Journal of forensic and legal medicine
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Aluminium (Al) is the third most prevalent element, representing approximately 8% of total mineral components in the earth's crust (1). Chronic exposure to Al is mainly encountered at particular work places, for example, in foundries or in the Al powder industry, as an occupational exposure. In case of occupational Al exposure, inhalation is the main route of uptake. ⋯ Studies regarding the Al powder industry showed that long-term inhalative exposure to Al can induce pulmonary fibrosis (2). Although there is only one report about ventricular tachycardia as a cardiac manifestation in occupationally exposed persons (3), in this report, we presented a case that had Mobitz type I second-degree atrioventricular block and nonsustained ventricular tachycardia. To our knowledge, this is the first report in chronic poisoning.
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Immediate trauma fatality is not amenable to trauma care and primary prevention is the key. The published profiles of deaths due to trauma differ in different regions. Injury mortality rates are higher in developing countries where injury data capture systems are unreliable for prevention purposes. ⋯ Injury was a significant cause of mortality among adults of working age in this urban African setting. Intentional injuries predominate in causation of immediate but not late deaths. Local prevention programs should incorporate mortuary data to unravel further aspects of trauma and address violence as a key determinant of prehospital mortality.
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Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. ⋯ A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships.
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Multiple inflicted injuries in traumatic deaths usually indicate homicide. Three cases are reported where homicide was initially suspected due to findings at the death scene and the apparent nature of the injuries however, after investigation, involvement of any other individuals in the deaths could be excluded. Case 1: A 52-year-old male was found with multiple stab wounds. ⋯ A high level of clozapine was detected on toxicological analysis of blood and a history of schizophrenia was reported. Although multiple self-inflicted wounds are most often caused by sharp objects such as knives, on occasion multiple gunshot wounds and rarely, blunt trauma may also be encountered. Careful integration of scene and autopsy findings may be required to avoid misinterpretation of the circumstances and manner of death.
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We describe a case of unintentional intoxication due to tramadol and propofol self administration, occurred in a middle aged man, healthcare provider, deceased despite advanced medical assistance an hour later the onset of severe and increasing dyspnea. Toxicological analysis performed with gas chromatography-mass spectrometry in blood sample, evidenced a lethal tramadol concentration and therapeutic level of Propofol. Quantitative determination was also performed in other specimens such as bile, tissues (liver, spleen, kidney) and pubic hair, to assess chronic exposure. Toxicological results and autopsy findings, supported by clinical and hematochemical data, suggested a myocardial damage, associated with respiratory failure.