nastaran eizadi-mood

Due to the entry of various bodybuilding and narcotic compounds into the consumption market and the lack of accurate knowledge of their contents, this study aims to determine the contents of the substance of abuse Sorcheh and the products used in addiction treatment and bodybuilding drugs available in the market of Isfahan city in terms of classification. Toxicology was performed.

In this cross-sectional study, samples of 7 commercial drugs GC, black raspberry, and Mohazal for obesity treatment and Fereshteh, Galaxy, and Gainup brands for slimming treatment and a narcotic compound called Sorche were examined. Their contents were identified by performing keratography tests and compared with the commercial stickers on their packaging.

Sibutramine, Morphine, and Fluspirlene are the main ingredients in GC slimming, as Pseudoephedrine, Methamphetamine, and Morphine in black raspberry, Carbamazepine, Morphine, Haloperidol, and Diphenoxylate in Gainup, Morphine, Cyproheptadine, Hydroxyprogesterone, Glutamine, Thioridazine, Chlordiazepoxide, Haloperidol, Epitestrone, Methadone and Betamethasone, in Galoxymelatonin, Clonazepam, Haloperidol, Meperidine, Trifluperidol, and Cyproheptadine, in angel, Haloperidol, Cambinol, Oxazepam, Hydrocortisone, Carbamazepine, Diclofenac, Hydrocortisone, and Imipramine were present. The sample of Sorcheh contained 70% Heroin plus caffeine.

Medicines that are sold under the claim of herbal medicines for weight loss and obesity treatment have various chemical compounds, including narcotics and sedatives, which can lead to numerous liver and kidney and may lead to digestive complications in the long run, in addition to drug dependence, cardiac, neurological, and psychological.

Considering the high prevalence of paraquat poisoning with the intention of suicide and its extremely deadly effects on the major organs of the body, choosing the best treatment can play a significant role in reducing the mortality rate of these patients. For this purpose, this study was conducted to evaluate the therapeutic outcomes of paraquat-poisoned patients treated with a new treatment protocol.

The current retrospective study was conducted on 39 paraquat-poisoned patients treated with a new protocol. In the new protocol, in addition to the standard protocol, treatment with curcuma, pirfenidone, selenium plus, and silymarin is prescribed by gavage. By referring to the archive, basic and clinical information of these patients was extracted and recorded.

In this study, 18 (46.2%) recovered and 21 (53.8%) died. The prevalence of mortality was significantly related to the frequency distribution of gender and age of patients. Hence, the percentage of mortality was higher in men and in those over 35 years of age. In addition, in the new treatment protocol, it was found that although the administration of selenium, curcumin, and silymarin increased the chances of patients' recovery to an insignificant extent (P > 0.05), the administration of pirfenidone can significantly increase the recovery of patients (OR = 3.14 and P = 0.028).

According to the results of the present study, the administration of pirfenidone and other antioxidants can increase the recovery rate. Although the administration of silymarin, selenium, and curcumin did not show a significant relationship in terms of reducing mortality or increasing recovery, it seems that the treatment regimen based on these drugs results in a higher recovery rate.

The objective is to summarize evidence from systematic reviews, scoping reviews, and meta?analyses evaluating the effects of any format of Internet?based, mobile?, or telephone?based intervention as a technology?based intervention in suicide prevention.

This is an umbrella review, that followed Preferred Reporting Items for Systematic Reviews and Meta?Analyses 2020 statement guidelines. An electronic search was done on September 29, 2022. Data were extracted by reviewers and then methodological quality and risk of bias were assessed by A Measurement Tool to Assess Systematic Reviews?2. Statisticalanalysis was done by STATA version 17. Standard mean difference was extracted from these studies and by random effect model, the overall pooled effect size (ES) was calculated. I2 statistic was used to assess the heterogeneity between studies. For publication bias, the Egger t st was used.

Six reviews were included in our study, all with moderate quality. The overall sample size was 24631. The ES for standard mean differences of the studies is calculated as ? 0.20 with a confidence interval of (?0.26, ?0.14). Theheterogeneity is found as 58.14%, indicating a moderate?to?substantial one. The Egger test shows publication bias.

Our results show that  echnology?based interventions are effective. We propose more rigorous randomized controlled trials with different control groups to assess the effectiveness of these interventions.

Poisoning with Organophosphates (OP) and/or Pyrethroids (PYR) pesticides is common. We present a rare case of OP+PYR poisoned patient who suffered from Atrial Fibrillation (AF) at the beginning of treatment by a low dose of atropine and reviewed the literature. 

A 50-year-old man had ingested about 5-10 ml of a mixture of chlorpyrifos/cypermethrin.  Half an hour later, he went to the rural hospital and 2 hr later, after gastrointestinal decontamination, he was referred to the clinical toxicology department with normal vital signs except normal sinus tachycardia [Heart rate (HR)]=105. On admission, he had nausea, vomiting, diarrhea, mild sialorrhea, symmetric mid-size pupils, wet skin, and bilateral moist rales in his lungs. His cardiac rhythm changed to rapid AF (HR >140 beats/min) after treatment with 3 mg midazolam followed by 0.3 mg of atropine (0.1 mg every 1-3 min). Atropine administration was discontinued and he was treated with 0.5 mg of digoxin. 6 hr later, his arrhythmia disappeared and all cardiac and laboratory evaluations changed to normal except reduced serum cholinesterase activity.  

AF may be induced by Organophosphates (OP) and Pyrethroids (PYR) intoxication or during the treatment by atropine. We could not find any known risk factor (cardiac or medical issues) for AF in the current case. It may be suggested that poisoning with OP, PYR (alone or mixed) or atropine (in general or in low dose), or combination is the trigger of AF. However, AF is not life threating and can easily cure by antiarrhythmic therapy.

This study aimed to investigate the impact of child abuse and substance desire on adolescent suicide. This cross-sectional analytical study was conducted on all adolescents aged 12 to 19 who attempted suicide in 2018 at Khorshid Hospital, Isfahan, Iran. A checklist of the patients’ demographic information, toxicological data, and 2 standard questionnaires, including substance desire (family, personal, social) and child abuse questionnaire (emotional abuse, physical abuse, and neglect abuse), were collected. The data were analyzed using SPSS version 15. Comparisons between the 2 groups were performed using t tests, chi-square tests, regression analysis, and crude model analysis. Odds ratio (OR) and 95% confidence interval were calculated based on logistic regression. A total of 196 teenagers were included in the study, with a mean age of 16.48±1.6 years. Out of these, 155 individuals (79.1%) were female, resulting in a female-to-male ratio of 3.78. There was a significant relationship between gender and alcohol consumption in the personal aspect, as well as between the history of psychiatric diseases and alcohol consumption in the physical aspect (P<0.005). The previous history of suicide was the only variable that showed significance in all aspects of both the substance desire and child abuse questionnaires. History of neglect abuse (OR: 1.2, 95% CI [1.07–1.41]; P=0.009) was a predictive factor for suicide attempt. However, being male (OR: 0.12, 95% CI [0.039–0.37], P=0.000), having no psychiatric history (OR: 0.23, 95% CI [0.10–0.52], P<0.001) and not consuming alcohol (OR 0.33, 95% CI 0.15–0.71, P=0.005) were identified as protective factors for attempted suicide. A public health strategy for suicide prevention includes implementing prevention strategies aimed at reducing risk factors, such as alcohol consumption and the risk of neglect abuse

Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning. The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had attempted suicide by poisoning and were admitted from 2013 to 2023 were included in this study. Different variables, including age, gender, hematological index on admission, hospital stay, and outcome (mortality), were recorded in a data-gathering form. ANOVA and chi-square or Fisher’s exact tests were used for analysis. This study was conducted on 48186 patients, 53.4% of whom were male. The average age of the patients was 34.92 (±13.23). Of all patients, 6% had anemia, 15.1% leukocytosis, 15% higher than average hemoglobin, and 9.1% lower than average platelet count. White blood cell (WBC) count was higher (mean difference=3741.85, SD=151.35, 95% CI=3445.21–4038.5) in deceased patients, while platelet count was significantly lower in deceased patients (mean difference=17.19, SD=2.57, 95% CI=12.14–22.24) (P<0.001). Anemia correlated with more extended hospital stayby an average of 1.61 days (SD=0.27, 95% CI=0.98–2.24) compared to patients with normal hemoglobin. Thrombocytopenia also correlated with more extended hospital stays by an average of 1.38 days (SD=0.21, 95% CI=0.88–1.89). The frequency of abnormal hematological indices was not high in patients with acute poisoning. Deceased patients had higher WBC and lower platelet counts compared to surviving patients. Patients with anemia and thrombocytopenia had more extended hospital stays

Dry bite in snakebite is when progressive local symptoms, systemic manifestations, and laboratory disorders are not seen, generally there is no need for antivenom. The purpose of this research was to investigate the pattern of dry bites and their treatment outcome in the referral center.

In this cross-sectional study, patients with viper bites who were admitted to the poisoning department of Khurshid Hospital in Isfahan from April 2013 to 2019 as dry bites; were studied. Demographic characteristics, local, systemic, and laboratory symptoms of these patients were collected and analyzed.

During this period, 47 patients (33.81% of all snakebites) had dry bites. Bites were more common in men and more in spring and summer, and the north of Isfahan province than in other regions. Snake bites were more frequent in the upper limbs, lower limbs and, trunk, respectively. The most common symptom of the patients was pain at the bite site (63.8%), which improved with anti-inflammatory drugs in 63.8% and without any specific treatment in 36.2% of cases. During hospitalization and follow-up, the patients did not have any complications.

Pain was the most common symptom in hospitalized patients with dry bites caused by viper bites; However, many snakebite patients did not require antivenom. This finding can indicate that pain at the bite site alone does not justify the requirement to receive antivenom.

Today, methanol intoxication is increasing. Identifying mortality predictors has a significant correlation with poisoning progress. This meta-analysis study aimed to identify and evaluate mortality predictors for methanol poisoning.

In this study, we searched electronic databases for case-control and cohort studies related to methanol poisoning. The quality of the studies was evaluated using the STROBE checklist. Comprehensive meta-analysis 3 was used to calculate the odds ratio (OR) and 95% CI of the factors present, as well as to perform heterogeneity, sensitivity, and publication bias assessments.

In this meta-analysis study, 14 out of 945 initial studies were included. The results identified 15 mortality predictors of methanol poisoning. The risk factors were ranked by the integrated OR values and included venous blood pH (OR=3.79, 95% CI, 2.42%, 5.19%), methanol concentration (OR=1.64, 95% CI, 1.05%, 2.55%), venous carbon dioxide pressure (PCO2) (OR=9.993, 95% CI, 5.80%, 17.18%), base deficit (OR=2.943, 95% CI, 1.20%, 7.165%), hemodialysis time (OR=2.69, 95% CI, 1.35%, 5.35%), blood sugar (OR=9.84, 95% CI=3.86, 25.09), venous bicarbonate (HCO3) (OR=2.97, 95% CI, 1.68%, 5.26%), creatinine (OR=13.10, 95% CI, 2.68%, 64.04%), potassium (K) (OR=3.51, 95% CI, 1.66%, 7.43%), alanine aminotransferase (OR=7.57, 95% CI, 1.03%, 55.57%), sodium (OR=6.69, 95% CI, 1.78%, 25.12%), white blood cells (OR=7.16, 95% CI, 1.42%, 36.16%), coma (OR=32.73, 95% CI, 18.59%, 56.70%), visual disturbances (OR=3.37, 95% CI, 1.59%, 7.16%), and gastrointestinal symptoms (OR=1.94, 95% CI, 1.16%, 3.22%).

Identifying mortality predictors and disease progression in methanol intoxication patients can help doctors diagnose patients at risk better and faster to provide effective treatment interventions for them.

Hypoxic encephalopathy in adults is associated with different causes including Cardiorespiratory arrest, shock, and some poisonings such as carbon monoxide poisoning.

In this case series study, all the poisoned patients who had hypoxic encephalopathy based on radiological findings and were admitted to the poisoning department of Taleghani and Imam Khomeini hospitals in Urmia between 2016 and 2016 were included. Demographic characteristics, type of poison, type of poisoning, imaging findings, mortality, and length of hospitalization were extracted from the available files.

A total of 14 patients, all of whom were men, with an average age of 41.21 years, were examined. 64.3% of patients had a history of addiction. 85.7% of poisoning cases were unintentional. The most common intoxicant was methadone (42.6%) and the most common cause of encephalopathy was cardiorespiratory arrest (50%). The most common CT scan finding was diffuse edema and loss of white and gray matter differentiation, and the most common laboratory finding was leukocytosis. The average length of hospitalization was 34.4 days. The mortality rate was 85.7%.

Drug-consuming patients are at risk of overdose and possible occurrence of hypoxic encephalopathy, increasing the length of stay in hospitals, and death.

Gastrointestinal (GI) manifestations of lead poisoning include abdominal pain, constipation, and diarrhea. Depending on the severity of a symptom, surgical consultation is required. The present study aimed to make a comparison between the mean blood lead levels of patients hospitalized for lead toxicity and the various Gl symptoms. A retrospective cross-sectional study was performed in 2020 at Khorshid Hospital, the main regional referral center for poisoned patients (Isfahan, Iran). A total of 82 patients aged ≥18 years who were hospitalized for lead poisoning during 2017-2018 were included in the study. Patients’ information was extracted from hospital medical records, including demographic information, clinical manifestations, blood lead levels, and treatment outcome. The mean age of the patients was 48.18±11.9 years, 91.5% were men, and 62.2% suffered from multiple GI symptoms, with abdominal pain being predominant (31.7%). Blood lead levels in patients with multiple GI symptoms were higher than those with only one symptom (P=0.01). Surgical consultation was required in 14.6% of the patients. Multiple GI symptoms were the main predictive factor for blood lead levels above 70 mg/dL (P=0.03, Odds ratio=3.06, 95% CI=1.09-8.61). Given the prevalence of abdominal pain and its association with elevated blood lead levels, differential diagnosis of abdominal pain should include lead toxicity.

Organophosphorus poisoning is one of the most common and dangerous causes of pesticides poisoning. We compared the clinical manifestations and outcome between organophosphate poisoning patients with and without aspiration pneumonia. We also determined the predictive risk factors for aspiration pneumonia.

This cross-sectional study was conducted at the Poisoning Referral Center in Khorshid Hospital, affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. Patients with organophosphate poisoning aged over 18 years were included in the study from April 2018 to September 2022. To find the predictive factors for aspiration pneumonia, binary logistic regression test was used.

217 patients were evaluated in the study. Most of them were men (62.2%) with an average age (SD) of 38.2 (16.5). Aspiration pneumonia was observed in 11.52% of patients. The mortality rate in two groups with and without aspiration pneumonia was 28% and 3.6%, respectively (P < 0.001). Patients with aspiration pneumonia were older, had higher frequency of addiction and underlying somatic disease (P < 0.05). The frequency of coma, muscarinic symptoms, tremors, decreased blood oxygen saturation and endotracheal intubation on admission were higher in patients with aspiration pneumonia (P < 0.05).

Although the above factors were different between the group with and without aspiration pneumonia, regression analysis showed that only the history of addiction, underlying somatic disease, sweating, miotic pupils, abnormal lung auscultation and endotracheal intubation before or at admission were predictive factors.

Poisoning with super-warfarin, zinc phosphide (ZnP) and aluminum phosphide (ALP) are among the most common poisonings with rodenticides. The purpose of this study was to investigate the frequency of macroscopic and microscopic findings obtained from autopsy in the deceased due to poisoning with these rodenticide poisons.

This cross-sectional study was conducted in 2020 in Isfahan Forensic Medical Center and referral poisoning emergency center in Khorshid Hospital, Isfahan, Iran. The autopsy and pathological findings in the deceased cases due to phosphides and super warfarin poisoning from 21 March 2018 to 20 Feb 2021 were evaluated.

During the study period, 165 patients were hospitalized due to super warfarin and ZnP; and 105 patients with ALP poisoning. Death ‎due to super warfarin was not reported. One patient died due to ZnP poisoning who did not undergo autopsy. 37(35.2%) people died from ALP of which 33 cases underwent postmortem examination. 24 (72.7%) of the deceased were men. And the average age was 29.39 years. In the autopsy findings, pulmonary edema (69.6%) and pleural effusion (21.2%) were the most common findings in ALP poisoning. The pathological findings were liver degeneration, pulmonary edema, and pulmonary hemorrhage. There was a significant relationship between serum bicarbonate on admission and liver autopsy finding. Also time from ingestion to hospital admission was correlated with liver pathology finding.

Considering the prevalence of pulmonary edema and pleural effusion in deceased patients with ALP, guiding fluid therapy by controlling central venous pressure should be considered.

Poisoning is a common cause of referring to poisoning emergencies. The aim of this study was to evaluate the epidemiologic and laboratory findings of household product-poisoned patients.

This was a cross-sectional descriptive-analytical study that was conducted retrospectively. The demographic and laboratory findings of the poisoned patients who were hospitalized in the poisoned emergency department of Khurshid Hospital in Isfahan from March 2016 to March 2020 were collected using the census method. Data analysis was performed using one-way analysis of variance, Chi-square and T-test.

This study analyzed 281 cases of household product-poisoned patients. The mean ± SD age of the patients was 32.95 ± 17.14 (1-83) of whom 48% were men (female to male ratio = 1.08). The most and least common cause of poisoning was pesticide (37.3%) and mercury (0.4%) compounds, respectively. The mean duration of hospitalization was 25.02 hours. The mortality rate was 2(0.7%) which was due to pesticide poisoning. Regarding the trend of Poisoning, we observed 233% increase in 2019 compared to 2016 and 64% decrease in 2020 compared to 2019.

In this study, pesticides and corrosive agents were the most common cause of poisoning. Women were more affected than men. It highlights the importance of emotional and psychological support and educating the correct methods of storing and consuming household chemical products.

Complications or death risk factors is necessary for better monitoring and treatment. The aim of this study was to define the relative risk of toxico‑clinical parameters with regard to poisoning severity and outcomes in patients with acute poisoning.

This cross‑sectional study entailed of patients with acute poisoning admitted to the poisoning emergency center of khorshid hospital, Isfahan, Iran from December 2018 until March 2019. Patients(n = 300) were categorized into four groups(minor, moderate, severe, and fatal poisoning) based on severity. Multivariate logistic regression analysis was employed to calculate the odds ratio (OR) as the estimate of the relative risk of the different variables for the poisoning severity and outcomes prediction.

In the minor group, opioids/opiates, alcohols, and benzodiazepines(14.7%) were the most prevalent poisoning, multidrug (23.3%) was in the moderate and severe groups and finally, pesticides poisoning (23%) was most common in the fatal group. The predictive factors for poisoning severity were pre‑hospital antidote administration [OR, (95%CI); P value) [7.08 (1.77‑28.34); 0.006]; loss of consciousness[4.38 (1.84‑10.42), 0.001]; abnormal ECG [4.56 (1.65‑12.56); 0.003]; and time interval of poisoning to admission in the hospital [1.15 (1.02‑1.28); 0.01). Patients without complications was observed in 49.7% of subjects. Patients with the loss of consciousness [66.06 (2.41‑180.07); 0.01); underlying disease [3.65 (1.09‑12.24); 0.03]; abnormal respiration [1.14 (1.02‑1.27); 0.02); have had a greater risk of complications and death.

Important factors for poisoning severity and/or outcome were loss of consciousness, pre‑hospital antidote administration, abnormal ECG or respiration, underlying disease, and delay to presentation to hospital.

Tricyclic antidepressants poisoning (TCA) is associated with cardiovascular complications, electrocardiographic abnormalities, and central nervous system toxicity. This study aimed to compare the clinical manifestations of poisoned patients with tricyclic antidepressants alone or with benzodiazepine (BZD) intoxication according to the dose of BZDs.

In this case–control study, 120 patients with TCA poisoning were divided into four groups: the first group of TCA poisoning alone, the second group of TCA and BZD poisoning of <7.75 mg, the third group of TCA and B poisoning of 7.75 to 80 mg, and the fourth group of more than 80 mg of TCA and BZD poisoning. Patients’ demographic, clinical, and cardiac information was extracted from their records at admission and 6 h after admission.

Cardiac complications 6 h after referral and total cardiac complications between TCA and TCA low-dose BZD groups were significantly reduced in the low‑dose BZD poisoning group. Comparison of TCA and TCA groups with a moderate dose of BZD showed a significant reduction in time six and total cardiac complications. However, due to the significant difference in TCA values between the two groups, the results are not significant. Comparing the two groups of TCA and TCA with a high dose of BZD, both 6-hour cardiac complications and total cardiac complications in the high-dose BZD group, it was significantly reduced. However, the loss of consciousness was also considerably greater in the high-dose BZD group than in the TCA group.

Concomitant BZDs with TCA can reduce cardiovascular complications from TCA poisoning. However, with high doses of BZDs, there is a greater loss of consciousness.

Selective serotonin reuptake inhibitors (SSRIs) are one of the most common drug classes leading to toxicity. The aim of this study was to evaluate the demographic characteristics, clinical symptoms, and treatment outcome of patients with SSRI poisoning.

In this retrospective cross-sectional study, demographic, toxicological and clinical data were analyzed from the data of patients poisoned with SSRIs in 2019 in the referral poisoning emergency center of Khorshid Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran.

Out of the 6631 poisoned emergency patients, 66 patients (1%) were hospitalized due to SSRI poisonings. The most common poisoning drug was citalopram (39.4%) followed by sertraline (37.9%). The mean age of patients was 25.9 years and most of them were women (90.9%) with intentional poisoning (78.8%). Nausea and vomiting (43.9%) were the most common clinical symptoms. 20 patients (30.3%) had sinus tachycardia, which was mostly related to sertraline (26.7%). Two patients (3%) had seizures with citalopram and only one patient had serotonin toxicity following citalopram ingestion. The mean length of hospital stay was 0.56±1.54. None of the factors investigated was a good predictor for the duration of hospital stay duration.

In this study, the most common SSRIs causing poisoning were citalopram, followed by sertraline. All patients were discharged with supportive measures and with complete recovery, but in order to evaluate the effects of poisoning of these drugs, there is a need for studies in longer periods of time and with larger sample size.

Paraquat (PQ) poisoning is a serious public health concern, especially in developing countries, due to its easy access and lack of awareness of potential harms. No effective treatment has been reported yet. Conventional hemodialysis (HD) is still used in many centers for excreting PQ or reducing acute kidney injury, but there is no consensus on its efficacy. Therefore, we aimed to review the HD efficacy in PQ poisoning mortality.

We searched Web of Science, PubMed, Excerpta Medical Database, Google Scholar, Scopus, Cochrane, Web of Knowledge, Pro?Quest, ScienceDirect, Springer, Clinical Key,  cientific Information Database, Magiran, and Iran?doc, in publications before January 1, 2020. We compared patients who underwent HD (Group 1) with those who did not (Group 2). The outcome was considered mortality/survival. The data were analyzed by Comprehensive Meta?analysis Software.

This systematic review and meta?analysis included five studies with a combined total of 203 patients. The patients in the Group 1 had higher mortality than Group 2 (odds ratio, 2.84; 95% confidence interval: 1.22–6.64; P = 0.02). There was no evidence of publication bias (P value for Egger’s test = 0.833).

Although HD did not affect the survival of patients, other variables such as the amount of ingested PQ, poisoning severity, the time between PQ ingestion and the start of HD, duration, and times of HD sessions may influence the results regarding mortality.

Aluminum phosphide (ALP) (rice-tablet) is a common cause of adult poisoning in Iran, including Isfahan. So far, no effective treatment has been identified for this poisoning. We aimed to investigate the outcome of ALP poisoned patients admitted to the clinical toxicology ward of Khorshid Hospital in Isfahan from 2017 to 2019.

This chart-review study was performed on the population of ALP poisoned patients admitted to the clinical toxicology ward of Khorshid University Hospital from 2017 to 2019 treated with the hospital’s new treatment protocol, using the complete enumeration approach. The outcomes were determined by reviewing and abstracting medical charts of ALP poisoned patients from the hospital archive.

The most common complaints at admission were depressed consciousness (41.9%) and vomiting (32.2%). There was no significant change in blood sugar, pH, base excess (BE), and venous blood bicarbonate throughout their hospitalization (P > 0.05). Treatment outcomes had a significant relationship with blood pH 2 h and 6 h after admission and the BE 6 h after admission (P < 0.05). There was also a significant relationship between the outcome and the length of stay, initial ejection fraction (EF), and EF in predischarge echocardiography (P < 0.05). Out of 31 patients, 24 (77.4%) died within 72 h, 5 (16.1%) recovered without any complication, and 2 (6.5%) recovered with some complications.

The mortality rate of ALP poisoned patients was reasonably high and can be attributed to the poor efficacy of the new treatment protocol or the long time it takes for patients to reach the hospital and start receiving treatments.

Lead poisoning was on the rise in recent years. There exists a lack of easy access to some of the main chelator drugs in developing countries. Thus, this study aimed to explore the comparative effects of Succimer and D-Penicillamine on acute lead poisoning patients from 2013 to 2018.

This descriptive study was conducted in the Clinical Toxicology Department of Khorshid Hospital in Isfahan City, Iran. Adult patients with acute lead poisoning were included in the study. Patients in the 3 treatment groups of D-Penicillamine, D-Penicillamine with succimer, and succimer were compared concerning demographic characteristics as well as clinical and laboratory findings at admission time and two weeks later.

In total, 163 patients were evaluated in this research. There was no significant difference between the treatment groups respecting improvement in clinical symptoms. The mean blood lead levels during hospitalization and two weeks after the treatment did not significantly differ between the three groups; however, there was a significant reduction in all study groups after two weeks of treatment (P<0.05). The mean white blood cell count was significantly lower only in the D-Penicillamine group two weeks after hospitalization (P<0.05). In the D-Penicillamine group, the mean platelet, hematocrit, and hemoglobin levels were significantly lower two weeks after hospitalization, although within the healthy range.

D-Penicillamine may be an acceptable chelator drug for treating patients with acute lead poisoning, especially in communities without access to drugs, like succimer.

Patients with acute poisoning sometimes require hospitalization in the Intensive Care Unit (ICU). The correct admission of these patients has resulted to lower mortality. This study compared the characteristics of adult patients with acute poisoning who were admitted to the poisoning ward and the ICU. We also determined the relevant outcome predictive factors.

This cross-sectional study was conducted on adult acutely poisoned patients who were admitted to the emergency room of Khorshid Hospital affiliated with Isfahan University of Medical Sciences from October 2018 to 2019. The clinico-epidemiological variables and outcomes were compared between adult patients hospitalized in the ward (n=100) and ICU (n=100). Binary logistic regression was used for predicting the outcome factors.

The Mean±SE age of the study patients in the ICU and ward were 36.6±1.62 (median: 34) and 34.20±1.19 years, (median: 33, P=0.23), respectively. There was no significant difference between the study groups respecting substance dependence, alcohol and drug abuse, disease history, and the type of exposure (P>0.05). However, self-mutilation, the kind of substance, the vital signs and level of consciousness at admission, and outcomes were significantly different between the research groups (P<0.05). Variables predicting outcomes (complication/death) were as follows: gender (male) (OR: 4.51; 95%CI: 1.51-13.42; P=0.007), the kind of substance (pesticides) (OR: 8.84; 95%CI: 1.78-44.07; P=0.008), time to admission (OR: 1.04; 95%CI: 1.02-1.08; P=0.002), hypotension (OR: 14.88; 95%CI: 3.01-71.58; P=0.001), and the place of hospitalization (ward) (OR: 2.85; 95%CI: 1.23-6.62; P=0.01).

The self-mutilation, kind of substance, vital signs, level of consciousness at admission, and outcomes were significantly different between the study patients hospitalized in the ICU, compared to the ward. Gender (male), the kind of substance (pesticides), delayed arrival times, hypotension, and the place of hospitalization (ward) were essential factors for outcome (complication/death) prediction.

Alcohol consumption leads to a significant number of deaths, mostly in men, worldwide. Considering the effect of ethanol toxicity on the heart, we studied various Electrocardiographic (ECG) changes in patients with acute ethanol poisoning.

A cross-sectional study was performed on patients admitted to Khorshid Hospital (affiliated to Isfahan University of Medical Sciences) due to ethanol poisoning. All 15- to 50-year-old patients with acute ethanol intoxication were included in the study (N=250). The patients’ information, including the demographic characteristics, clinical manifestations, and ECG changes were recorded and analyzed. Different variables were compared between the patients with or without ECG changes.

Most of the research patients (n=208) were men (83.82%). The Mean±SD age of the study patients was 26.8±8.87 years. About 54.8% of the patients presented abnormal ECG. The changes in ECG were not significantly different based on the demographic characteristic and clinical manifestations. The time interval between ethanol consumption and admission was significantly higher in patients with abnormal ECG, compared to those with normal ECG (Mean±SD: 7.09±10.67 vs. 4.77± 4.54 hours, respectively) (P=0.03).

ECG changes are common in patients with ethanol poisoning. The time interval between ethanol consumption to hospital admission may be an important factor in the occurrence of ECG changes.

Emergency Medical Service (EMS) has an important role in the management of patients with opioid poisoning. Proper administration of naloxone is life-saving in these patients. We performed a study to compare the correlation between naloxone prescribed by the EMS and poisoning emergency physician in hospital for patients with opioid poisoning.

Patients with opioid poisoning referred by EMS to the poisoning emergency room of Khorshid Hospital affiliated to Isfahan University of Medical Sciences, Iran, from April 2016 to March 2017 were evaluated for toxico-epidemiological factors and outcome.

Out of 340 patients studied, 80% were men. Poisoning with methadone (33.3%) and opium (23.2%) were the most opioid poisoning. 47.9% of patients were drowsy after administration of naloxone by EMS, 35.9% were fully conscious, and 3.5% were restless. There was a significant difference in blood oxygen saturation between the two groups receiving and not receiving naloxone by EMS (P = 0.02). The mean age of patients receiving naloxone by EMS and hospital emergency service was higher than patients not receiving naloxone. There was a strong correlation between naloxone administration by EMS and in the hospital (r = 0.77; P < 0.001). Kind of opioid (opium) and patient’s age (more than 40 years) predicted the naloxone administration by EMS and in the hospital. All patients recovered completely.

There was a strong correlation in naloxone administration between EMS and emergency service in hospital. Due to the high average age of patients receiving naloxone, more attention to prevent possible side effects of naloxone is recommended.

Digoxin is extensively prescribed for cardiac diseases, so its chronic or acute toxicity commonly occur. Although digoxin specific antibodies (anti-digoxin Fab) are recommended to be used in patients with cardiac symptoms of digoxin toxicity, there is ongoing controversy about the effectiveness and dose of anti-digoxin Fab. Because our department lacks access to anti-digoxin Fab and the high cost of the antidote, we evaluated 10 years of experience in treating patients with digoxin toxicity without using digoxin Fab antibodies considering outcomes.

A retrospective study was performed in Khorshid Hospital, affiliated with Isfahan University of Medical Sciences, from October 2008 to September 2018. Patients with acute or chronic digoxin toxicity were included in the study. The patients’ data were gathered and analyzed according to their medical documents.

Out of 150 cases with digoxin toxicity, 38% (n=57) were acute and 62% (n=93) were chronic. About 64.7% (n=97) were female. The most common non-cardiac manifestations of toxicity were gastrointestinal (67.3%, n=101) and neurological symptoms (52.7%, n=79). Bradyarrhythmia (80.5%, n=33) was the most cardiac manifestation in patients with acute (15.8% n=9) and chronic (25.8%, n=24) toxicity. A total of 144 (96%) cases fully recovered with supportive care, and 6 patients (4%) died. None of the cases received anti-digoxin Fab.

The majority of presentations with acute or chronic toxicity recovered with supportive measures without using anti-digoxin Fab

We aimed to find the toxicoepidemiological indicators of tramadol poisoning in children and also the relationship of these indicators (such as demographic characteristics, and referral time) with the final therapeutic outcome.

In this cross‑sectional study with retrospective data collection, we included the records for all the patients under 18 that have been admitted due to tramadol poisoning between 2010 and 2015 to Noor and Ali‑Asghar (PBUH) University hospital which serves as the referral medical center for acute poisonings management in the central part of Iran and is located in Isfahan. Demographic characteristics, ingested dose, dosage forms, clinical manifestations, coingested drugs, and the outcome of treatment for all pediatric patients were documented and descriptively analyzed.

Demographic and clinical data of a total of 189 patients including 101 male (53.4%) with a mean age of 16.66 ± 2.64 years were abstracted and included in this study. The average time between tramadol ingestion and hospital admission was 3.39 ± 3.23 h. Mean duration of hospitalization was 12.3 ± 10.7 h. In all cases, the route of drug exposure was oral, and the most common form of drug dosage form was 100 mg tablets (n = 122) proceeded by 200 mg tablets (n = 32). The mean estimated dose of ingested tramadol was 1126 ± 1061 mg (median, 900 range, 50–7000 mg). 43.9% of the poisoned patients were high school students, and 23.3% had a high school diploma. Intentional intoxications were reported in 93.1% cases and 42.9% had coingestions. Activated charcoal (87.3%), gastric lavage (59.3%), oxygen therapy with mask (46.6%), naloxone (11.6%), anticonvulsants (13.2%), and intubation and ventilation (5.3%) were done as first‑line therapeutic measures.

Our results suggest that the trend of acute tramadol poisoning among children is decreasing, mostly accidental in adolescents and commonly intentional among young children. Proper education to improve emotional intelligence for young adults and to keep drugs out of reach of the children and safer packaging is recommended to reduce tramadol poisoning incidence in the pediatric population.

The trend of methadone toxicity in children and adolescents seems to be increasing in Iran since it is used as a legal measure of the treatment for opioids addiction in methadone maintenance therapy clinics. In the present study, we describe the clinical and demographical characteristics of acute methadone toxicity in a cohort of pediatric poisoned patients in Isfahan, Iran and discussed the predictive factors for their treatment outcomes.

In this 4-year cross‑sectional study which was performed from 2013 to 2016 in a referral university hospital (Isfahan, Iran), medical records of the demographic and admission time clinical characteristics of all in‑patients aged <18 years with acute methadone poisoning were abstracted and analyzed. According to the outcomes of hospital care and treatment, patients were divided as survived without medical complication and patients survived with at least one medical complication or death.

A total number of 157 (79 male) children and adolescents with a mean age of 105.4 ± 6.1 months were hospitalized and included in the study. A total of 145 (92.4%) patients survived and discharged from the hospital without any medical complication. Pupil size, respiratory rate, and level of consciousness were predictive factors for the outcome of death or medical complications.

It seems that methadone poisoning in children and adolescents is more commonly accidental in school‑aged boys (6–12 years old) and it occurs mostly with the syrup dosage form, especially when one of the parents or people who live with the child has an addiction history and if the patients’ house located in lower socioeconomic class area of Isfahan city (Iran).