International Journal of Medical Toxicology and Forensic Medicine

Background: Tramadol is a synthetic opioid used to control chronic pain and pain after surgery. However, many cases of poisoning and dangerous side effects have been reported. In order to discover the causes of death in forensic medicine is usually examine tissue samples taken from the body, although the results of toxicology tests generally give us more information, but identifying the pathological effects of Tramadol on the internal organs, especially the livers can be very helpful.

Methods: In this cross-sectional study, information on the history, the autopsy report and toxicology testing of patients who died due to poisoning Tramadol were studied. In this study, all of the information already provided by the use of particular forms collected and then analyzed using computer software SPSS.

Results: A total of 49 cadavers were examined in this study. There were 39 dead (80%) of men and 10 of (20%) women. Most common age groups in the study were 24 to 34 years old (41%), 15 to 24 years old (39%), were reported. There were significant difference between liver microscopic spread among different ages, history of Tramadol, positive and negative toxicology tests stomach contents, urine, blood, tissue and vitreous. Most common pathological changes were in liver, degenerative changes and inflammatory cell infiltration in patients who under 35 years old.

Conclusion: In this study, the majority of patients had acute poisoning with Tramadol, it can be concluded that the majority of changes in tissue obtained was as a result of acute Tramadol, respectively incidence of atelectasis and edema and alveolar bleeding in the liver were most pathological findings. In reviewing toxicology, Tramadol are also present in the stomach contents, urine, gall bladder, liver and blood were positive, the result of stomach contents will be most helpful for us.

Background: The UNESCO, in the case of children's rights, has stressed that a child has a right to live in the best possible condition of health and hygiene as well as a safe and un-risky environment. Evaluation of the reasons for the death and mortality of children and adolescents can prevent similar deaths. The aim of this study was to evaluate the reasons of mortality among children and adolescents in Lorestan province.

Methods: This cross-sectional study was conducted on children and adolescents (younger than 18 years old) in Lorestan province, west of Iran, in the period of 2007-2014 in Lorestan Legal Medicine Research Center. The demographic data of dead individuals, including age, sex and cause of death, were studied. The main reasons of death were classified in four main groups of trauma, asphyxia, poisoning, and miscellaneous causes (including physiological disease, infant insufficiency, cancer, and unknown cause). The data was analysed by the SPSS software (version 17). P value <0.05 was considered statistically significant.

Results: In the period of 2007 to 2014, 1115 children died in Lorestan province, consisting of 634 (56.8%) boys and 481 (44.2%) girls. The highest mortality rate was observed in 15 to 18 year age group (n= 395, 35.4%). The most prevalent reasons of death were different types of trauma (65.3%), asphyxia (18%), miscellaneous causes (10.8%) and poisoning (5.8%).

Conclusion: The outbreak of death and mortality in children and adolescents following trauma and accidents in our country seems significant in relation to the developing countries and few of the neighbouring countries. Considering the ability to carry out the preventative measures in this field, instantaneous policy making is needed in order to eliminate the present defects in the security provision to this group of society.

Background: Dental identification mainly involves the comparison of antemortem and postmortem records. Keiser-Nielson (1980) recommended restored tooth surfaces as the smallest unit to consider in the comparison of dental restorations for identification purposes. Unique appearance of radiographic images of amalgam has led to their application in dental forensic. The present study aimed to investigate the value of composite restorations and their features in forensic identification.

Methods: The antemortem sample included 40 periapical radiographs of anterior teeth with class III composite restorations which had been taken at least one year before the study. Ten randomly selected recent radiographs of the same subjects along with two radiographs from other patients were regarded as postmortem samples. Afterward, 12 dentally trained examiners were asked to match the 12 radiographs of group 2 with those of group 1 and to determine which features of the teeth (e.g. shape, contour, and surface) had helped them.

Results: Ten examiners were able to correctly match all of the 12 images. According to kappa coefficient, the inter-rater agreement was high (0.8-1.0). The shape of the restoration was the most useful feature in identification.

Conclusion: A composite restoration has a unique radiographic morphology that can be used for human identification. Therefore, if the antemortem radiograph of a single composite restoration is available, its comparison with a postmortem radiograph can help identify unidentified human beings.

Background: Analysis of the leading causes of death in a community and comparing it with other communities is crucial for planning public health policy. The aim of this study was to determine mortality statistics in South Khorasan Province of Iran by using causes of death data which are classified based on the 10^th revision of the International Classification of Diseases (ICD10).

Methods: In this cross-sectional study, data related to 20281 deaths for the period of 2004 to 2010 which were under the coverage of Birjand University of Medical Sciences were used. These data were collected by the office of statistical system of mortality (Death Registry) and the causes of deaths were classified based on ICD10. The obtained data was analyzed statistically with Pearson's Chi-square (χ2) test, t test and ANOVA in order to find out the pattern of mortality trend in South Khorasan Province.

Results: Cardiovascular diseases (CVD) were the leading cause of death (29.8%) with the mean age of 72.6±15.5 in all registered deaths. Moreover, ischemic heart disease (44.87%) and cerebrovascular disease (25.67%) were the most common causes in CVD group, respectively. The second leading cause was unintentional injuries (12.9%) which are mostly due to road traffic accidents. The mean age in this group was 36.8±24. Cancers ranked the 3^rd place during the period of study with the mean age of 64.86±18.26. The most frequent cancers are related to stomach (15.3%) followed by liver and biliary system (11.4%), lungs and bronchus (9.5%).

Conclusion: Three leading causes of death were cardiovascular diseases, unintentional injuries and cancers which may be prevented by changing life style, diet and reducing risk factors like smoking, obesity and stress.

Background: In resent years, crime rate has been increased.  The aim of this study was to evaluate the computer assisted hand tracing overlay method for bite mark analysis.

Methods: Impressions of both, maxillary as well as mandibular arches of 50 consenting volunteers were taken and dentition casts were prepared. Tracing by hand was manually done, and computer assisted overlay comparison was carried out.

Results: Out of 2500 cross matches, expected result should have been 50 true positives and 2450 true negatives. In our study there were 38 true positive, 2406 true negatives, 44 false positive and 12 false negative matches in maxillary comparison, 44 true positive, 2424 true negatives, 26 false positive and 6 false negative matches in mandibular comparison and 31 true positive, 2446 true negatives, 4 false positive and 19 false negative matches when complete dentition (maxillary and mandibular) comparison was done. Hence this method showed significantly high false positive and true negative cases.

Conclusion: We conclude that this computer assisted hand tracing overlay method for bite mark analysis helps in arriving at an exclusion rather than inclusion type of identification, owing to its high true negative cases.

Background: One of the most important issues affecting the stability of marriage is sexual function, so its problem can lead to divorce or separation of the couple. Pregnancy and delivery as one the most important periods of women's life can have significant effects on sexual function. This study reviews the postpartum sexual function and its related factors in Iran.

Methods: This study is a systematic review of the sexual function after childbirth in Iran. By using of valid keywords and searching in databases such as Google scholar, SID, Magiran, Medlib, Irandoc, Iranmedex, the total number of 15 articles between 2005 and 2012 years have been evaluated. Results were reported quantitatively and qualitatively.

Results: Total Sample was 4109 women, with an average of 274 samples per study. Plenty of studies in Tehran was 46% and other cities was 54%. The majority of studies showed no relation between mode of delivery and sexual function (P=0.14), but there were significant relation between lactation and postpartum sexual function (P<0.05) as, breastfeeding decreased sexual function. Also sexual function score has decreased with increasing parity.

Conclusion: According to the effects of lactation and parity on women sexual function, therefore high risk for divorce, sex education after childbirth, especially in the first six months after delivery, maybe helpful in prevention of sexual dysfunction after delivery.

Background: Identification is the determination of the individuality of a person based on certain physical characteristics. It is the process of exact fixation of personality. In partial or incomplete identification, certain facts are determined, such as; race, age, sex, stature and etc., while other characteristics are not known.

Case Report: Unknown skeleton came to the department of forensic medicine, Institute of Medical Sciences, Banaras Hindu University, and Varanasi in 2015 for the purpose of identification and to determine the cause of death. It was estimated to be a male of age 25-35 years with a depressed comminuted fracture along with two other antemortem fractures in the skull. So, based upon the type of skull fracture found, the most likely cause of death was opined to be coma as a result of head injury. Time since death was estimated to around 3-4 weeks based on the ambient temperature being 40±5ºC, entomology and semi-skeletonised condition of the body.

Conclusion: The case has been reported in view of the fact that an unknown body with a little history came to us mainly for the purpose of identification had eventually turned out to be a case of possible homicide. Hence, a thorough examination of each and every case is recommended.

Background: Homicide followed by the perpetrator's suicide commonly seen in dyadic death. The time lag between homicide and suicide is very less. Dyadic deaths are rare in occurrence and their nature varies in each case. Also, the causes of death in suicide and homicide are different but it may be same in few cases. Perpetrators are usually male and always use weapons that are easily available in their vicinity for homicide and suicide.

Case Report: We received two calls, one hour apart from a local police station in South Mumbai, regarding death due to firearm injuries. At the first crime scene, we found a forty-year policeman with a contact shot over the right temporal region. Subsequently, we visited second crime scene that was 100 meters away from the first crime scene. We observed a forty-eight-year-old female with contact shot over the sternal region. Initially investigating authorities mystified over two deaths due to the firearm. We collected evidence from crime scenes. We performed autopsies at the tertiary care teaching hospital. We studied role of perpetrator dyadic death and constructed a crime scene.

Conclusion: Meticulous efforts revealed a dyadic death i.e. murder followed by suicide due to an extra-marital relationship and monetary dispute. Also, the misuse of service pistol (issued by police department) by the perpetrator for killing the victim and himself.

Background: Male external genitalia comprising penis and scrotum though exposed externally, being a mobile anatomical structure are less prone to injuries during a vehicular accident. Injuries are reported usually during sports activities, violent sexual acts and sometimes vehicular accidents. Injuries to scrotum, penis or adjoining structures may lead to temporary or permanent impotence or infertility or both.

Case Report: A 53 years old male sustained injuries as a result of accident with a car while he was walking along the roadside. He was brought immediately to a tertiary care hospital and was treated by a quick response team of doctors in emergency department. Despite of all resuscitative measures by expert doctors, he could not be revived. Autopsy revealed enlarged bluish red colored scrotum with loss of rugosities associated with multiple other injuries. On dissection of scrotum, it was showing a dark red colored hematoma covering whole scrotum. Most frequently, hematoma covering whole scrotum is due to rupture of tunica albuginea, with tunica vaginalis pooling to the epididymis. Death in this case was attributed to scrotal injury.

Conclusion: Even though blunt trauma is the commonest mechanism causing about 85% of scrotal trauma, it is often missed on routine autopsy procedure. At least in cases of instantaneous death following a vehicular accident, scrotum must be properly examined.

Background: Elderly abuse is a prevalent entity in the Indian society. Apart from physical and verbal abuse, neglect is very commonly seen in families with disputes. Neglect as a form of elderly abuse rarely comes to light as many people are not forthcoming to disclose these aspects due to social stigma associated with it.

Case Report: Here is a case of an elderly male who committed suicide to end his misery of unresolving dysphagia as stated in his death note.

Conclusion: An oesophageal leiomyoma was incidental finding at autopsy which explained the symptoms mentioned in his death note which drove him to desperation to end his life.

Background: Webbed penis is a rare congenital anomaly of penis which can be presented in late childhood or adolescence. It can be present in isolation or can also occur in combination with hypospadias, chordee, and micropenis.

Case Report: A 42-years old unmarried male, working as tailor was brought by police with alleged history of sexual assault with 6 years old girl. On examination of penis and scrotum, the penoscrotal fusion extending from the preputial skin to the scrotal wall was seen suggestive of simple type, grade-03 webbed penis.

Conclusion: In cases of alleged accused of sexual offences having webbed penis without having any other penile deformity will not to be considered as legitimate cause of impotency.