International Journal of Medical Toxicology and Forensic Medicine

Background: Paraquat poisoning is a common and often fatal herbicide poisoning in society. This study presents a clinical case series of patients who survived after paraquat poisoning.
Cases Presentation: This study evaluated patients hospitalized between March 2016 and March 2021 with paraquat (PQ) poisoning who survived. Out of 115 patients with PQ poisoning, three cases of severe toxicity with an average age of 24.33 years are presented here. The urinary sodium dithionate test result was positive in all three surviving patients. All patients arrived at the poisoning emergency center within an hour of ingestion and received gastric lavage and charcoal therapy. They were also treated with corticosteroids, N-acetylcysteine (NAC), vitamins C and E, Curcumin, and Livergel. Hemodialysis was performed for the patients, with one undergoing hemodialysis and hemoperfusion after ingesting 250 mL of PQ 20%. After a six-month follow-up, all surviving patients were in good health.
Conclusion: Various factors, such as early admission after exposure, prompt gastrointestinal (GI) decontamination, corticosteroids with Curcumin and Livergel, antioxidants, hemodialysis, and hemoperfusion in one case may have contributed to the survival of patients with PQ poisoning in this study. However, individual vulnerability should also be considered a crucial factor requiring further investigation.

Background: This study aims to examine the demographics, risk factors, interventions, and outcomes of pediatric snakebite victims in South Khorasan, Iran. It provides crucial insights for healthcare workers and policymakers. The results can guide future interventions and policies to address this significant public health issue.
Methods: This retrospective study analyzed all children and adolescents with snakebite complaints from 2015 to 2022. Data on age, gender, bite location, clinical and laboratory symptoms, treatment, and outcomes were collected and analyzed.
Results: The prevalence of snakebite was 1.55 per 100 000, with 34 cases. The average age was 9.38±3.91 years. Most patients were men and from rural areas. Snakebites mostly occurred at night, in spring and summer, and involved the lower extremities. Pain was the most common symptom. Coagulation disorder was the most prevalent laboratory finding (76.5%). Antivenom was given to 91.2% of patients. No deaths were reported. One case was compartment syndrome and three cases were gangrene (8.8%). Hospital stay duration showed no significant differences based on gender, residence, season, time to hospital, age group, or treatment type (P>0.05).
Conclusion: Despite the low prevalence, snakebites are a significant health issue for children in South Khorasan, especially in rural areas. The high frequency of coagulopathy underscores the urgent need for early antivenom administration and close monitoring. Providing information about local snake species to health clinics can aid patient management, but swift and effective treatment is the key to reducing the impact of snakebites. These results should serve as a call to action for healthcare professionals, researchers, and policymakers to prioritize early intervention in snakebite cases.

Background: Substance abuse leads to blood-brain barrier dysfunction and activation of neuro-inflammatory pathways. However, the contribution of serum levels of Toll-like receptor 2 (TLR-2) and S100 calcium-binding protein B (S100B) to neuropsychological outcomes has not been clearly established. This study aims to explore the relationship between TLR-2 and S100B serum concentrations in individuals with substance abuse and their potential influence on neuropsychological results, specifically regarding the functioning of the frontal lobe.
Methods: This study involved 28 individuals who were diagnosed with substance abuse at Loghman Hakim Hospital’s Toxicology Unit in 2022. Serum TLR-2 concentration and S100B levels, as neuroinflammatory markers, and the frontal assessment battery (FAB), as executive function markers, were measured.
Results: Substance abuse patients exhibited elevated levels of both TLR-2 and S100B. In drug addicts, a strong positive relationship was detected between serum levels of TLR-2 and S100B (r=0.742, P=0.0021) levels. Nevertheless, no significant relationship was found between FAB scores and serum concentrations of S100B and TLR-2.
Conclusion: This study reveals increased serum TLR-2 and S100B levels in individuals with substance abuse. However, these elevated levels did not appear to be associated with risk factors related to substance abuse or frontal lobe function.

Background: Recognition of unknown individuals is an essential element in forensics. This study aims to analyze the morphometrics of the sella turcica, foramen magnum (FM), and mastoid process in adult sex determination. In addition, to identify from the previously mentioned parts which is the most efficient single parameter in adult sex determination. In addition, we look forward to correlating the significant efficacy of the previously mentioned parts in sex determination using two or all of them together compared to using one bony part alone.
Methods: In this cross-sectional study, 60 Egyptian adults (30 men and 30 women) with multislice computed tomography (MSCT) bone window scans of the head and neck obtained for different purposes were included to obtain cranial measurements of the sella turcica, FM, and mastoid triangle area.
Results: The Sella turcica anterior-posterior (A-P) diameter of the adult male cases had a Mean±SD of 14.015±2.15 mm compared to 12.851±1.904 mm among adult female cases. The mean maximum FM width (FMW) of men was 32.183±2.126 mm, while that of women was 30.169±2.530 mm. The men’s FM area (FMA) had a Mean±SD of 885.606±124.665 mm2; In women, the Mean±SD were 784.179±140.997 mm2. The mastoid triangle area’s Mean±SD were 778.559±87.218 mm2 among men compared to a mean of 645.215±88.733 mm2 among women.
Conclusion: This study determined that sella turcica A-P diameter, mastoid area, FMW, FMA, the maximum length of the right and left occipital condyle (LROC), and length of the left occipital condyle (LLOC) showed significantly higher measures in adult Egyptian males. The best single parameter determining the adult sex was the mastoid triangle area with a cut-off level of 647.22 mm2. The sella turcica A-P diameter, LLOC, and mastoid triangle area represent the best combination of all measured parameters for determining sex in adults. A predictive formula was performed using the best combination in adult cases with an accuracy of 87% in sex determination.

Background: Phytotherapy is a common practice around the world, including Pakistan. One such medicinal plant is Tagetes patula. Its flower is edible and used for various local illnesses, especially cancer. However, they lack the toxicological evaluation of this plant, including its active flavonoid i.e. Patuletin, which is addressed in the present investigation.
Methods: Wistar rats of either sex (150 g) were intraperitoneally treated (acute [1 day], sub-acute [7 days], and repeated dose [28 days]) with T. patula flower methanolic extract (1 and 2 g/kg) and patuletin (5, 30 and 60 mg/kg). Weight changes in rats were observed. Additionally, the hematological and biochemical (hepatic and renal function) indicators were assessed using respective analyzers. Histological examination of the liver and kidney was also performed following hematoxylin and eosin staining.
Results: Our data showed that none of the treatments caused a significant alteration in the weight of rats compared to the control. Among the various hematological parameters, the white blood cell count was significantly reduced by both extract and patuletin treatments. However, the enhanced levels of aspartate aminotransferase along with morphological changes in the liver were observed only in patuletin-exposed animals.
Conclusion: The present study demonstrated the toxic potential of T. patula flower methanolic extract and its active flavonoid i.e. patuletin. It further recommends the implementation of a regulatory check over its consumption to protect fellow citizens from the harmful effects.

Background: Wilson’s disease is a chronic, gradually developed disease. Its concern is as an autosomal recessive inherited metabolic disorder. The deposition of copper in many organs, such as the liver, eyes, kidneys, and basal ganglia in the brain is the main cause of this disease.
Case Presentation: A 13-year-old male patient was admitted to the Children’s Department in Al-Kadhimae Hospital, Iraq with chief complaints of vomiting, abdominal pain, pallor, icterus, fever, and chest complaints. The laboratory data showed elevated levels of total bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase and reduced levels of globulin (α2 and β), ceruloplasmin, and serum copper. Additionally, high urine copper was reported. After that the patient was diagnosed with Wilson disease and treated with D-penicillamine drug (copper chelation) and zinc acetate tablet.
Conclusion: Wilson’s disease is a metabolic error of copper, if undetected and untreated immediately, it causes declining in the function of many organs, such as the liver and brain.

Background: Peripherally inserted central catheter (PICC) migration into smaller veins is rare, often recognized only when catheter dysfunction occurs or associated clinical complications manifest. This study aims to highlight subcutaneous tissue infections as an unusual complication of PICC migration in newborns.
Case Presentation: We report a case of a newborn male who experienced PICC migration into the angular vein after a prior successful repositioning. Factors contributing to this migration include anatomical variations in the venous system, left-sided catheter insertion, the need for mechanical ventilation due to persistent pulmonary hypertension of the newborn, and the potential influence of using a 2 Fr diameter PICC line.
Conclusion: Maintaining detailed documentation of the external catheter length and conducting regular imaging post-PICC placement is crucial, especially if the patient shows signs of catheter dysfunction or if unanticipated complications develop.