• جایگاه : پژوهشی
• مجله: Journal of Emergency Practice and Trauma
• نوع مقاله: Journal Article
• کلمات کلیدی: lead,autopsy,Organ failure,Cadavers
• چکیده:
• چکیده انگلیسی: Objective: Due to the rapid pace of industrialization and the high prevalence of addiction, toxicity caused by heavy metals, especially lead, has become one of the major health problems associated with high morbidity and mortality. Therefore, reliable information is critical to manage this condition. Methods: This descriptive cross-sectional study was performed on 30 cadavers, suspected of lead poisoning. The hospital records and the results of anatomical investigations were studied. Data were collected in a researcher-made questionnaire and analyzed in SPSS Version 22. Results: The results showed a significant correlation between the pathological results of pulmonary autopsy and the duration of drug use (P= 0.01). Also, the pathological results of cardiac autopsy had significant correlations with age (P= 0.006) and blood lead level (P= 0.03). Moreover, significant correlations were found between the pathological results of liver autopsy and age (P=0.00), between the pathological results of brain autopsy and the route of drug administration (P=0.01), and between the pathological results of kidney autopsy and age (P=0.00). Most pathological changes were observed in the brain and kidney tissues. Conclusion: Lead poisoning does not cause any specific pathological changes in the liver, heart, brain, lung, or kidney tissues; however, these non-specific changes, alone or together, can lead to death
• انتشار مقاله: 18-03-1399
• نویسندگان: Fares Najari,Seyed Mojtaba Abolbagaei,Babak Mostafazadeh,Dorsa Najari
• مشاهده

• جایگاه : پژوهشی
• مجله: Asia Pacific Journal of Medical Toxicology
• نوع مقاله: Journal Article
• کلمات کلیدی: PROTHROMBIN TIME,Acetaminophen Poisoning,N-acetylcysteine,Bleeding Time
• چکیده:
• چکیده انگلیسی: Background: Acetaminophen (N-Acetyl-p aminophenol; APAP) is one of the most common types of analgesics. It is also the most common xneobitic reported to poison centers. This study investigates if therapeutic doses of NAC can falsely increase coagulation tests, prothrombin time (PT) and bleeding time (BT). ​​
  Methods: Thirty-six APAP poisoned patients whose acetaminophen serum concentration were in toxic zone in the Rummak-Matheiw graph were treated by NAC according to standard intravenous 21 hours protocol.  Prothrombin time (PT) and bleeding time (BT) in all cases were measured before the start of the NAC and at the 8^th and 16^th hour of the treatment.
  Results: The mean age of the cases was 21.5 ± 5.12 years old. Among them, 31 cases (86%) were female. The mean dose of ingested APAP was 9.6 ±2.0 grams (7.8 – 16.1 g). Mean of SLA was 196.0±37.7. The means of BT were nor significantly different at all evolution times (2.6±0.64, 2.6±0.62 and 2.6± 0.6. The means of PT rose at 16^th hour of NAC treatment in as compared 8^th hour (16.1± 1.1 s 12.3±0.6 s, respectively) (P <0.001).   
  Conclusion: With specific reference to our study results, a low level of rising PT resulting from an NAC treatment is not a reliable indicator of liver damage. Further investigation on the effect of NAC on clotting factors is recommended.
• انتشار مقاله: 11-08-1394
• نویسندگان: Babak Mostafazadeh,Soheila Vaghefi,Mohammadali Emamhadi,Latif Gachkar
• مشاهده

• جایگاه : پژوهشی
• مجله: Asia Pacific Journal of Medical Toxicology
• نوع مقاله: Journal Article
• کلمات کلیدی: Glasgow Coma Scale,Psychomotor agitation,Sedation,Unconsciousness,Weights and Measures
• چکیده:
• چکیده انگلیسی: I read with interest a recent paper in your journal, in which three consciousness assessment scales were compared in poisoned patients and finally a new scale "AVPU plus" was proposed (1). The study was very interesting with a worthy objective. I would like to admire the authors for exploring how the Alert/Verbal/Painful/Unresponsive (AVPU) responsive scale corresponds with the Glasgow Coma Scale (GCS) and Richmond Agitation-Sedation Scale (RASS) scores in drug-poisoned patients, and for proposing an augmented AVPU scale. The GCS was developed by Teasdale and Jennet in 1974 (2), aimed at standardizing assessment of level of consciousness in head trauma victims (3). The AVPU scale has been developed for rapid neurologic assessment of  traumatic patients and for those in need of advanced life support (1,4). RASS has been developed to assess agitation-sedation status of critical patients in intensive care unit (5,6). Because there has been no standardized unified method for assessment of consciousness impairment in patients with drug and chemical poisoning, physicians have used different methods or scales in different medical settings. Therefore, developing a research-based scale that is agreed among most medical toxicologists seems necessary. My colleagues and I usually use the AVPU scale in our routine practice. Nonetheless, looking at this newly proposed scale, we believe using AVPU plus for poisoned patients in emergency setting or clinical toxicology ward would be helpful and practical. As a recommendation, I think if the grading of AVPU plus is scaled in numerical instead of alphabetical, it would be easier to use.
• انتشار مقاله: 01-08-1394
• نویسندگان: Babak Mostafazadeh,Babak Mostafazadeh,Babak Mostafazadeh
• مشاهده

• جایگاه : پژوهشی
• مجله: Asia Pacific Journal of Medical Toxicology
• نوع مقاله: Journal Article
• کلمات کلیدی: Poisoning,mortality,Methanol,blindness,Neurologic manifestations
• چکیده:
• چکیده انگلیسی: Background: In this study we sought to investigate clinical findings (with a focus on neurologic effects) and also to analyze outcomes of a series of patients with methanol poisoning admitted to two poisoning treatment centers in Tehran, Iran.
  Methods: In this prospective cross-sectional study, methanol-poisoned patients admitted to departments of forensic medicine and toxicology of Loghman Hakim and Baharloo hospitals in Tehran during October 2010 to October 2011 were included; and their data were recorded in predesigned checklists.
  Results: Twenty-eight methanol poisoned patients (82.1% men) with mean age of 29.3±4.6 years were studied. Most patients (67.9%) had metabolic acidosis at presentation. On admission, all patients had different degrees of decrease in consciousness, who the majority of them (57.1%) were admitted with mildly reduced consciousness (grade I of Grady coma scale). Headache and vertigo were observed in 7.1% and 17.9% of patients, respectively. Most patients (53.6%) had no ocular effects, while 46.6% of patients developed impaired vision. All patients received sodium bicarbonate. Ethanol as antidote and folic acid were given to 18 patients (64.2%) and 16 patients (57.1%), respectively. Six patients (21.4%) underwent hemodialysis. Over half of the patients (53.6%) fully recovered and were discharged without complications. Four patients (14.3%) developed total blindness. Four patients (14.3%) left the hospital against medical advice by self-discharge (they had no significant complication at the time of discharge). Five patients (17.9%) died; who compared to survived cases had significantly lower blood pH (P=0.028), higher coma grade (P<0.001) and more delayed presentation to hospital (P=0.004). Age had no significant impact on mortality.   
  Conclusion: Methanol poisoning causes major neurologic effects such as coma and blindness. It is also responsible for high mortality.
• انتشار مقاله: 11-09-1393
• نویسندگان: Hakimeh Eghbali,Babak Mostafazadeh,Mazaher Ghorbani,Behnam Behnoush
• مشاهده

• جایگاه : پژوهشی
• مجله: Asia Pacific Journal of Medical Toxicology
• نوع مقاله: Journal Article
• کلمات کلیدی: Drug Overdose,Loss of consciousness,Suicidal attempt,Deliberate self-poisoning,Risk Factor
• چکیده:
• چکیده انگلیسی: Background: Most drug overdoses are due to suicidal attempts. This study was designed to analyze the risks and risk factors of poisoned patients with repeated suicidal attempt in Iran.
  Methods: This case-control study was conducted at Loghman Hakim Hospital, Tehran, Iran, during April to May 2008. Eighty-seven patients who were admitted due to drug overdose with loss of consciousness were enrolled. Patients were categorized to cases including 19 patients with history of previous suicidal attempt (repeated suicidal attempt), and controls including 66 patients without this history. Only patients who consumed drugs for self-harm were included. Demographic characteristics, past medical history, baseline physical examinations, dose and class of drugs used were recorded.
  Results: History of previous suicidal attempt had a significant association with the type of drugs used for poisoning (P=0.04) and history of psychological disorders (P<0.01). Dose of ingested drugs (P=0.020), time interval between drug ingestion and emergency medical service arrival (P=0.021), severity of unconsciousness (P=0.046) and need for ICU care (P=0.013) were significantly higher in patients with repeated suicidal attempt. There was no significant difference between the two groups in terms of age, gender and history of illicit substance abuse.
  Conclusion: According to these findings, when dealing with patients with loss of consciousness due to drug overdose, those with history of previous suicidal attempt are in more risks and need significantly more attention compared to those without such history. Considering history of previous suicidal attempts in poisoned patients can help medical professionals in determining more definitive prognosis and more effective treatment plan.
• انتشار مقاله: 18-10-1391
• نویسندگان: Babak Mostafazadeh,Esmaiel Farzaneh
• مشاهده