Original Article

Status of 25-OH Vitamin D Serum Level among Wheezy Chronic Respiratory Diseases with Airway Obstructive Patterns; Office- Base Study

Kh Agin, E Hoodeh, M Nasseri, M Moinazad Tehrani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 57-63


Background: Vitamin D is a homeostasis hormone of the calcium and bone metabolism. It has additional effects in the infections, cardiovascular, immunity, anti- inflammatory, chronic respiratory diseases and small airway disease (SAD). Wheezing is the common clinical feature of small airway obstructive diseases. Prevalent of asthma and chronic obstructive pulmonary disease (COPD) are noticeable among SAD. Propose of the study assessed status of vitamin D level among wheezy chronic respiratory diseases with airway obstructive pattern.


Methods: Sample population sequentially enrolled among office base- wheezy patients with chronic obstructive pattern. Vitamin D level was measured by ELISA.


Results: We studied on 67 patients. Mean age was 42.9±1.5 SD years, ranged between 17-76 years. Their sex distribution was male 51% and female 49%. Vitamin D deficiency and insufficiency recorded 13% and 40%, respectively. Frequency of lower than set point value of vitamin D among subtypes of SAD was asthma, COPD and other subtypes of SAD, respectively.


Conclusion: Outcome of the study disclosed relevant 25-OH vitamin D deficiency and insufficiency among wheezy respiratory diseases with airway obstructive pattern. COPD and asthma small airways were noticeable within population. Deficiency and insufficiency of vitamin D were considerable in female and male, respectively.


A Study of Sexual Assaults in Northern Range of Himachal Pradesh

S Pal Kumar, A Sharma, A Kumar Sehgal, A Singh Rana

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 64-72

Background: Rape is among the highest forms of underreported crime experienced by women in all sections of the society and obtaining an accurate measurement of sexual assault is a challenge. An increasing rate of sexual assaults constitutes a large number of cases registered under different sections of the Indian law, their medico-legal examination and forensic investigations.

Methods: The study was conducted on 35 sexual assaults cases received for examination at RFSL, Northern Range, Dharamshala, Himachal Pradesh, India. A self-innovated proforma including the details pertaining to socio-demographic profile, medical examination, and results of specimens of victims collected during forensic analysis was designed. Benzidine test, gel-diffusion test, acid phosphatase test and microscopic examinations were conducted in the lab.

Results: The common location of offence was house of the accused (31.42%) followed by house of the victim (20.0%). 48.57% of the alleged rape victims were students. Highly affected age group was 11-20 years. Fifteen girls (42.85%) were below eighteen years of age, which was the age of invalid consensual rape. Forcible rape and invalid consensual rape was reported in 68.56% cases. 77.14% victims were unmarried and 22.85% were married. 85.71% victims were Hindus followed by Muslims (11.42%) and Christian (2.85%). 80% victims knew the assailant. Rupture of hymen was found in 88.57% cases and hymen was intact in 11.42% cases. Delay of medico-legal examination of victim was noted. 31.42% victims had combined genital and extra genital injuries. Acid phosphatase test was found positive in 34.28% cases and positivity for spermatozoa in 22.85% cases. Blood was detected on clothes, undergarments and vaginal swabs in 42.85% cases. In 8.55% cases rape was committed by family members. Only one victim became pregnant following the act of sexual intercourse.

Conclusion: Cases were reported from Hindu, Muslim and Christian communities and adolescents were more at risk. Majority of the victims have acquaintance with the assailant and the residence of the accused was the most common location of sexual assault. Delay in medico-legal examination caused problems in detection of semen and spermatozoa. Most of the victims had bath and genital wash after the sexual act, before medical examination and destroyed the evidence.

Risk Factors for Mortality in Organophosphate Poisoned Patients

S Raouf-Yazdinejad, MA Emamhadi, A Okazi, A Memarian

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 73-77

Background: Organophosphates (OP) compounds are used as insecticides in agricultural and domestic settings throughout the world. Acute pesticide poisoning has a high morbidity and mortality, especially in developing countries. The purpose of this study was to evaluate the data on acute adult organophosphate poisoning (OPP).

Methods: In Descriptive cross sectional study at Loghman Hakim Hospital in Tehran-Iran during March 2010 to June 2013 and identify the risk factors of mortality, patients with the primary diagnosis of OPP who were admitted to Loghman-Hakim Hospital Poison Centre (LHHPC) were the subjects of this prospective study. Cholinesterase (CE) activity and the PR interval was determined for each patient using the Bazett formula and considering >200 msec. as prolonged. Comparative outcomes of the study were respiratory failure, systolic blood pressure, GCS and intentional poisoning, analysis of the PR interval in the primary ECG on admission, and rate of mortality.

Results: The study included 201 patients with a diagnosis of OPP. The mean age of the patients was 33.93. The mortality rate was 9%. Nine patients had conductive abnormality (PR prolongation) in ECG. There was no significant difference between two groups (prolonged and normal PR intervals) according to respiratory failure and systolic blood pressure<90mm Hg and GCS and intentional poisoning. The mortality rate in the long PR group was significantly higher than that of the normal PR group.

Conclusion: In our study it has been well demonstrated that PR-interval prolongation affects mortality rate. Prolongation of the PR interval is associated with increased risks of mortality in OPP.

Short Communication

The Mechanics of Injury Production and Wounding Forces in Judicial Context

R Ruwanpura

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 78-80

An injury is defined as illegally caused harm to any person’s body, mind reputation or property. In practice, injuries often consist of combination of several basic injury types and usually classified according the predominant injury type. The wounding process and distribution of injuring force are governed by equations of motion physics. However, the purpose Legal judgment demands the forensic medical expert, as an independent witness, to explain those complex biophysical remedies in the context of the common legal sense, which can be easily understood by the courts. Therefore, we suggest the following simple biomechanical classification of wounding process that could serve the purpose; light force, moderately heavy force and heavy force injuries.

Review Article

Aluminum Phosphide Poisoning in Animals

S Shakeri, O Mehrpour

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 81-97

Several articles have showed the effect of ALP toxicity on different organs. Toxicity mechanisms are not clearly understood yet. Due to the potential increased use of ALP as a fumigant and the lack of adequate toxicity data, previous studies were re-evaluated to characterize the epidemiological, toxicological, and clinical/ pathological aspects of ALP poisoning and its management. Related terms were looked up in bibliographical databases such as the Tehran University Medical Science Digital Library, PubMed, Scopus, Google Scholar, and British library. The studies suggest that phosphine targets the mitochondria and inhibits respiration in rat liver mitochondria, insect mitochondria, and intact nematodes. On the other hand, glutathione (GSH) levels are reduced in various tissues of ALP-poisoned rats, while remaining unchanged in insects and mammalian cells. Also, acetylcholine signaling is an important component of phosphine toxicity. Phosphine (PH3) induces oxidative stress and lipid peroxidation in insects, mammalian cells, and other animals. There is no known antidote for ALP intoxication; but, melatonin as an effective antidote protects against oxidative damage in the brain, lung, and liver of the rats and suggests the involvement of ROS in the genotoxicity of PH3. Cholinesterase inhibition responds to treatment with atropine, pralidoxime, and oral sweet almond oil, especially if used immediately after ALP poisoning. Several treatments have been used in animals some of which have not been tested in human-beings yet. Such treatments should be given in controlled situations with the hope they may be helpful in treating these patients.

Case Report

Fatal Case of Diazepam and Paraquat Poisoning – A Case Report

S Peranantham, G Manigandan, V Tamilselvi, K Shanmugam

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 98-101

Background: A very dangerous activity among youth and young adults is the indiscriminate mixing and sharing of prescription drugs, often in combination with alcohol or other drugs. The effects of these combinations of substances can be fatal.

Case Report: A 28 years old adult male with alleged history of diazepam and paraquat poisoning was admitted with complaints of chest discomfort, epigastric pain, vomiting and drowsiness. The patient developed acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS) and expired on the next day. To conclude, diazepam even though considered to be a safer drug, has risk of drug abuse and is fatal when taken in overdose along with other central nervous system depressants. Paraquat is a highly toxic compound widely used as herbicide and ingestion of the drug causes death due to respiratory failure. 

Conclusion: The present study emphasizes on the proper surveillance of diazepam intake in known psychiatric patients and strict rules must be enforced by the Government on marketing of herbicides and pesticides.

Mosquito Coil Poisoning with Neurological Manifestation


International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 102-104

Background: Mosquito coil (allerthrin) is a type of pyrethroid. Few reports describe severe poisoning after ingestion of this common household product. This is the first ever report on severe form of mosquito coil poisoning in adult.

Case Report: A case of allerthrin poisoning with neurological and gastrointestinal manifestation reported. A 19 year old house wife belonging to Bengali Hindu community presented after ingesting six pieces of mosquito coil. Initial manifestations were nausea, vomiting, sore throat. During hospital stay she had three episodes of generalized seizure. Level of consciousness altered. She received supportive management as no specific antidote exists. Recovery occurred by several days.

Conclusion: Mosquito coil (allerthrin) ingestion can infrequentl induce medical emergency.

A Maternal Death due to an Unsafe Abortion in Rural Nepal - A Case Report

A Karn, B K Mandal

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 105-110

Background: Abortion was illegal before 2002 A.D. in Nepal and was legalized under the 11th amendment to the Country Code (Muluki Ain) in March 2002, receiving royal assent in September 2002. Nepal Government began providing comprehensive abortion care services from March 2004 after 18 months of legalization of abortion, when the government issued Safe Abortion Service Procedure. The maternal mortality ratio in Nepal is among the highest in South Asia. Unsafe abortion is defined as an induced abortion process either conducted by less skilled personnel or performed in a non-accredited facility. Though abortion has been legal in Nepal for more than 14 years now; physicians in Nepal still face problems of abortions done by less qualified personnel.

Case Report: We report a fatal case of unsafe abortion in a 32 year old lady whose cause of death was ascertained as irreversible septic shock due to septic abortion.

Conclusion: Prompt diagnosis and appropriate intervention might provide better outcome in these types of cases. Therefore, we stress the importance of safe abortion services provided by skilled personnel at rural areas in developing countries and of early referral in case complication arises so that the life of the patient is not endangered.

Role of Fluid Dynamics in Cardiac Blast Effect – A Case Report


International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 2(Spring) (2015), 29 June 2015, Page 111-115

Background: A large variety of injuries is sustained during vehicular accidents. Blunt cardiac injury (BCI) encompasses a wide spectrum of clinical manifestations, ranging from cardiac concussion to cardiac rupture.  Apart from the usual blunt injuries, an uncommon type is the compression injuries of the chest.  Such compression results not only in direct damage to the solid organs but also results in blast injury of fluid filled organs due to the variations  in the intraluminal pressure, in accordance with laws of fluid dynamics.

Case Report: Here is a rare and interesting case of such nature, in which tangential force over the chest resulted in the massive rise of intraluminal pressure in the ventricles leading to burst of chambers resulting in death.

Conclusion: In this article, we have tried to explain the various factors resulting in bursting of the fluid filled organs and their relations with fluid dynamics.