Forensic Science, Medicine, and Pathology

Ventricular septal defect (VSD) generally has a good prognosis unless complicated by heart failure (HF). We report a case of sudden infant death because of clinically undiagnosed VSD in a seemingly healthy 16-day-old boy. Although a cardiac murmur was auscultated at birth, detailed clinical examination was not performed. Medicolegal autopsy revealed a perimembranous large VSD with a single coronary artery. The infant was diagnosed to have had HF based on the increased weight of the heart and extremely high serum brain natriuretic peptide levels...

Determining the cause of unexplained death in all age groups, including infants, is a priority in forensic medicine. The triple risk model proposed for sudden infant death syndrome involves the intersection of three risks: (1) a critical developmental period in homeostatic control (2), exogenous stressors, and (3) a vulnerable infant. Even though sex and age factor into some forms of inherited arrhythmogenic deaths in young individuals and adults, more appropriate a dual-risk disease model for adults involves exogenous stressors and a vulnerable individual...

In this paper we present the study of a skull belonging to a young male from the Italian Bronze Age showing three perimortem injuries on the frontal and parietal bones; the peculiarity of the frontal injury is represented by its singular shape, which may be indicative of the weapon that caused the lesion. The aim of the present study is to examine the traumatic evidence in relation to possible etiological factors, in order to attempt to establish if the lesion occurred peri or post-mortem, and to evaluate if these traumatic injuries could be interpreted as an evidence of interpersonal violence, by combining anthropological, taphonomic and ESEM investigations...

Forensic routine consists of more than just the classical legal medicine described in textbooks. It is often crucial to answer forensic questions that involve numerous interfaces with other medical disciplines. These interdisciplinary questions that arise in routine autopsy proceedures can also be addressed scientifically, despite decreasing autopsy numbers. Forensic medicine is not only able to generate epidemiologically relevant data, but can also contribute to the establishment of new treatment pathways based on forensic data ("preventive pathology"), at least for certain autopsy sub-populations...

Humans constantly lose epithelial cells, and these biological traces are frequently studied in the context of criminal investigations. The objective of this work was to examine the genetic profile in samples of forensic interest (nail and skin epithelial cells) of bone marrow transplant patients and discuss its forensic and clinical implications. The genetic profile of nail, epidermal cells and blood samples of patients receiving HSCT was analyzed by the amplification and sequencing of 38 insertion/deletion polymorphisms and 15 short tandem repeat polymorphisms...

Hoarding is defined as the acquisition of, and failure to discard, possessions of little use or value to others, usually associated with a significant degree of clutter in the individual's home. We describe a case of a woman who died from a combined traumatic and confined space asphyxia, after being trapped under some of the objects amassed in her apartment. The event was considered to be accidental; by taking into account the information gathered during assessment of the scene, we believe that the accident took place while entering or exiting the apartment...

The mandibular canine index (MCI) has been described as a suitable methodology for sex estimation in forensic scenarios but there are contradictory reports about its accuracy. Moreover, the two mandibular canine teeth must be available, which is not always a viable option. The aim of this study was to strip the MCI by analyzing the MCI itself and its components, in order to optimize its use for sex estimation. The mesiodistal dimensions of the mandibular canine crown and the mandibular canine arch width were measured in a sample of 120 cast models...

Although forensic parasitology remains in its infancy compared with more developed fields like forensic entomology, parasites can be useful forensic indicators. We present the case of an individual who disobeyed animal health legislation and crossed animal quarantine boundaries and two state lines with a cattle tick (Rhipicephalus australis) infested horse. Following recognition of the infestation by animal health officers, the individual asserted that the infestation had occurred either during transport or upon arrival at the site of discovery, and that they had not contravened quarantine legislation...

Postmortem genetic testing is a diagnostic tool that is becoming increasingly utilized. The benefits and limitations of genetic testing in cases of sudden, unexpected death in the young (≤ 40 years old) are reviewed from the perspective of the Office of Chief Medical Examiner of the City of New York, whose Molecular Genetics Laboratory, accredited by College of American Pathologists, has had 15 years of postmortem testing experience. Challenges to the interpretation and communication of testing results are highlighted, and opportunities for improving testing yield are discussed for age groups across the lifespan, from infancy to adulthood...

An adult male skeleton was submitted to the Department of Anatomy at the University of Belgrade for evaluation. It was believed to represent the remains of a second to third century Christian saint from the Lesje Monastery in central Serbia. Examination of the remains revealed an old crush fracture of a thoracic vertebra and an unusual, probably congenital, malformation of the atlanto-occipital joint with deformation of the left occipital condyle and resultant narrowing of the foramen magnum. Although the occipital malformations were most likely congenital, they may still have caused, or contributed to, death by compression of the underlying upper cervical spinal cord...

Fat embolism is markedly underdiagnosed, even though it is a well-known phenomenon following fractures of the long bones, injury to subcutaneous fat tissue, rupture of a fatty liver, surgical operations on fatty tissues, septicemia, burns and barotrauma. Forensic pathologists tend to "simplify" autopsy report conclusion in cases with multiple injuries where fat embolism and exsanguination could be considered to be the concomitant causes of death. Herein we present a case of 24-year-old male who was beaten with a metal rod by several persons...

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A major task of forensic investigations is the documentation and interpretation of evidence to reconstruct a forensically relevant incident. To accomplish this task, a scene is documented not only with photographs but also with 3D documentation technologies. The resulting 3D data are used for 3D visualization and to perform 3D reconstructions. In this article, we present an approach for using forensic 3D data in conjunction with virtual reality to perform scene walkthroughs in the context of witness or suspect interrogations...

Death does not occur instantaneously and organs do not decompose at the same rate or in the same way. Nulligravid human uteri and prostate glands are the last internal organs to deteriorate during decomposition; however, the reason for this very important observation is still enigmatic. Recent studies have elucidated that the composition and abundance of microbes in the human thanatomicrobiome (microbiome of death) varies by organ and changes as a function of time and temperature. The ileocecal area has the largest absolute postmortem burden that spreads to the liver and spleen and continues to the heart and brain depending on the cause of death...

An adult male Australian sea lion (Neophoca cinerea) presented with a deep, almost circumferential, incised wound around the neck caused by a noose formed by a single strand of green nylon rope. The wound extended 4-5 cm deeply through the skin and blubber into skeletal muscle, predominantly on the dorsal surface and left side, but had not involved the airway or major vessels. The edges of the wound were sharply incised and oozing blood with a granulating infected base. The rope was removed and the wound debrided of necrotic tissues and irrigated with disinfectant...

An accident occurred at a construction site and a 27-year-old worker was fatally injured. Equipped with personal protective equipment (helmet and a safety belt), he was standing on an 8-meter-high platform holding a large hose that was attached to a pipe connected to a concrete pump truck. Whilst in use the pipe broke and the hose sent the man flying with force, knocking down the platform railing. Autopsy examination showed that man fell to the ground landing on his head. Prominent Simon's hemorrhages were noted on the L5-S1 and L4-L5 intervertebral discs...

Ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) are metabolites of alcohol that when detected in hair can provide evidence of a person's drinking behavior. The analysis of these compounds in hair has become commonplace in recent years and has been used as evidence in legal proceedings. Despite the routine use of such toxicological analysis, the correct interpretation of alcohol biomarker hair testing can be complex, and there may be debate as to the significance of the data. This paper considers whether the accepted norm of applying interpretative cut-off values to EtG and FAEE concentrations from hair samples is appropriate, and asks whether Bayesian theory, using a likelihood ratio approach may offer greater insight as to the strength of evidence...

Kratom is a plant with dose-dependent mixed stimulant and opioid properties whose pharmacologic characteristics and social impact continue to be described. The main active isolate of kratom is mitragynine, an indole-containing alkaloid with opioid-like effects. Kratom toxicity and kratom-associated fatalities have been described, including those in association with additional drugs. In this paper we describe the case of a 27-year-old man who was found deceased with a toxic blood concentration of quetiapine in conjunction with the qualitative presence of mitragynine...

Animal inflicted fatal or near fatal injuries are well described in the forensic literature, with the most frequently described cases involving dogs, large cats and bears. To our knowledge, a deer inflicted fatality has not been described in the forensic literature previously. This article reports a case of a 64-year-old male, who was found lying in a pool of blood near an enclosure for stags and hinds at the end of October. There were mechanical defects on his jacket and trousers, which appeared to be torn or penetrated, as well as multiple lacerations and stab wounds in different parts of his body...

A 22-year-old male with a medical history of depression was found lying on his right side with a pool of blood around his head. A pistol-shaped metal device was found next to the right hand of the deceased. Examination of the body revealed the presence of a gunshot wound to the head. The entrance wound was located in the right temporal area and was partially surrounded by a semicircular muzzle imprint. Analysis of the firearm revealed a home-manufactured device constructed from the posterior part of a captive bolt gun chamber containing a firing pin...