Background: Differentiating between homicide and suicide can be difficult and even impossible. In... more Background: Differentiating between homicide and suicide can be difficult and even impossible. In this report, we presented a fatal stabbing injury, which made a challenge in the verification of the manner of death. Case Report: A 45-year-old man was found dead in his workplace with a knife beside him. His mouth was closed with a scarf, his clothes were intact, and no evidence of a struggle was observed in the scene investigation. There was a vertical stab wound on the midline of the victim's belly and his intestines were tangled out of the wound. In the autopsy, no defense wound was found. There was blood in the abdominal cavity and retroperitoneal region and several perforations were observed in the intestine and liver along the superficial wound. Painful death and torturous extraction of visceral organs resembled homicide, but nothing indicative of hostility and homicide was found by the forensic exploration and police investigation. Finally, the manner of death was assigned as suicide and the cause of death was a hemorrhagic shock as a result of sharp force injuries. Conclusion: This case represents a bizarre suicide, which is rare and highly suspicious of homicide. In such mysterious cases, the evidence of autopsy and crime scene and police investigation should be regarded to make a decision.
Maternal mortality is a woman's death during pregnancy or postpartum period due to direct or indi... more Maternal mortality is a woman's death during pregnancy or postpartum period due to direct or indirect causes. Its direct causes are related to obstetrical issues. The indirect cause of it refer to an underlying disease, i.e. aggravated during pregnancy and leads to death. A routine data-based study conducted at the Legal Medicine Organization of Tehran City, Iran, the autopsy findings of maternal mortalities during April 2017-2019 were reviewed. During the study period, 53 cases were autopsied of which 29 (54.7%) and 24 (45.3%) died due to direct and indirect causes, respectively. , The prevalent direct causes of death, were bleeding (22.6%), eclampsia/preeclampsia (13.2%), and ectopic pregnancy (5.7%). Frequent indirect causes were cardiac diseases (20.7%) and nervous system and infectious diseases (both: 7.5%). This study revealed the considerable share of indirect causes in maternal mortalities in Tehran. Moreover, we outlined the importance of early detection of non-obstetrical medical conditions during pregnancy care to reduce preventable maternal mortalities.
Background: Substance abuse in drivers is a global public health concern. We investigated pattern... more Background: Substance abuse in drivers is a global public health concern. We investigated patterns of alcohol and illicit drug consumption in drivers died in traffic accidents in Tehran Province, Iran. Methods: In this cross-sectional study, presence of alcohol and illicit drugs in the body of dead drivers referred to Tehran Legal Medicine Organization during April 2016 to April 2018 were investigated. All participants underwent autopsy and their urine, visceral and vitreous samples were examined for alcohol and illicit drugs. Victims with Complete Toxicology Tests for both alcohol and non-alcoholic drugs and those autopsied during their first 24 hours of death were included. Victims’ demographic characteristics, results of their toxicology tests and accident-related factors were investigated, too. To warrant confidentiality of information, identities of victims were concealed. The obtained data were analyzed by SPSS V. 16 and statistically significant level was set at less than 0.05. Results: Of 618 study participants (mean age of 36.95 years), 601 (97.3%) were male. Of victims, 566 (91.3%) were city inhabitants and 471 (76.2%) were with educational attainment of lower than high school. The majority (93%) of crashes happened inside the city. Causes of death were head trauma in 519 (84%) cases, multiple traumas in 62 (10%) cases and bleeding in 37 (6%) cases. Multiple and single-vehicle accidents account for 498 (80.5%) and 98 (17.5%) crashes, respectively. A total of 73 (11.8%) cases were found positive for alcohol/drug consumption: 24 (4%) were alcohol positive, 52 (8.4%) were positive for non-alcoholic drugs (3 were positive for both). Main detected non-alcoholic drugs were morphine and tramadol. There was statistically significant association between drug/alcohol consumption of drivers and cause of death and crash mechanism (Both P<0.001). Multiple traumas and single vehicle crashes were more prevalent among drivers with drug/alcohol positive tests. Conclusion: Rate of alcohol use in our drivers was lower than many countries which is attributed to religious and legal issues. Consistent with the reported pattern of drug abuse in Iranian general population, opioids and tramadol were the main drugs of abuse among studied drivers. Drug or alcohol use result in drivers’ distraction and more fatal injuries.
Background: Rate of tramadol poisoning and seizure and its complications is high in Iran. We
inve... more Background: Rate of tramadol poisoning and seizure and its complications is high in Iran. We investigated the occurrence and recurrence of tramadol-induced seizures and related factors in patients with tramadol poisoning. Methods: This was a descriptive longitudinal study conducted in a poisoning referral hospital in Tehran, Iran. During April to June 2017, adult patients (≥16 years) with tramadol ingestion and poisoning admitted to hospital were selected by convenience sampling method. We studied the rate of seizure occurrence and recurrence among them. Also, the association between seizure occurrence and recurrence and patients’ demographic characteristics and poisoning-related factors were investigated. Data were analyzed by SPSS 16 and significant level was set at <0.05. Results: In total, 250 patients participated in the study. Their mean age was 26.39 years and 214 (85.6%) of them were male. Of all, 159 (63.6%) were single, 106 (42.4%) were unemployed and 24 (9.6%) were students. Main reason of tramadol consumption was suicide. Co-administration of drugs was reported in 83 (33.2%) cases. Incidence of seizure occurrence and recurrence were 31% and 38.5%, respectively. There was no statistically significant relationship between the occurrence and recurrence of seizures and patients’ age, gender, marital status, occupation, reason for tramadol consumption, co-administration of drugs and naloxone administration. Probability of seizure occurrence and recurrence raised with increased tramadol dose (P<0.001 and P<0.01, respectively). Seizure recurrence led to longer hospital stay (P<0.001). Conclusion: Rate of the occurrence and recurrence of tramadol-induced seizure seems clinically significant, but the prognosis is generally good in cases with seizure. Greater ingested dose and late hospital admission were associated with higher probability of seizure occurrence and recurrence. Further studies are required to investigate the risk factors of tramadol-induced seizure.
Background: " Body packing " is concealing illegal substances in the digestive system for smuggli... more Background: " Body packing " is concealing illegal substances in the digestive system for smuggling or transfer across borders and " body packers " are those who carry these substances. Illegal substances are wrapped in packages that are swallowed by body packers and delivered at destination by defecation. The most common fatal consequence of body packing is intoxication due to rupture of packages in the body. Due to secret nature of this form of smuggling, accurate statistics on its prevalence and complications are lacking. Iran is a big consumer of opioids, located in the route of transfer of illicit substances from Afghanistan to other parts of the world, and also implement tight restrictions on the carriage and distribution of opioids; thus rate of body packing is expected to be high in this country (especially for opioids). In this report we present a young man's sudden death with unknown cause in central part of Iran that was referred for autopsy. Results: In the autopsy, 2237 g of opioid was found in his gastrointestinal system in the form of wrapped packages of which three were ruptured and caused fatal acute intoxication. The victim had no criminal records, however, he had psychological problems and was in low socioeconomic position. Conclusion: This report underlines the importance of primary prevention programs with focus on susceptible groups which are usually people from low socioeconomic groups and are unaware of health risks of body packing and take part in this trade for financial benefits.
Background: Differentiating between homicide and suicide can be difficult and even impossible. In... more Background: Differentiating between homicide and suicide can be difficult and even impossible. In this report, we presented a fatal stabbing injury, which made a challenge in the verification of the manner of death. Case Report: A 45-year-old man was found dead in his workplace with a knife beside him. His mouth was closed with a scarf, his clothes were intact, and no evidence of a struggle was observed in the scene investigation. There was a vertical stab wound on the midline of the victim's belly and his intestines were tangled out of the wound. In the autopsy, no defense wound was found. There was blood in the abdominal cavity and retroperitoneal region and several perforations were observed in the intestine and liver along the superficial wound. Painful death and torturous extraction of visceral organs resembled homicide, but nothing indicative of hostility and homicide was found by the forensic exploration and police investigation. Finally, the manner of death was assigned as suicide and the cause of death was a hemorrhagic shock as a result of sharp force injuries. Conclusion: This case represents a bizarre suicide, which is rare and highly suspicious of homicide. In such mysterious cases, the evidence of autopsy and crime scene and police investigation should be regarded to make a decision.
Maternal mortality is a woman's death during pregnancy or postpartum period due to direct or indi... more Maternal mortality is a woman's death during pregnancy or postpartum period due to direct or indirect causes. Its direct causes are related to obstetrical issues. The indirect cause of it refer to an underlying disease, i.e. aggravated during pregnancy and leads to death. A routine data-based study conducted at the Legal Medicine Organization of Tehran City, Iran, the autopsy findings of maternal mortalities during April 2017-2019 were reviewed. During the study period, 53 cases were autopsied of which 29 (54.7%) and 24 (45.3%) died due to direct and indirect causes, respectively. , The prevalent direct causes of death, were bleeding (22.6%), eclampsia/preeclampsia (13.2%), and ectopic pregnancy (5.7%). Frequent indirect causes were cardiac diseases (20.7%) and nervous system and infectious diseases (both: 7.5%). This study revealed the considerable share of indirect causes in maternal mortalities in Tehran. Moreover, we outlined the importance of early detection of non-obstetrical medical conditions during pregnancy care to reduce preventable maternal mortalities.
Background: Substance abuse in drivers is a global public health concern. We investigated pattern... more Background: Substance abuse in drivers is a global public health concern. We investigated patterns of alcohol and illicit drug consumption in drivers died in traffic accidents in Tehran Province, Iran. Methods: In this cross-sectional study, presence of alcohol and illicit drugs in the body of dead drivers referred to Tehran Legal Medicine Organization during April 2016 to April 2018 were investigated. All participants underwent autopsy and their urine, visceral and vitreous samples were examined for alcohol and illicit drugs. Victims with Complete Toxicology Tests for both alcohol and non-alcoholic drugs and those autopsied during their first 24 hours of death were included. Victims’ demographic characteristics, results of their toxicology tests and accident-related factors were investigated, too. To warrant confidentiality of information, identities of victims were concealed. The obtained data were analyzed by SPSS V. 16 and statistically significant level was set at less than 0.05. Results: Of 618 study participants (mean age of 36.95 years), 601 (97.3%) were male. Of victims, 566 (91.3%) were city inhabitants and 471 (76.2%) were with educational attainment of lower than high school. The majority (93%) of crashes happened inside the city. Causes of death were head trauma in 519 (84%) cases, multiple traumas in 62 (10%) cases and bleeding in 37 (6%) cases. Multiple and single-vehicle accidents account for 498 (80.5%) and 98 (17.5%) crashes, respectively. A total of 73 (11.8%) cases were found positive for alcohol/drug consumption: 24 (4%) were alcohol positive, 52 (8.4%) were positive for non-alcoholic drugs (3 were positive for both). Main detected non-alcoholic drugs were morphine and tramadol. There was statistically significant association between drug/alcohol consumption of drivers and cause of death and crash mechanism (Both P<0.001). Multiple traumas and single vehicle crashes were more prevalent among drivers with drug/alcohol positive tests. Conclusion: Rate of alcohol use in our drivers was lower than many countries which is attributed to religious and legal issues. Consistent with the reported pattern of drug abuse in Iranian general population, opioids and tramadol were the main drugs of abuse among studied drivers. Drug or alcohol use result in drivers’ distraction and more fatal injuries.
Background: Rate of tramadol poisoning and seizure and its complications is high in Iran. We
inve... more Background: Rate of tramadol poisoning and seizure and its complications is high in Iran. We investigated the occurrence and recurrence of tramadol-induced seizures and related factors in patients with tramadol poisoning. Methods: This was a descriptive longitudinal study conducted in a poisoning referral hospital in Tehran, Iran. During April to June 2017, adult patients (≥16 years) with tramadol ingestion and poisoning admitted to hospital were selected by convenience sampling method. We studied the rate of seizure occurrence and recurrence among them. Also, the association between seizure occurrence and recurrence and patients’ demographic characteristics and poisoning-related factors were investigated. Data were analyzed by SPSS 16 and significant level was set at <0.05. Results: In total, 250 patients participated in the study. Their mean age was 26.39 years and 214 (85.6%) of them were male. Of all, 159 (63.6%) were single, 106 (42.4%) were unemployed and 24 (9.6%) were students. Main reason of tramadol consumption was suicide. Co-administration of drugs was reported in 83 (33.2%) cases. Incidence of seizure occurrence and recurrence were 31% and 38.5%, respectively. There was no statistically significant relationship between the occurrence and recurrence of seizures and patients’ age, gender, marital status, occupation, reason for tramadol consumption, co-administration of drugs and naloxone administration. Probability of seizure occurrence and recurrence raised with increased tramadol dose (P<0.001 and P<0.01, respectively). Seizure recurrence led to longer hospital stay (P<0.001). Conclusion: Rate of the occurrence and recurrence of tramadol-induced seizure seems clinically significant, but the prognosis is generally good in cases with seizure. Greater ingested dose and late hospital admission were associated with higher probability of seizure occurrence and recurrence. Further studies are required to investigate the risk factors of tramadol-induced seizure.
Background: " Body packing " is concealing illegal substances in the digestive system for smuggli... more Background: " Body packing " is concealing illegal substances in the digestive system for smuggling or transfer across borders and " body packers " are those who carry these substances. Illegal substances are wrapped in packages that are swallowed by body packers and delivered at destination by defecation. The most common fatal consequence of body packing is intoxication due to rupture of packages in the body. Due to secret nature of this form of smuggling, accurate statistics on its prevalence and complications are lacking. Iran is a big consumer of opioids, located in the route of transfer of illicit substances from Afghanistan to other parts of the world, and also implement tight restrictions on the carriage and distribution of opioids; thus rate of body packing is expected to be high in this country (especially for opioids). In this report we present a young man's sudden death with unknown cause in central part of Iran that was referred for autopsy. Results: In the autopsy, 2237 g of opioid was found in his gastrointestinal system in the form of wrapped packages of which three were ruptured and caused fatal acute intoxication. The victim had no criminal records, however, he had psychological problems and was in low socioeconomic position. Conclusion: This report underlines the importance of primary prevention programs with focus on susceptible groups which are usually people from low socioeconomic groups and are unaware of health risks of body packing and take part in this trade for financial benefits.
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Papers by Fardin Fallah
of alcohol and illicit drug consumption in drivers died in traffic accidents in Tehran Province, Iran.
Methods: In this cross-sectional study, presence of alcohol and illicit drugs in the body of dead
drivers referred to Tehran Legal Medicine Organization during April 2016 to April 2018 were
investigated. All participants underwent autopsy and their urine, visceral and vitreous samples were
examined for alcohol and illicit drugs. Victims with Complete Toxicology Tests for both alcohol and
non-alcoholic drugs and those autopsied during their first 24 hours of death were included. Victims’
demographic characteristics, results of their toxicology tests and accident-related factors were
investigated, too. To warrant confidentiality of information, identities of victims were concealed.
The obtained data were analyzed by SPSS V. 16 and statistically significant level was set at less
than 0.05.
Results: Of 618 study participants (mean age of 36.95 years), 601 (97.3%) were male. Of victims,
566 (91.3%) were city inhabitants and 471 (76.2%) were with educational attainment of lower
than high school. The majority (93%) of crashes happened inside the city. Causes of death were
head trauma in 519 (84%) cases, multiple traumas in 62 (10%) cases and bleeding in 37 (6%)
cases. Multiple and single-vehicle accidents account for 498 (80.5%) and 98 (17.5%) crashes,
respectively. A total of 73 (11.8%) cases were found positive for alcohol/drug consumption: 24 (4%)
were alcohol positive, 52 (8.4%) were positive for non-alcoholic drugs (3 were positive for both).
Main detected non-alcoholic drugs were morphine and tramadol. There was statistically significant
association between drug/alcohol consumption of drivers and cause of death and crash mechanism
(Both P<0.001). Multiple traumas and single vehicle crashes were more prevalent among drivers
with drug/alcohol positive tests.
Conclusion: Rate of alcohol use in our drivers was lower than many countries which is attributed
to religious and legal issues. Consistent with the reported pattern of drug abuse in Iranian general
population, opioids and tramadol were the main drugs of abuse among studied drivers. Drug or
alcohol use result in drivers’ distraction and more fatal injuries.
investigated the occurrence and recurrence of tramadol-induced seizures and related factors in
patients with tramadol poisoning.
Methods: This was a descriptive longitudinal study conducted in a poisoning referral hospital in
Tehran, Iran. During April to June 2017, adult patients (≥16 years) with tramadol ingestion and
poisoning admitted to hospital were selected by convenience sampling method. We studied the
rate of seizure occurrence and recurrence among them. Also, the association between seizure
occurrence and recurrence and patients’ demographic characteristics and poisoning-related factors
were investigated. Data were analyzed by SPSS 16 and significant level was set at <0.05.
Results: In total, 250 patients participated in the study. Their mean age was 26.39 years and 214
(85.6%) of them were male. Of all, 159 (63.6%) were single, 106 (42.4%) were unemployed and
24 (9.6%) were students. Main reason of tramadol consumption was suicide. Co-administration of
drugs was reported in 83 (33.2%) cases. Incidence of seizure occurrence and recurrence were 31%
and 38.5%, respectively. There was no statistically significant relationship between the occurrence
and recurrence of seizures and patients’ age, gender, marital status, occupation, reason for tramadol
consumption, co-administration of drugs and naloxone administration. Probability of seizure
occurrence and recurrence raised with increased tramadol dose (P<0.001 and P<0.01, respectively).
Seizure recurrence led to longer hospital stay (P<0.001).
Conclusion: Rate of the occurrence and recurrence of tramadol-induced seizure seems clinically
significant, but the prognosis is generally good in cases with seizure. Greater ingested dose and late
hospital admission were associated with higher probability of seizure occurrence and recurrence.
Further studies are required to investigate the risk factors of tramadol-induced seizure.
of alcohol and illicit drug consumption in drivers died in traffic accidents in Tehran Province, Iran.
Methods: In this cross-sectional study, presence of alcohol and illicit drugs in the body of dead
drivers referred to Tehran Legal Medicine Organization during April 2016 to April 2018 were
investigated. All participants underwent autopsy and their urine, visceral and vitreous samples were
examined for alcohol and illicit drugs. Victims with Complete Toxicology Tests for both alcohol and
non-alcoholic drugs and those autopsied during their first 24 hours of death were included. Victims’
demographic characteristics, results of their toxicology tests and accident-related factors were
investigated, too. To warrant confidentiality of information, identities of victims were concealed.
The obtained data were analyzed by SPSS V. 16 and statistically significant level was set at less
than 0.05.
Results: Of 618 study participants (mean age of 36.95 years), 601 (97.3%) were male. Of victims,
566 (91.3%) were city inhabitants and 471 (76.2%) were with educational attainment of lower
than high school. The majority (93%) of crashes happened inside the city. Causes of death were
head trauma in 519 (84%) cases, multiple traumas in 62 (10%) cases and bleeding in 37 (6%)
cases. Multiple and single-vehicle accidents account for 498 (80.5%) and 98 (17.5%) crashes,
respectively. A total of 73 (11.8%) cases were found positive for alcohol/drug consumption: 24 (4%)
were alcohol positive, 52 (8.4%) were positive for non-alcoholic drugs (3 were positive for both).
Main detected non-alcoholic drugs were morphine and tramadol. There was statistically significant
association between drug/alcohol consumption of drivers and cause of death and crash mechanism
(Both P<0.001). Multiple traumas and single vehicle crashes were more prevalent among drivers
with drug/alcohol positive tests.
Conclusion: Rate of alcohol use in our drivers was lower than many countries which is attributed
to religious and legal issues. Consistent with the reported pattern of drug abuse in Iranian general
population, opioids and tramadol were the main drugs of abuse among studied drivers. Drug or
alcohol use result in drivers’ distraction and more fatal injuries.
investigated the occurrence and recurrence of tramadol-induced seizures and related factors in
patients with tramadol poisoning.
Methods: This was a descriptive longitudinal study conducted in a poisoning referral hospital in
Tehran, Iran. During April to June 2017, adult patients (≥16 years) with tramadol ingestion and
poisoning admitted to hospital were selected by convenience sampling method. We studied the
rate of seizure occurrence and recurrence among them. Also, the association between seizure
occurrence and recurrence and patients’ demographic characteristics and poisoning-related factors
were investigated. Data were analyzed by SPSS 16 and significant level was set at <0.05.
Results: In total, 250 patients participated in the study. Their mean age was 26.39 years and 214
(85.6%) of them were male. Of all, 159 (63.6%) were single, 106 (42.4%) were unemployed and
24 (9.6%) were students. Main reason of tramadol consumption was suicide. Co-administration of
drugs was reported in 83 (33.2%) cases. Incidence of seizure occurrence and recurrence were 31%
and 38.5%, respectively. There was no statistically significant relationship between the occurrence
and recurrence of seizures and patients’ age, gender, marital status, occupation, reason for tramadol
consumption, co-administration of drugs and naloxone administration. Probability of seizure
occurrence and recurrence raised with increased tramadol dose (P<0.001 and P<0.01, respectively).
Seizure recurrence led to longer hospital stay (P<0.001).
Conclusion: Rate of the occurrence and recurrence of tramadol-induced seizure seems clinically
significant, but the prognosis is generally good in cases with seizure. Greater ingested dose and late
hospital admission were associated with higher probability of seizure occurrence and recurrence.
Further studies are required to investigate the risk factors of tramadol-induced seizure.