Daniel Tabian

Introduction: The global spread of the SARS-CoV-2 pandemic led to a serious health, social and economic global crisis. This pandemic was and remains the most important health emergency worldwide, for which all professionals have been called to provide diagnosis and treatment support. Despite early concerns about safety, forensic medicine has contributed to a better understanding of the pathological mechanisms involved. Objective: This study aims to describe and analyze the postmortem pathological findings in confirmed SARS-CoV-2 cases, emphasizing the contribution of forensic autopsies to elucidating the mechanisms of death and associated comorbidities. Methods: A retrospective study was conducted on 279 autopsies between 2020 and 2022. Demographic, clinical, and pathological data were collected and statistically analyzed. Results: Following the descriptive analysis of the cases included in the study, as well as the analysis of the relevant scientific literature, the major impact of the COVID-19 pandemic was highlighted in terms of the death mechanisms involved, occurring consequences and induced changes. Conclusions: Autopsies remain the essential tools for investigating COVID-19-related deaths. The findings confirm that SARS-CoV-2 primarily affects the pulmonary and cardiovascular systems. However, the overlap between “death from” and “death with” COVID-19 highlights the need for standardized postmortem diagnostic criteria and comprehensive clinical–pathological correlation.

Introduction: Aortic dissection represents a life-threatening vascular emergency. Objectives: The aim is to highlight the benefits and practical utility of complementary exams in solving medico-legal cases. Methods: We present the case of a 65-year-old man who died from aortic dissection 6 days after suffering physical aggression. Results: Taking into consideration all the available data (physical aggression victim presenting chest pain, chronic aneurysm, atherosclerosis, left ventricular hypertrophy), and given the morpho-pathological findings, we were able to confirm the direct causality bond between the trauma and the aortic dissection (the cause of death: post-traumatic aortic dissection, aortic rupture and massive left hemothorax), conditioned by the preexisting pathological background (aneurysmal dilatation of the aorta, systemic atherosclerosis, aortic kinking). Conclusions: A particularity of this case is the occurrence of traumatic aortic dissection after physical aggression with blunt chest trauma. Patients who suffer blunt chest trauma may present atypical signs and symptoms and should be investigated more thoroughly before making a diagnosis. Rezumat Introducere: Disecția de aortă reprezintă o urgență vasculară amenințătoare de viață. Obiective. Scopul lucrării este de a prezenta avantajele și contribuția examenelor complementare la rezolvarea cazurilor medico-legale. Metodă: Prezintăm cazul unui bărbat în vârstă de 65 de ani, care a decedat în urma unei disecții de aorta, survenită la 6 zile post agresiune fizică. Rezultate. Luând în considerare toate datele disponibile (victimă agresiune fizică, cu dureri toracice, anevrism cronic, ateroscleroza, hipertrofia ventriculară stângă) și constatările morfo-patologice, am putut confirma legătura directă de cauzalitate dintre traumatism și disecția de aortă (cauza decesului: disecția de aortă post-traumatică, cu ruptură de aortă și hemotorax masiv stâng), condiționată de patologia preexistentă (dilatație anevrismală a aortei, ateroscleroză sistemică, kinking aortic). Concluzii: O particularitate a acestui caz este apariția disecției traumatice de aortă post agresiune fizică. Pacienții cu traumatism toracic pot prezenta semne și simptome atipice și ar trebui investigați mai amănunțit, înainte de a se pune un diagnostic.

Background and Objectives: Schizophrenia is associated with a 15–20-year reduction in life expectancy, with cardiovascular disease as the leading cause. Sudden unexpected death is common in this population, often linked to structural heart disease, antipsychotic use, and overlapping cardiometabolic, autonomic, and drug-related factors. This study aimed to determine the incidence and causes of sudden unexpected death among schizophrenia inpatients between 2014 and 2024 and compare these findings with historical data from the same institution. Materials and Methods: We conducted a retrospective cohort study of schizophrenia inpatients admitted from January 2014 to December 2024. Hospital records were reviewed to identify sudden and unexpected deaths, verified by the Forensic Medicine Service Brașov. Sudden death was defined as death in an asymptomatic patient or within one hour of new symptom onset, excluding suicide, homicide, or accidental overdose. In accordance with Romanian legislation, an autopsy was performed in every case. Results: Over the 10-year period, six schizophrenia inpatients (mean age 53.2 ± 17.8 years) died suddenly. All had long-standing schizophrenia (mean illness duration 28.7 ± 17.7 years) and were receiving second-generation antipsychotics. Cardiovascular comorbidity was present in three cases. All patients received antipsychotic treatment within 24 h before death. No deaths occurred within the first 24 h of admission; one occurred within 48 h. Compared with the 1989–2013 cohort, which included 57 sudden deaths, the incidence during 2014–2024 declined substantially (0.27% vs. 0.79%). Conclusions: The incidence of sudden unexpected death among schizophrenia inpatients declined significantly over the past decade compared with the 1989–2013 cohort, reflecting improved multidisciplinary care, prompt transfer to general hospitals, and wider use of second-generation antipsychotics. Autopsy findings emphasize the continuing importance of cardiovascular disease and airway obstruction as preventable causes of sudden death in this population.

Individuals with schizophrenia face significantly higher mortality rates than the general population, with a typical reduction in life expectancy of 15–20 years. This study investigated 10-year all-cause mortality and its clinical correlates in a Romanian cohort of patients with schizophrenia, using real-world clinical and hospital and forensic records. A total of 635 individuals hospitalized between 2010 and 2013 were followed for 10 years. Mortality rates, causes of death, and risk factors were assessed using Cox regression models and standardized mortality ratios (SMRs). During the follow-up, 123 patients (19.37%) died, corresponding to a mortality rate of 21.3 per 1000 person-years. The SMR was 1.58 compared to the Romanian general population. Non-violent causes predominated, with cardiovascular disease (27.64%) and infections (17.07%) being the most frequent. Violent deaths, including suicides and accidents, accounted for 17.07% of all mortality. The mean age at death was 58.97 years, reflecting a 17-year reduction in life expectancy. Age was the strongest independent predictor of mortality (HR = 1.07, p < 0.001). Use of second-generation antipsychotics (HR = 0.37, p < 0.001) and low frequency hospitalization (HR = 0.09, p < 0.001) were significantly associated with reduced all-cause and cause-specific mortality. Schizophrenia is associated with significantly increased premature mortality, primarily due to preventable physical illnesses and violent deaths. Early intervention, sustained treatment adherence, and integrated medical care are essential to improve survival outcomes.

Background: Identifying skeletal remains has been and will remain a challenge for forensic experts and forensic anthropologists, especially in disasters with multiple victims or skeletal remains in an advanced stage of decomposition. This study examined the performance of two machine learning (ML) algorithms in predicting the person’s sex based only on the morphometry of L1–L5 lumbar vertebrae collected recently from Romanian individuals. The purpose of the present study was to assess whether by using the machine learning (ML) techniques one can obtain a reliable prediction of sex in forensic identification based only on the parameters obtained from the metric analysis of the lumbar spine. Method: This paper built and tuned predictive models with two of the most popular techniques for classification, RF (random forest) and XGB (xgboost). Both series of models used cross-validation and a grid search to find the best combination of hyper-parameters. The best models were selected based on the ROC_AUC (area under curve) metric. Results: The L1–L5 lumbar vertebrae exhibit sexual dimorphism and can be used as predictors in sex prediction. Out of the eight significant predictors for sex, six were found to be particularly important for the RF model, while only three were determined to be important by the XGB model. Conclusions: Even if the data set was small (149 observations), both RF and XGB techniques reliably predicted a person’s sex based only on the L1–L5 measurements. This can prove valuable, especially when only skeletal remains are available. With minor adjustments, the presented ML setup can be transformed into an interactive web service, freely accessible to forensic anthropologists, in which, after entering the L1–L5 measurements of a body/cadaver, they can predict the person’s sex.

Identifying skeletal remains has been and will remain a challenge for forensic doctors and forensic anthropologists, especially in disasters with multiple victims or skeletal remains in an advanced stage of decomposition. This study proposes a machine learning method to determine gender starting from morphometric analysis of L1-L5 lumbar vertebrae in a modern Romanian population. The purpose of the present study was to observe whether by using the ML method there is a good predictability of gender in forensic identification based on parameters obtained from the metric analysis of the lumbar spine specific to the Romanian population. This paper offers two models of ML, RF and XGB, each with its own characteristics, and presenting different performance, random forest having the best. For both, we used two metrics (accuracy and roc_auc), the latter being the most used to highlight model performance. The L1-L5 lumbar vertebrae exhibit sexual dimorphism and can be used in gender estimation. Machine learning is more accurate in determining gender than discriminatory function analysis.

An original kinetic spectrophotometric procedure was developed for the determination of hydrogen cyanide (HCN) in the whole blood of fire victims. Cyanide poisoning by smoke inhalation is common in forensic medicine, but the blood HCN of fire victims has not been studied in detail so far. In this research project, we developed a simple, fast, sensitive, and selective quantification method for both free and metabolized HCN based on the kinetics of cyanide reaction with ninhydrin. The method was linear in range, from 0.26 to 2.6 μg mL⁻¹, with a coefficient of determination of r = 0.994. A high molar absorptivity of 4.95 × 10⁵ L mol⁻¹ cm⁻¹ was calculated under the reaction conditions. The limit of quantification was 0.052 μg mL⁻¹; the detection limit was 0.012 μg mL⁻¹ and the standard error was ±2.7%. This micro method proved to be accurate, sensitive, and selective and has been successfully applied to the analysis of blood samples, allowing rapid monitoring of blood cyanide in several fire victims.

Diabetic ketoacidosis (DKA) is a lethal acute hyperglycemic complication of diabetes mellitus (DM) and it represents the initial manifestation of DM in about 15–20% of cases in adults and about 30–40% of cases in children. Postmortem diagnosis of DKA can only be made by applying thanatochemistry. Biochemistry applied postmortem is viewed with skepticism by many practitioners in the forensic field, completely lacking in many forensic services around the world, and especially in the national ones. This article aims to underline the importance of the postmortem application of biochemistry by reviewing the case of a person in the third decade of life who died suddenly at home due to diabetic ketoacidosis (DKA), whose autopsy was performed at an early PMI of approximately 24 h. Routine postmortem examinations (macroscopic, anatomopathological, and toxicological) could not establish a clear cause of death. When attention was turned to biochemical determinations (i.e., determination of glycated hemoglobin, glucose and ketone bodies (acetone, beta-hydroxybutyrate) in the blood, vitreous humor, and cerebrospinal fluid), the identified values clarified the thanatogenic mechanisms by establishing the diagnosis of DKA.

Carbon monoxide (CO) and hydrogen cyanide (HCN) are two common toxic products of combustion. HCN concentrations of fire victims are not routinely determined in most legal medicine services in Romania. We present the case of a room fire victim in which we evaluated the concentrations of HCN and carboxyhemoglobin (COHb), their contribution to the mechanism of death, and the possibility that HCN concentration can be interpreted as vital sign. COHb was determined by spectrophotometry. HCN was spectrophotometrically determined with ninhydrin in postmortem blood samples after its removal with 20% phosphoric acid and uptake into a solution of potassium carbonate. The presence of ethyl alcohol was determined by gas chromatography. The COHb concentration was 6.15%, while the blood HCN concentration was 1.043 µg × mL⁻¹ and the total HCN was 1.904 µg × ml⁻¹. A blood alcohol content of 4.36 g‰ and a urine alcohol content of 5.88 g‰ were also found. Although the fire produced a considerable amount of soot, and there were signs of inhalation of soot particles, the COHb level cannot be interpreted as a vital sign. Toxic concentrations of HCN and total HCN can be interpreted as a vital sign and indicates a contributive effect of HCN in the mechanism of death.

Hydrogen cyanide (HCN) can be a major contributory factor in death from fire‐related inhalation injury. Although carbon monoxide (CO) is considered the lethal agent of smoke in fires, its liability as a cause of death is sometimes debatable. The purpose of this report is to present the case of an 80‐year‐old man with locomotor disabilities who died due to an open space fire of vegetation debris and household waste in his yard. We evaluated here the concentrations of HCN and carboxyhemoglobin (COHb) and their contribution to the mechanism of death. In addition, the risk factors and the contributing effect of the factors that compose the complex toxic environment that develops in fires were discussed. COHb was determined by spectrophotometry as recommended by Katsumata et al. in 1982. HCN was determined with ninhydrin in postmortem blood samples after removal with 20% phosphoric acid and capture in a potassium carbonate solution. A toxic concentration of 1.3 μg ml⁻¹ HCN and a lethal COHb level of 73.7% were determined in the blood samples. Although death was mainly attributed to CO poisoning and extremely severe burns in this open space burning case, the additive effect of HCN in the mechanism of death was also highlighted. The results suggested the possibility that the man's clothing may have played an important role in the production of HCN in this open space fire, as well as other types of garbage that were burned.