Vilma Pinchi

Background: Wrist-hand radiographic skeletal maturation methods are widely used for forensic age estimation of living individuals, remaining among the most widely accepted imaging modalities in forensic practice despite limited evidence supporting their use at the legally relevant 18-year threshold. This systematic review aims to provide a quantitative synthesis of the widely recognized but previously unsynthesized body of evidence regarding their diagnostic accuracy (sensitivity, specificity, AUC-curve, mean absolute error-MAE) for forensic adult age estimation. Methods: Six databases (Scopus, PubMed, Google Scholar, Embase, Cochrane, Clarivate) between 1980 and 2026 were searched. Studies evaluating wrist-hand skeletal maturation for forensic age estimation in individuals ≥16 years with verified chronological age were included. Two reviewers independently screened studies and extracted data. Quality was assessed using QUADAS-2. DerSimonian-Laird random-effects model estimated the sensitivity and specificity of the wrist-hand bones maturation at the age of 18 years, and pooled MAE. GRADE assessed the certainty of evidence. Results: From 747 records, 23 studies (11,425 participants, 15 countries, 2003–2025) were included. Pooled MAE was 0. 537 years (95% CI: 0.387–0.686; 95% PI: 0.33–0.79 years), but obtained from 3 Italian studies conducted on clinical populations, and all characterized by high risk of bias. At the 18-year threshold, pooled sensitivity was 69.5% (95% CI: 61.6–77.3%; 95% PI: 35.3–100%) and specificity 85.56% (95% CI: 83.53–87.60%; 95% PI: 77.2–93.9%). Nevertheless, the heterogeneity was extreme (I² > 98%) for all diagnostic measures, and calculated prediction intervals confirm that individual study results are expected to vary widely. QUADAS-2 assessment revealed 82.6% of studies with high/unclear patient selection bias. GRADE-certainty was VERY LOW for both outcomes due to serious risk of bias, very serious inconsistency, and serious indirectness. Conclusions: Wrist-hand skeletal maturation shows low accuracy and high rates of misclassification for age estimation at the 18-year threshold. The wide prediction intervals (sensitivity 35–100%, specificity 77–94%, MAE 0.33–0.79 years) indicate that performance in a new study population may differ substantially from the pooled estimates. Very low certainty evidence, extreme heterogeneity, and substantial methodological limitations preclude confident application. Results should be interpreted with caution in forensic contexts, preferably combining multiple age indicators, in particular dental evidence.

Background/Objectives: Elder abuse remains a significantly underreported public health issue. The study examines how elder abuse is detected through a passive, suspicion-based case-finding pathway in an Italian university hospital emergency department (ED) and what the findings imply for improving systematic screening. Methods: This retrospective study analyzed elder abuse cases accessed at Careggi University Hospital ED (Florence, Italy) from 2017 to 2022. Eligible patients were aged ≥65 years and had suspected or confirmed elder abuse identified through Rosa Code protocol activation, abuse-related ICD-10 codes, and forensic consultation records. Two investigators independently reviewed eligible charts using predefined inclusion criteria and a standardized data-extraction form. Missing or unclear documentation was quantified descriptively, and no imputation was performed. Results: Sixty-seven elder abuse cases were identified during the six-year period, corresponding to a reported detection rate of 0.8% among the records screened for this study (mean: 11.2 cases/year). All eligible cases were captured through Rosa Code activation; ICD-10 and forensic-record searches did not identify additional cases. The majority of victims were women (76.1%), with a mean age of 75.5 years, and 76.1% had documented comorbidities. Physical abuse was the most common form (61.2%), predominantly perpetrated by family members (93.8%) within the victim’s home (64.2%). Head and neck injuries were most frequent (43.3%). A notable 50% decline in reported cases occurred during the COVID-19 pandemic. Despite law enforcement notification in 78% of cases, 65.7% of patients were discharged home. Conclusions: The study’s detection rate (<1%) falls critically short of international benchmarks (3–5%), underscoring urgent need for systematic screening using validated tools and staff training and multidisciplinary safeguarding pathways in Italian emergency departments.

Background/Objectives: Accurate post-mortem interval (PMI) estimation remains challenging in forensic pathology. Although potassium (K⁺) is the most well-validated single biomarker in vitreous humor (VH), multivariate approaches may enhance precision by capturing the complex cascade of post-mortem biochemical changes. This study aimed to develop and validate a multivariate PMI estimation model incorporating three biochemical markers—potassium, ammonium (NH₄⁺), and albumin (ALB)—in vitreous humor using automated clinical chemistry platforms for practical forensic application. Methods: Vitreous humor samples from 38 autopsy cases with documented PMIs (39.5–285 h; mean, 105.5 h) were analyzed for K⁺ (Cobas C8000), NH₄⁺ (Cobas C8000), and ALB (Immage 800 nephelometry). Univariate and multivariate regression analyses were performed, with the residual standard error (RSE) as the primary measure of accuracy. Model validation was conducted by back-calculating PMI in four samples completely distinct from the training cohort. Results: All three analytes demonstrated strong individual correlations with PMI (R²: K⁺ = 0.88, ALB = 0.78, NH₄⁺ = 0.69; all p < 0.001). The multivariate regression model [PMI = 40.25[Alb] + 0.01573[NH₄⁺] + 5.339[K⁺] − 53.032] yielded an RMSE of ±15.5 h (MSE = 240.25 h²), outperforming potassium-only models (RMSE = ±22.6 h). Although NH₄⁺ showed limited statistical significance in the multivariate model (p = 0.128), its inclusion improved overall predictive accuracy. External validation in an independent cohort of four subjects (distinct from the 38 subjects in the training set) demonstrated a mean absolute error (MAE) of 20.4 h. Conclusions: The multivariate approach combining K⁺, NH₄⁺, and ALB in VH improves PMI estimation accuracy compared with single-marker methods. The use of automated clinical chemistry platforms enhances reproducibility and facilitates practical implementation in forensic laboratories.

Domestic violence against men remains significantly under-recognized, despite affecting 20–40% of men worldwide. Societal stigma, gender-normative expectations, and institutional biases often discourage help-seeking behaviors among male victims. This retrospective analysis characterizes domestic violence against adult men by examining victim–perpetrator dynamics, injury patterns, reporting behaviors, and behavioral barriers to help-seeking within an Italian emergency department setting. Overall, 80 adult male domestic violence victims presenting to the Emergency Department of Careggi University Hospital (Florence, Italy) between January 2017 and December 2022 were examined. Data included demographics, injury characteristics, perpetrator relationships, and formal reporting rates. Descriptive statistics and chi-square tests were used to examine associations between victim characteristics and help-seeking behaviors. The majority of victims were Italian men (age range 18–90 years, mean 44.2 ± 15.1); of these, 55% experienced IPV perpetrated by female partners. Physical injuries were predominantly minor (classified as minor according to ED prognosis ≤ 7 days) (78.8%), including abrasions and contusions affecting the head (52.5%), neck (28.8%), and upper limbs (41.3%). Formal reports were filed with judicial authorities in 58.8% of cases, yet only 15% accepted protective interventions. Visible facial injuries (OR = 3.85, 95% CI, p = 0.004) and female perpetrators (OR = 8.23, 95% CI, p < 0.001) were independent predictors of formal reporting. Documented behavioral barriers included stigma (68%), fear of disbelief (45%), and adherence to traditional masculine norms (52%). Our findings demonstrate that male domestic violence victims face substantial behavioral and systemic barriers that prevent help-seeking. Enhanced clinical–forensic training, gender-inclusive response protocols, and public awareness campaigns are essential to provide equitable support and reduce under-reporting.

Background: Medical child abuse (MCA), previously known as Münchausen syndrome by proxy, involves the fabrication or induction of illness by caregivers—most commonly the mother—leading to unnecessary medical interventions and potential harm to the child. Methods: This retrospective study analyzed cases of suspected or confirmed MCA managed by the GAIA multidisciplinary team at Meyer Children’s Hospital, Florence, between 2010 and 2022. Cases were identified using Rosenberg diagnostic criteria and red flags outlined by the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH). Data were extracted from medical records and analyzed descriptively. Results: Among 816 cases of child maltreatment, 8 (0.99%) were identified as MCA. The median age of affected children was 5 years (range: 4–12 years), with a female predominance (6/8, 75%). All perpetrators were biological mothers (8/8, 100%). Children had a median of 23 emergency department visits (range: 4–44), with the most frequent presentations being fever (6/8, 75%), minor trauma (7/8, 87.5%), respiratory complaints (5/8, 62.5%), and gastrointestinal symptoms (4/8, 50%). According to Rosenberg criteria, 5 cases (62.5%) were classified as “possible diagnosis,” 1 (12.5%) as “definitive diagnosis,” 1 (12.5%) as “diagnosis by exclusion,” and 1 (12.5%) as “inconclusive.” Conclusions: Despite its low prevalence, MCA poses serious clinical and ethical challenges. Early detection requires thorough documentation, interdisciplinary collaboration, and improved access to shared medical records. The GAIA model offers a replicable framework for effective multidisciplinary management.

Breastfeeding is recommended because of its benefits for the woman and the newborn, but during lactation, pre-existing or lactation-related health conditions that require medication can expose the minor to the risk of acute or chronic intoxication. While drug safety during pregnancy is a well-discussed topic, there is scarce evidence about the safety of common licit and illicit substances during breastfeeding. Hence, we performed a systematic review on the toxicity of licit and illicit substances during lactation. Applying PRISMA criteria for systematic reviews, we found 26 eligible papers published in the last ten years. Our review showed that human milk should be considered a specific (and dynamic) matrix for toxicological analysis, and relatively little is known about the actual levels of common substances in this matrix. Current recommendations on drug safety are mainly based on a benefit–risk ratio based on the little available information. Experimental research in this field should be promoted, which is also because of the relatively high frequency of sudden infant deaths that is currently unexplained.

Teeth may serve as alternative matrices for post-mortem toxicological analysis. Although the mechanism of drug incorporation into dental tissues remains unclear, it is hypothesized that orally ingested substances can permeate dental enamel and reach dentin and the pulp. This study investigated enamel permeability to commonly ingested drugs, considering molecular characteristics (methadone - MET and dextromethorphan hydrobromide - DXM), pH, sugar content, and tooth conditions (intact enamel, cement-enamel junction-CEJ exposure, enamel wear). Sixteen clinically extracted teeth were divided into three groups and immersed in different substances, including MET with sugar, DXM with and without sugar (pH 4.5, 1 mg/ml), and acidified saliva (pH 5-6), simulating an addicted individual's oral environment. Cyclic immersions (substance-saliva-substance) mimicked chronic drug intake for about six weeks. After treatment, each tooth was separated into enamel, dentin, and pulp, and analyzed using liquid-liquid extraction and LC-MS/MS. Preliminary results showed that both MET and DXM can penetrate both the enamel and dentin, reaching the pulp regardless of tooth integrity or molecule type. Acidity and sugar content significantly increased the diffusion. These findings suggest that other substances orally assumed might be endowed with similar effects on dental tissues, especially when combined with sugar or acid solutions, supporting teeth as viable matrices in post-mortem toxicology. However, pulp concentrations may reflect oral contamination rather than systemic levels.