Characterization of five cases of suspected bathtub suicide

Review of washing machine-related deaths in South Korea

We reviewed data on washing machine-related deaths between 2008 and 2020 in South Korea to analyze the case characteristics, manners of death, and causes of death. Washing machine-related deaths are very rare, and only 23 incidents were identified over the study period. Of these cases, 19 (82.6%) were related to general pulsator-type top load washing machines; the other 4 (17.4%) were related to front-load washing machines. The pulsator-type top load washing machine-related deaths occurred in people aged between 40 and 93 years (mean age, 68 years), including 9 men (47.4%) and 10 women (52.6%). The manners of death among the incidents were suicide in 12 cases (63.2%), accident in 6 cases (31.6%), and unknown in 1 case (5.3%). A Medline search of the English literature currently does not yield results for washing machine-related suicidal deaths in adults. Of the 12 suicide cases, 4 were autopsied; suicidal death was determined by postmortem investigation or based on suicide notes. Washing machine-related suicidal deaths are presumed to have characteristics similar to those of bathtub suicidal deaths. The front-load washing machine-related deaths involved boys aged between 6 and 8 years, and all cases were concluded as accidents. The cause of death was hypoxia resulting from the children being accidentally trapped inside the washing machine while playing. Greater attention to vulnerable groups, especially children and older adults, is required to reduce the rate of washing machine-related accidental or suicidal deaths.

Development of 18S rRNA gene arrays for forensic detection of diatoms

Diatom test is the most commonly used method to diagnose drowning in forensic laboratories. However, microscopic examination and identification of diatom frustules is time-consuming and requires taxonomic expertise. At present, the identification of drowning is still a challenge in forensic casework. In this study, we developed a novel diatom microarray based on the detection of specific 18S rRNA gene fragments of diatom species. The array covers 169 diatom species which were documented as commonly found in a wide range of fresh waters in China. Diatom arrays were prepared from species specific oligonucleotide probes targeting to variable regions of the 18S rRNA gene. We also developed an auxiliary sample preparation method for isolation of diatom DNA from tissues, which enabled detection of diatom species in real forensic samples as well as environmental waters. We applied the diatom arrays to analyze six drowned cases and eight environmental samples. The diatom arrays showed much better sensitivity and more consistent results than those of the conventional SEM methods. We discovered major discrepancies between results generated by the diatom arrays and the routinely used SEM based diatom tests. We verified the results of our diatom arrays by species specific PCR and Sanger sequencing and found that the currently used SEM diatom test method has a serious deficiency in sensitivity due to high loss rate of frustules in the sample preparation procedure. We anticipate that the application of diatom arrays will transform current forensic practice of diagnosing drowning deaths.

When bathing leads to drowning in older adults

INTRODUCTION

Bathing is the most problematic activity of daily living for aging adults, and the ability to perform it is influenced by physical capabilities that decrease with age. Drowning is an under-documented event related to bathing for older adults. This study investigates the circumstances of these tragedies, to prevent them.

METHODS

Census of 2005-2014 bathtub drownings in the province of Quebec (Canada) involving victims aged 65+. Coroner's reports were analyzed using a grid based on factors previously associated with bath-related drownings in literature, iteratively modified.

RESULTS

Among the 92 bathtub drowning victims inventoried, 42% were aged 65+. The average age of older victims is 79 (65-97, ±9 years). Main probable cause of drowning is a cardiac problem, although only 19% of victims had a medical history of heart disease. Most victims were alone in their apartment or residence when drowning occurred. Risky periods appear to be springtime, Sundays, and evenings. Despite expectations, relevant information about the physical environment is very scarce.

CONCLUSIONS

At least 39 Quebecers, aged 65+, drowned in their bathtubs over a 10-year period. More older adults than children are victims of bathtub drownings in community-dwellings. It seems that bathing may induce heart distress, leading to an appreciable number of drownings.

PRACTICAL IMPLICATIONS

Since cardiac health problems are present in these deplorable events, promoting access to safety devices in the environment (emergency button, grab bars) and modified personal hygiene habits (bathing chair, showering) might be potential ways to prevent drowning and improve safety in older adults while they perform their personal hygiene, an essential activity for health and human dignity.

Bath-related deaths: Preventive strategies and suggestions for general physicians

Bath-related deaths occur frequently in Japan, particularly in the elderly population; however, this fact is not sufficiently well known by the public. The advent of a super-aging society will expose general physicians to more cases of fatal and nonfatal bath-related accidents. As many of the victims have one or more lifestyle-related diseases, general physicians will play a more important role in preventing these fatalities in the future. In addition, general physicians may have to perform postmortem examinations in these cases. This review article addresses the latest studies on bath-related deaths from various medical departments, including forensic medicine, emergency medicine, and physiology. We also discuss preventive strategies based on the assumed mechanisms, and because Japan does not have a well-developed system of medical examiners, we also provide suggestions for physicians who will encounter bath-related deaths in the future.

Postmortem computed tomography findings in cases of bath-related death: Applicability and limitation in forensic practice

PURPOSE

Bath-related deaths occur frequently in Japan, and many of these deaths are diagnosed as death from disease without autopsy in the current Japanese death-investigation system. Therefore, we aimed to examine the postmortem computed tomography (PMCT) findings of bath-related deaths to determine if PMCT can differentiate between real cases of drowning and sudden deaths not related to drowning.

METHODS

Bath-related deaths were sampled from all autopsies conducted at the Tokyo Medical Examiner's Office from September 2015 to August 2016. A total of 90 bath-related deaths (77 drowning cases and 13 non-drowning cases) and 50 controls (sudden cardiac deaths non-related to bathing) were included in this study. We investigated factors contributing to drowning and measured PMCT parameters (presence/density of fluid in the maxillary sinus/trachea, distance between the lungs, lung patterns [ground glass opacities, consolidation], position of the right diaphragmatic dome, density in the right atrium, stomach volume, and density of the gastric/duodenal contents).

RESULTS

The analysis of the factors contributing to drowning showed that alcohol intoxication was the most frequent (n=25), followed by cardiac pathology (n=22), and psychotropic drug intoxication (n=6). Radiological evaluation showed that measurements of all parameters differed significantly between the drowning group and the controls. In addition, significant differences were observed between drowning and non-drowning cases in three radiological parameters (i.e., distance between lungs, stomach volume, and density of gastric contents).

CONCLUSIONS

Majority of bath-related deaths in this study showed signs of drowning at autopsy, and we observed a range of factors that contributed to drowning. By using several radiological parameters (e.g., the distance between the lungs, stomach volume, and the density of the gastric contents), PMCT for the investigation of bath-related deaths might indicate that drowning as opposed to other factors unrelated to drowning (e.g., sudden cardiac death) was the cause of death. This might allow for calculation of accurate mortality statistics on bath-related deaths.