Cause and Manner of Death of a Skeletonized Cadaver: Meeting Some Challenges.

Cause of death is defined as a natural disease or injury that led to physiologic changes resulting in death. Manner of death refers to the circumstances surrounding death. Decomposition, especially in advanced stages, creates difficulties in post-mortem examination for it encompasses the processes that lead to the loss of important observable findings and features. Traumatic injuries observed in decomposed cadavers might be analyzed by their vital features and significance for the occurrence of fatal outcomes that help determine the cause and manner of death. An almost fully skeletonized cadaver was admitted to the Department of Forensic Medicine and Deontology at The Medical University, Sofia, Bulgaria. Along with the obligation to answer the post-mortem interval, what were the anthropological and biological features, the cause and manner of death had to be determined in order to classify the case as criminal or not. The cause of death was established by the morphological finding - gunshot injury of the head, passing the brain. The manner of death remained undetermined because of the absence of soft tissues in the areas of the injuries. It was concluded that there was no sufficient forensic data to answer if it was suicide, homicide, or even an accident.

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.

Forensic Pathology and Legal Issues in COVID-19: Case Report and Literature Review.

Autopsy investigations of deaths following nosocomial coronavirus disease 2019 (COVID-19) infection have enormous medical and social significance, as autopsies are essential for the correct statistical recording of COVID-19 deaths, presenting new lessons, which is important to policymakers and in the improvement of public health in general.  Our study is based on the presentation of a case of a road traffic accident involving an elderly 73-year-old female with a complication of nosocomial COVID-19 infection and death leading to forensic pathological investigation. This involved autopsy, histopathological examinations, and other tests, and highlighting the importance of medicolegal matters, including the legal and ethical practicalities encountered in healthcare. This article highlights the fact that patients who have sustained various traumatic injuries accompanied by nosocomial COVID-19 infection have higher risks of morbidity and mortality. The significance of the role of a Forensic Pathologist in dealing with the analysis of injuries and the performance of autopsies to determine the cause, mechanism, and manner of death. In addition, the important lesson of testing patients for COVID-19 more regularly during a long hospital admission period, to offer early treatment and isolation, including avoiding the further spread of the COVID-19 infection variants to patients and healthcare professionals, thereby minimising and preventing hospital-acquired infection and death is stressed.

Mammoth Bilateral Ovarian Serous Cyst Adenomas in a Postmenopausal Woman: A Rare Case Report.

Serous cyst adenomas account for about 40% of all ovarian tumors and most commonly are diagnosed in middle-aged women. The aim of this publication is to present an extremely rare case of mammoth bilateral cyst adenomas in a postmenopausal woman, occupying the pelvis and the most of abdominal cavity. A 67-year-old obese woman was presented to our emergency department with abdominal pain. Ultrasound and computed tomography of the abdomen verified two huge cystic masses. Exploration of the abdominal cavity by laparotomy established two intact giant cystic masses with ovarian origin. The cysts were removed by bilateral salpingo-oophorectomy and hysterectomy was performed. Histological examination revealed that both cystic masses were ovarian serous cyst adenomas. The woman was discharged with an uneventful recovery. We present a case of the largest gigantic bilateral ovarian cyst adenomas in the oldest woman ever reported.

Severe Burns of the Genital Area After Laser Hair Removal: A Case Report.

Burn injuries are among the most commonly observed complications of laser hair removal. Here, we present a case, in which severe massive burns were caused in the genital and perineal areas during such a procedure. The consequent scar formation led not only to negative aesthetic effects but also affected the physical and psychological health of the patient.

Difficulties Encountered by Forensic Pathologists in Proving Abusive Head Trauma in Children: A Case Report.

Shaken baby syndrome (SBS) or abusive head trauma (AHT) is one of the most common causes of death or serious neurological injury resulting from child abuse. AHT is defined as injury to the skull or intracranial contents of an infant or child younger than five years due to intentional abrupt impact and/or violent shaking. It is characterized by acute encephalopathy with subdural and retinal hemorrhages. We present a case of AHT that does not show the typical clinical triad. We describe one case of a pediatric patient addressed for forensic autopsy and where suspicion of AHT has arisen. The injury mechanism involved in the production of this syndrome and its clinical manifestation are sources of debate in forensic medicine. Thus, forensic pathologists must analyze all findings to determine SBS/AHT.

Elderly abuse - a forensic case of homicide-suicide as act of intimate partner violence.

Homicide-suicide as a criminal act is a distinct subcategory of homicide in which the assailant kills his wife and/or her children in a relationship that has been broken down. The present case is about the dyadic deaths of an 89-year-old male and an 82-year-old female who are in a relationship as intimate partners (as husband and wife). In the early autumn of 2020, an event report was received in the Police District of Plovdiv about a woman who was found dead in her home. Her husband's body was found next to hers in the same building, with the clinical features of a coma - the man was breathing but unresponsive. Unfortunately, he passed away immediately before the arrival of the emergency crew.

Posttraumatic Parinaud's syndrome as a contrecoup injury in a case of closed head trauma.

The purpose of the study was to present a rare case of post-traumatic Parinaud's syndrome with a history of closed head injury. The clinical characteristics, examination, and management are presented in a 12-year-old boy who was a victim of physical violence at the hands of a young boy who punched him in his chin with his fists, with associated paralysis of the upward gaze of the left eyeball, and convergence nystagmus with pupillary involvement. CT examination indicated posttraumatic lesions in the dorsal midbrain and in the cavity of third ventricle, suggestive of acute hemorrhages. Posttraumatic Parinaud's syndrome is a rare phenomenon that can occur in a case of closed head trauma as contrecoup injury.

Child abuse syndrome - a forensic case of fatal impulsive act of violence.

Child abuse syndrome is a medico-social problem widely spread around the world, which includes a complex of clinically manifested forms of violence against children. This syndrome includes different forms of physical violence, sexual violence, neglect, and emotional violence against children. The main problem with this type of violence continues to be the large number of unregistered "hidden" cases. The consequences of violence against children are serious and have a lasting negative effect on the physical and mental health of the victims. Child abuse is often a result of impulsive violent behavior with minimal provocation and may have a fatal outcome.

The advantage of the virtual forensic autopsy - A new approach which could benefit forensic expertise.

We aimed to assess the accuracy and advantages of postmortem CT examination and three-dimensional (3D) view of the cadaver with the Sectra Visualization Table compared to the full conventional autopsy of a forensic suicidal case. Our survey concerned unusual case of self-strangulation where a body was found in the stage of mummification with a nylon cable tie around the neck and another around the feet. The case was initially determined as a homicide, but later reconsidered a suicide based on objective scene investigation, virtual autopsy and the positions of knots. Unlike the physical autopsy in case of mummification 3D examination does not alter evidence and can revisit the body for additional investigation.