ISSN: 2251-8762

Vol. 10 No. 2 (2020)

In progress as Continuous Publication Model

Short Communication

Factors Affecting Unsuccessful Suicide Among Women Referred to Emergency Room of Ardabil City Hospital, Ardabil, Iran

Esmaeil Farzaneh, Firouz Amani, Fariba Sadeghi-Movahhed, Kaveh Mataei

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 27412

Background: Along with the complexity of social communications, the rate of suicide is increasing, and according to studies, women commit suicide more than men. Various factors affect the occurrence of this phenomenon. The purpose of this study was to determine the factors affecting unsuccessful suicide among women referring to the emergency room of the hospital of Ardabil City, Iran.
Methods: This study was a descriptive cross-sectional study conducted on 236 women who had unsuccessful suicide. Questions were asked from patients with a checklist. This checklist has four parts. The first part relates to the patient’s personal information, and the second part relates to the patient’s previous history of mental, physical, and addiction problems. The third part asked about the causes of suicide and the fourth part related to the prior announcement. The collected data were analyzed by statistical methods in SPSS v. 18.
Results: The Mean±SD age of the women was 27.66±9.95 years, and the majority was between 15 and 20 years old. About 64% of women were housewives, and 37.7% had undergraduate education. Also, 36% had a positive history of psychological diseases, and 30.9% had a history of suicide. The most common causes of suicide among women were emotional problems (91.9%), family and marriage conflict (81.8%), spouse’s disregard (50.4%), and economic issues (44.5%).
Conclusion: The results showed that emotional problems and family and marital conflicts were common causes of suicide among women, and all women had at least one crucial reason for their suicide attempt.

Organophosphorus Insecticide Poisoning Related Mortality and Neurotoxicity in Sabzevar

Davood Soroosh, Narges Ranjbar, Mohammad Nematshahi, Seyed Alireza Javadinia

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 27706

Background: This study aimed to assess mortality and neurotoxicity caused by the pesticide organophosphate and its correlation with the type of poison and treatment in patients admitted to Vasei Hospital of Sabzevar City, Iran, in 2018.
Methods: Out of 122 cases, 52 patients (43.3%) were male, and 70 patients (56.9%) were female. The Mean±SD age of the men was 32.65±29.15, and women was 30±15.30 years.
Results: Mortality in women and men was 10% and 17.3%, respectively. Among treated people, diazinon had the highest frequency of 76.4%, and among dead people from diazinon and malathion had the highest rates of 56.3% and 43.8%, respectively.
Conclusion: The prevalence of mortality in patients was 7.3% (n=9). As most people with organophosphorus poisoning have been exposed to diazinon toxins; therefore, strategies to prevent and reduce exposure to this toxin are essential.

Original Article (General Medicine)

The Inhibitory Role of Di-2-ethylhexyl Phthalate on Osteogenic Differentiation of Mesenchymal Stem Cells Via Down-regulation of RUNX2 and Membrane Function Impairment

Mohammad Hossein Abnosi, Zahra Aliyari Babolghani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 26673

Background: Blood contamination of di-2-ethyl hexyl phthalate (DEHP) has been reported due to its release following medical procedures such as blood transfusion and vital liquid injection. We investigated the effect of DEHP on osteogenic differentiation of mesenchymal stem cells and their viability.
Methods: The rat bone marrow mesenchymal cells (MSCs) were cultured three times, and the third passage kept in the differentiation medium with the presence of DEHP. The viability of differentiated cells, sodium and potassium level, calcium concentration, total protein concentration, and the activity of lactate dehydrogenase, alkaline phosphatase, alanine transaminase, and aspartate transaminase were determined. Also, the concentration of malondialdehyde, total antioxidant capacity, the activity of superoxide dismutase and catalase were estimated. Finally, the level of matrix deposition and expression of alkaline phosphatase (ALP) and runt-related transcription factor 2 (RUNX2) genes were evaluated.
Results: We observed a concentration-dependent and significant reduction of matrix mineralization based on alizarin red and calcium analysis. Besides, the expression of ALP and RUNX2 gene was down-regulated, and alkaline-phosphatase activity reduced significantly. Also, we observed cell viability reduction but the elevation of lactate dehydrogenase activity and malondialdehyde level. Sodium level was elevated too, whereas the activity of transaminases, oxidative stress enzymes, potassium level, and total antioxidants decreased.
Conclusion: DEHP contamination reduced matrix mineralization due to the down-regulation of the genes involved in osteogenic differentiation and viability reduction via electrolyte and metabolic imbalance as well as induction of oxidative stress.

Study of the Pattern and Frequency of Road Traffic Injuries in Car Occupants in the Eastern Part of Iran

Davood Soroosh, Mohammad Nematshahi, Seyed Alireza Javadinia, Mitra Hesamifard

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 28112

Background: Since Iran has one of the highest mortality rates of car accidents in the world, the study of the pattern and reasons of trauma in car occupants can provide useful information to determine the underlying causes of injuries and deaths in traffic accidents. Accordingly, this study was conducted to determine the pattern, frequency, and causes of traumatic injuries caused by traffic accidents in car occupants.
Methods: This cross-sectional study was conducted during the first 6 months of 2017 in Shahid Beheshti Hospital in Sabzevar City, Razavi Khorasan Province, Iran. The data were obtained from the medical records of patients and the checklist designed by our research team.
Results: During the period of study, 300 people were involved in car accidents, of whom 58.3% were men with an average age of 35.16 years. In both sexes, 29.3% of the subjects were in the age group of 30-40 years. Twenty-two car occupants were involved in non-injury car accidents. No significant relationship was found between traumatic injuries and variables of sex, seatbelt use, airbag deployment, and the seat occupant in the cars (P>0.05), as well as between death and variables of sex, airbag deployment and seat occupant in cars (P>0.05). But there was a significant relationship between death and fastening seat belts (P=0.003).
Conclusion: The results of this study revealed that sex, airbag deployment, and seat occupant had no effect on traumatic injury or mortality rate in the car occupants. However, fastening the seatbelt can reduce the mortality rate in car occupants, but it does not impact the traumatic injuries rate.

Exploring the Therapeutic Effects of Transcranial Direct Current Stimulation on Sleep Quality Among Patients Under Methadone Maintenance Treatment

Mohammad Sadeghi Bimorgh, Abdollah Omidi, Fatemeh Sadat Ghoreishi, Amir Rezaei Ardani, Amir Ghaderi, Hamid Reza Banafshe

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 29088

Background: Patients under Methadone Maintenance Therapy (MMT) are susceptible to several problems, including sleep disturbances and risk of relapse. The present study aimed to assess the effect of transcranial direct current stimulation (tDCS) on sleep quality of addicts under MMT.
Methods: This clinical trial was conducted on 27 male patients who underwent maintenance methadone therapy in MMT clinics of Mashhad City, Iran. They were divided into the experimental and sham groups. The experimental group received seven 20-min sessions of tDCS every other day. In the sham group, the electrical current was delivered for a few seconds, but the electrodes were remained to the end of the session. Sleep quality was measured at baseline, during, and after the intervention by Pittsburg Sleep Quality Index (PSQI). The obtained data were analyzed by descriptive statistics such as mean and standard deviation and inferential statistics, such as t test, Chi-square, Mann Whitney, and Fischer exact test in SPSS v. 25.
Results: The difference between the two groups after tDCS in sleep duration was significant (P=0.04). In the experimental group, the total score of sleep had a reducing trend (P<0.000), while in the sham group, the overall score in 3 phases of evaluation had no significant change (P=0.19). However, the rate of inappropriate sleep quality was not significant between the two groups after the intervention (P=0.12).
Conclusion: This trial demonstrated the positive effect of tDCS on sleep quality in patients under MMT programs. Further studies are needed to confirm our findings.

Comparison of Three Different Methods of Dressing for Skin Graft Donor Site

Abdolreza Mehdinavaz Aghdam, Afshin Alizadeh, Seyed Babak Mousavi Toomatari, Seyed Ehsan Mousavi Toomatari

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 29059

Background: There are various methods to dress the Skin Graft Donor Site (SGDS), but some are very expensive and not available in Iran. This study aimed to compare three different dressings for the management of the SGDS.
Methods: Ninety-six patients participated in the study, and they were randomly divided into three groups. Donor sites were dressed with one of these methods: Vaseline gauze or method A, mupirocin 2% or method B, and nitrofurazone or method C. In each method, the dressing layer was covered by 5 layers of dry gauze. The three groups were compared regarding the epithelialization time, infection, pain, and cost.
Results: The epithelialization time was significantly longer in group A compared with groups B and C (P<0.05), but there was no significant difference between groups B and C (P<0.05). There was no significant difference between the three groups in infection and pain at rest, activity, and dressing time (P<0.05). There was a substantial difference between the three groups in the cost of dressing as method A was cheaper.
Conclusion: Due to the lower cost of Vaseline gauze and no significant difference in infection, dressing adhesion to the skin, and amount of pain between three dressing methods, Vaseline gauze is a preferred method to skin graft donor site dressing.

Original Article (Clinical Toxicology)

Investigating the Characteristics of Tramadol-induced Seizures: A Cross-sectional Study

Davood Soroosh, Mahdi Foroughian, Bahram Zarmehri

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 27869

Background: According to statistics, tramadol intoxication is one of the most common drug poisoning cases in Iran. Because seizure is one of the severe and dangerous side effects of tramadol, the present study aimed to investigate the characteristics of tramadol-induced seizures.
Methods: In this cross-sectional descriptive study, all patients who referred to the emergency departments due to the tramadol-induced seizures were examined by the census method. The patients’ data were collected with a checklist. Then, the data were analyzed with descriptive and inferential statistical tests in SPSS v. 23 and at a significant level of P<0.05.
Results: In this study, 350 patients (52.9% male, and 47.1% female) were examined. The Mean±SD dose consumed was 1171.4±802.77 mg. The minimum dose that caused the seizure was 200 mg, and the average dose consumed of tramadol was different in patients who had one, two, or three seizures outside the hospital (P=0.002). The consumed average dose of tramadol was 1144.5 mg, 2017.7 mg, and 511.1 mg for patients who had one, two, or three seizure(s), respectively. There was a significant relationship between dose consumed and the number of seizures (P=0.001). The study showed that patients who had a one-time seizure, have experienced this condition outside the hospital. There was a significant relationship between the number of seizures and the location of the seizure (outside or inside the hospital) (P=0.001).
Conclusion: The results showed no significant relationship between consumed dose and location of the seizure. The number of seizures is not dependent on the consumed dose. It means that increasing the consumed dose, the number of seizures does not increase, and there is no significant relationship between the amount of dose consumed and the number of seizures.

Investigation of the Frequency of Foodborne Botulism in Patients Referred to Loghman Hospital in Tehran City, Iran, From 2008 to 2019

Mohammad Mehdi Soltan Dallal, Fares Najar, Ahdie Karbalaei Shabani, Khadijeh Ezoji, Minoosh Shabani, Mohammad Reza Montazer Khorasan, Alireza Jannani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 28348

Background: Foodborne botulism is a fatal paralytic illness caused mainly by the neurotoxin produced by an anaerobic bacterium called Clostridium botulinum. In this study, the frequency of foodborne botulism in patients referred to a hospital in Iran has been reviewed for ten years.
Methods: In this routine database study, medical records of patients with foodborne botulism referred to Loghman Hospital in Tehran City, Iran, from March 20, 2008, to March 20, 2019, were reviewed. Information on variables of age, sex, place of residence, food consumed, clinical symptoms of patients (such as dysphagia, nausea, vomiting, ataxia, etc.), toxin type, and length of hospitalization were collected with a researcher-made questionnaire. Finally, the collected data were analyzed in SPSS-24 with descriptive and analytical statistical tests.
Results: In this study, 61 suspected botulism patients were clinically diagnosed in Loghman Hospital, of whom 55 patients were clinically suspected of foodborne botulism, 5 patients had iatrogenic botulism, and 1 patient had infant botulism. Of these 55 patients with the clinical diagnosis of foodborne botulism, 19 patients were confirmed by laboratory examinations, and 2 patients died. Sixteen patients confirmed by laboratory had neurotoxin botulinum type A. The mean age of the patients was 36.9 years with a standard deviation of 18.6 years. About 54.5% of the patients were male and 45.5% female. Weaknesses (58.2%), ptosis (droopy eyelid) (56.4%), and diplopia (double vision) (52.7%) were the common clinical symptoms of the patients under study. Canned foods and dairy products were the main foods consumed by the patients. The duration of admission time ranged between 1 and 41 days, with an average of 7.7 days. About 23.64% of patients were admitted to the intensive care unit.
Conclusion: The prevalence of foodborne botulism is rare compared with other food poisonings but is still a major public health problem due to the consumption of traditional food products and unboiled canned foods in Iran.

Comparing APACHE II, APACHE IV, SAPS II, and SOFA Predictive Power in Poisoned Patients Admitted to the Intensive Care Unit

Samaneh Silakhori, Bita Dadpour, Majid Khadem-Rezaiyan, Alireza Sedaghat, Farzad Mirzakhani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 28814

Background: This study aimed to assess the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiologic Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores in predicting mortality rate in poisoning patients admitted to an intensive care unit (ICU).
Methods: This cross-sectional study was performed on all admitted patients in the poisoning ICU of Imam Reza Hospital, Mashhad City, Iran. All patients were evaluated for three consecutive days since admission time and then every two days until discharge from ICU or death. The scoring systems mentioned above were calculated and analyzed by MedCalc statistical software version 18.9.1 and SPSS version 16.
Results: Overall, 150 patients were studied, out of whom 67% (101) were male. Their mean±SD age was 41.6±18.9 years. In their whole hospitalization period, APACHE II (79.5%), SAPS II (78.7%), APACHE IV (78.4%), and SOFA (72.9%) were the most precise measures. On the first day of admission APACHE II (77.4%), on the second day, APACHE II (83.1%), on the third day, APACHE II (90.7%), and on the fifth day, SOFA (81.6%) were the most precise measures.
Conclusion: All four systems have acceptable discriminatory power for poisoned patients. However, it seems that APACHE II can be used for mortality prediction, especially in the early days of admission.


Original Article (Forensic Medicine)

Alternative Medicine’ Complaints Lodged to the Tehran Forensic Medicine Organization From 2011 to 2017

Mohammad Ali Emam Hadi, Baharak Sabet Divshaly, Farahnaz Azimy, Babak Sabet Divshaly

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 26707

Background: Complementary and alternative medicine is a non-conventional therapy and includes a wide range of medical treatments in different countries. This study was done to evaluate alternative medicine complaints lodged to the Tehran Forensic Medicine Organization from 2011-2017.
Methods: In this cross-sectional study, all documented complaints of complementary medicine lodged to the Tehran Forensic Medicine Organization from 2011-2017 were reviewed and assessed with retrospective follow-up. The inclusion criterion was complaints from complementary and alternative medicine, and the exclusion criterion was incomplete data. The study data included patients’ demographic data, the therapist, the specialty of the therapist, type of disease, treatment method, adverse effects, the initial and final decision by the commission, and the amount of medical error. This information was extracted from the existing documents and recoded in the checklists.
Results: Medical errors were found in 53.4% of the complaints examined. The most common cause of complaint (63%) was the adverse effects, of which the most common ones were phytotherapy (45.2%) and cupping (Hijama) (20.5%). The error was significantly different between physician and non-physician healers (P=0.001).
Conclusion: Based on this study, among the alternative medicine complaints lodged to the Tehran Forensic Medicine Organization from 2011-2017, the adverse effects were the main problem of complementary therapies confirmed in more than half of the complaints.

The Measurement of Height Via 3D Scans of the Seventh Cervical Vertebra in Iranian Adults

Seyed Reza Saadat Mostafavi, Azadeh Memarian, Omid Motamedi, Arash Heidari

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 27887

Background: The cervical vertebrae are more durable than other skeletal components, and maybe the only remains of a deceased, and their role in determining the height of the deceased has been underestimated. The present study investigated the role of linear differential dimensions of the seventh cervical vertebrae in determining the height of the Iranian adult population using CT scans.
Methods: In this cross-sectional study, height were evaluated by 10 indices of the seventh cervical vertebra. The indices were obtained through a CT scan of 66 adult patients, ≥18 years of age, who referred to Rasoul Akram and Firoozgar hospitals for spine CT scan. The sampling method was random, and the study was performed during the first six months of 2018.
Results: Four indices of the Length of the Inferior Facets) LIF, (Length of the Inferior Surface of the Vertebral Body) LIVB, (Width of the Inf surface of the Vertebral Body) WIVB, (Length of Spinous Process ) LSP. were statistically significant differences.
Conclusion: The results of this study show the accuracy of linear dimensions of the seventh cervical vertebrae for determining height from skeletal remains in the Iranian adult population.

Case Report

Thrombotic Thrombocytopenic Purpura Following Honeybee Envenomation: A Case Report

Zahra Khalighi, Golnaz Azami, Elham Shafiei, Ali Sahebi, Aliashraf Mozafari

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 28794

Background: Thrombotic Thrombocytopenic Purpura (TTP) is a rare and life-threatening disorder characterized by severe thrombocytopenia, microangiopathic hemolytic anemia, fever, renal dysfunction, and neurological deficient. TTP leads to the formation of blood clots in small blood vessels throughout the body. TTP is associated with many risk factors such as pregnancy, HIV, cancer, lupus, and infections. Recently there have been few published case reports of bee sting associated TTP.
Methods: A 67-year-old man from a rural area of the Southwest Province of Iran, Ilam, was referred to the academic general hospital because of fever, chills, sweating, vomiting and dizziness following the honeybee sting on his body.
Results: this study showed that,multiple co-morbidities including CVD and diabetes, along with coagulation abnormalities after honeybee stings, seriously exacerbated patient hemodynamic status.
Conclusion: TTP, as a major complication due to the toxic reaction of a large number of bee stings with underlying diseases in patients, should be given more attention.

Induced Abortion by Vaginal Use of Aluminum Phosphide in a 44-Year-Old Woman: A Case Report

Zahra Khalighi, Fatemeh-Sadat Hashemi, Nasrin Bazgir, Golnaz Azami, Elham Shafiei

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 29025

Aluminum phosphide (AlP) is an efficient and toxic pesticide that is easily available in many Asian countries such as Iran. Many cases of unintentional or suicidal use of AlP have been reported in these countries, and these statistics are rising rapidly. We aim to present a case of abortion induced by vaginal use of AlP. We report a 44-year-old gravid woman who self-administered one-quarter of a 3-g AlP tablet intravaginally. Ultrasound at 6 hours post-admission showed no fetal movement or heart motion. Intravaginal administration of AlP can lead to fetal death and abortion. There is concern about the spread of vaginal use of these agents in pregnant women, as the number of illegal abortions is increasing.

Letter to the Editor

Lessons Learned From Trauma Injuries in Arbaeen 2019 in Ilam Province, Iran

Aliashraf Mozafari, Elham Shafiei, Yousef Jamshibeigi, Ali Sahebi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 28614

Arbaeen is the largest peaceful religious gatherings on Earth. In this event, millions of people go to the holy city of Karbala in Iraq.  Annually, about 20 million pilgrims attend Arbaeen ceremony, including about three million foreigners, that most of whom are Iranians. Ilam province is located near Iran’s western border with Iraq. Every year, many Iranian pilgrims enter Iraq through Ilam borders for the Arbaeen ceremony, which lasts two weeks before and after Arbaeen day. Pilgrims after the religious rituals enter to their home.

A Letter About Phenobarbital Poisoning

Zahra Ataee, Maryam Sayyari Doughabadi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 10 No. 2 (2020), 21 June 2020 , Page 29079

The ever-increasing sensitivity of humans and living in a world full of stress and anxiety have led to the increased consumption of painkillers and sleeping pills. Barbiturates, which are among the most important sedatives, are regularly used by ordinary people. Addiction, suicide, and accidental deaths from inappropriate use of these drugs have been a subject of constant concern in medicine.