Purpose: To study the respective contributions and correlations of autopsy and PMCT in fatal ballistic injuries. Methods: A single-center retrospective descriptive study was carried out over a 10-years period (2008–2017) that included cases of fatal ballistic injuries that had undergone unenhanced PMCT followed by autopsy. In addition to demographics, the main data collected independently at autopsy and PMCT were the number of injuries, their trajectory, distances from the sole of the feet of the entry and exit wounds, projectile caliber and gunshot residue, detailed examination of the injuries, and detection of effusions. Results: Initially, 225 cases were included, of which 158 complete records were analyzed. The mean age of the victims was 41.5 years, and 93% were male. PMCT and autopsy findings were concordant concerning the number of injuries, their trajectory, and distance of the entry and exit wounds from the sole of the feet. Findings were not concordant regarding gunshot residues on the skin (autopsy more efficient) or detection of effusions (PMCT more efficient). The limitations of PMCT were the positioning of the limbs outside the field of acquisition and the impossibility of reliably determining the caliber of the projectiles. Some discrepancies were related to occasionally missing autopsy data, particularly the distance from the sole of the feet or measurements of the volume of effusion. Conclusions: This study provides more detailed knowledge of the accordance of autopsy and PMCT in analyzing fatal ballistic injuries.
Evaluation of long-term tolerance to antiretroviral exposure during pregnancy is required. An increased risk of cancer has been suggested in children exposed in utero to didanosine.Updated evaluation of cancer incidence in uninfected children exposed to nucleos(t)ide reverse transcriptase inhibitors (NRTIs) in the French perinatal study of children born to HIV+ mothers, by cross-checking with the National Cancer Registry. Associations between cancer risk and exposure to NRTIs were evaluated by univariate survival analysis and Cox proportional hazard models. Standardized incidence ratios (SIR) were used for comparison with the general population.A total of 21 cancers were identified in 15 163 children (median age: 9.9 years [interquartile range (IQR): 5.8-14.2]) exposed to at least one NRTI in utero, between 1990 and 2014. Five children were exposed to zidovudine monotherapy, and 16 to various combinations, seven including didanosine. Didanosine accounted for only 10% of prescriptions but was associated with one-third of cancers. In a multivariate analysis, didanosine exposure was significantly associated with higher risk [hazard ratio = 3.0 (0.9-9.8)]. The risk was specifically linked with first-trimester exposure [hazard ratio = 5.5 (2.1-14.4)]. Overall, the total number of cases was not significantly different from that expected for the general population [SIR = 0.8 (0.47-1.24)], but was twice that expected after didanosine exposure [SIR = 2.5 (1.01-5.19)].There are strong arguments to suggest that didanosine displays transplacental oncogenicity. Although not extrapolable to other NRTIs, they stress the need for comprehensive evaluation of the transplacental genotoxicity of this antiretroviral class.
