Forensic Medicine Experts Research Articles

Suspicious death – trace evidence identified the complainant as accused: A real crime scene report

Unnatural death incidents are reported to police wherein the dead body appearance confuses the first officer in the crime scenes. Generally, the forensic medicine experts are not involved in crime scene visit, but waiting for the body at the autopsy room. Anyhow, the forensic crime scene investigators or mobile forensic scientists have an active part in the examination of the crime scene and the body under suspicious condition. Through keen crime scene observation, they may able to link the physical evidence in the scene with the dead body in the suspicious death cases and solve the mystery. In the present suspicious death case study, a woman was found hanged in her residence under suspicious condition. The complainant husband alleged that his wife committed suicide by hanging while he was away from home. The examination of physical evidence and the dead body in the crime scene indicated it as a homicidal hanging rather than suicidal hanging as alleged by husband. This fact was confirmed by the forensic medicine expert in the autopsy examination.

Problematyka identyfikacji ciał ofiar katastrof lotniczych w Polsce. Rola biegłego z zakresu medycyny sądowej w grupie oględzinowej oraz w zespole do spraw identyfikacji ciał ofiar katastrof (DVI)

This article deals with the problematic aspects relating to aviation crash victim identification in Poland and the specific nature of participation of a forensic medicine expert in activities undertaken as part of an external examination group and a Disaster Victim Identification (DVI) team. It describes in a concise manner the course of the process of identification of the victims' bodies, beginning with the actions undertaken at the incident site and ending with the public prosecutor's decision to allow for the interment of dead bodies or human remains. It presents a catalogue of identification methods by grouping them from the most credible ones to the ones that merely suggest the victim's identity. It concisely describes the tasks faced by the forensic pathologist, who plays a double role at a crash site, i.e. as a member of an external examination group and of a DVI team.Niniejsza praca porusza zagadnienia związane z problematyką identyfikacji ciał ofiar katastrof lotniczych w Polsce oraz specyfiką udziału biegłego z zakresu medycyny sądowej w działaniach podejmowanych w ramach grupy oględzinowej oraz zespołu do spraw identyfikacji ciał ofiar katastrof (disaster victim identification) – DVI. W sposób zwięzły opisuje przebieg procesu identyfikacji ciał ofiar, poczynając od czynności podejmowanych na miejscu zdarzenia, a kończąc na decyzji prokuratora o zezwoleniu na pochowanie zwłok czy szczątków ludzkich. Przedstawia katalog metod identyfikacyjnych, grupując je od najbardziej wiarygodnych do tych, które jedynie sugerują tożsamość ofiary. Zwięźle opisuje zadania, jakim musi sprostać medyk sądowy działający na miejscu katastrofy w podwójnej roli – zarówno w ramach grupy oględzinowej, jak i w ramach zespołu DVI.

The work of transnational forensic medicine experts in colonised zones: the Palestinian case

This article aims to shed light on the post-mortem practices for Palestinian dead bodies when there is suspicion of human rights violations by Israeli military forces. By focusing on the case of Omran Abu Hamdieh from Al-Khalil (Hebron), the article explores the interactions between Palestinian social-institutional agents, Israeli military forces and international medico-legal agents. Drawing on ethnographic and archival data, the article explores how the intersectionality between the various controlling powers is inscribed over the Palestinian dead bodies and structures their death rites. The article claims that inviting foreign medico-legal experts in the Palestinian context could reveal the true death story and the human rights violations, but also reaffirms the sovereignty of the Israeli military forces over the Palestinian dead and lived bodies.

Digital restoration of fragmentary human skeletal remains: Testing the feasibility of virtual reality

Experts in forensic anthropology and medicine have become gradually accustomed to examining components of the human body in the virtual workspace. While the computer-assisted approach offers numerous benefits, the interactions with digital three-dimensional biological objects are often problematic, particularly if conducted with mouse, keyboard and flat-panel screen. The study focusses on feasibility of a virtual reality (VR) system for virtual restoration of fragmentary skeletal remains.The VR system was confronted with three cases of fragmentary remains. The cases were reassembled manually by twenty participants using a HTC Vive headset combined with an in-house application A.R.T. The same task was performed using a CloudCompare software in conjunction with a desktop peripheral. The two systems were compared in terms of time efficiency, the geometric properties of the resulting restorations, and convenience of use.Restoration using the VR system took approximately half the time the desktop set-up did. The VR system also yielded a lower error rate when a severely fragmented skull was reassembled. Ultimately, although the efficiency of the reassembling was shown to be strongly dependent on the operator's experience, the use of the VR system balanced out the uneven levels of proficiency in computer graphics.The current generation of virtual reality headsets has a strong potential to facilitate and improve tasks relating to the virtual restoration of fragmented skeletal remains. A VR system offers an intuitive digital working environment which is less affected by an operator's computer skills and practical understanding of the technology than the desktop systems are.

An observational study on the parameters influencing the duration of forensic medicine expert reports in assessment of inmates’ health status in view of sentence interruption on medical grounds - conducted at the Cluj-Napoca Legal Medicine Institute between 2014 and 2018

An observational study on the parameters influencing the duration of forensic medicine expert reports in assessment of inmates’ health status in view of sentence interruption on medical grounds - conducted at the Cluj-Napoca Legal Medicine Institute between 2014 and 2018

Compared growth patterns of the foot and its correlation with stature in Western Uttar Pradesh and NCR Delhi children aged between 6 and 10 years

Introduction: The present study is based on the measurement of foot length and width which is correlated with the stature of 250 Western Uttar Pradesh and NCR Delhi children between 6 and 10 years of age. The measurements of the feet were taken on a flatbed scanner, and the image was captured and analyzed on a computer using Photoshop software. Material and Methods: The present study was conducted on 250 Western UP and NCR Delhi children who belong to different parts of Western UP and NCR Delhi. The stature of the person was measured from vertex to the floor while the individual was standing in an anatomical position. Obtained data were analyzed, and an attempt was made to find the correlation and to derive the linear regression formulae between stature and foot measurement. A good correlation was observed between stature and foot measurements. Results: Foot length of both right and left feet had a stronger correlation to stature with a value of 0.736, and the significance level was 0.01. Foot width of the right foot had a good correlation to stature with a value of 0.591, and the significance level was 0.01. Foot width of the left feet also had a good correlation to stature with a value of 0.588, and the significance level was 0.01. Discussion and Conclusion: Stature is an important parameter in determining the partial identity of unidentified bodies and dismembered remains. Determination and monitoring of growth rate may be possible with the correlation of foot length and stature. Results obtained would be useful for anthropologists and forensic medicine experts.

Suspicious death-Crime scene evidence indicated the cause of death: An interesting multiple death case report

In death investigation, sometimes the body posture may causes confusion and complication to the crime scene investigators to explain. This may occur in the context of suicide or body found in non-residential or outer area. Natural disasters like storm, drought, lightning, flood may cause the situation complicated and confused the investigators to arrive a conclusion. Lightning is the beautiful display in nature but deadly natural phenomena known to man. The following is a case report in India, as investigated by the corresponding author, wherein two villagers who went for their routine goat herding activity in forest area but never returned home except the goats. The villagers and relatives have searched and found the dead bodies under a tree in the forestarea. The relatives and villagers alleged that somebody had murdered the two herders in the forest area. But based on the physical evidence in the crime scene, it was proved as a case of lightning by the author, formerly a field criminalist (forensic crime scene investigator). The bodies were sent to autopsy room and the forensic medicine experts confirmed the crime scene finding in the autopsy examination also.

Management of psychogenic non-epileptic seizures: a multidisciplinary approach.

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.

Human deaths from drug overdoses with carfentanyl involvement-new rising problem in forensic medicine: A STROBE-compliant retrospective study.

Carfentanyl, an ultra-potent synthetic opioid, is approved for use only in veterinary medicine as a tranquilizing agent. However, many cases of human poisoning with carfentanyl have recently appeared in the news with limited information given and scientific literature provides only 1 case of documented human exposure to carfentanyl.Fifteen cases of death from drug overdoses with carfentanyl involvement are being presented. Fifteen blood and urine samples have been taken for alcohol and drug testing. Headspace gas chromatography was used for alcohol detection. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography–time-of-flight mass spectrometry (LC/MS TOF) system was used for drug detection.Sixty-three cases of death from poisoning with drugs have been tested for carfentanyl in the State Forensic Medicine Service. Fifteen of them were positive for carfentanyl.The cases mentioned above show that carfentanyl exposure causes signs and symptoms similar to other opioid toxicity. Carfentanyl intoxication may even be fatal if appropriate treatment is not available. Therefore, nowadays it is very important to draw forensic medicine expert's attention to new substances in drug trade.

A review of the diversity in taxonomy, definitions, scope, and roles in forensic medicine: implications for evidence-based practice

The scope, roles, and tasks of forensic medicine and forensic medical experts currently vary widely between countries and legal systems, which has resulted in barriers to organization, standard setting, and quality assurance for practice in forensic medicine, including for reporting. The legal fact finder is thus confronted with variability in the quality, structure, and content of forensic medical reports. We sought to define and categorize the scope, methods, and practices that fall under the description of forensic medicine, the various issues encountered in current forensic medical practice, and the potential role of evidence-based practice in forensic medicine. We searched electronic databases and reviewed relevant articles, as well as conducting personal correspondences with forensic medical practitioners around the world, to obtain a description of current forensic medical practice. The terms forensic medicine, legal medicine, medical jurisprudence, medico-legal services, forensic pathology, and clinical forensic medicine are used with mixed interpretations in different countries. The systems and services rendered are not uniform either. The methods used by forensic medical practitioners are not always evidence-based, or based on standardized methods, and vary greatly between experts and centers. There are also no universally accepted guidelines to prepare a standard and admissible report. The lack of a uniform system in forensic medicine creates difficulties in assessing the development and performance of forensic medicine as a distinct discipline. To prepare evidence-based forensic medical reports, generally accepted guidelines are necessary.

Effects of Killing Liquids on the Larval Length of Forensically Important Lucilia sericata

Objective: Forensic entomological practices rely upon accurate larval identification and measurement of larval length, for the estimation of post-mortem intervals. The methods used for killing larvae may affect the length of larvae. In the autopsy hall, corpses which are contain entomological remains have been washed with grape vinegar. Besides, while collecting and killing the larvae on corpses, crime scene teams use ethanol 70% because it is practical.
 The aim of this study was to determine which of hot water (90°C), cold vinegar and cold ethanol 96% method, preserved the best the length of larvae.
 Materials and Methods: To achieve this aim, third instar larvae which are reared on 200 g of veal meat were killed using hot water, cold vinegar and cold ethanol. Before killing and after killing the maggots, their length was measured. To determine the difference between the groups to be compared ANOVA test, to reliability and validity analyses Kruskal-Wallis and whether there was any difference between the groups were made with Tukey’s Honestly Significant Difference (Tukey’s HSD)
 Results and Conclusion: Hot water was found to preserve the length of the larvae more accurately than cold vinegar and ethanol. Forensic medicine experts and crime scene teams should kill the larvae collected from a corpse for entomological examination using hot water, dry them in paper towels and preserve them in 96% ethanol and then send them to a forensic entomologist.

Injury potential of one-litre beer steins.

Injuries resulting from blows with beer steins are a frequent occurrence during annual autumn fairs or at beer halls in South Germany and Austria. The majority of these cases are tried in court and thus being assessed by a forensic medicine expert. The article at hand gives a short overview on the injury potential of one-litre beer steins and explains the key variables to consider when analyzing beer stein injuries. On the basis of representative cases, which were assessed by specialists from the Institute of Legal Medicine of the Munich University over the last 5years, the main biomechanical aspects and resulting injuries of one-litre beer stein assaults are discussed. Several severe and potentially life-threatening injuries have been observed after an assault with a one-litre beer stein. There is a discrepancy between the mechanical stability of brand new and used steins and the corresponding injuries, which can be explained by a decrease in impact tolerance of the steins with their use. In general, a blow with a one-litre glass or stonework beer stein to the head can cause severe and even life-threatening blunt as well as sharp trauma injuries.

Estimation of the Stature from Length of the Mandible in the South Indian Population

The present study is based on the measurements of mandible length and height of body total 50 subjects between 18 to 40 years of age. The mandible length was measured by vernier caliper. The height was measured in standing erect, anatomical position with standard height measuring instrument. To avoid variation, all measurements were taken at a fixed time. Obtained data was analysed and attempt was made to find out correlation and to derive a regression formula between mandible length and height of an individual. A good correlation of height was observed with mandible length and it was statistically highly significant. The results of the present study would be useful for Anthropologists and Forensic Medicine Experts.

FORENSIC MEDICAL ASPECT OF RIGHT TO LIFE VIOLATION CASES IN ECHR DECISIONS ABOUT TURKEY FROM 1998 TO 2002: REVISITING THE COMMON ERRORS IN DEATH INVESTIGATIONS

Violation of the right to life is the most severe type of physical assault against humans. In this study decisions by the European Court of Human Rights (ECHR) about violation of the right to life cases in Turkey are investigated, with the aim of determining deficiencies and errors in forensic medical procedures and to discuss the effect of these on the violation decision. Digital court files with decisions made by the ECHR from 1998 to 15.05.2002 published on the internet were retrospectively investigated. Cases with decisions against Turkey for right to life violations were determined. This study assessed data related to death investigations. Data analysis was performed with the Epi-Info 2000 program. From a total of 21 files (22 cases) with decisions of right to life violation and/or torture, there were 12 cases with decision of right to life violation (54.5%). For 11 cases (91.7%) examination of the deceased was performed, with this examination only performed by a forensic medicine expert for 2 cases (18.2%). It was determined that autopsy was not performed for 8 cases (66.7%). Of the 4 cases with autopsy performed, none (100.0%) had photographs or radiologic imaging taken, skin sampling for microscopic and chemical analysis or sampling of any biological material performed. This research showed that, there were serious deficiencies and errors in forensic medical procedures and those investigations of death are not standardized. To prevent violations of the right to life and to efficiently perform inquiries related to death, doctors with sufficient knowledge and skills about forensic medical procedures should be required to abide by the Minnesota autopsy protocol.

Unexpected complications following an occupational injury

Experts in forensic medicine are often requested to give an opinion on bodily damage resulting at work. General hazards in a work environment include electricity, fire, inflammable gases, high pressure gases and liquids, powerful or sharp moving machinery and fall. When an occupational trauma is complicated with an unexpected sequelae the forensic pathologist is in a dilemma. We report a workman who was brought following blunt head and chest trauma complicated with a facial palsy and lobar pneumonia. Case study A 53 year old security officer was brought to the hospital following improperly fixed gate falling on to him while at work. He was recruited by the security company two months back and was appointed to this place without informing the condition of the gate. History revealed that he was unconscious for a few minutes and remained to have dizziness and vertigo. Next day he developed profound left lower motor neurone facial nerve palsy. He had fractures of the right petrous temporal bone, and a left scapula. Two weeks later he developed shortness of breath and fever, which was diagnosed as left sided lobar pneumonia. Conclusion Fracture of the bones and the facial nerve damage could be easily categorized as grievous injuries. Chest trauma may result in localized pulmonary contusion which can be complicated as an infection presenting late. The appreciation of the association between the infection and initial injury needs thorough scientific basis since the category of hurt is crucial in formation of medico legal opinion.

Handling medical negligence: necessity of a proper system

Handling medical negligence: necessity of a proper system

3rd International Arab Forensic Sciences & Forensic Medicine Conference, ASFSFM 2017: Conference Report

The Arab Society for Forensic Sciences and Forensic Medicine (ASFSFM) at Naif Arab University for Security Sciences seeks to present the latest developments in all fields of forensic sciences through holding specialized scientific events and academic activities. This is also achieved through its periodic scientific peer-reviewed journal, the Arab Journal of Forensic Sciences and Forensic Medicine. It also seeks to promote scientific research in all fields of forensic science and forensic medicine, and seeks actively to contribute in holding scientific meetings in accordance with advanced scientific standards, including the 3rd International Arab Forensic Sciences & Forensic Medicine Conference. This important event was attended by scientists and experts from various fields of criminal and forensic sciences from both Arab and non-Arab countries. This conference was a significant scientific accomplishment that contributed to the advancement of forensic sciences and forensic medicine in the Arab world. The conference aimed, in accordance with the vision of Naif Arab University for Security Sciences, to enhance peace, security and justice in Arab societies. Naif Arab University for Security Sciences, represented by the Arab Society for Forensic Sciences and Forensic Medicine, held the 3rd International Arab Forensic Sciences & Forensic Medicine Conference on the University's campus during the period from 21st to 23rd November 2017. The event included the participation of more than 720 experts in forensic sciences and forensic medicine from 33 countries all over the world. Experts discussed and presented the latest developments in their fields. The conference provided a creative environment for students from both local and international universities to benefit from experts and specialists, and to access the most recent research. On behalf of His Excellency the president of Naif Arab University for Security Sciences, and the Arab Society for Forensic Sciences and Forensic Medicine, we would like to pay tribute to all scientists and experts who contributed by sharing their scientific researches through lectures, workshops, and posters within this event. We appreciate their contributions that added great value to the subject of the conference.

The medico-legal evaluation effect: Asylum grant rate in the metropolitan city of Milan

The Istanbul Protocol (IP) defines standards and procedures in relation to torture. The main body of the protocol relates to medical and psychological examination of the torture victim and to the writing of a medico-legal opinion in those cases. In a refugee situation, the proof that a person suffered persecution and torture in his country of origin or during his journey represents an important piece of evidence in the application process for asylum. Based on our experience, we analyze the asylum grant rate among asylum seekers receiving medical evaluations, in order to identify predictors of grant status. In Milan, local authority and the academic Section of Legal Medicine, have assembled a team, composed by experts in clinical forensic medicine, ethno-psychiatry, psychology and social workers, with the task of examining asylum seekers. After the evaluation, the Territorial Committee, comprised of civil servants, will determine the positive or negative outcome of the asylum application. We compared medico-legal reports, given according to the IP, and judgements from the Committee. Raising the level of consistency between refugee's narrative and analyzed scars, the percentage of subjects with a positive response increases. Furthermore, the positive outcome depends on the type of reported trauma, especially gunshot victims. In addition, both the number and the co-existence of different types of lesions play a role: the larger they are, the more favorable judgment is obtained. These data show forensic assessment may have a relevant weight on the final judgment given by the Committee, but there are still open problems: – the need for more detailed analysis on these subjects during the examination, maybe using imaging, – an implementation of the IP could allow physicians to increase the grade of consistency, – introducing health professionals, “expert in migrations and torture”, as members of the Committee, could help to empathize the physical and psychological effects of trauma on applicants, – organizing a follow-up program for refugees after the Committee judgment.

Sudden Unexpected Death in Epilepsy: A Retrospective Autopsy Study of 112 Epileptic Patients.

Sudden unexpected deaths comprise the most important and worthy investigation case profiles in both neurology and forensic medicine. Epilepsy, which is one of the neuropathological causes of sudden unexpected deaths, is an important disorder having mysterious aspects. The aim of this study is to make common the points of view between neurology and forensic medicine experts and to discuss the features of the findings together with the related clinical hypotheses, leading to the differential diagnosis of sudden unexpected death in epilepsy (SUDEP) by presenting autopsy findings and available medical data of patients who had a prior diagnosis of epilepsy. In Istanbul, the cases of 20334 autopsied patients who were referred to The Ministry of Justice Council of Forensic Medicine between 2007 and 2011 were identified from the complete forensic autopsy data of the city and were retrospectively reviewed. Patients who had a prior diagnosis of epilepsy were included. Both descriptive and inferential statistical analyses were performed through the parameters of demographical data, physical properties, incident features, macroscopic-microscopic autopsy findings, and cause of death initially for all cases and then separately for SUDEP cases. Among the 20334 patients, 112 were determined to have a prior diagnosis of epilepsy. A possible macroscopic and/or microscopic epileptic focus was present in 23 (20.5%) of these 112 cases. The cause of death was determined to be SUDEP in 40 (35.7%) cases, while it could not be determined in 28 (25%) cases. Among patients whose death cause was considered as SUDEP, the male-to-female ratio was 1.1:1, while the mean age was 31.5±13.9 years in males and 29.6±12.9 years in females. The presence of hypertrophy and myocardial scar tissue findings in the microscopic examination were significantly more frequent among patients determined to have died from cardiovascular diseases compared to patients in the SUDEP group (p=0.001 for each finding). Besides, in 40 SUDEP cases, 38 (95%) patients underwent toxicological analysis and no antiepileptic agent was detected in 21 (55.3%) of these. It can be concluded that there is equality in gender distribution among SUDEP patients, that the young adult population has a slightly increased risk for SUDEP, and that the inconsistent use of antiepileptic medicines is a greater risk factor for SUDEP than polytherapy. Besides, it is important to emphasize that all clinical and postmortem parameters together should be considered for the differential diagnosis of SUDEP, particularly with cardiovascular diseases.

Profile Study of Negative Autopsy among the Post Mortem Cases Referred from Medical Officers to Forensic Medicine Department, Ahmedabad, India

Background : The principal aim of an autopsy is to determine the cause of death, and the state of health of the person before he or she died. But in several instances even after detailed autopsy and various laboratory investigations, autopsy surgeon/ Forensic medicine expert cannot determine the cause of death and they end up with negative autopsy. The present study was carried out to find out the types of cases where we were unable to determine cause of death after autopsy at forensic medicine department, B J medical college, civil hospital, Ahmedabad, India. Methods: A total of 251 dead bodies were referred by Medical officers to forensic medicine department, B J medical college, Ahmedabad for expert post mortem examination from 1 st January 2011 to 31 st December 2015. Results: After thorough and complete post mortem examination, it was found that in 43(17.13%) cases no opinion as to the cause or nature of death could be given. Most common types of cases include decomposition (53.50%), and skeletal remains (23.25%). Conclusion: According to above mentioned facts it is clear that chances of getting cause of death is very poor if time lapse more and more after death like in decomposition and skeletal remains.