Fatal bowel perforation caused by ingestion of high-powered magnets in a 6-year-old boy.

Foreign body ingestion in children is a frequent cause for medical consultation. Although most foreign bodies are spontaneously eliminated from the gastrointestinal tract, life-threatening complications such as gastrointestinal obstruction or perforation can occur. We report the case of a 6-year-old boy who died 2 days after the onset of nausea and abdominal pain, with no foreign body ingestion witnessed or reported in the previous days. Autopsy showed a diffuse peritonitis and a perforation of the transverse colon caused by three high-powered magnets stacked together, and attached to the outer stomach wall via a fourth magnet located in the stomach. The cause of death was peritonitis due to bowel perforation by ingested magnets, which were shown to have come from a toy belonging to the child. Ingestion of multiple high-powered magnets carries a high risk of gastrointestinal complications and can exceptionally have a fatal outcome, especially as it often goes unreported and causes non-specific gastrointestinal symptoms that can delay diagnosis and management. This case highlights the need to raise public awareness of the potential risks of ingesting such magnets and to strengthen safety standards to protect children from this serious health hazard.

Age assessment in unaccompanied minors: assessing uniformity of protocols across Europe.

Age assessment of migrants is crucial, particularly for unaccompanied foreign minors, a population facing legal, social, and humanitarian challenges. Despite existing guidelines, there is no unified protocol in Europe for age assessment.The Forensic Anthropology Society of Europe (FASE) conducted a comprehensive questionnaire to understand age estimation practices in Europe. The questionnaire had sections focusing on the professional background of respondents, annual assessment numbers, requesting parties and reasons, types of examinations conducted (e.g., physical, radiological), followed protocols, age estimation methods, and questions on how age estimates are reported.The questionnaire's findings reveal extensive engagement of the forensic community in age assessment in the living, emphasizing multidisciplinary approaches. However, there seems to be an incomplete appreciation of AGFAD guidelines. Commonalities exist in examination methodologies and imaging tests. However, discrepancies emerged among respondents regarding sexual maturity assessment and reporting assessment results. Given the increasing importance of age assessment, especially for migrant child protection, the study stresses the need for a unified protocol across European countries. This can only be achieved if EU Member States wholeheartedly embrace the fundamental principles outlined in EU Directives and conduct medical age assessments aligned with recognized standards such as the AGFAD guidelines.

Influence of the toxicological status on the diagnosis of fatal drowning.

Drowning is the leading cause of death by accident of everyday life in people under 25 years of age. Xenobiotics are frequently involved in drowning cases but their influence on the diagnosis of fatal drowning has not been studied so far. This preliminary study aimed to assess the influence of an alcohol and/or a drug intoxication on the autopsy signs of drowning, and on the results of diatom analyses in drowning deaths. Twenty-eight autopsy cases of drowning including 19 freshwater drownings, 6 seawater drownings, and 3 brackish water drownings were prospectively included. Toxicological and diatom tests were performed in each case. The influence of alcohol and other xenobiotics on drowning signs and diatom analyses was assessed separately then in combination through a global toxicological participation score (GTPS). Diatom analyses showed positive results in lung tissue in every case. No significant association was found between the degree of intoxication and the diatom concentration in the organs, even after considering freshwater drowning cases only. The vast majority of the traditional autopsy signs of drowning were not significantly affected by the individual toxicological status either, with the exception of lung weight which tended to raise in case of intoxication, probably due to the pulmonary edema and congestion increase. Further research on larger autopsy samples is needed to confirm the results of this exploratory study.

Forensic age assessments of alleged unaccompanied minors at the Medicolegal Institute of Montpellier: a 4-year retrospective study.

BACKGROUND: As many other European countries, France has to deal with a growing number of migrants including some who contend age minority entitling them to benefits and privileges reserved for children within the context of legal proceedings. In case of doubtful minority, medical examinations may be carried out to assess skeletal and dental age. Our objective was to analyse the age assessments regarding individuals of doubtful minority assertion at the Medico-legal Institute of the University Hospital of Montpellier since 2018. METHODS: Expert reports of forensic age assessments performed during the 2018-2021 period were reviewed. Demographic data and results from medical and radiological investigations based on AGFAD recommendations were recorded in each case. When available, conclusions of judicial investigations about the individuals' actual age were collected. RESULTS: A total of 265 reports were compiled. Age assessments predominantly concerned males (97.7%) and the main reported country of origin was sub-Saharan Africa (80.4%). The mean reported age was 16.3 ± 0.8 years. The individual's stated age was compatible with the age assessment in 31 cases (11.7%), while expert reports concluded that the age of majority had been reached in 131 cases (49.4%). In cases of discrepancies, the average difference between the stated and the assessed lowest possible age (= assessed minimum age) was 2.7 ± 2.3 years and 6.9 ± 3.8 years between the stated and the most probable age. Age assessments could be compared with actual ages determined by court proceedings in 27 cases, with established ages being systematically higher than the assessed minimum ages (mean difference = 4.4 ± 4.0 years). The difference between actual and stated ages ranged from 1.8 up to 18.9 years (mean difference = 6.4 ± 4.0 years). The used protocol never led to any age overestimation in this population. CONCLUSION: Our study reinforces the relevance of AGFAD recommendations for forensic age assessment and calls for the harmonization of practices based on this methodology in the European countries.

[Forensic autopsies and pathological examination: Current practice in Montpellier's jurisdiction. A retrospective study of 630 autopsies]. / Autopsies judiciaires et expertises anatomopathologiques complémentaires : état des pratiques sur le ressort de la cour d'appel de Montpellier. Étude rétrospective de 630 autopsies.

INTRODUCTION: In France, pathological examination is not systematically required in forensic autopsies. The factors affecting the decision to carry out a pathological expertise have not yet been defined. The aim of this study was to describe in which conditions a pathological expertise was required after forensic autopsy by the high court of Montpellier. METHODS: This study included and analyzed retrospectively all of the autopsy elements, of all forensic autopsies carried out over a year. These elements were classified: pre-autopsy, per-autopsy, and post-autopsy. RESULTS: A pathological expertise was required in 19.2% of 630 cases, among which 31% in a context of undetermined cause of death and in 14% of cases of determined causes of death. The forensic practitioner recommended a pathological expertise in 10 to 31% of autopsies. Overall, 64 pathological examinations were realized out of 121 recommended examinations (52.9%), this rate varied from 25 to 73% depending on the court. The magistrate tended to favor anatomopathological expertise in cases of determined causes of death, and in certain manner of death (80% homicide versus 35% natural). The pathologist's expertise enabled to change the cause of death in 22% of cases and the manner of death in 19%. The pathological approach was a major asset in the 65% of unknown manner of deaths and in the 20% of natural, whereas the expertise did not help in cases of homicides, suicides and accidents. The cause of death was modified in 5.6% of initially determined causes of death, against 42.9% in case of initially unknown cause. CONCLUSION: The use of pathologic examination in forensic autopsies is scarce and uneven. The factors resulting to its request are not directly linked to its scientific assets. A conjoint work between forensic and pathologist practitioners would be beneficial.

Estimation of the time since death based on body cooling: a comparative study of four temperature-based methods.

The estimation of the time since death is an important task in forensic medicine that mainly relies on body cooling in the early post-mortem period. The rectum has been traditionally used to determine the central core temperature after death, though the external auditory canal has been proposed as an alternative site by several authors. The objective of this study was to assess the ability of four body temperature-based methods (Henssge's rectal nomogram, Henssge's brain nomogram, and Baccino's both interval and global formulae based on ear temperature) to estimate the post-mortem interval (PMI). PMI calculations were carried out based on ear and rectal temperature measurements performed with a reference metal probe on 100 inpatient bodies with an average PMI of 4.5 ± 2.5 h. For practical purposes, ear temperature measurements were applied to Henssge's brain nomogram. All methods could be applied to 81 cases, since high body temperatures prevented the rectal nomogram method from being used in most of the remaining cases. The actual PMI was within the time interval (95% CI) provided by the rectal nomogram method in 72.8% of cases, and in 63.0% to 76.5% of cases when using ear temperature-based methods. The proportions of adequate estimates did not differ statistically between the different methods. When the methods failed to provide a reliable time interval, all except the brain nomogram tended to underestimate the PMI. Similar results were obtained in the subgroup of normothermic patients at the time of death (n = 63), confirming that the PMI calculations had not been biased by the inclusion of patients with thermoregulation disorders. Our findings are in accordance with the published literature which suggests that ear temperature-based methods are as reliable as those based on rectal temperature for estimating the early PMI and that they may be used as quick, simple, and non-invasive methods at the scene, although caution should be taken in interpreting their results given their high error rates. However, further research including field studies is recommended to confirm their practical relevance in forensic casework.

Is infrared thermometry suitable for the determination of the time since death based on ear temperature? A comparative study of two measurement methods.

Infrared thermometry has been proposed as an interesting alternative to probe thermometers for recording ear temperature in cadavers to estimate the postmortem interval (PMI), but it has still to be validated in this setting. Our objective was to compare the performance of an infrared thermometer to that of a reference probe thermometer for measuring ear temperature. Temperature measurements were performed on 100 cadavers (mean PMI: 4.5 ± 2.5 h) using the infrared and the probe thermometers. The repeatability of the measurements, their correlation, and the agreement between both methods were evaluated. We showed a good repeatability of the measurements with the infrared thermometer (Lin's concordance correlation coefficient (CCC) = 0.93 [0.72;0.98] for the right ear; CCC = 0.94 [0.75;0.98] for the left ear), and there was a strong and significant correlation between measurements provided by the two instruments (p < 0.001). However, a poor agreement was found between both methods, with a systematic underestimation of about 2 °C of the ear temperature when measured with the infrared thermometer. Data from auricular infrared thermometry should not be applied to algorithms developed for probe thermometers to estimate the PMI. Further research is needed to develop a reliable algorithm specifically based on infrared thermometry.

Usefulness of a blood glucose and ketone monitoring device as a screening tool for lethal diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is a frequent and life-threatening complication, whose diagnosis remains challenging in forensic practice. We aimed at assessing the performance of a commercially available blood glucose and ketone monitoring device (BGMD) in measuring glucose and ketone levels in post-mortem vitreous (VH) and blood samples, in order to determine if such a device can be used for screening lethal cases of DKA at autopsy. VH and blood samples were collected in cases of unexplained causes of death at autopsy. Glucose and ß-hydroxybutyrate (BHB) were measured in VH and BHB in blood using the BGMD. The values were compared to those obtained with validated enzymatic methods. Values ≥ 10 mmol/L were considered to be elevated for glucose, and BHB values ≥ 2.5 mmol/L were considered to indicate ketoacidosis. There was a strong and significant correlation between VH glucose and blood BHB concentrations measured with the BGMD and the validated method (r = 0.78 and r = 0.80, p < 0.0001, respectively), whereas no correlation was found for VH BHB values (r = 0.19, p = 0.19). The sensitivity and specificity of the BGMD were both excellent (1.0) to detect elevated VH glucose levels with a threshold of 14.4 mmol/L, and to detect elevated blood BHB levels with a threshold of 2.85 mmol/L. In contrast, the specificity of the BGMD to detect high BHB levels in VH was poor (0.50) with an optimal threshold of 2.5 mmol/L. We showed that a commercially available BGMD is suitable for identifying cases of lethal DKA and other metabolic disorders at autopsy, through the investigation of vitreous glucose and blood BHB. We therefore recommend the systematic use of a BGMD for screening these conditions in cases of unexplained deaths.

Tau protein in cerebrospinal fluid: a novel biomarker of the time of death?

BACKGROUND: Tau proteins are recognized biomarkers of neurodegeneration and neuronal damage in the cerebrospinal fluid (CSF). It has also been suggested that these CSF proteins could increase post-mortem due to neuronal death. The aim of this study was to investigate the changes in CSF total and phosphorylated tau (p-tau) levels in the early post-mortem interval (PMI), to determine whether these proteins could be relevant biomarkers of time since death. METHODS: Tau and p-tau levels were measured by ELISA in lumbar and cisternal CSF samples from 82 corpses (46 men, 36 women, mean age: 72.4 ± 15.2 years) with a PMI < 12 h. Forty-eight of them were considered neurologically healthy at the time of death. Rectal and tympanic temperatures were also measured in 37 individuals, and two validated temperature-based methods of PMI estimation were applied (Henssge's nomogram and Baccino's method). RESULTS: CSF tau and p-tau levels were significantly increased, with respective median values of 3315 pg/mL and 68.5 pg/mL in the whole cohort, while lower but still increased levels were observed in neurologically healthy patients. Sub-occipital punctures systematically provided higher tau and p-tau values (p < 0.0001). Despite a great inter-individual variability, the concentrations of both biomarkers were positively correlated with the early PMI, with the highest correlation for cisternal p-tau (r = 0.50, p < 0.0001 in the whole cohort; r = 0.58, p = 0.0003 in the neurologically healthy patients). Higher levels of CSF biomarkers were observed for PMI > 6 h versus PMI ≤ 6 h, the discriminatory power of the biomarkers being higher in the subgroup of neurologically healthy patients. Based on cut-off values obtained by ROC curve analysis, the CSF biomarkers could rectify or adjust the time interval provided by the temperature-based methods in a significant number of cases. A predictive model combining tympanic temperature and cisternal tau values was found to be particularly accurate to assign individuals according to their PMI (≤ or > 6 h), with a Se of 83% and a Sp of 100% (AUC = 0.95). CONCLUSION: Our findings suggest that CSF tau and p-tau proteins could serve as potential biomarkers of time since death, in association with tympanic temperature. The practical applicability of such an integrated approach has to be assessed by further studies.

Cytokines as new biomarkers of skin wound vitality.

BACKGROUND: The diagnosis of skin wound vitality is currently based on standard histology, but histological findings lack sensitivity in case of a short survival time. New reliable biomarkers of vitality are therefore strongly needed. We assessed the ability of 10 candidate cytokines (IFN-γ, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, TNF-α) to discriminate between vital and early post-mortem wounds. METHODS: Twenty-four cadavers with a recent open skin wound (< 3 h) were included (20 men, 4 women, mean age = 51.0 ± 24.3 years). An early post-mortem wound was performed in an uninjured skin area, and both wounds were sampled at the autopsy (post-mortem interval (PMI) = 66.3 ± 28.3 h). Needle-puncture sites related to resuscitation cares were included as very early post-mortem wounds (n = 6). In addition to standard histology, cytokines levels were simultaneously measured in each sample using a multiplex sandwich immunoassay, then normalized on healthy skin levels. A quantitative evaluation of IL-8-positive cells in ante- and post-mortem wound samples was also performed. RESULTS: In the training set of samples (n = 72), cytokine levels were significantly higher in vital wounds (mean age = 47 ± 53 min) than in post-mortem wounds (mean PMI = 6.9 ± 9.0 h) (p < 0.2), except for two cytokines (IFN-γ and IL-2). IL-8 was the best discriminatory cytokine (Se = 54%, Sp = 100%, AUC = 0.79), while a multivariate model combining IL-4 and IL12p70 was a bit more discriminant (Se = 55%, Sp = 100%, AUC = 0.84). In the validation set (n = 72), the discriminatory power of the cytokines and the predictive model was slightly lower, with IL-8 remaining the best cytokine (Se = 46%, Sp = 96%, AUC = 0.75). The predictive model remained highly specific (Sp = 100%). Both the cytokines and the predictive model allowed the iatrogenic injuries to be correctly classified as post-mortem wounds. Standard histology and immunohistochemistry showed 21% sensitivity and a specificity of 79% and 100%, respectively. Only two iatrogenic wounds could be properly categorized histologically. CONCLUSION: This study suggests that cytokines could be useful biomarkers of skin wound vitality and that the immunoassay method could be more sensitive than immunohistochemistry to identify wounds with a short survival time. Further research is underway to confirm these preliminary data.

Biochemical markers of time since death in cerebrospinal fluid: A first step towards "Forensomics".

The accurate estimation of the time of death is a challenge in forensic medicine, as the methods routinely used to assess the postmortem interval (PMI) are far from being precise. Over the past decades, biochemical methods have been implemented on postmortem samples to improve the precision of PMI estimation. Studies have focussed on the biochemical profiles of closed compartment body fluids, as they are preserved longer than blood after death and are thus subject to confined postmortem chemical changes. Cerebrospinal fluid (CSF) has been considered a suitable fluid to investigate these changes, as it is found in large amounts and is easy to sample. Moreover, the main molecules found in CSF have known reference values in living subjects, unlike most other body fluids. In this literature review, we focus on the panel of biomarkers that have been studied in CSF based on their potential of offering information on the time of death. The interest in these biomarkers for casework and the research perspectives in this field are discussed. Integrating data from different methods, including biochemistry, for better estimation of the time of death would represent a step forward in the forensic field, paving the way for an innovative approach that we suggest to call "Forensomics."

Age estimation at death using pubic bone analysis of a virtual reference sample.

Age at death estimation is a major part of forensic anthropology, but is often poor in the latter decades of life and should benefit from specific population standards. The aim of this study was to test a virtual reference sample with a uniform age distribution in order to improve the accuracy of age estimation for individuals over 40 years of age. We retrospectively built a random virtual reference sample of pubic symphyses from 1100 clinical cases using computed tomography at two French hospitals; this was compared with a test sample (pubic symphyses from 75 corpses undergoing post-mortem computed tomography at a French forensic department) and with the sample originally used in the Suchey-Brooks (SB) system. Inaccuracy and bias were calculated and the proportions of cases in which the real age fell within the estimated age ± 1 standard deviation were calculated. Compared to using the SB sample, using our French sample resulted in a lower inaccuracy for males over 55 years and bias showed that that for males aged 56 to 70 years were less underestimated. Compared to using the SB sample, using our French sample resulted in a lower inaccuracy for females over 70 years and bias showed that that for females aged 56 and older were less underestimated. This study presents a large data set of pubic symphyseal phases from a French virtual sample that allows for improving age estimation accuracy at death, particularly for individuals over 40 years. This kind of material can be useful to improve the age estimation accuracy in a specific region. However, the reliability remains poor and the variability of pubic symphysis morphology related to bone degeneration seems to be an unavoidable limit of the method.

A novel methodology for the objective ascertainment of psychic and existential damage.

Personal injury is a legal term for a physical or psychic injury suffered by the plaintiff under civil and/or tort law. With reference to non-pecuniary damages, the evidence itself of physical and/or psychic injury is not sufficient for damage compensation. The process of ascertaining impairments and/or disabilities which pertain to the "personal sphere" of the individual, such as pain and suffering, loss of amenity, and/or psycho-existential damage, poses particular difficulties in relation to the obtainment of scientific evidence. The "immateriality" and the subjective connotation of the personal sphere are, in themselves, critical issues. The clinical data obtained from the neuropsychological ascertainment find their essential prerequisite in the active participation of the examinee who, in legally relevant contexts (criminal law, civil law, insurance), may be "affected" by personal interests. The present manuscript presents a novel interdisciplinary methodology, experimented on a series of judicial and extra-judicial cases, aimed at the attainment of objectivity and accuracy eligible in relation to the judicial settlement of cases and other matters involving the ascertainment of peculiar aspects of non-pecuniary damage.

Padova Charter on personal injury and damage under civil-tort law : Medico-legal guidelines on methods of ascertainment and criteria of evaluation.

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first "International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law". This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among sexual assault victims referred to three French clinical forensic units.

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are the most common bacterial sexually transmitted infections (STIs) worldwide. These STIs are frequently asymptomatic, which often delays diagnosis and treatment with the risk of serious long-term complications. Current French recommendations call for targeted screening of populations considered to be at risk, including victims of sexual assault. However, no recent data on the prevalence of these STIs in this population are available in France. The aim of this study was therefore to determine the prevalence of CT/NG infections among victims of sexual assault attending three Clinical Forensic Units (CFUs). METHODS: We retrospectively reviewed the forensic records of patients aged over 12 years reporting a sexual assault and referred between January 1, 2020 and December 31, 2021 to the CFU of Montpellier, Angers or Saint-Denis de La Réunion. Patients who had been screened for CT and NG infections were included. RESULTS: 341 alleged victims of sexual assault (324 women, 17 men, median age = 23 years) were screened for CT/NG STIs during the inclusion period (Montpellier, n=196; Angers, n=63; Saint-Denis, n=82). The median time between the sexual assault and the examination was 1 day. CT and NG were detected in 28 patients (8.2 %) and 8 patients (2.3 %) respectively, with no men tested positive. Positive results concerned genital samples, except for two CT-positive anorectal samples and one NG-positive oropharyngeal sample. Two patients (0.6 %) were co-infected with CT/NG. The overall prevalence of CT/NG STIs was 10.0 % and was higher in the 18-24 age group, reaching 13.2 % for CT. CONCLUSIONS: This multicenter study confirms the high prevalence of CT/NG STIs in victims of sexual assault, and the vulnerability of the youngest age groups to these infections. Systematic screening for CT/NG STIs at the time of the forensic examination is the key to early diagnosis and effective treatment to prevent transmission and subsequent complications in these patients.

Applicability of Cameriere's third molar maturity index on orthopantomograms and computed tomography scans from a French population.

Cameriere developed a method on orthopantomograms (OPG) to assess adult age of 18 years based on the relationship between age and the third molar maturity index I3M. The aim of this study was to evaluate whether Cameriere's method could be applied to computed-tomography scans (CT-scans) from a population of French juveniles and young adults and compare the results obtained from OPG of the same individuals. Our sample comprised 200 examinations that had been performed at the radiological department of a French University hospital between 2007 and 2020. Each patient had received an OPG and a cranial CT scan for medical purposes, and we used a similar adaptation of I3M based on OPG to determine the I3M based on CT scans. Due to exclusion criteria, our final sample comprised 71 OPGs and 63 CT scans. Based on the 71 OPGs, there was concordance between chronological age and estimated age, with a sensitivity of 78.57%, a specificity of 89.47%, and a misclassified rate of 18.03% based on tooth 38, and a sensitivity of 78.79%, a specificity of 91.67%, and a misclassified rate of 17.78% based on tooth 48. Our results based on CT scans presented concordance between chronological age and estimated age for tooth 38 described by a sensitivity of 77.78%, a specificity of 94.12%, and a misclassified rate of 16.98%. The concordance between chronological age and estimated age based on 48 had a sensitivity of 75.00%, a specificity of 93.75%, and a misclassified rate of 19.23%. The > 90% ICC indicate an excellent similarity between measurements of teeth 38 and 48 based on OPGs and CT scans. This study has revealed the applicability of the Cameriere's method to calculate the I3M based on CT scans from a French population. The results based on CT scans are similar to results based on OPGs from the same individuals.

Malpractice and medical liability. European Guidelines on Methods of Ascertainment and Criteria of Evaluation.

The manuscript presents the European Guidelines on medico-legal Methods of Ascertainment and Criteria of Evaluation in cases of suspected subjective "Medical Responsibility and/or Liability" developed by an international working group under the patronage of the European Academy of Legal Medicine. It includes a step-by-step illustrated explanation of approved Flow Charts, articulated in 18 sequential steps and comprehensive of both Methods of Ascertainment and Evaluation Criteria.

A case of drug-facilitated sexual assault involving 3,4-methylenedioxy-methylamphetamine.

Typical scenarios of drug-facilitated sexual assaults usually involve victims having ingested a drink after which they had little, partial or no recollection of events for a period of time. We were surprised by the case of a woman who was sexually assaulted and described a state of amazement, leading to an incapacity to resist physically or verbally to her aggressor, and who remembered everything. Alcohol was first suspected but toxicological analysis revealed the presence of 3,4-methylene-dioxy-methylamphetamine (MDMA, Ecstasy). In the literature review, a few cases of sexual assault involving involuntarily MDMA intake are described.

Influence of the ear temperature range on the measurement bias between an infrared thermometer and a reference probe for post-mortem interval determination.

The aim of this study was to assess the influence of the post-mortem outer ear temperature (OET) on the measurement bias previously observed for short post-mortem intervals (PMI) between a commercially available infrared thermometer and a reference metal probe thermometer. To that end, 100 refrigerated bodies were added to our initial cohort to investigate lower OET. In contrast to our previous findings, a very good concordance was noted between both methods. There was still an overall underestimation of ear temperatures with the infrared thermometer, but the average bias was significantly reduced compared to that observed in the initial cohort (1.47 °C for the right ear and 1.32 °C for the left ear). Most importantly, this bias progressively decreased as the OET decreased, becoming negligible for OET lower than 20 °C. These results are in agreement with literature data regarding these temperature ranges. The discrepancy observed with our previous observations may be due to the technical characteristics of the infrared thermometers. The lower the temperatures measured, the more the measurements approach the lower limit of the measuring range of the device and tend to give constant values, resulting in a smaller underestimation of the measurements. Further research is needed to assess the interest of integrating in the already validated OET-based formulae a variable dependent on the temperature measured with the infrared thermometer, to eventually allow infrared thermometry to be used for PMI estimation in forensic practice.

Characterization of Domestic Violence among Patients Consulting a French Psychiatric Emergency Department.

The aim of the present study was to identify the prevalence of domestic violence among patients attending a French psychiatric emergency department and its association with psychiatric disorders. This retrospective study was performed, including all patients examined in the psychiatric emergency department of the Lapeyronie University Hospital of Montpellier (France) in the daytime from 1 July 2021 to 31 October 2021. A total of 152 patients were eligible during this study period. The prevalence of domestic violence was 38.2% (n = 58) overall. The percentage of female victims of domestic violence was higher than that of male victims (47.6% vs. 17.0%, p < 0.001). Among the 58 victims of domestic violence, 20.7% reported psychological abuse, 17.2% physical abuse, 3.4% sexual abuse, and 58.6% multiple forms of abuse. The risk of suicide attempt and anxiety disorder among the female patients was associated with domestic violence (p = 0.006, OR = 7.24, and p = 0.010, OR = 0.16). Our study showed that the psychiatric population should be identified as a population at risk for domestic violence, especially when the patient is female and suffers from anxiety disorders or if she has performed a previous suicide attempt.