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Transfer and persistence of microbiota markers from the human hand to the knife: A preliminary study 微生物群标记从人手转移到刀上并持续存在:初步研究
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-16 DOI: 10.1016/j.jflm.2024.102757
Sukriye Karadayı , İlknur Yılmaz , Tülin Özbek , Beytullah Karadayı

New scientific techniques and methods are always needed to link the perpetrators to the incident or the crime scene. Recent microbiota studies based on NGS (Next-generation sequencing) show that various biological samples from crime scenes have the potential to be used in forensic investigations. Especially when DNA traces belonging to more than one person are insufficient to fully determine the genetic profile, a secret sample, such as a microbiota sample created by the suspect's touch, can be used. In this preliminary study, a fictionalized experimental model was designed to investigate the transfer and persistence of the hand microbiome on the knife handle, which has a high potential to be used in criminal incidents, by metagenomic analysis methods. In addition, it was aimed to determine the transfer of specific bacterial species identified only to the person among the five participants onto the knife handle and their persistence over time. In the first stage of the research, samples were collected from the hands of 5 volunteer participants using the swap method, including their palms. Then, after each participant held a different knife, samples were collected from the knife handles via swabs from different angles of the knives at 4 and 24 h and analyzed by metagenomic methods. The findings of this preliminary study showed that the heatmap graphs generated after UniFrac distance analysis were not successful in establishing any similarity between the hand samples and the post-transfer knife handle samples. Nonetheless, it was observed that the transfer of bacterial species detected in the hand samples to knives differed according to the individuals and some bacterial species were transferred to the knife samples held by the participants. The number of bacterial species detected that are specific to each participant's hand sample was 302 in total, and it was determined that a total of 8.28 % of these bacterial species were transferred to the knife handle samples of the 4th hour and 6.95 % to the knife samples of the 24th hour. In the presented study, considering the transfer of some bacterial species in the hand microbiome, which are effective in the variation between individuals, onto the knife; It has been evaluated that some rare bacterial species can be important potential markers to associate the object with the perpetrator.

要将罪犯与事件或犯罪现场联系起来,总是需要新的科学技术和方法。最近基于 NGS(下一代测序)的微生物群研究表明,犯罪现场的各种生物样本都有可能用于法医调查。特别是当属于多人的 DNA 痕迹不足以完全确定基因图谱时,可以使用秘密样本,如嫌疑人触摸产生的微生物群样本。在这项初步研究中,我们设计了一个虚构的实验模型,通过元基因组分析方法,研究极有可能用于犯罪事件的刀柄上的手部微生物群的转移和持久性。此外,研究还旨在确定五名参与者中仅针对个人识别的特定细菌物种在刀柄上的转移及其随时间推移的持久性。在研究的第一阶段,采用交换法从 5 名志愿参与者的手部采集样本,包括手掌。然后,在每位参与者手持一把不同的刀后,分别在 4 小时和 24 小时内从刀柄的不同角度用棉签采集样本,并通过元基因组学方法进行分析。这项初步研究的结果表明,UniFrac 距离分析后生成的热图并不能成功地确定手部样本与转移后的刀柄样本之间存在任何相似性。尽管如此,研究人员还是观察到,手部样本中检测到的细菌种类转移到刀上的情况因人而异,有些细菌种类转移到了参与者所持的刀样本中。在每个参与者的手部样本中检测到的特有细菌种类共有 302 种,其中 8.28% 转移到了第 4 小时的刀柄样本中,6.95% 转移到了第 24 小时的刀具样本中。在本研究中,考虑到手部微生物组中的一些细菌种类会转移到刀上,而这些细菌种类在个体之间的变化中是有效的;据评估,一些罕见的细菌种类可以成为将物体与犯罪者联系起来的重要潜在标记。
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引用次数: 0
Analysis of non-metric dental traits for ethnicity identification in a mixed population of Uttar Pradesh 分析北方邦混血人口的非度量衡牙齿特征以识别种族
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-14 DOI: 10.1016/j.jflm.2024.102755
Sharon John , Priya Devi , Prashasti Chundawat, Roshna Sankar, Shalini Gupta

Background

Forensic odontology involves the identification of individuals through dental records, making it a crucial tool in legal investigations. Non-metric dental traits (NMDT), which are variations in dental morphology play a key role as these traits are inherited characteristics that can help establish biological relationships or ancestry. Thus, we aim to assess the frequency and variability of NMDT in the human dentition of four ethnically mixed populations in Uttar Pradesh. This study can aid in the future by maintaining records of ethnic groups and their variability, which can be crucial for disaster victim management and forensic odontology.

Methods

The study was conducted on a total of 100 patients coming to the OPD of Oral Medicine and Oral Pathology and Microbiology of King George's Medical University from January 2022 to July 2023. Impressions of both arches were made for participants using irreversible hydrocolloid (alginate), and casts were examined under a stereomicroscope to assess 15 different morphological characteristics.

Results

NMDTs such as winging, shoveling, double-shoveling interruption groove, canine mesial ridge, hypocone, metacone, carabelli's trait, peg-shaped incisors, peg-shaped molar, premolar lingual cusp variation, deflecting wrinkle, protostylid, metaconulid, entoconulid was evaluated. The NMDTS were evaluated in four different ethnics Nordics, Mediterranean, Oriental Mediterranean, and Protoaustraloid amongst which various traits showed a statistically significant variation among the population of Uttar Pradesh.

Conclusion

The sample studied presented confirmed supernumerary traits like metacone, protostylid, carabellis trait, metaconulid, premolar lingual cusp variation, and deflecting wrinkle were seen highest in Nordic, Mediterranean, Oriental Mediterranean, and Protoaustraloid ethnicity have a significant association with the Uttar Pradesh population.

背景法医牙科学涉及通过牙科记录识别个人身份,是法律调查中的重要工具。非度量衡牙齿特征(NMDT)是牙齿形态的变异,由于这些特征是有助于确定生物关系或祖先的遗传特征,因此发挥着关键作用。因此,我们旨在评估北方邦四个种族混居人群的非测量牙齿特征的频率和变异性。这项研究可以通过保存种族群体及其变异性的记录来帮助未来的研究,这对灾难受害者管理和法医牙科学至关重要。方法这项研究是在 2022 年 1 月至 2023 年 7 月期间对前来乔治国王医科大学口腔医学和口腔病理学与微生物学手术室就诊的 100 名患者进行的。使用不可逆水胶体(藻酸盐)为参与者制作双侧牙弓印模,并在体视显微镜下检查铸模,以评估 15 种不同的形态特征。结果评估了翼状、铲状、双铲中断沟、犬齿中脊、下锥体、元锥体、卡拉贝利特征、钉状切牙、钉状臼齿、前臼齿舌尖变异、偏转皱纹、原臼齿、元臼齿、内臼齿等 NMDTs。对四个不同人种的 NMDTS 进行了评估:北欧人种、地中海人种、东方地中海人种和原臼齿人种。结论所研究的样本证实,北欧、地中海、东方地中海和前牙乳头状畸形等畸形特征在北方邦人口中最高,与卡拉贝里特征、元冠状畸形、前臼齿舌尖变异和偏转皱纹有显著关联。
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引用次数: 0
An evaluation of potential challenges in forensic psychiatric assessment in Parkinson's disease 评估帕金森病法医精神病学评估的潜在挑战。
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-14 DOI: 10.1016/j.jflm.2024.102758
Uğur Takım, Tarık Sağlam
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引用次数: 0
Femicide in Ireland 2012–2023 2012-2023 年爱尔兰杀戮女性情况
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-13 DOI: 10.1016/j.jflm.2024.102754
Kate McGoldrick , SallyAnne Collis , Linda Mulligan

Introduction

Femicide represents the dramatic end-point on a spectrum of violence against women and is an increasingly prevalent medico-legal issue. Whilst there is no definition of femicide in the Irish legal system, femicide can be understood as the gender based killing of women or girls.1 The pervasiveness of gender-based violence against women is a growing cause for concern with 2018 estimates by the World Health Organisation (WHO) revealing that 1 in 3 women have experienced Intimate Partner Violence (IPV).2 Femicide remains poorly defined and underreported worldwide due to enduring stigmatisation, shame and a lack of official statistics addressing national femicide rates.

Aim

The aim of this study was to explore Irish cases of femicide, quantify the prevalence of femicide in Ireland and identify any emerging trends over a 12-year-period.

Methods

All homicides referred to the Office of the State Pathologist (OSP) from 2012 to 2023 were reviewed and a total of 97 cases of femicide were ?identified and included in this study.

Results

Femicide rates increased from 1 in 5 (19 %) homicides referred to the OSP in 2012–2020 to 3 in 10 from 2021 to 2023 (29 %). Domestic femicides accounted for 74 % of cases, with 41 % of women murdered in the home they shared with their killer. 56 % of women were killed by a current or former intimate partner and 20 % by a family member. Sharp force injuries were present in 75 % of femicides associated with a history of sexual violence. These cases had the highest average number of injuries per case (n = 30) and a significantly lower average age than that of the entire cohort (19 years versus 41 years).

Conclusion

The true scale of gender-based violence against women remains largely hidden due to a lack of focused official statistics and a clear definition of femicide. As populations become more diverse, and displacement secondary to environmental, or humanitarian crises becomes more common, it is essential that official data is collected in order to understand and ultimately prevent gender-based violence in this vulnerable cohort.

导言:杀害妇女是暴力侵害妇女行为的极端表现,也是一个日益普遍的医学-法律问题。虽然爱尔兰法律体系中没有杀害妇女的定义,但杀害妇女可理解为基于性别杀害妇女或女童。世界卫生组织(WHO)2018 年的估计显示,每 3 名妇女中就有 1 人曾遭受过亲密伴侣暴力(IPV)。2 由于长期存在的污名化、羞耻感以及缺乏针对全国杀戮女性比率的官方统计数据,杀戮女性行为在全球范围内仍未得到充分定义和报告。本研究旨在探讨爱尔兰的杀戮女性案件,量化杀戮女性行为在爱尔兰的发生率,并确定12年间任何新出现的趋势。方法对2012年至2023年期间提交至国家病理学家办公室(OSP)的所有凶杀案进行审查,共确定97起杀戮女性案件并将其纳入本研究。家庭杀戮女性案件占 74%,其中 41%的女性是在与凶手共同居住的家中被杀害的。56%的妇女是被现任或前任亲密伴侣杀害的,20%是被家庭成员杀害的。在有性暴力史的女性被害案件中,75%存在锐器伤。这些案件的平均伤害次数最多(n = 30),平均年龄明显低于整个群体(19 岁对 41 岁)。随着人口日趋多样化,环境或人道主义危机导致的流离失所现象越来越普遍,收集官方数据对于了解并最终预防这一弱势群体中的性别暴力至关重要。
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引用次数: 0
A critical assessment of the diatom test of rib bone marrow as a supporting procedure in the case of drowning 对肋骨骨髓硅藻测试作为溺水案件辅助程序的批判性评估
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-12 DOI: 10.1016/j.jflm.2024.102753
Iwona Bogusz , Marek Bogusz , Beata Borowska , Łukasz Szleszkowski , Joanna Żelazna-Wieczorek

Diatoms (Bacillariophyta), being single-celled photosynthetic organisms, are widely distributed in aquatic ecosystems around the globe. Their exoskeletons are resistant to most environmental factors as well as chemical reagents in laboratory settings. Moreover, the ornamentation featured on exoskeletons can be used to identify individual diatomaceous species. As a result, the detection of diatoms in the internal organs, and especially rib marrow, of corpses found in water can serve as an important tool for diagnosing drowning as the cause of death as long as passive postmortem penetration of diatoms into those organs is excluded. In the environmental experiments described in this paper, diatoms were detected in rib marrow only when contamination resulted from a mechanical breach of bone integrity and structure, irrespective of the residence time of bone material in the aquatic environment. Our research suggests that the presence of diatom in the rib marrow may be the gold standard in the diagnosis of drowning in the future. Our animal model research dispels one of the doubts, such as the possibility of passive penetration of diatoms into the bone marrow, which is still under discussion in the forensic medicine community.

硅藻(Bacillariophyta)是单细胞光合生物,广泛分布于全球各地的水生生态系统中。它们的外骨骼可抵抗大多数环境因素以及实验室环境中的化学试剂。此外,硅藻外骨骼上的装饰物可用于识别硅藻个体。因此,在水中发现的尸体的内脏,特别是肋骨骨髓中检测硅藻,可以作为诊断溺水死因的重要工具,只要排除硅藻在死后被动渗入这些器官的可能性。在本文所述的环境实验中,只有当骨骼的完整性和结构受到机械破坏而导致污染时,才能在肋骨骨髓中检测到硅藻,而与骨骼材料在水生环境中的停留时间无关。我们的研究表明,肋骨骨髓中硅藻的存在可能是未来诊断溺水的金标准。我们的动物模型研究消除了法医学界仍在讨论的一个疑点,如硅藻被动渗入骨髓的可能性。
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引用次数: 0
Risk factor analysis of medical litigation outcomes in obstetrics and gynecology: A retrospective cohort study of 344 claims in Japan 妇产科医疗诉讼结果的风险因素分析:对日本 344 起索赔案的回顾性队列研究
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-06 DOI: 10.1016/j.jflm.2024.102752
Kyosuke Kamijo , Ayako Shibata , Norio Yamamoto , Jun Watanabe , Takashi Watari

Aim

Medical errors are critical in obstetrics and gynecology (OB/GYN) and contribute to high litigation risks. However, few studies have examined system and diagnostic errors as potential preventable problems. This study aimed to enhance medical safety and reduce litigation by identifying and addressing key contributory factors.

Methods

We retrospectively searched the national Japanese malpractice claims database for OB/GYN cases between 1961 and 2017. We evaluated provider characteristics and background information of the patients (plaintiffs). The main outcome was litigation (acceptance or rejection) in the final judgment. Using multivariable logistic regression models, we assessed the associations between medical malpractice variables (system and diagnostic errors, facility size, situation, place, time, and clinical outcomes) and litigation outcomes (acceptance).

Results

Overall, 344 malpractice claims were analyzed. Among these, 277 (80.5 %) were obstetric, and 67 (19.5 %) were gynecological. Of the obstetric cases, 193 were perinatal, and 84 were maternal. Malpractice claims were accepted (OB-GYN losses) in 185 cases (53.8 %). In multivariable analyses, system errors (odds ratio 97.4, 95 % confidence interval 35.2–270.0), diagnostic errors (odds ratio 4.5, 95 % confidence interval 1.8–11.3), and clinic (odds ratio 2.7, 95 % confidence interval 1.2–4.8) had a significant statistical association with accepted claims.

Conclusion

System errors, diagnostic errors, and clinics were significantly associated with acceptance claims. These findings underscore the necessity of addressing modifiable factors at the physician level and within the healthcare management system to enhance patient safety and reduce litigation risks, thereby ensuring a safer and more reliable healthcare environment for patients and medical professionals.
目的医疗差错是妇产科(OB/GYN)的关键问题,也是导致高诉讼风险的原因之一。然而,很少有研究将系统错误和诊断错误视为潜在的可预防问题。本研究旨在通过识别和解决关键的促成因素来加强医疗安全和减少诉讼。方法我们回顾性地检索了日本全国医疗事故索赔数据库中1961年至2017年间的妇产科病例。我们评估了提供者的特征和患者(原告)的背景信息。主要结果是最终判决中的诉讼(接受或拒绝)。我们使用多变量逻辑回归模型评估了医疗事故变量(系统和诊断错误、机构规模、情况、地点、时间和临床结果)与诉讼结果(接受)之间的关联。其中,产科 277 例(80.5%),妇科 67 例(19.5%)。在产科病例中,193 例为围产期病例,84 例为孕产期病例。有 185 例(53.8%)接受了渎职索赔(妇产科损失)。在多变量分析中,系统错误(几率比 97.4,95% 置信区间 35.2-270.0)、诊断错误(几率比 4.5,95% 置信区间 1.8-11.3)和诊所(几率比 2.7,95% 置信区间 1.2-4.8)与受理索赔有显著的统计学关联。这些发现突出表明,有必要在医生层面和医疗保健管理系统内解决可改变的因素,以加强患者安全和降低诉讼风险,从而确保为患者和医疗专业人员提供更安全、更可靠的医疗保健环境。
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引用次数: 0
Three-dimensional visualization of gunshot cavities in ballistic gelatine with computed tomography – A forensic ballistics case study 利用计算机断层扫描对弹道明胶中的枪弹空腔进行三维可视化 - 一项法医弹道学案例研究
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-08-28 DOI: 10.1016/j.jflm.2024.102740
Petteri Oura , Mikael Brix , Eveliina Lammentausta , Timo Liimatainen , Juha Kiljunen , Alina Junno , Jaakko Niinimäki , Juho-Antti Junno

Three-dimensional (3D) imaging, primarily computed tomography (CT), has proven valuable in the documentation and analysis of gunshot injuries. Explicit visualization of findings may play a pivotal role in judicial settings. This forensic ballistics case study aimed to examine the potential of CT-based 3D reconstruction to digitally visualize gunshot cavities in ballistic gelatine. Three .30 caliber bullets of different types (full metal jacket, soft point, and expanding monolithic) were fired into standardized blocks of 10% ballistic gelatine. The blocks underwent CT scanning with clinical equipment. Gelatine and air were segmented from the CT data using an open-source software. 3D reconstruction views of the segmented gelatine and air components were created. The gunshot cavities were clearly observed in both gelatine and air segmentation. The differences in cavitation between bullet types were evident in both reconstruction approaches, although gelatine segmentation produced higher resolution of small details. The obvious benefit of digital reconstruction was the ability to freely tilt and rotate the 3D images, with the possibility of taking measurements manually or automatically from any plane. Moreover, all the data can be stored for future analysis. This study introduces a preliminary method for digital visualization and documentation of gunshot cavitation in ballistic gelatine, to be fine-tuned and implemented for research purposes and routine practice in forensic institutions.

事实证明,三维(3D)成像,主要是计算机断层扫描(CT),在记录和分析枪伤方面非常有价值。对研究结果的明确可视化可能会在司法环境中发挥关键作用。本法医弹道学案例研究旨在研究基于 CT 的三维重建技术在数字化可视化弹道明胶中的枪伤空腔方面的潜力。将三颗不同类型的 .30 口径子弹(全金属护套、软点和膨胀单片)射入 10%弹道明胶的标准块中。用临床设备对这些弹块进行 CT 扫描。使用开源软件从 CT 数据中分割出明胶和空气。创建了分割后的明胶和空气成分的三维重建视图。在明胶和空气分段中都能清晰地观察到枪弹空洞。在两种重建方法中,子弹类型之间的空化差异都很明显,不过明胶分割对小细节的分辨率更高。数字重建的明显优点是能够自由倾斜和旋转三维图像,并可从任何平面进行手动或自动测量。此外,所有数据都可以存储起来,以备将来分析之用。本研究介绍了一种对弹道明胶中的枪弹空化进行数字可视化和记录的初步方法,有待微调和实施,以用于研究目的和法医机构的日常实践。
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引用次数: 0
Sudden infantile death due to left ventricular myocardial ischemia associated with undiagnosed single coronary artery of Lipton's type LII-B 与未确诊的 Lipton's LII-B 型单支冠状动脉有关的左心室心肌缺血导致婴儿猝死
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-08-27 DOI: 10.1016/j.jflm.2024.102738
Kyoko Hasuwa , Hideki Uemura , Takeshi Kondo , Shogo Kasuda

Single coronary artery (SCA) is a rare malformation, particularly in isolation without other congenital heart defects. Here, we describe a case of sudden infantile death due to myocardial ischemia associated with undiagnosed SCA. A 1-year-and-7-month-old female infant died suddenly after vomiting at home. A medicolegal autopsy revealed that the orifice of the right coronary artery (RCA) was absent. As expected, the left coronary artery was detached from the left coronary sinus; however, the ostium was covered with a flap-like fibrous ridge. The thin RCA originated from the left main trunk (LMT) and passed between the aorta and pulmonary artery trunk. The left circumflex artery branched from the LMT at a right angle. Judging from the origin and course of the anomalous RCA, the deceased was diagnosed with SCA of Lipton's type LII-B. Microscopic examination revealed ischemic changes around the endocardium of the lateral wall of the left ventricle (LV) rather than on the side of the abnormal RCA. This evoked attention, as there appeared to be some discrepancy. To the best of our knowledge, this is the first case report describing sudden infantile death related to LV myocardial ischemia associated with undiagnosed SCA of Lipton's type LⅡ-B.

单冠状动脉(SCA)是一种罕见的畸形,尤其是在没有其他先天性心脏缺陷的情况下。这里,我们描述了一例与未确诊的单冠状动脉畸形相关的心肌缺血导致婴儿猝死的病例。一名一岁七个月大的女婴在家中呕吐后突然死亡。法医尸检发现,右冠状动脉(RCA)开口缺失。不出所料,左冠状动脉从左冠状动脉窦分离出来,然而,动脉窦表面覆盖着一层瓣状纤维嵴。细长的 RCA 起源于左主干(LMT),在主动脉和肺动脉干之间穿过。左侧环状动脉以直角从 LMT 分支。根据异常 RCA 的起源和走向,死者被诊断为 Lipton's LII-B 型 SCA。显微镜检查发现,左心室(LV)侧壁心内膜周围出现缺血性病变,而不是在异常 RCA 的一侧。这引起了人们的注意,因为其中似乎存在一些差异。据我们所知,这是第一例与未确诊的Lipton's LⅡ-B型SCA相关的左心室心肌缺血导致婴儿猝死的病例报告。
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引用次数: 0
A machine learning approach for age prediction based on trigeminal landmarks 基于三叉神经标记的年龄预测机器学习方法
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-08-26 DOI: 10.1016/j.jflm.2024.102742
Youssef Keyrouz , Marianne Saade , Mona Nahas Gholmieh , Antoine Saadé

Objective

The aim of this study was to estimate the chronological age (CA) of a growing individual using a new machine learning approach on Cone Beam Computed Tomography (CBCT).

Materials and methods

The dataset included 48 CBCT and hand-wrist radiographs of growing individuals. 12 landmarks related to trigeminal trajectories were plotted on each CBCT and principal component analysis was applied for dimensionality reduction. The estimated CA was obtained using a decision tree. Finally, a genetic algorithm was implemented to select the best set of landmarks that would optimize the estimation. The age was also assessed following Greulich and Pyle's (GP) method on hand-wrist radiographs. The results (GP and Machine Learning) were then compared to the true CA.

Results

Among the 12 landmarks, the genetic algorithm selected 7 optimal features, and 12 principal components out of 36. The best results for age prediction were obtained by a combination of genetic algorithm, principal component analysis, and regression tree where the Mean Squared Error (MSE) and Mean Absolute Error (MAE) were respectively 1.29 and 0.92. These outcomes showed improved accuracy compared to those of the hand-wrist method (MSE = 2.038 and MAE = 1.775).

Conclusions

A numerical application on a dataset of CBCT showed that the proposed machine learning method achieved an improved accuracy compared to conventional methods and had satisfying performance in assessing age for forensic purposes. Validation of the presented method on a larger and more diverse sample would pave the way for future applications in forensic science as a tool for age prediction.

材料和方法数据集包括 48 张生长期个体的 CBCT 和手-腕部 X 光片。在每张 CBCT 上绘制了与三叉神经轨迹相关的 12 个地标,并应用主成分分析进行降维。使用决策树获得估计的 CA。最后,采用遗传算法来选择能优化估算的最佳地标集。此外,还根据 Greulich 和 Pyle(GP)的方法对手腕 X 光片进行了年龄评估。结果在 12 个地标中,遗传算法选择了 7 个最佳特征,从 36 个主成分中选择了 12 个主成分。遗传算法、主成分分析和回归树的组合获得了最佳的年龄预测结果,平均平方误差(MSE)和平均绝对误差(MAE)分别为 1.29 和 0.92。结论 在 CBCT 数据集上的数值应用表明,与传统方法相比,所提出的机器学习方法提高了准确性,在法医年龄评估方面的表现令人满意。在更大和更多样化的样本上验证所提出的方法,将为今后在法医学中应用年龄预测工具铺平道路。
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引用次数: 0
A medical child abuse case with spurious bleeding; importance of collecting the evidence 一个有假性出血的医疗虐童案;收集证据的重要性
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-08-26 DOI: 10.1016/j.jflm.2024.102741
Hasan Fatih Çakmaklı , Mehmet Ertem , Elif Ünal İnce , Zhala Abdullayeva , Talia İleri , Betül Ulukol

Background

Medical Child Abuse (MCA) is a severe form of child abuse. In MCA, the caregiver abuses the child by exaggerating, fabricating, simulating, or inducing symptoms, and unnecessary, potentially harmful medical care harms the child. Bleeding is one of the most common manifestations of MCA. Diagnosis of MCA is challenging, and late diagnosis may increase the severity and complications. Once suspected, it is essential to apply all relevant methods of investigation to support and confirm the diagnosis, as soon as possible, as late diagnosis increases the risks.

Case presentation

An 18-month-old boy was referred to the Pediatric Hematology by the Department of the Emergency with multiple admissions in a 2-week period for recurrent said-to-be bleeding episodes from different sites. Previously, he had been investigated for recurrent bleeding episodes in different hospitals for 4 months. In our center, the review of medical history, examination findings, and laboratory results showed some important inconsistencies leading to suspicion of MCA and the mother as the perpetrator. Then he was hospitalized for close observation. During hospitalization, multiple episodes of said-to-be bleeding were reported by the mother, but active bleeding was never observed by any hospital staff. No bleeding foci were detected in the nose or ears, supporting the diagnosis of MCA. After the file was forwarded to the prosecutor's office, the child was taken for institutional care, and no further bleeding was observed after separation from the mother. DNA, which was obtained from a so-called nosebleed during hospitalization, was analyzed and was reported to belong to the mother, confirming the diagnosis.

Conclusions

This case report draws attention to timely diagnoses by focusing on inconsistencies in the history and clinical signs and good clinical practices for the management of MCA, with a special emphasis on collecting evidence, including DNA samples, to confirm the diagnosis and help the legal process.

背景医疗虐待儿童(MCA)是一种严重的虐待儿童行为。在 MCA 中,看护人通过夸大、捏造、模拟或诱导症状来虐待儿童,而不必要的、可能有害的医疗护理则会伤害儿童。出血是 MCA 最常见的表现之一。MCA 的诊断具有挑战性,晚期诊断可能会增加病情的严重性和并发症。病例介绍一名 18 个月大的男童因在两周内多次在不同部位反复出血而被急诊科转诊至小儿血液科。此前,他曾因反复出血在不同医院接受过 4 个月的检查。在我们中心,对病史、检查结果和实验室结果的审查发现了一些重要的不一致之处,从而怀疑是 MCA 和母亲所为。随后,他被送往医院接受严密观察。住院期间,母亲报告了多次所谓的出血,但医院工作人员从未观察到活动性出血。鼻腔和耳部均未发现出血灶,支持 MCA 诊断。卷宗转交给检察官办公室后,孩子被送往医疗机构,与母亲分离后没有再发现出血现象。本病例报告通过关注病史和临床症状的不一致性以及处理 MCA 的良好临床实践,特别强调了收集证据(包括 DNA 样本)以确诊和帮助法律程序,从而引起了对及时诊断的关注。
{"title":"A medical child abuse case with spurious bleeding; importance of collecting the evidence","authors":"Hasan Fatih Çakmaklı ,&nbsp;Mehmet Ertem ,&nbsp;Elif Ünal İnce ,&nbsp;Zhala Abdullayeva ,&nbsp;Talia İleri ,&nbsp;Betül Ulukol","doi":"10.1016/j.jflm.2024.102741","DOIUrl":"10.1016/j.jflm.2024.102741","url":null,"abstract":"<div><h3>Background</h3><p>Medical Child Abuse (MCA) is a severe form of child abuse. In MCA, the caregiver abuses the child by exaggerating, fabricating, simulating, or inducing symptoms, and unnecessary, potentially harmful medical care harms the child. Bleeding is one of the most common manifestations of MCA. Diagnosis of MCA is challenging, and late diagnosis may increase the severity and complications. Once suspected, it is essential to apply all relevant methods of investigation to support and confirm the diagnosis, as soon as possible, as late diagnosis increases the risks.</p></div><div><h3>Case presentation</h3><p>An 18-month-old boy was referred to the Pediatric Hematology by the Department of the Emergency with multiple admissions in a 2-week period for recurrent said-to-be bleeding episodes from different sites. Previously, he had been investigated for recurrent bleeding episodes in different hospitals for 4 months. In our center, the review of medical history, examination findings, and laboratory results showed some important inconsistencies leading to suspicion of MCA and the mother as the perpetrator. Then he was hospitalized for close observation. During hospitalization, multiple episodes of said-to-be bleeding were reported by the mother, but active bleeding was never observed by any hospital staff. No bleeding foci were detected in the nose or ears, supporting the diagnosis of MCA. After the file was forwarded to the prosecutor's office, the child was taken for institutional care, and no further bleeding was observed after separation from the mother. DNA, which was obtained from a so-called nosebleed during hospitalization, was analyzed and was reported to belong to the mother, confirming the diagnosis.</p></div><div><h3>Conclusions</h3><p>This case report draws attention to timely diagnoses by focusing on inconsistencies in the history and clinical signs and good clinical practices for the management of MCA, with a special emphasis on collecting evidence, including DNA samples, to confirm the diagnosis and help the legal process.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102741"},"PeriodicalIF":1.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088641","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}
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Journal of forensic and legal medicine
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