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Dorooshi G, Samsamshariat S, Gheshlaghi F, Zoofaghari S, Hasanzadeh A, Abbasi S, Eizadi-Mood N. Comparing Sequential Organ Failure Assessment Score, Acute Physiology and Chronic Health Evaluation II, Modified Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Poisoning Severity Score for Outcome Prediction of Pesticide Poisoned Patients Admitted to the Intensive Care Unit. J Res Pharm Pract 2023; 12:49-57. [PMID: 38463184 PMCID: PMC10923200 DOI: 10.4103/jrpp.jrpp_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 03/12/2024] Open
Abstract
Objective This study aimed to assess the severity of poisoning, various scoring systems, including Sequential Organ Failure Assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II), Simplified Acute Physiology Score (SAPS II), Modified APACHE II, and poisoning severity score (PSS) were used. In this study, we compared the predictive value of these scoring systems on the outcome of pesticide-poisoned patients. Methods This is a cross-sectional study of pesticide-poisoned patients (140 patients) who were admitted to the intensive care unit (ICU) of Khorshid Hospital, Isfahan, Iran, between January 2015 and 2019. The area under the receiver operating characteristic (AUC) curve and the predictive value of scoring systems were compared. Findings Poisoning was higher in the male population (72.8%). The causes of poisoning were paraquat, (38.6%), aluminum phosphide, (32.1%), and organophosphate, (29.3%). The mean age of the patients was 33.9 years. Most patients (79.3%) attempted suicide. The mortality rate was 46.43%. The mean of "SOFA score," "APACHE II," "SAPS II," "Modified APACHE II," and "PSS" was 5.9; 15.7; 30.02; 15.8; and 1.9, respectively. There was a significant difference in the mean of all scoring systems for outcome prediction. Among all scoring systems, the SAPS II score with the cutoff point (16.5) had the best criteria for outcome prediction (AUC (0.831 ± 0.037), sensitivity (83.1%, 95% confidence interval [CI]: [71.7-91.2]), specificity (75.7%, 95% CI: [64.3-84.9]), positive predictive values (75.0%, 95% CI: [66.4-82.0]), negative predictive values (83.6%, 95% CI: [74.5-89.9]). Conclusion The SAPS II scoring system may be a suitable indicator for outcome predictions in pesticide-poisoned patients in the ICU.
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Affiliation(s)
- Gholamali Dorooshi
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Samsamshariat
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzad Gheshlaghi
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shafeajafar Zoofaghari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hasanzadeh
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Abbasi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nastaran Eizadi-Mood
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Tarhani F, Nezami A, Heidari G, Hosseinizadeh-Salavati N. Epidemiological Study of Acute Unintentional Poisoning Among Children in Iran. Drug Res (Stuttg) 2022; 72:306-311. [PMID: 35605968 DOI: 10.1055/a-1819-6453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The occurrence of different types of poisoning and early diagnosis is important for therapeutic measures. In this study, we investigate the epidemiological causes of acute poisoning in children.In this retrospective descriptive study, children presented with acute poisoning during 2010-2019 to Shahid Madani Hospital were included. The Electronic Medical Record system of the hospital was accessed to obtain the data of the patients. The data included was demographic information, type of poisoning, clinical findings, complications, duration of hospitalization, parents' education status, and mortality status.Of 336 patients included in the study, the mean age of patients was 4.90±3.27 years (range: 1-12 years). There was a significant correlation between the age of the child and the type of poisoning, p=0.001. The most frequent age group was 5 years and less (69.6%). The most frequent sex group was male (58.6%). However, there was no significant correlation between the sex of the child and the type of poisoning. Parents' education and ICU admission were also associated significantly with the type of poisoning, p=0.001, respectively. The most common type of poisoning in children was medication (60.6%) which was mainly due to methadone. The mortality rate in the study was 1.2%.Our study showed that pharmacological drugs are the main cause of poisoning in our population. Age of the children is likely to be associated with the type of poisoning however, no gender difference was found in this regard was found in our study.
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Affiliation(s)
- Fariba Tarhani
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Alireza Nezami
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ghobad Heidari
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Banaye Yazdipour A, Moshiri M, Dadpour B, Sarbaz M, Heydarian Miri H, Hajebi Khaniki S, Kimiafar K. The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study. Health Sci Rep 2022; 5:e587. [PMID: 35509401 PMCID: PMC9059223 DOI: 10.1002/hsr2.587] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Aims Poisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran. Methods This was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16. Results Thirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%). Conclusion These findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.
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Affiliation(s)
- Alireza Banaye Yazdipour
- Department of Health Information Management, School of Allied Medical Sciences Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences Mashhad University of Medical Sciences Mashhad Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
- Department of Pharmacodynamy and Toxicology, School of Pharmacy Mashhad University of Medical Sciences Mashhad Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Masoumeh Sarbaz
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences Mashhad University of Medical Sciences Mashhad Iran
| | - Hamid Heydarian Miri
- Department of Epidemiology, School of Health Mashhad University of Medical Sciences Mashhad Iran
| | - Saeedeh Hajebi Khaniki
- Student Research Committee, Department of Biostatistics, Faculty of Health Mashhad University of Medical Sciences Mashhad Iran
| | - Khalil Kimiafar
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences Mashhad University of Medical Sciences Mashhad Iran
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Gholami N, McDonald R, Farnaghi F, Hosseini Yazdi M, Zamani N, Hassanian-Moghaddam H. Fatal Outcome in Acutely Poisoned Children With Hospitalization: A 10-Year Retrospective Study From Tehran, Iran. Pediatr Emerg Care 2022; 38:e659-e663. [PMID: 33848098 DOI: 10.1097/pec.0000000000002429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute poisoning is a significant and preventable cause of mortality among children internationally. The aims of this study were to assess the case fatality rate of children admitted to an inner-city hospital for acute poisoning and to compare the demographics and source of poisoning of fatal cases. METHODS This was a retrospective review of patient data recorded in the Hospital Information System for Loghman Hakim Hospital, that is, the central referral hospital for poisoning in Tehran, Iran. We searched Hospital Information System for all admissions for poisoning in children (age, 0-12 years) over the 10-year period from March 2010 to March 2020, and all cases were included in the analysis. We determined the case fatality rate by dividing the number of fatal cases by the number of included cases. RESULTS Of 8158 children admitted for poisoning, 28 cases (0.3%) died, among whom 19 (67.9%) were boys and 9 (32.1%) girls. The median age was 42 months, ranging from 2 to 144 months. Twenty-two cases (78.6%) were 0 to 5 years old. The most common cause of mortality in acute poisoning was methadone (n = 13, 46.4%), followed by raw opium (n = 5, 17.9%), aluminum phosphide, carbon monoxide, and wild mushrooms (n = 2 deaths each, 7.1%). Tramadol, colchicine, and petroleum accounted for 1 death each (3.6%). CONCLUSIONS Mortality from unintentional poisoning disproportionately affects children younger than 5 years. Opioids (ie, methadone, opium, tramadol) accounted for two thirds of deaths in our sample. Our findings highlight the importance of educating parents that any toxic materials (licit or illicit) must be stored out of reach for children.
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Affiliation(s)
- Narges Gholami
- From the Department of Pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rebecca McDonald
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Fariba Farnaghi
- From the Department of Pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Asgarian F, Akbari H, Mahdian M, Motalebi M, Kashani M. Epidemiology, incidence, and trend of injuries in Iran: A national study. ARCHIVES OF TRAUMA RESEARCH 2022. [DOI: 10.4103/atr.atr_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Meamar R, Dorooshi G, Kalantar K, Amini Z. Intoxication-related deaths in a poisoning center in Isfahan: Demographic and other-related factors. Adv Biomed Res 2022; 11:82. [DOI: 10.4103/abr.abr_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/20/2021] [Accepted: 07/20/2021] [Indexed: 11/04/2022] Open
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Astaraki P, Ahadi M, Salehinejad F, Honardoost V. Fatalities Due to Poisoning with Aluminum Phosphide (Rice Pill) and Methadone. Drug Res (Stuttg) 2021; 72:82-85. [PMID: 34607375 DOI: 10.1055/a-1647-2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute poisoning is commonly seen with pharmaceutical substance or pesticides. Understanding pattern of acute poisoning due to different agents can enable better emergency management. The aim of this study is to present and evaluate the fatality-related data of acute poisoning due to aluminum phosphide (rice pills) and methadone. This descriptive-analytical study was performed on patients Shahid Rahimi Hospital due to poisoning with rice tablets (aluminum phosphide) and methadone from 2015-2020. The data collection tool was a questionnaire using with demographic data, type and dose of poison and clinical presentation, duration of hospitalization was obtained and statistically analyzed. Out of 19 238 patients with poisoning referred to this center, 412 people referred to the hospital due to rice pill poisoning, of which 56 (13.59%) died and among 2157 patients due to methadone poisoning, 22 of them (1.09%) died. In both the groups, rice pill and methadone, there were more male patients 53.57 and 81.81%, respectively. In aluminum phosphide poisoning, the greatest population was in the age group (15-35). However, no specific age group was seen in methadone poisoning. The duration of hospitalization and the time of referral to the emergency department to the death of the patient was significantly correlated with mortality in both the groups. The prevalence of intentional rice kill poising was greatest, effecting young population, we recommend that health care awareness program and training should be provided in this regard. Furthermore, psychiatric care should be made easily available in the region.
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Affiliation(s)
- Peyman Astaraki
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Ahadi
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Foroutan Salehinejad
- Department of Physiology, School of Medicine, Dezful University of Medical Sciences, Khuzestan, Iran
| | - Vahideh Honardoost
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Yan Y, Zhang J, Yi S, Liu L, Huang C. Lighting up forensic science by aggregation-induced emission: A review. Anal Chim Acta 2020; 1155:238119. [PMID: 33766314 DOI: 10.1016/j.aca.2020.11.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/15/2020] [Accepted: 11/27/2020] [Indexed: 01/30/2023]
Abstract
Forensic science requires a fast, sensitive, and anti-interfering imaging tool for on-site investigation and bio-analysis. The aggregation-induced emission (AIE) phenomenon exhibits remarkable luminescence properties (large Stokes shift, diverse molecular structures, and high photo-stability), which can provide a viable solution for on-site analysis, while at the same time overcoming the problem of aggregation-caused quenching (ACQ). Based on the outstanding performance in chemical analysis and bio-sensing, AIE materials have great prospects in the field of forensic science. Therefore, the application of AIE in forensic science has been summarized for the first time in this article. After a brief introduction to the concept and development of AIE, its applications in the determination of toxic or hazardous substances, based on data on poisoning deaths, has been summarized. Subsequently, besides the bio-imaging function, other applications of AIE in analyzing markers related to forensic genetics, forensic pathology, (focusing on the corpse) and clinical forensics (focusing on the living) have been discussed. In addition, applications of AIE molecules in criminal investigations, including recognition of fingerprints and blood stains, detection of explosives and chemical warfare agents, and anti-counterfeiting have also been presented. It is hoped that this review will light up the future of forensic science by stimulating more research work on the suitability of AIE materials in advancing forensic science.
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Affiliation(s)
- Yibo Yan
- Department of Forensic Medicine, Tongji Medical School, Huazhong University of Science and Technology, Hangkong Road #13, Wuhan, 430030, China
| | - Junchao Zhang
- Department of Forensic Medicine, Tongji Medical School, Huazhong University of Science and Technology, Hangkong Road #13, Wuhan, 430030, China
| | - Shaohua Yi
- Department of Forensic Medicine, Tongji Medical School, Huazhong University of Science and Technology, Hangkong Road #13, Wuhan, 430030, China
| | - Liang Liu
- Department of Forensic Medicine, Tongji Medical School, Huazhong University of Science and Technology, Hangkong Road #13, Wuhan, 430030, China.
| | - Chuixiu Huang
- Department of Forensic Medicine, Tongji Medical School, Huazhong University of Science and Technology, Hangkong Road #13, Wuhan, 430030, China.
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10
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Ghodsi Z, Moghaddam SS, Vezvaei P, Yoosefi M, Rezaei N, Saadat S, Sheidaei A, Sharif-Alhoseini M, Sadeghian F, Ahmadi N, Jazayeri SB, Salamati P, Khosravi A, Moradi-Lakeh M, Mokdad AH, O'Reilly G, Rahimi-Movaghar V. The mortality rate from self-harm in Iran. Public Health 2020; 186:44-51. [PMID: 32768623 DOI: 10.1016/j.puhe.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/22/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years. METHODS The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults. RESULTS Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period. CONCLUSION Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions.
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Affiliation(s)
- Z Ghodsi
- Department of Midwifery, Tuyserkan Branch, Islamic Azad University, Tuyserkan, Iran.
| | - S S Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - P Vezvaei
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - M Yoosefi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - N Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - S Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - A Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - M Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - F Sadeghian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - N Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - S B Jazayeri
- Department of Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA.
| | - P Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - A Khosravi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran.
| | - M Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - A H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Washington, USA.
| | - G O'Reilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - V Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Hassanian-Moghaddam H, Zamani N, Kolahi AA. Re: 'Trend of fatal poisoning at national and provincial levels in Iran from 1990 to 2015'. Public Health 2019; 178:179-180. [PMID: 31836242 DOI: 10.1016/j.puhe.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/26/2019] [Indexed: 11/15/2022]
Affiliation(s)
- H Hassanian-Moghaddam
- Social Determinant of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicne, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - N Zamani
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicne, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A-A Kolahi
- Social Determinant of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Ghodsi Z, Saeedi Moghaddam S, Mokdad AH, Rahimi-Movaghar V. Re: Letter to the Editor of Public Health in response to 'Trend of fatal poisoning at national and provincial levels in Iran from 1990 to 2015'. Public Health 2019; 178:181. [PMID: 31780046 DOI: 10.1016/j.puhe.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Z Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - A H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Washington, USA
| | - V Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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