The wounding potential of assault rifles: analysis of the dimensions of entrance and exit wounds and comparison with conventional handguns. A multicentric study.

The appearance of a gunshot wound (GSW) is greatly influenced by the velocity of the projectile, where high-velocity projectiles (HVPs) are defined as ballistic agents reaching a muzzle velocity of > 600 m/s fired from assault rifles. The aim of the study is to present and explain the differences in the dimensions of entrance and exit wounds between the most used handguns and assault rifles and to propose a predictor of HVP, i.e., the ratio of exit and entrance wounds (EX/ENR). The surface area of entrance and exit GSWs and the EX/ENR were calculated. 66 perforating GSWs produced by NATO FMJ 7.62 × 52 mm and 5.56 × 42 mm fired from assault rifles were assigned to the HVP, while 64 lesions produced by conventional projectiles fired from revolvers and semi-automatic pistols were assigned to the low-velocity projectile (LVP) group. The dimensions of the exit wounds of the HVP group were significantly higher when compared to the LVP group (95% CI 0.9886-2.423, p < 0.05). The HVP group showed significantly higher values for the EX/ENR when compared to the LVP group (95% CI 2.617-7.173, p < 0.05). The evaluation of the EX/ENR can be considered an adequate tool to assess the type of weapon involved and to roughly estimate the associated wounding mechanisms, which can guide both the physician in the management and treatment of the patients affected by GSW, and the forensic pathologist in crime investigation.

Committed suicide: forensic autopsy analysis at Ramathibodi Hospital during year 2001-2010.

BACKGROUND: Suicide is one of the most important causes of death in the world. To study the behaviors and risk factors may be helpful to prevent suicide. OBJECTIVE: To retrospectively study the factors that affected suicide in forensic postmortem cases at Ramathibodi Hospital, Bangkok, Thailand between 2001 and 2010. MATERIAL AND METHOD: Two hundred ninety suicidal cases from 7,102 forensic postmortem autopsies in Ramathibodi Hospital between 2001 and 2010 were descriptively retrospective studied. Study topics included sex, age, nationality, year, methods of suicide, and HIV. RESULTS: The suicide-rate in the present study varied between 2.53% and 6.91% (average 4.08%) of the forensic autopsy cases. The peak was found in 2003. Males had higher suicide rate than females [ratio of M:F of 4.3:1 (235 males and 55 females)]. The age varied from seven years to 91 years. Although the average age of suicide was 37.38 years, the peak was found in the young adult (age group of 21 to 30 years). Male, younger age, and foreigner were related to suicide with statistical significance. Hanging was the most frequent method of suicide followed by fall from height (62.1% and 17.2% respectively) and by firearm (in male) and toxic substance ingestion (in females). Of all the suicide, 5.1% were HIV seropositive, which is slightly more than non-HIV cases (4.0%) but this was not statistically significant. CONCLUSION: The suicidal cases among unusual death were related to varieties of factors. Male, younger age, and foreigner were significant related to suicide. Hanging and falling from height were the most frequent method of suicide.

Methamphetamine-induced profound rhabdomyolysis and myoglobin cast nephropathy: A case report and a literature review.

A 46-year-old male with a history of substance abuse was found dead in custody 30 hours post incarceration for a minor offense. The scene demonstrates the body lying in a prone position in the cell room, locked from the outside. No signs of violence were found at the scene. External examination revealed no significant injuries, except for multiple minor contusions and abrasions. The autopsy demonstrated only a moderate degree of bilateral pulmonary edema. No internal injuries were found, except for fractures in the three lower left ribs. Dark reddish-brown urine was detected in the urinary bladder. Histological examination revealed a diffuse tubular injury with intraluminal eosinophilic granular casts. The myoglobin cast demonstrated pale PAS staining with a granular appearance, Masson Trichrome staining demonstrated fuschinophilic deposits on the casts, and immunoperoxidase staining for myoglobin was strongly positive in the casts (the images will be displayed). Blood myoglobin and creatine kinase levels were elevated. These findings revealed profound rhabdomyolysis caused by several factors. Blood toxicology tests revealed lethal methamphetamine and amphetamine levels. All the findings were consistent with methamphetamine-induced severe rhabdomyolysis. Therefore, forensic pathologists should carefully search for gross and histological findings and conduct thorough laboratory investigations to diagnose this condition for complete medicolegal examination.

Autopsy study of alcohol-associated unnatural deaths in Thailand, 2007-2019.

BACKGROUND: To date, there have been no major studies of alcohol-associated unnatural deaths in Thailand or South East Asia. Thailand leads South East Asia in per capita alcohol consumption. The objectives of this study were to determine the incidence of alcohol-associated unnatural deaths in Thailand and their relation to post-mortem blood alcohol concentration (BAC); to investigate correlations between BAC and selected demographic variables; and to evaluate the incidence of co-use of alcohol and illicit substances. METHODS: We conducted a retrospective register-based study of alcohol-investigated unnatural deaths in Thailand for the period 2007-2019. The core study sample (n = 77,006) was derived from a Thai government computerized database of unnatural-death autopsies. RESULTS: Of the total autopsy sample 32.49% was alcohol positive (BAC ≥0.20 g/L). The rate at which male autopsy cases were alcohol positive (35.52%) was approximately twice that of female autopsy cases (16.62%), with males having significantly higher median BAC levels, 1.64 and 1.31 g/L, respectively. The incidence of female alcohol-positive cases with extremely high BACs (≥3.50 g/L) was comparable to that of male alcohol-positive autopsies. The rates at which victims of accidents, homicides, and suicides were alcohol positive were 42.44%, 38.81%, and 33.25%, respectively. Drowning fatalities had the highest rate of alcohol detection (49.12%) and the highest median BAC (2.47 g/L). The next highest rate (48.47%) was among road traffic fatalities (RTFs, BAC 1.92 g/L), which accounted for about one-half of all RTFs and one-third of all alcohol-positive autopsies. Of the total alcohol-positive population, 8.33% tested positive for illicit substances, most commonly methamphetamine/amphetamine. CONCLUSIONS: BAC results for the majority of male and female alcohol-positive victims exceeded the generally accepted threshold for Heavy Episodic Drinking (0.8 g/L) and provided a rare BAC-documented (≥3.50 g/L) example of gender parity in the incidence of heavy alcohol consumption. The median BAC value for alcohol-positive RTFs (1.92 g/L) was about 10% higher than in studies in most other countries and about four times greater the Thai legal limit for motor-vehicle operation (0.50 g/L).

Myocardial tissue embolism in lung due to gunshot wound to the chest.

Myocardial tissue embolism due to gunshot wound is a very rare event, as only a few cases of myocardial tissue embolization, occurring after cardiac surgery or myocardial infarction, have been reported. According to this study's referenced report from forensic autopsy, one case of myocardial tissue emboli to the lung has been found, in an Asian male, 22 years old, who died from a gunshot to the chest by a handgun. From the examination, myocardial tissue embolism was considered important forensic evidence, showing that the gunshot occurred while the victim was still alive, and that he also survived for some period of time after being shot.

The use of pilocarpine eye drops for estimating the time since death.

OBJECTIVE: The objective of this study was to estimate the time since death using pilocarpine eye drops. METHODS: In this study, 100 postmortem cases with known time of death were included. In each case, the left pupil was measured in millimeter units using a vernier caliper, and pilocarpine eye drops were applied. The pupil was measured again 10 min later, and statistical analysis was used to analyze the correlation between the time since death and the change in the pupil. RESULTS: The longest duration since death that the pupils showed reaction to pilocarpine was 15 h. The correlation between the change in the pupil and the postmortem interval was found (Spearman's rho, r = -0.304, p = 0.002), and the change in the pupil may be used to predict the postmortem interval by the following regression equation: postmortem interval (PMI) = 8.310-3.702 (Diff) ± 0.735 (PMI was postmortem interval in hours and Diff was the difference in the size of the pupil after administering pilocarpine in millimeter units). CONCLUSION: The present study showed that pilocarpine eye drops can be used to estimate the time since death.

Entrance and exit wounds of high velocity bullet: An autopsy analysis in the event of dispersing the mass rally in Bangkok Thailand, May 2010.

Fatal mass casualties by high velocity bullets (HVBs) are rare events in peaceful countries. This study presents 27 forensic autopsy cases with 32 shots fired by 5.56×45mm. HVB (M-16 rifle bullets) during the dispersing the mass rally in Bangkok Thailand, May 2010. It was found that twenty-three (71.88%) typical entrance HVB wounds had round sizes less than the bullet diameters. Most entrance wounds had microtears but no collar abrasion since a HVB has a small streamlined spitzer tip and full metal jacket. For exit wounds, there were various sizes and shapes depending on which section of wound ballistics presented when the bullet exited the body. If a bullet exited in the section of temporally cavity formation, there would be a large size exit wound in accordance with the degree of bullet yaw. This is different from civilian bullets whereby the shape looks like a cylindrical round nose and at low velocity that causes entrance wounds with a similar size to the bullet diameter and is usually round or oval shape with collar abrasion. The temporary cavity is not as large as in a HVB so exit wounds are not quite as large and present a ragged border compared to a HVB. We also reported 9 out of 32 shots (28.13%) of atypical entrance wounds that had various characteristics depending on site of injury and destabilization of bullets. These findings may be helpful to forensic pathologists and to give physicians, who need to diagnose HVB wounds, more confidence.

Fatal firearm injuries in autopsy cases at central Bangkok, Thailand: a 10-year retrospective study.

Even though there have been previously published reports on firearm injuries in various countries, the incidence and pattern of death from firearm injuries in Thailand have not been studied before. In present study, 149 fatal firearm injuries from 2002 to 2011 were reviewed. At total of 7126 autopsies, fatal firearm injuries comprised of 2.09% (n = 149) of total autopsies cases. Among those victims, 136 were male (91.3%), 13 (8.7%) were female. The youngest age of victim was 10 years and the oldest was 79 years. Mean age of the victims was 33.79 years and median age was 30 years. Outdoor incident was the most common scene of crime. Night time incident (18:00 PM-05:59 AM) was higher than day time one. Most of the cases occurred in week ends (n = 52). Homicide (77.2%) was the most frequent manner of death. Head/face and chest were the most common sites of entrance. The autopsy report also study on entrance wound, range and types of projectiles. Blood alcohol concentration was examined in 122 cases and 38 victims showed positive results, 11 cases revealed using of illegal substances in blood and urine analysis. This study also included the association between manner of death and other factors. Age group, time of incidence, place of incidence, number of entrance wound and range showed statistically significant association with manner of death.

Comparison between prostate specific antigen and acid phosphatase for detection of semen in vaginal swabs from raped women.

OBJECTIVE: To compare the effectiveness of the prostate specific antigen (PSA) test and the acid phosphatase (AP) test for semen detection in human vaginal samples. MATERIAL AND METHOD: The source materials were vaginal swabs that were tested at Ramathibodi Hospital between 2008 and 2010 from 2450 cases of raped women. Each swab was tested for semen by three methods: sperm detection by light microscopy, the AP enzymatic reaction, and the presence of PSA by using an immuno-chromatographic rapid kit test. The efficiencies of the AP and PSA tests were compared using the light microscopy result for the presence of sperm as the gold standard. RESULT: The specificities of the AP, the PSA and the combined AP-PSA tests were 96.4%, 92.3% and 91.9%, respectively, and the sensitivities were 65.5%, 80.4% and 84.5%, respectively. The receiver operating characteristic (ROC) area of the AP, PSA and combined AP-PSA tests were 0.8091, 0.8639 and 0.8823, respectively. The ROC area of the PSA test was significantly greater than that of the AP test (p < 0.0001), and the ROC area of the combined AP-PSA test was significantly greater than both the tests individually (p < 0.0001). DISCUSSION: Based on the ROC area, the PSA test was better than the AP test for semen detection in the vaginal swabs, and the combined results (AP + PSA) were better than the individual tests. The specificity of the AP test was higher than the PSA test in this study because a positive detection was made within only 15 s. While the PSA test was more convenient as it was available in a rapid test kit format, our recommendation is PSA detection should be done together with AP test and spermatozoa examination to identify evidence of rape. CONCLUSION: Using these three tests together (AP, PSA, and spermatozoa detection) was recommended as a forensic tool for investigations of vaginal swabs of the rape victims.