A look at forensic dentistry--Part 2: teeth as weapons of violence--identification of bitemark perpetrators.
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Teeth are often used as weapons when one person attacks another or when a victim tries to ward off an assailant. It is relatively simple to record the evidence from the injury and the teeth for comparison of the shapes, sizes and pattern that are present. However, this comparative analysis is often very difficult, especially since human skin is curved, elastic, distortable and undergoing oedema. In many cases, though, conclusions can be reached about any role a suspect may have played in a crime. Additionally, traces of saliva deposited during biting can be recovered to acquire DNA evidence and this can be analyzed to determine who contributed this biological evidence. If dentists are aware of the various methods to collect and preserve bitemark evidence from victims and suspects it may be possible for them to assist the justice system to identify and prosecute violent offenders. This paper reviews the recognition and recovery of this evidence and provides insight into modern methods used to investigate bitemark evidence from heinous crimes. (+info)
Comparative in vitro activity of ertapenem and 11 other antimicrobial agents against aerobic and anaerobic pathogens isolated from skin and soft tissue animal and human bite wound infections.
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We studied the comparative in vitro activity of ertapenem, a new carbapenem, against 240 aerobic and 180 anaerobic recent clinical bite isolates using an agar dilution method and an inoculum of 10(4) cfu/spot for aerobes and 10(5) cfu/spot for anaerobes. Ertapenem inhibited 410/420 (98%) of the isolates tested at < or = 4 mg/L with only 4/5 Campylobacter gracilis and 1/3 Campylobacter rectus strains requiring . or = 16 mg/L for inhibition. Ertapenem was only moderately active (MIC 8 mg/L) against 4/6 Enterococcus faecalis and 1/11 Staphylococcus epidermidis strains. All Pasteurella multocida, Pasteurella septica, Pasteurella canis, Pasteurella dagmatis, Moraxella spp. and EF-4 isolates were inhibited at < or = 0.015 mg/L. MIC(90)s for other aerobic genera and species were as follows: Corynebacterium spp., 4 mg/L; Staphylococcus aureus, 0.25 mg/L; Staphylococcus epidermidis, 4 mg/L; other coagulasenegative staphylococci, 0.25 mg/L; Streptococcus milleri group, 0.5 mg/L; Eikenella corrodens, 0.03 mg/L; and Bergeyella zoohelcum, 0.5 mg/L. For anaerobes the range of MICs and MIC(90)s were: Prevotella ssp., < or = 0.015-0.5, 0.125 mg/L; Porphyromonas spp., < or = 0.015-0.03, 0.015 mg/L; Fusobacterium spp., 0.015-0.125, 0.03 mg/L; Bacteroides tectum, 0.03-0.125, 0.125 mg/L; and Peptostreptococcus spp., 0.01-2, 1 mg/L. Ertapenem showed excellent potency against the full range of animal and human bite wound pathogens. (+info)
Strangulation injuries.
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Strangulation accounts for 10% of all violent deaths in the United States. Many people who are strangled survive. These survivors may have minimal visible external findings. Because of the slowly compressive nature of the forces involved in strangulation, clinicians should be aware of the potential for significant complications including laryngeal fractures, upper airway edema, and vocal cord immobility. Survivors are most often assaulted during an incident of intimate partner violence or sexual assault, and need to be specifically asked if they were strangled. Many survivors of strangulation will not volunteer this information. Accurate documentation in the medical chart is essential to substantiate a survivor's account of the incident. Medical providers are a significant community resource with the responsibility to provide expert information to patients and other systems working with survivors of strangulation. This case study reviews a strangulation victim who exhibited some classic findings. (+info)
Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments.
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Previous studies of infected human bites have been limited by small numbers of patients and suboptimal microbiologic methodology. We conducted a multicenter prospective study of 50 patients with infected human bites. Seventy percent of the patients and assailants were young adult men. Fifty-six percent of injuries were clenched-fist injuries and 44% were occlusional bites. Most injuries were to the hands. Fifty-four percent of patients were hospitalized. The median number of isolates per wound culture was 4 (3 aerobes and 1 anaerobe); aerobes and anaerobes were isolated from 54% of wounds, aerobes alone were isolated from 44%, and anaerobes alone were isolated from 2%. Isolates included Streptococcus anginosus (52%), Staphylococcus aureus (30%), Eikenella corrodens (30%), Fusobacterium nucleatum (32%), and Prevotella melaninogenica (22%). Candida species were found in 8%. Fusobacterium, Peptostreptococcus, and Candida species were isolated more frequently from occlusional bites than from clenched-fist injuries. Many strains of Prevotella and S. aureus were beta-lactamase producers. Amoxicillin-clavulanic acid and moxifloxacin demonstrated excellent in vitro activity against common isolates. (+info)
Common acute hand infections.
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Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Tetanus prophylaxis is indicated in patients who have at-risk infections. Paronychia, an infection of the epidermis bordering the nail, commonly is precipitated by localized trauma. Treatment consists of incision and drainage, warm-water soaks and, sometimes, oral antibiotics. A felon is an abscess of the distal pulp of the fingertip. An early felon may be amenable to elevation, oral antibiotics, and warm water or saline soaks. A more advanced felon requires incision and drainage. Herpetic whitlow is a painful infection caused by the herpes simplex virus. Early treatment with oral antiviral agents may hasten healing. Pyogenic flexor tenosynovitis and clenched-fist injuries are more serious infections that often require surgical intervention. Pyogenic flexor tenosynovitis is an acute synovial space infection involving a flexor tendon sheath. Treatment consists of parenteral antibiotics and sheath irrigation. A clenched-fist injury usually is the result of an altercation and often involves injury to the extensor tendon, joint capsule, and bone. Wound exploration, copious irrigation, and appropriate antibiotics can prevent undesired outcomes. (+info)
Hand and wrist injuries: Part II. Emergent evaluation.
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Primary care physicians must be able to recognize wrist and hand injuries that require immediate attention. A complete history and physical examination, including assessment of distal limb function, are essential. Hemorrhage control is necessary in patients with vessel lacerations and amputations. Amputations require an understanding of the indications and contraindications in the management of the amputated limb. High-pressure injection injuries and compartment syndromes require a high index of suspicion for early recognition. Infectious entities include "fight bite," open fractures, purulent tenosynovitis, animal bites, and retained foreign bodies. Tendon disruptions should be recognized early to optimize management. (+info)
Forensic odontology: the roles and responsibilities of the dentist.
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Dentistry has much to offer law enforcement in the detection and solution of crime or in civil proceedings. Forensic dental fieldwork requires an interdisciplinary knowledge of dental science. Most often the role of the forensic odontologist is to establish a person's identity. Teeth, with their physiologic variations, pathoses and effects of therapy, record information that remains throughout life and beyond. The teeth may also be used as weapons and, under certain circumstances, may leave information about the identity of the biter. Forensic odontology has an important role in the recognition of abuse among persons of all ages. Dental professionals have a major role to play in keeping accurate dental records and providing all necessary information so that legal authorities may recognize malpractice, negligence, fraud or abuse, and identify unknown humans. (+info)
Best evidence topic report. Are antibiotics indicated following human bites?
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A short cut review was carried out to establish whether antibiotics are indicated for human bites. Eighty nine papers were found using the reported search, of which two represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. Prophylactic antibiotics should be given to all patients with human bites to the hands, feet, and skin overlying joints or cartilaginous structures, and to all patients with bites that penetrate deeper than the epidermal layer. (+info)