The danger of the toxicity and inefficacy of alcohol-based hand rubs in Iran during COVID-19: a cross-sectional study.

BACKGROUND: The use of disinfectants and alcohol-based hand rubs (ABHR) to prevent COVID-19 transmission increased in the first wave of the infection. To meet the increased demand, the Iranian Ministry of Health issued an emergency use authorization allowing new manufacturers to enter the market, despite the limited capacity for surveillance of these products during COVID-19. Methanol poisoning outbreaks spread rapidly, and more people died from methanol poisoning than COVID-19 in some cities. The aim of this study was to analyze some ABHRs in the Iranian market to see if (a) ABHRs are standard and suitable for hand antisepsis and (b) contained potentially dangerous toxic alcohols. METHOD: Between February and March 2020, 64 brands of ABHR were conveniently collected from pharmacies, supermarkets, and shops selling hygienic products and analyzed using Gas Chromatography. World Health Organization and Food and Drug Administration guidelines were used to define minimum requirements for ABHR. For estimating the risk for acute methanol poisoning, we assumed a serum methanol concentration of 200 mg/L following ABHR ingestion was sufficient to cause intoxication. This threshold concentration would be achieved in an average 75-kg adult after consuming 8000 mg (or eight grams) methanol in 1-2 h. RESULTS: The median [IQR] (range) concentration of ethanol, isopropanol, and methanol were 59% v/v [32.2, 68] (0, 99), 0 mg/L [0, 0] (0, 197,961), and 0 mg/L [0, 0] (0, 680,100), respectively. There was a strong negative correlation between methanol and ethanol contents of hand rubbers (r= -0.617, p < 0.001). Almost 47% of ABHRs complied with minimum standards. In 12.5% of ABHRs, high concentrations of methanol were observed, which have no antiseptic properties but could cause acute methanol poisoning if ingested. CONCLUSION: COVID-19 initiated a policy for distribution and use of ABHR with little control. As ABHR and masks are still accepted preventive measures of the disease, non-standard ABHR compositions may increase the population's risk to both COVID-19 infection and methanol poisoning.

Evaluating new simplified assays for harm reduction from methanol poisoning using chromotropic acid kits: An analytical study on Indian and Iranian alcoholic beverages.

Background: Ingestion of methanol can result in severe irreversible morbidity, and death. Simple and easy methods to detect methanol and other hazardous additives prior to consumption can prevent fatalities. This form of harm reduction is analogous to the widely practiced "pill testing" of recreational drugs in various countries. We aimed to evaluate the performance of two qualitative and quantitative kits to simultaneously identify the presence of methanol and formaldehyde in alcoholic beverages, and compare this to the standard gas chromatographic (GC) method. Methods: Two-hundred samples of Indian and Iranian alcoholic drinks were examined by two new qualitative and quantitative chemical kits designed based on a modified chromotropic acid (CA) method, as well as a gold standard GC method. Results: Methanol levels were similar when evaluated by GC and quantitative method (Z = - 0.328, p = 0.743). The 75th percentile of methanol level detection was 4,290 mg L-1 (range; 0-83,132) using GC compared to that of 4,671 mg L-1 (range; 0-84,960) using the qualitative kit (predefined color intensity reflecting the methanol/ethanol ratio). The quantitative kit was able to detect all methanol-contaminated and non-contaminated samples (110 and 60 cases, respectively: 100% sensitivity). In 25 samples, GC analysis showed no methanol; but the qualitative kit detected possible toxic substances. Formaldehyde measurement by UV/Vis analysis showed the presence of formaldehyde in 23 samples (92%) with a median 912 [IQR 249, 2,109; range 112-2,742] mg L-1. Conclusion: Methanol and formaldehyde can be easily detected using these simple CA chemical kits. Qualitative positive results may indicate the risk of poisoning if the beverage is consumed. CA kits can be used in community setting by public health units and community organizations to monitor for methanol contamination and inform a public health response to reduce methanol-related harms to the public.

Evaluation of methanol content of illegal beverages using GC and an easier modified Chromotropic acid method; a cross sectional study.

BACKGROUND: Methanol is highly toxic to human beings and naturally exists in some beverages. Having access to an easy and cheap method for its determination is of great importance to increase the safety of use of these beverages. Our main aim is to evaluate methanol concentration of some alcoholic beverages in Iran black market and compare it with the European and US standards. Also, we evaluated the efficacy of a newly designed and produced chemical kit in determining the risk of methanol toxicity by drinking of such samples compared to gas chromatography method. METHODS: Methanol content of suspected alcoholic beverages referred to forensic toxicology laboratory, Guilan province, Iran was measured using gas chromatography and a recently designed kit based on modified colorimetric chromotropic acid method. RESULTS: Of 1221 samples, 145 (11.9%) had no ethanol content, while in three samples (0.25%), methanol was high enough (700,000; 870,000; 920,000 mg/L) to cause severe methanol toxicity. Median [IQR] ethanol content of the suspected samples was 9% [3.7, 32.75]. Methanol was detected in 128 (10.48%) samples using gas chromatography method and 160 samples (13.1%) with designed kit with 100% sensitivity, 97.07% specificity, and 100% negative-predictive-value. CONCLUSIONS: Alcoholic beverages produced in local black market in Iran are not safe at all. The application of the new method is practical, rapid, easy, and accurate to evaluate the risk of methanol toxicity in suspected alcoholic drinks.

Rapid Determination of Methanol In Herbaceous Distillates For Their Safety Evaluation by A New Modified Chromotropic Acid Method.

All sophisticated methods for direct determination of methanol require advanced instruments and high technical knowledge whose preparing them is very expensive in none developed and developing countries. This work reports a simple and efficient qualitative technique for semi determination of methanol content in herbal distillates by a new modified chromotropic acid method. The technique is based on the indirect detection of methanol after its oxidation and transforming to formaldehyde by chromotropic acid (formaldehyde specific color indicator). To measure methanol level in herbal distillates, a water diluted sample was mixed with 50 µL of sulfuric acid and potassium permanganate and after 5 min, followed by addition sodium bi-sulfite, chromotropic acid, and concentrated sulfuric acid in two separated steps and finally, eye comparing with four color standard tubes which gives a range of amount of methanol in the sample. The method has a good precision and accuracy and its Limit of Detection is 25 mgL-1. It is particularly suitable for semi quantitative measurement of methanol in herbal distillates not only in the production process quality control of workshops or small companies with no laboratory equipment and adequate financial properties but also the quality check of point of-sale samples from commercial markets. To the best of our knowledge, there isn't any report about such method.