Loperamide as a Potential Drug of Abuse and Misuse: Fatal Overdoses at the Medical University of South Carolina

Loperamide is an over‐the‐counter, μ‐opioid receptor agonist commonly used as an antidiarrheal agent. Loperamide was thought to have minimal abuse potential due to its low bioavailability and limited central nervous system activity; however, there have been increasing reports of loperamide misuse in supratherapeutic doses to achieve euphoria and/or avoid opioid withdrawal. A literature review suggests a rise in loperamide abuse was inevitable, with substantial increases in reported cases over the last decade. Five fatal cases of toxic medication use where loperamide was listed as a primary or contributory cause of death were identified at the Medical University of South Carolina. The characteristic autopsy demographics and findings are described, and the mechanisms of abuse and toxicity of loperamide are reviewed. Loperamide overdoses are a growing concern from both a forensic and clinical standpoint, and the frequency of reported cases will likely increase as awareness grows within the medical and toxicological communities.     

Under the Radar: Airborne Arms Trafficking Operations in Africa

Airborne illicit arms traffickers from the former Soviet space are resourceful and adaptable international criminals who have built complex air trafficking networks by successfully cultivating strategic connections in a number of geographically distant states. This paper examines the airborne arms trafficking operations of networks from former Soviet states which transfer weapons and ammunition to areas of conflict in Africa, embargoed African states, or those descending into conflict. As such, these arms traffickers brazenly circumvent international regulations by obscuring their air cargo operations and securing impunity through subornation, fraud, and exploitation of lax regulations. Importantly, they rely on strategic connections in former Soviet states for a steady supply of arms, on states such as UAE for relaxed oversight and free trade zones for transit, product warehousing, and laundering of proceeds, and on carefully-cultivated connections with “big men” and/or local fixers in African states for speedy delivery and payment.     

Patterns of Aggressive Behavior and Peer Victimization from Childhood to Early Adolescence: A Latent Class Analysis

The developmental period characterized by the transition from childhood and elementary school to early adolescence and middle school has been associated with increases in aggressive behavior and peer victimization. Few longitudinal studies, however, have examined the stability of aggression and victimization during this critical transition. This study uses latent class analysis (LCA) to examine patterns of aggressive behavior and victimization during the transition to middle school among urban, public school students (N = 458; Girls = 53%; Latino/a = 53%; M age at t1 = 10.2 years). Independent LCA models were conducted using self-reported data assessing subjects’ involvement in aggressive conduct and victimization during the spring semesters of grades four, five, and six. Elementary school students in the fourth grade initially belonged to one of four groups identified as aggressor, victim, aggressor-victim, and uninvolved latent classes. Contrary to prior research, membership in these classes changed significantly by the time students completed their first year of middle school with most youth participating in episodes of aggression and victimization during the transition. Six common paths that describe patterns of aggressive behavior and victimization from the last two years of elementary school to the first year of middle school were found. Findings are discussed in the context of social dominance theory and prior research that has found greater stability in aggression and victimization among early adolescents.     

Fracture patterns on the infant porcine skull following severe blunt impact

The objective of this study was to document patterns of fracture on infant porcine skulls aged 2-28 days (n = 57) because of a single, high energy blunt impact to the parietal bone with rigid (nondeformable) and compliant (deformable) interfaces. Fracture patterns were mapped using Geographic Information System software. For the same generated impact force, the rigid interface produced more fractures than the compliant interface for all ages. This study also showed that this increased level of impact energy versus an earlier study using a lower energy resulted in new sites of fracture initiation and also caused previously defined fractures that propagate into an adjacent bone. Several unique characteristics of bone and diastatic fracture were documented as a function of specimen age, impact energy, and interface. These data describe some baseline characteristics of skull fracture using an animal model that may help guide future studies from forensic case files.     

A review of blunt force injury homicides of children aged 0 to 5 years in bexar county, Texas, from 1988 to 2009

ABSTRACT: It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.