Medicine,Science and the Law

Ethanol is the most commonly encountered drug in forensic toxicology, with widespread use throughout society. For this reason, it is important that there are a variety of reliable and robust methods to detect and quantify the content of alcohol in blood samples of suspected drink drivers. A common method of detection is gas chromatography with flame ionisation detector, with a number of sample preparation techniques employed. Typically, venous blood is sampled and used in the analysis. However, there is currently no legal specification in the UK of the blood sample source. This study investigates the use of capillary blood as an alternative to venous blood alongside two different sample volumes: 100 and 10 µL. Venous and capillary blood were collected from volunteers who had consumed alcohol. All blood sampling was carried out one hour after cessation of drinking. The results show a statistically significant difference between venous and capillary samples, with an average difference of 3.38 ± 1.99 mg/100 mL at 100 μL and approximately 4.13 ± 2.42 mg/100 mL at 10 μL, respectively. Predominantly, venous blood was detected at higher concentrations than the corresponding capillary samples. The deviations in alcohol samples between venous and capillary blood are consistent with previous studies. However, our research indicates that capillary blood is a viable matrix to test for alcohol, albeit one that underestimates blood-alcohol content in relation to venous sampling. There was no statistically significant difference between the 100 and 10 µL sample preparation methods on an individual basis, which infers that micro-volumes of alcohol are suitable for forensic blood-alcohol analysis.

Forensic post-mortem toxicological data provide valuable information for the elucidation of cause of death. However, this is still not routine practice in Brazilian laboratories. This study investigated the presence of illicit and prescription drugs, pesticides and metabolites in 111 post-mortem blood samples from cases investigated by the Forensic Medical Institute of the Federal District, Brazil. Quantitative analysis was performed for 14 analytes using a validated programmed temperature vaporisation-large volume injection-gas chromatography–mass spectrometry method, which was also used as screening (qualitative analysis) for an additional 19 substances of forensic interest. At least one analyte was found in 61.2% of the samples, of which 34 were related to homicide, 15 to accidental death and 10 to suicide cases. The victims were 14–72 years old. The benzodiazepines diazepam, midazolam and 7-aminoflunitrazepan were detected in 46% of the positive samples (0.02–1.12 µg/mL; midazolam only qualitative). Cocaine was found in 34% (0.02–4.07 µg/mL), associated with substances commonly used as cocaine adulterants (e.g. caffeine, lidocaine and phenacetin). Three suicide cases involved the illegal rodenticide chumbinho, residues of which were found in the gastric content, and blood samples showed the presence of terbufos (0.03 and 0.04 µg/mL) and carbofuran (27.3 µg/mL). These results are discussed, along with autopsy and crime-scene information.

In view of the scarcity of literature data on the use of radiological imaging techniques in forensic veterinary medicine, while at the same time the number of reported crimes against animals involving the use of firearms is rising, this paper attempts to assess the usefulness of radiography and computed tomography (CT) in the post-mortem diagnosis of gunshot wounds (GSW) in comparison to classic necropsy. The design of the experiment was as follows: preparation of the research material (13 dog carcasses), shooting of the material from different distances (1.5 and 12 m, plus one contact shot to the head) and using different types of ammunition, followed by X-rays and CT scans in each case to examine the injuries resulting from the shot. The final steps of the experiment were photographic documentation and autopsy by the Virchow method. In the examined material, post-traumatic bone lesions and the presence of metallic foreign bodies were successfully imaged by both radiography and CT. GSW analysis using CT provided much better data quality and some additional information. Two general conclusions can be drawn from the results of the experiment. First, damage caused by gunshots is correlated with the calibre, initial velocity and kinetic energy of the projectile, as well as the distance from the muzzle of the gun to the object shot. Second, radiological examination is useful in preparing forensic veterinary opinions. Used as a complement to classic necropsy, they increase the possibility of an accurate post-mortem diagnosis of shooting victims.

This study sought to determine how often a medico-legal (coronial) autopsy contributes by identifying the source of infection when there has been a clinical diagnosis of sepsis prior to death. Autopsy reports were retrieved in which it was documented there had been a clinical diagnosis of sepsis preceding death. The autopsy report was reviewed to determine if a source for sepsis had been identified. It was found the autopsy was contributory in this respect in less than one fifth of all cases (35 of 198, 18%). It was also determined if there was a post-autopsy diagnosis of sepsis or if sepsis was excluded by a definite alternative diagnosis. During the study, of the 198 cases, sepsis was excluded by an alternative diagnosis in 78 (39%). Thus, the autopsy may be of more application to confirming or excluding a diagnosis of sepsis than identifying a source for sepsis.

Although the increasing popularity of tattoos has challenged the previous associations with criminality and psychiatric illness, particular subsets of tattooed individuals may still have an association with unnatural deaths in a forensic context. A retrospective review of the autopsy database at Forensic Science South Australia was undertaken over a 23-year period from 1997 to 2019 for cases with swastika tattoos. Twenty-six cases (23 males and 3 females) were identified, ranging in age from 19 to 67 years (M_age = 36 years). The cases comprised seven (27%) suicides, seven (27%) accidents (including five vehicle crashes), five (19%) drug-related deaths (toxicity/overdose), four (15.4%) natural deaths and three (11.5%) homicides. There were significantly more unnatural deaths in the group with swastika tattoos compared to tattooed controls (p < 0.01). Multiple swastikas, expletives and white supremacist sentiments were also present in a number of cases. However, in one Asian male, the presence of a sacred Buddhist tattoo suggested that the swastika tattoo instead had religious rather than antisocial/racist significance. This study shows that in the population of individuals undergoing forensic autopsies, subgroups may be identified by their tattoos who have a predisposition to violent and unnatural death. Evaluation of this risk has to be tempered by considering the cultural/religious background of a decedent, as the symbol may have completely different connotations for certain religious groups such as Jains, Hindus and Buddhists.

Etizolam is a thienodiazepine that although licensed for clinical usage in Japan, India and South Korea is commonly abused and detected in post-mortem cases around the world. To date, there are limited data in the literature to allow for the interpretation of blood concentrations of etizolam in post-mortem cases. A liquid chromatography with tandem mass spectrometry method was used to quantitate etizolam concentrations in 28 post-mortem cases where etizolam was detected. The median concentration of etizolam in femoral blood was 8.5 ng/mL (range 1.0–172.0 ng/mL; n = 24); in antemortem plasma, the etizolam concentration range was 4–44 ng/mL (n = 4). The mean age of the individuals abusing etizolam was 38.5 ± 8.4 years (median 39 years), with the majority being male (86%). In all of the cases, multiple drugs were detected, with the most common being pregabalin (61%) followed by morphine/heroin (54%), diazepam (54%) and benzoylecgonine (21%), illustrating the increasing problem of poly-substance use in drug abusers. The cause of death in the cases in which etizolam was detected was multi-drug toxicity in 87.5% of the cases, with 12.5% unrelated to drug use (hangings and blunt-force trauma). These data will further help forensic practitioners with the interpretation of post-mortem etizolam concentrations.

The term ‘amphetamine’ refers to a class of synthetic drugs which includes methamphetamine. The latter is a globally popular drug of abuse which induces euphoria, affecting cognitive/psychomotor performance and sleep. It also provokes risk taking and violent behaviour. The central effects of methamphetamine are due to the overproduction of neurotransmitters, resulting in high levels of dopamine. In recent years, there have been significant increases in cases of methamphetamine abuse in North and South America, Australia and Asia due to its ready availability and low cost. The following review examines changing trends in methamphetamine use and problems that arise diagnostically in medico-legal cases in determining the significance of post-mortem blood levels, the relationship of these to ante-mortem levels, the possible effects on physical and psychological behaviours and the possible contribution of the drug to a lethal episode.

Of the many roles that forensic anthropologists and medico-legal professionals need to perform, forensic age estimation is one of the most frequent and important. Scoring medial clavicular epiphyseal (MCE) fusion is a method used to estimate age in young adults. The aim of this systematic review is to assess the reliability and reproducibility of MCE fusion visualised by conventional radiography and scored by Schmeling’s grading system to determine whether an individual has attained the age of 18 years. Four articles were acquired after screening 4589 articles across four databases, and these were subjected to qualitative and quantitative synthesis. The risk of bias was calculated in the qualitative synthesis using the QUADAS-2 tool. Horizontal box plots were constructed to see whether MCE fusion as visualised by conventional radiography can be used to ascertain whether an individual has attained the age of maturity (18 years). It was observed that stages 4 and 5 of the Schmeling’s method of age estimation from MCE fusion are observed only in individuals aged ≥18 years. This indicates that MCE fusion, when visualised using x-rays, which are associated with less ionisation radiation compared to computed tomography, can be used to verify the attainment of the age majority in individuals.

Accusations of witchcraft and witch-hunting activities remain serious problems in Nepal, where many women are subjected to violence or torture following accusation and persecution. Many experience serious physical and mental injury, and some die. However, most of these incidents are not reported because women and their families fear reprisals. Poverty, systemic gender inequality and weak state laws provide a context in which this behaviour occurs. Allegations of witchcraft will, however, not be fully eradicated without improvements in education and legal safeguards.

Establishing identity from skeletal remains is a challenging task for forensic experts. Identification in such cases can be achieved by dental records, post-mortem radiography and DNA profiling. However, these methods require additional data for comparisons. Positive identification can also be achieved using implanted medical devices. This is a rapid and inexpensive method, as long as a central database is maintained for effective tracking of such devices. We present a case report in which identity was established from skeletal remains using information furnished on the implanted metallic dynamic hip screw and side plate. This case report discusses the legal scenario in India and globally with regard to medical devices and their utility for forensic application. It emphasises the need for legal provision relating to medical devices in India, which would compel the manufacturer to use unique identification numbers for each medical device and to maintain a person-specific database.

While gastro-oesophageal varices commonly complicate portal hypertension and may be a life-threatening condition, fatal haemorrhaging from cirrhosis-related caput medusae has seldom been described in the scientific literature. This article documents a rare death due to the rupture of a varix in the umbilical area. This case raises a number of points for medico-legal discussion, such as the negative consequences of an erroneous cause of death in evaluating medical malpractice cases and the importance of a thorough external examination of the body in order to ensure this type of vascular lesion is not overlooked.