فهرست مطالب

International Journal of Medical Toxicology and Forensic Medicine
Volume:8 Issue: 4, Autumn 2018

  • تاریخ انتشار: 1397/08/23
  • تعداد عناوین: 7
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  • Abdolrazagh Barzegar, Fatemeh Shahbazi, Davood Mirtorabi, Mohammad Reza Ghadirzadeh, Ahmad Shojaei, Seyed Saeed Hashemi Nazari* Pages 123-130
     
    Background
    The present study aimed to evaluate the epidemiology of mortality due to substance abuse to provide useful information for local, national, and international administrators.
    Methods
    This cross-sectional study was carried out in 12 months from March 2016 to February 2017. The study population was a random sample of people who died from substance abuse. Data were collected by checklists which were designed according to the study objectives. The obtained data were analyzed in Stata software.
    Results
    Our findings show that the mortality rate for illicit opiate users was 40.90 per 1000000 population. Most deaths occurred among people aged 30 to 39 years (25%), single (46.75%) with low education levels. Kermanshah, Lorestan, and Alborz provinces had the highest mortality rate. History of overdose, suicide, hospitalization in psychiatric in hospital and incarceration was observed in some people who died from substance abuse.
    Conclusion
    A large number of deaths from drug abuse occurred in unmarried, self-employed, young males 30 to 39 years old with low education levels. We suggest that training programs and harm reduction approaches be focused in these high risk groups
    Keywords: Opium, Opioids, Opioid dependence, Mortality, Epidemiology
  • Mohammad Hadizadeh, Neisanghalb, Mohammad Salehi, Pooya Rostami, Seyed Hadi Mirhashemi* Pages 131-135
    Background
    Delayed caustic injury complications are common, especially in developing countries, and several treatments have been proposed to prevent the resulting esophageal strictures so far. Although inflammatory nature of caustic injury makes the anti-inflammatory agents a viable option, few studies have investigated these agents. High-dose corticosteroids therapy for reduction of stricture formation in the esophagus after the ingestion of caustic material is still a controversial topic. In this regard, this study aimed to determine the impact of high doses of methylprednisolone in preventing esophageal stricture.
    Methods
    A total of 112 patients with grade II esophageal caustic injury, diagnosed by esophagogastroscopy within 24 hours of injury, were enrolled in our study. The treatment group (n=44) received methylprednisolone (1 g/d for 3 days), pantoprazole, ceftriaxone, and metronidazole and the control group (n=58) received the same regimen excluding methylprednisolone. Endoscopic and radiologic findings were used to compare the severity of the damage to the esophagus and stomach between the two groups.
    Results
    After 8 months of follow-up, stricture development was observed in 3 (5.6%) patients in the treatment group and in 11 (19%) patients in the control group. The difference was statistically significant (P=0.038). The gastric outlet obstruction was observed in 4 (7.4%) patients in the treatment group and in 19 (32.7%) patients in the control group. Again, the difference was statistically significant (P<0.05). There were not any side effects due to the high doses of methylprednisolone in the study group.
    Conclusion
    High doses of methylprednisolone can prevent the development of esophageal stricture in grade II of caustic injury.
    Keywords: Caustics, Steroids, Esophageal stenosis
  • Mohammadreza Ghadirzadeh, Mehdi Forouzesh, Abdolrazagh Barzegar, Seyed Davood Mirtorabi, Mohammadjavad Hedayatshodeh, Amir Mohammad Mohajerpour, Fardin Fallah* Pages 137-143
    Background
    Substance abuse in drivers is a global public health concern. We investigated patterns of alcohol and illicit drug consumption in drivers died in traffic accidents in Tehran Province, Iran.
    Methods
    In this cross-sectional study, presence of alcohol and illicit drugs in the body of dead drivers referred to Tehran Legal Medicine Organization during April 2016 to April 2018 were investigated. All participants underwent autopsy and their urine, visceral and vitreous samples were examined for alcohol and illicit drugs. Victims with Complete Toxicology Tests for both alcohol and non-alcoholic drugs and those autopsied during their first 24 hours of death were included. Victims’ demographic characteristics, results of their toxicology tests and accident-related factors were investigated, too. To warrant confidentiality of information, identities of victims were concealed. The obtained data were analyzed by SPSS V. 16 and statistically significant level was set at less than 0.05.
    Results
    Of 618 study participants (mean age of 36.95 years), 601 (97.3%) were male. Of victims, 566 (91.3%) were city inhabitants and 471 (76.2%) were with educational attainment of lower than high school. The majority (93%) of crashes happened inside the city. Causes of death were head trauma in 519 (84%) cases, multiple traumas in 62 (10%) cases and bleeding in 37 (6%) cases. Multiple and single-vehicle accidents account for 498 (80.5%) and 98 (17.5%) crashes, respectively. A total of 73 (11.8%) cases were found positive for alcohol/drug consumption: 24 (4%) were alcohol positive, 52 (8.4%) were positive for non-alcoholic drugs (3 were positive for both). Main detected non-alcoholic drugs were morphine and tramadol. There was statistically significant association between drug/alcohol consumption of drivers and cause of death and crash mechanism (Both P<0.001). Multiple traumas and single vehicle crashes were more prevalent among drivers with drug/alcohol positive tests.
    Conclusion
    Rate of alcohol use in our drivers was lower than many countries which is attributed to religious and legal issues. Consistent with the reported pattern of drug abuse in Iranian general population, opioids and tramadol were the main drugs of abuse among studied drivers. Drug or alcohol use result in drivers’ distraction and more fatal injuries.
    Keywords: Alcohol, Driver, Drug, Mortality, Substance
  • Arash Okasi, Behnam Behnoush, Ali Shakori Rad, Mohammad Hossein Sadeghian* Pages 145-150
    Background
    Morphometric measurements are important for identification in forensic medicine. Gender is one of the important components of identity. Many studies have reported that hyoid bone can be used for sex estimation but this claim must be verified in different populations.
    Methods
    We evaluated 372 hyoid bones of 15 to 87 years old Iranian people who had a valid identity certification. Nine anthropometric indices of hyoid bone were measured and investigated in this regard. Computerized tomography scan was done after fixation of dissected tissue in formalin. Logistic regression analysis was performed. The cut-off point (ROC) and discriminative formula were determined.
    Results
    In this study, hyoid bones of Iranian bodies were studied, of which 217 were male and 155 were female cases. The length of the hyoid body, great left horn length, angle between right great horn and left great horn with body of hyoid are associated with sex determination.
    Conclusion
    Hyoid bone in male is generally larger than in females. The result indicate that the hyoid bone morphometry with a high degree of accuracy can determine the sex. Discriminant formula was determined for hyoid bone.
    Keywords: Hyoid bone, Delete CT-Scan, morphometry, Exchange sex estimation with sex determination, Anthropology, Human identification
  • Ali Ostadi, Maryam Paeezi* Pages 151-155
    The present study was conducted on paraquat poisoning cases, from January 2017 to January 2018, a total of 9 patients of paraquat poisoning transferred to our referral Toxicology center. Six of them survived. Paraquat is one of the most used herbicides, a non-selective, killing green plants on contact. It is very toxic for human. We used immunosuppressant and antioxidant drugs in most cases. In addition, many patients were given gastrointestinal decontamination and activated charcoal at a local hospital before transferring to our center. According to our treatments, early management and hemoperfusion after ingestion can increase the rate of survival.
    Keywords: Paraquat, Activated charcoal, N-Acetylsycteine, Hemoperfusion
  • Abbas Aghabiklooei, Meysam Abolmaali* Pages 157-160
    Drugs and poisons are the most common causes of new cases of seizure at emergency wards, a fact that can be easily missed unless physicians consider its likelihood in mind. In this report, we describe a case of recurrent seizures due to intentional ingestion of a pesticide poison (strychnine) that was refractory to very high doses of benzodiazepines and other anticonvulsants. Our patient suffered from 12 times tonic seizures and generalized muscular spasms, until he underwent anesthesia to control the seizures. Finally, he was discharged without any serious complications.
    Keywords: Seizure, Strychnine, Poisoning, Suicide, Benzodiazepines
  • Cyrus Emir Alavi, Abbas Sedighinejad, Gelareh Biazar*, Fardin Yousefshahi, Bahram Naderi Nabi, Siamak Rimaz, Elahe Rafiee, Farimah Mirblook Pages 161-166
     
    Background
    Nowadays, complaints against the medical staff and the demand for physicians’ malpractice compensation are increasing. Anesthesiologists are also faced with medical litigation. Because of the importance of this issue and lack of such a research in Guilan Province, this study was conducted to determine the causes and consequences of complaints against anesthesiologists. This study aimed to reveal the anesthesia malpractice claims and underlying factors of its medico-legal litigations.
    Methods
    This study surveyed all complaints against anesthesiologists from the Medical and Forensic Medicine Organization of Rasht from 2011 to 2015.
    Results
    In this study period, 40 complaints against anesthesiologists were registered. The patients who complained were mostly male (52.5%), married (72.5%), and aged >50 years (62.5%). Of these, 6 medical malpractice were occurred (15%). Death of patients (55%) was the most common cause of complaints and negligence is the highest rate of failure by anesthesiologists (90%). Patients in general surgery wards under general anesthesia in governmental educational hospitals were affected the most; 45% in recovery and 27.5% in ICU sectors. In addition, 15% of all referred anesthesia-related malpractice claims positive legal action.
    Conclusion
    Based on the results, a great concern over the performance of assistants in educational care centers, especially in general surgery ward is recommended. It is also necessary to monitor patient’s status carefully in the recovery room and use experienced personnel in there as well as intensive care units.
    Keywords: Complaint, Anesthesiologist, Medical system, Forensic medicine