Victims of childhood sexual abuse are at an increased risk for a multitude of mental health conditions. While many children exhibit concerning behavioral changes following abuse, there is often a delay in identification and implementation of psychiatric services, resulting in worsening mental and physical health outcomes for victims. This case series aims to demonstrate the importance of multidisciplinary victim-centered and trauma-focused treatment including proactive psychiatric care. The review presents three cases of child victims of sexual abuse who received psychiatric care after their initial presentation to the Puerto Rico Health Justice Center (PRHJC). As evidenced by the following cases and extant literature, child victims of sexual abuse have an increased risk of severe mental health disorders. This indicates the importance of recognizing and understanding behavioral warning signs of childhood sexual abuse and the importance of psychiatric care as early as possible following disclosure.

We present a case of a complete external ear amputation, caused by a human bite, that took place during a quarrel in a local farmers\' market. The male victim was transferred to the Hospital. After surgical reattachment of the auricle, a forensic clinical examination was performed, as per legal obligation. During examination, the victim was found to have sustained: contusions of the orbital regions (lower eyelids), bilaterally, soft tissue oedema of the forehead (to the left of the middle line), and contusion of the right neck area. He also sustained multiple soft tissue injuries (contusions, abrasions) on the torso and on both upper and lower extremities. Clinical forensic examination of human bite injuries requires thorough description of the wound, proper photography and possibly collection of swabs for DNA identification (in case of unknown perpetrator). Nevertheless, the Forensic Pathologist is often required to perform clinical examination, only after medical care has been provided. Therefore, clinicians should be aware of the need of proper documentation and act accordingly.

OBJECTIVE: To identify the risk factors and assault characteristics of family violence among victims referred for forensic medical examination in Victoria, Australia.
METHODS: A retrospective 1:1 case-control study was conducted, comparing adult family violence victims and non-family violence victims examined by clinical forensic practitioners from the Victorian Institute of Forensic Medicine, between July 2015 and June 2016. Data were extracted from victims\' forensic medical casework. Chi-square or Fisher\'s exact tests and Mann-Whitney U tests were used to examine group differences. A multiple logistic regression analysis was used to determine independent predictors of family violence.
RESULTS: One hundred and forty-three family violence victims (97.2% female, Mdnage = 29, 90.2% intimate partner violence) were identified and gender- and age-matched with controls. Family violence victims had significantly higher odds of reporting a history of violence victimisation (OR = 5.20; 95% CI, 2.54 to 10.66) and current pregnancy (OR = 5.28; 95% CI, 1.09 to 25.46) than controls. Family violence was significantly more likely than non-family violence to occur in the victim\'s home, and to involve physical assault, use of weapon(s), trauma to the neck and anal sexual assault. Family violence victims sustained significantly more physical injuries, and were more likely to be injured to almost every bodily location, than controls.
CONCLUSIONS: This study highlights the importance of assessing and managing risk for family violence following initial victimisation and throughout pregnancy. Findings further indicate that family violence is more dangerous (i.e. more likely to involve severe forms of assault and cause injury) than non-family violence.

Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.

Dental injuries, especially of the incisors, caused by punches in violent criminal attacks could be seen in daily forensic casework involving the identification of injuries to a living body. Sometimes, when there is neither circumstantial evidence nor information about the surrounding circumstances, it is difficult to discern the cause of these injuries and the manner in which they were inflicted. As an example of clinical forensic medicine, we present the case of a 58-year-old woman whose teeth were injured when fighting with her son-in-law over household affairs with no witnesses present. The two parties had conflicting stories about the cause of the woman\'s injury. The woman claimed that her teeth were lost while she was being beaten by her son-in-law, and the man argued that the damage to his mother-in-law\'s teeth was self-inflicted when she bit his fingers. The police attending the crime called for a forensic examination. Forensic practitioners analysed the mechanism of the tooth loss using multi-slice spiral computed tomography (MSCT) and imaging reconstruction technology. Local alveolar bone (medial alveolar) fracture and a small area of alveolar bone loss were found on MSCT. Thus, forensic medical experts speculated that the woman\'s lower central and lateral incisors were lost as a result of a violent attack and were not self-inflicted. Finally, forensic practitioners helped police in avoiding a miscarriage of justice and wrongful conviction.

BACKGROUND: Self-inflicted injuries are a known, but challenging topic in the healthcare sector and the judicial system. Therefore, differentiation of these injuries from a third-party-interference is crucial in the field of forensic medicine. However, self-painted injuries with makeup, which entail misleading of medical staff and the administration of justice, have apparently not been described in the literature so far.
METHODS: A case of a rare kind of victim role staging in a 26-year-old Caucasian woman in the field of forensic medicine is presented. She supposedly had been robbed and harmed by two unknown men. The forensic examination revealed subjective symptoms and objective findings, such as skin discolorations appearing as fresh bruises. However, a closer look revealed makeup. After removal, no injuries were seen.
CONCLUSIONS: Awareness of the existence of exceptional cases of victim role staging is essential in the daily routine of healthcare, judicial and forensic professionals. Therefore, a questioning attitude within the physical examination as well as proper assessment of objective findings is crucial. Furthermore, the importance of an interdisciplinary approach of possible factitious disorders is demonstrated. The sensitization may exclude a third-party-interference, prevent damages to the health care system, avoid misleading of the administration of justice, and, therefore, reduce socioeconomic costs. Moreover, the recognition may enable adequate interventions and provide patients with professional help.