The iliac crest in forensic age estimation: evaluation of three methods in pelvis X-rays.

Age assessment in children and young adults is a relevant forensic issue. It is requested not only in evaluating criminal responsibility in youths without proper identification documents, often in relation to age thresholds, but also for release of a residency permit, and asylum seekers of minors. The analysis of the Risser sign and the iliac crest ossification process has been proposed as a useful tool for forensic age estimation. We evaluated the applicability of three different age estimation methods on a sample of 497 pelvic radiographs of Italian individuals between 10 and 25 years of age. Each method showed high reliability for both reproducibility and repeatability. The staging technique inspired by Kreitner and Kellinghaus methods (KK-MS) is easier than the Risser method in applicability, as it is not affected by the variations of ossification. We observed that all subjects who attained stage 3c of KK-MS and 5 of Risser Fr were >14 years, suggesting the benefits of these methods for that age threshold. The applicability of the area measurement method, inspired by Cameriere's approach, ranged between 12 and 20 years, but the statistical analysis showed only a moderate correlation with age. In order to evaluate the possible use of this approach it is therefore necessary to clarify and exclude external factors influencing the parameter. In conclusion, the iliac crest ossification is of interest in age estimation for forensic purposes. The evaluation of the pelvis X-ray, in addition to the other common dental and skeletal methods, could become a useful supplementary tool in age estimation for the 14 year threshold in order to fulfill forensic-level requirements.

Dental Ritual Mutilations and Forensic Odontologist Practice: a Review of the Literature.

BACKGROUND: Ethnic mutilations have a social and anthropological significance both in contemporary and past human behavior, influenced by geographic, religious and cultural factors which can greatly help forensic odontologist's practice in dental profiling process.Dental ritual mutilations and dental decorations were - and still are - practiced among many ethnic groups and cultures. Throughout the history of humanity, having healthy teeth has a symbolic meaning of youth, beauty and strength, but it can also have other meanings.Dental ritual mutilations were documented in many cultures in the past and were practiced mainly for religious rituals purposes, for esthetic reasons and because they represented a symbol of status or of belonging to a particular social group. Similar rituals are still performed. MATERIAL AND METHOD: The present paper is a systematic review of the literature reporting on dental ritual mutilations from the early 1960s and is included in Pubmed, Scopus and Googlescholar. The research was deliberately limited only to the ritual mutilations, which can be defined as "any irreversible impairment of the integrity of the human organism, made with a ritual purpose and without any curative aim". Therefore all the articles dealing with single or multiple dental self extractions of psychotic origins were excluded, as well as the infant oral mutilations, since the practice is deemed to have therapeutical effects among ethnic groups dedited to this practice. CONCLUSIONS: The knowledge of dental alteration due to oral mutilations can be a powerful tool for the identification procedures of living or dead persons or even in human remains especially providing relevant information about the ethnic origins and the cultural background of a subject. Some medical legal issues for the odontologist about dental mutilation are also addressed in the paper.

Ethical implications of Italian legislation on 'epilepsy and driving'.

The laws concerning driving licences and epilepsy in different countries are very diverse with regard to the criteria for issuance or renewal of licences, and also the methods of evaluating fitness. In 2011, a law was issued in Italy implementing the European directives on driving licences, including provisions for mandatory notification that a driver is epileptic. This was established regardless of the European rules that require compulsory notification only of patients. The Federation of Italian Boards of Physicians has made recommendations against mandated physician reporting, resulting in a current confusion between legal and ethical recommendations to medical doctors. The mandatory notification enacted by Italian law raises ethical concerns about disparities in access to care and possible violations of the right to confidentiality of patient information. Moreover, the law discussed here fails to emphasise the importance of physicians ensuring compliance by the patient, by sharing the correct information about the risks associated with illegal driving and by obtaining information from the patient through regular check-ups. An urgent revision of the law is required to implement the duty of the physician to provide information and to ensure that the rule about mandatory notification should be erased in favour of optional self-reporting by epileptics as the preferred way to notify the licensing authority. The implementation of these measures could correct the dichotomy between the law and the ethical recommendations for medical doctors and protect the rights of people with epilepsy as well as those of any other patients whose pathology or impairment could imply a risk to the community.

Aminorex poisoning in cocaine abusers.

Levamisole is found in more than 80% of illicit cocaine seized within United States borders. Percentages are somewhat lower in Europe. In 2009, controlled in vivo studies demonstrated that horses metabolize levamisole to aminorex. Earlier this year our laboratory demonstrated that the same conversion occurs in man. Levamisole itself causes aplastic anemia and numerous reports have begun to appear in the literature, but the conversion of levamisole to aminorex is of much more concern. Aminorex ingestion was responsible for a five-year epidemic (1967-1972) of idiopathic pulmonary hypertension (IPH) confined to Switzerland, Austria, and Germany, the only countries where aminorex had been marketed as an anorectic. The incidence of IPH reverted to normal levels as soon as aminorex was withdrawn. In most cases onset of symptoms in IPH began after six to nine months of aminorex use, with average dosage ranges of 10 to 40 mg per day. The outcome was almost uniformly fatal. The conversion rate of levamisole to aminorex has not been established, but given the high daily intake of cocaine by many abusers, it seems likely that many of them will have ingested enough contaminated cocaine to ultimately cause IPH. Until the disease is well established, the symptoms of IHP are vague, and existing drug registries specifically exclude drug abusers, making it difficult to track these cases. This review is intended to draw attention to what may be a slowly emerging new epidemic.