Pro-active drug-facilitated crimes (DFC): a study in the Department of Forensic Medicine of Paris, France.

INTRODUCTION: Proactive drug facilitated crime (DFC) is the administration of psychoactive substances (PAS) for criminal purposes without the victim's knowledge or by force. In Paris, France, patients who report suspected proactive DFC to the police are examined at the Department of Forensic Medicine (DFM) of the Hôtel-Dieu Hospital. Preventively blood and urine samples are collected but not systematically analyzed by the judicial authority. We aimed to assess the proportion of probable proactive DFC in patients examined at the Hôtel-Dieu DFM following a police report for suspected proactive DFC. METHOD: Blood and urine samples were collected from 100 patients. Toxicological analyses were performed by the toxicology laboratory of the Lariboisière Hospital. The results were correlated with the clinical data collected at the initial and follow-up consultations. RESULTS: At least one PAS was detected in 86% of the cases (voluntary or involuntary intake). After correlation with clinical data, 32% of the cases were classified as probable proactive DFC. In these cases, 49% of the substances identified were illicit substances (amphetamines, MDMA, etc.); 16% were benzodiazepines and related substances; 16% were antihistamines and sedatives; 14% were opioids; and 5% were antidepressants and anti-epileptics. In 90% of the cases, patients reported a voluntary ethanol consumption in the hours prior to the suspected proactive DFC. CONCLUSION: Toxicological analyses revealed a high proportion of both probable proactive DFC and probable opportunistic DFC. Our results indicate the need to perform systematical toxicological analysis in cases of suspected DFC.

Prevalence, consequences of female genital mutilation among asylum seekers in Ile-de-France and socio-demographic characteristics / Prévalence, conséquences des mutilations sexuelles féminines chez les demandeuses d'asile en Île-de-France et caractéristiques sociodémographiques

Introduction: Female Genital Mutilation (FGM) is an intervention on the female genital organs for non-medical reasons. In France, asylum is possible for girls at risk of FGM in their country of origin. The procedure includes a forensic examination of the child. Purpose of research: To describe the prevalence of FGM and the sociodemographic characteristics of girls and their mothers examined at the Department of Forensic Medicine of Paris. Results: Between 2018 and 2021, 2422 family interviews were conducted. The mothers were mainly from Côte d'Ivoire, Mali, and Guinea Conakry. A FGM was found in 84.4% of the 1838 women examined, mostly of type IIb. The mothers reported immediate complications (21.2%: hemorrhage, pain) and long-term complications (31.8%: sexual disorders, obstetrical complications) due to these FGM. The families often included several children, and 3307 girls were examined. They were mostly born in France (72.0%). An FGM was identified in 61 of these girls (1.8%, mostly type IIb); it was already known by the family in half of the cases. Three of these girls were born in Europe. Conclusions: FGM is a public health problem on a global scale, but also in France due to migratory pathways. This descriptive study carried out an initial medical assessment of FSM in female asylum seekers examined at the Department of Forensic Medicine of Paris, and difficulties in the diagnosis of FSM. Other studies are useful to corroborate and compare our results.

Introduction: Une Mutilation Sexuelle Féminine (MSF) est une intervention sur les organes génitaux sans justification médicale. En France, un octroi d'asile est possible pour les mineures à risque de MSF dans leur pays d'origine. La procédure prévoit un examen médico-légal de l'enfant. But de l'étude: Décrire la prévalence des MSF et les caractéristiques sociodémographiques des mineures et de leurs mères examinées à l'UMJ de l'Hôtel-Dieu à Paris. Résultats: Entre 2018 et 2021, 2 422 entretiens de famille ont été réalisés. Les mères étaient majoritairement originaires de Côte d'Ivoire, du Mali et de la Guinée Conakry. Des MSF ont été mises en évidence chez 84,4 % des 1 838 femmes examinées, majoritairement de type IIb. Les mères rapportaient des complications immédiates (21,2 % : hémorragie, douleurs) et à long terme (31,8 % : troubles sexuels, complications obstétricales). Les familles comportaient souvent plusieurs enfants, 3 307 mineures ont été examinées. Elles étaient majoritairement nées en France (72 %). Une MSF a été objectivée chez 61 d'entre elles (1,8 %, majoritairement de type IIb) ; elle était déjà connue de la famille dans la moitié des cas. Trois de ces mineures étaient nées en Europe. Conclusions: Les MSF sont un problème de santé publique à l'échelle mondiale mais également en France du fait des parcours migratoires. Cette étude descriptive a permis de réaliser un premier état des lieux médical des MSF chez les demandeuses d'asile reçues à l'UMJ Hôtel-Dieu de Paris, et des difficultés au diagnostic de MSF. D'autres études seraient utiles pour corroborer et comparer nos résultats.

Male Victims of Rape: An Observational Study over Four Years in Paris, France.

Sexual violence is a common and under-reported form of violence that affects all categories of individuals. We sought to provide epidemiological data on men aged 15 years and over, victims of rape or suspecting a rape, and who reported it to the police. We conducted a retrospective study at the Department of Forensic Medicine of Hôtel-Dieu, Paris, France, between 2018 and 2021. Two-hundred men were included in the study, with an average age of 28.8 years. A vulnerability was mentioned for 17.5% of them. Most of the patients reported anal penetration, committed by a single male assailant, whom they met on the day of the assault. More than 60% of the patients reported the voluntary consumption of alcohol and/or illicit substances prior to the assault. Most patients were examined shortly after the assault (median 1 day). Anal lesions were found on examination in 37.0% of patients reporting anal penetration regardless of the time frame. The presence of anal lesions was statistically higher when patients were examined within 48 h. Our results reinforce the data in the literature on the risk factors associated with sexual violence among men, notably the consumption of alcohol and illicit substances, and psychological, economic, and social vulnerability.

[Population of people placed in police custody, hidden barometer of diverted medicines]. / La population des personnes placées en garde à vue à Paris, baromètre du détournement invisible des médicaments.

PURPOSE OF THE STUDY: The population of people in police custody is a sentinel niche that is poorly represented in the "usual panels" of public health studies. The aim is to make an overview of their diversion of drugs. PATIENTS AND METHODS: A retrospective study based on cases of misuse in a sample of people in custody examined between 2015 and 2016 at the forensic medicine unit of the hospital Hôtel-Dieu-Paris. RESULTS: Of the 5149 medical examinations, 302 were for substance use disorder or drug misuse. In 2016, the number of notifications for misuse of clonazepam increased (n=65); the user population appears to be getting younger (average age=23.5 years) and to be supplied mainly by deal (63%). Regarding opioid substitution treatments, the indicators of abuse and diversion are confirmed, while morphine sulfate stands out with a strong deal (>75%), IV injection (62%) and polydrug use, including methadone, cocaine (62%). CONCLUSION: From our results, national surveys in general population and studies carried out in the context of deprivation of liberty, people in police custody constitute a real barometer of the parallel market for street drugs. Clinical impacts can be major; a better monitoring is needed. For caregivers, it is also a matter of better identification of misuse, substance use disorder for a future orientation of the patient.

An overview of forensic operations performed following the terrorist attacks on November 13, 2015, in Paris.

On the evening of November 13, 2015, the city of Paris and its surroundings was hit by a series of attacks committed by terrorist groups, using firearms and explosives. The final toll was 140 people deceased (130 victims and 10 terrorists or their relatives) and more than 413 injured, making these attacks the worst mass killings ever recorded in Paris in peacetime. This article presents the forensic operations carried out at the Medicolegal Institute of Paris (MLIP) following these attacks. A total of 68 autopsies of bodies or body fragments and 83 external examinations were performed within 7 days, and the overall forensic operations (including formal identification of the latest victims) were completed 10 days after the attacks. Over this period, 156 body presentations (some bodies were presented several times) were provided to families or relatives. Regarding the 130 civilian casualties, 129 died from firearm wounds and one died from blast injuries after an explosion. Of the 10 terrorists or their relatives who were killed, eight died from suicide bombing, one was shot by police and one died from crush injuries due to partial collapse of a building following the police raid against a terrorist's hideout after the attacks. All mass shootings were perpetrated with AK-47 or Zastava M70 assault rifles using 7.62 mm × 39 mm cartridges. In the case of ballistic injuries, death was most often obviously caused by craniocerebral injuries, extensive organ lacerations and/or massive haemorrhage. Among the terrorists killed by bombing, the lesion patterns were body transection, multiple amputations, extreme organ lacerations and the presence of foreign bodies owing to the shrapnel load (steel nuts, glass fragments) or the explosive charge fastening system of the devices. This discussion highlights the particular difficulties of interpretation encountered within the framework of ballistic injuries, a conclusion that should lead to a modest and realistic approach in these exceptional situations where forensic operations involve a very large number of victims in a constrained time.

The contribution of Micro-CT to the evaluation of trabecular bone at the posterior part of the auricular surface in men.

AIM: Using multi-slice computed tomography (MSCT), Barrier et al. described the disappearance at the posterior auricular surface of a "central line" (CL) and "juxtalinear cells" (JLCs) belonging to a trabecular bundle, and a trabecular density gradient around the CL that decreased with age. The aim of our study was to use micro-CT to test these findings, referring to the concept of Ascadi and Nemeskeri. METHODOLOGY: The coxal bones of fifteen males were used; age was known. CLs were identified on MSCT-sections using Barrier's method (64 detectors, 0.6 mm slice thickness, 0.1 mm overlap) with two different software programs (Synapse®, Amira®). Then, CLs were researched on microCT slices (pixel size: 36 µm). Three volumes of interest were defined (around, above, and below CL), and 3D morphometric parameters of the trabecular microarchitecture (particularly BV/TV and DA) were calculated. Two-tailed statistical analyses were performed attempting to correlate these parameters with age at death. RESULTS: CLs and JLCs were observed on micro-CT slices, but with moderate agreement between both imaging techniques. Their presence was not correlated with the age of the subjects. Around the CL, BV/TV decreased significantly with age; DA was negatively correlated with BV/TV and had a tendency to increase with age. Between areas above and below the CL, there was a BV/TV gradient and both BV/TVs decreased in parallel with age. CONCLUSION: Our findings regarding the contribution of micro-CT to the evaluation of trabecular bone could be a promising research approach for application in a larger study population.