ORIGINAL_ARTICLE
Poly Drug Use - A Challenge for Drug Treatment
Poly-drug use refers to the use of two or more substances at the one time or repeatedly. It is common among both recreational and regular drug users across the world. Poly-drug use is a great contributor to the global number of deaths related to drug overdose. In this case, the likelihood of drug overdose and its pertaining complications in an individual is higher especially when benzodiazepines or alcohol is consumed along with other drugs. According to the recent WHO report, there are 3 patterns of poly-drug use: (1) different substances are taken together to have a cumulative or complementary effect, which is commonly seen among (a) cannabis or cocaine users (the drug may be used in combination with alcohol), (b) heroin users (the drug might be used in combination with benzodiazepines, alcohol or other opioids), (c) cocaine users (the drug might be used in combination with other stimulants); (2) the use of a drug to mitigate the adverse effects of another drug (e.g., use of cocaine and heroin or other opioids); (3) a drug is gradually replacing by another drug due to changes in price or availability (e.g., ecstasy is substituted by mephedrone or other psychoactive substances). Opioids, alcohol, cannabis and cocaine are the most common substances implicated in poly-drug use in different parts of the world. The paradoxical or sometimes amplifying effects of drugs used concurrently make the treatment of the poly-drug use patients extremely challenging. It has been considered important to understand the patterns of poly-drug in different regions to prevent and modify the risk factors and to provide useful guidelines for physicians.
https://apjmt.mums.ac.ir/article_2803_e6270ba1e7afda90afb484b3627d6d82.pdf
2014-05-01
1
1
10.22038/apjmt.2014.2803
Alcohols
Ethanol
Poisoning
Poly-Drug Use
Nadeem
Rehman
1
Regional Coordinator, Drug Demand Reduction and HIV, Regional Programme for Afghanistan and Neighbouring Countries, UNODC
LEAD_AUTHOR
ORIGINAL_ARTICLE
International Health Problems Related to Alcohol Abuse
The harmful use of alcohol inflicts great deal of social and economic losses on individuals and societies. Given the increase in world population and the predicted increase in alcohol consumption, the alcohol related burden of disease progressively catches higher ranks in the list of factors threatening humans' life. It has been considered that the social and economic burden related to alcohol use may even increase further unless effective prevention policies and measures are implemented worldwide. According to the latest report on alcohol use and its inherent health consequences by World Health Organization (WHO), approximately 3.3 million deaths, or 5.9% of all global deaths, were attributable to alcohol consumption in 2012. The male: female ratio for deaths related to alcohol consumption was 1.9: 1 in 2012. Moreover, at the same time, 5.1% of the global burden of disease and injury, have been attributable to alcohol consumption. Among different WHO regions, the highest alcohol-attributable deaths and DALYs were reported in the European Region, while in the South-east Asian and Western Pacific Regions, an increasing trend in alcohol consumption is observable.
https://apjmt.mums.ac.ir/article_2804_c16a4ec0010d000d8d4dd75d1fbdbdd7.pdf
2014-05-01
1
1
10.22038/apjmt.2014.2804
Alcohols
Alcohol-Induced Disorders
Burden of Disease
Reza
Afshari
afsharireza@yahoo.com
1
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
A Glimpse of the Production and Consumption of Alcohol (Ethanol) in Iran under the Supervision of Food and Drug Organization (FDO)
Alcohol in Iran is produced mainly from molasses of sugar cane and sugar beet. Other sources of alcohol production like wheat and barley exist, but because of some cultural and political reasons, they cannot be legally used for producing alcohol in Iran. Twenty-six manufacturers in 18 provinces are officially active. The actual capacity of ethanol production with medical purity is about 100million liters, but the real volume of production is about 40 million liters. 10 million liters of ethanol production is exported. Obviously, the importance of export multiplies after increase of price ratio between Dollar and Rial. Thirty million liters use internally as bulk in various industries provided in 1, 2 and 5 liter packages in hygienic and medical centers and also medical laboratories. 1 and 2 liter packages are made from glass with amber color and 5 liter packages are made from plastic. The bright glass packages with smaller volume, are sold in market, actually are out of control products and obviously illegal. Also there is no available data on extra volume of alcohol production, although the sources of out of control alcohol are definitely the other kind of material except molasses. Since marketing of alcoholic beverages is prohibited in Iran, there are no exact statistics of the amount of alcoholic drinks used in this country. Also there is no official import of medical alcohol in Iran. It is concluded that there is no available data for real volume of out of control alcohol and alcoholic beverages in Iran, so no one can predict prevalence of ethanol and methanol poisoning in Iran.
https://apjmt.mums.ac.ir/article_2805_92dfe746e823ef482d7e2fd0cd83b0d8.pdf
2014-05-01
2
2
10.22038/apjmt.2014.2805
Alcohols
Chemical Industry
Chemical Safety
Iran
Talat
Ghane
t_ghane@yahoo.com
1
Central Headquarter of Drug and Poison Information Center, Food and Drug Organization, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Alcohol in Ancient Islamic Chemical and Medical Texts
Nowadays, Alcohol is widely used in medicine and industry. On the other hand, it is well-known for its intoxicant and addictive effects and they were common in the past. Discovery of it was imputed to Mohamad ibn Zakaria Razi (Rhazes, 925 AD) or Jaber ibn Hayan (Geber, 815 AD). The Islamic researchers’ viewpoint about alcohol and their knowledge about this substance are aimed to be explored in this study. Hence, medical texts until end of 12 century were reviewed. Most of them were written in Arabic. In this way, Arabic terms like "alkohl", "alcohol" and "alqol" were used. In this study, the books of Islamic scholars including Rhazes, Geber, Alkendi (866 AD) and Ibn Sina (Avicenna, 1037 AD) were reviewed.
https://apjmt.mums.ac.ir/article_2808_24afc590af673a8a3b972662b628c382.pdf
2014-05-01
2
2
10.22038/apjmt.2014.2808
Alcohols
Ethanol
History
Islam
Tahereh
Azimzadeh Tehrani
1
Faculty of Letters and Humanities, Ferdowsy University of Mashhad, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Alcoholism – the Worst Addiction
Introduction: The most common substance of abuse/dependence in patients presenting for treatment in western countries is alcohol. Ethyl alcohol or ethanol which is also called medicinal alcohol is used as an official drug compendium. It is also administered as an antidote in methanol poisoning. However, regular consumption of high amounts of alcoholic drinks induces dependence and addiction leading to alcoholism. Definition: Alcoholism is a broad term for advanced chronic ethanol abuse. It is, in fact, a compulsive and uncontrolled consumption of alcohol beverages usually to the detriment of the drinker's health, personal relationships, and social standing. World Health Organization expert committee discouraged the use of "alcoholism" in medicine and recommended a preferred term of "alcohol dependence syndrome". However, alcoholism is still used more frequently and the people suffering from alcoholism are called "alcoholics". Clinical Manifestations and Complications: Women are more sensitive to ethanol than men. Long-term complications of alcohol dependence also develop more rapidly in women than in men with higher mortality. Genes play an important role in alcoholism and its complications. Brain, heart and liver are the main affected organs in alcoholism. Physical symptoms or diseases produced by alcohol addiction include cirrhosis of the liver, pancreatitis, epilepsy, polyneurpopathy, dementia, peptic ulcer, malabsorption, cardiovascular complications and even cancer. Death is mainly due to cardiovascular complications. Management: All factors which encourage an alcoholic to continue drinking must be considered to successfully prevent a relapse. Detoxification alone does not actually treat alcoholism. It is thus necessary to follow-up detoxification with an appropriate treatment program to reduce the risk of relapse. Medications (benzodiazepines, acamprosate, calcium carbimide, disulfiram and naltrexone) have been used for treatment of alcoholism without great success. Even various forms of psychotherapy, social supports with medications have had limited success. Conclusion: The most common and the worst substance of abuse is ethanol which leads to alcoholism with many social and health problems. Therefore, prevention of alcohol abuse is the most advisable.
https://apjmt.mums.ac.ir/article_2809_652f915dec4617d35742451cfc9668a0.pdf
2014-05-01
3
3
10.22038/apjmt.2014.2809
Addiction
Alcoholism
Ethanol
Mahdi
Balali-Mood
1
Medical Toxicology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Fomepizole as a First-line Treatment of Patients with Methanol Poisoning
Methanol is responsible for a life-threatening poisoning. Fomepizole, a potent alcohol dehydrogenase inhibitor, is an efficient and safe antidote that prevents or reduces toxic methanol metabolism. Although no study has compared its efficacy with ethanol, fomepizole is recommended as a first-line antidote. Treatment should be started as soon as possible, based on history and initial findings including anion gap metabolic acidosis, while awaiting measurement of serum alcohol concentration. Administration is easy (15 mg/ kg-loading dose, either intravenously or orally, regardless of alcohol concentration, followed by intermittent 10 mg/kg-doses every 12 hours until alcohol concentration becomes less than 30 mg/dL). There is no need to monitor fomepizole concentration. If administered early, fomepizole prevents methanol-related visual and neurological injuries. When administered prior to the onset of significant acidosis or organ injury, fomepizole may obviate the need for hemodialysis. When dialysis is indicated, 1 mg/kg/h-continuous infusion should be provided to compensate for its elimination. Its side-effects are rarely serious and with a lower occurrence than ethanol. Fomepizole is contraindicated in case of allergy to pyrazoles. It is both efficacious and safe in the pediatric population, but is not recommended during pregnancy. In conclusion, fomepizole is an effective and safe first-line antidote for methanol poisoning.
https://apjmt.mums.ac.ir/article_2810_9f28e1dad136683691a1a8869249ec76.pdf
2014-05-01
3
3
10.22038/apjmt.2014.2810
Fomepizole
Methanol
Poisoning
Bruno
Mégarbane
bruno-megarbane@wanadoo.fr
1
Department of Medical and Toxicological Intensive Care Medicine, Lariboisière Hospital, INSERM U1144, Paris-Diderot University, Paris, France
LEAD_AUTHOR
ORIGINAL_ARTICLE
Accelerated Cytotoxicity Mechanism Screening
By discovering how chemical compounds/xenobiotics cytotoxicity is affected when their metabolic pathways are inhibited or activated, the metabolic pathways that activate versus detoxify chemical compound can be identified. Reactive metabolites contributing to cytotoxicity can also be identified. In this lecture, the pretreatment of inhibitors and activators of xenobiotic metabolizing enzymes as well as other xenobiotic cellular targets in freshly isolated rat hepatocytes for the accelerated cytotoxicity mechanism screening (ACMS) of xenobiotics (a technique used in our laboratory) are discussed. This technique is useful for determining toxicity mechanisms. The inhibitors/ activators have been selected on the basis of their selectivity, modulator effectiveness, and their lack of toxicity. The use of these inhibitors/activators with other cells or subcellular fractions (e.g. mitochondria) for assessing target organ toxicity mechanisms is also reviewed.
https://apjmt.mums.ac.ir/article_2811_d03db5ba71ceda7e499dfe76caa61731.pdf
2014-05-01
4
4
10.22038/apjmt.2014.2811
Cytotoxicity
Enzymes
Xenobiotics
Jalal
Pourahmad
1
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Pharmacokinetic/Pharmacodynamic (PK/PD) Relationship-based Approach to Understand the Variability of Central Neurological Effects of Ethanol
Pharmacokinetic/pharmacodynamic (PK/PD) relationships describe the quantitative relationships between the drug-induced effects and the concurrent corresponding drug concentrations in an individual. Since a long time, rough qualitative relationships have been described between neurological presentation and plasma ethanol concentration in acute ethanol ingestion. However, to date, precise quantitative PK/PD relationships have not been extensively studied. We studied PK/PD relationships in ethanol poisonings. Plasma concentrations were measured using an enzymatic assay. Coma depth was assessed using the Glasgow Coma Scale (GCS). Non-linear regression was used for modeling PK/PD relationships. The PK/PD relationships were well fitted with the sigmoidal Emax model. A maximal toxic effect (GCS of 3) was associated with a wide range of plasma ethanol concentrations, suggesting the saturation of drug targets at high doses. During the course of poisoning, the relationships between the depth of coma and the corresponding plasma concentrations were of sigmoidal shape. The elevated values of the Hill coefficient showed that a small decrease in plasma concentrations near the EC50 was associated with a dramatic improvement in the level of consciousness. In chronic alcoholic patients, EC50 was higher than in non-tolerant. Analyzing blood concentrations with respect of the delay elapsed since the ingestion may help predicting the time of awakening and thus the evaluation of outcome. In conclusion, PK/PD relationships are helpful in suggesting mechanisms of inter-individual variability of central neurological response to ethanol.
https://apjmt.mums.ac.ir/article_2812_0a6462e9e7c5a6554bd217b0dc050bcc.pdf
2014-05-01
4
4
10.22038/apjmt.2014.2812
Alcoholic Neuropathy
Pharmacokinetics
Pharmacodynamics
Ethanol
Bruno
Mégarbane
bruno-megarbane@wanadoo.fr
1
Department of Medical and Toxicological Intensive Care Medicine, Lariboisière Hospital, INSERM U1144, Paris-Diderot University, Paris, France
LEAD_AUTHOR
ORIGINAL_ARTICLE
Measurement of Methanol Contents in Most Commonly Used Herbal Distillates in Mashhad
Background: Herbal distillates had been used for many centuries as herbal medicine in Traditional Persian medicine. Recently, some studies claimed the presence of methanol in different types of herbal distillates which can cause different complications or even death as methanol is highly toxic. The main purpose of this study was to determine methanol content in the commonly-used industrial herbal distillates produced in Mashhad. Methods: A total of forty-five herbal water extracts of five types of most commonly used herbal distillates including peppermint, camel thorn, chicory, fumitory and rose water were randomly bought from market. Methanol content of each sample was measured according to the standard method. Collected data was analyzed by SPSS software using appropriate descriptive statistical tests. Results: The lowest and highest concentration of methanol were found in rose water extract (mean=9.04 ± 3.42 mg/dL) and peppermint extract (mean=93.87 ± 76.59 mg/dL) samples respectively. One-way ANOVA showed statistically significant differences between methanol concentration in the studied herbal distillates (P =0.03). Conclusion: Methanol concentration, especially in peppermint extract was very high that may induce toxicity in people taking these products regularly for a long time. Therefore, considering the harmful effects of methanol on human health, further studies are required for determining permitted levels of methanol in herbal distillates.
https://apjmt.mums.ac.ir/article_2813_6438ba8bf8db868fa66a6efa5bde01e2.pdf
2014-05-01
5
5
10.22038/apjmt.2014.2813
Methanol
Plant extracts
Toxicity
Mahdi
Yousefi
1
Department of Persian Traditional Medicine, School of Complementary and Persian Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Reza
Afshari
afsharireza@yahoo.com
2
Addiction research Centre, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Development of the Alcohol Policy Document in Iran
Background: Statistics of alcohol use Iran was investigated in the beginning of 2010 in Mental, Social Health and Addiction Department of Ministry of Health. The findings showed that the alcohol use, especially in young people, is notable. Hence a strategic plan or a policy document in alcohol use was needed to explain the main vision also provide countrywide strategies for all related domains such as prevention, treatment and harm reduction. Methods: Several expert panels for scientific and technical support, also identifying interested researchers and people who can help us in this issue were held. We continued to do this with snowball sampling method. In addition, the best evidences about the topic were collected, and several meetings with main and the most related alcohol use stakeholders were held. Results: Initially, a sub-national alcohol policy document was written that was communicated by health minister to all medical universities throughout the country. Subsequently, we expanded our audiences and wrote the national alcohol policy document which consists of main interventions and determines the direct responsible and collaborative organizations of all these interventions. In this process, our activities were formed in the national committee of prevention and control of alcohol use that works under the supervision of Ministry of Interior. This document was finally communicated by Interior Minister to the all related organizations in the late of 2013. Conclusion: We should try to employ this document that was created as the result of a lot of efforts during 4 years.
https://apjmt.mums.ac.ir/article_2875_2d1d93727a105ea5f188cb519a7628b3.pdf
2014-05-01
5
5
10.22038/apjmt.2014.2875
Alcohols
Health Policy
Health Planning
Iran
Nadereh
Memaryan
1
Academy of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Epidemiological Profile of Methanol Poisoning in Bangladesh (2008-2014) and Clinical Experience of a Single Outbreak
Background: World Health Organization (WHO) reported continuous increase of alcohol consumption in Southeast Asian region. On social and religious ground, open alcohol consumption is banned in Bangladesh though incidence of acute methanol intoxication is seriously increasing. Unfortunately, apart from WHO report (2004) there is no available epidemiological and clinical data in Bangladesh. This study was designed to gather the epidemiological information of methanol intoxication in Bangladesh since 2008. The in-depth clinical analysis of a single outbreak was also done. Materials and Methods: Data were collected from the national archive center of Bangladesh. Two most circulated Bengali and one English daily newspapers were searched manually from March, 2008 to March, 2014 for the news of any incident of methanol intoxication happened throughout the country. Google scholar and PubMed search engines were also explored using the word ‘methanol intoxication’ as the search word. All data were cross-checked with the archive of a popular electronic channel. Clinical analysis of an incident was done using the patients’ files from the hospital archive of Sylhet M.A.G. Osmani medical college in august, 2010. Data were expressed as table and charts. Student t test and chi-square test was performed to rule out statistical significance. Results: Seventeen incidents happened within the study period, where total victim was 104. Out of them 79 died and only 25 survived with a death rate of 75.9%. Mean age of the victims was 40.2 years (range 3- 65 years). The majority of incidents (12, 70.5%) occurred in north-western belt of the country followed by 3 incidents (17.6%) in southern and 2 incidents (11.7%) in north-eastern part of the country. 70.5% of the incidents happened in the later part of the year (September- December). A massive methanol poisoning incident happened at north-eastern part of Bangladesh on 20th August, 2010. Total number of victims was 23 with an age range of 3to 60 years (mean: 38.7 years). Among them, four victims died at home and four was brought dead to the emergency room. Fifteen patients were admitted to hospital and of them two died giving a total death rate of 43.4%. Major clinical findings were gastrointestinal manifestations (abdominal pain, vomiting/ nausea) in 15 patients (100%), followed by CNS effects including dizziness and vertigo in 7 patients (46.6%), visual disturbances (blurred vision, dilated pupil and hyperemia of optic disc) in 3 patients (20%), metabolic acidosis in 3 patients (20%), respiratory distress in 3 patients (20%) and renal involvement (oliguria) in 1 patient (6.6%). In addition to symptomatic management, intravenous sodium bicarbonate (for acidosis) and intravenous folinic acid (for ocular manifestations) were given with favorable outcomes. Two patients required hemodialysis for acidosis and renal involvement, while one of them ultimately died. On short term follow up (after 6 weeks) no patient had any residual complications. Conclusion: Strong legislative initiatives are required to control the sale and consumption of methanol in Bangladesh. Considering its high death rate, medical personnel requires more training for prompt management of the cases. Development of public awareness especially among the rural community is a must to face the catastrophe.
https://apjmt.mums.ac.ir/article_2876_f3c520ded84d7a9b989134cc5a06fc81.pdf
2014-05-01
6
6
10.22038/apjmt.2014.2876
Disease Outbreaks
Epidemiology
Methanol
Poisoning
Bangladesh
Fazle Rabbi
Chowdhury
1
Department of Medicine, Sylhet M.A.G.Osmani Medical College, Sylhet, Bangladesh
LEAD_AUTHOR
Mohammad
Bari
2
Department of Medicine, Sylhet M.A.G.Osmani Medical College, Sylhet, Bangladesh
AUTHOR
Jahangir
Alam
3
Department of Medicine, Sylhet M.A.G.Osmani Medical College, Sylhet, Bangladesh
AUTHOR
ORIGINAL_ARTICLE
A Large Cohort Study of the Mashhad Residents’ Beliefs about the Effects of Alcohol on Common Health Problems
Background: Religious beliefs, access to alcohol and country rules clearly have impact on people's attitudes towards alcohol consumption. In this large study, sociological perspectives of people have been assessed about the effects of alcohol on some of common health problems. Methods: In this survey, 143 real estate owners in city of Mashhad were randomly selected and asked to give our questionnaire to every person who comes to their office. In the questionnaire peoples' idea about the effects of alcohol on 10 medical and psychological issues including diabetes, hypertension, concentration, thinking, memory, sexual function, cerebrovascular diseases, food digestion, obesity and hyperlipidemia was investigated. The answers were determined according to Likert scale from strongly agree to strongly disagree. Results: In total, 8768 subjects that most of them were men (89%) were studied. Mean (SD, Min-Max) age was 38 (9, 24-65). Among the users, 2% used alcohol in the past week, followed by 22% in the last month, 43% in the last year and 33% in more than 1 year ago. 50% were using handmade alcohols, 10% were using brand products and the rest both. It was found that people on average believe that alcohol use has negative impact on thinking (mean (SD) score of Likert = 1.3 (0.5)), memory (1.6 (0.6)), blood pressure (1.6 (0.5)) and obesity (1.8 (0.7)). On the other hand, they believed that alcohol use has positive impact on sexuality (2.6 (1.0)) and food digestion (2.6 (0.9)). Men believed more positively about alcohol impact on digestion (P < 0.001), thinking (P < 0.001), obesity (P < 0.001), sexuality (P = 0.007) and diabetes (P = 0.022) than women, and had less positive attitude with regards to blood pressure (P = 0.026) and attention (P < 0.001). Conclusion: People should be educated about negative impacts of alcohol use on health. The preventive measures should be focused on special subpopulations such as men.
https://apjmt.mums.ac.ir/article_2877_7fe46b32d18a48f3887627c7f0777db2.pdf
2014-05-01
7
7
10.22038/apjmt.2014.2877
Alcohols
Attitude
health
Medical Sociology
Hamid
Khosrojerdi
hamidkhped15@yahoo.com
1
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Mozhgan
Amini
mojg.am@gmail.com
2
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Alcohol and Cognition; From Neurotoxicity Prevention to Cognitive Rehabilitation
Alcohol provokes different molecular pathways contributing to a clinically significant neurotoxicity in different brain areas. Affected cognition in alcoholics can influence both daily life functioning and alcohol craving management abilities. Preventing alcohol-induced neurotoxicity with different neuroprotective pharmacological interventions is receiving strong scientific backgrounds from published evidences done on animal models. But the question is how we can translate these evidences into clinical applications for active alcohol users. Cognitive rehabilitation with targeted and graded exercises has provided clinicians with new hopes for helping affected clients to retain their functions for a normal healthy life. Moreover, rehabilitation protocols for patients who have serious cognitive impairments due to chronic alcohol use disorder, current available interventional packages and future horizons for further studies in Iran should be addressed.
https://apjmt.mums.ac.ir/article_2878_c0ef552f5894a9aa82e462e069ca6ccc.pdf
2014-05-01
7
7
10.22038/apjmt.2014.2878
Alcohols
Alcohol-Induced Disorders Cognition
Neurotoxicity Syndromes
Hamed
Ekhtiari
1
Neurocognitive Laboratory, Iranian National Center for Addiction Studies. Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
An Epidemiologic Study on Methyl Alcohol Poisoning in Tehran, Iran
Background: In Iran, methyl alcohol poisoning rarely occurs accidentally and usually occurs through abuse of contaminated ethanol. However, with proper and timely treatment complications and mortality of methanol poisoning can be prevented. In this study, the epidemiological profile of methanol poisoning in the Iranian society was investigated. Methods: In this prospective cross-sectional study, 28 methanol poisoned patients referred to the department forensic medicine and toxicology of Loghman Hakim and Baharlu Hospitals were examined and their data were collected. Results: Most of the patients (82.1%) were men. Mean age of patients was 29.3 ± 4.57 years. The most common cause of poisoning was drinking unknown contaminated alcoholic beverage (82.1%) without knowing the effects and risks. Most patients (57.1%) had mild decreased level of consciousness. 14.3% of patients developed toxic complications (blindness) at discharge and 17.9% of patients died at the hospital despite receiving appropriate treatment. Conclusion: Considering the high frequency of methanol poisoning in young men without knowing the side effects and risks, it is necessary to educate youths about the effects of alcohol and alcoholic beverages, with special attention recognition of its potential complications. It is also essential to train medical staff, especially emergency physicians about symptoms, diagnostic keys and early treatment of alcohol poisoning to prevent sever complications such as visual loss and brain damage.
https://apjmt.mums.ac.ir/article_2879_dcd3fd6ab9122c84601b8c575f06d877.pdf
2014-05-01
8
8
10.22038/apjmt.2014.2879
Alcohols
Methanol
Poisoning
Iran
Babak
Mostafazadeh
mstzbmd@sbmu.ac.ir
1
Department of Forensic Medicine and Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Hakimeh
Eghbali
2
Legal Medicine Organization, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Evaluation of the Reliability and Validity of Alcohol Use Disorders Identification Test (AUDIT)
Background: Alcohol consumption is one of the main health problems in most countries. The purpose of the present study is to evaluate the reliability and validity of Alcohol Use Disorders Identification Test (AUDIT).
Methods: By employing the method of available sampling, 70 alcoholic patients were included as case group and 70 normal age, gender and education matched individuals were also included as the healthy group (controls). Both groups filled out the AUDIT questionnaire. Statistical tests, Cronbach’s alpha, correlation coefficients and exploratory factor analysis were done to analyze the data.
Results: The internal reliability of the questionnaire was estimated to be 0.84 by employing Cronbach’s alpha test, which indicates that approximately 16% of the total variance of the results obtained from the questionnaire was affected by the measurement error. This value was reported to be 0.85 for the cases and 0.84 for the controls. After omitting the second question of the questionnaire the Cronbach’s alpha increased, but the amount of the increase was rather limited and thus no change in the questionnaire was required. By omitting each of the questions from the questionnaire, the alpha coefficient changed ranging between 0.8 and 0.85. Moreover, using the method of questionnaire classification the coefficient of internal consistency was reported to be 0.78. The reliability of the questionnaire was determined to be 0.84 by employing Cronbach’s alpha. The coefficient of internal consistency for each question was estimated to be 0.18 to 0.74. The consistency between test and after-test results was found to be significant (P = 0.020 and r = 0.710). Using the ROC curve on cutoff point, sensitivity and trait of the test was determined to be 99% and 89% respectively. By employing exploratory factor analysis and varimax rotation, the test examines two key factors I and II that respectively accounted 35% and 34% and overall 56% of the total variance to them.
Conclusion: The AUDIT questionnaire has favorable psychometric properties and therefore can be used as a valid tool to carefully sift through patients for alcohol use.
https://apjmt.mums.ac.ir/article_2880_fe233be666192813c88941198bbd8535.pdf
2014-05-01
8
8
10.22038/apjmt.2014.2880
Alcohol-Induced Disorders
Mass screening
Psychometrics
Substance Abuse Detection
Abbas
Zavar
1
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Bahman
Alimoradi
alimoradibahman@yahoo.com
2
SYB Institute of Preventive Medicine, Mashhad, Iran
AUTHOR
Lida
Jarrahi
3
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Nafiseh
Khosravi
khosravinafise@yahoo.com
4
SYB Institute of Preventive Medicine, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Development of a New Vernacular Tool for Diagnosis of Alcohol Dependence in the Emergency
Background: Alcohol dependence (AD) is a major reason for morbidity and visits to emergency medical settings. However, the detection of AD is often difficult or overlooked. This study aimed to develop a brief screening questionnaire in Hindi language for detection of AD in an emergency medical setting. Methods: The authors in consultation devised a set of questions related to AD in the Hindi language requiring binary yes/no type of response. These questions were guided by clinical experience, nosological criteria and previously published screening questionnaires. After initial piloting, these questions were administered by the treating doctors to 100 consenting adult patients presenting with possible AD in the emergency medical services of a tertiary care hospital in North India. A diagnosis of AD was done by administering Mini-International Neuropsychiatric Interview separately. Identification of the most discriminant combinations of items for the detection of AD were based on the chi-square test and binary logistic regression analyses. The final version of the questionnaire was then externally validated on another cohort of patients. Results: Based on the analyses, we retained 5 items in the final version of the questionnaire. Sensitivity and specificity values for cut-off scores were calculated. Subsequent external validation revealed satisfactory psychometric properties of the questionnaire. Conclusion: The questionnaire represents a simple and brief clinician-administered instrument for screening of AD in an emergency medical setting.
https://apjmt.mums.ac.ir/article_2881_286fa8a7d7944bb865a51e63f79efacc.pdf
2014-05-01
9
9
10.22038/apjmt.2014.2881
Alcoholism
Addiction
Psychometrics
Substance Abuse Detection
Shubhmohan
Singh
surjit51@hotmail.com
1
Department of Psychiatry and Internal Medicine, PGIMER, Chandigarh, India
AUTHOR
Ashish
Bhalla
bhalla.chd@gmail.com
2
Department of Psychiatry and Internal Medicine, PGIMER, Chandigarh, India
LEAD_AUTHOR
Om Prakash
Giri
3
Department of Psychiatry and Internal Medicine, PGIMER, Chandigarh, India
AUTHOR
Siddharth
Sarkar
sidsarkar22@gmail.com
4
Department of Psychiatry and Internal Medicine, PGIMER, Chandigarh, India
AUTHOR
ORIGINAL_ARTICLE
Prevalence of Attention Deficit Hyperactivity Disorder in Adults Hospitalized in Toxicology Ward of Mashhad University of Medical Sciences with Alcohol Poisoning
Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric disorder among children and adolescents that can be continued into adulthood in 30 to 50% of cases. Adult ADHD disorder can affect the performance of an individual and may predispose to drug abuse, alcoholism, smoking, sexual offenses, violation of law, educational and other social problems. The coincidences of this disorder and mood disorders or anxiety disorders are common. Therefore this study was aimed to investigate the prevalence of ADHD in adult patients hospitalized with alcohol poisoning symptoms. Methods: This cross sectional study was performed for 6 months on 95 patients with alcohol poisoning who were hospitalized in Imam Reza Hospital. The patients were selected by non-random sampling after psychiatric interview and completing the demographic features checklist and the Conners adult attention –deficit/hyperactivity (CAARS-S: OV) questionnaire. Data were analyzed by SPSS-18 software. Results: The prevalence of adult ADHD was found to be 5.5%. Hyperactivity disorder in adult men was higher than women and likely to be four times higher. Smoking prevalence in the patients was greater than the normal population (3%). Demographic features such as marital status, education level and employment status in these patients had no significant association with the risk of adult ADHD. The incidence of psychiatric disorders, including cluster B personality traits and depression disorder and alcohol abuse in people with adult ADHD who were admitted due to alcohol poisoning, was higher. Conclusion: ADHD seems to be common among adults with a history of alcohol abuse compared with the normal population. The diagnosis and treatment of hyperactivity disorder in adolescents and adults can play an effective role in the prevention and treatment of serious behavioral problems and psychiatric disorders, including alcohol-related disorders.
https://apjmt.mums.ac.ir/article_2882_f906d17b96052e2f507ba13f7140a08a.pdf
2014-05-01
9
9
10.22038/apjmt.2014.2882
Alcohol-Induced Disorders
Attention Deficit Disorder with Hyperactivity
Psychiatry
Mahdi
Talebi
talebimh@mums.ac.ir
1
Addiction Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Department of Family Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mahboobeh
Rahimi
2
Addiction Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Fetal Alcohol Syndrome
Background: About 40 thousand newborns are delivered annually with fetal alcohol syndrome (FAS). It induces serious CNS complications. Methods: In a review of, the word “fetal alcohol syndrome” was searched in PubMed and Google Scholar and the retrieved articles were summarized. Results: Many studies showed that alcohol can cause more defects in fetus than heroin, cocaine and marijuana. The possible defects caused by alcohol include physical, mental and behavioral retardation, learning deficits, growth restriction, and some social problems. FAS is more common than Down syndrome (1%). In Germany, 2200 newborns are delivered with FAS annually. According to the 2007 US National Survey on Drug Use and Health, pregnant women aged 15 to 44 reported alcohol use at a rate of 11.6%, with 3.7% reported binge drinking and 0.7% reported heavy drinking in the month before the survey. However, these rates were considerably higher in non-pregnant women with same age (53%, 24.1%, and 5.5% respectively). Alcohol use during pregnancy is a significant clinical concern. In South Africa, it is counted as 70-80 in 1000 live births. Alcoholic fathers may also induce some defects in their children. Conclusion: FAS is nonhereditary cause of mental retardation and neurologic deficit in the Western world. The prevalence is high. It is preventive completely but has no treatment. In Iran we have no exact prevalence of FAS due to cultural problems. The day September 9th has been named for the FAS as the sign of 9 months of intrauterine life. Many countries such as Germany, USA, England, New Zealand, Scotland, Switzerland, Canada, Australia and Austria have paid lot of attention to prevention of FAS.
https://apjmt.mums.ac.ir/article_2883_17fc7059185a85da9b8812203bc95d02.pdf
2014-05-01
10
10
10.22038/apjmt.2014.2883
Alcohol-Induced Disorders
Fetal Alcohol Spectrum Disorders
Intellectual Disability
Ashraf
Mohammadzadeh
mohamadzadeha@mums.ac.ir
1
Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Ahmadshah
Farhat
farhata@mums.ac.ir
2
Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Effect of Alcohol on Heart: Case Presentation of Two Alcoholic Patients with Alcoholic Cardiomyopathy
Background: Alcohol consumption has multiple side effects on heart which can be divided to six subgroups: Heavy alcohol drinkers (80 g/day alcohol consumption) are most susceptible to cardiac complications. The aim of this study was to review alcohol side effects on heart and two present two alcoholic patients with alcoholic cardiomyopathy. Case report: Case A: A 52 year-old man presented with fatigue, dyspnea, FC III from many years ago. He had previous history of increased TG and cigarette smoking. He had normal BP and FBS, TFT. Chest X ray revealed global cardiomegaly and wide carina angle. ECG showed LAE and sinus tachycardia. Coronary angiogram demonstrated normal coronary arteries. Echocardiography showed LVEF=30%, LAE, LVE, RVE and trace pericardial effusion. This patient was treated as a case of DCM for many years but he did not show any improvement. In following history taking, the patient told that he drinks alcohol for many years so we advised him to discontinue alcohol consumption. After several months, patient’s clinical status improved and EF increased to 50%. Case B: A 39 years man presented with palpitation who was treated with beta blocker but he did not respond to the treatment. ECG revealed atrial fibrillation with rapid ventricular response (HR= 140/min). On echocardiography, valves function were normal and LVEF=58%, TFT was normal and patient denied smoking. This patient also had history of alcohol consumption, and after discontinuation of alcohol his symptoms resolved completely. Discussion: In western countries the most common etiology of non-ischemic cardiomyopathies is alcohol consumption. But in Islamic countries it is very rare. However this diagnosis must be considered in all cardiomyopathy syndromes. The most common arrhythmia which could be seen with alcohol consumption is atrial fibrillation but other arrhythmias such as PVC, PAC, sinus tachycardia, atrial flutter, ventricular fibrillation can also be associated with heavy alcohol consumption. This kind of arrhythmia which is more common on holidays in western countries has been nominated as holiday heart syndrome.
https://apjmt.mums.ac.ir/article_2884_361570b24440fb6e212a37a7dad8be60.pdf
2014-05-01
10
10
10.22038/apjmt.2014.2884
Alcoholism
Atrial fibrillation
Cardiomyopathies
Mehdi
Emadzadeh
1
Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Complications of Alcohol Use in Pregnancy
Background: Alcohol is a potent teratogen and alcohol use in pregnancy and the periconception period can cause many complications in mother, fetus and neonate. Discussion: Alcohol in the mother's blood passes through the placenta to the baby through the umbilical cord. Drinking alcohol during pregnancy can cause miscarriage, stillbirth, and a range of lifelong disorders. Alcohol-related birth defects (ARBDs) and alcohol-related neurodevelopmental disorder (ARND) in addition to fetal alcohol syndrome (FAS) are known as potential effects of alcohol use during pregnancy. Alcohol-related facial dysmorphology and growth deficiencies were increased in women with first trimester alcohol exposure and alcohol consumption in the second trimester affected birth weight and length and third trimester exposure affected length. Stillbirth and FAS are the most severe consequences of prenatal alcohol exposure. A diagnosis of FAS requires characteristic facial anomalies, growth retardation, and neurodevelopmental abnormalities. ARBD includes a confirmed history of maternal alcohol use plus one or more congenital defects, most often cardiac, renal, vision, hearing, or skeletal. Premature labor or preterm birth (small for gestational age neonates) is another complication of alcohol use in pregnancy. Excessive alcohol intake by mother can cause placental abruption which is dangerous for fetus and mother. Alcohol is one of the most frequent none genetic causes of mental retardation as well as leading cause of preventable birth defects. Conclusion: Pregnant women and women planning to become pregnant should be advised to abstain from drinking alcohol.
https://apjmt.mums.ac.ir/article_2885_61b4c16f7112339f75e139125f33f7f9.pdf
2014-05-01
11
11
10.22038/apjmt.2014.2885
Alcohols
Fetal Alcohol Spectrum Disorders
pregnancy
Farideh
Akhlaghi
1
Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Antioxidant Effect of Ardeh and Honey Combination on Ethanol-induced Oxidative stress in Liver and Kidney of Rats
Background: The pathogenesis of ethanol in the liver and kidney is associated with an increase in free radicals and oxidative stress that leads to structural and functional abnormalities in these vital organs. Methods: Forty-eight male wistar rats were placed in eight groups and were treated as follows: control group (normal saline), group of ethanol (4 g/ kg), three doses of Ardeh and honey combination (1, 2 and 5 g/ kg body weight), and the three groups received three doses of Ardeh and honey combination with ethanol (the same three doses of combinations along with 4 g/ kg ethanol). All treatments were performed once daily for 60 consecutive days with method of stomach gavages. Serum, liver and kidney tissue samples were obtained in order to assess serum components, tissue antioxidant enzyme activities, and the level of thiobarbituric acid reactive substances (TBARS). Results: Hepatic superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymes in the ethanol group significantly decreased compared with the control group, while the Ardeh and honey combination (5 g) could only significantly increased glutathione peroxidase activity. Renal GPx activity in ethanol consumption significantly increased compared to controls. GPx activity in Ardeh and honey combination and alcohol (5 g, 4 g) were significantly reduced compared to ethanol group. In the present study, the amount of TBARS which represents the rate of lipid peroxidation, in liver of ethanol group compared with the control group showed a significant increase (P<0.05). Conclusion: Ardeh and honey combination as a pre-treatment, protect liver and kidney against oxidative damage induced by ethanol.
https://apjmt.mums.ac.ir/article_2886_d5193f9f2f0939867af9525ee4402eea.pdf
2014-05-01
11
11
10.22038/apjmt.2014.2886
Antioxidants
Ethanol
Kidney
Liver
Oxidative stress
Mahmoud
Ebrahimi
1
Atherosclerosis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Mohsen
Ebrahimi
2
Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Abolghasem
Allahyari
3
Department of Clinical Hematology-Oncology, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mostafa
Gholizadeh
4
Department of Chemistry, Faculty of Basic Sciences, Ferdowsi University, Mashhad, Iran
AUTHOR
Mohammad
Karimi
5
Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mohammad Reza
Kazemi
6
Imam Reza Teaching Hospital Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Marziyeh
Karimi
7
Faculty of Nursing, Islamic Azad University, Sabzevar Branch, Sabzevar, Iran
AUTHOR
ORIGINAL_ARTICLE
Effects of Alcohol on Athletic Performance
Background: Alcohol is a substance that is consumed widely around the world. There are different interpretations regarding the effects of alcohol on athletic performance. Today, alcohol is introduced as a contributing factor for increasing athletic performance by some sport clubs. Methods: The purpose of this article is to investigate the effects of alcohol on athletic performance. PubMed, Scopus, Medline, and textbooks were reviewed. Results: The effect of alcohol is different according to the dose, individual habits and duration of exercise. The main mechanisms of the effect of alcohol on athletic performance are: Inadequate synthesis of hepatic glucose and impaired hepatic gluconeogenesis, even at low dose; alcohol can cause hypoglycemia and impair performance in prolonged exercise. Impaired regulation of body temperature during exercise is also an effect of alcohol. The vasodilator effect of alcohol cause a drop in core body temperature and impair athletic performance. Alcohol causes dehydration due to its diuretic effect. So, alcohol is not a good choice for rehydration after an exercise. Impairment of glycogen re-synthesis after exercise is due to alcohol interaction with glycogen synthesis in the liver. Psychological effects of alcohol impair reaction time, fine motor control, decision making, judgment and balance. Conclusion: The result of this review does not show a positive effect of alcohol on athletic performance.
https://apjmt.mums.ac.ir/article_2887_92162aa484e9620a88dace54c16284bb.pdf
2014-05-01
12
12
10.22038/apjmt.2014.2887
Alcohols
Athletic Performance
Osmotic Diuretics
Vasodilator Agents
Mohsen
Nematy
1
Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Samaneh Sadat
Ayoubi
2
Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Alcohol Abuse and Oral Cancer
Background: Various medical, psychiatric and social problems affecting alcohol abuser tend to overshadow their oral health. From an epidemiologic viewpoint, chronic consumption of alcoholic beverages is associated with an increased risk for the upper gastrointestinal tract cancer, and tobacco and alcohol are regarded as the major risk factors for oral cancer. The objective of this presentation is to express different hypotheses proposed to explain how ethanol, via oral or systemic route, can act as a risk factor for the development of oral cancer. Methods: A web-based search for all types of articles published was initiated using Medline/PubMed, with the keywords such as "oral cancer", "alcohol consumption" and "prevention". The search was restricted to English articles published up to December 2013. Results: Various hypotheses have been proposed in the explanation for ethanol acting as a risk factor, locally or systemically, in the development of oral cancer. The main local effects of ethanol are: increase in oral mucosa permeability, action of acetaldehyde, and the role of retinoid and the most important systemic effects are: liver suppression and salivary gland dysfunction. Alcohol and tobacco are considered as two principal risk factors in the development of oral cancer. Ethanol itself is not carcinogenic. However, its first metabolite (acetaldehyde) has recently been shown to be a local carcinogen in humans. Establishing a direct cause-effect relationship between both entities turns out to be difficult. This is due to the frequent association of alcohol with other risk bearing practices such as cigarette smoking. The alcohol in contact with the oral mucosa is capable of producing an alteration in morphology characterized by an epithelial atrophy, which means an increase in the susceptibility of the said tissue against other carcinogenic chemicals. In this manner, it was suggested that ethanol is capable of increasing the penetration of carcinogens through the oral mucosa. Conclusion: A large body of evidence from epidemiological studies of different designs and conducted in different populations has consistently supported that alcohol consumption is strongly associated with an increase in risk of oral and pharyngeal cancer.
https://apjmt.mums.ac.ir/article_2888_c489fcf926a65cb5ee426048aafcda8f.pdf
2014-05-01
12
12
10.22038/apjmt.2014.2888
Alcohol Drinking
Alcohol-Induced Disorders
carcinogens
Mouth Neoplasms
Atesa
Pakfetrat
1
Addiction Research Center and Department of Oral Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Zoherh
Dalir-Sani
2
Oral and Maxillofacial Diseases Research Center , Department of Oral Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Zahra
Delavarian
3
Oral and Maxillofacial Diseases Research Center , Department of Oral Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Ethanol Concentration and Its Correlation with CNS Suppressor Drugs in Postmortem Subjects
Background: Many studies have been done in order to interpret correctly the results of ethanol analysis and its related problems. Unfortunately, it was not easy to determine BAC rate, due to postmortem different conditions or personal and clinical differences in metabolism and excretion of ethanol. The time between death and autopsy, the environmental conditions (temperature and humidity) are important factors to be taken into account. Concentration of ethanol in vitreous humor depends on the person’s age, drinking experience and degree of tolerance development. Methods: In this study, concentration of ethanol in vitreous humor was assessed in 100 cases with consumption of CNS suppressor drugs that were detected in urine and tissue. Results: The toxicity of ethanol is often considerably enhanced by the concomitant use of other drugs with their site of action in the brain especially opiates, antidepressants and some sedative hypnotics. Conclusion: Death occurs in low concentration of alcohol consumed simultaneously with CNS suppressor drugs.
https://apjmt.mums.ac.ir/article_2889_2703a20f1b597e5d867acf9f0687df8c.pdf
2014-05-01
13
13
10.22038/apjmt.2014.2889
Autopsy
Central Nervous System Agents
Ethanol
Vitreous Body
Hamideh
Ghorbani
dr.h.ghorbani@gmail.com
1
Legal Medicine Research Center, Tehran, Iran
AUTHOR
Arya
Hedjazi
2
Forensic Medicine Specialist, Legal Medicine Research Center, Tehran, Iran
LEAD_AUTHOR
Daniel
Zarif
3
Legal Medicine Research Center, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Therapeutic Effects of High Dose Intravenous Prednisolone on Methanol Induced Toxic Optic Neuropathy
Background: The effects of high dose steroids for the treatment of methanol optic neuropathy was evaluated in this study. Methods: In an interventional case series, 9 patients with a history of sudden visual loss after an ingestion of homemade alcoholic beverages were included in the study. The patients received 250 mg intravenous methyl prednisolone every 6 hours for 4 days continued with oral prednisolone at 1 mg/Kg for 10 days. Best corrected visual acuity (BCVA), optical coherent tomography (OCT), fundus photo, and a complete ophthalmologic exam of the patients were taken before the treatment and 3 months after treatment. Six of them referred before 48 hours and 3 after 72 hours. Results: All patients were men. The mean age was 24.68 ± 4.2 years. In those who referred before 48 hours, the mean BCVA before the treatment was 0.86 ± 0.08 in the right eye (RE) and 0.93 ± 0.1 in the left eye (LE) using the logMAR scale. Four patients showed nerve fiber layer edema as a white density in peripapillary area. After treatment, the mean BCVA in the RE was 0.33 ± 0.18 and 0.29 ± 0.2 in the LE using the logMAR scale. The differences between before and after treatment were significant (P = 0.008 and P = 0.003, respectively). The mean macular thickness and CDR were unchanged. In those who referred after 72 hours, BCVA was not changed significantly (0.96 ± 0.3 and 0.94 ± 0.2 vs. 0.97 ± 0.3 and 0.94 ± 0.2 in RE and LE respectively). Conclusion: Intravenous high dose methyl prednisolone may have benefits in the treatment of methanol optic neuropathy, if initiated before 48 hours.
https://apjmt.mums.ac.ir/article_2890_f4442db409c14c06198d96439be95570.pdf
2014-05-01
13
13
10.22038/apjmt.2014.2890
Methanol
Optic Neuropathy
Poisoning
Prednisolone
Mojtaba
Abrishami
1
Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Mohammad
Abrishami
2
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Alcohol and Lactation
Background: Breastfeeding is the safest and best method for nurturing infant growth and health. While the harmful effects of alcohol during pregnancy are well-established, the consequences of alcohol intake during lactation have been far less examined. The effects of alcohol intake with large amounts noted on the infant include drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain. Daily consumption of 1 g/Kg alcohol decreases milk ejection reflex. The aim of the present study is to review the literature on the physiological process and hormonal control of lactogenesis, the milk ejection reflex (let down), and the effect of alcohol on these processes in both short and long term. Methods: A systematic literature review was conducted using the electronic databases PubMed, Drugs and Lactation Database (LactMed) and ISI Web of Knowledge from 1999 to 2014. The search terms were "breastfeeding", "lactation" and "alcohol". Results: Alcohol levels in the breast milk are similar to the blood alcohol levels of the mother at the time of feeding. A breastfeeding infant is exposed to a very small amount of the alcohol the mother drinks, but infants detoxify alcohol in their first weeks of life at half the rate of adults. Alcohol is not stored in the breast milk and passed to the infant at a later feeding. A single exposure of alcohol from breast milk may have a mildly sedating effect or alter the odor or taste of the breast milk. It has been recommended to avoid breastfeeding for about 2 hours after drinking one alcoholic beverage. Excessive use of alcohol can affect milk flow in lactating mothers. Adverse effects on nursing infants include: impaired motor development, changes in sleep patterns, decrease in milk intake, risk of hypoglycemia and slightly reduce milk production Conclusion: Exposure to alcohol in mothers' milk disrupted the infant's sleep-wake pattern and motor development in ways that are contrary to the folklore. Scientific evidences such as that discussed above should not frighten women away from breastfeeding. Clear guidelines for alcohol consumption are required for lactating women and health professionals to guide breastfeeding mothers to make educated choices regarding alcohol intake during this critical period of infant development.
https://apjmt.mums.ac.ir/article_2891_5246b98022e1393fd0dff49af2f3da81.pdf
2014-05-01
14
14
10.22038/apjmt.2014.2891
Breast Feeding
Ethanol
Lactation
Sleep
Bahareh
Imani
1
Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Effect of Thymoquinone and Nigella sativa Seeds Oil on Ethanol Toxicity in Rats
Background: In this study, the protective effect of thymoquinone (TQ) and Nigella sativa seeds oil (NSO) was evaluated against oxidative damages induced by ethanol in rats. Methods: Animals were treated with ethanol 40% daily by gavages once a day for 4 weeks. NSO and TQ were injected intraperitoneal once a day for 4 weeks. The histopathological examination of liver, kidney, brain and heart was done at the end of 4 weeks. Biochemistry tests such as level of serum liver enzymes (ALT, AST, ALP), triglyceride, cholesterol, LDL, HDL were measured. Malondialdehyde (MDA) level and glutathione (GSH) content in the liver and kidney were also evaluated. The level of specific biomarkers such as TNF-α and IL-6 in liver were measured. Apoptosis was assessed by evaluating the amounts of Bax, Bcl-2, caspase 3, caspase 8 and caspase 9 proteins in liver and kidney tissues by western blotting. Quantitative real-time RT-PCR was used to evaluate the expression of Bcl-2 and Bax. Results: Ethanol induced hepatotoxicity and nephrotoxicity as evidenced by histophatological damages, and it also increased the level of ALT, AST and ALP. Data showed that MDA level was significantly increased while GSH content was significantly decreased in the liver and kidney of ethanol-treated rats. The levels of TNF-and IL-6 as specific biomarkers were significantly increased. These effects were associated with increased apoptosis by induction of the expression of Bax/Bcl2 ratio (both protein and mRNA level) and activation of caspase 3, caspase 8 and caspase 9 in liver and kidney. However, the increase in caspase 9 and mRNA level of Bax/Bcl2 ratio in kidney were not statistically significant. The concurrent administration of NSO or TQ and ethanol (3 g/kg) improved the toxic effects of ethanol on kidney and liver. Conclusion: NSO and TQ may prevent ethanol-induced oxidative stress and have protective effects against ethanol-induced toxicity in rat through attenuating lipid peroxidation, increasing GSH content and inhibiting increase of a specific biomarker (IL-6) level. The black cumin and its constituents may reduce apoptosis by modulating Bax/Bcl-2 ratio, and the level of caspase 3, caspase 8 and caspase 9.
https://apjmt.mums.ac.ir/article_2892_f32f45793962e25bb25c6af7b59d0c5e.pdf
2014-05-01
14
14
10.22038/apjmt.2014.2892
Ethanol
Nigella Sativa
Oxidative stress
Thymoquinone
Toxicity
Hossein
Hosseinzadeh
1
Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Khalil
Abnous
2
Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Elaheh
Taghiabadi
3
Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Ali Reza
Timcheh Hariri
4
Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hamed
Pourbakhsh
5
Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Seyed Masoud
Hosseini
6
Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Brief Motivational Intervention to Reduce Alcohol Consumption in Young Patients in an Emergency Department: The AURAIA Research Study
Background: Sixty-two percent of the young people between 16 to 24 years-old living in the catchment area of the study take 5 glasses and more in one occasion as compared to 45.8% in the entire France. Previous studies showed that if the alcohol consumption starts earlier, the risk for alcohol dependence increases at the adult age. In some countries, the motivational intervention has been already proposed for adult and can be used in emergency department (ED) setting for young patients. This study was conducted to establish the effectiveness of a Brief Motivational Intervention (BMI) in reducing alcohol consumption among young patients with hazardous or harmful drinking admitted to an urban French ED compared to the delivery of an information leaflet and a list of addresses of relevant care and treatment services for alcohol misuse. Methods: A two-group simple blind randomized controlled trial was done with a follow-up self-report at 3 months. Patients aged 16 to 24 who were positive for blood alcohol content (BAC) of 0.5g/L or above were enrolled. Randomization was stratified according to patients’ age (16-17 or 18-24). Brief interventions were performed by a psychologist in the ED setting from September 2011 to July 2012. A phone booster session was delivered at one and two months for participants assigned randomly to the treatment group. The principal criteria used to assess the reduction of alcohol use at 3 months follow-up was the number of alcoholic drinks in the last week. Data analysis was conducted for a poison frequency distribution and analysis of variance was done. Results: A total of 263 patients were randomized of which 132 patients were allocated to the treatment group and 131 to the control group. Attrition accounted for 40.7%. Analysis with intention to treat showed an odds ratio at 0.93 (0.64-1.36), motivational intervention is not associated with alcohol consumption at 3 months (adjusted to the consumption before the visit to ED, T0 = one week before the ED visit). The quantity of glasses drunk at T0 was associated with high risk. To drink one glass more at T0 increased by 3% the consumption at 3 months. Sex was significantly associated with alcohol consumption with an OR at 0.62 (0.41-0.95). We observed a decrease of alcohol consumption in women as compared to men at 3 months. The poison regression model and analysis of variance did not show association between intervention and evolution of alcohol consumption. Conclusion: This study did not detect a difference in effectiveness between the two conditions (OR 0.93 [0.64; 1.36]). Further studies to test the effectiveness of BMI in the ED are needed.
https://apjmt.mums.ac.ir/article_2893_8d4b81cfc773a49ad698a3481d0cf2ac.pdf
2014-05-01
15
15
10.22038/apjmt.2014.2893
Alcoholism
Psychotherapy
Emergency Medical Services
Cristina
Gomez
1
Observatoire Français des Drogues et des Toxicomanies, Observatoire Français des Drogues et des Toxicomanies, Saint Denis, France
AUTHOR
Marcus
Ngantcha
2
Observatoire Français des Drogues et des Toxicomanies, Observatoire Français des Drogues et des Toxicomanies, Saint Denis, France
AUTHOR
Nathalie
Legarjean
3
Centre d’information régional sur les drogues et les dépendances, Centre d?information régional sur les drogues et les dépendances, Rennes, France
AUTHOR
Nadine
Brouard
4
Emergency Department, University Hospital, Rennes, France
AUTHOR
Muriel
Lasbliez
5
Emergency Department, University Hospital, Rennes, France
AUTHOR
Mathieu
Perennes
6
Emergency Department, University Hospital, Faculty of Medicine, Rennes, France
AUTHOR
François Jérome
Kerdiles
7
Emergency Department, University Hospital, Faculty of Medicine, Rennes, France
AUTHOR
Caroline
Le Lan
8
Liver Diseases Department, University Hospital, Faculty of Medicine, Rennes, France
AUTHOR
Romain
Moiran
9
Liver Diseases Department, University Hospital, Faculty of Medicine, Rennes, France
AUTHOR
David
Travers
10
Adult Psychiatric Department, University Hospital, Faculty of Medicine, Rennes, France
AUTHOR
Abdelouahab
Bellou
11
Emergency Department, University Hospital, Faculty of Medicine, Rennes, France. Harvard Medical School, Beth Israel Medical Center, Boston, USA
LEAD_AUTHOR
ORIGINAL_ARTICLE
Evaluation of Clinical and Biochemical Variables in Acute Methanol Poisoning: Is blood pH a Good Prognostic Factor for Prediction of Outcome?
Background: Acute methanol poisoning is one of the most important chemical poisoning due to drinking of illegal and handmade alcoholic beverages in Iran. The aim of this study was to evaluate clinical and biochemical parameters as prognostic factor in acute methanol poisoning. Methods: A retrospective study was performed on acute methanol poisoning cases admitted to the Loghman Hakim Hospital Poison Center (Tehran, Iran) over a two-year period. The demographic data, clinical presentations, paraclinical findings and patients’ outcome were extracted from medical records. Results: During this period, thirty patients with acute methanol poisoning have been enrolled in the study. All of the patients were men, with the median age of 25.5 years. Visual disturbances, respiratory manifestations, and loss of consciousness were the most common clinical manifestations on admission. The median of blood methanol level was 20 mg/dL. The median of pH, PaCO2 and HCO3 was 7.15, 22.35 mmHg and 7.2 mEq/L, respectively. Fatality rate was 30%. There was a significant difference between survivors and non-survivors with regards to coma, blood methanol level, and PaCO2 and blood glucose. Also, we did not observe a significant difference between these two groups regarding pH and HCO3 level. Conclusion: It can be suggested that coma, PaCO2 and hyperglycemia on admission time could be used as strong predictors of poor outcome and blood pH and HCO3 is not a good prognostic factor for assessment of methanol poisoning outcome.
https://apjmt.mums.ac.ir/article_2894_84b0fa067feb016550b49293bd705f9a.pdf
2014-05-01
16
16
10.22038/apjmt.2014.2894
Hydrogen-Ion Concentration
Methanol
Poisoning
Prognosis
Shahin
Shadnia
shahin1380@yahoo.com
1
Excellent Center of Clinical Toxicology, Toxicological Research Center, Clinical Toxicology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Kambiz
Soltaninejad
2
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Biochemical Markers of Acute and Chronic Ethanol Use: Forensic and Clinical Applications
Background: The analysis of ethanol in bio-samples is an important method for determination of acute alcohol use/abuse both in clinical and forensic toxicology. In forensic cases, it is known that micro-organisms involved in the postmortem putrefaction process can produce alcohol and when the body has been traumatized. In clinical setting, post-ingestion time has a critical role for determination of alcohol level in biological fluids and the ethanol has been decreased during post-ingestion period, especially in chronic alcohol abusers. From this view, new biomarkers have been studied for evaluation of acute and chronic ethanol use/abuse in clinical and forensic cases. In this article, the role of each biomarker in determination of alcohol use/abuse was reviewed.Methods: We searched the PubMed and Google Scholar databases for articles about biomarkers of ethanol use/abuse with words “Alcohol”, “Ethanol”, “Biomarker”, “Abuse”, “Forensic” and “Clinical” from 1975-2014. Results: In postmortem cases, alcohol concentrations in blood, urine and vitreous depending on the status of the body. Urine and vitreous analysis may also be helpful, particularly in conjunction with blood. If none of these specimens is available, resort can be made to other organ and tissue samples but there are difficulties in both methodology and interpretation of results relating any alcohol present to ingested ethanol. Ethanol in gastric contents generally indicates recent ingestion, but the rapid absorption of ethanol and postmortem diffusion from the stomach may limit the usefulness of analysis of gastric contents. It is possible to measure parameters which are associated with or indicate ethanol consumption. Recently, ethyl glucuronide (EtG), 5-hydroxytryptophol (5-HTOL), gamma- glutamyltransferase (GGT), mean corpuscular volume (MCV) of erythrocytes and aminotransferases were found to have some applications in the clinical and medico-legal settings for determination of alcohol use/abuse history in acute and chronic states. Conclusion: 5-HPTOL and EtG can be considered as new biomarkers for determination of alcohol use/abuse in clinical and medico-legal settings.
https://apjmt.mums.ac.ir/article_2895_d6b3182005fa10a496f0d3b4a25deef1.pdf
2014-05-01
16
16
10.22038/apjmt.2014.2895
Biological Markers
Ethanol
Forensic Toxicology
Kambiz
Soltaninejad
1
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
AUTHOR
Shahin
Shadnia
shahin1380@yahoo.com
2
Excellent Center of Clinical Toxicology, Toxicological Research Center, Clinical Toxicology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Anesthetic Considerations for Alcohol Using Patients
Alcohol use poses a variety of health complications. Because alcohol consumption in the days prior to surgery can induce lower blood pressure, the anesthesiologist will need to monitor blood pressure very closely during surgery to prevent hypotension. Before surgery, it is important for anesthesiologist to be aware about the amount and timing of recent alcohol consumption. Less anesthesia should be administered for chronic alcohol users during surgery. Alcohol impairs liver function and the liver is less able to metabolize the anesthetics given during surgery. Hence, fewer anesthetics are needed during surgical procedure. Indeed, nerve receptors are mostly diminished in chronic users of alcohol and hence this is another reason to avoid an abundant amount of anesthesia during surgery. Anesthesiologists should determine what type of anesthetic is the best for patient and what levels of dosing should be administered. The anesthesiologist must know about history of alcohol use due to determine what levels are most appropriate for the approach. In the postoperative period, the patient may require a sedative to reduce any withdrawal symptoms, pain relieving and cognitive distortions management.
https://apjmt.mums.ac.ir/article_2896_968065d30ce4e0b4ff7aaa255dd653d7.pdf
2014-05-01
17
17
10.22038/apjmt.2014.2896
Anesthesia
Alcoholics
Alcoholism
Postoperative Period
Mehdi
Fathi
1
Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Legal and Moral Issues Regarding Alcohol Abuse in Iran
Legally speaking, consumption of any substance that causes inebriation is prohibited in the laws of the Islamic Republic of Iran. In terms of medicine, alcoholic liquor is ethanol-containing liquid whether causes inebriation or not. Its consumption is considered as a crime and the user will be punished. Ethanol as a known harmful substance might lead to mood instability and subsequently different crimes. Ethanol is the most abused substance throughout the world. There are 15 to 20 million alcohol consumers in the United States. 200 mg per deciliter is considered as the level of inebriation. When it rises to 300 or 400 mg and above, it may cause unconsciousness and coma and even death. Inebriation in Islamic jurisprudence is a conditioned state, so that it occurs following consumption of an inebriant substance. Islamic penal code does not have a definition of inebriation; although consumption of the inebriant substance is considered as a crime. Inebriant in Islamic jurisprudence is any substance which causes inebriation and its consumption is known as a crime. Therefore, the punishment is stated in Islamic sharia in details. Based on Islamic criminal law, if an individual consumes an inebriant substance leading to inebriation, he will be punished even if one drop is drunk; no matter if it is low or high, pure or mixed, diluted or concentrated. Inebriation induced by inebriant substances is in different types. Islamic crime law has been revised in 2013 and the related subjects to alcohol use are 165, 168, 169, 173, 174 and 175.
https://apjmt.mums.ac.ir/article_2897_33600fe53b7299fc629c89d177cf6139.pdf
2014-05-01
17
17
10.22038/apjmt.2014.2897
Alcohols
Forensic medicine
Iran
Islam
Law
Gholam Ali
Zare
1
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Psychological Effects of Alcohol Abuse
In fact alcohol is a toxic substance that has a direct effect on brain. Some of the most common mental disorders due to alcohol abuse are: Memory disorder: Hazardous amounts of alcohol may cause intoxication, impairment of memory so that the person who took a drunken accident may not remember the event. Periods of memory impairment in those with a history of alcohol addiction would also happen in binge drinkers. Memory impairment may happen all days or most part of the day. Depression: Depression may be caused by long term alcohol abuse. On the other hand, in some cases, depressed people have tendency towards abusing alcohol, but it may improve their symptoms. The depression that can lead to more alcohol abuse and alcohol abuse can lead to depression, so the exact sequence of two modes should be revealed. Suicide: Based on current evaluation, 6 to 20 percent of alcoholics committed suicide due to harmful feature of alcohol. Evidence of suicidal behavior or intention to harm themselves is more prevalent than normal people in their age. Personality disorder: Personality disorder is one of the problems that often occur in large proportion of alcoholic people. It can interfere with their self-centered manner. Excessive alcohol abuse is rare but serious complication of pathological jealousy. Suspicion to partners is also very common among these people. Sexual Dysfunction: People who consume alcohol for a long period, often complain of sexual and erectile dysfunction and their ejaculation are usually delayed. Effects of alcohol on the nervous system or vascular disorders associated with excessive abuse of alcohol and sexual dysfunction in men may have been involved. Hallucination: Transient vision or hearing hallucinations are seen in some abusers. Even in the rare disorder called alcoholic hallucinations, severe threatening voices is usually heard. Some patients hear loud voices and others are also experienced violence in these sounds. These people are delusional about the possibility of the harm and injury.
https://apjmt.mums.ac.ir/article_2898_4c82cb6f43cced42310b0675191cb56e.pdf
2014-05-01
18
18
10.22038/apjmt.2014.2898
Alcoholics
Hallucinations
Mood disorders
Psychology
Suicide
Nazila
Ariaee
1
Addiction Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Alireza
Ghassemi Toussi
2
Addiction Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
The Composition of Alcohol Samples in Mashhad and Suburbs Based On Records of Forensic Medicine Organization
Background: Public health burden from hazardous and harmful use of alcohol warrants drastic action throughout the world. Although less alcohol related harm is anticipated in Islamic countries, unrecorded alcohol remains a considerable concern which needs intelligent and realistic policy options. Methods: In a descriptive study, records of chemically analyzed samples of alcohol obtained from Mashhad and suburbs during one year (March 2013 to March 2014) was evaluated in terms of ethanol percentage, methanol percentage, volume and pH of alcohol and location of sample. Some items such as inorganic elements (including lead) were not included because there was no information about them in records. Results: Of 877 reports of alcohol samples, more than 50% of them were obtained from Mashhad and 41.7% of them were from suburbs. 32.7% of reports were in spring, 24.8% in summer, 22.4% in autumn and 20.1% in winter. Mean (SD, Min-Max) of ethanol percentage was 30.04% (17.5, 0-98.4). In 4 cases, methanol was detected. Mean (SD, Min-Max) of methanol percentage was 23% (40.2, 4-95). Conclusion: Future research should focus on collection of large representative samples along with more precise analysis to judge about a toxicological concern beyond ethanol in alcohol products. Educational programs might increase the awareness about the risks associated with ethanol and other additives in alcohol products.
https://apjmt.mums.ac.ir/article_2899_98443ead76741b6eca61af0d0b943e71.pdf
2014-05-01
18
18
10.22038/apjmt.2014.2899
Alcohols
Alcoholic Beverages
Iran
Methanol
Bita
Dadpour
dadpourb@mums.ac.ir
1
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Seyed Mohsen
Vaziri
2
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Haleh
Malekzadeh
3
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hamid
Khosrojerdi
hamidkhped15@yahoo.com
4
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hamideh
Ghorbani
dr.h.ghorbani@gmail.com
5
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Nazila
Ariyaee
6
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
ORIGINAL_ARTICLE
Concurrent Abuse of Alcohol and Methadone
Background: Opioid abuse is common in Iran. In recent years, methadone maintenance therapy (MMT) has gained popularity in this country. This study aimed at evaluation concurrent abuse of alcohol in patients under MMT. Methods: A predesigned questionnaire was developed and completed after obtaining verbal consent among 49 subjects under MMT in Kian Rehabilitation Centre during January 2014. Results: In total, 41 men and 8 women were included. Concurrent use of alcohol reported in 0% of cases during last 24 hours, 2% in last week, 3% last month and 9% last year. Men were significantly more prone to drink alcohol (P = 0.023); they mostly abused homemade alcohols. Conclusion: Patients under MMT are relatively prone to abuse homemade alcohols. Educational programs should be focused on disadvantages of concurrent use of CNS depressant alcohols in patients under MMT.
https://apjmt.mums.ac.ir/article_2900_cdc4da8641428015df9c34e2a53c4eff.pdf
2014-05-01
19
19
10.22038/apjmt.2014.2900
Ethanol
methadone
Poly-Drug Use
Khatereh
Tufani
1
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
The Motivational Model of Alcohol Abuse: Implications for Prognosis, Prevention and Treatment Programs
Growing number of evidence indicates that individuals' motivational structure - the patterning of an individual's way of relating to goals - plays an important role in increasing the risk of alcohol use. Adaptive motivational structure which includes pursuit of important, subjectively attainable, alcohol-unrelated goals is inversely related to substance use. The strength of this relationship increases as the individual has experienced more life problems as a consequence of consuming illegal substances such as alcohol. Treatment by Systematic Motivational Counseling (SMC) which improves motivational structure reduces substance/alcohol use, and the amount of reduction is correlated with the amount of change in motivational structure. Here, evidences from various cultures supporting the claims are presented that demonstrate motivational structure is a predictor of substance/alcohol abuse, its prognosis and intervention outcomes based on SMC.
https://apjmt.mums.ac.ir/article_2901_ffd905626fb4897b349b64649d593f6d.pdf
2014-05-01
19
19
10.22038/apjmt.2014.2901
Alcoholism
Motivation
Psychotherapy
Javad
Salehi Fadardi
1
Ferdowsi University of Mashhad, Mashhad, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Study on Prevalence of Alcohol Abuse among Injecting Drug Users in Tehran and 5 Major Cities of Iran
Background: Alcohol use could be a risk factor for high risk sexual behaviors and injection especially among injecting drug users (IDUs). Data presented in this abstract extracted from the “Study on situation of HIV, Latent Tuberculosis (TB) and Active TB Infection among IDUs Receiving Harm Reduction Services in Tehran and 5 large cities in Iran” which had been conducted from June to December 2013 by support from United Nation Office on Drug and Crime in Iran (UNODC), Drug Control Head Quarter (DCHQ) and the US Center for Disease Control at Ministry of Health (CDC). Methods: This was a cross-sectional study on 420 IDUs, recruited by convenient sampling. After taking consent forms, questionnaire completed and participants tested for HIV by rapid test and tuberculin skin test performed for all of them. Results: Life-time alcohol use had prevalence from 27.1% to 82.7% in different cities and in average 55.7%. Past month alcohol use was 8.5% among those who had history for alcohol use; an average day for using alcohol in recent groups was 8.2 days. Mean age for starting alcohol use was 17.5±4.7 years. There was no statistical relationship between HIV with those who had alcohol use in life-time and past month with those who had not. There was a significant difference for cumulative years of using crystal heroin (crack), methadone, tramadol / diphenoxylate / codeine, methamphetamine, average age for starting methadone and tramadol based on independent factor of life-time alcohol use. Dysuria and inguinal bubo as well as used syringe use had significant correlation with independent factor of past month alcohol use. Those who had life-time alcohol use also started cigarette smoking sooner than those who had not positive history for alcohol use in their life-time (P=0.03). Conclusion: After cigarette, alcohol is the first substance that IDUs started to use. Past month alcohol users were at higher risk for sexually transmitted disease and high risk injection which are strong risk factors for HIV. This study was designed for exploring alcohol use but based on findings, further studies are highly recommended.
https://apjmt.mums.ac.ir/article_2902_4a4fb3721189bcf79676ca648ff7fa32.pdf
2014-05-01
20
20
10.22038/apjmt.2014.2902
Alcohol Drinking
Drug Users
HIV
Iran
Seyed Ramin
Radfar
1
University of California, Los Angeles, Integrated Substance Abuse Programs, USA
LEAD_AUTHOR
Alireza
Noroozi
2
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
AUTHOR
Katayoun
Tayeri
3
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
AUTHOR
Abbas
Motavalian
4
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
AUTHOR
Pardis
Nematollahi
5
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
AUTHOR
Setareh
Mohsenifar
6
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Prediction of Risky Behaviors Based on Concurrency of Alcohol Abuse and Opiate Dependence in Patients Treated in Methadone Maintenance Program: North Khorasan Addiction Study
Background: High prevalence of risky behaviors in alcohol dependents have been shown in several studies, but correlation between alcohol abuse and risky behaviors and relapse in patients with opiate dependence has been less investigated. This study aimed to determine the effect of alcohol abuse in rate of risk-taking behaviors in opiate dependents patients treated on maintenance program in North Khorasan addiction rehabilitation clinics in northeastern of Iran.
Methods: We conducted a cross sectional survey of patients sampled from North khorasan addiction rehabilitation clinics database. Data was collected using an interviewer-administered questionnaire, which included the alcohol abuse self-report and risk-taking behaviors checklist and socio-demographic and substance use characteristics. Chi-square test was used for comparison of results. Statistical analyses were performed using the SPSS 22 software. Differences were considered significant at P<0.05.
Results: We interviewed 7133 patients (82.5% were men). The median age was 32.4 years. 953 patients (13.4%) had a history of risk-taking behavior in last year. Risk-taking behavior in patients with alcohol abuse was significantly higher compared with patients without history of alcohol abuse (49.7% vs. 12.3 %, P < 0.001). History of being in jail in last year was significantly higher in alcohol abusers compared to non-abuser group (12.7% vs. 5.1% P<0.05). The prevalence of risk-taking behaviors in patients with opium dependence was 9.6%, with heroin dependence was 35.9% and in subjects with concomitant use of heroin and methamphetamine was 54.6%.
Conclusion: Alcohol abuse among patients undergoing MMT is associated with an increased rate of risky behaviors. Moreover, risky behaviors were significantly correlated with type of substance abused. Concurrent treatment of alcohol-related problems including systematic monitoring of alcohol use is recommended to reduce the risk for relapse into illicit drug use and improve harm reduction program.
https://apjmt.mums.ac.ir/article_2903_93522d630441acdb13c16dea692721b4.pdf
2014-05-01
21
21
10.22038/apjmt.2014.2903
Addiction
Alcoholism
Opioid-Related Disorders
Risk-Taking
Poly-Drug Use
Seyed Kaveh
Hojjat
1
Assistant Professor of Psychiatry, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
AUTHOR
Ebrahim
Golmakani
golmakanie@mums.ac.ir
2
Assistant Professor of Anesthesiology, Mashhad University of Medical Sciences, Mashhad
LEAD_AUTHOR
Mina
Norozi Khalili
3
Resident of Community Medicine, Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Arash
Akaberi
4
MSc of Biostatics, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
AUTHOR
ORIGINAL_ARTICLE
Conformity of Drug Abuse International Standards, Psychological and Sociologic Theories and Drug and Alcohol Use Prevention in Iran in 4 National Development Programs
Background: The international drug abuse standards were achieved by review of a vast meta-analysis in the world and released 2 years ago in Vienna. Review of national programs in recent 20 years and conformity of them is the main objective of this presentation. Methods: Based on research that was supported by UNODC and DCHQ, the demand reduction program in Iran at the mentioned time was studied. The international standards and national plans were compromised and the conformity was found. Results: Life skills training, at universal level and this training for adolescence is done that is acceptable. Community-based programs and basic approach of that are used from 12 years ago. This program is acceptable too. Universal education and media campaign is also used at a vast widespread that is not recommended by international standards as single activity. Tobacco and alcohol policies are observed only in a few years ago, the activities that are very important. Conclusion: based on these findings and scientific findings (psychological and sociologic), we should partially revise national activities, policies, budgeting and other aspects of alcohol use prevention. It means we should become free from prejudice and try to be evidence-based planners. Otherwise we will approach to loss our resources.
https://apjmt.mums.ac.ir/article_2904_91026c9e737d6e2e8e620717ba868e23.pdf
2014-05-01
21
21
10.22038/apjmt.2014.2904
Addiction
Alcoholism
Health Policy
prevention and control
Mehrdad
Ehterami
1
Welfare Organization, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Epidemiology of Alcohol Abuse in Iran
Background: World Health Organization report in 2014 indicates a considerable range of alcohol consumption across the world which had a growing trend during last 5 years. A study on 5,231 students in 57 universities has shown that alcohol consumption became more common than other drugs, and alcohol is in the first rank for repeated usage. In another study in 2010, the prevalence of alcohol use was 15.1% among high school students in Tehran with predominant use among boys. This study was aimed to estimate the hidden population of alcohol consumer, commissioned by the Bureau of Mental and Social health and Addiction, Ministry of Health of Iran. Methods: In 2012, Iranian Ministry of Health has implemented a national program for estimation of the frequency of alcohol abusers from the hidden and high risk population by an indirect method. The method of network extension, social network measurement and data collection tool were done through questionnaire. Results: The consumption of alcohol is more than other substances in the country and it is estimated to involve 1,583,752 individuals. This was observed in all of the provinces and included more than 2,000 individuals per 100,000 population which consumed alcohol at least once in the past year. In young population, 1,063,557 people have consumed alcohol at least once in the previous year, which represents an incidence of 5%. Consumption in men aged 18 to 30 years is higher than the other age-groups. In terms of geographical separation, Isfahan, Fars, Tehran, Kurdistan, Zanjan, Yazd and Golestan provinces are at a very high risk. Conclusion: Alcohol is a serious health problem in our society. Based on higher rate of consumption in men and younger population, there must be higher attention. Adjusting systems for alcohol screening and treatment policies should be prioritized. In addition, studies to estimate the knowledge, attitude and practice of alcohol abusers are required.
https://apjmt.mums.ac.ir/article_2905_cfed3ff79228310d49df51d56da94266.pdf
2014-05-01
22
22
10.22038/apjmt.2014.2905
Alcohol Drinking
Epidemiology
Ethanol
Iran
Sharareh
Eskandarieh
1
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
AUTHOR
Ahmad
Hajebi
2
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
LEAD_AUTHOR
Alireza
Noroozi
3
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
AUTHOR
Ali Akbar
Haghdoost
4
Public Health School, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Mohammad Reza
Baneshi
5
Public Health School, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
ORIGINAL_ARTICLE
A Comparative Review on National Alcohol Prevention Policies in Different Selected Countries
Alcohol, with its impact on both communicable and non-communicable diseases, is considered as the third global public health priority. Alcohol ranked third among causes of ill health and premature death, and ranked second in terms of cost among all the substances of abuse, after tobacco, even though nearly half the world’s population drinks alcohol. In most countries, where alcohol is considered as legal; governments facing the dilemma of dealing with alcohol, as they play the roles of the regulator, the wholesaler, and the retailer. In these countries, a broad unity of purpose and action has been emerged within the alcohol problems perspective, against diverse cultural, social and economic situations and experiences with alcohol at national level. The scientific basis for that perspective enrooted in a sustained global research effort. Many common features of these policies include monitoring of public health and safety impacts of policies, increased prevention programming (with a focus on children and youth and on modifying risky drinking behaviors), rigorous monitoring and enforcement of laws, enhancement of the addiction treatment and rehabilitation system, evaluation of prevention policies and programs and involvement of public health experts in the planning of future changes to alcohol policy. Many success stories has raised in reducing the alcohol problem in different countries, however, many challenges still exist.
In this presentation policies of different countries on alcohol problem prevention were reviewed to provide a wealth of evidences to address the issues that policy makers are facing in terms of alcohol prevention program in Iran.
https://apjmt.mums.ac.ir/article_2906_7be49bcfeb267188c51f579978c669d4.pdf
2014-05-01
22
22
10.22038/apjmt.2014.2906
Alcohol-Induced Disorders
Iran
Health Policy
Prevention
Mohsen
Roshanpajouh
1
Iranian Welfare Organization, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Principles of Psychotherapies for Alcohol Addiction
Alcoholic beverages are assumed to be the most popular drinks which are being consumed after water. Though for people who drink alcohol in excessive amounts longer time would be taken to become dependent in comparison with other drugs. Alcohol causes more severe medical and social harm as well as many fatal accidents for its users. Non-medical interventions are still on the top of the list of evidence-based practices for alcohol excessive drinkers and dependents. Building motivations, enabling behavioral changes and modifying the social context are the elements of effective treatments. Then interventions like brief intervention, social skills training, motivational enhancement therapy, community reinforcement approaches, 12-step facilitation, behavioral contracting (for instance contingency management), cognitive–behavioral interventions are the most scientifically-based approaches used as treatments. Other novel and promising approaches for alcohol and drug dependence are third wave behavior therapies especially Acceptance and Commitment Therapy. It promotes an environment to support sobriety and puts a plan into action for the client to "start living" and finally sobriety as an indirect outcome of intervention.
https://apjmt.mums.ac.ir/article_2907_7d57d6489342b06e3a21619c9d6d7c59.pdf
2014-05-01
23
23
10.22038/apjmt.2014.2907
Alcoholism
Cognitive Therapy
Psychotherapy
Ali
Farhoudian
1
Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
LEAD_AUTHOR
Alireza
Noroozi
2
Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
AUTHOR
Ahmad
Hajebi
3
Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Alcohol Policy Development: A Case of I. R. of Iran
The harmful use of alcohol causes an estimated 2.5 million deaths every year, of which a significant proportion occur in the young. Alcohol use is the third leading risk factor for poor health globally. In response to harmful use of alcohol, World Health Organization developed a global strategy to reduce the harmful use of alcohol endorsed by the Sixty-third World Health Assembly in 2010. Parallel with international initiatives, and in response to epidemiological data on alcohol use disorders in the country and incidence of few cases of methanol intoxication mass epidemics, Iran Ministry of Health has formulated national policies on alcohol prevention, tackle, treatment and rehabilitation of alcohol use which were ratified in high rank national councils. Following strategic objectives were proposed in national policy document: (a) 25% decrease in alcohol burden until the end of the plan in 2017 (b) To clearly define and institutionalize the role and responsibilities of governmental and civil society organizations in stabilization and reduction of burden of alcohol use disorders (c) To increase public awareness in different age groups about etiological factors, risks and consequences of alcohol use (d) To increase utilization of treatment, harm reduction and rehabilitation services in urban and rural areas (e) To prevent/tackle use of alcoholic beverages and (f) To decrease availability and increase the costs of alcohol related crimes. A public health approach to address alcohol problem has been successfully adopted by Islamic Republic of Iran. To decrease sensitivity associated with alcohol use disorders from one hand and insufficiency of resources to develop new standalone programs on the other hand, Iranian Ministry of Health policy is to integrate alcohol programs within currently available network of drug treatment and health facilities. It is critical for responsible governmental and non-governmental organizations to implement the program in a culturally sensitive manner and to show the feasibility, acceptability and effectiveness of the programs during implementation phase.
https://apjmt.mums.ac.ir/article_2908_23a19a1bf54d0da7a45c591427fa83d1.pdf
2014-05-01
23
23
10.22038/apjmt.2014.2908
Alcohol-Induced Disorders
Alcoholism
Iran
Health Policy
Prevention
Ahmad
Hajebi
1
Bureau of Mental and Social Health and Addiction, Ministry of Health, Tehran, Iran
LEAD_AUTHOR
Alireza
Noroozi
2
Psychiatrist, Head of Substance and Alcohol Abuse Prevention and Treatment Office, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Development of Alcohol Treatment Services Models in Iran
The international data have indicated a growing trend of alcohol use worldwide during recent years. Although alcohol use is against cultural norms and religious law in Iran, anecdotal reports from substance abuse treatment providers show that there is demand for alcohol treatment in the country. A recent national report also documented alcohol use disorders in Iran. Development and implementation of evidence-based and culturally appropriate alcohol treatment services is one of Islamic Republic of Iran Ministry of Health national multi- pronged approach to address burden of alcohol use disorders. During development of national alcohol use disorders treatment guideline, guideline development team reviewed international evidences and guidelines for alcohol and drug treatment and designed a draft model for alcohol treatment. The preliminary model presented in an expert panel of drug treatment specialist and was finalized. Three tiers of treatment facilities were recommended to provide cost-effective treatment response to alcohol problems including out-patient, ambulatory treatment, residential treatment with defined medical monitoring and management and inpatient facilities. The inpatient level sub-categorized to two categories including alcohol treatment section within a drug treatment ward of a general hospital, and specialized alcohol treatment ward or section within a general psychiatry ward. The inpatient facilities need to have an Intensive Care Unit (ICU) or be affiliated to an ICU in another hospital. Since there is high stigma attached to alcohol use in Iran, it is recommended that the alcohol services are integrated within currently available drug treatment and health facilities.
https://apjmt.mums.ac.ir/article_2909_b41c64f4910cf7aaf78e0144e18daa3d.pdf
2014-05-01
24
24
10.22038/apjmt.2014.2909
Alcoholism
Iran
Substance Abuse Treatment Centers
Alireza
Noroozi
1
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
LEAD_AUTHOR
Babak
Roshanaie Moghadam
2
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
AUTHOR
Ali
Farhoodian
3
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
AUTHOR
Narges
Beyraghi
4
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
AUTHOR
Seyed Vahid
Shariat
5
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
AUTHOR
Jalal
Shams
6
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
AUTHOR
S.
Hassibi
7
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
AUTHOR
Ahmad
Hajebi
8
Substance and Alcohol Prevention and Treatment Office (SAAPTO), Ministry of Health and Medical Education, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Epidemics/Outbreaks of Methanol Poisoning
Epidemics of methanol poisoning happen across the globe. There are prognostic factors associated with morbidity or mortality from methanol poisoning. Recently we have compared retrospective observational case series of methanol-poisoned patients from Norway (1979 and 2002-2005), Estonia (2001) and Tunisia (2003/2004), and patients from two different centers in Iran (Teheran 2004-2009 and Mashhad 2009-2010).1 According to this findings, 23% died. Among them, a pH < 7.00, Glasgow Coma Scale (GCS) < 8, and a pCO2 ≥ 3.1 kPa in spite of a pH < 7.00 were found to be the strongest risk factor for poor outcome. In Iran, methanol poisoning outbreaks happen on yearly basis. It is important to have a treatment protocol in place to be prepared for potential large ones, such as what has happened in Rafsanjan last year. This review emphasizes on a road map to develop a national guideline to encounter methanol poisoning/outbreaks.
https://apjmt.mums.ac.ir/article_2910_afd24f09e792ee0581ab5b9e20ee98d3.pdf
2014-05-01
24
24
10.22038/apjmt.2014.2910
Epidemics
Disease Outbreaks
Methanol
Poisoning
Reza
Afshari
afsharireza@yahoo.com
1
Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
1. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes--a multicenter study. Clin Toxicol (Phila) 2012;50:823-31.
1