Forensic Science, Medicine and Pathology最新文献

Spontaneous pneumothorax (SP) is a condition defined by abnormal gas accumulation in the chest cavity. Mutations of the collagen type III alpha 1 chain, COL3A1 gene, are primarily linked to vascular Ehlers-Danlos syndrome (vEDS); however, they can also contribute to structural changes in the tissue, like bullae of the lungs. In this case report, we present a young, thinly built boy who died due to a spontaneous pneumothorax. Post-mortem genetic testing revealed a novel COL3A1 mutation, likely contributing to the pathogenic events underlying death due to spontaneous pneumothorax. We recommend implementing genetic testing of correlative or causative genes in the context of SP.

Matrix-assisted laser Desorption/Ionization Mass Spectrometry Imaging (MALDI MSI) is an analytical technique used for the spatial mapping of drugs, explosives, and organic samples, making it a game-changer in Forensic examination. It detects a wide range of biomolecules in their native state without specific tags, antibodies, labels, and dyes. This review aims to highlight the advancement of MALDI-MSI over time and its impact on Forensic Science due to high-resolution molecular imaging. To foster the development of forensic investigations the utility of MALDI-MSI in six different broad areas, Latent Fingerprinting division, forensic toxicology division, Crime Scene Reconstruction and investigation division, Sex crimes, forensic trichology division, question document analysis, is explored in this review. MALDI-MSI possesses a unique strength of molecular imaging of biomolecules without complex preparation from diverse sample types. In the future, the sensitivity and detection limits of MALDI-MSI can be enhanced and its instrumental size should be reduced to perform on-site investigation.

A 36-year-old woman diagnosed with complicated cholecystolithiasis underwent elective laparoscopic cholecystectomy (LC), then converted to open cholecystectomy because of a massive intraoperative bleeding. Hemostasis was performed with clipping and suturing the source of bleeding. In post-operative period, the patient suffered from persistent anemia associated with hemoperitoneum diagnosed through abdominal CT scanning, in absence of any sign of active bleeding. She died 16 days after the surgical procedure. Autopsy revealed the presence of 2 clips adjacent to the suture used for ligating the cystic artery and the presence of 3 surgical metal clips on the right hepatic artery, that should not be present in a routine cholecystectomy. The review of CT scans performed during the hospital stay revealed contrast extravasation from the right hepatic artery, near the 3 clips, allowing the post-mortem diagnosis of pseudoaneurysm (PA). The diagnosis of PA of right hepatic artery is typically made in living patients, through imaging, and autoptic identification is rarely obtained. The innovation of this report is to present an iconographic correlation between in vivo imaging and autopsy data, allowing for the tracing of the PA's origin to the wall weakening caused by the placement of 3 clips on the right hepatic artery, and having significant medico-legal implications.

The diagnosis of septic arthritis remains challenging in the clinical setting, often leading to a suspicion for medical liability. Our purpose is to describe an unusual case of a post-mortem diagnosis of P. multocida fatal septic arthritis, in a healthy 67-year-old woman presenting with pain in the right shoulder. Moreover, a literature review of cases of fatal septic arthritis is provided. The multidisciplinary approach consisted of a forensic autopsy and additional post-mortem analyses (microbiology, biochemical analyses, histopathology, and revision of radiological images) carried out during the prosecutor's investigation for medical liability. A systematic review of the literature was performed to collect cases of fatal septic arthritis and to understand its frequency and characteristics. No clear cause of death was determined after the autopsy, that only highlighted swelling and purulent exudation in the right glenohumeral joint. The microbiological swab performed on the shoulder tested positive for P. multocida, while histopathological and biochemical data were consistent with a sepsis. These results guided the interview with the woman's relatives, until a history of a previous contact with a stray cat emerged. The cause of death was deemed as fatal septic arthritis caused by P. multocida, occurred after cat scratches and bites and only diagnosed post-mortem. The review of the literature provided 15 articles about fatal septic arthritis, only 1 caused by P. multocida, and all with ante-mortem diagnosis. Given the nonspecific symptoms, usually including a localized pain, and the absence of a clear history, e.g. of animal contact, septic arthritis might represent an under-reported clinical and pathological diagnosis, leading to a judicial autopsy for the suspicion for medical liability. The post-mortem examination, following a multidisciplinary approach including integration of the clinical history, microbiological and histopathological analysis, could represent the only opportunity for the diagnosis of the cause of death.

Forensic diagnosis of sudden cardiac death (SCD) is an extremely important part of routine forensic practice. The present study aimed to develop and validate nomograms for predicting the probability of SCD with special regards to ischemic heart disease-induced SCD (IHD-induced SCD) based on multiple autopsy variables. A total of 3322 cases, were enrolled and randomly assigned into a training cohort (n = 2325) and a validation cohort (n = 997), respectively. Prediction models of SCD and IHD-induced SCD were developed through multivariable logistic regression based on variables selected by LASSO regression or ridge regression, and prediction model with higher area under the curve (AUC) of the receiver operating characteristic (ROC) curve in the validation cohort was used to establish nomograms. For SCD prediction, discrimination of the nomogram was determined based on the ROC with AUC of 0.751 (95% CI, 0.726-0.775) and 0.735 (95% CI, 0.696-0.774) in the training cohort and validation cohort respectively. The AUC of IHD-induced SCD prediction nomogram in the training cohort and validation cohort were 0.742 (95% CI, 0.716-0.768) and 0.738 (95% CI, 0.698-0.777). To facilitate the use of nomograms in routine casework in forensic practice, web calculators ( https://forensic.shinyapps.io/Forensic_SCD/ , https://forensic.shinyapps.io/Forensic_IHDinducedSCD/ ) were constructed. In conclusion, the present study developed and validated simple and practical nomograms for predicting the probability of SCD and IHD-induced SCD based on multiple autopsy variables. The nomograms have certain efficiency for discrimination and calibration to provide a novel approach to diagnose cause of death, and may become a valuable tool in forensic practice.

In fatalities caused by falls from height, the analysis of the injury pattern, alongside with circumstantial data, is crucial for understanding the dynamics of the incident. In rare cases, even a differentiation between accidental and intentional events might be possible. The injury pattern of the lower limbs is particularly significant in this context. In the present case - fall from height with primary impact on the feet - fractures of the lower limbs were diagnosed, including comminuted fractures in the middle-distal third of the tibiae and bilateral perforation of both feet and shoes by bone fragments. The longitudinal transmission of high kinetic energy caused by the impact could thus be proven. This specific feature allowed to conduct a complete and accurate assessment of injuries resulting from falls from height.

Purpose: Hypothermia occurs when core body temperature drops below 35 °C. The purpose of this review was to identify and analyze studies on the topic of hypothermia from an immunohistochemical perspective to determine robust markers of fatal hypothermia.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. It has been registered with Prospero (registration number: CRD42024572782).

Results: In total, 2618 publications met the search criteria. A total of 63 duplicate articles were excluded and a further 2489 publications were excluded for not meeting the inclusion criteria, leaving 29 full-text articles. Furthermore, from the bibliographies of the included articles, four more publications were selected, which also respected the established inclusion and exclusion criteria. Only six studies identified a statistically significant correlation between immunohistochemical patterns and hypothermia-related deaths.

Conclusion: The existing literature examined appears fragmented and lacks robust statistical validation. Therefore, there is an evident need for more comprehensive and methodologically rigorous research to develop reliable diagnostic criteria.

Neonatal sepsis is an important concern in the field of neonatology, contributing significantly to morbidity and mortality among newborns worldwide. Despite progress in medical care, the accurate diagnosis and comprehension of the pathological underpinnings of neonatal sepsis continue to present challenges. Conventional diagnostic autopsy (CDA) provides unique opportunities to gain insights into the histomorphological alterations associated with neonatal sepsis. There is a paucity of literature regarding autopsy-related histomorphological features in neonatal sepsis in various organs. This narrative review aims to glean data from published literature concerning autopsy-related histomorphological findings in neonatal sepsis, which would aid in understanding organ-related pathological changes and assisting pathologists in determining the exact cause of death.

Just like in other medical specialties, medical malpractice claims arise in pathology as well. Although the exact rate of malpractice related to pathology cannot be clearly stated in Turkey, it is known to occur more frequently during the diagnosis stage, as reported worldwide. This study discusses the measures that should be taken to prevent these claims by comparing cases with alleged malpractice in pathology, evaluated by the Council of Forensic Medicine, with the literature. Reports in which the pathologist or the procedure is directly or indirectly accused and in which a medical malpractice claim related to a pathologist or procedure was questioned, were retrospectively reviewed from the archive by the 7th Specialization Board of the Council of Forensic Medicine. The patients' clinical complaints, the procedures performed, histopathological diagnoses of tissue samples, the court inquiry, the re-evaluation of the slides in the relevant department, and the outcome of the relevant board were analyzed in conjunction with the literature. It was found that the majority of the cases were related to the breast (37.5%) and the urogenital system (37.5%). In seven cases, the court directly questioned the pathologist's fault, while in nine cases, the fault of all doctors was questioned. In two cases, the failure to perform immunohistochemical examination was considered a medical practice error. In the breast cases, the pathologist's diagnosis was incorrect in two cases, and in a lymphoma case, the pathologist's diagnostic error did not cause harm to the patient but was considered a lack of diligence. Improving the working conditions of pathologists, enhancing communication between clinicians and pathologists, having clinicians correlate pathology diagnoses with clinical findings before initiating treatment, and ensuring that immunohistochemical examinations are not neglected in necessary cases are among our medical recommendations. To ensure that the judicial process progresses within a scientific framework, we also recommend the establishment of Specialization Courts dedicated solely to malpractice, as well as the creation of a pool of expert pathologists who are trained and certified to serve as expert witnesses for the courts. Additionally, with future studies, medical malpractice claims related to pathology can be discussed in greater depth.

Uterine inversion refers to the condition where the fundus is turned inside and positioned within the uterine cavity. Uterine inversion is a life-threatening and uncommon obstetric emergency that can be fatal because of postpartum hemorrhage and shock. Acute uterine inversion is the most common type, which occurs within 24 h of delivery and is usually associated with untrained birth attendants and a lack of knowledge of labor-inducing drugs. We present a case of alleged medical negligence in the death of a 23-year-old female following vaginal delivery of a second child with autopsy findings suggestive of uterine inversion. The primary cause of death in this patient was postpartum hemorrhage and shock resulting from acute uterine inversion. This case underscores the importance of postmortem examinations in determining responsibility in legal proceedings.