Vol 6, No 4 (2020)

REVIEWS
Epidemiological aspects and a current approach to the problem of carbon monoxide poisoning
Indiaminov S.I., Kim A.A.
Abstract

Background: Carbon monoxide (CO) poisoning is the leading cause of death from poisoning (accidental and intentional). The number of cases of CO poisoning is increasing day by day.

Aims: The aim of the study was to analyze the epidemiological situation of CO poisoning and identify the urgent aspects of this problem. In the article, the author provided a retrospective analysis of 117 cases of CO poisoning, registered in a number of regional branches of the Republican Scientific and Practical Center of the Forensic Medical Examination of Uzbekistan, after he studied and analyzed the world literature on the epidemiology of CO poisoning. It has been revealed that fatal poisoning ranks third after mechanical injuries and mechanical asphyxia and constitutes 6.3% (513 cases) in the range of deaths by violence (8078 cases). Therefore, CO poisoning is considered as one of the most prevailing (51%) causes of mortality.

Conclusion: This is a global problem, with young males at risk. Further studies on the current clinical and forensic aspects of CO poisoning are required, and the necessity for regular analysis of epidemiological data for taking comprehensive measures to prevent CO poisoning is emphasized.

Russian Journal of Forensic Medicine. 2020;6(4):4-9
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ORIGINAL INVESTIGATIONS
COVID-19 pathology: experience of 2000 autopsies
Zayratyants O.V., Samsonova M.V., Cherniaev A.L., Mishnev O.D., Mikhaleva L.M., Krupnov N.M., Kalinin D.V.
Abstract

Background: Pathological anatomy, patogenesis and the morphogenesis of manifestations and complications of COVID-19 remain insufficiently studied. The fullest information on structural bases of organs and tissues alterations by new coronavirus disease can be obtained as a result of autopsies.

Aims: The aim of the study was to study the morphological changes of lungs and other organs of the autopsies of COVID-19 deceased persons. Results of 2000 autopsies of people who died of a severe form of COVID-19 in Moscow, consisting of 1212 men and 788 women, from March 20 to May 22, 2020 (a ratio 1.54:1) aged from 20 to 99 years (on average 68.5±15.63 years) were presented. This experience was previously generalized in the Atlas COVID-19 pathology. Autopsies were made in the converted interstationary pathoanatomical offices at strict observance of rules of biosafety according to standard and legal documents of WHO, Russian Ministry of Health and Rospotrebnadzor.

Results: Morphological changes of lungs with varying severity and extent were detected in all examined cases; however, damage to other organs was also common, which in some cases prevailed over pulmonary changes and was the cause of death. The main morphological changes in lungs were diffuse alveolar damage and microangiopathy, alveolar hemorrhage syndrome, thrombosis, and thromboembolism.

Conclusion: The involvement of the lungs, other organs, and vascular system in the pathological process is a result of multiple factors. It is advisable to implement clinical and morphological «masks» of COVID-19.

Russian Journal of Forensic Medicine. 2020;6(4):10-23
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Mechanical intestinal obstruction as a cause of death in forensic practice: a retrospective study
Rubtsov A.E., Morozov M.Y., Nikolenko V.N., Morozov Y.E.
Abstract

Background: Acute mechanical intestinal obstruction is relevant for surgical and forensic practice. However, in forensic literary sources, the structure of death from intestinal obstruction is not sufficiently covered.

Aims: Investigate the structure of mortality due to acute mechanical obstruction of the intestine according to the conclusion of forensic medical examinations for the period 2015–2019, generalize and highlight the peculiarities of sectional practice in this pathology compared to clinical data.

Results: The number of deaths from mechanical intestinal obstruction during the studied period of forensic practice was stable. The most common cases were deaths from acute mechanical intestinal obstruction caused by the impairment of various external ventral hernias or prior to the adhesion process in the abdominal cavity.

Conclusions: The structure of mortality from acute mechanical intestinal obstruction according to forensic expert practice differs from clinical data, where the adhesion form of mechanical obstruction prevails significantly.

Russian Journal of Forensic Medicine. 2020;6(4):24-29
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Neuro-gliovascular module of the corpus callosum in the diagnosis of diffuse axonal brain injury
Koludarova E.M., Zorikov O.V., Tuchik E.S.
Abstract

Background: Currently, there is no scientifically based diagnostic complex for diffuse axonal brain injury (DAI) which allows to reveal its morphological substrate and determine the time elapsed after it, especially in the early post-traumatic period.

Aims: The aim of the study was to identify of morphological changes in the corpus callosum in various post-traumatic periods after DAI. The material of the study is the corpus callosum of victims who died from traumatic brain injury with DAI within the first hour (group I, n=25), in the period from 1 to 12 hours (group II, n=30) and in the period from 12 to 48 hours (group III, n=17) before the death. The control group of the study comprises the corpus callosum (n=25) of those who died from various causes of non-violent and violent death (without any head trauma).

Results: The main diagnostic criterion for DAI is represented by hemorrhages in the substance of the corpus callosum truncus. The proposed complex of morphological changes in the neuro-gliovascular module will allow to determine the time elapsed after DAI.

Conclusions: DAI as a special type of traumatic brain injury is manifested by a pathognomonic complex of pathomorphological changes in the deep structures of the brain, including the corpus callosum. Objectification of the time elapsed after DAI should be based on a comparative assessment of all morphological features of the identified neuro-gliovascular module, while its individual features can not be considered as diagnostic.

Russian Journal of Forensic Medicine. 2020;6(4):30-34
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MANUAL FOR THE FORENSIC MEDICAL EXPERT
Work experience bureau of forensic medicine of Moscow region in the context of a pandemic caused by a new coronavirus infection
Prikhodko A.N., Maksimov A.V., Frolova I.A., Krupin K.N.
Abstract

Background: The article presents the results of studying cases of deaths of individuals from a new coronavirus infection according to forensic research.

Aims: The aim of the study was to generalize and identify patterns of damage to internal organs and body systems in cases of death caused by COVID-19 without medical assistance based on the study results of forensic research of corpses.

Results: A total of 198 cases of fatal outcomes from a new coronavirus infection was studied. The frequency of fatal outcomes was determined in various age groups. The leading morphological manifestations of internal organ lesions were established. Absolute (abs) and relative (%) frequencies were calculated for qualitative variables. The lungs were found to be most susceptible to changes. In 77.8% of cases, pathological changes corresponded to the acute phase of diffuse alveolar damage. In addition to lung damage, the most common sign was the depletion of spleen parenchyma by lymphocytes, indicating an immune inflammatory response of the body.

Conclusion: The identified characteristic morphological signs of alveolar lung damage in COVID-19 can be used as a differential diagnosis of lung damage from shocks of other etiology.

Russian Journal of Forensic Medicine. 2020;6(4):35-40
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Use of computed tomography data for forensic identification of an individual
Leonov S.V., Shakiryanova J.P.
Abstract

Background: The article presents our own experience of using computer tomography for identification of individuals with known results.

Aims: The aim of the study was to verify the possibility of performing an identification study using a three-dimensional model obtained from computed tomography of the head. Identification was performed using a three-dimensional model of the head, based on computer tomography sections made in various projections, with a step of 1.23–1.25 mm. Two-dimensional images of the face (photos) were used for comparison. All comparative studies were conducted using approved methods of craniofacial and portrait identification: by reference points and contours. The experiment used a computer program that allows you to export DICOM-files of computed tomography results to other formats (InVesalius), as well as computer programs that directly work with the research objects (Autodesk 3ds Max, alternative programs Adobe Photoshop, Smith Micro Poser Pro).

Results: In the course of research, it was found that, having computer tomography data of the head, it is possible to conduct identification studies on the following parameters: on the reconstructed three-dimensional model of the soft tissues of the face, on the three-dimensional model of the skull (craniofacial identification), on the features of the structure of the ear.

Conclusion: Positive results were obtained when comparing objects, which makes it advisable to use them in practical and scientific activities.

Russian Journal of Forensic Medicine. 2020;6(4):41-45
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EXPERT PRACTICE
Diagnostics of the cause of aneurism rupture in case of basal subarachnoid hemorrhage: a rare case report
Veselkina O.V., Plis S.S., Khutornoy N.V., Shishkina L.V., Prazdnikov E.N., Klevno V.A.
Abstract

Background: Basal subarachnoid hemorrhage (SAH) caused by rupture of intracranial aneurysms usually has non-traumatic etiology. However, head injury shortly before death can start legal case, even if aneurysm was found. In such cases, forensic pathologists have to decide on the cause of the rupture and the role of the injury.

Case presentation: The article presents a rare case from forensic practice: 43 years old male dies after a head blunt trauma. The death was caused by basal SAH, which was caused by a microaneurysm rapture of the left posterior cerebral artery. The autopsy revealed external damages on the face and focal hemorrhages in soft tissues of the head and back. A detailed analysis of the morphological findings, clinical picture and circumstances was performed. The results showed that it was non-traumatic basal SAH. The cause of aneurism rupture was intracranial hypertension increased by vomiting and unusual body position shortly before the death.

Conclusion: Available published articles were studied on the causes of ruptures of pathological cerebral arteries and forensic interpretation in controversial cases. Results suggest that current recommendations should be revised. The hypothesis of the most significant sign indicating unnatural death (localization of the damage in the projection of the brain base) could not be confirmed.

Russian Journal of Forensic Medicine. 2020;6(4):46-53
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Midgut agenesia (clinical and forensic medical aspects): a rare case report
Maltsev A.E., Razin M.P., Skobelev V.A., Schukhina A.Y.
Abstract

Background: Congenital obstruction of the gastrointestinal tract in the form of complete atresia occurs in newborns in 60% of all cases of obstruction of the digestive tract, while agenesis of the derivative of the midgut is a rather rare defect.

Case presentation: After birth, the child in this case was repeatedly operated on for congenital intestinal obstruction. Most of the jejunum, ileum, cecum, ascending, right half of the transverse colon were absent in the child, and an anastomosis was performed between the jejunum and transversum. In the postoperative period, it was not possible to cope with the intestinal and protein -energy deficiency and the child exerted at home. The section has confirmed clinical diagnoses.

Conclusion: The authors draw attention to the possibility of resorption of the extraperitoneally located intestine at the end of the first period of intrauterine rotation with a possible vascular and/or ischemic disaster.

Russian Journal of Forensic Medicine. 2020;6(4):54-58
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РERSONALITY
On the 65th birthday of Pavel Leonidovich Ivanov
Klevno V.A., Zemskova E.Y.
Abstract

Doctor of Biological Sciences, Professor Pavel Leonidovich Ivanov celebrated his 65th birthday on July 27, 2020. He is known as an internationally recognized scientist, an outstanding forensic geneticist, renowned both in Russia and in other countries, Deputy Director for High-Tech Research of the Russian Center for Forensic Science of the Ministry of Health of the Russian Federation, an expert of the Russian Academy of Sciences, a member of the International Society of Forensic Genetics and the European Network of Forensic Science Institutes (ENFSI), a full member of the World Academy of Science for Complex Safety, and an author of more than 300 scientific papers.

Russian Journal of Forensic Medicine. 2020;6(4):59-64
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