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International audience; ObjectiveThe aim of this study was to describe the health and social conditions of arrestees, as compared to the general population.MethodsWe studied a sample of 600 adult arrestees in three locations in the Greater Paris area, prospectively included (February–May 2013). A descriptive analysis has been performed, then prevalence was estimated using an indirect standardisation according to age, based on data from a population-based, representative survey in the same area.ResultsArrestees had a median age of 31 years; 92% were males. As compared to the general population, arrestees had a lower level of education (8.6 vs. 7.6%, p < 0.001), were more frequently unemployed (42.0 vs. 11.9%, p < 0.001) and in a difficult financial situation (43 vs. 11%, p < 0.001) and had less significant social support (48.1 vs. 87.9%, p < 0.001). They reported also more frequently a chronic health condition (54 vs. 36%, p < 0.001) and a limited health insurance coverage (36 vs. 15%, p < 0.001).ConclusionComparative analysis of male arrestees and males from the general population showed that the former had worse social and health conditions. These results argue for widespread medical interventions on all arrestees. Medical examination during detention could act as a gateway to health care and social support.

Resume L’imagerie medicale en medecine legale apparait comme un outil d’evaluation incontestable dans l’aide a la resolution d’affaires judiciaires. Toutefois, son champ d’application en medecine legale du vivant apparait encore limite. Nous rapportons le cas d’un patient victime d’une plaie par arme blanche a la cuisse survenue lors d’une agression dans la rue. Cette blessure etait compliquee d’une plaie vasculaire evoquee devant une deglobulisation et des alterations hemodynamiques. Sa confirmation et sa localisation precise ont ete apportees par l’angioscanner. En outre, l’analyse de ces images a permis a l’expert medical mandate par la justice dans le cadre d’une procedure criminelle de repondre en grande partie aux questions qui lui ont ete posees, alors que la victime ne s’est jamais presentee a sa convocation.

OBJECTIVES: In cases of assault and battery, the French Penal Code considers some aggravating factors. No data are available on the frequency of aggravating factors. Our main objective was to determine this frequency. A secondary objective was to present the evaluation in several forensic medicine units of the duration of the victims' inability to fulfil their usual daily activities, in days of "Total incapacity to work" (TIW). METHODS: Data were collected from six forensic medicine units on 300 evaluations of assaults survivors: aggravating factors, characteristics of the victims and of the assaults, results of medical examination, and determinants of TIW. RESULTS: Aggravating factors were present in most cases (232 of 300, 77%). Median duration of TIW was 2 days (range: 0-60). Medical evaluation ended in the absence of TIW in 0 to 56% of cases in the 6 units (Chi(2), P Language: fr

In cases of assault and battery, the French Penal Code considers some aggravating factors. No data are available on the frequency of aggravating factors. Our main objective was to determine this frequency. A secondary objective was to present the evaluation in several forensic medicine units of the duration of the victims' inability to fulfil their usual daily activities, in days of "Total incapacity to work" (TIW).Data were collected from six forensic medicine units on 300 evaluations of assaults survivors: aggravating factors, characteristics of the victims and of the assaults, results of medical examination, and determinants of TIW.Aggravating factors were present in most cases (232 of 300, 77%). Median duration of TIW was 2 days (range: 0-60). Medical evaluation ended in the absence of TIW in 0 to 56% of cases in the 6 units (Chi(2), P0.0001). Forensic physicians considered that they had not evaluated the victims' mental state in 63 of 300 cases (21%). This rate varied significantly from one unit to another (P0.0001). Determinants of TIW were primarily traumatic injuries in 45% of cases and functional impairment in 55%. Such proportions varied from one unit to another (P=0.01). Mental state impairment was the main determinant of TIW in 0 to 23% of cases (P=0.009).The present study documented the high frequency of aggravating factors and the heterogeneity of forensic evaluation in cases of assault and battery. Identifying determinants of TIW in everyday practice can participate in the development of national guidelines.

A retrospective study was undertaken to determine the frequency of traumatic lesions found in individuals alleging police brutality during official custody in the departement of Hauts-de-Seine, located in the west suburbs of Paris. All medical certificates relating to the examination of 11,653 individuals detained during the year 2004 were analysed. From this population, there were 119 cases where victimized individuals alleged police assault and 245 revealed aggressive police manhandling, as indicated by traces of tight handcuffs. Among the individuals alleging police violence, most of them showed recent traumatic lesions (n=91). The majority of lesions were superficial contusions frequently located in the cervico-cephalic area. All traumatic lesions were compatible with the allegations of police assault. Neurological complications secondary to the application of handcuffs were encountered in less than 2% of the cases. Although no death was recorded in police custody during the period of the study, approximately 5% of the population that had encountered some form of police violence was found to require emergency hospitalization.

Lactic acidosis is a life-threatening complication of antiretroviral therapy with nucleoside reverse transcriptase inhibitors (NRTIs) (2, 3), and there is a spectrum of conditions associated with lactic acid elevation, ranging from moderate asymptomatic hyperlactatemia to life-threatening lactic acidosis. Identification of the compounds responsible for hyperlactatemia is uneasy, because most patients now receive combination therapies (8). Isolated case reports have suggested the role of single-NRTI treatment in the development of hyperlactatemia, but little is known about the role of human immunodeficiency virus (HIV) infection (1, 7). Data obtained in the era of single-agent antiretroviral therapy could be helpful in assessing the roles of individual NRTIs and of HIV itself. Between May 1991 and December 1992, we measured lactic acid in blood from 53 unselected HIV-infected patients evaluated in a specialized unit. Testing for blood lactate was part of a routine clinical and biological evaluation of HIV disease. None of them had sepsis, fever, acute disease, respiratory or cardiac failure, recent surgery, or recent traumatism or engaged in intense physical activity. Both asymptomatic (20 of 53) and symptomatic (33 of 53) patients were evaluated. Symptomatic patients had fatigue, myalgia, or proximal weakness. Thirty-five patients were receiving NRTIs: 31 were receiving zidovudine (200 to 1,000 mg/day), and 4 were receiving didanosine (250 to 400 mg/day). Eighteen patients were not treated by NRTIs. Zidovudine receivers had no history of treatment with another NRTI. The total cumulated dose of zidovudine was 35 to 660 g (median, 230 g). The CD4 count was 0 to 540 (median value, 100/mm3) for patients receiving NRTIs and 10 to 1,000 (median value, 380/mm3) for untreated patients. Venous blood samples were collected with the patients at rest between 8:30 and 10:30 a.m. after an overnight fast. Samples were obtained by direct venipuncture without venostasis or hand clenching. The samples were frozen, stored at −20°C, and assayed within 4 days. Lactic acid was measured from the supernatant (4). Lactatemia was abnormal if higher than 1.5 mmol/liter (reference values obtained using the same technique and blood draw protocol from 45 subjects in whom the diagnosis of mitochondrial disorder could be excluded were 0.3 to 1.5 mmol/liter [mean ± 2 standard deviations]). Hyperlactatemia was found in 18 patients (18 of 53 [34%]; 1.6 to 7.5 mmol/liter [median, 2.0 mmol/liter]), of whom 17 (94%) were receiving NRTIs (zidovudine, 14; didanosine, 3). The proportion of patients with hyperlactatemia was higher for patients treated with NRTIs than for untreated patients (17 of 35 versus 1 of 18; P = 0.002 [Fisher's exact test]). Lactatemia correlated with the total cumulated dose of zidovudine received (Spearman correlation coefficient, r = 0.54; P = 0.002) and, to a lesser extent, with the duration of treatment by NRTIs (r = 0.39; P = 0.02). We tested the influence of the stage of disease on lactatemia: no correlation was found between the CD4 count and lactatemia (r = −0.13; P = 0.36). Following strict criteria for blood sampling, lactic acid determination, and comparison to normal values, we found that hyperlactatemia in HIV-infected patients was commonly associated with treatment by zidovudine or didanosine. The correlation between lactatemia and the total received dose of zidovudine is another argument for considering this compound to be responsible for hyperlactatemia. Such a correlation was not evaluated with didanosine receivers because of the small number of patients. Lactate elevation was uncommon among untreated HIV-infected patients. The absence of correlation of lactatemia and CD4 counts suggests that the comparison between treated and untreated patients is appropriate even though median CD4 counts are different. There is evidence that combination therapy may exacerbate some metabolic toxicities (5, 6). Our findings of relatively common hyperlactatemia in patients on zidovudine or didanosine monotherapy strengthen the association between this condition and nucleoside analogues.