ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Navabi   S.J. (1)
Eivazi   M. (*1)
Beiranvand   B. (2)






(*1) Internal Department, Medicine Faculty, Kermanshah University of Medical Sciences, Kermanshah, Iran
(1) Internal Department, Medicine Faculty, Kermanshah University of Medical Sciences, Kermanshah, Iran
(2) Biostatistics & Epidemiology Department, Health Faculty, Lorestan University of Medical Sciences, Khoramabad, Iran

Correspondence

Address: Internal Department, Medicine Faculty, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Phone: +98-83-37249179
Fax:
meivazi66@yahoo.com

Article History

Received:  September  5, 2016
Accepted:  May 10, 2017
ePublished:  December 20, 2018

BRIEF TEXT


Every year, many people refer to emergency care due to methanol poisoning.

Methanol poisoning can increase the heart's enzymes (a symptom of heart failure) [7]. Necrosis of putamen with or without bleeding and injury of subcortical white matter is accompanied by a bad prognosis [7]. The pH below 7 with coma is the strongest risk factor for poor prognosis of patients [8]. Treatment by ethanol and high doses of methylprednisolone play an important role in improving and maintaining visual acuity in patients. The rate of acidosis is effective in determining the final prognosis of the patient's vision. It seems that the early treatment of patients is not effective in determining the final prognosis of patients' visual perception, especially in acute poisoning [10]. In recent years, cases of collective methanol poisoning have been reported [11].

The aim of the present study was to investigate the effective factors in the prognosis of patients with acute methanol poisoning in Emam Khomeini hospital in 2010-2015.

The research is a retrospective descriptive analytical study.

This study was carried out on the patients with acute methanol poisoning, which referred to the Emam Khomeini hospital of Kermanshah in 2010-2015.

The subjects were the patients with acute methanol poisoning, which referred to the Emam Khomeini hospital of Kermanshah in 21010-2015. The information was collected by patient records using a checklist containing the date of visit, gender, age, the time interval from consumption to referral to the hospital, clinical symptoms, laboratory symptoms, electrocardiography changes, type of treatment, frequency and duration of dialysis, consequences, and type of complications. Since dialysis criteria were not recorded in the patient records and could not be investigated, patients with concurrent poisoning (for example poisoning with opium or drug) were excluded from the study. Considering unclear consequences of complications in some of the patients, the information was completed by phone call. The number of original cases was 357 which 287 cases were investigated and because of lack of access to the required information of the cases, 195 cases were investigated.

Since dialysis criteria were not recorded in the patient records and could not be investigated, patients with concurrent poisoning (for example poisoning with opium or drug) were excluded from the study. Considering unclear consequences of complications in some of the patients, the information was completed by phone call. The number of original cases was 357 which 287 cases were investigated and because of lack of access to the required information of the cases, 195 cases were investigated. Because the name of the poisoned people was not recorded in the study and the identity of the patients remains confidential, therefore, there was no ethical problem in this research. Data were analyzed by SPSS 22. The Mann-Whitney U test was used for the analysis of quantitative variables, and Chi-square test or Fisher's exact test was used for the analysis of qualitative variables. Multivariate logistic regression was used to determining the predictive risk factors of mortality.

188 people of patients were men (96.5%) and 7 people of patients were the women (30.5%). Clinical and laboratory findings were evaluated at the entrance of the patients to the emergency department. Descriptive features and related factors with the mortality of poisoned patients with methanol were presented (tables 1-5). There was a significant relationship between the age and mortality of the patients (p<0.05), so that with increasing the age, mortality increased. There was a significant relationship between hospitalization date and the mortality rate (p<0.05) so that the mortality rate decreased from the first year of the study to the last year. The clinical symptoms including Coma, blurred vision, nausea and vomiting and size change of pupil had a significant relationship with the rate of mortality (p<0.05). In another world, the rate of mortality increased in patients with coma, blurred vision, nausea and vomiting, and mydriatic and miotic pupil. Also, the laboratory symptoms including levels of urea, creatinine, sugars, AST، ALT، CPK، LDH، pH and bicarbonate had a significant relationship with the rate of mortality (p<0.05). In another world, the rate of mortality increased with increasing the levels of urea, creatinine, sugars, AST، ALT، CPK، LDH and decreasing the pH and bicarbonate. A significant relationship was observed between lacking sinus rhythm in electrocardiogram (ECG) with the rate of mortality (p<0.05), so that the rate of mortality increased in the patients without sinus rhythm. Types of treatments including ethanol administration, folic acid, corticosteroid, bicarbonate and the frequency and duration of dialysis were significantly correlated with the rate of mortality (p<0.05)so that lacking the effective therapeutic measures and reducing the frequency and duration of dialysis, led to an increase in the mortality rate. Wald test was statistically significant for coma and creatinine (p<0.05: Table 6). Indeed, these two factors statistically had a significant contribution to the classification of patients and the prediction of mortality (Diagram 1). Diagnostic value of creatinine was significant in predicting the death of patients with boundary limit of 1.5, 1.4 and 1.3/ (p<0.05: Table 7).

Based on the results of this study, the mortality rate due to methanol poisoning in the studied population was 18.4% which is comparable with results of studies conducted in the other poisoning centers over the past few years. The rate of mortality due to methanol poisoning in Iran has been reported in a range of 0.07-50 [12-18]. In other countries, the rate of mortality due to methanol poisoning has been reported in a range of 3.3%-34 [19-22]. In the study of Cultter et all, big osmolar gap, anion gap and pH less than 22.7 related to the mortality rate in poisoning with methanol as well as pH had the most predictive value [19]…[23-28].

It is suggested that in the future, studies be planned to examine the level of methanol in blood.

One of the limitations of this study was the lack of facilities to determine the level of methanol in blood in the hospital of the case study

Level of consciousness, serum creatinine level and pH of blood in the patients when they referred to an emergency can predict the consequences of treatment and the possibility of death in the patients.

I would like to appreciate the efforts of my respected professors at Kermanshah University of Medical Sciences.

There is no conflict of interest.

There was no ethical problem in this research because the name of the poisoned people was not recorded in the study and the identity of the patients remains confidential.

There are no funding sources.

TABLES and CHARTS

Show attach file
Every year, many people refer to emergency care due to methanol poisoning.

Methanol poisoning can increase the heart's enzymes (a symptom of heart failure) [7]. Necrosis of putamen with or without bleeding and injury of subcortical white matter is accompanied by a bad prognosis [7]. The pH below 7 with coma is the strongest risk factor for poor prognosis of patients [8]. Treatment by ethanol and high doses of methylprednisolone play an important role in improving and maintaining visual acuity in patients. The rate of acidosis is effective in determining the final prognosis of the patient's vision. It seems that the early treatment of patients is not effective in determining the final prognosis of patients' visual perception, especially in acute poisoning [10]. In recent years, cases of collective methanol poisoning have been reported [11].

The aim of the present study was to investigate the effective factors in the prognosis of patients with acute methanol poisoning in Emam Khomeini hospital in 2010-2015.

The research is a retrospective descriptive analytical study.

This study was carried out on the patients with acute methanol poisoning, which referred to the Emam Khomeini hospital of Kermanshah in 2010-2015.

The subjects were the patients with acute methanol poisoning, which referred to the Emam Khomeini hospital of Kermanshah in 21010-2015. The information was collected by patient records using a checklist containing the date of visit, gender, age, the time interval from consumption to referral to the hospital, clinical symptoms, laboratory symptoms, electrocardiography changes, type of treatment, frequency and duration of dialysis, consequences, and type of complications. Since dialysis criteria were not recorded in the patient records and could not be investigated, patients with concurrent poisoning (for example poisoning with opium or drug) were excluded from the study. Considering unclear consequences of complications in some of the patients, the information was completed by phone call. The number of original cases was 357 which 287 cases were investigated and because of lack of access to the required information of the cases, 195 cases were investigated.

Since dialysis criteria were not recorded in the patient records and could not be investigated, patients with concurrent poisoning (for example poisoning with opium or drug) were excluded from the study. Considering unclear consequences of complications in some of the patients, the information was completed by phone call. The number of original cases was 357 which 287 cases were investigated and because of lack of access to the required information of the cases, 195 cases were investigated. Because the name of the poisoned people was not recorded in the study and the identity of the patients remains confidential, therefore, there was no ethical problem in this research. Data were analyzed by SPSS 22. The Mann-Whitney U test was used for the analysis of quantitative variables, and Chi-square test or Fisher's exact test was used for the analysis of qualitative variables. Multivariate logistic regression was used to determining the predictive risk factors of mortality.

188 people of patients were men (96.5%) and 7 people of patients were the women (30.5%). Clinical and laboratory findings were evaluated at the entrance of the patients to the emergency department. Descriptive features and related factors with the mortality of poisoned patients with methanol were presented (tables 1-5). There was a significant relationship between the age and mortality of the patients (p<0.05), so that with increasing the age, mortality increased. There was a significant relationship between hospitalization date and the mortality rate (p<0.05) so that the mortality rate decreased from the first year of the study to the last year. The clinical symptoms including Coma, blurred vision, nausea and vomiting and size change of pupil had a significant relationship with the rate of mortality (p<0.05). In another world, the rate of mortality increased in patients with coma, blurred vision, nausea and vomiting, and mydriatic and miotic pupil. Also, the laboratory symptoms including levels of urea, creatinine, sugars, AST، ALT، CPK، LDH، pH and bicarbonate had a significant relationship with the rate of mortality (p<0.05). In another world, the rate of mortality increased with increasing the levels of urea, creatinine, sugars, AST، ALT، CPK، LDH and decreasing the pH and bicarbonate. A significant relationship was observed between lacking sinus rhythm in electrocardiogram (ECG) with the rate of mortality (p<0.05), so that the rate of mortality increased in the patients without sinus rhythm. Types of treatments including ethanol administration, folic acid, corticosteroid, bicarbonate and the frequency and duration of dialysis were significantly correlated with the rate of mortality (p<0.05)so that lacking the effective therapeutic measures and reducing the frequency and duration of dialysis, led to an increase in the mortality rate. Wald test was statistically significant for coma and creatinine (p<0.05: Table 6). Indeed, these two factors statistically had a significant contribution to the classification of patients and the prediction of mortality (Diagram 1). Diagnostic value of creatinine was significant in predicting the death of patients with boundary limit of 1.5, 1.4 and 1.3/ (p<0.05: Table 7).


















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