Age- and gender-specific acute poisoning with drugs and medications affecting nervous system.

BACKGROUND: We investigated acute poisonings resulting from medications affecting the nervous system and illicit substances at Loghman Hakim Hospital in Tehran. METHODS: We retrospectively reviewed patient records at Iran's largest tertiary toxicology referral center between January 2010 and December 2015. We analyzed the prevalence, trend, age and gender distribution of acute poisoning caused by nervous system agents. RESULTS: The present study included 16,657 (57.27%) males and 12,426 (42.73%) females, resulting in 29,083 patients. The median age of men and women was 29 and 26 years, respectively (p < 0.0001). There were 12,071 (72.47%) men and 10,326 (83.10%) women under the age of 40 (p < 0.001). Most cases were intentional (69.38% in men and 79.00% in women, p < 0.001) and 44.10% had a history of poisoning. The proportions of men and women varied significantly between different age groups and nervous system agents. For women, the most common agent was alprazolam, whereas for men, methadone. The overall trend of acute poisoning with drug used in addictive disorders, opioids and alcohol was increasing but decreasing with benzodiazepines and antidepressants. Acute poisoning by nervous system agents led to more deaths in men (1.95% vs. 0.56%; p < 0.001). CONCLUSIONS: Methadone intoxication was common especially among young men and most of these intoxications were intentional. Women and men aged 20-29 most frequently suffer poisoning from alprazolam and clonazepam, respectively. Women over 60 and men over 30 used opium. Illicit drugs caused more than half of the deaths, and opium dominated. This study may create awareness and develop educational and preventive gender and age-specific local programs.

A nationwide study on consumption of opioid analgesics in Iran from 2000 to 2018.

BACKGROUND: Opioid analgesics play a unique role in pain management. National opioid consumption studies could provide indirect evidence of pain management in a country. National, regional, and global opioid consumption have been studied in other countries so far; however, conducting a focused study to illuminate the consumption of opioid analgesics over the past decades in Iran seemed necessary. AIM: The main objective of this study was to determine the consumption of opioid analgesics and explore the trend of their use during 19 years in Iran. METHOD: Iran pharmaceutical wholesale data were used to extract the annual consumption figures of the opioid analgesics in group N02A of the World Health Organization (WHO) Anatomical Therapeutic Chemical classification and were available in Iran (morphine, fentanyl, pethidine, and oxycodone as strong opioids and, tramadol and pentazocine as weak opioids), from 2000 to 2018. Using Defined Daily Dose (DDD) by WHO and Oral Morphine Equivalent (OMEQ), the amount of annual consumption was determined in DDD/1000 inhabitants/Day (DID) and OMEQ (mg)/1000 inhabitants/Day (OID). RESULTS: Total opioid analgesic utilization based on DID and OID increased 31.12-fold (from 0.0196 to 0.61) and 21.06-fold (from 1.97 to 41.5 mg) over 19 years, respectively with a significant sharp increase from 2003 to 2006 (ß = 1.78 (DID), P value < 0.001). Medications that constituted 70% of annual opioid analgesics utilization were morphine in 2000, compared to tramadol in 2018. The annual weak and strong opioids share were 86.7% and 13.2% in 2018, respectively. CONCLUSION: Despite considerable growth in the consumption of opioid analgesics in Iran over nearly two decades, the consumption amount remained low, which might signal sub-optimal pain management. On the other hand, misuse and abuse seem to be the main reason behind significant increases in the consumption of opioid analgesics with less controlled distribution.

A systematic review and meta-analysis on serum and salivary levels of total antioxidant capacity and C-reactive protein in oral lichen planus patients.

OBJECTIVE: Oral lichen planus (OLP) is an inflammatory disease that total antioxidant capacity (TAC) and C-reactive protein (CRP) play an important role in its pathogenesis. In this meta-analysis, we compared the salivary and serum levels of TAC and CRP between OLP patients and controls. DESIGN: A comprehensive search was performed in four databases (PubMed, Scopus, Web of Science, and Cochrane Library). Standardized mean difference (SMD) and 95% confidence intervals (CI) were computed by the RevMan 5.3. Sensitivity analysis, subgroup analysis, meta-regression, and publication bias were analyzed by the CMA 2.0. RESULTS: Nineteen articles were included in the meta-analysis. The pooled SMDs were -1.80 µmol/L (95%CI: -2.75, -0.85; p = 0.0002) and -2.56 µmol/L (95%CI: -4.40, -0.72; p = 0.006) for the salivary and serum levels of TAC, respectively. The SMDs for salivary and serum levels of CRP were 0.64 µg/L (95%CI: 0.35, 0.94; p < 0.0001) and 0.97 mg/L (95%CI: 0.56, 1.338; p < 0.00001), respectively. Geographical area based on the country was a significant factor in the subgroup analysis for salivary TAC level. There was adequate evidence supporting the occurrence of less salivary and serum TAC levels in OLP patients than controls, but the amount of information was inadequate to make valid conclusions for salivary CRP level. CONCLUSIONS: In OLP patients, salivary and serum levels of TAC is significantly lower while the salivary and serum levels of CRP is significantly higher than controls.