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.

Background and Objectives: Male infertility is a growing public health concern, with up to 50% of cases lacking a clearly identifiable cause. This study aimed to assess the epidemiological characteristics of male infertility in Lithuania and evaluate the clinical utility of oxidative stress assessment using the MiOXSYS system. Materials and Methods: A two-stage retrospective study was conducted between 2019 and 2023 at one of the largest fertility centers in Lithuania. The first stage involved an epidemiological analysis of 718 men who met the inclusion criteria. In the second stage, 261 men underwent oxidation-reduction potential (ORP) testing using the MiOXSYS system. Semen parameters were evaluated according to World Health Organization (WHO) 2010 guidelines. ROC curve analysis was used to assess the diagnostic value of ORP. Results: Male infertility was identified as the sole factor in 20.1% of couples, while unexplained infertility accounted for 24.4% of all cases. Among normozoospermic men, 48.5% exhibited elevated ORP levels (>1.34 mV/10⁶ sperm/mL). ROC analysis demonstrated moderate diagnostic accuracy of ORP (AUC = 0.634; sensitivity: 75.3%; specificity: 51.5%). The inclusion of ORP testing reduced the proportion of unexplained cases and supported their reclassification under the Male Oxidative Stress Infertility (MOSI) framework. Conclusions: This study provides novel epidemiological data on male infertility in Lithuania and highlights the potential of ORP testing as a supplementary diagnostic tool. Systematic evaluation of oxidative stress may help better identify cases previously labeled as unexplained and enable more personalized treatment strategies.

Background and Objective: Unexplained infertility is a major challenge in reproductive medicine and requires advanced diagnostic approaches to identify the underlying factors accurately. This study aims to evaluate the utility of risk factor analysis and a gene panel in diagnosing unexplained infertility using the next-generation sequencing (NGS) technology. Our study aimed to characterize and identify risk and genetic factors associated with unexplained infertility. Materials and methods: A cohort of patients with unexplained infertility was comprehensively screened for risk factors and genetic variations using a targeted 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) presenting genes that may be associated with unexplained infertility. A gene panel for unexplained infertility was compiled based on the literature data. A customized virtual panel was created from the exome sequencing data. Results: In the female group, controls had a higher mean age, while in the male patients, both groups were similar in terms of age. Both gender groups had comparable BMI values. No significant associations (p > 0.05) between risk factors and unexplained infertility were found when evaluating anthropometric parameters and other sociodemographic characteristics. In two male patients (20%), a molecular defect was detected in NGS variants classified aspossible benign and probably benign In particular, missense variants were identified in the UGT2B7 and CATSPER2 genes, A molecular 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 often related to mechanisms beyond causative mutations and highlights the need for integrative genomic research involving broader gene panels and multi-faceted approaches, including transcriptomics and epigenetics, to uncover latent genetic predispositions.

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.

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: 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.