“Tampering to Death”: A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation

Many homemade tamper processes of medical codeine formulations are available on selected “forums” on the Internet, where recreational codeine users claim to be able to purify codeine by removing additives, such as acetaminophen, to avoid or limit adverse effects. In this work, it is reported and discussed a fatal case of codeine intoxication. The findings of objects such as jars, filters, and tablets, and amounts of unknown liquid material at the death scene investigation suggested a fatal codeine intoxication after the tampering procedure called “cold water extraction.” Toxicological results obtained from the analysis of both the nonbiological material and the body fluids of the decedent integrated with the information collected at the death scene investigation confirmed the above‐mentioned hypothesis. This report underlines the importance of a tight interconnection between criminalistics and legal medicine to strengthen the identification of the cause of death and the reconstruction of the event.     

Methylenedioxypyrovalerone (“Bath Salts”),Related Death: Case Report and Review of the Literature,

Cathinone derivatives (bath salts) have emerged as the latest drugs of abuse. 3,4‐methylenedioxypyrovalerone (MDPV) is the primary active ingredient in bath salts used in this country. This article presents the second reported cause of death by MDPV intoxication alone. In April 2011, a delusional man was emergently brought to a hospital, where he self‐reported bath salt usage. He became agitated, developed ventricular tachycardia, hyperthermia, and died. Comprehensive alcohol and drug testing was performed. Using the alkaline drug screen, heart blood contained 0.7 mg/L MDPV and peripheral blood contained 1.0 mg/L MDPV. His bizarre behavior with life‐threatening hyperthermia was consistent with an MDPV‐induced excited delirium state. MDPV is not yet found by routine immunoassay toxicology screens. Testing for MDPV should be considered in cases with a history of polysubstance abuse with stimulant type drugs, report of acute onset of psychogenic symptoms, excited delirium syndrome, or presentation in a hyperthermic state.     

Forensic Paleontology: A Tool for “Intelligence” and Investigation

Paleontology and facies analysis proved to be useful tools in activities of intelligence and investigation on some criminal cases, as well as in in‐court activities, thus defining the “forensic paleontology” area of study. The definition was given by analyzing its possible specific applications and excluding some marginal activities. The reliability of forensic paleontology was then assessed in light of the results achieved in some actual cases and in an ad hoc simulation. The investigated cases concerned intelligence and ordinary law enforcement activities. Special attention was paid to crimes against the cultural heritage. Ex post re‐examination of the cases substantiated the value of this scientific branch in investigations, while stressing the possible difficulties in explaining its results to lay persons. Therefore, careful preparation of technical and linguistic preliminary notes for judges, prosecutors, and lawyers as well as a special training for consultants are recommended before presenting results as exhibits in in‐court cross‐examinations.     

Fatal Wounds by “Manja” to a Motorbike Rider in Motion

“Kite fights” are quite popular throughout Asia. Most kite variations, including the fighter kites of India, Pakistan, and Japan, are small, flat, roughly diamond‐shaped kites composed of paper, with a tapered bamboo spine and a balanced bow. They are flown with the help of a “Manja,” which is a thread made of cotton or nylon, and coated with fine glass powder using glue and other chemical adhesives to cut down opponent's kite string. The nylon “Manja” is particularly more dangerous, as it not only cuts down opponent's kite string but also causes bodily injuries to humans, which may be at times fatal. The pattern of injuries by Manja is underreported in literature. In the present case, the deceased had encountered fatal injuries by “Manja” while riding on his motorbike. This case discusses the pattern of injuries caused by Manja when the victims are in motion on their two‐wheelers.     

The Utility of the Samworth and Gowland Age‐at‐Death “Look‐up” Tables in Forensic Anthropology*

Abstract: Accurate age‐at‐death estimates are crucial to forensic anthropologists when onstructing biological profiles aimed at narrowing a missing‐persons list and to allow for timely and efficient identification of an unknown victim. The present contribution evaluates the utility of three new age‐at‐death estimation techniques recently proposed by Samworth and Gowland (2007). Results indicate that, in the samples under study, the Samworth and Gowland estimates from the pubic symphysis and auricular surface perform similar to alternate phase methods. The combined method does not appear to further enhance either the precision or the accuracy of the single pubic symphysis age‐at‐death estimate. In conclusion, these new methods seem to be more robust to distribution deviations than originally proposed by Samworth and Gowland (2007). They are therefore suitable for immediate and reliable forensic usage in the United States and worthy of further research for their use in North American forensic contexts.     

Forensic Approach to an Archaeological Casework of “Vampire” Skeletal Remains in Venice: Odontological and Anthropological Prospectus*

Abstract: During the years 2006–2007, the Archeological Superintendent of Veneto (Italy) promoted a research project on mass graves located on Nuovo Lazzaretto in Venice, where the corpses of plague deaths were buried during the 16th and 17th centuries. The burials were of different stages and are believed to be the remains of plague victims from the numerous outbreaks of pestilence, which occurred between the 15th and 17th centuries. Among the fragmented and commingled human bones, an unusual burial was found. The body was laid supine, with the top half of the thorax intact, arms parallel to the rachis axis, the articulations were anatomically unaltered. Both the skull morphology and the dimensions of the caput omeris suggest the body was a woman. A brick of moderate size was found inside the oral cavity, keeping the mandible wide open. The data collected by the anthropologist were used to generate a taphonomic profile, which precluded the positioning of the brick being accidental. Likewise, the probability of the brick having come from the surrounding burial sediment was rejected, as the only other inclusions found were bone fragments from previous burials in the same area. The data collected by the odontologist were employed for age estimation and radiological dental assessment. The forensic profile was based conceptually on the “circumstances of death” and concluded that the positioning of the brick was intentional, and attributed to a symbolic burial ritual. This ritual confirms the intimate belief held at those times, between the plague and the mythological character of the vampire.     

Fatal Wounds Sustained from “Falling Bullets”: Maintaining a High Index of Suspicion in a Forensic Setting

Celebratory gunfire injuries from “falling bullets” occur when guns are fired into the air during celebrations without realizing that this can cause serious injuries or even fatalities. Fatal celebratory gunfire injury is an uncommonly reported event in the continental United States. Our electronic database was queried for homicides occurring within days of July 4th and December 31st over a 14‐year period. We describe two cases of fatal gunfire injury due to celebratory gunfire occurring during New Year's Eve in Southern Florida. The relevant literature is reviewed. These case reports illustrate that fatal gunfire injuries sustained from “falling bullets” may pose as an unexpected mimic to sudden natural deaths especially in patients with prior medical history. A high index of suspicion to recognize such injury is required particularly during holidays.     

Sudden Death Due to Hydatid Disease: A Six‐Year Study in the Northern Part of Tunisia

Human ecchinococcosis also known as hydatid disease is a zoonotic infection caused by the tapeworm Ecchinococcus with 2–3 Million cases worldwide. We hereby report a 6 years period study of Sudden death due to hydatidosis aiming to analyze the epidemiological criteria, death circumstances, and autopsy observations attributed to hydatid disease. During the past 6 years, 26 death cases were due to hydatid disease. Our analysis shows that the sex ratio (M/F) was 1.6, the mean age was 31‐year old, and 65% of the subjects lived in rural places. In 17 cases, death occurred in the victim's place, five victims died after a heavy exercise, and in two cases, death occurred immediately after trauma. At autopsy, 91% of the cysts were found in the liver. In three cases, death followed a septic state, and in two cases, it followed an acute respiratory failure. Death was attributed to anaphylaxis in 17 cases.     

The Search for “Fred”: An Unusual Vertical Burial Case,

Police witness intelligence stated a murdered adult male “Fred” had been vertically buried in wooded hilly terrain 30 years ago in the Midlands, U.K. Conventional search methods were unsuccessful; therefore, the police requested a geophysical investigation to be undertaken to determine whether “Fred” could be detected. A multiphased geophysical approach was conducted, using bulk ground conductivity and metal detectors, then follow‐up magnetics and ground penetrating radar (GPR) survey profiles on electromagnetic (EM) anomalous areas. A tight grid pattern was used to account for the reduced target size. Relatively high‐resolution EM and GPR techniques were determined optimal for this terrain and sandy soil. Geophysical anomalies were identified and the most promising intrusively investigated, and this was found to be a large boulder and tree roots. Study implications suggest careful multiphase geophysical surveys are best practice and give confidence in cold case searches. This study yielded a no‐body result, effectively saving police time and costs from further investigations.     

Sudden Death Due to Primary Intraventricular Hemorrhage: Report of Two Cases

Primary intraventricular hemorrhage (PIVH) is a rare type of stroke defined as bleeding within the ventricles of the brain without any associated parenchymal hemorrhage. Here, we reported two cases of sudden death due to PIVH. One of the patients was found dead under a highway bridge without witnesses, and the other patient was hospitalized with hemorrhage in the ventricular system, as revealed by a head computed tomography scan. In these two patients, autopsy and macroscopic examination only showed hemorrhages in the ventricular system without any traumatic brain injury or other intraparenchymal hemorrhage. The sources of bleeding for both patients were ultimately confirmed as ruptured brain arteriovenous malformations located in the subventricular zone. We reported these cases to broaden our understanding of sudden death associated with PIVH, especially when caused by brain arteriovenous malformation. We also summarized the essential details of the diagnoses and available technical methods for PIVH cases.     

Expressing Uncertainty in Dental Age Estimation: A Comparison between Two Methods of Calculating the “Average” Standard Deviation

The expression of uncertainty is defined by the standard deviation and is usually expressed in multiples of the standard deviation (±1sd, ±2sd, and ±3sd). The objective was to use weighting of the sd calculation by the number or count of subjects for each tooth development stage. A comparison shows the difference between the range of uncertainty using the unweighted sd and the weighted sd. The range of uncertainty related to Dental Age Estimation is statistically significantly greater (p < 0.001) for the weighted sd compared to the unweighted sd. It is concluded that the number of subjects for each Tooth Development Stage in the Reference Data set should be included in the calculation for a single Dental Age Estimation using the Simple Average Method when presenting the uncertainty associated with the point estimate of the “mean” for Dental Age Estimation of a single subject of unknown age.     

Unusual Suicide in Italy: Criminological and Medico‐Legal Observations—A Proposed Definition of “Atypical Suicide” Suitable for International Application

This work is the result of a kind of categorization of suicidal conduct based on an empirical–phenomenological approach, with integrated assessment of certain criteria, such as the dynamics, correlation of types of injury and how they were produced, evidence gathered during official inspections in loco, and case history findings about “suicide.” This categorization is an attempt to provide a nosographic definition of atypical suicide, that is, cases in which the parameters of “typical” suicide are missing. Case studies are described, taken from a systematic exploration mainly of the Italian specialized literature of the 20th century, supplemented by earlier references when deemed significant. In‐depth analysis of atypical suicide can supply additional interpretations of the problem of differential diagnosis of suicide, homicide, and accidental death, that is, the real punctum dolens in overall medico‐legal determination of the cause of death in scenarios in which death cannot be definitely traced to a deliberate act.     

Unpredictable Behavior Under the Influence of “Magic Mushrooms”: A Case Report and Review of the Literature

Fatalities implicating psychedelic mushrooms are not a common clinical situation in everyday forensic medicine. Despite classification as an illegal drug in many countries, psilocybin mushrooms have the reputation of being safe. We report the case of a young man who jumped from a second story balcony under the influence of psilocybin mushrooms. The psilocin assay was performed by gas chromatography coupled to an electron‐impact ionization time‐of‐flight detector (GC‐EI‐TOF) after solid‐phase extraction. Total psilocin was quantified in peripheral and cardiac blood as 60 and 67 ng/mL, respectively, and in urine (2230 ng/mL), bile (3102 ng/mL), and vitreous humor (57 ng/mL). This case report and review of literature highlights the danger of psilocybin mushrooms. Isolated use of psilocybin mushrooms by a regular consumer without psychiatric history, even under “safe” circumstances, can lead to a fatal outcome.     

The Value of Outsourcing Selected Cases in a Medical Examiner Population: A 10‐Year Experience

Due to increasing caseloads and inadequate staffing, the burden on Coroner/Medical Examiner Offices to comply with recommended autopsy limits for forensic pathologists (FPs) has been difficult. Since 2006, pathologists at the University of Alabama at Birmingham have performed select autopsies for the Alabama Department of Forensic Sciences. Each case was reviewed by a state FP and scene investigator to determine appropriateness for referral. All referred cases received full postmortem examination including microscopic examination and collection of toxicological samples, and toxicology was ordered by the referring FP as appropriate. The final cause and manner of death were determined by the referring state FP after review of all findings. A majority of the 421 cases were ruled accidental deaths (233), most due to drug toxicity. Of the 178 natural deaths, 118 were attributed to cardiovascular disease. Outsourcing select forensic cases can be educational and an effective tool to manage workflow without compromising quality.     

Lead Theft—A Study of the “Uniqueness” of Lead from Church Roofs

In the United Kingdom, theft of lead is common, particularly from churches and other public buildings with lead roofs. To assess the potential to distinguish lead from different sources, 41 samples of lead from 24 church roofs in Northamptonshire, U.K, have been analyzed for relative abundance of trace elements and isotopes of lead using X‐ray fluorescence (XRF) and inductively coupled plasma mass spectrometry, respectively. XRF revealed the overall presence of 12 trace elements with the four most abundant, calcium, phosphorus, silicon, and sulfur, showing a large weight percentage standard error of the mean of all samples suggesting variation in the weight percentage of these elements between different church roofs. Multiple samples from the same roofs, but different lead sheets, showed much lower weight percentage standard errors of the mean suggesting similar trace element concentrations. Lead isotope ratios were similar for all samples. Factors likely to affect the occurrence of these trace elements are discussed.     

“Bath Salts” the New York City Medical Examiner Experience: A 3‐Year Retrospective Review

“Bath salts” are synthetic derivatives of cathinones, compounds found in the leaves of Catha edulis, which possesses amphetamine‐like properties. At the New York City Office of Chief Medical Examiner, we conducted a 3‐year retrospective analysis of deaths in which cathinones were detected. Two categories emerged; those in which cathinones were a contributory cause of death (15 cases) and those in which they were an incidental finding (15 cases). Of the former group, 13 were associated with additional intoxicants; two deaths were attributed solely to cathinone intoxication, both survived 10 h: a man whose postmortem blood methylone concentration was 0.71 mg/L and a woman whose postmortem blood ethylone concentration was 1.7 mg/L. In the latter category, there were several individuals who had higher concentrations of cathinones than the above two, the highest being a blood methylone of 4.8 mg/L. Based upon our data and the literature presented, lethal concentrations of cathinones cannot be established.     

DART‐MS as a Preliminary Screening Method for “Herbal Incense”: Chemical Analysis of Synthetic Cannabinoids

Direct analysis in real time mass spectrometry (DART‐MS) served as a method for rapid high‐throughput screening of six commercially available “Spice” products, detecting various combinations of five synthetic cannabinoids. Direct analysis in real time is an ambient ionization process that, along with high mass accuracy time‐of‐flight (TOF)‐MS to 0.0001 Da, was employed to establish the presence of cannabinoids. Mass spectra were acquired by simply suspending a small portion of sample between the ion source and the mass spectrometer inlet. The ability to test minute amounts of sample is a major advantage when very limited amounts of evidentiary material are available. In addition, reports are widespread regarding the testing backlogs that now exist because of the large influx of designer drugs. This method circumvents time‐consuming sample extraction, derivatization, chromatographic, and other sample preparative steps required for analysis by more conventional mass spectrometric methods. Accordingly, the synthetic cannabinoids AM‐2201, JWH‐122, JWH‐203, JWH‐210, and RCS‐4 were identified in commercially available herbal Spice products, singly and in tandem, at concentrations within the range of 4–141 mg/g of material. Direct analysis in real time mass spectrometry decreases the time necessary to triage analytical evidence, and therefore, it has the potential to contribute to backlog reduction and more timely criminal prosecution.     

Deaths Related to Tractor Accidents in Eskişehir,Turkey: A 25‐Year Analysis

This study aimed to analyze deaths related to tractor accidents in Eski?ehir Province and characteristics of these cases to provide data and suggestions along with the literature. The cases involved individuals died due to tractor‐related accidents were retrospectively examined between 1992 and 2016 (25‐year period). Demographic data related to the cases and crime scenes, characteristics of events, and autopsy findings were evaluated. In the 25‐year period, 61 individuals (88.5% males, average age: 48.7 years) died due to tractor accidents in Eski?ehir Province, and approximately 45.9% of these accidents most commonly involved tractor rollover. Deaths due to tractor accidents will be decreased by raising awareness among tractor drivers, preventing young individuals from driving tractors, not allowing individuals to drive without license, making mechanical and physical features of tractors suitable for agricultural activity to be performed, ensuring their safety for travel and use, and avoiding carrying passengers on tractors.     

Tracking Movement and Temperature Selection of Larvae of Two Forensically Important Blow Fly Species Within a “Maggot Mass”

The current study responds to the lack of understanding about the temperatures experienced by individual blow fly larvae within “maggot masses.” The temperature selection of both aggregating (in a mass) and nonaggregating larvae was compared and their pattern of movement assessed. Infrared imaging determined the temperatures within a mass and in the vicinity of the constituent individual larvae, whose movements were tracked by dyeing their tissues red. Individual Chrysomya rufifacies larvae selected temperatures above 27°C, significantly higher than the temperature selected by Calliphora vicina larvae (24.5°C). However, this same difference was not seen within a mass, with both species selecting temperatures around 28°C. Larval movement in a mass was nonrandom, indicating that larvae actively select their position in a mass. Furthermore, larvae have a strong tendency to select the hottest part of a mass; therefore, maximum mass temperatures might provide a reliable proxy for the actual temperatures experienced by larvae.     

Death of a 10‐Month‐Old Boy After Exposure to Ethylmorphine

Abstract: Ethylmorphine, an opiate that is partially metabolized to morphine, is a common ingredient in antitussive preparations. We present a case where a 10‐month‐old boy was administered ethylmorphine in the evening and found dead in bed the following morning. Postmortem toxicological analyses of heart blood by gas chromatography‐mass spectrometry and liquid chromatography‐mass spectrometry revealed the presence of ethylmorphine and morphine at concentrations of 0.17 μM (0.054 mg/L) and 0.090 μM (0.026 mg/L), respectively. CYP2D6 genotyping showed that the deceased had an extensive metabolizer genotype, signifying a “normal” capacity for metabolizing ethylmorphine to morphine. The autopsy report concluded that death was caused by a combination of opiate‐induced sedation and weakening of respiratory drive, a respiratory infection, and a sleeping position that could have impeded breathing. This is the first case report where the death of an infant has been linked to ethylmorphine ingestion.