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Wall Falls: Blunt Trauma Sustained from Border Wall Crossings
The border wall between the United States and Mexico consists of stretches of metal fencing of varying heights alternating and overlapping with areas of electronic surveillance. Despite national conversations centered around the social, environmental, economic, and political implications of this wall, there is a paucity of studies on deaths occurring in this region. Herein are described 2 cases of fatal injuries sustained from scaling the fence and accidentally falling onto the United States’ side in New Mexico. These injuries are compared with those typically incurred in falls from lower and higher heights, and implicat...
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Case Reports Source Type: research

A Computed Tomographic Analysis of Spheno-Occipital Synchondrosis Ossification for Age Estimation in a Sample of Egyptians
The aim of the present work was to create statistically quantified age estimation standards based on spheno-occipital synchondrosis (SOS) fusion state as visualized in computed tomography in Egyptians. The study included 208 Egyptians between the ages of 5 and 30 years (117 male and 90 female participants). Spheno-occipital synchondrosis was visualized in a midsagittal view in a neutral head position. Degree of ossification of SOS was assessed using a 4-stage system. Interobserver agreement and intraobserver agreement were almost perfect with Cohen κ values of 0.863 and 0.983, respectively. The mean ages of complete fusio...
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Original Articles Source Type: research

Classifying Microscopic Acute and Old Myocardial Infarction Using Convolutional Neural Networks
This study was carried out to investigate whether CNNs are able to identify and age myocardial infarction (a common example of forensic/postmortem histopathology) from histology slides. As a proof of concept, this study compared 4 CNNs commonly used in surgical/anatomical histopathology to identify normal myocardium from myocardial infarction. A total of 150 images of the myocardium (50 images each for normal myocardium, acute myocardial infarction, and old myocardial infarction) were used to train and test each CNN. One of the CNNs used (InceptionResNet v2) was able to show a greater than 95% accuracy in classifying norma...
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Original Articles Source Type: research

Autopsy Cardiac Troponin I Plasma Levels Can Be Elevated in Myocardial Infarction Type 3: A Proposal to Modify the Definition of Myocardial Infarction Type 3
Conclusions If cTnI plasma levels are measured in autopsy blood samples after sudden and unexpected death due to MI type 3, highly elevated cTnI plasma levels may be detected. We propose that the current MI type 3 definition be slightly modified to include the possible elevation of cTnI plasma levels if measured at autopsy in the immediate postmortem period. (Source: The American Journal of Forensic Medicine and Pathology)
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Original Articles Source Type: research

Longitudinal Opioid Surveillance Project Involving Toxicologic Analysis of Postmortem Specimens from 9 Counties in Michigan Suggests the Discovery of New High-Intensity Drug Trafficking Areas
This article describes data from a longitudinal opioid surveillance program and details 102 decedents in MI who were found to have evidence of heroin in their postmortem blood. A large portion of these decedents were also found to have evidence of fentanyl and AF. Our data further show significant overlap in incidence rates of AF and heroin-related overdose deaths in several MI counties, suggesting that AF is becoming enmeshed in heroin trafficking. Furthermore, we report unprecedented high incidence rates of AF and heroin-related overdose deaths in Calhoun county, and we propose that it is a high-intensity drug traffickin...
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Original Articles Source Type: research

Homicide by Unspecified Means: Cleveland 2008 to 2019
The diagnosis homicide by unspecified means (HUM) is used to categorize deaths occurring under suspicious or criminal circumstances, but a specific cause of death cannot be identified. In 2010, Matshes and Lew (Am J Forensic Med Pathol. 2010;31(2):174–177) presented a HUM cases series, from which they derived 5 diagnostic criteria; however, the accuracy of these criteria has not been assessed. (Source: The American Journal of Forensic Medicine and Pathology)
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Original Articles Source Type: research

Autopsy Education in Canadian Pathology Programs: A Survey of Canadian Trainees
Discussion Most Canadian pathology residents believe that autopsy education is an important component of residency training. Limited access to quality autopsy teaching seems to be an important factor in resident interest in forensic pathology as a future career, despite a perceived good job market in comparison with most other subspecialties. (Source: The American Journal of Forensic Medicine and Pathology)
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Original Articles Source Type: research

In Memoriam: Jan Edward Leestma, MD, 1938–2020
No abstract available (Source: The American Journal of Forensic Medicine and Pathology)
Source: The American Journal of Forensic Medicine and Pathology - August 21, 2021 Category: Forensic Medicine Tags: Editorial Source Type: research

Disseminated Herpes Simplex Virus in an Immunocompetent Patient Without Presence of Epidermal or Mucosal Lesions
Herpes simplex virus (HSV) is a disease usually characterized by lesions within the epidermis or mucosa of children and adults. However, this infection can also cause complications to many systems of the body, including the peripheral and central nervous system, respiratory system, and hepatobiliary system. In this case, we present a 43-year-old man with a history of substance abuse, who presented with fever, cough, and headache, and within days, progressed into fulminant hepatitis and hypoxic failure. Bacterial and fungal cultures were negative, as well as the workup for human immunodeficiency virus. However, the presence...
Source: The American Journal of Forensic Medicine and Pathology - May 20, 2021 Category: Forensic Medicine Tags: Illustrated Forensic Pathology Source Type: research

Anaphylactoid Syndrome of Pregnancy—An Autopsy Case Report
No abstract available (Source: The American Journal of Forensic Medicine and Pathology)
Source: The American Journal of Forensic Medicine and Pathology - May 20, 2021 Category: Forensic Medicine Tags: Illustrated Forensic Pathology Source Type: research

The Importance of Autopsy in a Case of Digestive Perforation Undetected by Postmortem Computed Tomography
We describe the case of a patient who died in a psychiatric seclusion room with no obvious cause and for whom a forensic autopsy was requested. Further investigations showed the existence of a subdural hematoma associated with a midline shift, secondary to a skull fracture that was considered to be the cause of death. Toxicological analyses identified in blood several drugs, including diazepam (24 ng/mL) and its major metabolite nordazepam (24 ng/mL), propranolol (57 ng/mL), paliperidone (9 ng/mL), and loxapine (620 ng/mL). The forensic autopsy revealed the existence of a gastrointestinal perforation after the ingestion of...
Source: The American Journal of Forensic Medicine and Pathology - May 20, 2021 Category: Forensic Medicine Tags: Case Reports Source Type: research

Cocaine Consumption and Antineutrophil Cytoplasmic Antibody–associated Glomerulonephritis: A Case Report
We present a case of cocaine/levamisole-induced pauci-immune glomerulonephritis. A 22-year-old patient was sent to the hospital after a laboratory result showed an unexpected acute kidney injury, with an estimated glomerular filtration rate of 34 mL/min/1.73 m2. The medical history included cocaine abuse. Renal biopsy showed a pauci-immune necrotizing glomerulonephritis. Antineutrophil cytoplasmic antibodies were positive with a perinuclear staining pattern and target specificity for leucocyte myeloperoxidase (antimyeloperoxidase). Despite treatment, the kidney function did not show significant improvement. The forensic im...
Source: The American Journal of Forensic Medicine and Pathology - May 20, 2021 Category: Forensic Medicine Tags: Case Reports Source Type: research

Massive Brainstem and Cerebellum Infarction Due to Traumatic Extracranial Vertebral Artery Dissection in a Motor Traffic Accident: An Autopsy Case Report
Traumatic unilateral vertebral artery (VA) injury can cause focal thrombosis and may block the basilar artery which can further lead to ischemic stroke and massive cerebral infarction and subarachnoid hemorrhage and even rapid death. Here, we present an autopsy case with a traumatic extracranial VA dissection in a motor traffic accident, and the identification of cause of death underwent 2 autopsies. A 62-year-old male pedestrian collided with the right rearview mirror of a car and fell down to the ground. He complained pains in the head and neck. Head computed tomography (CT) showed a right linear temporal bone fracture a...
Source: The American Journal of Forensic Medicine and Pathology - May 20, 2021 Category: Forensic Medicine Tags: Case Reports Source Type: research

Actinomyces in Forensic Practice
A 19-year-old woman in septic shock with recent computed tomography findings of a loculated hepatic abscess was transferred to an intensive care unit where she went into asystolic cardiac arrest. After resuscitation, surgical exploration revealed a purulent pericardial effusion with tamponade and a liver abscess. Microbiological analyses from both sites were negative. Shortly after surgical exploration, she developed multiorgan failure and died. At autopsy, pus was observed both within the pericardial cavity and around the left lobe of the liver. Green “sulfur granules” suggestive of infection with Actinomyces spp. wer...
Source: The American Journal of Forensic Medicine and Pathology - May 20, 2021 Category: Forensic Medicine Tags: Case Reports Source Type: research

Unusual Case of Progressive Multifocal Leukoencephalopathy in a Patient With Sjögren Syndrome
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease caused by reactivation of John Cunningham virus affecting typically subcortical and periventricular white matter of immunocompromised hosts (human immunodeficiency virus infection, hematologic malignancies). Cerebral hemispheric white matter is most commonly affected by lytic infections, leading to progressive damage to oligodendrocytes in the central nervous system. Neuroimaging usually highlights scattered foci of white matter hypodensity not attributable to contrast enhancement or mass effect. In contrast, we present an unusual case of PML ...
Source: The American Journal of Forensic Medicine and Pathology - May 20, 2021 Category: Forensic Medicine Tags: Case Reports Source Type: research