Forensic science, medicine, and pathology
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Forensic Sci Med Pathol · Jun 2021
Case ReportsAnother suicide by sodium nitrite and multiple drugs: an alarming trend for "exit"?
This case report describes a fatal case of sodium nitrite and multiple drug consumption. A 37-year-old female was found in bed with a plastic bottle containing sodium nitrite and a bag containing multiple drugs and a suicide note. ⋯ This represents the second case in just a few months and highlights how relatively easy it is to buy sodium nitrite to commit suicide, indicating that specific responses should focus on restricting its access, especially in large quantities. It was also evident that the number of web forums and shadow markets explaining how to use sodium nitrite for euthanasia (several times called the "exit") are increasing.
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Forensic Sci Med Pathol · Mar 2021
Comparative StudyComparison of conventional autopsy with post-mortem magnetic resonance, computed tomography in determining the cause of unexplained death.
Conventional autopsy is the gold standard for identifying unexplained death but due to declines in referrals, there is an emerging role for post-mortem imaging. We evaluated whether post-mortem magnetic resonance (PMMR) and computed tomography (PMCT) are inferior to conventional autopsy. Deceased individuals ≥ 2 years old with unexplained death referred for coronial investigation between October 2014 to December 2016 underwent PMCT and PMMR prior to conventional autopsy. Images were reported separately and then compared to the autopsy findings by independent and blinded investigators. ⋯ The sensitivity and specificity were 57% and 57% for PMMR and 38% and 73% for PMCT. Both PMMR and PMCT identified 61% (57/94) of other significant abnormalities. Post-mortem imaging is inferior to autopsy but when reported by experienced clinicians, PMMR provides important information for cardiac and neurological deaths while PMCT is beneficial for neurological, traumatic and gastrointestinal deaths.
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Forensic Sci Med Pathol · Mar 2021
Case ReportsGreenish-blue discoloration of the brain and heart after treatment with methylene blue.
Greenish-blue discoloration of the brain and heart was observed during the autopsy of a 63-year-old woman who had been treated with methylene blue for septic shock following a traffic accident. This "pistachio" or "avatar" discoloration occurs when the colorless metabolite leucomethylene blue is oxidized to methylene blue upon exposure to atmospheric oxygen. ⋯ In medicine, methylene blue is an inhibitor of nitric oxide synthase and guanylate cyclase with different clinical applications, namely, rapid reversal of circulatory shock that is refractory to fluid administration, inotropic agents, and vasoconstrictors. Postmortem differential diagnosis with putrefaction and hydrogen sulfide poisoning should be made, and forensic pathologists should be aware of methylene blue-related greenish-blue discoloration to avoid unnecessary workup and investigations.
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Forensic Sci Med Pathol · Sep 2020
The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body.
During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. ⋯ A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.
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Forensic examination of skeletal remains exhumed in 2012 from the site of the former Church of the Greyfriars in Leicester, United Kingdom, revealed a gracile adult male of around 30 to 34 years of age with 11 perimortem injuries. These were consistent with descriptions of injuries sustained by King Richard III, the last Plantagenet King of England, at the Battle of Bosworth Field in 1485. ⋯ This investigation provides an excellent demonstration of how contemporary forensic techniques can answer historical questions. The remains of the last Plantagenet king have been identified, his vertebral disease confirmed, and the nature of his last moments verified.