Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of inherited diseases. These disorders show genetic mutations with loss of function of primary components of connective tissue, such as collagen and elastic fibers. There are more than 200 conditions that involve hereditary connective tissue disorders, while the most known are Marfan syndrome, Osteogenesis Imperfecta, and Ehlers-Danlos syndromes. These disorders need continuous updates, multidisciplinary skills, and specific methodologic evaluations sharing many medicolegal issues. Marfan syndrome and Ehlers-Danlos syndromes show a high risk of early sudden death. As a consequence of this, postmortem genetic testing can identify novel genotype-phenotype correlations which help the clinicians to assess personalized cardiovascular screening programs among the ill subjects. Genetic testing is also essential to identify children suffering from Osteogenesis Imperfecta, especially when a physical abuse is clinically suspected. However, this is a well-known clinical problem even though there are still challenges to interpret genetic data and variants of unknown significance due to the current extensive use of new genetic/genomic techniques. Additionally, the more significant applications and complexities of genomic testing raise novel responsibilities on the clinicians, geneticists, and forensic practitioners as well, increasing potential liability and medical malpractice claims. This systematic review provides a detailed overview on how multidisciplinary skills belonging to clinicians, medicolegal consultants, radiologists, and geneticists can cooperate to manage HCTDs from autopsy or clinical findings to genetic testing. Thus, technical aspects need to be addressed to the medicolegal community since there is no consensus works or guidelines which specifically discuss these issues.

The ability to analyze blunt-force trauma is crucial for deciphering valuable clues concerning mechanisms of injury and as evidence for medico-legal investigations. The use of alternate light sources (ALS) has been studied over the past decade, and is proposed to outperform conventional white light (CWL) during bruise assessments. In response to the growing interest of the technology worldwide, a systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to address the ability of ALS to detect and visualize bruising. From an initial 4055 records identified, ten studies met the eligibly criteria and were selected for this review. Evaluation also included a novel framework, referred to as SPICOT, to further systematically assess both scientific evidence and risk of bias in forensic literature. Analysis reveals that narrowband wavelengths within in the infrared or ultraviolet spectral ranges do not significantly outperform CWL in visualizing or detecting bruising. However, wavelengths within the visible spectrum, particularly 415 nm combined with longpass or bandpass yellow filters, are more effective. However, the majority of selected studies only address the sensitivity of ALS, and therefore, results may only be considered valid when the location of a bruise is known. Further investigation is required to understand the specificity of ALS, in particular how the use of topical cosmetic products, previous wounds/scar-tissue, tattoos, moles and freckles may affect detection. The ethical concern regarding the interpretation of enhanced visualized trauma should also be considered in prospect discussions prior to implementing ALS into routine practice. Nevertheless, this review finds that narrowband ALS within the visible spectrum demonstrates potential for improved injury documentation, outperforming CWL in the detection and visualization of bruising.

OBJECTIVE: This study was conducted to assess the need for clinical forensic medicine (CFM) training (hands-on and bedside) in medical undergraduate students and to determine the utility of skill-based teaching methodology in CFM.
METHODS: A cross-sectional study was carried out in the Government Medical College, where we used the mixed model approach (qualitative and quantitative component) to access the approach of three groups containing 50 participants each from (1) resident doctors/interns, (2) faculty, (3) casualty medical officers, toward skill-based teaching of CFM. A structured pretested questionnaire was administered to all study participants. The questionnaire was based on their perception regarding the legal problems faced during clinical practice and their attitude toward the need for CFM. It was followed by a focus group discussion (FGD) arranged separately for each group of 10 participants. Each FGD session lasts for 40 minutes with a moderator and recorder.
RESULTS: Present MBBS (Bachelor of Medicine & Bachelor of Surgery) curriculum teaches CFM very early is strongly agreed by 20 (40%) of the faculty, four (8%) of interns, and three (6%) of medical officers. 40 (80%) of interns, 43 (86%) of medical officers, and 40 (80%) of faculty necessitate hands-on training in CFM in the MBBS curriculum. Forensic medicine specialists should handle clinical medico-legal cases (MLCs), as agreed by 50 (100%) faculty, 46 (98%) interns, and 47 (94%) medical officers.
CONCLUSIONS: Hands-on training in CFM is needed for a better practical approach for doctors toward handling MLCs. Hands-on training should be introduced in the second-year MBBS curriculum, and their clinical aspects should be taught simultaneously with clinical subjects till the internship.

Much has been written about bite mark comparisons and bite mark analysis. It has largely been written for, and remained within the domain of, the forensic odontologist despite the limited number of such specialists and the even smaller subset who have expertise in this area. For those health professionals who work in the field of clinical forensic medicine, most will not have access to a forensic odontologist. Courts can be reticent about the costs involved in obtaining another expert opinion. For health professionals, who will likely encounter more bite marks in their career than forensic odontologists, the difficulty is knowing what can legitimately be opined about such injuries.

Initial experiences with magnetic resonance imaging (MRI) of living strangulation victims demonstrated additional findings of internal injuries compared to the standard clinical forensic examination. However, existing studies on the use of MRI for this purpose mostly focused on the first 48 h after the incident. The aims of this study were (a) to evaluate the longitudinal visibility of MRI findings after violence against the neck by performing two MRI examinations within 12 days and a minimum of four days between both MRI scans and (b) to assess which MRI sequences were most helpful for the detection of injuries. Twenty strangulation victims participated in this study and underwent one (n = 8) or two (n = 12) MRI scans. The first MRI examination was conducted during the first five days, the second five to 12 days after the incident. Two blinded radiologists assessed the MRI data and looked for lesions in the structures of the neck. In total, 140 findings were reported in the 32 MRI examinations. Most of the findings were detected in the thyroid and the muscles of the neck. T2-weighted SPACE with fat suppression, T1-weighted TSE and T1-weighted MPRAGE were rated as the most helpful MRI sequences. Subjects who showed findings in the initial scan also demonstrated comparable results in the second scan, which was performed on average 8.4 days after the incident. Our results show that even up to 12 days after the incident, the criminal proceeding of strangulation cases may greatly profit from the information provided by an MRI examination of the neck in addition to the standard clinical forensic examination.

BACKGROUND: Interpersonal violence impacts communities, victims, perpetrators, families, and children. This audit of 315 cases of non-sexual assault compares characteristics of general assault to those of non-fatal strangulation (NFS).
METHODS: Clinical review of all cases referred to Clinical Forensics Australian Capital Territory (CFACT) by ACT Policing between 2018 and 2022, following allegations of non-sexual assault. Descriptions of the model of care, victim characteristics, alleged perpetrators, and presentations in NFS versus general assault, from forensic medical examination.
RESULTS: Patients: Of 315 cases, 170 were victims of NFS, females (153/170, 90%), males 16/170 (9%), and one person with another preferred term. General assault cases comprised 145/315 (46%) presentations, 69/145 (47.6%) patients being female, 76/145 (52.4%) male. A majority of individuals who experienced NFS 113/170 (66%) presented within 12 h of the events, 41% of victims thought they might die during the NFS. Perpetrators: Most NFS perpetrators were male (161/170: 95%), NFS was mostly perpetrated by a partner 104/170 (62%), ex-partner 35/170 (21%), or family member 17/170 (10%). Repeated assaults by the same perpetrator was common 109/170 (64%). Children were present in 48/170 (28%) cases of NFS.
CONCLUSIONS: NFS is gendered violence overwhelmingly affecting women, many experience NFS repeatedly. Later presentation may affect clinical signs, symptoms, and evidence collection. Forensic medicine management of NFS provides an opportunity to effect change, especially in those who thought they may die during the attack. Intervention to prevent trauma in children may be enabled by reporting their presence during an assault. Twenty-four-hour service provision enables both clinical and forensic assessment following NFS.
CONCLUSIONS: NFS is gendered, mostly affecting women, occurs in a family violence context, perpetrated by current and/or ex-partners, and often occurs with children present. Clinical forensic medicine doctors can provide care and support, provide referrals, and collect forensic medical evidence to support legal process.

Purpose:The COVID-19 pandemic prompted significant challenges in clinical forensic medicine and forensic psychiatry and emphasised the need for sustainable service delivery. Both fields faced difficulties in maintaining services due to COVID-19 precautions and limited referrals. This review examined the changes in forensic practices, aiming to understand their impact and learn from them to inform future strategies. Methods: A search was conducted across Ovid Medline, Ovid Embase, Ovid Emcare and PubMed, and webpages of governments and other organisations. Studies were included if they assessed any change that occurred in clinical forensic medicine or forensic psychiatry during the pandemic. A narrative review with a systematic approach was undertaken. Results: A total of 27 articles were included. There was a notable decrease in the volume of forensic assessments in early 2020. The numbers gradually rebounded with the easing of restrictions yet have not fully returned to pre COVID-19 levels. Telemedicine and COVID-19 precautions were widely incorporated into forensic services, which were seen to disrupt the patient-doctor dynamics, restrict the setting of examinations and complicate work processes and sample handling steps. Conclusion: This is the first review that describes the pandemic-driven changes in clinical forensic medicine and forensic psychiatry in respect of case trends and incorporation of COVID-19 precautions. The pandemic emphasised the need for adaptability and adoption of new assessment approaches in forensic services. Technology, like telemedicine, emerged as a valuable tool, enhancing accessibility for individuals in remote or high-risk areas. It is necessary to review the changes and re-evaluate their impacts in the post COVID-19 era.

The recognition of abuse and/or neglect still represents a challenge for both clinicians and forensic pathologists. Whereas abusive behaviors have been largely described among pediatric and elderly populations, adults\' abuse and neglect is less frequently encountered, and therefore investigated. We report a case of a middle-aged woman without any known organic or psychiatric disorders who died of a multiple organ failure (MOF) due to extreme cachexia and bed-resting syndrome. The integration of all clinical, autopsy and histopathological data highlighted a picture of severe malnutrition, restraint, and widespread traumatic injuries related to abuse and neglect. We believe that the case here presented could be useful for both clinicians and forensic pathologists as it underlines once again the importance of collecting and integrating all medical evidence (both in the ante- and post-mortem settings) for reconstructing the most probable pathophysiology of disorders and injuries, comparing that reconstruction with the allegations of the caregivers, and thus identifying any potential abuse and/or neglect behaviors.

Child sexual abuse is a public health problem that affects children worldwide in all ethnic, educational, and socioeconomic groups. These assaults are extremely dangerous not only due to their direct physical traumas received at the time of the abuse, but they also have long-term consequences that can worsen the future quality of the victim\'s life. A retrospective study of all cases related to child sexual abuse for five years was performed by materials of the Clinic of Forensic Medicine and Deontology, Sofia, Bulgaria. Ninety-five cases involve children from both genders. The traumatic injuries were carefully examined and classified according to their localization over the victim\'s bodies and based on the time that had passed after the reported assaults. In cases of sexual violence, the most informative and pointing at the exact type of violence are the injuries situated in the anogenital area. Too often, there is a lack of physical findings, depending on the type of sexual violence or associated with the prolonged time that passes after the crime. Children are unaware of what they have to do after suffering such traumas, or they are scared to share their experience with different family members, which can lead to late forensic examination and lack of physical and biological findings, which are the most critical traces in the criminal prosecution of the crimes and this can be a possibility for the perpetrator not to be charged for his unlawful actions.

Self-mutilation refers to the state in which a person deliberately hurts himself without the intention to commit suicide but with the motive of some personal gain. Four cases are described in the current study with four different personal motives - drug supply, accusation of intimate partner violence, confrontation of parental prohibition, and a way to hide and escape from a committed crime. Evaluating the injuries due to self-mutilation might be challenging due to atypical lesions and well-structured false stories when the victim has some level of competency. Careful analysis of the victim\'s story and a thorough evaluation of the sustained injuries are needed. If doubts about artificial injuries exist, immediate consultation with a forensic pathologist is required.