The article provides information about the educational and pedagogical, research, medical-expert and public activities of the renowned forensic scientist, Professor, Doctor of Medical Sciences, Honored Professor of the Astrakhan State Medical Institute of the Ministry of Health of Russia, Honored Doctor of the Russian Federation Vadim Alexandrovich Sundukov (1924-2014).

The Seventh All-Russian scientific and practical conference with international participation “December Readings in Forensic Medicine at Peoples’ Friendship University of Russia: The Main Issues of Forensic Medicine and Medical Criminology” took place on December 22, 2023. The conference was held at the Department of Forensic Medicine of the Medical Institute of the Peoples’ Friendship University of Russia named after Patrice Lumumba. The conference traditionally covers a wide range of topics related to organizational and procedural, theoretical, and practical issues of forensic medicine, medical criminology, and medical law. It was participated by Russian and foreign specialists, postgraduate students, residents, and students. Participants and guests of the conference noted the high scientific and methodological level of the event and wished for new scientific meetings for specialists and young scientists at the Peoples’ Friendship University of Russia named after Patrice Lumumba.

The purpose of the work was to analyze the current literature data on the morphology and thanatogenesis of alcoholic cardiomyopathy, as well as to determine further prospects for research on this issue. Domestic and foreign literary sources devoted to sudden death, pathomorphology of alcoholic cardiomyopathy, immunohistochemical and biochemical methods of its diagnosis were studied. As a result of the analysis, the essence of thanatogenesis in alcoholic cardiomyopathy is revealed, the prospect of immunohistochemical and morphometric methods is outlined. According to the literature data, based on the results of the studies, an approximate scheme of thanatogenesis and subsequent scientific directions for the study of investigative deaths in alcoholic cardiomyopathy, in search of other diseases, can be built. In the Australian literature, the benefits of immunohistochemical are used to elucidate the antecedent pathochemical consequences. Also, in relation to the diagnosis of death from alcoholic cardiomyopathy, thanatogenetic analysis can be provided, since the sequence of development of fatally significant events in the form of various sudden deaths is not the same. In the interpretation of the processes occurring at the end of thanatogenesis in the myocardium, polarization microscopic examination is indispensable. I would like to note a number of biochemical changes in alcoholic cardiomyopathy, which demonstrate some features of the course of metabolic processes in this pathology, especially since this method and the immunohistochemical study are more in line with the modern requirements of evidence-based medicine. As a result of the literature analysis, the essence of thanatogenesis in alcoholic cardiomyopathy was revealed, the prospect of immunohistochemical and morphometric methods was outlined.

The aim of the study is to summarize the histology and morphometry of cortical neurons in acute clozapine and ethanol poisoning. Material and methods . Histological examination of the parietal cortical brain samples of 26 patients died during the Day 1 of acute clozapine and ethanol poisoning (23 males and 3 females aged 22-63 years) was performed. The blood ethanol level was 1.4-4.1%o. The level of clozapine in the blood ranged between 0.24 and 5.8 mg%, in the liver between 0.097 and 6.5 mg%, in kidneys between 0.03 and 3.5 mg%. The cortical samples for morphometric examination were placed in 10% neutral paraformaldehyde, the histological sections were done and stained with hematoxylin and eosin, as well as according to Niessl. The morphological analysis was performed using the video light microscopy. The number of damaged neurons (with separate quantification of reversible, intermediate, and irreversible damage) was assessed. The statistical analysis was done using the non-parametric methods. Results . The signs of brain neuronal damage in acute clozapine and ethanol poisoning, as well as forensic chemical tests, might be used for establishing the direct cause of death.

OBJECTIVEEvaluation of the relationship between the activity of proteolytic enzymes (cathepsin D and calpains) and the dynamics of the fluorescence intensity of the coenzymes nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD) in the rats' skeletal muscles in relation to the time of death. The proteolytic activity of enzymes in rat skeletal muscle was determined at the postmortem time points corresponding to the most significant changes in the dynamics of coenzymes NADH and FAD fluorescence intensity. The proteolytic enzymes activity was found to be low during the period of increasing intensity of NADH fluorescence observed within 3 hours after death. An increase in the activity of proteolytic enzymes was registered in 4.5 hours after death which corresponds to the initial point of decrease in NADH fluorescence intensity. In 24 hours post-mortem, corresponding to increased FAD fluorescence intensity a significant decrease in the activity of calpains was found. The results of the study suggest that the nature of the postmortem dynamics of the fluorescence intensity of coenzymes is largely due to the peculiarities of intracellular proteolysis. The study results suggest that the pattern of post mortem changes in coenzyme fluorescence intensity is largely attributable to the specifics of intracellular proteolysis. The relationship between coenzyme fluorescence and molecular mechanisms of cell death confirms the viability and feasibility of laser-induced spectroscopy for post-mortem changes assessment when determining the time of death.

The aim of the study: to assess the lung histopathology in acute intoxication with baclofen alone and its combination with alcohol (in the same dose) 3 hours after the ingestion.Materials and methods. The study was performed on 15 male Wistar rats weighing 290-350 g and aged 20 weeks. The animals were divided into 3 groups, 5 animals each: control group that included intact rats; Group 1 composed of rats received baclofen alone; Group 2 that included rats received a combination of baclofen and ethanol. Baclofen was administered orally at a dose of 85 mg/kg animal weight under anesthesia (chloralose), and 40% ethanol, 7 ml/kg animal weight, was orally administered along with baclofen at the same dose. Animals of all groups were sacrificed after 3 hours by overdosing anesthetic agent. Lung tissue samples were examined by light microscopy using a video system at x400 magnification. The following histological characteristics were evaluated: circulatory disorders (engorged capillaries and venules, hemorrhages in interalveolar septa and alveoli, sludge), atelectasis (including partial), emphysema, cellular response (increased WBCs in the interalveolar septal area), thickening of interalveolar septa due to edema, epithelial desquamation into bronchial lumen. The diameter of alveoli and thickness of interalveolar septa were measured.Results. Three hours after the baclofen administration, circulatory disorders in the lungs (engorged venules and capillaries, hemorrhages in the interalveolar septa, sludge), emphysema, atelectasis (complete and partial) as well as cellular response (leucocyte infiltration of interalveolar septa) were detected. In the Group 2, baclofen resulted in circulatory disorders (engorged venules and capillaries, sludge), emphysema, atelectasis (complete and incomplete), cellular response (infiltration with leukocytes), as well as fluid in the lumen of bronchioles. In Group 1, the alveolar diameter was significantly larger than in the control group and Group 2, while the thickness of the interalveolar septa was lower. In group 2, alveolar diameter was significantly less than in group 1, but still greater than in the control group. The thickness of the interalveolar septa in group 2 was significantly greater than in the control group and group 1.Conclusion. After administration of baclofen alone and in combination with ethanol, the following alterations were found in the lungs: circulation disorders (venular and capillary engorgement, sludge), increased vascular permeability because of developing hypoxia, leukocyte infiltration of interalveolar septa. The monitoring of morphological alterations may aid in evaluating the severity of pathological processes in intoxication with baclofen alone and in combination with ethanol and in determining the method of intoxication (baclofen alone or in combination with ethanol).

In forensic medical practice, when diagnosing the cause of death from blood loss, it is often necessary to solve questions related to the etiology of loss of circulating blood volume (CBV), the degree and severity of the injury, as well as its role in thanatogenesis and the duration of the terminal (agonal) period. When investigating the cases of death from acute blood loss, the authorities often ask forensic experts to solve issues related to the possibility of performing active targeted actions by the dying person, as well as to assess the timeliness of medical care and the actions of medical personnel. The solution of these issues is often difficult for experts, and it is associated with both objective and subjective reasons. For example, in cases where the circumstances of death are unknown, or there are no medical documents, or they do not contain sufficient information, without which it is impossible to conduct a retrospective clinical and anatomical analysis for the purpose of differential diagnosis between hemolytic shock and post-hemorrhagic anemia. The article deals with the use of new methodological approaches in postmortem morphological diagnostics of blood loss by the rate of its development and its role in thanatogenesis, in forensic medical practice. For example, a particular forensic expertise (case study) shows that the application of two new methods allowed to solve the issues for the investigator related to the cause of death and duration of dying from blood loss. Experts knowledge of new methodological approaches to the forensic diagnosis of acute blood loss will help law enforcement authorities to counteract crimes against the life of citizens, as well as to development the measures to improve the methods for prevention and reduction of mortality from traumatic injuries with blood loss.

The aim of the study is to summarize the histology and morphometry of cortical neurons in acute clozapine and ethanol poisoning.Material and methods. Histological examination of the parietal cortical brain samples of 26 patients died during the Day 1 of acute clozapine and ethanol poisoning (23 males and 3 females aged 22-63 years) was performed. The blood ethanol level was 1.4-4.1%o. The level of clozapine in the blood ranged between 0.24 and 5.8 mg%, in the liver between 0.097 and 6.5 mg%, in kidneys between 0.03 and 3.5 mg%. The cortical samples for morphometric examination were placed in 10% neutral paraformaldehyde, the histological sections were done and stained with hematoxylin and eosin, as well as according to Niessl. The morphological analysis was performed using the video light microscopy. The number of damaged neurons (with separate quantification of reversible, intermediate, and irreversible damage) was assessed. The statistical analysis was done using the non-parametric methods.Results. The signs of brain neuronal damage in acute clozapine and ethanol poisoning, as well as forensic chemical tests, might be used for establishing the direct cause of death.

Одной из важнейших задач, с которой сталкивается судебно-медицинский эксперт при проведении экспертизы идентификации личности по костным останкам, является установление групповых признаков, к числу которых относится тип телосложения. В настоящей статье впервые показана возможность диагностики прижизненного типа телосложения мужчин при экспертизе скелетированных останков. Цель исследования . Разработка диагностических математико-статистических моделей, позволяющих реконструировать предполагаемый прижизненный тип телосложения у мужчин по остеометрическим признакам скелетированных ключиц. Материал и методы . В исследование вошли данные, полученные при измерении ключиц из остеологического собрания кафедры антропологии МГУ им. М. В. Ломоносова (62 скелета взрослых мужчин) по расширенной программе 15 признаков, которые затем были обработаны в программе StatSoft STATISTICA 10 с помощью многомерного дискриминантного анализа (МДА) в пошаговом варианте. Результаты . В ходе исследования получены диагностические модели, позволяющие восстанавливать прижизненный тип телосложения (грудной, брюшной, мускульный) по изолированным ключицам с точностью от 62,9 до 79 %. Индивиды грудного и мускульного типа телосложения при использовании предлагаемой методики идентифицируются лучше (точность корректной классификации составила 90 %), брюшного — менее точно (41–58,8 %). Вероятность отнесения экспертного случая к конкретному типу телосложения определяется согласно значению статистической функции Pl, что позволяет значительно повысить степень объективности исследования. Полученные диагностические модели тестировались на костяках из собрания Музея антропологии и этнографии РАН им. Петра Великого (Кунсткамера). В ходе верификации было обнаружено, что фактическая степень точности метода совпадает с расчетной и составляет 80 %.

Professional activity of intensivists consistently ranks high among the most «risky» areas of medicine. In 6 out of 89 criminal «iatrogenic» cases initiated by investigative authorities in the Moscow region in 2016–2018 anesthesiological or intensive care in the ICU was the subject of investigation. In 4 of these 6 cases, iatrogenic complications were detected during the forensic examination. Intensivist is considered an attending doctor and therefore holds responsibility for defects in the provision of medical care and its adverse outcome.The purpose of the study is to outline the professional risks in the work of an intensivist and identify ways to reduce them by using a case study with a fatal outcome, which led to criminal proceedings.Materials and methods. We studied and analyzed the criminal case files which included the complaint of the patient’s relatives with the prosecutor’s office, the explanations and interrogation records of the patient’s relatives (4) and healthcare workers (6), the minutes of the Morbidity and Mortality conference, the expert report on patient care quality issued by health insurance company, the final report of sanitary and epidemiological examination, autopsy protocol, emergency call files (3), the inpatient medical records, outpatient records and the final report of Commission of forensic medical examination.Results. Defects in the provision of medical care were not identified. The differential diagnosis was performed correctly. The severity of the patient's condition was due to brain infarction and associated abnormalities. Underdiagnosis of botulism did not affect the outcome of the disease and was not the cause of death of the patient.Conclusion. The reasons for filing a complaint with the Prosecutor's office and initiating a criminal case were organizational shortcomings and ethical and deontological aspects.

One of the major challenges faced by a forensic medical expert when performing the examination of bone remains for the purposes of personal identification is the determination of group characteristics, which include the person’s body type. The present study focuses on a new method for determining the intravitam body type when considering skeletonised remains. Aim. To develop diagnostic mathematico-statistical models that allow the intravitam body type in men to be determined, drawing on the osteometric characteristics of skeletonised clavicles. Material and methods. We studied clavicles from the osteological collection held at the Department of Anthropology, Lomonosov Moscow State University (62 adult male skeletons) according to the expanded osteometric program (15 characteristics). The obtained data were processed by StatSoft STATISTICA 10 using multivariate stepwise discriminant analysis (MDA). Results. We have developed diagnostic models allowing the intravitam body type (ectomorph, mesomorph and endomorph) to be determined on the basis of skeletonised clavicles with an accuracy of 62.9–79 %. Using the proposed models, a more accurate determination of ectomorphs and mesomorphs (90 %) than endomorphs (41–58.8 %) is observed. In order to increase the objectiveness of the expert’s conclusion, we used function Pl showing the probability of correct body type classification in every single case. The diagnostic models were successfully verified using the skeletal samples held at the Peter the Great Museum of Anthropology and Ethnography, with the maximum accuracy level reaching 80 %.

Aim of the study is to identify patterns of variations of the fluorescence intensity of NADH (reduced nicotinamide adenine dinucleotide) and FAD (oxidized flavin adenine dinucleotide) in the skeletal muscle depending on the time since death. For the evaluation of fluorescence intensity of the studied coenzymes, laser-induced spectroscopy in situ was used. We revealed the dynamic of the fluorescence intensity of NADH and FAD in the skeletal muscle of a rat at different times during the post-mortem period, and theoretically justified the observed phenomena. The results obtained allow us to consider the studied indicators as a potential criterion for determining the post-mortem interval.

Objectives. Systematization of cerebellar Purkinje cell injuries to clarify the pathogenesis of combined clozapine-alcohol poisoning and to substantiate the immediate cause of death. Material and methods. Experimental studies were performed on 25 white outbreed rats divided into 5 groups: control, group I (clozapine 3 hours), group II (clozapine 24 hours), group III (clozapine + alcohol 3 hours), group IV (clozapine+alcohol 24 hours). Te assessment of Purkinje cell injury was performed using the classifcation of neuronal damage.Results. In the control group of animals reversible changes in Purkinje cells prevailed: primary irritation and acute swelling (15-20%). Irreversible changes were detected in 2-5%. In case of clozapine poisoning the number of Purkinje cells with irreversible changes (shrinking, karyocytolysis, severe changes, Ghost-like cells) was increased. Te percentage of Purkinje cells with such changes was 30-40%. In case of combined clozapine-alcohol poisoning the percentage of irreversible Purkinje cells injury increased to 40-60% (especially 24 hours afer starting the study). Quantitative diferences in irreversible changes in Purkinje cells in the experimental groups were statistically signifcant if compared to the controls (p0.05). Conclusion. As a result of the study the most commonly detected injuries of Purkinje cells of cerebellum in clozapine poisoning were revealed. Te most prominent damage to Purkinje cells with predominance of irreversible changes were found in cases of combined clozapine-alcohol poisoning. 24-hour duration of the experiment led to the more severe Purkinje cell injuries if compared to the 3-hour duration.

The purpose of the study: scientific evidence and development of accessible morphological criteria that allow to determine the duration of dying and the rate of dying.Materials and methods. The material of the main study included 206 identified deaths of persons with different pre-known processes of dying, which served as criterion for selection from1500 deaths (n=206, 14%). Of these, 110 cases were observed by the forensic medical expertize, 79 cases were revealed by the forensic medical examination of the dead body and 17 cases were included after the postmortem autopsy. The sample included from 30 to 57 cases subdivided in 5 groups. 53 cases were selected for the first time interval, 30 observations for the second one, 32 observations for the third one, 34 observations for the fourth one and 57 observations for the fifth time interval. The following methods were used to study the material: analysis of information about the circumstances of death (based on the records), retrospective clinical and anatomical analysis, the main (classical) method of autopsy of human corpses in sectional studies and histological examination. In addition, an immunohistochemical test, as well as morphometric, macroscopic and photographic methods were used. For the accuracy and reliability of the findings, morphological and statistical analysis was used, which included both statistical analysis of morphological characteristics and tanatogenetic analysis of the cases of the sampled material.Study results. We developed and scientifically proved a methodology for determining 5 rates of dying according to the morphological characteristics systematized in morphological complexes: fulminant rate ≤15-30 min; fast rate >30 min — ≤2 h; moderate rate >2 — ≤6 h; slow rate >6 — ≤12 h; lingering rate >12 h. Approbation of the proposed method on the gross experimental material allowed to set the diagnostic limit of the total significance for each morphological complex, and thereby, to improve the methodology of establishing the rate of dying in accordance to the morphological characteristics for the use in forensic practice.Conclusion. The morphological complexes of the rate of dying established in this work would serve as a base for further development of not only forensic thanatology, but also for the aim of improving the medical and preventive care.

Clozapine is an atypical antipsychotic agent with a confirmed effectiveness which is widely used in the clinical practice. However, its administration is associated with a high risk of serious adverse events. Life-threatening conditions related to administration of clozapine may be a result of idiosyncrasy, acute poisoning resulting from unintentional overdose of the prescribed dug, suicidal behavior, and criminal actions. The review presents current data on the mechanism of therapeutic and toxic effect of clozapine. It describes the effect of clozapine on cell receptors and ultracellular structures. It dwells on the contribution of major and intermediate metabolites of this medicinal agent to the development of toxic effects.