Detection of human chorionic gonadotropin (HCG) in fabric urine stains older than five years

Human chorionic gonadotropin (HCG) is used in clinical medicine as a particularly important indicator to determine pregnancy. In this study, it was necessary to determine whether the urine spots on car seat fabric from a murder 5 years previously were from a pregnant woman. The HCG in the dried urine spot on a car seat was detected using an immunochromatography kit. It was found that the HCG in urine can be detected for much longer periods of time than the previously reported period of approximately 6 months.     

Intellectual and developmental disabilities and Ontario’s forensic inpatient system: a population-based cohort study

Individuals with intellectual and developmental disabilities (IDD) in forensic inpatient beds are both complex and understudied. Previous studies have been limited and largely based on smaller clinical samples. We used data from a population-based cohort of Ontario adults with IDD (H-CARDD cohort, n?=?66,000) to describe their prevalence in forensic inpatient beds during 2005–2015 and compare their demographic and clinical profiles with non-IDD forensic patients. Results show that forensic patients with IDD and without IDD have similar profiles, with the exception that patients with IDD are more likely to have a psychiatric disorder and to be younger, rural, and have high or very high morbidity. Strong support was found for disproportionate admission: individuals with IDD are 12.2% of forensic inpatients but only 0.8% of the general population (d?=?1.57). Support for disproportionate utilization was less dramatic and mixed. Little difference was found in terms of the per cent of longer-stay (treatment) admissions or multiple forensic admissions; however, patients with IDD did have longer number of bed days over 10 years (averaging 220.6 days more, d?=?0.28). A better understanding of the barriers to discharge for individuals with IDD will support implementation of appropriate pathways out of the hospital.     

An Expanding Culture of Control? The Municipal Administrative Sanctions Act in Belgium

This article provides an in-depth study of the Act on Municipal Administrative Sanctions 1999 (MAS), which is the first major piece of legislation regulating antisocial behaviour in Belgium. MAS provides municipalities with an instrument to sanction antisocial behaviour and conduct perceived to disturb public order. The article uses Garland’s (2001) thesis on the culture of control to analyse whether MAS has led to increased government control and the exclusion of significant groups of the population. The research is based on a multiple case study in which the application of MAS was analysed over a 25-year period of security policies in Belgium (1985–2010). The Act’s implementation was studied in the two Belgian cities of Antwerp and Liège in order to consider the influence of the Flemish government and the Walloon government, respectively, in this policy area. The article uses insights from this comparison to revisit the culture of control thesis and its limitations in understanding the political competition that exists over the formulation of policies on antisocial behaviour.     

The toxicological challenges in the European research project DRUID

Within the epidemiological studies of the integrated European research project DRUID (Driving Under the Influence of Drugs, alcohol and medicines), 13 laboratories from across Europe will analyse whole blood, oral fluid (OF) or urine from the general driving population and injured drivers. To ensure the comparability of toxicological results from the different studies, the collection of samples, analytical methods, target analytes and analytical cut-offs have been standardized for all laboratories involved.Target analytes were selected based on suspected impairing effects and prevalence. Twenty-three drugs are included in the ‘core list’ for which analysis is mandatory: ethanol, amphetamine, MDMA, MDA, MDEA, methamphetamine, cocaine, benzoylecgonine, THC, THC-COOH, 6-acetylmorphine, diazepam, flunitrazepam, alprazolam, clonazepam, oxazepam, nordiazepam, zolpidem, zopiclone, lorazepam, morphine, codeine and methadone. Additionally, 28 other drugs will be analysed in 1–12 countries.All whole blood samples are collected in glass Vacutainer-type tubes containing sodium fluoride and potassium oxalate. Based on a comparative study of 10 collection devices, it was decided to collect oral fluid using the Statsure™ device. Since only a small sample volume is available (5–10 mL blood and 1 mL oral fluid), all laboratories have to develop methods for simultaneous detection of the target analytes. All laboratories agreed to use either LC–MS–MS or GC–MS in SIM-mode. Proficiency testing for both blood and oral fluid are organized.Analytical cut-offs were established for the core list based on those used in ROSITA-2, SAMHSA cut-off values for oral fluid and recommendations from an expert meeting in Talloires.Because of practical and legal considerations, different sample types are used: whole blood, serum/plasma and oral fluid. Literature on correlation between analyte concentrations in these body fluids is limited, which makes several comparisons of study results difficult: (1) comparison of epidemiological (blood, oral fluid and urine) and experimental studies (serum and plasma) performed in DRUID and (2) comparisons within the epidemiological studies themselves (most countries: oral fluid in road-side survey, blood in hospital studies).A combination of literature findings, new findings from DRUID and semi-quantitative results will likely have to be used to solve these problems.     

Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as “caput medusae.” Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.     

3D forensic facial approximation: Implementation protocol in a forensic activity

The primary objective of this paper is to report on the successful implementation of forensic facial approximation in a real case in the forensic context. A three‐dimensional (3D) facial approximation protocol of the skull was performed with free software, applying techniques in a virtual environment that have already been consolidated in the literature. The skull was scanned with the photogrammetry technique, the digital replica was imported in the Blender software (Blender Foundation, Amsterdam) and individualized model sketches of the face were traced with the MakeHuman software (MakeHuman Org) according to the anthropological profile of the victim. The face created was imported in Blender, where it was adapted, modeled, and sculpted on the 3D skull and its soft tissue markers, using an American open‐source application of the technique in the digital environment. The face created in a virtual environment was recognized and legal identification procedures were started, resulting in the more agile delivery of the disappeared body to its next of kin. It is therefore concluded that facial approximation may not be a primary method of human identification, but it can be satisfactorily applied in the forensic field as an individual recognition resource. It has great value in narrowing the search, reducing the number of alleged victims, and leading to identification tests, therefore significantly reducing the number of genetic DNA (deoxyribonucleic acid) tests—which are considered costly for the State or Federation—and consequently reducing the waiting time before delivery of the body to its family.     

Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy

Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54‐year‐old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.     

Intentional overdose of glargine insulin: Determination of the parent compound in postmortem blood by LC-HRMS

Insulin glargine is a long-acting insulin analog that is converted after enzymatic cleavage of the arginine pair of the β-chain into its main metabolite M1 (21^A-Gly-insulin), which is responsible for the hypoglycemic activity. In all the overdose cases described in the literature, only M1 concentrations have been reported, whereas insulin glargine was always absent or below the limit of quantitation. In this study, we present a case of suicide of a young nurse by injection of insulin glargine in which the parent molecule was found at a toxic concentration in blood. The determination and the discrimination of insulin glargine from human insulin and other synthetic analogs in the blood specimen were performed by liquid chromatography coupled to high-resolution mass spectrometry (Waters XEVO G2-XS QToF) and extraction after precipitation in the presence of bovine insulin (internal standard), with a mixture of acetonitrile/methanol +1% formic acid followed by purification on solid phase extraction cartridges C18. Glargine insulin tested highly positive in the blood with a concentration of 1.06 mg/L. Due to the difficulty in obtaining a M1 pure standard, the metabolite could not be dosed. This unique presence of the parent molecule, reported for the first time, can be explained by inter-individual variability in the rate of conversion to metabolite. Intravenous injection versus subcutaneous injection can also explain the presence of insulin glargine. Finally, the dose injected may have been so high that saturation of the proteolytic enzymes responsible for conversion to M1 should have occurred.     

Radiodense bullet wipe around osseous entrance gunshot wounds

“Bullet wipe” is the material deposited by a bullet on any surface with which it comes into contact after it is fired and may contain debris from the gun barrel, including particles of primer and metal fragments from previously fired bullets. X‐ray analysis is a non‐destructive method by which traces of metallic elements can be visually detected. The analysis of osseous defects for radiodense bullet wipe (RBW) assists in determining the presence or absence of perforating gunshot wounds, especially in fragmented, skeletonized remains. The aim of our current study was to determine the frequency of RBW around entrance firearms injuries that perforated bone. We prospectively analyzed entrance gunshot wounds for RBW over a three‐year period using digital X‐ray analysis (n = 59). We retrospectively reviewed the corresponding autopsy reports to determine the frequency of RBW by biologic sex, reported ancestry, age‐at‐death, location of wound, manner of death, range of fire, bullet caliber, and presence of bullet jacket. Data were analyzed by Fisher's exact test or Chi‐square test with significance levels accepted at p < 0.05. RBW was present in 66% (n = 39) of examined cases. Decedent characteristics did not significantly alter RBW distribution, including biologic sex (p = 0.75), reported ancestry (p = 0.49), and age‐at‐death (p = 0.43). Additionally, the location of the osseous entrance gunshot wound, manner of death, range of fire, and cartridge caliber did not affect RBW detection. All cases involving non‐jacketed rounds (n = 5) showed RBW (p = 0.30). To our knowledge, this study is the first to report the frequency of RBW detection from osseous entrance gunshot wounds.     

Forensic veterinary radiology: ballistic-radiological 3D computertomographic reconstruction of an illegal lynx shooting in Switzerland

The most popular handgun in Brazil is the single round-barrel caliber 0.38 revolver. In recent years, however, owing to the modernization of police arms and their availability on the legal and illicit markets, pistols have become increasingly popular and currently represent about 20% of police seizures. In a previous paper we presented a novel collection method for gunshot residues (GSR) using a sampling procedure based on ethylenediamine-tetraacetic acid (EDTA) solution as a complexing agent on moistened swabs with subsequent detection using sector field-high resolution-inductively coupled plasma-mass spectrometry (SF-HR-ICP-MS). In the present paper, we discuss the capability of this methodology to identify antimony (Sb), barium (Ba) and lead (Pb) on the hands of volunteers after shot tests with 9 mm and 0.40 in. caliber pistols. Two types of munitions were tested: 9 mm Taurus and clean range. The use of a technique with high sensitivity, such as SF-HR-ICP-MS, permits the identification of low concentrations (less than 1 microg/L) of metals in firearm residue and constitutes a powerful tool in forensic science. We also discuss the importance of the sampling procedure, including collection from a different body part than the gun hand of the suspect. Comparison of the analytical data obtained allows clear discrimination between samples from the hands of shooters and non-shooters.