International Journal of Medical Toxicology and Forensic Medicine

Background:COPD is one of the common diseases in pulmonary medicine. Current knowledge indicated that there was a link between COPD with thyroid hormonal abnormalities. Thyroid function disturbances can be able to affect on the COPD through upper airway obstruction,respiratory muscle weakness, development of central and obstructive sleep apnea,alveolar hypoventilation, and pleural effusion. Thyroid abnormalities are often both detectable and treatable. The aim of the study is to assessserum levels of thyroid hormones among moderate to severe stable COPD patients.

Methods: 34 men were enrolled consecutive among established and stable COPD patients with moderate to the severe stages. Their selection constructed on the ATS/GOLD guidelines.  Thyroid functions and hormonal concentrations measured according to manufacturer's instructions.

Results:Mean age of sample was 51.7±5.76SD years. It ranged over 42–60 years (Mode=49). Significant thyroid hormonal abnormalities were detected among established moderate to the severe COPD patients. The mean±SD of TSH, TT4 and free T3 concentrations in the focus population was 2.36±1.53 microIU/ml, 12.15±2.15 Micro/dl and 2.20±0.45 pg/ml, respectively. Frequency distribution of thyroid disorders included euthyroid functions 76.5%; three subjects of those had euthyroid sick syndrome, subclinical hyperthyroidism 20.6% and over hypothyroidism 2.9%, respectively. Grades of goiter on WHO classifications observed 0=44% and 1=41%.

Conclusion:Frequent exacerbations of thyroid disorders were detected among stable, moderate to severe COPD patients. Subclinical hyperthyroidism and euthyroid sick syndrome were significant. Despite that prevalence of hypothyroidism is considerable in age-rang of Iranian’s population.

Background:One of the most important health associated problem are events, which burns considered the most common of them. To prevent burn and reduce the complication and mortality rate, accurate information of epidemiology of burn is essential for planning properly.This study was conducted to determine the relationship between environmental and cultural factors and the type, cause and extent of burn injuries admitted to the trauma and burn center of Motahari hospital during 1386 to 1390.

Methods: In this routine data base study, we recruited all burned patients whichreferred to trauma andburncenter of ShahidMotahari hospital between 2007 and 2011. Mainvariables includingeconomic conditions, season ofoccurrenceof the accident,the accident tocurriedonspecial occasions, yearof accident, accidentstatuson holidays, type of injury, cause of injury, injuryseverity, burnarea, anddemographic variables such asage and gender were entered in checklist from patient’s documents.Collected data were entered into softwareSPSS version 11 and were analyzed.

Results:5511 patients were admitted to Motahari hospital during the April of 1386 to the end of 1390, from which 1448 (26.3%) cases were female and 4063 (73.7%) male. The mean age of subjects was 28.47 (SD=1.88).There was significant difference between different gender and etiology, so that men were burned more by oil, gasoline and diesel fuel rather than women.There was significant difference about the number of burned cases by the flame at different seasons of the year. Average number of people burned by gas cylinders,electricity,caraccident,bitumen was significantly different in different seasons.

Conclusion:There were significant differences about burn injuries due to the gas cylinders,bitumen,electricity and car accidents in different seasons and months.To inform burn centers, principalship of these data increases their ability to manage populated and harmful days. According to the higher rate of explosive burn injury in the last month of the year producing harmless explosive materials can be so effective to support patients lives.

Background:Around 800,000 to a million people die by suicide every year, making it the 10th leading cause of death worldwide. According to high rates of suicide and hanging and death due to these reasons in the world and also in Iran,this study was conducted to evaluate cases of suicide by hanging.

Methods: This descriptive cross-sectional study was conducted on 79 cadavers in forensicdissection centerof Shahriar in 2011. Necessary information including age, sex, laryngeal bone fracture, bleeding of soft tissue, number of family members, educational level, marital status, history of depression, addiction, smoking, history of any special disease, location of hanging, leaving any note, ethnicity and suicide intensity  was entered in the checklist and were analyzed.

Results:The mean age of cases was 33.4 (SD=13.62) years. 63 (79.7%) were male and 16 (20.3%) were female.10 (12.7%) patients of the study population were illiterate and 56 (78.9%) were under diploma and only 8 (11.3%) patients had diploma. 17 (23.9%) were unemployed, 5 (7%) were students, 20 (28.2%) were workers, 10 (14.1%) were employees and 15 (21.1%) were self-employment. 23 patients (32.4%) were drug addict. 13 patients (18.3%) had a history of depression. 38 patients (53.5%) were smokers. 56 (78.9%) of hanging were in home and 15 (21.1%) were in outdoors. Suicidal impulses in 33 patients (46.5%) was unspecified, in 10 cases (14.1%) was substance abuse, in 11 (15.5%) was mental disorders, in 6 patients (8.5%) was family problems, and in 7 patients (9.9%) was unemployment.

Conclusion:Given the high rate of suicide, it is necessary to identify the risk factors, to prevent to the extent possible. Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past may also be effective.  Economic development through its ability to reduce poverty may be able to decrease suicide rates. Efforts to increase social connection especially in elderly males may be effective.

Background: Vermiform appendix is different in terms of anatomical position, length and mesoappendix.  Knowing the anatomical position of vermiform appendix is important for the surgeons in terms of diagnosis and management. The aim of this study is analysis of length, anatomical position and mesoappendix of vermiform appendix.

Methods: This is a cross-sectional study on the 400 randomly selected cadavers (306 male and 94 female) who have been referred to the autopsy hall of legal medicine organization of Tehran province to be autopsied between March 21, 2010 and March, 2011. The cause of death was very heterogeneous among autopsied cadavers.

Results:According to our results the anatomical positions were pelvic, subcecal, retroileal, retrocaecal, ectopic and preileal in 55.8%, 19%, 12.5%, 7%, 4.2% and 1.5% respectively. The mean length of vermiform appendix was 91.2 mm and 80.3 mm in men and women, respectively. Mesoappendix was complete in 79.5% and incomplete in 20.5%. No association was seen between sex and anatomical position of vermiform appendix.

Conclusion:Anterior anatomical position was the most frequent vermiform appendix position in our population which is in discrepancy with most of the reports from western countries. It might be possible that factors such as race, geographical regions and nutritional regiment play roles in determining the position of vermiform appendix.

Background:Accidental electrocutions during working activities account for a considerable amount of morbidity and mortality.

Case Report: In this case, the findings were suggestive of a high voltage electrocution but the opinion of the electrical engineer helped the forensic pathologists to ascertain the real mechanism.A labourer was cleaning an abandoned porcelain factory, wearing incomplete protective attires, had a sudden explosion when he attempted to remove an iron pole with a shovel. He was thrown off and lost consciousness.

There were dark brown superficial burns on facing and exposed sides. Areas covered by the helmet, hair and beard were spared. There were burn-free radially arranged elongated areas of the skin around eyes and nose. Eye brows were partially singed and eye lashes were completely burnt.  Inner aspects of both forearms (right more than left) were burnt leaving a horizontal upper margin at the elbow. The right sleeve of the shirt was melted along the fold with blister formation on the skin. Superficial light brown burns were on dorsum of both feet sparing the areas covered by the straps of slippers. 

There were no charring, joule burns or multiple circumscribed and cavitated lesions. Though it was severe explosion involving more energy, the electrical engineer confirmed that it was a low voltage electrical explosion.

Conclusion:Severe flash burns including partial loss of eye brows, complete loss of eye lashes and melting of clothes suggested high voltage electrocution. The electrical expert confirmed a low voltage electrocution and the severity of the explosion could have been due to three phase supply and the close proximity to the transformer.

Background:Methadone is considered as a good choice for maintenance treatment program (MMTP) in opioid addicted individuals. QT interval prolongation was reported previously in methadone chronic usersespecially in high dose prescription. QT-interval prolongation predisposes patients to lethal dysrhythmia. This is a report of corrected QT(QTc) prolongation due to acute methadone poisoning. To the best of our knowledge, in review of literatures, there is no previous report of QTc prolongation in cases that are not on chronic methadone therapy.

Case Report: The patient was a 20 years old man who has occasionally used opium and ice since 8 month before admission. One night before admission he consumed ice and found psychotic state so he was referred to the addiction treatment center and they put him on methadone maintenance treatment with high dose of methadone. After 40 minutes the patient was drowsy and then hypopnea was started. The patient was referred to the hospital and resuscitation was done after naloxone prescription. After stabilizing general conditions the electrocardiograph shows QTc prolongation which was returned to normal status after 2 days. After 5 days the patient was transferred to psychiatric service with normal sinus rhythm and stable condition.

Conclusion:QT interval prolongation in chronic methadone maintenance therapy is defined previously especially in patients on other drugs that interact with the CYP3A4 isoenzyme system and who are on high dose methadone treatment, but it seems that acute methadone intoxication also may prolong the QT interval which should be investigated in future studies.