International Journal of Medical Toxicology and Forensic Medicine

Background: Determining the cause of death among drug addicts in Residential Rehab Campuses (RRCs) is of paramount importance, since it may prevent and reduce morbidity and mortality rates. Therefore, the present study was done to investigate the cause of death among drug addicts in RRCs in Kahrizak Dissection Hall, Tehran Province, Iran, from September 2011 to September 2019.
Methods: In this descriptive cross-sectional study, a total number of 166 drug addicts, who had died in the RRCs located in Tehran, Iran were examined, and the findings were analyzed using the SPSS v. 26. Moreover, the Chi-square test was utilized to compare the results.
Results: In this study, the most important causes of death, were infections, drug side effects, Myocardial Infarction (MI), and drowning, respectively. The highest frequency of death had occurred in the 31-40-year-old age group and was mostly observed in unmarried individuals. The most common causes of death were infection among the single and divorced ones and were MI for married cases. Toxicological results were generally negative in 60.84% of the cases. Also, 86.74% of the cases were non-pathological with regard to the brain tissue samples and 65.66% of the individuals had no pathological cardiac lesions. Besides, the most common microscopic findings of the lungs were associated with pulmonary edema. In the trauma group and also drug side effects and drowning groups, the most frequent pathological findings were pulmonary hemorrhage and pulmonary edema, respectively. As a whole, 69.87% of the deaths had occurred in the RRCs and 55.42% of them were assumed natural in terms of mode of occurrence.
Conclusion: The majority of the deaths in the RRCs should not have occurred if the given centers were authorized and the illegal centers were closed. Moreover, these centers should have proper management with the presence of resident physicians and trained medical staff as well as necessary medical equipment, proper nutrition, no access to drugs and other illicit substances, along with adherence to hygienic principles to minimize mortality rates among the drug addicts living in the RRCs.

Background: Aspiration pneumonia is among overdose complications, requiring timely appropriate treatment. The present study aimed to evaluate the effects of ampicillin-sulbactam, compared to our usual regimen ceftriaxone + clindamycin on aspiration pneumonia in opioid-poisoned patients.
Methods: In a randomized-controlled clinical trial, opioid-poisoned patients with aspiration pneumonia were randomly divided into the experimental and control groups to receive ampicillin-sulbactam 3 g Intravenously (IV) every 6 hours (experimental group) and ceftriaxone 1 g IV every 12 hours + clindamycin 600 mg IV every 8 hours (control group) followed by co-amoxiclav 625 mg orally every 8 hours and cefixime 400 mg once daily + clindamycin 600 mg orally every 8 hours in experimental and control groups, respectively, to complete a 7-day course of therapy. White blood cell count and temperature (axillary) at baseline and the third day of the intervention and the treatment outcome on the third day of the intervention, defined as either complete response, partial response, or failure, were evaluated and recorded for all patients.
Results: Except for the number of cases of leukocytosis on the third day of the intervention, i.e., lower in the control group (5 patients, 26.30%) than the experimental group (13 patients, 68.40%) (P=0.020), no significant difference was observed between the study groups regarding other outcome variables. Clinical response was similar between the study groups; so that, 10.50% and 63.20% of patients in the experimental group and 21.10% and 47.4% of patients in the control group presented complete and partial responses, respectively (P=0.550).
Conclusion: The obtained data suggested that ampicillin-sulbactam is an effective antibiotic for the treatment of aspiration pneumonia in patients with opioid overdose, in which case, it has the same efficacy as the two-drug regimen of ceftriaxone + clindamycin.

Background: One of the most common medical emergencies worldwide is deliberate or accidental poisoning. The ever-increasing consumption of toxins and fatal drugs is getting more critical by the time. The purpose of intentional poisoning is to harm self and others. It includes objectives like robbery, sexual abusing (rape). The perpetrators of sedative and hypnotic drugs could sedate patients and make them sleepy.
Methods: This descriptive, cross-sectional study investigated the suspected Drug-Facilitated Crime (DFC) admitted patients and Outpatient Department (OPD) in the emergency room and toxicology ward. A researcher-made questionnaire was completed for each patient. The biological samples (urine, blood) were provided to a clinical toxicology lab.
Results: The information of 40 suspected DFC patients was analyzed. 70% of intoxicated patients were men, and 30% were women. The patients’ mean age was 31-43 years; 42% were low in education, and 37% were self-employed. Furthermore, 75% of total intoxicated patients had a sedentary level of consciousness. Approximately 92.5% had one positive substance test, and 7.5% had negative lab test results. The most used drug was diazepam, by 70%. The motivation for poisoning was 80% robbery, 12.5% for rape, and 7.5% were no diagnostic.
Conclusion: The prevalence of poisoning, especially deliberate poisoning, is dramatically growing in this part of the world. Accordingly, this study reveals the flexibility of criminals in Tehran Province, Iran. Thus, the Ministry of Health should seriously control legal and illegal drugs purchase.

Background: The suicide with aluminum phosphide, known as rice tablet, has increased significantly. This study aimed to investigate the epidemiology of Aluminum Phosphide (ALP) poisoning and determine the in-hospital mortality prognostic factors in adult people referring to ALP poisoning to one of the main poisoning centers in southern Iran.
Methods: This retrospective cross-sectional study (March 21, 2014, to March 21, 2018) was conducted on all adult patients (>16 years) with ALP poisoning who were referred to Ali-Asghar Hospital (affiliated with Shiraz University of Medical Sciences). All data were extracted from the patients’ medical files. The patients were categorized into two groups of survived and non-survived. Univariate and multivariate logistic regression analyses were conducted to determine prognostic factors for in-hospital mortality, and Odds Ratios (ORs) were reported.
Results: Totally, 97 patients were enrolled in this study. The patients’ Mean±SD age was 29.3±12.2 years. Both study groups (survived and non-survived) were matched in most demographic and poisoning characteristics. Nausea (62.9%) and vomiting (49.5%) were the most symptoms at the time of admission. Castor oil (66%), N-acetyl cysteine (56.7%), and magnesium sulfate (52.6%) were the most frequent treatment in these patients. The multivariate analysis showed that age (OR=1.12, 95%CI: 1.03-1.22), body temperature (OR=0.02, 95%CI: 0.01-0.48), resistant acidosis (OR=77.10, 95%CI: 5.05-1176.86), and taking sodium bicarbonate (OR=12.35, 95%CI: 1.25-122.10) were the prognostic factors of in-hospital mortality.
Conclusion: The in-hospital mortality rate in patients with ALP poisoning was 29.9%. Age, illiteracy, body temperature, resistant acidosis, and taking sodium bicarbonate were the prognostic factors of in-hospital mortality in these patients.

Background: Death by hanging is a vital health hazard worldwide; it is classified as violent mechanical deaths resulting from asphyxia. The manner of death in hanging is suicide in the majority of the cases, and accidental hanging is less common, and homicidal hanging is still less common. The study was aimed towards analyzing sociodemographic patterns, precipitating factors for committing hanging at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India.
Methods: A retrospective study was conducted at the mortuary of VIMS, Ballari, Karnataka, India. From January 01, 2016, to December 31, 2020, 356 alleged hanging cases were brought to the mortuary for postmortem examination, and the cause of death was attributed to hanging. The necessary data were collected with the help of history, inquest reports, meticulous postmortem examination, etc. The results were obtained after tabulating and data analyzed with a cross-sectional study.
Results: Of 356 cases of hanging, the majority of the cases were in the age group of 31-40 years (140 patients; i.e., 39.32%). Male preponderance was detected in 235(66%) cases, and most victims have married 199(56%) subjects. Concerning seasonal variation, we noted that the maximum number of suicides by hanging was reported in July to September 141(39.60%). Out of 356 hanging cases, 178(50%) were employed. The predisposing factor was Chronic illness in 136(38.20 %) cases, followed by financial stress and psychological problems in 120(33.70%) and 50(14.04%) cases, respectively. Most of the victims belonged to the Hindu religion, 290(82%) cases. Moreover, 320(90%) of cases had no suicide note.
Conclusion: Hanging is challenging to prevent due to numerous concomitant factors, but psychological counseling, economic support, and education can reduce the incidence of hanging.

Background: Violence and strife are among the most important causes of health threats and account for more than half a million deaths per year, especially at young ages. Considering the young population of Iran and the occurrence of identity crisis in the young age group and the fact that this phenomenon is costly for our country’s health care system, this study was conducted to investigate the factors related to violence and strife and the related mortality in patients admitted to the Sabzevar Emdad Emergency department.
Methods: In this descriptive cross-sectional study, 207 patients who were admitted to Sabzevar Emdad Hospital in 2017 following strife were included. The inclusion criterion was hospitalized patients who were referred to the Emergency department following the strife and the exclusion criterion was incomplete registration of patients’ information. The data collection tool was a researcher-made checklist. Data analysis was performed using SPSS software version 18.
Results: The Mean±SD age of patients was 34.81±14.75 years. Most patients were from urban living places, while the mortality rate, gender, and the cause of trauma were not statistically associated with patients’ place of residence. The most common type of lesions following strife was bruising, tearing, and scratching accounting for nearly 70% of cases. The most common site of injury was bruising and scratching in the head and neck, followed by tears and fractures in the limbs. In general, the most common site of injury was the upper extremity followed by the head and neck. The majority of patients (52%) underwent medical treatment, including receiving medication, dressing, and splinting, while 37% of patients were referred to the operation room for surgery. A significant relationship was observed between mortality rate and the site of injury (P=0.001).
Conclusion: The results showed that in Sabzevar city, the prevalence of strife ‎ is higher among men. Also, the most common effects following these types of trauma are bruising, scratching, and tearing. It seems that by providing appropriate solutions and creating a culture and increasing people’s awareness of injuries caused by strife, it would be possible to pave the way for reducing such injuries in the future.

Background: According to the Qur’an, man is the servant and the successor of Allah, the representative of prosperity on earth, and has the responsibility for the universe. This approach will create a constructive human interaction with the environment. Environmental degradation is against the will of Allah. It originates from ignorance, human selfishness, passions, and evil temptations, manifest in greed, arrogance, and extravagance. If humans control these abnormal factors and follow Qur’an teachings, they will enjoy a healthy environment that is a universal right. This paper seeks to study the anthropological theory of the Qur’an and its role in reducing environmental degradation.
Methods: Based on the descriptive-analytical design, we explored 70 verses of the Holy Qur’an in which the words samā’, ‘ard, mas’ūl, khalīfah, shaytān, and those are cognate with the Arabic verbs sa-khkha-ra, ha-ra-sa, sa-ra-fa, ki-ba-ra, ha-wā, ‘a-ba-da, and ‘a-ma-ra, as well as the related articles, books, and philological and exegetical sources. We investigated the Qur’an to find the effect of awareness and more attention of human beings to the dimensions of man’s creation to reduce environmental degradation. These issues will be discussed in two parts: 1) the anthropology and the dimensions of human creation in the Qur’an, and 2) the causes of environmental degradation.
Results: This study showed that the survival of life and human enjoyment of a healthy environment depends on enough knowledge of oneself, seeking help from Allah, and following the Qur’anic guidelines. These facts effectively control internal and external causes of environmental degradation, including ignorance, egoism, selfishness, and evil temptations. These actions destroy the roots of greed, arrogance, and extravagance in human beings. For this reason, Allah demands humans to develop earth, care for and rescue it from any destruction, avoid extravagance, and observe justice.
Conclusion: Meditating in the Qur’an, the man knows his creative dimensions and environmental degradation factors that are incompatible with nature and are rooted in some of the inner and outer dimensions of human personality. Hence, he will consciously enjoy sustainable development and maintaining a healthy environment. This behavior will then reduce anomalies in the environment on his part.

Background: The aim of this study was to compare, review, and evaluate the studies on patients right in Iran and Iraq.
Methods: This is a review study conducted by searching the Iranian and Iraqi databanks, such as Scientific Information Database (SID), Iranian Research Institute for Information Science and Technology, Iran Medex, Iraqi Academic scientific journals, and Google Scholar for both Iranian and Iraqi articles from 2002 to 2017 using the keywords, such as “Patient Rights”, “Patient Rights Charter”, “Patient Rights Observance”, “Iraq”, “Iran”, and “Patient Awareness and Rights”.
Results: Of a total of 32 Iranian and Iraqi articles, only 25 articles met the aim of our study.
Conclusion: The growing number of articles published indicates that from 1999 forwards, this topic began to attract the attention of Iranian researchers in a gradual manner, as for the Iraqi researchers, their attention has been attracted from 2013 onwards. Also, despite the poor knowledge of physicians about the patients’ rights in Iran, they have shown acceptable awareness and attitude regarding some patients’ rights. The same is true for Iraqi doctors and health care providers, but they have shown unsatisfactory consequences for some of the rights of Iraqi patients. Patient education through media and careful observation of the patient rights charter, and educating healthcare professionals, and developing professional training on patients’ legal rights by engaging them in educational sessions and lectures on patient rights is necessary. Adequate monitoring of practice according to the patient charter is strongly suggested.

Background: Clinical trials are the golden key in medical science research with human participants. They have always been considered interesting topics by researchers and scientists working in this field. However, the samples are “human participants,” so the research should be carefully conducted.
Methods: In the present study, the published articles on the ethical challenges of conducting clinical trials were evaluated between 2010 and 2019 in Google Scholar, PubMed, and Scopus. The English search keywords were “clinical trial,” with at least one of the phrases of “ethical consideration” or “standard”.
Results: In this article, we examined the ethical requirements and considerations in these research studies in four stages: research design and question, proposal review and approval, supervision and implementation, and publication of the results. We have examined them using relevant articles published between 2010 and 2019 and identified important and prominent issues or neglected ones.
Conclusion: During this study, it was found that the “research design and question” stage was the most discussed and challenging stage, and the authors’ sensitivity about it has been more than the other three stages. On the other hand, the “results publishing” stage has been considered less sensitive with the least number of references in articles.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic promptly became a significant public health challenge with extra-pulmonary manifestations, including liver damage. Postmortem examination is crucial for gaining a better understanding of these manifestations and improving patient management. This study summarized the current knowledge of the postmortem liver pathology of patients with COVID-19.
Methods: This review was conducted on studies evaluating the postmortem macroscopic and microscopic findings of the liver in patients with COVID-19. Accordingly, we searched 4 electronic databases (PubMed, Scopus, Google Scholar, & Web of Science) until June 2021. From the 317 screened articles, 16 articles examining a total of 332 patients who had died due to COVID-19 were selected.
Results: The significant findings of the liver were moderate macro and microvesicular steatosis with mild sinusoidal dilation, active lobular and portal vein thrombosis, mildly-increased lymphocyte filtration in sinusoidal space, and multifocal hepatic necrosis. Additionally, the most common comorbidities were hypertension and other metabolic diseases. In conclusion, liver damage due to COVID-19 infection has various manifestations in patients who have expired due to COVID-19.
Conclusion: Therefore, monitoring liver function during the course and treatment of this disease is necessary for better patient management and to decrease the COVID-19-induced mortality rate COVID.

Amphetamines and methamphetamines are two groups of substance whose use are increasing globally. Methamphetamines poisoning may develop different sympathetic symptoms; however, developing some complications, such as vasculitis, central nervous system involvement, and kidney injury. In this study, we report a case of methamphetamine poisoning that presented with loss of consciousness and developed Thrombocytopenic Purpura (TTP), Disseminated Intravascular Coagulation (DIC), and pulmonary pseud vasculitis

Organophosphate (OP) poisoning is prevalent in developing countries. Toxicity occurs by voluntary injection, inhalation, and absorption. Self-injection is rare. The current case report describes a 61-y/o male with subcutaneous self-injected one cc OP poisoning presenting with delayed drowsiness, nausea, and vomiting. He was treated and presented a good clinical response to treatment with pralidoxime and had a successful recovery. Diagnosis of OP compound toxicity by the parenteral route is a challenge. By observing patients, the dose, and the time between poisoning until the time to start treatment, we can conclude different presentations and outcomes of OP poisoning.

Deep Venous Thrombosis (DVT) and Subsequent Pulmonary Thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Accordingly, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, they may end up with fatal thromboembolic events. Here, we report a case of a low-lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings, and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

Background: Methanol poisoning is a life-threatening condition that requires accurate prognosis and treatment. This study aims to evaluate the predictive value of laboratory and clinical variables in methanol poisoning.
Methods: This was an observational retrospective study performed on patients with methanol poisoning. Variables were determined based on the literature review, and patient data were extracted from the patient’s file. The data was analyzed by SPSS software.
Results: There were significant differences between survived group and the dead group in GCS, heart rate, PH and HCO3, serum potassium, serum creatinine, and blood sugar levels, neurological symptoms, requiring intubation, and hemodialysis. Significant differences were not observed in the number of hemodialysis sessions, respiratory rate, age, gastrointestinal symptoms, and PCO2 levels between survived and non-survived groups.
Conclusion: In our study, mortality was significantly associated with low GCS, high heart rate, low PH and HCO3, high potassium, creatinine, blood sugar levels, neurological symptoms, intubation, and hemodialysis. Despite other studies in this study, there was no association between the number of hemodialysis sessions, respiratory rate, age, gastrointestinal symptoms, and PCO2 levels with mortality.