Serological Response to Treatment of Syphilis According to Disease Stage and HIV Status

The serological response to treatment was studied in 264 syphilis patients; it was influenced by syphilis stage but not by human immunodeficiency virus infection and reinfection. Some of the recommendations of current guidelines are critically discussed, and amendments are propose

Technical note: post mortem CT angiography of iliacofemoral arteries after cardiovascular surgery

This technical note details a variation of post mortem computed tomography angiography that usually uses femoral access. In this instance, the focus of the forensic investigation centered around a heavily calcified and surgically altered femoral region. So instead, a subclavian access to the aorta was employed. In order to preserve anatomical areas of interest, alternate access may increase evidential value of resulting imagery and autopsy results

Possible XOR fallacy – Case report of combined foramen sternale with an osseous sternal knife stab injury

This case report details a sternal finding that first was reported as penetrating knife stab wound. It was one in a series of 24 otherwise relatively superficial skin stab wounds allegedly performed by a single assailant within the scope of a single attack. The effort required to penetrate the sternum with a knife appears to be considerably higher than to inflict relatively superficial skin and soft tissue penetration. This initially raised suspicion of another person contributing to the attack, or, a different weapon being used. After reviewing the clinical CT scans, we identified the combination of a preexisting sternal foramen with a marginal fracture and concluded that the sternal “penetration” was in keeping with the depth of the other 23 stab wounds. None of the injuries were lethal, the victim survived the attack. Assuming that a knife penetration fracture of a sternum and a foramen sternale are mutually exclusive constitutes an exclusive-OR fallacy (XOR fallacy)

Serological response to treatment of syphilis according to disease stage and HIV status

Background. Serology is the mainstay for syphilis diagnosis and treatment monitoring. We investigated serological response to treatment of syphilis according to disease stage and HIV status. Methods. A retrospective cohort study of 264 patients with syphilis was conducted, including 90 primary, 133 secondary, 33 latent, and 8 tertiary syphilis cases. Response to treatment as measured by the Venereal Disease Research Laboratory (VDRL) test and a specific IgM (immunoglobulin M) capture enzyme-linked immunosorbent assay (ELISA; Pathozyme-IgM) was assessed by Cox regression analysis. Results. Forty-two percent of primary syphilis patients had a negative VDRL test at their diagnosis. Three months after treatment, 85%-100% of primary syphilis patients had reached the VDRL endpoint, compared with 76%-89% of patients with secondary syphilis and 44%-79% with latent syphilis. In the overall multivariate Cox regression analysis, serological response to treatment was not influenced by human immunodeficiency virus (HIV) infection and reinfection. However, within primary syphilis, HIV patients with a CD4 count of <500 cells/μL had a slower treatment response (P = .012). Compared with primary syphilis, secondary and latent syphilis showed a slower serological response of VDRL (P = .092 and P < .001) and Pathozyme-IgM tests (P < .001 and P = .012). Conclusions. The VDRL should not be recommended as a screening test owing to lack of sensitivity. The syphilis disease stage significantly influences treatment response whereas HIV coinfection only within primary syphilis has an impact. VDRL test titers should decline at least 4-fold within 3-6 months after therapy for primary or secondary syphilis, and within 12-24 months for latent syphilis. IgM ELISA might be a supplement for diagnosis and treatment monitoring

Postmortem 1^1H-MRS—detection of ketone bodies and glucose in diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a metabolic complication of diabetes mellitus that takes a lethal course if untreated. In this way relevant to forensic medicine, secure diagnosis of DKA usually involves the evidence of elevated levels of glucose and the ketone bodies acetone, acetoacetate, and β-hydroxybutyrate in corpse fluids. We conducted a postmortem hydrogen proton magnetic resonance spectroscopy ($^1$H-MRS) in a case of lethal DKA. Distinctive resonances of all three ketone bodies as well as glucose were visible in spectra of cerebrospinal fluid, vitreous humor, and white matter. Estimated concentrations of ketone bodies and glucose supported the findings both of autopsy and biochemical analysis. Advantages of human postmortem $^1$H-MRS are the lack of movement and flow artifacts as well as lesser limitations of scan duration. Postmortem $^1$H-MRS is able to non-invasively measure concentrations of glucose and ketone bodies in small volumes of various regions of the brain. It may thus become a diagnostic tool for forensic investigations by quick determination of pathological metabolite concentrations in addition to conventional autopsy