The wristwatch - A supplemental tool for determining time of death.

Estimation of the time of death (TOD) is a central task to forensic pathologists. The current gold standard method for TOD-estimation is only applicable in the first 24 h post-mortem and it is advisable to employ multiple methods, if possible. A wristwatch found on the decedent can be a valuable additional tool for TOD-estimation. This technical report provides a brief overview of the two major watch types - mechanical and quartz-based timepieces - and a step-by-step guide to using these for TOD-estimation. The methods are demonstrated using case illustrations.

Trends in infant mortality: an evaluation of forensic autopsied infants in Eastern Denmark over 39 years.

BACKGROUND: SIDS is a diagnosis of exclusion applied to the death of an infant < 1 year of age after an extensive post-mortem investigation. From 1980 to 2018, a total of 870 infants have been autopsied at the Section of Forensic Pathology, Department of Forensic Medicine, UCPH, covering East Denmark. In the same period, Danish national guidelines for infant care have been revised to avoid infants dying of SIDS. OBJECTIVE: This study aimed to describe trends in infant autopsies regarding cause and manner of death, gender, age, month of death, sleeping position, and bed-sharing. The trends were compared to the change in national SIDS guidelines during the period of this study. DESIGN: Information from autopsy reports from 1980 to 2018 were collected into 55 categories designed specifically for this study. Data from 7 of these categories were chosen and processed in Excel for basic epidemiological comparison. RESULTS: The trends show that most infants in the study die of natural manner and most predominant causes of death are SIDS, infection, and congenital malformations. A change in national guidelines in 1991 recommending supine- or side sleeping position coincided with a reduction in the overall infant mortality and cases of SIDS. The peak age in the cohort is 90 days, but stratification in decades shows the infants dying younger each decade. Through the study period, the number of infants found dead sleeping in the prone position has declined. Relatively more infants in this cohort have been found dead while bed-sharing, even though the prevalence of these cases has remained largely the same for four decades.

Increased risk of sudden death in untreated primary carnitine deficiency.

Primary carnitine deficiency (PCD) affects fatty acid oxidation and is associated with cardiomyopathy and cardiac arrhythmia, but the risk of sudden death in PCD is unknown. The Faroe Islands have a high prevalence of PCD, 1:300. This study systematically investigated a possible association between untreated PCD and sudden death in young Faroese subjects. We investigated all medico-legal cases of sudden death between 1979 and 2012 among subjects below the age of 45. Stored biomaterial was examined with molecular genetic analysis to reveal PCD. We compared the prevalence of PCD among sudden death cases with that of the background population (0.23%) to calculate the odds ratio (OR) for sudden death with PCD. Biomaterial was available and genetically analyzed from 53 of 65 sudden death cases (82%) in the Faroe Islands. Six (one male and five females) of the 53 cases were homozygous for the PCD related c.95A>G mutation-a prevalence of 11.3% (95% CI 5%-23%) and an OR of 54.3 (95% CI 21-138, P < .0001) for the association between sudden death and untreated PCD. Only 11 of the 53 sudden death cases were women-of whom five were homozygous for the c.95A>G mutation (45.5%) yielding an OR of 348.8 (95% CI 94-1287, P < .0001) for the association between sudden death and untreated PCD in females. This study showed a strong association between sudden death and untreated PCD, especially in females.

The Expression of Markers for Intratubular Germ Cell Neoplasia in Normal Infantile Testes.

BACKGROUND: Positive immunohistochemical expression of testicular cancer markers is often reported beyond 12 months of age in cryptorchid testes, which is assumed to indicate delayed maturation of the fetal germ cells, or neoplastic changes. These findings allowed for questions as to the extent of positive reaction in normal testes. The aim of the study was to clarify the expression of these markers in a normal material up to 2 years. METHODS: Testicular material from 69 boys aged 1-690 days, who died of causes with no association of testicular pathology. Histology sections were incubated with primary antibodies including anti-placental-like alkaline phosphatase (PLAP), anti-C-Kit, anti-D2-40, and anti-Oct3/4. The mean germ cell number per tubular transverse section (G/T) was calculated based on the G/T of both testes of every boy. RESULTS: The mean G/T declined through the 690 days. PLAP appeared stably expressed throughout the ages studied. The likelihood of a positive reaction for C-Kit waned with increasing age within the study period. Positive staining for D2-40 and Oct3/4 was demonstrated up to 6 and 9 months respectively. CONCLUSION: Up to 1 or 2 years of age, normal infantile testes contain germ cells positive for the immunohistochemical markers commonly utilized to aid in the detection of testicular cancer. This finding supports the concept of germ cells undergoing a continuous maturational process in a heterogeneous fashion, and that this process is not complete by 2 years of age.

[Rape of men happens too].

The Department of Forensic Medicine, Copenhagen, perform clinical forensic examinations of sexually assaulted victims at the request of the police. Three cases with male victims are presented and the forensic focus in these cases is discussed. It is important to report lesions and to secure saliva and semen for DNA analysis correctly to form an important part of the subsequent police investigation and ultimately the legal proceeding. We believe that rape of men is underreported, and that more information can help men initially with reporting to the police and help focusing on the right prophylaxis for this group.

[Thorough family history and a multidisciplinary approach are important in sudden cardiac deaths]. / Grundig familieanamnese og et multidisciplinært samarbejde er vigtigt ved udredning af årsager til pludselig hjertedød.

Sudden cardiac death (SCD) is rare, yet well-known in children and adolescents. We present two cases of aborted SCD which reminds us of the importance of comprehensive family history as it proved difficult to ask the right questions revealing the number of family members with cardiac symptoms. Earlier recognition of sudden deaths in the family might have led to more extensive multidisciplinary examinations, and earlier diagnosis.

Discrepancy between information reported by the victims of sexual assaults and clinical forensic findings.

INTRODUCTION: From the clinical forensic examination reports made at the Department of Forensic Medicine, the University of Copenhagen, in 2007 concerning rape, attempted rape and sexual assault (RAS), information about the assault, including both violence and the perpetrator's line of sexual action was extracted, analysed and compared to the observed lesions (LE). MATERIAL AND METHODS: A total of 184 girls and women were included in this retrospective study. RESULTS: 75.5% of the victims were under 30 years of age. Observed LE: 79% had observed LE. 41% had body LE only, 19% genito-anal LE only, and 40% had both body and genito-anal LE. Half of the victims, who reported no exposure to violence, had body LE. Five victims also had LE of a self-inflicted character. Genito-anal LE: 47% had genito-anal LE, 64% of whom had one or two, commonest a tear. Body LE: 64% had body LE. 57% was caused by slight, blunt force. Information on line of sexual action was present in 148 cases. A total of 123 victims reported penetration: 94% vaginal, 16% anal and 20% oral. Three were exposed to anal penetration only. Eleven perpetrators used a condom. 50% of the cases with vaginal and/or anal penetration had genito-anal LE. Victims with both vaginal and anal penetration and victims who reported more than one perpetrator did not show more genito-anal LE. Anal penetration or attempted anal penetration has increased to 21% of cases. CONCLUSION: Young victims are exposed to RAS. Half of them have genito-anal LE, typically one. Anal penetration or attempted anal penetration is increasing. This will often cause genito-anal LE. This finding stresses the importance that these examinations take place where both forensic and health-care expertise are offered. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Sexually assaulted victims are getting younger.

INTRODUCTION: From the clinical forensic examination reports produced by the Department of Forensic Medicine, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark, in 2007 concerning rape, attempted rape and sexual assault (RAS), circumstances were extracted and analysed focussing on age, relationship, lesions, violence, location and alcohol intoxication. MATERIAL AND METHODS: A total of 184 girls and women over the age of 12 years were included in this retrospective study. RESULTS: The median age of the victims was 20 years (range 12-89 years). 75.5% were under 30 years of age. 53% knew the perpetrator. More than one perpetrator was reported in 11%. 46% of the assaulted victims had a total number of 1-5 observed lesions and these were observed in all types of perpetrator relationship. Eight victims with more than 20 lesions were assaulted by a stranger or an acquaintance (first contact) (ACQ). 50% of the victims who had lesions were assaulted by a stranger or an ACQ. 55% of assaults occurred in private homes. A total of 107 had their blood alcohol concentration (BAC) measured. In all, 133 victims were assessed by the examining doctor to be unaffected by alcohol, eight of these had a BAC exceeding 1.0 per thousand. There was no correlation between the BAC and number of lesions. Two victims had a positive pregnancy test and were pregnant before the RAS. CONCLUSION: In Denmark, RAS victims' age continues to decrease. RAS by a stranger or an ACQ involves a higher risk of lesions and the possibility of many lesions. More than half of those exposed to manual strangulation or other kinds of violence against the neck were assaulted by a stranger or an ACQ. Half of the women knew the perpetrator and the perpetrator was an ACQ in 26% of the cases. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Forensic odontological examinations of alleged torture victims at the University of Copenhagen 1997-2011.

BACKGROUND: Clinical forensic examinations of alleged torture victims have been performed by forensic pathologists at the University of Copenhagen since 1995. In 13.2%/33 of these cases the examinations were supplemented by a forensic odontological clinical examination. In this study the forensic odontological cases from the years 1997-2011 are presented and discussed. METHODS: This study includes 33 reports from alleged torture victims (4 females, 29 males) who have been examined by a forensic odontologist at the Copenhagen School of Dentistry in the years 1997-2011.The material available consisted of copies of medical forensic reports and the forensic odontological reports including x-rays. BACKGROUND data, anamnestic data and results of the forensic odontological clinical examinations were registered as well as the conclusion of the clinical examinations. FINDINGS: The forensic odontological clinical examinations were complicated by the presence of unspecific injuries and various degrees of active oral pathology. In 27 of the cases it was concluded that the findings were consistent with the alleged torture, in six of the cases the findings were concluded to be highly consistent with the alleged torture.

[Sudden unexpected cardiac death in an 18-year-old female with familial hypercholesterolaemia]. / Pludselig uventet hjertedød hos en 18-årig kvinde med familiær hyperkolesterolæmi.

Familial hypercholesterolaemia (FH) is a well-defined but underdiagnosed dyslipidaemia occurring in 1:500 persons. We report a case where an 18-year-old woman with an untreated FH dies a sudden cardiac death due to acute myocardial infarction. In patients with FH atherosclerotic manifestations are common at a young age and FH should always be suspected in patients with P-low-density lipoprotein cholesterol level above 5 mmol/l (4 mmol/l for persons < 16 years of age). Patients with FH should be referred to specialized units so that family members with FH systematically are identified.

Abandonment of newborn infants: a Danish forensic medical survey 1997-2008.

Concealment of pregnancy and newborn infant abandonment are closely associated with neonaticide, the killing of an infant within the first 24 h of life or less than 28-30 days depending on the jurisdiction. Abandonment of newborn infants occurs throughout the world and often the outcome for the infant is death. Together with neonaticide it is felt to be one of the least preventable crimes. In this retrospective study we present all forensically known Danish cases of abandoned newborn infant corpses, covering the period from 1997 to 2008. Eleven newborn infant corpses were found; we registered characteristics of the newborn infants and the circumstances of the cases based on autopsy reports. One further newborn infant was included, dating back to 1992, as it was found to be connected with one of the later cases. The mean age of the women who abandoned their newborn infants was 22 years, and five of the autopsied newborn infants were probably alive when abandoned. In two cases the newborn infants were half siblings and abandoned by the same mother. The time span from abandonment to when the newborn infant was found ranged from hours to 7 years. Two-thirds of the newborn infants were girls (66.6%). The most common means of disposal was in a plastic bag (~60%); only one newborn infant was wearing clothes when found. Causes of death were usually given as asphyxia, brain injury or simply undetermined. Two-thirds of the newborn infants showed signs of violence. None of the newborn infants had congenital malformations.

Sudden unexpected death in infancy in Denmark.

BACKGROUND: Incidence of sudden unexpected death in infancy (SUDI) and sudden infant death syndrome (SIDS) differs among studies and non-autopsied cases are difficult to assess. OBJECTIVES: To investigate causes of sudden death in infancy in a nationwide setting. Validate the use of the ICD-10 code for SIDS (R95) in the Danish Cause of Death registry. DESIGN: A retrospective analysis of all infant deaths (< 1 year of age) in Denmark in 2000-2006. All death certificates and autopsy reports were read. RESULTS: We identified 192 SUDI cases (10% of total deaths, 0.42 per 1000 births) with autopsy performed in 87% of cases. In total, 49% of autopsied SUDI cases were defined as SIDS (5% of all deaths, 0.22 per 1000 births); Cardiac cause of death was denoted in 24% of cases. The Danish Cause of Death Registry misclassified 30% of SIDS cases. CONCLUSIONS: A large proportion of infant deaths are SUDI, and the majority of these are caused by cardiac disease or SIDS. Autopsy is not always performed and valuable information is subsequently lost. Cause of Death registry data is not accurate in describing SIDS.

An oxcarbazepine-related fatality with an overview of 26 oxcarbazepine postmortem cases.

We present an oxcarbazepine-related fatality together with an overview of 26 postmortem cases involving oxcarbazepine observed during the period 2001-2006. The fatality case concerned a 27-year-old woman with epilepsy, who was found dead in her bed. Oxcarbazepine and its active metabolite, 10-hydroxycarbazepine, were the only compounds detected. The concentrations of oxcarbazepine were as follows: femoral blood, 2.9mg/kg; muscle, 1.8mg/kg; liver, 0.9mg/kg; gastric content (300ml), 860mg/kg; and vitreous humour, not detected. The concentrations of 10-hydroxycarbazepine were as follows: femoral blood, 66mg/kg; muscle, 40mg/kg; liver, 62mg/kg; gastric content, 27mg/kg; and vitreous humour, 25mg/kg. The analyses were performed by HPLC-DAD after liquid-liquid extraction. Oxcarbazepine intoxication was regarded as a possible cause of death. For the other 26 cases, the 10-hydroxycarbazepine concentrations ranged from 2.2 to 48mg/kg with a median of 25mg/kg.

Application of thiopropyl sepharose 6B for removal of PCR inhibitors from DNA extracts of a thigh bone recovered from the sea.

PCR amplification of DNA from forensic samples often proves difficult due to the presence of inhibitors of the polymerase chain reaction. One possible way to remove PCR inhibitors from a DNA extract is the use of the affinity resin thiopropyl sepharose 6B (TS), which has been used previously for the removal of PCR inhibitors in DNA extracts originating from stains on clothing. Here we show that TS is efficient also for the removal of inhibitors from PCR extracts from a highly decomposed human thigh bone. TS treatment, however, leads to a substantial loss of DNA making the technique best suited when substantial amounts of DNA are present.