An unusual form of fatal ethanol intoxication

Forensic pathologists are very familiar with deaths due to ethanol intoxication. The overwhelming majority of these deaths are a result of the oral ingestion of ethanol. We report an unusual case of an individual who expired in his secured residence after self administration of a wine enema. Toxicology showed an ethanol concentration of 0.40 g/dL in the blood and 0.41 g/dL in the vitreous fluid. Scene investigation was of paramount importance in determining the unusual method by which the decedent absorbed the alcoholic beverage.     

A foxy intoxication

Foxy is the colloquial name for the hallucinogen 5-ethoxy-diisopropyltryptamine (5-MeO-DIPT). A non-fatality involving a 23-year-old Caucasian man who ingested a capsule containing 5-MeO-DIPT is described. He presented to the Emergency Department, not with visual nor auditory hallucinations but with sensory hallucinations, that of formication and paranoia. He was observed and given supportive care for 4 h, then discharged without any known sequelae. Blood and urine were collected for laboratory analyses. Foxy and its metabolites were identified in urine by gas chromatography-mass spectrometry. The concentrations of 5-MeO-DIPT in the serum and urine were 0.14 and 1.6 microg/mL, respectively. The drug undergoes oxidative deamination to form 5-methoxy-indole acetic acid. The urinary concentration of this metabolite was 0.17 microg/mL. Also, the urine contained three other related compounds. Two of them have been described in a previous case of 5-MeO-DIPT ingestion as 5-methoxy-isopropyltryptamine (5-MeO-IPT) and 5-methoxy-diisopropyltryptamine-N'-oxide (5-MeO-DIPT-N'-oxide). The third compound was substantially present in the urine and was tentatively identified as 5-hydroxy-diisopropyltryptamine (5-OH-DIPT). Only the parent drug, 5-MeO-DIPT was detected in the serum sample.     

Characterization of human control region sequences of the African American SWGDAM forensic mtDNA data set

The scientific working group on DNA analysis Methods (SWGDAM) mitochondrial DNA (mtDNA) population data set is used to infer the relative rarity of control region mtDNA profiles obtained from evidence samples and of profiles used for identification of missing persons. In this study, the African American haplogroup patterns in the SWGDAM data were analyzed in a phylogenetic context to determine relevant single nucleotide polymorphisms (SNPs) and to describe haplogroup distributions for Africans observed in these data sets. Over 200 SNPs (n=217) were observed in the African American data set (n=1148). These SNPs ranged from having 1-39 changes in the phylogenetic tree, with sites 152 and 16519 being the most variable. On average there were 5.8 changes for a character on the tree. The most variable sites (with 19 or more changes each) observed included 16093, 16129, 16189, 16311, 16362, 16519, 146, 150, 152, 189, and 195. These rapidly changing sites are consistent with other published analyses. Only 34 SNPs are needed to identify all clusters containing 10 or more individuals in the African American data set. The results show that the African American SWGDAM mtDNA data set contains variation consistent with that described in continental African populations. Thirteen of the 18 haplogroups previously observed in African populations were observed and include: L1a, L1b, L1c, L2a, L2b, L2c, L3b, L3d, L3e1, L3e2, L3e3, L3e4 and L3f. Haplogroup L2a is the most commonly observed cluster (18.8%) in the African American data set. The next most common haplogroups in the African American data set include the clusters L1c (11.0%), L1b (9.1%), L3e2 (9.0%) and L3b (8.1%). Approximately 8% of the haplogroups observed within African Americans were common in European Caucasians or East Asians; these were H (n=32), J (n=4), K (n=5), T (n=2), U5 (n=6), U6 (n=9 also known from North Africa), A (n=12), B (n=7), C (n=4), and M (n=16), respectively. The European Caucasian and East Asian haplogroups are expected due to admixture between individuals with recent ancestry in Western Eurasia and sub-Saharan Africa. The genetic characterization of these relevant data sets is fully consistent with other published mtDNA genetic variation. The sequence diversity observed in this data set makes it a valuable tool for forensic applications.     

Work, the Right to Work, and Durable Solutions: A Study on Sierra Leonean Refugees in The Gambia

It is rare indeed that the forced movement of people will nothave an economic dimension. Economic issues related to the movementof people have generally been viewed as beyond the scope ofthe debate on the international status and protection of refugees.Instead, ‘economics’ and ‘refugees’when heard together, or even in loose association, have evokedthe pejorative images of those who move to seek a ‘betterlife’. While recognising on the one hand the inevitabilityof economic dimensions to refugee movements, many advocatesfor refugees have traditionally taken great care in their policyand advocacy work to downplay the economic element of the complexmatrix of motivations that lead refugees and other forced migrantsto move. This paper takes a different approach. It promotesthe right to work, a social and economic right, as integralto protection and to all durable solutions. It explores itsrelevance, and indeed its significance, as a matter of law,policy and practice to the lives of refugees and those responsiblefor their protection, including their hosts. After all, ‘[d]espitethe statistical existence of unemployment in every country inthe world, work continues to be "an essential part of the humancondition"’. In addition, the paper examines the importanceof a rights-based analysis of work in understanding its relevancein the field both of international and national protection.In doing so, it explores the connections between work and theright to work and the three durable solutions. It acknowledgesthat social and economic conditions and inequities are oftenamongst the root causes of conflict which then lead to the failureof national protection and precipitate flight.     

External quality assessment of laboratory performance in analysis of toxicological cases

A mean of 44 members of the United Kingdom national external quality assessment scheme (UKNEQAS) for toxicology reported analytical findings on 10 toxicological cases circulated between December 1995 and February 2000. Material distributed usually consisted of a 5ml blood and a 20ml urine sample simulated by quantitative addition of drugs and their metabolites to material donated by volunteers and patients. The samples were accompanied by a brief outline of the circumstances surrounding the case. Laboratories were requested to report their analytical findings, list methods of analysis, and provide interpretation of their findings. The mean overall success rate for identification of drugs or their pharmacological group was 76%, failure being largely by laboratories providing an immunoassay-based screening service for a fixed range of drug groups. The latter laboratories indicated that cases would be referred to regional toxicology centres for further investigation or confirmation. The coefficient of variation of measurements was <7% for routine analytes, such as ethanol and paracetamol, but 26-44% for tricyclics and opiates. There were 3% false positive reports. The quantity and content of interpretative comment provided by the laboratories was very variable. A number provide nothing in addition to the analytical result.