Original Article

Epidemiological Study of Poisoning in Patients Referring Educational and Clinical Center of Ayatollah Kashani Hospital, Shahrekord (West of Iran) throughout 2008-2014

F Najjari, P Ramazannejad, A Ahmadi, Z Amini

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 121-127

Background: Appropriate and early diagnosis and treatment of poisoning could be vital. Awareness of general pattern of poisoning in any geographical regions could be helpful in this regard. According to the lack of information and not being specified the epidemiologic forms of poisoning in Chaharmahal and Bakhtiari province (west of Iran), this study was carried out to determine the epidemiologic status of poisoning.

Methods: In this routine data base study, available data were used in medical records of 394 patients with poisoning diagnosis throughout 2008-2014 at Ayatollah Kashani Hospital (only recipient hospital of poisoning in Chaharmahal and Bakhtiari province), which affiliated with Shahrekord University of Medical Sciences. Association between the studies was variable and also reasons for poisoning was investigated by chi-square, analysis of variance, independent t-test, Pearson's correlation in stata software.

Results: Of 395 patients with poisoning, 207 (52.5%) were female and the rest were male. For the years under study, the highest poisoning ratio (20.26%) was seen in 2010 and the lowest (3%) in 2014. Mean age of all, male and female patients was 27.6 , 29.8, and 25.6 years, respectively, with a significant difference between male and female patients (P<0.05).

The mean and standard deviation of duration of hospitalization in respiratory patients was 3.2±4.2, injection 3±3.8, oral 2.5±3, others 2±1.2, and bite was 2 days (P>0.05).

The highest poisoning ratio (62%) was obtained for oral poisonings and the lowest (0.5%) was due to beating. For marital status, the highest poisoning ratio was obtained in the single individuals and the lowest in the divorced (P<0.05). Of 395 patients, 358 (90.6%) survived and the rest died. The highest mortality (17 deaths) was due to oral poisoning.

Conclusion: Poisoning occurs often in young people and has a high load in this group. Trend of poisoning in this province is steadily diminishing. Epidemiological, regional data helps to use the sources appropriately to prevent and control poisoning. Further, analysis of the effective factors could contribute to decreasing poisoning incidence by planners and policymakers.

Epidemiologic Study of Fatal and Non-Fatal Poisoning Case in Pediatric, Around Jamnagar Region, Gujarat in India (January-December 2013)

M Trangadia, R Kharadi, B D Gupta

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 128-134

Background: In spite of successful interventions and safety measures to prevent accidental poisoning in pediatric population, it contributes significantly to childhood morbidity and mortality.

Methods: This Retrospective study comprising of 204 cases of poisoning was conducted during the period of a year, from 1st January 2013- 31st Dec 2013 at Forensic Medicine Department, Shri M. P. Shah Govt. College, Guru Gobindsinh Govt. hospital (GGG) Jamnagar.

Results: The incidence of poisoning was more in age group of 2-3 year. Majority of victims were male as compared to females. The most common place of incidence of poisoning was home followed by playground. Most common route of poisoning was oral followed by poisonous animal bites and sting. All poisoning cases were accidental in nature. No suicidal or homicidal case was found in our study. Poisoning cases were more common in the months of April and October than in the rest of the months. The most common agent involved in pediatric poisoning was kerosene.

Conclusion: Based on observation most of the cases were accidental poisoning in young children so precaution like proper storage and proper disposal of chemicals and parental awareness regarding these issues could sufficiently reduce the prevalence of poisoning among children.

Analysis of Negligence in field of Neonatology in Medical Commissions Office in Tehran, Iran

M Fallahi, SS Vaghefi, M Makhmalbaf, M kazemian, SA Afjeh, B Mostafazadeh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 135-141

Background: Despite progression of medical’s science, patient’s complaints are increased. Analysis of risk factors cause to decrease complaints.

Methods: This research is a retrospective study of medical malpractice cases in neonates’ from 2012 to2014 in Medical Commissions Office in Tehran province.

Results: Among 171 cases were studied, 53 cases were in neonatal period. 30.1% was announced medical malpractice. Ages of most infants were 0-10 days (88.6%), 66% of babies were male, 69.8% had full-term gestation, 62.2% APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of neonates was above 7 and 73.5% of cases were the first child of the family. Most babies had cerebral palsy and asphyxia (20.7%), then respiratory distress syndrome (11.3%), furthermore shoulders dystocia and brachial plexus damage (7.5%). Ages of most plaintiffs (parents of neonates) were 30-39 years. Most of them were male, and their levels of education were high school and lower. The most cause of parent’s claim was medical mistake.

Conclusion: Levels of parents’ education may relationship with complaints and increasing their awareness can effect to decrease these.

Pattern of Injuries among Two or Four Wheeler Occupants in Fatal Road Traffic Injuries

Yadukul S, PK Devadass, G Gururaj

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 142-147

Background: Every day, we read, listen, or witness, injuries in our day to day lives. Over time, it has moved from 5th to 3rd to 1st page of our newspapers. Some days, it is not uncommon to see the entire page of our newspaper filled with news about injury and violence. On television channels, even on prime time, injury and violence has occupied the center stage. Many times, the ‘breaking news’ is only deaths due to road crashes, suicides, mass burns and blood loaded violence. The present study is aimed at analyzing the various types of injuries that occur in road traffic injuries and to take necessary actions by the concerned authority to prevent such incidents in the future.

Methods: In this study, we studied the various patterns of injuries sustained by the occupants of two/four wheeler during fatal road traffic injuries. A total number of 238 cases (those who died in road traffic injuries) were included in the study for a period of 2 years from October 2010 to September 2012 in Department of Forensic Medicine and Toxicology, Bangalore Medical College and Research Institute, Bengaluru.

Results: Among the cases studied in our study (n=238), majority of the victims were males constituting 94% of the cases and in age-wise distribution of cases, age group of 21-30 years (46.2%) followed by 31-40 years (21.4%) constitutes to about 2/3rd of the cases. Time of injury among the cases studied showed that highest incidence being during the night times (18:01-00:00) which constitutes 44.11%. Among the road user category, two wheeler riders (78.15%) formed the major contributors for road traffic injury.

Conclusion: In the present study, it is very clear that the middle aged, male bike riders are more prone for fatal road traffic injuries. Hence, Government should take proper initiatives in the future to focus on these high risk individuals to prevent such fatalities.


Epidemiology of Burn Deaths in Aurangabad Region, India

G V Tasgaonkar, V P Meshram, H K Khartade, K U Zine, R M Kamble, A H Hosmani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 148-155

Background: Amongst all discoveries by men, barely few like cultivation of soil, speech and writing, have borne such significant developments as has finding out how to make fire. From the discovery of fire and its tremendous force, manufacturing, transportation and practically all phases of modern industrial life emerged out. Burns are injuries often produced by contact with dry heat, such as flame, radiation, or some solid heated material like metal or glass to the body.

Methods: This study was conducted prospectively on 325 cases of death due to burns in the period from January 2010 to December 2010.

Results: Hindu married females belonging to rural background were most common victims of burns. Maximum cases were observed in the evening with involvement of cooking apparatus most of the time.

Conclusion: The present study has findings more or less consistent with the findings of the other Indian studies. Rising incidences of burns can be prevented by awareness and education about the hazards of fire and safety measures also upgrade of social and educational standards of population.

Review Article

Art of Tattooing: Medical Applications, Complications, Ethical and Legal Aspects

J Barwa, A Rani, R Singh

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 156-163

The art of tattooing has been practiced since the ancient times for a variety of reasons. The descriptive, decorative patterns have not only been used as a means of identification but have established itself in the field of medicine as well, being employed as a therapeutic modality or diagnostic method. These include corneal tattooing, gastrointestinal tattooing during endoscopy, reconstructive and cosmetic tattooing for camouflage, radiotherapy field marking etc. An emerging application of tattooing is medical alert tattooing often practiced by the patients themselves without medical consultation inscribing their disease condition or allergy to a particular medication which may affect diagnosis or treatment. However, tattoos indicating advance health directives (do not resuscitate/do not defibrillate) or the organ donor tattoo pose ethical and legal problems as they may not reflect patient’s current wishes. Furthermore, they are not recognized as meeting any of the legal requirements, so they cannot be considered as valid directives or as consent, but only as a way to guide treatment decisions. In this paper, we outline a brief review of the numerous applications, its advantages, potential drawbacks along with the ethical and legal issues related to it.

Case Report

Death due to Positional Asphyxia – a Case Report

S B George, S S Shetty, M S Raj, M Shetty

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 164-166

Background: Positional asphyxia is virtually always an accident and is associated with alcohol or drug intoxication. In positional asphyxia individuals do get trapped in restricted spaces.

Case Report: We are presenting a case of 26-years old young adult male, who was intoxicated with alcohol, positioned himself in such a way that it led to his death due to positional asphyxia.

Conclusion: The positional asphyxia has been defined as asphyxia caused due to unusual position of the body which interferes with the breathing and thus pulmonary ventilation The cases of positional asphyxia are difficult to diagnose because of the absence of any specific external findings. 

Fabricated or Assault Wounds - A Scientific Approach

G S Vidhate, H Pathak, M Parchake, S Patil, G Tasgaonkar, R Sukhadeve

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 167-170

Background: Fabricated (fictitious, forged or invented) wounds are usually superficial injuries mostly produced by a person on his own body (self-inflicted) or occasionally, caused by another person acting in agreement with him (self-suffered). Assault means a physical attack by another person.

Case Report: We received two cases, within a short period, from different police stations, with multiple incised wounds over different regions of the body. Characteristically one of the cases was brought with all fresh wounds and another with all healed linear scar marks. Both these cases were presented as assault wounds in the hospital. As the history of both cases was misleading and the investigating authority was suspecting fabricated wounds, medical opinion regarding the manner of injuries was sought.

Conclusion: Present case report deals with importance of proper history taking, pattern of injuries, examination and use of simple techniques like photography and hand lens to rule out assault wounds.

Miliary Tuberculosis: an Accidental Finding at Autopsy

P V Tarvadi, Sh Suares, H S Permi, Sh Manipady, M Shetty

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 171-174

Background: Forensic pathologists often encounter various disease conditions at autopsy which would not have been diagnosed ante-mortem and they often explain poor clinical outcomes in some patient.

Case Report: The following is a case report of a 55-years old female who died of complications of degloving injury to the right lower limb.

Conclusion: Miliary Tuberculosis was an accidental finding at autopsy and thus explained the deteriorating condition of patient and failure to respond to the treatment.

Unsuspected Tracheal Web with Asthma-Like Symptom in a Young Female: Case Report

M Moinazad-Tehrani, Kh Agin

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 175-178

Background: Although most patients with asthma are easily controlled with appropriate medication, a small proportion of patients (approximately 5% of asthmatics) are difficult to control despite maximal inhaled therapy.

Case Report: A 20-year-old girl admitted to the emergency ward (EW) of loghman hakim hospital in tehran with severe dyspnea. She was born with asphyxia for which oxygen therapy prescribed for two days.  Conclusion: Congenital abnormality of the trachea can rarely present as asthma symptoms in adulthood. It is important to know, when encounter too difficult to treat asthma as the condition can be curable surgically.

Corridor Roof Causing Almost Decapitation: a Rare Case Report

J Deshkar, S Mittal, Sh K Naik

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 179-183

Background: Cut throat injury can be homicidal, suicidal or accidental in manner. However, in the absence of tentative cuts, deep cut throat injury usually raised suspicion towards homicide, even against the circumstantial history provided by close relatives or eye witness. Decapitation or almost decapitation is usually noticed in homicidal assault using any heavy cutting weapon like sword and axe or in suicidal railway injury.

Case Report: A 91-years old, otherwise healthy lady (empress of one high profile Company) died due to almost decapitation as a result of accidental fall of wheel chair and trapping of neck underneath roof of corridor while moving up in an elevator (lift). With suspicion of property dispute, the investigating police agency was not ready to accept it as a case of accident till the neck injury was clarified demonstrating associated injuries during autopsy and later during visit to scene of death.

Conclusion: In high profile case, video recording of autopsy findings, even if not mandatory as per the law, should be made to remain in safer side. Although police should not be allowed during conduction of autopsy, it will be healthy practice to clarify any doubts then and there over autopsy table, if the case warrants so.

Massive Subcutaneous Emphysema, Pneumothorax and Pneumoscrotum: Diagnostic Dilemma on Autopsy

G S Vidhate, H Pathak, R Kamble, A Hosmani

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 184-187

Background: Subcutaneous emphysema is when gas or air in the layer under the skin. It literally means trapped air in the tissues beneath skin. It has characteristic crackling feel to touch, a sensation that has been described as similar to touching to Rice Krispies; this sensations under skin is called as subcutaneous crepitation.

Case Report: A 50-years old male sustained injuries allegedly as a result of vehicular accident and was taken to a nearby private hospital. He was intubated there and then referred to a tertiary care hospital. He succumbed to death during transportation and was declared as brought dead on arrival. His body was brought for autopsy.

Conclusion: There was massive subcutaneous emphysema, pneumothorax and pneumoscrotum. Their origin created a dilemma on autopsy due to various reasons. It is discussed in detail and tried to track the origin.

Accidental High Voltage Electrocution: a Case Report

Sh K Kishore, S Rani, R M Marigoudar, M B Balaraj

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 188-190

Background: Without electricity, mankind wouldn’t have progressed to the heights we are at now. As much as electricity is helpful, being careless with it can be fatal. The passage of electric current through the body produces wide range of effects, varying from insignificant localised spasm, little or no contact burns, fatality with little or no burns or extreme severe burning.

Case Report: This case report discusses the injuries sustained by a young adult, due to accidental contact with high tension wire.

Conclusion: This paper also highlights safety rules pertaining to high voltage cables.

Letter to the Editor

The Importance of Medical Toxicology Training

A Banagozar-Mohammadi, M Zaare-Nahandi, M Kavehei

International Journal of Medical Toxicology and Forensic Medicine, Vol. 6 No. 3(Summer) (2016), 22 October 2016, Page 191-192

One of the most common reasons for reference of patients to the emergency department or sending them to high level specialized centers is poisoning. The treatment of these patients requires special scientific and practical skills, that in the absence of skilled staff necessary to perform diagnostic and therapeutic procedures the mortality and morbidity rate of these patients will be greatly increased. This study is a case report of a patient death cases of poisoning after staying in one of the health centers in Iran due to lack of medical staff and unfamiliarity physicians with properly managing the poisoning patients.