International Journal of Medical Toxicology and Forensic Medicine

Background: Mobile phones are widely used, raising questions about the possible health effects of the radiofrequency electromagnetic fields they emit. Fatigue is frequently reported in this context, but it is influenced by multiple, interacting factors that are difficult to model with classical statistical methods. Artificial neural networks (ANNs) may help explore these complex relationships.

Methods: An ANN model was developed to estimate fatigue associated with cell phone use. Data were collected via a semi-structured questionnaire completed by 478 Algerian participants. The survey recorded sociodemographic data and patterns of mobile phone use. The network had a 5-10-1 architecture, and its performance was evaluated by mean squared error (MSE) and the coefficient of determination (R²). A simple MATLAB interface was created to allow user input and display model outputs with a colour-coded indicator.

Results: The ANN achieved an MSE of 0.5993, indicating that it reproduced some general patterns in the data. However, the coefficient of determination was low (R² = 0.0338), showing that only a small proportion of the variability in fatigue scores was explained and that individual predictions were imprecise.

Conclusion: This exploratory study suggests that ANN-based models are feasible for analysing fatigue associated with mobile phone use, but the findings should be regarded as preliminary and are subject to some limitations. Larger, more diverse samples and richer, preferably objective, exposure and health measures will be required before such tools can be used for reliable risk assessment or public health guidance.

Background: Ephedrine, the alkaloid of Ephedra (mainly Ephedra sinica, or Ma Huang), has been utilized in traditional Chinese medicine for decades to treat colds, bronchitis, and asthma due to its sympathomimetic and bronchodilator properties. The isolation of Ephedrine in the late 19th century was a milestone in the field of natural product pharmacology. It was first discovered in Western medicine as an orally active adrenergic receptor agonist. Although therapeutically beneficial, Ephedrine is also associated with dose-related toxicities that range from a mild manifestation such as restlessness and insomnia to serious cardiovascular and neurological adverse effects like hypertension, arrhythmias, seizures, and sudden death. In addition, its use as a precursor to illicit methamphetamine manufacture has contributed to control and public health problems.

Methods: A certified analytical procedure was established that combined FTIR and ¹H-NMR spectroscopy for the authentication of the structure and purity assessment of the analgesic drug ephedrine. In ¹HNMR spectroscopy, the main goal was the assignment of typical environments for protons in the molecule in an effort to ensure the molecular structure is not compromised. The other technique used was FTIR spectroscopy, which aimed to produce a fingerprint of the functional groups.

Results: The ¹H-NMR spectrum of Ephedrine displayed well-resolved and characteristic resonances at δ 7.0–7.4 ppm corresponding to aromatic protons, δ 4.7–5.0 ppm attributed to the hydroxyl (–OH) proton, δ 3.2–3.5 ppm for the methine proton adjacent to the hydroxyl group (–CHOH), and δ 1.0–1.2 ppm corresponding to the methyl group. The absence of extraneous signals confirmed high chemical purity and structural integrity of the sample.

Conclusion: Current analytical advances have enhanced the certainty of ephedrine identification. Fourier-transform infrared spectroscopy (FTIR) provides a rapid structural fingerprint and practical purity assessment. In contrast, proton nuclear magnetic resonance (¹H-NMR) provides detailed information on molecular structure, enabling accurate assignment of functional groups and stereochemistry. Applied in combination, these techniques form a complementary analytical platform for forensic and clinical confirmation of Ephedrine in complex matrices. Concurrently, modern synthetic methodologies maximize enantioselectivity, high yield, and environmental benignity, thereby extending both pharmacological use and forensic discrimination. Therefore, Ephedrine is an exemplar of the dual nature of natural products: an ancient medicine of immense therapeutic utility that, in the twentieth century, has also come to be associated with toxicological hazard, regulatory control, and societal harm.

Background: Azithromycin, a widely used macrolide antibiotic, is associated with dose-dependent hepatorenal toxicity primarily mediated by oxidative stress and inflammation. Rutin, a natural flavonoid, possesses potent antioxidant and anti-inflammatory properties that can mitigate organ damage. This study aimed to evaluate the potential of Rutin to ameliorate azithromycin-induced histopathological alterations in the livers and kidneys of albino rats.

Methods: Thirty-six adult male albino rats (180–200 g) were allocated into five groups: a control group (normal saline), groups receiving azithromycin (30 mg/kg) for 7 (T1) or 14 days (T2), and groups receiving concurrent azithromycin and rutin (50 mg/kg) for 7 (T3) or 14 days (T4). After the treatment period, liver and kidney tissues (one kidney per animal) were harvested for histopathological examination using hematoxylin and eosin (H&E) staining.

Results: Azithromycin administration induced a significant time-dependent histopathological damage. The T2 group (14-day azithromycin treatment) exhibited severe hepatic injury, including hepatocellular necrosis, sinusoidal dilatation, and inflammatory infiltration, as well as renal damage characterized by glomerular atrophy and tubular necrosis. Cotreatment with Rutin markedly attenuated these effects. The T4 group (14-day cotreatment) showed near-complete preservation of the hepatic architecture and renal histology, with minimal signs of inflammation and cellular damage.

Conclusion: Co-administration of Rutin confers significant protection against azithromycin-induced hepatorenal damage, attributed to its antioxidative and anti-inflammatory mechanisms. These findings highlight the potential of Rutin as an effective adjuvant therapy to minimize antibiotic-associated organ toxicity.

Background: Excessive drinking can cause liver damage and even liver fibrosis and cirrhosis. This study aimed to investigate the influence of alcohol and its related mechanisms on the transformation of growth factor-β1 (TGF-β1) and the loss of epithelial phenotype in hepatocytes.

Methods: In the present study, HepG2 cells (2 × 10⁵ cells/ml) were co-cultured with K562 cells (2 × 10⁵ cells/ml) and treated with 50 mM, 100 mM, and 200 mM alcohol for 24 hours. Cell morphology, as well as the expression of endothelial markers E-cadherin, Desmoplakin, CK18, and TGF-β1, were detected.

Results: The study showed that alcohol induced the loss of epithelial phenotype, considerably decreasing the mRNA levels of E-cadherin, Desmoplakin, and CK18, as well as E-cadherin protein expression. In contrast, alcohol increased the mRNA levels and concentrations of TGF-β1 in the cultured media of co-cultured HepG2 cells in a concentration-dependent manner. These results demonstrated that alcohol attenuated the epithelial phenotype in HepG2 cells co-cultured with K562 cells; meanwhile, K562 cells played an essential role in enhancing the expression of TGF-β1 in HepG2 cells.

Conclusion: Our research has established an in vitro model of alcohol-induced epithelial phenotype loss in hepatocytes and partly explained the mechanisms of alcohol-induced liver fibrosis.

Background: Poisoning is one of the main causes of emergency admissions and deaths worldwide, which could be affected by the COVID-19 pandemic. This study aimed to assess poisoning patterns before, during, and after the COVID-19 pandemic at poisoning centers in Urmia.

Methods: In this retrospective, descriptive-analytical study, all poisoned patients hospitalized in  Urmia poisoning centers from 2018 to 2023 were studied. Patients were categorized into groups before, during, and after the COVID-19 pandemic. Then, statistical analyses were performed using SPSS version 21.

Results: This investigation evaluated 13197 patients (51.7% males, 48.3% females). The mortality rate was 323 (2.45% total; 75.9% males; 24.1% females). The patients' Mean± standard deviation age was (28 ± 14.05) years (min=14, max=96). Most patients were aged 21-30 years, and approximately half were male. The number of hospitalizations during the COVID-19 pandemic (2,665) decreased significantly compared with before (5,697) and after (4,835). Pesticide (41.1%), Pharmaceuticals (20.6%), Substance abuse (17.8%), Mixed poisonings (12.2%), and Alcohol (6.5%) were the most common causes of death during the COVID-19 pandemic, respectively. Mortality among males was higher than among females at all times. But the mortality rate during the COVID-19 pandemic (4%) increased significantly compared to before (1.7%) and after (2.5%). Significant relationships were detected between the patients' outcomes and age>60 years, Male, Widowed status, Higher (Academic) education, and Alcohol poisoning, Gases, Pesticides, Bites, and Foods/Mushrooms.

Conclusion: Despite a decline in hospitalizations due to fears of COVID-19, it was able to change patterns of poisoning and mortality. Therefore, education to prevent pesticides, Alcohol, and drugs during public health crises can reduce morbidity and mortality.

Background: The ethyl acetate fraction of melinjo (Gnetum gnemon L.) leaves has been reported to possess antihyperlipidemic and antidiarrheal activities, and phytochemical screening has identified tannins, phenolics, and flavonoids. However, the safety profile of this fraction remains unclear, necessitating toxicity evaluation. The purpose of this study was to use the fixed-dose method to examine the acute toxicity of the ethyl acetate fraction of melinjo leaves in male Wistar rats.

Methods: Based on preliminary testing, the main study used a single oral dose of 2000 mg/kg BW. In silico predictions using Swiss ADMET, Pro-Tox II, and pkCSM showed LD₅₀ values ranging from 159 to 5000 mg/kg.

Results: There were no deaths or obvious symptoms of toxicity in either the treatment or control groups, according to observations. Additionally, biochemical analysis showed no significant differences across groups (p > 0.05). The treatment group's mean results were SGPT 76.01 ± 3.20 U/L, SGOT 144.31 ± 34.62 U/L, urea 42.12 ± 7.74 mg/dL, and creatinine 0.622 ± 0.066 mg/dL, while the control group showed SGPT 72.45 ± 11.64 U/L, SGOT 144.19 ± 19.90 U/L, urea 46.08 ± 6.32 mg/dL, and creatinine 0.618 ± 0.024 mg/dL. Macroscopic examination of the liver, kidneys, and heart revealed no pathological changes.

Conclusion: At a dose of 2000 mg/kg BW, the ethyl acetate fraction of melinjo leaves did not cause acute toxicity, indicating a good safety profile for further pharmacological research.

Background: Phyllanthus emblica L. exhibits notable antioxidant and therapeutic activities attributed to phenolic and flavonoid compounds. This study aimed to identify the phytochemical constituents of P. emblica fruit nanoherbs and evaluate their acute oral toxicity.

Methods: Both in silico and in vivo approaches were employed. Toxicity tests were conducted using a fixed-dose method, followed by clinical, macroscopic, and histopathological assessments of the liver and kidneys in Wistar rats.

Results: Phytochemical screening revealed the presence of alkaloids, flavonoids, tannins, saponins, steroids/triterpenoids, and glycosides. In silico predictions using SwissADME, Pro-Tox II, and pkCSM showed LD₅₀ values ranging from 159 to 2500 mg/kg. Quercetin and kojic acid were classified as moderately toxic (class 3), while nicotinamide was categorized as practically non-toxic (class 5) with a potential hepatotoxic risk. In vivo studies demonstrated no significant changes in body weight, organ weight, or mortality up to 5000 mg/kg, and histopathological examinations confirmed preserved hepatic and renal structures, with only mild alterations at the highest dose.

Conclusion: Overall, nanoherbs derived from P. emblica fruit were found to be safe in acute and subchronic exposure, supporting their potential application in pharmaceutical development.

Background: Chromosomal abnormalities are a major cause of hereditary disorders, congenital anomalies, and developmental impairments. Conventional karyotype analysis relies on manual inspection by cytogenetic experts, making it time-consuming and prone to subjective interpretation.

Methods: To overcome these shortcomings, this article illustrates an automated chromosomal abnormality detection framework based on a Varifocal-Net–integrated Convolutional Neural Network (CNN) architecture. The proposed model adopts a dual-scale learning strategy, where a global-scale network captures overall chromosomal morphology, and a local-scale network extracts fine-grained structural features such as banding patterns and centromere regions. Deep feature learning is achieved using dual VGG-16 backbones enhanced with residual connections and multi-task learning. The system has undergone training and validation on a curated and expert-verified karyotype image dataset.

Results: Significant classification of performance is demonstrated by findings on experiments achieving 99.04% accuracy, 98.63% sensitivity, and 100% specificity, outperforming baseline CNN and residual architectures.

Conclusion: The inferences depicts that the proposed framework offers a reliable and efficient solution for automated analysis of karyotype evidencing promising potential for clinical decision-support applications.

Background: Antihistamines are widely used for allergic and respiratory conditions, but can cause severe toxicity when taken in overdose. Differences in pharmacokinetic properties between first and second-generation agents influence clinical presentation and outcomes. This study aimed to describe the epidemiological and clinical features of intentional antihistamine poisonings in patients consulting our emergency department (ED) in Tunisia and to identify drug-specific and dose-specific associations with anticholinergic symptoms.

Methods: A retrospective study was conducted at the ED of the Mahmoud Yaacoub Center for Urgent Medical Assistance in Tunis from January 2021 to July 2024. Patients presenting with acute intentional antihistamine poisoning were included. Epidemiological and clinical data were analyzed using univariate and multivariate logistic regression to identify independent predictors of anticholinergic symptoms.

Results: Among 134 included cases (median age 24 years; 83.6% female), most involved H1-antihistamines (91.8%), predominantly first-generation agents (58.6%). Cyproheptadine (32.1%) and chlorpheniramine (9.7%) were the most frequently implicated first-generation drugs, while cetirizine (23.9%) was the most common second-generation agent. Symptomatic presentations occurred in 47% of patients, being more common and more severe with first-generation drugs than second-generation (69.8% vs 25.4%, p<0.001). Cyproheptadine poisoning was associated with tachycardia (P=0.034, OR=2.441) and toxic psychosis (P=0.032, OR=6.206), with a cutoff dose of ≥108 mg determinant for toxic psychosis (P=0.025, OR=12.73). Chlorpheniramine was linked to sedation (P=0.022, OR=5.43) and hypotension (P=0.043, OR=16.38). ICU admission occurred in 9.7% of cases, and 2 patients required mechanical ventilation. The majority of patients (73.1%) were discharged home, and 12.7% were referred for psychiatric evaluation.

Conclusion: Most intentional antihistamine poisonings resulted in mild or no symptoms; first-generation agents, particularly cyproheptadine and chlorpheniramine, were linked to more severe toxicity and consequences. Recognition of dose thresholds and drug-specific clinical patterns can guide early management in acute antihistamine poisoning.

Background: Precise detection of drugs in urine samples is crucial in both clinical and forensic settings. However, the pre-analytical phase, which encompasses sample handling before testing, can significantly affect results. Additionally, Forensic investigations may involve longer storage periods than traditional clinical scenarios with immediate testing; therefore, proper sample collection and storage are essential to ensure accurate analysis. This study aims to evaluate the impact of temperature and storage duration on the stability of target compounds in urine samples.

Methods: Specifically, the research paper analyzes the impact of different storage conditions, i.e., freezing vs. refrigeration, on the detectability of Tramadol. The stability of Tramadol under the following temperatures (room temperature, 40°C, 4°C, and -20°C) with the preservatives in place and without them in place in the presence of urine samples (n= 240) was established. Findings indicate the nature of the interconnection among Tramadol stability, temperature, and storage time.

Results: We have determined that the conditions that gave the most stable state with Tramadol were those that provided a reasonable degree of stability over time after one month, mild loss of concentration after three months, and comparative degradation after six months, under storage at -20°C and with the preservative. The reason is that the sample can also be kept in Formaldehyde, as it is an antibacterial agent in addition to carbon, hydrogen, and oxygen.

Conclusion: These findings imply that one must be careful when measuring urine temperatures to maintain the integrity of the samples used for proper drug testing. The impact of such a discovery extends widely to health care professionals, toxicologists, and laboratory analysts within the urine drug testing industry. These findings hold significant implications for healthcare professionals, toxicologists, and laboratory analysts involved in urine drug testing. Ultimately, the present research seeks to minimize errors and misinterpretations caused by mishandling during the pre-analytical phase and storage, leading to more reliable drug testing outcomes.

Background: Troponin has been widely recognized as a key prognostic biomarker for predicting mortality in patients with severe COVID-19. This study aimed to assess the relationship between troponin concentration and mortality in patients infected with the Delta variant of COVID-19.

Methods: This retrospective, single-center study included 40 hospitalized COVID-19 patients aged 18 to 65 years, classified as having moderate or severe disease. Patients with pre-existing cardiovascular or muscular disorders, prior use of anticoagulants, or non-standard treatment protocols were excluded to reduce confounding. All participants had documented serum troponin levels measured at admission (troponin 0) and repeated six hours later (troponin 6). Data on demographics, comorbidities, laboratory findings, and clinical outcomes were extracted from medical records. Statistical analyses were performed to assess correlations between troponin levels and disease severity.

Results: Serum troponin levels showed a significant positive correlation with age (r = 0.482, P = 0.002) and were notably higher among retired individuals (H = 6.45, P = 0.040). No significant association was found between troponin levels and clinical symptoms (P > 0.05). A significant negative correlation was observed between diastolic blood pressure (DBP) and troponin (r = –0.421, P = 0.008). Patients who died had significantly elevated troponin levels (U = 0.62, P = 0.001). A troponin cutoff value of 15.5 ng/L predicted mortality with 70.6% sensitivity and 90.9% specificity.

Conclusion: The findings of this report indicate that elevated troponin concentrations were more frequently observed in older individuals and in patients with lower DBP. Moreover, higher troponin levels were significantly associated with increased mortality, likely due to direct cardiac damage from SARS-CoV-2 or the body’s inflammatory response to the infection.

Background: This study provides a bibliometric overview of global research on the toxicological impacts of nanoparticles (NPs), with a particular focus on oxidative stress in environmental systems.

Methods: A total of 1507 documents published between 2000 and 2025 were retrieved from the Scopus database. Using Bibliometrix and VOSviewer, we analysed leading countries and authors, keyword co-occurrence, publication trends, and research gaps.

Results: Scientific output in this field has increased rapidly, with an average annual growth rate of 24.15% and a mean of 41.98 citations per article, indicating substantial scholarly impact. Oxidative stress emerged as the central theme, with particular emphasis on the roles of reactive oxygen species (ROS) and antioxidant defense systems.

Conclusion: Despite the field's strong growth, important gaps remain, including limited work on chronic exposure, interactions between NPs and other pollutants, and effects on non-model organisms.

Background: Stab and incised wounds are frequently encountered in forensic practice. Burned skeletal remains often complicate the evaluation of such injuries, making it essential to understand how fire alters cut marks on bones. This study aimed to investigate macroscopic changes in bones subjected to sharp-force trauma after exposure to high temperatures.

Methods: Three bovine humeri were incised with a 32 cm non-serrated kitchen knife. The length, width, direction, and interrelationships of each incision were measured with a forensic scale, photographed, and recorded. The bones were then burned in open-air conditions using oak wood, without accelerants, at 460–570 °C for 60 minutes. Following combustion, the incisions were remeasured, and pre- and post-burning characteristics were compared statistically.

Results: Despite advanced thermal destruction, most incisions remained macroscopically visible. Heat exposure caused significant increases in incision length and width (p < 0.05). Linear fissures radiating from the cuts were observed, and the cut margins appeared sharper and drier after burning. In one specimen, thermal fractures disrupted the evaluation of a distal incision.

Conclusion: Sharp-force trauma marks on bones are not completely obscured by fire and may even become more pronounced. However, heat-related expansion of cut dimensions can lead to overestimation of blade size. These findings emphasize the need for caution in interpreting burned skeletal remains and highlight the importance of further research with larger sample sizes to improve forensic accuracy.

Background: A cornerstone of forensic practice is determining the postmortem interval to resolve suspicious deaths and assist in criminal investigations. The work aims to estimate the postmortem interval (PMI) using oxidative stress markers, and to Assess Molecular, histopathological, and immunohistochemical changes in the spleen, pancreas, and heart of adult albino rats.

Methods: 30 adult albino rats were divided into five groups. All rats were sacrificed and kept at room temperature. Dissection of the spleen, pancreas, and heart was done at 0 (control), 6, 24, 48, and 72 hours. The following parameters were measured: malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), hypoxia-associated factor (HAF), apoptosis-inducing factor (AIF), and B-cell lymphoma 2 (BCL2) immunostaining.

Results: MDA, GSH, and SOD showed strong positive correlations with PMI in the pancreas, whereas in the heart, GSH showed a fair positive correlation with PMI.SOD showed a strong positive correlation with PMI in the spleen, while GSH showed a strong negative correlation with PMI. HAF showed a strongly significant positive association with PMI in the heart and the spleen, whereas in the pancreas, it showed a fair correlation. AIF showed a significant negative correlation with PMI in the heart. Histological changes showed time-dependent changes. BCL2 immunohistochemical expression showed a significant decrease over time in all organs.

Conclusion: Oxidative stress markers, Molecular, histopathological, and immunohistochemical changes can help estimate PMI. Four novel equations were developed to estimate PMI using the studied parameters across different organs.

Background: Forensic anthropology relies on skeletal analysis to establish a biological profile in medicolegal cases, including age and sex estimation. While the skull and pelvis are considered the most reliable indicators, they are not always available due to fragmentation or postmortem changes. The sternum, being centrally located and relatively resistant to damage, offers an alternative skeletal element for forensic identification.

Methods: A cross-sectional descriptive-analytical study was conducted using 200 thoracic CT scans from Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. The samples consisted of 100 males and 100 females, distributed across four age categories. Morphometric parameters measured included Manubrium Length (ML), Manubrium Width (MW), Corpus Length (CL), Manubriocorpus Length (MCL), Corpus Width 1 (CW1), Corpus Width 2 (CW2), and the Sternal Index (SI). Statistical analyses were performed using the Kruskal-Wallis and Mann-Whitney U tests, followed by multivariate modeling to assess age- and sex-related differences.

Results: Significant sexual dimorphism was observed, with males showing larger sternum dimensions compared to females, except for SI, which was higher in females. Age-related changes were evident, with sternal dimensions increasing until early adulthood before plateauing. Minimal ethnic variation was found, with notable differences limited to CL among young adult Toraja males.

Conclusion: Three-dimensional CT-based sternal morphometry provides reliable markers for age and sex estimation, supporting its role as a complementary tool in forensic anthropology, particularly when traditional skeletal elements are unavailable.

Background: Forensic examination of child victims of sexual abuse mainly prioritizes the identification and documentation of physical findings for legal purposes. As a result, psychosocial problems may remain underrecognized during the initial assessment. A brief and practical screening instrument is therefore needed to support early detection in clinical forensic services. To assess the agreement between Pediatric Symptom Checklist-17 (PSC-17) screening results and clinical psychological evaluation findings in child victims of sexual abuse.

Methods: This analytical observational study used a cross-sectional design and was conducted from April to September 2025 at a forensic referral hospital. A total of 101 child victims of sexual abuse aged 1−17 years underwent PSC-17 screening. Clinical psychological evaluation was subsequently completed for 51 respondents, depending on the referral pathway and service availability. Agreement between PSC-17 classification and clinical psychological evaluation was assessed using a 4 × 4 contingency matrix and Cohen’s kappa coefficient. The 95% confidence interval was estimated using bootstrap analysis with 1,000 replications.

Results: Of the 101 respondents, 39 children (38.6%) were classified as having severe psychosocial problems based on the PSC-17 classification applied in this study. Among the 51 respondents who underwent clinical psychosocial evaluation, 26 children (51.0%) were classified as having severe psychosocial problems. Classification accuracy was 86.27%, with a Cohen’s kappa of 0.778 (95% CI [0.606, 0.908], p < 0.001), indicating substantial agreement between PSC-17 screening and clinical psychological evaluation.

Conclusion: PSC-17 showed good agreement with clinical psychological evaluation in identifying psychosocial problems among child victims of sexual abuse. These findings support its potential use as an initial screening tool to facilitate early detection and psychosocial triage in clinical forensic settings.

Background: The vast Chinese synthetic drug market has given rise to numerous illicit drug production groups; empirical research on these groups remains limited.

Methods: In this study, the author collected data on 96 cases of illicit drug production from 2010 to 2020 through a website established by the Supreme Court of China.

Results: The findings revealed that the majority of these groups were located in Sichuan Province and Guangdong Province, both of which suffer from serious drug epidemics. Methamphetamine and ketamine were identified as the primary substances manufactured by these groups. Ephedrine and phenyl-2-propanone are commonly used as precursors in methamphetamine production, while hydroxyimide chloride is frequently utilized in the synthesis of ketamine.

Conclusion: To effectively combat such criminal activities, governments should enhance inter-regional cooperation to jointly address crimes related to drug production.

Background: In traumatic forensic cases, road accidents represent an essential percentage of morbidity and mortality. The majority of these are unintentional incidents that have the same manner of death.

Case Presentation: A 42-year-old man, was admitted to the regional hospital in Pazardzhik with symptoms of epigastric pain, vomiting, and weight loss. Following a physical examination, additional ultrasound tests, laboratory tests, and gastroscopy, which included a biopsy, the results indicated a malignant tumor in the stomach with the morphological characteristics of middle-grade adenocarcinoma. On the fourth day of the diagnostic and treatment process, the patient voluntarily left the hospital without notifying the medical staff.

Conclusion: Road traffic injuries are a significant cause of increasing mortality rates among young and middle-aged individuals globally.  While suicide is less common among traffic-related fatalities, both accidents and suicides can contribute to road traffic deaths. Suicides continue to be a significant cause of mortality and morbidity worldwide. Understanding the issues surrounding these cases, especially the rarer forms of suicide, is crucial for preventing this negative social phenomenon.

Background: α-Pyrrolidinovalerophenone is a potent synthetic cathinone, also known as “Flakka,” that has been associated with severe neuropsychiatric and cardiovascular toxicity. With its emergence worldwide, detailed analytical characterizations of high-purity α-PVP remain limited. In this study, the synthesis of α-PVP was performed under controlled laboratory conditions, followed by transformation to its hydrochloride salt and its further purification to an analytical-grade quality.

Methods: Confirmation of the chemical structure and purity was carried out by using Fourier-transform infrared spectroscopy (FTIR), proton nuclear magnetic resonance (¹H NMR), and mass spectrometry.

Results: The FTIR spectrum showed characteristic absorption bands at 3568–3478 cm⁻¹ (N–H stretching), 3091–2998 cm⁻¹ (C–H stretching), 1601 cm⁻¹ (aromatic C=C), and 1530 cm⁻¹ (C=O–N), confirming the pyrrolidinophenone framework. The ¹H NMR (400 MHz, CDCl₃) showed signals at δ 7.27–8.17 (m, Ar–H), 3.92 (t, N–CH₂), 2.57–2.74 (m, CH₂–N), 1.92–1.73 (m, CH₂), and 1.27–0.87 (t, CH₃), consistent with α-PVP. The base peak observed in the mass spectrum corresponded to m/z 126, for the pyrrolidine fragment. Analytical validation proved that purity was higher than 98%, with acceptable precision and linearity within forensic analytical limits.

Conclusion: The findings pointed out structural determinants, notably the β-keto and pyrrolidine groups of α-PVP underlying dopaminergic overstimulation and sympathomimetic toxicity, respectively. The present work provides an extended analytical and toxicological reference for forensic laboratories for the distinguishing of authentic α-PVP from street analogues and for standardization in synthetic cathinone identification.

Background: The Javanese and Chinese ethnic groups are the most predominant in Indonesia. Saliva presents a major advantage over serum as it may be obtained non-invasively by persons with minimal training. However, there are 13 CODIS loci; hence, it requires more resources and time. This research utilized an observational comparative study design.

Methods: The CODIS system has been validated as an identifying tool in forensics. CODIS was developed to compare target DNA records with those in the database, utilizing software for identification matching.

Results: Saliva from 12 participants aged 17 to 21 was divided into two groups: Javanese and Chinese. Each group comprises six members. The saliva was analyzed using Short Tandem Repeat (STR) and Polymerase Chain Reaction (PCR) at three loci: D13S317, D5S818, and D3S1358. In comparison to the standard DNA K562, variations in base pairs were observed in bands between the Javanese and Chinese races at three loci: D5S818: Javanese alleles are 10, 11, 12; Chinese alleles are 11, 12, 13. D13S317: Javanese 9, 11; Chinese 9, 12. D3S1358: Javanese 16, 17; Chinese 16, 17, 18 Utilizing the three loci from saliva, we can distinguish between the Javanese and Chinese races for forensic identification.

Conclusion: This research successfully demonstrated that the analysis of Short Tandem Repeat (STR) alleles at three loci (D5S818, D13S317, and D3S1358) can distinguish between the Javanese and Chinese populations in Indonesia using saliva samples. Significant differences in allele frequencies were found between the two populations at all three loci, making this method effective for ethnic forensic identification. In addition, the use of saliva as a non-invasive biological sample demonstrates practical advantages in the forensic context, allowing for easier and faster sample collection compared to invasive methods.

Background: The increasing incidence of decomposed body discoveries in Indonesia poses significant challenges in forensic investigations. Forensic entomology, particularly the identification of fly larvae, plays a critical role in estimating the post-mortem interval (PMI) and identifying potential body relocation. This research directly aligns with SDG 3 (Good Health and Well-Being), SDG 11 (Sustainable Cities and Communities), SDG 16 (Peace, Justice and Strong Institutions) through its contribution to mortality assessment and evidence-based forensic investigations.

Methods: This descriptive, observational, cross-sectional study was conducted on eight decomposed bodies examined at Sardjito Hospital and Bhayangkara POLDA DIY Hospital from July to December 2024. Larva samples were collected from specific anatomical sites and morphologically identified through posterior spiracle analysis.

Results: Out of a total of 334 larvae examined, four types of larvae were found: Chrysomya (63%), Sarcophaga (20%), Calliphora (13%), and Musca (4%). Chrysomya species were predominantly found on indoor corpses within optimal larval development temperatures (24.2°C–35.6°C). Morphological classification also identified distinct patterns in hairy and non-hairy larvae across the discovery environment.

Conclusion: Larval diversity aids post-mortem interval estimation and may indicate body relocation based on species and habitat. In eight examined cases, four larval types of Chrysomya predominated, with prior temperatures ranging from 25.2°C to 35.4°C.

Background: This study examines the concentration of touch DNA on various surfaces using analysis of the amelogenin locus to identify the donor’s gender. Touch DNA, which is transferred through contact, was collected from masks, iron door handles, plastic, and glass. DNA extraction and amplification were performed using PCR.

Methods: Touch DNA samples were collected from masks, iron door handles, plastic, and glass using sterile swabs after contact by male and female donors. DNA extraction was performed using the Chelex method, followed by PCR amplification targeting the amelogenin locus. DNA concentration was measured and compared across different surface types to evaluate variations in DNA transfer.

Results: The findings indicate that masks provided the highest DNA concentration, while plastic and glass had the lowest. Factors such as surface type, individual activity, and environmental conditions significantly influence DNA concentration. Additionally, male donors consistently left more DNA than female donors, consistent with previous studies. The study highlights the importance of surface roughness and porosity in DNA retention, with rougher surfaces generally retaining more DNA.

Conclusion: This research offers valuable insights for forensic investigators by demonstrating the utility of touch DNA in linking individuals to crime scenes. However, more extensive studies with larger sample sizes are needed to confirm these results and strengthen conclusions.

Background: Ammonia is toxic at high concentrations, and those who handle corpses should be cautious about the ammonia produced by decomposition. However, there is a dearth of reports showing an appropriate index for the ammonia level of corpses.

Methods: The progression of decomposition was divided into four stages based on easily visible changes in appearance, namely, skin discoloration and soft tissue destruction. Ammonia was quantified in the liquid decomposition products on the surface of the corpse and in the air surrounding it.

Results: During moderate to severe decomposition, ammonia concentrations rose to levels that could cause serious damage to the respiratory system and ocular mucosa due to chemical irritation. However, as decay progressed and bone became exposed, ammonia concentration decreased.

Conclusion: This study revealed that ammonia levels can be predicted from the visual stage of corpse decomposition. We believe that these results can guide the safe handling of bodies.

Background: Forensic odontology is essential for human identification when DNA or fingerprinting is compromised. Postmortem identification uses teeth because they resist environmental degradation and may remain intact under extreme conditions. While dental morphological traits are useful in forensics, population-level data are needed before using them in identification protocols. Mesial marginal developmental groove (MMDG) data in maxillary premolars in Malay are scarce. To determine the prevalence and sexual dimorphism of the MMDG in maxillary premolar one and two (PM1 and PM2) among Malay patients.

Methods: One hundred ninety plaster dental casts were retrieved from the Orthodontic Department. Standardised photographs of the occlusal surface of maxillary PM1 and PM2 were assessed for the presence or absence of MMDG. Descriptive statistics were employed to determine prevalence, and Chi-square tests were performed to evaluate sexual dimorphism.

Results: MMDG prevalence in PM1 was 90.5%–93.2% and 53.7%–57.4% in PM2, with bilateral symmetry observed across all tooth types. No significant sexual dimorphism was determined in the prevalence of MMDG for all tooth types.

Conclusion: The MMDG in maxillary premolars showed no sexual dimorphism in Malay people, limiting its use in forensics. However, its high prevalence and bilateral consistency make MMDG a stable morphological marker for dental identification and population studies.

Background: Wounds are associated with increased levels of inflammatory biomarkers. In forensic investigations, biomolecular analysis can help determine the age of a wound. This study aimed to estimate the levels of inflammatory biomarkers: chitinase 3-like 1 (CHI3L1), interleukin-4 (IL-4), and interleukin-13 (IL-13); and to correlate them with immunohistopathological effects.

Methods: Cutaneous incisional (IW) and lacerated (LW) wounds were induced in thirty-six male rats, with eighteen rats allocated to each group. Tissue samples were collected at 4 and 8 days post-injury for histopathological, immunohistochemical, and biomolecular examinations.

Results: IL-4, IL-13, and CHI3L1 demonstrated significant time-dependent upregulation, with expression levels rising four- to six-fold at days 4 and 8 post-injury (P<0.05). CHI3L1 showed a biphasic expression pattern, with peak expression on day 4. IW generally exhibited higher gene expression levels compared to LW.

Conclusion: The biphasic time-dependent expression patterns of CHI3L1 in cutaneous injuries could be useful for wound age estimation, supporting their future application in medical and forensic contexts through further human clinical validation.

Background: Children are especially vulnerable to potentially fatal injuries from illness or accidents. This study aims to examine the circumstances surrounding out-of-hospital cardiac arrest and to evaluate unsuccessful emergency rescue attempts.

Methods: This retrospective study reviewed records of patients under 18 years admitted to Iran University of Medical Sciences–affiliated hospitals from March 2013 to March 2024. The study included children who received emergency medical services and were transported during ongoing CPR.

Results: Among 134 cases, the mean age was 4.75 years and male-to-female ratio was 1.39:1. While 61.9% were Iranian, 38.1% were Afghans. Mortality was highest in infants under one year (35.1%) and in children aged 1–5 years (25.4%). The leading causes of death were underlying medical illnesses, followed by accidents, notably pedestrian collisions.

Conclusion: Cardiac arrest due to medical illnesses at home and pedestrian accidents account for a large share of unsuccessful pre-hospital resuscitations, most of which are preventable. Migrant children have a markedly higher mortality risk, likely due to socio-economic factors. These findings call for targeted injury prevention and policy reforms to address migrant populations and reduce the public health burden.

Background: Persistent high-risk human papillomavirus (HR-HPV) infection is necessary for cervical carcinogenesis, yet most infections regress. Host microRNAs (miRNAs) that regulate cellular stress responses may help discriminate persistent from transient infection. In this study, we evaluated cervical expression of miR-21, miR-155, and miR-9 in relation to oxidative stress, DNA damage, apoptosis, and inflammatory signaling in HR-HPV persistence.

Methods: Cervical samples from 60 women referred to private laboratories in Tehran, the capital of Iran (2023-2024), were classified as persistent HR-HPV (qPCR-positive at baseline and 9 months), transient HR-HPV (positive at baseline and subsequently cleared), or HPV-negative controls with normal cytology. HPV DNA was monitored seasonally by qPCR; E6/E7 mRNA was assessed using the Aptima assay. miR-21, miR-155, and miR-9 were quantified using stem-loop RT-qPCR with normalization to U6 snRNA; relative expression was calculated by ΔΔCt. Group comparisons were performed using t-tests/ANOVA with Bonferroni correction (p<0.05).

Results: miR-21 and miR-155 were significantly elevated in persistent infection versus transient infection and controls (p<0.01). E6/E7 mRNA was detected in all persistent cases. In the transient group, 13/17 (76.5%) were E6/E7 mRNA-negative, whereas 4/17 (23.5%) were mRNA-positive at any time point. miR-21 and miR-155 correlated with E6/E7 mRNA positivity (r=0.74 and r=0.71; p<0.01). Over 12 months, miR-21 and miR-155 increased progressively in persistent infections (both p < 0.01), whereas they remained largely stable in the transient and control groups. miR-9 showed greater intra-group variability, fluctuating without a consistent trajectory and being lower than controls at multiple time points (p<0.05). Low-grade cytological abnormalities (inflammation/CIN1) were more frequent in persistent infections (p<0.05), with no HSIL observed.

Conclusions: HR-HPV persistence is associated with sustained upregulation of miR-21 and miR-155 and a heterogeneous, often reduced miR-9 pattern. This profile is biologically consistent with HPV-related molecular toxicity, including impaired apoptotic checkpoints, pro-inflammatory signaling, and potential facilitation of oxidative DNA damage accumulation. These miRNAs warrant further validation as early biomarkers of persistence and as indicators of stress-pathway remodeling during HPV-driven cervical transformation.

Background: The middle cerebral fossa is accessible from several foramina in orbit. They are referred to as Warwick's foramen, orbito-meningeal foramen, and metopic canal in addition to superior orbital fissure, inferior orbital fissure, and optic canal. Anatomists, ophthalmologists, and maxillofacial surgeons might benefit from the morphometric assessment of orbital fissures in order to prevent damage to the neurovascular bundles that travel through these fissures. To study the dimensions and variations in shape of superior orbital fissure (SOF) and inferior orbital fissure (IOF).

Methods: The Department of Anatomy at the Akash Institute of Medical Sciences in Bangalore, Karnataka, India, carried out a cross-sectional study between February 2023 and March 2024. Sixty-six dry human skulls were measured for superior and inferior orbital fissure diameters using a needle divider and manual Vernier callipers. The SOF and IOF morphologies were examined and categorized into various kinds for every orbit. The length and width of the SOF and IOF were among the parameters assessed bilaterally. Nine distinct morphological kinds of SOF and six morphological types of IOF were identified. Applications included descriptive statistics and the Pearson correlation coefficient.

Results: The most prevalent SOF shape in the current present study was Type VI. The most common IOF shapes were Type I-right and Type II bilaterally, which appeared in 19 orbits out of 66 skulls (28.8%), with 30 orbits on the left (45.5%) and 27 orbits on the right (40.9%).The mean length of SOF was 13.80 mm on the right side and 13.91 mm on the left side. The mean breadth of SOF was 5.90 mm on the right side and 5.84 mm on the left side. The mean length of IOF was 22.21 mm on the right side and 20.98 mm on the left side. The mean breadth of IOF was 6.31 mm on the right side and 6.18 mm on the left side.

Conclusion: The morphometry of orbital fissures would facilitate a smooth surgical approach and the design of eye protective equipment.

Background: A serious public health issue in Iraq is diabetes mellitus (DM), which is becoming more common due to demographic and lifestyle factors. The purpose of this research is to examine the association between smoking behaviors, body mass index (BMI), and age in Iraqi patients with diabetes mellitus.

Methods: A cross-sectional study was conducted at the National Diabetes Center, Al-Mustansiriya University, between September and December 2016. A total of 300 diabetic patients aged 30–84 years were enrolled and classified into five groups based on age and gender. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), body mass index (BMI), and daily cigarette consumption were measured.

Results: Among patients aged 50–59, males had the highest mean FBG (462.0 ± 96.3 mg/dl) and BMI (35.7 ± 29.4 kg/m²). Across all age groups, female patients' BMI remained elevated, and patients aged 50–69 years had the highest HbA1c readings. Male and female patients showed the most significant positive relationships between FBG and HbA1c (r = 0.631 in Group E). There was little correlation between smoking and FBG, except for a moderately positive correlation in middle-aged women, and a weak and erratic correlation between BMI and FBG.

Conclusion: In Iraqi diabetic patients, age and BMI have a significant impact on glycemic control, especially in middle-aged people. Poor glycemic control is more consistently associated with BMI in female patients. In some subgroups, smoking may exacerbate glycemic indices, although its impact seems to be limited. It is advised to implement focused weight-control and smoking cessation strategies to improve diabetes outcomes.

Background: Brain tumors are among the most critical neurological disorders affecting individuals worldwide and are associated with increasing mortality rates. Early and precise tumor classification is essential for effective clinical diagnosis, treatment planning, and patient management.

Methods: This study proposes an advanced deep learning-based framework for brain tumor classification using a multi-branch, multi-scale attention network. The proposed architecture extracts significant spatial and contextual features from magnetic resonance imaging (MRI) scans. An optimization-based feature selection technique is incorporated to identify the most relevant features, thereby reducing computational complexity and enhancing classification efficiency. The selected features are subsequently processed through a classification model to identify various categories of brain tumors accurately.

Results: The proposed method was evaluated using publicly available brain tumor MRI datasets. Experimental results demonstrated improved classification accuracy, robustness, and interpretability when compared with conventional deep learning approaches.

Conclusion: The developed framework provides an efficient and reliable automated system for brain tumor diagnosis and has strong potential to support medical professionals in clinical decision-making and early disease detection.

Background: Since type-2 diabetes mellitus (T2DM) is becoming more common, it is crucial to implement an appropriate care plan for these patients' hyperglycemia to lower the risk of complications. While Sliding Scale Insulin (SSI) has been the traditional approach, Basal-bolus insulin (BBI) therapy is a promising strategy and is increasingly recommended. We aimed to compare the efficacy of SSI versus BBI regimens in hospitalized patients with T2DM.

Methods: The demographics, complications, and type of insulin therapy for type 2 diabetic hospitalized patients were recorded from patients’ archived documents.

Results: We observed that 59.7% of the patients were treated for SSI accompanied by macrovascular complications. While 37.8% of patients treated with BBI had macrovascular complications, the difference between the BBI & SSI groups was statistically significant. For microvascular complications, also, a statistically significant difference was detected between the BBI & SSI groups (P-value = 0.001). Only 18.6% & 17.2% of the patients developed hypoglycemia in the BBI group & SSI group, respectively. We evaluated the efficacy of both treatments on daily random blood glucose (RBG) in our patients for 1 week; a slight decrease in RBG was observed between the first & the seventh days of treatment in the SSI group. An obvious improvement was observed in the BBI, indicating that BBI was more effective at controlling RBG than SSI.

Conclusion: Our study demonstrated that BBI therapy was superior to SSI therapy in achieving ideal blood glucose levels, with fewer hypoglycemic episodes and cardiovascular events.

Background: Lung cancer remains a leading cause of mortality worldwide, and computed tomography (CT) imaging plays a vital role in its diagnosis, follow-up, and medico-legal evaluation. However, manual interpretation of CT images is time-consuming and often affected by inter-observer variability, particularly in resource-limited settings.

Methods: This study proposes a region-oriented CT lung image analysis framework that integrates Fuzzy Possibilistic C-Means (FPCM) segmentation with a multi-level neural network classifier. After preprocessing, CT images are segmented to delineate lung parenchyma, nodules, and surrounding tissues. Intensity, texture, and shape-based features are then extracted, and a hierarchical neural network is employed to progressively classify lung regions, abnormalities, and suspicious cancer-related patterns.

Results: Experimental evaluation demonstrates that the proposed framework outperforms conventional clustering techniques and single-level classifiers. Improved performance is observed in terms of accuracy, sensitivity, specificity, and Dice similarity coefficient, along with a reduction in false positive detections across diverse CT lung images.

Conclusion: The proposed automated framework provides an accurate and cost-effective solution for CT lung image analysis. Its robustness and interpretability make it suitable for clinical diagnosis as well as medical toxicology and forensic applications, including deployment in resource-constrained environments.

Background: Microplastics (MPs) have emerged as pervasive contaminants in the global food supply chain, raising growing concerns about their potential toxicological effects on ecosystems and human health.

Methods: The present study is a cross-sectional bibliometric and science-mapping study of Scopus-indexed publications from 2000 to 2025. Using VOSviewer and Bibliometrix (RStudio), we mapped the scientific landscape of this field, highlighting a marked increase in research output and identifying the leading contributors by authorship, country, and collaboration patterns.

Results: Keyword co-occurrence analysis identifies seven dominant research themes spanning marine pollution pathways, toxicological mechanisms, human exposure risks, environmental fate, polymer-specific impacts, interactions with co-contaminants, and ecological effects on the early life stages of aquatic organisms.

Conclusion: Temporal evolution analysis highlights a shift from environmental distribution studies toward mechanistic toxicology and human health risk assessment. Despite rapid advances, critical research gaps remain in standardized analytical protocols, long-term exposure effects, and combined-contaminant toxicity. This integrative study offers a strategic overview of scientific progress, identifies knowledge frontiers, and provides guidance for future interdisciplinary research and evidence-based policy development to mitigate microplastic contamination in food systems.

Background: Pregabalin (PGB) misuse represents a growing public health concern in Algeria, where routine urinary immunoassay screening is limited by elevated cut-off values (≥ 500 µg/L) and cross-reactivity with structurally related compounds, notably gabapentin. This study aimed to develop and validate a simple, low-cost thin-layer chromatography (TLC) method for the qualitative detection of pregabalin in human urine.

Methods: Urine samples were acidified, extracted with ethyl acetate, and spotted onto silica gel plates. Development used a methanol–ammonia mobile phase (98.5:1.5, v/v), and detection was achieved by spraying with ninhydrin reagent followed by heating at 60°C, yielding a characteristic violet spot at Rf = 0.56.

Results: The method demonstrated excellent selectivity (6/6 blank matrices), full specificity against a panel of 30 drugs and substances of abuse, a limit of detection (LOD) of 100 µg/L, and urine stability at −20°C for seven days. Applied to 87 clinical samples, TLC identified 10 false-negative immunoassay results and resolved 7 gabapentin-related false-positive cases, confirming its diagnostic value in resource-limited toxicology settings.

Conclusion: This validated, chloroform-free TLC method provides a cost-effective, selective, and highly sensitive alternative for urinary pregabalin screening, making it an ideal tool for resource-limited toxicology laboratories.

Background: Estimating the postmortem submersion interval (PMSI) is a persistent challenge in the forensic examination of bodies recovered from water. Established approaches like diatom analysis, aquatic entomology, and gross decomposition staging to lose reliability once remains are skeletonized or when seasonal and environmental conditions limit insect and algal evidence. The microbial “necrobiome” provides a complementary line of evidence: during decomposition, microbial communities undergo a time-ordered, reproducible sequence of changes.

Methods: We hypothesize that a decomposing body submerged in freshwater alters the microbial communities associated with the biofilms of nearby aquatic macrophytes, notably water hyacinth (Eichhornia crassipes), in a time-dependent manner usable for PMSI estimation. We outline a controlled mesocosm framework that compares three macrophytes, utilising destructive sampling across a 28-day interval, 16S rRNA amplicon sequencing, and supervised machine-learning models. These models are validated by a leave-one-tank-out strategy and an independent run.

Results: No data have yet been collected; this communication presents the hypothesis, rationale, and study design. If supported, plant-associated microbiomes could provide an independent PMSI estimator for tropical freshwater settings, a context currently absent from the necrobiome literature.

Conclusion: This study presents a hypothesis-driven framework for PMSI estimation based on microbial succession associated with aquatic macrophytes. Experimental validation may establish this approach as a complementary forensic tool for aquatic death investigations in tropical freshwater ecosystems.

Background:  Illicit substance use imposes a substantial global health burden, extending beyond well-characterised neuropsychiatric and cardiovascular sequelae to encompass clinically significant dermatological pathology. This review aims to systematically evaluate and classify the spectrum of dermatological disorders associated with major classes of illicit drugs, specifically opioids, stimulants, cannabinoids, and novel psychoactive substances (NPS).

Methods: A PRISMA-guided systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted. Observational studies and relevant case reports were included. Data on drug class, dermatological condition, pathophysiology, and prevalence were extracted.

Results: Of 2,847 identified records, 184 studies met the inclusion criteria. Distinct patterns emerged: Opioids were primarily linked to injection-related complications and pruritus; Stimulants were strongly associated with psychocutaneous disorders and vasculopathies; Cannabis showed milder, often allergic manifestations, with severe reactions linked to synthetic cannabinoids; NPS presented with emerging patterns of severe excoriation and rash. Indirect effects from malnutrition and associated infections were prevalent across all user groups.

Conclusion: Illicit drug use precipitates a wide range of direct and indirect cutaneous pathologies, often severe and substance-specific. The skin serves as a critical diagnostic indicator and a significant source of morbidity. In tegrated dermatological screening and management within addiction treatment frameworks are urgently needed to improve holistic care outcomes.

Background: Internet addiction (IA) and its subtypes such as problematic use of social media, online gaming addiction, online pornography addiction, and smartphone addiction are increasingly recognized as behavioral disorders with significant psychosocial consequences. Early maladaptive schemas (EMSs), pervasive cognitive and emotional patterns formed in childhood, are thought to be the basis of vulnerability to these addictions. This review was conducted to systematically investigate the relationship between EMSs and various types of IA according to the PRISMA guidelines.

Methods: A comprehensive literature search was conducted using Scopus, Web of Science, and PubMed. The inclusion criteria were peer-reviewed quantitative and meta-analyzed studies in English that examined EMSs and any form of IA. Data extraction and study selection were performed according to the PRISMA standards.

Results: Nine studies met the inclusion criteria including cross-sectional (6 studies), causal- comparative (one study), review (one study) and meta-analytic (one study) designs, covering general IA, problematic use of social media, online gaming addiction, online pornography addiction, and smartphone addiction. Disconnection/rejection, impaired autonomy/performance, and impaired limits were the most consistently implicated EMS domains in the study.

Conclusion: EMSs are strongly associated with multiple forms of IA. Schema-focused interventions may be beneficial for prevention and treatment.

Background: Paraquat is a widely used, inexpensive contact herbicide that can cause fulminant multi-organ failure and death after ingestion, and no specific antidote is available. Extracorporeal membrane oxygenation (ECMO) has been used sporadically as rescue therapy in patients with severe paraquat intoxication, but its impact on clinical outcomes remains uncertain. This study systematically reviews the existing evidence on ECMO use in paraquat poisoning.

Methods: We searched Web of Science, PubMed, Scopus, Embase, the Cochrane Library, and Google Scholar from database inception to 1 November 2023 for human studies reporting paraquat-poisoned patients treated with ECMO. Eligible designs included case reports and case series. Two reviewers independently screened records, extracted data, and assessed methodological quality using the Joanna Briggs Institute critical appraisal tools. Quantitative synthesis was descriptive, comparing survivors and non-survivors.

Results: After removal of duplicates, 21 records were screened, and 14 full-text articles were assessed for eligibility. Nine studies published between 1985 and 2023, comprising 15 ECMO-treated patients, were included. The mean age was 27.3 ± 12.4 years. Survivors started ECMO later after paraquat ingestion than non-survivors (32.6 ± 8.8 vs 7.7 ± 8.4 days, P < 0.001). Survivors also had a longer hospital stay (78.5 ± 2.1 vs 21.8 ± 33.1 days, P = 0.049). In contrast, ECMO duration, indication for ECMO, concomitant extracorporeal therapies, and ECMO configuration (veno-venous vs. veno-arterial) were not significantly associated with survival. Most survivors underwent bilateral lung transplantation during or after ECMO support.

Conclusion: The limited evidence suggests that ECMO may have a role, often alongside lung transplantation, in selected patients with paraquat poisoning. Larger registries and observational studies are needed to clarify patient selection, timing, and outcomes of ECMO in this setting.

Background: Food addiction (FA) is a multifaceted behavioral disorder involving an uncontrollable craving for high-calorie, palatable foods. FA plays an important role in threatening public health. The purpose of this literature review is to systematically examine the multifaceted nature of FA by elucidating the neurobiological, psychological, and environmental factors involved.

Methods: This literature review adhered to PRISMA guidelines and searched international databases, including PubMed, Scopus, ScienceDirect, IranDoc, Civilica, and SID, from 2014 to July 2025. Fourteen high-quality studies that met the inclusion criteria were identified using relevant keywords.

Results: Three main drivers of key pathophysiological mechanisms in FA have been identified: hormonal dysregulation, impaired inhibitory control, and reward system dysregulation. Two emerging research areas have also been identified: genetic and epigenetic factors and dysregulation of the gut-brain axis. Factors influencing the development of FA include individual, sociocultural, neurobiological, and cognitive factors.

Conclusion: Managing FA requires an interdisciplinary approach targeting its behavioral and biological components. Effective prevention is a public health imperative that depends on a three-pronged strategy of public education, improved food policies, and healthier environments. This integrated approach, which spans subject treatment and population-level intervention, is essential to mitigating the incidence and societal burden of the disorder.

Background: Zinc is an essential trace element for humans, although its excessive and prolonged ingestion or inhalation can cause harmful health problems.

Case Presentation: We report the clinical case of a 25-year-old male patient from Yambrasbamba, Amazonas, Peru, who carried out agricultural and livestock activities in an area adjacent to a zinc oxide mining project closed in 2007 and 2008. The patient was admitted to the Lambayeque Regional Hospital with initial symptoms of decreased muscle strength, low back pain, nausea and vomiting, vesicular skin rash and polydipsia. Supporting tests revealed a notable increase in transaminases and total creatine phosphokinase and abdominal radiological image with multiple metallic calcifications along the colon. The history of consuming spring water with unusual organoleptic characteristics suggested environmental exposure to heavy metals. Analysis confirmed the diagnosis of chronic zinc poisoning. Compared with poisonings by other metals, such as mercury, zinc showed distinctive cutaneous symptoms and a favourable response to supportive measures.

Conclusion: This case underlines the importance of considering environmental exposures in the differential diagnosis of patients with non-specific symptoms and highlights the need to raise awareness of the risks associated with zinc and other heavy metal poisoning in rural settings.

intersection of public health and forensic science. Many students face intense academic pressure, emotional burden, and social instability, all of which can contribute to suicidal thoughts and actions. One particularly troubling aspect is the “copycat” phenomenon, where exposure to another person’s suicide, whether through media, social networks, or personal connections. Those all can lead to imitative behavior, especially among young people. Although this effect is recognized worldwide, there is a lack of detailed forensic documentation in Southeast Asia.

Case Presentation: This report examines the case of a 20-year-old female undergraduate who died after a fail. The external examination revealed multiple healed scars on her forearm, indicating a history of self-harm, and severe head injuries consistent with a high-impact fall. Friends reported that she had recently sent messages that sounded like farewells, and there were rumors of a previous suicide at a nearby institution. The presence of similar stressors, a history of self-harm, and contextual similarities suggest that the possibility of a copycat effect should not be overlooked, even if a direct link cannot be confirmed.

Conclusion: This case highlights the urgent need for thorough forensic investigations and stronger mental health support systems on university campuses. Preventing suicide contagion among students requires not only careful documentation but also responsible media reporting and targeted interventions for those at risk. By addressing these factors, we can work towards reducing the spread of suicide and protecting vulnerable students.

Background and Aim: Bupropion, a monocyclic phenylethylamine antidepressant, is the only FDA-approved synthetic cathinone, commonly prescribed as monotherapy or adjunctive therapy for major depressive disorder, seasonal affective disorder, and smoking cessation.

Case Presentation: Although traditionally considered non-serotonergic, bupropion overdose has been associated with serotonin syndrome (SS), particularly when combined with other serotonergic agents like fluoxetine. Bupropion overdose may cause tachycardia, QRS widening, and QTc prolongation, but these effects are usually transient and resolve within a few days. Co-ingestion with other drugs can worsen toxicity. Sodium bicarbonate shows inconsistent benefit, and while most patients recover fully, severe cases can occasionally result in fatal arrhythmias. The management of bupropion toxicity encompasses administration of activated charcoal for recent ingestion, stabilization of cardiovascular and neurological function, and continuous cardiac monitoring due to the potential for arrhythmias and QT interval prolongation. Sodium bicarbonate may be considered in cases of QRS complex widening despite lack of evidence. Benzodiazepines represent the primary therapy for seizure activity and agitation. Supportive care measures—including intravenous fluid administration, correction of electrolyte imbalances, and temperature regulation—are crucial, especially in addressing delayed complications associated with extended-release bupropion formulations. This case describes a young woman with depression who overdosed on bupropion while taking fluoxetine. She developed recurrent seizures, QT prolongation, ventricular tachycardia, and cardiovascular collapse, ultimately requiring ECMO. Extubation failed on day four, and she died on day seven.

Conclusion: The case underscores the risk of severe complications from bupropion-fluoxetine toxicity, stressing the importance of close monitoring and prompt intervention.

Background: Suicide ranks as the primary cause of mortality among Indian individuals between 15 and 34 years old. The investigation of crime scenes is essential to distinguish between suicide and homicide cases. People who suffer cut-throat injuries are more likely to have been murdered than to have killed themselves. Suicidal incised wounds most commonly appear in the anterior neck area next to the laryngo-tracheal region and often show signs of hesitational cuts.

Case Presentation: The victim, a 25-year-old male, average build, used a razor blade to create an incised wound in his laryngo-tracheal region before ending his life through hanging. The deceased committed suicide in his parents' house by using a bedsheet as a soft ligature that was attached to a ceiling fan with the help of a chair. Fatal asphyxia resulted from neck constriction and soft tissue trauma due to the specific length and placement of the ligature. The knot of the ligature was located at the sub-occipitomastoid area on his neck. The investigation of this unique case focuses on understanding how neck trauma played a role in causing death.

Conclusion: This research presents an atypical suicide case involving self-inflicted damage to the laryngo-tracheal area combined with a ligature knot positioned at the sub-occipitomastoid region. Forensic experts conducted an extensive examination that involved analyzing the crime scene structure, body placement, and blood splatter patterns to establish the manner of death. No defensive injuries combined with hesitation marks and knot placement, along with bloodstains on fingertips and seminal discharge, indicated suicide as the cause of death. The case demonstrates how autopsy results combined with detailed scene examination are essential to differentiate between suicide and homicide in difficult cases.

Background: Stevens–Johnson Syndrome (SJS) is a rare but potentially life-threatening mucocutaneous hypersensitivity reaction, most commonly induced by drugs. Fluconazole, an antifungal agent widely used to treat candidiasis, is infrequently associated with SJS.

Case Presentation: We report a case of a 37-year-old male with Type 2 Diabetes Mellitus admitted with multiple oral ulcers, erythematous genital lesions, and excoriation of skin over hands and feet. He had been diagnosed with oral candidiasis and candidal balanitis five days earlier and was on oral Fluconazole 150 mg daily. On admission, the dose was escalated to 200 mg intravenously and subsequently to 250 mg. Within three days, the patient developed crusted erosions over the lips and buccal mucosa, with erythematous erosions over the genitalia, suggestive of SJS. Fluconazole was immediately withdrawn, and systemic corticosteroid therapy was initiated along with supportive care. The patient showed gradual improvement with re-epithelialization and complete recovery over one week.

Conclusion: This case highlights the rare occurrence of Fluconazole-induced SJS and underscores the importance of early recognition, prompt withdrawal of the offending drug, and multidisciplinary management to prevent morbidity.

Background: Helium is an inert gas without inherent toxic properties, which explains its widespread use in both industrial and medical settings. However, despite its chemical inertness, inhalation of helium can cause severe oxygen displacement within the respiratory system, leading to tissue hypoxia and potentially fatal outcomes.

Case Presentation: Cases of helium intoxication pose particular clinical and forensic difficulties because toxicological examinations may not always produce positive findings. Death associated with helium exposure is primarily caused by hypoxia resulting from the mechanical replacement of oxygen during breathing.

Conclusion: Due to the largely non-specific morphological findings observed at autopsy, establishing the cause and manner of death requires a multidisciplinary approach that integrates scene investigation, forensic pathology, toxicology, and criminalistic analysis.

Background: Organophosphate poisoning is a major public health issue in many low and middle-income countries. Paraquat, a widely used herbicide, can often cause severe, usually fatal poisoning in humans. Dual poisoning involving both organophosphates and paraquat is rare.

Case Presentation: A 17-year-old male who ingested both substances was admitted to the emergency department intensive care unit. He was treated with four sessions of hemoperfusion, along with intravenous atropine and pralidoxime. After the fourth hemoperfusion, the patient developed respiratory distress due to acute cholinergic syndrome secondary to organophosphate poisoning, requiring endotracheal intubation. By day five, his clinical condition improved, and he was extubated. Six hours after extubation, he developed sudden respiratory distress and was re-intubated with a 7.5 mm endotracheal tube and connected to a mechanical ventilator. The patient was diagnosed with intermediate syndrome secondary to organophosphate poisoning, and atropine infusion was restarted. By day seven, his condition improved and he was successfully weaned off ventilation. He was discharged hemodynamically stable on day 10.

Conclusion: This mixed organophosphate-paraquat poisoning case was clinically complex and challenging. Management involved a combination of mechanical ventilation and hemoperfusion, which had to be carefully titrated. Further studies are needed to improve treatment protocols and outcomes for mixed poisoning cases.

Background: Road traffic accidents (RTAs) are a serious social problem, both for individuals and their families, and have their own importance for the protection of public health.

Case Presentation: In the interest of such fatality and morbidity, we present a case of a fatal road traffic accident of a man struck by a stray dog hit by a vehicle at high speed. Even in the field of Forensic Medicine, such cases are an increased level of expert difficulty; that’s why for correct interpretation of the manner of crime and mechanism of injuries, systematic and complex detailed analysis must be performed, including crime scene examination, evidence analysis, rich autopsy assessment, and additional video surveillance analysis.

Conclusion: Recent case report shows that a systematic approach remains essential for increasing road safety and protecting vulnerable road users.

Background: Drowning remains a significant cause of unintentional mortality, requiring comprehensive forensic investigation to determine the mechanism and circumstances of death.

Case Presentation: This case report is about a 30-year-old person whose name is not known and who was found in a freshwater river. After that, they were examined on the outside, inside and in other ways. The external findings included fine, frothy fluid coming from the airways, livor mortis that made the skin look pale, rigor mortis of the upper extremities, signs of hypoxia, and maceration of the hands. An internal examination found the Nile sign, no structural problems with the major organs, and stomach contents that were consistent with recent eating. Ancillary tests showed a positive diatom test with Pennales diatoms found in over 10 fields, which supports the idea of freshwater drowning.

Conclusion: However, the lung fluid study had a chance of false positives because the body had been preserved for a long time. This case underscores the persistent necessity for comprehensive forensic evaluation encompassing diatom analysis, organ examination and contextual interpretation to ascertain drowning as the cause of death.