Lucia Tarda

Background: Cigarette burns represent a well-established forensic indicator of inflicted injury, frequently encountered in cases of domestic violence. Clinical significance: Their morphological consistency and anatomical distribution offer valuable elements for differentiating between intentional and accidental trauma. Case Presentation: In this study, we report the case of a 40-year-old woman who presented with multiple cutaneous lesions attributed to repeated assaults by her intimate partner. The forensic medical examination revealed five discrete scars characterized by sharply demarcated borders, circular to oval shapes, and dimensions ranging from 0.7 to 1.5 cm. These lesions were anatomically located in regions not typically accessible for self-infliction. To reinforce the diagnostic interpretation and assess reproducibility, a controlled experimental protocol was conducted using porcine skin matrices. Cigarette burns were recreated under variable conditions of contact pressure and exposure duration. The lesions produced on the biological substrate exhibited morphological features consistent with those observed in the patient, suggesting compatibility with cigarette-induced thermal injury. Conclusions: These findings provide circumstantial support for the forensic interpretation but must be considered within the limitations of the experimental model. This integrated approach underscores the relevance of combining clinical forensic documentation with experimental validation to support medico-legal conclusions in cases of suspected interpersonal violence.

Myocarditis, an inflammatory disease of the myocardium, is increasingly recognized as a potential contributor to sudden infant death syndrome (SIDS), though often underdiagnosed. This study reviews the current literature on the association between myocarditis and sudden death in infants, with a focus on autopsy and histopathological findings. A comprehensive search of the PubMed database yielded 64 studies published between 1960 and 2024; after applying specific inclusion criteria—such as patient age (0–6 years), presence of autopsy data, and forensic investigation—40 studies were analyzed in detail. The review identified myocarditis—especially lymphocytic—as an underrecognized but critical cause of sudden death in infants and children. Histological, molecular, and immunohistochemical findings highlighted viral infections, immune dysregulation, and structural anomalies as frequent etiological factors. Several SIDS cases were reclassified as myocarditis upon in-depth examination. These findings underscore the value of standardized autopsy protocols and integrated diagnostic approaches. Advanced postmortem diagnostic techniques, including polymerase chain reaction (PCR) and immunohistochemistry, have enhanced the detection of viral myocarditis. In addition, structural cardiac anomalies, such as cardiomyopathies and coronary abnormalities, may co-exist and contribute to sudden cardiac death. These findings emphasize the need for standardized autopsy protocols and the integration of molecular diagnostics in forensic investigations of SIDS. Further research is essential to improve early detection, refine diagnostic criteria, and develop preventive strategies to reduce the incidence of sudden infant death related to myocarditis.

Forensic biochemistry has often relied on the vitreous humor as a matrix for toxicological investigations due to its stability and isolation from post-mortem redistribution processes. Recently, the scope of research has expanded to explore the vitreous humor as a medium reflecting systemic and pathological changes, particularly in its protein composition. This study delves into the detection and quantification of cardiac damage markers such as CK-MB and myoglobin in vitreous humor samples from 45 autopsy cases. For the first time, it demonstrates a statistically significant correlation between these markers and the perimortem agony interval (PAI), defined as the survival time before death. This discovery paves the way for innovative forensic applications, including the estimation of the PAI, a critical parameter for judicial and compensatory assessments. The findings underscore the potential of the vitreous humor as a diagnostic medium, opening new avenues for understanding the systemic dynamics of cardiac markers and the role of the blood–retinal barrier in post-mortem scenarios.

Oleander poisoning, resulting from the ingestion of Nerium oleander or Thevetia peruviana, is a serious toxicological issue in various parts of the world, particularly in regions where these plants grow abundantly and are easily accessible. Oleander contains potent cardiac glycosides, such as oleandrin and thevetin, which exert powerful effects on the cardiovascular system, leading to symptoms ranging from nausea and abdominal pain to severe arrhythmias and sudden cardiac death. This review summarizes the existing literature on the epidemiology, clinical features, pathophysiology, and challenges in treatment management associated with oleander poisoning. While supportive care, gastric decontamination, and the administration of digoxin-specific Fab antibody fragments (Digifab) are essential therapeutic measures, limited access to Digifab, delays in intervention, and insufficient supportive care practices remain significant complicating factors. Particular attention is given to findings from autopsy reports, which provide critical insights into the pathophysiological effects of oleander toxins and help bridge gaps in understanding fatal cases. This review acknowledges key limitations, particularly the scarcity of English-language publications, which restricts input from regions such as southern Asia and the Mediterranean—areas where oleander-related poisoning, especially in cases of intentional self-harm, is more prevalent. Additionally, this review highlights the socio-cultural dimensions of oleander ingestion, often linked to intentional self-poisoning, and emphasizes the need for enhanced preventive measures and public education. Future research efforts should prioritize addressing these gaps through autopsy-based studies and the development of more accessible and effective antidotes, which are essential to mitigate the global health burden of oleander-related mortality.

The emergence of SARS-CoV-2, responsible for the COVID-19 pandemic, has prompted extensive research into its transmission dynamics; yet, a critical aspect that remains underexplored is the post-mortem infectivity of the virus within cadaveric tissues. Understanding the mechanisms by which SARS-CoV-2 maintains infectivity after death is essential, as it raises significant concerns regarding public health and forensic practices. Research indicates that the virus can persist in various tissues, including lung, liver, and kidney tissues, with studies showing that factors such as the time elapsed since death, the presence of underlying health conditions, and environmental conditions at the time of death can influence the level of infectivity in deceased individuals. These findings are not only crucial for establishing safety protocols for forensic investigators who handle cadavers but also for informing public health guidelines that govern the management of bodies during and after outbreaks. As we investigate the implications of post-mortem SARS-CoV-2 infectivity, it becomes imperative to establish comprehensive protocols to mitigate risks associated with the handling and disposal of infected bodies, thereby protecting public health and ensuring the safety of those working in forensic environments. This paper aims to elucidate the mechanisms of infectivity in cadaveric tissues, explore the persistence of the virus in various tissue types, and assess the broader implications for public health and forensic investigations, ultimately contributing to a safer approach in dealing with COVID-19-related fatalities.

Background/Objectives: Differential diagnosis of sudden cardiac death (SCD) remains challenging, particularly in cases lacking evident structural abnormalities. Cardiac markers have been proposed as useful tools for this differentiation in forensic contexts. However, key issues include the influence of postmortem interval (PMI) on marker stability and the limitations of traditional approaches that focus on pericardial fluid, which requires invasive sampling compared to peripheral blood. This study aimed to evaluate the potential of cardiac markers in peripheral blood for diagnosing SCD, addressing methodological concerns related to PMI, hemolysis, and sample handling. Methods: This study analyzed 5 cardiac markers (creatine kinase-MB [CK-MB], myoglobin, troponin I [TnI], BNP, and D-dimer) in peripheral blood samples from 42 autopsied cadavers, divided into an SCD group and a control group. Marker levels were quantified using immunofluorescence, with cases meticulously selected to exclude confounding factors such as chronic diseases, pulmonary thromboembolism, and drowning. The study also accounted for potential degradation due to PMI, and evaluated the accuracy of point-of-care testing (POCT) in forensic samples. Results: The study identified statistically significant differences in myoglobin and TnI levels between the SCD group and the control group, though myoglobin’s diagnostic reliability remains limited due to its lack of specificity for myocardial injury. TnI emerged as a more robust marker for SCD. Contrary to prior concerns, PMI showed no significant correlation with marker levels in samples handled without freeze–thaw cycles. Issues related to hemolysis were addressed, and no significant effects were observed from resuscitation maneuvers. Conclusions: This study supports the potential use of cardiac markers, particularly TnI, in peripheral blood for postmortem SCD diagnosis, emphasizing the importance of rapid and systematic analysis to minimize hemolysis-related variability. While further validation is needed to confirm these findings, this approach offers a less invasive, economical, and practical method for forensic investigations.

Background: Rapunzel syndrome is a rare and severe form of trichobezoar, characterized by the presence of hair masses in the stomach that often extend into the bowel, resembling the legendary “Rapunzel’s” long hair. Methods: This review examines the clinical, diagnostic, forensic, and post-mortem aspects associated with Rapunzel syndrome, with a focus on cases resulting in mortality or those at high risk of death due to complications. In particular, the review systematically analyzes the existing literature on fatal cases of Rapunzel syndrome, emphasizing insights into risk factors, clinical manifestations, diagnostic methods, autopsy findings, and preventive measures to provide a focused understanding of these critical aspects. Results: The syndrome predominantly affects young females with a history of trichotillomania (hair-pulling) and trichophagia (hair-eating), often associated with underlying psychiatric conditions. Clinically, Rapunzel syndrome presents with non-specific gastrointestinal symptoms, including abdominal pain, vomiting, and malnutrition, which may complicate timely diagnosis. Diagnosis typically involves imaging techniques such as ultrasound, CT scans, and endoscopy, but cases often go unrecognized until complications like intestinal obstruction, perforation, or even fatal outcomes occur. Forensically, Rapunzel syndrome presents unique challenges, as misdiagnosis or delayed intervention can lead to fatalities that may raise questions in medico-legal investigations. Post-mortem investigations, particularly autopsies, have proven instrumental in elucidating rare complications and advancing understanding of the syndrome’s long-term effects. Conclusions: Increased awareness, timely diagnosis, and comprehensive evaluation, including autopsy studies, are essential to improve patient outcomes and reduce the potential for life-threatening complications in this rare yet serious condition.

Background: The “copycat effect” is a psychological phenomenon in which a person’s actions influence the behavior of others, leading to imitations of behaviors, events, or ideas. It is often observed in contexts such as crimes, suicides, or violent behaviors, where media coverage of an event can trigger similar reactions in other people. Usually, many studies associate the copycat phenomenon with homicide or serial crimes. Little attention is paid to the phenomenon of emulation in suicide and, therefore, to the copycat phenomenon in this context. Methods: In our study, a systematic review of the literature was carried out using keywords related to copycat and suicide. Subsequently, each study was read and analyzed. Results: The results were compared with each other and demonstrated how it is essential to mitigate the resonance of suicidal events, especially through the media and social networks. In particular, this risk of emulation is greater among young people who are exposed to a continuous external source of information through news from the web in an incessant and constant way. This risk increases most immediately after the publicity of the suicidal event in a limited period of time. Conclusions: Unfortunately, little attention is given to the analysis of the copycat phenomenon, which causes an underestimation of the data related to suicide emulation, especially from the preventive perspective of a phenomenon that is still widespread.

Abusive head trauma (AHT) represents a very serious global public health problem. Prevention of these episodes is essential to reduce the morbidity and mortality of this phenomenon. All healthcare professionals should be able to recognize the signs of abuse. However, diagnosis is very complex as the signs are often blurred and cannot be recognized with certainty without carrying out adequate instrumental investigations. It has been calculated that approximately one-third of AHT cases remain undetected and require more than one medical visit to be correctly interpreted and diagnosed. On the other hand, the literature has recently also emphasized the problems related to possible false diagnoses of abuse and the numerous family and personal repercussions that follow from this issue. For these reasons, correct and timely recognition is essential to avoid the risk of recurrence of AHT and to start proper forensic investigations, in order to identify the offender or exonerate a suspect. The present work explores the most recent evidence of recent years in the field of AHT diagnostics through a literature review. The purpose of this article is to provide forensic pathologists with clear tools for diagnosis based on the literature. To this end, the review suggests clinical and forensic protocols aimed at the timely diagnosis of AHT in order to prevent abuse from remaining undetected.