Pub Date : 2022-03-01DOI: 10.32598/IJMTFM.VI.36127
Amir Ghabousian, A. Alizadehasl, Niloufar Ansari, M. Haghazali
Background: Around 20% of breast cancers (BCs) overexpress Human Epidermal Growth Factor Receptor 2 (HER-2). HER-2 overexpression is associated with increased tumor aggressiveness and poor prognosis. Trastuzumab (an anti-HER2 monoclonal antibody) has been reported to improve overall survival in early-stage and metastatic BCs, but at the expense of increasing cardiac morbidity. In the current review study, we aims to discuss the pathogenesis of trastuzumab-induced cardiotoxicity and the potential ameliorating role of spironolactone in this regard. Methods: The search strategy aimed to identify both published and unpublished studies. First off, we identified keywords and index terms, including trastuzumab, cardiotoxicity, heart failure, and spironolactone to conduct a broad search in PubMed, Embase, Scopus, and Web of Science, using the aforementioned keywords either individually or in combination. Lastly, the reference list of all identified articles was also evaluated. Our study included observational and interventional studies, case-reports, and systematic reviews and meta-analyses. Results: Trastuzumab could deteriorate mitochondrial function and subsequently leads to the accumulation of Reactive Oxygen Species (ROS) in cardiomyocytes. Published clinical studies offered conflicting results regarding the efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in respect of trastuzumab-induced cardiotoxicity. On the other hand, spironolactone was found to have both antioxidant and anti-inflammatory properties. Recent in-vivo studies supported the cardioprotective effect of spironolactone through maintaining mitochondrial ultrastructure and reducing ROS production. Conclusion: Although spironolactone mitigates oxidative stress and mitochondrial dysfunction, there is a lack of clinical evidence to support the effectiveness of spironolactone in trastuzumab-induced cardiotoxicity. Design and implementation of clinical trials are recommended to determine the potential beneficial effects of spironolactone on trastuzumab-induced cardiotoxicity.
背景：大约20%的乳腺癌（BCs）过表达人表皮生长因子受体2（HER-2）。HER-2过表达与肿瘤侵袭性增加和预后不良有关。据报道，曲妥珠单抗（一种抗HER2单克隆抗体）可以提高早期和转移性BCs的总生存率，但以增加心脏发病率为代价。在目前的综述研究中，我们旨在讨论曲妥珠单抗诱导的心脏毒性的发病机制以及螺内酯在这方面的潜在改善作用。方法：检索策略旨在识别已发表和未发表的研究。首先，我们确定了关键词和索引术语，包括曲妥珠单抗、心脏毒性、心力衰竭和螺内酯，并在PubMed、Embase、Scopus和Web of Science中单独或组合使用上述关键词进行了广泛搜索。最后，还评估了所有已确定文章的参考文献清单。我们的研究包括观察性和介入性研究、病例报告、系统综述和荟萃分析。结果：曲妥珠单抗可使线粒体功能恶化，进而导致心肌细胞中活性氧（ROS）的积累。关于血管紧张素转换酶抑制剂和β受体阻滞剂对曲妥珠单抗诱导的心脏毒性的疗效，已发表的临床研究提供了相互矛盾的结果。另一方面，螺内酯被发现具有抗氧化和抗炎特性。最近的体内研究支持螺内酯通过维持线粒体超微结构和减少ROS的产生来发挥心脏保护作用。结论：尽管螺内酯可以减轻氧化应激和线粒体功能障碍，但缺乏临床证据支持螺内酯对曲妥珠单抗诱导的心脏毒性的有效性。建议设计和实施临床试验，以确定螺内酯对曲妥珠单抗诱导的心脏毒性的潜在有益作用。
{"title":"Potential Ameliorating Role of Spironolactone in Trastuzumab-induced Cardiotoxicity: A Narrative Review","authors":"Amir Ghabousian, A. Alizadehasl, Niloufar Ansari, M. Haghazali","doi":"10.32598/IJMTFM.VI.36127","DOIUrl":"https://doi.org/10.32598/IJMTFM.VI.36127","url":null,"abstract":"Background: Around 20% of breast cancers (BCs) overexpress Human Epidermal Growth Factor Receptor 2 (HER-2). HER-2 overexpression is associated with increased tumor aggressiveness and poor prognosis. Trastuzumab (an anti-HER2 monoclonal antibody) has been reported to improve overall survival in early-stage and metastatic BCs, but at the expense of increasing cardiac morbidity. In the current review study, we aims to discuss the pathogenesis of trastuzumab-induced cardiotoxicity and the potential ameliorating role of spironolactone in this regard. Methods: The search strategy aimed to identify both published and unpublished studies. First off, we identified keywords and index terms, including trastuzumab, cardiotoxicity, heart failure, and spironolactone to conduct a broad search in PubMed, Embase, Scopus, and Web of Science, using the aforementioned keywords either individually or in combination. Lastly, the reference list of all identified articles was also evaluated. Our study included observational and interventional studies, case-reports, and systematic reviews and meta-analyses. Results: Trastuzumab could deteriorate mitochondrial function and subsequently leads to the accumulation of Reactive Oxygen Species (ROS) in cardiomyocytes. Published clinical studies offered conflicting results regarding the efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in respect of trastuzumab-induced cardiotoxicity. On the other hand, spironolactone was found to have both antioxidant and anti-inflammatory properties. Recent in-vivo studies supported the cardioprotective effect of spironolactone through maintaining mitochondrial ultrastructure and reducing ROS production. Conclusion: Although spironolactone mitigates oxidative stress and mitochondrial dysfunction, there is a lack of clinical evidence to support the effectiveness of spironolactone in trastuzumab-induced cardiotoxicity. Design and implementation of clinical trials are recommended to determine the potential beneficial effects of spironolactone on trastuzumab-induced cardiotoxicity.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44571854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.32598/ijmtfm.v12i2.36827
F. Akrami, A. Zali, M. Abbasi
Background: Human Rights (HRs) framework supports improving human health status and the reduction of health inequalities through action on Social Determinants of Health (SDH). Given the shortcoming of HRs to protect the children, the question is, how can we ensure child protection and well-being rather than just child health? Methods: In this conceptual analysis study, first, we explain the fundamental rights of the child and the steering role of them in moving towards health equity through action on SDH; second, meanwhile argue the shortcoming of rights-based protection, provide a list of the core capabilities and corresponding rights of the child; and third, we represent a conceptual framework for child protection and well-being using both HRs norms and moral entitlements based on recent ethical theories of justice, with a preventive approach. Results: According to the framework, HRs instruments should lead to the protection of the child and the development of core capabilities through addressing social determinants and providing equal opportunities, of which the ability to live a healthy life is just one. In addition, actualizing these capabilities depends on the context. Since achieving well-being rather than just the health, in addition to acquiring the core capabilities as states of beings, implies their function as doings, that requires considering the socioecological context to provide means necessary to meet the essential dimensions of well-being at the level of adequacy. Conclusion: Implementing the suggested framework requires that each country create a national action framework and determine the role and duties of the responsible organizations.
{"title":"Entanglement of the Rights of the Child, Well-being, and Justice: A Conceptual Framework for Child Protection and Well-being","authors":"F. Akrami, A. Zali, M. Abbasi","doi":"10.32598/ijmtfm.v12i2.36827","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.36827","url":null,"abstract":"Background: Human Rights (HRs) framework supports improving human health status and the reduction of health inequalities through action on Social Determinants of Health (SDH). Given the shortcoming of HRs to protect the children, the question is, how can we ensure child protection and well-being rather than just child health? Methods: In this conceptual analysis study, first, we explain the fundamental rights of the child and the steering role of them in moving towards health equity through action on SDH; second, meanwhile argue the shortcoming of rights-based protection, provide a list of the core capabilities and corresponding rights of the child; and third, we represent a conceptual framework for child protection and well-being using both HRs norms and moral entitlements based on recent ethical theories of justice, with a preventive approach. Results: According to the framework, HRs instruments should lead to the protection of the child and the development of core capabilities through addressing social determinants and providing equal opportunities, of which the ability to live a healthy life is just one. In addition, actualizing these capabilities depends on the context. Since achieving well-being rather than just the health, in addition to acquiring the core capabilities as states of beings, implies their function as doings, that requires considering the socioecological context to provide means necessary to meet the essential dimensions of well-being at the level of adequacy. Conclusion: Implementing the suggested framework requires that each country create a national action framework and determine the role and duties of the responsible organizations.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44170150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.32598/ijmtfm.v12i2.35084
M. Forouzesh
Background: The type of suicide is determined by various factors, such as accessibility to drugs, economic problems, and psychological disorders.This study aimed to assess the rate of suicide and its reasons in children <18 years. Methods: This was a cross-sectional study carried out on 350 autopsy bodies less than 18 years of age in Tehran Forensic Medicine Center in 2010-2020 who had struggled with suicide. Data were analyzed using SPSS software v. 18. Results: Mean±SD age of children was 16.36±1.76 years. The most common method in children less than 15 years and over 15 years was hanging (n=36) and poisoning with chemical substances (n=139), respectively (P<0.001). The most common method of suicide was poisoning with chemical substances (n=147, 42%). The most common method of suicide in girls and boys was poisoning with chemical substances (n=81) and hanging (n=75), respectively. The highest number of children who struggled were residents in the outskirt of Tehran (n=113, 32.5%). The suicide rate in people with depressive disorder and tentative injury was 10% (n=35) and 18.6% (n=65). In 13 patients, vitreous humor alcohol was positive (Mean±SD alcohol: 60.61±43.03 mg/dl). The most common toxin observed in toxicology was rice tablet or aluminum phosphide (n=90, 25.7%). Regarding drug toxicity in toxicology, 52.6% (n=86) was not positive. Opium was found in 7.4% of cases (n=26). Conclusion: The suicide rate has been on the rise during the past ten years through hanging and poisoning with chemical substances, such as aluminum phosphide, opium, and tricyclic antidepressants, especially in the outskirts.
{"title":"The Rate of Suicide and its Reasons in Children Under the Age of 18 Years","authors":"M. Forouzesh","doi":"10.32598/ijmtfm.v12i2.35084","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.35084","url":null,"abstract":"Background: The type of suicide is determined by various factors, such as accessibility to drugs, economic problems, and psychological disorders.This study aimed to assess the rate of suicide and its reasons in children <18 years. Methods: This was a cross-sectional study carried out on 350 autopsy bodies less than 18 years of age in Tehran Forensic Medicine Center in 2010-2020 who had struggled with suicide. Data were analyzed using SPSS software v. 18. Results: Mean±SD age of children was 16.36±1.76 years. The most common method in children less than 15 years and over 15 years was hanging (n=36) and poisoning with chemical substances (n=139), respectively (P<0.001). The most common method of suicide was poisoning with chemical substances (n=147, 42%). The most common method of suicide in girls and boys was poisoning with chemical substances (n=81) and hanging (n=75), respectively. The highest number of children who struggled were residents in the outskirt of Tehran (n=113, 32.5%). The suicide rate in people with depressive disorder and tentative injury was 10% (n=35) and 18.6% (n=65). In 13 patients, vitreous humor alcohol was positive (Mean±SD alcohol: 60.61±43.03 mg/dl). The most common toxin observed in toxicology was rice tablet or aluminum phosphide (n=90, 25.7%). Regarding drug toxicity in toxicology, 52.6% (n=86) was not positive. Opium was found in 7.4% of cases (n=26). Conclusion: The suicide rate has been on the rise during the past ten years through hanging and poisoning with chemical substances, such as aluminum phosphide, opium, and tricyclic antidepressants, especially in the outskirts.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42044957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.32598/ijmtfm.v12i2.36951
M. Jalilvand, Z. Nikmanesh, Fariborz Bagheri
Background:Attention Deficit Disorder/Attention-Deficit/Hyperactivity Disorder (ADD/ ADHD) is one of the most prevalent childhood diseases, and it may substantially influence social behaviors, legal issues, and disputes. The goal was to see how cognitive rehabilitation training affected executive functioning and impulsivity in children with ADHD in Tehran, District 5. Methods: A quasi-experimental design was used, with two groups (experimental and control) and a pretest-posttest. All students with ADHD disorder aged 7 to 12 years were included in the statistical population. The sample comprised 30 kids who were age-matched and randomly split into two groups. They were tested for two months in February and March 2021. Slow cognitive rehabilitation training was given to the experimental group. Both groups were given a pretest and a posttest. Information was gathered using the BRIEF (parent form) and Conners’ (parent form) questionnaires. MANCOVA was used to analyze the data, using the SPSS software v. 26, with a significance threshold of 0.05. Results: There was a significant difference in executive function variables (inhibition, attention transfer, emotional control, initiation, working memory, planning, material organization, and control) and reduced impulsivity (attention deficit , hyperactivity, opposition, and ADHD) (P≤0.001). Conclusion: Cognitive rehabilitation improves executive skills and impulsivity in children with ADHD aged 7-12 years. Cognitive rehabilitation training should be utilized with other educational approaches to rectify social behaviors, minimize conflict, and improve executive functions.
{"title":"Cognitive Rehabilitation Training in Improving Executive Function, Antisocial Behaviors, and Legal Problems in Children With Attention-Deficit/Hyperactivity Disorder","authors":"M. Jalilvand, Z. Nikmanesh, Fariborz Bagheri","doi":"10.32598/ijmtfm.v12i2.36951","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.36951","url":null,"abstract":"Background:Attention Deficit Disorder/Attention-Deficit/Hyperactivity Disorder (ADD/ ADHD) is one of the most prevalent childhood diseases, and it may substantially influence social behaviors, legal issues, and disputes. The goal was to see how cognitive rehabilitation training affected executive functioning and impulsivity in children with ADHD in Tehran, District 5. Methods: A quasi-experimental design was used, with two groups (experimental and control) and a pretest-posttest. All students with ADHD disorder aged 7 to 12 years were included in the statistical population. The sample comprised 30 kids who were age-matched and randomly split into two groups. They were tested for two months in February and March 2021. Slow cognitive rehabilitation training was given to the experimental group. Both groups were given a pretest and a posttest. Information was gathered using the BRIEF (parent form) and Conners’ (parent form) questionnaires. MANCOVA was used to analyze the data, using the SPSS software v. 26, with a significance threshold of 0.05. Results: There was a significant difference in executive function variables (inhibition, attention transfer, emotional control, initiation, working memory, planning, material organization, and control) and reduced impulsivity (attention deficit , hyperactivity, opposition, and ADHD) (P≤0.001). Conclusion: Cognitive rehabilitation improves executive skills and impulsivity in children with ADHD aged 7-12 years. Cognitive rehabilitation training should be utilized with other educational approaches to rectify social behaviors, minimize conflict, and improve executive functions.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44935020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.32598/ijmtfm.v12i2.35789
S. H. S. Mostafavi, A. Memarian, O. Motamedi, Khalil Sharboo, M. Khaleghi, Shirin Habibi, Ramin Emami
Background: Identification of victims is one of the main challenges of forensic medicine. Height is one of the key measurements of the biological profiles of individuals. This study aimed to evaluate height based on measuring three-dimensional CT scan indices of twelfth thoracic (T12), first lumbar (L1), and fifth lumbar (L5) vertebrae in Iranian adults. Methods: The present study was a cross-sectional study performed on 100 patients who underwent a spinal CT scan. Vertebral T12, L1, and L5 indices were measured in these individuals. Finally, the evaluated indices were statistically compared and the diagnostic effect of each was evaluated to estimate the height. Independent t-test and linear regression were used using SPSS software v. 21. A P value less than 0.05 was considered significant. Results: The results showed that the mean difference between T12, L1, and L5 indices in the two groups of male and female patients was statistically significant. With one unit increase in the Transverse process distance T 12 (TDM T12), there is an increase of 0.42 units in height (P=0.02). Conclusion: According to the results of the present study, the measurements of the T12, L1, and L5 vertebral indices have a significant relationship with gender. Among the measurements of the T12, L1, and L5 vertebral indices, just TDM T12 can be a predictive factor to estimate the height of the Iranian population.
背景:受害人身份鉴定是法医学的主要挑战之一。身高是衡量个体生物特征的关键指标之一。本研究旨在通过测量伊朗成年人第十二胸椎(T12)、第一腰椎(L1)和第五腰椎(L5)的三维CT扫描指数来评估身高。方法:本研究是对100例接受脊柱CT扫描的患者进行的横断面研究。测量这些个体的椎体T12、L1和L5指数。最后，对评价指标进行统计比较，并评价各指标的诊断效果，估算身高。采用SPSS v. 21软件进行独立t检验和线性回归分析。A P值小于0.05被认为是显著的。结果:结果显示，两组男女患者T12、L1、L5指标平均差异有统计学意义。横程距离T12 (TDM T12)每增加1个单位，高度增加0.42个单位(P=0.02)。结论:根据本研究结果，T12、L1、L5椎体指数测量值与性别有显著关系。在T12、L1和L5椎体指数的测量中，只有TDM T12可以作为估计伊朗人口身高的预测因素。
{"title":"Height Estimation Based on 3-Dimensional CT Scan of 12th Thoracic, 1st and 5th Lumbar Vertebrae","authors":"S. H. S. Mostafavi, A. Memarian, O. Motamedi, Khalil Sharboo, M. Khaleghi, Shirin Habibi, Ramin Emami","doi":"10.32598/ijmtfm.v12i2.35789","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.35789","url":null,"abstract":"Background: Identification of victims is one of the main challenges of forensic medicine. Height is one of the key measurements of the biological profiles of individuals. This study aimed to evaluate height based on measuring three-dimensional CT scan indices of twelfth thoracic (T12), first lumbar (L1), and fifth lumbar (L5) vertebrae in Iranian adults. Methods: The present study was a cross-sectional study performed on 100 patients who underwent a spinal CT scan. Vertebral T12, L1, and L5 indices were measured in these individuals. Finally, the evaluated indices were statistically compared and the diagnostic effect of each was evaluated to estimate the height. Independent t-test and linear regression were used using SPSS software v. 21. A P value less than 0.05 was considered significant. Results: The results showed that the mean difference between T12, L1, and L5 indices in the two groups of male and female patients was statistically significant. With one unit increase in the Transverse process distance T 12 (TDM T12), there is an increase of 0.42 units in height (P=0.02). Conclusion: According to the results of the present study, the measurements of the T12, L1, and L5 vertebral indices have a significant relationship with gender. Among the measurements of the T12, L1, and L5 vertebral indices, just TDM T12 can be a predictive factor to estimate the height of the Iranian population.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48601165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.32598/ijmtfm.v12i2.37176
Maryam Vasheghani Farahani, S. Soltani, S. Marashi
Nitroglycerin, a vasodilator, is commonly administered to treat ischemic heart disease. Adverse effects after toxicity are light-headedness, nausea, blurry vision, and syncope due to low systolic blood pressure as well as methemoglobinemia. A 19-year-old female was admitted to our toxicology department after suicidal ingestion of 320 mg extended-release nitroglycerin about 45 minutes before the admission. She was conscious, and her initial blood pressure was 98/65 mm Hg, which was decreased to 77 mmHg within 1.5 hours despite administration of 1 liter of normal saline. Due to severe hypotension, norepinephrine infusion was started for systolic blood pressure maintenance above 80mm Hg; however, she started complaining of palpitation and chest pain. So, the dose of norepinephrine was reduced, and glucose, insulin, and potassium protocol were started. After 3 hours of therapy, her hemodynamic condition stabilized with systolic blood pressure above 90mm Hg; hence norepinephrine was discontinued. She was discharged on the 3rd day after the psychiatric consultation, with regular clinical and paraclinical examinations.
{"title":"Hyperinsulinemic Euglycemia Therapy for Acute Nitroglycerin Poisoning: Case Report","authors":"Maryam Vasheghani Farahani, S. Soltani, S. Marashi","doi":"10.32598/ijmtfm.v12i2.37176","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.37176","url":null,"abstract":"Nitroglycerin, a vasodilator, is commonly administered to treat ischemic heart disease. Adverse effects after toxicity are light-headedness, nausea, blurry vision, and syncope due to low systolic blood pressure as well as methemoglobinemia. A 19-year-old female was admitted to our toxicology department after suicidal ingestion of 320 mg extended-release nitroglycerin about 45 minutes before the admission. She was conscious, and her initial blood pressure was 98/65 mm Hg, which was decreased to 77 mmHg within 1.5 hours despite administration of 1 liter of normal saline. Due to severe hypotension, norepinephrine infusion was started for systolic blood pressure maintenance above 80mm Hg; however, she started complaining of palpitation and chest pain. So, the dose of norepinephrine was reduced, and glucose, insulin, and potassium protocol were started. After 3 hours of therapy, her hemodynamic condition stabilized with systolic blood pressure above 90mm Hg; hence norepinephrine was discontinued. She was discharged on the 3rd day after the psychiatric consultation, with regular clinical and paraclinical examinations.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44240449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.32598/ijmtfm.v12i2.36738
Sara Sabbaghian Tousi, Roya Jabbari, B. Dadpour, Hosein Roghangaran Khiabani
Background: Poisoning is a medical emergency, and is considered as a common cause of morbidity and mortality worldwide. In this study, the extended Cox model was used to determine the factors affecting the length of hospitalization in those with drug poisoning. Methods: The sample size included 2408 patients with opioids poisoning referring to the Emergency Department of Imam Reza Hospital in Mashhad, Iran from March 21, 2018 to March 20, 2019. Extended Cox model was fitted to determine the effect of five covariates (age, gender, marital status, type of poisoning, and type of opioids). In survival analysis, the length of hospitalization was considered as a time covariate (T). Patients’ recovery was also regarded as an event. Results: Of 2408 patients, 399 (16.6%) were censored and 2009 (83.4%) were uncensored. The risk of failure in complete recovery from poisoning in males was 1.189 times more compared to females. The risk of failure in complete recovery for the 15-24, 25-44, 45-64, and >65 years age groups were 0.277, 0.241, 0.289, and 0.481 times lower, respectively compared to the <2 years age group. For the married patients, the risk was 0.291 times lower compared to the divorced patients. For those poisoned accidentally, the risk was 0.490 times lower than compared to those poisoned intentionally. For those used methadone, morphine, opium, and tramadol, the risk was 1.195, 1.243, 1.193, and 1.147 times more, respectively compared to those used marijuana. By increasing the time (day) of hospital stay, the risk of failure for the 25-44, 45-64, and >65 years age groups were 1.024, 1.028, and 1.040 times more, respectively compared to the <2 years age group. Moreover, for those poisoned accidentally, the risk was 1.197 times more compared to those poisoned intentionally by the time (day) of hospital stay. Conclusion: The factors affecting the length of hospitalization in those poisoned by drugs are gender, marital status, and type of opioids covariate as time-independent covariate, and age and type of poisoning as time-dependent covariates. Since the complications of drug poisoning impose many costs on the health system, knowledge of these covariates can help take some measures for complete recovery of poisoned patients in a shorter length of hospital stay.
{"title":"Using the Extended Cox Model to Determine Factors Affecting the Length of Hospitalization in Patients with Drug Poisoning","authors":"Sara Sabbaghian Tousi, Roya Jabbari, B. Dadpour, Hosein Roghangaran Khiabani","doi":"10.32598/ijmtfm.v12i2.36738","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.36738","url":null,"abstract":"Background: Poisoning is a medical emergency, and is considered as a common cause of morbidity and mortality worldwide. In this study, the extended Cox model was used to determine the factors affecting the length of hospitalization in those with drug poisoning. Methods: The sample size included 2408 patients with opioids poisoning referring to the Emergency Department of Imam Reza Hospital in Mashhad, Iran from March 21, 2018 to March 20, 2019. Extended Cox model was fitted to determine the effect of five covariates (age, gender, marital status, type of poisoning, and type of opioids). In survival analysis, the length of hospitalization was considered as a time covariate (T). Patients’ recovery was also regarded as an event. Results: Of 2408 patients, 399 (16.6%) were censored and 2009 (83.4%) were uncensored. The risk of failure in complete recovery from poisoning in males was 1.189 times more compared to females. The risk of failure in complete recovery for the 15-24, 25-44, 45-64, and >65 years age groups were 0.277, 0.241, 0.289, and 0.481 times lower, respectively compared to the <2 years age group. For the married patients, the risk was 0.291 times lower compared to the divorced patients. For those poisoned accidentally, the risk was 0.490 times lower than compared to those poisoned intentionally. For those used methadone, morphine, opium, and tramadol, the risk was 1.195, 1.243, 1.193, and 1.147 times more, respectively compared to those used marijuana. By increasing the time (day) of hospital stay, the risk of failure for the 25-44, 45-64, and >65 years age groups were 1.024, 1.028, and 1.040 times more, respectively compared to the <2 years age group. Moreover, for those poisoned accidentally, the risk was 1.197 times more compared to those poisoned intentionally by the time (day) of hospital stay. Conclusion: The factors affecting the length of hospitalization in those poisoned by drugs are gender, marital status, and type of opioids covariate as time-independent covariate, and age and type of poisoning as time-dependent covariates. Since the complications of drug poisoning impose many costs on the health system, knowledge of these covariates can help take some measures for complete recovery of poisoned patients in a shorter length of hospital stay.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47613830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.32598/ijmtfm.v12i2.36863
Vedpal Singh Punia, Shaavi Mittal, Apoorva Shetty, N. Bansal, P. Garg, P. Kumar, Neelabh Pratap
Posterior Reversible Encephalopathy Syndrome (PRES), also known as Reversible Posterior Leukoencephalopathy Syndrome, presents with rapid onset symptoms, including headache, seizures, altered consciousness, and visual disturbance. It is seen most frequently in settings of acute hypertension and is usually related to eclampsia. Only a few cases in the literature described PRES syndrome following benzodiazepines. We present a young male with benzodiazepine poisoning brought to the hospital in a deep coma, hypoxia, acidosis, and shock. Diagnosis of PRES was made on history, clinical examination, and radiologic findings of symmetric bilateral hyperintensities on T2 weighted Magnetic Resonance Imaging (MRIs) representing vasogenic edema.
{"title":"Posterior Reversible Encephalopathy Syndrome: An Unusual Complication of Benzodiazepine Poisoning: A Case Report","authors":"Vedpal Singh Punia, Shaavi Mittal, Apoorva Shetty, N. Bansal, P. Garg, P. Kumar, Neelabh Pratap","doi":"10.32598/ijmtfm.v12i2.36863","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.36863","url":null,"abstract":"Posterior Reversible Encephalopathy Syndrome (PRES), also known as Reversible Posterior Leukoencephalopathy Syndrome, presents with rapid onset symptoms, including headache, seizures, altered consciousness, and visual disturbance. It is seen most frequently in settings of acute hypertension and is usually related to eclampsia. Only a few cases in the literature described PRES syndrome following benzodiazepines. We present a young male with benzodiazepine poisoning brought to the hospital in a deep coma, hypoxia, acidosis, and shock. Diagnosis of PRES was made on history, clinical examination, and radiologic findings of symmetric bilateral hyperintensities on T2 weighted Magnetic Resonance Imaging (MRIs) representing vasogenic edema.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43966600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.32598/ijmtfm.v12i2.36486
M. Sharifi, M. Ghadipasha, Amirahmad Shojaei, S. Nedjat, Roya Rashidpouraie, Hamideh Moosapour, Seyed Mahmood Tabatabaei
Background: Effective and acceptable practice in Legal Medicine (LM) requires special attention to ethical and professional behaviors. In LM, the importance of practitioners’ compliance with ethical standards is higher. LM covers a wide range of practices, requiring specific ethical considerations. This study aims to identify the ethical principles for considerations in Iranian Legal Medicine Organization (ILMO) from the perspective of experts in LM. Methods: This is an applied and qualitative study using in-depth interviews and conventional content analysis. The study was conducted in three steps: 1) Determination of the main areas of work by reviewing academic texts، surveying 131 experts in this field with a questionnaire. 2) Qualitative Study for determination of ethical considerations of these areas by structured and in-depth interviews with 49 owner’s Forensic and medical ethics experts obtained by purposive sampling and theoretical saturation and analysis of interviews by the conventional approach of content analysis to specify propositions and confirm the reliability of 80% research in coding through the double-coder agreement method. 3) Drafting ethical guidelines by the research group (students، supervisors، and consultants) in the focus group meetings based on the results of the second step. Results: The ethical principles of LM were categorized as general and specific principles according to the perspective of experts in LM. General ethical principles included virtue ethics, professional and ethical behavior, and proper environment and working conditions. The specific ethical principles included six principles related to the entire organization, legal physical examinations, legal mental examinations, dissection rooms and crime scenes, LM laboratories, and LM commissions. Conclusion: Developing and implementing general and specific ethical guidelines for ILMO is recommended. The comprehensive and holistic view of ethical considerations for main practices of LM in Iran provided by this study can be seen as a good taxonomy and a preliminary step to develop local ethical guidelines.
{"title":"The Ethical Considerations in the Main Practices of the Iranian Legal Medicine Organization: A Qualitative Study","authors":"M. Sharifi, M. Ghadipasha, Amirahmad Shojaei, S. Nedjat, Roya Rashidpouraie, Hamideh Moosapour, Seyed Mahmood Tabatabaei","doi":"10.32598/ijmtfm.v12i2.36486","DOIUrl":"https://doi.org/10.32598/ijmtfm.v12i2.36486","url":null,"abstract":"Background: Effective and acceptable practice in Legal Medicine (LM) requires special attention to ethical and professional behaviors. In LM, the importance of practitioners’ compliance with ethical standards is higher. LM covers a wide range of practices, requiring specific ethical considerations. This study aims to identify the ethical principles for considerations in Iranian Legal Medicine Organization (ILMO) from the perspective of experts in LM. Methods: This is an applied and qualitative study using in-depth interviews and conventional content analysis. The study was conducted in three steps: 1) Determination of the main areas of work by reviewing academic texts، surveying 131 experts in this field with a questionnaire. 2) Qualitative Study for determination of ethical considerations of these areas by structured and in-depth interviews with 49 owner’s Forensic and medical ethics experts obtained by purposive sampling and theoretical saturation and analysis of interviews by the conventional approach of content analysis to specify propositions and confirm the reliability of 80% research in coding through the double-coder agreement method. 3) Drafting ethical guidelines by the research group (students، supervisors، and consultants) in the focus group meetings based on the results of the second step. Results: The ethical principles of LM were categorized as general and specific principles according to the perspective of experts in LM. General ethical principles included virtue ethics, professional and ethical behavior, and proper environment and working conditions. The specific ethical principles included six principles related to the entire organization, legal physical examinations, legal mental examinations, dissection rooms and crime scenes, LM laboratories, and LM commissions. Conclusion: Developing and implementing general and specific ethical guidelines for ILMO is recommended. The comprehensive and holistic view of ethical considerations for main practices of LM in Iran provided by this study can be seen as a good taxonomy and a preliminary step to develop local ethical guidelines.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43519053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-15DOI: 10.32598/IJMTFM.VI.36171
S. Shadnia, Lida Shojaei Arani, K. Bahmani, M. Akhgari, H. Farajidana, Mohamadreza Ghadirzadeh, Mohamadreza Haj esmaeili, Omidvar Rezaei Mirghaed
Background: Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020. Methods: This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient’s files and analyzed with appropriate statistical tests. Results: Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients. Conclusion: Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication.
背景:在2019冠状病毒病大流行期间观察到甲醇中毒暴发。急性甲醇中毒是一场全球性危机。甲醇可通过代谢性酸中毒引起急性和致命的毒性。在本研究中，我们评估了2020年3月至4月在德黑兰最近爆发的甲醇中毒中死亡的患者的人口学、临床和临床旁特征。方法:本横断面研究是在德黑兰的Loghman-Hakim医院完成的80例甲醇中毒死亡患者。回顾性收集患者档案中的人口学、临床和实验室数据，并采用适当的统计检验进行分析。结果:男性明显多于女性(85% vs. 15%)。男性和女性患者的其他特征无显著差异，包括到达医院的时间间隔、透析次数、脉搏率、呼吸率、意识丧失、癫痫发作、急性肾损伤、脑CT和脑出血(ICH)。多数患者血糖、血钾、肝功能均高于平均水平。结论:我们的研究表明，这次甲醇中毒的爆发是由于使用了含有甲醇的酒精饮料。男性主要受到影响，这可能是因为我们国家的文化和社会地位。女性更大的癫痫发作概率可能是由于雌激素增强了NMDA受体。多数患者血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和凝血酶原时间(PT)异常，提示肝损害。对饮酒对COVID-19的保护作用的误解可能导致许多人饮用含有甲醇的劣质酒精，并暴发甲醇中毒。
{"title":"Demographic and Clinical Characteristics of Patients Who Died of Methanol Toxicity During COVID 19 Period in Loghman-e Hakim Hospital in Tehran","authors":"S. Shadnia, Lida Shojaei Arani, K. Bahmani, M. Akhgari, H. Farajidana, Mohamadreza Ghadirzadeh, Mohamadreza Haj esmaeili, Omidvar Rezaei Mirghaed","doi":"10.32598/IJMTFM.VI.36171","DOIUrl":"https://doi.org/10.32598/IJMTFM.VI.36171","url":null,"abstract":"Background: Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020. Methods: This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient’s files and analyzed with appropriate statistical tests. Results: Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients. Conclusion: Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication.","PeriodicalId":14168,"journal":{"name":"International Journal of Medical Toxicology and Forensic Medicine","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44346111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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