فهرست مطالب shahin shadnia

The objective of this study was to propose a model for examining the impact of inward internationalization on outward internationalization in Iranian pharmaceutical companies by focusing on organizational capabilities.

Qualitative research was employed, and the grounded theory approach was utilized for data analysis. The study involved conducting interviews with 16 individuals who possessed experience in international activities within the pharmaceutical sector and expertise, using the snowball sampling method. The data gathered from the interviews underwent open, axial, and selective coding analyses, resulting in the development of a paradigm model of internationalization within the pharmaceutical industry. The paradigm model is composed of causal conditions, background conditions, intervening conditions, central phenomena, strategies, and consequences.

The research findings indicated that causal factors of internationalization encompass learning from other countries, updating medical and technical knowledge, expanding activities beyond domestic markets, facilitating production quality improvement, and promoting growth within the pharmaceutical industry. Strategies for internationalization include adopting an international perspective, implementing effective macro-level policies, utilizing long-term strategies, enhancing workforce professional capabilities through training, improving standards and documentation, devising strategies for rational budget utilization, planning for optimal capacity utilization, and strengthening international communication and political relationships.

Ultimately, the consequences of inward internationalization and the enhancement of organizational capabilities lead to outward internationalization and a favorable position within the global pharmaceutical industry, improvements in organizational capabilities and international relations, development of cross-border business, economic prosperity within the pharmaceutical industry, and heightened commitment to foreign markets.

Alcohol toxicity is a significant medical emergency with implications for patient management and outcomes. This single-blinded randomized intervention study investigated the effects of oral probiotics on various laboratory parameters in patients with acute alcohol toxicity.

A total of 30 eligible patients were randomly assigned to either the control (placebo) or intervention (oral probiotics) group.

While the study did not reveal a significant impact on the length of hospital stay (LOHS), it did demonstrate notable improvements in laboratory variables, including pH, serum glutathione level, serum vitamin B6 level, and O2 saturation, in the probiotic group.

These findings suggest the potential benefits of probiotics in mitigating certain aspects of alcohol toxicity.

Nowadays, erythropoietin is employed as a substitute therapy for eye ailments, particularly optic nerve damage induced by methanol toxicity. Despite its benefits, erythropoietin can have negative effects on blood factors. These effects may include thrombosis, stroke, seizures, and changes in hematological function. This study examined the adverse effects of erythropoietin on individuals suffering from optic neuropathy caused by methanol.

This study was a prospective descriptive study at Loghman Hakim Hospital, Tehran City, Iran, in 2022. The study involved individuals who suffered from methanol poisoning and were administered erythropoietin twice a day for three days, with a dosage of 10000 units each time. Patients were examined up to 6 weeks after discharge in terms of increased hemoglobin levels, seizures, central vascular thrombosis, and heart attack or stroke. The data was analyzed by SPSS software, version 18.

The study comprised of 37 patients. No patient reported seizures, heart and cerebral strokes, and deep vein thrombosis except polycythemia. After being discharged from the hospital, the mean hemoglobin levels increased by 2.01% six weeks later compared to the levels measured during admission. Moreover, there was a 2.4% rise in hemoglobin levels six weeks after discharge when compared to the levels measured two weeks after being discharged.

Using erythropoietin to treat optic neuropathy can improve vision, but it also carries the risk of increasing hemoglobin levels, which must be monitored closely in treated patients.

Benzodiazepines have been highly prescribed by physicians and have attracted public attention due to their high safety. These drugs have sedative, hypnotic, anti-anxiety, and anti-seizure properties. However, these drugs are also widely used for suicide. The present study was designed and implemented to determine the distribution of patients poisoned with benzodiazepines in terms of clinical and demographic characteristics.

Investigation of poisoning with benzodiazepines in one year in the poisoning department of Loghman Medical Center in Tehran City, Iran, was carried out as a descriptive-prospective study. In this research, 458 poisoned patients were studied to collect data on their age, gender, drug dosage, type of drug, duration of hospitalization, blood analysis results, and mortality.

The majority of patients poisoned with benzodiazepines were women (62.2%). The mean age of people was 31.67 years. The most frequently used drugs were clonazepam and alprazolam. Other drugs used with benzodiazepines were propranolol, methadone, and acetaminophen. The death rate was 1.7%. The incidence of hypoglycemia and creatinine above 1.3 was 8.53% and 11.3%, respectively. Hyperglycemia was 10.6%. There were 11, 80, and 178 cases of elevated alanine transaminase, aspartate aminotransferase, and alkaline phosphatase, respectively.

Benzodiazepines have the potential to cause liver and kidney damage and changes in insulin secretion and blood sugar. This issue should be considered when dealing with a poisoned patient to prevent serious injuries.

Methanol is a toxic alcohol for the human body. The molecular biology of methanol metabolites affecting different organs, such as the brain, is under investigation. This systematic review aimed to consider methanol toxic molecular biology, based on the original articles obtained from data banks to figure out recent achievements.

Scientific articles regarding the toxic effects and metabolites of methanol on the central nervous system (CNS) were collected from valid databases and classified based on their validity. Exclusion criteria were articles with duplicates, no available full text, review articles, case reports, and letters.

Current metabolic reactions were addressed in the development of CNS diseases, such as optic neuropathy, basal ganglia lesions, and Alzheimer’s disease. However, proteomic investigations introduced new metabolic changes, and serum proteins regarding blood coagulation, vitamin A metabolism, and immune responses were suggested for early detection of toxicity.

Besides CNS disorders introduced for methanol toxicity, there is no exact proteomic serum marker to diagnose toxicity soon; however, the interleukin-1 beta system is suggested as a candidate, and more investigation is required to improve its competency.

Many studies have investigated the rate of suicide attempts and their risk factors during the coronavirus disease 2019 (COVID-19) pandemic; however, the results are still challenging.

This study investigated and compared the risk factors effective in suicide attempts during the pandemic period and one year before.

This case-control study was conducted at Loghman Hakim hospital, Tehran, Iran. Random sampling included all patients in the inpatient ward who were over 12 years of age and committed suicide during the pandemic within October 1, 2021, to August 30, 2022 (case group; n = 160) or one year before within March 11, 2019, to March 11, 2020 (control group; n = 160). Demographic information, mental-psychological status, and socioeconomic status (SES) of the patients in the case group, before and after the COVID-19 pandemic, were recorded during face-to-face interviews using a predesigned semi-structured questionnaire by study staff trained and supervised by a clinical psychiatrist. Additionally, the data of the patients in the control group were retrospectively recorded during the review of medical records and telephone interviews. The Wilcoxon signed-rank test was used to compare the variables in the case group before and after the COVID-19 pandemic. The Student’s t-test and chi-square test were used to compare the variables between the case and control groups. Additionally, to determine the risk factors predicting suicide attempts during the pandemic, a multivariable logistic regression test was used. The data were analyzed using PASW18 software.

The results showed that the patients in the case and control groups had significant differences in terms of age (P = 0.01), underlying mental disorders (P = 0.032), and parental relationship (P = 0.001). Moreover, the variables of suicidal ideation (P = 0.002), feeling lonely (P = 0.023), sleep disorder (P = 0.32), and domestic violence (P = 0.004) in the case group were significantly higher than the control group. In addition, the comparison of these variables in the patients of the case group, before and after the COVID-19 pandemic, showed that the start of the pandemic triggered these factors and led to an increase in suicide attempts in this population. Finally, the logistic regression analysis showed that the variables of SES, having a close friend, parental relationship, previous planning for suicide, domestic violence, andjob loss could be considered predictive risk factors for suicide attempts during the pandemic period.

According to the present study’s findings, the psychological and socioeconomic conditions triggered by the COVID-19 pandemic led to an increased likelihood of suicidal ideation or attempts in vulnerable individuals.

Aluminum Phosphide toxicity is a common deliberate toxicity, and due to no specific antidote available for its treatment, most toxicity leads to death. The present study aimed to evaluate the efficacy of Hyper Insulin Euglycemia protocol in combination with vitamin E and N-Acetyl Cysteine in patients with acute ALP poisoning treatment. In this incidental prospective clinical trial, 76 individuals with toxicity were enrolled and assigned into two groups: One treatment group undergoing by glucose, insulin, and potassium() administration in combination with vitamin E and N-Acetyl Cysteine,  and one control group who were mainly managed by supportive treatments. Signs and symptoms at arrival and during hospitalization, complications, and outcomes were recorded and compared between these two groups to find any possible effect of, vitamin E, and protocol for toxicity treatment. This study investigated the mortality and safety of therapy in 76 poisoning patients with an average age of 28. The mortality rate in the group was 26% lower than in the control group (p-value: 0.058). Furthermore, this research detected a significant rise in systolic blood pressure during hospitalization in the treatment group. Regarding pH and bicarbonate levels, the group showed less metabolic acidosis. In contrast to the case group, the therapy group's bicarbonate levels significantly increased throughout hospitalization. Using the, vitamin E, and protocol accompanied by Symptomatic and supportive treatments in acute ALP toxicity among the treatment group of this study resulted in a significant increase in systolic blood pressure,  longer hospitalization duration, and lower death rates.

Rhabdomyolysis is a clinical syndrome accompanied with biochemical changes that is diagnosed in some patients with acute chemical or drug poisoning. In this regard, the present study aimed to evaluate the effects of Montelukast in the treatment of intoxication-induced rhabdomyolysis.

This single-blind randomized clinical trial study was conducted in Loghman Hakim Hospital from March 2021 to March 2022. The study participants were 60 individuals evenly distributed into experimental and control groups. The experimental group received Montelukast plus routine treatment and the control group Creatine phosphokinase (CPK), urea, creatinine, aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were monitored daily in both groups for seven days. The variables of age, gender and history of diabetes mellitus and kidney diseases were recorded.

The mean age was 39.9 ± 16.87 and 38.2 ± 16.3 years in the control and intervention groups, respectively. Montelukast significantly (P < .05) reduced CPK levels on days five and seven, urea on days three, four, five and seven, and creatinine on days two to seven. The AST and ALT levels, unlike the control group which has a decreasing trend, increased first in the Montelukast group and then decreased on the sixth and seventh days.

The results showed that Montelukast effectively reduced CPK, urea and creatinine levels, as well as the recovery time in patients with poison-induced rhabdomyolysis. In other words, Montelukast is effective in the treatment of rhabdomyolysis.

Even though naloxone is the main treatment for methadone poisoning treatment there are controversiesabout the proper method of its tapering. This study aimed to compare two methods in this regard.

Thisstudy was a prospective, single-blind pilot quasi-experimental study on non-addicted adult patients poisoned withmethadone. Patients were randomly divided into 2 groups. In one group, after stabilization of respiratory conditionsand consciousness, naloxone was tapered using the half-life of methadone and in the other group, naloxone was taperedusing the half-life of naloxone. Recurrence of symptoms and changes in venous blood gas parameters were comparedbetween groups as outcome.

52 patients were included (51.92% female). 31 cases entered Group A (taperingbased on methadone’s half-life) and 21 cases entered Group B (tapering based on naloxone’s half-life). The two groupswere similar regarding mean age (p = 0.575), gender distribution (p = 0.535), the cause of methadone use (p = 0.599),previous medical history (p = 0.529), previous methadone use (p = 0.654), drug use history (p = 0.444), and vital signson arrival to emergency department (p = 0.054). The cases of re-decreasing consciousness during tapering (52.38% vs.25.81%; p = 0.049) and after discontinuation of naloxone (72.73% vs. 37.50%; p = 0.050) were higher in the tapering basedon naloxone half-life group. The relative risk reduction (RRR) for naloxone half-life group was -1.03 and for methadonehalf-life group was 0.51. The absolute risk reduction (ARR) was 0.27 (95% confidence interval (CI) = 0.01-0.53) and thenumber needed to treat (NNT) was 3.7 (95% CI= 1.87- 150.53). There was not any statistically significant difference be-tween groups regarding pH, HCO3, and PCO2changes during tapering and after naloxone discontinuation (P > 0.05).However, repeated measures analysis of variance (ANOVA), showed that in the tapering based on methadone’s half-lifegroup, the number of changes and stability in the normal range were better (p < 0.001).

It seems that, bytapering naloxone based on methadone’s half-life, not only blood acid-base disorders are treated, but they also remainstable after discontinuation and the possibility of symptom recurrence is reduced.

The present study was conducted to determine the prevalence of acute iron poisoning among patients in a referral poison control center located in Tehran. It also studied their clinical profile, treatment, and outcome. This retrospective cross-sectional study was conducted on acute iron poisoned patients, who were admitted to the poison center from March 21, 2015 to March 19, 2020. Some background variables such as age, gender, ingested dose, time interval between onset of poisoning to hospital admission, the need for antidote, clinical presentations, paraclinical findings and outcome of poisoning were extracted from patients’ medical records. Data analysis was carried out using SPSS software.  A total of 74 patients with acute iron poisoning with a mean age of 16.85 ± 11.97 years included in this study. Sixty-one (82.4%) patients were female and the most affected age group was 19-30 years (35.1%). The ingestion dose median in patients under 18 years old was 2450 (IQR=5600, Min= 120, Max= 30000) mg and in the group over 18 years old it was 9000 (IQR= 11125, Min= 600, Max= 30000) mg. Vomiting (66.2%) and lethargy (24.3%) were the most common clinical presentations on admission. Metabolic acidosis was the most common abnormality in blood gas analysis (43.2%). Positive findings in abdominal radiography have been observed in 4 (5.4%) cases. The serum iron concentration in the patients were 259.54 ± 153.96 μg/dL. Moreover, mortality was reported in one case (1.3%). There was a significant difference between the age of the patients whom received deferoxamine and more patients under 18 years of age received the antidotal therapy (p=0.003). The present study showed a low mortality rate among the acute iron poisoning patients. From this view, it can be concluded that adults have lower mortality rates than children.

Aluminum phosphide (AlP) is an effective fumigant and rodenticide which is a commonly used agent for suicide in parts of developing countries. AlP poisoning results in serious manifestations involving many vital organs and it has high mortality. Electrolyte and metabolic abnormalities including metabolic acidosis is a common problem in AlP poisoning. 

Case report:

 Here, we report two cases of AlP poisoning who take AlP tablets intentionally. The therapeutic intervention initiated for both of them including glucose, insulin, and potassium (GIK) protocol, antioxidants agents, intravenous magnesium, intravenous calcium, and norepinephrine. The arterial blood samples obtained in a serial manner and interestingly it showed no abnormality.

This is first cases of AlP poisoning with normal acid base balance which emphasis the importance the early initiation of therapeutic intervention

Suicide is one of the most important psychological emergencies and it is necessary to deal with it. The goal of this study was to evaluate the frequency of suicide attempts, suicide re-attempt, and guesstimated risk factors in suicidal patients in the poisoning ward of Loghman Hakim Hospital.

This study was performed on suicidal patients in Loghman Hakim hospital in 2021 (January to August). The suicide attempt and the type of mental disorder were confirmed by a psychiatrist and the data sheets were completed. The sample size was 500 cases based on previous similar studies.

Three hundred fifteen cases attempted suicide for the first time and 185 had a history of suicide. In both groups, the numbers of women were significantly more than men. In addition, 196 cases of the first group and 121 cases of the second group were under 30 years old and 65.1% of cases with first-time suicides and 62.2% of cases with suicide re-attempts were unemployed. In both groups, the most common drug for suicide was benzodiazepines (30.5% and 21.6%). Unfortunately, two patients died. Also, 67.6% in the first-time suicide attempt group and 57.3% in the suicide re-attempt group had adjustment disorder. No significant differences were observed between both groups in terms of gender, age, marital status, education, chronic disease, drug and habit history, employment status, diagnosed mental disorder, and type of drug used for the current suicide.

Young age, unemployment, mental disorders (especially adjustment disorder), and female gender are the most important risk factors for a suicide attempt and re-attempt.

Organophosphates are among the most common causes of poisoning worldwide—responsible for 3 million poisoning and 200000 deaths every year. Nearly 15% of people who are poisoned die. This cross-sectional toxicological/clinical study aimed to investigate the prevalence and influential factors in the incidence of delayed peripheral neuropathy and intermediate syndrome in acute poisoning with organophosphorus toxins. The study was conducted in Loghman Hakim Hospital, Tehran City, Iran, from 2017 to 2020.

The study data were obtained from the patients’ records during follow-up. Data included demographic information (age, sex, etc.), vital signs, muscarinic, nicotinic, and neurological symptoms at admission, atropine therapy status, and pralidoxime intake status. Post-discharge complications were obtained, and patients’ Electromyography (EMG) and Nerve Conduction Velocity (NCV) results were recorded and evaluated during hospitalization and follow-up. Statistical analysis was performed using SPSS software, version 22.

Of 63 studied patients, 61.9% were female. The Mean±SD age of the patients was 31.90±13.128 years. Male patients were significantly (P<0.010) older than female ones. The most common muscarinic symptoms were nausea and vomiting (73.2%), diarrhea (34.92%), and abdominal pain (33.33%). Regarding the nicotinic symptoms, sweating (30.16%) and fasciculation (19.05%) were the commonest. Neurological complications were less common; seizures were observed in 3 cases (4.76%) and coma in 2 cases (3.17%). Most patients (79.4%) received pralidoxime with atropine. The Mean±SD days of treatment with atropine and pralidoxime were 5.51±3.52 and 4.06±4.62 days, respectively. Only one death was recorded. The results of the initial EMG-NCV test on the second day of hospitalization showed abnormalities in 4 patients (6.3%), indicating the presence of the intermediate syndrome.

The results of the EMG-NCV tests at our patients’ follow-up (30 days) showed no abnormalities. Hence no cases of delayed neuropathy were seen. During hospitalization, one patient had flaccid paralysis and showed significant impairment on the EMG-NCV test (P<0.01).

Tracheal intubation is a life-saving measure in patients poisoned acutely with opioid, and when naloxone treatment is inadequate. This study determined the risk factors for early unplanned extubation in these patients and evaluated the effects on the clinical outcomes.

At a poisoning center in Tehran, Iran, 165 opioid overdose patients who were admitted to the intensive care unit and intubated between September 2019 and March 2020 were enrolled into this study. Patients were categorized in two groups: a) those extubated based on the physicians’ decision, and b) those who were extubated by self or were accidentally. The two groups were compared regarding their clinical outcomes and complications during hospitalization. In addition, the re-intubated patients in both groups were compared to those with successful intubation regarding the predisposing factors and mortality. 

Of these patients, 36 (21.8%) died before extubation, and planned extubation was performed in 109 of them (84.5%). Unplanned extubation occurred in 20 patients (15.5%). Agitation, elevated temperature (>38.5ºC), and insufficient nursing care were the independent risk factors for the unplanned extubation. 6(5.5%) and 3(15%) patients died following the planned and unplanned extubation, respectively, and 24 patients required reintubation. Patient transfer, succinylcholine use, aspiration pneumonia, presence of brain injury, and insufficient nursing care were independent risk factors for re-intubation.

Among the patients with high drug dependency, higher doses of sedatives were needed to avoid self-extubation. Infection control and sufficient nursing care were factors that led to better clinical outcomes for extubation in these patients.

Opioids have been the leading cause of death from poisoning in Iran for several years. This studyaimed to evaluate the clinical and para-clinical presentations of naltrexone intoxication, its toxic dose, andits epidemiological properties.

This retrospective cross-sectional study was conducted on medicalrecords of patients presenting to Toxicology Department of Loghman Hakim Hospital, Tehran, Iran, followingnaltrexone intoxication, from 2002 to 2016. Patients’ demographic and laboratory data, clinical signs, supposedingested dose, and intent of naltrexone consumption were collected, analyzed, and then interpreted.

907 patients with the mean age of 36.6 ±11.7 years were evaluated (94.3% male). The mean amount of naltrex-one consumed by the intoxicated patients reported in the medical records was 105.8 ± 267.8 mg. One hundredthirty patients (14.3%) used naltrexone to treat substance use disorder. Two hundred eighty-seven poisoned pa-tients (31.6%) were current opium users who intentionally or unintentionally used naltrexone concomitantly.The most common symptoms observed in these patients were agitation (41.8%), vomiting (16.4%), and nau-sea (14.8%). Among patients with naltrexone poisoning, 25 patients were intubated (2.8%), and three passedaway. Aspartate aminotransferase (AST) levels were significantly higher in patients intoxicated with naltrexonewho needed intubation (p = 0.02).

The probability of intubation of cases with naltrexone intoxica-tion was associated with AST elevation. It seems that, the number of intensive care unit (ICU) admissions andmortality rates are not high among these patients.

Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020.

This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient’s files and analyzed with appropriate statistical tests.

Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients.

Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication

The prevalence of poisoning is on the rise in Iran. A poisoning registry is a key source of information about poisoning patterns used for decision-making and healthcare provision, and a minimum dataset (MDS) is a prerequisite for developing a registry.

This study aimed to design a MDS for a poisoning registry.

This applied study was conducted in 2021. A poisoning MDS was developed with a four-stage process: (1) conducting a systematic review of the Web of Science, Scopus, PubMed, and EMBASE, (2) examining poisoning-related websites and online forms, (3) classification of data elements in separate meetings with three toxicology specialists, and (4) validating data elements using the two-stage Delphi technique. A researcher-made checklist was employed for this purpose. The content validity of the checklist was examined based on the opinions of five health information management and medical informatics experts with respect to the topic of the study. Its test-retest reliability was also confirmed with the recruitment of 25 experts (r = 0.8).

Overall, 368 data elements were identified from the articles and forms, of which 358 were confirmed via the two-stage Delphi technique and classified into administrative (n = 88) and clinical data elements (n = 270).

The creation of a poisoning registry requires identifying the information needs of healthcare centers, and an integrated and comprehensive framework should be developed to meet these needs. To this end, a MDS contains the essential data elements that form a framework for integrated and standard data collection.

Methanol poisoning is a life-threatening condition that requires accurate prognosis and treatment. This study aims to evaluate the predictive value of laboratory and clinical variables in methanol poisoning.

This was an observational retrospective study performed on patients with methanol poisoning. Variables were determined based on the literature review, and patient data were extracted from the patient’s file. The data was analyzed by SPSS software.

There were significant differences between survived group and the dead group in GCS, heart rate, PH and HCO3, serum potassium, serum creatinine, and blood sugar levels, neurological symptoms, requiring intubation, and hemodialysis. Significant differences were not observed in the number of hemodialysis sessions, respiratory rate, age, gastrointestinal symptoms, and PCO2 levels between survived and non-survived groups.

In our study, mortality was significantly associated with low GCS, high heart rate, low PH and HCO3, high potassium, creatinine, blood sugar levels, neurological symptoms, intubation, and hemodialysis. Despite other studies in this study, there was no association between the number of hemodialysis sessions, respiratory rate, age, gastrointestinal symptoms, and PCO2 levels with mortality.

In acute and chronic phases of severe diseases, endocrine changes occur. Some hormones, such as prolactin (PRL) and thyroid hormones, were considered predictors of ICU patients' outcomes. The present study evaluates thyroid hormone profile, serum PRL level, and their relationship with ICU poisoned patients' mortality rate. This study included 140 inpatients in the Toxicology Intensive Care Unit (TICU) who enrolled in a prospective study of a single center and observational. After admission to the ICU, the researchers collected venous blood samples from all patients directly. Concurrently, the APACHE II score was calculated. The collected samples analysis was performed based on the entire triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and PRL level. One hundred and forty subjects were studied, of which 109 (75.85%) were male with a mean age of 34.17 ± 14.01. One hundred and eighteen patients were survivors with a mean age of 33.29 ±13.76. In contrast, 22 patients with a mean age of 38.91 ±14.69 died. The model of PRL combined with APACHE II score (OR 1.17, 95% CI 1.06 to 1.28, P-value =0.001) was the best model for predicting post-ICU mortality in our study. This study’s results are consistent with the previous research, indicating a higher incidence of thyroid and PRL hormone changes in patients hospitalized in the ICU.   It can be concluded that the presence of PRL based on the APACHE II score can lead us to be more precise in predicting the outcome of poisoning in hospitalized patients.

Poisoning is a common condition worldwide that requires precise evaluation of the quality and rapid management. Registry plays an essential role in the management of toxins. This study aimed to examine the features and processes of poisoning registries.

This review study was conducted in 2020. Several searches were conducted in the following scientific databases: PubMed, Scopus, Embase, and Web of Science using a combination of keywords, such as “data management, registry, poison, and toxic”. The review of titles, abstracts, and full-text of the selected articles was independently performed by two researchers. Besides, the obtained data were analyzed based on the research objectives by the content analysis method.

Some critical features of registries were considered the confidentiality of patients’ information, i.e., equipped with various technologies, such as Geographical Information System (GIS), warning systems, searches, and text retrieval tools. The most common sources of case findings were self-reported contacts by individuals and healthcare professionals to poison control centers. Moreover, the main tool for data collection was electronic forms. The major indices of data quality were the accuracy, completeness, and consistency of the data. Phone calls were usually made at follow-ups.

The registry’s features and processes are an essential and fundamental step to achieve the registry goals, as well as designing and developing these systems. It is recommended that the registries be equipped with various technologies to better manage the exposure cases. It is recommended to use educational, incentive, competitive, participatory, and motivational mechanisms among all organizations and individuals involved in poisoning registry programs.

The overdose of illicit drugs is not always fatal but can lead to various complications. One of the unusual medical complications is a sensorineural hearing loss (SNHL). There are multiple case reports about this subject. Considering the importance of hearing loss on quality of life, we investigated hearing status in patients with overdose of illicit drugs.

This cross-sectional study was performed in Loghman Hakim hospital in Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2016-2017. The hearing status of 95 patients with illicit drugs overdose and 44 healthy individuals were assessed using standard pure tone audiometry and distortion product otoacoustic emissions. The patient group was categorized based on hearing status and compared based on some variables. We applied 2 independent t tests, Mann-Whitney, Chi-square, and binary logistic regression tests. All analyses were conducted in Stata 12 (STATA Corp, USA) and significance level was set at less than 0.05.

We found higher percentage frequency of SNHL in the patient group than the control group (15.8% vs 2.3%; p=0.021). The frequency of hearing loss was 21.7% in opioid users, 5.3% in stimulant users, and 6.3% in concomitant use of both. There was a significant relationship between SNHL and overdose of illicit drugs (aOR = 14.48, 95% CI = 1.53-136.44; p=0.019) with adjusting age, sex, and smoking.

Illicit drugs overdose can potentially affect the hearing system. Opioid drugs, especially methadone and tramadol, have been found to affect the hearing system. Therefore, it is important to conduct longitudinal studies to demonstrate the role of opioid drugs on the hearing system.

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

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

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

It seems thatmethadone treats the withdrawal signs and symptoms faster in dependent patients. However, these drugs aresimilarly powerful in controlling the withdrawal signs in these patients.

Delirium is one of the most common complications in patients admittedto intensive care units (ICUs). Delirium is a definite cause for more extended hospitalstays, higher mortality rates, and possibly persistent cognitive decline in the future.Antipsychotics have been frequently evaluated as first drugs of choice, but the mostappropriate, evidence-based treatment is yet to be discovered. This study aims to comparethe efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU.

This double-blind, randomized controlled clinical trial was undertaken on 35 ICUadmitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosiswas based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-V) criteria for delirium, and clinical toxicologists included the patients accordingto the study’s inclusion and exclusion criteria. Patients received either haloperidol orolanzapine based on computerized randomization. The severity of delirium was measuredwith the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICUadmission.

The total sample size was 35 in which 16 patients received haloperidol, and 19patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg threetimes a day and 5 mg three times a day, respectively. There was no significant difference inbaseline characteristics and the scores of MDAS between groups.

Olanzapine and haloperidol have the same efficacy in the managementof delirium in toxicology ICU-admitted patients. They can be interchangeably used fordelirium treatment in these patients

Poisoning, as a well-known medical condition, puts everyone at risk. As a data management tool, a registry plays an important role in monitoring the poisoned patients. Having a poisoning minimum data set is a major requirement for creating a poisoning registry. Therefore, the present systematic review was conducted in 2019 to identify the minimum data set for a poisoning registry. Searches were performed in four scientific databases, i.e., PubMed, Scopus, Web of Science, and Embase. The keywords used in the searches included minimum data set, “poison”, and “registry”. Two researchers independently evaluated the titles, abstracts, and texts of the papers. The data were collected from the related papers. Ultimately, the minimum data set was identified for the poisoning registry. Data elements extracted from the sources were classified into two general categories: administrative data and clinical data. Ninety-eight data elements in the administrative data category were subdivided into three sections: general data, admission data, and discharge data. One-hundred and thirty-one data elements in the clinical data category were subdivided into five sections: clinical observation data, clinical assessment data, past medical history data, diagnosis data, and treatment plan data. The minimum data set is a prerequisite for creating and using a poisoning registry and data system. It is suggested to evaluate and use the poisoning minimum data set in accordance with the national laws, needs, and standards based on the opinion of the local experts.

Colchicine is a medication with narrow therapeutic index, leading to both accidental and suicidal poisonings incidents. This study aimed to investigate the clinical and laboratory manifestations, as well as out- comes of colchicine poisoning patients referred to emergency department.

In this retrospective cross sectional study, demographics, clinical features, laboratory parameters, and outcomes of colchicine poisoned patients who were admitted to an academic referral center, Tehran, Iran, during 7 years were extracted from the patients’ profiles and analyzed.

21 patients with the mean age of 25.48 ± 12.65 years were studied (61.9% female; 85.7% suicidal). The mean ingested colchicine dose was 30.25 ± 21.09 mg. The most common symptoms were nausea and vomiting observed in 19 (90.5%) cases, followed by abdominal pain in 10 (47.6%) and diarrhea in 9 (42.8%) cases. 3 (14.3%) had died, the cause being disseminated intravascular coagulation (DIC) in two cases and severe metabolic acidosis in one. Prevalence of abdominal tenderness (p = 0.001) and abdominal pain (p = 0.049) was significantly different between survived and non-survived patients. There were significant correlations between systolic blood pressure (p = 0.010), diastolic blood pressure (p = 0.002), serum glucose (p = 0.031), calcium (p = 0.017), white blood cell (WBC) count (p = 0.043), aspartate aminotransferase (AST) (p = 0.001), alkaline phosphatase (ALP) (p = 0.012), prothrombin time (PT) (p = 0.006), partial thrombo- plastin time (PTT) (p = 0.014), PaCO 2 (p = 0.011), DIC (p < 0.001), and need for mechanical ventilation (p = 0.024) with survival.

Based on the findings of the present study, the mortality rate of colchicine poisoning was 14.3% and there was significant correlation between lower blood pressure, lower serum glucose and calcium levels, lower PaCO 2 , higher WBC count, higher AST and ALP levels, higher PT and PTT, need for mechanical ventilation, presence of DIC, and also abdominal pain and tenderness with survival.