Facial soft tissue thickness (FSTT) constitutes one of the most critical variables in forensic craniofacial reconstruction, and the application of advanced imaging modalities such as magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT) can strengthen confidence in these technologies. Using MRI, we evaluated FSTT at 29 anatomical landmarks in 36 healthy adults. We conducted standardised infrared facial imaging on the same participants to obtain 26 anthropometric measurements. We generated three digital facial reconstructions using anonymised three-dimensional skull models and ZBrush software. Under double-blinded conditions, we reconstructed two skulls, one male and one female. In the female case, we applied a postural correction factor to account for the supine imaging orientation, whereas we completed the male reconstruction without adjustment. We assessed the anatomical accuracy of both reconstructions using public recognition surveys and facial resemblance analysis with FaceVACS software. For the third case, we applied region-specific FSTT values derived from CBCT in a real forensic investigation in Karnataka, India. Investigators disseminated the reconstructed face as an investigative aid and subsequently contributed to the identification of a missing person, with identity confirmed through police records. These findings indicate that posture-corrected MRI-derived data and regionally calibrated CBCT datasets improve anatomical accuracy in three-dimensional facial reconstruction, thereby enhancing its utility in forensic identification, particularly within the Indian context.
{"title":"From skull to face: MRI vs. CBCT-based soft tissue depths in forensic 3D craniofacial reconstruction","authors":"Anurag Dubey , Raja Rupani , Garima Sehgal , Anit Parihar , Ashutosh Deo Tiwari , Shiuli Rathore , Anoop Kumar Verma , Abhishek Mishra , Sandeep Bhattacharya","doi":"10.1016/j.jflm.2026.103073","DOIUrl":"10.1016/j.jflm.2026.103073","url":null,"abstract":"<div><div>Facial soft tissue thickness (FSTT) constitutes one of the most critical variables in forensic craniofacial reconstruction, and the application of advanced imaging modalities such as magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT) can strengthen confidence in these technologies. Using MRI, we evaluated FSTT at 29 anatomical landmarks in 36 healthy adults. We conducted standardised infrared facial imaging on the same participants to obtain 26 anthropometric measurements. We generated three digital facial reconstructions using anonymised three-dimensional skull models and ZBrush software. Under double-blinded conditions, we reconstructed two skulls, one male and one female. In the female case, we applied a postural correction factor to account for the supine imaging orientation, whereas we completed the male reconstruction without adjustment. We assessed the anatomical accuracy of both reconstructions using public recognition surveys and facial resemblance analysis with FaceVACS software. For the third case, we applied region-specific FSTT values derived from CBCT in a real forensic investigation in Karnataka, India. Investigators disseminated the reconstructed face as an investigative aid and subsequently contributed to the identification of a missing person, with identity confirmed through police records. These findings indicate that posture-corrected MRI-derived data and regionally calibrated CBCT datasets improve anatomical accuracy in three-dimensional facial reconstruction, thereby enhancing its utility in forensic identification, particularly within the Indian context.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103073"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047578","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 : 2026-02-01Epub Date: 2026-01-03DOI: 10.1016/j.jflm.2026.103071
Mustafa Okudan , Doruktan Tufekci , Fatma Ofluoglu , Mahmut Asirdizer
Background
Most deaths in closed-space fires occur due to inhalation of carbon monoxide, hydrogen cyanide, and other gases in the environment.
Material and methods
This study retrospectively examined 42 forensic autopsy reports and the associated crime scene reports of individuals who died in indoor fires. The autopsies were performed at the Morgue Department of the Forensic Medicine Institute in 2022 and 2023.
Results
Cyanide analysis was not conducted in 33.3 % of the 42 cases, and cyanide was detected in only 10.7 % of the 28 cases in which blood cyanide analysis was requested. All cases had positive carboxyhemoglobin levels, although 76.2 % of cases had HbCO values more than 10 %. More than half of the deaths occurred at the scene, primarily in the victims' homes. All cases had burns on their bodies, ranging from second degree to carbonization degree, and soot contamination in the upper and lower respiratory tracts was determined in 77.7 %. The toxicological analysis of blood from victims who received medical treatment, either in ambulances or hospitals, showed no evidence of antidote administration.
Conclusion
The findings of this study highlight the importance of collecting blood samples from the bodies of those who have died at the fire scene, administering cyanide antidotes to survivors via immediate intravenous injection after smoke exposure, and testing survivors for metabolites due to the short half-life of cyanide. For the prevention of cyanide poisoning exposure, and implementation of the administrative actions and training that medical professionals in Türkiye should undertake to assist victims who survive smoke exposure, a brief review is also provided of the legal requirements that must be followed in the construction and interior design of buildings where people congregate.
{"title":"Examining the role of cyanide poisoning in the autopsies of closed-space fire deaths in Istanbul (Türkiye)","authors":"Mustafa Okudan , Doruktan Tufekci , Fatma Ofluoglu , Mahmut Asirdizer","doi":"10.1016/j.jflm.2026.103071","DOIUrl":"10.1016/j.jflm.2026.103071","url":null,"abstract":"<div><h3>Background</h3><div>Most deaths in closed-space fires occur due to inhalation of carbon monoxide, hydrogen cyanide, and other gases in the environment.</div></div><div><h3>Material and methods</h3><div>This study retrospectively examined 42 forensic autopsy reports and the associated crime scene reports of individuals who died in indoor fires. The autopsies were performed at the Morgue Department of the Forensic Medicine Institute in 2022 and 2023.</div></div><div><h3>Results</h3><div>Cyanide analysis was not conducted in 33.3 % of the 42 cases, and cyanide was detected in only 10.7 % of the 28 cases in which blood cyanide analysis was requested. All cases had positive carboxyhemoglobin levels, although 76.2 % of cases had HbCO values more than 10 %. More than half of the deaths occurred at the scene, primarily in the victims' homes. All cases had burns on their bodies, ranging from second degree to carbonization degree, and soot contamination in the upper and lower respiratory tracts was determined in 77.7 %. The toxicological analysis of blood from victims who received medical treatment, either in ambulances or hospitals, showed no evidence of antidote administration.</div></div><div><h3>Conclusion</h3><div>The findings of this study highlight the importance of collecting blood samples from the bodies of those who have died at the fire scene, administering cyanide antidotes to survivors via immediate intravenous injection after smoke exposure, and testing survivors for metabolites due to the short half-life of cyanide. For the prevention of cyanide poisoning exposure, and implementation of the administrative actions and training that medical professionals in Türkiye should undertake to assist victims who survive smoke exposure, a brief review is also provided of the legal requirements that must be followed in the construction and interior design of buildings where people congregate.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103071"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914283","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 : 2026-02-01Epub Date: 2026-02-10DOI: 10.1016/j.jflm.2026.103088
Peter Vanezis , Rebecca Andrews , Limon Nahar , Ganesh Raj Selvaraja , Andrew Vanezis
Introduction
Ketoacidosis is a form of metabolic acidosis caused by the excess production of ketone bodies. It can be commonly found in the context of both diabetes mellitus and alcohol dependency but is also associated with a myriad other aetiologies. To date the extent of risk of developing ketoacidosis is unclear in diabetic persons who are alcohol dependent and/or have abused alcohol acutely as in ‘binge drinking’.
Methodology
We performed a retrospective analysis of consecutive coroners' autopsies between 2015 and 2023 in a London Coroner's jurisdiction of individuals aged 18 years and above to assess whether significant ketoacidosis, when present, was of diabetic or alcoholic aetiology or a combination of both. Data was obtained from the medical history, circumstances of death, histology, toxicology and biochemical markers. The deceased individuals were surveyed and categorised into the following three groups: 1. Individuals with diabetes mellitus type 1or 2 and with no known history of alcohol dependency according to their medical history; 2. Alcohol dependent persons or persons abusing alcohol acutely, without diabetes mellitus; 3. Diabetic individuals with known alcohol dependency or acute abuse as in ‘binge drinking’. Individuals suffering from other causes of ketoacidosis were excluded.
Results
From an overall total of 3873 autopsies performed of persons 18 years or above over a 9-year period (2015-2023), 1021 cases were analysed and divided into three groups as stated above. Group 1 consisted of 635 diabetic individuals, with ketoacidosis present in 23 (3.6%). Group 2 consisted of 333 individuals with alcohol dependency, in which ketoacidosis was present in 17 (5.1%). Group 3 consisted of 56 individuals, with both diabetes and alcohol dependency, in which ketoacidosis was present in 7 (13%).
Conclusions
This study demonstrated a statistically significant risk of developing ketoacidosis in all individuals with both diabetes mellitus and alcohol dependency (Group 3) when compared to diabetics alone (Group 1): Risk ratio = 3.8; p = .0001). There was less but significant increased risk when females alone were compared in these two groups. Less but significant increased risk was also found in all Group 3 individuals when compared to those in the alcohol alone category (Group 2) or when all individuals or males alone were compared between Group 1 + Group 2 with those in (Group 3). There was no significant increased risk when diabetics in Group 1 were compared to persons with alcohol dependency in Group 2.
{"title":"A post-mortem audit of the prevalence of ketoacidosis in diabetes and alcohol dependency","authors":"Peter Vanezis , Rebecca Andrews , Limon Nahar , Ganesh Raj Selvaraja , Andrew Vanezis","doi":"10.1016/j.jflm.2026.103088","DOIUrl":"10.1016/j.jflm.2026.103088","url":null,"abstract":"<div><h3>Introduction</h3><div>Ketoacidosis is a form of metabolic acidosis caused by the excess production of ketone bodies. It can be commonly found in the context of both diabetes mellitus and alcohol dependency but is also associated with a myriad other aetiologies. To date the extent of risk of developing ketoacidosis is unclear in diabetic persons who are alcohol dependent and/or have abused alcohol acutely as in ‘binge drinking’.</div></div><div><h3>Methodology</h3><div>We performed a retrospective analysis of consecutive coroners' autopsies between 2015 and 2023 in a London Coroner's jurisdiction of individuals aged 18 years and above to assess whether significant ketoacidosis, when present, was of diabetic or alcoholic aetiology or a combination of both. Data was obtained from the medical history, circumstances of death, histology, toxicology and biochemical markers. The deceased individuals were surveyed and categorised into the following three groups: 1. Individuals with diabetes mellitus type 1or 2 and with no known history of alcohol dependency according to their medical history; 2. Alcohol dependent persons or persons abusing alcohol acutely, without diabetes mellitus; 3. Diabetic individuals with known alcohol dependency or acute abuse as in ‘binge drinking’. Individuals suffering from other causes of ketoacidosis were excluded.</div></div><div><h3>Results</h3><div>From an overall total of 3873 autopsies performed of persons 18 years or above over a 9-year period (2015-2023), 1021 cases were analysed and divided into three groups as stated above. Group 1 consisted of 635 diabetic individuals, with ketoacidosis present in 23 (3.6%). Group 2 consisted of 333 individuals with alcohol dependency, in which ketoacidosis was present in 17 (5.1%). Group 3 consisted of 56 individuals, with both diabetes and alcohol dependency, in which ketoacidosis was present in 7 (13%).</div></div><div><h3>Conclusions</h3><div>This study demonstrated a statistically significant risk of developing ketoacidosis in all individuals with both diabetes mellitus and alcohol dependency (Group 3) when compared to diabetics alone (Group 1): Risk ratio = 3.8; p = .0001). There was less but significant increased risk when females alone were compared in these two groups. Less but significant increased risk was also found in all Group 3 individuals when compared to those in the alcohol alone category (Group 2) or when all individuals or males alone were compared between Group 1 + Group 2 with those in (Group 3). There was no significant increased risk when diabetics in Group 1 were compared to persons with alcohol dependency in Group 2.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103088"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170205","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}
Post-mortem imaging plays a crucial role in forensic investigations. While self-inflicted gunshot wounds to the head are common, cases involving multiple shots, especially with a clear sequential pattern, are extremely rare.
Case presentation
We report the case of an 82-year-old man found deceased by his wife, seated in a chair with a 9mm firearm on his lap. Two ejected shell casings were found nearby. No signs of struggle or forced entry were noted. The decedent had a known history of metastatic prostate cancer and had previously expressed suicidal ideation.
Technique and imaging findings
Post-mortem CT-scan (PMCT) allowed precise visualization of entrance and exit wounds, fractures, bullet paths, and hemorrhagic patterns. The fractures from the second shot stopped against the fractures from the first shot, revealing the direction and chronology of the injuries: a non-lethal submental gunshot followed by a fatal right temporal shot.
Discussion
This case highlights the forensic value of PMCT in determining the chronological order of gunshot wounds. The imaging confirmed the cause of death and established the sequence of injuries, crucial for medico-legal investigations.
Conclusion
PMCT provides non-invasive, high-resolution insights into bone trauma. In cases of multiple self-inflicted gunshots, it can help establish the precise chronology of injuries, supporting forensic analysis.
{"title":"Post-mortem CT scan reveals sequential self-inflicted gunshot wounds to the head: Initial non-lethal followed by fatal injury","authors":"Sylvain Grange , Carolyne Bidat-Callet , Elodie Hattat , Claire Boutet , Natalia Gorelik","doi":"10.1016/j.jflm.2026.103092","DOIUrl":"10.1016/j.jflm.2026.103092","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-mortem imaging plays a crucial role in forensic investigations. While self-inflicted gunshot wounds to the head are common, cases involving multiple shots, especially with a clear sequential pattern, are extremely rare.</div></div><div><h3>Case presentation</h3><div>We report the case of an 82-year-old man found deceased by his wife, seated in a chair with a 9mm firearm on his lap. Two ejected shell casings were found nearby. No signs of struggle or forced entry were noted. The decedent had a known history of metastatic prostate cancer and had previously expressed suicidal ideation.</div></div><div><h3>Technique and imaging findings</h3><div>Post-mortem CT-scan (PMCT) allowed precise visualization of entrance and exit wounds, fractures, bullet paths, and hemorrhagic patterns. The fractures from the second shot stopped against the fractures from the first shot, revealing the direction and chronology of the injuries: a non-lethal submental gunshot followed by a fatal right temporal shot.</div></div><div><h3>Discussion</h3><div>This case highlights the forensic value of PMCT in determining the chronological order of gunshot wounds. The imaging confirmed the cause of death and established the sequence of injuries, crucial for medico-legal investigations.</div></div><div><h3>Conclusion</h3><div>PMCT provides non-invasive, high-resolution insights into bone trauma. In cases of multiple self-inflicted gunshots, it can help establish the precise chronology of injuries, supporting forensic analysis.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103092"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170098","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 : 2026-02-01Epub Date: 2026-02-10DOI: 10.1016/j.jflm.2026.103093
Bahriye Ayaz , Ferhat Altunsoy
Clonazepam (Rivotril®) is among the most widely prescribed benzodiazepines. However, its non-therapeutic use carries a substantial risk of misuse, dependence, and fatal overdose. The presence of such substances in tissues has the potential to complicate post-mortem interval (PMI) estimations in forensic entomology by altering insect growth rates. The present study investigated the effects of clonazepam on the developmental duration, larval weight and length of Calliphora vicina Robineau-Desvoidy 1830 (Diptera: Calliphoridae) under controlled laboratory conditions. Larvae were reared on bovine lung tissues treated with varying concentrations of clonazepam, and developmental duration, larval weight, and length were systematically recorded until adult emergence. The results demonstrated that Clonazepam exposure produced significant, concentration-dependent alterations in development. At the highest concentration tested, larval development was prolonged by 40 h, with a total developmental delay of up to 64 h compared with the control group. Furthermore, larval weight and length were significantly reduced, with developmental responses varying across larval, pupal, and post-feeding stages. Notably, this study reveals for the first time that clonazepam significantly delays the developmental stages of C. vicina. These findings underscore the necessity of correcting PMI estimates in cases of benzodiazepine intoxication, as ignoring this delay could lead to an underestimation of the time since death.
{"title":"Effects of clonazepam on developmental stages of Calliphora vicina Robineau-Desvoidy 1830 (Diptera: Calliphoridae) and its implications for PMI estimation","authors":"Bahriye Ayaz , Ferhat Altunsoy","doi":"10.1016/j.jflm.2026.103093","DOIUrl":"10.1016/j.jflm.2026.103093","url":null,"abstract":"<div><div>Clonazepam (Rivotril®) is among the most widely prescribed benzodiazepines. However, its non-therapeutic use carries a substantial risk of misuse, dependence, and fatal overdose. The presence of such substances in tissues has the potential to complicate post-mortem interval (PMI) estimations in forensic entomology by altering insect growth rates. The present study investigated the effects of clonazepam on the developmental duration, larval weight and length of <em>Calliphora vicina</em> Robineau-Desvoidy 1830 (Diptera: Calliphoridae) under controlled laboratory conditions. Larvae were reared on bovine lung tissues treated with varying concentrations of clonazepam, and developmental duration, larval weight, and length were systematically recorded until adult emergence. The results demonstrated that Clonazepam exposure produced significant, concentration-dependent alterations in development. At the highest concentration tested, larval development was prolonged by 40 h, with a total developmental delay of up to 64 h compared with the control group. Furthermore, larval weight and length were significantly reduced, with developmental responses varying across larval, pupal, and post-feeding stages. Notably, this study reveals for the first time that clonazepam significantly delays the developmental stages of <em>C</em>. <em>vicina</em>. These findings underscore the necessity of correcting PMI estimates in cases of benzodiazepine intoxication, as ignoring this delay could lead to an underestimation of the time since death.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103093"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215222","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 : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.jflm.2026.103072
Omar Al Farsi , Raniya Al Kiyumi , Akram Al Adawi , Faiz Al Harmali
Background
Accurate mortality statistics are vital for establishing health policies. However, reporting numerous undetermined causes of death especially in the primary healthcare hinder the accuracy and usefulness of vital statistics, impacting resource allocation for disease prevention and control. Utilizing International Classification of Diseases (ICD-10) coding systems and addressing physician-related challenges are essential to improve the quality of mortality data and support effective policymaking. Therefore, this study aims to assess physicians' awareness in assigning accurate causes of death at the primary healthcare institutions.
Methods
A cross-sectional study conducted with 202 physicians from the primary health care institutions in Muscat and South Batinah governorates. A convenience sampling method has been used to distribute self-administered questionnaire.
Results
The findings indicated that a higher proportion of physicians were familiar with the ICD-10 coding and World Health Organization (WHO) guidelines, with (41.9 %) of non-Omani physicians demonstrating awareness, compared to (22 %) of Omani physicians. Both groups showed limited knowledge about the use of garbage codes, with a notable proportion unaware of their implications. Additionally, challenges in determining the underlying cause of death (UCOD) were reported, with (48.6 %) Omani physicians facing difficulties, compared to (40.9 %) of the other group. Training gaps and lack of feedback from the Ministry of Health (MoH) were identified as contributing factors affecting both groups.
Conclusion
The findings highlight key implications for policy and practice in coding mortality data. Ongoing awareness programs for physicians on ICD-10 coding system are essential, and establishing structured feedback channels with the MoH is crucial to improve data quality.
{"title":"Physician awareness of the ICD-10 coding system for assigning the cause of death in primary health centers in Muscat and South Batinah governorates, Oman","authors":"Omar Al Farsi , Raniya Al Kiyumi , Akram Al Adawi , Faiz Al Harmali","doi":"10.1016/j.jflm.2026.103072","DOIUrl":"10.1016/j.jflm.2026.103072","url":null,"abstract":"<div><h3>Background</h3><div>Accurate mortality statistics are vital for establishing health policies. However, reporting numerous undetermined causes of death especially in the primary healthcare hinder the accuracy and usefulness of vital statistics, impacting resource allocation for disease prevention and control. Utilizing International Classification of Diseases (ICD-10) coding systems and addressing physician-related challenges are essential to improve the quality of mortality data and support effective policymaking. Therefore, this study aims to assess physicians' awareness in assigning accurate causes of death at the primary healthcare institutions.</div></div><div><h3>Methods</h3><div>A cross-sectional study conducted with 202 physicians from the primary health care institutions in Muscat and South Batinah governorates. A convenience sampling method has been used to distribute self-administered questionnaire.</div></div><div><h3>Results</h3><div>The findings indicated that a higher proportion of physicians were familiar with the ICD-10 coding and World Health Organization (WHO) guidelines, with (41.9 %) of non-Omani physicians demonstrating awareness, compared to (22 %) of Omani physicians. Both groups showed limited knowledge about the use of garbage codes, with a notable proportion unaware of their implications. Additionally, challenges in determining the underlying cause of death (UCOD) were reported, with (48.6 %) Omani physicians facing difficulties, compared to (40.9 %) of the other group. Training gaps and lack of feedback from the Ministry of Health (MoH) were identified as contributing factors affecting both groups.</div></div><div><h3>Conclusion</h3><div>The findings highlight key implications for policy and practice in coding mortality data. Ongoing awareness programs for physicians on ICD-10 coding system are essential, and establishing structured feedback channels with the MoH is crucial to improve data quality.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103072"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968213","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}
Determining antemortem drowning in medico-legal casework remains a persistent forensic challenge, particularly in bodies exhibiting advanced putrefactive changes, where conventional morphological indicators are no longer discernible. Forensic diatomology provides a critical microtrace-evidence framework for substantiating drowning and enabling immersion-site attribution through ecological fingerprinting of diatom assemblages. Despite the frequent retrieval of suspected drowning victims from the Pong Dam reservoir hydrologically influenced by the Beas river no comprehensive spatiotemporal diatom baseline exists to support comparative forensic analyses.
In this study, high-resolution limnological profiling and detailed morphotaxonomic diatom characterization were undertaken across five sampling stations and six seasonal intervals. A total of 113 taxa were identified using light microscopy and standardized diatom preparation protocols. Canonical Correspondence Analysis (CCA) demonstrated statistically robust relationships between diatom community composition, hydroclimatic seasonality, and key physicochemical drivers. The reservoir exhibited pronounced assemblage homogenization, reflecting dominance by environmentally tolerant euryhaline and eurythermal taxa with high dispersal potential.
This investigation provides the first spatially resolved, seasonally stratified diatom reference dataset for Pong Dam, delineating site-specific and season-responsive indicator taxa with demonstrable forensic utility. The dataset significantly strengthens diatomological comparison in drowning cases, particularly when postmortem intervals encompass multiple seasonal transitions. These findings enhance diagnostic reliability in immersion-site reconstruction and reinforce the evidentiary value of diatom microtraces in complex medico-legal drowning determinations.
{"title":"Forensic diatomology of Pong dam reservoir: Implications for drowning diagnosis and site identification","authors":"Ajay Singh Rana , Priyanka Verma , Meenakshi Mahajan","doi":"10.1016/j.jflm.2026.103094","DOIUrl":"10.1016/j.jflm.2026.103094","url":null,"abstract":"<div><div>Determining antemortem drowning in medico-legal casework remains a persistent forensic challenge, particularly in bodies exhibiting advanced putrefactive changes, where conventional morphological indicators are no longer discernible. Forensic diatomology provides a critical microtrace-evidence framework for substantiating drowning and enabling immersion-site attribution through ecological fingerprinting of diatom assemblages. Despite the frequent retrieval of suspected drowning victims from the Pong Dam reservoir hydrologically influenced by the Beas river no comprehensive spatiotemporal diatom baseline exists to support comparative forensic analyses.</div><div>In this study, high-resolution limnological profiling and detailed morphotaxonomic diatom characterization were undertaken across five sampling stations and six seasonal intervals. A total of 113 taxa were identified using light microscopy and standardized diatom preparation protocols. Canonical Correspondence Analysis (CCA) demonstrated statistically robust relationships between diatom community composition, hydroclimatic seasonality, and key physicochemical drivers. The reservoir exhibited pronounced assemblage homogenization, reflecting dominance by environmentally tolerant euryhaline and eurythermal taxa with high dispersal potential.</div><div>This investigation provides the first spatially resolved, seasonally stratified diatom reference dataset for Pong Dam, delineating site-specific and season-responsive indicator taxa with demonstrable forensic utility. The dataset significantly strengthens diatomological comparison in drowning cases, particularly when postmortem intervals encompass multiple seasonal transitions. These findings enhance diagnostic reliability in immersion-site reconstruction and reinforce the evidentiary value of diatom microtraces in complex medico-legal drowning determinations.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103094"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170100","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 : 2026-02-01Epub Date: 2026-01-21DOI: 10.1016/j.jflm.2026.103082
Charles D. Deakin
Background
Conducted Energy Devices (CEDs) or Conducted Energy Weapons (CEWs), among which the best known are the TASER® brand, are increasingly deployed by law-enforcement agencies. Their established cardiac safety is overshadowed by temporally-associated sudden deaths, which are often directly attributed to CED discharge. Concern remains that in rare cases, high-voltage CED pulses might directly induce fatal cardiac arrhythmias.
Methods
This review considers electrophysiological evidence, computational modelling, and forensic case data to understand the mechanisms governing cardiac stimulation during CED exposure. It discusses strength–duration relationships, differential excitement of neuromuscular and myocardial tissues, and compares predicted electrical stimulation thresholds with those determined by finite element modelling. This evidence is compared with clinical evidence of CED-induced malignant arrythmias.
Findings
CED pulses of 50–100 μs are both too brief and too weak to depolarise cardiac myocytes under normal anatomical conditions. Finite-element and finite-integration models show typical myocardial current densities of 0.27–0.6 mA cm−2 which are more than two orders of magnitude below the short-pulse VF threshold of ∼100–150 mA cm−2 (≈4 mA cm−2 RMS). Layered thoracic modelling demonstrates that muscle anisotropy and chest-wall thickness diverts almost 90 % of current laterally, producing cardiac field strengths far beneath depolarisation levels. Rare trans-cardiac probe alignments or thin chest walls, however, may approach capture thresholds and therefore cannot be considered completely risk-free.
Conclusions
Current evidence indicates that in all but extreme probe geometries or paediatric exposures, CED are at minimal risk of inducing malignant arrhythmias. Forensic assessment of CED-related deaths should consider electrophysiological principles with probe placement, the timing of the collapse, and toxicological findings in order to distinguish coincidental from causally related events.
背景传导能量装置（ced）或传导能量武器（CEWs），其中最著名的是泰瑟®品牌，越来越多地被执法机构部署。他们建立的心脏安全性被暂时性猝死所掩盖，后者通常直接归因于CED出院。在极少数情况下，高压CED脉冲可能直接诱发致命性心律失常。方法本综述考虑了电生理证据、计算模型和法医案例数据，以了解在CED暴露期间控制心脏刺激的机制。它讨论了强度-持续时间的关系，神经肌肉和心肌组织的不同兴奋，并将预测的电刺激阈值与有限元模型确定的阈值进行了比较。这一证据与ced诱发的恶性心律失常的临床证据进行了比较。发现在正常解剖条件下，50-100 μs的sced脉冲既短又弱，无法使心肌细胞去极化。有限元和有限积分模型显示，典型的心肌电流密度为0.27-0.6 mA cm - 2，比短脉冲VF阈值约100-150 mA cm - 2 （RMS≈4 mA cm - 2）低两个数量级以上。分层胸腔模型表明，肌肉各向异性和胸壁厚度将近90%的电流侧向转移，产生远低于去极化水平的心脏场强度。然而，罕见的经心探头排列或胸壁薄可能接近捕获阈值，因此不能认为完全没有风险。结论目前的证据表明，除了极端探头几何形状或儿科暴露外，CED诱发恶性心律失常的风险很小。对ed相关死亡的法医评估应考虑探针放置的电生理学原理、崩溃的时间和毒理学结果，以区分偶然事件和因果相关事件。
{"title":"Cardiac Safety of Conducted Energy Devices: Electrophysiological mechanisms, risk assessment, and forensic interpretation","authors":"Charles D. Deakin","doi":"10.1016/j.jflm.2026.103082","DOIUrl":"10.1016/j.jflm.2026.103082","url":null,"abstract":"<div><h3>Background</h3><div>Conducted Energy Devices (CEDs) or Conducted Energy Weapons (CEWs), among which the best known are the TASER® brand, are increasingly deployed by law-enforcement agencies. Their established cardiac safety is overshadowed by temporally-associated sudden deaths, which are often directly attributed to CED discharge. Concern remains that in rare cases, high-voltage CED pulses might directly induce fatal cardiac arrhythmias.</div></div><div><h3>Methods</h3><div>This review considers electrophysiological evidence, computational modelling, and forensic case data to understand the mechanisms governing cardiac stimulation during CED exposure. It discusses strength–duration relationships, differential excitement of neuromuscular and myocardial tissues, and compares predicted electrical stimulation thresholds with those determined by finite element modelling. This evidence is compared with clinical evidence of CED-induced malignant arrythmias.</div></div><div><h3>Findings</h3><div>CED pulses of 50–100 μs are both too brief and too weak to depolarise cardiac myocytes under normal anatomical conditions. Finite-element and finite-integration models show typical myocardial current densities of 0.27–0.6 mA cm<sup>−2</sup> which are more than two orders of magnitude below the short-pulse VF threshold of ∼100–150 mA cm<sup>−2</sup> (≈4 mA cm<sup>−2</sup> RMS). Layered thoracic modelling demonstrates that muscle anisotropy and chest-wall thickness diverts almost 90 % of current laterally, producing cardiac field strengths far beneath depolarisation levels. Rare trans-cardiac probe alignments or thin chest walls, however, may approach capture thresholds and therefore cannot be considered completely risk-free.</div></div><div><h3>Conclusions</h3><div>Current evidence indicates that in all but extreme probe geometries or paediatric exposures, CED are at minimal risk of inducing malignant arrhythmias. Forensic assessment of CED-related deaths should consider electrophysiological principles with probe placement, the timing of the collapse, and toxicological findings in order to distinguish coincidental from causally related events.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103082"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078232","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}
Point-of-care (POC) diagnostics represent promising health-technology tools capable of providing rapid, on-site analytical support for forensic investigations. This scoping review aimed to systematically map the available evidence on applying POC diagnostics in forensic investigations. The focus is on their potential ability to act as rapid screening and triage tools to assist in determining the cause of death and exploring the challenges and opportunities associated with their implementation on a global scale.
Methods
A comprehensive literature search was conducted across multiple databases, including PubMed, ProQuest Central, Academic Search Complete, Africa Wide, CINAHL, MEDLINE, and Web of Science. Out of the 7603 records screened, four studies met the eligibility criteria and were included in the review. Reporting adhered to the PRISMA-ScR guidelines.
Results
These studies demonstrated the expanding role of POC devices in various aspects of forensic investigations, including rapid triage in overdose cases, malaria diagnosis in travel-related deaths, SARS-CoV-2 screening, and hemoglobin testing in child deaths. These studies also highlighted the limitations of POC devices in the postmortem context, emphasizing the need for careful calibration, confirmation, and interpretation of the results. This review identified POC diagnostics as a potential bridge between forensic investigations and public health surveillance, with findings indicating both cause-of-death determination and broader public health strategies. Operational, ethical, and policy considerations for using POC devices in forensic investigations were also discussed.
Conclusion
This review revealed challenges in ensuring the standardization, accuracy, and integration of POC diagnostics into established forensic practices. Further research is required to evaluate the diagnostic accuracy, cost-effectiveness, and performance of POC tools in forensic settings. Comprehensive guidelines and standardized operating procedures should be developed to ensure the successful implementation of POC diagnostics in forensic investigations. Given the limited and heterogeneous evidence, POC devices in forensic death investigations should be seen as preliminary aids rather than diagnostic instruments.
医疗点诊断是有前途的卫生技术工具，能够为法医调查提供快速的现场分析支持。该范围审查旨在系统地绘制在法医调查中应用POC诊断的现有证据。重点是它们作为快速筛查和分类工具的潜在能力，以协助确定死亡原因，并探讨在全球范围内实施这些工具所面临的挑战和机遇。方法在PubMed、ProQuest Central、Academic search Complete、Africa Wide、CINAHL、MEDLINE、Web of Science等数据库中进行综合文献检索。在筛选的7603份记录中，有4项研究符合资格标准，被纳入本综述。报告遵循PRISMA-ScR指南。结果这些研究表明，POC设备在法医调查的各个方面发挥着越来越大的作用，包括药物过量病例的快速分诊、旅行相关死亡的疟疾诊断、SARS-CoV-2筛查和儿童死亡的血红蛋白检测。这些研究还强调了POC装置在死后情况下的局限性，强调需要仔细校准、确认和解释结果。本次审查确定POC诊断是法医调查和公共卫生监测之间的潜在桥梁，其调查结果表明了死因确定和更广泛的公共卫生战略。还讨论了在法医调查中使用POC设备的操作、道德和政策方面的考虑。结论本综述揭示了在确保POC诊断的标准化、准确性和整合到现有法医实践中的挑战。需要进一步的研究来评估法医环境中POC工具的诊断准确性、成本效益和性能。应制定全面的指导方针和标准化的操作程序，以确保在法医调查中成功实施POC诊断。鉴于证据有限且种类繁多，法医死亡调查中的POC装置应被视为初步辅助工具，而不是诊断工具。
{"title":"Evidence of point-of-care diagnostics in forensic death investigations: A scoping review","authors":"Sebueng Ramatsokotla , Bathabile Soul , Evans Duah , Letlhogonolo Sekwele , Gabrielle Thompson , Kuhlula Maluleke , Linda Mbonambi , Tivani Mashamba-Thompson","doi":"10.1016/j.jflm.2026.103086","DOIUrl":"10.1016/j.jflm.2026.103086","url":null,"abstract":"<div><h3>Background</h3><div>Point-of-care (POC) diagnostics represent promising health-technology tools capable of providing rapid, on-site analytical support for forensic investigations. This scoping review aimed to systematically map the available evidence on applying POC diagnostics in forensic investigations. The focus is on their potential ability to act as rapid screening and triage tools to assist in determining the cause of death and exploring the challenges and opportunities associated with their implementation on a global scale.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across multiple databases, including PubMed, ProQuest Central, Academic Search Complete, Africa Wide, CINAHL, MEDLINE, and Web of Science. Out of the 7603 records screened, four studies met the eligibility criteria and were included in the review. Reporting adhered to the PRISMA-ScR guidelines.</div></div><div><h3>Results</h3><div>These studies demonstrated the expanding role of POC devices in various aspects of forensic investigations, including rapid triage in overdose cases, malaria diagnosis in travel-related deaths, SARS-CoV-2 screening, and hemoglobin testing in child deaths. These studies also highlighted the limitations of POC devices in the postmortem context, emphasizing the need for careful calibration, confirmation, and interpretation of the results. This review identified POC diagnostics as a potential bridge between forensic investigations and public health surveillance, with findings indicating both cause-of-death determination and broader public health strategies. Operational, ethical, and policy considerations for using POC devices in forensic investigations were also discussed.</div></div><div><h3>Conclusion</h3><div>This review revealed challenges in ensuring the standardization, accuracy, and integration of POC diagnostics into established forensic practices. Further research is required to evaluate the diagnostic accuracy, cost-effectiveness, and performance of POC tools in forensic settings. Comprehensive guidelines and standardized operating procedures should be developed to ensure the successful implementation of POC diagnostics in forensic investigations. Given the limited and heterogeneous evidence, POC devices in forensic death investigations should be seen as preliminary aids rather than diagnostic instruments.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103086"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078233","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 : 2026-02-01Epub Date: 2026-01-21DOI: 10.1016/j.jflm.2026.103084
Margaret Stark , Bernadette Butler , Michael Devlin , Alex Gorton
Professional judgement in forensic & legal medicine (FLM) refers to the ability of healthcare professionals (HCPs) to use their knowledge, experience, and critical thinking skills to make informed decisions about patient care, often in complex or ambiguous situations.
Clinicians must keep patients the focus of any assessment and HCPs need to use professional judgement when interpreting Guidelines and/or Recommendations and when there is a clear and justifiable requirement to deviate from a Standard Operating Procedure because of patient need. Only with training and supervision by expert educators will quality standards be maintained with a workforce that is skilled in using professional judgement.
{"title":"Professional judgement in Forensic & Legal Medicine (FLM)","authors":"Margaret Stark , Bernadette Butler , Michael Devlin , Alex Gorton","doi":"10.1016/j.jflm.2026.103084","DOIUrl":"10.1016/j.jflm.2026.103084","url":null,"abstract":"<div><div>Professional judgement in forensic & legal medicine (FLM) refers to the ability of healthcare professionals (HCPs) to use their knowledge, experience, and critical thinking skills to make informed decisions about patient care, often in complex or ambiguous situations.</div><div>Clinicians must keep patients the focus of any assessment and HCPs need to use professional judgement when interpreting Guidelines and/or Recommendations and when there is a clear and justifiable requirement to deviate from a Standard Operating Procedure because of patient need. Only with training and supervision by expert educators will quality standards be maintained with a workforce that is skilled in using professional judgement.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103084"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023202","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}
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