Reviewing postmortem photographs is routine in forensic pathology. Although standard photographic techniques are used, sorting postmortem photographs can be overly time-consuming, especially when reviewing large quantities of photographs. Artificial intelligence may assist in identifying body parts/locations but is challenged in determining spatial relationships such as sidedness, angle, and distance/depth. Metadata stored in modern digital cameras provides physical data that would assist in determining this information, which can be critical in the legal setting. This proof-of-concept study used photograph metadata and artificial intelligence to develop a tool to sort postmortem photographs using living volunteer subjects. This "tool" automatically sorts through general, close-up images (hands, eyes, face, and hands) and mock injury (with a scale) photographs. The study compared using photograph metadata and artificial intelligence in different proportions (hybrid photograph metadata and artificial intelligence vs. artificial intelligence alone). Results demonstrated that using both metadata and artificial intelligence for different tasks was more accurate and efficient than using artificial intelligence alone.

Gelatin-based phantoms are commonly used as soft-tissue simulants in wound ballistics research, yet MRI has not previously been applied for volumetric analysis in this setting. This study compared permanent cavity volumes measured on CT using soft and hard-kernel reconstructions (CTsoft, CThard) and MRI using 3D T1 and T2-weighted sequences (MRIT1, MRIT2) in 20 gelatin head phantoms shot with different ammunition types. Volumes were segmented manually and evaluated using correlation and Bland-Altman analyses. CT-MRI comparisons showed small mean biases (-1.07 to 3.03 cm3) but wide 95% limits of agreement (LoA), ranging from -22.1 to 19.9 cm3 depending on the modality pair, corresponding to potential deviations of approximately ±90% to 100% of a typical cavity volume. The closest agreement was observed for CThard-MRIT1 and CTsoft-MRIT2, while MRIT1-CTsoft exhibited the widest LoA. Metallic fragments did not impair segmentation, whereas air-filled regions produced susceptibility-related signal voids on MRI. Overall, CT and MRI both allow reliable visualization and measurement of permanent wound channels, but variability between modalities limits their interchangeability for precise volumetry in individual cases.

Fatal anaphylaxis caused by stings from Hymenoptera insects remains challenging to diagnose postmortem owing to the lack of specific pathologic findings and the influence of postmortem changes on biochemical markers. Herein, we report a rare forensic case involving a 79-year-old woman who was found deceased with numerous hornet stings. Autopsy revealed severe laryngeal edema with substantial narrowing of the airway and extensive subcutaneous hemorrhage at the sting site. Postmortem femoral blood analysis revealed markedly elevated tryptase and histamine levels, indicating mast cell degranulation. There was no evidence of traumatic injury, resuscitation, or acute cardiac pathology. Despite the unusually high number of stings, toxic envenomation was excluded based on the biochemical profile and absence of systemic organ damage. This case highlights the forensic importance of integrating scene investigations, autopsy findings, and postmortem biochemistry to differentiate anaphylactic shock from venom toxicity in cases of death involving multiple stings. Overall, this study offers an efficient approach for postmortem diagnosis of fatal anaphylaxis in complicated sting-related deaths.

Motor vehicle collisions are a common cause of fatalities in the United States, and remain a significant public health concern. This study aims to analyze crash characteristics in accidental traffic fatalities. All accidental traffic fatalities reported to the Bexar County Medical Examiner's Office from January 1, 2011, to December 31, 2024, were reviewed. Demographic information and crash details were extracted, and statistical analysis was performed utilizing the Student t test (continuous variables) and Pearson χ2 (categorical variables). There were 2088 fatalities identified that met the inclusion criteria. Of those, 1125 involved motor vehicles, 311 motorcycles, 46 bicycles, and 606 pedestrians. The decedent ages ranged from 0 to 92 years, averaging 40 years, and included 1536 males and 552 females. Among motor vehicle deaths, 847 were drivers, and 270 were passengers. Decedent vehicles included 493 sedans, 225 pickup trucks, 275 sport utility vehicles (SUVs) and vans, 55 sports cars, and 34 commercial trucks. Crashes involving sedans showed significantly more seat belt use and airbag deployment and had fewer ejections; SUVs showed significantly less seat belt use and more ejections. There was a higher proportion of male ejections in SUVs compared with females.

Cannabinoid positivity in motor vehicle collision (MVC) fatalities is a topic of public interest, particularly as cannabis legalization expands. In Connecticut, recreational cannabis legalization in 2021 raised questions about impairment in fatal motor vehicle crashes. A retrospective study using Connecticut Office of the Chief Medical Examiner (CT OCME) data investigated MVC fatalities between 2018 and 2024, providing 3.5 years of data before and after legalization. We examined 1168 driver, 380 pedestrian, and 52 suicide fatalities. For the drivers, cannabinoid positivity increased from 32.8% prelegalization of cannabis to 37.9% postlegalization (P=0.0789). There was a statistically significant increase in cannabinoid-positive motorcyclist deaths following legalization. For pedestrians, cannabinoid positivity increased from 11% prelegalization to 20.6% postlegalization (P=0.016). Multidrug detection was common in cannabinoid-positive cases, most frequently with ethanol. This study demonstrates a rise in cannabinoid positivity in driver and pedestrian MVC fatalities in Connecticut after cannabis legalization. The findings suggest cannabis may play a growing role in MVC fatalities, and/or a demonstration of greater cannabinoid use following legalization. The challenges with interpreting cannabinoid concentrations and the multidrug findings complicate the ability to attribute cannabinoid use to impairment. These data, however, are useful for understanding and responding to evolving drug trends in traffic fatalities.

Air embolism is an uncommon but well-recognized cause of sudden death, most frequently encountered in iatrogenic settings. Traumatic air embolism is rare and typically associated with injuries of the head, neck, or thorax. We report an exceptional occupational fatality caused by massive systemic air embolism following penetrating facial trauma. A high-pressure industrial pump component ruptured and was propelled into the worker's right infraorbital region, producing fractures of the orbital floor and skull base with laceration of the right cavernous and sigmoid venous sinuses. Autopsy revealed extensive intravascular and extravascular gas throughout the body, including the heart, abdominal tissues, and subcutaneous planes. Gas aspirated from the right atrium was analyzed by gas chromatography-mass spectrometry and demonstrated an air-like composition consisting of nitrogen, oxygen, and carbon dioxide. No alternative lethal, traumatic, or natural pathology was identified. This case highlights a rare anatomic portal for the forced entry of air into the venous system. It further demonstrates the value of combined autopsy, radiologic, and chemical analyses in the forensic diagnosis of fatal air embolism.

There are no legal regulations regarding the handling of forensic stored samples obtained during medicolegal autopsies in Japan. Therefore, this study surveyed the attitudes of forensic doctors and criminal retrial lawyers to examine the appropriate management and handling of forensic stored samples derived from medicolegal autopsies. A questionnaire was distributed to 75 forensic doctors and 43 criminal retrial lawyers in Japan. Responses were received from 34 doctors and 21 lawyers. While 73.5% of the doctors believed that they should manage the specimens, 47.6% of the lawyers thought that a public third-party organization should manage it. Regarding the preservation of frozen samples, nearly 90% of the lawyers responded that they should be preserved permanently, and only 20% of the doctors held the same view. There was a significant difference in the perspectives between the 2 groups. It became clear that opinions on the legal management authority of samples were inconsistent not only between the forensic doctors and lawyers but also within each group. The medical and jurisprudential nature of forensic samples will require constructive discussion and appropriate management based on the principles of due process, considering the decreasing evidentiary capacity of each samples as it ages.

Artificial intelligence (AI) technologies have begun to be used more frequently in forensic sciences, just as in every other field of medicine, and have become part of research topics. This study aims to conduct a comprehensive bibliometric analysis to systematically examine publication dynamics, collaboration networks, citation patterns, and thematic trends of AI in forensic sciences. A comprehensive literature search was conducted using the keywords "forensic medicine," "forensic sciences," "forensic pathology," autopsy, "artificial intelligence," "deep learning," and "machine learning" and analyzed using R Bibliometrix and VOSviewer software. The analysis identified 3434 authors, 8372 keywords, and 6276 references across 730 articles. A publication growth rate of 24.16% and international collaboration rate of 28.77% were observed. The United States emerged as the most productive country. The leading institutions were University of California and Shanxi Medical University. Research trends concentrated on diagnosis, bone age estimation, and forensic odontology. Publications appeared predominantly in high-impact journals including Forensic Science International and Nature Communications. AI and machine learning research in forensic sciences has experienced rapid growth. Although these technologies offer substantial potential to enhance accuracy, efficiency, and standardization in forensic investigations, critical challenges such as model interpretability and ethical considerations require further attention for future implementation.

Tramadol is a centrally acting analgesic that is widely prescribed for the management of postoperative pain, and it is often considered to have low abuse potential. Fatal pediatric mono-intoxication is an exceptionally rare occurrence. The following report details the case of a 4-year-old child with no significant medical history, who was found dead in his bed 24 hours after undergoing circumcision. According to the family, the mother administered a single dose of 90 drops of Tramal (~400 mg) in accordance with the prescribed postoperative medication plan. A forensic autopsy was conducted, which revealed a eutrophic child with no traumatic injuries and pulmonary edema as the only significant finding, confirmed histologically. Postmortem toxicological analysis demonstrated a plasma tramadol concentration of 2500 ng/mL, which exceeds the therapeutic range (100-300 ng/mL) and is above the concentration often cited as fatal (>2000 ng/mL) in toxicological references. A thorough examination of the pharmaceutical container confirmed the presence of an excessive dose of the drug. The cause of death was attributed to acute tramadol intoxication, most likely due to respiratory depression. This case underscores the critical role of forensic toxicology when autopsy findings are nonspecific and highlights significant medicolegal concerns regarding prescription practices and parental education.

Health care workers have access to intravenous potassium chloride (KCl), making them vulnerable to suicide in the presence of risk factors. A 54-year-old registered female nurse was found unconscious during the night shift at her duty station in a hospital. She was declared dead soon after. One empty vial of KCl, 1 empty vial of acetylcysteine, 2 intravenous cannulae, a used syringe, a piece of flexible plastic tube and a burette with flexible tubing were found beside her. Autopsy revealed a swelling surrounding a puncture mark in the anterior surface of the left forearm, suggestive of the injection site. Internal examination was unremarkable, except for pulmonary edema and splenic congestion. There was no evidence of violence. Antemortem arterial blood obtained during initial resuscitation demonstrated hyperkalemia at 8.9 mmol/L. Autopsy blood, analyzed using flame emission spectrophotometry, yielded a potassium level of 35 to 40 mmol/L. Collateral history revealed frequent marital disputes and treatment for depression. It was apparent that she had self-administered KCl, which attributed to her death. Health care workers, especially those with psychiatric illnesses, are more prone to utilize easily approachable therapeutic agents to commit suicide. Care must be taken when assigning those individuals to man such stations.

Meconium aspiration syndrome (MAS) is a disease of near-term, term, or post-term newborns linked to increased infant morbidity. It results from inhalation of meconium-stained amniotic fluid (MSAF). MSAF occurs in 4% to 22% of pregnancies; 3% to 12% of those affected by MSAF develop MAS, which has a fatality rate of <1%. The presence of meconium in the amniotic fluid often indicates fetal distress. We present a case of severe MAS overlooked at birth, highlighting the importance of including MAS in the differential of sudden natural death in infancy, particularly with MSAF, even if APGAR scores are reassuring. This case involves a 1-day-old male, born at 42 weeks after an uncomplicated pregnancy and midwife-led water birth with MSAF. APGAR scores were reported as 8/9 with no initial respiratory issues. He had poor latch and lethargy, became apneic during feeding at 16 hours, and died despite attempted resuscitation. The postmortem revealed meconium staining, right ventricular hypertrophy, diffuse alveolar damage, meconium-laden macrophages, airway obstruction, and histologic evidence of persistent pulmonary hypertension of the newborn (PPHN). MAS is a recognized complication of term deliveries. Postnatal bathing can obscure meconium signs, complicating autopsy confirmation. Out-of-hospital births hinder diagnosis and management, making histology essential. The absence of visible meconium or high reported APGAR scores should not exclude the diagnosis of MAS. This case highlights the forensic pathologist's role in infant death investigations and the need for heightened clinical vigilance in the postnatal period.

This study evaluates the epidemiological, clinical, and autopsy findings of 6 rabies-related deaths occurring in the Şanlıurfa province of southeast Türkiye between 2012 and 2023. The primary objective was to identify region-specific risk factors and preventable causes through a retrospective, descriptive analysis. The study group comprised 5 males and 1 female, with a mean age of 18.4 years. All cases involved animal contact, categorized as either scratches (n=3) or bites (n=3). A critical finding regarding postexposure prophylaxis was that only one case received both the vaccine and immunoglobulin, while the remaining five received the vaccine alone. Clinically, hypersalivation and aggressiveness were the most frequently observed symptoms, each occurring in 50% of the cases. The mean survival time following the onset of symptoms was 24.3 days. Among the cases undergoing autopsy and histopathologic evaluation, encephalitic changes and, in selected cases, Negri bodies were identified. Although rabies is a preventable public health threat, these findings suggest that fatalities in the region are closely associated with insufficient prophylaxis and unequal access to health care services. To mitigate future risks, it is of vital importance to strengthen preventative health care in high-risk areas, ensure the control of stray animal populations, and provide comprehensive training for health care personnel on current prophylaxis guidelines.

Intussusception is the telescoping of one bowel segment into another, causing obstruction and ischemia. It is uncommon in adults and is most often associated with an underlying neoplasm. Colonic involvement is less frequent, and arteriovenous malformations (AVMs) represent an unusual etiology, with no previously reported fatal rectosigmoid cases to our knowledge. We describe the case of a 41-year-old man with a medical history of tuberculosis and gastrointestinal disease who suddenly developed severe abdominal pain at home. His condition rapidly deteriorated, and he was transported to the emergency department, where he arrived in cardiac arrest. External examination revealed no signs of trauma. Autopsy showed bilateral pleural effusion and markedly emphysematous lungs. Abdominal examination revealed peritoneal effusion, diffuse bowel wall thickening, and hemorrhagic intraluminal content. A colo-recto-sigmoid intussusception causing near-complete obstruction was identified, with a firm intraluminal mass acting as the lead point. Histopathologic analysis demonstrated a vascular lesion composed of arteries, veins, and capillaries associated with neural hyperplasia, favoring a vascular malformation with AVM-like features. No malignancy was found. This case describes a fatal rectosigmoid intussusception associated with a colonic vascular lesion showing AVM-like features and underscores the importance of considering vascular lesions as potential lead points in adult intussusception.

This retrospective forensic autopsy study investigated the association between body mass index (BMI) and suicide by hanging in Türkiye. Autopsy records from 15,014 cases examined between 2019 and 2021 were reviewed, and 994 confirmed hanging deaths with reliable anthropometric measurements were included. BMI values were calculated using autopsy-derived height and weight measurements and classified according to World Health Organization criteria. The distribution of BMI categories among hanging cases was compared with age- and sex-matched national population data. The majority of cases were male (79%), with a mean age of 41.6±15.8 years. Normal and overweight BMI categories predominated, whereas obesity was significantly underrepresented compared with the general population. Statistical analyses demonstrated a progressive decrease in the likelihood of suicide by hanging with increasing BMI in both sexes. In men, hanging was significantly more frequent in low and normal BMI categories, while obesity was associated with a reduced risk. In women, a significant association was observed only in the normal BMI group. These findings indicate that BMI may influence suicide method selection and should be considered in forensic and public health evaluations of suicidal behavior.