Browsing by Subject "Forensic medicine"

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    Biochemical correction factors to estimation of post-mortem interval in vitreous humor
    (Romanian Society of Legal Medicine, 2017) Prieto Bonete, Gemma; Pérez Martínez, Cristina; Pérez Cárceles, María Dolores; Luna, Aurelio; Legaz Pérez, Isabel; Ciencias Sociosanitarias
    Vitreous humor is the matrix chosen on most occasions because it is less likely to be affected by postmortem changes. Potassium concentration is the common measurement of estimation time since death in vitreous humor, but there are another electrolytes concentrations are stable after death. The aim of this study was to analyze whether any of the components or characteristics of VH can be use as inner standard in a postmortem interval of less than 24 hours to accurately estimate the time of death in both natural and violent death. A total of 298 vitreous humor from 298 different cadavers (204 males, 94 females) with a mean age of 19.9 ± 13.31 (hours ± SD) and different causes of death (myocardial infarction, multiple injuries, suffocation or intoxication).The concentrations of potassium, phosphate, hypoxanthine, uric acid, microproteins, microalbumine, chloride, sodium were determined. After measurement, we observed that chloride, sodium, urea and osmotic pressure were independent of the PMI. Our results show that sodium concentration is the best inner standard to have a accurate estimation of post-mortem interval and it can give information about disturbed electrolyte homeostasis at the moment of death.
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    Causes of death and survival in alcoholic cirrhosis patients undergoing liver transplantation: influence of the patient’s clinical variables and transplant outcome complications
    (MDPI, 2021-05-27) Bolarín, J. M.; Pérez Cárceles, María Dolores; Luna, A.; Minguela, A.; Muro, Manuel; Hernández del Rincón, Juan Pedro; Legaz Pérez, Isabel; Ciencias Sociosanitarias
    Background. Clinical and molecular mechanisms involved in the cause and time of death of alcoholic cirrhosis (AC) patients undergoing liver transplantation (LT) are not entirely understood. In sudden death cases, judicial autopsy practice is mandatory for determining the cause and circumstances of death. The medico-legal autopsy data are essential for helping health authorities to guide future public health activities, assess the effectiveness of health systems, and adopt the necessary preventive measures to improve and adapt the treatments in order to increase these patients’ survival. Objective. Our study aimed to determine the different clinical and sociodemographic causes that influence the different causes of death and the short- and long-term survival of AC patients undergoing liver transplantation. Methods. A total of 122 deceased AC patients undergoing LT were analyzed at different times post-transplantation. The main pre- and post-transplant complications were analyzed in relation to the cause of death and the patient’s survival, as well as the causes and time at which the patient’s death occurred. Results. A total of 53.3% of non-sudden death was observed. A large number of the deaths of AC patients undergoing transplantation were due to non-sudden death, sepsis, and graft failure (GF), the main causes of death in the sample being similar in both sexes. In non-sudden deaths, there were no significant differences between the death rates either related or not related to the liver transplant. Sepsis was the main cause, with the highest percentage (21.3%) of mortality, followed by GF (18.9%) and multiorgan failure (15.6%) at ten years. Furthermore, our results showed how pre-transplant clinical complications, such as viral infections and encephalopathy, influence the age at which multiorgan failure occurs in the transplanted patient. Conclusion. Multiorgan failure is the leading cause of sudden death, with higher mortality during the first year after transplantation, followed by sepsis and GF. Our results show the vulnerability of AC patients, both in the hospital period after the transplant and outside.
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    Drug-facilitated sexual assault and other crimes: a systematic review by countries
    (2021-03-12) García, M. G.; Pérez Cárceles, María Dolores; Osuna, E.; Legaz Pérez, Isabel; Ciencias Sociosanitarias
    Drug-facilitated sexual assault (DFSA) and drug-facilitated crime (DFC) constitute a mode of violence that is generally unknown to the population and may go unnoticed by health professionals. The aim of this systematic review was to analyze the victims of DFC, compiling their sociodemographic characteristics, the toxic substances used and their biological matrices and modes of action, in order to identify the substances that are commonly put to criminal use. The aim would be to establish political and health strategies that inform and warn people about possible criminal social behaviors consequent danger to health. This systematic review was conducted following the PRISMA guidelines. Alcohol, benzodiazepines and cocaine were among the most commonly detected substances. In most of the hospitals, immunoassays, liquid chromatography (LC-MS), or gas chromatography-mass spectrometry (GC-MS) analyses were used to identify the substances, while the most frequently used biological matrices were blood and urine. From a judicial point of view, the instrumental protocols and techniques followed for the detection of toxics in different biological matrices must guarantee the reliability and validity of the results for use in a court of law. The recommendations of international organizations should be followed and must be called upon to strengthen their respective national laws against this chemical submission (CS) phenomenon.
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    Estudio comparativo entre la Tomografía Computarizada Postmortem y la obducción del cadáver
    (2024-06) Martínez Esquiva, David; Osuna Carrillo-Albornoz, Eduardo Javier; Hernández del Rincón, Juan Pedro; Sin departamento asociado; Facultades de la UMU::Facultad de Medicina
    Introducción. La medicina forense se apoya cada vez más en técnicas de imagen para la investigación de la etiología de muerte. La tomografía computarizada postmortem (TCPM) ofrece una evaluación no invasiva y rápida de la anatomía interna del cadáver, proporcionando una posible alternativa a la obducción. Este trabajo examina la aplicación de la TCPM como técnica complementaria a la autopsia en el Instituto de Medicina Legal y Ciencias Forenses (IMLCF) de Murcia entre 2020 y 2023. Objetivos. El objetivo principal es caracterizar los hallazgos forenses obtenidos mediante TCPM y compararlos con los hallazgos de la obducción. El objetivo secundario es describir el uso de la TCPM en casos donde no se realizó obducción o donde su aplicación fue limitada. Material y Métodos. Se realizó un estudio observacional de diseño retrospectivo basado en los informes de autopsias realizadas en el IMLCF entre 2020 y 2023. Los datos se agruparon en tres categorías: -Grupo 1: Casos con hallazgos comparables entre TCPM y obducción. -Grupo 2: Casos donde la TCPM sólo descartó fracturas. -Grupo 3: Casos donde la obducción fue evitada debido a infección por SARS-CoV-2. Resultados. -Grupo 1: La TCPM mostró ventajas significativas sobre la obducción en la detección de lesiones esqueléticas, especialmente en cráneo y pelvis. -Grupo 2: La TCPM proporcionó un análisis preliminar para descartar fracturas, lo que permitió dirigir la obducción al descartar una etiología traumática. -Grupo 3: La TCPM facilitó el estudio en casos COVID-19, evitando la obducción y reduciendo el riesgo de contagio. Conclusiones. La TCPM proporciona una herramienta complementaria a la autopsia, especialmente en la detección de lesiones esqueléticas y en situaciones de riesgo de infección. Se evidencia la necesidad de formación en imágenes forenses y de protocolos estandarizados para maximizar su potencial diagnóstico. Además, se recomienda la instalación de equipos de TCPM en centros forenses.
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    Influence of preformed antibodies in liver transplantation
    (MDPI, 2020-03-05) Boix, Francisco; López, Manuela; Alfaro, Rafael; Galián, José A.; Llorente, Santiago; Campillo, José A.; Botella, Carmen; Ramírez, Pablo; Sánchez Bueno, Francisco; Pons, José A.; Moya Quiles, María R.; Minguela, Alfredo; Muro, Manuel; Legaz Pérez, Isabel; Ciencias Sociosanitarias
    The significance of human leukocyte antigen (HLA) matching and preformed donor-specific antibodies (DSAs) in liver transplantation remains unclear. The aim of this study was to analyze the presence of DSAs in a large cohort of 810 liver recipients undergoing liver transplant to determine the influence on acute (AR) or chronic liver rejection (CR), graft loss and allograft survival. DSAs were identified using complement dependent cytotoxicity crossmatch (CDC-CM) and multiplexed solid-phase-based flow cytometry assay (Luminex). CDC-CM showed that a 3.2% of liver transplants were positive (+CDC-CM) with an AR frequency of 19.2% which was not different from that observed in negative patients (−CDC-CM, 22.3%). Only two patients transplanted with +CDC-CM (7.6%) developed CR and suffered re-transplant. +CDC-CM patients showed a significantly lower survival rate compared to −CDC-CM patients (23.1% vs. 59.1%, p = 0.0003), developing allograft failure within the first three months (p < 0.00001). In conclusion, we have demonstrated a relationship between the presence of preformed DSAs and the low graft liver survival, indicating the important role and the potential interest of performing this analysis before liver transplantation. Our results could help to detect patients with an increased risk of graft loss, a better choice of liver receptors as well as the establishment of individualized immunosuppressive regimens.
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    Monitoring of soluble forms of BAFF System (BAFF, APRIL, sR-BAFF, sTACI and sBCMA) in kidney transplantation
    (Springer, 2022-09-22) Alfaro, Rafael; Llorente, Santiago; Martínez, Pedro; Jiménez Coll, Víctor; Martínez Banaclocha, Helios; Galián, José Antonio; Botella, Carmen; Moya Quiles, María Rosa; Peña Moral, Jesús de la; Minguela, Alfredo; Muro, Manuel; Legaz Pérez, Isabel; Ciencias Sociosanitarias
    BAFF system plays an essential role in B cells homeostasis and tolerance, although it has widely not been tested in transplantation with doubtful results. The main purpose was to study the BAFF soluble forms and their correlation with acute rejection (AR) and donor-specific antibodies production. Serum levels of BAFF, APRIL, and soluble forms of their receptors were analyzed in renal recipients with and without acute rejection (AR/NAR) appearance. All molecules were evaluated at pre- and post-transplantation. sTACI showed a significant correlation with BAFF and sR-BAFF levels, and sBCMA also showed a positive correlation with sAPRIL levels. A significant increase in sAPRIL levels in patients suffering AR was also found, and ROC curves analysis showed an AUC = 0.724, a concentration of 6.05 ng/ml (sensitivity: 66.7%; specificity: 73.3%), the best cutoff point for predicting AR. In the post-transplant dynamics of sAPRIL levels in the longitudinal cohort, we observed a significant decrease at 3 and 6 month post-transplantation compared to pretransplantation status. We also observed that recipients with high pre-transplant levels of sAPRIL generated antibodies earlier than those with lower sAPRIL levels, although their long-term post-transplantation was not different. Our results show that elevated serum levels of APRIL may be helpful as a biomarker for the diagnosis of AR, although the longitudinal study shows that it is not helpful as a prognostic biomarker.