Category Archives: Forensic pathology

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

Death following ingestion of an edible marijuana product – Colorado, March 2014

MMWR Morb Mortal Wkly Rep. 2015 Jul 24;64(28):771-2.

In March 2014, the Colorado Department of Public Health and Environment (CDPHE) learned of the death of a man aged 19 years after consuming an edible marijuana product. CDPHE reviewed autopsy and police reports to assess factors associated with his death and to guide prevention efforts. The decedent’s friend, aged 23 years, had purchased marijuana cookies and provided one to the decedent. A police report indicated that initially the decedent ate only a single piece of his cookie, as directed by the sales clerk. Approximately 30-60 minutes later, not feeling any effects, he consumed the remainder of the cookie. During the next 2 hours, he reportedly exhibited erratic speech and hostile behaviors. Approximately 3.5 hours after initial ingestion, and 2.5 hours after consuming the remainder of the cookie, he jumped off a fourth floor balcony and died from trauma. The autopsy, performed 29 hours after time of death, found marijuana intoxication as a chief contributing factor. Quantitative toxicologic analyses for drugs of abuse, synthetic cannabinoid, and cathinones (“bath salts”) were performed on chest cavity blood by gas chromatography and mass spectrometry. The only confirmed findings were cannabinoids (7.2 ng/mL delta-9 tetrahydrocannabinol [THC] and 49 ng/mL delta-9 carboxy-THC, an inactive marijuana metabolite). The legal whole blood limit of delta-9 THC for driving a vehicle in Colorado is 5.0 ng/mL. This was the first reported death in Colorado linked to marijuana consumption without evidence of polysubstance use since the state approved recreational use of marijuana in 2012.

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The need for informatics to support forensic pathology and death investigation

J Pathol Inform 2015,  6:32;  DOI: 10.4103/2153-3539.158907

As a result of their practice of medicine, forensic pathologists create a wealth of data regarding the causes of and reasons for sudden, unexpected or violent deaths. This data have been effectively used to protect the health and safety of the general public in a variety of ways despite current and historical limitations. These limitations include the lack of data standards between the thousands of death investigation (DI) systems in the United States, rudimentary electronic information systems for DI, and the lack of effective communications and interfaces between these systems. Collaboration between forensic pathology and clinical informatics is required to address these shortcomings and a path forward has been proposed that will enable forensic pathology to maximize its effectiveness by providing timely and actionable information to public health and public safety agencies.

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Bite-mark and pattern injury analysis: a brief status overview

J Calif Dent Assoc. 2015 Jun;43(6):309-14. [PMID:26126346 ]

Bite marks are one component of forensic investigation requiring subjective interpretation for determining unknown source evidence to a putative suspect. Recent scrutiny has lead to questions about the scientific validity of patterned evidence, bite-mark analysis in particular, and its role in judicial proceedings. This article discusses some issues that persist in forensic circles and the difficulties surrounding the field of bite-mark analysis that inherently must employ human subjectivity in its execution of duty.

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Unexpected death due to dengue virus infection in a non-endemic area

Australian Journal of Forensic Sciences Published online: 29 Jul 2015

Dengue viral infections are increasing in number globally as more travellers are being exposed to the vector in endemic areas. A 41-year-old previously-well woman is reported who died suddenly and unexpectedly from dengue fever following a holiday overseas. Clinical manifestations prior to her collapse were non-specific, consisting of headaches, fever and diarrhoea. The autopsy findings were also non-specific with no skin rash or evidence of coagulopathy. A rapid immunodiffusion assay for dengue NS1 antigen, however, gave a rapid and strong reaction on two occasions and real-time polymerase chain reaction (RT-PCR) testing on a post-mortem blood sample confirmed the presence of flavivirus RNA identified as dengue type 1. This case demonstrates the possibility of serious dengue infections being associated with recent international travel. The non-specificity of symptoms, signs and autopsy findings, combined with its occurrence in non-endemic areas, makes a heightened awareness of this condition important in contemporary forensic settings.

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A suicide involving intraperitoneal injection of pentobarbital

International Journal of Legal Medicine  July 2015; DOI  10.1007/s00414-015-1231-1

We present an unusual case of suicide by intraperitoneal injection of pentobarbital, an overdose of zolpidem and the intake of diazepam, ethanol and other psychoactive substances. The autopsy and specimen collection were conducted in a 10 to 18 h postmortem interval. The toxicological analysis revealed a significantly higher pentobarbital concentration in femoral blood compared to cardiac blood (36 vs. 15 mg/L). On the contrary, zolpidem and diazepam concentrations in cardiac blood (2700 and 590 µg/L) were found to be significantly higher than in femoral blood (1500 and 230 µg/L). These findings point to a postmortem redistribution with a distinct gradient from areas of high drug concentrations in the gastrointestinal tract (zolpidem and diazepam) and the injection site (pentobarbital) to peripheral tissue. Ethanol concentration was 0.95 ‰ which amplified the CNS depression. The choice of this unusual suicide method was associated with the deceased’s former job as a veterinarian’s assistant. In veterinary medicine, the intraperitoneal injection of a lethal dose of pentobarbital is quite commonly performed to euthanise small animals. Intraperitoneal injection is rare as route of administration in humans.

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[In Depth] Forensic labs explore blind testing to prevent errors

Science 31 July 2015:  Vol. 349 no. 6247 pp. 462-463
DOI: 10.1126/science.349.6247.462

Last week, at the first International Symposium on Forensic Science Error Management in Arlington, Virginia, nearly 500 forensic scientists, crime lab managers, and other practitioners confronted the factors that have led to unreliable results in the field. A key problem, many said, is that people who evaluate evidence from crime scenes have access to information about a case that could bias their analysis. That subconscious bias could arise from irrelevant contextual information, such as the nature of the crime or police investigators’ beliefs about a suspect’s guilt, or from the physical evidence itself. As forensics struggles to recover from revelations of serious flaws in its methodology and scientific underpinnings, more labs are considering ways to shield their examiners from potential bias.

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Characterization of five cases of suspected bathtub suicide

Legal Medicine Available online 13 July 2015

We reviewed five autopsy cases of suspected bathtub suicide. The immediate cause of death in all cases was determined to be drowning on the basis of macropathological findings such as frothy fluid in the airways or overinflation of the lungs as well as histological findings obtained at autopsy. We suspected that the manner of death in those cases was suicide based on comprehensive postmortem investigations of statements from witnesses, the presence of a farewell letter, the fact that clothes had been worn, additional means to ensure suicide, and results of drug tests, as well as autopsy findings. Cases of bathtub suicide should be investigated carefully to distinguish them from accidental or natural death.

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