The role of necroscopy and autopsy investigations in the diagno-sis and risk management of infections related to public health care: forensic and medico legal implications.

Background: Healthcare-associated infections (HAIs) represent the most frequent adverse event in healthcare systems around the world. From a forensic point of view, HAIs show various legal implications. Therefore, it is essential in cases of death or injury from a suspected nosocomial infection that the infection itself, the source and the method of contamination are correctly diagnosed in order to evaluate any profiles of professional liability. Methods: This study combined a minireview of the scientific literature using the Pubmed search engine, the website of the Higher Institute of Health and the member states information sessions on infection prevention and control (IPC). Discussion: Despite the significant impact that HAIs have on healthcare systems, their severity is often not fully understood by healthcare professionals, leading to insufficient responses. In the autopsy setting, the diagnosis of these infections is not always simple due to the risk of post-mortem contamination determined by the endogenous bacterial flora. In the forensic field, the medical examiner during the autopsy can use various diagnostic techniques and investigative tools to identify the infection. Some usefulpp approaches include: 1) Macroscopic examination of the organs; 2) Histopathological investiga-tions; 3) Microbiological analyzes with the performance of swabs; 4) Immunofluorescence tests for the detection of antigens or antibodies on biological liquids; 5) Molecular tests. The choice of methods will depend on the nature of the suspected infection and the availability of diagnostic resources.

Revisión sobre la metodología para el diseño de la estrategia de calidad en los servicios de patología forense / Review on the methodology for the design of quality strategies in forensic pathology services

La culminación del proceso de creación de los Institutos de Medicina Legal (IML) con la puesta en funcionamiento al IML de Madrid en 2020, homogeniza las funciones de la medicina forense en todo el territorio nacional. Recientes reformas legislativas en materia de formación médica especializada amplían sus competencias para abarcar, además de la función pericial, responsabilidades en materia docente y de investigación. El diseño e implementación de sistemas de calidad, debe convertirse en una prioridad de los IML, con el objetivo de garantizar su eficacia y eficiencia ofreciendo resultados exactos, fiables y en los plazos apropiados. El presente artículo ofrece una revisión detallada del procedimiento a seguir para diseñar una estrategia de calidad en los Servicios de Patología Forense. (AU)

The culmination of the process of creating the Institutes of Legal Medicine (IML) with the commissioning of the IML of Madrid in 2020 homogenizes the competences of forensic medicine throughout the country. Recent legislative reforms in specialized medical training, expand their responsibilities to cover, in addition to the expert function, a stronger role in teaching and research. The design and implementation of quality systems must become a priority for IMLs in order to guarantee their effectiveness and efficiency by providing accurate, reliable and timely results. This article provides a detailed review of the procedure to be followed to design a quality strategy in Forensic Pathology Services. (AU)

Applicability and usefulness of the Declaration of Helsinki for forensic research with human cadavers and remains.

Bodies of deceased persons and human remains and their specimens (i.e., organs, bones, tissues, or biological samples) are essential in forensic research but ad hoc worldwide-recognized ethical standards for their use are still lacking. Such standards are needed both to avoid possible unethical practices and to sustain research in the forensic field. Pending consensus within the forensic science community regarding this topic, with this article we aim to stimulate a debate as to the applicability and usefulness of the Declaration of Helsinki in the field of forensic research involving human cadavers and remains. Considering the fundamental differences compared to clinical research involving human beings and the different moral obligations involved, we focus on the risks, burdens, and benefits of research, ethics committee approval, and informed consent requirements. The Declaration of Helsinki framework allows forensic researchers to focus on substantial ethical principles promoting the consistency, integrity, and quality of research. Consensus regarding ethical standards and the adoption of national and supranational laws that clearly regulate the use of human cadavers and remains, including those from autopsies, continues to be of primary importance for the forensic science community.

[On the quality of the external post-mortem examination in cases of fatal head trauma : A comparison of death certificate and forensic autopsy]. / Zur Qualität der ärztlichen Leichenschau bei todesursächlichem Schädel­Hirn­Trauma : Ein Vergleich von Todesbescheinigung und gerichtlicher Obduktion.

BACKGROUND: In Germany it is required by law that basically every type of physician needs to be capable of executing a correct external post-mortem examination of a corpse. In recent years, numerous investigations on external post-mortem examinations repeatedly reported systematic mistakes and erroneous procedures in various clinical and medicolegal case groups. Accordingly, the completion of death certificates is frequently performed incorrectly. As one of the typical unnatural death cases, decedents dying from fatal head trauma (FHT) represent a special autopsy case group, which is expected to be correctly recognized during the primary external post-mortem examination because the external injuries are mostly obvious. OBJECTIVE: The present study aimed at investigating the quality of the external post-mortem examination in medicolegal FHT cases by means of comparison of death certificates and autopsy reports from a 10-year period. MATERIAL AND METHODS: In a retrospective study design all autopsy cases from the Institute of Legal Medicine of the University Hospital Münster in the years 2006-2015 (n = 3611) were analyzed as to the presence of FHT. A total of 328 cases with FHT and the concomitant presence of a death certificate filled out before the autopsy were identified. Subsequently, the cause of death according to the death certificate was compared with the cause of death according to the autopsy. The degree of agreement was classified into six different categories from I to VI. While category I represented a complete lack of agreement, category VI was assigned to cases with full agreement. RESULTS: In 58.5% of the cases (category VI) FHT was identified correctly during the external post-mortem examination. In 1.5% of the cases, a completely different cause of death was determined during the external post-mortem examination (category I). In 19.2% of the cases, no cause of death or the statement "unclear" was given as the cause of death in the death certificate (categories II and III). Cross-analyses and intuitive heatmap visualization were generated to identify case constellations with an increased risk for discrepancies. These analyses revealed that among all discrepant cases (categories I-V), falls were found significantly more often than in the nondiscrepant cases (p < 0.01), especially falls of women older than 57 years (median age of women) or falls considered as accidents by the examiner. In addition, traffic-associated FHT of men older than 44.5 years (median age of men) was identified more frequently in the external post-mortem examination. CONCLUSION: Despite the fact that FHT should be a cause of death that is comparably easy to identify during external post-mortem examination, more than one third of the cases were not sufficiently recognized. Therefore, special attention must still be paid to certain case constellations during the external post-mortem examination. Typical examples of such cases are burned bodies, cases of advanced putrefaction and falls.

What should private-sector doctors do when relatives of deceased patients pressurise them to prevent medicolegal autopsies in cases of unnatural death?

This article deals with what doctors in the private sector should do if relatives of deceased patients refuse to consent to medicolegal autopsies and demand that the bodies be handed over to them. The law does not require consent by relatives for medicolegal autopsies, because the State has a compelling interest in ensuring that such deaths are properly investigated. Relatives of patients who have died an unnatural death may be criminally prosecuted if they attempt to obstruct doctors from carrying out their duties under the Inquests Act 58 of 1959 and the regulations regarding the rendering of forensic pathology services.

[Visualization of the reconstruction of a criminal event by means of 3D-modeling]. / Vizualizatsiia rekonstruktsii kriminal'nogo sobytiia metodom 3D-modelirovaniia.

Forensic medical expertise carried out with a view to reconstruction of an event is a time-consuming procedure because it requires collection of a large amounts of various materials for the institution of a criminal investigation including physical evidence, photoboards of the site of an occurrence, etc. A forensic medical expert may encounter difficulties when reconstructing and scrutinizing the scene of action at a single computer monitor in order to analyze the behaviour of each participant of the event. Of great help in such situations are modern software programs allowing to visualize the site of an occurrence with a maximum approximation to reality, simulate the actions of the victim(s) and alleged offender(s), perform a large number of other forensic studies. The present article provides the practical examples illustrating the possibilities of reconstruction of various events with the use of the three-dimensional modeling based on the MicroSmith Poser and Agisoft PhotoScan software packages for clarifying various circumstances, facts, and conditions of special interest for the preliminary investigation and inquiries.

Esqueletización de lesiones en un cadáver descuartizado y congelado / Skeletonization of injuries in a dismembered and frozen body

No disponible

Impacto beneficioso de la incorporación de las fuentes forenses a las estadísticas de mortalidad / Beneficial impact of forensic sources to cause-of-deaths statistics

No disponible

Fractura de radio por proyectil que permite reproducir la posición de la víctima / Fracture of radius by projectile allowing to reproduce the position of the victim

No disponible

[Correct indications and performing of autopsies in the Czech republic]. / Správný postup pri indikaci a provádení pitev v Ceské republice.

Since July 1st 2016 Czech law, after more than two years after the new Civil code came into force, in turn, permits performing the clinician indicated pathological-anatomical autopsies with regard to their basic purpose, which is to identify the cause of death, other diseases, complications of diseases and to verify the clinical diagnosis and medical treatment of patient.For physicians requesting an autopsy it is important to know the rules for their indication and implementation. These rules respect the public interest in performing the autopsies as well as the possibility to decide about post-mortem treatment of the own body and bodies of close relatives.Clinical autopsies can be divided into three groups: absolutely obligatory (carried always), relatively obligatory for professional reasons (with possibility of cancellation after additional professional assessment by a provider performing the autopsy) and relatively mandatory after the disapproval of the autopsy (by the deceased during his life or on the request of close relatives after death).The paper presents a review of medical practice regarding autopsies indicated by clinicians according to generally binding legal regulations in the Czech Republic.

A Perspective on Veterinary Forensic Pathology and Medicine in the United Kingdom.

Internationally, forensic medicine and pathology are increasingly recognized as an important aspect of work done by veterinary clinicians and veterinary pathologists. In this article, a forensic veterinary clinician, a forensic veterinary pathologist in private practice, and a forensic veterinary pathologist at a veterinary school discuss the interactions among veterinary clinicians, veterinary pathologists, and law enforcement agencies and how future interactions can be improved. The focus is on the United Kingdom, but many of the principles, challenges, and suggestions are applicable to other jurisdictions. Clinicians and pathologists require forensic training to enable them to apply their veterinary knowledge to suspected cases of animal abuse and to subsequently present their findings and conclusions to a court of law in a concise, professional, and unbiased manner, and some opportunities for such advanced training in the United Kingdom are indicated. It is important that forensic veterinary clinicians and pathologists interact in an unbiased and collegial manner to answer the questions posed by courts of law. Opportunities for improved training, communication, and interaction among forensic veterinarians, forensic scientists, and law enforcement are discussed.

Forensic Analysis of a Contact Lens in a Murder Case.

Contact lenses have had rare relevance in trials and/or investigations. After 5 years of burial, orbital remnants were retrieved from an exhumed body and subsequently identified as a key piece of material evidence in a murder trial. The exhumed case materials were evaluated under laboratory conditions and were determined to be contact lens remnants. Contact lens fracture and burial simulation studies were performed to provide additional corroboration of the physical findings of the exhumed contact lens remnants. This material evidence was instrumental in providing factual proof refuting the defendant's testimony in the murder trial. A brief history of contact lens composition and use is provided for understanding the methods and observational results. This forensic case study represents the first published documentation of a contact lens from an exhumed body being used in a murder investigation and establishes an operational procedure for future forensic contact lens examinations.

Veterinary Forensic Pathology of Animal Sexual Abuse.

Animal sexual abuse (ASA) involves harm inflicted on animals for the purposes of human sexual gratification and includes such terms as bestiality, zoophilia, zoosadism, animal sexual assault, and others. The prevalence of ASA is not known, although it may be more common than is currently perceived. Veterinarians have the skills required to identify and document cases of ASA. This article reviews the terminology, legal definitions and forms of ASA, and its social and psychological context. An investigative approach is outlined, including an alternate light source examination; collection of swabs for DNA analysis; sampling vaginal washes, rectal washes, and toenails for trace evidence and biologic analyses; radiographic studies; and a complete forensic necropsy, including histopathology. Gross lesions identified in ASA victims include injuries to the anus, rectum, penis, scrotum, nipples, and vagina; the presence of foreign bodies; and abrasions, bruising, and other evidence of nonaccidental injury. Specialized procedures, including examination using alternate light sources and screening tests to identify human seminal fluid within samples from ASA victims, are of potential value but have not been validated for use in animals.

Demystifying the Courtroom: Everything the Veterinary Pathologist Needs to Know About Testifying in an Animal Cruelty Case.

When veterinary pathologists testify as expert witnesses in animal cruelty trials, they may find themselves in an intimidating and unfamiliar environment. The legal rules are clouded in mystery, the lawyers dwell on mundane details, and the witness's words are extracted with precision by a verbal scalpel. An unprepared expert witness can feel ungrounded and stripped of confidence. The goal of this article is to lift the veil of mystery and give the veterinary pathologist the tools to be a knowledgeable and confident expert witness before and during testimony. This article discusses the types of expert witnesses, disclosure requirements and the importance of a good report, the legal basics of expert testimony, and how to be an effective expert witness. The article references Minnesota law; however, the laws are similar in most jurisdictions and based on the same constitutional requirements, and the concepts presented are applicable in nearly every courtroom.(1).

Animal Abuse and Interpersonal Violence: The Cruelty Connection and Its Implications for Veterinary Pathology.

The role of the veterinary forensic pathologist in the investigation of animal abuse or neglect can go beyond documenting the condition of animals presented as evidence. Although animal cruelty is a moral concern and a crime in itself, law enforcement response to such crimes is often enhanced by the recognition that crimes against animals can be both indicators of other ongoing crimes against people and predictors of the potential for interpersonal violence. An understanding of common motives underlying animal cruelty can aid the pathologist in asking appropriate questions. The authors review the forms of pathology evidence commonly seen in various presentations of animal cruelty. Understanding these forms of evidence can help the pathologist describe findings that can be significant for assessing the potential risks the alleged perpetrator may pose to other animals and humans.

[Clinical forensic imaging. Detection and documentation of internal injuries in living victims of violence]. / Klinisch-forensische Bildgebung. Erfassung und Dokumentation innerer Verletzungsbefunde bei lebenden Gewaltopfern.

External examination of the body surface with documentation of all visible findings can still be regarded as the status quo of clinical forensic injury assessment. It is obvious that internal findings cannot be detected using this technique. For obtaining such findings accessible well-established radiological techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI) should be used. Especially MRI with no damaging radiation exposure for the examined person allows the detection of internal soft tissue and organ damage and offers a great potential regarding new techniques for allowing insights into tissue composition and function. Furthermore, imaging data collected in clinical institutions before the patient was transferred to the department of legal medicine will play a major role in the future. Although these data were obtained based on a different approach, they provide excellent and recent information on injuries in the respective (current) case und can therefore be of high value for the forensic expertise.

La práctica de la diligencia judicial de autopsia en los supuestos de fallecidos en los que se han extraído órganos para su trasplante / Judicial autopsy practice in cases of deceased after the removal of organs for transplantation

En España, el número de donaciones de fallecidos judiciales es mayor que en otros países de nuestro entorno, posiblemente porque el modelo español facilita en gran medida la interconexión activa entre el médico forense, el Juez de guardia y los coordinadores de trasplantes. Desde esta perspectiva humana, enaltece a la sociedad, basándose en la solidaridad y el altruismo por parte del donante y su familia. También la dota de un alto nivel sociocultural y técnico, tanto por la cantidad como por la calidad de los profesionales que intervienen en todo el operativo de trasplantes. En el presente trabajo se analiza la intervención judicial y del médico forense en las donaciones de órganos de cadáveres judiciales, enfatizando sobre las situaciones que en la práctica se pueden producir con respecto a las autopsias, así como en la necesidad de planes de actuación y protocolos que faciliten la intervención de los distintos operadores implicados para minimizar, en la medida de lo posible, el número de negativas judiciales (AU)

In Spain the number of donations from deceased under judicial investigation is greater than other surrounding countries, possibly because the Spanish model facilitates the active communication between the judge on duty, the forensic doctor and transplant coordinators. From the human perspective, it ennobles the society, based mainly on solidarity and altruism on the part of the donor and his family. It also provides a high socio-cultural and technical level, as a consequence of the quantity and quality of professionals involved in the whole transplant operation. In this paper the court and forensic doctor intervention on donations from deceased under judicial investigation is analyzed. We emphasize different possibilities in daily practice, as well as the need for action plans and protocols that promote the involvement of various operators involved, in order to reduce as much as possible the number of judicial refusals (AU)

Significance of Crime Scene Visit by Forensic Pathologist in Cases of Atypical Firearm Injuries.

Deaths due to firearms are some of the interesting and contentious cases that a forensic pathologist/autopsy surgeon encounters in his practice. Whenever there is 'ambiguity' regarding the nature or sequence of events any unnatural deaths including those caused by firearms the practice of visiting crime scene should be encouraged especially in a country like India where autopsy surgeons often neglect it. Here we present a case report in which there were inconsistencies in the autopsy findings with the alleged history. The witnesses heard about four to six gunshot sounds, whereas only two spent cartridge cases were retrieved from the crime scene. Authors identified the atypical nature of firearm injuries sustained by the victims that were possible by just two bullets. Crime scene visit was undertaken where we discovered the possibility of the echo effect behind the production of four to six sounds. Further by using computer software program, positions of the gunman, victims and the bullet trajectory of the two bullets was created.

[The modern view on inside vehicle trauma].

Forensic medical diagnostics of the injuries to the driver and passengers remains a challenging problem for forensic medical experts investigating traffic accidents. Specifically, the investigators encounter difficulties in the conduction of comprehensive medico-autotechnical studies. The objective of the present work was to propose the algorithm of actions for elucidating not only qualitative but also quantitative characteristics allowing to determine the position of both the driver and the front-seat passenger of the vehicle. This algorithm significantly improves the quality of expert judgment making it more objective and reliable.