Insight into stress-induced cardiomyopathy and sudden cardiac death due to stress. A forensic cardio-pathologist point of view

Emotional, physiological and physical stress is associated with increased rates of cerebrovascular events and sudden deaths. The pathophysiology of stress-induced cardiomyopathy is not well understood. Proposed mechanisms for catecholamine-mediated stunning in stress cardiomyopathy include epicardial vasospasm, microvascular dysfunction, hyperdynamic contractility with midventricular or outflow tract obstruction, and direct effects of catecholamines on cardiomyocytes. Studies show evidence of significant heritable influences on individual responses to adrenergic stimulation. Data from such studies may be of help for a more accurate comprehension of clinical and morphological alterations of the heart. Irrespective of the cause, patients with the classic stress-induced cardiomyopathy morphology deserve special attention because this extensive distribution of wall motion abnormalities has implications for potential associated complications. Cardiac response may be significantly coupled to genetic differences at candidate loci that encode components of catecholamine biosynthesis, storage, and metabolic pathway. Given the role of the sympathetic nervous system in responses to acute stress, it is reasonable to explore whether genetically determined alterations in catecholamine system functions contribute to acute and chronic cardiovascular disorders such as stress-induced cardiomyopathy.     

Death Caused by Toxic Epidermal Necrolysis (Lyell Syndrome)

Abstract: Toxic epidermal necrolysis (TEN) is characterized by fever, scalded appearance of the skin, and epidermolysis associated to blister formation and exfoliation, and it is caused by hypersensitivity reaction to a drug. The authors report two cases of death as a result of TEN; both referred to old aged women treated with a polytherapy including allopurinol. Both patients displayed erythematous skin lesions similar to scald burns and epidermolysis at the face, chest, and abdomen and died shortly after hospitalization. Autopsy findings and histological examinations revealed epidermal necrolysis and confirmed the clinical diagnosis. A strict time‐correlation between allopurinol administration and symptoms was evidenced. Because of its iatrogenic origin, TEN often arises suspicions of medical liability; however, because of its unpredictable nature, the occurrence of this syndrome cannot be ascribed to the medical staff whose main task is the rapid diagnosis and the correct management.     

Preventing Suicide in Jails and Prisons: Suggestions from Experience with Psychiatric Inpatients

Abstract:  Both among psychiatric inpatients and inmates of prisons and jails, suicide is highly prevalent with alarming rates. In many countries, there has been a call for action to prevent such deaths and to educate staff in the early recognition of suicide risk. A careful MedLine search was used to identify relevant papers dealing with suicide prevention in psychiatric inpatients. This paper reviews this research and the policy recommendations that have been developed for psychiatric hospitals in order to reduce the incidence of suicide in their patients. Results derived from this search indicated that these policy recommendations can be applied to suicide prevention in correctional settings, and it is argued that suicide prevention programs in correctional settings can benefit from the research conducted and the policy recommendations for suicide prevention in psychiatric facilities. In conclusion, the best practices for preventing suicides in jail and prison settings should include the following elements: training programs, screening procedures, communication between staff, documentation, internal resources, and debriefing after a suicide.     

Age Estimation of Infants Through Metric Analysis of Developing Anterior Deciduous Teeth

This study provides regression equations for estimation of age of infants from the dimensions of their developing deciduous teeth. The sample comprises 97 individuals of known sex and age (62 boys, 35 girls), aged between 2 days and 1,081 days. The age‐estimation equations were obtained for the sexes combined, as well as for each sex separately, thus including “sex” as an independent variable. The values of the correlations and determination coefficients obtained for each regression equation indicate good fits for most of the equations obtained. The “sex” factor was statistically significant when included as an independent variable in seven of the regression equations. However, the “sex” factor provided an advantage for age estimation in only three of the equations, compared to those that did not include “sex” as a factor. These data suggest that the ages of infants can be accurately estimated from measurements of their developing deciduous teeth.     

Selling stolen goods on the online markets: an explorative study

Historically, criminologists studied theft from different perspectives, but only a few focused their attention on the reselling of stolen items. The advent of the Internet has boosted stolen good markets by facilitating interactions between vendors (thieves and receivers) and buyers. This study, based on 227 cases reported by news sites in 2015 and 2016, focuses on the markets and methods used to sell stolen goods online. The results suggest that the online selling methods are quite independent from existing offline methods. The findings innovate with respect to the typology provided by Sutton. The online markets for stolen goods are rather a new environment where perpetrators may choose among several methods of disposal. The results reflect a preference for resale through classified ads sites (44.24%), auction sale sites (28.11%) and social media (19.35%). In the light of this study, more research is needed to understand online stolen goods markets and their mechanisms.     

The Duty to Bring Terrorists to Justice and Discretionary Prosecution

In Res. 1373 (2001), the Security Council laid down the dutyto bring terrorists to justice and to deny them safe haven.Whereas such duty expressed a clear political imperative inthe aftermath of 11 September 2001, it is less clear how nationalauthorities are supposed to translate it into a set of enforceablelegal obligations. If it is interpreted as ‘obliging’states to prosecute and try terrorists, as the Security CouncilCounter Terrorism Committee seems to suggest, the power of prosecutorsto decide whether or not to bring a case to court may be severelyimpaired. An unconditional obligation to bring terrorists tocourt would not necessarily strengthen states’ judicialresponse to the threat of international terrorism. A sensibleexercise of prosecutorial discretion may be instrumental inarticulating a flexible and more effective response in variouscircumstances. Moreover, a rigid interpretation of the requirementto bring terrorists to justice does not find support in SecurityCouncil and General Assembly resolutions on terrorism. Far frommandating that alleged offenders be unconditionally broughtto trial, the universal counter-terrorism conventions and protocolslimit themselves to requiring that the jurisdiction of nationalcourts be established, which is conceptually different fromimposing its actual exercise.     

Dental amalgam and mercury levels in autopsy tissues: food for thought

Eighteen cadavers from routine autopsy casework were subject to a study of tissue levels of total mercury in brain, thyroid, and kidney samples by atomic absorption. On these same cadavers, all dental amalgam fillings (the most important source of inorganic mercury exposure in the general population, according to the World Health Organization (WHO) were charted. Total mercury levels were significantly higher in subjects with a greater number of occlusal amalgam surfaces (>12) compared with those with fewer occlusal amalgams (0-3) in all types of tissue (all P < or = 0.04). Mercury levels were significantly higher in brain tissues compared with thyroid and kidney tissues in subjects with more than 12 occlusal amalgam fillings (all P < or = 0.01) but not in subjects with 3 or less occlusal amalgams (all P > or = 0.07).