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Carbohydrate-deficient transferrin and alcohol use in medical examiner cases
Literature citation
DEATH
Deaths among homeless people in Istanbul G. Altun, A. Yilmaz, D. A z m a k , Forensic Science International 99 (2): 143-147, 1999 Jan 11 The number of the homeless people in Istanbul, one of the largest cities in the world, is at present unknown. There has been no previous study in Turkey on cases and causes of death occurring among these individuals. In this paper, documents and autopsy reports of the Mortuary Section of the Council of Forensic Medicine, Istanbul, covering the period January 1st, 1991 - December 31st, 1995, were reviewed. We established that there were 126 cases of death among homeless individuals in Istanbul during this period, 120 of them being males (95%), four (3%) females, and two (2%) transsexuals. Ninety-four corpses were found outdoors, 32 indoors. No personal documents, such as identity cards, were found in 110 individuals (87%), whereas only 16 individuals could be identified. Most deaths occurred in the age group of 41-50 years. One hundred and three of the cases (82%) died in the cold season between October and April. The deaths of 98 cases were attributable to natural causes, whereas the remaining 28 cases died from unnatural causes. Respiratory tract diseases occupied the first rank among cases of death from natural causes (44%). Alcohol abuse and other infections were further striking factors contributing to the fatal outcome. This is the first retrospective study on this topic in Turkey. However, more detailed and anterospectively programmed studies on this subject, a growing social problem, should be carried out.
ALCOHOL
Carbohydrate-deficient transferrin and alcohol use in medical examiner cases R. Malcolm, R. E. A n t o n , S. E. C o n r a d , S. Sutherland Alcohol 17 (1): 7-1 i, 1999 Jan Carbohydrate-deficient transferrin (CDT) has been studied as an index of heavy alcohol use. The present study evaluates the utility of CDT as a marker for chronic alcohol use in medical examiner cases. Over a 5-month period, serum specimens were collected in consecutive deaths that were referred to the medical examiner's office (n = 25). Manner of death was accidental in nine cases, homicide/suicide for eight cases, and natural causes for seven cases. Fifteen of the 17 cases having alcohol abuse had positive CDT levels above threshold, indicating chronic use (sensitivity 88%). Eight cases had no evidence of alcohol abuse but three of these cases had CDT levels also above threshold (specificity 63%). There was no correlation between serum CDT levels and the time of death to blood collection for the total sample, indicating that CDT is stable postmortem for at least 36 h. CDT appears to have value as a marker of ante-mortem alcohol use prior to time of death in medical examiner cases.
169
confirmed to have medium chain acyl-CoA dehydrogenase (MCAD) deficiency by outside laboratories, indicating that elevated dodecanoic acid is highly specific and sensitive for predicting MCAD deficiency in SIDS victims. Dodecanoic acid was easily detected in routine toxicology for acid and neutral drugs done at autopsy. MCAD deficiency is an autosomal recessive genetic disease, carrying a 25% recurrence risk. Families should be notified that siblings, both presently living and yet to be born, should be screened for this deficiency because MCAD deficiency can be treated, and sudden, unexplained infant deaths of living and subsequent offspring can be prevented.
TIME OF DEATH
Can routinely combined analysis of glucose and lactate in vitreous humour be useful in current forensic practice? E. A. D e Letter, M. H. Piette American Journal of Forensic Medicine & Pathology 19 (4): 335-342, 1998 Dec To confirm and extend previous research concerning glucose and lactate in vitreous humour, we investigated a randomly selected study population of 271 forensic cases. On the whole, we find our results agree with those of previous studies, but we add certain observations. First, when we considered the sum value of glucose and lactate in the vitreous humour, we found that not only diabetes patients are included in the higher range group (values > or = 430 mg%): intensive reanimation or prolonged or intense agony should also be taken into account. Indeed, when we split our study group into acute agony and prolonged agony subgroups, we noticed a statistically significant difference; persons dying after protracted agony showed a higher sum value, which can be explained in terms of biophysical dynamics. Second, a positive correlation was found between the lactate and the sum values on one hand, and the postmortem interval on the other. However, the vitreous glucose, lactate and sum values are so dispersed that a precise determination of the postmortem interval cannot be obtained on the basis of these parameters. Additionally, we compared several causes of death, but unfortunately, we did not manage to reveal that some causes of death were specifically limited to high or low concentrations. Indeed, the statistically significant differences in sum values could easily be explained by factors such as intensity of agony, reanimation attempts, or iatrogenic interventions (e.g. gJucose infusions). Nonetheless, when the death scene as a whole is unclear or confusing, analysis of the vitreous humour can provide some insights, provided that the other autopsy findings are also taken into consideration.
FORENSIC SCIENCE
Forensic evidence based on mtDNA from dog and wolf hairs P. Savolainen, J. Lundeberg
PAEDIATRICS
Whole blood levels of dodecanoic acid, a routinely detectable forensic marker for a genetic disease often misdiagnosed as sudden infant death syndrome (STDS): MCAD deficiency. P. M. Kemp, B. B. Little, R. O. Bost, D. B. D a w s o n American Journal of Forensic Medicine & Pathology 17 (1): 79-82, 1996 Mar We investigated whether or not elevated whole blood dodecanoic acid concentration was due to a beta-oxidation defect in fatty acid metabolism previously reported. We prospectively analyzed blood from 55 consecutive sudden infant death syndrome (SIDS) cases for fatty acid concentrations by gas chromatograph. Three of 55 cases had elevated dodecanoic acid concentrations (> or = 18.4 mg/L). The three SIDS cases with elevated blood dodecanoic acid were
Journal of Forensic Sciences 44 (1): 77-8t, 1999 Jan In six forensic cases involving murder, bank robbery, theft and poaching, evidence material comprising shed hairs supposedly originating from dogs or wolves was analyzed by mitochondrial (mt) DNA sequencing. A 79 bp segment of the control region was amplified, sequenced, and compared with an established database of the domestic dog and wolf populations. In three murder cases exclusions of all eight suspects could be made. Furthermore, two of the murders could be linked to each other by a rare sequence variant, and the breed of the dog was indicated. In a theft case and a bank robbery a link could be established between the evidence material and the suspects. In a case of suspected wolf poaching, it could be established that the evidential material was of dog rather than wolf origin. We conclude that single hairs from common pets are suitable for DNA analysis and that the described method has proved to be a valuable tool for forensic investigations.
DEATH
Deaths among homeless people in Istanbul G. Altun, A. Yilmaz, D. A z m a k , Forensic Science International 99 (2): 143-147, 1999 Jan 11 The number of the homeless people in Istanbul, one of the largest cities in the world, is at present unknown. There has been no previous study in Turkey on cases and causes of death occurring among these individuals. In this paper, documents and autopsy reports of the Mortuary Section of the Council of Forensic Medicine, Istanbul, covering the period January 1st, 1991 - December 31st, 1995, were reviewed. We established that there were 126 cases of death among homeless individuals in Istanbul during this period, 120 of them being males (95%), four (3%) females, and two (2%) transsexuals. Ninety-four corpses were found outdoors, 32 indoors. No personal documents, such as identity cards, were found in 110 individuals (87%), whereas only 16 individuals could be identified. Most deaths occurred in the age group of 41-50 years. One hundred and three of the cases (82%) died in the cold season between October and April. The deaths of 98 cases were attributable to natural causes, whereas the remaining 28 cases died from unnatural causes. Respiratory tract diseases occupied the first rank among cases of death from natural causes (44%). Alcohol abuse and other infections were further striking factors contributing to the fatal outcome. This is the first retrospective study on this topic in Turkey. However, more detailed and anterospectively programmed studies on this subject, a growing social problem, should be carried out.
ALCOHOL
Carbohydrate-deficient transferrin and alcohol use in medical examiner cases R. Malcolm, R. E. A n t o n , S. E. C o n r a d , S. Sutherland Alcohol 17 (1): 7-1 i, 1999 Jan Carbohydrate-deficient transferrin (CDT) has been studied as an index of heavy alcohol use. The present study evaluates the utility of CDT as a marker for chronic alcohol use in medical examiner cases. Over a 5-month period, serum specimens were collected in consecutive deaths that were referred to the medical examiner's office (n = 25). Manner of death was accidental in nine cases, homicide/suicide for eight cases, and natural causes for seven cases. Fifteen of the 17 cases having alcohol abuse had positive CDT levels above threshold, indicating chronic use (sensitivity 88%). Eight cases had no evidence of alcohol abuse but three of these cases had CDT levels also above threshold (specificity 63%). There was no correlation between serum CDT levels and the time of death to blood collection for the total sample, indicating that CDT is stable postmortem for at least 36 h. CDT appears to have value as a marker of ante-mortem alcohol use prior to time of death in medical examiner cases.
169
confirmed to have medium chain acyl-CoA dehydrogenase (MCAD) deficiency by outside laboratories, indicating that elevated dodecanoic acid is highly specific and sensitive for predicting MCAD deficiency in SIDS victims. Dodecanoic acid was easily detected in routine toxicology for acid and neutral drugs done at autopsy. MCAD deficiency is an autosomal recessive genetic disease, carrying a 25% recurrence risk. Families should be notified that siblings, both presently living and yet to be born, should be screened for this deficiency because MCAD deficiency can be treated, and sudden, unexplained infant deaths of living and subsequent offspring can be prevented.
TIME OF DEATH
Can routinely combined analysis of glucose and lactate in vitreous humour be useful in current forensic practice? E. A. D e Letter, M. H. Piette American Journal of Forensic Medicine & Pathology 19 (4): 335-342, 1998 Dec To confirm and extend previous research concerning glucose and lactate in vitreous humour, we investigated a randomly selected study population of 271 forensic cases. On the whole, we find our results agree with those of previous studies, but we add certain observations. First, when we considered the sum value of glucose and lactate in the vitreous humour, we found that not only diabetes patients are included in the higher range group (values > or = 430 mg%): intensive reanimation or prolonged or intense agony should also be taken into account. Indeed, when we split our study group into acute agony and prolonged agony subgroups, we noticed a statistically significant difference; persons dying after protracted agony showed a higher sum value, which can be explained in terms of biophysical dynamics. Second, a positive correlation was found between the lactate and the sum values on one hand, and the postmortem interval on the other. However, the vitreous glucose, lactate and sum values are so dispersed that a precise determination of the postmortem interval cannot be obtained on the basis of these parameters. Additionally, we compared several causes of death, but unfortunately, we did not manage to reveal that some causes of death were specifically limited to high or low concentrations. Indeed, the statistically significant differences in sum values could easily be explained by factors such as intensity of agony, reanimation attempts, or iatrogenic interventions (e.g. gJucose infusions). Nonetheless, when the death scene as a whole is unclear or confusing, analysis of the vitreous humour can provide some insights, provided that the other autopsy findings are also taken into consideration.
FORENSIC SCIENCE
Forensic evidence based on mtDNA from dog and wolf hairs P. Savolainen, J. Lundeberg
PAEDIATRICS
Whole blood levels of dodecanoic acid, a routinely detectable forensic marker for a genetic disease often misdiagnosed as sudden infant death syndrome (STDS): MCAD deficiency. P. M. Kemp, B. B. Little, R. O. Bost, D. B. D a w s o n American Journal of Forensic Medicine & Pathology 17 (1): 79-82, 1996 Mar We investigated whether or not elevated whole blood dodecanoic acid concentration was due to a beta-oxidation defect in fatty acid metabolism previously reported. We prospectively analyzed blood from 55 consecutive sudden infant death syndrome (SIDS) cases for fatty acid concentrations by gas chromatograph. Three of 55 cases had elevated dodecanoic acid concentrations (> or = 18.4 mg/L). The three SIDS cases with elevated blood dodecanoic acid were
Journal of Forensic Sciences 44 (1): 77-8t, 1999 Jan In six forensic cases involving murder, bank robbery, theft and poaching, evidence material comprising shed hairs supposedly originating from dogs or wolves was analyzed by mitochondrial (mt) DNA sequencing. A 79 bp segment of the control region was amplified, sequenced, and compared with an established database of the domestic dog and wolf populations. In three murder cases exclusions of all eight suspects could be made. Furthermore, two of the murders could be linked to each other by a rare sequence variant, and the breed of the dog was indicated. In a theft case and a bank robbery a link could be established between the evidence material and the suspects. In a case of suspected wolf poaching, it could be established that the evidential material was of dog rather than wolf origin. We conclude that single hairs from common pets are suitable for DNA analysis and that the described method has proved to be a valuable tool for forensic investigations.