Journal of forensic and legal medicine最新文献

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Transfer and persistence of microbiota markers from the human hand to the knife: A preliminary study 微生物群标记从人手转移到刀上并持续存在:初步研究
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-09-16 DOI: 10.1016/j.jflm.2024.102757
{"title":"Transfer and persistence of microbiota markers from the human hand to the knife: A preliminary study","authors":"","doi":"10.1016/j.jflm.2024.102757","DOIUrl":"10.1016/j.jflm.2024.102757","url":null,"abstract":"<div><p>New scientific techniques and methods are always needed to link the perpetrators to the incident or the crime scene. Recent microbiota studies based on NGS (Next-generation sequencing) show that various biological samples from crime scenes have the potential to be used in forensic investigations. Especially when DNA traces belonging to more than one person are insufficient to fully determine the genetic profile, a secret sample, such as a microbiota sample created by the suspect's touch, can be used. In this preliminary study, a fictionalized experimental model was designed to investigate the transfer and persistence of the hand microbiome on the knife handle, which has a high potential to be used in criminal incidents, by metagenomic analysis methods. In addition, it was aimed to determine the transfer of specific bacterial species identified only to the person among the five participants onto the knife handle and their persistence over time. In the first stage of the research, samples were collected from the hands of 5 volunteer participants using the swap method, including their palms. Then, after each participant held a different knife, samples were collected from the knife handles via swabs from different angles of the knives at 4 and 24 h and analyzed by metagenomic methods. The findings of this preliminary study showed that the heatmap graphs generated after UniFrac distance analysis were not successful in establishing any similarity between the hand samples and the post-transfer knife handle samples. Nonetheless, it was observed that the transfer of bacterial species detected in the hand samples to knives differed according to the individuals and some bacterial species were transferred to the knife samples held by the participants. The number of bacterial species detected that are specific to each participant's hand sample was 302 in total, and it was determined that a total of 8.28 % of these bacterial species were transferred to the knife handle samples of the 4th hour and 6.95 % to the knife samples of the 24th hour. In the presented study, considering the transfer of some bacterial species in the hand microbiome, which are effective in the variation between individuals, onto the knife; It has been evaluated that some rare bacterial species can be important potential markers to associate the object with the perpetrator.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239479","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}
引用次数: 0
Analysis of non-metric dental traits for ethnicity identification in a mixed population of Uttar Pradesh 分析北方邦混血人口的非度量衡牙齿特征以识别种族
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-09-14 DOI: 10.1016/j.jflm.2024.102755
{"title":"Analysis of non-metric dental traits for ethnicity identification in a mixed population of Uttar Pradesh","authors":"","doi":"10.1016/j.jflm.2024.102755","DOIUrl":"10.1016/j.jflm.2024.102755","url":null,"abstract":"<div><h3>Background</h3><p>Forensic odontology involves the identification of individuals through dental records, making it a crucial tool in legal investigations. Non-metric dental traits (NMDT), which are variations in dental morphology play a key role as these traits are inherited characteristics that can help establish biological relationships or ancestry<strong>.</strong> Thus, we aim to assess the frequency and variability of NMDT in the human dentition of four ethnically mixed populations in Uttar Pradesh. This study can aid in the future by maintaining records of ethnic groups and their variability, which can be crucial for disaster victim management and forensic odontology.</p></div><div><h3>Methods</h3><p>The study was conducted on a total of 100 patients coming to the OPD of Oral Medicine and Oral Pathology and Microbiology of King George's Medical University from January 2022 to July 2023. Impressions of both arches were made for participants using irreversible hydrocolloid (alginate), and casts were examined under a stereomicroscope to assess 15 different morphological characteristics.</p></div><div><h3>Results</h3><p>NMDTs such as winging, shoveling, double-shoveling interruption groove, canine mesial ridge, hypocone, metacone, carabelli's trait, peg-shaped incisors, peg-shaped molar, premolar lingual cusp variation, deflecting wrinkle, protostylid, metaconulid, entoconulid was evaluated. The NMDTS were evaluated in four different ethnics Nordics, Mediterranean, Oriental Mediterranean, and Protoaustraloid amongst which various traits showed a statistically significant variation among the population of Uttar Pradesh.</p></div><div><h3>Conclusion</h3><p>The sample studied presented confirmed supernumerary traits like metacone, protostylid, carabellis trait, metaconulid, premolar lingual cusp variation, and deflecting wrinkle were seen highest in Nordic, Mediterranean, Oriental Mediterranean, and Protoaustraloid ethnicity have a significant association with the Uttar Pradesh population.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239481","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}
引用次数: 0
An evaluation of potential challenges in forensic psychiatric assessment in Parkinson's disease 评估帕金森病法医精神病学评估的潜在挑战。
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-09-14 DOI: 10.1016/j.jflm.2024.102758
{"title":"An evaluation of potential challenges in forensic psychiatric assessment in Parkinson's disease","authors":"","doi":"10.1016/j.jflm.2024.102758","DOIUrl":"10.1016/j.jflm.2024.102758","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304959","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}
引用次数: 0
Femicide in Ireland 2012–2023 2012-2023 年爱尔兰杀戮女性情况
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-09-13 DOI: 10.1016/j.jflm.2024.102754
{"title":"Femicide in Ireland 2012–2023","authors":"","doi":"10.1016/j.jflm.2024.102754","DOIUrl":"10.1016/j.jflm.2024.102754","url":null,"abstract":"<div><h3>Introduction</h3><p>Femicide represents the dramatic end-point on a spectrum of violence against women and is an increasingly prevalent medico-legal issue. Whilst there is no definition of femicide in the Irish legal system, femicide can be understood as the gender based killing of women or girls.<sup><u>1</u></sup> The pervasiveness of gender-based violence against women is a growing cause for concern with 2018 estimates by the World Health Organisation (WHO) revealing that 1 in 3 women have experienced Intimate Partner Violence (IPV).<sup>2</sup> Femicide remains poorly defined and underreported worldwide due to enduring stigmatisation, shame and a lack of official statistics addressing national femicide rates.</p></div><div><h3>Aim</h3><p>The aim of this study was to explore Irish cases of femicide, quantify the prevalence of femicide in Ireland and identify any emerging trends over a 12-year-period.</p></div><div><h3>Methods</h3><p>All homicides referred to the Office of the State Pathologist (OSP) from 2012 to 2023 were reviewed and a total of 97 cases of femicide were ?identified and included in this study.</p></div><div><h3>Results</h3><p>Femicide rates increased from 1 in 5 (19 %) homicides referred to the OSP in 2012–2020 to 3 in 10 from 2021 to 2023 (29 %). Domestic femicides accounted for 74 % of cases, with 41 % of women murdered in the home they shared with their killer. 56 % of women were killed by a current or former intimate partner and 20 % by a family member. Sharp force injuries were present in 75 % of femicides associated with a history of sexual violence. These cases had the highest average number of injuries per case (n = 30) and a significantly lower average age than that of the entire cohort (19 years versus 41 years).</p></div><div><h3>Conclusion</h3><p>The true scale of gender-based violence against women remains largely hidden due to a lack of focused official statistics and a clear definition of femicide. As populations become more diverse, and displacement secondary to environmental, or humanitarian crises becomes more common, it is essential that official data is collected in order to understand and ultimately prevent gender-based violence in this vulnerable cohort.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1752928X24001161/pdfft?md5=97a34b2ce3f5d6c6ec5c1629361882e8&pid=1-s2.0-S1752928X24001161-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A critical assessment of the diatom test of rib bone marrow as a supporting procedure in the case of drowning 对肋骨骨髓硅藻测试作为溺水案件辅助程序的批判性评估
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-09-12 DOI: 10.1016/j.jflm.2024.102753
{"title":"A critical assessment of the diatom test of rib bone marrow as a supporting procedure in the case of drowning","authors":"","doi":"10.1016/j.jflm.2024.102753","DOIUrl":"10.1016/j.jflm.2024.102753","url":null,"abstract":"<div><p>Diatoms (Bacillariophyta), being single-celled photosynthetic organisms, are widely distributed in aquatic ecosystems around the globe. Their exoskeletons are resistant to most environmental factors as well as chemical reagents in laboratory settings. Moreover, the ornamentation featured on exoskeletons can be used to identify individual diatomaceous species. As a result, the detection of diatoms in the internal organs, and especially rib marrow, of corpses found in water can serve as an important tool for diagnosing drowning as the cause of death as long as passive postmortem penetration of diatoms into those organs is excluded. In the environmental experiments described in this paper, diatoms were detected in rib marrow only when contamination resulted from a mechanical breach of bone integrity and structure, irrespective of the residence time of bone material in the aquatic environment. Our research suggests that the presence of diatom in the rib marrow may be the gold standard in the diagnosis of drowning in the future. Our animal model research dispels one of the doubts, such as the possibility of passive penetration of diatoms into the bone marrow, which is still under discussion in the forensic medicine community.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239480","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}
引用次数: 0
Risk factor analysis of medical litigation outcomes in obstetrics and gynecology: A retrospective cohort study of 344 claims in Japan 妇产科医疗诉讼结果的风险因素分析:对日本 344 起索赔案的回顾性队列研究
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-09-06 DOI: 10.1016/j.jflm.2024.102752
{"title":"Risk factor analysis of medical litigation outcomes in obstetrics and gynecology: A retrospective cohort study of 344 claims in Japan","authors":"","doi":"10.1016/j.jflm.2024.102752","DOIUrl":"10.1016/j.jflm.2024.102752","url":null,"abstract":"<div><h3>Aim</h3><div>Medical errors are critical in obstetrics and gynecology (OB/GYN) and contribute to high litigation risks. However, few studies have examined system and diagnostic errors as potential preventable problems. This study aimed to enhance medical safety and reduce litigation by identifying and addressing key contributory factors.</div></div><div><h3>Methods</h3><div>We retrospectively searched the national Japanese malpractice claims database for OB/GYN cases between 1961 and 2017. We evaluated provider characteristics and background information of the patients (plaintiffs). The main outcome was litigation (acceptance or rejection) in the final judgment. Using multivariable logistic regression models, we assessed the associations between medical malpractice variables (system and diagnostic errors, facility size, situation, place, time, and clinical outcomes) and litigation outcomes (acceptance).</div></div><div><h3>Results</h3><div>Overall, 344 malpractice claims were analyzed. Among these, 277 (80.5 %) were obstetric, and 67 (19.5 %) were gynecological. Of the obstetric cases, 193 were perinatal, and 84 were maternal. Malpractice claims were accepted (OB-GYN losses) in 185 cases (53.8 %). In multivariable analyses, system errors (odds ratio 97.4, 95 % confidence interval 35.2–270.0), diagnostic errors (odds ratio 4.5, 95 % confidence interval 1.8–11.3), and clinic (odds ratio 2.7, 95 % confidence interval 1.2–4.8) had a significant statistical association with accepted claims.</div></div><div><h3>Conclusion</h3><div>System errors, diagnostic errors, and clinics were significantly associated with acceptance claims. These findings underscore the necessity of addressing modifiable factors at the physician level and within the healthcare management system to enhance patient safety and reduce litigation risks, thereby ensuring a safer and more reliable healthcare environment for patients and medical professionals.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1752928X24001148/pdfft?md5=1d3a89edb634d6daf5ae67be3cbc306b&pid=1-s2.0-S1752928X24001148-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three-dimensional visualization of gunshot cavities in ballistic gelatine with computed tomography – A forensic ballistics case study 利用计算机断层扫描对弹道明胶中的枪弹空腔进行三维可视化 - 一项法医弹道学案例研究
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-08-28 DOI: 10.1016/j.jflm.2024.102740
{"title":"Three-dimensional visualization of gunshot cavities in ballistic gelatine with computed tomography – A forensic ballistics case study","authors":"","doi":"10.1016/j.jflm.2024.102740","DOIUrl":"10.1016/j.jflm.2024.102740","url":null,"abstract":"<div><p>Three-dimensional (3D) imaging, primarily computed tomography (CT), has proven valuable in the documentation and analysis of gunshot injuries. Explicit visualization of findings may play a pivotal role in judicial settings. This forensic ballistics case study aimed to examine the potential of CT-based 3D reconstruction to digitally visualize gunshot cavities in ballistic gelatine. Three .30 caliber bullets of different types (full metal jacket, soft point, and expanding monolithic) were fired into standardized blocks of 10% ballistic gelatine. The blocks underwent CT scanning with clinical equipment. Gelatine and air were segmented from the CT data using an open-source software. 3D reconstruction views of the segmented gelatine and air components were created. The gunshot cavities were clearly observed in both gelatine and air segmentation. The differences in cavitation between bullet types were evident in both reconstruction approaches, although gelatine segmentation produced higher resolution of small details. The obvious benefit of digital reconstruction was the ability to freely tilt and rotate the 3D images, with the possibility of taking measurements manually or automatically from any plane. Moreover, all the data can be stored for future analysis. This study introduces a preliminary method for digital visualization and documentation of gunshot cavitation in ballistic gelatine, to be fine-tuned and implemented for research purposes and routine practice in forensic institutions.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1752928X24001021/pdfft?md5=26c94dd835839fb85bf2631572116d3c&pid=1-s2.0-S1752928X24001021-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sudden infantile death due to left ventricular myocardial ischemia associated with undiagnosed single coronary artery of Lipton's type LII-B 与未确诊的 Lipton's LII-B 型单支冠状动脉有关的左心室心肌缺血导致婴儿猝死
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-08-27 DOI: 10.1016/j.jflm.2024.102738
{"title":"Sudden infantile death due to left ventricular myocardial ischemia associated with undiagnosed single coronary artery of Lipton's type LII-B","authors":"","doi":"10.1016/j.jflm.2024.102738","DOIUrl":"10.1016/j.jflm.2024.102738","url":null,"abstract":"<div><p>Single coronary artery (SCA) is a rare malformation, particularly in isolation without other congenital heart defects. Here, we describe a case of sudden infantile death due to myocardial ischemia associated with undiagnosed SCA. A 1-year-and-7-month-old female infant died suddenly after vomiting at home. A medicolegal autopsy revealed that the orifice of the right coronary artery (RCA) was absent. As expected, the left coronary artery was detached from the left coronary sinus; however, the ostium was covered with a flap-like fibrous ridge. The thin RCA originated from the left main trunk (LMT) and passed between the aorta and pulmonary artery trunk. The left circumflex artery branched from the LMT at a right angle. Judging from the origin and course of the anomalous RCA, the deceased was diagnosed with SCA of Lipton's type LII-B. Microscopic examination revealed ischemic changes around the endocardium of the lateral wall of the left ventricle (LV) rather than on the side of the abnormal RCA. This evoked attention, as there appeared to be some discrepancy. To the best of our knowledge, this is the first case report describing sudden infantile death related to LV myocardial ischemia associated with undiagnosed SCA of Lipton's type LⅡ-B.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095646","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}
引用次数: 0
A machine learning approach for age prediction based on trigeminal landmarks 基于三叉神经标记的年龄预测机器学习方法
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-08-26 DOI: 10.1016/j.jflm.2024.102742
{"title":"A machine learning approach for age prediction based on trigeminal landmarks","authors":"","doi":"10.1016/j.jflm.2024.102742","DOIUrl":"10.1016/j.jflm.2024.102742","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study was to estimate the chronological age (CA) of a growing individual using a new machine learning approach on Cone Beam Computed Tomography (CBCT).</p></div><div><h3>Materials and methods</h3><p>The dataset included 48 CBCT and hand-wrist radiographs of growing individuals. 12 landmarks related to trigeminal trajectories were plotted on each CBCT and principal component analysis was applied for dimensionality reduction. The estimated CA was obtained using a decision tree. Finally, a genetic algorithm was implemented to select the best set of landmarks that would optimize the estimation. The age was also assessed following Greulich and Pyle's (GP) method on hand-wrist radiographs. The results (GP and Machine Learning) were then compared to the true CA.</p></div><div><h3>Results</h3><p>Among the 12 landmarks, the genetic algorithm selected 7 optimal features, and 12 principal components out of 36. The best results for age prediction were obtained by a combination of genetic algorithm, principal component analysis, and regression tree where the Mean Squared Error (MSE) and Mean Absolute Error (MAE) were respectively 1.29 and 0.92. These outcomes showed improved accuracy compared to those of the hand-wrist method (MSE = 2.038 and MAE = 1.775).</p></div><div><h3>Conclusions</h3><p>A numerical application on a dataset of CBCT showed that the proposed machine learning method achieved an improved accuracy compared to conventional methods and had satisfying performance in assessing age for forensic purposes. Validation of the presented method on a larger and more diverse sample would pave the way for future applications in forensic science as a tool for age prediction.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095643","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}
引用次数: 0
A medical child abuse case with spurious bleeding; importance of collecting the evidence 一个有假性出血的医疗虐童案;收集证据的重要性
IF 1.2 4区 医学
Journal of forensic and legal medicine Pub Date : 2024-08-26 DOI: 10.1016/j.jflm.2024.102741
{"title":"A medical child abuse case with spurious bleeding; importance of collecting the evidence","authors":"","doi":"10.1016/j.jflm.2024.102741","DOIUrl":"10.1016/j.jflm.2024.102741","url":null,"abstract":"<div><h3>Background</h3><p>Medical Child Abuse (MCA) is a severe form of child abuse. In MCA, the caregiver abuses the child by exaggerating, fabricating, simulating, or inducing symptoms, and unnecessary, potentially harmful medical care harms the child. Bleeding is one of the most common manifestations of MCA. Diagnosis of MCA is challenging, and late diagnosis may increase the severity and complications. Once suspected, it is essential to apply all relevant methods of investigation to support and confirm the diagnosis, as soon as possible, as late diagnosis increases the risks.</p></div><div><h3>Case presentation</h3><p>An 18-month-old boy was referred to the Pediatric Hematology by the Department of the Emergency with multiple admissions in a 2-week period for recurrent said-to-be bleeding episodes from different sites. Previously, he had been investigated for recurrent bleeding episodes in different hospitals for 4 months. In our center, the review of medical history, examination findings, and laboratory results showed some important inconsistencies leading to suspicion of MCA and the mother as the perpetrator. Then he was hospitalized for close observation. During hospitalization, multiple episodes of said-to-be bleeding were reported by the mother, but active bleeding was never observed by any hospital staff. No bleeding foci were detected in the nose or ears, supporting the diagnosis of MCA. After the file was forwarded to the prosecutor's office, the child was taken for institutional care, and no further bleeding was observed after separation from the mother. DNA, which was obtained from a so-called nosebleed during hospitalization, was analyzed and was reported to belong to the mother, confirming the diagnosis.</p></div><div><h3>Conclusions</h3><p>This case report draws attention to timely diagnoses by focusing on inconsistencies in the history and clinical signs and good clinical practices for the management of MCA, with a special emphasis on collecting evidence, including DNA samples, to confirm the diagnosis and help the legal process.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088641","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}
引用次数: 0
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