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Accurate methods of age estimation are more essential than ever due to the rise in undocumented individuals without proper identification, often linked to illegal immigration and criminal activities. This absence of reliable records presents challenges within the legal systems, where age thresholds in the context of children's rights vary across countries. Age 14 has global significance, as established by the UN Convention on the Rights of the Child and the EU for administrative purposes. Accurate age estimation is crucial in medical decisions, reproductive health, and forensics. This study focuses on age estimation via dental radiographs, proposing a method for estimating the likelihood of having attained the age of 14. Orthopantomograms were analyzed from two samples, 191 Italian children (aged 5–15) and 822 Chilean subjects (aged 11–22), using dental maturity indices. These indices evaluated open tooth apices and complete root development. Statistical analysis confirmed the method's reliability in identifying individuals aged 14 or older, with sex-specific cut-offs. The proposed method particularly advocates an approach based on dental mineralization, which could surpass those relying on bone growth. The collaboration between medical experts, including pediatricians and diagnostic imaging specialists, is vital for standardized age estimation strategies. Ethical concerns regarding radiation exposure and accountability are recognized, although the method's low radiation doses are deemed acceptable. The proposed method will help health professionals to accurately predict whether or not the 14-year threshold has been reached, opening up new avenues of medico-legal interest and laying the foundations for a legal framework that would allow the pediatrician, when involved, to use a valid and recognized diagnostic approach. [ABSTRACT FROM AUTHOR]

Orbital and nasal parameters among modern humans show considerable variation, which affects facial shape, and these characteristics vary according to race, region, and period in evolution. The aim of the study was to ascertain whether there are sex differences in the orbital and/or nasal indexes and/or the single measurements used to calculate these in a Kosovar population. The following parameters were taken into consideration: orbital height (OH), orbital width (OW), nasal height (NH), and nasal width (NW). The ratios between orbital index/nasal index (RONI) were calculated. All measurements were obtained from a population sample comprising 408 individuals. The accuracy in sex prediction was 52.86% (CI95% = 45.05%–60.67%) for NW and 64.96% for NH (CI95% = 57.50%– 72.42%). The difference between male and female indexes was statistically significant (P < 0.05). The anthropometric study revealed that only NW and NH are configured as predictors of sexual dimorphism. It could be useful to increase the number of samples to test the discriminant function in other population groups. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic raised concerns about the potential for co-infection or over-infection with other respiratory infections, as they can complicate the diagnosis, treatment and prognosis of the disease. This is also a challenge for forensic pathologists, who may come across cases where the presence of co-infection or over-infection is suspected or confirmed, and it is important that they take this into account when determining the cause of death. The aim of this systematic review is to analyse the prevalence of each specific pathogen co-infecting or over-infecting patients with SARS-CoV-2 infection. In total, 575 studies were selected from the Scopus and Pub-Med online databases and 8 studies were included in a meta-analysis. Male gender, advanced age and nursing home care are risk factors associated with the development of co-infection, whereas age, tachypnoea, hypoxaemia and bacterial infection are predictors of mortality. Overall, however, having a SARS-CoV-2 infection does not represent a real risk for the development of co-infections/super-infections. [ABSTRACT FROM AUTHOR]

Featured Application: Roberto Cameriere and Ivan Galić equally contributed to this paper. This paper aims to propose a statistical model to assess pubertal growth spurt using the ratio of the anterior height projection to the posterior (Vba) of the fourth cervical vertebra body (C4) on cephalograms and to calculate the residual proportion of skeletal maturation and the time for the pubertal growth spurt to end for a given Vba. A sample of 538 cephalograms from healthy-living children aged between 5 and 15 years was analyzed. A segmented regression model was used to explain the different Vba stages relative to the pubertal growth spurt. In addition, the time to achieve skeletal maturation was evaluated for a given Vba between the beginning (Vba1) and the end (Vba2) of the pubertal growth spurt. A longitudinal sample of 25 males and 25 females was analyzed to validate the proposed method. The values of Vba corresponding to higher pubertal development rate ranged from Vba1 = 0.677 (95%CI, 0.644–0.711) to Vba2 = 0.966 (95%CI, 0.905–1.028) and from Vba1 = 0.669 (95%CI, 0.645–0.693) to Vba2 = 1.073 (95%CI, 1.044–1.101) in males and females, respectively. The validation process results showed that our model did not produce any incorrect forecasts. The proposed method estimates the beginning and the end of the pubertal growth spurt together with the residual proportion of skeletal maturation for a given Vba. [ABSTRACT FROM AUTHOR]

This article presents an effective model for estimating the age of subjects without identification documents, in accordance with Italian legislation covering unaccompanied minors, using instrumental methods recognized by the scientific community for age estimation. A decision-making tree has been developed, in which the first step is a physical examination. If secondary sexual characteristics are fully developed and there are no obvious signs of abnormal growth, dental X-rays are the next step. If the roots of the seven left mandibular teeth between the central incisor and the second molar are completely developed, the focus then moves to the third molar. If the index of the third molar (I3M) value is less than 0.08, or if third molars are not assessable, the following step is to study the clavicle which, if fully formed, indicates that the subject is an adult with 99.9% probability; otherwise, the probability is 96%. In all other cases (where the I3M is over 0.08), the probability that the subject has reached 18 years is less than 60%. The research, carried out initially on x-rays of the wrist, teeth and clavicle, highlighted the uselessness of the x-ray of the wrist for determining the age of majority, because in our sample, all subjects with incomplete maturity of hand/wrist bones were under 16 years of age; thus, OPT was necessary anyway. What we propose is a practical, easily feasible, fast, economical, and extremely reliable method, which can be used on Caucasian populations and beyond for multiple forensic purposes. [ABSTRACT FROM AUTHOR]

Hand-wrist X-rays are the most objective tools for forensic age estimation. The aim of this study is to compare the accuracy of skeletal age (SAg) versus chronological age (CAg) assessments using Bo/Ca and TW2 methods in a South African sample of 224 individuals, aged between 6 and 16 years, focusing on ancestry and biological sex. The differences between estimated SAg and CAg were considered the method performance indicators. Accuracy, sensitivity and specificity have been calculated based on the age limit of 13 years (yrs). Bo/Ca and TW2 correctly classified Europeans (Eu) and Africans (Af) (−0.08 and 0.18 yrs vs −0.07 and −0.20 yrs, respectively) as well as boys and girls (−0.19 and 0.19 yrs vs −0.03 and −0.21 yrs, respectively). The standard error (SE) was calculated for each method according to biological sex and ancestry in children younger than 13 yrs (SE range for Bo/Ca: ±0.123–0.179 and for TW2 ±0.095–0.140) and in subadults 13 yrs or older (SE range for Bo/Ca: ±0.143–0.157 and for TW2: ±0.092–0.183). Bo/Ca seems to be less influenced by ancestry and biological sex in respect to TW2. According to previous studies, both methods showed greater inaccuracy in subadults aged 13 yrs or older compared with younger. [ABSTRACT FROM AUTHOR]

The present study aimed to assess the performance of second (I2M) and third (I3M) molar maturity indices, the sum of both indices (I2M+3M), and the sum of the seven mandibular teeth indices (S) in terms of determining whether an individual is at least 12 or 15 years old. The panoramic radiographs of 763 individuals aged between 10–17 years were analysed. For the 12-year age threshold, I2M was found to be the highest specific indicator for both sexes. The optimal cut-off values for the I2M were determined to be 0.072 in females and 0.106 in males. The sensitivity, specificity, and area under the ROC curve (AUC) were 0.749, 0.978, and 0.925 in females, while they were 0.776, 0.953, and 0.925 in males, respectively. With regard to the 15-year age threshold, an optimal I2M cut-off value of 0.026 was established for females, as it showed the best discriminative ability. The sensitivity, specificity, and AUC were 0.893, 0.779, and 0.885, respectively. For males, an optimal cut-off value of 0.593 was obtained for I2M+3M with the highest specificity (0.900) and AUC (0.931) as well as a sensitivity of 0.857. In conclusion, the identified cut-off values may represent alternative methods in forensic age diagnostics. [ABSTRACT FROM AUTHOR]

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This study evaluated the accuracy of Cameriere's method based on normalized measurement of open apices of developing permanent teeth (xi) and a number of teeth with closed apices (N0) in a sample of 121 cone-beam computed tomography (CBCT) scans of children (60 males and 61 females), aged between 5 and 13 years from Krakow, Poland. Intra-class correlation coefficient on randomly selected 30 CBCT scans showed good to exceptional intra-observer, and inter-observer agreement of normalized open apices, while Kappa score showed an absolute agreement of the number of teeth with complete maturation. Dental age overestimated by 0.17 years (p = 0.120) and 0.18 years (p = 0.149) in males and females, respectively. The mean absolute errors between dental and chronological age of MAE between dental and chronological age of the complete sample were 0.73 years and 0.77 years in males and females, respectively. In conclusion, the present results support usage of Cameriere's method for age estimation in Polish children in cases where CBCT scans are available and previously taken for a specific clinical indication and taking into account the more demanding procedure of measuring variables in a non-orthogonal projection of teeth compared to a panoramic image. [ABSTRACT FROM AUTHOR]

Age estimation in children is fundamental in both clinical and forensic fields. The aim of this study was to evaluate the accuracy of the Cameriere's European and Italian formulae for age estimation in Sardinian children and adolescents, a genetically isolated population. A sample of 202 orthopantomograms of healthy Sardinian children and adolescents (100 females and 102 males) aged between 6 and 17 years was retrospectively evaluated. The seven left mandibular teeth were assessed with the Cameriere's European and Italian formulae. The teeth with closed apex (N0) were counted and, in the teeth with open apex, the distance between the inner sides was calculated. All variables showed a significant and negative correlation with age except N0 and g. Sex (g), the variables s, N0, and the first-order interaction between them, contributed substantially to the age measurement (p < 0.001). Although the value of x5 had a low prediction level, it generated the following multiple linear regression formula, specific for the Sardinian sample: Age = 10.372 + 0.469 g + 0.810 N0 − 1.079 s − 0.398 s ∙ N0 − 0.326 × 5. Only the Sardinian and European formulae allowed to obtain an acceptable interclass agreement (both the lower and upper >0.7). The results showed that the European formula could be accurate for assessing age in this sample of children and adolescents. [ABSTRACT FROM AUTHOR]