International Journal of Medical Toxicology and Forensic Medicine

Background: Considering the breadth of medical knowledge, it is very important to study medical students’ learning and ways to facilitate it. One of the key areas in learning is studying methods. This study aimed to determine the preferred learning style in medical students and the level of learning in a medical discipline (Toxicology) as well as its correlates.
Methods: Thirty-seven medical students who were admitted to an internship course, completed a questionnaire about their preferred learning style using the VARK (Visual, Auditory, Read/Write and Kinesthetic) method. Then, a standardized test was applied to measure the students’ score for each level of learning and the total score of learning.
Results: The study participants included 20 males and 17 females. The preferred style of learning was mostly (32%) aural. Thirteen (35%) students preferred single-style of learning, and 24 (65%) preferred more than one style. No significant relationship was found between the learning style and the score on each learning level. No significant relationship was found between the preferred learning style and the total score of the final test (P>0.05). There was also no significant difference between persons with regard to single style and multiple styles of learning (P=0.46). The scores of theoretical knowledge was higher than the practical knowledge in all styles and among those with a multiple style of learning.
Conclusion: Learning style is just one of the effective factors in medical education and it has no significant relationship with the level of learning. The current training method in some areas (toxicology training) for medical students, is more successful in transferring knowledge than skills to apply that knowledge.

Background: Lead is a heavy metal used in industries in developing countries. Lead exposure remains a widespread problem. Lead may induce molecular damage in the kidney as a consequence of Reactive Oxygen Species (ROS) formation, induction of caspase-3, and apoptosis.
Methods: Thirty male Wistar rats (Mean±SD weight: 300±20 g) were randomly divided into 3 equal groups: control (normal saline, oral), lead group (lead 100 mg/kg/d, oral) and lead+L-Carnitine (lead 100 mg/kg+L-Carnitine 200 mg/kg, intraperitoneal injection) for one week. At the end of the experiment, plasma creatine kinase activity, plasma creatinine and urea concentrations and plasma Superoxide Dismutase (SOD), Glutathione Peroxidase (GPx), catalase and nitric oxide levels were determined. Glutathione and malondialdehyde levels in renal tissue were also measured.
Results: Creatine kinase, creatinine and urea levels increased significantly, in the group treated with lead (P<0.05), compared to the control group. Administration of L-Carnitine in (Lead+carnitine treated group) significantly (P<0.05) decreased creatine kinase activity and plasma urea and creatinine contents. Enzymatic activity (SOD, GPx, and CAT) decreased significantly in the lead group, in comparison with the control group (P<0.05). Treatment with L-Carnitine significantly retrieved the depletion in enzyme activity (P<0.05). However, there were no significant differences in the GPx parameter between the Lead+carnitine group, in comparison with the control group.
Conclusion: L-Carnitine administration in rats with lead-induced nephropathy led to improved kidney protection, due to the reduction of Lipid Peroxidation (LPO). Furthermore, L-Carnitine prevents the adverse effects of Reactive Oxygen Species (ROS), which is an important biomolecules mechanism.

Background: The effect of low pressure pneumoperitoneum in laparoscopic cholecystectomy on partial pressure of carbon dioxide in the arterial blood (PaCO2) is an important subject which has not been completely defined.
Methods: In a double-blind clinical trial, we randomly studied 202 ASA (The ASA physical status classification system) class 1, 2 patients aged between 20 and 85 years who were candidates for elective laparoscopic cholecystectomy. They were randomly divided into two groups of low pressure pneumoperitoneum (6-8 mm Hg) and standard pressure pneumoperitoneum (12-14 mm Hg). By the same general anesthesia protocol in the two groups, PaCO2 was assessed before CO2 insufflation and desufflation. Mean Arterial blood Pressure (MAP) was measured in the two groups.
Results: PaCO2 was not significantly different between the 2 groups before CO2 insufflation. But, PaCO2 was statistically lower in low pressure pneumoperitoneum group before CO2 desufflation (P= 0.001). Mean Arterial Pressure (MAP) in standard pressure pneumoperitoneum group was lower than the low pressure pneumoperitoneum group at 5 and 10 minutes after CO2 insufflation and before the time of CO2 desufflation (P=0.001, P=0.006 and P=0.001, respectively). While, MAP was not statistically different between the two groups before CO2 insufflation (P=0.55).
Conclusion: Low pressure pneumoperitoneum during laparoscopic cholecystectomy can be an effective protocol to prevent the rise of PaCO2 by preserving the hemodynamic status in such cases.

Background: Rate of tramadol poisoning and seizure and its complications is high in Iran. We investigated the occurrence and recurrence of tramadol-induced seizures and related factors in patients with tramadol poisoning.
Methods: This was a descriptive longitudinal study conducted in a poisoning referral hospital in Tehran, Iran. During April to June 2017, adult patients (≥16 years) with tramadol ingestion and poisoning admitted to hospital were selected by convenience sampling method. We studied the rate of seizure occurrence and recurrence among them. Also, the association between seizure occurrence and recurrence and patients’ demographic characteristics and poisoning-related factors were investigated. Data were analyzed by SPSS 16 and significant level was set at <0.05.
Results: In total, 250 patients participated in the study. Their mean age was 26.39 years and 214 (85.6%) of them were male. Of all, 159 (63.6%) were single, 106 (42.4%) were unemployed and 24 (9.6%) were students. Main reason of tramadol consumption was suicide. Co-administration of drugs was reported in 83 (33.2%) cases. Incidence of seizure occurrence and recurrence were 31% and 38.5%, respectively. There was no statistically significant relationship between the occurrence and recurrence of seizures and patients’ age, gender, marital status, occupation, reason for tramadol consumption, co-administration of drugs and naloxone administration. Probability of seizure occurrence and recurrence raised with increased tramadol dose (P<0.001 and P<0.01, respectively). Seizure recurrence led to longer hospital stay (P<0.001).
Conclusion: Rate of the occurrence and recurrence of tramadol-induced seizure seems clinically significant, but the prognosis is generally good in cases with seizure. Greater ingested dose and late hospital admission were associated with higher probability of seizure occurrence and recurrence. Further studies are required to investigate the risk factors of tramadol-induced seizure.

Background: In addition to odor perception, the nose also plays an important role in breathing and speech. In Iran, 70% of plastic surgeries is performed on the nose.
Methods: In the present study, all patients underwent rhinoplasty during 5 years from April 2012 to March 2017 and were evaluated using a census method. A researcher-made questionnaire including the following variables were used: age, gender, level of education, season of performing the operation, length of hospitalization, occupational status, type of surgery, surgical procedure, and type of repair surgery. The obtained data were analyzed by SPSS.
Results: A total of 106 individuals, with the mean age of 27.37 years were enrolled into the study. Most of the rhinoplasty surgeries were performed in summer and the lowest frequency was in spring. Most clients had a diploma, and in terms of occupational status, most subjects were students.
Conclusion: There was a significant relationship between gender, educational level, and type of surgery.

Background: Appendectomy is one of the most common abdominal operations. The prevalence of appendicitis increases with increased lymphatic tissue with the maximum prevalence at the beginning of adulthood. Owing to the high prevalence of appendectomy, patients will be benefited from a better method with improvement of surgical site and management of postoperative pain and infection. Subcuticular repair method due to better scar formation and less pain is preferred to the routine repair method, if the infection rate is comparable.
Methods: The current study was conducted on appendectomy candidates in 2017. After providing the necessary explanations, the interested patients signed the informed consent forms and voluntarily participated in the study. The subjects were randomly assigned into two groups of randomized clinical trial with parallel design and 1:1 ratio. The sample size was 120 individuals based on previous studies. Subjects were assigned into two groups of 105 subjects each: the first group as subcuticular and the second group as transdermal accordingly. Then, they were studied and followed up.
Results: One week after operation, 8.5% of subcuticular and 5.7% of transdermal repairs developed localized infection, and no significant difference was observed between the two groups. One week after surgery in the first group, 10% had no pain, 36% mild pain, 27% moderate pain, and 27% severe pain. In the second group, 7% had no pain, 36% mild pain, 30% moderate pain, and 27% severe pain. Therefore, there was no significant difference between two groups in this regard.
Conclusion: There was no significant difference in the surgical wound infection rate between two methods. Accordingly, subcuticular repair was suggested as the preferred method owing to its better scar formation.

Peganum harmala, is a plant of the family Nitrariaceae with small seeds, traditionally used to induce abortion and menstruation. It also has pharmacological properties such as lowering blood glucose, as well as analgesic, anti-cancer, antibacterial and antifungal effects. The current report presents a rare case of a middle-aged female referring to Clinical Toxicology Service with the history of drinking a glass of boiled Esfand seeds, in order to reduce blood sugar, and complaining of nausea, abdominal pain, general weakness, dizziness, and several vomiting episodes.