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Background: Opioid poisoning is the most common type of poisoning in intensive care units (ICUs). This group usually includes patients who have been drug abusers for a long time and now require hospitalization either because of acute overdose or due to side effects of routine opioid use. This study aimed to compare the severity and prognosis of patients using common mortality predictors Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score (SAPS II), Acute Physiology And Chronic Health Evaluation (APACHE II, APACHE IV) on different days of hospitalization. Methods: This cross-sectional study was performed on all patients with opioid poisoning admitted to the ICU, Imam Reza Hospital, Mashhad, Iran, from the beginning of April 2016 to March 2017 (Persian Calendar). For all poisoned patients enrolled in the study, the four mortality predicting tools were filled daily in the first three days of hospitalization and then every other day until discharge from the ICU or patientchr('39')s death. Results: Overall, 57 patients were evaluated of whom 72% (41 patients) were male. The mean age was 49.9±19.8 (median 53, range 18-94) years. The mean length of stay in the ICU was 13.5±17.5 (median 7, range: 75-75) days. The mortality rate was 17.5% (10 patients). The scores of SOFA, SAPS II, APACHE II, and APACHE IV were significantly higher in deceased patients than in discharged ones. The highest diagnostic accuracy (area under the curve) for all four predicting tools was observed in the second week of hospitalization. On the other hand, SAPS II (74%) on the first day, APACHE-II (76%) on the second day, APACHE-II (82%) on the third day, SOFA (77%) on day 4-5, and SAPS II (82%) on day 6-7 had the highest diagnostic accuracy. Conclusion: In the present study scores of all four mortality predicting tools at admission were significantly associated with mortality. The accuracy of SAPS II, APACHE IV, and APACHE II are appropriate for estimating prognosis, especially after the second week of admission.

Objective: Due to the rapid pace of industrialization and the high prevalence of addiction, toxicity caused by heavy metals, especially lead, has become one of the major health problems associated with high morbidity and mortality. Therefore, reliable information is critical to manage this condition. Methods: This descriptive cross-sectional study was performed on 30 cadavers, suspected of lead poisoning. The hospital records and the results of anatomical investigations were studied. Data were collected in a researcher-made questionnaire and analyzed in SPSS Version 22. Results: The results showed a significant correlation between the pathological results of pulmonary autopsy and the duration of drug use (P= 0.01). Also, the pathological results of cardiac autopsy had significant correlations with age (P= 0.006) and blood lead level (P= 0.03). Moreover, significant correlations were found between the pathological results of liver autopsy and age (P=0.00), between the pathological results of brain autopsy and the route of drug administration (P=0.01), and between the pathological results of kidney autopsy and age (P=0.00). Most pathological changes were observed in the brain and kidney tissues. Conclusion: Lead poisoning does not cause any specific pathological changes in the liver, heart, brain, lung, or kidney tissues; however, these non-specific changes, alone or together, can lead to death

Objective: Determination of victim’s clothes in gunshot wounds is important due to the necessity of immediate workup in the emergency room as well as the legal aspects of cases. The aim of this study is to evaluate the importance of victim’s clothes in gunshot wounds referred to autopsy hall of legal medicine bureau of Tehran, Iran from 2014 to 2017. Methods: In this analytical comparative study, 202 consecutive cadavers of gunshot victims, referred to Tehran Legal Medical Hall from 2014 to 2017, were enrolled and the effect of shotgun and gunshot wound were determined and compared. Data were collected using a researchermade questionnaire. The significance level of the tests was considered as PResults: In this study, all women were killed by gunshot. Also, all of the 26 people who were killed by shotgun were men. The mean of age only in males was 39-48 years for shotgun, and 29-38 years in both genders for gunshot. Evaluation of their clothes in the emergency room and autopsy hall was helpful in 70% of cases in order to determine shot distance and type of gun (P=0.0001). Conversely, we did not observe a significant difference between sex (P=0.082) and the pattern of death (P=0.211). Conclusion: Based on the obtained results, it seems that some characteristics of victim’s clothes may be useful to differentiate shotgun and gunshot.

Background: Cholinesterase is an enzyme that plays a critical role in regulating neural transmission. Many factors may decrease the cholinesterase levels in serum and Red Blood Cells (RBCs). It is suggested that the use of opium may effectively change the levels of Cholinesterase in serum and RBCs. This study aimed to evaluate the serum and RBC levels of cholinesterase in patients who were acutely poisoned with opium. Methods: This cross-sectional study was conducted in 65 patients suffering from acute opium poisoning. The serum levels of cholinesterase were measured using an automated analyzer. The levels were also measured in RBCs, using a colorimetric method. Simultaneously, 65 patients served as the positive controls from among those poisoned with organophosphates. Results: The serum cholinesterase levels were lower than the normal range in 16.9% of patients poisoned with opium and in 76.9% of those poisoned with organophosphate agents (P

Background: Increasing the number of complaints against medical staff emphasizes the need for physicians to be more familiar with legal issues before and during providing medical services to the patient. Signing the informed consent form before medical practices and informing the patient of all possible outcomes can cause mental health and better collaboration of patients as well as increase the physician's self-confidence to provide better services. The current study aimed at determining the status of standard informed consent in medical cases related to different surgical fields referring to Tehran's Commission of Forensic Medicine during the first quarter of 2017. Materials and Methods: In the current descriptive, cross-sectional study, the cases of medical malpractice related to different surgical fields referring to Tehran's Commission of Forensic Medicine in the first quarter of 2017 were investigated. Data were analyzed with SPSS version 16. Results: In the current study, 124 cases of complaints against the medical staff of the surgical fields were examined. Based on the obtained data, the age and specialty of physicians, faculty status, and type of treatment center were effective in obtaining standard informed consent, and the highest percentage of allegations against the charge was related to cases attempted to obtain informed consent. Conclusion: Obtaining the standard consent can significantly improve the patient-physician relationships and reduce the rate of medical malpractice complaints.

Implantation of vascular access devices is of great importance in critically ill patients or those vulnerable to clinical worsening. The aim of this study was to identify the complications of implantation of vascular access leading to complaints from patients, in the forensic medicine commissions of Tehran.The present descriptive-cross sectional study was performed on all cases that died from implantation of vascular access devices and complaints about permanent local complications caused by this procedure, filed with the forensic medicine commissions of Tehran in period of 2013-2018, based on selected variables, and the results were statistically analyzed using the chi-square and Fisher exact tests in SPSS Version 18. A p-value of0.01 was considered statistically significant.All alleged deaths were due to implantation of central venous port placed in a large vein in the neck, and most organ failure cases were attributed to anterior forearm deformity. The most common cause of death was acute cardiac death; internal bleeding was observed in 14% of them. Most complaints of death were filed against general surgery and anesthesia assistants, and most complaints about peripheral venipuncture were against trainee nurses. The present study findings were significantly different in terms of cannulation site, age, cause of death, type of local complication (p0.01).This study shows, as patients become more aware, complaints from physicians about implantation of vascular access, in the judicial authority are also on the rise. Therefore, in choosing these patients, Venice should be treated more carefully.

Background: Botulism is mostly caused by Clostridium botulinum neurotoxin which has been described as a bilateral symmetric descending flaccid paralysis. Preventing and responding to botulism outbreaks is a public health emergency. In this study, the disease is reported in a family. Methods: In a case series study, during an outbreak, four members of a family with symptoms including paralysis, ptosis, blurred vision, diplopia, weakness, dysphagia, dry mouth, respiratory problems, vertigo, and lethargy, referred to Loghman Hospital of Tehran. Among the patients was an elderly woman and a pregnant woman. All clinical signs and symptoms of the patients were recorded daily in a researcher-made questionnaire from 27 August to 3 September 2018. At the time of admission, vital signs (pulse rate, respiration rate, and body temperature) of patients were stable and within normal limits. Following clinical suspicion of food-borne botulism in these patients, samples of the first two patients, including serum, stool, gastric secretions, and homemade whey were sent to the Botulism Laboratory of Microbiology Department of Pasteur Institute of Iran for the mouse bioassay. Results: Type A neurotoxin was detected in homemade whey after the mouse bioassay. Therefore, foodborne botulism was confirmed in patients with laboratory results. Patients included two men and two women with a mean age of 52.7 years old. The length of hospitalized days was between 2 and 6 days. Two of the patients were admitted to the intensive care unit (ICU). Patients under study were fully recovered with timely diagnosis of the disease, treatment with antitoxin, and supportive care. Conclusion: When conscious patients referred to the hospital with symptoms of paralysis, foodborne botulism is an important differential diagnosis. On-time diagnosis and antitoxin treatment can prevent serious complications.

Background : The clinical and laboratory manifestations of methanol poisoning and Diabetic Ketoacidosis (DKA) might be very similar. Case Presentation : A 15-year-old male, who lived in Mashhad, Iran, was referred to a medical toxicology center because of the loss of consciousness following the consumption of home-made alcohol. Laboratory tests revealed metabolic acidosis, the high blood levels of methanol, and ketonuria and glucosuria in urine analysis. The treatment of DKA and methanol poisoning was started simultaneously. Conclusion : Methanol poisoning, as physical stress or because of pancreatitis as a complication, could be a trigger for diabetes in susceptible individuals, and physicians should be aware of the similarity of presentation of these situations.

The electrical injury is a common cause of death needing forensic assessments. In these cases, the histopathological assessment is a routine practice. The aim of this study was to determine the pathological results in cadavers suspected to electrical injury referred to the Forensic Medicine Center of Tehran, Iran. In this observational descriptive-comparative study, 745 consecutive cadavers suspected to electrical injury referred to the Forensic Medicine Center of Tehran from 2006 to 2016 were enrolled; also, the histopathological findings among them were determined and compared according to other variables. The results of this study demonstrated that 44 patients (86.3%) of those suspected to have an electrical injury and 101 patients (92.7%) of those with definite electrical injury had positive pathological results, showing a statistically significant difference (P

Background: QT dispersion means the difference between the minimum and maximum QT interval in a standard twelve standard electrocardiogram, which indicates ventricular repolarization and electrical instability of the heart. In this study, we try to find a link between methadone poisoning and the change in QT dispersion, so that we can accurately assess the patient's condition and medical needs in the future. Methods: In a descriptive, randomized/ cross-sectional study in the poisoning ward of Imam Reza Hospital in Mashhad from October 2013 to April 2015, all patients who referred to the emergency department because of their methadone toxicity or symptoms, had an ECG with 12 leads taken from them, at the time of the arrival. QT dispersion was calculated manually in comparison to other parameters. Also their blood sample were taken to the lab in order to measure different electrolytes (Mg, K, Ca). To ensure the accuracy of study, patient’s urine samples were taken and tested for methadone. There was no intervention in this study. The control group was also not considered QT scattering and dispersion was compared with normal reference in this study. Results: In this study, 100 patients were studied, 65 of them males (65%) and 35 females (35%). Mean age of subjects entering the study was 33.87±14.5. The average dose of methadone in these cases was 35.5±35.7 mg. However, their usual dose was 1.11±4.85 mg prior to overdoses, and the average duration of use mentioned in patients who had a history of usage was 5.1 months, but 90% of the subjects did not mention any history. The average measured potassium was 3.99±0.5 meq/l, calcium was 8.94±0.5 meq/l, and magnesium was 1.98±0.26 mg/dl. Average measured oxygen saturation at the time of admission was 94.43±5.6%. Mean QT dispersion was 0.041±0.018 millisecond. Conclusion: In our study, no significant correlation was found between QT dispersion and methadone poisoning.

Background : Amphetamines constitute a group of central nervous system stimulators with an increasing frequency of usage and destructive outcomes on the metabolism, perfusion, and structure of the brain. This study aimed at evaluating the structural brain changes following amphetamines abuse, using Magnetic Resonance Imaging (MRI). Methods : This cross sectional study was conducted on the individuals, who were admitted to the toxicology Emergency Room (ER) with continuous amphetamines abuse for at least six months and a positive methamphetamine urine test. Positive Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for dependency and addiction to methamphetamine were also considered as the inclusion criteria. Following informed consent, the demographic information, and data on methamphetamine use were collected. An MRI was performed for all participants as soon as relative recovery. A matched control group also underwent MRI simultaneously. Results : Forty male (20 cases of methamphetamine addicts and 20 healthy individuals) with a mean±SD age of 28.1±5.11 years were investigated. The mean±SD age of starting methamphetamine abuse was 25.6±10 years. About (75%), (n=15) of the patients abused methamphetamine 6-9 months, while others had abused it for more than 10 months. All cases used to abuse methamphetamine at least once a week, with (85%) of them inhaling it. The results showed that the only change in the brain MRI of methamphetamine abusers was hyperintensities increase in deep and periventricular white matter (only positive MRI in 3 cases, P=0.231). Oral consumption and higher doses had induced greater changes in the brain structure. Conclusion : Methamphetamine dependency may increase deep and periventricular white matter hyperintensities.

Background: A major challenge in medicine is patients’ dissatisfaction and complaints against doctors. Medical complaints in Iran, similar to the other countries, have a growing trend. Over the past two decades, the implementation of laparoscopic surgery rapidly grew in many countries. The current study aimed to investigate complaints against surgeons in laparoscopic surgeries, compared to open surgeries. Methods: The current cross-sectional study was conducted on all laparotomy and laparoscopic surgery complaint cases. The medical records were extracted based on the study variables, using a researcher-made questionnaire. To analyze the obtained data, frequency tables were used and to investigate the relationship between variables, Chi-Squared and Fisher’s Exact tests were employed. Results: A total of 369 medical complaint cases were brought to the Department of Tehran Legal Medical Committee, Tehran, Iran, from 2011 to 1016. The Mean±SD age of studied patients was 45.8±13.4 years. The most frequent medical complaint cases were against physicians working at private hospitals. In addition, most complaints were after laparotomy cases. More than half of the cases were voted on the malpractice of physicians. The frequency of postoperative infections was significantly higher in laparoscopic surgeries. The frequency of sentence for malpractice was significantly higher in laparoscopic surgeons, compared to laparotomy ones. Conclusion: Physicians’ knowledge about legal medical issues and building intimate and trustful relationship with patients along with the provision of desirable healthcare services can be effective in reducing medical error complaints.

Background: Cancer is among the leading causes of mortality in India. Studies have reported antineoplastic agents as the common class of drugs causing Adverse Drug Reactions (ADRs). The present study aimed to conduct active surveillance of ADRs of anticancer drugs in the hematology department. Methods: A prospective observational study was conducted in 136 patients with cancer and the incidence and frequency of ADRs were assessed. The study was conducted in 6 months in a multispecialty hospital. Results: Among 136 cancer patients, All was more prevalent (39.70%); CLL, Non- Hodgkin’s Lymphoma were less prevalent (0.73%). ADRs were more prevalent in the Pediatrics department, i.e., 18.53% of ADRs were observed in patients aged

COVID-19 pandemic is a challenge in the current era. The spread of this viral infection began in Wuhan City in China, and Iran was also one of the countries struggling with it. Considering the nature of this virus and the current pandemic, it is essential that the healthcare system authorities issue a clear and firm law on treating people infected with COVID-19 to prevent the consequences affecting the professional life of physicians and healthcare staff. The current study aimed at evaluating the legal consequences of COVID-19 cases in emergency department (ED). This case series reported 10 patients that filed complaints against medical staff for problems that occurred on arrival, during the hospital stay or discharge in Shohada-ye-Tajrish and Shahid Modarres educational Hospitals, Tehran, Iran. Consultation with forensic medicine department was requested for all patients and the final decision for each case was reported under the title legal considerations.

Background: Filicide is the term to describe the homicide of the child performed by one of the parents or both. Many different methods and devices may be used for these types of murders, for example, asphyxia, planned car accidents, stabbing by knife, battering, electricity, and so on. Most deaths due to electrocution are categorized as accidental in domestic and industrial environments. Murder by electrocution is reported very rarely. This case presents the murder of the child by his father in the way which is not usually applied in either filicide or homicide. Case Presentation: The body of a dead eight-year-old boy was brought to the Legal Medicine Organization center for autopsy with the history of separated parents and father with bipolar disorder. The coroner noticed the boy`s toes wired directly to an electric socket at the scene of the crime so the deceased was referred for further evaluation. Conclusion: Although filicide by electrocution is a rare method, especially for familicide according to literature, it should be considered in such murders.

Background: The development of clinical teaching necessitates the use of novel and appropriate clinical evaluation methods. In the meantime, the use of new evaluation approaches that enhance learning at the same time has been recommended. This study aimed to compare the effect of the two new evaluation methods of direct observation of procedural skills (DOPS) and short clinical evaluation exercise (Mini-CEX) with the conventional evaluation method on clinical skills of forensic medicine residents.Methods: This is a randomized trial performed among forensic medicine residents. Using Cochran's formula, the minimum sample size was calculated to be 25 individuals per group. All the residents were randomly divided into either the experimental or the control groups. After training and evaluation, the experimental group was tested using the DOPS and Mini-CEX methods three times during the course, and the control group was evaluated using the conventional method. The basis for the evaluation of the procedures (physical examination and autopsy) in both groups was the valid and reliable checklists prepared by the researchers. The results were analyzed using descriptive and inferential statistics (e.g., the Chi-square and independent t-test).Results: There was no significant difference between the two groups in terms of demographic variables such as age, sex, and grade point average (GPA) (P>0.06). The means of total scores were significantly higher in the experimental group (using the Mini-CEX and DOPS methods) than the control group (conventional method) (P

Background and aims: Complaints of obstetrics and gynecology specialist are on the top of complaint from doctors and these have been increasing with increased population and births. In this regard, parallel to industrialization of life, tendency to cesarean against vaginal delivery has been increased in patients. All the cases of complaint increased from 1995 until 2010. In multiple studies and evaluation of complications of cesarean and vaginal delivery conducted in legal authorities like forensics due to patient and her relatives complains can have an effective role on selecting delivery method in specialists by creating virtue of working. Limited information is available on this study. We aimed to investigate the effect of selecting delivery method on medical malpractice incidence in the specialized field of obstetrics and gynecology. Methods: This is a descriptive-analytic study, and 913 cases of 2011 to 2012 who referred to Tehran forensics organization have been assessed and computer software SPSS was applied for data analysis. Our study was approved by the Ethical Committee of Forensic Medicine. Results: Of the total referred cases, 12.8% were in the field of obstetrics and gynecology in which 691 cases were obstetric and 222 cases related to gynecological. In 44.5% of cases, medical malpractice was confirmed and 2.3 of them were due to caesarian surgery. The rate of maternal injuries was more prevalent than babies and children, and most of complains were related to inexperience surgeons. Conclusion: As in our study, 2.3 of complaints were associated with cesarean patients and the rate of approved malpractice in cesarean was almost double the vaginal delivery. Furthermore, the rate of complains associated with mother in cesarean delivery has been twice the vaginal birth. The type of medical malpractice associated with type and method of delivery. In this study cesarean surgery delivery is pioneer. Discussion: Considering the patient and fetus situation and patients’ education selecting the type and method of delivery has an important role in prevention of patients’ complaint to surgeons from forensic view and creation of more awareness among obstetrics and gynecology specialists about medical mistakes and special training that should be given to those joining with these specialties.

Introduction: Natural and unexpected death that happens within less than one hour of first symptom occurrence is called sudden death. Cardiovascular diseases are the main known reason of sudden death and more than 75% of sudden deaths in athletes are assigned to it. Here we reported the autopsy results of all cases with sudden death following exercise that were referred to forensic center of Tehran, Iran, from 2009 to 2014. Methods: In this cross sectional study all subjects who were registered to forensic medicine center of Tehran, Iran, from 2009 to 2014, as a case of sudden death following exercise were evaluated. Demographic data and medical history as well as autopsy and toxicology findings were retrospectively gathered using profiles of the deceased. Results were reported using descriptive analysis. Results: 14 cases were registered as sudden death following exercise in forensic medicine profiles during the study period. Exploring the files of the mentioned deceased, revealed five non-compatible cases in this regard. Finally, 9 eligible cases were enrolled (88.9% male). The mean age of the deceased was 28.66 ± 10.86 years (range: 7 – 40). Toxicological tests were available for 7 cases, one of which was positive for tramadol. Sudden death following football was reported most frequently (44.4%). Only 3 (33.3%) cases had herald signs such as chest pain, syncope, or loss of consciousness. 1 case (11.11%) had a positive history of sudden death in relatives. Conclusion: Although most sudden death victims are asymptomatic until the event, all those who suffer from symptoms such as chest pain, shortness of breath, dizziness, fatigue and irregular heart rate during physical activities, should be screened regarding common probable causes of sudden death.

Background: Methanol is a toxic alcohol found in illegal liquor, and its poisoning may cause death if not treated timely and properly. In 2018, methanol toxicity in Iran increased dramatically. Regarding the high prevalence of methanol toxicity, its high mortality rate, and the cost of treatment as well as the importance of timely diagnosis in the treatment of this condition, we decided to review methanol toxicity, its signs, symptoms, diagnosis, and treatment.Evidence Acquisition: We searched for articles on reliable databases such as Embase and Medline from January 2018 to May 2018 using the following keywords: “methanol,” “toxic alcohol,” and “ethanol toxicity treatment.”Results: This review discusses how to diagnose methanol toxicity by using clinical signs and symptoms and laboratory examinations; it also suggests new treatments. Meanwhile, we provide alternatives for diagnosis in case of shortages of tests in the emergency department.Conclusion: Diagnosis of ethanol toxicity due to non-specific signs and symptoms, late patient’s referral, and lack of proper history-taking can be very difficult and delay the onset of treatment. There is also no clear scientific evidence as to whether ethanol or fomepizole should be used as the first choice of therapy for methanol toxicity because there is no direct comparison between these two antidotes regarding their effectiveness and safety. The appropriate antidote is chosen depending on the availability, cost, accessibility of hemodialysis, and the physician’s experience. If the therapist does not have enough experience, it is easier to use fomepizole.

Introduction: Previous studies have raised the probably of cardiac manifestation in tramadol poisoning. However, conclusive information on electrocardiographic (ECG) abnormalities of tramadol overdose remains to be explained. Therefore, the present study aimed to evaluate the epidemiology of ECG abnormalities in tramadol poisoned patients. Methods: In a prospective cross-sectional study, all patients with tramadol poisoning, who were admitted to the emergency department of Loghman Hospital during 2012 – 2013, were evaluated. Patients’ baseline characteristics and ECG findings including axis, rate, rhythm, PR interval, QRS duration, QTc interval, evidence of Brugada pattern, and evidence of blocks were recorded. Obtained Data were descriptively analyzed using SPSS 21.0 statistical software. Results: 1402 patients with the mean age of 24 ± 6 years were studied (71.1% male). Sinus tachycardia was detected in 463 (33%) patients, sinus bradycardia in one patient (0.07%), right axis deviation in 340 (24.2), QRS widening in 91 (6.5%), long QTc interval in 259 (18.4%), dominant S wave in either I or aVL lead in 395 (28.1%), and right bundle branch block in 73 (5.2%). Increased PR interval was not detected in any cases. The evidence of Brugada pattern was observed in 2 (0.14%) patients (100% male), both symptomatized with seizure. All abnormalities had same sex distribution. Conclusion: Based on the results of the present study, the most common types of ECG changes were sinus tachycardia, a deep S wave in leads I and aVL, right axis deviation, and long QTc interval, respectively. Brugada pattern and sinus bradycardia were rarely presented.

Echinococcosis is an infection caused in human by complex parasites that causes cystic hydatid disease. These infections are prevalent in most areas where livestock is raised in association with dogs. These parasites are found in all continents. Slowly enlarging cysts generally remain asymptomatic until their size has expanded. Here we present a case of sudden death following cyst emboli to the large veins and right heart of a young adult female.

Introduction: Pulmonary embolism (PE) is introduced as the third major cause of death after trauma in those who survive more than 24 hours. This study aimed to describe the characteristics of mortalities due to trauma related PE in cases referred to the forensic medicine department. Methods: The present cross sectional study was conducted on medical profiles of cadavers that were registered as trauma related mortality in the dissection department of the Forensic Medicine Organization, Tehran, Iran, during 2011 to 2016. Results: The cause of death for 92 of the 10800 (0.85%) evaluated cadavers was diagnosed as trauma related PE. The mean age of these patients was 58.37 ± 19.39 years (66.3% male). Only 14 (15.2%) hospitalized patients had received anticoagulant agents. The most frequent trauma related PE mortality cases were male (p = 0.003) and aged > 55 years (p = 0.005), with trauma to death time of < 3 weeks (p = 0.004), lower limb injury (p = 0.003), car crash trauma mechanism (p = 0.003), and no anticoagulant prescribed (p = 0.001). Conclusion: According to the results of the present study, the prevalence of trauma related PE mortality was 0.85%. It seems that, having a clear anticoagulation therapy protocol in trauma centers could be helpful in decreasing the prevalence of traumatic thromboembolism and its’ related mortality.

Introduction: Determination of suicide as the cause of death due to shotguns can be challenging because shotguns are usually designed for hunting, sport, and recreation. Therefore, the impact of their bullets on the human body may present several unclear signs. In this case, pellets were reported to spread in contact wounds. The manner of death seemed to be initially murder yet after the autopsy, it seemed suicidal. Case Presentation: The incident occurred during March 2015 in a house in the capital city of Iran, Tehran. The case was a 39-year-old man, who upon initial examination, was reported to have committed suicide using a shotgun. This was evident by the presence of distributed pellets in the chest and pelvis, which confirmed a contact shot. Conclusions: The following were hypothesized: 1- After the plastic cap of the bullet hit the sternum, it was fragmented, and pellets were scattered. 2- Regarding the existence of the pellets in the heart's ventricles, it seemed the pellets were distributed immediately through the aorta, to the chest, and through to the abdominal aorta, and the pelvis.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), pica is described as eating one or more non-nutritive, non-food substances over a period of at least 1 month that is severe enough to warrant clinical attention. The present case is a 44-year-old man who was brought to emergency department following severe abdominal pain, but died before admission or receiving any treatments. On the autopsy, 64 bolts and metal fittings (3700 grams) were found in the esophagus, stomach, small intestine, and large intestine of the patient.

Introduction: Septorhinoplasty is one of the most common cosmetic procedures in Iran. Intracranial complications such as meningitis, cerebrospinal fluid (CSF) rhinorrhea, pneumocephalus, and damage to the skull’s base are rare, but potential life-threatening complications are associated with such procedures, though very few cases of intracranial complications after septorhinoplasty have been reported. Case Presentation: A 29-year-old woman was admitted to a limited surgery clinic in Tehran, Iran in 2015 for septorhinoplasty, and 4 days post-operation she complained of headache, drowsiness, and CSF rhinorrhea. The patient’s surgical complications included a skull base fracture, pneumocephalus, and an epidural hematoma. Conclusions: Prevention of life-threatening complications following septorhinoplasty is important. Prevention, early detection, and appropriate treatment of intracranial complications will result in fewer catastrophic outcomes. To prevent damage to the skull base and other cerebral complications, it is necessary that surgeons use a suitable technique, understand appropriate anatomical information, maintain awareness of possible anatomic variations, and practice gentle manipulation of the ethmoid roof.

Background Organophosphate compounds cause poisoning and death more than any other insecticide. These toxins can cause peripheral neuropathy which is delayed for about 3 - 6 weeks and no method has been known for predicting the incidence. It has been claimed that electrophysiological tests (EMG - NCV) can help in predicting the disorder. Objectives The main purpose of this research was to study EMG - NCV tests in patients with moderate to severe organophosphate poisoning. Methods This was a cross-sectional study conducted on patients with moderate to severe organophosphate poisoning from 2014 to 2016 in Imam Reza hospital of Mashhad. The minimum sample size was calculated as 68 patients and then all data was collected on the basis of inclusion and exclusion criteria using data collection form designed by the researcher, and finally data were analyzed using SPSS V.21 software, descriptive tests (including mean, median, mode) and analytical tests (K square, ANOVA). Results Of all 78 patients with the mean age of 27.50 ± 10.0, 45 were female and the rest were male. Totally 29.5% of the patients had abnormal EMG - NCV. Although no significant differences were observed between electro diagnostic tests (EMG - NCV) and age, gender, clinical symptoms and levels of acetylcholinesterase serum activity, the relationship between EMG - NCV and RBC levels of acetylcholinesterase activity was significant. Conclusions Electrophysiological tests are not associated with clinical symptoms (muscle weakness) and they cannot be considered as a determining factor to discharge the patients; therefore, careful examination of the patients or evaluating the level of AChE activity in red blood cells is needed.

Objectives. Clinical studies to reduce the side effects of tramadol, such as seizure, are necessary. Owing to the high prevalence of tramadol consumption and subsequent complications that result from seizures, the aim of the present study was to find a relationship between clonus and prediction of seizure outcome in patients with tramadol overdose. This can be used to determine the need for essential actions if a significant indicator of preventive medical measures is observed.Methods. In this case-control study, three groups of patients poisoned with tramadol and with marked ankle clonus were evaluated. A sample size of 50 patients per group was calculated using the Cohen first method. The data were analyzed using SPSS16 software.Results. All patients with ankle clonus were evaluated. Seizures occurred most commonly in patients aged 21–25 years or younger. The patients who received the preventive medication of magnesium sulfate were seizure-free for 72 h after admission.Conclusion. It is recommended that, for all patients referred with tramadol poisoning who have symptoms of ankle clonus, the administration of magnesium sulfate should be considered in addition to medication for the prevention of seizures and arrhythmias.

Pressure on the neck is one of the oldest and controversial types of death. However, the only hypoxia as the cause of speed death is not always correct. Many victims die immediately without classic symptoms of respiratory failure (Shirzad & Gharedaghi, 2007). Most of the deaths which occur in less than one to three minutes are falls in this category. Pressure on the neck leads to airway obstruction, neck veins obstruction, blocking the carotid arteries, and affect the nerves. A variety of causes is associated with fatal pressure on the neck, including strangulation by hand, strangulation with a ligature, and hanging. Hanging is the method used maximally in suicide as compared to other methods of suicide (Graham et al., 2000; Gould & Kramer, 2001). Including Iran, it is the most common method adopted for suicide in Asian countries (Morovatdar et al., 2013; Shojaei et al., 2014), especially adopted by men, older and especially illeterate people (Pridmore & Walter, 2013).

Introduction: Natural and unexpected death that happens within less than one hour of first symptom occurrence is called sudden death. Cardiovascular diseases are the main known reason of sudden death and more than 75% of sudden deaths in athletes are assigned to it. Here we reported the autopsy results of all cases with sudden death following exercise that were referred to forensic center of Tehran, Iran, from 2009 to 2014. Methods: In this cross sectional study all subjects who were registered to forensic medicine center of Tehran, Iran, from 2009 to 2014, as a case of sudden death following exercise were evaluated. Demographic data and medical history as well as autopsy and toxicology findings were retrospectively gathered using profiles of the deceased. Results were reported using descriptive analysis. Results: 14 cases were registered as sudden death following exercise in forensic medicine profiles during the study period. Exploring the files of the mentioned deceased, revealed five non-compatible cases in this regard. Finally, 9 eligible cases were enrolled (88.9% male). The mean age of the deceased was 28.66 ± 10.86 years (range: 7 – 40). Toxicological tests were available for 7 cases, one of which was positive for tramadol. Sudden death following football was reported most frequently (44.4%). Only 3 (33.3%) cases had herald signs such as chest pain, syncope, or loss of consciousness. 1 case (11.11%) had a positive history of sudden death in relatives. Conclusion: Although most sudden death victims are asymptomatic until the event, all those who suffer from symptoms such as chest pain, shortness of breath, dizziness, fatigue and irregular heart rate during physical activities, should be screened regarding common probable causes of sudden death.

Although death is a gradual process, sometimes sudden death occurs in a fraction of a minute or seconds. Here we report a 49-year-old man without any underlying disease, which has instantly died in an accident scene due to compression of neck critical elements by a three-point seat belt. The examination of the body and the results of the autopsy, toxicology and pathology tests are described from the viewpoint of forensic medicine.