搜索结果：Forensic toxicology

Forensic pathology and forensic toxicology are experiencing one of the most significant scientific transformations since the introduction of molecular biology into biomedical research [...].

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.

Quality assurance in medicolegal (ML) reporting is essential to ensure accuracy, consistency, and compliance with legal and scientific standards. Since forensic opinions significantly influence judicial decisions, it is crucial to uphold high standards. In the Arab region, there are notable differences in forensic medicine practices among countries, emphasizing the urgent need for unified standards. Therefore, this initiative aims to improve the quality of ML reporting by proposing a standardized training and auditing framework based on international best practices, tailored to the realities of Arab forensic institutions. A key part of this article is developing a training framework grounded in best practices to unify forensic medical examiner competencies and reduce variability. At the same time, a specialized auditing framework has been created for senior forensic leaders to improve institutional accountability. This includes implementing a structured auditing protocol that uses newly adopted standardized checklists to assess report quality and detect non-conformities. Additionally, institutional leaders are encouraged to systematically investigate the root causes of substandard opinions within their organizations using Root Cause Analysis (RCA) methodology. Identifying these root causes offers opportunities for improvement. We recommend implementing this initiative through a Training of Trainers (TOT) model. This method enables institutional leaders and senior practitioners to disseminate standardized practices across all levels effectively. The multiplying effects of this initiative are vital for enhancing quality assurance and promoting continuous improvement within forensic practice across Arab countries.

Truncus arteriosus (TA) is a rare conotruncal malformation in which a single arterial trunk supplies the systemic and pulmonary circulations. Severe left ventricular hypoplasia in association with TA is exceptional and creates a complex neonatal circulatory disorder. In a forensic setting, such malformations may be encountered as unexpected neonatal deaths, particularly when antenatal diagnosis is absent. We report the forensic autopsy findings of a term male neonate with a birth weight of 4260 g, born to first-cousin parents after a pregnancy without regular antenatal follow-up. Respiratory distress developed on the third day of life, and the infant died on the seventh day despite intensive care. Clinical records described a complex congenital cardiac anomaly with single-atrium/single-ventricle physiology. Autopsy demonstrated Collett-Edwards type II TA, a markedly hypoplastic aorta, a single common atrium consistent with complete atrial septal defect, absence of a ventricular septal defect, severe left ventricular hypoplasia, a bileaflet atrioventricular valve, a tricuspid truncal valve, and a widely patent ductus arteriosus acting as the main conduit to the aortic arch. The coronary arteries originated from the hypoplastic aorta. Histology showed multifocal acute ischemic myocardial injury and hepatic hemorrhagic necrosis. Toxicological analysis did not identify a toxic cause of death. This case illustrates a fatal and exceptionally rare association of type II TA, common atrium, and severe left ventricular hypoplasia. The findings support the value of complete forensic autopsy, histopathology, toxicology, and careful clinicopathological correlation in unexpected neonatal death. The case also highlights the importance of standardized cardiac dissection and photographic documentation in neonatal forensic autopsies involving complex congenital heart disease.

The growing use of e-cigarettes as vehicles for illicit drug delivery has created an urgent challenge for forensic surveillance and public health in East Asia. This study analyzed 496 e-liquid samples seized by law-enforcement agencies in Eastern Taiwan (January-July 2025) using a full-scan GC-MS workflow validated in accordance with ANSI/ASB forensic toxicology standards. Overall, 80.8% of samples (n = 401) tested positive for psychoactive substances, with 35.4% (n = 142) containing polydrug mixtures. Etomidate dominated detections (87.0% of positive cases), followed by isopropoxate (25.4%), ketamine (9.7%), metomidate (8.5%), propoxate (7.2%), and methamphetamine (7.2%); cannabinoids (Δ9-THC and Δ8-THC) were comparatively rare (2.0% each). Predominant polydrug profiles included sedative-analog, sedative-dissociative, and sedative-stimulant combinations of acute toxicological concern. The present Eastern Taiwan dataset revealed a distinct etomidate-analog-centered adulterant profile, in marked contrast to the cannabinoid-dominated patterns reported in published seizure datasets from North America, Europe, and the Middle East. To our knowledge, seized-e-liquid surveillance data of this scale have not previously been reported for Eastern Taiwan. These findings highlight the value of seized-material toxicology as an early-warning component of forensic surveillance and support adaptive, class-level regulatory responses to the rapidly evolving landscape of designer-anesthetic vaping.

Accidental death, suicide, and homicide have resulted from the intravenous injection of propofol. There have been at least 30 accidental victims of propofol self-administration; more than 75% were medical workers who chronically used it as a recreational drug. At least 13 of the 14 individuals who committed suicide by injecting themselves with propofol were either a physician or a nurse. A fatal injection of propofol was used to murder a minimum of 10 people; for many of these deceased persons, neither the drug nor homicide was initially suspected at the time of death. Therefore, the discovery of an intravenous needle mark wound, or additional clinical history, may lead to further evaluation of the death scene or the victim or both and result in the appropriate toxicology studies of the deceased person, which can establish that the cause of death was from propofol and the manner of death was homicide. A meticulous and thorough examination of the cutaneous and mucosal surfaces of a dead person may provide the essential forensic dermatology clue to either the cause of death (which is the specific illness, pathophysiologic aberration, or trauma that results in the individual's dying) or the manner of death (which is the situation of how the death occurred, such as the consequence to an accident, a suicide, a homicide or a natural sequela of disease, aging or bodily malfunctioning) or both. In summary, propofol intravenous injection can result in accidental death, suicide, or homicide; the number of needle mark wounds can be multiple or solitary. A thorough search of the death scene and a comprehensive forensic examination of the victim may be useful in establishing the manner of death when the cause of death has been attributed to propofol injection. The intent of this paper is to provide a comprehensive narrative forensic review of propofol deaths from accidents, suicides, and homicides.

Background/Objectives: Sexual offences remain a global challenge, disproportionality affecting developing and conflict-stricken countries. Differential DNA extraction (DDE) is standardly applied to intimate swabs collected in these cases to separate and purify sperm and epithelial fractions ahead of DNA profiling. Whilst DNA purification steps using magnetic bead technology are routinely automated in general forensic workflows, the separation step within DDE workflows usually relies on centrifugation, which is challenging to automate in a high-throughput manner. This proof-of-concept study aimed to develop a novel method to separate sperm and epithelial fractions using magnetic bead technology to enable a fully automated and high-throughput DDE workflow. Methods: First, the Macherey-Nagel NucleoMag® Forensic DNA kit's protocol for forensic samples was modified to be DDE-based, and different magnetic beads for the separation and purification steps were assessed on mock sexual offence samples. Once a working protocol was established, variables within the protocol were systematically adjusted to improve quality metrics and DNA profiling outcomes. The top-performing method was then assessed with decreased input biological material and on a post-coital swab. Results: The DDE protocol developed in this study identified Cytiva SeraSil-MagTM magnetic beads to successfully separate epithelial and sperm fractions, which will enable a fully automated and high-throughput DDE workflow for the first time. DNA extracted from the sperm fraction of mock sexual offence samples prepared with 1 μL of semen input yielded a mean Y-target DNA yield of 25.04 ng (SD = 15.11 ng), a median M:F ratio of 1:3.53 (range = 1:1.08-1:22.46) and a mean log(LR) of 12.01 (SD = 5.41) when the female contributor's DNA profile was unknown. Conclusions: The proof-of-concept of a magnetic bead-based DDE method was successfully demonstrated across a range of different semen input volumes, and the benefit of information-preserving genotyping using the TrueAllele® system was demonstrated.

Sudden death in childhood is a particularly demanding subject of forensic investigation, especially when a known genetic syndrome coexists. We present the case of the sudden death of a three-year-old female toddler diagnosed with Rubinstein-Taybi syndrome, who was found pulseless and apneic at home and pronounced dead shortly after being transferred to a children's hospital. A comprehensive forensic investigation was conducted, including an autopsy, histological examination, and toxicological analysis. The histopathological findings revealed extensive lesions of severe bronchopneumonia with necrosis, abscess formation, and interstitial pneumonitis, without evidence of trauma or toxic etiology. The cause of death was attributed to severe respiratory infection in a child with Rubinstein-Taybi syndrome. Although immunological abnormalities have been described in some patients with Rubinstein-Taybi syndrome, no direct immunological evaluation was available in the present case. The case highlights the importance of individualized evaluation of pediatric deaths and the correlation of clinical, genetic, and pathologic data.

Background/Objectives: Antidepressants are widely prescribed medications that may affect psychomotor performance and driving ability depending on their pharmacological profile. This study investigated the prevalence and patterns of antidepressant use among drivers undergoing forensic toxicological evaluation and explored their potential implications for road safety. Methods: An observational study was conducted on n = 6316 drivers undergoing forensic toxicological assessment following licence suspension for driving under the influence (DUI) of alcohol and/or drugs between January 2023 and December 2025. Reported antidepressants were classified into selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), serotonin antagonist and reuptake inhibitors (SARIs), tricyclic antidepressants (TCAs), norepinephrine-dopamine reuptake inhibitors (NDRIs), noradrenergic and specific serotonergic antidepressants (NaSSAs), and monoamine oxidase inhibitors (MAOIs). Distribution patterns were analysed descriptively and discussed considering the available literature. Results: Antidepressant use was reported by n = 132 participants (2.1%). SSRIs were the most common class (44.0%), followed by SNRIs (26.5%) and SARIs (17.4%). TCAs (6.1%), NDRIs (3.7%), and NaSSAs (2.3%) were less common, while no MAOI use was reported. Among antidepressant users, n = 28 individuals (21.2%) tested positive for other psychoactive substances, including benzodiazepines, cocaine, and cannabinoids. Conclusions: The use of antidepressants was relatively uncommon in the study population. However, clinical evaluation remains important, particularly at the start of treatment and during dose adjustments to determine the potential for an increased risk while driving. Further studies integrating toxicological analyses and clinical data are needed to better define the relationship between antidepressant exposure, polysubstance use, and road safety.

A bifid cardiac apex is a rare congenital anomaly resulting from the nonunion of the right and left ventricles at the cardiac apex, producing two distinct apical projections with a cleft between them. This article illustrates two cases with a bifid apex: the first with a deep cleft and the other with an apparently superficial indentation. Dissection of the heart confirmed separation of the myocardium of both ventricles at the apex. Both cases were free of other congenital anomalies, and the cause of death was unrelated to the bifid apex. We also present a case of a prominent apical notch that might simulate a bifid apex; however, dissection demonstrated myocardial continuity. In addition, we summarized ten autopsy cases of bifid apices reported in the literature. Five cases had other concomitant fatal congenital cardiac anomalies. In four cases, a bifid apex was the sole congenital anomaly, and the patients died from poisoning, sickle cell disease, road traffic accidents, and drowning. In one case, the death was attributed to myocarditis, which was also unrelated to the bifid apex. The incidental discovery of a bifid apex at autopsy indicates its benign nature. Therefore, forensic medicine professionals must not attribute death to a bifid apex and must determine the actual cause of death. Most importantly, the presence of a bifid apex mandates a search for potential associated congenital anomalies through comprehensive cardiac dissection.

This article presents a fatal case of local anesthetic systemic toxicity (LAST) in a healthy 26-day-old male following a ritual circumcision. Bupivacaine, a local anesthetic, was used to induce a dorsal penile nerve block and a ring block. No other medications were administered. Postoperatively, the mother noticed the neonate had become sleepy. She allowed him to rest, assuming he was asleep. Two hours later, she attempted to awaken him but found him dead. Postmortem examination revealed a circumcised penis with a localized hematoma, suggesting inadvertent vascular injection of bupivacaine. Dissection revealed generalized cerebral edema and focal subarachnoid hemorrhage. Histopathological assessment of brain tissue revealed perineuronal vacuolations in the brain cortex consistent with cerebral edema. The watershed region demonstrated perivascular hemorrhage, associated with spongiosis and vacuolation of the neuropil, and focal neutrophilic perivascular infiltrates. Histological sections of the leptomeninges revealed focal subarachnoid hemorrhage with erythrocyte extravasation and inflammatory cell infiltration. Regarding toxicological analysis, the bupivacaine concentration in peripheral blood was 5 µg/mL. A thorough post-mortem examination did not reveal signs of pathology or trauma. The cause of death was assumed to be LAST, based on the temporal association between the death and the circumcision performed under this local anesthetic, the detection of bupivacaine in blood, and the pathological findings. While there are no pathognomonic pathological features of LAST, the pathological results may align with hypoxic-ischemic brain injury. Severe hypoxia could develop in bupivacaine systemic toxicity due to direct inhibition of the respiratory center or to fatal arrhythmia and cerebral hypoperfusion. KEY POINTS: • This article presents a case of fatal bupivacaine toxicity in a neonate following circumcision. • Postmortem examination revealed a circumcised penis with a localized hematoma. • Pathological examination revealed cerebral edema, inflammatory reaction, and focal subarachnoid hemorrhage. • Bupivacaine was detected in peripheral blood at a concentration of 5 µg/mL. • The pathological findings suggest hypoxic-ischemic brain injury due to bupivacaine toxicity.

The illegal drug trade has changed dangerously since xylazine, a veterinary α2 adrenergic agonist, has become a common additive in illegally made fentanyl, creating the "tranq dope" mix. Together, they cause a synergistic central nervous system and respiratory depression that is more severe than that observed with opioid toxicity alone. This raises important questions about awareness, stigma, and clinicians' responses. A scoping review was performed in accordance with PRISMA-ScR guidelines, utilizing a PCC-structured research question. Studies examining fentanyl and/or xylazine exposure with clinically or toxicologically significant data were searched in PubMed and ScienceDirect. 38 studies were included, most from North America, including case reports, retrospective studies, narrative reviews, animal studies, qualitative research, and toxicological analyses. Co-exposure to fentanyl and xylazine has been linked to severe necrotic cutaneous ulcers, unique postural phenomena like the forward-flexed "fentanyl fold," acute muscle rigidity, including Wooden Chest Syndrome, and synergistic respiratory depression. Naloxone reverses the opioid component but does not counteract the sedative effects of xylazine, making overdose management more difficult and necessitating multimodal strategies like wound care, oxygenation support, and increased drug-checking services. Exposure to fentanyl-xylazine calls into question established models of opioid overdose and necessitates coordinated clinical and public health interventions. To combat this rapidly evolving threat, stigma must be reduced, harm reduction infrastructure expanded, and prospective research funded.

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.

Targeted and untargeted mass spectrometric analyses of urine, a preferred matrix for toxicological screening, require comprehensive spectral libraries of drug metabolites. To detect new synthetic cannabinoids (SCs), biomarkers for newly emerging compounds must be incorporated rapidly. Unfortunately, reference standards for metabolites of new psychoactive substances (NPS) such as SCs are scarce. Since parent SCs are rarely detectable in urine, elucidating their metabolism poses a significant challenge for forensic toxicology laboratories. Untargeted high-resolution mass spectrometry (HRMS) approaches, often complemented by in silico methods, are increasingly vital to forensic toxicology and metabolomics. A pooled human liver microsome (pHLM) assay was used for in vitro generation of phase I metabolites of three prevalent SCs (ADB-BUTINACA, MDMB-BUTINACA, and MDMB-4en-PINACA). Analysis was performed by trapped ion mobility spectrometry-time-of-flight mass spectrometry (timsTOF-MS) using parallel accumulation serial fragmentation (PASEF) acquisition and MetaboScape software with the T-ReX (time-aligned region complete extraction) 4D workflow including in silico metabolite prediction, fragmentation, and collision cross section (CCS) forecasting. In addition, hydrolyzed and nonhydrolyzed SC-positive urine samples were reanalyzed with this workflow. Results showed successful annotation of predicted metabolites for all three SCs, including monohydroxylations and ester hydrolysis. Qualitative pHLM and urine findings were in good agreement. Compound-specific and most abundant in vivo metabolites were incorporated into a targeted UHPLC-QTOF-MS method to analyze 42 urine samples from the casework. Although complex multistep biotransformation reactions (e.g., ADB-BUTINACA dihydrodiol formation) continue to pose a challenge for in silico prediction, this approach is significantly less time-consuming and less labor-intensive than manual evaluation of known metabolic patterns.

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.

Background in forensic toxicology, the detection of pharmacologically active exogenous substances is routinely performed. Interpretation of analyte concentrations must consider multiple variables, markedly affected by diffusion and degradation. These factors complicate toxicological assessment and have stimulated interest in alternative substrates. To assess the toxicological informativeness of cerebrospinal fluid (CSF) through comparison with standard post-mortem matrices, and to investigate whether quantitative relationships exist between CSF and femoral blood concentrations of cocaine and benzoylecgonine. CSF and standard toxicological matrices were collected from 10 forensic cases and three controls. All specimens underwent solid-phase extraction followed by HPLC-Orbitrap mass spectrometry for detection and quantification of cocaine, benzoylecgonine, and other relevant substances. Cocaine and benzoylecgonine were consistently detected in cerebrospinal fluid whenever present in standard matrices, indicating their passage across the blood-brain barrier and supporting CSF as a reliable alternative post-mortem matrix. However, the limited sample size and absence of temporal or clinical information precluded robust quantitative interpretation, highlighting the need for larger studies to clarify pharmacokinetic relationships. Cocaine and benzoylecgonine are detectable in cerebrospinal fluid when present in peripheral blood, but no stable proportional relationship allowing quantitative extrapolation from CSF to femoral blood could be established.

Nitazenes are highly potent synthetic opioids of increasing concern in clinical and forensic toxicology, thus underscoring the need for sensitive and selective analytical methods for biological specimens. This study describes the development and validation of an LC-MS/MS method for the quantification of nitazene analogs and related metabolites in plasma using micro-QuEChERS sample preparation. The validated concentration range was 0.05-20 ng/mL, with coefficients of determination R2 > 0.99. The limit of detection (LOD) was 0.025 ng/mL, and the lower limit of quantification (LLOQ) was 0.05 ng/mL. Bias ranged from -2.6% to 15.7%, within-run precision from 3.4% to 12.7%, and between-run precision from 4.4% to 14.9%, as evaluated at three quality control levels. Matrix effects and recovery were analyte-dependent but compatible with satisfactory overall validation performance. No interferences or carryover were observed. Method applicability was demonstrated in an authentic intoxication case, in which N-pyrrolidino protonitazene was quantified at 1.4 ng/mL, representing, to our knowledge, the first clinical case reported in Brazil. The case was clinically characterized by severe opioid toxicity requiring repeated naloxone administration. The proposed method combined low sample volume, simple sample preparation, and suitable analytical performance for targeted analysis of emerging nitazene compounds. These findings support the use of micro-QuEChERS and LC-MS/MS as a practical approach for targeted nitazene quantification in clinical and forensic toxicology.

Despite the routine use of postmortem lividity (PML) in forensic practice to estimate the postmortem interval, its temporal progression remains inconsistently defined across the literature. This study aimed to synthesize the available evidence on the timing of lividity appearance, complete formation, and fixation, and to evaluate the forensic reliability of these parameters. A systematic review and meta-analysis were conducted following PRISMA guidelines, with protocol registration in PROSPERO. A systematic literature search was conducted across five major databases up to December 2025. Eligible studies included original research on human cadavers assessing external PML in relation to time since death. Data extraction and quality assessment were performed independently by two reviewers. Random-effects meta-analysis using REML estimation was applied to derive pooled estimates for each stage of lividity progression. Eleven studies (n = 1,789) were included qualitatively, with eight studies eligible for quantitative synthesis. The pooled mean times were 3.56 h for appearance, 5.80 h for complete formation, and 10.33 h for fixation. However, extreme heterogeneity was observed across all components (I2 = 99.9%), with wide prediction intervals. The observed variability was attributable to inconsistent definitions, heterogeneous assessment methods, and inadequate control of confounding factors. Though a general chronological sequence of PML progression is observed, the substantial heterogeneity limits the reliability of fixed timelines for estimating postmortem interval. The findings highlight substantial uncertainty in traditional textbook timelines and emphasize the need for standardized, objective approaches to enhance the forensic utility of postmortem lividity.

The use of sweat as an alternative specimen for biological analyses is well recognised and has been successfully applied in forensic toxicology and clinical health assessments. Compared to conventional matrices such as urine and blood, sweat samples are easy to obtain, are less invasive and present a reduced number of endogenous interferents. Advanced analytical techniques in sweat analysis have considerably expanded capabilities in the isolation of drugs, detection of complex metabolites and identification of biomarkers. The ability to detect a broader range of substances with greater sensitivity and accuracy, improved speed and efficiency and enhanced reliability present opportunities for non-invasive chemical sensing in sweat for a much broader scope of metabolites than traditionally recognised. The year 2023 was marked by an evolutionary step in artificial intelligence (AI), opening the door for improved pattern analysis and classification algorithms to improve diagnostic precision and therapeutic accuracy. It is anticipated that when combined with advances in the performance and miniaturization of integrated circuits, stretchable electronics, wireless connectivity and longer battery life, a substantial impact is expected on the development of wearable biosensor devices to provide meaningful information to the physiology of end-users, expanding its role in personalized medicine and health monitoring. Therefore, the aim of this review is to provide an integrative overview of sweat as a diagnostic and monitoring biofluid by first discussing traditional methods in clinical and forensic applications. Recent advancements in sweat biomarker detection are then highlighted, followed by an evaluation of sweat's potential for real-time physiological monitoring.