Child sexual abuse: a preliminary study

In 1997, 52 child victims of sexual abuse were examined at Oporto Institute of Forensic Medicine. The authors analysed the data concerning these cases in an attempt to contribute to the elucidation of child sexual abuse, particularly in the north of Portugal.     

Sudden death in a teaching hospital of the Wuxi area: a retrospective autopsy study

Sudden death (SD) has a great impact on the medical community and on society in general. The aim of this study was to investigate the autopsy causes and associated pathological characteristics of SD in a teaching hospital of the Wuxi area and to discuss suitable methods for diagnosis and prophylaxis. In this retrospective study, data were collected from 134 SD patients. Ancillary studies covering histology and toxicology were also performed and analysed for the presence of risk factors. The subjects included 94 men and 40 women (M:F ratio = 2.35:1; P < 0.05). The peak age was 20–39?years, accounting for 32.1% (43 cases) of the total number of cases. The most common cause of SD in all cases was cardiovascular disease (n = 79, 59.0%). Cases in which coronary atherosclerotic heart disease was the prime culprit were named sudden cardiac death (SCD). Other causes of death included respiratory disease, neurological disease, and other diseases. Sudden death causes are numerous. This study aims to help prevent SD and to improve the processes of diagnosis and prevention. The results of completely accurate autopsies are necessary, in order to encourage epidemiological and preventive studies on sudden death.     

Post-mortem external examination: competence,education and accuracy of general practitioners in a metropolitan area

International Journal of Legal Medicine - In several countries, general practitioners conduct post-mortem external examination (PMEE) and certify death in out-of-hospital cases. A possible lack of...     

Harassment, sexual abuse, and safety of the female athlete

Sexual harassment and abuse by authority figures in sports are discussed in relation to how female athletes might improve their personal safety to guard against such practices. The origins of sport research on this theme are traced, and the processes of sexual harassment and abuse are identified. Risk factors for the coach, the athlete, and the sport are presented, and, finally, sources of prevention measures for coaches, athletes, parents, and clubs are provided.     

Swipe right: the emergence of dating-app facilitated sexual assault. A descriptive retrospective audit of forensic examination caseload in an Australian metropolitan service

The use of dating ‘apps’ to facilitate real-word social encounters between strangers is culturally mainstream. Sexual assaults facilitated following dating-app meetings have been reported in the media, and anecdotally noted at increasing frequency by clinical forensic physicians. Limited empirical data suggests there has been a marked increase in real life sexual offences facilitated in this manner. There is little additional information known about the circumstances of these alleged incidents. This retrospective audit of a small forensic examination caseload from an Australian metropolitan clinical forensic medicine service identified that 14% (11 of 76) of alleged sexual assaults where complainants underwent a forensic examination were facilitated following a dating-app meeting. Further analysis of these cases identified that all complainants were female, most under 30 years of age. All alleged a single male perpetrator and in over half of the cases the complainant was impaired. In all cases where it was asked (n = 9), the alleged incident occurred at the first face-to-face meeting. More than half of the incidents occurred at the alleged perpetrator’s private residence. Anogenital injuries were observed at the time of forensic examination in 60% of cases, and 70% had visible body injuries. There was no reported condom use. Only one complainant had no observable injury. This small case series quantified a high proportion of forensic sexual assault examination caseload as being facilitated by dating-app meetings, and identified some common features that may be characteristic of alleged sexual assaults occurring in this manner. The authors propose a larger prospective period of data collection at the time of forensic medical examination, to characterize the features of sexual assaults allegedly occurring following app-based meetings.     

The use of HIV post-exposure prophylaxis in forensic medicine following incidents of sexual violence in Hamburg,Germany: a retrospective study

In Hamburg, Germany, the initiation of HIV post-exposure prophylaxis (HIV PEP) in cases of sexual violence is often carried out by forensic medical specialists (FMS) using the city’s unique Hamburg Model. FMS-provided three-day HIV PEP starter packs include a combination of raltegravir and emtricitabine/tenofovir. This study aimed to investigate the practice of offering HIV PEP, reasons for discontinuing treatment, patient compliance, and whether or not potential perpetrators were tested for HIV. We conducted a retrospective study of forensic clinical examinations carried out by the Hamburg Department of Legal Medicine following incidents of sexual violence from 2009 to 2016. One thousand two hundred eighteen incidents of sexual violence were reviewed. In 18% of these cases, HIV PEP was initially prescribed by the FMS. HIV PEP indication depended on the examination occurring within 24 h after the incident, no/unknown condom use, the occurrence of ejaculation, the presence of any injury, and the perpetrator being from population at high risk for HIV. Half of the HIV PEP recipients returned for a reevaluation of the HIV PEP indication by an infectious disease specialist, and just 16% completed the full month of treatment. Only 131 potential perpetrators were tested for HIV, with one found to be HIV positive. No HIV seroconversion was registered among the study sample. Provision of HIV PEP by an FMS after sexual assault ensures appropriate and prompt care for victims. However, patient compliance and completion rates are low. HIV testing of perpetrators must be carried out much more rigorously.     

A retrospective study of CT findings in cases undergoing appendectomy at a single hospital

The purpose of this study was to determine which clinical information or computed tomography (CT) features can distinguish perforated from nonperforated appendicitis. We collected data from 102 patients (62 men, 40 women; mean age, 49.6 years; age range, 16-85 years) who presented to the emergency department with acute abdominal pain or suspicion of acute appendicitis and underwent appendectomy. In the clinical information, there was no significant factor to predict appendiceal perforation. As for CT features, significant imaging factors for predicting appendiceal perforation included abscess, phlegmon, and thickening of lateroconal fascia. The treatment strategy of acute appendicitis varies according to the integrity of the appendiceal wall. Besides clinical findings, CT features can distinguish perforated from nonperforated appendicitis, facilitating proper decision making in ER.     

Pitfalls in the diagnosis of child sexual abuse

Case 1: nurses in charge of a 6-year-old girl in a holiday camp noticed some blood spots on the girl's underwear. The possibility of sexual abuse was considered and the girl alleged that her father was responsible. The father was arrested. A surgeon was asked to examine the girl and planned to do it under general anesthaesia. Meanwhile, the girl was brought to the Forensic Medicine Unit. We found a normal hymen and no detectable anal lesions. The girl complained of dysuria and pollakiuria. Urinalysis revealed the presence of blood, leukocytes, and nitrite. Antibiotic treatment for lower urinary tract infection was initiated and all symptoms improved rapidly. The father was released. Case 2: a 7-year-old boy complained of having been sexually assaulted 24 h before. The boy did not report any pain or bleeding during or after the assault. Examination of the perianal region and of the anal sphineter were normal. Proctoscopy did not show any evidence of trauma to the anal canal. Tests to detect spermatozoa in the rectum were positive. The assailant was arrested. The present cases illustrate that: (i) psychological and social consequences of the biased interpretation of common symptoms may be dramatic in the case of child sexual abuse; (ii) both questioning and examining a child may be difficult for non-specialized practitioners; and (iii) tests to detect spermatozoa should be systematically performed in the case of a suspected or alleged recent assault, even in the absence of any clinical lesions.     

Medical evaluation of young sexual abuse victims: a view entering the 1990s

This paper reviews current knowledge of medical evaluations of young victims of alleged sexual abuse. The several purposes and the value of these examinations are discussed. The evaluation of physical findings is reviewed with emphasis on recent progress in improving the reliability and validity of such examinations. The complexities of the identification and interpretation of sexually transmitted diseases are reviewed. Areas in which additional progress is expected in the 1990s are identified.     

Forensic examination of suspected child victims of sexual abuse in the UK: a personal view

Expert opinion in child abuse has received considerable bad press and currently public confidence in this area of medical practice is low. Media interest has focused most on the diagnosis of factitious illness. However doctors who examine children in respect of proceedings arising from suspected sexual abuse should be mindful this area is potentially just as problematic. Widely different rates of abnormal findings have been reported. At least in part this has reflected inconsistency in interpretation. Findings once assumed diagnostic of penetration are now recognised to occur in non-abused children. The practical difficulties of examining a reluctant child and achieving adequate visualisation of the hymen in relaxed state, are frequently underestimated. Where normal or non-specific findings are presented as "consistent with the alleged event" there is a high risk the court will perceive them to be significant. Guidelines have tended to lag behind existing knowledge and made inadequate differentiation between prepubertal and adolescent cases. They have also placed a high degree of reliance on statements from children without regard to the context in which any "disclosure" had arisen. Photodocumentation has important benefits, and limitations. Images may not display the true depth of field and are not the same as examining the child directly. Examination must remain the gold standard. There is a moral duty of care on the examining doctor to understand and clarify the status of findings dispassionately and with due regard to the level of the evidence base.     

The risk of misinterpreting genital signs of sexual abuse in cadavers: a case report

The significance of genital findings in a case of suspected child sexual abuse has been widely debated in the past decades, as shown by the different classifications available in literature. In the case of postmortem examination, the search for signs of sexual abuse is considerably more difficult because of the superimposition of postmortem modifications, which may determine tissue modifications that can be mistaken for traumatic lesions. This study aims at reporting a case where presumed findings of the first autopsy were denied by histological analysis; in detail, what looked like a possible bruise of the hymen was correctly recognized as hypostasis (livor) of the hymenal tissue by histological analysis. This case report suggests caution in the analysis and discussion of genital lesions found during postmortem examination since the superimposition of cadaveric modifications may radically modify the morphology of soft tissues.     

Electrocution in South Delhi: a retrospective study

One hundred and fifty three unselected autopsy cases of electrocution received from South Delhi were studied during the period 1996-2001. Data for the study was gathered from autopsy reports and hospital records. The cases represented approximately 1.98% of all autopsy cases received from South Delhi at the All India Institute of Medical Sciences, New Delhi (India). Data was analysed with regard to the age and sex of the victim, season of the year, site of the body, time of day, place of occurrence and presence of entry and exit wounds on the body. Death occurred at the scene of the fatal event in 150 cases and three cases died in hospital. Three cases showed no electric burn marks on the body; the cause of death in one of these cases was polytrauma due to a fall from a height and one case had committed suicide.     

Seasonal variation of air kerma in the "Vulcano Porto" area (Aeolian Islands, Italy).

Air kerma was measured in the "Vulcano Porto" area of the Vulcano Island, belonging to the Aeolian Islands, in the Mediterranean Sea. Measurements were carried out using thermoluminescence dosimeters. The relationship between observed dose values and source lithology has been assessed. Data show a seasonal variation due to weather conditions but also probably related to features of the soils, making the variation more evident.     

Suicide in India: a four year retrospective study

Suicide is one of the ten leading causes of death in the world, accounting for more than a million deaths annually. The purpose of the study was to identify the risk groups. In the four-year period from January 2000 to December 2003, 588 suicide victims were autopsied. Information was obtained by interviewing the acquaintances of the victim, perusal of hospital records and the autopsy findings. All the cases were analyzed as to sex, age, and methods of suicide, seasonal variation, diurnal variation and other sociological aspects. The present study depicts a suicidal rate of 11.76 per 100,000 population. Males and females were almost equally the sufferers. The largest number of victims were found in the age group of 21-30 years. Hanging and poisoning constituted the two major modes of suicides (63%). Majority of the victims were mentally sound, married and were from rural background. Victims were mostly drawn from low socioeconomic status (48%). Less educated or illiterates were usually the victims. Suicidal note was detected in 5% of cases. Suicidal tendency and alcohol intake could not be encountered in most of the cases. Indoor incidence was almost double of the outdoor incidence, mostly seen in rainy season (43%) and occurred almost equally during day and night. Financial burden (37%) and marital disharmony (35%) were the principal reasons for the suicide.