Injury deaths have a major impact on public health systems, particularly in the Latin American re... more Injury deaths have a major impact on public health systems, particularly in the Latin American region; however, little is known about how different drugs, in combination or not with alcohol, interact with each injury type. We tested an epidemiological protocol for investigating alcohol and other drug acute use among fatally injured victims taking into account the injury context for all injury causes in Sao Paulo, Brazil. Blood alcohol and drug content were fully screened and confirmed following a probability sample selection of decedents (n=365) during 19 consecutive months (2014-2015). Drug concentrations, including benzodiazepines, cannabis, cocaine, and opioids were determined by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography tandem mass spectrometry (LC-MS/MS). Toxicology data were interpreted in combination with injury context retrieved from police records regarding cause, place of injury, and victims' criminal history. More than half of all fatally injured victims studied were under the influence of at least one substance (55.3%). Alcohol was the leading substance consumed before a fatal injury event (30.1%), followed by cocaine (21.9%) and cannabis (14%). Illicit drug use (cocaine and cannabis) comprised more than two thirds of all drug-related deaths. Alcohol-positive deaths are over-represented among road traffic injuries, while drug-positive deaths are more prevalent among intentional injuries. Victims who had previous criminal convictions were significantly more likely to have used illicit drugs compared to those who did not have a criminal *
Introduction: Deaths due to external causes, mainly homicides, are a serious public health proble... more Introduction: Deaths due to external causes, mainly homicides, are a serious public health problem in Brazil. There is evidence that the tendency to impulsive and / or violent behavior is exacerbated after alcohol consumption. Otherwise, the relationship between alcohol and violent deaths is described in the medical literature without much precision. Objective: Analyze the relationship between victims' blood alcohol levels and homicides, in the micro-region formed by some municipalities in Greater São Paulo. Methods: Retrospectively, we reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo (IML-SP) in Franco da Rocha, Brazil, from 2001 to 2017. Descriptive statistics were calculated to assess BAC testing status among decedents overall. The variables studied were sex, age, manner of death and blood alcohol level (BAC). Results: Of the 230 individuals analyzed, 200 (86.9%) were male and 30 (13.04%) female. The most preva...
Forensic research & criminology international journal, Oct 20, 2023
The child's testimony is a central part of investigating child sexual abuse. Many episode... more The child's testimony is a central part of investigating child sexual abuse. Many episodes of abuse do not leave physical signs. Forensic examiners and pediatricians and psychiatrists, and psychologists must be prepared to interview the child and obtain their description of the attack properly to get reliable evidence for the punishment of the crime. Based on medical literature research, the authors discuss the procedures adopted in Brazil after the enactment of Law 13431 of 2017, which establishes the obligation of "protected listening" to child victims of sexual abuse in the criminal process, as well as the justifications that lead the experts to consider the child testimony/disclosure about the abuse as vital evidence to convict the perpetrators in the courtroom.
Forensic Science, Medicine and Pathology, Dec 26, 2023
Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evid... more Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evidence shows that the tendency to impulsive behavior is exacerbated after alcohol consumption. The relationship between alcohol and suicide is poorly described in the medical literature. The study aims to analyze the relationship between victims' blood alcohol levels and suicides in some municipalities in Greater São Paulo, Brazil. We reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo in Franco da Rocha, Brazil, from 2001 to 2017. The manner of death was established based on the result of police inquiry. Deaths due to suicide (n=41) were selected for the study. Descriptive statistics and Student t-test was applied when appropriate. The variables studied were sex, age, suicide mechanism, and blood alcohol level (BAC). In all cases we could not determine how much time the deceased consumed alcohol before suicide. Of the individuals analyzed, 85.36% were male, and 14.64% were female. The most prevalent age range for males was between 18 and 23 (19.5%). For females, it was between 12 and 23 years (33.2%). Most suicides (48.78%) were due to hanging, followed by self-poisoning (22.08%) and firearms (17.1%). 38 victims (92.68%) presented a positive BAC, over 0.3 mg/dl. The higher levels were in the group of suicide by hanging (2.3 mg/ml). Thus, alcohol intoxication is common among suicide victims, and it can contribute to the fatal outcome as a risk factor. Further studies are necessary for a better comprehension of the effect of alcohol on suicide victims.
Confidentiality is a central element of the physician-patient relationship and is associated with... more Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study aims to show the main aspects of confidentiality in occupational medicine. For this, a narrative review of the literature on the subject was carried out, using free access databases and based on the codes of medical ethics. The occupational physician's performance involves the worker, other non-medical professionals and the employer, a situation that may trigger conflicts, requiring physicians to know their obligations and ethical-legal limits. The protection of confidentiality respects human rights, but dilemmas may arise, not only to obey ethical precepts, but to follow legal norms. This study seeks to show the main and updated ethical and legal aspects regarding occupational health.
Sexual violence is a pervasive global issue that affects individuals of all genders. However, the... more Sexual violence is a pervasive global issue that affects individuals of all genders. However, the experiences of male survivors have often been marginalized and inadequately represented. Male rape, which encompasses several forms of sexual violence against men, remains a sensitive and under-discussed topic in academic literature and public discourse. This study presents a descriptive cross-sectional analysis based on data collected from the Legal Medicine Institute (IML-São Paulo, Brazil) between 2014 and 2017. The analysis includes 7386 reports of sexological examinations performed on male victims of alleged rape. The analysis reveals that a significant majority of rape reports involved victims under the age of 12 or 14, which is considered vulnerable rape by the Brazilian legislation. Regarding the examination of reported cases of abuse against men, it was observed that only the minority of these cases exhibited visible injuries consistent with rape or tested positive for the presence of spermatozoa in the perianal region. Since the absence of visible injuries or spermatozoa does not negate the possibility of rape, this work highlights the challenges in obtaining conclusive evidence, necessitating a comprehensive approach to investigate and prosecute these crimes, creating a more inclusive and supportive environment for all survivors of rape, irrespective of their gender.
International Archives of Otorhinolaryngology, Jan 21, 2014
Introduction: Bullous systemic lupus erythematosus (BSLE) is an autoantibody-mediated disease wit... more Introduction: Bullous systemic lupus erythematosus (BSLE) is an autoantibody-mediated disease with subepidermal blisters. It is a rare form of presentation of SLE that occurs in less than 5% of cases of lupus. Case Report: A 27-year-old, female, FRS patient reported the appearance of painful bullous lesions in the left nasal wing and left buccal mucosa that displayed sudden and rapid growth. She sought advice from emergency dermatology staff 15 days after onset and was hospitalized with suspected bullous disease. Intravenous antibiotics and steroids were administered initially, but the patient showed no improvement during hospitalization. She displayed further extensive injuries to the trunk, axillae, and vulva as well as disruption of the bullous lesions, which remained as hyperemic scars. Incisional biopsy of a lesion in the left buccal mucosa was performed, and pathological results indicated mucositis with extensive erosion and the presence of a predominantly neutrophilic infiltrate with degeneration of basal cells and apoptotic keratinocytes. Under direct immunofluorescence, the skin showed anti-IgA, anti-IgM, and anti-IgG linear fluorescence on the continuous dermal side of the cleavage. Indirect immunofluorescence of the skin showed conjugated anti-IgA, was anti-IgM negative, and displayed pemphigus in conjunction with anti-IgG fluorescence in the nucleus of keratinocytes, consistent with a diagnosis of bullous lupus erythematosus. Discussion: BSLE is an acquired autoimmune bullous disease caused by autoantibodies against type VII collagen or other components of the junctional zone, epidermis, and dermis. It must be differentiated from the secondary bubbles and vacuolar degeneration of the basement membrane that may occur in acute and subacute cutaneous lupus erythematosus.
Revista Brasileira De Otorrinolaringologia, Jun 1, 2003
Oral involvement in Oral involvement in Oral involvement in Oral involvement in Oral involvement ... more Oral involvement in Oral involvement in Oral involvement in Oral involvement in Oral involvement in pemphigus vulgaris pemphigus vulgaris pemphigus vulgaris pemphigus vulgaris pemphigus vulgaris Resumo / Summary O O O O O Pênfigo Vulgar (PV) é uma doença vesicobolhosa caracterizada pela presença de auto-anticorpos contra moléculas de adesão intraepidérmicas. Objetivo: Objetivo: Objetivo: Objetivo: Objetivo: Identificar as características do PV em cada sexo, formas de apresentação, idade de acometimento, métodos de diagnóstico e tratamento utilizado. Forma de Estudo:
Highlights: 1. A rise in cocaine use has been observed since 2010, especially in South America 2.... more Highlights: 1. A rise in cocaine use has been observed since 2010, especially in South America 2. Hair analysis is useful when analyzing crack-cocaine analytes in postmortem samples 3. LPME has proven to be a 'green', cost-effective, simple and reproducible technique Determination of cocaine and its derivatives in hair samples by liquid phase microextraction (LPME) and gas chromatography-mass spectrometry (GC-MS
Objectives: To evaluate the accuracy of serum calcium levels in detecting, localizing, and treati... more Objectives: To evaluate the accuracy of serum calcium levels in detecting, localizing, and treating mediastinal parathyroid adenomas after cervical exploration. Methods: A retrospective cohort study of 83 patients with primary hyperparathyroidism during a 13-year period was reviewed; 86% of these patients had cervical adenomas, and 14% had naediastinal adenomas. Neck exploration was performed for all cervical adenomas, and mediary sternotomy was performed in patients with mediastural adenomas. Results: Serum calcium levels dropped in patients with cervical adenomas if an adenoma remained in the neck. No decline in calcium levels was noted in patients with mediastinal adenomas. CT scans were of little value in localizing parathyroid adenomas. Accurate localization and detection of parathyroid adenomas was most successful when selective venous evaluation of PTH levels in the great veins was performed. Conclusion: Mediastinal parathyroid adenomas should be suspected if serum calcium levels do not fall after cervical exploration.
Injury deaths have a major impact on public health systems, particularly in the Latin American re... more Injury deaths have a major impact on public health systems, particularly in the Latin American region; however, little is known about how different drugs, in combination or not with alcohol, interact with each injury type. We tested an epidemiological protocol for investigating alcohol and other drug acute use among fatally injured victims taking into account the injury context for all injury causes in Sao Paulo, Brazil. Blood alcohol and drug content were fully screened and confirmed following a probability sample selection of decedents (n=365) during 19 consecutive months (2014-2015). Drug concentrations, including benzodiazepines, cannabis, cocaine, and opioids were determined by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography tandem mass spectrometry (LC-MS/MS). Toxicology data were interpreted in combination with injury context retrieved from police records regarding cause, place of injury, and victims' criminal history. More than half of all fatally injured victims studied were under the influence of at least one substance (55.3%). Alcohol was the leading substance consumed before a fatal injury event (30.1%), followed by cocaine (21.9%) and cannabis (14%). Illicit drug use (cocaine and cannabis) comprised more than two thirds of all drug-related deaths. Alcohol-positive deaths are over-represented among road traffic injuries, while drug-positive deaths are more prevalent among intentional injuries. Victims who had previous criminal convictions were significantly more likely to have used illicit drugs compared to those who did not have a criminal *
Introduction: Deaths due to external causes, mainly homicides, are a serious public health proble... more Introduction: Deaths due to external causes, mainly homicides, are a serious public health problem in Brazil. There is evidence that the tendency to impulsive and / or violent behavior is exacerbated after alcohol consumption. Otherwise, the relationship between alcohol and violent deaths is described in the medical literature without much precision. Objective: Analyze the relationship between victims' blood alcohol levels and homicides, in the micro-region formed by some municipalities in Greater São Paulo. Methods: Retrospectively, we reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo (IML-SP) in Franco da Rocha, Brazil, from 2001 to 2017. Descriptive statistics were calculated to assess BAC testing status among decedents overall. The variables studied were sex, age, manner of death and blood alcohol level (BAC). Results: Of the 230 individuals analyzed, 200 (86.9%) were male and 30 (13.04%) female. The most preva...
Forensic research & criminology international journal, Oct 20, 2023
The child's testimony is a central part of investigating child sexual abuse. Many episode... more The child's testimony is a central part of investigating child sexual abuse. Many episodes of abuse do not leave physical signs. Forensic examiners and pediatricians and psychiatrists, and psychologists must be prepared to interview the child and obtain their description of the attack properly to get reliable evidence for the punishment of the crime. Based on medical literature research, the authors discuss the procedures adopted in Brazil after the enactment of Law 13431 of 2017, which establishes the obligation of "protected listening" to child victims of sexual abuse in the criminal process, as well as the justifications that lead the experts to consider the child testimony/disclosure about the abuse as vital evidence to convict the perpetrators in the courtroom.
Forensic Science, Medicine and Pathology, Dec 26, 2023
Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evid... more Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evidence shows that the tendency to impulsive behavior is exacerbated after alcohol consumption. The relationship between alcohol and suicide is poorly described in the medical literature. The study aims to analyze the relationship between victims' blood alcohol levels and suicides in some municipalities in Greater São Paulo, Brazil. We reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo in Franco da Rocha, Brazil, from 2001 to 2017. The manner of death was established based on the result of police inquiry. Deaths due to suicide (n=41) were selected for the study. Descriptive statistics and Student t-test was applied when appropriate. The variables studied were sex, age, suicide mechanism, and blood alcohol level (BAC). In all cases we could not determine how much time the deceased consumed alcohol before suicide. Of the individuals analyzed, 85.36% were male, and 14.64% were female. The most prevalent age range for males was between 18 and 23 (19.5%). For females, it was between 12 and 23 years (33.2%). Most suicides (48.78%) were due to hanging, followed by self-poisoning (22.08%) and firearms (17.1%). 38 victims (92.68%) presented a positive BAC, over 0.3 mg/dl. The higher levels were in the group of suicide by hanging (2.3 mg/ml). Thus, alcohol intoxication is common among suicide victims, and it can contribute to the fatal outcome as a risk factor. Further studies are necessary for a better comprehension of the effect of alcohol on suicide victims.
Confidentiality is a central element of the physician-patient relationship and is associated with... more Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study aims to show the main aspects of confidentiality in occupational medicine. For this, a narrative review of the literature on the subject was carried out, using free access databases and based on the codes of medical ethics. The occupational physician's performance involves the worker, other non-medical professionals and the employer, a situation that may trigger conflicts, requiring physicians to know their obligations and ethical-legal limits. The protection of confidentiality respects human rights, but dilemmas may arise, not only to obey ethical precepts, but to follow legal norms. This study seeks to show the main and updated ethical and legal aspects regarding occupational health.
Sexual violence is a pervasive global issue that affects individuals of all genders. However, the... more Sexual violence is a pervasive global issue that affects individuals of all genders. However, the experiences of male survivors have often been marginalized and inadequately represented. Male rape, which encompasses several forms of sexual violence against men, remains a sensitive and under-discussed topic in academic literature and public discourse. This study presents a descriptive cross-sectional analysis based on data collected from the Legal Medicine Institute (IML-São Paulo, Brazil) between 2014 and 2017. The analysis includes 7386 reports of sexological examinations performed on male victims of alleged rape. The analysis reveals that a significant majority of rape reports involved victims under the age of 12 or 14, which is considered vulnerable rape by the Brazilian legislation. Regarding the examination of reported cases of abuse against men, it was observed that only the minority of these cases exhibited visible injuries consistent with rape or tested positive for the presence of spermatozoa in the perianal region. Since the absence of visible injuries or spermatozoa does not negate the possibility of rape, this work highlights the challenges in obtaining conclusive evidence, necessitating a comprehensive approach to investigate and prosecute these crimes, creating a more inclusive and supportive environment for all survivors of rape, irrespective of their gender.
International Archives of Otorhinolaryngology, Jan 21, 2014
Introduction: Bullous systemic lupus erythematosus (BSLE) is an autoantibody-mediated disease wit... more Introduction: Bullous systemic lupus erythematosus (BSLE) is an autoantibody-mediated disease with subepidermal blisters. It is a rare form of presentation of SLE that occurs in less than 5% of cases of lupus. Case Report: A 27-year-old, female, FRS patient reported the appearance of painful bullous lesions in the left nasal wing and left buccal mucosa that displayed sudden and rapid growth. She sought advice from emergency dermatology staff 15 days after onset and was hospitalized with suspected bullous disease. Intravenous antibiotics and steroids were administered initially, but the patient showed no improvement during hospitalization. She displayed further extensive injuries to the trunk, axillae, and vulva as well as disruption of the bullous lesions, which remained as hyperemic scars. Incisional biopsy of a lesion in the left buccal mucosa was performed, and pathological results indicated mucositis with extensive erosion and the presence of a predominantly neutrophilic infiltrate with degeneration of basal cells and apoptotic keratinocytes. Under direct immunofluorescence, the skin showed anti-IgA, anti-IgM, and anti-IgG linear fluorescence on the continuous dermal side of the cleavage. Indirect immunofluorescence of the skin showed conjugated anti-IgA, was anti-IgM negative, and displayed pemphigus in conjunction with anti-IgG fluorescence in the nucleus of keratinocytes, consistent with a diagnosis of bullous lupus erythematosus. Discussion: BSLE is an acquired autoimmune bullous disease caused by autoantibodies against type VII collagen or other components of the junctional zone, epidermis, and dermis. It must be differentiated from the secondary bubbles and vacuolar degeneration of the basement membrane that may occur in acute and subacute cutaneous lupus erythematosus.
Revista Brasileira De Otorrinolaringologia, Jun 1, 2003
Oral involvement in Oral involvement in Oral involvement in Oral involvement in Oral involvement ... more Oral involvement in Oral involvement in Oral involvement in Oral involvement in Oral involvement in pemphigus vulgaris pemphigus vulgaris pemphigus vulgaris pemphigus vulgaris pemphigus vulgaris Resumo / Summary O O O O O Pênfigo Vulgar (PV) é uma doença vesicobolhosa caracterizada pela presença de auto-anticorpos contra moléculas de adesão intraepidérmicas. Objetivo: Objetivo: Objetivo: Objetivo: Objetivo: Identificar as características do PV em cada sexo, formas de apresentação, idade de acometimento, métodos de diagnóstico e tratamento utilizado. Forma de Estudo:
Highlights: 1. A rise in cocaine use has been observed since 2010, especially in South America 2.... more Highlights: 1. A rise in cocaine use has been observed since 2010, especially in South America 2. Hair analysis is useful when analyzing crack-cocaine analytes in postmortem samples 3. LPME has proven to be a 'green', cost-effective, simple and reproducible technique Determination of cocaine and its derivatives in hair samples by liquid phase microextraction (LPME) and gas chromatography-mass spectrometry (GC-MS
Objectives: To evaluate the accuracy of serum calcium levels in detecting, localizing, and treati... more Objectives: To evaluate the accuracy of serum calcium levels in detecting, localizing, and treating mediastinal parathyroid adenomas after cervical exploration. Methods: A retrospective cohort study of 83 patients with primary hyperparathyroidism during a 13-year period was reviewed; 86% of these patients had cervical adenomas, and 14% had naediastinal adenomas. Neck exploration was performed for all cervical adenomas, and mediary sternotomy was performed in patients with mediastural adenomas. Results: Serum calcium levels dropped in patients with cervical adenomas if an adenoma remained in the neck. No decline in calcium levels was noted in patients with mediastinal adenomas. CT scans were of little value in localizing parathyroid adenomas. Accurate localization and detection of parathyroid adenomas was most successful when selective venous evaluation of PTH levels in the great veins was performed. Conclusion: Mediastinal parathyroid adenomas should be suspected if serum calcium levels do not fall after cervical exploration.
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