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Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Forensic Medicine".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 59720

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Dr. Francesco Sessa

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Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
Interests: genetics and molecular biology; forensic and biological sciences; forensic genetics; genomic physiology; aging and genetics; pharmacology; toxicology; health professions; translational pharmacology; biochemistry
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Special Issue Information

Dear Colleagues,

Even if the terms “forensic sciences” and “legal medicine” seem to be synonymous, they could be defined as two sides of the same coin. It has been demonstrated that they are different components of the application of medical knowledge upon the legal system. Legal medicine has greater relevance to civil and tort law, impacting upon patient care, whereas forensic medicine relates to criminal law and damage to (or by) patients.

The discipline of forensic science is remarkably complex and includes methodologies ranging from DNA analysis to chemical composition and pattern recognition. Many forensic practices were developed under the auspices of law enforcement and vetted primarily by the legal system rather than being subjected to scientific scrutiny and empirical testing. Furthermore, the recent experience of the COVID-19 pandemic suggests a pivotal role of the forensic autopsy in order to gather information about unknown diseases. As previously described, only a full autopsy can investigate the potential mechanisms of damage to organs or systems not readily accessible to biopsies, such as central nervous system or cardiovascular system, leading to appropriate health-care strategies that are useful in the control of the disease. Another important perspective that underlines the importance of forensic sciences is related to the development of vaccine candidates and new therapies for the prevention and treatment of different diseases, with certain benefit for healthcare.

Furthermore, legal medicine plays a pivotal role in risk management. In healthcare, the term “risk management” refers to all processes employed to detect, monitor, assess, mitigate, and prevent risks in healthcare facilities and safeguard patient safety. Considering the importance of this issue, a further aim of this Special Issue is to assess the role and progress of research and training in the field of risk management.

Given the importance of the topic, the journal Healthcare is launching a Special Issue entitled “Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!” with the aim of gathering accurate and up-to-date scientific information on all aspects of this theme, collecting original investigations, case series and case reports, and reviews in all forensic and medico-legal branches. Particularly, this Special Issue aims to provide an overview of recent technological advances in all fields of the forensic and medico-legal sciences, such as forensic pathology, anthropology, criminalistics, digital and multimedia sciences, engineering and applied sciences, pathology/biology, psychiatry and behavioral science, jurisprudence, odontology, risk management, questioned documents, and toxicology.

Similar submissions dealing with forensic aspects of other sciences and the social sciences are also welcome, as are submissions dealing with scientifically sound emerging science disciplines.

Dr. Francesco Sessa
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Forensics Sciences
Autopsy
Forensic pathology
Forensic toxicology
Forensic genetics and genomics
Postmortem investigation
Technology and forensics
Genomic application in forensic sciences
Risk management
Legal medicine

Published Papers (10 papers)

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Research

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9 pages, 238 KiB

Open AccessCommunication

Microbiome Forensic Biobanking: A Step toward Microbial Profiling for Forensic Human Identification

by Luciana Caenazzo and Pamela Tozzo

Healthcare 2021, 9(10), 1371; https://doi.org/10.3390/healthcare9101371 - 14 Oct 2021

Cited by 6 | Viewed by 2326

Abstract

In recent years many studies have highlighted the great potential of microbial analysis in human identification for forensic purposes, with important differences in microbial community composition and function across different people and locations, showing a certain degree of uncertainty. Therefore, further studies are necessary to enable forensic scientists to evaluate the risk of microbial transfer and recovery from various items and to further critically evaluate the suitability of current human DNA recovery protocols for human microbial profiling for identification purposes. While the establishment and development of microbiome research biobanks for clinical applications is already very structured, the development of studies on the applicability of microbiome biobanks for forensic purposes is still in its infancy. The creation of large population microbiome biobanks, specifically dedicated to forensic human identification, could be worthwhile. This could also be useful to increase the practical applications of forensic microbiology for identification purposes, given that this type of evidence is currently absent from most real casework investigations and judicial proceedings in courts. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

10 pages, 1883 KiB

Open AccessArticle

Forensic Application of Monoclonal Anti-Human Glycophorin A Antibody in Samples from Decomposed Bodies to Establish Vitality of the Injuries. A Preliminary Experimental Study

by Benedetta Baldari, Simona Vittorio, Francesco Sessa, Luigi Cipolloni, Giuseppe Bertozzi, Margherita Neri, Santina Cantatore, Vittorio Fineschi and Mariarosaria Aromatario

Healthcare 2021, 9(5), 514; https://doi.org/10.3390/healthcare9050514 - 29 Apr 2021

Cited by 12 | Viewed by 2299

Abstract

Glycophorins are an important group of red blood cell (RBC) transmembrane proteins. Monoclonal antibodies against GPA are employed in immunohistochemical staining during post-mortem examination: Through this method, it is possible to point out the RBC presence in tissues. This experimental study aims to investigate anti-GPA immunohistochemical staining in order to evaluate the vitality of the lesion from corpses in different decomposition state. Six cases were selected, analyzing autopsies’ documentation performed by the Institute of Legal Medicine of Rome in 2010–2018: four samples of fractured bones and three samples of soft tissues. For the control case, the fracture region of the femur was sampled. The results of the present study confirm the preliminary results of other studies, remarking the importance of the GPA immunohistochemical staining to highlight signs of survival. Moreover, this study suggests that the use of this technique should be routinely applied in cases of corpses with advanced putrefaction phenomena, even when the radiological investigation is performed, the macroscopic investigation is inconclusive, the H&E staining is not reliable. This experimental application demonstrated that the use of monoclonal antibody anti-human GPA on bone fractures and soft tissues could be important to verify whether the lesion is vital or not. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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12 pages, 1134 KiB

Open AccessArticle

A Descriptive Study on Causes of Death in Hospitalized Patients in an Acute General Hospital of Southern Italy during the Lockdown due to Covid-19 Outbreak

by Pasquale Mascolo, Alessandro Feola, Carmen Sementa, Sebastiano Leone, Pierluca Zangani, Bruno Della Pietra and Carlo Pietro Campobasso

Healthcare 2021, 9(2), 119; https://doi.org/10.3390/healthcare9020119 - 25 Jan 2021

Cited by 4 | Viewed by 1948

Abstract

(1) Background: All deaths that occurred in a hospital of Southern Italy (“San Giuseppe Moscati” Hospital of Avellino) with medium jurisdiction (up to 425,000 citizens approximately) in the period from 9 March to 4 May 2020 were analyzed. The primary endpoint of the study was to analyze the causes of death in the period study. Secondary endpoints included: (1) the assessment of overall mortality in the emergency period compared with the same period of the past years (2018–2019) in the jurisdiction area; (2) the assessment of the amounts of deaths with positive and negative reverse transcription-polymerase chain reaction (RT-PCR) of nasopharyngeal and oropharyngeal swabs; (3) the frequency of clinical and radiological features consistent with Covid-19 infection in negative RT-PCR cases. (2) Methods: Patients’ information and laboratory data were collected through the computerized medical record system (My Hospital, Italy) used for the clinical management of all referring patients. Epidemiological, clinical, and radiological data were reviewed along with the results of nasopharyngeal and oropharyngeal swabs. (3) Results: From 9 March to 4 May 2020, 140 deaths (87 males, 53 females) from all causes occurred in total at “San Giuseppe Moscati” Hospital, of which 32 deaths were Covid-19 related. (4) Conclusions: The excess of mortality could be higher than the one reported in the official epidemiological surveys. False negative cases can have a distorting effect on the assessment of the real mortality rate and the excess mortality. Furthermore, many who died from Covid-19 were likely never tested or they had false negative RT-PCR results. Other victims probably died from causes indirectly related to Covid-19. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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15 pages, 10988 KiB

Open AccessArticle

Anaphylactic Death: A New Forensic Workflow for Diagnosis

by Massimiliano Esposito, Angelo Montana, Aldo Liberto, Veronica Filetti, Nunzio Di Nunno, Francesco Amico, Monica Salerno, Carla Loreto and Francesco Sessa

Healthcare 2021, 9(2), 117; https://doi.org/10.3390/healthcare9020117 - 22 Jan 2021

Cited by 12 | Viewed by 3766

Abstract

Anaphylaxis is a life-threatening or fatal clinical emergency characterized by rapid onset, and death may be sudden. The margin of certainty about the diagnosis of anaphylactic death is not well established. The application of immunohistochemical techniques combined with the evaluation of blood tryptase concentrations opened up a new field of investigation into anaphylactic death. The present study investigated eleven autopsy cases of anaphylactic death, carried out between 2005 and 2017, by the Departments of Forensic Pathology of the Universities of Foggia and Catania (Italy). An analysis of the medical records was carried out in all autopsies. Seven autopsies were carried out on males and four on females. Of the eleven cases, one showed a history of asthma, one of food ingestion, two of oral administration of medications, six did not refer any allergy history, and one subject was unknown. All cases (100%) showed pulmonary congestion and edema; 7/11 (64%) of the cases had pharyngeal/laryngeal edema and mucus plugging in the airway; only one case (9%) had a skin reaction that was found during external examination. Serum tryptase concentration was measured in ten cases, and the mean value was 133.5 µg/L ± 177.9. The immunohistochemical examination using an anti-tryptase antibody on samples from the lungs, pharynx/larynx, and skin site of medication injection showed that all cases (100%) were strongly immunopositive for anti-tryptase antibody staining on lung samples; three cases (30%) were strongly immunopositive for anti-tryptase antibody staining on pharyngeal/laryngeal samples; and eight cases (80%) were strongly immunopositive for anti-tryptase antibody staining on skin samples. We conclude that a typical clinical history, blood tryptase level >40 µg/L, and strongly positive anti-tryptase antibody staining in the immunohistochemical investigation may represent reliable parameters in the determination of anaphylactic death with the accuracy needed for forensic purposes. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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8 pages, 639 KiB

Open AccessArticle

Changes and Variations in Death Due to Senility in Japan

by Masaki Bando, Nobuyuki Miyatake, Hiroaki Kataoka, Hiroshi Kinoshita, Naoko Tanaka, Hiromi Suzuki and Akihiko Katayama

Healthcare 2020, 8(4), 443; https://doi.org/10.3390/healthcare8040443 - 30 Oct 2020

Cited by 3 | Viewed by 2224

Abstract

Objective: The proportion of elderly individuals (≥65 years old) in Japan has markedly increased. However, the definition of senility in Japan is controversial. The aim of the present study was to investigate changes and variations in the number of deaths due to senility in Japan. Methods: Information on the number of deaths due to senility between 1995 and 2018 as well as other major causes of death was obtained from the Statistics Bureau of Japan official website. Changes and variations in the number of deaths due to senility were compared with other major causes of death in Japan. The relationships between the number of deaths due to senility and socioeconomic factors were also examined in an ecological study. Results: The number of deaths due to senility was 35.7 ± 23.2/one hundred thousand people/year during the observation period and has continued to increase. A change point was identified in 2004 by a Jointpoint regression analysis. Variations in the number of deaths due to senility, which were evaluated by a coefficient of variation, were significantly greater than those due to other major causes of death, i.e., malignant neoplasm, heart diseases, cerebrovascular diseases, and pneumonia. The number of elderly individuals (≥65 years old) (%) and medical bills per elderly subject (≥75 years old) correlated with the number of deaths due to senility. Conclusion: The number of deaths due to senility has been increasing, particularly since 2004. However, variations in the number of deaths due to senility were observed among all prefectures in Japan. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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Review

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17 pages, 836 KiB

Open AccessReview

Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance

by Francesco Sessa, Massimiliano Esposito, Giovanni Messina, Giulio Di Mizio, Nunzio Di Nunno and Monica Salerno

Healthcare 2021, 9(7), 870; https://doi.org/10.3390/healthcare9070870 - 09 Jul 2021

Cited by 23 | Viewed by 11345

Abstract

The medico-legal term “sudden death (SD)” refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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19 pages, 1146 KiB

Open AccessReview

Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

by Giuseppe Davide Albano, Francesco Amico, Giuseppe Cocimano, Aldo Liberto, Francesca Maglietta, Massimiliano Esposito, Giuseppe Li Rosi, Nunzio Di Nunno, Monica Salerno and Angelo Montana

Healthcare 2021, 9(1), 97; https://doi.org/10.3390/healthcare9010097 - 19 Jan 2021

Cited by 62 | Viewed by 23976

Abstract

Anabolic-androgenic steroids (AASs) are a large group of molecules including endogenously produced androgens, such as testosterone, as well as synthetically manufactured derivatives. AAS use is widespread due to their ability to improve muscle growth for aesthetic purposes and athletes’ performance, minimizing androgenic effects. AAS use is very popular and 1–3% of US inhabitants have been estimated to be AAS users. However, AASs have side effects, involving all organs, tissues and body functions, especially long-term toxicity involving the cardiovascular system and the reproductive system, thereby, their abuse is considered a public health issue. The aim of the proposed review is to highlight the most recent evidence regarding the mechanisms of action of AASs and their unwanted effects on organs and lifestyle, as well as suggesting that AAS misuse and abuse lead to adverse effects in all body tissues and organs. Oxidative stress, apoptosis, and protein synthesis alteration are common mechanisms involved in AAS-related damage in the whole body. The cardiovascular system and the reproductive system are the most frequently involved apparatuses. Epidemiology as well as the molecular and pathological mechanisms involved in the neuropsychiatric side-effects of AAS abuse are still unclear, further research is needed in this field. In addition, diagnostically reliable tests for AAS abuse should be standardized. In this regard, to prevent the use of AASs, public health measures in all settings are crucial. These measures consist of improved knowledge among healthcare workers, proper doping screening tests, educational interventions, and updated legislation. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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Other

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10 pages, 188 KiB

Open AccessCase Report

Two Cases of Feigned Homicidality: Assessing the Third Dimension in Homicidal Threats

by Pavan Madan, Alexander Graypel and Alan R. Felthous

Healthcare 2022, 10(1), 31; https://doi.org/10.3390/healthcare10010031 - 24 Dec 2021

Cited by 1 | Viewed by 1864

Abstract

Although data and research on the topic are lacking, the phenomenon of feigned homicidality in short-term hospitalization appears to have increased in recent years. Inpatient psychiatrists not only assess the seriousness of homicidal threats, but also whether such threats are authentic. However, specific literature and diagnostic manuals provide virtually no clinical guidance for this. The authors present two case examples of homicidality feigned for self-serving purposes that had little to do with hostility against the would-be victim. They recommend an approach to assessment that first takes any threat of homicide seriously, and involves an attempt to assess the seriousness of the threat and risk of harm. Secondly, if feigned homicidality is suspected, clinicians can methodically assess for this using criterion that have been applied to the assessment of malingering. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

14 pages, 1848 KiB

Open AccessCase Report

Sudden Death from Primary Cerebral Melanoma: Clinical Signs and Pathological Observations

by Alfonso Maiellaro, Antonio Perna, Pasquale Giugliano, Massimiliano Esposito and Giuseppe Vacchiano

Healthcare 2021, 9(3), 341; https://doi.org/10.3390/healthcare9030341 - 17 Mar 2021

Cited by 4 | Viewed by 5276

Abstract

Primary cerebral tumors rarely provoke sudden death. The incidence is often underestimated with reported frequencies in the range of 0.02 to 2.1% in medicolegal autopsy series. Furthermore, primary cerebral melanoma is an uncommon neoplasm. It represents approximately 1% of all melanoma cases and 0.07% of all brain tumors. This neoplasm is very aggressive, and its annual incidence is about 1 in 10 million people. In the present study, a 20-year-old male was admitted to hospital with vomiting, headache, paresthesia and aggressive behavior. A computed tomography (CT) scan of the head was performed showing a hyperdense nodule in the right parietal lobe with inflammation of the Silvian fissure. A complete autopsy was performed 48 h after death. A blackish material was displayed on the skull base, and posterior fossa. Microscopic examination diagnosed primary brain melanoma. A systematic review of the literature was also performed where no previous analogous cases were found. The forensic pathologist rarely encounters primary cerebral melanoma, and for these reasons, it seemed appropriate to describe this case as presenting aspecific clinical symptoms and leading to sudden unexpected death. Histopathological observations are reported and discussed to explain this surprising sudden death caused by a primary cerebral melanoma. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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11 pages, 2005 KiB

Open AccessCase Report

A Rare Case of Suicide by Ingestion of Phorate: A Case Report and a Review of the Literature

by Angelo Montana, Venerando Rapisarda, Massimiliano Esposito, Francesco Amico, Giuseppe Cocimano, Nunzio Di Nunno, Caterina Ledda and Monica Salerno

Healthcare 2021, 9(2), 131; https://doi.org/10.3390/healthcare9020131 - 29 Jan 2021

Cited by 10 | Viewed by 2481

Abstract

Phorate is a systemic organophosphorus pesticide (OP) that acts by inhibiting cholinesterases. Recent studies have reported that long-term low/moderate exposure to OP could be correlated with impaired cardiovascular and pulmonary function and other neurological effects. A 70-year-old farmer died after an intention ingestion of a granular powder mixed with water. He was employed on a farm for over 50 years producing fruit and vegetables, and for about 20 years, he had also applied pesticides. In the last 15 years, he used phorate predominantly. The Phorate concentration detected in gastric contents was 3.29 µg/mL. Chronic exposure to phorate is experimentally studied by histopathological changes observed in the kidney. In the light of current literature, our case confirms that there is an association between renal damage and chronic exposure to phorate in a subject exposed for years to the pesticide. Autopsies and toxicological analyses play a key role in the reconstruction of the dynamics, including the cause of the death. Full article

(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)

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