Child and adolescent violent deaths: an epidemiologic investigation.

OBJECTIVES: An apparent increase in violent deaths among children and adolescents in Detroit, MI in 2002 prompted a coordinated epidemiologic investigation involving federal, state and local organizations. METHODS: A descriptive analysis of cases and violent deaths (homicide, suicide or firearm-related) among juveniles <17 years was conducted, along with a case-control study using records from the medical examiner, police, schools and social service agencies. RESULTS: Twenty-nine cases were identified. Median age was 10 years (range 1 day-16 years), and 15 (52%) were male. There were 25 homicides, two suicides and two unintentional firearm-related deaths. Nine (31%) homicides resulted from child abuse and neglect, and eight (28%) were among bystanders. The most common mechanism of fatal injury was firearm (63%). Victims' families were more likely to have a history of familial violence, prior contact with the state social services agency, > or = 2 adults and > or = 4 persons in the household (P<0.05). CONCLUSIONS: The 2002 deaths did not represent a statistically significant increase from previous years. Several findings were remarkable: the proportion of deaths among bystanders, females and children age <5.

Analysis of GHB and 4-methyl-GHB in postmortem matrices after long-term storage.

Postmortem heart blood, peripheral blood, vitreous humor, urine, and bile specimens from 26 autopsy cases were analyzed for the presence of gamma-hydroxybutyric acid (GHB) and gamma-methyl gamma-hydroxybutyric acid (4-Me-GHB) after long-term freezer storage. Cases were selected for which exogenous GHB, gamma-butyrolactone (GBL), gamma valerolactone (GVL), or 1,4-butanediol use was not suspected. One documented positive GHB case subjected to the same storage conditions was also evaluated for comparison. Specimens did not contain any preservatives or additives except heart blood, which contained sodium fluoride (2% w/v). The results of the analysis for GHB in vitreous humor (n = 26) demonstrated, with one exception, concentrations below the limit of detection for the method (5 mg/L). In the exception case, the value was determined to be 7 mg/L. Documented cases of GHB positive fatalities showed vitreous humor concentrations (n = 6) that exceeded this range by a factor of 12 or more. There was no apparent relationship between storage times and GHB concentrations. The data developed in this study demonstrate a postmortem endogenous range for GHB in vitreous humor that is less than or equal to 7 mg/L. Studies of the stored GHB-positive case demonstrated no significant change in concentration over the time period studied. None of the specimens analyzed in this study contained detectable amounts of 4-Me-GHB. This would support the contention that when 4-Me-GHB is detected, it is most likely due to the exogenous consumption of GVL.

Role of forensic doctors in Thailand's tsunami: experiences from Chulalongkorn Medical School.

Personal identification was the major task of forensic doctors in Thailand's Tsunami. Identification can be done by visual identification, circumstantial evidence and physical evidence. Among the physical evidences dental data is the most effective method of identification, followed by fingerprint and DNA. A disaster Identification team should be set up to handle the problems and plan for the future.

Sudden cardiac death after manual or automated snow removal.

To examine the proximate circumstances of sudden cardiac death (SCD) in the setting of major snowstorms, we reviewed records from the medical examiners' offices of 3 counties in the weeks before, during, and after 2 heavy snowfalls that occurred in the greater metropolitan Detroit area. Of those who experienced SCD due to atherosclerotic cardiovascular disease (n = 271), 36 (33 men, 3 women) were engaged in snow removal, representing the largest number of exertion-related deaths after heavy snowfalls reported to date.