Search Results (62)

Background/Objectives: Age estimation is of fundamental importance in forensic investigations. When traditional methods based on gross bone morphology or morphometric analysis cannot be applied, forensic experts must rely on multidisciplinary approaches. Histomorphometry has consistently proven to be reliable in cases of highly fragmented or incomplete skeletal remains, particularly in older individuals. Building on the foundational study of Amprino and Bairati, this study evaluated the correlations between bone microstructural features in femoral cross-sections and the age and sex of individuals. Methods: The sample comprised 95 femoral mid-diaphyseal thin sections obtained from autopsy specimens housed at the Institute of Legal Medicine, University of Bari (Italy), representing both male and female individuals aged 18 to 92 years. The numbers and densities of primary, intact secondary, and fragmentary secondary osteons, together with osteon circularity and the mean osteonal area, were measured to investigate age-related variation. Statistical analyses included t-tests, Mann–Whitney tests, Spearman’s rank correlation, and General Linear Models (GLMs). Results: No significant differences in histomorphometric variables were observed between males and females. However, the number of intact secondary osteons and osteon population density increased with age, while the mean osteonal area and osteon circularity decreased with age. Although some variables displayed significant correlations with age, residual analysis indicated a lack of heterogeneity in variance, which limited the development of a robust predictive model. Conclusions: The findings highlight both the potential and the limitations of histomorphometry in forensic age estimation. While certain microstructural variables correlate with age, inter-individual variability reduces predictive accuracy. Further research is needed to refine models that account for biological and biomechanical variability, particularly in older adults. Full article

Acute appendicitis is a common cause of acute abdominal pain but is rare in infants because of anatomical and physiological characteristics that reduce the risk of the luminal obstruction of the appendix. However, when it occurs in infants, it is often difficult to diagnose clinically and may progress rapidly to a fatal outcome. We report a forensic autopsy case of an 11-month-old infant who died 2 d after developing fever and decreased oral intake, without antemortem diagnosis. Autopsy revealed fibrinous ascitic fluid and an edematous, dark-red appendix with fibrin deposits, but no macroscopic luminal obstruction or perforation. Histopathological examination showed diffuse inflammatory cell infiltration and hemorrhage across all layers of the middle and peripheral portions of the appendix, along with lymphoid hyperplasia in the middle portion. Intestinal bacteria were detected in the ascitic fluid. The cause of death was identified as acute appendicitis with subsequent generalized peritonitis. Although luminal obstruction is a common cause of appendicitis, it was not observed macroscopically in this case. However, histopathological findings suggested that lymphoid hyperplasia in the middle portion of the appendix caused luminal narrowing and impaired circulation in the appendiceal wall, triggering appendicitis. This case demonstrates that infantile appendicitis can be fatal even without perforation and highlights the potential role of lymphoid hyperplasia in the pathogenesis. It also underscores the importance of considering appendicitis in the differential diagnosis of infants with nonspecific symptoms and illustrates the value of postmortem histopathological investigation in elucidating the disease mechanism. Full article

Australian scuba fatalities over 50 years were examined to determine temporal changes over two consecutive periods, 1972–1999 and 2000–2021. The Australasian Diving Safety Foundation database and National Coronial Information System were searched to identify scuba deaths from 1972 to 2021. Historical data, police and witness reports, and autopsies were recorded and comparisons made between the two periods. Of 430 total deaths, 236 occurred during 1972–1999 and 194 during 2000–2021, with average annual fatalities of 8.4 and 8.8, respectively. The proportion of males reduced (83% to 76%) and median ages rose (33 to 47 years) with a large rise in the percentage of casualties among people aged 45 years or older (24% to 57%). There were increases in certified divers (64% to 81%) and in the proportion of divers who were with a buddy at the time of their incident (17% to 27%), as well as a decrease in out-of-gas incidents (30% to 25%). A reduction in primary drowning (47% to 36%) was accompanied by more than a doubling of cardiac-related disabling conditions (12% to 26%). The substantial increase in casualties’ ages and of the proportions of casualties aged 45 or more and of females between the periods indicate the inclusion of a broader cohort of participants and ageing of longtime divers. The reduction in primary drowning was likely due to increased training and improvements in equipment, particularly BCDs and pressure gauges. The rise in cardiac-related deaths was due to an older and more obese cohort. Improved health education and surveillance and improved dive planning are essential to reduce such deaths. Full article

Background and aim: The death of a woman while pregnant or within 42 days of delivery, regardless of the cause of death, or even up to one year after the end of the pregnancy, due to causes related to or aggravated by pregnancy remains a critical public health problem globally and in Colombia. While the country shows a general decreasing trend (preliminary Maternal Mortality Ratio 38.6/100,000 live births in 2023), significant regional disparities persist. Understanding precise underlying causes, especially in high-complexity referral centers, is vital. This study describes the sociodemographic and anatomopathological characteristics associated with autopsy-verified maternal mortality cases at a Level-4 hospital in southwestern Colombia (2000–2023). Methodology: A descriptive observational retrospective study analyzed 42 maternal mortality cases verified by clinical autopsy (2000–2023) at the Pathology Department of Universidad del Valle, a Level-4 referral center in Cali, Colombia. Cases met the WHO definition. Data on sociodemographic, clinical, and pathological characteristics were retrospectively extracted from clinical records and autopsy reports. Results: The analysis of 42 autopsies (2000–2023) showed that 85.7% were early maternal deaths. Indirect causes predominated (57.1%, n = 24) over direct (42.9%, n = 18). Septic shock was the main indirect cause (65.2% of indirect), often from endemic infections. Hypovolemic shock due to PPH was the main direct cause (50% of direct). A high proportion were from subsidized/uninsured schemes (65.7%) and had a migratory history (20%). Discussion and conclusions: This study highlights the value of autopsy in revealing maternal mortality etiologies, showing a predominance of indirect/infectious causes and endemic diseases often missed clinically, despite PPH remaining the main direct cause. Findings reaffirm the strong link between maternal death and social/economic inequity, access barriers, and regional/migratory vulnerabilities. Effectively reducing maternal mortality necessitates rigorous clinical management, regionalized public health strategies addressing inequities, and integrating pathological data for targeted surveillance. Full article

Antenatal inflammation/infection is a major cause of neonatal apnoea and hypoventilation. Prostaglandin E2 (PGE₂) is a key inflammatory mediator associated with depression of fetal and neonatal breathing. We aimed to determine whether antenatal ibuprofen, a cyclooxygenase inhibitor that reduces synthesis of PGE₂, restores fetal breathing movements (FBM) in late-gestation fetal sheep exposed to systemic lipopolysaccharide (LPS). Fetal sheep (125 days gestation, d; term ~148 d) were instrumentally monitored for continuous measurement of FBM and physiological parameters. At 130 d fetuses were randomly allocated between groups receiving i.v. saline (CTL_SAL, n = 9), escalating doses of LPS (i.v.) over 3 days (LPS_SAL, n = 8), or ibuprofen one hour after each LPS dose (LPS_IBU, n = 8). Regular plasma samples were collected for PGE₂ assessment. At 135 d, cerebrospinal fluid and brainstem tissue were collected at autopsy for assessments of PGE₂ expression, and immunohistochemical quantification of astrocytes and microglia within key brainstem respiratory centres was performed to assess inflammation. LPS exposure increased PGE₂ levels in plasma, cerebrospinal fluid and the RTN/pFRG (p < 0.05) and decreased the incidence, amplitude and amount of the accentuated (>5 mmHg) FBMs. Ibuprofen reduced plasma and RTN/pFRG PGE₂ expression (p < 0.01 and p = 0.031, respectively) but did not restore FBMs. Astrocyte and microglial density increased in the RTN/pFRG, NTS and raphe nucleus in LPS_IBU fetuses, compared to LPS_SAL (p < 0.05). Antenatal ibuprofen treatment did not restore depressed FBM, despite reducing the circulating and brainstem PGE₂ levels in LPS-exposed fetal sheep. Other inflammatory pathways or more specific targeting of PGE₂ may be more effective in preventing apnoea caused by exposure to intrauterine infection/inflammation. Full article

Chitinase-3-like protein 1 (CHI3L1) has been implicated in multiple sclerosis (MS) pathology, yet its precise role remains unclear. To elucidate its involvement, we performed proteomic analysis of cerebrospinal fluid (CSF) from relapsing-remitting MS (RRMS) patients using two-dimensional difference gel electrophoresis (2D-DIGE). CHI3L1 emerged as the most upregulated protein in recurrent RRMS. ELISA confirmed significantly elevated CHI3L1 levels in recurrent RRMS and secondary progressive MS (SPMS) patients, with levels decreasing in steroid responders but increasing in non-responders. Immunohistochemistry of MS brain autopsies revealed CHI3L1 expression predominantly in mature oligodendrocytes. In an experimental autoimmune encephalomyelitis (EAE) model, CHI3L1 was highly expressed in the spinal cord, particularly in oligodendrocytes and microglia/macrophages. Functional studies demonstrated that recombinant CHI3L1 (rCHI3L1) protected oligodendrocytes from LPC-induced cell death by attenuating ER stress (GRP78, ORP150). Moreover, rCHI3L1 counteracted IFN-β- and PSL-mediated inhibition of oligodendrocyte differentiation. In microglia, rCHI3L1 suppressed LPS-induced proinflammatory markers (IL-1β, iNOS). In vivo, rCHI3L1 administration significantly mitigated EAE severity by reducing gliosis, demyelination, and axonal degeneration. These findings highlight CHI3L1 as a critical modulator of neuroinflammation and oligodendrocyte survival, positioning it as a promising therapeutic target for MS. Full article

Introduction: Invasive aspergillosis (IA) is an opportunistic fungal infection that typically occurs in the immunocompromised host and is associated with severe morbidity and mortality. Myocardial abscess formation is seldomly described. Detailed Case Description: We present a case of IA with purulent myocarditis. The patient was on long-term high-dose corticosteroid and mycophenolate mofetil therapy for severe lupus nephritis. After multiple visits to his general practitioner and nephrologist for general malaise, he was admitted to our hospital with visual complaints. Within several days, he developed atrial fibrillation, respiratory insufficiency, and, finally, a decreased level of consciousness. After admission to the intensive care unit, the broncho alveolar lavage (BAL) fluid galactomannan (GM) index was normal, but the serum GM index was severely elevated. Despite initiation of antifungal therapy, the patient passed away shortly thereafter. Autopsy revealed massive intracranial hemorrhage and disseminated IA affecting the lungs, brain, and myocardium, with macroscopic myocardial abscess formation. Discussion: This classic case of diagnostic uncertainty illustrates how invasive fungal infections can progress to disseminated disease while showing nonspecific symptoms only. It emphasizes the importance of vigilance for opportunistic fungal infections in a growing category of immunocompromised patients. Conclusion: Clinicians should have a low threshold of suspicion for fungal infections in patients on combination immunosuppressive medication, such as high-dose corticosteroid therapy in combination with T-cell inhibitors like MMF. Full article

Subgroup discovery (SD) is a data mining technique that allows us to obtain the properties of each element given a particular population; these properties are of interest for a specific study, finding the most important or significant subgroups of the population. Also, the larger the population, the more successful the analysis and the creation of the subgroups, since, on this basis, the possibility of finding more unusual characteristics among the elements of the population is greater. The principal purpose of SD is not to obtain a predictive function, but to achieve a result that users can comprehend and interpret easily, and at the same time provide a more complete and suggestive description of the data. In this paper, we present an application of this technique to the medical field to analyze the opinions of physicians on the decreasing rates of autopsies in Mexican hospitals, utilizing five SD algorithms. The results obtained are the rules that allow for the comparison of medical opinions in three hospitals. Full article

This study focused on evaluating the anti-obesity effects of an extract from Ampelopsis grossedentata (Hand.-Mazz.) W. T. Wang, also known as vine tea, in mature adipocytes and high-fat diet-induced obese mice. Vine tea extract (VTE) effectively decreased lipid accumulation in mature adipocytes without cytotoxicity, as confirmed by the regulation of several factors associated with adipogenesis, lipogenesis, or lipolysis. Subsequently, in a 12-week experiment with obese mice, oral VTE administration significantly reduced body weight gain induced with high-fat diet intake. Au-topsy findings showed reduced fat accumulation in various areas without liver damage. The VTE-administered group showed lower serum LDL levels, while increasing HDL, than the high-fat diet-administered group. Analysis of adipose tissue biomarkers indicated VTE’s ability to inhibit adipogenesis and lipogenesis, promote lipolysis, and regulate energy metabolism, contributing to reduced adiposity induced by the consumption of a high-fat diet. Full article

Road traffic accidents (RTAs) represent the key sign of the level of road safety. Romania once held the record for road deaths among European Union (EU) countries and as of 2023, it came second place. It is of utmost importance to assess whether measures that restricted human mobility during the coronavirus disease 2019 (COVID-19) pandemic led to a significant reduction in road fatalities. This study assesses the impact of the COVID-19 pandemic on victims of fatal RTAs by analyzing medicolegal autopsies from the Timisoara Institute of Legal Medicine (TILM), Timis County, Romania. Materials and methods: Medicolegal autopsy records of RTA victims from TILM in a 5-year period (2017–2021) were analyzed. Results: 395 cases (10.5%) were represented by victims of fatal RTAs. The reduction in the number of cases in the pandemic period was not statistically significant (p = 0.061) compared to the pre-pandemic period, but the number of victims of RTAs decreased by 17.6%. This highlights the importance of understanding the role of other risk factors in fatal RTAs, since a lesser volume of traffic did not cause a significant decrease in road fatalities. Male victims were predominant, with 18–50 years being the most affected age group. In the pandemic period, the most affected age groups were 31–40 (18.5%), followed closely by 41–50 (17.6%) and 18–30 (16.7%). In the pre-pandemic period, the first place was held by people in the age interval of 61–70 (20.5%), followed by 18–30 (19.2%). Drivers were the most involved type of road user, and a slight increase in the proportion of cyclists (13.9% from 10.5%) and motorcyclists (6.5% from 5.9%) was noted. Conclusions: Our findings show that measures implemented to control the COVID-19 pandemic may have had a positive effect on the reduction of RTAs, as shown by the information based on medicolegal autopsies in Timis County, Romania, but more attention needs to be focused on other risk factors. Further studies need to identify reasons for the small reduction in fatal injuries when the volume of traffic was reduced during mandated national lockdown. Full article

Background/Objectives: There seems to be a global reduction in the number of clinical post-mortems requested and performed worldwide, suggesting a decreasing need for post-mortem examinations. Despite advances in medical technology, autopsies remain a relevant tool to determine cause of death. Methods: A total of 276 post-mortem results were extracted from the NHLS lab track database, of which only 152 were included in this study. Discrepancies between ante and post-mortem diagnoses were evaluated using the Goldman classification. Data were analysed using STATA-18. Results: The sample consisted largely of females (n = 101, 66.45%) aged 30 and above (n = 58, 33.80%), with a mean age of 28.3. Of the 152 samples analysed, 60% (n = 92) of all postmortems showed a correlation between ante- and post-mortem diagnoses. However, 29.1% (n = 45) of cases showed major discrepancies which could have been prevented if correct diagnoses were made. Metabolic diseases were most frequently misdiagnosed (p = 0.020), with more cases of Class I discrepancies than Class V discrepancies (15.5% (n = 7) vs. 2.1% (n = 2), respectively. Additionally, infections (n = 59; 39%) were the most common cause of death. Conclusions: Even with marked improvements in diagnostic technology, a post-mortem examination is a necessary quality control tool that can be used to verify cause of death, and thus improve clinical practice. Full article

The pathogenesis of multiple sclerosis (MS) is not completely understood, but genetic factors, autoimmunity, inflammation, demyelination, and neurodegeneration seem to play a significant role. Data from analyses of central nervous system autopsy material from patients diagnosed with multiple sclerosis, as well as from studies in the main experimental model of multiple sclerosis, experimental autoimmune encephalomyelitis (EAE), suggest the possibility of a role of oxidative stress as well. In this narrative review, we summarize the main data from studies reported on oxidative stress markers in patients diagnosed with MS and in experimental models of MS (mainly EAE), and case–control association studies on the possible association of candidate genes related to oxidative stress with risk for MS. Most studies have shown an increase in markers of oxidative stress, a decrease in antioxidant substances, or both, with cerebrospinal fluid and serum/plasma malonyl-dialdehyde being the most reliable markers. This topic requires further prospective, multicenter studies with a long-term follow-up period involving a large number of patients with MS and controls. Full article

Practically, when only parts of an unidentified human body are found, age estimation with limited materials is required. The purpose of this study was to investigate methods for estimating age using the uterus and ovaries. Among forensic autopsies performed between January 2011 and March 2022, 211 uteruses and 521 ovaries of 322 women were used for this study. Measured values for ovarian weight and uterine volume index were corrected by body surface area to consider the effect of body size. The corrected uterine volume index increased in teenage years and achieved its maximum in the 40–49 group, then gradually decreased with increasing age. The corrected ovarian weight increased until the twenties, after which it decreased with age. For women aged 20 years or more, receiver operating characteristic (ROC) curve analysis suggested that a uterine volume index of 41.2 cm³/m² was the cutoff value for classifying the age as ≥60 years or <60 years, with an area under the ROC curve (AUC) value of 0.751. Ovarian weights of 2.27 g/m² and 1.92 g/m² were the cutoff values for classifying the age as ≥40 years or <40 years, or ≥50 years or <50 years, with AUC values of 0.935 and 0.930, respectively. These methods can help determine an unknown individual’s age group simply and quickly, even for incomplete cadavers. Full article

Temporal and spatial epigenetic modifications in the brain occur during ontogenetic development, pathophysiological disorders, and aging. When epigenetic marks, such as histone methylations, in brain autopsies or biopsy samples are studied, it is critical to understand their postmortem/surgical stability. For this study, the frontal cortex and hippocampus of adult rats were removed immediately (controls) or after a postmortem delay of 15, 30, 60, 90, 120, or 150 min. The patterns of unmodified H3 and its trimethylated form H3K9me3 were analyzed in frozen samples for Western blot analysis and in formalin-fixed tissues embedded in paraffin for confocal microscopy. We found that both the unmodified H3 and H3K9me3 showed time-dependent but opposite changes and were altered differently in the frontal cortex and hippocampus with respect to postmortem delay. In the frontal cortex, the H3K9me3 marks increased approximately 450% with a slow parallel 20% decrease in the unmodified H3 histones after 150 min. In the hippocampus, the change was opposite, since H3K9me3 marks decreased steadily by approximately 65% after 150 min with a concomitant rapid increase of 20–25% in H3 histones at the same time. Confocal microscopy located H3K9me3 marks in the heterochromatic regions of the nuclei of all major cell types in the control brains: oligodendrocytes, astrocytes, neurons, and microglia. Therefore, epigenetic marks could be affected differently by postmortem delay in different parts of the brain. Full article

The rate of parental consent for fetal and perinatal autopsy is decreasing, whereas parents are more likely to agree to virtual autopsy by non-invasive imaging methods. Fetal and perinatal virtual autopsy needs high-resolution and good soft-tissue contrast for investigation of the cause of death and underlying trauma or pathology in fetuses and stillborn infants. This is offered by micro-computed tomography (CT), as opposed to the limited resolution provided by clinical CT scanners, and this is one of the most promising tools for non-invasive perinatal postmortem imaging. We developed and optimized a micro-CT scanner with a dual-energy imaging option. It is dedicated to post-mortem CT angiography and virtual autopsy of fetuses and stillborn infants in that the chamber can be cooled down to around 5 °C; this increases tissue rigidity and slows decomposition of the native specimen. This, together with the dedicated gantry-based architecture, attempts to reduce potential motion artifacts. The developed methodology is based on prior endovascular injection of a BaSO₄-based contrast agent. We explain the design choices and considerations for this scanner prototype. We give details of the treatment of the optimization of the dual-energy and virtual mono-energetic imaging option that has been based on minimizing noise propagation and maximizing the contrast-to-noise ratio for vascular features. We demonstrate the scanner capabilities with proof-of-concept experiments on phantoms and stillborn piglets. Full article