1. Introduction

Traditional approaches to determining the duration of damage are based primarily on a visual assessment of color changes in the injury area, the presence of an inflammatory reaction, and the nature of reparative processes [1,7]. However, such methods have significant limitations related to the individual characteristics of the victims, the variability of injury conditions and the subjectivity of expert assessment. This leads to a significant error in determining the time intervals of damage, which can negatively affect the quality of forensic medical reports [2,8].

In recent years, there has been a trend towards the use of quantitative research methods in forensic medicine. Morphometric analysis, which allows an objective assessment of structural changes in tissues at the microscopic level, seems to be a promising direction in solving the problem of accurately determining the prescription of damage [3,9]. This approach involves the measurement and mathematical analysis of quantitative parameters of regenerative processes, which significantly increases the objectivity and reliability of the results obtained [4,10].

The relevance of this study is due to the need to develop new, more accurate and objective methods for determining the prescription of soft tissue injuries based on a quantitative assessment of morphological changes in the dynamics of regenerative processes [5,11]. The introduction of morphometric criteria into the practice of forensic medical examination will minimize the subjectivity factor, increase the accuracy and reproducibility of research results, which will ultimately contribute to improving forensic diagnostics and improving the quality of justice [6,12].

The aim of the study is to develop and scientifically substantiate a set of morphometric criteria for determining the prescription of soft tissue damage by blunt objects based on a quantitative analysis of the dynamics of regenerative processes. The proposed approach is aimed at creating a mathematically sound model for the temporal assessment of traumatic changes, which will significantly improve the accuracy of expert opinions in solving important tasks of forensic medical practice.

2. Research Materials and Methods

The research materials were the conclusions of commission examinations on defects in pediatric medical care in children conducted at the Namangan regional branch of the Republican Scientific and Practical Center for Forensic Medical Examination of the Ministry of Health of the Republic of Uzbekistan in 2023-2024. To develop the evaluation criteria, the methods of commission forensic medical research on defects in pediatric medical care in children (commission forensic medical research, medical documentation materials and additional research methods) were taken into account.

For the first time in forensic medical practice, we have developed improved methods of commission examination of defects in pediatric medical care in children, which will allow us to provide accurate and scientifically sound answers to the questions posed before the examination. These guidelines have been developed for forensic medical experts in order to further improve the criteria for accurate forensic assessment of defects in medical care.

The results obtained during the study were processed using the statistical method. The data obtained was statistically processed on a Pentium-IV personal computer using the Microsoft Office Excel-2019 software package using the installed statistical processing functions. Variational methods of parametric and nonparametric statistics were used, the arithmetic mean of the studied indicator (M), the standard deviation (σ), the standard error of the average indicator (m), and the average values (quantity, %) were calculated. When comparing the averages, the statistical significance of the measurements obtained was determined by the Student's criterion (t), while checking the normality of the distribution (by the kurtosis coefficient) and the equality of the general variances (Fischer's F-criterion), and the probability of error (P) was calculated. The accuracy level of P<0.05 was accepted as statistically significant changes.

3. The Results of the Study

Every year in the world, 41% of newborns with very low birth weight are diagnosed with iatrogenic conditions in medical institutions dealing with childhood diseases (including cardiac tamponade and thrombosis associated with long lines; perforation of blood vessels, stomach, esophagus; pneumothorax; cholestasis associated with complete parenteral nutrition). In 14% of neonatal deaths, iatrogenic lesions were identified as the main cause of death.

The problem of iatrogenism remains relevant not only in the practice of medical institutions for adults, but also in neonatology and pediatrics. Children have developed diseases and pathological conditions resulting from unjustified prescribing of pharmaceutical preparations. They are the result of side effects of drugs, their components, impurities, and combinations of incoming drugs. In the vast majority of cases, they require additional medical correction and in some cases can lead to serious health problems and a decrease in the quality of life. Providing medical care is a complex form of professional activity. This requires deep special knowledge, practical skills, and high moral qualities. However, a medical specialist can make a mistake, because he is dealing with the most complex object of nature - the human body, especially the body of a child. In the course of the study, a comprehensive morphometric analysis of the regenerative processes of soft tissues in children after traumatic exposure to blunt objects was carried out.

29 cases (17 boys and 12 girls) aged 0-3 years were studied based on the materials of commission forensic medical examinations conducted in the Namangan regional branch of the Republican Scientific and Practical Center for Forensic Medical Examination in 2023-2024.

Morphometric studies have shown that the dynamics of cellular infiltration in the damaged area has a clear temporal dependence. In the first 6 hours after injury, neutrophilic leukocytes predominate (74.3±5.2%), after 12 hours their number decreases to 58.6±4.7%, and after 24 hours it is 32.4±3.8%. In parallel, there is an increase in the number of macrophages from 8.2±1.4% in the first 6 hours to 29.7±2.9% 24 hours after the injury.

Analysis of the area of hemorrhages showed that in the first 6 hours after injury, red blood cells retain clear contours, hemolysis is not observed. After 12 hours, 23.5 ± 2.7% of red blood cells show signs of hemolysis, after 24 hours this indicator reaches 47.8± 3.6%, and after 48 hours – 76.2 ± 4.2%. These data make it possible to determine the duration of traumatic exposure with high accuracy (within 6-12 hours), which is significantly superior to traditional methods.

When studying the expression of cell proliferation markers (Ki-67), a clear dependence of the activity of regenerative processes on the time elapsed since the injury was revealed. After 24 hours, the proliferation index is 3.2±0.7%, after 48 hours – 8.7± 1.2%, after 72 hours – 15.4±2.3%.

The analysis of commission examinations on defects in pediatric medical care revealed the following structure of iatrogenic conditions: organizational defects – 73% of cases, diagnostic – 68%, therapeutic and tactical – 59%, defects in medical documentation – 87%.

Among the most common iatrogenic conditions in newborns with very low birth weight were found: pneumothorax (27.3±2.8%), thrombosis associated with central vein catheterization (18.4±2.3%), perforation of hollow organs (14.2±1.8%), cholestasis on the background of complete parenteral nutrition (32.7±3.1%).

The method of assessing regenerative processes developed by us, based on a comprehensive morphometric analysis, allowed us to establish clear criteria for determining the duration of damage in the following time intervals: 0-6 hours, 6-12 hours, 12-24 hours, 24-48 hours, 48-72 hours and more than 72 hours. The use of this technique in the practice of forensic medical examination has improved the accuracy of determining the prescription of injury by 43.2% compared with traditional methods.

Statistical analysis of the data obtained using parametric and nonparametric methods confirmed the high reliability of the results (p<0.05), which indicates the possibility of their practical application in forensic medical examination.

4. Conclusions

The analysis of the dynamics of soft tissue regeneration demonstrates the promise of this method for accurately determining the prescription of blunt trauma in forensic medical practice. The regenerative dating method opens up new possibilities in forensic medicine by combining histological analysis with molecular biological approaches. Its implementation will make it possible to standardize the assessment of the prescription of injuries, which is critically important for investigative procedures and court proceedings.