Academic Forensic Pathology最新文献

Sexual child homicide is a very high impact event. We report an instance where an 11-year-old boy was noticed by his grandmother hanging from the silver wired drying line which they are using for hanging the clothes in the house. Examination of the crime scene, autopsy findings, toxicological and DNA analysis confirmed the manner of death as sexual child homicide in a chronically abused child. A 28-year-old male perpetrator confessed to raping and murdering the boy, with DNA evidence and the perpetrator's confession providing strong legal proof. This case underscores the importance of post-mortem examinations in determining the exact manner of death and calling for vigilance in cases of suspected abuse.

Introduction: Cardinal Decio Azzolino Jr. (1623-1689), a leading figure at the Roman curia in the 17th century met in 1655 queen Christina of Sweden, arrived in Rome after her conversion to Roman Catholicism. The queen appointed the cardinal as her universal testamentary heir before her death on April 16th, 1689. Azzolino died of a sudden death shortly after, on June 8th. The article aims to question Azzolino's sudden death through the analysis of the cardinal's illnesses from which he was afflicted in the last decades of his life, examining the most likely causes of his demise. Methodology: Various unpublished epistolary letters were analysed, according to the chronological order of production between 1660 and 1689. A philological approach coupled with clinical-medical hypothesis inferable by the examined sources. Results: The cause of death is identified as an unexpected dropsy in some letters and the death certificate. The analysis of the letters allows the reconstruction of Azzolino' state of health and illnesses in the last two decades of life: bilious excesses, inflammations, podagra and gout, which appeared with the inflammation of the knee and walking difficulties, and, finally, asthenia, dyspnea and a probable stroke. Conclusion: The dropsy is a symptom underlying various possible pathologies. The cardinal's state of health had been precarious and already marked by various symptoms, which were progressively worsening over the last decades of his life. The hypothesis of a stroke is also plausible. His death was not sudden as the Roman curial environments lead us to believe.

Background: Adverse effects following vaccination are well-known. While most effects are mild and transient, some may be severe or even lethal. Particularly with regard to coronavirus disease 2019 (COVID-19) vaccinations, which were "fast-tracked," it is incumbent upon the medical community to be diligent in identifying potential vaccine-associated adverse events so that physicians and patients can make truly informed decisions when considering the risks versus benefits of vaccination. Objective: To provide an in-depth discussion about post-vaccination seizures, particularly with regard to COVID-19 vaccinations. Research Design: Retrospective review of two cases where death was deemed to be the result of new-onset seizures; in each case, the seizures began shortly following vaccination. Subjects: In one case, death was certified by the primary care physician, without implicating the recent COVID-19 vaccination. In the other case, certified by the medical examiner, recent simultaneous vaccination with a COVID-19 vaccine and an influenza vaccine were considered to be contributory to death. Measures: The case specifics are presented for each case, including clinical work-up (both cases) and autopsy findings (one case). Conclusions: When attempting to determine whether or not a seizure-related death is due to a vaccine-induced new-onset seizure disorder, forensic pathologists need to rule-out other explanations for the seizures. Although a temporal association between seizures and vaccination is not sufficient, in and of itself, to prove causality, the temporal association, in combination with the absence of another explanation for seizures, and knowledge of similar cases in the medical literature, is sufficient to ascribe a causal role to the vaccination.

Suicide is still a global public health concern. Electrocution suicide is a rarely observed method of ending life. We reported the incident of a young electrical technician in his 30s who was brought dead to the emergency room of a hospital with a history of electrocution. A detailed examination revealed that the electric lines were attached to the left thumb and left toe and connected to the electrical plug switch (220 V). A written, signed suicide note was recovered in the room, from which it was possible to derive details about the suicide's planning and draw the conclusion that an electric current had also gone through the body. This case was unusual in the methods used, highlighting the need for multidisciplinary involvement.

Introduction: Forensic pathologists routinely testify in courts of law as part of their occupation. As such, part of their training involves learning how to testify responsibly and competently. As experts, they are permitted to offer opinions in order to assist the triers of fact.

Results: This review examines such concepts as burden of proof by manner of death, mechanisms of death, survival intervals, and the differences between possibilities, probabilities, and reasonable degree of medical certainty. It also addresses legal concepts and issues that may arise in court, including those of pain and suffering, cognitive bias, objections, attempts at witness impeachment, and surrogate witness testimony, as well as a summary of pertinent case law.

Discussion: The special issues and considerations of the expert forensic pathologist are discussed with the aim to summarize some of the key issues that may arise in court for the forensic pathologist.

Introduction: Forensic pathologists are the only medical specialists who routinely testify in courts of law as part of their occupation. As such, one element of their training involves learning how to testify responsibly and competently. Individuals qualified as experts are permitted to offer opinions in order to assist the triers of fact.

Results: We review the forensic pathologist's primary role as an expert witness which is to lay out concepts clearly, methodically, and objectively, in medicine, pathophysiology, toxicology, and injury, to convey these concepts with understandable, plain language, and to explain how certain evidence, physical, medical, and historical, supports their conclusions and/or presents limitations.

Discussion: We discuss various components about testifying in court, some common expert questions posed to the forensic pathologist, and what concepts and facts they might consider when answering them. We do not offer a prescription as to how one should answer these questions specifically, but rather we provide a single resource that summarizes some of the key issues that may arise in court for the forensic pathologist.

Background: Sexual dimorphism plays a vital role in individual identification, and body dimensions can contribute to establishing a biological profile for identification purposes. Aims and Objectives: To determine the reliability of the Heel-Ball Index (HBI) in estimating sex from foot dimensions and footprint dimensions and also to investigate the potential of dimensions and indices, using a standardized value, in estimating sex, from foot dimensions and footprint dimensions. Materials and Methods: In this study, a group of 112 young Indian adults aged 18 to 22, consisting of 56 males and 56 females, was examined. The foot breadth at ball (BBAL) and foot breadth at heel (BHEL) of both feet were measured using sliding digital calipers from foot and footprint dimensions. Results: Significant sexual dimorphism was observed in BBAL, BHEL, and HBI (HBI = BHEL/BBAL × 100) measurements in both feet of both sexes. Conclusion: HBI yielded better accuracy for foot dimensions than footprint dimensions. It was also found that utilizing absolute foot dimensions (BBAL and BHEL) yielded more accurate results in estimating sex compared to the HBI, which is calculated as a ratio of absolute measurements.

Study Design: This observational study focuses on select cases where death may have been related to COVID-related fears or the unintended consequences of protocols or public health mandates imposed during the COVID-19 pandemic. Objective: The objective of this study is to highlight examples of "COVID-collateral" deaths for the expressed purpose of preventing similar deaths in the future. Methods: The study represents a retrospective observational study from the case work at an academically-based regional medical examiners' office. Cases were selected based on identification of deaths that may have been related to COVID-19 fears, mandates or policies. Results: Six cases of COVID-collateral deaths are highlighted in this report, including cases where fear or isolation related to COVID-19 infection resulted in untreated exacerbation of an underlying disease/condition with eventual death, as well as cases where COVID-related psychological/mental stress or isolation played a role in suicide. Conclusions: Medical examiners/coroners should be aware of these cases if future pandemics or similar events occur, so that more thorough and accurate data regarding such deaths can be gathered. Public health officials, the medical community, and the general public also need to be aware of such cases so that appropriate preventive strategies can be employed.

Introduction: Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal dominant disorder that results from mutations in the collagen type III gene. It is a risk factor for medium-sized artery aneurysms, dissections, and ruptures. We report a case of hemoperitoneum due to medial dissection and rupture of the superior mesenteric artery related to vEDS. Methods: A full body CT scan and full three cavity autopsy was performed in a 47-year-old man with a history of an intermittent abdominal cramping for one week rand complex past medical history that included a sigmoid bowel perforation at age 20, and previous popliteal artery pseudoaneurysm rupture. Histology and genetic testing were performed. Results: The postmortem computed tomography and autopsy showed a significant hemoperitoneum due to a ruptured dissection of the superior mesenteric artery and branches, and multiple splanchnic artery dissections with renal and small bowel infarctions. Genetic testing revealed a heterozygous COL3A1 gene variant associated with Ehlers-Danlos syndrome. Death was attributed to hemoperitoneum due to medial dissection and rupture of the superior mesenteric artery due to arteriopathy. Discussion: The relatively young age and medical history correlate with the autopsy findings and genetic testing towards the conclusion of an arteriopathy consistent with vEDS.

This article describes two cases of rare surgical complications during functional endoscopic sinus surgery (FESS) and the resulting forensic investigations. The first case involved damage to the skull base and intracerebral artery, leading to a fatal cerebrovascular event, while the second case involved destruction of the medial orbital wall. The clinical and pathological findings are described in detail for each case. In Russia, in cases of disputes regarding medical malpractice, a commission-based expert examination is appointed by the civil court, criminal court, or investigator. This commission includes, in addition to a forensic pathologist, a practicing physician specializing in the field related to the case under consideration. Single-expert examinations for such cases are not provided; the investigation is always conducted jointly by a forensic pathologist and a clinician. It is important to investigate whether the mistake was due to preventable causes or deviations from accepted standards. This can only be done through the joint work of clinicians and forensic pathologists. These two cases are important because they demonstrate how different forensic conclusions can be for patients who undergo the same operation and experience similar severe complications. Despite the similarities, the forensic and legal outcomes were entirely different due to different reasons for the mistakes.