Reporte de caso: decapitación y desmembramiento del cuerpo; Lesiones postmortem con sierra de cinta.

El desmembramiento y la decapitación son procedimientos que frecuentemente se observan en la práctica médico forense, en la etiología descrita se incluyen de tipo suicida, accidental y criminal, esta última se produce generalmente de forma inmediata posterior a la muerte; dentro los principales motivos por los cuales se realiza la mutilación de un cadáver postmortem incluyen el transporte del cuerpo a un lugar distinto de la escena primaria, impedir la identificación del fallecido, envío de mensajes, limpiar la escena, retrasas la investigación e incluso facilitar el transporte del cuerpo. Este proceso es realizado en dos tiempos, en el primero se seccionan piel, tejidos blandos, músculos y tendones y posteriormente en un segundo tiempo realizar el corte sobre el hueso o las articulaciones. Diversas líneas de investigación se han enfocado en la identificación de las características morfológicas a nivel de los bordes de corte, es por ello que en el presente reporte de caso se busca mostrar las características macroscópicas de una amputación postmortem realizada mediante la utilización de una sierra de cintaDismemberment and decapitation are procedures that are frequently seen in forensic medical practice, the described etiology include suicide, accidental and criminal. the criminal etiology usually occurs immediately after death; the main reasons for the mutilation of a corpse include transportation of the body to a different place than the primary scene, impede the identification of the deceased, send messages, clean the crime scene, obstruct the investigation and facilitate the body transportation. This process is performed in two stages, in the first time the skin, soft tissues, muscles and tendons are dissected and then in the second time the bones or articulations are cut. Several lines of research have focused on the identification of morphological characteristics, it is why in the present case report we want to show the macroscopic characteristics of an amputation postmortem with a bland saw

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care