English hospital episode data analysis (1998-2018) reveal that the rise in dog bite hospital admissions is driven by adult cases

Dog bites are a global health issue that can lead to severe health outcomes. This study aims to describe the incidence and sociodemographics of patients admitted to English National Health Service (NHS) hospitals for dog bites (1998-2018), and to estimate their annual direct health care costs. An analysis of patient level data utilising hospital episode statistics for NHS England, including: temporal trends in annual incidence of admission, Poisson models of the sociodemographic characteristics of admitted patients, and direct health care cost estimates. The incidence of dog bite admissions rose from 6.34 (95%CI 6.12-6.56) in 1998 to 14.99 (95%CI 14.67-15.31) admissions per 100,000 population in 2018, with large geographic variation. The increase was driven by a tripling of incidence in adults. Males had the highest rates of admission in childhood. Females had two peaks in admission, childhood and 35-64 years old. Two percent (2.05%, 95%CI 0.93-3.17) of emergency department attendances resulted in admission. Direct health care costs increased and peaked in the financial year 2017/2018 (admission costs: £25.1 million, emergency attendance costs: £45.7million). Dog bite related hospital admissions have increased solely in adults. Further work exploring human-dog interactions, stratified by demographic factors, is urgently needed to enable the development of appropriate risk reduction intervention strategies.

Histologic Observations of Dermal Wound Healing in a Free-Ranging Blacktip Shark from the Southeastern U.S. Atlantic Coast: A Case Report

Despite indications that sharks have an exceptional capacity to heal from traumatic injuries, no detailed microscopic observations of integumental wounds have been reported for sharks. This study details the histopathological features of such wounds in a free-ranging shark. An adult male Blacktip Shark Carcharhinus limbatus was collected in 2017 during fisheries-independent sampling efforts in the coastal southeastern U.S. Atlantic. The shark had numerous lesions on his head, torso, and left pectoral fin that were compatible with shark bites. Representative samples from two wounds on the head were examined by light microscopy. The epidermal changes included hyperplasia and hypertrophy; intracellular edema; and the absence of goblet cells, denticles, and chromatophores. In the dermis, fibrinocellular exudation, granulation tissue, and marked skeletal muscle necrosis and regeneration were observed. The above features were comparable to wound healing in bony fish, albeit minor differences were found. Although this case documents exceptionally good regeneration of skeletal muscle in the shark, we found no evidence of unique morphological healing patterns. Further studies on wound healing are needed because recent molecular and genetic findings do suggest evolutionary adaptations enhancing healing in sharks.

Dual Genotype Orientia tsutsugamushi Infection in Patient with Rash and Eschar, Vietnam, 2016

We report a dual genotype Orientia tsutsugamushi infection in Vietnam in 2016. The patient had fever, rash, and an eschar. The Kawasaki genotype was identified in the eschar specimen and Karp genotype in the whole blood specimen. The genotype co-infection rate for scrub typhus is unknown and should be further evaluated.

Morphological characteristics of preparator air-scribe marks: Implications for taphonomic research

Taphonomic analyses of bone-surface modifications can provide key insights into past biotic involvement with animal remains, as well as elucidate the context(s) of other biostratinomic (pre-burial) processes, diagenesis, excavation, preparation and storage. Such analyses, however, first require researchers to rigorously disambiguate between continuums of damage morphologies prior to attributing individual marks to specific actors and effectors (e.g., carnivore tooth, stone tool cutting edge, etc.). To date, a number of bone-modifying agents have been identified, and criteria for identifying their traces have been published. Relatively little research, however, has focused on bone-surface modifications imparted during specimen preparation. Herein we report that air scribes, small pneumatic tools commonly used for preparation in museum contexts, can generate unintentional marks that may mimic surficial modification caused by carnivores. To aid investigators in assessing the hypothesis that a mark in question is derived from air-scribe preparation activities, we provide high-resolution, detailed morphological information imaged with scanning electron microscopy (SEM). The main diagnostic characteristic of air-scribe damage is the occurrence of sequential, variously spaced, sub-millimeter scallop-like stepped bone removals. This morphology can resemble damage imparted by carnivore teeth. In contrast to marks produced by trampling, stone tools and carnivores, however, no continuous internal features, such as linear microstriations, were observed within grooves produced by the air scribe. Thus, the presence of such features can be used to disprove an air-scribe origin. A culmination of the morphological criteria presented herein, cross-cutting relationships with other surficial features (e.g., diagenetic discoloration, weathering textures), the position of occurrence, and an overall contextual framework for the assemblage is suggested for accurate identification of such traces. The ability to recognize or disprove air-scribe damage will allow researchers to confidently proceed with interpreting past biological and sedimentological interactions with animal remains.

Dog bite and injury awareness and prevention in migrant and left-behind children in China

Dog-incurred injury is a serious public health concern worldwide, especially for children, responsible for numerous infectious diseases, such as rabies. Our study aims to investigate the current status of dog-incurred injury and its prevention among special groups of children. A cross-sectional study was conducted among migrant children (MC) and non-MC, "left-behind" children (LBC) and non-LBC in two cities in southern China. A questionnaire was used to collect socio-demographic data and experience with dog-incurred injury, to assess knowledge of dog behaviour and rabies prevention and attitudes in risk identification and practice in risk behaviour. A total of 9,380 children aged 6-19 years old participated in this study. The self-reported prevalence of overall lifetime dog-incurred injuries in MC was 19.4% (vs. 11.2% in non-MC, χ² = 175.8) and LBC was 20.6% (vs. 13.5% in non-LBC, χ² = 114.1). MC were more likely to provoke a dog before the injury happened (12.7% vs 11.0%), while LBC (13.3% vs. 10.7%) and non-MC (13.1% vs. 12.2%) did not manage their wounds (all P < 0.001). 45.6% of victims were alone when the attack happened. MC from other provinces who live in rural areas and LBC with their mother absent had the lowest levels of knowledge among the groups. Taken together, MC and LBC are at greater risk for dog-incurred injury. They had lower knowledge of and attitudes towards prevention and more high-risk behaviour. Therefore, an appropriate public health education intervention is needed for schoolchildren regarding the prevention and management of dog-incurred injury and disease.

Fatal Pulmonary Edema in a Child After Jellyfish Stings in Korea

Jellyfish have been increasing at a global scale in recent years. These blooms not only have deleterious effects on marine ecosystems, they also increase the risk of jellyfish stings and accompanying envenomation. Here, we report a fatal case of pulmonary edema caused by jellyfish envenomation in a child in Korea. The patient died 4 h after envenomation despite cardiopulmonary resuscitation. Nemopilema nomurai was the suspected species of jellyfish encountered by the patient, although we are unable to confirm this. With this case report, we aim to inform on the serious issue of toxicity associated with jellyfish species that bloom mainly along Korean, east Chinese, and Japanese shores and to discuss appropriate first aid methods in case of jellyfish stings.

[Partial finger amputation after weever sting and second-degree burn]

The greater weever (Trachinus draco) is the only venomous fish in Denmark, and if stung by the weever the venom may cause symptoms such as pain, headache, nausea, dizziness and in severe cases systemic allergic reaction or tissue necrosis. The venom is heat-labile and should therefore be treated with warm water to the afflicted area. We report a case of a patient who was stung in the second finger and because of the treatment, he got a second-degree burn, that may have enhanced the effect of the venom, thus resulting in partial finger amputation.

Perineal evisceration secondary to a bite injury in a dog with an untreated perineal hernia

Emergency surgery was performed on a 6-year-old castrated male springer spaniel dog with evisceration of most of the small intestinal tract through the perineal region, secondary to a dog attack. This is the first report describing successful treatment of perineal evisceration secondary to dog attack at an untreated perineal hernia, employing abdominal and perineal approaches.

Extensive unusual lesions on a large number of immersed human victims found to be from cookiecutter sharks (Isistius spp.): an examination of the Yemenia plane crash

Accurate determination of the origin and timing of trauma is key in medicolegal investigations when the cause and manner of death are unknown. However, distinction between criminal and accidental perimortem trauma and postmortem modifications can be challenging when facing unidentified trauma. Postmortem examination of the immersed victims of the Yemenia airplane crash (Comoros, 2009) demonstrated the challenges in diagnosing extensive unusual circular lesions found on the corpses. The objective of this study was to identify the origin and timing of occurrence (peri- or postmortem) of the lesions.A retrospective multidisciplinary study using autopsy reports (n = 113) and postmortem digital photos (n = 3 579) was conducted. Of the 113 victims recovered from the crash, 62 (54.9 %) presented unusual lesions (n = 560) with a median number of 7 (IQR 3 ∼ 13) and a maximum of 27 per corpse. The majority of lesions were elliptic (58 %) and had an area smaller than 10 cm² (82.1 %). Some lesions (6.8 %) also showed clear tooth notches on their edges. These findings identified most of the lesions as consistent with postmortem bite marks from cookiecutter sharks (Isistius spp.). It suggests that cookiecutter sharks were important agents in the degradation of the corpses and thus introduced potential cognitive bias in the research of the cause and manner of death. A novel set of evidence-based identification criteria for cookiecutter bite marks on human bodies is developed to facilitate more accurate medicolegal diagnosis of cookiecutter bites.

Epidemiology of jellyfish stings reported to poison centers in Texas

This study examined the relationship between selected factors and all human exposures involving jellyfish stings reported to Texas poison centers. Cases were obtained retrospectively from calls to poison centers in Texas and included all reported human exposures during 1998-2004 involving jellyfish stings. The distribution of cases was determined for a variety of demographic and clinical parameters. There were 423 total cases. Among the cases with a known patient age, 19.8% were<6 years of age, 53.5% were age 6-19 years, and 26.7% were > 19 years of age. Males accounted for 52% of the cases. Of the 118 cases with a known clinical outcome, 0.8% had no effect, 80.5% had minor effects, and 18.6% had moderate effects. Counties along the Gulf Coast accounted for 72.3% of the calls. This information can be used to identify those portions of the population most at need of education regarding the prevention and treatment of jellyfish stings.

The magnitude of severe box jellyfish cases on Koh Samui and Koh Pha-ngan in the Gulf of Thailand

BACKGROUND

Despite recent deaths caused by box jellyfish envenomation occurring on the islands of Samui and Pha-ngan in the Gulf of Thailand, many people do not believe box jellyfish can kill humans and many people dismiss the problem as insignificant. More evidence has been requested from the communities in order to evaluate the need for and the implementation of sustainable prevention measures. We aimed to determine the magnitude of cases of severe stinging by box jellyfish and describe the characteristics of these cases on the islands of Samui and Pha-ngan in Surat Thani Province from 1997 to 2015.

METHODS

Various strategies were integrated prospectively. Toxic jellyfish networks and surveillance system were established. Outbreak investigations were conducted retrospectively and prospectively from 2008 to 2015.

RESULTS

There were 15 box jellyfish cases. A small majority of them were women (60.0) with a median age of 26.0 years (range 5.0-45.0 years). The highest incidence by month were August (33.3%), September and October (20.0%), and July (13.3%). Eight cases occurred on Samui (53.3%), 6 cases on Pha-ngan island (40.0%), and one case on the boat. All cases developed symptoms and signs immediately after being stung. More than half of the cases were unconscious. There were six fatal cases (46.7%). The wound characteristics had an appearance similar to caterpillar tracks or step ladder-like burn marks. Almost all cases involved Chirodropidae. One fatal case received fresh water and ice packs applied to the wounds (16.7%). Among the cases with known first aid, only one out of six fatal cases had vinegar applied to the wounds (16.7%), while haft of six surviving cases received the vinegar treatment.

CONCLUSIONS

The islands of Samui and Pha-ngan have the highest incidence of fatal and near fatal box jellyfish cases in Thailand. There is an urgent need for informed pre-clinical emergent care. Optimal pre-clinical care is an area of active research.

Toxicity of Mediterranean Scyphomedusae: An Overview

Following in-depth analysis and examination, jellyfish toxins have been found to consist of a mixture of proteins, carbohydrates, and other non-proteinaceous components. What remains to be clarified is the specific chemical nature of jellyfish toxins due to their heat lability. This paper reviews current knowledge of the toxic properties of the most common Mediterranean scyphozoans (A. aurita, C. hysoscella, C. tuberculata, P. noctiluca, R. pulmo) and the activity of their venom.

How not to train your dragon: a case of a Komodo dragon bite

Komodo dragons (Varanus komodoensis) are the world's largest lizards, known for killing prey that exceed their body mass. Reports of bites to humans in the popular press suggest high degrees of morbidity and mortality. Reports in the medical literature are lacking. We describe the case of a zookeeper who was bitten by a Komodo dragon, with a resultant mallet finger. We further discuss the various potential mechanisms of Komodo dragon lethality, including sepsis and venom deposition theories that are useful in guiding management.

Animal attack: an unusual case of multiple trauma in childhood

A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.

Clinical manifestations and experimental studies on the spine extract of the toadfish Porichthys porosissimus

Toadfish are fish from the family Batrachoididae that are found in marine and brackish environment around the world. Among the toadfish, Porichthys genus is very common, where Porichthys porosissimus, also called Atlantic Midshipman is found in Southwest Atlantic, from Rio de Janeiro, Brazil to eastern Argentina. There was no consensus about the classification of the genus Porichthys as venomous fish because so far there are no published studies regarding human envenomations and/or toxic activities induced in animal models. Herein, we report two conclusive envenoming in human beings caused by P porosissimus spines, with clear signs and symptoms that were very important for the development of our experimental studies. We demonstrated that the P. porosissimus spine extract, now venom, can induce nociceptive and edematogenic responses in mice as well an induction of an inflammatory response elicited by intravital microscopy and leukocyte migration. Finally, we identified in the P. porosissimus spine extract, through analysis by mass spectrometry, the presence of proteins previously detected in the venoms of other fish species and other venomous animals. We believe that based on our studies we will dismiss the non-venomous nature of this fish and clarify this issue.

Characterization of the early inflammatory infiltrate at the feeding site of infected sand flies in mice protected from vector-transmitted Leishmania major by exposure to uninfected bites

Background

Mice exposed to sand fly saliva are protected against vector-transmitted Leishmania major. Although protection has been related to IFN- γ producing T cells, the early inflammatory response orchestrating this outcome has not been defined.

Methodology/Principal findings

Mice exposed to uninfected P. duboscqi bites and naïve mice were challenged with L. major-infected flies to characterize their early immune response at the bite site. Mostly, chemokine and cytokine transcript expression post-infected bites was amplified in exposed compared to naïve mice. In exposed mice, induced chemokines were mostly involved in leukocyte recruitment and T cell and NK cell activation; IL-4 was expressed at 6 h followed by IFN-γ and iNOS2 as well as IL-5 and IL-10 expression. In naïve animals, the transcript expression following Leishmania-infected sand fly bites was suppressed. Expression profiles translated to an earlier and significantly larger recruitment of leukocytes including neutrophils, macrophages, Gr⁺ monocytes, NK cells and CD4⁺ T cells to the bite site of exposed compared to naïve mice post-infected bites. Additionally, up to 48 hours post-infected bites the number of IFN-γ-producing CD4⁺T cells and NK cells arriving at the bite site was significantly higher in exposed compared to naïve mice. Thereafter, NK cells become cytolytic and persist at the bite site up to a week post-bite.

Conclusion/Significance

The quiet environment induced by a Leishmania-infected sand fly bite in naïve mice was significantly altered in animals previously exposed to saliva of uninfected flies. We propose that the enhanced recruitment of Gr⁺ monocytes, NK cells and CD4 Th1 cells observed at the bite site of exposed mice creates an inhospitable environment that counters the establishment of L. major infection.

Sand flies transmit Leishmania parasites during bloodfeeding. Salivary molecules are deposited alongside parasites and can reshape the host's immune response to infection. Exposure to uninfected sand fly bites or immunization with salivary molecules protects the host against Leishmania infection. Here we show that mice exposed to bites of uninfected Phlebotomus duboscqi sand flies are protected against P. duboscqi-transmitted L. major and characterize the formerly unknown early cellular infiltrate at the bite site following L.major vector-transmission. The kinetics and nature of the inflammatory response at the bite site of exposed mice were notably different from those of naïve mice showing an amplified expression of cytokines and chemokines after parasite transmission. The transcripts reflected a faster and more robust infiltrate of immune cells to the bite site of exposed mice composed of neutrophils, macrophages, monocytes, NK cells and CD4+ T cells. In addition, there was an increased influx of activated IFN-γ producing CD4+ T cells and Granzyme B-producing mature NK cells in exposed animals. These findings suggest that the observed robust and persistent proinflammatory response in exposed animals restrict parasite multiplication.

Outdoor post-mortem depredation by local fauna

We present the case of complete post-mortem decapitation of a 43 years old man killed by gunshots discharged from a distance of 40 - 50 cm. The corpse was left in the courtyard of his isolated carpentry and a mongrel dog lived in that courtyard, maybe attracted by the blood gushed from the wound, got a depredation of the corpse till the complete decapitation and the removal of all intrathoracic organs. The action of the dog was completed by the rats and mice that lived in the place. The case is not rare and sometimes the alteration of the features of the corpse makes it impossible for the investigators, to objectify any other signs of criminal nature.

Geographic variation in access to dog-bite care in Pakistan and risk of dog-bite exposure in Karachi: prospective surveillance using a low-cost mobile phone system

BACKGROUND

Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi.

METHODOLOGY AND PRINCIPAL FINDINGS

A total of 6212 dog-bite cases were identified over two years starting in February 2009 with largest number reported from Karachi (59.7%), followed by Peshawar (13.1%) and Hyderabad (11.4%). Severity of dog-bites was assessed using the WHO classification. Forty percent of patients had Category I (least severe) bites, 28.1% had Category II bites and 31.9% had Category III (most severe bites). Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non-medical facilities (Odds Ratio = 0.20, 95% CI 0.17-0.23, p-value<0.01), and had shorter mean travel time to emergency rooms, adjusted for age and gender (32.78 min, 95% CI 31.82-33.78, p-value<0.01) than patients visiting hospitals in smaller cities. Spatial analysis of dog-bites in Karachi suggested clustering of cases (Moran's I = 0.02, p value<0.01), and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city's largest abattoir in Landhi. The direct cost of operating the mHealth surveillance system was USD 7.15 per dog-bite case reported, or approximately USD 44,408 over two years.

CONCLUSIONS

Our findings suggest significant differences in access to care and health-seeking behaviors in Pakistan following dog-bites. The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease-control efforts in the city. Mobile phone technologies for health (mHealth) allowed for the operation of a national-level disease reporting and surveillance system at a low cost.

[Causes of problems in multidisciplinary bitemark analysis]

Since a successful bitemark analysis depends on many factors, it is important that the phases preceding the analysis be carried out as thoroughly as possible. Interpretive errors in the analysis arise primarily from the complex nature of bitemarks, but also as a result of faulty research methodology, false assumptions or technical errors made during the identification and documentation process. The key role is played by qualifications, knowledge and experience of experts involved in the investigations. In case bitemarks are detected, it is recommended to seek consultations by forensic odontologists or members of an interdisciplinary team experienced in bitemark analysis. The thus obtained information allows for gathering evidence guaranteeing a reliable expert opinion.

Biology and ecology of Irukandji jellyfish (Cnidaria: Cubozoa)

Irukandji stings are a leading occupational health and safety issue for marine industries in tropical Australia and an emerging problem elsewhere in the Indo-Pacific and Caribbean. Their mild initial sting frequently results in debilitating illness, involving signs of sympathetic excess including excruciating pain, sweating, nausea and vomiting, hypertension and a feeling of impending doom; some cases also experience acute heart failure and pulmonary oedema. These jellyfish are typically small and nearly invisible, and their infestations are generally mysterious, making them scary to the general public, irresistible to the media, and disastrous for tourism. Research into these fascinating species has been largely driven by the medical profession and focused on treatment. Biological and ecological information is surprisingly sparse, and is scattered through grey literature or buried in dispersed publications, hampering understanding. Given that long-term climate forecasts tend toward conditions favourable to jellyfish ecology, that long-term legal forecasts tend toward increasing duty-of-care obligations, and that bioprospecting opportunities exist in the powerful Irukandji toxins, there is a clear need for information to help inform global research and robust management solutions. We synthesise and contextualise available information on Irukandji taxonomy, phylogeny, reproduction, vision, behaviour, feeding, distribution, seasonality, toxins, and safety. Despite Australia dominating the research in this area, there are probably well over 25 species worldwide that cause the syndrome and it is an understudied problem in the developing world. Major gaps in knowledge are identified for future research: our lack of clarity on the socio-economic impacts, and our need for time series and spatial surveys of the species, make this field particularly enticing.

The development of a colorimetric scale as a visual aid for the bruise age determination of bite marks and blunt trauma

Medical examiners and forensic odontologists are frequently asked to establish the age of a bruise or bitemark on either a living and deceased subjects. The age of bruising has an important medico-legal significance and may be relevant in the investigations related to such crimes as child abuse, domestic violence and homicide. A colorimetric scale for forensic photography based on the colors of the bruise itself, has never been proposed due to the fact that photographic reproduction of color is unreliable and depends on several factors; the camera used, lighting, printer and photo-editing color calibration. The authors propose two colorimetric scales, both with and without linear measurements, and with 90° angulations, six bruise colors, and three circles with black and white calibrators, which are to be used for the forensic photography of injuries involving the epidermis of Caucasian subjects. The two scales could also be employed on living subjects during different stages of the healing process, or on cadavers in order to provide evidential documentation, image verification and analysis. Such an aid would provide a reliable standard condition and allow for color calibration. The colors represented on the scales would be an aid for the interpretation and objectivity required in estimating the age of the bruise, particularly when the analysis is made directly onto computer images prior to printing. The proposed colorimetric scales do not attempt to give a definitive account of the diverse scientific methods available for the assessment of the age of bruising. The observation of a large sample of blunt trauma and bite mark injuries employing the proposed colorimetric scales would be needed in order to verify and validate the use of these scales. It should be borne in mind that bruise age estimation requires an expert opinion with several degrees of accuracy and variability involved. The age of a bruise cannot be determined by color alone.

Scorpion sting in Iran: a review

Among Middle Eastern countries, at least 52 species of scorpions, especially dangerous types, have been reported in Iran. This is more than any other country in the region. In addition, in Iran the recorded scorpion stings from 2001 to 2009 were more than 42,500 per year, of which, approximately 19.5 deaths have been reported each year, mostly in spring and summer. About 10 species are responsible for the reported envenoming which belong to the Buthidae family apart from Hemiscorpius lepturus which is a Hemiscorpiidae. The Buthidae family includes: Androctonus crassicauda, Mesobuthus eupeus, Odontobuthus doriae, Hottentotta saulcyi, Hottentotta schach, Compsobuthus matthiesseni, Orthochirus scrobiculosus, Apistobuthus pterygocercus and Olivierus caucasicus. A. crassicauda and H. lepturus are usually cited as the most dangerous species among Iranian scorpions. This article focuses on the main Iranian scorpions and their geographical distribution, especially those which are medically important and considered to be the more dangerous to human, and also attempts to demonstrate an accurate magnitude of scorpion stings in Iran.

[Classification of bone injuries inflicted by the teeth of the carnivorous animals]

The morphological characteristics of a variety of bone injuries inflicted by the teeth of the carnivorous animals are presented. The results of their analysis provided a basis for the morphological classification of such traumas taking into consideration the current views of the mechanisms underlying the process of their formation.

Brown recluse spider bite to the upper lip

Brown recluse spiders are predominantly found in south central United States. Their bites usually cause mild self-limiting reactions, although localized tissue necrosis and rare systemic, potentially fatal, envenomations are known to occur. Herein, we report an atypical presentation of a brown recluse bite in a 20 year old female who was admitted to the intensive care unit due to angioedema and cellulitis. We photographically document the bite site for twenty-four hours following envenomation. She received glucocorticoids, antihistamines, antibiotics and dapsone while hospitalized and was subsequently discharged with complete resolution of symptoms without the development of tissue necrosis or scarring.

[Classification of skin injuries inflicted by the teeth of the carnivorous animals]

The current approaches to the classification of skin injuries inflicted by the teeth of the carnivores on the human body are discussed. The new morphological classification is proposed taking into consideration the current views of the mechanisms underlying the formation of tooth marks on the integumental tissues of the victims of attacks by carnivorous animals. Morphological characteristics of skin injuries are briefly described in the framework of the new classification.

Atypical abdominal lacerated wound--differentiation from an incised wound

In the Department of Forensic Medicine, Medical University in Lodz, there was performed an autopsy of a man with an extensive defect of the abdominal integument and perineum. The inspection of the body at the site it was found together with the deposition of the deceased man's concubine suggested the possibility of criminal degloving of the body using a sharp-edged tool with superimposed injuries inflicted by a dog. Autopsy findings combined with results of additional tests (microscopic examination of tissue sections, ethyl alcohol level determination) allowed for verification of the investigation hypothesis, exclusion of a criminal act and demonstrating dog-inflicted injuries as the cause of death.

Centipede bite victims: a review of patients presenting to two emergency departments in Hong Kong

OBJECTIVE. To review the clinical characteristics of patients presenting after centipede bites in Hong Kong. DESIGN. Descriptive case series. SETTING. Emergency departments of two public hospitals in Hong Kong. PATIENTS. Patients presenting after centipede bites between 2006 and 2010. MAIN OUTCOME MEASURES. Demographics, time and locations of bites, symptoms and signs, treatments and outcomes. RESULTS. A total of 46 relevant patient records were retrieved. The bites were frequently at night, indoors, on lower limbs, and consistently resulted in pain. The majority of the victims were treated with analgesia, anti-histamines, and antibiotics. One patient developed necrosis and five re-attended for delayed pruritus and relapsed/recurrent swelling. CONCLUSIONS. Centipede bites are usually uncomplicated, but may lead to necrosis or delayed hypersensitive reactions.

[About classification of injuries inflicted on humans by carnivorous animals]

The biological classification of living species is shown to be inapplicable for the purposes of forensic medical examination. A list of the families of carnivorous animals that may be of forensic medical significance is presented. Their working classification is proposed taking into account the size and behaviour of the animals as well as their body parts and organs with which they may inflict injuries to man in various situations. The main types of wounds caused by carnivores are considered.

Intercanine distance in the analysis of bite marks: a comparison of human and domestic dog dental arches

One common parameter considered helpful to identify the origin of bite wounds has been the distance between the canine teeth marks left on the victim. The reliability of this parameter to differentiate the origin of the marks (human or animal) was evaluated using a sample of: a) domestic dogs (n=50) weighting between 4.9 kg and 46 kg of undefined breed and b) human beings (n=50). Dog intercanine distances (ID) were measured directly using calipers, those from the human sample were measured from wax imprints using calipers. It was found that dog bite intercanine distance measurements were overall 2.8% wider for the upper arch and 10.4% wider for the lower arch when compared with the overall result for humans. However, it was observed that the measured values for medium sized dogs (between 9.1 kg and 23.0 kg) are similar to the overall results for humans. Therefore, for this range, the stand alone use of intercanine distance measurements from bite wounds marks are inconclusive with respect of defining if of human origin.

Pattern of animal-related injuries in Iran

Animal related injuries as most common causes of human morbidity have different pattern by geographical zones. We aimed to explore the main descriptive epidemiology of animal-related injuries in both rural and urban areas in Iran. Between 2000 and 2004, we collected the data of all the cases of animal related trauma hospitalized for more than 24 hours in eight cities (Tehran, Mashhad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol). Further evaluations were conducted on 17753 eligible subjects. Of 17753 traumatic patients, 40 subjects (0.2%), had animal-related injuries. The highest rate was seen in Tabriz with 11 cases. Upper and lower extremities were the most frequent sites of trauma and they were injured in 13 and 11 cases respectively. Dog bite and cow-related injuries were responsible for 40% and 32.5% of injuries respectively. Amputation of the phalanx was done in 2 cases due to dog bite and bull gore occurred. One thoracotomy, one laparatomy and one craniotomy were done. One patient needed fasciatomy due to snake bite. Educating the patients could decrease the incidence of morbidity of these injuries.

[The possibility of inflicting additional lesions in the wounds by small birds]

Structural characteristics of the beaks of small birds are discussed in the context of trace evidence analysis for the purpose of forensic medical examination. Special attention is given to the additional morphological changes that the birds may cause in the previously inflicted skin wounds. The possible mechanisms of such lesions are discussed. It is recommended that these observations be taken into consideration for the purpose of identification studies. The signs indicative of particular lesions that can be attributed to the small birds' activities are described.

[Observations on injuries by blunt objects]

Based on my personal experience publishing case reports on blunt injuries, I hereby focus on issues that have recently come to my attention. 1. Abrasions: 1) As to whether they occurred ante-mortem or post-mortem; those reddish in color cannot always have occurred antemortem. When they overlap with reddish (-purple) discoloration, as in hypostasis, post-mortem abrasions look reddish as well. Abrasions larger than the tip of the finger or the palm of the hand are often seen post-mortem and are thought to occur due to the touching of putrefied skin post-mortem. 2) There are cases where the direction in which the epidermis peeled-off is not apparent, when it peels off in many directions or where there is no residual epidermis. 3) The shape and size of an abrasion can indicate the structure of the offending blunt object. When there is an abrasion on the scalp 3 to 4 cm in diameter, with structures 5 mm in diameter at the margins of the abrasion, it can be inferred that the victim fell on a paved gravel road. 2. Bruises: 1) Inferring the nature of a blunt object: (1) Evidence of a fist blow: Co-existence of the following three features indicates a blow by the fist : 1. macular discoloration, 2. within an area of approximately 8 cm by 5 cm, 3. with an abrasion from the thumb nail. (2) Evidence of being grabbed:Try to grab the corpse with your own hand during autopsy to find how the person was grabbed. Bruise-like discoloration can be generated post-mortem on the upper arm, when a body is being drawn out of water, for example. 2) Tram-line bruises: These appear when a victim was struck by a stick. To estimate the diameter of the object, it is useful to measure two parts of the bruising : the width of the pale part between the bruises and the width between the outer margins of the bruises. 3. Intradermal bleeding: There tends to be a grouping of hemorrhagic spots, the interval between which 1 mm or less. It can be generated by both direct and indirect force. Abrasions may be both present or absent. 4. Contused lacerated wounds: First of all, it is necessary to determine the characteristics of the offending blunt object based on the findings of the wound. When the edge of the end of a column works against the skin at an angle, abrasions are mainly generated on the one margin abraded by the edge. When the smooth round surface of a column is applied, abrasions are not likely to occur on or near the margins. To diagnose a wound as being contused, the following findings are considered valuable : the margins of the wound are more irregular than the incision; the margins are contused; the osseous membrane is detached at the bottom of the wound; and abrasions are present at the margins. Abrasions are generated when the surface of the object is rough and when the sharper edge is at an angle. They tend not to occur when the surface of the object is smooth with no angular edge or when the sharper edge works perpendicularly against the skin. 5. Post-mortem mutilation by animals: It is necessary to distinguish wounds caused by animals from those that are man-made. Crows will tear out the eyeballs, open the intercostal muscle and devour the lungs. They pull and rip off the skin, but do not seem to chew on the bones. Dogs and foxes will chew on the bones, leaving traces of their teeth about 5 mm in width. Rats leave round-shaped parts missing from the skin, the margins of which are quite sharp. They do not seem to chew on the bones. 6. One pattern of injuries from an immersed body: A set of abrasions, bruises, pocket formation (décollement) of the head and face, accompanied by dehiscence or fracture of the spine and drowning indicates jumping into the water face first and banging the head against the bottom of the body of the water, followed by drowning. 7. A case of a traffic accident: The details of the accident became apparent from the following findings in and on the autopsied body: contused lacerations on both knees, abrasions and pocket formation (décollement) on the parietal region of the head, characteristically shaped abrasions on the back, acetabula fractures caused by raising of the femoral head, fractured ribs caused by antero-posterior or posteroanterior compression, and an annular fracture at the base of the skull. The abrasions on the back were determined to have been generated by compression of structures on the underside of the car. The contused lacerations on the knees were considered to have been generated upon impact with the bumper, and the posture of the victim was concluded to have been supine with his knees drawn up. Collaboration with police traffic investigators is considered essential. 8. The medico-legal diagnostic capability of young pathologists could be improved if they observed unexplainable findings during autopsy with their own eyes, researched and discussed the findings with their mentor and colleagues, and published case reports.

[Fatal sepsis due to capnocytophaga canimorsus after dog bite]

A 56-year-old man was bitten by a dog. 8 days later he was admitted to a hospital because of severe deterioration of his clinical situation. He developed the clinical picture of fulminant sepsis. In spite of aggressive intensive care therapy the patient died 24 hours later. Capnocytophaga canimorsus was identified from initial blood cultures. This gram-negative rod is part of the normal oral flora of dogs and cats. It can be spread to humans by bites, licking or scratches and causes severe infections, especially in persons with special risk factors (splenectomy, alcoholism). The mortality rate in the published cases is 25-30%.

Tropical aquarium aquatic dermatoses: bristle worm envenomation

A 55-year-old high school science teacher with diabetes presented with severe pain and swelling of his left hand. He reported receiving a "shock" 2 days earlier while cleaning out his classroom's aquarium with a bare left hand. Thinking it was a "short" in the electrical connections to the aquarium's pump, he disconnected the electrical cord and continued to clean behind the pump mechanism. After a few more such shocks he put on a glove and retrieved 10 foot-long worms. Antibiotics were started. It took more than 2 weeks for the hand to return to its normal size. On presentation to our office, the patient's left hand was moderately swollen, with blistering and purpura seen on his distal fingers. He reported pain, itching, and numbness in the hand, which was getting worse. No systemic symptoms were reported. The patient was a non-insulin-dependent diabetic who was also taking warfarin for a carotid vascular problem. He brought to our office a bucket with coiled aquatic worms at the bottom (Figure 1). When extended, they measured about 1 foot and their morphology could be better seen (Figure 2). No spicules could be seen in the patient's hand on magnification, but taping was performed to remove any possible residual spicules. The patient was given oral antibiotics, a Medrol dose pack, oral antihistamines, and topical corticosteroids. Within 1 day of starting treatment his symptoms and hand swelling began to abate, by 1 week his hand skin peeled, and by 2 weeks the swelling and skin appearance was almost back to normal. Bacterial cultures of the hand's wounds showed no growth.

[Vital animal predation of the genital region caused by a mongrel dog]

A 79-year-old man, who was in a helpless situation due to cardiac decompensation, suffered dog bite injuries on the left thigh and in the genital region while still alive. Two extensive soft-tissue defects with contused and bruised wound edges were surrounded by multiple slit-like skin lesions. The outer genitals were almost completely missing. Because of surgical emergency treatment, molecular biological investigations were no longer possible. Therefore, the cause of the bite injuries had to be determined solely on the basis of the documented morphology of the wounds.

[Forensic medical examination of wounds inflicted by the teeth of a dog]

Trasologic characteristics of individual types of the dog's teeth and morphological features of skin wounds inflicted by a bite are presented. The data obtained may be used to discriminate these injuries from other wounds caused by sharp objects.

Evaluation of the effects of various chemicals on discharge of and pain caused by jellyfish nematocysts

Jellyfish tentacles in contact with human skin can produce pain swelling and redness. The pain is due to discharge of jellyfish nematocysts and associated toxins and discharge can be caused by a variety of mechanical and chemical stimuli. A series of tests were carried out with chemicals traditionally used to treat jellyfish stings e.g. acetic acid ammonia meat tenderizer baking soda and urea to determine if these chemicals stimulated or inhibited nematocyst discharge and if they brought relief to testers who were exposed to jellyfish tentacles. Chrysaora quinquecirrha (sea nettle) Chiropsalmus quadrumanus (sea wasp) and Physalia physalis (Portuguese man-of-war) were used in the study. It was found that many of the chemicals traditionally used to treat jellyfish stings stimulated nematocyst discharge and did not relieve the pain. However there was immediate relief when a common anesthetic lidocaine was sprayed on the skin of testers in contact with jellyfish tentacles. Initial exposure of tentacle suspensions to lidocaine prevented the nematocyst discharge by subsequent exposure to acetic acid ethanol ammonia or bromelain. Thus lidocaine in addition to acting as an anesthetic on skin in contact with jellyfish tentacles inhibited nematocyst discharge possibly by blocking sodium and/or calcium channels of the nematocytes.

[Post-mortem partial skeletization of the face and neck by an Appenzell mountain dog]

An 81-year-old man died unexpectedly from a cardiac cause. His wife, who lived in the same house and suffered from Alzheimer's disease, did not realize his death. When the body was found at the foot of the stairs 2-3 days afterwards, extensive soft tissue defects with notched wound edges, but no signs of vitality, were observed on the head and neck. The site where the body was found showed almost no traces of blood. In view of the injuries and their obviously post-mortem origin it was assumed that they had been caused by the man's Appenzell mountain dog which also lived in the house. By means of DNA typing, swabs from the wound edges of the soft-tissue defects could be assigned to the deceased's dog.

L-tryptophan and correlates of self-injurious behavior in small-eared bushbabies (Otolemur garnettii)

Self-injurious behavior (SIB) among captive primates is a recurring problem for those who manage such facilities. Its prevalence highlights the need for research evaluating the effectiveness of potential treatment approaches. In the present study, 4 wk of dietary supplementation with L-tryptophan (100 mg daily) was evaluated for the treatment of self-inflicted wounds in 22 small-eared bushbabies, a prosimian primate, with a history of SIB. The treatment significantly reduced stereotypy and was associated with a reduction in wound area and severity. In terms of physiologic measures, preexisting high levels of cortisol were reduced in bushbabies with SIB, whereas serotonin concentrations were increased after 4 wk of treatment. Results indicate that L-tryptophan as a dietary supplement may be a viable adjunct to standard husbandry procedures for animals exhibiting maladaptive behaviors such as stereotypy and SIB.

[Post-mortem animal predation of the genital region caused by a half-breed dog]

The authors describe and discuss the case of a 51-year-old man, who was lying mummified in his apartment. Beside the corpse, the well-fed half-breed dog of the deceased was found. Only the penis and testicles of the corpse were destroyed by post-mortem animal scavenging, whereas the face and the rest of the body were intact. There was plenty of dog food in the apartment. In contrast to wild animals, with domestic dogs hunger is the cause for post-mortem scavenging only in the minority of cases. It is rather a displacement activity. Frequently, the face and hands are destroyed by post-mortem animal predation, as these body regions are usually unclothed and thus easily accessible. Lesions in other localizations are seldom seen and injuries in the genital region are a rarity.