An epidemiological study of poisoning cases in Babol (northern Iran) from 2015 to 2018

BACKGROUND

Poisoning is a major public health problem that constitutes a significant share of the global burden of disease. Previous studies conducted in this area indicated the importance of such epidemiological studies. The most critical impact of these studies is their effect on changing current regulations and, therefore, decreasing poisoning cases. We aimed to evaluate all poisoning cases with regard to the patients' demographics and the involved intoxicants.

METHODS

The present study was conducted to investigate all poisoning cases who were admitted during a three-year period. Causes of poisoning, hospitalization, management procedures and outcome of the cases were surveyed. A total of 1448 patients referred to Shahid Beheshti Hospital (Babol, Iran) from 2015 to 2018.

RESULTS

More than half of the patients were females (51.7%), and the majority of poisoning cases were seen in patients aged between 15 to 25 years (34.2%). It was found that suicide made a large part of poisoning cases (65.6%), and females tend to attempt suicide more than males (64.3% vs. 35.7%, respectively). Also, regular drugs followed by club drugs were the most abundant toxic agents (52.1% and 23.3%, respectively). Aluminum phosphide (AlP) was the most lethal intoxicant in our study, accounting for 68.2% of all deaths.

CONCLUSION

According to the results, it is concluded that the existing regulations for drug control and suicide prevention have not been efficient enough and further actions yet to be made to reduce the consequences of drug- and non-drug-related toxicities.

Insulin within the Arcuate Nucleus Has Paradoxical Effects on Nociception in Healthy and Diabetic Rats

Introduction

Broad neural circuits originate from the hypothalamic arcuate nucleus and project to many parts of the brain which are related to pain perception. Insulin receptors are found in the arcuate nucleus. Since nociception may be affected in type 1 diabetes, the present study aimed to investigate the intra-arcuate nucleus insulin role in pain perception in streptozotocin (STZ)-induced diabetic and healthy rats.

Methods

Regular insulin was microinjected within the arcuate nucleus and the pain tolerance was measured using the hot plate and the tail-flick apparatus in diabetic rats.

Results

The results showed that the arcuate nucleus suppression with lidocaine could increase thermal nociception in non-diabetic animals. Also, insulin within the arcuate nucleus decreased the acute thermal pain perception in these animals. STZ-induced diabetes produced hypoalgesia which the latency of these tests, progressively increased over time after induction of diabetes. Also, in the same animal group, intra-arcuate injection of insulin reduced the latency of nociception.

Conclusion

Intra-arcuate insulin has paradoxical and controversial effects in healthy and diabetic rats' nociception. These effects seem to be due to the insulin effect on releasing proopiomelanocortin and its derivatives.

Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis

BACKGROUND

Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard.

METHODS

A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty. They were divided into four groups: Group D (n = 15) received 8 mg dexamethasone, group T (n = 15) received 10 mg/kg tranexamic acid, group DT (n = 15) received both 8 mg dexamethasone and 10 mg/kg tranexamic acid, and group P (n = 15) received neither medication and served as the placebo control group. The medications were given intravenously (IV) 1 h before and three doses every 8 h postoperatively. Digital photographs were taken on the first, third and seventh postoperative days. One expert examiner blinded to the study evaluated the periorbital edema and ecchymosis on a scale of 0-4. Periorbital edema and ecchymosis were examined in all groups.

RESULTS

In group D, group T and group DT, periorbital edema and ecchymosis ratings were significantly lower compared with the control group (p < 0.01). No statistically significant difference was seen in preventing or decreasing both periorbital edema and ecchymosis among group D, group T and group DT.

CONCLUSION

Tranexamic acid and dexamethasone, separately or in combination, had similar effects in reducing periorbital edema and ecchymosis in open rhinoplasty. Combined application did not show a significantly higher beneficial effect in this regard.

LEVEL OF EVIDENCE III

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Efficacy of alum for treatment of recurrent aphthous stomatitis

BACKGROUND

Recurrent aphthous stomatitis (RAS) is the most common painful ulcers of oral mucosal which can cause many sufferings. Treatment of RAS often includes administration of corticosteroids, analgesics and regulators of the immune system. However, considering the side effects of these medications, even their topical application must be done with caution. Alum is used in traditional medicine for treatment of oral ulcers without significant side effect. This study sought to assess the effect of topical application of alum on aphthous ulcers.

METHODS

This clinical randomized double-blind placebo-controlled study was conducted on 50 females aged 21 to 27 years. Mucosal adhesive patches were prepared in two forms of basic and 7% alum-containing patches. Subjects in two groups of case and control randomly received the mucosal adhesive patches containing alum and the basic patches, respectively three times in five days. Duration of recovery, changes in size of lesion and severity of pain were recorded. Data were entered into SPSS Version 16 and analyzed using t-test.

RESULTS

The average period of full recovery was 7.52 days in the case and 12.2 days in the control groups; which was significantly different (p<0.001). Size of wound and severity of pain were significantly lower at one, three and five days posttreatment compared to baseline values before treatment in the case group (p<0.001) and the difference in this regard between the case and control groups was statistically significant.

CONCLUSION

Alum can significantly decrease the size of aphthous lesions, severity of pain and expedite the recovery of patients with RAS.

Comparison of pyridostigmine and bisacodyl in the treatment of refractory chronic constipation

BACKGROUND

Treatment of chronic constipation is creating one of the major problems for doctors and patients. Pyridostigmine increases the gastrointestinal motility through the effects on cholinesterase. It seems that this mechanism can reduce chronic constipation. The aim of this study was to compare the effects of pyridostigmine and bisacodyl on chronic constipation.

METHODS

This study was conducted on 68 patients who suffered from chronic constipation. Patients were randomly divided into two groups of Pyridostigmine and bisacodyl in which each consisted of 34 patients, respectively. Bristol stool form score, straining defecation, the time of defecation, the number of defecation per week, sense of incomplete evacuation and self-digitation were collected by means of questionnaires and the data were compared.

RESULTS

Sixty-eight patients with the mean age of 68.12±84.49 were studied. The mean difference in the frequency of defecation per week, VAS score, the time to defecation and the Bristol Stool form Scale in pre and post-treatment were 4.33±1.88, 5.96±2.29, 12.30±7.95 min and 2.10±0.95 in pyridostigmine group and 2.96±1.81, 4.06±2.22, 6.67±5.23 min and 1.41±0.84 in bisacodyl group, respectively. The significant difference was observed in both pyridostigmine and bisacodyl groups (P=0.005, P=0.002, P=0.002 and P=0.005, respectively). 60% and 32.3 of patients in pyridostigmine and bisacodyl groups recovered from self-digitations, respectively. In pyridostigmine and bisacodyl groups, 66.7% and 32.3 of them had improvement in the sense of incomplete defecation, respectively.

CONCLUSION

Pyridostigmine and bisacodyl significantly improved the symptoms of chronic constipation similarly.

Effect of zinc-deficient nutrition on craniofacial bone growth in rats

BACKGROUND

Zinc (Zn) is an essential nutrient that is required in humans and animals for the growth, development, and maintenance of healthy bones. The aim of this study is to investigate the effects of zinc-deficient nutrition on the dental, mandibular, maxillary, and cranial dimensions of rats.

MATERIALS AND METHODS

This experimental study was carried out on 14 male Wistar rats. The rats were randomly divided into two groups. Group I rats were fed with a Zn-deficient (ZD) diet, and Group II rats with a Zn-containing (ZC) diet. All the rats on the experimental diet were killed at the end of the fourth week and their blood samples were taken. The serum Zn levels were measured by an atomic absorption spectrophotometer. Radiographic assessment of the jaw bone density was done at the end of the study. Subsequently, the final measurements were made on the dry skulls, the mandibles, and teeth in both the groups. Statistical evaluation was performed by the student's t-test and repeated measures analysis. The difference between the groups was considered statistically significant if P < 0.05.

RESULTS

The ZD group showed a significantly lower value in body weight (P < 0.05), serum level of zinc (P < 0.0001), and radiographic bone density of the mandible (P = 0.02). With regard to the craniofacial parameters, a significant difference was observed only in the length of the clinical crowns of the teeth (L13), which were longer in group II as compared to group I (P = 0.03).

CONCLUSION

This study confirmed that changes in zinc intake could not affect the growth of craniofacial structures. Also, it might change the radiographic bone density of the mandible.

Effect of zinc-deficient diet on oral tissues and periodontal indices in rats

Zinc (Zn) as a nutritional factor affects the health of the oral tissues. This study was done for the evaluation of the effects of zinc deficiency on the oral tissues of rats. The study was carried out on 14 male Wistar rats, cessation of lactation on the 24(th) day after birth. The rats were randomly divided into two groups. Zinc deficient (ZD) diet was used for one group and another group was fed with a zinc-containing (ZC) diet. The alterations of the oral tissues in both groups were evaluated clinically after four weeks. Also the gingival index and periodontal pocket depth were recorded. The measurement of serum zinc level was done by atomic absorption spectrophotometry. The microscopic slides of oral tissue specimen were evaluated quantitatively. The serum zinc level of the ZD rats was lower than the ZC group (p< 0.001). According clinical findings, the gingival index was lower in ZC rat (p=0.001), but there was no significant difference regarding the periodontal pocket depth between two groups (p=0.07). Aphthous ulcer was observed in ZD rats on the floor of the mouth. There was no significant difference regarding the epithelial and keratin thickening between two groups. This study indicated that oral and periodontal health was better in ZC rats than in ZD rats. Aphthous lesions were more prominent in ZD rats. This study confirmed that zinc deficiency may endanger oral and periodo ntal structures.

The efficacy of a paste containing Myrtus communis (Myrtle) in the management of recurrent aphthous stomatitis: a randomized controlled trial

Recurrent aphthous stomatitis (RAS) is a common, painful, and ulcerative disorder of the oral cavity with unknown etiology. Treatment is a highly controversial topic. The aim of this study was to evaluate the clinical efficacy of a novel paste containing Myrtus communis (Myrtle) in the treatment of recurrent aphthous stomatitis. Myrtle is a particular herb used in some cultures as treatment for mouth ulcers. The study was a randomized, double-blind, controlled before-after clinical trial. Forty-five patients with RAS randomly participated in this study. The subjects were treated with placebo paste and myrtle oral paste in two consecutive episodes. The paste was applied by subjects themselves four times a day for 6 days. Five parameters (size change, pain scale, erythema and exudation level, oral health impact profile, and patient overall assessment of their treatment) were recorded both before (baseline) and during each episodes of treatment (on the morning of days 2, 4, and 6). There were no statistically significant differences between baseline parameters (p > 0.05). The data indicated a statistically significant reduction of ulcer size (p < 0.001), pain severity (p < 0.05), and erythema and exudation level (p < 0.001). Oral Health Impact Profile improved significantly in the treatment group (p < 0.001). Patient overall assessment of their treatment improved after applying paste containing myrtle (p < 0.05). No side effects were reported. This study has shown myrtle to be effective in decreasing the size of ulcers, pain severity and the level of erythema and exudation, and improving the quality of life in patients who suffer from RAS.

The effect of topical application of pure honey on radiation-induced mucositis: a randomized clinical trial

AIM

Radiation-induced mucositis is an early effect of head and neck radiotherapy. Mucositis can cause ulcers, and patients may experience pain and dysphasia which need treatment. The aim of this study is to evaluate the effect of pure natural honey on radiation induced mucositis.

METHODS AND MATERIALS

In this randomized single blind (examiner blind) clinical trial 40 patients with head and neck cancer requiring radiation to the oropharyngeal mucosa were randomly assigned to two groups. Twenty patients assigned to the study group received honey, while both the study and control groups received standard head and neck radiation therapy based on a standard protocol. In the study group patients were instructed to take 20 ml of honey 15 minutes before radiation therapy, then again at intervals of 15 minutes and six hours after radiation. In the control group patients were instructed to rinse with 20 ml of saline before and after radiation. Patients were evaluated weekly for progression of mucositis using the Oral Mucositis Assessing Scale (OMAS). Data were analyzed using the independent t-test, Mann-Whitney, and Friedman tests.

RESULTS

A significant reduction in mucositis among honey-received patients compared with controls (p=0.000) occurred.

CONCLUSION

Within the limits of this study the results showed the application of natural honey is effective in managing radiation induced mucositis.

CLINICAL SIGNIFICANCE

Natural honey is a product with rich nutritional qualities that could be a pleasant, simple, and economic modality for the management of radiation mucositis.