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Niknahad H, Heidari R, Jangjou A, Asghari V, Niknahad FM, Goudarzi F, Tavakoli N, Rahimi M, Niknahad AM, Rashedinia M. The therapeutic effect of a novel parenteral formulation of dihydroxyacetone in aluminum phosphide-intoxicated patients. Heliyon 2023; 9:e22165. [PMID: 38053886 PMCID: PMC10694179 DOI: 10.1016/j.heliyon.2023.e22165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Background and objectives Aluminum phosphide (AlP), known as "rice tablet," is widely used as an effective pesticide. However, AlP poisoning is a common cause of mortality in many countries, such as Iran. Unfortunately, there is no specific antidote for AlP toxicity to date. AlP releases phosphine gas when it is exposed to moisture or acid. Phosphine is a potent mitochondrial toxin that could significantly inhibit cellular energy metabolism. AlP poisoning is an emergency condition that needs instant and effective intervention. Dihydroxyacetone (DHA) is a simple saccharide used for several pharmacological as well as cosmetic purposes. Previously, we found that DHA could significantly prevent mitochondrial impairment induced by toxic agents such as cyanide and phosphine in various in vitro and in vivo experimental models. Methods Hospitalized patients (n = 111) were evaluated for eligibility criteria. Among these patients, n = 35 cases were excluded due to incomplete data (n = 11) and suspicion of poisoning with poisons other than AlP (n = 24). Meanwhile, n = 76 cases with confirmed AlP poisoning were included in the study. AlP-poisoned patients who did not receive DHA (n = 18) were used as the control group.Patients (n = 58) received at least one dose of DHA (500 ml of 5 % DHA solution w/v, i.v.) as an adjuvant therapy in addition to the routine treatment of AlP poisoning. Arterial blood gas (ABG), blood pH, bicarbonate levels, and other vital signs and biochemical measurements were monitored. Moreover, the mortality rate and hospitalization time were evaluated in DHA-treated and AlP-poisoned patients without DHA administration. Several biomarkers were assessed before (upon hospitalization) and after DHA treatment. The routine tests for AlP-poisoned patients in this study were the measurement of electrolytes (K+ and Na+), WBC, RBC, hemoglobin, INR, carbonate (HCO3), blood pH, PaCO2, and PaO2 and SGPT, SGOT, BUN, Cr. Results Upon patients' admission, significant decreases in blood pH (acidosis), blood PaO2, and HCO3 levels were the hallmarks of AlP poisoning. It was found that DHA significantly alleviated biomarkers of AlP poisoning and tremendously enhanced patients' survival rate (65.52 % in DHA-treated vs 33.34 % in the control group) compared to patients treated based on hospital routine AlP poisoning protocols (no DHA). No significant adverse effects were evident in DHA-treated patients in the current study. Interpretation and conclusions These data suggest that parenteral DHA is a novel and effective antidote against AlP poisoning to be used as an adjuvant in addition to routine supportive treatment. Trial registration IR.SUMS.REC.1394.102.
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Affiliation(s)
- Hossein Niknahad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Heidari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Jangjou
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Fazel Goudarzi
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasim Tavakoli
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Rahimi
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Marziye Rashedinia
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Erlangsen A, Khan M, Su W, Alateeq K, Charfi F, Madsen T, Qin P, Morthorst BR, Thomsen M, Malik A, Bandara P, Fleischmann A, Saeed K. Situation Analysis of Suicide and Self-Harm in the WHO Eastern Mediterranean Region. Arch Suicide Res 2023:1-19. [PMID: 37837375 DOI: 10.1080/13811118.2023.2262532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
OBJECTIVE An estimated 41,000 lives are lost to suicide each year in World Health Organization Eastern Mediterranean Region Office (WHO EMRO) countries. The objective of this study was to conduct a situation analysis for suicide and self-harm in the WHO EMRO region. METHODS Data on suicide were obtained from the WHO Global Health Estimates for the years 2000-2019. Information on risk groups efforts to prevent self-harm and suicide in the EMRO region were retrieved through scientific studies, grey literature, and public websites. RESULTS During 2000-2019, the age-standardized suicide rate was 6.7 per 100,000 inhabitants, albeit there are concerns regarding data quality. Self-harm and suicide remain criminal acts in more than half of the countries. Few countries have a national plan for prevention of suicide. Toxic agents, such as pesticides and black henna, are easily available and frequently used for suicide in some areas, as are firearms and self-immolation. Successful prevention measures include means restriction and psychosocial interventions after self-harm. CONCLUSION Many WHO EMRO countries remain underserved in terms of mental health care. Decriminalization of suicide and means restriction might be further promoted. Online-based tools for mental health literacy and psychosocial therapy are other options to explore.
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Juárez-Martínez A, Madrigal-Anaya JDC, Rodríguez-Torres YP, Dorado-García R, Montes-Ventura DM, Jiménez-Ruiz A. Zinc Phosphide Poisoning: From A to Z. TOXICS 2023; 11:555. [PMID: 37505522 PMCID: PMC10386637 DOI: 10.3390/toxics11070555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/29/2023]
Abstract
Zinc phosphide is a rodenticide that is used in agricultural, urban and industrial environments in México. After ingestion, it reacts with hydrochloric acid, hydrolyzing into phosphine. It causes cellular hypoxia via mitochondrial toxicity, resulting in multiple organ dysfunction and death. There is no antidote or specific treatment for zinc phosphide toxicity. We present the case of a 45-year-old female who ingested zinc phosphide with suicidal intent. On arrival at the emergency department, she had multisystemic disorders. Supportive care, decontamination and antidotal therapy were initiated. Subsequently, she evolved to clinical improvement with a resolution of the biochemical abnormalities of tissue hypoperfusion. She was discharged on day 7 without complications. In this review, we provide updated therapeutic options and discuss their specific pathophysiological basis.
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Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN, Raschi E, De Ponti F, Pelotti S, Poluzzi E. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. Drug Saf 2023; 46:283-295. [PMID: 36689131 PMCID: PMC9869307 DOI: 10.1007/s40264-022-01269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes. METHODS We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs. RESULTS We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g). CONCLUSION Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Chiara Pugliese
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mattia Bartolucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Elena Narmine Necibi
- School of Emergency Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Susi Pelotti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Albano GD, Malta G, La Spina C, Rifiorito A, Provenzano V, Triolo V, Vaiano F, Bertol E, Zerbo S, Argo A. Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries. TOXICS 2022; 10:toxics10110654. [PMID: 36355945 PMCID: PMC9698482 DOI: 10.3390/toxics10110654] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 05/15/2023]
Abstract
The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.
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Affiliation(s)
- Giuseppe Davide Albano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
- Correspondence: ; Tel.: +39-3312264328
| | - Ginevra Malta
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Corinne La Spina
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Arianna Rifiorito
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valeria Provenzano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valentina Triolo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Fabio Vaiano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Elisabetta Bertol
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Stefania Zerbo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Antonina Argo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
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Dai J, Liu J, Zhang M, Yu Y, Wang J. Network toxicology and molecular docking analyses on strychnine indicate CHRM1 is a potential neurotoxic target. BMC Complement Med Ther 2022; 22:273. [PMID: 36244968 PMCID: PMC9575290 DOI: 10.1186/s12906-022-03753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Improper use of strychnine can cause death. The aim of this study was to identify and evaluate toxic mechanisms of action associated with active compounds in strychnine using a network toxicology approach, and explore potential pathogenic targets. Methods In the present study, strychnine target and central nervous system-related gene set were established using the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database and four disease gene databases (Genecards, OMIM, PharmGkb, TTD). An “ingredient-target” interactive active network map was constructed using Cytoscape software (version 3.8.0). Functional enrichment analysis was performed based on the hub genes. A protein-protein interaction network was constructed using STRING database. The pharmacokinetics (ADMET) properties of strychnine were evaluated using SwissADME tool. Molecular docking was performed using Autodock Vina to explore the interactions between the active compounds and the target protein. Results Five strychnine toxicity-related components and a gene set of 40 genes were obtained. GO and KEGG analyses showed that Strychnine acts on the central nervous system through G protein-coupled receptor signaling pathway. Analysis of “ADMET” related parameters showed a high gastrointestinal tract absorption of (S)-stylopine and isobrucine and the compounds could cross the blood brain barrier. CHRM1 was selected as a key gene in strychnine toxicity. Molecular docking results showed that the co-crystalized ligands did not form hydrogen bond with CHRM1. (S)-stylopine had the highest binding affinity (binding energy = − 8.5 kcal/mol) compared with the other two compounds. Conclusion Network toxicology and molecular docking reveal the toxicity mechanisms of strychnine active compounds. The findings showed that CHRM1 is a potential neurotoxic target. (S)-stylopine showed stronger neurotoxic effect compared with the other ligands.
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Affiliation(s)
- Jialin Dai
- grid.413458.f0000 0000 9330 9891School of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou Province China
| | - Jiangjin Liu
- grid.413458.f0000 0000 9330 9891School of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou Province China
| | - Maoxin Zhang
- Department of technology, Zhongshan branch of Liupanshui Public Security Bureau, Liupanshui, Guizhou Province China
| | - Yanni Yu
- grid.413458.f0000 0000 9330 9891School of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou Province China
| | - Jie Wang
- grid.413458.f0000 0000 9330 9891School of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou Province China
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Stimulant use in suicides: A systematic review. Forensic Sci Int 2022; 338:111391. [PMID: 35908335 DOI: 10.1016/j.forsciint.2022.111391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022]
Abstract
Suicide remains a global public health concern and the increased supply and use of synthetic stimulants globally may have implications for the burden of suicides attributable to substance use. This systematic review investigated any potential associations of stimulant use detected in post-mortem biological specimens and suicides. We conducted a systematic review and narrative synthesis (CRD42021237966). Medline, EMBASE, TOXLINE, and Scopus databases were searched for terms related to forensic toxicology, post-mortem toxicology, suicide and stimulants. The primary outcome was to estimate the prevalence of stimulant use in suicides. There were 26 studies whichcontributed to prevalence measures; in studies reporting at the individual compound level, suicides involved cocaine (0.1-23%), caffeine (3.2-22%), 3,4-methylenedioxymethamphetamine (0.1-17%), amphetamine (0.2-9.3%), methamphetamine (3.1-7%), and phentermine (0.9-1%). Overall, stimulant use in suicides was over-represented compared to estimates of stimulant use in the general population and has increased over time. Thirteen case reports used to contextualise suicides involving stimulants found no examples of cocaine or methamphetamine mono-intoxication of suicidal intent. This suggests mechanisms other than acute toxicity involved in stimulant-associated suicide. Future research by in-depth psychological autopsies of suicides involving stimulants, in combination with segmental hair analysis to determine the chronicity of stimulant exposure, may contribute to a better understanding of the burden of suicide attributable to stimulant use.
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Mahdavi SA, Zamani N, McDonald R, Akhgari M, Kolahi AA, Gheshlaghi F, Ostadi A, Dehghan A, Moshiri M, Rahbar-Taramsari M, Delirrad M, Mohtasham N, Afzali S, Ebrahimi S, Ziaeefar P, Khosravi N, Kazemifar AM, Ghadirzadeh M, Farajidana H, Barghemadi T, Sadeghi F, Hadeiy SK, Hadipourzadeh M, Mesbahi J, Malekpour MR, Arabi M, Jamshidi F, Dadpour B, Hovda KE, Hassanian-Moghaddam H. A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic. Sci Rep 2022; 12:9741. [PMID: 35697919 PMCID: PMC9189800 DOI: 10.1038/s41598-022-14007-1] [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: 10/13/2021] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
| | - Nasim Zamani
- 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
| | - Rebecca McDonald
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Maryam Akhgari
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Gheshlaghi
- Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Ostadi
- Department of Internal Medicine, Sina Medical Research & Training Hospital, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Dehghan
- Accident Prevention and Crisis Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morteza Rahbar-Taramsari
- Department of Forensic Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Delirrad
- Department of Forensic Medicine, School of Medicine, Food and Beverages Safety Research Center, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Neda Mohtasham
- Department of Pediatric Clinical Toxicology, Abuzar's Children Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Afzali
- Department of Forensic Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sara Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Khosravi
- Department of Emergency Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Hoorvash Farajidana
- Department of Emergency Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Tahereh Barghemadi
- Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farangis Sadeghi
- Clinical Development Research Unit, Seyad Shirazi Hospital, Golestan University of Medial Sciences, Gorgan, Iran
| | - Seyed Kaveh Hadeiy
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hadipourzadeh
- Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad-Reza Malekpour
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Arabi
- Department of Family Medicine, Sari Medical School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farkhondeh Jamshidi
- Department of Forensic Medicine and Social Determinant of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Knut Erik Hovda
- The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - 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. .,Loghman-Hakim Hospital Poison Center, South Karegar Street, Kamali St, Tehran, Iran.
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Meamar R, Dorooshi G, Kalantar K, Amini Z. Intoxication-related deaths in a poisoning center in Isfahan: Demographic and other-related factors. Adv Biomed Res 2022; 11:82. [DOI: 10.4103/abr.abr_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/20/2021] [Accepted: 07/20/2021] [Indexed: 11/04/2022] Open
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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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Azarbakhsh H, Moftakhar L, Amiri S, Mirahmadizadeh A. Epidemiology of Suicide by Medication Overdose: A Population-based Study 2011-2019. Arch Med Res 2021; 53:304-311. [PMID: 34756732 DOI: 10.1016/j.arcmed.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/26/2021] [Accepted: 10/13/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUNDS The trend of suicide attempt by medication overdose has shown an increasing trend in recent years. The present study was conducted to investigate the epidemiology of suicide attempts and completed suicide by medication overdoses in Fars's province between 2011 and 2019. METHODS This cross-sectional study was performed on 40334 suicide attempts by medication overdose. First, fetal rate, and crude and aged-standardized mortality rate (ASR) were calculated. Then, χ2 test was used to calculate the trend of rates of suicide attempt and completed suicide, also to explore differences between qualitative and outcome variables. Finally, logistic regression analysis was performed to identify factors associated with suicide outcome. RESULTS The mean age of the participants was 26.66 ± 11.03 years. The highest ASR for suicide attempt by medication overdose was observed in the age range of 15-24 years. The rate of completed suicide by medication overdose was estimated as 1.22%. The odds of completed suicide were 2.7 times higher in men than in women, 2.7 times higher in people with a family history of suicide, and 1.7 times higher in people with a previous history of suicide. CONCLUSION The results of our study may help health policymakers to effectively prevent recurrence of suicide attempts through establishing effective strategies for timely identification and appropriate intervention among high-risk individuals with previous history of suicide.
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Affiliation(s)
| | - Leila Moftakhar
- Student Research Committee,Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Amiri
- Epidemiology in Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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12
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Bai R, Xie B, Cong B, Ma CL, Wen D. Epidemiological Characteristics of Sedative-Hypnotics and Opioid Painkillers at High-Frequency Exposure. FA YI XUE ZA ZHI 2021; 37:694-698. [PMID: 35187923 DOI: 10.12116/j.issn.1004-5619.2020.300702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Drug poisoning has a high incidence and serious consequences in medical institutions; its epidemiological characteristics also directly affect the changes in national laws and policies and the implementation of local management policies. Chinese statistics on drug-related abnormal death cases generally come from judicial appraisal centers and medical units. However, due to differences in work content and professional restrictions, there are differences in information management forms, which makes it difficult for appraisers to conduct a professional and systematic analysis of drug-related cases. This article focuses on the analysis of epidemiological characteristics of sedative-hypnotics and opioid painkillers and their exposure patterns in cases of poisoning death by analyzing the annual report of the American Association of Poison Control Center, combined with the characteristics of drug exposure in China.
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Affiliation(s)
- Rui Bai
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Bing Xie
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Bin Cong
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Chun-Ling Ma
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Di Wen
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
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13
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Mahdavi SA, Kolahi AA, Akhgari M, Gheshlaghi F, Gholami N, Moshiri M, Mohtasham N, Ebrahimi S, Ziaeefar P, McDonald R, Tas B, Kazemifar AM, Amirabadizadeh A, Ghadirzadeh M, Jamshidi F, Dadpour B, Mirtorabi SD, Farnaghi F, Zamani N, Hassanian-Moghaddam H. COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study. Alcohol Clin Exp Res 2021; 45:1853-1863. [PMID: 34487368 PMCID: PMC8653331 DOI: 10.1111/acer.14680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
Background During the first wave of COVID‐19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID‐19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID‐19 and the previous year. For poisoning admissions during COVID‐19, we also evaluated the cause by age and clinical outcomes. Methods This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol‐poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre‐COVID‐19 reference period (same dates in 2019). Results Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID‐19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15‐ to 18‐year‐olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15‐ to 18‐year‐olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001). Conclusion The Iranian methanol poisoning outbreak during the first wave of COVID‐19 was associated with significantly increased hospitalization rates among children and adolescents—including at least six pediatric in‐hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.
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Affiliation(s)
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Akhgari
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Farzad Gheshlaghi
- Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Gholami
- Department of Pediatrics, School of Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Mohtasham
- Department of Pediatric Clinical Toxicology, Abuzar's Children Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rebecca McDonald
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Basak Tas
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Alireza Amirabadizadeh
- Cardiovascular Disease Research Center, Birjand University of Medical Sciences, South Khorasan, Iran
| | | | - Farkhondeh Jamshidi
- Department of Forensic Medicine and Social Determinant of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Fariba Farnaghi
- Department of Pediatrics, School of Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Mahdavi SA, Kolahi A, Akhgari M, Gheshlaghi F, Gholami N, Moshiri M, Mohtasham N, Ebrahimi S, Ziaeefar P, McDonald R, Tas B, Kazemifar AM, Amirabadizadeh A, Ghadirzadeh M, Jamshidi F, Dadpour B, Mirtorabi SD, Farnaghi F, Zamani N, Hassanian‐Moghaddam H. COVID‐19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study. Alcohol Res 2021. [DOI: https://doi.org/10.1111/acer.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Ali‐Asghar Kolahi
- Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Maryam Akhgari
- Legal Medicine Research Center Legal Medicine Organization Tehran Iran
| | - Farzad Gheshlaghi
- Department of Clinical Toxicology Isfahan Clinical Toxicology Research Center School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Narges Gholami
- Department of Pediatrics School of Medicine Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Neda Mohtasham
- Department of Pediatric Clinical Toxicology Abuzar’s Children Medical Center Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Sara Ebrahimi
- School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Pardis Ziaeefar
- School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Rebecca McDonald
- National Addiction Centre Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Basak Tas
- National Addiction Centre Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | | | - Alireza Amirabadizadeh
- Cardiovascular Disease Research Center Birjand University of Medical Sciences South Khorasan Iran
| | | | - Farkhondeh Jamshidi
- Department of Forensic Medicine and Social Determinant of Health Research Center Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Bita Dadpour
- Medical Toxicology Research Center Mashhad University of Medical Sciences Mashhad Iran
| | | | - Fariba Farnaghi
- Department of Pediatrics School of Medicine Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
- Department of Clinical Toxicology Loghman Hakim Hospital School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Hossein Hassanian‐Moghaddam
- Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
- Department of Clinical Toxicology Loghman Hakim Hospital School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
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15
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Pawer S, Rajabali F, Zheng A, Smith J, Purssell R, Pike I. Analyses of Child and Youth Self-Poisoning Hospitalizations by Substance and Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137003. [PMID: 34208955 PMCID: PMC8297021 DOI: 10.3390/ijerph18137003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Child and youth self-poisoning is a growing public health issue in many regions of the world, including British Columbia (BC), Canada, where 15–19-year-olds have the highest rates of self-poisoning hospitalizations compared with those of all other ages. The purpose of this study was to identify what substances children and youth commonly used to poison themselves in BC and how socioeconomic status may impact self-poisoning risk. Self-poisoning hospitalization rates among 10–14 and 15–19-year-olds from 1 April 2012 to 31 March 2020 were calculated by substance using ICD-10-CA codes X60-X69 and T36-T65, as well as by socioeconomic status using the Institut National de Santé Publique du Québec’s Deprivation Index. Nonopioid analgesics, antipyretics, and antirheumatics were the most common substances involved, with rates of 27.6 and 74.3 per 100,000 population among 10–14 and 15–19-year-olds, respectively, followed by antiepileptic, sedative–hypnotic, antiparkinsonism, and psychotropic drugs, with rates of 20.2 and 68.1 per 100,000 population among 10–14 and 15–19-year-olds, respectively. In terms of socioeconomic status, rates were highest among 10–19-year-olds living in neighbourhoods with the fewest social connections (243.7 per 100,000 population). These findings can inform poisoning prevention strategies and relevant policies, thereby reducing the number of self-poisoning events among children and youth.
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Affiliation(s)
- Samantha Pawer
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
- Correspondence: ; Tel.: +1-604-875-3572
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Jennifer Smith
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Roy Purssell
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- British Columbia Drug and Poison Information Centre, BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC V5Z 4R4, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
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16
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Mohammadinejad A, Rizi KS, Oskuee RK, Aryan E, Meshkat Z, Ulianas A, Rezayi M. Development of detection methods for the diagnosis and analysis of highly toxic metal phosphides: A comprehensive and critical review. Biotechnol Appl Biochem 2021; 69:1121-1147. [PMID: 33987922 DOI: 10.1002/bab.2190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/03/2021] [Indexed: 01/29/2023]
Abstract
Metal phosphides, especially aluminum phosphide, and phosphine (PH3 ) are widely used as insecticides and rodenticides for protection of grains during process of storage and transportation. The main reason of poisoning with this compound is related to the conscious ingestion of salts or accidental inhalation of PH3 . So the early and accurate diagnosis of poisoning can significantly help to the effective clinical treatment or recognition of death cause. PH3 is somewhat unstable due to reaction with oxygen or hemoglobin leading to formation of oxy-acids phosphorous. Here, we critically reviewed the literature introducing the quantitative and qualitative methods for the detection of metal phosphides, PH3 , and its products. This study obviously demonstrates that during past years, different diagnosis methods have been remarkably progressed. Head-space gas chromatography and confirmatory colorimetric methods have been as the most popular techniques. Also, the gas sensors are a promising method that must be more progressed.
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Affiliation(s)
- Arash Mohammadinejad
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kobra Salimiyan Rizi
- Antimicrobial Resistance Research Center, Department of Medical Bacteriology and Virology, Qaem University Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Kazemi Oskuee
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Aryan
- Antimicrobial Resistance Research Center, Department of Medical Bacteriology and Virology, Qaem University Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Meshkat
- Antimicrobial Resistance Research Center, Department of Medical Bacteriology and Virology, Qaem University Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alizar Ulianas
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang. J1. Prof. Hamka, Air Tawar Padang, Indonesia
| | - Majid Rezayi
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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17
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Hadeiy SK, Parhizgar P, Hassanian-Moghaddam H, Zamani N, Khoshkar A, Kolahi AA, Amirabadizadeh A, Rezaei O. Trends of acute drug and chemical toxicities in adults and adolescents in Tehran, Iran between 2012 and 2018: a retrospective chart review. Drug Chem Toxicol 2021; 45:2039-2048. [PMID: 33858280 DOI: 10.1080/01480545.2021.1903486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Seyed Kaveh Hadeiy
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parinaz Parhizgar
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - 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
| | - Nasim Zamani
- 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
| | - Ali Khoshkar
- Department of Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Valipour R, Shekari A, Setareh M, Soltaninejad K. Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths: A Retrospective 7-Year Forensic-Based Study in Iran. Am J Forensic Med Pathol 2021; 42:23-29. [PMID: 32868498 DOI: 10.1097/paf.0000000000000607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.
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Affiliation(s)
| | | | | | - Kambiz Soltaninejad
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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19
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Chen CK, Chan YL, Su TH. Incidence of intoxication events and patient outcomes in Taiwan: A nationwide population-based observational study. PLoS One 2020; 15:e0244438. [PMID: 33362242 PMCID: PMC7757892 DOI: 10.1371/journal.pone.0244438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intoxicated patients were frequently managed in the emergency departments (ED) with few studies at national level. The study aimed to reveal the incidence, outcomes of intoxications and trend in Taiwan. METHODS Adults admitted to an ED due to an intoxication event between 2006 and 2013 were identified using the Taiwan National Health Insurance Research Database. The rate of intoxication and severe intoxication events, mortality rate, hospital length of stay (LOS), and daily medical costs of these patients were analyzed. Changes over time were analyzed using Joinpoint models. Multivariable generalized regressions with GEE were used to assess the effect of sex, age, and presence of prior psychiatric illness. RESULTS A total of 20,371 ED admissions due to intoxication events were identified during the study period, and the incidence decreased with annual percentage change of 4.7% from 2006 to 2013. The mortality rate, hospital LOS, and daily medical costs were not decreased over time. Males and geriatric patients had more severe intoxication events, greater mortality rates, and greater daily medical costs. Patients with psychiatric illnesses had higher mortality rates and a longer hospital LOS, but lower daily medical expenses. CONCLUSION From 2006 to 2013, there was a decline in the incidence of ED admission for intoxication events in Taiwan. Males, geriatric patients, and those with psychiatric illnesses had greater risks for severe intoxication and mortality.
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Affiliation(s)
- Chun-Kuei Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail:
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20
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Paknahad S, Akhgari M, Ghadipasha M. An alarming rise in the prevalence of deaths with methamphetamine involved in Tehran, Iran 2011-2018. Forensic Sci Med Pathol 2020; 17:208-215. [PMID: 33237521 DOI: 10.1007/s12024-020-00339-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
Methamphetamine is one of the most commonly abused illicit drugs in Iran. Despite this fact, there has been relatively little research on methamphetamine-associated deaths in Iran. The present study aimed to investigate the cause of death in methamphetamine positive cases based on forensic toxicology findings In this data base descriptive study, individuals with methamphetamine-associated deaths that were referred to the Legal Medicine Organization, Tehran, Iran (2011-2018) were assessed. Deaths including those from natural causes, toxicity, accident and suicides with positive forensic toxicology analyses for methamphetamine and its metabolite amphetamine in postmortem samples were investigated. All cases were examined to determine trends in methamphetamine-associated deaths, and in the manner and causes of deaths. During the eight year study there were 1389 methamphetamine-associated deaths. The mean age was 37.47±10.87 years, with a male/female ratio of 12.36:10. The methamphetamine-associated death rate increased significantly during the study period (2.05 vs. 21.93 per 106 Tehran province populations). The most common cause of death was cardiac arrest due to stimulant abuse with supportive histologic findings of acute myocardial infarction, myocardial fiber hypertrophy, aortic dissection and perivascular fibrosis (25%). Opioids (methadone, tramadol and morphine), tricyclic antidepressants and benzodiazepines were frequently present in postmortem samples of study cases. Methamphetamine-associated deaths significantly contribute to illicit drug-associated deaths in Tehran and represent a substantial clinical and public health problem.
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Affiliation(s)
- Somayeh Paknahad
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran
| | - Maryam Akhgari
- Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
| | - Masoud Ghadipasha
- Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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21
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Paknahad S, Akhgari M, Ghadipasha M. An alarming rise in the prevalence of deaths with methamphetamine involved in Tehran, Iran 2011-2018. Forensic Sci Med Pathol 2020. [DOI: https://doi.org/10.1007/s12024-020-00339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Sharif Nia H, Heidari M, Naghavi N, Lehto RH, Haghdoost AA, Jafari-Koulaee A, Matbue YH, Yaghoobzadeh A, Goudarzian AH, Sharif SP. Age Changes and Suicidal Activity in Iran Over the Past Decade: A Systematic Review and Meta-Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:312-337. [PMID: 33106088 DOI: 10.1177/0030222820966934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review study fills an important gap by aiming to determine the age changes in attempted and completed suicide in Iran during the past decade. A systematic review of related articles in international and Iranian databases from January 2008 to January 2020 was first conducted and relevant studies were extracted based on established criteria. Results showed that the mean age of suicide in Iran is 29.8 (range 27.7 - 31.8) years old for men and 27.4 (range 25.8 - 28.9) for women (P < 0.0001). The youngest and oldest populations of completed suicide belong to eastern and central regions of the country respectively. Findings imply the critical importance of increasing awareness through educational programs and public health campaigns to increase awareness and reduce suicidal behavior in Iran.
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Affiliation(s)
- Hamid Sharif Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Heidari
- Department of Epidemiology and Biostatistics, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Navaz Naghavi
- Taylor's Business School, Faculty of Business and Law, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
| | - Rebecca H Lehto
- Michigan State University, College of Nursing, East Lansing, United States
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Azar Jafari-Koulaee
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yasaman Hatef Matbue
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ameneh Yaghoobzadeh
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Pahlevan Sharif
- Taylor's Business School, Faculty of Business and Law, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
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23
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Ghodsi Z, Moghaddam SS, Vezvaei P, Yoosefi M, Rezaei N, Saadat S, Sheidaei A, Sharif-Alhoseini M, Sadeghian F, Ahmadi N, Jazayeri SB, Salamati P, Khosravi A, Moradi-Lakeh M, Mokdad AH, O'Reilly G, Rahimi-Movaghar V. The mortality rate from self-harm in Iran. Public Health 2020; 186:44-51. [PMID: 32768623 DOI: 10.1016/j.puhe.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/22/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years. METHODS The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults. RESULTS Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period. CONCLUSION Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions.
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Affiliation(s)
- Z Ghodsi
- Department of Midwifery, Tuyserkan Branch, Islamic Azad University, Tuyserkan, Iran.
| | - S S Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - P Vezvaei
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - M Yoosefi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - N Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - S Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - A Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - M Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - F Sadeghian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - N Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - S B Jazayeri
- Department of Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA.
| | - P Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - A Khosravi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran.
| | - M Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - A H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Washington, USA.
| | - G O'Reilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - V Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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24
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Hassanian-Moghaddam H, Zamani N, Kolahi AA. Re: 'Trend of fatal poisoning at national and provincial levels in Iran from 1990 to 2015'. Public Health 2019; 178:179-180. [PMID: 31836242 DOI: 10.1016/j.puhe.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/26/2019] [Indexed: 11/15/2022]
Affiliation(s)
- H Hassanian-Moghaddam
- Social Determinant of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicne, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - N Zamani
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicne, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A-A Kolahi
- Social Determinant of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Ghodsi Z, Moghaddam SS, Saadat S, Yoosefi M, Rezaei N, Ostadrahimi H, Mehdipour P, Khalafi B, Sobhani S, Haghshenas R, Alaedini M, Jazayeri SB, Sadeghian F, Sharif-Alhoseini M, Bazireh H, Naghdi K, Derakhshan P, Salamati P, Moradi-Lakeh M, Mokdad AH, O'Reilly G, Rahimi-Movaghar V. Trend of fatal poisoning at national and provincial levels in Iran from 1990 to 2015. Public Health 2019; 170:78-88. [PMID: 30978579 DOI: 10.1016/j.puhe.2019.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Comprehensive and up-to-date data on fatal injury trends are critical to identify challenges and plan priority setting. This study provides a comprehensive assessment of poisoning mortality trends across Iran. STUDY DESIGN The data were gathered from various resources, including death registration systems, cemetery databases of Tehran and Esfahan, the Demographic and Health Survey of 2000, and three rounds of national population and housing censuses. METHODS After addressing incompleteness for child and adult death data separately and using a spatio-temporal model and Gaussian process regression, the level and trend of child and adult mortality were estimated. For estimating cause-specific mortality, the cause fraction was calculated and applied to the level and trend of death. RESULTS From 1990 to 2015, 40,586 deaths due to poisoning were estimated across the country. The poisoning-related age-standardized death rate per 100,000 was estimated to have changed from 3.08 (95% uncertainty interval [UI]: 2.32-4.11) in 1990 to 0.96 (95% UI: 0.73-1.25) in 2015, and the male/female ratio was 1.35 during 25 years of study with an annual percentage change of -5.4% and -4.0% for women and men, respectively. The annual mortality rate was higher among children younger than 5 years and the elderly population (≥70 years) in the study period. CONCLUSIONS This study showed that mortality from poisoning declined in Iran over the period from 1990 to 2015 and varied by province. Understanding the reasons for the differences of poisoning mortality by province will help in developing and implementing measures to reduce this burden in Iran.
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Affiliation(s)
- Z Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S S Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - N Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - H Ostadrahimi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - P Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - B Khalafi
- Lung Diseases and Allergy Research Center, Kurdistan University of Medical Science, Sanandaj, Iran
| | - S Sobhani
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - R Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - M Alaedini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S B Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - F Sadeghian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - M Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - H Bazireh
- Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - K Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - P Derakhshan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - P Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - A H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Washington, USA
| | - G O'Reilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - V Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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26
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A retrospective study of poisoning deaths from forensic autopsy cases in northeast China (Liaoning). J Forensic Leg Med 2019; 63:7-10. [DOI: 10.1016/j.jflm.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/24/2018] [Accepted: 02/15/2019] [Indexed: 11/19/2022]
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27
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Fakoor M, Akhgari M, Shafaroodi H. Lead Poisoning in Opium-Addicted Subjects, Its Correlation with Pyrimidine 5'-Nucleotidase Activity and Liver Function Tests. Int J Prev Med 2019; 10:36. [PMID: 30967922 PMCID: PMC6425880 DOI: 10.4103/ijpvm.ijpvm_490_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/31/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Lead may be added to the opium by drug smugglers. It can cause elevated blood lead level (BLL) in opium-addicted patients. Erythrocyte pyrimidine 5′-nucleotidase (P5N) activity is susceptible to high BLL. The aim of this study was to find out whether opium-addicted patients show erythropathy and elevated liver enzymes explainable by high BLL and decreased P5N activity. Methods: Forty orally opium-addicted subjects and 40 normal healthy volunteers were enrolled in this study. BLL was measured in whole blood specimens using atomic absorption spectrometry instrumentation. Enzymatic activity, protein amount of P5N, and erythrocyte purine/pyrimidine ratio were determined. Blood films were analyzed for the presence of basophilic stippling of red cells and hemolytic anemia. The level of liver function enzymes was measured. Results: The mean BLL for opium-addicted patients was significantly higher than control group (P < 0.001). On the contrary, P5N activity showed a valid decrease in opium-addicted patients when compared with control group (P < 0.001). In line with repressed P5N activity, erythrocyte purine/pyrimidine ratio in patients was lower than control group (P < 0.001). A statistically significant reverse correlation was found between BLL and P5N activity (P < 0.05, r = −0.85). The prevalence of both basophilic stippling (P < 0.001, z = 6.62) and hemolytic anemia (P < 0.001, z = 6.52) in study population was significantly associated with elevated BLL. We could not find any significant correlation between serum level of liver enzymes and BLL. Conclusions: Opium-addicted patients in Tehran, Iran, are at high risk of lead poisoning which may result in hematologic problems and possibly hepatic damage.
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Affiliation(s)
- Mandana Fakoor
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran
| | - Maryam Akhgari
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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28
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Gharedaghi F, Hassanian-Moghaddam H, Akhgari M, Zamani N, Taghadosinejad F. Drug-facilitated crime caused by drinks or foods. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: https://doi.org/10.1186/s41935-018-0100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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29
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Gharedaghi F, Hassanian-Moghaddam H, Akhgari M, Zamani N, Taghadosinejad F. Drug-facilitated crime caused by drinks or foods. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0100-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Karimani A, Mohammadpour AH, Zirak MR, Rezaee R, Megarbane B, Tsatsakis A, Karimi G. Antidotes for aluminum phosphide poisoning - An update. Toxicol Rep 2018; 5:1053-1059. [PMID: 30406022 PMCID: PMC6214862 DOI: 10.1016/j.toxrep.2018.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023] Open
Abstract
Aluminum phosphide (AlP), an inexpensive solid fumigant, is frequently used for grain conservation despite its alleged high toxicity. Increased utilization of AlP for agricultural and non-agricultural purposes during the last four decades has resulted in increment of AlP-attributed poisoning numbers. Moreover, due to its limitless accessibility in developing countries, AlP has been increasingly used for suicide. Moisture-exposed AlP undergoes a chemical reaction producing phosphine gas, which in turn inhibits cytochrome oxidase and impedes cellular oxygen consumption. Lethality remains elevated reaching rates of >50% and no effective antidote is available. Nevertheless, experimental and clinical studies suggested that magnesium sulfate, melatonin, N-acetylcysteine, glutathione, sodium selenite, vitamin C and E, triiodothyronine, liothyronine, vasopressin, milrinone, Laurus nobilis L., 6-aminonicotinamide, boric acid, acetyl-L-carnitine and coconut oil, may serve as antidotes by reducing the deleterious oxidative properties of AlP. This article reviews the afore-mentioned chemicals suggested to specifically treat AlP poisoning and discusses their protective mechanisms and main outcomes.
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Affiliation(s)
- Asieh Karimani
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Zirak
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Gholamreza Karimi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
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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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32
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Dastjerdi AG, Akhgari M, Kamali A, Mousavi Z. Principal component analysis of synthetic adulterants in herbal supplements advertised as weight loss drugs. Complement Ther Clin Pract 2018. [DOI: https://doi.org/10.1016/j.ctcp.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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33
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Principal component analysis of synthetic adulterants in herbal supplements advertised as weight loss drugs. Complement Ther Clin Pract 2018; 31:236-241. [PMID: 29705461 DOI: 10.1016/j.ctcp.2018.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/24/2022]
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34
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Akhgari M, Amini-Shirazi N, Iravani FS. Forensic Toxicology Perspectives of Methadone-associated Deaths in Tehran, Iran, a 7-year Overview. Basic Clin Pharmacol Toxicol 2017; 122:436-441. [PMID: 29076627 DOI: 10.1111/bcpt.12930] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/20/2017] [Indexed: 02/02/2023]
Abstract
Methadone has a long history of pain relief and successful substitute for maintenance treatment in heroin and narcotic addiction. The aim of the study was to assess the trends of methadone-associated deaths in Tehran, Iran, in 2009-2015, from a forensic toxicology point of view. All methadone-associated deaths during this 7-year study period were evaluated according to demographic parameters and forensic toxicology analysis results. Results showed that 1274 cases of methadone-associated deaths were investigated during the study period. The incidence rate of methadone-associated deaths had risen 7.7 times in 2015 in comparison with 2009 (p < 0.05). The majority of cases were men (90.35%), aged from 20 to 40 years. About 80% of cases had shown positive results for other drugs and poisons in combination with methadone. Methamphetamine and tramadol were the most drugs detected in post-mortem samples. Death rates among methadone users in Tehran, Iran, increased year by year during 2009-2015. These findings raise the attention to the concomitant use of drugs with the need for changes in regulation and regulatory policy to restrict access and use of controlled drugs.
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Affiliation(s)
- Maryam Akhgari
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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35
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Akhgari M, Amini-Shirazi N, Iravani FS. Forensic Toxicology Perspectives of Methadone-associated Deaths in Tehran, Iran, a 7-year Overview. Basic Clin Pharmacol Toxicol 2017. [DOI: https://doi.org/10.1111/bcpt.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maryam Akhgari
- Legal Medicine Research Center; Legal Medicine Organization; Tehran Iran
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