Estudio mediante técnicas moleculares del tanatomicrobioma intestinal en la estimación del intervalo post mortem temprano empleando un modelo de ratón / Early post mortem interval estimation in a mouse model using molecular analyses of the gut thanatomicrobiome

Introducción: en la actualidad, la falta de métodos cuantitativos fiables ha llevado a distintas líneas de investigación a buscar un modelo que prediga el intervalo post mortem (IPM). El tanatomicrobioma, presente desde el momento de la muerte, parece sufrir cambios predecibles y que siguen una correlación con el IPM.Materiales y métodosse ha analizado experimentalmente el comportamiento del tanatomicrobioma en la región del intestino delgado posterior y del colon ascendente durante las primeras 24 h de descomposición en Mus musculus. Para ello, se ha llevado a cabo una aproximación molecular basada en el análisis del gen ribosomal 16S (ARNr 16S) mediante electroforesis en gel con gradiente desnaturalizante (DGGE) y, seguidamente un análisis de la alfa y beta diversidad.Resultadoslos resultados basados en el análisis de los índices de diversidad ecológica reflejaron cambios estadísticamente significativos antes de las 12 h, y un descenso de la diversidad a partir de esas 12 h postmortem, siendo este estadísticamente significativo en las 2 regiones intestinales analizadas. Por otro lado, el estudio comparativo de las comunidades microbianas mostró que cambian estructurada y diferenciablemente desde el momento de la muerte, alejándose en similitud de las mostradas en vida (IPM 0 h).Discusiónestos resultados coinciden con el descenso de la diversidad sugerido a largo plazo por distintos autores. Sin embargo, en las condiciones del estudio, se ha visto que este descenso no se inicia hasta las 12 h. Conclusión como conclusión, se han podido establecer, según los cambios en la diversidad bacteriana, fases de la dinámica bacteriana durante la descomposición que podrían ayudar a mejorar los modelos de correlación microbiana para la estimación del IPM. (AU)

Introduction: Currently, the lack of reliable quantitative methods has led different research lines to find a model that predicts the postmortem interval (PMI). The thanatomicrobiome, present from the moment of death, has been shown to change in predictable ways, allowing a correlation with PMI.Materials and methodsIn this study, the shifts of the thanatomicrobiome in the region of the posterior small intestine and the ascending colon in Mus musculus during the first 24 hrs of decomposition have been analyzed experimentally. For this purpose, a molecular approach based on the analysis of the 16S ribosomal gene (16S rRNA) and a denaturing gradient gel electrophoresis (DGGE) was adopted, followed by analyses of the ecological diversity indices Alpha and beta diversity.ResultsThe results based on the analysis of the ecological diversity indices reflected statistically significant changes before 12 hrs, and a decrease in diversity after 12 hrs postmortem, this being statistically significant in the two intestinal regions analyzed. Moreover, the comparative study of microbial communities indicated distinct and structured changes from the moment of death, with shifts in the degree of similarity from the composition detected in life (PMI 0 hrs).DiscussionThese results agree with other studies demonstrating a decrease in microbial diversity. However, under the conditions of the study, this decrease does not begin until 12 hrs after death. Conclusions: In conclusion, by examining the dynamics of bacterial diversity our study has identified phases during decomposition that could help to improve microbial correlation models for PMI estimation. (AU)

Revisión sobre las nuevas perspectivas de datación cadavérica desde el necrobioma / Review of cadaveric dating methods and new perspectives from the necrobiome

Hoy en día existen numerosas estrategias desde un punto de vista científico que ayudan a esclarecer los casos forenses, entre ellas la datación cadavérica. La ausencia de métodos fiables cuantitativos para estimar el intervalo post mortem explica el incremento de nuevas líneas de investigación prometedoras con dicha finalidad. Tras la aparición de las nuevas técnicas de secuenciación masiva y bioinformáticas, surge también el estudio del necrobioma como un área novedosa y poco estudiada dentro de las ciencias forenses, que se ha llegado a denominar «microbiología forense». En esta revisión se realiza un breve recorrido por las técnicas y procedimientos existentes de datación cadavérica, centrándose en la utilidad del tanatomicrobioma, o conjunto de microorganismos presentes en el momento de la muerte, que podría ser un método prometedor para la estimación del intervalo post mortem en el futuro. (AU)

Nowadays there are numerous scientific strategies that helping to clarify forensic cases, including time since death. The absence of reliable quantitative methods to estimate the post-mortem interval explains the increase in promising new lines of research for this purpose. After the appearance of the new techniques of massive sequencing and bioinformatics, also arises the study of the necrobiome through a new and little studied area within the forensic sciences, Forensic Microbiology. In this review, a tour of the existing techniques and procedures of cadaveric dating is made, which includes new cutting-edge techniques in different areas of knowledge and also mentions the utilities of Forensic Microbiology, where the thanatomicrobiome, present from the moment of death, according to recent studies, points to be a promising method for estimating the post-mortem interval in the future. (AU)

Análisis descriptivo del suicidio en el bienio 2018-2019 en Valladolid (España) / Descriptive analysis of suicide in the 2018-2019 biennium in Valladolid (Spain)

Introducción: El suicidio y su prevención suponen un reto esencial en salud pública. Como primera causa externa de muerte en nuestro país, parece escapar a nuestra comprensión y control en vista de los numerosos estudios e intervenciones realizadas. Llevamos a cabo un estudio de los suicidios mortales estudiados por el Instituto de Medicina Legal y Ciencias Forenses de Valladolid durante el bienio 2018-2019. Material y métodos: Se recogieron todas las muertes por suicidio durante 2018-2019 y se cruzaron con los datos anonimizados del Servicio de Psiquiatría del Hospital Clínico Universitario de Valladolid en 2019. Resultados: La tasa de suicidios fue de 8,5/100.000 habitantes, 49 casos en 2018 y 44 en 2019, con una distribución de 3:1 para varones frente a mujeres, principalmente en el medio rural. La franja de edad con mayor incidencia fue la de 31-70 años. La ahorcadura en el medio rural y la precipitación en el urbano fueron los principales métodos. La comorbilidad psiquiátrica identificada más frecuente fueron los trastornos del estado de ánimo-afectivos (F30-39 CIE-10). Conclusiones: Las tasas de suicidio presentan un ligero descenso, mientras que el perfil de riesgo y las características del suicidio mortal se mantienen constantes en nuestro medio más de 20 años después, lo que indica una escasa eficacia de los esfuerzos preventivos realizados hasta ahora. La prevención efectiva del suicidio debe partir de la mejor identificación, prevención y tratamiento de los trastornos psiquiátricos, pudiendo resultar esencial la participación de los Institutos de Medicina Legal y Ciencias Forenses en programas poblacionales multinivel. (AU)

Introduction: Suicide and its prevention are a serious public health challenge. As the primary external cause of death in our country, it seems to be beyond our understanding and control in view of the numerous studies and interventions carried out. We conducted a study of suicide at the Valladolid Institute of Legal Medicine from 2018-2019. Material and methods: All deaths by suicide from 2018-2019 were collected and crossed with anonymized data of the Psychiatry Service of the University Clinical Hospital of Valladolid in 2019. Results: The suicide rate was 8.5/100,000 inhabitants, 49 cases in 2018 and 44 in 2019, with a 3:1 male to female ratio, mainly in rural areas. The age group with the highest incidence was 31-70 years. Hanging in rural areas and precipitation in urban areas were the main methods. Affective disorders (F30-39 ICD-10) were the most common identified psychiatric disorders. Conclusions: Suicide rates are slightly lower, while the risk profile and features of suicide remain constant in our environment more than 20 years later, indicating that preventive efforts carried out have not been completely successful. The effective prevention of suicide must start with better identification, prevention, and treatment of psychiatric disorders, but the contribution of the Institutes of Legal Medicine in the implementation of multilevel population programmes is also essential. (AU)

La especialidad de Medicina Legal y Forense en España: La consolidación por el sistema de residencia / Legal and Forensic Medicine Specialty in Spain: the consolidation by the medical residency system

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Emergency Department Management of the Sexual Assault Victim in the COVID Era: A Model SAFET-I Guideline From San Diego County.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has contributed to an increase in intimate partner violence (IPV), posing challenges to health care providers who must protect themselves and others during sexual assault examinations. Victims of sexual assault encountered in prehospital and emergency department (ED) settings have legal as well as medical needs. A series of procedures must be carefully followed to facilitate forensic evidence collection and law enforcement investigation. A literature review detected a paucity of published guidance on the management of sexual assault patients in the ED, and no information specific to COVID-19. OBJECTIVE: Investigators sought to update the San Diego County sexual assault guidelines, created in collaboration with health care professionals, forensic specialists, and law enforcement, through a consensus iterative review process. An additional objective was to create a SAFET-I Tool for use by frontline providers during the COVID-19 pandemic. DISCUSSION: The authors present a novel SAFET-I Tool that outlines the following five components of effective sexual assault patient care: stabilization, alert system activation, forensic evidence consideration, expedited post-assault treatment, and trauma-informed care. This framework can be used as an educational tool and template for agencies interested in developing or adapting existing sexual assault policies. CONCLUSIONS: There is a lack of clinical guidance for ED providers that integrates the many aspects of sexual assault patient care, particularly during the COVID-19 pandemic. A SAFET-I Tool is presented to assist emergency health care providers in the treatment and advocacy of sexual assault patients during a period with increasing rates of IPV.

Coronavirus Act 2020: An overview by a lawyer interested in medico-legal matters.

The Act and the regulations. How long they might last. The suspension of the renewals. Enforcement and the role of the police. Protection of whistleblowers. The trial scene. The ultimate impact.

Evaluación de las periciales extrajudiciales en Cataluña (España) en 2016-2017 / Evaluation of extrajudicial expert advice in Catalonia (Spain) in 2016-2017

INTRODUCCIÓN: Desde la entrada en vigor de la Ley 35/2015, los Institutos de Medicina Legal y Ciencias Forenses realizan periciales extrajudiciales a petición de particulares para la resolución de las reclamaciones por accidentes de circulación. El objetivo es analizar los aspectos médico-legales más relevantes de estas periciales. MATERIAL Y MÉTODO: Se trata de un estudio descriptivo retrospectivo de las periciales extrajudiciales en las divisiones de Barcelona y l'Hospitalet y Tarragona del Instituto de Medicina Legal y Ciencias Forenses de Cataluña durante los años 2016-2017. Los datos se obtuvieron de los registros de periciales extrajudiciales de ambas divisiones. RESULTADOS: Se realizaron 547 informes médico-forenses. Los accidentes fueron mayoritariamente causados por colisión por alcance entre turismos en trayectos urbanos. Las lesiones fueron en su mayoría de carácter leve, siendo la afectación cervical la más frecuente. En un alto porcentaje, se resolvió con tratamiento conservador en una media de 69 días, asociándose la aparición de secuelas leves en casi la mitad de los casos. El perjuicio estético se informó en el 14%. No hubo diferencias entre ambas divisiones. CONCLUSIÓN: Las periciales extrajudiciales resultan una fuente de información valiosa para la valoración de los perjuicios causados a las víctimas de accidentes de circulación. Como en otros estudios, la mayoría de lesiones son de carácter leve y se asocian a colisiones entre turismos, causando secuelas en la mitad de los casos. Parece que la vía extrajudicial es eficaz en las reclamaciones por accidentes de circulación, pero son necesarios más estudios para obtener una visión más completa

INTRODUCTION: Since the application of Law 35/2015, the Legal and Forensic Medicine Institutes provide extrajudicial expert advice at the request of individuals for the resolution of traffic accident claims. The objective is to analyze the most relevant medical-legal aspects of this expert advice. MATERIAL AND METHOD: This is a retrospective descriptive study of the extrajudicial expert advice in the divisions of Barcelona and l'Hospitalet, and Tarragona of the Catalonian Legal and Forensic Medicine Institute from 2016-2017. The data was obtained from the extrajudicial expert records of both divisions. RESULTS: 547 medical-forensic reports were made. The accidents were mainly caused by a rear collision between cars on urban routes. The injuries were mostly minor, with cervical involvement being the most frequent. A high percentage were resolved with conservative treatment in an average of 69 days, there were mild sequelae in almost half of the cases. Aesthetic damage was reported in 14%. There were no differences between the two divisions. CONCLUSION: Extrajudicial expert advice is a valuable source of information for assessing the damage caused to traffic accident victims. As in other studies, most injuries are mild and are associated with collisions between cars, causing sequelae in half of the cases. It seems that the extrajudicial route is effective in helping resolve traffic accident claims, but more studies are needed to obtain a more complete vision

The Rapidly Changing US Illicit Drug Market and the Potential for an Improved Early Warning System: Evidence from Ohio Drug Crime Labs.

BACKGROUND: The US has seen a rapid increase in synthetic opioid-related overdose deaths. We investigate Ohio, a state with one of the highest overdose death rates in 2017 and substantial numbers of deaths related to fentanyl, carfentanil, and other fentanyl analogs, to provide detailed evidence about the relationship between changes in the illicit drug market and overdose deaths. METHODS: We investigate the illicit drug market using Ohio's Bureau of Criminal Investigation's (BCI) crime lab data from 2009 to 2018 that shows the content of drugs seized by law enforcement. We use Poisson regression analysis to estimate the relationship between monthly crime lab data and monthly unintentional drug overdose death data at the county level. RESULTS: During this time period there has been a rapid change in the composition of drugs analyzed by the BCI labs, with a rapid fall in heroin observations, simultaneous rise in synthetic opioids, and an increase in the number of different fentanyl analogs. We find that the increased presence of fentanyl, carfentanil, and other fentanyl analogs have a strong correlation with an increase in overdose deaths. The types of opioids most associated with deaths varies by the population size of the county. CONCLUSIONS: Crime lab data has the potential to be used as an early warning system to alert persons who inject drugs, harm reduction services, first responders, and law enforcement about changes in the illicit opioid risk environment.

Research Progress on Forensic Molecular Phenotyping in the Age of Precision Medicine.

ABSTRACT: With the development of new technologies, such as whole genome sequencing and big data, many countries have constructed large cohorts as strategic resources for precision medicine study. Related studies have significantly promoted research progress in many fields, such as medicine and biology, creating the genetic testing industry. In the forensic field, characterization technologies for features, such as biogeographic ancestry, genetic genealogy and physical appearance have emerged and developed rapidly. Compared with traditional forensic DNA technology, the new technology can search for characteristics and provide clues, quickly becoming an important means to solve difficult cases such as cold cases and accumulated cases. This paper briefly reviews the current status of the construction of large cohorts at home and abroad, and the research progress of forensic molecular phenotyping in the context of precision medicine in the context of precision medicine.

A quarter century of decline of autopsies in the Netherlands.

OBJECTIVE: Autopsy rates have been declining worldwide. The present study reports the outcome of a retrospective analysis of all non-forensic autopsies in the Netherlands over a course of 25 years, and compares these with the most recent Dutch study. METHOD: Retrospectively, 25 years of data on clinical autopsies from the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA) was paired with the mortality registry (Statistics Netherlands). RESULTS: The crude prevalence of autopsies declined from 7.07% in 1991 to 2.73% in 2015. After adjusting for age at death, there was no difference in autopsy rate between males and females. An increasing age significantly decreased the autopsy rate. CONCLUSION: In the Netherlands, clinical autopsies have been declining over the last quarter century. Age at death, but not sex, was associated with the autopsy rate. These different results stress the importance of correct collection and analysis methods of data.

Building a Patient-Centered Medical-Legal Home in Hawaii's Kalihi Valley.

The Medical-Legal Partnership for Children in Hawai'i (MLPC) has worked to address the social determinants of health for low-income patient-families since 2009. Focused on identifying health-harming legal needs, doctors and lawyers work together to assist families with family law, housing, public benefits, education, employment, civil rights, and other concerns. Providing free, direct legal service in the medical setting allows the medical-legal partnership (MLP) team to identify community-wide concerns such as language access violations, racial discrimination, and unfair policies. These individual concerns then inform systemic advocacy and community engagement efforts. The MLPC Hawai'i team has grown through its experiences working with public housing residents, Micronesian migrant communities, and low-income families, ultimately evolving the national MLP framework to become a patient-centered "medical-legal home." This evolution is possible through the utilization of "rebellious lawyering" concepts of working with, not just on behalf of, community clients. This article will introduce the concept of a medical-legal partnership, provide examples of lessons learned from working alongside vulnerable and resilient communities, and explore the idea of the patient-centered medical-legal home as an innovative program to improve the social determinants of health and reduce health disparities.

Research Progress on Forensic Molecular Phenotyping in the Age of Precision Medicine / 法医学杂志

With the development of new technologies, such as whole genome sequencing and big data, many countries have constructed large cohorts as strategic resources for precision medicine study. Related studies have significantly promoted research progress in many fields, such as medicine and biology, creating the genetic testing industry. In the forensic field, characterization technologies for features, such as biogeographic ancestry, genetic genealogy and physical appearance have emerged and developed rapidly. Compared with traditional forensic DNA technology, the new technology can search for characteristics and provide clues, quickly becoming an important means to solve difficult cases such as cold cases and accumulated cases. This paper briefly reviews the current status of the construction of large cohorts at home and abroad, and the research progress of forensic molecular phenotyping in the context of precision medicine in the context of precision medicine.

[Forensic medical expertises and the studies of material evidence of biological origin in Russia (based on the materials collected during the period from 2003 till 2017)]. / Sudebno-meditsinskie ékspertizy i issledovaniia veshchestvennykh dokazatel'stv biologicheskogo proiskhozhdeniia v Rossii (po materialam 2003-2017 gg.).

The objective of the present study was the analysis of expert activities of the forensic biological, forensic cytological, and molecular genetic divisions and laboratories of the state agencies carrying out forensic medical expertise in the Russian Federation during the past 15 year period (2003-2017). We scrutinized the data on the organizational structure and the personnel scheduling chart of the aforementioned units. The study has demonstrated the progressive decrease in the number of forensic biological and forensic cytological investigations versus enhanced activities of the molecular genetic laboratories. The volume of work done by the forensic biological department was reduced by 42% during 2017 in comparison with 2003 whereas that of molecular genetic expertises and investigations increased by 6.9 times within the same period. Simultaneously, the structure of the molecular genetic expertises and investigations underwent appreciable changes. The relative amount of blood studies decreased while that of hair, teeth, bones, and other biological tissues increased. The time spent for the performance of expertises and investigations in the respective departments and laboratories decreased in comparison with 2003.

Human deaths from drug overdoses with carfentanyl involvement-new rising problem in forensic medicine: A STROBE-compliant retrospective study.

Carfentanyl, an ultra-potent synthetic opioid, is approved for use only in veterinary medicine as a tranquilizing agent. However, many cases of human poisoning with carfentanyl have recently appeared in the news with limited information given and scientific literature provides only 1 case of documented human exposure to carfentanyl.Fifteen cases of death from drug overdoses with carfentanyl involvement are being presented. Fifteen blood and urine samples have been taken for alcohol and drug testing. Headspace gas chromatography was used for alcohol detection. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography-time-of-flight mass spectrometry (LC/MS TOF) system was used for drug detection.Sixty-three cases of death from poisoning with drugs have been tested for carfentanyl in the State Forensic Medicine Service. Fifteen of them were positive for carfentanyl.The cases mentioned above show that carfentanyl exposure causes signs and symptoms similar to other opioid toxicity. Carfentanyl intoxication may even be fatal if appropriate treatment is not available. Therefore, nowadays it is very important to draw forensic medicine expert's attention to new substances in drug trade.

La consolidación de Revista Española de Medicina Legal (2008-2018) / Strengthening of Spanish Journal of Legal Medicine (2008-2018)

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