American Journal of Forensic Medicine and Pathology最新文献

Abstract: Multiple studies have documented various factors that influence or determine forensic pathologist classification of manner of death. There do not appear to be any published studies on manner of death classification specifically regarding arrest-related deaths (ARDs). The goal of this study was to consider a large body of cases of nonfirearm ARDs to analyze the homicide classification with regards to numerous decedent and practitioner (medical examiner/coroner [ME/C]) variables. We analyzed 1145 US autopsy reports from the years 2006-2020, inclusive, and considered decedent variables of age, ethnicity, height, weight, body mass index, toxicology, and mention of a conducted electrical weapon and ME/C influence variables of gender, country region, and year. We found that the homicide classification likelihood increased by a factor of 1.04-1.05 per year, 1.34-1.37 for a female medical examiner, and 1.4-1.5 going from Southern states to Western states. There is an increasing trend for ME/C to label nonfirearm ARDs as homicides in the United States. The homicide classification is more common in Western states and less common in Southern states, and it was more common with a female ME/C.

Abstract: We report 8 children younger than 2 years who died from acute illicit fentanyl intoxications in Connecticut between 2020 and 2022.The Connecticut Office of the Chief Medical Examiner (CT OCME) investigates all unexpected, violent, and suspicious deaths in Connecticut. The CT OCME's electronic database was searched for fentanyl deaths by age. All underwent autopsies and toxicology testing.The ages ranged from 28 days to 2 years (mean age, 12 months). The causes of death involved acute fentanyl intoxications with 1 having xylazine, 1 having para-fluorofentanyl, and 1 having cocaine and morphine. All the manners of death were certified as homicide. The postmortem fentanyl blood concentrations ranged from 0.40 to 46 ng/mL. Most of the children were found unresponsive after being put to sleep. Three were co-sleeping with adults (2 in bed; 1 on a recliner). There was a known history of parental/caregiver drug abuse in 7 of 8 of the fatalities.We summarize the key investigative, autopsy, and toxicological findings. As illicit fentanyl use increases, there is a potential for infant exposure and death. The investigation and certification of these deaths and the role of intentional administration versus inadvertent exposure due to caregiver neglect in the context of the certification of the manner of death are described.

Abstract: The extremities are the important anatomical regions that are disproportionately injured during road traffic accidents in poor and medium-income countries. The data regarding extremity injuries, particularly in pillion passengers, are minimal globally. We analyzed the pattern of extremity injuries and their association with various parameters such as collision type, seating position, road type, and type of vehicle. This was a hospital-based cross-sectional study. The pillion riders of fatal motorized 2-wheeler road accident cases that were subjected to autopsy were studied over a period of 2 years. We analyzed 73 cases of pillion riders. Females (60%) were the most commonly affected group. The upper extremities were injured in 55 cases (75.3%) and the lower extremities in 49 cases (67.1%). The shoulder (41%), hand (31.3%), and elbow (23.2%) were the predominantly injured anatomical regions of the upper limb. In the lower extremity, knee (41%) and foot (21.9%) were mostly affected. Forty-nine (67.1%) and 48 (65.8%) cases had abrasions in the upper limbs and lower limbs, respectively, followed by lacerations and contusions. Upper extremity injuries are more common compared with lower extremity. The majority of the pillion riders were seated in a side-saddle position, and self-fall from the bike without any collision with other vehicles was the most common mode of injury. Thus, appropriate seating posture with safety gear can be used to reduce extremity injuries.

Abstract: Sickle cell trait is typically thought to be an asymptomatic carrier state, but it is rarely associated with exertional rhabdomyolysis in cases termed Exercise Collapse Associated with Sickle Cell Trait (ECAST). In a subset of these cases, underlying disease contributes to the development and/or severity of the ensuing medical complications. We describe the first ever case of ECAST reported in a previously asymptomatic, multiply deployed, highly physically active service member with an underlying heterozygous LAMA2 mutation. Moreover, the mutation identified via whole exome sequencing is a novel, likely pathogenic variant that has yet to be described in the literature.

Abstract: On April 14, 1865, Abraham Lincoln was assassinated while watching a play from the Presidential Box at Ford's Theatre in Washington, DC. There is still controversy concerning the findings of Lincoln's autopsy. The physicians that attended the autopsy documented that the bullet entered the left occipital region of the brain, but opinions differ as to the path the bullet took through the brain. The official autopsy report documented that the bullet traveled through the left brain and did not cross the midline. Others who watched the autopsy claimed that the bullet entered on the left side of the president's brain, crossed the midline, and ended up just above the orbit on the right. In this manuscript, we reviewed all of the statements of the witnesses to the assassination in an effort to reconstruct the approach that John Wilkes Booth, the assassin, took through the Presidential Box as he approached the president. In addition, we conducted an on-site analysis of the shape and dimensions of the Presidential Box at Ford's Theatre to support the approach that Booth took. Based on this forensic analysis, we provide supportive evidence that the findings of the official autopsy report are accurate; that is, the bullet that entered the president's left brain stayed on the left and did not cross the midline.