Revista Espanola de Medicina Legal最新文献

Given the inclusion of the Complex Post-Traumatic Stress Disorder (C-PTSD) in the International Classification of Diseases 11th edition, this article analyses the C-PTSD as a possible new diagnosis in women victims of gender-based violence to explain a wide range of symptoms resulting from interpersonal, persistent, continuous, severe and uncontrollable traumas that may occur in this context. Thus, it describes the psychological impact and the psychopathological consequences it produces on the victims, which are most serious when the violence suffered has occurred repeatedly and over time. In addition, it delves into the differential diagnosis of C-PTSD with other psychopathologies. Finally, a protocol for forensic psychological assessment is proposed based on C-PTSD as a clinical disorder, which explains the serious psychological impact on the evaluation of women victims of gender-based violence, considering this disorder as an alternative diagnostic hypothesis in the forensic psychological assessment of the psychological injury.

Despite progress in the development and validation of analytical methods. In the meantime, the challenges in interpretive forensic toxicology remain persistent, since it is no easy to establish a causal link between the concentration of a compound in biological samples and its impact on a real case. A proper interpretation of results is required to ascertain their relevance and to ensure that the investigator or jurist can make the most of the utility of the trace within the framework of the investigation or within the courtroom.

Because of their complexity and frequent presence at toxicology laboratories, in this article we have focused our attention on the interpretation of results in drug-facilitated offences, in cases where hair samples are involved and in cases related with post mortem investigation. Following this review, the advances in analytical results interpretation in the selected cases, are being mainly conducted towards metabolic studies.

In cases of drug-facilitated crimes it allows to extend the detection window and identify low concentration consumption markers for fast-clearing compounds. Regarding hair metabolomics analysis, recent studies can assist us to determine the deterioration caused by cosmetic treatments or to elucidate the difference between consumption and extern contamination, which are a well-known factor affecting the interpretation of hair analysis. Concerning post mortem results, progress is intended to ensure better reference data, to the study of drug-to-drug interactions as well as to the application of metabolomics and to the acknowledgment of the genetic variances related with drugs metabolism, location, and mechanism of action.

Introduction/Objectives

Situated in West Central Morocco, the Doukkala region carries the distinction of being one of North Africa's oldest human settlement zones. Nonetheless, it has been notably understudied in the realm of population genetics. Through allele frequency analysis and integration of forensic parameters, the research aims to gain insights into the genetic structure and neighboring affiliations of the Doukkala population.

Methods

This study employed the AmpFlSTR Identifiler PCR system to assess the allelic frequencies and forensic parameters of 15 autosomal STRs in a cohort of 134 unrelated, healthy individuals from the Doukkala region who identify as Arab-speakers. Additionally, we explored the genetic relationships between the Doukkala population and other reference groups, considering both our dataset and previously published population data.

Results

A total of 180 alleles were observed in the study population. With a count of 19 alleles, D18S51 proved to be the most diverse marker in the study. After Bonferroni's correction, 3 loci (FGA, TH01, and TPOX) deviated from Hardy–Weinberg equilibrium. The combined power of discrimination (PD) was 0.99999999999999999526 and the combined probability of exclusion (PE) was 0.99999664790900144592. The Arabic-speaking population of Rabat-Salé–Zemmour-Zaer and Southern population from Morocco exhibit the shortest genetic distance from population of Doukkala. No significant difference was observed between the Arabic-speaking population of Doukkala and all North African populations at all loci, except for the Egyptian population (North-East Africa), where a difference was observed at 2 specific loci (CSF1PO and TH01).

Conclusions

These results indicate that the diversity found in populations from North Africa transcends geographic and linguistic barriers. The dataset's relevance to this research could stem from its capacity to offer valuable reference data for forensic, anthropological, and genetic investigations.

A 56-year-old man who collapsed in the street was found at autopsy to have died from mixed drug toxicity. Also present was a cholecystoduodenal fistula with an inflamed gallbladder adherent to an area of duodenal ulceration. The fistula was longstanding with significant fibrous scarring and predominantly chronic inflammation, but also with bacterial colonies, ulcer slough, and a polymorphonuclear leukocyte infiltration. It is uncertain whether the fistula originated from acute inflammation of the gallbladder with adherence to the duodenum (the most common aetiology) or from a penetrating duodenal ulcer, or from a combination of dual pathologies. Non-specific clinical features and illicit drug usage may have contributed to failure of diagnosis during life This case demonstrates significant rare pathology that may be more completely demonstrated with an internal autopsy examination.

Introduction

Suicide remains one of the leading causes of death worldwide. Due to the relationship between suicidal behavior and mental disorder, our aim is to determine the number of people who received care by the Mental Health Network among the total number of suicides consummated between 2017 and 2022 in Gran Canaria, as well as the characteristics of that population and the care received.

Material and methods

Longitudinal observational retrospective study in which the study population was extracted from the total number of suicides in the database of the Legal Medicine Institute. Subsequently, the data were cross-checked by the Mental Health Network databases. Finally, a univariate statistical analysis was carried out and the results were compared according to sex and care in the Community Mental Health Unit.

Results

Only 39.4% had received care at the Mental Health Unit, the majority being women (55.3% vs. 34.6%), with a mean age of 50.9 years for both sexes. History of previous attempts was much more frequent in the population receiving care (45.4% vs. 7%), as well as emergency care (42% vs. 5.7%) and hospital admissions (25.3% vs. 0.7%).

Conclusion

Less than half of the deceased persons had contact with a Community Mental Health Unit. In addition, care by this unit was higher among those with previous attempts and among the female sex, with the most frequent diagnosis being monopolar affective disorders.

Introduction

Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in young epileptic patients. The objective of the work is to analyze its frequency and clinical-pathological characteristics as a cause of sudden death in epileptics under 35 years of age.

Methods

Retrospective population study of all SUDEP in people aged 1–35 years in Bizkaia (period 1991–2021) and Seville (2004–2021) investigated in the Forensic Pathology Services (FPS). In each case, a complete autopsy was carried out with histopathological and toxicological studies, and review of clinical and circumstantial data. Data from the Mortality Registry for deaths by epilepsy were examined.

Results

101 deaths due to epilepsy were registered in the Mortality Registries and 46 SUDEP cases in the FPS, representing 6% of forensic sudden deaths in this age population. A high frequency of post-traumatic epilepsy cases (n = 5), brain abnormalities (n = 5) or epilepsy associated to developmental disorders (n = 4) or mental retardation (n = 3) was observed. The toxicological analysis was positive in 75%, highlighting the presence of antiepileptic drugs (n = 26). Illegal drugs were detected in 5 young people, mainly cocaine (n = 3). Death was unwitnessed in most subjects (85%) and occurred at night (n = 63%) while sleeping.

Conclusions

SUDEP in children and young people is infrequent, however it is an important cause of mortality in epileptics. Although the mechanisms are not well understood, it is recommended to strengthen the medical control of epilepsy in youth, mainly in patients with post-traumatic or post-surgical epilepsy or in those who have associated developmental disorders or mental retardation.

Introduction

Thoracic aortic dissection/rupture has a high mortality, constituting 3.9-5.4% of sudden deaths in forensic series. Medial histopathological findings associated with these entities have received multiple terms and definitions. In 2016, the European Association for Cardiovascular Pathology and the Society for Cardiovascular Pathology published a consensus document, applied to surgical specimens, to unify criteria. The aim of this work is to assess its application in forensic autopsies. A secondary objective is to study inflammatory changes useful for dating.

Material and methods

Aortic histological preparations of the 54 cases of sudden deaths due to aortic rupture/dissection studied between 2019 and 2022 were reviewed.

Results

Medial degeneration was observed in 49 cases (90.8%) (severe in 42.9%). By lesions, the order of frequency was: fragmentation and/or loss of elastic fibers (74.1%); accumulation of extracellular mucoid matrix (61.1%); loss of smooth muscle cell nuclei (48.1%) and collapse of the media (44.4%). Some lesions of the consensus paper could not be assessed. No significant differences were found by age; presence or not of collagenopathies; or bi/tricuspid aortic valves. Granulation tissue or neutrophilic infiltrate was observed in those deceased with pain several days or <24 h before death, respectively.

Conclusion

With the application of the document, lesions in the media are found in >90% of cases and fundamental lesions can be studied. The inflammatory response to rupture/dissection appears to correlate with the timing of dissection/rupture.