Cases Of Violent Death Research Articles

Post-mortem toxicology in violent fatalities in Cape Town, South Africa: A preliminary investigation

BackgroundIn South Africa, violence-related injury and mortality contributes highly to the nation's burden of injury. Drug abuse, which is also reported to be rife across the county, has been associated with violence, resulting injury, and death. While post-mortem toxicological investigations are comprehensive and routine in violent fatalities internationally; this is not currently the case in South Africa. ObjectivesTo conduct a post-mortem toxicological investigation on a cohort of violent fatalities in the West-Metropole of Cape Town, Western Cape. MethodsThe study included a prospective toxicological analysis and a retrospective review of the corresponding blood alcohol results on a small cohort of victims of violent death (whether homicidal, non-overdose suicidal, or accidental) admitted to the Salt River State Mortuary in Cape Town. Biological specimens were collected from the victims following informed consent from the next-of-kin, and a targeted screening approach using liquid chromatography coupled to tandem mass spectrometry was used for the qualitative toxicology analysis. At the Forensic Chemistry National Laboratory, blood alcohol testing was conducted using a headspace gas chromatography with flame ionisation detector according to national standards. Data was analysed with regards to demographics, circumstances of death, and toxicological results. ResultsConsent was obtained for 104 violent death cases, autopsied between August–October 2015, most were male victims of homicide (n = 92, 88%). Volatiles analysis for ethanol was performed on 98% of cases, with 41% testing positive (>0.01 g/100 mL). Other drugs of abuse were detected in 63 (61%) cases and more than one substance were present in 51 (49%) cases. The most commonly detected substances were combinations of methamphetamine, diphenhydramine, and methaqualone. ConclusionsA high prevalence of drugs of abuse was identified in a cohort of victims of violent death. Objective drug trends observed were consistent with national self-reported rehabilitation centre data and research on self-reported drug user. This study was limited by the sampling strategy, including challenges associated with obtaining consent and the rapid turnover of violent fatalities. Despite this – and to the authors’ knowledge – this study provided the first prospective post-mortem toxicological investigation into violent death in South Africa. Contextually, it highlights the need for routine and comprehensive toxicology in these cases to strengthen research and service provision, so as to better understand the role of drugs in violent death.

Suicide identification during on-site inspection. Proposal and application of an interpretative method for death scene investigation

Death scene investigation (DSI) is critically important for the identification of the manner of death. The present study aims to present a scoring system for the correct framing of a case as a suicide starting from the DSI and its preliminary application. The method is based on five items: (1) statistical frequency of the method adopted; (2) victim’s history of mental illness; (3) circumstantial data; (4) number of means; (5) compatibility of means and injuries with suicidal dynamics; and the application of a correction factor if suicide risk indicators are present. We blindly analyzed 180 cases of violent deaths equally divided into suicides, homicides and accidental deaths and the results obtained were compared with the established dynamics of death. The proposed method has proven to be efficient in the identification of suicide at the DSI, but further on-site studies making use of a wider number of cases is necessary.

Evaluation of usefulness of post-mortem computed tomography in the diagnosis of abdominal parenchymal organ injuries compared to medicolegal autopsy findings

Post-mortem computed tomography (PMCT) is an examination technique which provides particular benefits in forensic medical practice in the evaluation of traumatic injuries. However, the usefulness of PMCT in the diagnosis of parenchymal structures in the human body is not obvious. To evaluate the usefulness of PMCT in the diagnosis of parenchymal organ injuries (liver, pancreas, spleen and kidneys) and the presence of blood in the abdominal cavity. The study was conducted on apopulation of deceased persons who underwent medicolegal autopsy in the Chair and Department of Forensic Medicine, Jagiellonian University Medical College in Krakow. The study included cases of violent death with the presence of blunt-force trauma. In all cases studied, the autopsy examination was preceded by PMCT. Both methods were employed to identify signs of injury to parenchymal organs and the presence of blood in the abdominal cavity. Observations made during the autopsies were considered in this study as the gold standard to which the PMCT findings were compared. The data obtained in the study was analyzed statistically to determine arange of parameters including sensitivity, specificity, positive and negative predictive values, and reliability. The values were presented in atabulated form. The evaluation of usefulness of PMCT in the detection of abdominal parenchymal organ injuries and the presence of blood in the abdominal cavity failed to yield satisfactory results that would justify the application of PMCT in medicolegal practice as adiagnostic tool comparable to autopsy. However, promising results were obtained with respect to the suitability of PMCT as ascreening test to exclude the presence of such injuries.

Identification of patterns in the structure of violent death in the Mykolaiv region according to the data of the statistical accounting of Mykolaiv regional bureau of forensic medical examination

The article presented is a continuation of a retrospective statistical analysis of cases of violent death in the Mykolayiv region by nosology. The stages of the study were divided according to the annual reports of MRBFDE for 2009-2013 and 2014-2017 (a total of 10445 cases). The study established the presence of regularities in the percentage of the main types of violent death, as well as in the ratio of the investigated nosologies by sex. Indicators are reliable regarding the Mykolayiv region, since all cases of violent death, as well as suspicions of them, are subject to compulsory forensic analysis.

INFLUENCE OF REVOLUTIONARY EVENTS IN THE SOCIETY ON VIOLENT DEATHS STRUCTURE

Relevance. The detector of the stability of the social system and its level of development is the frequency of violent deaths – murders, suicides and accidents. The level of murders correlates with the economic and social protection of the population. In a society reform, these indicators are changing. On the basis of the analysis of cases of violent death, on the basis of forensic medical expertise, it is possible to plan areas for preventive work of the police and health services to improve the assistance to the population.
 Objective: to study the peculiarities of the violent death of Kyiv residents against the backdrop of the revolutionary events of 2013, in order to improve the preventive work of health authorities and law enforcement agencies in reducing the incidence of violent deaths among the population in the context of the reform of society.
 Materials and methods. The material of the research was the acts of forensic research of 43138 corpses – residents of the city of Kyiv who died of violent death in 2001-2015 as a result of causing death wounds, gunshot injuries, height drop, mechanical asphyxiation, traffic accidents, poisoning, high and low temperature, and electrical trauma that were investigated in the Kyiv City Clinical Bureau for Forensic Medical Examination.
 Results. In the course of active revolutionary events, 92% of deaths are death by force. The number of deaths among women is significantly reduced. The number of incidents of firearms is 21 times higher. The number of murders increases by 49%, and in the next it falls to the original level. The number of suicides remains at a constant level during revolutionary events, but increases by 25% after them. The level of accidents decreases by 3.7 times during the revolutionary events and increases after them to a level that was even higher than at the beginning of this period. The number of injuries in dull and sharp objects increased by 25%, followed by a fall to a level that was less than revolutionary events.
 Conclusions. During active revolutionary events, the distribution of types of violent death changes.

INFLUENCE OF REVOLUTIONARY EVENTS IN THE SOCIETY ON VIOLENT DEATHS STRUCTURE

Relevance. The detector of the stability of the social system and its level of development is the frequency of violent deaths – murders, suicides and accidents. The level of murders correlates with the economic and social protection of the population. In a society reform, these indicators are changing. On the basis of the analysis of cases of violent death, on the basis of forensic medical expertise, it is possible to plan areas for preventive work of the police and health services to improve the assistance to the population.
 Objective: to study the peculiarities of the violent death of Kyiv residents against the backdrop of the revolutionary events of 2013, in order to improve the preventive work of health authorities and law enforcement agencies in reducing the incidence of violent deaths among the population in the context of the reform of society.
 Materials and methods. The material of the research was the acts of forensic research of 43138 corpses – residents of the city of Kyiv who died of violent death in 2001-2015 as a result of causing death wounds, gunshot injuries, height drop, mechanical asphyxiation, traffic accidents, poisoning, high and low temperature, and electrical trauma that were investigated in the Kyiv City Clinical Bureau for Forensic Medical Examination.
 Results. In the course of active revolutionary events, 92% of deaths are death by force. The number of deaths among women is significantly reduced. The number of incidents of firearms is 21 times higher. The number of murders increases by 49%, and in the next it falls to the original level. The number of suicides remains at a constant level during revolutionary events, but increases by 25% after them. The level of accidents decreases by 3.7 times during the revolutionary events and increases after them to a level that was even higher than at the beginning of this period. The number of injuries in dull and sharp objects increased by 25%, followed by a fall to a level that was less than revolutionary events.
 Conclusions. During active revolutionary events, the distribution of types of violent death changes.

A case of a death in the fortress Hisn al‐Bab, on the first cataract of the Nile

AbstractA skeleton was discovered during the excavation of fortifications at Hisn al‐Bab in southern Egypt. It was not found in a grave but was lying on its back in an outspread position at the foot of the collapsed northern wall of the fort, covered by wall debris. The individual was probably male and about 25 to 30 years old. The osteological evidence strongly suggests that the man met his death through interpersonal violence. A deep kerf was identified on the medial shaft of his left femur, caused perimortem by a large, bladed weapon. In addition, fractures of the facial bones, the skull base, and the right ribs occurred around the time of his death. These traumas, as well as the archaeological evidence of a contemporary destruction horizon of the fort, suggest some sort of conflict. The taphonomic changes to the bones indicate that the body was partly covered by wall debris soon after death, whereas some parts remained exposed. Distinct marks on the facial bones may suggest the presence of larger, scavenging birds, such as vultures. The analysis and interpretation of the traumas, and the taphonomic changes in relation to the archaeological context, give an insight into the last moments of one phase of occupation at Hisn al‐Bab. They illustrate an ancient case of violent death on the border between Egypt and Nubia.

Implications of entomological evidence during the investigation of five cases of violent death in Southern Brazil

Implications of entomological evidence during the investigation of five cases of violent death in Southern Brazil

Use of Cardiac Injury Markers in the Postmortem Diagnosis of Sudden Cardiac Death.

In the daily practice of forensic pathology, sudden cardiac death (SCD) is a diagnostic challenge. Our aim was to determine the usefulness of blood biomarkers [creatine kinase CK-MB, myoglobin, troponins I and T (cTn-I and T), and lactate dehydrogenase] measured by immunoassay technique, in the postmortem diagnosis of SCD. Two groups were compared, 20 corpses with SCD and 8 controls. Statistical significance was determined by variance analysis procedures, with a post hoc Tukey multiple range test for comparison of means (p < 0.05). SCD cases showed significantly higher levels (p < 0.05) of cTn-T and cTn-I compared to the control group. Although only cases within the first 8 h of postmortem interval were included, and the control group consisted mainly of violent death cases, our results suggest that blood troponin levels may be useful to support a diagnosis of SCD.

Statistical Analysis on Legal Autopsy in Jeju During 2011-2014

The aim of this study was to reveal the current status of forensic practice in Jeju Province. The range of subjects was limitedto deaths autopsied in Jeju National University during the years of 2011 through 2014. The total number of autopsies was 451,of these 35 cases unidentified or unknown manner of death for severe decomposition were excluded in this study. A total 416subjects were reviewed with respect to age, sex, cause of death and manner of death. Of these 296 cases were males and120 were females. In age distribution, the age group of 40-49 occupied the highest proportion(26.7%). According to themanner of death, the cases of violent deaths were 280(67.3%), natural deaths; 136(32.7%). For the violent deaths, thepercentage of accidental death was 36.8 and homicide; 14.6, suicide; 24.3, undetermined cases; 24.3. In natural deaths,ischemic heart disease was the leading cause of death(27.9%).

Toxicology findings in cases of hanging in the City and County of San Francisco over the 3-year period from 2011 to 2013

In postmortem cases where the cause of death is hanging, toxicological analyses may be considered unnecessary by some medical examiners, toxicologists, and other persons involved in medico-legal investigations because the cause of death seems “obvious.” To ascertain if toxicological analyses are necessary when the cause of death is hanging, all 102 hanging cases (25 females; 77 males) from 2011 to 2013 that came under the jurisdiction of the San Francisco Office of the Chief Medical Examiner were examined from a total of 3912 sudden, unexpected, or violent death cases in the same period. Suicide was the manner of death in 99 of these cases, with two accidental and one undetermined death. The average age of decedents was 43.9 years (median 41), the youngest was an 11-year old male and the oldest was an 86-year old female. Of the 102 cases, 33 had negative toxicology while 69 cases had at least one positive toxicology result. Females were equally likely to have negative or positive results (12 and 13 cases respectively), but males were 37.5% more likely to have positive toxicology (n=56) rather than negative toxicology (n=21). For females, alcohol, mirtazapine, venlafaxine, and trazodone were the top psychoactive substances in peripheral blood while THC, cocaine, hydrocodone, bupropion, olanzapine, doxylamine, quetiapine and dextromethorphan were also reported. For males, alcohol, THC, cocaine, amphetamine, methamphetamine, bupropion, and diphenhydramine were the top psychoactive substances in blood, but several other drugs were also found in individual cases. Our study of hanging cases over a 3-year period support the idea that complete postmortem toxicology investigation of hangings should be performed, even when the “obvious” cause of death is asphyxia due to hanging. Many of these cases involved psychoactive substances (most often alcohol and cannabis), and having such knowledge provides a better understanding of the circumstances surrounding the decedent's death, their possible state of impairment, including the possibility of a staged suicide if the decedent was too impaired to perform a self-hanging.

Different degrees of ischaemic injury in the right and left ventricle in cases of severe, nonfatal, pulmonary embolism.

Pulmonary fat embolism (PFE) is a common complication of blunt force traumas with bone fractures. Severe forms cause impedance to right ventricular (RV) ejection, with eventual right heart ischaemia and failure. In a prospective study, we have investigated 220 consecutive autopsy cases (73 females, 147 males, mean age 52.1 years, min 14 years, max 91 years). PFE was detected in 52 cases that were divided into three groups according to the degree of PFE (1-3). A fourth group of cases of violent death without PFE was used for comparison. In each case, histology (H&E, Masson) and immunohistochemistry (fibronectin and C5b-9) were performed on six cardiac samples (anterior, lateral and posterior wall of both ventricles). The degree of cardiac damage was registered in each sample and the mean degree of damage was calculated in each case at the RV and left ventricle (LV). Moreover, a parameter ∆ that is the difference between the mean damage at the RV and the LV was calculated in each case. The results were compared within each group and between the groups. In the present study, we could not detect prevalent RV damage in cases of high degree PFE as we did in our previous investigation. In the group PFE3 the difference of the degree of damage between the RV and LV was higher than the one observed in the groups PFE0-2 with the antibody anti-fibronectin. Prevalent right ventricular stress in cases of severe PFE may explain this observation.

B-learning training in the certification of causes of death

IntroductionAn adequate certification of causes of death is essential for Public Health. The objective of this work is to improve the professional competence of medicine students and family doctors with regard to the certification of causes of death according to the international regulations of the WHO. MethodsIntervention-formation, before and after design, addressed to students of Medicine in their last year (6th year), and Family Doctors and Interns. The blended learning or b-learning program consisted in an on-site seminar-workshop, plus basic information/documentation stored in an on-line platform, together with the preparation of Certificates of Causes of Death based on Clinical Histories of real cases. Results308 students participated in the program. We observed an individual improvement in the professional competence in all certifications of death, which was significant in 3 out of 5 cases (it was not significant in a medical-legal case of violent death and the case of a pluripathological chronic patient). The intermediate causes improved in all cases. Most formal aspects of the certification improved with significant changes. In the group of 62 Family Doctors and interns who took part in the program there were improvements in the basic or underlying causes in 4 of the 5 cases and improvements in the formal quality of the assessment, although less significantly than in students, because they started with better basal indexes in their certificates in the Before stage of the study. ConclusionsBlended learning training has shown to be effective in improving the professional competence, both in students of the Degree of Medicine and in practicing Family Doctors and Interns.

Prevalence of post-mortem blood alcohol concentration among deaths in Serbia during 2011

The prevalence of alcohol in blood samples from medicolegal autopsies performed in the Institute of Forensic Medicine in Belgrade, in 2011, was studied. In total, 293 blood samples were analyzed for alcohol by headspace gas chromatography. The blood alcohol concentrations were evaluated according to sex, age, and cause of death. The blood alcohol concentrations were . 0.5 g/L in 23.9% of the cases; in suicides 22.4%, accidents 34.4% and homicides 25.0%. The largest proportion of high BACs were found in the sample from subjects killed in traffic accidents. These findings confirm that alcohol use is an important factor in many fatal accidents, suicides and cases of violent death.

Tracing the mobility of individuals using stable isotope signatures in biological tissues: “locals” and “non-locals” in an ancient case of violent death from Central California

Stable isotope analyses of biological tissues that grow during different phases of life can be used to trace the geographic location of individuals during different windows of time. We apply this principle and reexamine three prehistoric skeletons excavated in 1964 from archaeological site CA-YOL-117 in Central California. Field evidence suggests they were killed as part of a single violent event. We report new radiocarbon dates and Strontium, Oxygen, Carbon, and Nitrogen isotopic data from first molars, third molars, and bone to examine circumstances surrounding their death. Data suggest two of the three individuals were born, and all three lived their teenage years, near the site they were buried in. However, as adults they lived elsewhere, likely to the north along the Sacramento River. Around AD 1450, upon returning to the territory of their childhood years, they were killed and placed in a mass grave. The data invite a more nuanced interpretation of how we view “local” and “non-local” individuals archaeologically. Overall, the analysis provides an interesting glimpse into the nature of warfare and violence among pre-contact hunter–gatherers of Northern California.

Violence in the Central Iberian Peninsula during the Bronze Age: A Possible Prehistoric Homicide

ABSTRACTOne of the most interesting sites of the Bronze Age in the central area of the Iberian Peninsula is La Motilla del Azuer (Daimiel, Ciudad Real), dated between 2200 and 1350 bc. The main objective of this study was to investigate interpersonal violence in this site and to report an uncommon case of violent death. No traumatic injury was detected in any child, and men and women significantly differed in the frequency of traumas. More traumatisms were found in men from the earlier stages of occupation, including a young man with at least three blunt force traumas and 26 sharp force traumas. The archaeological findings and trauma patterns in the skeletons of the 65 individuals studied suggest a relatively intense level of exposure to violence for adult men in the earlier stages of occupation of this settlement. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Patterns of the most abundant volatiles detected in post-mortem blood

The most abundant volatiles detected during the forensic ethanol analysis are ethanol, acetaldehyde, 1-propanol, 2-propanol, and acetone. These volatiles could either be initiated in the human body after the consumption of alcoholic beverages; or have been produced ante mortem during metabolic processes or post-mortem by microbes. Aims of this study were the determination of the volatiles' concentrations in autopsy blood samples received from 483 routinely autopsied corpses and classification of their patterns according to the manner of death, and the presence of putrefaction at autopsy. The volatiles concentrations were determined by a validated gas chromatographic method. The experimental values obtained from these determinations were submitted to statistical evaluation by principal component analysis (PCA). Blood acetaldehyde, acetone, 1- and 2-propanol concentrations were higher in cases of violent and undetermined deaths compared to the ones determined in cases of natural deaths. Blood volatiles concentrations were dispersed in higher values in cases with putrefaction compared to cases without putrefaction at autopsy. Blood volatiles had low values in the majority of cases with low BAC. All volatiles had higher maximum concentrations and broader concentration ranges when BAC ranged from 10-100 mg/ dL. Cases of undetermined manner of death along with some cases of violent deaths achieved clustering (PCA) from cases of violent or natural manner of death indicating similarities among the grouped samples on the basis of measured blood 1-propanol and ethanol concentrations. The latter novel finding needs further investigation using a larger dataset pool and possibly other classification method with a different regression model.

Elevated Body Core Temperature in Medico-Legal Investigation of Violent Death

Pathologically elevated body core temperature, measured at the death scene, is an important finding in medico-legal investigation of violent deaths. An abnormally high rectal temperature at any death scene may point to an underlying pathology, the influence of certain drugs or a hidden cerebral traumatism, and death by suffocation which would remain undetected without further medico-legal investigations. Furthermore, hyperthermia and fever, if unrecognized, may result in an erroneous forensic estimation of time since death in the early postmortem period by the "Henssge method." By a retrospective study of 744 cases, the authors demonstrate that hyperthermia is a finding with an incidence of 10% of all cases of violent death. The main causes are: influence of drugs, malignant tumors, cerebral hypoxia as a result of suffocation, infections, and systemic inflammatory disorders. As a consequence it must be stated, that hyperthermia must be excluded in every medico-legal death scene investigation by a correct measurement of body core temperature and a comparison between the cooling rate of the body and the behavior of early postmortem changes, notably livor and rigor mortis.

Drugs and violent death: comparative toxicology of homicide and non‐substance toxicity suicide victims

To determine the comparative toxicology of death by homicide and suicide by means other than substance toxicity. Cross-sectional (autopsy reports). Sydney, Australia. A total of 1723 cases of violent death were identified, comprising 478 homicide (HOM) cases and 1245 non-substance toxicity suicide (SUI) cases. Substances were detected in 65.5% of cases, and multiple substances in 25.8%, with no group differences. Illicit drugs were detected in 23.9% of cases, and multiple illicit in 5.3%. HOM cases were significantly more likely to have an illicit drug [odds ratio (OR) 2.09] and multiple illicits (OR 2.94), detected, HOM cases being more likely to have cannabis (OR 2.39), opioids (OR 1.53) and psychostimulants (OR 1.59) present. HOM cases were, however, significantly less likely to have benzodiazepines (OR 0.53), antidepressants (OR 0.22) and antipsychotics (OR 0.23) present. Alcohol was present in 39.6% of cases (median blood alcohol concentration = 0.12), with no group difference in prevalence. The role drugs play in premature death extends far beyond overdose and disease, with illicit drugs associated strongly with homicide.

Assessment of chronic kidney disease based on necroptic microscopical examination in violent death cases

Assessment of chronic kidney disease based on necroptic microscopical examination in violent death cases