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Hassan Solhi,1 Hossein Sanaei-Zadeh,2 Sadra Solhi,1 Mohammad Ali Azizi Nadian,1 Morteza Gharibi,3 Bahman Sadeghi Sedeh4 1Department of Internal Medicine, Arak University of Medical Sciences, Arak, 2Emergency Room, Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Shiraz University of Medical Sciences, Shiraz, 3Department of Emergency Medicine, Arak University of Medical Sciences, 4Department of Social Medicine, Arak University of Medical Sciences, Arak, Iran Abstract: The present study aimed to evaluate the effectiveness of morphine and meperidine (pethidine) as pain relief in opioid-dependent patients with acute pain. A total of 122 opioid-dependent patients with acute pain were included in the study. Their pain severity was assessed, using visual analog scale (VAS) scores ranging from 0 to 10. The patients randomly received intravenous morphine (up to 0.15 mg/kg) or meperidine (up to 1.5 mg/kg) for pain control by patient control analgesia (PCA) pump. The clinical opioid withdrawal scale (COWS) was employed for the assessment of withdrawal symptoms. The pain relief and the emergence of withdrawal symptoms were measured at 15, 30, and 60 minutes after drug administration. The patients who received morphine reported a better pain control compared to those who received meperidine (mean ± standard deviation [SD] VAS scores 4.11±1.90 vs 5.85±2.08 at the end of the study; P

The aim of this study was to determine the demographic characteristics of burnt children in need of hospitalization, causes of burns and associated complications in Fars province, Iran. This is a retrospective cross-sectional study. Files of all children under 15 years of age who were hospitalized in the only burn referral centre of Fars province were evaluated. Data regarding age, gender, location (urban, rural), burn surface area (BSA), cause of burn, length of hospital stay and complications were extracted from patients' files. Data were analyzed using SPSS, version 22 and the Chi-square test. A p-value of less than 0.05 was considered as statistically significant. A total of 122 patients (54.9% males) were studied. Children from rural areas were hospitalized 1.4 times more often than urban children. Overall, 31.2% of admissions occurred in winter. Burning with hot liquids (scalding) was the most common cause of burns (56.6%, n = 69). Mean BSA was 12.29 ± 21.18% and mean length of hospital stay was 7.59 ± 12.78 days. Burn complications were seen in 19 cases (15.6%). One child died due to inhalational thermal injury. This study showed that burns mostly occur in boys, in the winter and in rural areas of Fars province. Furthermore, scald burns are the most common type of burn injury. Since a significant number of children suffer from permanent complications following burn injuries, special planning is needed to prevent this type of injury. [ABSTRACT FROM AUTHOR]

Aim: Early radiologic evaluations including noncontrast computed tomographic (CT) scan of the brain have been reported to be useful in the diagnosis and management of the intoxicated patients. Changes in the brain CT scan of the acute opium overdose patients have little been studied to date. This study aimed to evaluate changes of the brain CT scans in the acute opium overdose patients. Methods: In this retrospective study, medical records of all acute opium overdose patients hospitalized in Loghman-Hakim Poison Hospital in Tehran, Iran, between September 2009 and September 2010 were identified. Those who had undergone noncontrast brain CT within the first 24 hours of hospital presentation were included. Patients with any underlying disease, head trauma, underlying central nervous system disease, epilepsy, and multidrug ingestion were excluded. The patients' demographic information, vital signs, and laboratory data at presentation were extracted and recorded. The data were analyzed using SPSS software version 17 (SPSS, Chicago, IL). Results: A total of 71 patients were included. Fifty-eight patients (80.5%) survived, and 10 (13.8%) died. Fourteen cases (19.7%) had abnormal CT findings including 8 cases of generalized cerebral edema and 6 cases of infarction/ischemia. There were no statistically significant differences between the patients with and without abnormal CT scan findings with respect to age, sex, systolic and/or diastolic blood pressures, pulse rate, respiratory rate, occurrence of seizures, pH, Pco(2), HCO(3)(-), blood sodium level, and blood glucose level (all P values were > .05). However, a statistically significant difference was found between these patients in terms of outcome (P = .007). Conclusion: Abnormal brain CT findings are detected in about 20% of the acute opium overdose patients who are ill enough to warrant performance of the brain CT scan and associate with a poor prognosis in this group of the patients. [ABSTRACT FROM AUTHOR]

Discusses the adverse effects of intravenous N-acetylcysteine as an antidote for paracetamol poisoning. Early symptoms of paracetamol poisoning; Occurrence of facial flushing; Development of a significant increase in serum transaminase.

In the patients with medication poisoning, diagnosis and treatment may be complicated due to the decreased level of consciousness or lack of the patient cooperation. In this review, we tried to assess the role of ultrasonography in detection of the ingested medication in the stomach of the patients with suspected medication poisoning. Of the studies performed in this regard, only one managed to determine the extended phenytoin capsules in the stomach of a poisoned patient. In actual acute poisoning -- even in the hands of an experienced ultrasonographer -- detection of the medications in the patients' stomach seems to be difficult due to the presence of the food or lack of the water in their stomach. Also, after dissolution of the tablets or capsules or their passage from the pylorus, they can not further been visualized by ultrasound. We, therefore, conclude that ultrasonography is not an appropriate tool for diagnosis of the medication ingestion in acute poisoning. [ABSTRACT FROM AUTHOR]

The article describes the case of a 70-year-old male patient who was bitten by a centipede, Scolopendra spp. which was treated with lidocaine, pentazocine, hydrocortisone, chlorpheniramine, hand elevation and tetanus prophylaxis.

A letter to the editor is presented in response to the article "Lipid Emulsion Improves Glasgow Coma Scale and Decreases Blood Glucose Level in the Setting of Acute Non-Local Anesthetic Drug Positioning-A Randomized Controlled Trial," by E. Taftachi and colleagues in the 2012 issue.

This article describes a case study of shoulder dislocation in a tramadol-intoxicated patient complaining of pain and stiffness of the shoulder after a seizure.

Competing Interests: Conflict of Interests The author has no conflict of interest

Paraquat is a nonselective contact herbicide that has significant importance in clinical toxicology due to its high mortality rate. The cause of mortality in the acute phase of poisoning is a multi-organ failure while in the sub-acute phase is alveolar injury and lung fibrosis. The aim of this study was to evaluate the advantages and drawbacks of mechanical ventilation (MV) in paraquat-induced pulmonary injury and its consequential respiratory failure (PIPI-CRF). This retrospective descriptive analytical study was done to investigate the outcome of patients who had developed PIPI-CRF and underwent conventional treatments with invasive MV in three teaching hospitals in Shiraz, Iran, from March 2010 to February 2015. In total, 44 patients (mean age of 27.9 ± 9.98 years) had undergone MV due to PIPI-CRF. None of the patients had a successful wean off from the ventilator. Although all the patients' were on aggressive life support and full efforts to resuscitate were carried out in case of cardiac arrest, all of them expired. We suggest that in the case of conventional treatment of paraquat poisoning, only noninvasive ventilation should be applied. However, considering the chance of patient's survival performing novel treatments, such as extracorporeal membrane oxygenation (ECMO), lung protective ventilation with optimal positive end-expiratory pressure (PEEP) could be applied only in such circumstances.

Background: Methamphetamine cannot be detected through conventional urine screening tests or other analytical methods in methamphetamine abusers who have not used the drug for some time. In some instances, detection of methamphetamine in fingernails can be a good alternative. We aimed to determine the sensitivity and specificity of the one-step methamphetamine test strip used in the detection of methamphetamine in urine in the detection of methamphetamine in fingernails., Methods: We took 72 fingernail samples, including 60 samples from methamphetamine abusers and 12 samples as controls from their relatives who had no history of methamphetamine use. The liquid-liquid extraction method was used on fingernail samples, and the resultant solution was tested with one-step methamphetamine test strip. We analysed participants' demographics including age, gender, duration of methamphetamine abuse and strip test results., Results: The mean (SD) age of the participants was 25 (4.33) years. The mean (SD) duration of methamphetamine abuse was 10 (4.5) months. Of the 72 participants, 61 (84.7%) had positive and 11 (15.3%) had negative strip test results. All 60 methamphetamine abusers had positive test results. A positive or negative history of methamphetamine abuse was taken as the gold standard. The sensitivity and specificity of the test was 100% and 91.6%, respectively., Conclusion: Performing liquid-liquid extraction on fingernails and using the strip test for detection of methamphetamine is a simple, inexpensive, rapid and accessible method, and its high sensitivity and specificity make it appropriate for screening. This method may be preferred over other urine and blood methamphetamine detection methods when the patient has not used the drug for a few days., Competing Interests: None

Background: Scorpionism is a public health problem in some provinces in Iran. The present study aimed to assess the clinical manifestations of scorpion envenomation in Shiraz and determine a clinical severity grading for Iranian scorpion envenomation in order to suggest a treatment guideline for emergency physicians. Methods: In this analytic retrospective study, all medical charts of patients with scorpion sting admitted in the adult medical toxicology center in Shiraz during July 2012 to July 2016 were assessed. Data regarding the patient's age, gender, sting site, month of envenomation, time of sting, clinical manifestations, vital signs, presence of blood or hemoglobin in urine analysis, duration of admission, color of scorpion, received treatments, and administration of scorpion antivenin were recorded. Results: The scorpions in Shiraz and its suburban area were classified into two groups: yellow scorpions ( Mesobuthus eupeus, Mesobuthus caucasicus , and Compsobuthus matthiesseni ) and Hottentotta scorpions ( Hottentotta jayakari and Hottentotta zagrosensis ). A total of 126 cases of scorpion stings were assessed. About 59% (n=74) were males. The patients aged 8-63 years (mean age, 33.8±11.5 years). About 38.4% (n=48) of the stings occurred during summer. More than 40% of patients (n=51) referred to the emergency department (ED) at night. Localized pain was the most frequent presenting complaint (76.2%). The most frequent general symptom was nausea (6.3%). The most prevalent envenomation site was the lower extremities followed by upper extremities (43.5% and 41.9%, respectively). Based on the clinical severity grading for Iranian scorpion envenomation, 65, 43, and 18 patients (51.6%, 34.1%, and 14.3%) were classified in the grades I, II, and III, respectively. Eighty-one (73%) patients stayed in the ED from 1 to 6 hours, and 30 (27%) patients stayed for >6 hours for observation. Severe localized pain was more prevalent in stings with Hottentotta scorpions than yellow scorpions (P=0.01). The season of envenomation with Hottentotta scorpions was summer in all cases, but envenomation with yellow scorpions was seen throughout the year. All patients received symptomatic treatment, and five were given scorpion antivenin. No death was reported. Conclusion: Hottentotta jayakari is recommended to be listed among the medically important scorpions in Iran. Moreover, scorpion-stung patients in geographical regions where Hemiscorpius lepturus and Androctonus crassicauda are not prevalent may be treated in outpatient departments. The presented grading system can be used for treating patients with scorpion envenomation.

It is occasionally difficult to distinguish between a self-inflicted bruise and true bruise. The important point of diagnosis is a good, thorough history taking and detailed examination of the affected area.