Epidemiological and Demographic Status of Violence and Strife in the Emergency Department of Sabzevar Emdad Hospital

Background: Violence and strife are among the most important causes of health threats and account for more than half a million deaths per year, especially at young ages. Considering the young population of Iran and the occurrence of identity crisis in the young age group and the fact that this phenomenon is costly for our country’s health care system, this study was conducted to investigate the factors related to violence and strife and the related mortality in patients admitted to the Sabzevar Emdad Emergency department. Methods: In this descriptive cross-sectional study, 207 patients who were admitted to Sabzevar Emdad Hospital in 2017 following strife were included. The inclusion criterion was hospitalized patients who were referred to the Emergency department following the strife and the exclusion criterion was incomplete registration of patients’ information. The data collection tool was a researcher-made checklist. Data analysis was performed using SPSS software version 18. Results: The Mean±SD age of patients was 34.81±14.75 years. Most patients were from urban living places, while the mortality rate, gender, and the cause of trauma were not statistically associated with patients’ place of residence. The most common type of lesions following strife was bruising, tearing, and scratching accounting for nearly 70% of cases. The most common site of injury was bruising and scratching in the head and neck, followed by tears and fractures in the limbs. In general, the most common site of injury was the upper extremity followed by the head and neck. The majority of patients (52%) underwent medical treatment, including receiving medication, dressing, and splinting, while 37% of patients were referred to the operation room for surgery. A significant relationship was observed between mortality rate and the site of injury (P=0.001).Conclusion: The results showed that in Sabzevar city, the prevalence of strife ‎ is higher among men. Also, the most common effects following these types of trauma are bruising, scratching, and tearing. It seems that by providing appropriate solutions and creating a culture and increasing people’s awareness of injuries caused by strife, it would be possible to pave the way for reducing such injuries in the future

Prevalence of Opioid Poisoning and Related Factors in Under 17-year-olds

Background: Poisoning is among the leading causes of childhood injuries. With the increasing prevalence of substance dependence in the community, there is a rise in the frequency of children admitted to hospitals with drug intoxication. Therefore, we investigated the prevalence of acute opioids poisoning in children. Methods: The present cross-sectional study was performed on children under 17 years of age who were admitted to Sabzevar hospitals with a diagnosis of opioids poisoning. A researcher-made checklist was used for data collection, including the patient’s age, gender, intoxication agent, drug consumption route and form, hospitalization length and outcome, family’s educational level, occupational status, and living area. Besides, descriptive tests were used in SPSS to analyze the obtained data.Results: In total, 129 cases of opioids poisoning were reported during the study period. The mean±SD age of the studied children was 2.74±3.05 years. The minimum and maximum ages of poisoned children were 1 and 16 years, respectively. The liquid-soluble form was the most common form of opioids used (38.3%). Opium was also the most commonly used substance (68.45%). In 85 (65.89%) children, a decrease in Glasgow Coma Scale (GCS) was observed at baseline. Moreover, 7 of the explored children have died. Besides, 90.7% of their fathers and 95.3% of their mothers had an educational level of a diploma or below. The most common factor associated with opium poisoning was the family’s substance dependence in 120 (93%) cases. Substance dependence in children was mostly observed in those aged 3-5 years. Conclusion: Poisoning with opium is the most common type of children’s opioid poisoning in Sabzevar. A decreased level of consciousness is the most frequent manifestations in these patients. Therefore, in all children, by observing a sudden decrease in the level of consciousness without apparent reasons, especially along with other symptoms, such as acute diarrhea, restlessness, etc., it is recommended to consider opioids poisoning

Investigating the Characteristics of Tramadol-induced Seizures: A Cross-sectional Study

Background: According to statistics, tramadol intoxication is one of the most common drug poisoning cases in Iran. Because seizure is one of the severe and dangerous side effects of tramadol, the present study aimed to investigate the characteristics of tramadol-induced seizures. Methods: In this cross-sectional descriptive study, all patients who referred to the emergency departments due to the tramadol-induced seizures were examined by the census method. The patients’ data were collected with a checklist. Then, the data were analyzed with descriptive and inferential statistical tests in SPSS v. 23 and at a significant level of P<0.05. Results: In this study, 350 patients (52.9% male, and 47.1% female) were examined. The Mean±SD dose consumed was 1171.4±802.77 mg. The minimum dose that caused the seizure was 200 mg, and the average dose consumed of tramadol was different in patients who had one, two, or three seizures outside the hospital (P=0.002). The consumed average dose of tramadol was 1144.5 mg, 2017.7 mg, and 511.1 mg for patients who had one, two, or three seizure(s), respectively. There was a significant relationship between dose consumed and the number of seizures (P=0.001). The study showed that patients who had a one-time seizure, have experienced this condition outside the hospital. There was a significant relationship between the number of seizures and the location of the seizure (outside or inside the hospital) (P=0.001). Conclusion: The results showed no significant relationship between consumed dose and location of the seizure. The number of seizures is not dependent on the consumed dose. It means that increasing the consumed dose, the number of seizures does not increase, and there is no significant relationship between the amount of dose consumed and the number of seizures

The Rate and Pattern of Disclosing Medical Errors in Iranian Physicians and Healthcare Staff

Background: Ethics is of great significance in the medical community, i.e., because of the importance of this profession. How a physician manages a medical error, regardless of its cause, is among the major issues of medical ethics. Given the nature of the medical profession, medical malpractice may occur at any time during treatment. Medical malpractice is frequent in Iran and other countries. Methods: The present cross-sectional study was conducted using a researcher-made checklist. The study participants attended legal medicine training and refresher courses in Mashhad and Sabzevar Cities, Iran, from June 2012 to June 2017.Results: During five years, 1537 cases were enrolled in the study. Most of the study participants were female (n=832, 52.89%), with a Mean±SD age of 32.3±3.4 years. All study participants, except for 25 (1.58%) subjects answered “I do not disclose the malpractice” to the question “would you disclose your medical malpractice with treatable harm to the patient, while he/she gets hurt by not revealing the malpractice?”; the rest [1463 (92.94%) individuals] answered “I disclose the malpractice, but I do not mention that the harm is due to malpractice, and 85 (5.40%) participants answered, “I disclose the malpractice to the patient and mention that the harm is due to malpractice and it could be cured.” Conclusion: The study findings suggested that the majority of study participants did not tend to disclose their malpractice to patients and their families

Study of the Pattern and Frequency of Road Traffic Injuries in Car Occupants in the Eastern Part of Iran

Background: Since Iran has one of the highest mortality rates of car accidents in the world, the study of the pattern and reasons of trauma in car occupants can provide useful information to determine the underlying causes of injuries and deaths in traffic accidents. Accordingly, this study was conducted to determine the pattern, frequency, and causes of traumatic injuries caused by traffic accidents in car occupants.Methods: This cross-sectional study was conducted during the first 6 months of 2017 in Shahid Beheshti Hospital in Sabzevar City, Razavi Khorasan Province, Iran. The data were obtained from the medical records of patients and the checklist designed by our research team. Results: During the period of study, 300 people were involved in car accidents, of whom 58.3% were men with an average age of 35.16 years. In both sexes, 29.3% of the subjects were in the age group of 30-40 years. Twenty-two car occupants were involved in non-injury car accidents. No significant relationship was found between traumatic injuries and variables of sex, seatbelt use, airbag deployment, and the seat occupant in the cars (P>0.05), as well as between death and variables of sex, airbag deployment and seat occupant in cars (P>0.05). But there was a significant relationship between death and fastening seat belts (P=0.003). Conclusion: The results of this study revealed that sex, airbag deployment, and seat occupant had no effect on traumatic injury or mortality rate in the car occupants. However, fastening the seatbelt can reduce the mortality rate in car occupants, but it does not impact the traumatic injuries rate

Organophosphorus Insecticide Poisoning Related Mortality and Neurotoxicity in Sabzevar

Background: This study aimed to assess mortality and neurotoxicity caused by the pesticide organophosphate and its correlation with the type of poison and treatment in patients admitted to Vasei Hospital of Sabzevar City, Iran, in 2018.Methods: Out of 122 cases, 52 patients (43.3%) were male, and 70 patients (56.9%) were female. The Mean±SD age of the men was 32.65±29.15, and women was 30±15.30 years.Results: Mortality in women and men was 10% and 17.3%, respectively. Among treated people, diazinon had the highest frequency of 76.4%, and among dead people from diazinon and malathion had the highest rates of 56.3% and 43.8%, respectively. Conclusion: The prevalence of mortality in patients was 7.3% (n=9). As most people with organophosphorus poisoning have been exposed to diazinon toxins; therefore, strategies to prevent and reduce exposure to this toxin are essential

Successful Treatment of Acute Aluminum Phosphide Poisoning by Aloe Vera Syrup: A Case Report

Background: Aluminum phosphide, known as rice pill in Iran, is a very effective pesticide for commercial and industrial ‎use. The high lethality of Aluminum phosphide is due to Phosphine gas (PH3) which is released by its ‎reaction with water. One of the most important properties of aluminum phosphide, which despite being ‎very lethal to almost all living creatures, still makes it one of the most widely used pesticides, is its very ‎high yield, ease of use, and, most importantly, the absence of residues in products after application; while ‎its exposure to the human body is associated with high mortality.‎Case Presentation: In this article, we reported the successful treatment of rice pill-induced poisoning in a 30-year-old man using a novel approach. Accordingly, we used sodium bicarbonate (50 ccs) and aloe vera syrup (1-2 L), followed by olive oil (150 cc olive oil was given every 2 hours).Conclusion: While numerous studies recommend observing patient conditions as the treatment approach, our presented case was a successful experience of treating acute aluminum phosphide poisoning

Tramadol Poisoning: A Systematic Review of Studies in Iran

Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran.Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation.Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for >24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level.Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults

Drug-induced prolonged corrected QT interval in patients with methadone and opium overdose

Abstract Background Iran is a country with the highest rate of opioid addiction in the world. The most commonly used opioid in Iran is opium, and methadone is in second place. The trend of drug use has changed from opium to methadone from 2006 to 2011. Presence of a large number of addicted people and methadone maintenance therapy clinics make methadone readily available in Iran. Therefore, evaluation of the epidemiological characteristic of methadone toxicity and its effects on the heart is essential. Methods In This cross-sectional, retrospective, descriptive, analytical study all patients with methadone or opium toxicity who had been admitted to Vasei hospital, Sabzevar, Iran, during the years 2015 and 2016 were included, and their records were evaluated. Demographic data, addiction history, underlying diseases, and the outcome of admission were recorded. Then, corrected QT interval (QTc) of the first ECG of the patients after admission was evaluated. Results The Majority of toxicities occurred in those above 30 years of age (71.4%), who lived in cities (62.8%), and were married (69.2%). A positive history of addiction was considerably higher in the opium group (72.3% versus 43.3%). There was no significant difference regarding QTc prolongation between patients with methadone and opium toxicity (p = 0.3). Conclusion QTc prolongation is one of the adverse effects of methadone or opium overdose. It seems that significant QTc prolongation is not uncommon among patients with opium overdose

Comparative Assessment of the Effects of Hydroxyethyl Starch and Normal Saline on Severe Hypotension in Patients with Aluminum Phosphide Poisoning: A Retrospective Study

BACKGROUND: Aluminum phosphide poisoning is one of the most common forms of poisoning which requires immediate and urgent treatment. OBJECTIVE: This study aimed to compare the efficiency of two solutions, including hydroxyethyl starch and normal saline, in treating hypotension in patients with aluminum phosphide poisoning. METHODS: This retrospective cohort study was conducted on 35 patients with aluminum phosphide poisoning. We reviewed the profile of 18 patients treated with hydroxyethyl starch and 17 patients treated with normal saline. Within-group and between-group differences in systolic blood pressure before and after treatment were compared using paired t-test and independent t-test, respectively. RESULTS: The mean ± standard deviation (SD) age of the subjects in the starch and normal saline groups was 27.06 ± 9.72 and 27.88 ± 9.08, respectively. The levels of blood pressure in the two groups were not significantly different before the treatment; the mean ± SD of systolic blood pressure in the starch and normal saline groups was 72.67 ± 14.49 and 68.59 ± 8.3, respectively (P=0.313). After the treatment, it was significantly increased to 94 ± 24.45 and 85.18 ± 19.9 in the starch group (P=0.001) and the normal saline group (P=0.004), respectively. However, there was no significant difference between the two groups (P=0.245). Only one person survived in each group. CONCLUSION: According to the results of this study, although there was no significant difference between the two groups in terms of their effects on hypotension, these treatments could not prevent mortality