Evaluation of Agonal Cardiac Function for Sudden Cardiac Death in Forensic Medicine with Postmortem Brain Natriuretic Peptide (BNP) and NT-proBNP: A Meta-analysis

Sudden cardiac death (SCD) is an unexpected death caused by a sudden loss of cardiac function, which is currently a global public health problem. Evaluation of the agonal cardiac function of the deceased is a quite important task for the diagnosis of SCD in forensic medicine. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are currently considered as significant biomarkers for the diagnosis of heart failure in both clinical and forensic practices. To investigate the postmortem evaluation roles of postmortem BNP and NT-proBNP levels for SCD, the present study meta-analyzed eight related studies from Embase, Cochrane Library, PubMed, China Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang Data. Newcastle–Ottawa Quality Assessment Scale was used to assess the quality of the included literature, and the meta-analysis was performed by RevMan 5.3.5 software. Postmortem NT-proBNP in pericardial fluid showed higher levels in the SCD group than that of the non-SCD group with the weighted mean difference = 3665.74, 95% confidence interval: 1812.89–5518.59, and p = 0.0001. However, postmortem levels of BNP in pericardial fluid and NT-proBNP in serum revealed no statistical difference between SCD and non-SCD subjects. The results of present meta-analysis demonstrated that postmortem NT-proBNP in the pericardial fluid could be used as an ancillary indicator for evaluation of agonal cardiac function in forensic medicine.     

Importance and Approach to Manner of Death Opinions in Opioid-Related Deaths

The majority of opioid-related deaths are accidental. However, the number of opioid-related suicidal deaths is likely under recognized. Presented here is a case of suicide by heroin overdose. The manner of death would have likely been deemed accidental if not for critical information shared by the decedent’s family during follow-up telephone interviews between the forensic pathologist and the decedent’s family, which included text messages that were sent by the decedent just before his death that were not known at the time of the initial medicolegal death scene investigation. This case highlights that when a forensic pathologist establishes an engaged relationship with the decedent’s family, the information elucidated can prove to be invaluable in reaching an informed opinion about the manner of death. For overdose cases, identifying an accurate manner of death allows the design of public health efforts that adequately address the health risks in the community. For aid in the determination of the manner of death for overdose cases, we propose a five-step checklist that may assist forensic pathologists and medicolegal death investigators when approaching similar cases.     

Accidental Trauma Mimicking Homicidal Violence

Homicide investigations represent an important function of death investigators. Although recognizing nonobvious homicides is crucial, an equally important role involves the identification of cases that initially present as possible homicides, but are ultimately discovered to not represent homicides. Failure to recognize such cases results in wasted time, squandered resources, false allegations, and potential life‐altering consequences. The authors review a series of cases wherein initial investigation suggested a possibility that the deaths represented homicides. By carefully considering additional information, including scene findings, history, and postmortem examination, each was determined to represent an accidental traumatic death. In addition to highlighting the importance of recognizing accidental traumatic deaths that initially present as homicides, the cases serve to highlight the fact that forensic pathology cannot be practiced without knowledge of appropriate ancillary information. Although guarding against cognitive bias is important in all forensic disciplines, including forensic pathology, access to vital case‐related ancillary information is an essential component of practicing medicine as a forensic pathologist.     

HIV-infection in forensic autopsy cases

Sudden and unexpected death and violent death of persons with a high risk of acquiring HIV-infections, especially homosexual males and intravenous drug abusers, have to be investigated by forensic autopsies. Therefore every forensic pathologist has to be aware of this infection and should try to make the proper diagnosis. Three typical cases are described: (1) suicide by hanging, (2) homicide by cutting the throat and (3) intravenous heroin overdose. Merely retrospectively it could be cleared up that the deceased were homosexual but did not manifestly suffer from AIDS. The morphological findings in the lymph nodes and the postmortem serological findings are described in detail.     

Sharp Force Injury Fatalities: A Retrospective Study (1982–2012) in Brescia (Italy)

A retrospective study was carried out on postmortem examination data of 131 sharp force‐related casualties recorded by the Brescia Institute of Forensic Medicine between 1982 and 2012. The objective was to identify relevant parameters that may be used to distinguish the manner of deaths between homicide, suicide, and accident. The following variables were considered: manner of death; demographic data; scene; type of sharp object; location and numbers of wounds; the presence of hesitation marks/defense wounds; toxicological findings; psychiatric history. There were 92 homicides, 28 suicides, and 11 accidents. Most victims were male, with an average age of 43. Injuries in isolation were present in 9.8% of homicides, in 35.7% of suicides, and in 54.5% of accidents. Most injuries involved the left anterior chest in homicides and the forearms in suicides. This study underlines the importance of a meticulous postmortem examination of injuries on the body and their relationship with other results from the death scene investigation.     

Trichophyton Mentagrophytes Perforates Hair of Adult Corpses in the Gaseous Period*

Abstract: Despite the substantial literature on mycology, there are still limited reports of the interaction between fungi and human hosts in the postmortem period. Thus, the main goal of this study was to investigate the in vitro perforation test using Trichophyton mentagrophytes on hair from adult corpses in the postmortem period (gaseous period). The protocol was carried out with positive (prepubescent children’s hair) and negative controls (healthy adult hair) as well. One strain of Trichophyton rubrum was also used as a negative perforation control. Perforations were found in all the hair samples from corpses and prepubescent children after 12–14 days exposure to T. mentagrophytes and were absent in the hair samples of healthy adults. Furthermore, hair perforation was not observed with T. rubrum. Our preliminary findings suggest the use of T. mentagrophytes as a potential marker of the death interval in forensic science.     

Undetermined Manner of Death: An Autopsy Series

A manner of death may be ruled undetermined by the forensic pathologist when there is insufficient information about the circumstances surrounding the death to make a ruling. The aim of our study was to retrospectively analyze a series of autopsy cases that were classified as undetermined manner of death after complete investigations. In all, 48 cases were examined. In 23 cases (48%), the cause of death was determined. The most frequent cause of death was toxic death (n = 11). More than one manner of death was deemed conceivable for most cases (n = 39). The most frequent and the most probable manner of death was accident (n = 37). Homicide was not excluded in about 23% of the cases. Our study showed that the manner of death may remain undetermined despite an established cause of death, and even when two or more conceivable causes of death are considered. Our study pointed out that undetermined manner of death covers a wide range of situations and that homicide may be underestimated.     

Entomological and Cardiologic Evidence of Time Since Death in Short Postmortem Intervals

Estimating the time since death of the deceased is a main goal in forensic investigations, but this can be challenging due to contradictory results derived from different investigations at the scene of death. We present a case of a 78‐year‐old woman, found dead in a small forest with broad‐leaved trees, whose husband had a history of domestic violence. Routinely performed investigations, such as postmortem rectal temperature and lividity, yielded inconsistent time since death results between only a few and longer than 20 h. This difficulty was most likely caused by high ambient temperatures of up to 38.0°C, which negatively influenced the informative value of the applied nomogram method. Additionally, performed entomological investigation of fly maggots (Lucilia illustris) recovered from the corpse and the assessment of heart pacemaker data revealed consistent and incontrovertible results. The presented case highlights the benefits of information provided by entomological investigations and data evaluation of cardiac implantable electronic devices and the combined use of the two techniques.     

中毒死亡案件的法医学分析

目的分析中毒性死亡案件和与中毒死亡有关的医疗纠纷案件的法医学特点,探讨此类案件的防护重点和鉴定要点。方法对四川大学法医学院1985～2004年106例中毒死亡尸体剖验病理材料进行回顾性统计分析。结果性别:男性61例,女性45例,男女比例1.36:1;年龄:以21～40岁年龄组(60.38%)为主;死亡方式:意外死亡最多见(52.83%),其次为自杀(33.02%)和他杀(14.15%);死亡原因:CO中毒、有机磷类中毒、毒鼠强及药物中毒多见(72.64%);医疗纠纷:发生医疗不当12例(11.32%),7例为医源性中毒性医疗纠纷,5例为中毒后在医院抢救中发生的医疗纠纷,主要发生于乡镇医院和县级医院(83.33%)。结论加强毒物的管理、提高安全意识、加强法制教育、增加生产安全等是减少中毒性死亡的重要手段。提高城乡医疗水平,加强中毒急诊抢救临床技能是防止中毒性医疗纠纷的关键。     

Do bone elasticity and postmortem interval affect forensic fractographic analyses?

Forensic fractographic features of bone reliably establish crack propagation in perimortem injuries. We investigated if similar fracture surface features characterize postmortem fractures. Experimentally induced peri- and postmortem fractures were used to assess if fractographic features vary as bone elasticity decreases during the postmortem interval (PMI). Thirty-seven unembalmed, defleshed human femoral shafts from males and females aged 33–81 years were fractured at varying PMIs with a drop test frame using a three-point bending setup and recorded with a high-speed camera. Vital statistics, cause of death, PMI length, temperature, humidity, collagen percentage, water loss, fracture energy, and fractography scores were recorded for each sample. Results showed that fractographic features associated with perimortem fractures were expressed in PMIs up to 40,600 accumulated degree hours (ADH), or 60 warm weather days. Hackle was the most consistently expressed feature, occurring in all fractures regardless of ADH. The most variable characteristics were wake features (78.4%) and arrest ridges (70.3%). Collagen percentage did not correlate strongly with ADH (r = −0.04, p = 0.81); however, there was a strong significant correlation between ADH and water loss (r = 0.74, p < 0.001). Multinomial logistic regression showed no association between fractographic feature expression and ADH or collagen percentage. In conclusion, forensic fractographic features reliably determine initiation and directionality of crack propagation in experimentally induced PMIs up to 40,600 ADH, demonstrating the utility of this method into the recent postmortem interval. This expression of reliable fractographic features throughout the early PMI intimates these characteristics may not be useful standalone features for discerning peri- versus postmortem fractures.     

Artifacts Caused by Leaf-Cutting Ants of the Genus Atta (Hymenoptera: Formicidae): Postmortem Bite Injuries and the Tearing of Clothes

Ants are one of the first insects to find an exposed cadaver and can be present during all stages of decomposition. Although these organisms are not commonly used in postmortem interval estimates, they are to be taken into account on criminal investigations involving human corpses, since they can leave bite marks that can be mistaken for antemortem or perimortem injuries, which could be misleading when ascertaining the occurrence of abuse or physical altercation during a crime. A few studies report the action of ants on human cadavers and even though leaf-cutting ants of the genus Atta are frequently encountered in succession studies that use animal carcasses, there are no records of these fungus-growing species on human corpses. Atta is a genus restricted to the New World, ranging from northern Argentina to southern United States and acts as one of the most conspicuous neotropical herbivores. In this study, we report three cases of violent death that illustrate the impact of ants, especially those of the genus Atta, in a forensic setting. We compare the patterns displayed by postmortem bite injuries caused by leaf-cutter ants and other common species with less robust mandibles. We also present the capability of Atta ants to create artifacts by cutting victim’s clothes in a crime scene, contributing to the knowledge of ant-mediated confounding factors in crime scene investigation.     

Shells and Bones: A Forensic Medicine Study of the Association of Terrestrial Snail Allopeas micra with Buried Human Remains in Brazil

Little is known regarding the scavenger fauna associated with buried human corpses, particularly in clandestine burials. We report the presence of 20 shells of the terrestrial snail Allopeas micra, within hollow bones of human remains buried for 5 years, during the process of collecting DNA material. The fact that a large number of shells of A. micra had been found in the corpse and in the crime scene supports the assumption that there was no attempt to remove the corpse from the area where the crime occurred. Despite this, our observations cannot be used to estimate the postmortem interval because there is no precise knowledge about the development of this species. This is the first record of a terrestrial snail associated with a human corpse and its role in this forensic medicine case.     

The Institution of a Standardized Investigation Protocol for Sudden Infant Death in the Eastern Metropole,Cape Town,South Africa,,

The rate for the sudden infant death syndrome (SIDS) in Cape Town, South Africa, is estimated to be among the highest in the world (3.41/1000 live births). In several of these areas, including those of extreme poverty, only sporadic, nonstandardized infant autopsy, and death scene investigation (DSI) occurred. In this report, we detail a feasibility project comprising 18 autopsied infants with sudden and unexpected death whose causes of death were adjudicated according to the 1991 NICHD definitions (SIDS, n = 7; known cause of death, n = 7; and unclassified, n = 4). We instituted a standardized autopsy and infant DSI through a collaborative effort of local forensic pathology officers and clinical providers. The high standard of forensic investigation met international standards, identified preventable disease, and allowed for incorporation of research. We conclude that an effective infant autopsy and DSI protocol can be established in areas with both high sudden unexpected infant death, and elsewhere. (SUID)/SIDS risk and infrastructure challenges.     

Age Estimation Based on Pulp Cavity to Tooth Volume Ratio Using Postmortem Computed Tomography Images

Pulp cavity size is known to decrease with age and can therefore serve as an indicator for age estimation. Here, we evaluated whether reconstructed images of multidetector‐row computed tomography (MDCT) acquired before forensic autopsy are useful for estimating age at death. Images of 136 mandibular first premolars obtained from bodies of known age at death were analyzed, and the volume of the regions corresponding to pulp cavity and that of the whole tooth were determined using a voxel counting function. The pulp cavity was clearly distinguishable from dental hard tissue on the reconstructed images when using a cutoff value of 1400 Hounsfield units. Regression analysis adjusted for sex showed that estimated age correlated significantly with the pulp cavity to tooth volume ratio (r = 0.76). MDCT is gaining more widespread use in forensic medicine, and analyzing dental images to obtain parameters for age prediction is a practical approach for postmortem identification.     

Post-mortem Iris Decomposition and its Dynamics in Morgue Conditions

With increasing interest in employing iris biometrics as a forensic tool for identification by investigation authorities, there is a need for a thorough examination and understanding of postmortem decomposition processes that take place within the human eyeball, especially the iris. This can prove useful for fast and accurate matching of antemortem with postmortem data acquired at crime scenes or mass casualties, as well as for ensuring correct dispatching of bodies from the incident scene to a mortuary or funeral homes. Following these needs of forensic community, this paper offers an analysis of the coarse effects of eyeball decay done from a perspective of automatic iris recognition. We analyze postmortem iris images acquired for a subject with a very long postmortem observation time horizon (34 days), in both visible light and near-infrared light (860 nm), as the latter wavelength is used in commercial iris recognition systems. Conclusions and suggestions are provided that may aid forensic examiners in successfully utilizing iris patterns in postmortem identification of deceased subjects. Initial guidelines regarding the imaging process, types of illumination, and resolution are also given, together with expectations with respect to the iris features decomposition rates. Visible iris features possible for human, expert-based matching persists even up to 407 h postmortem, and near-infrared illumination is suggested for better mitigation of corneal opacity while imaging cadaver eyes (Post-mortem iris decomposition and its dynamics in morgue conditions. ArXiv pre-print, 2019).