Aluminium Phosphide Poisoning: a Case Report

Background: Aluminum phosphide as pesticide commonly used to protect crops from pests. Despite the limited number of cases of poisoning with this substance, it is important due to the high risk of being fatal. The major cause of the poisoning is suicide attempt. Due to the lack of specific treatment in poisoning, taking more than 500 mg is fatal.Case Report: The patient was a 16-year-old woman who attempted suicide by consuming some 4.5gram aluminum phosphide tablets. Within half an hour after consumption she had vomiting and nausea then smoking cigar, followed closely by smoking in her mouth flames around his mouth is created which will burn (grade II). Subsequently she had argument with her husband and injured her right ear. During the admission she was alert, 2nd degree burn were observed on the upper lip and around the mouth and nose and ears areas. Physical examination was normal, when she arrived she had severe hypotension and her oxygen saturation was 69% with tachycardia. The patient was immediately intubated and received mechanical ventilation. After installing Nasogastric tube, gastric lavage was done with potassium permanganate and bicarbonate. At Arterial Blood Gas (ABG), severe metabolic acidosis (pH 6.9) and a chest X-ray, diffuse lung opacities was seen. Blood test showed that there was a leukocytosis (22,000). Treatment was given Saline, high dose inotrope drugs (norepinephrine and dopamine), bicarbonate, calcium gluconate, magnesium sulfate hydrocortisone. Burns around the mouth was dressing after admission. On the third day the patient was alert and complained of pain in the right ear and hearing loss. 9 days after admission, the patient was discharged well with complication of sensory neural hearing loss (unrelated to slap injury).Conclusion: Despite the extreme virulence of the Aluminum phosphide (rice tablets), especially in high doses, conventional therapeutic measures can sometimes unexpected ways leading to improved patient. The patient's well general condition was discharged with remained hearing loss in her right ear, despite the very poor prognosis. It is recommended that phosphine gas research on the possible impact of hearing loss further

Predictors of Paan, Nass and Gutka (Oral Tobacco) Use among University Students

Background: Prevalence of cancers associated with the use of oral tobacco (OT) is rising very rapidly and prevention of use is the best option to tackle this scenario. This cross-sectional study estimated the proportion of OT use and predictors associated with its initiation and determined the knowledge, attitude. Method: A total of 354 students (15-30 years age) in five colleges were interviewed by medical students and completed a peer reviewed, pre-tested, self-administered questionnaire. Chi square test and logistic regression analyses were applied to the results. Results: Thirty nine (11.0%) students were lifetime users of smokeless tobacco among which nineteen (5.4%) were occasional users, seven (2.0%) were current users and thirteen (3.6%) fulfilled the criterion for established users. Paan was the most commonly used form of smokeless tobacco followed by Nass. On univariate analysis, lifetime use of smokeless tobacco showed significant associations with the use of cigarettes, student gender (M > F), individual condition (native > guest) and kind of the College (Engineering > Psychology). Conclusion: We suggest socially and culturally acceptable educational and behavioral interventions for control of OT usage and hence to prevent its associated cancers. Copyright©2012 Department of Forensic Medicine and Toxicology. All rights reserved

Knowledge and Attitudes towards AIDS in Mashhad (Northeast of Iran) Female Sex Workers

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

Can Psychopathic Traits Predict Homicidal Behavior in Male Murderers?

Background: The Increase in homicide has made criminologists think about basis of this crime. It seems the most successful, prolific killers are extraordinarily ordinary. Method: This research was carried out as cross-sectional study among 136 male criminal inmates in Tehran prisons. These individuals are evaluated by using SCL-90-R. Results: Most of these individuals were within 30-37 age range with an average age of 33.6. About 87% of them had psychological traits, among which aggression, anxiety, and somatization were the most abundant (P<0.01). Conclusion: This investigation clearly shows that majority of the cases in our study suffer from some of psychological traits such as aggression, depression, paranoia etc. Although according to Islamic Criminal Law, these psychological traits do not result in a reduction in penalty responsibility, but supposing in the presence of mild psychological disorders or traits, tendency to commit more severe crimes such as homicide may increase. Copyright©2012 Department of Forensic Medicine and Toxicology. All rights reserved

Ethanol Level of Vitreous Fluid in Road Accident fatalities referred to Tehran Legal Medicine Center in 2018

Background: High risk behaviors such as substance use are among the human factors that can play an important role in fatal road accidents and deaths. Objective: To determine the status of alcohol consumption based on vitreous fluid exam in cadavers sent to Tehran Legal Medicine Organization. Materials and Methods: In this descriptive analytical cross-sectional study, all fatalities sent to the Tehran Legal Medicine Organization during 2018 were studied. A vitreous sample was used to measure the amount of alcohol. Results: Out of 676 cadavers (85% male; mean age 40.6±6.45), the toxicology results for alcohol was positive in 6.51% (91% male; mean age 37.10±15.7). There was a significant difference between the two sexes (P < 0.00) and the educational level (P1< 0.00). Most fatal accidents occurred in positive toxicology cases between 10-12 pm and on Fridays followed by Thursdays. Conclusion: The policy of non-consumption of alcohol based on Islamic teachings in Iran has played an important role in significantly reducing fatal accidents caused by alcohol

2 Years follow up Sex Reassignment Surgery: Mental Health and its Associated Factors

Introduction: Transsexualism is a gender disorder in which the patient's physical gender is in conflict with his / her mental gender and emotionally and psychologically feels that he / she belongs to the opposite sex. There are several ways to correct this disorder and improve a person's physical and mental health. Gender reassignment surgery is one of the treatment methods commonly performed for this purpose. Materials and Methods: This cross-sectional study was performed in 2019 in patients referred to the psychiatric ward of the Forensic Medicine Organization, Dr. Mir Jalali Surgery Center and the Welfare Organization. The sample size was 30 people according to the facilities of the research team, which was selected by census sampling method. After completing the informed consent to participate in this research project, all subjects completed the GHQ-28 mental health questionnaire and the researcher-made information form. Subsequently, the results were statistically analysed under SPSS21 statistical software.Results: Amongst the 30 participants (Male to Female /Female to Male = 14/16), the mean age was 27.06 ± 2.40 years, the mean time after surgery was 30.17 ± 3.18 month and the mean age of sexual identity change was 10.45 ± 3.91 year, respectively. Illicit drugs were used by 20% of these people, all of whom were amphetamines. The majority of the samples were dissatisfied with family and community support. Also, no difference was reported in the quantity and quality of intercourse before versus after surgery. The results of GHQ-28 mental health questionnaire showed that all items were lower than the community average. There was no significant difference in mental health between the two groups. Conclusion: Financial and spiritual support of family and society is very effective on Gender reassignment surgery results, especial sexual function. It seems that despite the significant advancements made in the field of sex reassignment, such operations and the resultant change in individuals’ gender have not met their needs

Epidemiological Assessment of acute poisoning Death–One year Survey

Background: Acute poisoning by drugs and chemical agents is a medical emergency and carries a high morbidity and mortality rate. The epidemiology of acute poisoning varies between countries and different regions. Method: In this one year retrospective study, we reviewed the epidemiology of patients with acute poisoning (intentionally or unintentionally) who died during hospitalization at Loghman Hakim hospital, Tehran, Iran. Results: Of the 280 cases of completed suicide by self-poisoning 69 (24.6%) cases were female and 211(75.4%) cases were male, between 15-78 years old with mean±SD of 39±17.5. Most of them were conscious (69.6%) on admission to Emergency Department (ED). Past history of any self- harm were positive in 82 (29.3) cases of subjects. Multiple drug toxicity and opioid poisoning were the most common causes of acute poisoning death in 27.5% and 27.1% respectively. Conclusion: Differences based on age category, sex, the types of toxic agents involved and the outcomes of the poisoning death incidents were noted. Future interventions should take these differences into account

Medical Malpractice in Cardiovascular Surgery; Cases Referred to Tehran Forensic Medicine Organization during 2011-13

Background: Cardiovascular surgeries are a most common and important surgeries in Iran and because of its high risk nature, the outcome is not always satisfactory, so could lead to a complaint. In recent years, there has been an increase in complaints against cardiovascular surgeons. Aim of current study was to determine the frequency of medical malpractice in the field of cardiovascular surgery in the cases referred to the Tehran forensic medicine commission.Methods: In this retrospective cross-sectional study, all malpractice cases referred to the forensic medicine commissions in Tehran with regard to the field of cardiovascular surgery during 2011-2013 were collected. Information such as age, sex, type of hospital (state or private), type of cardiosurgery, type of malpractice, percentage of malpractice, cause of death, and background diseases were extracted and then analyzed.Results: Of the 56 cases, the frequency of malpractice was 27 cases (48.2 %) and the most important type of malpractice was negligence (32.2%) and the majority of cases were related to private centers. The most common malpractice was related to coronary artery disease and the main cause of complaint was the patient death (76.8%). 54.5% of malpractice rate was in men and in patients older than 60 years (67%) which was higher than other age groups. There was no significant association between age and sex with malpractice.Conclusion: Despite improvement in medical technology and the use of advanced techniques in the diagnosis and treatment, the complaint rate of cardiovascular surgeons is increasing. In addition to optimizing cardiovascular surgical techniques, informing the patient and his/her companions about the side effects of these high risk surgeries can be effective in prevention of malpractice and physician mistakes

Gender Identity Disorders in Iran; Request for Sex Reassignment Surgery

Background: Based on reports of the Tehran Legal Medicine Organization (LMO), requests for sex change operation by persons with Gender identity disorder (GID) have increased in the past few years in Iran. Due to the social and legal ramification of transsexualism, we decided to perform a study to assess the demographic status and legal aspects of Iranian Transsexuals who were applicants for sex reassignment surgery (SRS). Method: The total number of 69 cases with GID who requested sex change by surgery was assessed during a period of four years (2005-2009) in Tehran. Descriptive statistical methods and Chi square were used to analyze the data. Results: There were 44 male-to-female and 25 female-to-male Transsexuals with a mean age of 25 years. Out of 69 requests for sex change, transsexualism was confirmed in 61 cases and the remaining 8 cases had other Psychiatric disorders manifested by identity confusion. The onset of symptoms had developed in childhood (<10 y) in nearly 70% of patients. Depression was found in about 26% of cases. Eighteen cases (26%) had a history of suicide attempts. Among individuals with final diagnosis of Transsexualism, request of 93% was accepted for SRS. Conclusion: This study showed dominancy in Male to Female Transsexuals (1.7/1). Depression was the most common psychiatric disorder associated with Transsexualism. The article also showed that recently transsexualism accepted by community and country low more than before

Risk Factors for Mortality in Organophosphate Poisoned Patients

Background: Organophosphates (OP) compounds are used as insecticides in agricultural and domestic settings throughout the world. Acute pesticide poisoning has a high morbidity and mortality, especially in developing countries. The purpose of this study was to evaluate the data on acute adult organophosphate poisoning (OPP).Methods: In Descriptive cross sectional study at Loghman Hakim Hospital in Tehran-Iran during March 2010 to June 2013 and identify the risk factors of mortality, patients with the primary diagnosis of OPP who were admitted to Loghman-Hakim Hospital Poison Centre (LHHPC) were the subjects of this prospective study. Cholinesterase (CE) activity and the PR interval was determined for each patient using the Bazett formula and considering >200 msec. as prolonged. Comparative outcomes of the study were respiratory failure, systolic blood pressure, GCS and intentional poisoning, analysis of the PR interval in the primary ECG on admission, and rate of mortality.Results: The study included 201 patients with a diagnosis of OPP. The mean age of the patients was 33.93. The mortality rate was 9%. Nine patients had conductive abnormality (PR prolongation) in ECG. There was no significant difference between two groups (prolonged and normal PR intervals) according to respiratory failure and systolic blood pressure<90mm Hg and GCS and intentional poisoning. The mortality rate in the long PR group was significantly higher than that of the normal PR group.Conclusion: In our study it has been well demonstrated that PR-interval prolongation affects mortality rate. Prolongation of the PR interval is associated with increased risks of mortality in OPP