International Journal of Medical Toxicology and Forensic Medicine
Year:2024 | Volume:14 | Issue:1|Papers Count:9

Background: The association between the severity of coronary atherosclerosis and histopathologic findings in patients with non-alcoholic fatty liver disease (NAFLD) is not entirely understood. Considering the gold standard method, this study evaluates the histopathologic association between the severity of NAFLD and the grades of coronary atherosclerosis. Methods: In this descriptive-analytical study, data from 205 cadavers who were referred to an Iranian (Tabriz) forensic medicine organization between 2015 and 2017 and underwent simultaneous liver and coronary artery biopsies were examined. Finally, 168 cases were entered based on the inclusion criteria. First, pathological slides of these cadavers were extracted from the forensic medicine archive and re-examined. Then, the selected cases’ blocks were extracted from the tissue block bank, and again, after preparing a new slide, they were stained with trichrome for accurate estimation of liver fibrosis. Results: The assessment of NAFLD histological status in the studied cases revealed that 75. 6% of the cases were classified as severity I, 18. 4% as severity II, and 6% as severity III. Most cases with coronary atherosclerosis were classified as American Heart Association staging (AHA), type V (19. 6%), and normal (19. 6%). There was no statistically significant relationship between the severity of simple steatosis, steatohepatitis, and NAFLD, with coronary atherosclerosis. In subjects with higher severity of coronary atherosclerosis, the liver fibrosis rate is also higher, but no statistically significant difference was observed. Conclusion: The present study revealed no significant histopathological association between NAFLD and coronary artery atherosclerosis grade.

Background: This study evaluated ocular features and visual outcomes in patients of accidental methanol poisoning at a tertiary centre in Jharkhand, India. Methods: Seven consecutive patients were attended from January 2022 to December 2022 as bedside references in the emergency department of our hospital after accidental ingestion of methanol in the form of adulterated alcoholic beverages. Visual acuity, anterior segment, fundus, and intraocular pressure (IOP) were examined, followed by a magnetic resonance imaging (MRI) of the brain. They were started with intravenous methylprednisolone followed by oral prednisolone. All the patients were followed up for the next three months. Results: The mean age of patients was 36. 21±3. 3 years (ranging from 29 to 43 years), and all were males. Visual acuity ranged from perception of light to counting fingers at 1 meter. Visual loss was bilateral. The pupillary reaction was sluggish or non-reactive. Fundus pictures ranged from normal to optic disc oedema and tortuous vessels. MRI showed central nervous system involvement in all patients. In follow-up visits, three patients showed normal fundus as in the previous examination, while four patients showed optic atrophy, and none presented with any improvement in visual acuity. Conclusion: It was concluded that methanol causes irreversible visual loss.

Background: Methemoglobinemia manifests with cyanosis but no respiratory distress. Many substances implicated in methemoglobinemia also are known to cause either drug-induced hemolysis or oxidative stress on erythrocytes, leading to hemolysis. This case report described a patient presenting acutely with both cyanosis and jaundice. Case Presentation The patient is a 76-year-old female with a history of chronic obstructive pulmonary disease and a recently diagnosed urinary tract infection (UTI) who presented to the emergency department with urinary frequency and dysuria. She had recently been started on trimethoprim-sulfamethoxazole (TMP-SMX) and phenazopyridine for her UTI. On physical exam, she had both cyanosis and jaundice, giving her skin a dull, gray color. She had hypoxia to 75% oxygen saturation, which did not remarkably respond to supplemental oxygen. She also had hyperbilirubinemia and anemia. Laboratory errors confounded the evaluation, however, there was high concern for methemoglobinemia, and empiric treatment was initiated. Methemoglobinemia was later confirmed and the patient improved, although she required multiple blood transfusions. After removing the offending agents, treating the methemoglobinemia, and providing supportive care for her hemolytic anemia, she improved and was discharged home. Conclusion: Although methemoglobinemia has a classic presentation of cyanosis without respiratory distress, additional coincident pathologies can easily confuse the clinical picture. Understanding the pathophysiology of methemoglobinemia is key to understanding why our patient also developed hemolysis. When cyanosis and jaundice are both present, simultaneous management of methemoglobinemia and hemolytic anemia may be needed. Special attention to glucose 6-phosphate dehydrogenase status is required in these circumstances to avoid patient harm with methylene blue.

Background: Methemoglobinemia manifests with cyanosis but no respiratory distress. Many substances implicated in methemoglobinemia also are known to cause either drug-induced hemolysis or oxidative stress on erythrocytes, leading to hemolysis. This case report described a patient presenting acutely with both cyanosis and jaundice. Case Presentation The patient is a 76-year-old female with a history of chronic obstructive pulmonary disease and a recently diagnosed urinary tract infection (UTI) who presented to the emergency department with urinary frequency and dysuria. She had recently been started on trimethoprim-sulfamethoxazole (TMP-SMX) and phenazopyridine for her UTI. On physical exam, she had both cyanosis and jaundice, giving her skin a dull, gray color. She had hypoxia to 75% oxygen saturation, which did not remarkably respond to supplemental oxygen. She also had hyperbilirubinemia and anemia. Laboratory errors confounded the evaluation, however, there was high concern for methemoglobinemia, and empiric treatment was initiated. Methemoglobinemia was later confirmed and the patient improved, although she required multiple blood transfusions. After removing the offending agents, treating the methemoglobinemia, and providing supportive care for her hemolytic anemia, she improved and was discharged home. Conclusion: Although methemoglobinemia has a classic presentation of cyanosis without respiratory distress, additional coincident pathologies can easily confuse the clinical picture. Understanding the pathophysiology of methemoglobinemia is key to understanding why our patient also developed hemolysis. When cyanosis and jaundice are both present, simultaneous management of methemoglobinemia and hemolytic anemia may be needed. Special attention to glucose 6-phosphate dehydrogenase status is required in these circumstances to avoid patient harm with methylene blue.

Background: Alcohol toxicity is a significant medical emergency with implications for patient management and outcomes. This single-blinded randomized intervention study investigated the effects of oral probiotics on various laboratory parameters in patients with acute alcohol toxicity. Methods: A total of 30 eligible patients were randomly assigned to either the control (placebo) or intervention (oral probiotics) group. Results: While the study did not reveal a significant impact on the length of hospital stay (LOHS), it did demonstrate notable improvements in laboratory variables, including pH, serum glutathione level, serum vitamin B6 level, and O2 saturation, in the probiotic group. Conclusion: These findings suggest the potential benefits of probiotics in mitigating certain aspects of alcohol toxicity.

Background: Today, methanol intoxication is increasing. Identifying mortality predictors has a significant correlation with poisoning progress. This meta-analysis study aimed to identify and evaluate mortality predictors for methanol poisoning. Methods: In this study, we searched electronic databases for case-control and cohort studies related to methanol poisoning. The quality of the studies was evaluated using the STROBE checklist. Comprehensive meta-analysis 3 was used to calculate the odds ratio (OR) and 95% CI of the factors present, as well as to perform heterogeneity, sensitivity, and publication bias assessments. Results: In this meta-analysis study, 14 out of 945 initial studies were included. The results identified 15 mortality predictors of methanol poisoning. The risk factors were ranked by the integrated OR values and included venous blood pH (OR=3. 79, 95% CI, 2. 42%, 5. 19%), methanol concentration (OR=1. 64, 95% CI, 1. 05%, 2. 55%), venous carbon dioxide pressure (PCO2) (OR=9. 993, 95% CI, 5. 80%, 17. 18%), base deficit (OR=2. 943, 95% CI, 1. 20%, 7. 165%), hemodialysis time (OR=2. 69, 95% CI, 1. 35%, 5. 35%), blood sugar (OR=9. 84, 95% CI=3. 86, 25. 09), venous bicarbonate (HCO3) (OR=2. 97, 95% CI, 1. 68%, 5. 26%), creatinine (OR=13. 10, 95% CI, 2. 68%, 64. 04%), potassium (K) (OR=3. 51, 95% CI, 1. 66%, 7. 43%), alanine aminotransferase (OR=7. 57, 95% CI, 1. 03%, 55. 57%), sodium (OR=6. 69, 95% CI, 1. 78%, 25. 12%), white blood cells (OR=7. 16, 95% CI, 1. 42%, 36. 16%), coma (OR=32. 73, 95% CI, 18. 59%, 56. 70%), visual disturbances (OR=3. 37, 95% CI, 1. 59%, 7. 16%), and gastrointestinal symptoms (OR=1. 94, 95% CI, 1. 16%, 3. 22%). Conclusion: Identifying mortality predictors and disease progression in methanol intoxication patients can help doctors diagnose patients at risk better and faster to provide effective treatment interventions for them.

Background: Benzodiazepines have been highly prescribed by physicians and have attracted public attention due to their high safety. These drugs have sedative, hypnotic, anti-anxiety, and anti-seizure properties. However, these drugs are also widely used for suicide. The present study was designed and implemented to determine the distribution of patients poisoned with benzodiazepines in terms of clinical and demographic characteristics. Methods: Investigation of poisoning with benzodiazepines in one year in the poisoning department of Loghman Medical Center in Tehran City, Iran, was carried out as a descriptive-prospective study. In this research, 458 poisoned patients were studied to collect data on their age, gender, drug dosage, type of drug, duration of hospitalization, blood analysis results, and mortality. Results: The majority of patients poisoned with benzodiazepines were women (62. 2%). The mean age of people was 31. 67 years. The most frequently used drugs were clonazepam and alprazolam. Other drugs used with benzodiazepines were propranolol, methadone, and acetaminophen. The death rate was 1. 7%. The incidence of hypoglycemia and creatinine above 1. 3 was 8. 53% and 11. 3%, respectively. Hyperglycemia was 10. 6%. There were 11, 80, and 178 cases of elevated alanine transaminase, aspartate aminotransferase, and alkaline phosphatase, respectively. Conclusion: Benzodiazepines have the potential to cause liver and kidney damage and changes in insulin secretion and blood sugar. This issue should be considered when dealing with a poisoned patient to prevent serious injuries.

Background: Hydrogen cyanamide (Dormex®) is used as a fertilizer sprayed on fruits, especially grapes to stimulate buds’ opening. It causes oxidative stress leading to hepatic, renal, and lung damage. Melatonin is derived primarily from the amino acid tryptophan, produced from the pineal gland, and has antioxidant effects. This study aimed to examine the effects of acute hydrogen cyanamide (Dormex®) exposure on the liver of albino rats and evaluate the biochemical and histological changes caused by Dormex® toxicity. Additionally, the study evaluated the potential ameliorative role of melatonin in these harmful effects. Methods: Forty adult male albino rats were divided into four groups,group I: Negative control, group II: Melatonin-treated (100 mg/kg/day), group III: Dormex®-treated (100 mg/kg) as a single dose, and group IV: Receiving melatonin (100 mg/kg/day)+Dormex® (100 mg/kg). After 24 hours, all animals were evaluated for liver enzymes (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and bilirubin), hepatic markers for oxidative stress (malondialdehyde (MDA), reduced glutathione (GSH), and superoxide dismutase (SOD)) and histopathological examination was done for hepatic tissues. Results: The Dormex®-treated group showed significantly elevated liver enzymes, elevated MDA, and decreased GSH and SOD. Histopathological examination revealed normal structure in groups 1 and 2 while group 3 showed several histopathological changes characterized by inflammation and hepatic necrosis. Administration of melatonin with Dormex® in group 4 caused a decrease in liver enzymes and MDA and an increase in GSH and SOD with improvement in liver histopathology. Conclusion: Melatonin showed an ameliorative effect and can be used as a protective agent against Dormex®-induced hepatic injury.

Background: Nowadays, erythropoietin is employed as a substitute therapy for eye ailments, particularly optic nerve damage induced by methanol toxicity. Despite its benefits, erythropoietin can have negative effects on blood factors. These effects may include thrombosis, stroke, seizures, and changes in hematological function. This study examined the adverse effects of erythropoietin on individuals suffering from optic neuropathy caused by methanol. Methods: This study was a prospective descriptive study at Loghman Hakim Hospital, Tehran City, Iran, in 2022. The study involved individuals who suffered from methanol poisoning and were administered erythropoietin twice a day for three days, with a dosage of 10000 units each time. Patients were examined up to 6 weeks after discharge in terms of increased hemoglobin levels, seizures, central vascular thrombosis, and heart attack or stroke. The data was analyzed by SPSS software, version 18. Results: The study comprised of 37 patients. No patient reported seizures, heart and cerebral strokes, and deep vein thrombosis except polycythemia. After being discharged from the hospital, the mean hemoglobin levels increased by 2. 01% six weeks later compared to the levels measured during admission. Moreover, there was a 2. 4% rise in hemoglobin levels six weeks after discharge when compared to the levels measured two weeks after being discharged. Conclusion: Using erythropoietin to treat optic neuropathy can improve vision, but it also carries the risk of increasing hemoglobin levels, which must be monitored closely in treated patients.