International Journal of Medical Toxicology and Forensic Medicine

Background: Recent research has revealed the central adverse effects of Botox after intramuscular injection. The aim of this study was to examine the role of brain oxidative stress factors and circulatory cytokines as indicators of the severity of seizures following acute intramuscular (IM) injection of Botox in mice.
Methods: Botox (1, 5 and 30 U, IM) was injected 60 minutes before inducing maximal electroshock (MES) seizures. Nitric oxide (NO), malondialdehyde (MDA) and glutathione (GSH) levels were measured in the brain. Tumor necrosis factor-alpha (TNF-α) levels were also determined in the serum. The motor coordination was assessed after Botox administration by using the chimney test.
Results: Botox (5 and 10 U/kg, IM) significantly reduced the duration of hindlimb extension (HLE) and elevated levels of NO and MDA in the brain compared to the seizure group. Additionally, the administration of Botox (1 and 5 U, IM) increased the level of GSH in the brain, while 30 U decreased it. All Botox dosages demonstrated an enhancing effect on serum TNF-α levels compared to the seizure group. Botox at 5 and 30 U induced locomotor incoordination in mice.
Conclusion: Our results showed that IM injection of Botox can lead to the exacerbation of tonic-clonic seizures by stimulating oxidative stress in the brain and increasing circulating TNF-α levels in mice.

Background: Each year, a significant number of fatalities caused by drug poisoning are documented globally. Analyzing the pattern of poisonings is crucial for prevention, particularly in decreasing the incidence of suicides. This research aimed to investigate the trend of poisonings from 2019 to 2023 at Loghman Hakim Hospital, Tehran, Iran.
Methods: The present study collected data on gender, age, reasons for poisoning and patient outcomes from the archived records of Loghman Hakim Hospital Poison Center, Tehran, Iran, using the ICD- 10 coding system. Patients were categorized into medication groups following the guidelines in Goldfrank’s book and with input from clinical toxicology specialists. All records underwent a thorough review. The data were analyzed using SPSS software, version 24, incorporating statistical analyses, such as Fisher’s exact and chi-square tests.
Result: A comprehensive analysis was performed on 81,689 patients who had experienced poisoning, with 41336(50.6%) being male and 40353(49.4%) being female. The mortality rate over five years stood at 2.01%. The highest number of fatalities occurred in 2023 and 2022, with 359 cases (21.82%) and 358 cases (21.76%), respectively. Opioid and narcotic poisoning was identified as the primary cause of death, representing 30.33% of the cases.
Conclusion: It is crucial to restrict access to methadone and alcohol. Additionally, the increasing instances of poisonings underscore the societal requirement for government support to alleviate the psychological and economic burdens induced by the coronavirus pandemic.

Background: Unintentional pediatric poisoning with antipsychotic medications represents an important clinical entity. This study aimed to evaluate the epidemiology, clinical manifestations, and outcomes of antipsychotic poisoning among children presenting to a referral hospital.
Methods: This descriptive, cross-sectional study reviewed medical records of children <12 years old hospitalized for antipsychotic drug poisoning at Loghman Hakim Hospital in Tehran from 2015-2016. Data extracted included demographic details, agent and dose ingested, clinical findings, treatments administered, and patient dispositions.
Results: 141 cases were identified, comprising 2.3% of all pediatric poisonings. Patient ages ranged from 6 months to 12 years (mean 5.5 years), with a male predominance (52.5%). The most common offending agents were risperidone (53.2%) and olanzapine (13.4%). Unintentional exposures accounted for 72.3% of cases. Central nervous system (CNS) effects like somnolence (61.7%) and dysarthria (19.1%) were most prevalent. Significant toxicity was infrequent; no fatalities occurred. Mean length of stay was 2 days for uncomplicated admissions.
Conclusion: Antipsychotic poisoning in children chiefly involves atypical agents with a largely benign course. Risperidone predominated due to prescribing patterns. Somnolence represented the principal clinical manifestation. With reasonable supportive care, favorable outcomes are achievable in the pediatric population.

Background: Cyanide is a very toxic chemical that reacts with the ferric cytochrome oxidase in the mitochondrial system to form a stable complex. This complex inhibits the process of oxidative phosphorylation, thereby interrupting aerobic respiration in the organism. It is postulated that activated charcoal (AC) intercepts the ingested cyanide in the gastrointestinal tract before it is absorbed into the system.
Methods: A single dose of 3 mg/kg body weight of potassium cyanide (KCN) was orally administered to the rats in each of the five groups, each consisting of 6 rats. After 15 minutes, all rats in each group were given AC from different agro-based materials. The control group (group 1) received standard commercial AC orally at 1 g/kg. group 2 received AC from plantain peels, group 3 received AC from castor oil seed shell, group 4 received AC from coconut shell and group 5 received a combination of AC from plantain peels, castor oil seed shell, and coconut shell. Blood samples were collected sequentially from rats in each group for biochemical assays using standard procedures.
Results: The control group, which received KCN and standard commercial AC, exhibited the highest alanine transaminase (ALT) value (60.09±0.10 U/L) on day seven. Similarly, the highest aspartate transaminase (AST) value (196.28±0.72 U/L) was observed in the control group. Alkaline phosphate (ALP) levels followed a similar pattern. On day seven, the serum creatinine levels were 3.81±0.11 mg/dL for group 1 and 3.45±0.05 mg/dL for group 5. Subsequently, all biochemical parameters decreased after day 7, with the lowest levels recorded in rats that received AC derived from coconut shells.
Conclusion: The administration of locally prepared agro-based adsorbents to Wistar rats after exposure to sublethal doses of cyanide significantly mitigated the effects of the cyanide on the liver, kidneys, and heart, as indicated by the biochemical parameters of the albino Wistar rats in the study.

Background: Hair samples are recognized as alternative biological specimens in forensic and clinical toxicology for detecting drug abuse and poisoning. Forensic testing for opioids in hair has become a useful diagnostic measure for assessing chronic drug usage through segmental analysis. However, accurate, sensitive and specific analytical methods are needed. The aim of this study was to introduce a simple, sensitive and specific GC-MS method for the identification and quantitation of selected and commonly abused opioids (tramadol, methadone, morphine, and codeine) in hair samples.
Methods: After external decontamination, a 50 mg portion of powdered hair sample was combined with hydrochloric acid (0.1 M) and incubated on a magnetic stirrer at 56°C for 16 hours. Then, 1 mL of sodium hydroxide (0.1 M) and 2 mL of phosphate buffer (1 M, pH=8.4) were added. Chloroform-isopropanol (ratio: 80:20 V/V) was utilized as the extracting solvent and the sample was homogenized and centrifuged for 5 minutes (at 3500 rpm). After centrifugation, the organic phase was dried using dry nitrogen gas. The sample was derivatized with N-methyl-N-(trimethylsilyl) trifluoroacetamide (MSTFA). The blank, standards, and real samples were subsequently analyzed by GC-MS.
Results: The limits of detection in the linearity experiments ranged from 0.12 to 0.21 ng/mg. According to the validation results, the method exhibited linearity in the concentration range of 0.1-2.5 ng/mg for all analytes, with calibration curve slopes ranging from R2=0.98 to 0.99. Good inter and intra-day precision relative standard deviations (RSDs) were observed to be <3.5% for all compounds. Extraction efficiency varied from 91.8 to 102.4%.
Conclusion: The validation and analysis of actual samples indicate that this method is straightforward, sensitive, and specific for the analysis of opioids in routine hair analysis.

Background: Adolescence is a period marked by biological, psychological and behavioral changes, which evoke intense emotional responses in teenagers. The aim of this study was to investigate the relationship between internalizing syndromes and morbid curiosity, and cyber aggression among adolescents.
Methods: The study population included all male and female middle and high school students in District 3 of Tehran during the academic year 2021-2022. A statistical sample of 375 individuals was randomly selected through cluster sampling. The research utilized the cyber aggression scale for adolescents by Alvarez-Garcia cyber aggression scale for adolescents, the Achenbach and Edelbrock internalizing syndromes scale and the scrivener morbid curiosity scale. Data analysis was conducted using SPSS software, version 26 and AMOS software, version 24.
Results: The results showed a significant structural relationship between internalizing syndromes and cyber aggression, as well as between morbid curiosity and cyber aggression. However, internalizing syndromes and morbid curiosity accounted for only 4.8% of cyber aggression.
Conclusion: These findings have implications for adolescent counseling, psychotherapy, education, training and correctional and rehabilitation centers.

Background: Doxorubicin (DOX) is a potent anthracycline chemotherapy agent widely employed to treat various malignancies, such as cancers and this study sought to determine how allicin (ALC) and or L-carnitine (LC) affect DOX-induced cardiotoxicity in rats.
Methods: In this study, the possible alleviative role of ALC (20 mg/kg/day orally (PO)) or LC (100 mg/kg/day PO) or the combined treatment of both ALC and LC (with the previously mentioned dosages) was evaluated against the cardiotoxic effect of a widely used chemotherapeutic agent, DOX (20 mg DOX /kg intraperitoneal injection (IP) as a single dose) in rats in 30 days experiment.
Results: The results revealed that ALC and LC significantly suppressed the DOX-induced increment in serum levels of cardiac damage biomarkers, such as lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase-megabyte (CK-MB). Moreover, DOX-associated oxidative stress, including the elevation in malondialdehyde (MDA) level and reduced activity of antioxidant enzymes, such as catalase (CAT) and superoxide dismutase (SOD) and the level of reduced glutathione (GSH) was corrected in ALC and or LC treated groups. Furthermore, DOX-induced cardiomyopathy showed significant pathological changes, including myocyte degeneration, vacuolization, interstitial edema, and focal necrosis. Nevertheless, the histopathological lesions were corrected in the treated groups mostly in the combined treatment with ALC plus LC. Compared to ALC and LC, ALC plus LC was more effective at restoring the cardiac injury biomarkers, inhibiting cardiac oxidative damage and preserving the cardiac architecture.
Conclusions: Conclusively, the study results evidenced the beneficial role of the combined treatment with ALC plus LC in mitigating DOX-induced cardiotoxicity.

Despite the rarity of venomous aquarium fish stings, physicians sometimes encounter them. Therefore, it is essential to be familiar with these stings’ clinical effects and know how to approach and treat them. I searched through PubMed, PubMed Central, Scopus, and Google Scholar and found only a few case reports on this subject. To the best of my knowledge, no published articles review or present case series about all venomous aquarium fish, explaining their stings’ clinical manifestations and management. As you know, some aquarium fish, such as piranhas and snakeheads, are not venomous, but they may bite the finger or hand.