International Journal of Medical Toxicology and Forensic Medicine

Background: A wheezes is originated from small airway obstruction. Phenotypes of the wheeze have different in causal factors etiology.  Persistent wheeze detects in allergic and atopic disorders. Sulfur mustard (SM) is a potential chemical warfare agent. It can develop small airway diseases (SAD) with wheezes. 

The aim of the study was assessed prevalence of allergic markers and atopic phenotype among sulfur mustard induced small airway diseases with the persistent wheeze in Iranian veteran’s post wartime.

Methods: The study designed in two stages; diagnosis of SM induced SAD and detection of atopic subjects. Skin prick test, Total immunoglobulin E antibody’s concentration in serum and peripheral blood eosinophil count applied on samples of study.

Results: Sixty-three male chemical veterans associated with SAD meet criteria of the study. Chronic obstructive pulmonary disease (COPD) and asthma diseases had prevalently the frequency in focus population. Frequency of allergic status and atopic phenotype was observed in 56% and 22% of study population, respectively. Mean age recorded 45.98±9.99 SD years (ranged 35-67). The Mean±SD of total IgE (TIgE) concentrations and peripheral blood eosinophilia were 283.15±263.86 Iu/dl (range 5-900) and 266.60±240.94. A highly relevant difference in TIgE denoted between allergic and non-allergic subgroups (P<0.001). There were significant differences between allergic status with atopic phenotype (χ<0.001).

Conclusion: The study demonstrated the noticeable prevalence of allergic marker and atopic phenotype among SM induced SAD with persistent wheezes. They markedly distributed in the subgroup of bronchial asthma and COPD asthma-phenotype of target population.

Background: With the advancement of our society, we are able to control death rate by using advanced medical facilities for treatment of natural diseases but certainly we are not able to control the deaths occurring due to the unnatural causes, like deaths due to accidents, suicides and homicides, with hanging being common method of suicide.

Methods: During the 5 years of study period from 2008 to 2012, all the cases of hanging deaths brought to the mortuary of King George’s Medical University were studied with respect to incidence, relationship with sex and age, diurnal variations, manner of death, residence, ligature material and various post mortem findings.

Results: A total 1180 hanging death cases were autopsied with male dominance (54.66%). Most cases belong to 11-30 years age group. Noon and night were most frequent times. Ligature material used most commonly was saree by males and dupatta (scarf) by females. Most cases were from urban background (64.40%). Cyanosis and visceral congestion was found in every case. Most cases were of atypical hanging and suicidal in nature.

Conclusion: Our observation and result conclude that males and young age group population between 15–30 years are more vulnerable victims with suicide as the major contributing cause. This, somehow, indicates frustration and carelessness on the part of population which are preventable and needs to be rectified on urgent basis.

Background: In view of the fact that knowledge and attitudes are important in control of individuals' behaviors and because female sex workers with their multiple sexual relationships are in highly risk to HIV and also an important factor in transmission of AIDS in the community. This study evaluates the female sex workers' knowledge and attitudes toward AIDS.

Methods: This research was cross-sectional descriptive study. The statistical population was female sex workers that were being supported by Welfare Organization in Mashhad (central of Razavi Khorasan province in northeast of Iran) in 2011. Sampling method was census. So the whole of 61 female sex workers were completed questionnaires of knowledge and attitude toward AIDS.

Results: The results showed that the knowledge of the transmission Incubation period and Prevention of AIDS, 64% of subjects were at the low level. The knowledge about methods of transmission of AIDS in the 57% of female sex workers also was low. The subjects' attitude toward prevention of AIDS, their willingness to cooperate in the implementation of preventive programs and their feeling of risk for 18% were negative and attitude of 61% of them were neutral.

Conclusion: Knowledge about transmission, incubation period and prevention of AIDS were in low level. Also their attitude to AIDS's prevention, cooperation in prevention programs and their risk feeling mostly was neutral or negative that can be an alarm.

Background: Traffic traumatism in Bosnia and Herzegovina has not been given adequate attention and there is a lack of serious research on this problem. Motor vehicle occupants represent a significant number of fatalities on local roads. The aim of this study was to identify particular risk groups of traffic participants and determine the differences in injuring due to the position of the vehicle.

Methods: Study included 400 injured and fatally injured occupants among 2009-2013 in Banja Luka. We analyzed of demographic and injury characteristics, cause of death and alcohol intoxication of drivers. Data are presented numerically and in percentages, statistically analyzed.

Results: Men account for nearly 3/4 of the total number of deaths and over 95% of dead drivers. Nearly two-thirds of victims were aged 15-44 years, and one third of injured were in the third decade of life. Drivers more often had AIS3+ injuries of head, chest, abdomen and AIS2+ injuries of thoracic spine and lower extremities. More often drivers and front passengers had AIS3+ chest injuries, while the back seat occupants had AIS3+ head injuries. There was a positive correlation between age and frequency of AIS3+ chest injuries and AIS2+ spinal injuries. The most common cause of death were head (41%) and chest injuries (33.3%). Nearly 3/4 of injured persons were died at the scene of accident or during transport to the nearest health care facility. Nearly 60% of killed drivers had legally prohibited BAC (> 0.3 g/kg).

Conclusion: Men in motor vehicles more often die in traffic accidents, and a particularly vulnerable category is young male drivers. Seat belts using on domestic routes is dissatisfactory and additional efforts are required.

Background: Poisoning is a major public health problem and is one of the most common causes of referral to emergency departments. The aim of this study was to evaluate and define clinical and demographic details of poisoned patients who were admitted to Shahid Beheshti Hospital, Kashan, Iran in 2010.

Methods: In this descriptive-analytical and retrospective study, necessary data were collected from medical records of admitted poisoned patients and were evaluated prospectively and statistically analyzed and presented in the form of tables and graphs.

Results: Of 163 poisoned patients in this study, 47.6% were females and 52.4% were male. 88% of patients were from urban areas and the rest from rural areas. The most common reason of poisoning was suicide 50.6%, while 38.1% were accidental, and 11.3% had a variety of different reasons. Age group of 0-10 years was the most predominant affected group with 26.8% poisoned patients. The most common poisoning agents were clonazepam, acetaminophen, diazepam and methadone. Four patients in the study population died (2.4%).

Conclusion: The medications are the leading causes of poisoning, especially in children. Therefore, parents are advised to keep the medicines correctly, out of sight and reach of children, read the label carefully; learn about their safety and the right way of their use. It is also recommended to immediately dispatch the poisoned child to the emergency department. Giving the crucial information about the poisoning to help the medical staff to treat the child effectively and quickly, reduce the hospitalization period, and possibility of child death.

Background: Domestic violence is the most popular form of violence against women. Phenomenon of In the Declaration on the Elimination of Violence against Women-1993 (DEVAW), was introduced as a barrier for reaching equality, development and peace. The objective of this research was to study individuals’ lived experiences, especially the experiences of women exposed to violence in Iran.

Methods: This research is a descriptive research which employs a systemic review. The statistical population consists of all the qualitative studies conducted in Iran to consider the physical violence against women. To collect the data, Persian keywords for violence against women, domestic violence, wife abuse, violence against spouse and spouses who were beaten were searched in the Iranian online databases including SID, Irandocs, Iranmedex, Iranpsych, and Magiran. As the result of this search, 27 qualitative studies were selected which were exactly dedicated to the domestic violence from the viewpoints of men, women and experts. Then, the repetitions and the studies which were conducted before 2001 were excluded. After close reading of all the researches 10 of them were eventually selected.

Results: The most reported items after studying the individuals’ lived experiences of physical violence against women in Iran included patriarchy, drug abuse, inappropriate sociability, lack of men’s mental stability, deficiency in communicative skills between the couples and ignorance of each other’s mental and sexual needs. The most reported strategies also encompass inactive and inefficient approaches such as keeping quiet but preoccupied with the problem, filing complaints, not being on speaking terms for a long while, revenge and deprivation of intercourse.

Conclusion: This social issue should be also studied like all other social issues as a multi-dimensional phenomenon in the social context.

Background: Stem cell research has emerged as one of the most promising research areas in modern biomedicine. However, despite much promise the use and derivation of these cells in many countries is ethically challenging. Stem cell laws are the law, rules, and policy governance concerning the sources, research, and use of stem cells in treatment of human diseases. These laws have been the source of much controversy and vary significantly by country.

Methods: Google search was used to find information on the Web about stem cell research in world countries and Iran.

Discussion: An ethical guideline in Iran has been recently approved. In compiling this guideline the accumulated experience of the governments and Islamic laws and Persian culture and special look to human health as well as the moral status of the human embryo has been used. Some part of this guideline is licensed research can only take place on embryos created in vitro: embryos that have developed from eggs fertilized outside the body. Most embryos used in stem cell research are embryos that initially created in order to use in fertility treatment, but not used. These 'surplus' IVF embryos, if donated with the full consent of the parents, can be used for research.

Conclusion: We propose a regulatory framework based on this moral guideline one of our suggestion for regulation of stem cell research is legal medicine organization.

Background: Dog bite is one of the most common childhood accidents causing significant morbidity and mortality in pediatrics age group (1). The exposed position compounded by the short stature of children makes the face very vulnerable to dog bite or animal bite injuries. Unlike wounds inflicted by assaults and accidents, animal bite wounds are distinctive as they are puncture type deep wounds which are injected by the bite force, with inoculums of pathogenic bacteria from the saliva of the attacking dog.

Case Report: A case of a 2 month-old child who had succumbed to multiple facial and head bite injuries is presented. At autopsy, multiple bite wounds were noted on the upper part of body like face, head, chest and abdomen. Distinctive bite marks diagnostic of canine dentition were present, most prominently on the head, face and chest. Death was due to cranio-cerebral damage.

Conclusion: Public health notification should occur for all dog bites. This would facilitate the development of regional dog bite registries with information on incidence and dogs at risk, which in turn could guide policies such as leash laws and licensing.

Background: Sedative drugs are important in many ways in medicolegal practice. They are used to subdue or alter the mind of a victim and also such drugs themselves can cause death. These drugs are used in robberies as well as in murder cases.

Case Report: Two averagely built healthy parents were found dead on bed with deep cut injuries to neck, with minimal evidence of volitional activities and defense injuries. An involvement of a poison was suspected. The elder daughter had felt a bitter taste of the dinner and kept it in the refrigerator at that night. The dinner was sent for toxicological investigations. Causes of deaths were cut injuries to neck. At the same time, the investigators found out that the younger daughter had mixed diazepam to dinner and her boyfriend and 4 others killed the parents. A film they had watched had influenced them to initiate this incident.

Conclusion: Two well-built conscious adult victims in sober state should have received at least few defense injuries or leave evidence of volitional activities. In such circumstances, intoxication with drugs or incapacitated with other means should be considered by the forensic pathologist.

Self-embedding is a form of self-injury where foreign objects are inserted underneath the skin. Though it is reported in scientific literature, it is not being reported in forensic literature.

In the year 2010, a housemaid returned from Saudi Arabia with 24 nails and needles in her body. After arrival, she had not informed that she had been tortured by the employer.      

In the year 2013, another Sri Lankan housemaid from Middle East admitted to hospital with needles in her body alleged that needles being inserted by her master.  X-rays showed 4 needles in her face and limbs, placed parallel to the skin surface. She would have self-embedded these needles in a way to escape from employer.    

There are cases of self-inflicted injuries in people with Munchausen syndrome, where people simulate trauma or illness in order to draw attention.

In conclusion, ‘the medico-legal significance of self-embedding of foreign objects’ is a new concept where the forensic physician has to exclude ‘torture’ by a third party before ascertaining the concept of self-harm. Multiple foreign objects, found parallel to body surface, at accessible sites and accessible directions to push foreign bodies between the thumb and index finger favors self-embedding.