Palatal rugae pattern in a Portuguese population: a preliminary analysis

Palatal rugae have been related with specific racial groups and are said to be useful in sex discrimination. This work aimed to characterize the palatal rugae patterns in a Portuguese population. Fifty plaster casts were examined for first and third rugae shape evaluation; shape, frequency, and association with sex were studied. In females, the most prevalent first rugae were the straight type on the right and the curve type on the left; in males, the straight type was the most prevalent on both sides. The most frequent third rugae type was sinuous on both sides, in both sexes. No significant sexual dimorphism in rugae shape was found (p > 0.05). When comparing these results with those from other investigations, it was clear that a particular rugae pattern could be established for different ethnic groups. However, the small sample size justifies further work in larger samples to validate these findings.     

Undiagnosed, untreated acute promyelocytic leukemia presenting as a suspicious sudden death

Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia frequently associated with clotting abnormalities and severe hemorrhagic diathesis. The disease is associated with a high incidence of early fatal hemorrhage. We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis.     

A proposed dissection procedure for vertebral arteries in forensic pathology

Vertebral artery removing constitutes a significant forensic pathology challenge. Dissection techniques during head-neck autopsy are based on anterior approach, a difficult method, which is unable to assess the transverse part of the artery. This work presents an original and simple method for dissecting vertebral arteries by a posterior approach, opening the vertebroarterial canal through the spinal canal without any special equipment. Once the spinal cord is removed, the transversarium foramens are opened by an internal cut at the pedicle and an external cut at the transverse process. This enables us to visualize vertebral arteries in its entirety. The method improves both the examination of the upper extracranial segment of the vertebral artery and the neuropathological study when arterial injury is suspected. Applying this method routinely is both feasible and useful in suspected cases of vertebral artery trauma and could contribute to assess more precisely the actual incidence of this injury.     

"Legal highs"-Toxicity in the clinical and medico-legal aspect as exemplified by suicide with bk-MBDB administration

The easily available "legal highs", which are products containing psychoactive substances, such as cathinones, piperazines and synthetic cannabinoids, are abused by adolescents in Poland and in the world as alternatives to classic drugs, such as amphetamines or marijuana. The majority of these potentially dangerous substances are still legal and they are associated with a risk of severe poisoning or even death, and provide new challenges in clinical and forensic toxicological practice. Investigations in the field of "designer drugs" may be well illustrated by the case of a suicide of a 21-year old male who ingested a specified dose of a preparation called "Amphi-bi-a" that contains bk-MBDB, chemically 2-methylamino-1-(3,4-methylenedioxyphenyl) butan-1-one, which belongs to the cathinone group, as a synthetic euphoric empathogen and psychoactive stimulant that is chemically similar to MDMA. It is one of more common components of "legal highs" examined in Poland and other countries. The documentation of the case includes a clinical assessment of the patient's health status performed during his almost 4-h hospitalization before death, autopsy and histological examinations supported by toxicological findings revealing bk-MBDB at extremely high concentrations (at 20mg/l in the blood and 33mg/kg in the liver); hence, this body of evidence contributes to knowledge in the field of "designer drugs". Inventions of designers of new psychoactive xenobiotics, which are much in demand, especially in view of the dynamic Internet marketing, which drums up narcobusiness, must be balanced by a national strategy developed by medical, legal and educational circles in the modern civilized world in order to prevent the spreading of the phenomenon.     

Postnatal ontogenesis of the tibia. Implications for age and sex estimation

The growth of five variables of the tibia (diaphyseal length, diaphyseal length plus distal epiphysis, condylo-malleolar length, sagittal diameter of the proximal epiphysis, maximum breadth of the distal epiphysis) were analysed using polynomial regression in order to evaluate their significance and capacity for age and sex determination during and after growth. Data were collected from 181 (90♂ and 91♀) individuals ranging from birth to 25 years of age and belonging to three documented collections from Western Europe. Results indicate that all five variables exhibit linear behaviour during growth, which can be expressed by a first-degree polynomial function. Sexual significant differences were observed from age 15 onward in the two epiphysis measurements and condylo-malleolar length, suggesting that these three variables could be useful for sex determination in individuals older than 15 years. Strong correlation coefficients were identified between the five tibial variables and age. These results indicate that any of the studied tibial measurements is likely to serve as a useful source for estimating sub-adult age in both archaeological and forensic samples.     

Traumatic bilateral vertebral artery dissection

Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death.     

Using EHRs to design drug repositioning trials: A devolved approach to data protection

One area where the application of data protection law has proven complex is in relation to the secondary usage of health data in EHRs for medical research. Here the tension between the privacy interests of patients and the risk of harm if such sensitive data are compromised, and on the other side, the potential societal value of utilizing the data for the benefit of medical science, is especially striking. In this paper, we consider the applicable provisions of the EU Data Protection Directive, and outline a general approach to patient data handling for research, which we believe to be compatible with relevant legal and ethical requirements. We then illustrate and apply this by reference to a specific EU FP7 project, involving EHR data processing to select patients for clinical pharmaceutical trials. After introducing the project (PONTE), we explain the ‘devolved’ data protection architecture it employs and provide a legal evaluation.     

Acts of Intimate Partner Violence and Feelings of Danger in Battered Women Seeking Help in a Spanish Specialized Care Unit

Acts of violence recounted by 161 female victims of Intimate Partner Violence (IPV) attended at a psychological care service in Spain are presented. The relationship between acts of violence and feelings of danger, childhood abuse, and dyadic adjustment are analyzed. Reported acts of IPV were obtained through a Semi-structured Interview on Domestic Violence; and marital satisfaction was assessed with the Dyadic Adjustment Scale. The results showed women who have felt their lives were in danger are more likely to have been victimized. In addition, women who were both abused by their partner and sexually abuse as children are the ones that perceive more situations of danger in their adult couple relationship. The importance of studying perceived danger and the diversity of IPV experiences are discussed to aid prevention and intervention strategies.     

No More! Women Reporting Intimate Partner Violence in Mexico

An analysis of the National Survey of Violence Against Women (2006) in Mexico was performed to estimate the prevalence and the associated factors of women suffering intimate partner violence (IPV) that report their aggressor by severity of violence. Women aged 15 years or older who reported IPV were analyzed by using logistic regression models. Prevalence of IPV was 33.33 %, 64.11 % of them were classified as non-severe violence (NSV) and 35.89 % as severe violence (SV). Women with SV reported the aggressor more often (24.69 % vs. 6.08 % of NSV). Variables associated with reporting the aggressor for both NSV and SV were having children living in the household, higher socioeconomic status, frequent alcohol consumption by the partner, and health personnel informing women that they were experiencing IPV. We can conclude that a low percentage of women reported IPV. Greater efforts should be made to empower women so they can effectively execute their right to live a life free of violence.