Browsing by Author "Pavlekić, Snežana (22035701700)"

BACKGROUND: Gas gangrene is a clostridium infection primarily of muscle tissue, most commonly caused by C. perfringens. Clinical diagnosis is usually made by local inspection of the wound: the infected tissue shows characteristic signs of tissue inflammation with blistered changes. The disease can starts suddenly, 4-6 hours after the injury, but most commonly the incubation period lasts 2-4 days. Without proper medical intervention, death occurs in 4-24 hours after the development of the first symptoms, but even with timely and adequate therapy, the lethality is very high (around 12%). Due to its fulminant course, in all cases with fatal outcomes, a forensic autopsy is an obligatory procedure. However, discovering the entrance gate and source of infection is not an easy task, especially in the absence of a traumatic injury. CASE PRESENTATION: Male, 27 years old, an intravenous heroin addict for about 10 years, injured his left leg in a traffic accident. He only visited the doctor after 5 days. Upon examination, it was determined that there were no externally visible injuries and no fracture, and he was given a splint immobilization for an ankle luxation. Twelve days after the accident (or 7 days after the immobilization) his mother found him unconscious. CONCLUSION: From medicolegal aspects, it’s important to have in mind even the less frequent paths of infection, in order to give an expert professional opinion on origin and cause of death. © 2021 Snežana Pavlekić, Dragan Ječmenica, Djordje Alempijevic.

Clinical and forensic significance of hand injuries incurred through mechanisms of indirect force with users of two-wheeled vehicles. Our aim is to explore and verify injuries resulting from the effect of indirect force, the clinical significance of which is small or insignificant in terms of their severity, but which have great significance in terms of expertise, primarily as a medical element in the reconstruction of the flow of traffic collisions and the complex dynamics of body movement of this unstable vehicles’ users. Hand injuries among users of two-wheelers may arise as a result of contact with the handlebars, when the hands (back of the hands) collide with the metal grips of the hand brake and clutch, or anytime the handlebars “wedge” into the space between the thumb and forefinger. In comparison with pedestrians, as a control group, a statistically significant difference was established in the incidence of hand injuries in motorcycle drivers. © 2015 Australian Academy of Forensic Sciences.

Background/Aim. Suicide and homicide are crucial social problems, especially frequent among the population younger than 40 years. The aim of this study was to assess the influence of different sociodemographic factors and relevant psychoactive substances on the difference between homicide and suicide victims. Methods. A cross-sectional study analyzed autopsy reports of 714 suicide and 166 homicide cases autopsied in five years (2011–2016). Out of these, 666 suicide and 127 homicide cases met the inclusion criteria for this study. Blood-ethanol concentration was determined by headspace gas chromatography with flame ionization detection. Analysis of substances other than ethanol was accomplished by gas chromatography-mass spectrometry and liquid chromatography with tandem mass spectrometry. Results. There was a significant difference in age, level of education, and employment rate between suicide and homicide cases (p < 0.05). The distribution of suicide and homicide cases differed significantly on weekdays compared to weekends [odds ratio(OR) = 1.5; 95 % confidence interval (CI) = 1–2.3; p < 0.05]. The presence of a psychoactive substance remained a nonsignificant predictor of whether a person would become a homicide or suicide victim (p > 0.05). Homicide victims were more likely to have significantly higher blood alcohol concentration (0.2–0.3 g/dL) than suicide victims (OR = 2.2; 95 % CI = 1–5; p < 0.05). Conclusion. The age, level of education, employment status, and high blood alcohol concentration (0.2–0.3 g/dL) of the victim were significantly different between suicide and homicide cases. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand-held parachute signal rocket during a football match is presented. A 17-year-old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand-held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination. © 2008 American Academy of Forensic Sciences.

Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand-held parachute signal rocket during a football match is presented. A 17-year-old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand-held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination. © 2008 American Academy of Forensic Sciences.

Introduction Heat stroke is the most dangerous among numerous disorders caused by elevated environmental temperature. It is characterized by an increased body temperature of over 40°C, the dysfunction of the central nervous system and the development of multiple organ failure. The aim of this paper was to highlight problems in the clinical and post-mortal diagnosis of fatal heat stroke. Case Outline A 20-year-old male was found unconscious on the street; on admission at the Emergency Center, Clinical Center of Serbia, Belgrade, he was in a coma. The body temperature of 40°C was maintained despite the applied therapy, meningeal signs were negative, tachycardia with gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of skin bruises. Laboratory findings: highly elevated LDH and creatine kinase, elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6 hours after admission, and the case remained clinically unsolved. Autopsy showed signs of hemorrhagic diathesis, brain and pulmonary edema, and microscopic examination revealed general congestion, internal bleeding in various organs, cerebral edema, massive blood aspiration and pulmonary edema. Toxicological and bacteriological examinations were negative. Based on these findings and subsequently obtained data on the conditions at the workplace where the young man had a part-time job, it was concluded that the violent death was caused by heat stroke. Conclusion Since heat stroke is associated with a high mortality rate and high incidence of serious and permanent organ damage in survivors, it is important to make the diagnosis of heat stroke as quickly as possible and apply appropriate treatment. Misdiagnosis of heat stroke, and consequently inadequate treatment, with a potential fatal outcome for the patient, can be the reason for blaming doctors for the legal offense of medical malpractice in failing to administer first aid. © 2014, Serbia Medical Society. All rights reserved.

Introduction. Even though lipomas are the most common benign tumors, they are rarely found in the pericardial cavity. Although histopathologically benign, they can cause life-threatening complications by rapid growth and may therefore be clinically considered malignant. Case report. We present an 80-year-old female who was injured during a syncopal episode when falling from a standing height and suffered bodily injuries for which she was hospitalized. In the further course of her short-term hospital treatment, death occurred, and the cause of death was marked as “unknown”. At the autopsy, a dilated and tense pericardium filling up a large part of the chest cavity was noted. A well-encapsulated soft tissue mass, 20 × 18 × 3 cm in size, weighing 820 g, was visualized in the pericardial cavity. Histopathological examination revealed that the mass was a lipoma and showed acute myocardial necrosis; therefore, it was assumed that the cause of death was probably due to the compression of lipoma on coronary arteries. Conclusion. Even though intrapericardial lipomas are benign tumors, they can cause life-threatening complications and sudden cardiac death. There are numerous diagnostic methods capable of detecting intrapericardial lipomas, and with timely treatment, the patient can be cured. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction: Suicide by sodium nitrite poisoning (SNP) is not common. In the last decade, an increase in the number of suicides caused by SNP was observed. Case report: A 47-year-old female was found dead in her apartment. Four cups with a yellowish liquid and a scale for precise measurement were found at the scene. Also, an empty plastic bag labeled “Sodium Nitrite NaNO2”. In the external examination, general signs of asphyxia were noticed. Bluish and slightly brownish hypostasis, which was prominent on the face and thighs, was present. The blood and all tissues were somewhat darker in appearance than usual. Toxicological analysis showed high levels of nitrites, nitrates, methemoglobin, and metoclopramide in blood and stomach content. It was concluded that this was a suicide by SNP. Discussion: Autopsy signs of SNP are nonspecific. The grayish-brown color of the hypostasis is a characteristic sign of SNP but is very subjective and may be missed. Sodium nitrite cannot be legally purchased for domestic use in Serbia. Even though sodium nitrite commerce is strictly regulated, the victim was able to illegally obtain it and use it in combination with the antiemetic drug metoclopramide, which shows the knowledge that exceeds the common knowledge regarding this substance and is an example of suicide committed by intellectuals. Conclusion: Cases of the fatal SNP may present a significant challenge in forensic practice due to their rarity and nonspecific presentation. Without any information about the circumstances of the case, it is often unrecognizable. © 2025 Elsevier B.V.

Introduction: Suicide by sodium nitrite poisoning (SNP) is not common. In the last decade, an increase in the number of suicides caused by SNP was observed. Case report: A 47-year-old female was found dead in her apartment. Four cups with a yellowish liquid and a scale for precise measurement were found at the scene. Also, an empty plastic bag labeled “Sodium Nitrite NaNO2”. In the external examination, general signs of asphyxia were noticed. Bluish and slightly brownish hypostasis, which was prominent on the face and thighs, was present. The blood and all tissues were somewhat darker in appearance than usual. Toxicological analysis showed high levels of nitrites, nitrates, methemoglobin, and metoclopramide in blood and stomach content. It was concluded that this was a suicide by SNP. Discussion: Autopsy signs of SNP are nonspecific. The grayish-brown color of the hypostasis is a characteristic sign of SNP but is very subjective and may be missed. Sodium nitrite cannot be legally purchased for domestic use in Serbia. Even though sodium nitrite commerce is strictly regulated, the victim was able to illegally obtain it and use it in combination with the antiemetic drug metoclopramide, which shows the knowledge that exceeds the common knowledge regarding this substance and is an example of suicide committed by intellectuals. Conclusion: Cases of the fatal SNP may present a significant challenge in forensic practice due to their rarity and nonspecific presentation. Without any information about the circumstances of the case, it is often unrecognizable. © 2025 Elsevier B.V.

Testicular displacement is a rare clinical presentation of blunt scrotal injury that may take place in road traffic accidents involving motorcycle occupants. We are presenting two cases of motorcycle occupant fatalities, 21 and 24years of age, where testicular displacement and other signs of groin trauma have been determined. In both cases, discrete external signs of scrotal trauma were noted on examination, while unilateral and bilateral traumatic testicular displacement, respectively, have been documented at autopsy. For motorcycle occupants involved in collision, it is necessary to perform a thorough analysis of injuries, in particular to look for specific trauma arising from fuel-tank impact to genitalia and/or groin. These injuries are of great medico-legal importance both at postmortem and in clinical cases involving motorcycle occupants involved in collision. © 2011 American Academy of Forensic Sciences.

Testicular displacement is a rare clinical presentation of blunt scrotal injury that may take place in road traffic accidents involving motorcycle occupants. We are presenting two cases of motorcycle occupant fatalities, 21 and 24years of age, where testicular displacement and other signs of groin trauma have been determined. In both cases, discrete external signs of scrotal trauma were noted on examination, while unilateral and bilateral traumatic testicular displacement, respectively, have been documented at autopsy. For motorcycle occupants involved in collision, it is necessary to perform a thorough analysis of injuries, in particular to look for specific trauma arising from fuel-tank impact to genitalia and/or groin. These injuries are of great medico-legal importance both at postmortem and in clinical cases involving motorcycle occupants involved in collision. © 2011 American Academy of Forensic Sciences.

Bullet embolism is rare complication of penetrating gunshot trauma. We are presenting a case of a single gunshot with entrance wound located on external side of a left thigh. The upward directed trajectory extends to the left lateral side of the neck, but the bullet has been recovered from right external iliac vein. The bullet migration was explained due to one rare variation of the mouth of vena cava superior and inferior. © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine.

Bullet embolism is rare complication of penetrating gunshot trauma. We are presenting a case of a single gunshot with entrance wound located on external side of a left thigh. The upward directed trajectory extends to the left lateral side of the neck, but the bullet has been recovered from right external iliac vein. The bullet migration was explained due to one rare variation of the mouth of vena cava superior and inferior. © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine.