Postmortem atropine concentrations in resuscitation cases

The medications used during resuscitation are often in and of themselves toxic. Several reports have been published regarding toxicities of these drugs, including lidocaine, procainamide, and atropine. But how does a forensic pathologist or toxicologist differentiate a possible intoxication from therapeutic or resuscitory use especially given that the concentrations of such drugs, when used in the setting of resuscitation, have not been studied? Concentrations of a well-known resuscitation medication, atropine, were assessed in cases where it was administered before death during attempted resuscitation in an effort to address this deficiency. A review of deaths occurring in 2009 was undertaken to identify cases where drugs known to be used during resuscitation were present on toxicological analysis. Autopsy reports and medical records were examined to determine how much atropine was administered, the timing and route of administration, the time the sample was drawn (antemortem and postmortem), the source of the sample, and the ultimate cause of death. Eighty-nine cases were identified in which atropine was given before death during attempted resuscitation and was detected in the blood on postmortem toxicological screening; 11 cases were identified in which atropine was administered before death yet was not detected on the postmortem toxicological screening. Mean age was 41 years, and there were 65 males and 35 females. The overall median dose of atropine given was 3 mg, the median difference between the time of last administration of the atropine to the time of death (or draw for antemortem samples) was 15 minutes, and the median atropine concentration was 0.1 mg/L. Analysis failed to reveal significant differences in the atropine concentration based on the route of administration (intravenous or intraosseus), the cause of death, or the time since administration (within the first 2 hours). Analysis did reveal a difference between the atropine concentrations in peripheral versus central blood sources and with prolonged postmortem interval (>24 hours) suggesting postmortem redistribution.     

Fatal cocaine interactions: a review of cocaine-related deaths in Bexar County, Texas

Although cocaine is a widely abused illicit substance that is known to cause death, deaths due to its use appear to occur in a minority of those who use it. This report was designed to review drug-related deaths due to cocaine, and the concomitant use of other drugs/medications. A retrospective review of drug deaths at the Bexar County Medical Examiner's Office in San Antonio, Texas, was undertaken for cases where cocaine was one of the drugs implicated in causing death. Analysis was performed comparing the concentrations of cocaine and benzoylecgonine present and the absence or presence of other drugs. The data obtained showed that cocaine was toxic over a large range with deaths occurring at concentrations ranging from 0.01 to 78 mg/L. Analyses also indicated an increased lethality when cocaine is used in combination with ethanol, heroin, opiates, and antidepressant/antipsychotic medications, which is consistent with previous reports and research. Antihistamine data showed that there may be relationship between increased toxicity and co-ingestion, although more research is necessary.     

Radical Change at the Ballot Box: Causes and Consequences of Electoral Behavior in Venezuela's 2000 Elections

This study aims to explain the victory of Hugo Chávez and his party in the 2000 Venezuelan elections, to analyze the factors that made this victory possible, and to examine the consequences for future developments in the Venezuelan political system. The decay of traditional party loyalties without the emergence of new parties deeply rooted in society (dealignment without realignment); underdevelopment; and an institutional setting dominated by a president elected by a plurality electoral system have opened the door to personality-centered politics and weak parties, which are the main features of the current political situation. Compared to the 1993 and 1998 elections, the 2000 elections once again confirm an increase in personality politics and the decay of parties as instruments for articulating interests, representation, and governance. As a consequence, this article argues, instability is likely to remain a feature of Venezuela's party system for some time.     

Avoidable causes of death and their effects on life expectancy. A socio-demographic interpretation. The case of the northern frontier, 1980-1990

"This study forms part of [a] research project on the health-disease-death process along the [Mexican] Northern Frontier--a by-product of the socio-economic structure of a specific social formation that determines disease and death--to support regional and sectorial design of policies and actions for the improvement of health conditions for its population.... An important finding is a 4.1 year increase of life expectancy due, among other causes, to a slight decrease in avoidable death causes, although these still produce about 50% of deaths." (SUMMARY IN ENG)     

A novel approach for fingerprinting mummified hands

Abstract:  Fingerprinting has long been used as a method for identifying bodies and, since first discovered, many advances have been made in both fingerprint acquisition and interpretation. However, in the field of forensic pathology, the attainment of fingerprints from mummified bodies has remained difficult. The most common technique historically used to obtain fingerprints in these cases usually employs the amputation of the fingers combined with soaking and/or injecting the fingers with various solutions in order to enhance the fingerprints. A novel approach to fingerprinting mummified fingers is presented which involves removal and rehydration of the fingerpads (including the epidermal, dermal, and adipose tissues) followed by inking and rolling, using a gloved finger for support. The technique presented produces a superior quality of print without amputation of the finger, yielding excellent results and assisting in obtaining positive identification.     

A Characterization of Sources of Isopropanol Detected on Postmortem Toxicologic Analysis

Abstract: Isopropanol is an important chemical to forensic pathologists in that intoxication can result in death yet presence does not necessarily indicate intoxication. Several reports have been published, which indicate that isopropanol can be created endogenously in certain situations including diabetes mellitus, starvation, dehydration, and chronic ethanol use; however, a large‐scale analysis addressing all of the possible causes of postmortem isopropanol detection has not been performed. A retrospective review of all cases examined at the Bexar County Medical Examiner’s Office between 1993 and 2008 in which isopropanol was detected in routine alcohol screening was undertaken. The cases were categorized by the source of the isopropanol, and the concentrations of isopropanol and acetone were analyzed. Analysis revealed isopropanol concentrations to be low (<100 mg/dL) in cases of antemortem and postmortem creation and in postmortem contamination and high (>100 mg/dL) in cases of antemortem exposure. These results are consistent with other published reports.     

Testing an Age-old Adage: Can Autopsy Findings be of Assistance in Differentiating Opioid Versus Cardiac Deaths?

Given the common occurrence of both opioid and cardiovascular deaths, and the concomitant use of opioids in those with cardiac disease, the present study was undertaken to see whether the old adage of using the triad of cerebral and pulmonary edema and bladder fullness to suggest an opioid death could be used to differentiate deaths due to opioid toxicity from deaths due to cardiac disease. Brain weight, lung weight, and bladder fullness were compared among opioid-related deaths, cardiac deaths, and a control population. It was found that opioid-related deaths were more likely to have heavy lungs, a heavy brain, and a full bladder, while cardiac-related deaths had smaller volumes of urine in the bladder and heavier hearts. In conjunction with a thorough investigation, these findings may be useful to forensic pathologists when determining whether a death is opioid-related, especially in the setting of concomitant cardiac disease.     

Promises,Rights, and Deontic Control

Law and Philosophy - This article argues that the notion of a promissory right captures a central feature of the morality of promising which cannot be explained by the notion of promissory...     

Increasing the Human Capital of Children in Latin American Countries: The Role of Parents’ Time in Childcare

In this paper, we focus on the relationship between parents’ education and activities aimed at increasing the human capital of children (for example, educational childcare). Using time use surveys from Mexico, Peru, Ecuador, and Colombia we find that in Mexico, Peru, and Colombia the level of education of both father and mother has a positive association with the time devoted to educational childcare, while in Ecuador only fathers’ level of education has a positive association with father’s time devoted to educational childcare. Furthermore, we find that the time devoted to educational childcare by parents is positively related in all four countries.