1,721,011 research outputs found
The outbreak of fentanyl-related deaths in Cook County, Illinois, between October 2015 and December 2017. A retrospective study and a comparison with previous data
No full textThe National Institute on Drug Abuse has observed an increase in fentanyl deaths in the United States. One epidemic related to the abuse of fentanyl happened in Cook County in 2005-2007 (350 deaths). Another outbreak of fentanyl deaths occurred in 2015-2017 in the same area. The database of the Cook County Medical Examiner's Office was searched for cases of fentanyl deaths between 2015 and 2017: 1244 deaths were found. A comparison was performed with the previous data: an increase in the number of females was observed in 2015-2017. Also, in 2005-2007, the majority of deaths occurred among African American, while in 2015-2017, Caucasians were more involved. Within our population, some drug combinations were more common in specific demographic subgroups (male/females; Caucasian/African American; and certain age groups). The epidemiology and the most significant drug associations found at the toxicology are discussed, highlighting the usefulness of the knowledge about this outbreak for public health
Deaths Due to Child Abuse: A 5-Year Review of Cases in the Cook County Medical Examiner’s Office.
No full textAfter attending this presentation, attendees will have a better understanding of the incidence and the significance of the injuries observed in fatal child abuse cases. This presentation will impact the forensic science community by providing a review of the pattern of injuries in deaths due to child abuse. Deliberately inflicted pediatric injuries are a significant issue in forensic pathology, with special regard to head injuries. Often questions arise regarding the plausibility of possible mechanisms of injury. This study reviewed case files from the Cook County Medical Examiner’s Office from 2007 to 2012 to study the characteristics of homicides due to child abuse in children less than three years of age. The manner of death was determined to be homicide based on the autopsy findings and the investigation. The cases were divided into the following age ranges: 0-11 months (group A); 12-23 months (group B); and, 24-35 months (group C). Data regarding age; race; sex; facial injuries; scalp injuries; presence and types of skull fractures; suture diastasis; extradural, intradural, subdural, and subarachnoid hemorrhages; cerebral edema; intracranial pressure; intracerebral findings; retinal and optic nerve hemorrhages; spinal cord findings; and extracranial injuries were collected using an electronic spreadsheet. Clinical details and information concerning the traumatic mechanism, where available, were also considered. Fifty-one cases (25 females and 26 males) were identified. Most of the cases fell into the group A (26 cases; 51%), followed by group B (17 cases; 33%), and by group C (8 cases; 16%). Females were more numerous than males in group A (15 cases; 57%); in group B, males were more numerous (11 cases; 65%); in group C, children of both sexes were present in equal number. External signs of impact to the head, that is to the face and/or scalp, were present in 42 cases (82%). Most of the examples of impact to the head consisted of bruises and abrasions of the skin and/or lacerations of the oral mucosa. Skull fractures were reported in 9 cases (18%), and showed a predominately linear appearance. Diastasis of the sutures was reported in 14 cases (27%). As might be expected, most of these examples were found in the youngest age range. Epidural hemorrhage was found in 10 cases (20%). Subdural hemorrhage was seen in 42 cases (82%). Subdural hemorrhage represented the most common intracranial pathology encountered, apart from cerebral edema, which was found in each case. Subdural hemorrhage was described as remote or recent, and/or with a thin film or layer of blood or a larger collection of blood. Subarachnoid hemorrhages were present in 27 cases (53%). In 24 cases (47%), there were intracerebral findings, such as hemorrhages, contusions, herniations, and areas of infarction. In eight cases (16%), brain evaluation was affected by marked non-perfusion changes (so-called “respirator brain”). Retinal hemorrhages were a very common finding in head trauma (38 cases, 75%). Most were bilateral and sometimes involved multiple layers of the retina (preretinal, intraretinal, subretinal). Optic nerve hemorrhages were present in 37 cases (73%). Intravitreal hemorrhages and macular folds were rare. In 19 cases (37%) there were spinal cord injuries, such as hemorrhages, but no spinal fractures were observed. This study reveals that in the cases surveyed, the majority of children who sustained abusive injuries fell into the 0-11 months of age range. Head injuries were the leading cause of death. Signs of impact to the head defined by the presence of skull fractures and/or bruises/abrasions to the head, often together with intracranial injuries, were present in 73% of the cases (19 out of 26) in group A, 94% (16 out of 17) of the cases in group B, and 88% (7 out of 8) of the cases in group C. As expected, epidural hemorrhages were rare and spinal fractures were not observed at all. Death due to extracranial injuries was an uncommon finding and it occurred when internal organs were damaged. Among these, blunt force abdominal injuries were the most commonly encountered (10 cases; 19%). These findings agree with other researchers who have found that head injuries are the leading cause of death in children less than three years of age. Moreover, in the cases reviewed for this study, retinal hemorrhages seemed to be strictly associated with head injuries
Sudden Death (SD) in Adults With Congenital Heart Disease (CHD): A Retrospective Review of Cases in the Cook County Medical Examiner’s Office
No full textLearning Overview: After attending this presentation, attendees will better understand the causes of SD in adults with diagnosed and undiagnosed CHD in Cook County, IL. Impact on the Forensic Science Community: This presentation will impact the forensic science community by providing information about the anatomic defects (simple or complex, single or multiple) and the medical history in adult CHD cases in a medical examiner’s population. CHD in adults is associated with a high rate of SD, despite improved life expectancy because of better surgical and interventional therapies. Most congenital heart defects are repaired in childhood; however, there may be less severe defects that go undiagnosed, resulting in SD in adulthood. The annual incidence of SD in the entire adult CHD population is relatively low, but because the CHD population is growing and aging, the risk profile for SD may have changed. The electronic database of the Cook County Medical Examiner’s Office in Chicago, IL, was examined using the keyword “congenital,” searching for cases of CHD as a primary or contributory cause of death, in the period between July 2008 and July 2018. Cases were reviewed for age, sex, race, cause and manner of death, medical history, type of congenital heart disease, and gross and microscopic cardiac findings. Only subjects between 18 and 99 years of age were included in this study. A total of 84,820 deaths were reported in the studied period in the Cook County Medical Examiner’s Office. Of these, there were 15 cases (0.02%) of adult CHD identified, including 14 natural deaths and 1 accidental death. The age ranged between 21 and 62 years. Seven subjects were Caucasian, six African-American, one Hispanic, and one Asian. The male/female ratio was 2.7/1. A complete autopsy was performed in 14 out of 15 cases with consultation with a cardiac pathologist requested in 7 cases. Of the 14 hearts examine, 12 hearts were enlarged, 8 were dilated, and 9 showed hypertrophy. Simple cardiac defects were observed in 7 cases (50%): 2 cases with isolated Atrial Septal Defects (ASD); 2 cases with isolated Ventricular Septal Defects (VSD); 1 case with VSD combined with pulmonary stenosis, 1 case of bicuspid aortic valve, and 1 case of congenital anomaly of the left coronary ostium. Complex defects were observed in 7 cases (50%): 2 tetralogies of Fallot, 1 Ebstein’s anomaly, 1 double outlet right ventricle, 1 transposition of the great vessels alone, 1 transposition of great vessels combined with tricuspid atresia, and 1 Total Anomalous Pulmonary Venous Return (TAPVR). Diagnosis of CHD was known in 12 cases out of 15 (80%) and, among these, 11 subjects had undergone prior (single or multiple) surgical repair. In 13 out of 15 cases, CHD was the primary cause of death, while it was a contributory cause in 2 cases. Toxicological analyses were negative in 14 out of 15 cases, while in 1 case the subject was found to be positive for a non-toxic level of ethanol. Despite the limited number of cases, CHDs were very heterogeneous and SDs were more common in adult males (73%). Almost all the CHDs were previously known. The three unknown CHD cases consisted of valvular diseases or coronary defect, which could explain the absence of clinical signs and, therefore, the lack of diagnoses. It is questionable whether these minor abnormalities can cause SD, but in the absence of other potentially lethal pathology at autopsy, they may be used as a cause of death. In 11 out of the 12 cases (92%) with a known diagnosis of CHD, surgical correction was performed in childhood and 3 of them required additional surgical interventions in adulthood. Since subjects suffering from these complex CHD may require multiple surgical corrections during their lifetimes, there could be misinterpretation of the original cardiac defect at autopsy because of the distortion of the usual anatomy due to the surgeries. It is important for the forensic pathologist to be trained in recognizing CHDs and the surgical procedures used to treat them. When the diagnosis is not clear, the forensic pathologist should request a consultation with a cardiac pathologist experienced in CHD
Anatomical distribution and autopsy features of gunshot injuries to determine the manner of death. A 5-year retrospective study from the cook county medical examiner’s office
No full textGunshot wounds are associated with significant morbidity and mortality worldwide. In such cases, determining the manner of death is mandatory. The analysis of the pattern and location of the gunshot wounds can help in understanding the circumstances of death. This study will provide data to support an association between gunshot wound features and the manner of death. The files of the Cook County Medical Examiner’s Office were searched for deaths due to gunshot wounds between August 2014 and April 2019. Complications due to remote gunshot wounds were not included in the study. The investigative, autopsy and toxicological reports were reviewed in each case. The following parameters were recorded: manner of death, gender, race and age, firearms, and bullets type (if available), number and sites of entrance and exit wounds, shooting distance, internal bullet pathway, blood drugs and/or alcohol concentration, and investigative narratives. The obtained data were then subcategorized as to the manner of death (suicide, homicide, accident, or undetermined). The information detected on the autopsy report were used to create a graphic reconstruction of the anatomical distribution of the gunshot wounds on the body surface. A total of 3492 deaths due to gunshot wounds were identified, that have been subcategorized based on the manner of death, showing: 2842 homicides (81%), 627 suicides (18%), 4 accidents (<1%), and 19 undetermined (<1%). The ages of the subjects ranged from 0 to 96 years, with an average of 32. Males accounted for 92% while females for 8%, and in 1 case the gender was undetermined (unknown bones). Regarding race, there were 2437 African Americans, 1006 Caucasians, 14 Asians, 1 Native American, 2 undetermined, and 32 "Others”. The presented research is one of the most extensive case studies about gunshot wound fatalities and presents distinct differences that should be considered while investigating gunshot-wounds related deaths. A thorough discussion of the results, including graphical models showing the most common location of the injuries will be presented
Deaths Due to Child Abuse: A 6-Year Review of Cases in the Cook County Medical Examiner's Office
No full textCase files from the Cook County Medical Examiner's Office from 2007 to 2012 were reviewed to analyze homicides due to physical child abuse in children <3 years old. Fatal cases mostly involved younger subjects. Intracranial injuries were the leading cause of death, while death due to extracranial injuries was uncommon. Eyes were involved in most of the cases. Spinal cord was involved in about 1/3 of the cases, mostly in the thoracic area. In some cases, previous injuries were present. There were significant differences in the pattern of injuries between age groups. Subjects showing signs of impact to the head and subjects with no evidence of an impact showed no significant difference in internal injuries. The association of multiple injuries is highly suggestive of child abuse. In suspected child abuse, a postmortem examination including neuropathological, ophthalmological, and radiological information should be always evaluated, together with investigative reports and the medical history
Sudden Cardiac Deaths in Adults with Congenital Heart Disease with Structural Abnormalities: A Retrospective Review of Cases in the Cook County Medical Examiner's Office.
No full textSudden cardiac death is a significant cause of mortality in adults with congenital heart disease (CHD). The Cook County Medical Examiner's Office database was queried for cases of CHD as a cause of death in the period between July 2008 and April 2019. Twenty-two cases were identified, including 11 decedents with simple defects and 10 decedents with complex defects. All of the subjects were in apparent good health at the time of death. In the absence of other obvious causes of death, simple defects were considered cases of sudden cardiac death. Significant cardiac morphological changes were common in complex defects. While 16 cases had known, diagnosed/treated CHD, 5 cases had no diagnosis prior to autopsy. In these cases, the ability to recognize CHD (sometimes subtle) helped in determining the causes of death. Therefore, forensic pathologists must be able to properly recognize various forms of CHD and request consultations, when needed
A simple depressed skull fracture in an old man with paget disease: forensic implications in a rare case
No full textHeroin and Asthma Deaths in Cook County, Illinois — A Two-Year Review.
No full textAfter attending this presentation, attendees will better understand the incidence, including seasonal trends, demographics, associated drugs, and significance of asthma history of heroin deaths. This presentation will impact the forensic science community by providing data on heroin deaths in Cook County and a comparison of the demographics, autopsy, and histological findings of heroin users who had a history of asthma to those with did not. According to the National Survey on Drug Use and Health (NSDUH), in 2012 approximately 669,000 Americans reported using heroin in the past year. The National Institute on Drug Abuse showed that in 2013 more than 8,000 deaths from heroin occurred in the United States. Asthma is a chronic inflammatory disorder of the airways characterized by hyper reactivity, with reversible airflow obstruction, and respiratory symptoms of an attack that can include shortness of breath or respiratory distress even until death. Asthma is a commonly encountered disease in the United States, with an estimated 25.5 million people afflicted in 2012. Although studies have shown a link between asthma deaths and heroin abuse, the process in which opiates exacerbate asthma is still unclear. Heroin may impair judgement during an acute asthma attack leading to inadequate treatment and late arrival for care. Alterations in mental status may increase aspiration risk and predispose to aspiration-induced bronchospasm. Some studies have demonstrated that opioid-induced bronchoconstriction is mediated by histamine release and that heroin itself can degranulate mast cells and release pre-formed mediators of inflammation. The files of the Cook County Medical Examiner’s Office in Chicago, IL, were searched for cases involving heroin as a primary or contributory cause of death from January 2013 to December 2014. Cases were reviewed for age, sex, race, cause and manner of death, gross and microscopic autopsy findings, and toxicology results. The route of administration of the drug was reported if determined during the death investigations. Six hundred ninety-six cases were identified that met the criteria: 149 female and 547 male. The ages ranged from 17 years to 68 years of age. The race distribution was: 435 Caucasian, 257 African-American, 1 Oriental, and 3 Hispanic. The manner of death was determined to be accident in 681 cases, suicide in 5, natural in 5, homicide in 2, and undetermined in 3. Of these cases, 662 listed heroin as the primary cause of death: 142 female and 520 male. In this group, the age range was the same as above. The smallest number of cases occurred in the month of January 2013 (17), while the greatest number occurred in September 2014 (37). Regarding seasonal distribution, it was found that in the spring (March-May of both years) the smallest number of deaths (154) occurred, whereas in the fall (September-November of both years) the greatest number (180) of deaths occurred. In 34 cases, heroin was a contributory cause of death. In this subset, the age range was 20 years to 64 years old. Seven were female and twenty-seven were male. Regarding the seasonal distribution, in spring (March-May of both years), the greatest number of deaths (15) occurred, whereas in fall (September-November of both years) the smallest number (5) of deaths occurred. In this group, six cases died of “bronchial asthma.” In both of the groups, “heroin as primary cause of death” and “heroin as a contributory cause of death,” this study found a history of asthma in 58 cases. In this subset, the age range was 19 years to 64 years old. Twenty-one were female and thirty-seven were male. Regarding the seasonal distribution, in the winter (January, February, December of both years), the greatest number of deaths (21) occurred, whereas in summer (June-July of both years) the smallest number (10) of deaths occurred. Whenever lung slides were available, they were reviewed and graded for asthma changes. This work supports the hypothesis that a history of asthma is frequently seen in heroin deaths. In these cases, deaths usually occur in the coolest months, perhaps because cold air acts as a trigger for exacerbations of asthma. Even though there are a number of limitations (route of administration not always known, small number of cases, etc.), this study provides a review of heroin deaths in a large county in the United States
Undiagnosed Congenital Heart Defects as a Cause of Sudden, Unexpected Death in Children.
No full textDespite advances in the diagnosis and treatment of congenital heart defects (CHDs), these defects are still an important cause of sudden, unexpected death in young children. This retrospective study identified 64 cases of CHDs presenting as a cause of sudden, unexpected death in a busy, urban Medical Examiner's Office pediatric population between 2006 and 2016. The majority of cases (52 of 64, 81%) were infants. Interestingly, 52% of cases were undiagnosed prior to autopsy. Ventricular septal defects and atrioventricular septal defects were the most common simple (14%) and complex (17%) malformations observed, respectively. In many cases, there were coexistent simple and/or complex defects. Most of the cases diagnosed with CHD prior to autopsy (48%) had undergone some type of surgical repair. This study highlights the importance of considering undiagnosed CHDs as a cause of sudden, unexpected death, particularly in young children
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