Deaths at high altitudes may arise from a range of quite disparate entities including trauma (e.g. falls), environmental factors (e.g. hypothermia and hypoxia), and pre-existing medical conditions (e.g. coronary artery disease). Unique conditions include high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) which may contribute to lethal mechanisms or precipitate a traumatic event. Forensic issues that may arise in these cases are logistical problems due to remote locations, sometimes with failure to find a body, delay in discovery and/or repatriation, prior local autopsies being performed with embalming, and the non-specificity of pathology markers. Traumatic deaths involve blunt force impacts, falls, suffocation, crush asphyxia and hypothermia. The assessment of cases requires careful integration of the autopsy findings with the medical history of the decedent and an accurate description of their behaviour in the hours leading up to death.

Blue toe syndrome, also referred to as cholesterol crystal embolism is characterized by the distal embolization of cholesterol crystals originating from ruptured atherosclerotic plaques. This condition commonly arises in the context of cardiovascular procedures. Emboli from the thoracoabdominal aorta primarily affect the downstream extremities and intra-abdominal viscera, often resulting in fatal atheroembolic renal failure. Owing to its insidious and delayed onset, antemortem diagnosis of cholesterol crystal embolism is often underrecognized. Two cases of blue toe syndrome secondary to cardiovascular procedures are presented. In Case 1, the patient died 35 days after coronary angioplasty, whereas in Case 2, the patient developed toe necrosis 95 days after endovascular aortic repair, leading to progressive renal failure over the following five years. A comprehensive forensic autopsy included external examination, skin biopsy, histopathological examination of major organs, and serum biochemical evaluation of renal function parameters. Two cases of blue toe syndrome secondary to cardiovascular procedures are presented. In Case 1, the patient died 35 days after coronary angioplasty, whereas in Case 2, the patient developed toe necrosis 95 days after endovascular aortic repair, leading to progressive renal failure over the following five years. A comprehensive forensic autopsy included external examination, skin biopsy, histopathological examination of major organs, and serum biochemical evaluation of renal function parameters. This report underscores the importance of including systemic cholesterol crystal embolism in the differential diagnosis of blue toe syndrome, particularly in patients with a history of cardiovascular procedures. Fingertips serve as reliable indicators of impaired blood perfusion. To assess blue toe syndrome accurately, we highlight the value of focusing on the toe tips where cholesterol crystal embolism can be consistently detected.

Various relics ascribed to have been in physical contact with the historical Jesus of Nazareth have been evaluated for the presence of blood, including the Tunic of Argenteuil, the Sudarium of Oviedo, and most famously, the Shroud of Turin. Interestingly, the blood type on all three textiles was found to be AB by serological testing; a similar result was observed for various modern Eucharistic miracles, in which consecrated hosts are reported to change into human cardiac tissue and blood. As AB is a relatively rare blood type, these collective observations have been used in numerous contemporary media outlets to support the idea that all such objects share a common origin. Here, the scientific validity of mutual blood type expression is evaluated. As discussed, AB antigens are not unique to human red blood cells but are also expressed in bacteria, providing a practical connection between such varied objects. Moreover, this article clarifies that the communal presence of specific and unique polymorphic markers would be required to validate that bloodstains associated with such items truly originate from a single source.

The selection of an appropriate STR allelic frequency database is the prerequisite for assessing the evidentiary value of DNA evidence. Four data sets comprising 50, 100, 200, and 500 samples were evaluated in 21 autosomal STR markers in the Indian and the Bahrain population. Allelic richness showed an increasing trend with the increase in sample size i.e., 193 and 201 (50 samples), 217 and 221 (100 samples), 255 and 238 (200 samples), and 292 and 285 (500 samples) in both the populations. TPOX and D13S317 markers did not show any increase in allele number, whereas SE33 markers showed the highest increase in both populations. With the increase in sample size, 70 (Bahrain population) and 100 (Indian population) alleles having < MAF were detected. Similarly, 37 and 47 previously undetected alleles could be detected when the sample size was increased from 50 to 500 in the Indian and Bahrain populations respectively. In the Indian population, Match probability, decreased with a 500-sample size, whereas, the PIC, PE, Heterozygosity, and PI increased with the increase in sample size. Further, database size did not show any statistical difference in the outcome of the Paternity Index value in the 50 paternity trio cases studied.

This study investigates the populations of dipterans in the southeastern Prealps of Trentino, Italy, along an altitudinal gradient that exceeds 1000 m. The study is important because dipterans play a significant role in crime scene analysis by helping to determine the post-mortem interval (PMI) and understand corpse relocation dynamics. Nine aerial traps were used across three sites from May to November 2023, and a total of 17,876 individuals from diverse species were captured. Statistical analyses revealed significant differences in dipteran populations across sites and exposure levels. The study identified relationships between species and environmental factors such as altitude, temperature, and sunlight exposure using Canonical Correspondence Analysis (CCA). Results demonstrated that species composition varied with environmental conditions, offering insights into potential shifts due to climate change. The presence of specific species was notably affected by temperature fluctuations, which could impact their usefulness in PMI estimation. Continuous monitoring is crucial to track dipteran population dynamics amidst changing environmental conditions. Such knowledge is important for improving accuracy in PMI estimations and enhancing forensic investigations. In conclusion, ongoing research is pivotal in adapting forensic entomological analyses to evolving ecological contexts, ensuring their reliability in forensic science applications. This study highlights the dynamic nature of dipteran ecology within forensic contexts and emphasises the need for further investigation to observe shifting population dynamics under climate change impacts.

Post mortem damage by predators varies with geography, climate, and location of cadavers. Frequently encountered facultatively parasitic terrestrial organisms include fly larvae (maggots), ants and beetles. This report describes for the first time opportunistic post mortem damage caused by the terrestrial flatworm Platydemus manokwari de Beauchamp,1963 (New Guinea Flatworm) (phylum Platyhelminthes: order Tricladida: suborder Continenticola: family Geoplanidae) to exposed skin of a body located in a tropical urban location. Several flatworms were attached to the body associated with areas of skin loss. Microscopy showed epidermal damage with no vital reaction and the presence of PAS-positive granules consistent with flatworm secretions. No human DNA profile was recovered with genetic testing of two of the flatworms. This case extends the range of potential post mortem predators to include flatworms, albeit opportunistically.

Traumatic brain injury (TBI) is a significant global health concern and frequently encountered in medico-legal autopsies. Previous studies suggest that certain TBI subtypes are more likely to co-occur than others. Therefore, we aimed to explore the potential of latent class analysis (LCA) to identify and characterize primary head injury combinations in neuropathologically examined medico-legal autopsy cases. The dataset comprised 78 cases from the Forensic Medicine Unit of the Finnish Institute for Health and Welfare over the period of 2016-2022. Data on background and circumstantial characteristics as well as primary and secondary head and brain injuries were collected from police documents, medical records, general autopsy reports and neuropathology reports. Latent class solutions with two to five classes were explored to identify clustering of primary head injuries among the sample. The dataset comprised 69.2% males and the median age was 49 years. In LCA, the solutions appeared reasonable, and each class appeared to represent a distinct TBI profile. The two-class solution was found to fit the present dataset best. Class 1 was characterized by older age, presence of an underlying CNS disease, and less diverse primary head injuries; these were interpreted as suggestive of lower traumatic forces. Class 2 was characterized by male sex and assaults as a prominent injury circumstance; subarachnoid and intracerebral/ventricular haemorrhages and contusions were classified exclusively into this class. In conclusion, this study identified two distinct subgroups of primary head injuries. Understanding typical injury combinations related to distinct circumstances could assist not only forensic pathologists but also clinicians treating TBI patients. However, the present latent class solution should not be interpreted as "ground truth", but instead further research is needed.

In Japan, the Medical Treatment and Supervision Act (MTSA) was enacted in 2005 to provide intensive interventions aimed at reintegrating forensic psychiatric patients into society. However, these individuals face challenges with social reintegration and have an elevated risk of suicide. Therefore, identifying the risk factors for suicide among forensic psychiatric patients is essential. We compiled an extensive database spanning 12 years of data on Japanese forensic outpatients. Using a generalized linear model (GLM), we explored the relationship between suicidal behaviors-both attempted and completed suicides-and several variables, including outpatient pathways defined by law, histories of psychiatric outpatient/inpatient treatment, diagnoses of schizophrenia or mood disorders, types of crimes committed, and the types of victims involved. Our analysis included data from 2,263 Japanese forensic outpatients. Suicidal behaviors were observed in 6.9% of patients, with 1.5% completing suicide. Risk factors for suicidal behavior included being a direct outpatient (odds ratio [OR] = 1.63, 95% confidence interval [CI]: 1.14-2.34), having a history of outpatient treatment (OR = 1.92, 95% CI: 1.07-3.48), and being arrested for arson (OR = 2.24, 95% CI: 1.33-3.76). Conversely, a diagnosis of schizophrenia was associated with a reduced risk of suicidal behavior (OR = 0.61, 95% CI: 0.39-0.95). Forensic psychiatric patients are at a higher risk of suicide compared to the general population. It is essential to account for both risk and protective factors when planning interventions for these individuals.

Aluminum phosphide (AlP) poses a significant health challenge in developing countries, primarily because of its accessibility to the unregulated market and the absence of specific antidotes. Although chemical analysis of routine viscera can provide valuable information regarding the type of poison present in the body during poisoning incidents, numerous factors can alter the test results of chemical analysis, such as decomposition changes, postmortem redistribution, and the chemical nature of drugs. Analytical methods are frequently impeded by the interference caused by coextracted putrefactive compounds, which can mask or alter the detection of drugs. This series of three cases is particularly noteworthy because it involves the postmortem detection of AlP in the abdominal subcutaneous fat of the deceased, a previously unreported occurrence. In the first case, the body showed findings of late postmortem changes, with stomach mucosa being congested and hemorrhagic, along with routine viscera, and abdominal subcutaneous fat was sent for toxicological analysis. To confirm these findings, in two further cases of suspected AlP poisoning, subcutaneous fat was sent along with routine viscera. Stomach mucosa in the other two cases showed findings similar to those in the first. In the third case, black paste-like material was noted as stomach content. All the cases revealed the presence of AlP in routine viscera samples and abdominal subcutaneous fat on gas chromatography-mass spectrometry (GC‒MS) analysis. Therefore, abdominal fat can serve as a suitable sample for toxicological analysis to identify the presence of AlP, even in cases with advanced putrefactive changes.

Despite various preventative measures, cocaine smuggling is still a major problem worldwide. A recent method of smuggling is the transportation of cocaine with various chemicals or with impregnated materials such as cloth and paper. This study aims to examine the change in the amount of cocaine on the paper surface and attempts to decide the best fingermark development method in the case of smuggling trafficking in the form of impregnated paper with the least effect on the cocaine concentration on the paper. The papers (n = 6 + 1) were prepared for each fingermark development method, including a blank paper, were dipped into a working solution prepared by dissolving 0.38 mg cocaine in 500 mL methanol. Fingermarks were developed by applying various chemicals, including Iodine vapor, 1,2-Indandione, DFO (1,8-diazafluoren-9-one), ThermaNin, 5-MTN (5-methylthioninhydrin), and silver nitrate chemicals and Ninhydrin, which is the most commonly used reagent for visualizing latent prints, particularly on paper surfaces. Also, the natural fingermarks of four different donors, two women and two men between 20 and 50 years of age, were used to compare with the presence of cocaine. Different from others, this study examined the application of DFO and 1,2-Indandione as alternatives to other chemicals and revealed that it is possible to identify cocaine using these methods. The order of success was Ninhydrin > DFO > 1,2-Indandione > ThermaNin > Iodine vapor = 5-MTN. To the best of our knowledge, the current study is the first to investigate fingermark identification methods along with the amounts of cocaine on cocaine-impregnated papers.

A 46-year-old man with a history of secundum atrial septal defect and interstitial lung disease was admitted to the hospital for a planned transcatheter closure of the atrial septal defect. Following multiple failed attempts to place a right femoral vein catheter, the procedure was aborted. Another attempt was made to the left femoral vein, but that attempt was complicated by an unfamiliar resistance. Even though resistance was met during insertion, the catheter was further inserted until a position in the inferior vena cava above the liver was obtained at fluoroscopy. Simultaneously, the patient became unresponsive. The procedure was immediately aborted and the atrial septal defect closure was not completed. Air embolism to the heart and brain was detected using echocardiography and computed tomography. The patient died 15 days after the procedure. Death was attributed to severe cerebral edema due to air embolism. The autopsy revealed a left-sided inferior vena cava. This case report demonstrates that unexpected congenital vascular anomalies complicating a routine transcatheter closure of the atrial septal defect can result in a fatal outcome.

Fingermarks are an important form of evidence in forensic science, routinely used for identification or exclusion purposes within the criminal justice system. The increasing use of fingerprint recognition in technology and biosecurity, such as for unlocking devices and accessing banking information, highlights the need for forensic fingermark recovery methods that serve both traditional forensic needs and modern technological demands. Current fingerprint development techniques, however, are not designed to fulfil this dual-purpose. This paper presents a novel approach that introduces the use of conductive paint and silicone to develop, recover, and preserve latent, patent, and plastic fingermarks. The innovative method produces conductive casts that capture detailed ridge patterns, thereby facilitating forensic examination as well as being used for unlocking capacitive and ultrasonic fingerprint scanners in a range of mobile devices.

Frailty syndrome occurs in elderly individuals with declining muscle mass (sarcopenia), unintentional weight loss, decreasing physical strength and activity, exhaustion, and slow ambulation. It significantly increases morbidity and mortality with cardiovascular, renal disease and neurological disorders, osteoporosis and fractures, endocrine and immunological dysfunction and a variety of malignancies. It is increasing in incidence as the population ages. However, unfortunately as identification relies on clinical and not pathological evaluations, its contribution to a wide range of comorbidities and its role in terminal episodes may not be recognized in a forensic context.

Utilizing a visual analysis of the literature on postmortem interval (PMI) estimation indexed by Web of Science (WOS), this study investigates developmental trends and research hot points across each 5-year period from 2006 to 2020. Additionally, collaborative efforts among authors, countries, and institutions were examined. Research hot points, high-frequency keywords, authors, countries and institutions in relevant papers were analyzed using CiteSpace.5.7.R2 information visualization analysis software over the past 15 years. The literature related to PMI estimation has witnessed consistent growth over time. In the keyword co-occurrence network, several impactful terms stand out, including blowfly, mitochondrial DNA, and emerging concepts like virtual autopsy. Technological advancements, such as RNA stability analysis and virtual autopsy tools, have played a pivotal role in shaping the direction of PMI research. Scientific research institutions dominate the high-frequency affiliations within the institutional cooperative network. Additionally, the country cooperative network exhibits a trend of co-occurrence and multi-clustering. As science and technology continue to advance, traditional PMI estimation methods mature while novel interdisciplinary approaches drive innovation. By identifying emerging trends and research hotspots, this study provides a roadmap for future investigations, guiding researchers toward new opportunities in PMI estimation.

A 52-year-old woman with of neck pain underwent percutaneous neck injection of local anesthetic and a corticosteroid without image guidance. She collapsed asystolic during the procedure was resuscitated and then died after 2 weeks in the intensive care unit with hypoxic encephalopathy. Complete postmortem examination included additional posterior neck dissection and cervical spinal cord removal with intact dura mater. The entire cervical spinal cord with the dura and leptomeninges was embedded in an oriented sequence of several paraffin blocks. Serial sections of each selected blocks were then studied to locate a putative puncture site. Serial sections from the third and fourth cervical levels (C3-C4) were stained with luxol fast blue-hematoxylin-eosin, iron stain, trichrome stain, and immunostained for b-amyloid precursor protein, and CD68. Histological examination revealed a linear needle track with a subacute healing reaction. The path included the dorsal spinal dura, arachnoid, and the left dorsal column. Clinicopathological correlation and the cause of death are discussed. Careful planning, dissection, sampling, and oriented serial sectioning with immunostaining were key points to document the injuries and understand this case.

To provide example cases within the peer-reviewed literature of a phenomenon related to certain gunshot wounds of the head where the bullet pathway courses along the inner table of the skull. Presentation of two cases discovered at medicolegal autopsy. The two cases provide radiologic and autopsy demonstration of bullet pathways within the head where the projectiles track along the inner aspect of the cranium, in a circumferential manner, such that the bullets are recovered in a location on the opposite side of the brain/head, with no projectile pathway within the intervening deep structures of the brain. The cases provide photographic and radiologic autopsy documentation of the phenomenon, which is described in forensic pathology textbooks and rare peer-reviewed literature sources, but without photographic demonstration. Recognition of this phenomenon in the clinical setting, or when correlating autopsy external and radiologic findings with historical information, may provide an explanation for situations where immediate incapacitation does not occur following a gunshot wound of the head.

Unusual findings during an autopsy may come from peculiarities in the position, shape, size, weight, consistency, smell or color of organs. The following study was triggered by an autopsy case in which an unusual blue-green discoloration of organs, which changed during the autopsy, was noticed. A review of the local autopsy database, selected cases including the antemortem clinical documentation and the literature has been performed to clarify the etiology of these conspicuous discolorations and to evaluate their diagnostic value. The study showed that certain xenobiotics may lead to such discoloration. After systemic administration of methylene blue, darkening blue-green discoloration of organs, especially the brain and heart, can be observed. In addition, the systemic administration of toluidine blue also appears to be capable of causing such discoloration. Beyond that, drugs (like Rohypnol) or other foreign substances (like detergents) containing warning colors, i.e. indigocarmin (E132) or Brilliant Blue FCF (E133) may cause discolorations of the upper gastrointestinal tract or the urinary bladder respectively. A blue-green, possibly darkening discoloration of organs during autopsy may point towards an antemortem administration of certain xenobiotics. The affected organs give an indication of the possible route of application and the type of substance. A differentiated interpretation of the etiology of such conspicuous discolorations at autopsy should only be made considering the (medical) history and, if necessary, complementary (toxicological) examinations.

Peer review of submitted manuscripts refers to the process of sending out papers for evaluation by suitably qualified academics/practitioners working in the same area. After their assessments and recommendations have been addressed by submitting authors editors will decide on whether publication is warranted or not. Unfortunately, 'peer review' has achieved a high status in courts without a real understanding of the way that the system works. Given that it has been deemed: 'a flawed process, full of easily identified defects with little evidence that it works', greater understanding of the nature of peer review is required. The following paper provides an overview of its strengths and weaknesses.

A 64-year-old man involved in a low-speed vehicle crash was found at autopsy to have altered blood extending from his stomach to his rectum. Within the stomach a small arterial vessel opened onto the mucosa of the posterior wall of the antrum adjacent to the pylorus with no adjacent mucosal ulceration or malignancy. Histologic sections showed the typical appearances of a Dieulafoy lesion with a tortuous small arteriole within the submucosa extending to the gastric lumen with an overlying cap of recently formed clot. There were no injuries attributable to the vehicle collision. Death was due to a bleeding Dieulafoy lesion of the stomach with a background of cardiomegaly. Dieulafoy lesion of the stomach is a rare disorder accounting for only 1-2% of cases of acute gastrointestinal hemorrhage. Although its pathogenesis is poorly understood it is capable of producing life-threatening bleeding, as in the present case. The small size of the lesion may make it difficult to identify at the time of autopsy.

The risk factors that modulate one's susceptibility for severe COVID-19 have been well documented. Despite this, hypercoagulability remains an often overlooked risk factor for severe disease for COVID-19. Because COVID-19 infection is a risk factor for hypercoagulability, a reasonable presumption/hypothesis is that patients with hereditary thrombophilia would be at a higher risk of thrombotic complications associated with COVID-19 infection.