فهرست مطالب elham bazmi

Mortality among children under 5 years is an important health indicator. Therefore, determining the most common causes and manners of death according to the postmortem data is necessary for designing intervention programs to reduce mortality.

This study aimed to evaluate the causes and manners of death in children aged under 5 years old in Tehran, Iran using autopsy findings.

This descriptive cross-sectional study was conducted on the data of all deaths among children aged under 5 years who were referred to the Legal Medicine Organization of Tehran, Iran, during January 2009-December 2019. The data were collected using the checklists of demographic characteristics, autopsy, toxicological findings, pathological findings, hospital records, and judicial documents, which were then analyzed.

Among 1750 children aged under 5 years old included in this study, 898 (51.3%) cases were male, and 997 (56.9%) were hospitalized. Most of the mortality cases occurred about two months after birth. The most common causes of death were found as congenital cardiovascular anomalies (14.7%), pneumonia (11.7%), and preterm labor (11%). Moreover, natural death (77.7%), accidental death (17.7%), homicide (2.7%), and unknown death (2%) were the major manners of death in these children.

Postmortem examination to determine the causes of unnatural death could help clinicians and policymakers to propose a suitable intervention for reducing the mortality rate in children under 5 years.

The coronavirus disease 2019 (COVID-19) epidemic is a great challenge among  healthcare workers, especially nurses,duet othei rmoref requent and closer contact with patients.

This study aimed to evaluate anxiety, depression, and their causes among nurses with COVID-19 infection in different wards of a hospital.

This cross-sectionalstudy was carried out between February 1stto October 30th, 2020, among all nurses with COVID-19 infection in different wards of Imam Khomeini Hospital (university hospital), Tehran, Iran. The nurses were contacted by phone, and data were collected using a self-administered, valid, structured questionnaireconsisting ofsociodemographic characteristics and clinical symptoms. Psychological complications, including anxiety and depression levels, were assessed and their association with other sociodemographic variables was also evaluated.

A total of 158 nurses were entered into the study, out of which 112 (70.2%) cases were females. Among all participants, 72.8%and 42.4% of the subjects reported anxiety and depression, respectively. The frequency of moderate to severe anxiety was significantly greater in women than in men (P<0.001). The infected nurses who worked in low-risk departments experienced a greater proportion of moderate to severe depression (P=0.004). In addition, the most prevalent reason for anxiety and depression was found to be the fear of infecting family members.

Nurses bear a significant psychological burden during the COVID-19 pandemic, markedly when they get infected and experience clinical symptoms. Therefore, the government and other staff should provide some facilities and supportive administrative work for reducing anxiety and depressionand improving nurses' psychological health.

 The Coronavirus Disease 2019 (COVID-19) pandemic promptly became a significant public health challenge with extra-pulmonary manifestations, including liver damage. Postmortem examination is crucial for gaining a better understanding of these manifestations and improving patient management. This study summarized the current knowledge of the postmortem liver pathology of patients with COVID-19.

 This review was conducted on studies evaluating the postmortem macroscopic and microscopic findings of the liver in patients with COVID-19. Accordingly, we searched 4 electronic databases (PubMed, Scopus, Google Scholar, & Web of Science) until June 2021. From the 317 screened articles, 16 articles examining a total of 332 patients who had died due to COVID-19 were selected.

 The significant findings of the liver were moderate macro and microvesicular steatosis with mild sinusoidal dilation, active lobular and portal vein thrombosis, mildly-increased lymphocyte filtration in sinusoidal space, and multifocal hepatic necrosis. Additionally, the most common comorbidities were hypertension and other metabolic diseases. In conclusion, liver damage due to COVID-19 infection has various manifestations in patients who have expired due to COVID-19.

 Therefore, monitoring liver function during the course and treatment of this disease is necessary for better patient management and to decrease the COVID-19-induced mortality rate COVID.

Today, despite the efforts of the medical community and health staff, the rate of dissatisfaction and complaints among patients is increasing and this highlights the importance of evaluating its related factors. The aim of this study was to analytically investigate complaints against ophthalmologists which were referred to the Legal Medicine Organization of Iran in Tehran during 2017-2019.

In this cross-sectional (analytical-descriptive) study, the demographic data of patients and physicians including age, gender, marital status and academic degree, type of treatment measures leading to complaints, last decision of the medical commission, characteristics of protesting of patients and vote of revision commissions for all the complaints of ophthalmology were recorded and analyzed.

During 3 years, 176 complaints were recorded in the field of ophthalmology. Of these, 90(51.1%) complaints were from medical interventions which took place in university or government hospitals and clinics. Also, 27(15.3%) cases of malpractice were reported, among which negligent was the most common type, with 22 cases (81.5%). The highest number of complaints was for cataract surgery and the most frequent treatments with malpractice of the physicians were cornea transplantation. Although the most protests to the first decision were from the patients, the effectiveness of physicians’ protest was significantly higher (P<0.001).

Nowadays, with advances in treatment methods and technologies in ophthalmology and enhancement in the knowledge of patients about their rights, their expectations from medical staff have changed. The findings of the present study suggest that due to the rise in the number of complaints in ophthalmological treatment while a decrease in malpractice rate, applying intervention actions such as good communication between physicians and patients and patient’s right perception of treatment and possible side effects can lead to less number of complaints. In addition, due to different opinions in consecutive commissions, utilizing a single approach based on new information and evidence seems necessary.

Seizure is a common complication of tramadol poisoning and predicting it will help clinicians in preventing seizure and better management of patients. This study aimed to develop and validate a prediction model to assess the risk of seizure in acute tramadol poisoning.

This retrospective observational study was conducted on 909 patients with acute tramadol poisoning in Baharloo Hospital, Tehran, Iran, (2015-2019). Several available demographic, clinical, and para-clinical characteristics were considered as potential predictors of seizure and extracted from clinical records. The data were split into derivation and validation sets (70/30 split) via random sampling. Derivation set was used to develop a multivariable logistic regression model. The model was tested on the validation set and its performance was assessed with receiver operating characteristic (ROC) curve.

The mean (standard deviation (SD)) of patients’ age was 23.75 (7.47) years and 683 (75.1%) of them were male. Seizures occurred in 541 (60%) patients. Univariate analysis indicated that sex, pulse rate (PR), arterial blood Carbone dioxide pressure (PCO2), Glasgow Coma Scale (GCS), blood bicarbonate level, pH, and serum sodium level could predict the chance of seizure in acute tramadol poisoning. The final model in derivation set consisted of sex, PR, GCS, pH, and blood bicarbonate level. The model showed good accuracy on the validation set with an area under the ROC curve of 0.77 (95% CI: 0.67–0.87).

Representation of this model as a decision tree could help clinicians to identify high-risk patients with tramadol poisoning- induced seizure and in decision-making at triage of emergency departments in hospitals.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

Brucellosis is one of the most prevalent bacterial zoonotic diseases considered as a public health problem in Golestan province (north-east of Iran), but its spatial pattern remains unclear. Hence we evaluated the spatial analysis of brucellosis disease in Golestan province during 2015-2017. In this study, we explored the Spatial and Spatiotemporal clusters by using scan-statistic to consider influencing factors. In addition, logistic regression and Pearson’s chi-square tests were used to analyze the clusters' zones and compare them with others. We used GIS to determine unites' (Golestan cities) coordinate centers and visualize the location of the clusters. Results revealed that the geographical distribution of brucellosis in Golestan province was affected by several spatial and spatiotemporal clusters. Constituent units of both spatial and spatiotemporal clusters were the same, but the identified time period of spatiotemporal clusters was from January 2015 to June 2016. The main influencing factors were in contact with livestock and dairy hygiene. This study can assist health authorities to plan more effectively to control diseases by highlighting the high-risk areas and behaviors.

Job burnout can cause physical and psychological damage and reduce job efficiency, especially in difficult jobs such as health care fields. This study aimed to assess the association between the level of job burnout and some contributing factors among health care providers in Iran.

This study was performed on the data derived from 1807 participants from the first phase of the employees’ health cohort in 2017-2018. The data were collected using as a self-administrated tool utilizing Maslach Burnout Inventory. The questionnaire scores ranged from never to everyday, with 3 levels of burnout as well as burnout itself; then, the scores were categorized as low, moderate, or high. Ordinal logistic regression model was used to adjust ordinal dependent variables.

The mean score of the total burnout was 16.5±7.77 and was associated with work experience and age group (p < 0.001). The components of burnout consisted of emotional exhaustion (8.9± 9.0), depersonalization (23± 2.9), and personal accomplishment (34± 8.6). Emotional exhaustion was related to sex (less among males, OR=0.48) and type of job (less among officials compared to health care staff, OR=0.488). Composite burnout was more common among younger staff (OR= 3.85). Depersonalization was associated with duty shift workers (OR=2.42).

Job burnout is a major concern, and lack of personal accomplishment, as a component of burnout, was highly prevalent among Iranian health care employees. Being a single woman, health care provider, and having more than 20 years of work experience with a duty shift were contributing factors for burnout experience. Monitoring symptoms of burnout and its associated factors in the workplace and proposing an alternative organizational and behavioral system and sharing it with relevant authorities may help prevent or reduce job burnout and its deleterious effects.

Acute poisoning is nowadays a common medical emergency. The important point about admitting patients with acute poisoning is its timely and early diagnosis. However, the rate of consistency between clinical diagnosis and autopsy of patients with acute lethal poisoning has not been investigated broadly. The goal of this study was to compare the clinical symptoms of poisoned deceased patients through autopsy and toxicology at Tehran’s Medico-Legal Organization. A cross-sectional study was conducted on all the admitted poisoning cases at Baharloo Hospital in 2014 to 2015 who passed away and were referred to Kahrizak Autopsy Hall. Through investigating the medical records of the Hospital and Autopsy Hall, the researcher examined and compared the existent files. The collected data were entered into SPSS 16. Data were analyzed using Cohen’s kappa coefficient. In all, 98 people who had died from acute poisoning were investigated. The most common causes of poisoning were drugs (49%), followed by pesticides (39%). The least common cause of poisoning was alcohol (1%). The most common poisonous drugs were opioids. The most common causes of death based on hospital records and autopsy results were rice tablets and high-dose opioid poisoning. Using Cohen’s kappa coefficient, the rate of agreement between the causes of death in hospital records and autopsy results was estimated at 0.744. Bearing in mind the consistency of clinical diagnosis with postmortem autopsy results, we may begin life-saving management of patients of acute poisoning in the shortest possible time.

Universal goniometer (UG) is commonly used as a standard method to evaluate range of motion (ROM) as part of joint motions. It has some restrictions, such as involvement of both hands of the physician, leads to instability of hands and error. Nowadays smartphones usage has been increasing due to its easy application..
The study was designed to compare the smartphone inclinometer-based app and UG in evaluation of ROM of elbow.
The maximum ROM of elbow in position of flexion and pronation and supination of forearm were examined in 60 healthy volunteers with UG and smartphone. Data were analyzed using SPSS (ver. 16) software and appropriate statistical tests were applied, such as paired t-test, ICC and Bland Altman curves.
The results of this study showed high reliability and validity of smartphone in regarding UG with ICC > 0.95. The highest reliability for both methods was in elbow supination and the lowest was in the elbow flexion (0.84).
Smartphones due to ease of access and usage for the physician and the patient, may be good alternatives for UG.

Blood alcohol concentration is a major factor in forensic analysis in criminal and civil litigation. Along with ethanol, other volatile compounds such as n-propanol are produced as products of putrefaction. The aim of this study is the evaluation of ethanol and n-propanol in postmortem blood. A case-control study was done on 300 blood samples obtained from cadavers that were referred to Legal Medicine Organization (LMO) of Tehran, Iran, over a year (2009-2010). Blood ethanol and n-propanol concentrations were analyzed in duplicate by HSGC. Data on cadavers were taken from the information sheets and were analyzed by SPSS software. In this study, mean n-propanol level in blood was 8.311 mg/dl in putrefied and 1.58 mg/dl in non-putrefied victims. Interval times between death and autopsy in putrefied and non-putrefied victims were 3.5 and 1.25 days. Results show that n-propanol concentrations increase 1.23 mg/dl/day after death. In 99% of putrefied victims, ethanol level was more than 10 mg/dl. There was a high correlation between ethanol and n-propanol concentrations. By increasing 1mg/dl of n-propanol concentration, ethanol levels increased 2.5 and 1.4 mg/dl in putrefied and non-putrefied victims, respectively. N-propanol produced in putrefied victims with ethanol. Production of ethanol increased by rising n-propanol levels. Therefore, we might use n-propanol as a putrefaction factor in postmortem blood to distinguish endogenous and exogenous ethanol production.

This is a case of a patient with bowel obstruction, imaging studies were suggestive for pneumatosis intestinalis. Clinically diagnosed as adhesion band and pnematosis intestinalis. She underwent laparatomy, enterolysis, obstructionolysis and enterorrhaphy. The patient developed respiratory distress and expired after 2 days. At autopsy we found gray-brown discoloration in the wall of some part of small bowel and flattening of mucus membrane. Grossly multiple gas-filled cysts were seen at the serosal surface. Microscopic evaluation of small intestine wall showed multiple cysts located in submucosal and serosal layers.

In Iran before 2003 and approval of therapeutic abortion law in parliament there was severe restriction in abortion permissions and at that time, after presenting "The Guidelines for Therapeutic Abortion" by legal medicine organization of Iran (from now on known as LMO) presented in 2003 and finally, Islamic consultative assembly voted to approve the indications determined by LMO in 2005. In this study all cases referred to the clinical examination department of legal medicine organization in Tehran central region to get therapeutic abortion permission during one year before approval of therapeutic abortion law (first study from June 1999 to the end of May 2000) and after that (second study from early October 2006 to the end of September 2007), who could get this permission were considered accurately. Information needed to perform this study collected via completion of pre-designated forms and analyzed with SPSS software and the results compared in these two groups. In the second study in 85.36% of cases, fetal disorders and in 14.63%, maternal diseases and in the first study just 126 permission were issued, with 17% fetal disorders (major Thalassemia was the only considered case at that time) and 83% maternal indications were the reason to issue permission for abortion. In the second study the major fetal and maternal indications were: anencephaly and cardiovascular problems. The 2nd study shows that in 202 cases (35.19%), abortion permission was issued after confirmation of three specialists (cases which were forecasted in the Predetermined Abortion Indications List). This study shows that in spite of all efforts made so far to present legal approaches for abortion, it is not still time to stop working on the issue and perhaps some other diseases should be added to the mentioned list in future; but this would definitely needs joint cooperation of different authorities, governmental and judicial organization.