Category Archives: Forensic pathology

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

Deaths linked to synthetic cannabinoids

Forensic Science, Medicine, and Pathology March 2015

Over the last 5 years there has been an influx of novel designer drugs (mostly illegal) which are intended to mimic the effects of cannabis (synthetic cannabinoids). Many of these compounds are created by research groups attempting to find an analog of cannabis that can be used therapeutically to treat pain and other conditions.
PB-22 (1-pentyl-8-quinolinyl ester-1H-indole-3-carboxylic acid) is a relatively new synthetic cannabinoid which has cannabis like activity and possibly other as yet unknown effects. There is no published data on the pharmacodynamics, pharmacokinetics or toxicology of PB-22. However, a recent publication has reported 4 deaths associated with use of 5F-PB-22 which is a derivative of PB-22 [1]. Although synthetic cannabinoids have been reported in association with sudden death, the precise pathophysiological mechanisms by which death occurs remain obscure.

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Histologic validation of locus coeruleus MRI contrast in post-mortem tissue

NeuroImage Available online 17 March 2015; doi:10.1016/j.neuroimage.2015.03.020

The locus coeruleus (LC) noradrenergic system regulates arousal and modulates attention through its extensive projections across the brain. LC dysfunction has been implicated in a broad range of neurodevelopmental, neurodegenerative and psychiatric disorders, as well as in the cognitive changes observed during normal aging. Magnetic resonance imaging (MRI) has been used to characterize the human LC (elevated contrast relative to surrounding structures), but there is limited understanding of the factors underlying putative LC contrast that are critical to successful biomarker development and confidence in localizing nucleus LC. We used ultra-high-field 7 T magnetic resonance imaging (MRI) to acquire T1-weighted microscopy resolution images (78 μm in-plane resolution) of the LC from post-mortem tissue samples. Histological analyses were performed to characterize the distribution of tyrosine hydroxylase (TH) and neuromelanin in the scanned tissue, which allowed for direct comparison with MR microscopy images. Our results indicate that LC-MRI contrast corresponds to the location of neuromelanin cells in LC; these also correspond to norepinephrine neurons. Thus, neuromelanin appears to serve as a natural contrast agent for nucleus LC that can be used to localize nucleus LC and may have the potential to characterize neurodegenerative disease.

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Sudden unexpected death in infancy: aetiology, pathophysiology, epidemiology and prevention in 2015 [Review]

Arch Dis Child  Online 19 February 2015 doi:10.1136/archdischild-2014-306424

Despite the fall in numbers of unexpected infant deaths that followed the ‘Back to Sleep’ campaigns in the early 1990s in the UK and many other countries, such deaths remain one of the largest single groups of deaths in the postneonatal period in many Western countries. Changes in the ways in which unexpected infant deaths are categorised by pathologists and coroners, and increasing reluctance to use the term ‘sudden infant death syndrome’, make assessment of nationally and internationally collected data on incidence potentially inaccurate and confusing. In this paper, we review current understanding of the epidemiology and aetiology of unexpected deaths in infancy, and current hypotheses on the pathophysiology of the processes that may lead to death. We also review interventions that have been adopted, with variable degrees of effectiveness in efforts to reduce the numbers of deaths, and new approaches that offer the possibility of prevention in the future.

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The role of forensic death investigators interacting with the survivors of death by homicide and suicide

J. Forensic Nurs. 2015; 11: 28-32;  doi: 10.1097/JFN.0000000000000058

When sudden unexpected death occurs, an investigation ensues in an attempt to discover the cause and manner of death. Autopsies are performed when reasons for death are not obvious. They are used to provide information, confirm the cause of death, and/or reveal conditions not recognized before death (Hendricks, 2011). One important reason for performing an autopsy is to help families to understand what happened to their loved one so that they can begin the process of grieving. The way that the initial notification and investigation is handled can have a bearing on how a family’s grief progresses. Forensic nurses are in a unique position to bring a holistic approach to death investigation with a focus of care that includes not only the decedent but the surviving loved ones as well (Koehler, 2008). Forensic nurse death investigators can assist families through initial stages of grief in the investigation of death.

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Predictors of depression among a sample of South African mortuary workers

J Nerv Ment Dis. 2015 Mar;203(3):226-30. doi: 10.1097/NMD.0000000000000260

Mortuary workers are at high risk of developing depression and other psychiatric disorders owing to the nature of their work and exposure to deceased victims of violent deaths. Few studies have investigated mental health among mortuary workers in low- and middle-income countries. Participants (N = 45) were recruited from mortuaries in South Africa and completed a battery of questionnaires measuring depression, physical health, perceived stress, fear of blood/injury/mutilation, and resilience. Participants with self-reported depression and posttraumatic stress disorder (PTSD) comprised 13.3% and 4.4% of the sample, respectively. Inexperienced mortuary workers had a higher prevalence rate of depression (16.7%) compared with experienced workers (9.5%). Prevalence of PTSD did not differ significantly between inexperienced (4.2%) and experienced (4.8%) workers. Physical health, perceived stress, fear of blood/injury/mutilation, and resilience were significant predictors of depression in the combined group (experienced and inexperienced). However, perceived stress was the only significant predictor of depression, in multiple regression, in the combined group. Inexperienced workers had significantly higher levels of blood/injury/mutation fear and depression. Mortuary workers seem to be at increased risk of depression, especially inexperienced workers. Perceived poor health, lower levels of resilience, and blood/injury/mutilation fears may lead to increased perceived stress among mortuary workers, which may, in turn, lead to depression. Interventions focused on promoting mental health may be beneficial to all mortuary workers, and preparatory training related to mental health may be beneficial to inexperienced mortuary workers before occupational uptake.

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Case of the month – Academic Forensic Pathology

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Volume 5, number 1. March 2015

Acute coronary artery thrombosis associated with synthetic cannabinoid intoxication / Stephanie A. Dean [et al…]

Postmortem diagnosis of primary small bowel volvulus in an adult / F. Garavan & H. Hameed

 Beyond the boundaries of forensic toxicology – the use of an atypical consultant in a rare case of cerberin poisoning / E. R. Severson [et al…]

Homicide versus hypothermia? An unusual case of hypothermia related to colloid cyst of the third ventricle / E. J. Schafer & J. A. Prahlow

The importance of genetic testing in a case of sudden death in hypertrophic cardiomyopathy due to troponin I mutation / Vivian Snyder [et al…]


Table of contents – Academic Forensic Pathology

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Volume 5, number 1. March 2015

Fatal 25I-NBOMe intoxication: a new recrational risk / Yoshi Umemura [et al…]

Prevalence of drugs and alcohol identificed in fatal work-related injuries: a two office experience / Amanda Maskovyak [et al…]

Characterization of diphenhydramine-related accidental overdose deaths / Elvy M. Varghese [et al…]

Two fatalities due to intentional pentobarbital and phenytoin intoxication / Brittany Symbol [et al…]

Cuyahoga County statistical reports project / Thomas Gilson [et al…]