International Journal of Medical Toxicology and Forensic Medicine

Being a matter of confidentiality, medical "secret" is an issue that physicians are aware of due to nature of their profession. Breach of confidentiality is defined as giving away a patient’s medical records by any means such as writing, telling, implying etc. According to law in Iran, medical confidentiality is one of the principles of medical profession and if anyone breaches it, they can be imprisoned up to one year. It is imperative that medical professionals make every effort to protect their patients’ secrets from being divulged even to their next of kin. Disclosure of patients' secret without their consent also results in public distrust in the healthcare system so that individuals either refuse to see the doctor or give incomplete and inaccurate information in the future, which per se can cause serious health risks.

the incidence of Hepatitis C Virus (HCV)
and Human Immunodeficiency Virus
(HIV) coinfection in People Who Inject
Drugs (PWIDs) is a public health issue; it
presents various contentions to the healthcare
providers. Although antiretroviral therapy improved
the life expectancy of HIV-infected people, HCV-related
mortality turned into a greater concern among these individuals
[1]. AccFurthermore, they mentioned, “injecting
drug users in the Taipei methadone maintenance
treatment program had a very high prevalence of HIV/
HBV coinfection and HCV mono-infection”[2].
Besides, a systematic review and meta-analysis results
suggested a high frequency of HIV/HBV coinfection
(>80%) in Intravenous (IV) drug users [3]. Although
the incidence of HIV among IV drug users has been
decreased, HCV is still endemic in this population [4].
We aimed to estimate HCV/HIV coinfection frequency
and its related risk factors among methadone poisoned
patients who were admitted to the Loghman Hakim poisoning
center between March 2012 and March 2017.
Loghman-Hakim Hospital is a unique poisoning referral
center in Tehran, Iran, that admits patients from all cities
in Tehran Province, Iran. Annually, around 20000 hospitalized
patients are observed and treated in this center,
with 80-100 patients daily turn-over.
The required data were collected using a questionnaire,
clinical examinations, and laboratory findings. The patients
with a history of infectious diseases, like hepatitis
B or C, HIV, and IV drug consumption, were excluded
from the present research. The obtained blood samples
were screened for antibodies to HCV and HIV using a
commercially available Enzyme-Linked Immunosorbent
Assay (ELISA). Furthermore, the relevant urine samples
were analyzed for the presence of methadone with a rapid
test. Among 200 participants, 134 (67%) were male, and
66 (33%) were female with the age range of 1 to 83 years.
The methadone serum levels of 129 (64.5%) patients were
positive, 39 (19.5%) were negative, and 32 (16%) patients
were not examined due to the short duration of hospitalization
(i.e. <2 days). Underlying diseases, such as noncommunicable
diseases (11%), psychotic disorders (1.5%), and
respiratory disease (3.5%) were detected in 30 cases. Reactive
HCV-antibodies, active HIV-antibodies, and HIV/
HCV coinfection were observed in 10 (5%), 2 (1%), and 2
(1%) of the study subjects, respectively. Figure 1 shows the
prevalence of HCV and HIV infection by gender and age.

Background: Methanol is a toxic alcohol found in illegal liquor, and its poisoning may cause death if not treated timely and properly. In 2018, methanol toxicity in Iran increased dramatically. Regarding the high prevalence of methanol toxicity, its high mortality rate, and the cost of treatment as well as the importance of timely diagnosis in the treatment of this condition, we decided to review methanol toxicity, its signs, symptoms, diagnosis, and treatment.

Evidence Acquisition: We searched for articles on reliable databases such as Embase and Medline from January 2018 to May 2018 using the following keywords: “methanol,” “toxic alcohol,” and “ethanol toxicity treatment.”
Results: This review discusses how to diagnose methanol toxicity by using clinical signs and symptoms and laboratory examinations; it also suggests new treatments. Meanwhile, we provide alternatives for diagnosis in case of shortages of tests in the emergency department.
Conclusion: Diagnosis of ethanol toxicity due to non-specific signs and symptoms, late patient’s referral, and lack of proper history-taking can be very difficult and delay the onset of treatment. There is also no clear scientific evidence as to whether ethanol or fomepizole should be used as the first choice of therapy for methanol toxicity because there is no direct comparison between these two antidotes regarding their effectiveness and safety. The appropriate antidote is chosen depending on the availability, cost, accessibility of hemodialysis, and the physician’s experience. If the therapist does not have enough experience, it is easier to use fomepizole.

Background: Brain tumors can be serious and life-threatening when they are treated effectively. Many therapeutic approaches, such as chemotherapy, radiotherapy, and surgery have been used to treat brain tumors. In this regard, selenium supplements have been reported effective.
Methods: Selenium Nanoparticles (SeNPs) were produced in two forms of synthetic and biogenic to evaluate their cytotoxicity on brain glioblastoma cell lines. A-172 cell line was cultured in DMEM medium. The cytotoxicity of the synthetic and biogenic SeNP was assessed by MTT assay.
Results: There was a significant difference between the group treated with biogenic and synthetic SeNP compared with non-treated cells after 24, 48, and 72 h. Both biogenic and synthetic SeNP increased Bax gene and decreased Bcl-2 gene expression.
Conclusion: It seems that biogenic SeNP was more lethal than its synthetic form. Therefore, it should be considered that the method of NP construction may be an important parameter for its bioactivity.

Background: There are many diseases around the world that threaten human health and its related hygienic issues. Cancer is among the conditions mentioned above that cause many problems for health sectors worldwide.
Methods: The present research analyzed the linear B-cell epitope of viscumin from European mistletoe using bioinformatics tools. We also provided references for the fast detection of biological agents. Several important tools, such as Protparam, NCBI, PDB, T-coffee, BCpred, Bptope, Ellipro, and Cn3D were used to predict the viscumin linear epitope and its physical and chemical properties.
Results: The 9-mer epitope found as QQTTGEEYF embedded in the A-chain of protein by the least sequence homology with other homologous rivals. Its molecular weight, theoretical isoelectric point, and the total number of negatively charged residues were 1102.1, 3.79, and 2, respectively.
Conclusion: Using different databases and establishing the accuracy level of ˃50% for linear B-cell epitope prediction, the selected epitope passed the related criteria and was introduced as a new linear epitope as a potential biological element in biosensors for cancer (viscumin) fast therapeutic detection.

Background: The popularity and use of herbal medicines and supplements are growing worldwide. Herbal anti-obesity products have been considered as suitable alternatives to synthetic pharmaceuticals as they are introduced as harmless natural products. However, some manufacturers often add undeclared synthetic pharmaceuticals to the anti-obesity herbal medicine products to improve their efficacy and potency. The present study aimed to analyze herbal weight loss products collected from the drug market in Bojnurd City, Iran.
Methods: Ninety-six herbal drug samples, as weight loss products, were obtained from herb shops and pharmacies in Bojnurd City, Iran. All samples were analyzed to detect undeclared active pharmaceutical ingredients using High-Performance Liquid Chromatography with Diode Array Detector (HPLC-DAD) and Gas Chromatography-Mass Spectrometry (GC-MS) techniques.
Results: Caffeine, trimethoxyamphetamine, and vitamin E were identified in herbal weight loss products. Caffeine was detected in 21.8% of the obtained samples, as the most common undeclared active pharmaceutical adulterant.
Conclusion: Undeclared active pharmaceutical ingredients in herbal weight loss products could threaten patients’ health. Thus, it is necessary to create awareness through health authorities in this regard.

Background: Identifying identity in the absence of large bones becomes more difficult and complicated; accordingly, it is highly beneficial to use the features of the sternum. The present study aimed to evaluate the dimensions of the sternum and its relation with gender in the Iranian population.
Methods: This cross-sectional study was conducted on 200 cadavers (100 men and 100 women). By performing an autopsy, the sternum bone was first cut in the midline using a vibrating saw, and the different dimensions were measured using a caliper.
Results: Among different dimensions related to the sternum, the mean length of manubrium, mesosternum, the largest width of manubrium, and the shortest width of manubrium were significantly higher in men compared to women. Regarding the value of each sternal diameter in discriminating male and female gender, the highest discriminative value was specified to the shortest width of manubrium (cutoff: 26.75, sensitivity: 100%, specificity: 84.0%), followed by the length of sternebrae 1 (cutoff: 8.45, sensitivity: 76.0%, specificity: 21.0%).
Conclusion: Measuring various indices of sternum bone, particularly the shortest width of the manubrium and the length of sternebrae 1, leads to gender identity accurately.

Background: The development of clinical teaching necessitates the use of novel and appropriate clinical evaluation methods. In the meantime, the use of new evaluation approaches that enhance learning at the same time has been recommended. This study aimed to compare the effect of the two new evaluation methods of direct observation of procedural skills (DOPS) and short clinical evaluation exercise (Mini-CEX) with the conventional evaluation method on clinical skills of forensic medicine residents.
Methods: This is a randomized trial performed among forensic medicine residents. Using Cochran's formula, the minimum sample size was calculated to be 25 individuals per group. All the residents were randomly divided into either the experimental or the control groups. After training and evaluation, the experimental group was tested using the DOPS and Mini-CEX methods three times during the course, and the control group was evaluated using the conventional method. The basis for the evaluation of the procedures (physical examination and autopsy) in both groups was the valid and reliable checklists prepared by the researchers. The results were analyzed using descriptive and inferential statistics (e.g., the Chi-square and independent t-test).
Results: There was no significant difference between the two groups in terms of demographic variables such as age, sex, and grade point average (GPA) (P>0.06). The means of total scores were significantly higher in the experimental group (using the Mini-CEX and DOPS methods) than the control group (conventional method) (P<0.0002).
Conclusion: The use of new evaluation methods of DOPS and Mini-CEX improved the clinical skills of forensic medicine residents. Therefore, it is recommended that resident training centers use these two methods of assessment, together with other methods, to evaluate clinical procedures and boost forensic residents' learning.

Background: Cathepsin B comprises a group of lysosomal cysteine proteases belonging to the Papain family; it has an intracellular function in the process of protein catabolism, antigen processing in the immune response, and Alzheimer’s disease. In cancers, cathepsin B interferes with autophagy and intracellular catabolism, and breaks down extracellular matrix, decreases protease inhibitors expression, and ultimately helps to accelerate metastasis, tumor malignancy, and reduce immune resistance.
Methods: In this study, the 3D structure of cathepsin B was constructed using modeler and Iterative Threading ASSEmbly Refinement (I-TASSER), based on similarity to the crystallographic model of procathepsin B (1PBH). Then, the predicted cathepsin B model was evaluated using PROCHECK and PROSA for quality and reliability. Molecular studies suggested that the amino acids cysteine 108, histidine 189, and histidine 190 form the envelope of the active site of cathepsin B. The docking studies of cathepsin B was performed with protease inhibitors cystatin C, E-64 and leupeptin.
Results: The lowest binding energy was related to the cathepsin B-E-64 complex. Accordingly, it was found that E64 interacts with the amino acid cysteine 108 of the active site of cathepsin B. Leupeptin made 2 hydrogen bonds with cathepsin B, but none with the active site of cathepsin amino acids. Cystatin C established a hydrogen bond with the arginine 18 of cathepsin B and made electrostatic bonds with aspartate 148 of cathepsin B.
Conclusion: Therefore, the bioinformatics and docking studies of cathepsin B with its inhibitors could be used as reliable identification, treatment, and alternative methods for selecting the inhibitors and controllers of cancer progression.

A 50-year-old woman was admitted to the emergency center with dyspnea, cough, and fever symptoms. She had a medical history of diabetes mellitus type II, rheumatoid arthritis, as well as several admission records due to aspiration pneumonia. The primary diagnosis was diabetic ketoacidosis and pneumonia. Normal breath sounds were reduced on the lower posterior right side of the thorax. A standard chest x-ray and lung Computed Tomography (CT) scan revealed collapse consolidation in the Right Lower Lobes (RLL) and Right Middle Lobes (RML). We here presented a case of unilateral diaphragmatic paralysis with a history of recurrent pneumonia.

Background: Meth mites is a false sense annoys methamphetamine abusers forces them to self-harm by picking the skin, scratching it.
Case Presentation: We reported the photos showed a regular small round skin injuries on the forearms of a middle-age multi-drug abuser man. He explained about his injuries: "I was hunting annoying ants by cigarette fire, however they were fire-resistant and skipped". He had isolated tactile hallucination without visual part. He explained that every time he abuses methamphetamine (Shisheh in Iran) the ants attack him and bite him.
Conclusion: Drug induced formication could be a very dangerous hallucination that forces the patient to self-harm to get rid of it, especially in multidrug abusers.