Recent trends in barbiturate detection in medicolegal deaths

A study was undertaken of 51 cases where barbiturates were detected in post-mortem blood samples from 2000 to 2019 at Forensic Science South Australia, Adelaide, Australia. The cause of death was drug toxicity in only 27 (53%) (M:F = 19:8; age range 19-74yrs, mean 46yrs). In 17 cases, barbiturate toxicity was the primary cause of death, 14 due to pentobarbitone and 3 to phenobarbitone. All were suicides. Barbiturates were obtained by online purchase from overseas sources in 9 cases (33%), and through veterinary practice in 2 cases (7%). Drug toxicity deaths where barbiturates were detected rose from 1 in 2000–2004 to 11 in 2015–2019, and those where deaths were primarily due to barbiturate toxicity rose from 1 in 2000–2004 to 9 in 2015–2019. However, the mere detection of barbiturates in post mortem samples did not equate with illicit use, as 23 of the deaths (45%) were due to natural causes in individuals prescribed barbiturates for epilepsy. The usefulness of examining subset populations separate from accrued national data is also demonstrated in the significantly younger age of decedents in South Australia dying from deliberately administered barbiturates (46 yrs) compared to the national average of 57.9 yrs. The reasons for this difference will require further investigation as this may impact upon local suicide prevention strategies.     

Changing patterns of female suicide: 1986-2000

A study was undertaken of the rates and methods of female suicide observed at the Forensic Science Centre in South Australia over a 15 year period from 1986 to 2000. A total of 609 cases of female suicide were found (age range= 13-88 yrs; mean= 44 yrs), with 249 drug overdoses, 114 hangings, 100 deaths due to carbon monoxide (CO) toxicity, 40 drownings, 35 firearm deaths and 71 miscellaneous deaths (including deaths due to self-immolation, jumping from heights and incised wounds). The most common age range was 26-50 yrs in all categories except for drowning where victims tended to be older. While overall suicide rates in females remained unchanged, with no changes in the rates at different ages, significant increases in hanging and CO deaths occurred over all age groups (p < 0.05), with significant falls in drug overdose deaths in the 10-25 year age group (p < 0.01), and significant overall falls in suicides due to gunshot wounds (p < 0.05). No changes were observed in female suicides due to drowning. This study has demonstrated, therefore, that although no changes in overall suicide rates for females occurred, there have been alterations in the types of methods being used. Although drug related deaths remained the largest category, hanging deaths, which were once uncommon in females, have increased markedly.     

Weight ratio of the lungs and pleural effusion to the spleen in the diagnosis of drowning

An accurate and reliable method of diagnosing death by drowning is an important requirement in forensic autopsies. In this study, we compared the weight ratio of the lungs and pleural effusion to the spleen for 55 cases of drowning (37 males, 18 females), 36 cases of mechanical asphyxiation (16 males, 20 females), and 26 cases of acute cardiac death (19 males, 7 females). In the case of the males, there were significant differences in the weight of the spleen and the total weight of the lungs and pleural effusion between drowning and the other causes of death; however, there was no such significant difference in the females. We observed significant differences in the lungs and pleural effusion/spleen weight ratio between drowning and the other causes of death for both sexes. Therefore, these findings suggest that the ratio may be a useful index to accurately diagnose death by drowning, while ruling out mechanical asphyxiation and acute cardiac death in forensic autopsies.     

Causes of community suicides among indigenous South Australians

A retrospective review of suicides occurring among Aboriginal people in the community in South Australia over a 5-year period was undertaken from January 2005 to December 2009. Twenty-eight cases were identified, consisting of 21 males (age range 16–44 years, mean 29.9 years) and 7 females (age range 23–45 years, mean 32.0 years). Deaths in all cases were caused by hanging (100%). Toxicological evaluation of blood revealed alcohol (39.3% of cases), cannabinoids (39.3%), benzodiazepines (10.7%), opiates (7.1%), antidepressants (7.1%), amphetamines (3.6%) and volatiles (3.6%). This study has demonstrated that the method of suicide overwhelmingly preferred by indigenous victims in South Australia is hanging. The precise reasons for this preference are uncertain, however, an indigenous person in South Australia presenting as a suicide where a method other than hanging has been used would be exceedingly uncommon, raising the possibility of alternative manners of death.     

Examination of regional differences in physical growth in urban and rural areas. Based on longitudinal data from South Korea

Although the land area of South Korea is small and the population density is high compared with the neighboring country of China, examination of the regional differences in physical growth in South Korea is thought to be insufficient. In this study, to examine the regional differences in physical growth in South Korea, we attempted to verify the effects of unique regional environments on physical growth by comparing an urban area within the city of Busan and a rural district in the surrounding area. The subjects were 300 males and 201 females in the final year of one high school within the city of Busan, and 230 males and 215 females in the final year of a high school in a rural area outside the city of Busan. Health check records for these subjects were reviewed retrospectively, and longitudinal growth data for height and weight were obtained from the first year of elementary school (age 7 years) to the final year of high school (age 18 years) (1988–1999). The wavelet interpolation method was then applied to the longitudinal growth data for height and weight classified into urban and rural areas, and the maximum peak velocity (MPV) and mid-growth spurts (MGS) were identified. The results revealed a significant difference between the urban and rural areas in the age at MPV of height and weight for males (P < 0.05), but no significant difference was seen for the females. Based on the results, the age at MPV in the physique of males showed a tendency for urban males to be physically younger. However, the age at MPV of physique in females was similar in the urban and rural areas. In addition, for the pattern of appearance of the MGS in males, there was one MGS in the greatest number of cases (41 %) in both the urban and rural areas, followed by two MGSs in 30–40 %. Among females, there was one MGS in 48 % of urban females and 54 % of rural females, the highest number. The next highest percentage was for no appearance of a growth spurt, in 41 % of urban females and 29 % of rural females. Although the MGS appearance pattern seemed to differ slightly in urban and rural females, the results of a χ² test showed no significant difference between the urban and rural area in the MGS appearance pattern in either males or females. The high economic growth has not ended in South Korea and from the above it is thought that there continues today to be a rising trend in physique with time. The differences in physical growth caused by this phenomenon together with the differences in the socioeconomic situation in the urban and rural areas are thought to have been demonstrated.     

Suicide methods in the elderly in South Australia 1981-2000

The files of the Forensic Science Centre in Adelaide, Australia were examined over a 20-year period from 1981 to 2000 for cases of suicide in individuals aged 65 years and over. A total of 445 cases were found (13.8% of all suicides) with an age range of 65-94 years (average= 73.5 years). All cases had undergone full autopsies and police investigation. There were significantly more male than female victims; M:F = 330:115 (p < 0.001). Hangings accounted for the highest proportion of cases (107/445; 24%) followed by gunshot wounds (96/445; 21.6%), drug toxicity (82/435; 18.9%), drowning (66/445; 14.8%), and carbon monoxide toxicity (52/445; 11.7%). A miscellaneous group accounted for 42 of 445 cases (9.2%). No significant changes occurred in either the total suicide rate or in the rates in males and females, except for drowning deaths in males, which showed a significant decrease over time (p < 0.01). Female victims tended to avoid violent methods such as gunshot wounds in favour of drug overdose. Gunshot wound deaths were far less common than published data from other countries would indicate, with relative increases in deaths due to hanging, drug toxicity, drowning and carbon monoxide toxicity. An awareness of the considerable variability that occurs among populations in suicide methods and rates is important in determining local requirements for suicide prevention campaigns.     

Early adolescent suicide: a comparative study

A study was undertaken of suicides in children and adolescents aged 16 years and under in South Australia, (Australia), and in San Diego County (USA) from January 1985 to December 1997. In South Australia there were 48 cases of youth suicide, representing 2% of the total number of 2251 suicides over that time. There were 34 males and 14 females (age range 13 to 16 years; mean = 15.3 years), with 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%). In San Diego County there were 70 cases, representing 1.6% of the total number of 4492 suicides. There were 48 males and 22 females (age range 11 to 16 years; mean = 14.7 years), with 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%). Preferred methods of suicide differed between the two areas, with significantly more gunshot suicides in San Diego compared to South Australia. The methods of suicide also differed in South Australia from older age groups, with more hangings, jumping deaths and self immolations, and fewer firearm and carbon monoxide inhalation deaths. Suicides in adolescents under the age of 17 years in both populations were, however, rare, with no demonstrable increase in numbers over the time of the study.     

Direct observation measurement of drowning risk exposure for surf beach bathers

Because not all persons bathe at surf beaches, drowning rates based on resident population are likely to be underreported. To facilitate more precise drowning risk exposure data, this study aimed to develop a reliable direct observation measure of frequency and duration for surf beach bather exposure to water, by gender and age group. Bathers were defined as persons entering the water to wade, swim or surf with equipment. Observed bathers were systematically selected entering the water in daylight hours at six patrolled or unpatrolled beaches over 10 days. Variables measured were: weather and water conditions, water entries, duration of water exposure, water exposure location and person factors. The dataset comprised 204 (69.6%) males and 89 (30.4%) females, with males more likely to be in an older age group (p < 0.05). Compared to females, males spent longer in the water, were more likely to use surfing equipment, and mainly used a surf zone located farther from the shore in deeper water (p < 0.05). Two factors were significant predictors of bathing duration (adjusted R² = 0.45): main surf zone occupied (based on water depth and distance from shore); and surf equipment used. The study provides new information about water exposure for bathers at surf beaches and new methods for measuring exposure to drowning risk. The findings suggest that overrepresentation of adolescent and adult males in surf beach drowning statistics is in part a product of greater total exposure to the water plus more frequent exposure to deeper water and bathing farther from shore.     

Magnetic resonance imaging of the proximal tibial epiphysis: could it be helpful in forensic age estimation?

There is an increasing demand for age estimations of living persons who are involved in civil and criminal procedures but lack a valid birth certificate indicating their date of birth. Several studies have recommended the application of magnetic resonance imaging (MRI) and assessment of the stage of epiphyseal fusion in age estimation. This study involved retrospective MRI analysis of 335 cases (217 males and 118 females) whose ages ranged from 8 to 28 years (yrs). We assessed the degree of ossification of the proximal tibial epiphysis depending on the classifications of Schmeling and Kellinghaus used for the main stages (I, II, III, IV & V) and substages (IIa, b, c & IIIa, b, c). Significant differences between males and females at stages IIIc, IV and V (p < 0.001) were observed. Additionally, the ossification of the proximal tibial epiphyses occurred earlier in females than in males (2–4 yrs). The mean of ages in stage IV was approximately 18.6 yrs. in females and 22.5 yrs. in males, meaning that stage IV can be used as a valuable forensic marker to determine whether the person in question has reached the age of 18 yrs. We concluded that the application of MRI in the assessment of the ossification status of the proximal tibial epiphysis could be helpful in age estimation for various forensic purposes.     

Sudden adult death: An autopsy series of 534 cases with gender and control comparison

The aim of our study was to highlight the epidemiological difference in adult sudden death between males and females. The type of pathologies found in adult victims of sudden death was compared to control cases in order to determine the most significant pathologies involved in sudden death.Among all autopsies performed between 1995 and 2009, 534 adult cases of sudden death and 154 cases who violently died were respectively selected. For each case, a complete autopsy was carried out, including systematic histological examination of all major organs.The sudden death population was composed of 369 males and 165 females. There was no statistical difference regarding age between males and female. Sudden death took place more often at home in women than in men (p < 0.0001). A stressful event was more frequently found in men than in women (p = 0.03). Deaths caused by cardiovascular diseases were more frequent in males than in females, especially Coronary Artery Disease (CAD) (p < 0.0001). Cardiomyopathy was more often the cause of death in women, particularly Arrythmogenic Right Ventricular Cardiomyopathy (ARVC). Cardiac pathologies were found in 45% of the control cases. CAD and ARVC were statistically more frequent in the sudden death group than in the control group.According to our study, profile of sudden death is different between males and females. Those data seem to be important for clinicians involved in prevention programs of sudden death, as they can adapt their screening according to the gender.     

A retrospective review of homicides in Mangalore,South India

A five-year retrospective study of homicides was carried out to determine the profile of victims and the pattern of injuries sustained between 2001 and 2005 at Government District Wenlock Hospital, Mangalore, South India. Of the 89 victims of homicide, 71 were males and 18 were females. On an average, about 17 cases of fatal assault cases were autopsied each year. The commonest age group affected was the 21–30 age group (28.1%). The head was found to be the most common site of injury followed by the extremities, abdomen and chest. In 49.4% of the cases, the victims had sustained sharp force injuries while in 34.8% blunt force injuries were present. Fatal injuries to the head were the commonest cause of death. Homicide by strangulation was seen in 8 cases and involved mostly women. The incidence of homicidal burns was low (n = 2, 2.2%). In 61.8% of the cases, death was immediate. In 52.8% of the cases the assailant(s) had a pre-planned motive for killing.     

Quantitative estimation of TNF-α and IL-3 by using ELISA from human lung tissue in fatal asphyxial deaths

Asphyxia-related deaths have always been a challenging task in the specialty of forensic pathology. Apart from helpful macroscopical signs (e.g., strangulation marks, cyanosis, petechial haemorrhage, and lung edema), recent literature indicates that prolonged asphyxia is sufficient to induce an increase in mast cells (MC). Inflammatory cells migrate from the bone marrow to the lungs, aiding in the diagnosis of fatal asphyxial death. The present study analyzed human lung tissue samples from 90 medico-legal autopsy cases, including 45 asphyxial deaths and 45 controls (non-asphyxial deaths). The cases ranged from 2 to 68 years, with a mean age of 33.23 years. In 90 cases, 74 cases were of males, and 16 were of females. Human lung tissue samples were analyzed by using the sandwich ELISA method. The results indicated a statistically significant increase in TNF-α and IL-3 concentration in fatal asphyxial deaths, including those caused by hanging, drowning, and smothering. Mean ± SD in asphyxial and non-asphyxial cases for the TNF-α and IL-3 concentration statistically analysed. In asphyxial cases, the average IL-3 concentration (Conc.) was 1558.50 ± 350.53 pg/ml, and the average TNF-α concentration (Conc.) was 499.75 ± 479.41 pg/ml. In contrast, in non-asphyxial cases, the average IL-3 concentration (Conc.) was found to be 849.73 ± 484.99 pg/ml, and the average TNF-α concentration (Conc.) was 208.08 ± 81.23 pg/ml. The mean change in IL-3 and TNF-α (Conc.) values are found to significant (<0.01) in asphyxial cases as compared to non-asphyxial cases. The ROC (Receiver operating characteristic curve) analysis revealed that TNF-α (AUC = 0.89) and IL-3 (AUC = 0.87) concentration (conc.) were stronger predictors of asphyxial deaths with an optimal cut-off value of 455.20 pg/ml for TNF-alpha and 1700.62 pg/ml for IL-3 respectively. Our findings imply that mast cells (MC) are critical in fatal hypoxia-related mortality and that TNF-α and IL-3 can be reliable markers for detecting mast cells in asphyxial deaths. It could be very beneficial to forensic pathologists tasked with differentiating fatal asphyxial fatalities from other causes of death.     

Cadence in youth long-distance runners is predicted by leg length and running speed

BackgroundLower cadence has been previously associated with injury in long-distance runners. Variations in cadence may be related to experience, speed, and anthropometric variables. It is unknown what factors, if any, predict cadence in healthy youth long-distance runners.Research questionAre demographic, anthropometric and/or biomechanical variables able to predict cadence in healthy youth long-distance runners.MethodsA cohort of 138 uninjured youth long-distance runners (M = 62, F = 76; Mean ± SD; age = 13.7 ± 2.7; mass = 47.9 ± 13.6 kg; height = 157.9 ± 14.5 cm; running volume = 19.2 ± 20.6 km/wk; running experience: males = 3.5 ± 2.1 yrs, females = 3.3 ± 2.0 yrs) were recruited for the study. Multiple linear regression (MLR) models were developed for total sample and for each sex independently that only included variables that were significantly correlated to self-selected cadence. A variance inflation factor (VIF) assessed multicollinearity of variables. If VIF≥ 5, variable(s) were removed and the MLR analysis was conducted again.ResultsFor all models, VIF was > 5 between speed and normalized stride length, therefore we removed normalized stride length from all models. Only leg length and speed were significantly correlated (p < .001) with cadence in the regression models for total sample (R² = 51.9 %) and females (R² = 48.2 %). The regression model for all participants was Cadence = −1.251 *Leg Length + 3.665 *Speed + 254.858. The regression model for females was Cadence = −1.190 *Leg Length + 3.705 *Speed + 249.688. For males, leg length, cadence, and running experience were significantly predictive (p < .001) of cadence in the model (R² = 54.7 %). The regression model for males was Cadence = −1.268 *Leg Length + 3.471 *Speed – 1.087 *Running Experience + 261.378.SignificanceApproximately 50 % of the variance in cadence was explained by the individual’s leg length and running speed. Shorter leg lengths and faster running speeds were associated with higher cadence. For males, fewer years of running experience was associated with a higher cadence.     

Scuba-diving related deaths in Okinawa, Japan, from 1982 to 2007

We reviewed the autopsies of scuba-diving related deaths (SDRDs) that were collected from April 1982 until March 2007. In the period under consideration, a total of 40 SDRDs were registered, out of which 34 were males and 6 females. Ages ranged from 19 to 65 years, with the average of 41.5 years (SD=12.9). Divers over the age of 40 accounted for 60% of all fatalities. The major cause of death was drowning (62.5%), followed by disease (28.5%). The average age for drowning and disease-related deaths was 38.6 (SD=12.8) and 48.7 years (SD=10.1), respectively. Of the 40 fatalities, 24 were beginners who had little or no experience. In this study, we compared SDRDs in the first term, from April 1982 to March 1995, and in the second term, from April 1995 to March 2007. The average age in the first and second terms was 35.4 and 45.2 years, respectively; the average age for the second term was 10 years older than the first. Of those in the first term, 13.3%, and of those in the second term, 40.0%, died from complications arising from already existing conditions. This study revealed that the onset of diseases during diving frequently causes fatal accidents, especially for older divers.     

Determining the effect of water temperature on the T1 and T2 relaxation times of the lung tissue at 9.4 T MRI: A drowning mouse model

Japanese individuals have a unique culture of soaking in a bathtub, and forensic pathologists have experienced fatal cases due to drowning. However, T1 and T2 relaxation times of a drowning lung are poorly documented.In the present study, we investigated the relationship between drowning water temperature and T1 and T2 relaxation times of drowning lung tissues at 9.4 T MRI (Bruker, BioSpec94/20USR). The mice used as animal drowning models were directly submerged in freshwater. Water temperature was set to 8 °C–10 °C (cold), 20 °C–22 °C (normal), 30 °C, and 45 °C. The regions of interest (ROIs) on the axial section of the third slice were set at the central and peripheral areas of each—the left and the right—lung. T1 relaxation times measured immediately after death differed by the presence or absence of soaking water, except in case of cold water temperature. In the drowning groups, T1 relaxation time showed a linear dependency on water temperature. By contrast, T2 relaxation time was almost constant regardless of the presence of drowning under the same temperature condition; when compared in the lung areas of the same individuals, the times were uniformly reduced in drowning models. To minimize the effects of hypostasis and decomposition, we performed measurements immediately after death and were able to determine the noticeable difference in drowning water temperature. These results may be useful for qualitative assessments of a drowning lung and may serve as a basis when imaging the human body during forensic autopsy cases.     

Postmortem urinary catecholamine levels with regard to the cause of death

Previous studies suggested that serum catecholamines are useful for investigating stress responses in the death process. The present study analyzed postmortem urinary adrenaline (Ad), noradrenaline (Nad) and dopamine (DA) in serial forensic autopsy cases (n = 199: 154 males and 45 females; age >9 years; survival time <0.5–168 h; within 10 days postmortem) to investigate the differences among the causes of death with special regard to hyperthermia (heatstroke; n = 11) and hypothermia (cold exposure; n = 10); other cases included fatalities from injury (n = 47), mechanical asphyxiation (n = 18), drowning (n = 14), intoxication (n = 31), fire fatality (n = 33) and natural death (n = 35). Each catecholamine level in urine was independent of the age or gender of the subjects, postmortem interval over 10 days or survival time, and did not correlate with the blood level. Urinary Adr and Nad levels were similar to those of clinical serum reference ranges, while DA was higher in all cases. Adr and Nad were higher in blunt head injury, methamphetamine abuse, hypothermia (cold exposure) and hyperthermia (heat stroke), but were low in mechanical asphyxia, drowning, fire fatality, sedative-hypnotic intoxication and acute cardiac death. DA was higher in injury, drowning, fire fatality, methamphetamine abuse and acute cardiac death, but was lower in mechanical asphyxiation and sedative-hypnotic intoxication. These profiles were quite different from those of serum levels, involving a predominant increase of DA, and may be useful for differentiating hyperthermia (heatstroke) and hypothermia (cold exposure) from drowning, sedative-hypnotic intoxication and sudden cardiac death.     

Toddler run-overs – A persistent problem

Trauma accounts for a high percentage of unexpected deaths in toddlers and young children, mostly due to vehicle accidents, drowning and fires. Given recent efforts to publicise the dangers of toddler run-overs a study was undertaken to determine how significant this problem remains in South Australia. Review of coronial files over 7 years from 2000 to 2006 revealed 50 cases of sudden and unexpected death in children aged between 1 and 3 years of which 12 of 28 accidents involved motor vehicles (6 run-overs and 6 passengers). The 6 children who were killed by vehicle run-overs were aged from 12 months to 22 months (ave = 16.8 months) with a male to female ratio of 1:1. Four deaths occurred with reversing vehicles in home driveways and one at a community centre. The remaining death involved a child being run over at the beach by a forward moving vehicle. Vehicles included sedans in four cases and a four-wheel drive in one case (one vehicle was not described), and were driven by the victim’s parent in four cases, a friend of the family in one, and an unrelated person in the final case. Deaths were all due to blunt cranial trauma. Despite initiatives to prevent these deaths, toddler run-overs in South Australia approximate the number of sudden deaths due to homicides, drownings and natural diseases, respectively, for the same age group; deaths are also occurring in places other than home driveways, and sedans were more often involved than four-wheel drive vehicles.     

Craniometric determination of population affinity in South Africans

A vital aspect of skeletal analysis is the determination of population affinity of an unknown individual. The aim of this paper is to develop discriminant function formulae to determine race from craniometric dimensions of South African blacks and whites. Skeletons used in this study came from the Universities of the Witwatersrand and Pretoria. The sample is composed of 53 white males and 53 white females and 45 black males and 45 black females. Using 13 standard cranial and 4 mandibular dimensions, average accuracies of 98% were obtained from the crania, which were much more discriminatory than the mandibles (74% males, 87% females). When a “leave-one-out classification” technique was applied to the sample to measure accuracy of multivariate classification, this accuracy was about the same as obtained from the multivariate function. A posterior probability of 0.80 or more was found in as much as 96% of the sample. Stepwise discriminant function formulae for incomplete remains (vault and face) were also derived. Prediction accuracy was considerably lower when North American based formulae were tested on the South Africans, indicating significant craniometric differences between these populations. Received: 2 February 1998 / Received in revised form: 3 July 1998