The Prevalence and Characteristics of Intrafamilial Child and Adolescent Homicides in Greece over 11 Years (2010-2020)

Intrafamilial child/adolescent homicide is the murder of a child/adolescent by one or more family members. This study delves into the medical and sociological consequences of child homicide, shedding light on the broader impact beyond individual families, which extends into the local community. Two Internet search engines and the search engines of major national news websites were surveyed to identify the number of intrafamilial child/adolescent homicide cases that occurred in Greece from January 2010 to December 2020. Over the study period, 34 victims of intrafamilial child/adolescent homicides were identified. The above deaths reflect an intrafamilial child/adolescent homicide rate of 0.15 homicides per year per 100,000 inhabitants. Most of the perpetrators (51.4%) were male, and the victims were equally divided into males and females. The ages of the perpetrators ranged from 13 to 61 years, and the ages of the victims ranged between 0 and 17 years. Most perpetrators (54.5%) had a previous psychiatric history and in many cases, they committed (33.3%) or attempted (15.2%) suicide after the homicide. The most common method of homicide was strangulation (usually combined with suffocation) (25%), followed by abandonment (15.6%). The most commonly reported motives were spousal revenge (26.5%) and psychotic disorders (26.5%). Raising awareness for intrafamilial child and adolescent homicide is of the utmost importance for the prevention of this dreadful phenomenon.

Serum concentrations of BDNF in adolescents with metabolic syndrome: a case-control study between normal - BMI adolescents and adolescents with obesity

Brain-Derived Neurotrophic Factor (BDNF) has been linked to various conditions of the cardiovascular and nervous systems. Scarce data exist about the concentrations of BDNF in children and adolescents in relation with obesity and metabolic syndrome (MetS). The aim of this study was to examine the serum BDNF concentrations in adolescents with metabolic syndrome and according to their body mass index (BMI) status. This was a case-control study, assessing BDNF concentrations between adolescents with MetS (with obesity vs. normal-BMI), in relation to sex, anthropometric, metabolic and endocrine parameters. Participants included male and female adolescents, whose anthropometric and metabolic panel, as well as serum BDNF concentrations were measured. A total of 59 adolescents (obesity: 29; normal-BMI: 30) were included in the study. Increased serum BDNF concentrations were observed in MetS adolescents with obesity when compared with normal-BMI adolescents (p < 0.001). Males exhibited higher concentrations of BDNF than females (p = 0.045). The sample was further divided into four categories by sex and BMI status, with normal-BMI females exhibiting significantly lower BDNF concentrations than females and males with obesity(p = 0.005). In the entire study sample, serum BDNF concentrations correlated positively with BMI z-scores, however, this statistical significance was preserved only in the females of the sample. No statistical difference was observed between males of different BMI z-scores categories.  Conclusion: Obesity appeared as a major factor for increased serum BDNF concentrations in adolescents with MetS (vs. normal-BMI), with a higher impact on BDNF concentrations in females than males. What is Known: • The brain-derived neurotrophic factor (BDNF) is involved in metabolic syndrome in adults but data in adolescents are scarce. What is New: • Obesity (vs. normal BMI) was a major factor for increased serum BDNF in adolescents with metabolic syndrome. • Obesity had a higher impact on BDNF concentrations in females than males with metabolic syndrome.

Age Estimation in 0-8-Year-Old Children in France: Comparison of One Skeletal and Five Dental Methods

Age estimation in juveniles is a critical procedure in judicial cases for verification of imputability or for civil reasons when adopting children. Several methods based both on skeletal and dental growth have been performed and applied on different populations; nevertheless, few articles have compared different methods in order to test their reliability in different conditions and age ranges, and this is a clear obstacle in the creation of common guidelines for age estimation in the living. A comparison of five dental methods (Anderson, Ubelaker, Schour and Massler, Gustafson and Koch, Demirjian) and one skeletal method (Greulich a Pyle atlas) was performed on a population of 94 children aged between 0 and 8 years. Results showed that, whereas under 2 years all the methods have the same inaccuracy, over 2 years the diagram methods, such as Schour and Massler and Ubelaker's revised one, have a lower error range than the most frequently used Greulich and Pyle atlas and Demirjian method. Schour and Massler, Gustafson and Koch, and Ubelaker methods showed, respectively, a mean error amounting to 0.40, 0.53, and 0.56 years versus the 0.74 and 0.88 years given by Demirjian and the Greulich and Pyle atlas. An in-depth analysis of the potential of several methods is necessary in order to reach a higher adherence of age estimation with the complexity of growth dynamics.

Extended Stanford Type-A Aortic Dissection with Multivessel Coronary and Peripheral Artery Involvement: An Autopsy Case Report

We report the case of a 64-year-old male who died suddenly short after his admission to hospital because of strong chest pain and before any clinical diagnosis was established. His medical history included coronary disease with coronary by-pass surgery at the age of 40 years old, uncontrolled hypertension, diabetes mellitus, and elevated levels of cholesterol. The autopsy revealed quite a rare case of Stanford A aortic dissection with extension to the common and internal carotid arteries; the subclavian, axillary, brachial, and radial arteries; three coronary arteries; the superior mesenteric artery; and the iliac arteries. There was no histological evidence of aortitis or connective tissue disease. The death did not result from the rupture of the aortic dissection, but from myocardial ischemia due to coronary occlusion in combination with hemodynamic disturbance from stress caused by the extended aortic dissection.

Decisions of Greek Courts Securing the Right of Parent-Child Communication and Their Determinants

BACKGROUND

There is an increasing awareness that a child's separation from one parent after the divorce places the child's development and well-being at risk. The aim of this study was to determine how Greek courts deal with the cases of parental prevention of communication with their children and which factors affect the judicial decisions.

METHODS

The Greek legal databases "NOMOS" and "Isokratis" were searched, and associations between judicial decisions, as well as communication prevention ways, and several parameters, were assessed.

RESULTS/CONCLUSIONS

A total of 50 parental communication prevention law cases were retrieved for the time period from 1992 to 2019. Results showed that mothers were more frequently alleged to interfere with father-child communication. Both direct and indirect methods of interfering with communication were followed. In cases of a single child, the method of indirect interference was more frequently followed. Judicial decisions were unaffected by the age and gender of the child, the gender of the parent preventing the communication, the number of children, the gender of the child and whether the child is the same gender as the preventing or prevented parent, the way of prevention, and the reference to parental alienation.

A rare case of complicated suicide: Self-immolation and subsequent stab heart injury due to fall into a glass door

Complicated suicides can be defined as incidents where death is caused by a subsequent trauma rather than the primary injury. Deaths which occur as a complication of the suicidal act are very rare with few reports in the literature. We present the case of a 60-year-old man who was found at his home while still alive. His body was burning and he was lying on his back impaled by shards of glass that had come from a broken glass door. An ambulance was called but the man died before arrival at hospital. The autopsy showed stab heart and lung injuries in thorax and an abdominal stab trauma which resulted in the protrusion of the small intestine. Homicide was excluded and the sequence of events was reconstructed to reveal a complicated suicide intended to result from self-immolation but which resulted in a fall against a glass door which in turn resulted in shards of glass piercing his body and a fatal stab wound to the heart.

Prevalence of Homicide-Suicide Incidents in Greece over 13 Years

Prevalence of homicide-suicides is difficult to determine in Greece due to the lack of a national tracking system. The aim of this study was to estimate the prevalence of the homicide-suicide incidents in Greece over the past 13 years, and to determine the circumstances under which they occurred, as well as the characteristics of perpetrators and victims. Two Internet search engines (google and yahoo), as well as the search engine of the major national news websites, were surveyed to identify the number of homicide-suicide cases that occurred in Greece from January 2008 to December 2020. Over the study period, 36 homicide-suicide incidents occurred in Greece, resulting in 36 suicides and 41 homicides. The above incidents reflect an annual homicide-suicide rate of 0.02 cases per 100,000 inhabitants. Most perpetrators were male (88.9%), whereas most victims were female (80.6%). Spousal-consortial cases accounted for 52.7% and familial cases for 41.7% of the total number of incidents. The use of firearms (mostly shotgun) was the most common method of homicide and suicide (58.3% and 63.9%, respectively). Women killed only their children, while men committed homicide and suicide mainly in the context of a former or current intimate partnership with the victim. Our results are in line with international homicide-suicide data. The establishment of a national surveillance system for homicides-suicides would be of paramount importance as it would facilitate accurate recording, identification of risk factors and characteristics of potential victims and perpetrators and it could ultimately be an aid to the prevention of such tragic events.

Evaluation of senescent cells in intervertebral discs by lipofuscin staining

Intervertebral disc (IVD) degeneration is considered an important contributor of low back pain, a major age-related disease. Interestingly, an unprecedented high number of senescent cells has been reported in aged and degenerated IVDs, most probably affecting tissue homeostasis. In previous studies classical markers of cellular senescence have been used, such as SA-β-gal staining or p16^Ink4a expression. Aim of the presented study was a re-evaluation of the number of senescent IVD cells by using a newly established staining procedure for lipofuscin, based on a Sudan Black-B analogue (GL13), which can be used in fresh, as well as in fixed and embedded tissues. In cultures of senescent rat and human IVD cells both SA-β-gal and GL13 gave similar percentages of senescent cells. Similarly, in fresh tissues from old rats the ratios of senescent cells were high with both detection procedures. Finally, in formalin-fixed and paraffin-embedded tissues from humans, a significant increased number of GL13-positive cells was found in herniated tissues, as compared to apparently normal ones, while similar numbers of p16^Ink4a-positive cells were observed. These data confirm the significantly enhanced number of senescent cells in aged and degenerated IVDs, most probably contributing to the degeneration of this tissue.

Interpersonal Violence Against Children and Adolescents: A Forensic Study From Greece

OBJECTIVE

To investigate differences in victimization of minors after allegations of domestic violence and community violence.

METHODS

This retrospective study was conducted by reviewing the archive of clinical examinations after allegations for interpersonal violence against minors that were performed at the Department of Forensic Medicine and Toxicology of our Medical School from 2012 to 2016.

RESULTS

216 cases of allegations for victimization of minors' were referred to our department, representing 8.8% of all clinical forensic examinations. Boys community violence victims were affected mainly on the head, whilst girls mainly on the genital area. Upper limbs were the predominant site of injuries on domestic violence victims of both sexes.

CONCLUSIONS

Adolescents were in greater danger of sustaining injuries than younger children. Upper limb injuries may prove to be a useful screening tool for domestic violence in school-age children and adolescents, while trunk injuries may indicate domestic violence in preschool children.

A burned body with a shotgun head injury found on an "altar" made of banknotes: A case report from Greece and brief review of the literature

We describe an unusual case of a burnt body with a shotgun head injury found on a "bed" made of wooden boards on a pile of banknotes, resembling an altar. The body belonged to a 64-year-old man, of Greek nationality, with cancer who set his house (including the room in which he was found) and vehicle on fire before shooting himself, planning this way his postmortem burning. The combination of fire with the use of an "altar" and the destruction of body and possessions creates a unique death scene that implies a suicide with a ritual character.

Intimate partner violence in Greece: a study of 664 consecutive forensic clinical examinations

BACKGROUND

Intimate partner violence (IPV) is a well-known phenomenon, which affects mostly women. While IPV victims may attend emergency departments (EDs) seeking medical care, not all of them will make an allegation against their abusers.

OBJECTIVE

The aim of this study was to examine the prevalence and the characteristics of the victims, who had made an allegation about the violent incident and had been examined by a forensic pathologist for judicial purposes, and had attended EDs seeking medical care, before the forensic examination.

METHODS

We reviewed the archives of clinical examinations that were conducted at the Department of Forensic Medicine and Toxicology of National and Kapodistrian University of Athens during a 5-year period (2012-16).

RESULTS

Six hundred sixty-four clinical examinations were conducted at our Department for IPV allegations. According to our findings, women were more likely to seek medical care than men. Victims who have attended EDs were more likely to have sustained injuries located at least on the head or on the lower limbs.

CONCLUSION

The majority of IPV victims in the broader region of Attica (Greece) were women, usually married, and aged between 30 and 49 years old. Despite the fact that the majority of IPV incidents are not reported to police, every person who is engaged in the process of dealing with IPV victims has to be educated and adequately informed about this phenomenon, its implications and the possible ways to deal with it. Furthermore, victims need to be educated and informed adequately in waiting rooms of EDs.

Violent deaths among elderly in Attica, Greece: A 5-year survey (2011-2015)

According to World Health Organization (WHO) estimations, approximately 6 million people lose their lives yearly due to some kind of injury, while one-third of these incidents are due to violent acts. Violent deaths include accidents (road traffic accidents, drownings, falls, heat effects etc), suicides as well as homicides. Elderly people seem to be at greater risk due to their special characteristics as a vulnerable social group. The aim of this study was to investigate violent deaths (accidents, suicides and homicides) among elderly people in Attica, Greece, during the period 2011-2015 by examining manner of death with respect to demographic data (gender and age) and toxicological examination results. A total of 546 violent deaths among people over 65 years old were included in this study. Autopsy findings along with toxicological examination results were collected from the archives of the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens. The findings of the study showed that most of the victims were male (63.74%). The overwhelming majority of violent deaths (425 cases) were accidents, 92 cases suicides, and the remaining 29 cases homicides. Drowning was the leading cause of all accidental deaths, followed by road traffic accidents. Hangings prevailed among violent suicide methods and asphyxiation presented as a predominant homicide method.

Cardiac iron overload following liver transplantation in patients without hereditary hemochromatosis or severe hepatic iron deposition

BACKGROUND

Cardiac iron overload following liver transplantation in patients without hemochromatosis but with severe hepatic iron deposition has been reported to result in heart failure and/or death in case reports and small case series. However, the frequency and causes of cardiac iron overload following liver transplantation and its relationship to cardiac dysfunction in patients without severe hepatic iron deposition are unclear.

METHODS

The primary inclusion criteria for this study were liver transplantation followed by autopsy or cardiac transplantation within 1 year. Cases of known hemochromatosis were excluded. Iron stains were performed on left ventricular myocardium from either the autopsy or surgically resected heart, as well as the surgically resected liver.

RESULTS

Nineteen cases met the study criteria: 18 autopsies and 1 case of cardiac transplantation. None of the resected livers evaluated showed severe iron deposition. Myocardial iron deposition was identified in 7 (37%) of the cases. The presence of myocardial iron deposition was not significantly associated with the grade of hepatic iron deposition, or the pre-liver transplantation serum iron or ferritin levels. However, in the patients with myocardial iron deposition, there were trends toward higher pretransplant transferrin saturation (TSAT) and more units of red blood cells transfused (uRBC). The product of the TSAT multiplied by the uRBC was significantly greater in the patients with myocardial iron deposition [4700 (3100-9800) vs. 680 (400-2300), median (interquartile range), P=.003]. New reduced left ventricular ejection fraction (<50%) following liver transplantation occurred in four of five patients with myocardial iron deposition, compared with zero of eight patients without myocardial iron deposition (P=.007).

CONCLUSIONS

In this series of patients without severe hepatic iron deposition, cardiac iron overload was associated with cardiac dysfunction following liver transplantation and was related to the product of the pre-liver transplant TSAT multiplied by the number of uRBC transfused during and following the surgery.

Possible Implication of GSTP1 and NQO1 Polymorphisms on Natalizumab Response in Multiple Sclerosis

Oxidative stress plays a pivotal role in the pathogenesis of multiple sclerosis (MS). Inactivating polymorphism of genes encoding detoxification enzymes, such as NQO1 and GSTP1 could influence susceptibility to MS. The monoclonal antibody natalizumab is an effective treatment in MS. Natalizumab's efficacy in MS patients with regard to NQO1 and GSTP1 genetic polymorphisms is investigated. 130 patients with definite MS according to the Mc Donald's criteria treated monthly with natalizumab were included in the study. MS patients were classified with regard to their clinical subtype, gender and clinical outcome after Natalizumab administration. GSTP1 and NQO1 genotyping was performed using Real-Time PCR and PCR-RFLP assays. Among our cohort of MS patients, 88.5% responded and 11.5% manifested clinical deterioration after natalizumab treatment. Statistical analysis revealed a significantly increased frequency of double NQO1 and GSTP1 mutant polymorphisms in non responders compared to the responders. Therefore, patients who carry the wild type genotype or only one polymorphism for either NQO1 or GSTP1 gene have possibly a better clinical outcome after the natalizumab therapy. Our findings indicate that antioxidant efficiency might reflect a better clinical outcome after natalizumab administration. Hence, oxidative stress reduction might be another mechanism through which natalizumab exerts its protective effect.

The microvascular anatomy of superior and inferior gluteal artery perforator (SGAP and IGAP) flaps: a fresh cadaveric study and clinical implications

BACKGROUND

Our study aimed to highlight anatomical similarities, differences, and variations in the microvascular anatomy between superior and inferior gluteal artery perforator (SGAP and IGAP) flaps.

METHOD

Thirty gluteal flaps (15 SGAP and 15 IGAP) were studied on 22 adult fresh cadavers. We recorded the number and location of perforators, the characteristics of the main perforator (course, length, and diameter at the level of division at the greater sciatic foramen), and the anatomical variations of the submuscular venous plexus.

RESULTS

The mean number of perforators was similar in both flaps (n = 7). We found a statistically significant difference in the total length of the vascular pedicle between SGAP (mean = 9.80 cm) and IGAP (mean = 13.36 cm) flaps, which correlated strongly with the difference in the intramuscular length (mean difference = 3.40 cm) of the perforator. There was no statistically significant difference in the diameter of the superior and inferior gluteal vessels at the point of pedicle division. The complex submuscular venous plexus, which is typically found on SGAP flaps deep to the sacral fascia, was never encountered on IGAP flaps. Perforators originating from the inferior gluteal artery were found on the lower half of five superior gluteal flaps. These were dominant perforators in two cases. We also report a rare anatomical communication between superior and inferior gluteal vessels deep to the piriformis muscle and a case of atheromatous disease of the inferior gluteal artery.

CONCLUSION

Our findings are highly relevant to clinical practice and contribute to the understanding of the vascular anatomy of SGAP and IGAP flaps and the successful use of these challenging flaps.

NO LEVEL ASSIGNED

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Clinical Diagnoses and Autopsy Findings: A Retrospective Analysis of 252 Cases in Greece

Context.—Despite medical and technologic advances, clinicians may misdiagnose a patient's situation and the cause of death. Autopsy may be valuable in uncovering the most frequent diagnostic pitfalls and helping clinicians to learn and to develop the medical art and science.

Objective.—To compare the clinical diagnoses with postmortem findings and evaluate the frequency of diagnostic errors assessed by autopsies.

Design.—Retrospective analysis of the protocols of 252 consecutive cases of adult patients autopsied in the Department of Forensic Medicine and Toxicology of Athens Medical School during the period 1999–2003. The outcome measures included concordance between diagnosis before death and at autopsy, sex, age, and length of hospitalization of the patient.

Results.—In 73 cases (29%), the autopsy findings confirmed the clinical diagnosis and the cause of death suggested by the clinicians. In 45 cases (19%), the clinical diagnosis and the cause of death suggested by the clinicians were discordant with the autopsy findings. In 105 cases (42%), the autopsy requests did not include any suggestion about the cause of the patient's death. In 7 cases (3%), several diagnoses were suggested by the clinicians, and in 16 cases (6%), the comparison between clinical and postmortem diagnosis was not possible. The most frequently misdiagnosed diseases were coronary disease and pulmonary embolism.

Conclusions.—It is concluded from this study that autopsies may reveal unexpected findings that are of critical importance and that a continued emphasis on autopsy evaluation is necessary to improve the quality of patient care.

The use of alcohol and other psychoactive substances by victims of traffic accidents in Greece

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual as well as the reflexes of a pedestrian increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the major part of Greece. The findings of the toxicological analyses that were performed in our laboratory during the years 1995 to 1997 are classified according to the alcohol concentration and the kind of psychoactive substance detected as well as to the gender and the age of the victims, drivers or pedestrians. The results of the above classification are evaluated and the conclusions regarding alcohol, drugs and traffic accidents in Greece are discussed thoroughly.