Publications by authors named "Nasim Zamani"

161 Publications

Developing a novel prediction model in opioid overdose using machine learning; a pilot analytical study.

Health Sci Rep 2022 Sep 8;5(5):e767. Epub 2022 Aug 8.

Brain Mapping Research Center, Department of Neurology Shahid Beheshti University of Medical Sciences Tehran Iran.

Background And Aims: The opioid epidemic has extended to many countries. Data regarding the accuracy of conventional prediction models including the Simplified Acute Physiologic Score (SAPS) II and acute physiology and chronic health evaluation (APACHE) II are scarce in opioid overdose cases. We evaluate the efficacy of adding quantitative electroencephalogram (qEEG) data to clinical and paraclinical data in the prediction of opioid overdose mortality using machine learning.

Methods: In a prospective study, we collected clinical/paraclinical, and qEEG data of 32 opioid-poisoned patients. After preprocessing and Fast Fourier Transform analysis, absolute power was computed. Also, SAPS II was calculated. Eventually, data analysis was performed using SAPS II as a benchmark at three levels to predict the patient's course in comparison with SAPS II. First, the qEEG data set was used alone, secondly, the combination of the clinical/paraclinical, SAPS II, qEEG datasets, and the SAPS II-based model was included in the pool of classifier models.

Results: Seven out of 32 (22%) died. SAPS II (cut-off of 50.5) had a sensitivity/specificity/positive/negative predictive values of 85.7%, 84.0%, 60.0%, and 95.5% in predicting mortality, respectively. Adding majority voting on random forest with qEEG and clinical data, improved the model sensitivity, specificity, and positive and negative predictive values to 71.4%, 96%, 83.3%, and 92.3% (not significant). The model fusion level has 40% less prediction error.

Conclusion: Considering the higher specificity and negative predictive value in our proposed model, it could predict survival much better than mortality. The model would constitute an indicator for better care of opioid poisoned patients in low resources settings, where intensive care unit beds are limited.
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http://dx.doi.org/10.1002/hsr2.767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9358662PMC
September 2022

Strategies for the treatment of acute benzodiazepine toxicity in a clinical setting: the role of antidotes.

Expert Opin Drug Metab Toxicol 2022 Jun 1;18(6):367-379. Epub 2022 Aug 1.

Department of Biology, Tehran North Branch, Islamic Azad University, Tehran, Iran.

Introduction: Although not a potentially life-threatening poisoning, benzodiazepine (BZD) intoxication may be life-threatening in special situations/populations or those with background diseases.

Areas Covered: The aim of this review is to evaluate all possible treatment options available in the literature for the management of benzodiazepine poisoning with special attention to antidote administration. We conducted a literature search using PubMed, Google Scholar, EMBASE, and Cochrane central register from 1 January 1980 to 10 November 2021 using keywords 'benzodiazepine,' 'poisoning,' 'toxicity,' 'intoxication,' and 'treatment.'

Expert Opinion: Careful patient selection, ideally by a clinical toxicologist, may decrease the complications of flumazenil and add to its efficacy. The cost-to-benefit ratio should be considered in every single patient who is a candidate for flumazenil administration. In case a decision has been made to administer flumazenil, careful consideration of the possible contraindications is essential. We recommend slow administration of low doses of flumazenil (0.1 mg/minute) to avoid complications or withhold the administration with development of first signs of adverse effects. The main treatment of benzodiazepine toxicity is conservative with administration of activated charcoal, monitoring of the vital signs, prevention of aspiration and development of deep vein thrombosis due to prolonged immobilization, and respiratory support.
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http://dx.doi.org/10.1080/17425255.2022.2105692DOI Listing
June 2022

Chronic exposure to methadone impairs memory, induces microgliosis, astrogliosis and neuroinflammation in the hippocampus of adult male rats.

J Chem Neuroanat 2022 Jul 21;125:102139. Epub 2022 Jul 21.

Hearing Disorders Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, the Islamic Republic of Iran; Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, the Islamic Republic of Iran. Electronic address:

Methadone is a centrally-acting synthetic opioid analgesic widely used in methadone maintenance therapy (MMT) programs throughout the world. Given its neurotoxic effects, particularly on the hippocampus, this study aims to address the behavioral and histological alterations in the hippocampus associated with methadone administration. To do so, twenty-four adult male albino rats were randomized into two groups, methadone treatment and control. Methadone was administered subcutaneously (2.5-10 mg/kg) once a day for two consecutive weeks. A comparison was drawn with behavioral and structural changes recorded in the control group. The results showed that methadone administration interrupted spatial learning and memory function. Accordingly, treating rats with methadone not only induced cell death but also prompted the actuation of microgliosis, astrogliosis, and apoptotic biomarkers. Furthermore, the results demonstrated that treating rats with methadone decreased the complexity of astrocyte processes and the complexity of microglia processes. These findings suggest that methadone altered the special distribution of neurons. Also, a substantial increase was observed in the expression of TNF-α due to methadone. According to the findings, methadone administration exerts a neurodegenerative effect on the hippocampus via dysregulation of microgliosis, astrogliosis, apoptosis, and neuro-inflammation.
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http://dx.doi.org/10.1016/j.jchemneu.2022.102139DOI Listing
July 2022

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

Sci Rep 2022 Jun 22;12(1):10574. Epub 2022 Jun 22.

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

The COVID-19 outbreak affected mental health globally. One of the major concerns following the COVID-19 pandemic was increased incidence of risky behaviors including alcohol consumption. This study evaluates the trend of alcohol poisoning in Loghman-Hakim Hospital (LHH), the main referral center of poisoning in Tehran, during the 2-year period from 1 year prior to 1 year after the onset (February 23rd, 2020) of the COVID-19 epidemic in Iran. All patients admitted with alcohol intoxication from February 23rd, 2019 to February 22nd, 2021 were evaluated and patient data extracted from LHH electronic hospital records. Alcohols were categorized as toxic (methyl alcohol) and non-toxic (ethyl alcohol). Of 2483 patients admitted, 796/14,493 (5.49%) and 1687/13,883 (12.15%) had been hospitalized before and after the onset of the COVID-19 epidemic in Iran, respectively. In total, 140 patients did not survive, of whom 131 (93.6%) were confirmed to have methanol intoxication. Mortality was significantly higher during the outbreak (127 vs 13; P < 0.001; OR: 4.90; CI 95%: 2.75 to 8.73). Among the patients, 503 were younger than age 20. Trend of alcohol intoxication showed increases in children (57 vs 17) and adolescents (246 vs 183) when compared before and after the COVID-19 epidemic outbreak. A total of 955 patients were diagnosed with methanol toxicity which occurred more frequently during the COVID-19 era (877 vs 78; P < 0.001; OR: 10.00; CI 95%: 7.75 to12.82). Interrupted time series analysis (April 2016-February 2021) showed that in the first month of the COVID-19 epidemic (March 2020), there was a significant increase in the alcohol intoxication rate by 13.76% (P < 0.02, CI = [2.42-24.91]). The trend of alcohol intoxication as well as resulting mortality increased in all age groups during the COVID-19 epidemic in Iran, indicating urgent need for the prevention of high-risk alcohol use as well as improved treatment.
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http://dx.doi.org/10.1038/s41598-022-14799-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9216300PMC
June 2022

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

Clinical, Laboratory, and Electrocardiographic Findings in Colchicine Toxicity: 10 Years of Experience.

Front Med (Lausanne) 2022 19;9:872528. Epub 2022 May 19.

Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: We aimed to investigate the clinical, laboratory, and electrocardiographic (ECG) findings of colchicine poisoning and to evaluate if there is a correlation between them and the two major outcomes of this toxicity which are respiratory/cardiovascular failure and death.

Materials And Methods: Medical records of 34 colchicine-intoxicated patients that were treated in our center during the past 10 years were retrospectively evaluated. The patient's clinical presentation, vital signs, laboratory tests, ECGs, and outcomes were reviewed.

Results: Abdominal pain, and hypotension at presentation had significant correlation with mortality ( = 0.003, OR: 2.2 [4.1, 7.9], = 0.029, OR: 13.0 [1.5, 111.8]). Mortality significantly occurred in those with sinus tachycardia, hypokalemia, metabolic acidosis, and impaired liver and kidney function tests (-values = 0.025, 0.007, 0.04, and 0.008, respectively). All the patients had some ECG abnormalities. Most frequent ECG abnormalities were pathologic ST segment elevation and depression (70%), left atrial enlargement (48%), and sinus tachycardia (37%), PR elevation in aVR lead (37%), and T wave inversion (37%).

Conclusions: Colchicine toxicity is a dangerous entity regarding the cardiovascular events and requires close general and cardiac monitoring.
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http://dx.doi.org/10.3389/fmed.2022.872528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160711PMC
May 2022

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

BMC Endocr Disord 2022 Jun 2;22(1):148. Epub 2022 Jun 2.

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

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

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

Conclusions: Diabetic ketoacidosis and methanol poisoning can happen simultaneously in a diabetic patient. Given the analogous high anion gap metabolic acidosis, physicians should pay particular attention to examination of the diabetic patients. Meticulous evaluation for both conditions is highly recommended.
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http://dx.doi.org/10.1186/s12902-022-01037-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164356PMC
June 2022

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

BMC Endocr Disord 2022 Jun 2;22(1):148. Epub 2022 Jun 2.

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

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

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

Conclusions: Diabetic ketoacidosis and methanol poisoning can happen simultaneously in a diabetic patient. Given the analogous high anion gap metabolic acidosis, physicians should pay particular attention to examination of the diabetic patients. Meticulous evaluation for both conditions is highly recommended.
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http://dx.doi.org/10.1186/s12902-022-01037-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164356PMC
June 2022

Comment on: predictors of severe outcome following opioid intoxication in children.

Clin Toxicol (Phila) 2022 May 23. Epub 2022 May 23.

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

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http://dx.doi.org/10.1080/15563650.2022.2075375DOI Listing
May 2022

Protective Effect of Curcumin, Chrysin and Thymoquinone Injection on Trastuzumab-Induced Cardiotoxicity via Mitochondrial Protection.

Cardiovasc Toxicol 2022 07 14;22(7):663-675. Epub 2022 May 14.

Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, P.O. Box: 56189-53141, Ardabil, Iran.

Mitochondrial dysfunction may lead to cardiomyocyte death in trastuzumab (TZM)-induced cardiotoxicity. Accordingly, this study was designed to evaluate the mitochondrial protective effects of curcumin, chrysin and thymoquinone alone in TZM-induced cardiotoxicity in the rats. Forty-eight male adult Wistar rats were divided into eight groups: control group (normal saline), TZM group (2.5 mg/kg I.P. injection, daily), TZM + curcumin group (10 mg/kg, I.P. injection, daily), TZM + chrysin (10 mg/kg, I.P. injection, daily), TZM + thymoquinone (0.5 mg/kg, I.P. injection, daily), curcumin group (10 mg/kg, I.P. injection, daily), chrysin group (10 mg/kg, I.P. injection, daily) and thymoquinone group (10 mg/kg, I.P. injection, daily). Blood and tissue were collected on day 11 and used for assessment of creatine phosphokinase, lactate dehydrogenase (LDH), troponin, malondialdehyde (MDA) amount, glutathione levels and mitochondrial toxicity parameters. TZM increased mitochondrial impairments (reactive oxygen species formation, mitochondrial swelling, mitochondrial membrane potential collapse and decline in succinate dehydrogenase activity) and histopathological alterations (hypertrophy, enlarged cell, disarrangement, myocytes degeneration, infiltration of fat in some areas, hemorrhage and focal vascular thrombosis) in rat heart. As well as TZM produced a significant increase in the level of CK, LDH, troponin, MDA, glutathione disulfide. In most experiments, the co-injection of curcumin, chrysin and thymoquinone with TZM restored the level of CK, LDH, troponin, MDA, GSH, mitochondrial impairments and histopathological alterations. The study revealed the cardioprotective effects of curcumin, chrysin and thymoquinone against TZM-induced cardiotoxicity which could be attributed to their antioxidant and mitochondrial protection activities.
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http://dx.doi.org/10.1007/s12012-022-09750-wDOI Listing
July 2022

Priorities Towards Fair Allocation of Ventilators During COVID-19 Pandemic: A Delphi Study.

Front Med (Lausanne) 2021 24;8:769508. Epub 2022 Jan 24.

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

Background: COVID-19 pandemic has resulted in severe shortage in vital resources, including invasive mechanical ventilators. The current imbalance between demand and supply of mechanical ventilators has called for investigations on the fair allocation of mechanical ventilators.

Objective: To determine the priorities of the medical experts towards the fair allocation of ventilators during the COVID-19 pandemic.

Methods: This study was conducted from May 28 to Aug 20, 2020. The questionnaire was sent to 50 medical specialists as the Delphi panel. Participants were asked to rate each prioritising factor: "-1" for low priority, "+1" for high priority, and "Zero" for equal priority.

Results: Among 38 experts who responded to the email, the responses of 35 were analysed. 31 (88.6%) participants recommended that pregnant women be considered high priority in allocating ventilators, 27 (77.1%) mothers of children <5 years, 26 (74.3%) patients under 80-years, and 23 (65.7%) front-line-healthcare-workers. In contrast, 28 (80.0) participants recommended that patients who are terminally ill should be considered as a low priority, 27 (77.1%) patients with active-malignancy, 25 (71.4%) neurodegenerative diseases, and 16 (45.7%) patients aged >80. The panel did not reach a consensus regarding the role of patients' laboratory profiles, underlying diseases, or drug abuse in the prioritisation of ventilators.

Conclusions: The panel considered pregnant mothers, mothers of children under 5 years, age groups younger than 80, and front-line healthcare workers to have high priority in allocating mechanical ventilators.
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http://dx.doi.org/10.3389/fmed.2021.769508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818721PMC
January 2022

Post-mortem blood lead analysis; a comparison between LeadCare II and graphite furnace atomic absorption spectrometry analysis results.

J Forensic Leg Med 2022 Feb 22;86:102317. Epub 2022 Jan 22.

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. Electronic address:

Purpose: A comparison of the LeadCare II (LCII) point-of-care (POC) device with the gold standard graphite furnace atomic absorption spectroscopy (GFAAS) device was done in the context of post-mortem blood lead concentrations to determine comparability for screening value.

Methods: Consecutive autopsy cases from March 2018 to March 2019 were examined by the forensic medicine center. Blood samples with lead concentrations <10 μg dL by LCII analysis were excluded from GFAAS analysis. Samples were collected from femoral veins or cardiac chambers. Bland-Altman analysis was conducted to evaluate the agreement between both GFAAS and LCII lead values. Linear regression modeling was performed to predict GFAAS results based on LCII results. Five-hundred post-mortem blood samples were evaluated by LCII for blood lead. For 46 cases with LCII blood lead level (BLL) values more than 10 μg dL, further analysis was performed by GFAAS.

Results: Mean difference of BLL between the two methods was 5.92 μg dL (SD = 7.51; range: -14 to 23.7). GFAAS BLL values were significantly higher than LCII values (p = 0.029). Moreover, substance-user samples had significantly higher GFAAS BLLs (p = 0.006; mean difference = 11.62 μg dL). A significant regression equation was found (F [1, 44] = 108.44, p < 0.001, with an R2 of 0.711). Based on Bland-Altman plot averages for both predicted GFAAS BLL and measured GFASS BLL showed a mean difference was 0.014 (SD = 7.51; range: -17.9 to 20).

Conclusion: In conclusion, on post-mortem BLL samples, LCII and GFAAS show favorable correlation. LCII can be used as a screening technique for post-mortem blood lead analysis.
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http://dx.doi.org/10.1016/j.jflm.2022.102317DOI Listing
February 2022

Blood lead concentrations among pediatric patients with abdominal pain: a prospective cross-sectional study.

BMC Gastroenterol 2021 Dec 20;21(1):493. Epub 2021 Dec 20.

Washington Poison Center, University of Colorado Anchutz Medical Campus, Rocky Mountain Poison & Drug Safety, Denver, CO, Seattle, WA, USA.

Background: Lead exposure is one of the most menacing of environmental exposures, particularly in children. Children are more susceptible to the effects of lead which manifest in many organ systems, including interference with mental and motor development. Lead poisoning can cause colicky abdominal pain. In this study, the authors sought to evaluate the prevalence of elevated blood lead level (BLL) and its contributing factors among pediatric patients presenting with abdominal pain. An epidemic of lead poisoning in adults was previously uncovered, and thus a concern for pediatric lead poisoning was raised.

Methods: Pediatric patients presenting to two pediatric clinics in Tehran with abdominal pain were eligible for enrollment in a descriptive prospective cross-sectional study. A predesigned questionnaire was filled for each patient by their consenting parents. The questionnaire queried demographic information, environmental, social, and other relevant parameters for lead exposure. After completion of the questionnaire, biometrics were obtained, and a blood sample was taken from each patient for measurement of BLL and complete blood count.

Results: A total of 187 patients were enrolled in the study. Of them, almost 20% had BLL ≥ 5 µg/dL. Univariate analysis showed that age (p = 0.002, OR 3.194, CI 95% 1.504-6.783), weight (p = 0.009, OR 2.817, CI 95% 1.266-6.269), height (p = 0.003, OR 3.155, CI 95% 1.443-6.899), and playing with both plastic and cotton toys (p = 0.03, OR 2.796, CI 95% 1.072-7.295) were significant predictors of high BLLs. Maternal level of education correlated with blood lead concentrations (p = 0.048, OR 2.524, CI 95% 1.006-6.331).

Conclusions: A clinically significant number of cases of abdominal pain may have high BLLs. Specific attention should be paid to children presenting with abdominal pain, especially due to the detrimental effects of lead on their mental and motor development.
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http://dx.doi.org/10.1186/s12876-021-02023-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690485PMC
December 2021

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

Correction to: Lead poisoning; a neglected potential diagnosis in abdominal pain.

BMC Gastroenterol 2021 Oct 29;21(1):411. Epub 2021 Oct 29.

University of Colorado Anchutz Medical Campus, Rocky Mountain Poison & Drug Safety, Denver, CO and Washington Poison Center, Seattle, WA, USA.

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http://dx.doi.org/10.1186/s12876-021-01920-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555200PMC
October 2021

Fentanyl versus Methadone in Management of Withdrawal Syndrome in Opioid Addicted Patients; a Pilot Clinical Trial.

Arch Acad Emerg Med 2021 13;9(1):e62. Epub 2021 Sep 13.

Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: The most effective treatment for withdrawal syndrome in Opioid-dependent patients admitted to intensive care units (ICUs) remains unknown. This study aimed to compare fentanyl and methadone in this regard.

Methods: This prospective, single-blinded, controlled pilot study was conducted on opioid-dependent intubated patients admitted to the toxicology ICU of Loghman Hakim Hospital, Tehran, Iran, between August 2019 and August 2020. Patients were alternately assigned to either fentanyl or methadone group after the initiation of their withdrawal syndrome. Duration and alleviation of the withdrawal signs and symptoms, ICU and hospital stay, development of complications, development of later signs/symptoms of withdrawal syndrome, and need for further administration of sedatives to treat agitation were then compared between these two groups.

Results: Median age of the patients was 42 [interquartile range (IQR): 26, 56]. The two groups were similar in terms of the patients' age (p = 0.92), sex (p = 0.632), primary Simplified Acute Physiology Score (SAPS) II (p = 0.861), and Clinical Opiate Withdrawal Score (COWS) before (p = 0.537) and 120 minutes after treatment (p = 0.136) with either methadone or fentanyl. The duration of intubation (p = 0.120), and ICU stay (p = 0.572), were also similar between the two groups. The only factor that was significantly different between the two groups was the time needed for alleviation of the withdrawal signs and symptoms after the administration of the medication, which was significantly shorter in the methadone group (30 vs. 120 minutes, p = 0.007).

Conclusion: It seems that methadone treats the withdrawal signs and symptoms faster in dependent patients. However, these drugs are similarly powerful in controlling the withdrawal signs in these patients.
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http://dx.doi.org/10.22037/aaem.v9i1.1384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464014PMC
September 2021

Adult Lead Poisoning Caused by Contaminated Opium: A Two-Year Longitudinal Follow-Up Study.

Ann Glob Health 2021 9;87(1):89. Epub 2021 Sep 9.

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

Background: A major episode of lead poisoning caused by lead-adulterated opium occurred in Iran in 2016. Patients were removed from exposure and treated with chelating agents. A subset of those patients was evaluated in this follow-up study to evaluate treatment efficacy in relation to patient outcome.

Methods: Between March 2016 and December 2017, thirty-five male cases of lead poisoning due to ingestion of lead-adulterated opium were followed for two years. There are three patient groups: 1) those who abstained from opium use; 2) those who continued to use potentially contaminated opium; and 3) those who abstained from opium and were placed on maintenance therapy. Maintenance therapy included: methadone and opium tincture, offered by the Opioid Maintenance Therapy (OMT) clinics. Amongst the three patient groups Blood Lead Levels (BLL), complete blood count, and kidney and liver function tests were compared.

Findings: The results of BLL, hemoglobin, hematocrit, and aspartate aminotransferase were significantly different between the admission time and follow-up. Of the three patient groups, no difference was detected in these measures.

Conclusions: Treatment of lead poisoning combined with OMT proved an effective method to prevent recurrent lead poisoning.
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http://dx.doi.org/10.5334/aogh.3420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428290PMC
October 2021

Organ Procurement From Poisoned Patients: A 14-Year Survey in 2 Academic Centers.

Exp Clin Transplant 2022 05 20;20(5):520-525. Epub 2021 Sep 20.

From the School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Organ transplant from poisoned donors is an issue that has received much attention, especially over the past decade. Unfortunately, there are still opponents to this issue who emphasize that toxins and drugs affect the body's organs and do not consider organs from poisoned donors appropriate for transplantation.

Materials And Methods: Cases of brain death due to poisoning were collected from 2 academic centers in Tehran, Iran during a period from 2006 to 2020. Donor information and recipient condition at 1 month and 12 months after transplant and the subsequent transplant success rates were investigated.

Results: From 102 poisoned donors, most were 30 to 40 years old (33.4%) and most were men (55.9%). The most common causes of poisoning among donors were opioids (28.4%). Six candidate donors had been referred with cardiorespiratory arrest; these patients had organs that were in suitable condition, and transplant was successful. Acute kidney injury was seen in 30 donors, with emergency dialysis performed in 23 cases. For 51% of donors, cardiopulmonary resuscitation was performed. The most donated organs were the liver (81.4%), left kidney (81.4%), and right kidney (80.4%). Survival rate of recipients at 1 month and 12 months was 92.5% and 91.4%, respectively. Graft rejection rate at 1 month and 12 months after transplant was 0.7% and 2.21%, respectively.

Conclusions: Organ donation from poisoning-related brain deaths is one of the best sources of organ supply for people in need. If the organ is in optimal condition before transplant, there are no exclusions for use of the graft.
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http://dx.doi.org/10.6002/ect.2021.0259DOI Listing
May 2022

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

Environmental assessment of pediatric Lead exposure in Tehran; a prospective cross-sectional study.

BMC Public Health 2021 07 21;21(1):1437. Epub 2021 Jul 21.

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

Background: Ingestion and inhalation are common routes of exposure for lead in humans. Developing countries still have unacceptably high rates of lead toxicity, especially in children. Studies on probable risk factors of lead poisoning in Iranian children are insufficient. In this study, we aimed to evaluate possible environmental factors in children with high blood lead concentrations living in Tehran and neighboring cities.

Methods: In a prospective cross-sectional study between March 2018 and March 2019 we followed all children referred from two pediatric gastrointestinal clinics with blood lead level (BLL) > 5 μg/dL in metropolitan Tehran to investigate possible environmental risk factors in their home. Household specimens including scratched wall paint, house floor dust, windowsill dust, tap water, and consumed spice were evaluated using atomic absorption method to detect lead concentrations. Epidemiological and environmental data collected through in-depth interviews with parents/guardians. Industrial areas were defined based on municipality maps on industrial places.

Results: Thirty of 56 parents/guardians with BLL > 5 μg/dL agreed to be followed through environmental investigation. The only categorical statistically significant risk factor was a history of lead poisoning in the family and living in an industrial zone. There was a positive correlation between BLL and interior windowsills dust lead level, r = 0.46, p = 0.01. Scratched paint lead level and BLL showed a significant positive correlation, r = 0.50, p = 0.005. House floor dust lead level (median = 77.4, p < 0.001) and interior windowsill dust lead level (median = 291, p = 0.011) were both significantly higher than the environmental protection agency (EPA) standards of 40 μg/ft, 250 μg/ft. Interior windowsill dust lead concentrations were significantly higher in industrial areas (p = 0.026).

Conclusion: Children's playing environment should be cleaned more often to reduce dust. Moreover, specific rules may need to be implemented for paint lead concentrations and air pollution, especially in industrial areas.
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http://dx.doi.org/10.1186/s12889-021-11494-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296531PMC
July 2021

Comparing the Clinical Characteristics, Laboratory Findings, and Outcomes between Epidemic and Episodic Methanol Poisoning Referrals; a Cross-sectional Study.

Arch Acad Emerg Med 2021 12;9(1):e46. Epub 2021 Jun 12.

Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Due to illegal manufacturing and sales of alcoholic beverages, epidemic outbreaks of methanol poisoning may occur. The aim of this study was to determine if there were differences in the severity, course of poisoning, and outcomes between methanol-poisoned patients admitted during an outbreak versus those who were admitted following episodic exposures.

Methods: The present retrospective study was performed in a single referral poisoning center between March 2018 and March 2019 in patients with confirmed methanol poisoning. During this time, in addition to episodic cases of methanol intoxication, there were three methanol poisoning outbreaks. Outbreaks were characterized by an unexpected increase in the number of methanol-poisoned patients in a short period of time, which impacted resources and decision-making. The two groups were compared regarding their severity of poisoning, sessions of hemodialysis, and clinical outcomes.

Results: Outbreak cases had a higher level of methanol than episodic cases. Odds of being dialyzed more than once was 5.4 times higher in the cases presenting during an outbreak (95% CI 2.1-14.0; p=0.001). Mean hospital stay, intubation/mechanical ventilation, and death were similar between the two groups. An evaluation of the alcoholic beverage samples available in the Iranian black market during the outbreak showed a 7-percent methanol concentration with no ethanol content.

Conclusions: Poisoning risk may be higher during methanol outbreaks due to the higher methanol concentrations, requiring more hemodialysis sessions for persistent metabolic acidosis. In addition to alcohol dehydrogenase blockade, careful risk assessment of all methanol poisonings can assist with stratifying the priority for, and duration of, hemodialysis to optimize outcomes.
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http://dx.doi.org/10.22037/aaem.v9i1.1278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221550PMC
June 2021

Comparing the Clinical Characteristics, Laboratory Findings, and Outcomes between Epidemic and Episodic Methanol Poisoning Referrals; a Cross-sectional Study.

Arch Acad Emerg Med 2021 12;9(1):e46. Epub 2021 Jun 12.

Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Due to illegal manufacturing and sales of alcoholic beverages, epidemic outbreaks of methanol poisoning may occur. The aim of this study was to determine if there were differences in the severity, course of poisoning, and outcomes between methanol-poisoned patients admitted during an outbreak versus those who were admitted following episodic exposures.

Methods: The present retrospective study was performed in a single referral poisoning center between March 2018 and March 2019 in patients with confirmed methanol poisoning. During this time, in addition to episodic cases of methanol intoxication, there were three methanol poisoning outbreaks. Outbreaks were characterized by an unexpected increase in the number of methanol-poisoned patients in a short period of time, which impacted resources and decision-making. The two groups were compared regarding their severity of poisoning, sessions of hemodialysis, and clinical outcomes.

Results: Outbreak cases had a higher level of methanol than episodic cases. Odds of being dialyzed more than once was 5.4 times higher in the cases presenting during an outbreak (95% CI 2.1-14.0; p=0.001). Mean hospital stay, intubation/mechanical ventilation, and death were similar between the two groups. An evaluation of the alcoholic beverage samples available in the Iranian black market during the outbreak showed a 7-percent methanol concentration with no ethanol content.

Conclusions: Poisoning risk may be higher during methanol outbreaks due to the higher methanol concentrations, requiring more hemodialysis sessions for persistent metabolic acidosis. In addition to alcohol dehydrogenase blockade, careful risk assessment of all methanol poisonings can assist with stratifying the priority for, and duration of, hemodialysis to optimize outcomes.
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http://dx.doi.org/10.22037/aaem.v9i1.1278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221550PMC
June 2021

Fatal Outcome in Acutely Poisoned Children With Hospitalization: A 10-Year Retrospective Study From Tehran, Iran.

Pediatr Emerg Care 2022 Feb;38(2):e659-e663

Kish Institute of Science and Technology.

Background: Acute poisoning is a significant and preventable cause of mortality among children internationally. The aims of this study were to assess the case fatality rate of children admitted to an inner-city hospital for acute poisoning and to compare the demographics and source of poisoning of fatal cases.

Methods: This was a retrospective review of patient data recorded in the Hospital Information System for Loghman Hakim Hospital, that is, the central referral hospital for poisoning in Tehran, Iran. We searched Hospital Information System for all admissions for poisoning in children (age, 0-12 years) over the 10-year period from March 2010 to March 2020, and all cases were included in the analysis. We determined the case fatality rate by dividing the number of fatal cases by the number of included cases.

Results: Of 8158 children admitted for poisoning, 28 cases (0.3%) died, among whom 19 (67.9%) were boys and 9 (32.1%) girls. The median age was 42 months, ranging from 2 to 144 months. Twenty-two cases (78.6%) were 0 to 5 years old. The most common cause of mortality in acute poisoning was methadone (n = 13, 46.4%), followed by raw opium (n = 5, 17.9%), aluminum phosphide, carbon monoxide, and wild mushrooms (n = 2 deaths each, 7.1%). Tramadol, colchicine, and petroleum accounted for 1 death each (3.6%).

Conclusions: Mortality from unintentional poisoning disproportionately affects children younger than 5 years. Opioids (ie, methadone, opium, tramadol) accounted for two thirds of deaths in our sample. Our findings highlight the importance of educating parents that any toxic materials (licit or illicit) must be stored out of reach for children.
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http://dx.doi.org/10.1097/PEC.0000000000002429DOI Listing
February 2022

Troponin, A Predictor of Mortality in Methadone Exposure: An Observational Prospective Study.

J Am Heart Assoc 2021 04 6;10(8):e018899. Epub 2021 Apr 6.

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

Background Methadone poisoning/overdose is a global public health problem. We aimed to determine whether methadone poisoning increased cardiac troponin and whether high-sensitivity cardiac troponin I (hs-cTnI) levels predicted the need for intensive care unit admission, intubation, and mortality. Methods and Results This observational, prospective single-center study was done at Loghman-Hakim Hospital (Tehran, Iran) from June 2018 until February 2019. Patients aged >14 years admitted with a diagnosis of methadone exposure were included. Patients were excluded if they had coexisting conditions associated with elevated hs-cTnI levels. An ECG and hs-cTnI levels were obtained on emergency department presentation. Patients were followed up on their need for intubation, intensive care unit admission, and in-hospital mortality. Of 245 included patients (186 [75.9%] men; median age, 33 years), most referred to loss of consciousness (210 cases, 89%). Nineteen (7.7%) patients had hs-cTnI levels of >0.1 ng/mL (positive), and 41 (16.7%) had borderline levels of 0.019 to 0.1 ng/mL. Twenty-three (9.3%) cases were admitted to the intensive care unit, 21 (8.5%) needed intubation, and 5 (2%) died during hospitalization. An hs-cTnI cutoff value of 0.019 ng/mL independently predicted mortality. For optimal concomitant sensitivity and specificity, receiver operating characteristic curve analysis was conducted and showed that hs-cTnI had an independent significant association with mortality, with a cutoff value of 0.0365 ng/mL (odds ratio, 38.1; 95% CI, 2.3-641.9; <0.001). Conclusions Methadone exposure/toxicity is a newly identified cause of elevated hs-cTnI. Values >0.019 ng/mL, and particularly >0.0365 ng/mL, of hs-cTnI predicted mortality in our sample. Future studies should measure troponin levels in methadone maintenance treatment clients to assess the risk of myocardial injury from long-term exposure.
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http://dx.doi.org/10.1161/JAHA.120.018899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174177PMC
April 2021

Complications and hospital stay after endoscopic retrieval of drug baggies in body stuffers: an observational prospective study.

Sci Rep 2021 03 8;11(1):5359. Epub 2021 Mar 8.

National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addiction Sciences, London, UK.

Body stuffers routinely receive conservative treatment, i.e. administration of the laxative polyethylene glycol for the passage of ingested drug baggies and observation. Endoscopic baggie removal may offer a safe alternative that could result in shorter hospitalization. We aimed to compare complications, hospital stay, and final outcome in body stuffers assigned to endoscopy versus conservative treatment. This is an observational prospective study of body stuffers presenting to a clinical toxicology center in Tehran (Iran) in 2016-2019, irrespective of the drug ingested. Eligible patients had baggies in their upper gastrointestinal tract and presented without severe poisoning. Patients received either endoscopy or conservative treatment, and clinical outcomes were compared between the groups. A total of 69 patients were enrolled, with a median age of 29 years (range 18-64), among whom 1 was female (2%). Eighteen and 51 patients were endoscopically and conservatively managed, respectively. Drugs most commonly ingested were heroin in endoscopy patients (8/18 cases; 44%) and methamphetamine in the conservative group (28/51 cases; 55%). Endoscopy patients had a shorter hospital stay (median 1.5 vs. 2 days, P = 0.018). In the conservative group, one patient died, and the rate of complications was significantly higher, with more patients experiencing side effects (OR = 1.4, 95% CI = 1.2, 1.7) and requiring intubation (OR = 1.3, 95% CI = 1.1, 1.5). Endoscopic retrieval was associated with fewer complications and shorter hospitalization. Endoscopy may be a safe treatment for body stuffers without severe poisoning on presentation.
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http://dx.doi.org/10.1038/s41598-021-84898-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940431PMC
March 2021

Correction to: Protective effect of flumazenil infusion in severe acute benzodiazepine toxicity: a pilot randomized trial.

Eur J Clin Pharmacol 2021 Apr;77(4):555-556

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

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http://dx.doi.org/10.1007/s00228-021-03117-wDOI Listing
April 2021

Unintentional buprenorphine and methadone poisoning in children: a matched observational study.

Clin Toxicol (Phila) 2021 Aug 21;59(8):727-733. Epub 2021 Jan 21.

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

Objective: To compare accidental pediatric poisoning from methadone vs. buprenorphine in terms of clinical indicators and in-hospital morbidity.

Methods: A matched observational study conducted on children aged ≤12 years admitted to our center between March 2018 and March 2019 with acute poisoning from methadone or buprenorphine. Data were extracted from the electronic patient files of the pediatric methadone poisoning cases, and buprenorphine poisoning cases were followed from ED, during the study period. Cases were compared regarding rates of bradypnea/apnea (primary outcome), the need for antidote therapy and intubation, duration of hospital stay, miosis, loss of consciousness, blood gas analyses, and mortality (secondary outcomes).

Results: A total of 90 methadone- and 30 buprenorphine-poisoned children were evaluated. Methadone cases had significantly higher rates of apnea (20/90 methadone vs. 0/30 buprenorphine; OR = 17.7, 95% CI 1.1, 302.8;  = 0.047), but there was no group difference in bradypnea (39/90 methadone vs. 10/30 buprenorphine; = ns). 28 (31%) methadone and 3 buprenorphine (10%) cases had been referred to as fully awake ( = 0.013). Methadone cases required higher median naloxone doses for initial bolus (0.4 vs. 0.02 mg;  = 0.014) and maintenance infusion (14.4 vs. 2.4 mg;  < 0.001). 20 apnea cases (all from the methadone group) had miotic pupils, and miotic pupils were seen in 44 (90%) cases with bradypnea (OR = 3.2, 95% CI 1.1, 9.3;  = 0.026). Intubation was needed in only 5 methadone cases (5.5%; = ns). All patients survived.

Conclusion: Compared to children poisoned with methadone, buprenorphine cases had higher rates of loss of consciousness on admission but subsequently experienced fewer complications during hospital treatment, which is likely due to the buprenorphine partial antagonist effect. Our findings suggest that methadone exposure is more toxic than buprenorphine in pediatric populations.
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http://dx.doi.org/10.1080/15563650.2020.1869755DOI Listing
August 2021

A study of the effectiveness of naltrexone in preventing recurrence of methadone poisoning in opioid-naive children.

Drug Alcohol Depend 2021 02 24;219:108425. Epub 2020 Nov 24.

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. Electronic address:

Background: The prevalence of poisoning from methadone and prescription opioids is increasing in pediatric populations. Naloxone is the main antidote for treatment. Long-acting opioid toxicity may need close observation in the intensive care unit (ICU). In our previous study, naltrexone prevented re-narcotization in methadone-poisoned adults. Here, we aim to share our experience with the use of oral naltrexone for preventing recurrence of toxicity in opioid-naïve children.

Methods: In a single-center, retrospective case series, children (age ≤12 years) admitted to a poison center in Tehran (Iran) between March 2014-March 2016 were included if they presented with methadone poisoning and received naltrexone treatment in hospital. Naltrexone (1 mg/kg) was administrated orally after initial administration of 0.1 mg/kg naloxone intravenously. Children were monitored for level of consciousness, cyanosis, respiratory rate, VBG results, and O2 saturation for ≥48 h during their hospitalization.

Results: Eighty patients with methadone poisoning were enrolled, with median age of three years (range: 0.2-12.0). None involved polysubstance poisoning. Following naltrexone treatment, none experienced recurrent opioid toxicity during hospitalization, and hospital records indicated no readmission within 72-h post-discharge.

Conclusion: Oral naltrexone could be a potential substitute for continuous naloxone infusion in methadone-poisoned children and reduce the need for ICU care.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108425DOI Listing
February 2021

Oral clonazepam versus lorazepam in the treatment of methamphetamine-poisoned children: a pilot clinical trial.

BMC Pediatr 2020 12 3;20(1):543. Epub 2020 Dec 3.

Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: To evaluate the efficacy of oral clonazepam versus oral lorazepam following initial parenteral benzodiazepine administration to control methamphetamine-induced agitation in children.

Methods: In a single-center clinical trial, intravenous diazepam (0.2 mg/Kg) was initially administered to all methamphetamine-poisoned pediatric patients to control their agitation, followed by a single dose of oral clonazepam (0.05 mg/Kg; n = 15) or oral lorazepam (0.05 mg/Kg; n = 15) to prevent relapse of toxicity.

Results: The median age [IQR] (range) was 15 [10, 36] (6-144) months. The source of poisoning was methamphetamine exposure from oral ingestion in 23 (76.7%) and passive inhalation in 7 (23.3%) patients. The most common symptoms/signs were agitation (29; 96.7%), mydriatic pupils (26; 86.7%), and tachycardia (20; 66.6%). Two in each group (13.3%) needed re-administration of intravenous diazepam due to persistent agitation. There was no report of benzodiazepine complications in either group.

Conclusions: Clonazepam and lorazepam treatment was equally effective at similar doses. However, considering the higher potency of clonazepam, it seems that lorazepam is the safer benzodiazepine for oral maintenance treatment of methamphetamine-induced agitation in children and can be used with minimal complications.

Trial Registration: IRCT20180610040036N2, April 18th, 2020. Retrospectively registered.
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http://dx.doi.org/10.1186/s12887-020-02441-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713025PMC
December 2020

Blood Lead Levels in Opium-Poisoned Children: One Cross-Sectional Study in Iran.

Addict Health 2020 Jul;12(3):159-166

Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

Background: Lead poisoning is now more common due to accidental or intentional exposure to opium impregnated with lead. We aimed to determine the relationship between the blood lead levels (BLLs) and basic characteristics in opium-poisoned children.

Methods: In this cross-sectional study, 32 children younger than 13 years old who had been admitted to Loghman Hakim Poison Center, Tehran, Iran, due to opium poisoning, were evaluated for BLLs. Patients' demographics, symptoms, signs, and lab tests were evaluated as well as the BLLs.

Findings: The median and range of age in children with opium poisoning were 14 and 141 months with minimum and maximum age of 3 and 144 months, respectively, and 62.5% were boys. Their mean BLL was 9.78 ± 3.44 μg/dl and in 70% of opium-poisoned children, BLL was ≥ 5 μg/dl. There was a significant difference between mean BLLs in girls and boys (17.07 ± 6.57 μg/dl in girls and 6.61 ± 3.22 μg/dl in boys, P = 0.02). We found a significant correlation between BLL and hemoglobin (Hb) level. In very low Hb level (< 8 g/dl), the BLL was higher but with increasing Hb level, BLL increased as well; in Hb levels > 14 g/dl, BLL decreased again (P = 0.01).

Conclusion: Although none of the children needed chelation therapy, strategies should be developed to prevent children from being exposed to opium and other materials impregnated with lead regarding its effects on all organs of children.
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http://dx.doi.org/10.22122/ahj.v12i3.268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679490PMC
July 2020
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