مجله پزشکی قانونی
سال چهاردهم شماره 3 (پیاپی 51، پاییز 1387)

Age determination of living children with unknown identity, suspected of crime or violence as well as identification procedure of unknown skulls has a great value. Owing to a comparatively low variability of tooth calcification in relation to chronological age, it seems that methods based on stages of tooth formation are more suitable in estimation of chronological age than those based on other indicators of somatic growth. One widely used method for the comparison between different populations is that first described by Demirjian. The study was designed to determine dental age from orthopantomograph using Demirjian method and to investigate applicability of Demirjian method for estimation of chronological age in children of Isfahan. After obtaining approval from ethical committee of university, a sample selected in a department of pedodontic consisted of 104 orthopantomograph of 41 boys and 62 girls of 6–14 years of age. Seven mandibular teeth in orthopantomograph were examined. Tooth formation is divided into eight stages and criteria for the stages from A to H are given for each tooth. Each stage is given score according to a model. Standards are given for each sex separately. The sum of the score for the seven teeth is transferred to a dental age. Chronological age was calculated by subtracting the birth date from the date on which the radiographs were exposed for individual. Dental and chronological age was showed high correlation (r =0.924 for girls and r = 0.932 for boys). When Demirjian method was applied to Isfahanian children, mean difference between true and assessed age for males showed overestimation of 0.02 years (7 days) and females showed overestimation of 0.14 years (51 days). Demirjian method showed high accuracy when applied to children of this study. By using of this method we can estimate age especially in forensic medicine.

Bloodstains can be found in most cases that a violent crime has occurred. DNA typing analysis can establish the genetic profile(s) of the participant in a violent crime. The recovery and detection of possible bloodstains at crime scene when a crime scene is cleaned up become even more important. Utilizing a new solution that comprises luminol, it is possible to detect latent bloodstains with high sensitivity and precision. Firs, luminol solution was prepared and through changing conditions and using different chemicals, the solution sensitivity was optimized, afterwards the solution examined with different blood proportions and dilutions and light intensity provided by the reaction between solution and blood was measured with the Luminometer. In addition, various surfaces and optical situations in the experiments were assessed. Eventually blood samples were used for DNA profiling. By means of the new luminol solution and comparing it with the elder one, in addition to very high sensitivity to blood on various surfaces, the reaction was performed up to 10-6 dilution. Furthermore this method has no need for absolute darkness and it provides the facility for taking PHotos or records without DNA damage, therefore acquiring DNA typing results from very small bloodstains was feasible. Bloodstain is one of the most important biological evidence that remains in criminal scene. In most cases criminals try to wipe it out and one of duties of the forensic group is to detect such traces. Nowadays, criminal scene is inspected using UV and also the elder luminol solution that in the most cases are not sufficient. The goal of this study was to optimize and standardization of the elder luminol solution and analyzing the reaction results and with distinguish between true and false results. Hence with using this method, DNA typing can provide judge and inspectors with powerful evidence. Some advantages of the new solution are easy to use and preparation and also it dose not have any harmful effects on DNA profile determination.

Informed consent has been considered as a basis of medical ethics. This study aimed to determine the quality of informed consent process in inpatients undergoing surgery in educational hospitals in Kashan. In this cross sectional study, 300 random inpatients were surveyed through a questionnaire before surgery in clinical wards. The questionnaire was included questions about disclosure of information, voluntary decisions, consent form understandability, and attention to physician-patients relationship factors. We analyzed the data based on percent of frequency, means and SD. The most patients (or surrogates) believed that they were not informed about benefits of surgery (45%), risk and consequences (55.7%), other alternative treatment (67%), duration of hospitalization (50.7%), and follow up after surgery (66.3%). 69% of them said that the consent form was understandable and consent form was not explained for 82.7% of them. About voluntary decisions, benefits and risks of other alternatives were not disclosed for patients (70.7%, 69.7%). 67.3% of them believed that they were not allowed to choose between alternatives, however, 43% were informed about the right to refuse suggested treatment. 68.7% had enough time to think and question about treatment; 59.7% believed that they could contact to physician; 72.7% were answered adequately; and 77% considered physicians’ explanations understandable. There is not enough informed consent observance, except for physician-patient interaction. patients seem to be more informed about benefits, risk and consequences of surgery, other alternative treatments, benefits and risks of other alternatives, duration of hospitalization, follow-ups. In addition, explaining the consent form seems necessary.

DNA Typing methods offer great help in identification of single deceased individuals, war and mass disaster victims. It has been a challenge to extract DNA from bones previously soaked in water, burned or buried for a long time, due to the reduced quality and quantity of DNA in the bone samples. The aim of this investigation is the comparison and evaluation of two different DNA extraction methods, namely the phenol-chloroform-silica and the guanidinium thiocyanate-Silica for DNA analysis of old bones. DNA was extracted from twenty randomly chosen bone samples, with 8 years passing of their death, from unknown human remains by using of phenol-chloroform-silica and guanidinium thiocyanate-Silica methods. Spectrophotometer was used to estimate the quantity and quality of DNA. Then, extracted DNA was profiled by a set of eight short tandem repeats (STRs) loci named CD4, vWA, LPL, D5S818, D16S539, D13S317, F13 and FES. The successfulness of the DNA profiling of the specimens was measured by counting all type able electrophoretic results in each case. DNA quantification results showed that the phenol-chloroform-silica extracted on average 256.27 µg/ml of DNA with the average purity degree of 1.07, compared with the DNA concentration of 170.86 µg/ml and purity of 0.94 by the guanidinium thiocyanate-Silica. Our results on the overall success rate of polymerase chain reaction (PCR) amplification in eight STRs loci mentioned above indicates that phenol-chloroform-silica method (76%) was more effective than guanidinium thiocyanate-Silica (64%). Although the phenol-chloroform-silica showed better results in STR Typing from degraded bone samples than guanidinium thiocyanate-Silica, we suggest using both methods in analysis of old bone tissue simultaneously to improve the interpretation of results.

Human mitochondrial DNA (mtDNA) is a double-stranded circular molecule present in 1,000 to 10,000 copies per cell. The complete nucleotide sequence of the 16,569 base-pair molecule was determined in 1981.The aim of this study is to assess polymorphism, the rate of mutation, homoplasy, haplogroups frequency, haplotypes variance and nucleotide diversity in HVS-1 region of mtDNA from a portion of the Iranian ethnic groups. In present study, blood samples were randomly obtained from 357 healthy unrelated volunteer according to their place of birth and their information’s records for Persian, Azerbaijanian, Gilaki, Kurdish, Baluchi, Sistain, Turkmen and Arabs. Genomic DNA was extracted from blood following salting out method. Amplification of HVS-1 region was carried out using one set of primers encompassing the HVS-1 region. Automated DNA sequencing was carried out using dye-terminator chemistries, on an automated DNA sequencer (ABI 310). The sequences were edited for HVS-1 and aligned with the Cambridge reference sequence by clustalx program. According to mtDNA phylogenetic tree the haplogroups were determined. A total of 160 polymorphic sites were observed, in 357 HVS-1 templates. The highest homoplasy (similar mutation in individuals) with 40% belongs to Persians and the lowest with 13% was seen in Sistains. The rate of nucleotide diversity in Persian is 0.862 and it is the lowest diversity in all studied ethnic groups. We found that the variance of haplotype in Sistain was the highest with 0.87.The most common haplogroup in Persian, Azerbaijanian, Gilaki, Kurdish, Sistain, was HV and in Baluchi,Turkmen and Arabs were M and N. According to our results, contrary to our initial assumption, since Iran is situated in Asian continent, in Persian, Azerbaijanian, Gilaki, Kurdish, Sistain the haplogroups of western Eurasia were dominant and in Arabs and Baluchi, western Eurasia Haplogroups shows the equal frequency. On the other hand in Turkmen the highest frequency haplogroup belongs to eastern Eurasia. According to variance of mtDNA haplotypes in Iranian ethnic groups specially sistains, application of mtDNA in forensic investigation and identity is an effective tool.

Organophosphates poisoning are the second cause of death in poisoned patients in Isfahan Poisoning Center. However, early diagnosis and appropriate management significantly can reduce both complications and mortality. Cardiovascular toxicity is one of the common system which affectd in this poisoning. The aim of this study is assessment of cardiovascular signs and symptoms on admission in relation of other manifestation of poisoning and outcome. One hundred patients with documented organophosphate poisoning (as determined by history and clinical manifestations) and with complete medical records were enrolled in this cross-sectional study and data were analyzed by SPSS software and Fisher, chi-square tests. Organophosphate poisoning occurred more commonly in men (70%) and the average age of patients was 26.5±13. The most common symptoms were muscarinic symptoms (Increased secretion) (70%) and the most common cardiovascular parameter was tachycardia (26%). There was a significant correlation between cardiovascular parameters and respiratory and muscarinic parameters. Also, there was a significant correlation between some cardiovascular parameters (such as bradycardia and arrhythmia) and the poisoning prognosis. Our results show that patients with cardiovascular signs on admission such as bradycardia or arrhythmia have a more grave prognosis and because they may need close monitoring in ICU setting so this type of poisoned patient must be consult or refer to poisoning emergency department early.

Tracheo–innominate artery fistula (TIF) is a rare but fatal complication of tracheostomy with an incidence of one out of every 150 tracheostomies, which almost always results in death without immediate surgical intervention. In such cases forensic pathologist may be called for an autopsy to determine cause of death and any probable medical or surgical negligence. So their familiarity with this complication of tracheostomy is necessary. Case report: In this article we present three fatalities due to hemorrhage from the tracheostomy site, which were referred to Mashad Legal Medicine Center two for autopsy and one for determining any probable medical negligence. A clinical review article is followed. pressure necrosis from high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, radiotherapy, prolonged intubation, excessive head and neck movements, and innominate artery anomalies are all implicated in TIF formation. Massive hemorrhage occurring 3 days to 6 weeks after tracheostomy is a result of TIF until proven otherwise. When this happens, one must tampon the bleeding vessel by overinflating tracheostomy tube cuff or by digital compression of vessel against sternum via tracheostomy stoma, while transferring the patient to the operating room. The mainstay of surgical treatment is to terminate flow within the innominate artery by debriding and transecting it. As a result of their small size, post-mortem diagnosis of TIF can be difficult until specifically searched for by forensic pathologist.

The right of living is known as vested rights for human being. While these rights are denied without raw justification, the appropriate action must be considered for the discovery of crime and conviction of the doer or doers of homicide. One of the ways of crime discovery is the exact functions of legal medicines. This essay, in addition to significance of autopsy, will discuss the ideas, methods and its effects in. Justice performance and responsibility of legal medicines. Autopsy has a great importance in criminal procedure and recognition of reality with legal medicines that helps judge to find the truth of subject. this process is the subjects of argument for medicines in this essay and shows ambiguous approach of the law sometimes legislative authority emphasize on independence of the judge and in some instances emphasize on importance of proficiency and knowledge, that ambiguity act without attendance to fulfill of duty that related to those preferences also create any problems in judicial authorities and legal medicines. The historic process of autopsy must be surveyed in criminal law and criminal procedure of Islamic of Iran and also it is appropriates to kind of judges supervision and role of the legal medicines in different frames, skillful, expert, or proficient. Whereas rules of Islamic of Iran has religious era that rooted in percept of Islam religion based on constitution. The ideas of Islamic Jurisprudents has shown and plan about autopsy which nevertheless first interdict of. jurisprudents about anatomy in some cases his function is known lawful by regard to conditions of this terms. In some cases find out the truth autopsy has been a great importance. It is essential for the performance of justice. This matter needs judicial justification but physician will be free to choose the kind of anatomy's function and diagnostic acts.