Artificial intelligence in forensic medicine and forensic dentistry

This review article aims to highlight the current possibilities for applying Artificial Intelligence in modern forensic medicine and forensic dentistry and present the advantages and disadvantages of its use. For this purpose, the relevant academic literature was searched using PubMed, Web of Science and Scopus. The application of Artificial Intelligence in forensic medicine and forensic dentistry is still in its early stages. However, the possibilities are great, and the future will show what is applicable in daily practice. Artificial Intelligence will improve the accuracy and efficiency of work in forensic medicine and forensic dentistry; it can automate some tasks; and enhance the quality of evidence. Disadvantages of the application of Artificial Intelligence may be related to discrimination, transparency, accountability, privacy, security, ethics and others. Artificial Intelligence systems should be used as a support tool, not as a replacement for forensic experts.

Glomerular filtration rate is an independent prognostic factor in patients with B-large cell lymphoma

Chronic kidney dysfunction is associated with increased mortality in multiple cancer types. Preliminary evidence suggests the same to be true for B-large cell lymphomas (B-LCL). To analyze the relationship of glomerular filtration rate (GFR) and outcome of B-LCL in detail we collected data on outcomes of 285 consecutive patients with newly diagnosed B-LCL treated at our institution with standard rituximab-containing regimens who did not have preexisting kidney disease or urinary tract obstruction at presentation. Median age was 59, range 18 to 87, 145 were male and 140 females. Forty-four had GFR < 60 mL/min, 123 had 60 to 90 mL/min, and 118 > 90 mL/min. Median follow-up of surviving patients was 49 months and estimated 3-year survival 76%. In univariate analysis age (P < .001), GFR (P = .014), stage (P < .001), performance status (P = .044), chemotherapy regimen (P < .01), and international prognostic index (IPI) (P < .001) were statistically significant prognostic factors. In multivariate analysis, age and GFR remained the only independent prognostic factors. Subtracting 1 from the IPI score of patients who had GFR > 90 mL/min and IPI > 1 resulted in a prognostic index that divides patients into 3 prognostic groups (low risk = 0-1, intermediate risk = 2-3 and high risk = 4-5) with an acceptable patient distribution frequency (38%, 39%, and 23%, respectively) and improved statistical significance and separation in comparison to IPI (5-year survival rates of 92%, 74%, and 42%, respectively). GFR is an important independent prognostic factor for B-LCL that should be taken into account in clinical decision making and data analysis and probably be incorporated in prognostic indices.

Causative agents of bloodstream infections in two Croatian hospitals and their resistance mechanisms

Blood samples were collected alongside with routine blood cultures (BC) from patients with suspected sepsis, to evaluate the prevalence of different causative agents in patients with bacteraemia. Among 667 blood samples, there were 122 positive BC (18%). Haemoglobin content, platelet number, and systolic blood pressure values were significantly lower in patients with positive BC, whereas serum lactate levels, CRP, creatinine and urea content were significantly higher in patients with positive BC. The rate of multidrug (MDR) or extensively drug resistant (XDR) bacteria was 24% (n = 29): Klebsiella pneumoniae (9), Pseudomonas aeruginosa (9), Acinetobacter baumannii (4), Escherichia coli (1), vancomycin resistant Enterococcus spp (VRE) (3), and methicillin-resistant Staphylococcus aureus MRSA (3). The dominant resistance mechanisms were the production of extended-spectrum β-lactamases, OXA-48 carbapenemase, and colistin resistance in K. pneumoniae, VIM metallo-β-lactamases in P. aeruginosa and OXA-23-like oxacillinases in A. baumannii. The study revealed high rate of MDR strains among positive BCs in Zagreb, Croatia.

Forensic determination of dental age by cementum thickness of human teeth

The purpose of this study was to assess the correlation between the known chronological age and the dental cementum thickness (DCT) in male and female subjects in different age groups.

MATERIAL AND METHODS

The study sample consisted of 57 donor teeth of both sexes. Teeth were classified by donors' sex and divided into three age groups: 10-19, 30-39 and 60-69 years. Tooth roots were cut with transverse ground sections in the apical, middle, and cervical thirds. DCT measurements were made on photomicrographs of light microscope. The correlation between DCT and the chronological age was calculated using the Spearman correlation coefficient.

RESULTS

A positive correlation was found (r=0.47, p <0.001) between DCT and age of the donor. DCT decreased from apical to cervical ground section (median [IQR] apical section 216.72 [128.25-375.00] μm, middle section 158.44 [87.66-284.90] μm; cervical section 96.60 [70.05-165.59] µm). DCT variability was influenced by sex, number of tooth roots and the condition of the tooth crown. The influence differed depending on the location of the section, being most prominent cervically.

CONCLUSION

The present study showed correlation of DCT with age, with significant influence of sex, number of tooth roots, condition of the tooth crown and location of the root section.

Prevalence of and risk factors for urolithiasis in Croatian patients with hemophilia

Urolithiasis may be more prevalent in patients with hemophilia (PWH) than in age-matched non-hemophilic males. We conducted a cross-sectional evaluation of 92 adult PWH at University Hospital Center Zagreb. The primary objective was to investigate the frequency of urolithiasis in adult PWH, and the secondary objective was to determine associated risk factors. Urolithiasis was diagnosed by ultrasound and other patient- and hemophilia-related parameters were recorded. The prevalence of urolithiasis was significantly higher among PWH than the reported prevalence in the general Croatian population (10.9% vs 5.9%; P = 0.042). Similarly, the incidence of urolithiasis during the course of the disease was significantly higher than the estimated cumulative lifetime incidence of urolithiasis in the Croatian population (25% vs 12%; P = 0.001). Multivariate analysis showed that arterial hypertension, the presence of inhibitors, hypercalciuria and hyperbilirubinemia were independent predictors of current urolithiasis (P < 0.05), and that hematuria (P = 0.051) and prior urinary infections (P = 0.059) were also relevant factors.Urolithiasis is a significant burden in adult PWH. Identifying associated risk factors might help in establishing strategies for earlier recognition and more successful prevention and treatment of urolithiasis.

Extensive Deep Venous Thrombosis in a Young Male Patient as the First Manifestation of a Rare Venous Anomaly - Inferior Vena Cava Duplication: Case Report

Although venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary embolism is a major health problem in the world, it is an infrequent disease among young people. It is always mandatory to look at the underlying conditions for VTE, and in young patients, inherited prothrombotic factors should also be evaluated, especially in case of unprovoked VTE. Anomalies of inferior vena cava (IVC) are very rare in the general population. In this case report we describe rare occurrence of extensive DVT in a young male patient with rare anomaly of IVC - duplication of IVC - as a predisposition factor for DVT. Physicians need to be reminded of the IVC anomalies that should be considered in young patients with idiopathic DVT of lower extremity, which may require extended anticoagulant treatment.

A case report of acute inferior myocardial infarction in a patient with severe hemophilia A after recombinant factor VIII infusion

RATIONALE

The extent of protective effects of hemophilia against thrombotic events such as myocardial infarction (MI) and other acute coronary syndromes remains to be determined, as major risk factors for cardiovascular disease exist despite factor VIII (FVIII) deficiency. We present a case report of a 41-year-old male with severe hemophilia A and several cardiovascular risk factors.

PATIENT CONCERNS

This morbidly obese patient developed chest pressure, followed by chest pain and difficulty in breathing shortly after receiving on-demand treatment with intravenous recombinant FVIII (rFVIII) (turoctocog alfa) dosed per body weight.

DIAGNOSES

An electrocardiogram revealed a diagnosis of inferior ST-segment elevation MI.

INTERVENTIONS

The patient underwent an urgent coronary angiography using a radial artery approach. During the next 12 months, he received dual antiplatelet treatment, acetylsalicylic acid 100 mg, and clopidogrel 75 mg daily. His treatment for severe hemophilia A was changed to plasma-derived FVIII replacement therapy.

OUTCOMES

During this 12-month period, he experienced several small bleeds in his elbows.

CONCLUSIONS

The temporal relationship between rFVIII infusion and onset of the MI suggests a possible association; however, apart from obesity, the patient also had other major risk factors for arterial thrombosis, such as hypertension and smoking. Furthermore, atherosclerotic disease and underlying atherosclerotic changes could not be excluded with certainty. This case highlights the importance of studies assessing the impact of excess body weight on rFVIII dosing.

The impact of type 1 diabetes on the development of the craniofacial mineralised tissues (bones and teeth): literature review

BACKGROUND

There are many reports on the impact of diabetes on periodontium as well as the state of organs in diabetics; however, there is little research on the impact of the disease on morphological and anatomical changes in the mineralised tissues like teeth and craniofacial bones. The aim of this study was to present a review of literature on morphological and anatomical changes of mineralised tissues in the course of type 1 diabetes.

MATERIALS AND METHODS

A review of PubMed database was made using the keywords: morphological changes, anatomical changes, enamel hypoplasia, type 1 diabetes, induced diabetes and the names of individual anatomical and morphological structures of the teeth.

RESULTS

The analysis of experimental studies have shown that in induced type 1 diabetes in rats there is a substantial reduction in the thickness of the enamel and dentin, compared with the control group. The changes in the content of indivi-dual minerals in the tissues of the tooth have been shown - a decrease in the concentration of calcium and fluoride ions and an increase in the concentration of magnesium. In a study conducted on embryos of rats born of diabetic dams, defects were observed in enamel organ, which can cause delayed enamel hypo-plasia. Literature analysis revealed morphological disorders also in some clinical cases of patients with type 1 diabetes.

CONCLUSIONS

Type 1 diabetes mellitus as a metabolic disorder may affect changes in the structure of mineralised tissues, thereby increasing their susceptibility to caries development and orthognathic disorders.

Carabelli's trait in Croatian populations over 1800 years

Examination and comparison of the morphological features of tooth crown in archaeological and recent samples can be difficult due to the different levels of tooth wear seen both within and between populations. These differences make the comparison of frequency data for Carabelli trait problematic. The aim of the present study is to detect the frequency and degree of expression of Carabelli's trait in Croatian populations from late antiquity to recent times and to use these data as supplementary evidence of complex population migration. A total of 1287 individuals from the late antiquity, medieval, early modern and modern periods were examined. Correlation between the presence of Carabelli's trait and tooth crown size was tested. The results of our analyses show that the frequency of Carabelli's trait is significantly greater in the early modern period (51.3%) and in the 21st century (43.1%) than in the late antiquity (20.4%) and medieval periods (23.4%). These results are consistent with historical evidence of migration and population change in the territory of present-day Croatia throughout the almost 1800 years covered by this study. The results also provide additional evidence for the complex nature of population change in the transition from the late antiquity to the early medieval period.

Age estimation in archaeological skeletal remains: evaluation of four non-destructive age calculation methods

Estimation of age at death is an essential part of reconstructing information from skeletal material. The aim of the investigation was to reconstruct the chronological age of an archaeological sample from Croatia using cranial skeletal remains as well as to make an evaluation of the methods used for age estimation. For this purpose, four age calculation methods were used: palatal suture closure, occlusal tooth wear, tooth root translucency and pulp/tooth area ratio. Cramer's V test was used to test the association between the age calculation methods. Cramer's V test showed high association (0.677) between age determination results using palatal suture closure and occlusal tooth wear, and low association (0.177) between age determination results using palatal suture closure and pulp/tooth area ratio. Simple methods like palatal suture closure can provide data about age at death for large number of individuals, but with less accuracy. More complex methods which require qualified and trained personnel can provide data about age for a smaller number of individuals, but with more accuracy. Using different (both simple and complex) age calculation methods in archaeological samples can raise the level of confidence and percentage of success in determining age.

Influence of the intensity of NaCl solutions on adaptation degree and recovery time course

The degree of adaptation and the time course of recovery after adaptation to NaCl solutions of various intensities were examined by magnitude estimation and simple sensory reaction time using a test stimulus of constant intensity. The results show that the degree of adaptation increased with the adapting concentration following a negatively accelerated function. Similarly, all recovery curves were negatively accelerated functions of the recovery time. The relation between the recovery constant (time necessary to attain two-thirds of normal responsivity) and adapting concentration approximates with both criteria more or less a linear function. Thus the recovery constant is a positively accelerated function of the degree of adaptation. The relationship between concentration and degree of adaptation can be approximated by Beidler's equation of taste stimulation, while the time course of recovery can be expressed by an exponential equation that can also be related to Beidler's theory. The two criteria used showed similar deteriorating effects of taste adaptation, indicating that reaction time can also be a useful criterion of the level of sensory responsivity.

Central processes in gustatory adaptation

In two experiments the adapting stimuli at the periphery of the taste system were of a constant objective intensity but, using mixture suppression and spatial summation, their perceived intensity was varied. The results have shown that, in spite of the constancy in stimulus concentration, the adaptation degree changed with the perceived intensity of the stimulus. The adaptation to the compounds when in binary mixtures proved to be significantly less effective than the adaptation to the same equimolar compounds when unmixed. Similarly, the adaptation effects of solutions of a constant concentration, when applied to a small tongue area, were significantly smaller than when applied to a larger area. This adaptation dependence upon the taste sensation intensity suggests that in the gustatory adaptation, peripheral as well as central processes take part.