Machine Learning Models for Prediction of Sex Based on Lumbar Vertebral Morphometry.

BACKGROUND: Identifying skeletal remains has been and will remain a challenge for forensic experts and forensic anthropologists, especially in disasters with multiple victims or skeletal remains in an advanced stage of decomposition. This study examined the performance of two machine learning (ML) algorithms in predicting the person's sex based only on the morphometry of L1-L5 lumbar vertebrae collected recently from Romanian individuals. The purpose of the present study was to assess whether by using the machine learning (ML) techniques one can obtain a reliable prediction of sex in forensic identification based only on the parameters obtained from the metric analysis of the lumbar spine. METHOD: This paper built and tuned predictive models with two of the most popular techniques for classification, RF (random forest) and XGB (xgboost). Both series of models used cross-validation and a grid search to find the best combination of hyper-parameters. The best models were selected based on the ROC_AUC (area under curve) metric. RESULTS: The L1-L5 lumbar vertebrae exhibit sexual dimorphism and can be used as predictors in sex prediction. Out of the eight significant predictors for sex, six were found to be particularly important for the RF model, while only three were determined to be important by the XGB model. CONCLUSIONS: Even if the data set was small (149 observations), both RF and XGB techniques reliably predicted a person's sex based only on the L1-L5 measurements. This can prove valuable, especially when only skeletal remains are available. With minor adjustments, the presented ML setup can be transformed into an interactive web service, freely accessible to forensic anthropologists, in which, after entering the L1-L5 measurements of a body/cadaver, they can predict the person's sex.

Can a Bullet be Dangerous without a Weapon?

Background: Blast injuries have a unique ability to cause acute harm to multiple individuals simultaneously. The severity and mechanism of injury depend on factors such as distance, released kinetic energy, material properties, affected area, and available protective measures. The resulting explosion wave can cause a range of injuries, from superficial to internal, and potentially lifethreatening. Therefore, it is crucial to promptly evaluate the patient clinically and with imaging techniques and provide immediate emergency interventions. Case Report: We present the case of a 19-year-old male who accidentally sustained blast injuries while mishandling a cartridge while attempting to cut the bullet with a hand-held circular saw. The explosion caused injuries in five anatomical regions. After receiving immediate emergency care, the patient underwent surgical intervention performed simultaneously by three surgical teams. Subsequently, he was monitored in the intensive care unit (ICU) for six days and was eventually discharged after a 13-day hospitalization. Conclusion: The natural curiosity of young individuals plays a significant role in promoting ongoing progress. However, it can sometimes lead to detrimental consequences for their well-being. Effective management by a polytrauma team becomes a race against time to preserve the patient's life and prevent disabilities.

The Vital Role of Thanatochemistry in the Postmortem Diagnostic of Diabetic Ketoacidosis-Case Report.

Diabetic ketoacidosis (DKA) is a lethal acute hyperglycemic complication of diabetes mellitus (DM) and it represents the initial manifestation of DM in about 15-20% of cases in adults and about 30-40% of cases in children. Postmortem diagnosis of DKA can only be made by applying thanatochemistry. Biochemistry applied postmortem is viewed with skepticism by many practitioners in the forensic field, completely lacking in many forensic services around the world, and especially in the national ones. This article aims to underline the importance of the postmortem application of biochemistry by reviewing the case of a person in the third decade of life who died suddenly at home due to diabetic ketoacidosis (DKA), whose autopsy was performed at an early PMI of approximately 24 h. Routine postmortem examinations (macroscopic, anatomopathological, and toxicological) could not establish a clear cause of death. When attention was turned to biochemical determinations (i.e., determination of glycated hemoglobin, glucose and ketone bodies (acetone, beta-hydroxybutyrate) in the blood, vitreous humor, and cerebrospinal fluid), the identified values clarified the thanatogenic mechanisms by establishing the diagnosis of DKA.

Thanatochemical Study of Glycated Hemoglobin in Diabetic Status Assessment.

Background and objectives. In forensic medicine, the postmortem determination of glycated hemoglobin (HbA1c) helps identify undiagnosed cases of diabetes or cases with uncontrolled glycemic status. In order to contribute to the solidification of thanatochemistry, both globally and especially nationally, we aimed to determine this biomarker postmortem, for the first time in our institution, in order to identify undiagnosed pre-mortem diabetics, as well as those with inadequate glycemic control. Materials and Methods. Our research consisted of analyzing a total number of 180 HbA1c values, 90 determinations from the peripheral blood and 90 from the central blood. The determination of HbA1c was performed by means of a fully automatic analyzer (HemoCue HbA1c 501), certified by the National Glycohemoglobin Standardization Program (NGSP)/Diabetes Control and Complications Trial (DCCT) and calibrated according to the standards developed by the International Federation of Clinical Chemistry (IFCC). According to ADA criteria, HbA1c values can provide us with the following information about the diagnosis of diabetes: normal 4.8-5.6%; prediabetes 5.7-6.4%; diabetes ≥ 6.5%. Results. A considerable number of cases with an altered glycemic status (cases that had HbA1c values equal to or greater than 5.7%) were identified-51% demonstrable by peripheral blood determinations and 41% by central blood determinations. Notably, 23 people with diabetes (25%) were identified by analyzing the peripheral blood; 18 other people with diabetes (20%) were identified by analyzing the central blood. Conclusions. Our study managed to confirm the antemortem diagnosis of DM using a simple point-of-care analyzer and applying standardized and certified criteria on HbA1c levels measured postmortem. We also identified a considerable number of cases with DM in patients with no antemortem history of glucose imbalance-at least 20% more cases. Although the two different sites used for blood collection showed a strong statistical correlation, it seems that the peripheral site could have a higher sensibility in detecting postmortem altered glycemic status.

Toxic Blood Hydrogen Cyanide Concentration as a Vital Sign of a Deceased Room Fire Victim-Case Report.

Carbon monoxide (CO) and hydrogen cyanide (HCN) are two common toxic products of combustion. HCN concentrations of fire victims are not routinely determined in most legal medicine services in Romania. We present the case of a room fire victim in which we evaluated the concentrations of HCN and carboxyhemoglobin (COHb), their contribution to the mechanism of death, and the possibility that HCN concentration can be interpreted as vital sign. COHb was determined by spectrophotometry. HCN was spectrophotometrically determined with ninhydrin in postmortem blood samples after its removal with 20% phosphoric acid and uptake into a solution of potassium carbonate. The presence of ethyl alcohol was determined by gas chromatography. The COHb concentration was 6.15%, while the blood HCN concentration was 1.043 µg × mL-1 and the total HCN was 1.904 µg × ml-1. A blood alcohol content of 4.36 g‰ and a urine alcohol content of 5.88 g‰ were also found. Although the fire produced a considerable amount of soot, and there were signs of inhalation of soot particles, the COHb level cannot be interpreted as a vital sign. Toxic concentrations of HCN and total HCN can be interpreted as a vital sign and indicates a contributive effect of HCN in the mechanism of death.

From punishment to education--juvenile delinquency in Romanian criminal law.

For centuries children were considered "mini-adults". Together with expressing the need to educate children and putting a stop to their integration in the work field from the earliest years the 19th century also displayed a new image of the child, which clearly separates him from the adults. In this paper the authors analyze the Romanian legislation addressing juvenile delinquency in criminal temporal evolution. On the one hand the minority age limits are sought and modulation of legislative provisions according to these, and on the other hand, types of penalties for minors are discussed. The authors conclude that the approach to juvenile delinquency in the current Romanian Criminal Code is the result of a long process of reflection of the legislators on adopting a different system of sanctions for juvenile offenders and on creating special regulations concerning the prosecution, trial and enforcement of the decisions regarding them.

Utility of autopsy in medical education--students' opinions and attitudes.

UNLABELLED: Autopsy has been for centuries part of medical education, providing benefits to medical students in terms of knowledge, skills, and development of respect, empathy and compassion. AIM: To evaluate the utility of autopsy in medical education based on the opinions and attitudes of medical students. MATERIAL AND METHODS: A questionnaire was applied to 219 medical students. The answers were grouped according to two main themes: the utility of autopsy in medical education and students' attitudes toward autopsy. RESULTS: Most of the respondents considered that autopsy is useful to society, medical practice and medical education. On average, participants felt "moderately uncomfortable" on exposure to the first autopsy. CONCLUSIONS: Our study indicates the need for medical education to emphasize the utility of autopsy in the medical practice. Extracurricular activities to deepen the medico-legal knowledge and skills would be beneficial for the students who are particularly interested in this specialty. It is also necessary to take into account the possible negative psychological reactions of the students caused by the first exposure to autopsy and identify adequate methods to solve them.

Ethical evaluation model for technologies. the role of medical technology in the development of autonomy in diabetes patient.

UNLABELLED: Romanian Government Decision (GD) No. 8/2012 amending and supplementing GD No. 144/2010 regarding the function and organization structures of the Ministry of Health defines health technology assessment (HTA) as "a systematic and multidisciplinary analysis of the existing and new medical technologies, through which medical, economic, social, ethical and organizational information are synthesized so that medical technologies to be used in a transparent and unbiased manner". We propose an ethical assessment model of technologies used in the care of diabetic patients. The nature of this research was exploratory, giving the novelty of this approach to the clinical and social context of Romania. MATERIAL AND METHODS: The assessment of health technologies used in the care of diabetic patients was based on the following research question: What is the role of health technology in developing autonomy and responsibility in patients suffering from chronic diseases? Individual interviews and focus groups were held from June, 2011 to November, 2012 in Iasi. The criterion for selecting the participants was belonging to the target groups: family doctors or diabetes specialist, patients with type 1 (TID) and type 2 diabetes (T2D), caregivers and other professionals involved in diabetes patient care. KEYWORDS: The diabetic patient benefits from a specific treatment and has the privilege of self-administering it, his life expectancy and quality of life depending upon the compliance and responsibility he demonstrates.

Medical and ethical dilemma in brain death.

For centuries, death has been defined, medically speaking, as the irreversible cessation of breathing and of nervous and cardiac activity. What radically changed this definition was the introduction of the concept "brain death" in 1968, by the "Ad Hoc Committee of the Harvard Medical School". According to it, the irreversible coma was associated with brain death and considered to be a criterion for the diagnosis of the deceased individual. The evergrowing need for transplant organs (provided this respects the dead honor rule, stipulating that organs can't be harvested unless someone is deceased) lead to making arbitrary decisions regarding the establishment of the exact time of death during the process of "losing life". What actually triggers the controversy related to the concept of brain death is the dilemma of associating this concept with that of biologic death or death of the person, the difference between the two being made by whether the mental characteristics are accepted or not in defining and individualizing the death of the human being. Given these circumstances, a dilemma appears--that of defining the death of the individual: we define death, as it has been for centuries, as the moment when the cardio-respiratory function no longer exists, which leads to the loss of tens of thousands of lives that might have been saved through transplant. Yet, this may lead to manipulating the border between life and death, with the risk of trespassing each individual's right to life.

[Epidemiological and forensic medical considerations regarding frequency and causes of violent deaths in Iasi. County, between 1997-2006]. / Consideratii epidemiologice si medico-legale asupra frecventei si cauzelor producerii deceselor prin violenta, in judetul Iasi, in perioada 1997-2006.

UNLABELLED: Authors present some epidemiological aspects of violent deaths in Iasi County, with certain comparisons with Romania, during the period 1997-2006. MATERIAL AND METHOD: The study included information collected by Institutes of Forensic Medicine at the national level. RESULTS: In Romania, violent deaths registered values between 2.6 and 4.5%, with yearly non-significant statistical differences when reported to causes of death, excepted years 2005 and 2006. Violent deaths situated Iasi County over the national level (8-11 / 2.7% per hundred thousand). Homicides registered 9.3% per hundred thousand, as compared with much more reduced values in other 12 Romanian counties, in the same period of study. CONCLUSIONS: Violent death in Romania and Iasi County highlighted a dependence of difficulties to carry out efficient programmes of prevention and emergency assistance.

[Epidemiologic and forensic medical assessment of suicide incidence and other causes of violent death in Romania and Iasi, between 1997 and 2006]. / Unele evaluari epidemiologice si medico-legale asupra incidentei sinuciderilor si a altor cauze ale mortii violente, comparativ, la nivel national si in judetul Iasi, in perioada 1997-2006.

UNLABELLED: The study included information collected in the reports of Forensic Medicine Institutes, at the national level, processed and interpreted using epidemiological and biostatistical methods. RESULTS: In Romania, at the national level, the annual values of suicide incidence increased from 18 to 30% and in 70-80% of cases, other causes led to violent death (intoxication, precipitation, submersion, burning, cut wounds, shooting a.s.o.). In lasi County, the annual values of suicide incidence varied between 1.1 and 2 per thousand inhabitants, and the main cause was hanging registered in 60.2% of cases in 31-60 age groups, with male predominance. CONCLUSION: Results are useful for the orientation of educational prevention programs.

[Investigation of statistic data evolution with social impact]. / Interpretarea evolutiei datelor statistice cu impact social.

Usually statistical analysis of medical and social data consists the final product of the research activity, the mean values, percentages, deviations etc. being an important information to share with other researchers. This paper shows the alternate possibility, using the statistical analysis to discover conclusions not so obvious from the available data. We use this method to analyze couples evolution towards marriage or towards divorce. Age influenced tendency is determined from official referendum and statistical data regarding both married and cohabiting couples.