Academic Forensic Pathology

Background: Sexual dimorphism plays a vital role in individual identification, and body dimensions can contribute to establishing a biological profile for identification purposes. Aims and Objectives: To determine the reliability of the Heel–Ball Index (HBI) in estimating sex from foot dimensions and footprint dimensions and also to investigate the potential of dimensions and indices, using a standardized value, in estimating sex, from foot dimensions and footprint dimensions. Materials and Methods: In this study, a group of 112 young Indian adults aged 18 to 22, consisting of 56 males and 56 females, was examined. The foot breadth at ball (BBAL) and foot breadth at heel (BHEL) of both feet were measured using sliding digital calipers from foot and footprint dimensions. Results: Significant sexual dimorphism was observed in BBAL, BHEL, and HBI (HBI = BHEL/BBAL × 100) measurements in both feet of both sexes. Conclusion: HBI yielded better accuracy for foot dimensions than footprint dimensions. It was also found that utilizing absolute foot dimensions (BBAL and BHEL) yielded more accurate results in estimating sex compared to the HBI, which is calculated as a ratio of absolute measurements.

Suraj S. Shetty

M. A. S. Ananthan

Varsha A. Shetty

Nevin Tom

Aashi Verma

Mahabalesh Shetty

Smitha Rani

Sex Estimation Using Heel–Ball Index: A Metric-Based Comparative Study on Foot and Footprint Dimensions

使用跟趾指数进行性别估计：基于足部和足迹尺寸的比较研究

Introduction Forensic pathologists are the only medical specialists who routinely testify in courts of law as part of their occupation. As such, one element of their training involves learning how to testify responsibly and competently. Individuals qualified as experts are permitted to offer opinions in order to assist the triers of fact. Results We review the forensic pathologist's primary role as an expert witness which is to lay out concepts clearly, methodically, and objectively, in medicine, pathophysiology, toxicology, and injury, to convey these concepts with understandable, plain language, and to explain how certain evidence, physical, medical, and historical, supports their conclusions and/or presents limitations. Discussion We discuss various components about testifying in court, some common expert questions posed to the forensic pathologist, and what concepts and facts they might consider when answering them. We do not offer a prescription as to how one should answer these questions specifically, but rather we provide a single resource that summarizes some of the key issues that may arise in court for the forensic pathologist.

James R. Gill

Susan F. Ely

Forensic Pathologist Testimony, Part 1: Common Questions and Considerations

法医病理学家证词，第1部分：常见问题与考虑

Introduction Forensic pathologists routinely testify in courts of law as part of their occupation. As such, part of their training involves learning how to testify responsibly and competently. As experts, they are permitted to offer opinions in order to assist the triers of fact. Results This review examines such concepts as burden of proof by manner of death, mechanisms of death, survival intervals, and the differences between possibilities, probabilities, and reasonable degree of medical certainty. It also addresses legal concepts and issues that may arise in court, including those of pain and suffering, cognitive bias, objections, attempts at witness impeachment, and surrogate witness testimony, as well as a summary of pertinent case law. Discussion The special issues and considerations of the expert forensic pathologist are discussed with the aim to summarize some of the key issues that may arise in court for the forensic pathologist.

Forensic Pathologist Testimony, Part 2: Special Issues and Considerations

法医病理学家证词，第二部分：特殊问题与考量

Study Design: This observational study focuses on select cases where death may have been related to COVID-related fears or the unintended consequences of protocols or public health mandates imposed during the COVID-19 pandemic. Objective: The objective of this study is to highlight examples of “COVID-collateral” deaths for the expressed purpose of preventing similar deaths in the future. Methods: The study represents a retrospective observational study from the case work at an academically-based regional medical examiners’ office. Cases were selected based on identification of deaths that may have been related to COVID-19 fears, mandates or policies. Results: Six cases of COVID-collateral deaths are highlighted in this report, including cases where fear or isolation related to COVID-19 infection resulted in untreated exacerbation of an underlying disease/condition with eventual death, as well as cases where COVID-related psychological/mental stress or isolation played a role in suicide. Conclusions: Medical examiners/coroners should be aware of these cases if future pandemics or similar events occur, so that more thorough and accurate data regarding such deaths can be gathered. Public health officials, the medical community, and the general public also need to be aware of such cases so that appropriate preventive strategies can be employed.

Joseph A. Prahlow

Theodore Brown

“COVID-Collateral” Deaths

“新冠附带”死亡

We report a case of a somatic overgrowth syndrome diagnosed at forensic autopsy with the aid of next generation sequencing as Proteus syndrome. Somatic overgrowth syndromes result from spontaneous somatic mutations that arise early in development and display a mosaic pattern of expression in patient tissues. Due to the temporal and anatomic heterogeneity of these syndromes, phenotypes vary widely, resulting in clinical overlap. Furthermore, the variable ratio of mutated to nonmutated cells in patient tissue can result in low-level mutations that could be missed using Sanger sequencing. Due to these factors, recent literature points to next generation sequencing (NGS) as an adjunct to diagnosis of these rare entities. A male in his fourth decade of life presented to our forensic autopsy service with physical features suggestive of a somatic overgrowth syndrome. Due to the paucity of clinical information accompanying the individual, a definitive diagnosis based on physical characteristics, alone, was not possible. Next generation sequencing of affected formalin-fixed and paraffin-embedded brain tissue confirmed the presence of the variant in AKT1 (c.49G>A, p.Glu17Lys, in 14.13% of reads) found in Proteus syndrome. To our knowledge, this is the first report of the mosaic variant of AKT1 detected in brain tissue and the first reported case of a postmortem diagnosis of Proteus syndrome with the aid of NGS. We conclude that NGS can be used as an adjunctive method to support a specific diagnosis among the somatic overgrowth syndromes postmortem in the absence of sufficient clinical history.

Tiffany G. Baker

William B. Glen

Robert C. Wilson

Nicholas I. Batalis

Daynna J. Wolff

Cynthia T. Welsh

Postmortem Diagnosis of the Proteus Syndrome by Next Generation Sequencing of Affected Brain Tissue

通过下一代测序对受累脑组织进行尸检诊断普罗透斯综合征

Introduction: Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal dominant disorder that results from mutations in the collagen type III gene. It is a risk factor for medium-sized artery aneurysms, dissections, and ruptures. We report a case of hemoperitoneum due to medial dissection and rupture of the superior mesenteric artery related to vEDS. Methods: A full body CT scan and full three cavity autopsy was performed in a 47-year-old man with a history of an intermittent abdominal cramping for one week rand complex past medical history that included a sigmoid bowel perforation at age 20, and previous popliteal artery pseudoaneurysm rupture. Histology and genetic testing were performed. Results: The postmortem computed tomography and autopsy showed a significant hemoperitoneum due to a ruptured dissection of the superior mesenteric artery and branches, and multiple splanchnic artery dissections with renal and small bowel infarctions. Genetic testing revealed a heterozygous COL3A1 gene variant associated with Ehlers-Danlos syndrome. Death was attributed to hemoperitoneum due to medial dissection and rupture of the superior mesenteric artery due to arteriopathy. Discussion: The relatively young age and medical history correlate with the autopsy findings and genetic testing towards the conclusion of an arteriopathy consistent with vEDS.

Fabio Tironi

Wijesinghe Lakmali

Jayantha Herath

Hemoperitoneum Due to Dissection and Rupture of the Superior Mesenteric Artery in a Patient With COL3A1 Mutation

COL3A1突变患者中肠系膜上动脉夹层破裂导致的腹腔内出血

ISSN	1925-3621
h-index	18

涉及主题	医学内科学地理病理历史考古尸检法医病理学生物医疗急救心理学环境卫生急诊医学毒物控制遗传学伤害预防自杀预防外科政治学法学精神科人为因素与人体工程学
出版信息	出版商: SAGE Publications Inc.，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2011，原创研究文献占比: 0.00%，自引率:N.A.， Gold OA占比: 0.00%

Academic Forensic Pathology

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Sex Estimation Using Heel–Ball Index: A Metric-Based Comparative Study on Foot and Footprint Dimensions

Forensic Pathologist Testimony, Part 1: Common Questions and Considerations

Forensic Pathologist Testimony, Part 2: Special Issues and Considerations

“COVID-Collateral” Deaths

Postmortem Diagnosis of the Proteus Syndrome by Next Generation Sequencing of Affected Brain Tissue

Forensic Pathologist Testimony, Part 1: Common Questions and Considerations

Forensic Pathologist Testimony, Part 2: Special Issues and Considerations

Sex Estimation Using Heel–Ball Index: A Metric-Based Comparative Study on Foot and Footprint Dimensions

“COVID-Collateral” Deaths

Hemoperitoneum Due to Dissection and Rupture of the Superior Mesenteric Artery in a Patient With COL3A1 Mutation