Death in Sadistic Sexual Crimes: A Neural Network Analysis of Factors Associated With a Lethal Outcome

This study aims to determine the factors associated with the victim’s death in sadistic sexual crimes. Specifically, this article examined whether the lethal outcome is more likely to be associated with an escalation of violence during the crime-commission process, an instrumental motivation, or the manifestation of specific sadistic fantasies. We used a database including 735 cases of sadistic sexual assaults. Among this sample, 100 sadistic sexual assaults ended with a lethal outcome. Bivariate analyses, logistic regression, and neural network models were used to identify how the different factors predicted the lethal outcome of sadistic crimes. Our results show that the expression of sadistic behaviors associated with torture and/or bodily punishment plays a fundamental role in the lethal outcome of sadistic sexual crimes. Theoretical and practical implications are discussed.

Tumor budding as a prognostic criterion of colorectal cancer

Colorectal cancer (CRC) is the second leading cause of mortality among cancers after malignant tumors of respiratory system. One of the most significant prognostic features of CRC is tumor budding (TB), which isn’t widely implemented in clinical practice. The aim of this research: to find the prognostic criteria of recurrence and lethal outcome of CRR IIA and IIIB stages (рТ3N0-2M0), the ratio of tumors with certain differentiation in groups of research was taken equal. Material and methods. The group I was formed from primary CRC without recurrences. The main relapse-free survival time was 5 years (62.5 ± 16.5 months). The ІІ group – primary CRC with recurrences; ІІА – with recurrences during 5 years from the moment when the tumor was removed, without fatal outcome; ІІВ – with recurrences and lethal outcome from genera­lization of tumor process during 5 years from the moment when the tumor was removed. The microslides of CRC were made by using the standard methods. Results. TB was identified in 46.66 % (28/60) of CRC рТ3N0-2M0. The direct relationship between tumor grade and presence of TB was found (Р < 0.05), but TB didn’t define differentiation of the CRC. There was a statistically significant relationship between TB and metastatic spreading of CRC to regional lymph nodes (Р < 0.001). Metastasis was associated with 3 stage of TB, absence of metastasis was typical for CRC without TB. The tendency was found in a larger number of cases of the CRC with TB 3 stage among recurring CRC compared with CRC without recurrence, mainly due to the ІІВ group of the research. Inverse correlation between TB stage and time of recurrence appearance was found (Р < 0.05). TB in central tumor sites was followed by presence and higher stage of TB in peripheral tumor sites (Р < 0.05), that can be taken into account during biopsies of CRC. Conclusions. TB is a prognostic criterion of metastasis and time of recurrence appearance for CRC рТ3N0-2M0, which is mostly typical for tumors in patients with recurrences and lethal outcome at the taken equal ratio of tumors by differen­tiation.

ABANDONED AND FORGOTTEN? VIOLENT DEATHS OF PREVIOUSLY ABUSED FEMALE VICTIMS IN CROATIA

The paper is divided into two parts to facilitate a clearer understanding of different aspects of the violent death of previously abused female victims. The first part offers a brief overview of the most recent phenomenological conclusions on violence ending in death and explains the need to focus on gender differences in homicide victimisation. A bulk of research has confirmed that most women are more vulnerable to homicide within home and that the lethal outcome is an escalation of previously experienced abuse. In order to contribute to a more in-depth study of female intimate homicides, the authors focus on a variety of definitions and draw a clear line between the term femicide and the aggravated murder of a closely related person. In the second part of the paper, the authors have analysed the case-law of the Supreme Court of the Republic of Croatia in which the perpetrators were found guilty of the criminal offence of aggravated murder of a closely related person (Art. 111, Para. 3 of the Criminal Code) in the period from 1 January 2013 to 1 June 2020. The research primarily focused on the circumstance of previous abuse, especially on the relationship between the victim and the perpetrator, the duration and frequency of abuse, and the reaction of the environment and competent authorities in cases where they knew about the abuse or when it was reported.

C-reactive protein and Neutrophil-Lymphocyte Ratio as predictors of clinical severity of COVID-19

COVID-19 is an infectious disease that can manifest quite differently. In this study we examined the relationship between the value of serum CRP(C-reactive protein) andneutrophil-lymphocyte ratio (NLR) as predictor factors for the development of a severe clinical manifestation in COVID19 patients. Materials and methods: We followed 95 COVID-19 positive patients who were hospitalized at the University Clinic for Eye Diseases - COVID Center. We analyzed the initial laboratory parameters of white blood cells and CRP on admission of the patients and the results of laboratory analyses performed before they left the Clinic, or the last parameters before the lethal outcome in those patients who died. Several models of logistic regression were tested to analyze the predictive value of these markers of inflammation for lethal outcome in patients hospitalized for COVID-19. Results: Bivariate analysis demonstrated that the length of hospital stay was significantly shorter in patients with lethal outcome (p=0.001). The NLR was significantly higher in patients with lethal outcome at both times (p=0.005; and p=0.017). Leukocyte’s count (p=0.046, and p<0.001) and CRP (p=0.013,and p=0.005) were also significantly higher in patients with lethal outcome at both times. The increase on the NLR scale both at hospitalization and at discharge (or the last analysis before death) leads to increase in the odds of lethal outcome (T1:40.4% increased odds; T2:36% increased odds). Conclusion: CRP and NLR are laboratory parameters that can predict the severity of the clinical manifestation in patients with COVID-19.

Surgical treatment of pneumothorax in patients with COVID-19 – results and management

Introduction: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate. Aim: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome. Materials and methods: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021. Results: Seventeen of the patients were men and nine &ndash; women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77&plusmn;12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice. Conclusions: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients.

The role of tumoral stroma in determining the forecast of recurrence and fatal consequence of stage IIA-IIIB colorectal cancer

Colorectal cancer (CRC) ranks 2nd in the structure of mortality from malignant neoplasms (MN). One of the criteria for the prognosis of CRC may be a tumor stroma, which has not been widely used in clinical practice. The aim was to determine the main morphological features of the stroma CRC T3N0-2M0 and search for prognostic criteria for their recurrence and lethal outcome according to the operating material and autopsy. Materials and methods. Group I included primary CRC without recurrence. The average recurrence-free period was 5 years (62.5±16.5 months). Group II – primary CRC with recurrence; IIA – with recurrences within 5 years from the date of tumor removal that did not lead to death; IIB – with the appearance of recurrence and lethal consequence of the generalization of the tumor process within 5 years from the moment of removal of the primary tumor. CRC micropreparations made according to the standard method with G + E staining were studied; immunohistochemical study was performed using monoclonal antibodies to smooth muscle actin alpha. Results. Stromal-parenchymal ratio >50 % is a prognostic criterion for recurrence (p<0.05) and shorter recurrence-free survival (p<0.001) of patients with stage IIA-IIIB CRC. Immature stroma type CRC stage IIA-IIIB is associated with the presence of tumor budding (p<0.001), G3 differentiation (p<0.01), shorter recurrence-free survival (p<0.001); among recurrent CRCs, the immature type of stroma is associated with the lethal outcome of patients (p<0.05). Expressed levels of tumor-activated fibroblasts are one of the criteria for immature CRC stroma (p<0.003), but as an independent prognostic criterion has limited prognostic value. Conclusions. TSR and immature type of stroma are prognostic criteria for recurrence and recurrence period of CRC pT3N0-2M0, more typical of tumors of patients with recurrence and lethal outcome with the same ratio of tumors by differentiation.

Cardiac Function Index as a Possible Target Parameter Hemodynamic Correction in Abdominal Sepsis (Pilot Study)

Aim of the study: to determine the predictive value of central hemodynamic parameters in relation to mortality and evaluate their potential acceptability for goal-directed therapy during days 1-4 of treatment in patients with sepsis.Material and methods. The results of investigation and treatment of 62 patients aged 50.9±2.13 years with abdominal sepsis were analyzed. The patient severity on admission to the intensive care unit was 13 [10-15] on the APACHE II scale, 8 [6.75-9.25] on the SOFA scale. Lethal outcome 15.6±1.4 days after admission occurred in 19 (31%) patients. Central hemodynamic parameters were studied by transpulmonary thermodilution according to the standard technique. Infusions and administration of sympathomimetic drugs were performed according to Sepsis-3 guidelines. Statistical analysis was performed using logistic regression and ROC analysis.Results. The median values of the main circulatory parameters during days 1-4 of sepsis treatment were within normal ranges. Cardiac index, afterload-related cardiac performance, global cardiac ejection fraction and cardiac function index were predictors of mortality at all stages of treatment. However, the first three parameters did not provide either sufficient model quality at the study stages or a stable cutoff value with acceptable sensitivity and specificity. The cardiac function index maintained good model quality (area under the ROC curve 0.708-0.753) and a stable cutoff value (≤5.75 to ≤5.81 min-1) with acceptable and balanced sensitivity and specificity of about 70% at all study stages.Conclusion. The cardiac index, afterload cardiac performance, global cardiac ejection fraction and cardiac function index during days 1-4 of intensive care of sepsis are predictors of lethal outcome. At the same time, only the cardiac function index maintains good model quality and consistent cut-off point value with acceptable sensitivity and specificity at all stages of the study. The feasibility of using the cardiac function index as one of the parameters of goal-directed therapy aimed at cardiovascular function improvement in sepsis needs further investigation.