Therapeutic and ethical dilemma of puberty and menstruation problems in an intellectually disabled (autistic) female: A case report and review of the literature

Intellectual disability is a term used when a person has certain limitations in mental functioning and skills. Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). Teenagers with learning and physical disabilities are more likely to have menstrual problems compared to the general populations. The parents of a 12-year-old girl with autism spectrum disorder and intellectual disability referred to the coroner due to her numerous problems of puberty (menstruation) including: poor hygiene and polluting herself and the environment, not allowing to put or change the pads and changes in mood and physical health prior period, requested for the surgery (hysterectomy). In legal medicine organization after reviewing the medical records, physical exams and medical consultations with a gynecologist and psychiatric, surgery was not accepted. Hysterectomy (surgery) due to the age of the child, either physically or morally is not recommended. The use of hormone replacement therapy has side effects such as osteoporosis. In these cases, it seems noninvasive methods (behavioral therapy and learning care skills) under the welfare experts is also more effective and morally. © 2015 Tehran University of Medical Sciences. All rights reserved

Sudden death due to association between NAFLD and cardiovascular changes in a 37-year-Old Man: A case report

Fatty liver disease (FLD) is the most prevalent form of liver disease worldwide. Overnutrition can induce nonalcoholic fatty liver disease (NAFLD), a spectrum of conditions ranging from simple steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis and cirrhosis. Some of the epidemiological and pathological studies have also suggested an association between the presence of fatty liver and sudden death. A 37-year-old man was found dead when he was asleep in the bed at home. According to his family, he was single and a costermonger. He was not an athlete, and there was no history of any physical and mental disorder. He was not addicted and did not use any drugs or alcohol. The positive points, in this case, were: a large heart with mild coronary stenosis and steatohepatitis in autopsy and sudden death. Since steatohepatitis did not have any complication such as fat embolism, it can be concluded that the combination of steatohepatitis and cardiovascular disorder led to sudden unexpected death. Heart more than 450 gr is susceptible to arrhythmia, and fatty liver disease can cause cardiovascular changes. © 2016 Tehran University of Medical Sciences. All rights reserved

Characteristics of absconders from a general health service, Rasoul Akram Hospital in 2013

Introduction Absconding is an important health and security concern because of its adverse effect on patients, care providers, and the community. Studies are limited. Aim This study aimed to describe the characteristics of absconding events in Tehran. Material and methods In this analytical cross-sectional study, 334 absconders from 34 192 patients who were admitted to the Rasoul Akram Hospital in 2013 and escaped from the hospital were recruited. These patients were evaluated based on variables that included age, sex, marital status, hospitalization duration, smoking, alcohol use, addiction, psychiatric disorders or underlying disease, type of insurance, cause of hospitalization, time of scape, and cost of treatment. Results and discussion The study group consisted of 260 (77.8) males and 74 (22.2) females, with a mean age of 37.4 (SD = 17.1). Mean duration of hospitalization was 99 h (SD = 14.8). A total of 70 (21) patients were smokers, 14 (4.2) consumed alcohol, and 65 (19.5) were drug addicts. Psychiatric disorders were observed in 18 (5.4) patients, and underlying diseases were detected in 87 (26). Higher rates of escape were observed in single men (N = 162; 62.30) as well as married women (N = 52; 70.27). The most common time of escape was 12:00 PM. The highest number of escapes was observed in the month of July. Conclusions The present study identified single males, younger patients, psychiatric disease, underlying illness, and addiction as common features of escapees. Particular attention in observing, improvement in observation methods, and staff focusing on engagement could be helpful in decreasing the number of absconding events. © 2015 Warmi�sko-Mazurska Izba Lekarska w Olsztynie. Published by Elsevier Sp. z o.o. All rights reserved

Characteristics of traumatic brain injury among accident and falling down cases

Motor vehicle and falling down are responsible for the most number of traumatic injuries. This study aimed to compare the characteristics of traumatic brain injury among accident and falling down cases. In this analytical cross- sectional study, data were collected from the records of cadavers who died due to accident or falling down and referred to Kahrizak dissection hall, Tehran forensic medicine organization during 2013. A total of 237 subjects (183 (77.2) accident and 54 (22.8) falling down) with a mean age of 35.62 (SD=15.75) were evaluated. A number of 213 (89.9) were male. From accident group, scalp injury was seen in 146 (79.8), scalp abrasion in 122 (66.7), scalp laceration in 104 (56.8), sub skull bruising in 176 (96.3), skull fracture in 119 (65), hemorrhage in 166 (90.7), Subdural hemorrhage (SDH) in 155 (84.7), Subarachnoid hemorrhage (SAH) in 161 (88), Epidural hemorrhage (EDH) in 41 (22.4), contusion in 140 (76.5), and skull base fracture in 140 (76.5) of cases. In falling down group scalp injury was seen in 42 (77.8) cadavers, scalp abrasion in 38 (70.4), scalp laceration in 30 (55.6), sub skull bruising in 49 (90.7), skull fracture in 39 (72.2), Hemorrhage in 49 (90.7), SDH in 43 (79.6), SAH in 47 (87), EDH in 10 (18.5), contusion in 33 (61.1), and skull base fracture in 39 (72.2) of cases. There was no significant difference between these two groups (P Value> 0.05). Accident and falling down had no difference in terms of any injury or hemorrhage. © 2015 Tehran University of Medical Sciences. All rights reserved

Correlation between serum vitamin D level and neonatal indirect hyperbilirubinemia

Background: Considering the significant prevalence of Neonatal Indirect Hyperbilirubinemia (NIH) and its irreversible neurological complications, identifying the factors involved in the prevalence of neonatal jaundice is essential. The present study was conducted to determine the relationship between serum vitamin D levels and the prevalence of NIH in infants admitted to Qods Hospital of Qazvin in Iran in 2015-16. Methods: In this case-control study, 30 term infants with NIH (the case group) were compared with 30 healthy, non- icteric, term infants (the control group) in terms of serum levels of 25-hydroxyvitamin D. The results were analyzed and compared between the two groups using t-test and the Chi-square test. Results: The mean and standard deviation of serum 25-hydroxyvitamin D levels were 10.76±8.6 ng/dl in the case group and 14.88±11.38 ng/dl in the control group. There were no significant differences between the two groups (P=0.11). Conclusion: The results suggest the lack of a relationship between vitamin D levels and NIH. However, further prospective studies are needed to conclude that vitamin D has no role in the pathogenesis of NIH. © 2018 The Author(s)

Correlation between serum vitamin D level and neonatal indirect hyperbilirubinemia

Background: Considering the significant prevalence of Neonatal Indirect Hyperbilirubinemia (NIH) and its irreversible neurological complications, identifying the factors involved in the prevalence of neonatal jaundice is essential. The present study was conducted to determine the relationship between serum vitamin D levels and the prevalence of NIH in infants admitted to Qods Hospital of Qazvin in Iran in 2015-16. Methods: In this case-control study, 30 term infants with NIH (the case group) were compared with 30 healthy, non- icteric, term infants (the control group) in terms of serum levels of 25-hydroxyvitamin D. The results were analyzed and compared between the two groups using t-test and the Chi-square test. Results: The mean and standard deviation of serum 25-hydroxyvitamin D levels were 10.76±8.6 ng/dl in the case group and 14.88±11.38 ng/dl in the control group. There were no significant differences between the two groups (P=0.11). Conclusion: The results suggest the lack of a relationship between vitamin D levels and NIH. However, further prospective studies are needed to conclude that vitamin D has no role in the pathogenesis of NIH. © 2018 The Author(s)

Epidemiologic study of burns in elderly people over 60 years old

Background: Burns are one of the most devastating forms of trauma worldwide. In the elderly, flame and scald burns, or scalds alone, are the major causes of burns, occur at home, particularly in the kitchen and bathroom. Because elderly burned patients suffer from greater morbidity and mortality than younger patients with similar burn extents, preventing burns is paramount to continuing functionality and quality of life. Burns are largely explainable by characteristics of both the individual and the physical environment. Our study aims to analyses the epidemiologic characteristics of burn in the elderly (above 60 years old) in Iran. Methods: Records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the Shahid Motahari Hospital, Tehran, Iran, between March 2007 and March 2014 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, mortality, severity of burn, length of stay in hospital, and outcomes were reviewed. The information was analyzed by SPSS software, version 18 (SPSS Inc., Chicago, IL, USA). T-test, oneway anova and K square were used. Results: A total of 374 elderly patients were admitted. Majority of the patients were men 231 (61.8) and the number of women were 143(38.2). The most common etiologies were scalds (20.3) and (oil-benzine-gasoline) (19.8). The mean age of the patient was 71.5 years, which was average in women (72) and men (70.5 years). There was a statistically significant difference between the mean age in both male and female groups, so that the mean age of women was significantly higher than men (P=0.004). There was a significant correlation between gender and (etiology, hospital stay-mortality) and between treatment outcome and (etiology and motivation) and between motivation and etiology (P<0.001). Conclusion: Boiling water was the main cause of burning in older women. Diminished senses, concentration disorders, slower reaction time, reduced mobility, and bedridden states may decrease elder's ability to identify fire and also to escape harm. © 2018, Tehran University of Medical Sciences. All rights reserved

Congenital goiter in North of Iran: A case report

Congenital goiter (CG) is one of the rarest disorders observed in a newborn at birth diagnosed with hypothyroidism. Considering the simultaneity of pregnancy and baby's hypothyroidism at birth, the goiter can be caused by diabetes during pregnancy and hypothyroidism emergence in the baby. © 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Lt

Evaluation of the anatomical position of the vermiform appendix in Iranian cadavers in 2013: Brief report

Background: The relationship of the base of appendix to the cecum remains constant, whereas the tip can be found in a retrocecal, pelvic, subcecal, preileal, or right pericolic position. These anatomic considerations have significant clinical importance in the context of acute appendicitis. The knowledge about the correct anatomical position of appendix may facilitate in generating an accurate diagnosis of appendicitis as well as assist in achieving a better prognosis and early treatment. The present study aimed to determine the anatomical location of the appendix in Iranian cadavers. Methods: This descriptive cross-sectional study was conducted on 200 cadavers who were referred to the Forensic Center of Tehran from March to September 2013. The data including age, sex, weight, and appendix length and position were collected and analyzed using SPSS software, version 16 (SPSS, Inc., Chicago, IL, USA). Results: In the present study, 200 cadavers were evaluated accidentally, of which 173 (86.5) were males and 26 (13) were females, and the mean age was 39.96 years±16.31 (SD). The mean wall thickness of the appendix was 9.78 cm±16.31 (SD). The mean appendix length was 9.86 cm±1.79 (SD) in men and 9.30 cm±1.56 (SD) in women. The appendix height was long in 20 cadavers (10), short in 3 cadavers (1.5), and moderate in 177 cadavers (88.55) cadavers. The appendix position was posterior in 120 (60), ectopic in 32 (16), and pelvic in 48 (24) cadavers. Conclusion: Majority of appendices examined in the present study were positioned at the posterior (Retrocecal) of pelvis. According to different positions of appendices in different populations and different races, the knowledge of appendix position in various populations is necessary for early diagnosis and treatment and fewer complications for related disease. © Tehran University of Medical Sciences. All rights reserved

Injuries due to caustics ingestion in children: A psychological approach to the suspicion of childish jealousies

Most injuries from caustics ingestion occur due to parental negligence, but other causes such as psychological tendency or childish jealousy or behaviour may be the major cause for harming. Here, we describe a case of injury in a neonate who ingested a caustic substance, probably induced by his brother, but not as a consequence of the negligence of his parents. The mother said she had fed the child toilet bleach instead of water and was very concerned about the child's condition. However, when the baby's older brother was interviewed he did not show concern and was very confused and provided contradictory responses about his knowledge of the poisoning. Later, it was revealed that the baby's brother had prepared the milk and knew what was in it. In our case, damage by caustics ingestion may have been intentional due to psychological problems in parents causing child abuse or in other children due to childish jealousy