فهرست مطالب

International Journal of Medical Toxicology and Forensic Medicine
Volume:10 Issue: 2, Spring 2020

  • تاریخ انتشار: 1399/04/01
  • تعداد عناوین: 12
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  • Davood Soroosh, Narges Ranjbar, Mohammad Nematshahi*, Seyed Alireza Javadinia Page 1
    Background

    Along with the complexity of social communications, the rate of suicide is increasing, and according to studies, women commit suicide more than men. Various factors affect the occurrence of this phenomenon. The purpose of this study was to determine the factors affecting unsuccessful suicide among women referring to the emergency room of the hospital of Ardabil City, Iran.

    Methods

    This study was a descriptive cross-sectional study conducted on 236 women who had unsuccessful suicide. Questions were asked from patients with a checklist. This checklist has four parts. The first part relates to the patient’s personal information, and the second part relates to the patient’s previous history of mental, physical, and addiction problems. The third part asked about the causes of suicide and the fourth part related to the prior announcement. The collected data were analyzed by statistical methods in SPSS v. 18.

    Results

    The Mean±SD age of the women was 27.66±9.95 years, and the majority was between 15 and 20 years old. About 64% of women were housewives, and 37.7% had undergraduate education. Also, 36% had a positive history of psychological diseases, and 30.9% had a history of suicide. The most common causes of suicide among women were emotional problems (91.9%), family and marriage conflict (81.8%), spouse’s disregard (50.4%), and economic issues (44.5%).

    Conclusion

    The results showed that emotional problems and family and marital conflicts were common causes of suicide among women, and all women had at least one crucial reason for their suicide attempt.

    Keywords: Suicide, Psychological stress, Emotional problems, Effective factors
  • Davood Soroosh, Narges Ranjbar, Mohammad Nematshahi*, Seyed Alireza Javadinia Page 2
    Background

    This study aimed to assess mortality and neurotoxicity caused by the pesticide organophosphate and its correlation with the type of poison and treatment in patients admitted to Vasei Hospital of Sabzevar City, Iran, in 2018.

    Methods

    Out of 122 cases, 52 patients (43.3%) were male, and 70 patients (56.9%) were female. The Mean±SD age of the men was 32.65±29.15, and women was 30±15.30 years.

    Results

    Mortality in women and men was 10% and 17.3%, respectively. Among treated people, diazinon had the highest frequency of 76.4%, and among dead people from diazinon and malathion had the highest rates of 56.3% and 43.8%, respectively.

    Conclusion

    The prevalence of mortality in patients was 7.3% (n=9). As most people with organophosphorus poisoning have been exposed to diazinon toxins; therefore, strategies to prevent and reduce exposure to this toxin are essential.

    Keywords: Organophosphorus poisons, Mortality, Neurotoxicity
  • Mohammad Hossein Abnosi*, Zahra Aliyari Babolghani Page 3
    Background

    Blood contamination of di-2-ethyl hexyl phthalate (DEHP) has been reported due to its release following medical procedures such as blood transfusion and vital liquid injection. We investigated the effect of DEHP on osteogenic differentiation of mesenchymal stem cells and their viability.

    Methods

    The rat bone marrow mesenchymal cells (MSCs) were cultured three times, and the third passage kept in the differentiation medium with the presence of DEHP. The viability of differentiated cells, sodium and potassium level, calcium concentration, total protein concentration, and the activity of lactate dehydrogenase, alkaline phosphatase, alanine transaminase, and aspartate transaminase were determined. Also, the concentration of malondialdehyde, total antioxidant capacity, the activity of superoxide dismutase and catalase were estimated. Finally, the level of matrix deposition and expression of alkaline phosphatase (ALP) and runt-related transcription factor 2 (RUNX2) genes were evaluated.

    Results

    We observed a concentration-dependent and significant reduction of matrix mineralization based on alizarin red and calcium analysis. Besides, the expression of ALP and RUNX2 gene was down-regulated, and alkaline-phosphatase activity reduced significantly. Also, we observed cell viability reduction but the elevation of lactate dehydrogenase activity and malondialdehyde level. Sodium level was elevated too, whereas the activity of transaminases, oxidative stress enzymes, potassium level, and total antioxidants decreased.

    Conclusion

    DEHP contamination reduced matrix mineralization due to the down-regulation of the genes involved in osteogenic differentiation and viability reduction via electrolyte and metabolic imbalance as well as induction of oxidative stress.

    Keywords: Differentiation, Di-2-ethylhexyl phthalate (DEHP), Metabolic enzymes, Mesenchymal stem cell, Oxidative stress
  • Davood Soroosh, Mohammad Nematshahi, Seyed Alireza Javadinia*, Mitra Hesamifard Page 4
    Background

    Since Iran has one of the highest mortality rates of car accidents in the world, the study of the pattern and reasons of trauma in car occupants can provide useful information to determine the underlying causes of injuries and deaths in traffic accidents. Accordingly, this study was conducted to determine the pattern, frequency, and causes of traumatic injuries caused by traffic accidents in car occupants.

    Methods

    This cross-sectional study was conducted during the first 6 months of 2017 in Shahid Beheshti Hospital in Sabzevar City, Razavi Khorasan Province, Iran. The data were obtained from the medical records of patients and the checklist designed by our research team.

    Results

    During the period of study, 300 people were involved in car accidents, of whom 58.3% were men with an average age of 35.16 years. In both sexes, 29.3% of the subjects were in the age group of 30-40 years. Twenty-two car occupants were involved in non-injury car accidents. No significant relationship was found between traumatic injuries and variables of sex, seatbelt use, airbag deployment, and the seat occupant in the cars (P>0.05), as well as between death and variables of sex, airbag deployment and seat occupant in cars (P>0.05). But there was a significant relationship between death and fastening seat belts (P=0.003).

    Conclusion

    The results of this study revealed that sex, airbag deployment, and seat occupant had no effect on traumatic injury or mortality rate in the car occupants. However, fastening the seatbelt can reduce the mortality rate in car occupants, but it does not impact the traumatic injuries rate.

    Keywords: Injury, Accident, Traffic pattern, Iran
  • Mohammad Sadeghi Bimorgh, Abdollah Omidi, Fatemeh Sadat Ghoreishi, Amir Rezaei Ardani, Amir Ghaderi, Hamid Reza Banafshe* Page 5
    Background

    Patients under Methadone Maintenance Therapy (MMT) are susceptible to several problems, including sleep disturbances and risk of relapse. The present study aimed to assess the effect of transcranial direct current stimulation (tDCS) on sleep quality of addicts under MMT.

    Methods

    This clinical trial was conducted on 27 male patients who underwent maintenance methadone therapy in MMT clinics of Mashhad City, Iran. They were divided into the experimental and sham groups. The experimental group received seven 20-min sessions of tDCS every other day. In the sham group, the electrical current was delivered for a few seconds, but the electrodes were remained to the end of the session. Sleep quality was measured at baseline, during, and after the intervention by Pittsburg Sleep Quality Index (PSQI). The obtained data were analyzed by descriptive statistics such as mean and standard deviation and inferential statistics, such as t test, Chi-square, Mann Whitney, and Fischer exact test in SPSS v. 25.

    Results

    The difference between the two groups after tDCS in sleep duration was significant (P=0.04). In the experimental group, the total score of sleep had a reducing trend (P<0.000), while in the sham group, the overall score in 3 phases of evaluation had no significant change (P=0.19). However, the rate of inappropriate sleep quality was not significant between the two groups after the intervention (P=0.12).

    Conclusion

    This trial demonstrated the positive effect of tDCS on sleep quality in patients under MMT programs. Further studies are needed to confirm our findings.

    Keywords: Transcranial direct current stimulation, Methadone, Sleep quality
  • Davood Soroosh, Mahdi Foroughian, Bahram Zarmehri* Page 6
    Background

    According to statistics, tramadol intoxication is one of the most common drug poisoning cases in Iran. Because seizure is one of the severe and dangerous side effects of tramadol, the present study aimed to investigate the characteristics of tramadol-induced seizures.

    Methods

    In this cross-sectional descriptive study, all patients who referred to the emergency departments due to the tramadol-induced seizures were examined by the census method. The patients’ data were collected with a checklist. Then, the data were analyzed with descriptive and inferential statistical tests in SPSS v. 23 and at a significant level of P<0.05.

    Results

    In this study, 350 patients (52.9% male, and 47.1% female) were examined. The Mean±SD dose consumed was 1171.4±802.77 mg. The minimum dose that caused the seizure was 200 mg, and the average dose consumed of tramadol was different in patients who had one, two, or three seizures outside the hospital (P=0.002). The consumed average dose of tramadol was 1144.5 mg, 2017.7 mg, and 511.1 mg for patients who had one, two, or three seizure(s), respectively. There was a significant relationship between dose consumed and the number of seizures (P=0.001). The study showed that patients who had a one-time seizure, have experienced this condition outside the hospital. There was a significant relationship between the number of seizures and the location of the seizure (outside or inside the hospital) (P=0.001).

    Conclusion

    The results showed no significant relationship between consumed dose and location of the seizure. The number of seizures is not dependent on the consumed dose. It means that increasing the consumed dose, the number of seizures does not increase, and there is no significant relationship between the amount of dose consumed and the number of seizures.

    Keywords: Tramadol, Seizure, Emergency, Hospital
  • Mohammad Mehdi Soltan Dallal, Fares Najari, Ahdie Karbalaei Shabani*, Khadijeh Ezoji, Minoosh Shabani, MohammadReza Montazer Khorasan, Alireza Jannani Page 7
    Background

    Foodborne botulism is a fatal paralytic illness caused mainly by the neurotoxin produced by an anaerobic bacterium called Clostridium botulinum. In this study, the frequency of foodborne botulism in patients referred to a hospital in Iran has been reviewed for ten years.

    Methods

    In this routine database study, medical records of patients with foodborne botulism referred to Loghman Hospital in Tehran City, Iran, from March 20, 2008, to March 20, 2019, were reviewed. Information on variables of age, sex, place of residence, food consumed, clinical symptoms of patients (such as dysphagia, nausea, vomiting, ataxia, etc.), toxin type, and length of hospitalization were collected with a researcher-made questionnaire. Finally, the collected data were analyzed in SPSS-24 with descriptive and analytical statistical tests.

    Results

    In this study, 61 suspected botulism patients were clinically diagnosed in Loghman Hospital, of whom 55 patients were clinically suspected of foodborne botulism, 5 patients had iatrogenic botulism, and 1 patient had infant botulism. Of these 55 patients with the clinical diagnosis of foodborne botulism, 19 patients were confirmed by laboratory examinations, and 2 patients died. Sixteen patients confirmed by laboratory had neurotoxin botulinum type A. The mean age of the patients was 36.9 years with a standard deviation of 18.6 years. About 54.5% of the patients were male and 45.5% female. Weaknesses (58.2%), ptosis (droopy eyelid) (56.4%), and diplopia (double vision) (52.7%) were the common clinical symptoms of the patients under study. Canned foods and dairy products were the main foods consumed by the patients. The duration of admission time ranged between 1 and 41 days, with an average of 7.7 days. About 23.64% of patients were admitted to the intensive care unit.

    Conclusion

    The prevalence of foodborne botulism is rare compared with other food poisonings but is still a major public health problem due to the consumption of traditional food products and unboiled canned foods in Iran.

    Keywords: Clostridium, Botulism, Antitoxin, Food poisoning, Paralysis
  • Samaneh Silakhori, Bita Dadpour, Majid Khadem-Rezaiyan, Alireza Sedaghat, Farzad Mirzakhani* Page 8
    Background

    This study aimed to assess the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiologic Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores in predicting mortality rate in poisoning patients admitted to an intensive care unit (ICU).

    Methods

    This cross-sectional study was performed on all admitted patients in the poisoning ICU of Imam Reza Hospital, Mashhad City, Iran. All patients were evaluated for three consecutive days since admission time and then every two days until discharge from ICU or death. The scoring systems mentioned above were calculated and analyzed by MedCalc statistical software version 18.9.1 and SPSS version 16.

    Results

    Overall, 150 patients were studied, out of whom 67% (101) were male. Their mean±SD age was 41.6±18.9 years. In their whole hospitalization period, APACHE II (79.5%), SAPS II (78.7%), APACHE IV (78.4%), and SOFA (72.9%) were the most precise measures. On the first day of admission APACHE II (77.4%), on the second day, APACHE II (83.1%), on the third day, APACHE II (90.7%), and on the fifth day, SOFA (81.6%) were the most precise measures.

    Conclusion

    All four systems have acceptable discriminatory power for poisoned patients. However, it seems that APACHE II can be used for mortality prediction, especially in the early days of admission.

    Keywords: Critical زare, Prognosticmodels, Acute Physiology -Chronic Health Evaluation(APACHE), Simplified acutephysiology score, Organdysfunction scores
  • Baharak Sabet Divshaly, Farahnaz Azimy, Babak Sabet Divshaly, Mohammad Ali Emam Hadi* Page 9
    Background

    Complementary and alternative medicine is a non-conventional therapy and includes a wide range of medical treatments in different countries. This study was done to evaluate alternative medicine complaints lodged to the Tehran Forensic Medicine Organization from 2011-2017.

    Methods

    In this cross-sectional study, all documented complaints of complementary medicine lodged to the Tehran Forensic Medicine Organization from 2011-2017 were reviewed and assessed with retrospective follow-up. The inclusion criterion was complaints from complementary and alternative medicine, and the exclusion criterion was incomplete data. The study data included patients’ demographic data, the therapist, the specialty of the therapist, type of disease, treatment method, adverse effects, the initial and final decision by the commission, and the amount of medical error. This information was extracted from the existing documents and recoded in the checklists.

    Results

    Medical errors were found in 53.4% of the complaints examined. The most common cause of complaint (63%) was the adverse effects, of which the most common ones were phytotherapy (45.2%) and cupping (Hijama) (20.5%). The error was significantly different between physician and non-physician healers (P=0.001).

    Conclusion

    Based on this study, among the alternative medicine complaints lodged to the Tehran Forensic Medicine Organization from 2011-2017, the adverse effects were the main problem of complementary therapies confirmed in more than half of the complaints.

    Keywords: Alternative medicine, Complementary medicine, Forensic medicine, Malpractice
  • Zahra Khalighi, Golnaz Azami, Elham Shafiei, Ali Sahebi, Aliashraf Mozafari* Page 10
    Background

    Thrombotic Thrombocytopenic Purpura (TTP) is a rare and life-threatening disorder characterized by severe thrombocytopenia, microangiopathic hemolytic anemia, fever, renal dysfunction, and neurological deficient. TTP leads to the formation of blood clots in small blood vessels throughout the body. TTP is associated with many risk factors such as pregnancy, HIV, cancer, lupus, and infections. Recently there have been few published case reports of bee sting associated TTP.

    Methods

    A 67-year-old man from a rural area of the Southwest Province of Iran, Ilam, was referred to the academic general hospital because of fever, chills, sweating, vomiting and dizziness following the honeybee sting on his body.

    Results

    this study showed that,multiple co-morbidities including CVD and diabetes, along with coagulation abnormalities after honeybee stings, seriously exacerbated patient hemodynamic status.

    Conclusion

    TTP, as a major complication due to the toxic reaction of a large number of bee stings with underlying diseases in patients, should be given more attention.

    Keywords: Thrombotic Thrombocytopenic Purpura (TTP), Honey bee sting, Anaphylactic shock
  • Aliashraf Mozafari, Elham Shafiei, Yousef Jamshibeigi, Ali Sahebi* Page 11

    Arbaeen is the largest peaceful religious gatherings on Earth. In this event, millions of people go to the holy city of Karbala in Iraq.  Annually, about 20 million pilgrims attend Arbaeen ceremony, including about three million foreigners, that most of whom are Iranians. Ilam province is located near Iran’s western border with Iraq. Every year, many Iranian pilgrims enter Iraq through Ilam borders for the Arbaeen ceremony, which lasts two weeks before and after Arbaeen day. Pilgrims after the religious rituals enter to their home.

  • Zahra Ataee*, Maryam Sayyari Doughabadi Page 12

    The ever-increasing sensitivity of humans and living in a world full of stress and anxiety have led to the increased consumption of painkillers and sleeping pills. Barbiturates, which are among the most important sedatives, are regularly used by ordinary people. Addiction, suicide, and accidental deaths from inappropriate use of these drugs have been a subject of constant concern in medicine.

    Keywords: Phenobarbital, poisoning, reduced consciousness