مجله پزشکی قانونی
سال سی و یکم شماره 3 (پیاپی 115، پاییز 1404)

Poisoning remains one of the leading causes of unnatural deaths in Iran. Understanding its epidemiological patterns is crucial for effective prevention and public health planning. This study aimed to investigate the epidemiological characteristics of poisoning-related fatalities and identify the types of chemicals, pharmaceuticals, and narcotics detected in bodies referred to the Forensic Medicine Organization of Isfahan Province, Iran, from 2017 to 2023.

A cross-sectional study was conducted using registered data of all poisoning-related deaths referred to the Isfahan Forensic Medicine Center over seven years (March 2017-March 2023). Demographic variables, type of toxic substance, year and location of incident, and occupation of the deceased were extracted using a standardized checklist. Data were analyzed using descriptive statistics in SPSS version 23.

A total of 3,640 poisoning-related deaths were recorded, of which 81.4% were male. Narcotics were the most common cause of fatal poisoning (59.4%), followed by carbon monoxide (11.5%), alcohol (5.0%), and prescription/over-the-counter medications. The highest incidence was observed in the 31-40-year age group, with a peak in 2022-2023. Self-employed individuals and homemakers were the most affected occupational groups. A significant increasing trend in poisoning deaths was noted over the study period, particularly involving narcotics and non-narcotic pharmaceuticals in recent years.

The shifting patterns of toxic substances involved in fatal poisonings, along with the rising annual trend, underscore the urgent need for comprehensive preventive strategies. These should include restricting access to highly toxic substances, strengthening pharmaceutical and illicit drug market surveillance, and enhancing community mental health services, especially for high-risk groups.

Physicians, facing the high-stress environment inherent to the medical profession, are disproportionately susceptible to psychological distress and exposure to aggressive behaviors compared to other occupational groups. Such incidents can adversely impact physician mental well-being, compromise the quality of healthcare delivery, and diminish patient satisfaction. This study sought to determine the prevalence and interrelationships among bullying, aggression, and violence experienced by physicians in public hospitals affiliated with Shiraz University of Medical Sciences.
This descriptive-analytical, cross-sectional study was conducted in 2024. The target population included all physicians working in public hospitals who reported experiencing at least one instance of bullying, aggression, or violence within the preceding year. A total of 158 physicians participated, completing 282 questionnaires overall. Data were gathered using validated instruments measuring workplace violence, organizational bullying, cyberbullying, and aggression, and were analyzed using SPSS version 22.
The findings revealed that 12% of physicians encountered physical violence, 72.15% experienced verbal violence, 13.92% reported sexual violence, and 8.2% faced racial violence. Organizational bullying exhibited a significant positive correlation with both aggression and cyberbullying, and cyberbullying was found to be directly associated with violence. The mean organizational bullying score was 56.91, while the overall mean aggression score was 68.68. Job stress, heavy workload, and inadequate organizational support were identified as significant contributing factors to these behaviors.
Violence, bullying, and aggression among physicians result in extensive individual and organizational repercussions. Essential strategies for mitigating these issues include bolstering organizational support mechanisms, implementing training programs for violence coping strategies, enhancing on-site security measures, and fostering a positive organizational culture.

Various approaches have been proposed for the treatment of posterior cruciate ligament (PCL) avulsion, with some clinicians favoring surgical methods while others consider non-surgical management appropriate. This study aimed to compare the outcomes of both treatment modalities with respect to fragment size.
This descriptive-analytical study included two groups of patients with PCL avulsion who referred to medical centers in Isfahan during 2022–2023. A total of 41 patients were enrolled through a census method, of whom 21 underwent surgical treatment (typically for larger fragments) and 20 received non-surgical treatment (usually for smaller fragments). Patients were followed up at 6 weeks and 3 months. Data were collected using a checklist.
According to the findings, no statistically significant differences were observed between the surgical and non-surgical groups regarding full knee range of motion and pain at both follow-up intervals (P>0.05). The posterior drawer test showed no significant difference between the groups at 6 weeks (P>0.05), but a significant difference was observed at 3 months (P<0.05). In the surgical group, the number of patients with PCL avulsion significantly decreased at 3 months compared to 6 weeks (P<0.05), while no significant change was observed in the non-surgical group (P>0.05). On average, with each 1 cm increase in fragment size, the probability of successful outcome with surgical treatment increased by 27%.
Both surgical and non-surgical treatments significantly improved full knee range of motion and reduced pain within 3 months after treatment, with no significant difference observed between the two groups in these outcomes.

Road traffic fatalities remain one of the leading causes of premature death in Iran. This study aimed to investigate the human, environmental, and temporal factors associated with the severity of fatal crashes occurring on urban roads in Isfahan Province.
A population-based cross-sectional study was conducted using all 1,023 fatal traffic crashes registered by the Isfahan Traffic Police on urban roads between 2018 and 2020. Cases were identified through census sampling. Data were extracted from standardized police report forms and analyzed using chi-square tests and stepwise multivariable logistic regression in SPSS version 27.
The most frequent definitive causes of fatal crashes were driver inattention (n=388, 37.9%), excessive speed (n=219, 21.4%), and failure to observe safety precautions (n=175, 17.1%). Chi-square tests revealed significant associations between high-severity crashes and year of occurrence, day of the week, time of day, age, gender, lighting conditions, type of non-culpable vehicle, and primary crash cause (P<0.05).
The severity of fatal urban crashes in Isfahan Province is primarily driven by the interplay of human factors (especially driver inattention and gender-specific vulnerability), environmental factors (nighttime darkness), and temporal factors (Thursday traffic peaks). Preventive strategies should simultaneously target distraction reduction, enhanced nighttime illumination and enforcement, and implementation of Thursday-specific safety measures to reduce immediate and multiple fatalities.

Hypothyroidism is one of the most common endocrine disorders and may influence the course of viral infections such as COVID-19 by reducing immune function and enhancing inflammatory responses. Previous studies have suggested a potential interaction between hypothyroidism and COVID-19 severity. This study aimed to investigate the association between hypothyroidism and clinical outcomes in hospitalized patients with COVID-19.
This descriptive-analytical cross-sectional study was conducted on 2,461 hospitalized COVID-19 patients at Sina Educational and Medical Center in Tabriz, Iran, from February 2020 to December 2020. Demographic data, thyroid disease status, length of hospital stay, ICU admission, need for mechanical ventilation, and laboratory markers (CRP, LDH, ferritin) were extracted from medical records and analyzed using SPSS software. A significance level of 0.05 was considered.
Ninety-three patients (3.7%) had a history of hypothyroidism. The mortality rate was higher among hypothyroid patients (31.2% vs. 25.3%), but this difference was not statistically significant (P=0.221). Similarly, no significant differences were observed in ICU admission (P=0.089) or need for ventilation (P=0.607). However, hypothyroid patients had a significantly longer hospital stay (P=0.015), and their LDH levels were also significantly higher (P=0.045). There were no significant differences in CRP or ferritin levels. Elevated CRP, LDH, and prolonged hospitalization were significantly associated with increased mortality.
In this study, hypothyroidism was associated only with longer hospital stay and higher LDH levels, while no significant association was found with severe clinical outcomes such as mortality, ICU admission, or the need for mechanical ventilation. Further studies with more rigorous control of potential confounders are warranted to better clarify the possible role of thyroid status in the clinical course of COVID-19.

Today, the forensic medicine organization responds to a part of society's needs in relation to psychiatric expertise and helping the courts for judicial proceedings. Considering the increasing number of referrals to the Psychiatric Commission, knowing about the reason of the initial and repeated expression and checking the possible defects of the documents in the files can help to reduce the density of files and increase the efficiency of the legal system. The purpose of this study is to determine the reasons for referral of psychiatric cases to the Rasht Forensic Medicine Commission in 2022-2023.
  This research was a descriptive-cross-sectional study. The study was conducted on the cases referred to the Rasht Forensic Psychiatry Commission in 2022-2023. Demographic questionnaire and checklist was the Data collection tool. Data were recorded in spss26 software and descriptive statistics were used.
71.1% of the held medical commissions were 3-member commissions, 27.6% were 5-member commissions, and 1.3% were 7-member commissions. The highest percentage of the reasons for the presentation in the 3-person commissions were the "interdiction” and “emancipation”, and the 5- and 7-person commissions were objector. Cognitive disorder with 29% was the most psychiatric diagnosis in the initial commission.
  Most criminal cases and all cases of emancipation and gender transition are referred to the commission. It seems that the greatest reduction in the cases of re-commissioning can be achieved by announcing the exact date of confirmation in the initial commission and specifying the ability to manage the property affairs of the people referred to the commission.

Early identification of students at risk of dropping out is essential for providing timely support, improving retention rates, and promoting academic success. Machine learning offers a powerful approach to analyze patterns in student behavior, allowing universities to predict dropouts and implement preventive interventions.
A hybrid model combining Particle Swarm Optimization and Extreme Gradient Boosting algorithms was developed to classify at-risk students. Additional data analysis techniques were applied to examine the dataset and extract meaningful insights.
The proposed model achieved an accuracy of 98.12%, outperforming alternative models. Academic variables were identified as the most influential factors in dropout decisions. Students who failed to pay tuition on time were at substantially higher risk of dropping out (87.05%) and had a lower probability of graduation (4.95%), compared to those who paid on time, who exhibited a dropout rate of 25.21% and a graduation rate of 55.13%. Dropout rates also increased with age for both genders, although women consistently showed lower dropout rates across all age groups.
Machine learning-based prediction of dropout risk enables institutions to target interventions more effectively, optimizing resource allocation and supporting students in completing their education