Federica Amirante

Factitious Disorder Imposed on Another (FDIA), formerly known as Munchausen Syndrome by Proxy, is a rare form of abuse where parents induce or fabricate symptoms in their child, exposing them to unnecessary and potentially harmful medical treatments. In over 90% of cases, the perpetrators are mothers. A father was put on trial for the murder of his three-month-old daughter and was eventually convicted of repeatedly inducing respiratory crises, ultimately causing her death. Investigations began after multiple visits to the Emergency Department for respiratory episodes reported by the father but not confirmed by physicians: the attending paediatrician first hypothesized FDIA. A medico-legal autopsy excluded diseases justifying prolonged hospitalization or independently causing death; the only relevant post-mortem findings were massive pulmonary congestion with minute subpleural petechiae and hemosiderin-laden intra-alveolar macrophages, indicating nonspecific acute respiratory failure. Forensic psychiatric evaluation of the father revealed a rigid personality, excessive conformity and interpersonal immaturity. Publicly, the father appeared caring and deeply involved with his daughter. He exhibited a propensity to develop somatic symptoms and a tendency towards reality distortion. These traits aligned with FDIA, later confirmed by judicial reconstruction of events. The multidisciplinary approach led to the establishment of the judicial truth: a case of paternal infanticide by asphyxiation. In Italy, FDIA is not a mental illness excluding criminal responsibility, though the diagnosis may influence sentencing. The first-instance judgment classified the act as preterintentional homicide, considering Munchausen by proxy. The final verdict, however, convicted the father of intentional homicide. This case highlights the intrinsic diagnostic dilemma at the clinical–forensic interface, where psychiatric assessment and judicial interpretation may align or diverge, underscoring the need for caution in translating psychiatric diagnoses into legal conclusions.

Background: Digital pathology (DP) and whole-slide imaging (WSI) are increasingly utilized in clinical pathology; however, their role in forensic medicine remains less defined, as evidentiary standards demand robust validation, auditability, and a chain of custody. Methods: We conducted a systematic review of PubMed, Scopus, and Web of Science for studies that applied DP and WSI to forensic, autopsy, or postmortem contexts, with eligibility requiring peer-reviewed human studies that reported methods and outcomes. Data were charted for study design, tissue, devices/software, and outcomes (diagnostic agreement, quantitative metrics, validation/quality assurance (QA)). Results: The search retrieved 361 records; after screening and full-text assessment, 21 studies were selected for inclusion. Fifteen studies primarily advanced diagnostic knowledge using postmortem material (e.g., quantitative neuropathology and organ-specific morphometry), while five had direct forensic aims (casework validation or core forensic tests). Conclusions: The review highlights that DP is technically ready for medico-legal workflows; however, its use remains low compared to other clinical settings. Adoption in forensics should centre on CAP-style, use–case–specific validation, traceable/auditable pipelines (including hashing, logs, and tile-linked overlays), stain/colour governance, and external robustness testing. Under these conditions, DP can deliver reproducible, transparent, and court-defensible evidence across forensic practice.

Background: Starvation represents a specific pathological entity characterized by severe nutritional deprivation leading to multi-organ failure. Despite its forensic relevance, a comprehensive synthesis of autopsy findings remains lacking. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and Google Scholar were searched from inception to June 2025 using a pre-specified Boolean query. Eligible studies included case reports, case series and cohort investigations reporting post-mortem evidence of starvation or starvation-related malnutrition. Data extracted encompassed demographic, contextual, macroscopic, histological, and ancillary findings. Results: Fourteen studies were included, comprising 20 individual cases and two population-based cohorts (totaling 1647 deaths). Most cases (75%) involved children, predominantly victims of domestic neglect; adults accounted for 25%, mainly due to anorexia nervosa or voluntary fasting. Six cadavers were severely decomposed or mummified. Across studies, consistent autopsy findings included extreme emaciation, near-total loss of subcutaneous and visceral fat, empty gastrointestinal tract, and diffuse organ atrophy, especially of the liver, heart, thymus, and pancreas. Histology revealed hepatic steatosis, myocardial fibrosis, thymic involution and gelatinous transformation of adipose tissue. Ancillary methods (dual-energy X-ray absorptiometry, stable isotope and anthropological analyses) confirmed malnutrition in decomposed or skeletonized remains. Conclusions: This review delineates the morphological and histopathological hallmarks of starvation and suggests the possible diagnostic value of ancillary techniques in advanced decomposition. The predominance of neglect-related pediatric cases underscores starvation as a forensic indicator of social and caregiving failure. Establishing reproducible morphological and histological indicators may improve the consistency of forensic diagnosis and strengthen the evidentiary basis for determining starvation as a cause of death.

The well-established anti-inflammatory and antioxidant properties of red fruits leave room for a biological pathway of improved muscle health promoted by berries in the diet. Our objective was to systematically review the number of trials conducted on human and animal species around the relationship between a berry diet and muscle health outcomes. Two independent examiners conducted a search for studies that utilized keywords associated with muscle health outcomes and a berry-based diet in both human and animal trials, in accordance with the PRISMA statement guidelines. The literature was searched through six electronic databases until December 2023. Screening of 152 retrieved articles resulted in a final selection of 16 reports investigating the effect of exposure to a berry-based diet and skeletal muscle health outcomes. The study protocol was registered on PROSPERO (CRD42023479682). Among the selected studies, nine involved humans and seven animal models (rats and mice). Overall, most of the studies reported positive effects on performance or muscle health. Specifically, five studies investigated the possible effects of blackcurrant on active human subjects or athletes; three studies focused on blueberry and presented results on running performance (human sample) and muscle health (rat models). The rest of the studies involved raspberries (two studies, rat models), aronia (one study, rat models), elderberry (one study, rat models), and a mixed compound (one study, rat models). In conclusion, there is some early evidence that a berry-rich diet may increase performance or muscle health, but more research is needed to fully understand the underlying biological trajectories, and thus, no firm conclusions can yet be drawn.