Vehicle cabins represent confined microenvironments where heat stress, limited ventilation, and emissions from interior materials may interact to create potentially hazardous conditions. This article reviews environmental and toxicological factors that may contribute to adverse health outcomes in sealed vehicles, particularly in hot climates. Reports of fatal incidents have described sudden deaths occurring in enclosed vehicles during summer power outages with no evidence of trauma, intoxication, or carbon monoxide poisoning, suggesting hypoxia and exposure to accumulated gases. In such circumstances, multiple environmental factors may operate simultaneously. Vehicle interior materials are known to emit volatile organic compounds (VOCs) including aromatic hydrocarbons, aldehydes, and ketones, especially under elevated temperatures. Solar heating can raise cabin temperatures to 40-70 °C, increasing emission rates and reducing air exchange when ventilation is limited. Under these conditions, accumulation of VOCs may occur together with oxygen depletion, carbon dioxide buildup, and severe heat stress. This review highlights the need for improved ventilation and evaluation of in-cabin air quality in hot climates.

Modern medical education increasingly emphasizes deep learning, professional identity formation (PIF), and longitudinal competency development. The tea-steeping metaphor, drawn from the gradual infusion process of tea leaves into water, offers a novel lens to conceptualize immersive and time-dependent learning. This metaphor holds particular relevance in forensic medicine, where learners must develop a nuanced understanding of medico-legal principles, ethical reasoning, and procedural competence over time. Objective of this article is to explore the origin, educational applications, benefits, limitations, and practical impact of the tea-steeping metaphor in the context of forensic medicine teaching. A narrative review methodology was employed, integrating theoretical frameworks from constructivist learning, competency-based education, and experiential learning. Real-world applications in forensic education were examined, including longitudinal case-based learning, simulation-based training, reflective practice, and PIF. The tea-steeping metaphor supports gradual cognitive and affective skill development by allowing learners to process complex information over time and within context. In forensic medicine, this approach enhances critical thinking, ethical decision-making, and integration of theory with practice. Benefits include promotion of deep learning, reflective practice, and adaptability. However, challenges such as time constraints, potential information overload, and the need for optimal learning conditions limit its universal applicability. The tea-steeping metaphor provides a valuable pedagogical framework for forensic medicine education. When implemented strategically, it can foster immersive, reflective, and ethically grounded learning experiences. Further research is warranted to assess its longitudinal outcomes and adaptability across diverse educational contexts.

Study Design: This observational study focuses on select cases where death may have been related to COVID-related fears or the unintended consequences of protocols or public health mandates imposed during the COVID-19 pandemic. Objective: The objective of this study is to highlight examples of "COVID-collateral" deaths for the expressed purpose of preventing similar deaths in the future. Methods: The study represents a retrospective observational study from the case work at an academically-based regional medical examiners' office. Cases were selected based on identification of deaths that may have been related to COVID-19 fears, mandates or policies. Results: Six cases of COVID-collateral deaths are highlighted in this report, including cases where fear or isolation related to COVID-19 infection resulted in untreated exacerbation of an underlying disease/condition with eventual death, as well as cases where COVID-related psychological/mental stress or isolation played a role in suicide. Conclusions: Medical examiners/coroners should be aware of these cases if future pandemics or similar events occur, so that more thorough and accurate data regarding such deaths can be gathered. Public health officials, the medical community, and the general public also need to be aware of such cases so that appropriate preventive strategies can be employed.

Gastrointestinal bleeding is one of the complications seen after a liver transplant with a poor prognosis and low survival. The most common cause of gastrointestinal bleeding after a liver transplant is ulcers followed by hemorrhagic enteritis and portal hypertensive lesions. We present a case of a middle-aged male, with improving liver function labs and imaging, who passed away from large-volume hematemesis approximately 2 months after a liver transplant. On autopsy, the cause of death was concluded to be from acute upper gastrointestinal hemorrhage due to esophageal variceal bleeding.

Retrospective review of deaths in Ontario where there was Coroner's investigation and a postmortem examination between 2018 and 2021 to compare year by year changes before and during the COVID-19 pandemic. To establish the changes in patterns of toxicological deaths over the pandemic. Using the database of the Office of the Chief Coroner for Ontario to determine the numbers of postmortem examinations for the province of Ontario as well as the primary cause and manner of death. Those with a toxicological primary cause of death were isolated from 2003 to the first half of 2022 and divided by year. For those between the years 2018 and 2021 deaths were divided by manner of death. Further all deaths with either a toxicological primary cause of death or unfinalized investigations which were highly suspicious for a toxicological cause based on circumstance with a positive toxicology were isolated. From these the data on demographics and substances detected were compiled by year for comparison. Comparing two years prior to the COVID-19 pandemic to the following two years there was an increase in total case load of 22%. Comparing the year before the pandemic to the first year of the pandemic deaths from natural causes fell from 52% to 47% of total cases, while drug-related cases increased from 24% to 36%. Fentanyl remained as the most prevalent detected substance in toxicological deaths. Combined opioid toxicity with stimulants increased, as well as the detection of nonpharmaceutical benzodiazepines. Deaths in men increased to comprise 3 in 4 drug-related deaths with the 30 to 39 years age-group remaining the most impacted. There was an increase in numbers and relative proportions of cases attributed to drug-related deaths which remained high over the two years of the pandemic.

Electrocution is a leading cause of unnatural deaths, especially in industrial and developing regions like India. In a recent case, an individual was brought in for autopsy following an apparent accidental electrocution. Strikingly, the postmortem examination revealed no typical entry or exit wounds associated with electric shocks. The body exhibited rigor mortis and a unique sign: reddish froth draining from the nasal cavities. Internal examination unveiled distinctive findings. Multiple tiny hemorrhages were observed over the heart's left ventricle, while the heart's blood vessels and valves remained unobstructed. In contrast, the lungs showed a frothy, whitish-red appearance extending into the bronchioles. This case presents an unprecedented observation: the presence of froth in the respiratory tract during electrocution. This case underscores the need for thorough autopsies. Even when specific indicators are absent, it highlights the importance of considering electrocution when froth is found in the respiratory tract. Such cases remind forensic pathologists of the diverse and occasionally unexpected manifestations they may encounter, encouraging the exploration of new phenomena within forensic medicine.

Paraquat is a highly toxic agent used as an herbicide worldwide. Despite its easy and widespread availability, data regarding cases of paraquat poisoning in India is limited. Diagnosis often becomes difficult without a clear history, owing to its rather nonspecific and varying presentation. In the present case, a 22-year-old man was brought with a history of high-grade fever, sore throat, and oral ulcers for around a week. He was symptomatically treated at multiple hospitals and was worked up for suspected diagnoses like diphtheria and influenza (H1N1). Later during treatment, it was revealed that "Paraxzone" was procured online by the patient himself two weeks before the onset of his symptoms. Thence, the treatment regimen was modified following suspicion of paraquat poisoning. However, the delay in diagnosis led to the worsening his condition, and the patient succumbed to death due to pulmonary and renal complications after 16 days of survival. The postmortem examination, supplemented with histopathological evaluation, supported the diagnosis of paraquat poisoning. Paraquat poisoning can mimic a myriad of clinical conditions. Thorough history taking, a high degree of suspicion, and collaborative work with the investigating agency are of paramount importance while dealing with cases of suspected paraquat poisoning in hospital settings.

In order to reduce transmission of COVID-19, in March 2020 the UK national and devolved governments imposed restrictions including spatial distancing, stay-at-home orders, and travel restrictions. The aim of this study is to compare the characteristics of cases referred to the Coronial system for autopsy in the months before and during the lockdown period. In all, 580 autopsy cases, performed in the London area between January and June 2020 were included in the study. In the postlockdown period, there was an increase in the proportion of black individuals referred for autopsy, which just attained statistical significance (p = 0.047). The proportion of decomposed bodies submitted for examination was significantly increased (p = 0.011). The study did not show a significant increase in the proportion of out-of-hospital (community) deaths, traumatic deaths, or deaths due to alcohol or drug abuse or overdose. The study shows no evidence that COVID-19 preventative measures led to a change in the causes of death referred to the Coroner, except, of course, for COVID-related deaths. The proportion of black people among subjects for autopsy increased, probably because of a relatively higher incidence of COVID deaths among this group. Decomposed subjects were more common, probably due to social isolation.