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

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

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

A Study of Domestic Violence against Women: A Qualitative Meta-Synthesis

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

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

Explode Metacarpal Bone by Gunshot: A Case Report

Background: The incidence of firearm related non-fatal and fatal accidents has been increased worldwide. Most of the unintentional or intentional nonfatal gunshot injuries involve an extremity.Case Report: A 33-year-old man was admitted to emergency department with a complaint of injury related to 5th metacarpal area of right hand. The patient reported that he is a police officer who suffered gunshot injury during crashes with smugglers in himself right hand. At arriving time into hospital, hand was neurologically intact and no vascular injury was noted. There was a distractive entrance wound in the 5th metacarpal hypothenar palmar area and a distractive exit wound on the dorsal side. The wound was irrigated and debrided. All lose bone fragments were removed. The lose area covered by distant flap of skin from the abdomen. All of the wounds were healed on postoperative 15th day.Conclusion: This report is an attempt to present the problem of firearm injury and appeal to a wide range of disciplines working to expand their knowledge and redirect new energy to address the urgent problem of firearm injury

Anxiety Level of Pregnant Women from Ahwaz Exposed to Domestic Violence

Background: Domestic violence is a concern in the communities and need a wide attention. Violence against women can cause all kinds of physical and mental illness. This is a threat to woman’s and family member’s health. Stress, anxiety and depression during pregnancy are risk factors for adverse consequences. Little is known about the level of the mental illnesses in women who exposed to domestic violence during pregnancy. This study reported the level of anxiety in women who were victims of domestic violence in health centers in Ahwaz.Methods: This was a cross-sectional study in which a sample of 110 pregnant women with domestic violence and pregnant women without violence were recruited.  The data were collected using the demographic questionnaire, World Health Organization standardized domestic violence questionnaire, and the Beck Anxiety Inventory (BAI). The data entered in SPSS 21 and were analyzed using Chi-Square, Independent-t and Multiple Logistic Regression.Results: The pregnant women in the domestic violence group had a higher mean score of anxiety (P<0.05). Women exposed to violence experienced psychological violence (57.75%), physical violence (37.73%) and sexual violence (33.88%). The psychological violence was the greatest influence on the level of anxiety in pregnant women.Conclusion: This study demonstrated the impact of domestic violence on the level of anxiety in pregnant women and confirmed its treat to women's mental health

Postpartum Sexual Function; Conflict in Marriage Stability: A Systematic Review

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