Toxicology Department Research Articles

Probable interaction between levothyroxine sodium and thyme (Thymus vulgaris), about a case report

Thyme (Thymus vulgaris) is often used thanks to its anti-infectious properties to treat seasonal influenza. Some patients use it in conjunction with their conventional treatment, which can expose them to adverse effects or interactions. A case of probable pharmacokinetic interaction of levothyroxine and thyme is described. This is a case of 52-year-old woman admitted to the toxicology department in January 2024 after a phytovigilance questionnaire. The patient had a treatment for hypothyroidism consisting in levothyroxine sodium with a daily dose of 150 µg, but she showed palpitations following the taking of a T. vulgaris tea to treat her seasonal flu. She reported that the symptoms disappeared by reducing the doses of T. vulgaris. The score of the probability scale of the interaction was 6, so a probable interaction may occur in patients with thyroid disorders and taking levothyroxine sodium concomitantly with T. vulgaris.

Virulence and resistance genes in <i>Campylobacter spp</i> isolated from asymptomatic children at Kibera slum in Nairobi, Kenya

BACKGROUND Campylobacter spp. are among the global causes of food poisoning and harbour virulence and resistance genes which play a role in invasion and antibiotic resistance. This study aimed to detect selected resistance and virulence genes in archived Campylobacter spp. isolated from children in Kibera, Nairobi, Kenya. MATERIALS AND METHODS This was a retrospective laboratory-based cross-sectional study on archived samples of Campylobacter spp. at the Department of Public Health, Pharmacology and Toxicology, University of Nairobi. Campylobacter isolates were cultured on modified charcoal cefoperazone deoxycholate agar (mCCDA) media. The presence of selected virulence genes and resistance genes was detected by multiplex polymerase chain reaction (mPCR). STATA13 was used in data analysis. Binary logistic regression was used to ascertain the association between the genes and the Campylobacter spp. RESULTS The Campylobacter spp. under this study were Campylobacter jejuni (C. jejuni) (50%), Campylobacter coli (C. coli) (38%) and Campylobacter lari (C. lari) (12%). The virulence genes detected were cgtB 37 (25%), pldA (20%), cdtA (17%), cdtB (16%), cdtC (6%), wlaN (5%), iam (4%), ciaB (4%) and VirB11 (3%). The virulence gene waaC was not detected in any of the isolates. The resistance genes detected were TetA (42%), Tet B (26%), GyrB (18%) and GyrA (14%). CONCLUSION The study revealed the presence of various virulence and resistance genes in Campylobacter spp. isolated from children. This information could help guide the development and enhancement of guidelines for the management of Campylobacter infections.

Comparative Analysis of Drowning Index: Relevance in Drowning Deaths versus Non-Drowning Asphyxial Deaths

Drowning remains a significant cause of mortality worldwide, necessitating accurate diagnostic tools for forensic investigation. This paper conducts a comparative analysis of the Drowning Index (DI) to ascertain its relevance in distinguishing drowning deaths from non-drowning asphyxial deaths. Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many non-drowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. We compared the lung and pleural effusion weight, spleen weight, and DI from 124 autopsies of asphyxia deaths including both drowning deaths and non-drowning asphyxia deaths such as hanging, strangulation, suffocation and mechanical asphyxia at the department of Forensic Medicine and Toxicology at the Gandhi Medical College, Bhopal from January 2021 to August 2022. Findings highlight the potential utility of the DI as a valuable adjunctive tool in forensic investigations, providing insights into its comparative efficacy in differentiating drowning from other modes of asphyxial deaths. Such insights are critical for enhancing accuracy in forensic diagnoses and contributing to advancements in medicolegal death investigations.

The effect of vibroacoustic therapy on the structural integrity of erythrocytes and platelets in patients with acute exogenous poisoning

Background. Vibroacoustic therapy is used as a non-drug method of correcting respiratory disorders in various diseases, including acute poisoning. The effect of vibroacoustic therapy on blood cells currently remains unexplored.Objective. To evaluate the impact of vibroacoustic therapy on the morphofunctional rate of erythrocytes and platelets in patients with acute poisoning in patients with acute poisoning.Material and methods. Thirty eight patients with complicated acute poisoning transferred to the Toxicology Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine were examined. In 19 patients, along with the standard therapy, a vibroacoustic therapy was performed using a VibroLUNG device (the main study group); the other 19 patients received only standard therapy (the comparison group). Vibroacoustic therapy began on the 2nd day after the patient admission to the Toxicology Department. The course of vibroacoustic therapy consisted of 2–9 procedures. Morphofunctional analysis of erythrocytes and platelets in all cases was performed before the start of the vibroacoustic therapy (before treatment) and before discharge from the hospital (1–2 days after completing the vibroacoustic therapy course).Results. In both groups, before treatment, we noted normal morphofunctional rate of erythrocytes and normal level of platelets with granules in the circulating blood. The level of severely damaged or altered platelets was only slightly higher than normal and did not differ between the groups. Meanwhile, in 50% of patients, platelets had a tendency to spontaneous activation and hyperactivation. Before discharge, the morph functional parameters of erythrocytes and platelets did not significantly change in both groups, while treatment with vibroacoustic therapy allowed to eliminate or reduce spontaneous platelet activation in 7 of 9 patients in the main study group. In the comparison group spontaneous platelet activation was absent in only 3 of 10 patients. In parallel, the time till pneumonia resolution turned statistically significantly reduced, by 1.5 times.Conclusions. In acute exogenous poisoning with complicated course, the risk of spontaneous platelet activation and hyperactivation increases. Vibroacoustic therapy does not violate the structural integrity of circulating erythrocytes and platelets. Vibroacoustic therapy, using the VibroLUNG device, reduces the tendency of platelets to spontaneous activation and hyperactivation, reduces the time for resolving pneumonia.

Epidemiological, Clinical and Biological Profile of O Arab Hemoglobinosis: Experience of the Biochemistry Toxicology Department of HMIMV

Background: Hemoglobinopathies (HbPs) are inherited disorders of red blood cells caused by abnormalities in the globin chains of hemoglobin (Hb). Hemoglobin O-Arab is a specific variant with a mutation in the β-chain. These disorders range from asymptomatic to severe and represent a significant public health issue. Methods: A retrospective study was conducted over 10 years (February 2014 to April 2024) in the Biochemistry-Toxicology Department of HMIMV in Rabat. Hemoglobin variants were detected using HPLC and capillary electrophoresis. Data on socio-epidemiological, clinical, and biological aspects were collected from patient follow-up forms. Results: of 17,843 hemoglobin studies, 1,154 hemoglobinopathies (5.4%) were identified, with 63 cases (0.35%) of hemoglobin O-Arab: 58 heterozygous, 4 homozygous, and 1 composite heterozygous. Most cases were detected incidentally during HbA1c testing. Homozygous cases showed anemia, while heterozygous cases showed no significant abnormalities. The composite heterozygous case had severe clinical complication. Conclusions: Hemoglobinopathies, including hemoglobin O-Arab, are common genetic disorders. Advanced diagnostic techniques like capillary electrophoresis have improved detection, but multiple methods are still needed for accurate diagnosis. Effective collaboration between clinicians and laboratories is crucial for managing these disorders.

Epidemiological Aspects and Pattern of Intoxication among Elderly in Khorasan-Razavi; Northeast of Iran.

This study aimed to assess the risk factors and clinical-epidemiological patterns of acute poisoning among elderly individuals to guide prevention strategies. The epidemiological, clinical data, manner and cause of poisoning, and outcome of the registered elder cases (≥ 60 years old) in the clinical toxicology department of Imam Reza Hospital of Mashhad University of Medical Silences (CTD-IRH-MUMS) were investigated for nine months. The sex and age distribution of the patients were compared with the general population of Khorasan-Razavi using direct standardization. Among the 3064 cases registered at the hospital, 124 elderly patients were included in the study. The majority (71.8%) were male, with a mean age of 69.47. Male gender was found to be a significant risk factor for poisoning among elderly individuals compared to the general population (OR = 2.62) (1.55-4.42) (p-value < 0.001), however, it was not significant for age. Substance dependency, particularly on opiates, was common among the patients (56.5%), with a higher prevalence in males. Substance overdose (35.4%) and suicide (23.3%) were the most common methods of poisoning, with varying frequencies between genders (p-value = 0.002). Male gender was identified as a risk factor for opiate intoxication (OR = 4.68, CI = 1.70-11.83, p-value < 0.05) but not for suicide attempts. The average hospital stay duration was similar between male and female patients. The mean length of hospital stay was 3.53 ± 4.02 days (median = 3.0, range = 0.5-26 days) and was similar in both sexes. In conclusion,male gender and opiate dependency were highlighted as key factors in the poisoning of elderly individuals. These findings emphasize the importance of addressing these factors in preventive measures.

Clinical case of colchicum poisoning

Introduction. Autumn colchicum or crocus is a popular plant among gardeners, characterized by early beautiful flowering, but few people know that it is poisonous. Acute colchicum poisoning is a dangerous urgent clinical situation with high mortality rates. By disrupting cell division, colchicum venom leads to multiple organ failure and death in just a few days. However, colchicum extract in small doses is often used in modern medicine to treat various diseases, due to its high antimitotic and moderate anti-inflammatory activity. The article describes the clinical observation of a patient admitted to the toxicology department after a suicide attempt using a crocus flower, containing the alkaloid colchicine. The results of laboratory and pathological studies are presented. Clinical observation. A clinical case of acute crocus poisoning with the development of hemodynamic disorders, dyspeptic syndrome, respiratory failure, cytolysis syndrome, and oliguria is presented. Treatment was aimed at restoring organ functions and consisted of infusion, detoxification, and hemostatic therapy. Limitations. To carry out this scientific work, a study was conducted within the framework of only one clinical case committed on the territory of the Udmurt Republic. In this case report, there was no comparison group or observation group. The described documents were provided by the Budgetary Health Institution of the Udmurt Republic "City Clinical Hospital no. 6" of the Ministry of Health of the Udmurt Republic and the Budgetary Health Institution of the Udmurt Republic “Bureau of Forensic Medical Examination of the Ministry of Health of the Udmurt Republic” by prior agreement. Conclusion. Colchicum poisoning is a rare and extremely severe pathology, leading to multiple organ failure, agranulocytosis and death. Considering the rapid absorption in the gastrointestinal tract and the initial symptoms in the form of gastrointestinal lesion syndrome, early diagnosis in the absence of anamnesis is difficult, therefore, it is necessary to highlight the issues of diagnosing this poisoning, as well as the study and implementation of modern methods of treating colchicine poisoni

History of toxicology at the Technical University of Munich (TUM).

Toxicology at the TUM is mainly associated with the Faculty of Medicine at the Klinikum rechts der Isar (MRI). The Department of Clinical Toxicology has been founded in 1963. Max von Clarmann, the head, focused his activities on the treatment of intoxications and the development of analytical methods and established a poison information center. His successors, Thomas Zielker and Florian Eyer, further developed this department to an internationally renown institution.In 1967, the MRI became the TUM faculty of medicine with its Institute of Pharmacology andToxicology. The director Melchior Reiter, formerly Institute of Pharmacology of the Ludwig Maximilians University (LMU), in 1970 initiated the foundation of the Department of Toxicology at the Gesellschaft für Strahlen- und Umweltforschung (GSF) with the director Gerhard Lange. The research focused on the neurotoxic effects of heavy metals and the metabolism and hepatoxicity of persistent chemicals. After Lange's unexpected death in 1973, he was succeeded in 1975 by Helmut Greim from the University of Tübingen. The now Institute of Toxicology rapidly expanded developing and standardizing in vitro test methods, investigating the mechanism of carcinogens and mutagens and heavy metal toxicity. Training courses in the 15 major areas of toxicology have been organized at the GSF and competent centers in Germany. In 1987, Greim became the director of the newly founded Institute of Toxicology and Environmental Hygiene of the TUM, with expanded research and teaching activities, especially in toxicology at the faculties of Chemistry of the TUM and LMU, which thereafter became mandatory for students of chemistry at German universities.

The Pattern and Trends of Burn Related Death

Background: Since ancient times fire has kept amusing mankind in various ways. Though it hashelped human to evolve but if mishandled can lead to serious consequences. We know that fire canbe a friendly, comforting thing, a sources of light and heat, yet fire can also be most dangerous anddeadly. Burn is the one of the commonest cause of unnatural death in the world.Objectives: To find out the causes, epidemiological factors and pattern and trends of burn relateddeath.Methods: The present study was conducted at Dhaka Medical College and Hospital, for a period of1 year from January 2022 to December 2022. A total number of 1792 autopsy was done among ofwhich 418 cases were burn. Convenience sampling technique was followed and sample size was418 cases of burn among 1792 cases .Data were collected from police inquest, department RegisterKhata from the department of Forensic Medicine and Toxicology at Dhaka Medical college..Datawere analyzed, tabulated and presented by using SPSS version 16.0.Results: During the study maximum death due to burns were found in labourers 233(55.74%).Maximum death due to burn were found in illiterate 158(37.79%). Maximum cause of death due toburns were found in low socioeconomic status 213(50.95%) and the maximum death due to burnwere found in the age group 21-40 years 234 (55.98%). Maximum cases of death due burns werefound in male which contributed to 293(70.09%) of the total death. The most common source offire in death due to burn was cylinder gas explosion 208(49.76%). Maximum cases of death due toburn occurred in workplace 184(44.01%). As a result of burn, shock was the predominant cause ofdeath 287(68.66%). Accidental 316(75.59%) burn was the most common manner of death due toburn.Conclusion: The most accidental burn cases were preventable. By giving proper education andawareness about the causes of burn, burn injury and post burn complications. So we should takeproper preventive methods that may reduce mortality and morbidity rate due to burn.

Low-Dose Atropine-Triggered Atrial Fibrillation in Chlorpyrifos Plus Cypermethrin Poisoning: A Rare Case Report and Review of Literature

Background: Poisoning with Organophosphates (OP) and/or Pyrethroids (PYR) pesticides is common. We present a rare case of OP+PYR poisoned patient who suffered from Atrial Fibrillation (AF) at the beginning of treatment by a low dose of atropine and reviewed the literature. Case Presentation: A 50-year-old man had ingested about 5-10 ml of a mixture of chlorpyrifos/cypermethrin. Half an hour later, he went to the rural hospital and 2 hr later, after gastrointestinal decontamination, he was referred to the clinical toxicology department with normal vital signs except normal sinus tachycardia [Heart rate (HR)]=105. On admission, he had nausea, vomiting, diarrhea, mild sialorrhea, symmetric mid-size pupils, wet skin, and bilateral moist rales in his lungs. His cardiac rhythm changed to rapid AF (HR &gt;140 beats/min) after treatment with 3 mg midazolam followed by 0.3 mg of atropine (0.1 mg every 1-3 min). Atropine administration was discontinued and he was treated with 0.5 mg of digoxin. 6 hr later, his arrhythmia disappeared and all cardiac and laboratory evaluations changed to normal except reduced serum cholinesterase activity. Conclusion: AF may be induced by Organophosphates (OP) and Pyrethroids (PYR) intoxication or during the treatment by atropine. We could not find any known risk factor (cardiac or medical issues) for AF in the current case. It may be suggested that poisoning with OP, PYR (alone or mixed) or atropine (in general or in low dose), or combination is the trigger of AF. However, AF is not life threating and can easily cure by antiarrhythmic therapy.

ONE-YEAR PROSPECTIVE STUDY OF PATTERNS OF HOMICAL DEATHS- AN AUTOPSY BASED STUDY

Objectives: The aim of the study was to observe the profiling of the homicidal cases for 1 year. Methods: The present study was a prospective 1-year study of all autopsies alleged to be homicide under 302 Indian Penal Code, performed in the department of forensic medicine and toxicology at Government Medical College, Amritsar, Punjab, India, from January 01, 2021 to December 31, 2021, (1-year period) after taking permission from the institutional ethical committee. Results: The majority of cases reported were in the age group of 20–49 years, with 24 (61.5%) cases, followed by the age group of 40–59 years, which had 13 (33.3%) cases. 37 (94.9%) cases were males, followed by females 02 (5.1%).The male-to-female sex ratio is 18.5:1; 30 (76.9%) were married, while 09 (23.1%) were unmarried. The deaceased had Sikh religion in 24 (61.6%) cases, followed by Hindus in 11 (28.2%) cases; 26 (66.7%) belonged to the rural area, while 13 (33.3%) belonged to the urban area. The majority of cases where only a sharp weapon was used were 16 (41%), followed by both blunt and sharp in 14 (35.9%) cases, and blunt only in 06 (15.4%). Firearms were used in 03 (7.7%) cases. Conclusion: Based on the aforementioned observations, we believe there is a pressing need to address issues concerning youth, given their frequent involvement in such crimes. Additionally, enforcing strict nighttime surveillance and rigorously implementing laws against individuals in possession of dangerous weapons can contribute significantly to reducing such crimes.

An Assessment of Death Profile of Unknown Dead Bodies, Brought for Autopsy to the Department of Forensic Medicine and Toxicology in Government Medical College of Garhwal Region, Uttarakhand: A Retrospective Study

Background:an unknown dead body always becomes a challenge to the Investigating officer and forensic expert. However, the problem of determining the identity gets aggravated and taxes for the experts, when the dead body is recovered in decomposed/ skeletonized and mutilated form. Materials and Methods: A standard proforma was designed to collect the information to ensureconsistency for the whole sample. All dead bodies that were brought as unidentified were included however identified dead bodies were excluded from the study. Results:A total of 407 post-mortem examinations were conducted at the mortuary of the department during under study and amongst them, 56 cases (13.75%) were found unidentified. Of these unidentified cases, 69.64% (39 cases) were in decomposed and 30.35% (17 cases) were in fresh state. Unidentified cases comprised 80.35% males (45 cases) and 19.64% females (11 cases). Conclusion:Unidentified dead bodies were only 13.75% of the total dead bodies coming to the autopsy in the mortuary of the Department of Forensic Medicine and Toxicology, VCSGGIMS &amp; R, Srikot, Srinagar, Pauri Garhwal, UTTARAKHAND during the study period of 5 years.

Comparative analysis of unnatural deaths in Faisalabad during 2018-2022 – A raising trend.

Objective: To assess the pattern of unnatural deaths in Faisalabad during the last five years, to determine the gender and age group mostly affected and to explore the increasing trend if any. Study Design: Retrospective Cross-sectional Descriptive study. Setting: Department of Forensic Medicine and Toxicology, Punjab Medical College, Faisalabad. Period: January 2018 to December 2022. Methods: Subjects of the study were victims of unnatural death in areas covered by Police stations where the postmortem was performed in the Mortuary of Punjab Medical College / Faisalabad Medical University. Data was collected from respective official Police records, FIRs and Postmortem reports and recorded on pre-structured proformas. It was categorized on the basis of manner of death, type of weapon involved, age groups involved and gender. Results: Out of a total of 1340 autopsies conducted, 1024(76.4%) were males and 316(23.6%) were females. The male to female ratio was 3.2:1. Majority of the victims belonged to the 30–39-year age group i.e. 338 (25.2%) followed by the 20-29-year age group with 333 (24.8%) cases. The manner of death was homicidal in 896(67%) cases followed by 320(24%) accidental and 77(6%) of suicide. Firearm was the most commonly used weapon claiming 490 (36.6%) lives followed by RTA with 254 (19%) cases. September was the month in which maximum cases were reported (140,10.4%). Conclusion: Males are the major victims of unnatural deaths, with firearm weapons claiming the majority of lives. There is a rising trend in the number of unnatural deaths as the years go by and strict measures need to be implemented to keep a check and balance on the availability and easy access to firearms and strict traffic rules should be implemented.

Treatment with Digoxin – is it a clinical challenge? A Retrospective Analysis of Hospitalizations due to Digoxin intoxication

Introduction and purpose: Digoxin, a cardiac glycoside derived from Digitalis lanata, has stood as a cornerstone in the treatment of various cardiovascular disorders for centuries. This study aims to delve into the demographic aspects, clinical characteristics, and outcomes associated with Digoxin poisoning. By drawing upon a dataset involving 22 patients hospitalized for Digoxin intoxication at the Clinical Department of Toxicology and Cardiology in Lublin, Poland, spanning from April 2014 to December 2023, our investigation seeks to provide an understanding of this issue.Brief description of the state of knowledge: Despite the efficacy of Digoxin, the potential risk of intoxication, especially in the elderly, necessitate a comprehensive examination. Age-related changes, such as declining renal function, electrolyte imbalances, comorbidities and polypharmacy affect how drugs like Digoxin work. The symptoms of Digoxin poisoning can manifest in various organ systems such as cardiovascular, gastrointestinal, nervous system, highlighting the importance of prompt recognition to seek medical attention.Methods and results: In our study, we analyzed data from 22 patients hospitalized due to Digoxin intoxication, focusing on demographic aspects, clinical characteristics and outcomes. The cases of Digoxin poisoning were categorized according to several factors, including the quantity and nature of substances consumed, the cause of intoxication, gender, age brackets, health conditions, peak serum Digoxin levels, length and outcomes of hospitalization.Conclusions: Our study provides insights into the characteristics and outcomes of patients hospitalized due to Digoxin intoxication. The findings underscore the association of Digoxin poisoning, and emphasize the importance of monitoring serum levels to prevent adverse outcomes. As Digoxin continues to be relevant in treating cardiovascular conditions, our study calls for careful management and monitoring.

Senna alata with Selenium Mitigates Liver and Kidney Injury from Isoniazid and Rifampicin in Mice

Aim: This study aimed to evaluate the ameliorative potentials of S. alata in combination with Selenium on liver and kidney injury induced by Isoniazid-Rifampicin (INH-RIF). Study Design: Original Research work. Place and Duration of Study: Department of Pharmacology and Toxicology, National Institute for Pharmaceutical Research and Development (NIPRD), Idu, Abuja, between August and October 2023. Methods: Hydroethanolic extract of S. alata (EESA) was obtained by maceration, 25 Swiss mice (25-35g) were divided into 5 groups, GP1 received distill water, GP 2-5 INH-RIF 150mg/kg for the first two days; while groups 3-5 received S.alata 100mg/kg, 200mg/kg and 400mg/kg in combinAtion with Selenium 1mg/kg respectively from day 3 till day 14 orally. Sera samples were obtained and organs (liver and kidney) for weighing and histopathology on day 15. Results: This study showed that S.alata (EESA) (100mg/kg) and Selenium (1mg/kg) showed no reduction (P&gt;.05) in the biochemical parameters (AST, ALP, ALT, BUN, Uric acid, and creatinine); histo-anatomy of both organs showed injury. The 200mg/kg EESA/Se (1mg/kg) reduced significantly (P&lt;.05) elevated parameters for liver only (ALT, ALP); liver histo-picture showed no lesion; 400mg/kg combination decreased all parameters significantly (P&lt;.05); histo-pathology showed no lesion in both organs. Weights of the liver showed significant reduction (P=.0025, .0052, and .0027) at 100, 200, and 400mg/kg respectively; but no significant difference in weights of the kidney compared to the toxic group. Conclusion: It was concluded that EESA 200mg/kg with Selenium 1mg/kg can mitigate the toxic effects of Isoniazid-Rifampicin on the liver, while EESA/Se 400mg/kg combination has ameliorative potentials on liver and kidney toxicity from INH-RIF. These effects may be dose-dependent. It was recommended that 400mg/kg of EESA and 1mg/kg of Selenium combination be considered in drug development.

Epidemiology of suicide: Autopsy audit of five years in an industrial city of Punjab.

Objective: To determine the epidemiological pattern of suicidal deaths in an industrial city of Punjab Province over a period of five years as well as to determine the gender and age group mostly affected. Study Design: Retrospective Cross-sectional Descriptive study. Setting: Department of Forensic Medicine and Toxicology, Punjab Medical College, Faisalabad. Period: 1st January 2019 to 31st December 2023. Methods: Subjects of the study were victims of suicidal death in areas covered by Police stations where the postmortem was performed in the Mortuary of Punjab Medical College / Faisalabad Medical University. Data was collected from respective official Police records, FIRs and Postmortem reports and recorded on pre-structured proformas. It was categorized on the basis of manner of death, type of weapon, gender and age groups involved. Results: A total of 1329 autopsies were conducted during the Five-year time period from 2019 to 2023 in which 82 cases (6.17%) were labelled as Suicide on Autopsy and Police inquest. The highest percentage of suicides was recorded in year 2020 with 19 out of 254 cases (7.48%). Among the suicidal cases, 81.7% were males predominantly in the age group 20-29 years. It was found that 57.3% cases were reported from the rural areas. Hanging accounted for 65.8% of suicidal deaths making it the major method employed to commit suicide. Conclusion: Our study concluded that 6.71% cases of suicide were reported among all autopsy cases during the five-year time period of 2019-2023. Among these, young males in age group 20-29 years from rural areas were in majority and hanging was the most common method of suicide employed.

High-Dose Methotrexate (Hd-Mtx) : Therapeutic Drug Monitoring Of Patients Followed At The Toxicology Department Of The University Hospital Of Setif, Algeria

Therapeutic drug monitoring (TDM) of methotrexate is widely recommended during high-dose administration (&gt; 1 g/m2) in various chemotherapy protocols. This study aims to analyze the blood concentration methotrexate profile to detect delayed elimination in patients monitored at the toxicology department of the University Hospital of Sétif for MTX blood testing. A retrospective descriptive monocentric study was conducted, including all adult patients over 15 years old treated for malignant hematologic disorders with HD-MTX (&gt; 1 g/m2) during their initial therapy. The results revealed that out of 189 monitored patients, only 79 underwent MTX level assessment at 48 hours and 72 hours. Among them, 77.2% exhibited elimination delays at 48 hours and 52% at 72 hours. The analysis of risk factors associated with elimination delay (age, gender, and dosage) did not show any statistically significant correlation. Considering the risk associated with elimination delay in potentiating the toxic effect of MTX, pharmacological therapeutic monitoring remains essential to adjust rescue measures through folinic acid administration and/or intensification of alkaline hydration. This approach aims to enhance the safety and efficacy of HD-MTX-based treatments.

Significance of Contusion at the Vocal Cord and Perivocal Cord Area in Cases of Non-intubated Death.

Every finding during a neck autopsy may be essential for accurately diagnosing and explaining the mechanism of death. In this prospective study in the Department of Forensic Medicine and Toxicology of Jordan University Hospital, 17 out of 95 neck autopsies revealed contusions of the laryngeal mucosa in the vocal or perivocal area. These contusions were found to be associated with various causes of death, including mechanical asphyxia (such as throttling, ligature strangulation, hanging, smothering, choking, plastic bag asphyxia, gagging, and inhalation of blood) and other causes (such as atypical drowning, carbon monoxide poisoning, head injury due to a road traffic accident, burns, electrocution, and brain edema). This study provides insight into the mechanisms of this important lesion and may contribute to a better understanding of the cause of death.

Histological Changes in Adrenal Glands in Suicidal and Sudden Death Cases: A Postmortem Study.

Introduction Various studies have linked suicidal behavior, stress, affective disorders, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis resulting from chronic stress. Chronic stress has been shown to cause enlargement of the adrenal glands, altering their function and potentially leading to suicidal behaviors in individuals with depression. This study aimed to compare the histological changes in the adrenal glands of individuals who died by suicide with those who experienced sudden death. Suicide victims are exposed to chronic stress, while individuals with sudden deaths face acute stress related to the act of dying. Methods This analytical study, approved by the Institutional Ethics Committee (IEC), was conducted in the Department of Forensic Medicine and Toxicology at Gandhi Medical College, Bhopal. The study included 100 confirmed cases of suicide, irrespective of gender, aged 15-60 years, with notable autopsy findings, relevant history, no signs of decomposition, and varying survival periods (including immediate deaths within 24 hours). Additionally, 20 controls were selected, involving individuals who died suddenly from causes other than suicide within 24 hours of the incident. Informed consent was obtained using a prescribed proforma from relatives and the police. Histological examination slides of the adrenals were prepared and analyzed. Data were collected and statistically analyzed using GraphPad software and Epi Info 7. Results Capsular hemorrhage was observed in 98% of suicide cases and 40% of controls. Nodulation was present in 48% of suicidal cases and 20% of controls. Zonal extension of zona fasciculata was specific to chronic stress in suicidal cases. In 25% of suicidal cases, a prominent extension of the medulla was noted. Irregular thinning of zona glomerulosa with shrunken cells and increased nuclear density in 88% of cases were considered specific to chronic stress conditions and suicide, not observed in controls. Lipid depletion was observed in all suicidal cases, with diffuse depletion in 47% and focal depletion in 53% of cases. In contrast, 45% of those exposed to the acute stress of dying showed focal depletion, with none exhibiting diffuse depletion. Suicidal cases displayed dilated prominent sinusoids in all three zones and the adrenal medulla (98-99%), absent in controls. Adrenal hemorrhage and necrosis were specific to chronic stress conditions, with 7%, 8%, 32%, and 16% of cases showing hemorrhage in all three zones and adrenal medulla, respectively, and none in controls. Conclusion Histological changes observed in acute stress conditions included focal lipid depletion, capsular hemorrhage, nodular hyperplasia, and hemorrhage and necrosis with edema. However, the proportion and severity of these changes were lower than those observed in the suicidal group, suggesting that these findings may be considered non-specific for differentiating between acute and chronic stress.

Epidemiotoxicological Profile of Fatal Poisoning Cases Autopsied at a Tertiary Care Hospital

Poisoning is a major public health problem worldwide with thousands of death occurring every year and most of the cases are being reported from developing countries. The present study includes all the cases of poisoning or suspected poisoning subjected for autopsy at the Department of Forensic Medicine and Toxicology, Basaveshwara medical college and hospital, chitradurga, Karnataka during the period 1stjanuary 2022 to june 2023 in which it was seen that poisoning accounted for 19.9% of autopsies. 24 Males (66.6%) and 12 females (12%) in the age group 21-30 years were commonly affected. Many victims were married males. Majority of cases were suicidal in manner (94.4%) and were from middle class social status (41.1%). The commonest poisoning was organophosphorus compound.