Birgitte Schmidt Astrup

Retinopathy in severe malaria in Ghanaian children - overlap between fundus changes in cerebral and non-cerebral malaria

BackgroundIn malaria-endemic areas, reliably establishing parasitaemia for diagnosis of malaria can be difficult. A retinopathy with some features unique to severe malaria with a predictive value on prognosis, has been described. Detection of this retinopathy could be a useful diagnostic tool. This study was designed to determine the diagnostic usefulness of retinopathy on ophthalmoscopy in severe malaria syndromes: Cerebral malaria (CM) and non-cerebral severe malaria (non-CM), i.e. malaria with respiratory distress (RD) and malaria with severe anaemia (SA), in Ghanaian children. Secondly, to determine any association between retinopathy and the occurrence of convulsions in patients with CM.Methods and subjectsA cross-sectional study of consecutive patients on admission with severe malaria who were assessed for retinal signs, at the Department of Child Health, Korle-Bu Teaching Hospital, Accra, from July to August 2002 was done. All children had dilated-fundus examination by direct and indirect ophthalmoscopy.ResultsFifty-eight children aged between six months and nine years were recruited. Twenty six(45%) had CM, 22 with convulsion; 26(45%) had SA and six(10%) had RD.Any retinopathy was seen in: CM 19(73%), SA 14(54%), RD 3(50.0%), CM with convulsion 15(68%) and CM without convulsion 4(100%). Comparison between CM versus non-CM groups showed a significant risk relationship between retinal whitening and CM(OR = 11.0, CI = 2.2- 56.1, p = 0.001). There was no significant association with papilloedema(OR = 0.9, CI = 0.3 - 3.0, p = 0.9), macular whitening(OR = 1.6, CI = 0.5 - 4.8, p = 0.4), macular haemorrhage(OR = 0.28, CI = 0.03 - 2.7 p = 0.2), retinal haemorrhage(OR = 1.9, CI = 0.6 - 5.6, p = 0.3), vessel abnormality(OR = 1.9, CI = 0.6 - 6.1, p = 0.3) and cotton wool spots(OR not calculated, p = 0.08).Tortuous and engorged retinal veins, not previously described as a feature of CM, was the most common vascular abnormality(15/58 = 26%) and was detected even in the absence of papilloedema.ConclusionRetinal whitening, a sign suggestive of retinal ischaemia, was significantly more common in CM than in non-CM syndromes. However, the high prevalence of any retinopathy in the latter suggests that the brain and the retina may be suffering from ischaemia in both CM and non-CM.

Nature, frequency and duration of genital lesions after consensual sexual intercourse—Implications for legal proceedings

OBJECTIVE The purpose of this study was to make a normative description of the nature and duration of genital lesions sustained during consensual sexual intercourse, using the three most commonly used techniques; visualisation using the naked eye, colposcopy and toluidine blue dye followed by colposcopy. METHODS Ninety eight women were examined within 48 h of consensual sexual intercourse. Fifty of the women were examined twice again within the following 7 days of sexual abstinence after the first examination. RESULTS The participants had a median age of 22.4 years and 88% were nulliparous. Lesions were frequent; 34% seen with the naked eye, 49% seen with colposcopy and 52% seen with toluidine blue dye and subsequent colposcopy. The lesions lasted for several days; the median survival times for lacerations were 24, 40 and 80 h, respectively. CONCLUSIONS The legal implications of these findings are that genital lesions by themselves do not corroborate a rape complaint. Genital lesions may, however, corroborate specific details of a case and should be documented as carefully as any other lesion in rape complaints.

Detection of spermatozoa following consensual sexual intercourse

INTRODUCTION In cases of sexual assault, the finding of semen can provide crucial evidence. The presence of spermatozoa serves as proof of a sexual act and may give the identity of the alleged perpetrator through DNA-profiling. In most western countries, there are guidelines for standardized examinations of sexual assault victims. For an objective evaluation of the findings, substantial knowledge of aspects regarding consensual sexual intercourse is crucial. The aim of this study was to examine detection frequencies and genital sampling sites of spermatozoa following consensual sexual intercourse. METHODS In a prospective setting, 60 women underwent forensic examination following consensual sexual intercourse. Specimens were obtained from the external genitalia, the posterior fornix and the cervical canal, and examined using the Papanicolau stain and standard light microscopy. RESULTS We found that 88% of possible cases were positive for spermatozoa. The posterior fornix was significantly better than the other sites for detection of spermatozoa and the number of spermatozoa decreased significantly over time. In a large sub-group of women who reported that no intra-vaginal ejaculation had taken place during their latest intercourse, a significant number (14%) had spermatozoa in the vagina. CONCLUSION Spermatozoa were best recovered from the posterior fornix, but spermatozoa were also present on swabs taken from the external genitalia. Detection of spermatozoa is thus possible in cases where a speculum examination is denied.

The role of Coxsackievirus A16 in a case of sudden unexplained death in an infant - A SUDI case.

The Coxsackievirus A16 (CV-A16) is one of the main pathogens causing hand-foot-and-mouth disease in young children. It is a low-virulence virus rarely involved in serious illness. It is seen sporadically or in outbreaks all over the world. We report a case of sudden unexplained death in infancy, SUDI, in a 3 and 1/2 months old infant, in which a thorough post mortem investigation pointed at a fatal infection with CV-A16 as the most likely cause of death. Only five cases of fatal CV-A16 infection have been published and none of these presented as sudden death. The fatal cases involved two infants, two young children and an elderly man. Post mortem, pre-autopsy CT-scan and C-reactive protein analysis allowed for an autopsy procedure targeted at a microbiological cause of death. The case illustrates the usefulness of supplementary testing during autopsy.

Suffocation caused by plastic wrap covering the face combined with nitrous oxide inhalation

Suicide using a combination of a plastic bag over the head and inhalation of a non-irritating gas, such as helium, argon or nitrogen, has been reported in the literature. Here an unusual suicide method in a 17-year old man by suffocation from covering the face with household plastic wrap, combined with nitrous oxide inhalation, is presented. The case was reviewed based on police, autopsy and hospital reports. A PubMed search for scientific literature related to nitrous oxide abuse and suicide by suffocation was performed and our findings discussed in relation to the scientific literature found. The deceased was a 17-year old man who was found with the nose and mouth closed with a piece of kitchen plastic wrap. The plastic wrap had been removed prior to autopsy. Autopsy findings were suggestive of asphyxia, but were otherwise negative. Nitrous oxide was detected in the brain and lung tissue with headspace-gas chromatography-mass spectrometry (headspace-GCMS). The cause of death was assumed to be suffocation caused by plastic wrap covering the face, combined with nitrous oxide inhalation. Suicide was suspected because of a history of depression for several months. Nitrous oxide, also known as laughing gas, has a euphoric effect and is used as a recreational inhalant drug that can be purchased legally. Deaths caused by recreational nitrous oxide abuse are rare but may occur if used in combination with a plastic bag over the head. This is the first report of suicide by suffocation by external obstruction combined with nitrous oxide inhalation.

Post-coital genital injury in healthy women: A review.

Female genital injury following penile sexual intercourse in healthy women is a matter of importance and debate in many parts of society. However, the literature on the subject is sparse. There are a few studies regarding minor injury that does not require treatment in adult, pre‐menopausal women, a single study of adolescent women, and none regarding post‐menopausal women. Larger lesions requiring treatment are described casuistically. The purpose of this article is to provide a short, easy‐to‐read review of the literature regarding the prevalence and nature of female genital injury following consensual sexual intercourse in otherwise healthy women. Clin. Anat. 28:331–338, 2015.

A deep learning approach for the forensic evaluation of sexual assault

Abstract Despite the existence of patterns able to discriminate between consensual and non-consensual intercourse, the relevance of genital lesions in the corroboration of a legal rape complaint is currently under debate in many countries. The testimony of the physicians when assessing these lesions has been questioned in court due to several factors (e.g., a lack of comprehensive knowledge of lesions, wide spectrum of background area, among others). Therefore, it is relevant to provide automated tools to support the decision process in an objective manner. In this work, we evaluate the performance of state-of-the-art deep learning architectures for the forensic assessment of sexual assault. We propose a deep architecture and learning strategy to tackle the class imbalance on deep learning using ranking. The proposed methodologies achieved the best results when compared with handcrafted feature engineering and with other deep architectures .

Automated Detection and Categorization of Genital Injuries Using Digital Colposcopy

Despite the existence of patterns able to discriminate between consensual and non-consensual intercourse, the relevance of genital lesions in the corroboration of a legal rape complaint is currently under debate in many countries. The testimony of the physicians when assessing these lesions has been questioned in court due to several factors (e.g. a lack of comprehensive knowledge of lesions, wide spectrum of background area, among others). Thereby, it is relevant to provide automated tools to support the decision process in an objective manner. In this work, we compare traditional handcrafted features and deep learning techniques in the automated processing of colposcopic images for genital injury detection. Positive results where achieved by both paradigms in segmentation and classification subtasks, being traditional and deep models the best strategy for each subtask type respectively.

Life-Threatening and Suspicious Lesions Caused by Mechanical Cardiopulmonary Resuscitation

Abstract Chest compression devices for mechanical cardiopulmonary resuscitation (CPR) have become more common. Here, we report the case of a young woman who attempted resuscitated with LUCAS™2 after she was found unconscious at home. At autopsy, we found extensive intramuscular hemorrhages in posterior neck, between the scapulae, and in the lumbar region. Investigation of internal organs showed injuries to the lung, spleen, and kidney. The extension of the injuries gave rise to suspicion of homicide by smothering, which police investigation subsequently did not support. The pattern of injury could be attributed to automatic compression decompression CPR with LUCAS™2. The injuries may have been lethal had the patient survived. For the forensic pathologists, it is important to remain updated on developments in treatment techniques to avoid pitfalls when interpreting injury. Larger studies, prospective or retrospective, may be able to qualify the possible risks of automatic compression decompression CPR even further.

Further comments to the discussion regarding the article: macroscopically detected female genital injury after consensual and non-consensual vaginal penetration

The recently published letter A response to: Macroscopically detected female genital injury after consensual and nonconsensual vaginal penetration: A prospective comparison study by Lo et al.1 raises important questions regarding research on genital injury in sexual assault. The expressed concerns are valid, but one point in particular deserves elaboration. Lo et al. discuss the possibility of several types of “recruitment bias” or selection bias in both the consenting and non-consenting group. When looking at the literature on the subject, selection bias seems to be an inevitable part of research in this field, and a problem that needs attention. It is not correct when Lo et al. only cite two studies2,3 for comparing genital injury in a consenting and non-consenting group using macroscopy as diagnostic tool. The study by Astrup et al.4 (yours truly) published in 2012 in this journal, has also done exactly that, making it three al together.