Reza Afshari

BC Centre for Disease Control · OEH-University of British Columbia

While Indigenous food systems remain critical for community well-being, traditionally harvested foods are a potential source of toxic exposures. The Tsleil-Waututh Nation (TWN) is seeking to restore shellfish harvesting in Burrard Inlet (British Columbia [BC], Canada), where the cumulative effects of industrial activity have nearly eliminated safe...

Metal contamination of soil is primarily attributed to human activities and there is an increasing need to conduct risk assessments to characterize the nature and magnitude of risks to humans and ecological receptors from these contaminants. Trace metals (As, Sb, Cd, Cr, Pb, Co, Ni, V, Se, Zn, Fe) in soils from the Chelpu region of North East Iran...

Today atherosclerosis is considered as a main cause of death in the worldwide. There is a significant association between heavy metal exposure and atherosclerosis. In this study, we discussed the scientific literature about the effect of mercury on the pathogenesis of atherosclerosis. We also considered the epidemiological studies on mercury as a r...

Objectives Mercury occurs in the environment as a result of natural processes and human activities, including when individuals with amalgam dental fillings are cremated. This work aimed to estimate the quantity of mercury emitted to the atmosphere from crematoriums in British Columbia (BC) and assess the human health risk.MethodsA BC-specific emiss...

Background Acetaminophen is widely used as an analgesic and antipyretic agent in pediatrics. Although bioavailability of rectal acetaminophen is unpredictable, rectal route is a usual and acceptable method of prescription. Major anorectal surgery may alter the normal structure of the surgical site, especially the vascular elements and the normal co...

Energy projects may profoundly impact Indigenous peoples. We consider effects of Canada’s proposed Trans Mountain oil pipeline expansion on the health and food sovereignty of the Tsleil-Waututh Nation (TWN) through contamination and impeded access to uncontaminated traditional foods. Federal monitoring and TWN documentation show elevated shellfish...

Withdrawal syndrome is one of the initial focuses of opioid detoxification. Very low dose naltrexone (VLNTX) has been found to reduce opioid tolerance and dependence in animal and human clinical studies. The aim of this study was to determine the safety and efficacy of VLNTX during early stages of detoxification. In a multi-arm parallel, double-bli...

Background: Geospatial distribution analysis is a highly useful tool, especially in the field of health research and health economics. We aimed to study the geospatial distribution of poisoned patients and the risk factors in Mashhad, Iran. Methods: This was a retrospective cross-sectional study of patients treated at the Medical Toxicology Center,...

Future of Medical Education Journal This editorial aims at exploring the centrifugal and centripetal forces in the process of effective medical education within the preceding, performing and following up the standard medical and health training. It advocates for magnifying the educators’ enthusiasm and energy in teaching. In this proactive school o...

Environmental man-made disasters due to physical interventions have been proposed as a cause for the fall of civilizations due to declining resources. Among them, the fall of the Chilean Easter Island civilization in the southeastern Pacific Ocean is well recognized.Polynesian inhabitants arrived on the remote Easter Island around 1200 AD according...

Background: In maintenance therapy for opioid addiction, to reduce the risk of buprenorphine (BUP) abuse, the combination of BUP and naloxone (NX) has been developed and is commercially available as suboxone (BUP/NX). This study was designed to compare addiction relapse frequency in patients receiving BUP and BUP/NX as maintenance therapy. Methods:...

Avoidable systematic differences in health status of different population groups are called health inequalities. They cause significant social and economic costs to both individuals and societies (1, 2). For example, life expectancy at birth among Canadian First Nation Population is lower (73 for males and 78 for females) than that of total Canadia...

Snakebite is an important toxicologic emergency with the potential of triggering local and systemic inflammation. Antivenom has remained the mainstay of treatment for snakebite envenomation. In this study we sought to investigate the effectiveness of Iranian antivenom in a series of 44 viper envenomed patients through analysis of changes in clinica...

Background: Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein's regime in 1980s and more recently in Syria. The use of CWA is banned under the international law. Methods: Ancient uses of CWA are not well studied. Recently, their use...

Background: Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein's regime in 1980s and more recently in Syria. The use of CWA is banned under the international law. Methods: Ancient uses of CWA are not well studied. Recently, their use...

Background: The pattern of drug abuse varies in different parts of the world. Youngsters in the east of Iran abuse processed cannabis which is an ingredient of a traditional pie called Majoon Birjandi(MB). The aim of this study was to evaluate the clinical and paraclinical signs and symptoms in patients poisoned with MB. Method: We designed a cross...

Background Herbal distillates have been used for many centuries as herbal medicines in Traditional Persian medicine. The main purpose of this study was to determine methanol and ethanol contents in commonly-used industrial herbal distillates produced by three famous factories in Khorasan Razavi, Mashhad, Iran (2014–2015). Methods Ninety herbal wat...

Objective: Publications and research experiments are a major part of daily activities of the university academic members. Research misconduct, specifying its frequency and identifying the related behaviours is controversial. In recent years, there have been reports of scientific misconduct by Iranian academics. We examined the frequency of research...

Backgrounds: Envenomation is common in Asia including Iran that induces morbidity and mortality. This study investigated the epidemiological characteristics of cases with snake, spider and scorpion bites. Methods: In this cross-sectional design, epidemiologic data of admitted cases to the Toxicology Department of Imam Reza Hospital of Mashhad, Iran...

A statistical association between ambient air pollution and suicide mortality has been recently reported in Environmental Health, which seems not to be scientifically supported by their data. In this article, very low (unrealistic) suicide rate is reported, which is subjected to selection bias. Their justification is also flawed as high exposure to...

Lead is a heavy metal that remains a persistent environmental toxin. Although there have been a substantial number of reviews published on the health effects of lead, these reviews have predominantly focused on recent publications and rarely look at older, more historical articles. Old documents on lead can provide useful insight in establishing th...

Zolpidem is a non-benzodiazepine hypnotic drug used in short-term insomnia management. It is considered to be a safer drug than benzodiazepines. Zolpidem was initially considered to have lower incidences of dependence and tolerance than benzodiazepines. However, studies, have shown that zolpidem can lead to dependency. Although various cases of zol...

Background and Objectives: Suicide is one of the public health challenges. It involves the individual, family, and even society. Epidemiological study of suicide is one of the most important measures in primary prevention and integration program for suicide in primary health care system. This study evaluated cases who attempted suicide in Khorasan...

Background Thallium (Tl), lead and steroid exposures were reported as a result of street drug consumption such as heroin and cocaine. Objective This study aimed to compare the values of qualitative and quantitative assays for detecting Tl as an adulterant in opioid-like compound drug users. Methods This case-control study was conducted throughout...

Background: Alcohol-related disorders are among major public health problems around the world. We aimed to focus on the trends of alcohol intoxication in Mashhad for the recent seven years. Methods: Registry database was analyzed. All admitted cases with alcohol-related intoxication were included during 2004 to 2011. Two national censuses were used...

Introduction Cigarette smoking and alcohol consumption have a well-known effect on the development of upper aerodigestive tract carcinomas, but such a role for opium is questionable. This study was designed to assess the correlation between opium inhalation and cancer of the larynx and upper esophagus. Materials and Methods Fifty eight patients wi...

Introduction Toxic mushrooms are distributed across the globe with over 5000 species. Among them, 100 species are responsible for most of the cases of mushroom poisoning. This study aimed to evaluate the epidemiologic pattern of mushroom poisoning among patients referred to the main toxicology center of Mashhad province located in North-east of Ira...

Background: Pain, Agitation and Delirium (PAD) are common in critically ill patients admitted in Intensive Care Units (ICU) being reported in 15-80% of the patients. Control of agitation and delirium in critically ill patients is somehow different and hard to achieve in patients with drug abuse and opium addiction. Aim: We hypothesized if a protoco...

For more than five decades, modern medical practices have been provided for poisoned patients in Iran. Recently and for the first time in Asia, Mashhad Medical Toxicology Center has trained fellows as medical subspecialists since 2009. Despite these, no national academic textbook existed in this regard. "Management of Patients in Triage and Clinica...

Poster

Objectives: Methamphetamine (MA) is associated with alterations of cardiac structure and function, although it is less known. In this study, we assessed possible abnormality in myocardial perfusion and left ventricular function using gated myocardial perfusion SPECT. Methods: Fifteen patients with MA abuse, on the basis of Diagnostic and Statist...

An important outcome arising out of occupational/environmental exposure to arsenic (As) is immunotoxicity. To determine the impact of inorganic As on innate immune cells, effects of a low dose of NaAsO2 (i.e. 20 ng As/ml) on select parameters associated with human and bovine neutrophils (PMN) were evaluated in vitro. PMN isolated from the blood of...

Objective: Food contributes in measurable body burden of the widely used organophosphate pesticides. We designed a randomized controlled open label trial in Mashhad University Hospital in Iran, to study the possible alterations in cholinesterase activity resulting from consuming market melon known to be exposed to diazinon. Patients and methods:...

Background: CO poisoning is still a public health concern especially in developing countries. We aimed to focus on CO poisoning secular trends based on registry data for the recent 7 years in Northeast of Iran. Methods: Registry database of Imam Reza Hospital in Mashhad, Iran was analyzed. All admitted cases with CO exposure during 2004-2011 wer...

Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical...

Background: Iranian healthcare reform plan was devised to improve and expand health care services to Iranian nation and has been implemented since May 2014. Methods: This qualitative-descriptive study was conducted during May to September 2015 by performing a survey among medical and administrative staff in two governmental-university hospitals in...

Background: A consistent and comparative description of the burden of diseases, injuries and risk factors that cause them is an important input to health decision-making and planning processes. Objectives: The aim of this cross-sectional study was to compare the extent and pattern of variation in generic utility measures with respect to capturing t...

Background: In measuring health utilities, the primary reason for selecting patients as a source for valuations is that they directly experience the impact of the disease. Objectives: Accordingly, the aim of this study was to examine the variation in generic utility measures with respect to acute poisonings by including a comparison between thos...

Background: Disability weights (DWs) are used in disease burden studies, with the calculation of the weight of the disability as years lived with disability versus years of lost life accounting for mortalities. Currently, there is a single DW score available for poisoning, which is considered to be a single health state. This makes it difficult to...

Background Chemical exposures have been associated with a variety of health effects; however, little is known about the global disease burden from foodborne chemicals. Food can be a major pathway for the general population’s exposure to chemicals, and for some chemicals, it accounts for almost 100% of exposure. Methods and Findings Groups of foodb...

Raw data for Gibb et al. 2015, ‘World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010’ A detailed description of the data can be found in the text file provided (‘Raw data legends’).

Background: The prevalence of smoking is much higher in prisoners than it is in the general population. Prisoners who smoke cause many health problems for themselves and other prisoners. Therefore, we should help them stop smoking. Objective: To compare the effects of motivational interviewing-based (MI-based) treatment and its combination with...

Context: Lead-contaminated opium is one of the new sources of lead exposure in our region. As far as the literature review is concerned, there are limited comparative studies about comparison of blood lead level (BLL) in addict patients with healthy controls. Objective: We aimed to compare BLL and urine lead level (ULL) between opium addicts wit...

Background: Acute poisoning is a common health problem worldwide. Traditionally, the frequency of admitted cases, number of deaths or online resources were used to measure the volume of this problem. In this study, the burden of acute poisoning is addressed for the first time. Methods: Data related to 44,340 poisoned patients from 2004 to 2013 w...

Background: Thallium (Tl) is a toxic heavy metal that exists in nature. Tl poisoning (thallotoxicosis) may occur in opioid addicts. This study was designed to evaluate the frequency and level of urinary Tl in opioid abusers. In addition, clinical findings were evaluated. Methods: A total of 150 subjects were examined. Cases with a history of at...

Arsenic bioavailability in rock, soil and water resources is notoriously hazardous. Geogenic arsenic enters the body and adversely affects many biochemical processes in animals and humans, posing risk to public health. Chelpu is located in NE Iran, where realgar, orpiment and pyrite mineralization is the source of arsenic in the macroenvironment. U...

Background: Few methods have been introduced to assess the level of consciousness in critically-ill patients. This study was designed to evaluate how the AlertVerbalPainfulUnresponsive (AVPU) responsive scale corresponds with the Glasgow Coma Scale (GCS) and Richmond Agitation-Sedation Scale (RASS) scores in drug-poisoned patients and to devise an...

Background: In Asia Pacific (AP) region, the exact picture of the alcohol use problems has remained relatively obscure. In this study, the profile of alcohol consumption and alcohol related disorders in AP countries are presented. Methods: Official statistics on average alcohol consumption (alcohol per capita consumption, APC), alcohol related hea...

Rhabdomyolysis is a clinical and biochemical syndrome, which is observed in some patients with acute chemical and/or pharmaceutical poisonings. We aimed to investigate rhabdomyolysis in patients with acute poisonings due to different chemicals, natural toxins or drug overdose. Following approval of the University medical research committee and obta...

Background Tramalol overdose is disproportionately more common in Iran. In recent years, Tramadol overdose has become one of the most common causes of poisoning admissions to emergency departments in this country. To the best of our knowledge, there is little or no information regarding the toxicokinetic properties of Tramadol such as its half life...

This study was designed to evaluate the effectiveness of a new protocol implemented to standardize snakebite management in Iran. In this study, 27 patients treated according to the new protocol in 2012 (P+) were compared with 22 patients treated according to the previous modality in the year before implementation of the protocol (P-) in Mashhad Med...

Our knowledge about a link between buprenorphine and hepatotoxicity is controversial. This study evaluated the effects of buprenorphine on the liver of young, adult, and aged rats. For this reason, young, adult, and aged rats received intraperitoneally 0.25, 0.5, and 1 mg/kg buprenorphine for 30 days. The present results revealed that the normal ag...

Evaluation of scientists working in a specific area of science is necessary, as they may strive for same limited resources, grants and academic promotions. One of the most common and accepted methods of assessing the performance and impact of a scientist is calculating the number of citations for their publications. However, such method suffer from...

Psychoactive drugs are responsible for pathological changes in the mouth including dental caries, which most troublesome. The aim of the present study was to evaluate the effect of heroin on several salivary factors which are involved in the oral health and their changes after methadone maintenance therapy (MMT). Forty patients with heroin abuse hi...

The accumulations of Cd, Ni, Pb, and Cr were measured in muscle, gill, kidney, and liver of Platycephalus indicus and Pampus argenteus . Our results indicated that all metals were found to be the highest in tissues in P. indicus (benthic species). Except Ni in P. indicus , concentrations of metals and bioaccumulation factor were in the following se...

In this study, biochemical changes due to long term usage of morphine in rat's liver were assessed. Twenty male Wistar rats (180-220 g) were included and divided into two groups. Normal saline was given intraperitoneally in the control group (n = 10). Morphine group (n = 10) received morphine intraperitoneally at a dose of 4, 8, and 10 mg/kg/day in...

IntroductionThe phenomenon of black spotted larynx is introduced for the first time as a finding among opium abusers who inhale its smoke. The most common way to form an addiction to opium is to inhale its smoke. Drug dealers usually mix pure opium with cheap additives (mineral, animal or plant sources) in order to increase its weight and volume, s...

Background: The use of organophosphates (OPs) in developing countries is rising in large quantities and non-secure methods. This problem not only causes acute poisoning but also may lead to chronic diseases such as polyneuropathy. In Iran, 60% of pesticides are organophosphate compounds that may lead to delayed polyneuropathy. Objectives: The pu...

Background: In order to describe the patients and evaluate the effectiveness of treatments for widow spider envenomation, investigators require a reliable assessment tool. In this paper, the development of a clinical index for measuring the widow spider bite severity, Latrodectus Envenomation Severity Score (LESS), is described. Methods: According...

We investigated the effects of antioxidant activity of safranal, a constituent of Crocus sativus L., against lung oxidative damage in diabetic rats. The rats were divided into the following groups of 8 animals each: control, diabetic, and three diabetic + safranal-treated (0.25, 0.50, and 0.75 mg/kg/day) groups. Streptozotocin (STZ) was injected in...

Background: Hyoscine N-butyl bromide/scopolamine (H/S) is a type of anticholinergic agent that is commonly used as an antispasmodic drug. We have evaluated the effects of crushed H/S smoking in prisoners who illicitly abused this drug. Methods: All imprisoned cases with at least a 3-month history of HS were evaluated from April 2012 to September...

Snakebite in Iran has been a health concern. However, management of snakebite is not standardized and varies from center to center. This study is aimed at devising an evidence-based comprehensive protocol for snakebite management in Iran, to reduce unnecessary variations in practice. A narrative search in electronic databases was performed. Fifty p...

Lead poisoning is a major public health risk which may involve major organs. Recently, there have been reports of opioid adulteration with lead in Iran. The following case report is the first of its kind in that intrahepatic cholestasis due to lead toxicity has been described. A 65-year-old man presented to the emergency department with abdominal p...

Objective: Cultural factors may influence health. Street drugs (SDs) and traditional medicines are commonly used in Iran. Opium has been recommended for pain relief and diarrhea in Iranian traditional medicine. This study seeks to explain the potential knowledge, attitude and practice of students towards the therapeutic effects of SDs. It further s...

Recently a new type of heroin opiate has been introduced to heavy abusers in north east Iran Mashhad. According to the clinical features of the addicts that have been referred to Medical Toxicology Centre, Imam Reza Hospital, the euphoric effects of this opiate is reported to be more potent than coal heroin, crystal heroin and crack heroin. It is c...

This is letter to the editor.

To evaluate the pattern of use of opioid and other illegal drugs in patients seeking addiction treatment in Birjand, eastern Iran. The prospective study was conducted from March 21, 2009 to March 21,2010, and comprised all patients referred to the seven addiction treatment centres in Birjand. Data was obtained through pre-designed questionnaires an...

Tramadol is an analgesic medication that is frequently abused. It has two functions; mu-opioid receptors agonism, as well as, serotonergic activities. It has shown that tramadol overdose may induce serotonin syndrome (SS). This study evaluates whether early treatment with chlordiazepoxide could prevent SS in admitted tramadol overdoses. In this sin...

Abstract Despite the wide spread of lead environmental pollution, the effect of this heavy metal on respiratory disease was not shown yet. In respect to increased oxidative stress is an important mechanism in the pathogenesis of respiratory disease, the present study was designed to examine the association between lead toxicity and lung disease via...