Vol 9, No 4 (2023)

BACKGROUND: Near-hanging refers to individuals who survive a hanging injury for various durations. However, hospitalized patients succumb to complications resulting in delayed deaths.

AIM: to evaluate various factors associated with causes of delayed death in near-hanging events and provide insight into the improvement of emergency services.

MATERIALS AND METHODS: A prospective autopsy-based study was conducted at the Department of Forensic Medicine, M.S. Ramaiah Medical College, between 2012 and 2021. All near-hanging cases of hospitalized patients who later succumbed to complications and were subsequently subjected to medicolegal autopsy were included in the study.

RESULTS: Victims were commonly women aged 19–30 years. More than half of them could reach the hospital within 30 min to 1 hour, and 47.8% of them were suspended for between 1–3 min. Moreover, 65% survived for more than a day. Partial hanging with a faint ligature mark was more common, and 95.7% of them had taken off from a platform with a falling height of <1 metre. Cerebral edema and consolidation were the common postmortem findings in the brain and lungs. Death was attributed to hypoxic encephalopathy in the majority of the cases.

CONCLUSION: Longer the duration of suspension, higher fall height, noncontact with the ground while being suspended, cerebral edema, hypoxia, pulmonary edema, hypotension, and need for resuscitation are predictors of fatal outcomes in near-hanging events.

BACKGROUND: In Bulgaria, procedural protocols following a citizen’s death are governed by an intricate network of normative documents. Despite the presumed alignment between international and national guidelines, practical experiences reveal shortcomings in the proficiency of healthcare providers, particularly in cases involving prior medical interventions or systemic vulnerabilities.

AIM: This study aimed to assess the readiness of final-year medical students and early-career physicians in navigating death certification intricacies, including their responses, documentation precision, and postmortem procedures for bereaved families, with implications for national health statistics.

MATERIALS AND METHODS: By employing a mixed-methods approach, this study distributed questionnaires to sixth-year medical students and practicing physicians, including those in emergency medicine centers and general practice. Data collection included paper-based and digital questionnaires, ensuring anonymity and ethical compliance. Statistical analysis, employing parametric (t-test) and nonparametric (Chi-square) tests, forms the basis for actionable recommendations and educational material development.

RESULTS: This study included 143 participants, of which 41% expressed apprehension about managing out-of-hospital deaths. Approximately 44% claimed familiarity with death certification regulations, with students displaying higher theoretical confidence but lacking practical knowledge. Remarkably, 74% of physicians never received formal training in death certification. Discrepancies in issuing death certificates, timing, and notification procedures were identified.

CONCLUSION: Findings reveal varying practices among physicians according to their specialties. Issues related to documentation, timing, and notification were prevalent. The study emphasizes the need for improved training, particularly for medical students. Emergency medicine doctors exhibited higher preparedness levels. Medical students and early-career physicians urgently require enhanced education in death certification preparedness. Incorporating these topics into medical curricula, offering specialized courses, and disseminating instructional materials can significantly enhance effectiveness. Future studies should assess the quality and accuracy of recorded causes of death, which affect healthcare statistics, public service, and legal procedures, underscoring the societal and administrative significance of death certification practices.

BACKGROUND: No studies in the scientific literature have established the operator dependence of portrait identification with the manual method of measuring facial parameters in subjects compared with measurements from digital images. The labor costs and accuracy of the measurements with these methods have not been established.

AIM: To establish the operator dependence of methods of real-face measurement and measurement on digital images.

MATERIALS AND METHODS: Facial parameters were instrumentally measured in 24 Caucasian women aged 19–20 years who were studying at the Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University by four researchers independently of each other. The same type of standard digital photography of each subject’s face was taken in five projections, followed by a comparison of the results of real measurements with digital ones.

RESULTS: When comparing the results of facial measurements obtained from digital images and manual method, an error was observed both in the measurements of one parameter by one researcher using two methods and in the excellent results obtained by other researchers. However, the greatest deviations were observed with the manual method, which may be due to the dependence of measurements on the operator.

CONCLUSION: With a streamlined and methodically verified approach to working with digital facial images, this technique is more accurate and less labor-intensive than real measurements because of the absence of operator dependence, which can be used in investigating crimes.

BACKGROUND: Over the past 5 years, the number of commission examinations on improper provision of medical care by the Bureau of Forensic Medical Examination of the Tambov Region has increased. These examinations were performed to identify defects in the provision of medical care and determine their effect on an unfavorable outcome for the patient.

AIM: To analyze and evaluate forensic medical examinations performed at the Tambov Regional Bureau of Forensic Medicine in so-called medical cases.

MATERIALS AND METHODS: To identify medical specialties with the most frequent cases of inadequate medical care, which are the direct cause of unfavorable outcomes, an analysis of examinations was conducted for 2017–2021. The study included examinations performed from both the Tambov region and other regions.

RESULTS: The number of cases of inadequate provision of medical care, for which the examination confirmed a cause-and-effect relationship with an unfavorable outcome, remains approximately at the same level throughout 2017–2021, and the largest number of defects in the provision of medical care were identified in the profile “obstetrics and gynecology.” However, the identified defects in the provision of medical care do not directly correlate with the number of examinations prescribed.

CONCLUSION: The analysis of medical cases showed that the number of examinations in which a direct causal link was established between defects in the provision of medical care and adverse outcomes remained low annually (not more than 9%). The largest number of defects in the provision of medical care was found in the profile “obstetrics and gynecology,” which relates to defects in diagnosis and treatment.

A constant, clear trend is observed toward the appointment of forensic medical examinations in criminal and civil claims to healthcare institutions and individual medical workers. In some cases, criminal cases were initiated against medical workers without sufficient grounds. In their grief, relatives are not always able to objectively assess the actions of medical workers, which is often the reason for contacting investigative and judicial instances. Lawyers also support them in this. Often, medical workers receive complaints because they do not know how to properly explain to the patient and relatives the complexity of the situation and insist on hospitalization. All this is taken into service by lawyers, including medical professionals. Thanks to their actions, the prosecutor’s office, investigation, and courts are forced to do unnecessary and not always necessary work. All the above has become more often manifested during the investigation and trials to mitigate the guilt of the accused in criminal cases that harm health. The defendant or the representative of the defense declares that the consequences of the injury caused to the victim or the death of the victim are the result of the improper actions of medical workers, that is, the victim received inappropriate medical care. Explaining the purpose pursued by these people is difficult. However, such statements only lead to a delay in investigative actions and trials, appointment of additional, and sometimes repeated, forensic medical examinations, including commissions. In court hearings, not only forensic medical experts who conducted examinations are called witnesses to the incident but also medical workers. The presented work provides an expert observation of the death of a 4-year-old child. During the investigation and trial, the issue of inappropriate medical care arose, and a forensic medical examination commission was appointed. The forensic medical examination revealed that the child received appropriate medical care and had no connection with bodily harm.

One of the most difficult types of research conducted in the forensic department of the Bureau of Forensic Medical Examination is the identification of individuals by bone remains. When examining discovered bone remains, the first stage includes the tasks of determining the belonging of bones to a person and then determining the racial identity, sex, age, and growth of an individual. The set of established characteristics plays a decisive role in further search activities and identification of specific persons. This article presents an actual case. Human bone remains were found in the forest, which was established to belong to a white man. The victim was most likely 173–183.5 cm tall. The anatomical and morphological features of the bones correspond to the age of 49–56.5 years. Further, an identification examination was conducted with the study of radiological images of citizen N (52 years old) using graphic identification algorithms. The results established that the bone remains belong to citizen N. The above case demonstrates the possibilities of identity identification in a comprehensive study of bone remains and confirms the relevance of the problem of identifying unidentified corpses in forensic medicine. However, even today, no specific algorithm has been established for identifying the identity of a corpse in a particular situation, which creates additional difficulties in choosing the most correct method (s). Further modernization and improvement of methods for identifying the identity of unidentified corpses is required, and the search for new, simpler, more accessible and objective research methods has both scientific and significant practical interest.

1923 marked the 120th anniversary of the defense of the doctoral dissertation “On Teeth in Forensic Medicine” by the outstanding Russian odontologist Gilyariy Ivanovich Vilga. The dissertation included an extensive review of foreign literature and the results of his research performed on 160 young healthy men (soldiers) using hand-made instruments.

The work, performed at the junction of odontology and forensic medicine, was the first in Russia to analyze traumatic dental injuries (dislocations and fractures) from this point of view, describe methods of identification of a person by odontological status, methods of studying bite wounds, and approaches to forensic examination of dental and dental technique errors. For many years, this work remained the only manual for odontologists and forensic experts in Russia.

Many provisions of the doctoral dissertation of G.I. Vilga “About teeth in forensic medical relation” have not lost their relevance even today; all this certainly allows us to consider G.I. Vilga as the founder of domestic forensic dentistry.

This review contains an overview of the textbook “Forensic medical assessment of traumatic brain injury” published in “Practical Medicine” by V.A. Klevno, V.V. Frolova, and I.A. Frolova. The review emphasized the importance of the peer-reviewed publication for modern medicine and content of the main sections devoted to the epidemiology of traumatic brain injury, revealed the main mechanisms of traumatic effects for causing traumatic brain injury and brain damage both with well-studied impression, compression, inertial trauma, and with impulse action, and emphasized the importance of defining the concept of traumatic brain injury, disclosure, and systematization of the concept of “damaging factors.” set out in the first five sections. The review also noted the importance of practical forensic experts’ knowledge of traumatic isolated subdural hematoma and chronic subdural hematoma, including the pathogenesis of its development and macroscopic signs in Sections 6 and 7 of the textbook. The review also evaluated the important role of practical recommendations on the rules for the collection and referral of biological materials for forensic histological examination, examples of the design of a forensic medical diagnosis, a medical death certificate, and conclusions for various types of traumatic brain injury. A detailed list of literary sources is provided, which presents the names of the most authoritative experts on the problem under consideration, as well as a glossary that is important for the unification and uniform understanding of the terms and concepts used. The review emphasizes the high quality of the book’s design, convenience for readers of the chosen publication format, and rich color schemes and illustrations. The analysis shows that the reviewed textbook contains the main information on traumatic brain injury and intracranial hemorrhages to date, which gives readers a full understanding of this problem, interests them with the need to understand complex and controversial issues and study the works referred to by the authors, which will undoubtedly improve the understanding of the complex mechanisms of various types of traumatic brain injury and the quality conducted forensic medical examinations. The textbook is extremely relevant, modern, and designed at a high level and contains comprehensive information for the training processes and use in the work of most medical specialists. The review concluded with a statement of hope that Vladimir Alexandrovic et al. will not stop there and will release a full-fledged manual on the forensic diagnosis of traumatic brain injury, with a more detailed classification and content that meets modern scientific and practical needs.