مجله پزشکی قانونی
سال بیست و پنجم شماره 1 (پیاپی 89، بهار 1398)

Production and distribution of herbal drugs by herb sellers are increased for addiction treatment in recent years. The aim of this study was to investigate the medicine components of herbal drugs for addiction treatment, collected from the herb shops of Zanjan city.

This experimental study was performed in legal medicine laboratory of Zanjan city in 2014. Samples (N=143) collected from the herb shops (N=20) of Zanjan city and their components detected by GC/MS and HPLC instrument. Data were analyzed through SPSS 19 software.

31 samples (21.7%) of 143 samples didn’t have any medicine components and 112 samples (78.3%) had at least one medicine component. The most abundant medicine components were tramadol (69.9%) and diphenoxylate (31.5%), and atropine (31.5%). Investigating of the number of medicine components in one drug type revealed that 51 samples (35.7%) had one component, 23 samples (16.1%) had two components, 36 samples (25.2%) had three components and 2 samples (1.4%) had four components, simultaneously.

In most samples collected from herb shops, one or two medicine components of opium exists that the most abundant of them is tramadol, diphenoxylate, and atropine.

Lead is one of the heavy metals that can be a factor of acute or chronic toxicity. Smugglers may add lead to drugs during the production process in order to increase its weight and earning more benefits. In this regard, the aim of the present study was to investigate the relationship between blood lead levels in consumers of edible opium with abdominal pain.

This cross-sectional descriptive study was carried out on 122 consumers of edible opium with abdominal pain who referred to the emergency department of the Rasoul Akram, Firoozgar, Haft-e-Tir and Baharlu hospitals in 2016. The subjects were entered in the study by the counting-all method. Demographic information, health condition, and lifestyle of the patients were collected using a questionnaire as well as the blood lead level and blood factors of the subjects were measured. Data were analyzed through SPSS 22 software using independent t-test and Chi-squared test.

The mean of blood lead levels in patients with abdominal pain was 87.49±32.27μg/. The lead level showed the mild, moderate and acute poisoning respectively in the 29.5%, 39.3% and 27.9% of the patients.

The blood lead level in the consumers of edible opium with abdominal pain is above 25μg/dL which showed the toxicity. Therefore, there is a strong potential for lead poisoning in consumers of edible opium.

Today with increasing the number of surgeries and their variety, malpractice complaints against are increased. The aim of this study was to recognize the causes and effective factors in injuries lead to the anesthesia malpractice.

This cross-sectional descriptive-analytical study was carried out on the files of malpractice complains against the anesthesia care team in the Isfahan Legal Medical Center in 2009-2015. The subjects were analyzed through descriptive statistic using SPSS 23 software.

60 files related to the anesthesia field were investigated which in 28 files (46.7%) malpractice of anesthesia care team were confirmed and in all records, the anesthesiologist was the culprit.
Anesthesia method in 73.3% of cases was general anesthesia and most of the surgical procedures (86.7%) were elective surgeries. In 38 cases, the result was the death of the patients and autopsy were performed in 29 cases (76.2%). The mechanism of injury in 29 cases (48.3%) was respiratory system disorders.

Depending on the specific conditions in the operating rooms, visits of patients by before surgery, performing required tests and advice, perception in determining the anesthesia in elective surgery, pay attention to the patient's respiratory system function during surgery, anesthesia and in recovery status very necessary to reduce the anesthesia errors. As well as it is necessary to have an autopsy of the corpse in the case of a patient's death or impairment in order to identify the culprit easily.

Considering that ERCP is one of the most difficult and high risk activity fields of gastroenterologists, it is expected that a great percentage of complaints exist in this area. Therefore, the aim of this study was to investigate the ERCP-related medical complaints referred to the forensic medicine department of Tehran over six years (2011-2016).

This study was conducted by descriptive-analytical and retrospective method. First, the statistics of the recorded complaints in the forensic medicine department of Tehran province against gastroenterology subspecialist or subspecialist assistants were extracted over six years (2011-2016). Then, the ERCP-related complaint cases, that their investigation was completed were selected.

The ERCP-related complaints over the years of 2011-2016 included 35 cases, which 21 patients (60.0%) were males and 14 patients (40.0%) were females. In the 34 cases (97.1%) ERCP had accurate and scientific indication and only one case did not have an indication. In 26 (74.2%) cases after ERCP, proper diagnosis and treatment were performed. According to the primary commission, medical malpractice had been recognized in 10 cases (28.6%), and 25 cases (71.4%) had led to the acquittal of the doctor.

The selection of the patients based on the correct indication for ERCP operation and examination the patients after operation of the procedure in order to diagnose the probable side effects and its proper treatment have a significant role in reducing the number of complaints.

Reports of criminal cases in injuries reveal a great deal of ambiguity of the judicial experts and forensic medicine concerning the injury of Jaefe. This is due to the definition of Jaefe in the Law. The place of Jaefe in body, the tools of Jaefe Injuries, and the degree of penetration of tool in the place are the factors that should be explained to discover the nature of Jaefe. Articles 711 and 712 deal with Jaefe, but they are the cause of ambiguities. In article 711, the place of Jaefe is limited to stomach, chest, back, and sides while throat and pharynx have been added in article 712, without any specific criteria. In article 711, anything can be considered as a tool of Jaefe injuries while in article 712 Jaefe injuries only can be realized through a spear or bullet or things like them. The degree of tool penetration has been neglected wholly. The aim of the present study was to investigate the nature of Jaefe in the field of Feqh and criminal law through descriptive-analytic method.

The place of Jaefe is limited to the abdominal cavity, pelvic cavity and the chest. The tool of Jaefe has particular features. The valid penetration degree of a tool is merely the entering of the tool of injury in the place of Jaefe.

Virtopsy is a modern technology that identifies the cause of death through radiology without dissection. In addition to reducing the detection time, this technology also has high diagnostic sensitivity in some cases. One of the aims of criminal law science is accurate and rapid criminology. The aim of this study was to investigate the application of virtopsy method in crime detection and its comparison with the autopsy method.

In this analytical review study, after investigating and analyzing the relationship between criminology and virtopsy, the numbers of 18 English articles were investigated for comparing the virtopsy and autopsy dissection in the period of 2010-2016.

Virtopsy method as a supplement for autopsy method could detect the infanticide from stillbirth, choking by drowning from the other types of asphyxia and injuring by bullet hit and its details and it could recognize the cause of death through careful analyzing the organs, such as the face and jaw skeletons, ribs and brain.

Criminology legal aims are realized using the virtopsy method as a supplement for autopsy method.

In the present era, it is possible to maintain vital organs considering the major advances in medical science. Saving the lives of patients and resuscitation their life is possible through medical science and instruments. Although the use of medical instruments is beneficial in most cases and have satisfactory results, but in some cases, severe disorders are observed in function of vital organs because of  aging, systemic disease, and the other similar factors so that the medical science is unable to treatment the diseases and no action can be taken to maintain patient's life. This topic has led to discussions about “do not resuscitation” order in the face of these patients. Although philosophical and moral discussions have been raised in this regard it can also be investigated in terms of the legal perspective. The aim of the present study was to analysis of “do not resuscitation” order in patients without established life based on article 372 of the Islamic penal code.

It is possible to criminalization of the medical staff in terms of their nonintervention in the resuscitation of dying patients using the opposite concept of article 372 of the Islamic penal code.

Neck arteries dissection (carotid and vertebral) is known as one of the causes of stroke which often occurs after a neck trauma. This study was a case report of a vertebral artery dissection in a young woman following a neck manipulation in order to treat a headache by a local therapist.

The patient was a 27 years old woman with migraine headaches who referred to the emergency department with decreased consciousness. The results of metabolic and infectious examinations were negative, therefore brain imaging of the patient was considered.  Initial CT scan had no particular finding. Therefore, MRI was performed which indicated acute infarction in the pons and cerebellum. MR angiography was performed to examine the vascular system of the brain which determined the left vertebral artery occlusion. CT angiography recognized vertebral artery dissection as the cause of vascular occlusion. Detailed examination of the patient's condition revealed that the patient experienced the neck manipulation by a local therapist before referral to the hospital.

Neck arteries dissection as one of the causes of neurologic deficit and decrease the level of consciousness should be considered in patients with minor or severe trauma. After this diagnosis, the existence of trauma in the patient examination should be considered. Trauma may have a legal significance.