مجله پزشکی قانونی
سال پانزدهم شماره 4 (پیاپی 56، زمستان 1388)

Subendocard bleeding is one of significant findings during autopsy which its form with limited bleeding edge specified in the left ventricle subendocard will be visible as macroscopic. Subendocardial hemorrhage are found after intracranial hemorrhage following injury due to trauma, suddenly hypotension following any bleeding problems, obstetric complication, toxic poisoning particularly with iron, arsenic, cocaine and cerebral hemorrhage strokes. View this bleeding during autopsy, indirectly shows the possibility of one of the mentaioned cases in corpses and, will cause more the doctor's carefully considered examination of corpses. we decided to do a two-month cross-sectional study, in order to consider prevalence and factors associated with the hemorrhagic. During the investigations, 1224 body referred to forensic dissection hall of Tehran Legal Medicine Center to determine the cause of death, the bodies were examined by autopsy. After having done the autopsies, forensic medicine specialists and staff wrote the reports and collected the information and prepared them by using a questionnaire, and then analyzed them. Among the study, 1224 dead bodies examined by autopsy. In 79 cases (16.5% of them examined by autopsy) were found bleeding of subendocard. 66 patients (83.5%) of them were male and 13 (16.5%) females that age group between 26 to 30 years with 25 cases (31.6%) had the highest frequency. In 55.7% of the cranial trauma, in 36.7% multiple trauma, in 5.1% heavy bleeding, in 2.5% cardiovascular events and intracranial hemorrhage following vascular brain lesions were the cause of death. In 2.5% of the following bodies that have subendocard bleeding, death was non-traumatic, and in 97.5% death was traumatic. In 35 cases (44.8%), physical injuries and damages, were along with cranial injuries and in 15 cases (19%) physical injuries and damages were without along injuries of skull. This study showed that subendocardial hemorrhage often can be seen in severe trauma resulted to the death. View this bleeding in heart when reviewing during autopsy strongly suggest the probability of traumatic injuries in skull or other parts of body that it is necessary to considered.

Effort for enhancing health and reducing mortality of neonates is valuable from different viewpoints and its benefit is not limited only to neonatal period, but involves all the life of man. Although some efforts have been made and despite the reduction of infant's mortality by 50% in our country, there was not much success in decreasing neonatal mortality. With regarding that the majority of neonatal death occurs in hospital and since studying causes of it is important for choosing a proper intervention, the researcher decided to perform present study. This research is a cross-sectional descriptive study. Research community was all of the dead neonates in hospitals of Isfahan Province from April of 2005 to April of 2006 and sampling was performed by census method among the neonates of research community that were qualified to enter the research. The needed data were extracted through considering medical documents (clinical files of neonates). Descriptive statistics was used for analyzing the data. From 578 neonatal death cases occurred during the period of research, most frequency of neonatal death was related to hospitals that had NICU ward (43.4%), also most frequency of neonatal death causes in hospitals having NICU ward and also in hospitals without NICU ward was related to problems resulted from prematurity (44.6% versus 42.6%), congenital abnormalities (23.5% versus 21.3%) and Respiratory Distress Syndrome (RDS) (11.6% versus 12.7%), respectively, and in hospitals of other cities of mentioned Province the problems resulted from prematurity were (47.5%), RDS (18.1%) and Congenital abnormalities (12.4%). The results of this research revealed that more effort for preventing premature births, referring mothers who are exposed to premature delivery to centers having NICU ward and qualitative and quantitative enhancement of NICU wards is necessary and researcher hopes that with becoming executive the prenatal regionalization program in hospitals in future, these goals will be accessible.

We aimed to assess available evidence about medical misconducts and complaints in Iranian health system. We used systematic review methodology. We systematically searched four national databases and hand-searched three relevant journals. After quality appraisal, data was extracted from the literature and analyzed using qualitative synthesis approach. We retrieved 50 relevant reports and articles. They were classified into 3 categories: Medical negligence (26 reports), medical crimes (6 reports) and health care frauds and abuses (18 reports). Most of the papers in the first category focused on the results of complaints registered for litigation and few focused on their context or causes. We didn’t find any primary data in the majority of articles in the second and third categories. There was no estimation of the quantity, severity, or the effects of any of the misconduct and complaint categories. Conclusios: Studies only focused on some elements of the problem and rarely on process-related or systematic causes of misconduct. Studies that focused on medical criminal offences did not discuss potential legal limitations. Despite considerable financial impacts of healthcare fraud and abuse, this aspect of the problem had received even less attention.

Medical records documentation is used for maintenance of patient’s legal rights, providing information for research, medical education, general studies and qualitative surveys. Medical records documentation often renders after medical care accomplishment; therefore, it may be led to deficiency in documentation. In this study the completeness of medical history sheet, operation report sheet and physician order sheet by different documentaries in Isfahan teaching hospitals at 2007-8 was studied. This is a descriptive and perspective study. Statistical population is composed of the inpatient medical records pertinent to the patients referred to Isfahan teaching hospitals in 2007-8. About 1067 records selected for this survey. The tool of data collection is checklist. By using SPSS (Version10) and microsoft office excel 2003 the data were analyzed. Average of personality data registration in medical history sheet, physician order sheet and operation report sheet by department's secretaries was 57, 56 and 64 percent. Average of clinical data registration by physician in medical history sheet was 44 percent. Average of surgical data registration in operation report sheet by surgeon was 71 percent. Average of data registration by operation room's nurse in operation report sheet was 42 percent. Average of physician order data in physician order sheet by physician was 79 percent. According to the findings average of observance medical data registration in Isfahan teaching hospitals was unfavorable. This deficiency is due to different reason such as medicals record documentaries negligence, lack of adequate education for documentaries and shortage of time for completing data by documentaries.

Burn injuries are major health problems and still cause a significant morbidity and mortality in developing countries. Although there was no articles dealing with epidemiological studies of burn mortlity in Ardabil, investigation of epidemiology of burn injuries in Ardabil city was necessary. This was a cross sectionl study. Data on death by burn injuries that occurred in Adabil city from 1997-2006 were obtained from Legal medicine center and Fatemi hospital that included registers all burn injuries dealth in Ardabil. Mortality rate was calculated in order to compare age, sex and other items. For statistical analysis SPSS 15 software was used. During the period 1998-2007 a total of 65 death occurred in Ardabil city. The mean mortality rate was 1.86 in women and 0.88 in men per 100,000 person –year. The most common causes of death was hot liquids. %41.3 of burns mortality was due to suiside. There was a statistically significant association between mortality rate and sex,age group and burn causes. This study showed that mortality ratio of burn injuries in Ardabil due to suicide was higher than similar studies.We suggest future studies and efforts for prevention of burn injuries in Ardabil city specially in self conflicted burns.

Prolongation of procedure is one of the problems which the judiciary confront with it. A part of prolongation of procedure may due to examination and certification in legal medicine centers. The present study is conducted to assess this part of prolongation of procedure with the aim of reducing the unnecessary & frequent referrals from judicial authority system to legal medicine centers by analyzing the causes of rereferrals from judicial authority to legal medicine centers. This is a cross sectional descriptive study which is done on 450 cases of rereferral from judicial authority to legal medicine centers during one year from march 2006 to march 2007. The data collected by a questionnaire and analyzed by SPSS software. The resulting data showed that, the main Reason of rereferral was a problem due to claimant by her/himself (in 175 cases or 38.9%). Also in 118 cases (26.2%) a neglect or defect in legal medicine center caused the rereferral; and 157 cases (34.9%) a problem or misunderstanding via judicial authoritys was the responsible cause of rereferral. In first category, the main causes were complaining of pain in some part of the body, need for reexamination, protest from the initial certificate and uncooperation in process of examination or paraclinical investigations, respectively. Among the problems in legal medicine center, mistakes in writing the certificates was the leading cause (78% of cases). In category related to judicial authorityies, the leading cause was inaccurate reading of certificate, which cause misunderstanding in 54.1% of cases. With regarding to this study, we claim that major causes of rereferral from judicial authorities to legal medicine centers are avoidable by methods such as more attention to writ the certificate in legal medicine centers and certain educational curriculums for judges and their coworkers.

Awareness and consciousness are based on quintuplet sensory modality and loss of each of them maybe influences awareness. The mindfolness is an unintentional contempt ion on daily events. The aim of this study is comparison of mindfulness of blinds veteran with normal sighted matched person. In this cross sectional study we compare 93 blinds and 93 sighted people in mindfulness task. The test was Mindful Awareness Assessment Scale (MAAS). Mann –Whitney U Test was used to comparing blind with sighted. findings don’t show significant difference between two groups in mindfulness (P>0.05). Also mindfulness need sensory information but loss of one sensory modality can compensate information paucity for mindfulness.

Paraphilia is a collection of unfavorite or abnormal behaviors related to sexual function and usually corresponds with violence. A 30-year-old man resids in Shiraz created wound by the deep knife in the buttocks area of eleven women all wearing complete hijab (chador). In all cases the time of the incident was between 6 to 7 AM and it happened at geographical range of certain streets, especially in Shiraz and quiet streets. Finally with efforts of the police and the judicialauthorities of province the assailant arrested and was referred to Shiraz Legal Medicine Center for review of mental health. Most sexual assulter, experience several types of deviation over time. In this case the patient experienced four types of disorder display, view the game, and friction during sexual sadysm. When paraphilia would continue destructive behaviors on victims, gradually, will be more dangerious. In this particular patient it started with SD also view the display and the game and after long experience friction, it led to sexual sadism and if he didn’t detain, in cases of lock of data in, perhaps it ended up to a rape or murder.