An Unusually High Blood Alcohol Level in a Burnt Child Homicide Victim

Background: Alcohol detection is one of the most prevalent requests in forensic toxicology laboratories for medico-legal investigation. Interpretation of analytical toxicology results is important in deciding the cause and manner of death. The aim of the present case report is to introduce an unusually high blood alcohol level in a homicide victim and interpretation of analytical toxicology results considering crime scene investigation. Case Presentation: In the present study, we report a case of a burnt body on which autopsy examination and forensic toxicology analyses were carried out. Autopsy examination showed several stab wounds in the neck and thorax regions. Forensic toxicology analysis results showed 1055 mg/dL ethanol and 71 mg/dL methanol in right heart blood using headspace gas chromatography. The leading cause of death was stab wounds. Burning seemed to be a tool for covering up the homicide. Use of alcoholic fire accelerant and contamination of the corpse with alcohol was the main reason to detect high blood alcohol levels.Conclusion: It is essential to determine ethanol in different sampling sites to reach a reliable and scientific interpretation of analytical toxicology results. Also, some important factors such as crime scene investigation should be considered in the interpretations of unusual forensic toxicology results

A Case of Medical Malpractice; Misdiagnosis of Methamphetamine-related Cardiac Complications

Background: Professional neglect is a civil responsibility for any specialist or individual with a specific skill, including therapists, and is not limited to any particular profession.Case Presentation: A man 41-year-old drug abuser was diagnosed with a heart problem due to methamphetamine abuse. Despite his drug history, he was once admitted to the emergency room for chest pain, where acetaminophen and diazepam were prescribed. For the second time, he went to another medical center due to continued chest pain, and due to the suspicion of contracting COVID-19, a CT scan of the chest was performed, yielding negative results, and then he was discharged. The patient was found deceased in his bed the following day. An autopsy revealed a thinned heart wall, subendocardial hemorrhages, and severe atherosclerosis. Methamphetamine, amphetamine, and acetaminophen were detected in urine samples, and ethanol was detected in blood and vitreous humor samples. Conclusion: The case highlights the importance of medical negligence in treating patients with drug abuse

Fatal Abdominal Stabbing: A Confusing Picture in Differentiating Homicide and Suicide

Background: Differentiating between homicide and suicide can be difficult and even impossible. In this report, we presented a fatal stabbing injury, which made a challenge in the verification of the manner of death.Case Report: A 45-year-old man was found dead in his workplace with a knife beside him. His mouth was closed with a scarf, his clothes were intact, and no evidence of a struggle was observed in the scene investigation. There was a vertical stab wound on the midline of the victim’s belly and his intestines were tangled out of the wound. In the autopsy, no defense wound was found. There was blood in the abdominal cavity and retroperitoneal region and several perforations were observed in the intestine and liver along the superficial wound. Painful death and torturous extraction of visceral organs resembled homicide, but nothing indicative of hostility and homicide was found by the forensic exploration and police investigation. Finally, the manner of death was assigned as suicide and the cause of death was a hemorrhagic shock as a result of sharp force injuries.Conclusion: This case represents a bizarre suicide, which is rare and highly suspicious of homicide. In such mysterious cases, the evidence of autopsy and crime scene and police investigation should be regarded to make a decision

Causes of Maternal Mortality in Tehran, Iran

Maternal mortality is a woman’s death during pregnancy or postpartum period due to direct or indirect causes. Its direct causes are related to obstetrical issues. The indirect cause of it refer to an underlying disease, i.e. aggravated during pregnancy and leads to death. A routine data-based study conducted at the Legal Medicine Organization of Tehran City, Iran, the autopsy findings of maternal mortalities during April 2017-2019 were reviewed. During the study period, 53 cases were autopsied of which 29 (54.7%) and 24 (45.3%) died due to direct and indirect causes, respectively. , The prevalent direct causes of death, were bleeding (22.6%), eclampsia/preeclampsia (13.2%), and ectopic pregnancy (5.7%). Frequent indirect causes were cardiac diseases (20.7%) and nervous system and infectious diseases (both: 7.5%). This study revealed the considerable share of indirect causes in maternal mortalities in Tehran. Moreover, we outlined the importance of early detection of non-obstetrical medical conditions during pregnancy care to reduce preventable maternal mortalities

Trends in Poly Drug Use-associated Deaths based on Confirmed Analytical Toxicology Results in Tehran, Iran, in 2011-2016

Background: Poly drug use is a public health threat causing morbidity and mortality all over the world.Combined use of licit and illicit drugs is among the possible causes of death. In this retrospective analyticalstudy, we evaluated forensic toxicology analysis results from 2011 to 2016 in Tehran province, Iran.Methods: All deaths related to poly drug use and referred to the Legal Medicine Organization, Tehran duringthe 6-year study period were evaluated. Postmortem samples were analyzed to detect alcohols, andprescription and illicit drugs using headspace gas chromatography (HSGC), high performance liquidchromatography (HPLC), and gas chromatography/mass spectrometry (GC/MS) in a forensic toxicologylaboratory. Manner of death, demographic characteristics, and different drug categories in postmortemsamples were analyzed.Findings: A total of 1388 poly drug use-associated deaths were investigated during the 6-year study period.Overall, victims were mostly young men of 20-40 years of age (56.8%). The male to female ratio was 7:16.Methadone (n = 660; 47.6%) and amphetamine type stimulants (ATS) (n = 657; 47.3%) were in the highestcategory for poly drug use-associated deaths. Moreover, in some cases, opium (n = 458; 32.9%), tramadol(n = 389; 28.0%), and tricyclic antidepressants (n = 151; 10.9%) had been used with other drugs.Conclusion: The present study provides information about poly drug use-associated deaths in Tehran andhighlights the major role of substance abuse in death

A Case of Medical Malpractice; Misdiagnosis of Methamphetamine-related Cardiac Complications

Background: Professional neglect is a civil responsibility for any specialist or individual with a specific skill, including therapists, and is not limited to any particular profession. Case Presentation: A man 41-year-old drug abuser was diagnosed with a heart problem due to methamphetamine abuse. Despite his drug history, he was once admitted to the emergency room for chest pain, where acetaminophen and diazepam were prescribed. For the second time, he went to another medical center due to continued chest pain, and due to the suspicion of contracting COVID-19, a CT scan of the chest was performed, yielding negative results, and then he was discharged. The patient was found deceased in his bed the following day. An autopsy revealed a thinned heart wall, subendocardial hemorrhages, and severe atherosclerosis. Methamphetamine, amphetamine, and acetaminophen were detected in urine samples, and ethanol was detected in blood and vitreous humor samples. Conclusion: The case highlights the importance of medical negligence in treating patients with drug abuse

Epidemiology Study And Methods Of Suicide Under The Age Of 18 Years During 2010-2020 In Tehran Province

Background: Type of suicide is determined by various factors such as accessibility to drugs, economic problems and psychological disorders. Objective: This study aimed to assess the epidemiology of suicide death, autopsy and effective factors in children<18 years. Methods: This was a cross-sectional study carried out on 350 autopsy bodies less than 18 years of age in Tehran Forensic Medicine Center during 2010-2020 who had struggled with suicide. Data were analyzed using SPSS version 18. Results: Mean age of children was 16.36±1.76 years. The most common method in children less than 15 years and over 15 years was hanging (n=36) and poisoning with chemical substance (n=139), respectively (p<0.001). The most common method of the suicide was poisoning with chemical substance (n=147, 42%). The most common method of suicide in girls and boys was poisoning with chemical substance (n=81) and hanging (n=75), respectively. The highest number of children struggled with were residents in the outskirt of Tehran (n=113, 32.5%). Suicide rate in people with depressive disorder and tentative injury was 10% (n=35) and 18.6% (n=65). In 13 patients, vitreous humor alcohol was positive (mean alcohol: 60.61±43.03 mg/dl).  The most common toxin observed in toxicology was rice tablet or aluminum phosphide (n=90, 25.7%). Regarding drug toxicity in toxicology, 52.6% (n=86) was not positive. Opium was found 7.4% of cases (n=26). Conclusion: The suicide rate has been on the rise during the past ten years through hanging and poisoning with chemical substance such as aluminum phosphide, opium and tricyclic antidepressants especially in outskirts

Mortality due to H1N1 Influenza in Cases Registered at the Autopsy Halls of Kahrizak, Tehran

H1N1 swine flu is an acute disease that infects the upper respiratory tract and can cause inflammation of the upper respiratory tract, trachea, and possibly the lower respiratory tract. The known course for H1N1 swine flu is varied from one to four days, on average for most people about two days, but in some cases, it can be up to seven day

Quantitative Analysis of Methanol and Ethanol in Traditional Handmade Herbal Distillates in Iranian market

Background and purpose: Medicinal plants are among highly consumed natural drugs. Many herb shops produce and sell this products without any license. Traditional herbal distillates are widely used in Iran, so, the aim of this study was to determine ethanol and methanol concentrations in handmade herbal distillates in Tehran herb shops. Materials and methods: A total of 140 samples from 14 traditional handmade herbal distillates were obtained from Tehran herb shops and analyzed using headspace gas chromatography. Results: In this study, no sample contained ethanol. Peppermint distillate had significantly higher methanol content (334.62±153 ppm) compared with other distillates (P<0.05). Also, high amounts of methanol were found in Fenugreek (321.43 ppm) and Tarragon (311.39 ppm) distillates. Pennyroyal distillate did not contain methanol and rose water had the lowest methanol content (14.61 ppm). Conclusion: Handmade herbal distillates containing high concentrations of methanol can cause health problems in regular consumers. Therefore, highly consumed herbal distillates should be monitored to determine their methanol concentration

Claims about medical malpractices resulting in maternal and perinatal mortality referred to iranian legal medicine organization during 2011–2012

Background: Obstetricians, gynecologists, and midwives are the most common specialists of the medical sciences group against whom medical malpractices are claimed, many of which are avoidable and preventable. Therefore, the present study was conducted to investigate the causes of claims regarding medical malpractices resulting in maternal and perinatal mortality. Materials and Methods: A descriptive cross-sectional study was conducted and 7616 claims of medical malpractices in the field of obstetrics, gynecology, and midwifery that were referred from all 31 provinces to the central commission of legal medicine were studied during 2011–2012. Therefore, the present research is a national inclusive study covering all the provinces across Iran. To collect information from the transcript of medical malpractices cases, a researcher-made checklist was used, and the collected data were analyzed. Results: The results of the present study showed that among all the medical malpractice claims regarding pregnancy and childbirth (42.24%), the majority concerned perinatal death (71.82%) and maternal death (28.16%). Conclusions: Medical malpractice complaints are increasing; although, most of these claims are preventable. To achieve this aim, it is necessary for obstetricians, gynecologists, and midwives to try to reduce the complaints by paying more attention to the signs and symptoms of diseases, performing all the diagnostic and therapeutic measures according to the scientific criteria, and fully document patients' records. In addition, patients' acquaintance with the importance of measurements and examinations, before and during pregnancy care and even after childbirth is crucial