Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho - FM/MLS

URI Permanente desta comunidade

O Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, no Instituto Oscar Freire, é responsável pela cadeira de Medicina Legal na Faculdade de Medicina da Universidade de São Paulo (FMUSP). Além de oferecer cursos de pós-graduação e especialização, atua nas áreas de Bioética, Ciências Forenses, Medicina Legal e Medicina Social e do Trabalho.

Possui três núcleos e centros de estudos: CEARAS (Centro de Estudos e Atendimento Relativos ao Abuso Sexual); CEIOF (Centro de Estudos do Instituto Oscar Freire) e o Núcleo de Estudos de Bioética. O Grupo de Estudos em Bioética envolve a Faculdade de Medicina, Odontologia, Direito, Saúde Pública, Escola de Enfermagem e Instituto de Psicologia – tendo como missão ser um polo para difusão e implementação do conhecimento bioético; promovendo o intercâmbio com instituições nacionais e internacionais relacionadas ao tema pela formação e aprimoramento de profissionais da área. Desenvolve pesquisas conjuntas, presta serviços à comunidade por meio de cursos de formação e atualização, disseminado informação e estimulando o debate ético e bioético, além de desenvolver pesquisa sistematizada em diferentes áreas de formação.

Site oficial: http://medicina.fm.usp.br/iof/

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article 0 Citação(ões) na Scopus
Forensic genetics associated with hair analysis as a tool for jaguar ( Panthera onca ) identification
(2024) TREMORI, Talia Missen; ANTONIO, Lais Ubaldo; CARDENA, Mari Maki Siria Godoy; GWINNETT, Claire; DAVIDSON, Alison; AMARAL, Jackson Barros do; FRIDMAN, Cintia; ROCHA, Noeme Sousa
Animal smuggling and illegal wildlife trade comprise one of the most common crimes being committed on an international level. This action can affect biodiversity and most certainly increases the risk of extinction of several endangered species. Wildlife taxonomic identification is becoming routine to forensic experts. The aim of this study was to identify a possible jaguar sample ( Panthera onca Linnaeus, 1958) from legal evidence using hair morphology and mitochondrial DNA (mtDNA) to help in an official animal identification. Scanning and optical microscope images of hair samples were used to compare diagnostic characteristics of felines to reference studies. A preserved region, (cytochrome oxidase subunit 1 (COI)), from mtDNA was sequenced and compared to a DNA database (GenBank) to perform genetic identification. Forensic genetic and hair analysis techniques combined positively identified the sample as jaguar. These methods can help practitioners and forensics experts to identify evidence collected in wildlife crimes suspected to involve jaguars.
article 1 Citação(ões) na Scopus
Panel 1: Epidemiology and global health, including child development, sequelae and complications
(2024) GISSELSSON-SOLEN, Marie; GUNASEKERA, Hasantha; HALL, Amanda; HOMOE, Preben; KONG, Kelvin; SIH, Tania; RUPA, Vedantam; MORRIS, Peter
Objective: To summarise the published research evidence on the epidemiology of otitis media, including the risk factors and sequelae associated with this condition. Data sources: Medline (PubMed), Embase, and the Cochrane Library covering the period from 2019 to June 1st, 2023. Review methods: We conducted a broad search strategy using otitis [Medical Subject Heading] combined with text words to identify relevant articles on the prevalence, incidence, risk factors, complications, and sequelae for acute otitis media, otitis media with effusion, and chronic suppurative otitis media. At least one review author independently screened titles and abstracts of the retrieved records for each condition to determine whether the research study was eligible for inclusion. Any discrepancies were resolved by reviewing the full text followed by discussion with a second review author. Studies with more than 100 participants were prioritised. Results: Over 2,000 papers on otitis media (OM) have been published since 2019. Our review has highlighted around 100 of these publications. While the amount of otitis media research on the Medline database published each year has not increased, there has been an increase in epidemiological studies using routinely collected data and systematic review methodology. Most of the large incidence studies have addressed acute otitis media (AOM) in children. Several studies have described a decrease in incidence of AOM after the introduction of conjugate PCV vaccines. Similarly, a decrease was noted when rates of coronavirus disease of 2019 (COVID-19) were high and there were major public health efforts to reduce the spread of infection. There have been new studies on OM in adults and OM prevalence in a broader range of countries and population subgroups. Conclusion: Overall, the rates of severe and/or suppurative OM appeared to be decreasing. However, there is substantial heterogeneity between populations. While better use of available data is informative, it can be difficult to predict rates of severe disease without accurate examination findings. Most memorably, the COVID-19 pandemic had an enormous impact on the research and clinical services for otitis media for most of the period under review. Implications for practice: The use of routinely collected data for epidemiological studies will lead to greater variability in the definitions and diagnostic criteria used. The impact of new vaccines will continue to be important. Some of the lessons learned during the COVID-19 pandemic concerning behaviours that reduce spread of respiratory viruses can hopefully be used to decrease the burden of otitis media in the future. There are still many countries in the world where the burden of otitis media is not well described. In countries where otitis media has been studied over many years, new potential risk factors continue to be identified. In addition, a better understanding of the disease in specific subgroups has been achieved.
article 0 Citação(ões) na Scopus
The state of the art in therapeutic administration of botulinum toxin in children with cerebral palsy: an review
(2024) DORF, Sandro Rachevsky; FONSECA, Adriana Rodrigues; SZTAJNBOK, Flavio Roberto; OLIVEIRA, Thiffany Rodrigues Delfino de; BASTTISTELLA, Linamara Rizzo
Objective: To describe the current state of the art in the therapeutic administration of botulinum toxin with indications, efFicacy, and safety profile for children and adolescents with cerebral palsy. Data source: An integrative review was conducted. The MEDLINE/ PubMed database was searched twice within the last decade using distinct terms, and only studies written in the English language were included. The study population was limited to those aged 0-18 years. Articles that were duplicates or lacked sufFicient methodology information were excluded. Data synthesis: We found 256 articles, of which 105 were included. Among the included studies, most were conducted in developed countries. Botulinum toxin demonstrated good safety and efFicacy in reducing spasticity, particularly when administered by a multidisciplinary rehabilitation team. It is primarily utilized to improve gait and upper limb function, facilitate hygiene care, reduce pain, prevent musculoskeletal deformities, and even decrease sialorrhea in patients without a functional prognosis for walking. Conclusions: The administration of botulinum toxin is safe and efFicacious, especially when combined with a multi-professional rehabilitation team approach, which increases the probability of functional improvement. It can also be beneficial for patients with significant functional impairments to help with daily care tasks, such as hygiene, dressing, and reducing sialorrhea. Pediatricians must be familiar with this treatment and its indications to attend to and refer patients promptly when necessary, and to exploit their neuroplasticity. Further research on this topic is required in developing countries.
article
Legal Medicine and Otorhinolaryngology: Related Sciences
(2024) MIZIARA, Ivan Dieb
bookPart
Infecções bucofaríngeas e cervicofaciais
(2021) MIZIARA, Ivan Dieb; SENNES, Luiz Ubirajara
bookPart
Telerreabilitação
(2023) CARVALHO, Mariana Cavazzoni Lima de; MARTINS, Fernanda; BATTISTELLA, Linamara Rizzo
article 0 Citação(ões) na Scopus
Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study
(2024) SIMIS, Marcel; MARQUES, Lucas Murrins; BARBOSA, Sara Pinto; SUGAWARA, Andre Tadeu; SATO, Joao Ricardo; PACHECO-BARRIOS, Kevin; BATTISTELLA, Linamara Rizzo; FREGNI, Felipe
Background: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. Objectives: The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). Methods: Sixty participants were recruited from the rehabilitation program in Sao Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. Results: We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. Conclusion: These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.
article 0 Citação(ões) na Scopus
Characterization of male sexual assault in the state of São Paulo, Brazil: an epidemiological study from 2014 to 2017
(2024) SANTOS, Edmilson Ozorio dos; MOSCARDINI, Andrey Wellington; MIZIARA, Ivan Dieb
Sexual violence is a pervasive global issue that affects individuals of all genders. However, the experiences of male survivors have often been marginalized and inadequately represented. Male rape, which encompasses several forms of sexual violence against men, remains a sensitive and under-discussed topic in academic literature and public discourse. This study presents a descriptive cross-sectional analysis based on data collected from the Legal Medicine Institute (IML-Sao Paulo, Brazil) between 2014 and 2017. The analysis includes 7386 reports of sexological examinations performed on male victims of alleged rape. The analysis reveals that a significant majority of rape reports involved victims under the age of 12 or 14, which is considered vulnerable rape by the Brazilian legislation. Regarding the examination of reported cases of abuse against men, it was observed that only the minority of these cases exhibited visible injuries consistent with rape or tested positive for the presence of spermatozoa in the perianal region. Since the absence of visible injuries or spermatozoa does not negate the possibility of rape, this work highlights the challenges in obtaining conclusive evidence, necessitating a comprehensive approach to investigate and prosecute these crimes, creating a more inclusive and supportive environment for all survivors of rape, irrespective of their gender.
article 0 Citação(ões) na Scopus
Lower Limb Exoskeleton During Gait and Posture: Objective and Subjective Assessment Procedures With Minimal Instrumentation
(2023) PARIK-AMERICANO, Pedro; PINHO, Joao Pedro; SANTOS, Fabia Camile dos; UMEMURA, Guilherme Silva; BATTISTELLA, Linamara Rizzo; FORNER-CORDERO, Arturo
In this work, we propose and implement an enhanced methodology for assessing the impact of wearing a lower limb passive exoskeleton on the gait and posture of the wearer, integrating both objective and subjective assessment techniques. Using only an inertial measurement unit (IMU) and a heart rate monitor, we examined the gait of eighteen healthy volunteers during treadmill and overground walking, both with and without the exoskeleton. Postural control tests were conducted on a force platform and with an IMU during standing and crouching. Our findings indicate that exoskeleton use resulted in higher physical effort, perceived effort, and user frustration. Moreover, wearing the exoskeleton showed an augmented periodic stability, which is related to more constant strides, gait movements showed reduced smoothness, which is related to difficulties to adapt the strides in response to gait perturbations. Nevertheless, the exoskeleton exhibited better stability during stance, notably reducing medio-lateral displacement by over 30%. Finally, we found an increase in cognitive effort linked to exoskeleton use. These outcomes offer valuable insights into the comprehensive influence of exoskeletons on gait performance and user experience.
article 2 Citação(ões) na Scopus
The cerebellum is causally involved in episodic memory under aging
(2023) ALMEIDA, Jorge; MARTINS, Ana R.; AMARAL, Lenia; VALERIO, Daniela; BUKHARI, Qasim; SCHU, Guilherme; NOGUEIRA, Joana; SPINOLA, Monica; SOLEIMANI, Ghazaleh; FERNANDES, Filipe; SILVA, Ana R.; FREGNI, Felipe; SIMIS, Marcel; SIMOES, Mario; PERES, Andre
Episodic memory decline is a major signature of both normal and pathological aging. Many neural regions have been implicated in the processes subserving both episodic memory and typical aging decline. Here, we demonstrate that the cerebellum is causally involved episodic memory under aging. We show that a 12-day neurostimulation program delivered to the right cerebellum led to improvements in episodic memory performance under healthy aging that long outlast the stimulation period - healthy elderly individuals show episodic memory improvement both immediately after the intervention program and in a 4-month follow-up. These results demonstrate the causal relevance of the cerebellum in processes associated with long-term episodic memory, potentially highlighting its role in regulating and maintaining cognitive processing. Moreover, they point to the importance of non-pharmacological interventions that prevent or diminish cognitive decline in healthy aging.