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Background: Tramadol is a widely used centrally acting opioid analgesic and due to its ease of access in Iran as an over-the- counter drug, reported cases of intoxication are rising.
Case: A 19-year-old male who was referred to our center, Noor Hospital, Isfahan University of Medical Sciences, Isfahan, Iran, because of confusion, ataxia, agitation and an episode of seizure, followed by intentional ingestion of one hundred 100mg tablets of tramadol . On admission, he was confused, in hypotensive state, and with tachycardia. Suddenly, a generalized tonic colonic seizure occurred and resulted in cyanosis and a decrease in O2 saturation. By prompt management, he improved to some extent but unexpectedly 3 hours after admission he succumbed to cardiopulmonary arrest. Laboratory analysis, ECG, and postmortem pathology reports were normal. Semi-quantitative toxicological analysis (by Thin Layer Chromatography: TLC) was highly positive for tramadol, in all viscera, gastric contents and urine.
Conclusion: Contrary to previous beliefs, tramadol poisoning might cause sudden death even in oral form. It is not long since tramadol has become widely available as a rather safe analgesic nevertheless, it seems that available data concerning its toxicity is limited and to assist physicians in anticipating unexpected situations in tramadol overdose, scrutiny into its side effects is mandatory.

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Background:Purpose of present study was to investigate whether chronic exposure to zinc fume would affect serum zinc levels, memory, and cognition in zinc fume-exposed workers.
Methods:In a cross-sectional study, all zinc fume-exposed workers (exposed, n=20) were compared with unexposed workers (reference, n=20) matched for sex and education level in a zinc galvanization factory. The workers were undergone Wechsler Memory Scale (WMS) and Mini Mental State Examination (MMSE). Mean WMS score in exposed group (75.80 ± 14.40) was significantly lower than reference group (91.65 ± 15.79) however there was no significant difference in MMSE scores between two groups. There was a negative linear relationship between memory, MMSE scores, and serum zinc level. Exposure to zinc fume may lead to memory problems. Conclusion:Regular measurement of serum zinc level is recommended for exposed individuals.

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Background: Benzodiazepine (BZD) toxicity alone or with other drugs is common in poisoning emergency departments of Iran. The aim of this study was to evaluate the cardiovascular findings in patients with benzodiazepine poisoning upon admission to the emergency department.
Methods: In a prospective study which was followed by retrospective analysis, 267 patients poisoned with BZD were evaluated. ECG and initial vital signs and symptoms of poisoning were evaluated upon admission. To investigate the relationship between cardiovascular symptoms, changes in ECG, and the type of benzodiazepine consumption, Spearman correlation was utilized.
Results: Most patients had normal heart rate (92.88%), normal blood pressure (95.14%), and normal ECG (96.67%). Hypotension (2.99%), hypertension and bradycardia (1.87%), and tachycardia (5.25%) were also observed in the patients. There were not any significant relationships between cardiovascular symptoms, ECG changes, and the type of ingested BZD. All patients survived without any complications.
Conclusion: Cardiovascular toxicity with BZD alone is not common. Although few changes in cardiovascular or ECG are seen, the prognosis is considered good.

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Background: Drug abuse is a major health problem in many countries. Noticing the different patterns of drug abuse in different areas, we evaluated the epidemiology of drug abuse and related factors in Fars province, Southern Iran.
Materials and Methods: In a one-year cross-sectional study, from March 21st, 2009 to 2010, all subjects referring to Addiction Treatment Clinic of Shiraz University were evaluated. Demographic data including age, gender, marital status, occupation, level of education, type of drug, route of abuse, initiation time, and cause of drug abuse were recorded.
Results: The majority of the participants were multi-drug abusers (92%). Opium was the most commonly abused drug, solely (5.3%) or in combination with other drugs (88.7%). Mean age of the first experience of drug abuse was 20.66 years (ranging from 12 to 45). The Most common routes were smoking and ingestion (31.6%) followed by smoking (14.9%). Mean duration of drug abuse was 12.3±8.7 years (ranging from 1 to 38). The major reasons for drug abuse were temptation by friends (28.9%) followed by seeking pleasure (21.9%). A history of substance abuse in the family was reported by 41.9% of the participants.
Conclusion: Identifying the patterns of drug abuse in different parts of Iran may necessitate using different strategic protocols.

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Background: Hematological effects and digestive and neuro-psychological signs and symptoms are some manifestations of lead toxicity. However, there are conflicting reports of their prevalence among lead exposed workers and their relationship with blood lead levels (BLL). This case- control study assessed the relationship between BLL and hematological indexes and digestive (abdominal colic, iron taste), neural (tinnitus, anosmia, paresthesia, weakness, dizziness, headache), and psychological (fatigue, sleep disturbance, forgetfulness) findings in battery-manufacturing workers.
Methods: Cases and controls were a sub-sample of lead exposed and non-exposed workers in battery-manufacturing industry. BLL concentrations, hematological indexes, and clinical manifestations were evaluated in the two groups. Statistical analyses were performed using SPSS software.
Results: There were no significant differences in age and years of work between the two groups. BLL (mean ±SD) was significantly higher in the lead exposed group than in the controls (36.54 ± 4.34µg⁄dl and 8.82 ± 3.96 µg⁄dl, respectively) (P<0.001). There was a significant relationship between BLL and headache, fatigue, paresthesia, weakness, forgetfulness, sleep disturbance, iron taste, anemia, and eosinophil level. However, there was not a significant relationship between anosmia and BLL.
Conclusion: BLLs correlated with some clinical and para-clinical findings. Therefore, preventive measures towards exposure to lead at work places, and routine hematological investigations should be included in bio-monitoring the health status of lead workers.

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Background: Poisoning, a common worldwide problem, seeks its own treatments to improve, especially by the forthcoming evidence based medicine (EBM). Charcoal/sorbitol slurry (CSS) administration is one of these methods with great debates around it which needs to be investigated more.
 Methods: In this clinical trial, 105 cases of benzodiazepine toxicity with at least 3 symptoms and no contraindication for sorbitol prescription were divided into 3 groups. Patient grouping was based on the sorbitol manufacturing factory. Sorbitol was prescribed for the patients, with one kind of sorbitol for the patients of each group. The measured variable was the time passed up to the presence of charcoal-mixed stool and the gathered data were analyzed by ANOVA test using SPSS software.
Results: The average age was 25.8±8.4 in females and 24±8.5 years for males (P=0.641). The average follow up time was 8.3±3.1 hours for females and 8.1±2.7 hours for males (P=0.30). The average pass time from drug ingestion, was 46±23.15 min in females and 40±23.15 min in males (P=0.132). Interestingly, no sorbitol was able to increase in transit time in the study population despite a follow-up interval about 3 times more than expected (based on the reference).
Conclusion: No increase in transit time was seen by sorbitol prescription in our cases despite the appropriate follow-up interval. This ineffectiveness may be somehow due to the absence of standard sorbitol amounts in those products, but we assume that it is mainly due to the population-based bowel habits (i.e. constipated ones with essential prolonged transit time).