Pub Date : 2025-12-23DOI: 10.1016/j.jflm.2025.103057
Maysaa Fakhro , Paul Nahas , Mohd Fadhli Khamis , Mohd Firdaus Yhaya , Kah Haw Chang
Forensic odontology is adapted worldwide as a primary method of identification in mass casualty incidents due to the durability of tooth enamel and dentin. They remain highly resistant to postmortem alterations caused by taphonomic and diagenetic processes. However, the awareness of forensic odontology among Lebanese dentists have received limited attention. Therefore, this study aims to investigate the practice of maintaining dental records and awareness on forensic odontology among Lebanese dentists. In this study, a total of 80 responses from Lebanese dentists were collected through a survey covering their background, prior training experience, dental documentation practice and awareness of forensic odontology. This study demonstrates that no significant linear relationship was observed between the scores in keeping dental records and the backgrounds and prior training of Lebanese dentists. Nonetheless, through multiple linear regression test, there were statistically significant linear relationships between the awareness on forensic odontology and two predictors, F (2, 77) = 17.690, p < 0.001, R2 = 0.570. An increase of 0.957 in the awareness score was observed with participation in forensic odontology training, while an 0.574 score increase was expected when participating in legal training. Hence, training on the knowledge and implications of forensic odontology shall be initiated by the Lebanese government, supported by proper maintenance of dental records for the preparedness of any possible mass disasters which could lead to severe consequences.
由于牙釉质和牙本质的耐久性，法医牙科学在世界范围内被用作大规模伤亡事件中鉴定的主要方法。它们对由埋藏学和成岩过程引起的死后改变具有高度的抵抗力。然而，黎巴嫩牙医对法医牙科学的认识受到的关注有限。因此，本研究旨在调查黎巴嫩牙医维护牙科记录的做法和对法医牙科学的认识。在这项研究中，通过调查收集了黎巴嫩牙医的80份回复，调查内容包括他们的背景、先前的培训经历、牙科文件实践和对法医牙科学的认识。本研究表明，没有显著的线性关系，在保持牙科记录和黎巴嫩牙医的背景和先前的培训得分之间观察到。但经多元线性回归检验，两项预测因子与法医牙科学认知程度呈显著线性关系，F (2,77) = 17.690, p 2 = 0.570。参加法医学培训的学生认知得分提高0.957分，参加法律培训的学生认知得分提高0.574分。因此，黎巴嫩政府应开始对法医牙科学的知识和影响进行培训，同时妥善保存牙科记录，以便为可能导致严重后果的任何大规模灾难做好准备。
{"title":"Awareness of forensic odontology among Lebanese dentists: Implications for dental education and training","authors":"Maysaa Fakhro , Paul Nahas , Mohd Fadhli Khamis , Mohd Firdaus Yhaya , Kah Haw Chang","doi":"10.1016/j.jflm.2025.103057","DOIUrl":"10.1016/j.jflm.2025.103057","url":null,"abstract":"<div><div>Forensic odontology is adapted worldwide as a primary method of identification in mass casualty incidents due to the durability of tooth enamel and dentin. They remain highly resistant to postmortem alterations caused by taphonomic and diagenetic processes. However, the awareness of forensic odontology among Lebanese dentists have received limited attention. Therefore, this study aims to investigate the practice of maintaining dental records and awareness on forensic odontology among Lebanese dentists. In this study, a total of 80 responses from Lebanese dentists were collected through a survey covering their background, prior training experience, dental documentation practice and awareness of forensic odontology. This study demonstrates that no significant linear relationship was observed between the scores in keeping dental records and the backgrounds and prior training of Lebanese dentists. Nonetheless, through multiple linear regression test, there were statistically significant linear relationships between the awareness on forensic odontology and two predictors, F (2, 77) = 17.690, <em>p</em> < 0.001, R<sup>2</sup> = 0.570. An increase of 0.957 in the awareness score was observed with participation in forensic odontology training, while an 0.574 score increase was expected when participating in legal training. Hence, training on the knowledge and implications of forensic odontology shall be initiated by the Lebanese government, supported by proper maintenance of dental records for the preparedness of any possible mass disasters which could lead to severe consequences.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103057"},"PeriodicalIF":1.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835854","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 : 2025-12-22DOI: 10.1016/j.jflm.2025.103055
H. Stigter, J. Kloosterman, T. Krap, W.L.J.M. Duijst
<div><h3>Background</h3><div>Post-mortem, supravital muscle reaction (SMR) of human skeletal muscle is dependent on energy supply. Intrinsic variables, like peri-mortem body temperature and underlying diseases, influence the rate of cell metabolism in skeletal muscle cells post-mortem, and thus the available energy for SMR.</div></div><div><h3>Objectives</h3><div>A field study was conducted, comprising deceased found under differing conditions. We investigated the influence of the body temperature of the deceased on the outcome of post-mortem mechanical stimulation of skeletal muscle in the first hours post-mortem. In addition, we investigated the influence of sex, age, state of rigor mortis and the length of the dying process on SMR. Furthermore, we hypothesized that the outcome of post-mortem muscle stimulation could differ between musculus biceps brachii (MBB) and the musculus brachioradialis (MBR) on the same body examined at the same time, due to a higher cooling velocity of more peripheral located skeletal muscles (MBR).</div></div><div><h3>Methods</h3><div>In the period of January 2017 to August 2023 four forensic physicians from two different regions in the Netherlands performed mechanical stimulation of both upper and forearms of deceased with a known or an estimated PMI of <14 h, by using a reflex hammer. The research population concerned in-hospital-deaths, out-of-hospital deaths that were transferred to the morgue of a hospital, and out-of-hospital deaths that were examined at the place where the body was found. The sex and age of the deceased, body temperature, and state of rigor mortis were registered in the Dutch national register of forensic medicine, which was used as a data resource. The length of the dying process was registered separately using SPSS 27.0 which also served as a data resource. The Welch Two Sample <em>t</em>-test, chi-squared test, logistic regression and multiple logistic regression were performed to investigate the influence of the PMI, body temperature, sex, age, state of rigor mortis and the length of the dying process on the outcome of SMR. Statistical analyses were performed by using R 4.4.1. Significance was accepted at P < 0.05.</div></div><div><h3>Results</h3><div>In total, 142 cases were included, in which musculus biceps brachii (MBB) and the musculus brachioradialis (MBR) on both arms were mechanically stimulated with a reflex hammer. The population consisted out of 65 males (mean age: 73.4 ± 16.8 years) and 77 females (mean age: 82.1 ± 13.0 years). SMR was present in 74 out of 142 cases (52.1 %). The mean PMI did not differ significantly between cases with a positive SMR (157.3 min) and cases showing no SMR (168.4 min). The number of male cases that showed SMR (63.1 %) was significantly higher than the number of female cases (42.9 %) that showed SMR. No relationship was detected between age, body temperature, rigor mortis and the length of the dying process, and the outcome of post-mortem musc
{"title":"Intrinsic factors influencing the post-mortem mechanical excitability of human skeletal muscle","authors":"H. Stigter, J. Kloosterman, T. Krap, W.L.J.M. Duijst","doi":"10.1016/j.jflm.2025.103055","DOIUrl":"10.1016/j.jflm.2025.103055","url":null,"abstract":"<div><h3>Background</h3><div>Post-mortem, supravital muscle reaction (SMR) of human skeletal muscle is dependent on energy supply. Intrinsic variables, like peri-mortem body temperature and underlying diseases, influence the rate of cell metabolism in skeletal muscle cells post-mortem, and thus the available energy for SMR.</div></div><div><h3>Objectives</h3><div>A field study was conducted, comprising deceased found under differing conditions. We investigated the influence of the body temperature of the deceased on the outcome of post-mortem mechanical stimulation of skeletal muscle in the first hours post-mortem. In addition, we investigated the influence of sex, age, state of rigor mortis and the length of the dying process on SMR. Furthermore, we hypothesized that the outcome of post-mortem muscle stimulation could differ between musculus biceps brachii (MBB) and the musculus brachioradialis (MBR) on the same body examined at the same time, due to a higher cooling velocity of more peripheral located skeletal muscles (MBR).</div></div><div><h3>Methods</h3><div>In the period of January 2017 to August 2023 four forensic physicians from two different regions in the Netherlands performed mechanical stimulation of both upper and forearms of deceased with a known or an estimated PMI of <14 h, by using a reflex hammer. The research population concerned in-hospital-deaths, out-of-hospital deaths that were transferred to the morgue of a hospital, and out-of-hospital deaths that were examined at the place where the body was found. The sex and age of the deceased, body temperature, and state of rigor mortis were registered in the Dutch national register of forensic medicine, which was used as a data resource. The length of the dying process was registered separately using SPSS 27.0 which also served as a data resource. The Welch Two Sample <em>t</em>-test, chi-squared test, logistic regression and multiple logistic regression were performed to investigate the influence of the PMI, body temperature, sex, age, state of rigor mortis and the length of the dying process on the outcome of SMR. Statistical analyses were performed by using R 4.4.1. Significance was accepted at P < 0.05.</div></div><div><h3>Results</h3><div>In total, 142 cases were included, in which musculus biceps brachii (MBB) and the musculus brachioradialis (MBR) on both arms were mechanically stimulated with a reflex hammer. The population consisted out of 65 males (mean age: 73.4 ± 16.8 years) and 77 females (mean age: 82.1 ± 13.0 years). SMR was present in 74 out of 142 cases (52.1 %). The mean PMI did not differ significantly between cases with a positive SMR (157.3 min) and cases showing no SMR (168.4 min). The number of male cases that showed SMR (63.1 %) was significantly higher than the number of female cases (42.9 %) that showed SMR. No relationship was detected between age, body temperature, rigor mortis and the length of the dying process, and the outcome of post-mortem musc","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103055"},"PeriodicalIF":1.2,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829421","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 : 2025-12-19DOI: 10.1016/j.jflm.2025.103039
Sangita Moirangthem , Jayanthi Yadav , Jai Kumar Chaurasia , Johann Aibantyllilang Blah , Arun Kori , Leena Lokhande , Abarnna Sree
Objective and background
Head injury leading to meningeal haemorrhages, including subdural haemorrhage (SDH) and subarachnoid haemorrhage (SAH), is a major cause of morbidity and mortality in traumatic deaths. Determining the cause, mechanism, and dating of injury is crucial for forensic investigations. Histopathological examination plays a key role in accurately dating the injury from meningeal haemorrhages, which is essential for medicolegal investigation and the determination of the timeline of events. This study aims to evaluate histopathological changes in SDH and SAH in head injury cases and correlate them with post-traumatic survival time.
Materials and methods
This cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology, AIIMS, Bhopal. A total of 63 medicolegal autopsy cases of head injury having both SDH and SAH were examined with known time of injury, and time since death within 24 h, excluding decomposed cases and individuals with underlying pathological conditions that could influence haemorrhagic patterns. Collected samples were processed according to standard protocol and stained with hematoxylin and eosin. Histopathological findings, including haemorrhage, fibrin deposition, fibroblast proliferation, inflammatory cell infiltration, neovascularisation, and cell layer formation, were analysed and statistically evaluated using SPSS software.
Observations, findings, and discussion
The shortest post-traumatic survival time recorded was within 1 h, and the longest was 40 days. In SDH cases, fibrin and neutrophils were observed within 24 h, while macrophages and inflammatory cells appeared by day 3. Neovascularisation and cell layer formation were noted from day 4 onward, becoming more pronounced with longer survival times. In SAH, haemorrhage and neutrophils were present within the first 24 h, macrophages appeared by day 2, and neovascularisation and multiple cell layers were observed from day 4, becoming more prominent with increased duration of post-traumatic survival time. Histological dating of haemorrhages correlated significantly with post-traumatic survival time.
Histopathological examination serves as a critical forensic tool for accurately dating meningeal haemorrhages. By analysing both SDH and SAH in the same cases, this study provides novel evidence that strengthens the reliability of histology in distinguishing traumatic from pathological haemorrhage and in reconstructing timelines for medicolegal investigations.
{"title":"Histopathological study for dating of Subdural haemorrhage and Subarachnoid haemorrhage in a single cohort study of head injury","authors":"Sangita Moirangthem , Jayanthi Yadav , Jai Kumar Chaurasia , Johann Aibantyllilang Blah , Arun Kori , Leena Lokhande , Abarnna Sree","doi":"10.1016/j.jflm.2025.103039","DOIUrl":"10.1016/j.jflm.2025.103039","url":null,"abstract":"<div><h3>Objective and background</h3><div>Head injury leading to meningeal haemorrhages, including subdural haemorrhage (SDH) and subarachnoid haemorrhage (SAH), is a major cause of morbidity and mortality in traumatic deaths. Determining the cause, mechanism, and dating of injury is crucial for forensic investigations. Histopathological examination plays a key role in accurately dating the injury from meningeal haemorrhages, which is essential for medicolegal investigation and the determination of the timeline of events. This study aims to evaluate histopathological changes in SDH and SAH in head injury cases and correlate them with post-traumatic survival time.</div></div><div><h3>Materials and methods</h3><div>This cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology, AIIMS, Bhopal. A total of 63 medicolegal autopsy cases of head injury having both SDH and SAH were examined with known time of injury, and time since death within 24 h, excluding decomposed cases and individuals with underlying pathological conditions that could influence haemorrhagic patterns. Collected samples were processed according to standard protocol and stained with hematoxylin and eosin. Histopathological findings, including haemorrhage, fibrin deposition, fibroblast proliferation, inflammatory cell infiltration, neovascularisation, and cell layer formation, were analysed and statistically evaluated using SPSS software.</div></div><div><h3>Observations, findings, and discussion</h3><div>The shortest post-traumatic survival time recorded was within 1 h, and the longest was 40 days. In SDH cases, fibrin and neutrophils were observed within 24 h, while macrophages and inflammatory cells appeared by day 3. Neovascularisation and cell layer formation were noted from day 4 onward, becoming more pronounced with longer survival times. In SAH, haemorrhage and neutrophils were present within the first 24 h, macrophages appeared by day 2, and neovascularisation and multiple cell layers were observed from day 4, becoming more prominent with increased duration of post-traumatic survival time. Histological dating of haemorrhages correlated significantly with post-traumatic survival time.</div><div>Histopathological examination serves as a critical forensic tool for accurately dating meningeal haemorrhages. By analysing both SDH and SAH in the same cases, this study provides novel evidence that strengthens the reliability of histology in distinguishing traumatic from pathological haemorrhage and in reconstructing timelines for medicolegal investigations.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103039"},"PeriodicalIF":1.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822532","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}
Despite numerous efforts to prevent and control sexual violence in Ethiopia, the incidence continues to rise. It's crucial to have solid evidence to highlight the severity of the issue. Thus, this study aims to determine the overall prevalence of sexual violence and pinpoint the contributing factors among female night students in Ethiopia.
Method
A comprehensive and systematic literature search was conducted across various electronic databases, including PubMed, HINARI, Scopus, EMBASE, Web of Science, African Journal online (AJOL), and Google Scholar. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional studies, consisting of nine criteria. The heterogeneity of the studies was assessed using the Cochrane Q and I2 test statistics. The pooled prevalence estimate of sexual violence among female night students was calculated using a random-effects model.
Result
Out of 6410 studies reviewed, six studies involving 2699 night students were deemed relevant. The pooled estimate of sexual violence among female night students in Ethiopia was found to be 43.58 % (95 % CI: 30.68, 56.48). Factors associated with sexual violence included rural residency (POR = 2.51; 95 % CI: 1.17, 5.41), alcohol use (AOR = 3.30; 95 % CI: 1.68, 6.48), having multiple sexual partners (POR = 2.78; 95 % CI: 1.97, 3.92), and a commute time to school exceeding 20 min (POR = 1.74; 95 % CI: 1.18, 2.58).
Conclusion
The research revealed that nearly half of female night students encountered sexual violence, with significant correlations identified between this violence and factors such as having multiple sexual partners, residing in rural areas during childhood, having a commute time to school of over 20 min, and having a history of alcohol use. To effectively address and prevent sexual violence, the Federal Ministry of Health (FMOH), policymakers, and stakeholders must prioritize these findings and take targeted actions.
{"title":"Sexual violence and associated factors among female night students in Ethiopia: A systematic review and meta-analysis","authors":"Yeshiwas Ayale Ferede , Worku Chekol Tassew , Melese Legesse Mitku , Abiyie Demelash Gashe , Girum Meseret Ayenew , Adane Nigussie , Agerie Mengistie Zeleke","doi":"10.1016/j.jflm.2025.103053","DOIUrl":"10.1016/j.jflm.2025.103053","url":null,"abstract":"<div><h3>Background</h3><div>Despite numerous efforts to prevent and control sexual violence in Ethiopia, the incidence continues to rise. It's crucial to have solid evidence to highlight the severity of the issue. Thus, this study aims to determine the overall prevalence of sexual violence and pinpoint the contributing factors among female night students in Ethiopia.</div></div><div><h3>Method</h3><div>A comprehensive and systematic literature search was conducted across various electronic databases, including PubMed, HINARI, Scopus, EMBASE, Web of Science, African Journal online (AJOL), and Google Scholar. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional studies, consisting of nine criteria. The heterogeneity of the studies was assessed using the Cochrane Q and I2 test statistics. The pooled prevalence estimate of sexual violence among female night students was calculated using a random-effects model.</div></div><div><h3>Result</h3><div>Out of 6410 studies reviewed, six studies involving 2699 night students were deemed relevant. The pooled estimate of sexual violence among female night students in Ethiopia was found to be 43.58 % (95 % CI: 30.68, 56.48). Factors associated with sexual violence included rural residency (POR = 2.51; 95 % CI: 1.17, 5.41), alcohol use (AOR = 3.30; 95 % CI: 1.68, 6.48), having multiple sexual partners (POR = 2.78; 95 % CI: 1.97, 3.92), and a commute time to school exceeding 20 min (POR = 1.74; 95 % CI: 1.18, 2.58).</div></div><div><h3>Conclusion</h3><div>The research revealed that nearly half of female night students encountered sexual violence, with significant correlations identified between this violence and factors such as having multiple sexual partners, residing in rural areas during childhood, having a commute time to school of over 20 min, and having a history of alcohol use. To effectively address and prevent sexual violence, the Federal Ministry of Health (FMOH), policymakers, and stakeholders must prioritize these findings and take targeted actions.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103053"},"PeriodicalIF":1.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786444","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 : 2025-12-18DOI: 10.1016/j.jflm.2025.103054
Harshal R. Thube, V.J. Jishnu
The Eshmun complex is a term coined to describe self-genital mutilation or auto-castration under psychiatric disorders. Self-mutilation of the genitals can be an unfortunate outcome of different delusional beliefs regarding belonging to another gender or chronic substance abuse leading to self-harm. The result can be a minor injury or an adverse event, such as a fatality. In either case, the patient should undergo a medical and detailed psychiatric evaluation and counseling.
We describe a case involving a 24-year-old man who arrived at the hospital's emergency department. With an alleged history of self-instillation of a household cleaning liquid containing phenol into the scrotum using a needle and syringe. Upon examination of the injured region, a puncture wound was discovered in the left testicle, accompanied by a noticeable buildup of fluid. A short psychological examination revealed his desire for a sex change and a previous attempt at self-genital mutilation.
{"title":"Forensic and clinical insights into the eshmun complex: A case of scrotal self-mutilation with phenol in a gender dysphoric individual","authors":"Harshal R. Thube, V.J. Jishnu","doi":"10.1016/j.jflm.2025.103054","DOIUrl":"10.1016/j.jflm.2025.103054","url":null,"abstract":"<div><div>The Eshmun complex is a term coined to describe self-genital mutilation or auto-castration under psychiatric disorders. Self-mutilation of the genitals can be an unfortunate outcome of different delusional beliefs regarding belonging to another gender or chronic substance abuse leading to self-harm. The result can be a minor injury or an adverse event, such as a fatality. In either case, the patient should undergo a medical and detailed psychiatric evaluation and counseling.</div><div>We describe a case involving a 24-year-old man who arrived at the hospital's emergency department. With an alleged history of self-instillation of a household cleaning liquid containing phenol into the scrotum using a needle and syringe. Upon examination of the injured region, a puncture wound was discovered in the left testicle, accompanied by a noticeable buildup of fluid. A short psychological examination revealed his desire for a sex change and a previous attempt at self-genital mutilation.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103054"},"PeriodicalIF":1.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786445","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 : 2025-12-13DOI: 10.1016/j.jflm.2025.103052
Yuxuan Fu , Sujing Zhang , Yibo Yan , Ping Xiang , Jian Li , Lei Xin , Hongxiao Deng , Hejian Wu , Xin Wang
To characterize temporal trends in toxic substance patterns involved in clinical toxicology cases in Shanghai, while considering regulatory changes, and to benchmark these findings against data from other regions. The clinical toxicology results reported by the Academy of Forensic Science (AFS) from January 2017 to December 2023 were collated, summarized, and retrospectively analyzed for the types and blood concentrations of different drugs and poisons. Overall, 4422 clinical toxicology cases were recorded, accounting for an average of approximately 630 cases per year, with 62 % presenting positive results. The positively detected substances were mainly clinical drugs and pesticides. The detected clinical drugs were predominantly sedative-hypnotics, antidepressants, and antipsychotics. Estazolam (n = 347), midazolam (n = 272), bromadiolone (n = 265), clonazepam (n = 228), and quetiapine (n = 199) were the top five most frequently detected substances in clinical toxicological cases. Other cases related to plant poisons, toxic heavy metals, and toxic alcohols were also recorded. The blood concentrations of the various drugs showed significant variability. This study highlights a concerning rise in psychoactive drug use, particularly sedative-hypnotics and antidepressants, reflecting a growing mental health burden in the population. This pattern is further supported by the frequent detection of blood drug concentrations exceeding therapeutic upper limits, indicating widespread non-therapeutic exposure. In response, psychotropic drug prescribing practices must be comprehensively strengthened through stricter regulations and the establishment of prescription surveillance to ensure rational and safe medication use. Additionally, a decline in certain toxicants, such as paraquat, suggests the effectiveness of policy interventions. The findings also emphasize the risks of polypharmacy and the need for enhanced poisoning prevention and emergency response systems.
{"title":"Retrospective analysis of clinical toxicology results from 2017 to 2023: exploring the characteristics and prevalence trends of detected drugs and poisons","authors":"Yuxuan Fu , Sujing Zhang , Yibo Yan , Ping Xiang , Jian Li , Lei Xin , Hongxiao Deng , Hejian Wu , Xin Wang","doi":"10.1016/j.jflm.2025.103052","DOIUrl":"10.1016/j.jflm.2025.103052","url":null,"abstract":"<div><div>To characterize temporal trends in toxic substance patterns involved in clinical toxicology cases in Shanghai, while considering regulatory changes, and to benchmark these findings against data from other regions. The clinical toxicology results reported by the Academy of Forensic Science (AFS) from January 2017 to December 2023 were collated, summarized, and retrospectively analyzed for the types and blood concentrations of different drugs and poisons. Overall, 4422 clinical toxicology cases were recorded, accounting for an average of approximately 630 cases per year, with 62 % presenting positive results. The positively detected substances were mainly clinical drugs and pesticides. The detected clinical drugs were predominantly sedative-hypnotics, antidepressants, and antipsychotics. Estazolam (n = 347), midazolam (n = 272), bromadiolone (n = 265), clonazepam (n = 228), and quetiapine (n = 199) were the top five most frequently detected substances in clinical toxicological cases. Other cases related to plant poisons, toxic heavy metals, and toxic alcohols were also recorded. The blood concentrations of the various drugs showed significant variability. This study highlights a concerning rise in psychoactive drug use, particularly sedative-hypnotics and antidepressants, reflecting a growing mental health burden in the population. This pattern is further supported by the frequent detection of blood drug concentrations exceeding therapeutic upper limits, indicating widespread non-therapeutic exposure. In response, psychotropic drug prescribing practices must be comprehensively strengthened through stricter regulations and the establishment of prescription surveillance to ensure rational and safe medication use. Additionally, a decline in certain toxicants, such as paraquat, suggests the effectiveness of policy interventions. The findings also emphasize the risks of polypharmacy and the need for enhanced poisoning prevention and emergency response systems.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103052"},"PeriodicalIF":1.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786443","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 : 2025-12-13DOI: 10.1016/j.jflm.2025.103051
Jian Li , Yan-juan Wu , Xing-yu Lu , Shu-rui Zhang , Na Li , Qiu-xiang Du , Jie Cao , Ru-feng Bai , Jun-hong Sun
The application of machine learning in analyzing postmortem molecular alterations represents a promising strategy for estimating the Postmortem Interval (PMI), yet samples with undetermined PMI significantly compromise model efficacy and compound the existing scarcity of forensically viable samples. The generalization ability of the model is significantly impaired by the insufficient effective sample size, which greatly hinders the widespread application of PMI estimation based on machine learning. Semi-supervised learning (SSL) methods can effectively leverage both labeled samples with known PMI and unlabeled samples with unknown PMI to jointly train models. This approach is crucial for enhancing sample utilization and improving the accuracy of PMI estimation. In this study, we examined skeletal muscle from rats at different PMI. Using both labeled and unmarked PMI samples, we evaluated the efficacy of Supervised Learning (SL) and SSL models in addressing the prevalent challenge of PMI estimation within forensic science. On this basis, we employed the dynamic classifier selection (DCS) strategy to enhance the construction process of both SL and SSL models. The findings demonstrate that SSL-DCS significantly enhances the predictive efficacy of PMI compared to SL-DCS, exhibiting an area under receiver operating characteristic curve (AUC) of 0.89 and an R2 of 0.93 for time to death from 0 to 9 days. The outcomes of this study suggest that SSL-DCS not only enhances prediction efficacy but also improves the utilization rate of scarce samples, which would serve as a paradigm that can be extended and applied to other biomedical domains.
{"title":"Semi-supervised learning with dynamic classifier selection for PMI estimation: An animal study","authors":"Jian Li , Yan-juan Wu , Xing-yu Lu , Shu-rui Zhang , Na Li , Qiu-xiang Du , Jie Cao , Ru-feng Bai , Jun-hong Sun","doi":"10.1016/j.jflm.2025.103051","DOIUrl":"10.1016/j.jflm.2025.103051","url":null,"abstract":"<div><div>The application of machine learning in analyzing postmortem molecular alterations represents a promising strategy for estimating the Postmortem Interval (PMI), yet samples with undetermined PMI significantly compromise model efficacy and compound the existing scarcity of forensically viable samples. The generalization ability of the model is significantly impaired by the insufficient effective sample size, which greatly hinders the widespread application of PMI estimation based on machine learning. Semi-supervised learning (SSL) methods can effectively leverage both labeled samples with known PMI and unlabeled samples with unknown PMI to jointly train models. This approach is crucial for enhancing sample utilization and improving the accuracy of PMI estimation. In this study, we examined skeletal muscle from rats at different PMI. Using both labeled and unmarked PMI samples, we evaluated the efficacy of Supervised Learning (SL) and SSL models in addressing the prevalent challenge of PMI estimation within forensic science. On this basis, we employed the dynamic classifier selection (DCS) strategy to enhance the construction process of both SL and SSL models. The findings demonstrate that SSL-DCS significantly enhances the predictive efficacy of PMI compared to SL-DCS, exhibiting an area under receiver operating characteristic curve (AUC) of 0.89 and an R<sup>2</sup> of 0.93 for time to death from 0 to 9 days. The outcomes of this study suggest that SSL-DCS not only enhances prediction efficacy but also improves the utilization rate of scarce samples, which would serve as a paradigm that can be extended and applied to other biomedical domains.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103051"},"PeriodicalIF":1.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777027","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 : 2025-12-12DOI: 10.1016/j.jflm.2025.103050
Claudio Terranova , Clara Cestonaro , Stefano Palumbi , Laura Marino , Alessandro Gentili , Francesco Pozzebon , Rocco Miazzi , Anna Aprile
Introduction
Crashes are a global public health concern, with psychoactive substance use and attention impairments potentially increasing risk and affecting male and female drivers differently. This study aims to identify factors related to psychoactive substance use and attention impairments that predict road crash involvement by sex, offering insights for targeted prevention effort.
Methods
This observational study examined individuals assessed for driving license reissuance after driving under the influence of alcohol and/or drugs. Data collected included personal and sociodemographic details, results from a Continuous performance test (CPT-3) (a neuropsychological test assessing inattentiveness, impulsivity, sustained attention, and vigilance), and toxicological analyses of biological samples. Statistical analyses (chi-square, logistic regression, and ROC curve) aimed at identifing sex-specific predictors of road crash involvement.
Results
The study included 169 participants (82.8 % males, 17.2 % females). Initial univariate analyses indicated sex differences that were not confirmed after Bonferroni correction for multiple comparisons. Logistic regression found blood alcohol concentration predictive of crashes in males (p = 0.005, OR = 2.52), while inattentiveness was a major factor for females (p = 0.045, OR = 12.0). In the combined model, sex itself was not an independent predictor after adjusting for these factors. The model showed moderate accuracy for males (ROC-AUC = 0.695) and higher accuracy for females (ROC-AUC = 0.816), suggesting that inattentiveness may play a particularly important role in predicting crashes in the female subgroup.
Conclusions
Inattentiveness and alcohol use emerged as key predictors of crash involvement, with inattentiveness showing particular relevance in the female subgroup. Prevention should focus on modifiable risk factors rather than sex. The model's higher accuracy in females suggests attentional measures may help identify at-risk drivers, though the small female sample limits generalizability.
导言：车祸是一个全球性的公共卫生问题，精神活性物质的使用和注意力障碍可能增加风险，对男性和女性司机的影响不同。本研究旨在确定与精神活性物质使用和注意力障碍相关的因素，这些因素可以预测性别道路交通事故的发生，为有针对性的预防工作提供见解。方法：本观察性研究调查了在酒精和/或药物影响下驾驶后被评估补发驾照的个体。收集的数据包括个人和社会人口学细节，持续表现测试（CPT-3）（一种评估注意力不集中、冲动、持续注意力和警惕性的神经心理学测试）的结果，以及生物样本的毒理学分析。统计分析（卡方、逻辑回归和ROC曲线）旨在确定道路交通事故涉及的性别特异性预测因子。结果：研究纳入169名参与者（男性82.8%，女性17.2%）。最初的单变量分析表明，在Bonferroni校正多重比较后，性别差异未得到证实。Logistic回归发现血液酒精浓度可预测男性的撞车（p = 0.005, OR = 2.52），而注意力不集中是女性的主要因素（p = 0.045, OR = 12.0）。在综合模型中，在调整了这些因素后，性别本身并不是一个独立的预测因子。该模型显示，男性的准确度中等（ROC-AUC = 0.695），女性的准确度较高（ROC-AUC = 0.816），这表明注意力不集中可能在预测女性亚组的撞车事故中起着特别重要的作用。结论：注意力不集中和饮酒是导致车祸的关键因素，其中注意力不集中在女性亚组中表现出特别的相关性。预防应侧重于可改变的危险因素，而不是性别。该模型在女性中的较高准确性表明，注意力测量可能有助于识别有风险的驱动因素，尽管女性样本较少限制了普遍性。
{"title":"Impact of psychoactive substances and attention-related impairments on driving performance: Sex differences and road crash involvement","authors":"Claudio Terranova , Clara Cestonaro , Stefano Palumbi , Laura Marino , Alessandro Gentili , Francesco Pozzebon , Rocco Miazzi , Anna Aprile","doi":"10.1016/j.jflm.2025.103050","DOIUrl":"10.1016/j.jflm.2025.103050","url":null,"abstract":"<div><h3>Introduction</h3><div>Crashes are a global public health concern, with psychoactive substance use and attention impairments potentially increasing risk and affecting male and female drivers differently. This study aims to identify factors related to psychoactive substance use and attention impairments that predict road crash involvement by sex, offering insights for targeted prevention effort.</div></div><div><h3>Methods</h3><div>This observational study examined individuals assessed for driving license reissuance after driving under the influence of alcohol and/or drugs. Data collected included personal and sociodemographic details, results from a Continuous performance test (CPT-3) (a neuropsychological test assessing inattentiveness, impulsivity, sustained attention, and vigilance), and toxicological analyses of biological samples. Statistical analyses (chi-square, logistic regression, and ROC curve) aimed at identifing sex-specific predictors of road crash involvement.</div></div><div><h3>Results</h3><div>The study included 169 participants (82.8 % males, 17.2 % females). Initial univariate analyses indicated sex differences that were not confirmed after Bonferroni correction for multiple comparisons. Logistic regression found blood alcohol concentration predictive of crashes in males (p = 0.005, OR = 2.52), while inattentiveness was a major factor for females (p = 0.045, OR = 12.0). In the combined model, sex itself was not an independent predictor after adjusting for these factors. The model showed moderate accuracy for males (ROC-AUC = 0.695) and higher accuracy for females (ROC-AUC = 0.816), suggesting that inattentiveness may play a particularly important role in predicting crashes in the female subgroup.</div></div><div><h3>Conclusions</h3><div>Inattentiveness and alcohol use emerged as key predictors of crash involvement, with inattentiveness showing particular relevance in the female subgroup. Prevention should focus on modifiable risk factors rather than sex. The model's higher accuracy in females suggests attentional measures may help identify at-risk drivers, though the small female sample limits generalizability.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103050"},"PeriodicalIF":1.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776918","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}
Alcohol abuse remains a significant global public health challenge contributing to road accidents, chronic diseases, and social issues. In Tunisia, limited data on alcohol consumption trends among drivers and accident victims prompted this forensic study, which analyzed blood samples from 2068 individuals detained during roadside checks or involved in road accidents over five years (2019–2023).
Methods
This study used semi-quantitative immunoassay screening to assess alcohol prevalence and demographic patterns.
Results
The results revealed an 82.5 % positivity rate for blood alcohol concentration (BAC) exceeding the legal limit of 0.3 g/L, with a strong male predominance (97.8 %) and a majority of cases in the 20–35 age group (51.1 %). Alcohol consumption was most prevalent among manual laborers (48.2 %) and urban residents, particularly in Tunis (52.3 %). The study also identified seasonal peaks in alcohol-related arrests and highlighted the risks associated with various BAC levels, from minor impairments at 0.3–0.5 g/L to severe intoxication at levels above 1.5 g/L.
Conclusions
These findings provide the first systematic forensic evidence on alcohol-impaired driving in Tunisia. To our knowledge, this research work provides, for the first time, data on the prevalence and patterns of alcohol use in an African country based on large-scale forensic analysis. This potentially represents an important case study for comparison with other continental regions, particularly Europe and the northern Mediterranean. Furthermore, such analysis has highlighted differences in substance use trends in a comparative case study of the European Neighbourhood and Southern countries, helping to adjust and adapt prevention and harm reduction strategies to regional realities.
{"title":"Alcohol-impaired driving in Tunisia: Forensic insights and population-level data for North African public health and road safety","authors":"Omar Smaoui , Bilel Moslah , Mohamed Anouar Nouioui , Cyrine Messaoud , Nessrine Ben Haj Yahya , Dorra Amira","doi":"10.1016/j.jflm.2025.103049","DOIUrl":"10.1016/j.jflm.2025.103049","url":null,"abstract":"<div><h3>Aims</h3><div>Alcohol abuse remains a significant global public health challenge contributing to road accidents, chronic diseases, and social issues. In Tunisia, limited data on alcohol consumption trends among drivers and accident victims prompted this forensic study, which analyzed blood samples from 2068 individuals detained during roadside checks or involved in road accidents over five years (2019–2023).</div></div><div><h3>Methods</h3><div>This study used semi-quantitative immunoassay screening to assess alcohol prevalence and demographic patterns.</div></div><div><h3>Results</h3><div>The results revealed an 82.5 % positivity rate for blood alcohol concentration (BAC) exceeding the legal limit of 0.3 g/L, with a strong male predominance (97.8 %) and a majority of cases in the 20–35 age group (51.1 %). Alcohol consumption was most prevalent among manual laborers (48.2 %) and urban residents, particularly in Tunis (52.3 %). The study also identified seasonal peaks in alcohol-related arrests and highlighted the risks associated with various BAC levels, from minor impairments at 0.3–0.5 g/L to severe intoxication at levels above 1.5 g/L.</div></div><div><h3>Conclusions</h3><div>These findings provide the first systematic forensic evidence on alcohol-impaired driving in Tunisia. To our knowledge, this research work provides, for the first time, data on the prevalence and patterns of alcohol use in an African country based on large-scale forensic analysis. This potentially represents an important case study for comparison with other continental regions, particularly Europe and the northern Mediterranean. Furthermore, such analysis has highlighted differences in substance use trends in a comparative case study of the European Neighbourhood and Southern countries, helping to adjust and adapt prevention and harm reduction strategies to regional realities.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103049"},"PeriodicalIF":1.2,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733542","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 : 2025-12-05DOI: 10.1016/j.jflm.2025.103048
Taleed El-Sabawi , Shelly Weizman , Regina LaBelle
Civil litigation provides a novel and underutilized source of information about deaths in U.S. jails, particularly when official data are incomplete. This study systematically analyzes verdicts, settlements and judgments to explore patterns in practices linked to preventable mortality in U.S jails.
Results
Content analysis of facts alleged in 90 cases filed between 2015 and 2020 revealed thematic patterns related to inadequate or delayed medical care. Alleged facts routinely included observable signs of serious medical need—such as incoherence, convulsions, or pleas for help—followed by failures to provide timely or medically appropriate care. In cases of suicide, allegations commonly describe known mental health conditions, discontinued medication, and lapses in monitoring or suicide prevention protocols. Despite repeated warnings—by the individuals themselves, fellow incarcerated persons, or family members—jail staff frequently failed to act. A small subset of cases resulted in judgments for the defense, often where some care was provided or protocols were followed, even if outcomes were still fatal.
Conclusion
These findings suggest that in cases resulting in reported settlements, verdicts or judgments in-custody deaths in the U.S. could be prevented through improved intake screening, timely medical monitoring, care coordination, and adherence to established protocols. Litigation records offer important insight into how systemic failures contribute to jail mortality, with implications for policy, public health, and correctional practice.
{"title":"How people die inside: Fact patterns in civil litigation for in-custody deaths","authors":"Taleed El-Sabawi , Shelly Weizman , Regina LaBelle","doi":"10.1016/j.jflm.2025.103048","DOIUrl":"10.1016/j.jflm.2025.103048","url":null,"abstract":"<div><div>Civil litigation provides a novel and underutilized source of information about deaths in U.S. jails, particularly when official data are incomplete. This study systematically analyzes verdicts, settlements and judgments to explore patterns in practices linked to preventable mortality in U.S jails.</div></div><div><h3>Results</h3><div>Content analysis of facts alleged in 90 cases filed between 2015 and 2020 revealed thematic patterns related to inadequate or delayed medical care. Alleged facts routinely included observable signs of serious medical need—such as incoherence, convulsions, or pleas for help—followed by failures to provide timely or medically appropriate care. In cases of suicide, allegations commonly describe known mental health conditions, discontinued medication, and lapses in monitoring or suicide prevention protocols. Despite repeated warnings—by the individuals themselves, fellow incarcerated persons, or family members—jail staff frequently failed to act. A small subset of cases resulted in judgments for the defense, often where some care was provided or protocols were followed, even if outcomes were still fatal.</div></div><div><h3>Conclusion</h3><div>These findings suggest that in cases resulting in reported settlements, verdicts or judgments in-custody deaths in the U.S. could be prevented through improved intake screening, timely medical monitoring, care coordination, and adherence to established protocols. Litigation records offer important insight into how systemic failures contribute to jail mortality, with implications for policy, public health, and correctional practice.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103048"},"PeriodicalIF":1.2,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717081","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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