OBJECTIVES: Severe complications of tramadol overdose have been reported; however, few large-scale studies have investigated this issue. Therefore, this study aimed to explore the presentation and complications of tramadol overdose in patients admitted to an intoxication referral center in northwestern Iran.METHODS: Patients with tramadol overdose admitted to Sina Teaching Hospital in Tabriz, Iran during 2013-2017 were included. For each patient, the following data were collected: demographics, previous drug or medication overdose, whether the patient was in the process of quitting drug use, ingested dose of tramadol and co-ingestants, Glasgow Coma Scale (GCS) score, clinical symptoms at the time of admission, and admission characteristics. Serotonin toxicity was diagnosed in patients who fit the Hunter criteria. Multiple logistic regression was performed to identify variables associated with the incidence of severe complications of tramadol overdose.RESULTS: In total, 512 cases of tramadol overdose were evaluated, of which 359 patients were included, with a median age of 41 years (range, 16-69) and a median tramadol dose of 1,500 mg (range, 500-4,000). The most frequent complications associated with tramadol overdose were hypertension (38.4%), tachycardia (24.8%), and seizure (14.5%). No serotonin toxicity was detected in patients. Having a GCS score <15, having taken a tramadol dose of >1,000 mg, being in the process of quitting drug use, being 30-49 years old, and male sex were significantly related to the incidence of severe complications of tramadol overdose.CONCLUSIONS: Although seizure was prevalent among Iranian patients with tramadol poisoning, serotonin toxicity and cardiogenic shock were rare findings.

Introduction: Humans manifest a behavioral inclination towards more utility of one side of the body, in relation with the dominant hemisphere of the brain. The current investigation assessed handedness together with chewing preference which have not been evaluated in various food textures before. Methods: Nineteen young and healthy volunteers chewed hard (walnut) and soft (cake) foods, during surface electromyography recording from masseter muscles. The side of the first and all chews in the two food types were determined and compared with the side of the dominant hand. Results: Results indicated the two lateralities in the same side considerably (60%-70%), implying the solidarity in the control of the dominant hemisphere of the brain. The unilaterality was more prominent in the assessment of all chews in hard food, with higher statistical agreement and correlation. Conclusion: Thereupon masticatory preference is found with probable origins in the dominant hemisphere of the brain.

Background: Pheochromocytomas are rare tumors originating in chromaffin cells which predominantly are located in adrenal glands. Sustained or paroxysmal hypertension (HT) is the most frequent sign of pheochromocytoma. In some cases, it is associated with the classic triad including episodic headaches, sudoresis, and tachycardia; however, we present a case of pheochromocytoma with first presentation of cardiomyopathy. Case presentation: The authors describe a rare case of a pheochromocytoma which was first presented with cardiomyopathy in a 7-year-old patient. The patient was admitted with malaise, abdominal pain, polydipsia, and myalgia. Further evaluations revealed hyperglycemia, mild dehydration and sinus tachycardia but no HT. Echocardiography demonstrated some of the signs of cardiomyopathy which was incorrectly diagnosed as viral myocarditis. The patient was discharged with this diagnosis but he presented again with HT crisis a few months later. A diagnosis of pheochromocytoma was assigned after the evaluation of the HT secondary causes. The diagnosis was confirmed by metanephrine assay and the tumor was localized in the adrenal gland using the abdominal MRI. Conclusion: Pheochromocytoma can present itself with normotensive cardiomyopathy. Therefore, the possibility of pheochromocytoma should be considered in patients with cardiomyopathy especially in those with positive familial history.

The identified studies showed that lisinopril was highly effective for proteinuric kidney disease with a minor but inconsiderable decrease in GFR. Positive effects of lisinopril were demonstrated in seven other off-label uses; however, lisinopril cannot be recommended as the first choice for these until further clinical trials confirm these positive effects.

Numerous successful administrations of this drug in a variety of clinical conditions lead to promising perspectives toward it. Sclerotherapy with polidocanol as a minimal-invasive method (having similar outcomes like the prevalent surgeries) may reduce the rate of complications. Furthermore, for determining the most appropriate method and dosage, randomized clinical trials are needed, confirming and providing more clear instructions for different conditions.