Introduction: Brugada phenocopies are recently introduced as clinical entities with electrocardiographic patterns identical to true congenital Brugada syndrome in individuals, who are asymptomatic and have no other clinical criteria. One of the largest methanol poisoning outbreaks occurred in Iran during March and April 2020. This study aimed to investigate the relationship between Brugada Phenocopy with laboratory data and demographic factors and determine its association with mortality rate in methanol toxicity patients. Method and results: Demographic data such as age, gender, medical history, Glasgow coma scale score, laboratory data, and electrocardiographic data were obtained from 356 patients, who were diagnosed with methanol poisoning and were hospitalized in Faghihi and Namazi Hospitals in Shiraz, southern Iran, during March and April 2020. The follow-up data was gathered to examine the development of any complications or death. A total of 20 (5.6%) patients were admitted with a diagnosis of methanol toxicity and concurrent Brugada-like ECG patterns. Mortality rate, Glasgow Coma Scale Score <3, and blood sugar were significantly higher in the Brugada phenocopies; however, PH, O2 saturation, and calcium were lower among Brugada phenocopies in comparison to methanol toxicity patients with no Brugada pattern (P<0.05). Conclusion: According to the findings of this study, some recognizable ECG patterns and laboratory data may be used as novel prognostic factors of morbidity and mortality. Electrocardiography machines are widely available, and electrocardiograms can easily be obtained and interpreted. This may provide the grounds for caregivers to predict and prevent the incoming death and react more properly and timely.

Background: Binge alcohol eating especially in underdeveloped countries may be complicated by methanol toxicity, especially when blinded drunken cases come to emergency department. Unfortunately, in early months of 2020, Fars, one of the largest provinces in southern Iran, reported one of the largest methanol poisoning outbreaks with high case-fatality rate. Here we like to share our experience and introduce some simple measures which may announce more urgent dialysis to save the lives of these patients.Method: In this study, 356 cases with methanol toxicity referred to the Tertiary Hospitals (Faghihi and Namazi) affiliated to Shiraz University of Medical Sciences during March and April, 2020. To collect the required data, clinical findings on blindness and impaired level of consciousness, laboratory data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results: Among the participants, 321 (90.2%) patients were male, and 162 persons (45.5%) were aged below 30 years old. Reviewing the laboratory data of the included patients revealed that PH, HCO3, and O2 saturation decreased. While PCO2, Cr, K, BS increased (P<0.05). In the multiple analysis, when the intervening factors of age and gender were adjusted and all ECG items were included in the model, T slope>=70, Brugada pattern, low voltage QRS, severe metabolic acidosis (PH<7.2) and lack of hyperventilation when severely acidotic showed independent relationship with mortality with the odds ratios of 3.42, 5.65, 6.70, 4.55 and 5.74 respectively.Conclusion: Apart from usual modalities like acidosis, electrolyte imbalance, QTc prolongation and prominent U wave, we found Brugada like ECG, notch in QRS and steeply terminal T wave more than 70 degrees to be ominous signs and need urgent attention.

Objective. J point and coved ST elevation in right precordial leads (not produced by coronary artery disease) are still a matter of challenge, especially when resembling Brugada patients. This clinical entity, among asymptomatic individuals with no family history of sudden cardiac death, would be reported in some severely ill patients before ventricular fibrillation. This study investigated the relationship between the electrocardiograms with demographic and laboratory data and also analyzed their association with mortality rate among patients with methanol poisoning. Methods. The sample consisted of 356 patients who were hospitalized with a diagnosis of methanol poisoning in Faghihi and Namazi Hospitals in Shiraz, Southern Iran, in March and April 2020. In this period, a major outbreak of methanol poisoning had occurred in this area. Furthermore, the study used the data on any recorded complications or mortality during hospital course. Results. The ECG (BrP) was observed in a total of 20 (5.6%) patients. Its presence was associated with increased mortality, Glasgow coma scale score <3, and blood sugar levels and was inversely associated with PH, O2 saturation, and calcium levels ( P < 0.05 ). Conclusions. This study found that certain ECG patterns and laboratory data can be used as prognostic factors of morbidity and mortality in patients with methanol intoxication. Electrocardiography machines are widely available tools, which can be easily used for risk stratification based on the presence of Brugada approximating electrocardiograms among patients with methanol intoxication.