The Methanol Poisoning Outbreaks in Iran 2018

The role of the leukocyte glucose index in predicting clinical outcomes in acute methanol toxicity

Introduction

Acute methanol poisoning signifies a global health issue. This study was designed to explore the role of the leukocyte glucose index (LGI) in predicting clinical outcomes; in-hospital mortality and visual impairment, and length of hospital stay, in acute methanol toxicity and to evaluate the association between LGI and all initial patient characteristics.

Patients and methods

This was a retrospective analysis that involved 82 acutely methanol-intoxicated patients, starting from January 2021 to December 2023. Patients were categorized by on-admission LGI tertiles into low, intermediate, and high groups.

Results

Approximately 27 % (22 out of 82) of patients died during hospitalization, with most of them belonging to the high LGI group. No significant differences existed in the proportions of patients with total vision loss, or the length of hospital stay. The majority of the undesirable findings were apparent in patients in either the intermediate or high LGI groups. LGI can distinguish exceptionally between survivors and non-survivors with an area under the curve of 0.808. However, LGI does not have any discriminatory power in predicting adverse visual outcomes.

Conclusion

LGI can serve as a valuable tool in predicting early in-hospital mortality in acute methanol poisoning.

A quenched fluorescence sensor array based on bis-lanthanide metal-organic framework for acetaldehyde detection and Baijiu discrimination

Discrimination of segmented Baijiu contributes to stabilizing the quality of products, improving revenue-generating effects. A fluorescence sensor array is constructed based on four fluorescence characteristic peaks of terbium@lanthanum metal-organic framework (Tb@La-MOF). Its fluorescence signal is specifically quenched, when Tb@La-MOF encounters acetaldehyde. Acetaldehyde may inhibit the absorption of energy by the organic ligands in MOF, or/and hydrogen bonding with -COOH on the organic ligand, resulting in energy transfer to Tb(Ⅲ). According to this, the quantitative detection of acetaldehyde is completed with a range of 10-300 μM and the detection limit of 5.5 μM. At the same time, it has been successfully applied to the discrimination of segmented Baijiu. Fifteen segmented from three wine cellars are 100 % discriminated with the combined processing of sensor arrays and analytical methods. Accuracy, simplicity, and low-cost are highlights of this fluorescence sensor array, which has considerable potential for application in detection, production, and food field.

Highly selective methanol adsorption from dilute aqueous solutions using Mn3[Fe(CN)6]2: a Prussian blue analog

Mn3[Fe(CN)6]2 (MnHCF) selectively adsorbs methanol from water with a distribution coefficient of 11 mL g-1, which is 3-11 times that of activated carbons and zeolites. MnHCF exhibits an adsorption capacity of 0.36 mmol g-1 and can adsorb 1000 mg MeOH per L in aqueous solution, demonstrating its effectiveness for treating methanol-contaminated wastewater.

Methanol poisoning during the COVID-19 pandemic in Iran: A retrospective cross-sectional study of clinical, laboratory, and brain imaging characteristics and outcomes

Objective

To evaluate the frequency and significance of brain imaging findings in methanol poisoning patients and to propose a criterion for prioritizing brain imaging.

Methods

We retrospectively reviewed the data of 306 patients (286 men and 34 women, mean age 32.10 ± 9.9 years) with confirmed methanol poisoning who were admitted to two hospitals in Iran during the COVID-19 pandemic. We analyzed their demographic, clinical, laboratory, and brain imaging data.

Results

The main brain computed tomography (CT) scan findings were hypodensity in the putamen (11.1%), cerebellar nuclei (8.2%), diffuse cerebral edema (7.5%), and intracranial hemorrhage (ICH; 1.6%). These findings were associated with blood pH, Glasgow Coma Scale (GCS), renal failure, bicarbonate, oxygen, carbon dioxide, potassium, and glucose levels (p < 0.05). Poor prognosis was related to blindness, opium addiction, chronic alcohol use, hyperglycemia, and abnormal CT scans (p < 0.001 for all). The most predictive brain imaging findings for poor prognosis were hypodensity in the cerebellar nuclei, diffuse cerebral edema, and ICH.

Conclusion

Brain imaging can provide valuable information for the diagnosis and management of methanol poisoning patients. We suggest that patients with severe acidosis, low GCS, low pH, low oxygen saturation, and high glucose levels should undergo brain CT scan as a priority.

Outbreak of methanol-induced optic neuropathy in early COVID-19 era; effectiveness of erythropoietin and methylprednisolone therapy

BACKGROUND

Methanol is a highly toxic, non-potable alcohol. Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol. Recently, alongside the coronavirus disease 2019 (COVID-19) pandemic, rumors circulated on social media that consuming alcohol can prevent or cure the virus, leading to a COVID-19 and methanol-induced optic neuropathy (MON) syndemic.

AIM

To investigate the impact of erythropoietin (EPO) on the outcomes of patients diagnosed with MON.

METHODS

In this prospective study, 105 patients presenting with acute bilateral visual loss secondary to methanol intoxication were enrolled from March to May 2020 at Farabi Eye Hospital. A comprehensive ocular examination was conducted for all participants. Recombinant human EPO and methylprednisolone were administered intravenously to all patients for three consecutive days.

RESULTS

The mean age of the participants was 39.9 years (± 12.6). Ninety-four patients were male and eleven were female. The mean pre-treatment best corrected visual acuity (BCVA) improved from 2.0 ± 0.86 to 1.39 ± 0.69 logarithm of the minimum angle of resolution post-treatment (P < 0.001), with significant improvement observed in all age categories and genders (P < 0.001). Visual acuity improvement was also significant regardless of whether the patient presented before or after 72 h (P < 0.001), and the post-treatment BCVA remained significant at all monthly follow-up visits (P < 0.001).

CONCLUSION

EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with MON when administrated within the first month of exposure. Public awareness efforts are necessary to prevent further outbreaks of methanol toxicity in the current COVID-19 era.

Time course study of optical coherence tomography angiography in patients with methanol induced optic neuropathy

INTRODUCTION

In countries where alcoholic beverages are legally prohibited, methanol toxicity usually occurs due to ingesting homemade alcoholic drinks. The initial ophthalmologic symptoms of methanol toxicity typically appear 6-48 h after ingestion, and the severity of symptoms varies widely from mild and painless decreased vision to no-light perception vision.

METHODS

This prospective study examines 20 patients with acute methanol poisoning within 10 days of use. Patients underwent ocular examinations, BCVA (Best Corrected Visual Acuity) recording, and OCTA (Optical Coherence Tomography Angiography) of the macula and optic disc. BCVA measurement and imaging were repeated one month and three months after intoxication.

RESULTS

There was a statistically significant reduction in superficial parafoveal vascular density (P-value = 0.026), inner retinal thickness (P-value = 0.022), RNFL (Retinal Nerve Fiber Layer) thickness (P-value = 0.031), and an increase in cup to disc ratio (P-value < 0.001), and central visual acuity (P-value = 0.002) in this time course. However, there was no statistically significant difference in FAZ (Foveal Avascular Zone) area (P-value = 0.309), FAZ perimeter (P-value = 0.504), FD-300 (Foveal density, vascular density within a 300 μm wide region of the FAZ) (P-value = 0.541), superficial vascular density (P-value = 0.187), deep foveal vascular density (P-value = 0.889), deep parafoveal vascular density (P-value = 0.830), choroidal flow area (P-value = 0.464), total retinal thickness (P-value = 0.597), outer retinal thickness (P-value = 0.067), optic disc whole image vascular density (P-value = 0.146), vascular density inside the disc (P-value = 0.864), or peripapillary vascular density (P-value = 0.680) at different times.

CONCLUSION

Over time, methanol poisoning can cause changes in retinal layers thickness, vasculature, and optic nerve head. The most important changes include cupping of the optic nerve head, reduction in RNFL thickness, and inner retinal thickness.

Hemi-central retinal artery occlusion following methanol toxicity

Objective

To describe a patient with hemi-retinal artery occlusion following methanol toxicity.

Methods

Observational case report.

Results

We report a case presented with an acute altitudinal visual field loss in the right eye following consumption of illicit alcoholic drink. In fundus photography, a well demarcated superior hemi-retinal whitening with foveal sparing was noted. Careful inspection of the optic nerve head in the right eye revealed that there was no main trunk of the central retinal artery anterior to the lamina cribrosa. Two separately emerging superior and inferior arterial trunks were noted. In fundus fluorescein angiography, earlier dye filling in the territory of the superior arterial trunk compared to the inferior arterial trunk was evident.

Conclusion

Hemi-central retinal occlusion may happen as an ocular consequence of methanol toxicity in patients with a proximal bifurcation of the central retinal artery.

Acil Servise Başvuran Metil Alkol Zehirlenmelerinin Geriye Dönük Analizi

Objective: Methyl alcohol poisoning remains a significant cause of mortality and morbidity. This poisoning is still one of the important reasons for admission to emergency services. We aimed to examine the admission complaints, laboratory findings, treatment methods, clinical outcomes and examine the factors affecting the mortality of patients diagnosed with methyl alcohol poisoning in the emergency department. Methods: In this retrospective descriptive study, we analysed the patients who were considered to be diagnosed with methyl alcohol intoxication among those who came to our emergency department due to alcohol intoxication from June 1, 2018 to June 1, 2020. Results: The study included 20 (4.86%) individuals with methyl alcohol poisoning among 411 people who presented to the emergency department due to ethyl and methyl alcohol intake and resulting effects.The mean age of the patients was 47.35±14.2 years and 85% (n=17/20) were male. Upon reviewing the patients' admission symptoms, 70% were observed to have visual problems, 60% complaints of vomiting, 45% shortness of breath, and 40% changes in consciousness. In the study, it was revealed that 18.2%(n=2/11) females and 81.8%(n=9/11) males died, and the mortality rate was calculated as 55%(n=11/20). Conclusions: The presence of visual problems, hypotension, and coma in clinical findings, high anion gap metabolic acidosis, marked osmolar gap, an increase in lactate level, and hyperglycemia in laboratory findings may be the early signs of mortality in patients with methyl alcohol poisoning. Therefore, patients with these signs should be followed up more closely and treated.

An interrupted time series analysis of hospital admissions due to alcohol intoxication during the COVID-19 pandemic in Tehran, Iran

The COVID-19 outbreak affected mental health globally. One of the major concerns following the COVID-19 pandemic was increased incidence of risky behaviors including alcohol consumption. This study evaluates the trend of alcohol poisoning in Loghman-Hakim Hospital (LHH), the main referral center of poisoning in Tehran, during the 2-year period from 1 year prior to 1 year after the onset (February 23rd, 2020) of the COVID-19 epidemic in Iran. All patients admitted with alcohol intoxication from February 23rd, 2019 to February 22nd, 2021 were evaluated and patient data extracted from LHH electronic hospital records. Alcohols were categorized as toxic (methyl alcohol) and non-toxic (ethyl alcohol). Of 2483 patients admitted, 796/14,493 (5.49%) and 1687/13,883 (12.15%) had been hospitalized before and after the onset of the COVID-19 epidemic in Iran, respectively. In total, 140 patients did not survive, of whom 131 (93.6%) were confirmed to have methanol intoxication. Mortality was significantly higher during the outbreak (127 vs 13; P < 0.001; OR: 4.90; CI 95%: 2.75 to 8.73). Among the patients, 503 were younger than age 20. Trend of alcohol intoxication showed increases in children (57 vs 17) and adolescents (246 vs 183) when compared before and after the COVID-19 epidemic outbreak. A total of 955 patients were diagnosed with methanol toxicity which occurred more frequently during the COVID-19 era (877 vs 78; P < 0.001; OR: 10.00; CI 95%: 7.75 to12.82). Interrupted time series analysis (April 2016-February 2021) showed that in the first month of the COVID-19 epidemic (March 2020), there was a significant increase in the alcohol intoxication rate by 13.76% (P < 0.02, CI = [2.42-24.91]). The trend of alcohol intoxication as well as resulting mortality increased in all age groups during the COVID-19 epidemic in Iran, indicating urgent need for the prevention of high-risk alcohol use as well as improved treatment.

A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic

A methanol poisoning outbreak occurred in Iran during the initial months of coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the epidemiology of the outbreak in terms of hospitalizations and deaths. A cross-sectional linkage study was conducted based on the hospitalization data collected from thirteen referral toxicology centers throughout Iran as well as mortality data obtained from the Iranian Legal Medicine Organization (LMO). Patient data were extracted for all cases aged > 19 years with toxic alcohol poisoning during the study period from February until June 2020. A total of 795 patients were hospitalized due to methanol poisoning, of whom 84 died. Median [interquartile ratio; IQR] age was 32 [26, 40] years (range 19-91 years). Patients had generally ingested alcohol for recreational motives (653, 82.1%) while 3.1% (n = 25) had consumed alcohol-based hand sanitizers to prevent or cure COVID-19 infection. Age was significantly lower in survivors than in non-survivors (P < 0.001) and in patients without sequelae vs. with sequelae (P = 0.026). Twenty non-survivors presented with a Glasgow Coma Scale (GCS) score > 8, six of whom were completely alert on presentation to the emergency departments. The time from alcohol ingestion to hospital admission was not significantly different between provinces. In East Azerbaijan province, where hemodialysis was started within on average 60 min of admission, the rate of sequelae was 11.4% (compared to 19.6% average of other provinces)-equivalent to a reduction of the odds of sequelae by 2.1 times [95% CI 1.2, 3.7; p = 0.009]. Older patients were more prone to fatal outcome and sequelae, including visual disturbances. Early arrival at the hospital can facilitate timely diagnosis and treatment and may reduce long-term morbidity from methanol poisoning. Our data thus suggest the importance of raising public awareness of the risks and early symptoms of methanol intoxication.

Diabetic ketoacidosis as a complication of methanol poisoning; a case report

INTRODUCTION

Diabetic ketoacidosis (DKA) is a complication of diabetes presenting with high anion gap metabolic acidosis. Methanol poisoning, on the other hand, is a toxicology emergency which presents with the same feature. We present a case of methanol poisoning who presented with DKA.

CASE PRESENTATION

A 28-year-old male was referred to us with blurred vision and loss of consciousness three days after ingestion of 1.5 L of an unknown mixture of bootleg alcoholic beverage. He had history of insulin-dependent diabetes and had neglected his insulin shots on the day prior to hospital admission due to progressive loss of consciousness. Vital signs were normal and venous blood gas analysis showed severe metabolic acidosis and a methanol level of 10.2 mg/dL. After eight hours of hemodialysis, he remained unresponsive. Diabetic ketoacidosis was suspected due to positive urine ketone and blood sugar of 411 mg/dL. Insulin infusion was initiated which was followed by full awakening and extubation. He was discharged completely symptom-free after 4 weeks.

CONCLUSIONS

Diabetic ketoacidosis and methanol poisoning can happen simultaneously in a diabetic patient. Given the analogous high anion gap metabolic acidosis, physicians should pay particular attention to examination of the diabetic patients. Meticulous evaluation for both conditions is highly recommended.

Alcohol consumption epidemic and its complications during the COVID-19 pandemic in Khuzestan Province, Iran; 2020

Background: After unprecedented demand for ethanol in the pandemic, profiteers used methanol for making illegal alcoholic drink. Methods: This cross-sectional descriptive-analytical study investigated the effects of methanol poisoning on 400 patients who referred to hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences from March 20 to September 20, 2020. Results: Ninety-eight-point five percent of patients had consumed alcohol for social reasons and only 0.3% had used it as a measure to avoid COVID-19. Eighty-seven percent of the patients used homemade alcohol bought from peddlers. The most common clinical symptom was gastrointestinal disorders (64.8%) and the most common complications were vision problems (12.3%). Ten-point-six percent (42 patients) of the patients died. The most important factors affecting mortality risk were dyspnea, neuropathic problems, abnormal radiological findings, dialysis, abnormal blood pressure, vision problems and dizziness. Conclusions: Informing the public about the risks of using homemade alcoholic beverages is essential if the associated disability and mortality has to be avoided.

Methanol poisoning during COVID-19 pandemic; A systematic scoping review

OBJECTIVE

In this systematic scoping review, it was aimed to assess the epidemiology of methanol poisoning, clinical findings and patients' management, causes, and recommendations regarding prevention or reduction of methanol poisoning during COVID-19 pandemic.

METHODS

Three Electronic databases [Medline (accessed from PubMed), Scopus, and Science Direct] were searched systematically from December 01, 2019 to September 10, 2020, using MESH terms and the related keywords in English language. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, the studies' findings were assessed and reported.

RESULTS

Total of 86 articles were obtained within the first step of searching, and 64 ones remained after removing the duplications. Through the title and abstract screening, 35 were removed. Finally, after reading the full text of the remained articles, 15 ones included in data extraction. Most of the previous reported evidence (13/15) were letter to editor, commentary and short reports. None of them were interventional, and none of them followed the patients. Findings were summarized in four categories: 1) epidemiology; 2) clinical findings and patients' management; 3) causes; and 4) recommendation regarding prevention or reduction of methanol poisoning during COVID-19 pandemic.

CONCLUSION

The recent outbreak is the largest methanol mass poisoning outbreak throughout Iran and the world in recent decades. The causes of methanol poisoning during the COVID-19 pandemic are intertwined, and most of them are modifiable by health policy makers. Building trust, educating and warning, as well as controlling and monitoring are three main recommendation for prevention or reduction of methanol poisoning.

Knowledge of people in the East London District of South Africa about Coronavirus SARS-CoV-2: an online survey

Introduction: World Health Organization declared Coronavirus SARS-CoV-2 a pandemic after two months of its propagation in China. The lack of coordination among people about the new Coronavirus threat is evident mainly due to the dearth of knowledge. Objective: To assess the knowledge of people in the East London district of South Africa about Coronavirus SARS-CoV-2. Methods: The study was anchored on a quantitative method approach and adopted a descriptive research design. The sample consisted of 160 adults. Using the virtual snowball sampling technique, people who were 18 years and above of age and can read English were selected for the online survey. The data were collected using a 3-point Likert scale questionnaire which was uploaded in Google Form. Data were analyzed using descriptive and inferential statistics. Results: The majority of the participants knew the myths and facts about the news. They were aware that wearing a face mask prevents Coronavirus transmission, drinking liquor and using hand dryers would not kill the virus. Some people were not sure whether eating garlic or rinsing the nose regularly with saline water would help to prevent from being affected by Coronavirus. The findings also showed that there was a significant difference (p<0.05) among different age groups of people on their knowledge about the Coronavirus. Conclusion: By comparing the overall findings with the facts issued by World Health Organization, people in the East London district of South Africa had sound knowledge about Coronavirus SARS-CoV-2 on its transmission and what preventive measures should be taken.

Fatal methanol poisoning with different clinical and autopsy findings: Case report and literature review

Methanol poisoning is responsible for high morbidity and mortality, and the elevated concentration of methanol in the body is the major criteria for forensic diagnosis of methanol poisoning. However, in cases with lower methanol concentrations, diagnosis is mainly dependent on highly variable postmortem manifestations.Herein, we report a fatal methanol poisoning cases that two subjects ingested the same amount of methanol simultaneously, yet the subject one presented only non-specific gastrointestinal and mild central nervous system symptoms, while the other subject exhibited typical toxic manifestations with the exception of visual compromise. In autopsy, subject number 1 did not show typical pathological changes caused by methanol poisoning, except for the elevated levels of methanol in body fluids. On the contrary, bilateral basal ganglia hemorrhage and necrosis caused by methanol-induced brain lesion was observed in case number 2. Due to the complex and multifactorial process of methanol intoxication, many factors, including comprehensive autopsy, quantitative detection of methanol and formic acid, and genotype analysis, participate in its metabolism and toxicity, and can impact the clinical symptoms, prognosis and postmortem manifestations. Therefore, a combination of multiple diagnosis methods may more accurately contribute to the forensic diagnosis of methanol poisoning and should be tailored on an individual basis. This case report also reviews forensic diagnosis literature on methanol poisoning to provide a reference for forensic pathologists.

Acute pancreatitis due to methanol toxicity during the COVID-19 pandemic

Acute methanol poisoning may be associated with a variety of symptoms, such as abdominal pain, blurred vision, loss of consciousness, and acute pancreatitis. We present a 37-year-old man with acute pancreatitis due to methanol poisoning during the COVID-19 pandemic.

Severe Optic Disc Cupping Following the Methanol Toxicity in a 20-Year-old Man: A Case Report

In April 2018, a 20-year-old man with a history of methanol intoxication from an alcoholic drink two years ago, when he was 18 years old, was referred to Nikookari Eye Hospital in Tabriz, Iran. He was admitted to emergency service and underwent eight hours of hemodialysis at the time of poisoning. His past medical history was negative, and he did not take any medication after discharge. The patient had a driving license and never experienced any visual problems before. At presentation, his visual acuity was 160/200 in both eyes with the main complaint of visual field deterioration. Other neurologic exams and brain magnetic resonance imaging (MRI) were reported normal by a neurologist. Optic disc cupping was near total in both eyes with a very narrow remaining rim. Optic disc cupping was very similar to glaucomatous cupping. Intraocular pressure was checked several times via Goldmann tonometry and was 13 mmHg. There was no history of refractive surgery leading to thin cornea. Based on this case, methanol poisoning can mimic glaucomatous optic disc cupping. This is the first case report of methanol toxicity-related optic disc cupping from Iran.

Illicit Alcohol: Public Health Risk of Methanol Poisoning and Policy Mitigation Strategies

Illicit (unrecorded) alcohol is a critical global public health issue because it is produced without regulatory and market oversight with increased risk of safety, quality and adulteration issues. Undertaking iterative research to draw together academic, contemporary and historic evidence, this paper reviews one specific toxicological issue, methanol, in order to identify the policy mitigation strategies of interest. A typology of illicit alcohol products, including legal products, illegal products and surrogate products, is created. A policy landscape matrix is produced that synthesizes the drivers of illicit alcohol production, distribution, sale and consumption, policy measures and activity related signals in order to inform policy development. The matrix illustrates the interaction between capabilities, motivations and opportunities and factors such as access, culture, community norms and behavior, economic drivers and knowledge and information and gives insight into mitigation strategies against illicit alcohol sale and consumption, which may prove of value for policymakers in various parts of the world.

Trends of acute drug and chemical toxicities in adults and adolescents in Tehran, Iran between 2012 and 2018: a retrospective chart review

Poisoning is among the top three common causes of suicidal deaths in Iran. We aimed to evaluate the epidemiologic trend of poisoning and its mortality rate in the largest tertiary toxicology referral center in Iran between 2012 and 2018. A total of 84,242 patients were hospitalized or died due to poisoning in this center during the study period, of whom 2114 (2.5%) died. The most frequent poisonings were those with antiepileptics, sedativehypnotics, and antiparkinson medications (T42) followed by narcotics and psychodysleptics (T40). Psychodysleptics had the highest mortality rate (684; 32.4% of the deaths). Among drugs of abuse, methadone was the most common cause of admission reported in 10,398 cases (12.3%). In conclusion, suicidal or recreational methadone poisoning is becoming the most common cause of admission to poisoning referral wards in Iran. Rigorous supervision of daily dosing at opioid maintenance clinics as well as efforts to control the black-market offering methadone are needed to prevent further methadone-related acute poisonings and deaths.

COVID-19 and Alcohol Poisoning: A Fatal Competition

In March 2020, concurrently with the outbreak of coronavirus disease 2019 (COVID-19) in Iran, the rate of alcohol poisoning was unexpectedly increased in the country. This study has attempted to make an overall description and analysis of this phenomenon by collecting credible data from the field, news, and reports published by the emergency centers and the Iranian Ministry of Health. The investigations showed that in May 20, 2020, more than 6150 people have been affected by methanol poisoning from whom 804 deaths have been reported. A major cause of the increased rate of alcohol poisoning in this period was actually the illusion that alcohol could eliminate the coronaviruses having entered the body. It is of utmost importance that all mass media try to dismiss the cultural, religious, and political considerations and prepare convincing programs to openly discuss the side-effects of forged alcohol consumption with the public, especially with the youth. It must be clearly specified that "consuming alcohol cannot help prevent COVID-19."

Temperament and character of patients with alcohol toxicity during COVID - 19 pandemic

BACKGROUND

Corona virus epidemic may be acts as a stressor or trauma that affects both physical health and mental health. People exhibited various reactive behaviors to confront with this stressful situation. In Iran, one of the common motives for alcohol consumption is to scape problems and cope with stresses. It has been shown that personality factors influence alcohol consumption, since they are associated with drinking motives. The main purpose of this study was to investigate the correlation between temperament and character and alcohol abuse.

METHODS

This cross-section study was conducted on 135 alcohol intoxicated patients admitted to emergency room in March 2020 and 255 participants who were randomly selected from public in Shiraz. A questionnaire consisted of TCI (Temperament and character inventory) and several questions about COVID-19 pandemic. It was completed by a trained interviewer using the matched answer technique. Demographic factors were self-reported.

RESULTS

Among the alcohol intoxicated group, 117 (86.7%) were males and 18(13.3%) were females. The mean age of the participants was 32.43 ± 10.81 years. Among control group, 99 (38.8%) were males and 156 (61.2%) were females. The mean age of control group was 33.12 ± 14.77 years. Alcohol toxicity was mostly observed among the young males (male/female ratio was 6.45). According to temperament and character index, mean scores of novelty seeking, harm avoidant, and self-transcendence were higher in the alcohol toxicity group than normal population (P < 0.01). Mean scores of reward dependent, cooperativeness, and self-directedness were higher in normal population than the alcohol toxicity group (P < 0.001). The mean score of persistence was not significantly different between methanol intoxicated and normal population groups (P = 0.718).

CONCLUSION

Alcohol intoxicated patients had higher scores of novelty-seeking and self-transcendence and lower scores of reward-dependency scores, cooperativeness and self-directedness. These scores are associated with higher likelihood of personality disorders.

Alcohol intake in an attempt to fight COVID-19: A medical myth in Iran

The coronavirus disease 2019 (COVID-19) spread rapidly worldwide and led to the deaths of thousands of people. To date, there is not any vaccine or specific antiviral medicine that can prevent or treat this virus. This caused panic among people who try their best to prevent being infected. In Iran, methanol poisoning was reported and led to the death of hundreds of people in several provinces. The incident occurred after a rumor circulated in the country that drinking alcohol (ethanol) can cure or prevent being infected by COVID-19.

Electrocardiographic findings of methanol toxicity: a cross-sectional study of 356 cases in Iran

BACKGROUND

Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature.

METHOD

A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected.

RESULTS

The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P < 0.05 for all), respectively.

CONCLUSION

Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.

Lessons from a methanol poisoning outbreak in Egypt: Six case reports

BACKGROUND

Mass methanol poisonings are challenging, especially in regions with no preparedness, management guidelines and available antidotes.

CASE SUMMARY

Six Ukrainian patients were referred to our emergency department in Cairo, Egypt several hours after drinking an alcoholic beverage made of 70%-ethanol disinfectant bought from a local pharmacy. All patients presented with severe metabolic acidosis and visual impairments. Two were comatose. Management was based on the clinical features and chemistry tests due to deficient resources for methanol leveling. No antidote was administered due to fomepizole unavailability and the difficulties expected to obtain ethanol and safely administer it without concentration monitoring. One patient died from multiorgan failure, another developed blindness and the four other patients rapidly improved.

CONCLUSION

This methanol poisoning outbreak strongly highlights the lack of safety from hazardous pharmaceuticals sold in pharmacies and limitations due to the lack of diagnostic testing, antidote availability and staff training in countries with limited-resources such as Egypt.

A Brief History of Whiskey Adulteration and the Role of Spectroscopy Combined with Chemometrics in the Detection of Modern Whiskey Fraud

Food fraud and adulteration is a major concern in terms of economic and public health. Multivariate methods combined with spectroscopic techniques have shown promise as a novel analytical strategy for addressing issues related to food fraud that cannot be solved by the analysis of one variable, particularly in complex matrices such distilled beverages. This review describes and discusses different aspects of whisky production, and recent developments of laboratory, in field and high throughput analysis. In particular, recent applications detailing the use of vibrational spectroscopy techniques combined with data analytical methods used to not only distinguish between brand and origin of whisky but to also detect adulteration are presented.

A pocket-sized device enables detection of methanol adulteration in alcoholic beverages

Alcoholic drinks contaminated, either accidentally or deliberately, by methanol claimed at least 789 lives in 2019, mostly in Asia. Here, a palm-sized, multi-use sensor-smartphone system is presented for on-demand headspace analysis of beverages. The analyser quantified methanol concentrations in 89 pure and methanol-contaminated alcoholic drinks from 6 continents and performed accurately for 107 consecutive days. This device could help consumers, distillers, law-enforcing authorities and healthcare workers to easily screen methanol in alcoholic beverages.

Alcohol treatment systems in Muslim majority countries: Case study of alcohol treatment policy in Iran

BACKGROUND

Alcohol is a leading risk factor for death and disability globally. Due to the Islamic prohibition of alcohol consumption, alcohol policy is an under-studied and sensitive topic in Muslim majority countries (MMCs). In addition, drinkers in these countries may face barriers to treatment access due to stigma or the legal status of alcohol. Using Iran as a case study this paper explores how alcohol treatment is planned and delivered in the complex environment of an MMC.

METHOD

We searched academic and grey literature, clinical manuals, guidelines and policy documents for information on the development and implementation of alcohol treatment policy in Iran. The search was conducted in English, Persian and Arabic. We conducted 6 consultations to verify information obtained. We analysed information based on the Walt & Gilson health policy analysis triangle, which identifies context, process, actors and content as key factors for understanding policy.

RESULTS

Iran initiated an alcohol-specific national strategy in 2011-2012 that aims to prevent, reduce and treat alcohol use disorders. This strategy has been designed to be implemented on a multi-sectoral level. Screening and prevention are mainly initiated in primary health care and cases are referred accordingly. Alcohol treatment is provided in specialised outpatient and inpatient settings. Due to contextual factors such as stigma, feasibility and affordability, alcohol outpatient units are planned to be integrated into existing public/ private drug addiction treatment facilities. However, the Ministry of Health has faced many challenges in implementing this pilot project. To date only small numbers of outpatient and inpatient units have formally commenced offering alcohol treatment.

CONCLUSION

Implementing alcohol treatment has been challenging for Iran. Approval of new treatment programs may not be seen as a priority because of the low prevalence of alcohol use disorders in the country. Also, policy makers are implementing treatment services with caution due to the existing alcohol prohibition for the country's Muslim majority population. Barriers to treatment seeking need to be addressed at the micro and macro levels. Support from international agencies such as the WHO could assist MMCs to develop appropriate services that are feasible for their unique alcohol policy environment.

Tramadol, Methadone and Benzodiazepines added to Alcoholic Beverages

AIMS

To search for pharmaceutical additives in illicit alcoholic beverages referred to the laboratory of Legal Medicine Organization in Iran in 2017.

METHODS

Hundred beverages were sampled. Ethanol content was determined by gas chromatography with flame ionization detection (GC-FID) and then a liquid-liquid extraction combined with reversed-phase high performance liquid chromatography equipped with a photodiode array detector (PAD) was employed for the qualitative analysis. The analysis was confirmed using gas chromatography coupled with mass spectroscopy (GC/MS).

RESULTS

In 15% either one or more of the following were detected: tramadol, methadone, diazepam, oxazepam, flurazepam and alprazolam. Tramadol was found with highest frequency.

CONCLUSIONS

The wide availability of addictive pharmaceutical is leading to fortification of alcoholic beverages on some countries. The addition of such depressant additives should be better known because of the potentially fatal consequences of the combination with ethanol, as well as the potential for adverse effects on behavior.

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second-most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self-poisoning is not accepted in the Islamic point of view, and thus self-poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20 000 and 25 000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home-made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well-known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.