American Journal of Forensic Medicine and Pathology最新文献

Determining the postmortem interval (PMI) is vital in forensic investigations but remains challenging due to the limitations of traditional methods. Proteomics offers a promising alternative by analyzing time-dependent protein degradation patterns. The systematic review explores recent advances in protein-based PMI estimation using animal and human tissues. The objective is to evaluate current research trends, highlight key biomarkers, and assess the potential of proteomic approaches for improving PMI accuracy and reliability. A total of 40 studies were identified across PubMed, Web of Science, Scopus, and ScienceDirect for publications from 2018 to 2024 using PRISMA guidelines, focusing on postmortem protein degradation for PMI estimation. Skeletal muscle was the most studied tissue, followed by bone, heart, and gingival tissues. Analytical techniques such as LC-MS and MALDI were widely employed, allowing detection and quantification of time-dependent proteomic changes. Despite promising results, variability in experimental conditions, tissue types, and lack of standardized protocols remain critical challenges. Proteomics offers a highly sensitive and specific approach for PMI estimation, enabling detailed molecular insight. While current evidence supports its forensic applicability, widespread adoption requires methodological standardization and integration of multimarker strategies. With refinement, proteomic profiling has the potential to transform PMI estimation into a robust, objective component of routine forensic investigations.

Isobutyl nitrite is a malodorous chemical compound that is part of the larger group of alkyl nitrites. This group of chemicals is known to have potent vasodilation effects and, as such, was historically used to treat heart conditions like angina, though these have been replaced by other medications over time. Currently, alkyl nitrites are most frequently encountered as drugs of abuse, as inhalation of the chemicals induces vasodilation, creates a "head rush" and feeling of euphoria, and increases pleasure. While there is some toxicity associated with inhalation, it is generally not considered to be fatal. However, if the nitrites are instead ingested orally, the effects are much more profound, causing severe methemoglobinemia and potentially death. Reports of deaths due to nitrite ingestion are relatively rare overall and frequently are suicidal in nature. We report a death due to accidental ingestion of a vial of isobutyl nitrite with the aim of educating death investigators about the toxicity of this chemical, along with the pertinent autopsy findings and toxicology workup to aid them in the event they encounter such a case.

A Sinus of Valsalva aneurysm (SOVA) is a rare cardiac abnormality that involves the dilation or bulging of the aortic sinus(es). The symptoms of SOVA can be subtle and nonspecific, making the aneurysm difficult to detect before a possible rupture. When these aneurysms rupture, they are often fatal. In this case report, we present the sudden and unexpected death of a 36-year-old previously healthy male with no prior clinical history. Postmortem examination was notable for the unexpected finding of a multisinus SOVA with an atypical rupture into the pericardial sac resulting in a significant hemopericardium. An Arrhythmia and Cardiomyopathy and Aortopathy panel (Invitae Corp.) next-generation sequencing genetic testing was performed and revealed variants of unknown significance (VUS). This case report highlights an unusual presentation of SOVA in a young adult male and reviews the literature associated with this rare cardiac pathology entity. We also bring attention to the interpretation of ambiguous postmortem genetic testing results, including the importance of consent, cost, and access to genetic counseling. Postmortem genetic testing influences the living relatives of a decedent, and the autonomy of these individuals should be considered.

Postoperative meningitis, although rare, remains a devastating complication following neurosurgical procedures. This case report describes a 55-year-old male who succumbed to bacterial meningitis after lumbar laminectomy for intervertebral disc prolapse. Autopsy findings revealed extensive purulent exudate in the subarachnoid space, and microbiological analysis confirmed the presence of Acinetobacter baumannii complex and Pseudomonas aeruginosa. This case highlights the rapid and aggressive nature of nosocomial meningitis, the challenges in early diagnosis, and the critical importance of vigilance for atypical and multidrug-resistant pathogens in the post-operative period.

Carbon monoxide (CO) is a common agent of intentional poisoning due to its accessibility and perceived painless lethality. While most CO suicides result from combustion sources, the combination of formic and sulfuric acid represents a lesser-known but increasingly utilized method of CO generation through chemical reaction. This report describes the case of a 23-year-old male who died by CO inhalation inside a closed vehicle after mixing these 2 acids. The scene investigation revealed chemical containers and a suicide note; toxicological analysis showed 90% carboxyhemoglobin saturation and the presence of formic acid. An external examination noted cherry-red lividity and foam at the mouth. This case highlights a rare but growing method of suicide, as supported by a review of the literature identifying 17 fatal and 5 nonfatal cases. Reported carboxyhemoglobin levels ranged from 15.1% to 93.4%, with most decedents being young males. Acid vapors caused mucosal and dermal injuries in multiple cases, posing risks to bystanders and first responders. This report emphasizes the need for awareness of this emerging suicide method, recognition of its chemical hazards, and the implementation of appropriate safety protocols during scene investigation and forensic evaluation.