A Forensic Epidemiological Study of Homicide in Isfahan Province and Review of the Literature.

The epidemic of deaths by homicide affects every society around the world and represents a major public health crisis. Detailed information on the characteristics of homicides victims from Islamic countries is limited. This article presents forensic epidemiological data on homicides in Isfahan, Iran, during 2013-2015. Isfahan has a population of more than 5 million and 69,387 deaths with 246 homicides between 2013 and 2015. Most victims were male (73%), between the ages of 15 to 29 years (39.5%), married (54%), and employed (54%). The relationship between the actor and the victims showed that 12% were married, 15% friends, 25% strangers, and 47% others or unknown. The most frequent method of homicides was by stabbing (45%), followed by firearms (23%), strangulation (14%), and blunt force trauma (7%). The top 3 methods among males were stabbing, firearms, and strangulation, whereas among females, it was stabbing, strangulation, and by other methods. There was no significant effect on homicide rates by month, weekday, or temperature. Investigators examining deaths in Muslin countries must understand and adjust for the culture, norms, and religious ideology.

Forensic epidemiology: a method for investigating and quantifying specific causation.

The field of forensic epidemiology was initially introduced as a systematic approach to the investigation of acts of bioterrorism. In recent years, however, the applications of forensic epidemiology have expanded greatly, covering a wide range of medicolegal issues routinely encountered in both criminal and civil court settings. Forensic epidemiology provides a method of evaluating causation in groups and individuals based in the application of the Hill Criteria, with conclusions given in terms of relative or comparative risk, or as a Probability of Causation. The purpose of this paper is to give a brief overview of the methods and applications of forensic epidemiology.

Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience.

BACKGROUND: Intravenous thrombolysis is the only therapy for acute ischemic stroke that is approved by the US Food and Drug Association. The use of telemedicine in stroke makes it possible to bring the expertise of academic stroke centers to underserved areas, potentially increasing the quality of stroke care. METHODS: All consecutive admissions for stroke were reviewed for 1 year before telemedicine implementation and for variable periods thereafter. A retrospective review identified 2588 admissions for acute stroke between March 2005 and December 2008 at 12 hospitals participating in a telestroke network, including 919 patients before telemedicine was available and 1669 patients after telemedicine was available. The primary outcome measure was the rate of intravenous tissue plasminogen activator (IV tPA) use before and after telemedicine implementation. RESULTS: One hundred thirty-nine patients received IV tPA in both study phases, with 26 (2.8%) patients treated before starting telemedicine and 113 (6.8%) after starting telemedicine (P < .001). Incorrect treatment decisions occurred 7 times (0.39%), with 2 (0.2%) pretelemedicine and 5 (0.3%) posttelemedicine (P = .70). Arrivals within 3 hours from symptom onset were more frequent in the posttelemedicine compared to the pretelemedicine phases (55 [6%] vs 159 [9.5%]; P = .002). Among the patients treated with IV tPA, symptomatic intracranial hemorrhage occurred in 2 patients (1 [10.7%] pretelemedicine vs 1 [1.8%] posttelemedicine; P = .34). CONCLUSIONS: Telestroke implementation was associated with an increased rate of thrombolytic use in remote hospitals within the telemedicine network.

Impact of COVID-19 on poisoning-related mortality in Iran: An interrupted time series study.

BACKGROUND: The COVID-19 pandemic had many negative effects worldwide. These effects involved mental health status issues such as suicide, depression, and the pattern of death associated with drug/poisonings. One of the major concerns of the healthcare community during the pandemic was mortality from poisonings. This study aimed to investigate the trends of mortality from different types of poisonings before and after COVID-19. METHODS: The patients who died from six different categories of drugs or poisons were identified by forensic analysis of body fluids/tissues in Tehran, Iran. The pandemic was separated into the pre-COVID-19 period (April 2018 to January 2020), and the COVID pandemic (February 2020-April 2022). Demographic characteristics were collected from each victim, and comparisons of death trends before and after the pandemic were conducted using the interrupted time series analysis. The absolute number of deaths and proportion of deaths from each type of drug/poisoning were used for the analyses. RESULTS: A total of 6,316 deaths from drugs/poisoning were identified between April 2018-Mar 2022). During this period, 2,485 deaths occurred pre-COVID, and 3,831 were during the COVID-19 era. There were no statistical differences in terms of demographic characteristics before and after the pandemic, except for job status. There was a sharp increase in proportion of methanol death among all poisonings after the start of the pandemic (16.5%, p-value = 0.025), while there was a decreasing trend during the pandemic (-0.915 deaths monthly, p-value = 0.027). The trends for opioids, stimulants, and drug-related deaths changed from decreasing to increasing. No change was seen in the trends for ethanol and volatile substance deaths. This pattern was mirrored in the proportion of each type of poisoning relative to the total number. CONCLUSION: Changes in poisoning-related mortality patterns showed dramatic changes after the start of the pandemic, especially deaths from methanol. Other poisonings such as opioids, stimulants, and drugs should also be addressed as there was an increasing trend during the COVID-19 period, compared to the pre-COVID data.

Accidental through and through penetrating injury to the neck.

We present the case of a 24-year-old driver who died when a metal pole entered the front windshield, traveled through the victim's neck, and then exited via the back windshield. This case illustrated an unusual penetration injury and the importance of a thorough and complete death scene investigation.

Unsuspected hereditary hemochromatosis at forensic autopsy: its presentation, confirmation, and implications.

Hereditary hemochromatosis (HH) is one of the most common genetic disorders and may present clinically in a variety of ways. The most common presentation is micronodular cirrhosis with possible associated diabetes. However, HH may also present with cardiac dysfunction and sudden death. The confirmation of unsuspected HH at autopsy is complicated by the growing number of genetic abnormalities, which are not detected by current commercial genetic testing for C282Y and H63D mutations. Consequently, quantitative liver iron studies on fresh or paraffin embedded liver is recommended in confirming HH. The importance of detection and confirmation of HH cannot be overemphasized given the need to screen surviving family members in preventing organ damage of asymptomatic individuals. We present a case of a 38-year-old white woman with micronodular cirrhosis secondary to unsuspected HH that was confirmed by a quantitative liver iron study. The possible presentation of cardiac sudden death from HH, confirmation issues and implications of a HH diagnosis for surviving family members are also discussed.

Unnatural Deaths Among Children and Adolescents in Isfahan Province, Iran: A Forensic Epidemiology Study of Postmortem Data.

INTRODUCTION: The issue of child and adolescent injury and violence is often absent from discussions and is largely invisible in public health policies. The purpose of this study was to describe the frequency and pattern of unnatural deaths during childhood and adolescence in Isfahan province in Iran. MATERIALS AND METHODS: This retrospective, descriptive study involved unnatural deaths among individuals under the age of 20 years who died from unnatural causes as determined by a forensic autopsy at the Legal Medicine Center of Isfahan. During the study period, 8,010 unnatural deaths occurred, 1,222 of which were individuals under 20 years old. RESULTS: All 1,222 of these unnatural deaths were identified through autopsy. Among the 1,222 cases, 895 (73.2%) were male, and 327 were female (26.8%). Accidental deaths were found to be the most frequent manner of death comprising 1,029 (83.96%) cases, followed by suicide (120, 9.82%), undetermined cause of death (39, 3.19%), and homicide (9, 2.86%) cases. Road traffic accidents were the number 1 cause of death (597, 49%), followed by burns (122, 10%) and hanging (90, 7.4%). DISCUSSION: Injuries and violence that occur during childhood and adolescence represent a global public health problem, especially in low- and middle-income regions, and require urgent action.

The prediction of violence and homicide in young men.

In this prospective study, the authors predicted violence and homicide in 3 representative school samples (N = 1,517). Participants were part of a longitudinal, multiple cohort study on the development of delinquency in boys from late childhood to early adulthood in Pittsburgh, Pennsylvania. Thirty-three participants were convicted of homicide, 193 participants were convicted of serious violence, whereas another 498 participants self-reported serious violence. Predictors of violence included risk factors in the domains of child, family, school, and demographic characteristics. Boys with 4 or more violence risk factors were 6 times more likely to later commit violence in comparison with boys with fewer than 4 risk factors (odds ratio [OR] = 6.05). A subset of risk factors related to violence also predicted homicide among violent offenders. Boys with 4 or more risk factors for homicide were 14 times more likely to later commit homicide than violent individuals with fewer than 4 risk factors (OR = 14.48). Implications for the prevention of violence and homicide are discussed.

The risk of body packing: a case of a fatal cocaine overdose.

The process of swallowing or inserting illegal packets of drugs for the purpose of evading law enforcement officers carries risks other than criminal charges. It can be fatal. Individuals engaged in such activities are called "Body Packers" or "Mules". The most frequent cause of the death among body packers is acute drug intoxication due to rupture of the package(s) within the gastrointestinal tract. We present the first documented case of a body packer that died from cocaine intoxication following the rupture of packets of cocaine in Western Pennsylvania.

A case of a death by explosives: the keys to a proper investigation.

Suicidal deaths involving an explosive, unrelated to a terrorist act, are rare. The rarity of such events presents a unique environment for those investigating such a death. We report a case of suicide involving a 29-year-old white male who detonated a firework in his mouth, resulting in massive craniocerebral destruction. He was discovered in his residence shortly after the explosion. Initially, the case was believed to be a fatal gunshot wound by the paramedics and homicide detectives at the scene. Several small pieces of red colored paper and a possible end cap were located throughout the scene. Analysis of the paper and end cap showed trace components consistent with flash powder. The victim had used a pyrotechnic device to commit suicide. Therefore, it is critical for those who investigate deaths be able to identify cases that involve explosives in order to properly collect and analyze the evidence.

A review of nail gun suicides and an atypical case report.

The nail gun was designed as a powerful industrial tool to drive nails into various hard surfaces with ease. Serious injuries associated with the tool are uncommon and deaths are rare. Unintentional injuries normally occur from misuse of the tool or from ricocheting nails. The intentional use of a nail gun to commit suicide is unusual. This paper will review successful and unsuccessful suicide attempts by use of a nail gun. We will present an atypical case of suicide committed with a nail gun by a 46-year-old depressed male investigated by the Allegheny County Coroner's Office in Allegheny County, Pennsylvania in April 2002. This case reports for the first time a unique pathological finding of a ring of bone traveling with the nail, which has not been seen in wounds of the head caused by other types of projectiles.

Death by chainsaw: fatal kickback injuries to the neck.

Each year over 3 million new chainsaws are sold in the United States. The operation of these newer saws combined with the millions of older chainsaws in circulation results in over 28,000 chainsaw-related injures annually. The majority of the injuries involve the hands and lower extremities with less than 10% involving injuries to the head and neck regions. Deaths while operating a chainsaw are extremely rare. The most common hazards associated with chainsaws are injuries caused by kickback, pushback, and pull-in. Kickback is the most common and poses the greatest hazard. Kickback occurs when the rotating chain is stopped suddenly by contact with a more solid area throwing the saw rapidly backward toward the operator. The cause of most injuries can be traced to improper use of the saw or poor judgment on part of the operator. We present two fatal chainsaw deaths; one with an older style saw, and the other with a modern type. In both cases the victims died from fatal injuries received to the neck region from a chainsaw kickback. The first case involved a 49-year-old white male operating an older style chainsaw with limited safety features. The second case involved a 38-year old white male who was operating a newer model chainsaw equipped with a low kickback chain in an unsafe manner.

The role of suicide notes in death investigation.

The note left by a suicide victim is a key piece of forensic evidence in the investigation of a sudden death. This article provides some general information regarding suicide notes while also dispelling some of the myths.

Cause of death among elder homicide victims: a 10-year medical examiner review.

A study of elderly homicide victims brought to a Pennsylvania medical examiner's office reveals interesting findings about cause of death.

Accurately assessing elderly fall deaths using hospital discharge and vital statistics data.

Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deaths. However, studies have shown that discrepancies between the HDD and the corresponding DC often exist. This discrepancy was especially evident when comparing HDD to the vital statistics data (VSD) for deaths by falls among those aged 65 and over in 19 states. This was a retrospective forensic review of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998. Seventy-seven cases were identified, with the original manner of death listed as natural (34), suicide (1), and accidental (42) on the DC. Following a forensic review of the cases, the manner of the death on the DC should have been changed from natural to accidental in 28% (n = 12) of the cases, representing an undercount in the VSD. Undercounts were due to a failure of clinicians to account for the significance of a fall event that contributed to subsequent pathology and death. In addition, in that 22% (n = 17) of the HDD fall-associated deaths, the fall did not contribute directly or sequentially to the underlying cause of death, thereby representing an overcount in the HDD. Based on these findings we recommend (1) elderly fall surveillance systems should only count HDD E-coded falls that demonstrate a serious traumatic injury which directly or subsequently results in death, (2) all in-hospital fall-associated deaths should be reported to and reviewed by coroner/Medical Examiner offices for determination of the cause and manner of death, and (3) physicians should be better educated in properly completing death certificates.

Age-based factors in femicide.

Homicide is a topic of interest not only because of its severity but because it is a fairly reliable barometer of all violent crime, especially as it affects women. This exploratory study compared a group of murdered women over age 60 with a group of murdered women 30-59 and included age-based factors for both groups. Discussion focuses on forensics as insight to crime scene dynamics and homicidal behavior.

Forensic pathology and forensic epidemiology of suicides in allegheny county, pennsylvania : A 10-year retrospective review (1990-1999).

Suicide has assumed epidemic proportions and constitutes a major public health issue throughout the United States. Suicide remains one of the top eight leading causes of death, accounting for approximately 30,000 deaths annually. The understanding and prevention of suicide requires a multidisciplinary approach that involves psychosocial and medical specialties starting with a forensic analysis of the characteristics of suicide. The aim of this 10-year (1990-1999) retrospective study was threefold: first, to examine the forensic epidemiological characteristics of suicides examined by the Allegheny County Coroner's Office; second, to describe emerging epidemiological patterns of suicide; and finally, to make recommendations for preventive measures. A total of 1447 suicides were identified, with 1164 males (80%) and 283 females (20%) resulting in a male to female ratio of 4:1. The race distribution comprised 90% whites, 9% blacks, and 1% other races. The age of suicide victims ranged from 13 to 96 years old with a peak within the 31- to 40-year-old age group, which represented 24.5% of all suicides. Overall, 40% of the victims were single and more blacks than whites were single. The greatest number of suicides occurred in July, with the least in December. Suicides most frequently occurred between 9:01 AM and 3:00 PM. Suicide notes were present in 29% of all suicides. Firearm injuries, hanging, and drug overdose were the leading methods of suicide. Use of firearms was the leading method of suicide among both sexes. Female drug overdose deaths outnumbered male drug overdose deaths. The 10 most common overdose drugs were all central nervous system depressants, with amitriptyline being the most common prescription overdose drug. Based on reported antecedent trends in suicides, we make two recommendations regarding suicide prevention: (1) physicians should be educated to replace the prescription of older and more toxic antidepressants such as amitriptyline with newer and less toxic antidepressants such as serotonin reuptake inhibitors; and (2) firearms should be made inaccessible to individuals with risk factors for suicide, especially in the home.