Practice Of Forensic Medicine Research Articles

Deaths during Sexual Activity

Background: Deaths during sexual activities are a rarely identified phenomenon in forensic medicine practice. Most often, such deaths are classified as accidents or deaths due to the manifestation of certain diseases during sexual activity. It is important to rule out homicide or suicide as the cause of death when investigating sexual deaths. Determining the cause of death requires a comprehensive assessment of the evidence and circumstances and should not be based solely on autopsy findings. When determining the cause of death, it is necessary to evaluate the circumstances of the discovery, important evidence found near the body, the position of the deceased, the place where the deceased was found, and the characteristics of the environment. Cases: Case 1: A 65-year-old male was clothed in women’s underwear and was found hanging in a noose in a bedroom after a house fire. The autopsy revealed a ligature mark on the neck, bruises in neck muscles, tears in carotid arteries, and signs of acute pulmonary distension. The cause of death was determined to be suffocation due to neck compression by a ligature, compounded by significant alcohol intoxication, with additional postmortem burns covering 30% of the body surface area likely occurring after death. Case 2: A 55-year-old naked male was found without external injuries but with a plastic tube inserted into the rectum, causing a 2.5 cm rupture in the ileum. The perforation led to complications, including purulent diffuse peritonitis, intoxication, and acute cardiac and respiratory failure, resulting in death within 3-6 hours after insertion. Concurrent findings included atherosclerotic changes in the heart, internal organ hyperemia and edema, hepatic steatosis, renal cyst, and a lack of ethyl alcohol in blood but 0.17 ‰ presence in urine according to toxicology analysis. Conclusions: A detailed evaluation of all the evidence is very important in the forensic examination of the deceased during sexual activity. Therefore, to determine the cause of death, not only the autopsy data, toxicological and microscopic examinations of the deceased are important, but also the evaluation of all findings at the scene. The most common cause of death of an autoerotic nature is asphyxia, and the most commonly identified group of the dead are men aged around 40 years.

Forensic, medical and legal problems and solutions on passenger and cargo ships

Marine vehicles have an important place in international trade and tourism. There are various directives and studies on the prevention of health problems in marine vessels and injuries and deaths due to occupational accidents. In the literature, not enough studies have been found in which the issues to be considered in cases of injuries, sexual assaults, accidents, suicides and murders that are common in forensic medicine practice, and there are no guidelines or recommendations of internationally accepted organizations. It is important to determine the seafarer who is responsible for intervening in health emergencies on cargo ships, and to detect faulty ones, if any, in work accidents that result in serious injury and death. In addition, injuries, suicides and murders are encountered among the crew, and crime scene findings are lost until they are evaluated by the judicial authorities. Although rare, sexual assaults on cargo ships are also reported, but there are not enough scientific studies that indicate what should be done in terms of evidence evaluation. Our study emphasizes the issues to be considered, that one of the crew should be held responsible and necessary training should be given in order to make a forensic medical evaluation in forensic events that will be encountered on cargo ships, and that physicians and health workers should be competent in the first forensic medical evaluation in case of emergency on passenger ships. It is thought that the launch of the telemedicine application, which provides uninterrupted service for forensic medical emergencies in maritime vessels, under the leadership of organizations such as the “International Maritime Organization” (IMO), will make a significant contribution. In addition, suggestions are made for legal impasses in such cases that take place in high seas.

Determination of the time of death of a domestic cat by measuring the area of a wet spot

Animal cruelty is a criminal offence under the current legislation of Ukraine. When investigating criminal proceedings related to animal cruelty, including domestic cats, it is often necessary to establish the time of death. Therefore, the development of new methods for determining it and improving existing ones is extremely relevant. The purpose of the study was to establish the relationship between the obtained values of wet spot area indicators and the time of death. To achieve this goal, the authors propose a new method for determining the age of death of domestic cats based on the results of measuring the area of a wet spot obtained from skeletal muscle tissue samples of corpses (Shkundia method). To do this, samples of muscle tissue were taken from the corpses of cats, a wet spot preparation was obtained by pressing and its area was calculated to establish a correlation between the values of this indicator and the time that has passed since death. The study of the obtained indicators established that these values are constant, and the features of fluctuations in the values of this indicator with the time elapsed since the death of the animals were established and shown graphically. Using a number of statistical methods, the absence of dependence of wet spot area indicators on the muscles from which samples were taken for research and animal breeds was determined. The nature of changes in the values of the wet spot area indicator depending on time is established and the features of their fluctuations in different periods during 27 days from the moment of animal death were explained. Reference values of these indicators depending on the time elapsed since the death of animals are presented, which can be used by forensic veterinary experts in practical work to determine the time of the occurrence of death of domestic cats. Due to a number of advantages, this method can be widely implemented in the practice of forensic veterinary medicine

Effectiveness of forensic medicine practices: Rwanda facing shortage of forensic pathologists

Forensic pathology has often been disregarded in both Western and non-Western countries, including the African nations. In this article, we highlight the shortage of forensic pathologists in Rwanda and make recommendations to encourage physicians to pursue the subspecialty of forensic pathology. Critically, we analysed issues and challenges related to the inadequate supply of forensic pathologists in the healthcare sector of Rwanda. The authors referred to scientific and legal literature from books, journals, national and international reports, and electronic sources on forensic pathology training and workforce. As a result, authors have identified several reasons for the shortage, including lack of exposure to forensic pathology, absence of a direct path for forensic pathology training, and insufficient funding for fellowships in forensic pathology. It is important to note that there is a global shortage of forensic pathologists, which hinders the effective practice of forensic medicine, including examinations and assessments of various types of deaths and incidents. This ultimately affects the administration of justice. However, it is hopeful that Rwanda's efforts in the field of forensic medicine will have a positive influence on other African nations in the coming years.

The importance of diffuse axonal injury in the daily forensic medicine practice

The importance of diffuse axonal injury in the daily forensic medicine practice

Bone and Tooth: Substrates for Determining Drowning: A New Diagnostic Procedure in Forensic Medicine Practice?

IntroductionDiatom tests are rarely used during autopsy to confirm drowning as the cause of death (COD) because of limitations of the current literature involving these techniques. Instead, experts rely on physical examination by the pathologist. Due to interpretive concerns regarding Diatom tests, they are often insufficient in establishing a diagnosis, but offer the potential to be an extremely useful diagnostic tool with further understanding. The aim of study is to optimize “Diatom Tests” for use in forensic medicine in Bosnia and Herzegovina. MethodsA randomized prospective experimental study was conducted, using albino Wistar rat models (Rattus norvegicus), at the Veterinary Facility, University of Sarajevo. Thirty-two adult albino rats, were used and distributed into groups as follows: Group A (6 deceased rats with COD other than drowning, but due to mechanical asphyxia, which were then submerged for 1 hour after death); Group B (6 deceased rats with COD other than drowning, but due to mechanical asphyxia, which were then submerged for 72 hours after death); Group C (6 rats that were immediately autopsied after drowning, with COD determined as drowning); Group D (6 rats that underwent a 48-hour postmortem period after drowning); Group E (COD: drowning, post-mortem 72hrs after death, remained submerged in water until PM).Live algological material was collected for the research of the systematics of algae from the Bosna river, Sarajevo, and transported to the University of Sarajevo (Department of Biology, Faculty of Science). Periphyllon, epiphyllon and epipelon were used to collect phytobenthos. The material was fixed with 4% formalin solution. Laboratory processing of diatoms was performed using the methods described by Hustedt (16). In the process of obtaining pure diatom valves, part of the material is digested with potassium permanganate (KMnO4), sulfuric acid (H2SO4), and oxalic acid (C2H2O4). In the next step, the cleaned diatom valves were mounted in Canadian balsam. A light microscope under 1000x magnification (Best Scope 2020) was used to evaluate and analyze the species. The identification of diatoms was performed using the reference of Cantonati et al (17). The nomenclature of diatom species was performed according to Guiry & Guiry's worldwide electronic internet database. ResultsNo diatoms were found in Groups A and B. However, Navicula sp. and Sellaphora sp. cf., were discovered during bone analysis of Group C where rats were immediately autopsied after drowning. Hantzschia amphioxus taxon was present in Group D, which underwent a 48-hour postmortem period after drowning and before samples were taken.In Groups C and D, where drowning was the COD, Diatoma vulgaris i Pinnularia major, Achnanthidium minutissimum i Melosira varians were present in the tooth samples. ConclusionOptimization of the “Diatom Test” method could potentially lead to its future use as a routine method within experimental settings. This experimental study is a starting point that guides forenscic medicine pracitioners towards the optimization of tests and sampling in cases of unexplained etiology, where preserved soft tissue structures is not available. In these cases, teeth and bones serve as accessible materials for diagnosing COD, alongside standardized nonspecific findings in the absence of organs for micro- and macroanalysis.

Forensic Medicine Practices in Earthquake

Forensic Medicine Practices in Earthquake

Research progress and potential application of microRNA and other non-coding RNAs in forensic medicine.

At present, epigenetic markers have been extensively studied in various fields and have a high value in forensic medicine due to their unique mode of inheritance, which does not involve DNA sequence alterations. As an epigenetic phenomenon that plays an important role in gene expression, non-coding RNAs (ncRNAs) act as key factors mediating gene silencing, participating in cell division, and regulating immune response and other important biological processes. With the development of molecular biology, genetics, bioinformatics, and next-generation sequencing (NGS) technology, ncRNAs such as microRNA (miRNA), circular RNA (circRNA), long non-coding RNA (lncRNA), and P-element induced wimpy testis (PIWI)-interacting RNA (piRNA) are increasingly been shown to have potential in the practice of forensic medicine. NcRNAs, mainly miRNA, may provide new strategies and methods for the identification of tissues and body fluids, cause-of-death analysis, time-related estimation, age estimation, and the identification of monozygotic twins. In this review, we describe the research progress and application status of ncRNAs, mainly miRNA, and other ncRNAs such as circRNA, lncRNA, and piRNA, in forensic practice, including the identification of tissues and body fluids, cause-of-death analysis, time-related estimation, age estimation, and the identification of monozygotic twins. The close links between ncRNAs and forensic medicine are presented, and their research values and application prospects in forensic medicine are also discussed.

Metabonomics Analysis of Brain Stem Tissue in Rats with Primary Brain Stem Injury Caused Death.

To explore the potential biomarkers for the diagnosis of primary brain stem injury (PBSI) by using metabonomics method to observe the changes of metabolites in rats with PBSI caused death. PBSI, non-brain stem brain injury and decapitation rat models were established, and metabolic maps of brain stem were obtained by LC-MS metabonomics method and annotated to the HMDB database. Partial least square-discriminant analysis (PLS-DA) and random forest methods were used to screen potential biomarkers associated with PBSI diagnosis. Eighty-six potential metabolic markers associated with PBSI were screened by PLS-DA. They were modeled and predicted by random forest algorithm with an accuracy rate of 83.3%. The 818 metabolic markers annotated to HMDB database were used for random forest modeling and prediction, and the accuracy rate was 88.9%. According to the importance in the identification of cause of death, the most important metabolic markers that were significantly up-regulated in PBSI group were HMDB0038126 (genipinic acid, GA), HMDB0013272 (N-lauroylglycine), HMDB0005199 [(R)-salsolinol] and HMDB0013645 (N,N-dimethylsphingosine). GA, N-lauroylglycine, (R)-salsolinol and N,N-dimethylsphingosine are expected to be important metabolite indicators in the diagnosis of PBSI caused death, thus providing clues for forensic medicine practice.

Identification of time of death of cats according to histological changes in some organs

Determining the time of an animal’s death is an extremely relevant subject in the practice of modern forensic medicine, because the issue often arises when investigating crimes related to animal abuse, in particular, with domestic cats Felis silvestris catus (Linnaeus, 1758). Methods of identifying time of cats’ death are currently developed insufficiently and their introduction into the veterinary-forensic practice has been limited, including the histological method we have employed. We used five corpses of cats, from which we periodically, after certain time periods, gathered the material for histological study, sampling such organs as the liver, kidneys, lungs, heart (myocardium), and the skeletal muscles. From the collected material, we made histological sections and stained them with hematoxylin and eosin. We determined the general patterns in changes occurring in the internal organs of cats over time, namely changes in the staining intensity of the cell elements and intercellular structures on the histopreparations; formation of detritus-filled cavities; a number of distinctive changes in the connective-tissue stroma of the organs; emergence of baciliform bacteria in the tissues and formation of their colonies. In the muscle tissue, we found specific features such as loss of alignment and emergence of transversal grooves with subsequent fragmentation. The study revealed that the development of those changes in each organ clearly correlated with time that has passed since each animals had died. Thus, a complex evaluation of detected changes can give a more accurate – compared with other existing methods – assessment of the time of death of a corpse submitted to forensic veterinary examination. We recommend using the histological method for animals presumed to have been dead for no more than 18 days, because later the tissue disintegration reaches such a level that complicates the correlation of changes with time. We consider it promising to study the time of death of domestic cats using other methods for identifying criteria for postmortem intervals longer than 18 days, and also identifying time of death in other species of animals.

THE APPLICABLE VALUE OF 3D MODELING IN THE ASPECT OF FORENSIC MEDICAL DIFFERENTIAL DIAGNOSTICS OF THE TYPE OF A TRAUMATIC TOOL IN INJURIES FROM FIREARMS AND APPROXIMATE TO IT BY ITS CHARACTERISTICS

Implementation of up-to-date evidenced-based research methods is rather important in the process of conducting forensic expertise. One of them is 3D-modeling of body injuries of various genesis. The method has been widely applied into theory and practice of forensic medicine both by Ukrainian and foreign scientists. The article demonstrates new possibilities during making differential diagnostics of a traumatic tool type, which become informative due to the application of 3D modeling in the process of examination of injuries from firearms or other weapon approximate to it by its characteristics.
 Aim of the work. To improve the process of forensic differential diagnostics of the type of a traumatic tool by means of 3D-modelling of body injuries caused by small-caliber firearms or other weapon approximate to it by its characteristics, to create opportunities for the implementation of 3D-modelling techniques in the everyday practical work of forensic medical experts and forensic criminologists with the possibility of further adding the obtained results to the materials of criminal proceedings.
 Materials and methods. The material of the research was the results of experimental study when fired from small-caliber firearms and a gun for firing Flaubert cartridges. At the same time, measurements were made both by traditional measuring technique and in the process of 3D-modeling of the entrance gunshot wound on the skin of a pig and on the side of the subcutaneous fat tissue and the wound channel at its various intervals in ballistic plasticine Roma Plastilina №1, produced in the USA, used for ballistic tests according to NIJ, HOSDB standards. The results obtained were processed by means of the common methods of variation statistics applicable in medicine.
 Results. The study presents the major parameters and determines interdependence between the parameters when fired from a gun for firing Flaubert cartridges and small-caliber firearms, and morphological signs of gunshot injuries. Direct moderate and strong correlations are found between the initial speed, kinetic and specific energy of the bullet, and the length of the wound channel, diameter of the entrance wound, diameter of the wound channel in its middle portion and on exit measured by means of traditional measuring methods and those discovered in the process of their 3D-modeling (р≤0,05).
 Conclusions. The use of modern 3D-modeling techniques in the practice of forensic medical examination makes it possible to create 3D-models of both individual components of gunshot damage and the wound channel as a whole.
 At the same time, it becomes possible to study individual elements of gunshot damage and measure their sizes with significantly increased accuracy, store and re-analyze them if necessary.
 As a result, we get an improvement in the process of performing forensic medical examinations in cases of gunshot injuries with the possibility of conducting differential diagnosis of the type of traumatic projectile, studying new signs of gunshot injuries, increasing the visibility and objectivity of forensic medical conclusions during such examinations.

X anniversary international congress “Topical Issues of Forensic Medicine and Expert Practice, 2023”

The 10th Anniversary International Congress, Topical Issues of Forensic Medicine and Expert Practice, 2023, was held at the Moscow Regional Research Institute on April 1920, 2023. This article is an overview of the most important events of the Congress.

How to sample a seizure plant: the role of the visualization spatial distribution analysis of Lophophora williamsii as an example.

An accurate in situ MSI method for fresh water-rich succulent plants was obtained based on multi-parameter comparative experiments.Spatial imaging analysis of mescaline in Lophophora williamsii was performed using the above method.Based on the above results and previous results, a sampling proposal for forensic medicine practice is tentatively proposed.

Evaluation of distal tibial epiphysis and calcaneal epiphysis according to the Vieth method in 3.0T magnetic resonance images: a pilot study.

In forensic medicine practice, age estimation-both in living and deceased individuals-can be requested due to legal requirements. Radiologic methods, such as X-rays, for the estimation of bone age have been discussed, and ethical concerns have been raised. Given these factors, radiologic methods that reduce radiation exposure have gained importance and have become one of the research topics in forensic medicine. In this study, the MR images of the ankles of patients aged between 8 and 25years, obtained with a 3.0T MR scanner, were evaluated retrospectively according to the staging method defined by Vieth et al. In the study, the ankle MR images of 201 cases (83 females and 118 males) with sagittal T1-weighted turbo spin echo and T2-weighted short tau inversion recovery sequences were evaluated independently by two observers. According to the results of our study, the intra- and inter-observer agreements are at a very good level for both the distal tibial and calcaneal epiphyses. All the cases detected as stages 2, 3, and 4 in both sexes for both the distal tibial and the calcaneal epiphyses have been determined to be under the age of 18years. According to the data obtained from our study, we consider that stage 5 for males and stage 6 for both sexes in the distal tibial epiphysis and stage 6 for males in the calcaneal epiphysis can be used to estimate the age of 15years. As far as we know, our study is the first to evaluate ankle MR images with the method defined by Vieth et al. Further studies should be conducted to evaluate the validity of the procedure.

Medicolegal evaluation of geriatric deaths in Bursa, Turkey

Aim: Differentiation of natural and forced deaths observed in this age group is very important in the forensic medicine practice. According to the address based population registration system, population rate of 65 years and older has been 9.5% of the total population in 2020. In the present study, we aimed to medicolegal evaluation of demographic data and autopsy findings of judicial geriatric deaths in Bursa and around.Material and Method: Autopsy reports of the cases who have been taken to Morgue Specialization Office of Council of Forensic Medicine Institution and at 65 years and over, crime scene and deceased examination reports and data in the prosecution documents were assessed retrospectively between 2003-2008 in our study. Results: During 6-year period, totally 5155 autopsies have been investigated in Morg Specialization Office of Bursa Council of Forensic Medicine Institution. Among such cases, 870 (16.8%) were 65 years old and older. Cases who were 65 years old and older included 640 (73.6%) were male, 230 (26.4%) were female. In terms of death origin, 434 (49.9%) were natural deaths, 267 (30.7%) were accidents, 102 (11.7%) were suicides and 52 (6%) were homicides. Origin of death of the remaining 15 (1.7%) could not be detected. According to the information obtained from the statements of the witnesses in crime scene investigation and dead body examination reports, a previous disease existed in 336 (38.6%) cases before death. Diseases which have been existing before death includes cardiac diseases, hypertension, central nervous system pathologies, diabetes mellitus, respiratory system pathologies, undefined psychiatric disorders, gastrointestinal system pathologies and malignancies, respectively to frequency.Conclusion: In line with prolongation of life expectancy and increase in the geriatric population, it is observed according to our outcomes that an increase is detected in judicial geriatric death cases due to neuropsychiatric disease, leading a solitary life and psychomotor imbalance.

Improving Evidence-Based Practice in Forensic Medicine: Validation of INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements and Principles of Evidence-Based Reporting in FORensic Medicine-Pathology version in Indonesia

Abstract Introduction Expert opinions presented in legal proceedings should be scientifically accountable, which is known as evidence-based practice (EBP). Although forensic medical expert opinions are essential in legal proceedings, the methods used to formulate them are not always evidence based or based on standard methods. In forensic medicine, EBP has not been explicitly applied, including in Indonesia. One potential approach to formulate evidence-based expert opinions is called INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements (INFERENCE). In addition, there is also no universal guideline for making forensic pathological reports. One prospective guideline is named the Principles of Evidence-based Reporting in FORensic Medicine-Pathology version (PERFORM-P). Methods This article describes the validation process of INFERENCE and PERFORM-P in Indonesia. This study uses a mixed method through three interrelated phases, i.e., (1) a cross-sectional survey to determine the characteristics of Indonesian forensic doctors and their current practice, (2) the adaptation and validation process of the two tools through a review by the Indonesian College of Forensic Medicine, and (3) a one-group pre–postintervention study to assess the validity and reliability of forensic medical expert opinions formulated using Indonesian-INFERENCE (i-INFERENCE) and reported using Indonesian-PERFORM-P (i-PERFORM-P). Results and Discussion In general, both tools received a positive reception and can potentially be used in the Indonesian setting with some additions/clarifications in the user manuals. Participants envision that both tools will be most useful in complex cases. Conclusions By obtaining the i-INFERENCE and the i-PERFORM-P, it is hoped that Indonesian forensic medical doctors are better equipped in analyzing and reporting complex cases, and the implementation of EBP can be improved.

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.