Background:Agonist maintenance therapy with methadone is amongst the preferred remedies for treating opioid dependence and is increasingly supported by the regional governments in this part of the world. In this study we have investigated the clinical manifestations and factors affecting the outcome of therapy in patients with methadone poisoning in a Middle-Eastern (Iranian) referral tertiary care University hospital.Methods:In this prospective and descriptive-analytic study which was done in a tertiary care and referral University hospital in Iran (2012-2013) all of the admitted patients with a clear and reliable history of methadone poisoning (n=433) were included and demographic data, Clinical status on admission including Glasgow Coma Scale (GCS) score, time elapsed from ingestion to hospital admission, average dose of naloxone used, any history of psychiatric disorder, type of toxic exposure, co ingestion of other medication, hospitalization time and the outcome were recorded and statistically analyzed.Results:The average length of hospital stay was 33 ± 26 hours. 80.1% of patients had ingested methadone alone, and 90.3% survived. Complications were pulmonary edema (7%), aspiration pneumonia (1.4%), generalized tonic colonic seizure (0.9%), and renal failure (0.5%). GCS, systolic blood pressure and respiratory rate were lower in fatal cases and GCS had prognostic value for the outcome of therapy in methadone intoxicated patients. Patients with higher GCS on admission had better outcome [OR =0.47 (95% CI: 0.38-0.580); P value< 0.0001].Conclusion:Admission time GCS score maybe considered as an important predictor for the outcome of therapy in methadone poisoning.

Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium), pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery.

Background. Poisoning with tricyclic antidepressants (TCAs) is still a major concern for emergency physicians and intensivists. Concomitant ingestion of other psychoactive drugs especially benzodiazepines with TCAs may make this clinical situation more complex. This study aimed to compare the arterial blood gas (ABG) values and the outcome of treatment in patients with coingestion of TCA and benzodiazepine (TCA + BZD) poisoning and TCA poisoning alone. Methods. In this cross-sectional study which was carried out in a tertiary care university hospital in Iran, clinical and paraclinical characteristics of one hundred forty TCA only or TCA + BZD poisoned patients (aged 18–40 years) were evaluated. ABG analysis was done on admission in both groups. Outcomes were considered as survival with or without complication (e.g., intubation) and the frequency of TCA poisoning complications. Results. Arterial pH was significantly lower in TCA + BZD poisoning group compared with TCA only poisoning group (7.34 ± 0.08 and 7.38 ± 0.08, resp.; P = 0.02). However, other complications such as seizure, and the need for the endotracheal intubation were not significantly different. All patients in both groups survived. Conclusions. Concomitant TCA plus BZD poisoning may make the poisoned patients prone to a lower arterial pH level on hospital admission which may potentially increases the risk of cardiovascular complications in TCA poisoning.

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Introduction: The role of urinary neutrophil gelatinase-associated lipocalin (NGAL) as a prognostic biomarker in acute kidney injury (AKI) associated with coronary bypass graft has been suggested in some studies. However, the results have been inconclusive in different studies. Objectives: In the present research, we investigated the diagnostic and prognostic roles of NGAL in Iranian patients who developed AKI after coronary bypass surgery. Patients and Methods: This study was cross-sectional conducted on adult patients undergoing coronary artery bypass graft (CABG) surgery. Postoperative AKI was defined based on the RIFLE (risk, injury, failure, loss and end-stage kidney disease) criteria. Patients were divided into AKI and non-AKI groups. The urinary NGAL and serum creatinine levels were measured at different times after surgery. Results: Out of 29 patients, men constituted 75.9% of cases. Mean age of the patients was 61.4±7.7 years old and the mean duration of surgery was 4.9±0.6 hours. Based on serum creatinine, AKI was diagnosed in 37.9%, 17.25%, and 13.8% of patients at first, second, and third day post-surgery, respectively. The urine NGAL increased by 48.35% and 34.5% at 2 and 6 hours after surgery, respectively. However, there was no significant association between the urinary NGAL level and the incidence of post-surgery AKI. Conclusion: This study showed that urinary NGAL was inapplicable to independently diagnose or predict the outcome of transient AKI associated with CABG.