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

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

Comparative efficacy of silibinin and nano-silibinin on lead poisoning in Male Wistar rats.

Lead (Pb) is an environmental neurotoxin that can lead to toxicity. It has shown that tissues can be exposed to oxidative stress in lead poisoning. Since silymarin is a natural agent with antioxidant effects, this study aimed to investigate the antioxidant and chelation effects of silibinin and nano-silibinin on the oxidative stress status in lead-poisoned rats. Sixty male Wistar rats randomly divided into ten groups (n = 6). Control and Pb groups treated with or without silibinin and nano-silibinin for six days. Following measuring of weight and blood lead levels, biochemical antioxidant parameters evaluated. Finally, a histopathological examination of the liver performed. In this experiment, silibinin and more efficiently nano-silibinin prevented weight loss and blood lead level elevation induced by lead. Also, they increased the attenuated levels of superoxide dismutase (SOD) activity, catalase (CAT), total thiol molecules (TTM), glutathione (GSH), and total antioxidant capacity (TAC). Lead-induced elevation of lipid peroxidation products (MDA) and nitric oxide (NO) normalized to the standard level in silibinin and especially nano-silibinin groups. These data suggested that silibinin and especially nano-silibinin can decrease blood lead levels and prevent weight loss and oxidative stress in the lead-poisoned rat's model.

Investigating the Effect of Fresh Frozen Plasma and Albumin on DNA Damage and Oxidative Stress Biomarkers in Poisoning Cases by Organophosphates.

The efficacy of albumin and fresh frozen plasma (FFP) and their effects on biomarkers of oxidative stress has been evaluated. In a randomized clinical control trial, 33 poisoned patients by Organophosphate (OP) were enrolled in the research and divided into three groups. The first group underwent conventional treatments by atropine and pralidoxime (control group); the second and third groups, in addition to traditional treatments, received albumin and FFP. Cholinesterase (ChE) enzyme activity, total antioxidant capacity (TAC), serum thiol groups (TTG), malonyl aldehyde (MDA) and DNA damage were measured in all treatment and control groups. Patients were matched in terms of demographic characteristics at the beginning of the study. ChE activity was increased in all three groups during treatment, which was more noticeable in the FFP group and was statistically significant in both albumin and FFP group compared to the control group (p<0.05). TAC increased, and TTG decreased in FFP and albumin groups compared to the control group; no significant difference was observed. MDA decreased in albumin and FFP and was significantly different in the FFP group compared to the control group (p<0.05). The amount of DNA damage in FFP and albumin groups decreased, and there was a significant difference compared to the control group (p<0.05). According to the results of this study, due to the decrease of oxidative damage parameters and the increase of antioxidant parameters in albumin and specially FFP groups, FFP may be considered as an adjunctive treatment for OP poisoning.

Butyrylcholinesterase level in poisoned patients with phosphide compounds.

BACKGROUND: Metal phosphides are widely used as a rodenticide and insecticide and poisoning with these substances has a very high mortality. The aim of this study was to evaluate the butyrylcholinesterase (BuCh) level in poisoning with metal phosphides. METHODS: In this case series study, 60 poisoned patients with zinc phosphide (ZnP) and aluminum phosphide (ALP) who was admitted to poisoning ward in Hamadan, Iran, enrolled in the study and BuCh level was measured. The sex, age, amount of ingestion, time of consumption, signs and symptoms, ECG and arterial blood gas (ABG) changes and clinical outcomes were evaluated. RESULTS: Most (58.3%) patients were males, the mean age was 32.76±17.65 years. The average amount of ingestion was 7.5±4.6 and 2.5±2.96 gr for ZnP and ALP, respectively. Most signs and symptoms were hypotension (97%), nausea and vomiting (82%) and abdominal pain (32%). The average amount of BuCh level in all patients was 5163.25±2158.31 U/L, that's while in ZnP and ALP poisoned patients was 5608±1577 U/L and 4721.46±2562U/L respectively. The most dysrhythmia (26.7%) was sinus tachycardia. Acidosis was seen in 33.3% of patients. 14 patients died after hospital admission, which caused a 23.3% fatality rate. CONCLUSION: Our results showed that, there was no significant change in BuCh level in poisoned patients with phosphide compounds.

Frequency of alcohol and substance abuse observed in drivers killed in traffic accidents in Hamadan, Iran.

Human factor is one of the most important causes for traffic accidents. This study has been designed to determine the presence of alcohol and drug abuse among drivers killed in car accidents in Hamadan, Iran during a one year period. This study was conducted as a post-mortem series design. Forensic autopsies were performed on all drivers killed in car accidents who were referred to the Hamadan Medico-legal Center. Alcohol and drug abuse was evaluated in these drivers. Of the 106 drivers killed in car accidents, 98.1% were male. Most were 20-30 years of age. In the majority of cases (83%) the toxicologic tests were negative. Higher level of education (diploma and higher) was related to higher alcohol or drug abuse compared with those whose educational status was less than a diploma (46.7%) or those who were illiterate (16.5%; Chi-square: 7.13; P = 0.008). There was a remarkable difference between drug or alcohol abuse and season. The majority of substance abusers were in the summer (n = 13, 59.1%); the least were in the spring (n = 2; 9.1%). This study shows that alcohol and drug abuse, in particular opiates, could be important factors in traffic accidents in Hamadan, Iran.

Effect of terazosin on sweating in patients with major depressive disorder receiving sertraline: a randomized controlled trial.

OBJECTIVE: By considering the role of adrenergic nervous system in sweat secretion, we postulated that terazosin may be able to improve sweating after taking sertraline, a selective serotonin reuptake inhibitor (SSRI) drug. This study was designed to evaluate the effect of terazosin on sertraline -related sweating. METHODS: All patients diagnosed with major depressive disorder based on the DSM-IV criteria who were taking sertraline and suffered from excessive sweating were enrolled in the study and randomly allocated into two groups of receiving terazosin (1 mg) or placebo. Sweating severity was classified using Hyperhidrosis Disease Severity Scale. The patients were evaluated regarding the severity of sweating before beginning of the study and 14 days after taking either terazosin or placebo. RESULTS: Baseline characteristics including age, sex proportion and weight were not significantly different between the two groups (P > 0.05). At the beginning of the study, 33 (48.5%) and 31 (47%) patients in the terazosin and placebo groups, respectively, suffered from the highest grade of sweating. Fourteen days after treatment with terazosin severity of sweating reduced to the lowest grade in 46 (68%) and two (6%) cases in the terazosin and placebo groups, respectively (P < 0.001). CONCLUSIONS: Our findings revealed that terazosin may be effective in decreasing sweating severity in patients using sertraline.

Characteristics of hospitalized patients following suicide attempt in hamadan district, iran.

OBJECTIVES: Limited research has been undertaken on suicide in developing countries. This paper aims to investigate characteristics of suicide attempts in Hamadan district of Iran. METHODS: A prospective study was conducted in all university hospitals in the Hamadan district of Iran and patients admitted for attempted suicides were included. All cases were assessed by psychiatrists and visited by two trained interns of Medicine. RESULTS: The incidence rate per 100,000 persons of attempted suicides was 228.6 for males and 263.1 for females; moreover, 344.9 for rural areas and 222.7 for urban areas. The suicide attempt was the highest in the 15 to 24 age category for both sexes and regions. CONCLUSIONS: Suicide is a complex, long-term outcome that requires multifaceted theoretical constructs for the appropriate study of its antecedents. Findings of this study along with other studies in Iran revealed that unemployed men, housewives, and rural women, high-school students, and those with a low level of education were at higher risk of suicidal behaviors.

The therapeutic effect of Avonex, Rebif and Betaferon on EDSS and relapse in multiple sclerosis: a comparative study.

We aimed to compare the therapeutic effect of Avonex (Av), Betaferon (Be) & Rebif (Re) on the Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS). Ninety patients referring to Farshchian Hospital were entered in this study. The patients were divided into three equal groups: group 1 received Av, group 2 received Re and group 3 received Be, and after 24 months, comparison was done by calculating primary and final EDSS and the relapse rate. For comparison of the primary and final EDSS in each group, the relapse rate between the groups and side effects between the drugs, the paired samples t.test, the One-Way ANOVA test and the Pearson- chi-square were used. Average age was 31.11 +/- 8.62 years, 80% being female. Comparison of the average primary and final EDSS using the paired samples t.test showed a significant statistical difference (P < 0.05). Motor and visual disturbances (respectively 68.3% and 60.3%) were the most common signs and relapsing- remitting form was the most common form (42.1%). The average EDSS change of groups Av, Be and Re was respectively, 1.28 (29.76%), 1.30 (24.30%) and 1.26 (26.63%), showing no significant statistical difference in reducing EDSS. Groups Av and Be, showed no significant statistical difference in the average relapse rate before and after treatment, but in group Re there was a significant difference (P < 0.05). Treatment with these drugs reduces motor disability, with no significant difference between them. Also in comparison, Re has a greater effect in reducing the relapse rate, but again with no significant statistical difference among them.

Reflex anuria affecting both kidneys following hysterectomy.

In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA) and acute renal failure (ARF). Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruction. She was managed with hemodialysis, control of hypertension and correction of fluid and electrolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum creatinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.

The effectiveness of combined treatment with methylprednisolone and cyclophosphamide in oral paraquat poisoning.

BACKGROUND: Paraquat is a bipyridil herbicide and in appropriate and careful usage, will not be health threatening. Most adult cases of intoxication are due to suicidal attempts rather than accidental exposure. Therapeutic response has been reported to be appropriate with high doses of cyclophosphamide and glucocorticoids and survival is reported to be approximately 75%. So, this study was designed to evaluate the effects of combined treatment with cyclophosphamide and glucocorticoids in patients with paraquat poisoning. METHODS: During a two-year period 45 patients with paraquat poisoning were admitted to Sina Hospital, Hamadan, Iran, of whom 20 had moderate to severe intoxication. Eleven patients (group 1) received conventional treatment and nine patients (group 2) received conventional treatment plus intravenous infusions of cyclophosphamide 15 mg/kg daily for two days, methylprednisolone one gram daily for three days, and mesna 15 mg/kg for four days. RESULTS: The mean age+/-SD in group 1 was 25+/-10 years and in group 2 was 26+/-10 years. In group 1 three patients were females and eight patients were males. In group 2 one patient was female and eight patients were males. There were no differences between the groups in the time elapsed from ingestion to presentation at hospital or in the beginning of hemodialysis. The mortality rate in group 1 was 81.8% and in group 2 was 33.3% (P< 0.05). All fatalities caused by acute respiratory distress syndrome. CONCLUSION: Pulse therapy with cyclophosphamide and methylprednisolone may be effective in preventing respiratory failure and reducing mortality in patients with moderate to severe paraquat poisoning.