The "blind age assessment": applicability of Greulich and Pyle, Demirjian and Mincer aging methods to a population of unknown ethnic origin

PURPOSE

Age estimation is one of the most crucial issues in case of unknown deceased as well as in the living and is very frequently of radiological interest. Three methods for age estimation have been designated as the most reliable among the others: Greulich and Pyle, Demirjian and Mincer. The literature provides several studies concerning their applicability in different geographic contexts. However, not always can ancestry be ascertained, for example, in the case of badly preserved corpses. In these cases, age assessment must be performed without the corrections suggested by the literature for different ethnic groups. One may therefore wonder how reliable the result of age assessment performed without knowing the racial group to which the subject belongs may be. This study aimed at testing the applicability of the Greulich and Pyle Atlas, the Demirjian and the Mincer methods on a mixed population to compare skeletal and dental methods of age estimation.

MATERIALS AND METHODS

X-ray films of 167 subjects aged between 4 and 31 years from more than 18 countries were recruited. One hundred and nine orthopantomographs (OPG) of children aged between 4 and 15.5 years were evaluated by Demirjian's method; whenever the highest Demirjian score was reached (31 cases), the Mincer method was applied. The skeletal maturation of 54 subjects aged between 7 and 19 years was determined by the Greulich and Pyle method.

RESULTS

The lowest average variance from chronological age was shown by the Greulich and Pyle method, followed by Demirjian. The Mincer method showed very high mean variances.

CONCLUSIONS

Mean variances from the different methods do not significantly differ from data reported in the literature and demonstrate that the reliability of Demirjian, and Greulich and Pyle as they stand may be applied satisfactorily to remains or individuals of unknown ethnic origin.

The use of the anti-Glycophorin A antibody in the detection of red blood cell residues in human soft tissue lesions decomposed in air and water: a pilot study

The distinction between antemortem and postmortem wounds is one of the most important medico-legal problems. In fresh cadavers the macroscopic examination of haemorrhagic infiltration can be sufficient to reveal the vitality of a wound but in more difficult cases (putrefied corpses) histological and histochemical analyses need to be performed. The scope of this study was to detect the vitality of soft tissue samples in an advanced state of putrefaction using a monoclonal anti-human Glycoforin A antibody in order to evaluate the presence of red blood cells or red blood cell residues. Samples of skin wounds were taken from cadavers with a known time survival between trauma and death, and then submitted to a simulated putrefaction procedure. The skin samples were left to decompose for 30 days in air and in water and analyzed at a time interval of 3-6-15-30 days. These samples were stained with haematoxylin eosin stain, trichrome stain and with immunohistochemical stains. Results showed that in the air red blood cells could be seen for up to six days and granular deposits of Glycophorin reactive material for up to 15 days whereas no red blood cells were recognizable after 30 days. In water red cell putrefaction (or non-detection) was faster than in the air: after six days only amorphous granular deposits slightly reactive to Glycophorin could be seen. Nonetheless results showed that extravasated red blood cell residues can still be detected in skin bruises left to decompose in air and water, for up to at least 15 days in the open air and one week in water.

STUDIES ON A BACTERICIDAL AGENT EXTRACTED FROM A SOIL BACILLUS : III. PREPARATION AND ACTIVITY OF A PROTEIN-FREE FRACTION

A cell-free extract of cultures of an unidentified soil bacillus, which exerts a bactericidal effect on Gram-positive microorganisms, has been described in previous reports; the first active preparations which were obtained were found to contain a protein precipitable at pH 4.5. It is shown in the present report that the bactericidal agent can be obtained in an active form free of protein. The new purified preparations retain all the activity of the original material, both in vitro and in vivo.

Comparative evaluation of the group of teeth with the best prediction value in the mixed dentition analysis

AIM

Mixed dentition analysis allows the prediction of the tooth width of non erupted permanent canines and premolars (SPCP). It is an essential factor in treatment planning since it could predict a tooth-size to arch-length discrepancy. The aim of this study was to determine which group of permanent teeth presented the best prediction capability for the width sums of the unerupted canine and premolars in an Italian sample.

MATERIALS AND METHODS

A total of 150 subjects with complete permanent dentition were selected. Their dental casts were measured to 0.01 mm with a digital caliper. Pearson correlation and T-test were used for the statistical analysis.

RESULTS/STATISTICS

The combination of the sums of the four lower incisors and the first upper molars showed the best prediction capability for the SPCP in the Italian sample. Moreover new regression equations were formulated including sex and arch as additional predictor variables. In 80% of the cases estimated differences between the predicted and the actual values were smaller than 1 mm.

CONCLUSION

It can be concluded that the new regression equations proposed seemed to show good accuracy.

A national survey of the prevalence of childhood overweight and obesity in Italy

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third-grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8-9 years whose parents agreed to opt-out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third-graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut-offs) ranged from 7.5% (95% confidence intervals 6.7-8.2) in the north to 16.6% (95% confidence intervals 15.8-17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity-related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.

Unidentified bodies and human remains: an Italian glimpse through a European problem

The identification of cadavers (the main activity of forensic odontologists and anthropologists) is a crucial issue in forensic pathology, but the official entity of this problem is still poorly known in most countries, apart from a few American reports. In this article the authors present a descriptive study of unidentified decedents over a 14-year period (1995-2008) in Milan. The number of cadavers or human remains arriving at the morgue with no identity amounts to 454 - 3.1% of all autopsies at the Institute of Legal Medicine, with a mean of 32 unidentified subjects every year; 62% reached a positive identification in a period of time ranging from a few days to 10 years. 17% on an average remain unidentified. Most identification processes involved forensic odontology and anthropology. This study aims at revealing the problem and hopefully may provide some food for thought for forensic pathologists, anthropologists and odontologists so that they may focus on this issue and on possible solutions in their countries.

Zygomycosis in Italy: a survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology)

The aims of the study were to analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology of medical mycology survey. This prospective multicenter study was performed between 2004 and 2007 at 49 italian Departments. 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematological malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to EORTC criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. 51 patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy. Altogether an attributable mortality rate of 32% (19/60) was registered, which was reduced to 18% in patients treated with L-AmB (8/44). Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with a high mortality rate. This study indicates an inversion of this trend, with a better prognosis and significantly lower mortality than that reported in the literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, have improved the prognosis of these patients.

Oral cavity lymphomas in immunocompetent and human immunodeficiency virus infected patients

Oral cavity lymphoma (OCL) seems to occur more frequently in HIV-positive patients, but it is presently unknown whether HIV-related immune deficit plays a role in modifying the prevalence and the characteristics of these lymphomas. To clarify this issue, we compared OCL occurring in immunocompetent and HIV-positive patients. A comparison was made between cases of OCL occurring among 543 and 123 NHL consecutively diagnosed at a single center in immunocompetent and HIV-positive patients respectively. The prevalence of oral cavity involvement at diagnosis was significantly lower in the immunocompetent subgroup (HIV-negative: 1.66%; HIV-positive: 7.3%, P = 0.002). Extranodal T/NK nasal-nasal-type lymphoma (ET/NK-NL) was observed in 3 of 9 immunocompetent patients, whereas plasmablastic lymphoma (PBL) was observed in 3 of 9 HIV-positive patients. EBV expression correlated with HIV-positivity. Response to treatment was similar between the two subgroups, but the overall prognosis was significantly worse among HIV-positive patients. Median survival was 34 months in immunocompetent vs. 9 months in HIV-positive patients (P < 0.01). A higher frequency of oral cavity lymphoma was associated with HIV infection. ET/NK-NL and PBL seemed to be clinical entities characteristically related to immunocompetent and HIV-positive subgroups, respectively. Chemotherapy was feasible and effective in both subgroups, although a poor prognosis was associated with immunodeficiency.

[The first anthropological study of the victims of World War I]

In Italy many hundreds of victims of both armies who fought WWI still attend to be recovered and, if possible, identified and given back to their relatives. This study has as its objective to carry out a correct recovery, anthropological analysis and possible identification of these soldiers. Our plan has been elaborated so that it may involve various experts of different disciplines (archeologists, historians, antropologists, but also genetists and entomologists). So far, in this research project, 35 recovered skeletons have been studied. Thus the biological profile was defined (sex, age, stature and ancestry) then pathologies as well as trauma. The first results show the presence of adult men but also of adolescents. The subjects show diseases of a degenerative type (arthrosis, reumatoide arthritis), as well as perimortal lesions linked to blunt trauma, explosions, or due bullet wounds.

How old am I? Age estimation in living adults: a case report

Age estimation is a common task in forensic medicine. Odontologists are frequently involved in the age assessment of human remains or living juveniles. The need to estimate the age of living individuals is becoming more frequent, because of the increasing number of immigrants (illegal or otherwise) without acceptable identification documents and with missing or uncertain birth dates. Whereas age estimation in subadults is usually performed by methods based on the physiological growth of bones and teeth, in the case of living adults age determination is more difficult, because body maturation has come to an end and the most commonly used procedures in forensics on human remains are too invasive for the living individual. The following case report aims at highlighting the difficulties of performing age estimation in the living adult and the importance of a multidisciplinary approach including forensic odontology: a middle-aged woman from Ethiopia who was supposed to be 62 years old (according to one set of documents), was removed from employment lists as she had reached the retirement age for Italy. However another set of documents indicated a younger age (46 years). Hormonal dosage of E2 (17-β estradiol) and FSH (Follicle Stimulating Hormone) showed an age close to the begininng of menopause. An experimental dental method, based on the decrease of canine pulp chamber with age, was performed in order to obtain more information: the result was an estimation of a 47-57 age range. Combined results suggested that it was more likely that the actual age of the woman was closer to 46 than to 62.

Milk hygiene and udder health in the periurban area of Hamdallaye, Niger

The prevalence of intra-mammary infections in dairy herds was studied in Hamdallaye, Niger. A total of 956 milk samples were collected in 2007 from 239 lactating cows of four local breeds in eight traditional herds; the first sampling was undertaken in the dry season at morning milking, and the second in the rainy season at evening milking. Staphylococcus aureus, Coagulase-Negative Staphylococci (CNS) and environmental microorganisms were detected in significantly (p < 0.05) more samples in the rainy season, 55.2%, than in the dry season, 27.1%. Statistically significant (P < 0.05) differences in prevalence were observed among herds and according to lactation number. Infections were assigned to four classes, according to the major pathogen, and the respective mean somatic cell counts during the dry season were: S. aureus, 775 x 10(3) cells/ml; CNS, 447 x 10(3) cells/ml; environmental microorganisms, 407 x 10(3) cells/ml; and non-infected, 262 x 10(3) cells/ml. Most of the tested strains were sensitive to antibiotics, and selected strains of S. aureus (n = 15) were negative to the multiplex PCR tests for production of enterotoxins.

Infrared tympanic thermography as a substitute for a probe in the evaluation of ear temperature for post-mortem interval determination: a pilot study

Reported methods which have been used to measure tympanic temperatures on cadavers up to now are quite invasive. They involve the use of a probe which can perforate the tympanic membrane and frequently causes bleeding from the ear. For this reason a non traumatic method for estimating tympanic temperature should be applied. Infrared tympanic thermometry seems to be a plausible option. Reliability of infrared tympanic thermometry (ITT) has been largely assessed on living individuals but only one author up to now has assessed its applicability for post-mortem interval determination. Thus the authors set out to test the difference between ear temperatures taken with a probe vs. ITT, differences between left and right ear and reproducibility of measurements of ITT. The aim of the study was to verify whether ITT could be a plausible option for measuring ear temperature for PMI estimation. Ear temperatures were taken on 25 cadavers (15 males, 10 females). Temperatures were taken alternately by similarly trained personnel by two technical methods (Checktemp 1 thermocouple probe and First Temp Genius infrared thermometer) for a total of 93 measurements. Statistical analysis of the data was performed using SAS statistical software. The range of temperature measured was from 20 to 28 degrees C, statistical analysis revealed no differences within the two technical methods, both for right and left ear (ITT: 22.33+/-0.35 vs. probe: 23.08+/-0.25; P=0.087). The study shows the ITT method can be considered as a possible alternative to the probe for measuring ear temperative and further studies should be considered.

[Promotion of healthy life style and growth in primary school children (OKkio alla SALUTE)]

In October 2007, the Italian Ministry of Health, the Centre for Disease Control and the Regions entrusted the National Institute of Health with the coordination of the initiative "Okkio alla Salute"--Promotion of healthy lifestyle and growth in primary school children. This programme is linked to the European programme "Gaining health" and the National Plan for Prevention. The objective of the project was to develop and maintain a monitoring system for both the health services and the schools that could also be used to better target public health interventions. The first national survey to estimate the prevalence of overweight and obesity in children and to collect information on diet and physical activity has been conducted in close collaboration with the individual regions. In the first nine months of the project, 1025 health workers and approximately 1500 school teachers have received training, and, using standardised methods, they have collected data and weighed and measured nearly 45000 third grade students (median age 8.8 years) in 2000 schools throughout the country. Participation rates have exceeded 95%. The results obtained to date indicate that the methodology is sustainable using existing health and educational resources and can be adopted as a national surveillance system.

[Survey of the nutritional status and related risk factors in primary school children in two Italian health units]

During the months of May and June 2007 two prevalence studies were conducted in two local health units in Italy (Terni and Bari). The objectives of the studies were to test methods and procedures to be used in the nutritional surveillance in primary schools; to measure the prevalence of obesity and overweight in children from those schools; and to determine the prevalence of physical activity and sedentary behaviour A total of 1026 children were measured and interviewed. The refusal rate was 17% in Terni and 16% in Bari. In Terni 8% of children were obese, 24% overweight, while in Bari the corresponding values were 11% and 24%. A high prevalence of behavioural risk factors for obesity was registered such as: not eating breakfast, reduced physical activity and sedentary behaviour It was also demonstrated that parents are often unaware that their children were overweight. The results of these surveys were consistent with the high prevalence that has been registered in other studies on Italian children in the third grade. The results showed also the feasibility of surveys in schools on the nutritional situation of children in primary schools, that can be adopted as a tool for a national surveillance.

Dental superimposition: a pilot study for standardising the method

Dental superimposition is becoming more and more important because of the increasing number of illegal immigrants (at least in Italy), with no clinical history, no personal effects or relatives useful for genetic comparison, whose friends and acquaintances can usually only produce photographs. Very few authors have been involved in devising and using this method. The goal of the present study is to establish whether it is possible, and under which conditions, to identify individuals by dental superimposition of teeth visible in an ante-mortem photograph and dental casts of an unidentified body, and to develop a protocol for the spatial orientation analysis of the dentition and qualitative and semi-quantitative analysis of superimpositions. A non-mathematical scoring system has been applied to each superimposition as a first step towards the optimisation of a cheap, quick, semi-quantitative method of identifying individuals when other more used methods are not applicable.

Fatal hemophagocytic syndrome related to active human herpesvirus-8/Kaposi sarcoma-associated herpesvirus infection in human immunodeficiency virus-negative, non-transplant patients without related malignancies

Hemophagocytic syndrome (HS) may occur as a consequence of herpes viral infections. Human herpesvirus 8 (HHV-8)/Kaposi sarcoma-associated herpesvirus has so far been recognized as a trigger of HS only in immunosuppressed subjects or in patients with Kaposi sarcoma and/or HHV-8-related lymphoproliferative diseases. We report two Italian human immunodeficiency virus (HIV)-negative elderly men who developed an HS with a rapidly fatal course, following treatment with corticosteroids for autoimmune hemolytic anemia. An overwhelming active infection with HHV-8 was unequivocally documented by molecular and immunohistochemical methods, in the absence of HHV-8-related tumors. The occurrence of HHV-8-associated HS, although rare, may be considered, even out of the HIV or the transplantation settings, at least in areas endemic for HHV-8 infection.