Introduction: Falls are considered to be one of the significant public health problems worldwide, and are associated with increased mortality, hospitalization, and severe fractures. Fall-related injuries lead to socio-economic impacts, including psychological distress and decreased work productivity. This retrospective study aimed to study the correlation between falling height and the frequency and types of fall fractures in accidental high falls (AHF) and intentional high falls (IHF). Method: The study concluded that 268 patients were hospitalized between June 1, 2011, and June 1, 2017, for the treatment of fall-related injuries. The gender, age, falling height, and fall fractures and traumas were analyzed for each individual. Results: The results showed that there is no significant correlation between all types of fractures and the age of individuals. Furthermore, the correlation study of the falling height and different types of fractures also illustrated that there is no significant correlation between these factors in both groups, AHF and IHF. These findings showed that the pattern of fractures can be used to distinguish AHF from IHF. Conclusion: Since fractures are more common in older adults, particularly in older women, it is essential to implement comprehensive injury prevention programs and facilitate the diagnosis, treatment, and rehabilitation methods for this population to minimize the overall burden.

Inpatient falls are a significant health concern, leading to increased hospital stays, costs, and potential severe injuries or death. This study aims to investigate the incidence, risk factors, and challenges of inpatient falls in Firoozgar hospital . This cross-sectional study was conducted in a tertiary care hospital in Tehran, Iran. The study included all patients who experienced a fall incident in Firoozgar hospital between April 2023 and March 2024. We included 90 patients with an average age of 57.49 years. Falls were more prevalent among men, older patients, and individuals with lower education levels. Underlying conditions such as diabetes, heart disease, and addiction significantly increased the risk of falls. Identifying the specific causes of falls in each hospital ward can facilitate the development of targeted preventive strategies. Implementing environmental modifications and fall prevention measures could substantially reduce fall risks, enhance patient safety, and lower healthcare costs.

Background: Medical errors are one of the biggest problems of the health system in countries. Identifying the factors responsible for these errors is crucial to designing optimal strategies to reduce such occurrences. The aim of this study was to investigate the type and nature of medical errors. Methods: In this cross-sectional descriptive study, all documented medical errors that occurred between March 2021 and February 2022 at Firoozgar Educational and Medical Center were thoroughly examined. The data collection involved reviewing records from various departments within the center to ensure a comprehensive analysis of error types. The extracted data were processed and analyzed using SPSS v.22 software, allowing for statistical evaluation and identification of potential patterns or trends in medical errors over the specified period. Results: A total of 214 cases were reviewed. 45.3% of the recorded medical errors occurred in the morning shift, 20.6% in the evening shift and 34.1% in the night shift. The highest number of medical errors was reported by nurses (40.7%), followed by physicians (16.8%) and paramedics (11.7%). The etiology of most medical errors was systemic errors (63.6%) followed by pharmacological errors (15.4%) and technical errors (13.1%) and the most reported systemic errors were of insufficient supervision. Most of the patients who had medical errors were admitted to the inpatient wards (40.7%) and later to the surgical wards (17.3%) and ICU (12.6%). 62.1% of medical errors did not cause any specific complication and in 33.2% of cases, mild complication, 10.7% moderate complication and 3.3% severe complication occurred for patients. 62.1% of medical errors had no consequences for anyone, and in 36.9% of cases, the consequences of errors were to the patient and 1% of the consequences of errors were to the organization and employees. Conclusion: Most of the reported medical errors were performed by nurses and were uncomplicated errors. Establishing transparent and accurate self-reporting systems is essential to identify medical errors of all employees.

Background: In forensic medicine, predicting the age of a victim or suspect can be a clue to solving a crime. Epigenetics has recently played a vital role in age prediction in forensic medicine. Cytosine methylation at cytosine and guanine separated by phosphate (CpG) sites is well recognized as a novel epigenetic marker for age estimation. This study aimed to summarize the information obtained from previous studies to determine age by evaluating DNA methylation in the ELOVL2 gene. Methods: In this systematic review, all related articles published between 2012 and 2022 were extracted by searching reputable scientific databases, such as ISI Web of Science, Science Direct, PubMed, and Scopus. After selecting the appropriate articles, the full text of the articles was prepared and fully evaluated by the researchers. The protocol of this study was carried out based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Results: Out of 307 articles, 5 articles were eligible for review according to the study protocol. The strongest correlation between DNA methylation and age was observed at sites 11044644 and 11044634 on chromosome 6 in the living cases. The relationship between the chronological age and the age calculated through DNA methylation was above 90% with an approximate error ranging from 7.5 to 10.4. However, the relationship between the chronological age and the age calculated through DNA methylation was above 90% in the multivariate analysis of sites 11044624 and 11044634 on chromosome 6. In this case, the calculation error reached approximately 6.9 years. Hence, considering a combination of multiple cytosine and guanine separated by phosphate (CpG) sites improves the calculation accuracy and reduces the error percentage. The relationships between DNA methylation and the age at sites 11044880 and 11044640 on chromosome 6 were significantly less reported in the blood samples taken from the dead and in those taken from the living (nearly 64%–78.5%). Conclusion: The results of this study indicated that DNA methylation in the ELOVL2 gene could help predict a person’s biological age.

There is little evidence regarding pyrethroid poisoning manifesting with cardiac problems in the literature. Many authors, however, adopted that pyrethroids have a direct effect on heart tissue and can cause cardiotoxicity. Interestingly, no experimental studies have yet determined its mechanism of toxicity on cardiac muscle cells. This letter aims to describe the probable cause of clinical manifestations attributed to piperonylbutoxide, an ignored ingredient in pesticide poisoning, which is added to many pesticide products to increase their insecticidal potency. We think that cardiac manifestations in some cases of pyrethroid poisoning are due to the concomitant piperonylbutoxide toxicity and its possible effect on norepinephrine release from adrenal gland, which might explain changes in cardiac findings. Thus, it is necessary for all clinical toxicologists to determine suspicious ingredients when they are facing a doubtful manifestation.

BACKGROUND:Pituitary adenomas impose a burden of morbidity on patients and characterizing the molecular mechanisms underlying its pathogenesis received remarkable attention. Despite the appealing role of necroptosis as an alternative cell death pathway in cancer pathogenesis, its relevance to pituitary adenoma pathogenesis has yet to be determined that is perused in the current study.METHODS:The total number of 109 specimens including pituitary adenomas and cadaveric healthy pituitary tissues were enrolled in the current study. Tumor and healthy pituitary tissues were subjected to RNA extraction and gene analysis using Real-Time PCR. The expression levels of necroptosis markers (RIP1K, RIP3K and, MLKL) and their association with the patient's demographic features were evaluated, also the protein level of MLKL was assessed using immunohistochemistry in tissues.RESULTS:Based on our data, the remarkable reduction in RIP3K and MLKL expression were detected in nonfunctional and GH-secreting pituitary tumors compared to pituitary normal tissues. Invasive tumors revealed lower expression of RIP3K and MLKL compared to non-invasive tumors, also the attenuated level of MLKL was associated with the tumor size in invasive NFPA. The simultaneous down-regulation of MLKL protein in pituitary adenoma tissues was observed which was in line with its gene expression. While, RIP1K over-expressed significantly in both types of pituitary tumors which showed no significant correlation with patient's age, gender and tumor size in GHPPA and NFPA group. Notably, MLKL and RIP3K gene expression was significantly correlated in the GHPPA group.CONCLUSIONS:According to our data, the reduced expression of necroptosis mediators (RIP3K, MLKL) in pituitary adenoma reinforces the hypothesis that the necroptosis pathway can be effective in regulating the proliferation and growth of pituitary tumor cells and tumor recurrence.

Since the beginning of the COVID-19 pandemic, efforts have been made to design safe and effective vaccines against SARS-CoV-2. Numerous vaccines have been designed and tested in limited clinical trials in various countries. Among them, the Sputnik V vaccine has shown a relatively safe profile and, to our knowledge, has no associated major side effects. We describe the case of a 40-year-old female healthcare worker who developed severe persistent eczematous lesions on the second day after she received the first dose of the Sputnik vaccine. The eczematous lesions were refractory to an antihistamine and persisted at the 1 month follow-up. Severe persistent eczematous lesions should be viewed as a potential side effect of vaccination with the Sputnik V vaccine. Moreover, a severe allergic reaction to a COVID-2019 vaccine may indicate the vaccine is ineffective in the recipient.LEARNING POINTS:Vaccination against COVID-19 may be accompanied by rare complications.Eczematous lesions can be a side effect of the Sputnik V vaccine.A severe allergic reaction to a COVID-19 vaccine may result in decreased vaccine effectiveness in the recipient.

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Background: Using morphologic features of the bones is the basis of gender determination in anthropology and forensic medicine. In this study, we evaluated the calcaneus diameters for gender determination in the Iranian population. Methods: This cross-sectional study was conducted on Iranians referring to Hazrat-e Rasool Hospital's radiology ward for plain lateral X-ray of the foot. Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. These patients aged between 18 and 80 years old who did not suffer major trauma to the calcaneus bone were recruited. Using a picture archiving and communication system (PACS), four variables were calculated for each X-ray graph: Maximum anterior-posterior length of the calcaneus (MAXL), Maximum height of the bone (MAXH), Height of the cuboid facet (CFH) and Height the calcaneal body (BH). Cut off points for each index were calculated using the area under curve (AUC) in ROC curves. Results: Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. The means of the four indexes were compared between the sexes which showed all four means are significantly different p value <0.001. AUC for MAXL in differentiating the genders was 0.824, which showed 86.8 as the cut off with a sensitivity of 80% and specificity of 69.0%. Cut off point for MAXH was set at 59.8 with sensitivity and specificity of 78.0% and 60.0%, respectively. For BH, 49.5 was set as the cut off point with a sensitivity of 79.0% and specificity of 64.0%. The best cut off point for CFH was 27.8 with 76.0% sensitivity and 63.0% specificity. Conclusion: It can be concluded that the calcaneal diameters are reliable criteria for sex determination. Although the cutoff points are different between various races and populations, it is evident that these diameters can be used for sex determination in general.

Background: Chronic lead poisoning manifestations is often non-specific and may mimic neurologic diseases, gastrointestinal problems, and hematologic disorders. When there is no history of lead exposure, it may be misdiagnosed. Trying to search occult exposure is very important and poisoning could be diagnosed by a simple test of blood lead level.Methods: Here we describe a case of lead poisoning with presentation of acute generalized muscle weakness who was admitted with primary diagnosis of Botulism. We also reviewed the literatures on this topic.Results: The primary diagnosis was food poisoning in further investigation, it revealed that his job is recovering of electronic piece of old computers for about 20 years. Based on recurrent uncontrollable abdominal pain, constipation, generalized weakness, associated with hypochromic microcytic anemia, a highly suspicious to chronic lead toxicity was considered. Patient's blood lead level was 149 mu gr/dL (normal:2-25).Conclusions: Detailed clinical investigation is the first step for identifying rare presentations of lead poisoning cases. The health hazards of lead poisoning are rising due to lack of education regarding the dangers of working with lead. With improving national health policies, we can prevent this chronic and subtle poisoning.

Background: Patients with idiopathic scoliosis are exposed to repetitive x-ray for angle measurement. Therefore, the discovery or development of alternative techniques with less radiation has continuously been a major concern. Objectives: In this study, we compared the Cobb angles on supine Magnetic Resonance Imaging (MRI) with those on standing plain radiographs to figure out how precisely the supine MRI can show the real curve. Consequently, the need for certain exposures throughout the management of idiopathic scoliosis might be eliminated. Methods: A total of 103 patients with idiopathic scoliosis were included in this prospective study. The standing radiographs and supine MRI were obtained with less than a 1-month time lag. One senior author assessed Cobb angles of the major curves were on both standing radiographs and MR images. All the eligible patients had already signed the consent for diagnostic imaging, including MRI. The individuals, who were not requested for x-ray and MRI, were excluded from this study. Results: The Mean±SD Cobb angle was 55.5±11.2°‎‏ on the standing plain radiographs and 44.5±10°‎‏ on MR images (P<0.001). The Mean±SD difference between the Cobb angles on the standing plain radiographs and MR images was 11±1.4°‎‏. A significant positive correlation was found between the Cobb angles calculated on plain radiographs and MRI (r=0.996, P<0.001). Accordingly, Cobb angles on MRI could be converted to Cobb angles on plain radiographs under the formula of MRI=0.9* XRAY-5.31 (absolute error of 5.31°‎‏). Conclusion: Cobb angles on supine MRI correlates with measured ones on standing radiographs with an acceptable range of error and could be used as a valuable alternative for radiographic Cobb angle measurement.

The Qur’an, the word of God, is the best book that has been revealed to guide human beings contains a complete plan of human life. However, in addition to educational, ethical, and religious issues, it also contains valuable scientific information. Several verses in the Holy Qur’an discuss the importance of breast milk and its proper planning. Qur’an also orders up parents, especially mothers, for getting this goddamn blessing to their children. Qur’an verses as well as Islamic hadiths emphasize that breast milk is an unparalleled and comprehensive food that plays a valuable and unique role in the improvement of mental health, physical development, and desirable development of children. Based on Islamic sources, such as the Holy Qur’an and the traditions of the Prophet (PBUH) and Islamic hadith, there are some interesting and important points about breastfeeding, its benefits and its provisions. The Qur’an verses and Islamic hadiths emphasize the importance of breastfeeding and the importance of continuing it until 24 months. The description of these hadiths and verses is presented in the text. Considering the religious and Qur’an educations regarding the importance of breastfeeding infants, it can be concluded that breastfeeding contains the most complete immune and growth factors in the infant. In addition to physical needs, breastfeeding provides emotional and mental development and also gives countless benefits to the mother.

Background: Identifying identity in the absence of large bones becomes more difficult and complicated; accordingly, it is highly beneficial to use the features of the sternum. The present study aimed to evaluate the dimensions of the sternum and its relation with gender in the Iranian population.Methods: This cross-sectional study was conducted on 200 cadavers (100 men and 100 women). By performing an autopsy, the sternum bone was first cut in the midline using a vibrating saw, and the different dimensions were measured using a caliper.Results: Among different dimensions related to the sternum, the mean length of manubrium, mesosternum, the largest width of manubrium, and the shortest width of manubrium were significantly higher in men compared to women. Regarding the value of each sternal diameter in discriminating male and female gender, the highest discriminative value was specified to the shortest width of manubrium (cutoff: 26.75, sensitivity: 100%, specificity: 84.0%), followed by the length of sternebrae 1 (cutoff: 8.45, sensitivity: 76.0%, specificity: 21.0%).Conclusion: Measuring various indices of sternum bone, particularly the shortest width of the manubrium and the length of sternebrae 1, leads to gender identity accurately.

Background: The previously performed studies on the craniofacial injuries only evaluated the frequency of facial bone fractures and no specific differentiation was conducted between the cranial and facial fractures. The current study aimed to evaluate the craniofacial fractures pattern occurred in the motor vehicle accidents. Methods: The current cross-sectional study was conducted in Rasoul-akram Hospital in Tehran, Iran, from autumn 2013 to autumn 2014. All patients with Iranian nationality, 18 years and older and head and neck trauma in motor vehicle were evaluated. The head computed tomography (CT) was performed for all patients. Results: The results indicating fractures were considered positive. Age and gender of the patients were considered as demographic indices and the measures obtained from each group were separately recorded. Totally, 291 subjects with head and neck trauma were evaluated in the current study. In 141 subjects, the simple or comminuted craniofacial fractures were reported. Most of the subjects were male (87.94%) and less than 55 years (82.26%). Evaluating the pattern of fracture showed that the most frequent fractures in males were in nasal, temporal and frontal bones, respectively; while, the most frequent fractures in females were in temporal, nasal and occipital bones, respectively; 23.5% of females had temporal fracture, while this rate in males was 5.6% (P=0.029). Conclusions: The most prevalent fractures in motor vehicle accidents among male and youth occurred in nasal, frontal and temporal bones, and in females occurred in nasal, temporal and occipital bones. Temporal, nasal and cranial base fractures were the most prevalent fractures among the elderly.

Background: An oscillating bone saw is rarely used to perform laminectomy. The purpose of this study was to describe a relatively quick and harmless technique for multilevel laminectomy in patients with lumbar spinal stenosis (LSS) using an oscillating bone saw to find out how this instrument affects the time of surgery and rate of complications. Methods: This prospective study was conducted on 45 patients with LSS who required multilevel laminectomy. The bones were cut using an oscillating sagittal saw equipped with a fine 1-cm blade. Posterolateral fusion was performed if any evidence of spinal instability occurred, or the correction of deformity was addressed. The time spent for laminectomy from initial cutting to the whole bone removal (T1) and the duration of laminectomy (i.e., from initiation to the end of decompression; T2) were recorded for the corresponding level. The volume of harvested autograft was also measured, and any dural injuries were reported. Results: Posterolateral fusion was performed on 32 (71.1%) patients. The mean T1 and T2 per level were estimated at 70.5 +/- 5.4 and 157.5 +/- 12.1 sec, respectively. In addition, the mean volume of harvested autograft per level was obtained as 3.5 +/- 1.2 cc. No durotomy was observed during laminectomy using an oscillating bone saw. However, a dural tear occurred in one patient when a Kerisson punch was utilized for ligamentum flavum removal and foraminotomy. Conclusion: Based on the findings, it can be concluded that laminectomy by means of the oscillating bone saw is a safe procedure that provides a sufficient volume of harvested autograft for fusion. This technique could also induce a remarkable reduction in the time of surgery.

BACKGROUND:Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy.OBJECTIVES:In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis.METHODS:In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI).RESULTS:The study population included 32 (28.8%) males and 79 (71.2%) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r = -0.400, P < 0.001) and BMI (r = -0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r = -0.569, P < 0.001).CONCLUSIONS:Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis.

Background: Cervical cancer is one of the most common cancers in developing countries and the second most common cancer in women worldwide. Using the screening test, cancer can be detected in the early stages and, thus, mortality will be reduced. Also, the early detection of cervical cancer could affect survival rate and time. But, the diagnostic and therapeutic methods of this disease are usually accompanied by errors that deduct the success rate. Methods: In this study, a variety of common errors in the detection and treatment of cervical cancer were investigated by reviewing and evaluating scientific resources. Results: Studies show the different medical failures during sampling, preparation, review, and interpretation of the sample. On the other hand, inappropriate operation and errors in the treatment pathway are common errors after diagnosis. Because of the types of these errors, preparing the information of papers investigating the possible types of errors and observing accuracy will play a significant role in reducing the failures. Conclusion: Because of the fact that cervical cancer is fully curable with proper and timely diagnosis, the early diagnosis is important and it is the responsibility of doctors, pathologists, and surgeons in this area. Therefore, monitoring and preventing errors in the diagnosis and treatment is directly associated with a reduction in the mortality rate of the disease.

Background: Self-mutilation is one of the most extreme types of self-harm, which is done deliberately to hurt the body, regardless of suicidal intent. In self-mutilation, the most important targets are the eyes, genital tract, and hands. So far, genital self-mutilation (GSM) has been less frequently reported around the world. According to our study, this is the first case of GSM reported in Iran. The most common cause of GSM is psychological disorder, especially psychosis. Case Presentation: The patient was an unmarried 32-year-old man, who was hospitalized in Rasul-Akram Hospital in December 2018 for severe bleeding caused by GSM. He was diagnosed with type I bipolar disorder, which was treated from the late adolescence. Also, a history of drug abuse (amphetamine, opium, cannabis, alcohol) and multiple sexual relationships with different partners was reported. He abused tramadol tablets daily nowadays. His IQ was normal. He had lots of abrasions, scars and lacerations due to suicidal attempts in the past years. Two months before GSM, his auditory hallucinations about genital self-mutilation had started. He committed GSM after having sexual intercourse and was transferred to our hospital by an ambulance with severe hemorrhage, scrotum damage, and presentation of both testes, for which he received appropriate treatments. Conclusion: It seems that a set of factors, such as patient's history of psychosis following bipolar disorder, substance abuse, mental retardation, multiple sexual relationships, and strong emotional relationship with the mother can contribute to self-injury that may lead to genital self-mutilation. It should be noted that genital self-mutilation cases are less likely to be reported in Iran, considering the cultural and religious background. Therefore, the pathology of this devastating phenomenon should be more thoroughly examined.