Investigation of sudden infant deaths in the State of Maryland (1990-2000)

The Office of the Chief Medical Examiner (OCME) has recorded a significant decline in the deaths of sudden infant death syndrome (SIDS) in the state of Maryland since 1994. However, infants who died of accidental or non-accidental injuries remained consistent during the same time period. This report focuses on the epidemiological characteristics and scene investigation findings of infant victims who died suddenly and unexpectedly in Maryland between 1990 and 2000. A retrospective study of OCME cases between 1990 and 2000 yielded a total of 1619 infant fatalities. 802 infant deaths were determined to be SIDS, which represented 50% of the total infant deaths in our study population. Five hundred and twenty-three (31.8%) deaths were due to natural diseases, 128 (7.9%) deaths were accidents, and 74 (4.6%) were homicides. The manner of death could not be determined after a thorough scene investigation, review of history and a complete postmortem examination in 92 (5.7%) infants. SIDS deaths most often involved infants who were male and black. The peak incidence of SIDS was between 2 and 4 months of age. The majority of SIDS infants (60%) were found unresponsive on their stomach. Among SIDS infants, 269 (33.4%) were found in bed with another person or persons (bed sharing). Of the bed-sharing SIDS cases, 182 (68%) were African-American. In the past 11 years, 52 infants died of asphyxia due to unsafe sleeping environment, such as defective cribs, ill-fitting mattresses, inappropriate bedding materials. Of the 74 homicide victims, 53 (70%) involved infants less than 6 months of age. Twenty (27%) exhibited the classical abuse syndrome characterized by repeated acts of trauma to the infants.     

Ocular findings in pediatric deaths under 2 years of age (1994-2004)

Abstract:  Our purpose is to highlight novel ocular findings of 102 forensic pediatric cases under 2 years of age who die suddenly. Forensic information, grossing, and microscopic eye protocol was followed. The most common diagnosis was Sudden Infant Death Syndrome (SIDS) (57/102). Novel cytoid bodies were present in the retina of 72/102 cases and they were located predominantly 90% (65/72) at the anterior part of the retina ( p  < 0.001). Of the SIDS cases, 85% (47/57) showed the presence of cytoid bodies, and among all diagnosis, SIDS was the most associated with cytoid bodies ( p  = 0.003). A second observation was extramedullary hematopoiesis (EMH) identified in 35/102 cases and 22 of the 57 SIDS cases. The most frequent EMH location was the choroids (29/35). This study is the first to demonstrate the presence of cytoid bodies and extramedullary hematopoiesis in the retinas of SIDS cases and children who die suddenly from other causes.     

Concentrations of lidocaine and monoethylglycylxylidide (MEGX) in lidocaine associated deaths

Concentrations of lidocaine and MEGX were determined in a variety of tissues and other samples collected at autopsy. In 13 of the cases examined in which lidocaine was associated with death, tissue concentrations were greater than 15 mg/kg. Tissue concentrations in other patients treated with lidocaine were significantly lower.     

Malaria deaths in the United States: case report and review of deaths, 1979-1998

Malaria is the world's most important parasitic disease, accounting for an estimated 300 to 500 million new cases and between 1.5 and 2.7 deaths annually. The majority of these deaths occur in sub-Saharan Africa where malaria is endemic and are the result of infection with Plasmodium falciparum. The number of deaths in the United States due to malaria is comparably much lower and involves so-called "imported" cases in which U.S. travelers acquire the infection upon travel to endemic areas and subsequently return to the United States or in which infected foreign citizens travel to the United States. There were a total of 118 deaths due to malaria in the United States between 1979 and 1998 with an average of 5.9 deaths per year. Specific epidemiological data provided by the CDC regarding the 40 deaths that occurred between 1992 and 1998 yielded the following results. Deaths occurred in patients ranging from 9 months to 89 years of age (median, 53 years). Thirty-eight (95%) of these were due to P. falciparum and two (5%) due to P. vivax. Anti-malarial chemoprophylaxis was taken in 40% of cases, not taken in 45% of cases, and unknown in 15% of cases. Twenty-four (60%) of the cases involved U.S. travelers to endemic areas, of whom 59% traveled to Africa, 25% to South America, 8% to India, 4% to Haiti, and 4% to unspecified areas. The remaining cases included eleven foreign travelers to the U.S. (27.5%), three induced cases (7.5%), and two undetermined cases (5%). Thirty-nine (98%) of the cases were diagnosed antemortem and only one case was known to have come to the attention of the medical examiner/coroner. An illustrative case report demonstrates many of the features associated with fatal malaria infections in the United States. The case involves a U.S. student who was studying in Africa and who, by report, had not taken antimalarial chemoprophylaxis. Despite seeking medical attention, the patient was not diagnosed with P. falciparum infection and cerebral malaria until the time of medico-legal autopsy, where the classic gross and microscopic features of cerebral malaria were identified. This case represents one of the few cases of P. falciparum infection in the United States not diagnosed antemortem. Given the worldwide prevalence of the disease, increasing international travel, and rapidly developing drug resistance, malaria will continue to be an important disease and should be considered in cases of sudden, unexplained deaths. By reviewing the major epidemiological features of malaria-related deaths in the United States and by presenting the major gross and microscopic features of cerebral malaria, an attempt is made at raising the awareness of the forensic community to the potential of malaria-related deaths.     

Contents of Volume LII (2005)

Netherlands International Law Review -     

2005年《中国法医学杂志》文题索引

(期:页)论著大鼠脑损伤分级自由落体打击模型的建立吴旭王保捷张国华(1:1-3)…………………………………………85例成人闭合性脑挫伤组织病理学研究周亦武张益鹄邓伟年等(1:4-8)………………………………………480例活体损伤的法学鉴定分析陈溪萍陶陆阳刘兴本等(1:8-10)………………………………………………FAM羧基荧光素修饰引物检则DIS80基因座遗传多态性……………………顾明波李晓平王剑等(1:11-13)固相萃取同时提取尿中的39种药毒物张玉荣梁晨金琦芸等(1:14-16)…………………………………………尿液、血液中r-羟丁酸气质联用法分…     

溺死诊断中的浮游生物检测法

溺水是常见的死亡原因之一,浮游生物检验是法医学鉴定溺死的重要依据。浮游生物检验方法可分为破机法、非破机法和分子生物学方法三大类。前两者主要以形态标记为检验对象,依赖于浮游生物的理化特性,有很大局限性。分子生物学方法以分子标记为检验对象,适用范围广,信息丰富,是值得探索的新方法。本文回顾溺死鉴定中的各种浮游生物检测法,供法医工作者在实践和研究中进行参考。     

Cocaine- and methamphetamine-related deaths in San Diego County (1987): homicides and accidental overdoses

Cocaine- and methamphetamine-related homicides and fatal accidental overdoses in San Diego County were studied retrospectively for the 1987 calendar year. Cocaine was involved in 66 cases (39 homicides, 27 accidental overdoses), methamphetamine in 32 cases (23 homicides, 9 accidental overdoses), and a combination of cocaine and methamphetamine in 10 cases (4 homicides, 6 accidental overdoses). The composite for cocaine-related deaths was a 30-year-old black man in whom was also found at least 1 other drug, usually ethanol or morphine. The composite for methamphetamine-related deaths was a 32-year-old Caucasian man who used methamphetamine with at least 1 other drug (usually ethanol). For cases involving both cocaine and methamphetamine, the composite was a 36-year-old Caucasian man in whom was also found at least 1 other drug, usually ethanol, codeine, or morphine. Mean tissue concentrations of cocaine and benzoylecgonine were significantly higher in accidental overdoses than in homicides except for cocaine concentrations in liver, which did not differ significantly between the two groups. For methamphetamine-related deaths there was no significant difference between mean tissue concentrations in accidental overdoses and in homicides. Cocaine or methamphetamine or both were involved in approximately one third of homicides in San Diego County in 1987, and when fatal accidental overdoses were included, cocaine was involved in twice as many cases as methamphetamine.     

The descriptive epidemiology of unnatural deaths in Oregon's state institutions: a 25-year (1963-1987) study. III. A 25-year overview of unnatural deaths in the mental and correctional facilities.

I document 25 consecutive years (1963-1987) of unnatural deaths within the State of Oregon's mental and correctional institutions in Marion County. This study includes 93 unnatural deaths in the Oregon State Hospital, 18 in the Forensic Psychiatric Program, 52 in the Fairview Training Center, and 45 in the Corrections Department facilities. These institutional unnatural deaths are compared with the 2,618 unnatural deaths that occurred during this same period in Marion County (exclusive of these state facilities). Death rates are shown in five 5-year blocks of time to illustrate death trends. Accidents and suicides were the predominant types of unnatural death in the Oregon State Hospital; suicides predominated in the Forensic Psychiatric Program and the corrections facilities; and accidents predominated in the Fairview Training Center. Extremely high total unnatural death rates were found in the Oregon State Hospital (approximately 520/100,000 or 8.46 times that found in Marion County) and the Forensic Psychiatric Program (approximately 561/100,000 or 9.13 times that found in Marion County). The overall accident death rate for the Fairview Training Center was approximately 119/100,000 or 2.84 times that found in Marion County. The overall total unnatural death rate for the corrections facilities was approximately 75/100,000 or 1.23 times that found in Marion County. I compare these data with those of other investigators in the United States, Canada, and western Europe. The total unnatural death rate appears to represent a valid criterion of violent death within a community.     

Study of fatal burns cases in Kanpur (India)

Epidemiological and medicolegal, including forensic pathological, aspects of 180 cases of fatal burns were studied in Kanpur (India) during the period of one year (October 1985 to September 1986). These constituted 10.79% of the total medicolegal deaths autopsied. Majority of the victims were young Hindu housewives burnt within 5 years of their marriage. The most common source of fire was cooking apparatus like chulha, coalfire, stove or cooking gas. In a substantial number of cases, kerosene oil was poured over the victims and fired with a match stick. About half of the burn cases were accidental, in which cooking on open unguarded flames and loose highly inflammable synthetic sarees of the victims can be blamed. Among the others who died in suspicious circumstances, i.e., burnt alive or forced to commit suicide by fire, dowry and family quarrels and marital disharmony were the two important predisposing factors. Illiteracy, arranged and child marriages, joint family structure, oedipal dominance of mother-in-laws, unemployment and economic dependence of the husband on the parents, near complete dependence of women on their husbands and inlaws, and lack of social security amongst Hindu females were other contributory factors affecting the incidence in some way. Male burn deaths were few and usually accidental.     

An epidemic of illicit fentanyl deaths in Cook County, Illinois: September 2005 through April 2007

Between September 2005 and April 2007, 350 fentanyl intoxication deaths were investigated and certified by the Cook County Medical Examiners Office. Investigations revealed that the majority of these fatalities were by intravenous injection of a white powder followed by a rapid collapse. The fentanyl was clandestinely produced in a lab in Toluca, Mexico and sold by the Mickey Cobra street gang. The term "Drop Dead" was coined for this "tainted heroin." Postmortem samples were screened by ELISA and confirmed by standard GC-MS methods. Fentanyl fatalities peaked at 47 per month in May and June 2006. Fifty-two percent were single fentanyl intoxications, with the remainder accompanied by either cocaine, morphine from heroin, or alcohol. This epidemic stressed the limited resources of the toxicology laboratory and autopsy service of the Medical Examiners Office. The clandestine lab was terminated, distributing gang members and leaders arrested, and the epidemic ceased in April 2007.     

中国海商法协会大事纪(2005)

2005年3月15日海事法律专业委员会邀请英国南安普顿大学法学院Nick Gaskell教授作了“英国提单法的最新发展”的学术报告会。2005年3月21日海事法律专业委员会邀请世界海事大学P.K.Mukherjee教授作了“船舶优先权”的学术讲座。2005年3月22日和2005年8月4日协会分别召开九届一次和九届二次常务理事会议,对2005年协会的工作、第六届海商法国际研讨会的召开、协会主席变更的议案、中国海运(集团)总公司作为主席单位加入协会事宜、《中国海商法年刊》改为季刊、协会网站的改版工作、加强协会专业委员会工作以及修订协会章程等各项工作进行了…     

A novel microsatellite (STR) marker for forensic identification of big cats in India

India is the home to five of the eight majestic big cats of the world. The three major big cats namely, lion, tiger, and leopard are listed in the Schedule I of the Indian Wildlife Protection Act, 1972. Apart from the severe loss of the habitat, these are continuously facing the danger of extinction mainly due to poaching and hunting for their body parts, which are being greatly valued by apothecaries marketing traditional Chinese medicines. With the advent of polymerase chain reaction (PCR), DNA-based markers have emerged as major tools in the arena of wildlife forensics. Microsatellites (short tandem repeats, STRs) are markers of choice because of their polymorphic and co-dominant nature. These strictly follow the Mendelian inheritance and are highly reproducible. We have identified a new microsatellite (STR) locus Ple 46, which shows amplification in a species-specific manner (size of STR) in all the members of the family felidae studied here. This PCR-based, non-invasive method opens a new avenue to forensic identification of big cats.     

A study of fatal strangulation cases in Varanasi (India)

Strangulation is one of the oldest and widely used methods of committing murder in the Indian subcontinent. It is usually carried out by constricting the neck either with the hands, elbow, or other parts of body or by ligature, stick, and the like. In this paper we report a study of 26 cases of fatal strangulation occurring in the district of Varanasi (India) during 1982-1983 and analyze their epidemiological, medicolegal, and forensic pathological aspects. The paper also projects the mentality of perpetrators who, after strangling their victims, tried to hide the crime by disposing of the dead bodies by burning, burying, hanging, throwing them into water, or concealing them in distant places in most of the cases.     

Technology transfer perspectives in globalising India (drugs and pharmaceuticals and biotechnology)

The paper briefly outlines the status of technology transfer related issues in drugs & pharma and biotechnology sectors in India. The paper also outlines the contemporary business strategies including R&D and technology transfer models. The study indicates that present technology transfer policies and mechanisms are weak and need to be restructured. The current fiscal incentives and tax concessions etc. available for R&D in industry seem to have outlived and are no longer attractive because of continuous lowering of tariff rates and tax rates in the context of WTO and liberalization of policies. Moreover, the issue of R&D support to industry is not covered in the WTO as in case of subsidies. Therefore, it is advisable for the government to revisit the existing promotional measures for R&D. FDI policies also need to be tailored to encourage Technology transfers and capability building. Recommendations are made for making Technology Transfer more effective for the growth and competitiveness of the industry. A technology transfer management model is suggested.