The role of forensic medicine and forensic dentistry in estimating the chronological age of living individuals in Hamburg,Germany

International Journal of Legal Medicine - Age estimation represents one of the primary responsibilities of forensic medicine and forensic dentistry. It is an integral procedure aiming to estimate...     

Family violence in Victoria,Australia: a retrospective case-control study of forensic medical casework

Objective

To identify the risk factors and assault characteristics of family violence among victims referred for forensic medical examination in Victoria, Australia.

Methods

A retrospective 1:1 case-control study was conducted, comparing adult family violence victims and non-family violence victims examined by clinical forensic practitioners from the Victorian Institute of Forensic Medicine, between July 2015 and June 2016. Data were extracted from victims’ forensic medical casework. Chi-square or Fisher’s exact tests and Mann-Whitney U tests were used to examine group differences. A multiple logistic regression analysis was used to determine independent predictors of family violence.

Results

One hundred and forty-three family violence victims (97.2% female, Mdn_age = 29, 90.2% intimate partner violence) were identified and gender- and age-matched with controls. Family violence victims had significantly higher odds of reporting a history of violence victimisation (OR = 5.20; 95% CI, 2.54 to 10.66) and current pregnancy (OR = 5.28; 95% CI, 1.09 to 25.46) than controls. Family violence was significantly more likely than non-family violence to occur in the victim’s home, and to involve physical assault, use of weapon(s), trauma to the neck and anal sexual assault. Family violence victims sustained significantly more physical injuries, and were more likely to be injured to almost every bodily location, than controls.

Conclusion

This study highlights the importance of assessing and managing risk for family violence following initial victimisation and throughout pregnancy. Findings further indicate that family violence is more dangerous (i.e. more likely to involve severe forms of assault and cause injury) than non-family violence.

     

HIV/AIDS post-exposure prophylaxis (PEP) for victims of sexual assault in South Africa

An earlier study (Meel, 2003) showed that more than 90% of victims of sexual assault in Transkei region, South Africa, were HIV-seronegative at the time of the incident. This was despite the fact that the community had a high prevalence of HIV. In sexual assault cases post-exposure prophylaxis (PEP) is recommended to prevent HIV transmission. Therefore, therapy with zidovudine (AZT) and lamivudine (3TC) is justified. The purpose of this study is to describe the demographic characteristics of the victims, to assess the outcome of HIV transmission and to evaluate the success of PEP after its implementation in Transkei. There were 594 victims of sexual assault during the study period at Sinawe Centre from 2000-2003. Of these, 346 (58.2%) were children under the age of 15 years. Seventeen children (2.9%) were found to be HIV positive at the first test. Among the adults, 58(9.8%) tested HIV positive. Of the 225 who attended after PEP was introduced, only two were found to be HIV seropositive at the time of the incident. A second test was recommended after four weeks and a third after 12 weeks. The majority of the victims did not report for the second test, but all 35 who did come to be tested were seronegative. who did come to be tested were seronegative. Seventeen of those were between 11-15 years of age. Only seven victims came for the third test, and they, too, were negative. Nausea and vomiting were the commonest side effects of PEP treatment in four patients and one developed a generalized rash. Only one victim seroconverted.     

The use of radiography in forensic medicine

Forensic radiography has traditionally been carried out within imaging departments or mortuaries by radiographers on a voluntary basis. This paper presents an overview of traditional and newer techniques, together with an insight into some techniques carried out internationally, which may influence future developments in the United Kingdom, as uncovered in a search of the literature using CD-ROM and manual methods.     

DNase I: structure,function, and use in medicine and forensic science

In this review, available structural data of deoxyribonucleases I (DNases I) from several mammalian species, hen, snake and frog are summarized. Comparative studies on enzymatic and immunological properties and glycosylation are discussed, and several evolutionary conclusions are presented. Over the past decade, the availability of new investigative tools, including sensitive methods of electrophoresis, detection and determination, and genetically modified DNase I models has resulted in a clearer understanding of the molecular mechanisms that connect the function and usefulness of DNase I in medicine and forensic science.     

The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide

Adverse drug reactions and interactions are among the major causes of death in the United States. Antidepressants have been reported as causing suicide and homicide and share the class attribute of frequently producing akathisia, a state of severe restlessness associated with thoughts of death and violence. Medical examiners can now identify some pharmacogenetic interactions that cause drugs, deemed safe for most, to be lethal to others. Such deaths do not yet include medication-induced, akathisia-related suicides and homicides. An extrapyramidal side effect, akathisia is a manifestation of drug toxicity whose causes lie, inter alia, in drugs, doses, and co-prescribed medications that inhibit and compete for metabolizing enzymes, which may themselves be defective. In this paper, we report our investigation into adverse drug reactions/interactions in three persons who committed homicide, two also intending suicide, while on antidepressants prescribed for stressful life events. Their histories of medication use, adverse reactions and reasons for changes in medications are presented. DNA samples were screened for variants in the cytochrome P450 gene family; that produce drug metabolizing enzymes. All three cases exhibit genotype-based diminished metabolic capability that, in combination with their enzyme inhibiting/competing medications, decreased metabolism further and are the likely cause of these catastrophic events.     

Cases of asphyxia in children and adolescents: a retrospective analysis of fatal accidents,suicides, and homicides from 1998 to 2017 in Hamburg,Germany

International Journal of Legal Medicine - Injury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes...     

Strengthening the role of forensic medicine in health sector responses to violence: two initiatives

Each year world-wide tens of thousands of women and children suffer acts of physical, sexual and psychological violence inflicted by their family members, intimate partners, acquaintances, and sometimes, strangers. The consequences of this violence require sensitive and comprehensive services for victims—a need which often goes unmet. Forensic medicine has much to contribute to bridging the current gap between the care needs of victims of violence and the services that are available to them. This article describes two initiatives designed to strengthen the health sector response to violence, particularly the role of forensic medicine in that response.     

General practitioners and managing domestic violence: Results of a qualitative study in Germany

A qualitative interview based study on ways of addressing and managing domestic violence (DV) by general practitioners (GPs) is presented. Problem centred semi-structured topic-guided interviews were conducted with 10 male and nine female GPs. Transcribed passages were analysed with the deductive approach of qualitative content analysis. Female doctors gave broader definitions of DV. Addressing of DV by a patient was perceived as a demand to act by all doctors. Documentation of injuries was considered to be important. Time constraints, feelings of being ashamed and helpless were described as barriers in addressing DV. Female doctors reported being anxious about losing their professional distance in cases of female victims. While female participants tend to take an ‘acting’ role in managing cases of DV by being responsible for treatment and finding a solution in collaboration with the patient, male doctors preferred an ‘organising’ role, assisting patients finding further help. Definitions of DV and differences in addressing the issue seemed to be strongly affected by personal professional experience. Definitions of DV, personal barriers in addressing the subject and understanding of the own role in management and treatment of DV cases differed between male and female doctors. Pre-existing definitions of DV, personal experience and gender aspects have to be taken into account when planning educational programmes for GPs on the issue of DV.     

The potential for the use of personal computers in clinical forensic medicine

This paper describes the use of a personal computer in clinical forensic medicine. It shows how a database can be easily created, updated for each new case by unqualified personnel, and then used to provide statistical data with a minimum resource input, without the need for great computer expertise. Databases will only recognise exactly identical abbreviations. Once created they can cross-reference data and provide individually tailored statistics. Registration with the Data Protection Agency is required in the UK in order to hold personal information on file. The results of 2201 cases entered on the database of one forensic physician show high levels of drug and alcohol abuse co-existing with unemployment and homelessness. 53% of individuals brought to police stations as a place of safety (under Section 136 of the Mental Health Act 1983) were in need of admission to a psychiatric hospital. 12% of those individuals were of no fixed abode. The potential for a national database linking forensic physicians on a national basis, pooling their data thereby creating a powerful statistical tool is clear.     

Facial injuries due to criminal violence: a retrospective study of hospital attenders.

The material comprised 222 assault victims whose injuries required attention at the Departments of Oral Surgery and Ear, Nose, and Throat diseases, the Central Hospital in Falun or corresponding departments at the Karolinska Institutet, Stockholm or the University Hospital in Huddinge. Information was obtained from patient records. One hundred and thirty-eight patients had fractures and the remainder had flesh-wounds, haematomas or swellings. The most frequent fracture site was the nasal bone followed by the jaws. Forty-one per cent of the patients in Falun and 28 per cent in Stockholm reported the assaults to the police: in Falun the proportion of women victims who reported the assault was significantly higher than those who did not. The willingness to notify the police of the violence was not influenced by the use of drugs or the seriousness of the injuries. The study showed that violence in suburban Stockholm was aggravated: one-third of the patients in the study required hospitalization compared to a quarter in a rural area.     

The use of proteomics to study wound healing: a preliminary study for forensic estimation of wound age

Proteomics is the analysis of the protein complement of the genome. The technique involves extracting proteins from the tissue being examined; separating the proteins using methods such as two-dimensional gel electrophoresis and then identifying the proteins by mass spectrometry. This paper describes the application of proteomics to incised wounds of the rat to determine if this technology could be applied to the important forensic issue of determining the age of wounds. Experimental incised skin wounds were inflicted on rats 5, 15, 30 and 60 minutes, 3, 6, 12 and 24 hours and 2, 5, 7 and 12 days before euthanasia. Each wound was excised and frozen at 80 degrees C; protein extracts were prepared and subjected to two-dimensional polyacrylamide gel electrophoresis over the range pH 3 to pH 10. Protein spots were identified using Matrix-assisted Laser Desorption/Ionisation Time-of-Flight (MALDI-TOF) mass spectrometry. A number of proteins were identified in skin wounds. After wounding the most prominent change was in the level of haemoglobin, which was elevated in wounds five minutes old and remained elevated for three hours, falling to near control levels after 12 hours. This pilot study has illustrated the feasibility for proteomics to be applied to determining wound age.     

The use of interpreters in medical settings and forensic medical examinations in Australia: The relationship between medicine and linguistics

Medical examinations are dependent on combining communication with professional competence. In the development of a global multicultural community with the use of multiple languages, doctors have become increasingly dependent on language facilitation such as interpreting and translation. Despite professional studies, the use of language facilitation with its associated problems has not been fully explored in graduate and post-graduate medical and forensic medical training. There may still be some lack of reciprocal understanding between the medical and linguistic fields, their ethics, obligations and limits although both fields and their ethical frameworks are closer related than might be expected. This article is a discussion that aims at providing a basic understanding of guidelines as to the origin and appropriate use of language interpretation in medical and forensic medical examinations.     

Women undergoing investigation of sexual abuse in the metropolitan area of Porto Alegre, Brazil: a retrospective study

This is a retrospective study of 1,063 examinations performed on women at the Institute for Forensic Medicine in the city of Porto Alegre, RS, Brazil, between January 1998 and December 1999, as part of an investigation of charges of sexual abuse. Most women were white (83.9% - 892), single (89.1% - 947), and were between 11 and 20 years of age (59% - 627); 40% (425) were 14 years old or younger. There was evidence of previous sexual contact in 57% (606) of the patients; 37% (393) were virgins. Evidence of recent sexual intercourse was found in 287 (27%) cases, including presence of sperm in the vagina (18% - 191), recent rupture of the hymen (7% - 74), and pregnancy (2% - 21). Physical violence was evident in 30% (319) of all cases. In cases where information regarding the perpetrator was available (39% - 415), 25% (105) consisted of family members. Further studies should be carried out in order to assess the incidence of sexual violence by family members.     

The role of a forensic clinical nurse specialist in a sexual assault treatment program

The role of a Forensic Clinical Nurse Specialist has been developed within our Regional Sexual Assault Treatment Centre in London, Ontario, to assist in meeting the short-term and long-term physical and psychological needs of victims of acute sexual assault. We report on the development and application of this most valuable role within our medical and nursing health care team.     

The value of 100% retrospective peer review in a forensic pathology practice

Peer review in forensic pathology practice has become an important cornerstone of continuous quality improvement. Although there are several components to an effective and transparent peer review process, one of the most essential is the review of completed reports.The autopsy report may be reviewed prospectively (report reviewed before sign out) or retrospectively (report reviewed after sign out). Prospective reviews are more likely to be performed on criminal or criminally suspicious cases, pediatric and SIDS deaths and high profile cases.Retrospective reviews on the other hand are performed on a proportion of all other signed-out routine medico-legal cases. The actual percentage varies by jurisdiction since there are no agreed minimum standards. Manpower and workload factors appear to be critical to determining what percentage of cases are reviewed retrospectively.The objective of this report is to present a mechanism by which a 100% retrospective review policy has been implemented, how it integrates with quality management protocols, the outcomes of the reviews and what challenges remain to improve compliance with key quality indicators especially turn around time (TAT) statistics.     

The potential use of Piwi-interacting RNA biomarkers in forensic body fluid identification: A proof-of-principle study

In the forensic community, RNA profiling has been investigated as a potential method to identify body fluids. Several RNA molecules, including messenger RNA (mRNA), microRNA (miRNA) and circular RNA (circRNA), have been explored as biomarkers to distinguish different body fluids and have led to considerable interest in the development of RNA biomarkers for forensic purposes. Piwi-interacting RNA (piRNA), a class of noncoding RNAs, is a potential biomarker for body fluid identification because of its short length (˜24–32 nt) and specific expression pattern in human tissues. In this proof-of-principle study, we examined the expression levels of four carefully selected piRNAs in forensically relevant biological fluids (venous blood, saliva, semen, menstrual blood and vaginal secretions) using TaqMan quantitative real-time polymerase chain reaction (TaqMan qPCR). piR-55521, which was not detectable in saliva, can differentiate semen from other body fluids because it was strongly expressed in semen compared to the remaining three fluids (> 4000-fold change). Furthermore, piR-55521 could be detected in semen samples made from as little as 200 pg of total RNA, and addition of female component had no effect on the detection limit. Furthermore, the expression differences of other piRNAs, piR-61648, piR-43994 and piR-33151, were statistically significant between at least two types of body fluids. Stability tests also indicated that these piRNAs could be effectively detected in dried samples under laboratory and outdoor conditions for at least six months. Although limited to four piRNAs, this study suggests that the expression pattern of piRNAs could be used to identify body fluids, and that piRNA (piR-55521) is specifically expressed in semen. Such findings suggest that additional work could identify other piRNAs that could serve as biomarkers to identify body fluids.     

Dying with SARS-CoV-2 infection—an autopsy study of the first consecutive 80 cases in Hamburg,Germany

International Journal of Legal Medicine - Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel...