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Ushida H, Suzumura A, Yamada K, Shimizu H, Suzuki A, Ishikawa Y, Kikuchi R, Nishiguchi KM, Kaneko H. Decrease in electrolyte after vitrectomy surgery may affect the results of forensic investigations using vitreous humor. BMC Ophthalmol 2024; 24:219. [PMID: 38783230 PMCID: PMC11118106 DOI: 10.1186/s12886-024-03445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Vitreous humor (VH) is used for postmortem biochemical studies because it is well protected in an uncontaminated state even after death. The goal of this research was to investigate electrolyte concentrations in the VH from human eyes with and without a history of vitrectomy surgery. METHODS We analyzed the sodium (Na), potassium (K), chloride (Cl) and magnesium (Mg) concentrations from 34 VH samples from 34 patients. Eleven samples were from eyes with a history of vitrectomy, and the remaining 23 eyes had no history of vitrectomy. The correlations of Na, K, Cl and Mg concentrations with patient age, interval between first and second vitrectomy, and lens status (history of cataract surgery) were also evaluated. RESULTS The Na, K, Cl and Mg concentrations in VH from vitrectomized eyes were 134.1 ± 7.9 mmol/L, 3.7 ± 0.2 mmol/L, 99.7 ± 6.7 mmol/L and 0.59 ± 0.09 mmol/L, respectively; all were significantly lower than the corresponding concentrations in VH from control eyes (lower by 5.0%, 11.0%, 11.7%, and 22.6%, respectively). Na, K, Cl and Mg concentrations in VH from vitrectomized eyes did not show significant correlations with patient ages or the interval between their first and second vitrectomies. There were no significant differences in Na, K, Cl and Mg concentrations in VH between phakic eyes and intraocular lens-implanted eyes. CONCLUSIONS With the increasing number of vitrectomies being performed, it is necessary to consider the history of vitrectomy when using a subject's VH in forensic examination.
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Affiliation(s)
- Hiroaki Ushida
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Kazuhisa Yamada
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Hideyuki Shimizu
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Atsuo Suzuki
- Department of Clinical Laboratory, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Yusuke Ishikawa
- Department of Clinical Laboratory, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Ryosuke Kikuchi
- Division of Clinical Laboratory, Gifu University Hospital, 1-1 Yanagido, 501-1194, Gifu City, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan.
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Tumlinson AR, Calara JM, Azar DT, Adamis AP, Vavvas DG, Stewart JM. Feasibility demonstration of a device for vitreous liquid biopsy incidental to intravitreal injection. PLoS One 2024; 19:e0294526. [PMID: 38241211 PMCID: PMC10798501 DOI: 10.1371/journal.pone.0294526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/01/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE VitreoDx is an experimental device enabling push-button collection of a neat vitreous liquid biopsy incidental to an intravitreal injection. We explored the ability of the device to collect a sample usable for proteomic biomarker discovery and testing. DESIGN Pilot study using ex vivo human eyes. METHODS Non-vitrectomized, human eyes from nine donors 75-91 years of age were refrigerated in BSS and used within 5 days of death. Four VitreoDx devices fitted with 25G needles, and four staked needle insulin syringes with 30G needles, were inserted at equal intervals through the pars plana of each eye and held in place by a fixture. The sampling mode of each VitreoDx device was triggered to attempt to acquire a liquid biopsy up to 70 μL. The plunger of each insulin syringe was retracted to attempt to obtain a liquid biopsy with a maximum volume of 50 μL. Samples acquired with the VitreoDx were extracted to polypropylene cryovials, refrigerated to -80 ºC, and sent for offsite proteomic analysis by proximity extension assay with a focus on panels containing approved and pipelined drug targets for neovascular disease and inflammatory factors. RESULTS Of the attempted liquid biopsies with the novel 25G VitreoDx, 92% (66 of 72) resulted in successful acquisition (>25 μL) while 89% (64 of 72) attempted by a traditional 30G needle resulted in a successful acquisition. Sample volume sufficient for proteomics array analysis was acquired by the VitreoDx for every eye. Detectable protein was found for 151 of 166 unique proteins assayed in at least 25% of eyes sampled by VitreoDx. CONCLUSIONS The high acquisition rate achieved by the prototype was similar to that achieved in previous clinical studies where a standard syringe was used with a 25G needle to biopsy vitreous fluid directly prior to standard intravitreal injection. Successful aspiration rates were likewise high for 30G needles. Together, these suggest that it is possible to routinely acquire liquid vitreous biopsies from patients who typically receive intravitreal injections with an injection device using a standard size needle without a vitreous cutter. Protein analysis shows that proteins of interest survive the sampling mechanism and may have potential to direct care in the future.
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Affiliation(s)
- Alexandre R. Tumlinson
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
| | - Jennifer M. Calara
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
| | - Dimitri T. Azar
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
| | - Anthony P. Adamis
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Demetrios G. Vavvas
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
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Auen T, Linde E. Do Not Turn a Blind Eye on Forensic Biochemistry: Using Vitreous Electrolytes to Reveal Renal Insufficiency as Cause of Death. Am J Forensic Med Pathol 2024:00000433-990000000-00148. [PMID: 38215054 DOI: 10.1097/paf.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
ABSTRACT In both medical and forensic autopsy, the kidneys may be overlooked grossly and histologically. As both acute and chronic kidney dysfunction have major implications on morbidity and mortality, it is essential to consider the kidneys as a pathologic source for both immediate and proximate cause of death. For decades, vitreous humor has been used as a measure of postmortem electrolyte analysis to help understand ionic disturbances carried over from the antemortem period. Renal insufficiency from both acute and chronic kidney dysfunction can be ascertained from vitreous investigations and should be a consideration for cause of death. Here, we present 4 cases in which vitreous analysis was used to determine the cause of death. In highlighting these cases, we support the use of biochemical testing in autopsy while demonstrating how it can help elucidate an often overlooked means of mortality. Importantly, it can help with the formulation of clinicopathologic correlations between antemortem and postmortem findings.
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Affiliation(s)
- Thomas Auen
- From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Erin Linde
- Physicians Laboratory Services, Omaha, NE
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Kriikku P, Ojanperä I, Lunetta P. Ethylene glycol poisoning may be associated with elevated post-mortem vitreous glucose level. Leg Med (Tokyo) 2023; 64:102279. [PMID: 37295315 DOI: 10.1016/j.legalmed.2023.102279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
Ethylene glycol (EG) is a toxic chemical that is sometimes used as ethanol substitute. Besides the desired intoxicating effects, the intake of EG may often lead to death unless timely treatment measures are provided by medical professionals. We examined 17 fatal EG poisonings between 2016 and March 2022 in Finland in terms of forensic toxicology and biochemistry results and demographic information. Most of the deceased were male and the median (range) age was 47 (20-77) years. Of the cases, 6 were suicides, 5 accidents and in 7 cases the intent remained undetermined. In all cases, vitreous humour (VH) glucose was above the limit of quantitation 0.35 mmol/L (mean: 5.2 mmol/L; range 0.52-19.5 mmol/L). Other markers of the glycaemic balance were within the normal range in all except one case. As EG is not routinely screened for in most laboratories but only analysed in cases where the intake of EG is suspected, some fatal EG poisonings may remain unrecognised in post-mortem (PM) investigations. Although various conditions may induce hyperglycaemia, it is worthwhile keeping in mind that elevated PM VH glucose levels that cannot be otherwise explained may suggest intake of ethanol substitutes.
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Affiliation(s)
- Pirkko Kriikku
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland; Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland.
| | - Ilkka Ojanperä
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland; Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland
| | - Philippe Lunetta
- Department of Biomedicine, Forensic Medicine, University of Turku, Finland; Department of Forensic Medicine, Research Unit of Internal Medicine, University of Oulu, Finland
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Xiong L, Zhang J, Li D, Yu H, Tian T, Deng K, Qin Z, Zhang J, Huang J, Huang P. FTIR microspectroscopy of renal tubules for the identification of diabetic ketoacidosis death. Microchem J 2023. [DOI: 10.1016/j.microc.2023.108532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Simon G. Detection of Fatal Potassium Overdose: A Case Report and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13071339. [PMID: 37046560 PMCID: PMC10093193 DOI: 10.3390/diagnostics13071339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Potassium overdose usually occurs accidentally, but potassium is also used for judicial executions, assisted death, and, rarely, suicides. In addition to exogenous overdose, various drugs, and renal failure, diabetic ketoacidosis can cause hyperkalemia. Potassium tablets are used in most cases of suicidal potassium overdose. Suicide by intravenous administration of potassium is rare but usually fatal. The author reports a rare case of suicide with potassium infusion. Autopsy and histology findings, along with post-mortem biochemical analysis of different body fluids and fluid from the infusion set, are reported. Previously published reports of potassium overdose were reviewed, and the detection possibilities of potassium overdose are discussed. The detection possibilities of lethal hyperkalemia are very limited since hyperkalemia produces only nonspecific autopsy and histology findings. Post-mortem potassium concentrations are not indicative of ante-mortem potassium concentrations; therefore, post-mortem biochemical analysis has limited value in determining potassium overdose. The best way to prove potassium overdose is via the collection and analysis of circumstantial evidence.
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Affiliation(s)
- Gábor Simon
- Department of Forensic Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
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7
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Kutlu E, Çil N, Avci E, Bir F, Kiliç İD, Dereli AK, Acar K. Significance of postmortem biomarkers and multimarker strategy in sudden cardiac death. Leg Med (Tokyo) 2023; 61:102212. [PMID: 36738552 DOI: 10.1016/j.legalmed.2023.102212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 12/25/2022] [Accepted: 01/29/2023] [Indexed: 02/02/2023]
Abstract
The most common cause in the etiology of sudden cardiac death (SCD) is ischemic heart disease due to atherosclerosis. Postmortem diagnosis can be made by histopathological examinations, but routine histopathological examinations are limited, especially in the early period of postmortem ischemia. For this reason, many methods are being investigated for the postmortem diagnosis of ischemia, and postmortem biochemical studies are promising. In our study, we evaluated the biochemical markers; hs-cTnT, NT-proBNP, H-FABP, pentraxin-3, copeptin, ischemic modified albumin (IMA), and PAPP-A in postmortem serums. In forensic pathology practice, it was investigated whether it would be useful to go to the diagnosis by measuring more than one marker in a single biological fluid in SCD cases. The study included 35 sudden cardiac death cases and 24 control cases and as a result of our study, hs-cTnT, NT-proBNP, and H-FABP values were found to be significantly higher in the SCD group than in the control group. Within the scope of the multi-marker strategy, models were tried to be developed in which the markers were used together, and it was concluded that the model consisting of the myocardial ischemia marker hs-cTnT, the myocardial stress marker NT-proBNP, and the inflammation marker pentraxin 3 was the most accurate combination by correctly classifying the cases at a rate of 94.9%. As a result, it was thought that it would be appropriate to use the multi-marker strategy which is widely used in clinical applications, also in forensic medicine applications.
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Affiliation(s)
- Erdi Kutlu
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey
| | - Nazlı Çil
- Department of Histology, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
| | - Esin Avci
- Department of Biochemistry, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
| | - Ferda Bir
- Department of Pathology, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
| | - İsmail Doğu Kiliç
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey
| | - Ayşe Kurtuluş Dereli
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey
| | - Kemalettin Acar
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
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8
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Gwiti P, Davidson F, Beresford P, Gallagher PJ. Significant ketoacidosis at autopsy: a single-centre systematic review. J Clin Pathol 2023; 76:185-188. [PMID: 34980639 DOI: 10.1136/jclinpath-2021-207681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/11/2021] [Indexed: 11/04/2022]
Abstract
AIM To examine the value of vitreous beta-hydroxybutyrate and serum acetone in the investigation of sudden unexpected death. METHODS Coroners' autopsy reports from a provincial UK city, with a population of approximately 900 000, over a 24-month period with significant ketoacidosis were studied. Demographic features, medical history, anatomical and histological findings, and biochemical parameters, including renal function, vitreous glucose, serum and vitreous alcohol, were analysed. RESULTS Forty-two cases (28 males and 14 females) were identified; 55% had a history of alcohol and/or substance misuse, and mental health problems, particularly depression and anxiety, and 16% were diabetic. In all, 50% of subjects had alcoholic ketoacidosis (AKA), 19% had diabetic ketoacidosis (DKA) and 12% had a history of both diabetes and alcohol abuse. In 19% of cases, an exact cause of ketoacidosis was established. In AKA, the subjects typically had low vitreous glucose and low or undetected blood alcohol levels. All of the subjects with raised vitreous glucose levels had DKA. CONCLUSION Ketoacidosis is relatively common and should be considered as a cause of sudden death, especially in alcoholic patients and patients with diabetes with no clear cause of death at autopsy.
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Affiliation(s)
- Paida Gwiti
- Department of Histopathology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Fiona Davidson
- Department of Clinical Biochemistry, Southmead Hospital, Bristol, UK
| | - Peter Beresford
- Department of Clinical Biochemistry, Southmead Hospital, Bristol, UK
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Manetti AC, Visi G, Spina F, De Matteis A, Del Duca F, Turillazzi E, Maiese A. Insulin and Oral Hypoglycemic Drug Overdose in Post-Mortem Investigations: A Literature Review. Biomedicines 2022; 10:2823. [PMID: 36359343 PMCID: PMC9687110 DOI: 10.3390/biomedicines10112823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2023] Open
Abstract
Background and Objectives: Insulin and oral hypoglycemic agents are drugs widely used in the world population due to their therapeutic effects on diabetes mellitus. Despite these benefits, they can also cause accidental or voluntary drug overdose. This review aims to evaluate post-mortem investigations in cases of suspected hypoglycemic drug overdose. Materials and Methods: We performed a comprehensive search using the Preferred Reporting Items for Systematic Review (PRISMA) standards; we systematically searched the PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EM-BASE) databases from the point of database inception until August 2022. The following inclusion criteria were used: (1) original research articles, (2) reviews and mini-reviews, (3) case reports/series, (4) and only papers written in English. Results: Thirty-three scientific papers, including original research articles, case reports, and case series, fulfilled the inclusion criteria. A total of 109 cases of insulin or hypoglycemic drug overdose were found. There were 71 cases of suicide (65%), 25 cases of accidental poisoning (23%), and 13 cases of homicide (12%). The most commonly used drug was insulin (95.4%). Autopsy and post-mortem examinations were performed in 84 cases, while toxicological investigations were performed in 79 cases. The most common gross findings in the autopsy were pulmonary edema (55.7%) and congestion (41.8%), while the most common histological finding was neuronal depletion or necrosis (29.1%). Conclusions: In the suspicion of death from insulin or overdose from oral hypoglycemic agents, autopsy findings may be nonspecific, and the search for injection marks can be positive at the external examination. Significant post-mortal alterations can interest biological samples and an early autopsy investigation is recommended.
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Affiliation(s)
- Alice Chiara Manetti
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Giacomo Visi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Federica Spina
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Emanuela Turillazzi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Aniello Maiese
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
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10
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Jones J, James S, Brown F, O'Neal D, I Ekinci E. Dead in bed - A systematic review of overnight deaths in type 1 diabetes. Diabetes Res Clin Pract 2022; 191:110042. [PMID: 36007797 DOI: 10.1016/j.diabres.2022.110042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Type 1 diabetes is a significant, life-long condition which affects many people worldwide. One of the most feared causes of type 1 diabetes mortality, overnight mortality, often caused by the dead in bed syndrome, is largely underreported. A systematic literature search was undertaken to understand the frequency, risk factors, causes and impact that diabetes-related technologies have on overnight mortality, in this population. METHODS MEDLINE (Ovid), Embase (Ovid) and Cochrane were searched to June 2021, using defined inclusion and exclusion criteria. Quality appraisal was undertaken. RESULTS Overall, 26 records met the inclusion criteria. Large-scale cohort studies examined data up to 2013, and there were no studies published after 2018. The proportion of deaths attributable to the dead in bed syndrome was between 2 and 5% of deaths in children, adolescents, and young adults, with a slight decrease in proportion of dead in bed syndrome since 1991. CONCLUSION Overnight mortality is occurring for people with type 1 diabetes, reported as recently as in 2018. Living alone, alcohol and illicit substances consistently appear as risk factors, and the impact of technology on overnight mortality is not fully understood, with more recent data, from larger cohort studies being required.
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Affiliation(s)
- Jessica Jones
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Endocrinology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Steven James
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 1 Moreton Parade, Petrie, Queensland 4502, Australia
| | - Fran Brown
- Melbourne Diabetes Education & Support, 76 Edwin St, Heidelberg Heights, Victoria 3081, Australia
| | - David O'Neal
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Endocrinology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Elif I Ekinci
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Endocrinology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
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11
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Tijssen MPM, Hofman PAM, Robben SGF. Postmortem Fetal Temperature Estimation with Magnetic Resonance Imaging: Apparent Diffusion Coefficient Measurements in the Vitreous Body and Cerebrospinal Fluid. Top Magn Reson Imaging 2022; 31:25-30. [PMID: 36269228 DOI: 10.1097/rmr.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) is increasingly used in postmortem fetal imaging. Several factors influence the quality of MRI in this setting, such as small size, autolytic and maceration changes, and temperature. Knowing the fetal temperature at the time of scanning can improve the MRI interpretation. Temperature can be calculated using diffusion-weighted imaging with measurements of the apparent diffusion coefficient (ADC) in the cerebrospinal fluid (CSF). However, this is complicated by small ventricle size and hemorrhage and, therefore, may be unreliable in postmortem imaging. The current study evaluated the feasibility and reliability of using the ADC for temperature measurements of the vitreous body compared to that of CSF. MATERIALS AND METHODS Two lambs were scanned postmortem at five different time points over 28 hours. Furthermore, 10 stillborn fetuses were scanned once, at 4 to 62 hours after birth. The temperature was measured with a digital thermometer and calculated using the ADCs of the vitreous body (lambs and fetuses) and CSF (fetuses). RESULTS There was an excellent correlation between measured and calculated temperatures in vitreous bodies of lambs (r = 0.997, P < 0.001) and fetuses (r = 0.970, P < 0.001). The correlation between measured and calculated temperatures in the CSF was poor (r = 0.522, P = 0.122). CONCLUSION The calculation of the temperature based on the ADC of the vitreous body is feasible and reliable for postmortem fetal imaging.
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Affiliation(s)
- Maud P M Tijssen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
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12
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Forensic biomarkers of lethal traumatic brain injury. Int J Legal Med 2022; 136:871-886. [PMID: 35226180 PMCID: PMC9005436 DOI: 10.1007/s00414-022-02785-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
AbstractTraumatic brain injury (TBI) is a major cause of death and its accurate diagnosis is an important concern of daily forensic practice. However, it can be challenging to diagnose TBI in cases where macroscopic signs of the traumatic head impact are lacking and little is known about the circumstances of death. In recent years, several post-mortem studies investigated the possible use of biomarkers for providing objective evidence for TBIs as the cause of death or to estimate the survival time and time since death of the deceased. This work systematically reviewed the available scientific literature on TBI-related biomarkers to be used for forensic purposes. Post-mortem TBI-related biomarkers are an emerging and promising resource to provide objective evidence for cause of death determinations as well as survival time and potentially even time since death estimations. This literature review of forensically used TBI-biomarkers revealed that current markers have low specificity for TBIs and only provide limited information with regards to survival time estimations and time since death estimations. Overall, TBI fatality-related biomarkers are largely unexplored in compartments that are easily accessible during autopsies such as urine and vitreous humor. Future research on forensic biomarkers requires a strict distinction of TBI fatalities from control groups, sufficient sample sizes, combinations of currently established biomarkers, and novel approaches such as metabolomics and mi-RNAs.
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13
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Tambuzzi S, Gentile G, Bailo P, Andreola S, Zoja R. Use of cadaveric vitreous humor as an innovative substrate for diatoms research and forensic diagnosis of drowning. Int J Legal Med 2022; 136:1745-1754. [PMID: 34999927 DOI: 10.1007/s00414-021-02759-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
The search for diatoms is the test that most of all may contribute to the forensic diagnosis of drowning. Diatoms can be extracted through different methods, which are all complex and long. In this preliminary study, we assessed human vitreous humor as an innovative substrate on which to research diatoms. Sampling and analyses were performed on 3 groups of 10 corpses each. The first one was composed of drowned victims. The second one of victims of traffic accidents with subsequent projection in water; based on the severe traumatic injuries reported at autopsy, we considered such victims as ideally assimilable to bodies immersed in water postmortem. The third group was composed of subjects who died for natural causes and without any relationship with water. The vitreous humor was centrifugated and cytocentrifuged and spotted on two different histological slides: one was left blank and the other one was assessed with hematoxylin and eosin staining. Microscopic observation successfully revealed diatoms in all cases of the first group; in the second group diatoms were not detected in 6 cases; in the third group, no diatoms at all were observed. Diatoms were always qualitatively and quantitatively consistent with those found in the corresponding viscera and waters, which had been investigated through classical acid digestion. Our analyses have demonstrated that the vitreous humor behaves in a completely similar way to the other viscera in cases of drowning. Although further investigations are necessary, vitreous humor has proved to be an innovative, suitable, and reliable substrate for the forensic research of diatoms.
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Affiliation(s)
- Stefano Tambuzzi
- Dipartimento di Scienze Biomediche Per La Salute, Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy
| | - Guendalina Gentile
- Dipartimento di Scienze Biomediche Per La Salute, Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy.
| | - Paolo Bailo
- Dipartimento di Scienze Biomediche Per La Salute, Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy
| | - Salvatore Andreola
- Dipartimento di Scienze Biomediche Per La Salute, Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche Per La Salute, Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy
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14
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A Rapid Method for Postmortem Vitreous Chemistry—Deadside Analysis. Biomolecules 2021; 12:biom12010032. [PMID: 35053180 PMCID: PMC8773483 DOI: 10.3390/biom12010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/09/2023] Open
Abstract
Vitreous fluid is commonly collected for toxicological analysis during forensic postmortem investigations. Vitreous fluid is also often analyzed for potassium, sodium, chloride and glucose for estimation of time since death, and for the evaluation of electrolyte imbalances and hyperglycemia, respectively. Obtaining such results in the early phase of a death investigation is desirable both in regard to assisting the police and in the decision-making prior to the autopsy. We analyzed vitreous fluid with blood gas instruments to evaluate/examine the possible impact of different sampling and pre-analytical treatment. We found that samples from the right and left eye, the center of the eye as well as whole vitreous samples gave similar results. We also found imprecision to be very low and that centrifugation and dilution were not necessary when analyzing vitreous samples with blood gas instruments. Similar results were obtained when analyzing the same samples with a regular multi-analysis instrument, but we found that such instruments could require dilution of samples with high viscosity, and that such dilution might impact measurement accuracy. In conclusion, using a blood gas instrument, the analysis of postmortem vitreous fluid for electrolytes and glucose without sample pretreatment produces rapid and reliable results.
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Ang JL, Collis S, Dhillon B, Cackett P. The Eye in Forensic Medicine: A Narrative Review. Asia Pac J Ophthalmol (Phila) 2021; 10:486-494. [PMID: 34524140 DOI: 10.1097/apo.0000000000000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
ABSTRACT The eye, with its distinctive anatomy, not only reflects a wide variety of diseases in life but also undergoes a myriad of post-mortem changes. Consequently, the eye has long been an area of interest in forensic science, primarily for the estimation of post-mortem interval and therefore the time of death and also for assistance in ascertaining the cause of death. There has been significant progress in the knowledge of ophthalmic forensic science using new technologies which have allowed further possibilities to arise where understanding of this field can assist the forensic pathologist. This review aims to highlight the current knowledge which exists in this field and also to identify important avenues for further investigation. Post-mortem changes of the eye along with its current applications and challenges will be discussed. These include the important areas of post-mortem iris biometrics, pupil size correlation with post-mortem interval, use of point-of-care technology on vitreous humor, and the use of ophthalmic imaging in pediatric abusive head trauma.
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Affiliation(s)
- Juan Lyn Ang
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - SallyAnne Collis
- Department of Forensic Pathology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
- The University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Cackett
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
- The University of Edinburgh, Edinburgh, United Kingdom
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16
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Wu D, Luo YW, Zhang J, Luo B, Zhang K, Yu K, Liu RN, Lin HC, Wei X, Wang ZY, Huang P. Fourier-transform infrared microspectroscopy of pulmonary edema fluid for postmortem diagnosis of diabetic ketoacidosis. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 258:119882. [PMID: 33964633 DOI: 10.1016/j.saa.2021.119882] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
Determination of the cause of death for diabetic ketoacidosis (DKA), a common and fatal acute complication of diabetes mellitus, is a challenging forensic task owing to the lack of characteristic morphological findings at autopsy. In this study, Fourier-transform infrared (FTIR) microspectroscopy coupled with chemometrics was employed to characterize biochemical differences in pulmonary edema fluid from different causes of death to supplement conventional methods and provide an efficient postmortem diagnosis of DKA. With this aim, FTIR spectra in three different situations (DKA-caused death, other causes of death with diabetes history, and other causes of death without diabetes history) were measured. The results of principal component analysis indicated different spectral profiles between these three groups, which mainly exhibited variations in proteins. Subsequently, two binary classification models were established using an algorithm of partial least squares discriminant analysis (PLS-DA) to determine whether decedents had diabetes and whether the diabetic patients died from DKA. Satisfactory prediction results of PLS-DA models demonstrated good differentiation among these three groups. Therefore, it is feasible to make a postmortem diagnosis of DKA and detect diabetes history via FTIR microspectroscopic analysis of the pulmonary edema fluid.
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Affiliation(s)
- Di Wu
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, No. 76 West Yanta Rd., Xi'an, Shaanxi 710061, China; Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, No. 1347 West Guangfu Rd., Shanghai 200063, China
| | - Yi-Wen Luo
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, No. 1347 West Guangfu Rd., Shanghai 200063, China
| | - Ji Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, No. 1347 West Guangfu Rd., Shanghai 200063, China
| | - Bin Luo
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, No. 76 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Kai Zhang
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, No. 76 West Yanta Rd., Xi'an, Shaanxi 710061, China
| | - Kai Yu
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, No. 76 West Yanta Rd., Xi'an, Shaanxi 710061, China
| | - Rui-Na Liu
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, No. 76 West Yanta Rd., Xi'an, Shaanxi 710061, China
| | - Han-Cheng Lin
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, No. 76 West Yanta Rd., Xi'an, Shaanxi 710061, China
| | - Xin Wei
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, No. 76 West Yanta Rd., Xi'an, Shaanxi 710061, China
| | - Zhen-Yuan Wang
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, No. 76 West Yanta Rd., Xi'an, Shaanxi 710061, China.
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, No. 1347 West Guangfu Rd., Shanghai 200063, China.
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17
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Wille SMR, Elliott S. The Future of Analytical and Interpretative Toxicology: Where are We Going and How Do We Get There? J Anal Toxicol 2021; 45:619-632. [PMID: 33245325 DOI: 10.1093/jat/bkaa133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/02/2020] [Accepted: 11/18/2020] [Indexed: 01/26/2023] Open
Abstract
(Forensic) toxicology has faced many challenges, both analytically and interpretatively, especially in relation to an increase in potential drugs of interest. Analytical toxicology and its application to medicine and forensic science have progressed rapidly within the past centuries. Technological innovations have enabled detection of more substances with increasing sensitivity in a variety of matrices. Our understanding of the effects (both intended and unintended) have also increased along with determination and degree of toxicity. However, it is clear there is even more to understand and consider. The analytical focus has been on typical matrices such as blood and urine but other matrices could further increase our understanding, especially in postmortem (PM) situations. Within this context, the role of PM changes and potential redistribution of drugs requires further research and identification of markers of its occurrence and extent. Whilst instrumentation has improved, in the future, nanotechnology may play a role in selective and sensitive analysis as well as bioassays. Toxicologists often only have an advisory impact on pre-analytical and pre-interpretative considerations. The collection of appropriate samples at the right time in an appropriate way as well as obtaining sufficient circumstance background is paramount in ensuring an effective analytical strategy to provide useful results that can be interpreted within context. Nevertheless, key interpretative considerations such as pharmacogenomics and drug-drug interactions as well as determination of tolerance remain and in the future, analytical confirmation of an individual's metabolic profile may support a personalized medicine and judicial approach. This should be supported by the compilation and appropriate application of drug data pursuant to the situation. Specifically, in PM circumstances, data pertaining to where a drug was not/may have been/was contributory will be beneficial with associated pathological considerations. This article describes the challenges faced within toxicology and discusses progress to a future where they are being addressed.
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Affiliation(s)
- Sarah M R Wille
- Department of Toxicology, National Institute for Criminalistics and Criminology, Brussels, Belgium
| | - Simon Elliott
- Elliott Forensic Consulting Ltd, Birmingham, UK.,Department Analytical, Environmental & Forensic Science, King's College London, London, UK
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18
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Chen X, Dong X, Zhu R, Xue Q, Zhang D, Liu X, Zheng L, Jiang Y. Abnormally High Blood Acetaldehyde Concentrations Suggest Potential Postmortem Ethanol Generation. J Anal Toxicol 2021; 45:748-755. [PMID: 33206981 DOI: 10.1093/jat/bkaa173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/10/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
Ethanol is one of the most commonly used and abused substances worldwide. Identifying whether the source of ethanol detected in corpses is antemortem ingestion or postmortem generation is especially important for determining the cause of death, which remains a vibrant field of research. During the synthesis of ethanol in the putrefaction process of corpses, other small molecules such as acetaldehyde and n-propanol could also be produced. According to our prospective statistical analysis based on authentic samples from forensic cases, it is rational to suspect ethanol generation after death when the concentration of acetaldehyde detected in blood exceeds 0.014 g/dL. Through in vitro simulation experiments, in addition to confirming that ethyl glucuronide and ethyl sulfate are the reliable biomarkers of antemortem ingestion of ethanol, we propose that acetaldehyde is far more sensitive than n-propanol as a potential marker in the blood of corpses for postmortem ethanol formation.
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Affiliation(s)
- Xiaomin Chen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
| | - Xiaoru Dong
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
| | - Rongzhe Zhu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
| | - Qiupeng Xue
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
| | - Dingang Zhang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
| | - Xiaochen Liu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
| | - Lixing Zheng
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
| | - Yan Jiang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P. R. China
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19
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Dip A, Mozayani A. Evaluation of the Compatibility of Ethyl Glucuronide and Ethyl Sulphate Levels to Assess Alcohol Consumption in Decomposed and Diabetic Postmortem Cases. J Anal Toxicol 2021; 45:878-884. [PMID: 34086901 DOI: 10.1093/jat/bkab061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022] Open
Abstract
The aim of the study is to evaluate the contribution of ethanol metabolite detection in postmortem cases by showing the connection between the presence of ethanol metabolites, which are indicators of alcohol consumption, and the detection of potential postmortem ethanol formation in decomposed and diabetic cases. Determination of ethanol consumption before death is often one of the most important questions in death investigations. Postmortem ethanol formation or degradation products in the blood make it difficult to distinguish antemortem consumption or postmortem formation of ethanol and eventually may lead to misinterpretation. Decomposed bodies and diabetic cases are vulnerable to postmortem ethanol formation due to putrefaction, fermentation or other degradations. Ethyl glucuronide (EtG) and ethyl sulphate (EtS) are two metabolites of ethanol produced only in the antemortem time interval. In this study, EtG and EtS levels in urine and vitreous humor samples of 27 postmortem cases, including diabetic and degraded bodies were compared to ethanol results of their blood, urine, and vitreous humor samples. EtG and EtS in urine and vitreous humor were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS-MS) and ethanol was assayed by routine headspace gas chromatography-flame ionization detector (GC-FID). These cases were devoid of other influences from forensically relevant drugs, so ethanol and/or glucose were among the only positive findings in these cases. The results of this pilot study indicate the postmortem ethanol concentrations do not correlate with the measured EtG and EtS values but are beneficial in rulings of accidental or natural deaths. This preliminary study gives additional data to help distinguish between antemortem ethanol intake and postmortem formation. EtG and EtS were well correlated positively with antemortem ethanol use instead of forming spontaneously in samples from decedents who are decomposing or have a history of diabetic hyperglycemia.
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Affiliation(s)
- Aybike Dip
- Council of Forensic Medicine, Chemistry Department, Turkey Ministry of Justice, 01120 Adana, Turkey
| | - Ashraf Mozayani
- Department of Administration of Justice, Texas Southern University, 3100 Cleburne Street, Houston, Texas 77004, USA
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20
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Hagita T, Shiotani S, Toyama N, Tominaga N, Miyazaki H, Ogasawara N. Cardiac gas on immediate postmortem computed tomography after cardiopulmonary resuscitation indicates the progression of anaerobic metabolism. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Rosato E, Bonelli M, Locatelli M, de Grazia U, Tartaglia A, Savini F, D’Ovidio C. Forensic Biochemical Markers to Evaluate the Agonal Period: A Literature Review. Molecules 2021; 26:3259. [PMID: 34071519 PMCID: PMC8198460 DOI: 10.3390/molecules26113259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
Currently, forensic research is multidisciplinary with new methods and parameters useful to define the cause and time of death as well as survival/agony times. The identification of biochemical markers able to estimate agonal period has been studied by many forensic researchers. It is known that the estimation of agonal time in different types of death is not always easy, hence our interest in literature's data. The studies analyzed in this review confirm the important role of thanatobiochemistry for the estimation of survival times. Regardless of the death cause, the survival/agony time between the primary event and death influences markers concentrations in biological samples (e.g., blood, urine, cerebrospinal fluid). Different biomarkers can be used for qualitative evaluations in deaths with short and long agony (e.g., C-reactive protein, ferritin, GFAP, etc.). Instead, the quantitative interpretation showed limits due to the lack of reference cut-offs. Thanatobiochemistry is a useful tool to confirm what emerged from autopsies findings (macroscopic and histological analysis), but further studies are desirable to confirm the evidence emerging from our review of the literature.
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Affiliation(s)
- Enrica Rosato
- Department of Pharmacy, University of Chieti-Pescara “G. d’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (E.R.); (M.L.); (A.T.)
| | - Martina Bonelli
- Section of Legal Medicine, Center for Advanced Studies and Technology (CAST), Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via Polacchi, 66100 Chieti, Italy;
| | - Marcello Locatelli
- Department of Pharmacy, University of Chieti-Pescara “G. d’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (E.R.); (M.L.); (A.T.)
| | - Ugo de Grazia
- Laboratory of Neurological Biochemistry and Neuropharmacology, IRCCS Neurological Institute Foundation Carlo Besta, Via Celoria 11, 20133 Milan, Italy;
| | - Angela Tartaglia
- Department of Pharmacy, University of Chieti-Pescara “G. d’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (E.R.); (M.L.); (A.T.)
| | - Fabio Savini
- Pharmatoxicology Laboratory-Hospital “Santo Spirito”, Via Fonte Romana 8, 65124 Pescara, Italy;
| | - Cristian D’Ovidio
- Section of Legal Medicine, Center for Advanced Studies and Technology (CAST), Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via Polacchi, 66100 Chieti, Italy;
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22
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Diagnostic Application of Postmortem Cardiac Troponin I Pericardial Fluid/Serum Ratio in Sudden Cardiac Death. Diagnostics (Basel) 2021; 11:diagnostics11040614. [PMID: 33808170 PMCID: PMC8067238 DOI: 10.3390/diagnostics11040614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 01/29/2023] Open
Abstract
In approximately 5% of unexpected deaths, establishing a conclusive diagnosis exclusively on the basis of anatomo-pathological findings in a classic autopsy is difficult. Postmortem biomarkers have been actively investigated as complementary indicators to help to reach valid conclusions about the circumstances of death. Several studies propose either the pericardial fluid or peripheral veins as a location for troponin determination, but the optimum sampling site is still a matter of debate. Our objective was to evaluate the association between the ratio of troponin values in the pericardial fluid and serum (determined postmortem) and the diagnosis of acute myocardial infarction (AMI) in the context of sudden cardiac death. We included 175 forensic cases. Two groups were established: AMI deaths (48; 27.4%) and the control group (127; 72.6%). The cardiac Troponin I (cTnI) values in the pericardial fluid and the troponin ratio were found to be associated with the cause of death. Univariate regression analyses showed that both age and the cTnI ratio were significantly associated with the diagnosis of AMI death. In a multivariate analysis, adjusting for confounding factors, the age and cTnI ratio were independent predictors of death from myocardial infarction. We performed a receiver operating characteristic (ROC) curve for the cTnI ratio for AMI death and selected a cut-off point. Our biomarker was found to be a valuable and highly effective tool for use in the forensic field as a complementary method to facilitate diagnosis in nonconclusive autopsies.
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23
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Kerschen A, Schmit G, De Boosere E, Palmiere C, Vanhaebost J. Black esophagus as an autopsy discovery: a challenging interpretation. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2020. [DOI: 10.1186/s41935-020-0177-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBlack esophagus is a rare medical condition, characterized by a circumferential blackish discoloration of the distal part of the esophageal mucosa, abruptly ending at the gastroesophageal junction. The etiology is multifactorial since patients suffer from multiple comorbidities. While the mortality rate specifically linked to black esophagus is only around 6%, the mortality rate linked to the underlying comorbidities amounts to 32%.A series of five cases is provided in which black esophagus was an unexpected discovery at autopsy. Black esophagus is generally considered being a challenge to the forensic pathologist. There are often no other major gross anomalies found at autopsy and information about the patient’s medical history is not always available, which complicates a correct assessment.We present a review of the literature on black esophagus, limited to reports on deceased patients. The reviewed publications are divided into autopsy and endoscopy series to correctly compare the causes of death.The aim of this review is to identify a possible divergence in causes of death in autopsy and endoscopy series and additionally to analyze the causes of these differences to enable better assessment and interpretation of black esophagus at forensic autopsies. This paper emphasizes the importance of a minimal knowledge of the victim’s comorbidities and medical record and the use of toxicology and postmortem biochemistry analysis as a valuable tool in investigating the cause of death in the setting of black esophagus.
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24
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Pérez-Martínez C, Prieto Bonete G, Pérez-Cárceles MD, Luna A. Influence of the nature of death in biochemical analysis of the vitreous humour for the estimation of post-mortem interval. AUST J FORENSIC SCI 2020. [DOI: 10.1080/00450618.2019.1593503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Gemma Prieto Bonete
- Department of Legal and Forensic Medicine, University of Murcia, Murcia, Spain
| | | | - Aurelio Luna
- Department of Legal and Forensic Medicine, University of Murcia, Murcia, Spain
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25
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Application of scanning electron microscopy in the auxiliary diagnosis of death caused by potassium chloride intravenous injection: a case report. Int J Legal Med 2020; 134:1719-1725. [PMID: 32607752 DOI: 10.1007/s00414-020-02361-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Abstract
To determine the cause of death, in addition to routine autopsy, some assisted techniques are imperative to achieve a definite diagnosis. Herein, we report a case of 36-year-old man who was found dead in his apartment. Medical drug containers (potassium chloride, zolpidem, and propofol) and medical instruments (syringes and indwelling needles) were also found at the scene. An autopsy revealed large amounts of whitish foamy and brown liquid in the trachea and bronchi, and histopathological findings showed remarkable pulmonary congestion and edema. An injection mark with hemorrhage on the right wrist was found on external examination. Results of forensic pathology excluded the presence of mechanical injuries, mechanical asphyxia, embolism, and other fatal diseases. The data of toxicological analysis showed that concentrations of zolpidem and propofol in blood were appreciably higher than the therapeutic dose but they did not reach the absolute lethal dose. Moreover, the level of potassium in the blood and vitreous humor was higher than the expected concentration after death. A scanning electron microscope (SEM) combined with energy-dispersive X-ray microanalyzer (EDX) was subsequently applied to assess the skin samples collected from bilateral wrists. Ultrastructural observation discovered continuous visible interruption of the skin around the injection mark, and energy spectrum analysis revealed statistically significantly higher potassium content of the skin over the right wrist than the left wrist. Comprehensive analysis concluded that the deceased had died of potassium chloride intravenous injection under the zolpidem and propofol effects.
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26
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Trokielewicz M, Czajka A, Maciejewicz P. Post-mortem Iris Decomposition and its Dynamics in Morgue Conditions. J Forensic Sci 2020; 65:1530-1538. [PMID: 32569420 DOI: 10.1111/1556-4029.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Abstract
With increasing interest in employing iris biometrics as a forensic tool for identification by investigation authorities, there is a need for a thorough examination and understanding of postmortem decomposition processes that take place within the human eyeball, especially the iris. This can prove useful for fast and accurate matching of antemortem with postmortem data acquired at crime scenes or mass casualties, as well as for ensuring correct dispatching of bodies from the incident scene to a mortuary or funeral homes. Following these needs of forensic community, this paper offers an analysis of the coarse effects of eyeball decay done from a perspective of automatic iris recognition. We analyze postmortem iris images acquired for a subject with a very long postmortem observation time horizon (34 days), in both visible light and near-infrared light (860 nm), as the latter wavelength is used in commercial iris recognition systems. Conclusions and suggestions are provided that may aid forensic examiners in successfully utilizing iris patterns in postmortem identification of deceased subjects. Initial guidelines regarding the imaging process, types of illumination, and resolution are also given, together with expectations with respect to the iris features decomposition rates. Visible iris features possible for human, expert-based matching persists even up to 407 h postmortem, and near-infrared illumination is suggested for better mitigation of corneal opacity while imaging cadaver eyes (Post-mortem iris decomposition and its dynamics in morgue conditions. ArXiv pre-print, 2019).
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Affiliation(s)
- Mateusz Trokielewicz
- Institute of Control and Computation, Warsaw University of Technology, Engineering Nowowiejska 15/19, Warsaw, 00-665, Poland
| | - Adam Czajka
- Department of Computer Science, University of Notre Dame, Notre Dame, IN, 46556
| | - Piotr Maciejewicz
- Department of Ophthalmology, Medical University of Warsaw, Lindleya 4, Warsaw, 02-005, Poland
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Jia Y, Tian M, Wang T, Wu S, Zhu B, Cao Z. The Estimation of Postmortem Serum Urea via the Ultrafiltration of Hemolyzed Blood. J Forensic Sci 2020; 65:1761-1766. [PMID: 32539158 DOI: 10.1111/1556-4029.14474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/15/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
Postmortem serum urea has been demonstrated as an objective indicator for the forensic diagnosis of cause of death. However, samples used in postmortem biochemical analysis are always affected by hemolysis. To investigate whether hemolysis affects the biochemical analysis of urea and to explore the feasibility of using ultrafiltration to process hemolyzed blood samples, three different levels of hemolyzed blood samples were used to assess the influence of hemolysis on postmortem biochemical analysis of urea, and two ultrafiltration methods were used to process the hemolyzed blood samples. Bias% was used to assess the interference of hemolysis. Our results showed that heavy hemolysis had a significant influence on the biochemical analysis of urea. Both ultrafiltration methods in the present study could significantly reduce the interference of hemolysis, with the |bias%| of methods A and B decreasing from 69.74% ± 99.14% to 12.18% ± 7.23% and 10.77% ± 8.09%, respectively, compared to the original serum. After regression correction, there was no significant difference between the urea concentration in the ultrafiltrates of the two ultrafiltration methods and that in the original serum, which suggested that the postmortem serum urea concentration could be estimated by the corrected urea concentration in the ultrafiltrate. The current study also provided possible pretreatment methods for postmortem biochemical analysis of other biomarkers in hemolyzed blood samples of forensic practice.
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Affiliation(s)
- Yuqing Jia
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, 110122, China.,Department of Forensic Medicine, Dagong Institute of Forensic Science, Harbin, 150000, China
| | - Meihui Tian
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, 110122, China
| | - Tianqi Wang
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, 110122, China
| | - Shuqin Wu
- Department of Pathology, Qiqihar Medical University, Qiqihar, 161006, China
| | - Baoli Zhu
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, 110122, China
| | - Zhipeng Cao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, 110122, China
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Postmortem Determination of Short-Term Markers of Hyperglycemia for the Purposes of Medicolegal Opinions. Diagnostics (Basel) 2020; 10:diagnostics10040236. [PMID: 32325891 PMCID: PMC7235919 DOI: 10.3390/diagnostics10040236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022] Open
Abstract
Diabetes mellitus is classified as the epidemic of the 21st century. Due to the fact that acute carbohydrate metabolism disorders usually do not indicate morphological change, postmortem diagnosis is required to perform biochemical tests. The authors decided to evaluate the usefulness of determining glucose, lactate, acetone, β-hydroxybutyric acid (BHB), and 1,5-anhydroglucitol (1,5-AG) in postmortem blood/serum, urine, and vitreous humor (VH). Biological material was collected during autopsies. The study group consisted of 50 diabetics, while the control group consisted of 50 non-diabetics, who died a sudden death, with negative test results for the presence of ethyl alcohol and were not resuscitated before death. Statistical analysis was performed using the IBM SPSS Statistics 25 software package. The most statistically significant difference between the two groups was observed for mean 1,5-AG concentration. The authors found many correlations between the concentration of the examined markers in different materials, mainly between blood/serum and VH. The most suitable short-term glycemic marker in postmortem diagnosis is 1,5-AG. Diagnosis may be supported with determinations of acetone and BHB. For medicolegal assessment, the interpretation of the biochemical test results should comprise information on circumstances of death, medical history, results of other toxicological and histopathological tests, and autopsy report.
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Pigaiani N, Bertaso A, De Palo EF, Bortolotti F, Tagliaro F. Vitreous humor endogenous compounds analysis for post-mortem forensic investigation. Forensic Sci Int 2020; 310:110235. [PMID: 32169668 DOI: 10.1016/j.forsciint.2020.110235] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/04/2023]
Abstract
The chemical and biochemical analysis of bodily fluids after death is an important thanatochemical approach to assess the cause and time since death. Vitreous humor (VH) has been used as a biofluid for forensic purposes since the 1960s. Due to its established relevance in toxicology, a literature review highlighting the use of VH with an emphasis on endogenous compounds has not yet been undertaken. VH is a chemically complex aqueous solution of carbohydrates, proteins, electrolytes and other small molecules present in living organisms; this biofluid is useful tool for its isolated environment, preserved from bacterial contamination, decomposition, autolysis, and metabolic reactions. The post-mortem analysis of VH provides an important tool for the estimation of the post-mortem interval (PMI), which can be helpful in determining the cause of death. Consequently, the present review evaluates the recent chemical and biochemical advances with particular importance on the endogenous compounds present at the time of death and their modification over time, which are valuable for the PMI prediction and to identify the cause of death.
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Affiliation(s)
- Nicola Pigaiani
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy.
| | - Anna Bertaso
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy.
| | - Elio Franco De Palo
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy
| | - Federica Bortolotti
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy; Institute of Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
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30
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Heimer J, Gascho D, Madea B, Steuer A, Martinez RM, Thali MJ, Zoelch N. Comparison of the beta-hydroxybutyrate, glucose, and lactate concentrations derived from postmortem proton magnetic resonance spectroscopy and biochemical analysis for the diagnosis of fatal metabolic disorders. Int J Legal Med 2020; 134:603-612. [DOI: 10.1007/s00414-019-02235-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
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31
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Tattoli L, Dell'Erba A, Ferorelli D, Gasbarro A, Solarino B. Sepsis and Nosocomial Infections: The Role of Medico-Legal Experts in Italy. Antibiotics (Basel) 2019; 8:E199. [PMID: 31661804 PMCID: PMC6963620 DOI: 10.3390/antibiotics8040199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people's loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers' work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections.
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Affiliation(s)
- Lucia Tattoli
- S.C. Medicina Legale U - Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Alessandro Dell'Erba
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | - Davide Ferorelli
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | | | - Biagio Solarino
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
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32
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Bañón R, Hernández-Romero D, Navarro E, Pérez-Cárceles MD, Noguera-Velasco JA, Osuna E. Combined determination of B-type natriuretic peptide and high-sensitivity troponin I in the postmortem diagnosis of cardiac disease. Forensic Sci Med Pathol 2019; 15:528-535. [PMID: 31471870 DOI: 10.1007/s12024-019-00150-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Cardiac disease is the most common cause of sudden death in Western countries. It is known that high-sensitivity troponin I (hs-cTnI), widely used for detection of myocardial injury, is a sensitive biochemical marker. B-type natriuretic peptide (BNP) is a reliable tool for diagnosing heart failure, and for establishing prognosis or disease severity. We aimed to evaluate the diagnostic efficacy of the postmortem determination of BNP in serum alone or in addition to other biomarkers, such as hs-cTnI and MB isoenzyme of creatine kinase (CK-MB), to ascertain whether its determination improves the post-mortem diagnosis of heart failure-associated causes of death. This study involved 133 cadavers with a mean age of 58.2 (± 17.6) years and a mean postmortem interval of 12.8 (±6.6) h. Cases were assigned into two diagnostic groups, according to the cause of death: cardiac deaths (N = 62) and control (N = 71). In the cardiac group, two categories were established according to morphological features of the heart: 'ischemic deaths' (N = 39), and 'congestive heart' (n = 23). Both hs-cTnI and BNP were useful in diagnosing cardiac deaths, whereas CK-MB did not have any diagnostic relevance. hs-cTnI is higher in cases which acute ischemia as the principal pathology, while the presence of high BNP values is significantly related with chronic cardiac situations with significant ventricular overload. Our findings show that postmortem determination of hs-cTnI and BNP provides valuable information; hs-cTnI is useful for diagnosis of cardiac deaths, mainly with ischemic implications, and BNP gave better results for the diagnosis of congestive heart failure.
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Affiliation(s)
| | - Diana Hernández-Romero
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence ''Campus Mare Nostrum", University of Murcia, Murcia, Spain.
| | | | - María Dolores Pérez-Cárceles
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence ''Campus Mare Nostrum", University of Murcia, Murcia, Spain
| | | | - Eduardo Osuna
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence ''Campus Mare Nostrum", University of Murcia, Murcia, Spain
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33
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Olczak M, Poniatowski ŁA, Niderla-Bielińska J, Kwiatkowska M, Chutorański D, Tarka S, Wierzba-Bobrowicz T. Concentration of microtubule associated protein tau (MAPT) in urine and saliva as a potential biomarker of traumatic brain injury in relationship with blood–brain barrier disruption in postmortem examination. Forensic Sci Int 2019; 301:28-36. [DOI: 10.1016/j.forsciint.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/23/2019] [Accepted: 05/03/2019] [Indexed: 02/06/2023]
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34
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Elevation of Postmortem Cerebrospinal Fluid Sodium and Chloride Levels Is a Potential Adjunct Test in the Diagnosis of Salt Water Drowning. ACTA ACUST UNITED AC 2019; 40:251-257. [DOI: 10.1097/paf.0000000000000488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Garland J, Philcox W, McCarthy S, Kesha K, Lam L, Spark A, Palmiere C, Elstub H, Cala A, Stables S, Tse R. Post-mortem biochemistry differences between vitreous humour and cerebrospinal fluid. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1597920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. Garland
- Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia
| | - W. Philcox
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sinead McCarthy
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - K. Kesha
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - L. Lam
- Department of Biochemistry, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - A. Spark
- Wellington Hospital Mortuary, Wellington, New Zealand
| | - C. Palmiere
- CURML, University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - H. Elstub
- Department of Forensic Medicine, Newcastle, Forensic & Analytical Science Service (FASS), NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - A.D. Cala
- Department of Forensic Medicine, Newcastle, Forensic & Analytical Science Service (FASS), NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - S. Stables
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - R. Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
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36
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Rapid Streptococcus Pneumonia Antigen Detection on Postmortem Urine in a Death Due to Pneumococcal Meningitis. Am J Forensic Med Pathol 2019; 40:269-272. [PMID: 30663991 DOI: 10.1097/paf.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Streptococcus pneumoniae is the leading cause of adult bacterial meningitis. Differing from Neisseria meningitidis (the second most common cause of acute bacterial meningitis), contact tracing and chemoprophylaxis are not required. At postmortem, the differentiation between S. pneumoniae and N. meningitidis is traditionally done by culture and polymerase chain reaction performed on blood or cerebrospinal fluid, but may take hours, if not days, to analyze. We present a death from bacterial meningitis in a 73-year-old woman in which a rapid urinary pneumococcal antigen testing was able to identify S. pneumoniae as the causative organism within 1 hour. This was confirmed by subsequent brain swab culture. The rapid urinary pneumococcal antigen test in the case prevented the need for contact tracing and chemoprophylaxis. This case highlights the potential use of this test to rapidly identify the culprit organism at postmortem examination when acute bacterial meningitis is detected.
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37
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Srettabunjong S, Thongphap W, Chittamma A. Comparative and Correlation Studies of Biochemical Substances in Vitreous Humor and Synovial Fluid. J Forensic Sci 2019; 64:778-785. [DOI: 10.1111/1556-4029.13966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Supawon Srettabunjong
- Department of Forensic Medicine Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand
| | - Wantawanop Thongphap
- Department of Forensic Medicine Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand
| | - Anchalee Chittamma
- Division of Clinical Chemistry Department of Pathology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok 10400 Thailand
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38
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Biochemical Differences Between Vitreous Humor and Cerebral Spinal Fluid in a Death From Diabetic Ketoacidosis. Am J Forensic Med Pathol 2018; 40:188-191. [PMID: 30475235 DOI: 10.1097/paf.0000000000000450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Biochemical analysis of cerebrospinal fluid (CSF) and vitreous humor (VH) forms an important diagnostic ancillary test at autopsy. Cerebrospinal fluid can be sampled from the ventricular system (VA) and from lumbar puncture (LP), whereas VH can be sampled from the orbits. Biochemical electrolytes seem to vary between VH and CSF collected from different sites, but whether there is any difference in glucose and β-hydroxybutyrate is unclear. We present a case report of a 21-year-old man who died of diabetic ketoacidosis confirmed at autopsy. Ventricular system, LP, and VH were biochemically analyzed and showed that glucose was highest in VH (41 mmol/L) and was 6 and 8 mmol/L higher than CSF in the LP and VA, respectively. β-Hydroxybutyrate was also highest in VH (20 mmol/L) and was 5 and 6 mmol/L higher than LP and VA, respectively. Our findings suggest that postmortem CSF glucose and β-hydroxybutyrate may not truly reflect that of VH and vary between CSF sampling sites.
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39
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Pajunen T, Vuori E, Lunetta P. Epidemiology of alcohol-related unintentional drowning: is post-mortem ethanol production a real challenge? Inj Epidemiol 2018; 5:39. [PMID: 30382440 PMCID: PMC6211144 DOI: 10.1186/s40621-018-0169-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/17/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Post-mortem (PM) ethanol production may hamper the interpretation of blood alcohol concentration (BAC) in victims of drowning. Different exclusion criteria (e.g. cases with low BAC or with protracted interval between death and toxicological analysis) have been proposed with no factual figures to reduce the potential bias due to PM ethanol production when examining the prevalence rates for alcohol-related drowning. The aim of this study is to verify the extent to which PM alcohol production may affect the accuracy of studies on drowning and alcohol. FINDINGS Unintentional fatal drowning cases (n = 967) for which a full medico-legal autopsy and toxicological analysis was performed, in Finland, from 2000 to 2013, and relevant variables (demographic data of the victims, month of incident, PM submersion time, blood alcohol concentration, urine alcohol concentration (UAC), vitreous humour alcohol concentration (VAC) were available. Overall, out of 967 unintentional drownings, 623 (64.4%) were positive for alcohol (BAC > 0 mg/dL), 595 (61.5%) had a BAC ≥ 50 mg/dL, and 567 (58.6%) a BAC ≥ 100 mg/dL. Simultaneous measurements, in each victim, of BAC, UAC, and VAC revealed PM ethanol production in only 4 victims (BAC: 25 mg/dL - 48 mg/dL). These false positive cases represented 0.4% of drownings with BAC > 0 mg/dL and 14.3% of drownings with BAC > 0 mg/dL and < 50 mg/dL. CONCLUSIONS The present study suggests that PM ethanol production has a limited impact on research addressing the prevalence rate for alcohol-related drowning and that the use of too rigorous exclusion criteria, such as those previously recommended, may led to a significant underestimation of actual alcohol-positive drowning cases.
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Affiliation(s)
- Tuulia Pajunen
- Department of Biomedicine, Pathology and Forensic Medicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | - Erkki Vuori
- Department of Forensic Medicine, University of Helsinki, Kytösuontie 11, 00500 Helsinki, Finland
| | - Philippe Lunetta
- Department of Biomedicine, Pathology and Forensic Medicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
- Department of Forensic Medicine, University of Oulu, 90014 Oulu, Finland
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40
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41
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Woydt L, Bernhard M, Kirsten H, Burkhardt R, Hammer N, Gries A, Dreßler J, Ondruschka B. Intra-individual alterations of serum markers routinely used in forensic pathology depending on increasing post-mortem interval. Sci Rep 2018; 8:12811. [PMID: 30143737 PMCID: PMC6109050 DOI: 10.1038/s41598-018-31252-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/09/2023] Open
Abstract
Post-mortem biochemistry of serum markers has been the subject of numerous studies, but in-situ marker stability after death has not been sufficiently evaluated yet. Such laboratory analyses are especially necessary in the cases of functional deaths without morphological evidence of the death causes and also in cardiac death cases with only very short survival times. The aim of the study was to determine the post-mortem stability of commonly-used serum markers at predefined time points. In 20 cases, peripheral venous samples were taken starting immediately after circulatory arrest and ending 48 hours after death. Serum creatinine, urea, 3-β-hydroxybutyrate, tryptase, myoglobin, troponin T, creatin kinase and creatin kinase-MB have been included. For all markers, we observed increasing marker levels for longer post-mortem intervals. Significant marker level changes began two hours after death. Excessive increases were observed for cardiac and muscle markers. Marker levels showed high intra-assay precision. Furthermore, the markers were robust enough to withstand freeze-thaw cycles. Potential contamination of arteriovenous blood did not influence the post-mortem marker levels. Post-mortem blood should be sampled as soon as possible, as increased post-mortem intervals may heavily change marker levels in-situ in individual cases, whereas the markers are mostly unaffected by laboratory conditions.
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Affiliation(s)
- Lina Woydt
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Leipzig, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Leipzig, Leipzig, Germany.,Emergency Department, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.,LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Ralph Burkhardt
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
| | - André Gries
- Emergency Department, University Hospital of Leipzig, Leipzig, Germany
| | - Jan Dreßler
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Leipzig, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Leipzig, Germany.
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42
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Junttila IS, Vuorio A, Budowle B, Laukkala T, Sajantila A. Challenges in investigation of diabetes-related aviation fatalities-an analysis of 1491 subsequent aviation fatalities in USA during 2011-2016. Int J Legal Med 2018; 132:1713-1718. [PMID: 29974235 DOI: 10.1007/s00414-018-1879-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022]
Abstract
Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau's database between years 2011-2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.
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Affiliation(s)
- Ilkka S Junttila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Fimlab Laboratories, Tampere, Finland
| | - Alpo Vuorio
- Mehiläinen Airport Health Centre, Vantaa, Finland.,Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Bruce Budowle
- Center for Human Identification, University of North Texas Health Science Center, 3500 Camp, Bowie Blvd., Fort Worth, TX, 76107, USA
| | | | - Antti Sajantila
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
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43
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Danmaigoro A, Selvarajah GT, Mohd Noor MH, Mahmud R, Abu Bakar MZ. Toxicity and Safety Evaluation of Doxorubicin-Loaded Cockleshell-Derived Calcium Carbonate Nanoparticle in Dogs. Adv Pharmacol Sci 2018; 2018:4848602. [PMID: 30079088 PMCID: PMC6035816 DOI: 10.1155/2018/4848602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/17/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022] Open
Abstract
Doxorubicin (DOX) is a potent anticancer agent with cytotoxic effects which limit its clinical usage. This effect is due to its nonselective nature causing injury to the cells as a result of reactive free oxygen radical's release. Cockleshell-derived calcium carbonate nanoparticle (CS-CaCO3NP) is a pH-responsive carrier with targeted delivery potentials. This study aimed at evaluating the toxicity effects of repeated dose administration of DOX-loaded CS-CaCO3NP in healthy dogs. Fifteen dogs with an average body weight of 15 kg were randomized equally into 5 groups. Dogs were subjected to 5 doses at every 3-week interval with (i) normal saline, (ii) DOX, 30 mg/m2, and the experimental groups: CS-CaCO3NP-DOX at (iii) high dose, 50 mg/m2, (iv) clinical dose, 30 mg/m2, and (v) low dose, 20 mg/m2. Radiographs, electrocardiography, and blood samples were collected before every treatment for haematology, serum biochemistry, and cardiac injury assessment. Heart and kidney tissues were harvested after euthanasia for histological and ultrastructural evaluation. The cumulative dose of DOX 150 mg/m2 over 15 weeks revealed significant effects on body weight, blood cells, functional enzymes, and cardiac injury biomarkers with alterations in electrocardiogram, myocardium, and renal tissue morphology. However, the dogs given CS-CaCO3NP-DOX 150 mg/m2 and below did not show any significant change in toxicity biomarker as compared to those given normal saline. The study confirmed the safety of repeated dose administration of CS-CaCO3NP-DOX (30 mg/m2) for 5 cycles in dogs. This finding offers opportunity to dogs with cancer that might require long-term administration of DOX without adverse effects.
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Affiliation(s)
- Abubakar Danmaigoro
- Department of Veterinary Preclinical Science, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
- Department of Veterinary Anatomy, Faculty of Veterinary Medicine, Usmanu Danfodiyo University, P.M.B. 2346, Sokoto, Nigeria
| | - Gayathri Thevi Selvarajah
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
| | - Mohd Hezmee Mohd Noor
- Department of Veterinary Preclinical Science, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
| | - Rozi Mahmud
- Department of Imaging, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
| | - Md Zuki Abu Bakar
- Department of Veterinary Preclinical Science, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
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Mizutani T, Yoshimoto T, Ishii A. Pericardial fluid is suitable as an alternative specimen for the measurement of β-hydroxybutyrate within 96 h after death. Leg Med (Tokyo) 2018; 33:53-54. [PMID: 29859352 DOI: 10.1016/j.legalmed.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/15/2018] [Accepted: 05/20/2018] [Indexed: 11/16/2022]
Abstract
We examined postmortem β-hydroxybutyrate (BHB) levels in the body fluids obtained from 253 forensic autopsy cases whose causes of death were determined. Postmortem changes of BHB levels according to postmortem intervals (PMI) in various body fluids (plasma, urine, vitreous humor, and pericardial fluids) were investigated to determine appropriate alternative specimens as plasma samples. Our study has indicated the following points: 1) the BHB levels in plasma specimens from three sampling sites showed no significant differences, 2) postmortem changes of BHB levels in plasma and pericardial fluids could be negligible within 96 h PMI, while urine and vitreous humor BHB levels showed postmortem changes, and 3) pericardial fluid would thus be most suitable as an alternative to plasma in postmortem BHB level. We have also proposed that BHB levels could be applicable for the diagnosis of metabolic disorders in forensic autopsy.
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Affiliation(s)
- Tatsushi Mizutani
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Department of Legal Medicine and Bioethics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Takashi Yoshimoto
- Department of Legal Medicine and Bioethics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Akira Ishii
- Department of Legal Medicine and Bioethics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan.
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Nourbakhsh M, Miller A, Gofton J, Jones G, Adeagbo B. Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases. J Forensic Sci 2018; 64:270-274. [DOI: 10.1111/1556-4029.13819] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Mahra Nourbakhsh
- Department of Pathology and Laboratory Medicine Foothills Medical Center Cumming School of Medicine University of Calgary McCaig Tower 7542, 1403 29 Street NW Calgary AB T2N 2T9 Canada
| | - Angela Miller
- Department of Pathology and Laboratory Medicine Foothills Medical Center Cumming School of Medicine University of Calgary McCaig Tower 7542, 1403 29 Street NW Calgary AB T2N 2T9 Canada
- Department of Laboratory Medicine and Pathology 4B1.18 Walter Mackenzie Centre University of Alberta 8440‐112 Street Edmonton AB T6G 2B7 Canada
- Office of the Chief Medical Examiner 4070 Bowness Rd NW Calgary AB T3B 3R7 Canada
| | - Jeff Gofton
- Office of the Chief Medical Examiner 4070 Bowness Rd NW Calgary AB T3B 3R7 Canada
- Office of the Chief Medical Examiner 400 East Jackson Street Richmond VA 23219‐3694
| | - Graham Jones
- Department of Laboratory Medicine and Pathology 4B1.18 Walter Mackenzie Centre University of Alberta 8440‐112 Street Edmonton AB T6G 2B7 Canada
- Office of the Chief Medical Examiner 4070 Bowness Rd NW Calgary AB T3B 3R7 Canada
| | - Bamidele Adeagbo
- Department of Pathology and Laboratory Medicine Foothills Medical Center Cumming School of Medicine University of Calgary McCaig Tower 7542, 1403 29 Street NW Calgary AB T2N 2T9 Canada
- Department of Laboratory Medicine and Pathology 4B1.18 Walter Mackenzie Centre University of Alberta 8440‐112 Street Edmonton AB T6G 2B7 Canada
- Office of the Chief Medical Examiner 4070 Bowness Rd NW Calgary AB T3B 3R7 Canada
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Christensen MR, Bugge A, Malik ME, Thomsen JL, Lynnerup N, Rungby J, Banner J. Establishing post mortem criteria for the metabolic syndrome: an autopsy based cross-sectional study. Diabetol Metab Syndr 2018; 10:36. [PMID: 29713389 PMCID: PMC5918842 DOI: 10.1186/s13098-018-0339-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/18/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Individuals who suffer from mental illness are more prone to obesity and related co-morbidities, including the metabolic syndrome. Autopsies provide an outstanding platform for the macroscopic, microscopic and molecular-biological investigation of diseases. Autopsy-based findings may assist in the investigation of the metabolic syndrome. To utilise the vast information that an autopsy encompasses to elucidate the pathophysiology behind the syndrome further, we aimed to both develop and evaluate a method for the post mortem definition of the metabolic syndrome. METHODS Based on the nationwide Danish SURVIVE study of deceased mentally ill, we established a set of post mortem criteria for each of the harmonized criteria of the metabolic syndrome. We based the post mortem (PM) evaluation on information from the police reports and the data collected at autopsy, such as anthropometric measurements and biochemical and toxicological analyses (PM information). We compared our PM evaluation with the data from the Danish health registries [ante mortem (AM) information, considered the gold standard] from each individual. RESULTS The study included 443 deceased individuals (272 male and 171 female) with a mean age of 50.4 (± 15.5) years and a median (interquartile range) post mortem interval of 114 (84-156) hours. We found no significant difference when defining the metabolic syndrome from the PM information in comparison to the AM information (P = 0.175). The PM evaluation yielded a high specificity (0.93) and a moderate sensitivity (0.63) with a moderate level of agreement compared to the AM evaluation (Cohen's κ = 0.51). Neither age nor post mortem interval affected the final results. CONCLUSIONS Our model of a PM definition of the metabolic syndrome proved reliable when compared to the AM information. We believe that an appropriate estimate of the prevalence of the metabolic syndrome can be established post mortem. However, while neither the PM nor the AM information is exhaustive in terms of defining an individual's health status, a superlative estimate may be obtained by combining the PM and the AM information. With this model, we open up the possibility of utilising autopsy data for future studies of the metabolic syndrome.
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Affiliation(s)
| | - Anne Bugge
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Forensic Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Jørgen Lange Thomsen
- Department of Forensic Medicine, University of Southern Denmark, Odense, Denmark
| | - Niels Lynnerup
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Rungby
- Department of Endocrinology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
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Hess C, Sydow K, Kueting T, Kraemer M, Maas A. Considerations regarding the validation of chromatographic mass spectrometric methods for the quantification of endogenous substances in forensics. Forensic Sci Int 2017; 283:150-155. [PMID: 29301115 DOI: 10.1016/j.forsciint.2017.12.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/27/2022]
Abstract
The requirement for correct evaluation of forensic toxicological results in daily routine work and scientific studies is reliable analytical data based on validated methods. Validation of a method gives the analyst tools to estimate the efficacy and reliability of the analytical method. Without validation, data might be contested in court and lead to unjustified legal consequences for a defendant. Therefore, new analytical methods to be used in forensic toxicology require careful method development and validation of the final method. Until now, there are no publications on the validation of chromatographic mass spectrometric methods for the detection of endogenous substances although endogenous analytes can be important in Forensic Toxicology (alcohol consumption marker, congener alcohols, gamma hydroxy butyric acid, human insulin and C-peptide, creatinine, postmortal clinical parameters). For these analytes, conventional validation instructions cannot be followed completely. In this paper, important practical considerations in analytical method validation for endogenous substances will be discussed which may be used as guidance for scientists wishing to develop and validate analytical methods for analytes produced naturally in the human body. Especially the validation parameters calibration model, analytical limits, accuracy (bias and precision) and matrix effects and recovery have to be approached differently. Highest attention should be paid to selectivity experiments.
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Affiliation(s)
- Cornelius Hess
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
| | - Konrad Sydow
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany
| | - Theresa Kueting
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany
| | - Michael Kraemer
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany
| | - Alexandra Maas
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany
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Basso C, Aguilera B, Banner J, Cohle S, d'Amati G, de Gouveia RH, di Gioia C, Fabre A, Gallagher PJ, Leone O, Lucena J, Mitrofanova L, Molina P, Parsons S, Rizzo S, Sheppard MN, Mier MPS, Kim Suvarna S, Thiene G, van der Wal A, Vink A, Michaud K. Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology. Virchows Arch 2017; 471:691-705. [PMID: 28889247 PMCID: PMC5711979 DOI: 10.1007/s00428-017-2221-0] [Citation(s) in RCA: 299] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 02/07/2023]
Abstract
Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology has developed these guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate investigation of SCD. The present version is an update of our original article, published 10 years ago. This is necessary because of our increased understanding of the genetics of cardiovascular diseases, the availability of new diagnostic methods, and the experience we have gained from the routine use of the original guidelines. The updated guidelines include a detailed protocol for the examination of the heart and recommendations for the selection of histological blocks and appropriate material for toxicology, microbiology, biochemistry, and molecular investigation. Our recommendations apply to university medical centers, regionals hospitals, and all healthcare professionals practicing pathology and forensic medicine. We believe that their adoption throughout Europe will improve the standards of autopsy practice, allow meaningful comparisons between different communities and regions, and permit the identification of emerging patterns of diseases causing SCD. Finally, we recommend the development of regional multidisciplinary networks of cardiologists, geneticists, and pathologists. Their role will be to facilitate the identification of index cases with a genetic basis, to screen appropriate family members, and ensure that appropriate preventive strategies are implemented.
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Affiliation(s)
- Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - Beatriz Aguilera
- Histopathology Service, National Institute of Toxicology and Forensic Sciences, Madrid, Spain
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Cohle
- Department of Pathology and Laboratory Medicine, Grand Rapids, MI, USA
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Rosa Henriques de Gouveia
- Department of Pathology, Hospital de Santa Cruz (CHLO), Lisbon & Forensic Pathology, INMLCF & FMUC, Coimbra, Portugal
| | - Cira di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Aurelie Fabre
- Department of Histopathology, St Vincent's University Hospital, University College Dublin School of Medicine, Dublin, Ireland
| | | | - Ornella Leone
- Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Joaquin Lucena
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Seville, Spain
| | - Lubov Mitrofanova
- Department of Pathology, Federal Almazov North-West Medical Research Centre, St. Petersburg, Russian Federation
| | - Pilar Molina
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Valencia, Spain
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine and Monash University, Victoria, Australia
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Mary N Sheppard
- Department of Cardiovascular Pathology, St Georges Medical School, London, UK
| | - Maria Paz Suárez Mier
- Histopathology Service, National Institute of Toxicology and Forensic Sciences, Madrid, Spain
| | | | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Allard van der Wal
- Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Katarzyna Michaud
- University Hospital of Lausanne, University Center of Legal Medicine, Lausanne and Geneva, Chemin de la Vulliette 4, 25, 1000, Lausanne, Switzerland.
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Takamura A, Watanabe K, Akutsu T, Ikegaya H, Ozawa T. Spectral Mining for Discriminating Blood Origins in the Presence of Substrate Interference via Attenuated Total Reflection Fourier Transform Infrared Spectroscopy: Postmortem or Antemortem Blood? Anal Chem 2017; 89:9797-9804. [PMID: 28809481 DOI: 10.1021/acs.analchem.7b01756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Often in criminal investigations, discrimination of types of body fluid evidence is crucially important to ascertain how a crime was committed. Compared to current methods using biochemical techniques, vibrational spectroscopic approaches can provide versatile applicability to identify various body fluid types without sample invasion. However, their applicability is limited to pure body fluid samples because important signals from body fluids incorporated in a substrate are affected strongly by interference from substrate signals. Herein, we describe a novel approach to recover body fluid signals that are embedded in strong substrate interferences using attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopy and an innovative multivariate spectral processing. This technique supported detection of covert features of body fluid signals, and then identified origins of body fluid stains on substrates. We discriminated between ATR FT-IR spectra of postmortem blood (PB) and those of antemortem blood (AB) by creating a multivariate statistics model. From ATR FT-IR spectra of PB and AB stains on interfering substrates (polyester, cotton, and denim), blood-originated signals were extracted by a weighted linear regression approach we developed originally using principal components of both blood and substrate spectra. The blood-originated signals were finally classified by the discriminant model, demonstrating high discriminant accuracy. The present method can identify body fluid evidence independently of the substrate type, which is expected to promote the application of vibrational spectroscopic techniques in forensic body fluid analysis.
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Affiliation(s)
- Ayari Takamura
- First Department of Forensic Science, National Research Institute of Police Science , 6-3-1, Kashiwanoha, Kashiwa, Chiba 277-0882, Japan.,Department of Chemistry, Graduate School of Science, The University of Tokyo , 7-3-1, Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - Ken Watanabe
- First Department of Forensic Science, National Research Institute of Police Science , 6-3-1, Kashiwanoha, Kashiwa, Chiba 277-0882, Japan
| | - Tomoko Akutsu
- First Department of Forensic Science, National Research Institute of Police Science , 6-3-1, Kashiwanoha, Kashiwa, Chiba 277-0882, Japan
| | - Hiroshi Ikegaya
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , 465 Kajii-cho, Hirokoji Agaru, Kawaramachi-dori, Kamigyo, Kyoto 602-8566, Japan
| | - Takeaki Ozawa
- Department of Chemistry, Graduate School of Science, The University of Tokyo , 7-3-1, Hongo, Bunkyo, Tokyo 113-0033, Japan
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