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10 pages, 246 KiB

Open AccessArticle

Postmortem Diagnosis of Ketoacidosis by Determining Beta-Hydroxybutyrate Levels in Three Types of Body Fluids by Two Different Methods

by Diana Bulgaru Iliescu, Cristina Furnica, Nona Girlescu, Raluca Ozana Chistol, Lacramioara Perianu, Madalina Diac, Andrei Daniel Timofte, Anton Knieling and Ioan-Adrian Ciureanu

Appl. Sci. 2022, 12(11), 5541; https://doi.org/10.3390/app12115541 - 30 May 2022

Cited by 1 | Viewed by 1721

Abstract

Background: Postmortem assessment of endogenous ketoacidosis is primarily focused on the determination of 3-beta-hydroxybutyrate (BHB). The aim of our study was to identify the most adequate body fluid and postmortem quantification method for assessing ketoacidosis status immediately prior to death. Material and method: [...] Read more.

Background: Postmortem assessment of endogenous ketoacidosis is primarily focused on the determination of 3-beta-hydroxybutyrate (BHB). The aim of our study was to identify the most adequate body fluid and postmortem quantification method for assessing ketoacidosis status immediately prior to death. Material and method: We performed a prospective study on 53 cases of sudden death or in-hospital death that were considered forensic cases and could present a state of ketoacidosis prior to death, the autopsies being performed at a post-mortem interval of 24–72 h. BHB analysis was performed by Multi-Functional Monitoring System XPER Technology analyzer (method A—portable analyzer) for peripheral blood, and by BHB Assay MAK041 Kit (method B) for vitreous humor (VH) and cerebrospinal fluid (CSF). Results: We identified 11 ketoacidosis cases using method A and 9 ketoacidosis cases using method B. All nine cases of ketoacidosis identified using the MAK041 kit were confirmed with the portable analyzer. For the 2 cases of ketoacidosis identified only with the portable analyzer, the values obtained by method B were at the diagnostic limit. BHB concentrations determined in VH and CSF by method B were statistically significantly correlated with each other and with peripheral blood BHB concentration. Conclusion: BHB, a marker of ketoacidosis, should be determined post-mortem whenever a metabolic imbalance is suspected irrespective of known risk factors or obvious morphological substrate to help establish the thanatogenic mechanism. BHB quantification can easily be performed using a handheld automatic analyzer and a sample of peripheral blood as BHB levels in various body fluids correlate with each other. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

15 pages, 6373 KiB

Open AccessArticle

Clinical-Pathological Study on Expressions β-APP, GFAP, NFL, Spectrin II, CD68 to Verify Diffuse Axonal Injury Diagnosis, Grade and Survival Interval

by Iuliana Hunea, Laura Riscanu, Nona Girlescu, Madalina Diac, Anton Knieling, Sofia David, Cristina Furnica, Codrin Lucasevici, Irina Catrinel Dragomir, Diana Bulgaru Iliescu and Manuela Ciocoiu

Appl. Sci. 2022, 12(7), 3638; https://doi.org/10.3390/app12073638 - 4 Apr 2022

Cited by 1 | Viewed by 1740

Abstract

Traumatic brain injury (TBI) is one of the leading causes of death worldwide, particularly in young people. Diffuse axonal injuries (DAI) are the result of strong rotational and translational forces on the brain parenchyma, leading to cerebral oedema and neuronal death. DAI is [...] Read more.

Traumatic brain injury (TBI) is one of the leading causes of death worldwide, particularly in young people. Diffuse axonal injuries (DAI) are the result of strong rotational and translational forces on the brain parenchyma, leading to cerebral oedema and neuronal death. DAI is typically characterized by coma without focal lesions at presentation and is defined by localized axonal damage in multiple regions of the brain parenchyma, often causing impairment of cognitive and neuro-vegetative function. Following TBI, axonal degeneration has been identified as a progressive process that begins with the disruption of axonal transport, leading subsequently to axonal swelling, axonal ballooning, axonal retraction bulges, secondary disconnection and Wallerian degeneration. The objective of this paper is to report on a series of patients who have suffered fatal traumatic brain injury, in order to verify neurological outcomes in dynamics, relative to the time of injury, using antibodies for neurofilament (NFL), spectrin II, beta-amyloid (β-APP), glial fibrillary acidic protein (GFAP) and cluster of differentiation 68 (CD68). From the studied cases, a total of 50 cases were chosen, which formed two study groups. The first study group comprises 30 cases divided according to survival interval. The control group comprises 20 cases with no history of traumatic brain injury. Cardiovascular disease and history of stroke, cases suffering from loss of vital functions, a post-traumatic survival time of less than 15 min, autolysis and putrefaction were established as criteria for exclusion. Based on their expression, we tested for diagnosis and degree of DAI as a strong predictor of mortality. Immunoreactivity was significantly increased in the DAI group compared to the control group. The earliest changes were recorded for GFAP and CD68 immunolabeling, followed by β-APP, spectrin II and NFM. The most intense changes in immunostaining were recorded for spectrin II. Comparative analysis of brain apoptosis, reactive astrocytosis and inflammatory reaction using specific immunohistochemical markers can provide important information on diagnosis of DAI and prognosis, and may elucidate the timing of the traumatic event in traumatic brain injury. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

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17 pages, 3309 KiB

Open AccessArticle

Evaluation of Hydrogen Cyanide in the Blood of Fire Victims Based on the Kinetics of the Reaction with Ninhydrin

by Daniel Tabian, Diana Bulgaru Iliescu, Madalina Maria Diac, Mihaela Badea, Sebastian Ionut Toma and Gabi Drochioiu

Appl. Sci. 2022, 12(5), 2329; https://doi.org/10.3390/app12052329 - 23 Feb 2022

Cited by 2 | Viewed by 2127

Abstract

An original kinetic spectrophotometric procedure was developed for the determination of hydrogen cyanide (HCN) in the whole blood of fire victims. Cyanide poisoning by smoke inhalation is common in forensic medicine, but the blood HCN of fire victims has not been studied in [...] Read more.

An original kinetic spectrophotometric procedure was developed for the determination of hydrogen cyanide (HCN) in the whole blood of fire victims. Cyanide poisoning by smoke inhalation is common in forensic medicine, but the blood HCN of fire victims has not been studied in detail so far. In this research project, we developed a simple, fast, sensitive, and selective quantification method for both free and metabolized HCN based on the kinetics of cyanide reaction with ninhydrin. The method was linear in range, from 0.26 to 2.6 μg mL⁻¹, with a coefficient of determination of r = 0.994. A high molar absorptivity of 4.95 × 10⁵ L mol⁻¹ cm⁻¹ was calculated under the reaction conditions. The limit of quantification was 0.052 μg mL⁻¹; the detection limit was 0.012 μg mL⁻¹ and the standard error was ±2.7%. This micro method proved to be accurate, sensitive, and selective and has been successfully applied to the analysis of blood samples, allowing rapid monitoring of blood cyanide in several fire victims. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

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18 pages, 7109 KiB

Open AccessArticle

Effects of Loading Conditions on the Pelvic Fracture Biomechanism and Discrimination of Forensic Injury Manners of Impact and Run-Over Using the Finite Element Pelvic Model

by Zhengdong Li, Donghua Zou, Jianhua Zhang, Kaijun Ma and Yijiu Chen

Appl. Sci. 2022, 12(2), 604; https://doi.org/10.3390/app12020604 - 9 Jan 2022

Cited by 2 | Viewed by 1795

Abstract

This study aimed to systematically simulate the responses of pelvic fracture under impact and run-over to clarify the effects of boundary and loading conditions on the pelvic fracture mechanism and provide complementary quantitative evidence for forensic practice. Based on the THUMS finite element [...] Read more.

This study aimed to systematically simulate the responses of pelvic fracture under impact and run-over to clarify the effects of boundary and loading conditions on the pelvic fracture mechanism and provide complementary quantitative evidence for forensic practice. Based on the THUMS finite element model, we have validated the simulation performance of the model by a real postmortem human pelvis side impact experiment. A total of 54 simulations with two injury manners (impact and run-over), seven loading directions (0°, 30°, 60°, 90°, 270°, 300°, 330°), and six loading velocities (10, 20, 30, 40, 50, and 60 km/h) were conducted. Criteria of effective strain, Von-Mises stress, contact force, and self-designed normalized eccentricity were used to evaluate the biomechanism of pelvic fracture. Based on our simulation results, it’s challenging to distinguish impact from run-over only rely on certain characteristic fractures. Loads on the front and back were less likely to cause pelvic fractures. In the 30°, 60°, 300° load directions, the overall deformation caused a “diagonal” pelvic fracture. The higher is the velocity (kinetic energy), the more severe is the pelvic fracture. The contact force will predict the risk of fracture. In addition, our self-designed eccentricity will distinguish the injury manner of impact and run-over under the 90° loads. The “biomechanical fingerprints” based on logistic regression of all biomechanical variables have an AUC of 0.941 in discriminating the injury manners. Our study may provide simulation evidence and new methods for the forensic community to improve the forensic identification ability of injury manners. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

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10 pages, 223 KiB

Open AccessArticle

Estimation of Stature from Tibia Length for Romanian Adult Population

by Madalina Maria Diac, Tatiana Iov, Simona Irina Damian, Anton Knieling, Nona Girlescu, Codrin Lucasievici, Sofia David, Elena F. Kranioti and Diana Bulgaru Iliescu

Appl. Sci. 2021, 11(24), 11962; https://doi.org/10.3390/app112411962 - 15 Dec 2021

Cited by 1 | Viewed by 2667

Abstract

The estimation of stature from bones plays an important role in identifying unknown bodies, body parts, or skeletal remains, as it is an important component of the biological profile in forensic identification. The objective of this study is to enhance the development of [...] Read more.

The estimation of stature from bones plays an important role in identifying unknown bodies, body parts, or skeletal remains, as it is an important component of the biological profile in forensic identification. The objective of this study is to enhance the development of forensic anthropology in Romania by creating a new regression formula for stature estimation. This can be accomplished from the length of the tibia, taking into account sex and age, for the Romanian adult population. A total of 137 cases from a delimited territory of Romania were included in the study. The length of the tibia and the stature of the individuals were measured before autopsy. Statistical analysis was carried using (Statistical Package for the Social Sciences) SPSS 23. Tibia length showed a high correlation with stature for males, females, and the total sample. Four regression formulae were created for stature estimation of Romanian males, females, and unknown sex. The results of the analysis are impressive and have a good applicability in a forensic anthropological context. The data used in this paper provide reliable results with a large applicability in the future for estimating stature from the tibia length for the Romanian adult population. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

13 pages, 4798 KiB

Open AccessArticle

Pathological Mechanisms and Additional Factors Involved in Complex Neck Traumatology

by Diana Bulgaru-Iliescu, Andrei Nicolau, Ștefan Roșca, Ioan-Adrian Ciureanu and Florentina Severin

Appl. Sci. 2021, 11(24), 11863; https://doi.org/10.3390/app112411863 - 14 Dec 2021

Viewed by 1618

Abstract

Background. Cervical trauma can be closed or open, have different degrees of severity, incidence rates, prevalence, or mortality, with variations in the presence of demographic factors. The different types of traumatic injuries have a certain pattern of occurrence depending on criteria related [...] Read more.

Background. Cervical trauma can be closed or open, have different degrees of severity, incidence rates, prevalence, or mortality, with variations in the presence of demographic factors. The different types of traumatic injuries have a certain pattern of occurrence depending on criteria related to sex, age, alcohol consumption, and socio-demographic factors. Increasing the rate of trauma is becoming a public health problem and it is necessary to study their epidemiology and implement control strategies. Aims. The objectives of the study are to establish the particularities of epidemiological, morphopathological, and pathophysiological factors involved in complex neck traumatology. Methods. The study group consisted of 384 patients, representative for the population of Moldova, who presented at the ENT Clinic, Hospital “St. Spiridon” Iași and the Institute of Forensic Medicine, Iași during 2012–2016, with complex cervical trauma pathology, produced by various mechanisms, such as car accidents, domestic accidents, aggressions, ballistic trauma, self-inflicted attempts, hanging or strangulation. Data were collected from autopsy reports and medical records. Results. Complex cervical trauma occurs with a predisposition in males, with an average age of 43 years, from rural areas. The mechanism of cervical trauma is predominantly self-inflicted—hanging in 78.4% of the total number of cases, followed by 14.8% of stabbing aggression. The majority of neck injuries, both open and closed, are located in anatomical zone II (73.6%), vascular and pharyngeal are produced by stabbing. Psychiatric disorders and blood alcohol levels are correlated with complex cervical trauma caused by self-inflicted mechanism—hanging and can be considered a predictive factor of suicide attempts. Conclusions. Overall, the vast majority of closed neck injuries were caused by the self-inflicted mechanism, attempted suicide by hanging, followed by the accidental mechanism. Regarding the penetrating complex aero-digestive cervical traumas, they were mostly produced by stabbing both in aggression and self-inflicted circumstances. Aggravating addictive factors such as alcoholism and mental disorders require a competent assessment in terms of the indication of institutionalized treatment, prevention of repeated self-inflicted attempts, or social reintegration. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

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25 pages, 173375 KiB

Open AccessArticle

Postmortem Documentation of SARS-CoV-2 in Utero and Postpartum Transmission, through Amniotic Fluid, Placental, and Pulmonary Tissue RT-PCR

by Alexandra Enache, Veronica Ciocan, Camelia Oana Muresan, Talida Georgiana Cut, Dorin Novacescu, Corina Paul, Nicoleta Andreescu, Alexandra Mihailescu, Marius Raica and Raluca Dumache

Appl. Sci. 2021, 11(20), 9505; https://doi.org/10.3390/app11209505 - 13 Oct 2021

Cited by 6 | Viewed by 6288

Abstract

The physiopathology of SARS-CoV-2 infection, during pregnancy and in early childhood, is poorly understood. Unfavorable maternal outcomes, the risk of vertical/postpartum transmission, and severe, multisystem involvement in infants and children highlight the importance of developing a cohesive treatment and nuanced prophylaxis strategy. In [...] Read more.

The physiopathology of SARS-CoV-2 infection, during pregnancy and in early childhood, is poorly understood. Unfavorable maternal outcomes, the risk of vertical/postpartum transmission, and severe, multisystem involvement in infants and children highlight the importance of developing a cohesive treatment and nuanced prophylaxis strategy. In this study, we evaluate autopsy reports, pathological findings, and SARS-CoV-2 genome expression in three distinct clinical scenarios: maternal death due to severe COVID-19 with in utero fetal demise (27 weeks); mother with moderate COVID-19 and in utero fetal demise (29 weeks); and 2-month-old infant death with confirmed COVID-19 caregivers. We report the presence of the SARS-CoV-2 genome in amniotic fluid and placental tissue in the context of in utero transmission of SARS-CoV-2, but also in postmortem infant pulmonary tissue samples in a case of late postpartum SARS-CoV-2 transmission with asymptomatic, rapidly progressive disease, resulting in infant death. Key pathological findings offer a descriptive portrayal of maternal, in utero, and infantile COVID-19 pathogenesis. Further investigations are necessary to fully comprehend the clinical implications of SARS-CoV-2 infection during pregnancy, a prerequisite for adequate therapeutic management and harm reduction. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

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Review

Jump to: Research

13 pages, 272 KiB

Open AccessReview

Psychological Autopsy and Forensic Considerations in Completed Suicide of the SARS-CoV-2 Infected Patients. A Case Series and Literature Review

by Roxana-Mihaela Crisan, Ciprian Ionut Bacila, Bogdan Neamtu, Adrian Nicolae Cristian, Elena Topîrcean, Adriana Popescu and Silviu Morar

Appl. Sci. 2021, 11(23), 11547; https://doi.org/10.3390/app112311547 - 6 Dec 2021

Cited by 6 | Viewed by 2808

Abstract

Our paper aims to present three cases of committed suicide in SARS-CoV-2 infection during the quarantine period. We investigated if there is a role for the infection itself in triggering the suicidal act or if it is augmented by other risk factors such [...] Read more.

Our paper aims to present three cases of committed suicide in SARS-CoV-2 infection during the quarantine period. We investigated if there is a role for the infection itself in triggering the suicidal act or if it is augmented by other risk factors such as fear, psychosocial stress, lifestyle changes, and social isolation. To this goal, we analyzed the clinical, paraclinical, histopathological, toxicological records, mental health conditions, psychological, social, cultural, and economic aspects in detail. One patient committed suicide at home, by hanging, while the other two during hospitalization in the red zone, within the Sibiu County Emergency Clinical Hospital, hanging and falling from a height, respectively. The autopsy was carried out within the restricted area for COVID-19 in Sibiu County Forensic Medicine Service. Patients’ medical histories were analyzed based on the available medical reports. Additionally, we interviewed a family member, applying the so-called psychological autopsy method, based on open-ended questions and standardized instruments (questionnaire) to point out the motives and behavioral changes that might explain the committed suicide. With this data, we could fulfill a design to elucidate and outline the reasons for the suicidal act. Our findings showed that the mental state deteriorated progressively, both in preexisting depressive and non-depressive backgrounds. Furthermore, we highlight the COVID-19 psychological impact in the suicidal acts. Further on, we reviewed the risk factors presented in the literature that are associated with mental health problems and behavioral changes such as stress, anxiety, depressions, sleep disorders, impulsivity, loneliness. Full article

(This article belongs to the Special Issue Updates in Forensic Medicine: New Tools Applied in Forensic Science)

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