Category Archives: Forensic pathology

Journal articles relating to forensic pathology including coronial autopsies and Disaster victim identification.

New edition – Disposition of Toxic Drugs and Chemicals in Man (2014)

Disposition of Toxic Drugs and Chemicals in Man, 10th ed. (2014)  /  Randall C. Baselt

The purpose of this work is to present in a single convenient source the current essential information on the disposition of the chemicals and drugs most frequently encountered in episodes of human poisoning. The data included relate to the body fluid concentrations of substances in normal or therapeutic situations, concentrations in fluids and tissues in instances of toxicity and the known metabolic fate of these substances in man.

Cost is approximately $370 US including shipping.

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Diving fatality investigations: recent changes

Diving Hyperb Med. 2014 Jun;44(2):91-6.

Modifications to the investigation procedures in diving fatalities have been incorporated into the data acquisition by diving accident investigators. The most germane proposal for investigators assessing diving fatalities is to delay the drawing of conclusions until all relevant diving information is known. This includes: the accumulation and integration of the pathological data; the access to dive computer information; re-enactments of diving incidents; post-mortem CT scans and the interpretation of intravascular and tissue gas detected. These are all discussed, with reference to the established literature and recent publications.

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Suicide pact by drowning with bound wrists: a case of medico-legal importance

Medico-Legal Journal March 2014 vol. 82 no. 1 29-31;  doi: 10.1177/0025817213508676

Suicide pacts are uncommon and mainly committed by male–female pairs in a consortial relationship. The victims frequently choose methods such as hanging, poisoning, using a firearm, etc; however, a case of a suicide pact by drowning is rare in forensic literature. We report a case where a male and a female, both young adults, in a relationship of adopted “brother of convenience” were found drowned in a river. The victims were bound together at their wrists which helped with our conclusion this was a suicide pact. The medico-legal importance of wrist binding in drowning cases is also discussed in this article.

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Understanding death in custody: a case for a comprehensive definition

Journal of Bioethical Inquiry June 2014;   DOI: 10.1007/s11673-014-9545-0

Prisoners sometimes die in prison, either due to natural illness, violence, suicide, or a result of imprisonment. The purpose of this study is to understand deaths in custody using qualitative methodology and to argue for a comprehensive definition of death in custody that acknowledges deaths related to the prison environment. Interviews were conducted with 33 experts, who primarily work as lawyers or forensic doctors with national and/or international organisations. Responses were coded and analysed qualitatively. Defining deaths in custody according to the place of death was deemed problematic. Experts favoured a dynamic approach emphasising the link between the detention environment and occurrence of death rather than the actual place of death. Causes of deaths and different patterns of deaths were discussed, indicating that many of these deaths are preventable. Lack of an internationally recognised standard definition of death in custody is a major concern. Key aspects such as place, time, and causes of death as well as relation to the prison environment should be debated and incorporated into the definition. Systematic identification of violence within prison institutions is critical and efforts are needed to prevent unnecessary deaths in prison and to protect vulnerable prisoners.

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Study on the postmortem submersion interval and accumulated degree days for a multiple drowning accident

Forensic Science International Volume 238, May 2014, Pages e15–e19;  DOI: 10.1016/j.forsciint.2014.02.026

Recreational accidents in aquatic environments leading to death by drowning are quite frequent. Even if they do not usually require forensic investigation, they may provide useful information on the post mortem submersion interval (PMSI) and its relation with accumulated degree days (ADD). This is particularly useful to forensic science since most studies dealing with these matters rely mostly on animal carcasses as human analogues.

In this work we report on a multiple drowning accident resulting in 6 victims. ADD was calculated based on the PMSI and water temperature during this period. PMSI varied between ∼7.4 days and ∼11.4 days, and estimated body drift from the accident site ranged from 0.5 km to 8.0 km. Surface water temperature in the accident area showed little variation during the PMSI (14.5–16.0 °C). Estimated ADD varied between 115 °C and 174 °C, and between 104 °C and 191 °C when considering the cumulative lower (ADDmin) and upper (ADDmax) limits for ADD.

We compare the results with recently published data on two similar cases, and suggest a range for ADD that can be assumed as necessary before body floatability is regain after a drowning accident.

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Investigation of Oxyhemoglobin and Carboxyhemoglobin Ratios in Right and Left Cardiac Blood for diagnosis of Fatal Hypothermia and Death by Fire

Legal Medicine Available online 5 July 2014;   DOI: 10.1016/j.legalmed.2014.06.010

Few large-scale investigations have looked at the oxyhemoglobin ratio (%O2-Hb) or the carboxyhemoglobin ratio (%CO-Hb) in fatal hypothermia and death by fire as applicable to forensic medicine. We therefore retrospectively examined right and left cardiac blood samples for both%O2-Hb and%CO-Hb in 690 forensic autopsy cases. We therefore sought to establish reference values for the above forensic diagnoses, to compare%O2-Hb in fatal hypothermia with or without cardiopulmonary resuscitation (CPR), and to compare the relationship between%CO-Hb and smoking history. All%O2-Hb and%CO-Hb data were obtained during or immediately after autopsies using a portable CO-oximeter. Death by carbon monoxide (CO) intoxication and death by fire were excluded from the analysis involving smoking history.

In fatal hypothermia,%O2-Hb in the left cardiac blood was significantly higher than that in the right cardiac blood, providing important evidence for fatal hypothermia. Furthermore,%O2-Hb in the left cardiac blood increases with CPR but that in the right cardiac blood increases in parallel. No correlation was observed between rectal temperature and%O2-Hb in the right and left cardiac blood, indicating that it is unlikely that postmortem cooling increases%O2-Hb in cardiac blood.%CO-Hb in smokers was significantly higher than that in non-smokers, although the number of cigarettes smoked did not appear to be significant. When assessing death by fire, we identified that%CO-Hb of >10% was a reliable marker of antemortem CO inhalation, regardless of smoking history.

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‘Unreliable’ Articles, ‘Trial By Literature’ Revisited

New York Law Journal 12 May 2014

This column revisits a challenging topic that cuts across the spectrum of complex litigation—the reliance upon and use of unreliable hearsay literature by expert testifiers. Often these are technical or scientific articles published in some journal with a claim that the published work product has been “peer reviewed.”

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See also  ‘Unreliable’ Articles: More on Peer Review’s Frailties

 

DNA Analysis of Fingernail Clippings An Unusual Case Report

Am J Forensic Med Pathol 2014;35: 96-99

The case of an unusual DNA analysis of fingernail clippings
is described. A 20-year-old woman died of strangulation, and her former
boyfriend entered the police’s sight as suspect through rapid investigation
and inspection. Genomic DNA from debris scraped underneath the
suspect’s fingernail was extracted 2 days after the incident using the
modified DNA pretreatment method. Finally, mixed DNA profiles were
observed from the suspect’s fingernail clippings, one of them originating
from the victim, which is consistent with the result of criminal investigation.
With the support of strong evidence, the suspect soon confessed.
In this case, it was really unusual in practice that fingernail debris
extracted from the suspect was used to accuse the suspect himself. This
case demonstrates the usefulness of the modified DNA pretreatment
method and the possibility of getting DNA profiles from fingernail
clippings with 2 days’ lapse between the incident and recovery of the
evidential material.

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A study of elderly unnatural deaths in medico-legal autopsies at Lucknow locality

Medicine, Science and the Law 2014 54: 127

The main aim of this study was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. Data were collected on 4405 male and female victims of unnatural deaths aged 50 years or more from the total number of 21,235 autopsies performed in King George’s Medical University, Lucknow, India over a 5-year period, from 2008 to 2012. There were 3165 male victims and 1240 female victims. Unnatural deaths were higher in rural (64%) than in urban (37%) areas. Accidental deaths were the most common manner of unnatural deaths (59%), followed by suicidal deaths (34%) and homicidal deaths (7%). Traumas were the most common cause of unnatural death (77.3%), followed by undetermined causes (16.6%) and toxicological causes (6.1%). The most common causes of traumatic deaths were blunt head injuries (34%) followed by stab in the chest (6%), burn (16%), blunt injuries in abdomen and chest (10%), firearm injuries in the head and trunk (9%), strangulation (3%), stab in the abdomen (4%), smothering (4%), cut throat (3%), throttling (1%) and hanging (10%). Carbamate poisoning was the most common cause of toxicological deaths (44%) followed by organophosphorous poisoning (33%), ethyl alcohol poisoning (12%), barbiturate poisoning (3%) and zinc phosphide poisoning (8%).

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Can early myocardial infarction-related deaths be diagnosed using postmortem urotensin receptor expression levels?

Forensic Science, Medicine, and Pathology June 2014

Purpose

Myocardial infarction (MI) is one of the most prevalent causes of sudden adult death. It is difficult to diagnose early MI postmortem because there are no typical or characteristic changes in morphology. In this study, changes in the level of the mRNA for the urotensin receptor (UR) were investigated postmortem to determine the suitability of UR as a biomarker for diagnosis of early MI after death.

Methods

An MI rat model was developed by injecting rats with isoproterenol (ISO) (lethal dose 850 mg/kg) or normal saline (control group). The hearts of rats in the control and ISO-induced MI groups were harvested at 0, 1, 3, 6, 12, 24, 48, and 72 h (h) postmortem. The hearts were then immediately submerged in 1 mL of RNA stabilization solution and stored at 4 °C for <1 week before RNA extraction. Relative UR expression analysis was performed using the StepOne Plus Real Time PCR System with cDNA synthesized from rat heart.

Results

Postmortem UR mRNA expression was higher in the ISO-induced MI group than in the control group, at both 4 and 20 °C, at all of the time points examined except 72 h postmortem (p < 0.0001). The largest increases were observed at ambient temperature and 6 h postmortem.

Conclusions

Based on our findings, increased postmortem UR expression could serve as a biomarker to aid diagnosis of early MI.

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