BLOOD ALCOHOL CONCENTRATION AND ROAD TRAFFIC ACCIDENTS - AN OBJECTIVE BASED REVISION

Il primo obiettivo di questo lavoro \ue8 stato quello di studiare la distribuzione della concentrazione di alcol nel sangue (BAC) in soggetti coinvolti in incidenti stradali tra il 2006 e il 2010 nella Provincia di Verona. Ci\uf2 \ue8 stato possibile perch\ue9 tutti i soggetti coinvolti in incidenti stradali ammessi al Pronto Soccorso degli ospedali in provincia di Verona sono sottoposti ad analisi tossicologiche per verificare l\u2019abuso droghe e/o alcool. Il secondo obiettivo era quello verificare una possibile relazione tra BAC e la gravit\ue0 delle lesioni riportate e analizzare se l'alcol \ue8, oltre ad un rischio di incorrere in incidenti, anche un fattore di rischio per la gravit\ue0 delle lesioni. Abbiamo raccolto 3035 test alcolemici effettuati con HS-GC (Gas-cromatografia dello spazio di testa) presso il Laboratorio di Tossicologia del Dipartimento di Sanit\ue0 Pubblica e Medicina di Comunit\ue0 - Sezione di Medicina Legale, Universit\ue0 degli Studi di Verona, su soggetti coinvolti in incidenti stradali nella Provincia di Verona e ricoverati negli Ospedali di Verona, San Bonifacio, Peschiera, Legnago e Bussolengo. Dati clinici e anamnestici sono stati raccolti da 1706 soggetti coinvolti in incidenti stradali dal 2006 al 2009, al fine di valutare la gravit\ue0 delle lesioni. Inoltre su campioni di sangue di 393 soggetti coinvolti in incidenti stradali con lesioni e ricoverati negli ospedali della Provincia di Verona durante il 2010-2011, \ue8 stata determinata la CDT mediante cromatografia liquida ad alte prestazioni (HPLC). Sulla base della BAC, si sono trovati i seguenti risultati: 11% di soggetti aveva una BAC 640,5 g/L, 8% una BAC da 0,5 a 0,8 g/L, 24% una BAC da 0,8 a 1,5 g/L, 39% una BAC da 1,5 a 2,5 g/L e, infine, il 18% una BAC >2,5 g/L. Vale la pena sottolineare che l\u201981% dei soggetti positivi aveva una alcolemia superiore a 0,8 g/L, mentre il 57% era superiore a 1,5 g/L. La BAC media era di 1,69 g/L, 88% erano maschi, 72% italiani, l\u2019et\ue0 media era di 37 anni (ma il 66% della popolazione comprendeva soggetti dai 20 ai 40 anni). La pi\uf9 alta media di BAC (2,05 g/L) \ue8 risultata in soggetti di 41-50 anni di et\ue0. Per analizzare la possibile correlazione tra la concentrazione di alcol nel sangue e la gravit\ue0 delle lesioni, abbiamo considerato come criteri il codice di "Triage", la prognosi e la presenza di fratture importanti; inoltre i casi sono stati classificati come "gravi" o "non gravi" (dove "gravi" si segnalavano pazienti con almeno uno dei seguenti fattori: codice di triage rosso o giallo, il ricovero dal Pronto Soccorso presso un altro reparto, presenza di fratture maggiori); abbiamo considerato anche un \u201cpunteggio\u201d assegnato a ciascun soggetto in base alla gravit\ue0 delle lesioni riportate. Una sub classificazione \ue8 stata applicata anche sulla base del tipo di veicolo coinvolto. Il presente studio conferma i dati della letteratura scientifica internazionale, ovvero che il rischio di incidenti stradali \ue8 nettamente aumentata quando il tasso alcolemico >0,8 g/L (dove \ue8 raggruppato l\u201981% del campione). Inoltre abbiamo trovato una differenza statisticamente significativa tra il gruppo di BAC positivi e BAC negativi per la gravit\ue0 delle lesioni. Questa correlazione con soggetti BAC positivi sembra essere particolarmente forte nel gruppo dei motociclisti. Infine, i risultati del presente studio suggeriscono che elevate concentrazioni di CDT sono associate ad un pi\uf9 alto rischio di provocare o essere coinvolti in incidenti stradali con lesioni.The first aim of this work was to study the Blood Alcohol Concentration (BAC) distribution among subjects involved in road accidents occurred between 2006 and 2010 in Verona Province. This was possible because all the individuals involved in road accidents admitted to Emergency Room of the hospitals on province of Verona undergo toxicological analysis to determine drugs of abuse and/or alcohol. The second aim was to find a possible relation between BAC and the severity of crash-related injuries and analyze if alcohol is, besides an accident risk, even a risk factor for the severity of injury. We collected 3035 blood alcohol tests carried out by HS-GC (Head Space-Gas-Chromatography) at the Toxicology Lab of Department of Public Health and Community Medicine \u2013 Section of Forensic Medicine, University of Verona, from subjects involved in traffic accidents in Verona Province admitted to Hospitals of Verona, Hospital of San Bonifacio, Hospital of Peschiera, Hospital of Legnago and Hospital of Bussolengo. BAC analysis was performed by Head-Space Gas-Chromatography (HS-GC). Clinical and anamnestic data were also collected from 1706 subjects involved in road accidents from 2006 to 2009, in order to evaluate the severity of the injuries. Blood samples from 393 subjects involved in traffic accidents with injuries were collected at admission to hospitals of Verona Province during 2010-2011 and CDT was determined by High Performance Liquid Chromatography (HPLC). On the basis of BAC value, there were 11% of subjects with a BAC 640.5 g/L, 8% with a BAC ranging from 0.5 to 0.8 g/L, 24% with a BAC ranging from 0.8 to 1.5 g/L, 39% with a BAC ranging from 1.5 to 2.5 g/L and, finally, 18% with a BAC >2.5 g/L. It is worth to stress that 81% of subjects with alcohol in blood had more than 0.8 g/L, and 57% had even above 1.5 g/L. The average BAC was 1.69 g/L, 88% were male, 72% Italian; the average age was 37 years (but 66% of the population ranged from 20 to 40 years old). The highest BAC average (2.05 g/L) resulted in subjects of 41-50 years old. To analyze possible correlation between blood alcohol concentration and severity of injuries, we considered as criteria the \u201cTriage\u201d code, prognosis and presence of relevant fractures; moreover the cases were classified as \u201csevere\u201d or \u201cnot severe\u201d (where \u201csevere\u201d patients had at least one of the following factors: Red or Yellow triage code, admission from ER into another hospital division, relevant fracture/s); we considered also a \u201ctrauma index score\u201d assigned to each subject. A sub classification was applied also by type of vehicle involved. The present study confirms the data of the current international scientific literature that the risk of road accident relating motor vehicles is neatly increased when the BAC >0.8 g/L (where it is grouped the 81% of the sample). In addition we found a statistically significative difference between BAC positive and BAC negative group about severity of injuries. Correlation with BAC positive subjects seems to be particularly strong in motorbikers. Finally the results of the present study suggest that elevated CDT concentrations are associated with a higher risk of causing or being involved in traffic accidents with injuries

Unusual ligature mark after strangulation and skin maceration

Strangulation by ligature is often homicidal and is mainly diag- nosed through the detection of a ligature mark on the neck. We describe the unusual appearance of a ligature mark in a woman who was strangled and thrown into a river, where she lay for one month. On her neck, there was an irregular horizontal tear, asso- ciated with superficial ecchymosis and deep structures’ haemor- rhage. We made a comparison with literature cases of unusual features of the ligature mark. The ligature mark appearance can be influenced by post-mortem modifications, effects of conceal- ment methods, cut injuries and neck tightening resulting in decap- itation. Drowning victims could show injuries similar to those resulting from hanging/strangulation. We found just a few cases of water immersion after strangulation and no cases of a ligature mark presenting like a loss of substance. We tried to explain the unusual appearance of the ligature mark in our case: the skin at the ligature mark lost the superficial layer and underwent dehydration, so soaking and maceration have been accelerated and produced the appearance of loss of substance. Finally, the study led to the distinction from other sources of traumatic action and the defini- tion of the cause of death

Le indagini di Sopralluogo

Il sopralluogo giudiziario \ue8 il punto di partenza di ogni attivit\ue0 investigativa correlata all\u2019analisi della scena di un crimine. In questo capitolo vengono presentati i vari passaggi attraverso cui si articol

Il Sopralluogo Medico-Legale

Il sopralluogo giudiziario \ue8 il punto di partenza di ogni attivit\ue0 investigativa correlata all\u2019analisi della scena di un crimine. In questo capitolo vengono presentati i vari passaggi attraverso cui si articola

Fatal bleeding following scalp laceration: an uncommon cause of death in adults

Any wound of the scalp involving the subcutaneous layer may cause profuse bleeding. In such cases, haemorrhage may continue for a while because the natural tension of the scalp inhibits effective haemostasis. In addition, if special conditions coexist, this bleeding may lead to death. We described three cases of haemorrhagic shock by scalp lacerations. An 83-year-old man was found dead in his home lying on a large amount of blood on the floor. He had plenty of comorbidities and a multi-drug therapy, as anticoagulant. A 53- year-old heavy drinker man was found dead in his home with the bathroom and bedroom extensively smeared with blood. A 55-year- old woman with multiple sclerosis was hit in the face by a large stone while she was sitting on her car seat. A toxicological exam on blood revealed benzodiazepines at therapeutic levels. The most relevant conditions that must be present for a scalp laceration to become fatal are unwitnessed head trauma, delayed activation of emergency services, old age, comorbidities, anticoagulant medica- tion, alcohol abuse and significant blood loss from the scalp wound. Other possible causes of death should be excluded. Furthermore, in such cases, the differentiation between homicide and accident can be challengin

Trisomy 21 disclosure using STR and SNP markers typed by MiSeq FGx™ Forensic Genomics System

The presence of a tri-allelic pattern at a single locus in a multiplex short tandem repeat (STR) profile is a rarely observable event. Generally, based on peak height measured by the capillary electrophoresis (CE) method and combination of alleles, the tri-allelic pattern is distinguishable into two predominant types: type 1 and 2, which are caused, respectively, by somatic mutations and chromosomal rearrangements. When tri-allelic patterns at more than one STR located on the same chromosome are detected, there is a reasonable suspicion of a trisomy due to an extra copy of a chromosome. Therefore, information on the type of three-band pattern is usually limited to STRs localized on the same chromosome included in the forensic kit in use and sometimes in insufficient numbers to classify this event correctly. The opportunity to extend this evaluation to additional markers, such as SNPs detectable using NGS, has not yet been explored. In this study, using the ForenSeq™ DNA Signature Prep kit, two cases of autosomal aneuploidy were revealed on chromosome 21, relying not only on STRs assessment but also extending the analysis to the five identity-informative single nucleotide polymorphisms (iiSNPs) localized on chromosome 21

Can tissue deparaffinization influence the extracted DNA for forensic purposes?

In forensic genetics, sometimes the biological specimen available for DNA extraction is biopsy tissue taken in life from deceased subjects and then fixed in formalin and embedded in paraffin (FFPE). Degradation and chemical alteration of DNA caused by treatment of tissue with formalin and paraffin is an event reported in the literature, even if the influence of exposure time and intensity of the phenomenon are still uncertain. This results in obtaining DNA of degraded quality, the quantity of which is for sure affected by paraffin hindering its release from the tissues in the lysis step. Therefore, pretreatment of the biological sample, i.e. deparaffinization, may assume a relevant role in the subsequent DNA extraction and amplification steps. In this study, five different tissue deparaffinization protocols were compared to determine which was the most appropriate for the aim, exploiting two tissue samples (lung and kidney), FFPE over the next 24 h, taken during autopsies on two male cadavers. The deparaffinization protocols involved the use of the standard procedure with xylene and 100% ethanol and four methods in which paraffin solubilizing solvents were used, i.e. chloroform and white mineral oil. Then, DNA extraction was performed by employing the QIAamp DNA FFPE Tissue Kit, modifying the procedure only in the post-lysis step, in which the provided treatment at 90°C for 1 h was omitted, proceeding with incubation at 70°C for 24 h, after addition of Tris 1M to the lysate. Extracted DNA was quantified and normalized to 1 ng/µl and then submitted for amplification with two forensic kits. Amplicons were genotyped in capillary electrophoresis and fragment analysis was conducted with the GeneMapper ID-X v1.6 software. The two panels of Short Tandem Repeats yielded reproducible, albeit partial, genetic profiles, referable to 12/13 loci (molecular weight <300 bp), and showed no significant differences correlated with the adopted deparaffinization procedure. Therefore, while being aware that the study needs to implement the number of samples, it seems reasonable to assume that deparaffinization can also be carried out by procedures other than the standard one, using solvents with low toxic characteristics

Incomplete decapitation in suicidal vehicle-assisted ligature strangulation: A case report and a review of the literature

Vehicle-assisted ligature strangulation is an extremely rare suicide method. We report a case of a 43-year-old man who secured one end of a nylon rope to a tree and the other end around his neck, then got inside his vehicle and stepped on the gas, leading to an incomplete decapitation. A sharply demarcated encircling ligature mark was found upon external examination, along with a deep laceration in the anterior region of the neck. The severance plane passed between the third and fourth cervical vertebrae, with diffuse haemorrhagic infiltration of the cervical muscles, in accordance with autopsy findings reported in the literature. The lung histological examination described a large amount of red blood cells and pulmonary oedema. A review of the literature concerning suicidal vehicle-assisted ligature strangulation cases allowed us to investigate some common autopsy findings, as well as the rope features relevant to the beheading

Two cases of multiple stab wounds: suicide or homicide?

Introduction. Multiple stab wounds in traumatic deaths usually indicate homicide. Nonetheless, a self-harming action should always be taken into consideration. Self-inflicted wounds tend to be in readily accessible regions of the body such as the anterior chest, neck and abdomen; sensitive areas are often spared. Hesitation wounds and no defence injuries are also typical of suicide. Materials and methods. Two cases of atypical suicide with a knife are reported. Homicide was initially suspected due to the amount and distribution of the injuries but, after investigation, the involvement of any other person could be excluded. Each case was subjected to a full medicolegal investigation with an autopsy and toxicological analyses. Background information was also reviewed. Results. Case 1: A 44-year-old male was found in an advanced stage of putrefaction on the floor of his flat. A lot of blood traces and a butterfly knife were found on the site. At autopsy, 14 stab wounds were identified to the anterior chest. Case 2: A 39-year-old male was found dead in his garage with a kitchen knife in his right hand. At autopsy, 25 stab wounds were identified to the neck and abdomen although only 14 were deeply penetrating. In both cases, there was a history of depression and there was no sign of forced entry or assault. Conclusions. The integration of circumstantial data, scene and autopsy findings, in particular with the study of the site, shape and direction of wounds are required to avoid misinterpretation of the manner of death

Vehicle-assisted ligature strangulation: case report of a bizarre suicide method and literature review

Introduction. Vehicle-assisted ligature strangulation is an extremely rare suicide method. We report a case of a 43-year-old man who attached one end of a nylon rope to a tree, fastened the other end around his neck and started his vehicle, leading to an incomplete decapitation. The rope was not found during crime scene investigation; hence policemen wrongly assumed it was a homicide. Materials and methods. We performed a literature review of all the studies published on the major scientific search engines: only 14 cases of this unusual suicide method are described in literature and only one of which involved an incomplete decapitation. We analysed all available cases regarding victim’s gender, possible decapitation, rope features (material, length, thickness) and its eventual breaking. Results. 93,3% of victims were male. Complete decapitation occurred in 6 cases, incomplete decapitation in 2 cases, decapitation was absent in 7 cases. Length and thickness of the ropes were extremely variable. The materials included metal, nylon, and hemp. In both cases of partial decapitation, and in 4 out of 7 cases in which decapitation was not described, the rope was broken. Considering the cases in which complete decapitation occurred, none of the ropes broke. Conclusions. Vehicle-assisted ligature strangulation is almost exclusively chosen by men, careful on-site inspection should be performed, to rule out other manners of death; rope features should be noted to compare them to the ligature mark and the possible decapitation since longer and more resistant ropes are more commonly associated to complete decapitation