Just 'nanging' around - harmful nitrous oxide use: a retrospective case series and review of Internet searches, social media posts and the coroner's database.

BACKGROUND: The chronic recreational inhalation of nitrous oxide (N2 O) 'nanging', can have adverse neurological and psychiatric effects. AIM: To evaluate cases of chronic N2 O use presenting to two hospitals, as well as to evaluate nationally N2 O deaths reported to the coroner and trends in Internet searches and social media posts related to N2 O. METHODS: Retrospective review of two toxicology units, from July 2017 to October 2020, of patients presenting with chronic N2 O use and neurological and/or psychiatric symptoms. We evaluated 10 years (2010-2019) of Internet search and social media trends involving N2 O and the National Coronial Information System (NCIS) database for deaths across Australia. RESULTS: Twenty-two patients were identified: median age 22 years, half female, 17 Asian background and 15 students. Presentations included decreased mobility or unsteady gait (n = 15) and psychiatric symptoms (n = 5). The median reported bulb use/day was 300 (interquartile range (IQR): 200-370), for a median of 6 months (IQR: 3-24). On magnetic resonance imaging, 10/18 had subacute combined degeneration of the spinal cord and 7/7 sensorimotor neuropathy on nerve conduction studies. All received high-dose intramuscular vitamin B12 and 11 methionine. Despite prolonged rehabilitation, nine required walking aids on discharge. Since 2017, social media posts and Internet searches for N2 O increased rapidly, the latter mostly directed at obtaining N2 O canisters. From the NCIS, 36 deaths were identified, 12 unintentional (recreational drug use), 20 intentional self-harm and 4 traumatic. CONCLUSION: We report a case series of symptomatic chronic N2 O use, many with ongoing neurological sequelae. Furthermore, a sharp increase in Internet searches to obtain N2 O cannisters was noted. Education of high-risk student groups on the long-term sequelae is important.

El peritaje forense en los casos de violación en Honduras previo a la independencia / Forensic expertise in rape cases in Honduras before the independence

Justificación: la bibliografía sobre delitos sexuales en el periodo de dominación hispánica en América (1492-1821) es escasa, existiendo importantes vacíos historiográficos que dificultan la reconstrucción de un panorama general del proceso penal conducido en esa época, por lo que, investigar el peritaje conducido en los casos de violación es un primer paso para rastrear la evolución del tratamiento de esos casos en las instituciones judiciales. Objetivo: describir cómo se ejecutaba el peritaje forense en los casos de violación sucedidos en la Honduras previo a su independencia política de España. Metodología: se adoptó un enfoque cualitativo con un diseño exploratorio, utilizándose fuentes primarias que fueron seleccionadas mediante muestreo no probabilístico. Resultados: se logró identificar dos casos en los cuales se hizo recurso de peritos para confirmar una violación. En ambos las expertas tenían el oficio de partera, brindando declaraciones que reflejan una falta de preparación profesional y un conocimiento basado en la experiencia. Las declaraciones fueron transcritas conservándose la ortografía de la época y comentadas para ubicarlas en su contexto. Conclusión: en la Honduras de los años previos a la independencia se realizaba un peritaje forense en casos de violación basado en la experiencia laboral de los peritos y no en información científica o preparación académica, esto condujo a que los juicios de los expertos se vieran afectados por sus sesgos culturales...(AU)

The coroner's inquest.

In the awful circumstances of the death of a mother or baby around childbirth, midwives need to be prepared for what happens afterwards. This article sets out some top tips for midwives appearing at a coroner's court with practical advice from Peter Straker, Coroner for West Yorkshire (Western District). You should be respectful, say how very sorry you are for the death, dress well, make sure you read your notes before the hearing and of course be open, honest and truthful. You must also be prepared to answer questions from the family of the deceased as well as from the Coroner.

Coronial cases highlight failings in mental health patient management.

The state of mental health services is like a barometer of how well our public health system is working overall. Changes to patient care and staff safety have necessarily been on the reform agenda for mental health in recent years as details of mishandled cases come to light. Below are two such cases heard in Queensland's Coroners Court whose findings were handed down earlier this year. The details of both these cases offer instructive advice about how mental health care should not be delivered in our public system. More sadly, they highlight how vulnerability of people suffering severe episodes of mental illness once they're in the care of our health system.

Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community.

BACKGROUND: Some people in states of excited delirium die while in police custody. Emerging evidence suggests that physical restraint in certain positions may contribute to such deaths. In this study the authors determined the frequency of physical restraint among people in a state of excited delirium who died unexpectedly. METHODS: The authors reviewed the records of 21 cases of unexpected death in people with excited delirium, which were investigated by the Office of the Chief Coroner for Ontario between 1988 and 1995. Eyewitness testimony, findings during postmortem examinations, clinical history, toxicological data and other official documents describing the events surrounding the deaths were analyzed. Specific reference was made to documented eyewitness testimony of restraint method, body position and use of capsicum oleoresin (pepper) spray. Because cocaine was detected in the blood of some of these people during the postmortem examination, the role of cocaine in excited delirium was examined by comparing the cocaine levels in these cases with levels in 2 control groups: 19 people who died from acute cocaine intoxication and 21 people who had used cocaine shortly before they died but who had died from other causes. RESULTS: In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivity), with the person either in a prone position (18 people [86%]) or subjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained. The excited delirium was caused by a psychiatric disorder in 12 people (57%) and by cocaine-induced psychosis in 8 (38%). Eighteen people (86%) were in police custody when they died. Four (19%) had been sprayed with capsicum oleoresin, and heart disease was found in another 4 at autopsy. The blood level of cocaine in those whose excited delirium was cocaine induced was similar to levels found in recreational cocaine users and lower than levels found in people who died from cocaine intoxication. INTERPRETATION: Restraint may contribute to the death of people in states of excited delirium, and further studies to test this hypothesis are recommended. Meanwhile, law enforcement authorities and others should bear in mind the potential for the unexpected death of people in states of excited delirium who are restrained in the prone position or with a neck hold.

Serotonin and 5-hydroxyindoleacetic acid in brains of suicide victims. Comparison in chronic schizophrenic patients with suicide as cause of death.

Serotonin (5-HT) and 5-hydroxyindoleacetic acid concentrations were determined in various brain areas of nonschizophrenic suicide victims, chronic schizophrenic patients with or without suicide as the cause of death, and normal control subjects without psychiatric or neurologic disorders. Serotonin concentrations in the basal ganglia were significantly elevated in suicide victims and chronic schizophrenic patients, as were 5-hydroxyindoleacetic acid concentrations in the occipital cortex. These differences were not specific to either patient group and may have been caused by neuroleptic or antidepressant treatment. A decreased 5-HT concentration was found in the hypothalamus of nonschizophrenic suicide victims. Among the chronic schizophrenic patients, there was no significant difference in the hypothalamic 5-HT content between the suicide victims and others, indicating that low 5-HT levels in the hypothalamus are not characteristic of schizophrenic patients who died of suicide.

A procedure for the investigation of anesthetic/surgical deaths.

A procedure for the investigation of surgical/anesthetic deaths is presented which allows for clearly defined jurisdictional assessment and correlates the autopsy and toxicological findings with the pathophysiology of the anesthetic/surgical event. This procedure facilitates an accurate certification of the cause of death in patients who die during surgery and anesthesia.