Journal of forensic and legal medicine最新文献

{"title":"Forensic Herald","authors":"John AM. Gall","doi":"10.1016/j.jflm.2025.102951","DOIUrl":"10.1016/j.jflm.2025.102951","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"114 ","pages":"Article 102951"},"PeriodicalIF":1.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906877","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":"Death associated with wet cupping therapy (hijama): A case report","authors":"Emrah Emiral ,&nbsp;Erhan Serhat Demir ,&nbsp;Bülent Değirmenci ,&nbsp;Bekir Dinçer ,&nbsp;Mehmet Doğan ,&nbsp;İbrahim Üzün","doi":"10.1016/j.jflm.2025.102922","DOIUrl":"10.1016/j.jflm.2025.102922","url":null,"abstract":"<div><div>The World Health Organization defines traditional medicine as the sum of knowledge and practices unique to different cultures. Wet cupping therapy (hijama), a traditional medicine practice, holds religious and cultural significance, particularly in Middle Eastern and Islamic societies. However, this practice can lead to serious complications when performed under inappropriate conditions or by unqualified individuals. This study presents a case in which sudden cardiac death occurred following a hijama performed by an unlicensed practitioner on a patient diagnosed with ischemic stroke and a bladder tumor.</div><div>In the case review, it was determined that hijama applied to different parts of the body on consecutive days may have contributed to hemodynamic instability and potentially precipitated sudden cardiac arrest due to cumulative blood loss and stress. Autopsy findings revealed myocardial fibrosis associated with previous myocardial infarction, and no other acute toxicological or pathological findings were present. While a direct causal link cannot be definitively proven, the close temporal association, forensic assessment, and lack of alternative causes suggest a plausible connection between the hijama procedure and the fatal outcome.</div><div>This case underscores the importance of performing invasive traditional medicine practices under appropriate conditions and by authorized healthcare professionals. Raising awareness among the public and healthcare workers about such practices and ensuring the effective enforcement of legal regulations is critical to preventing potential complications.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"114 ","pages":"Article 102922"},"PeriodicalIF":1.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906876","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":"Forensic aspects of healthcare-related murders: a series of homicides and attempted homicides committed by nurses in Italy","authors":"Giacomo Visi ,&nbsp;Federica Spina ,&nbsp;Fabio Del Duca ,&nbsp;Aniello Maiese ,&nbsp;Donato Morena ,&nbsp;Luigi Papi ,&nbsp;Emanuela Turillazzi ,&nbsp;Vittorio Fineschi","doi":"10.1016/j.jflm.2025.102939","DOIUrl":"10.1016/j.jflm.2025.102939","url":null,"abstract":"<div><div>The murder of patients entrusted to the care of healthcare professionals presents an exceptionally rare and complex scenario. The motivations of the perpetrators, usually termed \"angels of death\" by the media, are not uniform and are often intricate, resulting from a unique combination of individual factors. Among the most sinister motivations are the altruistic desire to end the suffering of severely ill patients—concealing narcissistic-omnipotent tendencies or pathological insecurity—or even the pursuit of pure sadistic gratification. Due to the unique and complex nature of this field, determining the cause of death and the manner in which these victims were murdered poses significant challenges in forensic science. This study presents a retrospective analysis of deceased patients under questionable circumstances, documenting 43 cases of suspected or attempted homicides perpetrated by healthcare personnel across four healthcare facilities in Italy between 2004 and 2019. Most of the victims were elderly, vulnerable, and frail, with 72% hospitalized and 28% residing in nursing homes. The most common methods of inducing death included anticoagulant drugs (37%), intravenous gas injection (35%), promazine and/or other psicotropic drugs (14%), and insulin (7%). The investigation of suspected serial homicides in healthcare settings revealed several critical forensic considerations: i) a timely collection of toxicological samples should be performed within the first few hours post-mortem, due to the rapid degradation of chemical compounds; ii) a comprehensive autopsy examination, complemented by ancillary investigations (e.g., histopathological, toxicological, microbiological, and radiological analyses) should be considered mandatory; iii) in suspected cases of drug administration, the pathologist should carefully analyse the injection site, while a thorough examination of the lungs and pulmonary arteries is crucial in suspected gas embolism; iv) in some cases, exhumation could be necessary. Finally, we propose an operational flowchart to help stakeholders identify potential red flags and recognize dangerous situations, as well as assist forensic pathologists in determining the cause of death in cases of suspicious or unexplained fatalities. This flowchart provides a structured framework for investigations, ensuring a systematic and comprehensive approach to identifying potential homicides in healthcare settings.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"115 ","pages":"Article 102939"},"PeriodicalIF":1.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867424","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":"Evaluation of sexual dimorphism in the foramina of the middle cranial fossa using high-resolution multi-slice computed tomography scan: A cross-sectional study","authors":"Asmaa F. Sharif ,&nbsp;Ghada N. El-Sarnagawy ,&nbsp;Alaa Mohamed Reda ,&nbsp;Mona M. Ghonem","doi":"10.1016/j.jflm.2025.102935","DOIUrl":"10.1016/j.jflm.2025.102935","url":null,"abstract":"<div><h3>Introduction</h3><div>Sex estimation is a primary concern in forensic medicine. Although few studies have investigated sexual dimorphism in the middle cranial fossa, the obtained findings are still inconsistent.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted to investigate the sexual dimorphism in three foramina [foramen ovale, foramen rotundum, and foramen spinosum] using a high-resolution 128 multi-slice three-dimensional (3D) computerized tomography scanner. Two hundred and forty adult Egyptians (55.4 % females and 44.6 % males) were included with a female: male ratio 1.2 and a mean age of 42. 87 (10.82) years. All investigated cases were industrial and agricultural workers with no history of traumatic or pathological conditions affecting their middle cranial fossa.</div></div><div><h3>Results</h3><div>The obtained measurements were significantly greater on the left side. The Egyptian males displayed significantly higher anteroposterior dimensions of the foramen ovale, as well as the distance between the midline and the left foramen ovale (p &lt; 0.001)/the right foramen spinosum (p = 0.018). A proposed model for predicting sex exhibited a high area under the curve (0.819), a sensitivity of 80.37 %, and a specificity of 70.68 %. Furthermore, a substantial correlation was found between the actual and predicted probabilities, indicating good calibration.</div></div><div><h3>Conclusions</h3><div>This study offers an excellent non-invasive alternative to other unavailable skeletal measurements for estimating sex among Egyptian populations, filling a critical gap in forensic anthropology. Obtaining such objective morphometric measurements also contributes to safe clinical practice in diagnosis and treatment in various surgical fields, emphasizing the importance of anatomical variations in the context of sex differences.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"115 ","pages":"Article 102935"},"PeriodicalIF":1.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772821","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":"The interagency approach in Barbados for an infant with unexplained injuries","authors":"La-Toniá Arthur","doi":"10.1016/j.jflm.2025.102934","DOIUrl":"10.1016/j.jflm.2025.102934","url":null,"abstract":"<div><div>Despite only having one tertiary institution on the island, Barbados has eight other community clinics where free healthcare is obtained and numerous private options where one can access care. Ultimately, any significant or urgent case is referred to the Queen Elizabeth Hospital for further management. In the case of unexplained injuries in an infant, regardless of the route of healthcare access, the interagency approach ultimately involves other key entities. An interagency approach encompasses collaboration among various organizations to address this complex issue. This written work will highlight what works well and discuss the challenges faced when approaching unexplained injuries in an infant.</div><div>The interagency approach in Barbados to the management of an infant with unexplained injuries has the tendency to be a long process that occurs over weeks to months. However, the collaboration and teamwork that occurs between agencies for each case is and admirable feat that often leads to improved circumstances for the child of concern. It is acknowledged that, when compared to first world countries, the time taken for this multidisciplinary approach to garner any plausible result be seem mindboggling but it is a system that leads to thorough assessment of the child's physical state as well as the home circumstances and for that Barbados should be proud. Once the Child Protection Bill is passed in parliament then a greater push can be made at holding persons accountable for non-accidental injury in this country.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"114 ","pages":"Article 102934"},"PeriodicalIF":1.2,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679675","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":"Contributions of betahydroxybutyrate (BHB) determination and thanatological biochemistry in postmortem diagnosis of ketoacidosis-related fatalities: two case reports","authors":"Aurélien Bauduin ,&nbsp;Chadi Abbara ,&nbsp;Stéphane Malbranque ,&nbsp;Laura Renard ,&nbsp;Donca Zabet ,&nbsp;Séverine Ferec ,&nbsp;Xavier Dieu ,&nbsp;Nathalie Jousset ,&nbsp;Marie Briet ,&nbsp;Guillaume Drevin","doi":"10.1016/j.jflm.2025.102933","DOIUrl":"10.1016/j.jflm.2025.102933","url":null,"abstract":"<div><div>Postmortem biochemical analyses are increasingly recognized as valuable tools to complement traditional forensic investigations, particularly in cases where the cause of death remains unclear after autopsy and toxicological analyses. Among these, the quantification of β-hydroxybutyrate (BHB) in femoral blood (FB) and/or vitreous humor (VH) has proven crucial in identifying fatal ketoacidosis. The authors report two forensic cases in which targeted biochemical markers (including BHB, vitreous glucose, creatinine, and blood HbA1c) were evaluated to support the diagnosis of metabolic fatal metabolic disturbances. The first case involved a 57-year-old man with a known history of mellitus diabetes and chronic alcohol abuse, found deceased at home with postmortem genital mutilations. The second case concerned a 75-year-old diabetic man discovered in a neglected state after several weeks of insulin withdrawal. In both cases, toxicological findings were non-conclusive. However, markedly elevated BHB concentrations were observed in FB and VH, strongly supporting a diagnosis of ketoacidosis. In <em>Case 1</em>, the combination of chronic alcohol abuse together with elevated BHB concentrations in FB and VH suggested alcoholic ketoacidosis (AKA), with possible contribution from underlying diabetic condition. In <em>Case 2</em>, the history of prolonged insulin deprivation, abnormally high vitreous glucose concentration, and markedly increased BHB concentrations in FB and VH were consistent with diabetic ketoacidosis (DKA). Elevated vitreous creatinine and reduced estimated glomerular filtration rate (eGFR) further supported pre-existing renal dysfunction in both cases. These findings highlight the importance of integrating biochemical markers into routine postmortem protocols, as they may provide critical insights into otherwise unexplained deaths.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"114 ","pages":"Article 102933"},"PeriodicalIF":1.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679578","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":"PTSD assessments in sexual assault trials in Taiwan: Interdisciplinary Challenges and Implications for Judicial Policy Reform","authors":"Jun-Chien Liu ,&nbsp;Kuan-Ying Hsieh ,&nbsp;Tzu-Hsing Chen","doi":"10.1016/j.jflm.2025.102931","DOIUrl":"10.1016/j.jflm.2025.102931","url":null,"abstract":"<div><div>This study investigates the impact of forensic post-traumatic stress disorder (PTSD) evaluations on judicial outcomes in sexual offense cases in Taiwan, while also analyzing associated risks and proposing potential improvements.</div><div>In light of the limited statistical data and judicial assessments of such reports in Taiwan, the study employs a quantitative research design, analyzing sexual assault rulings from 2020 to 2023 across six district courts (Kaohsiung, Ciaotou, Taichung, New Taipei, Taipei, and Shilin). Additionally, in-depth interviews were conducted with three judges to gather qualitative insights into judicial perceptions of PTSD evaluation reports.</div><div>The results indicate a statistically significant correlation between the presence of PTSD forensic assessments and guilty verdicts. Judges generally recognized the evidentiary value of such reports, though the degree of reliance varied by region. Courts in southern Taiwan (Kaohsiung and Ciaotou) showed higher usage rates, whereas courts in central and northern regions tended to rely more on general medical diagnoses, likely due to limited collaboration with evaluation institutions, budget constraints, and lengthy assessment procedures. Moreover, the structure of Taiwan's National Health Insurance system may contribute to risks of overdiagnosis, potentially affecting the fairness of trials. Based on these findings, the study offers four key recommendations: (1) formal PTSD evaluations by certified institutions for suspected victims; (2) allocation of sufficient resources and budgets for assessments across all jurisdictions; (3) development of a national registry of forensic psychiatric units to support legal practitioners; and (4) enhanced collaboration between judicial and medical institutions to improve case processing efficiency. Limitations regarding sample size and geographic scope are acknowledged, and future research is encouraged to broaden the dataset and explore additional factors influencing judicial decisions, in order to strengthen the institutionalization and application of PTSD assessments in sexual assault litigation.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"115 ","pages":"Article 102931"},"PeriodicalIF":1.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781777","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":"Wischnewski spots and ethylene glycol fatal poisoning: a case report","authors":"Emanuele Capasso ,&nbsp;Pascale Basilicata ,&nbsp;Claudia Casella ,&nbsp;Ilenia Bianchi ,&nbsp;Andrea Ronchi ,&nbsp;Gaetano Di Donna","doi":"10.1016/j.jflm.2025.102930","DOIUrl":"10.1016/j.jflm.2025.102930","url":null,"abstract":"<div><div>We present the case of a woman who was found dead in a countryside 11 days after disappearing from home. At the examination of the scene of death a black plastic can of antifreeze fluid was found near the body.</div><div>The autopsy and complementary analysis allowed us to establish that the cause of death was an irreversible cardio-circulatory arrest caused by acute poisoning by the ingestion of ethylene glycol.</div><div>Moreover, the gastric mucosa showed numerous black hemorrhagic spots, histologically diagnosed to be “Wischnewski spots”.</div><div>Therefore, because most of the toxicity of ethylene glycol comes from its acid metabolites, we suggest that the presence of WSs in this case is strictly related to metabolic acidosis, supporting the thesis that acidosis plays a crucial role in the pathogenesis of WSs.</div><div>This is the first paper, to the best of our knowledge, that shows a correlation between ethylene glycol poisoning and Wischnewski spots.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"114 ","pages":"Article 102930"},"PeriodicalIF":1.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634102","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 retrospective survey of legal complaints on cosmetic procedures in Isfahan, Iran","authors":"Arash Ghodousi ,&nbsp;Sosan Sohrabi ,&nbsp;Mehdi Rasti Ardakani ,&nbsp;Alireza Sighari Deljavan ,&nbsp;Sina Ghertasi Oskouei ,&nbsp;Fariba Jokar","doi":"10.1016/j.jflm.2025.102929","DOIUrl":"10.1016/j.jflm.2025.102929","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Iran has one of the world's highest rates of cosmetic procedures, raising concerns about malpractice and related complaints. This study aimed to evaluate the profile and circumstances of legal complaints related to cosmetic procedures in Isfahan to inform preventive strategies.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, all complaints filed at Isfahan's Legal Medical Center between 2008 and 2012 were reviewed. Cases involving alleged negligence in cosmetic procedures and the resulting wergild evaluation were included. Data collected covered incidence, demographic characteristics, and details of complications or undesired outcomes. Statistical analysis was conducted using t-tests and chi-square tests.</div></div><div><h3>Results</h3><div>Among 128 cases analyzed, the mean age of plaintiffs was 35.1 ± 10.0 years, with females comprising 77.3 %. The majority of complaints (43.8 %) were related to cosmetic surgeries; deformity was the most frequently cited reason (50 %). Practitioners were specialists in 48.4 % of cases, non-specialists in 28.1 %, and of undetermined specialty in 23.4 %. Convictions were issued in 52.3 % of cases, including 17.9 % specialists, 38.8 % non-specialists, and 43.3 % with unknown specialty status among convicted practitioners. Both conviction rates and the involvement of non-specialists were significantly higher in cosmetic dental procedures than in other categories (P &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Deformity was the most common reason for legal complaints related to cosmetic procedures, with dental procedures contributing substantially to the overall complaint rate. These findings emphasize the importance of enhanced oversight and regulatory control in cosmetic practice.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"114 ","pages":"Article 102929"},"PeriodicalIF":1.2,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679577","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":"Hyperostosis frontalis interna, a clue in the reconstructive identification of skeletons. Epidemiology of an autopsy population at Limoges University Hospital (France)","authors":"Anaïs Du Fayet de la Tour ,&nbsp;Henri Duday ,&nbsp;Christine Couture ,&nbsp;Pierre Raguin ,&nbsp;François Paraf","doi":"10.1016/j.jflm.2025.102928","DOIUrl":"10.1016/j.jflm.2025.102928","url":null,"abstract":"<div><h3>Background</h3><div>Hyperostosis Frontalis Interna (HFI) is a localized thickening of the inner table of the frontal bone, frequently observed in postmenopausal women. Although often overlooked, it may provide valuable information for reconstructive identification in forensic contexts.</div></div><div><h3>Methods</h3><div>We conducted a macroscopic analysis of 195 autopsied individuals at Limoges University Hospital (France) to assess the prevalence of HFI and its associations with age, sex, and medical history.</div></div><div><h3>Results</h3><div>HFI was identified in 13.8 % of cases, with a striking sex disparity: 38.8 % of females presented with HFI compared to only 0.78 % of males (p &lt; 0.0001). A significant association with older age was observed (mean age 66.3 years in HFI-positive vs. 48.4 years in HFI-negative individuals, p &lt; 0.00001). The presence of HFI predicted female sex with a positive predictive value of 96.3 %. A significant association was also found with a history of depression.</div></div><div><h3>Conclusion</h3><div>Although HFI has limited sensitivity, its high specificity and ease of detection make it a useful auxiliary marker in reconstructive identification. It may help narrow the biological profile in cases involving degraded or incomplete remains. Further multicenter studies are needed to validate its forensic utility.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"114 ","pages":"Article 102928"},"PeriodicalIF":1.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604122","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}