Postmortem cross-sectional slicing of the frontal sinuses and comparison with antemortem anatomical imagens ­ a technical description / Secção transversal postmortem dos seios frontais e comparação com imagens antemortem ­ descrição de técnica

The anatomical features of the frontal sinuses (FS) are known as highly distinctive and potentially useful for human identification. Assessing these structures with advanced postmortem (PM) imaging, however, is not always feasible in medicolegal units worldwide. This study proposes and validates the anatomical assessment of the FS via cross-sectional slicing of the frontal bone to reproduce images comparable to antemortem (AM) axial views. The bodies of two unknown sisters with advanced decay (decomposition stage III.1) were referred for human identification. The AM data provided for comparative analysis consisted of multi-slice computed tomography (CT) and magnetic resonance images of the skull. In the lack of primary alternatives for human identification, PM assessment of the FS was considered. Justified by the mortuary facilities there were not equipped with CT devices, sequential cross-sectional slicing of the frontal bone was performed. With the skulls in supine position, the technique followed Griesinger's anteroposterior plane using an oscillating saw blade at 90°. Multiple slices (n = 20) of the frontal bone were obtained in craniocaudal direction up to the superior limit of the orbits. The outline of the FS, as well the number of lobes and position of the intersinus septum were visible and compatible with the AM data, enabling positive identification. External validation of the proposed technique was accomplished by reproducing it to successfully identify a male victim in a medicolegal institute 2,000 KM far from the original site

As características anatômicas dos seios frontais (FS) são consideradas distintivas e potencialmente uteis para a identificação humana. A análise imaginológica postmortem (PM) destas estruturas, contudo, não sempre é viável. O presente trabalho tem como objetivo a apresentação e validação de uma proposta de análise anatômica dos seios frontais utilizando a secção do osso frontal a fim de se permitir comparações com imagens axiais antemortem (AM). A corpo de um indivíduo do sexo masculino, não identificado, e em avançado estado de decomposição (estágio III.1) foi encaminhado para identificação. Os dados AM providenciados para análise comparativa consistiram em imagens de tomografia computadorizada (CT) multi-slice e ressonância magnética do crânio. Na falta de alternativas primárias para identificação humana, a análise dos seios frontais (SF). Pelo fato de que o instituto médico-legal era desprovido de unidades de Imaginologia avançada, cortes sequenciais do seio frontal foram realizados. Com os crânios em posição supina, a técnica foi conduzida seguindo o plano anteroposterior de Griesinger's com uma serra oscilatória em 90°. Secções múltiplas (n = 20) do osso frontal foram obtidas no sentido craniocaudal até o limite superior das orbitas. A anatomia dos SF, assim como o número de lobos e a posição do septo intersinual eram visíveis e compatíveis com os dados AM, viabilizando a identificação positiva. A validação externa da técnica proposta se deu durante a identificação de uma vítima do sexo masculino periciada em um instituto médico-legal 2.000Km distante do centro originalmente relatado no presente estudo

Análise odontológica de detalhes anatômicos incisais e oclusais, em especial "flor de lis", para identificação forense ­ relato de caso / Dental analysis of incisal and occlusal anatomic details, in particular "flor de lis", for forensic identification ­ case report

A identificação humana é feita pela análise das particularidades de cada indivíduo, inclusive odontológicas, a qual consiste em um método que necessita de documentação prévia ante mortem de qualquer natureza, mas que contenha características específicas e individuais sobre o periciando a ser identificado. O presente trabalho tem como objetivo relatar um caso de identificação cadavérica cujo componente principal foi a comparação de dois modelos ortodônticos fornecidos pela família, com as peculiaridades dos arcos dentais do cadáver, demonstrando inúmeras coincidências e nenhuma divergência excludente. Nesta comparação, foram evidenciados detalhes anatômicos das bordas incisais, em especial a "flor de Lis" no dente 12 e das faces oclusais que foram suficientes para a identificação do desaparecido.

Human identification is done by analyzing the particularities of each individual, including dental ones, which consists of a method that requires previous documentation ante mortem of any nature, but which contains specific and individual characteristics about the victim to be identified. This study aims to report a case of cadaver identification whose main component was the comparison of two orthodontic models provided by the family, with the peculiarities of the dental arches of the corpse, showing numerous coincidences and no exclusionary divergence. In this comparison, anatomical details of the incisal edges were evidenced, especially the "flor de Lis" on tooth 12 and the occlusal faces that were sufficient to identify the disappeared.

Shells and Bones: A Forensic Medicine Study of the Association of Terrestrial Snail Allopeas micra with Buried Human Remains in Brazil.

Little is known regarding the scavenger fauna associated with buried human corpses, particularly in clandestine burials. We report the presence of 20 shells of the terrestrial snail Allopeas micra, within hollow bones of human remains buried for 5 years, during the process of collecting DNA material. The fact that a large number of shells of A. micra had been found in the corpse and in the crime scene supports the assumption that there was no attempt to remove the corpse from the area where the crime occurred. Despite this, our observations cannot be used to estimate the postmortem interval because there is no precise knowledge about the development of this species. This is the first record of a terrestrial snail associated with a human corpse and its role in this forensic medicine case.

Child sexual abuse.

OBJECTIVE: To evaluate the prevalence of sexual abuse in the pediatric population of the Federal District and discuss the difficulties in interpreting the examination of the genitalia in this age group, both by general practitioners as medical expert forensic officers. METHODOLOGY: This is a retrospective, transversal, and epidemiological study on children younger than 12 years, who attended the Institute of Forensic Medicine of DF (IML-DF), Brasilia, Brazil, with suspicion of sexual abuse between 2008 and 2009. RESULTS: During this period, 3607 persons with suspected sexual abuse and 1762 (48.8%) children younger than 12 years were treated in IML-DF. Of this total, 238 (13.5%) were boys, and 1524 (86.5%) were girls. Among the boys, the average age was 6.5 years, and 9.6% were found to have injuries consistent with sexual abuse. In 43.4% of these cases, the perpetrator was known. The main lesions found were anal fissures and lacerations, bruises, and anal dilatation. In 20 cases (8.4%), the time interval between fact and examination precluded any conclusion. The girls (1524 cases) referred to the IML-DF were subjected to two types of tests: libidinous acts (773 to 50.7%) and rape (751 to 49.3%). In tests of libidinous acts, 5.3% had signs of sexual abuse perpetrated by acquaintances (68.2%), and 3.0% were inconclusive because of the long time lag between the examination and fact. In survey of rape cases, only 2.1% of subjects examined had lesions consistent with abuse. In 57 of 1524 cases, specimens were sampled for sperm test, and five cases (8.7%) showed positive results. The average age of girls being sexually abused (10.7 years) was higher than that for boys (6.5 years). DISCUSSION: Our findings confirm the discrepancy between the expectations of parents and the general practitioner, and the reality of the findings in specialized centers. Approximately 90% of child victims of abuse do not show evidence of physical damage. These were found in less than 10% of abused children. Physical signs of abuse often are difficult to recognize and should not be the only indicators.

Sistema de exercício online para apoio a aprendizagem de Medicina Legal na Universidade de Brasília / On line exercise systems to learning in Forensic Medicine at the University of Brasília

O propósito deste estudo retrospectivo foi avaliar o padrão de utilização do sistema de exercícios on-line, facultativos, assíncronos, para o apoio à aprendizagem da disciplina Medicina Legal e Deontologia Médica na Universidade de Brasília. Os sujeitos foram 38 alunos que cursaram a disciplina no segundo semestre de 2005. O sistema oferecia conteúdos textuais e imagens que podiam ser acessados anonimamente. Para a resolução dos exercícios do tipo "verdadeiro" ou "falso", alguns com imagens, era necessário que os alunos se identificassem por senha, o que permitiu o monitoramento. Os resultados mostraram que 32 alunos (84 por cento) realizaram exercícios on-line, com uma média de 183 respostas por aluno, entre os que aderiram; 52 por cento dos exercícios foram resolvidos nas últimas 24 horas antes da prova; 62,3 por cento dos exercícios foram resolvidos entre 19h e 01h. Conclui-se que os alunos, num sistema facultativo, concentram seus esforços na véspera da prova, o que diminui a eficiência do sistema, sugerindo que técnicas de motivação para o uso regular desse tipo de sistema devem ser implementadas.

The purpose of this retrospective study was to evaluate the usage patterns with the system of online optional asynchronous exercises to support the learning of Forensic Medicine and Medical Ethics at the University of Brasilia. The subjects were 38 students taking this course during the second term of 2005. The system offered text content and images that could be accessed anonymously. To solve the "true-or-false" exercises, some with images, students had to self-identify by means of a password, which allowed tracking. The results showed that 32 students (84 percent) performed exercises online, with an average of 183 responses per student among those who joined. Slightly more than half (52 percent) of the exercises were solved in the last 24 hours before the course test; 62.3 percent of the exercises were solved between 7 PM and 1 AM. In conclusion, students used a voluntary system to concentrate their efforts just before course tests, which reduces the system's efficiency, suggesting that techniques to motivate regular use of systems like this one should be implemented.

Termo de Consentimento Livre e Esclarecido Ilustrado / Illustrated Term of Free and Informed Consent

Este trabalho tem como objetivo propor o uso do Termo de Consentimento Livre e Esclarecido Ilustrado (TCLEI), adequado ao Código de Defesa do Consumidor e demais leis aplicáveis, de modo simples para profissionais e acessível aos pacientes. Tendo em vista que nos casos de processos judiciais, o ônus da prova recai sobre os profissionais, cabe a estes a responsabilidade na elaboração e arquivamento dos prontuários. A ocorrência de processos na área, envolvendo tratamentos executados em clínicas de instituições educacionais de graduação e pós-graduação em odontologia, reforça a preocupação dos docentes para a aplicação do TCLEI. A sua utilização no meio acadêmico, visa instruir e preparar os acadêmicos para a vida profissional, assim como resguardar a instituição e os docentes orientadores responsáveis pelo acompanhamento dos pacientes. É comum que pacientes destas instituições tenham dificuldade no entendimento de um termo convencional, apenas textual (AU).

This study aimed at proposing use of an Illustrated Free and Informed Consent Term (FICT), adapted to comply with the Consumer Defense Code and other relevant laws, in a fashion made simple to professionals and accessible to patients. In view of the fact that the burden of proof is on the professional in cases of legal disputes, it is the responsibility of these professionals to draft and file clinical records. The lawsuits involving treatments performed in clinics run by institutions offering undergraduate and graduate studies in dentistry reinforce the concern of professors regarding application of an illustrated FICT. Its academic implementation is intended to instruct and prepare students for their professional life, and also to protect dental professors responsible for monitoring patients (AU).

Resolução de Sommerset West: violência familiar

Tradução adaptada do texto da resolução adotada pela 48ª Assembléia Geral da Associação Médica Mundial, realizada em Somerset West, República da África do Sul, em outubro de 1996. Trata da questão da violência familiar e apresenta a posição da entidade, recomendando a adoção de diretrizes pelas entidades nacionais.