International Journal of Medical Toxicology and Forensic Medicine

Background: Traumatic asphyxia occurs when a powerful compressive force is applied to the thoracic cavity. This is most often observed in motor vehicle accidents, industrial and farming accidents, as well as the collapse of bridges, mansions, and during stampedes.

Methods: During the period of October 2016 to May 2018, 33 cases of traumatic asphyxia were recorded in the Varanasi district autopsy center, i.e. the Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Utter Pradesh State, India. We conducted a prospective study on these incidents.

Results: The incidence of traumatic asphyxia is irrespective of gender. However, men are more viable to it due to their outdoor activities. In the present study, males outnumbered females in the distribution of cases. The external and internal features in combination were congestion 26(78.8%), cyanosis 25(75.0%), and subconjunctival hemorrhage 10(30.3%). In the internal examination, rib fracture with flail chest was recorded in 5(15.2%) cases.

Conclusion: Accidental death as a result of traumatic asphyxia is a major contributing factor to violent asphyxia. It results in asphyxia due to the compression of the chest by an external powerful compressive force.

Background: A primary aim of forensic medicine is gender determination. Although hip is the optimal bone for this purpose, different determining criteria of this bone do not have the same accuracy. This is important in conditions that only parts of hip remain to determine gender. This study aimed to evaluate the accuracy of different hip criteria in gender determination.

Methods: This cross-sectional study evaluated a total of 160 paired hips (80 males and 80 females) removed from the bodies for bone transplantation. Morphometric criteria were vertical and horizontal acetabular diameters and superior and inferior pubic ramus widths. Morphological criteria were a greater sciatic notch, obturator foramen, pubic body, preauricular sulcus, acetabular fossa position, and ischial tuberosity. The obtained data were analyzed using Cross Tab, t-test, and logistic regression analysis by SPSS. The significance level was set at P<0.05.

Results: There was no significant difference in morphometric and morphological criteria between the studied left and right hip bones (P>0.05). In gender determination, acetabular diameter and greater sciatic notch had the highest accuracy (85%), and obturator foramen (67.5%) and superior and inferior pubic ramus widths (65%) had the lowest accuracy.

Conclusion: Hip bone is not always completely available and preserved to determine gender. Moreover, sometimes not all anthropometric criteria of the bone are in favor of one gender. Therefore, investigating the accuracy of different criteria can be very important in interpreting the results. Thus, it has always been emphasized on the use of all available information in gender determination.

Background: Gender determination is an important challenge in the identification of skeletal remnants and dismembered bodies. The femur bone is more likely to be preserved during accidents and over time; thus, it is one of the most useful bones in gender determination.

Methods: This cross-sectional study was conducted on 54 fresh femur pairs of ˃19-year-old Iranians without anomalies or trauma. We studied the length of the femur, vertical head diameter, bicondylar width, shaft angle with the horizon, and collo-diaphyseal angle in male and female samples. Data were analyzed in SPSS using t-test and Receiver Operating Characteristic curves. P<0.05 was considered as statistically significant.

Results: The samples’ mean age was 37 years in males and 41 years in females. The mean values of measurements were not significantly different between the left and right femurs (P>0.05). The vertical head diameter, maximum length, bicondylar width, and the shaft angle were significantly larger in the males, compared to females. The mean degree of collo-diaphyseal angle was significantly wider in females, compared to males (P<0.05). The highest precision of gender differentiation belonged to the collo-diaphyseal angle (96.3%) and the lowest one belonged to the vertical head diameter (77.8%).

Conclusion: Based on our findings, even with the existence of only one femur bone, gender determination can be achieved with high precision. Collo-diaphyseal angle would be helpful in gender determination, even with the sole availability of the proximal part of the femur.

Background: It is a challenge in forensic medicine to identify deceased bodies when body dismembered from remaining body parts, such as hands, arms, and feet. We aimed to determine gender and the correlation between stature, and index and ring fingers in an Iranian population.

Methods: In this cross-sectional study, 200 Iranian students aged between 18 and 25 years were included (2016-2017). The length of the nondominant index and ring fingers were measured from proximal crease to the tip. The exclusion criteria were a history of heavy physical work by hand, hand vocational sports, anatomical musculoskeletal deformities, and chronic internal diseases (diabetes, thyroid disorders, renal failure, etc.). The obtained data were analyzed using SPSS. t-test, Pearson’s correlation coefficient, and correlation and regression models were used to analyze the achieved data.

Results: The mean height was 179 cm in males and 164 cm in females. The mean index and ring fingers lengths were 73 mm and 74 mm in males, and 68 mm and 68 mm in females, respectively. The mean sum of index and ring fingers lengths were 147 mm in males and 136 mm in females. Height, index and ring fingers length, and the sum of them significantly differed between genders (P<0.0001). The accuracy of gender determination was 92%, 71%, 73% and 74.5% in terms of stature, index finger length, ring finger length, and the sum of index and ring fingers length, respectively. The correlation between height and index finger length, as well as the height and ring finger length, were significant in males, females, and total cases (P<0.0001).

Conclusion: Based on this study, index and ring fingers lengths can be used to predict height and determine gender.

Background: A major challenge in medicine is patients’ dissatisfaction and complaints against doctors. Medical complaints in Iran, similar to the other countries, have a growing trend. Over the past two decades, the implementation of laparoscopic surgery rapidly grew in many countries. The current study aimed to investigate complaints against surgeons in laparoscopic surgeries, compared to open surgeries.

Methods: The current cross-sectional study was conducted on all laparotomy and laparoscopic surgery complaint cases. The medical records were extracted based on the study variables, using a researcher-made questionnaire. To analyze the obtained data, frequency tables were used and to investigate the relationship between variables, Chi-Squared and Fisher’s Exact tests were employed.

Results: A total of 369 medical complaint cases were brought to the Department of Tehran Legal Medical Committee, Tehran, Iran, from 2011 to 1016. The Mean±SD age of studied patients was 45.8±13.4 years. The most frequent medical complaint cases were against physicians working at private hospitals. In addition, most complaints were after laparotomy cases. More than half of the cases were voted on the malpractice of physicians. The frequency of postoperative infections was significantly higher in laparoscopic surgeries. The frequency of sentence for malpractice was significantly higher in laparoscopic surgeons, compared to laparotomy ones.

Conclusion: Physicians’ knowledge about legal medical issues and building intimate and trustful relationship with patients along with the provision of desirable healthcare services can be effective in reducing medical error complaints.

Aluminum phosphide (AIP) poisoning is one of the major causes of mortality among toxic substances. The symptoms and signs of toxicity are nonspecific and related to dose and route of exposure. A 20-year-old woman was admitted to the emergency department due to the consumption of one AIP tablet. ECG was normal at 2 hours post-ingestion and echocardiography revealed LVEF of 55-60% at 4 hours post admission. ECG abnormalities in this patient included VT and VF on the second night. She experienced an unusual rhythm disturbance in term of LBBB and Brugada pattern besides low ejection fraction of left ventricue (about 20-25%) on the third day. The main emphasis for AIP poisoning cases is on a timely, precise and prompt symptomatic treatment.

Paraquat (PQ) is a herbicide with potent toxicity. The most frequent human poisoning occurs by ingestion and inhalation. Its clinical feature includes pulmonary edema in the first 48 hours post-toxicity with progression to acute respiratory distress syndrome. A 50-year-old male poisoned patient referred to the emergency department with the complaint of shortness of breath. His companions had an herbicide poison bottle. Respiratory failure gradually intensified. The patient was intubated and under mechanical ventilation for one month. kidney and liver insufficiency were gradually added to the patient’s clinical feature in the following days. He died with multiorgan failures one month later. Standard chest X-ray is not beneficial for assessing PQ intoxication. High resolution computed tomography scan is recommended at day 7 post-ingestion for evaluating PQ poisoning.