Iranian Journal of Forensic Medicine
Year:2007 | Volume:13 | Issue:2 (46)|Papers Count:13

Background & Aim: With attention to high prevalence of fire death and its multiple problems for determination of death cause in charred body and differentiate antemortem from postmortem burn, make use of vitality sign, at fire, example blood carboxyhemoglubin (HBCD) level and presence of soot in air ways evaluated as indicator of antimortem burn.Materials &Methods: This study is analytic, cross-sectional that conducts in central LMD of IRl at 2005 -2006 &for this study we evaluate 47 charred fire victims, with attension offamily and related members history, external examination and autopsy finding, penal records, definite antimortem & postmortem burn separated and then evaluate HBCD and presence of soot in victim s airways.Findings: A majority of victims 93.6% (44 cases) were male, 6.4% (3 cases) female. 59.6% (28 cases) of them were between 20-39 years old. Postmortem burn 29.8% (14 cases) and antemortem burn was 40.4% (19 cases). In victims with postmortem burn 92.9% (13 cases) have negative HBCD, and 7.1% (1 case) positive HBCD. But in cases with antemortem burn and evidence of life during fire progression 42.1% (8 cases) have positive HBCD, and 57.9% (11 cases) have negative HBCD. in cases with positive HBCD 80% (8 cases) have antimortem burn but in cases with negative HBCD 35% (11 cases) have postmortem burn.Conclusion: With attention to results, in cases with positive HBCD, 80% of victims (8 cases) have antimortem burn that shows persons was alive during fire. But 10% of victims (1 case) has postmortem burn that it possible antimortem burn disappear with stability of burn after death. This title at reverse is not conclusive. This study shows that in victims with negative HBCD, search of other cause of death such as, homicide, natural diseases or suicide (for uses of accelerator substances) is more likely necessary.

Background & Aim: Work related accidents cause the death of thousands of laborers annually. According to United States National Protection Agency the rate of disabilities resulted from work related accidents have increased from 5.9% in 1961 to 10.87% in 1976.The ILO data shows that in the EU, with the exception of England and Holland, every 6 in 100 thousand workers lost their lives due to work related accidents. The same figure is, 7 in Australia, 7 in Canada, 4 in Japan, 7 in Switzerland, 6 in Austria, 7 in Belgium, 3 in Denmark, 5 in Germany, 4 in Greece, 3 in Holland, 6 in Portugal, 10 in Spain 6 in Sweden and 16 in Turkey.The published data in Iran Shows that 14706 work-related accidents occurred in 1982, the mentioned data doesn’t show the real number of accidents it merely shows those of which reported by work inspectors. Materials and Methods: The design of the study was case series. Public service and green space laborers of Tehran Municipality who have died during 2004-2005 due to work related accidents were studied. Following the report of each accident a questionnaire containing question about the different aspects of the accident and the characteristics died person was completed by the health inspectors. The questionnaires were gathered and the data was analyzed. Findings: Totally 9 cases of deaths following work related accidents were reported in 2004 and 6 cases in 2005 which caused a total number of 67500 person-day work loss in 2004 and 45000 person-day work loss in 2005. Considering the fact that the number of the laborers was 21000 annually, it means 43 deaths in every 100 thousand workers in 2004 and 26 deaths in every 100 thousand workers in 2005. The leading cause of death in 2004 were driving accidents which in 22.5% of them the laborers had not used necessary safety equipments and in 66.5% the drivers were culprit. The remaining 11.5% were due to other reasons. In 2005 the leading cause of death was driving accidents again which in 67% of them the laborers had not used necessary safety equipments and in 33% the drivers were culprit.

Background and Aim: In spite of the numerous advancements in diagnosis and treatment of the disease, today, lodging files against physicians and medical assistants is increasing. Population growth, social awareness growth, and growing number of physicians, as well as implementation of complex and modern devices in diagnosis and treatment of the diseases are among the reason for such complains. Moreover, the lessening of traditional relationship between patient and physician accelerates this phenomenon. The aim of our study was to asses etiologies and motivations of complains, rate and type of malpractice and at last find a solution for decreasing physicians' Malpractice.Materials and Methods: In a retrospective descriptive-Analytic study we evaluated the records of medical malpractice in the field of orthopedic during 1998 to 2003, in the coroner's office of Forensic Medicine, province of Tehran.Findings: During this time among 965 cases of medical malpractice, 196 (20.31%) have been related to this field. This process has increased from 15 cases in 1998 to 39 cases in 2003.In 60.72% of the cases acquittal verdict, and in 39.28% of the cases malpractice verdict have been issued. Of the total number of the cases 54.59% of them have been related to private centers, 17.86% related to non academic governmental centers, and 21.94% were related to university centers and 5.61% related to charity centers. However, malpractice rate in these centers has been 52.34% 22.86% 20.93% and 36.36% respectively. 9.09% of the malpractice cases resulted in the death of the patient, the rest resulted in physical handicap, and deficiency. Conclusion: Improvement in the patient - physician relations, implementation of medical ethics, decrease in related financial affairs, improvement of professional skills and knowledge of the physicians, adequate briefing of the patients before diagnostic and therapeutic procedures, and accommodation of therapeutic centers with the advanced technical equipments has significant effect on the lessening of ignorance and complaints.

Background & Aim: More than 1.26 million people are killed each year as a result of road traffic crashes. Most of the road traffic fatalities occur in low and middle income countries. WHO reported that in 2020 more than 2.34 million people will be killed due to road traffic accidents. With study of pattern of road traffic accidents, we are able to prevent or decrease many of these fatalities.Materials & Methods: This is a cross-sectional study which is done with cooperation of Isfahan Legal Medicine Center. In this study Record of the deceased who died of accidents from 1381 to 1382, and their cadavers were brought to different Isfahan Legal Medicine Centers for issuing burial permit, were examined and for every one of them a checklist was prepared. After data collection they were analyzed with software spss.Findings: Between 2002 to 2003, 1446 people died because of road accidents, 1202 (81.3%) of them were men and 244 (16.9%) were women had. The most frequency of mortalities was in motor cyclists, the age range of 16 to 20 years and the final cause of death was head injury. The least frequency belonged to bicyclists.Conclusion: The consequences of this study was not so much different specially from developing countries except for bicycling which has more mortality rate in other studies, whereas it has less mortality rate in our country, that is because of bicycle usage is less common in daily transportation of Isfahan.

Background and aim: One of the factors that a physician cannot defend himself in claims is d medical files of patient. This study was done to evaluate the knowledge and practice rate of medical assistants and students in Semnan Medical University.Materials and Methods: This descriptive analytical study was performed to study the knowledge and practice rate of 134 medical assistants and students regarding medical documentation of provided care. A twelve section questionnaire and a checklist were used after confirming their validity and reliability. Data was gathered by interviewing with assistants and medical chart review.Findings: The results showed that 40% of assistants knew legal aspects of documentation, 25.2% of them knew how to use abbreviations in final diagnosis and surgeries. 14.2% knew duration of confirmation of verbal orders. The relationship between knowledge and educational course was significant (p<0.05) only 10% completed the medical chart legally. Most of assistants tended to record clinical data. There was a significant relationship between practice, education course and knowledge (p<0.05).Conclusion: According to the results, the knowledge and practice were weak. Process of clinical education must be evaluated in outpatient and inpatient wards.

Background & Aim: Anesthesiologists, like other specialists, are subjected to legal pursuit of their country during medical activities. The purpose of this study was to evaluate the causes of anesthesiologists ' legal pursuits. Materials & Methods: This is a retrospective study which the causes of anesthesiologist's legal pursuits with study of 70 files in Tehran Medical Council from 1993 to 2003 were determined and investigated; the cases were investigated that the ruling of high disciplinary committee was issued about them.Findings: The mean age of the patients (complainants/deaths) was 31.94±20.58 (1.5 to 87 years old). Most of the cases/deaths were below 40 years old (42 cases, 75.36%). There were 14 cases (20.3%) in group of children (below 15 years old). The most common reasons for complaint were death of the patient (56 cases, 80%) followed by neurological complications including paralysis (5 cases, 7.14%. The leading place of the subject of legal pursuits was the hospitals (64 cases, 91.43%). followed by day clinics (4.29%). More than 90% of the events happened during general anesthesia while 5% of them occurred during MAC. About 71, 64% of the events took place in an elective surgery. While most of the cases underwent anesthesia by an anesthesiologist (94%), there were 4 cases (5.97%) of anesthesia by other staff (technician or MS. of anesthesiology). The primary court verdicts convicted anesthesiologist in 66.18% of the cases and 66.67% of these verdicts were verified by higher-ranked courts. In 43 cases the anesthesiologists were sentenced to pay damages and 2 cases were sentenced to written warning in their records. Averagely the ratio of anesthesiologists' medical misdeed was 43.95%±25.4% (5% to 100%). Conclusion: Most of the cases leading to legal pursuit occur in daily routine anesthesia.

Background & Aim: The treatment of infertility by donating embryo is one of the methods to help fertility in couples suffering of infertility. In Iran, after it had been legitimized by religious dignitaries, the way to the implementation of such a method has been paved through a bill passed by the parliament in 2003, But a prerequisite for donating embryo is attention to more ethical Considerations which the legislator must explain it specifically and stop the unethical misuses. The applicant also must have more awareness to the medical and legal conditions.Materials & Methods: In this descriptive study, 86 couples applying to receive donated embryo over a period of six months were interviewed using the census method. The filled questionnaires yielded the data which were later analyzed using tenth version of Statistical Package for the Social Sciences (SPSS).Findings: Concerning study of infertility, in 93.9% of cases the cause of infertility was male. Any of the couples wasn't afflicted by drug addiction, AIDS, Hepatitis and Mental illness. 91.5% of the couples had no information about the identity of the donor and left the choice to the centre. 70.7% laid importance on moral characteristics 72% of them considered the genetic traits of the ensuing child much important. 59.8% of the couples never thought about the prospective relationship of the ensuing child with the donor as well as the identity problems coming out of the practice. 85.4% of couples would never disclose the embryo donation to the ensuing child.Conclusion: Anonymity of donor and recipient couples makes less legal and sentimental problems for the parents in future. In the other hand, the children s human right necessitates to inform the manner of conception to them. By the increasing of assisted reproductive birth, the risk of ignorant incest and genetic anomalies will be augmented. These problems lead the parents to tell the truth to their children who were born by embryo donation. As the embryo donation is almost a new technique in our country, a wide distance is seen between some of the attitudes and behaviors with the standard experienced advised one, especially in disclosure the manner of conception to the child and family. More extensive psychological consultation seems necessary to go underway. Moreover, couples need to know more about the legal aspects of embryo donation and how they would have a stronger family relationship between parents and children.

Introduction: The question of whether the physician is guarantor in the cases when the patient hurt or died during the cure period was brought to the question from a long time ago.Discussion: In this study after reconsidering the two doctrines of Shiite jurisprudents and for and against reasons it is concluded that for reasons cannot prove the claim about the physician guaranty. Since ,nowadays, physician theoretically and practically study in general specialty courses and at the end swear to applying medical rules, orders and skills with respect to the divine and humanity dignities, granting the guaranty is unjust.Conclusion: Of course, there is no discussion about responsibility of physician if he/she goes to extremes in remedial process. But if the basis is on the physician guaranty (taken from some of the articles Islamic criminal law), it remains a place for more critiques.It seems that, in new reconsidering, the basis is on the none guaranty of physician, it means the lack of necessity to take a quittance from physician, unless it is opposite proved. It is a part of Ehsan rule which takes off the responsibility.

Introduction: cardiovascular diseases are the most common cause of mortality and morbidity in developed and several of developing countries and estimates for 40 - 45% of that. In Iran statistics shows high prevalence of cardiovascular diseases and cardiovascular diseases with accidents are the most important causes of mortality.Health deputy of Ministry of Health reported 70000 deaths from cardiovascular diseases in 2007. Also cardiovascular diseases are one of the most causes of impairment.Discussion: cardiovascular impairment is high in Iran because of high rate of cardiovascular diseases, but unfortunately, it has not been paied attention yet and there is no known functional way for impairment assessment.Conclusion: Impairment and disability assessment is a complex and difficult method and physicians should assess impairment based on patients' history, physical and Paraclinical findings, but a team work is necessary for determination of disability based on multiple aspects such as impairment, psychosocial and job of patients.

Introduction: Digit amputation is a physical and psychological trauma that can influence the daily living of a person. In the past 200 years, successful replantation of amputated digits has gradually moved from fantasy to reality. Nowadays modern replantation is available in most large hospitals. In recent 40 years ago thousands of severed part of body of subjects has been reattached to themselves, preserving the quality of life for thousands of patients through improved function and appearance that the void remaining after amputation cannot provide. The legal aspects of determining the compensation for such patients is one of the interesting subjects of legal medicine.Case report: The patient is a 28 y/o man who was hurt while working in a factory near Tehran, on 16 July 2005, his left thumb, index and middle fingers zone 2 were totally amputated avulsion with local crush. The patient successfully treated by an experienced surgeon, his fingers was replanted and almost 50% of his ability was recovered.One year after accident, he was referred to Legal Medicine Organization for determining the compensation (Dieh & Arsh).Considering the case, the Islamic Punishment Law has no predict for treatment charges and it seems which insurance companies must compensate the treatment costs of such patients.