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Complex suicides refer to using two or more suicide modes. In the literature, complex suicides are distinguished into planned and unplanned. Using multiple methods is related to ensuring a fatal result or because the first method appears too painful, time-consuming, or ineffective. The review aims to provide an overview of the critical features of complex suicides in the forensic context. The review was conducted by searching online databases (PubMed Central and Scopus) up to March 2023. We identified 52 articles that met the inclusion criteria, describing 261 cases. Suicides were classified as planned in 136 cases (52.1%); 105 cases (40.2%) were defined as unplanned, while in the remaining 20 cases (7.7%), the authors did not propose any classification. In 2/261 (0.8%) cases, four modes were indicated, three modes were observed in 34/261 cases (13%), and in 224/261 (85.8%) cases the suicides were carried out using a combination of two distinct methods. The method most frequently employed in the first instance in unplanned suicides were sharp-force injuries and stabbing, followed by mechanical asphyxia (hanging, self-strangulation, plastic bag suffocation) and a fall from height. Regarding planned suicide, the most frequent suicide methods were asphyxia, intoxication (drugs, substances of abuse, or alcohol), and poisoning via toxic substances. Complex suicides represent a relatively rare entity in forensic pathology; nevertheless, they can be challenging for the forensic pathologist in terms of differential diagnosis compared to homicides, due to the sometimes multifaceted presentation. [ABSTRACT FROM AUTHOR]

Transformative processes generally occur singly and jointly involving the whole body. Rarely, they appear simultaneously as distinct transformative phenomena. The case study relates to a corpse found inside a storage tank in a rather unusual position, during the winter months. On external examination carried out at the crime scene, both legs and feet were out of the well bending over the storage tank and showing skeletonisation and tissue defects due to biting inflicted by the environmental macrofauna. The thighs were also skeletonised, inside the well but not immersed in the water, as was the torso which, however, was entirely corified. The colliquated shoulders, head and upper limbs were fully immersed into the water as well as the macerated hands. The corpse was exposed simultaneously to three different environmental conditions: the external setting with changes in temperature, rainfall and the action of the macro fauna, the unventilated and humid setting inside the tank, and lastly the stored water. The corpse, lying in a specific position and being exposed to different atmospheric conditions, underwent four post-mortem changes at the same time, making it challenging to estimate the time of death, based only on the available data and macroscopic findings. [ABSTRACT FROM AUTHOR]

Measles is a highly contagious viral disease spread through respiratory droplets. The number of reported cases increased worldwide in 2023, particularly in the European Region. Italy reported 213 cases in the first quarter of 2024, with most of them in unvaccinated adults aged 15–64. Maintaining high vaccination coverage is essential to prevent outbreaks, especially in healthcare settings where measles transmission is a significant risk. In our study, we collected serological and demographic information from all Italian and foreign medical students and residents (850) who underwent a pre-training assessment at the Tor Vergata Occupational Medicine Service, Rome, between 3 April 2023 and 31 January 2024. Of the 850 students and residents analyzed, we found only 546 (64.2%) with a protective level of IgG antibodies against measles, with a median IgG level of 2.00 AI. A significant proportion of students and residents were serologically non-immune, raising concerns about the potential risk of hospital transmission. To manage this risk, it is important to assess serological levels, vaccinate those with inadequate levels, and promote vaccination in the general population. [ABSTRACT FROM AUTHOR]

Nanoenergetics are defined as a class of nanomaterials that possess the ability to release energy in certain situations. These properties have been studied and deepened in recent years, so much so that nanoenergetics have been introduced into the use of the weapons industry, among others. It is therefore an emerging reality that deserves attention with regard to potential harmful effects on human and environmental health. it has been suggested that nanoenergetics may have genotoxic and immunotoxic effects, among others. Problems related to exposure to nanonenergetics can therefore potentially affect both exposed workers (both in the production and use phase) and the civilian population, if used in war scenarios, for example,. Starting from these assumptions, the INNOTOX research project aims to contribute to the in-depth study of the toxicity of nanonenergetics, through an integrated approach involving experts in occupational and forensic medicine, nanotoxicology and bioengineering. [ABSTRACT FROM AUTHOR]

The use of non-lethal weapons has spread worldwide, being introduced as an alternative to firearms in many countries such as the United States or the United Kingdom. Among non-lethal weapons, conducted electrical weapons have been adopted worldwide, to control unruly suspected criminals or to neutralise violent situations. The stun gun belongs to this category and is the most widely available, with more than 140,000 units in use by police officers in the field in the US, and an additional 100,000 electrical stun guns owned by civilians worldwide. In Italy, the use of conducted electrical weapons by law enforcement has only recently been introduced, with private use and commercialisation still prohibited, mainly due to controversies related to the potential dangers of such devices. Before the official adoption, several experiments had to be carried out, with mechanisms that reproduced the ballistics of the stun gun. Here we present the case of a man who suffered a self-injury trauma to his hand during a ballistics exercise with a crossbow loaded with stun gun probes. [ABSTRACT FROM AUTHOR]

Nowadays, it is vital to have new, complete, and rapid methods to screen and follow pharmacotoxicological and forensic cases. In this context, an important role is undoubtedly played by liquid chromatography-tandem mass spectrometry (LC-MS/MS) thanks to its advanced features. This instrument configuration can offer comprehensive and complete analysis and is a very potent analytical tool in the hands of analysts for the correct identification and quantification of analytes. The present review paper discusses the applications of LC-MS/MS in pharmacotoxicological cases because it is impossible to ignore the importance of this powerful instrument for the rapid development of pharmacological and forensic advanced research in recent years. On one hand, pharmacology is fundamental for drug monitoring and helping people to find the so-called "personal therapy" or "personalized therapy". On the other hand, toxicological and forensic LC-MS/MS represents the most critical instrument configuration applied to the screening and research of drugs and illicit drugs, giving critical support to law enforcement. Often the two areas are stackable, and for this reason, many methods include analytes attributable to both fields of application. In this manuscript, drugs and illicit drugs were divided in separate sections, with particular attention paid in the first section to therapeutic drug monitoring (TDM) and clinical approaches with a focus on central nervous system (CNS). The second section is focused on the methods developed in recent years for the determination of illicit drugs, often in combination with CNS drugs. All references considered herein cover the last 3 years, except for some specific and peculiar applications for which some more dated but still recent articles have been considered. [ABSTRACT FROM AUTHOR]

Among the methods of self-harm with suicidal purpose, hanging is the most common; classically, the subject fixes the end of a cable to a support placed at a higher height, on which the traction force given by the weight of the suspended body is applied, while the other end is passed around the subject's neck and secured with a knot. We present the case of a 56-year-old man found dead in his own home by his wife with an exercise rope fixed to a window and passed around his neck without a knot, with a discontinuous transversal groove, which, due to the absence of a knot and the furrow situation, had initially raised suspicions of being a simulated suicide. [ABSTRACT FROM AUTHOR]

Iatrogenic splenic injury during colonoscopy is a rare but known occurrence. Such a rare event raises many issues relating to medical professional liability, since it is not always easy to establish whether the onset of the splenic injury is related to a technical error on part of the operator or simply to a complication. We report the case of a 52-year-old woman who, after undergoing a diagnostic therapeutic endoscopic procedure, suffered an acute spleen rupture, without documented bowel perforation, requiring emergency splenectomy. In the case herein reported, a further medicolegal issue is related to the failure of predicting such a complication, given its rare occurrence in the informed consent form signed by the patient. [ABSTRACT FROM AUTHOR]

The tarsometatarsal joint is an anatomic area where a wide spectrum of injuries can occur. Regarding the damage mechanism, indirect injuries are more frequent and usually occur during bending or twisting movements applied to the midfoot. This mechanism is very common in sports but also possible in household accidents and falls. Patients can present with pain localized in the midfoot which can include swelling and functional disability to bear weight after trauma. Due to the diversity of injuries, there is no single evidence-based policy for treating all Lisfranc injuries in a similar manner. The goal of initial presentation of these injuries is directed towards improving the overall alignment of the foot. The diagnosis can be made by evaluating anteroposterior, lateral and 30° oblique X-rays of the foot bearing weight because in some cases the instability will only be evident after load is placed on the feet; minor displacement and smaller fractures may only be detected with CT or MRI. The diagnosis can be difficult and it is missed in up to one third of cases. It is important to recognize these injuries early and start treatment promptly because delayed treatment can lead to chronic pain, functional disability and, in some cases, to medical liability. This case illustrates a traumatic Lisfranc injury misdiagnosed at initial evaluation, which led to chronic pain and permanent functional disability. The aim of this paper is to raise awareness of this rare injury for orthopedic surgeons to avoid cases of malpractice claims and medical liability. [ABSTRACT FROM AUTHOR]

The authors present a case of a 54-year-old man with a fracture at the base of the odontoid process (dens) following a traffic accident. This paper describes the clinical-instrumental approach for research purposes, an objective diagnosis to find the presence of lesions, and the medico-legal issues caused by the difficulty in evaluating the impairment level resulting from this type of injury. [ABSTRACT FROM AUTHOR]