bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of Methadone and Tramadol in Vitreous Humor Specimens Using Dispersive LiquidLiquidMicroextractionandUltraHighPerformance Liquid Chromatography
Authors:   Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran., Akhgari Maryam
Published: July 2021

Background: Drug abuse is spreading rapidly all over the world. Methadone and tramadol are among not only the most abused opioids but also important from the forensic point of view. Therefore, we need to devise a simple and sensitive method for the sample preparation and identification of abused drugs in postmortem specimens. Methods: A simple and rapid Dispersive Liquid-Liquid Microextraction (DLLME) technique coupled with Ultrahigh Performance Liquid Chromatography (UHPLC) was developed for the extraction and analysis of methadone and tramadol from postmortem vitreous humor samples. Different parameters affecting the extraction recovery, such as the type and volume of extraction and dispersion solvents, pH value, sensitivity, and specificity, were optimized and studied. Results: Under optimized conditions, the recovery ranges were 82.3%-89.6% and 85.4%-87.1% for methadone and tramadol, respectively. The linear range was 25-100 ng/mL for both methadone and tramadol with a correlation coefficient (R2) of more than 0.98. Limit of Detection (LoD) and Limit of Quantification (LoQ) were 3 and 8 ng/mL for methadone and 6 and 16 ng/mL for tramadol. The accuracy level of the methods for methadone and tramadol detection were 99.4%-100% and 99.7%-99.9%, respectively. The method was specific enough for the qualitative and quantitative determination of methadone and tramadol. Conclusion: The obtained results showed that DLLME combined with UHPLC is a fast and straightforward method for determining methadone and tramadol in postmortem vitreous humor specimens.
Knowledge and Attitude of Midwives and Obstetricians Towards Therapeutic Abortion Law and its Ethical Pitfalls
Authors:   Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Bazmi Shabnam , Kiani Mehrzad ,   Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Saidi Mahdieh ,   Mental Health Research Center, Psychosocial Health Research Institue, Iran University of Medical Sciences, Tehran, Iran., Akrami Forouzan ,   Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Published: July 2021

Background: Despite the implementation of a safe motherhood program in many countries, unsafe abortion continues to be a matter of reproductive health. Thus, urgent efforts to make abortion legal and safe have been recommended in developing countries. The present study was done to determine the knowledge of midwives and obstetricians about the therapeutic abortion law as well as their attitude about the ethical pitfalls. Methods: In this descriptive knowledge and attitude study, a researcher-made questionnaire was used to gather data, after estimating the appropriate Cronbach’s Alpha coefficient. A total of 162 midwives and obstetricians working in public and private medical centers affiliated to Shahid Beheshti University of Medical Sciences in 2018 were included in the study by convenience sampling method. Results: According to the results, 9.3% of participants had a low level, 72.8% had a moderate level, and only 17.9% had a good level of knowledge. The total mean score of knowledge was 7.17±1.7. The mean score of knowledge in the group of obstetricians (7.60±1.74) was significantly higher than midwives (6.94±1.54), (t=2.29, p=0.024). There was a significant correlation between participants’ age and their knowledge (r=0.912, p=0.001). Also, 47.53% of the participants believed that the therapeutic abortion law has some pitfalls. The most frequent attitude was about the restriction of the therapeutic law up to 19 weeks for fetal indications. Conclusion: The level of participants’ knowledge was low to moderate. The findings indicated the need for training the professional standards related to prenatal genetic screening and therapeutic abortion.
The Modification of the Education System in a Medical Faculty in Iran During the COVID-19 Outbreak
Authors:   Department of Forensic Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran., Aghakhani Kamran , Memarian Azadeh ,   Department of Forensic Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran., Shalbafan Mohammadreza ,   Department of Psychiatry, School of Medicine, Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
Published: July 2021

Background: The coronavirus disease 2019 (COVID-19) pandemic has had an important effect on medical education. Universities around the world responded to the crisis by announcing the immediate closure and substituted the in-person sessions with online ones. Methods: Iran University of Medical Sciences designed a platform for medical students. To maintain the social distance, only onethird of students living in the dormitory were present at the dormitory in this condition. Some training courses were divided into two parts and each group was supposed to participate in given courses in-person for 15 days. The crash courses were trained on all days of the week. Then, the first group left the dormitories and was replaced with the second group, and they used dormitories for 15 days after being disinfected. Besides, for the best use of time, students who could not present in these 15-day training courses took part in virtual training programs. Results: It is depopulate the educational sessions at hospitals and classes in educational sectors. Besides, using the virtual classroom software given by the university, students can take part in virtual training programs. Conclusion: Using this platform, the number of trainees, as well as the gathering of students at dormitories, was reduced.
Clinical and Medicolegal Aspects of Fatal Imidacloprid Deliberate Self-poisoning: A Case Report
Authors:   Forensic Toxicology Laboratory, Legal Medicine Center, Kermanshah, Iran., Shiri-Ghaleh Vida , Khani Salim ,   Forensic Toxicology Laboratory, Legal Medicine Center, Kermanshah, Iran., Moradi Mehrdad ,   Forensic Toxicology Laboratory, Legal Medicine Center, Kermanshah, Iran., Soltaninejad Kambiz ,   Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
Published: July 2021

Background: Imidacloprid is a neonicotinoid insecticide and agonist of nicotinic acetylcholine receptors. Despite its low toxicity profile, there are rare studies on its fatal poisoning. In this report, we described clinical and postmortem findings of a fatal imidacloprid poisoning. Methods: A 33-year-old female presented to the emergency department with a history of deliberate consumption of unknown insecticide. On admission, she was drowsy and hypotensive with tachycardia and miotic pupils. Despite supportive therapy, she continued to be unconscious, with severe metabolic acidosis and developed a cardio-respiratory arrest and expired. Results: A forensic autopsy was performed. The result of the toxicological analysis showed that imidacloprid concentrations were 267.8 µg/mL in femoral blood, 144.5 µg/mL in stomach content, and 292.3 µg/mL in bile. Conclusion: Although imidacloprid is generally less toxic to humans high concentrations in biological samples could be considered lethal. Therefore, the educational programs about its toxicity should be considered for health care providers.
A Complicated Maternal Death in the context of Genetic Disorder: A Case Report
Authors:   Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran., Alipour Tabrizi Arash , Bordbar Azari Jafar ,   Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran., Raoofian Reza ,   Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran., Hedjazi Arya ,   Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran., Dadgar Moghaddam Maliheh ,   Department of Community Medicine, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran, Sajjadian Maryam ,   Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
Published: July 2021

Background: Investigation of the maternal cause of death and pregnancy-related death is one of the most important responsibilities of a forensic pathologist. From the public health point of view, it may help to prevent losses during and following pregnancy and save the lives of women, especially in developing countries. Methods: We report a case of maternal death with a history of neurofibromatosis type 1 who presented asymptomatic and normotensive with normal laboratory test results. Results: The first attack after delivery was associated with pulmonary edema, which led to death. Investigation during the medico-legal autopsy discovered a left suprarenal tumor with the diagnosis of pheochromocytoma, which was confirmed by further histopathology testing. Conclusion: We believe that although the association of neurofibromatosis type 1 and normotensive pheochromocytoma during pregnancy has been reported rarely, the possibility must be considered for evaluation before elective operations to adopt proper preoperative protocols.
The Biochemical Outcome of two Treatment Protocols in Patients With Opium-associated Lead Poisoning: A Cross-sectional Study in North of Iran
Authors:   Department of Forensic Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran, Badsar Alireza , Gholami Zeynab ,   Anzali International Campus, Guilan University of Medical Sciences, Rasht, Iran., Rahbar Taramsari Morteza ,   Department of Forensic Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran, Atrkar Roshan Zahra ,   Department of Statistic, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran., Mohammadi Kojidi Hamid ,   Department of Forensic Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran, Aghajany Nasab Monireh ,   Anzali International Campus, Guilan University of Medical Sciences, Rasht, Iran.,   Department of Biochemistry, Molecule and Cell Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Published: July 2021

Background: Lead is a potent toxin that targets heme synthesis and some antioxidant enzymes that induce oxidative stress. Lead exposure remains one of the significant health concerns all over the world. Chelating agents have been used as antidotes for acute and chronic lead poisoning. The present study was conducted to evaluate the biochemical outcome of two different chelating therapies. Methods: This descriptive cross-sectional study was performed in the Razi University Hospital, Rasht, Guilan. Fifty-six patients with a history of opium use were enrolled in the study who were treated symptomatically. Blood lead Llevels (BLL), Hemoglobin (Hb), Red Blood Cell (RBC), White Blood Cell (WBC), urea, creatinine, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and Alkaline Phosphatase (ALP) were evaluated before and after treatment. The BLL more than 100μg/dl with clinical symptoms was considered as severe lead poisoning (n=34) who received 4 days of DMPS (2,3-dimercaptopropane-1-sulfonate) injection. Other cases with BLL of 20-100μg/dl were considered as those with mild poisoning (n=22) that were treated with oral D-Penicillamine for 14 days. Results: The mean age of patients was 49.73±14.11 years. Data analysis indicated no significant differences between the groups at baseline regarding the demographic variables. A significant reduction was observed in BLL before and after the intervention using the D-Penicillamine from 75.88±26.22 to 44.3±17.51 μg/dl (P=0.0001). The BLL reduced from 105.5±34.04 to 24.51±24.08 μg/dl after treatment with DMSP (P=0.0001). The levels of ALT, AST, and WBC significantly decreased post-treatment following using D-penicillamine and DMPS (P<0.05). The D-Penicillamine-treated group showed an increase in Hb and RBC (P<0.05). Conclusion: According to the results, penicillamine improves low to moderate lead toxicity. Although DMSP decreases BLL significantly and reverses liver enzymes, further investigations on Hb and RBC, are needed.
N-Acetylcysteine Overdose: A Case Report
Authors:   Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran., Naraki Karim , Mousavi Seyed Hadi ,   Medical Toxicology Research Center, Faculty of Medicine. Mashhad University of Medical Sciences, Mashhad, Iran., Etemad Leila ,   Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran., Rezazadeh-Shojaie Seyed Mohsen ,   Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran., Sadeghi Toktam ,   Department of Internal Medicine, Poorsina Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran, Moshiri Mohammad ,   Medical Toxicology Research Center, Faculty of Medicine. Mashhad University of Medical Sciences, Mashhad, Iran.
Published: July 2021

Background: N-Acetylcysteine (NAC) is a cost-effective antioxidant and very useful treatment for several diseases. Methods: Here we report a rare case of iatrogenic NAC overdose following the mistake in calculation of the loading dose. Results: The patient was 14 years old girl referred to a local hospital due to history of intentional ingesting about 7grams acetaminophen. The physician prescribed her 6 grams NAC as a loading dose but 42grams NAC were infused by mistake. After infusion, the patient showed signs of anaphylactic shock and then transferred to Imam Reza toxicology-unite with weakness, lethargy, extreme fatigue, nausea, and dizziness. NAC overdosing, in a short period of time, led to coagulopathy, reduced platelet count, acute renal failure and metabolic acidosis. After 24 h, the patient died. The Medical forensic examination showed minor lung hemorrhage and presence of little amount of Aluminum phosphide in tissues they did not find no vital organ hemorrhage. It is unclear related to NAC overdose, phosphine intoxication or synergic effects. Conclusion: Massive transfusion of NAC was associated with impairment of coagulation factors, intracranial hypertension, renal failure and metabolic acidosis. Thus, NAC administration should be with caution. The medical history of patients committed suicide are not always accurate and complete evaluation are recommended.
Frequency of Patient Complaints Before and After Legal Medicine Consultation in Orthopedic Ward
Authors:   partment of Orthopedic Surgery, Faculty of Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Zandi Reza , Moshari Mohammadreza ,   Department of Anesthesiology, Faculty of Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Minator Sajjadi Mohammadreza ,   partment of Orthopedic Surgery, Faculty of Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Davari Farnoosh ,   Legal Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Mafi Amir Ali ,   Department of Anesthesiology, Faculty of Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Published: July 2021

Background: Patient who complain of the health community are unpleasant and may endanger the honor of the medical community. However, patients’ complaints can improve the quality of medical services, increase the accuracy of the medical staff, and reduce diagnostic and treatment costs. The aim of this study was to investigate the prevalence of patients’ complaints before and after legal medicine consultation in the orthopedic ward of Taleghani hospital in Tehran, Iran. Methods: This retrospective cross-sectional study investigated the frequency of the complaints of 460 patients before and after legal medicine consultation from spring 2011 to winter 2017. Data were analyzed by excel. Results: The results of this study showed that the frequency of complaints was lowest in spring and highest in fall. The number of complaints and frequencies also decreased over time compared with the previous year. The lowest number of complaints was in 2011 and the highest in 2013. Conclusion: In this study, performing legal medicine consultation in Taleghani hospital in Tehran, Iran reduced the number of registered complaints.
Clinical Poisonings Imposed by the COVID-19 Pandemic
Authors:   Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, Vahabzadeh Maryam , Mostafazadeh Babak ,   Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Published: July 2021

Background: Along with the COVID-19 pandemic, a new problem has appeared in the healthcare facilities: toxicities and poisonings caused by medications and home remedies, by which people have been trying to protect themselves from acquiring the virus. The authors of this paper aim to notify the global scientific society of several substances and medications that either have led to poisonings thus far or have the potential for an outbreak. Methods: Medical English literature reporting cases of poisonings during this pandemic between January and December 2020. Substances and drugs that could be a potential concern to public health are also reviewed. Results: Alcohols and chemical substances have been the main causes of poisonings during this pandemic. Opioids, household products and herbal remedies were partly to blame. Global spread of incorrect information related to the COVID-19 prevention and treatment is a major risk to human lives, particularly in this difficult situation where healthcare systems are overwhelms with high rate of COVID-19 morbidity and mortality. Conclusion: As additional waves of the coronaviruses may hit countries in the upcoming winter, confinements may as well continue. Therefore, emergency physicians must be prepared for possible outbreaks of poisonings and be able to predict any unusual pattern of toxicities.
Comparing Log-based and Exponent-based Functions to Predict Human Height by Foot Length
Authors:   Department of Health Sciences, Higher Colleges of Technology Sharjah, United Arab Emirates., Anwar Fozia , Saleem Alimgeer Khurram ,   Department of Electrical Engineering, Faculty of Engineering, COMSATS University Islamabad (CUI), Islamabad, Pakistan., Kumar Ramesh ,   Department of Health system and Policy, Health Services Academy, Islamabad, Pakistan., Somrongthong Ratana ,   Department of Public Health, Faculty of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
Published: July 2021

Background: Human height estimation is critical in medicolegal cases. This anthropometric measurement not only reveals racial differences but also aids police investigation to narrow down. Foot size varies in different races and ethnic groups, because of genetic influence on development height. The present study aimed to explore the relationship between foot size and the height of a person in a particular context. The current research also compared log-based function and exponent-based function to explore which best fits the relation between age, foot size, and height. Methods: This cross-sectional study included foot measurements from 240 participants of 6 different age groups in the age range of 2-21 years. Foot length and height were recorded as per standard methods after obtaining ethical approval from the Institutional Review Board of COMSATs University Islamabad Pakistan and gaining consent from the study participants. Correlation and regression analyses were performed using SPSS V 23. In this study, two mathematical functions of log-based and exponent-based were compared to more accurately predict the behavior of two variables. The appropriateness of these candidate functions was evaluated using statistical parameters, including the Sum of Squared Errors (SSE), R2, adjusted R2, and Root Mean Square Error (RMSE). Results: The mean height of male participants of the age group of 3-5 years was higher than that of the female participants. Among 6-10-year-olds and 11-15-year-olds, female participants presented a greater height than males. In the age groups of 16-20 and ≥21 years, males were taller than females. The average foot size of males and females of all age groups was 22.09 cm and 20.44 cm, respectively. The exponent-based candidate functions best fitted the relationship between age, foot size, and height, compared to the log-based candidate function. Conclusion: Foot size indicated the highest correlation with height and minimum standard error in the estimation of stature. Therefore, foot size provided the highest reliability and accuracy in estimating height.
Prevalence of Vascular Trauma and Related Factors in Iran: A Systematic Review
Authors:   Department of Surgery, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran, Karimian Mohammad , Okhli Atieh ,   Department of Nursing, Faculty of Nursing and Midwifery, Gonbad Kavoos Branch, Islamic Azad University, Gonbad Kavoos, Iran., Noormohammadi-Dehbalaee Abdollah ,   Departtment of Nursing, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran., Gholami Ali ,   Department of Anesthesiology, School of Medicine, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran., Abdi Alireza ,   Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran., Salimi Ebrahim ,   Student Research Committee, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran., Borji Milad ,   Clinical Research Development, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran., Tarjoman Asma ,   Student Research Committee, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran, Mahdikhani Somayeh ,   Non-comunicable disease research center, Ilam University of Medical Sciences, Ilam, Iran.
Published: July 2021

Background: Managing patients with Vascular Trauma (VT) is essential. This study aimed to determine the prevalence of VT and its related factors in Iran. Methods: This systematic review was performed by two skilled researchers. To access all the Persian and English articles on VT and its influencing factors (from 2000 to August 2019), in addition to Google Scholar search engine, other international databases, such as PubMed/ Medline, Scopus, Embase, Cochrane Library, Science Direct, Web of Science (ISI), and domestic databases, such as Magiran, IranDoc, National Library of Iran Organization, SID, and Barakatkns were used. Data analysis was conducted by MA (CMA) software. Results: The incidence of lower Lower Vascular Trauma (LVI) trauma was equal to 58.4 (95%CI: 41.1-73.8) (I2= 94.67, Q=112.57, P<0.001); the prevalence of upper LVI trauma was measured to be 31.5 (95%CI: 17.7-49.7) (I2=94.48, Q=108.70, P<0.001); the prevalence of penetrating trauma was calculated as 61.3 (95% CI: 49.5-71.9); the prevalence of ulnar nerve injury equaled 9.8 (95%CI: 2.8-28.6); the prevalence of radial nerve trauma was equal to 7.7 (95%CI: 1.2-35.4); the prevalence of death cases was reported as 12.3 (95%CI: 5.1-26.9); the prevalence of amputation rate was observed as 8.8 (95%CI: 5.7-13.4); the prevalence of fasciotomy rate was equal to 22.2 (95%CI: 13.2-34.5); the prevalence of complete artery cutting equaled 55.7 (95% CI: 35.4-74.3),and the prevalence of incomplete artery cutting was measured as 25.5 (95%CI: 12.1-45.9). Conclusion: According to the study results, VT has led to various complications in patients; thus, it is critical to provide the necessary conditions to preserve the patient’s life and prevent life-threatening complications. Such goals could be achieved by preventing this type of trauma and its related complications.
Prevalence of Opioid Poisoning and Related Factors in Under 17-year-olds
Authors:   Department of Emergency Medicine, Faculty of Medicines, Mashhad University of Medical Science, Mashhad, Iran., Foroughian Mahdi , Soroosh Davood ,   Department of Internal Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Published: July 2021

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.
The Prognostic Factors of Aluminum Phosphide Poisoning in Urmia: A-five-years Cross-sectional Study
Authors:   Department of Forensic Medicine and Clinical Toxicology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran., Majidi Mohammad , Jamalpour Mohammad ,   Student Research Committee, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran., Nekoueifard Solmaz ,   Urmia Health Center, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
Published: July 2021

Background: Aluminum phosphide is a highly toxic fungicide. It causes such severe adverse effects as cardiac arrhythmias, metabolic acidosis, acute renal failure, shock, and even death. Therefore, this study investigated the prognostic factors of aluminum phosphide poisoning. Methods: In this cross-sectional study, all hospitalized patients due to aluminum phosphide poisoning admitted to the poisoning center at Taleghani Hospital, Urmia City, Iran, from 2015 to 2019 were evaluated. The demographics characteristics, clinical findings, and laboratory profiles were retrospectively studied by an investigator-made checklist and evaluated concerning the explored patients’ treatment outcomes. Then, the obtained data were analyzed by descriptive and analytical statistics using SPSS V. 16. Results: The present study investigated 134 patients (96 males & 38 females). The mortality rate was equal to 29.8% (22.4% males & 7.4% females) in the study patients. The research patients’ Mean±SD age was 28.6±11.5) years. The Mean±SD ingestion amount of aluminum phosphide was 1.48±1.06 g (min=0.2 g, max=15 g). Nausea and vomiting with 119 (88.8%), hypotension: 89 (66.4%), vertigo: 80 (59.7%), and sinus tachycardia: 74 (55.2%) were the most signs and symptoms in the study patients, respectively. Statistically significant relationships (P<0.05) were found between the patients’ treatment outcomes and white blood cells, direct bilirubin, Hco3, base excess, magnesium, Aspartate Aminotransferase, Alanine Aminotransferase, Blood Urea Nitrogen, creatinine, blood glucose, pH, prothrombin time, and the international normalized ratio. Furthermore, significant relationships were detected between the patients’ treatment outcomes and leukocytosis, hypokalemia, hyperglycemia, and hypoglycemia (P<0.05). Conclusion: Such prognostic factors as demographics characteristics, clinical findings, laboratory profiles, and electrolytes could be used as good indices of the severity of toxicity in patients; accordingly, such data are beneficial for the proper management of patients by healthcare providers. Therefore, prognostic factors should be considered in the diagnosis, treatment, and follow-up stages for these patients.
Hypoglycemia in Patients With Pure Benzodiazepine Poisoning
Authors:   Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran., Goudarzi Fazel , Mousavi-Roknabadi Razieh Sadat ,   Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran., Abdollahpour Maryam ,   Student Research Committee, Department Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran., Sadegh Robab ,   Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Published: July 2021

Background: Various studies investigated the effects of benzodiazepines on insulin and blood glucose levels and provided contradictory results. The present study aimed to evaluate the clinical effects of benzodiazepine poisoning on hypoglycemia. Methods: This retrospective cross-sectional study (from 22/June/2018 to 22/December/2018) was conducted on all medical records of adult patients with benzodiazepine poisoning who were referred to Ali-Asghar Hospital. The required data were collected using a data-gathering form and then analyzed. Results: In total, 61 patients were enrolled in this study. Furthermore, 19 (31.2%) patients developed hypoglycemia. Besides, 50 (82%) patients used benzodiazepine for a suicide attempt, i.e. higher in patients with hypoglycemia (P<0.0001). Multivariate logistic regression test data indicated that benzodiazepine consumption for suicide attempt (OR=47.978, P=0.001, 95%CI, 5.313-433.277), and the respiratory rate at the time of suicide (OR=0.549, P=0.023, 95%CI, 0.328-0.920) were predictive factors for hypoglycemia in patients with benzodiazepine poisoning. Conclusion: Our study data suggested that 31% of patients who were poisoned with benzodiazepines developed hypoglycemia. The suicidal use of drugs and respiratory rates were predictive factors for hypoglycemia in these patients.
A 10-year Institutional Retrospective Analysis of Retroperitoneal Abscess
Authors:   Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Rashno Fariborz , Ebrahimian Manoochehr ,   Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Hajinasrollah Esmaeil ,   Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Shadidi Asil Rouzbeh ,   Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Rostambeigi Saman ,   Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
Published: July 2021

Background: Retroperitoneal Abscess (RA) is a rare and often insidious disease, i.e., difficult to diagnose. RA could originate from different retroperitoneal or intra-abdominal organs. The disease manifests various clinical symptoms and is usually treated with a combination of antibiotics and therapeutic interventions. Methods: Data from a total of 25 patients who were admitted to Loghman Hospital in Tehran City, Iran with a diagnosis of RA from 2010 to 2020 were reviewed in this research. Clinical findings, diagnostic tools, treatment approaches, and microbiology data were considered and analyzed. Results: Out of the 25 patients, the most frequent sources of RA were primary infections (36%), followed by gastrointestinal origin (20%). Fifty-two percent of patients presented no underlying disease; however, diabetes mellitus was the most prevalent underlying disease in the remaining ones. Fever, chills, and back or flank pain (56%) were the most common symptoms in the studied patients. Besides, a high erythrocyte sedimentation rate (mean: 93.58%) was found in most of the researched patients. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) could reliably diagnose the disease with an accuracy of 100% and 92.3%, respectively. Seventy-two percent of the study patients eventually underwent surgery. By taking advantage of CT scan, 24% of abscesses were drained and only 4% required medications to achieve remission. Mycobacteria and Klebsiella pneumonia were the most prevalent pathogens among the explored patients. The total mortality rate was equal to 12%; it occurred in cases with RA of a gastrointestinal (8%) or genitourinary (4%) origin. Conclusion: There exist 3 major choices for treating abscesses, including surgery, image-guided percutaneous drainage, and medical therapy. Image-Guided drainage is recommended in primary infections; however, extra-peritoneal surgery is useful to treat secondary infections, especially those of a gastrointestinal source.
Electrocardiogram Changes in Patients With Acute Ethanol Poisoning
Authors:   Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran., Dorooshi Gholamali , Akafzadeh Savari Mahsa ,   Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran., Nayeri Farzaneh ,   Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran., Meamar Rokhsareh ,   Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran., Tarrahi Mohammad Javad ,   Department of Epidemiology & Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran, Eizadi-Mood Nastaran ,   Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Published: July 2021

Background: Alcohol consumption leads to a significant number of deaths, mostly in men, worldwide. Considering the effect of ethanol toxicity on the heart, we studied various Electrocardiographic (ECG) changes in patients with acute ethanol poisoning. Methods: A cross-sectional study was performed on patients admitted to Khorshid Hospital (affiliated to Isfahan University of Medical Sciences) due to ethanol poisoning. All 15- to 50-year-old patients with acute ethanol intoxication were included in the study (N=250). The patients’ information, including the demographic characteristics, clinical manifestations, and ECG changes were recorded and analyzed. Different variables were compared between the patients with or without ECG changes. Results: Most of the research patients (n=208) were men (83.82%). The Mean±SD age of the study patients was 26.8±8.87 years. About 54.8% of the patients presented abnormal ECG. The changes in ECG were not significantly different based on the demographic characteristic and clinical manifestations. The time interval between ethanol consumption and admission was significantly higher in patients with abnormal ECG, compared to those with normal ECG (Mean±SD: 7.09±10.67 vs. 4.77± 4.54 hours, respectively) (P=0.03). Conclusion: ECG changes are common in patients with ethanol poisoning. The time interval between ethanol consumption to hospital admission may be an important factor in the occurrence of ECG changes.
From Leaving Home to Losing Identity: A Qualitative Study on Rough Sleeping in Drug Addicts in Iran
Authors:   Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Khoshnami Mohammad SabzI , Sheybani Fahime ,   Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Mohammadi Elham ,   Department of Social Work, Faculty of Social Sciences, Allameh Tabataba’i University, Tehran, Iran., Arshi Maliheh ,   Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Ostadhashemi Leila ,   Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Khalvati Maliheh ,   Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
Published: July 2021

Objectives: The phenomenon of rough sleeping in big cities of Iran, particularly in Tehran is a serious social problem. The term rough sleeping is mostly used for those who sleep on the public spaces including pavements, parks or under bridges. It is assumed that rough sleeping and drug addiction are linked to each other. This study aims to evaluate the process of rough sleeping based on the experiences of homeless drug addicted in Iran. Methods: This is a qualitative research. Participants were 20 homeless addicts (9 males and 11 females, mean age= 36.2 years) in Tehran city who were recruited using a purposive sampling method, and sampling continued until data saturation. The data were collected through a semi-structured in-depth interview and observations. Data analysis was performed based on the grounded theory recommended by Strauss and Corbin (1998). Results: The rough sleeping process had two steps: (a) Leaving home voluntarily (to protect family or escape from family problems) or involuntarily (Due to being expelled from home and losing the roof over the head), and (b) Being homelessness which had four main categories: Elusive life, informal and contravened subsistence, involving in exploitative relationships, and loss of individual/social identity. Conclusion: When leaving home and becoming rough sleeper, the individual becomes elusive, delinquent, damaged and socially rejected homeless, in addition to the risk of becoming a drug addict. Therefore, this group can be considered as a severely injured group involved in various social, legal and psychological issues. Given the complexity of the homelessness aspects in drug addicts, there is a need for coordinated interventions between individuals, families and the support systems at all levels.
Accuracy of Niacin Skin Flush Test for Diagnosing Schizophrenia
Authors:   Department of Psychiatry, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran., Arzanlou Mohammad , Armanikian Alireza ,   Department of Psychiatry, Shahid Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran., Saed Omid ,   Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran., Dobakhti Faramarz ,   Department of Pharmaceutics, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran., Motamed Nima ,   Department of Community Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran., Ahmadiafshar Akefeh ,   Department of Pediatrics, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran.
Published: July 2021

Objectives: This study aims to investigate niacin sensitivity in schizophrenia patients compared to healthy people and examine the accuracy of niacin skin flush test in diagnosing schizophrenia. Methods: This diagnostic study was conducted in 2018 in Zanjan, Iran. Three niacin concentrations (0.001 M, 0.01 M, and 0.1 M) was first applied topically to the skin of 36 schizophrenia patients and 33 healthy controls. Flush responses were evaluated at 10 and 15 min after application. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the test were measured for each niacin concentration and evaluation time. Results: At 10 min, the highest test accuracy was reported when 0.001 M niacin solution was used (Sensitivity=94%, specificity=50%, PPV= 51%, and NPV= 94%). At 15 min, the highest test accuracy was observed at 0.01 concentration (Sensitivity=52%, specificity=92%, PPV=79%, and NPV=77%). Conclusion: Flush responses to niacin is more impaired in patients with schizophrenia. Therefore, niacin can be considered as a biological marker of schizophrenia and can be used for its diagnosis.
Application of Negative Reinforcement and Reward Technique to Reduce Behavior of Collecting Goods In Individual with Schizophrenia
Authors:   Department of Professional Psychology, School of Psychology Education, University of Muhammadiyah Malang, Indonesia., Dewi Puspasari Karisma Karisma , Safira Nabila Zulfany Zulfany ,   Department of Professional Psychology, School of Psychology Education, University of Muhammadiyah Malang, Indonesia., Salis Yuniardi Salis Muhammad ,   Department of Professional Psychology, School of Psychology Education, University of Muhammadiyah Malang, Indonesia., Latipun Latipun ,   Department of Professional Psychology, School of Psychology Education, University of Muhammadiyah Malang, Indonesia.
Published: July 2021

Our subject is a 55-year-old man and a former civil servant. He claimed to have seen someone who others could not see. He believed that he is an important person. He had strange behavior such as separating himself from others, speaking and laughing alone, and collecting rubbish. Based on the assessment through observation, interviews, and psychological tests, the subject was diagnosed with schizophrenia and behavioral problems such as collect things. The subject’s behavior appears because he feels pleasure after collecting goods. He did not do other activities that make him feel good; thus, the behavior was repeated. The intervention aims to reduce the frequency of collecting things through negative reinforcement and rewards techniques. The intervention eventually suppressed the behavior of collecting things carried out by the subject gradually.
Effect of Emotion-focused Therapy on Anxiety, Depression and Difficulty in Emotion Regulation in Women With Binge Eating Disorder
Authors:   Department of Clinical Psychology, School of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Asmari Bardezard Yousef , Khanjani Sajad ,   Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran., Mousavi Asl Esmaeil ,   Department of Psychiatry, Golestan Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran., Dolatshahi Behrouz ,   Department of Clinical Psychology, School of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Published: July 2021

Objectives: This study aims to investigate the effect of Emotion-Focused Therapy (EFT) on depression, anxiety, and Difficulty in Emotion Regulation (DER) in women with Binge Eating Disorder (BED). Methods: This is a quasi-experimental study with pre-test/post-test/follow-up design using a control group. Study population consists of all women referred to the obesity clinics in Tehran in 2019. Of these, 40 were selected using a purposive sampling method and were randomly divided into two groups of intervention (n=20) and control (n=20). The intervention group received 10 sessions of EFT, each session for 90 minutes. Data collection tools were the Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI-II), Difficulties in Emotion Regulation Scale (DERS), and Binge Eating Scale (BES), which were completed before and after the intervention. Data were analyzed using descriptive statistics and repeated measure ANIVA in SPSS v. 21 software. Results: Group EFT significantly reduced the mean anxiety, depression, DER and severity of binge eating after intervention and over the 2-month follow-up period in BED women (P<0.05). Conclusion: The EFT can reduce anxiety, depression, DER and binge eating severity in BED women, and its effect remains constant after two months. It can be useful in the treatment of BED.
Infidelity a Challenge Facing Therapists
Authors:   Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran., Shirdel Saeedeh , Bolhari Jafar ,   Spiritual Health Research Center, School of Behavioral and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
Published: July 2021

It seems vital to address the problem of extramarital relationships or marital infidelity, which is a traumatic issue for families and spouses and a common issue in counseling and treatment for mental health therapists. This social problem is also very common, however, due to its crucial and personal aspect, accurate information about its prevalence is not available in Iran. Infidelity refers to any concealment of a spouse about an extramarital affair. In fact, secrecy is an important part of an illegitimate and romantic relationship. Types of infidelity include sexual, emotional, and virtual (Internet) infidelity. Men react more strongly to sexual infidelity and women to emotional infidelity. An important point to note is that dissatisfaction with marriage can lead to infidelity, but a successful marriage is no guarantee that it will not happen. Despite its prevalence, not much research has been done in this area. In a US study, integrative intervention therapy was used for couples with such problem and it was found that this integrated treatment model had a good effect on the symptoms of Post-Traumatic Stress Disorder (PTSD). Some tudies have been conducted in Iran despite the sensitivity of the issue. In a systematic review conducted in Mashhad to investigate the causes of infidelity in married women, four causes of individual-personality, cultural-social, family-educational, and religious-belief were more effective than other causes. In another study, Acceptance and Commitment Therapy (ACT) was performed in Tehran to reduce anxiety and depression among women with extramarital affairs and it was observed that this treatment clearly reduces the mentioned symptoms.