Matricide and psychiatric evaluation: An update.

Matricide is an infrequent crime that has often raised to the suspicion that the offender could suffer from a pathological mental status. Although it is hard to establish a relationship between mental disorders and specific forms of homicide, several studies suggest that matricide offender frequently suffers from schizophrenia or other psychotic disorders. Aim of the study was to review the literature in order to explore epidemiologic and psychiatric characteristics of matricide offenders with a focus on the cause of death and crime circumstances. According to the PRISMA statement, 16 out of 225 studies were included. Main findings were the following: 80 victims were reported in total, killed by 81 offenders. In one case two brothers were responsible for the matricide. 81.5% of the offenders were young males. The most represented psychiatric pattern of the offenders was schizophrenia and psychotic disorders (43.2%). 6.2% of victims had also psychiatric disorders. Sharp force injuries were the first cause of death (55%), followed by blunt trauma (15%) and asphyxia (15%). In 12% of cases overkilling was also reported. 13.6% of offenders were considered not guilty for reason of insanity while 25.9% of the offenders had diminished criminal responsibility. A case study of a young homicide offender suffering from personality disorder is reported. In this case the victim also suffered from psychiatric disorders and an overkilling occurred as she was stabbed multiple times post-mortem. In a second case of matricide, the victim was dismembered and the human remains were concealed in several plastic bags.

Hypoplastic Left Heart Syndrome: About a Postnatal Death.

BACKGROUND: Hypoplastic left heart syndrome (HLHS) is a congenital heart disease that is associated with high mortality rates in the early neonatal period and during surgical treatments. This is mainly due to missed prenatal diagnosis, delayed diagnostic suspicion, and consequent unsuccessful therapeutic intervention. CASE REPORT: twenty-six hours after birth, a female newborn died of severe respiratory failure. No cardiac abnormalities and no genetic diseases had been evidenced or documented during intrauterine life. The case became of medico-legal concern for the assessment of alleged medical malpractice. Therefore, a forensic autopsy was performed. RESULTS: the macroscopic study of the heart revealed the hypoplasia of the left cardiac cavities with the left ventricle (LV) reduced to a slot and a right ventricular cavity that simulated the presence of a single and unique ventricular chamber. The predominance of the left heart was evident. CONCLUSIONS: HLHS is a rare condition that is incompatible with life, with very high mortality from cardiorespiratory insufficiency that occurs soon after birth. The prompt diagnosis of HLHS during pregnancy is crucial in managing the disease with surgery.

MALDI-TOF Mass Spectrometry Analysis and Human Post-Mortem Microbial Community: A Pilot Study.

Introduction: The human post-mortem microbiome (HPM) plays a major role in the decomposition process. Successional changes in post-mortem bacterial communities have been recently demonstrated using high throughput metagenomic sequencing techniques, showing great potential as a post-mortem interval (PMI) predictor. The aim of this study is to verify the application of the mass spectrometry technique, better known as MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry), as a cheap and quick method for microbe taxonomic identification and for studying the PM microbiome. Methods: The study was carried out on 18 human bodies, ranging from 4 months to 82 years old and with a PMI range from 24 h up to 15 days. The storage time interval in the coolers was included in the final PMI estimates. Using the PMI, the sample study was divided into three main groups: seven cases with a PMI < 72 h; six cases with a PMI of 72−168 h and five cases with a PMI > 168 h. For each body, microbiological swabs were sampled from five external anatomical sites (eyes, ears, nose, mouth, and rectum) and four internal organs (brain, spleen, liver, and heart). Results: The HPM became increasingly different from the starting communities over time in the internal organs as well as at skin sites; the HPM microbiome was mostly dominated by Firmicutes and Proteobacteria phyla; and a PM microbial turnover existed during decomposition, evolving with the PMI. Conclusions: MALDI-TOF is a promising method for PMI estimation, given its sample handling, good reproducibility, and high speed and throughput. Although several intrinsic and extrinsic factors can affect the structure of the HPM, MALDI-TOF can detect the overall microbial community turnover of most prevalent phyla during decomposition. Limitations are mainly related to its sensitivity due to the culture-dependent method and bias in the identification of new isolates.

A Clue on the Skin: A Systematic Review on Immunohistochemical Analyses of the Ligature Mark.

BACKGROUND: A ligature mark is a common injury in cases of hanging or strangulation. Estimation of age and vitality of the ligature mark can be crucial for differentiating antemortem and postmortem wounds and to distinguish between simulated suicidal hanging or accidental strangulation to conceal a crime and not simulated events. The immunohistochemistry has been recommended by several Authors as a reliable tool to determine whether an injury was sustained during life or not. Unfortunately, no general agreement on the immunohistochemical markers to be used has been found among the scientific community. The aim of the study was to detect the type and function of the immunohistochemical markers useful in the assessment of the vitality and age of the ligature marks for routine diagnostics. METHODS: Papers available on Pubmed, Scopus, and Web of Science were reviewed according to the PRISMA statement. RESULTS: Only eight papers satisfied all the following inclusion criteria: full texts in English dealing with human ligature marks and immunohistochemistry published on impacted or indexed scientific journals. CONCLUSIONS: The assessment of the vitality of a ligature mark is still a challenging topic in forensic science. Under ideal conditions and in compliance with autopsy protocols, the diagnosis of death by hanging or strangulation on fresh bodies can be better supported by autopsy findings other than a ligature mark. The validation of immunohistochemical markers on large series could be of help in doubtful cases and differential diagnoses.

Electrocution Stigmas in Organ Damage: The Pathological Marks.

BACKGROUND: Diagnostic criteria for electrocution related death are still a challenge in forensic pathology and it seems that the electrical mark is the only reliable evidence. METHODS: A comparison of histological and morphological findings of skin and internal organs from an autopsy series of electrocution deaths with those mostly reported in literature as representative for electrocution. RESULTS: The morphological changes of heart, brain and other main internal organs are still unspecific. Organ's damage observed in electrocution deaths shows a wide variability, not reliable for a certain diagnosis of electrocution. The electrical mark is still the golden standard for diagnosis of electrocution. CONCLUSIONS: In electrocution related deaths, pathological findings of the main internal organs are not enough evidence to support with certainty a post-mortem diagnosis that a victim suffered an electrical damage. Although the organ histological changes are undoubtedly the starting point for a better understanding of the fatal even, the diagnosis of death from electrical damage is still a dark and unsolved chapter. The electrical mark still represents a fundamental indicator above all in the medical-legal field, but the identification of pathognomonic elements and signs not limited to the skin alone could be a valid help in the future, especially in unclear cases.

A Descriptive Study on Causes of Death in Hospitalized Patients in an Acute General Hospital of Southern Italy during the Lockdown due to Covid-19 Outbreak.

(1) Background: All deaths that occurred in a hospital of Southern Italy ("San Giuseppe Moscati" Hospital of Avellino) with medium jurisdiction (up to 425,000 citizens approximately) in the period from 9 March to 4 May 2020 were analyzed. The primary endpoint of the study was to analyze the causes of death in the period study. Secondary endpoints included: (1) the assessment of overall mortality in the emergency period compared with the same period of the past years (2018-2019) in the jurisdiction area; (2) the assessment of the amounts of deaths with positive and negative reverse transcription-polymerase chain reaction (RT-PCR) of nasopharyngeal and oropharyngeal swabs; (3) the frequency of clinical and radiological features consistent with Covid-19 infection in negative RT-PCR cases. (2) Methods: Patients' information and laboratory data were collected through the computerized medical record system (My Hospital, Italy) used for the clinical management of all referring patients. Epidemiological, clinical, and radiological data were reviewed along with the results of nasopharyngeal and oropharyngeal swabs. (3) Results: From 9 March to 4 May 2020, 140 deaths (87 males, 53 females) from all causes occurred in total at "San Giuseppe Moscati" Hospital, of which 32 deaths were Covid-19 related. (4) Conclusions: The excess of mortality could be higher than the one reported in the official epidemiological surveys. False negative cases can have a distorting effect on the assessment of the real mortality rate and the excess mortality. Furthermore, many who died from Covid-19 were likely never tested or they had false negative RT-PCR results. Other victims probably died from causes indirectly related to Covid-19.

Isolated Right Atrial Rupture From Blunt Chest Trauma in Motor Vehicle Collisions: Mechanisms of Injury and Outcomes.

ABSTRACT: Isolated right atrial rupture after nonpenetrating blunt chest trauma is rare, and very few cases have been reported in the literature. Isolated right atrial rupture is a diagnostic challenge in these patients, who are mostly victims of motor vehicle collisions. The clinical presentation is heterogeneous and can vary depending on rupture location and size. The anatomical sites mostly involved are the appendage and the free wall followed by the superior and inferior vena cava junctions. The present case study shows a fatal isolated rupture of the right atrial appendage in a victim of a motor vehicle collision. At the emergency room, a computed tomography scan revealed a severe pericardial blood effusion, and pericardiocentesis was promptly performed. Unfortunately, the patient suddenly worsened just before cardiac surgery. Autopsy findings showed a cardiac tamponade due to a linear laceration 1.8 cm in length on the right atrial appendage. No other relevant injuries were observed. A prompt diagnosis of isolated right atrial rupture can be crucial for victims of blunt chest trauma with unexplained hypotension or hemodynamic instability to improve their chances of survival. Medicolegal issues can be raised mainly related to delayed diagnosis. Once a cardiac rupture is suspected, the injury repair is essential to achieve the best outcome.

Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review.

Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake's size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake's mouth and victim's skin, age of the victim, weight, health status, and victim's activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.