Identification of bullet holes in mummified corpse.

Background: The evaluation of the cause of death in a forensic context is often challenging especially when the corpse is in a severely altered state (decomposed, skeletonized, charred, dismembered, etc.), thus making it difficult to obtain an overview of the features and/or lesions suggestive of the dynamics leading to death. Case Report: In this case, the corpse was partly in a state of saponification and partly in a state of mummification with signs of skeletonization. The head, trunk, arms and upper legs were mummified and almost completely dehydrated. Conclusion: The use of special techniques such as the rehydration of bodies is an ancient practice. Parts of skin in different states of decomposition with the use of rehydration solution represents a useful procedure for the study of some damaging modalities, being able to identify damaged areas characterized by compression/dehydration effects, hidden by the advanced transformative state of the corpse, highlighting very damaged, in which skin normality can no longer be restored.

Asphyxia with a blunt instrument: which forensic evidence to use in complex cases of murder.

Background: The blunt injuries may be heterogeneous. Due to the diversity, it is often difficult to establish the type of weapon used. Particular attention must be paid to the circumstantial data and previous diseases because the injuries often could not correspond to the presumed instruments used. Case Report: A man was found dead in his bedroom wearing pajamas. On the bed there was a blanket with visible traces of blood, which had dried. There were around 10 dogs in the house, poor hygienic and sanitary conditions, widespread excrements and unbreathable air. Testimonies from general practitioner, neighbors and the partner were collected. An autopsy, histological and toxicological examination was performed. On external examination the face showed blood smearing down the nose, subconjunctival hemorrhages, and labial cyanosis. Mo-reover, a hypochromic skin area was present on the right lateral region of the neck. The inguinal region showed large de-epithelized areas with multiple purplish red ecchymoses which were histologically analyzed. These areas showed hemorrhagic infiltration in the superficial and deep dermis up to the adipose tissue due to traumatic action. Conclusion: The reconstruction of the case allowed us to state a strangulation probably attributable to a belt. The discovery of intradermal hemorrhagic infiltrations, supported by histopathological investigations, confirmed the diagnosis of blunt force injuries, excluding other type of non-violent causes of lesions. Therefore, we recommended the use of experimental methods and procedures to evaluate the harmful suitability on biological matrices.

The role of necroscopy and autopsy investigations in the diagno-sis and risk management of infections related to public health care: forensic and medico legal implications.

Background: Healthcare-associated infections (HAIs) represent the most frequent adverse event in healthcare systems around the world. From a forensic point of view, HAIs show various legal implications. Therefore, it is essential in cases of death or injury from a suspected nosocomial infection that the infection itself, the source and the method of contamination are correctly diagnosed in order to evaluate any profiles of professional liability. Methods: This study combined a minireview of the scientific literature using the Pubmed search engine, the website of the Higher Institute of Health and the member states information sessions on infection prevention and control (IPC). Discussion: Despite the significant impact that HAIs have on healthcare systems, their severity is often not fully understood by healthcare professionals, leading to insufficient responses. In the autopsy setting, the diagnosis of these infections is not always simple due to the risk of post-mortem contamination determined by the endogenous bacterial flora. In the forensic field, the medical examiner during the autopsy can use various diagnostic techniques and investigative tools to identify the infection. Some usefulpp approaches include: 1) Macroscopic examination of the organs; 2) Histopathological investiga-tions; 3) Microbiological analyzes with the performance of swabs; 4) Immunofluorescence tests for the detection of antigens or antibodies on biological liquids; 5) Molecular tests. The choice of methods will depend on the nature of the suspected infection and the availability of diagnostic resources.

New perspectives of forensic pathology through machine learning approach on autopsy data: a pilot study.

Background: The analysis, interpretation and storage of information is entrusted to the individual expert, who bases his judgments on the knowledge resulting from the experience. The aim of this experimental study is to analyse and introduce a new line of research applicable to forensic pathology, based on the use of artificial intelligence techniques as a possible tool for data collection and analysis. Methods: The sample analysed is represented by judicial autop-sies performed at the University of Catanzaro from 01/01/2020 to 31/12/2021. For each case were performed: study of medical records; autopsy; histological examinations; toxicological analysis of blood samples. Continuous variables were presented as means ± standard deviations, and categorical variables were expressed as percentages. A random forest regression model was conducted, as a machine learning approach, to estimate the importance of individual solid organ weight variables in predicting cause of death. Conclusions: This study aimed to evaluate autopsy data to aid in the description and study of forensic cases, using a machine learning approach. To date, this study appears to be the first to evaluate the weight of organs in predicting a cause of death. Artificial intelligence techniques are an optimal solution in solving forensic dilemmas. The results of this study demonstrate that routine data can be submitted using machine learning techniques in order to identify key elements of procedures that provide more information in relation to the predic-tion of cause of death.

Heart proteomic profiling discovers MYH6 and COX5B as biomarkers for sudden unexplained death.

Sudden unexplained death (SUD) is not uncommon in forensic pathology. Yet, diagnosis of SUD remains challenging due to lack of specific biomarkers. This study aimed to screen differentially expressed proteins (DEPs) and validate their usefulness as diagnostic biomarkers for SUD cases. We designed a three-phase investigation, where in the discovery phase, formalin-fixed paraffin-embedded (FFPE) heart specimens were screened through label-free proteomic analysis of cases dying from SUD, mechanical injury and carbon monoxide (CO) intoxication. A total of 26 proteins were identified to be DEPs for the SUD cases after rigorous criterion. Bioinformatics and Adaboost-recursive feature elimination (RFE) analysis further revealed that three of the 26 proteins (MYH6, COX5B and TNNT2) were potential discriminative biomarkers. In the training phase, MYH6 and COX5B were verified to be true DEPs in cardiac tissues from 29 independent SUD cases as compared with a serial of control cases (n = 42). Receiver operating characteristic (ROC) analysis illustrated that combination of MYH6 and COX5B achieved optimal diagnostic sensitivity (89.7 %) and specificity (84.4 %), with area under the curve (AUC) being 0.91. A diagnostic software based on the logistic regression formula derived from the training phase was then constructed. In the validation phase, the diagnostic software was applied to eight authentic SUD cases, seven (87.5 %) of which were accurately recognized. Our study provides a valid strategy towards practical diagnosis of SUD by integrating cardiac MYH6 and COX5B as dual diagnostic biomarkers.

The use of dye to detect sites of hemorrhage and leak in postmortem cases.

This study introduces a novel, cost-effective, and rapid method for identifying hemorrhage or leakage sites following postoperative deaths, a critical aspect in the context of medical malpractice litigation. The technique employs diluted ink as an injectable dye, providing an alternative to postmortem contrast imaging. The utility of this method was demonstrated through a series of three cases. In the first case, the technique successfully detected leaks within vascular structures. The second case revealed a leakage in the cystic duct, while in the third case, the method was instrumental in identifying a leak in a hollow organ situated below the gastro-esophageal junction. Given its demonstrated efficacy, this technique has been incorporated into routine practice by the forensic pathologist in the medicolegal directorate in Baghdad, Iraq.

[Diagnostic criteria of death cause from low temperature in air and water established by traditional expert examination methods]. / Diagnosticheskie kriterii prichiny smerti ot deistviya nizkoi temperatury na vozdukhe i v vode, ustanavlivaemye s pomoshch'yu traditsionnykh metodov ekspertnogo issledovaniya.

Death from general hypothermia is one of the leading causes in the structure of violent death in the Russian Federation. OBJECTIVE: To clarify and supplement the complex of differential diagnostic macro- and microscopic signs of a fatal acute general cold trauma received when person is in the air and water. MATERIAL AND METHODS: The conclusions of forensic medical experts on the bodies of people who died from hypothermia in the air and in water (by 150 observations) were analyzed. Methods of descriptive statistics, calculation of the frequency ratio of signs' occurrence were used. RESULTS: The article provides quantitative assessment of occurrence (detection) rate of diagnostically significant signs established with the help of traditional methods of expert examination. A new classification of diagnostic death signs from hypothermia taking into account their differential diagnostic significance and reflecting the conditions of a person's stay in the air and water in the pre-mortem and post-mortem periods, as well as terminal period mechanisms is proposed. CONCLUSION: The established complexes of signs provide an objective basis for determining death cause in non-obvious conditions when cold exposure is expected to be one of the most damaging factors.

[Is this iatrogenic pathology or rare disease?] / Yatrogennaya patologiya ili redkaya bolezn'?

The article is devoted to the problem of diagnosis and treatment strategy of Buerger's disease rarely found in the expert and clinical practice, that is inflammatory disease of unknown etiology, affecting mainly small and medium arteries and veins of limbs. Vascular surgeons around the world have been solving this problem for many years, both in terms of timely diagnosis of this disease and its proper pathogenic treatment. The authors of the article described an expert case of Buerger's disease larvated course in 15-years-old girl, which primarily was mistakenly assessed by specialists as iatrogenic pathology of right forearm vessels in injecting aminazin solution that, according to the clinicians' opinion, led to dry gangrene formation of right wrist and its subsequent amputation. The results of the forensic histological study and retrospective analysis of all child's medical documents allowed to correctly diagnose this rare pathology but only on the stage of commission forensic medical examination in the framework of the initiated criminal proceeding against several leading medical organizations in Saint-Petersburg with a pediatric profile. The authors noted the role of routine medical manipulation in manifestation of larvated pathologic process in a teenage girl in addition to full health and well-being. The objective of present article is devoted to understanding this problem.

Traumatic axonal injury: Clinic, forensic and biomechanics perspectives.

Identification of Traumatic axonal injury (TAI) is critical in clinical practice, particularly in terms of long-term prognosis, but also for medico-legal issues, to verify whether the death or the after-effects were attributable to trauma. Multidisciplinary approaches are an undeniable asset when it comes to solving these problems. The aim of this work is therefore to list the different techniques needed to identify axonal lesions and to understand the lesion mechanisms involved in their formation. Imaging can be used to assess the consequences of trauma, to identify indirect signs of TAI, to explain the patient's initial symptoms and even to assess the patient's prognosis. Three-dimensional reconstructions of the skull can highlight fractures suggestive of trauma. Microscopic and immunohistochemical techniques are currently considered as the most reliable tools for the early identification of TAI following trauma. Finite element models use mechanical equations to predict biomechanical parameters, such as tissue stresses and strains in the brain, when subjected to external forces, such as violent impacts to the head. These parameters, which are difficult to measure experimentally, are then used to predict the risk of injury. The integration of imaging data with finite element models allows researchers to create realistic and personalized computational models by incorporating actual geometry and properties obtained from imaging techniques. The personalization of these models makes their forensic approach particularly interesting.

Atypical suicide by single incising cut to the throat without hesitation marks: Case report and review of the literature.

Several studies have been performed to recognize the main features in homicide and suicide sharp wound-related death, revealing that a single cutting wound to the neck is an infrequent event in suicide cases, and several hesitation marks near the fatal injury are usually present. We report a case of an atypical self-inflicted cutthroat injury without tentative marks involving a 79-year-old female. The weapon used, a kitchen knife, was found at the crime scene. The wound had clean margins, and no other incisions were found. Scene circumstances, namely the absence of signs of a break-in, the victim found on the bed, the knife located near the body, the vital wound in an accessible site, and the absence of defense injuries, collectively support a likely suicide. A literature review was also performed to compare forensic data of the case presented with the other 6 cases reported regarding atypical suicide characterized by a single incising cut to the throat without hesitation marks. Given the few cases reported and the lack of gross descriptions and histopathological data available in the literature, additional knowledge of such a case may help forensic pathologists in the identification of suicidal events when a single neck injury is observed. In this frame, suicide by a unique single incising cut to the throat without hesitation marks near the lethal injury may be observed as an atypical presentation, and the crime scene investigation, together with additional background information of the deceased, aid in the identification of the manner of the death.

Postmortem changes in the eye on computed tomography images.

BACKGROUND: Ocular tension decreases with increasing postmortem interval (PMI) and eyes collapse with extreme progression of postmortem change; however, time-related changes in postmortem computed tomography (PMCT) findings have not been clarified. This study aimed to quantitatively evaluate the vitreous volume and CT values of the vitreous body to clarify time-related changes in PMCT. METHODS: We retrospectively reviewed PMCT images of the eyes of subjects who underwent autopsy at our institution between July 2023 and February 2024. They were classified into four PMI groups: PMI-1: < 1 day, PMI-2: 1-2 days, PMI-3: 3-6 days, PMI-4: ≥ 7 days. The vitreous volumes and mean CT values of the vitreous chambers were measured. Additionally, the presence of intraocular gas and crystalline lens dislocation was observed. RESULTS: The PMCT images of 131 eyes of 66 patients (41 males, 25 females) were analyzed. The mean age was 63.7 (22-99) years. The volume of the vitreous cavity was significantly decreased at PMI-3 and PMI-4, which indicated scleral depression. Intraocular gas appeared in PMI-4. Lens dislocation began at PMI-3 and was more frequently observed at PMI-4 and in the higher-temperature environment group. CONCLUSION: Ocular findings on PMCT are useful for estimating the time of death.

Relationship between N-terminal pro-brain natriuretic peptide concentration and heart-type fatty acid-binding protein in postmortem urine.

The clinical use of N-terminal pro-brain natriuretic peptide (NT-proBNP) and blood concentrations of heart-type fatty acid-binding protein (HFABP) is well-established in diagnosing heart conditions. However, their applicability in forensics is controversial due to postmortem changes. NT-proBNP and HFABP are excreted in the urine due to their small molecular weights and may be found in postmortem urine samples; however, their correlation has not been evaluated. In this study, we compared the concentrations of urinary NT-proBNP and HFABP in 386 forensic autopsy cases. The urinary NT-proBNP levels were significantly higher in acute myocardial infarction (AMI), congestive heart failure (CHF), sepsis, and hyperthermia cases, with the highest levels in CHF cases. Similarly, HFABP concentration was significantly higher in CHF, sepsis, and hyperthermia cases, with the highest level observed in hyperthermia cases. However, the difference in urinary HFABP levels between the AMI and control cases was not significant. Our analysis revealed a correlation between postmortem urine NT-proBNP and HFABP levels, and the NT-proBNP/HFABP ratio was high in patients with CHF and sepsis cases and low in those with hyperthermia. The difference between the ratios was possibly due to the combined release of ventricular myocardial cells in response to ventricular wall stress and myocardial injury for NT-proBNP, as well as myocardial and skeletal muscle injuries for HFABP. This study, for the first time, demonstrates the utility of postmortem measurements of urinary NT-proBNP and HFABP levels, offering valuable insights for improving the accuracy of postmortem diagnosis in forensic medicine.

Micro-CT in a forensic examination of a fatal child abuse case: A case report.

Child abuse is a serious concern that can cause the death of a child. In such cases the medico-legal evidence is often pivotal but complex, drawing across multiple medical disciplines and techniques. One key specialism is histopathology, which is considered the gold standard for estimating the age of individual fractures. Another is micro-CT imaging, which can visualise the location of trauma across the body. This case report demonstrates how micro-CT was used to contextualise the histological evidence in the Criminal Justice Proceedings of a fatal child abuse case. This was achieved by overlaying the aged fracture evidence from histopathology onto the visuals rendered from micro-CT imaging. The case was a suspected child abuse of a deceased 1-month old infant who was reported unresponsive by their parents. The child was taken to hospital where they were pronounced dead. Suspicion was raised and post-mortem imaging confirmed head trauma and rib fractures, and the case was escalated for a forensic investigation. This case report details how the micro-CT imaging was merged with the gold standard of histopathology for visualisation of trauma, and how the court presentation was planned alongside Senior Investigating Officers and various medical experts. The presentation was used in court by the histopathologist to present the evidence. The resulting presentation provided additional clarity to jury members regarding the location, severity, frequency, and timings of the injuries. From the perspective of the investigating police force, the resulting presentation was crucial in ensuring understanding of the medico-legal evidence of how the infant died. The prosecuting lawyer noted that combining the histological and micro-CT evidence in this way allowed the evidence to be presented in a sensitive, clear, and impactful manner.

Gray-white matter contrast reversal on T1-weighted spin-echo in postmortem brain.

PURPOSE: The image contrast of postmortem magnetic resonance imaging (MRI) may differ from that of antemortem MRI because of circulator arrest, changes in postmortem tissue, and low-body-temperature scanning conditions. In fact, we have found that the signal intensity of white matter (WM) on T1-weighted spin-echo (T1WSE) images of the postmortem brain was lower than that of gray matter (GM), which resulted in image contrast reversal between GM and WM relative to the living brain. However, the reason for this phenomenon is unclear. Therefore, the aim of this study is to clarify the reason why image contrast reversal occurs between GM and WM of the postmortem brain. MATERIALS AND METHODS: Twenty-three corpses were included in the study (mean age, 60.6 years; range: 19-60 years; mean rectal temperature at scan, 6.9℃; range: 4-11℃). On a 1.5 T MRI system, postmortem T1W-SE MRI of the brain was conducted in the 23 corpses prior to medico-legal autopsy. Next, T1 and T2 of the GM and WM at the level of the basal ganglia were determined in the same participants using inversion recovery and multiple SE sequences, respectively. The proton density (PD) was also calculated from the T1 and T2 images (in the same slice). RESULTS: T1W-SE image contrast between the GM and WM of all postmortem brains was inverted relative to the living brain. T1 (579 ms in GM and 307 ms in WM) and PD (64 in GM and 44 in WM) of the postmortem brain decreased compared with the living brain. While T1 of WM/GM remained below 1 even postmortem, the PD of WM/GM decreased. T2 (110 ms in GM and 98 ms in WM) of the postmortem brain did not differ from the living brain. CONCLUSION: The decrease in PD of WM/GM in the postmortem brain may be the major driver of contrast reversal between the GM and WM relative to the living brain.

A Narrative Review on the Clinical Relevance of Imaging the Circumventricular Brain Organs and Performing Their Anatomical and Histopathological Examination in Acute and Postacute COVID-19.

ABSTRACT: Autopsy followed by histopathological examination is foundational in clinical and forensic medicine for discovering and understanding pathological changes in disease, their underlying processes, and cause of death. Imaging technology has become increasingly important for advancing clinical research and practice, given its noninvasive, in vivo and ex vivo applicability. Medical and forensic autopsy can benefit greatly from advances in imaging technology that lead toward minimally invasive, whole-brain virtual autopsy. Brain autopsy followed by histopathological examination is still the hallmark for understanding disease and a fundamental modus operandi in forensic pathology and forensic medicine, despite the fact that its practice has become progressively less frequent in medical settings. This situation is especially relevant with respect to new diseases such as COVID-19 caused by the SARS-CoV-2 virus, for which our neuroanatomical knowledge is sparse. In this narrative review, we show that ad hoc clinical autopsies and histopathological analyses combined with neuroimaging of the principal circumventricular organs are critical to gaining insight into the reconstruction of the pathophysiological mechanisms and the explanation of cause of death (ie, atrium mortis) related to the cardiovascular effects of SARS-CoV-2 infection in forensic and clinical medicine.