International Journal of Medical Toxicology and Forensic Medicine

Background: Children with Attention-Deficit Hyperactivity Disorder (ADHD) have deficiencies in their executive functions and also impulsivity that can result in various social harms and criminal behaviors.
Methods: The research had a two-group semi-experimental design (case/control) with a pre-/post-test. The statistical population consisted of all students’ mothers aged between 7 and 12 years old suffering from ADHD. The studied samples included 30 parents matched based on age and randomly divided into the case and control groups with 15 people in each group and were examined from 2nd February to March 2020. Positive parenting training was performed for the case group in eight sessions of 90 minutes by observing all protocols. Both groups experienced pre- and post-test. We applied the BRIEF (parent form) and Canners (parent form) questionnaires to collect data. Data were analyzed by MANCOVA using SPSS v. 26 software at a significance level of 0.05.
Results: The studied samples were in the age range of 22-40 years (Mean±SD: case group: 32.93±6.04 years and control group: 34.13±5.47 years), 56% with education lower than diploma (0.60% and 46.7% for the case and control groups, respectively), and 44% had an official business (0.40% and 46.7%, respectively). Results showed significant differences in the variables of executive functions (inhibition, attention transfer, emotional control, initiation, working memory, planning, material organization, and control) and reducing impulsivity (cognitive problems-neglect, hyperactivity, opposition, and ADHD index) in the control and case groups.
Conclusion: Positive parenting training significantly affects improving executive functions and impulsivity in children aged between 7 and 12 years old suffering from ADHD. Accordingly, it is achievable to help modify their social behaviors and also decrease the amount of conflict and legal problems among these children by providing a codified positive parenting training program in their educational programs.

Background: Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020.
Methods: This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient’s files and analyzed with appropriate statistical tests.
Results: Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients.
Conclusion: Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication.

Background: Rotenone, a chemical compound produced naturally by leguminous plants, has conventionally been used as a pesticide by blocking the uptake of oxygen by body cells. Our study aimed to investigate the effect of spirulina on oxidative damage, inflammation, and neurotoxicity in male mice treated by rotenone.
Methods: The experimental animals were divided into 5 groups. Group (I) served as control that received Dimethyl Sulfoxide (DMSO); Group (II) mice treated with rotenone (1.5 mg/kg, s.c.3 times per week); Group (III) mice received rotenone/L-dopa (25 mg/kg, P.O. daily); Group (IV) and Group (V) mice were treated with rotenone/spirulina (200 and 400 mg/kg, P.O. daily) respectively for two weeks.
Results: Rotenone-treated mice indicated impaired motor coordination and activity in wire hanging, wood walking, open field, and stair tests. Furthermore, rotenone treatment caused elevation in striatal levels of Malondialdehyde (MDA), Nitric Oxide (NO), Tumor Necrosis Factor (TNF-α), Interleukin -1 beta (IL-1β), and caspase 3 and decrement in Bcl-2; dopamine and Glutathione (GSH) levels. Moreover, severe neuronal degeneration, striatal DNA fragmentation, and increased striatal 8-OHdG levels and MTH1 expression in the rotenone group. Additionally, spirulina treatment prevented rotenone-induced motor deficits striatal DNA fragmentation and demonstrated good restoration of the substantial neurons with reservation of the typical dark appearance. Besides, rotenone-induced biochemical changes were ameliorated by spirulina treatment as dopamine, Bcl-2, and GSH levels were increased, and striatal MDA, TNF-α, IL-1β, and caspase 3 levels were decreased.
Conclusion: Natural products like spirulina could reverse rotenone-induced neurotoxicity in male mice due to their anti-inflammatory and antioxidant properties.

Background: The current status of medical malpractice in Tehran medical centers is unclear, while understanding the situation may help the authorities carefully plan, continuously monitor and, consequently, be sensitive to eliminate the weaknesses. Hence, the present study aimed at investigating the existing problems.

Methods: In the present Descriptive and cross-sectional study, all patients complaining of the medical staff of public hospitals affiliated to three medical sciences universities (i e, Tehran, Iran, Shahid Beheshti, and Baqiyatallah) were evaluated in terms of demographic characteristics, physicians gender, the type of hospital, the type of specialty, the type of staff, and reason for complaint (disability, death) using a data collection form, and the results were analyzed in SPSS version 18 using the Chi-square and Fisher tests. P-value <0.01 was considered the level of significance.

Results: Most of the filed complaints were against hospitals affiliated to Tehran and Shahid Beheshti universities of medical sciences, and 66% against private centers. Most cases won in the court were against general practitioners, dentists, general surgeons, and hospital technicians. The number of malpractices proven for teaching hospitals was significantly lower than that of non-teaching ones. Given the prevalence of plastic surgery in Iranian society, the number of complaints filed from female patients was two-thirds of male ones; almost 50% aged 21-40 years. For some reason, more than three-fourths of wrongful death complaints were for female patients.

Conclusion: Complaints of medical malpractice in hospitals are an integral part of physicians and nursing staff work, as the saying goes: an unwritten dictation has no errors.

Background: Stature and gender are essential parameters of forensic anthropology. Moreover, their estimation is critical for medico-legal investigations to identify unknown remains. The present study aimed to estimate stature and gender by the anthropometric dimensions of the Iranian population’s third, fourth, and fifth fingers.
Methods: In this cross-sectional study, 199 individuals (99 men & 100 women) were included. Individuals’ demographic information was recorded. A caliper measured the length of the fingers. An anthropometer was used for the measurement of stature. The obtained data were analyzed using SPSS. A multivariate linear regression test was used to predict the stature of individuals based on finger length.
Results: In males and females, a solid and positive direct relationship was observed between the length of the third, fourth, and fifth fingers of the hand with the stature of individuals and between the length of the fingers with each other. In the coefficient table of the regression model of this study, in males, the length of the fingers was not predictive of stature, and only the length of the third finger in females had a predictive effect on stature.
Conclusion: According to the obtained results, stature is predictable in women through the third finger length using the derived regression equation.

Background: Mental health issues and quality of life are among the critical items of general health in individuals, especially transgender subjects. The present study aimed to assess the quality of life, depression, anxiety, and stress in transgender women and determine the factors contributing to them.
Methods: A cross-sectional study was performed on 127 Iranian transgender women using a convenience sampling method from August 2019 to April 2020. The Quality of Life (QOL) was determined using the World Health Organization (WHO) Questionnaire (WHOQOL-BREF). The DASS-21 questionnaire was employed to evaluate the subjects’ anxiety, depression, and stress.
Results: In total, 48% of the individuals had a moderate QOL. The highest score was achieved in the physical health dimension and the lowest in social relationships. Depression, anxiety, and stress were severe and extremely severe in 22%, 20.4%, and 17.3% of the subjects, respectively. A significant relationship was observed between the overall perception of QOL and depression, anxiety, and stress (P<0.001).
A significant positive association was observed between the subscales of QOL and education and favorable economic status among transgender women. Furthermore, a significant negative correlation existed between the subscales of QOL with age and sexual violence. Regarding mental health, education had a significant relationship with reduced stress and anxiety, and good economic status had a significant relationship with reduced depression. Still, sexual violence was associated with increased stress in individuals.
Conclusion: The present study results emphasize that transgender women are at risk of mental health disorders, including depression, anxiety, and stress. These conditions are in close association with the quality of life in this population. Moreover, considering the high sexual violence in transgender women of the present study and its considerable effects on mental health disorders, there is a strong need to develop violence prevention services in the community and legal protections in this area. The culture of preventing violence against women in society should be emphasized, and education to families should be considered the first line of prevention.

Background: Childbirth is among the most significant and pleasant events in a woman’s life. This event can be a traumatic event and a threat to the mother’s mental health. This study recognizes the relationship between Post-Traumatic Stress Disorder (PTSD) after childbirth and social support and marital satisfaction.
Methods: This Cross-sectional analytical study was performed on a sample of 400 mothers who had delivered at Shohadaye-15-Khordad Hospital in Varamin (in two groups with & without PTSD). The research instruments include the Demographic, Midwifery, Neonatal Factors checklist, Enrich Marital Satisfaction, Weinfeld and Tigman Social Support, and the PTSD Symptoms Scale. We used SPSS to analyze the descriptive and Pearson correlation and logistic regression data. A P<0.05 was considered significant.
Results: The prevalence of PTDS in this study was equal to 16.8%. There was no significant correlation between the mean of the total score of PTSD in all dimensions with social support. Marital satisfaction significantly affected the probability of PTSD after childbirth (P=0.001). There was a significant correlation between PTSD total score and dimension of avoidance symptoms and infant gender (P=0.038). There was also a significant correlation between gestational age and avoidance symptoms (P=0.001) and type of nutrition feeding and motivational symptoms (P=0.041) of PTSD dimensions.
Conclusion: According to the relationship between marital satisfaction and PTSD, it is recommended to design suitable interventions to improve the marital status and promptly diagnose the susceptible mothers to prevent the spread of this complication.

Background: Patient safety is among the main goals in a health system. Medical errors are considered a significant threat to patient safety. An effective strategy to reduce this risk is reporting these errors even when the patient is not affected. This study investigated the main barriers to reporting medical errors and related factors.
Methods: This cross-sectional descriptive study was conducted in academic hospitals afflicted with Guilan University of Medical Sciences (GUMS) in 2020. University faculty members and residents enrolled in the survey, and a questionnaire was filled out via a face-to-face interview by the responsible resident of anesthesiology.
Results: Overall, 366 individuals, 156 faculty members, and 210 residents completed the questionnaires. Overall, 271 (74.2%), 134 (85.9%) faculty members, and 137 (65.6%) residents, the main barrier to report medical errors was concerning legal consequences. Furthermore, the other important factors were concerning losing job credit (63.4%) and losing the patient’s trust (61.2%). Moreover, the main predisposing factors of medical errors were high workload and a large number of patients (83.3%), long work shifts, and physicians fatigue (80.8%). High job stress and the lack of feeling of support from higher authorities (70.5%), and the lack of adequate equipment and appropriate medical facilities (56%) were the most related factors based on their perspective.
Conclusion: According to the obtained findings, the main barrier to reporting medical errors was legal consequences. Moreover, the main predisposing factors were high workload, many patients, long working shifts, and physicians’ fatigue. Attempts should be made to plan programs to improve the current conditions.

Background: Nanotechnology plays a significant role in medicine, especially in diagnosis and treatment as a carrier to drugs and vaccinology. Several studies were conducted using nanoparticles as an adjuvant. The main aim of this study was in vivo and in vitro toxicity evaluation of synthesized Cerium Nanoparticles (CeNPs).
Methods: In the present study, cerium nanoparticles were prepared using the wet chemical method. The formation of cerium nanoparticles was confirmed by scanning electron microscopy, transmission electron microscopes, x-ray diffraction analysis, dynamic light scattering. In vivo and in vitro toxicity of synthesized nanoparticles was evaluated in three different amounts of cerium nanoparticles (30 µg, 50 µg, & 100 µg) in mice and human fibroblast cell lines, respectively.
Results: Cerium nanoparticles were successfully synthesized, and the identity was confirmed by x-ray diffraction analysis. The shape and size of nanoparticles were spherical. The prepared nanoparticles had a charge of -26.6 mV and a hydrodynamic radius of 446 nm. MTT assay indicated that none of the concentration of cerium was toxic, and in vivo toxicity also clarified the safety of cerium nanoparticles in mice; no significant un-normal behavioral and physical symptoms were observed in mice after CeNP administration
Conclusion: Cerium nanoparticles have special properties, especially low toxicity, unique capabilities in stimulating the immune system. Cerium nanoparticles can be considered an effective and safe candidate in vaccines.

Background: A substantial body of evidence indicates that methamphetamine abuse can lead to persistent and severe cognitive dysfunction. Preclinical studies and early pilot clinical investigations suggested that atomoxetine, a cognitive enhancer, may improve cognitive dysfunction. The present study evaluated whether atomoxetine would affect cognitive dysfunction in methamphetamine-dependent patients.
Methods: Participants with methamphetamine dependence (N=86) under Methadone Maintenance Therapy (MMT) were enrolled in a double-blind, placebo-controlled, randomized clinical trial. This investigation was performed on 86 subjects to consume either 40 mg/day atomoxetine (n=45) or placebo (n=41) for 8 weeks. Between January 2016 and June 2017, volunteers were selected from methamphetamine abusers in MMT centers in Kashan City, Iran. They completed the Cognitive Abilities Questionnaire at the first and each monthly visit to assess the cognitive functions. The collected data were analyzed using the Independent Samples t-test, Mann Whitney U test, and Chi-square in SPSS software.
Results: This study revealed that atomoxetine treatment improved some cognitive dysfunctions in methamphetamine users, including memory, inhibitory control, selective attention, decision-making, planning, sustained attention, and cognitive flexibility in methamphetamine users; however, social cognition improvement was less than others (P=0.107). There were only mild adverse effects in the placebo and atomoxetine groups.
Conclusion: The obtained findings indicated the efficacy of atomoxetine for improving cognitive dysfunction in methamphetamine users and suggest the potential effectiveness of atomoxetine for treating them.

Background: Tramadol (TR) is a synthetic opioid-like centrally acting analgesic used for moderate to severe pain management in various diseases. Numerous investigations have supported the association between tramadol use and increased levels of oxygen-free radicals. Mass production of reactive oxygen species produces secondary toxic compounds. This could damage the internal components of the cell and ultimately causes organ damage. There exists a growing trend of tramadol abuse and the increasing reports of poisoning, abuse, and mortality due to this drug. Thus, the present study aimed to review the animals and human studies on the effects of acute and chronic exposure of tramadol in inducing organ toxicities through oxidative stress.
Methods: Pubmed, Google Scholar, and Scopus bibliographic databases were searched for studies that investigated oxidative stress as a mechanism of toxicity by tramadol. A manual search of reference lists of the retrieved articles was conducted. Data were collected from 2000 to 2021 (up to June 2021).
Results: From 28 articles concerning experimental and human studies of TR-induced oxidative stress organ damage, which included in this review, the occurrence of lipid peroxidation, alteration in the levels of total antioxidant capacity, and other oxidative stress biomarkers in many organs such as the brain, liver, kidney, adrenal and lung in the experimental studies of tramadol exposure have been observed.
Conclusion: Oxidative stress could be considered the most critical toxic mechanism in TR-induced tissue damage.