Possible Cause Of Death Research Articles

Deaths and clashes induced by rivalry among fans during FIFA World Cup 2022 in Bangladesh.

International sports events like the Football World Cup affect the collective emotions of the global community. Usually, major sports events like the Football World Cup show beneficial effects on the community. However, many unwanted consequences such as accidents, premature deaths and violent supporter rivalries have been noticed during it. We aimed to report preventable premature deaths and clashes induced by rivalry among fans during the FIFA World Cup 2022 in Bangladesh. We monitored local newspaper reports for data collection during the World Cup 2022 event and collected data for age, sex, the possible cause of death, and precipitating events related to the event. We found 23 World Cup Football-related deaths, 35 hospitalizations, and 45 injuries related to clashes between the rival fans of Argentina and Brazil. The median age of deceased was 20 years. The majority of the deaths happened in young males due to fall while hoisting flags. Deaths in the late age happened due to sudden emotional upsurge during the game day. And, clashes between rival fans mostly happened due to social bullying favoring and disfavoring a team. This report indicates an important area of potentially preventable death related to World Cup Football and warrants public health attention even in a non-participating country, both locally and internationally.

Foreign body pulmonary vessel embolism and granulomatosis in intravenous drug abuse: An autopsy study.

The abuse of illicit drugs causes a myriad of systemic complications. Intravenous (IV) injection of such drugs poses various additional threats, primarily due to the use of excipient materials in them. Pulmonary artery embolism with foreign material and granulomatosis may be encountered in the lungs on histopathological examination in such cases. In this study, we aimed to analyze the histopathological findings in lungs in postmortem specimens with suspected IV drug abuse. This was a retrospective study of 5 years in which 15 cases of known or suspected history of drug abuse were assessed. The clinical details were compiled, and the hematoxylin and eosin (H and E)-stained microscopic slides were retrieved from the archives for reviewing the histopathological features in lungs submitted for postmortem analysis. All the cases were male, aged 21 to 36 years (median: 27 years). Gross examination revealed edematous lungs in four cases (26.6%). On microscopic examination of the lungs, all the cases (100%) showed the presence of basophilic irregular structures to rod-like pale crystalline refractile material, which was accompanied by a granulomatous reaction in the lumen of the pulmonary arteries. Four of these cases (26.6%) showed birefringence on polarizing microscopy. The use of illicit drugs is becoming widespread, especially among young individuals. IV drug abuse increases the rate of morbidity and mortality by affecting primarily the pulmonary vasculature, particularly pulmonary arteries. An acquaintance with the various patterns of pulmonary involvement in IV drug abuse is essential to arrive at an accurate pathological diagnosis and provide a possible cause of death in such cases.

Long‐term (29‐year) spatiotemporal patterns of sea turtle deaths in the southern Gulf of Mexico

Abstract Sea turtles are key imperilled species that interact with numerous threats in their critical in‐water and inland habitats, which they occupy along their complex life cycle. Therefore, analysing these interactions is essential for adapting ongoing conservation and management actions. The long‐term recording of stranded sea turtle individuals and the potential causes of death in their breeding habitats is crucial for defining and adapting conservation actions. Twenty‐nine years of sea turtle stranding and mortality data (1992–2019) at nesting beaches in Campeche, Mexico, were analysed to describe their spatiotemporal patterns per species and possible causes of death. The most impacted species was the hawksbill turtle, followed by green and Kemp's ridley individuals. The most frequent probable causes of death in this region were bycatch, seismic surveys, vehicle strikes and slaughter at nesting beaches. Both immature and breeding individuals were stranded, mostly the former, and the most frequent months were in the summer (June–August). This study establishes a historic reference baseline for the spatiotemporal mortality patterns of imperilled sea turtle species in the southeastern Gulf of Mexico. It shows their interactions with anthropogenic activities and the circumstances jeopardizing their population recovery. It also points out management and conservation actions to implement to improve their long‐term viability in the context of the operationalization of their key attributes and interactions with their seascapes.

From rare events to systematic data collection: the RESCUED registry for sudden cardiac death in the young in Germany.

Approximately one-third of sudden cardiac deaths in the young (SCDY) occur due to a structural cardiac disease. Forty to fifty percent of SCDY cases remain unexplained after autopsy (including microscopic and forensic-toxicological analyses), suggesting arrhythmia syndromes as a possible cause of death. Due to the possible inheritability of these diseases, blood relatives of the deceased may equally be carriers of the causative genetic variations and therefore may have an increased cardiac risk profile. A better understanding of the forensic, clinical, and genetic data might help identify a subset of the general population that is at increased risk of sudden cardiac death. The German registry RESCUED (REgistry for Sudden Cardiac and UnExpected Death) comprises information about SCDY fatalities and clinical and genetic data of both the deceased and their biological relatives. The datasets collected in the RESCUED registry will allow for the identification of leading causes of SCDY in Germany and offer unique possibilities of scientific analyses with the aim of detecting unrecognized trends, risk factors, and clinical warning signs of SCDY. In a pilot phase of 24months, approximately 180 SCDY cases (< 50years of age) and 500 family members and clinical patients will be included. RESCUED is the first registry in Germany collecting comprehensive data of SCDY cases and clinical data of the biological relatives reviewed by cardiac experts. RESCUED aims to improve individual risk assessment and public health approaches by directing resources towards early diagnosis and evidence-based, personalized therapy and prevention in affected families. Trial registration number (TRN): DRKS00033543.

Fatal child abuse detected by systematic post-mortem fundus photograph in sudden death in infancy

In living children, the use of a wide field fundus camera such as RetCam is the gold standard practice to document retinal haemorrhages in suspected cases of abusive head trauma (AHT). In case of sudden unexpected death in infancy (SUDI), child abuse must be considered as a possible cause of death and an eye examination is required. However, no example of post-mortem fundus photograph (PMFP) of retinal haemorrhages related to AHT is yet available for clinicians.We report a SUDI case, with no external traumatic lesions or limb fractures, for which prompt PMFP showed retinal haemorrhages typical of AHT: child abuse was subsequently confirmed by the forensic investigation. We discuss why PMFP is a relevant screening test to detect retinal haemorrhages in the case of SUDI and why the use of the RetCam should be further investigated.

Efficacy and safety of mesenchymal stem cell-derived microvesicles in mouse inflammatory arthritis

ObjectiveTo determine the effective and safe intravenous doses of mesenchymal stem cells (MSCs)-derived microvesicles (MVs) and to elucidate the possible causes of death in mice receiving high-dose MVs. MethodsMVs were isolated from human MSCs by gradient centrifugation. Mice with collagen-induced arthritis were treated with different doses of intravenous MVs or MSCs. Arthritis severity, white blood cell count, and serum C-reactive protein levels were measured. To assess the safety profile of MSCs and MVs, mice were treated with different doses of MSCs and MVs, and LD50 was calculated. Mouse lungs and heart were assessed by live fluorescence imaging, histopathological measurements, and immunohistochemistry to explore the possible causes of death. Serum concentrations of cTnT, cTnI, and CK-MB were determined by ELISA. With the H9C2 cardiomyocyte cell line, cellular uptake of MVs was observed using confocal microscopy and cell toxicity was assessed by CCK-8 and flow cytometry. ResultsIntravenous treatment with MSCs and MVs alleviated inflammatory arthritis, while high doses of MSCs and MVs were lethal. Mice receiving a maximum dose of MSCs (0.1 mL of MSCs at 109/mL) died immediately, while mice receiving a maximum dose of MVs (0.1 mL of MVs at 1012/mL) exhibited tears, drooling, tachycardia, shortness of breath, unbalanced rollover, bouncing, circular crawling, mania, and death. Some mice died after exhibiting convulsions and other symptoms. All mice died shortly after injecting the maximum dose of MSCs. Histologically, mice receiving high doses of MSCs frequently developed pulmonary embolism, while those receiving high doses of MVs died of myocardial infarction. Consistently, the serum levels of cTnT, cTnI, and CK-MB were significantly increased in the MVs-treated group (P < 0.05). The LD50 of intravenous MVs was 1.60 × 1012/kg. Further, MVs could enter the cell. High doses of MVs induced cell apoptosis, though low concentrations of MVs induced cell proliferation. ConclusionsAppropriate dosages of MVs and MSCs are effective treatments for inflammatory arthritis while MVs and MSCs overdose is unsafe by causing cardiopulmonary complications.

Partial facial duplication (diprosopus): a case report and review of the literature

BackgroundDiprosopus, or craniofacial duplication, is a rare entity that occurs in approximately 1 in 180,000 to 15 million live births. The degree of duplication varies from complete facial duplication to small facial structure duplication like the nose and eye. The cause of diprosopus is unknown though there are proposed factors.Case presentationOur African patient was a term 72 hours old female neonate who was referred to our center with impression of lower facial duplication with two oral cavity that are located side to side separated by large soft tissue, she also had flat nasal bridge with widely separated nostrils and widely spaced eyes. Besides the facial malformation she had multiple episodes of vomiting with aspiration. Her blood tests were normal. Precontract brain computed tomography (CT) scan confirmed partially duplicated mandible and maxilla, two oral cavity separated by large fatty tissue, brain tissue were well formed and the only abnormality was corpus callosum agenesis and interhemispheric lipoma. In her stay at hospital nasogastric tube (NG) tube feed was initiated and started with antibiotics for aspiration pneumonia. After 25th day the neonatal passed away with possible cause of death being respiratory failure.ConclusionCraniofacial duplication is a very rare anomaly with only a few cases reported. Most of these patients are stillborn, even if they survive the prognosis is often poor. Early prenatal diagnosis is very important as termination of pregnancy can sometimes be considered an option.

Immune Dysfunction-Associated Elevated RDW, APACHE-II, and SOFA Scores Were a Possible Cause of 28-Day Mortality in Sepsis Patients.

To explore the early predictors and their predicting value of 28-day mortality in sepsis patients and to investigate the possible causes of death. 127 sepsis patients were included, including 79 cases in the survival group and 48 cases in the death group. The results of all patients on admission were recorded. After screening the risk factors of 28-day mortality, the receiver operating characteristic curve (ROC) was used to determine their predictive value for the 28-day mortality rate on admission, and the Kaplan-Meier curve was drawn to compare the 28-day mortality rate between groups. Finally, patients with cytokine and lymphocyte subsets results were included for investigating the possible causes of death through correlation analysis. APACHE II (acute physiology and chronic health evaluation II), SOFA (Sequential Organ Failure Assessment) and red blood cell distribution width (RDW) were the risk factors for 28-day mortality in sepsis patients (OR: 1.130 vs.1.160 vs.1.530, P < 0.05). The area under the curve (AUC), sensitivity and specificity of APACHE II, SOFA and RDW in predicting the mortality rate at 28 days after admission in sepsis patients were 0.763 vs 0.806 vs 0.723, 79.2% vs 68.8% vs 75.0%, 65.8% vs 89.9% vs 68.4%. The combined predicted AUC was 0.873, the sensitivity was 89.6%, and the specificity was 82.3%. The Kaplan-Meier survival curve showed that the 28-day mortality rates of sepsis patients with APACHE II≥18.5, SOFA≥11.5 and RDW≥13.8 were 58.5%, 80.5% and 59.0%, respectively. In the death group, APACHE II was positively correlated with SOFA, IL-2, and IL-10, and RDW was positively correlated with PLT, TNF-α, CD3+ lymphocyte count, and CD8+ lymphocyte count. Sepsis patients with high APACHE II, SOFA and RDW levels at admission have an increased 28-day mortality rate. The elevation of these indicators in dead patients are related to immune dysfunction.

The impact of chronic and acute problems on sea turtles: The consequences of the oil spill and ingestion of anthropogenic debris on the tropical semi-arid coast of Ceará, Brazil

Sea turtle mortality is often related to materials that reach the coast from different anthropic activities worldwide. This study aimed to investigate whether sea turtle mortality was related to older marine problems, such as solid waste, or one of the largest oil spill accidents on the Brazilian coast, that occurred in 2019. We posed three questions: 1) Are there solid residues in the digestive tract samples, and which typology is the most abundant? 2) Can meso‑ and macro-waste marine pollutants cause mortality? 3) Is the dark material found really oil? A total of 25 gastrointestinal content (GC) samples were obtained, of which 22 ingested waste of anthropogenic origin and 18 were necropsied. These 22 samples were obtained during or after the 2019 oil spill, of which 17 specimens were affected, making it possible to suggest oil ingestion with the cause of death in the animals that could be necropsied. Macroscopic data showed that the most abundant solid waste was plastic (76.05 %), followed by fabrics (12.18 %) and oil-like materials. However, chemical data confirmed only three specimens with oil levels ranging from remnants to high. It was possible to infer possible causes of death in 16 of the total 18 necropsied cases: Most deaths were due to respiratory arrest (62.5 %), followed by pulmonary edema (12.5 %), cachexia syndrome (12.5 %), circulatory shock (6.25 %), and head trauma (6.25 %), which may have been caused by contact with solid waste, oil, or both. The study showed that not all dark material found in the GCs of turtles killed in oiled areas is truly oil, and in this sense, a chemical analysis step to prove the evidence of oil must be added to international protocols.

Survival rates of wild and released White‐rumped Vultures (Gyps bengalensis), and their implications for conservation of vultures in Nepal

Beginning in the mid‐1990s, populations of three species of Gyps vultures declined by more than 97% in South Asia in little more than a decade, caused by unintentional poisoning by the non‐steroidal anti‐inflammatory drug (NSAID) diclofenac. This led to a ban on the veterinary use of the drug, and establishment of conservation breeding programmes, throughout the region. Once much of Nepal had been confirmed as being free from diclofenac, beginning in 2017 White‐rumped Vultures Gyps bengalensis were released from the captive breeding population. A total of 99 birds (n = 50 wild and n = 49 released) were fitted with GPS transmitters between 2017 and 2022 and monitored daily. Tag fixes suggesting death or ill‐health were followed up and dead vultures were retrieved for post‐mortem analysis. The estimated annual survival of wild adult vultures was 0.974 (95% confidence interval [CI] 0.910–0.997), while that of wild subadults was 0.880 (95% CI 0.721–0.966). Survival rates of released birds were lower than those of wild birds, being 0.644 (95% CI 0.490–0.778) for adults and 0.758 (95% CI 0.579–0.887) for subadults. Post‐mortem analysis of dead vultures indicated several possible causes of death, including predation, infection and electrocution. There was no evidence that any birds died of NSAID poisoning. The high survival rates of wild birds, especially adults, and the lack of evidence for NSAID‐caused mortality, suggest that vulture habitat in the Nepal Vulture Safe Zone is free from diclofenac and that other hazards are sufficiently infrequent to allow the vulture population to recover. The lower survival of released birds compared with their wild counterparts suggests a need to improve the conservation breeding programme and release protocol.

Autopsy findings in cases of fatal COVID-19 vaccine-induced myocarditis.

COVID-19 vaccines have been linked to myocarditis, which, in some circumstances, can be fatal. This systematic review aims to investigate potential causal links between COVID-19 vaccines and death from myocarditis using post-mortem analysis. We performed a systematic review of all published autopsy reports involving COVID-19 vaccination-induced myocarditis through 3 July 2023. All autopsy studies that include COVID-19 vaccine-induced myocarditis as a possible cause of death were included. Causality in each case was assessed by three independent physicians with cardiac pathology experience and expertise. We initially identified 1691 studies and, after screening for our inclusion criteria, included 14 papers that contained 28 autopsy cases. The cardiovascular system was the only organ system affected in 26 cases. In two cases, myocarditis was characterized as a consequence from multisystem inflammatory syndrome. The mean age of death was 44.4years old. The mean and median number of days from last COVID-19 vaccination until death were 6.2 and 3days, respectively. We established that all 28 deaths were most likely causally linked to COVID-19 vaccination by independent review of the clinical information presented in each paper. The temporal relationship, internal and external consistency seen among cases in this review with known COVID-19 vaccine-induced myocarditis, its pathobiological mechanisms, and related excess death, complemented with autopsy confirmation, independent adjudication, and application of the Bradford Hill criteria to the overall epidemiology of vaccine myocarditis, suggests that there is a high likelihood of a causal link between COVID-19 vaccines and death from myocarditis.

Fatal bleeding following scalp laceration: an uncommon cause of death in adults

ABSTRACT Any wound of the scalp involving the subcutaneous layer may cause profuse bleeding. In such cases, haemorrhage may continue for a while because the natural tension of the scalp inhibits effective haemostasis. In addition, if special conditions coexist, this bleeding may lead to death. We described three cases of haemorrhagic shock by scalp lacerations. An 83-year-old man was found dead in his home lying on a large amount of blood on the floor. He had plenty of comorbidities and a multi-drug therapy, as anticoagulant. A 53-year-old heavy drinker man was found dead in his home with the bathroom and bedroom extensively smeared with blood. A 55-year-old woman with multiple sclerosis was hit in the face by a large stone while she was sitting on her car seat. A toxicological exam on blood revealed benzodiazepines at therapeutic levels. The most relevant conditions that must be present for a scalp laceration to become fatal are unwitnessed head trauma, delayed activation of emergency services, old age, comorbidities, anticoagulant medication, alcohol abuse and significant blood loss from the scalp wound. Other possible causes of death should be excluded. Furthermore, in such cases, the differentiation between homicide and accident can be challenging.

The "angioletti" of Palermo: the health and development of mummified non-adults in late modern Palermo, Sicily (1787-1880 CE).

The Capuchin Catacombs in Palermo, Sicily, have been home to non-adult mummified remains since the seventeenth century CE. Despite the increasing numbers of scientific studies conducted at this site, very little research has focused specifically on the youngest members of late modern (1787-1880 CE) society. This research aims to redress the balance by examining 43 individuals to gain insight into the demographic profile of mummified non-adults, to characterize their health status and possible cause of death, and to better understand the funerary treatment offered to the youngest members of society. A portable X-ray unit was used to capture anteroposterior and lateral images of each mummy; this facilitated age estimation, the identification of pathological and/traumatic lesions, and evidence of conservation and the mummification process more generally. This study revealed that regardless of age and health status at the time of death, the mortuary rite performed was primarily influenced by the wealth and social standing of the deceased's kin. No demographic trends were observed in the data and the lack of evidence of metabolic, neoplastic, and traumatic bone lesions suggest these non-adults died from short-term, acute illnesses. Even when individuals did display evidence of chronic health conditions that would have impacted their day-to-day lives (e.g., B035), they were not excluded from this mortuary tradition on the basis of their long-term health and care requirements in life. Artifacts were found with all individuals examined and were associated with the mummification process, conservation of mummies, and/or their display. This research has ultimately demonstrated that non-invasive imaging can be used to gain a more comprehensive understanding of the lives and deaths of non-adults inhabiting late modern Palermo.

Noninvasive postmortem investigation of cases refusing autopsy using computed tomography

Background: CT is a well-known tool to assess several conditions in living patients. The post-mortem CT (PMCT) has been introduced to determine the cause of death in dead subjects. CT is also the imaging modality of choice for the analysis of autopsy findings including fracture, hematoma, gas collection and gross tumor injury. The rate of standard autopsy is continuing to decline and there are several reasons for refusing autopsy. Objective: The current research endeavor is investigate the usefulness of computed tomography (CT) in cases refusing autopsy. Materials and Methods: In this study, the PMCT were evaluated in 150 subjects in different contexts of death. The causes of death were classified into four categories which include a definite cause of death, a possible cause of death, a minor pathological finding and no fatal findings. For the definite cause of death and the possible cause of death, the specific lesions are described in detail. Results: The definite cause of death was detected in 48 (32%) of the subjects. The possible cause of death was detected in 18 (12%) of the subjects. The remaining 84 subjects were classified into minor pathological findings and no fatal findings in 46 (30.7%) and 38 (25.3%) of the patients, respectively. The fatal lesions of PMCT were found in 93 lesions(48 subjects) that were demonstrated by anatomical locations into the traumatic bone, intracranial, spine, thoracic, heart leak and abdominal lesions. We found definite causes of death in 6 subjects, which had no history of trauma and malignancy and were mentioned about a cardiopulmonary failure as a cause of death at first. Conclusion: The PMCT is a useful tool for identifying the cause of death in many cases that have limitations for conventional autopsy. The morphological change such as intracranial hemorrhage is easily diagnosed with PMCT. The PMCT appears to be an alternative tool to assess the cause of death in any reason of objections.

Outcome of paraquat poisoning patients admitted in a tertiary hospital in Bangladesh

Background: Paraquat Poisoning is not unknown in clinical practice. However, the data from our country is scanty. Therefore, to find the outcome of paraquat poisoning in a tertiary level hospital was the objective of this study. Methods: The study was a longitudinal descriptive study and conducted at department of Medicine, Rajshahi Medical College Hospital. Patients of paraquat poisoning were approached for inclusion. Informed written consent was taken from the patients and/or attendants. Data were collected by face-to-face interview by the researcher with an aid of a semi-structured questionnaire. All available investigation reports, follow up notes, discharge papers and death certificates were scrutinized. A total 30 patients were included in this study. Results: Total 30 subjects were interviewed. Mean age was 25.33±8.86 (SD) years with female to male ratio-2:1.Majority were from rural area (90%). About 94% consumed with an intention of suicide. Most of the patients had renal impairment (53.3%) and hepatic impairment (50%) as complication. 63.3% patients reached to hospital &gt;12 hours after ingestion of poison and 36.7% reached within 12 hours. Of all, 33.3% (n=10) patients survived. Possible cause of death were Multi organ failure (MOF) (40.0%), Acute renal failure (25.0%), ARDS (15.0%) and Hepatic failure (20.0%). However, overall outcome is not dependent with to time reaching hospital after poisoning but with amount of poison ingested (p&lt;0.05). Conclusion: About 67% patients died following ingestion of the paraquat poisoning and it is not dependant with the time required to reach the hospital rather to the amount of poison ingested. TAJ 2023; 36: No-2: 35-46

Scurvy complicated with Capnocytophaga sputigena sepsis as a possible cause of death of king Saint-Louis of France (1270 AD)

The cause of death of Saint-Louis is not known, but recent findings indicated that he presented scurvy and inflammatory jaw disease, which has been associated with infection by oral commensals. Here, we have the exceptional opportunity to analyze the relics of the viscera of King Saint-Louis.A 4.3 g sample from the viscera relics of King Saint-Louis conserved in Versailles’ cathedral was subjected to radiocarbon dating, electronic and optic microscopy, and elementary, palynological, molecular, proteomics and microbiological analyses including specific PCR and v3v4 16 S rRNA gene amplification prior to large-scale sequencing using an Illumina MiSeq instrument.The measured radiocarbon age was Cal 1290 CE–1400, which was compatible with that of the viscera of St Louis viscera, considering the addition of lime, incense and vegetables within the human organs. Elemental and palynological analyses confirmed a medieval embalming process. Proteomics analysis identified mainly human muscle and blood proteins. Specific PCR for plague, amoebiasis, shigellosis and typhoid fever was negative. C. sputigena was identified as the main pathogenic species representing 10.8 % of all microbial sequences. In contrast, C. sputigena was found in only 0.001 % of samples sequenced in our center, and the 23 positive human samples showed a dramatically lower abundance (0.02–2.6 %). In the literature, human infections with C. sputigena included odontitis, dental abscess, sinusitis, thoracic infections and bacteremia, particularly in immunocompromised patients with oral and dental diseases consistent with recent analysis of King Saint-Louis’ jaw.C. sputigena, a commensal of the mouth that is potentially pathogenic and responsible for fatal bacteremia, may have been the cause of the king's death.

A Forensic Case of Suicide Ingestion of Paraquat Herbicide: New Histological Insights and Revision of the Literature.

Paraquat (PQ) is one of the most widely used herbicides in the world, and poisoning is generally associated with accidental, suicidal, or homicidal events. Therefore, in the forensic context, PQ could be in various ways involved as a possible cause of death of a subject. However, even though its systemic toxicity is known, the biological effects exerted on individual viscera have been explored only to some extent, especially in case of victim's survival. Therefore, a case concerning a suicidal ingestion of PQ with survival of 3 days was deemed of interest. Clinical toxicological analyses confirmed acute PQ intoxication, and after the death of the victim, an autopsy was performed showing local and systemic signs of ingestion of a caustic substance. Histologic examination revealed marked cellular damage to the major viscera, particularly the gastroesophageal tract, liver, kidneys, and lungs, with initial alveolar fibrosis noted despite the patient's short survival. This finding represents a new element in the context of PQ lung injury, as it has not been previously documented in the literature. Thus, histological findings in lethal intoxications after survival can reveal specific peculiarities still unknown and, therefore, assume transversal relevance not only at forensic but also clinical level.

Interpretative problems due to the presence of chloromethcathinone isomers in the biological material from post-mortem cases.

While many NPSs often disappear from the drug market rather quickly, some, such as synthetic cathinones (SCs), still remain due to their popularity among users. The current knowledge of SCs concentrations in blood samples is based mainly on the published case reports of intoxications or fatalities caused by SCs intake. The aim of the present study was to present and interpret the obtained toxicological analysis results of these cases, in which it was possible to determine or detect the presence of one of the isomers of chloromethcathonone (CMC) along with its intake biomarker - dihydro-CMC. These cases include 27 deaths reported at the Department of Forensic Medicine in [name deleted to maintain the integrity of the review process] in 2016-2022. CMC constitute a major toxicological opinion challenge, in terms of toxicological evaluation of poisonings. As presented in this paper, a significant problem is its stability in the biological material and practices in the reporting of the obtained data. It is therefore important to monitor potential intake biomarkers that may show greater stability in the biological material than parent drug. In the case of CMC isomers, the good biomarker of intake is the dihydro-CMC metabolite, which was detected in the blood sample in every case presented, even with the absence of the parent substance. Interpretation of the results obtained for CMC in terms of assessing their toxicity and possible cause of death is difficult. However, it should be taken into account that in cases of NPS poisoning, an in-depth risk assessment is mandatory and the opinion of the unpredictability of the effects is taken as a principle.

Sudden unexpected death in epilepsy: A critical view of the literature.

Sudden unexpected death in epilepsy (SUDEP) is a sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death, occurring in benign circumstances, in an individual with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus in which postmortem examination does not reveal other causes of death. Lower diagnostic levels are assigned when cases met most or all of these criteria, but data suggested more than one possible cause of death. The incidence of SUDEP ranged from 0.09 to 2.4 per 1000 person-years. Differences can be attributed to the age of the study populations (with peaks in the 20-40-year age group) and the severity of the disease. Young age, disease severity (in particular, a history of generalized TCS), having symptomatic epilepsy, and the response to antiseizure medications (ASMs) are possible independent predictors of SUDEP. The pathophysiological mechanisms are not fully known due to the limited data available and because SUDEP is not always witnessed and has been electrophysiologically monitored only in a few cases with simultaneous assessment of respiratory, cardiac, and brain activity. The pathophysiological basis of SUDEP may vary according to different circumstances that make that particular seizure, in that specific moment and in that patient, a fatal event. The main hypothesized mechanisms, which could contribute to a cascade of events, are cardiac dysfunction (included potential effects of ASMs, genetically determined channelopathies, acquired heart diseases), respiratory dysfunction (included postictal arousal deficit for the respiratory mechanism, acquired respiratory diseases), neuromodulator dysfunction, postictal EEG depression and genetic factors.

In the case of extensively putrefied bodies, the analysis of entomological samples may support and complement the toxicological results obtained with other alternative matrices

Entomotoxicological analysis is not part of routine toxicological analysis. This work aims to present two cases to illustrate the potential of entomological samples as complementary matrices to identify substances in cases of advanced putrefaction. (Case#1) A woman wasexhumed after 14 months to ascertain the exact cause of death. She died after six weeks of hospitalization because of intestinal ischemia followed by multiorgan failure. (Case#2) The corpse of a woman, known to have a psychiatric disorder, was discovered in her apartment. The state of decomposition of the body was consistent with a post-mortem period of several weeks (approximately 6 weeks). Toxicological investigations were performed in the biological and entomological samples of case#1 (hair, adipocere, brain, and pupae) and of case#2 (hair, bone, flies, and pupae) using liquid chromatography with high-resolution mass spectrometry and tandem mass spectrometry detection methods. In case#1, several drugs and metabolites were detected. In particular, the pupae analyses allowed the objectification of morphine administration, whereas morphine was only found in adipocere, but not in hair nor in brain. In case#2, the pupae analyses allowed the detection of three metabolites of quetiapine, and the flies analyses allowed the detection of valpromide, which was only detected in hair. In conclusion, the pupae and flies analyses in these two cases complemented the results obtained in the other alternative biological samples, which may guide hypotheses about the possible causes of death. Nevertheless, additional data and case reports would be of benefit to assess the value of entomotoxicology in routine forensic investigations.