American Journal of Forensic Medicine and Pathology最新文献

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.

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.

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.

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.