The role of dentistry in forensic medicine: the process of human remains identification.

The use of dentistry in forensic medicine has gradually become an indispensable tool in the process of identifying human remains. In recent years, there has been a significant increase in the importance of this field in the identification of victims in mass disasters, criminal investigations, ethnic research, and the identification of decomposed and distorted bodies, such as drowning, fire and car accident victims. Dental examinations allow for precise determination of individual identities based on unique dental features. Various methods applied in forensic medicine in the realm of dentistry include dental impressions, radiographs, photographic examinations, rugoscopy, cheiloscopy, and molecular methods. Advanced dental analysis techniques make it possible to restore identities even in the most challenging cases. Equally important is the integration of knowledge and methods of forensic dentistry with other forensic disciplines such as molecular genetics and anthropology. Further research and development in this branch of science are crucial for improving investigative processes and ensuring the dignity of mass disaster victims. The aim of this work is to present methods using teeth for the identification of human remains along with the latest advancements in forensic DNA technology, which utilizes dental evidence to aid in the identification of human remains.

Uterine rupture following prostaglandins use in second trimester medical abortion: Fact or fiction? A systematic review.

BACKGROUND: Prostaglandins (PGs) have emerged as key drugs in second trimester medical abortion (STMA) and are currently a cornerstone in obstetric practice. Nevertheless, the application of PGs, integral to labor and abortion procedures, is not risk-free, and has been associated with several complications, particularly maternal fever and uterine rupture (UR). OBJECTIVES: The main outcome of the present systematic review was to assess the safety of PGs use in STMA, particularly in scarred uterus (SC). SEARCH STRATEGY: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We performed a comprehensive systematic review by searching multiple databases, including MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database, and the research registers of Web of Science during the years 1990-2022. SELECTION CRITERIA: Only articles regarding cases of UR occurred after the use of PGs for STMA were included in the article. We excluded papers regarding UR during first trimester abortion induction of labor or pregnancy or unrelated to PGs use for STMA. Risk of bias was assessed employing a modified version of the "Newcastle-Ottawa Scale" (NOS). DATA COLLECTION AND ANALYSIS: A total of 178 studies were initially identified as potentially meeting the criteria for inclusion in the review. After full text evaluation, 110 other articles were excluded and 67 studies that suited the inclusion criteria were included. A total of 19 of the included studies were judged to have a high risk of bias. Given the heterogeneous nature of the findings, we opted for a narrative synthesis of the results. MAIN RESULTS AND CONCLUSIONS: PGs appear to be an effective pharmacologic tool for STMA; however, their use is not entirely risk-free. STMA requires well-equipped obstetric centers with skilled clinicians and surgeons prepared for emergencies. Ultrasonographic scans should be routinely performed during STMA management, since a UR can also be silent during the induction of labor. Intrapartum transabdominal, transperineal, and transvaginal ultrasound may have the diagnostic potential to early recognize this obstetric emergency, to facilitate rapid medical and surgical treatment, improving the outcome.

Diagnosing fatal drownings: A review of the postmortem findings.

The lack of drowning-specific pathological findings postmortem complicates medico-legal investigations when bodies are recovered in water. This review provides an in-depth analysis of macroscopic and microscopic findings, as well as biochemical and molecular approaches typically used to diagnose drownings. To ensure that only studies fulfilling established scientific criteria were selected to form conclusions in this review, existing literature was systematically assessed using SPICOT for evaluation of scientific evidence and risk of bias. Analysis of selected studies indicates that several pathophysiological findings following suspected drowning lack scientific evidence, while others are supported by the literature. However, the shortage of suitable controls in drowning research, specifically addressing non-drowned immersed bodies significantly limits investigations on postmortem drowning pathology, and further research is warranted.

[Strangulation]. / Strangulation.

CLINICAL PROBLEM: Detection of manual strangulation, choking and hanging, as well as the intensity of these actions, helps to clarify the course of events, to enforce the state's right to prosecute and ultimately to protect against further attacks. However, this is complicated by the scarcity of externally visible findings. STANDARD PROCEDURE TO DATE: The forensic examination of the head and neck after strangulation is carried out by means of external inspection to detect injuries and congestion above the strangulation level. Lesions below the surface of the skin, in particular of the subcutaneous fat tissue, the muscles or the laryngeal structures, usually escape the external inspection. FORENSIC RADIOLOGY AS AN IMPORTANT COMPONENT: Imaging techniques allow internal injuries to be recorded and objectified, which can be of considerable added value in the collection of evidence. Since criminal proceedings must meet the highest standards of security, high demands are placed on imaging and diagnosis. ASSESSMENT: Imaging techniques are suitable for detecting and objectifying internal injuries after a person has survived strangulation. However, their excellent reconstruction and visualization capabilities also make them a valuable addition to postmortem examinations. RECOMMENDATIONS FOR PRACTICE: After reported and survived strangulation, choking or hanging, magnetic resonance imaging (MRI) of the soft tissues of the neck should be performed as soon as possible, and if cerebral damage is suspected, the skull should also be examined. If the event was not survived, whole-body computed tomography (CT) is now standard practice at many forensic medicine institutes.

Artificial intelligence in forensic medicine and related sciences - selected issues. / Sztuczna inteligencja w medycynie sadowej i naukach pokrewnych ­ wybrane zagadnienia.

Aim: The aim of the work is to provide an overview of the potential application of artificial intelligence in forensic medicine and related sciences, and to identify concerns related to providing medico-legal opinions and legal liability in cases in which possible harm in terms of diagnosis and/or treatment is likely to occur when using an advanced system of computer-based information processing and analysis. Material and methods: The material for the study comprised scientific literature related to the issue of artificial intelligence in forensic medicine and related sciences. For this purpose, Google Scholar, PubMed and ScienceDirect databases were searched. To identify useful articles, such terms as "artificial intelligence," "deep learning," "machine learning," "forensic medicine," "legal medicine," "forensic pathology" and "medicine" were used. In some cases, articles were identified based on the semantic proximity of the introduced terms. Conclusions: Dynamic development of the computing power and the ability of artificial intelligence to analyze vast data volumes made it possible to transfer artificial intelligence methods to forensic medicine and related sciences. Artificial intelligence has numerous applications in forensic medicine and related sciences and can be helpful in thanatology, forensic traumatology, post-mortem identification examinations, as well as post-mortem microscopic and toxicological diagnostics. Analyzing the legal and medico-legal aspects, artificial intelligence in medicine should be treated as an auxiliary tool, whereas the final diagnostic and therapeutic decisions and the extent to which they are implemented should be the responsibility of humans.

Evaluation of gunshot injuries to long bones from pneumatic weapons using a human thigh model. Part I. Introduction and assumptions. Discussion of shot ballistics. Human thigh model. / Ocena uszkodzen postrzalowych kosci dlugich z broni pneumatycznej z wykorzystaniem modelu uda ludzkiego. Czesc I. Wstep i zalozenia. Omówienie balistyki srutów. Model uda ludzkiego.

Introduction: In accordance with the Polish law, pneumatic weapons are weapons that use compressed gas to set a bullet in motion and generate a discharge energy of more than 17J. In recent years, Poland has seen an increase in crimes committed with pneumatic weapons. The research aim of the present study was to measure the velocity of selected 5.5 mm and 6.35 mm caliber shot and to create a model of a human thigh using a pig femur. Material and methods: This study used Air Arms Hi-Power Xtra FAC cal. 5.5 mm and FX Bobcat Mk II cal. 6.35 mm carbines and Haendler& Natterman's Spitzkugel, Hollow Point and Baracuda cal. 5.5 mm and 6.35 mm lead shot and Excite Apollo cal. 5.5 mm and Black Max Lead-Free cal. 6.35 mm lead-free shot. The velocity of the shot at a distance of 10 m was measured and its kinetic energy was calculated; pig femurs were measured and CT imaging was performed. Results: The 5.5mm caliber shot reached velocities between 253 m/s and 278 m/s, obtaining energies between 27J and 44J. The 6.35 mm cal. shot reached velocities between 242 m/s and 254 m/s and energies between 52J and 59J. Pig femurs had an average weight of 410 g, a length of 239 mm, and a shaft diameter at mid-length of 30.6mm. The thickness of pig femur shaft walls was variable. A ballistic model of the human thigh was created using gelatin available in Poland. Conclusions: 1. The number of registered crimes with pneumatic weapons and the wide access to pneumatic devices with the possibility of design modifications justify the initiation of experimental studies on the assessment of gunshot injuries from pneumatic weapons. 2. The parameters of the shaft of a pig femur obtained from pigs weighing about 115 kg are similar to those of a human adult femur, which makes it possible to create a human thigh model. 3. Of the 5.5 mm cal. shot, the highest impact energies were generated by barracuda type shot, and of the 6.35 mm cal. shot, it was barracuda type and lead-free shot. 4. The thickness of the bony layer of the pig femur shaft is heterogeneous; the posterior wall of the shaft is the thickest, the lateral wall is the thinnest; however, it shows the greatest individual variability.

Evaluation of gunshot injuries to long bones from pneumatic weapons using a human thigh model. Part II. Presentation and discussion of the detailed results of tests of gunshots of the anterior surface of the femur with 5.5 mm and 6.35 mm caliber shot. / Ocena uszkodzen postrzalowych kosci dlugich z broni pneumatycznej z wykorzystaniem modelu uda ludzkiego. Czesc II. Wyniki szczególowe badan postrzalów przedniej powierzchni kosci udowej srutem kal. 5,5 mm i 6,35 mm wraz z ich omówieniem.

Introduction: The development of pneumatic shooting has led to the construction of technologically advanced devices with discharge energies similar to those of firearms. The pneumatic weapons ammunition market offers a variety of shot which varies in penetration properties and the extent of gunshot damage. In view of the ease of "tuning" of air rifles, a study was conducted of the inlet damage to the anterior femoral surface after pneumatic gunshots. The paper shows the differences in damage parameters depending on the type of shot. Material and methods: In the study, Air Arms Hi-Power Xtra FAC cal. 5.5 mm and FX Bobcat Mk II cal. 6.35 mm pneumatic carbines were used and lead shot by Haendler&Natterman's Spitzkugel type, Hollow Point and Baracuda cal. 5.5 mm and 6.35 mm, as well as lead-free shot Excite Apollo cal. 5.5 mm and Black Max Lead-Free cal. 6.35 mm. Measurements were taken of the extent of inlet damage to the anterior surface of the femoral shaft with X-ray and CT imaging. Results: HollowPoint shot caused the greatest range of gunshot penetration damage in both bone and periosteum, Apollo lead-free shot caused the least. At the same time, HollowPoint shot showed the greatest susceptibility to ricocheting. Conclusions: 1. The type of shot used influences diversified morphology of the holes and the nature of gunshot damage to the femoral shaft. The differences concern both the gunshot holes and the nature, course and extent of associated fractures. 2. The smallest inlet holes and damage to the periosteum with a regular shape are caused by gunshots with pointed and pointed tip pellets. The greatest extent of bone and periosteum inlet damage was observed in gunshots with Hollow Point type shot due to its predisposition to deformation and fragmentation. 3. Radio-imaging studies are a valuable complement to macroscopic visual assessment providing a useful value for identifying the type of shot used.

Hair straightener burns in children: An experimental study originating from 2 cases.

Burns in children are a topic of fundamental importance in the context of the differential diagnosis between accidental events and abuse. In this context, the present study arose from two cases of children with second-degree burns (in case 1 on the leg, in case 2 on the foot) caused by contact with the hot surfaces of a hair straightener, which were reported as accidental events but trough the complete medico-legal investigation later turned out to be abusive burns. With an experimental set on pig skin and by simulating the two anatomical districts (leg and foot), using the same type of hair straightener, injuries were caused by simulating different positions and possible variants of accidental and non-accidental occurrence. The morphology of the injuries confirmed the assessment of child abuse in both cases by "pressing" between the two hot plates of the hair straightener, with almost mirror-like injuries on the inner and outer sides of the skin. Cases of child abuse contact burns with hair straighteners have never been described in the forensic literature, but their widespread diffusion makes knowledge of the characteristics of possible injuries important.

Visual analysis of postmortem interval estimation trends and collaborative networks: a 15-year study (2006-2020).

Utilizing a visual analysis of the literature on postmortem interval (PMI) estimation indexed by Web of Science (WOS), this study investigates developmental trends and research hot points across each 5-year period from 2006 to 2020. Additionally, collaborative efforts among authors, countries, and institutions were examined. Research hot points, high-frequency keywords, authors, countries and institutions in relevant papers were analyzed using CiteSpace.5.7.R2 information visualization analysis software over the past 15 years. The literature related to PMI estimation has witnessed consistent growth over time. In the keyword co-occurrence network, several impactful terms stand out, including blowfly, mitochondrial DNA, and emerging concepts like virtual autopsy. Technological advancements, such as RNA stability analysis and virtual autopsy tools, have played a pivotal role in shaping the direction of PMI research. Scientific research institutions dominate the high-frequency affiliations within the institutional cooperative network. Additionally, the country cooperative network exhibits a trend of co-occurrence and multi-clustering. As science and technology continue to advance, traditional PMI estimation methods mature while novel interdisciplinary approaches drive innovation. By identifying emerging trends and research hotspots, this study provides a roadmap for future investigations, guiding researchers toward new opportunities in PMI estimation.

Artificial Intelligence in Forensic Sciences: A Systematic Review of Past and Current Applications and Future Perspectives.

The aim of this study is to review the available knowledge concerning the use of artificial Intelligence (AI) in general in different areas of Forensic Sciences from human identification to postmortem interval estimation and the estimation of different causes of death. This paper aims to emphasize the different uses of AI, especially in Forensic Medicine, and elucidate its technical part. This will be achieved through an explanation of different technologies that have been so far employed and through new ideas that may contribute as a first step to the adoption of new practices and to the development of new technologies. A systematic literature search was performed in accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the PubMed Database and Cochrane Central Library. Neither time nor regional constrictions were adopted, and all the included papers were written in English. Terms used were MACHINE AND LEARNING AND FORENSIC AND PATHOLOGY and ARTIFICIAL AND INTELIGENCE AND FORENSIC AND PATHOLOGY. Quality control was performed using the Joanna Briggs Institute critical appraisal tools. A search of 224 articles was performed. Seven more articles were extracted from the references of the initial selection. After excluding all non-relevant articles, the remaining 45 articles were thoroughly reviewed through the whole text. A final number of 33 papers were identified as relevant to the subject, in accordance with the criteria previously established. It must be clear that AI is not meant to replace forensic experts but to assist them in their everyday work life.

The smallest traces of crime: Trace elements in forensic science.

BACKGROUND: Securing the evidence in various investigative situations is often associated with trace analysis, including fingerprints or blood groups. However, when classic and conventional methods fail, trace elements, such as copper, zinc, fluorine, and many others found in exceedingly insignificant amounts in organisms, may prove useful and effective. METHODS: The presented work reviews articles published between 2003 and 2023, describing the use of trace elements and the analytical methods employed for their analysis in forensic medicine and related sciences. RESULTS & CONCLUSION: Trace elements can be valuable as traces collected at crime scenes and during corpse examination, aiding in determining characteristics like the sex or age of the deceased. Additionally, trace elements levels in the body can serve as alcohol or drug poisoning markers. In traumatology, trace elements enable the identification of various instruments and the injuries caused by their use.

An Unusual Hunting Accident: A Case Report.

In Hungary, possessing certain weapons (e.g. firearms, bows, air pistols, and air guns mainly over 7.5 Joule muzzle velocity) is strictly regulated. In case of firearm deaths, in our country, we usually have to consider the role of military personnel or a hunter. Getting a game license for five years is a complex procedure. Class participation in weapon training, hunter ethics, and rules, first aid, manners of hunting, wild animals' knowledge, wildlife management, game laws, etc. is compulsory besides a prosperous exam at the Hunt Authority. A psychological license is also mandatory. Through permission from the police for a firearm license, buying weapons for hunting is possible. The storage of firearms and cartridges is rigidly controlled and checked. Some special types of hunting (e.g. with a bow, bird of prey) require additional licenses. The fact and the duration of the hunt and all shoots should be registered. The authors report an extraordinary fatal hunting accident because of non-regulation rifle (Blaser R8 338) use (unintentional shot), in which the travel distance of the projectile was more than 2000 m and the victim suffered fatal injuries at his daughter's homeyard. This was a non-target, extreme long-range shot. The ethical range in hunting is within 150 m, a practiced hunter with proper precision tools can shoot accurately within 300-400 m and in extremely rare cases within 700-800 m. Military snipers can operate over a 1000 m distance. Even if this was a targeted shot (with a 2161 m range), not many professionals would have been able to aim at the target. A sequence of accidents was necessary for this fatal case. With the application of X-ray examination and a special layer-by-layer method of forensic autopsy, the bullet, the entry wound, the primary shot channel, and lethal injuries have been revealed. With the help of the found projectile and the rigorous hunting regulations, the alleged perpetrator was identified within a short time.

Detection of substance use in clinical forensic cases: urine analysis of victims and perpetrators.

This study investigates the prevalence of substance use among victims and perpetrators involved in clinical forensic cases. Urine samples from 455 individuals aged 18 and above, collected in 2019, were analyzed using two LC-MS-based analytical methods and an HS-GC-FID method for the most frequently reported substances of abuse and medication. Data from case documents, encompassing gender, age, and the individual's role, were recorded in a database. Both the urine samples and the information from case documents were fully anonymized. The most frequently detected substance was alcohol (37% of all cases), followed by cannabis (22% of all cases) and central nervous system stimulants (24% of all cases). Other classes of substances detected included benzodiazepines, anabolic steroids, antipsychotic agents, and antidepressants. No drugs or alcohol were detected in 32% of the victims and 19% of the perpetrators. The study also examines the interrelationship of drug patterns between victims and perpetrators, and results show that both parties were influenced by substances at the time of the incident. Furthermore, there was a significant difference in the use of substances between perpetrators of blunt and sharp force cases and perpetrators in cases of sexual assault. Timely sample collection and a structured toxicological analysis of both victims and perpetrators in the same case are vital in clinical forensic cases to enhance comprehension of the connection between criminal activities and substance use. This understanding enables the development of prevention strategies at an informed level.

[Forensic radiology : Introduction and overview]. / Forensische Radiologie : Einführung und Übersicht.

BACKGROUND: In forensic medicine, documentation of findings is essential. During an autopsy, this is usually achieved by photography. However, there are numerous injuries that remain undetected even during a classic autopsy. In recent years, the importance of forensic radiology has grown in many countries to improve the documentation of findings and to increase the quality of post-mortem examinations. METHODS: While many methods, such as conventional X­rays or computed tomography, can be transferred quite easily to the post-mortem field, there are other methods that are more difficult to adapt. For example, performing a post-mortem angiography requires a specific concept that allows the vascular system to be filled and a contrast agent to circulate. Performing post-mortem magnetic resonance imaging is also a challenge, as image contrast depends on the temperature of the body being examined. When applying forensic radiology on living persons in the field of "clinical forensic medicine", there are further elements to consider. In particular, the question arises if radiological methods are acceptable for purely forensic medical purposes without a clinical indication. CONCLUSION: This overview article is intended to explain the various methods of forensic radiology, their areas of application, and their advantages and disadvantages. It also describes important historical developments in the use of forensic radiology and its current spread in German-speaking countries as well as current and future developments. Thanks to this information and a summarizing overview table, clear indications and recommendations for the use of forensic radiology in practice can be obtained.

Patterns in paternal and maternal filicide: A comparative analysis of filicide cases in Turkey.

Filicide is the act of a parent killing their own offspring. Previous studies indicate that there are both commonalities and distinctions between filicides committed by mothers and fathers. The main objective of this study was to compare maternal and paternal filicide with a major focus on clinical and sociodemographic features of perpetrators, incident details, and victims. Filicide cases were examined at the bedded unit of the Expertise Department of Observation of the Council of Forensic Medicine that were referred by the Turkish Ministry of Justice. A total of 51 perpetrators and 57 victims were analyzed from June 2014 to December 2023. The perpetrators were daily face-to-face interviewed by psychiatry and forensic medicine physicians. There were significant differences in sociodemographic characteristics and psychiatric conditions between maternal and paternal cases. Female perpetrators tended to be younger, unemployed, mostly targeted younger victims and used asphyxiation to kill, whereas males tended to target older victims and utilized firearms. The most common primary cause of filicide in maternal cases was "unwanted pregnancy," whereas "spousal revenge" and "anger or impulsivity" were predominant in paternal filicides. All perpetrators who were not criminally responsible were mothers, mostly diagnosed with psychotic depression. Unwanted pregnancy, psychotic depression, and postpartum psychosis should be assessed when evaluating risk for mothers, especially for infanticide. The desire for revenge on a spouse, often seen with personality disorders, impulsivity and anger, access to firearms should be screened for risk of paternal filicide, particularly in older victims. Early recognition of these factors can help in implementing prevention strategies.

[Blunt force trauma in forensic radiology]. / Stumpfe Gewalt in der forensischen Radiologie.

OBJECTIVE: Description of the main forensic radiological examination modalities and findings in blunt force trauma in living and deceased adults. METHODS: Elaboration of the essential points based on the authors' own experiences and relevant literature. RESULTS AND CONCLUSION: Injury-related consequences of blunt force are frequently observed in forensic radiological diagnostics, especially in the context of accidents and suicides, and less frequently in homicides. The method of choice for radiological imaging of blunt force in deceased persons is native postmortem computed tomography (PMCT). In principle, the radiological effects of blunt force in PMCT do not differ significantly from those in living persons. Postmortem magnetic resonance imaging (PMMRI) is very suitable for imaging blunt soft tissue injuries in the shorter postmortem interval. In the case of living individuals with the consequences of blunt force trauma, imaging is primarily indicated for clinical diagnostic reasons. Common indications are domestic violence, violence against the elderly, and disputes in public spaces. The choice of radiological examination method depends on the clinical history and symptoms, and the radiological examinations can be subjected to a forensic assessment.

A Case of Accidental Autoerotic Death by Hanging Linked to Erotic Photography.

Autoerotic death, as a subtype of mechanical asphyxia, refers to a person's fatal outcome while engaging in solitary sexual activity using various devices and methods to reduce oxygen supply and induce cerebral hypoxia, leading to increased sexual gratification. These asphyxial deaths are accidental and sporadic. In cases of sexual asphyxia, especially when strangulation methods such as hanging or ligature are used, thorough crime scene investigation is crucial to determine the type of asphyxia and the manner of death. Inadequate information about specific crime scene findings can lead to significant errors in determining the manner of death and the type of strangulation, potentially leading to cases being mistaken for ligature strangulation in a homicidal manner or hanging in a suicidal manner.

Clinical forensic medicine in emergency departments: a pilot study of a forensic training and evaluation of its effectiveness in an Italian hospital.

Because emergency departments are often the first point of contact for victims of violence, it is critical to provide the appropriate treatment in compliance with all necessary medicolegal precautions. For this reason, a randomized controlled trial was conducted at the Policlinico Hospital of Milan (Italy) in which an intervention group (12 physicians) received a 6-h course on clinical forensic medicine and their performance in medicolegal procedures in claimed cases of violence was compared with that of a control group (13 physicians) by means of a 16-item assessment scale over the 3 months before and the 3 months after the course. Overall, 195 medical records were included in the statistical analysis. Out of these cases, 105 occurred before the course (60 analyzed by the control group and 45 by the intervention group) and 90 occurred after the course (45 analyzed by the control group and 45 by the intervention group). The results showed that the overall mean score of physicians who participated to the course increased from 14.0 (IQR 7.0) to 19.0 (IQR 8.0) with a p-value < 0.0001 and that the comparison between the intervention group and the control group after the course was 19.0 (IQR = 8.0) and 14.0 (IQR = 7.0), respectively, with a p-value < 0.0001. The improvement was very little and below the expectations pointing out that educational courses, although they can be a first step towards raising the ED physicians' awareness of clinical forensics, may not be enough and that more structured training and new strategies should be implemented.

Avalanche fatalities in Czech Republic: a 23-years retrospective study.

Avalanche fatalities are quite rare in the Czech Republic. Due to the presence of avalanche fields in the two Czech mountains, forensic pathologists at some forensic medicine departments may encounter this specific mechanism of accidental death. The authors summarize medicolegal aspects of deaths in avalanches in the territory of the Czech Republic for the twenty-three-year period between 1993-2015. Ten avalanche fatalities were recorded during study period. The studied group consisted of nine male and one female victims. The average age of the deceased was 27.9 years. Skiers or ski-alpinists died in the avalanche in five cases (50%), climbers in two cases (20%), snowboarders in one case (10%), cross-country skiers in one case (10%) and in one case it was a fatality of child playing on a snowy hill (10%). The cause of death was suffocation in four cases (40%), blunt trauma in four cases (40%), and in the remaining two cases it was the survival of trapped persons several hours after being rescued from the avalanche in the hospital; both victims subsequently died as a result of prolonged shock (20%) due to a combination of prolonged suffocation and hypothermia. The time interval from the fall of the avalanche to the rescue of the trapped person was in the range of minutes to 3 hours. The presence of alcohol or drugs was not detected in any studied case.

Accident or abuse? Differential diagnosis of contact burns from radiators/heaters in children.

Contact burns in children are not uncommon and are often due to accidental contact. Medico-legal assessment is of paramount importance in these contexts to identify cases of abuse. In three cases of burns caused by contact with radiators or a portable heater -two accidental and one deliberate- thorough medico-legal assessment, combined with on-site event reconstruction, enabled accurate diagnoses. Accidental burns displayed a 'pattern' compatible with the incandescent instrument but were more irregular, with different depths and in different parts of the body. In contrast, intentional burns were uniform in depth, distribution and localisation, inconsistent with accidental events. In this context, the on-site inspection and direct evaluation of the objects involved were crucial in the medico-legal assessment. These are indispensable elements for a thorough analysis and abuse recognition.