International Journal of Medical Toxicology and Forensic Medicine

Thallium (Tl) is a highly toxic heavy metal with atomic number 81. It is a soft, bluish-white or gray water-insoluble metal but the salt forms are colorless, tasteless, and odorless. Tl is readily absorbed via ingestion, inhalation, and dermal contact. Any amount of Tl in the body is abnormal. The clinical manifestation of thallotoxicosis has a wide spectrum but painful ascending peripheral neuropathy, gastrointestinal, and dermatologic manifestations are major characteristics in Tl toxicity. Tl intoxication has been identified in drug abuse and cigarette smoking leading to various signs and symptoms. Substance abuse and cigarette smoke are a major public health hazard across the world.

Background: Because opium is mixed with lead to increase its weight, the prevalence of lead poisoning is high among opium consumers. Hence, measurement of serum lead level in these people is important for the prevention or early treatment of lead poisoning. To evaluate the blood lead level in opium consumers.
Methods: In this cross-sectional and descriptive study, a total of 214 opium consumers with lead poisoning referred to Imam Reza Hospital in Mashhad, Iran, in 2016, were evaluated. Atomic absorption spectrophotometry (Covanta Energy, GB) was used to measure the lead level of the blood samples.
Results: The mean (SD) age of the participants was 43.11(18.14) year, also their average (SD) blood lead level was 139.5(48.5) µg/dL. No relationship was found between the blood lead level and age in the participants (P=0.11). The number of male participants was significantly higher than females in this study (92.5% vs. 7.5%). Also about 129(60.3%) participants consumed opium orally and 85(39.7%) ones used opium by inhalation.
Conclusion: The blood lead level is higher than the acceptable limit in opium addicts, and the risk of lead poisoning should be considered among them, especially in oral consumers.

Background: Nowadays, cholecystectomy is the most prevalent elective abdominal surgery in the U.S., with over 750000 operations performed every year. However, laparoscopic cholecystectomy has been reported with 1% to 8% of major complications, including hemorrhage, wound infection, bile ducts and gallbladder damage.
Methods: A total of 1970 medical records of patients undergone laparoscopically at Modarres Hospital between 2010 and 2017 were studied in this research. Of them 1185 were female (60.15%) and 785(39.85%) male. A total of 1003(50.9%) patients were presented with cholecystitis, 955(48.5%) with symptomatic cholelithiasis, and 12(0.6%) with polyp.
Results: Biliary tract injury was reported in 11 cases, complete cut off of Common Bile Duct (CBD) in 4(0.2%) cases (3 males and 1 female), partial CBD injuries in 3 cases (2 males and 1 female), complete closure of CBD in 1 female case, and partially closure of CBD by clips in 3(0.1%) cases (1 male and 2 female).
Conclusion: The laparoscopic method seems to be the ideal method of cholecystectomy, not just because of its cosmetic reasons, also due to its less invasive procedure.

Background: In Sri Lanka and South Asian countries, three-wheeler vehicles are a popular mode of transportation. However due to poor vehicle safety features and road conditions, this vehicle is more vulnerable to accidents. In this regard, we hypothesize that the occupants of three-wheelers sustain a different pattern of injuries compared to occupants of other vehicles, which cause a fatal outcome.
Methods: This was a retrospective study from 2005 to 2014. The study samples were occupants of three-wheelers succumbed from road traffic accidents reported to 3 medico-legal units in Sri Lanka.
Results: In our study, majority of the victims were young males. The commonest site of fatal injury was head (78.8%), which was more common in passengers. The commonest skull fracture was on base (70.5%). Majority had brain contusion (36.4%) and subarachnoid haemorrhage (31%) was the commonest type of intracranial haemorrhage. Chest injuries directly contributed to death in 57 cases while rib fractures were seen in all such cases. Spinal injuries were seen in 41(31%) cases where cervical spine injuries were the commonest which was seen in 30(73.2 %) cases. In the present study, 65.2% of deaths have taken place within the first hour following the incident. Out of all the fatal cases, 84.8% of the victims were trapped inside the vehicle and others (15.2%) were thrown away. Toppling of the three-wheeler was seen in 27.3% of cases.
Conclusion: The poor safety structure of the three-wheeler plays a major role in the type of injuries sustained by the deceased and the safety of the occupants should be improved.

Background: Sleeve gastrectomy is an effective procedure for weight loss. However, some serious complications may occur during this operation such as strictures, bleeding, and leak. According to previous studies, the rate of leak was 1.06%. Using endoscopic stents have been hampered by some drawbacks the most important of which is repeated migration. The current study aimed to discuss the prevalence and management of leak after laparoscopic sleeve gastrectomy operated at Modarres Hospital, Tehran, Iran.
Methods: This cross-sectional study was conducted on patients with morbid obesity undergone laparoscopic sleeve gastrectomy at Modarres Hospital, Tehran, Iran. In addition to the patients’ demographic data; their leak complications, first symptoms and signs, WBC count, and method of management were extracted and collected from their medical files.
Results: A total number of 1263 patients were enrolled in this study. Of them 8(0.63%) patients suffered from leak after the operation. The mean (SD) age of patients with leak was 32.33(6.02) year. The mean (SD) BMI of patients with leak was 45.75(2.07) kg/m2. The mean (SD) of WBC count of the patients with leak was 13680(7272.68). The symptoms of the patients began on different days (3-240 day). Management of the patients was different but most of the patients underwent endoscopic stent.
Conclusion: It seems that stent insertion is a useful method for treatment of leak after sleeve gastrectomy, especially in immediate leak.

Background: Head injury is one of the commonest causes of mortality in motorcycle accidents. This study aims to determine the pattern of injuries in fatal cases of pillion rider accidents, because few studies have been conducted on this topic.
Methods: A total of 34 cases of pillion rider fatalities in Pondicherry, India were included in the study.
Results: Scalp injuries and fractures were more commonly seen over the occipital (41% and 47%, respectively) and temporal region (21% and 38%, respectively) of the head especially in females, also slip and fall off motorcycle (38%) was the commonest mode of injury.
Conclusion: Slip and fall was significantly higher (92%) in females as the position adopted by female pillion riders was usually the side saddle position and the impact part of the head, in falls from this position, usually involves the occipital or temporal region of the head. To prevent the slip and fall off the bike, a safety belt/harness can be used to control the fall of the pillion rider seated in a side saddle position, and this could reduce the mortality and morbidity in pillion riders to some extent.

Adrenal hemorrhage during neonatal phase is more prevalent than was thought before and most of the cases are diagnosed after the autopsy. However massive hemorrhage is rare. The mozst important cause of adrenal hemorrhage is perinatal injuries, but large fetal size, maternal diabetes, congenital syphilis, anoxia, hemorrhagic diseases and immaturity are predisposing factors. Incidence rate of adrenal hemorrhage is 0.2% to 0.5% during perinatal phase. The diagnosis of the adrenal hemorrhage in this phase is rare. Our case was a four-day-old full term neonate who was born via normal vaginal delivery, with Apgar score 3. The baby was intubated immediately which was followed by seizure attacks and unfortunately death on the fourth day of life. The neonate was female with 3100 g weight. At autopsy the left kidney appeared larger than normal and the adrenal subcapsular hematoma which amounts to about 50 mL, was seen. According to previous studies delivery per vaginam, macrosomia and acidemia are some important risk factors for adrenal hemorrhage. Risk factors of the present case were normal vaginal delivery and acidemia. The neonate may present no symptom or sign during fetal or neonatal phase. So serial sonography is considered one of diagnostic methods.