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The case report is the primary means by which forensic anthropologists communicate the outcomes of their examination. Despite their central role, considerable variability currently exists in the content, structure, and clarity of such reports. Drawing on published guidelines, forensic science standards, and the collective experience of an international group of practitioners from the Board of the Forensic Anthropology Society of Europe (FASE), this paper presents practical recommendations for forensic anthropology reporting. It outlines the fundamental aims and principles of reporting, identifies essential report elements, and distinguishes minimum requirements from discretionary components. Emphasis is placed on scientific integrity, transparency of methods and reasoning, and clear communication to a diverse audience. These recommendations are meant to be applicable across jurisdictions and professional contexts, including independent practice, while remaining aligned with contemporary forensic science standards. By promoting consistency and clarity in reporting, these recommendations aim to support the reliability, interpretability, and admissibility of forensic anthropological evidence, and to strengthen the contribution of forensic anthropology to medico-legal investigations.
As a part of the 21st INTERPOL International Forensic Science Managers Symposium, this work explores the latest scientific developments, methodologies, and trends in forensic biology and forensic DNA analysis of biological evidence during the years 2023 to 2025 and builds upon previous INTERPOL DNA reviews. Almost 2000 references covering the three-year time range of this review were located via various online searches including use of Scopus, Web of Science, and PubMed. The scientific articles, which originated from more than 300 different journals, were curated in a Zotero reference manager database (see Supplemental File 1) and sorted into 15 topics and 116 sub-topics (see Supplemental File 2) under sections focused on advances in current practices (Section 3) and emerging technologies and research studies (Section 4). This triennial review describes 24 books or major reports, 20 special issues of journals on aspects of forensic DNA, 292 articles from 2 International Society for Forensic Genetics (ISFG) conference proceedings, and 70 guidance documents from 17 different organizations to assist in quality DNA testing. Publications were evaluated and sorted into 10 topics around advances in current practices and 5 topics related to emerging technologies and research studies. These topics, which are further sub-divided in a compiled list (see Supplemental File 2) included rapid DNA analysis; law enforcement DNA databases and ethics; forensic investigative genetic genealogy (FIGG); forensic biology and body fluid identification; DNA processing; DNA typing with short tandem repeat (STR) markers; DNA interpretation at the source or sub-source level of the hierarchy of propositions along with mixture interpretation using probabilistic genotyping software (PGS); DNA interpretation at the activity level along with aspects of DNA transfer, persistence, prevalence, and recovery (TPPR); statistics and population genetic data; human identification and kinship analysis; next-generation sequencing (NGS) and technology developments; forensic DNA phenotyping (FDP) and methylation; lineage markers (Y-chromosome, mitochondrial DNA, X-chromosome analyses); new markers and approaches (microhaplotypes, insertion/deletion markers, proteomics, microbiome, single-cell analysis, using environmental DNA, and biomarkers for diagnosis of sudden death, molecular autopsy, or post-mortem interval); and non-human DNA testing and wildlife forensics. Artificial intelligence (AI) tools for summarizing references were explored and utilized in performing this review of over 1900 publications.
Animal cruelty is a persistent concern for animal welfare and society worldwide. In Thailand, the Prevention of Cruelty to Animals and Animal Welfare Act B.E. 2557 (2014) provides a legal framework to address animal abuse; however, effective enforcement remains constrained by limitations in investigative procedures and the limited integration of veterinary forensic science. Veterinarians from the Department of Livestock Development (DLD) play a central role in responding to cruelty reports, conducting inspections, and supporting legal processes. This study aimed to explore the attitudes of DLD veterinarians toward companion animal welfare, the effectiveness of existing animal welfare legislation, and the current and potential role of forensic science in animal cruelty investigations in Thailand. A cross-sectional qualitative study was conducted between August 2024 and December 2024. Eighteen veterinarians with DLD from six geographic regions of Thailand were recruited using stratified purposive sampling. Data were collected via a validated, open-ended online questionnaire that addressed animal welfare challenges, legal enforcement, investigative procedures, and forensic applications. Qualitative content analysis was performed using the NVivo software, with double-blind coding to enhance analytical rigor. The codes were organized into categories and overarching themes following inductive thematic analysis. Multiple interrelated drivers of companion animal cruelty were identified by veterinarians. The major welfare-related themes included a lack of owner responsibility and preparedness, insufficient knowledge and ethical awareness regarding animal care, socioeconomic constraints, deficiencies in stray animal management systems, weaknesses in law enforcement, and cultural attitudes that undermine animal welfare. While most respondents perceived the existing animal cruelty law as partially effective in reducing abuse, they highlighted critical gaps, including ambiguous legal definitions, inconsistent enforcement, and limited public awareness. The absence of standardized veterinary forensic protocols, limited forensic training, and restricted inspection authority were the primary factors driving investigative challenges. Respondents strongly supported the integration of forensic science, emphasizing its potential to improve evidentiary reliability, strengthen legal credibility, and enhance investigative outcomes, while also identifying the need for structured training programs and interagency collaboration. Companion animal cruelty in Thailand is driven by multifactorial welfare, legal, and societal challenges. Although current legislation provides a foundation for protection, the absence of standardized forensic practices limits investigative effectiveness. Strengthening veterinary forensic capacity through harmonized protocols, targeted training, and coordinated enforcement could substantially enhance animal welfare protection and support consistent application of animal cruelty legislation within a One Welfare framework.
The accurate documentation of bodies, injuries, death scenes, accidents, and crime scenes is fundamental to forensic investigations. Traditional two-dimensional (2D) photography and written reports have inherent limitations in representing complex spatial relationships. Recently, three-dimensional (3D) surface documentation technologies, including laser-scanning, structured light scanning, and photogrammetry, have been integrated into forensic practice to provide accurate, measurable, and reproducible digital evidence. This review provides an overview of current 3D methods and discusses their principles, advantages, and typical applications in documenting crime scenes and human remains. Furthermore, it introduces emerging image-based reconstruction approaches, such as neural radiance fields (NeRF) and 3D Gaussian splatting (3DGS), which generate high-quality reconstructions from multiple images. The integration of 3D data into immersive environments, such as virtual reality (VR) and augmented reality (AR), is also addressed, highlighting its potential in forensic analysis, courtroom presentation, and education. With the rapid evolution of 3D technologies, it is essential to understand the strengths and limitations of each technique in forensic applications. Future developments in algorithms and immersive integration will expand digital forensic capabilities.
Proficiency testing is widely used to assess expertise in medicine, engineering, and other high-stakes fields. In forensic science, such tests are often cited in court as evidence that pattern-comparison methods are accurate and reliable. Yet, the scientific value of proficiency testing depends on test design, scoring rules, and the extent to which results support valid inferences about real-world performance. A recent proficiency test of forensic firearm identification-the comparison of bullets and cartridge cases to determine whether they were fired from a particular gun-reported a false-positive error rate of nearly 20%. The broader significance of that result extends beyond the reported figure. We identify several limitations that can arise in forensic proficiency testing: use of items that may not reflect casework difficulty, reliance on consensus scoring rather than independently verified ground truth, inconsistent treatment of inconclusive responses, variation in test materials across examinees, and procedures vulnerable to contextual bias, including nonblind verification. These features make it difficult to distinguish examiner performance from properties of the test itself and weaken claims that reported scores estimate operational error rates. Properly constructed tests could measure individual differences in performance, identify sources of error, evaluate decision thresholds, and provide courts with more meaningful evidence about reliability. Although our focus is on firearms, these challenges extend to other pattern-comparison disciplines, including fingerprints and handwriting. We conclude that comprehensive, evidence-based reform of forensic proficiency testing is warranted.
The use of arthropods in a medicolegal framework is well-known and widely adopted in forensic death investigations. Typically, the life cycle and community composition of carrion arthropods can be used to establish a timeframe of events occurring after the death of an individual. However, because of their unique life strategies (eg the precise detection, location, and exploitation of ephemeral resources) and high dispersal abilities as adults, carrion arthropods can reveal much more information than meets the eye. In recent years, carrion arthropods have revealed important biological and chemical information regarding the substrates that they routinely visit in a natural environment: animal carcasses, feces, microbes, parasites, and even hazardous chemicals. These insects can act as environmental drones, passively acquiring vast amounts of biological and chemical information that can easily be extracted by investigators, given they know what to look for and what methodologies are available for such analyses. This forum piece presents the different ways that carrion arthropods, particularly blow flies, have been used as proxies to assess the health of the local environment and how these methodologies can be leveraged in a forensic context. Further, we propose environmental forensic entomology as an emerging framework and extension of forensic entomology, which currently includes stored products entomology, urban entomology, and medicolegal entomology. Finally, we outline recommendations for future research in this area and propose guidelines for the use of such data in a legal setting.
Falling trees and large branches can result in severe blunt trauma; however, detailed correlations between postmortem computed tomography (PMCT) and forensic autopsy findings in such deaths remain limited. We retrospectively analysed eight consecutive deaths occurring between 2012 and 2025 in which impact or compression by a tree trunk or large branch constituted the primary traumatic event and in which both PMCT and complete forensic autopsy were performed. Thin-slice PMCT of the head and trunk was obtained using standard brain, soft-tissue, lung, and bone windows, supplemented by a gas-optimised thoracic setting. Scene information, PMCT, and autopsy findings were integrated to determine the primary mechanism of death and to compare intracranial, thoracoabdominal, skeletal, and asphyxial injuries. Four lethal mechanisms were identified: instantly fatal head or brainstem injury (n = 2), haemorrhagic shock without cardiac rupture (n = 2), traumatic shock with cardiac rupture and/or aortic injury (n = 2), and asphyxia due to smothering or thoracic compression (n = 2). PMCT demonstrated complex fractures of the ribs, scapulae, spine, and pelvis, as well as haemothorax, haemoperitoneum, pneumomediastinum, and pre-existing coronary artery calcification, and suggested aortic injury in one case. However, brainstem lesions, precise sites of cardiac and aortic rupture, and low-contrast parenchymal injuries were identified only at autopsy. These results suggest that PMCT is valuable for delineating global injury patterns and high-energy marker lesions in falling-tree deaths, whereas full forensic autopsy remains essential for establishing the exact mechanism of death.
Determining whether ligature marks represent antemortem or postmortem injuries is a critical issue in forensic practice because this distinction directly influences the reconstruction of perimortem events. Consequently, assessing the vital reaction of neck skin plays an essential role in evaluating the viability of compression-related injuries. Cathelicidin antimicrobial peptide (CAMP), a multifunctional host-defense peptide involved in inflammation, immune cell recruitment, and wound repair, may serve as a reliable molecular marker for wound vitality. In this study, we examined CAMP expression in 40 ligature mark samples (32 samples of hanging and 8 samples of ligature/manual strangulation) obtained during forensic autopsies, along with matched intact skin controls, all with postmortem intervals of ≤ 3 days. Immunohistochemistry revealed strong CAMP expression in epidermal keratinocytes and moderate expression in dermal cells at compression sites, whereas control skin showed only faint or absent staining. Morphometric analysis demonstrated that the ratio of CAMP‑positive keratinocytes and the number of CAMP-positive dermal cells were significantly higher in compressed skin than in controls, independent of age, sex or postmortem interval. Moreover, neither ligature type nor mode of neck compression also had no influence on CAMP expression in the keratinocytes or dermal cells. These findings indicate that CAMP expression reflects a biological response to antemortem neck compression and may provide an objective molecular marker for assessing wound vitality in forensic pathology. Furthermore, combining CAMP with other established biomarkers may enhance diagnostic reliability when evaluating antemortem neck compression injuries.
The zebrafish (Danio rerio) has become a widely adopted vertebrate model in biomedical research, offering high translational value while supporting the principles of Replacement, Reduction, and Refinement (3Rs). Here, the Polish Zebrafish Society presents comprehensive, field-specific recommendations for the responsible and effective use of zebrafish across major areas of biomedical research. The document summarizes the scientific rationale and experimental advantages of zebrafish-based approaches in oncology, toxicology, neurology and neuropsychiatry, metabolic diseases, immunology, cardiology, and genetic disease modelling. The model's key strengths include rapid development, optical transparency, genetic tractability, and strong conservation of molecular and physiological pathways relevant to human disease. These features enable real-time in vivo analysis of pathological processes, high-throughput pharmacological and toxicological screening, and functional validation of disease-associated genes. By integrating ethical considerations with robust experimental evidence, these recommendations aim to promote standardized implementation of zebrafish models in academic research, pharmaceutical development, and regulatory science. Broad adoption of zebrafish-based approaches can accelerate preclinical discovery, enhance translational relevance, and substantially reduce reliance on higher vertebrate models.
This study performed a bibliometric analysis of global research on human facial recognition for forensic purposes, identifying trends in techniques, anatomical regions, and methodological evolution over five decades. Six databases (PubMed, Scopus, Web of Science, Embase, BVS, and Lilacs) were searched without language or year restrictions. We included studies focusing on human identification through clinical or imaging facial examinations. Data regarding year, journal, authors, keywords, age group, examination type, and methods (metric, morphological, or volumetric) were extracted. Two independent investigators used Rayyan™ for selection, and descriptive analysis was performed using VantagePoint™ and Excel™. From 5016 identified articles, 424 studies published between 1970 and 2022 were included (four systematic reviews, three clinical, 377 observational, and 40 laboratory studies). Forensic Science International was the leading journal (n = 113), and Stephan CN was the most prolific author. Photography was the most used examination (n = 125). Metric analysis prevailed as the primary method (n = 221). While the total face was the most frequent focus (n = 239), the nose emerged as the most studied isolated region (n = 20). Most studies (n = 415) reported identification results. Facial identification research has grown significantly, with photography and metric methods remaining the current standards. However, bibliometric trends point toward a paradigm shift: the integration of Artificial Intelligence and 3D volumetric analysis is emerging as a critical frontier to overcome the limitations of conventional 2D techniques, offering superior precision and optimized forensic workflows.
The infection fatality risk indicates the probability of death among infected individuals. The age-dependent heterogeneity of infection fatality risk is crucial for severity assessment and prioritization of countermeasures. However, infection fatality risk estimation requires infection data from a large-scale seroepidemiological survey combined with either direct ascertainment of deaths caused by infection or excess mortality estimates. To overcome the difficulty in ascertaining death, we propose an alternative approach to estimating the age-specific infection fatality risk for SARS-CoV-2 using medicolegal death investigation data in Tokyo with systematic post-mortem polymerase chain reaction testing. We integrated (i) polymerase chain reaction positivity among all deceased individuals at the Tokyo Medical Examiner's Office, (ii) age-specific all-cause mortality risks from vital statistics, and (iii) age-stratified cumulative infection risks derived from seroepidemiological surveys. Infection fatality risk was computed using Bayes' theorem. Results showed that infection fatality risk increased steeply with age. Our estimates (0.02% for ages 0-39 years, 0.30%-0.50% for ages 40-64 years, and 3.8%-4.2% for those aged ≥65 years) were consistent with published pre-vaccination meta-analytic estimates. Systematic testing within medicolegal death investigation systems can provide rapid, age-resolved severity assessments, improving the timeliness and comparability of infection fatality risk estimation across jurisdictions.
Wolves occasionally specialize on free-ranging horses when they are abundant and alternative prey is scarce, potentially reducing horse productivity, triggering conflicts with owners, and hampering conservation of both species. Yet, ecological and demographic impacts of wolf predation on horses remain poorly understood. We investigated wolf-horse interactions in NW Portugal by combining wolf monitoring, diet analysis, spatial overlap between wolf and horse activity areas, and horse pedigree reconstruction from genetically identified individuals recovered from wolf scat remains, feeding sites and horse faecal samples. Horses comprised 85% and 93% of wolf consumed biomass in 2017 and 2018 respectively, suggesting strong positive selection. Wolf GPS-tracking identified 19 feeding sites, all containing horse remains, with 26% within wolf core areas. Eight predation events were confirmed, affecting foals (12%), juveniles (> 1 year; 38%) and adults (50%). Genetic analyses identified 39 horses from wolf feeding sites and scat remains, 17 of which were assigned to 10 of the 14 families reconstructed from molecular data, revealing high predation impact on both juveniles and adults. These findings provide rare empirical evidence of wolf predation impacts on free-ranging horses and highlight the importance of integrating demographic and genetic approaches to inform conservation and conflict mitigation.
Giorgetti et al. report a carefully designed in vivo cross-over experiment showing that brief passive exposures to cannabis or "light cannabis" smoke inside a vehicle can deposit detectable Δ9-tetrahydrocannabinol (Δ9-THC) or cannabidiol (CBD) into hair, even after a validated dichloromethane washing step. Their findings are forensically relevant because washed-hair concentrations sometimes approached or exceeded Society of Hair Testing cut-offs used to infer active use. The work advances beyond in vitro models by using realistic exposure durations. However, two statistical practices warrant further examination: the repeated-measures structure from four volunteers contributing multiple samples was not fully accounted for in primary tests, and values below the limit of quantification were replaced by a constant equal to the limit of detection. These choices may underestimate variability and produce narrow confidence intervals. This discussion reanalyses the authors' tabulated data using linear mixed-effects models and maximum-likelihood Tobit regression. The qualitative conclusions remain consistent, but uncertainty estimates widen materially, suggesting the value of more conservative reporting in small-cohort forensic toxicology studies.
Sudden cardiac death is the leading cause of death among athletes during exercise. These events are devastating for both the family and society, especially when they occur in children and young adults. Some of these unexpected deceases occur in athletes who carry genetic alterations that predispose them to malignant arrhythmias, and exercise is the main trigger for these lethal episodes. These genetic alterations are the origin of inherited arrhythmogenic syndromes, often latent, and the first clinical manifestation can be sudden death itself. It is also important to take into account the toxicology data, since high doses of certain substances, as well as mixtures of them, can also be significant triggers of malignant arrhythmias, especially in genetically predisposed hearts. Genetic studies that can provide a diagnosis can be performed on deceased individuals (molecular autopsy) or on their relatives, who may be carriers of the genetic defect and at risk of malignant arrhythmogenic events. Early identification of individuals at risk allows adoption of preventive measures helping to reduce risk of life-threatening arrhythmogenic episodes. Our study examines the main arrhythmogenic causes of sudden cardiac death in athletes during exercise, highlighting a multidisciplinary interpretation of forensic, clinical, genetic and molecular data to obtain a definite cause for the lethal episode.
BACKGROUND: Life expectancy for individuals with Down syndrome (DS) has significantly increased, primarily due to medical advances. While DS is considered a genetically determined form of Alzheimer’s disease (DS-AD), with neuropathological markers evident by age 40, the onset of clinical dementia varies. Modifiable risk factors are thought to contribute meaningfully to dementia risk in the general population. Advances in intervention studies in the general population suggest cognitive decline can be reduced through multimodal lifestyle interventions, however no large-scale multimodal studies have been conducted in the DS population. SEARCH STRATEGY: A comprehensive search was conducted across five electronic databases—Medline, EMBASE, CINAHL, Web of Science, and ASSIA to identify studies that examined the relationship between lifestyle interventions and cognitive outcomes in adults with DS. The search combined database-specific controlled language with keywords related to exercise, diet, social activities, cardiovascular health, and brain stimulation. Studies included were peer-reviewed original research articles focusing on adults with DS and reported on cognitive outcomes or AD-related biomarkers. RESULTS: The search yielded 24,774 articles, with 16,868 remaining after duplicates were removed. A total of 44 articles met inclusion criteria across the domains of exercise, diet, cardiovascular health, social connectedness, and cognitive stimulation. Most studies focused on exercise, indicating some cognitive benefits, particularly in executive functions and working memory, though results were inconsistent, and many suggested the necessity of high adherence to intervention protocols. No studies were found that examined the direct impact of diet on cognition in DS. Findings on cognitive stimulation, cardiovascular health and social connectedness suggested potential but inconclusive benefits for cognitive function. CONCLUSIONS: This review underscores the significant gaps in research regarding non-pharmacological interventions for DS-AD. It highlights the need for tailored, well-structured studies to better understand and leverage potential cognitive benefits of lifestyle interventions in the DS population. Implementing such interventions early in life and before significant disease progression may help maintain quality of life and independence among individuals with DS. Future research should focus on comprehensive, multi-domain interventions to ascertain their efficacy and optimal application.
Necrotizing soft-tissue infection (NSTI) is a rapidly progressing, life-threatening disease that is difficult to diagnose based on clinical findings alone. NSTI often does not present with pus at the infection site, so it may not be suspected during an autopsy. Consequently, bacterial cultures are not performed, which hinders identification of the causative organism. In this study, we attempted to amplify the 16S ribosomal RNA (16S rRNA) gene (also referred to as 16S rDNA) from blood samples collected during forensic autopsies in two cases where death was suspected to be due to NSTI, as determined by postmortem histological examination. These samples had been stored frozen for up to 170 months. However, bacteriological testing was not performed at the time of autopsy because NSTI was not suspected. In one case, a 16S rRNA gene was amplified for Vibrio vulnificus, and in the other, for Streptococcus pyogenes (Group A Streptococcus). Based on the autopsy findings and laboratory results, it was determined that the NSTI caused by these bacteria was the most likely cause of death. These results suggest that amplifying bacterial 16S rRNA genes from frozen postmortem blood samples may help in future cases.
We describe the validation, cultural adaptation, and updating of The International Society for the Prevention of Child Abuse and Neglect, Child Abuse Screening Tool, Retrospective version (ICAST-R) for use in a Danish context. Thorough Danish questionnaires on child abuse and neglect exist, but some are proprietary, and their development precedes widespread use of social media. As forms of abuse evolve, including online sharing of abuse material, updated tools are needed, and we are not aware of any recent, comprehensive and validated questionnaires that are culturally adapted for Danish. The free ICAST-R measure has been translated into at least 20 languages and is widely used in the field. To develop a Danish version, the questionnaire has been back-and-forth-translated and has undergone cognitive testing and focus group interviews by eight individuals within the target age range and seven experts by experience with abuse and neglect. Further adaptation was done through focus group interviews with professionals from research and practice. Categorisation of severity of abuse was done through a Delphi process, and acceptability of the adapted measure was assessed in an online survey distributed to 450 Danish adults. The ICAST-R has also been reviewed in focus group interviews with 11 professionals working with child abuse and neglect, representing practitioners, researchers and non-governmental organisations. The final Danish measure incorporates additional questions focused on online sexual abuse, free-text options for other experiences of abuse, and items describing acts of abuse with subcultural attributions of meaning. The neglect section is substantially altered, and the section on sexual child abuse has been restructured into non-contact sexual abuse, non-contact technology-facilitated sexual abuse, and moderate and severe contact sexual abuse. For sexual abuse, the structure was changed so that sexual experiences were recorded and subsequent questions explored consent and age at the event. For all events, a number of questions exploring disclosure was added.
Neuropaediatric Rare Diseases (NRDs) impose a profound and multidimensional burden on patients, families, and healthcare systems. Persistently low clinical trial success rates reflect an unmet methodological need as much as a therapeutic one. A fundamental bottleneck is the absence of fit-for-purpose clinical outcome assessments. In fact, instruments validated for non-rare or adult populations fail to capture clinically meaningful change in heterogeneous, small, and developmentally complex NRD populations. Building directly on a systematic catalogue of methodological challenges in NRD outcome research published by our group (Acosta et al., 2025), this paper presents a structured set of actionable outcome strategies proposed by a large multidisciplinary expert group convened under the auspices of the European College of Neuropsychopharmacology (ECNP) and the International Society for CNS Clinical Trials and Methodology (ISCTM). Using a structured, iterative expert-opinion approach, each identified challenge served as a prompt for developing one or more candidate strategies, each mapped one-to-one to its corresponding barrier. Strategies are presented across four thematic domains: (1) innovative methodologies to enhance ecological validity and reduce rater context effects; (2) novel or adapted outcomes and endpoints that preserve clinical meaningfulness under conditions of high heterogeneity and limited sample sizes; (3) the purposeful use of natural history resources; and (4) approaches to support comparability and synthesis across programmes. Additional considerations address caregiver expectancy bias and recruitment, stakeholder alignment, maturational confounding, and preclinical-clinical connectivity. Collectively, these strategies constitute a practical, challenge-mapped "living" toolbox for clinical scientists designing NRD trials. Each strategy is already in use or validated in analogous rare-disease contexts. Realising their potential at scale requires institutional programmes, pre-competitive co-validation platforms, systematic stakeholder co-design, and early engagement with regulatory agencies as scientific partners in endpoint development.
Prolonged immersion in a reheated bathtub can cause extensive thermal alteration and produce intracranial findings that mimic traumatic lesions on postmortem computed tomography (PMCT). Here, we report a bath-related fatality in a woman in her late 60s in which PMCT demonstrated a crescent-shaped epidural collection along the right parietal convexity. The collection exhibited layered components, consisting of a fat-attenuation upper layer and a dependent low-attenuation layer with a small amount of gas. PMCT also demonstrated diffuse bilateral ground-glass opacities, bilateral pleural effusions, and left pneumothorax, as well as fluid accumulation in the paranasal sinuses and airway fluid with foam. At autopsy, extensive epidermal stripping and blistering with heat rigor were observed, and red frothy fluid was present within the airway. Autopsy revealed a brick-colored epidural deposit (approximately 15 g) without skull fracture, consistent with heat-coagulated blood. Toxicological analysis detected triazolam and mirtazapine in the blood. Drowning was considered highly likely; however, definitive confirmation was limited by severe systemic thermal alteration. This case highlights a forensic diagnostic pitfall in which heat hematoma-like epidural changes following prolonged hot-water immersion may mimic traumatic epidural hematoma on PMCT, underscoring the importance of integrating scene information, toxicology, PMCT, and autopsy findings.
To assess whether the Ketogenic Diet (KD) is associated with improvements in biochemical markers of hyperandrogenism in women diagnosed with Polycystic Ovary Syndrome (PCOS) with obesity or overweight. A systematic search was conducted in five databases: MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. Both RCTs and pre-post studies providing data for direct extraction or calculation of mean (SD) changes in the investigated outcomes, published until March 1, 2025, were considered. Protocols included "Very Low" and "Low" Calories KD, and modified KD regimens. The primary outcome was the effect of the KD on total testosterone (TT), Free T (FT) and Sex Hormone Binding Globulin (SHBG) compared to baseline. The KD was found to be associated with a statistically significant reduction in TT (n = 290, Mean Difference [MD] -0.35, CI -0.46; -0.24) and a significant increase in SHBG levels (n = 144, MD 19.50, CI 6.90; 32.11), independently of study design. When considering only RCTs (4 studies), the KD showed a moderate, statistically significant benefit on TT levels compared to the control intervention, with a high heterogeneity (n = 115 vs. 117, SMD -0.284, CI -0.543, -0.035; p = 0.031). Neither the duration of the KD protocol, the change in BMI, the change in fasting insulin levels nor the change in LH/FSH ratio were able to significantly affect the change in TT levels observed over time. In addition, the KD associated with a significant reduction in LH levels (n = 275, MD -3.48, CI -4.71; -2.26) and in the LH/FSH ratio (n = 275, MD -0.99, CI -1.44; -0.54). Our meta-analysis indicates a reduced biochemical hyperandrogenism-particularly a reduction in TT-and a reduction in the LH/FSH ratio among women with PCOS following a KD. Our findings also suggest a specific effect of ketosis on ovarian function acting alongside metabolic improvements, but a direct causal link cannot be definitively established. Owing to the low quality and heterogeneous nature of the available studies, larger, high-quality RCTs are essential to consolidate this evidence and determine clinical efficacy.