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Objective: The aim of study was to conduct a time-based analysis to utilize the obtained knowledge for forecasting the trend of accidents in the future. Methods: The present study, which was conducted as a cross-sectional research, investigated deaths from traffic accidents in Fars Province during a five-year period from 2013 to 2018. The pseudo-regression model of Spline was used to predict the increase in mortality rate by 2021. Results: The forecasted values indicated a decline in deaths from traffic accidents by 2021. A total of 8020 records of accidents leading to death were included in the study. The mean mortality rate from traffic accidents in the province was approximately estimated to be 33.7 per 100,000 populations. More than half of the people who died (52.36%) were in a car, 25.57% were motorcycle riders, and 19.93% were pedestrians. The highest rate of deaths was observed in the age group of 16 to 25 years old (21.5%). The data indicated a reduction in the rate of death among car riders and pedestrians and an increase in the number of deaths among motorcycle riders. The trend of deaths occurred outside the city had been increasing while the trend of deaths occurred inside the city had been decreasing. Conclusion: The present regulations are only able to reduce a small number of deaths each year. In order to achieve a downward trend in mortality with a steeper pace, it is necessary to design and implement more intelligent standards, not merely the stricter ones. This project has been approved by the research ethic committee, as well as, supported with grant number of 97-01-38-17825 by Shiraz University of Medical Sciences in Shiraz, Iran.

The high rate of medical errors, malpractice payments, legal issues, and complaints from physicians leads to waste of the physician’s time and energy as well as high costs for related individuals and organizations. Patients and methods We analyzed the outcomes of 275 medical malpractice cases reported in the Department of Forensic Medicine in Fars Province from January 2006 to December 2016. The study population included all the internists as defendants and the patients who had filed a complaint against them. Results Based on the plaintiffs’ gender in the investigated cases, the maximum age of patients with complaints by gender among males ranged between 30–39 and 50–59 years (22.4%) and among females it was 30–39 years (22.8%). The degrees of physicians who had been accused of medical commission were recognized as follows: 5 (1.8%) medical students, 36 (13.1%) GPs (general practitioners), 126 (45.8%) internists, 6 (2.2%) pulmonologists, 6 (2.2%) nephrologists, 4 (1.5%) hematologists, 2 (0.7%) rheumatologists, and 38 (13.9%) gastroenterologists. Conclusions Annual malpractice from the beginning of 2006 to the end of 2016 varied from 0 to 5%, while the rate of annual complaints in the same period varied from 0 to 45%. Maximum malpractice payment belonged to gynecology which is about 50,358,000 Rials equivalent to US$11,990 involving malpractice and complaint concurrent with internists. Specially fields of general surgery(9.4%), gynecology (9.1%), subspecialty fields of thoracic cardiovascular surgery (6.9%), and family general practice (13.1%) were the fields of most complaints parallel with those of internists.

During extensile lateral approach to the calcaneus, in order to see all fractured fragments and subtalar joint, all soft tissues including insertion site of superior peroneal retinaculum (SPR) on the calcaneus should be released. The aim of this study was to evaluate the probability of peroneal tendon dislocation by releasing all soft tissues attached to the calcaneus. In 10 fresh cadavers, after standard extensile lateral approach to the calcaneus in right side, all soft tissues attached to the lateral wall of the calcaneus were excised. In the left side of each cadaver, all soft tissues inserted to the superior border of calcaneal tuberosity in addition to the lateral wall of the calcaneus were cut out. Probable anterior dislocation of peroneal tendons in the retromalleolar groove was assessed by placing a clamp into the peroneal tendon sheath from distal to proximal and advancing it to the retromalleolar groove. Also by careful dissection, any instability of peroneal tendons was visualized. Not any anterior dislocation of peroneal tendons to the lateral malleolus tip was seen in any stage of the procedure. Insertions of the SPR to the fascia of the deep posterior compartment of the leg and the Achilles tendon sheath are the main soft tissue stabilizer of the peroneal tendons in the retromalleolar groove. So resection of the insertion site of the SPR to the calcaneus might not result in the peroneal tendon instabilities.

Objective Globally, suicide is the second leading cause of death among young people. Although completed suicide is rare before puberty, the incidence of adolescent suicide has increased significantly at the late ages of 10–19. Hence, this study investigates the adolescent suicide, aged 10–19, in southern Iran. Methods In this cross-sectional study, all data regarding the demographics, causes, methods, outcomes, past medical history of suicide attempts and suicide death were collected from the Mental Health and Suicide Surveillance Systems of Fars province between 2011 and 2016. Results Overall 6-year incidence rate of suicide attempts and death were 193.49/100,000 and 7.91/100,000, respectively. Case-fatality rate was 4.09%. During the period of 6 years, an increasing trend has been observed for both the rates of suicide attempt and death. Family conflicts were the major cause and medication overdose was the main method of suicides. After controlling the effects of confounders by logistic regression, male gender, living in the rural area and age are among the risk factors of fatality in suicide attempts. Conclusions Suicide attempts and deaths have been increased in adolescents. Therefore, due to the vulnerability of this age group, we need to understand all components of suicide to educate families and to help policy makers.

*Corresponding Author Email: saeedghmail@yahoo.com ABSTRACT Suicide is considered as the tenth cause of the death worldwide. Among different pesticides, organophosphorus pesticides (OPs) are the most widely used, but they are highly toxic, so there are increasing suicide reports about use of them. Considering the low rate of organophosphorus pesticides in the suicide reports, these two cases helped us to improve our customary methods of extraction. In this study, two cases of suicide related to a 25-yearold girl and 36-year-old man who have taken high doses of Diazinon. Both cases were dead on arrival to the hospital so no medical cases were done for them and they were brought to the Fars Legal Medicine Organization. They were suspected of using some toxins or drugs. Diazinon and Dithion were extracted using modified solid phase extraction method in the gastric content of both cases by GC-MS analysis. Modified solid phase extraction method is so helpful for toxicological analysis and detection of cause of the death in suicide, homicide or accidental died cases of organophosphorus poisoning referred to legal medicine organization.

Background: Childhood and adolescent injuries are among the most significant health system hazards, especially in developing countries including Iran. In this report, we evaluated the main characteristics of all cases of pediatric injury-related mortality in Shiraz in a 5 - year - period. Methods: This cross - sectional study comprised all injury- related deaths in children and adolescents up to 18 years of age, from September 2011 to September 2016 in Shiraz, Iran. The required information about demographic factors including age, sex, cause of death, the manner and location of death and time period between injury and death was collected for all the cases. Results: There were 485 cases (66% male) with mean age of 8.7 ± 5.9 years. The crude mortality rate was 21.6 per 100000 population in each year. Infants had the lowest rate during the first year (6.4%) and children between 1 to 4 years had the highest rate of death (28.7%). Accident was the most common manner of death occurring in 393 (81.0%) followed by suicide in 58 (12.0%) decedents. Mortality due to electrical injury, traffic accidents, falling down, burns, drowning and blunt trauma were more common in the 1 - 4 years age group. Suffocation, poisoning, work accident and firearm were the most common cause of death in 15 - 18 year - old children. Except for aspiration, firearm and penetrating trauma, all other causes were more common in boys. The most common location of death was at the scene of injury (48 %). The majority of deaths occurred in the first 6 hours after injury (311 cases, 64.1%). Conclusions: Most cases of pediatric injury - related mortality were secondary to preventable injuries and occurred during the first 6 hours and before arriving at the hospital. Thus, injuries should be considered as one of the priorities of the health system and preventive measures such as educating the caregivers regarding these events should be emphasized.

Background Suicide is a critical psychological issue worldwide with an increasing trend. This study investigated suicide comprehensively. Methods In this cross-sectional study, we reviewed data of 28 552 suicide attempts during 2011-16, in Southern Iran. To calculate age-standardized incidence rates, population statistics were derived from the Statistical Center of Iran and the National Organization for Civil Registration. We used the standard population of World Health Organization 2012 to adjust the suicide attempts and deaths rates by age. Results The mean age of participants was 26.8 ± 10.6 years with the highest suicide attempts rates in the age groups of 15-24 and 25-34 years (48% and 32.5%, respectively); 58.7% were women and 52.9% were single. Case-fatality rate (CFR) was 6.27%. Annual age-standardized incidence rates of suicide attempts during the 6-year period has increased (P 0.05). Logistic regression model showed male sex, rural area, older age, psychological and somatic disorders, and family history of suicide as significant factors. Conclusions In this comprehensive study, although the age-standardized mortality rate of suicide in southern Iran was lower than in other countries, the increasing trend of suicide attempts during the study period served as an alarming sign in this province.

Background Hepatitis B virus (HBV) as an infectious disease that has nine genotypes (A - I) and a 'putative' genotype J. Objectives The aim of this study was to identify the rare codon clusters (RCC) in the HBV genome and to evaluate these RCCs in the HBV proteins structure. Methods For detection of protein family accession numbers (Pfam) in HBV proteins, the UniProt database and Pfam search tool were used. Protein family accession numbers is a comprehensive and accurate collection of protein domains and families. It contains annotation of each family in the form of textual descriptions, links to other resources and literature references. Genome projects have used Pfam extensively for large-scale functional annotation of genomic data; Pfam database is a large collection of protein families, each represented by multiple sequence alignments and hidden Markov models (HMMs). The Pfam search tools are databases that identify Pfam of proteins. These Pfam IDs were analyzed in Sherlocc program and the location of RCCs in HBV genome and proteins were detected and reported as translated EMBL nucleotide sequence data library (TrEMBL) entries. The TrEMBL is a computer-annotated supplement of SWISS-PROT that contains all the translations of European molecular biology laboratory (EMBL) nucleotide sequence entries not yet integrated in SWISS-PROT. Furthermore, the structures of TrEMBL entries proteins were studied in the PDB database and 3D structures of the HBV proteins and locations of RCCs were visualized and studied using Swiss PDB Viewer software®. Results The Pfam search tool found nine protein families in three frames. Results of Pfams studies in the Sherlocc program showed that this program has not identified RCCs in the external core antigen (PF08290) and truncated HBeAg gene (PF08290) of HBV. By contrast, the RCCs were identified in gene of hepatitis core antigen (PF00906 and the residues 224 - 234 and 251 - 255), large envelope protein S (PF00695 and the residues 53-56 and 70 - 84), X protein (PF00739 and the residues 10 - 24, 29 - 83, 95 - 99. 122 - 129, 139 - 143), DNA polymerase (viral) N-terminal domain (PF00242 and the residues 59 - 62, 214 - 217, 407 - 413) and protein P (Pf00336 and the residues 225 - 228). In HBV genome, seven RCCs were identified in the gene area of hepatitis core antigen, large envelope protein S and DNA polymerase, while protein structures of TrEMBL entries sequences found in Sherlocc program outputs were not complete. Conclusions Based on the location of detected RCCs in the structure of HBV proteins, it was found that these RCCs may have a critical role in correct folding of HBV proteins and can be considered as drug targets. The results of this study provide new and deep perspectives about structure of HBV proteins for further researches and designing new drugs for treatment of HBV.

Non-suicidal self-harm includes cutting, scratching, burning and minor overdosing. There have been few studies that have examined the rate and pattern of self-harm among different individuals of the society. We performed a population-based study to determine different aspects of non-suicidal self-harm in cases referred to legal medicine organization of Fars Province and south Iran. In a population-based longitudinal survey, we applied data from cases referred to legal medicine organization of Fars province. The survey included questions about the history, method, frequency, age of onset and help-seeking for non-suicidal self-harm. The data about non-suicidal self-harm were collected since 2007 to 2011 and analyzed using students' T-test for continuous data and χ2 for binary or categorical data using SPSS ver. 21.0. Totally 2166 individuals were diagnosed who had ever harmed themselves. Self-injuries such as cutting, scratching and self-hitting were the most common forms of non-suicidal self-harm (83.2%). The mean age of onset was 25.7 ± 2.6 years. Self-injury was more frequent in males and individuals with lower education levels mostly unemployed. The most frequent injury site was posterior side of the body for example shoulders (157; 9.8%) and the most type of the injury was bruise in 398(55.26%) cases. Hard objects (1197; 55.26%) were the most used devices for self-injury followed by cutting and sharp devices. Among those who reported non-suicidal self-harm, 56% had sought help while self-injury. We found a high prevalence of non-suicidal self-harm in different individuals of the society in Fars province since 2007 to 2011. Many mental-health symptoms as well as legal and financial gains should be evaluated for any association with this behavior.

Legal Medicine Research Center, Legal Medicine Organization, Tehran, IR Iran Department of Theology, Faculty of Literature and Humanities Science College, Yasouj University, Yasouj, IR Iran Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Midwifery, Maternal Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran Corresponding author: Marzieh Akbarzadeh, Department of Midwifery, Maternal Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7116474250, Fax: +98-711647425, E-mail: akbarzadm@sums.ac.ir

Organ weight is one important indicator to discern normal from abnormal condition in forensic pathology as well as in clinical medicine. The present study aimed to investigate morphometric parameters and organ weights of southern Iranian adults, which can be fundamental sources to be compared to abnormal cases. Morphometric parameters and weights of 6 organs (heart, liver, kidney, spleen, appendix, and brain), which were harvested from 501 southern Iranian adults (385 males and 116 females) during ordinary postmortem examination, were measured. All the organs were heavier in males than in females. Heart, brain, spleen, and right kidney were significantly heavier in males compared to females, but no significant difference was observed between the 2 sexes regarding the weights of the rest of the organs. Moreover, brain and heart became heavier as one got older and most organs were heavier in middle-aged individuals compared to other age groups. Furthermore, various types of correlations were observed between different organs’ weights and body parameters. These results can be useful anatomical data for autopsy investigations, clinical practices, and research in southern Iran.