Applicability of the abbreviated injury scale in forensic medical practice in Bulgaria

Introduction: The present study offers a detailed analysis of the principles of the American system for trauma classification AIS (Abbreviated Injury Scale) and  tests  the possibility of  its application  in  the field of forensic-medicine in Bulgaria, where currently traumas are classified according to the experts` subjective judgments.Materials and Methods: For the purposes of the study, expert reports have been used by 20 Bulgarian forensic doctors, written between 2009 and 2013, describing at least one temporarily life-threatening trauma. The severity of the traumas was evaluated according to AIS by the authors.Results: The comparison between the reports and the results of AIS indicates that the scale is applicable for forensic medical purposes and in determining life-threatening conditions. At the same time, differences have been discovered between the medico-biological qualifications of the Bulgarian experts regarding the same trauma; apparently as a result of the ambiguous wording of the Bulgarian Penal Code (unchanged since 1896).Conclusion: These differences accentuate the need for accepting a unified method of evaluating trauma severity. Taking such a step would dramatically improve the quality of Bulgarian forensic-medical reports

Светилището в местността Мишкова нива край Малко Търново - слуга на много господари

Светилището в местността Мишкова нива край градчето Малко Търново е древен обект на нашето културно наследство. Дълги години обектът е недостъпен, защото попада зад граничното заграждение, в "ничията" зона между България и Турция. Обектът обаче присъства с причудливи легенди в местния комплекс от фолклорни наративи. Проучван е от няколко археологически експедиции, "доукрасяван" от лаици с екзотични и модернистични истории от фентъзи-тип, а днес е напълно достъпен за посещения от страна на обикновени и поклоннически туристи. Много легенди го превръщат в една от големите гордости, но и големите грижи на Малкотърновска община.The sanctuary in the area Mishkova Niva near the town of Malko Tarnovo is an ancient object of our cultural heritage. For many years the site is inaccessible because it falls behind the border enclosure, in the nobody area between Bulgaria and Turkey. However, the site is present with bizarre legends in the local complex of folk narratives. It has been studied by several archaeological expeditions, adorned by Laitsi with exotic and modernist stories of fantasy-type, and today it is fully accessible for visits by ordinary and pilgrimage tourists. Many legends turn it into one of the big prides, but also the great care of the Malkotrnovska municipality

Complete transposition of the great arteries - surgical results and prognosis

Objectives: The aim of this study was to analyze the surgical results and the prognosis in patients with complete transposition of the great arteries (TGA).Study design: A group of 64 children with complete TGA out of 272 patients with critical congenital heart disease (CCHD) from the region of North-East Bulgaria was retrospectively followed for a period of 25 years (1987-2011 year). Methods of investigations include: clinical examination, electrocardiography, conventional radiography, echocardiography and cardiac catheterization. Surgical results were based on a scale, elaborated by us.Results: Complete TGA is the most frequent CCHD in the region of North-East Bulgaria - 23%, and in 64.1% of the cases it was associated with other cardiac malformations. Surgical correction was performed in 41 of the children (64.1%) with TGA - an average 2.17 interventions on each patient. The overall postoperative mortality rate was 43.9% and it was highest if concomitant lesions were presented, such as pulmonary stenosis or atresia, criss-cross atrioventricular connection and others - up to 50-60%. The balloon atrioseptostomy was the most common initial palliative procedure, performed in 83% of the newborns at a mean age of 7.1days and a mortality rate - 8.8%. In 31 of the children (75.6%) a complete corrective intervention was made. The most frequent was arterial switch operation (ASO) - 16 children (51%). Six of the children died - 37.5%, but the mean age of which the surgery was performed was significantly higher - 32.2 days in contrast to 16.8 days for the whole group (p<0.05). The surgical results on the 5th year were assessed as good/very good in 4 of the children and satisfactory in 1 child. Senning procedure was performed in 8 of the patients (26%) with a mortality rate of 25%. Four of the children (13%) undergone Rastelli or REV procedure and 3 of them (10%) had one-chambered Fontan procedure.Conclusions : Complete TGA is the most frequent CCHD. The associated cardiac malformations have significant influence upon the prognosis and the surgical results. On different reasons still significantly high number of children with TGA remains without corrective interventions. The fundamental corrective procedure is ASO and the delayed intervention leads to unsatisfactory postoperative results

A multidisciplinary approach to investigate the osteobiography of the Roman Imperial population from Muracciola Torresina (Palestrina, Rome, Italy)

The present research provides the osteobiographical reconstruction of the Roman Imperial population of the rural area of Muracciola Torresina (Palestrina, Rome, Italy) through an innovative multidisciplinary approach, combining evidence from skeletal biology, biomolecules and archaeobotany. The excavation of the site, unearthed 76 individuals: 84.2% adults and 15.8% non-adults. Morphological examination showed a higher prevalence of females with respect to males (M:F = 0.89). Musculoskeletal stress marker analysis highlighted a probable division of daily tasks between sexes; the observed modifications mainly affected the upper limbs with a particular involvement of shoulder and elbow joints. The population seems to have experienced physically strenuous life conditions, as suggested by the high frequency of degenerative and infectious diseases. Carbon and nitrogen stable isotope data supported an omnivorous diet mainly based on C3 plants and terrestrial animal protein. No statistically significant difference was found between sexes or age classes, even though a discrete variability of nitrogen isotopic values was observed which was hypothesized to reflect the consumption of pulses by certain individuals with the lowest values. Microscopic analysis of dental calculus detected Triticeae starch granules in the majority of the analyzed individuals. Chromatographic profiles additionally revealed the presence of ephedrine derivatives in the calculus of two individuals, an alkaloid which might indicate the consumption of Ephedra species used as medicinal plant due to its bronchodilator, nasal decongestant and vasoconstrictor properties. This use of multiple cutting-edge techniques has revealed a detailed snapshot of the diet and lifeways of the first Roman Imperial population to be recovered from the area of ancient Praeneste

45 years department of forensic medicine and medical low in Medical University `Prof. Dr. Paraskev Stoyanov` Varna

Scripta Scientifica Medica 2009; 41(1): 53-55

Heroin-related death - a review

The purpose of this study is to analyse all autopsied cases from 2007 to 2011 year (5 years), died from heroin over dose. Also we made a review of the problem. We investigated 13 cases. In all cases the chemical analysis found morphine, the active component of heroin after hydrolyses. There were in some cases alcohol and benzodiazepines, also traces of marijuana, barbiturates or amphetamines.SSM, 2012;44(1):35-3

Determination of Human Growth by the Long Bones of Limbs in Forensic Medicine and in Anthropology /// Определяне на човешкия ръст по дългите кости на крайниците в съдебната медицина и в антропологията Determination of Human Growth by the Long Bones of Limbs in Forensic Medicine and in Anthropology /// Определяне на човешкия ръст по дългите кости на крайниците в съдебната медицина и в антропологията

[EN] Determination of human height by the long bones of the limbs is based on the biometric linear relationship between them. In Bulgaria there are no regression coefficients and tables for estimation of the skeletal bone growth, there are no studies measurements of the long bones of the limbs, nor for their shortening with age. The linear and transverse lengths of humerus, tibia and fibula of the forensic carcasses of grown Bulgarians and Hungarians of both sexes before autopsy were measured. A total of 685 individuals were surveyed, of which 416 Bulgarians (286 men and 130 women), and 269 Hungarians (186 men and 83 women). The total (physiological) length of the humerus and tibia were measured, and for the fibula - the maximum length. Regression analysis was performed using original software written on MATLAB 5.3. In both populations and both sexes regressions were measured separately for the three bones, along with a combination measurements of humerus and tibia. The same regressions were studied in mixed samples between Bulgarian men and Hungarian men, respectively Bulgarian women and Hungarian women. Data reported by different authors (in five scenarios) about age reduction of growth were investigated, recorded and partly merged - in a table and nomograms. All regression models were tested for heteroskedasticity and outliers. Coefficients of models and their standard deviations, the default standard error and confidence intervals, the covariance matrix of the coefficients, and the ANOVA model adequacy test, were calculated. Correlation coefficients between height and length of each of the examined bones were estimated, for the Hungarian population being slightly higher. Adequacy and applicability of the formulas of Trotter-Gleser, Bach, Breitinger, and Dupertuis-Hadden were tested for all regressions of the studied material. These formulas were inappropriate for our data. This was explained by population structure and temporal changes, as well as by the use of different bone lengths. Determination of lifetime maximum growth, except for the regression equations, can be performed by the nomogram of a single bone, their confidence limits can be calculated as well. Though the computerized model, the results of all regressions can be used to estimate height by measurements of the bones, sex and age studied, giving the maximum and age-adjusted values. The program allows for unified calculation of a country-wide estimates of bones. Practical guidelines for determining the growth by the long bones of the limbs in forensic medicine and in anthropology have been developed.[BG] Определянето на ръста на човека по дължината на дългите кости на крайниците се базира на биометричната линейна връзка между тях. В България липсват регресионни формули и таблици за определянето на ръста по костите на скелета, липсват проучвания за дължините на дългите кости на крайниците и за ръството спадане с възрастта. Измерени са ръста и двустранно дължините на humerus, tibia и fibula на съдебно-медицински трупове на израснали българи и унгарци от двата пола преди аутопсия. Изследвани са общо 685 индивида, от които 416 българи (286 мъже и 130 жени) и 269 унгарци (186 мъже и 83 жени). На humerus и tibia се измерва общата (физиологична) дължина, а на fibula - максималната дължина. Регресионният анализ се осъществява чрез оригинален софтуер, написан на MATLAB 5.3. При двете популации, при двата пола са изследвани регресиите по трите кости поотделно, както и по комбинация от humerus и tibia. Същите регресии се изследват и при смесените извадки между български мъже и унгарски мъже, респективно български жени и унгарски жени. Проучени, описани и отчасти обединени са данните на различни автори (в пет варианта) за възрастовото намаляване на ръста - в таблица и номограми. Всички регресионни модели са тествани за аутлаери и за хетероскедастичност. Пресмятат се коефициентите на моделите и техните стандартни отклонения, основната стандартна грешка с доверителните й интервали, ковариационната матрица на коефициентите, ANOVA-тест за адекватност на моделите. Пресметнати са и корелационните коефициенти между ръста и дължината на всяка от изследваните кости, които са малко по-високи при унгарската популация. При всички регресии се проверява адекватността и приложимостта върху изследвания материал на формулите на: Trotter-Gleser, Bach, Breitinger и Dupertuis-Hadden. Тези сравнявани формули са неадекватни за нашите данни. Това се обяснява с популационни и времеви промени, както и с използването на различни костни дължини. Определянето на прижизнения максимален ръст, освен по регресионните уравнения, може да се прави и по номограмите при единична кост, като по тях се пресмятат и доверителните му граници. Чрез компютърната система, получените резултати от всички регресии се използват и за предсказване на ръста по дължината на изследваните кости, пола и възрастта, като се получават стойностите на максималния и на възрастово-коригирания ръст. Програмата разрешава унифициране на пресмятането на ръстовите оценки по изследваните кости за цялата страна. Изготвени са и практически указания за работа при определянето на ръста по дългите кости на крайниците в съдебно-медицинската практика и в антропологията

Sex variances in palate and maxillo-alveolar breadth in the north-eastern Bulgarian population

Introduction: The cranium is the most studied bone conglomerate in anthropomorphology.  Determining the sex, based on the cranial proportions is a key step in human bone remains analysis, with all other aspects being dependent on it. The purpose of this study was to measure the palate breadth (PB) and the maxillo-alveolar breadth (MAB), using craniometrical methods and establish the sex variances in the proportions of the maxilla in the north-eastern population of Bulgarian.Methods: We used skeletal remains, which were beforehand determined as either male or female with the help of the Anthropolog digital algorithm. The study included n=11 skulls, of which n=6 male and n=5 female kept in the Clinic of Forensic Medicine and Deontology at the `St. Marina` University Hospital, Varna, Bulgaria. The remains had an overall normal anatomical appearance and existing or postmortem dropped out molars. Two breadth ratios of the maxilla were measured, using a drawing compass, between two sets of a total of four craniometrical landmarks- left and right endomolare points (ENM) and left and right ektomolare points (EKM). The ENM-ENM breadth represents the PB and EKM-EKM breadth represents MAB.Results: The mean PB measured was 40.5mm (p>0.05), standard deviation ±1.22mm, median 40mm, range 39-42mm for males and 36.66mm (p>0.05), standard deviation ±1.82mm, median 36mm, range 35-39mm for females. The mean MAB measured was 59.5mm (p>0.05), standard deviation ±1.52mm, median 59.5mm, range 58-62mm for males and 54.6mm (p>0.05), standard deviation ±.3.85mm, median 56mm, range 50-58mm for females.Conclusion: PB and MAB show sex differences, with both breadths being larger in males. The result however, although promising, prompt further research into this area to determine greater, statistically significant sex variances in the maxillary breadth proportions of the north-eastern population of Bulgaria

Methyl alcohol poisoning - a morphological study for 20-years period

The clinical manifestations of methanol poisoning have been the subject of several review articles over the past forty years (2, 11), though de tailed post mortem pathologic studies are relatively few. The earliest autopsy studies on methanol poisoning have emphasized the acute changes secondary to hypoxic or ischemic in jury to the gray matter, cerebral oedema and acute neuronal in jury. Post mortem studies of individuals, who survive intoxication several days or weeks have shown brain in jury characterized by bilateral putamen necrosis, particularly affecting the lateral portions of the nuclei (1, 10). In some of the cases there has also been a dramatic pattern of white matter hemorrhagic necrosis, involving the centrum semiovale, especially affecting subcortical regions /10/. The precise mechanism of methanol toxicity remains a matter of debate /2/. The observed lesions represent direct toxic effects of methanol and its metabolites and injury, secondary to anoxia and acidosis. In jury to the putamen likely represents a selective toxic effect, possibly potentiated by poor venous drain age. The pathogenesis of the white matter hemorrhagic necrosis remains unexplained /6/.Scripta Scientifica Medica 2008; 40(2): 175-176