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Shahpar A, Mirafzal A, Movahedi M, Zeinali Nezhad N. Early vs. delayed QTc prolongation in acute poisoning: A prognostic accuracy study-A case series. PLoS One 2024; 19:e0309940. [PMID: 39255304 PMCID: PMC11386474 DOI: 10.1371/journal.pone.0309940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024] Open
Abstract
Given the limited capacity of intensive care units in many countries, it is crucial to identify reliable prognostic markers to optimize poisoning patients management and improve outcomes. This study aimed to assess the predictive value of three variables, namely the initial QTc interval (iQTc) measured within two hours of admission, the delayed QTc interval (dQTc) measured between 6 and 12 hours of entry, and the QTc interval trend over time (ΔQTc), for mortality in patients with undifferentiated poisoning. A retrospective case series was conducted on 70 patients with undifferentiated poisoning admitted to the intensive care unit (ICU) of Afzalipour Hospital between March 21, 2021, and March 20, 2023. The results of the multivariate analysis revealed that dQTc, base deficit, and creatinine were independently associated with mortality (P value < 0.001). The dQTc had the highest predictive ability, with an area under the curve (AUC) of 0.84, followed by ΔQTc with an AUC of 0.76, and iQTc with an AUC of 0.67. Additionally, the results of the Generalized Estimating Equation model with repeated measurements revealed a higher odds ratio for dQTc (OR, 6.33; 95% CI, 2.54-15.79) compared to iQTc (OR, 4.92; 95% CI, 1.71-14.17). The study concluded that monitoring the dQTc interval could provide valuable prognostic information in acute poisoning cases.
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Affiliation(s)
- Amirhossein Shahpar
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Amirhossein Mirafzal
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Movahedi
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Mesgarpour B, Faridfar S, Rezaei M, Abdollahiasl A, Shadnia S, Mahdavinejad A, Abdollahi M. Age- and gender-specific acute poisoning with drugs and medications affecting nervous system. BMC Pharmacol Toxicol 2024; 25:37. [PMID: 38951926 PMCID: PMC11218142 DOI: 10.1186/s40360-024-00759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 06/19/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND We investigated acute poisonings resulting from medications affecting the nervous system and illicit substances at Loghman Hakim Hospital in Tehran. METHODS We retrospectively reviewed patient records at Iran's largest tertiary toxicology referral center between January 2010 and December 2015. We analyzed the prevalence, trend, age and gender distribution of acute poisoning caused by nervous system agents. RESULTS The present study included 16,657 (57.27%) males and 12,426 (42.73%) females, resulting in 29,083 patients. The median age of men and women was 29 and 26 years, respectively (p < 0.0001). There were 12,071 (72.47%) men and 10,326 (83.10%) women under the age of 40 (p < 0.001). Most cases were intentional (69.38% in men and 79.00% in women, p < 0.001) and 44.10% had a history of poisoning. The proportions of men and women varied significantly between different age groups and nervous system agents. For women, the most common agent was alprazolam, whereas for men, methadone. The overall trend of acute poisoning with drug used in addictive disorders, opioids and alcohol was increasing but decreasing with benzodiazepines and antidepressants. Acute poisoning by nervous system agents led to more deaths in men (1.95% vs. 0.56%; p < 0.001). CONCLUSIONS Methadone intoxication was common especially among young men and most of these intoxications were intentional. Women and men aged 20-29 most frequently suffer poisoning from alprazolam and clonazepam, respectively. Women over 60 and men over 30 used opium. Illicit drugs caused more than half of the deaths, and opium dominated. This study may create awareness and develop educational and preventive gender and age-specific local programs.
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Affiliation(s)
- Bita Mesgarpour
- Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran.
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, 1449614535, Iran.
| | - Shabnam Faridfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy and Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahya Rezaei
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy and Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Abdollahiasl
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy and Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Department of Clinical Toxicology, Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezou Mahdavinejad
- Department of Clinical Toxicology, Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, 1417614411, Iran
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Eizadi-Mood N, Sanjari H, Feizi A, Yazdi R, Dorostkar A, Mahvari R, Mirmoghtadaee P, Meamar R. Clinico-epidemiological evaluation of pharmaceutical/non-pharmaceutical poisoning in a referral poisoning emergency in the Central part of Iran. Sci Rep 2024; 14:10493. [PMID: 38714819 PMCID: PMC11076496 DOI: 10.1038/s41598-024-61411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/06/2024] [Indexed: 05/10/2024] Open
Abstract
The pattern of poisoning varies in different societies. In this study, we investigated the clinical-epidemiological features and outcomes of poisoned patients based on the substances involved, whether pharmaceutical or non- pharmaceutical toxins. This cross-sectional study involved a retrospective chart review of all poisoned patients who presented to the poisoning emergency hospital in the center of Iran between January 2015 and December 2019. We collected data on socio-demographics, the nature of the poisoning, and the outcomes. Backward stepwise binary regression analysis was conducted to predict the mortality. Throughout the study period, 5777 patients with acute poisoning met the inclusion criteria. Of these, 3524 cases (61%) were attributed to pharmaceutical, and 2253 cases (39%) were due to non-pharmaceutical poisoning. The majority of pharmaceutical poisonings (82.9%) were intentional, whereas non-pharmaceutical poisonings accounted for 46.2% of intentional exposures (P < 0.001). Patients with non-pharmaceutical poisoning were predominantly men, older in age, and had a history of addiction compared to those with pharmaceutical poisoning (P < 0.001). In binary logistic regression analysis, patients poisoned by non-pharmaceutical substances had a significantly higher risk of mortality [Odds ratio, 3.14; (95% CI 1.39-7.10); P = 0.006] compared to those poisoned by pharmaceutical substances (P < 0.001). The pattern of poisoning differs in terms of age and gender when comparing pharmaceutical to non-pharmaceutical poisoning. Patients poisoned by non-pharmaceutical may have a worse outcome compared to those poisoned by pharmaceutical substances.
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Affiliation(s)
- Nastaran Eizadi-Mood
- Department of Clinical Toxicology, Khorshid hospital, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Sanjari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology & Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Yazdi
- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Dorostkar
- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Mahvari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Mirmoghtadaee
- Deputy of Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rokhsareh Meamar
- Isfahan Clinical Toxicology Research Center, Khorshid hospital, Isfahan University of Medical Sciences, Ostandari Street, Hasht Behest Avenue, Isfahan, 81458-31451, Iran.
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Kovacic V, Kvartuc L, Mikacic M, Jerkovic I, Begovic TI, Maras M, Nazlic J. Clinical and demographic features with outcome predictors of adult patients with acute intoxication admitted to a medical intensive care unit in the Mediterranean part of Croatia. Toxicol Res (Camb) 2023; 12:626-634. [PMID: 37663800 PMCID: PMC10470373 DOI: 10.1093/toxres/tfad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 09/05/2023] Open
Abstract
Background The objective of the study was to assess the demographics, clinical parameters, and outcome of acute intoxications among adult patients admitted to a medical intensive care unit in southern Croatia. Materials and Methods An observational retrospective study was conducted over a 1-year period. The subjects were patients admitted to the intensive care unit for acute poisoning. Results In all, 81 subjects (32.1% females) aged 43.16 ± 14.77 years were admitted to the intensive care unit because of poisoning (14.97% of the total annual intensive care unit admissions). Psychiatric disorders were previously established in 76.5% participants, and 69.1% of all acute intoxications were classified as suicidal. Non-suicidal subjects differed from suicidal subjects in age (37.36 ± 9.71 vs. 45.75 ± 15.93 years; P = 0.009), in pCO2 (6.38 ± 1.78 vs. 5.50 ± 1.26 kPa; P = 0.020), in length-of-stay in intensive care unit (median 1.00, interquartile range 1.00 vs. median 2.00, interquartile range 2.00 days; P = 0.022), and in length-of-stay in hospital (median 2.00, interquartile range 2.00 vs. median 10.50, interquartile range 15.25 days; P < 0.001). Three (3.7%) patients died. Pharmaceutical psychoactive drug intoxications were the most common poisoning cases; of these, diazepam was the most frequent (16.8%), followed by ethanol (9.0%) and alprazolam (7.8%). Benzodiazepines/hypnotics were the most common group (28.7%), followed by antipsychotics (13.2%). Intoxications with more than 1 poison accounted for the largest number of cases (67.9%). The number of toxins was significantly correlated with length-of-stay in the hospital (rho = -0.265; P = 0.008), systolic blood pressure (rho = -0.318; P = 0.002), and diastolic blood pressure (rho = -0.262; P = 0.009). The electrocardiogram was considered abnormal in 50.62% of the cases. Conclusion Acute intoxicants were most commonly caused by psychiatric pharmaceutical drugs. Multidrug exposure was a typical pattern of acute intoxication.
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Affiliation(s)
- Vedran Kovacic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Lukas Kvartuc
- University of Split School of Medicine, 21000 Split, Croatia
| | - Marijana Mikacic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Ivan Jerkovic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Tanja Ilic Begovic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Marina Maras
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Jurica Nazlic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
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Dehghani R, Monzavi SM, Mehrpour O, Shirazi FM, Hassanian-Moghaddam H, Keyler DE, Wüster W, Westerström A, Warrell DA. Medically important snakes and snakebite envenoming in Iran. Toxicon 2023; 230:107149. [PMID: 37187227 DOI: 10.1016/j.toxicon.2023.107149] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Snakebite is a common health condition in Iran with a diverse snake fauna, especially in tropical southern and mountainous western areas of the country with plethora of snake species. The list of medically important snakes, circumstances and effects of their bite, and necessary medical care require critical appraisal and should be updated regularly. This study aims to review and map the distributions of medically important snake species of Iran, re-evaluate their taxonomy, review their venomics, describe the clinical effects of envenoming, and discuss medical management and treatment, including the use of antivenom. Nearly 350 published articles and 26 textbooks with information on venomous and mildly venomous snake species and snakebites of Iran, were reviewed, many in Persian (Farsi) language, making them relatively inaccessible to an international readership. This has resulted in a revised updated list of Iran's medically important snake species, with taxonomic revisions of some, compilation of their morphological features, remapping of their geographical distributions, and description of species-specific clinical effects of envenoming. Moreover, the antivenom manufactured in Iran is discussed, together with treatment protocols that have been developed for the hospital management of envenomed patients.
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Affiliation(s)
- Ruhollah Dehghani
- Department of Environmental Health, Kashan University of Medical Sciences, Kashan, Iran; Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mostafa Monzavi
- Medical Toxicology Center, Mashhad University of Medical Sciences, Mashhad, Iran; Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran; Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.
| | - Farshad M Shirazi
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Daniel E Keyler
- Department of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Wolfgang Wüster
- Molecular Ecology and Evolution at Bangor, School of Natural Sciences, Bangor University, Bangor, UK
| | | | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Behnoush AH, Bazmi E, Forouzesh M, Koehler SA, Monabati SJ, Behnoush B. Impact of COVID-19 on poisoning-related mortality in Iran: An interrupted time series study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104051. [PMID: 37182353 PMCID: PMC10160529 DOI: 10.1016/j.drugpo.2023.104051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic had many negative effects worldwide. These effects involved mental health status issues such as suicide, depression, and the pattern of death associated with drug/poisonings. One of the major concerns of the healthcare community during the pandemic was mortality from poisonings. This study aimed to investigate the trends of mortality from different types of poisonings before and after COVID-19. METHODS The patients who died from six different categories of drugs or poisons were identified by forensic analysis of body fluids/tissues in Tehran, Iran. The pandemic was separated into the pre-COVID-19 period (April 2018 to January 2020), and the COVID pandemic (February 2020-April 2022). Demographic characteristics were collected from each victim, and comparisons of death trends before and after the pandemic were conducted using the interrupted time series analysis. The absolute number of deaths and proportion of deaths from each type of drug/poisoning were used for the analyses. RESULTS A total of 6,316 deaths from drugs/poisoning were identified between April 2018-Mar 2022). During this period, 2,485 deaths occurred pre-COVID, and 3,831 were during the COVID-19 era. There were no statistical differences in terms of demographic characteristics before and after the pandemic, except for job status. There was a sharp increase in proportion of methanol death among all poisonings after the start of the pandemic (16.5%, p-value = 0.025), while there was a decreasing trend during the pandemic (-0.915 deaths monthly, p-value = 0.027). The trends for opioids, stimulants, and drug-related deaths changed from decreasing to increasing. No change was seen in the trends for ethanol and volatile substance deaths. This pattern was mirrored in the proportion of each type of poisoning relative to the total number. CONCLUSION Changes in poisoning-related mortality patterns showed dramatic changes after the start of the pandemic, especially deaths from methanol. Other poisonings such as opioids, stimulants, and drugs should also be addressed as there was an increasing trend during the COVID-19 period, compared to the pre-COVID data.
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Affiliation(s)
| | - Elham Bazmi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
| | - Mehdi Forouzesh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | | | - Behnam Behnoush
- Department of Forensic Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Kouli M, Al Houri HN, Jomaa S, Issa A, Arrouk DMN, Alhouri A, Almhanni G, Alhouri AN, Wardeh R, Kouli M. Epidemiology of poisoning in Syria (1999 through 2020). Clin Toxicol (Phila) 2023; 61:116-122. [PMID: 36524826 DOI: 10.1080/15563650.2022.2156882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Acute poisoning is a significant international public health issue and one of the leading causes of death in the emergency department (ED). In the absence of any previous reports describing the poisoning profile in Syria, we present this study to assess the epidemiological and clinical characteristics of poisoning over 21 years. METHODS We collected the data retrospectively from the Syrian Poisons Information Centre (SPIC) from January 1999 until December 2020. The data included patients who had accidental or non-accidental exposure to poisons, either by drugs, medicaments, and biological substances or substances chiefly nonmedicinal sources such as soaps and detergents, corrosive substances, pesticides, and other miscellaneous products. RESULTS We collected the data of 120,972 poisoned patients, of whom 52.6% were females, and 47.4% were males. Aleppo governorate reported the highest number of poisoned cases (28.6%), followed by Damascus governorate (19.9%). The highest poisoning rates were recorded in 2020, 2014, and 2010. Pharmaceutical (37.0%) and animal (33.8%) sources were the most common causative agents. The oral route was the route of poisoning in 58.3% of patients, and 33.4% through the skin. The most common poison was scorpion stings 19.5% while the most common cause of death was organophosphates 15.7%. DISCUSSION The differences in socioeconomic status, cultural habits, and agricultural and industrial activities between countries have led to a state of fluctuation regarding the most common poisoning agents. CONCLUSION Damascus and Aleppo, the two major governorates in Syria, had the highest poisoning cases. Oral administration of pharmaceutical agents was responsible for most of the poisoning cases. The most common individual poison was the scorpion poison, while the top killer was organophosphates.
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Affiliation(s)
- Moudar Kouli
- Doctor of Medicine M.D, Syrian Arab Republic Ministry of Health, Damascus, Syria
| | - Hasan Nabil Al Houri
- Internal Medicine Department, Damascus University, Al Assad University Hospital and Al Mouwasat University Hospital, Damascus, Syria
- Internal Medicine Department, Al-Sham Private University, Damascus, Syria
| | - Sami Jomaa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdulmoez Issa
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Abdullah Alhouri
- Division of Gastroenterology, Department of Medicine, Royal Berkshire Hospital, Reading, United Kingdom
| | - Ghaith Almhanni
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Rahaf Wardeh
- Department of pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maher Kouli
- Head of Syrian Poison Information Center, Ministry of Health, Damascus, Syria
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Pharmaceutical toxicity is a common pattern of inpatient acute poisonings in Birjand City, East of Iran. Sci Rep 2023; 13:1312. [PMID: 36693867 PMCID: PMC9873670 DOI: 10.1038/s41598-023-28353-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
Information on the pattern of acute poisonings in hospitals of Birjand city, Iran, is limited. This study aimed to address this knowledge gap by examining the admissions in a major poisoning center in eastern Iran. This cross-sectional study included patients admitted to the Imam Reza Hospital in Birjand over 12 months. Medical records of the poisoned patients were reviewed, and the study variables were used for data analysis. During the study period, 534 cases of acute poisonings were evaluated. The patient's ages ranged from 12 to 84 years, with a high rate of poisonings between 15 and 35 years. The female predominance in poisoning cases was 52.1%. Most cases of poisonings occurred in spring, and the common route of exposure was oral (93.1%). The incidence of poisoning in married couples, uneducated patients, and residents of urban areas was 56.5%, 90.1%, and 74.6%, respectively. Patients with a previous medical history experienced addiction and psychiatric disorders. Intentional poisoning accounted for 23.4% of acute poisoning cases referred to the hospital in the current study. The main groups of toxicants were pharmaceutical products (48.1%), narcotics (25.8%), chemical products (10.1%), envenomation (7.1%), and alcohol (1.7%). The mean hospital stay was 2.5 ± 3.0 days, and the final treatment outcome was complete recovery, except for one patient intoxicated by warfarin and alprazolam. Our results indicate that the high toxicity cases were related to pharmaceutical product and opioids abuse, especially methadone (8.4%), alprazolam (7.9%), clonazepam (7.5%), and acetaminophen (9.9%) taken orally and more commonly happened at home. Due to the high rate of deliberate poisonings, especially among young adults and students, monitoring drug distribution and exceptional attention to mental health should be seriously considered by national health authorities to prevent suicide attempts.
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The Applicability of Linehan Risk Assessment Scale: a Cross-Sectional Study from Alexandria Poison Centre, Egypt, During the COVID-19 Pandemic. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:218. [PMID: 36212982 PMCID: PMC9524316 DOI: 10.1007/s42399-022-01298-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/10/2022]
Abstract
Background/Objective Suicide is a critical health problem that is significantly rising during the COVID-19 pandemic worldwide, yet it is still under-reported in Egypt. To date, a deficiency of a reliable scale to probe the risk factors underlying suicide liability among patients with deliberate self-poisoning. The study’s objective was to offer a snapshot of the pattern of self- poisoning in Egypt during the COVID-19 pandemic. Methods Using the Linehan Risk Assessment and Management Protocol LRAMP, a psychological assessment was applied to evaluate vulnerable patients needing urgent psychiatric support and emphasize the influence of previous suicidal behaviors. A cross-sectional study was conducted on all patients admitted to Alexandria Poison Centre with deliberate self-poisoning biosocial and poisoning data that were recorded in a specially designed sheet. All patients were interviewed for underlying risk factors and protective factors for suicidal behavior. Results Significant relation was recorded between previous suicidal attempts and psychiatric diseases. CNS depressant drugs and rodenticides recorded the highest frequency. The calculated score (suicide and protective factors) was higher in patients with previous suicidal attempts. Conclusion The study was the first to test the applicability of Linehan scale in Alexandria Poison Centre. The results are promising; however, multicenter replication of the concluded findings will be valuable.
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Alsugoor MH. Availability of Antidotes for Management of Acute Toxicity Cases at Emergency Departments in Qassim Hospitals: A Retrospective Study. Cureus 2022; 14:e28992. [PMID: 36249602 PMCID: PMC9548525 DOI: 10.7759/cureus.28992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Drug overdose is a medico-social issue worldwide that may occur intentionally or unintentionally. It is one of the most common reasons for emergency department visits, and it is also a frequent cause of morbidity and mortality globally. This study aims to determine the occurrence of acute toxicity cases and their management outcomes at the emergency departments in Qassim Province hospitals in Saudi Arabia. In addition, the study aims to investigate the antidote availabilities at those medical centers. Methods: A retrospective hospital record-based study of acute toxicity cases admitted to the emergency department in hospitals in Qassim during the period from January 1, 2020, to December 31, 2020, was conducted. Data were collected based on hospital resources such as gastrointestinal decontamination, stabilization, elimination enhancement resources, and antidotes from Qassim hospitals, and the availability of antidotes as well as the clinical data of the patients with the management outcome. Results: A total of 264 patients with acute toxicity were admitted to the emergency departments of 14 hospitals in Qassim Province in 2020. Of the 264 cases, 179 (68%) were males, and 85 (32%) cases were females. Ninety-five percent of the cases were admitted to public hospitals, whereas 5% were admitted to private hospitals. The largest group by age of admitted cases were aged 11-20 years (19.3%). This study showed that 99% received appropriate treatment for their cause of toxicity, whereas 1% did not. The most common causes of toxicity in Qassim were found to be food poisoning (20.5%), followed by intentional suicide attempts with warfarin/enoxaparin/aspirin overdoses (15.9%) and acetaminophen (paracetamol) overdosage seen in 15.5% of admitted cases. Flagyl, in addition to fluids, was used in the management of 16.7% of cases, N-acetyl cysteine was used for 16.3%, and vitamins K and B6 were used for 14.0% of cases. Activated charcoal, atropine, calcium chloride, calcium gluconate, flumazenil, insulin, magnesium, sodium bicarbonate, and vitamin K were available at all the studied hospitals. However, all the hospitals lacked both ethylenediaminetetraacetic acid (EDTA) and a cyanide kit. Methylene blue and leucovorin were available in only one of the studied hospitals.
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Bagherian F, Kalani N, Rahmanian F, Abiri S, Hatami N, Foroughian M, Mehramiz NJ, Shahi B. Aluminum Phosphide Poisoning Mortality Rate in Iran; a Systematic Review and Meta-Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e66. [PMID: 34870232 PMCID: PMC8628645 DOI: 10.22037/aaem.v9i1.1396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: According to statistics provided by the forensic medicine facility of Iran, there are a high number of Aluminum phosphide (ALP) poisoning-related deaths in the country; while the mortality rate varies in different studies. This study aimed to determine a pooled estimate of ALP poisoning mortality rate in Iran. Methods: The present study was a systematic review and meta-analysis of the mortality rate of ALP poisoning in Iran. Through the quarry of Persian and English databases, using “aluminum phosphide”, “phosphine”, “rice pills”, “poisoning”, and “Iran” as keywords, and no time restrictions, studies reporting mortality rate in ALP poisoning cases were collected. The random-effects model was used to pool the proportions of mortality and age of survivors versus non-survivors. Results: 21 studies with 3432 cases of ALP poisoning were included in this meta-analysis. The pooled mortality rate of ALP poisoning in Iran was 39.6%, (95% CI: 31.5%-47.9%; I2 = 95%). Since there was significant publication bias, the trim-and-fill correction was conducted and the corrected pooled mortality rate was estimated to be 27.3% (95% CI: 18.9%- 36.5%), which is the rate that should be considered for clinical guidance. Morality rate in male and female patients was 62.3% (95% CI: 53.5%-70.8%) and 37.7% (95% CI: 29.2%-46.5%), respectively (p < 0.01). Survivors had significantly lower mean age than non-survivors (SMD: -0.26 (95% CI: -0.37 to -0.15); p < 0.01; I2=0%). Conclusion: According to this report, the Mortality rate of ALP poisoning in Iranian population is about 27%, with men having a higher fatality rate than women. Poisoning at a younger age is associated with better results.
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Affiliation(s)
- Farhad Bagherian
- Department of Emergency Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Navid Kalani
- Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Fatemeh Rahmanian
- Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Samaneh Abiri
- Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Naser Hatami
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neema John Mehramiz
- Department of Psychiatry Neurology, Banner university medical center, Tucson, AZ, USA
| | - Behzad Shahi
- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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12
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Rostam-Abadi Y, Gholami J, Noroozi A, Ansari M, Baheshmat S, Hamzehzadeh M, Ghadirzadeh MR, Vahdani B, Ekhtiari H, Mojtabai R, Rahimi-Movaghar A. Public health risks associated with methadone in Iran: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103529. [PMID: 34826790 DOI: 10.1016/j.drugpo.2021.103529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 09/25/2021] [Accepted: 10/30/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There has been a marked growth in methadone maintenance treatment (MMT) in Iran in the past two decades with positive health outcomes. We conducted a systematic review of studies on the prevalence of non-prescribed methadone use, methadone use disorder, and methadone-related poisoning and mortality in Iran. METHODS We searched International and Iranian databases up to May 2020 and contacted relevant experts. The pooled proportions were estimated through random-effects model. Methadone-related adverse outcomes were evaluated over time. RESULTS Sixty-five studies were included. The pooled estimates of non-prescribed methadone use in the last 12-month were 2.7% (95%CI: 0.9-5.4) and 0.1% (95%CI: 0.03-0.2) in the male and female general population, respectively. Among people who use drugs, 8.4% reported daily non-prescribed use in 2018. Four heterogeneous studies in drug treatment centers reported the existence of treatment-seeking for methadone use disorder. Methadone was responsible for 10.4% (95%CI: 4.5-18.3) of cases of acute poisoning in adults and 16.0% (95%CI: 9.3-24.1) in children. Methadone was reported as a cause of death in 53.5% of substance-related deaths referred to the Legal Medicine Organization while being the only cause in 35.8% of all cases. CONCLUSION Non-prescribed use of methadone in the general population is much less than opiates and some other available prescription opioids, like tramadol. However, notwithstanding the large and successful MMT program in Iran, increasing trends in methadone-related poisoning and deaths pose serious public health concerns. There is an urgent need to explore these fatal and non-fatal poisoning cases and implement policies to curb the harms associated with methadone use.
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Affiliation(s)
- Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Ansari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Baheshmat
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Hamzehzadeh
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bita Vahdani
- Center for Disease Affairs and Transplant, Ministry of Health, Tehran, Iran
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
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Moezi SA, Azdaki N, Kazemi T, Partovi N, Hanafi Bojd N, Mashreghi Moghaddam HR, Hamidi F, Khosravi Bizhaem S, Soltani M, Niroomand MS, Khazdair MR. The effects of opium uses on syntax score of angiography patients with coronary artery disease (CAD). TOXIN REV 2021. [DOI: 10.1080/15569543.2021.2000434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Seyyed Ali Moezi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Nahid Azdaki
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Toba Kazemi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Neda Partovi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Nazanin Hanafi Bojd
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Fatemeh Hamidi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeede Khosravi Bizhaem
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Maryam Soltani
- Razi Clinical Research Development Unit (RCRDU), Birjand University of Medical Sciences, Birjand, Iran
| | | | - Mohammad Reza Khazdair
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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14
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Hedayati-Moghadam M, Moezi SA, Kazemi T, Sami A, Akram M, Zainab R, Khazdair MR. The effects of Papaver somniferum (Opium poppy) on health, its controversies and consensus evidence. TOXIN REV 2021. [DOI: 10.1080/15569543.2021.1958232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Seyyed Ali Moezi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Toba Kazemi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Abdul Sami
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad, Pakistan
| | - Rida Zainab
- Department of Eastern Medicine, Government College University Faisalabad, Pakistan
| | - Mohammad Reza Khazdair
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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15
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Sayyari Dougabadi M, Etemad L, Moshiri M. Acute human lethal poisoning with hexaflumuron: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:119-123. [PMID: 33680410 PMCID: PMC7919176 DOI: 10.22088/cjim.12.1.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Hexaflumuron is a benzoyl urea pesticide widely used in agriculture. This is the first case of severe toxicity of hexaflumuron. Case presentation: A 51-year-old man was admitted to the poisoning ward of the Emam-Reza Hospital for loss of consciousness and hypotension secondary to pesticide toxicity. He had metabolic acidosis, bradycardia, and diffuse erythematous skin color change in the abdomen and legs. The results of toxicology tests were negative except positive test result for tricyclic antidepressants in immunochromatographic assay of urine. He was treated with normal saline, norepinephrine infusion and bicarbonate. His intoxication finally resulted to cardiac arrest and death on the 4th day of hospitalization, secondary to septic shock. Conclusion: Acute poisoning with hexaflumuron can be life-threatening, thought its LD50 is greater than 5000 mg/kg. It may change the patient’s skin color to cherry and cause hypotension, loss of consciousness and metabolic acidosis, however, conclusive evidence to support these assumptions are required.
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Affiliation(s)
- Maryam Sayyari Dougabadi
- Deparment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Etemad
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Clinical Toxicology and Poisoning, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Moshiri
- Department of Clinical Toxicology and Poisoning, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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16
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Barary M, Pirzadeh M, Rezaeian N, Dadashnia M, Mohammadi-Daniali S, Pahlavani F, Manouchehri A, Kazemi S, Moghadamnia A. An epidemiological study of poisoning cases in Babol (northern Iran) from 2015 to 2018. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:35-44. [PMID: 33680396 PMCID: PMC7919171 DOI: 10.22088/cjim.12.1.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 10/31/2022]
Abstract
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.
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Affiliation(s)
- Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Marzieh Pirzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Nastaran Rezaeian
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mahsa Dadashnia
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | | | - Fatemeh Pahlavani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Aliasghar Manouchehri
- Department of Internal Medicine, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Aliakbar Moghadamnia
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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17
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Tefera GM, Teferi LG. Prevalence, Predictors and Treatment Outcome of Acute Poisoning in Western Ethiopia. Open Access Emerg Med 2020; 12:365-375. [PMID: 33209064 PMCID: PMC7669523 DOI: 10.2147/oaem.s277269] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/24/2020] [Indexed: 12/05/2022] Open
Abstract
Background Acute poisoning is a common reason for visiting the emergency department (ED) worldwide. However, little is known about this issue in the western part of Ethiopia. This study was carried out to determine the prevalence, predictors, and treatment outcome of acute poisoning at the ED of western Ethiopia. Patients and Methods A hospital record-based retrospective study design was conducted on all patients admitted to the ED of the two hospitals between 01 January 2018 to 17 March 2019. Socio-demographic, clinical presentation, medication history, poisoning characteristics, time to hospital arrival, treatment given, and outcome of treatment were collected. All collected data were analyzed using SPSS Version 20. Backward multiple logistic regression analysis at p-value ≤0.05 tested the predictor for treatment outcome. Results The prevalence of acute poisoning was 134/7883 (1.7%) per ED admissions. The mean ±SD age of the study participants was 23.90±10.606 with female to male ratio of 1:1.06. The most vulnerable patients to poisoning were individuals in the age range of 18 to 29 years 68/134 (50.7%) for both genders. Moreover, the most common poisoning agent was organophosphate 72/134 (53.7%). Besides, intentional poisoning was the most common 103/134 (76.9%) manner of poisoning with family disharmony 37/103 (35.9%) as the common reason. The case fatality rate of acute poisoning in the two hospitals was 2/134 (1.5%). The mean ±SD length of hospital stay was 1.86 ±0.943. The independent predictors of poor treatment outcome of acute poisoning were age ≥35 years [p-value= 0.049], female gender [p-value= 0.027], and hospital stay of >48 hours [p-value= 0.035]. Conclusion The prevalence of acute poisoning in western Ethiopia is higher than the ever-reported data in Ethiopia. Thus, stakeholders should have to pay more attention to prevention and control strategies and appropriate handling of agrochemical substances to minimize their negative effects on this productive age group.
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18
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Thapa S, Dawadi BR, Upreti AR. Acute Poisoning among Patients Presenting to the Emergency Department of a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:470-473. [PMID: 32827007 PMCID: PMC7580394 DOI: 10.31729/jnma.4997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Acute poisoning is a major global public health problem contributing to one of the leading causes for a visit to an emergency department. This study aims to analyse the demographic and psychosocial characteristics of patients with acute poisoning presented to the emergency department. Methods: This was a descriptive cross-sectional study conducted in a tertiary care hospital from June to December 2019 after obtaining ethical approval from Institutional review board (reference number. 041-075/0760). A convenient sampling method was applied. Epidemiological factors, types of poison consumed, reason, motive, and place to take poison, time elapse in the presentation to the hospital were studied. Statistical analysis was done using statistical package for the social sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 76 cases of acute poisoning, the organophosphorus poisoning was 18 (23.7%) followed by unknown 12 (15.8). Of total, 28 (36.8%) had quarrel before taking poison and 41 (53.9%) had intention to commit suicide. Sixty-seven (88.2%) took a poison at home. The average elapsed time to the visit of the emergency department was 110±80 minutes Conclusions: The most common poisoning was organophosphorus with a suicide being the most common intention. Quarrel was the most frequent reason to take poison and the home was the most common place to take poison.
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Affiliation(s)
- Sameer Thapa
- Department of Emergency and General Practice, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Bishwa Raj Dawadi
- Department of Emergency and General Practice, Grande International Hospital, Dhapasi, Kathmandu, Nepal
| | - Anup Raj Upreti
- Clinical Pharmacist, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
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Lekei E, Ngowi AV, Kapeleka J, London L. Acute pesticide poisoning amongst adolescent girls and women in northern Tanzania. BMC Public Health 2020; 20:303. [PMID: 32156268 PMCID: PMC7065330 DOI: 10.1186/s12889-020-8374-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production. METHODS Over the period of 12 months, health facility-based surveillance for cases of APP was implemented in 10 Tanzanian healthcare facilities in 2006. RESULTS The study identified 108 APP cases of whom 31 (28.7%) occurred amongst adolescent girls. Suicide was the leading poisoning circumstances (60.2%) and the most vulnerable women were 20-29 years old who comprised 38.4% of all cases with suicide as circumstance. Organophosphates (OPs), zinc phosphide, paraquat and endosulfan were common amongst known reported poisoning agents. The annual APP incidence, mortality and Case Fatality Rate for women were 5.1/100,000, 0.2/100,000 and 3.7/100, respectively. CONCLUSION APP amongst women in Tanzania is common and this call for diverse preventive interventions to reduce poisoning incidents.
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Affiliation(s)
- Elikana Lekei
- Tropical Pesticides Research Institute, P.O. Box 3024, Arusha, Tanzania
| | - Aiwerasia V. Ngowi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), P.O. Box 65015, Dar es Salaam, Tanzania
| | - Jones Kapeleka
- Tropical Pesticides Research Institute, P.O. Box 3024, Arusha, Tanzania
| | - Leslie London
- School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
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20
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Titidezh V, Arefi M, Taghaddosinejad F, Behnoush B, Akbar Pour S, Mahboobi M. Epidemiologic profile of deaths due to drug and chemical poisoning in patients referred to Baharloo Hospital of Tehran, 2011 to 2014. J Forensic Leg Med 2019; 64:31-33. [PMID: 30927562 DOI: 10.1016/j.jflm.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/15/2018] [Accepted: 02/15/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND In developing countries with high mortality rates, poisoning is one of the most common causes of admission to emergency rooms. To minimize future deaths related to poisoning, the epidemiological profile of deceased individuals is essential. METHODS The medical records of all dead patients due to poisoning during 2011-2014 in Baharloo Hospital, Tehran, were evaluated. Exclusion criteria include: incomplete records, unknown causes of death, and persons less than 6 years of age. Data analysis was done by means of SPSS at the significance level of P < 0.05. RESULTS The study included 184 males and 65 females. The mean age range was 37.65 ± 16.78 years. The highest mortality rate was seen in the age range of 21-30 years (30.5%). The most common cause of poisoning was aluminum phosphide (101 cases). The average time of hospitalization was 3.61 days. Most deaths occurred during the first 10 days of admission with intentional poisoning being the most common type (81.5%). CONCLUSION The outcome of this study indicates that the main cause of death among young people is intentional poisoning with AIP. This study proves that a greater focus when diagnosing mental health patients, as well as an increase in restrictions when accessing lethal drugs and toxins, is crucial.
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Affiliation(s)
- Vahid Titidezh
- Department of Forensic Medicine and Toxicology, Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Arefi
- Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Behnam Behnoush
- Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samaneh Akbar Pour
- Occupational Sleep Research Center (OSRC), Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marzieh Mahboobi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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21
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Jamshidi F, Yazdanbakhsh A, Jamalian M, Khademhosseini P, Ahmadi K, Sistani A, Jokar A. Therapeutic Effect of Adding Magnesium Sulfate in Treatment of Organophosphorus Poisoning. Open Access Maced J Med Sci 2018; 6:2051-2056. [PMID: 30559859 PMCID: PMC6290410 DOI: 10.3889/oamjms.2018.350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 08/28/2018] [Accepted: 09/03/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: In recent years, the prevalence of poisoning has increased dramatically due to population growth and access to drugs and toxins. Today poisoning is one of the important reasons for visiting hospitals. AIM: The present study aimed to investigate the effect of magnesium sulfate on organophosphorous toxicity. METHODS: Patients who had inclusion criteria in the study were randomly assigned to one of two groups (control group or case group) by an emergency medicine specialist. Patients’ data including age, sex, ECG, vital signs, arterial oxygen saturation were recorded for patients. Patients in the case group (40 subjects) received 2 mg magnesium sulfate 50%, while the control group (40 subjects) received 100 cc normal saline (as placebo) as an intravenous infusion RESULTS: The distribution of gender in the two groups of patients was the same. Also, the mean age, Stature and weight of patients were similar in both groups. In the group receiving magnesium sulfate, diastolic blood pressure was lower when compared with another group, at 0 and 2 hours after intervention. Moreover, the mean of systolic blood pressure in both groups was determined to be the same at all hours. Furthermore, the heart rate in the group receiving sulfate was lower as compared to the control group for 8 hours, 16 and 24 hours after intervention. CONCLUSION: The use of magnesium sulfate in organophosphate poisoning reduces therapeutic costs an average hospital length of stay and mortality compared to those who did not receive magnesium sulfate.
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Affiliation(s)
- Fatemeh Jamshidi
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Arash Yazdanbakhsh
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Peyman Khademhosseini
- Department of Emergency Medicine, Karaj University of Medical Sciences, Alborz, Iran
| | - Koroosh Ahmadi
- Department of Emergency Medicine, Karaj University of Medical Sciences, Alborz, Iran
| | - Alireza Sistani
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Jokar
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
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Zin CS, Nazar NI, Rahman NS, Alias NE, Ahmad WR, Rani NS, Cardosa MS, Ng KS, Ye FL. Trends and patterns of analgesic prescribing in Malaysian public hospitals from 2010 to 2016: tramadol predominately used. J Pain Res 2018; 11:1959-1966. [PMID: 30288090 PMCID: PMC6160284 DOI: 10.2147/jpr.s164774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose To examine the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioid patients. Patients and methods This cross-sectional study was conducted from 2010 to 2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid, and naproxen), tramadol, and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Annual number of patients and prescriptions were measured in repeat cross-sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata version 13. Results A total of 192,747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were given for 97,227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n=72,999) was the most frequently prescribed analgesic, followed by ketoprofen (17.5%, n=33,793), diclofenac (16.2%, n=31,180), celecoxib (12.2%, n=23,487), and other NSAIDs (<4.5%). All the analgesics were increased over time except meloxicam, indomethacin, and mefenamic acid. Opioids, primarily morphine (2.2%, n=4,021) and oxycodone (0.5%, n=1,049), were prescribed the least, but the rate of increase was the highest. Conclusion Tramadol was the most frequently prescribed analgesic in hospital outpatient settings in Malaysia. Opioids were prescribed the least, but noted the highest increase in utilization.
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Affiliation(s)
- Che Suraya Zin
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Nor Ilyani Nazar
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Norny Syafinaz Rahman
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Nor Elina Alias
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Wan Rohaidah Ahmad
- Department of Anaesthesiology and Intensive Care, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Nurul Sahida Rani
- Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Mary Suma Cardosa
- Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia
| | - Kim Swan Ng
- Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia
| | - Felicia Loh Ye
- Department of Pharmacy, Hospital Selayang, Batu Caves, Malaysia
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Mehrpour O, Akbari A, Jahani F, Amirabadizadeh A, Allahyari E, Mansouri B, Ng PC. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med 2018; 18:30. [PMID: 30231863 PMCID: PMC6146606 DOI: 10.1186/s12873-018-0181-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/12/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute poisoning is a common chief complaint leading to emergency department visits and hospital admissions in developing countries such as Iran. Data describing the epidemiology of different poisonings, characteristics of the clinical presentations, and the predictors of outcome are lacking. Such data can help develop more efficient preventative and management strategies to decrease morbidity and mortality related to these poisonings. This manuscript describes the epidemiology of acute poisoning among patients admitted to the intensive care unit (ICU) in Birjand, Iran. METHODS This retrospective, cross-sectional study was conducted to characterize acute poisonings managed in the ICU during a 7-year period from March 2010 to March 2017 in a single center in Birjand, Iran. Patient characteristics, suspected exposure, the route of exposure, and outcome data were collected from hospital medical records. RESULTS During the study period, 267 (64% male and 36% female) patients met inclusion criteria. Pharmaceutical medication (36.6%), opioids (26.2%) followed by pesticides (13.9%) were the most common exposures 38.2% of these cases were identified as suicide attempts. There were different frequencies in terms of xenobiotic exposure in relation to gender (p = 0.04) and the survival (p = 0.001). There was a significant difference between various xenobiotics identified as the cause of poisoning (p = 0.001). Mortality rate in our study was 19.5%. The incidence of outcomes was significantly higher in patients poisoned with opioids, pesticides, benzodiazepines, and tricyclic antidepressants (p < 0.05). The median length of hospital stay was higher in pesticide-poisoned patients (p = 0.04). CONCLUSION Opioids and pesticides were the most common exposures. The mortality rate of the poisoned patients in the ICU was proportionately high. The mortality rate due to opioid poisoning is a major concern and the most significant cause death due to poisoning in the region. Further monitoring and characterization of acute poisoning in Birjand, Iran is needed. These data can help develop educational and preventative programs to reduce these exposures and improve management of exposures in the prehospital and hospital settings.
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Affiliation(s)
- Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
- Rocky Mountain Poison and Drug Center, Denver, CO USA
| | - Ayob Akbari
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Firoozeh Jahani
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Elaheh Allahyari
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Borhan Mansouri
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Patrick C. Ng
- Rocky Mountain Poison and Drug Center, Denver, CO USA
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Hassanian-Moghaddam H, Ghorbani F, Rahimi A, Farahani TF, Sani PSV, Lewin TJ, Carter GL. Federation Internationale de Football Association (FIFA) 2014 World Cup Impact on Hospital-Treated Suicide Attempt (Overdose) in Tehran. Suicide Life Threat Behav 2018; 48:367-375. [PMID: 28612472 DOI: 10.1111/sltb.12359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/08/2017] [Indexed: 11/27/2022]
Abstract
Social influences on suicidal behaviors may be important but are less frequently studied than the influences of mental illness, physical illness, and demographic variables. Major international sporting events may have an impact on suicidal behaviors at the national and local level, an effect possibly mediated by gender and age. We examined the association of hospital-treated deliberate self-poisoning episodes (by gender and by age) in Tehran: before, during, and after the 2014 FIFA World Cup held in Brazil, in which the Iranian national team participated and was eliminated after the pool games. We used a time series analysis within an autoregressive integrated moving average model and found a significant increase in hospital-treated deliberate self-poisoning during the 4-week period of the 2014 FIFA World Cup in Brazil in females but a nonsignificant increase in males. A significant increase was also seen in the youngest age group (12-20 years), but not in the two older age groups. If the effects of nonsuccess at major international sporting events could be shown to have a potential harmful effect on aggregate local or national rates of suicidal behaviors, the possibility of preventative interventions and preemptive additional service provision could be planned in advance of these events.
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Affiliation(s)
- Hossein Hassanian-Moghaddam
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ghorbani
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Rahimi
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tayyebeh Farmahini Farahani
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvane Sadat Vafaei Sani
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Terry J Lewin
- Centre for Brain and Mental Health Research (CBMHR), Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Gregory L Carter
- Centre for Brain and Mental Health Research (CBMHR), Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
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Navabi SM, Navabi J, Aghaei A, Shaahmadi Z, Heydari R. Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: characteristics and predictive factors. Epidemiol Health 2018; 40:e2018022. [PMID: 29807406 PMCID: PMC6060335 DOI: 10.4178/epih.e2018022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/27/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Aluminum phosphide (ALP), also known in Iran as rice tablets, is one of the most effective rodenticides used to protect stored grain. However, ALP poisoning regularly causes mortality in humans. The aim of this study was to evaluate the characteristics and predictive factors of mortality from ALP poisoning. METHODS This study evaluated all patients with ALP poisoning referred to Imam Khomeini Hospital in Kermanshah Province, Iran from 2014 to 2015. For each patient, the following information was recorded: age, sex, the number of tablets consumed, the number of suicide attempts, the time elapsed from consumption to treatment, blood pressure, blood pH, HCO3 levels, and PCO2 . Differences between the survivors and non-survivors of ALP poisoning were analyzed using univariate logistic regression and multivariate analysis. RESULTS In this study, 48 patients were male and 29 patients were female (total: 77 patients). The average age of the survivors and non-survivors was 28.7 and 31.3 years, respectively. All cases (100%) of ALP poisoning were intentional, with the goal of committing suicide. The main predictive variables of mortality from ALP poisoning were blood pressure, blood pH, and time elapsed from consumption to treatment. CONCLUSIONS The likelihood of mortality in patients with ALP poisoning can be predicted using blood pressure, blood pH, and time elapsed from consumption to treatment. These findings may help healthcare providers take more effective measures to treat patients with ALP poisoning.
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Affiliation(s)
| | - Jafar Navabi
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abbas Aghaei
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Shaahmadi
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ruhollah Heydari
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Alinejad S, Zamani N, Abdollahi M, Mehrpour O. A Narrative Review of Acute Adult Poisoning in Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:327-346. [PMID: 28761199 PMCID: PMC5523040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Poisoning is a frequent cause of referral to medical emergencies and a major health problem around the world, especially in developing countries. We aimed to review the epidemiology and pattern of adult poisoning in Iran in order to facilitate the early diagnosis and management of poisoning. The pattern of poisoning is different in various parts of Iran. Pharmaceutical compounds were the most common cause of poisoning in most parts of Iran. Pesticide-related toxicities were more common in northern agricultural regions, whereas bites and stings were seen more commonly in southern Iran. Carbon monoxide poisoning was common in cities with many motor vehicles such as Tehran and in colder climates such as in northern and western regions due to inadequately vented gas appliances such as stoves and heaters. Majoon Birjandi (containing cannabis) is a unique substance used in eastern Iran. Poisoning by opioids, tramadol, and pesticides (organophosphate and aluminum phosphide) has remained a common hazard in Iran. Poisoning-associated morbidity and mortality rates vary by region and have changed over time due to the introduction of new drugs and chemicals. Early diagnosis and proper treatment may be lifesaving; thus, understanding the general pattern of poisoning in different regions is important.
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Affiliation(s)
- Samira Alinejad
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran,Correspondence: Omid Mehrpour, MD; Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Moallem Avenue, Zip Code: 97178-53577, Birjand, Iran. Tel\Fax: +98 56 32381270
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Koskela L, Raatiniemi L, Bakke HK, Ala-Kokko T, Liisanantti J. Do pre-hospital poisoning deaths differ from in-hospital deaths? A retrospective analysis. Scand J Trauma Resusc Emerg Med 2017; 25:48. [PMID: 28482932 PMCID: PMC5422974 DOI: 10.1186/s13049-017-0391-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/26/2017] [Indexed: 11/21/2022] Open
Abstract
Background Most fatal poisonings occur outside the hospital and the victims found dead. The purpose of this study was to determine the general pattern and patient demographics of fatal poisonings in Northern Finland. In particular, we wanted to analyze differences between pre-hospital and in-hospital deaths. Methods All fatal poisonings that occurred in Northern Finland in 2007–2011 were retrieved from the Cause of Death Registry provided by Statistics Finland. We noted the patient demographics, causal agents, and other characteristics of the poisoning events. Results A total of 689 fatal poisonings occurred during the study period, of which only 42 (6.1%) reached the hospital alive. Those who died pre-hospital were significantly younger (50 vs. 56 years, p = 0.04) and more likely to be male (77% vs. 57%, p = 0.003). Cardiopulmonary resuscitation was attempted less often in pre-hospital cases (9.9% vs. 47.6%, p < 0.001). Ethanol was more frequently the main toxic agent in pre-hospital deaths (58.4% vs. 26.2%, p < 0.001), and multiple ingestions were more common (52.2% vs. 35.7%, p < 0.001) in pre-hospital deaths. Discussion Most of the pre-hospital fatal poisoning victims are found dead and the majority of in-hospital victims are admitted to hospital in an already serious condition. According to results of this and former studies, prevention seems to be the most important factor in reducing deaths due to poisoning. Conclusions The majority of poisoning-related deaths occur pre-hospital and are related to alcohol intoxication and multiple ingestions.
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Affiliation(s)
- Lauri Koskela
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. BOX 21, 90029 OYS, Oulu, Finland. .,Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland.
| | - Lasse Raatiniemi
- Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland.,Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
| | - Håkon Kvåle Bakke
- Anesthesia and Critical Care Research Group, University of Tromsø, Tromsø, Norway.,Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway
| | - Tero Ala-Kokko
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. BOX 21, 90029 OYS, Oulu, Finland.,Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland
| | - Janne Liisanantti
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. BOX 21, 90029 OYS, Oulu, Finland.,Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland
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Mousavi SG, Tehrani MN, Maracy M. The Effect of Active Treatment and Visit Compared to Conventional Treatment, on Preventing Recurrent Suicidal Attempts: A Randomized Controlled Clinical Trial. Adv Biomed Res 2017; 6:38. [PMID: 28503493 PMCID: PMC5414404 DOI: 10.4103/2277-9175.204586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Suicide is a major problem, and its prevention is a global priority. In many cases, suicide attempter attempts to do it again after the rescue. In current study we aimed to compare active visit and treatment of patients in a periodic manner with treatment as usual, in the prevention of recurrent suicidal attempts. MATERIALS AND METHODS This study was a randomized controlled clinical trial which was conducted in Isfahan Noor Hospital's Emergency Center on 60 patients in 2013-2014. The samples were selected using simple random sampling and they were assigned into two groups: The conventional treatment group (treatment as usual) (30 patients), and visit and active treatment (30 patients). In the intervention group, there were ten follow-ups by a face-to-face visit over 12 months, and six follow-ups by phone call in control group. Through the completion of the initial and follow-up questionnaire evaluation was performed. The data were analyzed using Cochran test, and repeated measure (ANOVA). RESULTS During the 12-month follow-up visit and active treatment, significant difference in reducing suicidal thoughts (P = 0.003) was observed and an increase in the life expectancy (P = 0.001), interest and motivation in life (P = 0.001) was found in the intervention group, and also nonsignificant reduction was found in the rate of suicidal attempts. CONCLUSION Visit and active treatment is useful in suicide attempters and it can helps in preventing recurrent suicide attempt as a preventive program by increasing hope and reducing suicidal thoughts.
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Affiliation(s)
- Seyed Ghafur Mousavi
- From the Department of Psychiatry, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marayam Nader Tehrani
- From the Department of Psychiatry, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Maracy
- Department of Epidemiology and Statistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Aminiahidashti H, Shafiee S, Mousavi SJ, Hajiaghaei G. Tramadol Pill Alone May Cause Serotonin Syndrome. Chin Med J (Engl) 2017; 129:877-8. [PMID: 26996488 PMCID: PMC4819313 DOI: 10.4103/0366-6999.178957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Seyed Jaber Mousavi
- Department of Community Medicine, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
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Hassanian-Moghaddam H, Sarjami S, Kolahi AA, Lewin T, Carter G. Postcards in Persia: A Twelve to Twenty-four Month Follow-up of a Randomized Controlled Trial for Hospital-Treated Deliberate Self-Poisoning. Arch Suicide Res 2017; 21:138-154. [PMID: 25774646 DOI: 10.1080/13811118.2015.1004473] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study reports the outcomes, during follow-up, of a low-cost postcard intervention in a Randomized Control Trial of hospital-treated self-poisoning (n = 2300). The intervention was 9 postcards over 12 months (plus usual treatment) versus usual treatment. Three binary endpoints at 12-24 months (n = 2001) were: any suicidal ideation, suicide attempt, or self-cutting. There was a significant reduction in any suicidal ideation (RRR 0.20 CI 95% 0.13-0.27), (NNT 8, 6-13), and any suicide attempt (RRR 0.31, 0.06-0.50), (NNT 35, 19-195), in this non-western population. However, there was no effect on self-cutting (RRR -0.01, -1.05-0.51). Sustained, brief contact by mail may reduce some forms of suicidal behavior in self-poisoning patients during the post intervention phase.
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Moradi M, Ghaemi K, Mehrpour O. A hospital base epidemiology and pattern of acute adult poisoning across Iran: a systematic review. Electron Physician 2016; 8:2860-2870. [PMID: 27790337 PMCID: PMC5074743 DOI: 10.19082/2860] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/03/2016] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Poisoning is one of the most important health issues in the world. There is no exact statistic regarding the epidemiology of poisoning in Iran. The aim of this systematic review was to study the epidemiology of poisoning of adults in Iran. METHODS All the published papers regarding the epidemiology and patterns of adult poisonings in different parts of Iran were reviewed in bibliographical databases, including SID, Iran Medex, Medlib, Magiran and Embase, Scopus, PubMed, and Google Scholar, without time limitation up to March 21, 2016. We searched for the terms poisoning, Iran, and epidemiology. After the final analysis, 38 articles that fulfilled all the required conditions were selected. RESULT In this article, we show that in most Iranian cities, except Ahvaz, pharmaceutical drugs, especially psychiatric pharmaceutical drugs, are the most common cause of poisoning in adults. In the Southwest region of Iran, poisoning due to envenomation is a very common. Although pesticide and opioid poisonings are less common, they are an important cause of death due to poisoning in Iran. CONCLUSION Pharmaceutical drugs are the most common cause of poisoning in most Iranian cities and it is recommended not to store pharmaceutical drugs at home and to set special rules regarding proper description of pharmaceutical drugs. More public health instruction is essential in the Southwest cities of Iran in order to reduce animal poisonings.
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Affiliation(s)
- Malihe Moradi
- M.D. General Physician, Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Kazem Ghaemi
- M.D. Neurosurgery specialist, Associate Professor, Department of Neurosurgery, Faculty of Medicine, Birjand University Of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- M.D, Fellowship of Medical Toxicology, Associate Professor, Atherosclerosis and Coronary Artery Research Centre, Birjand University of Medical Science, Birjand, Iran
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Shadboorestan A, Vardanjani HM, Abdollahi M, Goharbari MH, Khanjani N. A systematic review on human exposure to organophosphorus pesticides in Iran. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2016; 34:187-203. [PMID: 27333452 DOI: 10.1080/10590501.2016.1202756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Human exposure to organophosphorus (OP) pesticides is a serious health challenge. We conducted a systematic review by searching international and national databases for published literature on any human exposure to OPs in Iran from 1990 to March 2015. Qualified papers were in two categories including studies in which biomarkers of exposure were assessed (n = 13; total no. of subjects = 759) and studies that had reported prevalence of OPs-induced poisoning (OPP) and mortality (n = 26; total no. of subjects = 5428). The mean level of activity of acetyl-cholinesterase and butyryl-cholinesterase were 68.65% and 74.2%, respectively. Overall proportion (%) of OPP was estimated (16; 95% CI, 14 to 19).
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Affiliation(s)
- Amir Shadboorestan
- a Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Hossein Molavi Vardanjani
- b Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman , Iran
| | - Mohammad Abdollahi
- a Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Hadi Goharbari
- a Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Narges Khanjani
- c Environmental Health Engineering Research Center, Kerman University of Medical Sciences , Kerman , Iran
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Hamdi H, Hassanian-Moghaddam H, Hamdi A, Zahed NS. Acid-base disturbances in acute poisoning and their association with survival. J Crit Care 2016; 35:84-9. [PMID: 27481740 DOI: 10.1016/j.jcrc.2016.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/13/2016] [Accepted: 05/02/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose was to investigate the association between acid-base disturbances and mortality in acute poisoning. MATERIALS AND METHODS We performed a retrospective cross-sectional exploratory study on all acutely poisoned patients older than 12 years who had been admitted to the main tertiary toxicology hospital in Tehran between March and August 2010. RESULTS Of a total of 1167 patients (median age=25 years, 50.9% male), 98 died (74.5% male). Psychotropic medications were the most common cause of poisoning (36.5%), whereas narcotics and psychodysleptics were the most common cause of death (23.5%). Mixed respiratory alkalosis and metabolic acidosis with normal pH were the most common acid-base status (333, 28.5%). However, patients with primary metabolic acidosis and respiratory compensation had significantly higher mortality (31 cases, 18.8%). Logistic regression analysis identified age (odds ratio [OR], 1.051; 95% confidence interval [CI], 1.031-1.070; P<.001), intensive care unit admission (OR, 12.405; 95% CI, 7.178-21.440; P<.001), consciousness level (OR, 1.752; 95% CI, 1.301-2.359; P<.001), hospitalization period (OR, 1.1361; 95% CI, 1.079-1.195; P<.001), severe metabolic acidosis (OR, 6.016; 95% CI, 1.647-21.968; P=.007), and primary respiratory alkalosis (OR, 5.579; 95% CI, 1.353-23.001; P=.017) as death predictors during hospitalization (P<.001). CONCLUSION On-arrival acid-base status predicts survival and can be used in prognostication of the poisoned patients.
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Affiliation(s)
- Haleh Hamdi
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Excellence Center of Clinical Toxicology, Ministry of Health and Medical Education, Tehran, Iran.
| | - Amir Hamdi
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Narges Sadat Zahed
- Department of Nephrology, Loghman-Hakim Hospital, Shahid Beheshti University, Tehran, Iran
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Abstract
Background Organophosphates and carbamates are insecticides that are associated with high human mortality. The purpose of this study is to investigate the prognostic factors affecting survival in patients with cholinesterase inhibitor (CI) poisoning. Material/Methods This study included 92 patients with CI poisoning in the period from January 2005 to August 2013. We divided these patients into 2 groups (survivors vs. non-survivors), compared their clinical characteristics, and analyzed the predictors of survival. Results The mean age of the included patients was 56 years (range, 16–88). The patients included 57 (62%) men and 35 (38%) women. When we compared clinical characteristics between the survivor group (n=81, 88%) and non-survivor group (n=11, 12%), there were no differences in renal function, pancreatic enzymes, or serum cholinesterase level, except for serum bicarbonate level and APACHE II score. The serum bicarbonate level was lower in non-survivors than in survivors (12.45±2.84 vs. 18.36±4.73, P<0.01). The serum APACHE II score was higher in non-survivors than in survivors (24.36±5.22 vs. 12.07±6.67, P<0.01). The development of pneumonia during hospitalization was higher in non-survivors than in survivors (n=9, 82% vs. n=31, 38%, P<0.01). In multiple logistic regression analysis, serum bicarbonate concentration, APACHE II score, and pneumonia during hospitalization were the important prognostic factors in patients with CI poisoning. Conclusions Serum bicarbonate and APACHE II score are useful prognostic factors in patients with CI poisoning. Furthermore, pneumonia during hospitalization was also important in predicting prognosis in patients with CI poisoning. Therefore, prevention and active treatment of pneumonia is important in the management of patients with CI poisoning.
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Affiliation(s)
- In O Sun
- Division of Nephrology and Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, South Korea
| | - Hyun Ju Yoon
- Division of Nephrology and Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, South Korea
| | - Kwang Young Lee
- Division of Nephrology and Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, South Korea
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Eteiwi SM, Al-Eyadah AA, Al-Sarihin KK, Al-Omari AA, Al-Asaad RA, Haddad FH. Potassium Permanganate Poisoning: A Nonfatal Outcome. Oman Med J 2015; 30:291-4. [PMID: 26366264 DOI: 10.5001/omj.2015.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute poisoning by potassium permanganate is a rare condition with high morbidity and mortality. Diagnosis of the condition relies on a history of exposure or ingestion and a high degree of clinical suspicion. Oxygen desaturation and the presence of methemoglobin are also helpful indicators. Since no specific antidote is available, treatment is mainly supportive. Few cases have been reported in the literature following potassium permanganate ingestion, whether intentional or accidental, and most of the patients in these cases had unfavorable outcomes, which was not the case in our patient. Our patient, a 73-year-old male, purchased potassium permanganate over the counter mistaking it for magnesium salt, which he frequently used as a laxative. Several hours after he ingested it, he was admitted to the endocrine department at King Hussein Medical Center, Jordan, with acute rapidly evolving shortness of breath. During hospitalization, his liver function tests deteriorated. Since he was diagnosed early and managed promptly he had a favorable outcome.
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Affiliation(s)
- Suzan M Eteiwi
- Endocrine and Diabetes Department, King Hussein Medical Center, Amman, Jordan
| | | | | | - Ahmad A Al-Omari
- Endocrine and Diabetes Department, King Hussein Medical Center, Amman, Jordan
| | - Rania A Al-Asaad
- Endocrine and Diabetes Department, King Hussein Medical Center, Amman, Jordan
| | - Fares H Haddad
- Endocrine and Diabetes Department, King Hussein Medical Center, Amman, Jordan
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The correlation between prolonged corrected QT interval with the frequency of respiratory arrest, endotracheal intubation, and mortality in acute methadone overdose. Cardiovasc Toxicol 2015; 14:358-67. [PMID: 24811951 DOI: 10.1007/s12012-014-9259-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Corrected QT interval (QTc) prolongation is long considered as a predisposing factor for the occurrence of torsade de pointes (TdP) and sudden cardiac arrest in methadone maintenance treatment. We aimed to elucidate the correlation between QTc prolongation and in-hospital death, respiratory arrest, and endotracheal intubation in acute methadone-intoxicated patients presenting to the emergency department and to assess the value of QTc in predicting these outcomes. A prospective cross-sectional study with a convenience sample of patients with acute methadone overdose was done. Participants were 152 patients aged 15-65 with negative urinary dipstick test for cyclic antidepressants, no history of other QTc-prolonging conditions and co-ingestions, no severe comorbidities affecting the outcomes, and positive urinary dipstick results for methadone. QTc intervals were measured and calculated in triage-time electrocardiogram (ECG). Death was correlated with QTc (P = 0.014) and length of ICU admission (P < 0.001). In multivariable analysis, death was independently associated only with length of ICU admission [odds ratio (OR) 95 % confidence intervals (95 % CI) 1.36 (1.14-1.61)]. Intubation and respiratory arrest were independently associated with QTc interval [OR (95 % CI) 1.03 (1.02-1.04) and 1.02 (1.01-1.03), respectively]. The receiver operating characteristics curves drawn to show the ability of QTc to predict death, intubation, and respiratory arrest showed thresholds of 470, 447.5, and 450 ms with sensitivity (95 % CI) and specificity (95 % CI) of 87.5 (47.3-99.7), 86.8 (74.7-94.5), and 77.3 (62.2-88.5), respectively. Our study showed that QTc is a potential predictor for adverse outcomes related to acute methadone intoxication. The correlations shown in this study between triage-time QTc and in-hospital respiratory arrest or intubation in methadone overdose may be of clinical value, whether these outcomes are hypothesized to be a reflection of background TdP or intoxication severity.
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Alizadeh AM, Hassanian-Moghaddam H, Shadnia S, Zamani N, Mehrpour O. Simplified acute physiology score II/acute physiology and chronic health evaluation II and prediction of the mortality and later development of complications in poisoned patients admitted to intensive care unit. Basic Clin Pharmacol Toxicol 2014; 115:297-300. [PMID: 24517530 DOI: 10.1111/bcpt.12210] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Abstract
We aimed to determine the acute physiology and chronic health evaluation (APACHE) II and simplified acute physiology score (SAPS) II in poisoned patients admitted to the poisoning ICU and compare them to see which is a more sensitive and specific system for prognostication of the mortality and complications in these patients. Between February 2013 and July 2013, all patients referring to our centre with any poisoning mandating ICU admission were prospectively included. On ICU arrival, a questionnaire containing the demographic data, parameters of the APACHE II and SAPS II scores, the sum of the scores, complications during the stay and the patients' final outcome (compete recovery versus death) was filled for every single patient. A total of 195 patients were evaluated. Forty-two patients (21.5%) died. Mean SAPS and APACHE scores were 41 ± 16 and 15 ± 6, respectively. Mean SAPS and APACHE scores were significantly different between the survivors and non-survivors. Both scores could successfully prognosticate the development of the complications (p = 0.07 and 0.013, respectively). APACHE II was a better score in prediction of both mortality and later complications in the setting of poisoning ICU. APACHE >22 has a good specificity in determining the mortality and development of further complications in poisoned patients admitted to the medical toxicology ICUs. SAPS II score >59 and >43 can predict the risk of mortality and later complications in these patients, as well.
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Affiliation(s)
- Afshin Mohammad Alizadeh
- Department of Bone Marrow Transplantation, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Arefi M, Taghaddosinejad F, Salamaty P, Soroosh D, Ashraf H, Ebrahimi M. Renal failure prevalence in poisoned patients. Nephrourol Mon 2014; 6:e11910. [PMID: 24783168 PMCID: PMC3997944 DOI: 10.5812/numonthly.11910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 05/31/2013] [Accepted: 06/04/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Renal failure is an important adverse effect of drug poisoning. Determining the prevalence and etiology of this serious side effect could help us find appropriate strategies for the prevention of renal failure in most affected patients. OBJECTIVES The present study is aimed to identify drugs that induce renal failure and also to find the prevalence of renal failure in patients referred to emergency departments with the chief complaint of drug poisoning, in order to plan better therapeutic strategies to minimize the mortality associated with drug poisoning induced renal failure. PATIENTS AND METHODS This cross-sectional study surveyed 1500 poisoned patients referred to the Emergency Department of Baharloo Hospital in Tehran during 2010. Demographic data including age and gender as well as clinical data including type of medication, duration of hospital stay, and presence of renal failure were recorded. Mann-Whitney U test and chi-squared statistics were used to analyze the results. RESULTS A total number of 435 patients were poisoned with several drugs, 118 patients were intoxicated with sedative-hypnotic drugs, 279 patients were exposed to opium, and 478 patients were administered to other drugs. The method of intoxication included oral 84.3%, injective 9%, inhalation 4.3% and finally a combination of methods 2.3%. Laboratory results revealed that 134 cases had renal failure and 242 had rhabdomyolysis. The incidence of rhabdomyolysis and renal failure increased significantly with age, and also with time of admission to the hospital. Renal failure was reported in 25.1% of patients exposed to opium, vs. 18.2% of patients poisoned with aluminum phosphide, 16.7% of those with organophosphate, 8% with multiple drugs, 6.7% with alcohol, heavy metals and acids, and 1.7% with sedative hypnotics. CONCLUSIONS Based on the findings of this study, there is a high probability of renal failure for patients poisoned with drugs such as opium, aluminum phosphide, and multiple drugs as well as the patients with delayed admission to the hospital, and it is necessary to seek appropriate treatment to prevent this significant side effect.
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Affiliation(s)
- Mohammad Arefi
- Department of Forensic Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Peyman Salamaty
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran , IR Iran
| | - Davood Soroosh
- Department of Forensic Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | | | - Mohsen Ebrahimi
- Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Mostafalou S, Karami-Mohajeri S, Abdollahi M. Environmental and population studies concerning exposure to pesticides in iran: a comprehensive review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e13896. [PMID: 24693394 PMCID: PMC3955509 DOI: 10.5812/ircmj.13896] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 12/02/2013] [Accepted: 10/27/2013] [Indexed: 12/14/2022]
Abstract
Pesticides are widely used in Iranian agriculture and this has made a major toxicological concern among health professionals. The objective of this study is to explore national data about pesticides toxicity. All relevant databases such as Google Scholar, PubMed, and Scopus in a time period of 1960 to 2012 were searched for the keywords “Pesticides, Iran, Environment, and Population studies”. A total of 57 studies were found relevant and then included into study. Almost all non-experimental studies carried out in Iran were classified into two main categories of residue assessment in different samples and toxic effects on human. Depending on the dose and duration of exposure, toxic effects of pesticides have been studied in two classifications including acute toxicity or acute poisoning and chronic toxicity. High extent of pesticides have been used during the past decade in Iran while no enough proper studies were done to explore their possible toxic effects in the environment and the people.
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Affiliation(s)
- Sara Mostafalou
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Somayyeh Karami-Mohajeri
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, IR Iran, Tel: +98-2164122319, Fax: +98-2166959104, E-mail:
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Shadnia S, Rahimi M, Hassanian-Moghaddam H, Soltaninejad K, Noroozi A. Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran. Clin Toxicol (Phila) 2013; 51:777-82. [DOI: 10.3109/15563650.2013.830732] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gheshlaghi F, Piri-Ardakani MR, Yaraghi M, Shafiei F, Behjati M. Acute poisoning in children; a population study in isfahan, iran, 2008-2010. IRANIAN JOURNAL OF PEDIATRICS 2013; 23:189-93. [PMID: 23724181 PMCID: PMC3663311 DOI: pmid/23724181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 01/08/2013] [Indexed: 02/08/2023]
Abstract
Objective Acute accidental poisoning in children is still an important public health problem. The epidemiological investigation specific for each country is necessary to determine the extent and characteristics of the problem. The aim of our study was to elucidate the current pattern of acute poisoning among children. Methods The present retrospective study describes the epidemiology of acute accidental poisoning in children (less than 10 years old) admitted to the Emergency Department of two teaching hospitals during a period of two years. Findings Three hundred and forty four children under 10 years old were admitted to emergency department of two teaching hospitals due to acute accidental poisoning. Drugs were the most common agents causing the poisoning (58.1%), followed by Hydrocarbons (13.1%), and opioids (9.3%). Common signs were neurological (42.6%) with lethargy being the most common (39.1%). 50.6% of cases were discharged from hospital within 6-12 hours, 91.6% of them without any complication. Conclusion Accidental poisonings are still a significant cause of morbidity among children in developing countries. Regarding the high prevalence of pharmaceutical drug poisoning and because lethargic was the most frequent neurological sign, comprehensive toxicology screen tests should be included as part of the routine evaluation of children presenting to an ED with an apparent life-threatening event.
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Affiliation(s)
- Farzad Gheshlaghi
- Department of Clinical Toxicology and Forensic Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Hassanian-Moghaddam H. An educational and research opportunity for the largest university hospital poison control centers; Tehran and Cairo. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2013. [DOI: 10.1016/j.ejfs.2013.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hassanian-Moghaddam H, Afzali S, Pooya A. Withdrawal syndrome caused by naltrexone in opioid abusers. Hum Exp Toxicol 2013; 33:561-7. [PMID: 23690227 DOI: 10.1177/0960327112450901] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE Naltrexone is a competitive opioid receptor antagonist acting at the µ- and k-opioid receptors that blocks the euphoric effects of exogenous administered opioids. When used in opioid-dependent patients, naltrexone can cause acute and severe withdrawal symptoms. METHODS This was a cross-sectional study conducted from December 2007 to March 2008 and consisted of patients who had used naltrexone accidentally or deliberately and were referred to Loghman-Hakim Poison Hospital, Tehran, Iran. All symptoms and signs were assessed and the relationship between the dose of naltrexone, opioid dependence, and outcome was evaluated. RESULTS In 132 patients referred to our hospital, the most frequently reported symptoms and signs occurring in more than 10% of patients were agitation (96.2%), altered level of consciousness (38.6%), nausea (28%), vomiting (27.3%), abdominal pain (24.2%), diarrhea (16.7%), bone and muscle pain (15.9%), tachycardia (12.9%), and dilated pupils (11.4%). Being the most prominent symptom, the agitation was the most difficult aspect of withdrawal to manage. Except for agitation, no relationship was found between the presence of these symptoms and the dose of naltrexone used. Outcome of the patients (classified as complete recovery, partial recovery, death, and no follow-up) was related to the substance of addiction (p < 0.05) but not to the naltrexone dose. CONCLUSION Emergency physicians should be aware of the potential for severe agitation from naltrexone-precipitated hyperacute withdrawal and its appropriate management. Opioid-dependent patients who wish to continue withdrawal and abstinence must be encouraged to visit trained physicians and be warned about misuse of naltrexone.
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Affiliation(s)
- H Hassanian-Moghaddam
- Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Loghman-Hakim Poison Hospital, Tehran, Iran
| | - S Afzali
- Department of Internal Medicine, Hamedan University of Medical Sciences, Farshchian Hospital, Hamedan, Iran
| | - A Pooya
- Department of Community Medicine, Hamedan University of Medical Sciences, Farshchian Hospital Hamedan, Iran
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Khudair IF, Jassim Z, Hanssens Y, Alsaad WA. Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar. Hum Exp Toxicol 2013; 32:921-9. [DOI: 10.1177/0960327113479043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as “poisoning case” with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.
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Affiliation(s)
- IF Khudair
- Clinical Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Z Jassim
- Clinical Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Y Hanssens
- Clinical Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - WA Alsaad
- Accident and Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Boshehri B, Salimi S, Ranjbar S. Mortality from acute poisoning in urmia: a three- year retrospective study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:838-9. [PMID: 23482496 PMCID: PMC3587878 DOI: 10.5812/ircmj.1887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/28/2011] [Accepted: 12/28/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Behzad Boshehri
- Department of Toxicology and Forensic Medicine, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Saleh Salimi
- Nursing and Midwifery School, IAU of Urmia Branch, Urmia, IR Iran
- Corresponding author: Saleh Salimi, Nursing and Midwifery School, IAU of Urmia Branch, Urmia, IR Iran. Tel.: +98-4413472692, Fax: +98-4413472692, E-mail:
| | - Sara Ranjbar
- Urmia University of Medical Sciences, Urmia, IR Iran
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Anthony L, Kulkarni C. Patterns of poisoning and drug overdosage and their outcome among in-patients admitted to the emergency medicine department of a tertiary care hospital. Indian J Crit Care Med 2012. [PMID: 23188951 PMCID: PMC3506068 DOI: 10.4103/0972-5229.102070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Poisoning and drug overdose (DO) are important health problems in developing countries. These emergencies are associated with high mortality and morbidity. Different factors affect the final outcome of patients. This study aims to review the pattern of poisoning and DO in an urban tertiary care hospital and also the determinants and final outcome of patients with poisoning and DO. MATERIALS AND METHODS Observational, retrospective hospital records-based study at a tertiary care hospital (15 months). Data on demography, hospitalization, complications, type of poison/drug and outcome of patients with poisoning and DO were collected. Data were analyzed using descriptive statistics, Chi square test and ANOVA. P < 0.05 was considered significant. RESULTS Of the total of 296 records, 213 were included (122 poisoning, 91 DO). Organophosphates (OP) (32.5%), pyrethroids (17.2%) and organocarbamates (12.2%) were the commonly used poisons. Sedatives and antiepileptics (21% each) were the common DOs. Poisoning among men was greater than that among women (P < 0.001). Outcome parameters of hospital stay and ventilator requirement were significant (P < 0.001). The overall case fatality rate was 2.4%. CONCLUSIONS OP compounds were the most common among poisons, while sedatives were frequently consumed drugs. Young adults from urban areas were the common victims with suicidal intention. Regulations, educational awareness and poison information centers will help to reduce the growth of this public health problem.
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Affiliation(s)
- Leena Anthony
- Department of Pharmacology, St. John's National Academy of Health Sciences, Bengaluru, India
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Ghaleiha A, Afzali S, Bazyar M, Khorsand F, Torabian S. Characteristics of hospitalized patients following suicide attempt in hamadan district, iran. Oman Med J 2012; 27:304-9. [PMID: 23071883 DOI: 10.5001/omj.2012.75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 06/08/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Limited research has been undertaken on suicide in developing countries. This paper aims to investigate characteristics of suicide attempts in Hamadan district of Iran. METHODS A prospective study was conducted in all university hospitals in the Hamadan district of Iran and patients admitted for attempted suicides were included. All cases were assessed by psychiatrists and visited by two trained interns of Medicine. RESULTS The incidence rate per 100,000 persons of attempted suicides was 228.6 for males and 263.1 for females; moreover, 344.9 for rural areas and 222.7 for urban areas. The suicide attempt was the highest in the 15 to 24 age category for both sexes and regions. CONCLUSIONS Suicide is a complex, long-term outcome that requires multifaceted theoretical constructs for the appropriate study of its antecedents. Findings of this study along with other studies in Iran revealed that unemployed men, housewives, and rural women, high-school students, and those with a low level of education were at higher risk of suicidal behaviors.
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Affiliation(s)
- Ali Ghaleiha
- Associate Professor of Psychiatry, Behavioral Disorders and Substance Abuse Center of Hamadan University of Medical Sciences, Hamadan, Iran
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Talaie H, Emam-Hadi M, Panahandeh R, Hassanian-Moghaddam H, Abdollahi M. On the mechanisms underlying poisoning-induced rhabdomyolysis and acute renal failure. Toxicol Mech Methods 2012; 18:585-8. [PMID: 20020858 DOI: 10.1080/15376510802232167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ABSTRACT The clinical syndrome of rhabdomyolysis is caused by injury of skeletal muscles resulting in release of intracellular muscle constituents. Drug poisoning is one of the causes of severe rhabdomyolysis. Severe electrolyte disorders and acute renal failure may occur in rhabdomyolysis, leading to life-threatening situations. Early initiation of renal replacement therapy can help improve outcome. In the present retrospective study, medical records of 181 patients suspected of rhabdomyolysis from Loghman-Hakim Hospital in the period of 2004 to 2005 were reviewed. A creatinine phosphokinase (CPK) value of greater than five times normal (>/=975 IU/L) was the basis for confirmation of a rhabdomyolysis diagnosis. An increased serum creatinine level of more than 30% was the basis for acute renal failure diagnosis. Out of 156 patients, 100 were male with an age range of 13 to 78 years. One hundred and two (92%) patients had CPK >975 U/L, and 36 patients (28.6%) had a 30% or more increase in their creatinine level during their admission days. Mean fluid intake was the same in patients with renal failure and those without renal failure. In 8.3% of the cases, multiple drug poisoning was observed. The most common compound overdose associated with rhabdomyolysis was opium. It is concluded that fluid therapy alone is not adequate in the management of acute renal failure in rhabdomyolysis. Therefore, other etiological factors are involved that remain to be elucidated by further studies.
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Affiliation(s)
- Haleh Talaie
- Toxicological Research Center, Loghman-Hakim Hospital, School of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Sawalha AF, Sweileh WM, Tufaha MT, Al-Jabi DY. Analysis of the pattern of acute poisoning in patients admitted to a governmental hospital in Palestine. Basic Clin Pharmacol Toxicol 2012; 107:914-8. [PMID: 20533924 DOI: 10.1111/j.1742-7843.2010.00601.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objectives were to (i) analyse the pattern of poisoning and (ii) study gender distribution and management protocol of poisoning in patients diagnosed with acute poisoning. A retrospective analysis of cases diagnosed with acute poisoning and admitted to the emergency department of Al-Wattani governmental hospital during the year of 2008 was carried out. Data from patients' medical files were collected and then analysed using Statistical Package for Social Sciences (spss; SPSS Inc., Chicago, IL, USA), version 16. There were 674 cases diagnosed with acute poisoning in 2008 which accounted for 1.5% of the total admission to the hospital. The mean age of the cases was 21.8 ± 18.1 years. Approximately, 58% of poisoning cases occurred at home. Male to female ratio was 1.5:1. The maximum number of poisoning occurred during summer season. Poisoning cases were maximum in the age category >18 years. More than half (92%) of the cases were of unintentional type of poisoning. Unintentional poisoning was significantly more common among males (61.3%; p < 0.01), while intentional was more common among females (64.8%; p < 0.001). The causative agents encountered were mainly biological agents (77.4%), pharmaceuticals (11.6%), and other chemicals (10.9%). The most common route of poisoning was through stings (72.3%), followed by oral ingestion (23.5%) and inhalation (3.4%). The majority (91.1%) of cases did not undergo any decontamination methods. Of those who had decontamination procedure, gastric lavage was the most commonly used. This is the first study in Palestine that presents data on the pattern of acute poisoning. Awareness campaigns should be held about potentially toxic materials in the region, and methods of poison prevention should be spread among the public.
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Affiliation(s)
- Ansam F Sawalha
- Poison Control and Drug Information Center, An-Najah National University, Nablus, Palestine.
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Angoorani H, Narenjiha H, Tayyebi B, Ghassabian A, Ahmadi G, Assari S. Amphetamine use and its associated factors in body builders: a study from Tehran, Iran. Arch Med Sci 2012; 8:362-7. [PMID: 22662012 PMCID: PMC3361051 DOI: 10.5114/aoms.2012.28566] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 09/24/2009] [Accepted: 10/14/2009] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Epidemiological studies on all types of illicit drug use among athletes are essential for both the sport community and drug control achievements. Here, we investigated the prevalence and associated factors of amphetamine use in body builders in Tehran, Iran, 2007. MATERIAL AND METHODS This study is a secondary analysis of a substance use survey done in 103 randomly selected gymnasia in Tehran (capital city of Iran). The survey was conducted from November 2007 to January 2008 and included 843 randomly selected bodybuilders (aged 40 years or less). By interviews via questionnaires the following data were obtained: age, job, marital status, education level, housing status, average monthly family income, number of family members, gymnasium area (m(2)), number of trainers, number of gymnasium members, initiation time (months), weekly duration of the sporting activity (h), monthly cost of the sporting activity, purpose of participating in sporting activity, and history of anabolic steroid and amphetamine use. RESULTS One hundred twenty (13.3%) body builders reported a history of amphetamine use. According to the results of regression analysis, being married (risk ratio - RR = 0.540), and participating in body building to enhance self-esteem (RR = 0.423) or to enhance sport performance (RR = 0.545) had protective effects on amphetamine use. However, having university qualifications (RR = 1.843), using anabolic steroids (RR = 1.803) and participating in sport to maintain fitness (RR = 2.472) were linked to increased risk of amphetamine use. CONCLUSIONS Well-educated bodybuilders were more likely to use amphetamines, and why this is so needs to be discovered. If further studies show that they are not aware of the dangers associated with amphetamine use, providing them with information should be considered.
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Affiliation(s)
- Hooman Angoorani
- Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, Iran
| | - Hooman Narenjiha
- Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran
- Drug Control Head Quarters (DCHQ), Tehran, Iran
| | | | | | - Gelareh Ahmadi
- Medicine and Health Promotion Institute (MHPI), Tehran, Iran
| | - Shervin Assari
- Medicine and Health Promotion Institute (MHPI), Tehran, Iran
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