فهرست مطالب حسین حسنیان مقدم

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

In this cross-sectional study, 32 children younger than 13 years old who had been admitted toLoghman 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.

The median and range of age in children with opium poisoning were 14 and 141 months withminimum and maximum age of 3 and 144 months, respectively, and 62.5% were boys. Their mean BLL was9.78 ± 3.44 μg/dl and in 70% of opium-poisoned children, BLL was ≥ 5 μg/dl. There was a significantdifference 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).

Although none of the children needed chelation therapy, strategies should be developed toprevent children from being exposed to opium and other materials impregnated with lead regarding itseffects on all organs of children.

Evidence from past wars of human history and the present century presents undeniable examples revealing the importance of civil defense. In Iran, there have been numerous attacks with a varietyof chemical gases during the eight years of the battle with Iraq. In addition, unintended accidents during earthquakes, hurricanes, and car accidents while transporting chemicals and chemical gases, although rare, are inevitable. For example, large-scale chlorine gas emissions have occurred. Because these events are rare, ED personnel are often not prepared enough to play an effective role in such situation, especially in the early golden hours after their happening. Due to lack of observation and repetition, preparedness of medical centers in terms of equipment and trained staff after the occurrence of attacks and accidents is a basic necessity. According to its inherent duties, Iranian civil defense organization is responsible for training and taking action to prepare hospital staff. This project, supported by this organization, aims to report how to confront with an accident or chemical attack in Loghman Hakim Hospital, a tertiary referral center for poisonings in Tehran, Iran, in 2019.

This project was performed as a maneuver with participation of 65 physicians, hospital personnel, and students at Loghman Hakim Hospital affiliated to Shahid Beheshti University of Medical Sciences. Initially, training workshops were held to raise theawareness and preparedness of the members of the crisis team and all active staff using existing texts and instructions. Then, a designed imaginary scenario was presented and acted as a maneuver on a non-holiday day between 9.30 AM and 4 PM.

Sixty-five physicians, hospital staff, and students attended the maneuver. The findings are reported in three levels of A: directorship and management level reaching almost 70% of its goals; B: operational level reaching about 70% of its goals, andC: termination of the maneuver and initiation of rehabilitation reaching almost 40% of its goals.

The maneuver was performed with almost 65% of the aims reached. Physicians and staff readiness was assessed to be moderate. Lack of equipment was undeniably obvious, especially in decontamination tools and protective clothing for employees. In general, our referral center of poisoning is not prepared enough to deal with any chemical accident or attack if it happens. More attention is needed to chemical accident/attack preparedness at least in all referral centers for clinical poisoning throughout the country.

Because in today's societies, not only the nutritional role of plants and fungi is very high, but also the main basis of many drugs are plants and plant products, therefore one of the problems of clinical toxicologists is the toxicity of these products. This study aimed to define the prevalence, symptoms, complications, effective treatments, type of substance use, the cause of intake, location, gender distribution and age of poisoning with herbs and mushrooms in hospitalized patients of Loghman Hakim Hospital in Tehran. This is a retrospective study with questionnaire formulation. Patients reviewed from the beginning of 2007 to the end of 2013. of 103 cases of poisoning with plants and mushrooms 64.1% were male, and 35.9% were female. The mean age of patients was 21.59 ± 30.51 years. The most commonly used substance is Datura (34%). On the other hand, sole mushroom ingestion was found in 5.8% of cases. The most significant source of plants and mushrooms was reported from herbal-shops (27.18%). The reason behind intake was either random or euphoria. Four patients were admitted to the intensive care unit, and three patients needed intubation. The mean hospital stay was 1.64 ± 1.28 days. Ninety percent of the treatments were supportive, and 75.7% of the patients recovered without any clinical complications. Poisoning with toxic plants and mushrooms is one of the frequent causes of intoxication that is often accidental. In children poisoning is inadvertent, but youth are more likely wanted to have euphoria. Treatment strategies are supportive and symptomatic.

Tramadol is an analgesic medication. High prevalence of tramadol abuse has been frequently reported. This study was aimed to evaluate the common and serious complications and death cases due to tramadol intoxication.

A cross-sectional study was performed on 420 patients hospitalized in poisoning ward of Tehran Loghman Hospital for four months period. Patient’s characteristics and medical complications were recorded during hospitalization and subsequent visits.

Convulsion (31.3%) and apnea (6.2%) were the most serious side effects in patients using with tramadol intoxication. The incidence of apnea was correlated with the drug doses (P

The high prevalence of tramadol abuse, and its high and dangerous complications in our country that requires careful vigilance of physicians and pharmacists in prescribing and selling tramadol, and families’ awareness about the arbitrary use of his youth.

The sociomedical phenomenon of drug abuse remains among the most critical issues facing our society, today. The present study reports the pilot results of Drug Abuse Warning Network in Loghman-Hakim Hospital,Tehran. After taking history of 1850 patients who were chosen randomly for interview and screened for drug of abuse in the emergency department during 12 months;16 substances including morphine, methadone, bupernorphine, oxycodone, tramadol, propoxyphene, amphetamine, methamphetamine, 3, 4- ethylenedioxy methamphetamine, cocaine, ketamine, phencyclidine, tetrahydrocanabinol, benzodiazepines, ethanol and barbiturates were evaluated using urine screening immunoassay kits in Loghman-Hakim Hospital. Totally 1850 patients were chosen randomly for interview and screened for drug of abuse in the emergency department. From the above group 1258 (68%) including 739 (58.7%) women accepted to enter the study. The mean age was 28±11 (range 12-88). Totally 945 (75.1%) patients had deliberately poisoned themselves, while substance intoxication was the cause of admission in 194 (15.4%) patients. Taken all minimum substance abusers together, opioid abusers were 397 patients (31.6%), of whom 144 cases (11.4%) were hidden abusers that were revealed by lab tests. Stimulant abusers were 123 patients (9.8%) with 49(3.9%) hidden abusers, hallucinogen 22 (1.7%) patients abusers with 15 (1.2%) hidden abusers, sedative abusers 337 cases (26.8%) with 145 hidden abuse (11.5%) and alcohol abusers were 76 patients (0.6%). There are noticeable amount of hidden abusers in the community which need suitable and instant intervention.

N-Acetyl cysteine (NAC) is an effective antidote for acetaminophen poisoning. Now, in some poisoning centers the prescription of NAC is related to the dose of drug through medical history of patients, because of mines equipments and high load of patients. We evaluate the patient’s history more closely and compare it with the plasma acetaminophen to find the effective factors of history on severity of poisoning. This prospective cross sectional study was carried out over 170 patients who were consumed more than 7.5 grams of acetaminophen. Some variables like age, sex, number of suicides, the amount of drug, and the duration between drug consumption and hospital admission were evaluated and the data were analyzed using SPSS software. In total 170 patients, the mean age was 21.81 ± 6.05 years. Out of the total number of samples, 44.7% were men and 55.3% were women. The mean plasma level of acetaminophen was 18.7 µg/ml. The prevalence of poisoning was more in third decade of life. Number of suicides, amount of drug, and duration of consumption and emergency admissions were three variables which positively affect severity of poisoning. In conditions which quick plasma tittering of acetaminophen is impossible for determining the indication of NAC prescription, some factors through patients’ history help the physician for better decision. Positive history of suicide, high dose drug consumption, and long duration between drug poisoning and hospital admission are some risk factors for poisoned patients.

Children are vulnerable to different sort of injuries, including poisoning which may have inevitable effects and even significant mortality among this group. The aim of this study was to determine the pattern of poisoning-related deaths in Loghman hospital in Tehran. It was an existing-data type study from March 1995 to March 2004; all intoxication fatalities of under 12 year-old subjects which had been occurred in Loghman hospital were reviewed. Demographic data were reviewed for each case via a questionnaire and reported with descriptive statistics. A total of 11150 childhood severe poisonings were hospitalized during this period, of which 37 (0.33%) died. 32.4% were dead on arrival time. Male to female ratio was 1.2/1. The majority of fatalities occurred in children aged 1-4 years (59.1%). Their mean age was 4.3±3.5 years old. All poisonings happened accidentally. Thirty (81%) of exposures were via ingestion and most of them were in summer (37.8%). Most of deaths had not occured in Tehran but in rural areas or other cities and 35% reffered to hospital with more than 6 hours delay. Hydrocarbons were the most common cause of mortality (27%) followed by carbon monoxide, poisonous mushrooms and opium (10.8% for each of them), organophosphates pesticides and botulism (co-ingested with rice tablet) (8% for each), mercury vapor (5.4%) and scorpion stin and corrosive acid ingestion (2.7% for each) and 13.5% were other drugs. Our study points out the need to proper management of childhood dangerous poisoning like hydrocarbons, opium, organophosphates, etc. We also have to bear in mind that the prevention is an important issue

Acute poisoning is a significant mental health problem all over the world. Poisonings are a well-known cause of morbidity and mortality in adolescents in Iran. The main aim of this study was to determine the pattern of poisoning in adolescents admitted in Loghman-Hakim hospital, the only referral center for poisoning in Tehran.

In a six- month cross-sectional study (23 Mar to 23 Sep 2003), all 12-18 years cases of poisoning admitted to Loghman-Hakim hospital were reviewed. Demographic data were reviewed for each case. SPSS Version 11.5 was used for analysis the data, α=0.05 was considered as the level of significance.

A total of 12548 poisoning cases were admitted during this period, of which 2485(19.8%) had occurred in the adolescents, mostly students. Most cases 1674, (67.4%), were treated as outpatients. The majority of cases occurred in youths aged 17- 18 years, mean age 16.7 (±1.3) years. Most incidents of poisoning occurred in females (1529 cases, 61.5%), singles (2254 cases, 90.7%), and high school students, (1258 cases, 50.6%). The majority of events happened at home, (2223 cases, 89.5%), by oral ingestion, (2392 cases, 96.3%), and as an act of deliberate self harm, (2038 cases, 82%). Psychotropics were the most common agents, used in 1504(49.5%) cases. 324(13%) cases had a previous history of deliberate self poisoning. The mortality rate was 0.44%.

Most poisonings were intentional. Young girls are at risk for deliberate self-poisoning.

There is no specific center for poison control and surveillance in our country to gather information and analyze data. The Loghman Hospital is the only tertiary teaching hospital for poisoned patient in Tehran with more than 65 years of experience which serves from the resident population of capital city, so that most poisoned patients refer to this center. The aim of this study was to investigate the epidemiological feature of hospital-referred poisonings in Loghman hospital as a representative of capital city according to International Classification of Disease (ICD10). All adults and adolescents more than 12 years old admitted to the Emergency toxicology clinic of the Loghman hospital, from 21 March 2005 to 20 March 2006, were included in this study. We analyzed the clinical charts for etiological and demographical characteristics of the acutely poisoned patients whom were hospitalized. Variables including group of poisons, age, sex, history of mental illness and addiction, history of drug self poisoning and prognosis, were compiled and analyzed. Among 28,002 patients admitted to the Emergency toxicology clinic, there was 12,167(43.45%) poisoned cases (5,578 females and 6,545 males and 51 unknown). Intentional poisoning was more common (83.6%) than accidental exposures (16.4%) including drug abuses. Pharmaceutical drugs, especially antidepressants and sedative hypnotics were the major causes of intoxication which codified as T42 (21.6%) and T43 (15.4%), respectively, followed by T40 (11.8%) that mainly consisted of the opiates. The overall number of poisoned patients whom were hospitalized was a bit higher in spring and summer (51.5%). Three hundred and four patients were died due to acute poisoning or its complications. The majority of them was due to narcotics’ overdosage (33.22%), followed by pesticides (12.17%) (mostly aluminum phosphide), psychotropic drugs (8.55%) and alcohols (8.55%) (mostly methanol). Most of the deceased patients were male (73.35%) and 45.4% were below 40 years old. Although our rate of suicide is lower than western countries, the trend of deliberate self poisoning is more than population growth rate and because of substance abuse, the sex distribution of poisoning has been dramatically changed. It seems that national policy for controlling substance abuse is not efficient enough and needs urgent intervention, especially for high risk groups. To our knowledge, it seems that this unique center is the busiest clinical toxicology Department of the world.

The aim of this study is the report of our experience in diagnosis of the opium body packers with CT scan. For 12 cases that confessed to opium packet ingestion, we did abdominal and pelvic CT scan without contrast and evaluated the presence, number and location of opium packets and also measured the density of packets in Hounsfield unit(HU). Mean age of our cases was 28.2±5.9 years (ranging 17 – 35 years). Eleven (91.6%) of patients were male and only one case was female. In all patients, the packets were visualized in gastrointestinal (GI) lumen by CT scan. The mean of minimum HU was 163.8±19.6 and the mean of maximum HU was 205.3±32.8. We had mortality in an eighteen years old female due to opium overdose. CT scan could be a suitable imaging modality in identifying opium packets similar that reported for cocaine and heroin.