Original Article

Study Clinical Symptoms and Para-Clinical Findings in Poisoning Patient with Aluminum Phosphide in Patients Referred to Imam Khomeini Hospital in Ardabil (Northwest of Iran)

E Farzaneh, B Mostafazadeh, F Naslseraji, Y Shafaiee, H Ghobadi, F Amani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 175-179

Background: Aluminum phosphide is used in different area in Iran. According to that the herbal form of these pills are used increasingly, comparison and evaluation of these patients in terms of clinical and laboratory symptoms are important. We studied on clinical and Para-clinical findings in patients who had taken aluminum phosphide and its herbal form in this study.

Methods: This is a descriptive and analytic study which carried out during 2006-2012. In this study, laboratory variables, white blood cell count, hematocrit, blood glucose, sodium, potassium and bicarbonate, arterial blood gas also clinical finding after taking aluminum phosphide pills, and vital signs of poisoned patients were extracted.

Results: In this study 386 poisoned patients were evaluated. We divided poisoned patients in two groups, case and herbal. 35% had been taking original Aluminum phosphide (case group) and 65% herbal form (herbal group). In totally 18.7% of poisoned patients were male. The average age of patients in herbal group was 23.22 ±8.20 years and in case group was 24.78±7.04 years. In both groups, nausea and vomiting were the most prevalent clinical signs. Experiments in a separate group showed significant different in blood pressure upper (P<0.001), Po2 level lower (P<0.001), pH lower (P<0.001) and bicarbonate lower (P<0.001) but there was no significant difference in respiratory rate, temperature, hemoglobin level and hematocrit. Also was observed that 70.4% of patients in case group died but all patients in herbal group survived (P<0.001).

Conclusion: The results of this study indicated that arterial blood gas of patients is a useful tool for differentiating oral poisoning with original and herbal rice pill. Hence, in patients with clinical toxicity of rice tablet can be used to differentiate these two tablets.

Epidemiological Profile of Pesticide Poisoning Cases in Bijapur, Karnataka in Southwest India: a Retrospective Study

V V. Koulapur, S S Pujar, R S Honnungar, P S. Jirli, S Patil

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 180-184

Background: Pesticide poisoning is a major public health problem in developing countries. Its usage has increased in recent and thus increased even its misuse to commit suicide. The aim of his study was to determine the epidemiological profile of fatal pesticide poisoning in and around Bijapur district.

Methods: This retrospective study was carried out at Department of Forensic Medicine, B.M. Patil Medical College. Bijapur, Karnataka in southwest India, with the fatal pesticide poisoning cases from 2003 to 2009. All collected data was analyzed in all possible aspects, to identify risk factors, most common offending agent and other epidemiological factors etc.

Results: During the study period a total 980 medico legal autopsies were conducted, amongst them poisoning were 240 (24.48%) cases. Out of these, 210 cases were due to fatal pesticide poisoning (87.55%). All collected data was analyzed in all possible aspects, to identify risk factors, most common offending agent and other epidemiological factors.

Conclusion: Agrochemical poisons, more so organophosphates are responsible for most of the poison related fatalities in the present study. Besides this, the establishment of specialized toxicological units for detection and management of poisoning cases at all hospitals and primary health care centers could considerably minimize the morbidity and mortality due to poisoning.

Role of Feeling of Loneliness and Emotion Regulation Difficulty on Drug Abuse

Z Nikmanesh, Y Kazemi, M Khosravi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 185-191

Background: The Risk behaviors such as drug abuse are prevalent anxiously in youth. Thus investigation and recognition risk behaviors are important.  The aim of the study was to investigate on relationship between loneliness and the difficulties in emotion regulation with drug abuse.

Methods: This research was descriptive correlation. The sample was comprised of students of University of Sistan and Baluchestan, southeastern of Iran. Participants were selected by cluster sampling. The instruments were the loneliness scale, the difficult in emotion regulation scale and the drug abuse. For statistical analysis, Pearson correlation and regression analysis methods were used.

Results: The results showed that there is a positive and significant relationship between loneliness and the difficulties in emotion regulation with drug abuse. The Enter regression analysis for prediction of the drug abuse showed that the loneliness predicted 0.09 and the difficulties in emotion regulation predicted 0.08 of the drug abuse variances.

Conclusion: Regard to the results, it is recommended to university and cultural instructional planners to pay attention to variables of loneliness and emotional self-regulation as drug abuse risk factors and introduce especial and preventer programs in this subject.

Pattern of Acute Pediatric Poisonings in Birjand City, East of Iran

O Mehrpour, MD Sharifi, M Ebrahimi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 192-200

Background: Acute pediatric poisoning represents a frequent cause of admission to the emergency departments. This descriptive and retrospective study was conducted in Birjand, eastern Iran, with the aim of evaluating the pattern of pediatric poisoning in this region.

Methods: During the 6-year period from 21st March 2006 to 20th March 2012, all files of pediatrics poisoned patients admitted to the emergency department of Vali Asr teaching hospital was reviewed and the data were recorded in a pre-designed form. The results were analyzed by relevant statistical tests.

Results: During this period, 246 cases (41.1% female and 58.9% male) were admitted with a diagnosis of acute poisoning. The mean age was 37.6 +/-32.64 (range: 0.06-156) months. The majority of poisonings occurred in the children aged about 2 to 5 years. The most common agents involved were opioids (39.43%), pharmaceuticals (22.76%) and envenomations (15.9%). Most of the patients were living in urban areas (56.91%).  There was a significant correlation between older age and intentional poisoning (P<0.01). There were also significant correlations between the toxic agent and either the season (P<0.0001), or patients’ age (P<0.0001), residential status (P=0.008) and or consciousness (P<0.0001). Moreover, we introduced Majoon Birjandi as a new cause of poisoning in the literature.

Conclusion: Acute opium poisoning was the most common in terms of morbidity and mortality in this region. Health authorities should consider preventive programs in this regard. Moreover, Majoon-e-Birjandi as a new cause of poisoning should be considered in this region, which is not previously reported in the literature.

Epidemiological and Clinical Characteristics of Scorpion Stings in Ahwaz, Southwest Iran (2006-2010)

AH Rahmani, H Forouzandeh, M Kalantar, N Asad-Masjedi, Z Alavian, K Kavarizadeh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 201-216

Background: Scorpion sting is a health problem in the world including tropical regions of Iran as in rural region of Khuzestan province. Therefore appropriate diagnosis and treatment has a special aspect. The aim of present study was to evaluation of demographic status and clinical aspect of scorpion sting patient due to better prevention and treatment and diagnosis.

Methods: This survey done by analyzing medical records of patients suffered from scorpion sting, hospitalize in Razi hospital in Khuzestan province (southwest of Iran) among 2006-2010. Patient information have been extracted and inserted in the inquiry form and data were analyzed by SPSS software.

Results: In the present study 1922 patients have been studied. Proportion of females stung by scorpion to male was 1.29 to 1. Place of sting were mostly trunk (693 cases =36.05%) and remains were on other part of body. About 419 persons (21.8 %) have come to hospital about 6-24 hours after being stung and 708 people (36.83 %) came there in less than 6 hours. Most sting (41.2 %) were at night time and other were at daylight. 1308 persons were stung by an unknown black and yellow scorpion and 614 cases (31.94%) by scorpion known as Hemiscorpius lepturus. 708 persons of patients (39.83%) have been suffered from hemoglobinoria , 709 persons (39.88%) were suffered from coagulation dysfunction. Totally 508 persons of patients (26.43%) received blood products. 36 of patients were died, of which 24 cases (1.24%) were female and 12 patients (0.62%) were male. most of patients (1842 cases  95.83%) were hospitalized 1-2 days.

Conclusion: In this survey, Patients at the emergency units showed signs of local and systemic effects, 36 patients were died. We propose that public awareness and physician readiness combined with the availability of effective antivenom has potential value in reducing complications and lethality in scorpion envenomation.

Medical Malpractice in Cardiovascular Surgery; Cases Referred to Tehran Forensic Medicine Organization during 2011-13

Sh Kazemi, B Mostafazadeh, Sh Heshmati, MA Emamhadi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 207-213

Background: Cardiovascular surgeries are a most common and important surgeries in Iran and because of its high risk nature, the outcome is not always satisfactory, so could lead to a complaint. In recent years, there has been an increase in complaints against cardiovascular surgeons. Aim of current study was to determine the frequency of medical malpractice in the field of cardiovascular surgery in the cases referred to the Tehran forensic medicine commission.

Methods: In this retrospective cross-sectional study, all malpractice cases referred to the forensic medicine commissions in Tehran with regard to the field of cardiovascular surgery during 2011-2013 were collected. Information such as age, sex, type of hospital (state or private), type of cardiosurgery, type of malpractice, percentage of malpractice, cause of death, and background diseases were extracted and then analyzed.

Results: Of the 56 cases, the frequency of malpractice was 27 cases (48.2 %) and the most important type of malpractice was negligence (32.2%) and the majority of cases were related to private centers. The most common malpractice was related to coronary artery disease and the main cause of complaint was the patient death (76.8%). 54.5% of malpractice rate was in men and in patients older than 60 years (67%) which was higher than other age groups. There was no significant association between age and sex with malpractice.

Conclusion: Despite improvement in medical technology and the use of advanced techniques in the diagnosis and treatment, the complaint rate of cardiovascular surgeons is increasing. In addition to optimizing cardiovascular surgical techniques, informing the patient and his/her companions about the side effects of these high risk surgeries can be effective in prevention of malpractice and physician mistakes.

Case Report

Bloodbath Posed by Husband - a Case Report

M N Pawar, R M Pawar

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 214-217

Background: The corpse of a newly married woman was brought for the postmortem examination. It was having multiple stabs over the neck and chest. Incised wounds were there over the chest and both wrists, cutting the radial artery of either side. Total numbers of injuries were 107, comprising few injuries of post mortem nature.

Case Report: The case report highlighted the challenges for an autopsy surgeon in extricating, noting and describing such an exhaustive number of injuries with its corresponding internal injuries. Collecting and preserving the pertinent evidences out of the corpse would be the next challenge. Further, spotting out discrepancy with the number of injuries of an inquest report will remain as an additional task. Subsequently an autopsy surgeon also has to face griming questions in the Court of Law, as an expert witness.

Conclusion: This case report described the history in detail and explicated all the eventual solutions for autopsy surgeon.


Stab Injury with Tailoring Scissor Causing Inferior Gluteal Artery Pseudo Aneurysm: a Rare Case Report

MA Haseen, AA Mahmud, M Arshad, M Haneef-Beg

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 218-221

Background: Gluteal artery pseudo aneurysm (GAP) is a rare entity, as gluteal arteries are well protected under muscles and fat of gluteal region. Gluteal artery aneurysms constitute less than 1% of all aneurysms and most of them are pseudo aneurysmsThe common etiologies of GAP  areblunt or penetrating trauma to gluteal region, infection, fractures of the pelvis or iatrogenic injury during surgical procedures on the pelvis or hips to intramuscular injection. The usual presentation is a pulsatile gluteal mass often confused with a gluteal abscess presenting 1-2 months after injury. However, at times it can cause symptoms due to compression of pelvic structures.

Case Report: Our patient was a young boy who had injury to his right gluteal region with a tailoring scissor during a scuffle. He presented to casualty in shock with packing of wound done outside. After resuscitation his Computed tomographic angiography (CT angiography) revealed a psuedoanuerysm of inferior gluteal artery. He was immediately taken up for surgery a transperitoneal ligation of internal iliac artery of the involved side was done along with exploration of the gluteal wound.

Conclusion: These patients of Gluteal artery aneurysms can be managed with both open and endovascular techniques. Our patient was unique in the respect that no GAP has been reported after stab injury with a tailoring scissor and ours is first case report in English literature .We want that the surgeons should keep in mind the possibility of GAP while dealing with even trivial injuries of gluteal region.

Gag Deadens but doesn't Mute the Crime: a Case Series of Homicidal Gagging

A Tyagi, Y Kumar-Vashisht, K Panchal

International Journal of Medical Toxicology and Forensic Medicine, Vol. 5 No. 4(Autumn) (2015), 18 September 2015 , Page 222-226

Background: Asphyxia is the commonest mode of death in various violent homicidal deaths and in majority of such cases, there may not be any evidence of external injury except the general features of asphyxia being the only proof to rely upon. Under such circumstances, even an experienced medicolegal expert may not go further than to declare the death to be due to asphyxia; the exact mode adopted being left unexplained.

Case Report: We present here a case report of three family members who were killed by means of gagging with the motive of taking over the property.

Conclusion: Deaths due to gagging is rare but most of the times homicidal. This case was peculiar as there were multiple individuals who were gagged simultaneously and their bodies were stuffed into trunk.