A Three-Year Investigation on Corpses Referred to Legal Medicine Organization from An Iranian General Hospital: A Cross-Sectional Study.

Background: A Medical Certificate of Cause of Death (MCCD) is a legal and enforceable document issued by the attending physician. However, according to the instructions, in many cases such as sudden, unexplained, and extraordinary deaths, along with some uncommon causes, such as cases suspicious of murder, the deceased patient must be referred to the Iranian Legal Medicine Organization (ILMO). Moreover, the unnecessary referral of corpses to ILMO can increase the workload of the staff, finally confronting the family of the deceased with high emotional and financial costs. Methods: In this cross-sectional study, the medical records of all deceased patients referred from Hazrat Rasool Hospital to the ILMO (565 cases) in a three-year period from April 2016 to March 2019 were investigated and analyzed using SPSS22 software with chi-squared and T-test. Results: Among all the patients who passed away during this time (4,239 patients), 565 were referred to ILMO, accounting for 13.3% of deaths. The most common causes of referral were car and motorcycle accidents, with a total prevalence of 27.1%, dead-on-arrival (DOA) prevalence of 21.3%, and death with an unknown cause prevalence of 15.3%. Significant correlation was also detected between causes of referral with gender, time of death, and age. For example, Car accidents and lawsuits against medical staff were more common in men and women, respectively. Conclusion: Car and motorcycle accidents, DOA, and unknown causes were the most prevalent causes of referral in this study. In general, few studies have been conducted regarding the causes of referral of the deceased to the Legal Medicine Organization. In this study, we collected relevant variables to investigate this issue thoroughly.

Demographic Assessment of Burn Injuries in Iranian Patients.

Objective: This study investigated the demographic characteristics and factors influencing burn injuries, primarily in low socioeconomic societies where such incidents are prevalent due to factors such as illiteracy and poverty. Methods: This cross-sectional study included all burn patients admitted to Shahid Motahari Hospital in Tehran, Iran. Demographic data such as age, sex, occupation, education level, and residence as well as detailed information about the burn incidents such as date, time, location, number of people present at the scene, and referral place was collected. Additionally, comprehensive burn details such as cause, extent, severity, previous history, and need for hospitalization directly at the emergency department were documented. Results: The study included 2213 patients (mean age 34.98±19.41 years; range 1-96), with a men predominance (60.6%). The majority of burns (64.4%) occurred at home, primarily due to accidents (99.6%), with boiling water being the most common cause (39.2%). The most frequent burns were second-degree burns (91.8%), with an average injured body area of 6.31±6.67%. There were significant correlations between burn severity and demographic factors such as age, sex, occupation, cause of burn, hospital admission, outcome, and length of stay. Remarkably, the extent of burns was negatively correlated with the distance to the hospital, while positively correlated with the length of hospital stay. Conclusion: Burn injuries were significantly influenced by demographic factors. Enhancing treatment facilities and reducing the time and distance to medical care could be crucial in high-risk cases.

Demographic study of patients' mortality rate before and after the COVID-19 outbreak: A cross-sectional study.

Background and Aim: To better guide the health policies, it is essential to clarify the socio-demographic and clinical risk factors affecting the mortality rate of patients with coronavirus disease 2019 (COVID-19). Objective: The purpose of this project is to separate hospital mortality statistics into different groups, which will definitely help in planning to reduce the mortality rate. As well, we aimed to compare factors involved in COVID-19 death between the period before and after its outbreak. Methods: This cross-sectional study was performed based on all death certificates of archived records in Rasool Akram Hospital during the years 2018 and the first half of 2019. A checklist was completed based on the variables, including death cases by time, gender, age, duration of hospitalization, department of place and time of death, cause of death, cases referred to forensic medicine, information of the patient, including educational and occupational level and birth certificate issuing city, neonatal death, and IUFD, classification of diseases according to the provided version of ICD 10 (international classification of diseases 10th edition). Results: A number of 2632 deceased patients were included in this study, 1511 (57.4%) patients who died before the start of the COVID-19 outbreak, and 1121 (42.6%) patients died in the hospital after the start of this pandemic. There were statistically significant differences in gender (higher prevalence of males), increased average age, lower occupational status, decreased number of infants, increased cause of death due to COVID-19 and increased hospitalization in Royal ICU in dead patients (p < 0.05). Conclusion: The findings show that the elderly cases are more at risk of COVID-19 mortality than other age groups, which needs more attention to this group of society and clarifies other epidemiological factors, as well as clinicopathological and public healthcare practices.

Investigating Causes of Medical Errors in Intensive Care Units in Iran: A Cross-sectional Study.

Background: Medical errors cause disability and mortality in intensive care units (ICUs). We aimed to determine the occurrence and causes of medical errors in the ICUs of Iran. Methods: In this cross-sectional study, data from the family complaint files referred to The disciplinary authority of Iran Medical Council was retrospectively reviewed to explore the causes of medical errors. Statistical analysis was performed in SPSS Version 26.0. Results: A total of 293 complaint files were referred to the disciplinary commission from 2014 to 2019, of which 95 files were related to medical errors in ICUs. The median age of patients was 62 years (46-74 years) and 52 (54.7%) patients were men. Also, 37 (38.9%) patients had decreased levels of consciousness and 42 (42.2%) patients had cardiovascular disease. A total of 40 (42.1%) patients experienced a single medical error and 55 (57.9%) patients experienced more than 1. Causes of medical errors in patients were physician's or nurse's negligence in 53 (55.8%) patients, weak interaction of physician and nurse with the patient and family members in 11 (11.6%) patients, weak interprofessional interaction among physicians in 7 (7.4%) patients, equipment and structure of ICUs in 7 (7.4 patients, nature of ICUs and patients in 6 (6.3%) patients, weak physician-nurse interprofessional interaction in 5 (5.2%) patients) patients, low attention of the physician and the nurse to medication safety in 6 (6.3%) patients. Conclusion: Patient safety is impacted by a variety of medical mistakes. Interprofessional strategies can be developed and put into action to mitigate medical errors in ICUs.

Pattern of inflicted injuries to motorcyclists referred to Hazrat-E-Rasoul Akram hospital in Tehran during 2015 - 2016.

INTRODUCTION: In recent years, road accidents have been one of the leading causes of death in Iran, with the majority of victims being motorcyclists. Accurate knowledge of the pattern of injuries to those injured is a strategy to reduce the consequences of these fatal accidents. The aim of this study was to investigate the pattern of injuries to motorcyclists. METHODS: The present study was a cross-sectional study that was performed in Rasoul Akram (PBUH) Educational and Medical Center in Tehran. The information was extracted from 500 hospital records of the patients admitted due to motorcycle accidents from September 2015 to September 2016, which was recorded in the data collection checklist. RESULTS: About 67.9% of the injured did not have head injuries and 32.0% of the sample group suffered head injuries. Out of 160 people from the head injury group, 7.2% have Abbreviated Injury Scale (AIS) index = 1 and 93.8% have AIS ≥ 2. A total of 82% of the injured had no neck injuries and 18.0% of the sample group had neck injuries. Of these, 72.2% had AIS = 1 and 17.8% had AIS ≥ 2. About 65.0% of the injured did not have facial injuries and 35.0% of the sample group suffered facial injuries. CONCLUSION: An accurate knowledge of the pattern of injuries to this group of injured, providing pre-hospital services, timely diagnosis and treatment and the use of corrective and effective factors, has an effective role in reducing the incidence and consequences of this deadly accident.

Evaluation of job satisfaction of forensic medicine specialists and comparison with job satisfaction of some medical specialists in Tehran.

INTRODUCTION: Job satisfaction is a main factor to increase efficiency, productivity, and individual satisfaction in the organization. The purpose of this study is to determine the forensic expertise amount of job satisfaction and to compare them with other specialists in different. MATERIALS AND METHODS: In this cross-sectional study, 150 individuals were included in three groups of specialists including forensic, internal medicine, and pediatric. Data were collected by Brayfield and Rothe Job Satisfaction Questionnaire. SPSS software version 23 was used for statistical analysis. RESULTS: High levels of job satisfaction among forensic professionals were higher than low job satisfaction, but the same was true for the other two groups. In this study, job satisfaction status in the three groups of specialists was not significantly correlated with their type of expertise (P = 0.19). There was no significant relationship between job satisfaction and gender (P = 0.19). In addition, the mean age of the specialists with low and high job satisfaction was not significantly different (P = 0.99). In this study, although the mean of work experience in professionals with high job satisfaction was higher than those with low job satisfaction, this difference was not significant (P = 0.23). CONCLUSION: The results of this study showed that job satisfaction was high among forensic medical professionals and was not significantly different from other specialist groups including pediatric and internal medicine. In addition, job satisfaction was not significantly different in terms of age, gender, and work experience.

The association between type of spine fracture and the mechanism of trauma: A useful tool for identifying mechanism of trauma on legal medicine field.

BACKGROUND: Determining the association between mechanism of trauma, and the type of spine column fracture is a useful approach for exactly describing spine injury on forensic medicine field. We aimed to determine mechanism of trauma based on distribution of the transition of spinal column fractures. METHODS: This cross-sectional survey was performed on 117 consecutive patients with the history of spinal trauma who were admitted to emergency ward of Rasoul-e-Akram Hospital in Tehran, Iran from April 2015 to March 2016. The baseline characteristics were collected by reviewing the hospital recorded files. RESULTS: With respect to mechanism of fracture, 63.2% of fractures were caused by falling, 30.8% by collisions with motor vehicles, and others caused by the violence. Regarding site of fracture, lumbosacral was affected in 47.9%, thoracic in 29.9%, and cervical in 13.7%. Regarding type of fracture, burst fracture was the most common type (71.8%) followed by compressive fracture (14.5%). The site of fracture was specifically associated with the mechanism of injury; the most common injuries induced by falling from height were found in lumbosacral and cervical sites, and the most frequent injuries by traffic accidents were found in thoracic site; also the injuries following violence were observed more in lumbar vertebrae. The burst fractures were more revealed in the patients affected by falling from height and by traffic accidents, and both burst and compressive fractures were more observed with the same result in the patients injured with violence (p = 0.003). CONCLUSION: The type of spine fracture due to trauma is closely associated with the mechanism of trauma that can be helpful in legal medicine to identify the mechanism of trauma in affected patients.

Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015.

BACKGROUND: Suicide ranks among the top ten causes of death in all age groups all over the world. There are many methods for committing suicide including self-poisoning, firearm and hanging. The aim of the present study was to provide an overview of self-poisoning related suicidal deaths with special focus on forensic toxicology analysis results in Tehran, Iran from 2011 to 2015. METHODS: All suspicious cases with the the history of self-poisoning were investigated to define the cause and manner of death under the supervision of forensic medicine practitioners. Postmortem samples were analysed in forensic toxicology laboratory to confirm the presence of drugs in cadaver of suicidal cases. Drugs and poisons were analysed using thin layer chromatography, high performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography and gas chromatography equipped with nitrogen phosphorus detector. Demographic data were collected from autopsy reports of all cases with confirmed self-poisoning suicidal cause of death. RESULTS: Results showed that 674 cases of self-poisoning deaths were investigated during a five-year study period, of which 68.55% were male. The most often used suicide method was self-poisoning in young population. Phosphine gas liberated from aluminum phosphide tablets was the most toxic substance detected in postmortem samples (619 cases) followed by opioids, methamphetamine, organophosphates, cyanide and strychnine. CONCLUSION: In conclusion self-poisoning suicidal death was predominant in young male population in Tehran, Iran. It seems that free access to suicide means such as drugs and poisons should be restricted by national and health authorities. TRIAL REGISTRATION: Not applicable.

Sex prediction potential of hyoid metric measurements in Iranian adults.

OBJECTIVES: Human hyoid is sexually dimorphic and is useful for sexing unknown skeletal remains. We aimed to find sex prediction potential of three linear dimensions of hyoid bones obtained from a series of cadavers with Persian ethnicity. METHODS: This cross-sectional study was carried out in 2015 at Forensic Pathology Organization of Tehran, Iran. We directly measured three linear dimensions of a series of hyoid samples obtained from cadavers during their neck autopsy in a convenience method. These dimensions were width, length and distance between lesser horns of hyoid. Height and weight of cadavers were also documented. Cadavers were of Persian ethnicity and at least 25-year-old. Data were analyzed by SPSS16. Logistic Regression Model was applied to find independent sex predictor(s) of hyoid. Statistically significant level was considered <0.05. RESULTS: Hyoids of 349 adult cadavers (176 females and 173 males) with mean±SD age of 39.91±8.13years were investigated. Male cadavers had significantly higher BMI values (p-value<0.001). Mean±SD for width, length and distance between lesser horns of hyoids were 34.45±4.70, 34.61±4.67 and 22.71±2.80mm, respectively. All measured dimensions had greater mean values in males (all with p-values<0.001). After adjusting for BMI, length and distance between lesser horns of hyoid were independent predictors of sex with odd's ratio of 4.67 and 1.97, respectively. Combining these two measurements provided sex classification accuracy of 97.4%. CONCLUSION: Special metric hyoid indicators can help in accurate sexing of skeletal remnants of adult Iranians. Further studies will find the strongest sex predictors of hyoid bones among Persians.

Gender determination from diagnostic factors on anteroposterior pelvic radiographs.

BACKGROUND: Gender determination from skeletal remains is one of the primary factors in forensic medicine. This study aimed to identify the gender of patients referred to the radiology ward of the Rasoul Akram Hospital of Tehran using anteroposterior pelvic radiography. METHODS: A total of 200 patients (100 male and 100 female) referred to the radiology ward of the Rasoul Akram Hospital for anteroposterior pelvic radiography during 2013-2014 were included in this study. After taking a standard radiographic image of all patients in the supine position and an anteroposterior view of the pelvis, factors including subpubic angles, pubic angle, X angle, ischiopubic index, ratio of the length of the symphysis pubis to the mid and minimum width of the pubis body, and ratio of the length of the symphysis pubis to the minimum width of the pubic superior ramus were measured on radiographs. The Student t test and receiver operating characteristic curve were used to compare the data of male and female patients. Values were significant at p<0.05. RESULTS: All the evaluated variables were significantly different in male and female patients (p=0.000), with the highest level of measurement accuracy noted in the subpubic angle, Pubic Angle 1, X angle, Pubic Angle 2, minimum width of the pubic superior ramus, and ischiopubic index. Length of the symphysis pubis, length of the pubis, and ratio of the length of the pubis to the minimum width of the pubic superior ramus showed the lowest accuracy. CONCLUSION: The results of this study revealed that the evaluation of the radiographic images of pelvic bones by assessing the mentioned factors can be useful for sex determination from skeletal remains. However, ethical considerations should also be taken into account while using these factors.

Characteristics of Traumatic Brain Injury among Accident and Falling Down Cases.

Motor vehicle and falling down are responsible for the most number of traumatic injuries. This study aimed to compare the characteristics of traumatic brain injury among accident and falling down cases. In this analytical cross-sectional study, data were collected from the records of cadavers who died due to accident or falling down and referred to Kahrizak dissection hall, Tehran forensic medicine organization during 2013. A total of 237 subjects (183 (77.2%) accident and 54 (22.8%) falling down) with a mean age of 35.62 (SD=15.75) were evaluated. A number of 213 (89.9%) were male. From accident group, scalp injury was seen in 146 (79.8%), scalp abrasion in 122 (66.7%), scalp laceration in 104 (56.8%), sub skull bruising in 176 (96.3%), skull fracture in 119 (65%), hemorrhage in 166 (90.7%), Subdural hemorrhage (SDH) in 155 (84.7%), Subarachnoid hemorrhage (SAH) in 161 (88%), Epidural hemorrhage (EDH) in 41 (22.4%), contusion in 140 (76.5%), and skull base fracture in 140 (76.5%) of cases. In falling down group scalp injury was seen in 42 (77.8%) cadavers, scalp abrasion in 38 (70.4%), scalp laceration in 30 (55.6%), sub skull bruising in 49 (90.7%), skull fracture in 39 (72.2%), Hemorrhage in 49 (90.7%), SDH in 43 (79.6%), SAH in 47 (87%), EDH in 10 (18.5%), contusion in 33 (61.1%), and skull base fracture in 39 (72.2%) of cases. There was no significant difference between these two groups (P Value> 0.05). Accident and falling down had no difference in terms of any injury or hemorrhage.

Effect of current pathway on mortality and morbidity in electrical burn patients.

INTRODUCTION: Electrical injury is relatively uncommon but it is a devastating form of thermal injury. The aim of this study is to analyze specific aspects of electrical injuries, especially the effect of current pathways on morbidity and mortality. METHOD: This descriptive-analytical study was performed on patients with electrical burns who were admitted to the Shahid Motahary Burn Center from April 2010 to March 2012. Demographic and clinical data including gender, age, length of hospital stay, total body surface area (TBSA), grading of burn, electrical voltage, inlet electrical mark, outflow electrical mark, current pathway, surgical procedures, and place of electrical burn have been gathered from medical records. The site of inlet and outlet of current on the body is divided into six groups: Rt (right) upper limb, Lt (left) upper limb, Rt lower limb, Lt lower limb, head and neck, and trunk. According to these sites, the current pathway is defined to seven groups. Data were analyzed with SPSS software, version 20. RESULTS: From 287 patients, 283 were men and 4 were women. The mean age was 30±12 years (range 1-71) and mean TBSA was 13.56±12.97% (range 1-100). There were 233 patients (81.2%) with passage of the electrical current through the body and 54 patients (18.8%) with flash burns. A total of 859 surgical procedures were performed on 232 patients. One hundred and eighteen amputations were performed in 83 patients. The most common inlet electrical marks were in Rt upper limb and the most common outlet electrical marks were in Lt lower limbs, and consequently, the most common pathway was upper limb to lower limb. CONCLUSIONS: Electrical injuries are mainly occupation-related injuries and in this research majority of injuries occurred outdoor by high voltage cables in young men. Thus the government should consider a distinct strategy for this group. Also it is observed that there were no significant differences in mortality and complications such as amputation between different pathways.

Frequency of intracranial injury in cadavers with head trauma with and without scalp injury in Tehran.

Traumatic brain injury is a major cause of morbidity, disability and mortality in patients with head injury. The aim of this study was to elucidate the frequency of intracranial injury in cadavers with head trauma with and without scalp injury in Tehran. In this analytical cross-sectional study, we investigated 187 cadavers who died due to head trauma in motor vehicle accident or after falling in Tehran from November 2013 to February 2014. Age, sex, mechanism of trauma, scalp injury, sub-scalp bruising, skull fracture, hemorrhage including subdural hemorrhage (SDH), epidural hemorrhage (EDH), subarachnoid hemorrhage (SAH) and contusion were recorded from examination and autopsy. One hundred and eighty seven cadavers (165 (88.2%) male and 22 (11.8%) female) with head injury with the mean age of 36.14 years (SD = 15) were recruited in this study. Mechanism of trauma was motor vehicle accident in 147 (78.6%) cadavers and falling in 40 (21.4%) cadavers. One hundred and fifty eight (84.5%) had SDH, 44 (23.5%) had EDH, 162 (86.6%) had SAH and 139 (74.3%) had contusion. Hemorrhage was seen in 132 (93%) cadavers who had scalp injury and 36 (80%) cadavers who did not have scalp injury (p = 0.01). Overall, 168 (89.8%) cadavers had hemorrhage and 139 (74.3%) had contusion. There was a significant correlation between intracranial injuries and scalp injury (p < 0.05). There was not a significant correlation between EDH and scalp injury (p = 0.52). Consequently, in patients with head trauma, complete examination should be performed but absence of findings in examination cannot exclude intracranial injury.

A questionable bruise.

It is occasionally difficult to distinguish between a self-inflicted bruise and true bruise. The important point of diagnosis is a good, thorough history taking and detailed examination of the affected area.

Ischemic heart disease risk factors in lead exposed workers: research study.

BACKGROUND: Review of other epidemiological studies reveal inconsistent results of relationships between high blood lead level and risk of hypertension, hyperlipidemia and hyperglycemia. In this study we wanted to find if there is a relationship between blood lead level and these ischemic heart disease risk factors. METHODS: This cross-sectional study was conducted in a battery recycling plant, and 497 male workers with the mean age of 41.7 (±6.50) years were recruited from all over the plant (those from the products and maintenance sections were classed as "high lead exposed group" and those from amongst the office, laboratory, security services and food services sections as "low lead exposed group"). Personal information such as demographics and work history was obtained through a questionnaire. Mean (±Standard deviation) for quantitative variables, Frequency (Percent) for qualitative variables, and Odd's ratio (OR) with 95% confidence interval (95% CI) for estimating the effect of blood lead level on lipid profile[triglyceride (TG), cholesterol(CHOL), low density lipoprotein - Cholesterol(LDL-C),high density lipoprotein -Cholesterol(HDL-C)], hypertension(HTN) and fasting blood sugar (FBS) level. Logistic regression modeling was used for multivariate analysis and adjusting the effect of different variables (age, body mass index(BMI), eating habits, cigarette smoking). RESULTS: The mean Blood Lead Level (BLL) was >40 µg/dl in 281 (56.6%) subjects, ≤40 µg in 216 (43.4%) subjects and the mean BLL was 43.3 µg/dl (n = 497). The mean job experience involving lead exposure was 13 years. There was no significant correlation between BLL and FBS (p = 0.68), between BLL and TG (P = 0.32), between BLL and HDL-C (p = 0.49), between BLL and LDL-C (p = 0.17), between BLL and CHOL(p = 0.96), between BLL and systolic blood pressure (p = 0.12). The adjusted Odd's ratio for the effect of BLL >40.0 µg/dl on diastolic blood pressure was1.03 (95% CI: 1.01-1.05) with p = 0.05. CONCLUSION: This study showed an association of high BLL with diastolic blood pressure but not with TG, FBS, and HDL-C, LDL-C and CHOL . This result persisted even after adjustment was made for age, BMI and job experience, smoking and eating habits. Attention to health-protective policies, individual behavioral changes and regular periodic medical examination with focus on diastolic blood pressure in lead exposed workers is likely to decrease the public health burden of ischemic heart disease.

Brain computed tomographic scan findings in acute opium overdose patients.

AIM: Early radiologic evaluations including noncontrast computed tomographic (CT) scan of the brain have been reported to be useful in the diagnosis and management of the intoxicated patients. Changes in the brain CT scan of the acute opium overdose patients have little been studied to date. This study aimed to evaluate changes of the brain CT scans in the acute opium overdose patients. METHODS: In this retrospective study, medical records of all acute opium overdose patients hospitalized in Loghman-Hakim Poison Hospital in Tehran, Iran, between September 2009 and September 2010 were identified. Those who had undergone noncontrast brain CT within the first 24 hours of hospital presentation were included. Patients with any underlying disease, head trauma, underlying central nervous system disease, epilepsy, and multidrug ingestion were excluded. The patients' demographic information, vital signs, and laboratory data at presentation were extracted and recorded. The data were analyzed using SPSS software version 17 (SPSS, Chicago, IL). RESULTS: A total of 71 patients were included. Fifty-eight patients (80.5%) survived, and 10 (13.8%) died. Fourteen cases (19.7%) had abnormal CT findings including 8 cases of generalized cerebral edema and 6 cases of infarction/ischemia. There were no statistically significant differences between the patients with and without abnormal CT scan findings with respect to age, sex, systolic and/or diastolic blood pressures, pulse rate, respiratory rate, occurrence of seizures, pH, Pco(2), HCO(3)(-), blood sodium level, and blood glucose level (all P values were > .05). However, a statistically significant difference was found between these patients in terms of outcome (P = .007). CONCLUSION: Abnormal brain CT findings are detected in about 20% of the acute opium overdose patients who are ill enough to warrant performance of the brain CT scan and associate with a poor prognosis in this group of the patients.

Photophobia and methylphenidate.

It is a report of the case of a 7-year-old boy with attention-deficit hyperactive disorder (ADHD), who developed bilateral photophobia when taking methylphenidate (MPH). MPH was stopped and reintroduced many times, and on all of the trials, photophobia reappeared immediately. Photophobia might be an adverse effect of MPH that bothers ADHD children. With the consideration that MPH increases cortical excitability, it is possible that MPH increases sensitivity to some stimulus such as light, and these sensitivities make these children more irritable and sad.