Revista Espanola de Medicina Legal最新文献

Introduction

The estimation of the immersion time of bodies recovered from the water, through the evaluation of the cadaveric changes, allows inferring the time that they have remained in the water regardless of the cause of death. In the present study, the Daily Accumulation of Degrees (ADG) method is analyzed for the calculation of the immersion interval in bodies recovered from the water in 36 bodies with a known interval of permanence in the water.

Material and methods

A total of 161 bodies were recovered from the water between 2007 and 2022, in 41 cases there was data to be analyzed by the ADG method and 36 were suitable for analysis of the method when confronted with the known intervals of immersion of the bodies.

Results

The comparison of calculation by Daily Accumulation of Degrees versus Known Immersion Interval, of the sample of 36 cases, showed that the difference in days obtained is statistically significant (p= 0.48 > 0.005). In 16 cases (44.4%) there was an underestimation by the Daily Accumulation of Degrees method with respect to the time spent in the known water that differed by an average of 40%, and in 18 cases (50%) an overestimation of 41%. Based on the observation of the cadaveric changes, the month of the year and the water temperature, a table was made to estimate the Postmortal Interval of Immersion for watercourses in Northern Patagonia.

Conclusion

The method of Daily Accumulation of Degrees in bodies recovered from the water to estimate the immersion interval may give a false perception of accuracy due to the complexity of integrating all the changing factors that affect human decomposition in aquatic environments.

Introduction

The use of psychoactive drugs to facilitate sexual assault has acquired great relevance in recent years. The objective of this work is to help make this type of situation visible, establishing diagnostic criteria and thus being able to determine the real incidence of this type of crime.

Materials and methods

In order to determine the frequency and characteristics of victims of sexual assault with suspected chemical submission (SSQ), a retrospective descriptive study of sexual assaults facilitated by psychoactive substances has been carried out at the Institute of Legal Medicine and Forensic Sciences of Alicante in the years 2016-2020.

Results

Among 702 cases studied, 95 (13.5%) met the criteria for inclusion in the probable DFSA (drug-facilitated sexual assault) group.

The profile of the victim was a woman (95.4%) around 24 years old. In most cases, the sexual violence was committed by a single male aggressor, recently met or known by the victim, and generally these events happen on weekends. The victim had voluntarily consumed alcohol, drugs or psychotropic drugs immediately before the events in most cases (88,5%). This vulnerable state of the victim was used by the aggressor to sexually assault her (opportunistic DFSA). The toxicological analyses performed on blood and/or urine were positive in 85.3%. In almost half of them (46.3%), there was more than one substance found in the toxicological analyses. The most frequent substance found were: alcohol (54.7%), cannabinoids (37,9%), benzodiazepines (22.1%), cocaine (15.8%) and ecstasy or MDMA (8.4%).

In half of the cases (50.5%), unexpected positive toxicological findings were obtained for psychoactive substances that the victim did not admit to having consumed voluntarily.

The culmination of the process of creating the Institutes of Legal Medicine (IML) with the commissioning of the IML of Madrid in 2020 homogenizes the competences of forensic medicine throughout the country. Recent legislative reforms in specialized medical training, expand their responsibilities to cover, in addition to the expert function, a stronger role in teaching and research. The design and implementation of quality systems must become a priority for IMLs in order to guarantee their effectiveness and efficiency by providing accurate, reliable and timely results. This article provides a detailed review of the procedure to be followed to design a quality strategy in Forensic Pathology Services.

Introduction

Sudden unexpected deaths in infancy (SUDI) represents a serious public health problem. The objective of this work is to analyze its epidemiological and clinical-pathological characteristics.

Method

Retrospective population study of SUDI in Bizkaia between 1991–2020. Data from the Mortality Registry and Forensic Pathology Service were examined.

Results

1,109 deaths in children under one year were recorded. A forensic autopsy was performed in 107: 61 cases of sudden infant death syndrome (SIDS) and 23 SUDI of explained cause. In other 10 cases SIDS was coded as cause of death without forensic autopsy. The incidence of SIDS was 0.26/1000/year and decreased from 0.74 (1991–1995 five-year period) to 0.07 (2011–15 and 2016–20 periods). The percentage of SIDS in relation to total mortality decreased from 11.2 to 2.5%. In SIDS, category IB from San Diego (67%) and infants between 1 and 4 months (63%) predominated. An “unsafe sleep environment” was detected in 6 SIDS. 56.5% of the explained SUDI were infectious. Of the 84 autopsied SUDI cases, 70% had no pre-existing disease and 15% were premature and/or low birth weight infants. In 32% there were prodromal symptoms, mainly respiratory tract infection. Microscopic findings suggestive of respiratory infection were diagnosed in 10 SIDS.

Conclusions

The incidence of SIDS in Bizkaia is low and has decreased notably in the last 30 years. Prodromal symptoms and histopathological signs suggestive of infection are relatively common. Forensic studies provide relevant data, although prospective multidisciplinary and multicenter research would be desirable.

Uterine arteriovenous malformation (UAMM) for some authors, considered an arteriovenous fistula, represents between 1% and 2% of genital and intraperitoneal hemorrhage as a result of spontaneous or provoked vascular rupture after a surgical intervention.

We present a case of maternal death that occurred during a walk on a slope, presenting metrorrhagia and fainting with a fatal outcome. The medico-legal autopsy showed a pregnancy uterus with myometrial hemorrhage and multiple blood clots, diagnosed pathologically as a uterine arteriovenous malformation.

Maternal death is a multifactorial public health problem in underdeveloped countries. Uterine arteriovenous malformation is a rare cause, however some authors consider it underdiagnosed; reported cases have increased in recent years and in developing countries it can be lethal.

A case of suicide by nitrites ingestion is reported: a young woman was found death into a car with various objetcs around her, such as a white powder bag labelled as «sodium nitrite» and pills of lorazepam, acetaminophen and metoclopramide. The autopsy revealed signs compatible with methemoglobinemia and samples of blood, vitreous and gastric content were submitted to the Drugs Service of the National Institute of Toxicology and Forensic Sciences in Madrid, as well as the powder bag, the pills and other objects. The white powder was identified as sodium nitrite, and nitrites concentrations similar to other fatalities were detected in biological samples. The methemoglobin level was 80%. The existence of websites where suicide with nitrites and metoclopramide is described step-by-step, joined to the increasement of reports about these fatalities, alert us to a possible trend.