FACULTY OF MEDICINE AND PHARMACY HABILITATION THESIS CONTRIBUTIONS TO HUMAN IDENTIFICATION, ETHICAL AND FORENSIC ISSUES Domain: MEDICINE Author:… [311040]

[anonimizat]: MEDICINE

Author: Carmen-Corina Radu

-2020-

Table of Contents

Rezumat

Teza de abilitare este intitulată „[anonimizat]”.

[anonimizat] a autoarei începând cu anul 2006, [anonimizat].

Teza de doctorat cu titlul: „[anonimizat]”, a fost realizată sub îndrumarea prof. univ. dr. [anonimizat] a primit titulatura de doctor în științe medicale.

Mi-[anonimizat], [anonimizat]-o [anonimizat]:

SECȚIUNEA I

-descrie activitatea mea științifică cu principalele direcții de cercetare după susținerea tezei de doctorat și până în prezent (2006-2020).

[anonimizat]:

[anonimizat]-legală a cadavrelor cu identitate necunoscută a [anonimizat]-a [anonimizat]. Un element de cercetare din punct de vedere teoretic asupra căruia autoarea și-a îndreptat atenția a [anonimizat] a victimelor, exemplificându-mi activitatea practică prin cazurile prezentate.

Realizări științifice în domeniul bioeticii

Al doilea capitol al realizărilor știintifice este marcat prin prezentarea aspectelor de actualitate din domeniul eticii în facultăți de medicină și aspecte etice în situații de urgență. Am redat în conținutul lucrării implicațiile aduse pe aceste teme de către cercetările mele științifice.

Etica și în special bioetica a căpătat în ultimii ani o [anonimizat], religioase și legale. Autoarea a subliniat, [anonimizat] o atenție specială.

SECȚIUNEA II: [anonimizat].

[anonimizat] o creștere a [anonimizat] o [anonimizat] ([anonimizat]-Bihar) a [anonimizat]-un proiect transfrontalier „Laborator mobil de medicină legală pentru situații de urgență în zona transfrontalieră”.

O înclinație aparte o reprezintă activitatea didactică care este orientată către student: [anonimizat], [anonimizat]. [anonimizat]: medicină legală și bioetică. Apreciez, că între etică și cercetarea științifică există o legătură foarte puternică, care poate fi privită și ca o intercondiționare reciprocă în sensul că etica poate impune prin voință socială cadrul în care cercetarea științifică trebuie să se desfășoare. Reiese, așadar, că etica poate să constituie un subiect de cercetare aparte.

Eu sunt formată ca medic legist și practic medicina legală de peste 19 ani. În toată această perioadă, m-am implicat în diverse proiecte de cercetare-dezvoltare a acestui domeniu, dar și în domenii conexe. Dintre contribuțiile științifice notabile amintesc aspecte legate de stabilirea unui parteneriat durabil transfrontalier România – Ungaria, în domeniul Medicină Legală, prin intermediul proiectului intitulat „Laborator mobil de medicină legală pentru situații de urgență în zona transfrontalieră”.

În cadrul conferinței „Diaspora și prietenii săi, 2016”, am prezentat strategia de cercetare a Universității din Oradea – Facultatea de Medicină și Farmacie și realizările proiectul transfrontalier a cărui manager de proiect am fost.

Printre alte activități de cercetare se numără participarea în cadrul a 5 proiecte de cercetare științifică din care 3 câștigate: 1 proiect internațional în calitate de director; 2 proiecte în calitate de membru al echipei de cercetare, din care 1 proiect internațional.

Am ocupat funcția de expert consultant extern în proiectul: „Bihor Counties’ Health Care Contribution”; expert voluntar în cadrul proiectului: „Eficientizarea serviciilor medicale prin implementarea unui sistem integrat la Spitalul Clinic de Urgență Oradea”, proiect de tipul POSCCE și implementat de Spitalul Clinic Județean de Urgență Oradea, în perioada 01.08.2010-30.06.2012. În alte două proiecte de cercetare aplicate și necâștigate, am deținut funcția de asistent manager în cadrul proiectului „Program interdisciplinar de abordare a situațiilor de urgență” – Phare CBC 2006/018-446.01.01 România–Ungaria aplicat în anul 2008 și declarat necâștigător, beneficiar fiind Asociația Studenților Mediciniști din Oradea; manager proiect HURO, aplicat în anul 2011 și declarat necâștigător „Forensic processing procedures in emergency situations in the Bihor-Hajdu-Bihar cross border region”.

Am participat la programul Erasmus pentru cadre didactice, grant de predare: asistent mobilitate de predare în perioada 22.09.2014-28.09.2014 Universitatea Debrecen și staff mobility în perioada 21.09.2015-25.09.2015 Universitatea Debrecen.

Atribuțiile mele în implementarea proiectelor au fost extrem de diversificate și anume:

– redactarea de materiale editoriale sau cu caracter științifico-medical;

pregatirea, realizarea și susținerea de cursuri și prezentări de instruire și training destinate medicilor;

prin intermediul proiectului am pus bazele unui parteneriat transfrontalier româno-maghiar în domeniul Medicină Legală;

am derulat diverse activități precum gestionarea resurselor operaționale în cadrul proiectelor, am participat la managementul echipei de proiect precum și a calității proiectelor;

aptitudinile de comunicare în grup și individual, comunicare interactivă și interpersonală au fost dobândite atât prin practica medicală și cea de formare, cât și ca partener în procesul de cercetare, dar și în timpul activității de cadru didactic.

Ca urmare, pot sintetiza că, principalele puncte importante ale activității derulate de mine până la acest moment, sunt următoarele:

promovarea cunoștințelor din domeniile: bioetică și medicina legală prin educație și cercetare;

excelență în cercetare și educație;

implicarea în grupuri de cercetare multidisciplinare;

crearea unor direcții de cercetare care să stimuleze activitățile de cercetare interdisciplinare și transdisciplinare colaborative.

Abstract

The habilitation thesis is named „CONTRIBUTIONS TO HUMAN IDENTIFICATION WITH ETHICAL AND FORENSIC ISSUES”.

This habilitation thesis includes all of the aspects based on scientifically, professional and academic activity of the author since 2006, when the thesis was held, until now.

The thesis is titled „Forensic Pathologist’s Role in Collective Accidents” and was conducted under the guidance of Prof. Univ. Dr. Milan Leonard Dressler and after, the author received the title of doctor in medical sciences.

I structured my thesis in two main sections that are in a tight correlation.

Section I

– A description of my scientific activity along with the main research directions after sustaining the thesis to the present (2006-2020).

In this section, I approached the following research directions:

Scientific developments in forensic identification

Forensic identification of dead bodies with unknown identity became one of the priorities of my research, was developed during several years, materialized through the thesis and publishing a book. A research element based on an ethical view on which the author has turned her attention was represented by the forensic doctor`s contribution in forensic medicine based on the identification of the victims, exemplifying her practical activity through casuistry.

Scientific achievements in the field of bioethics

The second chapter of the scientific achievements is marked by the presentation of current issues about ethics in medical faculties and ethical aspects in emergency situations. I presented in the content of my work the implications made on these issues, along with scientific research.

Ethics and bioethics in particular, had become increasingly important in recent years, often involving social, religious and legal aspects. The author highlighted in some of the publications in the magazines from the index, elements related to medical liability, which deserves a special attention.

Section II: Professional activity

The research activity can only be analised together with the professional activity because my educational and research targets have their origins in my professional education and experience.

Starting from the reality that in the daily forensic medicine activity I identified a raise of numbers of collective accidents, I tried making an approach between Romania-Hungary borders (through counties Bihor -Hajdu-Bihar) about emergency situations, fact that was materialized in a project named „Mobile laboratory of legal medicine for emergency situations in the cross-border region”.

A special inclination is the teaching activity that is oriented towards students, PhD`s and residents. I believe that forming a solid career in any medical specialty consists in professional experience and research. An elite doctoral and residency program with theoretical and practical elements that are actualized and solid structured is what I try to implement in the fields of forensic medicine and bioethics. Between ethics and scientific research there are solid bound that can be seen as mutual inter conditionality, meaning, that ethics can impose through social will, the setting in which the scientific research has to develop. So, ethics can form a particular research subject.

I am formed as a forensic doctor and I'm practicing forensic medicine for about 19 years. In this period, I’ve been involved in various projects of research-development in this field, but in other connected fields as well. A notable scientific contribution was the establishing a durable partnership between Romania-Hungary, in the Forensic Field through the project titled „Mobile laboratory of legal medicine for emergency situations in the cross-border region”.

During the conference „Diaspora and friends, 2016”, I presented the research strategy of the University of Oradea- Faculty of Medicine and Pharmacy and the achievements of the project I named above, whose project manager I got to be.

Some other activities in research are the contribution in 5 projects in scientific research, 3 had won: 1 international project whose director I got to be; 2 projects as a member in the research team, 1 of them was international.

I had the position of extern expert consultant in the project „Bihor Counties’ Health Care Contribution; expert volunteer in the project Efficient health services by implementing an integrated system in the Emergency Hospital Oradea”, POSCCE type of project, implemented by the County Clinical Emergency Hospital Oradea, in the following period: 01.08.2010-30.06.2012. In another two research projects, applied but lost, I had the position assistant manager in the Project named „Interdisciplinary Program to address in emergency situations”- Phare CBC 2006/018-446.01.01 România–Ungaria, applied in year 2008 and was announced as lost, beneficiary being the Association of Medical Students from Oradea. Manager in the project HURO, applied in 2011 and declared lost „Forensic processing procedures in emergency situations in the Bihor-Hajdu-Bihar cross-border region”.

I was a participant in the Erasmus project for teachers: mobility assistant in teaching in the following period 22.09.2014-28.09.2014, University of Debrecen and staff mobility in the period 21.09.2015-25.09.2015, University of Debrecen.

My attributions in implementing these projects were extremely diversified:

– Wording the editorial materials with scientific-medical character;

– Preparing, realizing and supporting courses and presentations of trainings addressed to doctors;

– Through the project I succeeded to rise the partnership between Romania and Hungary in the Medical Field;

– I unrolled a variety of activities like questioning the operational resources in the projects, participated in the project team`s management and in the maintaining the quality of the projects;

– Communication aptitudes in groups but also as an individual, interactive and interpersonal communication were acquired through medical practice and forming practice, but also as a partner in the process of research and during the activity as a teacher.

As a conclusion, I can synthesize that the main points of my activity until this moment are the following ones:

– Promoting knowledge in fields of bioethics and forensic medicine through education and research;

– Excellence in research and education;

– Involvement in multidisciplinary research groups;

– Creating directions of research that can stimulate collaborative interdisciplinary research activities.

Section I

RESEARCH ACTIVITY

A short autobiography

My short and long-term research objectives originate in my education, professional and research experience. I am trained as a medical examiner and I have been practicing legal medicine for more than 19 years.

During this entire period, I've been involved in various research and development projects, as well as related areas. My attributions in project implementation have been extremely diversified, as follows:

– Drawing up editorial or scientific materials on legal medicine and or other medical fields;

– Preparing, drawing up and defending classes and training presentations for physicians;

– Presenting scientific opinions on topics such as forensic identification, emergency situation;

– I have developed various prevention and intervention protocols in emergency situations, or in cooperation with various relevant organizations, whereby multidisciplinary intervention teams have been set up;

– I have taken part in the training of experts in medico-legal identifications, courses held by invited professors: Michel Perrier and Thomas Krompecher from Switzerland – Lausanne, where I've been involved for more than 2 years.

Therefore, I have coordinated my research activity considering the following major strategic directions, which will be also envisaged in my future research activity, with further directions being added subsequently:

Collaborative research, mainly aiming at reinforcing the impact of my research, by developing the relations between our researchers, public institutions, governmental authorities and community at large, across the times.

Therefore, in the medium and long run, I shall keep on improving our research performance through investment in excellence and by exploring new and innovative cooperation methods, that will ensure the achievement of high quality results in research, closely related to national and international research priorities. My position is to encourage the increase of co-participation in investments in research efforts, as well as to increase cooperation in research projects, in accordance with the collaborative model currently in progress in Romania. To this purpose, my strategy is based on the organization of interdisciplinary research groups and due to the geographical position of the county, a cross-border research (Bihor-Hajdu-Bihar Counties).

Scalability and focus: My activity has aimed at supporting the scalability and focus in research strategy; therefore, I must be selective in investments with long-term benefits. While these initiatives will keep on being encouraged and supported, a relative priority for me will be passing from punctual initiatives to wide-scale research initiatives.

Research with an impact, meaning that, in accordance with my short-term goals, my priority development and reinforcement fields in the upcoming years will be mainly represented by the research in forensic identification and bioethics field with multiple medical and medico-legal consequences.

The priority research directions we have followed and developed along these years have been:

Research in Forensic Identification

Research in Bioethics

Chapter I

1.Research in the field of Forensic Identification

1.1. Introduction to Forensic Medicine and Identification

History

The genesis of identification begins with the year 66 a.C., during the reign of the Emperor Nero Claudius Caesar Augustus Germanicus. His mistress, Sabina, sent her soldiers to kill the emperor’s wife, wanting a proof: her head on a tray. She recognized the head by identification of a black frontal tooth. Later, in 1775, Paul Revere identified the victims of The United States of America’s Independence War by teeth and prosthetics works.

The father of forensic identification was Oscar Amoedo, a Cuban man that returned home in 1889 after finishing studies in New York City. In 1980 decided to move to Paris, where he worked as a dentist and University Professor. A firework during a charity event stimulated his interest in dental identification and dental-forensic identification field. Even if he wasn’t directly involved in the identification process of the bodies at that event, he wrote a paper about the importance of dental identification, which he presented at the International Congress of Moscow in 1897. Oscar Amoedo wrote a paper, named “The dental art in Forensic Medicine” which was his doctoral thesis and the basis of the book with the same name, published in 1898. The book that he wrote was the first one from the dental-forensic identification field, that’s why he is named the father of dental-forensic identification.

The first identification with help of dental structures reported in India was in 1995, when M. Raja Jayachandra Rathore de Canouj, a well known king of the history of India, died disfigured n on the battlefield in 1991; his body was identified by his prosthetic work of the anterior teeth. Until present, studies are talking about the techniques of dental identification, but many aspects (used materials, resistance, friability, costs) are still in the research stadium. Examples continued to show up, and the dental-forensic identification being completed in the past years with the ADN analysis that is also used in forensic medicine cases.

Forensic medicine is recognized as a science with application of medical knowledge and methodologies to legal questions. It has been used in law cases (i.e. criminal, civil, work, family and administrative) for more than 1000 years, but only in the early 19th century it was established as a specialty. Its field of study involves: observation, documentation, collection, assessment, scientific interpretation of medical data, and identification. Core branches in forensic medicine are Clinical Forensic Medicine and Forensic Pathology. Other specialties are: forensic odontology, forensic anthropology, forensic toxicology, forensic genetics, forensic psychiatry and forensic thanatology. The field of study involves: observation, documentation, collection, assessment, scientific interpretation of medical data, and identification.

Research on forensic identification, has been one of my research priorities, subsequently materialized in my doctoral dissertation. The research was initiated and conceived along several years, both as an extensive approach regarding a significant number of subjects, and as an intensive approach.

The mechanism of identification is looming a comparative study. Any information we acquire from the examination of the body, we have to compare it with ante-mortem data of the deceased. The fundamental occupation of forensic identification are the violent deaths, sometimes non-violent deaths, the suspicious deaths, deaths of unknown cause, deaths in institutions or in custody, deaths which happened during surgery or anesthesia and deaths occurred when no medical assistance has been provided.

1.2. Justification of the research topic

Identification is essential for different reasons: for affectivity reasons; the family wishes to have the body of the beloved back when a tragic incident has occurred, or if a body has been missing for a very long time the identifications can finally bring peace and relief to the family, for monetary reasons; settlements of legal claims as e.g. in heritage and life insurances cases, assistance for cases in court, payment of pensions or other benefits, all for which a death certificate is needed, for marriage reasons; a person cannot remarry unless its partner is positively confirmed dead, for burial reason; several religions require a positive identification certificate in order to bury the deceased in geographical places, for statistics and official records, for criminal purposes; a criminal investigation is not allowed unless the victim is positively identified. The necessity of identification is very crucial when the dead body is burnt, decomposed, mutilated or skeletonized.

1.2.1.The autopsy, an important identification tool

The autopsy has always been the primary post-mortem method to examine a dead body in order to determine the cause, the time and the type of lesions on the body, internally and externally. Autopsy, which is performed by the forensic pathologist, is also frequently used for identification of the dead person. If a weapon is the cause of the death (violent death) and the individual is unknown, a forensic pathologist examines the wound on the corpse and may tell the type of weapon that has been used and in what context. An example is a gunshot. By examining the wound the forensic pathologist can with precision tell the range and the angle of the fire. By further investigation performed by criminalists, the origin of the weapon can be traced and contribute to the identification of the body. Forensic medicine has played a very important role in the process of the identification of victims in mass disasters, e.g. plane crashes, massive train accidents, earthquakes, typhoons, tsunamis, etc. In court cases where insurance and inheritance issues have to be settled, forensic pathologists have presented the cause of death and identification data, thus making a significant contribution to the court outcome.

But, the necessity to perform a medico-legal autopsy and to legally establish the identity of the victim comes often to a situation of conflict of family beliefs. You may have a tricky situation where the family opposes an identification method, either because they simply don’t want their beloved to be anatomically dissected, or their religious belief, culture or moral principles require another approach. A typical example is when a Muslim or a Jew due to religious teaching must bury the body as soon as possible after the death, thus forbidding any voluntary autopsy as a disgrace for the deceased. There are though situations where the religious leaders accept autopsies. Another problem is that Islam and Judaism advocate the burial of a complete body. This can cause some difficulties for the medical examiners when they want to take samples of the body for investigations but at the same time show respect to the religious beliefs and ethics of the family. Even though the Christians do not support or recommends autopsies, they do not fiercely object them. All these external parameters have to be respected and taken into consideration in an appropriate way but at the same time not avoiding the professional work of the forensic examiner.

1.2.2. Dental identification in Forensic odontology/Forensic dentistry

Forensic dentistry has a primordial role in the identification of body leftovers, when post mortem modifications occur (putrefaction, terrestrial fauna, and so on), or complex lesion pictures which alter the face, but also when digital prints are not in the population evidence. The analysis of dental rests or prosthetic works are very important when the unidentified body is skeletonized, decomposed, carbonized, disintegrated. The main advantage is that because of the hard tissue and the localization (oral cavity), dental rests and prosthetic works are more protected than other anatomical structures. The fundamental principles of dental identification are those of comparison and exclusion (reconstructive). The comparative identification between ante mortem and postmortem registry is used in the case of a body that has a dental chart at a certain dentist, and death circumstances suggesting the victim identity. The exclusion principle is applied when on the surface of a prosthetic work in the oral cavity exists a mark that gives information about the body’s identity. There are situations when the principles are corroborating, giving exact information and lowering the time of identification. The availability and accuracy of these registers determine the success of forensic-dental identification, in the absence of these data and the presented circumstances, identification becomes impossible. Dental-forensic identification is using the dental methods with reconstructive identification (age, sexual dimorphism, rugoscopy, cheiloscopy, glossoscopy, and so on) and comparative identification (dental bite) that is using in identification of the body, and also in that of the aggressor. Each of these methods are wise, practical and helpful, adapted in a series of conditions and visioning utility, specificity, applicability. These methods brought controversy in time, the researchers tried to minimize their limits, by observing their efficiency.

Forensic odontology/Forensic dentistry is a branch of forensic medicine and was defined in 1970 by the Danish forensic dentist Keiser-Neilson as “that branch of forensic medicine which in the interest of justice deals with the proper handling and examination of dental evidence and with the proper evaluation and presentation of the dental findings”. It especially focuses on the anatomical, morphological and structural features of the dentoalveolar component. It is an interdisciplinary field, whose expertise is shared by forensic pathologists/physicians, anthropologists and criminologists.

Dental identification relies on the concept of studying the so called unique features of the teeth and has become a crucial forensic tool in identification purposes, especially in mass disaster, like e.g. earthquakes, air crashes and tsunamis, where it impossible to recognize the deceased. It is also used in situations when family members are not able to recognize the dead body by visual identification. This method has successfully been applied in severe mass disasters. In many other occasions this method has successfully been applied in crime investigations, for decomposed and disfigured bodies, e.g. in drowning, fire, and severe motor vehicle accidents.

Dental impressions were used for identification purposes already 130 years ago. At the end of 19th century this method was implied as a proof of evidence in the service of justice after disasters with large numbers of deaths. One example of this was fire of the Ring Theatre in Vienna (1881). After the Second World War forensic odontology experienced a rapid development, due to the urgent need to identify victims found in mass graves and in naval, air and rail disasters. This method was used for the teeth remains of Adolf Hitler and Eva Braun from the end of World War II. Since 1949 forensic dental evidence is accepted as a scientific method and therefore used as evidence in court cases. It came to be a crucial identification method in the New York City World Trade Center bombing. The traditional gold standard methods based on dental records as dental restoration, prosthesis and radiographs are facing new competitors today. Molecular biology has offered more accurate, effective and efficient techniques in DNA profiling of teeth. DNA is proved to be a very successful identification method in examining the pulp of the tooth. The enamel and the dentine are very good materials for DNA genetic type analysis. The pulp of the tooth is like a sealed box protecting the DNA from extreme environmental stress.

Four steps of dental identification:

Oral autopsy

Obtaining of ante-mortem dental records

Comparing ante mortem and postmortem dental data

Writing a report and drawing a conclusion.

Five objectives:

Identification of unknown bodies and human remains by examination of teeth, jaw and craniofacial bones

Recognition of the victims of mass disasters and criminal investigation

Estimation of age of the deceased

Assessment of bite marks on the corpse after e.g. an attack or on other material substances like e.g. wood and food stuff. The principle of bite mark analysis is also used to identify marks produced by the use of weapons

Investigation of family violence. Cases of marital, children and elder abuse are in included here.

Dental records and dental identification methods

Postmortem remains of dental origin are subjected to comparison with ante mortem dental records: written notes, drug prescriptions, clinical photographs, referral letters, study casts/models , radiographs (single, panoramic) etc. It has been shown that it is easier to identify an individual who had major restorative treatments, than another who had minor or no dental treatments at all. Here follow a number of radiography techniques met in dental identification. The following dental identification methods based on the use of teeth, upper and lower jaw and oro-facial characteristics:

Dental x-rays. Dental x-rays form the basis for a dental formula, which is recorded as a fraction-line arrangement; the numerator indicates the number of maxillary teeth (upper jaw) and the denominator shows the number of mandible teeth (lower jaw).

Retro alveolar radiography provides data on topography, morphology, dental therapy as well as structural features of the maxilla and mandible

Panoramic radiography has the following advantages: provides an overview of the dental apparatus, indicates the actual age of children and teenagers, shows the root development of the last mandibular molars, and the alveolar age of the adult. The panoramic radiographic technique is combined with manual x-rays to determine the actual age;

Lateral cephalometric radiography is the method that most accurately describes the craniofacial pathology

Instant x-ray of positive-negative type is using Polaroid technique and provides instant digital images of the bone structure. Especially it is used in mass disasters where there are a load number of bodies, in remote places where there is no access to radiographic centers.

Occlusal/palatal x-ray is performed on the cadaver after separating the maxilla and mandible from the rest of the cranium. It shows all the teeth in the upper and lower jaw in one shot. At the same time the film is picturing the biting surface of the teeth.

Dental impression provides data on the morphology of the teeth and the alveolar arches

Black/white and color photos are done with mirrors placed in the mouth. They highlight the labial surfaces of the teeth and the dental occlusions as well as the relations between the dental arches in the occlusions.

Dental and prosthetic markings: the dentist marks its work by printing a code number at the bottom of the cavity prior to dental fillings.

Source: Radu. C. et al. The administration of the risk factors in emergency situations- The victim’s identification. Analele Universității din Oradea, Fascicula: Protecția mediului (2007) vol. XII

Free translation: Table no.1 (above) Temporary dentition right and left, superior and inferior

Table no.2 (below) Permanent dentition right and left, superior and inferior

1.2.3. Nuclear DNA identification (DNA typing/DNA printing)

Blood typing versus nuclear DNA printing

Blood typing was a very used forensic tool before the introduction of DNA typing. However it was found that 30% of the American population had type A positive blood group, which means that if this blood group was found at a crime scene, then this could come from 30% of the population. DNA analysis on the other hand showed excellent discrimination properties. DNA typing is today considered one of the most powerful identification techniques. Except for identical twins, the chances of similarity in DNA are believed to be infinitesimal. Before the routine use of DNA profiling, blood typing was an important forensic tool.

nDNA printing technique

DNA printing is a technique which chemically divide the DNA molecules into fragments, forming a so called “identity profile”. This profile is then matched with e.g. the suspect’s blood specimen. If these profiles are matching, there is one chance in 30 billion that the DNA is not coming from the same person. Therefore DNA printing is of great statistical significance.

DNA is found in all nucleated cells in the body and can be extracted from the victim’s own body; blood, saliva, semen, vaginal epithelial cells, tooth pulp, hair roots, muscle, skin, mucous membranes, bone marrow, from close relatives of the victim; parents, children, siblings, from the victims person items; tooth brush, dirty laundry, comb or from the crime or accident scene.

Major applications of DNA analysis in body identification

Missing persons investigations- standardized collection kits are made in order to collect family reference samples for comparison.

Disaster victim identification (DVI), absence of traditional anthropological and other physical characteristics

Offender DNA data basing

Forensic DNA casework – matching known samples to unknown samples

With nuclear DNA each body piece can be identified and does not require intact features, e.g. fingers, jaws etc. Even if the remains are mixed of different individuals it is still possible to separate them and identify them. Disadvantages with this method are that environmental factors, as heat, humidity and acidic soil can under longer period of time degrade the DNA. Nuclear DNA identification is relatively expensive for the budget of many forensic offices and time consuming (several weeks). As with fingerprints most people do not have DNA records collected in a database.

1.2.4. Forensic Anthropology

Forensic anthropology is the application of physical (biological) anthropology for legal purposes. Its field of study is anatomy and osteology (skeletal biology), it strictly deals with human remains and bones and uses techniques only related to these two.

It is an interdisciplinary study involving; osteologists, forensic pathologists and homicide investigators in order to determine sex, gender, stature, age, and even the circumstances of death (ABFA website 2007) of individual victims as well as victims of genocides and mass disasters. The collected data from the analysis is then used in trials and other legal proceedings. Forensic anthropology is very often the last resort in identifying unknown bodies.

The activity of a forensic anthropologist includes:

Assistance at the crime scene by collecting human remains

Clean-up of the bones so that they may be looked at

Analyze of skeletal remains to establish the profile of the individual

Look for a trauma evidence on the bones to establish the pathway of a bullet or the number of stab wounds

Work with a forensic odontologist (dentist) to match dental records

Testify in court on the identity of the individual and/or the injuries that might be evident in the skeleton

Technology and costs

The last two decades forensic sciences have experienced a high-technology boom with new insights in the different forensic disciplines and new and more modern techniques have been introduced for identification purposes of dead bodies. This development has especially been evident in the United States and in European Union countries as e.g. Sweden and Netherlands. Their state forensic laboratories are now more equipped with investigation facilities and services in order to keep a high performance technology approach in the analysis of e.g. fingerprint and DNA, firearm ballistics, forensic chemistry. Better centrally coordinated operational procedures are applied, more practical logistical approach to statistical analysis, better sampling and collection of evidence, a baseline records for identification of victims from wars, natural mass disasters. Extended forensic logistics service is engaged i.e. GPS equipped vehicles, devices with tagging and locking systems with better collection and delivery to the police authorities all over the country and employed drivers who are security cleared. In the framework for European Union cooperation new methods in forensic medicine and science have been developed and promoted, and close contacts between the forensic science institutes have been established.

Forensic scientific identification methods – expensive

Forensic scientific identification is requiring huge funds in order to meet the scientific preciseness of e.g. forensic labs with their new high performance techniques, highly qualified employees and advanced logistics. The American Congress received a report by the National Criminal Justice Reference Service, stating that the American Society of Crime Lab Detectors made a cost estimation of 18 million dollars for the running of the 50 largest crime labs in the United States; trace evidence, firearms, questioned documents, toxicology, controlled substances. Today most forensic labs and other departments of forensic activity are owned by each country’s government and are financed by taxpayers. Therefore there is a pressure on the forensic actors as scientists and other forensic specialists to keep the costs low, by using more low-cost methods and equipment. More private labs and private forensic activity are competing in prices leading unfortunately many times to inaccurate and imprecise results with false convictions and false identifications.

Several countries governments worldwide do not have enough financial resources to invest in high-performance technology, thus leaving forensic medicine still with old facilities’ labs, lack of necessary machines and qualified personnel, bad maintenance of computer systems, understaffed departments, lack of centrally organized database systems for DNA and fingerprints. Due to high costs, the forensic examiners often have to rely mainly on visual identification, which is on one hand very cost-effective but on the other hand has the disadvantage of being a presumptive and an invalid legal testimony in court.

Forensic pathology examination -cheap and invaluable

Forensic pathology is probably the most important field within forensic science. Its major tasks are to establish the type of death (e.g. if it is non-violent or violent), the cause of death, i.e. the actual injury or disease that lead the death (e.g. a gunshot), the mechanism of death (e.g. death because of severe blood loss), the manner (e.g. suicide), the time of death and finally the identification of the deceased.

The forensic pathologist should be provided with the essentials:

First, a system of qualified forensic pathologists on a national basis.

Second, an office with adequate and qualified staff, i.e. administrators, investigators, technicians and secretaries. It is often that a forensic pathologist works alone with only his/her assistant in the examiner’s office. Often there are not adequate facilities and the forensic pathologist has only a spare room in the basement of the cemetery building to his/her disposal. Decent working conditions should be provided with enough space, i.e. a proper floor plan, cooling and ventilation systems.

Third, every forensic pathologist should have access to adequate and high quality instrumentation in order to make a scientific examination of the deceased. Even though x-rays in the autopsy room are considered a luxury for many forensic budgets, it should be baseline equipment for the forensic pathologist. Other basic requirements for the forensic pathologist are the autopsy suite and a toxicology laboratory where precise and accurate drug examinations can be performed.

Fourth, a developed system of computerization with regular maintenance is necessary.

Too often, due to financial restrictions the above standards are not reached, thus putting more time and energy constraint on the forensic examiner. In the long run, this means increasing risks of mistakes, inaccurate and imprecise results and finally erroneous forensic testimonial. A well-functioning forensic pathologist examination system is relatively cost-effective and beneficial if you compare it to the expenses and consequences of medical and legal errors. It is absolutely necessary to achieve an accurate identification of the deceased, not only for for the ease of the family but also for legal purposes in order to make correct convictions.

1.3. Concrete results of this research until 2020 can be quantified as:

A. Projects:

• Project coordinator for the project: ”Mobile laboratory of legal medicine for emergency situations in the cross-border region”.

Project HURO 0801/153 is a project implemented in Hungary-Romania Cross-border Cooperation Programme 2007-2013. Clinical Emergency County Hospital Oradea – RO (Lead Partner) in partnership with University of Debrecen – HU (Project Partner), implemented the project in the period 15.12.2009 to 14.01.2011.

Purpose of the project:

Was the common approach of trans boundary emergency situations created by the production of collective traffic accidents in the Bihor-Hajdu-Bihar area by developing common mechanisms for these situations requiring quick reactions and interventions.

Formation of the nucleus of the intervention team consisting of: pathologists, attorney, orthopedist, radiologist, dentist, mentioning that they are members of the project team.

Informing and raising public awareness of the dangers represented by emergency situations

The project team was made up of forensic doctors from the two border regions; from the Department for Forensic Bihor, where Doctor Radu Carmen served as project manager.

Within the project we organized academic training

“Forensic aspects of emergency situations” from 05/11/2010 to 05/15/2010 was held in Oradea, vocational training course conducted by a specialist in emergency situations, Professor Thomas Krompecher from Switzerland. Subtasks involved course work and training seminar setting, Questionnaires were developed for assess activity, attendance, prepared PowerPoint presentations by the project manager. The course was attended by over 100 participants, project team, consisting of representatives of target groups, local public institutions and institutions involved in emergency management and doctors of various specialties. Doctors participants received a participation diploma course (the course was credited with 18 hours EMC), folder, material presented on paper, have completed an evaluation form. Activity was announced in the weekly press Together Business in appearance from 19th to 25th of April 2010 (simultaneous communication model, transmission model, collecting paper, archival paper). In Hungary trainings continued over 5 days.

”Intervention protocols in collective accidents” (credited with 6 hours EMC) held on 13 January 2011 consisted in drawing interventional protocols for emergency situations caused by road traffic, railways and plane casualties, also a protocol for identification of victims of collective accidents. After extending the implementation time of the project with a month, we made conferences to promote the interventional plans that we did and the project. At the conference were present the project team members and forensic doctors from counties as Arad, Satu-Mare, Timis, Bistrita-Nasaud, Caras-Severin, Cluj, Salaj.

B. Works published in scientific journals:

„General Aspects Regarding The Management Of Disasters”, Carmen Radu, Dalea Atanasie, Analele Universității din Oradea – Fascicula Protecția Mediului vol. 12, anul XII, Editura Universității din Oradea, 2007 ISSN 1224-6255 pg. 236-240

In this paper are mentioned the operations at the identification center:

1.Body reception at the morgue

It is essential that in every collective accident all the bodies to be received at the same morgue. The identification center can be organized in the nearest morgue from the disaster site, with the mention that one can organize a temporary morgue even in a hangar, skate ring, warehouse, military facility, etc.

At the morgue the reception team formed of coroners, police officers, and medical students will receive each body.

Reception team’s tasks:

Will hold a special register where they will note the number of the body and the arrival hour at the morgue;

Body inspection and taking picture of the head and face (2 pictures and one will be sent to the victim registration office);

Detailed inventory of each item and putting them in plastic bearing the number of the body;

External examination of the body, noting the general signs (according to the preservation condition of the body): waist, age, sex, various details, infirmities, scars, surgery signs, color and length of the hair, tattoos.

Depositing the bodies and the corpus delicti

In case the identification center is organized in a morgue, the bodies are put in refrigerators, according to their capacities; if it is about other locations they are placed in parallel rows, with at least 1,5 m between them to ease their manipulation.

The evidence and corpus delicti will be packed, labeled and sealed.

The sealing specifies the integrity of the evidence; on the superior part of the plastic bags it is to be made 3 cm fold which is to be refolded and secured with an isolating tape. When the evidence need to be refrigerated or frosted they are put in special refrigerators, with the mention that the corpus delicti depositing belongs to the police.

The body autopsy

All the data obtained during the autopsy must be discussed with other specialists and must be compared with the information referring to the conditions of the accident. Only a good collaboration between the coroner, anatomist-pathologist, toxicologist and the persons investigating the case will offer results in establishing the cause of the accident.

The reception of the relatives

A team will be made containing: members of the Red Cross, social assistance, psychologists, volunteers, priests whose assistance may be good for the relatives.

Cooperating with other agencies

The need of collaboration with other agencies has already been indicated as being essential for a proper investigation.

Mass media may be of great help in publishing some emergency telephone numbers, some photographs and in describing the deceased and unidentified persons.

In order to prevent the publishing of incorrect details it is essential for the press to have access to information. Therefore, it is important to organize a press office for each accident and assigning a person to bear the responsibility of offering authentic information. We must mention the fact that the press will not have access in the working halls, waiting rooms and autopsy rooms.

The victim office must be installed early for each incident and will hold the information regarding the hospitals that had received injured people, their identity, the situation of the morgue and of the bodies received here.

In march 2006, I published in the Romanian Journal of Legal Medicine the article entitled: „Identificarea cadavrelor cu identitate necunoscută rezultate din catastrofe și accidente colective” [Identification of unknown cadavers from mass disasters and collective accidents], Radu C., Mihalache G., Buhaș C., Revista Română de Medicină Legală, vol. XIV, nr. 1 march 2006.

This writing highlights the forensic field as follows:

General concepts on the forensic identification

The structure of the Identification Center.

The center will be leaded by a person with a vast of personal and professional experience in the field of forensic identification (usually a prosecutor) who subordinates a team of heads of departments involved in the identification process. The identification center should be divided in two sections: one for gathering of the information about the victims (ante-mortem) and another one who collects information by examining the death body (post-mortem). The research team is form by:

Forensic doctors who fills the identification files, perform the autopsies (in collaboration with the criminologist), takes samples for the lab examination, establish the cause, time and circumstance of death and the existences of other lesions;

Police officers who interrogate the witnesses;

Criminologists who intervene in the process of the external examination, takes fingerprints, collect samples and takes pictures of location;

Other specialists like plasticians, orthopedics, and dentists.

Identification methods:

Must be mentioned that the identification process is not supposed to be separated from the full investigation of the disaster, but to be a part of this. For an accurate identification it has to be noted the data ante-portem and post-mortem gathered from examining the clothes, jewelry, personal goods and internal/external examination of the body.

Visual identification – is a relative method, which is done by the family members or closed friends, and in many countries are the only accepted criteria. In many situations, the results of this approach have been proven to be resilient, so that the identification to be accurately we need combined methods, not only the simply visual identification.

Personal goods – the description of the clothes, jewelry and the pockets and purses content is fully necessary to be mentioned. This description can provide substantial evidence of the identity but is never definitive.

The external examination of the body- is generally accepted that the identification of the bodies with unknown identity is based on physical evidence, obtained from the external examination. The description of the physical characteristics is made by a police officer in collaboration with the forensic doctor. This will specify the gender, age, height and the development of the musculoskeletal and adipose tissue, the color of the skin and will be remembered that some characteristics like the color of the hair and the eyes can have measure of subjectivity in the description leading to non-accurate conclusions. Specific features like tattoos, scars and other abnormalities are usually unique and must be compared with the data ante-mortem.

The internal examination of the body – in some countries the identification of the bodies and establishing the cause of death is made only by external identification, the autopsy being made only if the identification is impossible. Because of the fact that the natural disasters and collective accidents are events with general spreading, is needed a standardization of the autopsy methods, not only for identification and to specify the cause of death, but also for preventing and mitigating their effects. By doing the autopsy will be taken blood samples for the examination of the blood type, CO levels, alcohol level and drugs, tissue samples for the microscopic, serological, histopathological and toxicological examination.

Odonto-stomatology identification is an important method for identification and is done by examining the teeth, maxillary and mandible, soft tissues and prints from the delict object or other bodies.

Genetically identification is the most certain method of identification, being well known that the genetic material is unique for every human being, and it could resist even after death. Also this method needs comparing data ante-mortem or the genetic profile, which can be determined using the biological material obtained from relatives.

In the issue, I appreciated that the conclusions can be from one of these categories:

Positive identification (certainly)

Probable identification

Unidentified (in this situation all the information gathered about that body will be kept so that could be identify at a later date).

The autopsy that is made by the forensic doctor is used often for identifying the corpse, being always the most important method to examine the body to establish the cause and type of death and also the moment when the external and internal injuries could have been produced. For example, if a weapon is the one who produced the death, the forensic doctor can specify what was the type of weapon used and the circumstance. By examining the injuries the forensic doctor can differentiate the range and the angle of the fire. Corroborating the data from the police officers, the origin of the weapon can be detected, and this can lead to the identification of the body.

The forensic field had an important role in the identification of victims in mass disasters like plane crashes, massive train accidents, earthquakes, typhoons, tsunamis; so, in court where the inheritance and insurance issues are established, the forensic pathologists are the ones who detailed the cause of death, contributing in this way to the processes verdict.

„The administration of the risk factors in emergency situations–the victim’s identification”, Gabriela Radu, Radu Carmen, Lajosi P., Dalea A., Analele Universității din Oradea – Fascicula protecția mediului vol. 12, Editura Universității din Oradea, 2007 pag. 247-251

According to this paper the Forensic Odontological Identification, represents a used method in the following situation: bodies in corruption, carcasses, dead bodies (having the head part), unknown deads, and situations when it is necessary the verify of identity (e.q. murder), when are storus or flood, or even calamities.

The identify process includes some specific levels: the preparing when the dentist will be informed about the case; the post-mortem examination (oral autopsy) when they can find 3 different situations: bones, carcasses, burned bodies, disabled bodies, identifiable bodies; the obtain of the recorders for the before death dentition; the comparison between before and after death information; the final report.

It is important to be a mixt team for the identification of the deeds, a team formed of forensic doctors who complete the identification acts, made the extern consultation of the death body (together with the team of criminal police), they establish the cause of death, discover the wounds, necessary elements for identification (old brokers, treatment marks). They assure the collection of the marks and prove for the lab. The policeman ask the witness, examine the material proves; the criminalists examine the external body, take amprents, photos, work together for the painting of the portrait; the dentist make the x-rays of specialty, collect necessary pieces, write the existent date in specific formularies; other specialists like surgeons, plastic surgeons, anthropologists, man of lab’s.

Because of the resistance of the dental structures, even in severe disables (e.q. carcasses, burned bodies) the forensic odontological identification represents a good method of identification.

In 2015, I published the article entitled: „Environmental Factors that influence Forensic Anthropological Identification”, Carmen Radu, Dan Perju-Dumbravă, Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XIV/A.

This article had the role to highlight the importance of the environmental factors that can change quickly and essential the corpse and the medico-legal expertise.

The forensic anthropology is based on anatomy and osteology, studying the human remains and the bones using the propitious methods. For this kind of study is necessary the collaboration between osteology specialists, forensic doctors and police investigators; this closely collaboration leads to the identification of humans, which includes the identification of gender, height, age and circumstance of death. All these data are used in low process or other legal procedures.

Fundamental, the first stage to identify a corpse is to analyze the bones, which was proved to be an extraordinary information source. Starting with the skull, which can give us a lot of data that orientates us finding the gender or age, trough other bones, like the hands for example, that could have increased areas who indicate that person worked hard with the hands. Also the skeletal abnormalities, the dental formula and the surgical interventions are part of the interests of anthropologic specialists.

A basic mechanism used in identification is Bertillon method. Is an anthropometric technique that uses photography? This process had lead to the modernization of forensic identification methods.

Facial reconstruction is a traditional and non-scientific identification method that is used when no other method gives results. This requires a fine balance between science and art, because in the present there are new techniques that can make possible the CT scan and 3D reconstruction.

Forensic identification is one of the juridical and legal problems that occur more and more frequently in the field of forensic pathology and criminology. Beside the modern DNA techniques, the classic and on-the-place methods are quick and have a rapidity that helps the work of the police and prosecutors giving them clues and starts. That is why these methods used in identification are still and will be still in use. In these quick and essential identification methods, the environmental factors have a major importance, because they can change the aspect quickly and essentially.

This paper highlights this aspects, and is a reminder of the importance of the study of the factors of the medium on the decomposition of the body.

I concluded that, the medico-legal identification is one of the major problems from our domain but also in the criminology field. Even if we use the described methods, the environmental factors have an exclusive role.

„The Importance of Environmental Factors in Visual Identification”, Carmen Radu, Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XIII/A, 2014 pag. 211-214

Visual identification is the most common worldwide used identification method. It is cheap, easy and used when no other method is available. It has its limitation as it can only be used when the body is fresh and intact. When there are severe alterations of the body this method are not appropriate, and visual identification can not considered a positive identification method should be confirmed by scientific identification methods.

In order to interpret the data, obtained by examining the body, and to continue the identification of the corpse, the first step that has to be done is to recognize the primary and secondary physical characteristics of the deceased.

Primary physical characteristics:

Some of the primary characteristics could change after death. For example:

height: it can change by becoming 2-3 cm longer post-mortem, because the muscles relax;

sex: usually is quite obvious, but sometimes we can find ourselves in difficult situations like in the cases of hermaphrodites and adreno-genital syndrome or transvestites. Other cases like mutilated or charred bodies are also special circumstances, where to the female the uterus or cervix, and to the men the prostate could be quite resilient; but having this background we can use the pelvis, which is the strongest sex determinant, or the skull, sternum and the long bones that could give us clues about the gender;

race: the determination of the race is not in many times very emphasized, but the best method to discover this, is by examining the skull.

age: can be determined by evaluating the physiological age of the skeleton in comparison with some patterns of growing, the results
demonstrating the estimated chronological age; but the skeleton can change during life, based on various factors like nutrition or internal degenerative diseases; another vector of alteration of the corpse are the environmental factors;

DNA examination: the DNA is a molecule that is coding the genetic material; it is unique to every human being, except the monozygotic twins. It has a very long period of resistance, especially in bones. This is an extraordinary method that makes possible to compare the material of the decedent with the family members. The DNA can be analyzed only if we have the means and elements required, because there are situations when DNA cannot be analyzed by sampling of soft tissues, which has a shorter life, if it is exposed to environmental factors, like humidity and heat.

In many occasions when primary biometric trait are missing e.g. fingerprints, palm prints, face and iris are missing, soft biometric traits like for scars, marks and tattoos can instead give some identifying information.

Secondary physical characteristics can be modified easier during life, either deliberately by the individual, or by any medical/ dental interventions. Also some of the secondary characteristics can change post-mortem.

These are:

Skin color: it can be modified during life, but also after death;

Eyes: can change both ante-mortem and post-mortem;

Teeth: it’s a very resistant tissue, can be changed during life and it can provide essential information post-mortem;

Hair: the color, the style and length can change both ante-mortem and post-mortem; the same thing could do with the beard or moustache;

Scars: that results from surgical interventions or prostheses; can be highlighters to post-mortem changes. A scar is a lesion in the dermis and it remains on the skin for the rest of the person’s life. It is a result either of a surgical intervention, self-induced or accidently acquired. A scar can give important pieces of information about the deceased; can be self-inflicted in a suicide attempt, a previous surgery, or a symbol indicating religious beliefs. Above all a scar is a mark which friends or close family members usually remember and constitute a very important identification tool in visual identification.

Fingerprints: that could change during life in cases of the patients with chemotherapy treatment or in cases with professional disease that could cause fingerprint alteration like the brick layers;

External peculiarities: circumcision (Muslims), moles, warts;

Clothing and objects, cosmetics;

Tattoos: even if the corpse is putrefied we can observe them. A tattoo is an ineradicable mark or a larger modification of the dermis of the skin and like a scar it can accidentally or intentionally be acquired. It can be professionally done or it can be an amateur work, e.g. done in prison by prisoners. Medical reasons can also be the cause of tattoos e.g. radiotherapy markings.

Tattoos very often have information as, names, dates, blood types, military service records. They can give a clue to gang memberships, religious beliefs, the years spent in prison etc. Like with the scars, these tattoos are often remembered by friends or close family members and therefore of great help in the identification process.

In 2016, I published the article entitled: „Biblically Inspired Tattoos in forensic examinations made on inmates bodies in prisons territorially assigned to the forensic institute of medicine from Cluj”, Dan Perju-Dumbravă,Ureche Daniel, Cristian Gherman, Ovidiu Chiroban, Laurian Ștefan Bonea, Carmen Corina Radu, Journal for the Study of Religions and Ideologies, vol 15, no 45

As we know, tattoos are a form of expressing spiritual trends or a lifestyle. Over time, tattoos had different meanings, beginning like a right of free way or a mark of a social rank, symbol of spiritual and religious devotion, decorations for braveness, sexual and fertility signs, but also could've been proofs of love, punishments or like charms for protection, slaves and convicts demarcation .

Today, people associate tattoos with gangs and criminal groups, but we have to mention the fact that these are signs of their faith, and we don’t have to judge them, we should think that it represents a very important thing for that human being and that are suggesting something about their life, way of thinking and also about their character.

Worldwide biblical tattoos are extremely popular. According to forensic literature, for Christians it is a personal way of having a Christian iconography always with them. Comparing with the Jewish belief, Christianity doesn’t have rules against tattoos, except the fact that should not be showed very often among people.

In our country we don’t have a very complex culture regarding tattoos or persons who practice this kind of art, the majority are with no special meaning. Most of them are made on ‘the black market’ in illegal cabinets or prisons, with no suitable equipment. From this outlook, we can say that is becoming a very important problem of public health, because, according to some convicts’ testimonies, during the procedure they contacted illnesses with blood transition; but this wasn’t an impediment for them tattooing new works of art to acquire a certain statute in prison.

In forensic science, by conducting psychical, traumatic expertise or by postponing the punishment, we meet a lot of persons who have tattoos with a biblical inspiration. No matter for what the person is in detention, the examination is necessary. Even if we find them on people in life, we can also see it to some corpses

According to this retrospective study, we noticed an increased frequency of biblical tattoos to convicts. These are signs that offer clues about the offense brought against the law or could say something about their personality. Also, tattoos can have different connotations to people who use drugs or to people with psychical disorders that have criminal implications, all of these being part of the forensic expertise.

Even if that tattoo, a particular skin sign, represents just a small part from the forensic criteria of identification of the deceased, his importance is based in pointing out the individual characteristics, which can lead to essential identification elements.

All over the world we find a tattoos’ culture, where every tattoo means something specific, and has the role to express the character of a human in community he belongs to. Of course, these acts are more experienced in prisons; but we have to say that in the Romanian’s prisons are more reduced, considering there is no well-established hierarchy.

Tattoos are often stamps of a desperate search of the human personality and they are made in places close to them, so we can conclude that can be an unsuccessful replacement of personality, representing cultures, eruditions, sense of humor, joy, opening and creative uniqueness.

Even if a lot of people don’t recognize that they belong to a certain religion, everyone has a reliable seed that somewhere there is a divine power. These are the testimonies of prisoners, that during the sentence need something to lean on, but also because tattoos are like some business cards, as are diplomas of graduation for other people.

For the prisoner that we met in the forensic practice, all that matters is the plurality and the size of them, some of them having no knowledge regarding this tattoos’ meaning. From their point of view, the meaning represents an intense feeling, experience that is wanted to remain as a mark or just a copy of other tattoos seen at their colleagues. Some convicts make and wear a biblical tattoo as an accessory without a specific meaning; it just looks good or amplifies the sense of faith of the bearer.

DISCUSSIONS

There are two basic principles that can determinate the identification method, as follows:

State of the corpse

Circumstances around the person’s death.

Principle 1. State of the corpse

Following the theory of Lee Goff that is based on the type of insects that inhabit the body are described five stages of decay/purification of the corpse:

Is the initial stage of decomposition that occurs between the moment of death and the first signs of bloating; this stage is composed by: algor mortis, livor mortis and rigor mortis. In this phase the body is still intact and the first blowflies arrive to the corpse within a few minutes of death, more species occurring after.

Bloated phase:

On land: about 36 hours after death, bacteria is
crossing the intestinal tract and initializes the melting process of the body. After the bacteria transition, maggots and other insects invades the body, appearing new species of beetles. This phase determine the foul smell typical for a putrefying body;

In water: it can be observed the gas formation, skin maceration and adipocerous;

Active decay stage: in this phase putrefaction gases are reduced, because the larva of the flies are now pricking the body, that is wet due to liquefaction of the tissues. The feeding larvae are removing the flesh from the body starting with head, umbilicus area, and anus and forward towards thorax and abdominal cavity. The foul smell is very strong in this stage.

Advanced decay stage: The foul smell is now disappearing and the removal of the flesh of dead body is most completed.

Skeletonized: is the last stage of decomposition. The time when a dead body gets skeletonized depends on the period of time since death occurred and of course environmental factors, for example a body that has been exposed to 37, 8 ᵒ C and under extreme humidity may completely decompose in few weeks.

There are situation where we find only fragmentary decomposed or skeletal remains on the scene. In this cases, automatically several questions may be raised which are important in the identification process and can lead us to a real hypothesis. Those questions are:

Are the remains human or animals?

If it is only bones that have been found, are they really bones and not e.g. woods, stones or other objects with similar surface appearance?

Are there many pieces of bones?

How old are they?

Which is the sex?

Which is the age?

Which is the cause of death?

Principle 2. Circumstances around the death

Is important to examine the scene and the environment where the death occurred and correlate the data with the autopsy findings, because together can determine or reconstruct the circumstances of death. The type of death dictates very often the choice of identification method, so if it was a natural death, a homicide, a murder, a suicide, a vehicle accident or a mass disaster? We have to find out how these events affect the body and its environment. Particular situations are:

Mutilated: represents the state of the body with the absence of a member or another part of the body, or deprival of an organ or severe disfigurement. This can for example happen in crimes. The term mutilation also covers the term „dismemberment" which means amputation of a limb or a part of it.

Charred: represents the state of the body resulted from the application of the fire or radiant heat, radiation, chemical or electrical burns. The effects of the heat to the body continue after death. Therefore the effects of the temperature to the body can be post-mortem and has to be considered when making the autopsy. On the charred body the internal and external findings depend on several factors like:

The degree of temperature;

When the body was exposed to the temperature;

The way of the heat transmission to the body.

Complete, partially disruption of the body due to violent mechanical force. A typical example is a railway track suicide or a railway track accident.

Dental identification through comparative study needs: ante mortem data, the existence of medical history, dental X-rays, study models and photographic images, also a list with the dental procedures and postmortem, examination of the bodies’ denture, rugoscopy, cheiloscopy, glossoscopy. This method can be limited by the lack of dental charts, lack of complete paraclinical examinations and the lack of dental tourism- meaning that most of the patients are having multiple dentists and there isn’t a continuous diagnosis and treatment, so there isn’t stability of information that can be used precisely in case of need of identification. Also, there are some discrepancies and errors that can harden the comparative study (modification of occlusal surfaces, old medical charts, multiple individuals that are alike) and also the lack of inclusion/exclusion criteria.

”The Influence of Environmental Factors in a case of Forensic Identification”, Carmen Radu, Dan Perju-Dumbravă, Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XIV/A, 2015 pag.441-445

Case history: On 25.08.2009 a 82-old female suffering from known dementia disappeared from home. On 16.01.2010 bone fragments and clothing were found on the rocks at the riverside near the village Drăgești, Romania. Within a radius of about 4 m2 in an underbrush -bones, clothes and a stick were discovered. The body was skeletonized.

Autopsy examination

Identification data: examination of clothes Photos1, 2, 3- white cotton shirt, green cotton blouse, gray-beige striped sweater, black knitting sweater, blue crochet vest, sleeved blue shorts, brown knitting trousers, black wide skirt, dark blue apron, black woolen scarf, blue plastic shoes, partially red;

Personal belongings: walking stick.

The clothes were cold-frozen, they were lying next to the skeleton and they were covered with dry leaves, mud and maggots.

Photo.1 Photo.2 Photo.3

The dental formula of the subject was analyzed, but unfortunately the deceased didn’t have any ante mortem dental records to compare it with.

Table no.3

Internal examination

Head: complete detachment of the head from the cervical column, which was covered with dry leaves and larvae up to 0.6 cm. Cranial bones and viscerocranium are integral, mandible is dislocated.

Neck: soft tissue is missing. C1 vertebra is missing. C2-C7 vertebrae are present and of integrity, articulations between the vertebral bodies, covered with muscular debris at sites and white mold deposits.

Thorax: lack of soft tissues. Integrity of thoracic bones, articulations between the vertebral bodies (integrity of ribs, sternum incomplete – missing xiphoid appendix, the thoracic vertebral column persists at T1-T4 level, the rest is missing). Thoracic organs cannot be examined, the thoracic cavity contains a whitish-brown paste, covered with whitish mold deposit and larvae up to 0.6 cm; it gives of a foul smell of putrefaction and mold.

Abdomen: lack of soft tissues. Abdominal organs are missing. Basin with disarticulated bones, right hipbone and sacrum persist and are fully or partially covered by brown-blackish soft tissue. Left hipbone disarticulated.

Skeleton: left upper limb – bones and soft tissues are missing, shoulder girdle (scapular bone) bones are present; right upper limb and bones totally disarticulated. The humorous, radius, ulna, carpal bones , metacarpal bones and phalanges are present and are complete or partially covered by blackish brown soft tissue; inferior limbs and bones disarticulated; femur, tibia, fibula and partially the tarsal bones, metatarsals and phalanges are complete or partially covered by blackish brown soft tissue.

Diagnosis based on macroscopically path anatomical analysis: advanced putrefaction with partial skeletonization.

Forensic autopsy conclusions:

1. Medical type and cause of death of A.A. cannot be established precisely because of the advanced state of putrefaction and partial skeletonization.

2. According to the autopsy findings and the survey data, the death could be classified as nonviolent, and a possible cause is coronary myocardial sclerosis

3. The death may have occurred approximately 4-6 months ago

4. Autopsy examination revealed no injuries in the skeleton and of the remaining soft tissues.

5. Actual signs of death (lividity, rigidity) cannot highlight.

6. Signs of violence: No evidence.

The family members based on the recognition of the clothes and the walking stick did the identification of the subject.

In cases of forensic identification with delayed discovery of the body, the influence of environmental factors is essential. In opposition with situations when the body is preserved due to natural mummification, freezing or lignification, the importance of the environmental factors in cases of deaths that occur in the direct and intense action of the medium factors is statistically overwhelming in Romania. The existence of materials more resistant than the soft tissues is primordial, clothes, also the existence of a chartered dental file, or a personal belonging easily recognizable. That is why the forensic specialists have to take into consideration all the factors that concur in the decomposition of the body, and to reconstruct and work backwards the environmental factors that caused the existing situation of the body of the deceased. The idea is to exert a scientific synergistic addition of all forensic methods of identification and of course mainly to consider the environment factors that led to the existing state of decomposition of the body.

„Suicide on Railway Track”, Carmen Radu, Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XIII/B, 2014 pg. 237-240

Scene of event history: the subject JI, 26-year-old male, found dead on 23.10.2010 at at Oradea West railway station at Km 116+9".

Crime scene investigation Photo unit 8

Photos 13-14. Both photos show the locations where fragments of organic substances where found (marked with signs 0, 1); Photos 15-18. Place where the head of the corpse (marked with sign 2) was found and details of location in which it was found.

The forensic autopsy report presented the following conclusions:

Type of death: violent

Cause of death: Crushing and sectioning of the neck vessels, decapitation

Manner of death. Railway track injury

Lesions found on the body could have been produced in a railway accident, through crushing and sectioning by the wheels of the train.

Mechanism of death: massive external bleeding

The victim's blood alcohol level at the time of death was 0 (zero) mg per 100 ml of blood

Date of death 23.10.201

The train had no outside stairs, which could have explained why there were no injuries on the other part of the body.

Discussions with family showed that he was going to take part at his sister's wedding next day. He was a construction worker and wall painter.

Identification clues:

Mobile found in the pocket of trousers with numbers to the family;

Piece of paper with address in the pocket of the trousers leading to the place where the subject had performed a painting job;

Three days later after the death of JI a farewell letter was found by the family, in which the victim gives the reasons for his decision to terminate his life. Farewell letter to the family Photo 9,10.

Farewell letter to the family Photo 9

Farewell letter to the family. Photo 10

Discussion about the results:

The visual identification is not a favorable method in identification of severely decomposed or damaged bodies. In this particular case the sister came three times for identification, as she couldn’t recognize the deceased due to severe disruptions of the face. At the same time the family refused to believe that it could be their son and he could have committed suicide. As they said „Our son is orthodox, and could not have done this to himself”.

The two items, the mobile and the piece of paper with an address contributed to the process of identification of the body. Three days later the family found the farewell letter, which sustained that suicide was the cause of death. For forensic examiners it is not an easy task to establish the cause of death when a body is found on a railway track. Generally the lesions on the body will not tell if it was suicide, homicide or accident. It is also very difficult for the examiners to distinguish between ante-mortem and post-mortem lesions.

The alcohol blood level in this case showed 0. This result must be questioned, as there was a massive hemorrhage. Studies have shown that heavy blood losses can give false negative alcohol blood level results.

Suggested Identification methods if available:

DNA-profile compared with family member.

Dental profile- the age and compare with ante mortem dental records

Fingerprints-compare with ante-mortem civil fingerprint database as the fingers where intact in this body

Decapitation or complete severance of the head from the body is imminently a fatal condition without any exception. The forensic pathologists often have to deal with the challenging work to find out if the railway incident was an accident or a suicide. Some authors argue that there are differences in body position and type of lesions between railway accidents and suicides. A case of decapitation in a railway accident in Bihor County, Romania is presented in this paper. The characteristics of the case fit into suicide, but the leading clue was the victims’ farewell letter and the circumstances around his death.

„The risk factors in rail traffic accidents. Case reports”, Radu Carmen. Analele Universității din Oradea Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară, 2012 pag. 197-203

In this paper, the authors presented the rail traffic accidents, produced in Bihor County, in the period 2010-2011, accidents resulting in the death of the victims involved. As a result of the research on crime scene, in conjunction with the results of the autopsy and complementary examinations it was established the cause of death, estimation of date of death and the corpses have been identified.

DISCUSSIONS:

Having all these theoretical concepts, to which are added the cases presented I have to distinguish between three types of comparative forensic methods: scientific identification methods, non-scientific methods and factors that correspond to the decedent and the missing person.

Scientific identification methods: traditional and new

These methods compose a systematic comparison procedure between known characteristics of a missing individual (ante mortem data) and revealed characteristics from an unknown body (post mortem data). All these methods are based on objective observations, experiments and other scientific research and they are considered very accurate and reliable.

The scientific identification methods that belong to the traditional ones are:

Dental identification

Fingerprints

Nuclear DNA

Forensic radiology (x-rays)

Forensic anthropology (skeleton remains)

There are new and more sophisticated techniques that not only are used to confirm the identity but also to exclude identity. This one demands more accuracy and reliability. They are as follows:

Mitochondrial DNA tests

High performance liquid Chromatography (HPLC)-mass spectrometry (MS),

3D computer imaging,

Digital forensics

Multi-detector CT scans.

The above methods are not only used to confirm the identity but also to exclude identity.

Since all these methods are based on objective observations, experiments and other scientific research, they are considered very accurate and reliable.

Non-scientific identification method

The major non-scientific identification method is visual identification. This method is based on the statement of a person who is familiar with the deceased and who can confirm its identity. It does generally not include any picture evidence. The visual identification is based on primary and secondary physical characteristics. Visual identification is based on conclusion relied on subjective observations and perceptions and therefore less accurate and reliable than the scientific.

Factors that correspond to the decedent and the missing person

In this group we include the cases where we do not have any ante-mortem data which can match with the decedent, but we have information which has to be examined in its context, e.g. the place where the dead body was found and its physical features e.g. tattoo, birthmarks, dental characteristics, and so on.

Results of identification

Regardless the choice of identification method, the results have to be directed into one of the following groups:

Positive identification

In positive identification the ante-mortem and the post-mortem data match in sufficient detail to establish that they are from the same individual. In addition there are no irreconcilable discrepancies. This is the only identification, which can be used alone in court.

The main positive identification methods are: dental records, DNA and fingerprint analysis, x-rays and that part of forensic anthropology, which deals with scientific anthropological methods when examining bones.

Presumptive identification

In presumptive identification the ante-mortem and the post-mortem data have consistent features, but due to the poor quality of either the most-mortem remains or the ante-mortem evidence, it is impossible to establish positive identification. This method is not valid alone in court. It needs to be confirmed by positive identification testimonial.

The primary presumptive identification methods are: visual identification and the part of forensic anthropology dealing with facial reconstruction. Jurisdictions in several countries are using these when there is lack of positive identification methods or as assisting methods to the positive identification methods.

„Three-dimensional (3D) reconstructions of the skull and its value in the field of forensic medicine” Carmen Corina Radu, Monica Rotaru, Bogdan-Andrei Bumbu, Virginia-Bianca Vulcan, Diana Bulgaru-Iliescu, Iuliu Fulga, Dan Perju-Dumbrava. Romanian Journal of Legal Medicine 2019, No.4 (acceptance letter)

Blood typing was a very used forensic tool before the introduction of DNA typing. However it was found that 30% of the American population had type A positive blood group, which means that if this blood group was found at a crime scene, then this could come from 30% of the population. DNA analysis on the other hand showed excellent discrimination properties. DNA typing is today considered one of the most powerful identification techniques. Except for identical twins, the chances of similarity in DNA are believed to be infinitesimal. Before the routine use of DNA profiling, blood typing was an important forensic tool. DNA printing is a technique which chemically divide the DNA molecules into fragments, forming a so called “identity profile”. This profile is then matched with e.g. the suspect’s blood specimen. If these profiles are matching, there is one chance in 30 billion that the DNA is not coming from the same person. Therefore DNA printing is of great statistical significance.

DNA is found in all nucleated cells in the body and can be extracted from the victim’s own body; blood, saliva, semen, vaginal epithelial cells, tooth pulp, hair roots, muscle, skin, mucous membranes, bone marrow, from close relatives of the victim; parents, children, siblings, from the victims person items; tooth brush, dirty laundry, comb or from the crime or accident scene.

The authors presented a case of a man found in advanced putrefaction in a storage tank in Oradea. There were traces of violence on his body, but the authors focused in this paper only on the forensic identification methods that were used to establish the body’s identity. The sculptural portrait that was made of clay (by the expert criminologist from the National Forensics Institute within the General Inspectorate of the Romanian Police) was sent to the mass media, but still no data was found that could help the identification process of the victim, so the work team decided to make a CT scan.

3D computer imaging

After the analysis of the axial images and the 3D and VR (Volume Rendering) reconstructions fig.10-11, the imagistic results showed: old fracture of the horizontal branch of the left mandible.

In the next step, the oral surgeon participated together with the team at the extraction of the osteosynthesis material. We extracted an osteosynthesis plate with five holes, cut at an end, malleable, made from titanium, module 2.0, made by Synthes-Stryker and four titanium screws, module 2.0, 9 mm length also made by Synthes-Stryker (fig. 14).

By analyzing the aspect of the fracture, the osteosynthesis material, the operating technique as well as the autopsy results, we established the following data: a male aged between 45-55 years, with a fracture of the left mandibular angle operated 1-3 years ago, and who has only the right congenital kidney.

We continued by going through the medical files of hospitalized persons in the Maxillofacial Surgery Department, by following the data mentioned above. After analyzing the files, we identified a medical file of a patient who was hospitalized in this department in April 2017 after a poly-trauma resulted from a tram accident (he was a pedestrian). The victim was a male aged 53 at the moment of the hospitalization, coming from a rural area but without residence, and hospitalized with the diagnosis of left mandible fracture. A surgery was performed and the fracture was reduced, a plate inserted and the fracture was immobilized and tooth 3.6.extracted. The abdominal ultrasound that was made at the beginning of the hospitalization detected only the right congenital kidney.

Genetics analysis of the bone samples taken from the unknown body found in the storage tank in Oradea showed a unique genetic profile belonging to a man. His comparative DNA profile perfectly matched all data markers of the hospitalized person and he had a twin brother as a result of a monozygotic twin pregnancy (Table 3).

In positive identification, the ante-mortem and the post-mortem data match in sufficient detail to lead to the conclusion that they are from the same individual. In our case, a DNA match successfully confirmed the identity of the decedent.

Table no. 4: Genotypes obtained using Applied Bio systems kits

The case presented by the authors is highlighting the need of an accurate identification of the deceased, not only for the ease of the family, but also for legal purposes in order to reach correct decisions of conviction. The authors of the homicide were found in short time after the identification of the corpse.

The success of the identification could not have been possible without the very good teamwork between the criminal prosecutor, the forensic pathologist and two specialists in radiology and dental alveolar surgery.

Other scientific papers:

„Rolul medicinei legale în combaterea fenomenului femeia victimă a violenței domestice” [The role of forensic medicine in preventing domestic violence], C. Buhaș, Gabriel Mihalache, C. Radu. Rom J Leg Med 15 (4) 313 – 317 (2007)

A domestic abuse may be a physical, mental or sexual aggression; it is any kind of violent act, physically or emotionally, that take place between the members of a family.

The authors establish, upon their medical experience, that this kind of violence involves women as victims. Based on this fact, the authors illustrated a statistical case with graphics and tables containing items that show: the age of the victims, medium of providence, the mechanism of making the wounds, the factors that encouraged the domestic abuse and the circumstance of the aggressors.

The conclusions they reached can be considered an signal on the gravity of this social phenomenon.

„Mechanical asphyxia due to biological agents. Case report and literature review”, D Perju-Dumbravă, O Chiroban, CC Radu- Rom J Leg Med, 2015
The paper presents a unique case and a literature review data of the fatal situations in which biological agents acted upon a human body mechanically, and thus inducing traumatic asphyxia.

A 54-year-old man, working as a shepherd, was found dead in a valley, at the bottom of a natural pit, by the family members. The pit had very steep walls, was 3,5 meters deep and had a diameter of about 10 meters. The investigators stated that most probably, some sheep fell into the pit, the shepherd lowered himself there in order to bring them out, but unfortunately the rest of the sheep followed him into the pit, thus collapsing over him and preventing him to get out. At the scene of investigation there were found 75 dead sheep, covering the dead body and surrounding him. A medico-legal autopsy was performed, followed by histological and forensic toxicology analysis. Autopsy revealed advanced putrefaction, a vital sternal fracture and generalized atherosclerosis. The toxicological exam showed an alcohol blood concentration of 2,80 g/l. Therefore, taking into account the onsite scene investigation, the autopsy findings and the ancillary examinations, the death was considered violent, produced by an accidental traumatic asphyxia due to biological agents (sheep), this being a unique case in the activity of the Department of Legal Medicine.

„Accessory spleen” Carmen Corina Radu, Gabriela Muțiu, Ovidiu Pop- Rom. J. Morphol. Embryol, 2014

Literature describes the accessory spleen as common phenomenon for both sexes and at all ages and has been encountered in different causes of death. Therefore, a medical autopsy can be a means to determine the incidence and the characteristics of accessory spleens (location, dimension, and so on) in the population.

An accessory spleen, or splenunculi, is a small nodule of splenic tissue found outside of the spleen. Post-mortem examinations, also known as autopsies, are carried out to identify a cause of death, and to assess the state of the organs of the deceased. We present two incidental cases of splenunculi, one localized in greater omentum and a second one localized in the hilum of the spleen, diagnosed during a histopathological examination. An immunohistochemical profile of the normal and accessory spleen was followed where the expression of the CD20, CD3, CD23, α-SMA were analyzed.

„Accessory spleens at autopsy: the incidence and the presence of myoepithelial cells in the spleen capsule” C. C. Radu, D. P. Dumbravă, D. Ureche, C. Rebeleanu, D. B. Iliescu, I. Fulga, A. Cămărășan, O. Pop – Rom J Leg Med 27(3) 247-253(2019)

In this paper, the authors have investigated 150 forensic autopsies, the purpose of the study being to discover the incidence, distribution, histological aspect and immunohistochemistry features of accessory spleens.

In all of the research cases, accessory spleens were diagnosed post-mortem and none of it while the person was still alive. Accessory spleens are integrated in the immune response as a functional accessory organ, and also have immunological functions like the normal spleens. We discovered the existence of the myoepithelial cells in the spleen capsule. The proper management in spleen trauma in adults is in debate and the role and myoepithelial cells number need further studies.

„Obesity and overweight risk factors in sudden death due to cardiovascular causes: A case series” D Perju-Dumbrava, O Chiroban, CC Radu – Iranian journal of public health, 2017

Obesity is often due to an unbalanced diet and an exaggerated food income at people with genetic predisposition. Also metabolic, endocrine, tumor or traumatic disorders contribute.

I did a retrospective observational study during the period of January- December 2014 in the Forensic Medicine Service of Bihor County, using registers; medical certificates death ascertaining and medico-legal expertise reports.

The result was that 96 persons died because of heart diseases, sudden deaths, 20 were women and 76 men. I took into consideration even the body weight index of the bodies and the adipose abdominal tissues thickness from opening of the abdominal cavity.

The causes of death were: 53% acute myocardial stroke, 26% myocardia sclerosis, 13 subjects had cardiomyopathies, 4% arterial hypertension, 2% myocarditis and 1.04% myocardial ruptures. These data confirm those from the literature, that show that acute myocardial strokes represent the main cause of death in sudden cardiac diseases in the developing countries.

Another particular aspect was the relative young age in men, 51-60 years old that deceased because of acute myocardial stroke. Obesity is a risk factor known for developing cardiovascular diseases and that can lead to sudden cardiac death. Metabolic system is also incriminated.

New studies show that free fatty acids with high values can cause arrhythmias, which can be lethal. As a conclusion, if we could prevent obesity and supraponderability we could obtain a major downgrade of cardiac deaths and sudden cardiac deaths.

„The medico-legal value of histopathological examination in hanging” Dan Perju-Dumbravă, Codrin Rebeleanu, Daniel Ureche, Ovidiu Pop, Diana Bulgaru-Iliescu, Carmen Corina Radu. Rom J Leg Med, 2018

Hanging is a form of mechanical asphyxia in which the body is totally or partially suspended by an lath around the neck. It’s an extremely common method used by suicidal people, being included (based on specialty literature) as being a part of the 3 most common death methods in any country of the world.

The tegument harvested from the hanging groove is examined by histopathologists and does not offer relevant information regarding the fact that the person was alive or not at the moment of the hanging, literature data of Casper experiments induce the fact that the hanging groove can be produced until two hours postmortem, but studying also the subcutaneous tissue, microscopic exams offer imperative data for differentiating a strangulation from a hanging.

We are proposing through this paper to establish the cause of death by using the histopathology and immunohistochemistry data from the tissue samples that were harvested from the hanged bodies. The study included 66 hanging cases from 3 counties: Bihor, Cluj, Bistrita-Nasaud, between 01.01.2015 and 31.12.2015, respecting the criminal laws that were in force and without influencing in any matter the autopsy or investigation data. There were harvested tegument fragments and subcutaneous cellular tissue or muscle for microscopic exam.

The histopathological exam of the tegument and the cervical subcutaneous tissue was done only for 16 cases, meaning 24,24% of the total.

Our study demonstrated the fact that only the histopathological exam can identify the vital character of the hanging groove and the underlying subcutaneous tissue.

Of course, we always have to correlate the data: macroscopic, microscopic, and the investigation’s. Immunohistochemistry should be included as an examination, because it gives important and precise data regarding the difference between strangulation and hanging. The retention of harvesting multiple fragments of tissue and precise examining shouldn’t exist anymore, it could due to errors of case’s approach, because of the economic considerations guided by the institutions.

„Sudden death of a teenager caused by Actinomyces israelii: a case report” Radu Carmen Corina, A Camarasan, CM Podila… – Iranian journal of public health, 2018

Actinomycetes are Gram positive bacteria’s that are usually present in oral, gastrointestinal and feminine genital microbial flora, and that produce a quite rare infection named actinomicosis, seen at immunocompromised patients, for causes like: local traumatism, surgical interventions, chronic alcoholism, HIV, diabetes, transplants, and so on., or even at women that use intrauterine contraceptive instruments.

In literature there are known 30 species of actinomycetes, only 8 from those produce human diseases, Actinomyces Israeli being the most incriminated. The affected areas include the regions: oral-cervical, thoracic, abdominopelvic and central nervous system, with the possibility of migration from a space to another.

The case that we presented is that of a 14 years old teenager, from Bihor County, that from the investigation analysis, it concluded with the ingestion of energizing drinks. He felt bad right after and he fell on the ground. CPR was operated, but without effect. Hetero anamnestic, the family related the fact that the teenager had thoracic pain, sleepiness, fatigability, productive cough and subfertility, treated with Tylenol and aspirin.

The autopsy was made and at the external exam no traumatic lesions were revealed. At the examination of the oral cavity, gingivitis was found at the level of the teeth 1.1, 1.2, 1.3, 2.1 and 2.2. The lungs had signs of pneumonia, emphysema and pulmonary edema; the myocardial had myocarditis aspect with areas of cardio sclerosis on the posterior wall of the left ventricle that could be considered as a post myocarditis scar.

The histopathology exam described inflammatory granulomas with Antinomies Israeli (PAS negative, uncolored), in the bronchi. At the level of the myocardia there were bacterial colonies present, with micro abscess, diffuse cardio sclerosis and myocardia necrosis with polymorph nuclear cells. The diagnosis that was established was: acute myocardial infarction, consecutive of a chronic myocarditis and pneumonia with A.israelii. The most probably, the entry gate was at the level of oropharynx, with aspiration of the secretion in the lungs and the entrance of bacteria in the blood, affecting the myocardia.

Infection with A. Israeli is a very rare disease, and not much is known about its prevention. We think that a good oral hygiene and antibiotics prophylaxis in interventions that can harm the natural barrier of oral mucosa, gastrointestinal mucosa, can be used as a preventing it.

„An Unusual Case of Accidental Carbon Monoxide and Ethanol Intoxication in Two Commorientes Deaths” DP Dumbrava, CC Radu, T Iov, SI Damian, I Sandu… – Rev. Chim.(Bucharest), 2018

Acute intoxications with substances that are restricted, like ethanol, methanol, etilenglicol and carbon monoxide are common causes of violent deaths in Romania.

Carbon monoxide (CO) is a gas without any specific smell that results from incomplete burning of organic substances. It’s toxic, because its manner of tying up to the hemoglobin in erythrocytes. The most common are the accidental deaths, followed by suicide.

Ethanol, CH3-CH2-OH, is a liquid that is volatile, uncolored, and inflammable, with a specific smell. It absorbs through respiratory, cutaneous and digestive way. It is metabolized in the liver through oxidation, in the most part, but also extra hepatic 20% of the cases. The lesions are unspecific. We use toxicology determinations that are really helpful to find the cause of death.

In this paper I will present the case of two married couple that were lethally intoxicated with two types of substances. The cases were selected from the casuistic of Forensic Medicine Institute Cluj-Napoca. The doctor on call went at the place of production in a home with a floor from the center of Cluj, where there was a deceased couple in a suspect manner. The man, aged 88, was found in bed, on the first floor, and the woman, aged 76, in a putrefaction stage, was found in the attic. Hetero Anamnestic was found that the man was immobilized 15 years because of a cerebral vascular accident, and the woman was used to drink alcohol in the attic, where he couldn’t see her. They were leaving alone and had no family to visit them. The place was heated by a gas center.

The medico-legal necropsy was made. The man’s body had the signs of real death, with generalized rigidity, dorsal declive lividity, red coloured. No external traumatic lesions that could be identified macroscopic. The internal exam revealed: at the level of the brain there was a massive temporo-parietal right scar, brown-yellowish, pulmonary emphysema, myocardia sclerosis with coronary atherosclerosis and nephroangiosclerosis. The stomach was empty. Urinary bladder dilated with a green-yellowish liquid. Histopathology confirmed the macroscopic exam.

Toxicology revealed 49% carboxyhemoglobin, so the death was violent because of the acute intoxication with carbon monoxide.

The woman’s body didn’t reveal any traumatic lesions at the external exam. It was in a extreme putrefaction stage, tumefactive tissues, green-blackish color and postume circulation. At the internal exam stasis and cerebral edema was found, stasis and pulmonary edema, dilative cardiomyopathy and hepatic fat dystrophy. Histopathology didn’t revealed anything much to establish the diagnosis. Toxicology exam was made, that determined a concentration of 3,5 g/L alcohol in blood. The death was violent and caused of acute intoxication with ethyl alcohol. The both cases are representative for deaths through accidental intoxications. Most probably, regarding the advanced putrefaction stage, the woman died first, than the man that was immobilized and with morbidity. We thought that there were two simultaneous deaths, cases that occur really rare and induce difficulty in exact determination of the time of death for each side.

„The importance of alcohol testing by gas chromatography vs the cordebard classical method modified in the medico legal investigation” DP Dumbrava, CC Radu, S David, T Iov, CJ Iov… – Rev. Chim.(Bucharest), 2018

Determination of alcohol in blood is a toxicological medico-legal examination that is made often, regarding the fact that lately in Romania cases of driving after ingesting alcohol are rising. In 15 of June 2018, The Superior Council of Forensic Medicine made a decision, that bind every institution that use alcohol determination, at alive or death people, to use only the gas chromatography method; until first of January 2019 also the classic Cordebard method was accepted, modified by Banciu and I. Droc, so here was enough time for purchasing the equipment.

We exposed the methods one by one, detailing the principle of the method, equipment and necessary materials, reactive, calibration, stages and acceptance criteria.

As a conclusion, we found out that gas chromatography is a more precise method than the classical one, with the possibility of identification the exact alcohol that was used, and that thing was impossible before with the classic method, it couldn’t distinguish the difference between ethyl alcohol and methanol. It permits also establishing the precise values of alcohol in blood, being a truthful help in the justice field.

The necessary biological probes are 100 times smaller than those for the classical method, and the factor that implicates the human error is almost totally excluded, together with the human subjectivity. Also the data are kept in the camera’s memory and cannot be modified retroactively. The only important disadvantage that needs to be mentioned is the price of the camera and the materials that are needed for the analysis.

„Postmortem Specificity of Troponin for Acute Miocard Infarction Diagnosis throug Qualitative Dosing from Pericardial Fluid” I Hunea, SI Damian, CC Radu, S Moldoveanu, T Iov – Rev. Chim.(Bucharest), 2018

Sudden cardiac death occupies the first place in sudden deaths of natural causes and is the first cause of death. Sudden cardiac death due to lethal arrhythmia may be the first manifestation of a cardiac disease, such cases becoming suspect dead, thus forensic cases. The autopsy performed in such cases may reveal important cardiovascular disease but not obvious macroscopic or histological changes of acute myocardial infarction (IMA), except for cases of survival for several hours after the onset of the symptomatology. Biochemical markers were used to test for myocardial lesions in the absence of morphological changes. Methods for determining myoglobin, CK-MB, troponin T (cTn T), troponin I (cTn I) were introduced to the clinic to diagnose the condition of patients with chest pain as early as the 1990s. The lack of pathognomonic elements in corps investigations requires verification of the value of the investigations that can be carried out, with reference to the biochemical in the present case, in establishing the diagnosis with certainty.

1.4. Ethical aspects in forensic medicine identification

The rationale for this study is based on a deep fascination with the nature of identification, not only from a scientific point of view, but also from an existential and ethical perspective. The purpose of this work is to explore and unfold the complexity of the field of forensic identification, by defining and clarifying the theories and applications comprising different scientific and non-scientific identification methodologies.

The choice of identification for the cases in Romania, most often, is visual identification method, as the possibilities for other methodological approaches were limited. Even though visual identification is the most used forensic identification method worldwide, it must be emphasized that it is a presumptive method, whose conclusions are derived from subjective observations and perceptions, making it a less reliable and accurate.

In view of the disadvantages of visual identification a question was raised: “Can visual identification be more reliable and accurate? In order to answer this question the concept of “moral sensitivity” is introduced and discussed.

Works published in scientific journals:

„The relationship between work environment and moral sensitivity”, Carmen Radu, Dan Perju-Dumbravă – Analele Universității din Oradea, Fascicula: Protecția Mediului, 2016

As we have mentioned above, the method of visual identification is one that raises many problems. Still though, it is the most used identification method worldwide. Despite the fact that many new and high-sophisticated techniques have been introduced, its advantages of being cost-effective, easily performed and often correct, will continue to make it a widely practiced method in forensic identification. Even though visual identification is not regarded as a scientific identification method and it is generally not allowed to be used in court as a testimony, interestingly enough, the medico-legal systems throughout the world are dealing differently with the importance of visual identification. Some of these jurisdictions require the closest blood relative or relative to actually be present and visually identify the deceased, others require a photograph of the deceased as a part of visual identification and several jurisdictions allow visual identification by familiar persons only after a rapid scientific identification. A visual identification is very often asked after a scientific identification had been performed; by the family members in order to “be sure” that their beloved is the deceased one.

We have to take into consideration that many forensic offices do not owe any appropriate financial resources to acquire or maintain adequate technology equipment and logistics in order to perform a scientific identification. In deaths which have occurred in remote places and no equipment was available, the visual identification may be the only possible identification method.

Can visual identification turn into a more reliable and more accurate method?

Visual identification will never meet the criteria of a scientific method or reach those standards of uniqueness, accuracy and preciseness that the other methods claim to have. But if we focus on the main component in visual identification which is the nearest environment of the dead person, e.g. family members, friends, colleagues, and see how we can approach them in relation to ourselves and to the deceased we may come closer to the answer of the question above.

In this context we would like to make a philosophical-psychological approach and introduce the concept of “moral sensitivity” in the discussion of visual identification. It is a term taken from bioethics and is a new field of interest among professionals in the health care system. Lutzen K. gives a very good explanation by introducing the word sensitivity in relation to the welfare and right of others, especially when they come into conflict with one’s own interests. Moral sensitivity should be seen as a process of reflection on the consequences of one’s own acts towards the others.

According to Muriel Bebeau and her colleagues (1999), moral sensitivity “is the awareness of how our actions affect other people. It involves being aware of the different possible lines of action and how each line of action could affect the parties involved (including oneself). Moral sensitivity involves imaginatively constructing possible scenarios (often from limited cues and partial information), knowing cause-consequent chains of events in the real world, and having empathy and role-taking skills. Moral sensitivity is necessary to become aware that a moral issue is involved in a situation.”

The „moral sensitivity” is not only the ability to identify an ethical problem by the process of reasoning and understanding the moral consequences of the ethical code that dictated that particular decision, but even to distinguish what is right or wrong in a „normative” perspective. „Moral sensitivity” is also a process of being able to raise the ethical norms above „reason” and put them on „a human inter-relational cross-boundary level” and to leave open for an intuitive approach to what is good for the others.

What is visual identification, besides being a moment during which the family members recognize and identify the deceased?

It is a meeting point, between the deceased, the family members and the forensic officer. The meeting point is on the level of a human inter-relational cross-boundary between three individuals in the domain of life and death. It is a moment when the deceased has the right to be identified and treated with respect and dignity. It is an emotional and cognitive process during which the family members meet themselves in a moment of extreme emotional stress with conflicting feelings, goals, desires and expectations. It is a moment when the forensic examiner has to balance between being professional i.e. following rules and protocols and at the same time showing respect to the integrity and dignity of the dead as well as preparing the family members for the recognition. It requires more than reason from the forensic examiner-he/she has to be willing to step out of himself/herself and meet the involved people in the current situation by acting balanced and calm, giving them the feeling that this moment is theirs, being compassionate and understanding, showing empathy and patience. It sounds like an utopia at first, but we firmly believe it is possible, if the forensic examiners decide to invite themselves to reach a communication on an inter-human level where ethical and moral codes can find an intuitive point of expression; it is a dynamic moment when the meeting point between life and death is completed and the three components: the dead, the forensic examiner and the close members of the dead have reached an optimal level of interaction.

The purpose of this paper is to introduce the concept of „moral sensitivity” in Forensic Medicine. „Moral sensitivity” is the sensitivity to the welfare and the rights of others, especially when these rights come into conflict with one’s own interests. It is a dynamic concept including the reflection about the consequences of one’s own acts towards the others; it is a meeting point of a triangular interaction between the rights and the dignity of the dead, the emotional state of the family member and the professionalism and human qualities of the forensic pathologist. It is the point when identification is completed.

Identification means recognition, recognition means memories memories mean individualization. Individualization is the purpose of identification.

The concept of „moral sensitivity” should be introduced in forensic medicine in Romania since, due to the lack of financial resources for expensive scientific identification methods; visual identification is the most widely used in this country. It is worth mentioning that the visual form of identification, which is by definition not scientific, is also the most interpersonal one. It is an open field for non-scientific approach of ideas, such as moral sensitivity.

In order to introduce „moral sensitivity” in forensic medicine it has to be accepted by the professional staff. We, as forensic pathologists, are working strictly according to the law and protocols. Our behavior and actions are also dictated by an accepted moral code of what is right or wrong. Therefore we have to evaluate and discuss this new concept and approach it from different angles. Educational forums and workshops could be held by specialists in bioethics, which could present their ideas and discuss them with the forensic staff, including pathologists, nurses and physicians.

We firmly believe that moral sensitivity can in practice improve and give new perspectives to visual identification, by the action of the three components of the triangle mentioned above.

Dead person: requires respect and dignity for his or her integrity, as it is his/her human right

Relatives: require respect for the emotional stress he/she experiencing and time and space to face the situation

Forensic pathologists: besides doing a professional job, forensic pathologists have a very important task; to meet these requirements and to deal with them.

Our conviction is that many mistakes in visual identification could be avoided, thus making visual identification better

The end of the section is an attempt to make a philosophical approach to some identification methods, which are claimed by their supporters to be based on the theory of “uniqueness”. It is a challenging claim, which is counteracted, in an argumentative discussion.

„Claims of „uniqueness” in forensic medicine”, Carmen Corina Radu, Diana Bulgaru-Iliescu – Romanian Journal of Legal Medicine, 2016

To support my research I wrote this article that was meant to prove the nature of identification, from an ethical point of view, not only from a scientific angle. In our times, where everything has to be identified to prove his existence, the identification, in forensic field, has an important role for the living person.

My goal for this paper was to make a philosophical approach, by gathering information about a few identification methods that are supposed to be based on the theory of „uniqueness”.

As the word uniqueness appears as a statement of truth, it’s obvious that the result is a „proof”. The concept has a fundamental thinking that goes from the particular to general, so we have to corroborate information, formulate premises that will lead to general conclusion. As it seems, an inductive conclusion is almost a probable conclusion, which can be strong or weak. For this hypothesis I brought strong examples, to sustain my opinion, which demonstrate that, both sciences, forensic and philosophy, follows the hypothetico-deductive model. This assumes if something is true for a class of things in general, then this is true also for all members of that class.

Everything starts with a statement, that is processed by examining the possibilities for testing, therefore a deductive reasoning will go to a valid or invalid conclusion, so, if we are pointing the forensic science, that uses fingerprints analysis and ballistics, or forensic odontologists that works with dental formulas, how can occur technological errors or is the human perceptual and cognitive not sufficient. To explain these we have to examine the errors from the aspect of „uniqueness”, from the forensic point of view. In our field, the probability is always greater than zero; so forensic examiners round down the probability in order to justify the uniqueness of their theory.

The probability prototype is based on statistically modeled combinations of traits, which has real data from the population, like DNA, fingerprints, and dentition. But, instead of analyzing the frequency of data, the analysts often just assume the distribution of traits, or are not verifying the frequency of the trait in the population. From this, we can conclude that it is unknown if the samples are truly random or if they truly represent the population that has been studied.

Another very interesting principle is that the theory of uniqueness relies on the assumption that the trait of each individual is independent of any other. For example, the DNA analysis has accepted the fact that there is no complete independence of alleles by trying to solve it through mathematical formula, so this demonstrates a realistic approach to the probability claim.

In completion of this article, I may say that humans wish to believe in the concept of uniqueness, even if there is no scientific proof for this, so I concluded that uniqueness is a way of belief, than a scientific rule. I believe that the forensic field is not favored by this concept, and I support my thinking with three logical reasons and examples. First of all are the technological devices, like computers who use complex mathematical models. By example, in our field of work, was demonstrated that the human dentition is physically unique, but a device showed that cannot be reliably distinguished when is compared. Another reason and example are the fingerprints that are based on several experiments where duplicate images were used in order to set a match score. This match is scheduled by the comparison of different images taken from different fingers and not comparison of the same fingers! The third reason that I believe about of uniqueness is not good for the legal system, is the error rate crescending, and us, the forensic doctors we have to provide the most accurate results.

In conclusion, „uniqueness” is not a scientific method, because is based on assumption. It cannot be used in forensic science, as it belongs to pure philosophy. Forensic doctors have to corroborate facts, sustained by probative information and not use the claim of uniqueness, which can lead to a wrong presumption.

CONCLUSIONS

Forensic medicine is dealing with medical knowledge and methodologies for legal purposes. Identification is a field of study in forensic medicine. It is a comparative study between ante-mortem and post-mortem data. Its core stone is the autopsy, with which the identification process starts. Forensic identification covers e.g. violent deaths, suspicious deaths and deaths of unknown cause. Forensic medicine has played a very important role in the process of the identification of victims in mass disasters, e.g. plane crashes and court cases where insurance and inheritance issues have to be settled. A forensic identification can be requested for different reasons: affectivity, monetary, marriage and burial reasons, for statistics and official records and for criminal purposes.

In order to identify a dead body the examiner need to evaluate the state of the corpse and the circumstances around the death. After the first step of the identification by examining the physical characteristics of the body different identification methods can be applied scientific and non scientific. Regardless the choice of identification method, the results have to be positive, i.e. the ante-mortem and the post-mortem data match in sufficient detail to establish that they are from the same individual or presumptive: the ante-mortem and the post-mortem data have consistent features but due to the quality of either the most-mortem remains or the ante-mortem evidence, it is impossible to establish positive identification.

The most well known traditional scientific methods; dental identification, fingerprints, nuclear DNA, radiographs and forensic anthropology have been developed in order to meet the demand of accuracy and reliability in the identification process. The method of choice is mostly dependent on the status of the dead body, the type and manner of death and the financial resources of the forensic identification authorities. These methods are used separately, together or as confirmation methods to visual identification.

Despite the rapid increase of new forensic scientific technology methods, visual identification is the most common world-wide used identification method. It is cheap, easy and used when no other method is available. It has its limitation as it can only be used when the body is fresh and intact. When there are severe alterations of the body this method are not appropriate. Visual identification has other disadvantages which put limitations to its accuracy and reliability: The visibility may be poor, research have shown that the general ability in humans to identify is poor leading e.g. innocent to convictions the biased identifications which have happened repeatedly in crime history, the distress and shock by family members have resulted in negative or positive identifications.

Can visual identification turn into a more reliable and more accurate method? “Moral sensitivity” is introduced into forensic identification. It is the sensitivity to the welfare and the rights of others, especially when these rights come into conflict with one’s own interests. It is a dynamic concept including the reflection about the consequences of one’s own acts towards the others; it is a meeting point of a triangular interaction between the rights and the dignity of the dead, the emotional state of the family member and the professionalism and human qualities of the forensic officer. It is the point when identification completed. Identification means recognition, recognition means memories memories mean individualization. Individualization is the purpose of identification.

„Uniqueness” should not be used in forensic science, as it belongs to the realm of a pure philosophy. The induction model which “uniqueness” is based on is not favoring forensic individualization. It is definitely not a scientific conclusion. On the contrary it is a pure assumption. The job of the forensic examiner is to collect facts sustained by probative data and not to claim uniqueness, which can lead to prejudices and conclusions not supportable by facts. Uniqueness is impossible to prove.

Chapter II

RESEARCH IN THE FIELD OF BIOETHICS

2.1. Justification of the research topic

By definition: Bios “life in Greek” and Ethicos (good or bad, write or wrong). Ethics Based on this definition, bioethics deals with ethical problem of life and death, since death is a function or process of life. Ethics deals with values and bioethics deal with life and processes of life.

As mentioned in the first chapter, identification represents an important objective of forensic autopsy. Identification of the intact bodies, of fragments of the body or decomposed bodies is most often a laborious activity, and although the ultimate goal is to obtain the identification, the specific context of testing human identity has specific problems, which vary from the technical approach to statistical interpretation, or ethical issues.

Some of the ethical issues covered are: the humanitarian importance of identification; allocating resources in order to identify victims; secondary use for research of the samples originally collected for identification purposes.

Therefore, it follows that it is a topical subject and future research topic.

2.2.Some of the results of this research in progress

Books/chapters in books

The book entitled „Introduction to bioethics in forensic medicine – lecture notes" is a first attempt to provide an overview of how bioethics can apply in current forensic practice.

As seen from this, the pathologist must be subject to the fundamental obligations and responsibilities, individual to the profession, to the medico-legal system of death investigation laws and rules, to the legal system as witness, to forensics and science, and not ultimately to society. It is not just about committing crimes or offenses that are, of course, the main priorities, but also ethical and moral issues, major or minor, occurring in everyday legal practice. Often the questions are very complicated and the pathologist must make a decision.

Therefore, it is required a model for professional-personal ethical decisions in which values and rights are based on both "reason" and "intuition". This model is developed and presented in this book and acts like an "ethical and moral compass" in the ethic and moral decision making in daily forensic.

I suggest a professional-personal ethical model based on three elements:

Universal and conditional ethical values and rights

Professional-personal ethical reasoning: the four principles of medical bioethics in forensic medicine

Moral sensitivity

Universal ethical values and rights and conditional ethical values

My model is based on a holistic approach to the human being, where he/she is not only defined by his/her social, cultural, religious, political, financial and legal status, but by his/her a priori values and rights.

Values give us our rights, or better said; to have values is to have rights. In order to identify universal human rights we need first to identify values, which are common for all humans. This in its turn prerequisites that we identify what all-human has in common. Assuming that all humans have rights in common; they are autonomous creatures, they can act in a moral way; and they belong to a moral community.

The Universal Declaration of Human Rights, which concerns the living people states that there are two specific values common for all humans; dignity and agency. It further stipulates, “all humans are born free and equal in dignity and rights”. If we accept that death is a function or process of life then the values above are also valid for dead people.

In modern western societies there is a strong tendency to analyze, individualize and categorize, giving holistic views and approaches to life and less importance to death. It is necessary to integrate these two aspects of reasoning in order to optimize problem solving. Our ethical model will include both, but emphasis will be given to the holistic approach, i.e. to see the human being in relation to “itself”, as an inherent unite of nature which is in constant change and in interaction with its environment.

Our rights are categorized into e.g. legal, social and political, they are woven into national and international laws, which are stipulated by jurisdictions.

The dead person can be exposed to different crimes e.g. trafficking, dissection without consent or sexual use. Therefore he/she must be protected and ensured according to the rights dictated and realized by the society. These rights are so called conditional rights- they originate in the accepted values of each society and are time related. I would like to present two other opposite concepts, dignity and agency, which could be placed in the realm of inherited/universal rights. These two concepts will be the starting point for our professional-personal ethical approach.

„Human dignity” versus “my dignity”

Human dignity is a word that is almost never challenged or negotiated. It is innate or inherited. It goes back to itself. It is a priori. To have human dignity means to have rights and claims and should be seen in respect to how other treat us. It is not to be confused with the individual dignity “my dignity”, which is referring to my actions. There is not a clear definition on what dignity is. Nevertheless, everybody unconsciously seems to know what it means. One hardly hears conflicting ideas about human dignity and it is rarely under the loop of examination or criticism. Mostly it is perceived and accepted as an absolute notion, but without any clear measurable frame. You cannot demonstrate dignity, except to the self. Sometimes it is defined as e.g. autonomy, human rights, and assertion of claims, duties. I believe it would be useful to see human dignity in the context of rights and claims. Some scholars give human dignity an even broader definition; they argue that dignity is a description of a behavior directed to the individual from outside; the right to be treated with dignity, i.e. with proper respect. Human dignity is something we possess, we cannot lose it but it can be violated or disrespected. “My dignity” on the other hand can be lost since it has to do with what we do to others. My dignity is only conditional and related to my religion, culture, society, and family and can be lost by acting disrespectfully, irresponsibly, and unequally, etc.

I consider that human dignity should clearly be separated from the notion of respect, which is a conditional and a cultural act, customs and rituals about the dead are set by different cultures. It is important to emphasize that if a dead person is not acknowledged or respected, it doesn’t mean that he has no dignity. Respect describes the behavior of a person while human dignity expresses a value a person possesses.

Many people encounter difficulties in perceiving and understanding the meaning of “being dead” or what a dead body actually means. What they know though is that it is “something” very important. I am of the opinion that human dignity is nothing that appears as soon as you come into contact with a dead person. It is there a priori, within that person. That is why human dignity is not conditional. If the dead person has human dignity it consequently has human rights, i.e. he/she has the right e.g. not to be treated inhumanely, cruelly, humiliatingly or with indignity.

Agency- a universal inherited right as well as a conditional right

The definition of agency is changeable and often influenced by different intellectual approaches. Agency in contrast to human dignity can be observed and measured. It is the capacity of a person to make choices and have duties in an interactive way with his/her outside world. If we accept this definition, then any demented, newborn or person with inherited cognitive impairment would lack agency. But would they lack needs or interests? I would say no. Needs and interests are affecting our external world, not in the active way that duties and choices may do, but certainly they have an impact on different levels of the society; i.e. family, friends or the state in general. The dead is an “agent” of his history but also of the future. To have a historical agency is to have a “futurity” agency. An interesting example that elucidates this aspect is the belief of the Māori people on New Zealand, who respect the wishes of the deceased to shape the political reasoning of the living. The dead ancestors are participating actively in politics and society by their agency. Even if the body of the dead literally does not speak out its needs, wishes, claims or interests it has a social voice affecting those who are living, by leaving memories, changes in relations and spaces. There are controversial ideas about the futurity of the dead. Archeologists for example are interested in the dead himself and not his wishes, claims or debts to the society. Many scholars argue that there is no way for the living to actually know what a dead wants or wishes, because as soon as death appears the voice of the dead will be filtered by the living.

Even though agency is conditional and “actualized” in a cultural and social context, we could make an attempt to widen the definition, by considering that an individual a priori has an agency, in the past; in the presence; in the future.

By universalizing the concept of human dignity and agency and making them kind of “virtues “of being a human being, we will be able to obtain a more human and unapologetic approach to the dead.

We should always start our ethical reasoning by accepting that every human being possesses human dignity and “agency” of her past, her presence and her future. They are both related to her rights and claims in respect to how she is treated by others. The deceased has the right to be identified and it is the moral responsibility of the forensic service to make sure that the respect for the deceased is ensured.

Professional ethical reasoning: the four principles of medical bioethics in forensic medicine

Instead of only listing a series of rights, I would like to introduce the notion of responsibility of the living in respect to the values and rights of the dead. Every society, organization, profession, individual sets certain values about what is right or wrong, good or bad, fair or unfair, true or false, equal or unequal. Value-based reasoning defines and determines whether the action performed conforms to these values. When we talk about human values, we mostly relate them to living people. Our question is, are these values the same for dead individuals? The answer is not very clear. As soon as we try to apply ethical principles on dead people, definitions of values become more diffuse.

The four principles of bioethics medicine; to respect each individual’s autonomy, non-maleficence, beneficence and justice29 will be approached from a professional-ethical point of view. It is our responsibility to respect, acknowledge and actualize the values that constitute these principles.

For our purpose we will attempt to apply these four principles in forensic medicine.

Autonomy

„Does the dead person have autonomy”? If we accept the current definition that a dead person does not have desires, wishes or demands, nor is he/she capable of forming intentions or understanding, then the dead does not have autonomy. Therefore autonomy, in this respect can only be valid for a living person. This seems to me a quite narrow definition, which would lead to the conclusion that those who have dementia or other congenital, inherited or accidental cognitive impairments would not have autonomy. There are many controversies around the concept of autonomy of the dead and how it should be interpreted. In its strict meaning, the individual is not totally autonomous, because this would mean that he/she has access to all facts prior to his/her decisions. Even if there is a written prior-to-death consent by the deceased to donate organs, still we don’t know under which circumstances this was written. Therefore it would be of benefit to actually analyze the term autonomy in degrees. One person can be more autonomous on one occasion and less in another, depending on the degree of understanding, intentionality and external impact at the very moment of the decision.

Principle of non-maleficence

The forensic practitioner is obliged to avoid doing harm to his/her subject whether alive or dead according to the principle of non-maleficence. How can a forensic pathologist avoid doing harm to a dead person? The dead body must and should be entitled to a moral status, which protects it from violations and disrespect as a result of mistakes, negligence or intentional acts. A forensic pathologist is obliged to the following.

Perform an autopsy without letting stress or other external delays affect the quality of the examination, thus avoiding missing any subtle factors or evidence that could jeopardize the results.

Not to injure the body by being careless when put in a state of stress or not performing the dissection according to the scientific techniques. Destruction or injury of an organ, would jeopardize the best possible evidence for the cause of death.

To be aware of the objective of the medico-legal autopsy, not only the cause, time, manner, mechanism of death but also for potential litigation in medical death, the duration of disease.

To perform a complete autopsy. Several autopsy studies have shown that failure to diagnose and misdiagnosis are common in critically ill patients.

To perform a medico-legal autopsy before giving the permission to embalm the deceased. Gross tissue changes are much better appreciated when the body has not been embalmed.

To aim at an examination and a description of the external lesions on the body, which are satisfactory and acceptable in quality, in order to get the best possible evidence.

To examine the dead person at the crime scene.

To take adequate photographs, audio and video recordings for the evidence.

To violate or disrespect the above principles would lead to inaccurate, unreliable and even false results.

Principle of beneficence

As the medical physician has the duty to act for the benefit of the patient, so has the forensic practitioner for the dead and the living. How would we describe an act of beneficence in forensic pathology? Here are some examples:

Respect for the moral status of the dead body by examining and treating it according to its rights and needs.

Compassion, kindness and understanding during the communication with the relatives, even in situation where there is stress

Respect for and consideration of any religious belief, in the best possible way, without violating the legal purpose of the autopsy.

The principle of justice

The principle of justice and its subcategories should also be applied for the dead person. He must receive equal, fair and just treatment and care according to his/her needs and rights.

Moral sensitivity

I would like to make a philosophical-psychological approach to our discussion on professional-personal ethics by introducing the concept of “moral sensitivity”. Moral sensitivity is also a process of being able to raise the ethical norms above “reason” and put them on “a human inter-relational cross-boundary level” leaving it open for an intuitive approach to decide what is good for the others. In forensic practice this could be as simple as e.g. holding a relative’s hand when he/she is in shock or folding the dead person’s clothes and putting them gently in a bag when given to the relatives

Table no.5

The book entitled „Aspecte medico-legale si etice ale traumatismului cranio facial"

The subject of craniofacial trauma is an extensive, complicated and diverse one, which extends far beyond the emergency service and which through an interdisciplinary approach raises ethical and forensic issues.

The manuscript elaborates the cephalic extremity, including chapters such as head bones, head muscles, continuing with cranio-facial traumatology, forensic examination of people with cranio-cerebral or facial trauma and concludes with ethical aspects.

In dealing with cranio-facial trauma, the attending doctor works in the light of autonomy, beneficence, nonmaleficence and justice, acting in the best interests of the patient. The informed consent chapter aims to provide the necessary tools for a basis and overview of the informed consent process.

The author, through this book, wanted a holistic approach to the subject, presenting her experience in the fields of forensic medicine, anatomy and bioethics.

Works published in scientific journals

„Ethics and suicide prevention. A case report”, Carmen Corina Radu, Dan Perju-Dumbravă, Codrin Rebeleanu  – Studia Universitatis Babes-Bolyai, Bioethica (2011), 2016

Medical professions, through multiple human relationships that are committed during and for making medical act, were involved from the start with rich professional ethical conduct content. Professional ethics in the field of medicine is a system of moral norms and rules governing the behavior of the doctor and of health workers. The medical moral as any moral professional is socially determined, not only by doctor's personal qualities, but also the character of the social system, the dominant health care system, the social prestige of medical workers and their working conditions.

The medical act must primarily be conducted in the direction to help and protect the patient, i.e. legally, nominally and personally. The organization or the institution offers legal protection but the nominal and personal protection is given by our personal values and common dictated professional values. Laws, regulations and protocols and nominal protection e.g. human rights, principles and professional codes cover legal protection. For the protection of the patients ethical codes are given and are based on the classical principles of autonomy, beneficence, non-maleficence and justice.

Bioethics has developed responsibilities, which are based on the principle of autonomy such as: respect for individuals based on patient rights; telling the truth and giving all the details; confidentiality, fidelity. Autonomy advertises respect, dignity and choice.

The principles are there but they are not sufficient to solve dilemmas in everyday professional life. We need personal protection of the patients. Personal protection is under the umbrella of our personal values, which are dictating our contact with the patients. Good examples are: awareness, understanding, integrity and respect for patients’ rights, honesty, and trust, maintaining a good relationship with the patient, empathy, listening skills, and patience.

Watson said in 2006 "the values of the organization are dictated by economics, technology, medical sciences, administration". The organization protects mainly its own interests.

The ethical dilemma begins where there is a conflict between loyalty to the organization/institution (upper hierarchical structures), to the patient, to oneself or sometimes to the rules of the group. It is important to note that legal is not equal to ethical. In most cases, laws only provide the minimum standard of attitude- ethics claims for more.

The studied case is of a 26 year old woman who suffered for a year and a half of severe anxiety, repeated panic attacks, which finally led to suicide by hanging in an inpatient psychiatric clinic. The ethical dilemmas presented make this study unique.

„The ethical and legal issues concerning the use of human tissue in Romania”, Carmen Corina Radu, Dan Perju Dumbravă, Alexandru Rusu

A civilized society can be measured by how it treats its deceased. The dignity of the human body represents a priority according to our ethical and moral values. It’s a legal right for any deceased person in unnatural circumstances, despite race, religion, gender or social beliefs to get an examination conducted by a forensic pathologist in order to include or exclude the possibility of a crime. Other aspects that are also being investigated are the cause, time, manner, and mechanism of death. The results of the examinations can determine eventual mistakes or negligence in the health care. The poor, the disadvantaged people such as the homeless people are frequently unclaimed and unidentified. Usually these bodies are the source of cadaveric material. According to Romanian law (Law no. 104/2003) there are two cases in which it is legal and ethical to use a dead body for teaching or learning purposes. In the first case the person in cause must sign a written agreement prior to his/her death or if the person is already deceased the family has the right to agree with the consent. The second case regards unclaimed bodies that can be used as long as there is no evidence of his/her identity. A forensic pathologist’s conduct must be guided by ethical codes that protect the human body, which imply the following principles: autonomy, beneficence, non-maleficence and justice. It is morally wrong and illegal to use a human body without consent, regardless the purpose.

Necropsy is an examination procedure of the organs and tissues of a body, by finding the cause of death. There are two types of postmortem examination: anatomopathological necropsy (in case of pathological deaths) and the forensic necropsy (which is done by request from the juridical organs in special cases like violent deaths, sudden deaths and suspect deaths. Both types of autopsy are also used in a didactic purpose at the Faculties of Medicine, as a good academic development for the students that are attending these institutions.

Dissection of the bodies is practiced in the matter of studying topographic anatomy. This is the first procedure that the students are seeing, because is the main part of anatomy. Students have to take the teacher’s example and to respect at their time the rules of good practice.

These three practices are accepted as ethic and moral procedures because of its finality, that has a noble purpose, and all are present in the legislative norms in use.

At the end of autopsy, the family in the purpose of burial takes the body. The bodies that are dissected, remain kept in the purpose of study and scientific matter.

These days, dissection is not being used as much, because it’s substituted by anatomical models from trade, dissections programs (Adam Animated Dissection of Anatomy for Medicine) and database with dissection images (A visible Human Project). (58)

The body of the deceased represents a form of identification; respect for its identity, like it’s was still alive. Also the memory of the person has to be respected. Taken from religion’s view, we have to consider the aspect of belief in life after death and “ Resurrection”. Lack of respect attributed to a deceased person’s body is a negation of human character existence. We have to remember the respect according the patient’s confidentiality, a right that persists even after death and also keeping the professional secret.

„A practical approach to ethical decisions in anatomy classes of romanian medical faculties”, Carmen Corina Radu, Dan Perju Dumbravă, Chiriac Serghei, Diana Bulgaru Iliescu. Studia Universitatis Babes-Bolyai – Bioethica 59/2014

According to Davidson’s statement “throughout history and in cultures around the world, education rightly conceived has had two great goals: helping students become smart and helping them become good. They need character for both”.

The fundamental ethical principles under which the universities shall follow are the following: academic freedom, personal autonomy, justice, fairness, professionalism, excellence, transparency, quality and professional collaboration.

Some ethical issues which have appeared in anatomy classes of the English section in the Faculty of Medicine and Pharmacy of Oradea is an attempt to alert the academic community by emphasizing the necessity of ethics in teaching. It is not enough to have laws and regulations; we must formulate ethical codes based on common and accepted values and apply them in daily academic work. The academic environment is responsible for everything that happens within the four walls of its house. Therefore we advise participation of all the members of the academic society in forming and joining workshops, discussions in order to identify problems and to find ways to solve them. In such team, students’ mentors would be of great value. Many universities all over the world use mentors’ quality as channels for solving ethical and moral dilemmas among students.

I appreciate that the academic community will stay free and independent from any religious, political or financial doctrine or orientation.

In 2014 I wrote “ Ethical and religious aspects regarding the transplant of organs in the case of homosexuals”- this work presents the medical behavior and church's behavior when it comes to helping people that have other sexual orientations, homosexuals. The social side of these persons made them authors in different community matters. One of those is that they are donating organs to people in need, and society grew a sensitive behavior regarding the matter of a homosexual donor.

In history, homosexuality was recognized even in the early ages and watched through different perspectives, such as: religious, legal, ethical perspectives during the passing of time, having a culminating stage in 13th century when the punishment for homosexuality was death.

In the last years, homosexuality statute has significantly improved and they are more comfortable integrated in societies. In a medical view, starting with year 2013 in United States of America was initiated a program that permitted the fact of homosexuals as blood donors. Interdiction was way before implemented because of high risk of infection with HIV virus. Today, even if there is a advanced medical development that is capable to detect most of infections, no matter their type, there still are countries that prohibit donation of blood by homosexuals. Another perspective is that of the Orthodox Church, in our case, that doesn’t recognize this sexual orientation because of immorality and impossibility of procreation like the holy books are stipulating. Much more than that, homosexuality is considered a sin and provokes repulsion and disgust. There are many arguments that support these sayings in the Bible, in LEV 20:13 and I Corinthians 6:9-11.

From the exposed facts in this paper we observe a coalition between doctors and Orthodox Church, which limit the access of homosexuals in improvement of medical healthcare system by donation of blood or donation of organs. The donors of organs in Romania increased as number, and the medical service also improved by giving the patients another chance at life.

Even if the number increased, there still are deficits of organ donors to cover all of the patients written on the waiting lists. A major impact is education, because people more often realize that the ending of life to a person can give life to another one, talking about renal or hepatic transplant. Even the transplant of organs was hardly accepted by orthodox churches during the years, by not understanding that transplant is a intervention that is saving lives. Today, medically and religiously speaking there are some criteria and conditions that the donor has to achieve, but nothing about homosexual donors, being excluded from these practices. Ethically there are no circumstances that can prevent people with other sexual orientations to donate, the only aspects being those of medical order meaning compatibility between donor and patient. (68)

The religious problem revealed a hard to prove situation by medical studies, that the stage or sexual orientation of the person that gets an organ from a homosexual person can be influenced or changed by genetic mutations that occur after implementation of the new organ.

In a experimental study made on 400 homosexual people was discovered, uncertainly, that gene Xq28 is involved in influence of sexual orientation. Also through church’s view, the person that gets an organ from a homosexual donor has to be spiritually excluded from the church. That’s why it was implemented that the person that gets the organ shouldn’t know its provenance, to prevent every type of speculation.

The number of homosexual people that want to donate is extremely low and doesn’t influence the donation rate that much. There can be cases in which donors of a certain organ are hardly to find, and when the found donor is homosexual, society has to take an ethical and religious decision. The decision has to be strictly medical and from the perspective of the patient when there is a homosexual donor, and the church should not have a decisional role, only a conference role. Also, through direct contact with the persons, church has to facilitate access to people from the medical act no matter its nature, and helping to grow life savings. The primordial role of the church is that of growing hope of life in a view of a person that already has the fear of having the possibility to die without having a medical specialized intervention.

„Ethical notions in catastrophes”, Carmen Radu, Diana Bulgaru-Iliescu, Daniela Rahotă, Dan Perju Dumbravă. Revista Română de Bioetică, 2014

Starting from the premise that disasters only happens to others, the majority of cases present with a deficiency in intervention capacity. As such, we can encounter inefficient first aid instruments within the first hours of a calamity or in the cases when a calamity occurs over an extended space and is accompanied by poorly organized intervention squads. The ethical imperative in these situations is saving all of the victims, in the shortest amount of time, using the resources available at that particular moment. In case the number of victims outnumbers the intervention squad, a priority in offering first aid goes to people with more severe lesions. It is not morally correct to discriminate based on women, children and older people. Favoring one of the aforementioned categories relates to the generosity and availability of each particular person, with heroism and martyrdom always being voluntary and lauded, but never requested. In these cases first aid should be offered to everybody, respecting the will of people who want to risk their personal safety in order to save other people. There has been a tendency in offering priority to victims who have greater chances of survival or preferring people who have more to offer to society. The opinions are split, with some people believing in the application of the temporal principle (first come, first helped) and others supporting the application of the therapeutic principle, which states that people with greater chances of survival should be treated first.

In cases of disaster, a special respect needs to be offered to the deceased. In the practice of forensic medicine we encounter situations in which family members of the deceased are interested in the cause of death and the circumstances that lead to the death of their loved one. Informing them is necessary, even if it breaches the rule of confidentiality, with the note that some medical aspects which could damage the image of the deceased such as venereal disease or chronic alcohol consumption will be tactfully approached and only disclosed to close family. The family will be warned not to release information, which could damage the memory and reputation of the deceased person. This is an exception from the rule of confidentiality, according to which each deceased individual examined has the right to have his medical information kept secret even after death.

Mentioning the principle of responsibility brought into discussion by the founder of bioethics, V.R. Potter is paramount; according to this principle, we are in absolute need of responsible measures in order to prevent calamities, and once these calamities have unfolded, we are in more need of people willing to sacrifice their own lives in order to save the lives of others. In crisis situations, respecting some basic ethical principles is imposed.

2.3. Discussions

The interpretation of universal ethical principles varies depending on the cultures and nations; however, they follow a common trend in most cultures that is beneficence, justice, non-maleficence and human dignity.

2.4. Conclusions

In the field of expertise, no matter the nature of it, the forensic medicine doctor has to exhibit the lesions in a professional and understanding matter. Most of the time it helps in justice at staging the facts, framing them and finding the guiltiness and circumstances of production. So the forensic doctor helps, thorough his interpretation, to protect the patient’s and his family’s interests, such as the field of psychiatric expertise, where the discernment evaluation can attract interdiction of the patient with protecting his legally property and interests.

Through his activity, the forensic doctor interposes between medical notions, patient and justice. In this way he has to keep a professional dignity and correctitude in the interpretation of recorded data and given documents, maintaining a constant high scientific behavior. This is what I tried to respect and forward in the work I’ve done all these years in the Service of Forensic Medicine, Bihor County.

Section II

PAST, PRESENT AND FUTURE

Professional, scientific and academic contributions

Career overview

My entire career is presented in the Curriculum vitae. However, I considered useful to insert here a very brief synthesis of my experience to facilitate the interpretation of the scientific achievements presented in detail in Section I, and their correlation with future research directions mentioned below. Thus, the most representative landmarks of my activity include:

Editorial activity consisting of: 4 specialty books as sole author, 2 specialty books in electronic format, co-author of one book, contributor for two chapters in an international published book, author and/or coauthor of 8 chapters published in collective volumes.

Regarding the published articles I mention 24 papers published in ISI scientific journals with impact factor, 19 as the principal author, 25 indexed BDI papers. An ISI (Web of Science) 6 Hirsch factor, with medium citations number of 3,04. The number of citations, excluding self-citations, is 61, and the impact cumulated factor 14. The themed area regarding these citations is multidisciplinary: forensic medicine (11 articles), chemistry, public health, medical ethics, social sciences.

In the period between her doctoral thesis and currently, the author has participated in numerous scientific sessions and conferences, both national and international, where she improved her professional experience and teaching skills, being always updated with the latest discoveries and changes in legal medicine and bioethics.

An important point concerning the latest research in the field is represented by her membership in the Research Ethics Committee of Oradea University (CEC UO).

At the same time, certifying the professional quality of the author, she is a member of the organizing committees of national congresses and member of scientific and professional societies: national and international, in which she is a founding member in Forensic Association of Romania.

PhD thesis

„FORENSIC PATHOLOGIST ROLE IN COLLECTIVE ACCIDENTS”, supervisor: Prof. PhD. Milan Leonard Dressler

Contemporary forensic medicine dealing with collective accidents presumes a very good methodological approach in this field. The large number of victims, the diversity of situations as well as the often-unpredictable circumstances, requires the forensic medicine to adapt according to the nature of the incident and collaborate with healthcare professionals who are involved in the research of criminalities and justice. One such topic, although commonly met, has not gained a distinguished place in forensic practice.

The hypothesis and the aim of this thesis are to thoroughly study and implement procedural guidelines for the development of a methodology.

The thesis has an irreproachable theoretical foundation and is a comprehensive analysis supported by legislature.

The personal part of this thesis includes an objective analysis of the current situation of collective accidents in our country. I approached topics such as: dynamic collective accidents during the last five years; I conducted a comparative study on the methodology of approach of collective accidents in different countries by accident type. The entire research approach is outlined in detail in order to clarify forensic emergency assistance and its relations to existing conditions that should exist in our country in order to achieve the relevance of forensic evidence in collective accidents. Many other casuistically examples have certain methodological value for forensic practice.

The methodological proposals can constitute a prototype for the laws and can support legislative initiatives.

Academic activity

I shall refer below to the most important achievements in the field of teaching activities, dissertations coordinated, books published, as well as my attendance in different committees and commissions.

Regarding the academic work, the author holds the rank of lecturer in the University of Oradea, Faculty of Medicine and Pharmacy, where she began working in 2003. She is teaching courses for students (behavioral sciences), for resident doctors (Bioethics), coordination and training of resident doctors, conducting the graduation thesis. Noteworthy is the membership of admission and examination committees, selection and equivalence committee of Erasmus, the Faculty representative member in the Council for Research Development-Innovation, the Ethics Committee of Scientific Research, the year directive of MGE.

Based on the theoretical and practical experience accumulated, between 2006 and 2020, I have supervised more than 50 dissertations (in Romanian and in English), all of them in the field of Forensic Medicine. The major aim for every thesis was to teach the students how to do a literature review (how to select good articles, how to extract useful information and then how to build a proper review) and a basic study (which information should be extracted from every file, how to organize them, how to do simple statistical interpretations, how to correlate the results and how to formulate conclusions). Students also learned how to do a references list and how to design and to present a PowerPoint presentation. All the theses passed the final evaluation with maximum mark.

My academic activity also includes writing books. In the interval mentioned above, I have written or contributed to 7 books and another 8 chapters.

Concerning my attendance in different commissions of the university, I think I should mention that I was appointed member of the commission that selects overseas candidates that apply to become students in the Faculty of Medicine and Pharmacy – Oradea University. I have also been a member of promotion commission in our faculty; as well I have attended the commission for the entrance exam for graduate students. Moreover, I have been a tutor of graduate students (English series).

For all these jobs I have accomplished my mission as good as I could, trying to get the maximum benefit for all the parts involved and to encourage people to develop their potential.

Research projects

I have teacher training knowledge and skills formally acquired within trainer training programs, through my educational experience in continuous medical training and in university teaching.

I have participated on a constant basis in the development and performance of projects, in the coordination of multidisciplinary teams and in organizational management.

I can synthesize that the major aspects of my activity so far are as follows:

Promoting legal medicine knowledge through education and research;

Excellence in medico-legal services, research and education;

Involvement in multidisciplinary research groups;

Creation of research programed/ plans stimulating collaborative inter- and trans disciplinary research activities.

Project HURO 0801/153 „Mobile laboratory of legal medicine for emergency situations in the cross-border region” a project implemented in Hungary-Romania Cross-border Cooperation Programme 2007-2013. Clinical Emergency County Hospital Oradea – RO (Lead Partner) in partnership with University of Debrecen – HU (Project Partner), implemented the project in the period 15.12.2009 to 14.01.2011. Total value of the project: 73,943.25 EUR. An important activity was held in Oradea, vocational training course conducted by a specialist in emergency situations, Professor Thomas Krompecher from Switzerland. The course was attended by over 100 participants, project team, consisting of representatives of target groups, local public institutions and institutions involved in emergency management and doctors of various specialties. Interventional plans developing activity was made and consisted in interventional plans for emergency situations caused by road traffic, railways, and aircraft collective accidents and a protocol for victims identification results in collective accidents. Finally, both institutions involved in the project were recovered amounts from ERDF and MDRT. This success was due to a very good inter institutional cooperation.

The projects: „Interdisciplinary program of emergency situations approach” and „Forensic processing procedures in emergency situations in the Bihor-Hajdu-Bihar cross-border region” with the acronym PPMLISU and project code: HURO 1001 were unsuccessful projects.

In the project HURO/0802/082_AF entitled: „Bihor Counties’ Health Care Contribution” valued at 1,909,898.28€, I served as extern expert consultant. Project duration: March 1st 2011 – July 31st 2013. The project’s beneficiary: Bihor County Council and Oradea’s County Emergency Clinical Hospital was PP3 partner. Within the project we organized a symposium entitled: Common treatment protocols and medical procedures in Oradea’s Emergency County Hospital, during 22-23.11.2015 (organizing committee) concluded by making a CD, entitled Common treatment protocols and medical procedures in Oradea’s Emergency County Hospital, University of Oradea Publishing, ISBN 978-606-10-0953-4 2012 in electronic format.

The basic concept relies on the planned material put together during project meetings and previous communications between the partners. The encompassing goal of the project was to give birth to a such a cooperation between Debrecen-Oradea-Felix Spa health care centers, where they focus on the emergency treatment of patients and would like to improve the potency of medical service provided in Hajdú-Bihar and Bihor counties and expand the professional knowledge and tools of the hospital staff of the institutions involved in the project through knowledge transfer programs, the mutual treatment of patients and increasing the capacity of diagnostics and surgery.

It was multiple partnerships with Romanian Partners (Bihor County Council, Oradea County Emergency Clinic and Hospital, Clinical Rehabilitation Hospital Felix Spa, Oradea County Emergency Clinic and Hospital) and Hungarian partners (Kenézy Hospital and Clinic Medical Service Provider Non-Profit Ltd; Medical Out-Patient Centre Service Provider Non-Profit Ltd).

Future directions

My plan of career development is correlated with the development plan of the Faculty of Medicine and Pharmacy, University of Oradea, implying that I realize as reasonable as possible the necessary imperatives for my profession: teacher, member of the Ethics Commission of Research of Oradea University (CEC-UO), representative of faculty in CCDI (Council of Research-Development-Innovation) and director of the research center within the Faculty of Medicine and Pharmacy – University of Oradea, entitled: Center for research in Medical Sciences, Pharmaceutical and Dental Medicine (CCFMD), plus: maintaining and increasing standards of academic and professional excellence, direct collaboration with peers, teachers and students.

Development and evolution plans of the scientific career will pursue the purchasing of a portable x-ray machine for autopsy to increase the quality of forensic identification of victims; this acquisition is possible by applying a project within the Interreg V program.

Another professional plan is the establishment of a Trans boundary Bioethics Center. I'm referring to a partnership with the University of Debrecen and establishing a research core in the field of Bioethics, in the border area. I must point out that I have initiated a cross-border partnership in the field of forensic medicine through the LMLTRANSSU project. Research areas: forensics, held to date, in the future it will remain a priority given the existence of strong base of collaboration.

I also add my interest to research in the field of legal methodology applied in forensics.

Career development can be summed up in continuing the forensic services with the participation in the conferences and scientific sessions organized nationally and internationally. I'm a forensic expert with international recognition: being a scientific expert certified both nationally and internationally. My wish is to further collaborate with all our colleagues from other universities or services, perhaps even more intensively than to date, in order to highlight and take cognizance of all the professional discoveries and innovations traced in the forensic, legal and bioethical fields.

The major plan in order to develop the academic career includes the proposal of a topic and the establishment of courses for doctoral school with the purpose to train professionals in the field of research and forensic practice and why not in the field of research and jurisprudence also. Simultaneously targets set till today on undergraduate and postgraduate courses will continue with the same objective, which is to train medical and legal professionals or acquire a certain competence.

Only through training and ensuring a qualified and professional staff we can ensure that in future scientific achievements will evolve even further by finding new trends in the field and the works discovered and materialized today will stand as a basis or milestone in the evolution of science.

Therefore, my professional and scientific accomplishments so far represent a support that will allow me to both continue educating generations of students and doctors, and also to select and train new academics and PhD’s in a quality adapted to the requirements of modern European universities, parallel to the development of scientific research in the fields of forensics, bioethics and related matters.

Objective 1 (teaching-oriented)

Developing graduate and postgraduate education in Legal Medicine and Bioethics.

Summary of my future research activities:

Analyzing the ethical questions of suicide, and examining the moral permissibility of the so called „rational suicide”;

Analyzing the questions of victims identification;

Analysis of forensic medicine and ethical problems related to tissue and organ transplantation;

Examining the stigmatizing effects of psychiatric disorders and their influence on the quality of life of psychiatric patients.

SECTION III

List of publications

1.ARTICLES PUBLISHED IN EXTENSO IN ISI/BDI QUOTED

ISI with an impact factor as main author

Carmen Corina Radu, Monica Rotaru, Bogdan-Andrei Bumbu, Virginia-Bianca Vulcan, Diana Bulgaru-Iliescu, Iuliu Fulga, Dan Perju-Dumbrava, Three-dimensional (3D) reconstructions of the skull and its value in the field of forensic medicine, Romanian Journal of Legal Medicine 2019, No.4 (Acceptance letter)

Carmen Corina Radu, Dan Perju-Dumbravă, Daniel Ureche, Codrin Rebeleanu, Diana Bulgaru-Iliescu, Iuliu Fulga, Andreea Cămărășan, Ovidiu Pop, Accessory spleens at autopsy: the incidence and the presence of myoepithelial cells in the spleen capsule, Romanian Journal of Legal Medicine 2019, No. 3, Pages: 247-253 Impact Factor: 0,48

Dan Perju Dumbrava, Carmen Corina Radu, Daniel Tabian, Stefan Cristian Vesa, Iuliu Fulga, Ovidiu Chiroban, The Relation between Suicide by Chemical Substances and the Level of Education, Revista de Chimie (Bucharest) 2019, No. 7, Pages:2643-2646 Impact Factor: 1,605 corresponding author

Dan Perju Dumbrava, Carmen Corina Radu, Ovidiu Chiroban, Diana Bulgaru-Iliescu, Tatiana Iov, Simona Irina Damian, Daniel Ureche, Retrograde Extrapolation Of Blood Alcohol Concentration, Revista de Chimie (Bucharest), 2019 No. 2, Pages: 407-409, Impact Factor: 1,605 corresponding author

Radu Carmen Corina, Camarasan Andreea, Podila Cristina Maria, et al., Sudden Death of a Teenager Caused by Actinomyces israelii: A Case Report, Iranian Journal of Public Health  2018 Volume: 47   Issue: 9   Pages: 1412-1417   Impact Factor: 1,225

Hunea I , Damian SI, Radu CC, Moldoveanu S, Iov T. Postmortem Specificity of Troponin for Acute Myocardial Infarction Diagnosis through Qualitative Dosing from Pericardial Fluid. Revista de Chimie. 2018 Volume: 69.Issue: 9 Pages: 2482-2486 Impact Factor: 1,605 corresponding author

Perju Dumbrava D, Radu CC ,  David S, Iov T, Iov CJ, Sandu I , Iliescu DB. The Importance of Alcohol Testing by Gas Chromatography vs the Cordebard Classical Method Modified in the Medico Legal Investigation. Revista de Chimie 2018 Volume: 69. Pages: 2407-2410 Impact Factor: 1,605 corresponding author

Perju-Dumbrava D, Rebeleanu C , Ureche, D, Pop O, Bulgaru-Iliescu D, Radu CC, The medico-legal value of histopathological examination in hanging. Romanian Journal Of Legal Medicine 2018,Volume: 26, Issue: 4, Pages: 349-353, Impact Factor: 0,48

Scripcaru V, Iov T, Knieling A, David SM, Radu Carmen Corina . Suicide and blood types. Romanian Journal of Legal Medicine 2018 Volume: 26 Issue: 2 Pages: 206-208, Impact Factor: 0,48

Dan Perju Dumbrava, Carmen Corina Radu, Tatiana Iov, Simona Irina Damian, Ion Sandu, Daniel Timofte, Ovidiu Chiroban. An Unusual Case of Accidental Carbon Monoxide and Ethanol Intoxication in Two Commorientes Deaths, Revista de Chimie, 2018 iulie, Pages: 1889-1891 Impact Factor: 1,605 corresponding author

D. I. Ureche, Carmen Corina Radu, E. Szigyártó, O. Chiroban, I. Miclutia. Evaluation of aggressive behaviour in forensic practice in Romania, Romanian Journal of Legal Medicine, 2018, 26(1)97-102, Pages 97-102, Impact Factor: 0,48 corresponding author

Carmen Corina Radu, C. Rebeleanu, D. Ureche, C. Scripcaru. Forensic, ethical and religious issues regarding the cremation process, Romanian Journal of Legal Medicine 2017  Volume: 25   Issue: 4  Pages: 432-434   Impact Factor: 0,32

Carmen Corina Radu, C Podilă, A Cămărășan, D Bulgaru-Iliescu, D Perju-Dumbravă. Ethical professional-personal model of making decisions in forensic medicine, Romanian Journal of Legal Medicine  2017, Volume: 25   Issue: 3   Pages: 314-316   Impact Factor: 0,32

Dan Perju-Dumbrava, Ovidiu Chiroban, Carmen Corina Radu. Obesity and Overweight Risk Factors in Sudden Death Due to Cardiovascular Causes: A Case Series, Iranian Journal of Public Health 2017. 46(6):856-857. Vol. 46, No.6, Jun, pp.856-857 Impact Factor: 1,05 Letter to the Editor

Carmen Corina Radu, Diana Bulgaru-Iliescu. Claims of „uniqueness” in forensic medicine, Revista Română de Medicină Legală. 2016, vol. 24, nr. 4, decembrie Impact Factor: 0,108

Dan Perju Dumbravă, Ovidiu Chiroban, Carmen Corina Radu. Mechanical asphyxia due to biological agents. Case report and literature review.
Revista Română de Medicină Legală. 2015, vol. XXII, nr. 3 Sept. pg. 177-180 Impact Factor: 0,144

Carmen Radu, Diana Bulgaru-Iliescu, Daniela Rahotă, Dan Perju Dumbravă. Ethical notions in catastrophes. Revista Română de Bioetică, vol 12, No 2, 2014 pg. 53-57 Factor de impact 0,462

Dan Perju Dumbravă, Serghei Chiria, Carmen Corina Radu , Diana Bulgaru Iliescu. Ethical and religious statements regarding organ transplantation in case of homosexuals. Revista Română de Bioetică, vol 12, No 3, 2014 pg. 44-48 Factor de impact 0,462 corresponding author

Carmen Corina Radu, Gabriela Muțiu, Ovidiu Pop. Accessory spleen- CASE REPORTS. Romanian Journal of Morphology and Embryology 2014, 55(3 Suppl):3–6 Factor de impact 0.723

ISI with an impact factor as coauthor

Iuliu Fulga, Carmina Liana Musat, Doinita Vesa, Ana Fulga, Dorel Firescu, Carmen Corina Radu, Diana Bulgaru-Iliescu, Dan Perju-Dumbrava, Ovidiu Chiroban, Asphyxial death related to sublingual hematoma after root canal intervention in a hemophilic patient-case report and literature review- Romanian Journal of Legal Medicine 2019, No.4, Pages: 242-246 Impact Factor: 0,48

C Delcea, AM Fabian, CC Radu, DP Dumbravă, Juvenile delinquency within the forensic context – Rom J Leg Med 27 (4), 2019, No.4, Pages: 366-372 Impact Factor: 0,48

Dragos Crauciuc,  Costescu Mihnea,  Scripcaru Calin,  Damian SI, Radu CC, Girlescu N. Forensic Aspects of Fluorine Poisoning. Revista de Chimie 2018, Volume: 69   Issue: 12   Pages: 3710-3713, Impact Factor: 1,605

ISI without impact factor

Dan Perju-Dumbravă, Ureche Daniel, Cristian Gherman, Ovidiu Chiroban, Laurian Ștefan Bonea, Carmen Corina Radu. Biblically Inspired Tattoos in Forensic Examinations Made on Inmates? Bodies in Prisons Territorially Assigned to the Forensic Institute of Medicine from Cluj. Journal for the Study of Religions and Ideologies, vol 15, no 45 (2016)

C Buhas, G Mihalache, C Radu. The role of forensic medicine in preventing domestic violence. Romanian journal of legal medicine, 2007 vol XV, Issue 4, pg.301-305

Articles from BDI magazines

Main author

Radu Carmen Corina, Holhos Larisa, stud. Radu Casandra Maria, Rebeleanu Codrin, Perju Dumbravă Dan. Biorhythm and the prediction of suicide behavior in Bihor County. Analele Universitatii din Oradea, Fascicula: Ecotoxicologie, Zootehnie si Tehnologii de Industrie Alimentara, Vol.XVI/B 2017, pg. 397-402 Indexed CABI  https://www.cabdirect.org/cabdirect/abstract/20183175155

Radu Carmen Corina, Perju-Dumbrava Dan, Ureche Daniel, Maxin Marius, Radu Casandra Maria. The influence of environmental factors on the human body – Cryoagression. Analele Universitatii din Oradea, Fascicula: Ecotoxicologie, Zootehnie si Tehnologii de Industrie Alimentara, Vol.XVI/B 2017, pg.359-367 Indexed CABI http://www.cabi.org/default.aspx?page=1016&site=170&pid=508&xslttab=2&newtitlesonly=0&letter=*&search=oradea

Dan Perju-Dumbravă, Codrin Rebeleanu, Carmen-Corina Radu. Particularities of forensic expertise in medical malpractice. Fiat Iustitia – „Dimitrie Cantemir” Christian University Bucharest. Faculty of Law Cluj- Napoca, No 2/2017 pg 144-151 Indexed EBSCO http://www.ebscohost.com/titleLists/lgs-coverage.pdf

http://fiatiustitia.ro/ojs/index.php/fi/article/view/331

Carmen Radu, Dan Perju-Dumbravă, Corina Beiușanu. The influence of cold in cardiovascular diseases. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XV/B, Anul 15, 2016 pg.189-192 Indexed CABI https://www.cabdirect.org/cabdirect/abstract/20173128176

Rebeleanu Codrin, Dan Perju-Dumbravă, Radu Carmen. Artisanal production of spirit beverages – Risk factor for chronic poisoning with methyl alcohol. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XV/B, Anul 15, 2016 pg.321-325 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20173128177

Daniel Ureche, Ovidiu Chiroban, Dan Perju-Dumbravă,  Carmen- Corina Radu. Forensic fundamentals in malpractice expertise. Fiat Iustitia – „Dimitrie Cantemir” Christian University Bucharest. Faculty of Law Cluj- Napoca, No 2/2016 PG. 302-310 Indexed EBSCO http://www.ebscohost.com/titleLists/lgs-coverage.pdf

Rebeleanu Codrin, Dan Perju-Dumbravă, Radu Carmen. Exposure to nitrates – Professional hazard or work accident in food industry workers. Case report of a collective intoxication. Analele Universitatii din Oradea – Fascicula protecția mediului vol. XXVII, Editura Universitătii din Oradea, 2016 pg 579-582 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20173122091

Carmen Radu, Dan Perju-Dumbravă. The relationship between work environment and moral sensitivity. Analele Universitatii din Oradea – Fascicula protecția mediului vol. XXVII, Editura Universitătii din Oradea, 2016 pg 573-578 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20173122090

Carmen Corina Radu, Dan Perju-Dumbravă, Codrin Rebeleanu. Ethics and suicide preventions. Case report. Studia Bioethica Ediția nr. 1-2 din 2016, pg 71-77 ISSN (online): 2065-9504 Indexed EBSCO, CEEOL https://www.ceeol.com/search/article-detail?id=282825

Dan Perju-Dumbravă, Adina Danciu, Ovidiu Chiroban, Cristian Gherman, Carmen Corina Radu. Discrimination against fat people and persons with physical and mental disabilities. Studia Bioethica Issue 1, 60/2015 pg. 61-67 ISSN (online): 2065-9504 Indexed EBSCO, CEEOL https://www.ceeol.com/search/article-detail?id=294496

Carmen Radu, DP Dumbravă. The influence of environmental factors in a case of forensic identification. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol.14 No.B 2015 pp.441-445 ISSN: 1583-4301 Indexed CABI https://www.cabdirect.org/cabdirect/abstract/20163002516

Carmen Radu, DP Dumbravă. Environmental factors that influence forensic anthropological identification. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol.14 No.B 2015 pp.  pp.437-440 ISSN: 1583-4301 Indexed CABI https://www.cabdirect.org/cabdirect/abstract/20163002515

Carmen Radu. Suicide on Railway Track. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XIII/B, 2014 pg. 237-240 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20153346013

Carmen Radu. The Importance of Environmental Factors in Visual Identification. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XIII/A, 2014 pg.211-214 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20153345958

Carmen Corina Radu, Dan Perju-Dumbravă, Daniel Mureșan, Chiriac Serghei, Diana Bulgaru Iliescu. A practical approach to ethical decisions in anatomy classes of romanian medical faculties. Studia Bioethica Issue 1-2 59/2014 pg. 83-88 ISSN (online): 2065-9504 Indexed EBSCO, CEEOL https://www.ceeol.com/search/article-detail?id=282812

Dan Perju-Dumbravă, Adina Danciu, Daniel Mureșan, Radu Moldovan, Paul Volsitz,  Carmen Corina Radu. The ethical approach of the infanticide – accused mothers in the medico-legal psychiatric expertise. Studia Bioethica Issue 1-2 59/2014 pg. 45-48 ISSN (online): 2065-9504 Indexed EBSCO, CEEOL https://www.ceeol.com/search/article-detail?id=282825

Radu Carmen. Behavioral factors which pose a health risk. Case study. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară Vol. XII/B, 2013 pg. 121-124 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20153345883

Radu Carmen. The risk factors in rail traffic accidents. Case reports. Analele Universității din Oradea Fascicula: Ecotoxicologie, Zootehnie si Tehnologii de Industrie Alimentară, 2012 pg. 197-203 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20133213488

Carmen Radu, Oros R. Transportation of dangerous substances – Risk factors for environment protection and human factor. Presentation of case. Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimentară vol. 10/A, anul 10, Editura Universitătii din Oradea, 2011 ISSN 1583-4301 pg. 319-324 Indexed CABI https://www.cabdirect.org/?target=%2fcabdirect%2fabstract%2f20123133771

Coauthor

Holhos Larisa, Cosmin Mihai Vesa, Bontea Mihaela, Razvan Parvan, Corina Beiusanu, Radu Carmen-Corina, Coroi Mihaela Cristiana. Subconjunctival haemorrhage in hanging. Analele Universitatii din Oradea, Fascicula: Ecotoxicologie, Zootehnie si Tehnologii de Industrie Alimentara, Vol.XVIII/B 2019, pg. 283-288 Indexed CABI  http://www.cabi.org/default.aspx?page=1016&site=170&pid=508&xslttab=2&newtitlesonly=0&letter=*&search=oradea

Vlad Alin Pantea, Larisa Renata Rosan, Daniela Rahotă, Carmen Radu, Teodor Maghiar. Marginal Parodontopathy – A Possible Effect of Cardiac Pathology. Internal Medicine vol. XVI No. 1 (2019). 16. 71-75. 10.2478/inmed-2019-0055. Indexed in Index Copernicus http://www.medicina-interna.ro/?lang=en

Dan Perju Dumbrava, Daniel I Ureche, Codrin Rebeleanu, Carmen C Radu, Ovidiu Chiroban. Forensic and psychiatric perspectives in domestic violence. Human and Veterinary Medicine Bioflux SRL (Mar 2019): 32-36.Indexed CAB International – Global Health  (CABI, UK) http://www.hvm.bioflux.com.ro/docs/2019.32-36.pdf

Dan Perju-Dumbravă, Daniel Mureșan, Carmen-Corina Radu, Ovidiu Chiroban, Raul Sîntămărean, Daniel Ureche, Radu-Bogdan Davidescu. Malpractice in obstetrics and gynecology case report and literature review. Fiat Iustitia – „Dimitrie Cantemir” Christian University Bucharest. Faculty of Low Cluj- Napoca, No 2/2016 PG. 220-229 Indexed EBSCO http://www.ebscohost.com/titleLists/lgs-coverage.pdf

Camelia Buhaș, Gabriel Mihalache, Carmen Radu, Gabriela Tășnade – The legal liability, malpraxis and the deontological liability in the medical practice – Agora International Journal of Juridical Sciences, Editura Universității Agora, Oradea 2009, ISSN 1843 – 570x pg. 43-47 Indexed https://home.heinonline.org/content/databases/ https://heinonline.org/HOL/LandingPage?handle=hein.journals/agoraijjs3&div=9&id=&page=

Gabriel Mihalache, Camelia Buhaș, Carmen Radu, Gabriela Tăsnade – Innovation about the medico-legal psychiatrically report: the report requested by persons that intend to pursue acts that have an alienation value – Agora International Journal of Juridical Sciences, Editura Universității Agora, Oradea 2009, ISSN 1843 – 570x pg. 155-157 Indexed https://home.heinonline.org/content/databases/ https://heinonline.org/HOL/LandingPage?handle=hein.journals/agoraijjs3&div=25&id=&page=

2.REPRESENTATIVE SCIENTIFIC WORKS

Radu Carmen-Corina. Aspecte medico-legale și etice ale traumatismului cranio facial. Editura Universității din Oradea, 2016, 141 pg, ISBN 978-606-10-1826-0, cod CNCS 149

Carmen Corina Radu, Diana Bulgaru-Iliescu. Claims of „uniqueness” in forensic medicine, Revista Română de Medicină Legală. 2016, vol. 24, nr. 4, decembrie Impact Factor: 0,108

Dan Perju-Dumbravă, Ureche Daniel, Cristian Gherman, Ovidiu Chiroban, Laurian Ștefan Bonea, Carmen Corina Radu. Biblically Inspired Tattoos in Forensic Examinations Made on Inmates? Bodies in Prisons Territorially Assigned to the Forensic Institute of Medicine from Cluj. Journal for the Study of Religions and Ideologies, vol 15, no 45 (2016)

Dan Perju Dumbravă, Ovidiu Chiroban, Carmen Corina Radu. Mechanical asphyxia due to biological agents. Case report and literature review.
Revista Română de Medicină Legală. 2015, vol. XXII, nr. 3 Sept. pg. 177-180 Impact Factor: 0,144

Radu Carmen-Corina. Noțiuni introductive de bioetică în medicina legală/ Introduction to bioethics in forensic medicine: note de curs/lecture notes. Editura Universității din Oradea, 2015, 106 pg ISBN 978-606-10-1461-3 , cod CNCS 149

Carmen Corina Radu, Dan Perju-Dumbravă, Daniel Ureche, Codrin Rebeleanu, Diana Bulgaru-Iliescu, Iuliu Fulga, Andreea Cămărășan, Ovidiu Pop, Accessory spleens at autopsy: the incidence and the presence of myoepithelial cells in the spleen capsule, Romanian Journal of Legal Medicine 2019, No. 3, Pages: 247-253 Impact Factor: 0,48

Perju Dumbrava D, Radu CC ,  David S, Iov T, Iov CJ, Sandu I , Iliescu DB. The Importance of Alcohol Testing by Gas Chromatography vs the Cordebard Classical Method Modified in the Medico Legal Investigation. Revista de Chimie 2018 Volume: 69. Pages: 2407-2410 Impact Factor: 1,605 corresponding author

Radu Carmen Corina, Camarasan Andreea, Podila Cristina Maria, et al., Sudden Death of a Teenager Caused by Actinomyces israelii: A Case Report, Iranian Journal of Public Health  2018 Volume: 47 Issue: 9 Pages: 1412-1417  Impact Factor: 1,225

Hunea I , Damian SI, Radu CC, Moldoveanu S, Iov T. Postmortem Specificity of Troponin for Acute Miocard Infarction Diagnosis throug Qualitative Dosing from Pericardial Fluid. Revista de Chimie. 2018 Volume: 69.Issue: 9 Pages: 2482-2486 Impact Factor: 1,605 corresponding author

Carmen Corina Radu, C Podilă, A Cămărășan, D Bulgaru-Iliescu, D Perju-Dumbravă. Ethical professional-personal model of making decisions in forensic medicine, Romanian Journal of Legal Medicine  2017, Volume: 25 Issue: 3 Pages: 314-316 Impact Factor: 0,32

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