International Journal of Medical Toxicology and Forensic Medicine

Background: Nowadays many people depend on herbal medicine for their healthcare needs; however, handmade herbal drugs are not screened for efficacy and safety. Undeclared active pharmaceutical ingredients have been detected in herbal medicine, even if there are claims to be natural. This study determines the undeclared active pharmaceutical ingredients in a weight gain herbal supplement collected from an Iranian online herbal shop.
Methods: One packet of herbal supplement (containing 45 tablets), advised as a weight gain product, was gathered from an online herbal shop in Iran. The sample was analyzed to detect undeclared active pharmaceutical ingredients using gas chromatography/mass spectrometry instrument, based on Iranian forensic standard operating procedures 920118-2655.
Results: The cyproheptadine was detected in this herbal supplement at a concentration higher than the therapeutic dose.
Conclusion: Although synthetic drugs cannot be produced except by permission of the licensing authorities, there is no regulation for herbal supplement production in Iran. Therefore, herbal supplements’ serious quality and safety concerns must be assured for patients’ health.

Background: This study evaluates the role of oral melatonin in improving vision in methanol toxicity since vision disorders are one of the side effects related to methanol toxicity and assumes the potential effects of melatonin in protecting neurons and optic nerves. Meanwhile, little attention has been paid by researchers to the effect of melatonin in these patients.
Methods: A double-blind randomized controlled clinical trial study was conducted on 40 patients diagnosed with methanol toxicity who were referred to Khorshid Hospital of Isfahan City, Iran, from May 2022 to May 2023. These patients were randomly divided into two groups. In the first group (the intervention group), in addition to the usual treatment, the patients were prescribed orally 3 mg of melatonin every morning and 6 mg of melatonin every night for 10 days. In the second group (the control group), in addition to the usual treatment, a placebo was administered similar to the intervention group protocol. Then, the clinical and vision parameters of the patients were evaluated before, during, and after the intervention.
Results: The mean pH, PCO2 and HCO3 increased significantly after the intervention compared to the pre-intervention in both groups (P<0.05); however, no significant difference was found between the two groups in any of the two follow-up times (P>0.05). The most common visual complication caused by methadone toxicity was blurred vision with 71.4% and 90% in the melatonin and non-melatonin groups, respectively. Visual complications improved significantly after the intervention compared to the pre-intervention; accordingly, the complete improvement of vision complications in the melatonin group (76.2%) was significantly more than the non-melatonin group (53.3%) (P=0.040).
Conclusion: Melatonin improves blurred or snowfield vision in methanol poisoning. Therefore, the administration of melatonin plus routine treatment can be effective in improving vision disorders (blurred or snowfield vision) caused by methanol poisoning.

Background: Wound detection is important in forensic science. The development of technology for automatic wound detection in the medical field has not been fully realized. This study aimed to compare the level of knowledge between medical students who utilized an application versus those who studied from textbooks.
Methods: An image processing-based application was developed using a Python program with the YOLO software, version 4 algorithm. The research utilized a cross-sectional study design. The participants were medical students undergoing clinical clerkships at the Forensic and Medicolegal Departments of the Faculty of Medicine, Public Health, and Nursing at Gadjah Mada University. Each group (textbook and application group) comprised at least 35 individuals. Both groups had identical study periods and answered the same questions. Participants then filled out a questionnaire about the application.
Results: The mean scores of the post-test showed significant improvement in both groups compared to their pre-test scores (P=0.00). There was no significant difference in the post-test scores between the groups using the questionnaire and the application (P=0.207).
Conclusion: The application for wound type determination could serve as a preferable alternative to traditional textbooks for learning. It demonstrated an increase in learning outcomes that was significantly comparable to that achieved through textbook study.

Background: In Iran, one of the main duties of forensic psychiatrists is to accurately diagnose post-traumatic stress disorder (PTSD). In order to achieve a more accurate diagnosis and reduce the possibility of deception, the autonomic reactions of patients with PTSD were investigated through virtual reconstructed trauma.
Methods: The autonomic activities of 80 patients who were diagnosed with PTSD by psychiatric interview based on the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) and PTSD checklist for DSM-5 (PCL-5) checklists, were recorded by an electronic wristband through virtual trauma exposure. Data were collected and analyzed by SPSS software, version 16.
Results: The galvanic skin response, heart rate, and body temperature can be the most reliable automatic reactions to diagnose true cases of PTSD.
Conclusion: The findings of this study along with psychometric tests can be used to distinguish between true cases of PTSD and fake cases.

Background: This study was done to achieve a new drug delivery system delivering two different chemotherapy molecules to the target tissue simultaneously.
Significance: Co-delivery of chemotherapy medicines provides synergistic effects leading to lowering the dose of administered drugs and side effects.
Methods: Doxorubicin (DOX) was introduced to water-soluble hyaluronic acid (Hyal) using 1-amino-3,3-diethoxy-propane (ADEP), as a pH-sensitive linker, to develop a new hydrophobic structure, i.e. Hyal-ADEP-DOX. The conjugates were grafted in three ratios (7.5%, 12.5%, and 20%) to Hyal and characterized by Fourier transform infrared (FT-IR) and proton nuclear magnetic resonance (1HNMR). Cannabidiol (CBD) was physically loaded in the core of nano-micelles.
Results: Prepared nano-micelles were analyzed for critical micelle concentration (CMC) particle size stability and drug release before and after loading the CBD. Hyal-ADEP-DOX-12.5 was the optimized ratio and had a mean diameter of 50 nm before loading the CBD and 120 nm after loading (observed by transmission electron microscopy). The release results showed that DOX releases slowly in physiological pH, and CBD has a burst release at acidic pH from Hyal-ADEP-DOX-12.5. These properties altogether make Hyal-ADEP-DOX nano-micelles, as a stimuli-sensitive nano-carrier, a potential candidate for hydrophobic anticancer agents’ co-delivery.
Conclusion: The grafted DOX exhibited pH-sensitive release behavior, i.e. while 22.8% of the drug was released after 24 h at pH 5.5, and 5% was released after 24 h at pH 7.4. Hyal-ADEP-DOX due to its low CMC value, colloidal stability, slow drug release in physiological pH, and burst release in acidic pH Hyal-ADEP-DOX, is an excellent candidate as a carrier to co-deliver hydrophobic therapeutic agents to tumor tissues.

Background: The objective of this study was to propose a model for examining the impact of inward internationalization on outward internationalization in Iranian pharmaceutical companies by focusing on organizational capabilities.
Methods: Qualitative research was employed, and the grounded theory approach was utilized for data analysis. The study involved conducting interviews with 16 individuals who possessed experience in international activities within the pharmaceutical sector and expertise, using the snowball sampling method. The data gathered from the interviews underwent open, axial, and selective coding analyses, resulting in the development of a paradigm model of internationalization within the pharmaceutical industry. The paradigm model is composed of causal conditions, background conditions, intervening conditions, central phenomena, strategies, and consequences.
Results: The research findings indicated that causal factors of internationalization encompass learning from other countries, updating medical and technical knowledge, expanding activities beyond domestic markets, facilitating production quality improvement, and promoting growth within the pharmaceutical industry. Strategies for internationalization include adopting an international perspective, implementing effective macro-level policies, utilizing long-term strategies, enhancing workforce professional capabilities through training, improving standards and documentation, devising strategies for rational budget utilization, planning for optimal capacity utilization, and strengthening international communication and political relationships.
Conclusion: Ultimately, the consequences of inward internationalization and the enhancement of organizational capabilities lead to outward internationalization and a favorable position within the global pharmaceutical industry, improvements in organizational capabilities and international relations, development of cross-border business, economic prosperity within the pharmaceutical industry, and heightened commitment to foreign markets.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs widely prescribed and used worldwide. Patients taking NSAIDs, including diclofenac, should be aware of its potential nephrotoxic effects. However, the rapid onset of acute kidney injury (AKI) after a single dose of diclofenac is considered a very rare side effect.
Case Presentation: We present a 66-year-old woman with habitual self-induced anuria with the chief complaint of shoulder pain due to falling down. The patient presented with various co-morbid conditions, including hypertension, type 2 diabetes, tricuspid valve repair, and aortic valve replacement. She rapidly developed anuria after receiving a single dose of diclofenac over the previous two days of admission. Creatinine and BUN exhibited a significant rise in laboratory tests. During hospitalization, the consumption of NSAIDs was prohibited and losartan and furosemide were discontinued. Moreover, phenacetin was used to relieve pain instead. Luckily, after two days of hospitalization, urine output returned to normal levels. Additionally, creatinine and BUN levels gradually decreased to baseline values.
Conclusion: To the best of our knowledge, we described a rare case of diclofenac-induced AKI presenting with anuria, a complete cessation of urine flow, in a patient with no previous kidney complications. This case can be explained by the phenomenon known as “quadruple Whammy,” which involves the concurrent use of NSAIDs, ARBs, and diuretics in the setting of hypovolemia.

Background: Professional neglect is a civil responsibility for any specialist or individual with a specific skill, including therapists, and is not limited to any particular profession.
Case Presentation: A man 41-year-old drug abuser was diagnosed with a heart problem due to methamphetamine abuse. Despite his drug history, he was once admitted to the emergency room for chest pain, where acetaminophen and diazepam were prescribed. For the second time, he went to another medical center due to continued chest pain, and due to the suspicion of contracting COVID-19, a CT scan of the chest was performed, yielding negative results, and then he was discharged. The patient was found deceased in his bed the following day. An autopsy revealed a thinned heart wall, subendocardial hemorrhages, and severe atherosclerosis. Methamphetamine, amphetamine, and acetaminophen were detected in urine samples, and ethanol was detected in blood and vitreous humor samples.
Conclusion: The case highlights the importance of medical negligence in treating patients with drug abuse.