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- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Viperidae,Snake Bites,Antivenins,Envenomation Syndrome,Species Specificity
- چکیده:
- چکیده انگلیسی: Background: Despite sharing common evolutionary features, Viperidae species including Echis carinatus and Macrovipera lebetina possess venoms with different proportions of toxic agents, thereby causing clinical effects with potentially variable severity. This study was an effort to differentiate the clinical effects and outcomes of E. c. sochureki and M. l. obtusa victims.
Methods: In this prospective cross-sectional study, snakebite patients treated at a reference poisoning center in northeast of Iran in 2012 were enrolled. The features of snakebite event, demographic and clinical data of patients were recorded in checklists.
Results: Twenty-seven patients (63% male) with mean age of 34.8 ± 18.1 years were included. The offending snakes were recorded as "E. c. sochureki" in 63%, "M. l. obtusa" in 25.9% and "unknown" in 11.1% of cases. The most common clinical findings were fang mark in 100%, local pain in 81.5% and local edema in 74% of patients. Although the victims of both species showed classic features of viper envenoming syndrome including marked local effect and hemostatic disturbances, the victims of M. l. obtusa had significantly higher creatine kinase levels (P = 0.031) and lower platelet counts (P = 0.043), whereas marked edema (> 15cm) was significantly more common in E. c. sochureki victims (P = 0.028). Envenomation severity, other clinical effects and outcomes did not differ between the two species. Patients with delayed presentation to hospital had greater envenomation severity and edema extent and higher rate of coagulopathy.
Conclusions: Species-specific description of clinical effects following snakebite envenoming is useful for syndromic approach to human victims. The clinical envenoming syndromes by E. c. sochureki and M. l. obtusa show many common similarities despite the difference in severity of some effects. The delay in hospital admission and antivenom therapy is a risk for increased severity of envenomation and development of poorer clinical outcomes.
- انتشار مقاله: 25-07-1398
- نویسندگان: Seyed Mostafa Monzavi,Reza Afshari,Ali Reza Khoshdel,Amir Ahmad Salarian,Hamid Khosrojerdi,Azam Mihandoust
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی:
- انتشار مقاله: 01-06-1398
- نویسندگان: Reza Afshari,Reza Afshari,Reza Afshari
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Iran,Poisoning,Spatial analysis,Spatial Autocorrelation
- چکیده:
- چکیده انگلیسی: Background: Geospatial distribution analysis is a highly useful tool, especially in the field of health research and health economics. We aimed to study the geospatial distribution of poisoned patients and the risk factors in Mashhad, Iran.
Methods: This was a retrospective cross-sectional study of patients treated at the Medical Toxicology Center, Imam Reza Hospital, Mashhad, Iran, which is the only referral center in northeast of Iran, in 2013. Negative binomial and Poisson approach via generalized linear mixed models were performed to investigate the association between socio-demographic characteristics with the number of reported cases of poisoning.
Results: A total of 5064 poisoned patients (52% females) were included. Most of the poisoned patients were within the age group of 20-29 years old (41.4%). Pharmaceutical agents were the most common cause of poisonings (64.6%). The local test of spatial autocorrelation (Moran’s I) confirms that the poisoning had cluster pattern in Mashhad. Number of poisoning events were found to be associated with population density (RR= 1.00011; 95% CI 1.0001-1.00013), and the frequency of people with less than high school education (RR=1.49; 95% CI 1.32-1.68).
Conclusion: The geospatial factors may have impact on the number of acute poisoning events in a city. Some parts of a city may exhibit spatial clustering in poisoning events. Once clusters are found, interventions can be focused to specific geographic locations and would be helpful for healthcare policymakers to focus on prevention programs.- انتشار مقاله: 14-02-1398
- نویسندگان: Mohammad Taghi Shakeri,Seyed Ehsan Saffari,Bita Dadpour,Hossein Aghajani,Ali Hadianfar,Reza Afshari
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی:
- انتشار مقاله: 07-12-1397
- نویسندگان: Reza Afshari,David C Bellinger
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی:
- انتشار مقاله: 15-11-1397
- نویسندگان: Reza Afshari,Reza Afshari,Reza Afshari
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی:
- انتشار مقاله: 15-08-1397
- نویسندگان: Reza Afshari,David C. Bellinger
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Iran,attitude,rabies,Animal Bite,Knowledge,Practice
- چکیده:
- چکیده انگلیسی: Introduction: Animal bites and rabies are perceived and managed differently from bites and stings related to envenoms snakes, scorpions and spiders. This study aimed at evaluating knowledge, attitudes and practices (KAP) of local population regarding animal bites and rabies, as a point of comparison for future studies on venomous animals.
Methods: This cross-sectional KAP study included 1093 subjects from four rural areas of Mashhad. Data gathered through a validated and reliable structured questionnaire.
Results: In total, 1093 respondents included in the study consist of 53% male and 42% adults of 20 to 9 years old. Assessing knowledge; 70% of cases were presented with weak and moderate knowledge related to clinical manifestations, but just the opposite, majority of the respondents (83%) were categorised as good or excellent in their knowledge of prevention. Assessing attitudes; almost all (91%) of respondents categorised as good or attitude. Assessing practices; 33% of cases revealed that there are no good practices with regard to animal bites and rabies.
Respondent’s knowledge of prevention was significantly correlated with age (P = 0.01) and educational level (P = 0.002). Both attitudes and practices had significant relations with age. Respondents aged 20- 39 years showed better practices than other age groups (P < 0.01).
Conclusion: this study found that while information on prevention is acceptable, clinical findings of bites and rabies are relatively unknown. Preventive measure should include clinical manifestations as well as currently implemented focus on prevention, vaccination and treatment.- انتشار مقاله: 12-05-1397
- نویسندگان: HR Bagherian,A Taghipour,M Mousavi Bazaz,F Nezamdoost,Reza Afshari,Farshid Abedi
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Persian,Chemical warfare agents,Dura-Europos,Roman
- چکیده:
- چکیده انگلیسی: Background: Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein’s regime in 1980s and more recently in Syria. The use of CWA is banned under the international law.
Methods: Ancient uses of CWA are not well studied. Recently, their use during the Persian siege of the Roman-held Dura-Europos (Salihiyah) in modern Syria in 256 C.E. has been theorized by revisiting the archaeological findings from Dura-Europos from the 1930s.
Case study: The paper describes the history of Persia (Iran) and Rome in that era and particularly Shapur I, the second King (Shah) of the [Sasanian] Persian Empire (215 - 270 C.E.) and Valerian, Publius Licinius Valerianus Augustus, the Roman Emperor (193/200 - 264 C.E.). In addition, composition of the potentially applied CWA and clinical findings related to the exposure are postulated through a medical toxicology lens taking into account archeological evidence (carbonized top of the tunnels and bodies and yellow crystals found in the tunnel), recent research and contemporary historical notes.
Conclusion: It is plausible that a combination of fire accelerant or so called pitch (oil based substance, naphtha, bitumen or crude oil) and Sulphur dioxide (SO2) were used in this occasion. SO2 in combination with water on the body membranes creates highly toxic sulphurous acid (H2SO3) which is life threatening in a small enclosed space. As a result, a burning sensation in the nasopharynx and eyes, coughing, dyspnea, choking that led to pulmonary edema and death would have shortly followed. Severe clinical manifestations, panic and consequent mass hysteria of the toxic exposure should have prevented any organized retreat. In this incident, nineteen Roman and one Persian soldier were killed.- انتشار مقاله: 15-05-1397
- نویسندگان: Reza Afshari,Reza Afshari,Reza Afshari
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی:
- انتشار مقاله: 20-01-1397
- نویسندگان: Reza Afshari,Reza Afshari,Reza Afshari
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Buprenorphine,Recurrence,Opioid-Related Disorders,Naloxone Drug Combination
- چکیده:
- چکیده انگلیسی: Background: In maintenance therapy for opioid addiction, to reduce the risk of buprenorphine (BUP) abuse, the combination of BUP and naloxone (NX) has been developed and is commercially available as suboxone (BUP/NX). This study was designed to compare addiction relapse frequency in patients receiving BUP and BUP/NX as maintenance therapy.
Methods: In this double-blind clinical trial with cross over design, 100 opioid abusers were randomly assigned to two treatment groups to receive either BUP or BUP/NX. After three months, without a time-out period, subjects undertook treatment with the other drug. The subjects were screened weekly for urinary morphine.
Results: In each of the study arms, when the patients were given BUP/NX, the number of relapses was significantly higher compared to when they received BUP (0.13±0.24 vs. 0.04±0.09, P = 0.001). If participants’ age was taken into account, the number of relapses was significantly higher when BUP/NX was given in age groups of 31 to 40 years and over 50 years (P < 0.05). The length of addiction had also a significant impact on the number of relapses, i.e., patients with over 10-year history of addiction had higher number of relapses if they were given BUP/NX compared with BUP (P < 0.05).
Conclusion:BUP seems to be more effective than BUP/NX in preventing addiction relapse in opioid abusers under maintenance treatment.- انتشار مقاله: 21-02-1396
- نویسندگان: Zahra Shojaei Ghalehney,Shahram Ilbeigi,Hamid Reza Arshadi,Reza Afshari
- مشاهده