SPECIALIZED and CONSULTIVE CENTER of FORENSIC MEDICAL SCIENCES in THE M.E. / LEBANON

SPECIALIZED and CONSULTIVE CENTER of FORENSIC MEDICAL SCIENCES in THE M.E. / LEBANON SOCIAL SOLIDARITY & PROSPERITY ASSOCIATION S.S.P.A. NORTH PALACE HOTEL S.C.C.F.M.S. in the MIDDLE EAST / LEBANON S.C.C.F.M.S. SERVICES EXAMINATIONS & METHODS IN SPECIALIZED FORENSIC Guest Book Dr. Guerrero article Photo

S.C.C.F.M.S. Founders.

Dr. Abdul Rahman Annous, pathologist - Medical Expert.

Dr. Mohtassem EL-Samad, General Manager.

Dr. Bilal Sablouh, Forensic Expert - Balist.

TARGETS & AIMS of the S.C.C.F.M.S.

Our center aims at filling the gap that exists in Lebanon because universities, government offices and even medical sectors do not have a center that combines the different and various fields of forensic science. Our modest attempt was followed by creating an awareness campaign on TV, radio and newspapers where our center specialists were hosted on major TV talk shows and were featured in local newspapers discussing the problems, challenges and future directions of forensic medicine. After the tragic assassination of our late prime minister Rafic Harriri in February 2005 and the series of bombs that targeted prominent politicians and innocent people, Lebanon has witnessed a radical change. For the first time, international experts have highlighted the weakness and the absence of professionalism and the technical expertise in the field of forensic medicine and criminology both in the legal system and the Lebanese security forces. Therefore, we were aware that there is an utmost need to build new units and departments that would deal with terrorism issues and would uncover the truth behind all the terrorist attacks and threats that are facing our country. We will benefit tremendously from our expertise and professional experience and relationships to assist in building such an infrastructure in our emerging democracy Lebanon. We are honored to declare our new department of anti-terrorism crime ,we will arrange issues on how to develop this department in order to serve every cause internationally.

Sincerely yours,

Dr. Abdul Rahman Annous

The Names of Ladies and Gentlemen ,Experts and Doctors Consultants Contracted with the S.C.C.F.M.S.:

Prof. Fouad Ayoub, Forensic Dentist.Stamothology.

Pres. Arz Al-Alam. Judge.

Dr.Mohamed El-Jiser. Radiologist.

Dr .Haitham El-Samad. Neurosurgery .

Dr.Khaled Al-Hussain. Rheumatology.

Dr.Samih Barake. Anesthesiology.

Dr.Albert Azar. General Laboratory.

Dr.Noha Fatfat. Gynecology-Obstetrics.

Dr.Hashem Al-Masri. Gynecology-Obstetrics.

Dr. Nazih Khayat. Surgery.

Dr. Bassam Issa . Cardiology.

Dr. Antoine Hayek. Pulmonologist.

Dr. Mustafa Alloush. Surgery.

Phd. Fouad Dabbousi. Molecular Biology.DNA.

Dr. Hatem Al-Monla. Cardio-Surgery.

Dr. Yemen Hwalla. Pediatrics.

Dr. Nataly Yenni.

Dr.Walid Sawalhi.

Dr. Yossef Al-Zhobi. Forensic Expert.

Lawyer. Rashid Derbas.

Lawyer. Mohammad Al-Mourad.

Lawyer. Nawaf Al-Mourad.

Text expert. Ret.capt. Nasr allah Fayad.

Dr. Marwan Shdid. Forensic Toxicology.

Dr. Tatiana Annous. Pediatrics.

Dr.Bilal Sablouh. Forensic Expert.Balist.

Dr. Souheil Raad.

Dr. Mohammed El-Assaad.

Dr. Nadim Al-Ayoubi.

Dr. Louis Ayoub.

Dr. Sabri Tatari.

Dr. Tamim Darwish.

Mr. Nadim Darwish.

LECTURE by Dr. ANNOUS & Dr.SABLOUH

The Direct and Indirect Causal Relation between Injury and Death

by Dr. Abdul Rahman Annous and Dr. Bilal Sablouh,

SCCFMS Lebanon Undoubtedly modern forensic medicine has specified the causal factor between the case and the injury and its direct and indirect relation to the cause of death. This fact makes it inevitable for practitioners, in general, and forensic doctors in particular to define the relation because the fate of many people lies in their hands. Many Forensic schools, especially in the west, have studied this relation. Recently there have been many studies and research findings that have tackled this issue. In this study, we are going to present the most prevailing themes. The causal relation is one kind of realistic relations that is defined by a relation that might be sometimes direct and other times indirect. For this perspective, the doctor always and exclusively has to define the direct causal relation between the injury or the case that the injured person has encountered and the cause of death. It is known that death is rarely caused by external factors but in most cases because of their consequences and complications. For example, when taking organic phosphoric products, death does not occur immediately but after a period of time that might be a week or more because of pulmonary failure. As for the indirect relation, the doctor has to decide it and decide the range of its effect on death. For example, the injuries that require the elderly to lie down for a long period of time might cause hypostatic pneumonia. This inflammation usually occurs because of the lack of ventilation, especially in the lower parts. In the causal relation there are several aspects:

The cause
The patient's situation
The motive

The cause always decides the result. On the other hand, the situation and the motive negatively or positively affect the relation between the reason and the result. For instance, a woman is suffering from chronic diabetes mellitus and is injured during a pedicure session in a beauty salon. After 10 days, symptoms of tissue necrosis and inflammation appear. Although she is treated, she has gangrene in her foot and that leads to the amputation of her foot. This example shows that that causal relation between pedicure and injury is direct. But the relation between pedicure and foot amputation is interpreted in this way: The reason behind foot amputation occurred because of microangiopathy that is caused by diabetes mellitus complications. But the injury that happened because of pedicure was one of the motives that lead to the result (the amputation). Thus, the causal relation between the injury that is caused by pedicure and amputation is indirect. In the cases of death, we should investigate the direct causal relations between all the connected series: the case history of the injury, which has to be logically, reasonably and continuously processed without the occurrence of any external medical interference or other factors that will dismantle the connection. For example, trauma leads to a ripped fracture of skull bone → cerebral edema and wide subarachnoidal hemorrhages → cerebellum dislocation into foramen magnum → heart and pulmonary failure → death. Ruptured aneurysm ↓↓ Trauma leads to a ripped fracture of skull bone → cerebral edema and wide subarachnoidal hemorrhages → cerebellum dislocation into foramen magnum → heart and pulmonary failure → death. In this example, the causal relation between the injury and death has become indirect. The injury played the role of the motive and not the cause. But the cause of the hemorrhages is ruptured aneurysm that might occur in any other situation. To be able to decide the causal relation between the injury and the result, the forensic medical experts must separate between traumatic process (traumatic disease) and several diseases that might have been concurrent or is related to it. Finally, autopsy is like an open book in front of the forensic doctor. There are many ambiguous and obscure cases that are not revealed unless one does autopsy. When it is not done, many secretes remain and are buried with the dead person. These unrevealed secrets might influence the court's decisions and might be used by opponents in the court of law, which might be impossible to reconsider it later on because of the factors that affect the corpse.

S.C.C.F.M.S.

Low Temperature Cause of Death

The Effects of Low Temperature on the Human Body and Death

by Dr. Abdul Rahman Annous and Dr. Bilal Sablouh, SCCFMS

Lebanon

The problem of low temperature and its effects on the human body rarely exists in our geographical area. Thus there are very few in-depth studies regarding this topic in the world in general and in our Arab countries in particular. Due to the scarcity of this case, it is important and useful to have a case presentation on a typical death case that occurred to an anonymous person not a long time ago. Before presenting the case, it is important to give an overview of the effects of low temperature on the human body and try to compare it to our case. The clinical features that appear during the outer examination of the body: 1- The rolling position and it is represented by all the extremities shrinking towards the body. 2- The duck skin. Some dots appear on the pale skin and hair perpendicularly stem out. 3- Sneezing erythema and it appears as small or big marks that are pale red on the skin. 4- Past-mortem hypostasis that has a spread red color or pale violet pink color. 5- Popariv symptoms and it is represented by scrotum contraction and extreme wrinkle and internal invagination of testicles to inguinal canal so that it becomes similar to inguinal hernia. This symptom appears less on people who wear thick clothes. 6- Freezing: The presence of freezing or freezing burns on the external parts of the body like the nose, the ears and fingers. The internal features that appear as a result of autopsy: 1- Morphological changes in the brain. Histochemical examination of the corpse and experimental material analysis proved that: In the case of the death by the influence of low temperature, the glycogen and RNA in the nerve cells of the brain were absent. This does not happen in cases of asphyxia and hemorrhagic shock and others. In addition it does not occur in the cases of low temperature on the brain of the dead person. 2- The color of tracheal and bronchial mucosa is red violet, and it contains foamy muscin. 3- Vishnovski marks and they are hemorrhages in gastric mucosa. And it always exists on the top of the fold of gastric mucosa and particularly on its decline point. Moreover, it is easy to remove through the back of the knife. 4- Fabrikantov sign which is small red mark that varies in number between four and twelve and appears on the calyces. Those marks appear in cases of drowning and asphyxia. 5- The disappearance of glycogen from the internal organs, especially the liver. The case presentation: An unknown person's body was found in winter during a period of heavy storms in which the temperature reached 0/-2C at night. It was found near a river in a mountainous area. The body was naked and it was assumed that the floods have carried it to that place. After examination, it was found out that death occurred around five days ago. The external examination showed the following signs: 1- Freezing erythema 2- post-mortem hypostasis pink violet colored 3- internal invagination of testicles Autopsy was made and the following was revealed: The existence of Vishnovski and Fabrikantov marks and the changes of the color of tracheal and bronchial mucosa. Fragments from all the organs were extracted and were microscopically examined and the following conclusions were made: Stomach: Mucosal and submucosal layers with focal hemorrhages, necrotic changes and inflammatory infiltration. Kidney: hemorrhages and necrotic changes in the calyces and medulla pyramids. Lungs: Focal hemorrhages and necrotic changes with thickened alveolar septum. Myocard: Dystrophic changes in the myocardiocytes. After two days, the dead person was identified and it was found out that he suffers from mental problems. He often used to leave his house and went to unknown places and then was found after long search.

sspa.lebanon@gmail.com