Vehicle-assisted ligature decapitation - an unusual case report.

Suicide by vehicle-assisted strangulation resulting in decapitation is a rare occurrence, characterized by a high kinetic energy mechanism that produces a clean-cut appearance in the decapitation area. Often resembling an incisive wound, this particular finding can mislead local authorities into investigating the case as a homicide. This case report describes an adult male who accelerated his vehicle after tying a nylon rope around his neck and securing it to a metallic structure on the wall. Furthermore, we conducted a brief review of cases published within the last ten years, summarizing the most prevalent findings associated with these incidents. By analyzing previously reported cases alongside our own, we aim to consolidate the prevailing patterns observed in vehicle-assisted strangulation cases. This underscores the paramount importance of thorough scene analysis by the medico-legal team and emphasizes the significance of subsequent necropsy findings in accurately discerning the manner of death.

Implications of literacy for health for body mass index.

INTRODUCTION: Literacy for health (LH) may be considered a set of skills that people appropriate, understand, evaluate and use information and knowledge of health to make informed choices, reduce risks to their health, maintain a healthy nutritional status and enhance quality of life. OBJECTIVES: To assess the level of literacy for health; analyse the relationship of socio-demographic variables with LH; to classify the Body Mass Index (BMI) and to determine the effect of LH on BMI. DESIGN: a quantitative study with a descriptive and cross-sectional approach conducted in the centre and north of Portugal. Particnipants: a non-probabilistic sample of 508 Portuguese participants with a mean age 44.48 years (SD = 21 years). MEASURING INSTRUMENTS: LH was assessed by the European Questionnaire on Literacy for Health (LHS-EU-PT) validated in Portuguese by Saboga-Nunes and Sorensen (2013) and BMI classification followed the WHO reference accepted by Portugal, DGS (2013). RESULTS: It was found that overall, 73.62% of the participants have an inappropriate and problematic level of literacy for health; this was significantly lower in women (P=.000). Participants with inadequate LH, are those with higher BMI (χ(2)=78.09; P=.000), so are at risk of a sub-optimal state of health. CONCLUSIONS: The results suggest a significant relationship between the LH and BMI. It is found that, the better the LH, the more appropriate is the BMI. This evidence reinforces the importance of promoting literacy for health to the Portuguese population.

MDMA Intoxication in a Potential Organ Donor with Cardiac Arrest.

Amphetamine and its derivatives' consumption is still an important public health issue, namely in terms of compounds variability and disposition to consumers. However, some of them, like 3,4-methylenedioxymethamphetamine (MDMA), still live in the illicit market, with continuous success. Nevertheless, there is always new information and data on MDMA intoxication, both in vivo and in postmortem context. The authors report an intoxication case with MDMA, in an 18-year-old male, considered a potential organ donor after a cardiac arrest. Whole blood samples were collected in vivo, at the emergency room (ER), and postmortem, at the National Institute of Legal Medicine and Forensic Sciences. After a general screening procedure, samples were extracted by solid phase extraction (OASIS® MCX), followed by gas chromatography-mass spectrometry analysis. The whole blood postmortem sample was positive for lidocaine (<500 ng/mL), compatible with the ER intervention, and positive for MDMA (2278 ng/mL) and methylenedioxyamphetamine (MDA) (49 ng/mL), while whole blood samples collected in vivo (during the maintenance of the individual under advanced life support), were positive for MDMA (504-1918 ng/mL) and MDA (20-89 ng/mL). Samples were negative for other substances, namely ethanol, other drugs of abuse and medicines. Results interpretation is pivotal to understand the behavior of the substance. Thus, in this case, MDMA postmortem behavior should be carefully evaluated, considering as possible influencers, in the specific context of the case, the time lapse between death verification, maintenance of the advanced life support and body manipulation for organ collection purposes. Also referred and discussed is the antemortem/postmortem ratio of MDMA obtained values, compared with literature references. There is no doubt that death was due to MDMA intoxication, but information from the analysis performed on the in vivo samples suggests that this type of sample should also be considered, in a complementary role, whenever possible.

Is the length of the sternum reliable for estimating adult stature? A pilot study using fresh sterna and a test of two methods using dry sterna.

Stature estimation is one of the four attributes of the biological profile obtained from human skeletal remains. The length of the long bones has been consistently used to estimate stature from regression equations, but these may be useless when dealing with fresh or decomposed mutilated remains. Until recently, there was no consistent assessment of the reliability of measurements of the sternum for stature estimation. The purpose of this paper is to test previously developed regression formulae for stature based on measurements of the dry sternum and to assess the reliability of measurements of the fresh sternum in estimating stature. The formulae developed by Menezes et al. and Singh et al. were applied to a sample of 5 known stature skeletons from the identified human skeletal collection curated at the National Museum of Natural History, in Lisbon, Portugal. Testing of these formulae showed that estimated stature confidence intervals do not allow discrimination between individuals with similar stature. The length of the fresh sternum was measured on a sample of 45 male individuals autopsied at the National Institute of Legal Medicine - North Delegation (Porto, Portugal). Cadaver length was regressed on sternum length and a simple linear regression formula was obtained. The regression model provided a 95% confidence interval of 13.32 cm and a correlation coefficient of only 0.329. Compared to other studies, regression formulae based on the length of the sternum provided considerably larger standard errors than that based on long bone lengths. These results suggest that the length of the sternum has limited forensic value and relatively low reliability in estimating stature from mutilated human skeletal remains, either skeletonized or fresh.

Influência da qualidade do esfregaço cérvico-vaginal na detecção de lesões intra-epiteliais cervicais / Influence of cervicovaginal smear quality in the detection of cervical intraepithelial lesions

A qualidade do esfregaço é fundamental em citologia para prevenção do câncer do colo uterino. Com a introdução do Sistema SISCOLO-Qualidade pelo Ministério da Saúde (1999) para diagnóstico em citologia cérvico-vaginal na Rede Pública, tem sido possível correlacionar diagnóstico e qualidade da amostra. No presente trabalho, foram revisados os laudos citológicos de duas Unidades de Saúde (U1 e U2) atendidas pelo Setor de Citologia Oncótica do Instituto Adolfo Lutz Central, um dos pioneiros em adotar este sistema. Foram analisados 4188 casos da U1 e 6250 casos da U2, e comparados os números de casos positivos em grupos de amostras com diferente qualidade: satisfatórias (S) e satisfatórias, porém limitadas por ausência de células da JEC (SL/JEC), dessecamento (SLD), fundo purulento (SLP) ou por outras causas (SLO). Foram considerados positivos os casos com diagnóstico de atipias de significado indeterminado, NIC graus 1 a 3 e carcinoma. A análise estatística mostrou que, nas duas unidades, a porcentagem de casos positivos foi significativamente maior no grupo de amostras S (3,28 por cento e 5,25 por cento respectivamente na U1 e U2) do que nas limitadas por ausência de células da JEC, dessecamento e outras causas. Os grupos de exames que detectaram menos casos positivos foram SL/JEC (0,08 por cento e 0,25 por cento), seguidos por SLO (0,61 por cento e 0,34 por cento) e SLD (0,78 por cento e 0,94 por cento). Nos grupos SLP, embora as porcentagens tenham sido menores, (1,16 por cento e 2,80 por cento) não houve diferença significativa com relação ao Grupo S. Os presentes resultados confirmam a necessidade de amostragem adequada em citologia cérvico-vaginal, especialmente a representatividade de células da JEC.

Candidíase e tricomoníase interferindo na variabilidade interobservadores no diagnóstico de ASCUS e SIL / Candidiasis and trichomoniasis interfering in interobserver variability in ASCUL and SIL diagnostic

Alterações citopáticas causadas pela Candida sp ou Trichomonas vaginalis são bem conhecidas em esfregaços cervicais. Atenção especial deve ser considerada nestes casos para evitar resultados falso-positivos. Objetivo deste estudo foi identificar os parâmetros morfológicos principais utilizados no diagnóstico de ASCUS ou SIL com Candida sp ou Trichomonas vaginalis. Foram selecionados 78 casos consecutivos com diagnóstico de ASCUS ou SIL que apresentavam infecção por Candida sp ou Trichomonas vaginalis. Estes casos foram revistos por três observadores em estudo cego e as alterações principais foram registradas. As alterações mais freqüentemente observadas foram: halo perinuclear e aumento do volume nuclear (100 por cento); hipercromasia discreta (70,8 por cento); binucleação (47,2 por cento); multinucleação (34,7 por cento); disqueratose (22,2 por cento). Outros achados citológicos como: células escamosas metaplásicas (84,7 por cento) e infiltrado leucocitário (61,5 por cento). Alterações citopáticas causadas pela infecção por Candida sp ou Trichomonas vaginalis podem reproduzir alguns critérios utilizados no diagnóstico de ASCUS ou SIL, e também simular algumas alterações morfológicas relacionadas ao HPV. Estas alterações celulares devem ser cuidadosamente consideradas, uma vez Palavras-chave ASCUS; SIL; Candida sp; Trichomonas vaginalis; secreção cervical.que podem ser observados resultados falso-positivos.