Original Article (Clinical Toxicology)

Hepatotoxicity Among Poisoned Patients: A Cross-sectional Study

Arezou Mahdavinejad, Haleh Talaie, Ali Saffaei, Mitra Rahimi , Sayed Masoud Hosseini

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 38931

Background: Drug-induced liver injury is a major cause of hepatitis worldwide. In patients diagnosed with acute poisoning, drug-induced liver injury is a critical challenge. This study aims to evaluate the pattern of hepatotoxicity in poisoned patients admitted to Loghman Hakim Hospital.
Methods: In this cross-sectional study that was conducted at Loghman Hakim hospital, the clinical records of poisoned patients were evaluated and patients with hepatotoxicity were selected for final analysis. The clinical and para-clinical information of these patients was recorded. The SPSS software, version 23. was used for statistical analysis.
Results: A total of 260 cases were included in this study. The Mean±SD age of patients was 38.24±16.29 years and most of them were male (79.2%). Patients with narcotics poisoning had the highest prevalence (38.5%), especially when they were taken together with acetaminophen or benzodiazepine. In addition, among the patients studied, those with underlying cardiovascular disease are more likely to develop hepatotoxicity.
Conclusion: In conclusion, among people with various types of poisoning, it seems that narcotics (opium, heroin, methadone, etc.), particularly when taken together with acetaminophen or benzodiazepines, cause hepatotoxicity and increase serum levels of liver aminotransferases. Also, in the study population, patients with underlying cardiovascular disease had a higher chance of liver injury. Therefore, clinicians are recommended to accurately monitor the sign and symptoms of hepatotoxicity in these populations.

Predictive Value of National Early Warning Score and Modified Early Warning Score in Outcome of Patients With Poisoning

Saeedehsadat Valiollahzadeh, Ali Ostadi, Farzad Rahmani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 38299

Background: Using different scores to predict the outcome of patients and determine the severity of their illness could be effective in making better clinical decisions and helping patients. The purpose of this study is to determine the predictive value of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) of in-hospital mortality in patients with a suicide attempt.
Methods: In a diagnostic study, we included 453 patients with suicide attempts in the poisoning unit and Intensive Care Unit (ICU) poisoning unit of Sina Hospital from December 2019 to September 2021. Patients’ vital signs and level of consciousness were recorded and then analyzed by statistical methods.
Results: The mean±SD of patients’ age was 31.82±12.28 and the mortality rate was 7.7%. The median (25%-75%) of NEWS and MEWS in all patients was 4(2-7) and 2(1-3), respectively. Based on the Receiver Operating Characteristic (ROC) curve of NEWS, the Area Under The Curve (AUC) (CI95%), standard error, and cut off point were 0.915(0.876-0.995), 0.020, and 7.5 respectively (85% sensitivity and 81% specificity) (P˂0.001). The results of MEWS based on Receiver Operating Characteristic (ROC) curve were 0.87 (0.805-0.932), 0.033, and 3.5 respectively (74% sensitivity and 84% specificity) (P˂0.001).
Conclusion: Based on our study results, we concluded that in hospitalized patients with suicide attempts, the accuracy of NEWS in predicting hospital mortality is higher than MEWS.

Original Article (Forensic Medicine)

The Effect of Temperature on Age Estimation of Semen Stains on Porous Versus Non-porous Surfaces Using Messenger Ribonucleic Acid Measurement

Basma Kamal Ibrahim, Abla Abdelmeguid Attia, Laila Ahmed Rashed , Mohamed Ahmed Abd El Salam, Heba Abdo Abdel Razik

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 38109

Background: While messenger Ribonucleic Acid (mRNA) can be used to identify the type of body fluid, its degradation can also indicate the time interval since it was deposited. This study was conducted to evaluate the effect of temperature on the estimation of the age of human semen stains using mRNA deposited on porous versus non-porous surfaces at different time intervals.
Methods: Ten semen samples were applied on two different media (glass and cotton) and exposed to three different temperatures (4°C, room temperature, 40°C) and examined at three-time intervals (0, 45, and 90 days). The semen-specific mRNA markers protamine 1 (PRM1) and protamine 2 (PRM2) were quantitatively assessed along with a reference gene, beta-actin, using a reverse transcription-quantitative polymerase chain reaction.
Results: Mean Cq values of mRNA markers (PRM1 and PRM2) and the reference gene (beta-actin) increased with time of storage at different temperatures in both examined media. The mean quantification cycle (Cq) values of PRM2 were lower than PRM1, indicating that the levels of PRM2 marker in semen stain were higher than those of PRM1 marker. However, the mean Cq values of PRM2 at each time interval were not significantly different between temperatures, while PRM1 showed statistically significant differences in mean Cq values between temperatures at day 45 in both media.
Conclusion: These results indicate that PRM2 can act as a reliable mRNA marker to estimate the time of deposition of semen stain at different temperatures on two different media.

Determining the Age Range Based on Machine-Learning Methods From Facial Skeletal Angles (Glabella and Maxilla Angle and Length and Width of Piriformis) in CT Scan

Seyed Ali Mohtarami, Aria Hedjazi, Reza Haj Manouchehri

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 38605

Background: One of the main steps in identifying a person in forensic medicine is determining the age of skeletal remains, including the skull. This study aimed to investigate the possibility of predicting age from facial angles (glabella, piriformis, and maxillary angle and measuring peripheral length and width) with artificial intelligence in a CT scan.
Methods: The cross-sectional study method is simple random sampling using a questionnaire. Accurately measurable CT scan samples are selected. For exclusion criteria, gender uncertainty, and the possibility of measurement based on CT scan quality, the researchers examined the facial angles (angle of the glabella and maxilla and length and width of the piriformis) for 100 men and 100 women. The mean±SD of the age was 39.16±2.22 years for men and 47.84±2.46 years for women. The samples were classified based on age differences, and then the data were analyzed using machine learning algorithms to determine the age group.
Results: After determining the exact amount of measurement, the data were evaluated by machine learning algorithms to determine the age group. Accordingly, in the age group classification based on the World Health Organization (WHO) (with an age difference of 10 years) (years±5) with 100% accuracy and in the second classification (with an age difference of 5 years) (years±2.5) with 88% accuracy and 79% precision of the age group was predicted.
Conclusion: The obtained data show the importance of new artificial intelligence methods, including machine learning, in providing new methods to determine age groups (age±2.5) through skull angles with high accuracy in cases where even cranial remains are found in identification in forensic medicine.

Application of the Methylated Markers (Spectrin Beta and DEAD-Box Protein) for Definitive Differentiation Between Fresh and Aged Semen by evaluating Their Role in Identifying Semen From Mixed Body Fluids

Abrar Roshdy Abouelkeir, Abla Abdel Alrahman Ali, Mokhtar Fathi Abdelsatar, Laila Ahmed Rashed, Shimaa Ahmed Alsaeed

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 38615

Background: Semen identification is assumed a crucial proof of sexual assault. Moreover, body fluids at the crime scene of a human being, such as blood, semen, and saliva, are often mixed.
Methods: Hence, in our study, we aimed to use methylation analysis targeting DNA epigenetic markers Spectrin beta chain (B_SPTB_03) and DEAD-box protein (DDX4) to differentiate between fresh semen (less than 4 hours) and aged semen (after 24 hours) as well as to differentiate between semen alone and semen mixed with other body fluids (blood and saliva) in the fresh and dried state.
Results: Our findings showed statistically significant differences in the methylation patterns of the SPTB and DDX4 loci to distinguish semen from mixed body fluids in fresh and old samples. We were able to obtain two novel cutoff values to differentiate between fresh and aged semen, which are (52.25) with the SPTB marker and (70.75) with the DDX4 marker.
Conclusion: It is concluded that the methylation approach based on the epigenetic markers of Spectrin beta chain and DEAD-box protein (B_SPTB_03 and DDX4) successfully identified fresh from aged semen and semen-derived alleles from mixed stains, hence it is recommended to be employed in forensic practice.

Original Article (General Medicine)

Evaluation of Outcome in Patients With Moderate and Severe COVID-19 Via H-Score

Shabnam Tehrani, Hadiseh Shabanpour Dehbaneh, Neda Khabiri, Ilad Alavi Darazam, Shervin Shokouhi, Zahra Sahraei, Mana Zaman, Minoosh Shabani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 37771

Background: Due to uncontrolled lymphocyte reaction, the overproduction of cytokines in COVID-19 patients can cause sepsis-like symptoms, suggesting sepsis, cytokine release syndrome (CRS), and secondary hemophagocytic lymphohistiocytosis (sHLH). Since different therapeutic approaches are used for each diagnosis, differentiation is essential. This study aims to use H-score as a possible prognostic tool in COVID-19 patients.
Methods: A sample of 64 moderate and severe COVID-19 patients was enrolled in this study. Clinical and laboratory findings were assessed. H-score was initially calculated and reevaluated among severe cases 72 hours later and among moderate cases showing severe features of COVID-19.
Results: Mortality of 31.3% was reported. Laboratory findings, including triglycerides (TG), ferritin, and aspartate aminotransferase (AST) showed significantly higher initial and follow-up laboratory assessment levels in severe cases than in moderate cases. Moreover, fibrinogen was significantly higher among severe cases than moderate cases at the initial assessment, but no significant difference was reported in the second fibrinogen assessment.
Conclusion: In this study, H-score was useful as a predictive tool for the initial evaluation of severe cases of COVID-19. H-score is much lower in these patients than in non-COVID-19 HLH patients may be due to the different underlying immunologic pathophysiology of COVID-19; thus, each H-score criterion must be evaluated for sensitivity and specificity in COVID-19 patients. The H-score cut-offs, H-score may be useful for diagnosing immune overreaction and determining the need for more exclusive immunomodulatory treatments.

Examining Side Effects of the Sputnik V COVID-19 Vaccine

Kourosh Eftekharian, Ali Eftekharian, Ilad Alavi Darazam, Latif Gachkar, Sajjad Panahi, Farzin Davoodi, Zahra Babamohamadi Esfand Abadi, Mohsen Fazli

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 38573

Background: As a result of the COVID-19 pandemic, many vaccines were developed to counter the disease, including the vector-based Sputnik V vaccine. This study aims to identify the side effects of the Sputnik V COVID–19 vaccine in a medical center and compare the results with the previous reports.
Methods: A questionnaire-based study was performed after the injection of the first and second doses of the vaccine to assess the side effects experienced by the participants. It was performed by reviewing similar previous studies.
Results: Injection site pain, muscle pain, fever, fatigue, chills, and headache were the most common side effects of the vaccine. The incidence of major side effects decreased with age and was lower in men. In our study and others, the incidence of side effects was decreased in the second dose. In some studies, participants with a previous history of Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCOV-2) infection developed more side effects, especially injection site pain, muscle pain, and fatigue.
Conclusion: Most studies agree with our reported results. Serious side effects of this vaccine are rare and may be considered tolerable in adults.

Case Report

Can Heroin Poisoning Lead To Stomach Necrosis? A Case Report

Mojtaba Ahmadinejad, Elham Valimohammdi, Ghazale Molaverdi, Seydehamideh Hashemi, Mohammad Hadi Bahri, Javad Zebarjadi Bagherpour

International Journal of Medical Toxicology and Forensic Medicine, Vol. 12 No. 4 (2022), 16 October 2022, Page 38932

Introduction: Opiate (including heroin) use prevalence is 1.2% of the world population according to the last report of UNOCD. In Iran about 2 million people of population are drug abusers..Heroin reduces gastric motility and prolongs gastric emptying time and it can cause gastric dilation which can be a reason for gastric ischemia . Gastric ischemia is an uncommon condition do to the rich gastric blood perfusion and collateral arteries . As some of studies show, gastric dilation can be a cause for gastric necrosis.

Case presentation: A 22-year-old woman who presented to our hospital with severe abdominal pain and several episodes of vomiting. The patient declared that she had a history of addiction to methamphetamine and heroin. In abdominal examination, a soft and non-distended abdomen with generalized tenderness, mostly in hypogastric region without rebound tenderness was revealed.Abdominal radiograph revealed a much distended stomach. A non-contrast CT abdomen confirmed severe gastric dilatation. On endoscopy, multiple necrotic lesions were seen throughout the stomach and mostly in the proximal part. Our finding in the laparotomy was gastric necrosis in the proximal part, which resulted in a total gastrectomy. esophagojejunostomy with roux en y reconstruction was done after total gastrectomy.

Conclusion: Opioids can increase the risk of GI dysfunction and they can increase risk of infection in GI tract. In our case ,abuse of heroin caused a gastric dilation and massive gastric necrosis.