The intervertebral discs' fibrocartilage as a DNA source for genetic identification in severely charred cadavers.

Identifying charred human remains poses a challenge to forensic laboratories. High temperature completely incinerates the superficial tissues and partially destroys bones, forcing the forensics to seek an alternative, for bones and teeth, forensic material that should quickly and cheaply deliver DNA of sufficient quantity and quality. We sought, other than rib cartilage, types of cartilages that could serve as a DNA source. DNA was isolated from the fibrous cartilage of a fibrous ring of intervertebral L1-L2 discs sampled from charred cadavers or charred body fragments: 5 victims of car fires, 1 victim of combustion during a residential house gas explosion, and 3 victims of nitroglycerin explosion. DNA was isolated by the column method. DNA quality and concentration were assessed by RT-PCR and multiplex PCR for 23 autosomal and 17 Y chromosome STR loci. STR polymorphism results obtained by capillary electrophoresis served for likelihood ratio (LR) calculations. DNA concentration in relation to the cadaver's age and post-mortem interval (PMI) were analyzed. All samples (n = 9) yielded good-quality DNA in quantities (0.57-17.51 ng/µL for T. Large autosomal sequence) suitable for STR-based amplification. The isolated DNA characterized a low degradation index (0.80-1.99), and we were able to obtain complete genetic profiles. In each of the nine cases, the genotyping results allowed identifying the victims based on comparative material from the immediate family. The results demonstrate the usefulness of human intervertebral disc fibrocartilage as an alternative DNA source for the genetic identification of charred bodies or charred torso fragments.

Medico-legal analysis of cases of children who died suddenly due to pneumonia undiagnosed in their lifetime. / Sadowo-lekarska analiza przypadków dzieci zmarlych nagle z powodu nierozpoznanego za zycia zapalenia pluc.

Pneumonia is one of the most common causes of children's hospitalization and death. The aim of the study was a medico-legal analysis of children who died suddenly due to pneumonia undiagnosed in their lifetime. The research was of a retrospective character and consisted in an analysis of prosecution files. The study included 47 children who died between 2011-2018 in whom pneumonia after post-mortem examination was indicated as the cause of death, as well as children in whom the cause of death, despite additional post-mortem examinations, including histopathological tests, was not established. In some cases, under additional post-mortem examinations, additional targeted immunohistochemical staining of selected lung sections was performed to establish the diagnosis. In children with prodromal symptoms, histopathological examination showed significantly more frequent atelectasis than in children without prodromal symptoms. Pneumonia is a significant clinical problem. Especially in young children, it may proceed with- out any symptoms that would cause such a diagnosis to be made. A properly conducted post-mortem diagnosis supplemented by immunohistochemical examinations allows to reduce the number of unexplained deaths in children.

Sodium nitrite detection in costal cartilage and vitreous humor - Case report of fatal poisoning with sodium nitrite.

Medico-legal case reports very rarely describe sodium nitrite poisonings, but when they do most often they describe fatal suicide attempts. The case report presents a suicidal attempt with sodium nitrite of unknown provenance and the first attempt to detect nitrite ions in costal cartilage and vitreous humor samples. In February 2020, the corpse of a 23-year-old man was revealed in a student apartment. According to the prosecutor's office, the deceased had an incomplete IT (Information Technology) degree. The onsite inspection revealed the body on the bathroom floor, an opened container with sodium nitrite III in the bathroom cabinet, and a farewell letter in the apartment. The autopsy showed the hypoxia symptoms. The blood and urine of the deceased showed no trace of ethyl alcohol or psychoactive substances. Analyses showed the presence of nitrite ions in the blood (0.2 µg/ml) and urine (24.6 µg/ml) of the deceased. Additional analyses revealed nitrites presence in the gastric contents (2200 µg/ml), liver tissue (0.3 µg/g), kidney tissue (3.6 µg/g) and, for the first time, in costal cartilage (3.4 µg/g) and vitreous humor (57.7 µg/ml). The autopsy concluded that the cause of death was an acute cardio-respiratory failure in the course of suicidal sodium nitrite poisoning. The presented case indicates the need for collecting a wide range of samples for toxicological analyses. It also proves that both costal cartilage and vitreous humor may serve as an alternative forensic material in sodium nitrite poisonings.

Quality of Life of Patients with Arterial Hypertension.

Symptoms of hypertension with accompanying complications result in a significant reduction in patients' quality of life. Effective conduct of prescribed pharmacotherapy supported by a healthy lifestyle allows to achieve satisfactory effects of treatment, which translates into an improvement in the quality of life of patients. The aim of the work was to determine the quality of life of patients with hypertension and the factors affecting it. The study included 100 people with hypertension, who are patients of the department of internal diseases of the hospital in Hajnówka during the period 1.6.2019-1.12.2019. The questionnaire survey, the standardized WHO Quality of Life (WHOQOL)-BREF scale and the Barthel scale were the research tools. The probability p < 0.05 was assumed as the level of statistical significance. The study group consisted of subjects between 30-89 years old. The majority were men and those living in the city. The average BMI (body mass index) of the subjects was 28.4 kg/m2. The duration of the disease among those surveyed was on average 7 ± 6.34 years. The highest-rated area of quality of life was the physical field and the lowest social sphere according to the WHOQOL-BREF questionnaire. Patients with hypertension have determined their quality of life at a good or medium level in the physical, psychological, social, and environmental sphere. There are many factors that improve quality of life in all areas. These include following the recommendations on modifiable risk factors.

The epidemiology of comorbidities among multiple sclerosis patients in northeastern Poland.

BACKGROUND: To determine and compare comorbidity levels in the multiple sclerosis (MS) population in Poland using a matched cohort from the general population. METHODS: We compared our database (standardized medical histories and medical records) from a MS center at the Department of Neurology, Medical University of Bialystok, Poland) with local National Health Fund (NHF) data (all patients presenting to healthcare facilities with a diagnosis of MS (ICD 10: G35)). We identified 1299 MS cases from the NHF data and 952,434 age and geographically matched controls. We estimated the prevalence of depression, sleep disorders, epilepsy, hypertension, hyperlipidemia, diabetes, atherosclerosis, lung infections, thyroid disease, discopathy, and urinary tract infections in the MS population versus matched controls. RESULTS: In all, 815 cases of MS (67.6% women and 32.4% men) were registered with the MS center. According to the patients' medical records (with ICD 10 coding), the most common comorbidities were hypertension (4.3%) and thyroid diseases (3.3%). In addition, in standardized medical histories comorbidities were reported by MS patients: depression/depressed mood in 37.6% of patients (67% of whom had sought treatment), pain in 69.6% patients, urinary incontinence in 39.2% patients (44.9% of whom were treated), memory-related problems and fatigue in 39.2% and 70.8% patients, respectively. In the local NHF data, the most common comorbidities were hypertension (8%), diseases that cause back pain [ICD 10:M50-54 (4.3%),G54-55 (3%), M47-48 (5.4%)], urinary tract infection (3.5%), depression (2.4%), hyperlipidemia (2%), and diabetes (2%). All comorbidities except depression and sleep disorders were more common in the matched controls than in the MS population. Diabetes and hyperlipidemia in the MS population were more common in men than women. Most patients (89%) were not treated with disease-modifying therapies. CONCLUSION: The most common comorbidity in the MS population is hypertension. The MS population has an increased prevalence of depression versus the matched controls. MS patients-especially men and older individuals-are at increased risk of developing vascular diseases.

Clinical evaluation of children with ulcerative colitis treated between 2013-2015 - own experience.

AIM: Evaluation of the changes in the endoscopic, laboratory and clinical status in children with ulcerative colitis (UC) with regard to the duration of the disease. MATERIAL AND METHODS: 91 children with UC were involved in the study. Each of them had colonoscopy and their laboratory values were tested. We assessed the colonoscopy results by the Paris classification and by the Baron score. Moreover, demographic, clinical and anthropometric data were collected. We divided our patients into five subgroups depending on the duration of the disease. In order to assess the changes in the variables, we conducted the Mann-Whitney U test. RESULTS: The most numerous group were patients whose disease had lasted between 1 and 2.5 years. At the time of assessment 39.6% did not have inflammation lesions in the mucosa and 60.4% were in sustained clinical remission. At the time of diagnosis 55% of the participants had pancolitis or extensive colitis and 66% had ulcers or ulcerations in the mucosa. We found a statistically significant decrease in the extension of the disease between the patient at diagnosis and the patient during the first year after diagnosis, with p=0.049, but there were no statistically significant differences in the activity of the inflammatory changes between those groups. No significant changes were found in laboratory values, apart from those pertaining to faecal calprotectin (FC). During our study 95% of the patients were exposed to mesalazin, 66% to corticosteroids, 57% to immunosuppressants and 10% to biologics. 20% of our patients were exposed to steroids more than once. CONCLUSIONS: The changes observed during colonoscopy in children with UC have a widespread localization and varied aggression. With the duration of the disease, inflammatory lesions tend to acquire more and more of the surface in the colon, but are not characterized by a progression of their activity. The issue requires further well-designed studies.

Demographic characteristics of children with early clinical manifestation of inflammatory bowel disease.

INTRODUCTION: Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition of the colon and small intestine. The disease is common in young people (children and young adults), but it is rare in children younger than five years of age. Therefore, IBD developing during the first years of life (under the age of 5) is known as an early-onset IBD (EO-IBD), and it is considered to be a specific entity with a distinct phenotype. However, the available data on that issue are still insufficient. AIM: To determine the characteristics and clinical course of children with early-onset IBD. MATERIAL AND METHODS: We performed a retrospective database analysis of 47 infants younger than 5 years old diagnosed with IBD. Patient's demographic data, including age, sex, and age at disease onset, were collected in 6 paediatric hospitals in Poland. Disease location was established on the basis of the review of all endoscopic, colonoscopic, histopathological, and radiological records. All possible complications were reported, as well as any treatment and its efficacy. Since the diagnosis was established all patients have been on follow up. RESULTS: Among 47 children registered in the database, 23 (49%) had a diagnosis of CD, 16 (34%) had UC, and 8 (17%) had IC (indeterminate colitis). The mean age at diagnosis was 28.5 ±27.5 months; 57.4% were male. The most common location/type of disease was ileocolonic disease (L3). The most common complication of IBD was anaemia, found in 30 (63.8%) children. The observed course of the disease was either severe or moderate. In 4 children younger than 2 years old, surgery was performed. CONCLUSIONS: Inflammatory bowel disease in children younger than 5 years old includes UC, CD, and a relatively high proportion of IC. In early-onset IBD severe and moderate course of the disease is usually observed. Disease manifestation in these patients is predominantly ileocolonic.

Traumatic basal subarachnoid haemorrhage or ruptured brain aneurysm in 16-year-old boy? - case report

Traumatic basal subarachnoid haemorrhage (TBSAH) represents only 1.8% of all subarachnoid haemorrhage cases diagnosed during autopsy. This report presents such a case from the current practice of the authors. Sixteen-year-old boy was beaten by the aggressors. Suddenly he lost his consciousness and fall after he received a single blow in the neck. He was resuscitated immediately, but died at the scene. During the external examination we did not find any significant external injuries. Autopsy revealed large contusion of right sternocleidomastoid muscle. In the cranial cavity we found extensive subarachnoid haemorrhage, located mainly on brain basis, in the posterior cranial fossa and covering the subtentorial structures. During the preparation of blood vessels we noticed a slight change of morphology suggesting damaged vessel or aneurysm, or vascular malformation located in the basilar artery bifurcation, which was taken to detailed microscopic evaluation using the special stainings. Histological examination showed vital interruption of the basilar artery wall with massive haemorrhage, without the presence of general microscopic pathology. From the medico-legal viewpoint, to determine traumatic background of haemorrhage it is necessary to find the coexistence of the following circumstances: a sustained trauma, post-mortem findings consistent with a time of injury, the presence of temporal relationship between injury and death, and morphological vital injury of the brain vessel, as well as the absence of prior vascular malformations. For this purpose Verhoeff-van Gieson's, Masson's, Turnbull's and Gomori' histological stainings may be successfully used.

[Efficacy and safety of cyclosporine in the treatment of inflammatory bowel disease in children - a retrospective study]. / Retrospektywna ocena skutczscii bezpieczenstwa leczenia cyklosporyna dzieci z nieswoistym zapaleniem jelit.

AIM: the aim of this study was to report single centre experience with cyclosporine used in treatment of children with inflammatory bowel disease with regard to safety and efficacy. METHODS: retrospective analysis included 23 patients, 21 with ulcerative colitis and 2 with Crohn's disease, aged 2.75 to 18.5 years. They were treated with cyclosporine during the last 5 years. Before cyclosporine therapy was started they received steroids and azathioprine. Cyclosporine treatment was given in severe steroid-resistant exacerbation of the disease (n = 10) or steroid-dependence (n = 13). Cyclosporine dose was set to obtain therapeutic levels (serum concentration > 100 ng/ml and < 200 ng/ml). RESULTS: Cyclosporine treatment was continued up to 2 months in 6 cases, 2 to 6 months in 8 patients and more than 6 months in 9 patients. Complications were reported in 2 patients: hirsutism and gingival hypertrophy. Cyclosporine treatment was stopped in the second case. None of the two patients with Crohn's disease improved during the treatment. Short-term improvement was observed in 11 patients with ulcerative colitis. Long-term recovery (> 6 months) was obtained in 6 cases. In 10 patients with severe exacerbation of ulcerative colitis colectomy was performed, in 4 of them elective surgery was performed when the clinical status improved. CONCLUSION: cyclosporine appears to be a safe and relatively effective treatment of ulcerative colitis in children. Cyclosporine is less effective in maintaining remission and it did not allow to avoid colectomy in severe exacerbation. Still case controlled studies are needed to show the efficacy of this treatment.