International Journal of Medical Toxicology and Forensic Medicine

Background: Suicide is one of the most important psychological emergencies and it is necessary to deal with it. The goal of this study was to evaluate the frequency of suicide attempts, suicide re-attempt, and guesstimated risk factors in suicidal patients in the poisoning ward of Loghman Hakim Hospital.
Methods: This study was performed on suicidal patients in Loghman Hakim hospital in 2021 (January to August). The suicide attempt and the type of mental disorder were confirmed by a psychiatrist and the data sheets were completed. The sample size was 500 cases based on previous similar studies.
Results: Three hundred fifteen cases attempted suicide for the first time and 185 had a history of suicide. In both groups, the numbers of women were significantly more than men. In addition, 196 cases of the first group and 121 cases of the second group were under 30 years old and 65.1% of cases with first-time suicides and 62.2% of cases with suicide re-attempts were unemployed. In both groups, the most common drug for suicide was benzodiazepines (30.5% and 21.6%). Unfortunately, two patients died. Also, 67.6% in the first-time suicide attempt group and 57.3% in the suicide re-attempt group had adjustment disorder. No significant differences were observed between both groups in terms of gender, age, marital status, education, chronic disease, drug and habit history, employment status, diagnosed mental disorder, and type of drug used for the current suicide.
Conclusion: Young age, unemployment, mental disorders (especially adjustment disorder), and female gender are the most important risk factors for a suicide attempt and re-attempt.

Background: Organophosphates are among the most common causes of poisoning worldwide—responsible for 3 million poisoning and 200000 deaths every year. Nearly 15% of people who are poisoned die. This cross-sectional toxicological/clinical study aimed to investigate the prevalence and influential factors in the incidence of delayed peripheral neuropathy and intermediate syndrome in acute poisoning with organophosphorus toxins. The study was conducted in Loghman Hakim Hospital, Tehran City, Iran, from 2017 to 2020.
Methods: The study data were obtained from the patients’ records during follow-up. Data included demographic information (age, sex, etc.), vital signs, muscarinic, nicotinic, and neurological symptoms at admission, atropine therapy status, and pralidoxime intake status. Post-discharge complications were obtained, and patients’ Electromyography (EMG) and Nerve Conduction Velocity (NCV) results were recorded and evaluated during hospitalization and follow-up. Statistical analysis was performed using SPSS software, version 22.
Results: Of 63 studied patients, 61.9% were female. The Mean±SD age of the patients was 31.90±13.128 years. Male patients were significantly (P<0.010) older than female ones. The most common muscarinic symptoms were nausea and vomiting (73.2%), diarrhea (34.92%), and abdominal pain (33.33%). Regarding the nicotinic symptoms, sweating (30.16%) and fasciculation (19.05%) were the commonest. Neurological complications were less common; seizures were observed in 3 cases (4.76%) and coma in 2 cases (3.17%). Most patients (79.4%) received pralidoxime with atropine. The Mean±SD days of treatment with atropine and pralidoxime were 5.51±3.52 and 4.06±4.62 days, respectively. Only one death was recorded. The results of the initial EMG-NCV test on the second day of hospitalization showed abnormalities in 4 patients (6.3%), indicating the presence of the intermediate syndrome.
Conclusion: The results of the EMG-NCV tests at our patients’ follow-up (30 days) showed no abnormalities. Hence no cases of delayed neuropathy were seen. During hospitalization, one patient had flaccid paralysis and showed significant impairment on the EMG-NCV test (P<0.01).

Background: Wheat is frequently contaminated by deoxynivalenol (DON) and nivalenol (NIV), which are type B trichothecenes produced by Fusarium fungi. Most problems related to these contaminants involve prolonged feed intake at low levels of contamination. This study investigated the occurrence of NIV and deoxynivalenol (DON) in wheat flour in flour factories in Khuzestan Providence, Iran.
Methods: In total, 104 samples were collected in this study. An acetonitrile/water mixture (84:16, v/v) was used to extract the samples. The extracts were filtered and purified using a Whatman No. 4 paper and MycoSepTM 227 column. Then, they were evaporated to dryness at 40˚C under a nitrogen stream. After dissolving the dry residue in the mobile phase, containing a mixture of methanol, acetonitrile, and water (5:5:90, v/v/v), the contents of NIV and DON in the samples were measured in High-Performance Liquid Chromatography (HPLC) system with a column C18 (150 mm×4.6 mm ID, 5 µm) and a UV detector (220 nm).
Results: The results showed that among 104 wheat flour samples, 28 (26.8%) and 54 (51.9%) samples were contaminated with NIV and DON, respectively. The mean and maximum concentrations were 118.75 and 2278 ng/g for NIV, and 593 and 67.88 ng/g for DON, respectively.
Conclusion: Based on the findings, DON and NIV had significantly lower concentrations than the maximum tolerated level (1 µg/g), established by the Institute of Standards and Industrial Research of Iran. Therefore, there were no health risks for consumers at the studied contamination levels.

Background: Analyzing recovered evidence, such as blood which is one of the most encountered types of biological evidence, can provide information to establish the definite time when a crime was committed. This study aims to investigate the time- and temperature-related effects on human bloodstain’s α-globin messenger RNA expression and to estimate the bloodstain’s age using α-globin mRNA.
Methods: A total of 22 blood samples were collected from healthy middle-aged volunteers (12 women and 10 men). After preparation, the samples were exposed to temperatures of 4°C, 24°C, and 40°C. Next, the mRNA expression of the α-globin gene was quantified by real-time RT-PCR at different time intervals of 0, 30, 90, and 150 days.
Results: The α-globin gene expression showed the highest mean values by 0 day and at 4°C and the lowest mean values by 150 days and at 40°C. Samples from male participants showed higher mean values of α-globin gene expression compared to their female counterparts. A significant negative correlation was detected between α-globin gene expression and time interval. Meanwhile, a regression equation was formulated to estimate the time interval using the α-globin gene concentration.
Conclusion: α-Globin mRNA could be a useful marker to estimate the age of human blood spots.

Background: Exhumation is the process of removing the dead body from the grave. The reasons and time limit for exhumation may vary from country to country. After receiving a request from the Magistrate, exhumation followed by postmortem is done to gain essential evidence.
To comprehensively analyze the exhumation cases done in Victoria Hospital, Bangalore, and how exhumation followed by postmortem examination aids in finding the cause of death.
Methods: All cases of exhumations performed for 10 years (from January 1, 2012, to December 31, 2021) in the Department of Forensic Medicine and Toxicology, Victoria Hospital, Bangalore, were studied retrospectively. The essential data were collected from requisition forms, exhumation, and postmortem reports. The results were obtained after tabulating, and data were analyzed with an observational method.
Results: A total of 37 exhumation cases were done during the study period. Young males in the age group of 21 to 30 years were the major population. Out of 37 cases, the cause of death was established in 25 cases (68%).
Conclusion: Analysis of postmortem examination in exhumed cases gives much information from a medicolegal point of view to determine the cause and reveal the mysteries behind the manner of death. Hence it is not a vain procedure.

Background: Violence against medical assistants (residents) by colleagues is a serious problem at educational hospitals that has not been sufficiently examined. The present study was conducted to determine the prevalence, risk factors, and types of violence perpetrated by colleagues against medical assistants.
Methods: In a cross-sectional study conducted at two large tertiary referral educational hospitals, the study questionnaires were distributed among 480 healthcare professionals to investigate their experiences of violence.
Results: Of 280 responders, 162 residents (57.9%) reported a history of violence or aggression. Of these, nearly 50% had experienced pure psychological violence, and 16.7% had been physically abused. The prevalence of victimization was high among the residents of the neurosurgery, orthopedic, and obstetric departments (90%, 88%, and 85%, respectively).
Conclusion: Harassment experience was more common among the surgical residents than the internal medicine residents because of the former’s high level of work stress. Senior residents or fellowship residents were the main abusers. Losing professional self-esteem, decreasing job satisfaction, and dropping out of school were the main adverse outcomes of violence experienced by the victims.

Background: COVID-19 is associated with a high rate of thromboembolic events in hospitalized patients, but it is unclear whether this risk remains high after discharge. This study aimed to evaluate the association of underlying factors with post-discharge thrombolytic events in COVID-19 patients and the association of thrombolytic events with subsequent mortality and ischemic heart disease.
Methods: In this study, eligible patients with COVID-19 who were admitted to the respiratory ward of Loghman Hakim Hospital, Tehran, Iran, followed up for about 3 months after discharge to record any thromboembolic events. Patients who reported post-discharge thromboembolic events were confirmed based on their diagnostic tests. The Chi-square test was used to evaluate the association between thromboembolic events and qualitative parameters, and an independent t-test was used to evaluate their association with quantitative parameters. Logistic regression analysis was performed to assess the association between independent variables and the composite outcome.
Results: Thromboembolic events were diagnosed in 35 patients (5.04%), including Myocardial Infarction (MI) in 17 patients (2.44%), venous thromboembolism in 10 patients (1.44%), and ischemic stroke in 8 patients (1.15%). None of the 26 patients who received thromboprophylaxis had thromboembolic events. During follow-up, 22 patients (3.17%) died, of whom, 10 patients (43.47%) had thromboembolic events. Thromboembolic events were not associated with sedentary life and oxygen (O2) dependency after discharge (P value of 0.40 and 0.098, respectively). Regression analyses showed that thromboembolic events were significantly associated with ischemic heart disease and mortality (P=0.007 and P<0.001, respectively).
Conclusion: Our findings support a high rate of post-hospitalization thromboembolic events in COVID-19 patients; however, it needs more large-scale trials.

Suicide by high-speed railway track trauma with complete decapitation is a rare event; however, it is well known and reported in the scientific literature. The authors analyzed 5 cases of suicide with complete decapitation along with upper limb amputation or severe injury by high-speed mainline train subjected to medico-legal autopsies at the Department of Forensic Medicine and Toxicology, Gandhi Medical College, Bhopal between 2019 and 2021. Upper limb injury is considered because of scientific reasons that they have been amputated along with decapitation. Personal, circumstantial, autopsy, and toxicological data and thevictim’s psychical profile were analyzed, and factors like the type of injury, the vital reaction of wound edges, absence of any signs of defense, alcohol, and drug consumption were also considered.

Background: Erb-Duchenne palsy is one of the common paralysis disorders in childbirth. Shoulder dystocia, obesity, anatomic pelvic disorders, and physicians’ incompetency are involved in Erb’s palsy. Performing standard maneuvers while delivering the baby can minimize such complications. This study aimed to answer the legal and ethical questions regarding the civil responsibility of physicians regarding Erb’s palsy and to express educational points of view.
Case Presentation: This study reports a 20-year-old female who attended legal consultation due to right arm plegia that happened after her childbirth. In such cases, medical professionals’ indemnity introduces them as accountable ones, and if their actions are not consistent with the guidelines and up-to-date medical textbooks, they are responsible for the sustained injury and are to be penalized and compensated.
Conclusion: Obstetricians and other medical professionals should undertake suitable education through a student’s curriculum and continuous professional development program, which complies with their legal and civil responsibilities.