Applicability of forensic facial approximation in the recognition process of unclaimed victims

BackgroundIdentifying bodies in a state of putrefaction, skeletonization or mutilation is often difficult. In these cases, it is possible to use auxiliary methods such as forensic facial approximation, considering the possibility of recognition by a relative or acquaintance, helping to obtain ante-mortem data for the identification process. The aims of the present study were to evaluate the capacity of recognition of individuals from digital facial approximation and to verify the association between the level of understanding of the issue by evaluators and the recognition success index.Methods16 skulls with previous photographic records were selected and then utilized for three-dimensional approximation using the digital technique, scanned by photogrammetry, and reconstructed by computerized method using open-source software. Twenty evaluators tried to recognize the facial approximation performed from images present in the photospreads.ResultsThe mean overall score was 23.75%, and it was observed that in only five approximations (31.24%) the option of correct recognition of the victim was the one that obtained the highest number of selections. False positives and negatives corresponded, respectively, to 11.56% and 12.5%.ConclusionsIt can be concluded that the methodology can provide recognition albeit in low numbers, and permitting the acquisition of ante-mortem data for the proper process of human identification through primary methods.     

Microvascular Dysfunction, Myocardial Ischemia, and Progression to Heart Failure in Patients with Hypertrophic Cardiomyopathy

Microvascular dysfunction can be demonstrated in most patients with hypertrophic cardiomyopathy (HCM), both in the hypertrophied and nonhypertrophied myocardial walls, mostly due to intimal and medial hyperplasia of the intramural coronary arteries and subsequent lumen reduction. As a consequence, regional myocardial ischemia may be triggered by exercise, increased heart rate, or arrhythmias, in areas which are unable to increase myocardial blood flow. In patients with HCM, microvascular dysfunction leading to severe myocardial hypoperfusion during maximal hyperemia represents a strong predictor of unfavorable outcome, left ventricular remodeling with progressive wall thinning, left ventricular dysfunction, and heart failure. Accurate quantitative assessment of microvascular dysfunction and myocardial ischemia is not easily feasible in clinical practice. Although signs of inducible myocardial ischemia may be detected by electrocardiogram, echocardiography, or myocardial scintigraphy, the vasodilator response to dipyridamole by positron emission tomography is considered the method of choice for the assessment of maximal regional and global flow. Cardiac magnetic resonance provides further information, by late gadolinium enhancement (LGE), which may show areas where replacement fibrosis has occurred following microvascular ischemia and focal necrosis. LGE areas colocalize with severe regional microvascular dysfunction, are associated with increased prevalence of ventricular arrhythmias, and show more extensive distribution in the late stages of the disease, when heart failure is the dominant feature. The present review aims to provide a concise overview of the available evidence of microvascular dysfunction and ischemia eventually leading to disease progression and heart failure in HCM patients.     

Segmental vertebral motion in the assessment of neck range of motion in whiplash patients

The purpose of this study was to obtain comparative data concerning the relative contribution of segmental cervical vertebral motion to the cervical range of motion (ROM) in whiplash and healthy subjects in an effort to evaluate the usefulness of X-ray analysis in future forensic and research efforts. Each subjects neck ROM was measured with an optoelectronic system and also by X-ray measurements of the angular rotation in flexion and extension. The X-rays were examined to calculate the angular movement in the sagittal plane of each of the functional units C2–C3 to C6–C7. The chronic whiplash subjects showed reduced total neck range in all directions as compared to healthy subjects (p<0.001). There was a reduced total angular rotation from flexion to extension between these two groups (p<0.01), but no significant difference, however, between chronic whiplash subjects and controls in the percentage contribution of each of the functional units C2–C3 to C6–C7 to this rotation. This data will now allow a design of trials where healthy subjects are asked to simulate restricted neck ROM while undergoing optokinetic and X-ray evaluation of segmental vertebral motion. We will be able to determine if simulators produce a similar pattern to chronic whiplash and healthy, non-simulating subjects, and thus determine if, at least for forensic and research purposes, this technique is useful in validating reported restricted neck range.     

Hemispheric cerebellar rTMS to treat drug-resistant epilepsy: case reports

Electrical stimulation of the cerebellar cortex by implanted electrodes has been shown to ameliorate refractory epilepsy. We investigated the potential therapeutic role of high-frequency cerebellar rTMS in patients affected by refractory epilepsy due to single or multiple foci. Six patients, three with single and three with multiple epileptic foci, underwent 20 rTMS sessions. Each session was given daily, excluding weekends, and consisted of two trains of 50 stimuli (5 Hz frequency and 90% motor threshold intensity), separated by 50s interval. rTMS was delivered through a focal coil (2 cm below and lateral to the inion) bilaterally in patients with multiple foci (two trains for hemisphere: 100 stimuli each side) and contralaterally to the epileptic focus in the others. Seizure frequency was monitored four weeks before stimulation (pre-rTMS), during the four-week treatment (rTMS) and four weeks after the treatment (post-rTMS). The rTMS over the cerebellar cortex was associated with a significant decrease of rTMS versus pre-rTMS seizure frequency both in patients with single and multiple epileptic foci. However, during the post-rTMS period seizure frequency was back to the pre-rTMS frequency. Although the results are still preliminary, they encourage further studies on larger series of patients. In particular, this rTMS approach, as compared with others, might be more useful in patients with multiple epileptic foci.