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Diagnostic Methods in Forensic Pathology

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (15 September 2023) | Viewed by 53315

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Dr. Elvira Ventura Spagnolo

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Legal Medicine Section, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
Interests: forensic pathology; forensic immunohistochemistry; forensic microbiology; forensic radiology; virtopsy; legal medicine; sudden cardiac death; criminology; violence and abuse; clinical risk management; healthcare security and safety; medical liability
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Dr. Cristina Mondello

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Legal Medicine Section, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
Interests: forensic pathology; forensic immunohistochemistry; forensic microbiology; legal medicine; sudden cardiac death; medical liability
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Dr. Gennaro Baldino

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Guest Editor Assistant

Legal Medicine Section, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
Interests: forensic pathology; forensic odontology, forensic microbiology; forensic radiology; virtopsy; medical liability
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are pleased to announce the launch of a new Special Issue, entitled "Diagnostic Methods in Forensic Pathology". This is a collection of important high-quality papers relating to all aspects of forensic pathology.

Understanding the cause of death in the forensic setting can be difficult and autopsies alone may not be conclusive, making the assessment of the dynamics which lead to death a challenge. Further issues in forensic pathology include the identification of the victim, the post mortem interval (PMI) estimation, injury vitality, and age estimation. In several cases, forensic assessment needs a multidisciplinary approach in which the forensic pathologist integrates his skills with other figures/specialists, such as toxicologists, anthropologists, odontologists, radiologists, entomologists, geneticists, and engineers. This cooperation has allowed innovations in forensic practice and the development of new diagnostic strategies.

This Special Issue aims to include scientific advances and perspectives for the developments and discoveries in all fields of post-mortem forensic diagnostics. To this scope, the Special Issue will include scientific articles on all the forensic methods/investigations/analysis useful to reach a clear post-mortem diagnosis.

Dr. Elvira Ventura Spagnolo
Dr. Cristina Mondello
Guest Editors

Gennaro Baldino
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

forensic pathology
multidisciplinary approach
post mortem interval
causes of death
personal identification
sudden cardiac death/unexpected death
fatal anaphylactic shock
sepsis
autopsy
toxicology
histopathology
postmortem immunohistochemistry
forensic odontology
forensic anthropology
forensic entomology
molecular biology
genetic investigations
postmortem CT
postmortem MRI
micro-CT
3D print
virtopsy
forensic geology
forensic veterinary
forensic microbiology
post-mortem biochemical analysis
stereomicroscopy
energy-dispersive X-ray analysis
scanning electron microscope (EDX/SEM)
metallization
forensic engineering

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Related Special Issue

Diagnostic Methods in Forensic Pathology: 2nd Edition in Diagnostics

Published Papers (9 papers)

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33 pages, 2250 KiB

Open AccessArticle

Autoptic Findings in Cases of Sudden Death Due to Kawasaki Disease

by Giacomo Visi, Federica Spina, Fabio Del Duca, Alice Chiara Manetti, Aniello Maiese, Raffaele La Russa, Paola Frati and Vittorio Fineschi

Diagnostics 2023, 13(11), 1831; https://doi.org/10.3390/diagnostics13111831 - 23 May 2023

Cited by 2 | Viewed by 1821

Abstract

Kawasaki disease (KD) is the second-most-common childhood vasculitis, and its etiology is still unknown today. Even though the acute illness is usually self-limiting, sometimes, it can generate complications, such as coronary artery aneurysms (CAA), acute myocardial infarction (AMI), heart failure, or arrhythmias, and can rarely cause sudden or unexpected deaths. We present a review of the literature, which collects autoptic and histopathological data relating to many of the cases of these deaths. On the basis of the titles and abstracts, we selected 54 scientific publications for a total of 117 cases. Among them, as expected, the majority of the deaths were due to AMI (41.03%), arrhythmia (8.55%), acute coronary syndrome (8.55%), and CAA rupture (11.97%), involving mostly 20-year-olds or younger individuls (69.23%). This is not surprising since the CAs are the most involved arteries. Gross autoptic and histopathological findings are reported in the paper. Our work revealed that, when compared with the incidence of KD, only a few cases suffered from sudden death, underwent an autoptic examination, and were then described in the literature. We suggest that researchers should perform autopsies to gain a better understanding of the molecular pathways involved in KD so as to propose further innovative therapeutic protocols or implement more appropriate prevention schemes. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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15 pages, 4866 KiB

Open AccessArticle

Beyond Henssge’s Formula: Using Regression Trees and a Support Vector Machine for Time of Death Estimation in Forensic Medicine

by Lívia Mária Dani, Dénes Tóth, Andrew B. Frigyik and Zsolt Kozma

Diagnostics 2023, 13(7), 1260; https://doi.org/10.3390/diagnostics13071260 - 27 Mar 2023

Cited by 4 | Viewed by 2067

Abstract

Henssge’s nomogram is a commonly used method to estimate the time of death. However, uncertainties arising from the graphical solution of the original mathematical formula affect the accuracy of the resulting time interval. Using existing machine learning techniques/tools such as support vector machines (SVMs) and decision trees, we present a more accurate and adaptive method for estimating the time of death compared to Henssge’s nomogram. Using the Python programming language, we built a synthetic data-driven model in which the majority of the selected tools can estimate the time of death with low error rates even despite having only 3000 training cases. An SVM with a radial basis function (RBF) kernel and AdaBoost+SVR provided the best results in estimating the time of death with the lowest error with an estimated time of death accuracy of approximately ±20 min or ±9.6 min, respectively, depending on the SVM parameters. The error in the predicted time (

t_{p}

[h]) was

t_{p} \pm 0.7

h with a 94.45% confidence interval. Because training requires only a small quantity of data, our model can be easily customized to specific populations with varied anthropometric parameters or living in different climatic zones. The errors produced by the proposed method are a magnitude smaller than any previous result. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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10 pages, 2840 KiB

Open AccessArticle

Diagnostic Methods in Forensic Pathology: A New Sign in Death from Hanging

by Maricla Marrone, Gerardo Cazzato, Pierluigi Caricato, Carlo Angeletti, Giuseppe Ingravallo, Nadia Casatta, Carmelo Lupo, Francesco Vinci, Gisella Agazzino, Alessandra Stellacci and Antonio Oliva

Diagnostics 2023, 13(3), 510; https://doi.org/10.3390/diagnostics13030510 - 30 Jan 2023

Cited by 2 | Viewed by 8744

Abstract

Purpose: To evaluate the usefulness of studying vital injuries at the sternal head insertion of the sternocleidomastoid muscle in the medico-legal assessment of death by hanging. Materials and Methods: Study material was obtained from eight bodies of people who died from hanging. The control group included as many specimens collected from people who died from traumatic causes other than hanging (precipitation from medium to large heights and traffic accidents). The structures under study were examined histologically with a BX-51 light microscope (Olympus). An analysis of the extravasated erythrocytes was performed by counting the number per mm² in the histologic section on 10 HPF (400×), and Student’s t-test for a comparison of the averages was applied for all parametric values. The authors noted that the key finding, indicative of the subject’s viability at the time of discontinuation, was the presence of recent hemorrhagic infiltrate (in the absence of hemosiderin) at the tendon insertion of the sternocleidomastoid muscle and the proximal part of the muscle itself. Results: All specimens tested were positive for the presence of hemorrhagic infiltrate at the portions tested in a statistically significant manner. In contrast, in the control cases there was no or, where present, no statistically significant (p < 0.05) presence of recent hemorrhagic infiltrate. The limitation of the study is the low number of samples examined. In any case, the results obtained are strongly indicative of the possibility of using this type of forensic pathological investigation in cases where there is a doubt in terms of a differential diagnosis between hanging (suicidal type) and suspension of a corpse in a simulation of hanging. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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13 pages, 26050 KiB

Open AccessArticle

Novel Prediction Method Applied to Wound Age Estimation: Developing a Stacking Ensemble Model to Improve Predictive Performance Based on Multi-mRNA

by Lihong Dang, Jian Li, Xue Bai, Mingfeng Liu, Na Li, Kang Ren, Jie Cao, Qiuxiang Du and Junhong Sun

Diagnostics 2023, 13(3), 395; https://doi.org/10.3390/diagnostics13030395 - 20 Jan 2023

Cited by 3 | Viewed by 1997

Abstract

(1) Background: Accurate diagnosis of wound age is crucial for investigating violent cases in forensic practice. However, effective biomarkers and forecast methods are lacking. (2) Methods: Samples were collected from rats divided randomly into control and contusion groups at 0, 4, 8, 12, 16, 20, and 24 h post-injury. The characteristics of concern were nine mRNA expression levels. Internal validation data were used to train different machine learning algorithms, namely random forest (RF), support vector machine (SVM), multilayer perceptron (MLP), gradient boosting (GB), and stochastic gradient descent (SGD), to predict wound age. These models were considered the base learners, which were then applied to developing 26 stacking ensemble models combining two, three, four, or five base learners. The best-performing stacking model and base learner were evaluated through external validation data. (3) Results: The best results were obtained using a stacking model of RF + SVM + MLP (accuracy = 92.85%, area under the receiver operating characteristic curve (AUROC) = 0.93, root-mean-square-error (RMSE) = 1.06 h). The wound age prediction performance of the stacking models was also confirmed for another independent dataset. (4) Conclusions: We illustrate that machine learning techniques, especially ensemble algorithms, have a high potential to be used to predict wound age. According to the results, the strategy can be applied to other types of forensic forecasts. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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10 pages, 2302 KiB

Open AccessArticle

Application of Teeth in Toxicological Analysis of Decomposed Cadavers Using a Carbamazepine-Administered Rat Model

by Hiroaki Ichioka, Urara Saito, Kaori Shintani-Ishida, Takahira Shirahase, Nozomi Idota, Narisato Kanamura and Hiroshi Ikegaya

Diagnostics 2023, 13(2), 311; https://doi.org/10.3390/diagnostics13020311 - 14 Jan 2023

Viewed by 1798

Abstract

In a regular autopsy, blood and organs are used to quantify drug and toxicant concentrations; however, specimens such as blood cannot be collected from highly decomposed corpses, making the quantification of drug and toxicants impossible. This study aimed to estimate the blood carbamazepine (CBZ) concentration from teeth, a part of the human body that is best preserved after death. We sampled teeth and blood of rats administered CBZ. The correlation between the tooth and serum CBZ concentrations was analyzed. Rats were euthanized after CBZ administration and kept at 22 °C for 0 to 15 days before sampling the teeth and measuring the CBZ concentration. Undecalcified, fresh, frozen sections of rat teeth were prepared, and CBZ localization was evaluated. CBZ concentrations in both teeth and cardiac blood peaked at 60 min after administration and increased in a dose-dependent manner. CBZ concentration in teeth did not substantially change after death, with high CBZ distribution being observed in the pulp cavity. The tooth and serum CBZ concentrations were highly correlated, suggesting that the measurement of toxicant concentration in sampled teeth would allow for the estimation of blood toxicant concentration in highly decomposed corpses. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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Review

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17 pages, 1860 KiB

Open AccessReview

Multidisciplinary Forensic Approach in “Complex” Bodies: Systematic Review and Procedural Proposal

by Gennaro Baldino, Cristina Mondello, Daniela Sapienza, Chiara Stassi, Alessio Asmundo, Patrizia Gualniera, Stefano Vanin and Elvira Ventura Spagnolo

Diagnostics 2023, 13(2), 310; https://doi.org/10.3390/diagnostics13020310 - 14 Jan 2023

Cited by 24 | Viewed by 2910

Abstract

The recovery of severely altered cadavers (i.e., extensively decomposed, mummified, charred or dismembered) can be a challenge for forensic pathologists due to the difficulties in identification, PMI estimation and manner and cause of death determination. In such cases, integrating routine approaches (autopsy, histology, toxicology) to more specific forensic branches can be fundamental to improving the investigative process. In this paper a systematic review using PubMed, Scopus and Web of Science databases has been performed. The aim was to evaluate the forensic approaches implemented in the management of severely altered bodies due to decomposition, mummification, skeletonization, charring or dismemberment (to which we refer to as “complex”), and the role of each approach in the solution of a case. Then, the literature revision results were used to propose a schematic flowchart summarizing the post mortem activities that can be performed in forensic practice, adaptable in relation to each case. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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Other

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11 pages, 3295 KiB

Open AccessCase Report

Detection of Fatal Potassium Overdose: A Case Report and Review of the Literature

by Gábor Simon

Diagnostics 2023, 13(7), 1339; https://doi.org/10.3390/diagnostics13071339 - 4 Apr 2023

Cited by 2 | Viewed by 28071

Abstract

Potassium overdose usually occurs accidentally, but potassium is also used for judicial executions, assisted death, and, rarely, suicides. In addition to exogenous overdose, various drugs, and renal failure, diabetic ketoacidosis can cause hyperkalemia. Potassium tablets are used in most cases of suicidal potassium overdose. Suicide by intravenous administration of potassium is rare but usually fatal. The author reports a rare case of suicide with potassium infusion. Autopsy and histology findings, along with post-mortem biochemical analysis of different body fluids and fluid from the infusion set, are reported. Previously published reports of potassium overdose were reviewed, and the detection possibilities of potassium overdose are discussed. The detection possibilities of lethal hyperkalemia are very limited since hyperkalemia produces only nonspecific autopsy and histology findings. Post-mortem potassium concentrations are not indicative of ante-mortem potassium concentrations; therefore, post-mortem biochemical analysis has limited value in determining potassium overdose. The best way to prove potassium overdose is via the collection and analysis of circumstantial evidence. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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13 pages, 1232 KiB

Open AccessCase Report

Idiopathic Pulmonary Hemorrhage in Infancy: A Case Report and Literature Review

by Fabio Del Duca, Aniello Maiese, Federica Spina, Giacomo Visi, Raffaele La Russa, Paola Santoro, Maria Serenella Pignotti, Paola Frati and Vittorio Fineschi

Diagnostics 2023, 13(7), 1270; https://doi.org/10.3390/diagnostics13071270 - 28 Mar 2023

Cited by 4 | Viewed by 2457

Abstract

Acute idiopathic pulmonary hemorrhage in infants (AIPHI) is a rare and quite low-described entity. Nowadays, pathophysiological mechanisms are poorly understood, although the lethality remains high. We present an autopsy case report of a 2-day-old male who developed respiratory distress and blood leakage from the endotracheal tube (ET) and suddenly died because of acute pulmonary hemorrhage. A postmortem examination and histological analysis were performed and are reported in this paper. Alveolar spaces were filled with red blood cells and hyaline membranes in all the examined samples. The absence of other findings led us to select a post-mortem diagnosis of AIPHI. To support our diagnosis, we conducted a systematic review of the updated scientific literature and found that only 61 cases have been reported. Most of them presented acute respiratory distress and bleeding from the upper airways with blood leakage from ET (9.83%), hemoptysis (52.45%), epistaxis (8.2%), and hematemesis (3.27%). The autopsy data revealed hemorrhages of the lower airways and hemosiderin-laden macrophages. The data from the scientific publications and our findings are essential to achieving a correct diagnosis. On these bases, we suggest autoptic criteria to achieve a post-mortem diagnosis of AIPHI. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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6 pages, 1056 KiB

Open AccessInteresting Images

Hypoplastic Left Heart Syndrome: About a Postnatal Death

by Pasquale Giugliano, Paola Ciamarra, Mariavictoria De Simone, Alessandro Feola, Pierluca Zangani, Carlo Pietro Campobasso and Gelsomina Mansueto

Diagnostics 2023, 13(5), 821; https://doi.org/10.3390/diagnostics13050821 - 21 Feb 2023

Cited by 3 | Viewed by 1889

Abstract

Background: Hypoplastic left heart syndrome (HLHS) is a congenital heart disease that is associated with high mortality rates in the early neonatal period and during surgical treatments. This is mainly due to missed prenatal diagnosis, delayed diagnostic suspicion, and consequent unsuccessful therapeutic intervention. Case report: twenty-six hours after birth, a female newborn died of severe respiratory failure. No cardiac abnormalities and no genetic diseases had been evidenced or documented during intrauterine life. The case became of medico-legal concern for the assessment of alleged medical malpractice. Therefore, a forensic autopsy was performed. Results: the macroscopic study of the heart revealed the hypoplasia of the left cardiac cavities with the left ventricle (LV) reduced to a slot and a right ventricular cavity that simulated the presence of a single and unique ventricular chamber. The predominance of the left heart was evident. Conclusions: HLHS is a rare condition that is incompatible with life, with very high mortality from cardiorespiratory insufficiency that occurs soon after birth. The prompt diagnosis of HLHS during pregnancy is crucial in managing the disease with surgery. Full article

(This article belongs to the Special Issue Diagnostic Methods in Forensic Pathology)

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