Primary hypothermia arises from prolonged exposure to low environmental temperatures without underlying pathology, whereas secondary hypothermia is triggered by impaired thermoregulation due to factors such as disease, trauma, or substance use. This study aimed to investigate core temperature changes in rats exposed to specific water temperatures over time, with a focus on differentiating primary and secondary hypothermia induced by alcohol and benzodiazepines.Survival analysis was performed using Kaplan–Meier survival curves to compare the time to event (in minutes) among three experimental groups: Control, ethanol, and Diazepam. Core temperatures were recorded at five key points: baseline (normal temperature), post-ketamine anesthesia, during immersion, at hypothermia onset, and at the time of death. Survival times were also recorded and statistically analyzed. Median survival times were highest in the control group (35 minutes), followed by Diazepam (29 minutes) and ethanol (28 minutes). Pairwise comparisons using the log-rank test, adjusted for multiple comparisons via the Benjamini-Hochberg method, revealed a statistically significant difference between the control and diazepam groups (p = 0.018), with the control group demonstrating longer survival time. A significant interaction between Diazepam and time was observed (β = -0.23, 95% CI: -0.35 to -0.12, p < 0.001), indicating that the rate of temperature decline over time was significantly greater in the Diazepam group compared to the control group. Our results indicate that Diazepam accelerates the decrease in body temperature over time, which may contribute to its observed effect on survival, and that Diazepam administration is associated with a significant reduction in survival time compared with untreated controls. Ethanol did not significantly alter the measured thermoregulatory or survival outcomes in this pilot study. Any potential forensic relevance of ethanol-induced hypothermia remains speculative and requires further investigation in larger, adequately powered studies. Our results could have potential forensic implications in differentiating between primary and drug-induced as secondary hypothermia in medico-legal investigations.

Climate change significantly affects human physiology and contributes to increased morbidity and mortality, with heat stress representing one of the most severe consequences of thermal imbalance. The aim of this study was to analyze morphological changes to leukocytes on the peripheral blood smears of Wistar rats exposed to hyperthermia using the geometric morphometrics method. A total of forty Wistar albino rats were divided into three experimental groups according to water temperature exposure (37 °C, 41 °C, and 44 °C). Peripheral blood smears were prepared, stained, and digitally recorded using Motic Images Plus 2.0 software, after which selected images were analyzed using geometric morphometric programs (tpsDig, tpsUtil, and MorphoJ) to evaluate leukocyte shape variations. Comparative analysis demonstrated statistically significant morphological changes in polymorphonuclear cell shapes between the control group (37 °C) and rats exposed to 41 °C (p = 0.009). Significant differences were also identified in mononuclear cell morphology between the antemortem and postmortem groups (p = 0.00307). The findings indicate that exposure to elevated temperatures induces measurable alterations in white blood cell morphology, confirming that hyperthermia produces significant structural changes in polymorphonuclear cells and mononuclear cells detectable through geometric morphometric analysis.

Background/Objectives: Accurate post-mortem interval (PMI) estimation becomes increasingly difficult when bodies decompose under extreme heat. Hyperthermal Mediterranean environments accelerate soft-tissue degradation, induce early mummification, and distort classical thanatological indicators, often resulting in substantial PMI overestimation. This study analyzes three forensic cases affected by climate-driven decomposition anomalies and presents a climate-adaptive, AI-assisted diagnostic framework applied uniformly across all cases to improve PMI interpretation. Methods: A retrospective case series analysis was conducted on three individuals recovered during summer heatwaves. Crime scene investigation, post-mortem computed tomography (PMCT), autopsy, and genetic identification were integrated with 5–15-year meteorological datasets. Classical PMI estimations were compared with circumstantial data. A multimodal AI model, incorporating environmental features, decomposition morphology, and microenvironmental modifiers, was operationalized for each case using a hybrid Random Forest–LSTM architecture. Engineered indices included Accumulated Degree Days (ADD), a Decomposition Index, and climate-stress metrics (Thermal Load Index, Desiccation Pressure Factor, Microenvironmental Distortion Coefficient). Quantile regression provided calibrated prediction intervals. Results: Morphological assessments overestimated PMI in every case, suggesting intervals of 1–6 months despite true PMIs of approximately 20 days (Cases 1–2) or 36–48 h (Case 3). The AI model yielded conceptual outputs more consistent with verified PMIs, ~21 days (Case 1), ~23 days (Case 2), and ~42 h (Case 3), each accompanied by 50% and 90% prediction intervals. Explainability analyses identified thermal load, desiccation pressure, and microenvironmental distortion, particularly insulation in Case 3, as dominant drivers. Conclusions: Extreme heat fundamentally alters decomposition trajectories, rendering classical PMI methods unreliable. Applying a climate-aware, AI-assisted diagnostic framework across all three cases improved interpretability, providing uncertainty-aware estimates aligned with true PMIs. The AI framework is presented as a conceptual, non-trained, proof-of-concept system, and reported outputs represent operational demonstrations rather than validated predictions, offering a promising foundation for next-generation PMI diagnostics in hyperthermal forensic settings.

Abusive head trauma (AHT), is considered a leading cause of fatalities resulting from physical abuse in infants under 2 years of age, with a peak incidence between 1 and 2 months after birth. The incidence of AHT ranges from 14 to approximately 40 cases per 100,000 children in industrialized countries with a mortality rate ranging from 10 to 20%. The absence of internationally recognized best practices or guidelines especially in the field of forensic medicine has resulted in methodological variability in the management of these cases across different settings. In response to this gap, a comparative working group involving experts from Italy and the Balkan countries was established, leading to the creation of a shared discussion platform. The aim of this collaborative effort was to identify strengths and critical issues in the forensic handling of abusive head trauma, ultimately with the goal of developing a shared workflow chart for the management of these complex cases within the network.

Immigrant populations frequently encounter barriers when accessing healthcare services, potentially affecting patient safety, healthcare utilization, and clinical outcomes. Understanding these barriers is essential for improving equitable and patient-centered care. A systematic review of qualitative and quantitative studies was conducted in accordance with PRISMA 2020 guidelines. PubMed/MedLINE, Embase, Cochrane Library, PsycINFO, EconLit, Web of Science (WoS), and CINAHL were searched from January 2005 to August 2023. Inductive thematic analysis was used to synthesize findings across studies. The review was not prospectively registered, included only English-language studies, and relied predominantly on qualitative evidence. Heterogeneity across study designs and healthcare settings may limit generalizability. The authors received no external funding for this study. Three interconnected themes consistently emerged: limited transcultural competence, language barriers, and discrimination in healthcare. Inadequate cultural competence was associated with communication difficulties and reduced care effectiveness. Language barriers contributed to miscommunication, delayed care, and increased healthcare utilization. Experiences of discrimination were linked to reduced trust in healthcare systems and poorer patient engagement. These factors negatively influenced patient safety, satisfaction, and clinical outcomes. Immigrant patients face persistent and interrelated barriers to healthcare access. Strengthening culturally responsive care, improving access to professional interpreter services, and addressing discriminatory practices are essential to improving patient safety, satisfaction, and clinical outcomes. Future research should evaluate targeted interventions aimed at improving communication, cultural competence, and healthcare equity.