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The authors present a case involving a 37-year-old woman discovered in an operating freezer. Suicide hypothesis has been considered from the beginning. Due to the exceptional scene circumstances, a forensic autopsy was performed. Apart from some non-specific hypothermia and asphyxia signs, the autopsy revealed several skull fractures, prompting extensive anatomopathological and histological analyses. These analyses confirmed the fractures origin and determined whether they were ante-mortem or post-mortem, thus ruling out the possibility of a criminal act disguised as suicide. The authors also describe the challenges in determining the cause of death, particularly the issues related to the post-mortem diagnosis of lethal hypothermia and asphyxia. This case is the first in the literature to describe suicide by exposure to cold in a confined environment. It highlights the importance of close collaboration between forensic pathologists, histologists, toxicologists, and police investigators to answer judicial inquiries. [ABSTRACT FROM AUTHOR]

In July 2023, an in-house forensic neuropathology consultation pilot was established at the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare. This offered an alternative to the previous practice of full outsourcing to a hospital neuropathology department. This paper aims to introduce the first year experiences of the pilot. The in-house consultant team comprised two forensic pathologists with special training in neuropathology. In-house consultations were offered for medico-legal autopsy cases with traumatic brain injury (TBI) and hypoxic-ischaemic encephalopathy. The in-house histology laboratory participated in the pilot, implementing beta-amyloid precursor protein (β-APP) stain at the end of the pilot year. An electronic database was also developed for data collection and reporting. The characteristics, costs, and duration of the first 25 consultation cases were reviewed. The cases involved mostly male decedents (84.0%) with TBI (84.0%). The median total cost of a pilot case was €624, which was substantially lower compared to the previous outsourced practice (€1013 per case + €38/84 for each microscope slide with special/immunohistochemical stain, respectively). After the implementation of β-APP stain into the in-house laboratory service, the median total cost of a pilot case was reduced further to €94. The median duration of an in-house consultation was 2.3 months. Thanks to a favourable in-house atmosphere, the first year experiences are encouraging. While the costs of the in-house consultation practice appear to be markedly lower than those of an external provider, both alternatives should be available for cases where sufficient expertise cannot be found in-house. [ABSTRACT FROM AUTHOR]

Research on suicide has always been an area of particular interest in the forensic field. Over time, classifications have been proposed to define different types of suicide. A category is represented by complex suicides (CS) defined using two or more suicide methods simultaneously or consecutively. Considering the victim's intentions, CS can be distinguished into planned, in which the victim plans the methods to ensure the fatal outcome, and unplanned, in which the methods are implemented in the mid-course because the first proves too painful or prolonged. The sometimes-varied dynamics with which such suicides are carried out can pose a diagnostic challenge for forensic pathologists and investigators. This paper aims to report the case history of complex suicides analysed during a year at the University of Rome 'Tor Vergata'. For each case, the data from the on-site investigation (presence of suicide note and anamnestic information from the medical records of the deceased or family members' reports) and autopsy investigations were analysed and discussed, with particular reference to the suicide methods used. For each case, a classification into planned and unplanned was proposed based on an integrated analytical approach. [ABSTRACT FROM AUTHOR]

Postmortem analysis of C-reactive protein (CRP) in autopsies has been extensively researched for its potential utility. This analysis could aid forensic pathologists in screening for and investigating the potential infectious or inflammatory causes of death, thereby guiding appropriate autopsy procedures. To assess the diagnostic accuracy of postmortem CRP analysis in autopsy settings, a thorough electronic literature search was conducted across databases such as PubMed, Scopus, Web of Science, and Cochrane Library. Two independent reviewers screened eligible studies, followed by a methodological quality assessment using the QUADAS-2 checklist. Utilising a random-effects model, hierarchical summary receiver operating characteristic (HSROC) curve analysis and bivariate model meta-analysis were performed to evaluate heterogeneity across studies. Of the 1286 studies initially identified, nine met the eligibility criteria for the final analysis. The pooled sensitivity of postmortem CRP analysis was 0.93 (95% CI, 0.76, 0.98), with a pooled specificity of 0.80 (95% CI, 0.71, 0.87). The prevalence across studies ranged from 0.23 to 0.68, with a median of 0.5. Moderate variability was observed in the heterogeneity assessment across the primary studies. In summary, the study findings indicate that postmortem serum CRP analysis demonstrates high diagnostic accuracy with moderate heterogeneity. Additionally, postmortem CRP testing may be useful as a screening tool in autopsy practice to rule out the likelihood of sepsis. [ABSTRACT FROM AUTHOR]

Suicide is one of the leading causes of death today, and among all mental illness, mood disorders account for one of the main risk factors. It is well known and proven that suicides are very common among people undergoing treatment and prescribed psychiatric medication. So far, however, there have only been a few studies dealing with this particular phenomenon. For this reason, autopsy patients who died by suicide, suffered from a mood disorder, and were known to be taking psychiatric medication at the time of death were selected for this study. The blood and urine samples taken during the autopsy underwent toxicological analysis and the results were compared with the prescribed therapy. A total of 22 people were included in the study: 12 presenting with depression and 10 with bipolar disorder. The toxicological analysis revealed that only 6 cases (27%) showed a qualitative match with the prescribed medication. In 5 cases (22.7%) the medication was only partially complied with and in 11 cases (50%) it was not complied with at all. Furthermore, even when medication was present, the value was often below the therapeutic range. Overall, more than 70% of the test subjects adhered to their medication only partially or not at all. Since treatment adherence is considered as a key factor in reducing the risk of suicide, this inevitably raises relevant clinical and forensic questions. Against this background, prospective monitoring of post-mortem medication levels in suicidal individuals and synergistic collaboration between clinicians and forensic pathologists could help to evaluate the effectiveness of specific medical interventions, highlight existing critical problems and develop new approaches to suicide prevention. [ABSTRACT FROM AUTHOR]

Active euthanasia is legally permissible in only eight jurisdictions worldwide and may only be administered by qualified personnel following specific selection criteria. Mercy killing refers to the deliberate termination of the life of an individual suffering from a terminal chronic medical condition. Detecting both illegally performed active euthanasia and instances of mercy killing presents challenges for forensic pathologists. The presented case describes a mercy killing involving a 72‐year‐old woman with multiple chronic conditions who was killed by her grandson via heroin intoxication after administration of the anxiolytic alprazolam. Key findings from the external postmortem examination included a single fresh injection site on the inside of the elbow and a superficial T‐shaped cut on the flexor side of the left forearm. Toxicological analyses revealed elevated blood levels of heroin metabolites, including 6‐monoacetylmorphine and absence of hydroxyalprazolam, indicating an only short survival time following heroin injection. A cocaine concentration in blood was comparatively low but rather high in hair samples. Elderly individuals with multiple chronic conditions are at increased risk of becoming homicide victims. Comprehensive forensic documentation of injection sites is essential to avoid overlooking deaths caused by injection and to differentiate them from medical measures during resuscitation attempts. [ABSTRACT FROM AUTHOR]

Background: Firearm wounds tend to have a precise pattern. Despite this, real-world case presentations can present uncertain elements, sometimes deviating from what is considered standard, and present uncommon features that are difficult for forensic pathologists and ballistic experts to explain. Methods: A retrospective analysis of autopsy reports from the Institute of Legal Medicine, University of Catania, covering 2019–2023, included 348 judicial inspections and 378 autopsies performed as part of the institute's overall activities. Among these, seventeen cases of firearm deaths were identified, with three atypical cases selected for detailed analysis. An interdisciplinary approach involving forensic pathology, radiology, and ballistics was used. Results: The selected cases included: (1) A 56-year-old female with a thoracic gunshot wound involving three 7.65 caliber bullets, displaying complex trajectories and retained bullets; (2) A 48-year-old male with two cranial gunshot injuries, where initial evaluation suggested homicide staged as a suicide, later confirmed to be a single self-inflicted shot; and (3) A 51-year-old male was found in a car with two gunshot wounds to the head, involving complex forensic evaluation to distinguish between entrance and exit wounds and determine trajectory. The findings showed significant deviations from standard patterns, underscoring the critical role of radiological imaging and ballistic analysis in understanding wound morphology and projectile trajectories. Conclusions: This case series highlights the necessity for standardized yet adaptable protocols and cooperation among forensic specialists. A flexible approach allows forensic investigations to be tailored to the specific circumstances of each case, ensuring that essential examinations are conducted while unnecessary procedures are avoided. Comprehensive data collection from autopsies, gross organ examinations, and, when needed, radiological and histological analysis is essential to accurately diagnose injuries, trace bullet trajectories, retrieve retained projectiles, and determine the fatal wound, particularly in complex cases or those involving multiple shooters. [ABSTRACT FROM AUTHOR]

Background & Objectives: During legal investigations, the forensic pathologist is often required to give an opinion regarding personal identification of the deceased. The bone that is among the most helpful for these investigations is the skull. As to my knowledge, this is the first study of its kind in this part of the world where an attempt is made to find any correlation between cranial vault thickness, age sex and general body build in a population group. Methods: The study was commenced after obtaining Institutional Ethics Committee clearance certificate (AJEC/REV/95/2016). Materials for the present study consists of eighty-two South Indian origin victims autopsied at the mortuary of A. J. Institute of Medical Sciences, Mangaluru, Karnataka between November 2016 and October 2018. The victims comprised of both the genders in the age group of 18-80 years belonging to various parts of South India (Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, Telangana & Union territories of Lakshadweep & Pondicherry). Results: The victims in the age group of 18-80 years belonging to various parts of South India The average stature among males was 168.69 ± 10.98 and ranged from 148cm and 192cm. There was found to be a significant correlation between the occipital thickness and the sexes. There was found to be no significant correlation between different areas of cranial vault thickness with respect to each other and also between cranial vault thickness with height, weight or general body build. Interpretation & Conclusion: The present study emphasizes the utility of cranial vault thickness in identifying individuals. It also provides useful insights in the fields of calvarial bone grafting and neurosurgery. [ABSTRACT FROM AUTHOR]

The workload of forensic pathologists involves performing autopsies for a coroner. In this study of Australia, it was hypothesized that autopsy numbers would increase over time owing to increasing numbers of deaths, but this potential trend could be influenced by changes in Coroners Acts. The five largest coronial jurisdictions of Australia were studied between 2006 to 2017. Regression analysis was used to compare autopsy numbers (from the National Coronial Information System) to the number of deaths (from the Australian Bureau of Statistics). The number of deaths increased over time in all jurisdictions. Two jurisdictions had changes to their Coroners Acts that appeared related to decreasing numbers of autopsies. Two jurisdictions had no changes to their Coroners Acts: one showed a greater increase in autopsy numbers than the increase in deaths, but the other's trend was significantly different to the increasing number of deaths. The fifth jurisdiction had a change in Coroners Act with a following, non-sustained decrease in autopsy numbers. The findings support the hypothesis that forensic pathology workload can be influenced by changes in Coroners Acts, but the finding also suggests that other factors may influence the number of autopsies that are performed by forensic pathologists. [ABSTRACT FROM AUTHOR]

Thrombus age determination in fatal venous thromboembolism cases is an important task for forensic pathologists. In this study, we investigated the time-dependent expressions of formyl peptide receptor 2 (FPR2) and Annexin A1 (ANXA1) in a stasis-induced deep vein thrombosis (DVT) murine model, with the aim of obtaining useful information for thrombus age timing. A total of 75 ICR mice were randomly classified into thrombosis group and control group. In thrombosis group, a DVT model was established by ligating the inferior vena cava (IVC) of mice, and thrombosed IVCs were harvested at 1, 3, 5, 7, 10, 14, and 21 days after modeling. In control group, IVCs without thrombosis were taken as control samples. The expressions of FPR2 and ANXA1 during thrombosis were detected using immunohistochemistry and double immunofluorescence staining. Their protein and mRNA levels in the samples were determined by Western blotting and quantitative real-time PCR. The results reveal that FPR2 was predominantly expressed by intrathrombotic neutrophils and macrophages. ANXA1 expression in the thrombi was mainly distributed in neutrophils, endothelial cells of neovessels, and fibroblastic cells. After thrombosis, the expressions of FPR2 and ANXA1 were time-dependently up-regulated. The percentage of FPR2-positive cells and the level of FPR2 protein significantly elevated at 1, 3, 5 and 7 days after IVC ligation as compared to those at 10, 14 and 21 days after ligation (p < 0.05). Moreover, the mRNA level of FPR2 were significantly higher at 5 days than that at the other post-ligation intervals (p < 0.05). Besides, the levels of ANXA1 mRNA and protein peaked at 10 and 14 days after ligation, respectively. A significant increase in the mRNA level of ANXA1 was found at 10 and 14 days as compared with that at the other post-ligation intervals (p < 0.01). Our findings suggest that FPR2 and ANXA1 are promising as useful markers for age estimation of venous thrombi. [ABSTRACT FROM AUTHOR]

In forensic practice, spinal cord injury (SCI) resulting in death has rarely been reported. Here, we present the case of a 65-year-old woman who on admission was conscious without dyspnea or dysphagia. Physical examination revealed two sharp objects penetrating the neck: a pair of scissors lodged in the neck on the right side of the thyroid cartilage and a knife embedded in the nuchal region accompanied by minor seepage of bloody exudate. Radiography showed that the scissors and knife were retained in the cervical spine. Despite a series of medical interventions, the patient died 26 days later. Method: A systematic forensic autopsy was performed. Results: The cause of death was confirmed to be respiratory failure associated with SCI, which was caused by the combination of scissors and a knife. Conclusion: Based on this case, we believe that when there are multiple causes of death, forensic pathologists should determine the primary, immediate, contributory, and other causes of death to ascertain criminal responsibility. [ABSTRACT FROM AUTHOR]

Human or time resources can sometimes fall short in medical image diagnostics, and analyzing images in full detail can be a challenging task. With recent advances in artificial intelligence, an increasing number of systems have been developed to assist clinicians in their work. In this study, the objective was to train a model that can distinguish between various fracture types on different levels of hierarchical taxonomy and detect them on 2D-image representations of volumetric postmortem computed tomography (PMCT) data. We used a deep learning model based on the ResNet50 architecture that was pretrained on ImageNet data, and we used transfer learning to fine-tune it to our specific task. We trained our model to distinguish between "displaced," "nondisplaced," "ad latus," "ad longitudinem cum contractione," and "ad longitudinem cum distractione" fractures. Radiographs with no fractures were correctly predicted in 95–99% of cases. Nondisplaced fractures were correctly predicted in 80–86% of cases. Displaced fractures of the "ad latus" type were correctly predicted in 17–18% of cases. The other two displaced types of fractures, "ad longitudinem cum contractione" and "ad longitudinem cum distractione," were correctly predicted in 70–75% and 64–75% of cases, respectively. The model achieved the best performance when the level of hierarchical taxonomy was high, while it had more difficulties when the level of hierarchical taxonomy was lower. Overall, deep learning techniques constitute a reliable solution for forensic pathologists and medical practitioners seeking to reduce workload. [ABSTRACT FROM AUTHOR]

Background: The SARS-CoV-2 pandemic led to an enormous global health, social and economic crisis. The pandemic caused considerable upheaval and considerable difficulties due to an unforeseen and devastating health condition. Materials and Methods: We discuss the numerous challenges encountered in the fields of forensic medicine and public health during the COVID-19 pandemic. Particularly during the first wave of the pandemic, forensic pathologists faced significant difficulties due to the lack of safe autopsy protocols and insufficient personal protective equipment. Mainly in Europe, they had to manage a substantial number of potential cases of medical liability related to COVID-19. The widespread outbreak of the virus in residential care homes and prisons posed another significant challenge. Furthermore, forensic pathologists had to address the issue of complications arising from vaccination campaigns. Conclusions: This article underscores the need for continued efforts in scientific research and healthcare preparedness to effectively manage such complex crises. Forensic pathologists must be equipped with the necessary resources and training to address unpredictable, complex situations with far-reaching social implications. [ABSTRACT FROM AUTHOR]

Background: Autopsy, being the precise and detailed study of a person's corpse following death is of different types. Medicolegal autopsy plays the pivotal role to the forensic pathologist. Regular weighing of different types of human viscera plays a significant role in medical sciences as any detection of dereliction in weight from the normal range is suggestive of some pathological changes in the organ. Recording of organ weights is regularly being done by the forensic pathologists during an autopsy. The findings are meant to be compared to what is standard or average of a specific organ for a specific age range and particular sex. The determination of weight of spleen in particular has significant clinical value. Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 570 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria. Results: Total 570 cases had been selected after following the inclusion and exclusion criteria out of which 362 were males and 208 were females. Among the studied 570 cases, 362 (63.5 %) were male and rest (36.5 %) were female. In this study the discussion was mainly on relation of age, sex, body weight, and body length upon the weight of spleen. Conclusion: A database may be deduced from this study regarding normal range of the weight of various organs and their relation with external parameters of the subjects which can be applicable on the population of this region for future reference. In severely mutilated bodies found in mass disasters or in homicidal killing, weights of isolated organs may give an idea about the stature, built and age of the victims helping in identification. [ABSTRACT FROM AUTHOR]

Background: Even in this modern era of advanced knowledge in medical science, still the human skeleton holds its medicolegal importance in forensic anthropology as before. The forensic pathologists still face the dilemma to identify and opine whether the skeletal remains are of human or not along with estimation of the relatively correct age, sex, and height of the specimen available. Innumerable scientific literature is not unavailable in forensic anthropometry for the identification of human skeletons. The examination of the human skeleton is an integral part to serve medico-legal purpose. The pivotal step of forensic investigation usually starts with the sexual differentiation of the adult human bone. The whole skeleton helps to identify the sex of bone (male/female) with almost 100% accuracy. This current pilot study is an attempt of finding morphometric relationship between sex and predefined transverse linear measurements of adult sternum. Materials And Methods: Following the approval of the institutional ethical committee, the research was carried out on 64 adult human sternums that were selected based on specific inclusion and exclusion criteria. Results: In the current study, the study population comprises 38 (59.4%) males and 26 (40.6%) females, selected through the complete enumeration method. Among total 64 cases of the present study 28(43.8%) cases are from 18-39 years age group and 22 (34.4%) cases are from 40-59years age group 14(21.9%) cases are from 60-90years. Predefined transverse linear parameters i.e. Manubrium Width and Mesothermal Width_ both found to be greater in Male sex. Independent t -test also suggested that the sex-wise differences also found to be statistically significant (<0.001) Conclusion: Transitioning from a morphological approach to a morphometric analysis for sex determination based on the sternum is expected to minimize subjective variability, allowing for subsequent refinement and enhancement through more detailed methodologies. [ABSTRACT FROM AUTHOR]

Forensic pathologists need to have comprehensive knowledge of a large variety of causes of sudden natural death. We describe a case of sudden and unexpected death in woman in her sixties due to rupture of a large paraesophageal hematoma. The post-mortem examination and differential diagnosis are discussed. The combined findings of whole-body post-mortem CT imaging (PMCT), targeted PMCT angiography, autopsy, and histology are most in keeping with 'esophageal apoplexy'; a rare cause of hemorrhage in the esophageal wall. A review of the literature indicates that most cases of esophageal apoplexy are self-limiting and that fatal complications are exceedingly rare. Our case demonstrates that esophageal apoplexy can present as sudden unexpected death. [ABSTRACT FROM AUTHOR]

Fatalities caused by sharp and pointed instruments, especially screwdrivers, are not frequently observed in the United States. The shape of the screwdriver tip generally determines the resulting wounds that can range from linear, to rectangular or cross‐shaped, often reflecting common screwdriver head shapes. Recognizing such patterns is crucial, as they can aid in identifying the potential weapon used in the crime. In the reported case, an adult male was found dead in his living room surrounded by a pool of blood, with multiple injuries. At autopsy, the pattern of penetration was consistent with that of a six‐point star (Torx) screwdriver, which has never been reported as a deadly weapon in the literature before. A Torx screwdriver has a blunt head, resulting in hybrid injuries with both penetrating and blunt force features. Because of its rigid structure and narrow tip, a Torx screwdriver may forcefully penetrate the skin, soft tissues, and bone, causing severe injuries to the deep organs. The case highlights the importance for the forensic pathologist to examine and recognize atypical penetrating wounds for the identification and location of rare weapons. High‐definition graphic documentation of the injuries allows thorough examination and comparison of injuries with potential weapons. When the weapon is not retrieved, detailed injury descriptions guide investigations toward searching for a screwdriver, improving the chances of identifying the weapon used to commit the crime. [ABSTRACT FROM AUTHOR]

Novel benzodiazepine (NBz) detections in Victorian coronial cases started early in 2018 and have continued to increase in number and type up to December 2022. The 11 different NBz detections included etizolam (n  = 82), flualprazolam (n  = 43), clonazolam or 8-aminoclonazolam (n  = 30), bromazolam (n  = 15), clobromazolam (n  = 13), phenazepam (n  = 13), flubromazolam (n  = 12), flubromazepam (n  = 8), desalkylflurazepam (n  = 6), diclazepam (n  = 2), and estazolam (n  = 1). The pattern of detections varied over the 5-year period, with different compounds appearing over different time frames. The most recent NBz to appear were bromazolam, clobromazolam, flubromazepam, and phenazepam, whereas etizolam had been seen regularly in case work since 2018. Of the total 133 deaths, 95 were considered drug-related deaths by forensic pathologists with at least one additional CNS depressant also present capable of contributing to death. All deaths involved other (non-benzodiazepine) CNS active drugs, although many involved multiple NBz, with five or more different benzodiazepines detected in eight cases. [ABSTRACT FROM AUTHOR]

Fat embolism (FE) is a historically recognised but still actively researched topic in forensic pathology. Several aspects remain not fully elucidated, such as its aetiopathogenesis, its causal role in death determination, the impact of interfering factors (e.g. cardiopulmonary resuscitation or other medical procedures) and both qualitative and quantitative diagnostic methodologies in clinical and forensic contexts. These issues are further underscored by the potential involvement of FE in the causal determination of non‐traumatic deaths, which often raises questions of professional liability. The present study aims to provide a comprehensive and up‐to‐date overview of the most recent scientific evidence relevant to forensic pathology. Our systematic research has included 58 articles from 1990 to the present on the topic of FE and fat embolism syndrome (FES). From these articles, we identified 45 case reports, from which the authors’ descriptions were extracted to provide information on individual cases and the operational methods of forensic pathologists. Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non‐traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest‐risk specialities. Experimental studies have re‐evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy–histological evaluation. The major critical points that emerged include the lack of complete and detailed information on premortem clinical conditions, the underutilisation of grading systems and the methodological heterogeneity applied, resulting in considerable variability regarding the organs studied histologically and the diagnostic techniques used. Despite the limitations associated with the analysis of case reports and the heterogeneity of included experimental studies, we believe that this study can provide a comprehensive overview of the FE topic. It furnishes pathologists with an updated overview useful for clinical practice and guiding future research trends, as well as facilitating the development of standardised procedures. [ABSTRACT FROM AUTHOR]

Background/Objectives. Burnout and occupational stress are significant issues among forensic professionals, impacting their well-being and job performance. This systematic review aims to provide an up-to-date overview of the occupational stress and burnout experienced by forensic personnel, exploring the profound and multifaceted impact on their physical, mental, professional, and interpersonal well-being. Methods. A systematic review was conducted following PRISMA guidelines using Scopus and WOS databases to search for articles published from 1 January 2000 to 31 August 2024. The search used keywords related to burnout and forensic professions. Inclusion criteria were original articles in English and French, while reviews, book chapters, editorials, and notes were excluded. A total of 10 studies were included after eliminating duplicates and excluding irrelevant articles. Results. The review identified seven key findings. (1) High levels of occupational stress and burnout among forensic personnel necessitate effective stress management strategies and resilience training; (2) autopsy technicians in Romania experience burnout and alexithymia, particularly related to traumatic events involving children, highlighting the need for specialized support systems; (3) disparities in burnout and post-traumatic stress disorder (PTSD) symptoms were observed in autopsy technicians and resident doctors, suggesting tailored mental health resources; (4) organizational factors, such as peer support and compensation satisfaction, significantly impact burnout and secondary traumatic stress (STS) among sexual assault nurse examiners; (5) burnout among forensic physicians, both in Romania and Egypt, is linked to personality traits, job satisfaction, and socio-demographic factors; (6) pathologists face a range of health issues, including musculoskeletal problems and psychological disorders, underscoring the need for industry-specific health measures; and (7) the lack of wellness resources for forensic professionals calls for improved mental health support and training. Conclusions. The findings highlight the pervasive issue of burnout and stress among forensic professionals globally. Addressing these challenges requires comprehensive stress management programs, tailored mental health resources, and organizational support. Future research should focus on developing and implementing effective interventions to enhance resilience and job satisfaction within this high-stress field. [ABSTRACT FROM AUTHOR]

Introduction: In a demographically diverse, vast, and highly densely populated developing country like India, the establishment of the identity of a deceased poses great medico-legal importance. It also poses a great challenge to the forensic pathologist working in an environment where decomposition and taphonomic processes are rapid. Structurally bones resist common degradation and putrefactive changes and remain longer as material for evidential value. Human skeletal remains, which are found under suspicious circumstances and doctors examining them need to give an opinion in the court of law. Forensic experts are often consulted regarding the identification of skeletal remains. One of the important bones that helps to determine sex is the Sternum Bone. For this purpose, a technique will be highly appreciated for the determination of sex from the morphometry of the sternum. This current pilot investigation was designed to determine the sex from the adult human sternum from predefined vertical linear measurements. Materials And Methods: After getting institutional ethical committee clearance, the study was conducted over the 64 adult human sternums screened through the inclusion and exclusion criteria. Results: In the current study, the study population comprises 38 (59.4%) males and 26 (40.6%) females, selected through the complete enumeration method. Among total 64 cases of the present study 28(43.8%) cases are from 18-39 years age group and 22 (34.4%) cases are from 40-59years age group 14(21.9%) cases are from 60-90years. On considering sex, it is found that the mean length of manubrium in male(52.44mm) is greater than that of female (45.19mm). The mean length of body in male(98.44cm) is greater than that of female (83..20cm). Most importantly unstandardized canonical discriminant function was estimated using two pre-defined vertical linear measurements as independent variables (Manubrium Length-ML and Mesosternum Length-SL) as :- D= (0.211* ML) + (0.37* SL) -13.845. CONCLUSION: A paradigm shift from morphological to morphometrical determination of sex from sternum will help to reduce the subjective variation to an extent that can be modified and sophisticated later through more thorough detailing. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between the cause of death stated on a post-mortem (medical) examination report and the subsequent cause of death given in a finding by a legal or judicial coroner (non-medical). A review of causes of death provided by forensic pathologists in their reports found the majority of cases (89%) were given in the traditional death certificate format, but were transformed to a sentence format in just over two thirds of coronial findings (68.5%). There was no evidence that converting the format of the cause of death statements caused a delay in finalizing the case. Of note, the post-mortem examination report provided an indefinite cause of death in 3.8% of cases and around a quarter (25.3%) of these were converted to a definite cause of death in the coronial finding (for example, by removing the word 'probable'). Where the post-mortem examination did not determine a cause of death (5.2% of cases), most remained undetermined in the coronial finding. It is suggested that pathologists could work with coroners to ensure the cause of death provided on post-mortem examination reports are in the preferred style for their jurisdiction. [ABSTRACT FROM AUTHOR]

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Background: Cardiovascular disease (CVD) has emerged as a pervasive source of illness and a prominent factor in death rates throughout the majority of nations. Atherosclerosis has been identified as the primary cause of this global health concern. Methods: 150 cases older than 30 years were subjected to medicolegal autopsy in the Department of Forensic Medicine, Government Medical College, Kannur. During a medicolegal autopsy, while dissecting the aorta, coronary arteries and cerebral arteries; gross macroscopic changes brought on by atherosclerosis were examined and documented. Results: The study group consisted primarily of males (62.7%) with an average age of 46.90±16.34 years. Nearly half of them were in their fourth and fifth decades of life. A total of 67 instances were diagnosed with atherosclerosis, with 22 of them falling within the age range of 40 to 49 years. 79 percent of these incidents involved males. Conclusion: Atherosclerosis is becoming increasingly recognized as the primary cause of around one-third of all fatalities in India. Conducting a study on atherosclerosis in living individuals is challenging, as it requires invasive and costly procedures. This is particularly true in underdeveloped nations. Therefore, autopsies are crucial for documenting the occurrence of atherosclerosis in the population. This study will assist doctors in evaluating the overall arterial health of patients and developing therapeutic protocols and courses of treatment. Additionally, it will aid forensic pathologists in determining the cause of death in cases of sudden death. [ABSTRACT FROM AUTHOR]

Acute corrosive acid ingestion presents significant challenges in clinical and forensic pathology due to its severe and often fatal outcomes. This case series examines four autopsies involving fatal acid ingestion: three cases of hydrochloric acid (HCl) poisoning and one case of sulfuric acid (H2SO4) poisoning. Each case provides detailed autopsy findings, focusing on macroscopic and microscopic pathological changes. The first three cases of HCl poisoning revealed extensive tissue damage characterized by coagulative necrosis, particularly affecting the esophagus, stomach, and duodenum. Histological examination showed dense inflammatory infiltrate, submucosal edema, and significant hemorrhage, with patchy necrosis observed in the liver and kidneys. Pulmonary findings included alveolar edema and hemorrhage. The fourth case, involving H2SO4 ingestion, demonstrated more severe injuries with transmural necrosis and extensive hemorrhagic infiltration in the esophagus. The stomach exhibited full-thickness necrosis with a pronounced sulfurousodor, indicating severe chemical injury. Histopathological findings included extensive tissue dehydration and charring, with severe alveolar edema and hemorrhage in the lungs and extensive necrosis in the liver and kidneys. Comparative analysis of the histopathological changes highlighted the differences in tissue damage caused by these two acids. HCl primarily induced superficial necrosis with relatively preserved tissue architecture, while H2SO4 caused more extensive and deeper tissue damage due to its strong dehydrating and exothermic properties. Recognizing these differences is crucial for forensic pathologists in accurately diagnosing and differentiating cases of acid poisoning, ultimately enhancing diagnostic precision and clinical outcomes. This study underscores the severe and often fatal consequences of acute acid ingestion and aims to enhance the understanding of the pathological changes associated with such poisonings, thereby improving forensic and clinical evaluations. [ABSTRACT FROM AUTHOR]

Drowning remains a significant cause of mortality worldwide, necessitating accurate diagnostic tools for forensic investigation. This paper conducts a comparative analysis of the Drowning Index (DI) to ascertain its relevance in distinguishing drowning deaths from non-drowning asphyxial deaths. Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many non-drowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. We compared the lung and pleural effusion weight, spleen weight, and DI from 124 autopsies of asphyxia deaths including both drowning deaths and non-drowning asphyxia deaths such as hanging, strangulation, suffocation and mechanical asphyxia at the department of Forensic Medicine and Toxicology at the Gandhi Medical College, Bhopal from September 2021 to August 2022. Findings highlight the potential utility of the DI as a valuable adjunctive tool in forensic investigations, providing insights into its comparative efficacy in differentiating drowning from other modes of asphyxial deaths. Such insights are critical for enhancing accuracy in forensic diagnoses and contributing to advancements in medicolegal death investigations. [ABSTRACT FROM AUTHOR]

Mortuary workers play a crucial role in ensuring the respectful, safe and dignified handling of human bodies. But despite of their irreplaceable role, there is prolonged neglect and under recognition of these mortuary staff in our country. It is in fact correct to say that mortuary workers were as important as nurses were to the Forensic Pathologists. The mortuary attendants assist in preparing bodies, specialized dissection and collecting specimens that were pertinent in performing meticulousautopsy techniques. Apart from this they also help in the examination of sexual offenders. These kind of diverse responsibilities makes them an integral part in the medicolegal system in India. There was only a few research done in regard to the mortuary staff. Understanding the work conditions and challenges faced by them will help in improving work environment. This will help in promoting the quality of work they offer and attract more eligible youth to take up this essential, yet risky profession. [ABSTRACT FROM AUTHOR]

Introduction: The high rate of incarceration, now exceeding 11.5 million people worldwide, has raised concerns about the conditions within penal institutions, such as the consequences of incarceration on the person. This retrospective study aims to investigate the issue of death in custody, exploring the relationship between incarceration, health vulnerabilities, and death from the forensic pathologist's point of view. Methods: We analyzed, from a forensic, clinical and toxicological perspective, 86 cases of deaths in detention facilities in North-Western Italy from 1999 to 2022. Results: The analysis has shown that suicide, mainly committed by hanging, plastic bag suffocation and butane intoxication, represents the leading type of violent death (52%), followed by accidental deaths (16%). On the other hand, cardiovascular diseases are the leading cause of natural deaths (42%), followed by infectious diseases (especially HIV-related). Discussion: The present study identifies the most frequent and critical situations and risk factors related to death in custody and the profile of the inmate who is at a higher risk of death, allowing to highlight the issues to be addressed from a public health point of view. On the whole, it calls for comprehensive reforms, aligned with international human rights standards, addressing mental and physical care gaps, improving correctional officers' education, and training, and focusing on rehabilitation with well-being and dignity. [ABSTRACT FROM AUTHOR]

Non-prescription use of anabolic androgenic steroids (AAS) is associated with an increased risk of premature death. However, these substances are seldom screened in connection with forensic cause-of-death investigation, unless the forensic pathologist specifically suspects use, often based on a positive AAS use history. Since AAS use is often concealed from others, this practice may lead to mistargeting of these analyses and significant underestimation of the true number of AAS positive cases undergoing forensic autopsy. Thus, more accurate diagnostic tools are needed to identify these cases. The main objective of this study was to determine, whether a multivariable model could predict AAS urine assay positivity in forensic autopsies. We analyzed retrospectively the autopsy reports of all cases that had been screened for AAS during forensic cause-of-death investigation between 2016–2019 at the Finnish Institute for Health and Welfare forensic units (n = 46). Binary logistic regression with penalized maximum likelihood estimation was used to generate a nine-variable model combining circumferential and macroscopic autopsy-derived variables. The multivariable model predicted AAS assay positivity significantly better than a "conventional" model with anamnestic information about AAS use only (area under the receiver operating characteristic curve [AUC] = 0.968 vs. 0.802, p = 0.005). Temporal validation was conducted in an independent sample of AAS screened cases between 2020–2022 (n = 31), where the superiority of the multivariable model was replicated (AUC = 0.856 vs. 0.644, p = 0.004). Based on the model, a calculator predicting AAS assay positivity is released as a decision-aiding tool for forensic pathologists working in the autopsy room. [ABSTRACT FROM AUTHOR]

When faced with increasing drug‐related deaths and decline in practicing forensic pathologists, the need to quickly identify toxicology‐related deaths is evident in order to appropriately triage cases and expedite turnaround times. Lateral flow immunoassays conducted pre‐autopsy offer quick urine drug screen (UDS) results in minutes and are used to inform the need for autopsy. Over 1000 medicolegal cases were reviewed to compare UDS results to laboratory enzyme‐linked immunosorbent assay (ELISA) blood results to evaluate how well autopsy UDS predicted laboratory findings. Mass spectral analysis was performed on ELISA‐positive specimens and these data were used to investigate UDS false‐negative (FN) results when possible. Five different UDS devices (STAT One Step Drug of Abuse dip card and cassette, Premiere Biotech multi‐drug and fentanyl dip cards and ATTEST 6‐acetylmorphine (6‐AM) dip card) were tested encompassing 11 drug classes: 6‐AM, amphetamine/methamphetamine, benzodiazepines, benzoylecgonine, fentanyl, methadone, opioids, phencyclidine, and delta‐9‐tetrahydrocannabinol. Sensitivity, specificity, efficiency, and positive and negative predictive values >80% indicated that UDS was useful for predicting cases involving benzoylecgonine, methadone, methamphetamine, and phencyclidine. UDS was unreliable in predicting amphetamine, benzodiazepines, fentanyl, and opiates‐related cases due to a high percentage of FN (up to 11.2%, 8.0%, 12.4%, and 5.5%, respectively) when compared to ELISA blood results. For the later analytes, sensitivities were as low as 57.5%, 60.0%, 72.2%, and 66.7%, respectively. Overall results support that UDS cannot replace laboratory testing. Because UDS is subject to false‐positive and FN results users must understand the limitations of using UDS for triage or decision‐making purposes. [ABSTRACT FROM AUTHOR]

The appearance of a gunshot wound (GSW) is greatly influenced by the velocity of the projectile, where high-velocity projectiles (HVPs) are defined as ballistic agents reaching a muzzle velocity of > 600 m/s fired from assault rifles. The aim of the study is to present and explain the differences in the dimensions of entrance and exit wounds between the most used handguns and assault rifles and to propose a predictor of HVP, i.e., the ratio of exit and entrance wounds (EX/ENR). The surface area of entrance and exit GSWs and the EX/ENR were calculated. 66 perforating GSWs produced by NATO FMJ 7.62 × 52 mm and 5.56 × 42 mm fired from assault rifles were assigned to the HVP, while 64 lesions produced by conventional projectiles fired from revolvers and semi-automatic pistols were assigned to the low-velocity projectile (LVP) group. The dimensions of the exit wounds of the HVP group were significantly higher when compared to the LVP group (95% CI 0.9886–2.423, p < 0.05). The HVP group showed significantly higher values for the EX/ENR when compared to the LVP group (95% CI 2.617–7.173, p < 0.05). The evaluation of the EX/ENR can be considered an adequate tool to assess the type of weapon involved and to roughly estimate the associated wounding mechanisms, which can guide both the physician in the management and treatment of the patients affected by GSW, and the forensic pathologist in crime investigation. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy worldwide. It results in characteristic acute and chronic findings on postmortem computed tomography (PMCT), macroscopic and microscopic examinations. While the diagnostic imaging and macroscopic features are not specific for SCD on their own, when coupled with microscopic features such as sickled erythrocytes and evidence of chronic venous congestion (i.e., Gamna-Gandy bodies), these clues can help alert forensic pathologists to the presence of SCD. Despite the prevalence of the disease and the constellation of findings alluded to above, SCD is not often explored in forensic pathology literature. This case demonstrates classic acute and chronic features of SCD on PMCT, macroscopic and microscopic examinations. It explores the pathophysiology leading to sudden and unexpected death in a person with SCD and possible pitfalls in attribution of cause of death. [ABSTRACT FROM AUTHOR]

The article responds to a study on the role of restraint in fatal excited delirium syndrome, highlighting flaws in the original study's methodology and conclusions. The authors argue that the study's scope goes beyond its stated aims and that the interpretation of the literature is flawed. They question the exclusion of cases and the subjective nature of diagnoses, ultimately concluding that the study fails to provide a balanced and accurate interpretation of the subject matter. The authors emphasize the need for a comprehensive post-mortem examination by a qualified forensic pathologist in cases involving restraint-related deaths. [Extracted from the article]

Water intoxication is rarely seen in forensic practice and is typically associated with excessive water consumption, amphetamine intake, and child abuse. Iatrogenic water intoxication is rare but usually related to medical disputes. Here, we report a 44-year-old female was admitted to the hospital due to a 3-month history of excessive menstrual bleeding. B-ultrasound revealed multiple substantial intrauterine masses, leading to a diagnosis of multiple uterine fibroids. After admission, she underwent submucous myomectomy, endometrial resection, and transcervical resection of endometrial polyps. During the procedure, the patient suffered dizziness and chest tightness, her blood pressure decreased to 89/52 mmHg, and moist rales were heard in her both lungs; she died despite medical efforts. A forensic autopsy was performed and revealed severe pulmonary edema. Considering the patient's clinical history, acute water intoxication was considered to be the cause of death. This highlights the need for forensic pathologists to be vigilant of postoperative water intoxication, a rare complication in obstetrics, to ensure accurate assessments. [ABSTRACT FROM AUTHOR]

Sodium nitrite (NaNO2) is an inorganic compound that is commonly used as a preservative (E250) in the fish and meat industry. When ingested, sodium nitrite will lead to methemoglobinemia, hypotension, and arrhythmias. An increasing trend in the use of sodium nitrite as a suicide agent has been reported. In Belgium however it remains a rare phenomenon. The ingestion of sodium nitrite is not always apparent from the death scene investigation, especially in cases of covert administration or accidental ingestion. Hence, the forensic pathologist must be aware of this trend and the postmortem changes related to the ingestion of sodium nitrite to effectively identify these cases and determine the cause and manner of death. We describe a case of fatal self-poisoning following the oral ingestion of sodium nitrite with suicidal intent. Postmortem investigations showed signs of methemoglobinemia, such as a gray-brown discoloration of lividity and a chocolate brown discoloration of the blood. Postmortem toxicological investigation revealed methemoglobinemia (35%) in cardiac blood, hypernatremia (159.6 mmol/L) in vitreous humor, and the presence of nitrite in gastric contents (1.15 g/L) and, for the first time in a forensic case, in serum (38 µg/mL). A review of the existing literature regarding cases of sodium nitrite intoxications was performed to correlate these findings. [ABSTRACT FROM AUTHOR]

Background: Although forensic pathology age estimation of a wound is difficult, it can help reconstruct murder scenes and identify potential culprits. Forensic specialists usually focus on two aspects when evaluating wound life and determining how long ago the wound occurred. Recent developments in forensic techniques, particularly in high-throughput analyses, have allowed for the simultaneous evaluation of several markers and molecular and cellular levels of material analysis. Aim: To evaluate valuable additional information offered by each marker, summarize recent literature, and offer an update on wound-age estimation in forensic pathology. With the intention of providingsome insight for future research, prospects for evaluating wound age in forensic practice are finally examined. Conclusions: Although forensic pathologists find it difficult to determine the age of wounds, doing so can help reconstruct crime scenes and help apprehend suspects. In circumstances where several traumas are sustained by various offenders, forensic pathologists must determine the chronology and sequence of injuries because the severity of an injury usually determines the severity of punishment. Wound tracing, photographic recording (including image analysis), biophysical approaches, and/or invasive protocols requiring wound biopsies are examples of protocols that can be used to do the assessment. We give a summary of some of the most frequently required and utilized methods in this article: (a) Preclinical and animal models, such as those involving incisions, excisions, burns, and damaged wounds; (b) techniques for assessing the rate of healing, image-based wound analysis, biophysical evaluation, histological, immunological, and biochemical assays; and techniques for assessing the healing progression. [ABSTRACT FROM AUTHOR]

In rural Crete, Greece, a mummified body was discovered inside a screw-top plastic barrel next to a dry riverbed. Local authorities conducted a field investigation along with a forensic pathologist, and the body was transferred inside the barrel to the Forensic Medicine Unit of the University of Crete for further investigation. Forensic examination included radiographs taken using a portable X-ray machine in situ followed by extraction of the remains, a full-body postmortem computed tomography scan, autopsy, DNA extraction, tissue and biofluid sampling, and histological and toxicological analyses. Two butane camping gases were recovered from inside the barrel. The remains were determined to belong to a middle-aged adult male. The postmortem interval was estimated to be over 4 months. DNA comparison revealed that the body belonged to a 58-year-old man who was reported missing 28 months prior to discovery. Examinations showed no evidence of skeletal or other trauma, and death was attributed to asphyxia due to oxygen deprivation. Careful examination of the barrel, which bore several peculiar modifications, in conjunction with contextual information pertaining to the deceased's personal life, led to successful case resolution. Key points Advanced decomposition and taphonomic alterations present challenges for forensic practitioners. A case of a set of mummified remains discovered inside a plastic screw-top barrel is reported. A multidisciplinary approach, including examination of the barrel and contextual information regarding the deceased, led to case resolution. [ABSTRACT FROM AUTHOR]

Mechanical asphyxiation has been a common method used to commit homicide, including femicide, throughout history. A recent report by the United Nations has shed light on the issue of misidentification and concealment of gender-related killings, which makes it difficult to effectively fight against it. Forensic pathologists are frequently asked to examine cases involving suspected asphyxia to determine whether other persons have been involved. Therefore, medicolegal experts must look for signs of occlusion of the oral/nasal orifices, compression of the neck, or specific signs such as the "facie sympathique". There are situations where the physical signs are not distinctive enough to diagnose asphyxia, especially in cases where the individual has limited ability to resist external compression. In such cases, judicial autopsies should include an anatomical dissection of the neck structures through a layer-by-layer progression. It is important to search for the Amussat's sign, e.g., as part of a Forensic Clinical Anatomy approach. Additionally, individual anatomical variations, age or artefactual modifications, must be considered for the correct interpretation of findings. Microscopic examinations could aid in the diagnosis by providing additional findings, and several attempts have been made to identify unique markers of asphyxia through various laboratory techniques such as biochemistry, radiology and miRNA studies. However, no single finding or method has been identified as definitive. In the future, biomedical-legal sciences will have to rely on scientific research and the retrospective case series to provide a scientific framework on which to base their hypothesis, giving weight to evidence in the trial. [ABSTRACT FROM AUTHOR]

Background: Intrauterine fetal death and perinatal death represent one of the most relevant medical scientific problems since, in many cases, even after extensive investigation, the causes remain unknown. The considerable increase in medical legal litigation in the obstetrical field that has witnessed in recent years, especially in cases of stillborn births, has simultaneously involved the figure of the forensic pathologist in scientific research aimed at clarifying the pathophysiological processes underlying stillbirth. Methods: our study aims to analyze cases of sudden intrauterine unexplained death syndrome (SIUD) to evaluate the role of oxidative stress in the complex pathogenetic process of stillbirth. In particular, the immunohistochemical expression of specific oxidative stress markers (NOX2, NT, iNOS, 8-HODG, IL-6) was evaluated in tissue samples of placentas of SIUDs belonging to the extensive case series (20 cases), collected from autopsy cases of the University of Ferrara and Politecnica delle Marche between 2017 and 2023. Results: The study demonstrated the involvement of oxidative stress in intrauterine fetal deaths in the placenta of the cases examined. In SIUD, the most expressed oxidative stress markers were NOX2 and 8-HODG. Conclusions: The study contributes to investigating the role of oxidative stress in modulating different pathways in unexplained intrauterine fetal death (SIUD) tissues. [ABSTRACT FROM AUTHOR]

The border river of the Evros/Meriç/Maritsa has been shaped during the century since its demarcation by the Lausanne peace treaty. Over this period, a dense overlap of environmental, geopolitical, legal and cultural actors has turned it into both a riverised border and a borderised river. The border regime appropriates the riverine characteristics of flow, erosion, mud, turbulence and fog as much as it is founded on military technology, international law, agricultural and conservation practices, resource logistics, border crossing and the denial thereof. Here, the river's movement of sand and alluvium has become an agent in the policing of the river border. Drawing on interviews with asylum seekers, locals, forensic pathologists, legal scholars and fish scientists, this paper weaves field research, primarily undertaken on the Greek side, with a historic and ecosystemic perspective of a century‐old border that has become a hotspot for violent practices. These practices themselves harness the uncertain physical conditions that the riverscape affords. In this article we argue that the disjunctures of the river's dynamic geomorphology and the history of demarcation of the median line frame the contemporary politics of mobility of those illegalised by the border regime. In the ambiguous territorial pockets produced by the movement of the river away from the median line of 1926, islands of hyperlegality have been produced where state violence takes place with impunity. [ABSTRACT FROM AUTHOR]

Background: Any portion of the body that has sustained damage due to mechanical force is referred to as an injury or wound. Weapon use, blunt force, and sharp force can all cause mechanical injuries. In many nations, the most common method of homicide is the use of sharp objects, particularly knives. One of a forensic pathologist's main responsibilities in the realm of forensics is wound examination. By identifying prospective criminal suspects and tracking the origin and progression of violent occurrences, wound assessment supports criminal investigations. Aim: The current review provides a view on wounds/injuries, their classifications, incised wounds, how to differentiate them from lacerations, and the importance of wound examination in the field of forensics. Conclusion: In summary, researchers have classified wounds/injuries according to many factors, and they frequently emphasize the significance of wound examination in the field of forensics. [ABSTRACT FROM AUTHOR]

Fentanyl is an opioid with powerful analgesic effects and a high speed of action. Due to its pharmacological properties, this molecule has therapeutic application as an anesthetic in surgery or as palliative therapy for cancer patients. Unfortunately, in recent years, the easy availability of this substance, the low cost and the illegal online market have favored the large-scale diffusion of fentanyl. Fentanyl is available in different forms, including nasal spray, oral patches, soluble capsules, aerosol or the new version of fentanyl mixed with other drugs, making its use very widespread. Subjects of various ages are involved in fentanyl consumption, including minors that have not yet reached adolescence. In this work, we performed a literature review using the search engines PubMed NCBI and SCOPUS regarding episodes of acute fentanyl intoxication occurring in those of a pediatric age using the Mesh Terms "fentanyl" AND "overdose" AND "children". The inclusion criteria were English papers published in the last 10 years regarding the cases of children under the age of 10. We evaluated the most frequent methods of intake and the circumstances of such episodes. In cases of death, we analyzed the autopsy, the toxicological findings and the investigations carried out. The review results show that in this age group (under < 10 y.o. s), it is possible to identify the risk factors for fentanyl intake, such as the presence of this molecule within the family unit due to drug addiction or medical therapy. The results also demonstrate a significant risk of underestimation of this phenomenon, since the molecule is often not investigated through adequate toxicological analysis. These results, therefore, suggest always carrying out toxicological investigations in the case of suspected fentanyl intoxication, both on patients or cadavers. The investigations must always include a urinary screening for opiates, and the request for a second level analysis with molecule dosage in cases of positivity or in cases of strong suspicion for assumption. In cases of intoxication in a family context of drug addiction, it is necessary to investigate the chronicity of the intake through hair analysis and evaluate the possible co-administration of other drugs. In conclusion, we suggest a protocol, applicable both on patients or cadavers, which can be useful for physicians and forensic pathologists in order to promptly identify these cases and allow for the reporting of them to the judicial authorities with the adoption of strict prevention and control measures. [ABSTRACT FROM AUTHOR]

Background. Homicide by drowning in adults is rare. Usually, marks of violence are found on both the victim and the perpetrator, unless the victim was under the influence of alcohol, drugs, or was unexpectedly forced or dragged into the water. Indeed, many cases of drowning in adults are believed to be accidental, but they may be the result of drunken fights or attempts to make the death appear accidental. In order to define the manner of death, cooperation between the forensic pathologist and the investigators is mandatory. Indeed, the autopsy is important to distinguish homicide by drowning from other kinds of drowning. The purpose of this study is to highlight the features of homicide by drowning. Materials and Methods. Literature search was conducted using PubMed databases, using the following keywords: "(homicide) and (drowning)". 3 articles were included in the systematic review, in addition to 3 cases observed in our institute. Conclusions. Both external examination and autopsy findings and the results of the investigation are essential to differentiate a homicide by drowning from accidental ones. The low specificity and variability of external and internal findings, the possibility of atypical asphyctic and nonasphyctic pathophysiological mechanisms, whose nature is not detectable at postmortem examinations, makes the diagnosis of cause of death difficult and often based on exclusion criteria only. In complex cases only using a strict forensic method allows to use the essential tools to identify the real manner of death. [ABSTRACT FROM AUTHOR]

While forensic pathologists have always played a pivotal role in victim identification after mass casualties, new developments in forensic methods have given forensic anthropologists more agency in positively identifying individuals who were previously unidentifiable. This review aims to contribute to the refinement of diagnostic tools, ensure optimal utilization of remnants and information available, and emphasize the contributions of forensic pathologists and forensic odontologist to victim identification and the importance of forensic pathologists and forensic odontologist in the criminal justice system. Considering the Interpol DVI Guide's emphasis on fingerprints, dental examinations, and DNA as primary identifiers, the forensic pathologist's role as the leader of a multidisciplinary team of experts in a disaster situation has taken on new significance. This is due to the forensic pathologist's and forensic odontologist training and experience leading similar teams during routine operations at a forensics institute. This thorough examination highlights the utmost significance of the job carried out by forensic pathologists and forensic odontologist. They play an important role in the judicial process by providing expert views in criminal investigations. Their expertise ensures accurate identification of victims and provides critical evidence that is necessary for holding offenders responsible. Their contributions are fundamental to the administration of justice, highlighting the great importance of their function in the overall structure of the criminal judicial system. [ABSTRACT FROM AUTHOR]

Multiple gunshot suicides are relatively rare and present significant challenges for investigators and forensic pathologists. In such cases, assessing the possibility of more than one shot being fired can be crucial in distinguishing homicide from suicide. We present a rare case of multiple self‐inflicted gunshot wounds to the chest with severe injury to the heart and left lung. Both the sudden, unexpected death of the man, the unknown source of the firearm, and the number and nature of the injuries sustained seemed quite unusual. The investigation revealed that the wounds were self‐inflicted at close range, and the interval between successive shots (estimated by witnesses at up to 2 min) suggests that even multiple gunshot wounds perforating the heart and lungs may not necessarily cause immediate incapacitation. Forensic investigations in such cases should be multi‐faceted and include full autopsy and ballistics expertise, as well as witness testimony and medical history. [ABSTRACT FROM AUTHOR]

Introduction: Zopiclone, a controlled substance prescribed for insomnia, has become a common toxicological finding in forensic autopsy cases. This study investigated the role and extent of zopiclone use in fatal intoxications in Sweden. Methods: All forensic autopsy cases positive for zopiclone in femoral blood during 2012–2020 were selected. Among these cases, fatalities caused by intoxication according to the cause of death certificates issued by the forensic pathologist were identified. Intoxications where zopiclone contributed to the cause of death were included in the study. The Swedish Prescribed Drug Register was utilized to examine whether the included cases were prescribed zopiclone or not. Results: In total 7320 fatal intoxications underwent a forensic autopsy during the study period, 573 of them were caused by zopiclone. Among the zopiclone fatalities, 87% (n = 494) had a prescription for zopiclone, and 8% (n = 43) were monointoxications. Most fatalities, 62% (n = 354) were suicides, and zopiclone was involved in about 17% (n = 354) of all intoxication suicides in Sweden. Women were significantly (p < 0.01) overrepresented in suicides with zopiclone, comprising 56% (n = 291) of fatalities. The median age was 55 years among zopiclone intoxications compared with 44 years amongst all fatal intoxications. Conclusion: This study demonstrates that the toxicity of zopiclone can be lethal both in combination with other substances and on its own. Most individuals dying in fatal zopiclone intoxications were prescribed zopiclone, which potentially indicates that a more restrictive prescribing rate could prevent future intoxication deaths, especially when caring for patients with an increased suicide risk. [ABSTRACT FROM AUTHOR]

Assessments of the impact of live-capture methods and tools are important to wildlife research and management efforts. Federal regulations (e.g., the Migratory Bird Treaty Act and the Animal Welfare Act) require humane and ethical treatment of migratory birds. Therefore, it is important to conduct live trapping using methodologies that minimize the potential for injury or mortality. We evaluated the injury rate experienced by red-tailed hawks Buteo jamaicensis captured using three commonly used live traps (i.e., bal-chatri, Swedish goshawk, and pole). Professional wildlife biologists at airports in Illinois live-captured 25 free-ranging red-tailed hawks using bal-chatri traps, 42 red-tailed hawks using Swedish goshawk traps, and 25 red-tailed hawks using pole traps. Of the red-tailed hawks (n 5 53) identified by a veterinary forensic pathologist as having one or more capture-related injuries, 85% of the injuries were classified as "minor" (e.g., cuts or scrapes), 13% were classified as "moderate" (e.g., hemorrhaging), and only 2% were classified as "severe" (e.g., fractures). When considering only injuries classified as moderate and severe, we found no difference (v2 1 5 0.38, P 5 0.54) in the frequency of these injuries among the three trap types. The three live-trap devices we evaluated can be efficient tools that result in minimal risk of injury or death when used by those with proper training and experience to live-capture red-tailed hawks for research purposes, for conducting raptor hazard management activities, or for licensed falconers to acquire wild red-tailed hawks. [ABSTRACT FROM AUTHOR]

Forensic medicine is a thriving application field for artificial intelligence (AI). Indeed, AI applications intended to forensic pathologists or forensic physicians have emerged since the last decade. For example, AI models were developed to help estimate the biological age of migrants or human remains. However, the uses of AI applications by forensic pathologists or physicians and their levels of integration in medicolegal practices are not well described yet. Therefore, a scoping review was conducted on PubMed, ScienceDirect, and Scopus databases. This review included articles that mention any AI application used by forensic pathologists or physicians in practice or any AI model applied in one expertise field of the forensic pathologist or physician. Articles in other languages than English or French or dealing mainly with complementary analyses handled by experts who are not forensic pathologists or physicians or with AI to analyze data for research purposes in forensic medicine were excluded from this review. All the relevant information was retrieved in each article from a grid analysis derived and adapted from the TRIPOD checklist. This review included 35 articles and revealed that AI applications are developed in thanatology and in clinical forensic medicine. However, those applications seem to mainly remain in research and development stages. Indeed, the use of AI applications by forensic pathologists or physicians is not actual due to issues discussed in this article. Finally, the integration of AI in daily medicolegal practice involves not only forensic pathologists or physicians but also legal professionals. [ABSTRACT FROM AUTHOR]