American Journal of Forensic Medicine and Pathology最新文献_第4页

Disseminated Mycobacterium tuberculosis from Infected Bone Graft Source: Case Study in Iatrogenic Infection and Our Approach.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-02-19 DOI: 10.1097/PAF.0000000000001027

Thomas Herb, Jeffrey Jentzen, Carl Schmidt

{"title":"Disseminated Mycobacterium tuberculosis from Infected Bone Graft Source: Case Study in Iatrogenic Infection and Our Approach.","authors":"Thomas Herb, Jeffrey Jentzen, Carl Schmidt","doi":"10.1097/PAF.0000000000001027","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001027","url":null,"abstract":"Abstract: Iatrogenic infections of cadaveric bone grafts have led to 2 outbreaks of Mycobacterium tuberculosis (Mtb) infection in the United States that have resulted in multiple fatalities. We report a case of one of the bone graft recipients from the 2023 outbreak. A 57-year-old immunocompromised female with a history of renal failure status post 3 kidney transplants underwent a laminectomy with a cadaveric bone graft due to spinal stenosis. She was later hospitalized with diffuse lymphadenopathy and surgical site purulent ulceration. The workup included positive cultures for Mtb. Despite appropriate therapy, the patient died in the hospital. Autopsy findings included purulent discharge from the surgical site, medullary abscesses of one of the transplanted kidneys, diffuse pinpoint areas of softening in the liver, and lung congestion. Histology of the liver and right lung demonstrated loose granulomas with abundant acid-fast organisms. The kidney abscesses were due to Candida species infection. Overall, findings were consistent with disseminated Mtb infection. Additional investigation found similar infections in recipients of the same bone graft source. We compare the Mtb outbreaks to similar outbreaks, including cases of fungal meningitis due to steroid injections, and discuss our approach and strategy in cases of iatrogenic infection.","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442818","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

Preventing Fentanyl-Related Overdose Deaths with Naloxone-A Medical Examiner Study.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-02-13 DOI: 10.1097/PAF.0000000000001028

Gabriel D Alexander, Pamela A Ferreira, Stephanie A Dean, Russell T Alexander

{"title":"Preventing Fentanyl-Related Overdose Deaths with Naloxone-A Medical Examiner Study.","authors":"Gabriel D Alexander, Pamela A Ferreira, Stephanie A Dean, Russell T Alexander","doi":"10.1097/PAF.0000000000001028","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001028","url":null,"abstract":"Abstract: An epidemic of fentanyl overdose deaths has led to community naloxone use to save lives, and it has been suggested that businesses face legal liability for failing to provide naloxone. This study reviewed Maryland fentanyl-related overdose deaths in 2022. A death was considered preventable by widespread availability and use of naloxone in the following circumstances: a witnessed arrest, a person suffering an overdose found within 30 minutes of last being known alive, a person found unresponsive who showed potential to be resuscitated by emergency medical services, or the person being \"found dead\" in a public area such that a reasonable opportunity existed for someone else to find the decedent earlier and administer naloxone before death occurred. Of the 2047 overdose deaths in the study, 13.5% were deemed possibly preventable, and 2.7% were found such that a business could have possibly provided naloxone. The preventable overdoses were most commonly found by a \"close contact\" (family, friend, boy/girlfriend, and room/housemate) in a residence. A targeted effort to educate and supply naloxone to people who use drugs and their close contacts offers the best chance of reducing fentanyl overdose deaths. Mandating all businesses to carry naloxone is not supported by this study.","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411704","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

Chainsaw Kickback Injury in a Child.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-02-13 DOI: 10.1097/PAF.0000000000001030

Jochen Pfeifer, Anke Rondorf, Ramona Filip, Katrin Altmeyer, Hashim Abdul-Khaliq

引用次数: 0

Diagnosing the Legal Age of 12 Using Second (I2M) and Third (I3M) Molar Maturation Indices in Brazil.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-02-13 DOI: 10.1097/PAF.0000000000001024

Johnys Berton Medeiros da Nóbrega, Tainá Nascimento Falcão, Isabella Lima Arrais Ribeiro, Ademir Franco do Rosário Júnior, Roberto Cameriere, Bianca Marques Santiago

{"title":"Diagnosing the Legal Age of 12 Using Second (I2M) and Third (I3M) Molar Maturation Indices in Brazil.","authors":"Johnys Berton Medeiros da Nóbrega, Tainá Nascimento Falcão, Isabella Lima Arrais Ribeiro, Ademir Franco do Rosário Júnior, Roberto Cameriere, Bianca Marques Santiago","doi":"10.1097/PAF.0000000000001024","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001024","url":null,"abstract":"Abstract: Children and adolescents receive varying levels of support and punishment when experiencing situations that classify them as defendants or victims. Age information is crucial for defining these cases. The objective was to apply the second (I2M) and third (I3M) molar maturity indices to diagnose the age of 12, and find out the cutoff points capable of generating better predictions among Brazilians. This observational cross-sectional study analyzed panoramic radiographs from the five geographic regions of Brazil. The radiographs were of individuals between 10 and 15 years old, taken between 2013 and 2019. The sample consisted of 125 images of each sex (n = 250), 50 from each geographic region, obtained for the purpose of clinical and/or orthodontic diagnosis and having the mandibular left second and third molars. Data collection followed the I3M methodology based on the measurements made on the second (I2M) and third (I3M) molars, using ImageJ®. The cutoff points found for the I2M, I3M, and I2M × I3M were 0.554 (AUC, 88.5%; 95% CI, 84.00-93.00), 0.519 (AUC, 77.8%; 95% CI, 76.14-79.46), and 0.699 (AUC, 88.4%; 95% CI, 84.48-92.32), respectively. The cutoffs by I2M, I3M, and I2M × I3M are sufficiently accurate for practical application and diagnosis of the age of 12 among individuals aged 10 to 15 in Brazil.","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411702","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

New and Emerging "Nitazene" Analogues Appearing in Medicolegal Death Investigations: N-Pyrrolidino Protonitazene and N-Desethyl Isotonitazene.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-02-13 DOI: 10.1097/PAF.0000000000001025

Sara Walton, Donna Papsun, Elisa Shoff, Kayla Ellefsen, Alex Krotulski

引用次数: 0

Unearthing the Unexpected: First Report of Ossa Cordis in a Human Heart.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-01-31 DOI: 10.1097/PAF.0000000000001018

Mehrnoosh Ghandili, Mark A Giffen

{"title":"Unearthing the Unexpected: First Report of Ossa Cordis in a Human Heart.","authors":"Mehrnoosh Ghandili, Mark A Giffen","doi":"10.1097/PAF.0000000000001018","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001018","url":null,"abstract":"Abstract: The ossa cordis (OC), or cardiac bone, is a bony structure within the cardiac skeleton of mammals, believed to maintain heart shape during systole and enhance contraction efficiency. Found in large mammals, especially ruminants, and has recently been described in chimpanzees; however, OC has not previously been described in humans. Herein, we present an incidental finding of OC in the heart of a 39-year-old man who suffered a stab wound to chest. A thorough postmortem examination revealed a 0.8 × 0.6 × 0.4-cm, well-defined, boomerang-shaped, bony structure embedded in atrioventricular node location in the right atrium within the triangle of Koch. The heart showed cardiomegaly and moderate atherosclerosis in the left anterior descending and right coronary arteries but was otherwise normal, without fibrosis, valvular abnormalities, or degenerative changes. Histological analysis revealed mature bone with trilineage hematopoietic elements. This finding highlights anatomical similarities between human hearts and other species, raising questions about whether OC in humans and primates is linked solely to degenerative cardiac disorders or represents a normal aspect of mammalian heart development and aging. To our knowledge, this is the first reported case of an OC in a human.","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069900","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

A Chain of Events Leading to Posttraumatic Subacute Meningitis.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-01-27 DOI: 10.1097/PAF.0000000000000975

Monica Harumi Miyakawa-Liu, Michelle A Jorden, Nika Aljinovic

{"title":"A Chain of Events Leading to Posttraumatic Subacute Meningitis.","authors":"Monica Harumi Miyakawa-Liu, Michelle A Jorden, Nika Aljinovic","doi":"10.1097/PAF.0000000000000975","DOIUrl":"https://doi.org/10.1097/PAF.0000000000000975","url":null,"abstract":"Abstract: There are few reports that discuss the nebulous entity known as posttraumatic subacute meningitis. Herein, we describe a case where a male was found deceased with Streptococcus pyogenes meningitis 7 days after experiencing head trauma inflicted with a tow chain. Computed tomography scan prior to death revealed a scalp laceration with subcutaneous gas and a subdural hematoma. On autopsy, the lacerations had exposed the cranial bone, but no fracture was identified. Purulence and a pinpoint defect were observed on the dura. Histologic sections of the dura and brain showed a chronic inflammatory infiltrate, ventriculitis, and vascular involvement by bacteria. Toxicology studies were positive for methamphetamine, fentanyl, and oxycodone. Post-mortem cerebrospinal fluid and blood cultures grew S. pyogenes, complementing the gram-staining of the bacteria seen in the brain sections.While the overlying parietal bone in the area of purulence was notably thinned, a direct route of infection from the soft tissue laceration to the meninges was not grossly identified. The middle ear mastoid cells did not display purulence, and the antemortem computed tomography scan did not provide any support for an otorhinolaryngeal source for the Streptococcus meningitis. To our knowledge, this is the first published report linking head trauma to S. pyogenes meningitis.","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048898","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

Anatomy of a Crash: Analysis of 102 Pedestrian and Bicyclist Fatalities.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-01-27 DOI: 10.1097/PAF.0000000000001017

Thomas Herb, Alexis Snyder, Allecia Wilson

{"title":"Anatomy of a Crash: Analysis of 102 Pedestrian and Bicyclist Fatalities.","authors":"Thomas Herb, Alexis Snyder, Allecia Wilson","doi":"10.1097/PAF.0000000000001017","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001017","url":null,"abstract":"Abstract: Pedestrian and bicyclist fatalities have increased over the past decade in the United States. Factors proposed to explain this increase include the increased popularity of larger passenger vehicles, road design to accommodate faster-moving traffic, and poor road infrastructure. We analyzed a series of 102 pedestrian and bicyclist fatalities to determine which factors were involved. Results demonstrated substance abuse as the most common pertinent decedent medical history, a disproportionate number of crashes occurred during evening/nighttime hours, and most crashes involved larger passenger vehicles. The percentage of cases involving sport utility vehicles (SUVs) has increased over time. Injury pattern analysis demonstrated that smaller passenger vehicles at lower speeds were more likely to cause lower extremity fractures compared to SUVs. Alcohol was the most common decedent substance detected on toxicology, and decedents with a previous mental health history were more likely to have positive toxicology for illicit substances than those without. Sixty-three percent of cases lacked sidewalks, and 85% of cases lacked bike lanes. We compared the trends that we saw on a small scale to those seen nationally and uncovered certain novel associations from the perspective of medical examination.","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048900","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

Hidden Trauma: An Analysis of the Identification of Contusions on Different Skin Tones.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-01-24 DOI: 10.1097/PAF.0000000000001014

Lydia R Du, David M Waters, Meredith A Reynolds, Lorenzo Gitto

{"title":"Hidden Trauma: An Analysis of the Identification of Contusions on Different Skin Tones.","authors":"Lydia R Du, David M Waters, Meredith A Reynolds, Lorenzo Gitto","doi":"10.1097/PAF.0000000000001014","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001014","url":null,"abstract":"Abstract: While abrasions and lacerations are typically easily identified, darker pigmentation of the skin may obscure contusions. Forensic pathology literature shows a disproportionate number of illustrations of contusions on lighter skin tones compared to darker ones. Skin and soft tissue dissection is the most reliable method to confirm contusions.The authors seek to establish a correlation between skin tone and the visual identification of contusions, confirmed by soft tissue dissection. Additionally, they aim to determine the utility of specialized dissections for identifying contusions on different skin tones to identify cases that may benefit from such procedures.A review of cases from the Cook County Medical Examiner's Office from 2014 to 2024 was conducted. The office database was searched for deaths in custody, causes including \"assault,\" and \"child abuse.\" Autopsy photos were compiled into predissection and postdissection sets, reviewed for skin tone, visual identification of contusions, and final confirmation of soft tissue hemorrhage.Results found a negative association between skin color and accurate visual identification of contusions and determined that decedents with a skin tone of 7 or higher on the Massey-Martin scale may benefit from specialized dissections.","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025604","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

Technical Note: Application of Luminol and Leucomalachite Green Tests to Wischnewsky Spots After Formalin Fixation.

IF 1 4区医学

American Journal of Forensic Medicine and Pathology Pub Date : 2025-01-24 DOI: 10.1097/PAF.0000000000001019

Norihiro Shinkawa, Ai Sonoda, Eiji Kakizaki, Nobuhiro Yukawa

引用次数: 0