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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Viperidae,Snake Bites,Antivenins,Envenomation Syndrome,Species Specificity
- چکیده:
- چکیده انگلیسی: Background: Despite sharing common evolutionary features, Viperidae species including Echis carinatus and Macrovipera lebetina possess venoms with different proportions of toxic agents, thereby causing clinical effects with potentially variable severity. This study was an effort to differentiate the clinical effects and outcomes of E. c. sochureki and M. l. obtusa victims.
Methods: In this prospective cross-sectional study, snakebite patients treated at a reference poisoning center in northeast of Iran in 2012 were enrolled. The features of snakebite event, demographic and clinical data of patients were recorded in checklists.
Results: Twenty-seven patients (63% male) with mean age of 34.8 ± 18.1 years were included. The offending snakes were recorded as "E. c. sochureki" in 63%, "M. l. obtusa" in 25.9% and "unknown" in 11.1% of cases. The most common clinical findings were fang mark in 100%, local pain in 81.5% and local edema in 74% of patients. Although the victims of both species showed classic features of viper envenoming syndrome including marked local effect and hemostatic disturbances, the victims of M. l. obtusa had significantly higher creatine kinase levels (P = 0.031) and lower platelet counts (P = 0.043), whereas marked edema (> 15cm) was significantly more common in E. c. sochureki victims (P = 0.028). Envenomation severity, other clinical effects and outcomes did not differ between the two species. Patients with delayed presentation to hospital had greater envenomation severity and edema extent and higher rate of coagulopathy.
Conclusions: Species-specific description of clinical effects following snakebite envenoming is useful for syndromic approach to human victims. The clinical envenoming syndromes by E. c. sochureki and M. l. obtusa show many common similarities despite the difference in severity of some effects. The delay in hospital admission and antivenom therapy is a risk for increased severity of envenomation and development of poorer clinical outcomes.
- انتشار مقاله: 25-07-1398
- نویسندگان: Seyed Mostafa Monzavi,Reza Afshari,Ali Reza Khoshdel,Amir Ahmad Salarian,Hamid Khosrojerdi,Azam Mihandoust
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Substance-related disorders,Tramadol,Muscle strength,Paresthesia,Seizure
- چکیده:
- چکیده انگلیسی: Background: Tramadol overdose is relatively common in Iran. A series of tramadol poisoned patients with paresthesia and decreased muscle strength are described.
Methods: In this prospective cross-sectional study, all referred cases to Mashhad Medical Toxicology Center with suspected tramadol poisoning between 1st July 2010 and 1st September 2012 were included. Patients with mixed overdose, history of neurologic and musculoskeletal disorders including primary seizure, and history of addiction were excluded. Patients were visited on admission, 6 and 12 hours later. All cases underwent complete neurologic examination. Muscle strength was assessed with manual muscle testing.
Results: Tramadol overdose accounted for 1026 cases during the study period. Eight hundred eighty nine cases were excluded and finally 137 cases were tramadol only overdose. Most patients (92%) were men. Mean (SD, min-max) age was 24.5 (6.9, 10-42) years. The strength of upper and lower limbs symmetrically declined in the first visit and increased gradually in 6 and 12 hours post-admission, but the strength of lower limbs was more significantly affected on admission and after 6 hours (P < 0.001) compared to upper limbs. Paresthesia happened in 64%, 9% and 0% in upper limbs and 86%, 35% and 3% in lower limbs on admission, and after 6 and 12 hours. No spasticity and flaccidity were observed. On admission, pupils were symmetrically reactive and 6.7 (2.3, 1-11) mm wide. Pupil size significantly declined to 5.6 (2.1, 1.3-9.0) mm 6 hours later (P < 0.001).
Conclusion: Transient paresthesia and transient symmetrical decline in muscle strength of upper and lower limbs are potential neurologic complications following tramadol abuse and overdose. Further studies are needed to fully clarify the pathogenesis and mechanism of these complications following tramadol overdose.- انتشار مقاله: 25-02-1393
- نویسندگان: Khosrow Ghasempouri,Hamid Khosrojerdi,Majid Khadem Rezaiyan
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Iran,Psychiatry,Snake Bite,Acute stress disorder,Post-traumatic stress disorder
- چکیده:
- چکیده انگلیسی: Background: Overwhelming life experiences can trigger stress disorders including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The objective of this study was to investigate the frequency of and predictive factors for ASD and PTSD in snakebite victims.
Methods: In this study, snakebite victims who were admitted to Mashhad Medical Toxicology Centre, Imam Reza Hospital, Iran, from 1st November 2010 to 30th April 2012 were enrolled. Psychiatric symptoms of patients were evaluated after stabilization of patients’ clinical condition. Structured Clinical Interview for DSM-IV Axis I Disorder questionnaire was used for interviewing the patients. Patients underwent 4 scheduled psychiatric interviews on admission, 3 weeks post-bite, 6 weeks post-bite and 6 months post-bite.
Results: Fifty-three patients (74% men) were included in the study with mean (SD) age of 33.6 (15.0) years. Patients were given psychological consultations during the study while they received no psychiatric medication. The set of efforts to avoid activities, places, or people that arouse recollections of the trauma was the most common symptom found in all visits. Re-experience was the most common class of symptoms in all visits. On admission and the 3rd week post-bite, 36% and 15% of patients had ASD. Moreover, 8% of patients developed PTSD and only 4% of patients developed chronic PTSD. ASD on admission (P < 0.001), ASD in 3rd week (P = 0.02) and PTSD (P = 0.01) were developed in patients with significantly younger ages. In addition, the presence of ASD on admission (P < 0.001), ASD in 3rd week (P = 0.003) and PTSD (P = 0.003) was significantly higher in female gender.
Conclusion: Snakebite is not only an emergency medical problem, but also is a traumatic event that can cause stress disorders. It is prudent to refer all snakebite victims, especially women in younger ages, to psychiatric specialist for better evaluation and psychological treatments.
How to cite this article: Khosrojerdi H, Amini M. Acute and Delayed Stress Symptoms Following Snakebite. Asia Pac J Med Toxicol 2013;2:140-4.- انتشار مقاله: 13-05-1392
- نویسندگان: Hamid Khosrojerdi,Mozhgan Amini
- مشاهده