Objective:Suicide is the second major reason of death in the age range of 15-24 and is the eighth reason for overall death of adults. Because of high accessibility of people to different medications in our society, one of the easiest ways for suicide is intentional self-poisoning with medications. Therefore, the aim of this study was to determine the rate of suicide with respect to influencing social factors on patients with intentional self-poisoning.Methods:This was an analytic-descriptive prospective study. All study data were collected through a checklist in patients with intentional self-poisoning who had been referred to referral hospital within 2011-2012.Findings:A total of 400 patients (60% female) were evaluated. Age average ± standard deviation of participants was 22.57 ± 9.20 years. About 78.2% had high school degree or less. Nearly 27.8% of all happened suicides take place as a result of family disputes, marital problems (21%) and poverty (11.5%). Love issues with a rate of 10.3% were set in the next step. About 23.2% had a history of a past psychological disorder. Around 97.5% of the patients survived. The shorter the time of hospitalization is for each patient, the better survival rate is obtained through post-suicidal medical care. A statistically meaningful relationship was observed between self-poisoning to commit suicide and absence of academic education (P = 0.02).Conclusion:Suicide attempt through self-poisoning is more common in female, married individuals, people without academic education and those with a poor socio-economic status. Furthermore, results announce family disputes as the most pre-disposing factor for suicide.

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.

Gabapentin is a common drug used as analgesic and anticonvulsant and also is prescribed for insomnia, depression, obsessive – compulsive disorder and panic attack. We report a case of a 48-year-old man who is prescribed gabapentin because of insomnia, headache, and depressed mood. In the first period of using the drug no complication has been seen. However in the next period, side-effects such as hyperesthesia, scaling and severe localized edema has been observed. After several laboratory tests and imaging, no reason was found for his edema. And after discontinuing gabapentin the pain and edema was quite relieved. We found out the brand of the drug has been switched in the second stage. The point which makes our study special is the incidence of side-effects such as severe edema, scaling and hyperesthesia for the first time because of using gabapentin and changing the drug combination.

Background and AimThe most common complication of renal transplantation is allograft dysfunction, which in some cases leads to graft loss. The role of graft nephrectomy in the management of transplant failure is controversial. The procedure remains associated with a significant morbidity and also mortality. Our main purpose was the comparison between clinical and pathological diagnosis of graft nephrectomy.Patients and MethodsThe documents of 88 patients who admitted for graft nephrectomy in Shariaty hospital for the last 25 years were reviewed. Slides of graft pathology were revised by an individual nephropathologist. Data was analyzed by SPSS 18 using ANOVA and Chi-square tests.ResultsThe percentages of clinical diagnoses for the graft nephrectomy are: chronic rejection (38%), graft infection (26%), gross hematuria (10%), acute rejection (10%), accelerated rejection (8%), hyper-acute rejection (4%) and thrombosis of the renal artery (4). On the other hand, the pathological diagnoses are: necrosis concomitant with thrombosis (35%), only necrosis (26%) and 5 (3) concomitant with 4 (3) in 16% of cases that means severe interstitial atrophy and fibrosis adjacent with acute cellular rejection and intramural vasculitis.ConclusionsPathology included necrosis in about half of the graft nephrectomized patients. If the panel reactivity test is negative preoperatively, and there is no absolute indication for the operation, one may abstain from graft nephrectomy to save the patient, the morbidity and even the mortality of the procedure. On the other hand, the advantages of leaving the graft in situ are erythropoietin production, hydroxylation of calcidiol and maintenance of some residual diuresis.

Oral ingestion is the most common method of paraquat poisoning. 1 Intramuscular (IM) paraquat injection is extremely rare. 2, 3 We wish to highlight the clinical presentation of such a case and illustrate delays in urine test positivity for paraquat in this situation.A 25-year-old female was referred to the clinical toxicology department of Noor General Teaching Hospital, Isfahan (Iran), 5 hours after deliberate IM injection of 15 ml of 20% paraquat into her buttocks.On admission, she was fully conscious and had normal vital signs, but complained numbness in her four extremities and muscle pain in lower extremities. The only abnormal physical fi nding were two 5 -10-cm-diameter injection sites, blue-purple discoloration of the skin in her both gluteal areas.Initial blood count, clotting, electrolytes, and LFTs were normal. The result for a semiquantitative color intensity test (sodium dithionite) on urine performed on admission was negative.Three hours after admission (about 8 hours after the initial injection), the sodium dithionite urine test became positive but not dark blue. Hemodialysis was implemented empirically, and after the fi rst 4 hours of hemodialysis the sodium dithionite urine test was repeated and was now dark blue. By the fi rst day, she developed shortness of breath, dull chest pain, and restlessness; the size of the injection sites enlarged and became painful. By the second day, the patient developed signs of progressive renal and hepatic failure, and severe dyspnoea. Serial coagulation studies became worse in subsequent tests parallel to deterioration of patient general condition.The patient died from severe hypoxemia at 41 hours subsequent to injection.The course of toxicity was as might be expected and, as previously reported, rapid. The lack of positivity of urine tests soon after a potential IM injection of paraquat is worthy of note in those countries where this herbicide is still available.