Original Article

Acute Lithium Intoxication and Factors Contributing to its Morbidity: a 10-Year Review

B Mostafazadeh, S Ghotb, F Najari, E Farzaneh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 1-6

Background: Lithium has been commonly used for the treatment of several mood disorders particularly bipolar disorder in the last 60 years. This study aimed to analyze patients with lithium intoxication referred to Loghman- Hakim teaching hospital.

Methods: This is a cross sectional study that has been done on 108 patients with lithium intoxication during 2001 to 2010. Necessary data were collected by checklists and then analyzed by statistical methods in SPSS version 20.

Results: 39.8% of patients were male and most of them were in age group 20-40 years (47.2%). The rate of lithium use in 66.7% of patients was lower than 20 grams and the level of lithium in blood was 1 mEq/lit in 44.4% of patients. The rate of recovery has been significantly relation with BUN, creatinin, Intubation, pCO2 and pH. There was a significant relation between hospitalized with pH, pCO2, Na, absorbent materials, intubation and bicarbonate.

Conclusion: Results showed that we should note to the rate and time of lithium used and also severity of signs in management and treatment of patients with the lithium toxicity.

Psychotropic Agents Poisoning: Analysis of Cases Reported to Shahid Beheshti Drug and Poison Information Center

A Esmaily, G Alavian, G Afzal, T Ghane

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 7-11

Background: Antidepressants, antipsychotics and benzodiazepines overdose events are the most reported poisoning each year from Shahid Beheshti Drug and Poison Information Center (DPIC) (a branch of Iran Drug and Poison Information Center in Tehran), which clearly shows the necessity of providing prevention program and instruction plan in taking psychotropic agents.

Methods: This survey was a descriptive retrospective study by reviewing 390 reported phone calls from Shahid Beheshti Drug and Poison Information Center (DPIC), in Tehran, through 2010 to 2012.

Results: 390 reported cases of psychotropic agents including overdoses, medical errors such as extra dose, accidental exposure of medications, especially in children, cases of suicide, and intentional use (were) recorded. The main causes of poisoning calls to the DPIC, were included intentional and suicidal actions (40%), accidental events (27%), drug abuse (26%) and, medical errors (7%), respectively. Up to 50% of calls were about benzodiazepines (BZD) poisoning and the most adverse effects were Central Nervous System (CNS) effects followed by gastrointestinal side effects.

Conclusion: According to the results, in order to achieve the proper effect of psychotropic agents and preventing related poisoning, providing pharmaceutical services and awareness of patients are necessary. It should be about the therapeutic effects and side effects of their medications by pharmacists and poison centers and limiting the accessibility of patients to large amounts of these medications by regulatory organizations.

Medicolegal Study of Alleged Rape Victim Cases in Mumbai Region

S Haridas, S. D. S Nanandkar

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 12-22

Background: The sexual assault on women and female children is one of the most heinous crimes against mankind. Sexual violence is ubiquitous; it occurs in every culture, in all levels of society and in every country of the world. Sexual violence has a significant negative impact on the health of the population. The root causes of sexual and gender-based violence lie in a society’s attitudes towards and practices of gender discrimination, which place women in a subordinate position in relation to men.

Methods: The prospective study was conducted in Mumbai region from 1st January 2011 to 31st December 2012 in which 152 cases of alleged rape victims which was booked under the section 376 of Indian Penal Code which was brought for medical examination. Strict confidentiality about their names was maintained.

Results: The most common age group comprised ages between 16-20 years in which total 63 (41.44%) cases were observed. Most of the victims i.e. 99 (65.13%) were unmarried. Most of the incidences took place at accused house, i.e. 69 (45.39%). In 142 (93.42%) cases the assailant was known to the victim. In 113 (74.34%) cases the time interval between the alleged incidence and examination was more than seven days. In 139 (91.44%) cases the hymen showed old tears at multiple positions. None of the report out of 66 reports from forensic science laboratory was found to be positive for spermatozoa.

Conclusion: Rape cases show a constantly rising pattern with a low conviction rate. There is no age safe from rape, maximum cases being in the age group 16-20 years as there are multiple physical, social and mental factors playing a role. Unmarried young women are at increased risk. Significant number of cases report late to the police/doctor. The delay results into loss of valuable biological trace material evidences.

Determination of Sex Using Hand Dimensions

P R Varu, C N Gajera, H M Mangal, P M Modi

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 23-28

Background: Whenever unknown or mutilated dead bodiesor dismembered body parts are found, crime investigative agencies focuses on establishment of identity of deceased in their primary investigation. Determination of sex from dismembered body parts can play vital role for identification of deceased. Present study can be helpful in such cases to determine sex from Hand dimensions, if isolated hand is found. Present study was done with the aim to derive cut off points for Hand length, breadth and Hand index to differentiate male and female.

Methods: Value more than cut off point denotes male and less than that denotes female. Total 100 male and 100 female cases were randomly selected from cadavers brought for post-mortem examination at mortuary of P.D.U. Govt. Medical College and Hospital, Rajkot. Hand length and breadth was measured by sliding caliperup to nearest 0.1 cm after breaking Rigor mortis, if developed. Collected data were statistically analysed using software like Epi info 7 and Microsoft excel 2007.

Results: No significant bilateral difference was found in Hand length (P>0.05) but Hand breadth was showing significant bilateral difference (P<0.05). However, bilateral difference in Hand breadth was relatively small (0.17 cm for males and 0.15 cm for females, on an average). So, combined right and left hand measurements were used to derive cut off points. Cut off point to differentiate male and female for Hand length, breadth and index were 17.2, 7.7 and 44.6 respectively.

Conclusion: Hand length, breadth and Hand index are showing sexual dimorphism and therefore they can be used for determination of sex when isolated hand is found. Hand breadth was showing highest accuracy in determination of sex, followed by Hand length and Hand index.

Gender Determination Using Diagnostic Values of Foramen Magnum

K Aghakhani, N Kazemzadeh, F Ghafurian, B Soltani, S Soltani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 29-35

Background: Foramen magnum is a big hole in the base of the skull. Its appearance can be useful in gender determination. So far, no study has been conducted in Iran that evaluates the value of foramen magnum in sex determination and calculates the cut-off points. This study aimed to evaluating of diagnostic value of the foramen magnum and to calculate the cut-off points for sex determination.

Methods: In this cross sectional study 50 male and 50 female patients referring to the radiology department of Rasol Akram Hospital in Tehran were evaluated. The required information about the sagittal diameter, transverse diameter, and diameter of foramen magnum were assessed by brain CT scan. Chi-square and independent t test was used for the comparison of different shapes and diameters between the sexes. ROC curve was used to determine the optimal cut-off point for each indicator.

Results: The best cut-off point to distinguish males from females along the anterior-posterior foramen magnum was calculated as 36.45 mm, at the transverse diameter of 30.4 mm. The proper cut-off points for the area of the foramen magnum were 877.477 mm2 and 870.29 mm2, based on the Teixeria formula and Routal formula respectively. Overall, the accuracy of these indicators was calculated as 85%.

Conclusion: Based on the results of this study using CT scans images, the diameter of the foramen magnum and its area had a high accuracy in sex determination.

Review Article

Virginity and Virginity Testing: Then and Now

M Robatjazi, M Simbar, F Nahidi, J Gharehdaghi, M Emamhadi, A Vedadhair, H Alavimajd

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 36-43

Background: Despite the increasing progresses in medicine and health in the 21st century especially in the area of reproductive health, myths related to “virginity” and “virginity testing” still figure out life and death in some communities after centuries. Overall, aim of this study was to investigate the myths and objective facts associated with virginity and virginity testing.

Methods: This review conducted by SID, Ovid, Science Direct, Pub Med, Pro Quest, Iran Medex, Google Scholar, Cochrane library, EBSCO, and United Nations Population Fund, WHO from 1980 to 2015. Keywords for search included virginity, virginity testing, hymen, sexual abstinence.

Results: The undeniable value of virginity, female virginity worth versus the shame of virginity for male, the idea to preserve virginity despite oral and anal sex and indicators to assess the intact hymen and wedding night bleeding to prove virginity are misconceptions that besides perceived premarital sex as signs of civilization and conflicts of gender inequality and violence against women lead to fail most of approaches against increasing of premarital sex.

Conclusion: Although programs such as "virginity pledge", "Silver Ring" and "Sexual abstinence education" are running in some countries, in order to expand virginity as a practical approach in controlling sexual transmitted diseases and teen pregnancy, the role of undeniable myths in advance to such approaches, the use of cultural, social and religious potentials of different societies to cope with the misconceptions and teaching of related objective facts seems necessary.

Case Report

Accidental Death of Construction Worker due to Unintended Nail Gun Discharge: a Case Report

AA Al-Habshan, A Al-Emam, M Hamoda

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 44-46

Background: In spite of being rare, intracranial nail gun injury represents one of the fatal penetrating head injuries.

Case Report: Here we report a case of intracranial nail gun injury in a 28 years old well-trained construction worker who left the electric nail gun on the edge of the window to pick up one of his tools from the ground. Unfortunately, his leg got entangled in the nail gun cable and thus the nail gun dropped on the ground firing a nail that killed the worker.

Conclusion: To the best of our knowledge, this first time death from nail gun injury is reported in the Arab world; although, there are previous reports of survivable nail gun cardiac injuries and cranial injuries from Saudi Arabia. Thus, it is important to raise public awareness about such cases in order to reduce the occurrence of nail gun injuries. Moreover, health and safety inspections mandated and supported by law, might be much more effective in reducing such injuries.

Meningioma - a Cause of Sudden Death

YP Babu Raghavendra, Sh Rai, Sh Bakkannavar M, P H Shetty

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 47-49

Background: Sudden unexpected death of an apparently healthy individual is an expected event in the life of a forensic expert. Neurological causes account for only 15% of all sudden deaths of which deaths from an undiagnosed primary intracranial neoplasm is exceptionally rare. Meningioma is a common intracranial tumor and it is rarely associated with sudden, unexpected deaths.

Case Report: We report one such case of sudden death in a 32-year old male with an olfactory meningioma without any prior history of neurological symptoms raising queries regarding the cause of death.

Conclusion: This case illustrates the possibility of meningioma remaining silent till middle age and can present with sudden onset of seizures which may lead to fatality.

An Unusual Case of Cut-Throat Injury: a Medico-Legal Masquerade

A M Bhat, M Shetty, V Tarvadi-Pratik, Sh Suraj S, K Abymon K

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 50-53

Background: Psychological autopsy is one of the most valuable tools in equivocal deaths.

Case Report: Hereby we present an unusual case of cut-throat injuries wherein an adult female was found dead in her house having single entry/exit which was locked from outside. On examination multiple incised wounds were found on the front aspect of the neck. Scene circumstances were equivocal.

Conclusion: Crime scene investigation and psychological autopsy plays a vital role in differentiating suicide from homicide in all cases of equivocal deaths.

Contrecoup Epidural Haematoma-a Rare Phenomenon: an Autopsy Case Report

M G Rao, KR Senthil, D Singh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 1(Winter) (2016), , Page 54-57

Background: Contrecoup extradural haemorrhage (CCEDH) is reported very rarely in literature, 13 to be exact. All these cases have been documented based on clinical, radiological and intraoperative findings.

Case Report: Here we report a rare entity of CCEDH with autopsy findings in a 48-year old male with an alleged history of fall. The clinical and the radiological findings recorded in the hospital files as well as information supplied by the investigating officer has been considered.

Conclusion: Various mechanisms of CCEDH hypothesised by the previous authors have been discussed.