ISSN: 2251-8762

Vol. 9 No. 4 (2019)

Review Article

Failures to Cure and Diagnose Cervical Cancer

Siamak Soltani, Azadeh Memarian, Maryam Ameri

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 175-180

Background: Cervical cancer is one of the most common cancers in developing countries and the second most common cancer in women worldwide. Using the screening test, cancer can be detected in the early stages and, thus, mortality will be reduced. Also, the early detection of cervical cancer could affect survival rate and time. But, the diagnostic and therapeutic methods of this disease are usually accompanied by errors that deduct the success rate.
Methods: In this study, a variety of common errors in the detection and treatment of cervical cancer were investigated by reviewing and evaluating scientific resources.
Results: Studies show the different medical failures during sampling, preparation, review, and interpretation of the sample. On the other hand, inappropriate operation and errors in the treatment pathway are common errors after diagnosis. Because of the types of these errors, preparing the information of papers investigating the possible types of errors and observing accuracy will play a significant role in reducing the failures.
Conclusion: Because of the fact that cervical cancer is fully curable with proper and timely diagnosis, the early diagnosis is important and it is the responsibility of doctors, pathologists, and surgeons in this area. Therefore, monitoring and preventing errors in the diagnosis and treatment is directly associated with a reduction in the mortality rate of the disease.

Reviewing the Status of Professional Commitment Principles in the Physician-Patient Communication Models

Shahriar Mousavinejad, Mehrzad Kiani, Shabnam Bazmi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 181-190

Much attention is paid to the importance of the relationship between patients and physicians and the ethical issues that have been considered from different perspectives. Moreover, different models have been developed to establish such a relationship. In one of the most advanced methods, Emanuel EJ categorized 4 paternalistic -informative-interpretive models that have been agreed upon by many medical professionals. Each model has its characteristics and in the relationship between a patient and a practitioner, and to some extent, the professional commitment values (professionalism). In other words, the observance of the values of professionalism in each of these models has been based on the definitions of these principles; each is of particular importance, and individual attention has been paid to these values in different models. The present work aimed to evaluate each communication model according to the values of medical resource planning. Analyzing and adapting these models in terms of professional ethics could finally lead to analyzing the comparative approaches to professional commitment values.

Original Article

Prognosis and Complications of Attempted Suicidal Hanging

Azadeh Memarian, Kamran Aghakhani, Babak Soltani, Siamak Soltani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 191-198

Background: Hanging is a form of strangulation, in which the body is suspended through the neck and the weight of the body acts as a constricting force. This study assessed various factors on the outcome of hanging and identification of prognostic factors related to the outcomes.
Methods: Ninety-nine hanging victims from 1995 to 2015 in Iran were evaluated; then, variables such as the cause of death, distribution of mortality, duration of hospitalization, substance abuse consumption, respiratory distress, and cerebral edema were studied in these people. Finally, the data were analyzed.
Results: Major cases of suicide by hanging were men. In connection with prognosis, about 12% of the deaths occurred in men and about 21% were represented in women. More importantly, in the matter of suspension, the model was largely incomplete to complete. Also, the outcomes of pulmonary stress and cerebral edema were recognized in association with the type of hanging and mortality prognosis.
Conclusion: Only two risk factors, including loss of consciousness at the time of entry into the medical center, as well as the complete suspension, would be predictive operations of death and unsuccessful revival.

Status of the Acute Respiratory Symptoms, Pulmonary Function Test, and Chest Radiograph Among Professional Firefighters of the Plasco Trade Center Disaster in Active Firefighting of Tehran, Iran in 2016

Khosrow Agin, Ali Mohammad Baigi, Bita Dadpour, Maryam Vahabzadeh, Babak Mostafazadeh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 199-204

Background: Firefighting is a high-risk occupation. The firefighters can be involved in acute and chronic diseases. The study was conducted to investigate the acute symptoms of pulmonary problems, chest radiography, and pulmonary function testing among the professional firefighters of Tehran Firefighting Stations in active firefighting of the Plasco trade center disaster.
Methods: A call was announced by the national Fars news agency to examine the firefighters in the Plasco trade center disaster.
Results: A total of 56 firefighters completed the study design. They were male, commonly at a young age, and less than their 3rd decade. Upper respiratory tract symptoms were at a higher frequency than a lower airway tract; 98% of the subjects complained of respiratory symptoms. Chest abnormality was 24% and normal acute short-term spirometry was 87%. Acute occupational bronchitis was a prominent respiratory disease.
Conclusion: Acute toxic inhalation respiratory diseases, including acute bronchitis, asthma-like disease, and laryngitis were found in our study. Medical monitoring is necessary for the detection of adverse health effects in the exposure, post-exposure, and long lifetime.

The Value of Foramen Magnum Diameters for Gender Identification Among Iranian Population

Siamak Soltani, Kamran Aghakhani, Hanieh Saboori-Shekofte, Sahar Rismantab-Sani, Forouzan Faress, Tayebe Khayamdar

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 205-212

Background: By assessing the size of the foramen magnum, it is possible to distinguish two genders, as well as the intergenerational interdependence of the affected individuals. The present study aimed at assessing the value of diameters of foramen magnum for gender identification among the Iranian population.
Methods: This analytical comparative cross-sectional study was performed on 200 Iranian cadavers (100 men and 100 women) referred to Kahrizak Autopsy Hall in Tehran between 2017 and 2018. In each case, the foramen magnum was measured by observation and its parameters were measured in a longitudinal anteroposterior and transverse diameter, using a calibrated caliper.
Results: The Mean±SD anterior-posterior diameter of the foramen magnum in men and women were 35.59±0.49 mm and 33.90±1.07 mm, respectively, which was significantly higher in men (P<0.001). Similarly, the Mean±SD transverse diameter of the foramen magnum in males and females was 29.49±0.56 mm and 28.5±0.50 mm, respectively, which was significantly higher in men (P<0.001). Based on the area analysis under the Receiver Operating Characteristic (ROC) curve, the anterior-posterior and transverse diameters of the foramen magnum had a high value in the differentiation of the male and female genders (AUC=0.953 and 0.896, respectively, P<0.001). The Mean±SD foramen magnum index in men and women was 84.15±3.02 and 82.87±1.95, respectively, which had a significant difference between the two genders.
Conclusion: Given that the anterior-posterior and transverse diameters of the foramen magnum in Iranian men are far more than Iranian women, these diameters can be used to distinguish between the two genders in the precise legal field.

Ultrasound-guided Placement of Permanent Hemodialysis Catheters Compared to the Traditional Blind Method

Arash Mohammadi Tofigh, Farbod Emami Yeganeh, Elham Mirzaian, Behzad Nemati Honar

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 213-220

Background: Central venous hemodialysis catheters are one of the most common vascular accesses for patients suffering from end-stage kidney disease. The application of ultrasound-guided placement of permanent hemodialysis catheters is highly recommended by the new guidelines because of its advantages over the traditional blind methods.
Methods: In this prospective study, the samples comprised patients (N=80) referred to a vascular surgery clinic by their nephrologist or elective vascular surgery consultations and asking for the placement of permanent hemodialysis catheters in Imam Hossain Hospital (A referral hospital complex center in, Tehran, Iran) during 2014 to 2015. The patients were randomly divided into two groups (n=40); one of the groups underwent the placement of catheters with the guidance of Doppler ultrasound and the other with the traditional blind method. Then, the data were analyzed by SPSS V. 21 software.
Results: There was statistically significant fewer attempts for successful placement (Z= -2.725, P=0.006), less insertion failure (Chi-Square=9.600, P=0.002), fewer failures with the first attempt (Chi-square=9.600, P=0.002), and less total placement time (t=1.379, df=69.549, P=0.172) in the sonography-guided group compared to the blind method. Furthermore, there was no significant difference in venous cannulation time and complications such as pneumothorax, neck hematoma, and carotid puncture between the two groups. Moreover, the patients had significantly greater satisfaction with the sonography-guided method (Z=-4.306, P=0.0001).
Conclusion: According to this study, it might be beneficial to use ultrasound as the first method of permanent hemodialysis catheters insertion and patients would be more satisfied with this approach as well. In addition, learning the blind method is recommended to the practitioners because of the possibility of lacking ultrasound in an emergency.

Optimization and Validation of a novel Nebulizer-assisted Liquid Phase Microextraction Followed by HPLC-DAD for Diazinon Analysis in Plasma Samples

Reza Mohammadzaheri, Mehdi Ansari Dogaheh, Maryam Kazemipour, Kambiz Soltaninejad

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 221-232

Background: Diazinon is among the most prevalently used broad-spectrum organophosphates insecticides. Diazinon toxicity depends on its blood concentration. The current study aimed to extract and determine diazinon in plasma samples using a new Nebulizer -Assisted Liquid-Phase Microextraction followed by High-Performance Liquid Chromatography with Diode-Array Detection (NALPME-HPLC-DAD).
Methods: Several effective parameters, including the type and volume of extracting solvent, pH, surfactant, salt amount, and nebulizing, were evaluated and optimized to find the best condition for the extraction and determination of diazinon in plasma samples using High-Performance Liquid Chromatography with Diode-Array Detection (HPLC-DAD). Additionally, the Plackett-Burman design was employed in preliminary experiments to screen the most appropriate parameters. Furthermore, we selected a central composite design to determine the best experimental conditions in NALPME-HPLC-DAD.
Results: In an optimum condition, 412 μL of toluene (as extracting solvent) and nebulizing with nitrogen gas as dispersing and emulsification, sodium lauryl sulfate (2.8% w/v) and 100μL sodium chloride (1.5% w/v) in pH 8.1 were selected. The standard calibration curves for diazinon were linear with the concentration range of 0.5–4 µg/mL with a correlation coefficient of 0.9992. The Limit Of Detection (LOD) and Limit Of Quantification (LOQ) for diazinon were 0.123 µg/mL and 0.372 µg/mL, respectively.
Conclusion: The proposed method was simple, accurate, precise, and sensitive for analyzing diazinon in the plasma samples. This method can be used for analyzing plasma diazinon concentrations in acute poisoning cases in clinical and forensic toxicology analyses.

Investigating Suicide Rate and Poisoning Severity and Their Relationship With Birth Month

Gholamali Dorooshi, Shiva Samsam Shariat, Mitra Shirvani, Shafeajafar Zoofaghari

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 233-242

Background: One of the most frequent causes of death is poisoning worldwide. Investigating the causes of mortality due to poisoning profoundly affects making decisions and improving standards for preventing adverse events. Therefore, to better understand this problem and evaluate the causes, this study aimed to determine the risk of suicide using the SAD PERSONS Scale (SPS) criteria and its relationship with the birth month in poisoned patients.
Methods: This cross-sectional descriptive-analytic study was conducted on poisoned patients admitted to Khorshid Hospital in Isfahan City, Iran, in 2018. First, the patients’ age, gender, and birth month were recorded. Then, their suicide risk was assessed by SPS.
Results: From 2735 referred patients with poisoning, 1839 (67.2%) attempted suicide, and 896(32.8%) cases were poisoned. The Mean±SD SPS score in patients with suicidal attempts was 4.89±1.94, and in the poisoned patients was equal to 2.74±1.46 (P<0.001). There was no significant relationship between suicide and birth month; however, gender (male), age, depression, previous suicidal attempts, ethanol abuse, rational thinking loss, social support lacking, and being unmarried significantly increased the risk of suicide (P<0.01). In addition, the SPS scores ≥5 with a sensitivity of 43.77%, and specificity of 98.44% had an acceptable diagnostic value in identifying the risk of suicide (P<0.0001).
Conclusion: As SPS criteria have an appropriate diagnostic value for suicide prediction, it is recommended that these criteria be assessed among individuals with susceptible suicide characteristics (e.g. males, elders, depression, the lack of social support, etc.), to prevent future suicide attempts and appropriate medical-psychological measures.

Determination of Common Pharmaceutical Adulterants in Herbal Medicinal Products Used in the Treatment of Opioid Addiction

Vida Shiri-Ghaleh, Mehrdad Moradi, Kambiz Soltaninejad

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 243-254

Background: Opioid addiction is a serious and growing global concern. Recently, herbal medicine has been popular for the treatment of opioid abusers worldwide. Unfortunately, the adulteration of herbal remedies with undeclared synthetic pharmaceuticals has been reported. In Iran, there are few reports on the adulteration of herbal remedies by synthetic pharmaceuticals sold as opioid addiction treatment. The aim of this study was to analyze herbal products used in opioid addiction treatment for the identification of synthetic pharmaceuticals as adulterants in the remedies.
Methods: Forty commonly-used handmade herbal products for the treatment of opioid addiction were collected from herbal shops in Kermanshah (western area of Iran). After organoleptic examinations, the samples were prepared and analyzed by high-performance liquid chromatography and gas chromatography-mass spectrometry for detecting probable synthetic pharmaceutical adulterants.
Results: The chromatographic analysis of the samples showed that 90% of the products had at least one undeclared pharmaceutical ingredient as an adulterant. The majority of the samples (n=19, 47.5%) had only one undeclared pharmaceutical. Diphenoxylate (n=24, 39.3%), tramadol (n=16, 26.2), methadone (n=8, 13.2%), and the combination of these drugs were reported as common adulterants. We detected the presence of buprenorphine and sildenafil as adulterating agents in the herbal formulations for the first time.
Conclusion: According to the presence of undeclared synthetic pharmaceuticals in opioid addiction herbal products, as well as their threats to public health, awareness, in this case, is necessary.

Case Report

Multiple Pulmonary Calssified Nodules and Cavitation Filled With the Dense Body on Chest X-Ray: A Case Report

Khosrow Agin, Marymo Sadat Moin Azad Tehrani, Bita Dadpour, Maryam Vahabzadeh, Babak Mostafazadeh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 255-260

Imaging in the clinical study has a significant value in medical diagnosing and the following diseases. The characteristic signs of imaging are a clue in approach to differential diagnosis. A conventional chest x-ray radiography is a more prevalent image used in the initial clinical assessment of pulmonary diseases. Iran is one of the 9 countries with a 95% burden of tuberculosis in the Eastern Mediterranian region. Chest radiography is the initial imaging for the evaluation of pulmonary tuberculosis.

Pathological Results in Cadavers Suspected to Electrical Injury Referred to the Forensic Medicine Center of Tehran From 2006 to 2016

Fares Najari, Mohammad Ali Emam Hadi, Ghazaleh Sadat Araban1

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 261-264

The electrical injury is a common cause of death needing forensic assessments. In these cases, the histopathological assessment is a routine practice. The aim of this study was to determine the pathological results in cadavers suspected to electrical injury referred to the Forensic Medicine Center of Tehran, Iran. In this observational descriptive-comparative study, 745 consecutive cadavers suspected to electrical injury referred to the Forensic Medicine Center of Tehran from 2006 to 2016 were enrolled; also, the histopathological findings among them were determined and compared according to other variables. The results of this study demonstrated that 44 patients (86.3%) of those suspected to have an electrical injury and 101 patients (92.7%) of those with definite electrical injury had positive pathological results, showing a statistically significant difference (P<0.05). The non-routine histopathology assessment is useful and would develop positive results in more than 80% of the cases.

Colchicine Overdose in a Suicidal Attempt

Fatemeh Eghbali, Reza Bidaki, Sina Negintaji, Maryam Dehghani, Adeleh Sahebnasagh, Ali Asghar Bagheri Atabak, Fatemeh Saghafi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 265-270

Colchicine overdose is uncommon; however, it can cause serious adverse effects and even death. Colchicine inhibits microtubule polymerization, causing mitotic spindle disruption. Ingesting ˃0.5 mg of colchicine per kilogram bodyweight causes severe adverse effects and can even be fatal. Therefore, colchicine toxicity must be accurately monitored and managed.
In this case report, we described a 21-year-old woman who attempted suicide by the ingestion of an estimated 30 mg colchicine. She was admitted to the hospital due to severe abdominal and chest pain, vomiting, lethargy, and weakness. The patient was medicated with ondansetron, apotel, antibiotics, platelet transfusions, sodium phosphate, calcium gluconate, calcitriol, desmopressin acetate, Granulocyte-Colony Stimulating Factor (G-CSF), and sodium bicarbonate. Fortunately, through the appropriate medical treatment, the signs and symptoms of colchicine toxicity were relieved and the patient survived despite the high colchicine serum level.

Short Communication

Comparing Neonatal Intensive Care Unit Nursing Support in Mothers With Newborn Abstinence Syndrome (NAS) and Mothers of Healthy Neonates

Seyedeh Najmeh Hosseini, Arash Ghodousi, Narges Sadeghi, Somayeh Abbasi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 271-278

Background: The experience of having neonates in the Neonatal Intensive Care Unit (NICU) is a psychological crisis. It might cause many emotional problems for parents. Entire parental support is among the duties of the healthcare team. Therefore, this study aimed to compare the nursing support received by the mothers with Newborn Abstinence Syndrome (NAS) and the mothers of other neonates admitted to the NICU.
Methods: The present cross-sectional descriptive-analytic study was conducted in the selected hospitals in Kerman Province, Iran. In total, 62 mothers with NAS and 61 non-addicted mothers with neonates admitted to the NICU were selected through convenience sampling method. The inclusion criteria were neonates under the care of parents, neonate admitted to the NICU for at least 24 hours, opiate dependence in the case group mothers, and no substance dependence in the control group mothers. The amount of nursing support for mothers having neonates with NAS was compared with that of the control mothers. The study groups were homogenized in terms of the study variables (neonate age, gender, and the duration of hospitalization). The required data were collected by the Nurse-Parent Support Tool (NPST) and analyzed in SPSS.
Results: The study results revealed that among the neonates of 123 mothers, 75 (60.97%) were boys, and 58(39.02%) were girls. The majority of neonates in both groups were breastfed. The Mean±SD age of the mothers in the case and control group were 31.93±7.25 and 28.99±4.36 years, respectively. The nursing support level was desirable in both groups, and no significant difference was found in this regard (P>0.05). Furthermore, the level of nursing support in emotional, information-communication, self-esteem, and quality caregiving support dimensions was desirable in both groups.
Conclusion: The obtained results revealed that nurses’ support was desirable in both groups. The prevalence of maternal addiction and the impact of this social harm on neonates who were admitted are essential. Furthermore, families having neonates with NAS need more support from the healthcare staff and nurses, in comparison with healthy parents; thus, the importance of this issue should be addressed in training and briefing courses for nurses.

The Prevalence and Patterns of Palmaris Longus Muscle Absence in an Iranian Population

Mehdi Forouzesh, Abdolrazagh Barzegar, Fardin Fallah

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 279-282

Palmaris Longus (PL) is a muscle of the forearm, i.e., not functionally necessary and does not exist in all people. It is a choice for tendon graft and investigating its prevalence is of clinical importance. During April-October 2009, 102 cadavers (78 males, 24 females) were bilaterally necropsied for PL exploration in Zanjan City, Iran. PL Absence (PLA) was observed in 37 (36.3%) cases (28 males, 9 females). PLA prevalence was similar in men (36%) and women (37.5%). Of PLA cases, 19 (51%) were unilateral (14 males, 5 females), and 18 (49%) were bilateral (14 males, 4 females). In conclusion, PLA prevalence of 36.3% in our population was similar to other studies conducted in Iran. We found no gender difference in PLA prevalence and its patterns. Due to geographical variability in PLA rate, future regional and national studies with more magnificent sample sizes are recommended to determine the prevalence and gender-specific patterns of PLA.

Causes of Maternal Mortality in Tehran, Iran

Abdolrazagh Barzegar, Mohammadjavad Hedayatshodeh, Mehdi Forouzesh, Masoud Ghadipasha, Pardis Shojaei, Fardin Fallah

International Journal of Medical Toxicology and Forensic Medicine, Vol. 9 No. 4 (2019), 11 November 2019 , Page 283-288

Maternal mortality is a woman’s death during pregnancy or postpartum period due to direct or indirect causes. Its direct causes are related to obstetrical issues. The indirect cause of it refer to an underlying disease, i.e. aggravated during pregnancy and leads to death. A routine data-based study conducted at the Legal Medicine Organization of Tehran City, Iran, the autopsy findings of maternal mortalities during April 2017-2019 were reviewed. During the study period, 53 cases were autopsied of which 29 (54.7%) and 24 (45.3%) died due to direct and indirect causes, respectively. , The prevalent direct causes of death, were bleeding (22.6%), eclampsia/preeclampsia (13.2%), and ectopic pregnancy (5.7%). Frequent indirect causes were cardiac diseases (20.7%) and nervous system and infectious diseases (both: 7.5%). This study revealed the considerable share of indirect causes in maternal mortalities in Tehran. Moreover, we outlined the importance of early detection of non-obstetrical medical conditions during pregnancy care to reduce preventable maternal mortalities.