Practice Of Forensic Medicine Research Articles

The Integration of Artificial Intelligence in the Forensic Medicine and its Applications in Medico-Legal Autopsy, Forensic Toxicology, and Disaster Victim Identification

Artificial Intelligence (AI) is revolutionizing various fields of medicine and science. In the realm of forensic medicine, AI is playing an increasingly significant role, not only in enhancing traditional forensic practices but also in improving the teaching of forensic medicine. This article explores the integration of AI in the teaching of forensic medicine and its applications in medico-legal autopsy, forensic toxicology, and disaster victim identification. By examining current AI technologies and their potential impacts, this article sheds light on the future of forensic medicine education and practice, emphasizing the need for continued research and development in this dynamic field.

An updated review on anesthesia and emergency medicine for forensic medicine practice

‘Anesthesia’ and ‘Emergency Medicine’ for ‘Forensic Medicine’ practice is an infrequently discussed topic in the current English literature. Demand of anesthesia and emergency medicine for forensic medical cases will probably increase in the future due to the ever-growing rate of drug trafficking and escalated sexual crimes at the regional as well as global levels. To address the relative scarcity of a review on this aspect, a comprehensive literature search was conducted using Cochrane, Medline, Scopus, and Google Scholar databases, to put forward the most up-to-date recommendations and guidance on the topic, which would shed light and help raise awareness among the emergency physicians, anesthetists, and intensivists about this important aspect of medical practice, ultimately improving the medical care of the affected ones without any prejudice and thus improve the outcome.
 Key words: Anesthesia; Body packers; Body stuffers; Emergency Medicine; Forensic Medicine; Sexual abuse
 Citation: Munasinghe BM, Pranavan S, Mayorathan U. An updated review on anesthesia and emergency medicine for forensic medicine practice. Anaesth. pain intensive care 2022;26(6):803−806; DOI: 10.35975/apic.v26i6.2057

Quality standards in forensic medicine

Forensic clinicians work with some of the most vulnerable members of society. Despite this it is one of the few areas of front line, undifferentiated healthcare in the UK that does not come under the National Health Service.The Faculty of Forensic & Legal Medicine (FFLM) has produced quality standards guidance for over a decade to support good practice in clinical forensic medicine. In April 2021 we surveyed their membership to ascertain whether clinicians working in the field felt that adequate standards were being maintained.The results demonstrate significant variability in the implementation of standards in both general forensic and sexual offence medicine for both adults and children. They highlight that despite some pockets of excellent practice there are significant areas of concern.

Artificial Intelligence in Forensic Medicine and Toxicology: The Future of Forensic Medicine.

The predominance of artificial intelligence (AI) will be the next Industrial Revolution. All the fields of industry will be reshaped with AI. Forensic medicine and toxicology is an important branch for investigations of crimes and this branch has tremendous scope of development with the help of AI. Any science or process cannot stay away long from newer techniques. The traditional way of doing an autopsy and framing an opinion has a lot of limitations and these limitations can be overcome with AI. Various procedures of forensic medicine like analysis of toxins, collection of the various samples of medicolegal importance from body cavity, detection of pathological changes in various organs of the body, detection of various stains on the body, detection of a weapon used in crime, time since death calculations, etc. are the areas where AI will play a key role in framing the various opinions of medicolegal importance. AI can also be integrated into existing testing and analysis processes to make the whole procedure rapid and more accurate. In the future, AI might become a key part of forensic medicine and toxicology practice.

RESEARCH OF TIME DYNAMICS OF CHANGE OF THE STEP OF DEPOLARIZATION OF LASER RADIATION BY TISSUE OF THE MAIN BRAIN

Taking into consideration the fact of the annual increase in the formulation of questions by the judicial authorities regarding the diagnosis of the prescription of death time and the need to increase their reliability, same as certain subjectivity of the moral and historical obsoleteness of the commonly used methods of forensic medicine practice, there is the need of developing of objective, cost-eff ectively more profi table, modern methods of the investigation of the dynamics of post-mortem changes of biological tissues of the human body. Therefore, the determining the prescription of the time of death due to its diff erent reasons is one of the most important issues of forensic science and practice. The paper deals with the results of the application of the latest methods of laser polarimetry used in forensic medicine, such as determination of the prescription of time of death due to mechanical asphyxia and massive blood loss by means of three- dimensional reconstruction of the time and spectral changes in the depolarization of laser radiation scattered by the human brain tissue.

A fatal case of spleen rupture secondary to thrombosed aneurysm of the splenic vein

ABSTRACT Vascular abnormalities of the spleen are infrequently encountered in medical practice and, among these, an aneurysm of the splenic vein is a rare event, being only a few dozen cases reported to date in the literature. The rarity of this clinical condition hinders the understanding of its clinical history, related medical management and potential complications, which are currently unclear. In this article, we report an autopsy case observed in the practice of forensic medicine concerning a 45-year-old woman, anaemic, who died at home a few hours after a previous hospital evaluation for abdominal pain and vaginal spotting. The autopsy revealed a massive secondary hemoperitoneum caused by a laceration of the spleen. On examination of the organ, an aneurysm of the proximal branch of the splenic vein was detected, affected by complete thrombotic occlusion. This case offers a new perspective regarding the clinical evolution of splenic vein aneurysm to death, unprecedented in the current literature.

An unusual complex suicide involving a chainsaw and a hanging: a case report

BackgroundSuicides or suicidal attempts with power tools such as band or circular saws are rarely encountered in forensic medicine practice; in the forensic literature, only a few cases have been reported. We present the case of a “combined suicide” (self-injurious actions using different methods and involving various bodily sites) carried out with uncommon deadly methods: chainsaw and hanging.Case presentationA 58-year-old Caucasian man was found dead by his wife, hanging from the basement ceiling of the cellar in which he lived. During the investigation of the crime scene, external examination revealed a wide incised wound in the umbilical area showing the muscular and adipose tissues below. On inspection of the garden around the courtyard, the police found a chainsaw with blood spatter on both the blade and the handle. The blade appeared to be compatible with the abdominal injuries.ConclusionsSince the corpse presented this incised wound, it was crucial to establish the manner and the causes of death, as well as to exclude any third-party involvement. In this case, the presence of multiple injuries, potentially lethal, required a differential diagnosis between suicide or homicide. A detailed post-mortem examination, in association with a precise study of the circumstantial data, led the authors to assume that they were dealing with a “complex suicide.”

Review and Prospect of Diagnosis of Drowning Deaths in Water.

Drowning is the death caused by asphyxiation due to fluid blocking the airway. In the practice of forensic medicine, it is the key to determine whether the corpse was drowned or entered the water after death. At the same time, the drowning site inference and postmortem submersion interval (PMSI) play an important role in the investigating the identity of the deceased, narrowing the investigation scope, and solving the case. Based on diatoms testing, molecular biology, imaging and artificial intelligence and other technologies, domestic and foreign forensic scientists have done relative research in the identification of the cause of death, drowning site inference and PMSI, and achieved certain results in forensic medicine application. In order to provide a reference for future study of bodies in the water, this paper summarizes the above research contents.

Accuracy of different dental age estimation methods for determining the legal majority of 18years in the Turkish population.

Radiographic evaluation of the third molar maturation is used to estimate dental age, especially in adolescence. This study aimed to assess the application of three age estimation methods (Cameriere's third molar maturity index (I3M), Demirjian's maturation stages, and The London Atlas) to determine whether an individual is 18years or older (adult) or younger than 18years (minor). The dental age was estimated using the I3M, Demirjian's maturation stages, and The London Atlas methods on panoramic radiograms of a total of 500 Turkish individuals aged 14-22years. A logistic model was derived with an individual's adult or minor status as the dependent variable, and each method and sex as predictive variables. The adult status was determined using dental age estimation methods and the performance of these methods in differentiating adults from minors was evaluated. The three methods were compared case-wise for their accuracy in predicting adult status. Logistic regression analysis showed that sex and each estimation method were statistically significant in discriminating adults and minors (p < 0.05). In the case-wise comparison for estimate adulthood, both Demirjian's stages and I3M methods tended to perform better than the London Atlas method, with this trend reaching statistical significance (p < 0.05). Cameriere's I3M and Demirjian's development stages are useful methods for adult age assessment in the tested population. In forensic medicine and legal practices, Cameriere's I3M and Demirjian's maturation stage methods based on the development of the third molar teeth can be used to determine whether an individual is a minor or an adult.

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview.

During the COVID-19 pandemic, forensic sciences, on the one hand, contributed to gaining knowledge about different aspects of the pandemic, while on the other hand, forensic professionals were called on to quickly adapt their activities to respond adequately to the changes imposed by the pandemic. This review aims to clarify the state of the art in forensic medicine at the time of COVID-19, discussing the following: the influence of external factors on forensic activities, the impact of autopsy practice on COVID-19 and vice-versa, the persistence of SARS-CoV-2 RNA in post-mortem samples, forensic personnel activities during the SARS-CoV-2 pandemic, the global vaccination program and forensic sciences, forensic undergraduate education during and after the imposed COVID-19 lockdown, and the medico-legal implications in medical malpractice claims during the COVID-19 pandemic. The COVID-19 pandemic has greatly influenced different aspects of human life, and, accordingly, the practical activities of forensic sciences that are defined as multidisciplinary, involving different expertise. Indeed, the activities are very different, including crime scene investigation (CSI), external examination, autopsy, and genetic and toxicological examinations of tissues and/or biological fluids. At the same time, forensic professionals may have direct contact with subjects in life, such as in the case of abuse victims (in some cases involving children), collecting biological samples from suspects, or visiting subjects in the case of physical examinations. In this scenario, forensic professionals are called on to implement methods to prevent the SARS-CoV-2 infection risk, wearing adequate PPE, and working in environments with a reduced risk of infection. Consequently, in the pandemic era, the costs involved for forensic sciences were substantially increased.

Forensic Medicine in South Asia: Comparison to the Developed Countries.

This study attempted to discuss the historical context and current practice of forensic medicine in South Asia. Comparisons within and between countries in South Asia, and between South Asia and the developed countries (represented by Japan and the USA) have been made to provide an insight into their distinct practice of forensic medicine. Though the formal establishment of forensic medicine in South Asia commenced at a comparable period to the developed countries, their pace of development has been considerably slow. Moreover, their ways of practice as well have evolved differently. In effect, South Asian countries follow an 'integrated service' system, whilst Japan and the USA practice 'divided service' systems to provide forensic medical services. Similarly, regarding the death investigations, most South Asian countries follow a Police-led death investigation system, whereas Japan and the USA follow a hybrid model and the Medical examiner's system of death investigation, respectively. Indeed, forensic medicine in South Asia is undeniably underdeveloped. In this paper, by highlighting the issues and challenges confronted in South Asia, key actions for prompt redressal are discussed to improve the standard of forensic medical services in South Asia.

Preparing reports in cases with blunt trauma to the heart area: Three cases

This case series has been prepared to create a perspective to evaluate blunt heart trauma, in which physical and psychological effects of trauma are seen together, in clinical forensic medicine practices. Case 1:A-50-year-old female patient with a history of hypertension had a heart attack in the first 24 hours after blunt trauma, she had an angiography and a coronary stent inserted. Case 2: A 60-year-old woman with no known disease fell after one of the children who entered her garden without permission kicked her ; she had angiography within 24 hours due to chest pain and stenocardia and found that she had coronary heart disease. Case 3: A 60-year-old man with a history of atherosclerotic heart disease had argued with neighbours and had a blow to his chest; in the emergency service, hospitalization was recommended to the patient due to left bundle branch block and troponin results; However, he refused hospitalization and left the hospital. Forensic medical evaluation of heart attack and rhythm disorders after blunt chest trauma or arguments is an important issue. Medical evaluation in terms of heart damage following blunt chest traumas is one of the factors that contribute to forensic reports prepared after the incident.

Problems in Postmortem Pathology Training.

In Turkey, autopsy performers, namely forensic medicine practitioners, are neither pathologists nor have properly received pathology training during residency in contrast to the Anglo-Saxon model of forensic medicine practices, since the current curriculum of forensic medicine residency lacks adequate training in post-mortem histopathology. Likewise, pathologists lack a specific post-mortem pathology clerkship. In this study, we intended to determine whether forensic physicians in Turkey find themselves competent in post-mortem histopathology or were adequately trained during their residencies. Turkish forensic medicine practitioners were administered an online questionnaire whereby self-evaluations of their histopathology knowledge and their views on histopathology training during forensic medicine residency were assessed. The 151 physicians who completed the questionnaire made up the study group. It was found out that the majority of Turkish forensic medicine practitioners (85.4%) did not find the histopathology training during their residency adequate. Similarly, 85.4% of the participants indicated their incompetence in histopathological examination of post-mortem tissue of any kind, and showed their willingness for further training in pathology. 66.9% strongly agreed that post-mortem histopathology requires training that is distinct from surgical pathology. In case of providing post-mortem histopathology training within the scope of forensic medicine residency, topics such as microscopic morphology of post-mortem changes, histological changes related to injuries, and estimation of wound age are expected to be beneficial to 88.7% 83.4%, and 83.4% of the participants respectively. The current curriculum should be revised in a way that the surgical pathology clerkship meets forensic physicians' needs, so that they can then refer more difficult, non-routine histopathological consultations to pathologists who are also well-trained in postmortem histopathology. Consideration should also be given to establishing a subspecialty training - a master's or doctoral degree programs in forensic pathology.

Research in forensic medicine under the view of biosafety.

In recent years, biotechnology is gradually getting popular and is playing a significant role in human productivity and life. The consequent biosafety problems are becoming increasingly prominent. Based on the connotation and extension of biosafety, this article sorts out the biosafety contents involved in traditional and modern forensic medicine research and analyzes the risks and challenges facing forensic medicine research from the perspective of biosafety. Based on the protection of legal medical experts, the establishment of working standards, and the promotion and support of research in forensic medicine on biosafety field and other aspects, this article discusses the prospectives of forensic medicine research from a biosafety point of view, and provides the insights and references for a smooth implementation of forensic medicine practice in the future.

Analysis of suicide hanging deaths in South Bangalore: A three-year retrospective study

Hanging is the most frequently encountered asphyxial death in forensic medicine practice. It is the second most common method employed to commit suicide in India. Easy availability and presence of wide range of ligature materials at home itself makes hanging a preferred method of committing suicide. This study was done at Kempegowda Institute of Medical Sciences &amp; hospital Bangalore with an aim to evaluate suicidal hangings through perusal of postmortem reports retrospectively during the study period between Jan 2011 to Dec 2013. During the 3-year study period the study population had a total of 519 decedents ranging between age 11 years to 77 years. Victims of both sexes comprised the study population. Suicidal hangings with reference to age, sex, socioeconomic status of the decedents, educational qualification, motive, time, type of suspension and position of knot were studied to evaluate the relationship between different parameters. 62.63% of the decedents were males. The most common age group affected were in their third decade of life, who made 43.35 population 66.1% of victims died in complete suspension and remainder 33.0952% of victims had typical know placement while 47.6% had atypical knot placement. 58.38% of victims belonged to lower socioeconomic strata of which a majority shared an educational qualification up to pre-university weighing a percentage of 26%. The motive in majority of the deaths remained unknown (38.15%), family disputes ranked second with a percentage of 36.03.

Fatal rectus sheath hematoma: a rare autopsy phenomenon

BackgroundRectus sheath hematoma is a condition where blood is accumulated within the sheath of the rectus abdominis muscle. It is caused by the rupture of either the superior or inferior epigastric artery or from a direct tear of the rectus muscle itself. This condition is usually self-limiting and most of the time, the hematoma is small, non-expanding and can be reabsorbed spontaneously over time. However, certain underlying pathology may lead to the expansion of the hematoma or even a recurrence, and without any medical treatment or intervention, this condition can even be fatal. Due to its rarity, only a few published cases of fatality associated with rectus sheath hematoma are reported worldwide.Case presentationWe present a case of non-traumatic fatal rectus sheath hematoma in the presence of underlying lung infection. The deceased complained of abdominal pain 2 days prior to death with a history of prolonged cough. The autopsy revealed the presence of a hematoma within the rectus sheath of the left lower quadrant of the abdomen extending down into the left pelvis and a multitude of small yellow-tan firm lesions scattered throughout the parenchyma of the right lung, suggestive of a lung infection which was later confirmed histologically.ConclusionsThe case serves to increase awareness of fatal rectus sheath hematoma as a cause of death given its rarity in forensic medicine practice. The importance of a thorough post-mortem examination is the key to noticing the fatal hematoma since its enclosed location within the rectus sheath may be obscured to the eye of an inexperienced prosector.

Computer assisted three-dimensional reconstruction of scene in firearm homicide.

Worldwide advances in computer techniques are not yet recognised in the practice of forensic medicine. A promising application is their use in making a three-dimensional reconstruction of the crime scene. This study analyses this technique in a homicide by firearm. Queries regarding the direction and number of shots, position of the victim inside the car when shot at and presence of the accused at the crime scene were answered by a scientific model. Similar reconstruction of the scene, nailing the accused in a heinous crime, has not previously been reported as a study or a case. The paper anticipates impetus to the growth of literature in criminology and forensic sciences. It will also expedite the delivery of justice based on scientific evidence in controversial causes of death.

Assessment of competency to stand a trial and the use of remote information and communication techniques in the argentine Justice

The COVID-19 has changed the way of working of forensic doctors, and the use of Information and Communication Technologies (ICTs) has gained relevance. But its implementation, for psychiatric-forensic evaluations, should comply with standards endorsed by the scientific community. Psycho-legal instruments are necessary in order to determine the procedural capacity of an accused person to stand trial. In the Justice of the Autonomous City of Buenos Aires (CABA), virtual proceedings are carried out, as the National Government decreed the obligatory social lockdown. In the case of the criminal jurisdiction, web platforms and electronic notifications are used for the processing of legal cases. However, in the practice of forensic medicine, there are difficulties in the use of ICTs to determine a person's capacity for criminal prosecution.

Clinical and legal analyzes of adverse cases in medical care on criminal cases: an innovative educational activity

Background: Currently, the Russian Federation is facing an especially acute problem of medical personal undergoing criminal liability (CL) owing to inappropriate medical care. Aim: The goal is to analyze the level of legal training among the Kazan State Medical University (KSMU) students in matters of possible CL resulting from medical malpractice. Material and methods: From January 1, 2018, to March 30, 2018, we surveyed 426 students of KSMU. The survey questionnaire included questions on Russian legislation, the materials of forensic medicine, open investigative, and forensic practice. In total, 122 first-year (28.6%), 51 second-year (12%), 63 third-year (14.8%), 58 fourth-year (13.6%), 68 fifth-year (16%), and 64 sixth-year students (15%) were questioned. Results: Overall, 272 respondents (64%) considered that there should be no CL for medical personnel. In addition, 392 (92%) students were unaware of the Criminal Code articles used to prosecute medical workers. A possibility of CL scared 204 (48%) students from practicing. Moreover, 342 (80%) respondents noted that the study of medical error cases would reduce the number of such cases in future practice. We have introduced a new educational project Medica Law Clinic at the KSMU Forensic Medicine Department. Its goal is to ensure increase legal and professional training among students through a comprehensive analysis of criminal medical cases. The work presents the personal experience of eight educational events. Conclusions: Our findings revealed a need to increase the level of legal training among students of medical universities regarding criminal matters. A comprehensive analysis of criminal medical cases is a progressive pedagogical format that has proven its efficacy in the Republic of Tatarstan.

Evidence in forensic practice

Evidence supporting much of clinical forensic medicine practice is deficient or dated. This presentation highlights the results from two local research projects which looked at various aspects of the sexual assault forensic examination.1.Do they who slide first, slide best: Jurisdictions within Australia and internationally differ with regard to preference for who creates the smear from those swabs taken to find DNA from semen. This research sought to articulate the function of slide preparation in sexual assault and to identify whether slide preparation by the forensic examiner, at time of examination, was preferable to slide preparation by forensic laboratory staff, at a later date. It also provided a review of the limited research in this area and posed questions for potential future research.2.Patient perception of forensic imaging: Historically, photography used in forensic documentation of injuries (especially genital injuries), sustained during an alleged sexual assault, has been controversial. This study explored the immediate and short-term experiential impacts of forensic photography from the victims’ perspective and supports the case for the routine use of forensic photography, with patient consent.