Pattern of Traumatic Injuries in Patients with Tramadol Poisoning: A Cross-Sectional Study in a Tertiary Care Hospital

Objective

This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuries in patients admitted to the hospital.

Methods

The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographic information, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, and occurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, including the Mann-Whitney U-test, Pearson's Chi-square test, and Student's t-test, were conducted to compare the patients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed using SPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant.

Results

The average patient's age was 24.66±5.64 years, with males comprising 84.3% of the sample. The mean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizures were observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma was reported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures, with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%). Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantly longer.

Conclusion

Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the need to perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolonged hospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handling and transferring to hospitals.

Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran

Background

Coronary slow flow phenomenon (CSFP) represents a clinical entity with recurrent chest pain leading to living impairment. The present study aimed to investigate whether opium use correlates with primary CSFP.

Methods

This study included Iranian patients with suspected coronary artery disease who underwent myocardial perfusion imaging. Coronary blood flow was measured quantitatively using the thrombolysis in myocardial infarction (TIMI) frame count and slow flow was defined as TIMI grade 2 standard deviations. Age and clinical conditions including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), history of chest pain, and opium use were recorded. First, the characteristics of the two groups were compared and then the main analyses were conducted to examine the relationship between CSFP and opium use. Data were analyzed using t test and chi-square test via SPSS 25.0. The significance level was set at P<0.05.

Findings

This study was conducted on 44 male patients with documented CSFP who had no stenotic lesions and 134 control group male patients who had normal coronary arteries with normal flow. The mean age was similar in the two groups (54.25 vs.52.69, P=0.474). Two groups were significantly different in terms of history of chest pain (P=0.003), but there was no significant difference in HTN (P=0.084), DM (P=0.284), HLP (P=0.183), smoking (P=0.696), and opium use (P=0.107).

Conclusion

This study indicated that opium use is not associated with primary CSFP.

Clinicoepidemiologic profile of patients with poisoning presenting to a tertiary care hospital; a one year preliminary descriptive study

Introduction: Poisoning is regarded as a matter of concern for health providers as the burden of health resources loss can be high. Since nature and diversity of poisoning are different among various regions around the country, this study was conducted to demonstrate type and reasons for poisonings in Qazvin province, Iran. Objectives: The aim of this study was to demonstrate the reason of toxic events as well as presenting symptoms and outcome of poisonings. Patients and Methods: This prospective, cross-sectional and hospital-based study was conducted during a one-year period. The patients recruited to the study were consecutive intoxicated cases presenting to the hospital with alleged poisoning. Relevant epidemiological and clinical data from patients were collected and then analyzed using SPSS software. Results: A total of 23161 patients were admitted to the hospital, out of which 766 (3.3%) intoxicated patients were enrolled in the study. Mean age was 29.8 years old. Females outnumbered males but difference was not significant. The majority of the poisonings were deliberate (95.2%). Main clinical features of poisoning were decreased consciousness (47.4%), followed by lethargy (38.1%) and nausea/vomiting (31.9%). The benzodiazepines were the predominant agent ingested by patients, followed by opioids. Mortality rate was found to be 1%. Conclusion: Although the majority of poisoning cases are deliberate, however according to the type of pharmaceuticals involved in the poisonings and low-mortality rate, it is believed that the occurrence of the toxic events in many cases arises from impulsive behaviors originated from minor familial conflicts and incompetent life skills. Improving mental health and efficient coping skills can contribute to the reduction of intentional poisonings which in turn reduces the burden of hospital costs.

Hot charcoal vomitus in aluminum phosphide poisoning - A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature

Aluminium phosphide (ALP) poisoning is a commonly encountered poisoning in emergency departments in most developing countries. Many papers have revealed metabolic derangements in this poisoning and also examined contributing factors leading to death, but only few have reported physical damage. Some case reports have described a complication that has been frequently termed ‘ignition’. The exact mechanism of this phenomenon has not been fully elucidated. An exothermic reaction during therapeutic administration of chemicals may contribute to this problem, but the incidence has occurred in the absence of treatment or drug administration. Here, we report a 34-year-old woman with ALP poisoning who presented with hot charcoal vomitus, a sign of internal thermal event, leading to the thermal burning of the patient's face and internal damage resulting in death. We reviewed all reported cases with similar complication to demonstrate varied characteristics of patients and to propose the possible mechanisms leading to this event.

Septic arthritis of sternoclavicular joint: a case report of a rare finding in injecting drug users

The sternoclavicular joint is an unusual site for bacterial infection. In this case, we describe a 25-year-old man who presented to the emergency department with fever, chills, limited range of motion in the right upper limb along with complaints of severe pain and tenderness in the right upper chest wall and shoulder. He was admitted to the hospital for further evaluation. This patient admitted to a history of injecting heroin use during the previous three months. The diagnosis of septic arthritis of the right sternoclavicular joint was confirmed by blood culture and MRI of the sternoclavicular joint. This case is, to the best of our knowledge, the 25th recorded staphylococcal septic sternoclavicular arthritis. He received appropriate intravenous antibiotic therapy and subsequently was discharged two weeks later with complete clinical and laboratory recovery.

Do Co‐intoxicants Increase Adverse Event Rates in the First 24 Hours in Patients Resuscitated from Acute Opioid Overdose?

BACKGROUND

Patients frequently arrive in emergency departments (EDs) after being resuscitated from opioid overdose. Autopsy studies suggest that multidrug intoxication is a major risk factor for adverse outcomes after acute heroin overdose in patients. If this is true, there may be high-risk drug combinations that identify patients who require more intensive monitoring and prolonged observation. Our objective was to determine the impact of co-intoxication with alcohol, cocaine, or CNS depressant drugs on short-term adverse event rates in patients resuscitated from acute opioid overdose.

METHODS

Data were extracted from the database of a prospective opioid overdose cohort study conducted between May 1997 and 1999. Patients were prospectively enrolled if they received naloxone for presumed opioid overdose. Investigators gathered clinical, demographic, and other predictor variables, including co-intoxicants used. Patients were followed to identify prespecified adverse outcome events occurring within 24 h, and multiple logistic regression was used to determine the association of concomitant drug use on short-term adverse event rates.

RESULTS

Of 1155 patients studied, 58 (5%) had pure opioid overdose and 922 (80%) reported co-intoxicants, including alcohol, cocaine, and CNS depressants. Overall, out of 1056 patients with known outcome status there were 123 major adverse events (11.6%) and 194 minor adverse events (18.4%). After adjustment for age, gender, HIV status, cardiovascular disease, pulmonary disease and diabetes, we found that coadministration of alcohol, cocaine, or CNS depressants, alone or in combination, was not associated with increased risk of death or adverse events during the 24 h follow-up period.

CONCLUSION

In patients resuscitated from acute opioid overdose, short-term outcomes are similar for patients with pure opioid overdose and multidrug intoxications. A history of cointoxication cannot be used to identify high-risk patients who require more intensive ED monitoring or prolonged observation.