مجله پزشکی قانونی
سال دهم شماره 1 (پیاپی 33، بهار 1383)

Carbon Monoxide is one of the air pollutants which is a by-product of technologic advancement. Carbon monoxide poisoning is one of the most common causes of death due to poisoning in developed countries. This study is a cross sectional evaluation which was performed in Tehran Legal Medicine Organization in 1999. In this year 134 deaths occured due to carbon monoxide poisoning. Male to Female ratio was 2.1/1. The highest rate was seen in young (21-30 yr), workers & house wives. Most cases wereAccidental and individual and occurred in cold months of the year in closed environments with poor ventilation. unintentional. The most common source of carbon monoxide was wall-mounted.

In the present study, we surveyed the death of cadavers due to ingestion and then rupture of illicit drug (opioid) packings through swallowing or inserting into body carities or orifices which were referred to Legal medicine centre in Tehran from 1999 to 2004. Out of all these cases, 13 were due to opioid intoxication because of rupture of ingested illicit drug packings, these cases were referred by Law enforcement, hospitals or were discovered by Autopsy in unknown cases of death of referred cadavers. Necessary data (including epidemiological and etiological) were gathered through guestionnaires. Majority of deaths were in 20-62 age group, (46.5 percent). Married, (31.46 percent) unemployed, (84.61 percent) with history of addiction, (61.53 percent) with history of offense. Leading to imprisonement, were other common groups. The most common drugs discovered were opium (84.61%) and herion and hashish. The most common place of packings in the alimentary Tract was Undetermined, the least common place was stomach (23.7 percent). The lighest packing weighed 20gr and the heaviest 1400 gr. The highest number of packs was 60 and the least 1 pack. The cause of death (61.53 percent) was unknown in 61.53% of cases and 30.76 percent were due to leakage of swallowed packings, and 76.92 percent due to rupture of swallowing packings. Fear of punishment, not referring to hospitals becsuse of fear of informing Law enforcement by hospital stuffs, and also lack of knowledge of hazards of smuggling the illicit drugs through body packing and complications due to leakage er rupture of packages and lack of ability of diagnosis and Treatment in most hospitals have increased the mortality rate among body packing smugglers.

Smoking and drugs are the chief causes of early mortality in the developed and developing countries. Mass production of cigarettes and widespread advertisement have caused many individuals to show interest in them and there has been a severe increase in their use during the last decades. Smoking cigarettes is an addictive behavior and getting rid of addiction caused by it is difficult, which indicates the importance of preventivemeasure for elimination or reduction of this worldwide problem.Logical practical theory is one of the most important theories that accounts for the foundation of studies relevant to cigarette smoking. This theory emphasizes on attitudes in shaping the behavior. This study was carried out to investigate the the attitudes of students in Guilan University of Medical Sciences (GUMS) in a descriptive-analytical method.Statistical population consisted of 290 female and male students. Data-collection was carried out by a questionnaire consisting of two parts (1) Demographic information, (2) Attitude measurement based on Lickert scale. Findings showed that the greatest percentage of students was 59% for females and mean age of students was 23.25 years. The majority of students were studying in the first year and most of them used dormitory and student loans.The highest percent of students (83%) had no smoker friends and 93% of them had never used cigarettes. The majority of students (86.9%) had proper attitude toward smoking (they were anti-smoking) and they believed in hazardous side-effects and disadvantages of cigarette smoking. Research findings suggest a strong relation between cigarette smoking and attitude toward smoking. Thus, by providing appropriate scientific information and by changing in the attitude of individuals, consumption rate of cigarettes can be reduced among high-risk groups such as the youth. Besides, the families should pay adequate attention to friend selection of their children. There was a significant correlation between educational level, personal and parents income level, educational level of the parents and the number of smoker friends with the attitude toward cigarette-smoking.

Violence against women with various causes has been existed in most communities, and women have adopted different solutions to fight against it. This study has been carried out to determine the causes and factors of violence and showing the methods from the women’s views referred to Semnan health care centers. During a quality research using a focus group discussion (FGD), women’s opinions about domestic violence were studied. In this survey, 120 women (6-12 people group) participated in twelve sessions. Data were categorized on the basis of study aims and coding. And findings of each group were interpreted. The most important predisposing factors of domestic violence against women on their side were competition, power of repartee, insolence in sexual, relations objection and goumbling and on men’s side were unemployment, addiction, irresolution and interference of outsiders, stubbornness, patriarchal patterns in decision- making, vanity, obstinacy and polygamy. Women mentioned other measures such as reciprocation, prolonged sulking, leaving home and which are among useless and non- effective methods. On the other hand, Silence of one of the partners, talking after the setlement of quarrels, and seeking advices from elder memebers of the family and referring to consultation services are considered to be the best and most offective methods. Control of poverty and addiction, fighting against luxury and encouraging the culture of simple living, correction of the patriarchal patterns, paying more attention to women’s right and respecting to them, promoting the individual and social culture, strengthening the religious views and fear of God can be useful in controlling domestic violence.

Various kinds of drugs have been evaluated as antidotes of acetaminophen; the most important of them is N-acetylcysteine (NAC). The optimal route, dose and duration of administration for NAC in the management of acetaminophen poisoning is controversial. Various anecdotal reports have mentioned development of adverse effects following intravenous NAC therapy that have restricted this form of usage. In Iran, it is unclear whether the use of intravenous NAC is associated with a significant incidence of adverse events. To investigate the frequency of adverse effects of intravenous NAC therapy, compare them with previous reports, and asses the safety of intravenous NAC therapy, we attempted to conduct this survey. This was a descriptive and prospective study, and was conducted at Loghman-Hakim Hospital in Tehran, Iran during a 1-year period (1380). We included all adult patients who had a history of one toxic dose (7.5 gr or more) of acetaminophen intake and presenting fewer than 12 hours after consumption. These patients were treated regardless of the serum levels of acetaminophen. Patients with concurrent intoxication, coma and hepatic encephalopathy were excluded from the study. Treatment of these patients was carried out using 20-hour therapeutic protocol. There was a structured data collection form, submitted to all patients prospectively. A logistic regression analysis (based on the stepwise variable selection method) was carried out using SPSS Software, with the adverse reactions as the dependent variable, and age, sex, history of asthma, and medical allergy as independent variables. Intravenous NAC was administrated to 206 adult cases. Adverse reactions to NAC were observed in 23.3% of patients. In none of the symptomatic poisoned individuals, we had to completely stop the IV NAC infusion. No patients developed any serious adverse effects requiring intensive care and there were no deaths. It was shown that there were no significant relationships between age, sex, asthma or medical allergy and side effects. On the basis of our findings, we concluded that not using the automatic infusion pump and also the low rate of hepatotoxicity would be expected to correspond with a high frequency of adverse effects. Despite the high frequency of adverse effects, they were transient, not life threatening, easily treated, and all patients received a complete course of intravenous NAC.Therefore, the treatment can be considered relatively safe in the management of acetaminophen poisoning.

Spouse abuse consists of: aggression, beating and slapping, affront, mental- social- economic- sexual abuse and etc. The side for wives effects range from physical, mental and social harms to death. There are few studies on this subject in Iran; therefore we designed a survey to study its situation in Isfahan city of Iran. In this Cross Sectional study with Cluster Random Sampling, we selected 4 serial houses from 50 blocks of 495 blocks according to map of Isfahan city and 386 married women were interviewed using standard questionnaire. The mean age of these women was 35.7(15-78) years and the mean age of marriage was 19.3(9-44) years, 2.4% of them were foreigners, 1.8% Christian and others Muslim, 7.5% of them were illiterate prevalence of Smoking-Alcohol and Drug abuse was 0.5% in them and 33.7%-7.8%-5.7%.respectively in their husbands prevalence of Spouse abuse from marriage time was 36.8% and incidence rate was 29.3% in recent year. The most common time of Spouse abuse was in the night. Themost common types of it were: disregarding wives’ feelings 45%, agression 43%, unconsented intercourse 31%, forced intercourse 18%, insecurity at home 15.8%. Threat to: Discontinue relations with other family members 38%, Affront 32%, Beating 24%, quitting 18%, Divorce 15%, Death 7%, knifing 6%, Gunning 2%. making problems such as: financial 10%, House- Clothing- Food supplies 14%- 14%- 8%. History of: Slapping 32%, humiliation 29%, Beating 27%, Knifing 3.4%. Given the high prevalence and incidence rate of Spouse abuse, we suggest that an analytical study to identify the risk factors of spouse abuse in our community be carried out and public enforce on mutual rights and duties of wives and husbands planned and performed.

Suicide is a self-destructive behavior and of all forms of self-harm. Burning by fire is perhaps the most dramatic and potentially fatal. The proportion of self-inflicted burns among patients admitted to burns wards ranges from 0.37% to 40%, with considerable variation around the world. In Iran, according to available data from 10 to 15 percent of burn patients admitted were those who have burned themselves. This descriptive cross-sectional study was designed to assess the epidemiology of self-burning in patients admitted in Birjand Imam Reza (p.b.u.h) hospital burns ward from May 1999 to February 2004. Medical records of all self-burning patients were assessed to collect the needed data. In this study, out of 442 burn cases 21.2% was due to self- burning. It was more common in Women (64.9%) and those in primary education level (48.9%). The mean age was 26.8 years and the incidence rate was higher among 11- 20 year olds. The method most commonly used in self-burning cases was pouring flammable liquid (specially kerosene) Over one-self and igniting it, (91.5%). Most cases have occurred at home (97.9%). The mean of burnt surface percently was 73% and mortality rate was 84%. The high incidence of self-burning in women and youth as high risk groups, high mortality rate makes, implementation of public education programs for prevention, providing support for high risk groups of people and psychologic consultancy service to find and manage main causes of self-burning essential, andcontinuous education for care providers to maintain the needed care.

Cyanide is a chemical widely used in industry and is a major environmental pollutant and an important toxic asphyxiant, to which exposure occurs through inhalation as well as ingestion and skin contact. In this study, fifty six (56) male workers exposed to cyanide salts, in some of Helwan factories, were enrolled, with a mean age of 31.81±9.93 years and a mean duration of exposure of 12±2.5 years. Fifty nine (59) males not exposed to cyanide, with a mean age of30.33±9.51 years were considered as control subjects.The examined group was evaluated using a self-administered questionnaire, medical examination, psychometric assessment and laboratory studies. The psychometric assessment showed that changes in digit total score, similarity test, digit symbol test, Trial making test and psychomotor speed test were statistically significant. In addition, changes in personality test, neuroticism and criminality were also statistically significant.The serum level of cyanide in the exposed workers who were also reported to be smokers, was 0.15=1:0.63 ug/ml compared to 0.086±0.004ug/ml in smokers of the control group, a difference which is statistically significant. On the other hand, cyanide serum level in exposed, non-smoker workers was 0.40±0.9 compared to 0.06±0.1 ug/ml in non-smokers of the control group, a difference which is also statistically significant. And thus, the study recommends that workers with a possibility of exposure to cyanide should be advised to wear protective gear and undertake protective measures to lessen direct exposure to cyanide.