Postmortem interval (PMI) estimation is a challenge of utmost importance in forensic daily practice. Traditional methods face limitations in accuracy and reliability, particularly for advanced decomposition stages. Recent advances in “omics” sciences, providing a holistic view of postmortem biochemical changes, offer promising avenues for overcoming these challenges. This systematic review aims at investigating the role of mass-spectrometry-based “omics” approaches in PMI estimation to elucidate molecular mechanisms underlying predictable time-dependent biochemical alterations occurring after death. A systematic search was performed, adhering to PRISMA guidelines, through “free-text” protocols in the databases PubMed, SCOPUS and Web of Science. The inclusion criteria were as follows: experimental studies analyzing, as investigated samples, animal or human corpses in toto or in parts and estimating PMI through MS-based untargeted omics approaches, with full texts in the English language. Quality assessment was performed using STROBE and ARRIVE critical appraisal checklists. A total of 1152 papers were screened and 26 included. Seventeen papers adopted a proteomic approach (65.4%), nine focused on metabolomics (34.6%) and two on lipidomics (7.7%). Most papers (57.7%) focused on short PMIs (120 days) (15.4%). Muscle tissue was the most frequently analyzed substrate (34.6% of papers), followed by liver (19.2%), bones (15.4%), cardiac blood and leaking fluids (11.5%), lung, kidney and serum (7.7%), and spleen, vitreous humor and heart (3.8%). Predictable time-dependent degradation patterns of macromolecules in different biological substrates have been discussed, with special attention to molecular insights into postmortem biochemical changes.

Attention disorder and substance use disorder are linked to driving impairment and increased road crash involvement. This study explores attention deficits in a population of drivers found driving under the influence (DUI) of psychoactive substances. A case-control study was conducted comparing subjects with a previous DUI episode (cases) to subjects who were negative for DUI offenses (controls). Personal, socio-demographic, and DUI data were collected for both groups. All subjects were administered the Continuous Performance Test–third edition (CPT-3), which measures dimensions of attention, including inattentiveness, impulsivity, sustained attention, and vigilance. Possible associations with a previous DUI episode, the use of illicit substances or excessive alcohol use, and road crash involvement were analyzed statistically. Overall, the study included 147 subjects (100 cases, 47 controls). The parameter distributions of detectability, probability of ADHD, and inattentiveness indicated statistical differences between the two groups. No attention deficits predicted substance use disorder or excessive alcohol consumption. Inattentiveness was an independent risk factor for previous road collision involvement. The results suggest that alterations exist in some attention dimensions in a population of DUI subjects who were users of alcohol or other psychoactive substances and involved in road traffic crashes. The CPT-3 had successfully distinguished between the two study groups, and after validation, it could be useful in the process of reinstating a driver's license. Future research should expand the study sample to better understand the relevance of the proposed methodological approach in terms of prevention, rehabilitation, and the monitoring of subjects evaluated for driving eligibility requirements.

Crashes are a global public health concern, with psychoactive substance use and attention impairments potentially increasing risk and affecting male and female drivers differently. This study aims to identify factors related to psychoactive substance use and attention impairments that predict road crash involvement by sex, offering insights for targeted prevention effort. This observational study examined individuals assessed for driving license reissuance after driving under the influence of alcohol and/or drugs. Data collected included personal and sociodemographic details, results from a Continuous performance test (CPT-3) (a neuropsychological test assessing inattentiveness, impulsivity, sustained attention, and vigilance), and toxicological analyses of biological samples. Statistical analyses (chi-square, logistic regression, and ROC curve) aimed at identifing sex-specific predictors of road crash involvement. The study included 169 participants (82.8 % males, 17.2 % females). Initial univariate analyses indicated sex differences that were not confirmed after Bonferroni correction for multiple comparisons. Logistic regression found blood alcohol concentration predictive of crashes in males (p = 0.005, OR = 2.52), while inattentiveness was a major factor for females (p = 0.045, OR = 12.0). In the combined model, sex itself was not an independent predictor after adjusting for these factors. The model showed moderate accuracy for males (ROC-AUC = 0.695) and higher accuracy for females (ROC-AUC = 0.816), suggesting that inattentiveness may play a particularly important role in predicting crashes in the female subgroup. Inattentiveness and alcohol use emerged as key predictors of crash involvement, with inattentiveness showing particular relevance in the female subgroup. Prevention should focus on modifiable risk factors rather than sex. The model's higher accuracy in females suggests attentional measures may help identify at-risk drivers, though the small female sample limits generalizability.

West Nile virus (WNV) is an arthropod-borne flavivirus first identified in 1937. Over time, WNV has spread globally and is now endemic in Italy. Although most human WNV infections are asymptomatic (80%), less than 1% progress to a neuroinvasive disease with high mortality rates. This case involves a 45-year-old woman with post-surgical hypoparathyroidism and Sjögren’s syndrome who developed severe encephalomyelitis linked to WNV, leading to ventilator-associated pneumonia and death. Neuropathological findings revealed a bilaterally cribriform thalamus and reddish punctate lesions near the dentate nucleus of the cerebellum. The trachea and bronchial hilum branches contained whitish foamy liquid. The left lung showed multiple brownish-violet areas, with whitish regions at dissection. The heart appeared unremarkable. A detailed neuropathological examination focused on areas involved in motor control pathways. Tissue samples were stained with hematoxylin and eosin and trichrome techniques, and immunohistochemistry was performed using CD68, CD3, and CD20. A significant damage was observed in the lenticular nucleus and motor thalamus, with prominent concentric vascular calcifications. The cerebellar cortex showed near-total depletion of Purkinje cells. In the spinal cord, CD68 and CD3 positivity was noted in the lateral funiculi, anterior horns, and Clarke’s column. Lung findings showed pulmonary edema, chronic emphysema, and bronchopneumonia. The observed CD3 and CD68 positivity confirms that WNV spreads trans-synaptically along motor control pathways. We speculate on the potential molecular mechanisms by which hypoparathyroidism and Sjögren’s syndrome may have played a role in the neuroinvasive progression of the disease.

Acute chorioamnionitis is a placental inflammatory condition often implicated in adverse pregnancy outcomes, including intrauterine death. The histopathological identification of maternal and fetal inflammatory responses (MIR and FIR) is critical for diagnosis and understanding potential causal mechanisms. Chorioamnionitis frequently warrants medico-legal investigation, particularly for suspected medical malpractice. Two forensic cases of intrauterine fetal death with histological finding of acute chorioamnionitis are presented. Each case has been investigated with a complete autopsy with histological examination of fetal organs and placenta. The investigations were conducted following the Royal College of Pathologists' Guidelines on autopsy practice for fetal death and the European Guidelines for forensic investigations involving suspected healthcare professional liability. In Case 1, histopathology revealed acute necrotizing chorioamnionitis associated with chorionic vasculitis, funisitis and fetal organ involvement (stage 3/grade 2 MIR; stage 2/grade 1 FIR), supporting a causal role in fetal death. In Case 2, only focal chorioamnionitis with minimal fetal inflammatory response (stage 2/grade 1 MIR; stage 1/grade 1 FIR) was detected. A definitive and certain causal relationship with the death cannot be established due to the absence of systemic fetal involvement. No substandard medical care was identified in either case. These cases underscore the importance of integrating clinical and histological data to determine the pathophysiological significance of chorioamnionitis in fetal death. The evaluation of FIR and organ involvement are critical for distinguishing between causal and incidental findings. Thorough histopathological evaluation is essential for accurate cause of death determination and medicolegal assessment.