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Fentanyl Deaths in Infants and Children: A Case Series and Literature Review. 婴儿和儿童死于芬太尼：病例系列和文献综述。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000943
Katrina Monday, Brandy Shattuck, Kristie Barba, Carolyn H Revercomb
{"title":"Fentanyl Deaths in Infants and Children: A Case Series and Literature Review.","authors":"Katrina Monday, Brandy Shattuck, Kristie Barba, Carolyn H Revercomb","doi":"10.1097/PAF.0000000000000943","DOIUrl":"10.1097/PAF.0000000000000943","url":null,"abstract":"<p><strong>Abstract: </strong>Death due to fentanyl and its various analogs has resulted in an exponential rise in deaths throughout the United States, overwhelming many medical examiner offices for over a decade. Its potency and prevalence have caused fentanyl to become the most reported substance in overdose fatalities, with an accompanying increase in exposure of the most vulnerable, infants and children. This report provides information about fentanyl in the pediatric population, including case examples, proposed investigative practices, published therapeutic and lethal blood concentrations, and available resources for future cases. Nine cases of pediatric death between 2013 and 2023 due to fentanyl were reviewed. Five case summaries are presented that highlight classic features of fentanyl deaths in infants, children, and teenagers. Deaths due to fentanyl have continued to rise year after year. Infants and children, most of whom are opioid naive, are at ever increased risk for exposure to high levels of fentanyl. The legal ramifications of a positive fentanyl level in a child increase the need for caution on the part of the forensic pathologist. Understanding what can and cannot be proven by autopsy as well as what resources are available to strengthen one's justification for fentanyl being the primary cause of death is critical.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"193-197"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effect of the COVID-19 Pandemic on Suicide Trends in Pretoria, South Africa. COVID-19 大流行对南非比勒陀利亚自杀趋势的影响。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000945
Kay-Leigh Robinson, Candice Pretorius, Ryan Blumenthal, Pieter Meyer
{"title":"The Effect of the COVID-19 Pandemic on Suicide Trends in Pretoria, South Africa.","authors":"Kay-Leigh Robinson, Candice Pretorius, Ryan Blumenthal, Pieter Meyer","doi":"10.1097/PAF.0000000000000945","DOIUrl":"10.1097/PAF.0000000000000945","url":null,"abstract":"<p><strong>Abstract: </strong>Suicide is one of the worldwide leading causes of unnatural death. Pretoria is a capital city of South Africa and is the fourth most populated city in South Africa. Between 16 and 22 suicide cases are recorded daily in South Africa.Case files from the Pretoria Medico-Legal Laboratory were reviewed between 1 January 2015 to 31 December 2021, which spanned the COVID-19 pandemic. All cases of possible and probable suicides were included. One-way analysis of variance and Pearson chi 2 tests were conducted to determine statistical significance in the observed trends.A total of 1820 possible and probable suicide cases were identified. The year following the outbreak of the COVID-19 pandemic accounted for the largest number of suicides. White males were the most heavily represented population, followed by Black males. Hanging was the most common method for males, whereas poisoning via ingestion and/or overdose was more commonly used by females.Suicides in Pretoria have increased since previous studies from 9.74% and 10.2% to 13.32%. Methods used have changed among various population groups over the past two decades. This paper examined changes in suicide trends in Pretoria compared to previous studies and highlighted correlations between suicide trends and COVID-19 lockdown measures.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"202-209"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fatal Iron Tablet Aspiration: Importance of Early Diagnosis and Forensic Pathologist Awareness. 致命的铁片吸入：早期诊断和法医病理学家意识的重要性。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-03-13 DOI: 10.1097/PAF.0000000000000937
Yvonne Hojberg, Mahmuod Abdeljaber, Yvonne Milewski, Joyce deJong, Joseph A Prahlow
{"title":"Fatal Iron Tablet Aspiration: Importance of Early Diagnosis and Forensic Pathologist Awareness.","authors":"Yvonne Hojberg, Mahmuod Abdeljaber, Yvonne Milewski, Joyce deJong, Joseph A Prahlow","doi":"10.1097/PAF.0000000000000937","DOIUrl":"10.1097/PAF.0000000000000937","url":null,"abstract":"<p><strong>Abstract: </strong>Pill aspiration is a significant source of foreign body aspiration in the United States and can occur without swallowing dysfunction or illness. Consequences depend on various factors, such as the pill's chemical composition, size, and diagnostic delay. Aspiration of iron tablets poses a higher risk because of hydroxyl radical formation and subsequent caustic burns, inflammation, obstruction, and/or necrosis. We present a case of a middle-aged obese woman who died 3 weeks after aspirating an iron tablet. Autopsy revealed morbid obesity, a necrotic focus in the right middle lobe of the lung, bronchiolar granulation tissue with iron staining foreign matter, extending into an adjacent arteriole, and mural perforation of the hilar right middle lobe. Despite seeking medical attention twice, the patient was only accurately diagnosed postmortem. This case highlights the importance of accurate and timely diagnosis in preventing fatal outcomes. To enhance diagnostic accuracy and reduce morbidity and mortality associated with pill aspiration, clinicians should maintain a high level of suspicion for foreign body aspiration in patients with persistent or worsening respiratory symptoms. Furthermore, it is crucial for forensic pathologists to have a high index of suspicion about the potential for lethal pill aspiration and complications days after the acute event.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"271-273"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Accidental Gunshot Wound Fatalities Related to Dropped Firearms. 与枪支掉落有关的意外枪伤死亡事故。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-02-27 DOI: 10.1097/PAF.0000000000000927
Margaret M Smith, Joyce L deJong, Joseph A Prahlow
{"title":"Accidental Gunshot Wound Fatalities Related to Dropped Firearms.","authors":"Margaret M Smith, Joyce L deJong, Joseph A Prahlow","doi":"10.1097/PAF.0000000000000927","DOIUrl":"10.1097/PAF.0000000000000927","url":null,"abstract":"<p><strong>Abstract: </strong>A death resulting from the accidental discharge of a firearm represents a rare but oftentimes preventable tragedy. Such deaths may occur in a variety of settings. One such setting involves the discharge of a loaded firearm, which occurs when it is accidentally dropped, thrown, or falls to the ground. We report on 3 cases in which a loaded firearm discharged when it was dropped, resulting in the deaths of 3 individuals. In 2 cases, the person carrying the dropped firearm was killed, whereas in the third case, a child standing near the person who dropped the weapon was killed. We discuss the risk factors involved in these tragic incidents and present preventive strategies.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"242-247"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Role of Fingernails in Death Investigation. 指甲在死亡调查中的作用。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-05 DOI: 10.1097/PAF.0000000000000930
Ashesh Gunwantrao Wankhede
{"title":"The Role of Fingernails in Death Investigation.","authors":"Ashesh Gunwantrao Wankhede","doi":"10.1097/PAF.0000000000000930","DOIUrl":"10.1097/PAF.0000000000000930","url":null,"abstract":"<p><strong>Abstract: </strong>In forensic pathology, forensic onychology studies fingernails and toenails for medicolegal purposes. It mainly deals with DNA profiling from nails, toxicological analysis for detecting poisons, and the collection of trace evidence present under the nails. Injuries to fingernails and their interpretation for medicolegal purposes are the neglected areas of this study. We have discussed the most common types of fingernail injuries and their significance. We found that their notification has significant value in drowning cases, defense wounds on the palm, self-inflicted cuts, burns, electrocution, blunt trauma, physical assault, sexual offenses, and other issues like torture. We emphasize the examination of fingernails in the autopsy and medicolegal clinical examination for better administration of law and justice.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"215-223"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medicolegal Implications of Deaths due to Agricultural Accidents. 农业事故导致死亡的医学法律影响。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-01-18 DOI: 10.1097/PAF.0000000000000909
Ugo Da Broi, Francesco Simonit, Lorenzo Desinan, Rexson Tse, Jack Garland, Benjamin Ondruschka, Danny Mann
{"title":"Medicolegal Implications of Deaths due to Agricultural Accidents.","authors":"Ugo Da Broi, Francesco Simonit, Lorenzo Desinan, Rexson Tse, Jack Garland, Benjamin Ondruschka, Danny Mann","doi":"10.1097/PAF.0000000000000909","DOIUrl":"10.1097/PAF.0000000000000909","url":null,"abstract":"<p><strong>Abstract: </strong>Agriculture encompasses a variety of activities that carry with them a variety of different risks. The unsafe use of vehicles, machinery, and tools as well as animal husbandry, working at heights, and exposure to chemical, biological, and weather events may result in the deaths of agricultural workers. Inexperienced operators and/or their inappropriate conduct may lead to avoidable fatalities. Forensic pathologists operating with the support of agricultural engineers or other professionals must evaluate the death scene, the case background and circumstances, the autopsy findings, and the toxicological data to establish the factors and dynamics responsible for such accidents and deaths.The aim of this review is to focus on the diagnostic approach required, by means of an interdisciplinary approach, to identify the cause of some typical agricultural fatalities, to confirm that death was accidental, and to help exclude the possibility of homicide or suicide.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"224-230"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gender Identity in Forensic Death Investigation: A Narrative Review and Suggested Guidelines for Documenting and Reporting. 法医死亡调查中的性别认同：法医死亡调查中的性别认同：叙述性回顾及记录和报告的建议指南》（A Narrative Review and Suggested Guidelines for Documenting and Reporting）。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000946
Juniper Fedor, Alison Krywanczyk, Anthony Redgrave
{"title":"Gender Identity in Forensic Death Investigation: A Narrative Review and Suggested Guidelines for Documenting and Reporting.","authors":"Juniper Fedor, Alison Krywanczyk, Anthony Redgrave","doi":"10.1097/PAF.0000000000000946","DOIUrl":"10.1097/PAF.0000000000000946","url":null,"abstract":"<p><strong>Abstract: </strong>In the current body of forensic literature, there is little guidance available regarding death investigations of transgender, intersex, and gender diverse individuals. An increase in the prevalence of gender diverse identifying people and the frequency in which these individuals experience a premature death makes it more likely these deaths will fall under the jurisdiction of the medical examiner's office. The inability to navigate these diverse cases due to a lack of training, education, and support may leave forensic professionals without the tools needed to accurately represent these deaths.This narrative review is intended to provide the foundational knowledge needed by forensic death investigators when investigating gender identity in death, including suggested guidelines for a more effective and empathetic death investigation. A better understanding of the implications and applications of this information when included in reports will bolster the quality and quantity of the data reported and collected. This will lead to more accurate monitoring and reporting of violent, suicidal, and homicidal deaths of transgender, intersex, and other gender diverse individuals, and a higher identification rate of unidentified remains with gender diverse markers.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"231-241"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Suicide by Gunshot Wound to the Posterior Head and Neck: A Retrospective Case Series and Review of the Literature. 头颈后部枪伤自杀：回顾性病例系列和文献综述。
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-07 DOI: 10.1097/PAF.0000000000000925
Nicholas R Bovio, Jared K Brooks, Joseph A Prahlow
{"title":"Suicide by Gunshot Wound to the Posterior Head and Neck: A Retrospective Case Series and Review of the Literature.","authors":"Nicholas R Bovio, Jared K Brooks, Joseph A Prahlow","doi":"10.1097/PAF.0000000000000925","DOIUrl":"10.1097/PAF.0000000000000925","url":null,"abstract":"<p><strong>Abstract: </strong>Suicide by firearm is a significant public health concern in specific regions of the world. Depending on firearm availability, any type of firearm may be used, including handguns, shotguns, and long rifles. Common entrance wound sites in suicidal gunshot wounds include the head, with classic gunshot wound locations including the temple, the forehead, the submental aspect of the chin, and inside the mouth. Occasionally, suicidal gunshot wounds occur in atypical body locations such as the back of the head and neck. Given their relative rarity, suicidal gunshot wounds in these regions may be mistaken for homicides. In this report, we present 5 cases of suicidal gunshot wounds to the back of the head and/or neck. In our series, we focus on differentiating each case from homicides involving gunshot wounds in similar areas of the head and neck.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"248-253"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Federal Ammunition: Syntech Total Synthetic Jacket. 联邦弹药：Syntech 全合成弹壳
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000953
Garrett Phillips
{"title":"Federal Ammunition: Syntech Total Synthetic Jacket.","authors":"Garrett Phillips","doi":"10.1097/PAF.0000000000000953","DOIUrl":"10.1097/PAF.0000000000000953","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"277-278"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Method Validation Study of Dipstick Urinalysis as a Screening Tool for Sodium Nitrite Toxicity. 将浸量尺尿液分析法作为亚硝酸钠毒性筛查工具的方法验证研究
IF 1 4区 医学
American Journal of Forensic Medicine and Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-02 DOI: 10.1097/PAF.0000000000000940
Jessicia S Schmitt, Laura D Knight
{"title":"Method Validation Study of Dipstick Urinalysis as a Screening Tool for Sodium Nitrite Toxicity.","authors":"Jessicia S Schmitt, Laura D Knight","doi":"10.1097/PAF.0000000000000940","DOIUrl":"10.1097/PAF.0000000000000940","url":null,"abstract":"<p><strong>Abstract: </strong>The incidence of suicide by intentional nitrite ingestion has increased since 2017. Limited options exist for commercial laboratory analysis for nitrite/nitrate. This study investigates the use of urine dipsticks for screening at autopsy for potential toxicity with sodium nitrite and, less commonly, alkyl nitrite. Archived samples of blood, urine, vitreous fluid, and gastric contents from 4 sodium nitrite/nitrate cases, 3 alkyl nitrite cases, and 4 control cases were tested using dipsticks. A rapid, strong positive result for nitrite was in the vitreous fluid of all 4-sodium nitrite/nitrate cases, along with 2 positive urine and 1 positive gastric. The 2 alkyl nitrite inhalation toxicity cases had no positive results. One alkyl nitrite ingestion case had a positive urine. The 4 controls had negative urine: equivocal results in 2 vitreous, and 1 positive gastric. Urine dipsticks are a useful adjunct to laboratory testing for nitrite toxicity and provide a rapid, cost-effective tableside result that may guide the need for further testing. Vitreous fluid and urine appear to be the most reliable specimens, although testing of gastric liquid may be useful to corroborate oral ingestion. Dipsticks may not be a reliable adjunct for testing for alkyl nitrite toxicity via inhalation route, likely due to the much lower nitrite concentration compared to nitrite ingestion cases.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"210-214"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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