Pub Date : 2025-02-01DOI: 10.1016/j.jflm.2025.102827
Ikram Kort , Khaled Bchir , Mohamed Belleli , Ons Hmandi , Syrine Mannoubi , Mohamed Allouche
Background
Complex suicide, whether planned or unplanned, presents significant challenges for forensic specialists and judicial authorities. Although rare, each case requires a thorough examination of both the body and the scene of death.
This study aims to analyze the pattern of complex suicide victims in northern Tunisia, comparing them with simple suicide cases.
Methods
This was a retrospective observational study with retrospective data collection. We included all cases of simple and complex suicides, autopsied at the Department of Legal Medicine of Tunis, from 2005 to 2021.
Results
In total, 72 complex suicides (3.3 % of 2153 suicide fatalities) were identified, with 35 planned and 37 unplanned complex suicides. Males represented 77.8 % of the cases and their mean age was 42.2 ± 15 years. A history of mental illness was reported in 31.9 %. Two suicide methods were used in 93.1 % of cases. The most frequent combination was poisoning and hanging (29.2 %), followed by drowning and falling from a height (12.5 %). The most common single methods were hanging (48.6 %), poisoning (55.6 %), sharp force (31.9 %), and fall from a height (25.0 %). The latter three methods were significantly higher than simple suicides (p < 0.001).
Conclusions
Complex suicide is infrequent and presents significant investigative challenges. A detailed analysis of the victim's background, an on-site inspection of the scene, reconstruction of the events, and a complete autopsy are essential to determine the cause and manner of death.
{"title":"Complex versus simple suicides in Northern Tunisia: A 17 years autopsy-based study","authors":"Ikram Kort , Khaled Bchir , Mohamed Belleli , Ons Hmandi , Syrine Mannoubi , Mohamed Allouche","doi":"10.1016/j.jflm.2025.102827","DOIUrl":"10.1016/j.jflm.2025.102827","url":null,"abstract":"<div><h3>Background</h3><div>Complex suicide, whether planned or unplanned, presents significant challenges for forensic specialists and judicial authorities. Although rare, each case requires a thorough examination of both the body and the scene of death.</div><div>This study aims to analyze the pattern of complex suicide victims in northern Tunisia, comparing them with simple suicide cases.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study with retrospective data collection. We included all cases of simple and complex suicides, autopsied at the Department of Legal Medicine of Tunis, from 2005 to 2021.</div></div><div><h3>Results</h3><div>In total, 72 complex suicides (3.3 % of 2153 suicide fatalities) were identified, with 35 planned and 37 unplanned complex suicides. Males represented 77.8 % of the cases and their mean age was 42.2 ± 15 years. A history of mental illness was reported in 31.9 %. Two suicide methods were used in 93.1 % of cases. The most frequent combination was poisoning and hanging (29.2 %), followed by drowning and falling from a height (12.5 %). The most common single methods were hanging (48.6 %), poisoning (55.6 %), sharp force (31.9 %), and fall from a height (25.0 %). The latter three methods were significantly higher than simple suicides (p < 0.001).</div></div><div><h3>Conclusions</h3><div>Complex suicide is infrequent and presents significant investigative challenges. A detailed analysis of the victim's background, an on-site inspection of the scene, reconstruction of the events, and a complete autopsy are essential to determine the cause and manner of death.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102827"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jflm.2025.102826
Vanita Parekh , Anna Brkic , Janine McMinn , David Williams , Caleb Boxx , Laura Bailey , Jane Van Diemen
Background
Non-fatal strangulation (NFS) is a major risk factor for female homicide. Victims may present in a variety of clinical settings. In this study, we analysed reported signs, symptoms and injuries following NFS.
Methods
This is a clinical audit of 170 NFS victims who underwent a documented clinical examination, including forensic photography.
Results
Patients reported neck pain (77.6 %), an inability to breathe (60 %), headache (55.9 %), sore throat (52.9 %) and voice changes (47.1 %). In 76.5 % neck injuries were detected comprising non-petechial bruising (59.2 %), linear abrasions (scratch marks) (25.4 %), neck swelling (12.3 %), petechial haemorrhage (7.7 %) and ligature marks (1.5 %) with no detectable neck injury in 23.5 % of cases. There was no typical patient profile of NFS signs, symptoms or injuries or correlation of any signs, despite extensive interrogation by statistical analyses.
Conclusions
To assist with therapeutic care and forensic evidence collection following NFS, signs, symptoms and injuries should be documented. A lack of detectable injury to the neck following NFS does not exclude NFS. In addition, detectable injury may indicate a defensive response by the patient and/or multiple applications of force.
{"title":"Informing therapeutic care and legal process in assault cases involving non-fatal strangulation","authors":"Vanita Parekh , Anna Brkic , Janine McMinn , David Williams , Caleb Boxx , Laura Bailey , Jane Van Diemen","doi":"10.1016/j.jflm.2025.102826","DOIUrl":"10.1016/j.jflm.2025.102826","url":null,"abstract":"<div><h3>Background</h3><div>Non-fatal strangulation (NFS) is a major risk factor for female homicide. Victims may present in a variety of clinical settings. In this study, we analysed reported signs, symptoms and injuries following NFS.</div></div><div><h3>Methods</h3><div>This is a clinical audit of 170 NFS victims who underwent a documented clinical examination, including forensic photography.</div></div><div><h3>Results</h3><div>Patients reported neck pain (77.6 %), an inability to breathe (60 %), headache (55.9 %), sore throat (52.9 %) and voice changes (47.1 %). In 76.5 % neck injuries were detected comprising non-petechial bruising (59.2 %), linear abrasions (scratch marks) (25.4 %), neck swelling (12.3 %), petechial haemorrhage (7.7 %) and ligature marks (1.5 %) with no detectable neck injury in 23.5 % of cases. There was no typical patient profile of NFS signs, symptoms or injuries or correlation of any signs, despite extensive interrogation by statistical analyses.</div></div><div><h3>Conclusions</h3><div>To assist with therapeutic care and forensic evidence collection following NFS, signs, symptoms and injuries should be documented. A lack of detectable injury to the neck following NFS does not exclude NFS. In addition, detectable injury may indicate a defensive response by the patient and/or multiple applications of force.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102826"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Attention to cases of death in custody and their prevention is an issue of increasing concern. However, the available epidemiological data on these events remain scarce and uncertain, hindering a comprehensive understanding of the issue and the effective implementation of intervention strategies. After reviewing the definition of death in custody and international legislation regarding systematic approaches to forensic investigations, our study aimed to analyze the available data within the Italian context and compare it with international findings. We discussed the emerging critical points to identify potential solutions. Epidemiological data from registers, reports, and individual international studies were extracted and analyzed. A statistical comparison was conducted for data obtained from the records of the Italian Department of Penitentiary Administration for the period 1992–2021. A significant and moderate correlation emerged between the average incarcerated population per year and the number of deaths due to natural causes (r = 0.459, p = 0.005), while no significant correlation emerged between the first and the number of deaths due to suicide (r = 0.294, p = 0.058). In addition, no significant correlations emerged between the overcrowding index and the number of deaths due to natural causes or suicide (respectively, p = 0.703 and p = 0.056). Furthermore, a concerning discrepancy emerged between national and international data regarding the causes of death in custody, especially for suicides, along with a lack of in-depth and certain data. The relevance of the issue sets the necessity of a reflection on the need for changes at multiple levels. From a legislative perspective, it is proposed to establish a forensic investigation for all deaths in custody. Such a function could be assumed by specialized university centers, independent of other institutions, capable of ensuring training, research, high quality, and timely delivery of results. The implementation of protocols and procedures, along with the recording of easily accessible data, could ultimately ensure the safety of results and transparency, triggering a socially beneficial virtuous cycle.
{"title":"Establishing the truth in deaths in custody: From an analysis of the Italian context to prospects for quality improvement in forensic pathology","authors":"Donato Morena , Cecilia Lugi , Matteo Scopetti , Martina Padovano , Emanuela Turillazzi , Raffaella Rinaldi , Paola Frati , Vittorio Fineschi","doi":"10.1016/j.jflm.2025.102830","DOIUrl":"10.1016/j.jflm.2025.102830","url":null,"abstract":"<div><div>Attention to cases of death in custody and their prevention is an issue of increasing concern. However, the available epidemiological data on these events remain scarce and uncertain, hindering a comprehensive understanding of the issue and the effective implementation of intervention strategies. After reviewing the definition of death in custody and international legislation regarding systematic approaches to forensic investigations, our study aimed to analyze the available data within the Italian context and compare it with international findings. We discussed the emerging critical points to identify potential solutions. Epidemiological data from registers, reports, and individual international studies were extracted and analyzed. A statistical comparison was conducted for data obtained from the records of the Italian Department of Penitentiary Administration for the period 1992–2021. A significant and moderate correlation emerged between the average incarcerated population per year and the number of deaths due to natural causes (r = 0.459, p = 0.005), while no significant correlation emerged between the first and the number of deaths due to suicide (r = 0.294, p = 0.058). In addition, no significant correlations emerged between the overcrowding index and the number of deaths due to natural causes or suicide (respectively, p = 0.703 and p = 0.056). Furthermore, a concerning discrepancy emerged between national and international data regarding the causes of death in custody, especially for suicides, along with a lack of in-depth and certain data. The relevance of the issue sets the necessity of a reflection on the need for changes at multiple levels. From a legislative perspective, it is proposed to establish a forensic investigation for all deaths in custody. Such a function could be assumed by specialized university centers, independent of other institutions, capable of ensuring training, research, high quality, and timely delivery of results. The implementation of protocols and procedures, along with the recording of easily accessible data, could ultimately ensure the safety of results and transparency, triggering a socially beneficial virtuous cycle.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102830"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jflm.2025.102813
Roy Amritha, P. Parvana, K.S. Riza, Isukapatla Arjun Rao
Psychological autopsy studies are a method to understand the causes of equivocal deaths. Suicides and homicide-suicide are the result of various events. The understanding of an individual's life before their death, by interviewing the next of kin, provides some insight into the causes. The research articles dealing with psychological autopsy studies through case studies of suicide or homicide-suicide instances, obtained from different search engines, shed light on the mental health, Alcohol use disorder (AUD), and Drug use disorders (DUD) of individuals before death. The primary characteristic of suicides in a population of late twenties to early fifties was romantic relationship conflicts. In contrast, suicides in the teenage years and early twenties were characterized primarily by a lack of familial acceptability and, to a lesser extent, self-acceptance. Simultaneously, there was a high risk of suicidal behavior and commission of acts among the DUD patients, getting treatment without psychiatric diagnosis and therapy. Over time, the psychological autopsy technique has shown to be quite helpful in determining the risk factors for suicidal behavior. The study helps to develop multiple rehabilitation and mental awareness that need to be created among various populations so that the suicide and homicide-suicide rates can be reduced.
{"title":"Psychological autopsy: Overview of equivocal deaths, suicides and homicide-suicides","authors":"Roy Amritha, P. Parvana, K.S. Riza, Isukapatla Arjun Rao","doi":"10.1016/j.jflm.2025.102813","DOIUrl":"10.1016/j.jflm.2025.102813","url":null,"abstract":"<div><div>Psychological autopsy studies are a method to understand the causes of equivocal deaths. Suicides and homicide-suicide are the result of various events. The understanding of an individual's life before their death, by interviewing the next of kin, provides some insight into the causes. The research articles dealing with psychological autopsy studies through case studies of suicide or homicide-suicide instances, obtained from different search engines, shed light on the mental health, Alcohol use disorder (AUD), and Drug use disorders (DUD) of individuals before death. The primary characteristic of suicides in a population of late twenties to early fifties was romantic relationship conflicts. In contrast, suicides in the teenage years and early twenties were characterized primarily by a lack of familial acceptability and, to a lesser extent, self-acceptance. Simultaneously, there was a high risk of suicidal behavior and commission of acts among the DUD patients, getting treatment without psychiatric diagnosis and therapy. Over time, the psychological autopsy technique has shown to be quite helpful in determining the risk factors for suicidal behavior. The study helps to develop multiple rehabilitation and mental awareness that need to be created among various populations so that the suicide and homicide-suicide rates can be reduced.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102813"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jflm.2025.102814
Junko Fujihara
Cell-free DNA (cfDNA) is DNA released from dying cells into the serum. The aim of the present study is to elucidate the mechanism of cell-free DNA (cfDNA) release in postmortem subjects by assaying Cytokeratin 18 (M30 and M65), cyclophilin A (CyPA), and myeloperoxidase (MPO) levels and to evaluate whether these levels are useful as markers for estimating postmortem intervals. Serum (n = 54) was sampled from postmortem autopsied Japanese subjects. cfDNA was extracted and M30, M65, CyPA, and MPO in serum were assayed by enzyme-linked immunosorbent assay. Significantly higher serum levels of M30, M65, and MPO were observed in postmortem subjects than in living subjects. Although the difference was smaller, CyPA was also significantly higher in postmortem subjects than in living subjects. In addition, serum M30 and MPO levels were significantly correlated with cfDNA concentrations in postmortem subjects. Furthermore, M30 levels slightly increased according to the postmortem interval, and MPO levels at 2.5 days were significantly higher than those at <2 days. The result of regression analysis revealed a significant difference between M30/MPO levels and postmortem intervals. These findings suggested that elevated levels of cfDNA in postmortem subjects are released by apoptosis and neutrophils via NETosis and that M30 and MPO levels can be used as markers to estimate postmortem intervals.
{"title":"The mechanism of serum cell-free DNA release in postmortem subjects and novel markers to estimate the postmortem intervals","authors":"Junko Fujihara","doi":"10.1016/j.jflm.2025.102814","DOIUrl":"10.1016/j.jflm.2025.102814","url":null,"abstract":"<div><div>Cell-free DNA (cfDNA) is DNA released from dying cells into the serum. The aim of the present study is to elucidate the mechanism of cell-free DNA (cfDNA) release in postmortem subjects by assaying Cytokeratin 18 (M30 and M65), cyclophilin A (CyPA), and myeloperoxidase (MPO) levels and to evaluate whether these levels are useful as markers for estimating postmortem intervals. Serum (<em>n</em> = 54) was sampled from postmortem autopsied Japanese subjects. cfDNA was extracted and M30, M65, CyPA, and MPO in serum were assayed by enzyme-linked immunosorbent assay. Significantly higher serum levels of M30, M65, and MPO were observed in postmortem subjects than in living subjects. Although the difference was smaller, CyPA was also significantly higher in postmortem subjects than in living subjects. In addition, serum M30 and MPO levels were significantly correlated with cfDNA concentrations in postmortem subjects. Furthermore, M30 levels slightly increased according to the postmortem interval, and MPO levels at 2.5 days were significantly higher than those at <2 days. The result of regression analysis revealed a significant difference between M30/MPO levels and postmortem intervals. These findings suggested that elevated levels of cfDNA in postmortem subjects are released by apoptosis and neutrophils via NETosis and that M30 and MPO levels can be used as markers to estimate postmortem intervals.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102814"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abnormal uterine bleeding (AUB) can be caused by uterine tumors, both benign and malignant, although they rarely lead to fatal vascular complications. We present a case of a woman found dead in her home, in which the autopsy highlighted a massive retroperitoneal haemorrhage extending to the left renal lodge and a voluminous uterine tumor of stony consistency and exophytic growth weighing 2250g. The histopathological examination identified the mass as a leiomyosarcoma and demonstrated the presence of a dilation with rupture of the left renal vein, in the absence of neoplastic cells infiltrating the vascular wall.
On these findings, it was concluded that the neoplastic mass had caused external compression of the left renal vein, leading to its rupture and to a fatal retroperitoneal haemorrhage. The case was considered of interest as it involved a peculiar etiopathogenetic mechanism causing a lethal complication from uterine leiomyosarcoma which has not yet been reported in the literature.
{"title":"Uterine leiomyosarcoma as a rare cause of fatal retroperitoneal haemorrhage due to compression and rupture of the renal vein","authors":"Giorgia Lodetti , Stefano Tambuzzi , Salvatore Andreola, Guendalina Gentile, Riccardo Zoja","doi":"10.1016/j.jflm.2025.102804","DOIUrl":"10.1016/j.jflm.2025.102804","url":null,"abstract":"<div><div>Abnormal uterine bleeding (AUB) can be caused by uterine tumors, both benign and malignant, although they rarely lead to fatal vascular complications. We present a case of a woman found dead in her home, in which the autopsy highlighted a massive retroperitoneal haemorrhage extending to the left renal lodge and a voluminous uterine tumor of stony consistency and exophytic growth weighing 2250g. The histopathological examination identified the mass as a leiomyosarcoma and demonstrated the presence of a dilation with rupture of the left renal vein, in the absence of neoplastic cells infiltrating the vascular wall.</div><div>On these findings, it was concluded that the neoplastic mass had caused external compression of the left renal vein, leading to its rupture and to a fatal retroperitoneal haemorrhage. The case was considered of interest as it involved a peculiar etiopathogenetic mechanism causing a lethal complication from uterine leiomyosarcoma which has not yet been reported in the literature.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102804"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jflm.2025.102825
Xing-yu Ma , Tian-qi Wang , Ke-shuang Tang , Ya-qi Yang , Zhi-xin Bai , Xuan Zhang , Dong Zhao
Sudden cardiac death (SCD) caused by ischemia heart disease (IHD) has traditionally been identified through autopsy and microscopic examination. However, these methods are limited in diagnosing cases of acute ischemia heart disease (AIHD) without typical myocardial necrosis and excessive reliance on the subjective experience of experts. Postmortem biochemistry is crucial in the assisted diagnosis of SCD in forensic medicine. We evaluated the expression levels of six sensitive biomarkers of myocardial injury in the training-set comprising 78 cases of acute ischemia (AI), 23 cases of acute myocardial infarction (MI), and 37 cases who died of high falls. The results showed that CK-MB, cTnI, BNP, LDH, and HBDH may be of great significance in diagnosing sudden death of AIHD. Among these, BNP, LDH, and HBDH are particularly useful for distinguishing between AI and acute MI. Using receiver operating analysis, we identified that the combination of five biomarkers-BNP, cTnI, CK-MB, LDH, and HBDH-achieved a significantly higher diagnostic accuracy for AIHD, with an AUC of 0.910. This combination outperformed the traditional three-biomarker combination (CK-MB, cTnI, BNP), which was considered highly accurate but only had an AUC of 0.857. Additionally, a three-biomarker combination (BNP, HBDH, and LDH) demonstrated clear advantages in differentiating between AI and acute MI, with an AUC of 0.794. Validation-set results proved that the strategy of finding the unique combination based on postmortem biochemistry is effective. It can provide valuable information for the discrimination of AIHD and the identification of AI and acute MI.
{"title":"Study on forensic diagnostic biomarker combination for acute ischemia heart disease based on postmortem biochemistry","authors":"Xing-yu Ma , Tian-qi Wang , Ke-shuang Tang , Ya-qi Yang , Zhi-xin Bai , Xuan Zhang , Dong Zhao","doi":"10.1016/j.jflm.2025.102825","DOIUrl":"10.1016/j.jflm.2025.102825","url":null,"abstract":"<div><div>Sudden cardiac death (SCD) caused by ischemia heart disease (IHD) has traditionally been identified through autopsy and microscopic examination. However, these methods are limited in diagnosing cases of acute ischemia heart disease (AIHD) without typical myocardial necrosis and excessive reliance on the subjective experience of experts. Postmortem biochemistry is crucial in the assisted diagnosis of SCD in forensic medicine. We evaluated the expression levels of six sensitive biomarkers of myocardial injury in the training-set comprising 78 cases of acute ischemia (AI), 23 cases of acute myocardial infarction (MI), and 37 cases who died of high falls. The results showed that CK-MB, cTnI, BNP, LDH, and HBDH may be of great significance in diagnosing sudden death of AIHD. Among these, BNP, LDH, and HBDH are particularly useful for distinguishing between AI and acute MI. Using receiver operating analysis, we identified that the combination of five biomarkers-BNP, cTnI, CK-MB, LDH, and HBDH-achieved a significantly higher diagnostic accuracy for AIHD, with an AUC of 0.910. This combination outperformed the traditional three-biomarker combination (CK-MB, cTnI, BNP), which was considered highly accurate but only had an AUC of 0.857. Additionally, a three-biomarker combination (BNP, HBDH, and LDH) demonstrated clear advantages in differentiating between AI and acute MI, with an AUC of 0.794. Validation-set results proved that the strategy of finding the unique combination based on postmortem biochemistry is effective. It can provide valuable information for the discrimination of AIHD and the identification of AI and acute MI.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102825"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143194660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jflm.2025.102834
Kate Willmot , Rachael Thomas , Radhika Seimon , Naomi Derrick , Michael M. Dinh , David J. Templeton
Background
Emergency Departments (ED) are a primary avenue for the initial assessment of sexual assault presentations in Australia. The aim of this study was to outline demographics and assault characteristics of people presenting to a Sexual Assault Service (SAS).
Methods
A retrospective review of 1218 presentations to the SAS in an ED of a tertiary referral centre in metropolitan Sydney between January 2020–May 2024 was conducted using the Medical Forensic Examination Record and electronic Medical Record. Variables related to nature of the assault, injuries, the ingestion of drugs or alcohol, sexually transmitted infections, and nature of the relationship with the perpetrator were assessed.
Results
Of all presentations, 89 % of cases identified as female, with a median (interquartile range) age of 26.8 (13.7) years. Victims reported that they consumed alcohol (n = 553, 45.4 %) and/or drugs (n = 368, 30.2 %) around the time of assault in a manner where it may have impacted their level of consciousness at the time of the assault. Penile-vaginal penetration was the most common mode of assault (54.6 %), while 37.4 % of cases were found to have bodily injuries documented. Chlamydia and gonorrhoea were detected in 4.5 % and 0.8 % of presentations respectively. Of all assaults 14.6 % were perpetrated by an intimate partner.
Conclusion
Most victims of sexual assault were young females and involved penile-vaginal penetration. Intimate Partner Violence accounted for a large number of sexual assault presentations. Our findings will improve local understanding of sexual assault amongst Forensic Medical Examiner (FMEs) and Emergency physicians and inform future staffing, resourcing and research.
{"title":"Demographics and characteristics of acute sexual assault presentations to a sexual assault service within metropolitan Sydney","authors":"Kate Willmot , Rachael Thomas , Radhika Seimon , Naomi Derrick , Michael M. Dinh , David J. Templeton","doi":"10.1016/j.jflm.2025.102834","DOIUrl":"10.1016/j.jflm.2025.102834","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Departments (ED) are a primary avenue for the initial assessment of sexual assault presentations in Australia. The aim of this study was to outline demographics and assault characteristics of people presenting to a Sexual Assault Service (SAS).</div></div><div><h3>Methods</h3><div>A retrospective review of 1218 presentations to the SAS in an ED of a tertiary referral centre in metropolitan Sydney between January 2020–May 2024 was conducted using the Medical Forensic Examination Record and electronic Medical Record. Variables related to nature of the assault, injuries, the ingestion of drugs or alcohol, sexually transmitted infections, and nature of the relationship with the perpetrator were assessed.</div></div><div><h3>Results</h3><div>Of all presentations, 89 % of cases identified as female, with a median (interquartile range) age of 26.8 (13.7) years. Victims reported that they consumed alcohol (n = 553, 45.4 %) and/or drugs (n = 368, 30.2 %) around the time of assault in a manner where it may have impacted their level of consciousness at the time of the assault. Penile-vaginal penetration was the most common mode of assault (54.6 %), while 37.4 % of cases were found to have bodily injuries documented. Chlamydia and gonorrhoea were detected in 4.5 % and 0.8 % of presentations respectively. Of all assaults 14.6 % were perpetrated by an intimate partner.</div></div><div><h3>Conclusion</h3><div>Most victims of sexual assault were young females and involved penile-vaginal penetration. Intimate Partner Violence accounted for a large number of sexual assault presentations. Our findings will improve local understanding of sexual assault amongst Forensic Medical Examiner (FMEs) and Emergency physicians and inform future staffing, resourcing and research.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"110 ","pages":"Article 102834"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-27DOI: 10.1016/j.jflm.2025.102811
Leah S. Wilk , Richelle J.M. Hoveling , Maud F.A.M. van Velthoven , Huub G.T. Nijs , Maurice C.G. Aalders
The detection and visualization of sub-dermal hematoma (bruises) plays a key role in suspected physical abuse cases, as it aids in the evaluation of both victim and suspect statements. Current methods rely on visual inspection, frequently aided by alternate light sources (ALS). Ideally, ALS increase visual contrast by exploiting differences in light absorption (due to the formation and clearance of chromophores within the bruise). However, in practice the achievable contrast is often limited by light-scattering: the short-wavelength region of the spectrum (comprising most of the chromophore-specific absorption peaks), is also strongly scattered by the dermal tissue. This, in turn, limits achievable penetration depths, effectively obscuring deep-lying bruises. ALS-based contrast enhancement is further complicated by bruise healing; diffusion and enzymatic activity alter the chromophore concentrations as well as their 3D-distribution within the tissue. To overcome these critical limitations, we employ a multi-spectral camera (8 wavelengths simultaneously) in conjunction with both observer-based scoring and a contrast-quantification algorithm to determine the optimal wavelength for the detection and characterization of bruises over time. We show that (i) bruise contrast significantly increases at 480 nm, 620 nm and 850 nm and (ii) the wavelength achieving optimal contrast gradually changes from 850 nm to 578 nm–480 nm as the bruise heals.
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Pub Date : 2025-01-01DOI: 10.1016/j.jflm.2024.102799
Roger W. Byard
Kodokushi is a Japanese term where ‘a person dies without being cared for by anyone, and whose body is found after a certain period’. These cases have also been called ‘lonely deaths’. Few forensic studies exist. Using decomposition as a surrogate marker for social isolation the following study was undertaken. Pathology files from Forensic Science SA (FSSA), Adelaide, South Australia were reviewed for all cases aged ≥60 years where death had occurred at home and where there was moderate to marked decomposition. Two five-year time periods were selected for comparison. There were 27 cases from 2000 to 2004, out of a total of 1673 autopsies (1.6 %), (M:F = 21:6; age range 60–90 years, ave. 72.8; post mortem intervals 3–60 days, mean 10.7 days). The majority of deaths were due to natural causes (N = 22), with 2 suicides and 3 undetermined. There were 67 cases between 2019 and 2023, out of a total of 696 autopsies (9.6 %), (M:F = 52:15; age range 60–91 years, ave. 69.4 years; post mortem intervals 3–240 days, mean 21 days). The majority of deaths were due to natural causes (N = 55), with 3 suicides and 9 undetermined. Comparing the two time periods showed a predominance of males (78 %) dying of ischaemic heart disease in each cohort (67 and 60 % respectively). The average ages were similar (72.8 and 69.4 years respectively). There was a significant increase in the number of cases over the two decades of the study: 27 to 67 (p < 0.001), with an increase in the post mortem interval from 10.7 to 21 days. It appears that increasing numbers of socially isolated elders are occurring in an Australia population. These individuals have higher rates of certain mental and physical disorders and may present unique diagnostic challenges.
{"title":"The forensic implications of lonely deaths (Kodokushi) – A South Australian study","authors":"Roger W. Byard","doi":"10.1016/j.jflm.2024.102799","DOIUrl":"10.1016/j.jflm.2024.102799","url":null,"abstract":"<div><div><em>Kodokushi</em> is a Japanese term where ‘a person dies without being cared for by anyone, and whose body is found after a certain period’. These cases have also been called ‘lonely deaths’. Few forensic studies exist. Using decomposition as a surrogate marker for social isolation the following study was undertaken. Pathology files from Forensic Science SA (FSSA), Adelaide, South Australia were reviewed for all cases aged ≥60 years where death had occurred at home and where there was moderate to marked decomposition. Two five-year time periods were selected for comparison. There were 27 cases from 2000 to 2004, out of a total of 1673 autopsies (1.6 %), (M:F = 21:6; age range 60–90 years, ave. 72.8; post mortem intervals 3–60 days, mean 10.7 days). The majority of deaths were due to natural causes (N = 22), with 2 suicides and 3 undetermined. There were 67 cases between 2019 and 2023, out of a total of 696 autopsies (9.6 %), (M:F = 52:15; age range 60–91 years, ave. 69.4 years; post mortem intervals 3–240 days, mean 21 days). The majority of deaths were due to natural causes (N = 55), with 3 suicides and 9 undetermined. Comparing the two time periods showed a predominance of males (78 %) dying of ischaemic heart disease in each cohort (67 and 60 % respectively). The average ages were similar (72.8 and 69.4 years respectively). There was a significant increase in the number of cases over the two decades of the study: 27 to 67 (p < 0.001), with an increase in the post mortem interval from 10.7 to 21 days. It appears that increasing numbers of socially isolated elders are occurring in an Australia population. These individuals have higher rates of certain mental and physical disorders and may present unique diagnostic challenges.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"109 ","pages":"Article 102799"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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