International Journal of Medical Toxicology and Forensic Medicine

Background: Several studies have proposed that C-reactive protein (CRP) levels could serve as a potential indicator for predicting coronavirus disease 2019 (COVID-19); however, the findings have been inconsistent. This study aims to evaluate the relationship between baseline CRP and thromboembolic complications in patients with COVID-19.

Methods: This case-control study involved two groups of COVID-19 patients admitted to Shahid Beheshti Hospital in Kashan: those with thromboembolic events (TEEs) and those without. Eligible patients were enrolled through simple random sampling based on predefined inclusion criteria. Data on patient demographics, clinical findings, and vital signs were collected using a standardized checklist.

Results: We examined 70 patients with COVID-19 who experienced TEEs and 70 patients who did not. The most common underlying conditions in both groups were high blood pressure, affecting 21 individuals (30%), and diabetes, affecting 25 individuals (35.7%) (P > 0.05). In the control group, the most prevalent clinical symptoms associated with TEEs were shortness of breath, reported by 60 individuals (85.7%), and cough, reported by 46 individuals (65.7%). The incidence of shortness of breath in the case group was significantly higher than in the control group (P < 0.001). Additionally, the two groups showed significant differences in breathing rate (P = 0.002) and heart rate (P = 0.016). There was also a significant difference in CRP levels between the two groups (P = 0.038), with patients in the case group exhibiting higher CRP levels.

Conclusion: This finding indicated that the level of CRP in patients with TEEs was significantly higher than in the control group. These results suggest that CRP may serve as an effective marker for identifying patients at risk of TEEs.

Background: Cannabis-derived substances like marijuana and hashish have various systemic effects, especially on the cardiovascular system. Due to conflicting reports about the cardiac complications of cannabis use, this study aimed to evaluate electrocardiographic (ECG) changes and serum troponin I levels in patients with cannabis intoxication.

Methods: This retrospective cross-sectional study reviewed medical records of patients admitted to the poisoning department at Khorshid Hospital in Isfahan, Iran, from 2011 to 2021, with documented cannabis use. After applying inclusion and exclusion criteria, 98 patients were included in the final analysis. Data on ECG findings, troponin I test results, demographic characteristics, and clinical history were collected and analyzed using SPSS version 25.

Results: Of the 98 patients studied, 37 (37.7%) had T-inversion. Nineteen patients (19.4%; 95% CI: 11.4–27.3%) showed changes associated with ACS, characterized by ST-elevation or ST-depression (with or without T-inversion or other abnormalities). The average age was 28.5 years, with most being male (83.7%), single (65.3%), having a history of substance abuse (74.5%), and co-ingesting other illegal drugs (62.2%).

Conclusion: The results of this study indicate that cannabis use may be linked to changes in ECGs associated with myocardial ischemic injuries. Due to the high incidence of abnormal cardiac findings in ECG and troponin I, evaluations are advised for patients presenting with cannabis intoxication to enable early detection of potential cardiac issues.

Background: Paraquat is a very fatal herbicide. It causes such serious complications as acute respiratory distress syndrome, fibrotic lungs, metabolic acidosis, cardiac shock, renal failure, and even death. For this reason, in this study, the prognostic factors of paraquat intoxication were evaluated.

Methods: In this retrospective study, all paraquat-intoxicated patients hospitalized to Taleghani Hospital in Urmia, Iran, from 2014 to 2020 were assessed. The demographics, clinical, and laboratory findings were evaluated using a checklist and investigated in relation to the patients’ outcomes. Then, the collected data were analyzed using SPSS version 21.

Results: Our study evaluated 102 cases (71 males & 31 females). The mortality rate was 46.1% (31.4% in males and 14.7% in females) in these patients. The patients’ age was (31.4 years ± 13.3 standard deviation) (min=14, max=79). The Median ingestion amount of paraquat was 174 ml (min = 10 ml, max = 1500 ml). Nausea 86 (84.3%), vomiting 78 (76.5%), mucosal lesions of the oral cavity and pharynx 60 (58.8%), epigastric pain 35 (34.3%), and acute respiratory failure 30 (29.4%), loss of consciousness 13 (12.7%), were the important findings in the investigated patients, respectively. Significant relationships (P<0.05) were observed between the patients’ outcomes and demographic (the ward & duration of admission), clinical findings (the level of consciousness, vomiting, epigastric pain, acute respiratory failure, hypertension, & sinus bradycardia) and laboratory indices, such as White Blood Cells, Bilirubin, Serum Hco3, Aspartate transaminase (SGOT), Alanine aminotransferase (SGPT), Creatinine, Blood glucose, Platelet, Calcium, Potassium, Leukocytosis, Metabolic acidosis, Hypokalemia.

Conclusion: Some factors, especially laboratory and clinical features, can be applied as a guide to the severity of patients' poisoning, which can be used for effective management by healthcare providers. However, more studies will be needed to clarify absolute prognostic factors in patients with paraquat toxicity.

Background: Poisoning with organophosphates (OP), one of the most common types of poisoning, can lead to decreased levels of calcium, magnesium, phosphorus, and albumin. Lower levels of these elements may help improve patient outcomes and reduce mortality rates. Since few studies have explored how these serum element levels change in patients poisoned with OP, this study aims to examine magnesium, calcium, phosphorus, and albumin levels in critically ill patients poisoned with OP.

Methods: This cross-sectional study included 89 critically ill patients (intubated or admitted to the intensive care unit) poisoned with various OP agents (including Chlorpyrifos (CPF), Diazinon (DZN), Malathion (MLT), and others) and hospitalized at Khorshid Hospital in Isfahan from 2013 to August 2023. Demographic and clinical data, along with magnesium, calcium, phosphorus, and albumin levels on days 1, 3, and 5, were extracted from patients’ records and documented.

Results: Examination of changes in magnesium, calcium, phosphorus, and albumin levels on days 1, 3, and 5 after hospitalization showed a significant downward trend in magnesium, calcium, and phosphorus levels in MLT poisoning (P-value < 0.001). In CPF poisoning, DZN levels decreased from day one to day three and then increased. Patients’ albumin levels also declined significantly over five days of treatment in cases of CPF, DZN, and MLT poisoning (P-value < 0.05). Additionally, a calcium reduction within five days of hospitalization increased the risk of death by 3.983 times (P-value = 0.013). Magnesium reduction significantly raised the risk of death (OR: 1.621; P-value = 0.044). However, reductions in phosphorus and albumin did not show a significant relationship with mortality (P-value > 0.05).

Conclusion: Severe OP poisoning results in a reduction in magnesium, calcium, phosphorus, and albumin levels over a period of five days. The reduction was more pronounced in MLT poisoning. Additionally, decreased levels of calcium, magnesium, phosphorus, and albumin increased the risk of death, although this effect was only significant for calcium and magnesium.

Background: Identification and verification of identity are mandatory in a variety of civil and criminal contexts. Sex estimation from morphometric craniofacial measurements in a sample of the Egyptian population.

Methods: This study employed a cross-sectional design, involving 303 computed tomography images (165 males and 138 females). Twenty craniofacial measurements were studied in relation to the corresponding sex.

Results: Most of the measurements were greater in males than in females. Bimastoid breadth, length of the cranial base, anteroposterior diameter of the right and left frontal sinuses, bizygomatic breadth, right maxillary sinus height, left maxillary sinus length, right and left maxillary sinus volume, and right mandibular ramus length showed a highly statistically significant difference between sex groups (P value < 0.001). Discriminant scoring was calculated to estimate sex from craniofacial measurements, and 80.6% of males and 78.9% of females in the original grouped cases were correctly classified.

Conclusion: Craniofacial measurements can be used as a reliable method for sex estimation. The establishment of a comprehensive national database for craniofacial measurements is recommended for documentation purposes.

Background: This paper studies the toxicological assessment alongside high-purity synthesis of three psychoactive and degradative Methamphetamine, Aminorex, and MDMA.

Methods: Each of these compounds was synthesized using novel methodologies, with an emphasis on purity, cartridge yield, and stereoisomeric resolution, where applicable. Analytical-grade products that could undergo toxicological profiling due to meeting rigorous retention criteria were guaranteed to undergo multistep purification and recrystallization.

Results: The true pharmacological and toxicological, whether legal or illegal, is marked for each substance without the removal of contaminating impurities. Distinguished analytical capabilities, for instance, enabled the use of unparalleled analytical methods to correlate some articulated nuclei with their respective neurophysiological, as well as systemic, reactionary constructs. A toxicological and purification prerequisite comparison of the compounds revealed an inequality. Methamphetamine, Aminorex, and ecstasy posed the most neurotoxic potential, while Aminorex and ecstasy posed distinct risks of decomposition.

Conclusion: This sets the framework for synthesis evaluation in toxicological research and forensic analysis.

Background: Hospital care data can be leveraged to benefit patients through various technological advancements in the artificial intelligence (AI) era. This will ultimately lead to improved outcomes and more efficient services. The purpose of our study was to assess physicians' opinions and knowledge regarding the ethical application of AI in Medicine in Fayoum, Egypt.

Methods: We conducted a cross-sectional survey among doctors and nurses working at Fayoum Hospitals. A standardized, validated questionnaire assessing knowledge, attitudes, and medical ethics related to AI was administered in both Arabic and English. The study was conducted from July 2024 to December 2024, spanning six months.

Results: Approximately one-fourth of participants thought that AI would help provide medical assistance in underserved areas, whereas 24% believed that it would be more useful in biopharmaceutical, 18% felt that it would be more useful in making diagnosis, 14% believed that it would be helpful in social awareness program, 11% believed that it would be useful in direct treatment and 7% believed that it would help make treatment decision. There was a statistically significant difference between the study groups in their knowledge and attitudes regarding the medical ethics of Artificial Intelligence. Physicians had higher knowledge scores than nurses (p=0.032). There was a statistically significant difference between the study groups. Physicians had a higher attitude score than nurses (p=0.026). Healthcare workers in medical departments had higher Knowledge scores than those in surgical departments (p=0.031) and higher attitude scores than those in surgical departments (p=0.025).

Conclusion: Healthcare workers showed positive attitudes but moderate knowledge about the ethical use of AI. Physicians and those in medical departments scored higher, highlighting the need for targeted education to support the responsible integration of AI in healthcare.

Background: Ethylene glycol and diethylene glycol, commonly found in automotive brake fluids, are highly toxic agents. While their nephrotoxic and neurotoxic effects are well documented, delayed and atypical systemic manifestations are less frequently reported.

Case Presentation: We describe a 53-year-old male who presented with acute epigastric pain after ingesting 50 mL of brake fluid. Initial assessment and laboratory findings were unremarkable. However, he returned 36 hours later with acute kidney injury, high-anion-gap metabolic acidosis, and worsening clinical status. Over the subsequent days, he developed progressive multi-organ failure, including hypoxemia, altered consciousness, optic disc edema, intraretinal hemorrhages, and visual impairment. By day seven, he demonstrated brainstem areflexia and diffuse cerebral edema, requiring intubation. Dermatomal vesiculobullous eruptions suggestive of viral reactivation and superinfected pressure ulcers. Despite hemodialysis and supportive treatment, he died on day 43 following cardiorespiratory arrest.

Conclusion: This case highlights rare, delayed manifestations of brake fluid poisoning, including optic neuropathy, dermatomal vesiculobullous eruptions, and progressive brainstem dysfunction. Such atypical features may delay diagnosis and complicate management. Brake fluid poisoning can present with evolving multisystem complications beyond the acute phase. Extended observation and a multidisciplinary approach are crucial, even in patients initially presenting with stable vital signs

Background: Battered Child Syndrome (BCS) is a grave medicolegal illness caused by repeated physical violence, usually resulting in severe injury or fatality. It is essential to differentiate the abuse injuries from other medical illnesses, such as coagulation disorders or metabolic bone disorders, that can mimic the pattern of injury.

Case Presentation: A two-year-old boy was found dead under his mother's boyfriend's care. The investigation included a clinical history assessment, external examination, autopsy, histopathology, forensic imaging, and differential diagnosis. Relatives, medical professionals, and police gave the clinical history. External examination provided bruises of multiple colors; autopsy provided rib fractures, subdural hematoma, pulmonary contusions, and organ damage. Histopathology confirmed injuries of different ages, while forensic imaging (X-ray, CT scan, UV/IR photography) detected fractures in the skeleton and hidden bruises. Multidisciplinary assessment disclosed overwhelming evidence of recurrent NAT in accordance with BCS. Shaken baby syndrome, Munchausen syndrome by proxy, sudden infant death syndrome, coagulopathy, and metabolic bone disease were excluded as differential diagnoses.

Conclusion: The case in question underscores the crucial importance of multidisciplinary forensic evaluation in distinguishing between abuse and medical illness. Reports require alterations to regular procedures, increased clinical suspicion, and system intervention for vulnerable children.