Possible Fatal Acetaminophen Intoxication with Atypical Clinical Presentation

Acetaminophen or paracetamol, a commonly used over‐the‐counter analgesic, is known to elicit severe adverse reactions when taken in overdose, chronically at therapeutic dosage or, sporadically, following single assumptions of a therapeutic dose. Damage patterns including liver damage and, rarely, acute tubular necrosis or a fixed drug exanthema. We present a case of fatal acetaminophen toxicity with postmortem blood concentration 78 μg/mL and unusual clinical features, including a visually striking and massive epidermolysis and rhabdomyolysis, disseminated intravascular coagulation and myocardial ischemia. This case is compared with the most similar previous reports in terms of organ damage, clinical presentation, and cause of death. We conclude that a number of severe patterns of adverse effects to acetaminophen are emerging that were previously greatly underestimated, thus questioning the adequacy of the clinical spectrum traditionally associated with acetaminophen intoxication and leading to the need to review this spectrum and the associated diagnostic criteria.     

Reconciling questions about dichotomizing variables in criminal justice research

Purpose

Despite accumulating evidence against the practice of artificial dichotomization, its continued use among criminal justice researchers indicates that there are still unresolved questions about its appropriateness. Farrington and Loeber (2000) provided a discussion of how these issues impact research on delinquency, and many researchers have cited their article as a justification for dichotomization within the field of criminal justice. In the current study, we examine the reasons why researchers have cited Farrington and Loeber as a mechanism for answering some unresolved questions about whether and when dichotomization may be justified.

Methods

We used a forward citation search in PsycInfo to locate all articles citing Farrington and Loeber (2000) in support of dichotomization.

Results

This search identified 126 articles which provided a total of 191 reasons supporting dichotomization. We explore these reasons, discussing whether they are consistent with evidence from simulation-based analyses and whether they are supported by existing statistical and methodological theory.

Conclusions

Despite the large number of reasons for dichotomization provided by authors, we found very few that had empirical or theoretical support.     

Book Reviews

This article argues that a major factor in terrorist acts is an appeal to the actor's own community at an emotional and symbolic level, through acts of sacrifice, particularly self-sacrifice. Although other aims also exist, a prime concern is to recall the actor's home audience to the struggle, because the actor regards himself as acting on their behalf. This utilizes the imagery and symbolism of traditional religion, implying a strong communal and non-material impetus to terrorist acts, rather than rational material calculation, that modern Western man finds difficult to comprehend. It also recalls much classical social theory, which emphasized the central role of religion in community. Self-sacrifice tells an emotional story to the actor's community that is comprehensible to them and will have an emotional appeal to maintaining the community. For the Northern Ireland hunger strikes (possibly analogous to suicide bombers) this is reflected in their appeal solely to a Catholic/nationalist community that equates strongly with ideas of a pre-modern society under threat from a modernizing society. All the hunger strikers were very normal for their community, but left non-Catholics completely unmoved. Consequently there is a need to understand the communal dynamics behind terrorism if one is to effectively counter the threat and that different societies may have different values regarding the individual, community, and life itself. Individual motivations do not provide an adequate explanation for much terrorism and it is a failure to grasp this that severely hinders much counterterrorism.     

Subarachnoid hemorrhage during sexual activity after sildenafil intake: an accidental association?

We report and describe an autopsy case of a man dead for rupture of cerebral artery aneurysm with subsequent subarachnoid hemorrhage after sexual intercourse. Toxicologic analysis demonstrated that he had consumed sildenafil (Viagra). Although subarachnoid hemorrhage has been reported to be associated with sexual intercourse, it is not among the known adverse effects of sildenafil. However, sildenafil has been found to interact with vascular physiology via multiple mechanisms and in most of the vascular districts of the human body. This case provides an example of a very rare association between this drug and a fatal pathologic event and deserves to be added to the existing clinical knowledge about sildenafil and the pathophysiology of the events involved. This knowledge may be helpful in orienting further investigation into the mechanisms of action of sildenafil and their clinical implications.     

Nanotechnology for forensic sciences: Analysis of PDMS replica of the case head of spent cartridges by optical microscopy, SEM and AFM for the ballistic identification of individual characteristic features of firearms

A novel application of replica molding to a forensic problem, viz. the accurate reproduction of the case head of gun and rifle cartridges, prior and after been shot, is presented. The fabrication of an arbitrary number of identical copies of the region hit by the firing pin and by the breech face is described. The replicas can be (i) handled without damaging the original evidence, (ii) distributed to different law enforcement agencies for comparison against other evidences found on crime scenes or ballistic tests of seized firearms, (iii) maintained on a file by the laboratories. A detailed analysis of the morphological features of the replicas has been carried out by standard microscopy techniques as well as by advanced microscopy such as scanning probe and scanning electron leading to a quantitative morphological characterization of the case heads down to the nanometer scale. The assignment of the cartridge replicas to the shooting weapon is demonstrated to hold below the micron scale, while it is hindered at the nanometer level both by the manufacturing differences and by eventual modifications occurring on the firing pin.     

Determination of carbohydrate deficient transferrin (CDT) with capillary electrophoresis: an inter laboratory comparison

Carbohydrate deficient transferrin (CDT) is currently the most specific laboratory marker of chronic or sustained alcohol abuse. CDT is increasingly being used as a diagnostic tool in the areas employment, traffic safety and forensic medicine. In recent times, capillary electrophoresis (CE) has been proposed as a convenient tool for rapid, precise and accurate CDT determination, not only for research but also for routine analyses. Quite recently, commercial kits have been introduced which, reportedly, could simplify and standardize CDT analysis with capillary electrophoresis. The present work was aimed at testing the ruggedness of a capillary electrophoretic method based on a commercial kit (CEofix, Analis), by comparing the results obtained with different instruments in different laboratories, on a panel of sera randomly collected and exchanged. The results showed, notwithstanding few outliers, excellent correlation of the results obtained in the two laboratories (R=0.974). Also high concordance was found when results were classified as positive or negative on the basis of a cut-off (1.25%) established from a control group of teetotalers. In conclusion the present data support the usefulness of capillary electrophoresis for CDT determination for clinical, forensic and administrative diagnosis of chronic alcohol abuse.