National Legal Medicine Institute

Background/Objectives: The presence of postmortem pink teeth is a phenomenon occasionally observed during forensic autopsies. This phenomenon has been typically associated with deaths involving drowning, asphyxiation, trauma, or electrocution. However, the recent literature suggests that it is nonspecific. Despite being recognized in forensic literature for decades, its pathophysiology, prevalence, and forensic relevance remain controversial. The existing evidence is scattered and primarily based on case reports, narrative reviews, or isolated observations. This scoping review aims to systematically map the available scientific evidence on the phenomenon of postmortem pink teeth and its potential role in determining the cause of death within the context of forensic medicine. Methods: This review was conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A comprehensive search was carried out across multiple databases to identify studies addressing the occurrence, mechanisms, and forensic interpretation of pink teeth in postmortem examinations. After application of the inclusion and exclusion criteria, the search allowed for the selection of 12 publications (case reports and observational studies). Conclusions: Collected data from the selected studies allowed us to conclude that PTP is a nonspecific taphonomic artifact, lacking diagnostic value in determining the cause of death. Mapping the current evidence on pink teeth contributed to a better understanding of this phenomenon and its lack of forensic significance, promoting more informed decision-making in postmortem assessments.

In forensic toxicology, the rapid and reliable detection of emerging synthetic opioids and hallucinogens is crucial for case investigations and public health monitoring. This work describes the development, optimization and validation of a simple, fast and sensitive methodology for the simultaneous analysis of 6 new synthetic opioids (carfentanil, fentanyl, isotonitazene, metonitazene, norfentanyl, and sufentanil) and 2 hallucinogens (lysergide [LSD] and mescaline), together with the main LSD metabolite 2-oxo-3-hydroxy-lysergide [LSD-OH], in whole blood samples by liquid chromatography coupled to tandem mass spectrometry. Under optimized experimental conditions, linearity was verified between 0.1 and 20 ng/mL for all analytes except mescaline (2.5-500 ng/mL), with r2 > 0.99 for 1/x weighting, and no significant carryover or matrix effects were observed. Good precision (% RSD < 13 %) and trueness (% Bias within ± 20 %) values were achieved. The estimated limit of quantification (LOQ) was 0.1 ng/mL for all compounds except mescaline (2.5 ng/mL). Authentic forensic samples were also analyzed, and positive samples for fentanyl, norfentanyl, and sufentanil were identified. The proposed methodology allows the simultaneous analysis of compounds from different families of psychoactive substances, in both postmortem and in vivo samples, using only 50 µL of whole blood. The demonstrated speed, simplicity, and effectiveness make it particularly advantageous for routine implementation in forensic toxicology laboratories.

Diseases affecting the craniofacial skeleton are normally associated with disturbances in the regulation of cellular differentiation, the development of bone structures, and changes in bone density and ossification. Thus, the objective of this integrative review is to evaluate the published scientific literature from the last 8 years concerning the impact of genetics on some craniofacial dysplasias. Our aim covers the identification of oral cavity alterations to those dysplasias, through the most common orofacial manifestations. Three dysplasias were selected to be part of this integrative review: cleidocranial dysplasia, ectodermal dysplasia and Apert syndrome. For this purpose, a bibliographic search was performed in the PubMed, ScienceDirect, Web of Science and Google Scholar databases with several keywords combined with each other. The research question of this review was as follows: "What is the impact of genetic factors on the development of craniofacial dysplasias and associated oral malformations?". After selecting the articles through the application of inclusion and exclusion criteria, 11 articles were selected for this review. Genetics plays a crucial role in craniofacial dysplasias and subsequent oral malformations. The main conclusion was that mutations in different genes can lead to identical phenotypes, while mutations in the same gene can present slight phenotypic differences depending on where they occur. In the future, it would be important to conduct studies with larger samples and control groups that include genetic testing to allow for a more comprehensive study on the impact of genetics on craniofacial dysplasias.

Involuntary commitment in mental health represent a challenge for professionals working in outpatient services, due to tensions between therapeutic necessity and criticisms from a human rights perspective. Effective management of involuntary commitment requires a dual-level approach: comprehensive risk assessment followed by appropriate risk management. This paper outlines practical guidelines for managing involuntary detention across diverse outpatient settings. We analyze six distinct healthcare scenarios: 1) outpatient services within specialized or general hospitals; 2) public outpatient care services; 3) private outpatient care services within healthcare centers; 4) private outpatient care services outside healthcare centers; 5) private practice offices; and 6) telepsychiatry. For each scenario, we provide detailed recommendations addressing referral protocols, patient safety measures, and inter-professional-institutional coordination. Our findings suggest that implementing clear protocols and standardized guidelines significantly reduces professional uncertainty, minimizes improvisation in critical situations, and ensures consistent, high-quality patient care.

Objetivo: Avaliar quais intervalos de tempo mais impactam na demora para liberação dos corpos aos familiares no Serviço de Verificação de Óbitos do Interior (SVOI) de Ribeirão Preto. Material e métodos: Estudo descritivo, quantitativo e retrospectivo, realizado no SVOI da Faculdade de Medicina de Ribeirão Preto (FMRP/USP), entre janeiro de 2014 e dezembro de 2019. A amostra incluiu 5.772 casos de óbitos por causas naturais, analisados por meio de dados provenientes de boletins de ocorrência (BO), registros de entrada e saída de corpos e anotações do serviço. Foram avaliados os intervalos entre a confirmação do óbito, a confecção do BO, o transporte até o SVOI, a realização da necropsia e a liberação do corpo. A análise dos dados utilizou estatísticas descritivas, além do teste de Kruskal-Wallis com ajuste de Bonferroni. Resultados: Os maiores tempos médios ocorreram entre a confirmação do óbito e a elaboração do boletim de ocorrência (média de 4h21min) e entre o boletim e a chegada do corpo ao SVOI (média de 3h50min). O tempo médio no SVOI, desde a chegada até a liberação do corpo, foi significativamente menor (2h30min). As maiores causas de demora foram associadas as etapas administrativas externas ao SVOI, especialmente elaboração do boletim e transporte. Conclusão: Os resultados demonstram que a maior contribuição para o atraso na devolução dos corpos está nos processos externos ao SVOI, enquanto os procedimentos internos, como a necropsia, têm impacto menor. Ficam evidenciadas a necessidade de melhorias administrativas, informatização e articulação interinstitucional para redução dos tempos de espera.

Objective: To characterize the medico-legal aspects of homicides involving women, based on statistical data derived from post-mortem reports conducted at the headquarters of the Institute of Legal Medicine during the period 2021 to 2023. Materials and Methods: A descriptive, cross-sectional case series study was carried out. The data were sourced from statistical records derived from post-mortem examinations performed at the Institute of Legal Medicine during the 2021–2023 period. The study included all 32 documented cases, representing 100% of the universe; therefore, no sampling strategy was employed. Results: The main demographic characteristics were as follows: age group 31–40 years (28.1%), housewives (53.1%), incomplete primary education (28.1%), and in a relationship (40.6% in common-law unions and 6.2% married). The majority of the perpetrators were either current or former intimate partners (34.3%) or family members (18.7%). Most of the homicides occurred in the shared residence of the victim and the aggressor (28.1%). The leading causes of death included stab wounds (40.6%), mechanical asphyxiation (28.1%), and gunshot wounds (18.7%). Most victims sustained multiple types of injuries, with the most frequent being abrasions (50.0%), contusions (46.8%), stab wounds (34.3%), hematomas (25.0%), and gunshot injuries (18.7%). Injuries were commonly found in multiple anatomical regions, most notably the neck (46.8%), upper limbs (40.6%), head (37.5%), and anterior thorax (37.5%). Overkill was identified in 18.7% of the cases, signs of torture in 6.2%, defensive wounds in 37.5%, and signs of sexual violence in 15.6%. Toxicological analyses tested positive for ethyl alcohol in 28.1% of cases, psychotropic substances in 12.5%, cocaine in 6.2%, and marijuana in 3.1%.

Introducción. El cáncer gastrointestinal es una de las principales causas de muerte por cáncer en Colombia, generando altos costos. En las mujeres la salud no solo depende de las enfermedades de los órganos femeninos, sino que las enfermedades malignas del tracto digestivo deben tenerse muy en cuenta. El objetivo de nuestro estudio fue determinar la asociación del riesgo cardiovascular con el estadio tumoral y la presencia de complicaciones posoperatorias en mujeres con cáncer gastrointestinal. Métodos. Estudio descriptivo, de corte transversal, en 231 mujeres con cáncer gastrointestinal atendidas entre 2018 y 2023 en el Servicio de Cirugía Gastrointestinal de La Liga AmaSalvarVidas, en Pereira, Colombia. Se incluyeron variables sociodemográficas, factores de riesgo cardiovascular, características del cáncer gastrointestinal y desenlaces clínicos y quirúrgicos. Se evaluó la asociación de factores de riesgo cardiovascular con el estadio tumoral y su desenlace posoperatorio. Resultados. La edad media de las pacientes fue 64 años. Los tumores más frecuentemente operados fueron de colon, recto y estómago. El riesgo cardiovascular alto se asoció con una mayor morbimortalidad posoperatoria, mientras que el riesgo cardiovascular bajo se asoció con la presencia de estadios tumorales avanzados. Conclusiones. La salud de las mujeres trasciende las enfermedades asociadas a sus órganos femeninos. La presencia de factores de riesgo cardiovascular en mujeres con tumores gastrointestinales desempeña un papel relevante en el estadio tumoral y el desenlace posoperatorio. Promover la salud integral de las mujeres es una condición sine qua non para la atención efectiva.