Forensic Science, Medicine and Pathology最新文献

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.

Diabetes is a prevalent disease in modern society. Since the development and widespread use of synthetic insulin, its therapeutic application has become globally recognized for managing diabetes. However, excessive administration of insulin may lead to fatal outcomes. The rapid pharmacokinetics of insulin in the human body, combined with the lack of distinct pathological changes, makes the forensic identification of fatal insulin overdose challenging. In this study, we present two cases of fatal insulin overdose, one with a postmortem interval of up to 28 days. Postmortem specimens were collected and analyzed. Immunohistochemical and immunofluorescence assays revealed the consistent distribution of insulin and protamine at the injection sites in both cases. Insulin and protamine particles were observed in the epidermis, epidermal cells, adipocyte membranes, inter-adipocyte spaces, inflammatory cells, and glandular structures. Toxicological analyses confirmed the presence of insulin in the injected skin, subcutaneous fat, blood, urine, vitreous humor, and bile. This study provides valuable insights and guidelines for the forensic identification of insulin overdose cases.

The intestinal content of newborns is known as meconium, usually described as a black-greenish slimy substance. However, in rare cases, meconium might be yellow. This is of great relevance with regard to the forensic assessment of life birth, i.e. (longer) survival time and possible (breast-)feeding before death. While in older German forensic literature, yellow meconium has been occasionally mentioned from the 19th century on - without any conclusions being drawn from this finding whether the newborn was alive or had been fed -, current forensic literature does not provide information about this phenomenon. No reports of yellow meconium were found in (older) English forensic literature as well. We report two cases of newborn autopsies with yellow meconium and provide a short overview of the respective literature.

A man in his mid-70s passed out in a public 90-degree sauna and remained unconscious for at least half an hour. He suffered third-degree burns to approximately 50% of his body surface area. Despite immediate transport to a burn center and intensive care therapy, he did not regain consciousness and died eleven days later.When the body was opened, the lungs, liver, kidneys, and spleen showed changes consistent with the burns, intensive care therapy, and clinically suspected septic shock. The stomach contained approximately 200 ml of thickened chyme with coarse vegetable components. Such food components were not seen in the duodenum or in the following intestinal segments.Considering the overall circumstances, the stomach contents must have been the last meal the man had eaten before the sauna session. The problem of reduced gastrointestinal motility in burn patients is clinically recognized. Nevertheless, a complete failure of gastric emptying for eleven days after intensive care therapy has not been described before and shows that the use of gastric contents in forensic practice is inappropriate for drawing conclusions about the time interval between last food intake and death and thus for estimating the time of death.

The case presents a suicide committed by a 21-year-old man who thrusted a broken tree branch into his chest which penetrated to his heart and caused death. Despite the unusual tool, a tree branch, suicide was confirmed on the basis of similar attempted self-injury, which was committed several weeks earlier, and a history of mental disorders. The man committed suicide 3 days after leaving the psychiatric ward, where he had been hospitalized after being admitted immediately after his previous suicide attempt by self-stabbing with knife. He was discharged from the psychiatric hospital after 1.5 months therapy with diagnosis of improvement and denials of suicide thoughts. The presented case reflects the tragedy of a young man with mental disorders, who effectively committed suicide by using an unusual tool after several previous attempts made with the use of more frequently observed suicide methods. Such cases may cause problems to investigators as to whether the death was a result of suicide, homicide or accident. Therefore it is very important to complete the result of autopsy with analysis of medical history of the deceased, particularly regarding previous suicide attempts and psychiatric treatment. This is a first report of using such peculiar tool as tree branch to pierce the chest in effective suicide attempt.

This bibliometric investigation aimed to analyze trends in author self-citation within prominent forensic odontology literature and explore potential correlations between self-citation rates and publication attributes. We reviewed seven leading forensic sciences journals from 2003 to 2023. For this analysis, we focused on two specific timeframes: 2003-2007 and 2018-2023. Our review encompassed original research articles, reviews, and case reports. Eligible articles underwent detailed examination for article and author attributes and citation metrics. Utilizing univariable and multivariable negative binomial regression analyses, we explored potential associations between the number of self-citations and various publication characteristics. This study analyzed 415 articles related to forensic odontology, of which 237 (57.1%) included at least one self-citation. Key findings highlight prevalent topics such as dental age estimation and human dental identification. A significant portion of the studies involved prospective, retrospective, and cross-sectional designs, and there has been a notable increase in the number of reviews and meta-analyses in recent years compared to an equivalent past period. Self-citation was observed in over half of the analyzed articles, with a median total citation count of 31 and a median self-citation rate of 7.5%. Further bibliometric investigation is required to establish definitive conclusions regarding author self-citation patterns in forensic odontology literature, particularly by exploring longer time spans.

The diagnosis of malaria during the autopsy of a decomposed corpse may prove challenging. Macroscopic changes are non-specific and may include, among others, cerebral oedema, pulmonary oedema, hepatosplenomegaly and, on occasion, the presence of petechiae. The most effective diagnostic tools for malaria are the examination of blood smears and the use of rapid immunochromatographic tests. As a result of the progressive putrefaction of the corpse and blood hemolysis, classical tests are no longer viable. Consequently, the sole remaining option is the utilisation of real-time reaction (RT-PCR) to ascertain the presence of plasmodium DNA in specific organs. This study concerns the diagnosis of a fatal form of cerebral malaria in a 23-year-old Caucasian male who had travelled to Africa. The autopsy was conducted at a local hospital, after which the body was embalmed and stored in cold storage for a period of 8.5 months. Subsequently, the corpse was transported to Poland, where a further forensic autopsy was conducted. A significant challenge was to confirm the presence of malaria in a corpse that had been embalmed several months prior to the investigation. Samples were obtained from internal organs for genetic analysis to determine the presence of parasite DNA. An RT-PCR test was conducted on genetic material obtained from the brain, heart, lungs, kidney, liver, and spleen. The presence of Plasmodium falciparum genetic material was identified in samples obtained from the brain, lungs, kidney, liver, and spleen. These findings substantiated the post-mortem diagnosis of a severe form of cerebral malaria, which was the underlying cause of death.

A mixture of baking soda (sodium hydrogen carbonate) and citric acid is used for cleaning purposes, but, in recent years, this mixture has been introduced on the internet as a method for suicide. Here, we report a case in which the two agents were mixed in a bathtub to generate carbon dioxide (CO₂). A man in his early 60s was found dead in his clothes in a bathtub with a lid. Postmortem changes were somewhat progressed, but only pulmonary edema was observed, with no injuries or lesions that could have led to cause of death, and no drug toxicants detected. Empty containers of baking soda (789 g) and citric acid (850 g) were found at the scene. We conducted a reproduction experiment showing that CO₂ reached a lethal concentration (~ 60%) within 12 s, but the O₂ concentration was about 10%, which is not a lethal concentration. Therefore, it is highly likely that the man died of CO₂ intoxication within a short period of time and before he would have suffered asphyxiation due to oxygen deficiency. Normally, this result can only be obtained with the cooperation of an investigative agency and a large-scale reproduction experiment, but we were able to diagnose the cause of his death, including a differential diagnosis of asphyxia due to oxygen deficiency, by means of a reproduction model at 1/35 scale that could easily be performed in the laboratory.