Treatment of high dose of intravenous midazolam abuse: a case report

This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.

Prevalence of mental disorders among middle-aged population of primary healthcare centers in Northeastern Iran

BACKGROUND

Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders.

METHODS

This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22.

RESULTS

This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45-60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant.

CONCLUSIONS

Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community.

Addressing food insecurity: An exploration of wheat production expansion

Wheat plays a crucial role in global food security, serving as a vital food crop that feeds billions of people worldwide. Currently, Russia and Ukraine are responsible for exporting approximately 25% of the world's wheat, making any issues in these regions a cause for concern regarding global wheat supply. The problems faced in these areas have led to a surge in wheat prices worldwide. Consequently, it becomes necessary to explore alternative regions that can compensate for the decline in wheat production and supply. This study focuses on wheat production and yield in major producing countries, utilizing the GYGA (Global Yield Gap Atlas) protocol for predictions. The findings reveal a global wheat production gap of 270,378,793 tons. Notably, the largest gap in irrigated wheat production exists in countries like China, India, Pakistan, Turkey, Iran, Afghanistan, Uzbekistan, Egypt, and Azerbaijan. Additionally, the rainfed wheat production gap on a global scale amounts to 545,215,692 tons, with Russia, the USA, Kazakhstan, Australia, Ukraine, China, Turkey, Canada, India, and France having the most significant production gaps. Through boundary line analysis, specific criteria were identified for suitable areas of irrigated and rainfed wheat cultivation. For irrigated conditions, the temperature range of 3000 to 7000 GDD (Growing Degree Days) and a temperature seasonality of 3 were determined as favorable. Under rainfed conditions, the suitable areas encompass a temperature range of 2000 to 4000 GDD, an aridity index exceeding 600, and a temperature seasonality of 2. Thirteen countries possess extensive agricultural land within the climatic codes favorable for irrigated wheat cultivation. Approximately 50% of the agricultural lands within these countries, corresponding to the total arable area for irrigated wheat, fall within the climatic codes 3403, 5403, 5303, 4303, 5503, 5203, 3503, 3303, and 4103. China, the United States, Ukraine, Russia, and Iran are the top five countries with favorable lands for irrigated wheat cultivation. Similarly, fourteen countries have significant agricultural lands within the favorable climatic codes for rainfed wheat cultivation. Around 52% of the agricultural lands within these countries are within the climatic codes 3702, 2702, 2802, and 4602. France, Germany, Britain, Poland, and Denmark possess the highest potential to expand rainfed wheat cultivation areas within these favorable climate codes, with respective areas of 2.7, 2.6, 1.6, and 0.9 million hectares. According to the study, the North China Plain emerges as a primary region for increasing irrigated wheat production, both in terms of cultivated area and yield potential. For rainfed conditions, the European continent stands out as a significant region to enhance wheat production.

Global insight into understanding wheat yield and production through Agro-Ecological Zoning

Global food security requires food production to be increased in the future decades. Agro-Ecological Zones (AEZ) methodology is a successful approach used in land evaluation studies to support sustainable agricultural development. This approach can facilitate finding suitable areas for wheat production on a global scale. This study was conducted based on a climate zone map, soil data, wheat cultivation area, yield, and production under irrigated and rainfed conditions, worldwide. The results for irrigated wheat indicated that there is an area of 59.5 Mha with an average yield of 4.02 t/ha which leads to the production of about 239.6 Mt of grain yield. Furthermore, climate zones (CZs) of 8002, 5203, 5302, 5403, and 8102 have the highest wheat production with an average of 20.7, 14.2, 13.3, 11.8, 11.5 Mt, respectively. The highest amount of irrigated wheat production has been achieved in soil type code 17 (Loam LF120), which has a cultivation area of around 23.6 Mha and a production of about 106.8 Mt. Rainfed wheat production is 410 Mt, and the cultivation area is 160.2 Mha. The highest rainfed wheat production with an average of 17 Mt was related to the 3702 CZ, followed by the other CZs (3802, 1303, 1203, 3602, 4602, etc.). The soil codes 11 (Loam HF120), 10 (Loam HF180), and 14 (Loam MF120) showed the highest rainfed wheat production. The findings of this study can be useful for agricultural scientists, authorities, and decision-makers around the world to find suitable lands to expand wheat cultivation and also to find new locations for increasing global wheat production to feed the increasing population in the world.

Effect of temperature and propylene glycol as a cosolvent on dissolution of clotrimazole

Herein, the solubility study of clotrimazole was performed in a propylene glycol+water system. The solubility values were fitted to various cosolvency equations. The model accuracies were studied with the computation of the mean relative deviations. The thermodynamic behavior was investigated according to the van't Hoff and Gibbs equations for clotrimazole in the propylene glycol+water system. Furthermore, the density data for clotrimazole were determined in mixtures of propylene glycol+water and fitted to the Jouyban-Acree equation.

Gastric Obstruction by Opium Packets: A Case Report

BACKGROUND

We reported a case of gastric obstruction in a body packer who swallowed a large number of opium packets.

CASE REPORT

A 36-year-old man opium addict visited the emergency department with epigastric pain for three days. He swallowed nearly 90 packets of opium for smuggling purposes four days earlier. He self-administered laxatives. In contrast, many times vomiting, he defecated only four packets and vomited one packet. The abdominal X-rays showed some amounts of fluid-air levels and multiple cylindrical opacities with the double-condom sign, corresponding to the distended stomach. Due to the worsening of his abdominal symptoms, he underwent an urgent laparotomy and 84 packets (4-6 cm in size and 8-10 g/ packet of opium) with a total weight of 870 g. They were wrapped in some layers of plastic and tied at the ends. He was discharged in stable condition.

CONCLUSION

A large number of ingested drug packets can induce gastrointestinal obstruction.

Clonal relatedness and antimicrobial susceptibility of Salmonella serovars isolated from humans and domestic animals in Iran: a one health perspective

Background

Salmonellosis is one of the most important zoonotic diseases in humans and animals worldwide.

Aims

The main objective of this study was to report serovars, clonal relatedness, and antimicrobial resistance of Salmonella strains isolated from human, different animal hosts including pigeons, broilers, cattle, camel, parrots, and hamsters in different regions of Iran.

Methods

Twenty-four Salmonella isolates were confirmed at the genus level by biochemical tests and polymerase chain reaction (PCR) by showing the presence of invA gene. Serovars were determined and their clonal relatedness was assessed by RAPD-PCR and antibiotic resistance profiles.

Results

Overall, Salmonella Typhimurium was the most prevalent serovar (45.8%, 11/24), which was recovered from humans, pigeons, and camels. Salmonella Enteritidis (29.2%, 7/24) was the second common serovar that was recovered from cattle, broilers, humans, and hamsters. Salmonella Infantis (12.5%, 3/24) belonged only to broiler sources, and Salmonella Seftenberg (12.5%, 3/24) was isolated from eggs and a parrot. The major RAPD pattern was VI (33.3%) in which the two S. Typhimurium isolates (belonged to humans and pigeons) exhibited similarity in both RAPD pattern and resistance profile. Antimicrobial susceptibility test showed full resistance to tylosin and erythromycin (100%, 24/24). All isolates (100%, 24/24) were susceptible to ceftriaxone, cefixime, and gentamicin. In total, 75% of the isolates were multi-drug resistant (MDR) and revealed 15 different antimicrobial resistance profiles (R-type).

Conclusion

This study supports the potential transmission of Salmonella serovars via animal contacts. Thus, it is necessary to establish a national systematic monitoring program with one health approach for controlling Salmonella infections.

Andrographolide, a novel inducer of apelin gene expression

ETHNOPHARMACOLOGICAL RELEVANCE

Andrographis paniculata (A. paniculata) has been used as a traditional medicine in Asia and Scandinavia for centuries to remedy several illnesses. It has since been shown to possess antibacterial, antifungal, antiviral, anti-neoplasm, hepatoprotective, hypoglycemic, hypocholesterolemic, and energetic effects.

AIMS OF THE STUDY

This study sought to investigate the effect of Andrographolide on apelin gene expression and serum levels of glucose.

MATERIALS AND METHODS

In this study, 18 male rats were used. They were divided into three groups of six, including i) negative control group, ii) 3.5 mg/kg Andrographolide group, and iii) 7 mg/kg Andrographolide group. Apelin gene expression was investigated by real-time PCR method. Serum levels of glucose were measured by the photometric method.

RESULTS

The results of this study revealed that 3.5 and 7 mg doses per kg of body weight of andrographolide, for six days, significantly increased hepatic expression of apelin gene in male Wistar rats, as compared with the control group (p < 0.05). Serum levels of glucose at doses of 3.5 and 7 mg/kg of andrographolide, and in the control group, were 71.5 ± 8.96, 51.5 ± 2.64, and 93.87 ± 14.27 mg/dl, respectively. Andrographolide induced a decrease in serum levels of HDL-c and an increase in LDL-c/HDL-c ratio.

CONCLUSIONS

Our results suggest that Andrographolide can elicit an increase of hepatic apelin gene expression and a decrease in serum levels of blood glucose.

Catalytic evaluation of promoted CeO2-ZrO2 by transition, alkali, and alkaline-earth metal oxides for diesel soot oxidation

Series of mixed metal oxides were synthesized by gel-combustion method and their catalytic activities for soot oxidation were investigated. The catalysts were M-Ce-Zr (M = Mn, Cu, Fe, K, Ba, Sr), and xK-20Mn-Ce-Zr (x = 0, 5, 10, 20), they were characterized by XRD, SEM, TPR and BET surface area techniques. The results of soot temperature programmed oxidation (TPO) in an O2 oxidizing atmosphere indicate that K-Ce-Zr has the highest catalytic activity for soot oxidation under loose contact condition, due to enhancement of the soot and catalyst contacts. On the other hand, under a tight contact condition, Mn-Ce-Zr and Cu-Ce-Zr nano-composites have high activities for soot oxidation and lower the soot TPO peak temperatures by about 280 and 270 degrees C, respectively, as compared to non-catalytic soot oxidation. Furthermore, the addition of up to 10 wt.% potassium oxides into Mn-Ce-Zr increases its catalytic activity and further reduces the soot TPO peak temperature by about 40 degrees C under loose contact condition.

Effect of Giardia infection on nutritional status in primary schoolchildren, in northwest Iran

In order to determine the association between Giardia infection and nutritional status, a cross-sectional study was performed on twenty randomly selected primary schools from two regions of Ardabil province in 2005. Anthropometric factors including height, weight and midarm muscle circumference (MAC) were measured for 813 children (413 males, 400 females). The food intake was estimated for energy and other nutrients by 24 h recall method for three days in week. Determination of Giardia infection was done by using direct wet mount and formalin-ether sedimentation concentration. 10.9% of boys and 17.2% of girls were infected with Giardia infection. Weight and MAC in none infected girls and boys (only 7 and 11 years old) were higher than in infected groups. The average values for weight, height and MAC for both genders were lower than those of NCHS values. Vitamin E and phosphorous intake in non infected boys (in 7-10 years old) were less than infected boys. Calorie, protein, vitamins (B3, B5, B6, E and folacin) and minerals (copper, magnesium, phosphorous, potassium and selenium) intake of infected girls were less than non infected girls in 11-12 years old category. Based on the results found in this study, we conclude that Giardia infection may affect on some of anthropometric factors as well as the calorie and other nutrients intake in some of age groups.

Radioprotective effects of hesperidin against gamma irradiation in mouse bone marrow cells

The radioprotective effects of hesperidin (HES), a flavonone glucoside, were investigated by using the micronucleus test for anticlastogenic and cell proliferation activity. A single intraperitoneal (ip) administration of hesperidin at doses of 10 mg kg(-1), 20 mg kg(-1), 40 mg kg(-1), 80 mg kg(-1) and 160 mg kg(-1) 45 min prior to gamma irradiation (2 Gy) reduced the frequencies of micronuleated polychromatic erythrocytes (MnPCEs). All five doses of HES significantly reduced the frequencies of MnPCEs and increased PCE/PCE+NCE ratio in mice bone marrow compared with non-drug-treated irradiated control (p<0.0001). There was a drug dose-response effect of HES in reducing MnPCE and increasing the PCE/PCE+NCE ratio in bone marrow cells. The maximum reduction in MnPCE was observed in mice treated with HES at a dose of 80 mg kg(-1). The total MnPCE values were 2.85 fold less in the 80 mg kg(-1) HES group after being exposed to 2 Gy of gamma-rays than those in the respective irradiated control. Our study demonstrates that hesperidin has powerful protective effects on the radiation-induced DNA damage and on the decline in cell proliferation in mouse bone marrow.