José I. Muñoz-Barús

Estimating adult stature from radiographically determined metatarsal length in a Spanish population

The ability to determine height in adult life can be crucial in the identification of skeletal remains. Very often, the small bones found among such remains are not only the most numerous, but also the best preserved, a fact which calls for more research into developing methods to estimate height from metatarsals. The aim of this paper is to verify the use of the dimensions of the metatarsals as estimators of adult height in a Spanish population using radiologically determined metatarsal lengths and to propose regression equations and test the formulae for determining adult stature. The present research is based on a study of 228 healthy Caucasoid adults from Galicia (NW Spain). The first and second metatarsals of the left foot were measured by a dorso-plantar X-ray using a digital medical image viewer. The best correlation obtained was with the maximum length of the 1st metatarsal for males. The corresponding regression equation is as follows: S=819.88+12.79 M1. A comparison of our statistical results with those of neighbouring population groups indicates that ours is more accurate. This must be due to the so-called specificity of regression equations in relation to the series on the base from which they were developed.

Applications of Tandem Mass Spectrometry (LC–MSMS) in estimating the post-mortem interval using the biochemistry of the vitreous humour

It is widely accepted that the quantification of potassium concentrations ([K+]) and hypoxanthine ([Hx]) in the vitreous humour is useful in estimating the time of death within a recent time interval. Despite all the advances made in this area, it is well recognized that difficulties in calibration, validation and the use of different methodologies and instrumentation from different laboratories may lead to obtaining different concentrations from the same sample. The extraction of the vitreous humour itself should also be carried out with a precise technique, taking care during the procedure to avoid causing any vascular injury that might lead to haematic contamination. Any fluid that is not clear could lead to erroneous results and should be discarded. We present a new LC-MSMS method developed for quantitative and qualitative analysis of [Hx] (valid also for guanine and xanthine), and qualitative determination of uric acid in vitreous humour. We also introduce a methodology to assess haematic contamination in order to improve the estimation of time since death. The method was fully validated in terms of linearity, sensitivity, imprecision, analytical recovery, extraction and process efficiency and matrix effect.

PMICALC: An R code-based software for estimating post-mortem interval (PMI) compatible with Windows, Mac and Linux operating systems

In legal medicine the correct determination of the time of death is of utmost importance. Recent advances in estimating post-mortem interval (PMI) have made use of vitreous humour chemistry in conjunction with Linear Regression, but the results are questionable. In this paper we present PMICALC, an R code-based freeware package which estimates PMI in cadavers of recent death by measuring the concentrations of potassium ([K+]), hypoxanthine ([Hx]) and urea ([U]) in the vitreous humor using two different regression models: Additive Models (AM) and Support Vector Machine (SVM), which offer more flexibility than the previously used Linear Regression. The results from both models are better than those published to date and can give numerical expression of PMI with confidence intervals and graphic support within 20 min. The program also takes into account the cause of death.

The use of computerized tomography in determining stature and sex from metatarsal bones

This study evaluates the efficacy of a radiological method to estimate stature from measurements of the first and second metatarsal taken from a collection of metatarsals of a Portuguese Caucasian population in which the measurements were made directly on the bone. The highest coefficient of determination and the lowest standard error were obtained with the physiological length of the second metatarsal (F2), using the equation S=895.4803+10.7848F2. The linear regressions obtained show significant differences between the estimated heights from M1. In addition, we offer a simple method for sex determination based on the maximum length (M1) and width (W1) of the first metatarsal, where W1=x1; (M1/W1)=x2; β0=55.4767; β1=-2.5796 and β2=-4.6898. Here we present a method of measurement using computerized tomography that enables population studies using live volunteers without incurring the difficulties of on the bone measurement.

Intimate partner violence against women in Spain: A medico-legal and criminological study

Intimate partner violence (IPV) is a significant worldwide problem whose magnitude and risk factors vary across different settings and cultures. Nowadays, it is a priority to improve the knowledge on this issue in order to formulate better evidence-based policy responses. This study aims to contribute to a better understanding of non-fatal IPV against women in Spain. A retrospective analysis of IPV cases with a final judicial decision was carried out. The period under study extended from January 2005 to December 2012, with a total of 582 files included in the investigation. Most IPV victims were young adult women of Spanish origin, either married or single, with children, unemployed and with a low family income level. The majority of alleged perpetrators were young adults, employed, with a middle-low income level, a history of alcohol consumption/abuse, but no criminal records. Most victims had previous history of IPV, were engaged in a long-term relationship with their abuser and lived with him at the time of assault. The combination of psychological and physical abuse was the most frequent form of violence. The most common mechanisms of assault consisted in minor acts of physical violence, which resulted in mild injuries, most of them in the upper limbs and face. Nearly half of women sought medical care, but physicians injury report was only made in about a quarter of these cases, even though it is mandatory for health professionals. The majority of criminal proceedings were initiated by the victims report and ended in conviction, most of them being considered occasional mistreatment. This study confirms the heterogeneity of the phenomenon of intimate partner violence. The importance of adopting standard IPV concepts and promoting the recognition and assessment of this form of violence amongst health care professionals, criminal investigators and forensic personnel is emphasized.

The Application of Flow Cytometry as a Rapid and Sensitive Screening Method to Detect Contamination of Vitreous Humor Samples and Avoid Miscalculation of the Postmortem Interval

Research into maximizing the speed, precision, and reliability of estimating the postmortem interval (PMI) has been a recurring object of investigation and methodologies based on the vitreous humor (VH) have provided good results. However, contamination from causes not readily apparent, such as blood, can occur, and thus lead not only to an erroneous estimation of PMI, but also interfere with the correct identification of other substances in the VH. We have developed a flow cytometry method which quantifies blood contamination and is able to detect erythrocytes in 1:750,000 dilution of contaminated VH which affects the results of hypoxanthine. It is an improvement on the previous more complex mass spectrometry method, being faster, more sensitive, and readily available. As such, it could be proposed for the rapid screening of appropriate samples by detecting and eliminating blood contaminated samples from PMI estimation.

Estimating height from the first and second cervical vertebrae in a Spanish population

One of the roles of forensic anthropology is the identification of skeletal remains and over the years many methods have been developed to obtain specific details of a corpse such as an estimation of age and height. The femur and tibia are ideal for this purpose but unfortunately they are often missing or badly fragmented. For this reason, in this present study, we used the smaller bones of the first and second cervical vertebrae, which are often better preserved than the long bones. Direct measurement of these bones has been found to be misleading, largely due to the remains of a covering of soft tissue, and to overcome this all measurements were taken from tomographic images. The aim of this study is to provide an auxiliary diagnostic method to evaluate the association of different anthropometric measurements taken with tomographic imagery of both the first cervical and second cervical vertebra with body height within a sample of the Spanish population. Measurements were taken from tomographic images taken with a dental CT of 203 healthy individuals from a Spanish population. The best correlation was obtained in the case of unknown sex using four measurements: two of the first cervical vertebra and two of the second vertebra using the following regression formula S=49.02+1.02O+1.58DO+0.49V+0.67I. All formulae provided statistically significant results and can be applied to any skeletal remains belonging to a Spanish population.

Unusual Forms of Adrenal and Extra-Adrenal Myelolipomas

Myelolipomas are rare benign tumors of poorly understood tumorigenesis composed of mature hematopoietic tissue and fat. They mostly occur in the adrenal glands, but extra-adrenal myelolipomas have been reported in other locations such as the presacral region or retroperitoneum. It is not unusual that they are incidental findings revealed in the study of different diseases. We report 3 unusual examples of myelolipomas. The first is a multiple, unusually large, extra-adrenal myelolipoma, presented as an autopsy finding in an individual who had died suddenly from a central nervous system hemorrhage. The remaining 2 were incidental findings in patients studied for different reasons. Both were located within another neoplasm, namely an adrenal adenoma and a liver focal nodular hyperplasia. Moreover, the first showed infiltration by a non-Hodgkin lymphoma.

High variation in hypoxanthine determination after analytical treatment of vitreous humor samples

In the field of legal medicine the correct determination of the time of death is of great importance because an error in calculating the post-mortem interval (PMI) could be crucial in a criminal investigation. The quantification of hypoxanthine (Hx) concentration in the vitreous humor (VH) as a means to estimate PMI is useful when dealing with a recent time interval of death and has several advantages over other biological matrices. However, due to its viscous nature, VH has to be liquefied prior to its analysis, and the different procedures to liquefy it may cause alterations in Hx concentration, and hence in estimation of PMI. The aim of this study was to determine differences in Hx concentration after applying several pre-analytical treatments to different aliquots of the same VH sample. Enzymatic digestion, sonication, centrifugation and heat were the liquefying methods applied to reduce the viscosity of 105 VH samples. Analysis was performed using solid phase extraction and liquid chromatography in tandem with mass spectrometry. Statistically significant differences in the measured Hx concentrations were found between enzymatic digestion and the other three methods analyzed (sonication, centrifugation, and heat). Additionally, high data dispersion was found under heat treatment but was not observed for centrifugation or sonication, where similar and more moderate results were found. We conclude that high variations in Hx determination are observed when enzymatic digestion or heat treatment is used and we therefore recommend sonication or centrifugation to quantify Hx concentration in the VH.

Cardiac Inhibitory Reflex as a Cause/Mechanism of Death

The role of cardiac inhibitory reflex as a potential cause of death is still a matter of debate. This study reports two cases of death under unusual circumstances. Case 1 corresponds to a man found hanging where the role of ligature compression of the carotid sinus became relevant as a possible explanation of death. In Case 2, the participation of a vasovagal syncope was clearly triggered by the laryngoscopic procedure. It is proposed that cardiac inhibitory reflex should be taken into account in those cases of unexpected death, which fulfills the following three criteria: (i) The investigation of the circumstances of the death is consistent with a hypothesis of cardiac arrest. (ii) A typical triggering peripheral stimulus is present. (iii) The performance of a complete autopsy cannot rule out the participation of a cardiac inhibitory reflex in the cause of death.