The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
To assess whether transfer-learning models applied to panoramic radiographs (PANs) can classify individuals at the threshold of legal majority (≥18 years). Vision Transformer (ViT) and EfficientNetV2 models were trained on PANs from Bosnian and Lebanese individuals aged 14-24.99 years (n = 1764), considering pooled and sex-specific datasets with and without augmentation. Binary classification, multiclass classification, and regression models were trained and evaluated. Model performance on an internal test set derived from the same sample was summarized using accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (ROC AUC). For regression and multiclass models, legal majority classification was additionally assessed by thresholding predicted ages or age categories at 18 years. External validation employed an independent Brazilian dataset (n = 1579; 14-24.99 years). Formal statistical comparison between internal and external performance employed two-proportion z-tests for accuracy and DeLong's test for ROC AUC. On the internal test set, the best-performing binary classification model, EfficientNetV2 with augmentation on the pooled dataset, achieved an accuracy of 0.90, sensitivity of 0.92, specificity of 0.86, F1 score of 0.91, and ROC AUC of 0.93. Using the same pooled, augmented configuration, thresholded regression predictions achieved accuracies of 0.85 for EfficientNetV2 and 0.83 for ViT, whereas thresholded multiclass predictions achieved accuracies of 0.84 and 0.73, respectively. Compared with direct binary classification, these thresholded outputs showed no clear advantage, and multiclass models generally showed higher specificity but lower sensitivity. This same pattern was retained when thresholded models were evaluated on the external validation set, with thresholded regression remaining comparatively stable and thresholded multiclass performance declining more markedly, especially for ViT. Visualization maps (gradient-weighted class activation mapping [Grad-CAM] and occlusion sensitivity) confirmed attention to relevant dental structures. On external validation, the same binary EfficientNetV2 configuration achieved an accuracy of 0.81, sensitivity of 0.90, specificity of 0.61, F1 score of 0.87, and ROC AUC of 0.85. Sex-specific models performed similarly, showing no clear advantage over pooled training. Statistical testing confirmed significant AUC degradation on external validation for both models (EfficientNetV2: p = 0.004; ViT: p < 0.001), while the accuracy drop was significant only for ViT (p = 0.035). This study demonstrated that transfer learning with EfficientNetV2 and Vision Transformer can distinguish minors from adults using PANs with high internal performance and acceptable external generalization. Direct binary classification provided the most robust approach for legal age assessment in the present dataset. The findings support the forensic potential of these models, while also indicating the need for further work to improve robustness and real-world applicability.
Artificial intelligence (AI) is reshaping healthcare, and forensic medicine and nursing are no exception. From automated wound pattern analysis to natural language processing (NLP) in medicolegal documentation, AI tools are entering a field situated at the intersection of clinical care, legal accountability, and human rights. This systematic review with narrative synthesizes contemporary clinical, forensic, and AI ethics literature to examine current and emerging applications of AI in forensic practice, with particular attention to injury interpretation, postmortem interval estimation, forensic imaging, survivor documentation, and medicolegal reporting. Forensic nursing practice, including sexual assault nurse examiner (SANE) programs, domestic violence assessment, and paediatric abuse evaluation, is a central focus. The review critically evaluates ethical risks associated with deploying algorithmic decision-making in high-stakes forensic contexts where outputs may influence criminal outcomes and judicial proceedings. Issues of algorithmic bias, chain-of-custody integrity, explainability, and the potential displacement of clinical judgment are examined alongside practical considerations for implementation. Given the still-emerging forensic-specific evidence base, this review draws selectively on adjacent clinical disciplines while emphasizing the distinct medicolegal demands of forensic practice. Responsible integration of AI, the review concludes, requires interdisciplinary governance, equity-stratified validation, and preservation of the clinician-examiner's primary interpretive authority.
Under South African (SA) law, all unnatural, sudden and unexpected deaths, as well as procedure-related deaths, must be reported to the SA Police Service and referred to the Forensic Pathology Service (FPS). In the Western Cape Province, referrals to FPS require completion of the FPS100 form by a senior medical practitioner. To assess the appropriateness, completeness and legibility of FPS100 referral forms submitted to Tygerberg Forensic Pathology Services over the course of 1 year in the Western Cape Province, and to evaluate whether the suspected presumed cause of death was in line with the World Health Organization's standards. This was a cross-sectional retrospective review of all FPS100 referral forms submitted to the Tygerberg Forensic Pathology Mortuary over 1 year. An experienced forensic pathology medical practitioner reviewed the appropriateness, completeness, legibility, commissioning status and accuracy of presumed cause-of-death classifications reflected on the FPS100 referral forms received. Of the 1 252 cases accompanied by a referral form, 81.6% were deemed incomplete, with 22.3% uncommissioned, rendering them inadmissible in court. Even though most of the referrals were legible, over 43% indicated misclassified formulations of the presumed causes of death. The study revealed significant deficiencies in FPS referrals, including incomplete or uncommissioned forms and frequent misclassification of presumed causes of death. These shortcomings undermine the legal validity of the referral forms, and may delay medicolegal processes and even result in direct subpoenas to referring medical practitioners. The findings highlight the urgent need for strengthened training for medical practitioners across all levels of experience, and for the implementation of standardised referral protocols. Equally important is enhancing awareness of the medicolegal value of FPS involvement, and the critical impact of accurate, high- quality referrals.
Deaths occurring during or shortly after police restraint pose a major forensic and legal challenge. Prone restraint with torso compression has been associated with fatal outcomes, yet underlying mechanisms and their legal interpretation remain unclear. Evidence is predominantly derived from North America and Western Europe, with limited systematic data from other regions. We conducted a multidisciplinary case series of prone restraint-related fatal and near-fatal police interventions documented in the Czech Republic between 2012 and 2023. Ten cases were identified using official records from the General Inspection of Security Forces and the Police of the Czech Republic. For each case, forensic pathology, toxicology, physiological considerations, operational characteristics, temporal sequencing, and legal outcomes were jointly evaluated. All cases involved prone positioning with torso compression and showed a consistent temporal pattern in which physiological collapse occurred shortly after restraint release rather than during active restraint. Most individuals exhibited pre-existing vulnerability factors, including elevated body mass index, psychiatric comorbidity, substance use, or cardiovascular pathology. External signs of asphyxia were uncommon, whereas internal findings compatible with hypoxia were frequent, and no case demonstrated fatal traumatic injury. Despite comparable medical and forensic findings, legal outcomes varied substantially. Our data suggest that fatal and near-fatal outcomes during prone restraint result from cumulative physiological stress rather than a single mechanical mechanism. The post-restraint collapse window represents a critical but under-recognized phase of risk, highlighting the need for improved post-restraint monitoring, standardized documentation, and integrated forensic-legal evaluation.
Compressed air-induced colonic barotrauma is a rare but potentially fatal injury type with distinctive forensic significance. Non-iatrogenic pneumatic injuries of the gastrointestinal tract are infrequently documented, yet are associated with high morbidity and mortality, frequently arising in occupational settings because of workplace misconduct or the misuse of pneumatic equipment. We report a fatal case of transanal high-pressure compressed air insufflation in a 15-year-old adolescent. Witness testimony and the accused's confession established that a compressed air hose was inserted transanally on two occasions while the victim was fully clothed. The second instance of insufflation resulted in immediate collapse at the scene with subsequent death. Medicolegal autopsy was conducted at the Egyptian Forensic Medicine Authority. External examination revealed a grossly distended abdomen as well as a grossly distended scrotum, and two vital perianal lacerations with contused and abraded margins, accompanied by perianal bruising. Internal examination demonstrated tension pneumoperitoneum, multiple colonic and mesenteric lacerations, and intraperitoneal hemorrhage. Toxicological analysis and anal swabs for evidence of sexual assault were negative. The cause of death was attributed to hemorrhagic shock secondary to extensive multiple colonic and mesenteric lacerations. Compressed air-induced colonic barotrauma, though rare, represents a forensically significant injury pattern. The current case illustrates the severe, potentially fatal effects of using pneumatic devices improperly and emphasizes the importance of considering scene evidence, witness statements, external examinations, and comprehensive internal autopsy findings to accurately reconstruct the mechanism, manner, and cause of death.
The identification of human remains is a central component of medico-legal practice, underpinning both judicial proceedings and the rights of families of missing persons. International protocols recognize three primary identification modalities - fingerprint comparison, DNA analysis, and dental comparison - yet the involvement of forensic odontologists remains discretionary in most jurisdictions. This paper examines the intersection between recent legislative reforms accelerating judicial declarations of presumed death and the reliability of forensic identification systems. Taking Italy's 2025 reduction of the general presumed-death threshold from ten to five years as a focal case, the paper argues that compressed legal timelines increase systemic reliance on forensic identification while simultaneously narrowing the margin for procedural insufficiency. The analysis situates presumed-death legislation within broader international human rights and humanitarian forensic frameworks, emphasizing that accelerated legal closure must be matched by adequate forensic capacity. Drawing on empirical evidence from mass fatality events and a recent systematic review demonstrating substantial pooled dental identification contribution in disaster contexts, the paper identifies specific scenarios in which single-modality identification approaches carry elevated failure risk, including advanced decomposition, carbonization, fragmentation, and DNA degradation. To address this gap, a risk-stratified model is proposed comprising seven trigger criteria under which forensic odontology consultation should be mandatory rather than discretionary. The model is operationally proportionate and adaptable across civil law and common law jurisdictions.
Pituitary gland injury following traumatic brain injury (TBI) is an increasingly recognised but underdiagnosed complication with significant clinical and forensic implications. Morphological data from Asian autopsy series remain scarce. This study aimed to estimate the frequency and histopathological pattern of pituitary gland injuries in fatal head injury cases and to correlate these findings with associated craniocerebral injuries and post-injury survival time. A cross-sectional autopsy study of 150 consecutive fatal head injury cases was conducted at a tertiary care forensic medicine institute in South India between February 2021 and August 2022. The pituitary gland was retrieved at autopsy, fixed in 10% neutral buffered formalin, sectioned in three planes, embedded in paraffin, cut at 6 μm, and stained with haematoxylin and eosin. Histological assessment was performed by a single forensic pathologist who was blinded to all clinical, circumstantial, and survival data at the time of microscopic examination. Gross and histopathological findings were correlated with craniocerebral injuries and post-injury survival time using descriptive statistics, stepwise logistic regression (reporting odds ratios [OR] with 95% confidence intervals [CI], Nagelkerke R2, and Hosmer-Lemeshow goodness-of-fit), and chi-square tests. Males constituted 74% and the commonest age group was 31-40 years (44%). Road traffic accidents accounted for 68.67% of cases. Histopathologically, 68 cases (45.33%) showed pituitary injury. The stalk was most frequently affected (haemorrhage 40.7%), followed by the posterior lobe (35.3%) and anterior lobe (30%). No individual craniocerebral injury subtype was independently associated with pituitary injury (all P > 0.05; OR range 0.89-1.44). Pituitary haemorrhage predominated in early deaths (≤48 h), whereas necrosis characterised late deaths (>48 h). Pituitary gland injury is present in nearly half of fatal head injury cases. The histopathological pattern-haemorrhage versus necrosis-correlates with the post-injury survival interval and may, pending independent validation, serve as a useful forensic indicator at autopsy. These findings underscore the need for prospective studies in TBI survivors to evaluate pituitary function and inform clinical management.
to describe the garbage codes (GCs) identified in the Global Burden of Disease Study (GBD) 2023 and their redistribution to underlying causes of death in Italy in 2021. Specifically, the study aims to: 1. compare temporal trends in the proportion of GCs in Italy with those of other Western European countries with similar population sizes; 2. identify the most frequent GC packages, analyze their geographic distribution, and determine the causes to which they are reassigned; 3. examine the relationship between the proportion of GCs and contextual factors related to death certification, including the type of certifier, place of death, and requests for autopsy. descriptive epidemiological study based on GBD 2023 estimates. the analysis focuses on the Italian population in 2021, stratified by 21 subnational units, including 19 regions and 2 autonomous provinces. total number of deaths; number of GCs, defined as deaths attributed to causes that do not represent underlying causes of death; percentage of GCs, calculated as the number of GCs divided by total deaths and multiplied by 100. the proportion of GCs in Italy gradually decreased over time, from 34.6% in 1990 to 28.8% in 2021. In 2021, the three most frequent GC packages at the national level were 'unspecified type of stroke' (4.28% of total deaths), 'unspecified type of diabetes' (2.44%), and 'heart failure, right or left' (2.38%). In the same year, the proportion of GCs was positively correlated with the share of deaths occurring at home (r 0.71; p <0.001), with missing data on the type of certifying physician (r 0.54, p=0.020), on place of death (r 0.77, p <0.001), and on autopsy requests (r 0.76, p <0.001). misreporting of causes of death arises from multiple mechanisms, reflecting errors of different nature and severity, with important implications for public health policies and health information systems. While redistribution methods are essential to produce comparable and policy-relevant estimates, improving data quality at the source remains a critical priority.
Unclaimed bodies continue to present important operational, forensic, ethical, and administrative challenges for hospitals in Malaysia. Variability in mortuary retention practices and the lack of a nationally standardised protocol may affect identification opportunities, mortuary capacity, and lawful disposition processes. To develop and pilot evaluate a standardised 30-day protocol for the management, identification, retention, and lawful disposition of unclaimed bodies in Malaysian hospitals. A mixed-methods pilot operational study was conducted using a structured review of hospital SOPs, Ministry of Health documents, operational reports, international mortuary standards, and forensic identification workflows published between 2010 and 2025. A retrospective pilot evaluation was subsequently performed in a tertiary hospital mortuary in Kuala Lumpur to assess operational feasibility, storage duration, identification timelines, and stakeholder acceptability. Approximately 400 unclaimed bodies are reportedly managed annually within Klang Valley hospitals, with considerable variation in institutional retention practices. Pilot evaluation of the proposed 30-day protocol involving 97 unclaimed bodies demonstrated operational feasibility, acceptable freezer utilisation, mean storage duration of 27.4 days, and positive stakeholder acceptability. Most identification processes occurred within the proposed retention window. The present pilot study demonstrates that a standardised 30-day protocol for unclaimed bodies is operationally feasible and acceptable within the Malaysian setting. The proposed protocol may support improved identification opportunities, standardised mortuary practices, and structured collaboration between the Ministry of Health, law enforcement authorities, and forensic agencies.
Forensic age estimation in individuals older than 50 years remains challenging because conventional skeletal indicators exhibit wide error margins in this age range. The manubriosternal joint (MSJ) is among the last joints in the human skeleton to undergo fusion, yet large-scale computed tomography (CT)-based data on its fusion patterns particularly from the Indian subcontinent are sparse. To determine the prevalence and age-sex distribution of complete MSJ fusion on CT in a large Indian cohort and to evaluate its diagnostic accuracy for forensic age estimation, with particular reference to the medico-legally relevant 55-65-year age window. In this retrospective cross-sectional observational study, MSJ fusion status was assessed on chest CT scans of 734 consecutive outpatients at a government hospital over a one-year period. Fusion was recorded as a binary variable (complete fusion vs. no fusion). Descriptive statistics, chi-square tests, binary logistic regression, and receiver operating characteristic (ROC) curve analysis were performed. Of 734 patients (age range 0-97 years), 194 (26.4%) showed complete MSJ fusion. The mean age of fused individuals was 57.2 years compared with 48.2 years in the unfused group (p < 0.001). Fusion prevalence rose progressively from 0% in the 0-9-year age group to 41% in the 70-79-year group but did not exceed 44% in any decade. On logistic regression, each one-year increase in age significantly increased the odds of fusion (adjusted odds ratio [aOR] 1.032 per year, 95% CI 1.021-1.043), while sex was not a significant independent predictor. The optimal age cutoff by Youden's index was ≥54 years, yielding a sensitivity of 64.9% and specificity of 57.0%, with an area under the ROC curve (AUC) of 0.642. Addition of sex to the model did not meaningfully improve discrimination (AUC 0.643). Complete MSJ fusion is significantly associated with advancing age but occurs in only a minority of individuals even beyond the seventh decade. Its moderate discriminative ability (AUC 0.642) indicates that MSJ fusion alone is insufficient for precise forensic age estimation. However, its high negative predictive value at younger thresholds may be useful as an adjunctive indicator within a multifactorial age-estimation protocol. Population-specific Indian reference data are presented for the first time from a CT-based sample of this size.
Parasomnias are undesirable physical events during sleep that can manifest as complex, violent behaviors, posing significant challenges for forensic psychiatry. The central legal dilemma involves "automatism," where actions lack the necessary mens rea for criminal liability. This study analyzes the prevalence, clinical characteristics, and adjudication of parasomnia defences within the Turkish legal system. A retrospective analysis was conducted using the nationwide archives of the Council of Forensic Medicine through the National Judicial Network Project database over a five-year period. Criminal cases explicitly raising a parasomnia defence were identified and evaluated by a multidisciplinary board under the legal framework of "temporary causes" (Article 34) of the Turkish Penal Code. Among 8920 criminal responsibility case files evaluated during the study period, a UYAP-based search and stepwise screening process identified 42 files with a documented parasomnia diagnosis or provisional diagnosis, of which 18 explicitly involved a parasomnia/sleepwalking defence. The multidisciplinary evaluation concluded that 4 subjects (22.2%) lacked criminal responsibility due to genuine sleep automatism. These validated cases involved violence against family members and were characterized by amnesia, confusion upon awakening, and lack of motive. Conversely, 14 defences were rejected, primarily due to exclusionary factors such as alcohol/substance intoxication (50%) or evidence of complex, goal-directed behavior inconsistent with parasomnia. While sleep-related violence is a rare forensic entity, it presents significant diagnostic and legal challenges. This study underscores that in Continental Law jurisdictions like Türkiye, such cases are adjudicated as 'temporary causes' through a rigorous multidisciplinary lens. The implementation of a structured evidentiary framework for medico-legal triangulation-integrating clinical history, event phenomenology, and objective sleep data-is essential to foster transparency and objectivity in criminal responsibility assessments, effectively differentiating genuine sleep automatism from volitional conduct, malingering, or intoxication-related behaviors.
Deaths in custody represent a critical intersection between health care, law enforcement and human rights. By depriving an individual of liberty, the State assumes an enhanced duty to protect life and ensure access to adequate medical care. Any death occurring in custodial settings must therefore be regarded as potentially suspicious until clarified through a prompt, independent and technically robust investigation. This systematic review synthesizes and critically examines scientific evidence on deaths in police and prison custody, with particular emphasis on physical restraint, pathophysiological mechanisms, and medico-legal investigation practices. A systematic search of PubMed and Scopus (2010-2025) was conducted in accordance with PRISMA 2009 guidelines. The evidence indicates that deaths in custody are predominantly multifactorial, resulting from the interaction between physical restraint, intense physiological stress, intoxication with psychoactive substances and individual vulnerabilities such as obesity or underlying cardiac disease. The concept of "excited delirium" remains highly controversial, lacking validated diagnostic criteria or specific biomarkers and is frequently used as a diagnosis of exclusion in medico-legal contexts. Physical restraint, particularly prolonged prone positioning with thoracic or cervical compression, may precipitate metabolic acidosis and restraint-associated cardiac arrest, even in the absence of significant hypoxemia. Experimental studies in healthy volunteers fail to reproduce real-world custodial conditions and should not be used to negate associated risks. Rigorous and independent medico-legal investigation, including complete autopsy, toxicological analysis and contextual reconstruction, is essential for accurate causal attribution and institutional accountability. These findings have direct implications for forensic practice, death certification and the prevention of avoidable deaths in custodial settings.
Previous post-mortem studies in victims of intoxication have typically focused on toxicological and biochemical analyses. This study aimed to assess the prevalence and types of cardiovascular disease in fatal intoxication cases. We included post-mortem autopsy examinations of 865 fatal intoxication cases performed on medico-legal basis at the Gade Laboratory for Pathology at Haukeland University Hospital, Bergen between 2000 and 2013. The mean age at death was 42.1 years (range 13-97) and 72% were males. The cause of death was attributed to intoxication with drugs in 35% cases, combination of drugs and narcotics in 17%, narcotics in 17%, ethanol and drugs in 15%, and ethanol alone in 8% cases. More than a third (36.0%) had concomitant causes of death. The mean heart weight was 387 ± 86 g. A total of 12.3% patients had mild, 8.4% moderate and 9.7% had severe atherosclerosis, while 69.6% had no atherosclerosis or only minor changes in the coronary arteries. A total of 14.9% patients had pathological changes in the brain: cerebral oedema in 23% (n = 29) cases, old ischemic strokes in 22% (n = 28), traumatic brain injury in 13.2% (n = 17) and intracranial hemorrhage in 8.5% (n = 11), while the incidence of acute ischemic stroke was 3.1% (n = 4). Myocardial infarction (old/healed) was evident in 10.3% (n = 89) of the victims. The incidence of left ventricular hypertrophy was nearly 3-fold higher than right ventricular hypertrophy (29.2% vs 10.6%). In victims of intoxication, cerebrovascular disease was found in 15% and heart diseases in up to 30% of cases. It is possible that the acute toxic effects of alcohol and substance abuse are aggravated in patients with underlying cardiac and cerebrovascular diseases. The findings from the current study highlight the importance of enhanced cardiovascular risk assessment in substance use disorders, with major forensic and public health implications.
Perineal injuries (PI) in females and children may result from blunt trauma, impalement, road traffic accidents, or sexual assault, with presentations ranging from superficial abrasions to deep lacerations involving genitourinary, anorectal, or intra-abdominal structures. Differentiating accidental trauma from sexual assault remains a clinical and medicolegal challenge, particularly when history is unclear or inconsistent. A retrospective analysis of challenging perineal injury cases presenting between 2019 and 2025 at a tertiary care centre was conducted. Cases included isolated perineal injuries, perineal injuries with associated bodily trauma, and extensive perineal injuries following reported consensual sexual activity. Clinical presentation, injury mechanisms, medicolegal dilemmas, consent-related issues, and evidence collection challenges were evaluated. A total of 532 cases of trauma and assault of female patients were forensically assessed during the study period and cases with perineal and/or genital injuries, history of sexual assault and suspicious cases wereevaluated for major challenges faced.These included injury-to-history mismatch, delayed presentation, previously treated referred cases with dressings or clots, absence of witnesses, and differentiation of impalement trauma from sexual assault. Variability in consent scenarios and evidence preservation difficulties were frequently encountered. Ten cases representing the spectrum of diagnostic and forensic dilemmas were choosen for discussion. A structured clinical-forensic evaluation strategy was formulated to guide history assessment, injury correlation, consent procedures, forensic evidence preservation, etc. CONCLUSION: A systematic interdisciplinary approach with increased awareness of medicolegal responsibilities can improve early evidence preservation, support accurate injury interpretation, and reduce the risk of missed forensic evidence in suspected sexual assault-related perineal injuries.
Individual identification plays an important role in forensic anthropology, where biological profiles are created. Estimating body height is a key parameter, alongside age, sex and ethnicity. This study aims to assess the relationship between height and hand dimensions, and to develop regression equations specific to the Slovak population. The sample consists of 125 women and 90 men aged 18-30. Twenty-two hand dimensions were measured on both hands (hand length and width, palm length, finger length, and the length of individual finger phalanges), as well as participants' height. The measurement data were subsequently analysed using simple and multiple regression analysis. Significant differences between the sexes were found for all measured variables, with bilateral asymmetry observed for certain dimensions. The accuracy of predicting height using these hand dimension-based equations ranges from ±5.14 to ±5.92 cm for women and from ±5.57 to ±7.35 cm for men. The results indicate a positive correlation between height and all hand-related variables (R = 0.366-0.894, p < 0.001), with a stronger association observed between hand and finger length than between finger phalanx length and height. Our study provides equations that can be used to estimate stature based on palm and finger measurements among Slovaks.
Forensic dentists are integral to the justice system, yet technical proficiency on its own does not guarantee effective courtroom participation. The adversarial, high-pressure environment of legal proceedings demands clear, accurate, and impartial communication of complex scientific findings to non-specialist decision-makers. Without targeted training, even skilled practitioners may struggle to navigate cross-examination effectively, preserve objectivity, and present evidence in a scientifically defensible manner. This pilot study evaluated the impact of a structured mock court trial on the self-perceived preparedness, communication skills and confidence of postgraduate forensic odontology students. All outcomes reflect students' self-reported perceptions rather than objective measures of courtroom performance. The intervention comprised three phases (preparation, simulation and debriefing) with anonymous questionnaires administered before and after the simulation (n = 18; 100% response rate). Post-trial, statistically significant improvements were observed across all measured domains, including confidence in presenting evidence, understanding of courtroom procedures, and communication with non-specialist audiences. Cross-examination was identified as the predominant challenge. Qualitative findings indicated gains in metacognitive awareness and a shift in professional identity toward understanding the expert witness as an impartial educator of the court. These findings suggest mock trial simulation shows promise as an educational intervention in forensic odontology, warranting investigation in larger, multi-institutional contexts.
Retained dental roots (ROV) represent a frequent but underexplored radiographic finding with clinical and forensic relevance. Their presence can potentially serve as valuable antemortem markers for postmortem identification. This study aimed to determine the prevalence and distribution of retained dental roots on panoramic radiographs in an Indonesian population and to assess their association with age, sex, and tooth region from a forensic odontology perspective. A total of 4796 digital panoramic radiographs obtained at the Universitas Airlangga Dental Hospital in 2024 were retrospectively reviewed. A retained root was defined as the loss of more than half of the vertical crown structure, following the INTERPOL AM Dental Data code (ROV). Descriptive and non-parametric statistical analyses were performed using Jamovi software (α = 0.05). Overall, 35.4% of patients presented with at least one ROV, with median values ranging from one to three roots across age groups. The number of ROVs increased significantly with age (p < 0.001) but showed minimal sex-related differences. Posterior molars, particularly mandibular first molars, exhibited the highest prevalence (9.7%), while mandibular first incisors showed the lowest (0.8%). Retained dental roots were a common radiographic finding that increased with age and predominantly affected the posterior sextants. Although not reliable for sex estimation, their distribution patterns and preserved root morphology hold forensic significance for antemortem-postmortem matching and potential DNA recovery. Integration of radiographic, clinical, and molecular data is recommended for future population-based forensic studies.
Postmortem microbial communities may provide useful information for forensic microbiology, but species-level and functional profiles across multiple cadaveric anatomical sites remain poorly characterized. Here, shotgun metagenomic sequencing was performed on 144 samples from six anatomical sites, including the oral cavity, nasal cavity, trachea, lung, colon, and anus, collected from 24 human cadavers. A total of 15,301,799,968 raw reads were obtained, and 6565 species were identified, and KEGG pathways were annotated at the L1, L2, and L3 levels. Species-level microbial composition differed significantly among anatomical sites. PERMANOVA with permutations blocked by individual identity showed that anatomical site was the dominant factor explaining microbial community variation (R2 = 0.3778, p = 0.001, q = 0.001), whereas postmortem interval did not show a significant independent effect within the 1-38-day interval. KEGG functional profiles also differed significantly among anatomical sites at the L2 and L3 levels, and 182 of 214 L3 pathways showed significant site-associated differences after false-discovery-rate correction. Pathway-level mixed-effect models further indicated that anatomical site remained significantly associated with most L3 pathways after accounting for postmortem interval, age, sex, cause of death, and repeated sampling from the same individual. Species-pathway correlation analysis identified significant taxon-function associations, but these were interpreted as correlative rather than direct evidence of species-specific functional contribution. Low-biomass sensitivity analyses indicated that respiratory-site results, especially lung and tracheal findings, should be interpreted cautiously because of high host DNA proportions and low non-host read counts. Inter-site shared occurrence and intra-site co-occurrence analyses further described distributional associations across anatomical sites. This study establishes a multi-site postmortem metagenomic reference framework for characterizing anatomical-site-specific microbial and functional patterns, offering insights into forensic microbiology and postmortem microbial ecology.
Child sexual abuse (CSA) is a serious public health and social problem, causing severe physical, emotional, and psychosocial harm to survivors. This retrospective, record-based, cross-sectional study aimed to assess the profile of CSA among child survivors attending the One Stop Crisis Centre (OSCC) at a tertiary care hospital from 2016 to 2020 and to examine associated sociodemographic characteristics and risk factors. A total of 62 medicolegal records were analysed. The majority of survivors were adolescent girls aged 12-18 years (64.5%), while 35.5% were younger than 12 years, with most belonging to rural or lower-middle socioeconomic backgrounds. Over half of the children experienced abuse lasting more than one week (51.6%) and multiple episodes (51.6%). Penetrative assault was reported in 79% of cases, and revictimisation occurred in 50%. In 82.3% of incidents, the assailant was a known individual. Genital injuries were documented in 58.1% of survivors, and external physical injuries in 48.4%. The timing of examination was frequently delayed, with 75.8% of cases assessed more than 24 h after the incident. Police referrals accounted for 53.2% of cases, reflecting increasing awareness of the POCSO Act and child protection resources. These findings underscore that CSA predominantly affects adolescent girls, often involves known perpetrators, and is associated with repeated abuse and genital injuries. The study highlights the critical need for timely reporting, prompt forensic evaluation, and comprehensive multidisciplinary care. Strengthening awareness, prevention strategies, and child protection mechanisms is essential to reduce the burden of CSA and provide effective support for survivors.