American Journal of Forensic Medicine and Pathology最新文献

Abstract: Previous studies on the sexual dimorphism of the mastoid triangle have typically focused on linear and area measurements. No studies in the literature have used mastoid air cell system volume measurements for direct anthropological or forensic sex determination. The aims of this study were to investigate the applicability of mastoid air cell system volume measurements and mastoid triangle measurements separately and combined for sex estimation, and to determine the accuracy of sex estimation rates using machine learning algorithms and discriminant function analysis of these data. On 200 computed tomography images, the distances constituting the edges of the mastoid triangle were measured, and the area was calculated using these measurements. A region-growing algorithm was used to determine the volume of the mastoid air cell system. The univariate sex determination accuracy was calculated for all parameters. Stepwise discriminant function analysis was performed for sex estimation. Multiple machine learning methods have also been used. All measurements of the mastoid triangle and volumes of the mastoid air cell system were higher in males than in females. The accurate sex estimation rate was determined to be 79.5% using stepwise discriminant function analysis and 88.5% using machine learning methods.

Abstract: Vascular involvement in tuberous sclerosis complex (TSC) is uncommon and even more so in pediatric patients. When asymptomatic, these vascular abnormalities carry increased risk of rupture with increased morbidity and mortality. Here, we describe a case of a ruptured unrecognized abdominal aortic aneurysm in an 11-month-old patient with a history of TSC. The abdominal aortic aneurysm was discovered at autopsy and highlights the rarity of abdominal aortic aneurysm in pediatric patients diagnosed with TSC and the importance of screening for associated aneurysmal disease in the pediatric population with TSC. Furthermore, the extensive retroperitoneal hemorrhage seen in this case also highlights a rare but potential mimic of abuse in the pediatric population.

Abstract: Spit hoods are used by law enforcement, officers in correctional facilities, and medical personnel during the restraint of agitated subjects that are actively spitting to prevent the transmission of droplet-transmitted pathogens. We could find no studies reporting on the time course of normal breathing to clear saliva from such a saturated spit hood. We purchased samples of 3 popular spit hood models and applied a section over the output of a pneumatic test system. We used a digital anemometer, digital manometer, and an inline controllable fan for back pressure and flow. The pressure was 3 mm Hg to match quiet breathing. The tested area was saturated with artificial saliva, and air pressure was applied while we recorded the pressure and airflow. Within 5 seconds, the spit hoods all cleared sufficient artificial saliva to allow 1 m/s of airflow, which exceeds that of an N95 mask with similar pressure. Commonly used spit hoods offer very low resistance to breathing even after being initially saturated with artificial saliva. Our results do not support the hypothesis that a saliva-filled spit hood might contribute to death.

Abstract: Thailand began offering the coronavirus disease 2019 (COVID-19) vaccine nationwide in February 2021, with 1,885 deaths reported by the end of the year. Therefore, it is essential to assess the correlation between vaccination and cause of death from autopsy. This study included 34 autopsies of a deceased within 30 days after COVID-19 vaccination performed in Bangkok under the postmortem inquest service area of Bhumibol Adulyadej Hospital. The autopsies were performed by forensic pathologists. Moreover, detailed information about the deceased was collected, including age, sex, medical records, vaccination history, scene investigation reports, autopsy reports, cause of death, and a probable causal relationship between vaccination and cause of death. There were 24 males (70.59%), and the average age of the deceased was 52.76 years. Of all individuals, 28 (82.36%), 4 (11.76%), and 2 (5.88%) were vaccinated with AstraZeneca, Sinopharm, and SinoVac, respectively. The most common cause of death was ischemic heart disease (n = 17). None of the deceased patients had a causal relationship to the vaccine. Deaths were due to natural causes, as no definitive link between vaccination and cause of death was established in the study.

Abstract: Pediatric deaths that occur because of environmental neglect often involve 4 common scenarios: (1) hyperthermia due to environmental exposure, (2) ingestion of an accessible drug or poison, (3) unwitnessed/unsupervised drownings, and (4) unsafe sleep practices. Given the same fact pattern, the manner of death will vary from accident to homicide to undetermined based on local custom and/or the certifier's training and experience. Medical examiner/coroner death certifications are administrative public health determinations made for vital statistical purposes. Because the manner of death is an opinion, it is understandable that manner determinations may vary among practitioners. No prosecutor, judge, or jury is bound by the opinions expressed on the death certificate. This position paper does not dictate how these deaths should be certified. Rather, it describes the challenges of the investigations and manner determinations in these deaths. It provides specific criteria that may improve consistency of certification. Because pediatric deaths often are of public interest, this paper provides the medical examiner/coroner with a professional overview of such manner determination issues to assist various stakeholders in understanding these challenges and variations.

Abstract: Heart-type fatty acid-binding protein (HFABP) is a 15-kDa substance reported to pass through the renal tubules and be renally excreted. Therefore, it is possible that its concentration in the urine collected postmortem may reflect antemortem blood levels. We measured the postmortem urine concentration of HFABP in 94 forensic autopsy cases and compared it between acute myocardial infarction (AMI), sepsis, heat stroke cases, and asphyxia cases as control cases to examine its diagnostic validity. Kidney tissue collected at autopsy was immunostained with antibodies against HFABP to evaluate the correlation with the urinary measurements. Urinary HFABP was significantly higher in AMI, sepsis, and heat stroke cases than in asphyxia cases. Quantitative immunostaining results showed no significant differences between any 2 groups. The usefulness of kidney immunostaining for HFABP in elucidating the cause of death was low. Two reasons may explain the lack of significant differences in kidney immunostaining: nonspecific leakage of tubular epithelial HFABP into the tubules because of postmortem changes and oliguria due to dehydration caused by heat stroke. In conclusion, the measurement of urinary HFABP may be useful in elucidating the cause of death; however, the kidney HFABP immunostaining was not significantly different from AMI.

Abstract: Paraquat (PQ) is one of the most widely used herbicides in the world, and poisoning is generally associated with accidental, suicidal, or homicidal events. Therefore, in the forensic context, PQ could be in various ways involved as a possible cause of death of a subject. However, even though its systemic toxicity is known, the biological effects exerted on individual viscera have been explored only to some extent, especially in case of victim's survival. Therefore, a case concerning a suicidal ingestion of PQ with survival of 3 days was deemed of interest. Clinical toxicological analyses confirmed acute PQ intoxication, and after the death of the victim, an autopsy was performed showing local and systemic signs of ingestion of a caustic substance. Histologic examination revealed marked cellular damage to the major viscera, particularly the gastroesophageal tract, liver, kidneys, and lungs, with initial alveolar fibrosis noted despite the patient's short survival. This finding represents a new element in the context of PQ lung injury, as it has not been previously documented in the literature. Thus, histological findings in lethal intoxications after survival can reveal specific peculiarities still unknown and, therefore, assume transversal relevance not only at forensic but also clinical level.