Žmogžudysčių Lietuvoje vertinimas teismo medicininiu, etiniu, socialiniu ir teisiniu požiūriu

The homicide rate and Lithuanian gross domestic product has a strong correlation, which suggests that homicide rate should increase due to poverty. In all subjects, the death due to injuries by hard and blunt objects accounts for a large percentage (52.2%). The stabbing – cutting follows next (33.2%). 68% of the murders used one type of method when they killed. In comparison with the male group, women had more experiences of trauma. Homicides by sharp instruments were committed more often between males. In the female group, asphyxia was the most common measure of death. The offenders were more likely to be severely intoxicated when committed homicide by a sharp instrument. The victims without alcohol experienced 3 or less of trauma when they were attacked with a hard, blunt things. They were more likely to survive more than 24 hours. 73% of victims were male. Younger men (45.5 ± 15 years) and older women (50.9 ± 17 years) made the majority of homicide victims. 58.6% of victims drunk alcohol. The majority of victims was unemployed and had only primary or secondary education. In more than half of the cases (53%), victims were acquainted with the murderer. The mean age of the male killer was 34.5 ± 14 years, and mean age of female murderers was 38.5 ± 14 years. The majority (66%) of the offender’s was intoxicated of alcohol. The occupational analysis showed that the majority (73%) of them were unemployed and had only primary or secondary education. The most likely scenario of a homicide in Lithuania is when the killer and the victims are both male. Recommendations for prevention of homicide: the stable condition of employment, to enhance the education programs of alcohol consumption in high-risk families, human rights education for young children, prevention programs of recurrence for those who already committed homicide, and to fulfil register and analysis system of homicide

Evaluating homicide in Lithuania in terms of forensic, ethical, social, and legal aspects

The homicide rate and Lithuanian gross domestic product has a strong correlation, which suggests that homicide rate should increase due to poverty. In all subjects, the death due to injuries by hard and blunt objects accounts for a large percentage (52.2%). The stabbing – cutting follows next (33.2%). 68% of the murders used one type of method when they killed. In comparison with the male group, women had more experiences of trauma. Homicides by sharp instruments were committed more often between males. In the female group, asphyxia was the most common measure of death. The offenders were more likely to be severely intoxicated when committed homicide by a sharp instrument. The victims without alcohol experienced 3 or less of trauma when they were attacked with a hard, blunt things. They were more likely to survive more than 24 hours. 73% of victims were male. Younger men (45.5 ± 15 years) and older women (50.9 ± 17 years) made the majority of homicide victims. 58.6% of victims drunk alcohol. The majority of victims was unemployed and had only primary or secondary education. In more than half of the cases (53%), victims were acquainted with the murderer. The mean age of the male killer was 34.5 ± 14 years, and mean age of female murderers was 38.5 ± 14 years. The majority (66%) of the offender’s was intoxicated of alcohol. The occupational analysis showed that the majority (73%) of them were unemployed and had only primary or secondary education. The most likely scenario of a homicide in Lithuania is when the killer and the victims are both male. Recommendations for prevention of homicide: the stable condition of employment, to enhance the education programs of alcohol consumption in high-risk families, human rights education for young children, prevention programs of recurrence for those who already committed homicide, and to fulfil register and analysis system of homicide

Suicides in Lithuania: rates, methods and distribution by age, gender and settlement, 2012-2016

INTRODUCTION: According to the World Health Organisation regarding suicide rate, Lithuania was on the top in 2016 with 31.9 suicide events per 100 000 people of the population. This research was aimed at analysing the situation including methods of suicide and its distribution between different age, gender and settlement groups in Lithuania. METHODS: 4610 particular suicide cases were found and analysed from the given retrospectively collected data by the Hygiene Institute’s Register of Death Causes in Lithuania from 2012 till 2016. These cases have been categorised into age (10-19 years old, 20-69 years old and >70 years old), gender and settlement groups. Chi-squared and Fisher tests were used to analyse the associations between the suicide methods used, sex, as well as age. A significance level of p<0.05 was used. RESULTS: In total, 4610 suicide cases were registered in Lithuania in 2012-2016. People aged 20-69 years had the biggest proportion with 80%, followed by 16% for people older than 70 and 4% people aged 10-19. 82% of all cases were men. The most common method of suicides in all age groups was hanging, self-strangulation and self-suffocation; 92%. There is no statistical significant difference in methods used by the 10-19 years old group and above 20 years of age (20-70+). A difference was found between the groups under 70 years and above 70 years old. Moreover, the following difference was found between their genders (p=0.0002). In terms of using drugs and biological substances, women (54.24%) are more likely to commit suicide through these means than men in all age groups, while 100% of suicide methods by gas, steam or solvents were used by men. Though slightly more suicides were registered in cities, there was no statistically significant difference between people living in cities and in villages. CONCLUSIONS: Despite the fact that incidences of suicides are gradually decreasing every year, the situation is not yet satisfactory. The pattern almost has not changed for years – the most inclinable person to commit suicide is a 50-59 years old man living in a city and the most used method is still hanging

Tuberkuliozė ir staigi mirtis Lietuvoje.

Background: Tuberculosis is one of the most common infectious diseases in the world. 10.6 million people fell ill in 2021 and 1.6 million died from the disease. Lithuania has the third-highest tuberculosis incidence rate per 100,000 and the second-highest mortality rate per 100,000 in EU/EEA countries. During 2015–2021 years, there were 799 deaths of pulmonary tuberculosis in Lithuania. However, the presence of pulmonary tuberculosis is often unknown before death and is only revealed during autopsy. The aim of the study is to review current literature on this topic and present statistical analysis on evaluated socioeconomical, epidemiological indicators, as well as autopsy findings that may suggest pulmonary tuberculosis infection.Materials and methods: This research was designed as a retrospective study focusing on full forensic pathology autopsies between 2015 and 2021. Of these, 100 cases were randomly selected where the cause of death was tuberculosis diagnosed during post-mortem examination and compared to a control group consisting of 415 cases of sudden death.Results: The study revealed that out of 100 pulmonary tuberculosis cases, 90% were male with the mean age of 53.48 ± 11.12 years old. In the case of sudden death where tuberculosis was found, a significant portion of the sample (91%) was not followed up at any medical institution. Regarding socioeconomic factors, a moderate negative correlation between Lithuania’s gross domestic product and tuberculosis distribution was observed, as well as a weak negative correlation between alcohol consumption (l per capita) in the general population and tuberculosis distribution. The lung weight of the pulmonary tuberculosis group was statistically significantly higher than that of the control group.Conclusions: Tuberculosis remains a major problem in Lithuania and the combination of socioeconomic indicators determines the prevalence of tuberculosis in the country. In cases of sudden death, autopsy helps to identify tuberculosis cases that have not been clinically detected and ensures tuberculosis monitoring. Therefore, the person who performs autopsy remains at high risk of contracting tuberculosis. Furthermore, extreme caution is advised if higher lung weight or hardenings are seen during autopsy because of the possibility of tuberculosis

Sudden cardiac death in patients with coronary heart disease and antemortem alcohol intake: A STROBE – compliant retrospective study

The present study was aimed to assess the prevalence and possible causal relationship of alcohol intake prior to a sudden cardiac death event in patients with coronary artery disease. The retrospective research was performed at the Vilnius branch of The State Forensic Medicine Service. The autopsy protocols for five years were analyzed and the cases of sudden cardiac death were selected, when the determined cause of death was Coronary Heart Disease (CHD), a forensic autopsy and toxicological blood and urine test had been performed. Cases of the sudden death of non-cardiac origin, cases of cardiomyopathy of various origins, and cases of acute cardiac arrest of unspecified origin were excluded. The data collected was processed using R software. The study sample consisted of 2133 cases. 706 (33%) CHD cases were alcohol positive. Males and young age CHD victims were more likely to find alcohol than females (72% vs. 28%, respectively, P < .001). The mean blood alcohol concentration of the sample was 1.37 ‰± 1.01, urine‘s 1.73‰ ± 1.29. Alcohol was more commonly found during the winter months and the holidays. Deaths in alcohol-positive individuals were more common in the alcohol elimination phase with hemodynamically insignificant coronary artery stenosis (up to 50% of arterial lumen). Nearly every third CHD victim in Lithuania who experienced sudden death also had signs of antemortem alcohol consumption

Homicides disguised as fire deaths

Background: When conducting a forensic examination of burnt bodies, it is important to determine whether the victim was exposed to fire while alive or after death. The differential diagnosis between antemortem and postmortem burning is difficult and often cannot be made based on information obtained solely from the autopsy. The aim of the study is to review current literature on this topic and present clinical cases that illustrate how challenging the determination of vitality during the fire and manner of death can be. Materials and methods: We present four cases of burnt homicide victims, illustrating the complexity of forensic determination of the cause of death in the fire and the importance of differential diagnosis of antemortem and postmortem exposure to flames. Results: In the forensic assessment autopsy is a fundamental to determine the cause of death. When death is related to fire, particular findings during autopsy can help to suspect that the victim was alive. One of the main antemortem signs is the deposition of soot in the respiratory tract. Another important test is the toxicological analysis, which determines the level of carboxyhaemoglobin in the blood: a concentration of more than 50% indicates that the person died in the fire. Conclusions: Forensic examination of burnt bodies requires a comprehensive and detailed assessment of all available data. The autopsy, together with additional diagnostic forensic methods, including histological examination, toxicological analysis and postmortem computed tomography, allows the exact cause of death to be determined

Epidemiology and risk factors of sudden death due to pulmonary thromboembolism: a retrospective study

Introduction. Pulmonary thromboembolism (PTE) is not an uncommon cause of sudden, unexpected death. Autopsy is the gold standard for cause of death determination in cases of suspected PTE. Mortality rates due to PTE are not estimated accurately. Objective. The aim of this study was to analyze distribution patterns and risk factors of sudden deaths due to PTE. Methods. Retrospective analysis of Lithuanian State Forensic Medicine Service autopsy data, period 2014-2018. A total of 4533 cases were reviewed; 80 cases met the criteria of immediate cause of death being PTE and were included in the study. PTE epidemiology, risk factors, clinical and pathoanatomical characteristics were described by reviewing scientific literature and statistical databases. Results. PTE as the cause of sudden death was diagnosed in 37(46.25%) men and 43(53.75%) women. Median age at the time of death was 62.8±17.2 years. Death occurred in hospital in 21(26.25%) cases. Trauma was the underlying cause of PTE in 11(13.75%) cases; 9(81.8%) patients were admitted to hospital after a traumatic event. Cardiac hypertrophy was observed in 70(87.5%) autopsies. Abdominal subcutaneous fat thickness was 4.08±2.64 cm in men and 5.35±2.69 cm in women. Deep vein thrombosis (DVT) was confirmed upon microscopic examination in all cases, being the underlying cause of death in 67(83.75%) cases. Conclusion. Sudden death due to PTE usually occurs at an older age and in absence of medical care. PTE is common after sustaining severe traumatic injuries which, when not immediately lethal, are managed in hospital. Cardiac hypertrophy and obesity may increase risk of death due to PTE. Undiagnosed and untreated DVT is often the underlying cause of sudden death due to PTE

The post-mortem evaluation of glucose concentration in blood and its diagnostical value

Introduction: Hyperglycemia is a consequence of uncontrolled diabetes and over a long period of time can lead to serious violations of the various systems of the body. In daily clinical practice, glucose level in blood and glycated hemoglobin are major and frequently used worldwide laboratory findings for the diagnosis of glucose metabolism disorders. In forensic medicine, the diagnostic value of post-mortem blood glucose levels is questionable because of its significant and rapid variation after death. Our research was aimed to analyse glucose concentration in blood after death and to estimate its diagnostic value. Methods: Data analysis of the State Forensic Medicine Service (SFMS) of Vilnius region of sudden death cases was performed. 238 autopsy findings were analysed. A retrospective analysis was performed using the R commander program. Results: The analysis included 238 individuals, 161 (67.6%) were men and 77 (32.4%) women. Mean age was 52.28 ± 15.45 yeras. Mean alcohol level in blood was 2.257 ± 1.482 g/L. Mean post-mortem glucose concentration in blood was 6.716 ± 5.800 mmol/l. The lowest glucose concentration was 0.600 mmol/l and the highest - 33.300 mmol/l. There were no significant glycemia level difference between men and women (p = 0.279). In 6 cases, glucose concentrations were compared before and after death. The difference in blood glucose was insignificant (p = 0.90). There was no strong correlation between ethyl alcohol and glucose concentration (r = 0.037, p = 0.667). There was a weak correlation between age and blood glucose concentration (r = 0.03, p = 0.639). Conclusions: According to SFMS autopsy data, post-mortem glucose levels remain within the normal values. Evaluation of glucose after death remains a valuable diagnostic criterion for sudden death due to hyperglycaemia, when the hyperglycaemic episode is first and fatal to the subject

Autopsy relevance determining hemochromatosis: case report

Rationale: Hemochromatosis is a disorder, associated with an abnormal accumulation of iron leading to toxic organ damage. Clinical symptoms develop during a long period of time, thus, determining accidental or late diagnosis, usually when complications are evident. Patient concerns: A 53-year-old man was brought to the emergency unit with symptoms of hypovolemic shock without any apparent cause, which ultimately led to multiple organ failure, severe metabolic acidosis. Diagnoses: The final diagnosis of hemochromatosis was determined after the autopsy. Interventions: Abnormal findings included a black-grayish pancreas, without any surrounding tissue reaction, and a dilated congestive cardiomyopathy. Histological findings revealed significant hemosiderin deposits in the internal organs, which were more distinct in the pancreas, liver, and kidneys. Outcomes: Patient death in less than 12 hours. Lessons: The necessity of a genetic examination after the autopsy, regarding this case was undeniable, especially focusing on the first-degree relatives, helping to diagnose and prescribe an adequate and early treatment

Traumatic spleen rupture diagnosed during postmortem dissection A STROBE-compliant retrospective study

Spleen is typically injured in blunt abdominal trauma. Spleen injuries make 42% of all blunt abdominal injuries. The aim of this study was to perform a retrospective assessment of the cases of acute and subacute isolated traumatic spleen ruptures. A retrospective study performed on 50 patients, whose cause of death was isolated spleen rupture and bleeding into the abdominal cavity. An acute spleen rupture was diagnosed in 47 cases, whereas the rest 3 cases demonstrated a subacute rupture. In cases of acute spleen rupture, the mean weight of spleen was 309.6 g, whereas in 3 cases of subacute rupture the mean weight of the organ achieved 710 g. The mean weight of spleen in the control group with no spleen rupture was 144.7 g. Recording of the cases of isolated acute and subacute traumatic spleen ruptures and morphological assessment of them are important in forensic pathology science and in clinical practice as well