total de personas en riesgo por el opio contaminado con plomo a nivel nacional. Resultados En febrero de 2016, advertimos un aumento pronunciado en los numeros de consumidores de opio porvia oral remitidos a nuestro centro de tratamiento de intoxicacion con dolor abdominal, anemia y constipacion. Los numeros tuvieron un pico en junio de 2016 pero el brote fue continuo en agosto de 2017. La media del nivel de plomo en sangre en una muestra de 80 pacientes fue 140.3 pg/dL (desviacion estandar: 122.6). El analisis de una muestra ilegal de opio mostro 3.55 mg de plomo en 1 g de opio. El tratamiento fue la reduccion de la exposicion con sustitutos de opio y laxantes, o terapia de quelacion si se indico. Durante 7 meses, 4294 casos de intoxicacion se atendieron en hospitales principales de referencia en Teheran de un estimado de 31914 consumidores de opio por via oral en la ciudad. Estimamos que mas de 260000 de 773 800 consumidores en toda la nacion continuan sin tratamiento y en riesgo de intoxicacion. Conclusion El opio y la heroina contaminados con plomo, que transito a traves de los mercados iranies, es un riesgo global y destaca la necesidad de un mejor control de los suministros de droga ilegal. [phrase omitted], Introduction Substance abuse is an important social and public health problem in the Islamic Republic of Iran. The country has a long and porous border with Afghanistan, the main producer [...]

Background Ketamine is traditionally avoided in sedation management of patients with risk of intracranial hypertension. However, results from many clinical trials contradict this concern. We critically analyzed the published data of the effects of ketamine on intracranial pressure (ICP) and other cerebral hemodynamics to determine whether ketamine was safe for patients with hemodynamic instability and brain injuries. Methods We systematically searched the online databases of PubMed, Medline, Embase, Current Controlled Trials, and Cochrane Central (last search performed on January 15, 2014). Trial characteristics and outcomes were independently extracted by two assessors (Xin Wang, Xibing Ding). For continuous data, mean differences (MD) were formulated. If the P value of the chi-square test was >0.10 or [I.sup.2] Results Five trials (n = 198) met the inclusion criteria. Using ICP levels within the first 24 h of ketamine administration as the main outcome, the use of ketamine leads to the same ICP levels as opioids [MD = 1.94; 95% confidence interval (95% CI), -2.35, 6.23; P = 0.38]. There were no significant differences in mean arterial pressure values between the two groups (MD = 0.99; 95% CI, -2.24, 4.22; P = 0.55). Ketamine administration was also comparable with opioids in the maintenance of cerebral perfusion pressure (MD = -1.07; 95% CI, -7.95, 5.8; P = 0.76). Conclusions The results of this study suggest that ketamine does not increase ICP compared with opioids. Ketamine provides good maintenance of hemodynamic status. Clinical application of ketamine should not be discouraged on the basis of ICP-related concerns. Keywords Ketamine * Opioids * Intracranial pressure * Hemodynamic instability * Brain injuries, Introduction Patients with or at risk of neurological injury are associated with elevated intracranial pressure (ICP), which could lead to secondary cerebral injury and poor outcome [1]. Several medicines are [...]

Management of chronic noncancer pain (CNCP) requires a comprehensive assessment of the patient, the Institution of a structured treatment regimen, an ongoing reassessment of the painful condition and Its response [...]

Both chronic pain and prescription opioid abuse are prevalent and exact a high toll on patients, physicians, and society. Health care professionals must balance aggressive treatment of chronic pain with [...]

Opiate analgesics have been used by humans for thousands of years and are the longest continuously used class of medications. The recent increased interest in opiates (drugs derived from opium) [...]