The Rules of Forensic Medicine Examination in Diagnosis of Electrical injury in Childhood

Background: History taking is a duty that must get out in different situation as child's parents or in adults by themselves, to able provide the best helps in minimum time. Certainly, the information come out from history have significant effects on management plans. Case Presentation: A 16 months baby that transfers to ER department with complete cardiorespiratory arrest and after response to resuscitation the medical management was done for him. As history taking, he found unconsciousness near dress pan with wet dressing in bathroom. In physical exam the little impact traumatism on his/her head and face was detected. In blood and urine samples, there were not significant findings for toxicological screening. The physician requested for forensic specialist consultation for ruling out any child abuse doubt. The future examination was done by forensic team and they found the hyperkeratotic nodules on palmar surface of first phalange of right index finger due to electrocution. Conclusion: The history taking and following physical exam have greatest significant moment and the detailed and exact physical examination include whole parts of body, especially in children who couldn't present and complain about their problems completely

Demographic Characteristics of Pediatric Burn in Shahid Motahhari Hospital from 2007-2011

Background: Severe burn is one of the major causes of morbidity and mortality in children and adolescents and is third most common cause of death among this age group. The aim of this study was to evaluate demographic characteristics of pediatric burn over a period of 5 years and the relationship between cause mortality in patients with burns. Method: In this cross sectional study, documents of children under 15 years, in Shahid Motahari hospital between 2007 and 2011 was evaluated. Variables such as age, sex, stay duration in hospital, burn cause, severity, accident cause burns and outcome of patients finally entered in SPSS v.16 and were analyzed. Results: In this study, 416 patients (34/8%) were female and 780 (65/2%) were male. Factors for burns in children include boiling water in 674 cases (56/4%), flame in 190 patients (15/9%), burns with flammable materials in 131 cases (11%), burns with a hot meal for 113 people (9/4%) and other hot bodies in 30 patients (2/5) and steam burns in 3 (0/3%). Increasing in burned body surface was significantly associated with mortality (P value= < 0.001). Burn severity in children who died was more than other children (P value= < 0.001). Also burn etiology was significantly different in patients who died and patients were discharged (P Value= 0.003). Conclusion: Based of the results of this study, burn in boys was more than girls and was common inpatients under 2 years of age. Thermal burns were the most common type of burns in children (95/4%) and hot water were also the most important cause in thermal burns in children (56/4%).Burn extent in the majority of children (75%), was less than 30% of the body surface and burns between 50 to 100% occurred in 6/3% of cases. Average stay duration in the hospital was 12/8 days and mortality rate was 7/2%. Area and depth of the burn injury were the most important determinants of mortality

Successful Suicide in a Child: Depression-Related or Paroxetine-Induced?

Background: Children and adolescents are prone to develop psychiatric problems after stressful life events. These problems need appropriate treatment because of negative consequences like disease-related suicide. Antidepressants (especially "Serotonin Selective Reuptake Inhibitors") are common treatments for psychiatric problems of children and adolescents; but different side effects, including drug-induced suicide, have been reported.Case Report: In this article, we describe a nine-year-old girl who developed depression after parental divorce and was prescribed paroxetine. During pharmacotherapy, she had suicidal thoughts and several unsuccessful attempts which have been neglected and finally last attempt was successful. This report is an evidence for physicians to prescribe antidepressants cautiously with reasonable indication. As still there is no certain contraindication of using antidepressants in pediatric patients, importance of follow-ups and screening of suicide in pediatric patients during treatment with antidepressants seems essential.Conclusion: This study discloses the magnitude of explaining the side effects of antidepressants to caregivers of children with psychiatric problems

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

Delayed Onset Brain Hypoxia and Subsequent Seizures: a Rare Fatal Consequence of Undiagnosed Foreign Body Aspiration

Background: Foreign body aspiration is a common medical emergency among children that can lead to lethal complications especially in neglected or misdiagnosed cases.Case Report: This article is a report of a 15-month-old child who aspirated food materials and after chocking crisis, she presented with unspecific respiratory symptoms and treated for respiratory tract infections. After five days, sudden airway obstruction led to hypoxic brain damage and seizure. Due to unavailability of bronchoscopic facilities, extraction of foreign body was postponed and persistent hypoxia led to irreversible brain damage, seizures and finally death. This report reveals the key role of physicians in prompt diagnosis and the importance of early extraction of aspirated foreign bodies, even in asymptomatic cases, to prevent later complications and related mortality and morbidity.Conclusion: This report contains warning hints for professionals in different fields of medicine that deal with pediatric patients

Gender Determination Using Diagnostic Values of Foramen Magnum

Background: Foramen magnum is a big hole in the base of the skull. Its appearance can be useful in gender determination. So far, no study has been conducted in Iran that evaluates the value of foramen magnum in sex determination and calculates the cut-off points. This study aimed to evaluating of diagnostic value of the foramen magnum and to calculate the cut-off points for sex determination.Methods: In this cross sectional study 50 male and 50 female patients referring to the radiology department of Rasol Akram Hospital in Tehran were evaluated. The required information about the sagittal diameter, transverse diameter, and diameter of foramen magnum were assessed by brain CT scan. Chi-square and independent t test was used for the comparison of different shapes and diameters between the sexes. ROC curve was used to determine the optimal cut-off point for each indicator.Results: The best cut-off point to distinguish males from females along the anterior-posterior foramen magnum was calculated as 36.45 mm, at the transverse diameter of 30.4 mm. The proper cut-off points for the area of the foramen magnum were 877.477 mm2 and 870.29 mm2, based on the Teixeria formula and Routal formula respectively. Overall, the accuracy of these indicators was calculated as 85%.Conclusion: Based on the results of this study using CT scans images, the diameter of the foramen magnum and its area had a high accuracy in sex determination

The Relationship between Environmental, Cultural and Chronological Factors with the Frequency, Cause and Type of Burn Injuries Admitted to the Trauma and Burn Center Motahari Hospital, during the Years 2007to 2011

Background:One of the most important health associated problem are events, which burns considered the most common of them. To prevent burn and reduce the complication and mortality rate, accurate information of epidemiology of burn is essential for planning properly.This study was conducted to determine the relationship between environmental and cultural factors and the type, cause and extent of burn injuries admitted to the trauma and burn center of Motahari hospital during 1386 to 1390.Methods: In this routine data base study, we recruited all burned patients whichreferred to trauma andburncenter of ShahidMotahari hospital between 2007 and 2011. Mainvariables includingeconomic conditions, season ofoccurrenceof the accident,the accident tocurriedonspecial occasions, yearof accident, accidentstatuson holidays, type of injury, cause of injury, injuryseverity, burnarea, anddemographic variables such asage and gender were entered in checklist from patient’s documents.Collected data were entered into softwareSPSS version 11 and were analyzed.Results:5511 patients were admitted to Motahari hospital during the April of 1386 to the end of 1390, from which 1448 (26.3%) cases were female and 4063 (73.7%) male. The mean age of subjects was 28.47 (SD=1.88).There was significant difference between different gender and etiology, so that men were burned more by oil, gasoline and diesel fuel rather than women.There was significant difference about the number of burned cases by the flame at different seasons of the year. Average number of people burned by gas cylinders,electricity,caraccident,bitumen was significantly different in different seasons.Conclusion:There were significant differences about burn injuries due to the gas cylinders,bitumen,electricity and car accidents in different seasons and months.To inform burn centers, principalship of these data increases their ability to manage populated and harmful days. According to the higher rate of explosive burn injury in the last month of the year producing harmless explosive materials can be so effective to support patients lives

Electrical Burn Patients According to Electrical Voltage in Shahid Motahari Burn Center

Background: Electrical injuries are rarely happened but it makes more harmful lesions comparing to other thermal injuries. The aim of this study was to report electrical burned patients according to electrical voltage in Shahid Motahari Burn Center.Methods: This Routine data base study was performed on patients with electrical burns which were admitted to Shahid Motahari Burn Center from April 2010 to March 2012. Demographic and clinical data had gathered from medical records. Association between voltage and morbidity or mortality was evaluated used SPSS v. 16.Results: Mean total body surface area of 287 patients (283 (98.60%) male and 4 (1.4%) female) with mean age of 30±0.7 years was 13.56±0.76% (range 1-100). There were 203 patients (70.7%) with low and 84 patients (29.31%) with high voltage injury. There was significant association between voltage and place of injury (p=0.001).Conclusion: High voltage injuries constitute large number of electrical injuries which more of these injuries occurred outdoor and in workplace and need more hospitalization. High voltage injuries are related with more amputation, so people and authorities should pay more attention to such injuries

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

Review of Fall Injuries and Related Factors in Patients Admitted to a Trauma Referral Hospital in Tehran, Iran

Background: Falls are important causes of mortality and morbidity in urban areas and put a high burden on societies. We investigated patterns of fall traumas and related factors in a referral trauma hospital in Tehran, Iran.Methods: In this routine-data-based study, all documents of fall cases in Hazrate-Rasool hospital, Tehran, Iran, during October 2014-2015 were investigated. Information on demographic factors of patients, fall conditions and outcomes were collected. Data were analyzed by SPSS 11.5. The statistically significant level was considered ≤ 0.05.Results: Of the 307 cases, 70% were male. Median (interquartile range) age was 32 (22-51) years. Of cases, 91% were undergraduates. The mortality rate was 2.6%. Suicide attempts reported in 17 (5.5%) cases and only 2 (12%) of them were successful. Injured body organs in order of frequency were extremities, head and neck, thorax, vertebras, abdomen and pelvis. Outcome (in terms of injured body organs) was related to age and gender of patients alongside with height and reason of the fall. Falls at workplaces, in suicide attempts and among males happened for significantly higher distances. High distance falls and low GCS at admission were related to higher mortality. Majority of falls on a same level happened at home among old women.Conclusion: In our region, fall was a problem of people with low socioeconomic status. Our mortality rate is similar to the highest mortality rates in the world. Personal characteristics along with trauma-related factors are both important in the outcomes of fall cases. Safety equipment at high risk jobs is essential to prevent falls