Forensic issues in cases of Diogenes syndrome

Diogenes syndrome is a syndrome described in the clinical literature in elderly individuals characterized by social isolation and extreme squalor. A number of typical features are found in the forensic evaluation of these deaths as the cases usually initiate medicolegal investigations due to the circumstances and the lack of recorded medical histories. Examinations of the death scenes are often difficult as victim's houses are in a state of disrepair, with filth and clutter, and pet dogs may resent the intrusion of strangers. Bodies are often filthy, with parasitic infestations, and are often putrefied due to the social isolation of the deceased and the delay in the finding of the corpse. Bodies may be traumatized from postmortem animal depredation by rodents or pets (eg, cats, dogs), and injuries such as bruises and lacerations may be present from falls associated with terminal illnesses or alcoholism. Blood or putrefactive fluids may be spread throughout the house by pets. Treatable medical conditions are often present in advanced stages, and features of hypothermia may be found. Attending police may suspect robbery due to disarray of the house and homicide due to apparent "bleeding" around the body from purging of putrefactive fluids, injuries from falls, or postmortem animal activity and "blood stains" throughout the house from antemortem injuries and/or fluid spread by animals. Finally, the identification of the deceased may be compromised by decay and/or postmortem animal activity. Thus, in addition to having typical clinical manifestations, such individuals appear to form a distinct subset of forensic cases having characteristic death scene and autopsy features and presenting particular difficulties in postmortem evaluations.     

The incidence and characteristic features of fatal hemorrhage due to ruptured varicose veins: a 10-year autopsy study

Death due to hemorrhage from ruptured peripheral varicose veins is an uncommon event. A review of the files of Forensic Science SA (FSSA) in Adelaide, South Australia, was undertaken over a 10-year period from January 1996 to December 2005 for such cases. A total of 8 cases were found out of a total of 10,686, representing <0.01% of autopsy cases. The male to female ratio was 1:3, with an age range of 58-84 years (mean = 78 years). The victims were all located at their home addresses, where they had been alone at the time of their deaths. Scene investigations revealed considerable blood loss, with pooling around the victims' bodies, and also in other parts of the house, particularly the bathroom/toilet areas. Four ulcers were of an acute perforative type and 2 were of a chronic ulcerative type. In 2 cases, bleeding followed trauma. Toxicologic evaluation was performed in only 3 of the cases, revealing blood alcohol levels of 0.06% and 0.14% in 2 cases, respectively. A further victim had been prescribed anticoagulant drugs for an unrelated condition. Additional findings of significance were ischemic heart disease in 3 cases and deep venous thrombosis of the calf veins on the side of the fatal hemorrhage in another case (with no evidence of pulmonary thromboembolism). One victim had acute gastric erosions, suggesting that hypothermia following collapse played a role in the terminal event. Autopsy evaluation of such cases should include careful layer dissection of the area of hemorrhage to confirm the presence of the ruptured varix and to enable directed histologic sampling.     

Domestic Violence Against Women: Systematic Review of Prevalence Studies

To systematically review the worldwide evidence on the prevalence of domestic violence against women, to evaluate the quality of studies, and to account for variation in prevalence between studies, using consistent definitions and explicit, rigorous methods. Systematic review of prevalence studies on domestic violence against women. Literature searches of 6 databases were undertaken for the period 1995 to 2006. Medline, Embase, Cinahl, ASSIA, ISI, and International Bibliography of the Social Sciences were searched, supplemented by hand searching of the reference lists from studies retrieved and specialized interdisciplinary journals on violence. A total of 134 studies in English on the prevalence of domestic violence against women, including women aged 18 to 65 years, but excluding women with specific disabilities or diseases, containing primary, empirical research data, were included in the systematic review. Studies were scored on eight pre-determined criteria and stratified according to the total quality score. The majority of the sudies were conducted in North America (41%), followed by Europe (20%). 56% of studies were population-based, and 17% were carried out either in primary or community health care settings. There was considerable heterogeneity both between and within geographical locations, health care settings, and study quality The prevalence of lifetime domestic violence varies from 1.9% in Washington, US, to 70% in Hispanic Latinas in Southeast US. Only 12% scored a maximum of 8 on our quality criteria, with 27% studies scored 7, and 17% scored 6. The mean lifetime prevalence of all types of violence was found to be highest in studies conducted in psychiatric and obstetric/gynecology clinics. Results of this review emphasize that violence against women has reached epidemic proportions in many societies. Accurate measurement of the prevalence of domestic violence remains problematic and further culturally sensitive research is required to develop more effective preventive policies and programs.     

Disseminated fungal infection with renal infarction simulating homicide

Renal infarction is an uncommon finding at autopsy most often related to occlusive thromboembolism or to trauma. A 42-year-old woman is reported who presented with persistent right flank pain after an alleged assault with injury to the area 3 weeks previously. Renal infarction necessitated a right nephrectomy that was followed by multiorgan failure and death. Given the possible link between the assault and the renal pathology, a homicide investigation was initiated. Although renal infarction had been confirmed by hospital pathologists, microscopy with special staining of both kidneys and the heart after autopsy revealed multifocal areas of angioinvasion by fungi having morphologic characteristics of mucormycosis. The only other finding of significance was alcohol-related micronodular cirrhosis of the liver. Renal infarction had therefore been caused by an angioinvasive fungal infection predisposed to by immunocompromise associated with alcoholism and not by trauma-induced arterial dissection. This case demonstrates that careful histological assessment of tissues from medicolegal autopsies may occasionally identify unexpected and rare disorders that have been confused with the sequelae of inflicted injury.     

Temporal Trends in Rainwater Tank Suicides in Rijeka,Croatia—A 30‐year Study

Although drowning in rainwater tanks is a generally rare phenomenon, this method for suicide has been observed in parts of Croatia. Review of autopsy records at the University of Rijeka, Croatia, was undertaken from 1987 to 2016 to examine this phenomenon. Of 469 drowning deaths, there were 35 suicides in rainwater tanks (7.5%). Overall drowning deaths showed no temporal trends. In contrast, suicidal drownings in rain water tanks showed a marked decline over the years, with 15 cases in 1987–1991, seven in 1992–1996, six in 1997–2001, six in 2002–2006, one in 2007–2011, and none in 2012–2016. Thus, suicidal drowning cases as a percentage of overall drownings dropped from 18% to zero (p<0.001). This study reports a very unusual method of suicide that may have occurred because of the ready availability of large water reservoirs in homes. The recent fall in numbers may relate to less reliance on domestic reservoirs of water.     

Partner reciprocity,telecommunications flows and balance of trade patterns between the United States and latin America

From 1982 to 1994, the balance of trade deficit for U.S. telecommunications services increased by tenfold. The Central and South American countries contributed greatly to this increase. Our analysis identifies partner reciprocity as a core issue of the international long-distance industry. We apply an economic anthropology perspective to suggest that the antecedent conditions of cultural distance, economic nearness and relative country-risk will affect a foreign partner's reciprocity and examine U.S.- Latin American contracts over 11 years to test our respective hypotheses.