International Journal of Medical Toxicology and Forensic Medicine
Volume:3 Issue: 1, Winter 2013

Carbone’s monoxide is a poisoning gas and a pollutant of ambient air. Sandstorm is episodic dust-laden that reinforced CO toxicity levels in the environment. Hospital healthcare professionals are the first line healthy system organization and hospital workplace should be safe. The objective of this study was to determine the threshold levels of CO toxicity among hospital healthcare professionals in thesandstorm ambient air pollution through pulse CO-oximetry method. Participations recruited base on the designed protocol and following inclusion and exclusion criteria.A total of 117 subjects enrolled with means age ± SD; 38.97±9.03 years. It ranged between 20-60 years. Of those, 68 subjects was female and 49 male. Mean level of carboxyhemoglobin concentration (COHB %) was 2.52±3.40 SD,(P=0.03). 43% of sample study had CO toxicity upper than the normal set point. COHB% level noticeably increased in the female sex respect to male subgroups (χ =0.019).The resultant’s study was indicated particularity in female sex that a significant carboxyhemoglobin concentration found an above- normal set point level among target of population. As well as, threshold levels of CO toxicity in the workplace setting were noticeably high. Intervals of toxicity are nearby hazardous action level. The outcome of the study should be considered as an alarm for the public health program and presenting occult indoor CO poisoning.

Generally, soft tissue hemorrhages in anterior part of the neck are attributed to the neck compression or trauma and suspicion goes more to homicidal death than suicide. Although artificial posterior neck hemorrhages are described as Prinsloo-Gordon phenomenon in cadavers with posterior lividity, studies conducted on such hemorrhages in the anterior and lateral compartments are rare. This study intends to investigate causes of death accompanied by soft tissue neck hemorrhages in different compartments of neck. In this retrospective case series, between March 2008 and 2009, cadavers whose autopsies indicated soft tissue neck hemorrhages and the lividity was dominant in posterior, were evaluated according to the cause of death and anatomical and histological locations of hemorrhage. Among 86 cases of neck hemorrhage, 72.1% (n=62) were male. Direct neck trauma, hanging, strangulation, chocking and positional asphyxia constituted 50% (n=43) of them, 40.7% (n=35) were non-asphyxial, non-traumatic deaths such as natural diseases, drug and CO poisoning, electrocution and drowning, and 9.3% (n=8) were unknown. 65.1% (n=28) of non-traumatic, non-asphyxial cases bore anterior or lateral neck hemorrhages. The considerable prevalence of soft neck tissue hemorrhages in non asphyxial deaths with no history of neck trauma and the location of such hemorrhages in anterior and lateral sides of neck, lead the investigators to pay more attention to interpret these hemorrhages and determining the mode and cause of death.

Despite the widespread prevalence of medical errors and increased concerns of healthcare managers and the public about the disclosure of medical errors in recent decades, existing evidence shows that physicians still ignore the importance of disclosure of those errors. The present study aims to investigate the attitudes of Iranian internists and surgeons towards the disclosure of medical errors. In this cross-sectional study, after a research purpose briefing, a checklist eliciting basic information and a questionnaire measuring attitudes towards the disclosure of medical errors was distributed to participant physicians at Imam Khomeini Hospital, Tehran, Iran. The questionnaires were returned filled out by 107 participants (54 internists and 53 surgeons). Although 77%, 53% and 44% of the participants agreed to the disclosure of serious, minor and near miss medical errors, respectively, 83% believed that it''s very difficult for them to disclose medical errors and 48% asserted that disclosure of medical errors would threaten patients'' trust in physicians. In addition, 78% of the participants believed in notifying hospital or ward authorities of the occurrence of medical errors while only 53% agreed to notify colleagues in case of medical errors. Patients'' litigations (51%), unfamiliarity with patients'' temperament (46%) and patients'' asperity (40%) were the most prevalence reasons for nondisclosure of medical errors. No significant difference was found among participants'' attitudes in terms of sex and age groups (p>0.05). In terms of specialty, surgeons expressed significantly more agreement than internists about declaration of medical errors to hospital and ward authorities (87% Vs 70%, p=0.039) and to other colleagues (66% Vs 41%, p=0.009). In addition, the surgeons believed that the disclosure of medical errors would minimize the likelihood of patients'' litigations (60% Vs 42%, p=0.049). Internists and surgeons'' attitudes did not differ over other issues (p>0.05). Although the majority of specialists agreed to the disclosure of serious medical errors, more than 80% of them regarded it as an awkward act. In addition, half of the participants considered disclosure as a threat to patient trust and felt deterred by patients'' litigations. Therefore, it seems that disclosure of medical errors is a serious issue in Iran which needs to be addressed by healthcare system policy makers.

Severe burn is one of the major causes of morbidity and mortality in children and adolescents and is third most common cause of death among this age group. The aim of this study was to evaluate demographic characteristics of pediatric burn over a period of 5 years and the relationship between cause mortality in patients with burns. In this cross sectional study, documents of children under 15 years, in Shahid Motahari hospital between 2007 and 2011 was evaluated. Variables such as age, sex, stay duration in hospital, burn cause, severity, accident cause burns and outcome of patients finally entered in SPSS v.16 and were analyzed. In this study, 416 patients (34/8%) were female and 780 (65/2%) were male. Factors for burns in children include boiling water in 674 cases (56/4%), flame in 190 patients (15/9%), burns with flammable materials in 131 cases (11%), burns with a hot meal for 113 people (9/4%) and other hot bodies in 30 patients (2/5) and steam burns in 3 (0/3%). Increasing in burned body surface was significantly associated with mortality (P value= < 0.001). Burn severity in children who died was more than other children (P value= < 0.001). Also burn etiology was significantly different in patients who died and patients were discharged (P Value= 0.003). Based of the results of this study, burn in boys was more than girls and was common inpatients under 2 years of age. Thermal burns were the most common type of burns in children (95/4%) and hot water were also the most important cause in thermal burns in children (56/4%).Burn extent in the majority of children (75%), was less than 30% of the body surface and burns between 50 to 100% occurred in 6/3% of cases. Average stay duration in the hospital was 12/8 days and mortality rate was 7/2%. Area and depth of the burn injury were the most important determinants of mortality.

Neurotoxic snake bite envenomation is a common life threatening medical emergency in India, especially in the rural areas. We report a case of a neurotoxic snake envenomation presenting with abdominal pain and neuromuscular paralysis, which developed bacterial meningitis during her stay in the hospital. Possibly, secondary to the snake bite, a very rare incidence. Our case is a step towards the direction pointing to the rare possibility of bacterial meningitis complicating snake bites which needs further research.

History taking is a duty that must get out in different situation as child''s parents or in adults by themselves, to able provide the best helps in minimum time. Certainly, the information come out from history have significant effects on management plans. A 16 months baby that transfers to ER department with complete cardiorespiratory arrest and after response to resuscitation the medical management was done for him. As history taking, he found unconsciousness near dress pan with wet dressing in bathroom. In physical exam the little impact traumatism on his/her head and face was detected. In blood and urine samples, there were not significant findings for toxicological screening. The physician requested for forensic specialist consultation for ruling out any child abuse doubt. The future examination was done by forensic team and they found the hyperkeratotic nodules on palmar surface of first phalange of right index finger due to electrocution. The history taking and following physical exam have greatest significant moment and the detailed and exact physical examination include whole parts of body, especially in children who couldn''t present and complain about their problems completely.

Doping is defined as the occurrence of one or more of the anti-doping rule encroachments. According to the world anti-doping agency code, athletes or other persons shall be responsible for knowing what constitutes an anti-doping rule encroachment and the substances and methods which have been placed on the prohibited list. It is each athlete’s personal task to be sure that no prohibited substance enters his or her body. Athletes must be responsible for any forbidden substance or its metabolites or markers found to be present in their samples. Therefore, it is not necessary that any attempt, mistake, neglect or understanding of use on the athlete’s part be demonstrated in order to establish an anti-doping. ..