American Journal of Forensic Medicine and Pathology最新文献

Endocarditis is a rare complication following surgical placement of prosthetic valves, especially within the first 3 months following the procedure. Endocarditis increases the incidence of valve replacement failures and occurrences of prosthetic valve dehiscence. The nature of dehiscence can be either partial or complete, with complete dehiscence less commonly outlined within the literature. We present a case of a 69-year-old man who died suddenly during treatment for endocarditis ∼2 months following aortic valve replacement. The patient had an initial aortic valve replacement and required a second surgery for the placement of a revisional valve nearly 4 years later. The patient died in the hospital 2 months following the second valve procedure from prosthetic valve endocarditis. Antemortem blood cultures grew Staphylococcus epidermidis. Autopsy findings confirmed bacterial infection of the bovine aortic valve prosthesis, valve annulus, and myocardium. Complete dehiscence of the prosthetic valve was found with embolization of the valve to the abdominal aorta. This case illustrates the presentation and autopsy findings of a case of sudden death due to embolization of a prosthetic aortic valve. Understanding the pathology and comorbidities associated with bacterial endocarditis is important in the evaluation of such cases.

Postmortem microbiology (PMM) is increasingly recognized as a key tool in forensic medicine, particularly in cases lacking antemortem data or when autopsy and histology are nonspecific. Salmonella enterica serovar Typhimurium, including the Copenhagen variant, is a major cause of foodborne disease. While most cases are self-limiting, severe, sometimes fatal outcomes have been reported. A 32-year-old previously healthy man developed profuse vomiting and was found dead the following morning. Autopsy revealed abundant bilious gastric content and liquid stools, without evidence of trauma or intoxication. PMM yielded abundant pure growth of S. typhimurium var. Copenhagen from gastric content, while no viral, protozoal, or other bacterial pathogens were detected. Histology revealed cerebral and pulmonary edema and diffuse gastric mucosal inflammation. Toxicology was negative. The integration of autopsy, histology, toxicology, and PMM supported the attribution of death to acute infectious gastroenteritis due to S. typhimurium var. Copenhagen. A severe dehydration leading to electrolyte imbalance and fatal cardiac arrhythmia was considered the most plausible mechanism of death. The rapid fatal course was explained by the absence of fluid replacement or medical intervention. This report underscores the value of rigorous PMM protocols not only for cause-of-death determination but also for strengthening infectious disease surveillance.

Estimation of hydration status in paediatric deaths provides valuable insight into contributors of mortality including dehydration and paediatric neglect. Diaper weights have been used in postmortem settings to indirectly assess fluid status. However, clinical literature suggests storage conditions may affect the accuracy of these estimates. This study examines the weight change in commercially available diapers stored within different postmortem conditions. Five replicates of dry, wet, and saturated diapers were stored at 4 °C and -20 °C in either a body bag or left exposed to environment. Weights were measured daily over 5 consecutive days. Statistically significant changes in diaper weight were observed across all groups. Overall dry diapers increased in weight, whereas wet/saturated decreased in weight (Pearson and paired t test, P < 0.05) for up to 9 g (~30% in dry and ~9% in wet/saturated diapers). However, when body bags were used, the average changes were <1 g (maximum: 3 g) across all diapers and temperatures. The findings of this study suggest that while diaper weight may be influenced by different postmortem environments, diapers stored in sealed body bags demonstrate more stability, thus may assist in providing a more accurate assessment of hydration status in paediatric deaths.

The NAME annual meeting focuses on platform presentations as a means of sharing research, ideas, and education; however, little is known about the rate at which these presentations are subsequently published. This study analyzed trends related to publication outcomes of 651 presentations given from 2013 to 2022. Using Python scripts that queried the PubMed database, we found that 175 presentations (27%) went on to be published in the peer-reviewed literature [we also accounted for presentations published in Academic Forensic Pathology (AFP) in the years when AFP was not indexed in PubMed]. The journals AFP and the AJFMP accounted for most of the publications, but over 30 other journals were identified. Publications in AFP declined in the latter years of our study range, while publications in AJFMP increased. First authors from NMS, the CDC, and Ottawa-based institutions were among the most likely to publish their presentations. To assess the performance of our automated scripts, we also performed a manual Internet/PubMed search of presentation titles and authors; our automated scripts detected 97% of all matched presentations with PubMed. Information gleaned from studying bibliometric trends can help inform strategies for improving future educational programs.

Potassium thiocyanate is a long-discontinued weak antihypertensive and an uncommonly encountered toxic agent. We report a 52-year-old man who presented to the emergency department with a sudden onset of altered mental status, vomiting, and seizures after a suspected toxic ingestion. Clinical laboratory tests showed a falsely elevated serum chloride (>200 mmol/L) with other normal electrolytes, resulting in a significant negative anion gap. An endoscopy showed gastric mucosa edema and hyperemia. Repeated electroencephalograms showed moderate to severe encephalopathy. He remained symptomatic until his death 9 days later. An autopsy found hypoxic-ischemic changes in the brain. Toxicological analysis on antemortem blood collected 93 to 95 hours after apparent ingestion revealed a thiocyanate concentration of 260 μg/mL and cyanide concentration of 0.21 μg/mL. Toxicology on postmortem specimens revealed thiocyanate concentrations of 78 μg/mL in cardiac blood, 75 μg/mL in peripheral blood, 16 μg/g in brain, 49 μg/g in kidney, 37 μg/g in liver, and 21 μg/g in skeletal muscle. Further investigation found an internet order for potassium thiocyanate in the days before ingestion. This case report raises the awareness of thiocyanate as a potentially re-emerging toxin and pseudohalide that can interfere with clinical laboratory testing and present as falsely elevated serum chloride (pseudohyperchloremia).

Self-inflicted gunshot wounds are a common modality of suicide. Cases with multiple gunshot wounds are rare. Problems with determining manner may arise when there is a lack of understanding of how and why they occur. Demographic data has seldom been explored in these cases. Gunshot wound suicides from the years 2015 to 2023 were reviewed at the Hillsborough County Medical Examiner's Office. Nineteen cases with multiple gunshot wounds were found. The multi-GSW cases, compared to the single-GSW cases, had a significantly increased proportion of revolvers (57.9% vs. 29.8%, P =0.008), lower muzzle energy handguns (86.7% vs. 39.6%, P <0.001), and shots to the torso (70.6% vs. 9.0%, P <0.001). Multi-GSW case decedents were significantly older than the single-GSW suicide average (16.2 y, P <0.001). There were also significant age differences between decedents who used the following: (Revolvers vs. semi-automatic pistols, 16.2 y, P <0.001; muzzle energy <400 vs. >400 J, 15.8 y, P <0.001; and shots to the torso vs. head, 8.4 y, P =0.002). In our population, older age was associated with factors that might necessitate multiple gunshot wounds in a suicide.

We present a case of a 47-year-old man found in the isolated boiler room of his house, lying on the floor in a pool of blood. Next to the body, a handmade firearm was discovered. The weapon consists of 2 metal plumbing pipes of different circumferences and a percussion detonator at the base. The shotgun shell is made of plastic, and the cartridge contains 4 handmade metal pellets, each 10 mm in diameter. Upon external examination of the body, a gunshot wound was identified in the middle of the chest, fired through the deceased's clothing, which is a rather unusual characteristic when it comes to suicide. No defensive wounds were observed on the body. Although the deceased had no history of depression, prior suicide attempts, known motives, or identifiable personality traits associated with suicidal behavior, the sudden emergence of unusual circumstances, such as fear of consequences and financial hardship, led him to an affective suicide. This is the only case where both the shotgun and the ammunition are handmade.