Background and Aims Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non‐prescribed use, regular tramadol use and dependence, tramadol‐induced poisoning and mortality in Iran. Methods Consistent with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol‐associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug‐poisoning records were estimated through a random‐effects model. Results A total of 84 records were included. Pooled estimates of last 12‐month use of tramadol in the Iranian general population were 4.9% [95% confidence interval (CI) = 4.1–5.9] and 0.8% (95% CI = 0.2–1.8) among males and females, respectively. The estimates for last 12‐month use among Iranian male and female university students were 4.8% (95% CI = 1.9–8.9) and 0.7% (95% CI = 0.3–1.1), respectively. Six heterogeneous reports indicated the existence of regular use of tramadol and dependence in Iran. Sixty‐two studies provided data on tramadol‐induced poisoning, seizures and mortality. The pooled estimate of the percentage of tramadol poisoning among all drug‐poisoning patients was 13.1% (95% CI = 5.7–22.9). The overall estimates of seizures and mortality among tramadol‐poisoning patients were 34.6% (95% CI = 29.6–39.8) and 0.7% (95% CI = 0.0–1.9), respectively. The pooled percentage of tramadol‐related fatalities among drug‐poisoned cases was 5.7% (95% CI = 0.5–15.4). Conclusion Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures and hundreds of tramadol‐related deaths have been reported in recent years.

Background: We aimed to investigate the suicide rate led to death in the elderly population of Iran between 2008 and 2014. Study design: A cross-sectional study. Methods: The present study was conducted on all suicide-related deaths in elderly people (≥65 yr) during the years 2008 to 2014 reported to the Iranian Legal Medicine Organization. For data collection, legal medicine standard form was used and the cases were classified by age, gender, suicide way and time (year). The incidence of death from suicide was calculated by age and sex. Statistical soft-ware stata12 was used to analyze data. The significance level has been considered to be 0.05. Results: Overall, 1,601 suicide-related deaths were investigated throughout the country. The mean age was 70.36 ± 0.17 years. The incidence trend (per 100,000 people) of the elderly suicides in Iran indicates that successful suicides have been on the rise, rising from 3.7 in 2008 to 4.37 per 100,000 people in 2014. Conclusions: It is necessary to identify and treat suicidal important predisposing factors of suicide such as psycho-social illnesses including depression and also implement prevention programs and policies for this fast-rising population age-group.

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Aims To search for pharmaceutical additives in illicit alcoholic beverages referred to the laboratory of Legal Medicine Organization in Iran in 2017. Methods Hundred beverages were sampled. Ethanol content was determined by gas chromatography with flame ionization detection (GC–FID) and then a liquid-liquid extraction combined with reversed-phase high performance liquid chromatography equipped with a photodiode array detector (PAD) was employed for the qualitative analysis. The analysis was confirmed using gas chromatography coupled with mass spectroscopy (GC/MS). Results In 15% either one or more of the following were detected: tramadol, methadone, diazepam, oxazepam, flurazepam and alprazolam. Tramadol was found with highest frequency. Conclusions The wide availability of addictive pharmaceutical is leading to fortification of alcoholic beverages on some countries. The addition of such depressant additives should be better known because of the potentially fatal consequences of the combination with ethanol, as well as the potential for adverse effects on behavior.

Background: Using dexmedetomidine (Dex) as a sedative agent may benefit the clinical outcomes of post-surgery patients. We reviewed randomized controlled trials (RCTs) to assess whether use of a Dex could improve the outcomes in post-surgery critically ill adults. Methods: We searched Medline, Embase, PubMed, and the Cochrane databases for RCTs comparing Dex with propofol or a placebo in post-operative patients, all included RCTs should be published in English before Jul 2016. Citations meeting inclusion criteria were full screened, and trial available data were abstracted independently and the Cochrane risk of bias tool was used for quality assessment. Results: Sixteen RCTs involving 2568 patients were subjected to this meta-analysis. The use of a Dex sedative regimen was associated with a reduce delirium prevalence [odd ratio (OR):0.33, 95% confidence intervals (CI): 0.24–0.45, I2= 5%, P<0.001], a shorter the length of ICU stay [mean difference (MD): -0.60, 95%CI: -0.69 to -0.50, I2=40%, P<0.001] and the length of hospital stay [MD: -0.68, 95%CI: -1.21 to -0.16, I2=0%, P=0.01]. However, using of Dex could not shorter the duration of mechanical ventilation [MD: -10.18. 95%CI: -31.08–10.72, I2=99%, P=0.34], but could shorter the time to extubation in post-surgery patients [MD: -47.46, 95%CI: -84.63–10.67, I2=98%, P=0.01]. Conclusion: The use of a Dex sedative regimen was associated with a reduce delirium prevalence, a shorter the length of ICU and hospital stay, and a shorter time to extubation in post-surgery critical ill patients.

Methyl alcohol poisoning usually happens by use of contaminated ethanol. So, development of an easy and cost-effective method to determine methanol in these products can be helpful to diagnosemethanolintoxication. The aim of this paper is introducing a new kit based on chromotropic acid method for measuring the methanol content of alcoholic beverages. In this study, a new modified chromotropic acid method (as a kit) was used to determine of methanol in 700 self-made samples with diverse ethanol concentration prepared by "add found" technique. Briefly, in the proposed method, produced formaldehyde by methanol oxidation is reacted with chromotropic acid in a high acidic media. The quantification limit of this kit lies below the permitted dose and safe amount of methanol in the beverages regulated by the European Parliament and the Council. The attained results indicate Limit of Quantification of the method is1250 mg/Land all examined samples with more methanol amounts are easily determined with good accuracy and precision. As for the European standard about permitted dose of methanol in beverages (up to 4000 mg/lin 40% v/v of alcohol strength) and gained results, it seems, this proposed method practically enables rapid and easy quantitative determination of methanol in all kind of alcoholic strength with suitable accuracy and precision. However, conclusive conclusions in this area will require further examination in actual samples of alcoholic beverages. But, to the best of our knowledge, there isn't any report about such easy method.

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