Calpain Expression in the Brain Cortex after Traumatic Brain Injury

Traumatic brain injury (TBI) is the leading cause of death and disability worldwide. Calpains, a family of cysteine proteases have been implicated in cells death following TBI. Using immunohistochemistry calpain expression was analyzed in post mortem brain tissue obtained from patients who died after TBI, and findings were compared with the brain tissue from patients who died from sudden cardiac arrest. In the injured cortex an increase in calpain expression was observed in all resident brain cells: neurons, glial and endothelial cells in comparison to the control group (all p<0.001). Calpain expression was analyzed in different post-traumatic intervals, from day 0 until 10 days post-injury, in order to establish a time course of expression in the brain cortex after TBI. Expression was detected in the cortex 5 hours after the accident, peaked at 72 hours, and substantially reduced by 10 days after TBI. Calpain expression in the cortex significantly changed during the time from TBI to death (p<0.001), and the most prominent expression was detected in the cortex 3 days after TBI. Our results indicate that prolonged calpain expression in resident brain cells (neurons, glial and endothelial cells) plays an important role in neuronal degeneration following TBI

Disposal of the Body after Murder Committed by Juvenile Offender

Disposal of the body by setting in concrete or sealing with bricks represents relatively rare form of corpse hiding after crime. We report a unique case of juvenile offender who killed his father and subsequently concealed the body. The victim had been reported missing by members of his family but the body was not found until 12 months later. Hidden in concrete body was well preserved allowing not only identification of the victim but also determination of the cause of death

Pedestrian Traffic Fatalities in Southwestern Croatia

Pedestrians are often considered the most vulnerable group of road users. The aim of our study was to analyze the forensic aspects of pedestrian traffic fatalities in Rijeka region. We analyzed pedestrian fatalities in a 5-year period (2002–2006), which included 44 fatally injured pedestrians examined at the Rijeka Institute of Forensic Medicine. The male:female ratio was 1:1. The median age was 57 (ranging from 2–95), with 66% aging over 60 and 89% aging over 40. The least of the accidents happened in July and during weekend. Almost 65% of the fatally injured pedestrians were sober (0.00 g/kg) and 24% had blood alcohol level of more than 1.50 g/kg. Our study showed that pedestrian fatalities in Rijeka region have specific forensic characteristics. These findings suggest the necessity of the specific approach and caution in planning of prevention measures for specific traffic fatalities, in this case pedestrian ones

Starvation as an issue in legal medicine

Izgladnjivanje do smrti samo je iznimno uzrok smrti u razvijenim zemljama. Međutim, ova pojava može imati daleko veći značaj ako je sudskomedicinski gledano smrt posljedica namjernog uskraćivanja hrane. U takvim slučajevima zadatak specijalista sudske medicine ili patologa je razjasniti uzrok smrti i dati stručno mišljenje o stupnju i trajanju gladi. Za procjenu proteinsko-energijske pothranjenosti razvijeno je nekoliko klasifikacijskih sustava koji se također opisuju u članku. Mnogo je faktora vezanih uz dob koji mogu dovesti do gubitka apetita i smanjenja težine, te se u preglednom članku oni i razmatraju. Sudskomedicinski su posebno interesantni slučajevi izgladnjivanja u kojima su, u sklopu pojave zlostavljanja i zanemarivanja, pogođena djeca,. Upravo takve primjere iz literature i navodimo u radu, uz osvrt na osobe starije životne dobi. Ove su osobe, zbog nerazmjera u odnosu snaga, posebno ugrožena skupina, kod koje je također najčešći tip pothranjenosti proteinsko-energijska pothranjenost.Starvation with a fatal outcome is just an exceptional cause of death in developed countries. However, this phenomenon may have far greater significance if a criminal case related-death is the consequence of deliberate denial of food. In such cases, the task of a specialist in the field of legal medicine or pathology is to clarify the cause of death and give a professional opinion on the degree and duration of violent starvation. For the evaluation of protein-energy malnutrition, several classification systems have been developed, which are also described in the article. There are many age-related factors that can lead to loss of appetite and weight loss, and they are being considered in this review article. Suddenly, specially interesting cases of starvation affect children, as a result of abuse and neglect. It is precisely these examples from the literature and we are cited in this paper, concerning older people. These people, due to the unbalanced relationship of strength, are particularly vulnerable to the group, which is also the most common type of malnutrition protein-energy malnutrition

Traffic Accidents with Fatally Injured Drivers in Southwestern Croatia

Traffic accidents represent a significant cause of death in Croatia, therefore being an important social and public- health problem. The aim of our study was to analyze the forensic characteristics of traffic accidents with fatally injured drivers in Southwestern Croatia. Study population included 277 fatally injured drivers, in a 10 year period (between 1994 and 2004). As for the gender, 92% were male and only 8% were female. The median age was 35 (13–86), with 53% of them aging 20–39, therefore being a part of the working population. Most of the accidents happened during the summertime (44%) and weekend (57%). Half of the fatally injured drivers (139) were sober (0.00 g/kg) and only 10 % (28) had blood alcohol level of 0.00–0.5 g/kg. Our results suggest that, as opposed to the current public opinion in Croatia, alcohol might not be the only crucial factor contributing to the drivers’ mortality in Croatia. As for the prevention measures, other factors (drug intoxication, fatigue…) should also be taken into consideration and further studied

Manual Snow Removal and Sudden Death

The aim was to analyze the causes of sudden death in middle-aged and elderly men during manual snow removal. During snowy winter months in Zagreb, from January 2013 to January 2014, four males aged 52, 65, 72 and 81, died suddenly while manually removing snow. They were all autopsied. All of them have suffered from arterial hypertension and coronary heart disease, and one suffered from metabolic syndrome. The cause of death in two was probable malignant ventricular arrhythmia. In the third who fell down on the icy surface, consequences were cerebral contusion and neck vertebral luxation. In the fourth who fell down from the top of the 15 m tall building during snow removal, cause of death were multiple injuries: fractures of both clavicles, ribs and vertebras Th5, Th6, hematothorax, cardiac contusion, hematopericardium, thoracic aorta rupture, contusion and rupture of both lungs, rupture of diaphragm, liver rupture, hematoperitoneum and cerebral edema. The estimated death rate in the City of Zagreb for males aged 30-64 years is 5.44/1,000,000 inhabitants, what is less than in those aged 65-85 years (40.03/1,000,000; p=0.2269). Sudden strenuous physical effort due to manual snow removal in two non-trained persons, who have suffered from arterial hypertension and coronary heart disease, was the cause of sudden death. Manual snow removal is an important cause of sudden death, as it is a very arduous effort in non-adapted middle-aged and elderly persons

The Methods of Committing and Alcohol Intoxication of Suicides in Southwestern Croatia from 1996 to 2005

Alcohol is the psychoactive substance most frequently associated with suicidal behavior.We hypothesized that the level of alcohol intoxication and the choice of specific methods of committing suicide are related. Suicides in the Southwestern Croatia in a 10-year period, especially regarding the method of committing and alcohol intoxication, were analyzed. Ten various methods of committing suicide were recorded. The average blood alcohol concentration at the moment of suicide was 0.68 g/kg with male, and 0.29 g/kg with female victims. The highest blood alcohol levels at the moment of suicide were recorded with suicides by explosive device (with the average blood alcohol concentration of 1.71 g/kg). This especially drastic method of suicide was rare in Croatia in a period prior to the Croatian Independence War (1991–1995), but its incidence significantly increased during the war and in a post-war period. These victims were not chronic alcoholics, but the excessive alcohol consumption occurred as a result of psychiatric disorders as a consequence of war stress they suffered

SUDDEN UNEXPECTED DEATH IN EPILEPSY

Pojam „iznenadna smrt u epilepsiji“ (engl. Sudden Unexpected Death in Epilepsy – SUDEP) označava iznenadnu, neočekivanu (bez obzira na postojanje evidentiranog napadaja), neposvjedočenu ili posvjedočenu smrt u bolesnika s epilepsijom, koja nije nastupila kao izravna posljedica neke traume. Budući da je iz definicije jasno da uzrok smrti nije očit, ne čudi što ovaj entitet u modernoj forenzici dobiva sve veću važnost. Naime, stručnjak sudske medicine u stvaranju svojih zaključaka rukovodi se uglavnom heteroanamnestičkim podacima, nekim tipičnim ozljedama i toksikološkom analizom. U sudskomedicinskoj praksi smrt pacijenta koji boluje od epilepsije može nastupiti tijekom izvođenja neke od svakodnevnih aktivnosti (poput vožnje ili ronjenja), što naglašava ulogu stručnjaka sudske medicine u utvrđivanju prirode smrti. Stoga smo pregledali literaturu o iznenadnoj i neočekivanoj smrti u epilepsiji, definirali termine, prikazali dosadašnje hipoteze o mehanizmu nastupanja smrti te ulogu suvremenih terapijskih pristupa. Epilepsija može biti povezana s mnogim patološkim stanjima, što na obdukciji treba prepoznati. S obzirom na to da se dijagnoza smrti zbog epilepsije temelji na metodi isključivanja, postoji mogućnost zanemarivanja prave incidencije takvih uzroka smrti.The term sudden unexpected death in epilepsy, regardless of the existing recorded attacks, represents a sudden, unexpected, witnessed or unwitnessed death in patients with epilepsy, which did not occur as a direct result of some trauma or drowning. As it is clear by definition that the cause of death is not obvious, it is not surprising that this entity is becoming increasingly important in modern forensics. In the creation of this conclusions a forensic expert mainly uses heteroanamnestic data, some typical injuries and toxicological examination. In forensic practice, the death of a patient suffering from epilepsy can occur during daily activities (such as driving or diving), which emphasizes the role of forensic medicine ­experts in such cases. Therefore, we conducted a literature review on the topic of sudden and unexpected death in epilepsy, defined terms, and showed the current hypotheses about the mechanism of death, and the role of modern therapeutic ­approaches. In particular, we review the possible forensic implications and the importance of conducting autopsies

Vjerodostojnost alkotestiranja koncentracije alkohola u izdahu, upotrebom Dräger Alcotest 7410Plus alkometra, kod utvrdivanja alkoholiziranosti u sudskom postupku

The aim is to determine the usefulness and reliability of breath alcohol tests performed with Dräger Alcotest 7410Plus analyzer, in comparison to more complex analysis methods of blood and urine alcohol testing. A total of 570 cases were taken from archival court evidence material. In all cases, individuals were driving under the influence of alcohol (DUI), and breath alcohol tests performed with Dräger Alcotest 7410Plus analyzer were positive. After breath alcohol testing, all individuals underwent repeated blood and urine alcohol testing, but this time concentrations were measured by headspace gas chromatography. In all individuals alcohol was in its elimination phase. The results obtained from both experiments were evaluated and compared. Comparison of breath alcohol concentration and blood alcohol concentration calculated to the time of breath alcotest, showed that 30 of 570 individuals (5.3%) were not within 95% predicament range, according to the linear equation CBAC ± 0.307 = 0.093 + 1.022CBrAC. Legal classification of being under the influence of alcohol refers to blood alcohol concentration, not breath alcohol concentration. Therefore it is not plausible to define the state of alcohol influence using Dräger Alcotest 7410Plus analyzer.Mogucnost primjene rezultata alkotesta Dräger 7410Plus kao zamjene za analizom utvrdene koncentracije alkohola u krvi i mokraci. U radu je obradeno 570 slucajeva koji se temelje na podacima dobivenim iz sudskih spisa gdje je vozacu nakon alkometrom utvrdene prisutnosti alkohola u izdahnutom zraku, upotrebom alkotesta Dräger Alcotest 7410Plus, metodom plinske kromatografije utvrdena koncentracija apsolutnog alkohola u krvi i mokraci. U svim obradenim slucajevima alkohol se nalazio u fazi eliminacije iz organizma. Analizom utvrdene koncentracije alkohola u krvi retrogradno su preracunate na vrijeme testiranja alkometrom i usporedene. Usporedbom rezultata Drägera i analizom utvrdene koncentracije alkohola u krvi preracunate na vrijeme alkotestiranja proizlazi da se 30 od 570 ispitanika (5,3%) ne nalazi unutar granice 95% predikcije jednadžbe pravca CBAC ± 0,307 = 0,093 + 1,022CBrAC Na osnovi provedenog ispitivanja može se odrediti koncentracijsko podrucje unutar kojeg bi se s 95%-om vjerojatnošcu morala nalaziti koncentracija alkohola u krvi pod pretpostavkom da je krv uzeta na analizu u vrijeme alkotestiranja. Sudskomedicinska klasifikacija stanja alkoholiziranosti odnosi se na koncentraciju alkohola u krvi, a ne u izdahu, te stoga na osnovi rezultata alkometra (koncentracije alkohola u izdahu) nije moguce odrediti niti stanje alkoholiziranosti

SUDDEN UNEXPECTED DEATH IN EPILEPSY

Pojam „iznenadna smrt u epilepsiji“ (engl. Sudden Unexpected Death in Epilepsy – SUDEP) označava iznenadnu, neočekivanu (bez obzira na postojanje evidentiranog napadaja), neposvjedočenu ili posvjedočenu smrt u bolesnika s epilepsijom, koja nije nastupila kao izravna posljedica neke traume. Budući da je iz definicije jasno da uzrok smrti nije očit, ne čudi što ovaj entitet u modernoj forenzici dobiva sve veću važnost. Naime, stručnjak sudske medicine u stvaranju svojih zaključaka rukovodi se uglavnom heteroanamnestičkim podacima, nekim tipičnim ozljedama i toksikološkom analizom. U sudskomedicinskoj praksi smrt pacijenta koji boluje od epilepsije može nastupiti tijekom izvođenja neke od svakodnevnih aktivnosti (poput vožnje ili ronjenja), što naglašava ulogu stručnjaka sudske medicine u utvrđivanju prirode smrti. Stoga smo pregledali literaturu o iznenadnoj i neočekivanoj smrti u epilepsiji, definirali termine, prikazali dosadašnje hipoteze o mehanizmu nastupanja smrti te ulogu suvremenih terapijskih pristupa. Epilepsija može biti povezana s mnogim patološkim stanjima, što na obdukciji treba prepoznati. S obzirom na to da se dijagnoza smrti zbog epilepsije temelji na metodi isključivanja, postoji mogućnost zanemarivanja prave incidencije takvih uzroka smrti.The term sudden unexpected death in epilepsy, regardless of the existing recorded attacks, represents a sudden, unexpected, witnessed or unwitnessed death in patients with epilepsy, which did not occur as a direct result of some trauma or drowning. As it is clear by definition that the cause of death is not obvious, it is not surprising that this entity is becoming increasingly important in modern forensics. In the creation of this conclusions a forensic expert mainly uses heteroanamnestic data, some typical injuries and toxicological examination. In forensic practice, the death of a patient suffering from epilepsy can occur during daily activities (such as driving or diving), which emphasizes the role of forensic medicine ­experts in such cases. Therefore, we conducted a literature review on the topic of sudden and unexpected death in epilepsy, defined terms, and showed the current hypotheses about the mechanism of death, and the role of modern therapeutic ­approaches. In particular, we review the possible forensic implications and the importance of conducting autopsies