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Semaglutide and GLP-1 Agonists: Forensic and Medicolegal Implications. Semaglutide和GLP-1激动剂:法医学和法律意义。
IF 0.8 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-09-01 Epub Date: 2025-04-23 DOI: 10.1097/PAF.0000000000001044
Michael Fagiola

Abstract: This article is intended as a brief review on the glucagon-like peptide-1 (GLP-1) agonist Semaglutide (Ozempic®, Rybelsus®, Wegovy®), an antidiabetic medication that has gained significant popularity in the United States for its role in long-term weight-loss management. While current research on GLP-1 agonists, including semaglutide, focuses primarily on their therapeutic effects in managing diabetes and obesity, information regarding their forensic and medicolegal significance is limited. Concerns related to GLP-1 agonists may arise due to their pharmacokinetics, potential drug-drug interactions, and side effects including hypoglycemia, which can be relevant in cases involving human performance, such as impaired driving, or in unexpected fatalities. Semaglutide additionally presents analytical challenges due to its large, highly charged molecular structure and potentially limited stability in whole blood, which may complicate its detection and quantification in forensic laboratories using common instrumentation. The development of robust analytical methods will be essential to account for its pharmacological effects and to address its potential role in intoxications or unexplained fatalities, especially in the context of misuse or off-label use for weight loss. A strong case can be made for the necessity of further research into the detection, quantification, and interpretation of semaglutide concentrations in forensic toxicology casework.

摘要:本文旨在简要回顾胰高血糖素样肽-1 (GLP-1)激动剂Semaglutide (Ozempic®,Rybelsus®,Wegovy®),这是一种抗糖尿病药物,因其在长期减肥管理中的作用而在美国广受欢迎。虽然目前对GLP-1激动剂(包括西马鲁肽)的研究主要集中在其治疗糖尿病和肥胖症的效果上,但有关其法医和医学意义的信息有限。GLP-1激动剂的药代动力学、潜在的药物-药物相互作用以及包括低血糖在内的副作用可能引起人们对其的关注,这可能与人类行为有关,如驾驶障碍或意外死亡。此外,Semaglutide由于其大而高电荷的分子结构和在全血中潜在的有限稳定性而带来分析挑战,这可能会使法医实验室使用普通仪器进行检测和定量复杂化。开发可靠的分析方法对于解释其药理作用和解决其在中毒或不明原因死亡中的潜在作用至关重要,特别是在误用或超说明书使用减肥的情况下。在法医毒理学案件中,有必要进一步研究semaglutide浓度的检测、定量和解释。
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引用次数: 0
Incidental Autopsy Finding of Intraosseous Dermoid Cyst With Craniosynostosis: A Case Report. 尸检意外发现骨内皮样囊肿伴颅缝闭塞1例。
IF 0.8 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-09-01 Epub Date: 2025-03-31 DOI: 10.1097/PAF.0000000000001037
Sarah Waszyn, Michael Belenky

Abstract: Dermoid cysts are benign developmental anomalies that are typically cutaneous and occur along lines of embryonic closure. Rarely, intraosseous dermoid cysts can occur in the pediatric population. This report presents an incidental finding of an intraosseous dermoid cyst found during autopsy in the frontal bone of a 3-year-old female patient who died by drowning. The cyst measured 1.2 × 0.7 × 0.6 cm and was located along the sagittal suture. Histopathologic examination of the cyst revealed keratinized stratified squamous epithelium alongside sebaceous glands and hair follicles, confirming the diagnosis of dermoid cyst. Premature closure of all cranial sutures, or craniosynostosis, was also noted. This unique combination of findings may indicate an etiological connection, which may warrant further research. Furthermore, this report provides rare photographs while most intraosseous dermoid cysts are only captured via radiography. From a forensic pathology perspective, incidental findings like these can provide critical insights into congenital anomalies that may impact the family, future research, or medicolegal conclusions, highlighting the broader relevance of thorough autopsies. Moreover, incidental findings such as this case contribute to the growing need for forensic guidelines on how to manage and document unexpected discoveries during investigations.

皮样囊肿是一种良性发育异常,通常发生在皮肤上,沿胚胎闭合线发生。很少,骨内皮样囊肿可发生在儿科人群。本报告提出了一个偶然发现的骨内皮样囊肿在尸检中发现的额骨3岁女性患者溺水死亡。囊肿尺寸为1.2 × 0.7 × 0.6 cm,沿矢状线定位。囊肿的组织病理学检查显示角质化层状鳞状上皮旁边皮脂腺和毛囊,确认皮样囊肿的诊断。所有颅骨缝合线过早闭合,或颅缝闭合,也被注意到。这一独特的组合发现可能表明病原学上的联系,这可能需要进一步的研究。此外,本报告提供了罕见的照片,而大多数骨内皮样囊肿只能通过x线摄影捕获。从法医病理学的角度来看,像这样的偶然发现可以为先天性异常提供重要的见解,这些发现可能会影响家庭、未来的研究或医学法律结论,突出了彻底尸检的广泛相关性。此外,像本案这样的偶然发现促使越来越需要关于如何在调查期间管理和记录意外发现的法医准则。
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引用次数: 0
Illustrated Forensic Pathology: Necklacing. 插图法医病理学:项链。
IF 0.8 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-09-01 Epub Date: 2024-12-30 DOI: 10.1097/PAF.0000000000001004
Ryan Blumenthal, Robert Maximilian
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引用次数: 0
Is Obesity a Factor in Lethal Opioid Toxicity? 肥胖是致死性阿片类药物毒性的一个因素吗?
IF 0.8 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-09-01 Epub Date: 2025-03-04 DOI: 10.1097/PAF.0000000000001029
Jeremy W S Hunter, Corinna Van Den Heuvel, Lilli Stephenson, Ian F Musgrave, Roger W Byard

Abstract: Both obesity and opioid abuse are increasing in numbers globally. As these entities may be associated with significant respiratory compromise, it was hypothesized that synergism may occur and that as a result of this obese individuals may be more sensitive to the effects of opiates, that is, that deaths may occur at lower blood levels. To investigate this possibility, case files at Forensic Science SA, Adelaide Australia, were reviewed for all cases that occurred between 2000 and 2019 where deaths had been attributed to heroin or morphine toxicity. There were 259 cases (66 females, 193 males; age range: 18-91; average: 41.5). The average body mass index (BMI) was 26.8 (females, 26.1; males, 27.0). The total number of obese (BMI ≥ 30 < 40) decedents was 50, and the total number of morbidly obese (BMI ≥ 40) decedents was 17. No significant association was found in the obese or morbidly obese between BMI and postmortem drug levels of <0.01, ≥0.1 < 0.3, ≥0.3, <0.4, or ≥0.4 mg/L ( P  = 0.30, Fisher exact test). The lack of association between fatal postmortem opiate levels and BMI suggests that the negative respiratory effects of opioids and a high BMI may in some way be compensated for by as yet unidentified metabolic/pharmacokinetic factors in obesity.

摘要:肥胖和滥用阿片类药物的人数在全球范围内都在增加。由于这些实体可能与严重的呼吸系统损害有关,因此假设可能会发生协同作用,因此肥胖者可能对阿片类药物的影响更加敏感,也就是说,可能会在较低的血药浓度下死亡。为了研究这种可能性,我们查阅了澳大利亚阿德莱德南澳大利亚州法医科学中心(Forensic Science SA)在 2000 年至 2019 年期间发生的所有归因于海洛因或吗啡中毒致死的病例档案。共有 259 个案例(66 名女性,193 名男性;年龄范围:18-91 岁;平均:41.5 岁)。平均体重指数(BMI)为 26.8(女性 26.1;男性 27.0)。肥胖(体重指数≥ 30 < 40)的死者总数为 50 人,病态肥胖(体重指数≥ 40)的死者总数为 17 人。在肥胖者和病态肥胖者中,体重指数与死后药物水平之间没有发现明显的关联。
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引用次数: 0
A Self-immolation Dilemma. 自焚困境。
IF 0.8 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-09-01 Epub Date: 2025-04-28 DOI: 10.1097/PAF.0000000000001049
Lindsey M Martens, Allison B Anderson, Selly Strauch, Susan Roe

Abstract: Setting oneself on fire, termed self-immolation, has high mortality and morbidity.A 60-year-old female patient with a history of depression and anxiety was found by drone search deceased with thermal injuries in a cornfield. Her abandoned vehicle was found with a dead battery and out of fuel 1/4 mile away. A lighter was lying 8 feet from the decedent, and a string of rosary beads, clothing, cigarettes, pliers, and a glass bottle with a cross on it were found nearby.Autopsy findings were notable for charring of the face, torso, and portions of the extremities, soot deposition in the peripheral airways, erythema of the epiglottis, bilateral lateral tongue hemorrhages, and pulmonary congestion and edema.The toxicology report revealed a blood carbon monoxide level of 23.8%. A blood volatile screen was negative. Blood drug screen was positive for a metabolite of marijuana and loperamide.The patient was determined to be alone at the time of the fire and death. No fuel or ignitable fluid was identified. The origin of the fire and the manner of death were listed as undetermined. The cause of death was determined to be thermal injuries and smoke inhalation. Whether this case represents a deliberate act or a possible accident remains in question.

摘要自焚是一种死亡率和发病率都很高的自焚行为。60岁女性患者,有抑郁和焦虑病史,经无人机搜索发现死于玉米地热伤。她的弃车在四分之一英里外被发现电池没电了,也没油了。在离死者8英尺的地方发现了一个打火机,附近还发现了一串念珠、衣服、香烟、钳子和一个上面有十字架的玻璃瓶。尸检结果为面部、躯干和四肢部分炭化,周围气道中有烟灰沉积,会厌红斑,双侧舌出血,肺充血和水肿。毒理学报告显示血液中一氧化碳含量为23.8%。血液挥发性检查呈阴性。血液药物检测大麻和洛哌丁胺的代谢物呈阳性。病人被确定在火灾和死亡时是独自一人。没有发现燃料或可燃液体。火灾的起因和死亡方式被列为未确定。死因被确定为热伤和吸入烟雾。这起案件究竟是蓄意行为还是可能的意外事故仍有待商榷。
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引用次数: 0
Sudden Neonatal Death Due to Primary Endocardial Fibroelastosis: Forensic Autopsy Findings. 原发性心内膜纤维弹性增生引起的新生儿猝死:法医尸检结果。
IF 0.8 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-08-20 DOI: 10.1097/PAF.0000000000001066
Tijana Petrović, Tijana Gojković, Milenko Bogdanović, Tatjana Atanasijević, Jelena Kuzmanović, Slobodan Savić
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引用次数: 0
Mast Cell Degranulation as a Histopathologic Marker in Fatal Anaphylaxis: An Illustrated Case of Vespidae Envenomation. 肥大细胞脱颗粒作为致死性过敏反应的组织病理学标记:一个蜘蛛中毒的例子。
IF 0.8 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-07-31 DOI: 10.1097/PAF.0000000000001064
Nuha Mahmood, Rachel Martindale, Jared Brooks
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引用次数: 0
An Autopsy Case of ANCA-Negative Small Vessel Vasculitis With Glomerular Crescents. anca阴性小血管炎伴月牙状肾小球尸检1例。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-06-23 DOI: 10.1097/PAF.0000000000001058
Thomas Auen, Erin Linde
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引用次数: 0
Type B Right Ventricular Thrombus With Postmortem Computed Tomography and Postmortem Examination Correlation. B型右心室血栓与死后ct和死后检查的相关性。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-06-16 DOI: 10.1097/PAF.0000000000001056
Gurnoor Bhatia, Samantha Waugh, Rexson Tse
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引用次数: 0
Meckel Diverticulum as a Lead Point for Fatal Volvulus in an 84-Year-Old Man. 梅克尔憩室作为84岁男性致死性肠扭转的先导点。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-06-06 DOI: 10.1097/PAF.0000000000001051
Hiro Ross, Jonathan Zuckerman
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引用次数: 0
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American Journal of Forensic Medicine and Pathology
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