A new magnetic internal distractor: cadaveric study of changes in trapeziometacarpal joint forces.

Distraction is a new treatment for trapeziometacarpal joint osteoarthritis. The purpose of this study was to test the efficiency of magnetic distraction using a new internal distractor in cadavers. The distractor consists of two magnets embedded inside titanium capsules that are implanted on either side of the trapeziometacarpal joint with the same poles facing each other, so that the force between the magnets distracts the joint. Intra-articular forces were recorded pre-implantation, immediately after implantation and again 10 minutes later. We also studied the changes in the forces before and after the procedure in different thumb positions. Our findings show that the trapeziometacarpal joint could be offloaded in all the studied trapeziometacarpal positions.

The Epidemiology of Gender Dysphoria in Iran: The First Nationwide Study.

Gender dysphoria (GD) is defined as a persistent and distressful incongruence between one's gender identity and one's at-birth-assigned sex. Sex reassignment has been religiously accepted for transgender individuals in postrevolutionary Iran since 1987; however, very little is known about how many individuals seek and receive such treatment annually. This study provides the first nationwide effort to assess the prevalence of GD in Iran as a function of diagnosis. The medical records of all transgender individuals referred to the Iranian Legal Medicine Organization between March 2012 and March 2017 were reviewed. All individuals diagnosed with GD were contacted. A total of 839 medical records meeting study criteria were received and evaluated. The prevalence of transgender individuals was estimated to be 1.46 per 100,000 Iranians with a transwoman (TW)/ transman (TM) ratio of 1:2. The mean age of individuals with GD at the time of referral was 25.22 (SD = 6.25) years for TW and 25.51 (SD = 5.66) years for TM. The findings are twofold. First, gender dysphoria is less prevalent in Iran than has been reported in Western countries. Second, the sex ratio is skewed toward at-birth-assigned females, which differs from what has been reported in Western countries. These findings have been interpreted in light of Iran's legal system, which is based on Islamic penal codes. These findings are of utmost importance for both health providers and legislators, as it can illustrate a more accurate picture of the transgender population in Iran.

Biomechanical evaluation of intraosseous distal radioulnar joint prosthesis: A prosthesis designed based on Sauvé-Kapandji procedure.

INTRODUCTION: To avoid the DRUJ surgical procedures disadvantages, a new intraosseous distal radioulnar prosthesis designed on Sauvé-Kapandji procedure has been introduced. Stability of the prosthesis and biomechanics are to be evaluated in this article. MATERIALS AND METHODS: On a cadaveric study, during placement of the prosthesis, biometry of the bones, prosthesis stability (in axial and lateral tractions, wrist pronation and supination, and squeeze test), wrist range of motion before and after implantation, and radiographic evaluation were done on 16 cadavers. RESULTS: Range of motion of the wrist joint before and after the insertion of the prosthesis, had no significant difference in all six directions. Stability of the prosthesis, when rotational pronation force was exerted, was greater than when rotational supination force was exerted. The prosthesis showed significant stability against longitudinal traction forces in a way that no prosthesis dislocation was observed up to 150N forces. Stability of the prosthesis was investigated when lateral force was applied to different wrist positions. The most stable position of the prosthesis was in the case of lateral traction forces in supination where no case of dislocation was observed. CONCLUSIONS: The intraosseous distal radioulnar prosthesis demonstrated stable structure with no effect on wrist range of motion. LEVEL OF EVIDENCE: IV.

Evaluation of Anatomic Variations of Fibula Free Flap in Human Fresh Cadavers.

BACKGROUND: Reconstruction of the head and neck defects is still one of the most challenging surgeries for the surgeons. This study investigated on anatomic variations of fibula free flap in human fresh cadavers. METHODS: Twenty fibula free flaps harvested from 10 fresh human corpses were enrolled. The number and type of skin perforators and their origin were recorded during the flap harvesting. After the completion of flap harvesting, the length of vascular pedicle and diameter of the artery and vein at the origin, the fibula length, the distance of the head of fibula to the site of peroneal artery bifurcation and harvesting time were also recorded. RESULTS: The fibula free flaps were performed on 2 women and 8 men with the mean age of 35.6 years. The average number of perforators per flap was 1.7, most of which were musculocutaneous (35.29%) from soleus muscle. The mean fibula length was 33.1 (range: 31-35) cm. The mean distance of the head of fibula to the site of peroneal artery bifurcation from the tibialis posterior trunk was 5.76 (range: 4.5-6.5) cm. The mean length of the pedicle flap was 11.15 (range: 10-13) cm. The mean diameters of the peroneal artery and vein at the origin were 2.83 and 51.5 mm, respectively. CONCLUSION: Although the fibula osteocutaneous flap is a reliable choice for maxillofacial reconstruction, flap harvesting is fairly difficult. Accordingly, surgeons must be aware of anatomical variations of the flap and have a suitable case selection to minimize the risk of surgical complications.

Comparison of the effect of standardized patient-based training with team-based learning on the knowledge of midwifery students in providing services to victims of rape.

BACKGROUND: Rape is a widespread and important issue in the field of public health, and its victims require comprehensive and gender-sensitive health services. Healthcare providers, especially midwives, play an important role in the diagnosis and treatment of rape, and improving their knowledge has been an essential factor in enhancing the quality of service provided. OBJECTIVE: The objective of the study is to compare the impact of standardized patient-based training and team-based learning on midwifery students' knowledge for providing services to rape victims. MATERIALS AND METHODS: In this randomized quasiexperimental study, 75 midwifery students of Mashhad School of Nursing and Midwifery were selected using available sampling method and were assigned to two groups of standardized patient-based training (n = 38) and team-based learning (n = 37). After performing pretest, standardized patient-based training group and team-based learning group were trained separately for 6 h. One week after intervention, posttest was performed. Data were collected and analyzed using the Academic Specifications Questionnaire and the Knowledge Assessment Questionnaire. Significance level was considered at P < 0.05. RESULTS: The two groups were homogeneous in terms of demographic characteristics. There was no statistically significant difference between the two groups in the posttest in terms of knowledge score (P = 0.079). However, there was a statistically significant difference in the level of knowledge between the two groups (P = 0.037). CONCLUSIONS: Given the effectiveness of both standardized patient-based training method and team-based learning method on enhancing midwifery students' knowledge for providing services to rape victims, these methods can be used in students' education.

Simultaneous measurement of formic acid, methanol and ethanol in vitreous and blood samples of postmortem by headspace GC-FID.

BACKGROUND: Formic acid (formate) is the main reason for toxicity and death through methanol poisoning. The simultaneous determination of methanol, ethanol, and formate in the body can help to discover the cause of death and is useful in the diagnosis of acute methanol poisoning. The measurement of formate is not yet available in Iran. With regard to the increasing rate of methanol poisoning and its related mortality in Iran, as well as the main role of formate in methanol poisoning, this study was designed to set up an analytical method for the concurrent determination of ethanol, methanol, and formate. METHODS: Following the modification of a previously developed gas chromatography method, vitreous and blood samples of 43 postmortem cases with a history of methanol intoxication were collected over a period of 2 years at the Legal Medicine Organization of Mashhad. Thereafter, ethanol, methanol, and formate concentrations were measured by headspace GC/FID. Formate esterification was performed by the methylation of formate with sulfuric acid and methanol. In order to confirm the esterification method for the production of methyl formate, we used gas chromatography with a mass detector (GC/MS) because of its higher sensitivity and accuracy. Furthermore, the correlations between formate and methanol concentrations in blood and vitreous samples, and between formate and methanol were investigated. RESULTS: A significant relationship was found only between methanol concentrations in blood and vitreous samples (P < 0.03). CONCLUSIONS: In postmortems, with the passage of time since alcohol ingestion, the measurement of only methanol concentration cannot determine the degree of toxicity or the cause of death. Therefore, using the present analytical method and measurement of formic acid, we can estimate the degree of toxicity and cause of death.

Three years evaluation of retained foreign bodies after surgery in Iran.

BACKGROUND: Medical errors such as retained foreign bodies (RFB) during surgery are not well studied. To define risk factors associated with this type of error, we performed retrospective study. METHODS: We reviewed medical records for unintentional foreign object remaining in the body during surgery such as gender, age, surgery ward, and incident reports referred to several forensic medicine administrations as well as adverse effects of retained foreign bodies and methods for detection of them over a 3-years period from January 2008 through May 2011. RESULTS: Thirty eight patients were involved in the study to have retained foreign bodies (73% sponges and 27% other instruments including 7 (18.42%) cases of other bandages, 2 cases (5.26%) of scissor and 1 case (2.63%) of forceps). The general surgery ward was most commonly involved (47%) followed by the gynecology surgery ward (34%). Men (58%) were more involved with RFB than women (42%). CONCLUSION: Considering the most frequent type of retained foreign bodies and also more frequent involved surgery wards besides detection methods for RFB, a mixed of preventing protocols such as regular counting of devices, post-operative X-ray with radiopaque markers and exact evaluation of surgery site should be employed to reduce the occurrence of retained foreign bodies and its complications.

Accessory Spleen in the Splenic Hilum: a Cadaveric Study with Clinical Significance.

AIM: An accessory spleen is an additional tissue of the spleen that may be found near the spleen. It is a congenital anomaly of the spleen that its incidence has been reported 10-30% of the population. Hence, the objective of this study was evaluation the incidence of accessory spleen in Iranian cadavers. METHOD: Sixty hundred and ninety three spleens (541 males, 152 females) were excised from cadavers in the dissection hall of Mashhad Forensic Medicine Organization cadavers. Inclusion criteria were as follows: Fresh Iranian cadavers with no history of alcohol, poisoning or drug abuse, and no evidence of pathologic abnormality or injury to the spleen. The presence of accessory spleens, its dimension and weight investigated in cadavers. RESULTS: During routine postmortem examination, five cases with an accessory spleen were found in the autopsy laboratory of Mashhad legal Medicine Organization between June 2014 and July 2015. Of the cases, 3 were male and 2 were female. The accessory spleens were observed at the splenic hilum. The length of the accessory spleens ranged from 2-3.5 cm, while the range of width was between 0.5 and 2.5 cm. The accessory spleens were confirmed by histological examination. CONCLUSION: An accessory spleen has clinical importance in some locations. When an accessory spleen is situated in another site, it may mimic some tumors such as pancreatic tumor and adrenal tumor. In addition, accessory spleen may cause hyperplasia after splenectomy and be responsible for a recurrence of the hematological disorders.

Study of the normal heart size in Northwest part of Iranian population: a cadaveric study.

Introduction: The heart is in a muscular organ in the middle mediastinum. According to our knowledge, there is no standard data about the anthropologic parameters of normal Iranian hearts. Hence, the aim of the present study was to investigate the normal heart size in Iranian cadavers. Methods: In a cross-sectional study, 550 cadavers (104 female/446 male) from June 2014 to July 2015 in the Razavi Khorasan province of Iran were included in the study. After approval of the Ethical Committee, cadavers were divided into 10 groups based on age groups. Length, width, weight, chordae tendineae, papillary muscles, and heart valves were measured using vernier caliper. Finally, data were analyzed using SPSS software. Results: The mean values of the demographic data were as follows: age= 42.12 ± 21.34 years; weight = 60.38 ± 15.32 kg; height = 158.14 ± 23.77 cm; and BMI = 24.66 ± 17.60 kg/m2. The mean values of the heart length, width, chordae tendineae, pupillary muscles, weight, and index of the heart were 11.41 ± 2.15 cm, 8.21 ± 4.38 cm, 19.41 ± 6.70, 5.74 ± 1.96, 247.78 ± 62.27 grams, and 5.74 ± 1.96, respectively. In addition, the circumference of the tricuspid valve, circumference of the mitral valves, and tricuspid and mitral areas were 8.80 ± 1.11 cm, 9.43 ± 1.44 cm, 4.11 ± 0.71 cm2, and 4.50 ± 0.90 cm2, respectively. Conclusion: Mean values of the heart's length and width was similar to previous reports from western population. The circumference of the tricuspid valve was less than the textbook's data, while circumference of the mitral valves was more than it. The study findings provide valuable information about standard data of the heart in the Iranian population, which is useful for surgeons as well as anthropologists. However, multi-center studies with a larger sample size are required to complete data about anatomical characteristics of normal hearts.

Chemical Components of Noncommercial Alcohol Beverage Samples: A Study With the Viewpoint of Toxic Components in Mashhad, Iran.

BACKGROUND: Iran has one of the lowest alcoholic beverage use rates in comparison with other countries, because it is legally forbidden and because of religious beliefs. Even so, unrecorded and noncommercial alcohol remains a considerable concern, which needs special attention. OBJECTIVES: In the current research, we have studied the general composition of noncommercial alcohol samples to identify potentially toxic components in the context of the city of Mashhad in IR Iran. PATIENTS AND METHODS: Using a descriptive study, chemical composition records of alcohol samples obtained from Mashhad and its suburbs (from March 2013 to March 2014) were evaluated in terms of ethanol percentage and methanol percentage using gas chromatography. Likewise, the pH of the alcohol and the location of the sample were also considered. Some substances, such as inorganic elements, were not included because there was no information about these substances in the records. RESULTS: Of 877 reports of alcohol samples, more than 50% were obtained from Mashhad and the rest were from the suburbs. Of the reports, 57.5% were in the spring and summer, followed by 42.5% in the fall and winter. The mean (min-max) of ethanol percentage was 30.04% (0 - 98.4). In four cases, methanol was detected. The mean (min-max) of methanol percentage was 23% (4 - 95).The majority of the samples had an acidic pH. CONCLUSIONS: The composition of unrecorded samples did not raise major toxicological concern beyond ethanol in alcohol products. However, concentration levels of methanol in some unrecorded alcohol samples made these samples detrimental for human consumption.

Nontraumatic Retroperitoneal Hematoma After Warfarin Administration: Fatal Case Report and Review of the Literature.

Spontaneous retroperitoneal hematoma after warfarin therapy is an extremely rare event. Here, we report a 25-year-old man who was brought in to the emergency service with confusion. On arrival, the patient had hypotension, tachycardia, tachypnea, low-grade fever, and Glasgow Coma Scale score of 12. Abdominal examination revealed distention and mild tenderness in the right upper quadrant of the abdomen. The patient had a history of aortic valve replacement surgery and was on warfarin treatment at an international normalized ratio of 2.4. Our patient progressed to cardiorespiratory arrest. The resuscitation was initiated promptly. Despite all resuscitation measures, including transfusion and administration of high doses of catecholamine, the patient died of hypovolemic shock 3 hours after admission. At autopsy, the external surface of the abdominal great vessels (descending aorta and mesenteric vessels) showed scattered petechial hemorrhages without any visible site of perforation. After comprehensive exploration of the abdomen, no evidence of traumatic event was identified and the cause of internal blood loss was noted as warfarin adverse effect.

Sudden death due to anaphylactic shock in a patient with an intact hepatic hydatid cyst.

Hydatid disease of the liver is a parasitic infection primarily caused by the larvae of Echinococcus granulosus. Hydatid cysts may remain clinically silent for many years and are often an incidental finding on ultrasonography performed for unrelated reasons. Sudden death due to unrecognized hydatid cysts can occur, and rare case reports of this kind are present in the literature. We present a sudden death due to an intact hydatid cyst in a 13-year-old girl, who had a sudden onset of anaphylactic shock after a blunt abdominal trauma. Sudden death in this case was attributed to anaphylactic shock caused by intravascular spread of the cyst contents. We believe that high intracystic pressure coupled with blunt trauma was the cause of leakage of cystic fluid into the bloodstream. In cases of sudden death in endemic areas, the possibility of a hydatid disease should be taken into consideration, especially if no other cause is evident.

The relationship between meteorological conditions and homicide, suicide, rage, and psychiatric hospitalization.

This study focuses on the relationship between the incidence of homicide, rage, suicide, and psychiatric hospitalization as violent behaviors with temperature, humidity, and air pressure as specific meteorological variables in the city of Mashhad, in the northeast of Iran. The data were obtained from Iran Meteorological Organization, official registry of Legal Medicine Organization and the local psychiatric hospital, March 2009 to Feb 2010 daily and were analyzed with SPSS-14 using Pearson correlation coefficient, ANOVA, and post hoc analysis tests. The rates of rage and psychiatric admission had a significant relationship with the daily mean air temperature, minimum relative humidity, maximum relative humidity, minimum daily pressure, and maximum daily air pressure (p < 0.0001). There was no significant correlation between homicide and suicide rates with any meteorological variables (p > 0.05). We concluded that, the possibility of nonfatal violence and psychiatric hospitalization would increase in hot and arid weather with low air pressure.

Missed opportunities for diagnosis of post-traumatic thrombosis: a case series and literature review.

Thrombosis is caused by abnormalities in the composition of the blood, the quality of the vessel wall, and the nature of the blood flow. Herein, we present four cases of fatal thrombus formation after a trauma, which were missed at clinical diagnosis as the symptoms were misinterpreted. We stress that a blunt trauma can be fatal because of its direct and indirect kinetic energy effects at the subacute phase. This report highlights the importance of considering thrombosis in the diagnosis of closed trauma, which is usually missed because of lack of awareness for early diagnosis and treatment or is detected too late for any therapeutic intervention, which can result in avoidable morbidity and mortality.

A report of five cases of self-mutilation for the purpose of insurance fraud.

Self-mutilation means direct and deliberate destruction of one's own body tissue without intending suicide. Some of the forensic referrals are the fraudulent persons who wish to obtain insurance benefits by simulating self-induced harms as injuries due to accidents. In this article we report five cases of self-mutilation for the purpose of obtaining insurance payments. These cases were interesting because of the following reasons: (1) Fracture of the tibia bone for the purpose of obtaining insurance payments is extremely rare. To our knowledge, the specialised literature does not present a similar case study as we described here. (2) In the cases we describe here, nobody had prior history of social and psychiatric problems and violence. In addition, on examination, no sign of previous scars was found in the whole body skin. (3) Self-mutilation injuries are often painless, parallel and delicate lines which are most frequently in the upper limb opposite to the dominant hand and in the areas that can be easily reached. In one of our cases, self-mutilation of the leg shin and the dominant hand were on the same side of the body. (4) In our study, all of the cases had high school education and were from small counties. Four patients were within the age range of 20-30 years, living in a populous family (six-member family) and of middle socioeconomic status. These results are consistent with previously available data for self-mutilation in Iran.

Time analysis of fatal traffic accidents in Fars Province of Iran.

OBJECTIVE: To analyze the time factor in road traffic accidents (RTAs) in Fars Province of Iran. METHODS: This study was conducted in Fars Province, Iran from November 22, 2009 to November 21, 2011. Victims'information consisted of age, sex, death toll involving dri- vers or passengers of cars, motorcycles and pedestrians, and site of injury etc. Accidents were analyzed in relation to hour of the day, season of the year, lighting condition including sunrise, sunset, daytime and nighttime. RESULTS: A total of 3 642 deaths (78.3% were males, and the ratio of males to females was about 3.6:1) were studied regarding their autopsy records. There was a steady increase in fatal accidents occurring at midnight to 15:59. The risk of being involved in a fatal traffic accident was higher for those injured between 4:00 to 7:59 than at other times (OR equal to 2.13, 95% CI 1.85-2.44). The greatest number of fatal RTAs took place in summer. Mortalities due to RTA during spring and summer were more pronounced at 20:00 to 23:59 and midnight to 3:59, whereas mortalities in fall and winter were more pronounced from 12:00 to 15:59. CONCLUSION: The high mortality rate of RTA is a major public health problem in Fars Province. Our results indicate that the time is an important factor which contributes to road traffic deaths.

Allele frequencies for 15 autosomal STR loci in Fars province population, southwest of Iran.

Allele frequency data at 15 short tandem repeat loci, D8S1179, D21S11, D7S820, CSF1PO, D3S1358, THO1, D13S317, D16S539, D2S1338, D19S433, VWA, TPOX, D18S51, D5S818 and FGA have been determined for unrelated individuals in a population sample of Iranian Fars individuals. With exception of the D13S317 (P-value=0.0458) and TPOX (P-value=0.0477), no deviation from HWE were found in the study population using the exact test. The most discriminating loci were FGA (PD=0.965) and D2S1338 (PD=0.964). These data can be used for estimating the frequency of short tandem repeat profiles in a population of Fars province individuals.

Lymph node co-infection of mycobacterium avium complex and cytomegalovirus in an acquired immunodeficiency syndrome patient.

Acquired immunodeficiency syndrome patients are known to have an increased tendency for developing opportunistic infections. However, there are no reports of simultaneous lymph node involvement of cytomegalovirus and Mycobacterium avium complex in a human immunodeficiency virus-positive patient. We report a 31-year-old man who presented with acute abdominal pain and tenderness and weight loss. He died a few hours after admission. Autopsy studies showed coinfection of cytomegalovirus, Mycobacterium avium complex and human immunodeficiency virus. Our case emphasizes the need to be careful in evaluating opportunistic infections in severely immunodepressed acquired immunodeficiency syndrome patients. This case report is the first manifestation of acquired immunodeficiency syndrome in this patient.