Original Article

The Frequency of Opium Addiction and Cofactors in Diabetic Patients Referred to Karaj Dr. Shariati Hospital in 1389-90

R Fatehi, M Hashemnejad, M Mirdamadi, M Shakeri

International Journal of Medical Toxicology and Forensic Medicine, Vol. 3 No. 3(Summer) (2013), 6 September 2013 , Page 75-79

Background: Diabetes mellitus is one of the most common and complicate endocrine disease in Iran. Also, opium addiction is one of the most prevalent social problems in Iran. The goal of this study was to determine the frequency of opium addiction and diabetic vascular complications in diabetic patients.

Methods: This study was a cross-sectional study conducted in two years (1389- 90) in Karaj Dr. Shariati hospital. Sampling method was non-probability convenience sampling. Sample size was 384 patients. Data collection forms filled with patient’s files evidences. Statistical analysis of data was performed with SPSS.

Results: 384 diabetic patients with age ranging from 13 to 91 years old (mean age 59.1 years) were evaluated. 40 patients (10.4%) were opium addict and 75 patients (19.5%) were smoker. After elimination of smoking effect, frequency of retinopathy, neuropathy and diabetic foot ulcer were significantly more in opium addicts than other diabetic patients.

Conclusion: Opium abuse in diabetic patients can accelerates and progresses some of diabetic vascular complications.

Background: Despite a significant increase in the number of persons using Methamphetamine, limited data exist concerning demographic characteristics non-fatal meth ”Shisha” overdoses, seeking for treatment.

Methods: Gender differences in socio-demographic characteristics, drug use record and self-harm behaviors related to Methamphetamine “Shisha” overdose were examined among 263 patients (189males, 74 females) admitted to poison center, Loghman hospital.

Results: Of the 263 methamphetamine “Shisha” overdose included in this study, 189 (71.9%) were Male and 74 (28.1%) were female with mean of age of 34 years and standard deviation of 12.8. Male “Shisha” users were more likely to be married, middle school educated, and self-employed. History of drug abuse was positive in 73.5% mainly in male. “Shisha” was the main drug used by 24.6% male and 23.1% female subjects. Inhalation was main rout in 174 (66.2%) of cases.

Conclusion: There may be gender difference in the characteristics of participants with “Shisha” overdose. The findings suggest that interventional programs are necessary for specific risk reduction strategies.

Frequency of Firearm Injuries, Deaths and Related Factors in Kanpur, India; an Original Study with Review of Literature

R Sachan, A Kumar, A Verma

International Journal of Medical Toxicology and Forensic Medicine, Vol. 3 No. 3(Summer) (2013), 6 September 2013 , Page 88-95

Background:Studies on fatal firearm injuries have been published in various countries. However, their pattern and incidence in various regions of India has largely gone unreported.

Methods: Present study was conducted to evaluate fatal firearm injuries, their pattern, associated factors, cause of deathand postmortem findings among their victims referred to the mortuary of Kanpur medical college and comparing it with the pattern seen in other countries.

Results:Sixty six firearm fatalities autopsied during the August 2008 to July 2010 were studied. 92% were victims of homicidal attacks, 2% suicidal and 2% accidental. In 4% deaths motive could not be ascertained.

Conclusion:This is in sharp contrast to the pattern seen in other countries where suicides were the predominant group. In maximum cases, illegal country made firearms was involved with the norm of single firing. Abdomen (39%) and head (30.30%) were the two most common entry sites for the bullets, a pattern somewhat similar to that of other countries. Survival time, cause of death and motives of incidence were also studied.



Case Report

Promethazine and Treatment Refractory Agitation in Clonidine Toxicity

M Teimoory, M Arefi, B Behnoush, B Bastani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 3 No. 3(Summer) (2013), 6 September 2013 , Page 96-98

Background:Delirium is an acute and transient turmoil disorder in consciousness which is often caused by drugs.One of the adverse effects of clonidine is agitation. Clonidine is an agonist of α2-receptor which functionally overlaps with μ-receptor of opioids. Promethazine is H1-receptor antagonist and has antipsychotic properties. The necessary dose for initial control of agitation is 25-50 milligrams.

Case Presentation: A 27 year old man has been sent to emergency department following consumption of clonazepam 1 milligram, clonidine 0.1 milligram and alprazolam 0.5 milligram. Upon arrival at the toxicity emergency of the hospital, the patient's pulse rate suddenly dropped to 20 per min along with widening of QRS and increase of QTc as well as severe agitation. At the end of the second day due to continuous bradycardia pace maker was devised. The patient showed hallucination. In the third day, the patient's delirium increased. Due to no control of agitation by benzodiazepine, haloperidol, Promethazine 25 milligram was injected then slept after 5 minute.

Conclusion:In such patient with above restrictions, prescription of promethazine not only maintained blood pressure and caused no disorder in electrocardiogram, but also it immediately and certainly controlled patient's agitation.

Torture by Introducing Foreign Object in Rectum-A Case Report

M Kaleem Khan

International Journal of Medical Toxicology and Forensic Medicine, Vol. 3 No. 3(Summer) (2013), 6 September 2013 , Page 99-102

Background: Foreign body in rectum has been reported earlier but not in context of torture .

Case Presentation: Here a case of foreign body in rectum was used as a revenge and torture leading to imminent threat, pain and agony for the person who suffered.

Conclusion: Indian constitution or the constitution of Indian subcontinent do not address the torture by foreign body in rectum as a sexual assault and other forms of grievous injury. So the grieved victim is often torched in society with stigma to be looked upon him and without any compensation social rehabilitation.


Cause of murder or normal variation, which one is true?

M Teimoory, M Ghadipasha, A Memarian, B Bastani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 3 No. 3(Summer) (2013), 6 September 2013 , Page 103-105

Background: Parietal hole is formed as a result of defect or delay in the ossifying one third of the posterior parietal in the fifth month of fetal in genetic transfer of mutated gene dominant autosomal genetic. Artery, vein, meningia or brain cortex is exited through it, as for as the equal with its size. Parietal foramen is located in syndromic frame.

Case Presentation: The case is Iranian 34 years old woman, that was found in dead state in the motel. The positive findings in examination:

- Abrasion in skin of left upper posterior area of parietal.

- Scars of cosmetic surgery and numerous tattoos.

- Purple bruises in the arms.

The positive findings in necropsy:

- A hematoma under the right and posterior site of parietal skin in 2˟ 2 cm, under parietal skin abrasion.

- A hole that it was in the posterior of right parietal bone,1 mm in diameter ,near the sagittal suture .It was extended to the inner surface of skull.

-Very mild desquamation in dura mater with very mild bleeding about 2 cc above arachnoid (under dural desquamation).

- A hematoma with 1˟1 cm , between the cervical muscles

- A 3˟3 cm hematoma under the skin of upper and anterior of chest wall.

The serologic, Toxicologic and pathologic sample were negative.

Conclusion: As for as wearing in the left posterior parietal and hematoma under the skin in this area and finding a holes in mentioned area, at first, it seemed that the lesion is created by a sharp object, hard edges or shot. But in closer examinations there was no rupture on scalp and edge of the hole was perfectly sharp and smooth. Hence in order to prevent confusion in similar cases, the physician is familiar with these variations.ith these variations.