فهرست مطالب behnam behnoush

Remdesivir (RDV) is one of the drugs that showed beneficial effects in treating Coronavirus disease in 2019 (COVID-19). We performed the present study to evaluate the safety of Remdesivir administration in the outpatient setting. In this study, 512 patients with COVID-19 participated. When selected patients came to the hospital for the drug injection on the appointed day, the vital signs and the percentage of oxygen saturation were measured before Remdesivir administration. During and after the injection, if any drug side effects occurred, it was recorded. Laboratory tests, including Complete blood count differential, C-reactive protein, Liver function tests, Blood urea nitrogen, and creatinine, were checked before and between the treatment courses. The mean age of participants was 46.19±14.20 years, and 46.9% were men. 97.4 percent of patients did not experience any side effects following Remdesivir administration. The amounts of laboratory components like White blood cells, Platelet, Alanine aminotransferase, and Blood urea nitrogen were significantly increased. In contrast, Hemoglobin, C-reactive protein, Aspartate aminotransferase, Alkaline phosphatase, and Creatinine levels were significantly decreased following the administration of Remdesivir compared to baseline values.

Investigation the causes of medical complaints and efforts to reduce it still further step towards the satisfaction of patients and medical staff. The aim of this study was to determine the causes and motivations of the complaint, the amount and type of malpractice done on the field of surgery and at the end provide solutions to reduce medical malpractice.

This study was a prospective cross-sectional study. The complaint cases in surgery field which referred to the Legal Medicine Organization Commission over a period of 5 years from the beginning of 2017 to 2022 were evaluated. Sampling method was census. Refer to the archives office of the Commissioner of Legal Medicine Organization of Tehran, Records and information relevant to the complaint was gathered and extracted. The data collected were entered into SPSS software version 16 and analyzed using descriptive and analytical statistical tests.

In the study period, 406 cases were included into the study, which 215 cases (53.0%) were male. Mean age of patients was 43.5± 17.08 year. Mean age of physicians was 52.73± 10.17 year. 90.9% of physicians were male and most of them were non-academic staff (64.0%).  In 365 cases (9/89%), cause of complaint was acting on the surgical procedure. In 284 cases (70%) cases of complaints made about a non-emergency procedure performed on patients. The most common complaints were generated in deceased patients (28/3%). Medical malpractice confirmed in 164 cases (40.4%). Most of the designated malpractice was negligence with 80 cases (19.7% of all cases and 48.8% of malpractice cases), respectively. Average percentage of negligence assigned to physicians was 20.73±20.34% with a median of 10 percent. There was not significant correlation between the percentages of negligence or malpractice with age, sex, measures taken, the experience and expertise of the physician (p> 0.05). Malpractice rate was significantly higher in non-emergency cases versus emergency (43.3 vs 33.6%) (p= 0.04). However, there was no significant correlation between the percentage of negligence and malpractice with urgency of act and site of medical service (p>0.05). Agreement rate between result of first commission and medical malpractice was 0.84.There was no significant relationship between education level, occupation and age of patients with their re complaining. But sex was significantly associated with the original protest vote (51.8% in women versus 42.3% for men) (p=0.04).

Our results show high frequency of negligence assignment in surgeons. In addition perform appropriate educational training in the field of patient selection, good communication with patients can be more effective in reducing the burden of patient’s complaints against this group and play important role in malpractice judgments issued against them.

Accidental or intentional poisoning with Aluminum phosphide (AlP) is associated with severe complications such as metabolic acidosis, cardiac failure, and death. Previous animal experiments demonstrated that fresh-packed RBC is protective in an experimental model of AlP poisoning. The aim of this study was to assess the effect of fresh-packed RBC on survival in patients admitted to a referral hospital due to AlP poisoning in a randomized clinical trial. Eighty-two patients were admitted to Clinical Toxicology Unit at Baharloo Hospital due to acute AlP poisoning after approval by the Iranian Registry of Clinical Trials (registration reference: IRCT20180428039443N1). All patients received standard treatment, and forty-one of them received fresh-packed RBC. There was no significant difference between groups in the underlying characteristics, including vital signs and laboratory investigations. But interestingly, the mortality rate was meaningfully decreased (difference: 31.7%, 95% CI: 0.10-0.52) in patients receiving fresh-packed RBC (10 deaths/31 survived; 24.4% mortality) in comparison to standard treatment patients (23 deaths/18 survived; 56.1% mortality). Furthermore, fresh-packed RBC substantially improved the GCS, systolic/diastolic blood pressure, ST changes, and pH 12- and- 24 hours after admission. This study showed that fresh-packed RBC infusion alongside standard supportive treatment leads to a decrease in mortality rate; also, it provided evidence for a protective role of fresh-packed RBC in the management of patients with acute AlP poisoning.

Mortality among children under 5 years is an important health indicator. Therefore, determining the most common causes and manners of death according to the postmortem data is necessary for designing intervention programs to reduce mortality.

This study aimed to evaluate the causes and manners of death in children aged under 5 years old in Tehran, Iran using autopsy findings.

This descriptive cross-sectional study was conducted on the data of all deaths among children aged under 5 years who were referred to the Legal Medicine Organization of Tehran, Iran, during January 2009-December 2019. The data were collected using the checklists of demographic characteristics, autopsy, toxicological findings, pathological findings, hospital records, and judicial documents, which were then analyzed.

Among 1750 children aged under 5 years old included in this study, 898 (51.3%) cases were male, and 997 (56.9%) were hospitalized. Most of the mortality cases occurred about two months after birth. The most common causes of death were found as congenital cardiovascular anomalies (14.7%), pneumonia (11.7%), and preterm labor (11%). Moreover, natural death (77.7%), accidental death (17.7%), homicide (2.7%), and unknown death (2%) were the major manners of death in these children.

Postmortem examination to determine the causes of unnatural death could help clinicians and policymakers to propose a suitable intervention for reducing the mortality rate in children under 5 years.

 The Coronavirus Disease 2019 (COVID-19) pandemic promptly became a significant public health challenge with extra-pulmonary manifestations, including liver damage. Postmortem examination is crucial for gaining a better understanding of these manifestations and improving patient management. This study summarized the current knowledge of the postmortem liver pathology of patients with COVID-19.

 This review was conducted on studies evaluating the postmortem macroscopic and microscopic findings of the liver in patients with COVID-19. Accordingly, we searched 4 electronic databases (PubMed, Scopus, Google Scholar, & Web of Science) until June 2021. From the 317 screened articles, 16 articles examining a total of 332 patients who had died due to COVID-19 were selected.

 The significant findings of the liver were moderate macro and microvesicular steatosis with mild sinusoidal dilation, active lobular and portal vein thrombosis, mildly-increased lymphocyte filtration in sinusoidal space, and multifocal hepatic necrosis. Additionally, the most common comorbidities were hypertension and other metabolic diseases. In conclusion, liver damage due to COVID-19 infection has various manifestations in patients who have expired due to COVID-19.

 Therefore, monitoring liver function during the course and treatment of this disease is necessary for better patient management and to decrease the COVID-19-induced mortality rate COVID.

Today, despite the efforts of the medical community and health staff, the rate of dissatisfaction and complaints among patients is increasing and this highlights the importance of evaluating its related factors. The aim of this study was to analytically investigate complaints against ophthalmologists which were referred to the Legal Medicine Organization of Iran in Tehran during 2017-2019.

In this cross-sectional (analytical-descriptive) study, the demographic data of patients and physicians including age, gender, marital status and academic degree, type of treatment measures leading to complaints, last decision of the medical commission, characteristics of protesting of patients and vote of revision commissions for all the complaints of ophthalmology were recorded and analyzed.

During 3 years, 176 complaints were recorded in the field of ophthalmology. Of these, 90(51.1%) complaints were from medical interventions which took place in university or government hospitals and clinics. Also, 27(15.3%) cases of malpractice were reported, among which negligent was the most common type, with 22 cases (81.5%). The highest number of complaints was for cataract surgery and the most frequent treatments with malpractice of the physicians were cornea transplantation. Although the most protests to the first decision were from the patients, the effectiveness of physicians’ protest was significantly higher (P<0.001).

Nowadays, with advances in treatment methods and technologies in ophthalmology and enhancement in the knowledge of patients about their rights, their expectations from medical staff have changed. The findings of the present study suggest that due to the rise in the number of complaints in ophthalmological treatment while a decrease in malpractice rate, applying intervention actions such as good communication between physicians and patients and patient’s right perception of treatment and possible side effects can lead to less number of complaints. In addition, due to different opinions in consecutive commissions, utilizing a single approach based on new information and evidence seems necessary.

Seizure is a common complication of tramadol poisoning and predicting it will help clinicians in preventing seizure and better management of patients. This study aimed to develop and validate a prediction model to assess the risk of seizure in acute tramadol poisoning.

This retrospective observational study was conducted on 909 patients with acute tramadol poisoning in Baharloo Hospital, Tehran, Iran, (2015-2019). Several available demographic, clinical, and para-clinical characteristics were considered as potential predictors of seizure and extracted from clinical records. The data were split into derivation and validation sets (70/30 split) via random sampling. Derivation set was used to develop a multivariable logistic regression model. The model was tested on the validation set and its performance was assessed with receiver operating characteristic (ROC) curve.

The mean (standard deviation (SD)) of patients’ age was 23.75 (7.47) years and 683 (75.1%) of them were male. Seizures occurred in 541 (60%) patients. Univariate analysis indicated that sex, pulse rate (PR), arterial blood Carbone dioxide pressure (PCO2), Glasgow Coma Scale (GCS), blood bicarbonate level, pH, and serum sodium level could predict the chance of seizure in acute tramadol poisoning. The final model in derivation set consisted of sex, PR, GCS, pH, and blood bicarbonate level. The model showed good accuracy on the validation set with an area under the ROC curve of 0.77 (95% CI: 0.67–0.87).

Representation of this model as a decision tree could help clinicians to identify high-risk patients with tramadol poisoning- induced seizure and in decision-making at triage of emergency departments in hospitals.

Acute poisoning is nowadays a common medical emergency. The important point about admitting patients with acute poisoning is its timely and early diagnosis. However, the rate of consistency between clinical diagnosis and autopsy of patients with acute lethal poisoning has not been investigated broadly. The goal of this study was to compare the clinical symptoms of poisoned deceased patients through autopsy and toxicology at Tehran’s Medico-Legal Organization. A cross-sectional study was conducted on all the admitted poisoning cases at Baharloo Hospital in 2014 to 2015 who passed away and were referred to Kahrizak Autopsy Hall. Through investigating the medical records of the Hospital and Autopsy Hall, the researcher examined and compared the existent files. The collected data were entered into SPSS 16. Data were analyzed using Cohen’s kappa coefficient. In all, 98 people who had died from acute poisoning were investigated. The most common causes of poisoning were drugs (49%), followed by pesticides (39%). The least common cause of poisoning was alcohol (1%). The most common poisonous drugs were opioids. The most common causes of death based on hospital records and autopsy results were rice tablets and high-dose opioid poisoning. Using Cohen’s kappa coefficient, the rate of agreement between the causes of death in hospital records and autopsy results was estimated at 0.744. Bearing in mind the consistency of clinical diagnosis with postmortem autopsy results, we may begin life-saving management of patients of acute poisoning in the shortest possible time.

Given the fact that various studies have reported the positive effects of hydroxyethyl starch therapy in controlling shock, this study aimed to compare the effects of hydroxyethyl starch on modifying acidosis and treating patients with aluminum phosphide poisoning.
This was a randomized clinical trial that was conducted on 60 patients with aluminum phosphide poisoning. We compared the two groups of patients treated with hydroxyethyl starch and normal saline. Base excess and serum pH of arterial blood gases (ABG) were measured before and after the treatment and compared by t-test.
Results showed that arterial pH in the starch group and normal saline group increased by 0.13 and 0.18, respectively, and the difference between the two groups was not statistically significant. The difference in the base excess before and after treatment in the starch group and normal saline group was 6.41 and 5.39, respectively, and the difference between the two groups was not statistically significant. Changes in mean values of arterial pH after the intervention in comparison with before treatment were statistically significant (p<0.05).
Overall, the results of the present study show that starch is at least as effective as normal saline in treating acidosis in patients poisoned with aluminum phosphide and can be used instead of normal saline, and both of the two treatments could be equally effective.

Morphometric measurements are important for identification in forensic medicine. Gender is one of the important components of identity. Many studies have reported that hyoid bone can be used for sex estimation but this claim must be verified in different populations. We evaluated 372 hyoid bones of 15 to 87 years old Iranian people who had a valid identity certification. Nine anthropometric indices of hyoid bone were measured and investigated in this regard. Computerized tomography scan was done after fixation of dissected tissue in formalin. Logistic regression analysis was performed. The cut-off point (ROC) and discriminative formula were determined. In this study, hyoid bones of Iranian bodies were studied, of which 217 were male and 155 were female cases. The length of the hyoid body, great left horn length, angle between right great horn and left great horn with body of hyoid are associated with sex determination. Hyoid bone in male is generally larger than in females. The result indicate that the hyoid bone morphometry with a high degree of accuracy can determine the sex. Discriminant formula was determined for hyoid bone.

Timely and correct diagnosis of poisoning is an important part of the management of poisoned patients. This study aimed to investigate the abnormal findings of brain CT scans of patients with drug overdose poisoning.
A retrospective cross-sectional study was conducted on patients with poisoning admitted to Baharloo Hospital, Tehran, Iran during 2015. Moreover, they underwent radiological assessment as a result of their decreased level of consciousness. For the purpose of the study, we examined patients’ Computerized Tomography (CT) scan reports. The collected data were analyzed with SPSS 16. Frequency and percentage frequency were calculated for qualitative variables, and mean and standard deviation were calculated for the quantitative variables.
Overall, 191 patients admitted with poisoning were evaluated. Of them, 119(62.3%) had normal brain CT scans and the remaining had pathologic findings. The most common pathologic findings in the brain CT scans comprised cerebral edema (24.6%) followed by infarction (5.2%). The least common pathologic finding was cerebral herniation (0.5%). This pattern was similar in both genders and in different subtypes of poisonings, with the exception of poisoning with cardio-respiratory drugs. The most common finding in the latter type of poisoning was herniation. In cases of simultaneous head trauma, the most common pathological brain CT scan findings were cerebral edema and hemorrhage.
The radiological assessment of the brain following poisoning and decreased level of consciousness can help in the diagnostic evaluation of patients. It can be a life-saving measure, through timely detection of the type of poisoning and brain damage.

Suicide is a complicated phenomenon which is influenced by the interaction of psychological and environmental factors. The aim of this study was to investigate rate of depression disorders in suicide attempters with drug or toxins in the Baharloo hospital, Tehran, Iran, duration 1394.
In this cross-sectional descriptive study, Beck Depression standardized questionnaire and demographic/socioeconomic information form was given to 248 suicide cases with drug or toxins to fill completely. For analyzing the data, Chi- Square and Multiple logistic regression tests were executed by spss19.
In this study, from 248 cases hospitalized due to suicide attempt with drugs or toxins, 87.2% diagnosed with depressive disorders. In chi2 analysis there was significant association between depression disorders and these variables “married status (p=0.001), housewife (p=0.002), family monthly income below 10000000 Rials[1] (p=0.005), substance use (p=0.001), psychiatric disorders history (p=0.001)”. In full model multiple logistic regression analysis (total variables entered in model) we found significant association between depressive disorders and " gender, woman (p=0.03, OR=6.2, 95%CI= 1.33-3.44), aged 25-15 years (p=0.002, OR=22.7, 95%CI= 3.16-154.9), married status (p=0.007, OR=10.2, 95%CI= 1.87-55.5), worker or self-employment (p=0.02, OR=15.66, 95%CI= 1.41-172.25), (p=0.02, OR=14.97, 95%CI= 1.32-162.5) and family monthly income below ten million Rails (p Future planning should focus on premature diagnosis of psychiatric disorders particular depression disorders because of first cause of suicide. This aim will be achieved through continuous consulting and following vulnerable cases.

Universal goniometer (UG) is commonly used as a standard method to evaluate range of motion (ROM) as part of joint motions. It has some restrictions, such as involvement of both hands of the physician, leads to instability of hands and error. Nowadays smartphones usage has been increasing due to its easy application..
The study was designed to compare the smartphone inclinometer-based app and UG in evaluation of ROM of elbow.
The maximum ROM of elbow in position of flexion and pronation and supination of forearm were examined in 60 healthy volunteers with UG and smartphone. Data were analyzed using SPSS (ver. 16) software and appropriate statistical tests were applied, such as paired t-test, ICC and Bland Altman curves.
The results of this study showed high reliability and validity of smartphone in regarding UG with ICC > 0.95. The highest reliability for both methods was in elbow supination and the lowest was in the elbow flexion (0.84).
Smartphones due to ease of access and usage for the physician and the patient, may be good alternatives for UG.

In this study we sought to investigate clinical findings (with a focus on neurologic effects) and also to analyze outcomes of a series of patients with methanol poisoning admitted to two poisoning treatment centers in Tehran, Iran. In this prospective cross-sectional study, methanol-poisoned patients admitted to departments of forensic medicine and toxicology of Loghman Hakim and Baharloo hospitals in Tehran during October 2010 to October 2011 were included; and their data were recorded in predesigned checklists. Twenty-eight methanol poisoned patients (82.1% men) with mean age of 29.3±4.6 years were studied. Most patients (67.9%) had metabolic acidosis at presentation. On admission, all patients had different degrees of decrease in consciousness, who the majority of them (57.1%) were admitted with mildly reduced consciousness (grade I of Grady coma scale). Headache and vertigo were observed in 7.1% and 17.9% of patients, respectively. Most patients (53.6%) had no ocular effects, while 46.6% of patients developed impaired vision. All patients received sodium bicarbonate. Ethanol as antidote and folic acid were given to 18 patients (64.2%) and 16 patients (57.1%), respectively. Six patients (21.4%) underwent hemodialysis. Over half of the patients (53.6%) fully recovered and were discharged without complications. Four patients (14.3%) developed total blindness. Four patients (14.3%) left the hospital against medical advice by self-discharge (they had no significant complication at the time of discharge). Five patients (17.9%) died; who compared to survived cases had significantly lower blood pH (P=0.028), higher coma grade (P<0.001) and more delayed presentation to hospital (P=0.004). Age had no significant impact on mortality. Methanol poisoning causes major neurologic effects such as coma and blindness. It is also responsible for high mortality.

“Shock” is one of the most important and frequently life threatening complications of chemical and drug toxicities. The aim of this study was to explore occurrences of shock induced by poisoning and their relation to toxic agents and outcome of patients in Baharloo Hospital, Tehran. in a cross-sectional study from June 2011 to June 2012 patients admitted as poisoning were assessed at Baharloo Hospital. Some 196 patients who had a systolic blood pressure less than 80 mmHg despite infusion of 2-3 liter of normal saline within 30 minutes were included in this study. Of these, 112 (57.1%) were male and 84 (42.9%) female. Collected data was analyzed using SPSS v. 19. The poisioning induced shock complication was more frequently occurred within 21-40 years range of age that included 57.1% of the patients. Aluminum phosphide poisoning was the most frequent cause of shock as well as death, with a frequency rate of 37.7% and 82.4% respectively. Totally and despite intensive care, 80 patients (40.8%) died in which 64 cases (32.6%) was because of refractory shock. In fact, all deaths in the context of tricyclic anti-depressants, calcium channel blockers and α2 agonists as well as 90.2% of deaths in aluminum phosphide poisoning, were related to refractory shock. This study showed that the poisoning induced shock was related with poor prognosis. As there are specific treatment strategies for combat shock in particular toxicities, it is necessary for doctors to learn more about them, and in the case of such situations effectively control the complication.

To date، studies on methadone overdose in adults have not been ‎reported in Iran. Hence، this study was performed to determine the frequency of ‎methadone overdose and its associated complications in Baharloo Hospital of Tehran ‎between August 2011 and August 2012. This cross-sectional study was done on 390 cases. All patients with ‎methadone overdoses and positive urine screen test for methadone were included in this ‎case study through census method. Demographic data and overdose complications، ‎such as loss of consciousness، respiratory complications، arrhythmia، hemodynamic ‎disturbances، and QTC interval، were recorded in the questionnaire. Data were analyzed ‎by SPSS software and Kolmogorov Smirnov، t-test، and Chi-square tests were used for ‎data analysis. ‎ Overall، 84. 1% of the samples were male and the mean age of the samples ‎was 35. 53±11. 25 years (range: 15-84 years). Mean of the methadone dose used in ‎current admissions was 96. 13±52. 34 mg. Concomitant drug abuse and concomitant ‎uses of medications were seen in 25. 9% and 36. 9% of the patients، respectively. ‎Respiratory depression، pulmonary edema، pneumonia، aspiration، and arrhythmia were ‎seen in 87. 9%، 26. 2%، 3. 3%، 7. 4%، and 15. 4% of the patients، respectively. There were significant differences between concomitant medications، duration of ‎methadone use، and QTc interval prolongation and arrhythmia (P<0. 05). Based on the findings of the present study، initial screening of ECG ‎changes and QT interval prolongation as well as arrhythmias should be considered in ‎patients on methadone therapy and concurrent drug abuse and co-administration of ‎medications that lead to QT prolongation should be avoided in them. ‎

Seizure is a frequent and important finding in the field of clinical toxicology. Almost all poisons and drugs can produce seizure. We have evaluated frequency and complications of drug-induced seizure in present study. The present descriptive cross-sectional study was done on patients who were referred to Baharloo Hospital, Tehran, Iran, that had developed seizure before or after hospitalization following intoxication between 20 March 2010 and 20 March 2011. The exclusion criteria were a positive history of epilepsy, head trauma, or abnormal findings in EEG or brain CT scan. Tramadol and tricyclic antidepressants were the most common causes of drug-induced seizure (31.5% and 14.7% of the cases, respectively). Overall, 6 patients (4.2%) had developed persistent vegetative state in consequence of brain hypoxia, 16 patients (11.2%) had died due to complications of seizure or the poisoning itself. Tramadol was the leading cause of drug-induced seizure and its morbidity and mortality. Tonic-colonic seizure was the most common type of drug-induced seizure. Seizure had occurred once in 58% of the patients, twice in 37.1% of the patients, and had been revolutionized to status epilepticus in 4.9% of them. Among the 7 patients who had developed status epilepticus, 3 cases had died. Appropriate measures for treatment of seizure and prevention of its complications should be taken when patients with drug poisoning are admitted into hospital, especially when the offending drug(s) has a higher likelihood to induce seizure.

Aluminum phosphide as a fumigant is extensively used for wheat preservation from rodents and bugs especially in silos worldwide. There is increasing number of acute intoxication with this potentially lethal compound because of its easy availability. We have tried to locate predictors of poor prognosis in patients with aluminum phosphide intoxication in order to find patients who need more strict medical cares. All cases of aluminum phosphide intoxication that had been referred to our hospital during April 2008 to March 2010 were studied by their medical dossiers. Pertinent data including vital signs, demographic features, clinical and lab findings, and incidence of any complication were collected and analyzed by the relevant statistical methods. Sixty seven cases of aluminum phosphide intoxication were included in the study. 44.8% of them were male. 97% of cases were suicidal. Mean amount of ingestion was 1.23+/- 0.71 tablets. Mortality rate was 41.8%. ECG abnormality and need for mechanical ventilation had negative relation with outcome. Correlation between some findings and complications with outcome in aluminum phosphide intoxication can be used as guidance for risk assessment and treatment planning in the patients.

The aim of this study was to evaluate the efficacy of arterial blood gases (ABGs) in determining the type of intoxication. Medical charts of all patients who had referred to the toxicology ward of Baharloo Hospital between January 2009 and December 2009 were evaluated. After excluding the patients with multi-drug toxicity, data, including age, sex, type of intoxication (the medication ingested), ABG options, including pH, pco2, Hco3, and the type of acid-base disturbance were collected and recorded in a self-made questionnaire. Data were analyzed using SPSS version 11. Of the 1570 cases evaluated, 807(51.4%) were male and 763(48.6%) were female. Most of the patients were 20 to 29 years old (554 patients; 35.3%). Arterial blood gases were normal in 578 (36.8%) patients. Metabolic acidosis, respiratory acidosis, respiratory alkalosis, mixed acidosis, and mixed alkalosis were detected in 434(27.6%), 292(18.6%), 177(11.3%), 60 (3.8%), and 29(1.8%) patients, respectively. Pure metabolic alkalosis was not detected in any of the patients. The toxins were classified into 18 groups with opium/opioids, acetaminophen/NSAIDS, and antidepressants and anticonvulsants being the most common toxicities. Although metabolic acidosis may not be helpful in diagnosis of the type of intoxication, respiratory and mixed acidosis as well as mixed alkalosis may indicate special types of intoxication. This may help faster diagnosis and reduce the mortality and morbidity of the patients.

Blood alcohol concentration is a major factor in forensic analysis in criminal and civil litigation. Along with ethanol, other volatile compounds such as n-propanol are produced as products of putrefaction. The aim of this study is the evaluation of ethanol and n-propanol in postmortem blood. A case-control study was done on 300 blood samples obtained from cadavers that were referred to Legal Medicine Organization (LMO) of Tehran, Iran, over a year (2009-2010). Blood ethanol and n-propanol concentrations were analyzed in duplicate by HSGC. Data on cadavers were taken from the information sheets and were analyzed by SPSS software. In this study, mean n-propanol level in blood was 8.311 mg/dl in putrefied and 1.58 mg/dl in non-putrefied victims. Interval times between death and autopsy in putrefied and non-putrefied victims were 3.5 and 1.25 days. Results show that n-propanol concentrations increase 1.23 mg/dl/day after death. In 99% of putrefied victims, ethanol level was more than 10 mg/dl. There was a high correlation between ethanol and n-propanol concentrations. By increasing 1mg/dl of n-propanol concentration, ethanol levels increased 2.5 and 1.4 mg/dl in putrefied and non-putrefied victims, respectively. N-propanol produced in putrefied victims with ethanol. Production of ethanol increased by rising n-propanol levels. Therefore, we might use n-propanol as a putrefaction factor in postmortem blood to distinguish endogenous and exogenous ethanol production.

Sulfur mustard gas is one of the chemical warfare gases that roughly about 45000 soldiers continue to suffer long-lasting consequences of exposure during the Iran-Iraq war between 1980 and 1988. According to the common pulmonary lesions due to this gas exposure, we studied gross and microscopic pulmonary lesions in cadavers and also assessed the main causes of mortality caused by mustard gas exposure. A case-series study was performed on hospital record files of 100 cadavers that were exposed with documented sulfur mustard gas during the Iran-Iraq war from 1979 to 1988 and autopsied in legal medicine organization In Tehran between 2005 and 2007 and gross and microscopic pathological findings of autopsied organs such as hematological, pulmonary, hepatic, and renal changes were evaluated. All cases were male with the mean age of 43 years. The time interval between the gas exposure and death was almost 20years. The most frequent pulmonary complication was chronic bronchitis in 81% of autopsied cadavers. Other pulmonary findings were progressive pulmonary fibrosis (9%), pulmonary infections and tuberculosis (29%), malignant cellular infiltration (4%), and aspergilloma (1%). According to the chronic progressive lesions caused by mustard gas exposure such as pulmonary lesions and also its high mortality rate, suitable programming for protection of the gas exposed persons and prohibiting chemical warfare are recommended.

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.

This is a case of a patient with bowel obstruction, imaging studies were suggestive for pneumatosis intestinalis. Clinically diagnosed as adhesion band and pnematosis intestinalis. She underwent laparatomy, enterolysis, obstructionolysis and enterorrhaphy. The patient developed respiratory distress and expired after 2 days. At autopsy we found gray-brown discoloration in the wall of some part of small bowel and flattening of mucus membrane. Grossly multiple gas-filled cysts were seen at the serosal surface. Microscopic evaluation of small intestine wall showed multiple cysts located in submucosal and serosal layers.

In Iran before 2003 and approval of therapeutic abortion law in parliament there was severe restriction in abortion permissions and at that time, after presenting "The Guidelines for Therapeutic Abortion" by legal medicine organization of Iran (from now on known as LMO) presented in 2003 and finally, Islamic consultative assembly voted to approve the indications determined by LMO in 2005. In this study all cases referred to the clinical examination department of legal medicine organization in Tehran central region to get therapeutic abortion permission during one year before approval of therapeutic abortion law (first study from June 1999 to the end of May 2000) and after that (second study from early October 2006 to the end of September 2007), who could get this permission were considered accurately. Information needed to perform this study collected via completion of pre-designated forms and analyzed with SPSS software and the results compared in these two groups. In the second study in 85.36% of cases, fetal disorders and in 14.63%, maternal diseases and in the first study just 126 permission were issued, with 17% fetal disorders (major Thalassemia was the only considered case at that time) and 83% maternal indications were the reason to issue permission for abortion. In the second study the major fetal and maternal indications were: anencephaly and cardiovascular problems. The 2nd study shows that in 202 cases (35.19%), abortion permission was issued after confirmation of three specialists (cases which were forecasted in the Predetermined Abortion Indications List). This study shows that in spite of all efforts made so far to present legal approaches for abortion, it is not still time to stop working on the issue and perhaps some other diseases should be added to the mentioned list in future; but this would definitely needs joint cooperation of different authorities, governmental and judicial organization.