Djordje Alempijevic

Guidelines for International Forensic Bio-archaeology Monitors of Mass Grave Exhumations

The systematic exhumation of mass graves is becoming a frequent occurrence globally. Historically, it has been mostly anthropologists with their particular expertise in osteology that have been engaged by non-governmental organizations (NGO) to monitor mass grave exhumations and postmortem examinations, conducted by a host country or international forensic team, to ensure competence and a concern for justice. The excavation of graves and examination of their contents for the purposes of personal identification of victims and/or collection of evidence for prosecution require the creation of standards that meet international concerns for forensic investigation of the highest quality. However, many anthropologists are not experienced with large sites; do not have much, if any, expertise in archaeology; and are not equipped by training to assess the quality of a forensic pathologists autopsy. This contribution is directed to both the NGO and the bio-archaeologist who are involved in the exhumation of mass graves. The experience and skills appropriate for the bio-archaeological monitor are outlined; similarly, the policies and standard operating procedures (SOPs) of the NGO that will enable the bio-archaeologist to perform their task are detailed. It is becoming increasingly clear that how a grave site was created, filled, and concealed, along with subsequent processes of site formation (e.g. slumping, robbing, animal scavenging and taphonomic alteration), require the expertise of a forensic archaeologist to discover and record site complexity along with associated forensic evidence. Similarly, the bodies themselves which are often skeletonized, fragmented and commingled pose challenges for the anthropologists and pathologists whose postmortem examinations must be critically evaluated. A model protocol for observations to make at the site as well as at the mortuary facility is provided to guide the monitor and to provide a structure for reports which are of standardized content suitable for international agencies concerned with mass grave investigation.

Child homicide on the territory of Belgrade

OBJECTIVE This study examines the incidence and other epidemiological and medico-legal characteristics of child homicide in the territory of Belgrade, Republic of Serbia. METHODS We performed a retrospective analysis of all autopsies carried out at the Institute of Forensic Medicine in Belgrade during a 15 year period between 1991 and 2005, focusing on homicide cases of victims aged 0-14 years. These were then analyzed in terms of number of deaths, mortality rates, age, and sex of the victim, relation to the perpetrator, and cause of death and injury. RESULTS Forty-six homicides were identified where the victims were aged 0-14 years. These included 24 girls and 22 boys. In 32 cases (69.6%) the perpetrator was one of the childs birth parents, more frequently the mother. Blunt head trauma was the most frequent cause of death, followed by exsanguination. In 9 cases (19.5%) there was evidence of physical abuse; 16 children died in the setting of multiple homicide and/or murder/suicide. In 4 cases (8.7%) there was evidence of neglect which contributed to the fatal outcome. There were 10 cases of neonaticide within the 46 homicides. There were, however, 49 further cases where bodies of newborn infants were discovered after having been disposed of in suspicious circumstances. CONCLUSIONS Proportionally, the largest number of victims fell within the 1-4 years age group, with a slight preponderance of females, most of them killed at home by a close family member, usually the mother. Blunt head trauma was the single most frequent cause of death. Injury patterns consistent with child abuse were identified among 20% of the study group.

Divergent patrilineal signals in three Roma populations.

Previous studies have revealed that the European Roma share close genetic, linguistic and cultural similarities with Indian populations despite their disparate geographical locations and divergent demographic histories. In this study, we report for the first time Y-chromosome distributions in three Roma collections residing in Belgrade, Vojvodina and Kosovo. Eighty-eight Y-chromosomes were typed for 14 SNPs and 17 STRs. The data were subsequently utilized for phylogenetic comparisons to pertinent reference collections available from the literature. Our results illustrate that the most notable difference among the three Roma populations is in their opposing distributions of haplogroups H and E. Although the Kosovo and Belgrade samples exhibit elevated levels of the Indian-specific haplogroup H-M69, the Vojvodina collection is characterized almost exclusively by haplogroup E-M35 derivatives, most likely the result of subsequent admixture events with surrounding European populations. Overall, the available data from Romani groups points to different levels of gene flow from local populations.

Ethical and Legal Consideration of Prisoner’s Hunger Strike in Serbia

Abstract:  Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48‐year‐old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15 days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as “heroin intoxication” in keeping with detection of 6‐MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made.

Amniotic fluid embolism-apropos two consecutive cases.

Abstract:  Amniotic fluid embolism (AFE) is a sporadic, unpredictable, and usual fatal obstetric complication. The paper deals with two cases of maternal deaths because of AFE verified by medicolegal autopsy. In both the cases, several known risk factors associated with AFE, such as increased maternal age (41 and 35 years), diabetes, augmented labor, and cesarean delivery, were identified. Clinical features were typical, including sudden onset of cardiovascular and respiratory symptoms. In the patient who survived longer, both clinical and autopsy signs of disseminated intravascular coagulopathy were present, while they were absent in the case where death occurred rapidly. This paper describes briefly the particular features to look for at autopsy and stresses the importance of histology examination and staining techniques.

Traumatic Testicular Displacement in Motorcycle Drivers

Abstract:  Testicular displacement is a rare clinical presentation of blunt scrotal injury that may take place in road traffic accidents involving motorcycle occupants. We are presenting two cases of motorcycle occupant fatalities, 21 and 24 years of age, where testicular displacement and other signs of groin trauma have been determined. In both cases, discrete external signs of scrotal trauma were noted on examination, while unilateral and bilateral traumatic testicular displacement, respectively, have been documented at autopsy. For motorcycle occupants involved in collision, it is necessary to perform a thorough analysis of injuries, in particular to look for specific trauma arising from fuel‐tank impact to genitalia and/or groin. These injuries are of great medico‐legal importance both at postmortem and in clinical cases involving motorcycle occupants involved in collision.

Medicolegal Aspects of Post‐traumatic Gastroduodenal Ulcers: A Retrospective Study*

Abstract:  Retrospective examination of 5‐year autopsy material showed the presence of posttraumatic gastroduodenal ulcers (PGDU) in 17.7% of decedents deemed to be at risk. They were more common in males (77%) and in patients aged over 50. In the majority of cases (76%) the survival period was <12 days; in 16.5% it was < 48 h. PGDU developed most commonly in victims of polytrauma and isolated craniocerebral injury, with ISS values ≥16; patients with spinal cord injuries were at greatest risk. Most frequently affected was the stomach, exhibiting numerous, usually superficial lesions, while solitary acute and exacerbated chronic peptic ulcers were more common in the duodenum. Complications of PGDU developed in 40% of cases, mostly in the form of hemorrhage; in 20% of cases PGDU have contributed to death. Medicolegal aspects of PGDU are, most frequently, concerned with the causal relationship between trauma, PGDU, and fatal outcome, as well as the potential for allegations of medical negligence.

Death Caused by a Signal Rocket—Not an Isolated Case*

Abstract:  Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand‐held parachute signal rocket during a football match is presented. A 17‐year‐old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand‐held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination.

A posttraumatic pseudoaneurysm of the left radial artery as a result of a stab wound in an 8-year-old girl

Pseudoaneurysms arise from a disruption of arterial wall continuity and are most commonly related to a penetrating trauma, an arterial wall inflammation or iatrogenic causes. They differ from real aneurysms due to a lack of one or more layers of the arterial wall. The frequency of peripheral artery pseudoaneurysms in the upper extremities is less than in the lower extremities and its most common cause is a gunshot or a stab wound. The risk of a rupture is higher than in true aneurysms due to a lack of wall layers, therefore requiring surgical treatment in most cases. Here we describe an unusual case of an 8-year-old girl who presented to the emergency department complaining of swelling and pain in her left distal forearm. One month before admission she experienced a penetrating trauma in the same area due to a self inflicted stab wound. After clinical and duplex ultrasonography evaluation the tumefaction proved to be a posttraumatic pseudoaneurysm of the left radial artery.

Social, clinical and radiological characteristics of physical abuse of children up to 3 years of age hospitalized in a tertiary health institution

Introduction/Objective: Child abuse is a significant public health problem in modern society. Many cases of violence against children remain undetected. Serbia has no official protocols for medical examination of abused children. The aim of the study is an analysis of the social, clinical and radiological characteristics of physical abuse of children under three years of age that required hospital treatment. Methods: This retrospective study included 98 physically injured children admitted to the University Children’s Hospital in the period from 2013 to 2015, with suspected physical abuse. In addition to the history of injuries, complete clinical examinations and standard laboratory analyses were performed in all children, as well as X-ray examination in children with apparent or suspected skeletal injury. Ultrasound examination and computerized tomography or magnetic resonance imaging were performed in selected patients. Final diagnosis of abuse was established by multidisciplinary assessment team. The children were divided into two groups – those with proven and those with suspected abuse. Results: Most of 98 children who were suspected of being abused (92%) were from one or both un- employed parents, 68% were male, 60% were first-born, and 44% younger than one year. Ninety-two percent of the children had skeletal fractures, 19% of whom had two or more fractures. The commonest fracture was a linear skull fracture, which was detected in 51% of the cases. Abuse was confirmed in only five of 98 suspected cases. Conclusion: Among the known social risk factors for abuse of children, the low economic status of the family was the most frequent one in our analyzed sample. The most common injury is a linear skull fracture. A national guideline for medical investigating of abused children is required.