Aluminium phosphide (ALP) is one of the most commonly used pesticides worldwide with high mortality rates. Cellular damage and cardiorespiratory failure are the most common causes of mortality and morbidity after poisoning. It is supposed that giving enough time to the patient to survive, the most critical hours after exposure may help the cardiovascular system to recover itself and save the patient's life. During a training workshop for medical extracorporeal membrane oxygenation (ECMO), a 28-year-old ALP-poisoned male was referred to us. Fifty minutes after admission, he developed hypotension and bradycardia and was transferred to ICU. On the second venous blood gas, he had severe metabolic acidosis. After starting the patient on the routine treatment of ALP poisoning, he was a candidate for veno-arterial (VA) ECMO. After three days, lactate level decreased and his general condition improved. On day four, the patient was completely separated from the ECMO machine with acceptable echocardiography and ejection fraction of 40%. One day later, he was extubated, sent to the ward and subsequently discharged in good condition. We suggest this method of treatment for severe ALP poisoning as well as any other poisoning that causes cell toxicity and abrupt cardiovascular or respiratory failure.

BackgroundMethamphetamine (meth) is a stimulant used illegally around the world, including in Iran. Cardiomyopathy and cardiac failure may occur following chronic meth use and may cause the patients referred to the emergency department.Case reportsA 28-year old man and two women, ages 29 and 31-year-old, with a history of meth use, were admitted to the emergency department with severe dyspnea at rest. Each had sinus tachycardia with tachypnea and an echocardiogram that showed severe systolic dysfunction consistent with heart failure. Additional evaluation in the hospital revealed cardiomyopathy with no other etiology other than the meth use.ConclusionThere are several reports that show an increase in frequency of meth use, suggesting that cardiomyopathy and acute heart failure may be a new medical concern.

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Fibromuscular Dysplasia (FMD) is a sporadic non-atherosclerotic disease. FMD has been established in nearly every arterial bed. However, the most frequent arteries affected are the renal and carotid arteries. Disease presentation may vary broadly, depending upon the arterial bed complication and the severity of illness. Hypertension, particularly resistant type, headache and dizziness are the most common presentations. String of beads appearance in angiographic views due to post-stenotic aneurysms is the characteristic view. It is most commonly described in young aged females; but in rare male cases has also been reported. Moreover, balloon angioplasty is standard and effective therapy for FMD. We present a young 28-year-old man who was referred for evaluation of resistant hypertension for nearly 3 years without comprehensive workup. The patient underwent renal artery angiography which confirmed beading narrowing of the right renal artery with significant stenosis at mid portion compatible with FMD; and balloon angioplasty was done. This case highlights that FMD should be kept in mind as a rare cause of resistant hypertension in young males; although it is most common in young females.

Introduction: High level of vitamin D is associated with a better health status. The role of vitamin D deficiency in the incidence of cardiovascular events is demonstrated in previous studies. The current study aimed at evaluating the effect of vitamin D supplement therapy on serum lipids profile, as a risk factor for cardiovascular diseases. Methods: The current prospective cohort study included 221 patients admitted to a university hospital from March 2014 to March 2015. The baseline levels of the patients′ serum vitamin D and lipid profile of the study subjects were recorded. After three months treatment with vitamin D, the patients′ serum vitamin D level and lipid profile were reevaluated. The results before and after the supplement therapy were compared using statistical methods. Results: The mean age of the patients was 48.2 ± 14.0 years. The mean vitamin D level was 21.0 ± 16.6 ng/mL at baseline, which increased to 35.8 ± 32.7 ng/mL (P = 0.001) after a three-month vitamin D supplement therapy. Mean low-density lipoprotein (LDL) decreased from 112.1 ± 30.0 to 98.7 ± 31.7 mg/dL (P = 0.003) after the supplement therapy. Mean high-density lipoprotein (HDL) increased from 42.8 ± 11.2 to 44.5 ± 9.0 mg/dL, but the difference was insignificant before and after the treatment (P = 0.2). Mean cholesterol reduced from 183.8 ± 42.3 to 169.5 ± 41.9 mg/dL (P = 0.02) and the mean TG dropped from 147.5 ± 98.7 to 134.7 ± 71.1 mg/dL, (P = 0.1) after vitamin D intake. Conclusions:The mean levels of LDL and cholesterol significantly decreased during the three-month intervention; in addition, although some changes were observed in the level of HDL and TG, the differences were statistically insignificant. Further studies on larger sample sizes and longer follow-ups are recommended.