Journal of forensic and legal medicine最新文献

{"title":"Sexual violence against men: Addressing an overlooked issue in Brazil and Indonesia","authors":"Aga Natalis","doi":"10.1016/j.jflm.2026.103217","DOIUrl":"10.1016/j.jflm.2026.103217","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103217"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silica-containing products at autopsy: An uncommon incidental finding","authors":"Hunter Koster,&nbsp;David Waters,&nbsp;Lorenzo Gitto","doi":"10.1016/j.jflm.2026.103222","DOIUrl":"10.1016/j.jflm.2026.103222","url":null,"abstract":"<div><div>Silica-containing products are widely encountered in consumer and pharmaceutical packaging as moisture-absorbing agents. Although generally considered non-toxic, accidental ingestion of silica desiccants has been documented in pediatric and elderly populations and may result in mechanical complications such as choking or gastrointestinal obstruction, particularly with cylindrical canister formulations. The authors present two rare forensic cases in which silica desiccant material was found within the gastrointestinal tract during postmortem examination. Case 1 involved a 39-year-old woman with a history of daily silicate ingestion based on alternative medicine beliefs, in whom sandy material was identified in the stomach; despite a complete autopsy, cardiovascular pathology consultation, and expanded toxicologic testing, no cause of death was identified, and the case was certified as undetermined. Case 2 involved a 63-year-old man found deceased in a cold environment, in whom both a desiccant packet within the esophagus and a desiccant canister within the stomach were incidentally retrieved; cause of death was certified as combined drug toxicity with environmental cold exposure as a contributing factor. In both cases the silica material was not considered a contributing factor to the death. At autopsy, it is critical to recognize silica-containing products when present, exclude mechanical airway compromise as a contributory mechanism, and avoid erroneous attribution of cause of death to silica toxicity, as current literature does not support a toxicologic effect of these compounds at typical ingestion doses.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103222"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic paralysis following conducted electrical weapon deployment","authors":"Mark W. Kroll,&nbsp;Michael A. Brave,&nbsp;Jiri Adamec,&nbsp;Sebastian N. Kunz,&nbsp;Robert C. Bux,&nbsp;Howard E. Williams","doi":"10.1016/j.jflm.2026.103218","DOIUrl":"10.1016/j.jflm.2026.103218","url":null,"abstract":"<div><h3>Background</h3><div>Conducted Electrical Weapons (CEWs) are widely used worldwide by law enforcement as an intermediate less-lethal force option. While CEW direct electrical effects are generally transient, and direct significant injuries are rare but sometimes severe, secondary effects from associated falls related to neuromuscular effects while rare, may also be severe.</div></div><div><h3>Objective</h3><div>To characterize the frequency, severity, and injury patterns of permanent paralysis associated with CEW deployments, with emphasis on fall-related and law-enforcement force related trauma.</div></div><div><h3>Methods</h3><div>We analyzed a curated case series of 17 incidents (2004–2024) in which individuals sustained paraplegia or tetraplegia associated with CEW use by law enforcement. We judged 13 of these falls to have been caused by the CEW while 4 may have been only temporally related. Demographics, circumstances, injury mechanisms, and neurological outcomes were summarized descriptively.</div></div><div><h3>Results</h3><div>Of the 17 cases we found, 15 were in the USA and 2 were in the UK. Permanent tetraplegia occurred in 8 cases and paraplegia in 8 cases; there was a single recovery. The mean age was 37 years (range 17–65). All cases involved subjects actively resisting or attempting to flee law enforcement interaction. Elevated falls with head-first impacts, generating thoracic or cervical spine trauma, predominated as causes.</div></div><div><h3>Conclusions</h3><div>Subject paralysis following CEW deployment is a rare but severe complication of attempted electrical weapon control by neuromuscular effects.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103218"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular non-compaction cardiomyopathy and sudden death: A case report","authors":"Aytül Buğra,&nbsp;Onur Merzifonlu,&nbsp;Alican Karagüzel,&nbsp;Çağla Ergin,&nbsp;İsmail Çoban","doi":"10.1016/j.jflm.2026.103219","DOIUrl":"10.1016/j.jflm.2026.103219","url":null,"abstract":"<div><div>Left ventricular non-compaction cardiomyopathy (LVNC) is a rare cardiac disease. This study presents a rare case of an 18-year-old male who died following sudden ventricular fibrillation, with LVNC identified at autopsy. The patient had a known clinical diagnosis of LVNC and a primary-prevention implantable cardioverter-defibrillator (ICD), with a left ventricular ejection fraction of 35-40%. Gross autopsy findings revealed increased trabeculation in the left ventricle, dark color changes in the trabecular muscles, and evidence of ischaemia in the anterior papillary muscle. Histopathological examination of the anterior papillary muscle showed myocardial infarction consistent with the first 24 hours post-infarction, hypertrophy in the trabecular muscles, and extensive perivascular, interstitial, and subendocardial fibrosis with positive Masson's trichrome staining. Widespread pulmonary edema, fibrin thrombi in the brachiocephalic vein, and fibrin thrombi within small blood vessel lumens were detected. This case emphasizes that LVNC is a potentially lethal disease due to electrical heterogeneity creating a re-entry arrhythmia substrate and a predisposition to myocardial infarction, which may lead to sudden cardiac death. When investigating sudden cardiac death cases in young patients, LVNC should be included in the differential diagnosis. Early diagnosis, appropriate cardiac monitoring, and preventive treatments such as the use of implantable cardioverter-defibrillators play a critical role in reducing the risk of sudden death. Postmortem genetic testing of the deceased and genetic counseling of first-degree relatives should be an integral part of management.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103219"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond adversarial and no-fault systems: The mixed Spanish framework of healthcare professional liability","authors":"J. Arimany-Manso,&nbsp;J. Benet-Travé,&nbsp;C. Martin-Fumadó","doi":"10.1016/j.jflm.2026.103228","DOIUrl":"10.1016/j.jflm.2026.103228","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103228"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in forensic medicine and forensic nursing: A systematic review of clinical applications, ethical risks, and implementation challenges","authors":"Rahul Panwar,&nbsp;Neha Sharma,&nbsp;Siddharth Vijay Vergia,&nbsp;Apoorva Gupta,&nbsp;Arvind Kumar","doi":"10.1016/j.jflm.2026.103226","DOIUrl":"10.1016/j.jflm.2026.103226","url":null,"abstract":"<div><div>Artificial intelligence (AI) is reshaping healthcare, and forensic medicine and nursing are no exception. From automated wound pattern analysis to natural language processing (NLP) in medicolegal documentation, AI tools are entering a field situated at the intersection of clinical care, legal accountability, and human rights. This systematic review with narrative synthesizes contemporary clinical, forensic, and AI ethics literature to examine current and emerging applications of AI in forensic practice, with particular attention to injury interpretation, postmortem interval estimation, forensic imaging, survivor documentation, and medicolegal reporting. Forensic nursing practice, including sexual assault nurse examiner (SANE) programs, domestic violence assessment, and paediatric abuse evaluation, is a central focus. The review critically evaluates ethical risks associated with deploying algorithmic decision-making in high-stakes forensic contexts where outputs may influence criminal outcomes and judicial proceedings. Issues of algorithmic bias, chain-of-custody integrity, explainability, and the potential displacement of clinical judgment are examined alongside practical considerations for implementation. Given the still-emerging forensic-specific evidence base, this review draws selectively on adjacent clinical disciplines while emphasizing the distinct medicolegal demands of forensic practice. Responsible integration of AI, the review concludes, requires interdisciplinary governance, equity-stratified validation, and preservation of the clinician-examiner's primary interpretive authority.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103226"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 10-year analysis of obstetric malpractice litigation according to court of cassation (Yargıtay) decisions (2016–2025): A descriptive study","authors":"Burak Çakmak,&nbsp;Çağlasu Keleş Sancaktar","doi":"10.1016/j.jflm.2026.103224","DOIUrl":"10.1016/j.jflm.2026.103224","url":null,"abstract":"<div><h3>Aim</h3><div>The judicial trajectory, clinical features, and institutional context of obstetric malpractice litigation in Türkiye have not been systematically examined over an extended interval. We analysed obstetric malpractice decisions rendered by the Court of Cassation (Yargıtay) between 2016 and 2025 to describe temporal patterns in the number of identified appellate decisions, lawsuit type, institutional distribution, clinical outcomes, expert-report fault assessment, and judicial outcomes.</div></div><div><h3>Material and methods</h3><div>A structured search of the public Court of Cassation decision database (<span><span>https://karararama.yargitay.gov.tr</span><svg><path></path></svg></span>), last performed in March 2026, identified 166 unique obstetric malpractice decisions meeting the predefined criteria. Cases were stratified into two consecutive five-year periods (Period I: 2016–2020, n = 60; Period II: 2021–2025, n = 106). Associations were tested with the chi-square or Fisher exact test; for the appellate outcome (affirmation versus pooled reversal/partial reversal) a Firth penalised logistic regression was additionally fitted because the expert-report variable produced near-complete separation.</div></div><div><h3>Results</h3><div>The mean annual number of identified decisions was approximately 77% higher in Period II (21.2/year) than in Period I (12.0/year). Civil/compensation proceedings rose from 68.3% to 88.7% and criminal proceedings fell from 31.7% to 10.4% (p = 0.002). Private hospitals accounted for 82.5% of cases overall (68.3% in Period I, 90.6% in Period II; p = 0.001); obstetrician-gynaecologists were the named defendant in 92.8%. Maternal mortality occurred in 18.1%, fetal/neonatal mortality in 25.3% and severe maternal or perinatal morbidity in 75.9%. The proportion of first-instance decisions not affirmed by the Court of Cassation fell from 85.0% in Period I to 38.7% in Period II (p &lt; 0.001). No clinical severity variable was associated with the appellate outcome (all p &gt; 0.05), whereas the expert-report fault assessment showed a strong and independent association (χ² = 120.9, df = 2, p &lt; 0.001; Firth-adjusted odds ratios remained large but imprecise owing to separation); 98.4% of decisions recording contradictory expert reports were at least partially reversed.</div></div><div><h3>Conclusion</h3><div>Within the appellate case pool, the dominant correlate of the Court of Cassation outcome was not the severity of the clinical event but the fault assessment recorded in the expert report. Because a substantial minority of reversals rested on non-evidentiary legal grounds and the dataset reflects only cases reaching the Court of Cassation, the findings should be read as associations within an appellate sample rather than as measures of malpractice incidence, institutional burden, or expert-report quality.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103224"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abusive head trauma in infants: Navigating diagnostic uncertainty, evidence gaps, and prevention approaches — A narrative review","authors":"Sebastian Glowinski,&nbsp;Alina Głowińska","doi":"10.1016/j.jflm.2026.103152","DOIUrl":"10.1016/j.jflm.2026.103152","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103152"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profile of sexual abuse among child survivors attending a tertiary health care centre","authors":"Vinod Ashok Chaudhari,&nbsp;Deepu Mathew,&nbsp;Latha Chaturvedula,&nbsp;Moushumi Purkayastha Mukherjee,&nbsp;Kusa Kumar Shaha,&nbsp;Niranjan Biswal","doi":"10.1016/j.jflm.2026.103220","DOIUrl":"10.1016/j.jflm.2026.103220","url":null,"abstract":"<div><div>Child sexual abuse (CSA) is a serious public health and social problem, causing severe physical, emotional, and psychosocial harm to survivors. This retrospective, record-based, cross-sectional study aimed to assess the profile of CSA among child survivors attending the One Stop Crisis Centre (OSCC) at a tertiary care hospital from 2016 to 2020 and to examine associated sociodemographic characteristics and risk factors. A total of 62 medicolegal records were analysed. The majority of survivors were adolescent girls aged 12–18 years (64.5%), while 35.5% were younger than 12 years, with most belonging to rural or lower-middle socioeconomic backgrounds. Over half of the children experienced abuse lasting more than one week (51.6%) and multiple episodes (51.6%). Penetrative assault was reported in 79% of cases, and revictimisation occurred in 50%. In 82.3% of incidents, the assailant was a known individual. Genital injuries were documented in 58.1% of survivors, and external physical injuries in 48.4%. The timing of examination was frequently delayed, with 75.8% of cases assessed more than 24 h after the incident. Police referrals accounted for 53.2% of cases, reflecting increasing awareness of the POCSO Act and child protection resources. These findings underscore that CSA predominantly affects adolescent girls, often involves known perpetrators, and is associated with repeated abuse and genital injuries. The study highlights the critical need for timely reporting, prompt forensic evaluation, and comprehensive multidisciplinary care<strong>.</strong> Strengthening awareness, prevention strategies, and child protection mechanisms is essential to reduce the burden of CSA and provide effective support for survivors.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103220"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuity of hormone replacement therapy in custody: Why abrupt discontinuation puts women at risk","authors":"Nichola Walker","doi":"10.1016/j.jflm.2026.103223","DOIUrl":"10.1016/j.jflm.2026.103223","url":null,"abstract":"<div><div>The continuity of essential medications is a fundamental component of clinical governance within custodial healthcare. National standards, including the Royal Pharmaceutical Society (RPS) <em>Professional Guidance on the Safe and Secure Handling of Medicines</em>¹ and the College of Policing's 2024 <em>Authorised Professional Practice</em> (APP) for Custody,² emphasise the importance of maintaining prescribed treatments to prevent avoidable clinical deterioration. Yet hormone replacement therapy (HRT) frequently remains excluded from rapid medicines continuity pathways, resulting in abrupt interruption for women entering police and prison custody despite risks highlighted in the UK National Preventive Mechanism (NPM) <em>Menopause in Detention Toolkit</em>.³</div><div>This article examines the immediate physiological and psychological consequences of abrupt iatrogenic oestrogen withdrawal, framing endocrine withdrawal as an acute patient safety issue rather than a lifestyle concern. It integrates emerging evidence, including the UK National Preventive Mechanism (NPM) Menopause in Detention Toolkit,³ the Independent Custody Visiting Association (ICVA) Menopause Impact Report,⁴ and the growing recognition that women and clinicians require clearer evidence to support decisions regarding the continuation or discontinuation of hormone replacement therapy(Hamoda and Panay, 2024).⁵ It also incorporates peer-reviewed neuroendocrine research demonstrating the destabilising effects of abrupt oestradiol withdrawal ^6–8.</div><div>The paper argues for a paradigm shift in custodial healthcare, recognising hormone replacement therapy as an essential endocrine treatment requiring timely continuity of care. It proposes practical approaches to medicines verification and rapid bridging protocols to reduce avoidable endocrine withdrawal, support accurate clinical assessment and improve patient safety.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"122 ","pages":"Article 103223"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}