A Case Report and Literature Review of Death by Potassium Chloride: Is it a Forensic Medicine Enigma?

The diagnosis of death from potassium chloride (KCl) injection is complex because it is a natural ion, so it is very difficult to trace the exogenous administration of drugs containing potassium. In these cases, it is important to perform a careful cadaver inspection, with the collection of circumstantial data on the scene, and proper autopsy investigations, in order to avoid errors regarding the reconstruction of the cause of death. The aim of this paper is to propose a forensic protocol, including evidence collected from the literature, that could help the medical examiner to perform the correct diagnosis, and also encourage control measures to avoid similar events, especially in nosocomial environments. This is important, especially for health professionals who can easily access drugs containing potassium. For this reason, we need to strengthen control measures of these drugs by proposing a double check in cases of pharmacological use, specifying the volume taken with a double authorization signature and the reasons for the withdrawal.

A Multidisciplinary Approach to a Complex Fatal Attack Due to a Pack of Maremma Sheepdogs: Is It Always an Accident?

Deaths due to dog attacks are a worldwide issue. Fatal dog attacks may occur in various environments, including the dog owner's property. A lot of difficulties emerge when the attack involves a pack of dogs, of different species and sizes. In this case, it becomes much more difficult for forensic investigators to evaluate the event, especially regarding the identification of the dog or dogs that caused the death as well as the identification of the owner and the reconstruction of the dynamics for forensic purposes. In this paper, we analyze a specific case of an attack by a herd of Maremma sheepdogs. A crime scene investigation has been carried out. In the first phase of this case, the victim interacted with dogs that had non-aggressive attitudes. Then, after an escape attempt, she was assaulted by about 20 Maremma dogs of different sizes, leading to multiple injuries all over her body. The greatest difficulty was precisely that of reconstructing the dynamics due to the numerous injuries and dogs involved in the attack. The dynamics were divided into several stages following the analysis of the injuries found on the victim. This case study highlights how the forensic multidisciplinary approach has made it possible to precisely reconstruct the event. The analysis of the dogs' state of malnutrition and their suddenly aggressive attitude towards the victim revealed profiles of responsibility of the owner attributable to improper management and training of the animals to defend their property.

The Risk of Suicide in the Post-COVID-19 Emergency Era: Psychological and Forensic Implications.

The emergence of the coronavirus disease 2019 (COVID-19) pandemic brought numerous challenges, including the management of psychological and psychiatric disorders, leading to an increased risk of suicide. At the end of the COVID-19 emergency, we wonder what the impact of the pandemic has been, and still is, on the state of public mental health with respect to the phenomenon of suicide. Therefore, this review aims to explore the psychological and forensic aspects of suicide in the post-COVID-19 emergency era. The paper will delve into the various psychiatric disorders associated in the literature with COVID-19, the risk factors for suicide during the pandemic, and measures that can be taken to prevent suicide in the post-COVID-19 era. Additionally, the paper will look at how forensic experts investigate suicide cases due to COVID-19 and the legal implications of suicide due to the pandemic. The findings of this study will provide insights into the psychological and forensic aspects of suicide in the post-COVID era, and emphasize interventions and policy development to address this growing public health concern.

Reconstruction of Trauma Dynamics Due to Ligature Strangulation by Using a Dynamometer: A Technical Report.

Asphyxiation caused by violence, particularly through ligature strangulation, necessitates the application of a force that is characterized by a point of application, direction, and intensity. These properties can be quantified through the use of a dynamometer, which is composed of a graduated scale and a spring. In this particular study, an experimental model utilizing a dynamometer was employed to aid in the diagnosis and analysis of the dynamics of violent trauma resulting from homicidal ligature strangulation. The experimental model was applied to an attempted murder case involving strangulation. The primary challenge in this case was to establish the attempted murder scientifically, as the offender claimed that there had been no intent to kill, but instead an attempt to frighten the victim. To prove his assertion, the assailant emphasized the absence of strangulation injuries on the victim's neck. To investigate, a crane scale dynamometer was fixed on a cable and placed on a manikin's neck. The potential measurable combinations with the dynamometer were then compared to witness accounts and the injuries found on the victim. The utilization of a dynamometer in our case permitted the diagnosis and verification of a trauma that was undoubtedly caused by violent asphyxiation via strangulation. The information yielded by the dynamometer was subsequently submitted as scientific evidence in Court, serving to substantiate the intent to commit homicide and substantiate the credibility of the victim's testimony.

Sudden Death of a Young Man Due to Massive Haemoptysis Associated With Pulmonary Tuberculosis: A Rare Case.

Asphyxia includes a large number of possible causes and mechanisms, such as infectious diseases of the lungs. Among these, tuberculosis (TB) is one of the main infectious causes of death worldwide. The burden of TB is very high, by virtue of antibiotic resistance and the risk of other concomitant infections, such as HIV. A major problem is related to the omitted diagnosis of TB infection which, in some cases, may remain completely unknown to the patient, with a significant increase in mortality and morbidity risk. There has been a decrease in the reported cases of sudden death due to TB, especially that associated with hemoptysis and aspiration of blood. In this report, we describe a case of sudden death that occurred in a young male in the workplace, under unclear circumstances. The autopsy detected acute asphyxia due to a massive pulmonary hemorrhage in the individual, who was apparently suffering from TB. The autopsy proved to be essential for understanding the cause of death and investigating the adequacy of the health surveillance measures carried out on the individual.

Clinical and Forensic Investigation Protocols for Diagnosing Abusive Head Trauma: A Literature Review.

Abusive head trauma (AHT) represents a very serious global public health problem. Prevention of these episodes is essential to reduce the morbidity and mortality of this phenomenon. All healthcare professionals should be able to recognize the signs of abuse. However, diagnosis is very complex as the signs are often blurred and cannot be recognized with certainty without carrying out adequate instrumental investigations. It has been calculated that approximately one-third of AHT cases remain undetected and require more than one medical visit to be correctly interpreted and diagnosed. On the other hand, the literature has recently also emphasized the problems related to possible false diagnoses of abuse and the numerous family and personal repercussions that follow from this issue. For these reasons, correct and timely recognition is essential to avoid the risk of recurrence of AHT and to start proper forensic investigations, in order to identify the offender or exonerate a suspect. The present work explores the most recent evidence of recent years in the field of AHT diagnostics through a literature review. The purpose of this article is to provide forensic pathologists with clear tools for diagnosis based on the literature. To this end, the review suggests clinical and forensic protocols aimed at the timely diagnosis of AHT in order to prevent abuse from remaining undetected.

Unexplained and Unexpected Pediatric Deaths: Forensic Review and New Perspectives.

Unexplained and unexpected pediatric deaths are a major challenge in global healthcare. The role of the forensic pathologist is crucial in determining the cause and manner of death in these cases, although to date, there are many limitations in post-mortem diagnosis. The role of the autopsy and related forensic investigations become a fundamental tool to investigate and give an explanation for an unacceptable event, considering the young age of the victims. From this point of view, even today, it is necessary that this phenomenon is correctly recorded through standardized systems and universally accepted methods. Furthermore, it is essential that scientific research on this topic is increased through the implementation of universally accepted operating protocols recognizing real risk factors in order to prevent such events. The purpose of the study is to offer a review of the state of the art about unexplained pediatric death and, above all, to propose an international reporting platform, extending proper investigations not only to judicial cases but also to all the other cases of unexpected pediatric death.

Exploring the Potential of Proteome Analysis as a Promising Tool for Evaluation of Sudden Cardiac Death (SCD) in Forensic Settings: A Literature Review.

Sudden cardiac death (SCD) represents a global emergency, with a high number of cases affecting all age groups every year. The prevention of these fatal events requires an accurate knowledge of etiology and pathogenesis, which can vary. Autopsy is an indispensable tool in cases of SCD for diagnostic purposes, as well as for judicial and preventive purposes for family members. Despite the completion of all routine post-mortem investigations, it is often complicated for the forensic pathologist to define the triggering cause of these events. The study of the proteome is proving to be extremely promising in the field of human cardiovascular disease. This paper aims to offer a literature review on the study of the proteome in post-mortem cadaveric biological samples obtained from SCD cases. The aim of this work is to outline the state of the art of the scientific advances that protein analysis can offer in the diagnosis of SCD and the limits that various studies have traced up to now. In conclusion, the work defines the future perspectives of this field in SCD, suggesting strategies to overcome the reported limits and improve the diagnostics of these events.

The Role of Autopsy and Post-Mortem Investigations in Falling Traumas in the Hospital Environment.

Falls in a hospital setting are a global public health problem. Despite the production of sensors and various preventive tools to reduce the risk, falls remain a dangerous event with a significant impact on the morbidity and mortality of patients. Despite numerous prevention strategies, falling in the hospital are not always investigated and the autopsy is not always performed in these cases, so it is often not known whether the death is related to the fall or to other causes, inevitably affecting the assessment of any profiles of medical liability for health personnel or for the hospital in the accident. We describe three cases of falls that occurred in different hospitals, in which the autopsy allowed to diagnose with certainty the extent of the trauma and to reconstruct its dynamics. Along with the circumstantial and documentary analyses, deficiencies both in the trauma diagnostics and in the application of the safety measures on the patients were showed. Together with the description of our cases, we propose the post-mortem investigations of these events, both for judicial and risk management purposes.