Criminal Poisoning: A Hospital-Based Survey in an Academic Center of Iran

Background: One of the most common medical emergencies worldwide is deliberate or accidental poisoning. The ever-increasing consumption of toxins and fatal drugs is getting more critical by the time. The purpose of intentional poisoning is to harm self and others. It includes objectives like robbery, sexual abusing (rape). The perpetrators of sedative and hypnotic drugs could sedate patients and make them sleepy. Methods: This descriptive, cross-sectional study investigated the suspected Drug-Facilitated Crime (DFC) admitted patients and Outpatient Department (OPD) in the emergency room and toxicology ward. A researcher-made questionnaire was completed for each patient. The biological samples (urine, blood) were provided to a clinical toxicology lab.Results: The information of 40 suspected DFC patients was analyzed. 70% of intoxicated patients were men, and 30% were women. The patients’ mean age was 31-43 years; 42% were low in education, and 37% were self-employed. Furthermore, 75% of total intoxicated patients had a sedentary level of consciousness. Approximately 92.5% had one positive substance test, and 7.5% had negative lab test results. The most used drug was diazepam, by 70%. The motivation for poisoning was 80% robbery, 12.5% for rape, and 7.5% were no diagnostic.Conclusion: The prevalence of poisoning, especially deliberate poisoning, is dramatically growing in this part of the world. Accordingly, this study reveals the flexibility of criminals in Tehran Province, Iran. Thus, the Ministry of Health should seriously control legal and illegal drugs purchase

Scorpion Stings in Tehran Province, Iran: A Seven-Year Hospital-Based Study

Background: Scorpion sting is an important public health problem in Iran. This study aimed to describe the demographics, clinical and laboratory findings of the scorpion stings victims in Tehran Province.Methods: This cross-sectional retrospective study evaluated demographic characteristics, clinical presentations, laboratory findings, treatments, and disposition of scorpion sting patients in Tehran Province, Iran, during 7 years (2012-2018).Results: A total of 199 cases of scorpion sting cases with a mean (SD) age of 30 (18.7) years were studied. The majority of patients were males (62.8%). The most affected age group was 20-30 years (31.1%). The majority of victims (45.7%) were residents in the southern districts of Tehran. The yellow scorpions (33.2%) were responsible for a larger number of envenomations. Most of the stings have been occurred in summer (68.8%). Also, the most affected limbs were hands and legs (94.4%). Most patients (58.8%) had localized manifestations, and the common systemic clinical presentations were hypotension (41.7%) and hypertension (17.1%). Also, the common laboratory findings increased blood urea nitrogen (48.7%), hyperglycemia (20.1%), and anemia (15.1%). The polyvalent anti-scorpion serum had been administered for 33.2% of victims. All patients had been recovered and were discharged in good condition without any complications. There was no fatality report. Conclusion: The demographic characteristics of scorpion sting in Tehran Province are similar to those previously reported from other Iran provinces. It seems that the incidence and clinical severity of scorpionism in Tehran are lower than those compared to other tropical and sub-tropical zones in Iran

Prevalence of Delayed Neuropathy and Intermediate Syndrome in Acute Organophosphorus Poisoning: A Cross-sectional Toxicological/Clinical Study

Background: Organophosphates are among the most common causes of poisoning worldwide—responsible for 3 million poisoning and 200000 deaths every year. Nearly 15% of people who are poisoned die. This cross-sectional toxicological/clinical study aimed to investigate the prevalence and influential factors in the incidence of delayed peripheral neuropathy and intermediate syndrome in acute poisoning with organophosphorus toxins. The study was conducted in Loghman Hakim Hospital, Tehran City, Iran, from 2017 to 2020.Methods: The study data were obtained from the patients’ records during follow-up. Data included demographic information (age, sex, etc.), vital signs, muscarinic, nicotinic, and neurological symptoms at admission, atropine therapy status, and pralidoxime intake status. Post-discharge complications were obtained, and patients’ Electromyography (EMG) and Nerve Conduction Velocity (NCV) results were recorded and evaluated during hospitalization and follow-up. Statistical analysis was performed using SPSS software, version 22.Results: Of 63 studied patients, 61.9% were female. The Mean±SD age of the patients was 31.90±13.128 years. Male patients were significantly (P<0.010) older than female ones. The most common muscarinic symptoms were nausea and vomiting (73.2%), diarrhea (34.92%), and abdominal pain (33.33%). Regarding the nicotinic symptoms, sweating (30.16%) and fasciculation (19.05%) were the commonest. Neurological complications were less common; seizures were observed in 3 cases (4.76%) and coma in 2 cases (3.17%). Most patients (79.4%) received pralidoxime with atropine. The Mean±SD days of treatment with atropine and pralidoxime were 5.51±3.52 and 4.06±4.62 days, respectively. Only one death was recorded. The results of the initial EMG-NCV test on the second day of hospitalization showed abnormalities in 4 patients (6.3%), indicating the presence of the intermediate syndrome.Conclusion: The results of the EMG-NCV tests at our patients’ follow-up (30 days) showed no abnormalities. Hence no cases of delayed neuropathy were seen. During hospitalization, one patient had flaccid paralysis and showed significant impairment on the EMG-NCV test (P<0.01)

Hepatotoxicity Among Poisoned Patients: A Cross-sectional Study

Background: Drug-induced liver injury is a major cause of hepatitis worldwide. In patients diagnosed with acute poisoning, drug-induced liver injury is a critical challenge. This study aims to evaluate the pattern of hepatotoxicity in poisoned patients admitted to Loghman Hakim Hospital.Methods: In this cross-sectional study that was conducted at Loghman Hakim hospital, the clinical records of poisoned patients were evaluated and patients with hepatotoxicity were selected for final analysis. The clinical and para-clinical information of these patients was recorded. The SPSS software, version 23. was used for statistical analysis.Results: A total of 260 cases were included in this study. The Mean±SD age of patients was 38.24±16.29 years and most of them were male (79.2%). Patients with narcotics poisoning had the highest prevalence (38.5%), especially when they were taken together with acetaminophen or benzodiazepine. In addition, among the patients studied, those with underlying cardiovascular disease are more likely to develop hepatotoxicity.Conclusion: In conclusion, among people with various types of poisoning, it seems that narcotics (opium, heroin, methadone, etc.), particularly when taken together with acetaminophen or benzodiazepines, cause hepatotoxicity and increase serum levels of liver aminotransferases. Also, in the study population, patients with underlying cardiovascular disease had a higher chance of liver injury. Therefore, clinicians are recommended to accurately monitor the sign and symptoms of hepatotoxicity in these populations

MedInsight: A Multi-Source Context Augmentation Framework for Generating Patient-Centric Medical Responses using Large Language Models

Large Language Models (LLMs) have shown impressive capabilities in generating human-like responses. However, their lack of domain-specific knowledge limits their applicability in healthcare settings, where contextual and comprehensive responses are vital. To address this challenge and enable the generation of patient-centric responses that are contextually relevant and comprehensive, we propose MedInsight:a novel retrieval augmented framework that augments LLM inputs (prompts) with relevant background information from multiple sources. MedInsight extracts pertinent details from the patient's medical record or consultation transcript. It then integrates information from authoritative medical textbooks and curated web resources based on the patient's health history and condition. By constructing an augmented context combining the patient's record with relevant medical knowledge, MedInsight generates enriched, patient-specific responses tailored for healthcare applications such as diagnosis, treatment recommendations, or patient education. Experiments on the MTSamples dataset validate MedInsight's effectiveness in generating contextually appropriate medical responses. Quantitative evaluation using the Ragas metric and TruLens for answer similarity and answer correctness demonstrates the model's efficacy. Furthermore, human evaluation studies involving Subject Matter Expert (SMEs) confirm MedInsight's utility, with moderate inter-rater agreement on the relevance and correctness of the generated responses

Design and Evaluation of the “Preparation Course for New Entrant Assistants” on the Awareness and Skills of Newly Arrived Surgery Resident

Background: Beginning of assistance course is associated with anxiety. This due to unfamiliarity with the assistance and insufficient training, knowledge, and required skills. The aims of this study were to design, implement and evaluate the effects of a period of 1-month as “preparation course for new entrant assistants” on the awareness and skills of newly arrived residents.Methods: 12 newly arrived assistant student were divided into two equal groups. Some steps such as understanding the environment and legislation, education about an emergency, and dealing with patients and also, suturing, chest tube insertion, and cut down skills were passed by the first group before starting the assistance course. The second group was entered in the assistance course without this preparation course. For performance evaluation and comparison of these two groups, four questionnaires were created and filled consequently before the entrance, at the end of the 2nd month, based on direct observation of procedural skills (DOPS) exam, and at the end of 6th month.Results: There were no significant differences between two groups at the beginning of the study (P < 0.05). At the end of the 2nd month, the first group had better performance in understanding the environment, patient examination, diagnosis and emergency skills in comparison to the second group (P < 0.05). Based on the DOPS score, the first group had significantly better performance (P < 0.05) except in performing cut-down (P > 0.05). Also procedure, the first group was better than the second group just in the consensus of the procedure (P < 0.05). Finally, at the end of the 6th month, the difference between two groups was becoming lower, and supervisors believed that after additional 3 months, this difference would be lost.Conclusions: Conducting a 1-month period of preparation for new entrant assistants can be useful in increasing awareness, understanding the environment, performance, the knowledge of the theory and how to deal with patients as well as increase their skills in performing the expected procedures

Lead Contamination of Opium, Opium Tincture, and Methadone Oral Solution, in Iran

Background: The present study is conducted with the aim to assess the lead contamination in opium tincture,methadone oral solution, and opium.Methods: 10 samples from each of the matters of opium tinctures, methadone oral solutions, and opium(provided by the Law Enforcement Force of the Islamic Republic of Iran) were collected. Then, an atomicabsorption spectrophotometer (AAS) was used to measure lead concentration in each of the samples. Datawere analyzed using the SPSS software. A P value of 0.05 or less was considered to be statistically significant(Two-tailed).Findings: In this study, the amount of lead measured in all samples was equal or less than 5 parts per million(ppm) and the only exception was the lead level of 5.6 ppm in one of the opium tincture samples, which wasslightly higher than the standard lead level.Conclusion: The results of the current study showed that lead was present in opium tincture, methadone oralsolution, and opium, but it was not in toxic levels. It is reasonable for opium derived medicinal products, butthe low levels of lead in opium may need to be addressed at different times in different regions of the countr

LOCALINTEL: Generating Organizational Threat Intelligence from Global and Local Cyber Knowledge

Security Operations Center (SoC) analysts gather threat reports from openly accessible global threat databases and customize them manually to suit a particular organization's needs. These analysts also depend on internal repositories, which act as private local knowledge database for an organization. Credible cyber intelligence, critical operational details, and relevant organizational information are all stored in these local knowledge databases. Analysts undertake a labor intensive task utilizing these global and local knowledge databases to manually create organization's unique threat response and mitigation strategies. Recently, Large Language Models (LLMs) have shown the capability to efficiently process large diverse knowledge sources. We leverage this ability to process global and local knowledge databases to automate the generation of organization-specific threat intelligence. In this work, we present LOCALINTEL, a novel automated knowledge contextualization system that, upon prompting, retrieves threat reports from the global threat repositories and uses its local knowledge database to contextualize them for a specific organization. LOCALINTEL comprises of three key phases: global threat intelligence retrieval, local knowledge retrieval, and contextualized completion generation. The former retrieves intelligence from global threat repositories, while the second retrieves pertinent knowledge from the local knowledge database. Finally, the fusion of these knowledge sources is orchestrated through a generator to produce a contextualized completion