Self‐Strangulation Through A Sphygmomanometer: An Uncommon Suicide

Suicide by asphyxia is quite a common event in forensic practice and may be implemented in different ways. The authors report a unique case of a 16‐year‐old youth who committed suicide by means of a standard mercury sphygmomanometer. This manner of suicide has never been described in the literature reviewed. A complete forensic investigation led to the conclusion that the cause of death was mechanical asphyxia, ascribed to self‐strangulation by means of an atypical item. The victim suffered from attention‐deficit/hyperactivity disorder (ADHD) syndrome and was assisted by support teachers. He had a solitary and depressive personality. The exceptional nature of this case suggests that sphygmomanometers may be regarded as possible means of self‐strangulation. The case also highlights the importance of managing patients with psychiatric or cognitive disorders; indeed, particular caution is required to keep them away from objects that, although apparently harmless, can become lethal.     

Forensic Paleontology: A Tool for “Intelligence” and Investigation

Paleontology and facies analysis proved to be useful tools in activities of intelligence and investigation on some criminal cases, as well as in in‐court activities, thus defining the “forensic paleontology” area of study. The definition was given by analyzing its possible specific applications and excluding some marginal activities. The reliability of forensic paleontology was then assessed in light of the results achieved in some actual cases and in an ad hoc simulation. The investigated cases concerned intelligence and ordinary law enforcement activities. Special attention was paid to crimes against the cultural heritage. Ex post re‐examination of the cases substantiated the value of this scientific branch in investigations, while stressing the possible difficulties in explaining its results to lay persons. Therefore, careful preparation of technical and linguistic preliminary notes for judges, prosecutors, and lawyers as well as a special training for consultants are recommended before presenting results as exhibits in in‐court cross‐examinations.     

n‐Ethyl Pentylone‐Related Deaths in Alabama

n‐Ethyl pentylone (NEP) is a chemical substance derived from cathinone. Synthetic cathinones are an evolving group of drugs with stimulating, mind‐altering effects sometimes referred to as novel or new psychoactive substances (NPS). There is scarce information in the medical literature regarding forensic cases in which NEP is detected in toxicological testing. We present four fatalities involving NEP from Alabama in 2017. Deaths were attributed to NEP toxicity in two cases (peripheral blood concentrations of 0.121 and 0.953 mg/L) and injuries caused by gunshot wounds in two cases (peripheral blood concentrations of 0.045 and 0.031 mg/L). One case involving NEP described an individual who exhibited classic CNS‐stimulant induced erratic behavior before being found dead. These cases enhance the forensic literature regarding specific NPS like NEP and provide contextual reference for professionals considering the significance of NEP in toxicological interpretation.     

Commotio Cordis – A Report of Two Similar Cases

Commotio cordis is a rare and fatal mechano‐electric arrhythmogenic syndrome, occurring mainly during sports activities. The present study describes two similar cases of sudden death caused by commotio cordis associated with homicide. The two decedents were both 15‐year‐old male teenagers. Both collapsed within several minutes after being punched in the precordial region, as observed by witnesses at the scenes. Although electrocardiograms were not recorded at the scenes or the hospitals, the sudden onset of cardiovascular, respiratory, and neural symptoms were consistent with sudden cardiac death caused by commotio cordis. Autopsy and forensic morphology both revealed no cardiac or pericardiac structural damage, evident lesions of other internal organs, or underlying diseases, along with negative toxicological analysis, conforming to criteria for diagnosis of commotio cordis. The diagnosis of commotio cordis by forensic pathologists is important in deliberating a verdict of homicide, especially involuntary homicide. In rare instances, a death caused by commotio cordis may have a homicide manner of death.     

Perineal‐Vaginal Injuries in Children: Accident or Abuse?

Abstract: A large number of conditions have been mistaken for abuse. Differentiating accidental injuries from inflicted injuries is important in the management of injured children. In this work, the authors describe two cases of accidental perineal‐vaginal injury in children. In case 1, a 4‐year‐old girl suffered a vaginal tear caused by violent stretching during play; in case 2, a 3‐year‐old girl had minor lacerations of labia minora and majora. The intervention of a multi‐specialist team including a forensic pathologist and forensic psychiatrist was the key factor in being able to exclude abuse by third parties in the described cases.. This leads to the appropriate recommendations to be adopted in the forensic medicine setting.     

Tables for the Metric Evaluation of Pair‐Matching of Human Skeletal Elements

A common task in forensic anthropology involves pair‐matching of left and right skeletal elements. This can be achieved through visual pair‐matching by evaluating similarities in morphology, and through osteometric sorting, a quantitative technique. To simplify the process of osteometric sorting, this article explains the use of a statistic (M), which captures the amount of size variation found between homologous bones from single individuals. A database of skeletal measurements for all major paired postcranial bones is used to calculate values of M from a variety of sources. The maximum value and the 90th and 95th percentiles of M are provided in tabular format, and values of M from forensic cases can be compared to these tables as an objective means for determining whether homologous bones could have originated from the same individual. This simple technique can be combined with visual pair‐matching to be particularly effective in cases involving commingling of skeletons.     

A multidisciplinary investigation of chronic animal abuse: Collaboration between veterinary forensics and forensic anthropology

An unknown juvenile female mixed breed dog was found non‐ambulatory on a dead‐end street in an urban setting adjacent to a public park. During initial veterinary examination, she was assessed to have untreatable injuries and was humanely euthanized. The forensic veterinarian requested consultation from a forensic anthropologist to assist with documenting antemortem skeletal trauma. Analyses of skeletal tissues indicated numerous injuries in various stages of healing diagnostic of non‐accidental injuries. Veterinary forensic cases may benefit from collaborative analysis of bony remains by forensic anthropologists.     

Effectiveness of Single‐Nucleotide Polymorphisms to Investigate Cattle Rustling

Short tandem repeats (STR)s have been the eligible markers for forensic animal genetics, despite single‐nucleotide polymorphisms (SNP)s became acceptable. The technology, the type, and amount of markers could limit the investigation in degraded forensic samples. The performance of a 32‐SNP panel genotyped through OpenArrays^TM (real‐time PCR based) was evaluated to resolve cattle‐specific forensic cases. DNA from different biological sources was used, including samples from an alleged instance of cattle rustling. SNPs and STRs performance and repeatability were compared. SNP call rate was variable among sample type (average = 80.18%), while forensic samples showed the lowest value (70.94%). The repeatability obtained (98.7%) supports the used technology. SNPs had better call rates than STRs in 12 of 20 casework samples, while forensic index values were similar for both panels. In conclusion, the 32‐SNPs used are as informative as the standard bovine STR battery and hence are suitable to resolve cattle rustling investigations.     

Incidence of Low Body Mass Index in the Elderly in Forensic Cases—A Possible Marker for Frailty Syndrome?

Diagnosing frailty syndrome at autopsy may be difficult if no adequate clinical history is provided. As low body mass index (BMI) may be associated with frailty in the elderly, the following study was undertaken to determine the percentage of medicolegal cases with BMIs < 18.5 in decedents aged over 75 years. Review was undertaken over three time periods: January to December 1986, January to December 2006, and January to December 2012. In 1986, 16% (15 of 93) of individuals aged ≥75 years had BMIs < 18.5, in 2006, 15% (50 of 336), and in 2012, 13% (35 of 274). In no case was frailty syndrome mentioned. This study demonstrates that frailty syndrome appears to be an underappreciated diagnosis in forensic practice despite a significant percentage of elderly decedents (13–16% over a 27‐year period) having low BMIs. Prospective assessment of this group is required to determine the incidence and contribution to mortality of frailty syndrome in a forensic context.     

肩袖损伤法医学鉴定研究进展

肩袖损伤是一种临床常见的肩关节病,成因复杂且症状有时不甚明显,缺乏特征性表现,容易被漏诊及误诊。在法医学鉴定中,时常遇到肩袖损伤的案例,判定该类案例是创伤所致、自身疾病抑或属于伤病共同作用导致是目前摆在法医鉴定人面前的难点问题。但因找不到客观的鉴别指标,容易使鉴定工作进入盲区,也时常引起当事人对鉴定意见的质疑,甚至长期的上访缠诉,引发社会的不稳定。基于此,从肩袖解剖结构、损伤机制、临床表现、鉴别诊断及法医学鉴定等方面展开论述,有助于为此类案件的鉴定提供参考。     

Fatal Overdose of Gamma‐hydroxybutyrate Acid After Ingestion of 1,4‐Butanediol

We report a case of fatal intoxication from 1,4‐butanediol (1,4‐BD), which was ingested by a young and “naïve” gamma‐hydroxybutyrate (GHB) consumer during a party with the co‐ingestion of alcohol, cannabis, and methylene‐dioxy‐methamphetamine. The following drug concentrations were found using gas chromatography coupled with mass spectrometry on autopsy samples and on a cup and a glass found at the scene: 20,350 mg/L (bottle) for 1,4‐BD; 1020 mg/L (femoral blood), 3380 mg/L (cardiac blood), 47,280 mg/L (gastric content), and 570 mg/L (vitreous humor) for GHB. The concentration of GHB is difficult to interpret in forensic cases due to the possibility of an endogenous production of GHB. The variable tolerance of the user may also modify the peri‐ and postmortem GHB concentrations. This case underscores the need to have many different sources of toxicology samples analyzed to avoid the hypothesis of endogenous production of GHB.     

The Forensic Implications of Turner's Syndrome

Turner's syndrome, the most common sex chromosome disorder of females, is caused by complete or partial loss of one X chromosome and is associated with a wide range of internal and external manifestations and increased mortality rates (three to nine times the background population). While individuals with Turner's syndrome may survive for many decades, premature and unexpected deaths can occur that bring decedents to the attention of forensic examiners. Causes of death in Turner's syndrome are often linked to underlying cardiovascular conditions such as aortic dissection, congenital cardiovascular disease, ischemic heart, and cerebrovascular disease, but deaths due to noncardiac causes also occur with increased frequency. The latter include epilepsy, diabetes mellitus, chronic renal disease, pneumonia, chronic liver disease, and malignancy. Thus, the autopsy evaluation of these cases requires careful examination of all major organ systems, with the consideration of confirmatory cytogenetic testing.     

Usefulness of dura mater in providing DNA samples for identifying cadavers

We examined the usefulness of the dura mater in identifying human remains. Dura mater was collected from 50 cadavers, including drowned, charred, and mummified remains. The STR genotype using the AmpFlSTR Identifiler Kit could be typed at 15 STR and amelogenin loci in 30 samples of 33 cases. Furthermore, the ABO genotype and amelogenin using gel-based methods could be typed in 44 samples of 50 cases. In cases with successful typing of STR, ABO-DNA, and amelogenin, the longest time after death was from 12 to 26 days in a drowned body. The minimum quantity of dura mater required for DNA extraction was about 2.5 mg, dried and fixed by ethanol, in a cadaver 15 h after death. The state of the DNA from the dura mater from the calvaria may be better than that from the basis cranii interna. We found that DNA from dura mater is one of the most useful samples for forensic identification.     

Feigning Hand Preference? A Case Report Preliminary Data

Hand preference may be crucial in the forensic domain, notably in cases where the assailant is known to be left‐handed and the defendant claims to be right‐handed (or vice versa). In such cases, forensic psychologists or physicians may be asked to test the hand preference of the defendant. However, hand preference may be faked. The case described here illustrates this problem and addresses potential solutions. We also present preliminary data showing that a standard instrument for measuring handedness is sensitive to feigning. We conclude that when hand preference is determined, multiple sources of information should be assessed in order to identify possible feigning.     

创伤性骨关节炎法医学鉴定41例分析

目的探讨创伤性骨关节炎的法医学鉴定要点。方法总结苏州同济司法鉴定所2006~2010年受理的41例创伤性骨关节炎法医临床学鉴定案例,对被鉴定人的性别、年龄、致伤方式、损伤部位、损伤形态、影像学表现、治疗方式、创伤性骨关节炎确诊的时间间隔等资料进行回顾性统计、分析。结果法医学检验检见生理结构破坏合并功能障碍7例,功能障碍30例,生理结构与功能检查均未见明显异常9例,另2例临床于外伤后短时间内即诊断为创伤性骨关节炎的,法医学鉴定时未予认定。创伤性骨关节炎影像学表现的严重程度与疼痛、功能障碍等临床表现并没有显著的相关性。结论创伤性骨关节炎作为骨折后常见的并发症之一,好发于负重关节,发生的间隔时间不一,其临床表现严重程度较影像学表现对法医学鉴定意见的意义更大。     

Evaluation and applicability of Alere iCup DX 14 for rapid postmortem urine drug screening at autopsy

Performing point‐of‐care urine drug screen testing at autopsy by a forensic pathologist may provide an early indication of the presence of analytes of interest during autopsy. An evaluation for the screening of 14 classes of common drugs of abuse in postmortem urine by the point‐of‐care screening device, Alere iCup DX 14, is presented. One hundred ninety postmortem urine samples were screened with the iCup occurring at autopsy by the forensic pathologist. Positive and negative results obtained from the screening kit were evaluated against confirmatory test results obtained using routine forensic toxicology analyses that employed LC‐MS/MS and GC‐MS to detect a combination of over 85 common drugs of abuse and medications. Sensitivity for each respective iCup drug class ranged from 66% (buprenorphine) to 100% (methadone, tricyclic antidepressants). Specificity for each respective iCup drug class ranged from 89% (benzodiazepines) to 100% (amphetamines, barbiturates, buprenorphine, 3,4‐methylenedioxymethamphetamine, methadone). Positive predictive values ranged from 44% (benzodiazepines) to 100% (amphetamines, barbiturates, buprenorphine, methylenedioxymethamphetamine, methadone), while negative predictive values ranged from 96% (methamphetamine) to 100% (barbiturates, methadone, tricyclic antidepressants). A high false‐positive rate was yielded by the benzodiazepine class. The lack of fentanyl screening in the point‐of‐care device is a significant limitation considering its prolific prevalence in forensic casework. The results obtained in the study should be acknowledged when considering the use of the Alere iCup DX 14 in the context of postmortem casework to help indicate potential drug use contemporaneously with autopsy and when requiring such preliminary results prior to the release of a final forensic toxicology report.     

Signs of Fungal Infection in Dead Mimic the Chronic Torture

The cases of battered woman syndrome (BWS) are very common in India. The majority of the women suffer battering by their family members especially in‐laws. The injuries occurring each time indicate their being battered, but on being questioned about these happenings, a mismatched history being given by them is the major indication of BWS. In many of the cases, the injuries present over the body either in healing stages or in association with skin diseases may mislead the forensic pathologists and investigating agencies. One such rare autopsy was conducted where the healing lesions of the chronic fungal infections were mistaken as the injuries of chronic torture. The case is presented here to remind to the forensic pathologist about the possibility of the signs of chronic fungal infections in dead, which can mimic the torture, and to discuss its medicolegal implications.     

Accuracy Rates of Sex Estimation by Forensic Anthropologists through Comparison with DNA Typing Results in Forensic Casework

A common task in forensic anthropology involves the estimation of the biological sex of a decedent by exploiting the sexual dimorphism between males and females. Estimation methods are often based on analysis of skeletal collections of known sex and most include a research‐based accuracy rate. However, the accuracy rates of sex estimation methods in actual forensic casework have rarely been studied. This article uses sex determinations based on DNA results from 360 forensic cases to develop accuracy rates for sex estimations conducted by forensic anthropologists. The overall rate of correct sex estimation from these cases is 94.7% with increasing accuracy rates as more skeletal material is available for analysis and as the education level and certification of the examiner increases. Nine of 19 incorrect assessments resulted from cases in which one skeletal element was available, suggesting that the use of an “undetermined” result may be more appropriate for these cases.     

Investigation Delayed Is Justice Denied: Proposals for Expediting Forensic Examinations of Digital Evidence*

Abstract: There is an urgent need to reduce the growing backlog of forensic examinations in Digital Forensics Laboratories (DFLs). Currently, DFLs routinely create forensic duplicates and perform in‐depth forensic examinations of all submitted media. This approach is rapidly becoming untenable as more cases involve increasing quantities of digital evidence. A more efficient and effective three‐tiered strategy for performing forensic examinations will enable DFLs to produce useful results in a timely manner at different phases of an investigation, and will reduce unnecessary expenditure of resources on less serious matters. The three levels of forensic examination are described along with practical examples and suitable tools. Realizing that this is not simply a technical problem, we address the need to update training and establish thresholds in DFLs. Threshold considerations include the likelihood of missing exculpatory evidence and seriousness of the offense. We conclude with the implications of scaling forensic examinations to the investigation.     

In search of identity: The field of forensic anthropology in Brazil—Profession and practice

The existing divergencies in the development of forensic anthropology (FA) around the world justify an analysis of its situation in each country/region. Our objective is to report information gathered directly from professionals acting in the field of forensic anthropology in Brazil, with the aim of highlighting the challenges of the discipline and contributing to its advancement. The research consisted of personal visits in Medico‐Legal Institutes (IMLs) in nine states of the country and semi‐structured interviews with 16 professionals. Detailed analysis of the Results suggests the field of forensic anthropology, despite the engagement and dedication of its professionals, cannot yet be considered a well‐structured discipline across the country. The academic background of professionals is highly heterogenous. The applied methods vary, and common protocol is not always followed. The demand highly exceeds the available human resources. The lack of comparative material Results in high percentage of cases remaining unsolved. Important divergences exist in terms of infrastructure and professional resources between the states. The limited cooperation between different IMLs and between different sections of the same IML—together with a general disbelief in the usefulness of anthropological examination in forensic cases—hampers FA’s development. There is a great openness for scientific collaboration and an abundance of material for research. Our research demonstrated structural, political, and academic limitations that affect the FA field in Brazil. However, the expertise and dedication of professionals point to human potential as the chief strength of this discipline that supports and enables research, providing high‐quality services in a challenging context.