Mortality due to visceral leishmaniasis in Brazil by municipalities, 2001-2018: a spatial-temporal analysis of estimates from the Global Burden of Disease study.

OBJECTIVES: In the American regions, Brazil accounts for 97% of visceral leishmaniasis (VL) cases, with a case fatality rate of approximately 10%. This study aimed to investigate the VL mortality distribution in Brazil and identify high-priority and high-risk areas for intervention strategies. STUDY DESIGN: This was an ecological study that analysed the spatial-temporal patterns of VL mortality in Brazilian municipalities. METHODS: Age-standardised VL mortality rates from the Global Burden of Disease study from 2001 to 2018 were used. The distribution of mortality in the municipalities was assessed, and subsequently the Local Index of Spatial Autocorrelation (LISA) analysis was conducted to identify contiguous areas with high mortality rates. Scan analysis identified clusters of high spatial-temporal risks. RESULTS: The highest mortality rates and clusters were in municipalities located in the Northeast region and in the states of Tocantins and Roraima (North region), Mato Grosso do Sul (Central-West region), and Minas Gerais (Southeast region). According to LISA, there was an increase in the number of municipalities classified as high priority from the first 3-year period (n = 434) to the last 3-year period (n = 644). The spatio-temporal analysis identified 21 high-risk clusters for VL mortality. CONCLUSION: Areas with a high risk of VL mortality should prioritise preventing transmission, invest in early diagnosis and treatment, and promote the training of healthcare professionals.

Current status of undergraduate teaching in forensic & legal medicine in Europe.

The European Council of Legal Medicine (ECLM) is the body established in 1992 to represent practitioners forensic & legal medicine and is composed of delegates of the countries of the European Union (EU) and from other countries which form part of Europe to a current total of 34 member countries. The aims of this study were to determine the current status of undergraduate forensic & legal medicine teaching in the curriculum of medical studies in ECLM countries and to use the results of this study to determine whether it would be appropriate to develop new guidelines and standards for harmonising the content of undergraduate forensic medicine training across ECLM member countries. A detailed questionnaire was sent to all individuals or organisations listed on the ECLM contact database. Responses were received from 21 of 33 countries on the database. These responses showed considerable emphasis on undergraduate teaching of forensic medicine in all countries with the exception of Belgium and the United Kingdom. There was great general consistency in the subjects taught. The data from this survey provide a baseline which should assist in developing a strategy to harmonise forensic & legal medicine undergraduate training in member countries of the ECLM. The ECLM is now in a good position to establish a pan-European working group to coordinate a consensus document identifying an appropriate and modern core undergraduate forensic medicine curriculum that can be presented to the medical education authorities in each country, and which can be adapted for local requirements, based on available personnel, the forensic medicine structure in the country, and most importantly, the needs of the local population.

DiatomNet v1.0: A novel approach for automatic diatom testing for drowning diagnosis in forensically biomedical application.

BACKGROUND AND OBJECTIVE: Diatom testing is supportive for drowning diagnosis in forensic medicine. However, it is very time-consuming and labor-intensive for technicians to identify microscopically a handful of diatoms in sample smears, especially under complex observable backgrounds. Recently, we successfully developed a software, named DiatomNet v1.0 intended to automatically identify diatom frustules in a whole slide under a clear background. Here, we introduced this new software and performed a validation study to elucidate how DiatomNet v1.0 improved its performance with the influence of visible impurities. METHODS: DiatomNet v1.0 has an intuitive, user-friendly and easy-to-learn graphical user interface (GUI) built in the Drupal and its core architecture for slide analysis including a convolutional neural network (CNN) is written in Python language. The build-in CNN model was evaluated for diatom identification under very complex observable backgrounds with mixtures of common impurities, including carbon pigments and sand sediments. Compared to the original model, the enhanced model following optimization with limited new datasets was evaluated systematically by independent testing and random control trials (RCTs). RESULTS: In independent testing, the original DiatomNet v1.0 was moderately affected, especially when higher densities of impurities existed, and achieved a low recall of 0.817 and F1 score of 0.858 but good precision of 0.905. Following transfer learning with limited new datasets, the enhanced version had better results, with recall and F1 score values of 0.968. A comparative study on real slides showed that the upgraded DiatomNet v1.0 obtained F1 scores of 0.86 and 0.84 for carbon pigment and sand sediment, respectively, slightly worse than manual identification (carbon pigment: 0.91; sand sediment: 0.86), but much less time was needed. CONCLUSIONS: The study verified that forensic diatom testing with aid of DiatomNet v1.0 is much more efficient than traditionally manual identification even under complex observable backgrounds. In terms of forensic diatom testing, we proposed a suggested standard on build-in model optimization and evaluation to strengthen the software's generalization in potentially complex conditions.

IPMICALC: an Integrated Post-mortem Interval Calculator.

Correctly estimating the post-mortem interval (PMI) is essential in forensic practice. In recent decades, the measurement of vitreous humor analyte concentrations - especially of hypoxanthine and potassium - and their correlation with the PMI have returned good results. However, calculating the PMI from the data collected can be quite complex. The present paper describes a web resource ( http://modestya.usc.es:3838/Forensic/ ) that simplifies the procedure. The PMI is determined (with its 95% confidence interval) in a rapid, easy, and reliable manner based on the use of mathematical models, the biochemistry of the vitreous humor, and physical variables such as the ambient temperature, the rectal temperature, and bodyweight. The application is entirely free to use.

Development and Validation of a GC-MS-EI Method to Determine α-PHP in Blood: Application to Samples Collected during Medico-Legal Autopsies.

New psychoactive substances (NPSs) still represent an issue of great concern worldwide despite efforts made by national and international control systems to limit the spread of these substances. Alpha-pyrrolidinohexanophenone (α-PHP) is a fairly recent synthetic cathinone (the second largest group of monitored substances in Europe) with only a few published studies on the substance. Though there is a low incidence of NPS consumption in Portugal, a recent increase in apprehensions and detections in biological matrices of the substance was verified. An analytical methodology was developed and validated for determining and quantitating α-PHP in blood. Solid-phase extraction was employed for sample preparation (500 µL), which was further analyzed by gas chromatography--mass spectrometry-electron ionization in single-ion monitoring mode with cocaine-d3 as the internal standard. Method validation followed the guidelines of the American National Standards Institute/AAFS Standards Board (ANSI/ASB Standard 036). The procedure was linear between 10 and 1,000 ng/mL, with determination coefficients (r2) higher than 0.999. Carryover was not observed. A limit of detection of 5 ng/mL and a limit of quantitation of 10 ng/mL were achieved. Intraday and intermediate precision and bias assessment showed satisfactory results (coefficient of variation <17.7%; bias <11.6%), and extraction efficiency ranged from 98.5% to 103.3%. The stability of the substance was considered acceptable for at least 6 h at room temperature, 48 h in the autosampler and 21 days after five freeze/thaw cycles. The developed methodology was applied to 15 real samples from the Laboratory of Chemistry and Forensic Toxicology, Centre Branch of the National Institute of Legal Medicine and Forensic Sciences, Portugal, with drug concentrations ranging from 15 to 227 ng/mL. Available information for each case is also detailed in the present article.

The biochemistry of the vitreous humour in estimating the post-mortem interval-a review of the literature, and use in forensic practice in Galicia (northwestern Spain).

The K+ and hypoxanthine (Hx) concentrations of the vitreous humour (VH) rise gradually after death, providing a means of estimating the post-mortem interval (PMI). The correlation between these analytes and the PMI is good since the vitreous chamber is partially isolated from autolytic events occurring elsewhere; the [K +] and [Hx] recorded is thus the result of changes within the eye. The present work provides a systematic review, following PRISMA recommendations, of 36 articles (3 reviews and 33 retrospective cohort studies) discussing the many procedures and regression models that have been developed for improving PMI estimates involving VH analytes. The results of a descriptive study are also provided, highlighting the causes and distribution of mortality as registered in medico-legal autopsies performed in 2019 in Galicia (northwestern Spain), and revealing the use of these PMI estimation methods in real forensic practice. Great heterogeneity was detected in the collection of VH samples, the treatments to which they were subjected before examination, and in their conservation and analysis. A lack of reproducibility in the analytical methods employed to estimate [K +] and [Hx] was noted, as well as an absence of external validation for most of the regression formulae used to determine the PMI from analyte values. The use of methods based on high-performance liquid chromatography, focal electrophoresis, or thermogravimetric/chemometric procedures might solve the problems encountered with traditional analytical techniques, offering reliable results more quickly and effectively (even when samples are contaminated). This study recommends using flexible multiple regression models that combine physical and chemical variables, and that population databases be constructed so that models can be properly validated.

Oxide-silicate petrology and geochemistry of subducted hydrous ultramafic rocks beyond antigorite dehydration (Central Alps, Switzerland).

Oxide minerals contained in ultramafic rocks are useful tools to assess the redox conditions of the rock and fluids liberated upon progressive serpentinite dehydration during subduction, as these minerals contain a relevant redox-sensitive element, iron. Previous studies have revealed that magnetite predominates across the antigorite-out reaction. However, the fate of magnetite and other oxides at higher pressure and temperature conditions has remained underexplored. We present a comprehensive petrological and geochemical study of oxide-sulfide-silicate mineral assemblages in metaperidotites beyond antigorite- and chlorite-out reactions (T = 650-850 °C and P = 1-3 GPa). Several ultramafic lenses, covering different bulk rock compositions and extents of oxidation upon oceanic serpentinization, were investigated from the Central Alps, Switzerland. Results point to two endmember scenarios: (i) Most frequently, metaperidotites have olivine with a Mg# of 89-91 (defined as molar Mg/(Mg + Fetot) × 100) and contain low oxide modes (0.06-1.41 vol.%), hematite is absent, and redox conditions are weakly oxidized and buffered by orthopyroxene-olivine-magnetite. (ii) Rare occurrence, high olivine Mg# > 94.5 metaperidotites display coexisting hematite and magnetite, high oxide modes (up to 4 vol.%), and redox conditions are hematite-magnetite (HM) buffered (Δlog10fO2,QFM of + 3 to + 4). Spinel displays evolving compositions from magnetite over chromite to Al-Cr-spinel, roughly correlating with increasing temperature. Most of the samples buffered by the olivine-orthopyroxene-magnetite assemblage contain coexisting pentlandite ± pyrrhotite, thus identifying stable sulfides beyond antigorite dehydration for these weakly oxidized samples (Δlog10fO2,QFM < 2.5). No sulfides were recognized in the highly oxidized sample. The transition of magnetite to chromite at around 700 °C goes along with a shift in fO2 to lower values. At the prevailing oxygen fugacity in the weakly oxidized metaperidotites sulfur in a coexisting fluid is always present in its reduced form. However, oxidized sulfur can be stable in the dehydration fluids released from highly oxidized serpentinites. Supplementary Information: The online version contains supplementary material available at 10.1007/s00410-023-02032-w.

Oral health professional intervention and child physical abuse-European legal approach.

Physical violence against children and adolescents is an issue of Global Public Health. This study aims to identify traumatic injuries and the medicolegal temporary framework of the victim's profile in the European legal approach. Participants and setting include the following: the clinical reports of a Portuguese European Clinical Academic Center database were analysed. An observational and prospective cohort study was performed. A descriptive analysis of the variables was conducted, considering gender, bimodal age groups, place of residence, offender data, place of occurrence, aetiology, localization, type of injuries, personal injury assessment by Quantum doloris, and injury time. The statistical analysis was performed by Spearman's rho and Kendall's tau-b correlation tests, Pearson's chi-square test of independence (χ2), and Mann-Whitney and Kruskal-Wallis nonparametric tests (P < 0.05). The relationship between age groups and the place of occurrence was statistically significant (P = 0.001). Orofacial and nonorofacial injuries were related (P = 0.035). The General Data Protection Regulation is not a barrier to the treatment and sharing of justified data but a framework for safeguarding individuals' fundamental rights, including the Right to Health. Meticulous reporting of the clinical situation involves the victim, the occurrence, and the potential offender. Key points: An oral health professional's notification of the event is a fundamental step of the judicial process.The timeline is the core of traumatic injury assessment in a child physical abuse scenario.Medicolegal evaluation impacts disability prevention, imputability, and notification of the crime.

Medico-Legal Examination of Sexual Assaulted Victims Unable to Consent in Portugal: Ethical Decision-Making.

Medical decision-making is a complex task in any field. In the medico-legal examination of victims that have (allegedly) been sexually assaulted there are many specific variables and features influencing the decision. It is essential to complement the clinical intervention with a forensic approach. Clinical parameters such as the victim's physical and cognitive state along with circumstantial information such as the elapsed time from the event and the type of abuse (described or suspected) grant different levels of priority to the forensic medical assessment. In such cases, forensic medical doctors or other medical doctors responsible for attending to the victim may have to decide whether to perform the examination prior to a judicial analysis of the case if consent cannot be obtained. This implies the need to deliberate about performing the examination and/or reporting the case to legal authorities. This article discusses the forensic medical decision-making process in cases of alleged recent sexual assault of victims who are legally unable to consent or unable to consent for other reasons. We aimed to identify possible ethical problems that can arise in this context and discuss which elements should be considered by medical doctors when making decisions about such cases. The Portuguese legal framework of medico-legal examinations is analyzed. The authors also make considerations about reporting these cases from a legal point of view. The discussion turns to an ethical perspective where possible ethical problems arising from medical deliberation are identified. Issues about legally incompetent victims and incompetent victims due to other reasons are addressed. A decision-making tree, based on the problems identified, is proposed.

Use of deep learning in forensic sex estimation of virtual pelvic models from the Han population.

Accurate sex estimation is crucial to determine the identity of human skeletal remains effectively. Here, we developed convolutional neural network (CNN) models for sex estimation on virtual hemi-pelvic regions, including the ventral pubis (VP), dorsal pubis (DP), greater sciatic notch (GSN), pelvic inlet (PI), ischium, and acetabulum from the Han population and compared these models with two experienced forensic anthropologists using morphological methods. A Computed Tomography (CT) dataset of 862 individuals was divided into the subgroups of training, validation, and testing, respectively. The CT-based virtual hemi-pelvises from the training and validation groups were used to calibrate sex estimation models; and then a testing dataset was used to evaluate the performance of the trained models and two human experts on the sex estimation of specific pelvic regions in terms of overall accuracy, sensitivity, specificity, F1 score, and receiver operating characteristic (ROC) curve. Except for the ischium and acetabulum, the CNN models trained with the VP, DP, GSN, and PI images achieved excellent results with all the prediction metrics over 0.9. All accuracies were superior to those of the two forensic anthropologists in the independent testing. Notably, the heatmap results confirmed that the trained CNN models were focused on traditional sexual anatomic traits for sex classification. This study demonstrates the potential of AI techniques based on the radiological dataset in sex estimation of virtual pelvic models. The excellent sex estimation performance obtained by the CNN models indicates that this method is valuable to proceed with in prospective forensic trials.Key pointsDeep learning can be a promising alternative for sex estimation based on the pelvis in forensic anthropology.The deep learning convolutional neural network models outperformed two forensic anthropologists using classical morphological methods.The heatmaps indicated that the most known sex-related anatomic traits contributed to correct sex determination.

Heavy metal contamination in Peru: implications on children's health.

Cerro de Pasco, Peru, has been excessively contaminated with heavy metals due to high mining activities in the region. We investigated the presence of chronic exposure to heavy metals in children living in Cerro de Pasco and its effect on health. Heavy metal concentrations were determined in hair samples collected from 78 children living in a region exposed to an open-pit mine (Paragsha region) and from other 16 children unexposed to mine activities (Carhuamayo region). Children exposed to the mine showed statistically significant higher concentration of aluminum, antimony, arsenic, cadmium, chromium, iron, lead, tin and thallium (p < 0.05) than control children. Hair samples collected from the same children in two occasions (2016 and 2018) showed that the exposure is chronic with higher levels of heavy metals observed in 2018. The concentration of heavy metals was higher in hair tip than in hair root samples. Heavy metals are associated with substantial higher risk of nosebleed (odds ratio, OR = 15.40), chronic colic (OR = 7.30), dermatologic alterations (OR = 6.16), mood alterations (OR = 7.07), presence of white lines on nails (OR = 12.10), reduced visual camp (OR = 3.97) and other symptoms (OR = 5.12). Chronic heavy metal exposure implies various negative consequences on children's health. Preventive measures are crucial to protect children's health.

Trends in microextraction approaches for handling human hair extracts - A review.

The complementary role of hair in testing scenarios has expanded across the spectrum of toxicological and clinical monitoring investigations and, over the last 20 years, hair analysis has gained increasing attention and recognition. Moreover, a great deal of attention has been paid to the miniaturisation of extraction procedures, minimising/eliminating toxic organic solvents consumption, making them user-friendly and rapid, in addition to maximising extraction efficiency. The aim of this work is to provide a critical review of the advances observed over the last 5 years in the use of miniaturised approaches for sample clean-up and drug pre-concentration in hair analysis. There have been major improvements in some well-established microextraction approaches, such as liquid phase microextraction, mainly through the use of supramolecular and ionic liquids. In addition, new developments have also been reported in solid phase microextraction, driven by d-SPE applications. In the last 5 years, a total of 69 articles have been published using some type of microextraction technique for hair specimens, thus justifying the relevance of a critical review of innovations, improvements and trends related to these miniaturised approaches for sample preparation.

A potential method for sex estimation of human skeletons using deep learning and three-dimensional surface scanning.

Deep learning based on radiological methods has attracted considerable attention in forensic anthropology because of its superior classification capacities over human experts. However, radiological instruments are limited in their nature of high cost and immobility. Here, we integrated a deep learning algorithm and three-dimensional (3D) surface scanning technique into a portable system for pelvic sex estimation. Briefly, the images of the ventral pubis (VP), dorsal pubis (DP), and greater sciatic notch (GSN) were cropped from virtual pelvic samples reconstructed from CT scans of 1000 individuals; 80% of them were used to train and internally evaluate convolutional neural networks (CNNs) that were then evaluated externally with the remaining samples. An additional 105 real pelvises were documented virtually with a handheld 3D surface scanner, and the corresponding snapshots of the VP, DP, and GSN were predicted by the trained CNN models. The CNN models achieved excellent performance in the external testing using CT-based images, with accuracies of 98.0%, 98.5%, and 94.0% for VP, DP, and GSN, respectively. When the CT-based models were applied to 3D scanning images, they obtained satisfactory accuracies above 95% on the VP and DP images compared to the GSN with 73.3%. In a single-blind trial, a multiple design that combined the three CNN models yielded a superior accuracy of 97.1% with 3D surface scanning images over two anthropologists. Our study demonstrates the great potential of deep learning and 3D surface scanning for rapid and accurate sex estimation of skeletal remains.

Acute liver failure requiring transplantation: A possible link to ulipristal acetate treatment?

The present case describes in detail a 55-year-old woman diagnosed with acute liver injury 3 days after completion of the first treatment course with ulipristal acetate (UPA), 5 mg/day orally for uterine fibroids causing persistent bleeding (treatment duration of 109 days). Liver transplantation was performed approximately 6 weeks after UPA suspension, and a photograph of the explanted liver is presented. Of note, other common causes of acute liver injury, such as history of alcohol or other psychoactive substances abuse, viral hepatitis and autoimmune hepatitis or preexisting liver disease were all excluded. This case was reported to the European Medicines Agency (EMA) and contributed to the final recommendations of the Pharmacovigilance Risk Assessment Committee (PRAC) disclosed in January 2021. The causality assessment considered a probable case of drug-induced liver injury as a consequence of UPA treatment, and the Roussel Uclaf Causality Assessment Method (RUCAM) was scored as unlikely. Although further studies are needed aiming to avoid confounding factors, this case suggests that liver function tests should be monitored during treatment with UPA.

Socialization During the COVID-19 Pandemic: The Role of Social and Scientific Networks During Social Distancing.

In the COVID-19 era, while we are encouraged to be physically far away from each other, social and scientific networking is needed more than ever. The dire consequences of social distancing can be diminished by social networking. Social media, a quintessential component of social networking, facilitates the dissemination of reliable information and fighting against misinformation by health authorities. Distance learning, telemedicine, and telehealth are among the most prominent applications of networking during this pandemic. Additionally, the COVID-19 pandemic highlights the importance of collaborative scientific efforts. In this chapter, we summarize the advantages of harnessing both social and scientific networking in minimizing the harms of this pandemic. We also discuss the extra collaborative measures we can take in our fight against COVID-19, particularly in the scientific field.

Patient Safety in Dental Practice: Lessons to Learn About the Risks and Limits of Professional Liability.

INTRODUCTION: Health professionals should work with the notion of risk involved in the health care process. Dental practice risk is of particular interest because it encompasses both aesthetic and functional components. Focusing on guidelines suggested by the World Health Organization and objectives on patient safety, this study has 2 objectives: to present Portuguese medicolegal data on corporal damage evaluation related to iatrogenic sequelae during dental practice and to present updated evidence on patient safety. MATERIALS AND METHODS: A retrospective study was performed by analysing data from the database of the Laboratory of Forensic Dentistry of the Faculty of Medicine, University of Coimbra, Portugal, from 2013 to 2018. RESULTS: One hundred seven medicolegal files were selected according to the inclusion and exclusion criteria. Iatrogenic sequelae (73.8%, 79 out of 107) were categorised as risks (60 out of 79) and malpractice (19 out of 79). The risk was associated mostly with mandibular dysfunction and orthodontic treatment (62.2%). Malpractice was mostly associated with neurological deficit and implant rehabilitation (47.4%). DISCUSSION AND CONCLUSION: Greater attention to these data by professionals was emphasised, especially when considering patient safety and health care quality. This article presents the Portuguese data on professional liability in the field of dental practice, categorising iatrogenic sequelae into risks and malpractice, as well as the oral rehabilitation procedure and timeline.

An efficient method for building a database of diatom populations for drowning site inference using a deep learning algorithm.

Seasonal or monthly databases of the diatom populations in specific bodies of water are needed to infer the drowning site of a drowned body. However, existing diatom testing methods are laborious, time-consuming, and costly and usually require specific expertise. In this study, we developed an artificial intelligence (AI)-based system as a substitute for manual morphological examination capable of identifying and classifying diatoms at the species level. Within two days, the system collected information on diatom profiles in the Huangpu and Suzhou Rivers of Shanghai, China. In an animal experiment, the similarities of diatom profiles between lung tissues and water samples were evaluated through a modified Jensen-Shannon (JS) divergence measure for drowning site inference, reaching a prediction accuracy of 92.31%. Considering its high efficiency and simplicity, our proposed method is believed to be more applicable than existing methods for seasonal or monthly water monitoring of diatom populations from sections of interconnected rivers, which would help police narrow the investigation scope to confirm the identity of an immersed body.

New miniaturized clean-up procedure for hair samples by means of microextraction by packed sorbent: determination of cocaine and metabolites.

Cocaine is still one of the most commonly used illicit substances worldwide, with an estimated 4 million users in Europe in the last year. Hair samples have been widely used for the determination of episodic or repeated consumption of this substance, but the use of miniaturized techniques for hair sample clean-up has been challenging due to the sample complexity. Despite hair's complex matrix, MEPS provides a method that is fast, reduces the volume of extraction solvents used, and offers low-cost options (since extraction beds may be reused several times). Microextraction by packed sorbent using a mixed-mode sorbent was optimized for hair sample clean-up in order to determine cocaine, benzoylecgonine, ecgonine methyl ester, norcocaine, cocaethylene and anhydroecgonine methyl ester by gas chromatography coupled to tandem mass spectrometry. The method was fully validated according to internationally accepted criteria, presenting good linearity between the limits of quantification (0.01-0.15) and 5 ng/mg. Precision and accuracy resulted in coefficients of variation typically lower than 15%, with mean relative errors within ±15% for all compounds, except for the limit of quantification (±20%). The present work describes the first application of microextraction by packed sorbent for the concentration of cocaine and metabolites extracted from hair samples. Graphical abstract.