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Journal: Journal of forensic and legal medicine

27

Adverse drug reactions and interactions are among the major causes of death in the United States. Antidepressants have been reported as causing suicide and homicide and share the class attribute of frequently producing akathisia, a state of severe restlessness associated with thoughts of death and violence. Medical examiners can now identify some pharmacogenetic interactions that cause drugs, deemed safe for most, to be lethal to others. Such deaths do not yet include medication-induced, akathisia-related suicides and homicides. An extrapyramidal side effect, akathisia is a manifestation of drug toxicity whose causes lie, inter alia, in drugs, doses, and co-prescribed medications that inhibit and compete for metabolizing enzymes, which may themselves be defective. In this paper, we report our investigation into adverse drug reactions/interactions in three persons who committed homicide, two also intending suicide, while on antidepressants prescribed for stressful life events. Their histories of medication use, adverse reactions and reasons for changes in medications are presented. DNA samples were screened for variants in the cytochrome P450 gene family; that produce drug metabolizing enzymes. All three cases exhibit genotype-based diminished metabolic capability that, in combination with their enzyme inhibiting/competing medications, decreased metabolism further and are the likely cause of these catastrophic events.

Concepts: Protein, Pharmacology, Metabolism, Cytochrome P450, Enzyme inhibitor, Adverse drug reaction, Pharmaceutical drug, Suicide

27

We investigated several methods for obtaining successful short tandem repeat (STR) results from high-humic acid (HA)-content samples. DNA purification efficiency was tested for QIAquick(®) PCR Purification, QIAamp(®) DNA Investigator and Prepfiler™ Forensic DNA Extraction kits. HA-removal capacity of Inhibitor Remover and InhibitEX(®) Tablet was tested. Experiments on overcoming HA effects on STR amplification were conducted using an AmpliTaq Gold(®) DNA Polymerase and a TaKaRa Ex Taq™ Hot Start Version (Ex Taq HS) with BSA addition. QIAquick kit was most efficient in HA removal and Ex Taq HS showed high resistance to HA. Increasing the amounts of Taq polymerases and BSA addition were shown to be efficient in overcoming PCR inhibition, but BSA addition was superior to the former method. Inhibitor Remover and InhibitEX(®) Tablet did not positively affect the STR results. This study will help achieve better STR results with high-HA-content samples.

Concepts: DNA, Polymerase chain reaction, Molecular biology, DNA replication, DNA polymerase, Polymerase, Short tandem repeat, Thermus aquaticus

24

The aim of this study was to examine and compare similarities and differences among types of parricide committed by adult offenders. The forensic psychiatric evaluation reports of the 4th Specialization Board of the Council of Forensic Medicine from 2009 to 2011 in Turkey were screened retrospectively. One hundred thirty-five adult perpetrators of parricide (125 male, 10 female) were detected, 51.9% of whom committed patricide, 40% of whom matricide and 8.1% of the perpetrators committed double parricide. Most of the perpetrators used sharp instruments as the killing method. No mental disorders were detected in 58.5% of the perpetrators, while psychotic disorders were identified in 30.4% of the cases. This study supported the predominance of sharp instruments as the killing method and a preponderance of matricide among the offenders with psychotic disorders. Although psychotic disorders were the most commonly detected mental disorders in the parricide offenders, most of them did not suffer from mental disorders.

Concepts: Mental disorder, Schizophrenia, Psychosis, Psychiatry, Psychiatric hospital, Schizoaffective disorder, American films, Patricide

2

Despite research demonstrating the overall safety of Conducted Electrical Weapons (CEWs), commonly known by the brand name TASER(®), concerns remain regarding cardiac safety. The addition of cardiac biomonitoring capability to a CEW could prove useful and even lifesaving in the rare event of a medical crisis by detecting and analyzing cardiac rhythms during the period immediately after CEW discharge.

Concepts: Logic, Security, Ammunition

1

A key challenge for asylum seekers in the United States is being able to provide evidence of prior persecution in their home countries. Medical/psychological affidavits corroborating applicants' accounts often make the difference between successful and unsuccessful applications. The purpose of this study was to identify the unmet demand for and features of effective medical/psychological affidavits in the asylum process, as well as the personal and systemic barriers for asylum seekers. This is a qualitative study of semi-structured interviews with legal professionals who work in asylum law. Sixteen asylum lawyers and one Board of Immigration Appeals accredited representative practicing in the state of Michigan, United States, participated in this study. All participants noted that a vast majority of their asylum cases would benefit from a medical affidavit but that they have difficulty finding qualified physicians with experience writing such affidavits and testifying as expert witnesses. The major barriers to obtaining medical/psychological evaluations included inability to pay for services, lack of practitioner availability, and lack of practitioner training. The participants reported that features of a strong medical affidavit included clear, concise, and corroborative accounts that supported the applicant’s story from a diagnostic perspective and forensic descriptions that reinforced the credibility of the applicant. Several also noted that medical/psychological evaluations frequently would reveal additional details and incidents of trauma beyond those stated in the applicant’s preliminary statement. The study results suggest substantial unmet need for trained physicians to perform medical and psychological evaluations on a pro bono basis. Lawyers' recommendations regarding effective medical affidavits and necessary ongoing support for asylum applicants should inform current efforts to improve physician and lawyer collaborations on asylum cases.

Concepts: Psychology, United States, U.S. state, Law, Evidence law, Lawyer, Right of asylum, Notary public

1

The suicide of doctors under regulatory investigation in the United Kingdom has recently been under scrutiny. Despite a commissioned report into the issues surrounding these deaths, we discuss a variety of procedural and legal lacunae not yet openly considered for reform. We identified that the UK coronial system has in place several legal instruments requiring coroners to report the physician suicides as preventable to the regulatory body, the General Medical Council (GMC). We were unable to identify that these suicides were reported in line with established legislation. We also explored the relationship between the GMC and its registered doctors, concluding that the GMC does indeed have a duty of care towards its members on this important matter and that there should be procedural reform to tackle the inherent risk of suicide whilst under investigation.

Concepts: Death, Physician, United Kingdom, Law, Suicide, Decolonization, General Medical Council, Scots law

1

The purpose of this review is to expand practitioners' knowledge on areas of liability when treating low back pain patients. Six cases where chiropractors in Canada were sued for allegedly causing or aggravating lumbar disc herniation after spinal manipulative therapy were retrieved using the CANLII search database. The case series involves 4 men and 2 women with an average age of 37.3 years (range, 31-48 years). Trial courts' decisions were rendered between 2000 and 2011. This study highlights the following conclusions from Canadian courts: 1) informed consent is an ongoing process that cannot be entirely delegated to office personnel; 2) when the patient’s history reveals risk factors for lumbar disc herniation the chiropractor has the duty to rule out disc pathology as an etiology for the symptoms presented by the patients before beginning anything but conservative palliative treatment; 3) lumbar disc herniation may be triggered by spinal manipulative therapy on vertebral segments distant from the involved herniated disc such as the thoracic spine.

Concepts: Spinal disc herniation, Low back pain, Back pain, Vertebral column, Hernia, Intervertebral disc, Chiropractic, Spinal manipulation

0

Clinical and forensic autopsies are the best methods for determining cause of death. The aim of this study was to determine demographic and etiologic characteristics in geriatric forensic cases analyzed in Erzurum, Turkey.

Concepts: Medicine, Death, The Canon of Medicine, Gerontology, Old age, Geriatrics, Autopsy, Elderly care

0

Estimation of age and vitality of burn injury both in the living and dead is essential in forensic practice. Nitric oxide and interleukin-6 (IL-6) play an important role in skin burn healing. In this study, the expression of inducible nitric oxide synthase (iNOS) and IL-6 proteins during skin burn healing in rats was studied for purposes of burn dating and to differentiate between ante-mortem and post-mortem burn. Ante-mortem skin burns were created on forty five rats. Normal and burnt skin samples were taken at 1, 3, 5, 7, 9, 11, 13, 15 and 21 days following burn induction (5 rats for each stage). Post-mortem burn was inflicted 6 h after scarification in another five rats. There was a statistically significant difference in both iNOS and IL-6 expression between the different time intervals of the ante-mortem burn. Expression of both iNOS and IL-6 decreased remarkably in the post-mortem burn with a statistically significant difference from ante-mortem intervals. A statistically significant positive association between the two markers was found. These results indicate that both iNOS and IL-6 expression in ante-mortem burnt skin was time dependent and significantly differed from post-mortem burn. Further research on humans is recommended.

Concepts: Electricity, Statistical significance, Endothelium, Nitric oxide, Vasodilation, Nitric oxide synthase, Burn, Biological functions of nitric oxide

0

Dental age (DA) has been widely accepted as a way to evaluate chronological age (CA) in recent years. However, the applicability of Willems method, as one of the most popular radiographic ways, still remains controversial in different areas. The aim of this study is to assess the difference between DA and CA with Willems method. Relevant studies published up to February 28th, 2017 were selected via PubMed, Embase, the Cochrane Library, CNKI, CBM and manual search. Studies that examined Willems dental age and chronological age were selected. 11 articles with 9347 individuals whose age ranged from 3.0 to 18.9 years old were ultimately included in this study. The general polled data indicated that Willems method overestimated CA by 0.18 years and 0.06 years for males and females respectively. Subgroup analysis for ethnicity showed significant difference for different ethnicities. Our aggregated data demonstrated that Willems method may not be an overall applicable tool to estimate chronological age for the reason of the difference of ethnicity and rational validity is suggested when necessary.

Concepts: Mathematics, Evidence-based medicine, Cochrane Collaboration, Systematic review, Cochrane Library, MEDLINE, Bibliographic databases, Centre for Reviews and Dissemination