Survival in Mudejar Spain in the Middle Ages (thirteenth-fourteenth centuries): Ancient Rare Diseases-an uncommon diagnosis in archaeological human remains.

PURPOSE: The finding of severe skeletal alterations in ancient remains could give us useful information not only about the pathologies of the individual per se, as it could infer the state of health of a population. METHODS: From the findings of the Mudéjar Cemetery of Uceda (Guadalajara, Central Spain) where a total of 116 burials with almost complete skeleton were recovered, an interesting individual is presented (palaeopathological perspective). The individual 114UC corresponds to a male of 20-25 years old and its age goes back to the thirteenth-fourteenth centuries. RESULTS: The first inspection showed the presence of serious alterations especially in the lumbar spine and pelvic girdle. Seven vertebrae (from T11 to L5) showed an unusual posterior fusion only in the postzygapophyseal joints. The pelvis, after being accurately assembled and congruence verified by X-ray and CT scan, showed a noticeable asymmetry of both iliac wings together with a coxa magna protusa (Otto's pelvis), severe anteversion of both cup hips and osteochondritis of the right femoral head. The posterior-slope of both tibias reached about 10°. CONCLUSIONS: The differential diagnoses lead us to think of Arthrogryposis Multiplex Congenita as the most probable diagnosis. We analyzed the same biomechanical aspects after taking into account some patterns that give us information about a possible mobility in the first stage of life. We discuss the very few other cases described both from artworks and in the palaeopathological record. To our knowledge, this case could be the oldest published case of AMC worldwide.

Quality analysis of the completion of death certificates in Madrid.

The Death Certificate (DC) is an important medical-legal. However, despite its importance, the professionals involved are not well trained and consequently there exist many errors in completion. This situation can cause misclassification in mortality statistics, but also it means that many natural deaths end up being studied by the medical examiner, entailing a waste of resources. An analysis of 1974 DCs in Madrid is carried out to assess the quality of the completion, discover the main errors in the certificates and analyse possible improvement strategies. The study highlights that the demographic and personal information about the deceased is mostly correct; in 16,2 % of the cases the official document was not used; 91 % of the DCs in the sample have a certain degree of error (major or minor); and 38,4 % of the documents chain of causes were incorrect. The main measure proposed is increased training for certifiers, which should begin with activities at undergraduate level and continue later with periodic training workshops. In addition, we consider it essential to digitalise DCs in Spain. This would greatly facilitate completion. It is also proposed that medical examiners use, in Spain, a document similar to the official DC so that the statistics of violent and natural deaths which have required the medical examiners' intervention will improve.

A Case of Acute Plastic Deformation of the Forearm in a Medieval Hispano-Mudejar Skeleton (13-14th Centuries AD).

INTRODUCTION: Acute plastic deformation refers to a traumatic bending or bowing without a detectable cortical defect. CASE PRESENTATION AND DISCUSSION: We describe a rare case from an individual that was exhumed from the Hispano-Mudejar necropolis in Uceda (Guadalajara, Spain) dated between the 13th and 14th centuries AD. The case corresponds to an adult woman, with a bowing involvement of the left ulna and radius. After making the differential diagnosis with various pathologies likely to present with this alteration, we reached the diagnosis of acute plastic deformation of the forearm through external and radiological examination and comparison with the healthy contralateral forearm. CONCLUSIONS: Acute plastic deformation is a rare traumatic injury, not described until the last century and only rarely described in palaeopathological contexts. We contribute a new case, the first being sufficiently documented, contributing to the knowledge and diagnosis of this type of trauma in the ancient bone, while deepening the knowledge of the living conditions of the medieval Mudejar population of Uceda.

The supracondylar process in the skeletal remains of a full-term fetus from Central Spain (V-VII century BC).

A rare case in the remains of a full-term fetus was recovered from the archaeological site 'Arriaca-Zaide' (Guadalajara, Spain) that dates to the century V-VII BC. The right humerus presents an osseous tubercle, fractured at its end that extends obliquely forward and medially, from the anteromedial aspect of the lower third of the humerus. It is a supracondylar process, a rare osseous anatomic variation. The presence of the supracondylar process in the fetal period allowed us to propose its congenital nature. Furthermore, its disposition and state of ossification allowed us to suggest that it was formed from the ossification center of the humeral diaphysis and not from a secondary ossification center. This case represents the first time that the supracondylar process during the fetal period has been described in the anthropological physical literature.

Judicial consequences in Spain for the completion of the medical death certificate.

The completion of the death certificate is indispensable in Spain for a death to be recorded in the civil registry. Occasionally, doctors may be reluctant to sign a death certificate due to possible legal consequences. This study seeks to analyse the possible judicial consequences doctors may face upon filling out this medico-legal document. Sentences published on the Judicial Power's website between 2009 and 2019 containing the term "death certificate" were analysed. From a total of 2100 sentences examined, only 15 were found to contain the term "death certificate" as part of the claim. In only 7 of these cases the claim was made against the physician, and in 5 the physician was found guilty. Three of them concluded falsity via criminal proceedings, one via administrative proceedings for refusing to sign the certificate and one through civil proceedings for filling out an erroneous antecedent cause of death. In view of the above, it can be inferred that the completion of the death certificate poses few judicial consequences for physicians. In addition, this study reveals the importance of the death certificate document as evidence in judicial proceedings.

A meta-analytic review for the patella sexual dimorphism assessment / Una revisión meta-analítica para la evaluación del dimorfismo sexual de la patela

Sexual dimorphism is one of the most important ways to identify bone remains in mass disasters. Many of them have been used for this purpose; mainly skull, pelvis and long bones. However, only a few studies using the patella have been done and, to our knowledge, there are no assessments of previous results in the literature. Meta-analysis provides a useful strong tool to test, in a systematic way, the most relevant information about a given research field. The aim of this study is to apply the meta-analytic technique to assess the major studies concerning sexual dimorphism in the patella by measuring classical metric traits: maximum height and maximum width, with different techniques, such as caliper, radiography, tomography and magnetic resonance. The 17 papers found, involving a total sample size higher than 2600 patellae, showed a very high heterogeneity- around 93 % of I2 value, for height and width measurements when all the studies were analyzed together. Homogeneity increased when each study was classified according to the techniques used. In this case, a statistical difference appeared, among the several subgroups of techniques for the two measurements, suggesting the importance of the methodology used. Maximum height and maximum width were all showed to be statistically relevant in distinguishing both sexes.

El dimorfismo sexual es una de las formas más importantes para identificar restos óseos en desastres masivos. Se han utilizado huesos como cráneo, pelvis y huesos largos para la diferenciación sexual. Sin embargo, solo se han realizado unos pocos estudios con la patela y, hasta donde sabemos, no hay evaluaciones de resultados anteriores en la literatura. El meta-análisis proporciona una herramienta sólida y útil para probar, de manera sistemática, la información más relevante sobre un cierto campo de investigación. El objetivo de este estudio consiste en aplicar la técnica metaanalítica para evaluar los principales estudios sobre dimorfismo sexual en la patela midiendo los rasgos métricos clásicos: altura máxima y anchura máxima, con diferentes técnicas: calibre, radiografía, tomografía y resonancia magnética. Los 17 de documentos encontrados, con un tamaño de muestra total superior a 2600 patelas, mostraron una heterogeneidad muy alta, alrededor del 93 % del valor de I2, para mediciones de altura y anchura cuando todos los estudios se analizaron juntos. La homogeneidad aumentó cuando cada estudio se clasificó de acuerdo con las técnicas utilizadas. En este caso, se observó diferencias estadísticas, entre los subgrupos de técnicas para las dos mediciones, lo que sugiere la importancia de la metodología utilizada. La altura máxima y la anchura máxima mostraron ser estadísticamente relevantes para distinguir ambos sexos.

Un caso de muerte súbita por estenosis aórtica subvalvular / Subvalvular aortic stenosis and sudden death. Presentation of a case

La estenosis subaórtica, aunque patología infrecuente, es susceptible de cursar con muerte súbita por un mecanismo arritmogénico. Si bien su etiología no está aún aclarada, dado el presumible componente genético subyacente, el examen autópsico se convierte en instrumento esencial para el diagnóstico posmortem y trasmitir el pertinente consejo médico a los familiares. Se presenta el estudio médico forense de una mujer de 39 años, que fallece de forma súbita a causa de esta etiología, se discuten los principales hallazgos y los antecedentes familiares conocidos

Subaortic stenosis, although an infrequent pathology, is prone to cause a sudden death through an arrhythmogenic mechanism. Although its aetiology is still unclear, and given an assumed underlying genetic component, the autopsy becomes an essential tool for post-mortem diagnosis of the disease and to give relevant medical advice to family members. A case of sudden death of a 39 year-old woman involving this aetiology is presented, and the medico-legal findings, as well as a discussion on the known family's medical background

[Comparative normative on sanitary practices of cadaveric preservation in Spain]. / Normativa comparada sobre prácticas sanitarias de conservación cadavérica en Españ.

In this paper the current regulations on cadaveric preservation practices required for the transfer of corpses in the different Autonomous Communities -Reglamentos de Policía Sanitaria Mortuoria- and national legislation are compared. The criteria taken into account have been: a) which sanitary practices are included in the regulations, b) which ones can be carried out in corpses posing a health risk, c) when they are compulsory to be carried out, d) when they can be carried out after death, and e) what professionals can carry them out and/or take responsibility for them. At the time of finishing the paper, a new mortuary regulation is being passed in Andalusia, as well as a decree from the Ministry of Health on technical and sanitary requirements concerning international transfer of corpses and human remains.

Se comparan las normativas vigentes sobre prácticas sanitarias de conservación cadavérica requeridas para el traslado de cadáveres, en las diferentes Comunidades autónomas y la legislación estatal. Los criterios tenidos en cuenta han sido: qué prácticas sanitarias se incluyen en la normativa, cuáles pueden llevarse a cabo en cadáveres de riesgo sanitario, cuándo se requiere su realización, en qué momento tras el fallecimiento pueden realizarse y qué profesionales las pueden llevarlas a cabo y/o responsabilizarse de las mismas. En el momento de finalizar el artículo se está tramitando la publicación del nuevo decreto de sanidad mortuoria de Andalucía, así mismo se está elaborando, por parte del Ministerio de Sanidad, Consumo y Bienestar Social, un Real Decreto sobre "Condiciones técnico sanitarias básicas en materia de traslado internacional de cadáveres, restos humanos y restos cadavéricos".

Normativa comparada sobre prácticas sanitarias de conservación cadavérica en España / Comparative normative on sanitary practices of cadaveric preservation in Spain

Se comparan las normativas vigentes sobre prácticas sanitarias de conservación cadavérica requeridas para el traslado de cadáveres, en las diferentes Comunidades autónomas y la legislación estatal. Los criterios tenidos en cuenta han sido: qué prácticas sanitarias se incluyen en la normativa, cuáles pueden llevarse a cabo en cadáveres de riesgo sanitario, cuándo se requiere su realización, en qué momento tras el fallecimiento pueden realizarse y qué profesionales las pueden llevarlas a cabo y/o responsabilizarse de las mismas. En el momento de finalizar el artículo se está tramitando la publicación del nuevo decreto de sanidad mortuoria de Andalucía, así mismo se está elaborando, por parte del Ministerio de Sanidad, Consumo y Bienestar Social, un Real Decreto sobre "Condiciones técnico sanitarias básicas en materia de traslado internacional de cadáveres, restos humanos y restos cadavéricos"

In this paper the current regulations on cadaveric preservation practices required for the transfer of corpses in the different Autonomous Communities -Reglamentos de Policía Sanitaria Mortuoria- and national legislation are compared. The criteria taken into account have been: a) which sanitary practices are included in the regulations, b) which ones can be carried out in corpses posing a health risk, c) when they are compulsory to be carried out, d) when they can be carried out after death, and e) what professionals can carry them out and/or take responsibility for them. At the time of finishing the paper, a new mortuary regulation is being passed in Andalusia, as well as a decree from the Ministry of Health on technical and sanitary requirements concerning international transfer of corpses and human remains

Utilidad de los actuales sistemas de escáner intraoral en la identificación forense / Utility of current intraoral scanner systems for forensic identification

No disponible

El listado de verificación como herramienta para la realización de informes periciales a particulares en las reclamaciones por hechos relativos a los accidentes de tráfico / The checklist as a tool for drawing up expert reports issued to individuals concerning road traffic accident claims

No disponible

Muertes por arma de fuego y disparo intraoral: etiología medicolegal / Deaths by firearm and intraoral gunshot: medicolegal etiology

El estudio de las muertes por arma de fuego, en sus distintas etiologías, forma parte de la práctica habitual medicoforense. En aquellas de origen suicida, la boca constituye un lugar preferente para el disparo, de forma contraria a los supuestos homicidas o accidentales. En el presente trabajo se revisan distintas variables de utilidad para la determinación medicoforense de la etiología, con especial referencia a los disparos intraorales. Entre ellas se analizan el lugar del suceso, tipo de arma empleada, el número y localización de las heridas, el trayecto seguido por el proyectil y las lesiones ocasionadas, siendo de especial interés la forma en que resultan afectados los labios, los dientes y la lengua. Para lo cual se ha realizado una búsqueda, incluyendo las bases de datos bibliográficas PubMed, Dialnet y Google Académico (AU)

Investigation of deaths caused by the use of firearms, with their different homicidal, suicidal and accidental etiologies, is part of the medical-forensic expert's regular work. Mouth is usually chosen by the suicide using a gun. However, gunshot rarely occurs -or it is an exception, in homicidal or accidental deaths. In this paper we shall review the different variables which are useful in order to discriminate the different etiologies, such as the scene, the kind of weapon used, the number of injuries sustained and their location, or the direction of the bullet. Also, we shall particularly focus on the types of injuries caused. The way that lips, teeth and tongue are affected is of particular interest in this investigation. For this purpose, we have conducted a research in books and medical articles, including the PubMed, Dialnet y Academic Google bibliographic database (AU)

El rito de la «Apertura de la Boca» en el Antiguo Egipto: estudio bucodental de una cabeza egipcia momificada / The Ritual of «Opening of the Mouth» in Ancient Egypt: study on a mummified egyptian head

La momificación o embalsamamiento es un proceso que se desarrolló en el Antiguo Egipto para conservar el cuerpo tras la muerte, y preservar así la identidad del individuo en la vida futura, de acuerdo con sus costumbres funerarias. El rito de la «Apertura de la Boca y los Ojos», formaba parte de los ritos funerarios y pretendía devolver al difunto la capacidad de hablar y de observar en el más allá. Se realizaba sobre el cadáver previamente a su embalsamamiento, o bien se «representaba» ante la momia ya embalsamada o una estatua de la misma. Se presenta el caso de un cráneo humano momificado del Museo de Antropología Forense, Paleopatología y Criminalística de la Escuela de Medicina Legal de Madrid. Presenta protrusión lingual y fracturas en los dientes del grupo anterosuperior (AU)

Mummification or embalming is a process which was developed in Ancient Egypt in order to preserve the body after death, and thereby to maintain the individual's identity in the afterlife, in accordance with Ancient Egyptian funerary customs. The ritual of Opening the Mouth and Eyes formed part of the funerary rituals and constituted an attempt to restore the ability of the deceased to speak and see in the life beyond. It was performed on the corpse prior to embalming, or it was «performed» in front of the mummy after embalming or a statue of the mummy. We present the case of a mummified human cranium from the Forensic Anthropology, Paleopathology and Criminal Studies Museum at the Legal Medicine School of Madrid. It displays a protruding tongue and fractures on the teeth in the anterosuperior group (AU)

El médico ante los tribunales: análisis de las sentencias judiciales relacionadas con la responsabilidad profesional médica en España / Doctors before the courts: Analysis of court rulings related to medical professional liability in Spain

INTRODUCCIÓN: Existen pocos datos objetivos referentes al número de reclamaciones legales contra médicos, de su distribución por especialidades o de sus consecuencias (porcentaje de condenas o cuantía de las indemnizaciones). MATERIAL Y MÉTODO: Se han analizado todas las sentencias presentes en las bases de datos jurídicas (CENDOJ y Westlaw-Aranzadi) hasta el año 2010. Se seleccionaron 2.817 referidas a praxis médica y que contuviesen datos completos. RESULTADOS: La mayoría de las sentencias, el 65,2% (1.837) se dictaron en el período 2001-2010, procediendo la mayoría de la jurisdicción civil (85%). Las especialidades más reclamadas judicialmente fueron ginecología y obstetricia (13,5%), cirugía ortopédica y traumatología (12,3%), urgencias (9,7%), cirugía y medicina estética (8,1%) y enfermedades infecciosas (6%). El 46% de las sentencias apreciaron algún tipo de mala praxis por parte del médico, y la cuantía media de las indemnizaciones fue de 83.457,5 €. CONCLUSIONES: El número de sentencias motivadas por reclamaciones de mala praxis médica ha aumentado progresivamente durante el período contemplado. Las especialidades médicas más reclamadas fueron ginecología y obstetricia, y cirugía ortopédica y traumatología. Estos datos coinciden con la gran mayoría de las series similares disponibles. El porcentaje de sentencias que aprecia algún tipo de mala praxis médica (46%) es más alto que en otras series, y la cuantía media en las indemnizaciones es 2 veces y media menor que en las series de referencia norteamericanas (AU)

BACKGROUND: There are few objective data on the number of legal claims against doctors, their distribution by specialty, or their consequences (conviction rate or amount of compensation). MATERIAL AND METHOD: We analyzed all rulings present in legal databases (CENDOJ and Westlaw-Aranzadi) until 2010. The 2.817 were selected regarding medical practice and that would contain complete data.ResultsMost of sentences 65.2% (1.837) were issued in the period 2001-2010, mostly originating from civil jurisdiction (85%). The most court claimed specialties were obstetrics and gynecology (13.5%), orthopedic surgery and traumatology (12.3%), emergency department (9.7%), surgery and aesthetic medicine (8.1%), and infectious diseases (6%). The 46% of the judgments noted some kind of malpractice by the physician, and the average amount of compensation was € 83457.5. CONCLUSIONS: The number of judgments caused by medical malpractice claims has increased steadily during the period covered. The most claimed medical specialties were obstetrics and gynecology and orthopedic surgery. These data are consistent with the majority of similar series available. The percentage of sentences where some sort of medical malpractice is noted (46%) is higher than in other series, and the average amount of compensation was two and 2.5 times lower than in the American reference series (AU)

Determining sex by bone volume from 3D images: discriminating analysis of the tali and radii in a contemporary Spanish reference collection.

The discriminant power of bone volume for determining sex has not been possible to determine due to the difficulty in its calculation. At present, new advancements based on 3D technology make it possible to reproduce the bone digitally and calculate its volume using computerized tools, which opens up a new window to ascertaining the discriminant power of this variable. With this objective in mind, the tali and radii of 101 individuals (48 males and 53 females) of a contemporary Spanish reference collection (twentieth century) (EML 1) were scanned using the Picza 3D Laser Scanner. Calculated for the tali were total volume, the volume of the posterior region, which includes the posterior calcaneal facet and other three volumes of the anterior region. Calculated for the radius were total volume, volume of the radius head, volume of the diaphysis, and volume of the distal end. The data are presented for all of the variables, distinguishing between the right and left side. The data were processed using the statistical program PASW Statistics 18, thereby obtaining classification functions for sex which accurately classify 90.9 % of tali and 93.9 % of radii on the basis of their total left and right volume, respectively. Studying the volume in different regions of the bone shows that the diaphysis of the right radius possesses a high level of discriminant power, offering classification functions which accurately classify 96.9 % of the sample. The validation test performed on a sample of 20 individuals from another contemporary Spanish reference collection (EML 2) confirms the high discriminant power of the volume obtaining an accurate classification rate of 80-95 % depending on the variable studied.