- Full professor of Legal Medicine, Bioethics, and Occupational Health at Sao Paulo University Faculty of Medicine.edit
requirements for health, aiming to prevent adverse health outcomes. Principle two: Public health should achieve community health in a way that respects the rights of individuals in the community. Principle five: Public health should seek... more
requirements for health, aiming to prevent adverse health outcomes. Principle two: Public health should achieve community health in a way that respects the rights of individuals in the community. Principle five: Public health should seek the information needed to implement effective policies and programs that protect and promote health. Principle seven: Public health institutions should act in a timely manner on the information they have within the resources and the mandate given to them by the public.
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Male rape is a relatively under-discussed topic in scientific literature, despite its significant relevance and prevalence worldwide, including in Brazil. To inform public health and safety policies, this study aimed to analyze cases of... more
Male rape is a relatively under-discussed topic in scientific literature, despite its significant relevance and prevalence worldwide, including in Brazil. To inform public health and safety policies, this study aimed to analyze cases of male rape using data from SINAN, the Information System for Notifiable Diseases, a division of the Brazilian Ministry of Health, for the years 2010-2022. Our findings reveal a 469 % increase in male rape cases in the country over the study period, with a predominance of cases in the state of São Paulo. Also, a higher prevalence of cases was observed among individuals aged 5-9 years. Furthermore, we identified a correlation between the occurrence of rape and certain factors, including individuals with less than 4 years of formal education if they were over the age of 50, and those who had a history of being sexually abused between the ages of 5 and 14. Additionally, this study reinforces the prevalence of rape cases occurring within domestic environments and perpetrated by individuals closely related to the victims. This study contributes to filling the gap in research on male rape in Brazil, laying the foundation for the development of strategies to prevent and combat rape in the country.
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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... more
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-São 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.
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Introduction: Mental and behavioral disorders corresponded to the third main cause of disability benefits granted by the National Institute of Social Security (INSS), especially the Major Depressive Episode (MDE). Objectives: Present the... more
Introduction: Mental and behavioral disorders corresponded to the third main cause of disability benefits granted by the National Institute of Social Security (INSS), especially the Major Depressive Episode (MDE). Objectives: Present the frequency of granting social security benefits for disability due to MDE in Brazil. Material and method: Ecological study of the INSS public database regarding work disability benefits granted between 2008 and 2019. Results and discussion: The average number of benefits granted by MDE was 56,643 (standard deviation – sd 6,201). The male mean was 16,837 (SD 2,227), or 29.67% (SD 1.13) and the female mean was 39,806 (SD 4,106), or 70.33% (SD 1.13). In the urban area, the average was 55,044 (SD 5,982), or 97.18% (SD 0.27) and, in the rural area, 1,599 (SD 267), or 2.82% (SD 0.27). Conclusion: Disabling MDE benefits were granted mainly to women from urban and non-work related regions. The data justify the need for effective measures to mitigate the impa...
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Introduction: Puerperal psychosis is defined as a type of brief psychotic disorder occurring within three weeks after delivery, but predominantly within the first 48-72 hours, although rare (0.1 to 0.2%), it is a medical emergency and... more
Introduction: Puerperal psychosis is defined as a type of brief psychotic disorder occurring within three weeks after delivery, but predominantly within the first 48-72 hours, although rare (0.1 to 0.2%), it is a medical emergency and should be be treated as soon as possible. The presence of prodromal symptoms (irritability, sudden change in behavior, among others) that rapidly progress to a psychotic condition (delusions and hallucinations). In this context, infanticide is the apex for forensic interpretation. In 2021, The Lancet publishes an article questioning whether puerperal psychosis is a new disease. Neither the ICD nor the DSM bring this diagnosis as a distinct disease . Objective: To expose the main conflicts faced by medical experts in the face of the alleged crime of infanticide from the perspective of the Penal Code Conceptual framework: Establishing the nexus between puerperal psychosis and infanticide is a very difficult task and often depends on documents from the at...
Research Interests: Psychiatry and Psychosis
The authors remind the importance of immediate reporting of cases of sexual violence against children in a way to prevent the loose of evidence.
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Introduction: The tendency to impulsive behaviors and/or violence is exacerbated after alcohol consumption. Still, the relation between alcohol/violent deaths reported in the literature is not accurate, and in general, alcohol is only... more
Introduction: The tendency to impulsive behaviors and/or violence is exacerbated after
alcohol consumption. Still, the relation between alcohol/violent deaths reported in the literature is
not accurate, and in general, alcohol is only seen as a trigger to aggressive actions. The relationship
of the victims with their blood alcohol is less studied. They were especially concerned about the
role of alcohol as a risk factor for victims of unnatural death. Thus, our goal is to check the infl uence
of alcohol in victims of violent deaths as homicides, suicides, and accidents.
Materials and methods: Retrospectively the medical records of 805 autopsies performed
at the Institute of Forensic Medicine (IML) of Franco da Rocha, in the period 2001 to 2017 were
reviewed. The variables studied were sex, age, types of violent death rates, and alcohol - these
were considered positive when above 0.3 mg/ml.
The dosage of blood alcohol concentration (BAC) was performed using samples of 10 ml of
blood collected at necropsy, is preferably taken from the cardiac chambers or of the right femoral
vein. Dosages of alcohol in blood samples were done in the Forensic Toxicology Center of the IML
by gas chromatography, using the technique of separation “headspace” and double column.
Results: Drug testing for alcohol was available for 488 (79.1%) of 617 necropsies. Of the
617 subjects studied, 532 (85.7%) were male, and 85 (13.8%) were females (with high rates of
adolescents). The vast majority (n = 230) were killed, and 40.5% of victims had BAC above 0.3 mg/
ml of blood. Traffi c accidents came next, accounting for 181 deaths, with 41% of victims presenting
positive BAC.
Discussion: High blood alcohol levels of the victims were associated mainly with the genesis
of accidents (drowning, falls, traffi c, aspiration/ smothering) and murder (with impaired ability to
resist or by causing the release of impulses to engage in violent situations), about 40% of cases.
Conclusion: Our results indicate that alcohol abuse is a risk factor for victims of violent
death. In these cases, alcohol has two types of action. Direct: contributes to accidents of various
kinds - from traffi c by decreasing powers of concentration, attention, and loss of refl exes, to other
types of accidents such as drowning, falls, swallowing disorders causing airway obstruction, and
mechanical asphyxia. And they were indirect, making it easier for individuals to engage in confl ict
(and thus become victims of crimes).
alcohol consumption. Still, the relation between alcohol/violent deaths reported in the literature is
not accurate, and in general, alcohol is only seen as a trigger to aggressive actions. The relationship
of the victims with their blood alcohol is less studied. They were especially concerned about the
role of alcohol as a risk factor for victims of unnatural death. Thus, our goal is to check the infl uence
of alcohol in victims of violent deaths as homicides, suicides, and accidents.
Materials and methods: Retrospectively the medical records of 805 autopsies performed
at the Institute of Forensic Medicine (IML) of Franco da Rocha, in the period 2001 to 2017 were
reviewed. The variables studied were sex, age, types of violent death rates, and alcohol - these
were considered positive when above 0.3 mg/ml.
The dosage of blood alcohol concentration (BAC) was performed using samples of 10 ml of
blood collected at necropsy, is preferably taken from the cardiac chambers or of the right femoral
vein. Dosages of alcohol in blood samples were done in the Forensic Toxicology Center of the IML
by gas chromatography, using the technique of separation “headspace” and double column.
Results: Drug testing for alcohol was available for 488 (79.1%) of 617 necropsies. Of the
617 subjects studied, 532 (85.7%) were male, and 85 (13.8%) were females (with high rates of
adolescents). The vast majority (n = 230) were killed, and 40.5% of victims had BAC above 0.3 mg/
ml of blood. Traffi c accidents came next, accounting for 181 deaths, with 41% of victims presenting
positive BAC.
Discussion: High blood alcohol levels of the victims were associated mainly with the genesis
of accidents (drowning, falls, traffi c, aspiration/ smothering) and murder (with impaired ability to
resist or by causing the release of impulses to engage in violent situations), about 40% of cases.
Conclusion: Our results indicate that alcohol abuse is a risk factor for victims of violent
death. In these cases, alcohol has two types of action. Direct: contributes to accidents of various
kinds - from traffi c by decreasing powers of concentration, attention, and loss of refl exes, to other
types of accidents such as drowning, falls, swallowing disorders causing airway obstruction, and
mechanical asphyxia. And they were indirect, making it easier for individuals to engage in confl ict
(and thus become victims of crimes).
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Research Interests: Dentistry, Brazil, Dermatology, Medicine, HIV, and 13 moreTuberculosis, Humans, Female, Male, Aged, Middle Aged, Adult, Mouth mucosa, Retrospective Studies, Sputum, Nose, Throat, and HIV infections
Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their... more
Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their parents/guardians. The Brazilian Penal Code dictates that deaf people may enjoy diminished criminal capacity. Many are the bioethical controversies around cochlear implants, as representatives from the deaf community have seen in them a means of decimating their culture and intrinsic values. Objective: This paper aims to discuss, in bioethical terms, the validity of implanting cochlear hearing aids in children by analyzing their vulnerability and the social/cultural implications of the procedure itself, aside from looking into the medical/legal aspects connected to their criminal capacity. Materials and methods: The topic was searched on databases Medline and Lilacs; ethical analysis was done based on principialist bioethics. Results: Cochlear implants are the best therapeutic option for people with profound deafness and are morally justified. The level of criminal capacity attributed to deaf people requires careful analysis of the subject's degree of understanding and determination when carrying out the acts for which he/she has been charged. Conclusion: Cochlear implants are morally valid. Implantations must be analyzed on an each case basis. ENT physicians bear the ethical responsibility for indicating cochlear implants and must properly inform the child's parents/guardians and get their written consent before performing the procedure.
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Research Interests: Medicine and Gynecology
Research Interests: Adolescent, Medicine, Humans, Child, Male, and 7 moreOtorhinolaryngology, Etiology, Recurrence, Sex Factors, Age Factors, Parotitis, and sialography
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Research Interests: Philosophy and Humanities
Summary The authors comments on the legal and ethical aspects of euthanasia, orthothanasia and dysthanasia in cases of terminal patients, making relevant observations about killing or letting die, using futile means of maintaining life... more
Summary The authors comments on the legal and ethical aspects of euthanasia, orthothanasia and dysthanasia in cases of terminal patients, making relevant observations about killing or letting die, using futile means of maintaining life from the perspective of ethics and the Brazilian legal system. The author points out that euthanasia, passive or active, is considered homicide in Brazil; when used out of compassion, even if the sentence is reduced, it is still considered a crime.
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introduction: In the early 1970s, a new type of firearm was introduced into the military arsenal, with a format and function identical to those that had been used for centuries by forces from different countries, but now fed with rubber... more
introduction: In the early 1970s, a new type of firearm was introduced into the military arsenal, with a format and function identical to those that had been used for centuries by forces from different countries, but now fed with rubber or plastic ammunition, whose use was intended to contain the targets without causing lethal damage. Until the present-day firearms with less lethal projectiles are used by police forces. objectives: This article aims to expose the characteristics of the injuries caused by this type of ammunition, which parts of the body are most affected, in addition to finding out which are the most frequent sequelae and whether there is a risk of death in its use. methods: A literature review was performed on PubMed and all articles and case reports involving injuries in live humans caused by this type of ammunition were analyzed. results: 37 articles were included in the present study and, together, they exposed a total of 932 injuries, of which 612 could be classified as simple blunt or perforated contusion. discussion: Shots by less-lethal ammunition, despite being known as “non-lethal ammunition”, can result in death or serious impairment by damaging organs, sense or function, especially when they reach more sensitive regions of the human body, such as the face or eyes. conclusion: Of the injuries that could be classified, 60% were blunt and 40% perforated-contuse. The head was the most affected region. The eyes accounted for 32% of the total number of injuries, which justifies visual loss as the most frequently reported sequelae. The risk of death exists; 26 people died from gunshot wounds.
Research Interests: Medicine and Ammunition
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Research Interests: Incidence Geometry, Adolescent, Medicine, Prospective studies, Humans, and 15 moreChild, Internal Medicine, Chronic Disease, Female, Male, Middle Aged, Sinusitis, Adult, Revista Brasileira De Fisiologia Vegetal, Rhinitis, Chronic Rhinosinusitis, Acquired immunodeficiency syndrome, Child preschool, Prospective Cohort Study, and HIV infections
INTRODUÇÃO: a violência sexual é problema de saúde pública, cujos dados são, provavelmente, subnotificados em serviços de saúde em decorrência da falha na identificação das vítimas, ou de notificações compulsórias ao sistema de saúde e à... more
INTRODUÇÃO: a violência sexual é problema de saúde pública, cujos dados são, provavelmente, subnotificados em serviços de saúde em decorrência da falha na identificação das vítimas, ou de notificações compulsórias ao sistema de saúde e à autoridade policial. Essa problemática apresenta variações de acordo com idade e sexo das vítimas.OBJETIVO: mostrar as principais técnicas de identificação criminológica de vítimas de violência sexual, com adequação às faixas etárias e ao sexo. MÉTODO: revisão narrativa de literatura na base de dados PubMed com os descritores “Violência Sexual; Medicina Forense, Prova Pericial”, sem limite de tempos de busca. Foram incluídos artigos em português, inglês e espanhol e obtidos na íntegra. RESULTADOS e DISCUSSÃO: a identificação do abuso em crianças varia de múltiplos fatores (idade, sexo, modus operandi do agressor etc.). Muitos crimes sexuais não deixam vestígios físicos nas vítimas, ou os vestígios deixados necessitam de técnicas aperfeiçoadas para a...
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Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study... more
Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study aims to show the main aspects of confidentiality in occupational medicine. For this, a narrative review of the literature on the subject was carried out, using free access databases and based on the codes of medical ethics. The occupational physician’s performance involves the worker, other non-medical professionals and the employer, a situation that may trigger conflicts, requiring physicians to know their obligations and ethical-legal limits. The protection of confidentiality respects human rights, but dilemmas may arise, not only to obey ethical precepts, but to follow legal norms. This study seeks to show the main and updated ethical and legal aspects regarding occupational health.
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Os autores clássicos da Medicina Legal brasileira fornecem uma base sólida para o estudo da decomposição cadavérica. Por meio da leitura de seus livros, notou-se que a marcha da decomposição é composta de fases ocorridas em períodos... more
Os autores clássicos da Medicina Legal brasileira fornecem uma base sólida para o estudo da decomposição cadavérica. Por meio da leitura de seus livros, notou-se que a marcha da decomposição é composta de fases ocorridas em períodos específicos, que podem se sobrepor ou ter seus rumos alterados por fatores que vão, desde o ambiente em que o cadáver se encontra, até sua compleição física e comorbidades em vida. Com o objetivo específico de aprender como contornar tais dificuldades durante as investigações e necropsias destes casos, foi realizado levantamento bibliográfico de artigos científicos nas bases PubMed, Scielo e Scopus, pelos unitermos Putrefied, Cadaveric Putrefaction, Diagnosis e Causa Mortis, que resultou em dez artigos em língua inglesa, publicados de 2000 a 2019, a respeito de cadáveres de seres humanos. Foi possível depreender que métodos já conhecidos pelos pesquisadores (a saber: equipamentos de imagem, histopatologia, e análises químicas de fluidos corporais), são c...
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Violência sexual é qualquer ato sexual indesejado voltado contra a sexualidade de uma pessoa, praticado por qualquer pessoa, independentemente de sua relação com a vítima, em qualquer cenário. A literatura sobre violência sexual contra... more
Violência sexual é qualquer ato sexual indesejado voltado contra a sexualidade de uma pessoa, praticado por qualquer pessoa, independentemente de sua relação com a vítima, em qualquer cenário. A literatura sobre violência sexual contra crianças do sexo masculino é escassa. O objetivo deste trabalho é descrever os atos libidinosos referidos por vulneráveis do sexo masculino atendidos em 2014 na Equipe de Perícias Médico Legais Bem Me Quer do Instituto Médico Legal do Estado de São Paulo (IML), além de dados epidemiológicos, como idade das supostas vítimas, relação interpessoal com o alegado agressor, tempo ocorrido entre a suposta violência e a perícia, presença de lesões corporais e positividade na coleta de espermatozoides. Foi realizada uma análise retrospectiva de dados coletados de perícias realizadas no ano 2014. Após aplicação dos critérios de inclusão e exclusão, foram estudados os laudos de 127 vulneráveis do sexo masculino. O suposto ato libidinoso referido mais frequente f...
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Introduction: The tendency to impulsive behaviors and/or violence is exacerbated after alcohol consumption. Still, the relation between alcohol/violent deaths reported in the literature is not accurate, and in general, alcohol is only... more
Introduction: The tendency to impulsive behaviors and/or violence is exacerbated after alcohol consumption. Still, the relation between alcohol/violent deaths reported in the literature is not accurate, and in general, alcohol is only seen as a trigger to aggressive actions. The relationship of the victims with their blood alcohol is less studied. They were especially concerned about the role of alcohol as a risk factor for victims of unnatural death. Thus, our goal is to check the influence of alcohol in victims of violent deaths as homicides, suicides, and accidents. Materials and methods: Retrospectively the medical records of 805 autopsies performed at the Institute of Forensic Medicine (IML) of Franco da Rocha, in the period 2001 to 2017 were reviewed. The variables studied were sex, age, types of violent death rates, and alcohol - these were considered positive when above 0.3 mg/ml. The dosage of blood alcohol concentration (BAC) was performed using samples of 10 ml of blood c...
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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... more
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-São 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.
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Introduction: Telehealth has been developing and expanding. The use of technologies aims to delivery health services to the entire population in a safe, convenient, efficient, and effective way; decrease the waiting time for care;... more
Introduction: Telehealth has been developing and expanding. The use of technologies aims to delivery health services to the entire population in a safe, convenient, efficient, and effective way; decrease the waiting time for care; overcome geographic, socioeconomic, and cultural difficulties, avoiding unnecessary displacement of the health team or the patient; and reduce costs. Material and methods: Literature review with analysis of articles and publications in Lilacs, Pubmed, Scielo and Embase databases, to collect data regarding forensic medicine using telemedicine, evaluating the techniques used in different medical-forensic areas and establishing the viability of the teleforensics and which situations the use of telemedicine technological resources is possible for forensic purposes; according to the current law in Brazil. Discussion: Teleconsulting is widely used in other countries and can be used substantially in all fields of forensic medicine. In some areas, with some reservations, the assessment of the subject by the expert can be done remotely. Conclusion: Teleforensics is possible, but with limitations and precautions. Screening is essential to select viable remote evaluation, developing specific standards for this model of care, respecting the autonomy of the professional who chooses to perform remotely or not, using high quality equipment and materials and, finally, hiring a team with stability, so they can be trained and act according to the established guidelines.
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INTRODUCTION: Aesthetic damage has gained special relevance in recent decades, due to the appreciation of themes related to image and body harmony. The assessment of this damage continues to be quite imprecise, because it is an... more
INTRODUCTION: Aesthetic damage has gained special relevance in recent decades, due to the appreciation of themes related to image and body harmony. The assessment of this damage continues to be quite imprecise, because it is an objectionable damage by the observer, measurable and valuable, however it has a large subjective component, both on the part of the subject who suffers from it, and on the part of the examiner. This article aims to present the current scenario in aesthetic damage valuation and to propose a new method for this purpose. METHOD: Bibliographic review of open access articles up to the year 2022, in Portuguese, Spanish and English. RESULTS: None of the existing methodologies proved to be sufficient to approach the real assessment of the damage that the aesthetic damage caused to the victims’ lives, none of the analyzed scales simultaneously evaluated the inherent characteristics of the lesion, the impacts on functionality and the psycho-emotional consequences. DISC...
Legal Medicine aims to assist justice in technical and scientific matters. Thus, for the expert to be able to act in the most appropriate manner in criminal, civil, labor, administrative, social security, and/or medical audits (public and... more
Legal Medicine aims to assist justice in technical and scientific matters. Thus, for the expert to be able to act in the most appropriate manner in criminal, civil, labor, administrative, social security, and/or medical audits (public and private), a broad and solid training is necessary. The Forensic and Legal Medicine Residency Program is the most complete and safe option for providing academic training of medical experts, who can then achieve specialist recognition in this specialty. The program develops and maintains the highest possible standards of competence and professional integrity, as will be presented in this article. Implemented in 2004, this three-year program, accredited by the National Medical Residency Commission, currently offers five first-year positions. To date it has trained 16 medical experts who work in the various areas of forensic medicine and in the academic environment (in undergraduate and graduate programs).
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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... more
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-São 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.