Tehran University Medical Journal

Background: The death certificate is a document consisting of the deceased individual’s basic information and identification which is filled out, registered and signed by a doctor. the World health organization’s policies in their health planning, provide a suitable database with knowledge of the required elements for planners and other authorized information demanders. During a multi-year cooperation between various organizations, the first uniformed death certificate according the ICD-10 standard got published in the country in the year 2004.
Methods: This is a retrospective study which is about all of the deceased individuals in  Tajrish and Modares Tehran hospitals from april 2013 until the march 2014 who had death certificates. In this study the data related to 777 individual’s death certificates and medical files was analyzed. The sampling method was census and all the cases in the study’s time period who had death certificates were studied. The cases that had a gap in their required information were ruled out of the study. The data that included age, sex, place of death, issuing doctor’s expertise, general information and the cause of death was extracted from the archived files.

Background: In forensic anthropological identification, we usually use body remains. Accurate sex estimation from these remains is very important and needs the knowledge of specific population standards of that area. Sometimes, human remains are damaged by environmental circumstances. So, we must examine single bones for sex estimation. One of the relatively resistant bones to environmental conditions are hand bones. Specific hand phalanges and metacarpals have significantly different dimensions in two sexes depending to each population and can be a helpful tool to estimate the gender of individuals. The aim of this study was to investigate the possibility of estimating gender using phalanges and metacarpals dimensions in Iranian people.
Methods: This prospective study was conducted on the X-ray images of adult people hands between the months of March and September 2017. They referred to Shafayahyaian Hospital, the educational and referral center of orthopedic disease of Iran University of Medical Sciences, in Iran. 200 adult persons (100 male and 100 female) without any background of specific disease, entered in our study. In each case, the length of D: distal phalanx, M: middle phalanx, P: proximal phalanx, MC: metacarpal, Fl: finger length, and T: total (Distal phalanx+middle phalanx+proximal phalanx+soft tissue of the finger tip) were measured in millimeter and reported in ratio. All analyses were done using SPSS software, version 20 (SPSS Inc., Chicago, IL, USA).
Results: Student t-test showed that many ratios were significantly different between two genders. It is concluded that the length ratio of metacarpals and phalanges could be used for sex determination. The most valuable ratios were FL1/FL3 and MC4/MC5. Multivariate logistic regression test reported an equation by which the gender is predictable. Z= 5.856+ -3.904 X FL1/FL3+ -1.865 X MC4/MC5.
Conclusion: If “Z=0”, the gender is male and if “Z=1”, it is female without any doubt. In our knowledge, this study provides the first population sex estimation formulae from the hand bones in Iranian population. However, we need further studies in larger groups to use this equation for sex determination in forensic contexts.

Background: Trauma is one of the main causes of maternal mortality and morbidity in societies, which annually causes millions of deaths worldwide and imposes a high financial burden on health facilities, the purpose of this study was to determine the frequency of physical trauma and its associated factors during pregnancy.
Methods: All data for this cross-sectional study were collected from medical records of pregnant women, who referred to the Mahdeeyeh Hospital in Tehran, Iran, as a result of trauma through 2015. Information related to the pregnant women with trauma was extracted from their medical records based on a researcher-made collection form. All patients who meet criteria for entering the study (based on entry and exit criteria from the study) were selected as samples. The significance level of the tests was considered as P<0/05, the Spearman correlation coefficient tests and Chi-square were used.
Results: A total of 68 people were enrolled on the basis of selected criteria, meanwhile, the mean age of subjects was 26 years and 100% had no history of abortion. In all cases the trauma was blunt and included 63% abdominal, 24% lower back, and 14% flank trauma. Abortion was reported in 3% and 8% of the cases with abdominal and lower back trauma, respectively. Also, according to the results of this study, in cases where the placental abruption (six cases) were lateral face pairs, in all of them physical trauma was also posed. It is necessary in the traumatic pregnant women referring with placental abruption symptoms and sign, due to the legal importance of doing a thorough examination and sonography, the type of placental abruption (lateral or central) is made sure and then documented in patients' files.
Conclusion: Physical trauma also is common in the pregnant women and the lateral aspect placental abruption can be one of the obvious evidence for physical trauma.

Background: Methotrexate is an anti-metabolite drug and one of the folic acid analog that it can play an important and functional role in the treatment of many malignancies and inflammatory diseases. However, the development of petechiae (maculopapular rash) is a very rare complication.
Case Presentation: The patient was a 77 years old woman, Aryan race, who was known a case of severe and progressive rheumatoid arthritis. She previously was treated by multiple drugs such as salicylates, gold, corticosteroids, because of unresponsiveness to these drugs, physician prescribed methotrexate once a day, but patient misunderstands and use three times per day for days. Patient with this history referred to a poisoning emergency. In a physical exam, she had oral and throat erythema and swelling of mucosa. In the funduscopy of eyes, bottom of the eyes was normal and conjunctival eyes were prurient she had multiple petechiae at the upper part of chest and base of neck and shoulders and arms with no swelling around petechiae. The lesion had no itching. She had no other sign besides laboratory analysis showed a high level of creatinine, leukopenia, decreased the level of platelets, patient with high suspicious of methotrexate poisoning underwent to granulocyte-macrophage colony-stimulating factor (GM-CSF) and folic acid treatment. After treatment all of her signs recovered and laboratory tests became normal.
Conclusion: At the time of taking methotrexate by the patient, even with appointment of a specialist physician, with any skin signs such as maculopapular rash without itching, we should consider poisoning with methotrexate, and think appropriately about it. This suggests that methotrexate can cause side effects even at low doses.

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: 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: 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 patient's death.

Background: Lightning is one of the most mysterious phenomena of nature that also, it has caused many financial and human losses. In tropical and sub-tropical countries, death due to thunderbolt is not unusual, and even tragic events may occur at high altitudes. Lightning physics is complex and not completely clear. Usually, the clouds are heavily pregnant and high voltages and amperages, they drain their load over earth through a massive arc. The death by lightning is naturally a component of the accident and does not pose a particular problem to the legal pathologist. But sometimes the body is found outdoors without special signs, and there may be doubts about death. The damage caused by the lightning is unpredictable and accidental.