Fatal Fentanyl Patch Misuse in a Hospitalized Patient with a Postmortem Increase in Fentanyl Blood Concentration

Opioid‐related mortality happens, even in healthcare settings. We describe serial postmortem fentanyl blood concentrations in a hospital inpatient who fatally abused transdermal fentanyl. This is a single‐patient case report. A 42‐year‐old man with lymphoma was started on transdermal fentanyl therapy while hospitalized for chronic abdominal pain. The patient was last seen awake 1.3 h prior to being found apneic and cyanotic. During the resuscitation attempt, a small square‐shaped film was removed from the patient's oropharynx. Femoral blood was collected 0.5 and 2 h postmortem, and the measured fentanyl concentration increased from 1.6 to 14 ng/mL. Study limitations include potential laboratory or collection errors and missing data. (i) Providers must be vigilant for signs of fentanyl patch abuse. (ii) Postmortem blood concentrations are not static postmortem, likely secondary to decreasing pH, increased aqueous solubility, and tissue redistribution, and are therefore unlikely to accurately represent antemortem blood concentrations.     

TESTING FOR TEMPORALLY DIFFERENTIATED RELATIONSHIPS AMONG POTENTIALLY CRIMINOGENIC PLACES AND CENSUS BLOCK STREET ROBBERY COUNTS

This study examined street robbery patterns in Philadelphia, Pennsylvania, from the years 2009 to 2011 to determine whether the effects of potentially criminogenic places are different across different periods of the day. Census block (N = 13,164) street robbery counts across four periods (6:45 a.m . to 9:59 a.m., 10:00 a.m . to 4:29 p.m ., 4:30 p.m . to 9:14 p.m ., and 9:15 p.m. to 6:44 a.m. ) were modeled with 12 different potentially criminogenic places, 3 measures of illicit markets, 4 compositional control variables, and spatially lagged versions of the 12 potentially criminogenic places and population using simultaneously estimated negative binomial regression models. Differences in the magnitudes of the parameter estimates across the time periods were assessed with Wald tests. Overall, the patterns across the four models were mostly consistent with the effects hypothesized based on the study's crime pattern theory and time‐geography theoretical frame; yet differences in the magnitudes of the coefficients were less pronounced than hypothesized. Overall, the results provide moderate support for the crime pattern theory and time‐geography explanation of spatial‐temporal robbery patterns; however, numerous points are raised for future crime and place research.     

Comparing Electronic News Media Reports of Potential Bioterrorism-Related Incidents Involving Unknown White Powder to Reports Received by the United States Centers for Disease Control and Prevention and the Federal Bureau of Investigation: U.S.A., 2009–2011

There have been periodic electronic news media reports of potential bioterrorism-related incidents involving unknown substances (often referred to as “white powder”) since the 2001 intentional dissemination of Bacillus anthracis through the U.S. Postal System. This study reviewed the number of unknown “white powder” incidents reported online by the electronic news media and compared them with unknown “white powder” incidents reported to the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Federal Bureau of Investigation (FBI) during a 2-year period from June 1, 2009 and May 31, 2011. Results identified 297 electronic news media reports, 538 CDC reports, and 384 FBI reports of unknown “white powder.” This study showed different unknown “white powder” incidents captured by each of the three sources. However, the authors could not determine the public health implications of this discordance.     

Differences in Handwritings of Schizophrenia Patients and Examination of the Change after Treatment

The aim of this study was to analyze the differences between the handwritings of schizophrenia patients and healthy subjects in addition to the changes that occurred in schizophrenia patients' handwriting in response to the treatment. The test subjects were 29 schizophrenia patients and 29 healthy individuals with the same age, gender, and dominant hand. The changes in the handwritings were examined according to 14 different parameters. On the day of admittance, the percentage of extra letters was 16.7%, and after 7–10 days of hospitalization, it rose to 33.3%. The percentage of skipped words decreased from 29.2% to 16.7% after 7–10 days of hospitalization, and to 10% after 3 weeks. The letters written by schizophrenia patients are significantly larger in height and width compared to the control group. The schizophrenia patients showed a higher incidence of crossed-out letters, adding extra words, missing punctuation as well as missing words.     

Ancestry and BMI Influences on Facial Soft Tissue Depths for A Cohort of Chinese and Caucasoid Women in Dunedin,New Zealand

This study measured and assessed facial soft tissue depths (FSTDs) in adult female Chinese and New Zealand (NZ) Europeans (Caucasoids). Ultrasound was used to obtain depths at nine landmarks on 108 healthy subjects (51 Chinese, 57 NZ European), erect positioned, of same age group (18–29 years). Height and weight were also recorded. Statistical analysis focused on comparison of tissue depth between the two ancestry groups and the influence of Body Mass Index (BMI) (kg/m²). Results showed mean depth differences at Supra M2 and Infra M2 landmarks significantly greater for Chinese than Caucasoid women for all three BMI Classes (BMI <20, 20 ≤ BMI < 25, 25 ≤ BMI < 30), even BMI <20. For both groups BMI positively correlated with FSTD values at all landmarks except Labrale superius. This study enabled ancestry and BMI influence on FSTDs to be observed and compared for two distinct groups. Results add to knowledge about facial tissue depth variation.     

Evaluation of a method for simultaneous quantification of codeine, ethylmorphine and morphine in blood.

Codeine, ethylmorphine and morphine are the most commonly detected opiates in forensic blood samples in Norway. A method for the simultaneous quantification of these opiates utilizing solid phase extraction and gas chromatography-mass spectrometry has been evaluated. The detection limits were 0.026 mumol/l for codeine, 0.025 mumol/l for ethylmorphine and 0.032 mumol/l for morphine (corresponding to 7.8, 7.8 and 9.1 micrograms/l, respectively). The analytical variations at concentrations of 1.0 mumol/l codeine, 1.0 mumol/l ethylmorphine and 0.5 mumol/l morphine were less than 5%.     

Diffuse gastropathy and gastritis--a main or secondary finding concerning the cause of death?

On the basis of the autopsy results in three cases, extensive pathomorphological changes were demonstrated in the stomach, such as Ménétrier's disease and diffuse superficial gastritis. For these cases of sudden death, no cause could be found that could be verified by morphological or toxicological means. Analogous to clinical experience on the protein deficiency syndrome and food allergies and based on the knowledge that the intestinal tract also represents an immune organ, as well as the finding of diffuse changes in the gastric mucosa ideas have been developed regarding hypersensitive immunological reactions which might have not only local but also systemic effects comparable with anaphylactic reactions of different origins. Diffuse gastropathy or gastritis should not simply be assessed as a secondary finding. If other explanations are lacking and there are indications of intensive cellular immune reactions, the possibility arises of reconstructing lethal pathophysiological mechanisms.