Craniofacial injuries by firearms projectiles : an analysis of 868 deaths in the five regions of Brazil

Orientador: Ana Cláudia RossiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: As lesões por armas de fogo possuem um importante significado jurídico e médico-legal, sendo especialmente letais quando atingem as regiões craniofaciais da vítima. As propriedades médico-legais desse tipo de lesão constituem pontos que precisam ser estudados pois são úteis para as investigações do caso. Assim, o objetivo desse estudo foi identificar as características das lesões craniofaciais decorrentes de projéteis de arma de fogo, observadas em cadáveres necropsiados em cinco Institutos Médico-Legais do Brasil, registrar as regiões craniofaciais mais atingidas por esse tipo de injúria e verificar o perfil demográfico das vítimas envolvidas. Para isso, foi realizado um estudo retrospectivo nos registros tanatoscópicos produzidos no primeiro semestre de 2015, nos Institutos de Medicina Legal de Porto Velho ¿ RO, João Pessoa ¿ PB, Vitória ¿ ES, Porto Alegre ¿ RS e Brasília ¿ DF, selecionados aleatoriamente em cada região do país. Foram selecionados laudos de cadáveres de qualquer sexo e cor da pele, com idade entre 12 e 80 anos e que apresentassem pelo menos uma lesão óssea craniofacial por arma de fogo. Os dados extraídos incluíram sexo, cor da pele e idade da vítima, região craniofacial atingida, distância do tiro, forma e tamanho dos ferimentos e causa jurídica da morte. Com base nos 868 laudos analisados, foi possível observar 1700 lesões de entrada de projéteis de arma de fogo em regiões craniofaciais. Entre os casos de causa jurídica conhecida, os homicídios foram os mais frequentes com 447 (97,0%) casos, em comparação com 13 (2,8%) de suicídio e 1 caso (0,2%) de acidente por arma de fogo. Observou-se maior frequência de vítimas do sexo masculino (93,3%), pardos (62,0%), na faixa etária de 12 a 29 anos (59,4%). Em todos os casos considerados como suicídio ou acidente houve apenas uma lesão de entrada, mas em 82,8% dos homicídios observaram-se múltiplas entradas. As regiões craniofaciais mais atingidas por entrada de projéteis de arma de fogo foram a temporal (25,2%) e a occipital (19,8%), considerando todos os casos. A saída dos projéteis foi mais comum nas regiões temporais (25,3%) e parietais (16,1%). Todos os casos de suicídio estavam relacionados a registro de tiro encostado (69,2%) ou de curta distância (30,8%), e entre os homicídios foram mais frequentes os disparos à distância (54,0%). O contorno da lesão de entrada foi majoritariamente circular (56,8%) e oval (31,3%) e entre as lesões de saída, as formas mais encontradas foram a irregular (43,3%) e a estrelada (24,1%). As lesões de entrada mostraram tamanhos menores do que as lesões de saída, com médias de 9,85 mm e 13,37 mm respectivamente (p < 0,0001, Teste de Mann-Whitney). A presente pesquisa concluiu que os homicídios são responsáveis pela maior parte das mortes causadas por projéteis, com vítimas majoritariamente do sexo masculino, pardos e jovens. As lesões de entrada são mais frequentes nas regiões temporal, occipital e parietal, causados por disparos à distância, com contorno circular ou oval, e tamanho menor que os ferimentos de saída. Tais dados podem fundamentar investigações e futuras pesquisas baseadas nas análises discutidas no presente trabalhoAbstract: Firearms injuries have an legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The medical-legal properties of this type of lesion are points that need to be studied because they are useful for investigations related to each case. Thus, the present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, observed in corpses necropsied at five Institutes of Legal Medicine in Brazil, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. For that, a retrospective study was carried out on the autopsy records produced in the first semester of 2015, at the Institutes of Legal Medicine in Porto Velho - RO, João Pessoa - PB, Vitória - ES, Porto Alegre - RS and Brasília ¿ DF, randomly selected in each region of Brasil. Reports were selected of corpses of any sex and skin color, aged between 12 and 80 years and presenting at least one craniofacial bone lesion by firearm. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death. Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent with 447 (97.0%) cases, compared with 13 (2.8%) suicides and 1 case (0.2%) of accident with gunshot. It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions, with averages of 9.85 mm and 13.37 mm respectively (p <0.0001, Mann-Whitney Test). The present study concluded that homicides are responsible for most of the deaths caused by projectiles, with victims mostly male, brown and young. Entrance injuries are more frequent in the temporal, occipital and parietal regions, caused by distance shots, with circular or oval outline, and smaller size than the exit injuries. Such data can base investigations and future researches based on the analyzes discussed in the present workDoutoradoAnatomiaDoutora em Biologia Buco-Dental001CAPE

Ensino de arte: história, memória e subjetividade

O presente trabalho faz parte da pesquisa do Mestrado em Educação intitulada “Ensino de Artes no Colégio de Aplicação João XXIII”, em que se pretende discutir o papel da Arte, assim como seu ensino e percurso no interior desta instituição. A primeira etapa deste trabalho é a pesquisa documental, a qual foi submetida como Projeto de Pesquisa modalidade PROBIC Jr à Pró-Reitoria de Pesquisa ProPesq/UFJF. Desta forma, a pesquisa documental do trabalho de Mestrado tornou-se um projeto de Iniciação Científica Júnior, que traz seu primeiro resultado parcial. Neste artigo, escrito em forma dramatúrgica, está sendo focalizado um recorte de sete anos dentro dos quarenta e oito que o Colégio já trilhou, misturado às memórias pessoais das três autoras. No Arquivo do Colégio, a análise foi iniciada por uma série de relatórios anuais referentes aos anos de 1978 a 1984. A Educação Artística não constava oficialmente na grade curricular de 5ª a 8ª séries, o que não significou a ausência da arte na formação dos alunos e alunas daquele segmento. Assumindo a perspectiva foucaultiana, o que significa pensar o ensino de Arte relacionado à constituição dos sujeitos, busca-se a presença permanente da arte na vida escolar, presença esta que se dava de forma transversal e como recurso pedagógico em algumas disciplinas e dentro de eventos e projetos realizados pelo/no Colégio, num convite a colocar em suspeita as potencialidades e desafios da arte fora da disciplina Artes, e suas articulações com a História, a Memória e os Processos de Subjetivação. Palavras-chave: Ensino de Arte; História; Memória; Subjetividade.

Multimorbidity worsened anxiety and depression symptoms during the COVID-19 pandemic in Brazil

Multimorbidity is a global health issue impacting the quality of life of all ages. Multimorbidity with a mental disorder is little studied and is likely to have been affected by the COVID-19 pandemic. We used a survey of 14,007 respondents living in Brazil to investigate whether people who already had at least one chronic medical condition had more depression and anxiety symptoms during social distancing in 2020. Generalized linear models and structural equation modelling were used to estimate the effects. A 19 % and 15 % increase in depressive symptoms were found in females and males, respectively, for each unit of increase in the observed value of reported chronic disease. Older subjects presented fewer symptoms of depression and anxiety. There was a 16 % increase in anxiety symptoms in females for each unit increase in the reported chronic disease variable and a 14 % increase in males. Younger subjects were more affected by anxiety symptoms in a dose-response fashion. High income was significantly related to fewer depressive and anxiety symptoms in both males and females. Physical activity was significantly associated with fewer anxiety and depression symptoms. Structural equation modelling confirmed these results and provided further insight into the hypothesised paths

Características das mortes violentas em estabelecimentos penais da região metropolitana de Vitória - ES

A situação carcerária no Brasil se encontra desestruturada, em condições de superlotação, confinamento, falta de serviços básicos e de saúde e extrema insegurança, que favorece a ocorrência de altos índices de mortes no interior das unidades prisionais. Os assuntos penitenciários têm importância significativa no contexto da segurança, da saúde pública e da medicina legal e o conhecimento de suas reais condições pode fomentar ações que visem à diminuição da violência nesses locais e a reeducação e recuperação dos internos. O objetivo do presente trabalho foi analisar as mortes violentas ocorridas no interior de presídios, discriminando as causas de morte mais frequentes e os meios ou instrumentos mais utilizados, e identificando características das vítimas como sexo, idade e instituição penal de procedência, além de discutir aspectos éticos e legais inerentes ao tema. O estudo retrospectivo foi realizado nos arquivos do Departamento Médico Legal de Vitória, por meio de um levantamento nos laudos referentes a necrópsias realizadas em cadáveres procedentes de estabelecimentos penais da região, examinados no período de janeiro de 2003 a dezembro de 2007, com idades entre 12 e 80 anos, sem distinção de sexo. A análise dos dados permitiu identificar algumas características particulares, tais como maior número de mortes entre presos do sexo masculino, de idade jovem, procedentes do Complexo Penitenciário de Viana. As mortes por traumatismo crânio-encefálico e asfixia corresponderam à maioria dos casos, e o instrumento contundente foi o mais utilizado para produzir as mortes. Evidenciou-se, portanto, a baixa capacidade de fazer valer as leis e os princípios fundamentais de respeito à integridade física dos indivíduos presos.The prison´s situation in Brazil is unstructured, in conditions of overcrowding, confinement, lack of health and basic services and extreme insecurity, which favors the occurrence of high rates of death inside the penitentiary units. The prison issues have significant relevance in the context of security, public health and forensic medicine, and the knowledge of their actual conditions could foster actions aiming the reducing of violence in these places, reeducation and rehabilitation of inmates. The aim of this study was to analyze violent deaths inside prisons, to define the most common causes of death and the most used means or instruments and to identify characteristics of the victims like as gender, age and penal institution of origin, as well as discuss ethical and legal issues inherent to the subject. The retrospective study was conducted in the archives of the Forensic Medical Department of Vitória, through a survey in the records related to autopsies performed in corpses from prisons of the region, examined in the period from January 2003 to December 2007, aged from 12 to 80, irrespective of sex. Data analysis identified some characteristics, such as greater rates of death among young age and male prisoners, coming from the Penitentiary of Viana. Deaths due to head trauma and asphyxia accounted for most cases, and the blunt instrument was used to produce the most deaths. It was evident, therefore, the lack of ability to enforce the laws and fundamental principles of respect to physical integrity of individuals arrested

What Are the Expectations of Legal Operators and Forensic Experts Regarding Photographic Documentation of Violent Death Autopsies?

The purpose of photography in violent death autopsies is to document the material evidence of the offense and guide decisions in the courts of law. The aim of the present study was to obtain the expectations of legal operators and forensic experts regarding what is expected as adequate photographic documentation in violent death forensics. For this purpose, a survey was prepared through an online form available on the “Google Forms” platform, whose link was sent by e-mail and by the WhatsApp Messenger® application. The 102 participants were divided into two distinct groups: legal practitioners, interested in the materialization of evidence (judges, prosecutors, criminal lawyers and police chiefs), and forensic experts, responsible for materializing the evidence (medical examiners, forensic dentists and criminal experts). The research showed that the inclusion of color photographs in the expert reports is essential for all research participants, as well as the marking of evidence in the images and the inclusion of explanatory text in the captions. It was also pointed out as fundamental for most participants to insert an image with simulation of the firearm bullets’ path, when applicable. In relation to the other aspects, it can be observed that the opinions of the participants were divergent between the groups of research professionals, especially regarding the size of the image to be incorporated in the reports. The differences found between the groups can be detrimental to the proper interpretation and judgment of evidence in the courts. Considering the found barriers, the authors suggest a form of photographic documentation that meets all expectations in a consensual way

Professional liability and neural injuries: Court case related to surgical grafts

Introduction: During implant placement and surgical practice, it is not uncommon the contact or the violation of the continuity of important nerve fibers from the region of the mouth, resulting in characteristic symptoms in patients. Such injuries can result in legal repercussions against the dental surgeon, who to avoid them shall establish specific actions in his proceeding. Purpose: The objectives of this study were to present a forensic case, emphasizing the legal care that the dentist must have in the course of treatment and to guide forensic dentistry experts during the expertise exam. Case description: In this case, the patient had complications after the autogenous bone graft surgery. The graft was resorbed, and the patient had hypoesthesia in the graft donor area. The dental surgeon had not informed her about the risks of surgery, and had not applied the Consent Form. With proof of damage, there was disruption of the doctor-patient relationship and patient sought rights in court. Conclusion: The correct diagnosis and planning, the prior written consent, including the risks of the procedure, and appropriate management of patients decrease the clinical and legal complications in cases of dental error. Similarly, the expert must have a competent clinical approach, performing the indicated and appropriated tests for the proper valuation of the damage generated

Admission dental examination: protocol and its importance in the diagnosis of oral pathology

The aim of this paper is to describe an efficient clinical protocol used in admittance dental examinations, highlighting the importance of this evaluation in the diagnosis of oral pathologies. Two admission case reports in which gingival abscess and radiopaque apical lesion were found during the examination are presented for illustration purposes. A clinical examination in the admission inspection is the main factor for a good selection of treatment and prevention of future difficulties. The admission dental examination by means of a standardized clinical approach including clinical interview, physical examination and complementary exams, avoids the person to be admitted to the public service while having some pathology that might compromises his/her capacity of handling the selected function, preventing absenteeism for dental reasons and consequently a cost to the state and functional repercussion to the server