Original Article

Anguishing Reports of Ambient Air Pollution in Tehran Capital of Iran

Kh Agin

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 75-76

Benzene is the aromatic hydrocarbon, organic and petrochemicals. It has high octane number and used as ethybenzene. It composed a few percent of gasoline mass less than 1%. Benzene was used before 1950 but after that year replaced with tetraethyl lead. The recent material was associated with environmental pollution so came back again benzene in the petrol cycle production.

Human is exposed withbenzeneby several ruts; gasoline fumes, motor vehicle exhaust, and smoking. Inhalation is the main route of toxicity in urban area.

Standard threshold of benzene concentration is 1.56 part per billion (PPB) in accepted air quality. The current study displayed that benzene concentrationin Tehran (capital of Iran) was between 2-20 times higher than the standard (1).  This is the first official report published aboutambient air pollution in 2013. However,IranMinistry of Health announced that Asbestos and benzene levels had 50-100, respectively. It means that there were 10 times more than standard levels in the Tehran urban area(2). These materials, specially benzeneBenzene has potential ability  as  cancer risk factor  to  inducing  acute and chronic bloods leukemia (3). In addition, there arerelations between benzene exposure and lung cancer (4).  Benzene can induce aryl hydrocarbon receptor which leads to tumorigenesis (5).

The vision of information dictates assumption of planning in two aspects. The arrangement may be suggestedthat  the sources of pollutants will be  reduced in the environment thought activation of dependable organizations and investigation  of at-risk population based on the prioritizes.

Cranio-Cerebral Injuries in Victims of Fatal Road Traffic Accident: A 5 year Post-Mortem Study

H S Gouda, PR Meghana, B B Prabha

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 77-82

Background:Victims of vehicular accident sustain different types of injuries, of which, head injury is considered as more fatal than injury to other systems. This study was carried out to know the incidence and pattern of cranio-cerebral injuries in victims of fatal vehicular accidents.

Methods: Medico-legal autopsies conducted on victims of vehicular accidents from 01-01-2008 to 31-12-2012 at the Dept. of Forensic Medicine, Father Muller Medical College, Mangalore, Karnataka, India, were retrospectively analysed.

Results:Deaths due to vehicular accidents constituted 69% of the total unnatural deaths. Cranio-cerebral injuries were present in 68.5% of victims of vehicular accident. Combination of skull fracture, intra-cranial haemorrhages and cerebral injury was seen in maximum number of victims (38.2%). If injuries are considered individually, most commonly observed injury was intracranial haemorrhage (90.7%), followed by skull fracture (78.9%). Subarachnoid haemorrhage was the commonest type of intracranial haemorrhage present (78.3%). In the skull vault, linear fracture was the commonest type (49%) and in the base, middle cranial fossa (68.3%) was the most commonly fractured fossa. Among the cerebral injuries, contusion of the brain tissue was the commonest injury seen. Frontal and temporal lobes were the most commonly injured parts of the cerebrum (65.8%).

Conclusion:Most of the cranio-cerebral injuries cannot be treated successfully because of their anatomical configuration. But, morbidity and mortality due to vehicular accidents can be reduced by preventing the occurrence of accidents. Therefore, the old saying, “Prevention is better than cure” holds good even here.

Status of Airway Reactivity among Small Airway Diseases with Regular Users Substance Abuse of Inhaling Opium; Preliminary Results of a Survey of Indirect Provocation Test

Kh Agin, MA Emam Hadi, B Mostafazadeh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 83-90

Background:Opium is an oldest recreational abuse substance with dependency.  Small airway diseases (SAD) were established within opium user’s population.  Bronchial hyper-responsiveness (BHR) reflects airway reactivity and inflammation. Opium can induce airway inflammation and following airway reactivity.The objective of the study assessed status of BHR among SAD with regular inhaled opium users. It performed with hypertonic normal saline provocation challenge test.

Methods: Target population enrolled among SAD with inhaled regular opium users. In the next step, standard hypertonic normal saline provocation test carried out on the sample study.

Results:A total of 46 subjects followed the study. The mean age±SD was 50.1±1.2 years, with median 48 years. 91% of those were male. A positive result of BHR was distributed more frequently in thechronic obstructive pulmonary disease(COPD) with the asthma phenotype.  In addition, it was more market in the youngest and advanced age classes equally.

Conclusion:hypertonic normal saline provocation test result was quite noticeable between regular inhaled opium users. BHR was detected more frequently in COPD with asthma phenotype, COPD, chronic bronchitis, and bronchial asthma disease, respectively. The outcome indirectly revealedthat there was a relation between airway inflammation and opium inhalation in population. It may be reflected an added effect on the predisposing risk factors of induced airway inflammation and hyperreactivity of airway in target populations.

Child Sexual Abuse; a Medico-Legal Analysis

M Vidanapathirana

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 91-97

Background: Child sexual abuse is frequently discussed in Sri Lanka. The type of abuse, hymenal injuries and their association with penetrative intercourse are important facts in the management of child sexual abuse.

Methods: Out of 7257 Medico-legal examinations, 78 child sexual abuse cases reported to a tertiary care hospital in Colombo, Sri Lanka, from January 2011 to December 2013 were studied.

Results: Females 85% and 59% were 11-15 years. Sixty nine percent during day time, 91% by known persons and 64% at outside place. Vaginal intercourse was alleged by 15% of below the age of 10 years and 62% of above 10 years (P<0.01) and committed was by 73% of ‘boyfriends’ and 33% of non-boyfriends (P<0.01). Hymenal tears were in 15% of fimbriated and 45% of non-fimbriated hymen (P<0.05). Hymenal tears at 5-7 O’clock position in 40% of alleged vaginal intercourse and 3% of not alleged (P<0.01). Hymenal orifice diameter greater than 2 fingers was in 69% of alleged vaginal intercourse and 3% of not alleged (P<0.01). Anal intercourse was in 6% of females and 58% of males (P<0.01).

Conclusion: Child sexual abuse is common among children above 10 years, during day time, by a known person at an outside place.  Vaginal intercourse is common among girls above 10 years by ‘boyfriends’ with a tear at 5-7 O’clock position.  Taut annular and crescentic hymen have a higher chance of getting torn than lax fimbriated hymen. Anal intercourse is committed on male than female children.  Findings will be useful for medico-legal and holistic management, and evidence based prevention of child sexual abuse.

Diagnostic Accuracy of Portable Ultrasonography in Confirmation of Adequate Reduction of Distal Radius Fracture

SH Rezashah, M Ebrahimi, K Ahmadi, M Afzal-Aghaie, A Ajvadi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 98-103

Background: Distal radius fracture (DRF) is one of the most common injury presented to the emergency ward and compromise about one sixth of fractures managed by emergency physicians

Methods: This study was performed in ED of two regional hospitals in eastern part of Iran, with combined census of 150,000 patients per year, serving a largely low-income population.

Results: Thirty patients were enrolled during the study period. Five patients required repeated M&R, one refuses to continue and 4 patients were reduced for the second time.

Conclusion: In the present study we show that US-guided DRF reduction has high sensitivity and specificity to diagnosed reduction adequacy in comparison with standard radiography.

Case Report

Treatment of 2, 4-Dichlorophenoxyacetic Acid (2, 4-D) Poisoning; a Case Study

Z Oghabian, N Ghanbarzadeh, MD Sharifi, O Mehrpour

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 104-107

Background: 2, 4-Dichlorophenoxyacetic Acid (2, 4-D) is an herbicide in chlorophenoxy group that use as a weed killer. Acute poisoning with 2, 4-D may be fatal in large ingestion. There is no specific antidote for 2, 4-D herbicide poisoning. We report here a case of 2, 4-D toxicity with rhabdomyolysis.

Case Report: In this case study we present a case of intentional consumption of 2, 4-D herbicide with main gastrointestinal complain that became toward   rhabdomyolysis and liver damage during hospital course. Successful treatment with sodium bicarbonate and other conservative therapies was performed.

Conclusion: In cases of 2, 4-dichlorophenoxyacetic acid poisoning, rhabdomyolysis should be in mind and an alkaline diuresis can increase herbicide elimination as well as treatment of rhabdomyolysis should be considered.

Accidental Corrosive Acid Intoxication - a Case Report

M Chand Meena, R Band, S Mittal

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 108-112

Background: Acute poisonings with corrosive substances cause serious chemical injuries to upper gastrointestinal tract, the most common site being the oesophagus and the stomach. The degree and extent of damage depends on several factors like the type of substance, the morphologic form of the agent, the quantity, and the intent. In the acute stage, perforation and necrosis may occur.  Injury to UGI tract due to ingestion of acidic corrosive substances is common in India. Acute corrosive intoxications constitute a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction.

Case Report: We report a fatal case of accidental corrosive acid ingestion with a brief review of literature.

Conclusion: Ingestion of a corrosive substance can produce severe injury to the gastrointestinal tract and can even result in death. Stringent legislation is necessary in developing countries to curtail unrestricted access of adults to dangerous corrosive chemicals.

A Perforated Duodenal Ulcer after Using of Methamphetamin and Methadone

S Vaghefi, B Mostafazadeh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 4 No. 3(Summer) (2014), 8 September 2014 , Page 113-118

Background: Acute poisonings with corrosive substances lead to serious peptic ulcer disease despite of the major improvements in both diagnostic and therapeutic strategies; perforated peptic ulcer is still the most common cause of gastrointestinal perforation and the second most common complication of the peptic ulcer. Duodenal ulcers tend to be the posterior penetrating and in pancreas can cause pancreatitis whereas gastric ulcers are penetrating to left liver’s lobe.

Case Report: We report the case of a 23-year-old man with a history of chronic consumption of methamphetamin and methadone referred to emergency state with epigastric pain. He consumed methamphetamin following about 10cc methadone, then amount of methadone syrup yesterday. When he was admitted, he was awake, alert, agitated and restless; also he was feeling abdominal pain. In examination, we found out generalized abdominal pain with garding and rebound tenderness. Pain is continuously and referred to back and the testis. The pupils had mild mydriasis and reactive to light. Free subdiphragmatic air was seen in the right subphrenic area in upright chest x-Ray. It didn’t administrate to activated charcoal due to perforation detection and immediately he was transferred to the operating room for diagnosis an acute abdomen. Purulent discharge was seen between the left lobe of liver and gastric as well as adhesion of omentum. Then, post pyloric perforation was seen after release of adhesion that bile discharge excreted. We treated him with essential treatment.

Conclusion: Here, we report a patient with a history of addiction to methamphetamin and methadone and perforated duodenal ulcer after took acute overdose of these substances. As a result of that perforation opened and postulated to the left lobe of liver, thus he was taken to the operating room. This patient had perforated duodenal ulcer after acute overdose of methamphetamin and also this ulcer opened atypically to the left lobe of liver. Furthermore, investigation on the effects of amphetamine and methamphetamine on peptic ulcer and its effect on the perforation is recommended.