Sudebno-Meditsinskaya Ekspertisa最新文献

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%.

The study objective is to analyze changes in court practice over a 10-year period (from 2013 to 2022) including the quantitative and qualitative composition of complaints for conducted dental treatment, considering legislative changes in the procedure for the provision of dental service and formalization of the relationship between patient and medical organization. An investigation of 1800 legal cases containing complaints, forensic reports and court decisions allowed to identify tendencies in increasing the number of cases in which patients' demands were fully or partially satisfied, from 54% in 2013-2017 up to 61% in 2018-2022. At the same time, the amounts of payments determined by the courts increased by 14 times. In addition, the percentage of claims against medical organizations providing care under the CHI program increased significantly (from 5% in 2013-2017 to 15% in 2018-2022). A significant impact of changes in normative legal documents regulating the provision of dental care on the qualitative composition of complaints and the issues formed for medical experts by court has been noted.

The article is devoted to legal and forensic medical problems of postmortem donation. The substantive provisions of postmortem donation, as well as normative legal documents regulating the processes of organs harvesting from deceased persons for subsequent transplantation and governing the work of transplantologists and forensic medical experts have been considered. The practical examples illustrating the essence and nature of the problem of postmortem forensic medical expertise of persons with absent organs has been given and the importance of the participation of a forensic medical expert involved in the decision-making process on possibility (or impossibility) of the corpse's organs and tissues explantation without prejudice to the further expert examination has been emphasized. The authors pay particular attention to the inadequacy of the legal framework, including the lack of a clear understanding of the legal status of the person holding the position of forensic medical expert, who provides an expert opinion on the organs' explantation.

Arterial hypertension is a disease that significantly increases the risk of sudden death in different age groups. It is of high scientific interest to study the relationship of arterial hypertension manifestations with different weather conditions. The article provides a review of literature data on the variability of arterial hypertension course depending on meteorological conditions as a risk factor for sudden death.

Objective: Study of 2.6-di(propan-2-yl)phenol (2.6-di(P-2-yl)F) distribution nature in warm-blooded in case of fatal poisoning due to intragastric administration of the substance.

Material and methods: The warm-blooded model consisted of Wistar male rats aged about 4 months, administered 1.800 mg 2.6-di(P-2-yl)F per 1 kg of animal body weight (≈3 LD₅₀). After the rats died, 2.6-di(P-2-yl)F was isolated from their corpses' biomatrices by infusing an ethyl acetate-acetone mixture (7:3), purified by extraction (distribution in the systems trichloromethane-aqueous solution (pH 11.0-11.5) and aqueous solution (pH 2-4) - ethyl acetate), and normal pressure chromatography in a silica gel column L 40×100 µm (eluent hexane-acetone (7:3). The analyte was identified using gas chromatography with mass spectrometry (capillary (0.2 mm) column, stationary phase - polysiloxane with a ratio (in %) of methyl and phenyl substituents of 95:5), thin layer chromatography (Sorbfil plates, dynamic phase hexane-diethyl ether (9:1)), and electronic spectrophotometry (solvent - ethanol). The analyte content was quantified by spectrophotometry.

Results: In the study, 2.6-di(P-2-yl)F mainly accumulated in the stomach contents (378.94±41.51) and tissues (175.20±17.12). Among other biomatrices obtained from poisoned rat corpses, a significant amount of the investigated toxic compound was found in the heart (142.79±13.08) and spleen (117.83±16.23), a bit smaller amounts - in the lungs (112.32±29.54) and small intestine (97.10±11.66).

Conclusions: A scheme for determining 2.6-di(propan-2-yl)phenol in biomaterial has been developed and applied to study the analyte localization in the body of animals poisoned by it. The highest amount of the toxicant (mg/100 g) was found in the stomach contents (378.94±41.51), its tissues (175.20±17.12), heart (142.79±13.08) and spleen (117.83±16.23).

Objective: To examine the changes in dermal mast cells density in the mechanically injured skin and to evaluate the applicability of dermal mast cells density increase as an injuries vitality diagnostic criteria (serial examination, statistically processed results).

Material and methods: 240 skin autopsy samples with mechanical injuries from 40 persons were divided to 3 groups (80 in each group): vital injuries, postmortal injuries, control non-injured samples. A routine histological examination using standard H&E stain and IHC with mast cells tryptase antibodies was performed consequented with histological slides full-format scanning and computer processing.

Results and conclusion: An increase in the density of dermal mast cells relative to control samples was found in 80% of samples with vital injuries and in 50% with postmortem ones. Statistically significant differences in mast cell density were revealed between samples of all 3 groups, but they cannot be used as a reliable vitality diagnostic method.