Forensic Medicine

Ethyl glucuronide (EtG) is a minor and direct metabolite of ethanol. EtG is incorporated into the growing hair allowing retrospective investigation of chronic alcohol abuse. In this study, we report the development and the validation of a method using gas chromatography–negative chemical ionization tandem mass spectrometry (GC–NCI-MS/MS) for the quantification of EtG in hair. EtG was extracted from about 30mg

Techniques of molecular biology have improved diagnostic sensitivity, accuracy and validity in forensic medicine very much, especially in the field of identification (paternity testing, stain analysis). Since more than 10 years these techniques -meanwhile well established in clinical disciplines -are used also for other applications in forensic medicine: determination of cause and manner of death, tissue identification by mRNA and microRNA, examination of gene expression levels (survival time, time since death, cause of death), toxicogenetics.

An adequate death investigation requires the combined efforts and cooperation of experts in different disciplines: crime scene technicians, death investigators, forensic pathologists, anthropologists, entomologists, other medical and non-medical professionals. These front-line experts play a crucial role in every death investigation process. The forensic pathologist normally has the legal authority to take charge of the dead body at a death scene and his primary functions are the exterior and interior examination of the cadaver by analyzing the extent of antemortem injuries and the postmortem changes and the recovery of physical evidence. He is responsible for determining how, when and why of any death which is the result of violence, suspicious or unexplained circumstances or a death which is sudden or unattended, defending and explaining the reasons for making these diagnoses in a courtroom. The forensic entomologist can provide invaluable aid in death cases where human remains are colonized by insects and in the overall investigation. His principal role is to identify the arthropods associated with such cases and to analyze entomological data for interpreting insect evidence. He is responsible for determining the period of insect activity according to all the variables affecting insect invasion of remains and their development. The major goal of medico-criminal entomology is to contribute to the determination of the time, cause, manner and place of the investigated death (especially on badly decomposed corpses or skeletonized human remains) with the support of all the elements which can be inferred from the study of insects found on the cadaver or nearby. The application of techniques devised recently in forensic entomology can allow experts in the ®eld to collect strong entomological evidence and provide useful information not only in a death investigation including movement or storage of the remains following death, time of dismemberment, postmortem artifacts on the body but also at the scene, and even more in child neglect, sexual molestation and identi®cation of suspects. As the role of the forensic entomologist at the death scene, at the autopsy and in the laboratory is de®ned and well known, this paper focuses on the dif®culties that could arise if forensic pathologists and entomologists are uncertain about the procedures that they have to follow, do not realize the value of objective ®ndings or fail to evaluate them. Although every forensic case presents a slightly different set of circumstances and has to be tackled individually, the forensic pathologist should work with the forensic entomologist from the visual observations of the cadaver on the scene, through the collection of arthropods and temperature data at the death scene and at the autopsy, up to the ®nal report with the interpretation of entomological and other biological evidence. # : S 0 3 7 9 -0 7 3 8 ( 0 1 ) 0 0 4 2 5 -X

Medical expertise is crucial in death investigations. It begins with body examination and evidence collection at the scene and proceeds through history, physical examination, laboratory tests, and diagnosis – in short, the broad ingredients of a doctor’s treatment of a living patient. The key goal is to provide objective evidence of cause, timing, and manner of death for adjudication by the criminal justice system. Death investigation has been performed for centuries in all societies, although not always by medical professionals (Committee, 2003). The association of law and medicine dates back to the Egyptian culture as early as 3000 B.C. The English coroner system was mentioned in documentations around the 12th century B.C. (Spitz, 2006).
Although the primary goal of a death investigation is to establish the cause and manner of death, the role of the death investigation extends much further than simply answering these two questions. A common question asked is, “Why does it matter? The person is dead.” While it is true that the dead cannot benefit, the value in death investigation is to benefit the living and future generations. In a culture that values life, explaining the death in a public forum (the meaning of “forensic”) is crucial for many reasons. And this interest goes beyond simple curiosity (Wagner, 2009).
In homicide, suspected homicide, and other suspicious or obscure cases, the forensic medicine expert should visit the scene of the death before the body is removed. Local practice varies but any doctor claiming to be a forensic medicine expert should always make himself available to accompany the police to the locus of the death. This duty is often formalized and made part of a contract of service for those forensic medicine experts who are either full-time or substantially involved in assisting the police, in England and Wales, the 'Home Office Pathologists' are permanently on call for such visits and in many other jurisdictions, such as the medical examiner systems in the USA, and the European State and University Institutes of Forensic Medicine, there is usually a prearranged duty roster for attendance at scenes of death (Saukko & Knight, 2004). In many cases, the scene investigation is more important than the autopsy. A thorough and complete investigation commonly leads to the proper diagnosis of the cause and manner of death prior to an autopsy (Avis, 1993; Dix & Ernst, 1999).
Why go to the scene? The purpose of having the forensic medicine expert attend the death scene is severalfold. By viewing the body in the context of its surroundings, the forensic medicine expert is better able to interpret certain findings at the autopsy such as a patterned imprint across the neck from collapsing onto an open vegetable drawer in a refrigerator. The forensic medicine expert is also able to advise the investigative agency about the nature of the death, whether to confirm a homicide by a specific means, evaluate the circumstances to be consistent with an apparent natural death, or interpret the blood loss from a deceased person as being more likely due to natural disease than to injury. This preliminary information helps the investigative agency to define its perimeter, structure its approach, organize its manpower, secure potentially important evidence, and streamline its efforts.
Nonattendance at death scenes has been regarded as one of the classical mistakes in forensic pathology. Hospital pathologists performing forensic autopsies who are not trained to, or able to, attend death scenes should be provided with information on how, when, and where the body was found, by whom, and under what circumstances. In some deaths, the immediate environment does not contribute to death, such as in cases of metastatic breast carcinoma. In other cases, the environment plays a role although it does not cause the death; for example, consider a case in which a person with marked coronary atherosclerosis collapses with a dysrhythmia while shoveling snow. On the other hand, the scene description and scene photographs are critical in documenting that the physical circumstances and body posture are indicative of death due to positional asphyxia because the autopsy in these cases may yield very few findings. The most meticulous autopsy in all academia will provide only a speculative cause and manner of death in a 30-year-old man with a negative history, negative toxicology, and autopsy findings of visceral congestion.
Yet at the scene, a screwdriver is next to an uncovered electrical outlet on a rain-soaked patio at the decedent's house, which is undergoing renovation. The cause and manner of death are provided by the scene (Lew & Matshes, 2005).
The examination of a death scene and subsequent collection of potential evidential material requires special skill, knowledge, aptitude, and attitude. The manner in which a death scene investigation is conducted may be a critical factor in determining the success of an investigation. The thorough examination of a death scene requires a disciplined and systematic approach to recording the various observations made and collection of potential evidential material. This must be combined with the analysis of various observations and the interrelationship of potential evidentiary material (Horswell, 2005a).
If resources are sufficient and the circumstances of death so dictate, it is ideal for a forensic medicine expert to perform a scene investigation. This is particularly relevant if the body remains at the scene of death, and has not been transported to the hospital during attempts at resuscitation; however, a scene investigation can be vitally important and provide valuable information even if the body has been transported to the hospital. If a body is pronounced dead at the scene (as opposed to after transport to the hospital), many death investigation systems require a scene investigation. Others have various protocols as to which case types absolutely require a scene investigation (whether or not the body is present at the scene). Case types that should always have a scene investigation include all confirmed or suspected homicides, suicides, accidents, child deaths, traffic-related deaths, in-custody deaths, and workplace-related deaths (Prahlow, 2010).
Death scene investigation may include a combination of the following types of incidents and examinations:
• Accidental deaths, which include a multitude of circumstances, including misadventure
• Suicidal deaths, which include a multitude of circumstances
• Homicidal deaths, which include a multitude of circumstances
• Sudden deaths, with or without suspicious circumstances
• Difficult victim identification, which includes mummification and putrefaction
• Disaster victim identification dealing with multiple casualties (Horswell, 2005a)
This chapter will focus on the steps of death scene investigation and some real cases will be analyzed.

Necrophagous insects are important in the decomposition of cadavers. The close association between insects and corpses and the use of insects in medicocriminal investigations is the subject of forensic entomology. The present paper reviews the historical background of this discipline, important postmortem processes, and discusses the scientific basis underlying attempts to determine the time interval since death. Using medical techniques, such as the measurement of body temperature or analysing livor and rigor mortis, time since death can only be accurately measured for the first two or three days after death. In contrast, by calculating the age of immature insect stages feeding on a corpse and analysing the necrophagous species present, postmortem intervals from the first day to several weeks can be estimated. These entomological methods may be hampered by difficulties associated with species identification, but modern DNA techniques are contributing to the rapid and authoritative identification of necrophagous insects. Other uses of entomological data include the toxicological examination of necrophagous larvae from a corpse to identify and estimate drugs and toxicants ingested by the person when alive and the proof of possible postmortem manipulations. Forensic entomology may even help in investigations dealing with people who are alive but in need of care, by revealing information about cases of neglect.

Sexual assault is a crime of violence, often motivated by aggression and rage, with the assailant using sexual contact as a weapon for power and control. Sexual assault can include a range of coercive behaviors ranging from kissing, fondling, and molestation, to rape or attempted rape. For the purposes of this review, sexual assault is defined as "an event that occurred without the victim's consent, involved the use of force, or the threat of the use of force, and involved actual or attempted penetration of the victim's vagina, mouth, or rectum."l8 According to recent statistics, one out of eight women will be raped during her lifetime, and 39% will be sexually assaulted more than once.I8 Many rapes are unreported, either because of feelings of shame and guilt, or because the victim does not define the event as rape (e.g., spousal and date rape). Well-known sequelae of rape, whether reported or not, include isolation, depression, anxiety, somatic symptoms, suicide attempts, and post-traumatic stress disorder (PTSD). The experience of rape has a strong effect on the subsequent health of victim/survivors and has thus become a major public health issue. Sexual assault victims often present to the emergency department (ED) for initial evaluation, evidence collection, treatment, and crisis intervention. Although some cities have model sexual assault centers or use specially trained sexual assault nurse examiners (SANE), the emergency physician (EP) is responsible for the initial evaluation and management in most EDs. It is, therefore, imperative that the El' be familiar with complex array of reactions (emotional and physical), common injuries, and elements of proper evaluation and treatment of sexual assault victims.

Positional asphyxia refers to a situation where there is compromise of respiration because of splinting of the chest and/or diaphragm preventing normal respiratory excursion, or occlusion of the upper airway due to abnormal positioning of the body. Examination of autopsy files at Forensic Science SA revealed instances where positional asphyxia resulted from inadvertent positioning that compromised respiration due to intoxication, multiple sclerosis, epilepsy, Parkinson disease, Steele-Richardson-Olszewski syndrome, Lafora disease and quadriplegia. While the manner of death was accidental in most cases, in one instance suicide could not be ruled out. We would not exclude the possibility of individuals with significant cardiac disease succumbing to positional asphyxia, as cardiac disease may be either unrelated to the terminal episode or, alternatively, may result in collapse predisposing to positional asphyxia. Victims of positional asphyxia do not extricate themselves from dangerous situations due to impairment of cognitive responses and coordination resulting from intoxication, sedation, neurological diseases, loss of consciousness, physical impairment or physical restraints.

Identification of sex from skeleton parts is of paramount importance to medicolegal investigations. The present study makes an attempt to assess sex from the ulna by devising new measurements for fragmentary bones. Dry and adult ulnae (100 male and 60 female) of Madhya Pradesh, India were subjected to three measurements (Olecranon-coronoid angle, length, and width of inferior medial trochlear notch) that were devised specifically for this study. The data were analyzed using discriminant function analysis. Direct analysis using single or multiple variables revealed the Olecranon-Coronoid angle as the best single parameter, yielding 85% accuracy. Measurements of the inferior medial trochlear notch have an additional advantage of being used in fragmentary bone where only the upper end is available. The calibrated discriminant functions correctly classified 90.6% of all males and females in an independent test sample.

Introduction: One of the world’s most significant public health issues has been HIV infections and AIDS(HIV / AIDS). The 1 percent of deaths worldwide are responsible for HIV / AIDS Knowledge of HIV /AIDS among students is crucial to the elimination of disease propagation. Besides, young adult universitystudents may start their own families someday and some may be health care providers in the future. Dataabout Knowledge, regarding HIV/AIDS are needed to sensitize and create awareness among nursingstudents as they were becoming health care administrators and providers in the future. Aim: To determinethe knowledge regarding HIV/AIDS among new entrants of the nursing institute. Materials and Methods:A cross-sectional study was carried out among new entrants of the nursing institute in Wardha district. Thestudents were chosen randomly. This cross-sectional descriptive research was carried out by pre-designed,pre-tested, and semi-structured surveys of eligible 296 nursing students in the...

Abused class substances use as inhalant which includes volatile solvents is endemic worldwide. Nowadays, glue sniffing is like disease to children in primary and secondary school and this problem is shown by media like a “time bomb” for our future generation. Glue is easily available and cheaper than drugs and because of that, more teenagers is using it to get ‘high’. Children who abuse glue early in life are more likely to use other illicit drugs. Later, the method of delivery is inhalation of a solvent from its container, a soaked rag, or a bag. In this study the volatile substance in glue will be determined using Fourier Transform Infra Red (FTIR), Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) and Gas Chromatography Mass Spectroscopy Detector (GC-MSD) with headspace method. This study proved from the results obtain that toluene is the one of the major substance this confirmed by GC-MSD with head space method. FTIR analysis of glue showed that strong absorptio...

The practice of using small partial reagent (SPR) for the visual development of latent fingerprints is the preferred choice, particularly concerning wet surfaces. In the present study, non-porous surfaces impinged with latent prints submerged in the water simulating acidic basic and salty water bodies were developed with activated charcoal based small particle reagent method. As evident from the observations, the activated charcoal-based SPR method was able to develop latent fingerprint submerged on the glass surface for up to 11 days and on aluminium substrate, up to 12 days but the quality of fingerprint observed was better on the glass substrate. The shelf life of the activated charcoal-based SPR method was found to be 52 days. The results have shown that the time-lapse of submersion and quality of fingerprint developed are inversely prepositional to each other. Although pond water submerged substrates showed good quality developed fingerprints for a longer period than other medi...

This study investigated the application of chemical imaging to the detection of latent fingerprints using the Condor macroscopic chemical imaging system (ChemImage Corp., Pittsburgh, USA). Methods were developed and optimised for the visualisation of untreated latent fingerprints and fingerprints processed with DFO, ninhydrin, cyanoacrylate, and cyanoacrylate plus rhodamine 6G stain. The results obtained with chemical imaging were compared to the detection achieved using conventional imaging techniques.

advancement are necessary. A total of 66 CST reports conducted within the last 5 years in two states were compared to a proposed model for CST assessment. Results indicated that although forensic examiners are maintaining legal relevance, some CST reports may lack thoroughness and/or provide information that exceeds their role responsibilities. The findings support the need for the development of a standardized method of conducting and writing CST evaluations that should improve the quality of such reports.

O ne of the challenges frequently discussed by sexual assault nurse examiners (SANEs) is the ability to retain experienced forensic nurses in their programs. Anecdotal information from nurse examiners indicates that some of the reasons for leaving SANE programs include high volume of on-call time in addition to primary nursing employment, pay that is not reflective of responsibility, and "burn out" associated with the demands of working with adults and children affected by violence.

On Dec. 12, 1985, a military charter DC-8 crashed shortly after takeoff at Gander, Nfld., Canada. All 256 aboard were killed, making this the deadliest US military aircraft accident in history. The investigation team (consisting of forensic pathologists, odontologists, ...

Analytical records concerning 440 living drivers suspected of driving under the influence of drug (DUID) were collected and examined during a 2 years period ranging from 2002 to 2003 in canton de Vaud, Valais, Jura and Fribourg (Switzerland). This study included 400 men (91%) and 40 women (9%). The average age of the drivers was 28 AE 10 years (minimum 16 and maximum 81). One or more psychoactive drugs were found in 89% of blood samples. Half of cases (223 of 440, 50.7%) involved consumption of mixtures (from 2 to 6) of psychoactive drugs. The most commonly detected drugs in whole blood were cannabinoids (59%), ethanol (46%), benzodiazepines (13%), cocaine (13%), amphetamines (9%), opiates (9%) and methadone (7%). Among these 440 cases, 11-carboxy-THC (THCCOOH) was found in 59% (median 25 ng/ml (1-215 ng/ml)), D 9 -tetrahydrocannabinol (THC) in 53% (median 3 ng/ml (1-35 ng/ml)), ethanol in 46% (median 1.19 g/kg (0.14-2.95 g/kg)), benzoylecgonine in 13% (median 250 ng/ml (29-2430 ng/ml)), free morphine in 7% (median 10 ng/ml (1-111 ng/ml)), methadone in 7% (median 110 ng/ml (27-850 ng/ml)), 3,4-methylenedioxymethamphetamine (MDMA) in 6% (median 218 ng/ml (10-2480 ng/ml)), nordiazepam in 5% (median 305 ng/ml (30-1560 ng/ml)), free codeine in 5% (median 5 ng/ml (1-13 ng/ml)), midazolam in 5% (median 44 ng/ml (20-250 ng/ml)), cocaine in 5% (median 50 ng/ml (15-560 ng/ml)), amphetamine in 4% (median 54 ng/ml (10-183 ng/ml)), diazepam in 2% (median 200 ng/ml (80-630 ng/ml)) and oxazepam in 2% (median 230 ng/ml (165-3830 ng/ml)). Other drugs, such as lorazepam, zolpidem, mirtazapine, methaqualone, were found in less than 1% of the cases. #

The sorption of explosives (TNT, RDX, PETN, TATP, EGDN) to hair during exposure to their vapors is examined. Three colors of hair were simultaneously exposed to explosive vapor. Following exposure of hair, the sorbed explosive was removed by extraction with acetonitrile and quantified. Results show that sorption of explosives, via vapor diffusion, to black hair is significantly greater than to blond, brown or bleached hair. Furthermore, the rate of sorption is directly related to the vapor density of the explosive: EGDN > TATP ≫TNT PETN > RDX. In some cases, the explosive-containing hair was subject to repeated washings with sodium dodecylsulfate or simply left out in an open area to determine the persistence of the explosive contamination. While explosive is removed from hair with time or washing, some persists. These results indicate that hair can be a useful indicator of explosive exposure/handling.

A method is described for genotyping alleles of the Y-chromosomal locus M9, incorporating DNA extraction, amplification by polymerase chain reaction (PCR), sample purification by ion-pair reversed-phase high-performance liquid chromatography (IP-RP-HPLC), and allele identification by on-line hyphenation to electrospray ionization mass spectrometry (ESI-MS). The alleles G and C were differentiated in 114 base pair amplicons on the basis of intact molecular mass measurements with a mass accuracy between 0.007 and 0.017%. The accuracy of mass determination was significantly reduced to less than 0.0036% upon amplification of a short, 61 bp fragment. The application of steep gradients of acetonitrile in 25 mM butyldimethylammonium bicarbonate not only enabled the efficient separation of non-target components from the PCR product in a monolithic, poly-(styrene-divinylbenzene)-based capillary column, but also allowed the high-throughput analysis of the PCR products with cycle times of 2 min. The new method was compared to a conventional restriction fragment length polymorphism assay with capillary gel electrophoretic analysis. In a blind study, 90 samples of unrelated individuals were genotyped. The high accuracy (,0.004%) and small relative standard deviation (,0.007%, n520) of mass measurements, which enables even the differentiation of A and T alleles with a mass difference of 9 mass units, make IP-RP-HPLC-ESI-MS a potent tool for the routine characterization of SNPs in forensic science. 

The use of psychoactive substances of fungal origin for recreational purposes has become an increasing problem in many countries all over the world. These fungis known as magic mushrooms can be grown wildly however their cultural products has been marketing more often. If their wild products are mistakenly collected and eaten by someone, there is not any infringement of law. Whereas marketing of their cultural products at any form such as fresh, dried, powered or capsulated causes legal responsibility. Because, psilocybin and psilocin are listed as Schedule I drugs under the United Nations 1971 Convention on Psychotropic Substances as well as they are listed as psycho-active substances according to the 19 th. paragraph of the act numbered 2313 in Turkey.

A palynological study was carried out on 28 corpses brought in one year (June 2003-May 2004 to the morgue of the Institute of Legal Medicine of Parma (Northern Italy). This preliminary research focuses on the date of death, which was known for all corpses examined. Pollen sampling and analyses were made with the first aim of comparing the pollen grains found on corpses with those diffused in the atmosphere in the region in the same season as the known date of death. Eyebrows, hair-line near the forehead, facial skin and nasal cavities were sampled. Most of the corpses had trapped pollen grains, with the exception of two December corpses. All pollen grains were found with cytoplasm and in a good state of preservation. In this way, a series of reference data was collected for the area where the deaths occurred, and we examined whether pollen grains on corpses could be an index of the season of death. To verify this hypothesis, the pollen analyses were compared with data reported in the airborne pollen calendars of Parma and the region around. Pollen calendars record pollen types and their concentrations in the air, month by month. The quantity of pollen recorded on corpses did not prove to be directly related to the quantity of pollen in the air. But qualitatively, many pollen types which are seasonal markers were found on corpses. Main corpse/air discrepancies were also observed due to the great influence that the local environmental conditions of the death scene have in determining the pollen trapped by a corpse. Qualitative plus quantitative pollen data from corpses appeared helpful in indicating the season of death. A preliminary sketch of a ''crime pollen calendar'' in a synthetic graphic form was made by grouping the corpse pollen records into three main seasons: A, winter/spring; B, spring/summer; C, summer/autumn. Trends match the general seasonal trend of pollen types in the air. #

The emergence of numerous cannabinoid designer drugs has been tied to large spikes in emergency room visits and overdoses. Identifying these substances is difficult for the following reasons: (1) the compounds are novel, closely structurally related, and do not usually test positive in drug screens; (2) novel analogs rapidly appear on the market; (3) no standard protocols exist for their identification; and (4) customized and extensive sample preparation/extraction and analysis procedures are required to demonstrate their presence. METHODS: Direct analysis in real time mass spectrometry (DART-MS) employing collision-induced dissociation (CID) provided confirmatory structural information that was useful in characterizing the various cannabinoid analogs, including those contained in mixtures. CID analysis illustrated that, although closely related compounds fragment in a similar fashion, their structural differences still resulted in multiple diagnostic peaks that provided additional confidence towards structural identification. RESULTS: DART-MS spectra were acquired under CID conditions to rapidly differentiate among five synthetic cannabinoids contained within 'herbal' products purchased locally in New York State (USA). The spectra exhibited [M+H] + ions and product ions unique to each cannabinoid that corresponded to major structural features. Five different cannabinoid analogs, alone and as mixtures of at least two cannabinoids, were identified in six herbal products and differentiated by their CID product ion patterns. CONCLUSIONS: Illicit synthetic cannabinoid products continue to be readily available despite national and international restrictions. These products contain a wide range of active components, and, in many cases, multiple active ingredients. DART-MS allows rapid analyses of these synthetic cannabinoids based on the exact masses of their [M+H] + ions and product ion peaks generated using CID.

When estimating the time since death or manner of death, the identification and the pathological evaluations of a body are generally impeded by post mortem changes. Research and case studies help experts to achieve a more accurate diagnosis, but at present there is scant literature covering topics concerning forensic science and decompositional processes in aquatic environments. The two case studies presented each involve a decomposed body found in a unique aquatic environment; namely wells containing ground water. In Case 1 an entomologist attended the scene and in Case 2 an entomologist was only involved after 20 months when it was decided that the insect evidence collected at the second autopsy may be useful in determining a time frame. The first case highlights the problems associated with body retrieval from aquatic environments as the body was removed it dismembered. Fortunately, the well was able to be drained, so much of the insect evidence was retrieved. In the second case the body was found dismembered but the entomological evidence was overlooked and lost. During the second autopsy insects were found, collected, and sent to an entomologist to help clarify the post mortem interval.

We reviewed a series of 66 deaths in Washington State between 1995-2000 in which tramadol (Ultram R and Ultracet R , Ortho-McNeil) was detected in the decedent's blood, in order to assess the role tramadol was determined to have played. Additionally, we reviewed a series of 83 impaired driving cases in which tramadol was detected in order to establish a non-lethal blood tramadol concentration reference range. In both populations, tramadol was consistently found together with other analgesic, muscle relaxant, and CNS depressant drugs. Death was rarely attributable to tramadol alone. However, tramadol may be a significant contributor to lethal intoxication when taken in excess with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased CNS depression. Although the incidence of tramadol detection has increased consistently over the last eight years, there is no evidence of a corresponding increase in the number of cases in which death was attributed solely to tramadol. Blood drug concentrations in many deaths exceeded the therapeutic serum range of 0.28-0.61 mg/L (1); however, the concentrations overlapped almost completely with the range identified in living subjects arrested for impaired driving. These findings suggest caution in the interpretation of blood tramadol concentrations outside of the recognized therapeutic range. It also suggests that the drug, even when used in moderate excess, is not a principle cause of death in suicidal or accidental deaths.

Delayed morbidity and mortality following traumatic and spontaneous intracranial haemorrhages (ICH) are common in both neurosurgical units and autopsy rooms. However, the causes of the delayed morbidity and mortality are complications of prolonged bed care such as aspiration or hypostatic pneumonia, urinary tract infection, dehydration, electrolyte imbalance, malnutrition and sepsis following bed sores. It can also be caused during the conservative management up to 14-21 days by delayed vasospasm and cerebral ischemia. A 67-year-old man with a history of hypertension was admitted to an ETU following a fall backwards. He lost his consciousness immediately after the fall for less than five minutes with retrograde amnesia, right sided paralysis and vomiting. On admission, blood pressure was 200/100mmHg and random blood sugar was 117mg/dl. Initial CT-brain revealed bilateral frontal lobe contusions with subarachnoid haemorrhages. In the second CT, an isolated left sided ICH that was not continuous with the brain surface was detected and the right sided hemiplegia was improved following evacuation. However, after 48 hours, he developed left sided hemiplegia. Repeat CT-brain, CT-angiogram and DSA-scan revealed no new hemorrhages, infarction, necrosis etc. There were no external injuries on the body. However, the MRI brain, showed a localized oedema of right supra-callosal area. Contre-coup contusions identified by CT-scan were compatible with the given history of fall backwards. Isolated left ICH identified in the second CT was compatible with a spontaneous ICH resulting right sided hemiplegia and could have precipitated the fall backwards. This ICH may be due to rupture of vessels due to long standing hypertension. The delayed left sided hemiplegia could have been due to the oedema of right supra-callosal area probably initiated by delayed cerebral ischemia fallowing vasospasm. This case also highlights the importance of radiological investigations in clinical forensic medicine for reconstruction of the events.

Automation and high through-put production of DNA profiles has become a necessity in every DNA database unit. In our laboratory we developed a Laboratory Information Management System (LIMS) controlled workflow architecture, which comprises a robotic DNA extraction-and pipetting-system and a capillary electrophoresis unit. This allows a through-put of 4,000 samples per person per year. Improved sample handling and data management, full sample-and batch-histories, and software-aided supervision of result data, with a consequent average turnaround time of 8 days, are the main features of our new system.

Body fluid traces recovered at crime scenes are among the most important types of evidence to forensic investigators. They contain valuable DNA evidence which can identify a suspect or victim as well as exonerate an innocent individual. The first step of identifying a particular body fluid is highly important since the nature of the fluid is itself very informative to the investigation, and the destructive nature of a screening test must be considered when only a small amount of material is available. The ability to characterize an unknown stain at the scene of the crime without having to wait for results from a laboratory is another very critical step in the development of forensic body fluid analysis. Driven by the importance for forensic applications, body fluid identification methods have been extensively developed in recent years. The systematic analysis of these new developments is vital for forensic investigators to be continuously educated on possible superior techniques. Significant advances in laser technology and the development of novel light detectors have dramatically improved spectroscopic methods for molecular characterization over the last decade. The application of this novel biospectroscopy for forensic purposes opens new and exciting opportunities for the development of on-field, non-destructive, confirmatory methods for body fluid identification at a crime scene. In addition, the biospectroscopy methods are universally applicable to all body fluids unlike the majority of current techniques which are valid for individual fluids only. This article analyzes the current methods being used to identify body fluid stains including blood, semen, saliva, vaginal fluid, urine, and sweat, and also focuses on new techniques that have been developed in the last 5-6 years. In addition, the potential of new biospectroscopic techniques based on Raman and fluorescence spectroscopy is evaluated for rapid, confirmatory, non-destructive identification of a body fluid at a crime scene.

Purpose Intra-vaginal traces can serve as supporting physical evidence of vaginal penetration in sex-crime cases. Vaginal trace sampling guidelines prescribe using a speculum and swabs or swabs only. The use of Locard's exchange theory requires samples of trace materials to always be contamination-free and of accurately known origin. If traces from the outer genital area are accidentally introduced into the vagina during sampling, these traces may be recorded as originating in a location where they were not present at the time of evidence collection. The goal of this study was to assess the risks of false positive findings in vitro of traces found inside the vagina due to trace dislocation caused by current vaginal trace sampling methods (swab-only or with speculum), and for a new method that uses a sleeve accessory to prevent trace dislocation. Methods Starch solution was applied to the labia of three clean female genitalia mock-ups with vaginas of various diameters and structures. The speculum, swab-only, and sleeve methods were each used 30 times on each mock-up, giving a total of 90 repetitions of each method. Iodine was used to determine whether any starch traces had been introduced vaginally. Results The speculum and swab-only methods gave 100 and 63-87 % false positive results respectively due to trace dislocation. The sleeve method reduced this to 2 % (0 % after correction).

The aim of the VIRTOPSY project (www.virtopsy.com) is utilizing radiological scanning to push low-tech documentation and autopsy procedures in a world of high-tech medicine in order to improve scientific value, to increase significance and quality in the forensic field. The term VIRTOPSY was created from the terms virtual and autopsy: Virtual is derived from the Latin word 'virtus', which means 'useful, efficient and good'. Autopsy is a combination of the old Greek terms 'autos' (=self) and 'opsomei' (=I will see). Thus autopsy means 'to see with ones own eyes'. Because our goal was to eliminate the subjectivity of ''autos'', we merged the two terms virtual and autopsy -deleting ''autos'' -to create VIRTOPSY. Today the project VIRTOPSY combining the research topics under one scientific umbrella, is characterized by a trans-disciplinary research approach that combines Forensic Medicine, Pathology, Radiology, Image Processing, Physics, and Biomechanics to an international scientific network. The paper will give an overview of the Virtopsy change process in forensic medicine.

The time of death can be established by determining the length of the postmortem interval. Many methods have been proposed to achieve this goal. Flow cytometric evaluation of DNA degradation seems to be reliable for the first 72 hours after death. Our study evaluated the correspondence of the corruption process between in vitro and corpse tissues. We chose spleen tissue to perform our investigation because it is rich in nucleated cells.

Knowledge about mutation rates and the mutational process of Y-chromosomal short-tandem-repeat (STR) or microsatellite loci used in paternity testing and forensic analysis is crucial for the correct interpretation of resulting genetic pro®les. Therefore, we recently analysed a total of 4999 male germline transmissions from father/son pairs of con®rmed paternity (probability ! 99:9%) at 15 Y-STR loci which are commonly applied to forensics. We identi®ed 14 mutations. Locus speci®c mutation rate estimates varied between 0 and 8:58 Â 10 À3 , and the overall average mutation rate estimate was 2:80 Â 10 À3 (95% CIL 1:72 Â 10 À3 À4:27 Â 10 À3 ). In two con®rmed father/son pairs mutation at two Y-STRs were observed. The probability of two mutations occurring within the same single germline transmission was estimated to be statistically not unexpected. Additional alleles caused by insertion polymorphisms have been found at a number of Y-STRs and a frequency of 0.12% was estimated for DYS19. The observed mutational features for Y-STRs have important consequences for forensic applications such as the de®nition of criterions for exclusions in paternity testing and the interpretation of genetic pro®les in stain analysis. In order to further enrich our knowledge of Y-STR mutations we suggest the establishment of a Y-STR mutation database and ask the forensic community for data contribution. # : S 0 3 7 9 -0 7 3 8 ( 0 0 ) 0 0 4 8 0 -1

The concealment of drugs inside the human body has been used by traffickers to transport it between countries, to escape being caught in the act or to make it inside controlled places, like prisons. Objective. To analyze cases suspected of drug concealment inside the body. Methods. The authors present a retrospective study of cases occurring in 2007 at the Institute of Legal Medicine of the Distrito Federal, Brasilia, Brazil. Results. Four hundred and two examinations were performed for detection of foreign body in natural cavities anda cadaveric investigation. Among the examinations in natural cavities, drugs were found in 42 cases, 40 in females(vagina) and two in males (anus). The people involved in this type of crime are, in most cases, women who attempted to get illegal drugs into prisons. The drugs could be tested in twenty-six cases. The analysis was performed by the Toxicology Laboratory of the Institute of Criminology. The only case of death was the result of cocaine intoxication after rupturing of a swallowed package in a prisoner who tried to avoid being caught in the act. The result of the toxicology exam was 25,310 microgram/g, and that characterizes the so called package syndrome. Conclusion. The authors draw attention to the trafficking of drugs into prisons, which then becomes a bargaining chip, the risks of such activity and the means of diagnosis and therapeutic approach.

Luminol, Bluestar ® , and Hemascein ® were tested to compare detection sensitivities to latent blood. Untreated, EDTA-treated human blood, and a catalytically similar blood substitute were diluted (neat to 1:1,000,000) and pipetted onto a variety of substrates. Luminol and Bluestar ® performed similarly on all surfaces and fabrics. Hemascein ® yielded poor results on wood surfaces, but performed well in the detection of latent blood on fabrics. Results from untreated, EDTA-treated, and synthetic blood results indicate that EDTA-treated blood is similar or slightly less sensitive than untreated blood at all dilutions and on all substrates, and the synthetic blood is less sensitive than real blood, but consistent in detection threshold and thus is useful as a training aid. Additionally, some foods and household chemicals that have previously been shown to cross-react were tested with Bluestar ® , Hemascein ® , and luminol. Hemascein ® cross-reacted with many substances, while both luminol reagents were more discriminating.

A growing body of literature addresses the application of diffusion tensor imaging (DTI) to traumatic brain injury (TBI). Most TBIs are of mild severity, and their diagnosis and prognosis are often challenging. These challenges may be exacerbated in medicolegal contexts, where plaintiffs seek to present objective evidence that supports a clinical diagnosis of mild (m)TBI. Because DTI permits quantification of white matter integrity and because TBI frequently involves white matter injury, DTI represents a conceptually appealing method of demonstrating white matter pathology attributable to mTBI. However, alterations in white matter integrity are not specific to TBI, and their presence does not necessarily confirm a diagnosis of mTBI. Guided by rules of evidence shaped by Daubert v. Merrell Dow Pharmaceuticals, Inc., we reviewed and analyzed the literature describing DTI findings in mTBI and related neuropsychiatric disorders. Based on this review, we suggest that expert testimony reg...

The ABO grouping results from approx. 1000 seminal stains have been collected and analysed. Most of the stains came from rape cases where the ABO and secretor status of both complainant and suspect were known. The results of the survey provided information concerning the usefulness of elution and inhibition as methods of body fluid grouping, the relative strengths of reaction of the A, B and H antigens in body fluids and the interpretation of the ABH reactions of body fluid stains.

Can someone claim property rights on a corpse? If so, to whom it belongs? If not, are there any limits to the "use-exploitation" of the human body? This paper discusses the ethical issues that arise in education and research with cadaveric materials by conducting a review of the international literature. In the light of various scandals concerning the retention of cadaveric tissues and organs and their use in education and research, the legislative framework in the UK was revised in 2006 to regulate the
management of a corpse. Similar acts exist in many other countries. In Greece, the current legal system only regulates the use of biological materials for transplantation, leaving a "gap" in education and research issues after death. Greece must leave behind the paternalism of the past and follow the principles of information and consent.

Although the effect of population differentiation on the forensic use of DNA profiles has been the subject of controversy for some years now, the debate has largely failed to focus on the genetical questions directly relevant to the forensic context. We re-analyse two published data sets and find that they convey much the same message for forensic inference, in contrast with the dramatically differing conclusions of the original authors. The analysis is likelihood-based and combines information across loci and across populations without assuming constant genetic differentiation. Our results suggest that the relevant genetic correlation coefficients are too large to be ignored in forensic work: although DNA profile evidence is typically very strong, the effect of genetic correlations can be important in some cases. Such correlations can, however, be accommodated in an appropriate assessment of evidential strength so that population genetic issues should not present a barrier to the efficient and fair use of DNA profile evidence.