Vol 8, No 2 (2022)
- Year: 2022
- Articles: 10
- URL: https://for-medex.ru/jour/issue/view/34
- DOI: https://doi.org/10.17816/2411-8729-2022-8-2
Full Issue
EDITORIAL
International congress: “Topical issues of forensic medicine and expert practice-2022”
Abstract
On April 20–21, 2022, the International Congress: “Topical Issues of Forensic Medicine and Expert Practice-2022” was held in Moscow based on the Moscow Regional Research Clinical Institute named after M.F. Vladimirsky. The International Congress has once again gathered a pool of leading experts in the field of forensic medicine from different countries. The International Congress was attended by leading practitioners and prominent scientists, department heads, and heads of forensic medical expert institutions. Specialists from Germany, Italy, Portugal, Japan, Turkey, the Czech Republic, Slovakia, Belarus, Kazakhstan, Turkmenistan, Kyrgyzstan, and other countries expressed a desire to share their experiences with colleagues and discuss the most pressing problems of forensic medicine. The scientific program of the congress was compiled, emphasizing the latest achievements in various fields of forensic medicine and related disciplines. Program reports on trends and ways of world forensic medicine development in the XXI century were presented at the plenary sessions, and the most promising areas of expert research in the field of thanatology, laboratory diagnostics of pathological processes, experts, and law enforcement practice of harm caused to human health were discussed at specialized sections.
5-11
ORIGINAL STUDY ARTICLES
Alcohol and children: clinical and forensic study
Abstract
BACKGROUND: This study aimed to evaluate the differences in the clinical pictures in the group of alcohol intoxication (without the loss of conscious) and alcohol poisoning (with the loss of conscious).
AIMS: This study aimed to investigate the clinical differences in the groups of alcohol intoxication (without loss of consciousness) and alcohol poisoning (with loss of consciousness) and determine the level of blood ethanol concentrations in children and adolescents from alcohol intake that causes a loss of consciousness, which means ethanol poisoning occurrence, and finally, offer practical recommendations for forensic doctors in cases of alcohol poisoning in children.
MATERIALS AND METHODS: The total amount of data was a combination of two studied populations: population No. 1 from the archive of the Bureau and population No. 2 from the Children’s Clinical Hospital No. 13 named after N.F. Filatov. The study is a retrospective population-based and prospective (observational) cross-sectional study. Data were grouped as (1) persons whose alcohol intake did not cause significant health disorders (alcohol intoxication) and (2) persons whose alcohol intake caused the onset of coma, respiratory arrest, or death (alcohol poisoning). Urine screening for psychoactive and narcotic substances was conducted using liquid chromatography-tandem mass spectrometry.
RESULTS: The data set included 67 minors aged 11–17 years. Blood and urine ethanol levels of males and blood of females were significantly higher than in patients with alcohol intoxication. The objective status of patients was the same. No differences were found in alcohol pharmacokinetics (resorption and elimination), as well as the instrumental parameter readings. The present study revealed that alcohol intoxication and poisoning were not associated with dangerous changes in such parameters as systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate.
CONCLUSION: The results showed that ethanol poisoning in children aged 11–17 years old developed at an ethanol concentration of 2.61 g/L in the blood and 3.01 g/L in the urine. Additionally, no significant differences were found in the instrumental parameters.
13-22
Trajectory simulations by the numerical solution of the point-mass equations of motion for 7.62 mm/.308” rifle bullets
Abstract
BACKGROUND: The understanding of the dynamics of the trajectory is important in ballistics to estimate the values of various flight variables accurately. The paper deals with the study of the fundamental principles of external ballistics, which allows to delve into the trajectory characteristics of the free flight trajectory of seven. 308” caliber bullets by numerically solving the point-mass equations of motion. Numerical solutions were performed by writing scripts in the Python programming language and using the Matplotlib library to plot simulated trajectories.
AIM: the three aims of the study were to observe the variation of CD with Mach number (Ma) of flight and calculate an average CD for each bullet under consideration. Further, solving the 3-DoF (Degrees-of-Freedom) Point-Mass trajectory equations of motion for the given bullets (along side observing the effects of range winds on the trajectory behaviour as a variable). And finally, solving the flat-fire approximation with analysis of the effects of a crosswind.
MATERIALS AND METHODS: Simulations of free-flight trajectories of seven different 7.62 mm/.308” rifle bullets (designated B0–B6) have been carried out by the numerical solution of the equations of motion. The average drag force coefficients (CD) for B0–B6 have been calculated by scaling the variation of CD with the Mach number of flight with reference to the G7 standard projectile. The Point-Mass trajectory model and its Flat-Fire approximation have been studied with and without the effect of range winds. The solutions of the systems of equations have been carried out by writing scripts in the Python programming language.
RESULTS: It is observed that an increase in the bullet weight and consequently the sectional density lowers the CD. As expected, it is seen that the bullet with the highest drag (B0) has the shortest range and lowest apogee, while lower drag bullets fly further and higher. The crossover of trajectories is observed at ~30° angle of gun elevation, which implies that the maximum range is not achieved when fired at 45°, as is the case with vacuum trajectories. Flat-fire approximation of the point-mass model was also solved to observe trajectories and crosswind deflections of the bullets when fired at <5° angles of elevation.
CONCLUSION: This project presents the numerical solution of equations of motion of the Point-Mass model for a bullet fired from a gun to computationally simulate its trajectory. A group of seven 7.62 mm/.308” rifle bullets were chosen as samples to simulate free-flight trajectories. The programming language Python is well-equipped to carry out numerical solutions of systems of differential equations owing to its library of in-built functions which assists in writing an efficient script and reduces computational load. This method of solution can be applied with suitable modifications in the field of forensic ballistics for the reconstruction of bullet trajectories and to form a conclusion based on the available evidence from a crime scene.
23-36
New methods of sectional studies of the human pelvis and perineum
Abstract
BACKGROUND: Currently, the issue of sectional studies in developing methods for expert assessment of pelvic organs and the perineum in road accidents, falls from a height, perineal intentional injury with any objects, and sexual crimes remain relevant.
AIM: To develop standardized sectional methods for pelvic and perineal forensic examinations.
MATERIALS AND METHODS: This study included 10 corpses of elderly and senile persons who are subject to forensic medical examination, no later than 12 h after death confirmation. We introduced three new methods for forensic studies of the pelvis and the perineum: the study of the human perineal organ complex (two males and one female); the method of perineal muscle isolation (two females and two males); the method of access the perineal center and associated muscles (two females and one male).
RESULTS: Three new methods of pelvic and perineal forensic examination were developed and patented. The method of human perineal organ complex isolation allows expert studies to sample the organ complex of the pelvis and the perineal region in the corpse while preserving the topographic and anatomical relationships. This method is of particular importance for expert studies of corpses with extra body weight. The method of perineal muscle isolation was intended for visual access to examine the pelvic diaphragm muscles, intermuscular spaces, and/or sample tissue fragments for histological examination. The method to access the perineal center and associated muscles are intended for urological and obstetric study of the perineum and pelvic floor muscles.
CONCLUSION: The proposed methods are recommended for sectional forensic studies in cases of suspicion of injuries and pathological processes of various genesis in the pelvic region and the perineum. These methods are simple in technical execution, as well as for expert studies of this area in corpses, with extra body weight, and do not require complex skills and special equipment.
37-44
CASE REPORTS
Inter-play of trauma and disease ― a case report
Abstract
Determining cause and manner of death in medico legal cases is of paramount importance in forensic practice. A 29 year old woman was brought by the police for medico legal autopsy with history of assault by her boyfriend. As per the initial police investigation and crime scene visit by the police, the case was registered as culpable homicide amounting to murder. Autopsy revealed that the deceased had acute on chronic meningitis, a natural disease incompatible with life if left untreated. It was also observed that there was a faint ligature mark around neck and multiple contusions at places over the body. There were no features suggestive of asphyxia or other findings which could alone cause death. The deceased was alive for some time after the assault. Considering these facts, cause of death was attributed to meningitis and further it was opined that the assault could have expedited the death.
45-50
A double-edged weapon or commission forensic examination in civil trial on medical cases
Abstract
BACKGROUND: A commission forensic medical examination is crucial for examining medical cases, and its conclusion is of fundamental importance to the court. However, experts often do not use their rights to the fullest extent, limiting themselves to the study of medical documentation. Such an approach negatively affects the quality of concrete conclusions, which is associated with legal risk in criminal and civil proceedings.
CASE PRESENTATION: This review is devoted to a case report on moral damage compensation recovery from the hospital to the relatives of patient A., who died during medical care. A commission forensic medical examination could not establish death causation, citing inadequate medical documentation. The commission made no attempts to gather additional information on the case. The victims sued the two hospitals for a total of 2,500,000 rubles. The court of first instance dismissed the lawsuit, finding the defendants’ guilt unproven. The appellate court reversed this decision and indicated that the defendants must themselves prove their innocence; however, neither the available documentation nor the expert opinion was allowed to do this. The court ordered the defendants to pay 1,600,000 rubles.
CONCLUSION: A commission forensic medical examination opinion must serve as evidence in the case. However, the court can interpret a formal approach to its performance against the defendants, sometimes even in cases where the medical care was potentially accurate and under accepted standards and recommendations.
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Precomatosis condition as a factor of violent death in patients with diabetes mellitus: a rare case report
Abstract
BACKGROUND: Diabetic coma is a common diabetes mellitus complication. The study of carbohydrate status is usually conducted with non-violent death; however, the death of patients with diabetes can occur with various types of violent death. This study aimed to describe and analyze rare expert cases of the circumstances of violent death in patients with diabetes mellitus.
CASE PRESENTATION: This publication presents two cases of the violent death of patients with diabetes mellitus, of which the cause was a precomatous state, which is the beginning of diabetic (hyperglycemic) coma development. The first case was a corpse of a 56-year-old male patient who was found in an apartment in a bathtub with water. The patient died from drowning in freshwater by aspiration. The second case was a 62-year-old male patient who lost control of the car and allowed the vehicle to overturn. The patient died due to a closed craniocerebral injury of the body. In both described cases, the provoking factor was an acute complication of diabetes mellitus in the form of diabetic coma development (precomatosis condition), which was confirmed by the data of a biochemical study of blood, urine, and the vitreous body.
CONCLUSION: One should not forget about the acute complications of diabetes mellitus (diabetic comas) due to its widespread among the population, which can become provoking factors for the onset of violent death. Therefore, conducting a complete laboratory study on patients with diabetes mellitus, even under any circumstances of the case, is recommended.
59-64
Forensic significance of X-ray data in the definition prescription of diaphyseal fractures: a case from expert practice
Abstract
BACKGROUND: Determining the prescription of fractures is important when conducting a forensic medical examination of victims, accused persons, etc. This allows the expert to immediately determine the causal relationship of the skeletal injury found in the sub-expert with the events described in the decision on the forensic medical examination, especially in cases when the conducted examination according to medical documents may be concealed or distorted of the incidental circumstances; thus the investigating authorities need to decide on the case and establish the truth. Often, medical documents, especially in cases of a single request for medical help, do not contain enough information about the clinical picture of the fracture, with limited or missing descriptions of the local status. In such cases, one of the most important sources of information for the expert is radiography data (radiographs in electronic form or on X-ray film and computed tomograms), which the study allows the expert to conclude the mechanism of injury and the prescription of fractures. The study of literary sources on this topic did not reveal the exact criteria for determining the prescription of fractures based on the study of the X-ray examination results in the forensic aspect.
CASE PRESENTATION: The description of a case from practice was provided. In our practice, a case with fractures that did not correspond to the events of the described incident in the resolution as found by the sub-expert, and these fractures were not regarded by the surgeon as “old” and unrelated to the specified circumstances of the case. The presented radiograph examination allowed the forensic medical expert to determine the time frame of the detected fractures and establish the absence of a causal relationship of this injury with the events specified in the resolution.
CONCLUSION: The analysis of this expert case allows us to conclude the importance of examining the radiography data by the forensic medical expert to determine the description of fractures.
SIGNIFICANCE FOR FORENSIC MEDICINE: The presented case from the practice demonstrates the need for a critical approach of the forensic expert, both to the presented medical data and the information contained in the materials of the preliminary examination or criminal case, as well as the importance of an independent study of the X-ray examination results of the subject.
65-71
Detection of fragments of an obstacle and a projectile in a gunshot injury
Abstract
BACKGROUND: Law enforcement agencies look for the presence of an obstacle between the human body and the muzzle of a firearm at the time of the shot when assigning forensic medical examination of a firearm injury. Imported particles removed from the corpse, a skin flap, or damaged clothing could be sent for a laboratory examination.
CASE PRESENTATION: Here, we present a case from expert practice which demonstrates the possibility of establishing the presence of barrier particles on surrounding objects in the case of a gunshot injury caused to a person. In the given case, detecting the fragments of an obstacle (triplex ― the windshield of a car) played a leading role in proving the suspect’s involvement in the incident under investigation. Described are the violations of an expert method of particle removal (in one case only, the material obtained from the clothing was placed on a special carbonic adhesive tape during a targeted search of micro overlays) and evaluation of the obtained data which contributed to incorrect findings in the expert’s conclusion.
Experts of the Federal State-Owned Institution “111 Main State Center for Medical and Forensic Examinations” conducted a re-examination of the above-stated objects, as well as experimental target shooting with similar weapons through a similar barrier. Presented are the possibilities of modern scanning electron microscopy and energy dispersion analysis, which allow not only to establish the presence of barrier particles on surrounding objects but also to identify the signs of gunshot damage inflicted upon a human body and clothing, identify the destroyed projectile particles, and establish the elemental composition of all the detected microparticles.
CONCLUSION: This study demonstrated the methodological gaps in establishing the existence of a passage of a firearm projectile through an obstacle in the case of a gunshot injury. The methods for identifying the fragments of a firearm projectile and particles of an obstacle, which we are currently developing, are aimed at solving this problem by improving the corresponding research methods in forensic medicine and science.
73-80
Skull injury due to atypical firearm: a case report
Abstract
BACKGROUND: Injuries from atypical firearms are highly variable in their morphology and often differ from typical gunshot injuries. This can lead to problems in forensic diagnostics. Knowledge of the atypical weapons design and discovery of atypical projectiles inside a body or at crime scene allows proper injury nature assessment.
CASE PRESENTATION: The morphological features of the entrance and exit gunshot wounds of the occipital and frontal bones caused by an atypical projectile ― a concrete nail 4.5×60 mm are described. The entrance gunshot injury had typical morphological features associated with the specific action of the projectile (a tissue defect, internal beveling of wound). The exit wound was atypical due to the incomplete exit of the concrete nail from the cranial cavity, as well as the anatomical features of the damaged area.
CONCLUSION: Atypical firearms and projectiles are diverse and their samples may have many unique designs and technological features knowledge of which may be crucial for forensic examination of gunshot injuries. A comprehensive medico-legal assessment of the injury gunshot nature and the number of shots is traditionally based on the injury morphology and revealing the gunshot residues. However, the presence of projectiles and/or their fragments in the body facilitates the solving of expert tasks. In our case the key to the correct interpretation of the wounds nature was the presence in the skull of an atypical projectile ― a concrete-nail.
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Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 60835 выдано 09.09.2021 г.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 – 59181 выдано 03.09.2014 г.