Application of the multiple drugs immunoassay test for rapid detection of drug abuse in postmortem urine.

OBJECTIVE: The ADVANCED QUALITY One Step Multi-Drug Screen test is a new urine on-site immunoassay test that is designed to detect multiple drugs of abuse in one time (barbiturates, benzodiazepines, cocaine, methylenedioxymethamphetamine (MDMA), methamphetamine, and opiates group). Thus, the present research was done to evaluate the diagnostic performance of this test. MATERIAL AND METHOD: Urine samples obtained from corpses subjected to medicolegal autopsy at the forensic unit in Ramathibodi Hospital between October 2007 and March 2009 were used for the present study. The diagnostic performance of this immunoassay test was determined by using the results of the rapid emergency drug identification high sensitivity (REMEDi HS) system as the gold standard. RESULTS: Two hundred forty six urine samples were used in the present study. The sensitivity with their 95% confidence interval of cocaine, opiates, methamphetamine, and benzodiazepines assay was 100% (100-100%) each. The specificity with their 95% confidence interval of these was 100% (100-100%), 98% (96.75-99.94%), 95% (91.70-97.38%), and 93% (89.89-96.24%), respectively. The MDMA and barbiturates were not evaluated because there was no true positive result. CONCLUSION: The ADVANCED QUALITY One Step Multi-Drug Screen test is reliable for drugs of abuse screening in postmortem urine.

DNA database of populations from different parts in the Kingdom of Thailand.

The polymorphism of 15 short tandem repeat (STR) loci-D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA from AmpFlSTR Identifiler PCR amplification kit were analysed in 929 unrelated individuals living in the north, northeast, central and south of Thailand. The comparison between these four subpopulations demonstrated that subpopulations in the north and northeast were different in two loci from all paired groups while those in the north, central and south were closely related. The inter-population comparisons between combined Thai population and other ethnic groups including Eastern Chinese, Japanese, Iraq and Egyptian revealed that Eastern Chinese and Thai were closely related.

A carbon dioxide fatality from dry ice.

This report documents a rare case of carbon dioxide intoxication in a young healthy male. The deceased hid in a small plastic container, size 1.5 x 1 x 1 m, and within 5 min he was located suffering convulsions and was reported as dead within minutes. Scene investigation revealed dry ice in the container. Autopsy findings were unremarkable. The probable cause of the convulsions was carbon dioxide intoxication due to both the dry ice sublimation and the small confined space in which he was hiding. This report emphasizes the significance of scene investigation in establishing the cause of the death.

An autopsy case report of suicide by multiple self-cutting and self-stabbing over the chest and neck.

A 27-year-old male with a clinical history of acquired immunodeficiency syndrome committed suicide by cutting and stabbing himself in his bedroom. During the scene investigation, the knife was recovered below his body and the room was not ransacked The external examination revealed one deep incised wound with one superficial incised wound over the anterior aspect of the neck, three horizontal stab wounds with five superficial small incised wounds over the chest and two superficial incised wounds over the ventral aspect of the left wrist. They showed multiple hesitation wounds. Subsequent autopsy showed a cut wound of the thyroid cartilage penetrating trachea and a penetrating wound of the left lower lung with 500 ml fresh blood hemothorax. All findings lead to suspicion of suicide by multiple sharp forces.

Correlation of internal organ weight with body weight and length in normal Thai adults.

OBJECTIVE: To retrospectively review forensic autopsy cases of a Thai population to show the relationship between the normal internal organ weight and body weight and body length. MATERIAL AND METHOD: The present study included 561 autopsies from Ramathibodi Hospital from August 2003 to June 2007. The subjects were from sudden unnatural death following criteria. The weighed organs included brain, heart, lungs, liver, spleen, and kidneys. RESULTS: The ages ranged from 15 to 89 years and there were 461 males and 100 females. The Mean were represented by males and females; 1330/1208, 302/259, 831/659, 1390/1211, 96/81, and 252/222 in brain, heart, lungs, liver, spleen, and kidneys respectively CONCLUSION: Relationship was found between internal organs weight and body weight and body length of males whereas, in females the weight of internal organs except the kidneys was not related to body length.

Sudden unexpected deaths in different age groups at Ramathibodi Hospital, Bangkok, Thailand: a retrospective autopsy study during 2003-2007.

A sudden unexpected death is considered one type of medico-legal death in Thailand. In some studies, it comprises up to 50-60% of all medico-legal deaths. In this retrospective study, data were collected from 1,460 cases of sudden unexpected deaths, 39.9% of all deaths in which a medico-legal autopsy had been carried out. The study was conducted over a 5-year period from January 2003 to December 2007. There were 1,009 males and 451 females (M:F ratio = 2.2:1). The mean age was 55.3+/-0.98 years. The peak age group was the 46-60 years accounting for 28.2% of cases. The most common cause of death in all age groups was coronary atherosclerosis. Understanding epidemiological autopsy data is vital for determining the characteristics of the population involved.

Differences between brain mass and body weight scaling to height: potential mechanism of reduced mass-specific resting energy expenditure of taller adults.

Adult resting energy expenditure (REE) scales as height( approximately 1.5), whereas body weight (BW) scales as height( approximately 2). Mass-specific REE (i.e., REE/BW) is thus lower in tall subjects compared with their shorter counterparts, the mechanism of which is unknown. We evaluated the hypothesis that high-metabolic-rate brain mass scales to height with a power significantly less than that of BW, a theory that if valid would provide a potential mechanism for height-related REE effects. The hypothesis was tested by measuring brain mass on a large (n = 372) postmortem sample of Thai men. Since brain mass-body size relations may be influenced by age, the hypothesis was secondarily explored in Thai men age < or =45 yr (n = 299) and with brain magnetic resonance imaging (MRI) studies in Korean men (n = 30) age > or =20<30 yr. The scaling of large body compartments was examined in a third group of Asian men living in New York (NY, n = 28) with MRI and dual-energy X-ray absorptiometry. Brain mass scaled to height with a power (mean +/- SEE; 0.46 +/- 0.13) significantly smaller (P < 0.001) than that of BW scaled to height (2.36 +/- 0.19) in the whole group of Thai men; brain mass/BW scaled negatively to height (-1.94 +/- 0.20, P < 0.001). Similar results were observed in younger Thai men, and results for brain mass/BW vs. height were directionally the same (P = 0.09) in Korean men. Skeletal muscle and bone scaled to height with powers similar to that of BW (i.e., approximately 2-3) in the NY Asian men. Models developed using REE estimates in Thai men suggest that brain accounts for most of the REE/BW height dependency. Tall and short men thus differ in relative brain mass, but the proportions of BW as large compartments appear independent of height, observations that provide a potential mechanistic basis for related differences in REE and that have implications for the study of adult energy requirements.

The relationship between bone and ash weight to body weight and body length of Thai corpses in Bangkok and central part of Thailand after cremation.

BACKGROUND: Although information about bone and ash weight compare to body weight and body length of Thai people exists, it was based on a few samples. OBJECTIVE: Collect data of the bone and ash weight after cremation and find out the relationship between bone and ash weight, body weight, body length, and age. MATERIAL AND METHOD: Two hundred and twenty three corpses, 97 females and 126 males were collected from four temples, three temples from Bangkok and one temple from Angtong province. The crematoria used in the present study created a temperature between 850 degrees C and 1,200 degrees C. Each cremation took about 1-1.5 hours. RESULTS: The average with SD of bone and ash weight of males was 2.44 kg +/- 0.9 Kg, while the weight of females was 2.07 +/- 0.89 Kg, and the average of bone and ash weight of total subjects was 2.28 +/- 0.95. There was negative correlation between age and bone & ash weight, while there was positive correlation between body length and body weight, body length and bone & ash weight, and body weight and bone & ash weight. The results of the present study indicated that age and body weight affected the bone and ash weight. The fitted linear equation was Log (bone & ash weight +1) = 0.413 - 0.001 (age) + 0.003 (body weight). CONCLUSION: Age and body weight affect bone and ash weight. Moreover, the age, body weight, and body length could be estimated by using the bone and ash weight.

An autopsy report case of rape victim by the application of PSA test kit as a new innovation for sexual assault investigation in Thailand.

The case of a 30 year-old Thai female found dead on the floor at the base of a small monument on Rajadumnern Road, Bangkok, Thailand with blood stains around the body and a naked bottom. The scene investigation and autopsy findings suggested a sexual assault and multiple sharp force injuries. The approach to the postmortem examination using different laboratory tests is reviewed. The specificity and sensitivity of prostate specific antigen (PSA) in specimens from rape victims is better than acid phosphatase test. The ELISA test for PSA was tested to confirm the PSA test kit. The present report suggests the PSA test kit in addition to conventional sperm smear and acid phosphatase test for sexual assault investigation in Thailand.

Comparable between rapid one step immunochromatographic assay and ELISA in the detection of prostate specific antigen in vaginal specimens of raped women.

BACKGROUND: Rape is a crime found in Thailand nowadays. The crime is often lacking of eyewitnesses. Therefore, examination for forensic biological evidence becomes quite important, especially investigating sperm and semen in vaginal specimens of the victim. Acid phosphatase test for semen is commonly used in Thailand but is just a presumptive test. Recently, confirmatory kit tests became available in Thailand for detecting the prostate specific antigen (PSA) from semen. This test is simpler and cheaper than ELISA. OBJECTIVE: To compare the rapid one-step immunochromatographic assay with ELISA for the detection of prostate specific antigen in vaginal specimens of raped women. MATERIAL AND METHOD: A diagnostic test was conducted on the vaginal specimens of raped women that were sent to the laboratory of the Pathology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University during April-August 2006. One hundred vaginal specimens were examined for prostate specific antigen by rapid one step immunochromatographic assay and compared with ELISA. RESULTS: There were 85% and 83% of sensitivity, 85% and 85% of specificity, 85% and 85% of accuracy, 89% and 89% of positive predictive value, and 79% and 77% of negative predictive value from rapid one-step test kit and ELISA respectively CONCLUSION: The result showed that there was no difference on specificity, accuracy and positive predictive value between the two methods but sensitivity and negative predictive value of rapid one-step test kit was better than ELISA. The research team recommends that rapid one-step test kit for prostate specific antigen should be routine service in vaginal specimens of raped women.

Invasive fungal infection in Ramathibodi Hospital: a ten-year autopsy review.

OBJECTIVE: Determine the clinicopathological findings in autopsy cases with invasive fungal infection. MATERIAL AND METHOD: The autopsy and medical records with invasive fungal infection in Ramathibodi Hospital between January 1997 and December 2006 were analyzed. The criterions for the diagnosis of invasive fungal infection were the evidence of fungal elements from histopathological section. The age, gender underlying predisposing risk factors for the disease, clinical manifestations, extent of systemic organ involvement documented morphologically at autopsy, and fungal culture were analyzed RESULTS: There were 155 autopsy cases (73 male, 82 female; mean age 45.3 years, range 3 months to 87 years) with the diagnosis of invasive fungal infection. The common clinical presentations were fever (55.5%), and dyspnea (26.5%). The invasive fungal infection was associated with hematologic malignancy in 31%. The common mycoses were aspergillosis and candidiasis, which were observed in 88 and 80 cases, respectively. There were 32 cases (20.6%) of mixed fungal infection. Cultures from autopsy materials were positive for fungus in 80 cases out of 99 cases (80.8%). The most frequent site of fungal infection was in the lungs (74.8%), followed by gastrointestinal tract (28.4%), and brain (26.5%). Invasive fungal infection was diagnosed intravitally in 63.9% of total cases. CONCLUSION: A diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompromised patients who presented with prolonged fever Clinical specimens must be sent for histopathology and fungal culture for a definite diagnosis and an appropriate management. Therefore, the physician should inform the laboratory if invasive fungal infection is suspected because special media are necessary for the best recovery of fungi. In addition, the present study underscores the significance of autopsy as a diagnostic method and means of medical quality control.

Normal internal organ weight of Thai adults correlated to body length and body weight.

OBJECTIVE: Examine the relationship between the internal organ weight with body weight and body length. MATERIAL AND METHOD: Analysis of data from 250 autopsies from the Ramathibodi Hospital from August 2003 to February 2005. The cases were from sudden unnatural death including accident, homicide and suicide and excluded decomposed bodies, fire related deaths and cases where medical treatment had been given. The age ranged from 15 to 88 years and there were 51 females and 199 males. Parson's correlation coefficient was used to examine the relationship between the internal organ weight with body weight and body length. RESULTS: The mean+/-standard deviation (SD) were represented by males and females respectively; Brain 1339+/-160/1165+/-184 gm, heart 311+/-66/278+/-160 gm, lung 910+/-347/675+/-255 gm, liver 1439+/-365/ 1214+/-275 gm, spleen 103+/-46/92.9+/-48 gm, kidney 260+/-68/230+/-42 gm. CONCLUSION: The relationship between internal organ weight and body weight showed each internal organ significantly correlated with body weight in males at p-value < 0.05, whereas in females it only correlated to liver, kidney and spleen at p-value < 0.05. For the correlation between internal organ weight and body length, it showed only brain, lung, liver and kidney correlated to the body length in males at p-value < 0. 05, but not in females.

Targeting of hematin by the antimalarial pyronaridine.

Pyronaridine, 2-methoxy-7-chloro-10[3',5'-bis(pyrrolidinyl-1-methyl-)4'hydroxyphenyl]aminobenzyl-(b)-1,5-naphthyridine, a new Mannich base schizontocide originally developed in China and structurally related to the aminoacridine drug quinacrine, is currently undergoing clinical testing. We now show that pyronaridine targets hematin, as demonstrated by its ability to inhibit in vitro beta-hematin formation (at a concentration equal to that of chloroquine), to form a complex with hematin with a stoichiometry of 1:2, to enhance hematin-induced red blood cell lysis (but at 1/100 of the chloroquine concentration), and to inhibit glutathione-dependent degradation of hematin. Our observations that pyronaridine exerted this mechanism of action in situ, based on growth studies of Plasmodium falciparum K1 in culture showing antagonism of pyronaridine in combination with antimalarials (chloroquine, mefloquine, and quinine) that inhibit beta-hematin formation, were equivocal.

Relationship between bone and ash weight to age, body weight and body length of thai adults after cremation.

BACKGROUND: Cremation is the most common Thai funeral mode. In Thailand, there have not been any previous reports of bone and ash weight after cremation. OBJECTIVE: Collect the bone and ash weight after the cremation and find the variables that affected the bone and ash weight. MATERIAL AND METHOD: One hundred and ten samples, including fifty-five males and fifty-five females, were collected from the Thai population. A Thai crematorium (Series Tiger 1) that could produce a temperature of approximately 850 degrees C - 1200 degrees C was employed. It took about 1-1.5 hours to complete the incineration. RESULTS: The average bone and ash weight of the males was 2.68 kg with SD 1.41; female was 2.12 with SD 1.25; and total was 2.40 with SD 1.36. The present study supported that age and body weight affected the bone and ash weight while the body length (height) did not. The fitted equation was y = 1.969 - 0.01846 (age) + 0.03087 (body weight), where y = predicted bone and ash weight. CONCLUSION: The present study shows that age and body weight affected the bone and ash weight. From this information, the authors could find the predicted value of either age or body weight. If the authors would like to find the age, the authors can employ the fittest equation y = 76.097 - 3.219 (Bone and ash weight) where y = predicted age. Additionally, if the authors would like tofind the body weight, we can employ thefittest equation = 51.930 + 1.673 (Bone and ash weight) where y = predicted body weight.

A report case of sudden cardiac death in a young adult male from northeastern part of Thailand with mitral valve prolapse.

A case of sudden unexpected natural death in a young adult male from the north-eastern part of Thailand with clinical non Lai-Tai disease, but pathologic feature of mitral valve prolapse is discussed. The approach to the postmortem examination of the mitral valve is reviewed. Because of the sudden nature of this death, this entity is more commonly seen in Medico-legal Medicine populations than in hospital autopsies.