Abortion Induced by Peganum Harmala Ingestion in a Pregnant Woman: A Case Report and Literature Review

Background: Peganum harmala is a medicinal plant used in Iran and other countries. Many therapeutic effects have been described for this plant; it is insect repellant, disinfectant, antimicrobial, sedative, analgesic, anti-inflammatory, emetic, and abortifacient. Roots and seeds are medicinally-active parts of the plant containing some β-carboline and quinazoline alkaloids, which are responsible for its pharmacological and toxicological effects. Poisoning with high doses of Peganum harmala can be life-threatening.Case Report: We reported a 31-year old woman with an unwanted pregnancy, who ingested 1 glass of Peganum harmala seeds to induce abortion. On admission, she had severe nausea and vomiting, mild abdominal pain, and stable vital signs. Physical examination was unremarkable, and the leukocytosis was the only abnormal laboratory finding. The patient underwent nasogastric tube insertion, gastric lavage, as well as the administration of activated charcoal. Although she left the hospital on self-consent, further follow-up revealed that she had a spontaneous abortion without any complications.Conclusion: Although most cases of Peganum harmala intoxication can be managed successfully, this poisoning led to abortion in our case. Physicians working in Iran and other regions, where Peganum harmala is used as traditional medicine, must be aware of its toxicity for the early diagnosis and management.

The Epidemiology of Human Mortality in West Azerbaijan Province, Iran, 2016

Background: This article presents the most recent mortality data in West Azerbaijan Province (WAP) of Iran in 2016 based on selected characteristics, including age, sex, state of residence, and cause of death.Methods: After the local Ethics Committee approval, we obtained the data for this systematic database study from the local health registration office. The causes of death are processed following the International Classification of Diseases, tenth revision (ICD-10). The vital statistics were refined from the yearbooks of the National Organization for Civil Registration.Results: In 2016, a total of 14688 deaths were registered in the Health Death Registration System (HDRS) and 14622 in the Civil Death Registration System (CDRS) of WAP (~4% of Iran’s mortality). The Crude Mortality Rate (CMR) was 4.30 per 1000, showing an increase of 7.5% from the 2011 rate. Of the deceased, 56.9% were males, and 60% were attributed to urban areas. On average, men died 4 years earlier than women (61.2 vs 65.3 years, respectively). The major causes of death in 2016 remained the same as in 2011.Conclusion: The pattern of human mortality in WAP is comparatively consistent with the other regions of Iran except for the higher rate of neoplasms (19.6% compared to 10.7% of the country average) and the lower ratio of certain infectious and parasitic diseases (1% compared to 3.8% of the national average). There was a significant difference in registering the state of residence between HDRS and CDRS, which is highly recommended for further investigation in future studies

Snake Envenomation in North-West Iran: A Three-Year Clinical Study

Background: Snakebite is a medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. A few reports have been published regarding snakebite in Iran. This study aimed to assess the snakebite cases in a tertiary teaching hospital in the northwest of Iran.Methods: We assessed demographic and clinical characteristics of adult patients who were admitted because of snakebite into Ayatollah Taleghani Teaching Hospital, Urmia, West Azerbaijan, Iran, between January 1, 2012, and December 31, 2014. After institutional Ethics Committee approval, the required data were extracted, analyzed, and reported.Results: Totally, 60 snakebite cases were recorded during three years study period, of them 63.3% were male. The patients’ Mean±SD age was 37.8±15.8 years. The majority of snake envenomations occurred in the farms and mountains (71.4%), frequently in the afternoons of spring and summer seasons, and mostly affected inhabitants or visitors of the rural areas. The Mean±SD time interval between snake envenomation and admission to the first health center was 15.3±28.6 hours. The anatomic sites of the snakebite were lower and upper extremities in most instances (96.6%). Only 5 (8.3%) patients had severe toxicity, and 2 patients underwent surgical fasciotomy. The patients were treated using antihistamines (n=45), corticosteroids (n=35), antibiotics (n=54), polyvalent snake antivenins (n=50), wound care and tetanus immunization (n=39). The Mean±SD number of polyvalent snake antivenins used for each patient was 3.3±1.9 (range, 1-8) vials. There was no in-hospital fatality.Conclusion: Most snakebites victims in the northwest of Iran were men in their productive age. Early diagnosis and proper use of snake antivenins could be life-saving and should be encouraged.

Foodborne Botulism: A Study of 57 Cases in Northwest Iran

Background: Foodborne botulism (FBB) is a rare paralyzing disease caused by ingestion of foods contaminated with botulinum neurotoxin (BoNT). It is still a health concern in many countries. This study aimed to investigate the epidemiology of FBB in West Azerbaijan Province, Iran. Methods: Botulism surveillance data of the Health Deputy of Urmia Medical Sciences University, northwestern Iran was used in this retrospective survey from 2010 to 2014. Demographics, clinical features, bioassay results, implicated foods and outcome were analyzed. Clinically, patients were classified to three groups (mild, moderate, and severe). Results: During the five years, 57 cases of FBB were identified involving 36 men (63.2%) and 21 women (37.8%). Mean age was 22.35±17.84 yr. Most events were sporadic (86%). Bioassay confirmed serotype A of BoNT in 19 patients (33.3%). The most implicated food was locally-made cheese (n=10). Average incubation period was 24.35±12.35 h. Clinically, mild, moderate and severe forms were observed in 68.4%, 19.3% and 12.3% of patients, respectively. All cases were hospitalized and treated with trivalent antitoxin. Mean hospital stay was 7.71±3.94 days Eight patients (14%) required mechanical ventilation and three of them deceased (5.3%). Median annual incidence rate of FBB was 0.37 cases per 100,000 population in this study. Conclusion: Comparing other part of the world, FBB has a medium incidence rate in our province. Unpasteurized dairy products are the main causative foods and BoNT/A is the most commonly recognized toxin type. Promoting correct preservation and appropriate cooking are recommended for preventing FBB

Letter to the Editor: Alarming Level of Tramadol Intoxication in Iran

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A Bibliometric Analysis of Toxicology Publications of Iran and Turkey in ISI Web of Science

Background: Web of Science (WoS) is an online academic citation index provided by Thomson Reuters which supplies valuable bibliometric information for comparing impact of specific author, organization, or country in science production. The aim of this study was to compare toxicology publications of Iran and Turkey indexed in WoS from bibliometric point of view. Methods: The WoS database was queried based on keywords “Iran” and “Turkey” separately in the “Address” field and refined by “Toxicology” as a category. All records were transferred to Microsoft Excel® application. The dataset were analyzed from different perspectives, such as publication years, number of references and citations, authorship pattern, publications types, affiliated organizations, core subject areas and journals. Results: There were 1178 and 2240 publications that met the criteria during 1993-2011 for Iran and Turkey, respectively. Less than 2% of authors had published more than 25% of all toxicology papers in both countries. The average number of citation per article was about 3.48 for Iranian and 6.73 for Turkish papers. By the time of the analysis, 54.3% of Iranian and 31.6% of Turkish articles had not received any citation. Conclusion: This analysis reveals that top Iranian toxicologists had a better performance than their Turkish counterparts but overall authorship pattern was well-distributed among Turkish researchers and organizations. If Iranian authors desire to achieve first rank of toxicology articles in the Middle East region by 2025, they must try to increase the quantity and quality of their international publications