Čaplinskienė, Marija

Learning Objectives: Following this presentation, attendees will have gained a comprehensive understanding of impalement-related deaths and their mechanisms. Emphasis will be placed on the value of a multidisciplinary approach to case analysis Impact Statement: This presentation contributes to the forensic science community by underscoring the importance of meticulous crime scene inspection and a multidisciplinary forensic approach to the body, raising critical questions concerning the accidental versus suicidal nature of impalement events as well as implications for occupational safety and prevention. A comparative evaluation with current literature enhances the discussion and informs forensic practice. Introduction. Site inspections represent the initial and irreplicable step in corpse recovery. The involvement of a forensic pathologist in the early phases of investigation is crucial to ensure accurate collection of evidence and data. Impalement fatalities are rare in medico-legal practice.1 A literature review was conducted to explore the spectrum of injuries and scenarios that may lead to fatal or near-fatal impalement. 2 Case Report. A57-year-old male construction worker was found deceased at the base of a scaffold, exhibiting a penetrating injury to the anterior neck. Forensic examination of the scene revealed an iron stake, typically a plant support, with blood on its upper end, morphologically consistent with the neck wound. Autopsy, histological, toxicological, and instrumental analyses determined the cause of death to be passive impalement trauma to the anterior neck, resulting in tracheal rupture. Surveillance footage corroborated the accidental fall from the scaffold and the immediate, self-removal of the iron stake post-injury. Toxicology revealed blood alcohol positivity. Conclusion. This case highlights the diagnostic complexity of passive impalement trauma, as illustrated through comparative analysis and supported by existing medical literature. It emphasizes the critical role of forensic crime scene reconstruction in differentiating accidental events from suicidal acts. The multidisciplinary integration of pathology, toxicology, and video analysis proved essential in elucidating the sequence of events and determining the cause of death. Furthermore, the findings underscore the importance of stringent workplace safety measures and reinforce the value of interprofessional collaboration in forensic investigations. References: 1. Byard RW. A forensic evaluation of impalement injuries. Med Sci Law. 2018 Apr;58(2):85-92. doi: 10.1177/0025802418755588. Epub 2018 Jan 24. PMID: 29363383. 2. Padoan A.et al. Impalement injuries in forensic pathology: case studies and literature review. Legal Medicine. 2021.

Artificial intelligence (AI) is increasingly applied in medical image analysis, although its application in forensic pathology remains limited. The assessment of ligature marks in hanging deaths is challenging and relies on forensic expertise. This pilot study evaluated a deep learning approach for morphological classification of hanging-related ligature marks. Methods: A Convolutional Neural Network (CNN) was trained on a dataset of 404 standardized JPEG images obtained from forensic medicine atlases and classified into hanging-related ligature marks and non-hanging lesions, including strangulation and post-mortem artefacts. Following internal validation, the model was tested on an independent set of forensic case images provided by forensic pathology experts from Messina, Italy, and Vilnius, Lithuania. Images were annotated and reviewed by a team of two forensic pathologists, with final labels assigned by consensus using morphological criteria. Results: The CNN demonstrated encouraging classification performance with an F1-score of 0.81 ± 0.04, distinguishing hanging-related ligature marks from morphologically similar lesions. The methodological framework and image standardization criteria for AI-assisted forensic analysis were also established. Conclusions: AI-based image analysis may support the evaluation of ligature marks during external examinations. Nevertheless, forensic diagnosis requires the integration of autopsy findings, physical examination, and circumstantial evidence. Larger datasets and multicenter protocols are needed to further assess reliability and applicability.

Background: Fatal choking is a preventable cause of mechanical asphyxia that occurs more frequently among individuals with psychiatric disorders due to behavioural abnormalities, neurological comorbidities, and medication-related swallowing impairment. This review aims to highlight the clinical and forensic factors contributing to fatal choking and the importance of a multidisciplinary approach to its investigation. Methods: A systematic review was conducted according to PRISMA guidelines by searching PubMed, Scopus, and Web of Science. In total, 25 studies describing fatal choking in adults with psychiatric disorders and including medico-legal investigations were selected and analyzed. Results: Schizophrenia was the most frequently reported psychiatric condition, followed by bipolar disorder, depression, and dementia. Antipsychotics, antidepressants, anxiolytics, and other psychotropic drugs were recurrently associated with dysphagia and reduced airway protective reflexes. Food boluses represented the predominant obstructive material, although several unusual foreign bodies were documented. Virtopsy, autopsy, histological, and toxicological investigations consistently proved essential for confirming airway obstruction, reconstructing the mechanism of death, and identifying contributing clinical and pharmacological factors. Conclusions: Fatal choking in psychiatric patients is a multifactorial event requiring early risk assessment, preventive strategies, and comprehensive forensic evaluation to improve patient safety and ensure accurate determination of the cause of death.

Background and Objective: Unexplained infertility is a major challenge in reproductive medicine and requires advanced diagnostic approaches to identify the underlyingfactors accurately. This study aims to evaluate the utility of risk factor analysis and a genepanel in diagnosing unexplained infertility using the next-generation sequencing (NGS)technology. Our study aimed to characterize and identify risk and genetic factors associatedwith unexplained infertility. Materials and methods: A cohort of patients with unexplainedinfertility was comprehensively screened for risk factors and genetic variations using atargeted gene panel (10 couples with unexplained infertility (UI) and 36 fertile couples).108 articles were selected (58 on female infertility and 50 on male infertility) presentinggenes that may be associated with unexplained infertility. A gene panel for unexplainedinfertility was compiled based on the literature data. A customized virtual panel wascreated from the exome sequencing data. Results: In the female group, controls had a highermean age, while in the male patients, both groups were similar in terms of age. Both gendergroups had comparable BMI values. No significant associations (p > 0.05) between riskfactors and unexplained infertility were found when evaluating anthropometric parameters and other sociodemographic characteristics. In two male patients (20%), a moleculardefect was detected in NGS variants classified aspossible benign and probably benignIn particular, missense variants were identified in the UGT2B7 and CATSPER2 genes, Amolecular defect classified as probably damaging was found in five female patients (50%).In particular, missense variants were identified in the CAPN10, MLH3, HABP2, IRS1, GDF9,and SLC19A1 genes. Conclusions: The study emphasizes that unexplained infertility is oftenrelated to mechanisms beyond causative mutations and highlights the need for integrativegenomic research involving broader gene panels and multi-faceted approaches, includingtranscriptomics and epigenetics, to uncover latent genetic predispositions.

Abstract Background: Fatal hemorrhage from ruptured varicose veins is a rare event that may mimic violent death given the quantity and distribution of blood at the scene. Accurate determination of cause and manner of death requires careful scene investigation, autopsy, histology, and ancillary methods such as bloodstain pattern analysis (BPA). Case presentation: We describe an 80-year-old woman found deceased at home, with evidence of extensive bloodstaining, no significant external trauma except a small laceration over a varicosity, and ultimately a ruptured branch of the small saphenous vein. The cause of death was hemorrhagic shock due to spontaneous varicose vein rupture. Discussion: This case reinforces the importance of integrating death scene findings (including shoe prints, bloodstain distribution), anatomical dissection, histology, and toxicology to exclude non-natural causes. We also review recent similar cases in the literature, noting risk factors, presentation, and common pitfalls. Conclusions: Forensic investigations of massive bleeding in elderly, isolated individuals should include varicose vein rupture in the differential. A multidisciplinary approach is essential to avoid misclassification of manner of death.

Abstract Introduction: Charred bodies represents a significant challenge for forensic pathologists due to the destructive effects of fire on human remains. Although most fire-related deaths are accidental, cases of suicide and homicide are not uncommon. Case Report: We report a peculiar case of a severely burned body discovered inside a torched vehicle. Under judicial investigation, a full autopsy was performed, including macroscopic and microscopic examination of key anatomical structures: the inspection of oral cavity revealed no soot deposits; a foreign object (a chestnut) was found anterior to the epiglottis, though not lodged within the glottis; no thermal injuries or soot were observed in the upper or lower airways. Histological analysis excluded thermal damage at the alveolar–capillary interface. Alveolar spaces appeared both hyperinflated and ectatic, likely due to septal rupture, suggestive of acute pulmonary emphysema and multiorgan congestion. Carboxyhemoglobin levels were below 5%, indicating a low level which did not support intravital inhalation of combustion gases. Based on the comprehensive medico-legal findings, the cause of death was attributed to an asphyxial mechanism. It was further demonstrated that the burning of the body occurred post-mortem. DNA extraction from two dental specimens enabled positive identification of the victim. Subsequent investigations confirmed the case to be a femicide. The perpetrator, following a domestic altercation over jealousy, suffocated his young wife and attempted to simulate accidental choking by placing a chestnut in her mouth. He then staged a vehicular fire to mimic a fatal accident. Conclusions: The case underlines that a multidisciplinary forensic approach is essential, and must integrate different methodologies and the analysis of both circumstantial evidence and scene investigation.

Introduction. Despite being relatively rare in our country, murder-suicide phenomena have garnered increasing media attention over the years. However, actual data on their prevalence and characteristics remain limited. This study aims to describe and characterize all murder/suicide events reported at the Institute of Forensic Medicine in the Province of Messina, with a particular focus on distinguishing between cases of filicide/suicide and dyadic deaths. Materials and Methods. A retrospective observational analysis of judicial cases from 2018 to 2023 was conducted. Injuries were primarily localized to the head, neck, and chest for women, and to the head for men. In the case of filicides, death occurred through an asphyxiation mechanism, followed by the mother’s suicide by hanging or falling. Conclusion. Within the scope of the medical examiner’s activities, it is clear that acquiring more information through a standardized technical investigation and adopting a uniform approach could enhance the quality of the forensic service provided daily. This improvement, which would be in the interest of institutions and civil society, could be achieved through the sharing of procedures at both national and international levels.

Title: EtG quantification in hair and different reference cut-offs in relation to various pathologies: a review Authors: Triolo Valentina1; Roberto Buscemi2; Gioè Simona1; Spanò Mario1-2; Marija Čaplinskiene; Argo Antonina1-2. Author Affiliations: 1Policlinic Hospital, AOUP “P. Giaccone”, 2University of Palermo, Italy. 3State Forensic Medicine Service, Mykolas Romeris University, Vilnius, Lithuania. Abstract: The purpose of this article is to describe, through accurate bibliographic research, the main and most frequent pathological conditions that may interfere with EtG quantification in hair and verify whether different reference cut-offs in relation to various pathologies have been identified in scientific literature. In fact, in-depth knowledge of these pathologies would allow a more appropriate interpretation of obtained data and rule out false positives or false negatives, with special attention to reported abstinence cases. Checking and quantifying chronic alcohol consumption is important for forensic and clinical purposes, since it affects possible lawsuits and/or care decisions concerning a person with suspicion chronic alcohol intake. It has implications in workplace, e.g. suspension of driver’s or pilot’s license, in childcare activities, or in care settings such as insertion or removal from liver transplantation’s waiting lists etc.. Furthermore, from a clinical point of view, monitoring of alcohol withdrawal in alcohol-dependent patients can affect the evaluation of treatments’ effect1. Markers are required to identifying and quantifying alcohol consumption to monitor alcohol abstinence /consumption. These markers should have the following characteristics: 1. Differentiate between “at-risk” drinkers, “non-risk” drinkers and subjects in withdrawal phase; 2. Detect alcohol consumption/abstinence over a long period of time (i.e., after complete alcohol elimination from the body)2. Directs and indirect markers are available. However, some of these show low specificity and sensitivity for detecting alcohol consumption, although they are widely available and relatively inexpensive. For this reason, some Authors proposed to combine them to ensure greater specificity. Since the 2000s ethyl glucuronide (EtG) has been identified as an excellent direct-type reference marker. EtG is a non-volatile, nonoxidative, hydrophilic, and stable ethanol phase II metabolite, with a molecular weight of 222 g/mol. This metabolite is produced through ethanol glucuronidation by UDP-glucurontransferase, by adding a glucuronic acid moiety to the ethanol molecule3. EtG can be extracted in different biological matrices: blood and urine samples (which only allow alcohol detection in short period), or keratin matrices, such as hair and nails. Therefore, besides good sensitivity and specificity, a big advantage of this marker is to verify chronic alcohol intake over a long period of time, which can range from months to years depending on samples length, through its quantification in keratin matrices (mostly hair). Unfortunately, many of these markers, including EtG, can undergo alterations due to various factors: 1. Intrinsic factors, e.g., gender, age, comorbidities that aren’t related to alcohol consumption which increase enzyme levels; 2. Extrinsic factors, e.g., cosmetic treatment and/or hair hygiene etc. In EtG case, the detection of its concentrations in hair depends on time to exposure and concentrations to blood EtG; in turn, blood EtG concentration is strongly influenced by individual metabolism. Consequently, all pathological alterations that affect ethanol metabolism must be considered potentially as confounding factors on hair EtG concentration and, therefore, the final data, used for both forensic and clinical purposes, must be interpreted with great caution. According to scientific literature, the main and most frequent pathologies that can influence EtG concentration in hair are liver and kidney diseases, and diabetes. In example, UDP-glucuronosyltransferase (or UGTs, enzyme responsible for the biosynthesis of saccharides) alteration, typical of some liver disease such as Gilbert’s syndrome, causes alterations on hair EtG levels4. References 1. F. Pragst, M. Rothe. B. Moench, M. Hastedt, S. Herre, D. Simmert, Combined use of fatty acid ethyl esters and ethyl glucoronide in hair for diagnosis of alcohol abuse: Interpretation and advantages. Forensic Sci. Int. 196 (2010) 101-110 2. H. Andresen-Streichert, G. von Rothkirch, E. 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Ethyl Glucuronide Elimination Kinetics in Fingernails and Comparison to Levels in Hair. Alcohol and Alcoholism, 2017, 52(5) 580–586 41. M.F. Bastiania, L.L.F. Lizota, A.C.C. Da Silvaa, R.Z. Hahna, S.S. Driesc, M.S. Perassolo, M.V. Antunesa, R. LindenaImproved measurement of ethyl glucuronide concentrations in hair using UPLCMS/MS for the evaluation of chronic ethanol consumption. Forensic Science International 306 (2020) 110071 42. V. Pirro, D. Di Corcia, F. Seganti, A. Salomone, M. Vincenti. Determination of ethyl glucuronide levels in hair for the assessment of alcohol abstinence. Forensic Science International 232 (2013) 229–236 Highlights: Monitoring alcohol consumption is important for forensic and clinical purposes concerning a person with suspicion chronic alcohol intake. Since the 2000s ethyl glucuronide (EtG) has been identified as an excellent direct-type reference marker. The article will describe pathological conditions that may interfere with EtG quantification in hair and reference cut-offs in relation to various pathologies.