Sudebno-Meditsinskaya Ekspertisa最新文献

Objective: To reveal pathological lung changes in baclofen poisoning and to assess their dynamics.

Material and methods: The experiment included 20 mature (at age 20 weeks) male rats of Wistar line weighing 290-350 gr. The animals were divided into 3 study groups (5 rats in each) depending on experiment's duration after 85 mg/kg baclofen administration: 3, 4.5 and 24 h in the 1st, 2nd and 3rd groups, respectively. Control group consisted of 5 animals without baclofen administration.

Results: A number of pathological reactions, including circulatory disorder (venular and capillary congestion, hemorrhage in interalveolar septa, alveoli, sludge) and the appearance of emphysema loci (interalveolar septa at emphysema loci are thinned), alternating with atelectases and dystelectases. The area taken up by vessels after 4.5 h. baclofen administration was statistically significantly higher than in control group, and after 24 h. - statistically significantly higher than in 4.5 h. The area with white blood cells and WBC/IAP ratio after 4.5 h of baclofen administration were statistically significantly higher than in control group after 3 and 24 h of administration. The number of white blood cells, giving PAS positive reaction, increases during baclofen administration. The complex of pathological lung changes, revealed by ourselves, has a certain dynamics.

Conclusion: The data on morphological lung changes combined with results of chemical examination can be used to diagnose baclofen poisoning and to determine the time elapsed since this medicine administration.

Over several months, 14 people were admitted in 6 hospitals with severe symptoms of intoxication with psychoactive substances as a result of mass poisoning. All symptoms occurred after taking a drink that contained crushed phenazepam tablets. Samples of blood (n=10) and urine (n=6) taken from 14 sufferers for forensic, chemical and toxicological examination were analyzed using the HPLC-MS/MS method. Phenazepam was detected in the biomaterial of all 14 patients. Other psychoactive substances (baclofen, pregabalin, chlorprothixene, chlorpromazine, phenibut, tramadol, diazepam), narcotic substances and ethanol were also found in the sufferers. The phenazepam concentration in the blood was in the range of 109.75-786.50 ng/ml, in the urine - 8.97-101.28 ng/ml. The pharmacokinetic and toxicokinetic characteristics of toxicants as well as additional factors characterizing the phenotype of the sufferer in addition to drug's content in the biological material must be taken into account to determine the toxicity level of phenazepam against the background of combined action with other psychoactive substances.

Objective: To study morphological changes of cerebral cortex in young people under the conditions of chronic alcohol intoxication (CAI).

Material and methods: Morphometric examination of cerebral cortex fragments obtained from 28 persons who died with a CAI diagnosis (average age was 38 years), and 25 subjects who died from other causes, which are not associated with alcohol consumption (average age was 39 years), was carried out.

Results: It was shown that neurons of pathological shapes, including hypo- and hyperchromic, pyknotic and «shadow-like», were dominant in group of CAI. There was an increase in the glial index and a greater intensity of perivascular and pericellular edema compared to the control group.

Conclusion: Morphological changes of cerebral cortex under the conditions of CAI are non-specific and largely similar to neurodegenerative alterations in other pathological conditions, senile dementia. Clearer histological criteria for alcoholic encephalopathy are needed, including with the use of immunohistochemical methods.

The article presents the main innovative methods used in forensic expert practice at the current stage, reveals the principle and algorithms of the developed software complex for registration and identification of the deceased. The proposed program automatically generates four documents, which reduces the time required for forensic expertise in the conditions of mass admission of deceased. The article's authors substantiate prospects of further application of computer technologies in forensic practice to improve organizational and methodological activities in emergencies with a large number of deceased.

The constant increase in the number of neurotraumas in the country leads to an increase in forensic examinations of a persons. In Russia, about 600 thousand people receive craniocerebral injuries annually, of which 50 thousand die, others are potentially will be in forensic examination during or after treatment. With an increase in the total number of such examinations, the number of erroneous conclusions is expected to increase. If it is impossible for the radiologist included in the commission to review the results of computed tomography of the head performed in the hospital, the experts are forced to use the data that are recorded in the medical documents. The present study revealed the percentage of erroneous interpretations in such descriptions, systematized typical errors, calculated the sensitivity, specificity and accuracy of computed tomography in craniocerebral injury.

Objective: To develop and implement an online application for the numerical method of determination of the postmortem interval and its limiting faults, caused by errors of measurement processes, based on the Marshall-Hoare law of cooling and dual thermometry of the corpse's core.

Material and methods: The numerical search for a minimum of two variables' target function, obtained from the system of non-linear Marshall-Hoare equations, reflecting the dual thermometry of the corpse's core was performed. The code of online program was written in Python 3 programming language.

Results: The method for determination of the postmortem interval, based on iterative algorithm of non-linear optimization, allowing by dual thermometry of the corpse to consider the uniqueness of its cooling conditions, as well as to calculate the degree of uncertainty of computational estimations, caused by the impact of measurement errors, has been developed. The method is implemented in the format of the Warm Bodies Z online application.

Conclusions: The developed numerical method and its online application are recommended for determining of the postmortem interval.

Objective: To perform a retrospective analysis of the commission forensic medical examinations' data of pediatric profile with identification of defects in health care delivery and establishment of their connection with unfavorable outcome.

Material and methods: The data of 3854 commission forensic medical examinations performed in the period from 2012 to 2021 regarding the evaluation of quality of health care delivery for children with the establishment of nature and type of defects in health care delivery, determination of disease (injury) outcome, identification of cause-effect relationship between the defect in health care delivery and negative disease (injury) outcome.

Results and conclusions: Defects in health care delivery were equal 9% in the studied commission forensic medical examinations. Studied data included all types of defects in health care delivery: defects of diagnosis, treatment and health care delivery. The structure of defects in various age groups differed: diagnosis defects prevailed in the age group of children aged from 29 days to 1 year; treatment defects were most frequent in children group of neonatal period and in children group aged 1-17 years. Child disability and death were negative consequences in all age groups. A direct cause-effect relationship was established between the defect in health care delivery and the negative outcome in all cases. The pathogenetically expectable correlation between the defect in health care delivery and negative outcome, represented by disability or death of a child, was considered to be the medical equivalent of this relationship.

The article presents results of a retrospective analysis of the commission forensic medical examinations of «medical malpractice cases» for 2017-2021 on materials of RCFME MH KR. It has been established that the number of commission examinations showed a pronounced tendency to increase in the analyzed period: 64 (9.78%) cases - in 2017, 86 (12.63%) - in 2018, 92 (16.46%) - in 2019, 179 (29.1%) - in 2020 and 80 (13.96%) in 2021 out of 501 cases of commission examinations on «medical malpractice cases». The considerable number of ordered examinations concerned the professional activity of obstetricians-gynecologists (131 cases; 26.1%) and surgeons (65 cases; 12.9%). Quite a large part of the examinations was represented by investigations regarding COVID-19 (72 cases; 14.37%) and AIDS infection (47 cases; 9.3%) among the commission examinations. Medical violations also concerned specialists who are not related to extreme medicine (tuberculosis specialists, oncologists, therapists, neurologists).

A rare clinical observation of death from prolonged uneven external irradiation due to the deliberate use of an ionizing radiation source for illegal purposes has been presented. The main difficulties of postmortem diagnosis of this type of radiation-induced injury, considering the features of histological examinations and special methods of retrospective dosimetric evaluations, have been identified.

Carbamazepine is used in the treatment of convulsive disorders, trigeminal neuralgia and mental illnesses such as bipolar disorder and pain syndromes. It has been found in clinical applications that carbamazepine causes many serious adverse drug reactions, which are associated with drug concentration in blood and dosage in clinical use. Due to its pharmacological properties, carbamazepine can be life-threatening in an overdosage, making the therapeutic drug control of carbamazepine important in any clinical settings. Creation of a method for carbamazepine quantification in biological objects during forensic chemical examinations is an urgent problem. A method of high-performance liquid chromatography with diode array detection is proposed for carbamazepine quantitation. The stability of proposed conditions for carbamazepine analysis has been proved in the modifying study conditions (flow rate of eluent, its composition, pH of buffer, column oven temperature). The relative standard deviation of retention time and areas of chromatographic peaks of carbamazepine did not exceed 0.5%.