Medical, Forensic and Social Quandaries of Sudden Infant Death Syndrome Today

Sudden Infant Death Syndrome (SIDS) is described as the sudden, unexplained death (with no attributable cause, during sleep) of a seemingly healthy child before reaching the first year of life. Statistically, SIDS is recognized today as a leading cause of death in infants aged 1 to 12 months. In the present article the authors have analyzed known risk factors, classifications and current standards of forensic investigation while highlighting the necessity of detailed clinical history, autopsy, scene of death examination and lab findings (radiology, metabolic anomalies, infectious diseases and toxicology) in SIDS diagnosis. For an infant death to be considered SIDS, all other possible causes of death must be first excluded, the diagnosis requiring detailed collection and analysis of antemortem patient data and a complete autopsy. Although the forensic methods of today are more exact, the distinction between SIDS and other causes of death (e.g. unintentional asphyxiation, infanticide) remains very difficult in some cases.</em

Ethical Aspects of Biometric Identification

The term biometrics derives from Greek (bio=life and metrics=measure) and implies the measurement of biological signs. Biometrics is the science of recognizing people based on their physical, behavioral, and physiological attributes, such as fingerprint, face scan, iris, retina, and voice. The present paper aims to develop a study on biometric identification. The major objective of the study is to conduct a survey among the Romanian population on the importance and knowledge of biometric identification methods. This objective was achieved by assessing the knowledge held by the general population of Romania regarding biometric indicators and the degree of adaptability and openness of citizens related to the widest possible implementation of biometrics.  The study was based on conducting a quantitative analysis using a questionnaire. Due to the high degree of accessibility, the online environment was chosen as a method of application, distribution being made through social networks. A biometric template digitizes the human body, it has been argued that the collection of biometric identifiers not only interferes with the privacy and right to protection of a person's data, but also with the integrity of an individual's body. In conclusion, the creation and storage of a unique biometric template must be seen in relation to the purpose of the operation. The protection of citizens from criminal activities is a primary obligation of the state. However, it must be exercised with due respect for a number of fundamental ethical values and in the light of modern human rights law

Morphometry of the Foramen Magnum for Sex Estimation in Romanian Adult Population

The foramen magnum makes the transition between the cephalic extremity and the spine, which is an anatomical element of the skull. So, there are multiple situations when the skull is the only skeletal element available for anthropological analysis. In this respect, the foramen magnum can provide valuable information in terms of skeletal anthropological expertise. According to the literature, the foramen magnum provides, from a morphometric and morphological point of view, individual and population characteristics. The study aims to evaluate the morphometry of the foramen magnum for establish the sex of an unknown person, specific for Romanian adult population. The authors analyzed morphometrically the foramen magnum of 50 cranio-cerebral computer tomographic images. Measurements of the foramen magnum were taken anteroposterior diameter, transverse diameter, based on the two being calculated the anthropometric index and the area of the foramen magnum. Statistical analysis was carried out using SPSS 23. Discriminant function analysis was applied, and discriminant formulas were created for sex determination of Romanian adult population. The results of the analysis are impressive and have a good applicability in a forensic anthropological context. The data used in this paper provides reliable results with a large applicability in the future for estimating the sex from foramen magnum for Romanian adult population.</p

Homicidal Act Commited by an Elderly Person with Sexual Dysfunction - Case Report

Sexual dysfunctions (SDs) are highly prevalent with aging. Studies reported an interactive correlation between psychiatric morbidity and SD. Also, SDs have significant influence on patients` self-esteem, body image, interpersonal relationships, and physical health in general. The aim of the present research is to present an intimate partner homicide case and to discuss a possible correlation between SDs of elderly patients and their inclination towards aggressive behavior from intimate partner violence (IPV).A forensic psychiatric assessment was performed on a married male patient, aged 61. He was diagnosed and treated for BPH and he could no longer have sexual intercourse. Using a knife, he provoked over 20 stab wounds to his wife, who died following the attack. He admitted that he was jealous, due to his wife having an affair. The psychiatric forensic expertise found that the killing was committed with discernment.Psychological states found in IPV perpetrators are partly like those met in SDs patients. The relation between SDs in older adults and aggressive behavior, especially IPV, requires further research. In the case discussed, a complex of negative emotions and aggressiveness could be determined equally by infidelity of the spouse or by the perpetrator’s SD, but we can assume that SD played a relevant role in the causal chain.</em

Shaken baby syndrome: Case report

Recognition of abuse and the treatment of child victims are recent concepts in the history of mankind. Increasing the awareness of the need to treat and prevent such abuse is a characteristic of modern society. The beaten child syndrome was described by Ambroise Tardieu in 1860, and Shaken Baby Syndrome (SBS) was clearly illustrated in medical literature a century later by Caffey in 1972. The definition of SBS is based on the association of major intracranial lesions with minimal external lesions and the diagnosis is still difficult to establish. The authors describe a reduced number of 7 cases of pediatric patients addressed for forensic expertise and where suspicion of SBS has arisen. The lesion mechanisms involved in the production of this syndrome are still controversial and are sources of frequent debates in legal medicine. These uncertainties can make legal punishment inoperable. The therapeutic management of these children in neurosurgery is not subject to international consensus, and discrepancies between different clinics impede a comparative cohort assessment. However, SBS is a major public health problem due to severe neurological injuries caused to child victims during brain development

Mental Illness and Patricide. A Case Report of Patricide

According to world-wide statistics, schizophrenia is the most common mental illness identified in people who commit this type of murder. Also, there are slight associations between matricide which is often committed by the sons and patricide which is often committed by daughters. Most of the perpetrators in cases of parricide are under the age of 30, with adolescents covering a big part of the chart. The age of schizophrenic debut, the psychiatric and social attendance of the patients, the active psychotic symptoms, with hallucinations and paranoid persecution ideas but also, the affective inversion towards close friends and family members are frequently found in people who commit parricide. Also, psychotic symptoms and schizophrenia-like clinical aspects can appear in other mental disorders such as mental retardation, dementia or bipolar disorder. The subject is extremely complex as it has to be understood through the characteristics of the mental illness, the basic family relations, the personality of the victims, and last, but not least, the discernment issue that gives more heaviness to the juridic and social involvements of these cases.We hereby present the case of a 17-year-old girl, from the forensic psychiatric board, diagnosed with mental retardation and psychotic symptoms that murdered her father by multiple strikes in vital areas with blunt and sharp objects. We will assess the familial, social and psychological aspects of the case, revealing the implications of mental illness and forensic psychiatry in law enforcement and social services.</p

Medico-legal implications of C1 vertebral fractures: Case report

Introduction: The upper C1-C2 column is the subject of several erroneous diagnostics. The most common mechanisms of injuries include fall from high-impact skulls, car accidents, etc. Vertebra C1 can also be injured by mild trauma. The Japanese show that atlas fractures occur in about 2-13% of the cervical spine fractures and about 1.3% of the total spinal cord injuries. It is underlined that CT examination is the most useful diagnostic method. The Czechs show that the atlas lesions appear in 1-2% of the cervical spine lesions. Americans reported fracture of the atlas in 7% of the cervical spine fractures. Even if CT has shown its value, lateral radiography is recommended in C1-C2 fractures. When victims are children or people injured in high-speed car crashes, the reported mechanisms were the fall from a high level and the impact on the tip of the flexed skull. The Italians mention that the C1-C2 area is the most exposed diagnostic area with errors.Material and methods: given the difficulty of establishing a diagnosis of C1 type fractures, we present in this paper such a case. We highlight the value of a CT scan. The victim is a 26-year-old woman with a trauma from the wall. The main issue in this case is that the diagnosis made by the radiologist seems to be wrong, the electronic and imprinted copies are of inferior quality. A second opinion revealed a very fine fracture that seemed to come from an older date than the date when the victim claimed she was assaulted. The better the lesions, the more misleading the interpretations. Any imaginary imaging lesion, especially if it is obvious in electronic reconstructions, must be brought to the attention of the physician if they are taken into account by "image". The axial CT sections may omit some lesions under certain conditions, for example at the upper and lower poles of a spherical, ovoid or cubic structure, such as the atlas lateral mass.Conclusions: the diagnostic solution in this case is the reconstruction of the axial sections in several planes. The crack can be highlighted, in the case of a reconstructed image, only after stacking the axial images. The mechanism could be through sudden compression, during a sudden head movement, uninitiated and uncontrolled by the neck muscles, when a movement occurs over the degree of elasticity of the occiput-atlas joint, the occipital condyles compressing abruptly, unilaterally one of the atlas masses. In such clinical cases, we experience pain, muscle contraction and torticollis, on a normal neurological background

Chemical Biomarkers of Diffusse Axonal Injury

Craniocerebral trauma is the most common cause of death and post-traumatic disability in people under 45 years of age. In Romania, the annual incidence shows, that for every 100,000 inhabitants, there are 300 cases of craniocerebral trauma that require specialized medical assistance. Craniocerebral traumas are the most common types of traumas encountered in current forensic practice. Research on the mechanisms of injury, the timing of head trauma and the establishment of causes of death remain relevant. Establishing the traumatic moment implies both the distinction between pre-mortem and post-mortem injuries but also considerations regarding the post-traumatic survival interval. Regarding the elucidation of the moment of occurrence of the craniocerebral trauma from the forensic point of view, a satisfactory result has not been reached so far. The classic hypothesis regarding the development of traumatic brain injuries shows that they are the result of primary traumatic injuries due to cell necrosis combined with the inflammatory brain response that causes secondary brain injuries. It was considered that post-traumatic neuronal losses are strictly due to necrosis and inflammation, and cellular apoptosis being a physiological process, does not play a role in this process. Due to recent experimental data, brain cell apoptosis has begun to be reevaluated. The pathophysiology of traumatic brain injury is far from being fully understood, with the idea that apoptosis would play an even more important role than originally thought. Specifically, damaged brain cells release neuromodulatory substances that can lead to late-onset neuronal damage long after necrotic and inflammatory brain phenomena have ceased to act. These neuronal cell losses are responsible for the development of various neurological deficits and post-traumatic sequelae.</p

Implications in Forensic Medicine - an Exploratory Lumbar Spine Analysis of Sex and Age for the Romanian Population

The attribution of biological sex and age are important aspects in forensic medicine investigations in establishing the identity of unknown skeletal remains. Where remains are incomplete or have been compromised by damage or fragmentation, this can affect the accuracy to which sex and age can be determined and require the development of other tecniques using different bone elements or isolateed bone elements. The objective of the paper was to conduct a descriptive and inferential analysis on certain parameters studied on the lumbar spine with implication in estimating sex and age. The present study used 149 images of magnetic resonance of the vertebral lumbar column, on which the authors perfomed a large-scale analysis of three parameters measured on the RM images from a modern Romanian population. The results of the study found that mostly all variables analysed are involved in evaluation of sexual dismorphism. Regarding age prediction, in this study we conclude that some analyzed parameters are important in providing significant age differences. The present work is a novelty in the field and brings more originality, as it took into account all 5 lumbar vertebrae. The lumbar vertebrae can reliably providing an additional element to the growing list of postcranial skeletal elements that can aid in developing the biological profile of unidentified human remains. However, we need further studies with a larger number of images and to derive population-specific discriminant and regression functions.</p

THE PAST, PRESENT AND FUTURE OF LEGAL MEDICINE IN ROMANIA

As a borderline science, forensic medicine has had a closely connected evolution, over the ages, with the evolution of law and medical sciences. The progress of law sciences determined the evolution of social relations and extended the application field of forensic medicine, whereas the new and modern techniques of investigation influenced considerably the development and accuracy of forensic investigation