Eesti Vabariigi loomine 1918. aastal toi kaasa muutused kohtuarstiteaduse erialal, kui uuendati k... more Eesti Vabariigi loomine 1918. aastal toi kaasa muutused kohtuarstiteaduse erialal, kui uuendati kohtu arstliku too korraldust nii Tartu Ulikoolis, Tartu linnas ja maakonnas kui ka kogu Eestis. Loomis- ja or ganiseerimistoo eesotsas seisis kohtuarstiteaduse professor Siegfried Talvik, kes kirjutas vajadusest panna Tartu linnas ja maakonnas kohtu-politseiarsti funktsioonid ulikooli kohtuliku arstiteaduse instituudi peale. See oli vajalik niihasti arstiteadlaste kui edaspidi ka juristide opetamise huvides ning oli oluline, sest “meie ulikooli kohtuliku arstiteaduse instituut on praegu ja vist kull edas pidigi pikemat aega veel ainukeseks oppeasutuseks, mis peab andma vabariigile kullaldaselt ettevalmistatud kohtu- ja politseiarste” (1). Jurist Otto Tief kirjutas 1923. aastal artiklis “Kohtu-arstlik ekspertiis kriminaalprotsessis”, et iga arsti voib eksper dina kohtusse kutsuda (2). Eesti Arst 2005; 84 (9): 626–630
An experimental study was made of gun-shot wounds inflicted by shots from a modern stub-barrelled... more An experimental study was made of gun-shot wounds inflicted by shots from a modern stub-barrelled pistol 9mm Glock 19. The study has ascertain characteristics differentiating injuries inflicted by shots from this pistol: specific recoil injury, specific topography, intensity and distribution of begrime, gunpowder and metal particles and relevant lesions. It was found that depth of penetration under the skin depends both on shooting distance and the position of the particle from the inlet.
Test shots at cloth and at human skin from autopsy material were performed with 7.62 mm Tokarev (... more Test shots at cloth and at human skin from autopsy material were performed with 7.62 mm Tokarev (TT), 9 mm Makarov (PM) and 9 × 19 mm Glock 19 pistols, using common ammunition. The largest central material defects, with fibre deformation in cotton, the largest burn holes in polyester, and also many fibre defects caused by the perforation of powder, were produced in shots from the TT at all distances. Tears in the cloth were longest in the case of the TT at 1 cm and were present at 3 cm, whereas the shots from the PM and the Glock 19 did not leave tears. There were small tears of the edges of the skin defect from shots fired from the TT at 1 and 3 cm. On cloth-soot deposits at 3 and 5 cm, the radial structures of soot resembled a cobweb (the TT), and radial branching structures (the PM) of soot were seen. Some shots from the PM left four shafts of rays of soot and formed the bullet wipe with four narrow and four wide sections, indicating the form of rifling. In the soot deposit from the Glock 19 with hexagonal rifling, hexagonal or polygonal or petal-like areas were visible. On skin, the soot zones were less distinct. The Glock 19 (at 3 and 5 cm) left a lot of gunpowder particles densely around the cloth and skin defect. The least powder left on the cloth and skin was by the PM. On histological tissue sections, in shots from the TT, a lot of soot and gunpowder residue particles in the epidermis and in both layers of the dermis, and intraepithelial tears and recesses containing soot, were seen. The PM left fine soot and only a few gunpowder particles in the epidermis and in the papillary layer of the dermis. The Glock 19 produced the least soot and a lot of gunpowder particles. The soot and most of the gunpowder particles were present on the tissue sections, which originated from the central area around the skin defect and were detected in the epidermis and in both layers of the dermis. Some tears and recesses in the epidermis were also seen. The further the distance from the centre of skin defect to the periphery, the depth of the penetration of the powder into the skin decreased.
in our study) in the electric mark depends not only on the composition of the wire causing the in... more in our study) in the electric mark depends not only on the composition of the wire causing the injury, but also on the duration of the current impact. This aspect should be taken into account in identification of the type of the wire inflicting the fatal injury. On the other hand, the metal ratio can be exploited to estimate the duration of the current impact provided that the type of the wire is known. Meanwhile, in the electric marks inflicted by other types of electric conductors (zinc-plated steel rope in our study), the plating and core metals are deposited at approximately the same rate, and the relative content of the metals is insensitive to the current impact duration. Thus, the ratio can be used for identification of the wire type irrespective of the current impact duration.
Firings at cloth targets and at human skin from autopsy material were performed from the pistols ... more Firings at cloth targets and at human skin from autopsy material were performed from the pistols 7.62 mm Tokarev (TT), 9 mm Makarov (PM) and 9 Â 19 mm Glock 19 with common ammunition. The differences were in the soot deposit pattern, the degree of scorching of the synthetic fibres on the edges of the entrance hole and in the findings of the soot and the gunpowder particles. The results were similar on the cloth and on the skin targets. In the case of the TT and the PM, the soot deposit patterns reminded of a blossom or shafts of rays or fans, or the bullet wipe had four narrow and four wide sections regarding the number of lands and grooves. The TT left a large amount of soot and many gunpowder particles and caused the melting of the synthetic fibres on the edges of the entrance hole, producing a defect of the material 0.1-0.3 cm in diameter and defects of textile fibres around the entrance hole. In the skin the TT caused many intraepithelial tears, folds of the epidermis and recesses of the epidermis containing soot. Firings from the PM and the Glock 19 caused the melting only of the ends of individual synthetic fibres on the edges of the entrance hole. The PM left a large amount of soot and only a few gunpowder particles. The Glock 19 gave the least soot and the greatest number of gunpowder particles and also caused tears and recesses in the epidermis. Only in the case of the Glock 19, hexagonal or polygonal zones were seen in the soot deposit pattern. The differences in the soot pattern were more distinct at the firing distance of 10 cm. By increasing the distance from 10 to 15 cm, the intensity of soot diminished and began to disappear at 25 cm, but remained more visible in the case of the TT. The gunpowder particles could be found in the epidermis and deeper in both layers of the dermis at all distances fired from the TT and the Glock 19. In the case of firings from the PM, at the distance 10 cm some of the gunpowder particles had penetrated into the dermis and most of them were in the upper layer of the dermis. At the firing distance of 15 and 25 cm, the gunpowder particles were only on and in the stratum corneum.
Väitekirja elektrooniline versioon ei sisalda publikatsioone.Töö eesmärgiks oli kuuli sisenemisav... more Väitekirja elektrooniline versioon ei sisalda publikatsioone.Töö eesmärgiks oli kuuli sisenemisavade võrdlemisel välja selgitada riide- ja nahavigastuste/sadestuste suhe laskekaugusega ning näidata, et relvaraua õõne ehitus mõjutab tahmasadestuse mustrit. Eksperimentaallasud sooritati püstolitest Tokarev, Makarov ja Glock 19 standardse laskemoonaga 1 cm kuni 100 cm kauguselt. Võrreldi puuvillasele ja polüesterriidele ning nahale (lahangumaterjal) tekitatud vigastusi/sadestusi. Järeldused: 1. Tulemused riietel ja nahal olid sarnased. 2. Erinevused leius olid tingitud laskekaugusest ja relvast. 3. Statistiliselt oluline seos oli laskekauguse ja riietel oleva tahmasadestuse läbimõõdu vahel, samuti laskekauguse ja püssirohuosakeste arvu vahel. Negatiivses seoses oli püssirohuosakeste arv ja nende paiknemiskoha kaugus riidedefekti keskkohast. Uurides laskekauguse ja püssirohu nahakihtides leidumise vahelist seost, ilmnes et püssirohuosakesed võivad tungida epidermisesse ja dermasse või j...
Aims: To describe clinical, mental and physical signs in children with different severity acute a... more Aims: To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children. Methods: Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatri- cian completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated. Results: The most correctly described signs in children in different SAC groups...
Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardio... more Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51e60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmentalegeographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.
Aims: To describe clinical, mental and physical signs in children with different severity acute a... more Aims: To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children. Methods: Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatrician completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated. Results: The most correctly described signs in children in different SAC groups were consciousness (r s = 0.16) and speech (r s = 0.13) (P < 0.0001). The severity of alteration of consciousness and degrees of disturbance in balance and speech were positively correlated with SAC (P < 0.001). The clinical judgment matched better with AAI determined by SAC rather than by BAC with the mean efficiency. The mean ratio between SAC and BAC was 1.19 ± 0.13 (P < 0.001) in children. Conclusion: The level of consciousness is the leading sign in the clinical evaluation of children with AAI and correlates well with SAC. The severity of AAI judged by clinical assessment matched better with AAI severity stages determined by SAC than by BAC. For legal cases where BAC is required, the SAC:BAC ratio of 1.19:1 should be used in children regardless of their gender or age.
The study was conducted at the Estonian Forensic Science Institute in 2008-2014 as continuous par... more The study was conducted at the Estonian Forensic Science Institute in 2008-2014 as continuous part of our previous study of alcohol and premature death in Estonian men. Autopsy data from 504 cases of male deaths (ages 19-79) were collected and blood and urine samples for glycated haemoglobin (HbA 1c), liver enzymes and alcohol concentration were analysed. The aim of our research was to find undiagnosed diabetes and diabetes risk cases postmortem on the basis of increased values of HbA 1c. HbA 1c was within the reference value 4.8%-5.9% (29-42 mmol/mol), in 88.1% (n = 444) of cases, below reference value in 2.4% (n = 12), in the risk group of diabetes, HbA 1c 6.0%-6.4% (42-46 mmol/mol) was within 5.8% (n = 29), and HbA 1c result of 6.5% (48 mmol/mol) manifested in 3.8% (n = 19) of cases. The higher the age, the more cases with HbA 1c value 6.0% (42 mmol/mol) occurred. In the group of external causes of death (n = 348), the HbA 1c value of 6.5% (48 mmol/mol) HbA 1c occurred in four cases. The HbA 1c value was 6.5% (48 mmol/mol) in 78.9% of 156 cases when the cause of death was disease, of which 58% were cardiovascular diseases. The prevalence of diabetes and diabetes risk was found lower compared to population-based study, as majority of the deceased were young and middle-aged males and no females were included. In the case of poisoning with narcotic substances, HbA 1c was within the reference range. A negative correlation occurred between alcohol intoxication and HbA 1c value. A positive correlation between ALT and HbA 1c was foundthe higher stage of liver damage correlated with the higher HbA 1c level.
Motor vehicle accidental injuries are a frequent cause of death among young children and adolesce... more Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.
Motor vehicle accidental injuries are a frequent cause of death among young children and adolesce... more Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.
Aims: To describe clinical, mental and physical signs in children with different severity acute a... more Aims: To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children. Methods: Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatrician completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated. Results: The most correctly described signs in children in different SAC groups were consciousness (r s = 0.16) and speech (r s = 0.13) (P < 0.0001). The severity of alteration of consciousness and degrees of disturbance in balance and speech were positively correlated with SAC (P < 0.001). The clinical judgment matched better with AAI determined by SAC rather than by BAC with the mean efficiency. The mean ratio between SAC and BAC was 1.19 ± 0.13 (P < 0.001) in children. Conclusion: The level of consciousness is the leading sign in the clinical evaluation of children with AAI and correlates well with SAC. The severity of AAI judged by clinical assessment matched better with AAI severity stages determined by SAC than by BAC. For legal cases where BAC is required, the SAC:BAC ratio of 1.19:1 should be used in children regardless of their gender or age.
Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardio... more Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51e60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmentalegeographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.
Eesti Vabariigi loomine 1918. aastal toi kaasa muutused kohtuarstiteaduse erialal, kui uuendati k... more Eesti Vabariigi loomine 1918. aastal toi kaasa muutused kohtuarstiteaduse erialal, kui uuendati kohtu arstliku too korraldust nii Tartu Ulikoolis, Tartu linnas ja maakonnas kui ka kogu Eestis. Loomis- ja or ganiseerimistoo eesotsas seisis kohtuarstiteaduse professor Siegfried Talvik, kes kirjutas vajadusest panna Tartu linnas ja maakonnas kohtu-politseiarsti funktsioonid ulikooli kohtuliku arstiteaduse instituudi peale. See oli vajalik niihasti arstiteadlaste kui edaspidi ka juristide opetamise huvides ning oli oluline, sest “meie ulikooli kohtuliku arstiteaduse instituut on praegu ja vist kull edas pidigi pikemat aega veel ainukeseks oppeasutuseks, mis peab andma vabariigile kullaldaselt ettevalmistatud kohtu- ja politseiarste” (1). Jurist Otto Tief kirjutas 1923. aastal artiklis “Kohtu-arstlik ekspertiis kriminaalprotsessis”, et iga arsti voib eksper dina kohtusse kutsuda (2). Eesti Arst 2005; 84 (9): 626–630
An experimental study was made of gun-shot wounds inflicted by shots from a modern stub-barrelled... more An experimental study was made of gun-shot wounds inflicted by shots from a modern stub-barrelled pistol 9mm Glock 19. The study has ascertain characteristics differentiating injuries inflicted by shots from this pistol: specific recoil injury, specific topography, intensity and distribution of begrime, gunpowder and metal particles and relevant lesions. It was found that depth of penetration under the skin depends both on shooting distance and the position of the particle from the inlet.
Test shots at cloth and at human skin from autopsy material were performed with 7.62 mm Tokarev (... more Test shots at cloth and at human skin from autopsy material were performed with 7.62 mm Tokarev (TT), 9 mm Makarov (PM) and 9 × 19 mm Glock 19 pistols, using common ammunition. The largest central material defects, with fibre deformation in cotton, the largest burn holes in polyester, and also many fibre defects caused by the perforation of powder, were produced in shots from the TT at all distances. Tears in the cloth were longest in the case of the TT at 1 cm and were present at 3 cm, whereas the shots from the PM and the Glock 19 did not leave tears. There were small tears of the edges of the skin defect from shots fired from the TT at 1 and 3 cm. On cloth-soot deposits at 3 and 5 cm, the radial structures of soot resembled a cobweb (the TT), and radial branching structures (the PM) of soot were seen. Some shots from the PM left four shafts of rays of soot and formed the bullet wipe with four narrow and four wide sections, indicating the form of rifling. In the soot deposit from the Glock 19 with hexagonal rifling, hexagonal or polygonal or petal-like areas were visible. On skin, the soot zones were less distinct. The Glock 19 (at 3 and 5 cm) left a lot of gunpowder particles densely around the cloth and skin defect. The least powder left on the cloth and skin was by the PM. On histological tissue sections, in shots from the TT, a lot of soot and gunpowder residue particles in the epidermis and in both layers of the dermis, and intraepithelial tears and recesses containing soot, were seen. The PM left fine soot and only a few gunpowder particles in the epidermis and in the papillary layer of the dermis. The Glock 19 produced the least soot and a lot of gunpowder particles. The soot and most of the gunpowder particles were present on the tissue sections, which originated from the central area around the skin defect and were detected in the epidermis and in both layers of the dermis. Some tears and recesses in the epidermis were also seen. The further the distance from the centre of skin defect to the periphery, the depth of the penetration of the powder into the skin decreased.
in our study) in the electric mark depends not only on the composition of the wire causing the in... more in our study) in the electric mark depends not only on the composition of the wire causing the injury, but also on the duration of the current impact. This aspect should be taken into account in identification of the type of the wire inflicting the fatal injury. On the other hand, the metal ratio can be exploited to estimate the duration of the current impact provided that the type of the wire is known. Meanwhile, in the electric marks inflicted by other types of electric conductors (zinc-plated steel rope in our study), the plating and core metals are deposited at approximately the same rate, and the relative content of the metals is insensitive to the current impact duration. Thus, the ratio can be used for identification of the wire type irrespective of the current impact duration.
Firings at cloth targets and at human skin from autopsy material were performed from the pistols ... more Firings at cloth targets and at human skin from autopsy material were performed from the pistols 7.62 mm Tokarev (TT), 9 mm Makarov (PM) and 9 Â 19 mm Glock 19 with common ammunition. The differences were in the soot deposit pattern, the degree of scorching of the synthetic fibres on the edges of the entrance hole and in the findings of the soot and the gunpowder particles. The results were similar on the cloth and on the skin targets. In the case of the TT and the PM, the soot deposit patterns reminded of a blossom or shafts of rays or fans, or the bullet wipe had four narrow and four wide sections regarding the number of lands and grooves. The TT left a large amount of soot and many gunpowder particles and caused the melting of the synthetic fibres on the edges of the entrance hole, producing a defect of the material 0.1-0.3 cm in diameter and defects of textile fibres around the entrance hole. In the skin the TT caused many intraepithelial tears, folds of the epidermis and recesses of the epidermis containing soot. Firings from the PM and the Glock 19 caused the melting only of the ends of individual synthetic fibres on the edges of the entrance hole. The PM left a large amount of soot and only a few gunpowder particles. The Glock 19 gave the least soot and the greatest number of gunpowder particles and also caused tears and recesses in the epidermis. Only in the case of the Glock 19, hexagonal or polygonal zones were seen in the soot deposit pattern. The differences in the soot pattern were more distinct at the firing distance of 10 cm. By increasing the distance from 10 to 15 cm, the intensity of soot diminished and began to disappear at 25 cm, but remained more visible in the case of the TT. The gunpowder particles could be found in the epidermis and deeper in both layers of the dermis at all distances fired from the TT and the Glock 19. In the case of firings from the PM, at the distance 10 cm some of the gunpowder particles had penetrated into the dermis and most of them were in the upper layer of the dermis. At the firing distance of 15 and 25 cm, the gunpowder particles were only on and in the stratum corneum.
Väitekirja elektrooniline versioon ei sisalda publikatsioone.Töö eesmärgiks oli kuuli sisenemisav... more Väitekirja elektrooniline versioon ei sisalda publikatsioone.Töö eesmärgiks oli kuuli sisenemisavade võrdlemisel välja selgitada riide- ja nahavigastuste/sadestuste suhe laskekaugusega ning näidata, et relvaraua õõne ehitus mõjutab tahmasadestuse mustrit. Eksperimentaallasud sooritati püstolitest Tokarev, Makarov ja Glock 19 standardse laskemoonaga 1 cm kuni 100 cm kauguselt. Võrreldi puuvillasele ja polüesterriidele ning nahale (lahangumaterjal) tekitatud vigastusi/sadestusi. Järeldused: 1. Tulemused riietel ja nahal olid sarnased. 2. Erinevused leius olid tingitud laskekaugusest ja relvast. 3. Statistiliselt oluline seos oli laskekauguse ja riietel oleva tahmasadestuse läbimõõdu vahel, samuti laskekauguse ja püssirohuosakeste arvu vahel. Negatiivses seoses oli püssirohuosakeste arv ja nende paiknemiskoha kaugus riidedefekti keskkohast. Uurides laskekauguse ja püssirohu nahakihtides leidumise vahelist seost, ilmnes et püssirohuosakesed võivad tungida epidermisesse ja dermasse või j...
Aims: To describe clinical, mental and physical signs in children with different severity acute a... more Aims: To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children. Methods: Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatri- cian completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated. Results: The most correctly described signs in children in different SAC groups...
Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardio... more Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51e60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmentalegeographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.
Aims: To describe clinical, mental and physical signs in children with different severity acute a... more Aims: To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children. Methods: Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatrician completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated. Results: The most correctly described signs in children in different SAC groups were consciousness (r s = 0.16) and speech (r s = 0.13) (P < 0.0001). The severity of alteration of consciousness and degrees of disturbance in balance and speech were positively correlated with SAC (P < 0.001). The clinical judgment matched better with AAI determined by SAC rather than by BAC with the mean efficiency. The mean ratio between SAC and BAC was 1.19 ± 0.13 (P < 0.001) in children. Conclusion: The level of consciousness is the leading sign in the clinical evaluation of children with AAI and correlates well with SAC. The severity of AAI judged by clinical assessment matched better with AAI severity stages determined by SAC than by BAC. For legal cases where BAC is required, the SAC:BAC ratio of 1.19:1 should be used in children regardless of their gender or age.
The study was conducted at the Estonian Forensic Science Institute in 2008-2014 as continuous par... more The study was conducted at the Estonian Forensic Science Institute in 2008-2014 as continuous part of our previous study of alcohol and premature death in Estonian men. Autopsy data from 504 cases of male deaths (ages 19-79) were collected and blood and urine samples for glycated haemoglobin (HbA 1c), liver enzymes and alcohol concentration were analysed. The aim of our research was to find undiagnosed diabetes and diabetes risk cases postmortem on the basis of increased values of HbA 1c. HbA 1c was within the reference value 4.8%-5.9% (29-42 mmol/mol), in 88.1% (n = 444) of cases, below reference value in 2.4% (n = 12), in the risk group of diabetes, HbA 1c 6.0%-6.4% (42-46 mmol/mol) was within 5.8% (n = 29), and HbA 1c result of 6.5% (48 mmol/mol) manifested in 3.8% (n = 19) of cases. The higher the age, the more cases with HbA 1c value 6.0% (42 mmol/mol) occurred. In the group of external causes of death (n = 348), the HbA 1c value of 6.5% (48 mmol/mol) HbA 1c occurred in four cases. The HbA 1c value was 6.5% (48 mmol/mol) in 78.9% of 156 cases when the cause of death was disease, of which 58% were cardiovascular diseases. The prevalence of diabetes and diabetes risk was found lower compared to population-based study, as majority of the deceased were young and middle-aged males and no females were included. In the case of poisoning with narcotic substances, HbA 1c was within the reference range. A negative correlation occurred between alcohol intoxication and HbA 1c value. A positive correlation between ALT and HbA 1c was foundthe higher stage of liver damage correlated with the higher HbA 1c level.
Motor vehicle accidental injuries are a frequent cause of death among young children and adolesce... more Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.
Motor vehicle accidental injuries are a frequent cause of death among young children and adolesce... more Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.
Aims: To describe clinical, mental and physical signs in children with different severity acute a... more Aims: To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children. Methods: Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatrician completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated. Results: The most correctly described signs in children in different SAC groups were consciousness (r s = 0.16) and speech (r s = 0.13) (P < 0.0001). The severity of alteration of consciousness and degrees of disturbance in balance and speech were positively correlated with SAC (P < 0.001). The clinical judgment matched better with AAI determined by SAC rather than by BAC with the mean efficiency. The mean ratio between SAC and BAC was 1.19 ± 0.13 (P < 0.001) in children. Conclusion: The level of consciousness is the leading sign in the clinical evaluation of children with AAI and correlates well with SAC. The severity of AAI judged by clinical assessment matched better with AAI severity stages determined by SAC than by BAC. For legal cases where BAC is required, the SAC:BAC ratio of 1.19:1 should be used in children regardless of their gender or age.
Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardio... more Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51e60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmentalegeographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.
Uploads
Papers by Delia Lepik