Exploring death scenes and circumstances in fatal opioid poisonings: Insights for preventive strategies using forensic autopsy cases in Western Denmark.

INTRODUCTION: Fatal opioid poisoning is a growing global issue. This study aims to describe circumstances surrounding fatal opioid poisonings by examining death scenes, demographics, and information from bystanders with the goal of informing prevention efforts. METHODS: We extracted data from the autopsy reports of 327 forensic autopsy cases with fatal poisoning involving methadone and/or morphine from 2013-2020. RESULTS: Fatal opioid poisonings occurred in both rural and urban areas. Death scene was the decedent's own home and a relative's or friend's home in 62% and 21%, respectively. The decedent died alone in 64% of the cases while other people were staying at the same address while death occurred in 30%. Decedents aged 15-34 years were more likely to die with other people staying at the same address than persons aged > 44 years (OR±SD: 2.3 ± 0.9, p = 0.005), and had lower postmortem blood methadone concentrations compared to persons > 34 years (Median [interquartile range]: 0.36 [0.23-0.62] vs 0.63 [0.28-1.2] mg/kg, p = 0.002). Female sex was more prevalent, and persons using illegal drugs were less prevalent in decedents aged > 44 years compared to those with age 15-44 years (29% vs 20%, p = 0.05% and 67% vs 89%, p < 0.001, respectively). Other psychoactive drugs were detected in 97% of decedents, mainly benzodiazepines (80%). CONCLUSIONS: Preventive strategies based on our findings include the need for harm reduction initiatives in both urban and rural areas, recognizing symptoms of fatal poisoning, and awareness of low tolerance among younger age groups. Urgent attention should be given to avoiding opioid use alone, particularly among older individuals, including women using prescribed opioids. Conveying the risks of polydrug use to all age groups is essential, especially co-use of sedative drugs.

Heart insufficiency after combination of verapamil and metoprolol: A fatal case report and literature review.

The combination of verapamil or diltiazem with beta-blockers should be avoided because of potentially profound adverse effects on AV (atrioventricular) nodal conduction, heart rate, or cardiac contractility. This effect is unpredictable but may be enhanced due to CYP2D6 poor metabolizer status which could be a special vulnerability factor.

[Chronic salicylate poisoning is a challenging diagnosis]. / Kronisk salicylatforgiftning er en svær diagnose.

Chronic salicylate poisoning is often seen in elderly patients as a result of an unintended overdosage, a change in metabolism or kidney function. The symptoms are often unspecific. This case report is about a 55-year-old man who was unconscious when admitted to hospital, and who died three hours after admission. An autopsy and a toxicological test showed a deadly level of salicylate in his blood. Afterwards, his wife told that he had complained about a sudden hearing loss, and that his behaviour had changed prior to his death. It is important to keep this diagnosis in mind when treating especially elderly patients.

[Chronic salicylate poisoning is a challenging diagnosis]. / Kronisk salicylatforgiftning er en svær diagnose

Chronic salicylate poisoning is often seen in elderly patients as a result of an unintended overdosage, a change in metabolism or kidney function. The symptoms are often unspecific. This case report is about a 55-year-old man who was unconscious when admitted to hospital, and who died three hours after admission. An autopsy and a toxicological test showed a deadly level of salicylate in his blood. Afterwards, his wife told that he had complained about a sudden hearing loss, and that his behaviour had changed prior to his death. It is important to keep this diagnosis in mind when treating especially elderly patients.

[Carbon monoxide deaths caused by town gas in Denmark 1995-99]. / Kuliltedødsfald forårsaget af bygas i Danmark 1995-1999.

INTRODUCTION: Over the years town gas has caused many fatal carbon monoxide poisonings. The aim of this paper is to document the circumstances surrounding town gas deaths in Denmark between 1995-1999 and to trace the development of these deaths in recent decades. MATERIALS AND METHODS: A retrospective study of death certificates and report material concerning carbon monoxide deaths in Denmark between 1995-1999 caused by town gas. Of 449 non-fire related carbon monoxide poisonings, 22 (4.9%) were caused by town gas. RESULTS: The deaths consisted of fourteen suicides, six accidents, and two with undetermined manner of death. Ten (71%) of the suicide victims were men and four (29%) were women, with an average age of 48 years (24-82 years); all had turned on two or more gas rings. The accident victims were one man and five women, with an average age of 84 years (77-92 years); all had only turned on one gas ring. CONCLUSION: The number of town gas deaths has been drastically reduced since 1969, which can be explained by the reduced number of town gas installations containing carbon monoxide as well as preventive measures. Most deaths can probably be avoided when the town gas supply is switched to carbon monoxide-free town gas in 2007, but it is important to be aware that incomplete combustion of carbon monoxide-free town gas can still lead to carbon monoxide poisonings.

[Fatal bicycle accidents involving right turning heavy goods vehicles--forensic pathological findings]. / Cyklister draebt af højresvingende lastbiler--retspatologiske fund.

INTRODUCTION: The objective of this study was to describe the forensic pathological findings in autopsies of cyclists involved in fatal accidents with right-turning, heavy goods vehicles (HGV). DESIGN AND SETTINGS: Retrospective analysis based on medico-legal autopsy reports concerning persons involved in fatal traffic accidents in Denmark between 1996 and 2005. Cyclists and moped-riders hit by a right-turning HGV were included. Forensic pathological findings, blood alcohol levels, place of death as well as several traffic parameters were registered. RESULTS: Twenty-five autopsies were included. In 20 cases (80%), death had occurred instantly. Also in 20 cases (80%), injuries in at least three body regions were found at autopsy. There were no cases with injuries in only one body region. There were fewest cases with head/neck injuries. In 16 cases, injuries in one or more body regions were so severe as to be described as complete crushing (conquassatio). CONCLUSION: In traffic accidents involving cyclists and right-turning HGVs, the cyclist is more often run-over rather than merely hit by the HGV. This mechanism of injury is crucial for both the severity and the distribution of injuries. This is reflected in this study by the number of multiple body regions involved, the number of complete crushing injuries and by the number of cases where death had occurred instantly. Future efforts should focus on the prevention of these accidents.