Mechanical Asphyxiation Due to Ligature Strangulation: A Case Report of Suicide

Introduction: Suicide by ligature strangulation has been rarely reported in literature. This case report was prepared to present this different method of suicide and to discuss the findings of this case in the framework of findings in literature. Case: A 37-year old male was found dead in his home where he lived alone, with no signs of forced entry to the house. The body was lying supine on the dining table, with the feet hanging free and the head completely resting on the table. A thick, orange-coloured rope was wrapped three times around the neck and below the table where the head was resting was a 20kg demijohn full of water, with a broken rope with the same features wrapped around the neck of the bottle. Discussion and Conclusion: The current case is unique in respect of showing the postmortem findings which could be created following the application of pressure with a force of 20kg on the airway and blood vessels. The necessity is emphasised for detailed examination of the scene to differentiate suicide from murder and of information from before death and from the autopsy to correctly establish the cause of death.

Quantifying Homicide Injuries: A Swedish Time Trend Study Using the Homicide Injury Scale

Studies report that the homicide rate has decreased considerably in most Western countries since the 1990s. However, few studies have examined the level of injury in homicides. The injury severity in homicide victims was studied in the Stockholm area using both the Homicide Injury Scale (HIS) and the number of lethal injuries per victim. Cases were included from four periods; 1976-78, 1986-88, 1996-98, and 2006-08. The number of homicides with overkill according to the HIS was significantly higher in 1996-98 compared to 1976-78. Compared with 1976-78, the number of lethal injuries per victim was significantly higher both in 1996-98 and 2006-2008. There are various possible reasons for the changes, including a brutalization of lethal violence or a more effective trauma care. More in-depth analysis of individual cases together with research on victims of attempted homicides is needed to explain these shifts in injury severity.

Iatrogenic deaths: A 25-year retrospective study of medicolegal autopsies

Background: It is stipulated in the Danish Health Act that any death which could be caused by a mistake, neglect or accident in relation to treatment or prophylaxis should be reported to the police. It is then within the power of the police to request a medicolegal autopsy. Aim: To profile the possible iatrogenic deaths in relation to different characteristics. Methods: All cases from 1992 to 2015 registered as doctor’s malpractice were selected. Cases from 2016 were selected based on the autopsy introduction. Included cases were analyzed focusing on different characteristics: type of iatrogenic event, responsible medical professional, place of death, cause of death. Results: A total of 275, i.e. 2.5% possible iatrogenic deaths out of a total of 11,143 autopsies were included. The most frequent type of iatrogenic event was negligence (42.2%). Most often a hospital doctor was the responsible party including surgeons (40%) and physicians (13.5%). The three most common causes of death were cardiovascular disease (22.2%), infection/inflammation (17.8%) and hemorrhage (16%). Conclusion: The results from this study can contribute to the knowledge of what to be aware of when dealing with the death of a person who has been in contact with the health care system.

Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

Diabetes mellitus is a disease caused by a deficiency in (type 1) or inability to use insulin (type 2). Untreated it can lead to diabetic ketocidosis (DKA) – state with high levels of ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate (BHB)). This state can be life threatening. Measurement of ketone bodies together with vitreous/urine glucose and glycosylated hemoglobin (HbA1C) are therefore essential to diagnose DKA-related deaths. All autopsy samples received at our department in the period 2016-2018 for toxicological investigations were analyzed for acetone, BHB, and vitreous glucose (N = 1394). In case of a high level of BHB, HbA1C and urine glucose were measured. Thirty two cases (2.3%) were concluded to be DKA-related deaths. Eleven (34%) of these had no known history of diabetes. BHB accounts for the major part of ketone bodies and is directly associated with the acidosis effect. Therefore, BHB is preferred to acetone when evaluating DKA and other ketoacidosis-related deaths. We compared acetone and BHB levels to evaluate if the easy acetone measurement could cover our needs for screening. We found that high BHB levels (>2000 µmol/L) were detected if the acetone cut off was set to 0.01 g/L. But, many samples would have low BHB < 3-500 µmol/L with this cut off, and many samples with raised BHB (500-1,200 µmol/L) would not be detected. We therefore recommend to screen all samples for BHB. In case of a high BHB (>1,000 µmol/L) vitreous/urine glucose and HbA1C must be measured to distinguish DKA from other types of ketoacidosis.

Forensic anthropological video-based cases at the Department of Forensic Medicine, University of Copenhagen: a 10-year retrospective review

In criminal cases where there is a lack of evidence, the authorities sometimes ask our department to make a comparison of a criminal and suspect for possible identification or exclusion. This paper provides a comprehensive overview of 113 such cases analysed by the Department of Forensic Medicine, University of Copenhagen, Denmark in 2006–2016. The aims of the analyses were to assist the authorities in identifying individuals, predominantly due to a suspicion of involvement in criminal activity. The videos comprised surveillance footage showing a criminal committing a criminal act. Based on comparisons of specific parameters, such as face, gait and general body proportions, conclusions were drawn on the plausibly of a suspect being the perpetrator of the crime in the video footage. This paper describes the most typical case: a comparison of one suspect with one criminal committing a robbery. In the majority of cases, the suspect could not be excluded from being the criminal based on the analysis of the video footage.

Circumstances and autopsy findings in drownings, Department of Forensic Medicine, Aarhus University, 2006-2015

The purpose of this study was to examine the demographic circumstances and the autopsy findings regarding drowning deaths autopsied at the Department of Forensic Medicine, University of Aarhus. The study is based on autopsy reports from the Department of Forensic Medicine in Aarhus, 2006-2015 with drowning as a cause of death. Among the 135 cases of the study, 87 (64.4%) were accidents versus 33 (24.4%) suicides. The study showed, that the majority of the drowned 73,3% were males, especially pronounced in the accidents (81.6% were males). In 60.7% victims, there was a positive blood alcohol analysis, most often in males. Females with positive alcohol analyses did however have the highest mean alcohol blood level (1.65 versus 1.47 per mile). The most frequent place of the submersions was docks (24.4%) and the most frequent time of day was in the evening (18.00 – 23.59; 19.3%) and at night (00.00 – 05.59; 20.0%). The study shows no significant connection between adipocere and type of water (OR=1.21, 95% CI (0.49;2.99), p=0.68), bulging lungs and type of water (OR=1.18, 95% CI (0.52;2.70), p=0.69), lung weight and type of water (z-test, p=0.38) and the amount of pleural effusion and water type (z-test, p=0.16). A significant connection between the presence of pleural effusion and type of water cannot discounted (OR=2.37, 95% CI (1.06;2.44), p=0.02).

SURVIVE: let the dead help the living—an autopsy-based cohort study for mapping risk markers of death among those with severe mental illnesses

Background: Forensic autopsy strategies may improve differential diagnostics both post-mortem and ante-mortem and aid in clinical settings concerning preventive efforts for premature mortality. Excess mortality and reduced life expectancy affect persons with severe mental illnesses (SMI) for multi-faceted reasons that remain controversial. Somatic conditions, medical treatment and lifestyle diseases, which are primarily examined in the living, contribute to premature deaths. The underlying pathophysiological mechanisms are unclear, though, and the benefits of a focused, standardised autopsy remain unproven. We have developed and implemented an optimised molecular–biological autopsy for deceased persons with SMI. Our aim is to map the occurrence of 1) somatic diseases and organ changes; 2) metabolic syndrome; 3) use and abuse of alcohol, pharmaceuticals and psychoactive substances; 4) pharmacokinetic and pharmacodynamic factors in the metabolism of pharmaceuticals; and 5) genetic variations (acquired and/or congenital) in sudden cardiac death. Additionally, we hope to contribute to diagnostic treatments and preventive measures to benefit those living with SMI. Methods: SURVIVE: let the dead help the living is a prospective, autopsy-based study on 500 deceased persons with SMI subjected to forensic autopsies under the Danish Act on Forensic Inquests and Autopsy. The autopsies followed an extended, standardised autopsy protocol comprised of whole-body computed tomography scanning, magnetic resonance imaging of the heart and brain and an extended forensic autopsy, including a wide panel of analyses (toxicology, microbiology, genetics, histology and biochemical analysis). Additionally, post-mortem data were linked to ante-mortem health data extracted from Danish national health registers. Discussion: The SURVIVE autopsy procedure, including tissue sampling and bio banking, has been shown to be effective. We expect that the SURVIVE study will provide unique opportunities to unravel the mechanisms and causes of premature death in persons with SMI. We also expect that identifying prognostic biomarkers for comorbidities will contribute to prevention of premature deaths and comorbidities in persons with SMI.

The death of a medieval Danish warrior. A case of bone trauma interpretation

In 1934 a grave was found in the church ruins of the Cistercian Abbey at Øm in central Jutland, Denmark (founded in 1172, demolished 1561 AD). The grave contained the skeletal remains of an individual lying in a supine position with the head towards the west. The anthropological analysis revealed that the remains belonged to a young male, aged 25-30 years at death and approximately 162.7 cm tall. He had 9 perimortem sharp force lesions, five of which were cranial and four were postcranial, indicating he suffered a violent death in a swordfight. This paper presents a detailed analysis and description of the individual lesions and their probable effect on the soft tissue, followed by a suggestion for the most likely order of the blows which caused the lesions, and finally a tentative reconstruction of the battle accompanied by photographs. This case illustrates both that forensic pathology can be very useful when applied to an archaeological case and suggests that the forensic pathologist could benefit from examination of ancient cases when interpreting bone lesions in modern cases.

Analytical Profiling of Airplane Wastewater - a New Matrix for Mapping Worldwide Patterns of Drug Use and Abuse

There is limited knowledge on the global prescription and consumption patterns of therapeutic (TD) and illicit drugs (ID). Pooled urine analysis and wastewater-based epidemiology (WBE) has been used for local-based drug screening. It is, however, difficult to study the global epidemiology due to difficulties in obtaining samples. The aims of the study were to test the detectability of TD and ID in airplane wastewater samples categorized according to their geographical origin. Wastewater samples (n= 17) were collected from long-distance flights and prepared with enzymatic conjugate cleaving followed by either precipitation or solid phase extraction. Aliquots were analysed on various liquid chromatography – mass spectrometers. TDs were grouped according to their Anatomical Therapeutic Chemical (ATC) codes. Identification confidence was assigned to three levels based on variables including detection on multiple instruments and number of targets per compound. A total of 424 compounds were identified across all samples, distributed on 87 unique TD and 2 ID. Two principal components in a principal component analysis separated three clusters of wastewater samples corresponding to geographical origin of the airplanes with therapeutic subgroup ATC codes as variables. Airplane wastewater analysis is useful for identifying targets for WBE and toxicological analysis and explore drug use and abuse patterns.

Fatal Cervical Spine Injury Following a Bicycle Crash

Spinal injury following direct loading of the head and neck is a rare sequel of bicycle crashes. Fatal head injuries following bicycle crashes have been described in great detail and safety measures such as bicycle helmets have been developed accordingly. Less frequently, however, potentially severe cervical spine injuries have been described. We present the case of a middle-aged female who sustained an ultimately fatal cervical spine injury following a collision with a car whilst biking wearing a helmet. We discuss the literature regarding the protective effects of bicycle helmets, the relevance to cervical spine injury and legislation on mandatory use of helmets for injury prevention.