Journal of forensic and legal medicine最新文献

{"title":"Ethyl alcohol consumption characteristics of deceased individuals in Lithuania","authors":"Augustinas Stasiunas ,&nbsp;Sigitas Chmieliauskas ,&nbsp;Jurgita Stasiuniene ,&nbsp;Sigitas Laima ,&nbsp;Diana Vasiljevaite ,&nbsp;Rokas Simakauskas ,&nbsp;Dmitrij Fomin ,&nbsp;Ineta Dvarvytyte","doi":"10.1016/j.jflm.2024.102785","DOIUrl":"10.1016/j.jflm.2024.102785","url":null,"abstract":"<div><div>The number of alcohol-related deaths in Lithuania has fallen by almost one-third in the last decade; however, the number of deaths has been on the rise since 2019. Data on the postmortem investigation of victims between 2018 and 2022 were obtained from the Lithuanian State Forensic Medicine Service database. This study analyzed data from 1200 autopsies. The deceased victims were categorized based on their cause of death and blood alcohol concentration (sober, legally intoxicated, mild, medium, or heavy). The causes of death were diseases (54.17 %, n = 650), suicides (12.08 %, n = 145), homicides (2.5 %, n = 30), and accidents (31.25 %, n = 375). Toxicological tests for alcohol were performed in all cases. Alcohol levels in the blood and urine were measured using gas chromatography. A significant correlation was observed between blood alcohol concentration and age (r = −0.13, p = 0.007). A statistically significant difference was observed in the proportions of men and women who were intoxicated. Among the causes of death, the group of individuals who died because of accidents exhibited the highest average blood alcohol concentration. Alcohol intoxication is undoubtedly a contributing factor to fatalities resulting from accidents and homicides. These findings assist in determining the intoxication level of victims and in assessing any potential links that may contribute to or predispose victims to lethal outcomes in cases of disease, suicide, homicide, or accident.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical analysis of vitreous humor and synovial fluid in the estimation of early postmortem interval: A meta-analytical approach","authors":"Raíssa Bastos Vieira ,&nbsp;Carlos Antonio Vicentin-Junior ,&nbsp;Nicole Prata Damascena ,&nbsp;Melina Calmon Silva ,&nbsp;Analany Pereira Dias Araujo ,&nbsp;Rafael Queiroz da Trindade ,&nbsp;Maria Gabriela Duarte Morais Vieira ,&nbsp;Eugénia Cunha ,&nbsp;Alexandre Raphael Deitos ,&nbsp;Bianca Marques Santiago ,&nbsp;Paulo Ricardo Martins-Filho ,&nbsp;Carlos Eduardo Palhares Machado","doi":"10.1016/j.jflm.2024.102782","DOIUrl":"10.1016/j.jflm.2024.102782","url":null,"abstract":"<div><div>The estimation of the postmortem interval (PMI) is a significant challenge in legal medicine and forensic sciences due to the dynamic and continuous decomposition of organisms after death. Thanatochemistry has emerged as a promising area to estimate PMI by measuring the concentrations of postmortem biochemical markers. This systematic review and meta-analysis aimed to summarize evidence on postmortem biochemical alterations in vitreous humor (VH) and synovial fluid (SF) to estimate early PMI. Comprehensive searches of electronic databases identified studies measuring postmortem biomarker concentrations in both matrices. Our analysis included three meta-analytical approaches: calculating standardized mean differences to assess variations in biochemical parameters, executing correlation meta-analysis (ρ) to explore relationships between these parameters and PMI, and conducting meta-regression to derive a predictive model. Results from five eligible studies indicated no correlation between sodium levels and PMI in both matrices. However, a strong correlation was found between potassium levels and PMI in VH (ρ = 0.69; 95 % CI 0.52 to 0.86) and SF (ρ = 0.81; 95 % CI 0.75 to 0.87), with the meta-regression yielding the optimal predictive equation for SF: [K+] = 6.15 + 0.21 × PMI. These findings support the use of potassium as a reliable biomarker for PMI estimation, particularly in SF.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of nine malpractice cases with allegations of causation of cervical artery dissection by cervical spine manipulation: No evidence for causation","authors":"Steven Brown","doi":"10.1016/j.jflm.2024.102783","DOIUrl":"10.1016/j.jflm.2024.102783","url":null,"abstract":"<div><div>Research shows no convincing evidence to support a causal link between cervical spine manipulation (CSM) and cervical artery dissection (CAD). Researchers have proposed that a belief in a causal link may have significant negative consequences such as numerous episodes of litigation. The objective of this study was to review 10 malpractice cases for evidence of unnecessary litigation due to a belief in a causal link between CSM and CAD.</div><div>A Google Scholar Case Law search from 1989 to 2024 was conducted to identify the 10 most recent English-language reports of malpractice cases involving an allegation that CSM caused CAD. Although our objective was to review 10 cases, only 9 cases were found.</div><div>In all cases, causation of CAD by CSM was not supported by the evidence. In 4 out 9 cases reviewed, causation of stroke by CSM was supported by the evidence. In all 9 cases reviewed, failure to diagnose an existing CAD was more likely than not but was not alleged.</div><div>We conclude that belief in a causal link between CSM and CAD does have negative consequences such as unnecessary litigation. In all 9 cases reviewed, allegations of failure to diagnose an existing CAD would have been more likely to result in a settlement without need for a trial.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xylazine abuse, the growing risk: A review of its effects, upsurge use and associated fatalities in the USA and Puerto Rico","authors":"Luz A. Silva-Torres ,&nbsp;Ashraf Mozayani","doi":"10.1016/j.jflm.2024.102780","DOIUrl":"10.1016/j.jflm.2024.102780","url":null,"abstract":"<div><div>In the last decade, the opioid overdose epidemic has been exacerbated by the emerging drug of abuse, xylazine. This veterinary anesthetic, an alpha-2 agonist, not only potentiates the fatal effects of opioids but also causes toxic endothelial effects. This review aims to assess the impact of xylazine use and overdoses within the context of the opioid crisis as a public health issue. The research used data from scientific publications, state health reports, and analyses from the Institute of Forensic Sciences of Puerto Rico. The databases PubMed, Google Scholar, and Scopus were searched for relevant publications. The search strategy employed two groups of terms: the drug of interest (xylazine) and types of exposure (drug use, overdose, substance abuse, etc.). The initial search in PubMed was then extrapolated, and the search terms were adjusted for appropriate database syntax. According to the most recent publications and CDC data in the USA, approximately 95 % of fentanyl overdose cases involve xylazine, while the other 5 % of overdose cases are attributed solely to xylazine, predominantly administered intravenously. In the last four years, more than 4000 overdose deaths have been related to xylazine use; the northeastern United States had reported the most significant number of deaths. This number changes daily as reanalysis results and new data are published. Less than 50 % of states perform tests for xylazine detection or maintain statistical monitoring of overdoses related to this drug. The absence of testing impedes emergency room physicians from making accurate diagnoses, increasing the likelihood of fatal overdoses. This review highlights five major concerns: (1) The recognition of intoxication as a primary concern and the unavailability of alpha-2 antagonists for treatment. (2) The challenges in the clinical setting linked to xylazine abuse and its co-administration with substances like fentanyl and its analogs. (3) The necessity for robust government statistical resources for the unification and dissemination of critical overdose and emerging drug abuse detection information. (4) The need for effective rehabilitation programs, including psychosocial support and treatment interventions, to respond to this public health crisis. (5) The urgency for further research to understand the prevalence, toxic effects of chronic or acute use, and the clinical implications in xylazine users, including the development of alpha-2 antagonists for treatment. We conclude that addressing these concerns is crucial to working with the xylazine abuse situation.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dentin thickness model: A novel method for dental age estimation using panoramic radiography","authors":"Deniz Yanık ,&nbsp;Şelale Özel","doi":"10.1016/j.jflm.2024.102781","DOIUrl":"10.1016/j.jflm.2024.102781","url":null,"abstract":"<div><div>The study aims to evaluate the reliability of the novel dentin thickness model based on root parameters when applied to panoramic radiography images of mandibular first molar in the southern Turkish subpopulation. A total of 946 panoramic images were analyzed for the study. The samples were allocated into four age groups: Group 1(between 10 and 18), Group 2(between 19 and 30), Group 3(between 31 and 50), Group 4(between 51 and 78). The dentin thickness model measurements consisted of root dentin thickness of the mesial aspect of the distal root and distal canal width. Regression, intraclass correlation coefficient, and Durbin-Watson analyses were used for statistics. A medium correlation was detected in the dentin thickness model (R = 0.398). Root dentin thickness and canal width had a significant effect (p &lt; 0.05), but gender did not (p &gt; 0.05). Group 3 showed the highest accuracy (p &lt; 0.001). Group 4 presented the lowest correlation with chronological age compared to other age groups (p &lt; 0.001). The dentin thickness model showed a promising result for the dental age estimation with a medium correlation. The dentin thickness model included root measurements of the mesial aspect of the mandibular first molar without any crown parameters in the southern Turkish subpopulation. Gender did not affect the dentin thickness model.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common errors in the completion of death certificates in teaching hospitals in northern Iran: A legal challenge","authors":"Seyed Mehran Razavipour ,&nbsp;Seyed Khosro Ghasempouri ,&nbsp;Navid Khosravi Kochaksaraei ,&nbsp;Zakaria Zakariaei ,&nbsp;Ashkan Ahodashti","doi":"10.1016/j.jflm.2024.102779","DOIUrl":"10.1016/j.jflm.2024.102779","url":null,"abstract":"<div><h3>Background</h3><div>The proper completion of death certificates (DCs) is of paramount importance for physicians, as they serve as vital medico-legal documents. The information contained within these certificates holds great significance in health statistics, as it serves as a crucial tool for epidemiological research and analysis.</div></div><div><h3>Methods</h3><div>This study comprises a descriptive cross-sectional analysis of all DCs issued in 2019 for approximately 1104 deceased patients at a teaching hospital in Mazandaran Province, in northern Iran. To conduct this research, a checklist was implemented, which contained comprehensive categories, including essential public information, and the primary and underlying causes of death (UCOD).</div></div><div><h3>Results</h3><div>The results of this study indicate that out of the 618 cases of deceased individuals, 273 (44.2 %) were women and 345 (55.8 %) were men. Notably, a total of 61 cases (9.9 %) exhibited an error in the writing of the primary cause of death (COD). Specifically, the UCOD was erroneously recorded as cardio-pulmonary arrest in 13.2 % of all DCs, thus resulting in an error in the main COD.</div></div><div><h3>Conclusion</h3><div>The findings of this study disclosed a high incidence of errors in the completion of DCs, particularly in the determination of the UCOD, which is universally recognized as the most critical aspect of these documents.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence and circumstances of child sexual assault in Maputo, Mozambique","authors":"Stela Ocuane Matsinhe ,&nbsp;Shahnaaz Suffla ,&nbsp;Tiffany Joy Hector","doi":"10.1016/j.jflm.2024.102778","DOIUrl":"10.1016/j.jflm.2024.102778","url":null,"abstract":"<div><h3>Background</h3><div>Child Sexual Abuse (CSA) is a significant public health issue, with its health and social consequences well documented. While CSA has been extensively studied in high-income countries, its incidence and circumstances of occurrence in low-income countries, especially in Africa, remains under-represented in the scholarly literature.</div></div><div><h3>Methods</h3><div>This study aimed to investigate the occurrence and circumstances of CSA among victims assisted at the Forensic Service of the Hospital Central de Maputo in Mozambique. A cross-sectional, quantitative study was conducted using secondary data from 2015 to 2020, extracted from the medico-legal reports of all victims under 18 years old. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 28.0.</div></div><div><h3>Results</h3><div>2610 cases of CSA were reported for the period 2015 to 2020, of which 2588 were included for analysis. Of the cases analysed, the majority of victims were girls (93.7 %), predominantly aged 12–17 years (48.6 %). The reported types of penetration revealed that vaginal penetration was the most frequent (86 %), followed by anal (11 %) and oral (2 %). Most assaults occurred either at the victims' or perpetrators’ homes (54.8 %), primarily during the week (71.1 %), and typically in the afternoon (36.5 %) or evening (41.9 %). The assaults were predominantly perpetrated by a single individual (88.7 %), who was most often identified as an acquaintance (72.9 %). Additionally, 54.1 % of the children experienced concomitant physical violence, and approximately 74.9 % of the perpetrators did not use condoms during the assault.</div></div><div><h3>Conclusions</h3><div>The findings of this study underscore the urgent need to implement prevention measures specifically targeting adolescent girls and younger boys, aiming to promote early reporting and prevent mental, physical, and sexual and reproductive health complications. Raising awareness about all forms of child abuse, including sexual abuse, and enhancing reporting and diagnostic systems in Mozambique is crucial.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study of the injury patterns seen in fatal falls downstairs","authors":"Kate McGoldrick ,&nbsp;SallyAnne Collis ,&nbsp;Linda Mulligan","doi":"10.1016/j.jflm.2024.102767","DOIUrl":"10.1016/j.jflm.2024.102767","url":null,"abstract":"<div><h3>Introduction</h3><div>Fatal falls involving stairs are often associated with advanced age, intoxication, acute natural pathology and less commonly – the involvement of a third-party. The injury patterns seen in these cases are often complex and from a medico-legal standpoint, determining third-party involvement based on pathology alone can prove a significant challenge. Classifying the manner of death in such cases, can become particularly complex when the injury pattern appears inconsistent with a simple fall downstairs, or there is an absence of eye-witness testimony.</div></div><div><h3>Aim</h3><div>To explore the circumstances and injury patterns seen in cases of fatal falls downstairs which were classified as accidental vs. undetermined by the coroners.</div></div><div><h3>Study design</h3><div>This retrospective study explored the injury patterns present in all cases of fatal falls downstairs referred to the Office of the State Pathologist (OSP) over a 10-year-period (2012–2022) (n = 51).</div></div><div><h3>Results</h3><div>Fatal falls downstairs which were classified as undetermined were found to have a greater number of craniofacial fractures, spinal fractures and intracranial injuries when compared to accidental falls. Undetermined staircase deaths also displayed more significant fracturing involving the facial skeleton.</div></div><div><h3>Conclusion</h3><div>Ultimately, where there is a question of third-party involvement, the Post-Mortem Examination (PME) findings alone cannot determine the manner of death. The pathologist's examination may identify injuries that are inconsistent with a simple fall downstairs, but it is the coroner who must conduct a thorough investigation into the circumstances of the fatal fall and ultimately determine the classification of the death.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age estimation at death in individuals over 50 using CT images: An innovative anthropological approach","authors":"Mohamed Kenani ,&nbsp;Marwa Boussaid ,&nbsp;Oumeima Brahim ,&nbsp;Mohamed Amine Mesrati ,&nbsp;Abir Aissaoui","doi":"10.1016/j.jflm.2024.102766","DOIUrl":"10.1016/j.jflm.2024.102766","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of the present work is to develop a novel method for predicting age in individuals over 50 years old, utilizing regression models.</div></div><div><h3>Methods</h3><div>The conducted study is of an analytical cross-sectional nature, involving a sample of 44 young subjects and 107 elderly subjects. The necessary data for this research were extracted from \"The New Mexico Decedent Image Database.\" Based on the phenomenon of height shrinkage with age, we created models for young subjects and applied them to elderly subjects, allowing us to extract the variables.</div></div><div><h3>Results</h3><div>We obtained highly encouraging results with an R² of 0.73, a mean absolute error of 3.94, and stable cross-validation. We used a Student's t-test, which demonstrated no significant difference between predicted and actual values (p-value &gt;0.05). We also conducted a learning curve analysis and examined residuals against predicted values. This suggests that the forecasts are accurate, with no significant bias in predictions.</div></div><div><h3>Conclusion</h3><div>This work has allowed us to conclude that it is possible to reliably estimate the age of subjects over 50, taking into account age-related physiological and pathological changes.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“It changed my whole entire thinking”: Identifying narrative elements in medical affidavit writing for asylum seekers","authors":"Alexandria Yap ,&nbsp;Radhika Sundararajan ,&nbsp;Andrew Milewski ,&nbsp;Mert Keceli ,&nbsp;Mohammed Alkhafaji ,&nbsp;Rachel Kowalsky","doi":"10.1016/j.jflm.2024.102759","DOIUrl":"10.1016/j.jflm.2024.102759","url":null,"abstract":"<div><div>The medical affidavit is critically significant for asylum seekers. Studies have shown that asylum seekers applying with a medical affidavit (versus without a medical affidavit) have double the success rate. There are many training resources for clinician-evaluators on the interviewing process, but little instruction exists on the affidavit writing process. Our objective was to identify the most common narrative elements in medical affidavits of successful (versus unsuccessful) asylum seekers to provide further writing guidance for clinician-evaluators. We hypothesized that these elements, when thoughtfully employed, help clinician-evaluators best represent their clients in the US immigration system. We focused on the most vulnerable applicants: those applying after the one-year deadline. Using grounded theory, we coded 23 affidavits filed after the one-year deadline for narrative elements. We identified seven narrative elements more common in medical affidavits of asylum seekers who filed after the one-year deadline and were successful: (1) Recommending specific clinical interventions; (2) Quoting elevated diction by the client; (3) Using headlines; including anecdotes that describe (4) The client forming human connections, (5) Archetypal female characters, (6) Love stories, or (7) Moments of realization.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}