Pub Date : 2024-11-01DOI: 10.1016/j.jflm.2024.102785
Augustinas Stasiunas , Sigitas Chmieliauskas , Jurgita Stasiuniene , Sigitas Laima , Diana Vasiljevaite , Rokas Simakauskas , Dmitrij Fomin , Ineta Dvarvytyte
The number of alcohol-related deaths in Lithuania has fallen by almost one-third in the last decade; however, the number of deaths has been on the rise since 2019. Data on the postmortem investigation of victims between 2018 and 2022 were obtained from the Lithuanian State Forensic Medicine Service database. This study analyzed data from 1200 autopsies. The deceased victims were categorized based on their cause of death and blood alcohol concentration (sober, legally intoxicated, mild, medium, or heavy). The causes of death were diseases (54.17 %, n = 650), suicides (12.08 %, n = 145), homicides (2.5 %, n = 30), and accidents (31.25 %, n = 375). Toxicological tests for alcohol were performed in all cases. Alcohol levels in the blood and urine were measured using gas chromatography. A significant correlation was observed between blood alcohol concentration and age (r = −0.13, p = 0.007). A statistically significant difference was observed in the proportions of men and women who were intoxicated. Among the causes of death, the group of individuals who died because of accidents exhibited the highest average blood alcohol concentration. Alcohol intoxication is undoubtedly a contributing factor to fatalities resulting from accidents and homicides. These findings assist in determining the intoxication level of victims and in assessing any potential links that may contribute to or predispose victims to lethal outcomes in cases of disease, suicide, homicide, or accident.
{"title":"Ethyl alcohol consumption characteristics of deceased individuals in Lithuania","authors":"Augustinas Stasiunas , Sigitas Chmieliauskas , Jurgita Stasiuniene , Sigitas Laima , Diana Vasiljevaite , Rokas Simakauskas , Dmitrij Fomin , Ineta Dvarvytyte","doi":"10.1016/j.jflm.2024.102785","DOIUrl":"10.1016/j.jflm.2024.102785","url":null,"abstract":"<div><div>The number of alcohol-related deaths in Lithuania has fallen by almost one-third in the last decade; however, the number of deaths has been on the rise since 2019. Data on the postmortem investigation of victims between 2018 and 2022 were obtained from the Lithuanian State Forensic Medicine Service database. This study analyzed data from 1200 autopsies. The deceased victims were categorized based on their cause of death and blood alcohol concentration (sober, legally intoxicated, mild, medium, or heavy). The causes of death were diseases (54.17 %, n = 650), suicides (12.08 %, n = 145), homicides (2.5 %, n = 30), and accidents (31.25 %, n = 375). Toxicological tests for alcohol were performed in all cases. Alcohol levels in the blood and urine were measured using gas chromatography. A significant correlation was observed between blood alcohol concentration and age (r = −0.13, p = 0.007). A statistically significant difference was observed in the proportions of men and women who were intoxicated. Among the causes of death, the group of individuals who died because of accidents exhibited the highest average blood alcohol concentration. Alcohol intoxication is undoubtedly a contributing factor to fatalities resulting from accidents and homicides. These findings assist in determining the intoxication level of victims and in assessing any potential links that may contribute to or predispose victims to lethal outcomes in cases of disease, suicide, homicide, or accident.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102785"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jflm.2024.102784
Zhonghao Yu , Yuhao Yuan , Qing Shi , Hang Gao , Erjuan Zhao , Jinghong Ma , Yiwu Zhou
Brodifacoum, a long-acting anticoagulant rodenticide, exerts inhibitory effects on blood coagulation factor synthesis, leading to abnormal clotting function and potential fatality. Poisoning of accidental exposure to brodifacoum is not rare, but death from brodifacoum poisoning can be largely avoided with timely and long-term effective treatments, consequently, forensic data on fatalities due to brodifacoum poisoning may be limited. This paper presents a case of brodifacoum-induced homicide, detailing the medial records and pathological changes observed in multiple organs. Furthermore, t liquid chromatography–tandem mass spectrometry (LC-MS/MS) was employed to measure the concentrations of brodifacoum in blood, hydropericardium, and urine 40 days post-poisoning (1 day post-mortem), yielding values of 0.097 μg/mL, 0.089 μg/mL, and 0.007 μg/mL respectively. The aim of this article is to contribute towards forensic identification of fatalities resulting from brodifacoum poisoning while also serving as a reference for clinical diagnosis in similar cases.
{"title":"Systematic forensic identification of a homicide by brodifacoum poisoning: A case report","authors":"Zhonghao Yu , Yuhao Yuan , Qing Shi , Hang Gao , Erjuan Zhao , Jinghong Ma , Yiwu Zhou","doi":"10.1016/j.jflm.2024.102784","DOIUrl":"10.1016/j.jflm.2024.102784","url":null,"abstract":"<div><div>Brodifacoum, a long-acting anticoagulant rodenticide, exerts inhibitory effects on blood coagulation factor synthesis, leading to abnormal clotting function and potential fatality. Poisoning of accidental exposure to brodifacoum is not rare, but death from brodifacoum poisoning can be largely avoided with timely and long-term effective treatments, consequently, forensic data on fatalities due to brodifacoum poisoning may be limited. This paper presents a case of brodifacoum-induced homicide, detailing the medial records and pathological changes observed in multiple organs. Furthermore, t liquid chromatography–tandem mass spectrometry (LC-MS/MS) was employed to measure the concentrations of brodifacoum in blood, hydropericardium, and urine 40 days post-poisoning (1 day post-mortem), yielding values of 0.097 μg/mL, 0.089 μg/mL, and 0.007 μg/mL respectively. The aim of this article is to contribute towards forensic identification of fatalities resulting from brodifacoum poisoning while also serving as a reference for clinical diagnosis in similar cases.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102784"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jflm.2024.102786
Zhe Zheng , Hongwei Li , Caiyuan Liu , Qiannan Xu , Zhenqian Zhang , Xinmin Pan , Haojie Qin
Cold-inducible RNA-binding protein (CIRBP) and RNA binding motif protein 3 (RBM3) are both members of the cold shock protein family expressed in response to low-temperature induction. However, their usefulness in the diagnosis of fatal hypothermia in forensic has not been reported. In this study, we report the case of a female who died of fatal hypothermia. Through detailed case investigation, scene examination, autopsy testing and tissue observation, we ultimately determined that the woman died of hypothermia. We further examined the expression of CIRBP and RBM3 in the postmortem brain, heart, lung and kidney via immunohistochemistry. The high expression of CIRBP and RBM3 in the brain, lungs, and kidneys suggested the possibility of hypothermia. This study may provide new auxiliary diagnostic indicators for the diagnosis of fatal hypothermia in forensic medicine.
{"title":"Cold shock proteins CIRBP and RBM3 may indicate hypothermia death: A case report","authors":"Zhe Zheng , Hongwei Li , Caiyuan Liu , Qiannan Xu , Zhenqian Zhang , Xinmin Pan , Haojie Qin","doi":"10.1016/j.jflm.2024.102786","DOIUrl":"10.1016/j.jflm.2024.102786","url":null,"abstract":"<div><div>Cold-inducible RNA-binding protein (CIRBP) and RNA binding motif protein 3 (RBM3) are both members of the cold shock protein family expressed in response to low-temperature induction. However, their usefulness in the diagnosis of fatal hypothermia in forensic has not been reported. In this study, we report the case of a female who died of fatal hypothermia. Through detailed case investigation, scene examination, autopsy testing and tissue observation, we ultimately determined that the woman died of hypothermia. We further examined the expression of CIRBP and RBM3 in the postmortem brain, heart, lung and kidney via immunohistochemistry. The high expression of CIRBP and RBM3 in the brain, lungs, and kidneys suggested the possibility of hypothermia. This study may provide new auxiliary diagnostic indicators for the diagnosis of fatal hypothermia in forensic medicine.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102786"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jflm.2024.102760
Michael D. Freeman
{"title":"Reflections on editorial and peer review in the forensic medical literature","authors":"Michael D. Freeman","doi":"10.1016/j.jflm.2024.102760","DOIUrl":"10.1016/j.jflm.2024.102760","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102760"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jflm.2024.102787
Tim Merriam , Markus Enders , Stephan A. Bolliger , Wolf Schweitzer , Michael J. Thali , Lars Ebert , Barbara Fliss
When the time since death must be calculated forensic pathologists often consider a calculation based on the Henssge nomogram. This calculation requires an estimated body weight. Previous research has indicated that healthcare workers generally inaccurately guessed patients’ body weights. In recent years, weight estimation methods based on anthropometric parameters, such as mid-arm or waist circumference, have been shown to improve estimation accuracy. This study aimed to examine whether anthropometric weight estimation methods could improve weight estimation accuracy compared to visual estimation in forensic pathology.
In 199 cases from a Swiss population, we measured the actual body weight, mid-arm circumference, waist circumference, and body height before autopsy. Additionally, two forensic pathologists visually estimated the body weight. We found mid-arm circumferences to correlate the strongest with actual body weight (Pearson ’sr 0.87, 95 % CI 0.83–0.90). However, all mid-arm circumference-based estimation methods performed worse than those previously described. A statistical bias between −12.3 % and −14.5 % indicated a systematic weight underestimation. Combined two-physician visual estimation performed significantly better than anthropometric measurements in our population but showed no difference from anthropometric estimation methods previously described in the literature. Further research is needed on novel body weight estimation methods that are currently not applicable for the global population.
当必须计算死亡时间时，法医病理学家通常会考虑根据亨斯格提名图进行计算。这种计算方法需要估计体重。以往的研究表明，医护人员对病人体重的猜测通常不准确。近年来，基于人体测量参数（如中臂围或腰围）的体重估算方法已被证明可提高估算的准确性。本研究旨在探讨在法医病理学中，与目测法相比，人体测量体重估计方法能否提高体重估计的准确性。在 199 例瑞士人中，我们在解剖前测量了实际体重、中臂围、腰围和身高。此外，两名法医病理学家目测了体重。我们发现中臂围与实际体重的相关性最强（Pearson 'sr 0.87, 95 % CI 0.83-0.90）。然而，所有基于中臂围度的估算方法都比之前描述的方法表现更差。-12.3%到-14.5%之间的统计偏差表明存在系统性的体重低估。在我们的研究人群中，两位医生的联合目测估算结果明显优于人体测量方法，但与之前文献中描述的人体测量估算方法没有区别。对于目前还不适用于全球人口的新型体重估算方法，还需要进一步研究。
{"title":"Anthropometric weight estimation is less accurate than visual weight estimation in forensic postmortem cases in a Swiss population","authors":"Tim Merriam , Markus Enders , Stephan A. Bolliger , Wolf Schweitzer , Michael J. Thali , Lars Ebert , Barbara Fliss","doi":"10.1016/j.jflm.2024.102787","DOIUrl":"10.1016/j.jflm.2024.102787","url":null,"abstract":"<div><div>When the time since death must be calculated forensic pathologists often consider a calculation based on the Henssge nomogram. This calculation requires an estimated body weight. Previous research has indicated that healthcare workers generally inaccurately guessed patients’ body weights. In recent years, weight estimation methods based on anthropometric parameters, such as mid-arm or waist circumference, have been shown to improve estimation accuracy. This study aimed to examine whether anthropometric weight estimation methods could improve weight estimation accuracy compared to visual estimation in forensic pathology.</div><div>In 199 cases from a Swiss population, we measured the actual body weight, mid-arm circumference, waist circumference, and body height before autopsy. Additionally, two forensic pathologists visually estimated the body weight. We found mid-arm circumferences to correlate the strongest with actual body weight (Pearson ’sr 0.87, 95 % CI 0.83–0.90). However, all mid-arm circumference-based estimation methods performed worse than those previously described. A statistical bias between −12.3 % and −14.5 % indicated a systematic weight underestimation. Combined two-physician visual estimation performed significantly better than anthropometric measurements in our population but showed no difference from anthropometric estimation methods previously described in the literature. Further research is needed on novel body weight estimation methods that are currently not applicable for the global population.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102787"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.jflm.2024.102782
Raíssa Bastos Vieira , Carlos Antonio Vicentin-Junior , Nicole Prata Damascena , Melina Calmon Silva , Analany Pereira Dias Araujo , Rafael Queiroz da Trindade , Maria Gabriela Duarte Morais Vieira , Eugénia Cunha , Alexandre Raphael Deitos , Bianca Marques Santiago , Paulo Ricardo Martins-Filho , Carlos Eduardo Palhares Machado
The estimation of the postmortem interval (PMI) is a significant challenge in legal medicine and forensic sciences due to the dynamic and continuous decomposition of organisms after death. Thanatochemistry has emerged as a promising area to estimate PMI by measuring the concentrations of postmortem biochemical markers. This systematic review and meta-analysis aimed to summarize evidence on postmortem biochemical alterations in vitreous humor (VH) and synovial fluid (SF) to estimate early PMI. Comprehensive searches of electronic databases identified studies measuring postmortem biomarker concentrations in both matrices. Our analysis included three meta-analytical approaches: calculating standardized mean differences to assess variations in biochemical parameters, executing correlation meta-analysis (ρ) to explore relationships between these parameters and PMI, and conducting meta-regression to derive a predictive model. Results from five eligible studies indicated no correlation between sodium levels and PMI in both matrices. However, a strong correlation was found between potassium levels and PMI in VH (ρ = 0.69; 95 % CI 0.52 to 0.86) and SF (ρ = 0.81; 95 % CI 0.75 to 0.87), with the meta-regression yielding the optimal predictive equation for SF: [K+] = 6.15 + 0.21 × PMI. These findings support the use of potassium as a reliable biomarker for PMI estimation, particularly in SF.
由于生物体在死后会发生动态和持续的分解，因此估算死后间隔时间（PMI）是法律医学和法医学面临的一项重大挑战。通过测量死后生化标志物的浓度来估算死后间隔时间是一个很有前景的领域。本系统综述和荟萃分析旨在总结有关玻璃体（VH）和滑膜液（SF）中死后生化变化的证据，以估算早期死亡原因指数。通过对电子数据库的全面检索，我们发现了测量两种基质中死后生物标志物浓度的研究。我们的分析包括三种元分析方法：计算标准化平均差以评估生化参数的变化；执行相关元分析（ρ）以探讨这些参数与 PMI 之间的关系；以及进行元回归以得出预测模型。五项符合条件的研究结果表明，在两个矩阵中，钠水平与 PMI 之间没有相关性。然而，在 VH（ρ = 0.69；95 % CI 0.52 至 0.86）和 SF（ρ = 0.81；95 % CI 0.75 至 0.87）中，钾水平与 PMI 之间存在很强的相关性，元回归得出了 SF 的最佳预测方程：[K+] = 6.15 + 0.21 × PMI。这些发现支持将钾作为估计 PMI 的可靠生物标志物，特别是在 SF 中。
{"title":"Biochemical analysis of vitreous humor and synovial fluid in the estimation of early postmortem interval: A meta-analytical approach","authors":"Raíssa Bastos Vieira , Carlos Antonio Vicentin-Junior , Nicole Prata Damascena , Melina Calmon Silva , Analany Pereira Dias Araujo , Rafael Queiroz da Trindade , Maria Gabriela Duarte Morais Vieira , Eugénia Cunha , Alexandre Raphael Deitos , Bianca Marques Santiago , Paulo Ricardo Martins-Filho , Carlos Eduardo Palhares Machado","doi":"10.1016/j.jflm.2024.102782","DOIUrl":"10.1016/j.jflm.2024.102782","url":null,"abstract":"<div><div>The estimation of the postmortem interval (PMI) is a significant challenge in legal medicine and forensic sciences due to the dynamic and continuous decomposition of organisms after death. Thanatochemistry has emerged as a promising area to estimate PMI by measuring the concentrations of postmortem biochemical markers. This systematic review and meta-analysis aimed to summarize evidence on postmortem biochemical alterations in vitreous humor (VH) and synovial fluid (SF) to estimate early PMI. Comprehensive searches of electronic databases identified studies measuring postmortem biomarker concentrations in both matrices. Our analysis included three meta-analytical approaches: calculating standardized mean differences to assess variations in biochemical parameters, executing correlation meta-analysis (ρ) to explore relationships between these parameters and PMI, and conducting meta-regression to derive a predictive model. Results from five eligible studies indicated no correlation between sodium levels and PMI in both matrices. However, a strong correlation was found between potassium levels and PMI in VH (ρ = 0.69; 95 % CI 0.52 to 0.86) and SF (ρ = 0.81; 95 % CI 0.75 to 0.87), with the meta-regression yielding the optimal predictive equation for SF: [K+] = 6.15 + 0.21 × PMI. These findings support the use of potassium as a reliable biomarker for PMI estimation, particularly in SF.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102782"},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.jflm.2024.102783
Steven Brown
Research shows no convincing evidence to support a causal link between cervical spine manipulation (CSM) and cervical artery dissection (CAD). Researchers have proposed that a belief in a causal link may have significant negative consequences such as numerous episodes of litigation. The objective of this study was to review 10 malpractice cases for evidence of unnecessary litigation due to a belief in a causal link between CSM and CAD.
A Google Scholar Case Law search from 1989 to 2024 was conducted to identify the 10 most recent English-language reports of malpractice cases involving an allegation that CSM caused CAD. Although our objective was to review 10 cases, only 9 cases were found.
In all cases, causation of CAD by CSM was not supported by the evidence. In 4 out 9 cases reviewed, causation of stroke by CSM was supported by the evidence. In all 9 cases reviewed, failure to diagnose an existing CAD was more likely than not but was not alleged.
We conclude that belief in a causal link between CSM and CAD does have negative consequences such as unnecessary litigation. In all 9 cases reviewed, allegations of failure to diagnose an existing CAD would have been more likely to result in a settlement without need for a trial.
{"title":"Review of nine malpractice cases with allegations of causation of cervical artery dissection by cervical spine manipulation: No evidence for causation","authors":"Steven Brown","doi":"10.1016/j.jflm.2024.102783","DOIUrl":"10.1016/j.jflm.2024.102783","url":null,"abstract":"<div><div>Research shows no convincing evidence to support a causal link between cervical spine manipulation (CSM) and cervical artery dissection (CAD). Researchers have proposed that a belief in a causal link may have significant negative consequences such as numerous episodes of litigation. The objective of this study was to review 10 malpractice cases for evidence of unnecessary litigation due to a belief in a causal link between CSM and CAD.</div><div>A Google Scholar Case Law search from 1989 to 2024 was conducted to identify the 10 most recent English-language reports of malpractice cases involving an allegation that CSM caused CAD. Although our objective was to review 10 cases, only 9 cases were found.</div><div>In all cases, causation of CAD by CSM was not supported by the evidence. In 4 out 9 cases reviewed, causation of stroke by CSM was supported by the evidence. In all 9 cases reviewed, failure to diagnose an existing CAD was more likely than not but was not alleged.</div><div>We conclude that belief in a causal link between CSM and CAD does have negative consequences such as unnecessary litigation. In all 9 cases reviewed, allegations of failure to diagnose an existing CAD would have been more likely to result in a settlement without need for a trial.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102783"},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.jflm.2024.102780
Luz A. Silva-Torres , Ashraf Mozayani
In the last decade, the opioid overdose epidemic has been exacerbated by the emerging drug of abuse, xylazine. This veterinary anesthetic, an alpha-2 agonist, not only potentiates the fatal effects of opioids but also causes toxic endothelial effects. This review aims to assess the impact of xylazine use and overdoses within the context of the opioid crisis as a public health issue. The research used data from scientific publications, state health reports, and analyses from the Institute of Forensic Sciences of Puerto Rico. The databases PubMed, Google Scholar, and Scopus were searched for relevant publications. The search strategy employed two groups of terms: the drug of interest (xylazine) and types of exposure (drug use, overdose, substance abuse, etc.). The initial search in PubMed was then extrapolated, and the search terms were adjusted for appropriate database syntax. According to the most recent publications and CDC data in the USA, approximately 95 % of fentanyl overdose cases involve xylazine, while the other 5 % of overdose cases are attributed solely to xylazine, predominantly administered intravenously. In the last four years, more than 4000 overdose deaths have been related to xylazine use; the northeastern United States had reported the most significant number of deaths. This number changes daily as reanalysis results and new data are published. Less than 50 % of states perform tests for xylazine detection or maintain statistical monitoring of overdoses related to this drug. The absence of testing impedes emergency room physicians from making accurate diagnoses, increasing the likelihood of fatal overdoses. This review highlights five major concerns: (1) The recognition of intoxication as a primary concern and the unavailability of alpha-2 antagonists for treatment. (2) The challenges in the clinical setting linked to xylazine abuse and its co-administration with substances like fentanyl and its analogs. (3) The necessity for robust government statistical resources for the unification and dissemination of critical overdose and emerging drug abuse detection information. (4) The need for effective rehabilitation programs, including psychosocial support and treatment interventions, to respond to this public health crisis. (5) The urgency for further research to understand the prevalence, toxic effects of chronic or acute use, and the clinical implications in xylazine users, including the development of alpha-2 antagonists for treatment. We conclude that addressing these concerns is crucial to working with the xylazine abuse situation.
{"title":"Xylazine abuse, the growing risk: A review of its effects, upsurge use and associated fatalities in the USA and Puerto Rico","authors":"Luz A. Silva-Torres , Ashraf Mozayani","doi":"10.1016/j.jflm.2024.102780","DOIUrl":"10.1016/j.jflm.2024.102780","url":null,"abstract":"<div><div>In the last decade, the opioid overdose epidemic has been exacerbated by the emerging drug of abuse, xylazine. This veterinary anesthetic, an alpha-2 agonist, not only potentiates the fatal effects of opioids but also causes toxic endothelial effects. This review aims to assess the impact of xylazine use and overdoses within the context of the opioid crisis as a public health issue. The research used data from scientific publications, state health reports, and analyses from the Institute of Forensic Sciences of Puerto Rico. The databases PubMed, Google Scholar, and Scopus were searched for relevant publications. The search strategy employed two groups of terms: the drug of interest (xylazine) and types of exposure (drug use, overdose, substance abuse, etc.). The initial search in PubMed was then extrapolated, and the search terms were adjusted for appropriate database syntax. According to the most recent publications and CDC data in the USA, approximately 95 % of fentanyl overdose cases involve xylazine, while the other 5 % of overdose cases are attributed solely to xylazine, predominantly administered intravenously. In the last four years, more than 4000 overdose deaths have been related to xylazine use; the northeastern United States had reported the most significant number of deaths. This number changes daily as reanalysis results and new data are published. Less than 50 % of states perform tests for xylazine detection or maintain statistical monitoring of overdoses related to this drug. The absence of testing impedes emergency room physicians from making accurate diagnoses, increasing the likelihood of fatal overdoses. This review highlights five major concerns: (1) The recognition of intoxication as a primary concern and the unavailability of alpha-2 antagonists for treatment. (2) The challenges in the clinical setting linked to xylazine abuse and its co-administration with substances like fentanyl and its analogs. (3) The necessity for robust government statistical resources for the unification and dissemination of critical overdose and emerging drug abuse detection information. (4) The need for effective rehabilitation programs, including psychosocial support and treatment interventions, to respond to this public health crisis. (5) The urgency for further research to understand the prevalence, toxic effects of chronic or acute use, and the clinical implications in xylazine users, including the development of alpha-2 antagonists for treatment. We conclude that addressing these concerns is crucial to working with the xylazine abuse situation.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102780"},"PeriodicalIF":1.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.jflm.2024.102781
Deniz Yanık , Şelale Özel
The study aims to evaluate the reliability of the novel dentin thickness model based on root parameters when applied to panoramic radiography images of mandibular first molar in the southern Turkish subpopulation. A total of 946 panoramic images were analyzed for the study. The samples were allocated into four age groups: Group 1(between 10 and 18), Group 2(between 19 and 30), Group 3(between 31 and 50), Group 4(between 51 and 78). The dentin thickness model measurements consisted of root dentin thickness of the mesial aspect of the distal root and distal canal width. Regression, intraclass correlation coefficient, and Durbin-Watson analyses were used for statistics. A medium correlation was detected in the dentin thickness model (R = 0.398). Root dentin thickness and canal width had a significant effect (p < 0.05), but gender did not (p > 0.05). Group 3 showed the highest accuracy (p < 0.001). Group 4 presented the lowest correlation with chronological age compared to other age groups (p < 0.001). The dentin thickness model showed a promising result for the dental age estimation with a medium correlation. The dentin thickness model included root measurements of the mesial aspect of the mandibular first molar without any crown parameters in the southern Turkish subpopulation. Gender did not affect the dentin thickness model.
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The proper completion of death certificates (DCs) is of paramount importance for physicians, as they serve as vital medico-legal documents. The information contained within these certificates holds great significance in health statistics, as it serves as a crucial tool for epidemiological research and analysis.
Methods
This study comprises a descriptive cross-sectional analysis of all DCs issued in 2019 for approximately 1104 deceased patients at a teaching hospital in Mazandaran Province, in northern Iran. To conduct this research, a checklist was implemented, which contained comprehensive categories, including essential public information, and the primary and underlying causes of death (UCOD).
Results
The results of this study indicate that out of the 618 cases of deceased individuals, 273 (44.2 %) were women and 345 (55.8 %) were men. Notably, a total of 61 cases (9.9 %) exhibited an error in the writing of the primary cause of death (COD). Specifically, the UCOD was erroneously recorded as cardio-pulmonary arrest in 13.2 % of all DCs, thus resulting in an error in the main COD.
Conclusion
The findings of this study disclosed a high incidence of errors in the completion of DCs, particularly in the determination of the UCOD, which is universally recognized as the most critical aspect of these documents.
背景：正确填写死亡证明书（DC）对医生来说至关重要，因为它们是重要的医学法律文件。这些证书中包含的信息在卫生统计中具有重要意义，因为它是流行病学研究和分析的重要工具：本研究对伊朗北部马赞达兰省一家教学医院 2019 年为约 1104 名死亡患者签发的所有 DC 进行了描述性横断面分析。为了开展这项研究，我们采用了一份核对表，其中包含全面的分类，包括基本公共信息、主要死因和潜在死因（UCOD）：研究结果表明，在 618 例死者中，273 例（44.2%）为女性，345 例（55.8%）为男性。值得注意的是，共有 61 例（9.9%）在书写主要死因（COD）时出现错误。具体来说，在所有 DC 中，13.2% 的 UCOD 被错误地记录为心肺骤停，从而导致主要死因出现错误：这项研究的结果表明，在填写 DC 时出错率很高，尤其是在确定 UCOD 时，而 UCOD 是公认的这些文件中最关键的部分。
{"title":"Common errors in the completion of death certificates in teaching hospitals in northern Iran: A legal challenge","authors":"Seyed Mehran Razavipour , Seyed Khosro Ghasempouri , Navid Khosravi Kochaksaraei , Zakaria Zakariaei , Ashkan Ahodashti","doi":"10.1016/j.jflm.2024.102779","DOIUrl":"10.1016/j.jflm.2024.102779","url":null,"abstract":"<div><h3>Background</h3><div>The proper completion of death certificates (DCs) is of paramount importance for physicians, as they serve as vital medico-legal documents. The information contained within these certificates holds great significance in health statistics, as it serves as a crucial tool for epidemiological research and analysis.</div></div><div><h3>Methods</h3><div>This study comprises a descriptive cross-sectional analysis of all DCs issued in 2019 for approximately 1104 deceased patients at a teaching hospital in Mazandaran Province, in northern Iran. To conduct this research, a checklist was implemented, which contained comprehensive categories, including essential public information, and the primary and underlying causes of death (UCOD).</div></div><div><h3>Results</h3><div>The results of this study indicate that out of the 618 cases of deceased individuals, 273 (44.2 %) were women and 345 (55.8 %) were men. Notably, a total of 61 cases (9.9 %) exhibited an error in the writing of the primary cause of death (COD). Specifically, the UCOD was erroneously recorded as cardio-pulmonary arrest in 13.2 % of all DCs, thus resulting in an error in the main COD.</div></div><div><h3>Conclusion</h3><div>The findings of this study disclosed a high incidence of errors in the completion of DCs, particularly in the determination of the UCOD, which is universally recognized as the most critical aspect of these documents.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102779"},"PeriodicalIF":1.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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