External Body Examination Research Articles

Drowning Death: A Literature Review

Background: The process of drowning begins with respiratory distress either because a person's airway is below the surface of the liquid (submersion) or the water only covers the face (immersion) (Putra, 2020). In a body submerged in water and suspected of having died from drowning, it is necessary to determine whether the victim was still alive at the time of the drowning. The probability was marked by intravital signs, whether there were other signs of violence or the cause of death. All these things can be determined through an external and internal body examination of the corpse and are supported by supporting examinations. With this series of examinations, the diagnosis of drowning can be established, and the cause and mechanism of death of the bodies found can be estimated. Doctors in forensic medicine have an important role in cases of drowning deaths, such as in helping to identify victims and determine the cause of death. (Armstrong & Erskine, 2018).
 Objective: This report aims to learn more about drowning deaths, the classification, the pathophysiology of drowning deaths, and the process of investigating drowning deaths.
 Conclusion: Drowning is asphyxia that prevents air entry into the lungs by inhaling fluid into the airways, i.e., nose and mouth. Cases of drowning death are caused by irreversible brain damage in the development of irreversible cerebral anoxia and hypoxia. There are two classifications of drowning, namely Dry Drowning and Wet Drowning. Doctors in the field of forensic medicine have an important role in cases of drowning deaths, such as in helping efforts to identify victims and determine the cause of death. The investigation process includes Pre-Autopsy Preparation and Interest in Victim History, External Findings, Internal Meetings, and Special Tests.

Tactical Particularities of Performing the Body Search

The article presents and analyzes aspects related to the body search, starting from the regulation of this procedural act in the Romanian Criminal Procedure Code. Body search is a probatory procedure that involves the external body examination of a person, the oral cavity, the nose, ears, hair, clothing, objects that a person has on him or under his control, at the time of the body search. KEY WORDS: body s

Analysis of 124 Suicide Cases in Wuhua District in Kunming

To analyze the relationship between the suicide method and the sex, age, education background and cause of suicide to provide reference for the forensic identification of suicide. After scene investigation, external body examination, autopsy and case investigation, 124 identified suicide cases which happened in recent three years in Wuhua district in Kunming were collected. Analytical methods as chi-square test and descriptive statistics were performed by SPSS 22.0. In all the suicide cases, male to female ratio was 1.53∶1. The suicide methods were mainly fatal fall, hanging and drowning. The ratio of local to non-native residents was 1∶1. The suicide rate in the people with primary school or junior middle school education level was highest. The group of >10-50 years tended to choose fatal fall suicide and people over 60 years were more likely to choose hanging. People with different academic background tended to choose fatal fall suicide. The suicide methods as fatal fall and hanging were chosen because of mental and physical diseases and economic problems, while the suicides with emotional problems were more likely to choose fatal fall and poisoning. Suicide belongs to a kind of complex cases. For the cases of suspected suicide, complete exploration and overall consideration should be done to determine the nature of cases based on comprehensive analysis of all the influence factors.

Epidemiological implications of houseflies (<i>Musca domestica</i>) in the dessimination of diseases in Owerri, south-east Nigeria

The epidemiological implications of houseflies (M. domestica) in human disease transmission were assessed in Owerri, Imo State, Nigeria between February and August, 2010. A total of 140 houseflies trapped from different micro-habitats were examined using standard parasitological and microbiological techniques which included washing and examination of external body parts, dissection and examination of internal guts and culture of crushed intestinal samples. Of these, 78 (55.7%) were infected with at least one of 7 parasites of medical importance encountered; Entamoba coli, Ascaris lumbricoides, Microsporidia, Enterobius vermicularis, Hookworm, Trichiuris trichiura and Entamoba histolytica, A. lumbricoides (17.1%) and E. histolytica (13.6%) were significantly higher than others (p<0.05). Infection was significantly higher in refuse dumps and toilets than from other sources (p<0.05). Eight bacterial isolates (opportunistic enteric pathogens inclusive) were recovered; Micrococcus species, Escherichia coli, Staphylococcus spp and Citrobacter spp. Their prevalence differed in the gut contents of houseflies while its public health significance are highlighted.Keywords: Houseflies; diseases; epidemiological implications; Owerri

Suicide by ingestion of caffeine

BackgroundMr K, aged 48, was found sweating by his partner at home at 11.50 pm. He claimed to have attempted suicide. She immediately called the Emergency Unit to ask for support. At the phone, the physician on duty indicated her to give a pill of Lysanxia (prazepam) to decrease the level of stress of the victim. However, the clinical situation worsened and he was taken to the hospital at 1.00 am. At his arrival at 1.28 am he was in cardiac arrest. Despite intensive resuscitation manoeuvres, death was pronounced at 2.30 am. At home, an empty plastic bag with a 100 g caffeine label was found. The drug was bought via Internet 6 months earlier. External body examination and autopsy revealed the lack of any traumatic injury.FindingsDuring examination, the pathologist collected peripheral blood (femoral blood). This specimen was tested for ethanol, volatiles, pharmaceuticals and drugs of abuse, using head space GC/FID and GC/MS, ELISA, LC-DAD, GC/MS and LC/MS/MS. Ethanol tested negative in blood. Using a dedicated LC/MS/MS procedure, caffeine was identified at 401 mg/l, which can correspond to a fatal concentration. Nordiazepam, sertraline and fluoxetine, the prescribed medications of the victim, were identified at therapeutic concentrations, 188, 31, and 48 ng/ml, respectively. Amiodarone was also identified at high concentration (4200 ng/ml), part of the medical assistance of the rescue team.ConclusionThe manner of death was considered as acute intoxication with caffeine.

Stability of endogenous GHB in vitreous humor vs peripheral blood in dead bodies

For the first time, the stability of GHB was tested in post-mortem peripheral blood and vitreous humor samples, collected from 22 dead bodies at two different times: at the external body examination at the place of death and then during autopsy.An ad hoc method for the detection and quantification of GHB in vitreous humor by gas chromatography coupled to mass spectrometry (GC–MS) was developed and validated, with a good linearity between 0.1 and 50μg/mL (r2=0.991) and a precision and accuracy always better than 10% and an analytical recovery higher than 90%.The geometric mean of GHB concentration in the 22 peripheral blood samples at t0 was: 3.6μg/mL (95% CI: 2.3–5.9μg/mL) and at t1 it was 7.4μg/mL (95% CI: 5.0–10.9μg/mL); that of GHB in the 22 vitreous humor at t0 was: 2.5μg/mL (95% CI: 1.5–4.1μg/mL) and at t1 it was 3.0μg/mL (95% CI: 1.9–4.8μg/mL). There was no significant difference between the GHB concentrations in vitreous humor and peripheral blood at t0 in all the samples (p>0.10). Conversely at t1, the increase of GHB in the peripheral blood was significantly increased by a 102% (range: 86–120%) (p<0.001 vs t0), while in the vitreous humor only a slight increase by 19% was observed (range: 16–21%) (p>0.05 vs t0). Finally at t1, GHB values in the two matrices were statistically different, being that of peripheral blood higher (p<0.01).This study demonstrated the usefulness of vitreous humor as a more stable alternative matrix in comparison to peripheral blood for the post-mortem determination of endogenous GHB.

Ocfentanil overdose fatality in the recreational drug scene

This paper describes the first reported death involving ocfentanil, a potent synthetic opioid and structure analogue of fentanyl abused as a new psychoactive substance in the recreational drug scene. A 17-year-old man with a history of illegal substance abuse was found dead in his home after snorting a brown powder purchased over the internet with bitcoins. Acetaminophen, caffeine and ocfentanil were identified in the powder by gas chromatography mass spectrometry and reversed-phase liquid chromatography with diode array detector.Quantitation of ocfentanil in biological samples was performed using a target analysis based on liquid–liquid extraction and ultra performance liquid chromatography tandem mass spectrometry. In the femoral blood taken at the external body examination, the following concentrations were measured: ocfentanil 15.3μg/L, acetaminophen 45mg/L and caffeine 0.23mg/L. Tissues sampled at autopsy were analyzed to study the distribution of ocfentanil. The comprehensive systematic toxicological analysis on the post-mortem blood and tissue samples was negative for other compounds.Based on circumstantial evidence, autopsy findings and the results of the toxicological analysis, the medical examiner concluded that the cause of death was an acute intoxication with ocfentanil. The manner of death was assumed to be accidental after snorting the powder.

A case of acute intoxication due to combined use of fentanyl and 3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide (U-47700)

A 30-year old man was found dead in his home after inhaling fumes of a powder burned on aluminum foil. Blood and urine were taken by the medical examiner during the external body examination and submitted to the laboratory for a comprehensive systematic toxicological analysis. A toxic fentanyl level of 10.9μg/L was measured in the subclavian blood. Police investigation revealed that the man searched the internet for information on new psychotropic substances, among others including U-47700. A powder found in the victims’ home was transferred to the laboratory for analysis, in which trace amounts of fentanyl (0.0035%, m/m) and U-47700 (0.0012%, m/m) were identified by gas chromatography mass spectrometry.U-47700 is an opioid analgesic drug, considered to have a potency of approximately 7.5 times that of morphine. A target analysis on U-47700 was performed using liquid–liquid extraction and ultra performance liquid chromatography tandem mass spectrometry operating in multiple reaction monitoring mode. The method validation was based on the Scientific Working Group of Forensic Toxicology document ‘Standard Practices of Method Validation in Forensic Toxicology’. In blood and urine the U-47700 concentration was 13.8 and 71.0μg/L, respectively. To the author's knowledge, this is the first case report of a fatal intoxication involving U-47700 abused as a new psychotropic substance.

Fatal alfentanil/morphine mixture: A case report

Summary A 23 year-old man, health care professional, was found dead in the toilets of a local hospital. Medical supplies for injection (syringe, needles) were found near the body at the scene, in a waste. External body examination revealed a single point of injection located at the left elbow crease and the lack of any traumatic injury. During examination, the pathologist collected cardiac blood and urine. These specimens were tested for ethanol, volatiles, pharmaceuticals and drugs of abuse, using headFspace GC/FID and GC/MS, Elisa, LC-DAD, GC/MS and LC/MS/MS. Ethanol tested positive in blood (0.99 g/L) and urine (0.19 g/L). Using a dedicated LC/MS/MS procedure, alfentanil was identified in both blood (19 ng/mL) and urine (25 ng/mL). Morphine was identified in blood, at 36 ng/mL (free morphine) and 39 ng/mL (total morphine). In urine, total morphine concentration was 81 ng/mL. No other drug was detected. Given the ratio (0.92) free morphine to total morphine in blood and the low concentrations of both alfentanil and morphine in urine, it was considered that the death occurred rapidly after drugs administration. The manner of death was considered as acute intoxication of both alfentanil and morphine, in presence of ethanol.

The significance of external body examination during crime scene investigation

Precise activity of crime scene investigating physician is especially important for the further work of medical examiner. Factors that may significantly affect the activities of the investigating physician include advanced decay post mortem changes of the human body. Our first case deals with a man, where the physician stated heart failure as the cause of death. In the second case, the physician determined a disease of high blood pressure as the cause of death. In two other cases, bodies were found in advanced stage of decay changes - firstly, a dead body of man was found immersed to the middle of the body in a metal barrel full of rainwater, which presumed asphyxia by drowning; and secondly, a dead body of woman was found in the bush near highroad, where a syringe with unknown content was found near the body, which led to the suspicion of an overdose from a foreign substance. In the first case, the autopsy clearly confirmed that the death occurred as a result of the conduct of another person - throttling. The finding of medical examiner of the second case was a firearm injury of the head. In the last two cases, injuries from the effect of sharp instruments were found. The aim of the work was to demonstrate substantial discrepancies between autopsy findings of medical examiner and the findings of crime scene investigating physician. These findings point out at the importance of on-site inspection of the body as a unique and unrepeatable act and at no less importance of autopsy as an irreplaceable investigative method. Demonstrated cases point to the fact that putrid changes may mask serious mechanical damages, such as cutting or stabbing wounds. Finally, we can assume that the phenomenon of under-performed examination negatively affects the work of law enforcement.

Analysis of Discrepancies Between External Body Examination and Forensic Autopsy

At present in France, most of the medico-legal investigations are restricted to death scene investigation, which means there is only an external body examination without subsequent autopsy. The aim of our study was to show the limits of death scene investigation by establishing the rate of discrepancies between the results of external body examination and forensic autopsy.A retrospective study was carried out on 200 autopsy cases which were all preceded by death scene investigation and performed in 2002. For each case, age, sex, body weight, body state, place, and time of death were reported. The number of recent trauma lesions detectable at external body examination and at autopsy was studied. Conclusions about manner and cause of death between death scene investigation and autopsy were also studied. Discrepancy rate about interpretation of the lesions seen at external body examination and at autopsy was determined. Discrepancy between minor external trauma lesions and severe internal trauma lesions was also studied.The mean age of the studied population was 42.4 years. Sex ratio was 2.2. External body examination was limited by body state in 32% of the cases. The mean number of recent external trauma lesions recorded at autopsy was significantly higher than those recorded during death scene investigation. Manner and causes of death were undetermined after death scene investigation in 54.5% and 49% of the cases, respectively. When the cases were determined by death scene investigation, discrepancy rate, respectively, was 5% and 9% of all cases (n = 200) for manner and causes of death.Death scene investigation even carried out by a well-trained forensic physician is not reliable relative to cause and manner of death. Our study underlines the necessity in the future to perform more forensic autopsies in France, relying on the European harmonization of medico-legal autopsy rules.

Carbon-monoxide poisoning in young drug addicts due to indoor use of a gasoline-powered generator

We report six fatal cases of unintentional carbon-monoxide poisoning which occurred in a house occupied by young people. The source of carbon monoxide was a gasoline-powered generator. For all victims, an external body examination was carried out and blood and urine samples collected. Blood carboxyhaemoglobin (COHb) was performed using an automated visible spectrophotometric analysis. Blood-alcohol level quantification was performed using gas chromatography and drug screening in urine was performed by a one-step manual qualitative immunochromatography (Syva Rapid test, Behring Diagnostics Inc.) for benzoylecgonine (the main metabolite of cocaine in urine), morphine, 11-nor-Delta(9)-THC-9-COOH (cannabinoids) and d-methamphetamine. In all victims the COHb value was as high or higher than 65%. No alcohol was found in blood samples, but urine samples were positive for methamphetamine, cocaine and cannabis in five cases and for opiates in one case. In four victims, the urine sample was positive for at least three drugs. The availability and accuracy of rapid toxicological screening is an important tool for the medical examiner at the immediate scene of a clinical forensic examination.