Iranian Legal Medicine Organization Research Articles

Mortality and Years of Life Lost Due to Occupational Injury in Iran (2012-2016).

Occupational injury is a cause of premature mortality, mainly in low- and middle-income countries. Occupational injuries estimated to kill more than 300,000 workers worldwide every year. We estimated the years of life lost (YLL) of fatal unintentional occupational injuries in Iran for the five years of 2012-2016. A cross-sectional study. To estimate the YLL, registered deaths due to occupational unintentional injury were identified from the Iranian Legal Medicine Organization. Estimated YLL was calculated according to Global Burden of Disease 2010 guideline. Population life expectancy in each corresponding years was retrieved from the national health database. All data collected entered into Excel software for calculations. In 2012-2016, fatal unintentional occupational injuries were the cause of 8,606 deaths in Iran, resulting in 4.6 prematurely lost life yr per 1000 males and 0.3 yr per 1000 females among workers, every year. 98.7% of the deaths occurred in males. Males from 15 to 19 yr of age and females from 10 to 14 yr of age showed the highest YLL rates. The rate of YLLs per 1,000 workers per year was 3.99 overall, 4.6 in males, and 0.4 in females. Premature mortality due to occupational injury is still a serious problem in the Iranian population. Our findings may be useful from a health policy perspective for designing and prioritizing interventions focused on the prevention of premature loss of life. Known prevention strategies need to be implemented widely to diminish avoidable injuries in the workplace.

Maternal and Neonatal Complications Leading to Midwifery Errors in Referred Cases to the Iranian Legal Medicine Organization and Medical Council of Forensic Medicine from 2006 - 2011 in Isfahan, Iran

Maternal and Neonatal Complications Leading to Midwifery Errors in Referred Cases to the Iranian Legal Medicine Organization and Medical Council of Forensic Medicine from 2006 - 2011 in Isfahan, Iran

Income-related inequality in completed suicide across the provinces of Iran.

OBJECTIVESThe aim of this study was to measure income-related inequality in completed suicide across the provinces of Iran.METHODSThis ecological study was performed using data from the Urban and Rural Household Income and Expenditure Survey-2010 conducted by the Iranian Center of Statistics, along with data on completed suicide from the Iranian Legal Medicine Organization in 2012. We calculated the Gini coefficient of per capita income and the completed suicide rate, as well as the concentration index for per capita income inequality in completed suicide, across the provinces of Iran.RESULTSThe Gini coefficients of per capita income and the completed suicide rate in the provinces of Iran were 0.10 (95% confidence interval [CI], 0.06 to 0.13) and 0.34 (95% CI, 0.21 to 0.46), respectively. We found a trivial decreasing trend in the completed suicide incidence rate according to income quintile. The poorest-to-richest ratio in the completed suicide rate was 2.01 (95% CI, 1.26 to 3.22). The concentration index of completed suicide in the provinces of Iran was -0.12 (95% CI, -0.30 to 0.06).CONCLUSIONSThis study found that lower income might be considered as a risk factor for completed suicide. Nonetheless, further individual studies incorporating multivariable analysis and repeated cross-sectional data would allow a more fine-grained analysis of this phenomenon.

Prevalence of Chlamydia pneumoniae Infection in Atherosclerotic Plaques of Corpses Referred to Iranian Legal Medicine Organization, Tehran

Prevalence of Chlamydia pneumoniae Infection in Atherosclerotic Plaques of Corpses Referred to Iranian Legal Medicine Organization, Tehran

Placenta Accreta at 15 Weeks of Gestational Age and Uterus Preservation with Hysterectomy Abortion

: Placenta accrete refers to an abnormality of placental implantation in which the anchoring placental villi attached to myometrium rather than decidua resulting in a morbidity adherent placenta. Placenta increta (chorionic villi penetrate into the myometrium) and placenta percreta (chorionic villi penetrate through the myometrium to the uterine serosa or adjacent organs) are related, but more severe, abnormalities of placental implantation. The pathogenesis is primarily attributed to defective decasualization of the implantation site. Placenta accreta has been recognized mostly in the third trimester however may also present in second trimester. It has very heavy, life-threatening hemorrhage to both the mother and fetus. The authors’ report a patient with two previous cesarean deliveries, who had been referred for pregnancy termination from Iranian legal medicine organization with 15 weeks of gestational age and placenta acctera. In this patient, uterus preservation and hysterectomy abortion was performed. The case totally lost 1500 cc blood and she was discharged from hospital two days later, with feeling of well- being. We have examined this patient after 1.5 months, she wasn’t vaginal bleeding and the uterus was in the pelvic and serum BHCG (with titer) was negative.

Silent Change of Suicide in the West of Iran (Kermanshah): Joinpoint Regression Analysis

Background: Suicide in Iran is more or less the problem of the western region of the country. Although previous studies have described the features of suicide, they didn’t study the trends through reliable methodology. Objectives: We study changes in temporal trends of suicide mortality in the west of Iran using joinpoint regression analysis. Methods: This is a cross-sectional study. Data for all registered suicide cases in western province of Kermanshah in Iran during 2003 - 2014 was retrieved from the death registry of Iranian legal medicine organization. After direct standardization of the rates, we analyzed data by joinpoint regression analysis to discover the main changes of the trends. Results: Overall suicide mortality has increased from 10.6 per 100,000 in 2003 to 12.4 in 2014, which equals to 1.5 % (+0.1 - + 2.8) annual percentage change (APC). Increase in suicide rate for women was remarkably higher than men (APC = 4.5 for women and 0.5 for men (P value < 0.001)). Majority of increase belonged to age group 20 - 29 in women and 30-39 in men. Old men have an increasing trend during the last decade. Hanging constantly increased in both genders with APC of 4.2 (+1.9 - + 6.5) while self-burning decreased after 2006 in women with APC of -5.9 (-12.6 - + 1.2) and poisoning increased in 2011 in men with APC of 17.0 (-4.0 - + 42.5). The number of suicide death in married couples has increased for both genders while for single women decreased in 2007. For women, suicide in low educated or illiterate decreased and in high educated increased, while in men it increased in both educational levels. Conclusions: Suicide in the west of Iran has increased slightly during 2003 - 2014 with remarkable differences for men and women. Suicide in old men and women has increased profoundly and may be due to losing their familial and social support in modern life. Pattern of suicide in women has changed dramatically from most rural, uneducated, and self-burned to most urban, high educated, and hanging use form.

Claims about medical malpractices resulting in maternal and perinatal mortality referred to iranian legal medicine organization during 2011–2012

Background:Obstetricians, gynecologists, and midwives are the most common specialists of the medical sciences group against whom medical malpractices are claimed, many of which are avoidable and preventable. Therefore, the present study was conducted to investigate the causes of claims regarding medical malpractices resulting in maternal and perinatal mortality.Materials and Methods:A descriptive cross-sectional study was conducted and 7616 claims of medical malpractices in the field of obstetrics, gynecology, and midwifery that were referred from all 31 provinces to the central commission of legal medicine were studied during 2011–2012. Therefore, the present research is a national inclusive study covering all the provinces across Iran. To collect information from the transcript of medical malpractices cases, a researcher-made checklist was used, and the collected data were analyzed.Results:The results of the present study showed that among all the medical malpractice claims regarding pregnancy and childbirth (42.24%), the majority concerned perinatal death (71.82%) and maternal death (28.16%).Conclusions:Medical malpractice complaints are increasing; although, most of these claims are preventable. To achieve this aim, it is necessary for obstetricians, gynecologists, and midwives to try to reduce the complaints by paying more attention to the signs and symptoms of diseases, performing all the diagnostic and therapeutic measures according to the scientific criteria, and fully document patients' records. In addition, patients' acquaintance with the importance of measurements and examinations, before and during pregnancy care and even after childbirth is crucial.

Investigation of Lethal Poisonings among Dead Bodies Referred to Regional Office of Iranian Legal Medicine Organization in Shiraz

Background:Death due to acute poisoning is of medical, legal and social significance. This study was designed to investigate lethal poisonings among dead bodies referred to a regional office of Iranian Legal Medicine Organization (ILMO). Methods:This was a retrospective descriptive-analytical study on dead bodies referred to Fars province regional office of ILMO in Shiraz, Iran, during April 2013 to the end of March 2014. For data analysis, only subjects with poisoning as the definitive cause of death were included. Results:During the study period, 2,594 autopsies were conducted in Fars province office of ILMO, among which poisoning was found to be the cause of death in 147 autopsies (5.7%). Eighty-eight cases (59.9%) were men. The majority of subjects aged 20 to 30 years (50.3%). The greatest number of subjects (73.5%) was unmarried persons. Regarding the occupation, most subjects were unemployed (49.7%) followed by housewives (19.7%). Over half of the cases (54.42%) had died within less than 6 hours after the poisoning. The majority of cases were found dead at home (73.5%), while the rest had died in outpatient department or hospital wards. Suicide cases were far more common than unintentional cases (75.5% vs. 24.5%). Suicidal intention was significantly higher in subjects with lower educational status (P = 0.033). The most common causes of poisoning were pharmaceutical products (66.7%) followed by aluminum phosphide (10.9%) and other types of pesticides (7.2%). Conclusion:Lethal poisonings is mostly seen in young adults, and those with lower educational level and unemployment. Suicidal intention is the main cause of lethal poisonings.

Toxicologic Laboratory Findings in Cases Reported with Hanging Death: a Two-Year Retrospective Study in Northeast Iran

Background: Suicide is one of the leading factors of death worldwide. Hanging is one of the most common methods of suicide. This study was designed to evaluate post mortem toxicology laboratory findings of subjects with hanging death in northeast Iran. Methods: This study was carried out on reported cases with hanging death to Razavi Khorasan Province-General Office of Iranian Legal Medicine Organization during 2009 to 2011. In this study, toxicologic investigations were performed on urine samples using thin layer chromatography and gas chromatography mass spectrometry techniques. For cases which required confirmation, another sample was also obtained from blood or the vitreous. Autopsy and scene investigation findings were also studied and entered into a predesigned checklist. Results: In total, 94 men (90.4%) and 10 women (9.6%) were studied. Suicide was proven in one hundred and one (97%) corpses and according to primary scene investigations and autopsy findings three (3%) cases were highly suspicious of non-suicidal events which eventually were clarified with the help of toxicology tests. No drug metabolites, substance or ethanol were noticed in 68 (65%) cases. Among 36 cases with discovered substances, morphine was the most common substance which was found in 27 (75%) cases. Ethanol and codeine came next and were reported in 9 (25%) and 8 (22%) cases, respectively. After plotting discovered substances against age groups, it was found that the presence of ethanol was significantly higher in younger individuals (P = 0.04). Conclusion: Although the nature of hanging death can be clarified by scene investigations, performing postmortem toxicology tests are also crucial to specify suicidal, homicidal or accidental background. In this study morphine was the main substance found in suicidal hanging cases. Hence, the abuse of opioids can be considered as one of the major risk factors of committing suicidal hanging in Iran.

Epidemiology of Circumcision-Related Mortality in Iran: A 10-year Survey.

Epidemiology of Circumcision-Related Mortality in Iran: A 10-year Survey.

Prevalence of pituitary incidentaloma in the Iranian cadavers

Although one-fourth of the pituitary tumors are inactive and silent, increased total volume of the pituitary gland exerts pressure on sella turcica and corrodes the clinoid processes, resulting in several problems. Therefore, determination of the prevalence of the concealed pituitary tumors is of major concern among clinical practitioners. This study was performed to determine the prevalence of these tumors in cadavers referred to the Iranian Legal Medicine Organization (Kahrizak, Tehran). This cross-sectional descriptive study was performed between June 2007 and February 2008. A total of 485 cadavers were selected by simple random sampling method. Pituitary glands were removed and then horizontally cut and four slides were prepared from each of them, stained by hematoxylin and eosin, and evaluated by a light microscope. For statistical analysis, SPSS software (version 16), Mann-Whitney U test, Kolmogorov-Smirnov nonparametric test (K-S test), and Chi-square test were used. Of the 485 investigated cadavers, 365 (75.3%) were males with an average age of 42 ± 20.5 years and 120 (24.7%) were females with an average age of 44 ± 22 years. A total of 61 (12.6%) had concealed pituitary masses. No statistically significant difference was found between the mean age, sex, and body mass index (BMI) of the cadavers with and without concealed tumors (P=0.380 P=0.450, and P=0.884, respectively). In the present study, the prevalence of the concealed pituitary adenomas was 12.6%. There was no correlation between age, sex, and BMI and the prevalence of the concealed masses.