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.

Evaluation of clinical manifestations of coronavirus delta variant in neonates admitted to a hospital in northern Iran during the sixth wave: A case series.

Eleven newborns infected with COVID-19 delta variant admitted to a hospital in northern Iran during the sixth wave were evaluated. Fever, poor breastfeeding, lethargy, and lung involvement were the most prevalent symptoms in COVID-19 delta variant infected neonates. Infected mothers may be a main cause of infection for neonates.

Second and third lumbar vertebral parameters for prediction of sex, height, and age in the Iranian population.

In this study, we aimed to assess the association between different parameters of the second and third lumbar vertebra with age, sex, and height in the Iranian population. A total of 14 parameters of the L2 and L3 vertebra were measured from three-dimensional lumbar topography. The measured parameters included vertebral length, foramen diameter, foramen width, endplate depth, endplate width, spinal process height, spinal process length, transverse process distance, the height of the vertebral body, articular process height inferior, articular process height superior, pedicle height, pedicle width, and maximum distance between articular processes. A total of 100 patients, including 46 males (46%) and 54 females (54%), were enrolled in this study. Our findings showed that most L2 and L3 parameters could differentiate males from females, with the area under the curve between 0.620 and 0.888. The majority of L2 and L3 parameters were positively associated with height in both males and females. Regarding age, there was a significant positive association between the spinal process length of L2 and vertebral length, spinal process height, and spinal process length of L3 with age in males. Also, several parameters of L2 and L3 were associated with age in females. In conclusion, we demonstrated that the parameters of the second and third lumbar vertebra could be valuable in the determination of the age, height, and sex of the Iranian population. Our results could have practical implications in forensic anthropology in serious events like earthquakes.

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.

Congenital goiter in North of Iran: A case report.

Congenital goiter (CG) is one of the rarest disorders observed in a newborn at birth diagnosed with hypothyroidism. Considering the simultaneity of pregnancy and baby's hypothyroidism at birth, the goiter can be caused by diabetes during pregnancy and hypothyroidism emergence in the baby.

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.

Insanity defence in bipolar patients at the time of committing murder according to Iranian law: Case studies.

Bipolar disorder is a chronic, relapsing illness characterised by recurrent episodes of manic or depressive symptoms, with intervening periods that are relatively (but not fully) symptom-free. Studies have found higher rates of psychiatric disorders in homicide offenders than in the general population. The insanity defence is a legal construct that, under some circumstances, excuses defendants with mental illness from legal responsibility for criminal behaviour. Here we report two cases of family murder by the mother of the family caused by bipolar disease. The role of the forensic psychiatrist in diagnosing insanity during the commission of a crime is very important as these patients should be diagnosed, treated as soon as possible, and monitored. Public education through social media should be considered to reduce crimes in societies. Diagnosing insanity during the commission of a crime is very important and requires high precision forensic psychiatry. Public education through social media should be considered to reduce crimes in societies.

Height estimation based on second cervical vertebra measured using three-dimensional computed tomographic scanning in Iranian adults.

OBJECTIVES: The cervical vertebrae are more durable than other skeletal components, and therefore may be the only remnants of a dead body. The present study aims to investigate the role of several linear dimensions of the second cervical vertebrae measured by Three-Dimensional Computed Tomographic Scanning (3D CT Scan) in height estimation of Iranian adult population. In this cross-sectional study, height determination was performed by measuring 15 indexes of the second cervical vertebrae. Indexes were obtained by screening cervical CT scan of 66 patients (33 males and 33 females) aged ≥ 18 years at Rasoul Hospital. Chi square, T student and logistic regression tests were used for statistical analysis. The significance level was considered to be < 0.05. RESULT: In the total population, among the indexes for the second cervical vertebrae, the Max height of the axis (AMA) (r = 0.470, P = 0.0001), Max length of the axis (CMA) (r = 0.320, P = 0.007), and Sagittal max body diameter (DSMC) (r = 0.281, P = 0.019) had a strong and positive correlation with height. The results of this study showed the accuracy of linear dimensions of cervical vertebrae in determining the body height of the Iranian adult population.

Medical negligence according to the Islamic Penal Code in Iran: A case report.

Crimes against a person's physical integrity are a serious and consequential felony in the Islamic criminal law. A war veteran and victim of chemical warfare deceased at the age of 69 was referred to Kahrizak Legal Medicine Center, Tehran, Iran for autopsy. According to Iranian law, deceased war veterans should undergo autopsy to have the potential damage to their organs due to chemical warfare identified, so that due compensation can be awarded to their heirs. When the chest was opened and the pericardium was removed to separate the heart from arterial bases, a sterile gauze was astonishingly found in the mediastinal cavity. According to the history provided by his children, the veteran had undergone coronary artery bypass graft (CABG) 10 years before, which had caused him physical and mental frailty and ultimately led to his death following a respiratory infection.

Injuries due to caustics ingestion in children: A psychological approach to the suspicion of childish jealousies.

Most injuries from caustics ingestion occur due to parental negligence, but other causes such as psychological tendency or childish jealousy or behaviour may be the major cause for harming. Here, we describe a case of injury in a neonate who ingested a caustic substance, probably induced by his brother, but not as a consequence of the negligence of his parents. The mother said she had fed the child toilet bleach instead of water and was very concerned about the child's condition. However, when the baby's older brother was interviewed he did not show concern and was very confused and provided contradictory responses about his knowledge of the poisoning. Later, it was revealed that the baby's brother had prepared the milk and knew what was in it. In our case, damage by caustics ingestion may have been intentional due to psychological problems in parents causing child abuse or in other children due to childish jealousy.

An unusual traumatic delivery malpractice: a case report.

Head trauma may occur during delivery and can lead to a number of conditions. When an infant is injured during birth, the cause of injury is generally due to mechanical forces, such as compression, excessive or abnormal traction during delivery, and the use of forceps. A 39-year-old woman who was a primagravida (first pregnancy) with a gestational age of 26 weeks premature pregnancy was referred to a hospital in Tehran due to premature rupture of membranes (PROM) and fever. She arrived 2 h after rupture (noting that the rupture lasted for one week and then the baby was delivered). Antibiotics were given early on. After weak labour pain, vaginal examination revealed that the cervix was fully dilated and one of the feet of the foetus had come out of the cervix and was seen in the vagina. The foetus had died. The delivery staff used traction with force. Due to the age of the foetus, the head was relatively big and could not be delivered; the neck was thin and broken and the head separated from the body. The mother underwent a caesarean section to deliver the head of the foetus a week after PROM. The father of the dead newborn foetus sued the hospital and the staff responsible for the delivery. When medical professionals damage the trust between patients and their families and babies are injured children, they should be held accountable.

Generalized Tonic Colonic Seizure Followed by Loss of Consciousness Early After Using Low Dose of Tramadol: A Case Report.

INTRODUCTION: Despite high efficacy and safety of tramadol as a pain relieving analgesic, some minor side effects have been reported following its consumption. However, very rarely, serious and life-threatening side effects may appear following administration of tramadol. CASE PRESENTATION: This research describes a case of tramadol poisoning that appeared with acute seizure needing emergent and intensive cares. In the described case, using a low dose of tramadol (200 mg, orally), the patient experienced generalized tonic colonic seizure followed by loss of consciousness and shoulder dislocation due to trauma, requiring admission to the intensive care unit. CONCLUSIONS: As shown in the study, even using a low dose of tramadol might lead to acute generalized seizure with loss of consciousness and the need for intensive care.

Correlation between serum vitamin D level and neonatal indirect hyperbilirubinemia.

BACKGROUND: Considering the significant prevalence of Neonatal Indirect Hyperbilirubinemia (NIH) and its irreversible neurological complications, identifying the factors involved in the prevalence of neonatal jaundice is essential. The present study was conducted to determine the relationship between serum vitamin D levels and the prevalence of NIH in infants admitted to Qods Hospital of Qazvin in Iran in 2015-16. METHODS: In this case-control study, 30 term infants with NIH (the case group) were compared with 30 healthy, non- icteric, term infants (the control group) in terms of serum levels of 25-hydroxyvitamin D. The results were analyzed and compared between the two groups using t-test and the Chi-square test. RESULTS: The mean and standard deviation of serum 25-hydroxyvitamin D levels were 10.76 ± 8.6 ng/dl in the case group and 14.88 ± 11.38 ng/dl in the control group. There were no significant differences between the two groups (P = 0.11). CONCLUSION: The results suggest the lack of a relationship between vitamin D levels and NIH. However, further prospective studies are needed to conclude that vitamin D has no role in the pathogenesis of NIH.

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.

A report of sexual abuse in an Afghan refugee boy in Iran.

All children have the right to complete and integrated physical and psychological protection against abuse. The most important reason and risk factors for child abuse are social causes including poor familial support, poverty, mood disorders in the family, and addiction. Here, we report a case of child abuse of an Afghan child in Iran with a background of mood disturbances who presented with multiple trauma and injury. A nine-year-old Afghan boy was described with multiple injuries on neck, upper and lower extremities, and trunk. On anal examination in knee chest position, a suspected mucosal injury was evident. Interviewing the patient and his sister revealed a report of sexual abuse through the anus by his father.

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.

Congenital anomalies following use of isotretinoin: Emphasis on its legal aspects.

We described a neonate with severe and multiple abnormalities following use of isotretinoin, in spite of the mother's previous knowledge of drug complications. Initial physical examination after delivery showed congenital absence of both eyes and both auricles as well as anal atresia and a cleft palate. Due to severe respiratory distress and atresia of the anus, the neonate was admitted to a neonatal intensive care unit and underwent reconstructive surgery. The drug should not have been used during pregnancy. Using this drug within pregnancy with awareness of its side effects may have legal consequences.

Risk Factors of Mortality Due to Acute Opium Poisoning: A Report from the Largest Intoxication Referral Center in Iran.

BACKGROUND: Studies have shown that Iran has a high rate of opiate abuse and the most prevalently used is opium. This study was aimed to evaluate risk factors in patients with acute opium intoxication who referred to Loghman Hakim Hospital, Tehran, Iran, in 2011. METHODS: A total number of 383 patients with acute opium overdose, who were referred to the Emergency Department of Loghman Hakim Hospital in Tehran during 2011, were enrolled into this descriptive, cross-sectional study. Clinical data including level of consciousness, vital signs, mode of consumption, medical management, and laboratory results were recorded. Independent t-test was used to analyze the results. FINDINGS: Level of consciousness at admission was lower in patients who expired compared to survivors (P = 0.020). Respiratory depression and tachycardia were both more common among patients who expired compared to survivors (P = 0.001). Increase in urea, creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (SGOT), and serum glutamic pyruvic transaminase (SGPT) was more common among patients who died compared to survivors and the relationships between death due to opium poisoning and increase in these factors were all statistically significant (P ≤ 0.001). CONCLUSION: The findings of this study clarify the importance of clinical and laboratory findings of patients with opium poisoning in predicting their outcome, although further studies in this context are appreciated.