Acute Benztropine Intoxication and Fatality

A woman was found unresponsive with an empty bottle of Cogentin^® prescribed to another. Admitted to an area hospital, her condition steadily declined until death 29 h after admission. Following toxicological screening on hospital (admission) whole blood, the only significant compound detected was benztropine. Benztropine was confirmed at 0.28 mg/L – the highest antemortem blood concentration recorded in a case of toxicity or fatality uniquely associated with benztropine. A second serum antemortem specimen showed a benztropine concentration of 0.19 mg/L. Despite over 24 h in the hospital, benztropine was also found in the postmortem specimens collected at autopsy. Peripheral blood, central blood, liver, and gastric concentrations were 0.47 mg/L, 0.36 mg/L, 9.6 mg/kg, and 44 mg, respectively. These results indicate that benztropine exhibited a potential difference between whole‐blood and serum (plasma) concentrations. Additionally, in consideration of literature data, benztropine was found indicative of a compound prone to at least some postmortem redistribution.     

Fatal Oral Methylphenidate Intoxication with Postmortem Concentrations

Methylphenidate (MPD) is a widely prescribed stimulant used primarily for the treatment for attention‐deficit/hyperactivity disorder (ADHD). Suicide attempts involving MPD ingestion have been well described; however, deaths attributed solely to MPD ingestion have not been reported. A 62‐year‐old woman was found dead on her floor. The only discrepancy in among her medication quantities was that >three hundred 10 mg MPD tablets were missing. Analysis utilizing gas chromatography–mass spectrometry revealed elevated postmortem MPD peripheral and central blood, liver and vitreous humor concentrations. Considering both the central blood to peripheral blood ratio (0.89) and the liver to peripheral blood ratio (3.3), MPD does not appear subject to significant postmortem redistribution. With no other identifiable cause of death, we report what appears to be the first isolated MPD ingestion associated with a fatality.     

Forensic implications of biting behavior: a conceptually underdeveloped area of investigation

Within the context of a criminal investigation the human bitemark traditionally provides the forensic dentist with both physical and biological evidence. In recent years, however, examples exist where in addition to discussing physical and biological evidence, expert witnesses have also testified in court regarding the behavioral aspects of biting behavior. Interested in this additional source of evidence, the authors reviewed the research literature from which biting behavior could be explained. The review found a hiatus of empirical knowledge in this respect, with only two papers seemingly related to the topic. With this dearth of knowledge in mind, the authors present a framework for further analysis and tentatively suggest reasons for biting behaviors, using a range of psychological models. The article ends with a cautionary note that vague and often misleading behavioral assumptions must not be applied to bitemark testimony until further data are available.     

A comparative reliability analysis of computer-generated bitemark overlays

This study compared the reliability of two methods used to produce computer-generated bitemark overlays with Adobe Photoshop (Adobe Systems Inc., San Jose, CA). Scanned images of twelve dental casts were sent to 30 examiners with different experience levels. Examiners were instructed to produce an overlay for each cast image based on the instructions provided for the two techniques. Measurements of the area and the x-y coordinate position of the biting edges of the anterior teeth were obtained using Scion Image software program (Scion Corporation, Frederick, MD) for each overlay. The inter- and intra-reliability assessment of the measurements was performed using an analysis of variance and calculation of reliability coefficients. The assessment of the area measurements showed significant variances seen in the examiner variable for both techniques resulting in low reliability coefficients. Conversely, the results for the positional measurements showed no significant differences in the variances between examiners with exceptionally high reliability coefficients. It was concluded that both techniques were reliable methods to produce bitemark overlays in assessing tooth position.