The completeness of the registration system and the economic burden of fatal injuries in Iran.

BACKGROUND: The present study aims to calculate completeness of the current registration system of fatal injuries in the legal Medicine Organization (LMO) and to estimate the economic burden of fatal injuries at the national level of Iran. METHODS: We estimated the completeness of registered fatal injuries using a three-source capture-recapture method among the Legal Medicine Organization, health departments and Traffic police in Hamedan County (HC) from June 22, 2015 to June 21, 2016. We also estimated the economic burden of fatal injuries using Years of Life Lost (YLL) during one year. Then, using appropriate statistical methods, we generalized the estimates to the national level. RESULTS: There were 487 registered fatal injuries in the LMO of HC. The male to female ratio was 2.89. Road Traffic Crashes (RTC) and suicide pertained 45 and 21 percent of deaths, respectively. The completeness of fatal injuries registration was estimated at 86.9%. Based on LMO information of HC, the percentage of fatal injuries numbering errors at the national level was estimated 1.1 times that was reported by LMO in the same period (41,936 vs. 36442). YLL and the economic burden of fatal injuries were estimated 1,706,373 years and 8,692,264,432 US$ at the national level, respectively. CONCLUSION: The completeness of the current registration system of fatal injuries is good. The economic burden of fatal injuries, especially due to motor vehicle crashes in Iran, is substantial. Strategies, legislative actions, and preventive programs should be considered to decrease the number of fatal injuries in our country.

A three source capture-recapture study of fatal injuries in Iran.

BACKGROUND: Well-functioning health systems and effective preventive measures require registering the exact number and valid data of fatal injuries. The present study aimed to determine the completeness of fatal injuries reported by LMO with the use of the capture-recapture method and finding the reasons for those unregistered fatal injuries in Hamedan County. METHODS: This cross-sectional study was conducted in Hamadan County from 22 August 2015 to 21 August 2016. The completeness of fatal injuries reported by LMO, as the main source of fatal injuries was estimated with the employ of the capture-recapture method including Health Department and Police. Log-linear modeling was used for statistical analysis. The number of fatal injuries that probably had not been detected in any three sources was estimated by using the GENLOG command. RESULTS: A total of 451 fatal injuries were registered in LMO for one year. The registries were included different amounts of detailed information from at least five variables in the Emergency Medical System (EMS) up to all detailed information in the LMO and Health Department. More fatal injuries occurred in males than females at all ages and the two-sex difference spectrum was wider between about 20 to 45 years old. Among cases of LMO, we found 29 unreported deaths. Therefore, the completeness of reported fatal injuries by LMO was estimated to be 86.9%. CONCLUSIONS: Fatal injuries are under-reported by the main source of this type of death in Iran. Identification of fundamental causes, integrated death registry system, and using a standard cause of death classification are needed to promote the registration of fatal injuries.

The diagnostic value of anthropometric indices of maxillary sinuses for sex determination using CT-scan images in Iranian adults: A cross-sectional study.

BACKGROUND: The identification of human remains is an essential part of forensic science. Studying paranasal sinuses is very useful in identification of mutilated or burnt bodies from accidents such as plane crashes. We aimed to assess the diagnostic value of anthropometric indices of maxillary sinuses for sex determination using CT-scan images in Iranian adults. METHODS: CT-scan slices of 228 maxillary sinuses (from 144 men and 144 women) were studied. The maximum height, maximum anterior-posterior diameter, maximum width, and maximum distance between the sinuses were measured in both sexes. Our participants were divided into three age groups of 20-34, 35-49, and over 50 to compare the recorded measurements in different age groups. RESULTS: We found a significant difference between men and women regarding the maximum height, maximum width, maximum A-P diameter of sinuses and the maximum distance between the right and left maxillary sinuses in all of our participants. We also found that the highest accuracy for sex determination was related to the maximum distance between the sinuses (65.6%) and the lowest to the maximum width of the right sinus (56.2%). The most accurate identification resulted from assessing the maximum distance between the sinuses in the 20-34 age group (74.3%), the maximum anterior-posterior diameter of the sinuses in the 35-49 age group (62.8%) and the maximum height of the left sinus in the over 50 age group (65.7%). CONCLUSION: Regardless of age, according to our study the parameters of height, width, anterior-posterior diameter of sinuses and the maximum distance between the right and left maxillary sinuses are partially valuable for sex determination. The most accurate sex identification was examined in the 20-34 age group from studying the maximum distance between the sinuses. Especially in the over 50 age group, it is not enough to consider the sinus parameter for sex identification.

Comparison of Quantitative and Qualitative Dermatoglyphic Characteristics of Opium Addicts with Healthy Individuals.

BACKGROUND: Recreational drugs have a significant impact on the lives of drug users, their close families andfriends, as well as their society. Social, psychological, biological, and genetic factors could make a personmore prone to using recreational drugs. Finger and A-B ridges (dermatoglyphics) are formed during the firstand second trimesters of fetal development, under the influence of environmental and genetic factors. Theaim of our study was to investigate and evaluate a possible link between dermatoglyphics and opium usage. METHODS: The pattern of dermatoglyphics - finger and A-B prints - obtained from a group of opium users(121 patients) was compared to those obtained from a group of opium non-users (121 patients) from Birjand,Iran. The results were analyzed using chi-square, t and Mann-Whitney tests. FINDINGS: The results showed that although A-B ridges of palms and fingers in our study group were highercompared to the control group, there was no significant difference between these groups. The only significantdifference was the fingerprint patterns of the left ring finger in the study group, which lacked the arch patternand had less loop patterns. The dominant type of fingerprint in the left ring finger was the whorl. In ouropium user group, the arch and loop fingerprint patterns were heterogeneous and significantly different incomparison with the control group (P < 0.01). CONCLUSION: These findings suggest that a genetic factor may increase the predisposition to recreational drugusage. Further research is required to confirm this possible impact of genetic factors on the addiction process.

Comparison of UHPLC and HPLC in benzodiazepines analysis of postmortem samples: a case-control study.

The aim of this study was to compare system efficiency and analysis duration regarding the solvent consumption and system maintenance in high-pressure liquid chromatography (HPLC) and ultra high-pressure liquid chromatography (UHPLC). In a case-control study, standard solutions of 7 benzodiazepines (BZs) and 73 biological samples such as urine, tissue, stomach content, and bile that screened positive for BZs were analyzed by HPLC and UHPLC in laboratory of forensic toxicology during 2012 to 2013. HPLC analysis was performed using a Knauer by 100-5 C-18 column (250 mm × 4.6 mm) and Knauer photodiode array detector (PAD). UHPLC analysis was performed using Knauer PAD detector with cooling autosampler and Eurospher II 100-3 C-18 column (100 mm × 3 mm) and also 2 pumps. The mean retention time, standard deviation, flow rate, and repeatability of analytical results were compared by using 2 methods. Routine runtimes in HPLC and UHPLC took 40 and 15 minutes, respectively. Changes in mobile phase composition of the 2 methods were not required. Flow rate and solvent consumption in UHPLC decreased. Diazepam and flurazepam were detected more frequently in biological samples. In UHPLC, small particle size and short length of column cause effective separation of BZs in a very short time. Reduced flow rate, solvent consumption, and injection volume cause more efficiency and less analysis costs. Thus, in the detection of BZs, UHPLC is an accurate, sensitive, and fast method with less cost of analysis.

Survey of factors related to criminal behavior in a sample of Iranian substance abusers.

OBJECTIVES: Many countries including Iran have a high rate of substance abuse. It is essential for public health and law enforcement strategies to know the causes and consequences of substance abuse and its relation to crimes. METHODS: In a prospective case-control study, covering a period of one year starting from March 21, 2010, 125 cases with criminal behavior and 125 cases with no history of criminal behavior were studied. RESULTS: Eight percent of our studied population had a previous history of psychological disorder. Most of our cases were cigarette users (78.4%). Forty-two cases had a history of alcohol abuse (16.8%). Modern drugs were the most common type of drugs (56%) being used. Multivariate analysis using logistic regression revealed that criminal behavior was correlated with divorce (RR = 5.35; 95% CI = 1.59-16.01; P = 0.023), history of alcohol use (RR = 2.63; 95% CI = 1.11-6.22; P = 0.027), history of psychological disorder (RR = 4.97; 95% CI = 1.44-17.20; P = 0.011), Modern drug use (RR = 4.86; 95% CI = 2.01-11.76; P = 0.001) and starting drug abuse at an early age (RR = 0.94; 95% CI = 0.88-0.99; P = 0.03). CONCLUSIONS: Risk factors for criminal behavior among substance abusers include being divorced, history of alcohol abuse, history of psychological disorder, modern drug abuse and starting drug abuse at an early age.

Feigned symptoms among defendants claiming psychiatric problems: Survey of 45 Malingerers.

OBJECTIVE: In many jurisdictions, psychiatric problems are intended for commutation. Therefore, a forensic psychiatrist has an important role in detection of malingering. While several studies evaluate diagnostic tests, it is less known what symptoms are more likely to be imitated by malingerers. METHOD: In a prospective study 45 malingerers, who were diagnosed according to interviews by two forensic psychiatrists, from defendants with a judicial order for evaluation of mental status and criminal responsibility during a period of eighteen months were examined in legal medicine center of Tehran. Participants were assessed in another interview to determine symptoms. Dichotomous symptoms in felony and misdemeanor groups were analyzed using fisher's exact test. The level of statistical significance was set at P < 0.05. RESULTS: Thirty-eight malingerers were charged with misdemeanors and seven with felonies. Behavioral symptoms were most frequently faked by 35 participants (77.8%). Participants charged with criminal accusation had a significantly lower mean age (P=0.032) and a higher level of education (P=0.008) than other non-criminal defendants. A statistically significant increase in memory function problems was demonstrated in the misdemeanor group (P=0.040). With regard to dual symptom imitation, statistically significant correlations were observed between thought content and perceptual symptoms (P=0.048) for felonies and mood & affect and thought process symptoms (P=0.034), mood & affect and behavioral symptoms (P=0.000) and cognitive function and behavioral symptoms (P=0.039) for misdemeanors. In general, many simulators attempted to mimic simple symptoms of behavioral disorders. Probably felony offenses need less accurate programming; therefore, their rates are higher in older, less educated participants. CONCLUSION: This study demonstrated that differences between presenting symptoms among different offenses may not be useful in detection of malingering,; however, unusual dual symptom imitations may be useful, particularly when standard tests are not performed.

Is there a role for progesterone in the management of acute organophosphate poisoning during pregnancy?

Organophosphates are commonly used pesticides and cause about one million unintentional and 2 million suicidal exposures with up to 300,000 fatalities every year around the world. Toxicity of organophosphates is due to inhibition cholinesterase activity and prolonging the effects of acetylcholine in the receptor site. Clinical features of organophosphate poisoning are defecation, urination, miosis, bronchorrhea, emesis, lacrimation and salivation. Spontaneous abortion reported some when in pregnant patients. Intravenous administration of benzodiazepines, atropine and pralidoxime is the formal treatment of this toxicity. Atropine and pralidoxime have been assigned to pregnancy class C by the FDA and should be recommended for use in pregnant women clinically suffer organophosphate poisoning. Benzodiazepines have been assigned to pregnancy class D and should be avoided during pregnancy. Clinical experiments suggest transplacental transfer of organophosphates is possible, and fetal sensitivity is probable, but a single acute overdose most likely don't make any physical deformities, therefore termination of pregnancy is not imperative. Nonetheless, no definite strategy focused on maintaining pregnancy. Here we propose an idea that in any female case of acute organophosphate poisoning in childbearing range of age, maternal serum Beta-HCG should be tested for pregnancy and prophylactic progesterone should be used in pregnant cases of organophosphate poisoning.

The value of radius bone in prediction of sex and height in the Iranian population.

OBJECTIVE: Measurement of anthropometric parameters of long bones can be applied in sex determination and height prediction. The aim of this study was to investigate the value of length of the radius in forensic identification. MATERIALS AND METHODS: Cross-sectional analysis of anthropometric parameters of the radius was done by Legal Medicine Organization of Tehran, Iran studying fresh cadavers of Iranian population during 2009 and 2010. RESULTS: This study surveyed length of radius of 106 fresh Iranian cadavers, 61 men and 45 women, in the age range of 10-85 years old. The study showed that genders can be distinguished using the length of radius with a sensitivity of 83% and specificity of 96%. Using the regression test, there was significant relation between the height of persons and the length of radius bone. The equations were obtained to estimate the height of the individuals on the basis of radius bone length in different age groups, with an exception in females of 40-64 Years old. CONCLUSION: In the cases of fresh cadavers, by using the length of radius, we could be able to determine the length of height and gender with high confidence.

The value of the anthropometric parameters of the tibia in the forensic identification of the Iranian population over the age of 20.

OBJECTIVE: Tibia is one of the bones which can be applied in sex determination in addition to its successful role in determination of stature. The aim of this study was to investigate the value of anthropometric parameters of the tibia in forensic identification. MATERIALS AND METHODS: Cross-sectional analysis of anthropometric parameters of the tibia was done by Legal Medicine Organization of Tehran, Iran studying Iranian population over the age of 20 during 2009 and 2010. RESULTS: This study covered four aspects of tibias of 80 fresh Iranian cadavers, 40 men and 40 women, including the maximum lateromedial length, medial length, proximal width, and the distal width. The study showed that genders can be distinguished using the lateromedial length with 90% sensitivity and 80% specificity, the medial length with 90% sensitivity and 85% specificity, the proximal width with 85% sensitivity and 87.5% specificity, and the distal width with 67.5% sensitivity and 75% specificity. CONCLUSION: In order to determine the relationships between the diverse aspects of tibia, the correlations between different dimensions of tibia were examined, resulting in the regression equations between its length and width.

Brain weight of Iranian population; the first report.

OBJECTIVE: Knowledge of the normal range of brain weight is a useful parameter in diagnosis of many pathological conditions. There are racial differences as well as other variables in any population affecting the brain weight. We conducted this study to determine the brain weight in healthy adult Iranian population among both sexes in order to formulate a standard reference range taking into account the variables of age, sex, weight, BMI and height. MATERIALS & METHODS: Prospective analysis of data from 1308 forensic autopsies of Iranian adults from 23 June 2008 to 22 June 2009 was performed. All subjects were Iranian adults dying of short survival injury time (<15 min) from unnatural deaths who showed no pathological changes. RESULTS: Brain weight, body weight, body height and BMI were evaluated in 1143 subjects, including 856 males and 287 females, ranging 16-88 years old. Brain weight in males and females was 1322.45 ± 117.05 and 1219.03 ± 127.85 gm respectively (P = 0.001). A negative significant correlation between age and brain weight was seen in both sexes (P = 0.001). Moreover, there was a positive significant correlation between body height and Brain weight in males and females (P = 0.001). CONCLUSIONS: The study indicated higher values in males than females. The observed correlation of brain weight with age, weight and body height was more prominent in females. The results revealed that body height and age in males and body height, weight and age in females may play a predictive role in estimation of brain weight.

Nonfire carbon monoxide-related deaths: a survey in Tehran, Iran (2002-2006).

OBJECTIVE: To depict the epidemiology of deaths due to carbon monoxide (CO) poisoning in Tehran, distinguishing those at greatest risk for acute poisoning resulting in death. METHODS: A retrospective survey was carried out with regularly collected information set in Tehran's Legal Medicine Organization, with a population of 11.1 million. The data included 666 deaths due to CO poisoning from January 2002 through December 2006. The principal consequence measures were age and sex standardized incidence rates for unintentional, suicidal, and undetermined poisonings for legal authorities. RESULTS: The overall rate of unintentional poisonings over the 5-year period was 7.5 per 100,000, with an annual rate of 1.5 per 100,000. The 5-year rates were highest in people aged 25 to 34 years: men, 16.4 per 100,000; women, 7.8 per 100,000. For suicides, the 5-year rate was 0.1 per 100,000; annual rate, 0.02 per 100,000. The suicidal 5-year rates were highest in men aged 35 to 44 years, that is, 0.9 per 100,000; there was no case for women. Unintentional poisonings displayed a powerfully seasonal variation with the highest rates being documented in the months October to March. Over the 5-year period, increasing rates of death from CO poisoning were found annually to be approximately 20%. CONCLUSIONS: In this study, middle-age people, young adults, and elderly people were at the greatest risk for unintentional CO poisoning, and rates were highest in the winter months. Death from suicidal CO poisoning was very rare in this study; on the other hand, unintentional CO poisoning deaths are increasing in Tehran. Health authorities require to consider all populations in any prevention plan.

Age-at-death estimation based on the macroscopic examination of spheno-occipital sutures.

OBJECTIVE: To examine the closure degree of spheno-occipital synchondrosis and its relationship with chronological age. MATERIALS AND METHODS: Cross-sectional analysis of the closure degree of spheno-occipital suture was done through direct inspection of 376 autopsies from both sexes whose ages ranged between 8 and 26 years in Legal Medicine Organization of Tehran, Iran from 1st of July 2007 to 1st of July 2009. The correlation between the degree of closure and chronological age was investigated. RESULTS: Mean ages of open, semi-closed and closed sutures were 12.27, 16.12 and 21.17 years in males, and 9.04, 12.38 and 19.44 in females, respectively. Seemingly, their difference was significant (p < 0.001). Partial fusion (semi-closed) was seen at the age of 12 in both sexes while complete fusion (closed) was seen at 15 year olds or above in males and 12 year olds or above in females. Spearman's correlation ratio coefficient showed a linear correlation between age and suture situation in both sexes (rho = 0.788, P < 0.001 in males and r = 0.645, P < 0.001 in females). CONCLUSION: The study showed that the closure degree of spheno-occipital suture can be used as a good indicator for age estimation in both sexes. Cadavers can be correctly grouped above or below 16 years old with sensitivity of 79.82% and specificity of 89.47% in males and above or below 13 years old with sensitivity of 100.00% and specificity of 81.58% in females.

Epidemiology of drowning in Mazandaran province, north of Iran.

OBJECTIVES: Drowning must be recognized as a major global public health problem with significant opportunities for prevention. METHODS: To examine the incidence and characteristics of drowning in recreational water settings, we analyzed 2002 to 2006 data from the Legal Medicine Organization of Mazandaran province, north of Iran, through a retrospective study. RESULTS: During 2002 to 2006, a total of 1107 persons suffered fatal drowning in Mazandaran province. Mean age was 23.65 +/- 11.47 and M/F ratio was 8.4:1. The most common age groups of drowned victims were 20 to 24 and 15 to 19 years (17.0 and 16.1 per 100,000 population/yr, respectively). Children under the age of 15 years comprised 14.2% of all drowning deaths. Unprotected beaches of the Caspian Sea were the locations with the highest number of drowned victims. Most of drowned victims (65.9%) were travelers from other parts of Iran, especially from Tehran. The manner of death was found as following: 95.5% accidental, 3.6% suicidal, 0.3% homicidal, and 0.6% undetermined. CONCLUSIONS: Mazandaran province has a mean drowning rate 7.6 per 100,000 population-year that is not comparable to the drowning-related mortality in developed countries. Effective prevention of drowning requires programming and policies that address known risk factors.

Identification of sex in Iranian population using patella dimensions.

OBJECTIVES: Heretofore, sex determination has been carried out on skeletal remains to identify individuals in forensic cases and to assess populations in archaeological cases. Since it has been shown that not all bones are found in a forensic case, discriminant function equations should be derived for various bones of the body to assist in sex determination. The aim of this study was to derive discriminant function equations for sex determination from measurements of the patella. METHODS: In a prospective study, dimensions of patella were measured using the fresh cadavers of Iranian population as referred to the Tehran's Legal Medicine Organization. RESULTS: A total sample of 113 (57 male, 56 female) patellae were measured using three measurements. Stepwise and direct analyses were performed with the average accuracy of 92.9% for sex classification, thereby making the patella useful for sex determination. CONCLUSIONS: The results of this study confirm the high accuracy of using the measurement of the patella for sex determination. Until further data collected suggests otherwise, the results expected in present study are limited to forensic cases of the Iranian population.

Electrocution-related mortality: a survey of 295 deaths in Tehran, Iran between 2002 and 2006.

BACKGROUND AND AIM: Electrical burns are associated with significant morbidity and mortality, which are usually preventable with simple safety measures. METHODS: We conducted a retrospective study of non-lightening electrocution deaths in Tehran, Iran, between 2002 and 2006. RESULTS: Of 295 deaths, 285 investigated were accidental. The remnants were suicidal. The age range was 11 months to 75 years with a mean age of 28.99 + or - 12.58 years. Two hundred seventy-nine victims (96.6%) were males. The upper extremity was the most frequently involved contact site in 185 deaths (66.3%). No electrical burn marks were present in 16 (5.4%) cases. Workrelated accidents were responsible for 188 cases deaths (63.9%) and home accident for 85 cases deaths (28.8%). Deaths were caused most frequently by touching an electrical cable (95 cases, 32.2%). There was an increase in electrocution deaths in the summer (119 cases, 40.3%). One hundred seventy-nine cases (60.7%) were dead on the scene of death and 94 cases (31.9%) were dead on arrival at hospital. The unique findings of our study include 10 cases (3.4%) of suicidal electrocution and a high rate of workrelated accidental electrocution among Afghan workers. CONCLUSION: Death rates from electrocution among all medico-legal deaths were found to be lower in our study than in previous reports, most of them were work-related and preventable. Workers and their employers should be educated to avoid such accidents with safety measures.

Study of the normal internal organ weights in Tehran's population.

OBJECTIVE: Examine the normal adult internal organ weight and its relationship with body height, body weight, body mass index and age. MATERIALS AND METHODS: Prospective analysis of data from 1222 autopsies in Legal Medicine Organization of Iran from 1st January, 2007 to 1st September, 2008. All the subjects were adult residents of Tehran died from external causes and showed no pathological changes. RESULTS: The weight of the brain, heart, lungs, liver, spleen, pancreas, kidneys, thyroid gland, the pituitary gland, the suprarenal glands, testes, prostate, ovaries and the uterus were collected from 914 males and 308 females between 15 and 88 years. The weight of all the organs was correlated statistically with at least one external parameter with the exception of the pancreas in men, the uterus, the spleen and the thyroid in women. Organ weights decreased with age except for the heart and the prostate, and increased in relation to body height and/or BMI. Except for the brain, the organ weight showed a better statistical correlation with the BMI than the body height. CONCLUSION: These results can be used as standard organ weights to determine abnormal evidences in Forensic and Pathologic corpses. However such results have to be regularly updated by pathologists in order to keep organ weight as a good criterion used in postmortem diagnosis.

A survey of suicide by burning in Tehran, Iran.

To identify the characteristics of completed suicide by burning in Tehran. A retrospective analysis of data obtained from Tehran's Legal Medicine Organization and judiciary system over 5-years (from 2002 to 2006). During the 5 years, 374 decedents (64.2% female and 35.8% male) were diagnosed as suicide by self-burning, and the annual incidence rate was 0.9 per 100,000 general population-years. The most at risk group was young females. Sixty-five decedents (17.4%) had died at the scene of incidents. The location at the time of attempted suicide in all female victims and 75.4% of male decedents was home. Sixty-one percent of decedents were married and 26.2% of them had no education. Most victims were residents of suburban areas. The annual incidence rate of self-burning suicide in Tehran was found to be lower than other Iran's geographic areas, although it was higher than developed countries. Self-burning was more frequent in females than in males and was noted mainly in young age groups' residents of suburban areas with low level of education. These characteristics suggest that social factors are the main drive leading to an unacceptably high rate of suicide by self-burning among women in Tehran.

Survey of sudden death from aneurysmal subarachnoid hemorrhage in cadavers referred to Legal Medicine Organization of Tehran, 2001-2005.

BACKGROUND AND AIM: Some cases with aneurysmal subarachnoid hemorrhage (SAH) never reach the medical centre alive and they are not included in most studies of SAH. To explain the clinical profile of sudden death from aneurysmal SAH, we examined the epidemiology and clinicopathologic characteristics of patients with aneurysmal SAH who never reached medical attention or died within first 24 hours of the onset of first symptoms. MATERIALS AND METHODS: Using the autopsy records in Legal Medicine Organization of Tehran, we identified all cadavers who were diagnosed with aneurysmal SAH between 2001 and 2005. RESULTS: There were 85 women and 60 men with a mean age of 50 years. Twenty patients (14%) died without reaching medical care and 58 (40%) died within first 24 hours of the onset of first symptoms. The remnant had died after 24 hours to 28 days of hospitalization. In comparing patients with sudden death versus remnant, the main variables were the frequency of posterior circulation aneurysms that was found in 59% compared with 19.4% in those who had died after 24 hours, intraventricular hemorrhage 53.8% versus 19.4%, and pulmonary edema 92.3% versus 34.3% (P = 0.01). CONCLUSION: In our population, the frequency of sudden death from aneurysmal SAH has not changed during the last 5 years. The typical clinical profile of sudden death in SAH includes intraventricular hemorrhage, pulmonary edema, and a ruptured posterior circulation aneurysm. Intracerebral hemorrhage is rarely connected to sudden death from aneurysmal SAH.

A survey of self-mutilation from forensic medicine viewpoint.

OBJECTIVES: Currently little research exists examining self-mutilation (SM) in samples of forensic referrals. The present study provides a comprehensive review on the frequency, etiology, and morphologic characteristics of self-inflicted injuries in a sample of outpatients' forensic referrals. METHODS: In a prospective cross-sectional study, during 3 years, we examined 9874 outpatients' forensic referrals and found 1248 SM cases in Ghouchan (an urban and suburban area of Iran). RESULTS: Based on forensic medical examinations, it was found that 12.6% of all outpatients' forensic referrals had engaged in SM behavior at sometime. Males had significantly higher rates of SM than females (76.9 vs. 23.1%, respectively). The mean age was found to be significantly lower in patients with SM (23.6 +/- 8.5) than patients without SM (40.0 +/- 10.5) (P < 0.001). Rate of being single and unemployed was higher in the SM group (58.2, 56.1%, respectively) than in the group without SM (19.1, 22.8%, respectively). Superficial cuts and scratches were found to be the most common type of SM (79.5%), followed by bruises (10.8%), burns (3.4%), deep cuts (3.2%), fractures (0.6%), and other miscellaneous injuries (2.5%). Upper extremities including forearms, wrists, and arms opposite the dominant hand were the most common areas of injury. CONCLUSIONS: Nonsuicidal self-injury, the deliberate-direct destruction of body tissue without suicidal intent is a relatively common event in forensic referrals. It is very important to distinguish between this and other types from forensic point of view. Forensic practitioners must be expert and trained for this purpose.