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Differences in volume, density, electrolyte concentration, and total proteins in the fluid of the paranasal sinuses of freshwater and saltwater drowning victims: a systematic review and meta-analysis

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Abstract

This study summarized the available evidence on the differences in volume, density, electrolyte concentration, and total proteins in paranasal sinus fluid between freshwater and saltwater drowning victims. A systematic search was conducted in electronic databases and gray literature, resulting in the inclusion of five studies with 234 drowning victims (92 saltwater incidents and 142 freshwater incidents). Meta-analyses using the inverse-of-variance method and a random-effects model were performed, reporting effect sizes as standardized mean differences (SMD) with 95% confidence intervals (CI). The findings showed a significantly higher sinus density in saltwater drowning cases compared to freshwater drowning cases (SMD 0.91, 95% CI 0.50 to 1.32). However, no significant differences were observed in sinus fluid volume. Saltwater drowning victims exhibited higher electrolyte concentrations (sodium: SMD 3.77, 95% CI 3.07 to 4.48; potassium: SMD 0.78, 95% CI 0.07 to 1.49; chloride: SMD 3.48, 95% CI 2.65 to 4.31; magnesium: SMD 4.01, 95% CI 3.00 to 5.03) and lower total protein concentrations (SMD − 1.20, 95% CI − 1.82 to − 0.58) in sinus fluid compared to freshwater drowning victims. This meta-analysis highlights the importance of analyzing the characteristics and composition of sinus fluid in forensic investigations of drowning cases. While no differences were found in sinus fluid volume, saltwater drowning victims exhibited higher sinus density, elevated electrolyte concentrations, and lower total protein concentrations compared to freshwater drowning victims.

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Data are available from the authors upon reasonable request.

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Authors and Affiliations

  1. Graduate Program in Oral Biology, Piracicaba Dental School, State University of Campinas, UNICAMP, São Paulo, Brazil

    Maria Gabriela Duarte Morais Vieira & Rafael Queiroz da Trindade

  2. Graduate Program in Pathology, Ribeirão Preto Medical School, University of São Paulo, USP, São Paulo, Brazil

    Raíssa Bastos Vieira & Carlos Antonio Vicentin-Junior

  3. Investigative Pathology Laboratory, Federal University of Sergipe, Rua Cláudio Batista, S/N. Sanatório, Aracaju, Sergipe, Brazil

    Nicole Prata Damascena & Paulo Ricardo Martins-Filho

  4. National Center for the Dissemination of Forensic Sciences, Brazilian Federal Police, Distrito Federal, Brazil

    Melina Calmon Silva, Analany Pereira Dias Araujo & Carlos Eduardo Palhares Machado

  5. National Institute of Criminalistics, Brazilian Federal Police, Distrito Federal, Brazil

    Analany Pereira Dias Araujo & Carlos Eduardo Palhares Machado

  6. Graduate Program in Dentistry, Federal University of Paraiba, Paraiba, Brazil

    Bianca Marques Santiago

Authors
  1. Maria Gabriela Duarte Morais Vieira
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  2. Rafael Queiroz da Trindade
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  3. Raíssa Bastos Vieira
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  4. Carlos Antonio Vicentin-Junior
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  6. Melina Calmon Silva
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  7. Analany Pereira Dias Araujo
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  8. Bianca Marques Santiago
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  9. Paulo Ricardo Martins-Filho
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Contributions

All authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by MGDMV, RQdT, BMS, and PRM-F. The first draft of the manuscript was written by MGDMV, RQdT, MCS, and PRM-F; and all authors commented on the previous versions of the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Paulo Ricardo Martins-Filho.

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Vieira, M.G.D.M., da Trindade, R.Q., Vieira, R.B. et al. Differences in volume, density, electrolyte concentration, and total proteins in the fluid of the paranasal sinuses of freshwater and saltwater drowning victims: a systematic review and meta-analysis. Forensic Sci Med Pathol (2023). https://doi.org/10.1007/s12024-023-00761-9

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