Medicolegal approach to skin lesions in trafficking victims: A case report.

Trafficking in human beings is an ancient phenomenon. The fight against trafficking in human beings is conceived as a priority by the European Union. Trafficked victims experience many types of abuse and neglect. Indeed, all human beings hold the right to have an identity and an estimated age as an assertion of their existence in the society, as expressly stated in the U.N. Convention on the Rights of the Child. Italy has been the scene of this phenomenon for many years. Since identification represents a fundamental human right and a prerequisite for any other measure of assistance and protection, the Italian procedure provides the execution of an interview and a forensic examination. This process takes time and requires willingness to listen and to create a trusting doctor-patient relationship. Although skin lesions in trafficking victims may be due to torture or other forms of mistreatment or abuse, they may also be related to ethnic practices. Here we demonstrate the importance of conducting a structured interview along with an accurate forensic examination to correctly discriminate the origin of skin lesions in trafficking victims.

Digital radiological research in forensic dental investigation: case studies.

The advent of dental digital radiology and new portable X-ray devices allows the execution of periapical X-ray images not only in the dental surgery but also in hitherto difficult locations such as field military hospitals, archaeological excavation sites, morgues and in cases of house arrest. In this work authors evaluated the feasibility of Nomad Examiner (Aribex inc.) handheld X-ray device combined with a digital sensor and a portable pc in forensic odontology applications. Employed for the first time forensically during the 2004 Tsunami victim identification process, the Nomad Examiner has now passed all security and conformity requirements of US and EU regulations. Examples of the practical use and the technical features of this device are seen when employed in odontological assessment of skeletonised and carbonized individuals and the assessment of individuals under house arrest complaining dental lesions. Results from the use this portable device demonstrate the benefits of a dental radiological assessment during an autopsy with the aim of human identification and the importance of a complete dental assessment (clinical and radiological) when evaluating dental traumatic lesions of individuals who cannot visit a dental surgery. In the first example forensic dentist would work alongside a forensic pathologist. On the other hand in the second example an odontologist - dentist could be appointed as an expert witness directly by a Court.

From doctor to incendiary nun: the importance of analysing the pathways of trauma.

ABSTRACT: Childhood traumatic experiences have often been associated with the development of severe psychiatric disorders or, at least, with serious impairment in the victims' developing personality. Emotional abuse and neglect can cause gradual damage to Self-image and to models of self-in-relation to Others. We report a case of a woman who underwent psychiatric evaluations for marriage annulment. The issues were the as-sessment of the outcomes of early psychic trauma and the examination of the remaining individual capacities from a judicial standpoint. The examiners found that the memories of the woman's history of childhood abuse had become integrated into her personality organization. The spheres most strongly influenced were those of psycho-sexual/affective maturation and a dysfunctional bond with religion. Psychodiagnostic evaluation diagnosed a Borderline Personality Disorder. The complexity of the case suggests the need of a multi-dimen-sional analysis by an interdisciplinary team including experts in legal medicine, forensic psychiatry and psychology as well as clinical crimi-nology.

A firearm double homicide committed by a paranoid neigh- bor: a psychopathological study.

Abstract: Serious mental illness is associated with a higher risk of violent interpersonal behavior. Characteristic traits denoting a psychopatho-logical picture such as schizophrenia, depression, a borderline, or narcissistic, antisocial, or paranoid personality disorder, are frequently observed in the personality of those who have committed one or more murders. For example, mass murderers are affected by a delusional syndrome with a persecution fixation, that develops in a subject with a paranoid, anacastic personality disorder. An abnormal mental frame-work develops as a consequence of continual experiences interpreted as traumatic. We present a complex case regarding a double murder whose vic-tims were shot by a 50-year-old neighbor, who underwent a psychiatric evaluation for the assessment of criminal responsibility. In the light of the historical reconstruction of his relation sensitive delusional mindset that triggered the final reaction, his life history, the "key event" and the "triggering environment" (constant conflictual and dysfunctional rela-tions with others) led to the violence. The correct understanding of the reported case demands investigation not only of the clinical, diagnostic and psychodiagnostic aspects, but also of the perpetrator-victim/s, their relational context and the situation where the crime evolves, in order to be able to reconstruct the event in a meaningful manner.

A reference database of forensic autosomal and gonosomal STR markers in the Tigray population of Ethiopia.

Allele frequencies of 21 autosomal STR markers (AmpF/STR GlobalFiler) and haplotype frequencies of 27 Y- and 12 X-STR markers (AmpF/STR YFiler Plus and Investigator Argus X-12, respectively) were investigated in the Tigray population of Ethiopia, representing the main population group in the Tigray regional state of Ethiopia and neighboring Eritrea. For autosomal STR allele frequencies, the average random match probability in the Tigray sample was 2.1 × 10-27. The average locus by locus FST distance calculated comparing autosomal STR allele frequencies from Tigray and from a broad regional reference dataset currently available for the Horn of Africa was 0.003. The Tigray male sample displayed high Y-STR diversity, with complete individualization of haplotypes using the AmpF/STR YFiler Plus panel. Analysis of molecular variance did not detect significant heterogeneity between Y-STR haplotypes observed in the present study and those previously reported in the literature for other Tigray population samples from Ethiopia and Eritrea. Study of the X-STR landscape in Tigray evidenced several distinctive features including: the molecular characterization of a novel null allele at locus DXS10146 with frequency > 1%; allele dependency between loci within linkage groups I and III; significant differences in haplotype distribution compared to other Horn of Africa populations, that should be taken into account in kinship analysis. The collected data can be used as a reference STR database by local forensic genetics services and in genetic identification procedures of victims of human trafficking in the Mediterranean Sea, which frequently involve individuals originating from the Horn of Africa.

A para-religious setting for financial exploitation of the mentally incapacitated: when the habit doesn't make a monk.

ABSTRACT: Exploitation and circumvention of the mentally incapacitated is a criminal offence listed in the Italian penal code (Penal Code Art. 643). It involves the exploitation and circumvention of people who are fragile and vulnerable owing to their health conditions and/or mental status, and fits into the grey area between such subjects' freedom to make decisions about their physical conditions and economic assets, and the abuse of their trust perpetrated by third parties for personal gain. The authors describe a case of financial exploitation and circumven-tion of a married couple that is remarkable in view of both the huge sums extorted from the victims and the duration of the peculiar illicit activities (that lasted more than 10 years). These were perpetrated by a charismatic figure leading a "para-religious" group. He claimed to be a prophet, but his private life was highly questionable. The method of ascertainment used to verify the victims' mentally incapacitated state is described, analyzed and commented; the diagnosis could not be deferred in view of the characteristics of the prolonged penal offences committed.

Child abuse and dental neglect: the dental team's role in identification and prevention.

Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases. The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect. Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.

Geometric morphometric analysis of sexual dimorphism in the mandible from panoramic X-ray images.

The human mandible is routinely utilised as part of the assessment of biological identity in forensic anthropological and odontological practice. The research introduces a novel geometric morphometric technique to investigate and quantify shape variation in the morphology of the mandibular corpus and ascending ramus and consequently highlights the potential for forensic purposes. Human mandibles from digital clinical orthopantomogram X-ray images, based on a sample of 50 male and 50 female adults from a modern Italian population, were examined. Three fixed landmarks were applied to the symphysis and condyle and 50 semi-landmarks re-sampled along the inferior corpus and the posterior ramus. Symmetrical reflection was applied yielding 200 configurations of 53 landmarks. Shape analyses were undertaken via: Procrustes superimposition; principal components analysis to investigate patterns of variation; classification using linear discriminant analysis with leave-one-out cross-validation; partial least squares (PLS) to test for structural modularity; and finally, retitle page sampling and re-analysis following PLS to optimize shape classification criteria. Stepwise re-sampling of landmarks reached an optimum cross-validated classification of 94.0% based on 25 landmarks; the results are strongly significant and suggest that the shape relationship between the mandibular corpus and ramus offers significant potential for forensic identification purposes using this method.

Forensic sciences and forensic odontology: issues for dental hygienists and therapists.

The scientific literature contains very little about the role of the dental hygienist/therapist in the specific areas of forensic investigations and collection of evidence. The authors examine how the contribution of a highly qualified dental hygienist can be particularly helpful during human forensic identification operations and non-accidental traumas like domestic violence, child abuse, neglect and bitemarks. Forensic dental identification of human remains is a highly complex multidisciplinary challenge. It requires the involvement of several professionals who are expert in forensic science. Among these, one or more adequately trained dental hygienists could be involved. Dental hygienists/therapists may also be asked to record cutaneous lesions in two different situations. The first may be the dental office where she/he may detect oval, elliptic, or semicircular lesions on the skin of the uncovered neck, shoulder and arms of a patient. The second is the crime scene or the morgue (if one is involved), which may require a visit by the forensic odontologist called by the medical examiner or the coroner to perform an odontological autopsy. The purpose of our study is to highlight procedures that should be followed by the dental hygienist/therapist in collecting forensic information in the above-mentioned scenarios. As a valuable resource, the authors recommend training of dental hygienists in the area of forensic sciences, with particular attention to information technology and photography.

The Tragic Tale of a Father and Son: an Unusual Patricide.

Parricide is a category of homicide in which the victims are the parents, and the killers, their children. The authors report a case of a 45-year-old man who killed his 73-year-old widowed father in an extremely violent manner: he struck the father in the head with a wooden wash board, stabbed him with a pair of scissors and several times with a screwdriver. Afterwards, he kicked the victim in the face and jumped up and down on his body, thereby crushing the father's chest with his weight. The case reported here may be classified as an "unusual patricide" when one considers the age of the aggressor, the diagnosis of psychiatric disorders, that the victim was the father, and that the murder was committed in an extremely violent manner.

Multiple stab wounds: understanding the manner of death through the psychological autopsy.

A 48-year-old physical therapist with no history of psychiatric disorders or suicidal tendencies was found dead by his relatives inside his apartment. Multiple stab wounds were present on the chest and the abdomen. Several more superficial cuts were also seen on the neck and the left wrist. At the death scene, there was a large pool of blood in the room, with secondary droplets and stains; a kitchen knife was found beside the body, and a suicide note on a table. Especially the number of wounds raised strong suspicion of a homicide in the first instance but some circumstances (the farewell letter, the absence of clothing injuries, no signs of third-party involvement) and autopsy findings (absence of defense or blunt injuries, the localization of the wounds, the presence of hesitation marks) pointed toward a suicide etiology. Because of the many stab injuries and the lack of a psychiatric history, further forensic investigations were required including a so-called psychological autopsy. This case report highlights that only a comprehensive interpretation of all the elements (circumstances, the scene of death, autopsy findings, and psychological autopsy) can lead to the correct solution of atypical cases of suicide.

The Body Worlds Exhibits and Juvenile Understandings of Death: Do We Educate Children to Science or to Voyeurism?

Gunther von Hagens' development of plastination as a method for preserving human remains has enabled his public display of skinless, dissected bodies in a series of popular international exhibitions entitled Body Worlds. These spectacular displays claim to be educative, democratizing the study of anatomy and liberating it from the traditional confines of professional medical study. However, Body Worlds has raised various ethical objections to its commercial purpose, sourcing of some bodies and arrangement of bodies in poses or dissections that some viewers find offensive. Here we consider a different, often overlooked ethical conundrum raised by these exhibitions: the likelihood that the viewing of plastinates posed in 'frozen motion' is ill­suited to the psychological development of young children (5-10 years old) whose understanding of death is still in formation. Often young children mistake corpses for models, even for living beings if they are posed in arrested motion. The educative value of Body Worlds for younger viewers is questionable and the display may even interfere with their understanding of death. If the exhibition of human remains can be justified where their authenticity can be made known to viewers and the remains invested by them with sympathetic emotional meaning, it may be pointless if not unethical to show quasi­lifelike posed plastinates to young children in lieu of replica models.

Evaluation of DNA typing as a positive identification method for soft and hard tissues immersed in strong acids.

Identification of human remains can be hindered by several factors (e.g., traumatic mutilation, carbonization or decomposition). Moreover, in some criminal cases, offenders may purposely adopt various expedients to thwart the victim's identification, including the dissolution of body tissues by the use of corrosive reagents, as repeatedly reported in the past for Mafia-related murders. By means of an animal model, namely porcine samples, we evaluated standard DNA typing as a method for identifying soft (muscle) and hard (bone and teeth) tissues immersed in strong acids (hydrochloric, nitric and sulfuric acid) or in mixtures of acids (aqua regia). Samples were tested at different time intervals, ranging between 2 and 6h (soft tissues) and 2-28 days (hard tissues). It was shown that, in every type of acid, complete degradation of the DNA extracted from soft tissues preceded tissue dissolution and could be observed within 4h of immersion. Conversely, high molecular weight DNA amenable to STR analysis could be isolated from hard tissues as long as cortical bone fragments were still present (28 days for sulfuric acid, 7 days for nitric acid, 2 days for hydrochloric acid and aqua regia), or the integrity of the dental pulp chamber was preserved (7 days, in sulfuric acid only). The results indicate that DNA profiling of acid-treated body parts (in particular, cortical bone) is still feasible at advanced stages of corrosion, even when the morphological methods used in forensic anthropology and odontology can no longer be applied for identification purposes.

[Parricide, abuse and emotional processes: a review starting from some paradigmatic cases]. / Parricidio, abusi e processi emozionali: una rassegna partendo da alcuni casi paradigmatici.

The authors of this study tackle the complex subject of parricide, which is a rare and often brutal form of homicide. Parricide has a high emotional impact on public opinion and on our collective imagination, especially in light of the fact that the perpetrators are often minors.. Three striking cases of parricide, taken from various documented sources and judicial files from the "N. Fornelli" Juvenile Penal Institute (Bari, Italy), are presented here. A review of the literature on the topic has revealed differences between parricides committed by adults and those committed by minors. In the end, the complex issues underlying such an unusual crime are connected to abuses and maltreatment that minor perpetrators of parricide have suffered, especially the emotional processes that are activated.

Sex determination by discriminant analysis of patella measurements.

The authors have analyzed 80 skeletons (40 males and 40 females) from the collection at the Institute of Legal Medicine of the University of Bari belonging to a known contemporary Southern Italian population; time of death was around 1970 and ages ranged from 25 to 80 years. Seven measurements taken on 80 intact, undeformed right patellae (max height, max width, thickness, height and width of the external facies articularis, height and width of the internal facies articularis) were used to determine sex by multivariate discriminant analysis. One function associating two parameters (max width and thickness) obtained the highest value of correct sex determination with a rate of 83.3%; other functions showed a higher percentage of misclassification (up to 17.5%). This study tests the success rate of correct sex prediction based exclusively on patellar dimensions. The discriminant factors carried out by statistical analysis may aid the forensic anthropologist when no other human skeletal remains suitable for sex determination are available.

Factors affecting decomposition and Diptera colonization.

Understanding the process of corpse decomposition is basic to establishing the postmortem interval (PMI) in any death investigation even using insect evidence. The sequence of postmortem changes in soft tissues usually gives an idea of how long an individual has been dead. However, modification of the decomposition process can considerably alter the estimate of the time of death. A body after death is sometimes subject to depredation by various types of animals among which insects can have a predominant role in the breakdown of the corpse thus, accelerating the decomposition rate. The interference of the insect community in the decomposition process has been investigated by several experimental studies using animal models and very few contributions directly on cadavers. Several of the most frequent factors affecting PMI estimates such as temperature, burial depth and access of the body to insects are fully reviewed. On account of their activity and world wide distribution, Diptera are the insects of greatest forensic interest. The knowledge of factors inhibiting or favouring colonization and Diptera development is a necessary pre-requisite for estimating the PMI using entomological data.

Seatbelt injury to the common iliac artery: case report.

In traffic accident victims, the seat belt syndrome is a well known injury which rarely involves the common iliac artery due to its posterior anatomical position and to protection by the pelvis. We report a case of blunt abdominal trauma related to the type of seat belt worn. The trauma provoked subintimal haemorrhaging of the left common iliac artery, without skeletal lesions or other visceral injuries. Correct diagnosis was delayed for three months after the crash, when an angiogram was performed to investigate disabling claudication and vascular pulse change in the left leg. This arterial injury could have been related to the association of two different types of force created during the crash ("compression/deceleration-type mechanism") that might have produced shearing forces causing a vascular wall discontinuity and/or an intimal flap. The authors speculate that the vascular lesion was observed on the same (left) side as the fastening point of the seat belt (a lap-and-shoulder belt with a three-point attachment) where the shearing forces may have been most intense due to the junction between the lap strap and the diagonal shoulder belt.

Determination of postmortem interval from old skeletal remains by image analysis of luminol test results.

The luminol test is routinely used in forensic serology to locate blood traces and identify blood stains not visible to the naked eye; its sensitivity is reported as ranging from 1:100,000 to 1:5,000,000. To evaluate the possibility of correlating the postmortem interval with blood remnants in bone tissue, the luminol test was performed on 80 femurs with a known time of death, grouped in five classes. Powdered bone (30 mg) was recovered from compact tissue of the mid-shaft of each femur and was treated with 0.1 mL of Luminol solution (Sirchie Finger Print Laboratories, Inc.). The reactions were observed in a dark room and filmed by a TV camera equipped with a recording tape. An intense chemiluminescence was observed after a few seconds in all 20 femurs with a PMI ranging from 1 month to 3 years. On the 20 femurs with a PMI ranging from 10-15 years, a clear chemiluminescence was visible with the naked eye in 80% of the sample. Among the 20 femurs with a PMI ranging from 25 to 35 years, a weaker chemiluminescence appeared in 7 femurs (33% of the sample). In the 10 femurs with a PMI ranging from 50 to 60 years, a faint reaction was observed only in a single femur. In none of the ten femurs with a PMI over 80 years was chemiluminescence observed. The image of each reaction was computerized and analyzed for gray scale. The results of image analysis show a possible quantitative relationship between the PMI and luminol chemiluminescence in powdered bone.

Sex determination by discriminant analysis of calcanei measurements.

Eight measurements taken on the right calcaneus (maximum length, load arm width, minimum width, height of calcaneus, body height, breadth of the facies articularis talaris posterior, breadth and height of the facies articularis cuboidea) of a known contemporary Southern Italian skeletal population (40 males and 40 females) were used to determine sex by multivariate discriminant analysis. Three functions revealed a correct sex-determination of 85%. These functions were obtained by the association of the following parameters: maximum length, load arm width and breadth of the facies art. talaris post. (function no. 1); maximum length and breadth of the facies art. talaris post. (function no. 2); maximum length and height of the facies art. cuboidea and breadth of the facies art. cuboidea (function no. 3). These results may aid the forensic anthropologist when no other remains, useful for skeletal sex determination, are available.

Human and insect mitochondrial DNA analysis from maggots.

During the course of our forensic investigations, we have encountered situations where it would have been useful to have evidence, other than direct contact between the two, for concluding that a carrion-fly maggot developed on a particular human victim. If a maggot collected during a death investigation did not develop on the victim, then its age is not relevant to estimating the postmortem interval. In this study we demonstrate that mitochondrial DNA (mtDNA) sequence data can be obtained from the dissected gut of a maggot that had fed on human tissue. These data can be used to identify both the human corpse upon which the maggot had been feeding and the species of the maggot itself.