Valoración de las lesiones físicas en 702 casos de violencia sexual en la provincia de Alicante (2016-2020) / Analysis of injuries in 702 cases of sexual assault in Alicante (Spain) during the years (2016-2020)

Introducción: el objetivo principal de este trabajo es analizar las características de las víctimas y circunstancias de la violencia sexual asociadas con un mayor riesgo de presentar lesiones físicas, así como determinar la frecuencia y severidad de las mismas. Material y Métodos estudio descriptivo retrospectivo de 702 casos de violencia sexual atendidos en el Instituto de Medicina Legal y Ciencias Forenses de Alicante entre 2016 y 2020. Se ha realizado un estudio comparativo entre las víctimas de violencia sexual con lesiones físicas y sin lesiones, para analizar las variables asociadas que pueden influir en su presentación. Resultados del total de 702 víctimas de violencia sexual, 314 casos (44,8%) presentaban lesiones físicas. Las víctimas con lesiones físicas la mayoría eran mujeres (95,5%), entre 18 y 27 años (31,3%), que referían un consumo voluntario previo de sustancias, fundamentalmente de alcohol (50%). Las lesiones físicas más frecuentes fueron a nivel extragenital (38,6%), seguidas de lesiones a nivel anogenital (15%), de carácter leve en la mayoría de los casos (97,5%). Los días totales de curación fueron menores o iguales a una semana (83,4%). La mayoría se curó sin secuelas (97,1%). Las víctimas que presentaron secuelas (9 casos), las más frecuentes fueron de carácter psíquico (1,6%). Conclusiones la violencia sexual en el grupo de víctimas con lesiones físicas se asocia a factores de vulnerabilidad para la víctima: sexo femenino, edad entre 18 y 27 años y consumo previo de alcohol. Nuestro estudio confirma que las lesiones anogenitales son poco frecuentes en la mayoría de las víctimas de violencia sexual, por lo que su ausencia no puede descartar el haber sufrido violencia sexual. Las lesiones físicas encontradas fueron de carácter leve en la mayoría de los casos. La ausencia de secuelas psíquicas en muchas de las víctimas puede estar condicionado por el escaso seguimiento de las mismas. (AU)

Introduction: The aim of this paper is to analyze the characteristics of the victims and the circumstances of sexual violence related with the risk of physical lesions, as well as to determine the frequency and severity of the injuries. Material and methods Descriptive study of 702 cases of sexual assault attended at the Institute of Legal Medicine and Forensic Sciences of Alicante between the years 2016–2020. A comparative study was carried out between victims with and without injuries, to identify the variables associated to their presentation. Results 314 victims attended showed physical injuries (44,8%). Profile of the victims with injuries were women (95.5%), aged 18 to 27 years (31.3%), and previous alcohol consumption (50%). Injuries physical were mainly extragenital (38.6%), anogenital (15%), or both, and most cases were mild in severity (97.5%). Recovery was less to one week (83.4%) and without aftermath (97.1%). When the victim showed aftermath (9 cases), the most frequent were psychological type (1.6%). Conclusions Physical injuries in sexual violence is related with circumstances of victim vulnerability: women, age between 18 to 27 years, and previous alcohol consumption. Our study shows that anogenital lesions are absent in a significative number of victims of sexual assault, so this absence cannot exclude sexual violence. The lesions found are mild in severity, and the absence of physical aftermath in most of the victims may be conditioned by the scarce follow-up of them. (AU)

Central symptoms of post-traumatic stress disorder on adult victims of sexual violence: A network analysis.

This study aimed to identify and compare central post-traumatic stress disorder (PTSD) symptoms experienced by rape and sexual harassment victims, and the differences between the 2 groups. This study included 935 female victims of sexual violence who visited Sunflower Center in Korea between 2014 and 2020. Of the 935 victims, 172 were rape victims and 763 were sexually harassed. The Korean version of the Post-traumatic Diagnosis Scale was used to evaluate PTSD symptoms, and network analysis was performed to examine the differences in symptoms. The central symptom was "Physical reactions (PDS05)" for the group of rape victims and Less interest in activities (PDS09)' for the group of sexual harassment victims. For the group of sexual harassment victims, the most distinct central edge was the one between "Being over alert (PDS16)" and "Being jumpy or easily startled (PDS17)," and for the group of rape victims, it was the edge between "Upset when reminded of the trauma (PDS04)," and "Physical reactions (PDS05)." Network analysis revealed differences in central PTSD symptoms and central edges between sexual harassment and rape victims. Although re-experiencing and avoidance symptom clusters were most central in both groups, the specific central symptoms and edges differed between the 2 groups.

Intimate Partner Violence and Sexual Violence.

Intimate partner violence and sexual violence represent significant public health challenges that carry many individual and societal costs. More than 1 in 3 women (35.6%) and more than 1 in 4 men (28.5%) in the United States have experienced rape, physical violence, and/or stalking by an intimate partner in their lifetime. Clinicians play an integral role on the screening, identification, and management of these sensitive issues.

Teenage dating abuse, rape, and violence: The dermatologist's role.

Teenage dating abuse, rape, and violence are considered major public health problems that affect the lives of millions of teenagers in the United States. Dermatologists have traditionally become involved in these cases when confronted with patients who have unexplained bruising or other skin injuries and/or sexually transmitted diseases that raise the possibility that they could be victims of sexual abuse and violence. This contribution explores the role of the dermatologist in the diagnosis and management of teen dating abuse. We suggest some screening questions that might help to broach these serious issues with teen patients when the suspicion of dating abuse arises. We also provide a list of resources and hotlines that offer advice on how best to handle teen dating abuse. Some legal issues concerning the physician's role in managing teen dating abuse, rape, and violence are also discussed.

Novel recovery methods for biological materials in cases of alleged sexual assault: A word of caution.

Many believe that an increase in the public confidence in the investigation of sexual crimes, and in conviction rates, will lead to an increase in the reporting of these crimes. Consequently, Forensic Science Providers are continually striving to make improvements in evidence recovery and examination and the subsequent interpretation of evidence. One development is in methods that enable an individual to self-sample. However, in cases where a complainant has self-sampled, questions of when the samples were taken, how they were stored and so on, can be legitimately raised. Additionally the continuity and integrity of evidential samples may be questioned resulting in them not being acceptable to the courts and potential evidence could therefore be lost. There is a large emotional and psychological impact of sexual assault and rape and no complainant who reports a sexual assault and recovers material should have that evidence inadmissible to a court. Specialised units for victims of alleged sexual violence are available and offer far more than the recovery of evidential samples. This commentary on behalf of the Faculty of Forensic & Legal Medicine (FFLM) and the Association of Forensic Science Providers Body Fluid Forum (AFSP BFF) highlights the need for after care for the victims of sexual assault and why all evidence recovered in cases of alleged sexual assault and sexual violence should be obtained in line with best practice protocols.

Challenges and Collaborations: A Case Study for Successful Sexual Assault Nurse Examiner Education in Rural Communities During the COVID-19 Pandemic.

ABSTRACT: Challenges can often only be overcome with collaboration. In this case report of a Health Resources and Services Administration-funded program for Advancing Nurse Education - Sexual Assault Nurse Examiner, we describe the unique challenges and collaborations that have taken place in rural communities as we continued to train nurses during the COVID-19 pandemic. Geography and lack of availability of sexual assault nurse examiner (SANE) trainees brought many challenges as we prepared them to successfully pass the SANE certification examination and recruit new cohorts to expand SANE education.During the implementation of this program, we found that our process model, community collaboration, and commitment to these rural counties were the keys to our success before and during the COVID-19 pandemic.SANE trainee process and outcome measures were collected through quantitative and qualitative data collection. These data from the first cohort, along with the strategies implemented as all partners navigated the challenges of COVID-19, helped to strengthen our collaboration and expand the program. Details of these strategies and outcomes to date will be discussed.

Fatal anogenital exenteration of the intestine.

A case of a sadistically motivated homicide with extraordinary injuries is reported. A 32-year-old woman was naked with signs of severe blunt trauma and oral, vaginal and anal penetration. At the crime scene, the intestine lay next to the woman without connection to the body. During the trial before the criminal court, the perpetrator admitted fisting and inserting several objects into the vagina, anus and oral cavity. Moreover, after anal and vaginal insertion of the hands, large parts of the intestine were torn and pulled out through the anus and the vagina. The results of the forensic pathological examination and additional investigation are discussed and compared with the pertinent literature. This extraordinary case of a sadistically motivated homicide ended with a final judgment that is extremely rare in German jurisdiction.

Sexual Assault of Women.

Sexual violence is a major public health and human rights issue affecting more than 40% of women in the United States during their lifetimes. Although men and women experience sexual assault, women are at greatest risk. Populations uniquely impacted by sexual assault include adolescents; lesbian, gay, bisexual, transgender, and queer people; and active-duty military service members. Health consequences of sexual assault include sexually transmitted infections, risk of unintended pregnancy, high rates of mental health conditions (e.g., posttraumatic stress disorder), and development of chronic medical conditions (e.g., chronic pelvic pain). Family physicians care for sexual assault survivors at the time of the assault and years after, and care should follow a survivor-centered and trauma-informed framework. Multiple organizations recommend screening all women for a history of sexual violence; however, the U.S. Preventive Services Task Force recommends only universal intimate partner violence screening in women of reproductive age. A validated tool, such as the Two-Question Screening Tool, can be implemented. Initial care should include treatment of physical injuries, prophylaxis for sexually transmitted infections, immunizations, and the sensitive management of psychological issues. Clinicians must comply with state and local requirements for the use of evidence-gathering kits. Many hospitals have developed collection protocols and employ certified Sexual Assault Nurse Examiners or Sexual Assault Forensic Examiners. Prevention of sexual violence requires a comprehensive approach to address individual, relational, community, and societal factors.

Paediatrics on exercise ASKARI SERPENT: reflections and recommendations for pre-deployment training.

The British Army has a long history of training in Kenya, including delivering health outreach to the local population on Exercise ASKARI SERPENT. This article presents data from two iterations of Exercise ASKARI SERPENT in which children accounted for almost 40% of all patients treated. Short case vignettes highlight the technical and non-technical challenges faced when treating children, before recommendations are made for pre-deployment training for Exercise ASKARI SERPENT and similar future deployments which may see military clinicians delivering treatment to the local population.

Sexual assault cases at a tertiary referral hospital in urban Ethiopia: One-year retrospective review.

INTRODUCTION: Sexual assault is an important health and social problem affecting young girls. The aim of the study is therefore to do a one-year retrospective review of documents of alleged sexual assaults managed at Saint Paulo's Hospital Millennium Medical College (SPHMMC) to determine survivors' characteristics, circumstances of the assault, and treatment offered. METHODS: This is a hospital-based one-year retrospective review of alleged sexual assault cases. The case records of survivors were retrieved, reviewed and information extracted analyzed using SPSS version 17. Characteristics of victims of the sexual assault, clinical presentation, and management provided were described by frequency and percentage distribution. RESULT: A total of 170 cases of alleged sexual assault who received care during the study period were identified. Around 96% of the survivors were female while there were 6 male cases. The mean age of the victims was 13 yrs. with a range from 2 to 25 yrs. About 23.6% of the victims were less than 10 years. Half of the victims were assaulted by neighbors (45%) followed by strangers (36.5%). The interval between the incident and presentation to the hospital ranged from 2 hours to 93 days (2224 hours) with an average of 98 hours. Most (93.0%) had one or more physical examination findings at presentation. Serology tests for HIV, Hepatitis B, and Syphilis were done in 97.3%, 88.7%, and 84.5% cases respectively. Urine pregnancy tests were done in 62.5% of the cases. Prophylaxis against HIV and STI prophylaxis was provided to 42% and 45% respectively. Social support/counseling was provided to 61% of the victims and legal evidence (certificate) was provided to 45.5% of the cases. CONCLUSION AND RECOMMENDATIONS: Although it is largely not reported by the victims, sexual assault is a grievous offense still happening constantly. Children and young girls remain the most vulnerable. There is inadequate forensic evidence collection, legal and medical care. There is also a delay in presentation to hospital by victims. Therefore, there is a need to have standardized protocols for comprehensive evaluation and care of the survivors. It is also imperative that a multidisciplinary approach like a one-stop clinic should be utilized to provide effective and efficient medical, social, psychological, and legal services. Finally, it is very necessary to increase public awareness and preventive interventions are required particularly to protect the vulnerable age group to enhance their safety.

A paper-based, cell-free biosensor system for the detection of heavy metals and date rape drugs.

Biosensors have emerged as a valuable tool with high specificity and sensitivity for fast and reliable detection of hazardous substances in drinking water. Numerous substances have been addressed using synthetic biology approaches. However, many proposed biosensors are based on living, genetically modified organisms and are therefore limited in shelf life, usability and biosafety. We addressed these issues by the construction of an extensible, cell-free biosensor. Storage is possible through freeze drying on paper. Following the addition of an aqueous sample, a highly efficient cell-free protein synthesis (CFPS) reaction is initiated. Specific allosteric transcription factors modulate the expression of 'superfolder' green fluorescent protein (sfGFP) depending on the presence of the substance of interest. The resulting fluorescence intensities are analyzed with a conventional smartphone accompanied by simple and cheap light filters. An ordinary differential equitation (ODE) model of the biosensors was developed, which enabled prediction and optimization of performance. With an optimized cell-free biosensor based on the Shigella flexneri MerR transcriptional activator, detection of 6 µg/L Hg(II) ions in water was achieved. Furthermore, a completely new biosensor for the detection of gamma-hydroxybutyrate (GHB), a substance used as date-rape drug, was established by employing the naturally occurring transcriptional repressor BlcR from Agrobacterium tumefaciens.

Eficacia del tratamiento ultrasónico en la recuperación de espermatozoides en la investigación de delitos sexuales / Efficacy of an ultrasound technique in the recovery of spermatozoa during the investigation of sexual offenses

Objetivo: Evaluar la eficiencia para la recuperación de espermatozoides utilizando una técnica estándar y una técnica basada en ultrasonido. Materiales y métodos: Se realizó un estudio experimental para comparar 2 técnicas de recuperación de espermatozoides: 1) la técnica estándar, basada en la elución de la evidencia en agua destilada con un solución tampón, y 2) una técnica modificada, que incluyó la concentración por centrifugado y el uso de ultrasonido. La eficacia se basó en el recuento manual de espermatozoides utilizando diluciones de 1:1 a 1:500. Resultados: La técnica modificada mejoró sustancialmente la recuperación de los espermatozoides. En la dilución 1:10, la técnica estándar recuperó el 3,1%, la modificada recuperó un 17,5%; representando un aumento de 6 veces más en la recuperación. La técnica modificada fue la única capaz de recuperar espermatozoides en diluciones superiores a 1:250. Conclusión: La implementación de la técnica ultrasónica mejora la recuperación de espermatozoides

Objective: To evaluate the efficiency for the recovery of spermatozoa using the standard technique and a technique based on ultrasound. Materials and methods: An experimental study was carried out to compare two techniques for spermatozoa recovery; I the standard technique, based on elution of the evidence in distilled water with a buffer and, II a modified technique that included concentration by centrifugation and ultrasound. The efficiency was based on manual counting of spermatozoa using dilutions 1:1 to 1:500. Results: The modified technique substantially improved the recovery of spermatozoa. While the standard technique recovered 3.1%, the modified one resulted in a recovery of 17.5% using the 1:10 dilution, which represents a six-fold increase. The modified technique was the only one able to recover spermatozoa in dilutions higher than 1:250. Conclusion: The implementation of the ultrasonic technique improves the recovery of spermatozoa

Legal mobilization in medicine: Nurses, rape kits, and the emergence of forensic nursing in the United States since the 1970s.

Routine administration of the sexual assault medical forensic exam (commonly known as the "rape kit") is one of the most significant healthcare reforms advanced by the U.S. anti-rape movement since the 1970s. To promote reform, nurses acted as practitioner-activists in emergency medicine and created the new specialty of forensic nursing to administer the medical forensic exam independent of physicians. Their efforts suggest a new way of conceptualizing the interface of law and medicine: the proactive invocation of criminal law in clinical medicine for the purpose of institutional reform in healthcare organizations, or what I term legal mobilization in medicine. Using the framework of legal mobilization in medicine, I ask: (1) how did nurses mobilize criminal law and rights to health in emergency medicine to facilitate reform? and (2) what were the effects on clinical practice and knowledge production? To chart this history, I draw on a review of published writings by early forensic nurses, interviews with leaders in the field, and ethnographic observation at the 20th anniversary International Association of Forensic Nurses conference in 2012, commemorating the founders and origins of this new specialty. Bringing together scholarship on law and social movements in socio-legal studies and scholarship on health and social movements in science, technology, and medicine studies, I argue that nurses forged a porous boundary between the overlapping institutional spheres of medicine and law in order to align the objectives of medical care and criminal investigation and, thereby, seek rights to healthcare and rights to justice for patient-victims through the enactment of new medical routines. I demonstrate the historical emergence of a novel, hybrid form of professional jurisdiction and medical practice, and I explore its benefits as well as its unintended consequences. I conclude by discussing the ethical implications of this case for the use of medical evidence to corroborate rape.

The evaluation of Oryza sativa L (Black rice) extracts for detection of spermatozoa on the clothing and vaginal swab samples.

Investigation of sexual assault cases from the evidence involving vaginal swab, clothing and others is examined by a forensic scientist. The explanation of trace findings on spermatozoa on clothing is often problematic due to the use of different staining methods. Conventional staining method used either Papanicolaou (PAP) or Dip quick® stain as synthetic dyes which are expensive imported material and harmful to human health. Therefore, the present study aims to determine the ability of Oryza sativa L (black rice) extract as a natural dye to detect spermatozoa on the clothing and vaginal swab casework samples for routine forensic examination. Results revealed that black rice extract has a highly effective for detecting spermatozoa on cloth and vaginal swab casework samples. There was no significantly different in the detection of spermatozoa compared with rapid PAP stain and Dip quick® stain. Results also showed that the staining of vaginal swab casework with black rice extracted can be used for PCR amplification of centromeric alphoid repeat gene on chromosome Y for 60 days. Moreover, the DNA extracted from stained semen slide generates a full profile of 16 alleles of STR typing. The results indicate that a new natural staining dye which extracted from black rice can be used to detect spermatozoa and identify a person from the trace evidence. The application of natural dyes for routine staining of spermatozoa from forensic specimens will decrease the expense to be spent in purchasing the synthetic dye and reduce their side effects on human and environment.

Collecting sexual assault history and forensic evidence from adult women in the emergency department: a retrospective study.

BACKGROUND: The objective of this retrospective study was to examine the discrepancy between information derived from written medical reports and the results of forensic DNA analyses on swabs collected from the victims in 122 cases of alleged sexual assault treated at the Emergency Department of Padua Hospital. The examination of discrepant results has proved useful to support a broader application of sexual assault management, particularly during the taking of case history. METHODS: The Laboratory of Forensic Genetics of Padua University have processed samples from 122 sexual assault cases over a period of 5 years. RESULTS: Of the 103 cases in which the victim reported a penetration and ejaculation, only 67 (55% of all the samples) correlated with positive feedback match from the laboratory. In 36 cases in which the patient reported penetration with ejaculation, no male DNA was found in the samples collected. Therefore, there was a total of 41 cases in which the patient's report were not supported by laboratory data. In the remaining ten cases, which had an ambiguous history, 3 tested positively for the presence of male DNA. CONCLUSIONS: To avoid discrepancies between the medical reporting and reconstruction of sex crimes, it is crucial to deploy strategies which focus not only on the technical aspects of evidence collection, but also on how the victim's story is recorded; such efforts could lead to better management of sexual assault victims, and to a strengthened legal impact of forensic evidence and of crime reconstruction.

Postictal Delirium and Violent Behavior in Patients with Post-Neurosurgical Epilepsy.

BACKGROUND: Neurosurgical brain interventions may result in lesions that can cause epilepsy. Diagnosis may be delayed in some situations. Meanwhile, violent behavior can occur during postictal delirium states. Although benign behavioral manifestations are well documented in literature, violent offenses in post-neurosurgical epilepsy have been rarely reported. Here we describe 2 such cases, focusing on management and emphasizing the need for prevention. CASE DESCRIPTION: Both patients were suffering from post-neurosurgical epilepsy and offended during postictal delirium states. The first patient had generalized epilepsy and committed an attempted rape. The second patient had temporal lobe epilepsy and committed an attempted homicide. Both patients were well managed using anticonvulsant medication after the offenses. CONCLUSIONS: Early diagnosis and regular follow-up are measures to take into consideration to prevent violent behavior in patients with post-neurosurgical epilepsy.