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Electrical injury may lead to damage to the conducting tissue, myocardial changes and even sudden cardiac death. Victims of low-voltage electrocution may have no electric marks, burns or other signs typical of electrical injuries. In these cases, the absence of other specific findings could make the identification of the cause of death very difficult. A broad spectrum of cardiac changes in cases of electrocution has been described in the literature, including the break-up of myocardial fibres, cardiomyolysis, haemorrhagic areas, the separation of myofibres and alternating hypercontracted-hyperdistended myocytes. All the described alterations, however, cannot be exclusively attributed to electrocution, since no specific morphological cardiac findings have so far been identified in electrocution. However, a few histological patterns recur, and their knowledge may be important for the forensic pathologist. This literature review describes the main pathological patterns observed in cases of fatal electrocution based on a literature search carried out up to September 2019 in the databases PubMed and Scopus. The search criteria included the keywords for cardiac lesions and electrocution. On the grounds of the literature data, a list of major and minor diagnostic markers for the passage of the electrical current through the heart tissue was created.

Since the beginning of the COVID-19 public health emergency, we have witnessed an increase in psychiatric problems and pathologies, such as depression, anxiety, isolation, posttraumatic stress disorder, substance abuse, and burnout. The world's collective sentiment finally turned toward optimism after authorization was granted for the COVID-19 vaccines' emergency use by the FDA in December 2020. With the increase in vaccine coverage in Western countries, case counts and deaths gradually plummeted while activity restrictions were progressively lifted. At the same time, however, a new COVID-19-related public health issue has arisen, as a substantial number of eligible individuals refused vaccination. Behaviors assumed by the so-called anti-vax people in manifesting their own opposition towards COVID-19 vaccination are various, and sometimes assume the forms of dramatic gestures with symbolic value, such as suicide. Here, we present the case of a healthy, convinced anti-vax, 58-year-old man, who allowed himself to be run over by a moving train in the presence of eyewitnesses, bringing with him a demonstrative note of his reasons. The present article aims to raise awareness against the social and psychological impact of COVID-19 vaccination refusal and to point out the need of a specific support net to avoid the spread of psychological impairment, social isolation and suicidal behaviors among the "anti-vax community". [ABSTRACT FROM AUTHOR]

In case of thoracoabdominal gunshot wounds (GSW), diaphragmatic lesions are common autopsy findings. In these cases, the bullet's path involves both the thorax and the abdomen, so the diaphragm (the muscle that separates the two cavities) is frequently damaged. In the present report we illustrate a very unusual autopsy finding, came up after a man was shot twice and affected by a lethal thoracoabdominal gunshot wound. In particular, as expected based on CT scans, the corpse exhibited a thoracic-abdominal path and a retained bullet in the abdomen, but no diaphragmatic lesions or hemorrhagic infiltrations of this muscle have been detected during the autopsy. After a scrupulous examination and the section of all the organs, the intracorporeal projectile's path was reconstructed, inferring that the thoracoabdominal transit of the bullet extraordinarily had occurred in correspondence of the diaphragmatic inferior vena cava's ostium, thus exploiting a natural passage without damaging the diaphragmatic muscle. [ABSTRACT FROM AUTHOR]

Autoerotic asphyxia is defined as a self-induced cerebral anoxia in an autoerotic context. This practice is used to induce a state of hypoxia to elicit or enhance sexual excitement and orgasm. Autoerotic deaths are very rare events and include different mechanism such as asphyxia by hanging, ligature or electrocution, overdressing wrapping and more. According to the literature, male subjects are reported as the main victims of these events. In this paper we describe an interesting case of a 54-year-old Italian man, who accidentally deceased by placing a hemp rope around his neck during autoerotic asphyxial activities. The rope examination revealed an interesting safety mechanism: a means to adjust its diameter through a supplementary rope. [ABSTRACT FROM AUTHOR]

Since the beginning of March 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been the cause of millions of deaths worldwide. The need to better define the pathogenesis of coronavirus disease 19 (Covid-19) as well as to provide the correct statistical records concerning deaths related to this virus, inevitably involves the role of forensic pathology and routine autopsy practice. Currently, some data on macroscopic and microscopic features in autopsies performed in suspected Covid-19 cases are reported in the literature. The persistence of SARS-CoV-2 in cadavers has not yet been elucidated and only a few reports have emphasized the importance of evaluating the Virus RNA in post-mortem tissues. In this preliminary study, we observed that SARS-CoV-2 survives in multiple cadaver tissues many days after death despite some extreme conditions of post-mortem body preservation. The results of this on-going analysis could help improve the safety of working practices for pathologists as well as understanding the possible interaction between microbiological agents and the cadaver tissue's supravital reactions. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms. [ABSTRACT FROM AUTHOR]

The correct definition of time of death often represents a key to solving judicial cases. One of the methods for determination of the time interval since death is at present the quantitative and qualitative characteristics of hypostases. However, the simple observation of the degree and fixation of hypostases is based on nonobjective parameters, and is therefore characterized by an intrinsic variability that can compromise their reliability. The purpose of the present study was to define an objective and standardizable method that allows estimation of time since death with good approximation. To achieve this, the instrument used was based on spectrophotometry, to analyze only the hemoglobin contribution to skin color, while excluding the role of melanin. This made it possible to analyze a hypostatic area, with a numerical value defined as a measure of the hemoglobin content before and after application of standardized pressure for a defined time interval. The study was conducted on 100 cadavers in various wards. The variables considered in the study were: Hb-pre (mean hemoglobin measure before weight force application); Hb-post (mean hemoglobin measure after weight force application), ΔHb (change in mean hemoglobin measures from before to after weight force application); and red% Hb (percentage reduction in hemoglobin after weight force application, compared to the mean measure of hemoglobin before weight force application). The analysis showed statistically significant correlations between red% Hb in the skin area analyzed and time from death to examination. This provided a mathematical formula to estimate time since death with good reliability ( ± 4 h, 50 min). [ABSTRACT FROM AUTHOR]