Vol 5, No 3 (2019)

The problem with violence among children and adolescents is very popular today. The reason is that the cases of aggressive verbal and physical acts on and among children have become very frequent. The better recognition of child rights, problems and needs will contribute to the elaboration of effective policies and practices for improvement of the state of children in Bulgaria. The legislation, procedures and authorities related to child protection in Bulgaria are described. Data collected from different sources concerning child abuse, are presented. The use of forensic medicine in prevention of child abuse is still not fully implemented in government politics. Actual priorities are common with other countries of the region. Many aspects of violence against children remain hidden for the specialized institutions and for the society, because in most cases these acts are not reported or registered. Reasons for this to happen are the lack of social sensitivity and engagement for prevention of violence against children, the ignorance of child’s right to protection and of everyone’s obligation to inform agencies for child protection about children at risk as well. This is not specific for Bulgaria only, but applies to all the European countries.

Objectives. To examine the objectivity and reliability of the branch statistical reporting on the number of deaths and divergences of the final clinical and medico-legal diagnoses in the hospitals of the Moscow region.

Material and methods. We have investigated materials of the Bureau of Forensic Medical Expertise of Moscow Region and data of the Federal statistical monitoring № 14 «Information on the activities of the inpatient care units’ in the Moscow region in 2018. It was the sampling inquiry. The causes of death were grouped by classes and nosologiсal entities of ICD‑10. Research methods: documentary, statistical and analytical. Descriptive statistics of the absolute and relative values.

Results. Significant differences between the data of Federal statistical monitoring No. 14 and the Bureau of Forensic Medical Expertise of Moscow Region were established both in the number of medico-legal examinations in relation to individual entities and in the number of established divergences of diagnoses.

Conclusion. The form of Federal statistical monitoring No. 14 provides biased information in the section of information on cases subjected to forensic autopsy: input errors are 90 %.

Objectives. Morphometry of the main vascular and parenchymal structures of the liver which reflect its morphofunctional state.

Material and methods. We examined the postmortem liver samples from 15 cases of rapid death of youth and adult men (26.6 % and 40 %, respectively) and women (13.4 % and 20 %, respectively). For histological studies we used archival paraffin-embedded tissue blocks of the liver. A series of 5 μm sections were made. Tissue sections were stained with hematoxylin-eosin. Random fields of view of histological slides were photographed with the OLYMPUS XC30 digital camera mounted on the OLYMPUS CX41 microscope (Japan) with SWH ocular magnification ×10 and UPLanFL aim magnifications ×10, ×20, ×40 (at least 10 fields of view of each slide). Morphometric data analysis was carried using Image Scope Color viewing program and Olympus cellSens imaging software (Japan). Statistical analysis was carried out using the software STATISTICA 10.

Results. The liver microvasculature vessels have different diameters: the largest one corresponds to the interlobular veins ((87.80 ± 1.84) μm), the smallest corresponds to the interlobular arteries ((25.62 ± 2.41) μm). The diameter of the central vein is (54.03 ± 0.86) μm. The diameter of sinusoids is (28.36 ± 0.93) μm, interlobular bile ducts – (13.86 ± 0.80) μm. The areas of hepatocytes and nuclei are of (486.14 ± 11.15) μm2 and (58.89 ± 1.86) μm2, respectively; the area of the cytoplasm is (427.25 ± 9.19) μm2. The nuclear cytoplasmic ratio is 0.137 ± 0.06.

Conclusion. The obtained morphometric data can be used for the comparison when studying the pathological features of the liver in other pathological conditions such as alcohol intoxication. Further development of this research area is required to select morphometric characteristics and map the relative morphometric norm of a “healthy” liver.

In the article we present results of the studies in cases of death with a long agonal period to determine the length of the agony.

Objectives. The task was to examine the features of oxidative modification of serum proteins in cases of deaths with a long agonal period.

Material and methods. In all experiments we analyzed the liquid blood sampled from 54 corpses of persons of both sexes who died from the violent and natural death in age of 13 to 89 years. The assessment of the oxidative modification of proteins (OMP) was performed by the level of carbonyl derivatives detected in the reaction with 2,4-dinitrophenylhydrazine. The levels of absolute and relative (in terms of protein) total OMP in cases of long agonal period were compared with the counterpart levels in cases of the short agony. The duration of the agonу was determined using information about the circumstances of the case and investigative data with the permission of the authority ordered the forensic examination. The autopsy data also were taken into account.

Results. We revealed the dependence of the OMP level on the duration of the agonal period. The total OMP (in terms of protein) in cases of long agony have decreased by 45.46 %. The data obtained have showed that the parameters of the OMP, taking into account all the relevant factors, can be used to develop criteria for establishing the duration of the agonal period as well as to increase the evidence-based significance of medico-legal conclusions.

The article presents the cases observed in the practice of the Office of medico-legal examinations of the Moscow Region when computed tomography (CT) was used for the first time in Russia for pre-autopsy examination (virtual autopsy) of three corpses with gunshot wounds followed by imaging-anatomical comparison of the results.

Objectives. Determination of the injury volume, visualization of the wound tracts, localization of the bullets.

Material and methods. Computed tomography was performed in radiology department using CT Scanner Hitachi Eclos‑16 (16 slices per rotation, slice thickness 1.5 and 2.0 mm) followed by multi-planar reconstruction of the images.

Results. 3D reconstruction of the CT scans of the corpses has visualized the whole volume of the trauma. Firearm perforating skull fractures, crushing injuries of the brain, injuries of the thoracic and abdominal organs along the wound tracks, bullets at the ends of the blind wound tracks were revealed on CT-scans.

Conclusion. Pre-autopsy CT with 3D-reconstruction has allowed to determine localization of the bullets in the bodies accurately. This allowed to choose the optimal examination tactics in each particular case and provided invaluable assistance in the search for the bullets. Virtopsy in the cases of firearm injury has great diagnostic opportunities in visualization and 3D presentation of the wound tracks and their direction. 3D CT has recorded the original position and characteristics of the skull fractures under the undamaged tissues. The authors made the assumption that a virtual autopsy could be a reliable alternative to traditional autopsy in the foreseeable future in cases of firearm injuries.

We describe and discuss the case of a 44-year old paranoid woman who committed suicide by ingestion of approximately 4 litres of toilet bowl cleaner. Autopsy findings consisted of central dysregulation and extensive mucosa ulcerations of oesophagus and stomach with fatal bleeding. Autopsy and toxicological results are presented in the light of the literature.

The criteria of differential diagnosis of death from alcoholic cardiomyopathy and acute alcohol poisoning are proposed on the basis of the characteristic pathogmonic histological changes revealed in authors in the kaordiomyocytes. An attempt was made to create recommendations on the differential diagnosis of death from alcoholic cardiomyopathy and some other causes of death (acute alcohol poisoning, sudden death from coronary heart disease).

Doctor of Medical Sciences, Professor V. A. Klevno has reviewed the textbook “Forensic Medicine” for the medical students written by the team of authors edited by the Doctor of Medical Sciences I. V. Buromskiy and published by “NORMA” in 2019. The textbook is recommended for use in the educational process as a main course book in the discipline of “Forensic Medicine”.