Original Article (Clinical Toxicology)

The Impact of COVID-19 on Intoxication Pattern by Drugs of Abuse in Egypt

Heba Mohamed Aboubakr, Nadia Abd El Monem Kotb, Fatma Shaban, Hanaa Mohamed Samir Elattar, Ezzeldin Shalaby

International Journal of Medical Toxicology and Forensic Medicine, Vol. 13 No. 1 (2023), , Page 39497

Background: Drug abuse is considered a global and growing problem worldwide. Emergency medical care is required for acute intoxication, which adds to the threat of COVID-19. This study aims to evaluate the effect of the COVID-19 pandemic on the pattern of acute toxicity in drug abuse patients admitted to National Environmental and Clinical Toxicology and Research Center (NECTR), Cairo University.
Methods: This comparative study included 978 cases admitted to NECTR during 12 months before the COVID-19 pandemic (2018-2019) and 12 months during the pandemic (2020-2021).
Results: The number of cases during the pandemic was lower than before; adults and men predominate in both periods. During the pandemic, cannabis, heroin, opium, and alcohol showed a mild increase, while the new synthetic drugs, tramadol, and pregabalin, showed a mild decrease. A significant increase in discharges and a decrease in intensive care unit (ICU) admissions were observed during the pandemic. Besides, more oxygen (O2) therapy was required, and more cases died on mechanical ventilation. The worst outcome was associated with old age, male gender, heroin and opium toxicity, and the highest score of poisoning severity.
Conclusion: The COVID-19 pandemic had a definite reforming effect on the pattern of intoxication by drugs of abuse in NECTR, Egypt.

The The Effects of Crocin Supplementation on Sleep Quality, General Health, and Happiness in Elderly Population: A Randomized, Double-blind, Placebo-controlled Trial

Hamidreza Sadeghi-Gandomani, Hamid Reza Banafshe, Zohreh Sadat, Amir Ghaderi, Fatemeh Shirvanizadeh , Mohammad Afshar , Narges Naseri-Borujeni

International Journal of Medical Toxicology and Forensic Medicine, Vol. 13 No. 1 (2023), , Page 38718

Background: Aging is a period of human life in which general health, especially happiness, and hope, may be impaired. Also, sleep quality, general health, and happiness of the elderly begin o decline at this stage of life. The present study aimed to determine the effect of crocin of saffron on sleep quality, general health, and happiness in the elderly population
Methods: In this triple-blind randomized trial, 70 elderly people referred to Kashan health center in 2020 were selected. The study samples were divided into intervention and control groups using computer-generated random numbers to receive 30 mg/d of crocin (2 plus crocin tablet, 15 mg Beck depression inventory [BID]) (n=35) or placebo (2 tablets per day, 15 mg Beck depression inventory [BID]) (n=35), one hour after taking food, for 4 weeks. The sleep quality, general health, and happiness were evaluated at the beginning of the study, 4 and 8 weeks after the intervention. Data were analyzed using Chi-square, independent t-test, and repeated measures analysis of variance (ANOVA).
Results: The two groups were matched in terms of demographic characteristics (P>0.05). The independent t-test showed no significant difference between the two groups in the baseline (sleep quality P=0.55, general health P=0.060, and happiness P=0.83) while a statistically significant difference was observed between the two groups on the post-test (P=0.001) and follow-up for three variables.
Conclusion: The consumption of crocin by elderly individuals had useful outcomes on sleep quality, well-being, and happiness. Given that the efficacy of the psychological drugs is vital, nurses can use natural medications, such as crocin to improve the psychological disorders of elderly people.

Original Article (Forensic Medicine)

Perceptions and experiences of Forensic Medicine Department service recipients and providers during male sexual dysfunction assessment following filing for divorce: a qualitative study in Iran

Minoo Safaei, Raziyeh Maasoumi, Seyed Amirhosein Mahdavi, Laleh Ghadirian

International Journal of Medical Toxicology and Forensic Medicine, Vol. 13 No. 1 (2023), , Page 39138

Background: In the current era, divorce has become quite commonplace. One of the significant reasons for divorce is sexual dysfunction. the aim of this study was to explore the perceptions and experience of Forensic Medicine Department service recipients and providers during male sexual dysfunction assessment following filing for divorce.

Methods: This study was a qualitative study that was analyzed through a content analysis approach. Individual interviews were used for data collection. The data were collected through in-depth semi-structured interviews with Twenty service recipients and nine service providers of Forensic Medicine Department in Tehran from Jan 2022 and ended in March 2022.

Results: The analysis of the data led to the extraction of two main categories, including: existing challenges of the forensic medical system in the sexual assessment process with 3 sub-categories (Absence of the plaintiff during the assessment process, sharing a common room with other clients, The psychosocial pressure associated with a Rigi Scan test) and features of desirable evaluation services with 5 Sub-categories (Service delivery to couples, Service delivery by observing ethical principles, confidentiality and human dignity, Comprehensive physical-psychological-communicative assessment, Service delivery that emphasizes informing couples about the road ahead, Provision of services if the authenticity of the sexual problem is proven).

Conclusion: Based on the results of the present study, Service recipients expected the claimant to be present throughout the evaluation process and to cover the expenses too. Moreover, they expected a better atmosphere to be available for these individuals and that human dignity and ethical principles be safeguarded. Furthermore, based on their opinions, a comprehensive physical-psychological-communicative assessment was necessary and couples should be informed and aware of the process when they enter it –particularly when the complaint is proven to be unreal, and all evaluations should be performed on both spouses, not just one.

Estimation of Gender and Age Based on Three-dimensional Computed Tomography Scan Indices of the Twelfth Thoracic Vertebrae and the First and Fifth Lumbar Vertebrae in Iranian Adults

Seyed Reza Saadat Mostafavi, Ramin Emami, Azadeh Memarian, Siamak Soltani, Omid Motamedi, Mohammadreza Khaleghi, Shirin Habibi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 13 No. 1 (2023), , Page 39171

Background: Gender identification is a crucial starting point in creating a biological profile for human skeletal remains because it reduces the number of possible matches by 50%. The vertebrae (especially the chest and back) can also be some of the best-preserved skeletal elements in some areas of forensics and archeology. In the present study, gender and age were assessed based on the measurement of three-dimensional computed tomography (CT) scan indices of the Twelfth thoracic (T12) vertebrae and the first and fifth lumbar (L1 and L5) vertebrae in Iranian adults.
Methods: The present study was a descriptive study carried out on 200 participants over 18 years of age in 2020. Individuals measuring thoracic and lumbar vertebrae diameters (T12 and first and fifth lumbar vertebrae) by three-dimensional computed tomography (CT) scan (Toshiba, Japan, 16-Slice) with multiplanar reconstruction (MPR) and volume rendering were placed in two sagittal and horizontal sections.
Results: The mean age of male and female participants was 34.62±9.63 years and 34.10±9.70 years, respectively, which were not significantly different (P=0.789). The present study showed that the mean indices for T12, L1 and L5 vertebrae were significantly higher in males (P>0.05). The results also showed that T12, L1, and L5 indices of nuts are not good predictors for age estimation.
Conclusion: Based on the results, the indices of the T12 vertebrae and the L1, and L5 vertebrae can be used to determine gender, but these indices are not a good criterion to estimate age and do not have the necessary accuracy to predict the age variable.

Systematic Review Article

Methotrexate-induced Toxicities in pediatrics with Malignancy: A Systematic Review and Meta-analysis

Somayeh Gharibi, Amal Saki Malehi; Hadi Jafari ; Fakher Rahim

International Journal of Medical Toxicology and Forensic Medicine, Vol. 13 No. 1 (2023), , Page 39863

Objective: An anticancer and anti-inflammatory drug broadly applied to treat various diseases is Methotrexate (MTX). A variety of patients are more prone to toxicity, and a variety of them resist chemotherapy. The relationship between MTX-related toxicities and pharmacogenetics has been investigated by most studies, and there is not much data on the relationship between the type of toxicity and MTX dosage.

Material and Methods: In this meta-analysis, 63 studies focusing on the association between MTX dosage and MTX-related toxicities were evaluated.

Results: As shown in our pooled analysis, mucositis has a higher prevalence (P= 0.3, 95%CI (0.21, 0.4)) versus other toxicities, followed by hepatic toxicity (P= 0.25, 95%CI (0 0.18, 0.32)), and hematologic toxicity (P= 0.42, 95%CI (0.25, 0.6)); however, the lowest prevalence was in dermal toxicity (P= 0.17 [95%CI (0.07, 0.28)). According to the result, a significant prevalence was seen in different dosages in all toxicity (except the hematologic toxicity). Also, the 12 mg dose exhibited higher toxicity than other doses.

Conclusions: One of the major leading treatment restrictions is MTX-related toxicities. Lower response to treatment, especially in pediatrics, accompanies this therapy interference. Treatment efficacy can be improved by understanding susceptible factors for developing adverse events and replacing MTX.

A Systematic Review of the Possibility of Determining Age Based on DNA Methylation of the ELOVL2 Gene in Human Samples

Foroozan Faress, Maryam Ameri, Marzieh Mojbafan, Mohammad Aminifard, Sayed Mahdi Marashi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 13 No. 1 (2023), , Page 39298

Background: In forensic medicine, predicting the age of a victim or suspect can be a clue to solving a crime. Epigenetics has recently played a vital role in age prediction in forensic medicine. Cytosine methylation at cytosine and guanine separated by phosphate (CpG) sites is well recognized as a novel epigenetic marker for age estimation. This study aimed to summarize the information obtained from previous studies to determine age by evaluating DNA methylation in the ELOVL2 gene.
Methods: In this systematic review, all related articles published between 2012 and 2022 were extracted by searching reputable scientific databases, such as ISI Web of Science, Science Direct, PubMed, and Scopus. After selecting the appropriate articles, the full text of the articles was prepared and fully evaluated by the researchers. The protocol of this study was carried out based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.
Results: Out of 307 articles, 5 articles were eligible for review according to the study protocol. The strongest correlation between DNA methylation and age was observed at sites 11044644 and 11044634 on chromosome 6 in the living cases. The relationship between the chronological age and the age calculated through DNA methylation was above 90% with an approximate error ranging from 7.5 to 10.4. However, the relationship between the chronological age and the age calculated through DNA methylation was above 90% in the multivariate analysis of sites 11044624 and 11044634 on chromosome 6. In this case, the calculation error reached approximately 6.9 years. Hence, considering a combination of multiple cytosine and guanine separated by phosphate (CpG) sites improves the calculation accuracy and reduces the error percentage. The relationships between DNA methylation and the age at sites 11044880 and 11044640 on chromosome 6 were significantly less reported in the blood samples taken from the dead and in those taken from the living (nearly 64%–78.5%).
Conclusion: The results of this study indicated that DNA methylation in the ELOVL2 gene could help predict a person’s biological age.

Case Report

An Autopsy Case of Drowning Under the Influence of Etizolam: A Case Report

Sella Takei, Hiroshi Kinoshita, Mostofa Jamal, Tadayoshi Yamashita, Etsuko Tanaka, Sachiko Kawahara, Hiroko Abe, Shoji Kimura

International Journal of Medical Toxicology and Forensic Medicine, Vol. 13 No. 1 (2023), , Page 40000

A fatal case of drowning under the influence of etizolam is presented. Quantitative toxicological analysis revealed etizolam concentrations of 0.50 µg/mL and 0.068 µg/mL in femoral venous blood and urine, respectively. According to the autopsy findings, the results of toxicological examinations, and the investigation by the authorities, it is concluded that the cause of death is drowning under the influence of etizolam.