Acute Psychosis Induced by Bath Salts: A Case Report with Clinical and Forensic Implications

Bath salts are new designer drugs with stimulant effects on the central nervous system. White or brown powder sold online and in mini‐marts under different brand names, bath salts can be used by injecting, snorting, smoking, or ingesting with food or drink. The case of a 30‐year‐old Caucasian male who developed acute psychosis within a few hours of injecting himself with bath salts is described. The patient was hospitalized with a complaint of hearing voices. The drug also induced in the patient a state of euphoria, increased energy level, along with decreased need for sleep and decreased appetite. The psychological effects of the bath salts subsided within a few hours of injection and his reality testing remained consistently intact over the next 3 days of hospitalization. This case brings to attention the fact that bath salts were legal throughout the United States until recently and is still not completely controlled. This report informs clinicians of harmful effects of bath salts, including severe agitation with possible rhabdomyolysis, psychosis, suicidal ideation, hypertension, tachycardia, and death.     

Implications of Pseudologia Fantastica in Criminal Forensic Evaluations: A Review and Case Report

Pseudologia fantastica, a psychological phenomenon that has been described in the literature for at least a century, is an understudied and poorly understood entity. Sometimes referred to as pathological lying, pseudologia fantastica involves disproportionate fabrication that may be present for many years or a lifetime. In a forensic context, it can significantly complicate the evaluation of capacity to stand trial and, in certain jurisdictions, criminal responsibility. We review the current literature regarding pseudologia fantastica and present a case to highlight the clinical and forensic challenges it may create. We specifically discuss the complications that pseudologia fantastica may have on the assessment of a defendant's rational ability to consult with an attorney, a required element of capacity to stand trial. In addition, we discuss the implications of pseudologia fantastica in the evaluation of criminal responsibility.     

Faith,Folie à Famille,and Mummification: A Brief Review of the Literature and a Rare Case Report

Folie à deux is a rare clinical syndrome characterized by the transference of delusional ideas from one person to one or more other people in close association with the primary affected patient. Mummification indicates the preservation of the corpse of a person for a variable period of time. A brief review of the literature in this field is presented, and an exceptional case is described, characterized by the association of both these rare phenomena. The case is an example of folie à fammille which developed out of a condition of extreme religiousness and seclusion of an entire family. The shared psychosis led to the horrible death of some of the family members, while the last surviving member of the family lived for more than a year and a half with their mummified remains. The Judge commissioned a forensic psychiatry assessment to verify the survivor's ability to bear witness. The development of the psychiatric syndrome and its consequences are extensively discussed.     

Cold Case Homicides: DNA Testing of Retained Autopsy Sexual Assault Smears

Archival medical examiner specimens may contain perpetrator DNA evidence useful in unsolved (“cold case”) homicides. The Office of the Chief Medical Examiner (OCME) histology slide archives were searched for sexual assault smears for all 376 female homicides from 1990 to 1999. Of these, the OCME had sexual assault smears on 84 of which 13 slides had sperm. Of these 13, six were still unsolved. DNA profiles were obtained on all six (5 from smears and one from swabs). Combined DNA Index System ( submission resulted in two matches (“hits”) for new suspects. In addition, three suspects were eliminated in two cases. Our review of archival sexual assault smears resulted in DNA profiles that were able to assist in the investigation of four cold case homicide investigations. It may be worthwhile for medical examiner offices to search their archival histology slides for sexual assault smears on previously unsolved cases particularly those prior to the mid‐1990s when DNA testing was less widely available.     

A Fatal Case of CO2 Intoxication in a Fermentation Tank

Carbon dioxide (CO₂) is an odorless constituent of air. Higher concentrations can be detected in geothermal and automotive emissions, fermentation, and sublimation of dry ice. An unskilled worker entered a fermentation tank to clean it, which had not been done for about 5 months allowing for high concentrations of CO₂ to build up. A second worker entered the tank to rescue the first one. Shortly after both were found the first worker was rescued directly whereas the tank had to be rotated to pull the second worker out. Cardiopulmonary resuscitation was successful only for the first worker. Medico‐legal autopsy showed bruises, hematoma, myocardial hemorrhage, and edema of the lungs. The right lung was vacuum degassed in an argon atmosphere and quadrupole‐mass‐spectrometry showed an elevated CO₂ content in lung gases. Thus, CO₂ intoxication/asphyxia in a vitiated atmosphere due to fermentation of wine mash was established as the cause of death.     

Diurnal and Nocturnal Flight Activity of Blow Flies (Diptera: Calliphoridae) in a Rainforest Fragment in Brazil: Implications for the Colonization of Homicide Victims

Nocturnal flight of blow flies (Diptera: Calliphoridae) is a controversial issue in forensic entomology. We performed two field experiments to investigate the diurnal and nocturnal activity of six blow fly species in a rainforest fragment in Brazil. Initially, nocturnal (17:30–05:30) versus diurnal (05:30–17:30) flight activity was investigated. Only 3.9% of adults were collected at night, mostly the native species Mesembrinella bicolor, and nocturnal oviposition did not occur. In the second experiment, collection of adults took place at the following intervals: 05:30–08:30, 08:30–11:30, 11:30–14:30, and 14:30–17:30. The proportions of adults did not differ significantly among the four diurnal intervals, except for Hemilucilia segmentaria, which was captured more frequently in the early morning. Calliphoridae has predominantly diurnal behavior, not laying eggs in darkness. The association of the native species M. bicolor, Hemilucilia semidiaphana, and H. segmentaria to forested areas reinforces the forensic relevance of data on their flight pattern.     

DXAGE: A New Method for Age at Death Estimation Based on Femoral Bone Mineral Density and Artificial Neural Networks

Age at death estimation in adult skeletons is hampered, among others, by the unremarkable correlation of bone estimators with chronological age, implementation of inappropriate statistical techniques, observer error, and skeletal incompleteness or destruction. Therefore, it is beneficial to consider alternative methods to assess age at death in adult skeletons. The decrease in bone mineral density with age was explored to generate a method to assess age at death in human remains. A connectionist computational approach, artificial neural networks, was employed to model femur densitometry data gathered in 100 female individuals from the Coimbra Identified Skeletal Collection. Bone mineral density declines consistently with age and the method performs appropriately, with mean absolute differences between known and predicted age ranging from 9.19 to 13.49 years. The proposed method—DXAGE—was implemented online to streamline age estimation. This preliminary study highlights the value of densitometry to assess age at death in human remains.     

The Effect of Flunitrazepam (Rohypnol®) on the Development of Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae) and its Implications for Forensic Entomology

This study investigated the potential effects of flunitrazepam (known as “date rape drug”) on the developmental cycle of Chrysomya megacephala, an important forensic species, and their possible implications for the calculation of the PMI. A 1050 C. megacephala eggs were divided into five groups with seven replications each. The eggs were placed on artificial diet prepared with four drug concentrations of flunitrazepam (4, 8, 16, and 32 ng/g), besides the control group (prepared with water). Were evaluated the potential effects on development time, weight gain, and mortality during the cycles. The drug had no significant effect on development time or mortality although it did affect the weight of the pupae and adults (Kruskal–Wallis, p < 0.05). The result can be deduced that the determination of the postmortem interval is not affected.     

The Impact of Daubert on the Admissibility of Forensic Anthropology Expert Testimony

Forensic anthropologists anticipated a significant impact from the 1993 Supreme Court Daubert decision, which addressed the standard of admissibility for expert testimony. In response, many forensic articles cited Daubert in the search for objective techniques or a critique of established subjective methods. This study examines challenges to forensic anthropological expert testimony to evaluate whether Daubert has actually affected the admissibility of such testimony. Thirty cases were identified that addressed the admissibility of the testimony, including 14 cases prior to Daubert and 16 after Daubert. Examination of these cases indicates that post‐Daubert cases do not result in more exclusions. Yet, this lack of exclusions may instead be viewed as a manifestation of the field's overall surge toward more objective and quantifiable techniques in a self‐regulating response to Daubert.     

An Unexpected Finding in SUDEP Involving a Child: Focal Myocardial Infarct Adjacent to Bundle of His

Sudden unexpected death in epilepsy (SUDEP) is a nontraumatic, nondrowning death of an individual with epilepsy in which an autopsy with appropriate ancillary studies does not identify a cause of death. The mechanism of death in SUDEP is unknown, but is thought to involve cardiac and/or respiratory mechanisms. Research in SUDEP is hindered by a lack of consensus regarding required components of a death investigation before a cause of death may be certified as SUDEP. Histopathologic examination of the cardiac conduction system is not routinely performed in SUDEP death investigations. We present a case of SUDEP where histopathologic examination of the cardiac conduction system revealed a focal myocardial infarct of the summit of the ventricular septum abutting the bundle of His, which potentially provides insight into the mechanism of SUDEP for this particular case, and suggests that routine examination of the cardiac conduction system in SUDEP may be beneficial.     

A Comparative Taphonomic Analysis of 24 Trophy Skulls from Modern Forensic Cases,

Cranial remains retained from fallen enemies are commonly referred to as “trophy skulls,” and many such crania were acquired as souvenirs by U.S. servicemembers during WWII and the Vietnam conflict. These remains increasingly have become the subject of forensic anthropological analysis as their possessors, typically veterans or their relatives, try to discard or repatriate them. The present research uses a qualitative analytical approach to review 24 cases of reported trophy skulls (14 previously unpublished cases and 10 from the literature) to determine which perimortem and postmortem characteristics are most useful for generating a taphonomic profile. Overall, the taphonomic signature of trophy remains includes traits relating to acquisition and preparation, ornamental display, and subsequent curation. Contextual evidence and the biological profile also are considered when determining the possible origin of human cranial remains as a trophy skull. Thorough taphonomic analysis will aid in identifying these types of remains as trophy skulls.     

Retropharyngeal Hematoma Secondary to Cervical Spine Surgery: Report of One Fatal Case

A 53‐year‐old woman suffering from radicular pain due to cervical herniation underwent a spinal surgery consisting of anterior cervical discectomy and fusion with an implantable titanium cage. Five hours after the procedure, the patient developed cervical swelling and dyspnea. An emergency surgery permitted evacuation of a deep cervical hematoma and intubation of the patient, who died some minutes later. The family of the deceased lodged a complaint with the public prosecutor because of unclear circumstances of death. After analysis of the medical records by two forensic pathologists, a medicolegal autopsy was ordered. Massive retropharyngeal and mediastinal hematomas were diagnosed. Pathological study confirmed acute cervical hemorrhage, but failed to detect the source of bleeding. The forensic pathologists concluded that death was due to mechanical asphyxia secondary to pharyngeal compression by the cervical hematoma. To the best of our knowledge, death secondary to retropharyngeal hematoma in this neurosurgical context is rarely encountered.     

Effects of Different Temperatures on the Development of Dermestes Frischii and Dermestes Undulatus (Coleoptera,Dermestidae): Comparison Between Species

Dermestidae could be useful in forensic investigations to assess the PMI as adults and larvae colonize dried remains. We reared two species of Dermestidae (Dermestes frischii and Dermestes undulatus) to understand the effects of different temperatures on the length of their whole life cycle and on their immature stages. Both species were reared at 23°C ± 0.5, RH 75% and at 26°C ± 0.5, 75% RH. Our result shows that the temperature is the main factor that influences the development of those species; in fact, increasing temperature leads to a shorter development cycle (59.8 ± 0.5 and 38.1 ± 0.2 for D. frischii; 50.6 ± 0.6 and 36.2 ± 0.2 for D. undulatus). Furthermore, we found that the number of the molts before the pupa decreases from 5–7 to 5–6 for D. frischii and from 4–6 to 4–5 for D. undulatus, respectively, at 23°C and 26°C.     

Complete Cardiac Rupture Associated with Closed Chest Cardiac Massage: Case Report and Review of the Literature

Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35‐year‐old workman who collapsed and underwent ECM by his co‐workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre‐existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.     

Associative Learning of Nasonia vitripennis Walker (Hymenoptera:Pteromalidae) to Methyldisulfanylmethane

Traditional methods of volatile detection used by police typically consist of reliance on canine olfaction. However, dogs have some limitations such as cost of training and time of conditioning. The possibility of using parasitic wasps for detecting explosives and narcotics has been developed. Moreover, wasps are cheap to produce and can be conditioned with impressive speed for a specific chemical detection task. We examined the ability of Nasonia vitripennis Walker to learn and respond to methyldisulfanylmethane (DMDS), a volatile discriminator of cadaver. The training aimed to form an association between an unconditioned stimulus (pupae) and the conditioned stimulus (odor source). After the training, the time spent by conditioned wasps in the DMDS chamber was measured. Statistical analysis showed that the increasing concentrations involved an increase in the time spent in the chamber containing DMDS. This study indicates that N. vitripennis can respond to DMDS, which provide further support for its development as a biological sensor.     

Statistical Modeling of the Case Information From the Ohio Attorney General's Sexual Assault Kit Testing Initiative

The Ohio Attorney General's Sexual Assault Kit (SAK) Testing Initiative has resulted in nearly 14,000 kits being processed since the initiation of the project in 2012. A logistic regression model was fit to the data from 2500 SAKs in order to determine the probability of obtaining at least one Combined DNA Index System (CODIS) eligible DNA profile based on a number of predictor variables. The probability of obtaining at least one CODIS eligible DNA profile from an SAK varied as a function of (i) days to kit collection following a sexual assault; (ii) years to kit submission to the laboratory for testing following kit collection; (iii) the age of the victim; and (iv) the occurrence of victim‐reported consensual sex around the time of the assault and/or kit collection. These findings demonstrate the utility of the statistical modeling of data obtained from the “forklift” testing approach of sexual assault kits.     

Analysis of the Effect of Cyclophosphamide and Methotrexate on Chrysomya megacephala (Diptera: Calliphoridae),

Forensic entomotoxicology investigates the effects of chemical substances in the development of scavenger insects and the reflection on estimating the minimum postmortem interval (PMI). To evaluate the impact of the chemotherapeutic drugs cyclophosphamide (CF) and methotrexate (MTX) on the postembryonic development of Chrysomya megacephala, controlled experiments were performed by rearing the larvae on spiked minced beef with different concentrations of these drugs. The results indicated that CF significantly decreased their developmental rate up to 28 h but had no significant effect on larval and adult sizes, survival rate, and sex ratio, whereas MTX decreased larval and adult sizes, survival rate, and there was a deviation in the expected sex ratio toward females in MTX‐exposed larvae but had no significant impact on developmental rate. These negative interference factors should be considered in cases of suspected death of people that have undergone chemotherapy.     

Death by Ram Attack: A Case Report from Greece and a Brief Review of the Literature

A case of a ram attack that caused injuries to a 73‐year‐old man is presented. The deceased survived the attack and had the opportunity to speak with a friend over the phone before being transferred to the hospital. After a 21‐day hospitalization, the patient passed away. A postmortem examination was performed to ascertain the cause of death. The autopsy findings are presented along with a brief review of the literature. Attacks by agricultural animals (or livestock) around the world are reported in the scientific literature. Fatalities from ram attacks are extremely rare. The need to implement specific codes in the ICD system, relevant to each animal attack, appears to be of great importance, in order to allow tracking of animal‐related deaths.     

A 2‐Year Study of Δ 9‐tetrahydrocannabinol Concentrations in Drivers: Examining Driving and Field Sobriety Test Performance,,

From November 1, 2010 through November 30, 2012, 1204 whole‐blood samples were confirmed to contain THC alone or in combination with other drugs out of nearly 5000 Orange County, California, drivers suspected of driving under the influence of drugs. The goal of this study was to examine police reports and drug recognition expert evaluations of THC‐positive samples within this 2‐year time frame to determine whether there is a correlation between whole‐blood THC concentrations and field sobriety tests performance on DRE and non‐DRE evaluations. The FSTs prove to be sensitive to impairment by marijuana although as suspected, the findings of this study did not find a correlation between performance on field sobriety tests and the concentration of THC tested in whole‐blood samples. Driving behaviors were also examined and found to be similar to those seen in alcohol impairment. Future studies examining DRE findings are needed to confirm the results.     

Visualizing Digital Forensic Datasets: A Proof of Concept

Digital forensic visualization is an understudied area despite its potential to achieve significant improvements in the efficiency of an investigation, criminal or civil. In this study, a three‐stage forensic data storage and visualization life cycle is presented. The first stage is the decoding of data, which involves preparing both structured and unstructured data for storage. In the storage stage, data are stored within our proposed database schema designed for ensuring data integrity and speed of storage and retrieval. The final stage is the visualization of stored data in a manner that facilitates user interaction. These functionalities are implemented in a proof of concept to demonstrate the utility of the proposed life cycle. The proof of concept demonstrates the utility of the proposed approach for the storage and visualization of digital forensic data.