Publications by authors named "Farzad Gheshlaghi"

41 Publications

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 06 13;12(1):9741. Epub 2022 Jun 13.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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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http://dx.doi.org/10.1038/s41598-022-14007-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9189800PMC
June 2022

Is high sensitive-troponin I a reliable biomarker for cardiac injury in methadone toxicity? A prospective cross-sectional study.

BMC Pharmacol Toxicol 2022 03 23;23(1):17. Epub 2022 Mar 23.

Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School Of Medicine, Isfahan University of Medical Sciences, Khoorshid Hospital, Ostandari Ave., Isfahan, Iran.

Background: Methadone is a synthetic opioid mostly used for detoxification therapy, as its use increases; the possibility for methadone-induced cardiotoxicity may rise. The aim of this study was to determine the association of high-sensitivity troponin I levels as a predictor of cardiac injury in methadone toxicity.

Methods: Sixty methadone toxicity patients included in this prospective cross-sectional study from October 2018-November 2020. High-sensitivity troponin I level and electrocardiogram were assessed in patients at admission. All patients underwent echocardiography at admission and 30 days later and compared this finding between two groups based on high-sensitivity troponin I results.

Results: Mean age of the patients was 34.5 ± 11.1 years (males: 67%). Twenty (20%) patients had positive high sensitive-troponin results. Long QT interval and inverted T in precordial leads were mostly observed in individuals with positive high-sensitivity troponin I (75% vs. 35%, P = 0.013 and 83% vs. 16%, P < 0.001, respectively). Patients with elevated troponin had reduced left ventricular ejection fraction in comparison to normal group during admission (43.1 ± 15.4% vs. 55%, P < 0.001) and this left ventricular ejection fraction remained abnormal after 30 days (43.7 ± 21.6%). Patients in positive high-sensitivity troponin I group had higher regional wall motion abnormality frequency both at admission and 30 days later compared to the other group (0 day: 42% vs. 0, P < 0.001, 30th days: 25% vs. 4%, P = 0.020).

Conclusion: Patients with simultaneous methadone toxicity and positive high-sensitivity troponin I had worse cardiac outcomes and this biomarker could be probably used for better implementation of therapeutic interventions and prognosis.
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http://dx.doi.org/10.1186/s40360-022-00558-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8940979PMC
March 2022

Prevalence of clinical and radiologic features in methanol-poisoned patients with and without COVID-19 infection.

Acute Med Surg 2021 Jan-Dec;8(1):e715. Epub 2021 Dec 6.

Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.

Aim: The aim of the current study was to evaluate the prevalence of coronavirus disease (COVID-19) in methanol-poisoned patients admitted to two toxicology academic centers during the COVID-19 outbreak and determine their clinical features and chest/brain computed tomography (CT) findings.

Methods: Methanol-poisoned patients who had been referred during the COVID-19 pandemic were evaluated for signs and symptoms of COVID-19 by chest CT scans and/or polymerase chain reaction test.

Results: A total of 62 patients with confirmed methanol poisoning were enrolled in the study, with a median (interquartile range) age of 35 (28-44) years. Thirty-nine (62.9%) survived. Nine (14.5%) were diagnosed to have COVID-19, of whom four survived. There was a significant correlation between COVID-19 disease and a history of alcohol consumption ( = 0.036; odds ratio 1.7; 95% confidence interval, 1.3-2.2). Univariate analysis showed significant differences between infected and noninfected patients regarding their urea and time for first and second hemodialysis sessions, as well as the duration of ethanol administration.

Conclusions: In conclusion, during the pandemic, specific attention should be paid to patients with a history of alcohol ingestion and elevated creatinine, loss of consciousness, and severe acidosis as these signs/symptoms could be present in both COVID-19 and methanol poisoning, making differentiation between the two challenging.
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http://dx.doi.org/10.1002/ams2.715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647202PMC
December 2021

A comparison of Australian and New Zealand versus UK hospital referral criteria for the management of supratherapeutic paracetamol ingestion.

Eur J Emerg Med 2021 12;28(6):486-488

Victorian Poisons Information Centre, Austin Toxicology and Emergency Department Austin Health, Heidelberg, and Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.

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http://dx.doi.org/10.1097/MEJ.0000000000000832DOI Listing
December 2021

COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

Alcohol Clin Exp Res 2021 09 6;45(9):1853-1863. Epub 2021 Sep 6.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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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http://dx.doi.org/10.1111/acer.14680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653331PMC
September 2021

Effectiveness of Plasmapheresis in Aluminum Phosphate Poisoning.

J Res Pharm Pract 2021 Jan-Mar;10(1):57. Epub 2021 May 13.

Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://dx.doi.org/10.4103/jrpp.JRPP_21_27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259597PMC
May 2021

Massive Citalopram Overdose Associated with Recurrent Seizures and Bilateral Shoulder Dislocations.

J Res Pharm Pract 2020 Jul-Sep;9(3):161-164. Epub 2020 Oct 8.

Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Selective serotonin reuptake inhibitors (SSRIs) are widely used in the treatment of many types of mental disorders. Citalopram is commonly used as a new generation of SSRIs in this regard; however, unfortunately, its overdose is associated with seizure and heart disorders. The reported case in the present study indicated recurrent seizures, nonspecific ST-T changes, and prolonged QT interval due to the overuse of citalopram. The patient had bilateral anterior shoulder dislocation along with right proximal humerus fracture that was occurred during the seizure. The dislocation was initially reduced and then fixed. Moreover, the seizure was controlled with diazepam without any problems, and cardiac monitoring continued for 2 days. Massive citalopram overdose may be associated with recurrent seizures and QT prolongation. Complications postseizures, such as shoulder dislocations, should be examined for and managed appropriately.
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http://dx.doi.org/10.4103/jrpp.JRPP_20_24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808186PMC
October 2020

Fatal metformin overdose presenting with refractory hypotension: Postmortem examination.

J Res Med Sci 2020 30;25:87. Epub 2020 Sep 30.

Faculty of Medical Sciences, Islamic Azad University, Najafabad Branch, Isfahan, Iran.

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http://dx.doi.org/10.4103/jrms.JRMS_196_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698376PMC
September 2020

Efficacy of fresh frozen plasma transfusion in comparison with conventional regimen in organophosphate poisoning treatment: a meta-analysis study.

Crit Rev Toxicol 2020 09 16;50(8):677-684. Epub 2020 Oct 16.

Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: To evaluating the efficacy of fresh frozen plasma (FFP) in comparison with conventional regimen in the treatment of organophosphate (OP) poisoning.

Methods: PubMed, ScopeMed, Cochrane, Scopus, and Google Scholar databases were searched. The search strategy used the following key words "organophosphate" and "poisoning or toxicity", "(atropine and oxime)", "fresh frozen plasma", "clinical trial", "outcome". The treatment with atropine or/and oxime was considered conventional therapy. The length of hospitalization, the length of ICU admission, need for mechanical ventilation and its duration, clinical recovery point, choline esterase level, mortality rate, and intermediate syndrome (IMS) occurrence were the key outcomes of interest. Databases were searched during the period of 2003-2019. Five studies were included in the analysis.

Results: Pooling of data showed that the relative risk (RR) of mortality in OP poisoning for five included trials comparing FFP-treated group with conventional regimen therapy was [0.563 (95% CI (0.252, 1.255)]. The summary of RR for IMS in two studies was [RR: 1.34, 95% CI (0.655, 2.742)]. In addition, there was a non-significant mean difference (MD) in hospital stay [MD: -0.106, 95% CI (-0.434, 0.223)] in three included trials. A significant MD was observed in the length of ICU admission in two trials between FFP-treated group compared to the conventional treatment group [MD: -2.672, 95% CI (-4.189, -1.154)], but after random effects meta-analysis, the changes were not significant [MD: -2.015, 95% CI (-6.308, 2.277)]. The summary of fixed-effect meta-analysis for choline esterase level in three trails was [MD: -0.117, 95% CI (-0.468, 0.234)]. The RR of ventilation requirement for two included trials in the FFP-treated group comparing to the conventional regimen therapy was [0.84, 95% CI (0.691, 1.022)] while for ventilation duration in two studies was [MD: -0.183, 95% CI (-0.567, 0.201)].

Conclusion: The addition of FFP to conventional therapy did not improve the outcomes of mortality, IMS, hospital length of stay, cholinesterase levels, need or duration of mechanical ventilation, and only the length of ICU stay could affect in the treated group.
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http://dx.doi.org/10.1080/10408444.2020.1823313DOI Listing
September 2020

Allergic Reaction to Intravenous Atropine in a Patient with Organophosphate Poisoning.

J Res Pharm Pract 2019 Jan-Mar;8(1):33-34

Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Atropine is a drug of choice for muscarinic effects in organophosphate (OP) poisoning. Allergic reaction to atropine is rare. Here, we report a case of a 17-year-old male who was admitted with clinical manifestations of acute OP poisoning. After intravenous atropine injection, cutaneous signs of hypersensitivity including erythema and urticarial were observed on his body. Atropine injection was stopped, and antihistamines and hydrocortisone were administered. His condition was improved, and he discharged with a good condition after 2 days hospitalization. Adverse allergic reaction to atropine should be in mind when managing OP poisoning cases.
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http://dx.doi.org/10.4103/jrpp.JRPP_18_83DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400035PMC
March 2019

Unstable Angina: A Rare Presentation of Minoxidil Intoxication: A Case Report and Literature Review.

J Res Pharm Pract 2018 Oct-Dec;7(4):210-212

Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Minoxidil is an antihypertensive direct vasodilator that can cause severe toxicity when sufficiently ingested. We report a case of accidental ingestion of 5 ml topical minoxidil solution 5% presented with chest pain and new-onset ST depressions. After giving IV saline and performing echocardiography/angiography, the patient fully recovered without any pharmacotherapy such as vasopressors and discharged 4 days after admission. The clinical toxicology, treatment, and previous case reports of minoxidil poisoning have been reviewed.
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http://dx.doi.org/10.4103/jrpp.JRPP_18_23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298144PMC
January 2019

A Newly Proposed Management Protocol for Acute Aluminum Phosphide Poisoning.

J Res Pharm Pract 2018 Jul-Sep;7(3):168-169

Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://dx.doi.org/10.4103/jrpp.JRPP_18_12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121759PMC
September 2018

A rare complication of nasogastric tube insertion.

J Res Med Sci 2018 26;23:66. Epub 2018 Jul 26.

Faculty of Medical Sciences, Islamic Azad University, Najafabad Branch, Isfahan, Iran.

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http://dx.doi.org/10.4103/jrms.JRMS_838_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091130PMC
July 2018

A New Treatment Approach for Acute Paraquat Poisoning.

J Res Pharm Pract 2018 Apr-Jun;7(2):115-116

Department of Clinical Toxicology, Noor University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://dx.doi.org/10.4103/jrpp.JRPP_18_13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036874PMC
July 2018

Effect of intravenous midazolam on cardiac parameters in acute tricyclic antidepressants poisoning.

ARYA Atheroscler 2016 Jul;12(4):195-200

Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Midazolam is commonly and safely used in poisoning management and intensive care for the control of agitated poisoned patients. Despite the introduction of newer and safer antidepressants, tricyclic antidepressants (TCAs) are still prescribed and used in many countries due to their cost-effectiveness. Severe morbidity and mortality associated with these drugs arises largely from their well-documented cardiovascular toxicity. In this study we aimed to investigate the probable effect of midazolam on some hemodynamic indices in TCAs-poisoned patients.

Methods: In this clinical trial, we have evaluated some cardiovascular and hemodynamic indices of 100 TCAs-poisoned patients whom were randomly allocated for receiving midazolam with a first loading dose of 0.1 mg/kg (2 mg/minute) followed by a 6-hour maintenance infusion of 0.1 mg/kg/h of the drug in dextrose-saline (3.33% of dextrose and 0.33% of NaCl) or placebo (dextrose-saline infusion without midazolam). Pulse rate, systolic/diastolic blood pressure, respiratory rate, neurologic status and the outcome of therapy for all patients were recorded at the time of admission and hourly for the next 6 hours.

Results: There was a statistically significant reduction in the heart rate of the midazolam treated group after the first hour of hospital admission. There were no significant differences in the respiratory rate, central nervous system manifestations and other indices between the two groups.

Conclusion: Midazolam may reduce tachycardia (and its fatal consequences) in the first hour of admission in TCAs-poisoned patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266137PMC
July 2016

Comment on "'Lipid Rescue' for Tricyclic Antidepressant Cardiotoxicity".

J Emerg Med 2017 01 29;52(1):103. Epub 2016 Sep 29.

Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran.

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http://dx.doi.org/10.1016/j.jemermed.2012.11.113DOI Listing
January 2017

N-acetylcysteine, Ascorbic Acid, and Methylene Blue for the Treatment of Aluminium Phosphide Poisoning: Still Beneficial?

Toxicol Int 2015 Jan-Apr;22(1):40-4

Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: Intentional and accidental intoxication with aluminium phosphide (ALP) remains a clinical problem, especially in the Middle East region. Considering the high mortality rate besides lack of any recommended first option drug for its treatment, this study was aimed to compare the therapeutic effects of N-acetylcysteine (NAC), vitamin C (Vit C), and methylene blue; both in isolate and also in combination, for the treatment of ALP intoxication in a rat model.

Materials And Methods: In this experimental animal study, 80 male Wistar rats in eight groups were intoxicated with ALP (12.5 mg/kg) and treated with a single dose of NAC (100 mg/kg) or Vit C (500-1,000 mg/kg) or methylene blue (1 mg/kg/5 min, 0.1%) or two of these agents or all three of them (controls were not treated). Rats were monitored regarding the parameters of drug efficacy as increased survival time and reduced morbidity and mortality rate for 3 consecutive days to ensure toxin neutralization. Macroscopic changes were recorded and biopsy sections were taken from brain, cerebellum, kidney, liver, and heart for microscopic evaluation regarding cellular hypoxia.

Results: The mean survival times of rats exposed to ALP and treated with VitC + NAC was 210.55±236.22 minutes. In analysis of survival times, there was a significant difference between Group 5 which received VitC + NAC and the other groups (P < 0.01). Serum magnesium levels after death were higher than normal (P = 0.01).

Conclusions: Despite the higher survival rate of antioxidant-treated rats compared with controls, this difference was not statistically significant.
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http://dx.doi.org/10.4103/0971-6580.172255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721175PMC
February 2016

Cardiovascular manifestations of anabolic steroids in association with demographic variables in body building athletes.

J Res Med Sci 2015 Feb;20(2):165-8

Pharmaceutical Students Research Committee, School of Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The most common drug abuse among athletes is anabolic steroids which lead to the development of cardiovascular diseases and sudden death. Thus, the aim of this study was to evaluate cardiovascular outcomes of anabolic consumption in body building athletes.

Materials And Methods: Totally, 267 male athletes at the range of 20-45 years old with the regular consumption of anabolic steroids for >2 months with at least once weekly. High-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and hematocrit (Hct) levels were measured after 10 h of fasting. Data analysis was performed using K2, t-test, ANOVA and correlation coefficient through SPSS 17.

Results: There was a nonsignificant difference between groups regarding HDL, TG, and total cholesterol. There was a significant decrease in the total and categorized LDL and Hct levels in consumers of anabolic steroid versus nonusers (P = 0.01 and P = 0.041, respectively). Results showed a significant increase in systolic and diastolic blood pressure (SBP and DBP) in anabolic steroid users which associates with duration of abuse (P = 0.02 and P = 0.03, respectively). No significant electrocardiography changes were found within the follow-up period.

Conclusion: Increase in SBP or DBP is a common complication of these drugs which can lead serious vascular disorders. The lower LDL cholesterol level might be due to the higher amounts of lipid consumption in these athletes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400712PMC
February 2015

The frequency of agitation due to inappropriate use of naltrexone in addicts.

Adv Biomed Res 2014 6;3:249. Epub 2014 Dec 6.

Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: There is a high tendency among specialists to treat the addicts with naltrexone; withdrawal symptoms are frequent after taking naltrexone along with opioids. This study investigated the frequency of agitation due to inappropriate use of naltrexone in addicts.

Materials And Methods: This was a cross-sectional study, conducted in Noor and Aliasghar hospitals in Isfahan city. The study population included the addicts who were agitated as a result of naltrexone abuse. Scores of patients with agitation were measured with Richmond Agitation Sedation Scale (RASS). Patient outcomes including recovery without complications, recovery with complications (rhabdomyolysis), and mortality were recorded.

Results: All the patients with agitation caused by naltrexone abuse during 1 year were 40 people, of whom nine were excluded due to their comorbid diseases (diabetes or cardiovascular disease). Among the remaining 31 patients, 30 were male. The patients' mean age was 29.93 (5.24) years. The most common symptoms observed besides agitation was midriasis (41.9%), and vomiting (41.9%), A 38.8% of the patients scored 3 or 4, and, 61.2% scored 1 or 2 for agitation. The mean time for patients' restlessness scores to reach zero was 9.30 (3.71) h (min: 3 h, max: 18 h). All the patients in both groups were discharged with recovery without complication.

Conclusion: Considering the high prevalence of agitation in the poisoning emergency department due to inappropriate use of naltrexone, more accurate planning for administration of naltrexone in addicts seems necessary.
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http://dx.doi.org/10.4103/2277-9175.146373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283245PMC
January 2015

The study of sexual satisfaction in Iranian women applying for divorce.

Int J Fertil Steril 2014 Oct 1;8(3):281-8. Epub 2014 Nov 1.

Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Marital instability is affected by many factors. In Iran, socio-cultural and political limitations are obstacles for sexuality-related studies; therefore, insufficient in- formation is available in this area. In the present research, we investigated the relation- ship between marital instability and sexual satisfaction among Iranian women.

Materials And Methods: A case-control study was carried out to investigate women ap- plying for divorce in comparison with our controls during 2011 to 2012 in Isfahan, Iran. Data gathering was done using a questionnaire including two parts: socio-demographic information and factors influencing sexual satisfaction. Larson Inventory of Sexual Sat- isfaction for determining sexual satisfaction was used to determine sexual satisfaction.

Results: Divorce rate is significantly related to sexual satisfaction (p=0.009). There were also significant relationships between sexual satisfaction and the following variables: age, economic status, amount of income, duration of marriage, number of children, hous- ing, alcohol/drug abuse by spouse, being beaten by spouse, compulsory marriage, second marriage of spouse, and being happy with current partner.

Conclusion: Sexual satisfaction plays an important role in marital stability of Iranian women. Thus, development of practical strategies in order to provide cultural intervention is needed to improve Iranian couples' awareness of their sexual relationship. Indeed, train- ings in communication skills through sexual encounters are essential.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221515PMC
October 2014

The study of sexual satisfaction in Iranian women applying for divorce.

Int J Fertil Steril 2014 Oct 1;8(3):281-8. Epub 2014 Nov 1.

Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Marital instability is affected by many factors. In Iran, socio-cultural and political limitations are obstacles for sexuality-related studies; therefore, insufficient in- formation is available in this area. In the present research, we investigated the relation- ship between marital instability and sexual satisfaction among Iranian women.

Materials And Methods: A case-control study was carried out to investigate women ap- plying for divorce in comparison with our controls during 2011 to 2012 in Isfahan, Iran. Data gathering was done using a questionnaire including two parts: socio-demographic information and factors influencing sexual satisfaction. Larson Inventory of Sexual Sat- isfaction for determining sexual satisfaction was used to determine sexual satisfaction.

Results: Divorce rate is significantly related to sexual satisfaction (p=0.009). There were also significant relationships between sexual satisfaction and the following variables: age, economic status, amount of income, duration of marriage, number of children, hous- ing, alcohol/drug abuse by spouse, being beaten by spouse, compulsory marriage, second marriage of spouse, and being happy with current partner.

Conclusion: Sexual satisfaction plays an important role in marital stability of Iranian women. Thus, development of practical strategies in order to provide cultural intervention is needed to improve Iranian couples' awareness of their sexual relationship. Indeed, train- ings in communication skills through sexual encounters are essential.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221515PMC
October 2014

ST-T segment changes in patients with tricyclic antidepressant poisoning.

J Res Pharm Pract 2013 Jul;2(3):110-3

Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: Tricyclic antidepressant (TCA) poisoning is among highly prevalent and potentially dangerous toxicities. ST-T changes are observed in the electrocardiogram (ECG) of most of TCA poisoned patients. We aimed to study ST-T segment changes in TCA toxicity and its probable relationship with other ECG findings.

Methods: This retrospective study was carried out in Noor and Ali Asghar University Hospital, Isfahan (Iran) in 2012. Patients with TCA toxicity based on the patients' history who had not consumed any cardio-active drugs and did not have a past medical history of cardiovascular disease in the recent 5 years, were randomly selected and investigated. Their demographic and medical data on admission including ECG, age, sex, type and amount of ingested TCA, poisoning severity score, QRS changes, QT interval, heart axis position and R-wave were all recorded. ST-T changes and their relation with other ECG parameters have been determined using statistical analysis.

Findings: Medical records of 272 patients were analyzed. In symptomatic patients, ST change prevalence was 40.8% and T change prevalence was 9.5%. In asymptomatic patients, the frequency of ST and T changes were 4.8% and 0.8%, respectively (P < 0.05). The most common ST and T changes in baseline (on admission) ECG were non-significant elevation (15.4%), significant elevation (11%) in pre-cordial leads, and T-wave flattening (6.6%). A statistically significant correlation was documented between ST segment changes with QRS and R-wave in aVR. The correlation between T-wave changes and R-wave in aVR lead was also significant.

Conclusion: ST-T changes in TCA poisoned patients are more prevalent in symptomatic patients. Obviously for a more definite conclusion, it is necessary to design a prospective study with the control group. This may facilitate a better understanding of ST-T segment changes.
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http://dx.doi.org/10.4103/2279-042X.122381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076916PMC
July 2013

Role of Benzodiazepines in the management of agitation due to inappropriate use of naltrexone.

Iran J Nurs Midwifery Res 2012 Jul;17(5):365-9

Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Agitation is an early symptom of the acute opioid withdrawal syndrome in addicts that may start by inappropriate use of naltrexone. The current drug interventions are not efficient or need critical care as well. This study compares the clinical role of midazolam and diazepam for the management of agitation due to inappropriate use of naltrexone.

Materials And Methods: In this double-blind randomized controlled clinical trial, 44 agitated addicts, who did not use any type of benzodiazepine, not on systematic central nervous system depressant drugs, without any known hypersensitivity to diazepam, midazolam, or any other component of their formulation and had no evidence for the need of critical care, were enrolled. An i.v. stat dose of 0.1 mg/kg diazepam and 0.1 mg/kg stat dose of midazolam and a 0.1 mg/kg/h infusion of these drugs were administered for different groups of patients, respectively. Agitation scores were recorded at 30, 60, 120 min after the start of drug administration using Richmond Agitation Sedation Scale score.

Results: A significant difference between the mean onset of agitation control in midazolam group (at 67 min) and diazepam group (at 81 min) was recorded. The difference of mean agitation score in the midazolam and diazepam group was only significant at 120 min. There was a negative correlation between agitation score and time elapsed from naltrexone administration to admission.

Conclusion: Midazolam and diazepam may not be considered suitable and perfect pharmacologic agents for the initial controlling of agitation induced by naltrexone.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703077PMC
July 2012

Acute poisoning in children; a population study in isfahan, iran, 2008-2010.

Iran J Pediatr 2013 Apr;23(2):189-93

Department of Clinical Toxicology and Forensic Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: Acute accidental poisoning in children is still an important public health problem. The epidemiological investigation specific for each country is necessary to determine the extent and characteristics of the problem. The aim of our study was to elucidate the current pattern of acute poisoning among children.

Methods: The present retrospective study describes the epidemiology of acute accidental poisoning in children (less than 10 years old) admitted to the Emergency Department of two teaching hospitals during a period of two years.

Findings: Three hundred and forty four children under 10 years old were admitted to emergency department of two teaching hospitals due to acute accidental poisoning. Drugs were the most common agents causing the poisoning (58.1%), followed by Hydrocarbons (13.1%), and opioids (9.3%). Common signs were neurological (42.6%) with lethargy being the most common (39.1%). 50.6% of cases were discharged from hospital within 6-12 hours, 91.6% of them without any complication.

Conclusion: Accidental poisonings are still a significant cause of morbidity among children in developing countries. Regarding the high prevalence of pharmaceutical drug poisoning and because lethargic was the most frequent neurological sign, comprehensive toxicology screen tests should be included as part of the routine evaluation of children presenting to an ED with an apparent life-threatening event.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663311PMC
April 2013

Evaluation of serum sodium changes in tricyclic antidepressants toxicity and its correlation with electrocardiography, serum pH, and toxicity severity.

Adv Biomed Res 2012 31;1:68. Epub 2012 Oct 31.

Associate Professor, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Tricyclic antidepressants (TCAs) is a group of drugs used for the depression treatment. One of the effects of these drugs is Na (sodium) channel blocking ability causing cardiac complications such as ventricular tachycardia and Torsades de pointes Arrhythmia. Sodium bicarbonate is used for treatment of these complications which may have some effect on serum sodium levels. Considering no specific research on Na changes on these patients, the serum Na changes and its correlation with ECG changes, serum pH, and TCA toxicity severity were evaluated.

Materials And Methods: A prospective descriptive-analytic cross-sectional study was done on TCA-poisoning patients who were admitted in Noor hospital in Esfahan in last 2 years. Serum sodium levels, ECG changes, and TCA severity toxicity of 92 patients were evaluated five times during first 24 h of admission.

Results: A total of 92 patients were studied. The most common symptoms were conscious level changes (81.52%) and mydriasis (64.1%). Based on toxicity severity by these symptoms the patients were classified into three groups: 12% of the patients had mild toxicity, 50% moderate, and 38% severe toxicity. There were no significant differences in mean serum Na during the time. There was not found any correlation between serum Na level, and serum pH, ECG, and toxicity severity.

Conclusions: Using sodium bicarbonate in TCA-poisoning cases does not change the serum Na levels significantly.
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http://dx.doi.org/10.4103/2277-9175.102972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544084PMC
January 2013

Comment on Iranian crystal a misunderstanding of the crystal-meth.

J Res Med Sci 2012 Feb;17(2):205

Department of Clinical Toxicology and Forensic Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. ; Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525045PMC
February 2012

Admission creatine phosphokinase in acute poisoning: is it a predictive factor for the treatment outcome?

J Pak Med Assoc 2012 Mar;62(3 Suppl 2):S67-70

Department of Clinical Toxicology and Forensic Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Poisoning has reported to be a major cause of death and burden of disease in low- and middle-Income countries. Rhabdomyolysis is a common consequence of many poisoning cases and serum creatine phosphokinase (CPK) is a marker for it. The aim of the study was to assess whether the admission creatine phosphokinase in comatose patients with acute poisoning is a predictive factor for the treatment outcome.

Methods: In this prospective observational study, eighty poisoned comatose patients who were admitted with a serum CPK > 250 IU/L (not due to muscular trauma in accidents, myocardial ischemia and infarction, infections, hyperthermia, electrolytic disorders and diabetic ketoacidosis) were included. The severity of poisoning was assessed using Poisoning Severity Score. The admission CPK level; and outcome (survived with and without complication and death) for all patients were recorded. Patients were divided based on CPK levels into three categorizes: Low, medium and high.

Results: Seventy five percent of the patients in high CPK level group, 29.5% in medium CPK level group and 35% in low CPK level group developed complications or death. Binary logistic regression results indicated that the chance of complications is much higher for patients with high admission CPK levels (more than 10000 IU/L) [OR, 5.57; 95% CI (1.29-23.93)] than whom with low levels.

Conclusion: We concluded that the admission serum CPK level for a poisoned patient, seems to be an acceptable predictor for the outcome in poisoned patients. Further studies are still needed.
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March 2012

Comment on "Hyperacute rejection from a donor who died of carbamate intoxication-a case report".

Am J Emerg Med 2012 Jul 23;30(6):1008-9; author reply 1009-10. Epub 2012 May 23.

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http://dx.doi.org/10.1016/j.ajem.2012.03.039DOI Listing
July 2012
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