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The paper reviews enclosure asphyxia as a cause of death of three Nigerian children aged three years, five years and seven years respectively, who were found dead and locked in the boot of a Mercedes Benz 200E Sedan car a day after they were declared missing. The first two were siblings of the same parent whose fathers actually owned the car, while the older child was a neighbour kid all of whom were well known to each other as friends and playmates. They had gone missing for a few hours prior to being seen playing together. Search parties were raised and they were never found until the following day when they were found dead in the boot of the car parked a few meters away from the house under a tree. Incidentally the same car was driven round the neighbourhood for 3 hours during the search the previous day with no inkling that they were in the boot of the car. Autopsy was ordered by the coroner to determine the cause of death.

This paper focuses on the mental health burden on medical and healthcare residents during the 1st wave of COVID-19 pandemic crisis in 2020 describing the activities of a mental health service for residents (NAPREME) in a public university, UNIFESP, Sao Paulo, Brazil; and a preliminary study showing an increasing of depressive symptoms and depression among residents. Data is related to the screening interviews of medical residents and healthcare multi-professional residents who sought the mental health service from March to December 2020. A comparison was conducted with the same period in 2019 (covering a period when Covid-19 was not affecting the Brazilian population). There was a 22% demand increase in 2020. Of the total amount who sought treatment: 23% were medical residents, 22% nursing residents, and the remaining distributed among other professions; and 58% were first year residents and 34% second year. Data from the BDI questionnaire showed some variance between the two years: the mean score for 2020 was 24.67 (± 7.86) which is in the depression range, higher than the mean score of 19.91 points in the previous year (± 10.15) which is only in the depressive symptoms range (p < 0.005). In the pandemic period there was an increase in residents with depression from 49% to 70%. Depression, anxiety, stress and burnout syndrome were observed, demanding psychological and psychiatric care for this population. Assessment of residents’ mental health will continue during 2021, during the 2nd wave of COVID-19 and an additional analysis will be conducted along the year.

Nothing without risk. As cholecystectomy is one of the most common procedures, any minor risk will be a mass volume. This study was to define the magnitude of that risk. In the study were 1486 patients between Feb. 2009 and April. 2018. Open in 292 (19.6%), 1194 (80.4%) laparoscopically, 1086 [91%] completed so and 108 (9%) converted. There were 18 (1.2%) with bile duct injury. 1 (0.3%) in the open group and 17 (1.4%) in the laparoscopic group. 9 diagnosed during surgery, 4 with jaundice, 2 early and 2 late, 5 with leak. Statistically the operative injury is insignificance in the 2 groups (P<0.3). The jaundice was significantly high in the laparoscopic group of patients (P<0.045). Also the bile leak (P<0.028). The same for morbidity (P<0.01. The revers was for mortality (P<0.04). Conclusion: The incidence of CBD injury in the literature is less than the actual rate. Laparoscopic interventions have a higher rate of injury and the proximal ducts are at higher risk.

Coroner and medical examiner offices are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profile case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities. Medico legal death investigation offices, including both medical examiner and coroner offices, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d’être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the next-of-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the office resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offices. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offices. Specifically, we believe the recent case of Otto Warmbier is such a case.

Background/aim: Amitriptyline belongs to class of known as tricycline antidepresant (TCA) that is being used to treat anxiety and depressive states. It may help improve mood and feelings of well-being, relieve anxiety and tension, help to improve sleep and increase energy level. The study investigated the effect of amitriptyline on learning and memory using eighteen (18) healthy Swiss mice of both sexes weighing 16 – 25 g. Method: The animals were divided into three (3) groups consisting of six (6) animals each. Group 1 served as the control group, Group 2 was administered with amitriptyline at a dose of 3 mg/kg body weight dissolved in 3 mls of distilled water, and used to test for learning, while Group three was also given similar administration like Group 2, but used to test for memory. All the animals were tested for learning and memory performance using Novel object recognition task and Morris water maze test. Results: The results obtained from the Novel object recognition task showed that there was a significant decrease (p < 0.05) in total object approach in acquisition trial of amitriptyline treated group when compared to the acquisition trial of the control group. There was a significant decrease (p < 0.05) in retention trial of amitriptyline group when compared to retention trial in the control group. There was a significant decrease (p < 0.05) in total duration exploring objects in acquisition trial of amitriptyline treated group when compared to the acquisition trial of the control group. There was a significant increase (p < 0.05) in total duration exploring objects in retention trial of amitriptyline treated group when compared to the retention trial of the control group. There was a significant decrease (p < 0.05) in the index of habituation of amitriptyline treated group when compared to the control group. The index of discrimination showed a significant increase (p < 0.05) in amitriptyline treated group when compared to the control group and a significant decrease (p < 0.05) in amitriptyline group when compared to the control group. In the Morris water maze test, Day 1 – 3 were for acquisition training, day 4 – 6 reversal training, day 7 the probe trial day and day 8 the visible platform day. During acquisition training in the Morris water maze test, there was no significant difference in Swim latencies in day 1 and 2. However in day 3, there was a significant increase (p < 0.05) in swim latency of group compared to control group and a significant decrease (p < 0.05) in swim latency of amitriptyline treated group compared to the control group. During reversal training in day 1, 2 and 3, there was no significant difference in swim latency among the three groups. Results for the retention quadrant in the probe trials showed a significant decrease (p < 0.01) in amitriptyline group when compared to the control group. Conclusion: Results suggest that amitriptyline impairs learning and memory functions.

Background: Minigastric bypass is gaining popularity worldwide as an effective bariatric surgery which has fewer complications than RYGB. There is raising concerns about biliary reflux and its effect on gastric mucosa. In this study we tried to find the link between the presence of bile in the stomach and the incidence of gastritis after MGB. Methods: This prospective study was conducted in Ain Shams university hospitals from January 2017 to May 2018 including 40 patients. All patients underwent MGB with a 12-month follow-up, UGI endoscopy was performed 9 months after MGB for all patients, where multiple biopsies and gastric aspirate were obtained for bilirubin level Results: Mean age at operation was 32 years (18–60) and preoperative BMI 44.31 kg/m2. The mean operative time was 95 (± 18 min), Mean % EWL was 81.2% at 12 months. Complete resolution occurred of hypertension in 8 patients (80%) and of Diabetes type 2 in 11 patients (84.2%). Level of bilirubin in gastric aspirate was elevated in 8 patients (20%) all of them had different levels pouch gastritis confirmed by histopathological examination. Conclusion: Biliary reflux reached about 20% after MGB, the severity of biliary gastritis is related to the elevation of bilirubin level in the gastric aspirates, this results need to be confirmed by further studies on the MGB.

Sepsis refers to a generalized inflammatory response of the organism to an infection or to bacterial products in circulation, rather than the development of an infection per se. Despite recent advances in clinical practice and overall medical care, sepsis remains a great health care problem and is still the most common cause of death in critically ill patients with infection. We suppose that during the course of sepsis the expression of TRAIL in different organs correlates with acute mortality and further development of multiple organ dysfunction syndrome (MODS). It is expected that dendritic cells (DCs) might become targets for apoptotic processes in a result of elevated TRAIL expression. This hypothesis is a bias for detailed investigations for in vivo studies in animal models and for in vitro studies of septic patients.

In homicide cases, knowledge about time of death is important as it directs police investigation towards the discovery of authorship, including or excluding suspects of a crime, and determining nature of death. In Brazil, entomological evidence is still neglected by official forensic organizations and for this reason cases using insects to estimate post-mortem interval (PMI) are still rare. Dipteran specimens collected and analyzed by the staff of Criminalistics Institute (CI) from São Paulo State, Brazil, made it possible to elucidate circumstances of the death, including suspects to the crime scene, in five occurrences involving discovery of cadavers. In all cases, blowflies were collected and were identified as belonging to species Chrysomya albiceps (Wiedemann, 1819), Chrysomya megacephala (Fabricius, 1794), Chrysomya putoria (Wiedemann, 1830), Hemilucilia semidiaphana Rondani, 1850 and Lucilia eximia (Wiedemann, 1819) (Diptera: Calliphoridae), while only in one case Sarcophagidae (Diptera) flies were also collected. PMI estimate was calculated taking into account laboratorial developmental rate data of mentioned species on the environmental temperature on which bodies and insects were exposed, along with comparisons to field research previously conducted in those areas. Based on larval age and behavior, the course of the investigation had changed, pointing to the crime author (case I), as well as the nature of the crime (cases I-III) and associated suspects to the criminal act (cases IV-V). Results show how promising is the use of entomological evidence during investigations of violent deaths.

From biomedical literature “autism disorder are involved in young patient, that we have abnormalities (Imaging, histology) in some brain areas, and a comples symptomatology. Genetic and environment can produce some unbalances in brain grow and immunitary situation is involved. Apoptotic signal contribute in brain growth and immunologic shock can unbalance the environment producing abnormalities.” We can see that some pharmacological molecules are been introduced in therapy in some brain pathologies with a specific mechanism: modulating the immune systems. We can see that some systemic immune modifications can unbalance this systems producing pharmacological effect in local place (as Brain). We can observe this phenomena like a kind of toxicity that can be deeply investigate to discover new Pharmacological strategies. Aim of this work is to observe this kind of pathologies under a specific immune-toxicological aspect. We think that in this field are needed deeply new approach in order to adequately focus this kind of disorder. A different way to set this kind of pathologies can help in searching new pharmacological strategies.

Introduction: Abdominal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera. In particular, internal hernias (IH) represents about 0.2-0.9% of all cases with para- duodenal hernias while obturator hernias accounting for only 0.07% of all hernias. Methods: We reported the case report of 79 year old women who was admitted to Internal Medicine Department of our Hospital for lung failure and after few days transferred to our Surgery Department for abdominal pain. Conclusion: Obturator hernia is rare type of hernia and it is more frequent in older women with history of multiple pregnancy, chronic cough, and habitual constipation. In our patients, detailed physical examination and MRI preoperative imaging studies, have induce to the successful diagnosis.

Urinary bladder distension is traditionally regarded as a sign of intoxication at autopsy, however, to date there is very little literature available to support this hypothesis. The purposes of our study were to correlate alcohol and/or toxicological analysis with calculated urinary bladder volumes and its sensitivity as well as to test the validity by using the radiologically calculated urinary bladder volumes (UBVs) from CT images. The study population was all the postmortem cases involving with blood and/or urine samples sent for alcohol and/or toxicology analysis in 2016 at the Kuala Lumpur Hospital. Out of that 485 cases, there were 127 postmortem cases retrieved with positive alcohol and/or toxicology results Positive toxicology results in this study was referring to drug of abuse (DoA) including amphetamine type stimulants, opiates, cannabis and ketamine. Urinary bladder volume (UBV) was calculated based on the equation used in ultrasonographic volumetry, V=axbxcx 0.5. These 3 parameters correlated well with the UBV and having a strong positive relationship. There was a significant positive correlation at low strength between alcohol concentrations with calculated UBV. There was statistical significant correlation between urinary bladder distension on postmortem CT and cases of intoxication especially more corresponding for positive alcohol detection. The average sensitivity was 35.65% whereby it was slightly lower than those reported in Rohner C, et al. In this study we have deduced that diuretics effect of alcohol was the main reason causing bigger urinary bladder or UBV and was more prominent than the influence of drug of abuse on the urinary bladder sphincter. The distension of urinary bladder should raise suspicion of intoxication, but would not provide information on the quantity of the intoxicating agent due to its significant but poor correlation. It was important to note that intoxication may also be present in cases with low urinary bladder volume. In conclusion, it is vital to consider circumstantial evidence, as well as the presence of additional findings on imaging before suggesting the diagnosis of intoxication based on urinary bladder distension on imaging. Currently, the use of CT bladder imaging should serve as a strong indication that the individual may be intoxicated but should be confirmed by a complete autopsy and a detailed toxicological analysis.

In the actual medical therapy of BPH, we can see: antibiotics, alpha blockers, 5-ARI, fitotherapeutics/natural products (Serenoa repens) with different which display clinical activities and other molecules such as FANS (local or systemic dosage forms) cortisones and others. Relationship between immune systems and chronic prostatitis are strictly involved in BPH progression. A vicious cycle that involve chronic flogosis, tissue remodeling, grow factors, inhibition of apoptosis, and other phenomena. Observing BPH pathogenesis under an immunologic point of view make possible to search new pharmacological strategies, to improve actual therapy. The aim of this work is to observe some relevant literature in our opinion related the management of BHP and its progression under a pharmaceutical and immunological point of view. A deep knowledge in the pharmaceutical properties of some molecules (antimicrobials, anti-phlogosis agents, Anti-androgenic agents, alpha blockers, 5-ARI and other treatments, techniques, interventions or instruments) can help the physicians to pick the right choice.

Gastrointestinal (GI) bleeding is a very common medical problem encountered in the acute care setting, and is a major cause of admission to hospitals with about 300,000 patients admitted annually. Obscure GI bleeding, defined as persistent or recurrent bleeding following initial negative upper and lower endoscopy, represents approximately 5% of all GI hemorrhages. The small bowel is the most common source for obscure GI bleeding. Variable lesions of the small bowel can cause obscure GI bleeding, with tumors, Crohn’s disease and Meckel’s diverticulum being more common in young age group. Meckel’s diverticulum, the most common GI congenital malformation, is usually asymptomatic and incidentally found. It can present with GI bleeding, seen more in pediatric patients, and rarely in adult patients. Herein, we present a 45 years old female patient, presenting with massive obscure GI bleeding due to Meckel’s diveticulum.

Radiofrequency proves to be a useful tool for snoring/ sleep apnoea cases. Its advantage includes relative precision in incision making, relative bloodless fields if used appropriately, decrease postoperative pain and excellent healing with fibrosis which aids in stiffening tissues. Radiofrequency is high frequency alternating current used to ablate (cut/coagulate) tissues. It can be applied to nasal turbinates, soft palate, tongue base, tonsils etc. and it can be used to perform various procedures in the cutting mode to improve obstructive sleep disordered breathing. The objective/aim was to assess efficacy of radiofrequency as a tool for procedures/surgeries for snoring/ sleep apnoea. The parameters assessed were post-op pain, post- op blood loss, reduction in subjective snoring sounds by patients and partner, reduction in AHI post operatively.

Age estimations process is not standardized worldwide. However, there is a wide agreement about the most suitable methods currently available. Up until now, the procedure of creating expert reports and to implement quality assurance in age estimation are variable. Aim: The aim of this paper was to examine expert age estimation reports from around the world and identify the similarities and shortcomings present, which will help in providing recommendations to improve the reporting to reach standardization in expert age estimation reports. Methods and Material: A questionnaire was developed to explore whether there is a universal consensus in writing age estimation reports. Countries participated in the survey were: Afghanistan, Australia, France, Indonesia, Italy, New Zealand, Norway, Paraguay, Saudi Arabia, Spain, Switzerland, United Arab Emirates, United Kingdom, and the United States of America. Areas investigated by the survey included: Information about the individual in question and the entity requesting the assessment, if age interval is given along with if statistics were described in the report, if population reference data are used and reported and finally if the format of the report is standardized within each country. Results: The results of this survey suggest that there is a high degree of individual variation in age estimation reports, sometimes even within the same country. While the majority of participants report the main findings, some important information is still missing. The statistical information remains extremely varied. Conclusion: Although a resolution is not obvious, it is hoped that this study will promote further research and discussion on reporting age estimation. International guidelines on quality assurance in age estimation reports are urgently needed. Information to be reported should be specified on an international level and the exact report format to be used could be left to the national societies.

Background: C-type natriuretic peptide (CNP) was isolated from porcine brain and is a 22-amino acid peptide which belongs to the natriuretic peptide (NP) family. Even though this peptide shares structural similarity to other endogenous NPs including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) its receptor selectivity is different from other NPs. The present study was undertaken to investigate the expression of C-type natriuretic peptide (CNP) and its specific guanylyl cyclase (GC)-coupled receptor in the granulosa cells of the pig ovarian follicle. Results: Specific 125I-[Tyr0]-CNP(1-22) binding sites were localized in the granulosa cell layer of the ovarian follicle with an apparent dissociation constant (Kd>) and a maximal binding capacity (Bmax) of 1.41±0.39 nM and 2.75±0.65 fmol/mm2 respectively. Binding of 125I-[Tyr0]-CNP(1-22) to these sites was also prevented by atrial natriuretic peptide (ANP(1-28)), brain natriuretic peptide (BNP(1-26)) and des[Gln18,Ser19,Gly20, Leu21,Gly22] ANP(4-23) (C-ANP). Production of 3’,5’-cyclic guanosine monophosphate (cGMP) by particulate GC in the granulosa cell membranes was stimulated by natriuretic peptides (NPs) with a rank order of potency of CNP(1-22)>>BNP(1-26)>ANP(1-28). HS-142-1, a selective antagonist of the two recognized GC-coupled NPRs, inhibited CNP(1-22)-stimulated cGMP production in granulosa cell membranes in a dose-dependent manner. Also mRNAs for all three recognized NPRs were detected in granulosa cells using reverse transcriptase-polymerase chain reaction (RT-PCR). Serial dilution curves of granulosa cell extracts were parallel to the standard curve of synthetic CNP. Conclusion: These results indicate that CNP and its specific receptor are expressed in the granulosa cells of the pig ovary, and suggest that CNP may be a local autocrine and/or paracrine regulator via activation of its specific GC-coupled receptor, NPR-B.

1. The concept of wounds. 2. Classification of wounds. 3. Signs of wounds. 4. Factors affecting the course of the wound process. 5. Phases of the wound process. 6. Types of wound healing. 7. Features of wounds in children. 8. First (first emergency) help. 9. Complications of wounds. 10. Specific bite wounds. Notion Treatment. Complications. 11. Snake bites. First aid. 12. Arthropod bites. First aid. Wounds are called traumatic violation of the integrity of the skin or mucous membranes with possible damage to the deeper tissues.

Sojourn to high altitude may affect various human systems if proper acclimatization not followed. If acclimatization failed, sojourners may suffer with high altitude sickness such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). Although a sojourner’s tolerance to high altitude hypoxia varies according to differences in physiology and physical conditioning. Acute mountain sickness may cause headache, insomnia, dizziness, nausea, vomiting and fatigue. While HACE is more serious stage where brain swelling occurs and it is potentially fatal. A sojourner with HACE may experience confusion, amnesia, delusions, and loss of consciousness. Staying in high altitude (above 9000 feet) environment poses low oxygen supply (hypobaric hypoxia) to the different body organs including brain.

There is evidence that complement components induce cell migration in mesenchymal stem cells and regulate cytokine production in osteoblastic cells thus playing a regulatory role in normal bone formation. The aim of the present study was to investigate the involvement of complement system in the differentiation of bone marrow cells in complement-depleted model of rheumatoid arthritis (RA). Arthritis was induced by intraarticular injection of zymosan in cobra venom factor (CVF)-treated mice depleted of functional complement. The expression of different markers by bone marrow [1], on fibroblasts (CD29), mesenchymal cells (CD105), dendritic cells (CD14, CD86), osteoclasts (CD265), cells expressing Dectin1 (CD369) and megakaryocytes (CD62P) was determined by flowcytometry. The lack of functional complement activity at the point of arthritis initiation (day 3) lead to an increase of fibroblast and megakaryocyte populations, to a decrease of mature and dectin1 positive populations, while the number of mesenchymal cells was not changed, all compared to arthritic mice. Immunohistochemical staining showed that low complement activity diminished arthritis-induced generation of megakaryocytes and platelets in BM. Chronic inflammation during erosive conditions such as rheumatoid arthritis, leads to dysregulated differentiation and prolifеration of bone cells, inflammation of synovial membrane and bone marrow, and degradation of cartilage and bone. Present results point that the lack of functional complement changed the ratio between different cell populations that can be used for determining the development and stage of rheumatoid arthritis and can help finding of new therapeutic approaches.

What is called “idiopathic biliary duct system dilatation” or better to name it “un-explained biliary dilatation” is mostly following surgical procedures related to upper gastrointestinal and hepato-bilio-pancreatic systems. Having such situation, adaptive physiology of the biliary duct system has to be considered and rational has to be explained. The vast multimodal progress in techniques of investigations that has been applied on studying the hepato-bilio-pancreatic system has been utilized to clear the clinical ambiguity of biliary duct system dilatation for no logic reason but missing the correlation between both fields; the technical and the clinical ones. This clinical review is trying to fill this gap and introduce a comprehensive discussion of the subject. Mechanical, biochemical and immune causes constitute a wide diversity of etiology related to biliary system dilatation that in some situations is really difficult to verify clinically. On the least, even we could not verify the etiology we need to identify that reaching a closed road is different than postulating suspicions that never exist. This review is a trial collecting all subject-related data that might be related to etiology mechanisms and utilize to find a correlation rationale. At some point verification of such correlation is really a far target that might be even impossible clinically with availing technical tools and hope in the future could be achieved.