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Albano GD, Malta G, La Spina C, Rifiorito A, Provenzano V, Triolo V, Vaiano F, Bertol E, Zerbo S, Argo A. Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries. TOXICS 2022; 10:toxics10110654. [PMID: 36355945 PMCID: PMC9698482 DOI: 10.3390/toxics10110654] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 05/15/2023]
Abstract
The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.
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Affiliation(s)
- Giuseppe Davide Albano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
- Correspondence: ; Tel.: +39-3312264328
| | - Ginevra Malta
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Corinne La Spina
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Arianna Rifiorito
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valeria Provenzano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valentina Triolo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Fabio Vaiano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Elisabetta Bertol
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Stefania Zerbo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Antonina Argo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
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Di Candia D, Giordano G, Boracchi M, Zoja R. Postmortem forensic toxicology cases: A retrospective review from Milan, Italy. J Forensic Sci 2022; 67:1640-1650. [PMID: 35506762 PMCID: PMC9325463 DOI: 10.1111/1556-4029.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Abstract
We are presenting a study on 136 cases performed in a 2-year period (2018-2019) at the Bureau of Legal Medicine of the University of Milan for which toxicological analyses were requested and we are making a detailed interpretation of clinical records and discussing toxicological results from each case included in the study. Total number of autopsies was 1323 and in 10.3% of the cases, toxicological analyses were requested to obtain further information. Analyses were assessed with High-Performance Liquid Chromatography-Mass Spectrometry system and Gas Chromatography-Mass Spectrometry analyses. Additionally, Blood Alcohol Concentration and detection of volatile substances were obtained with Head Space-Gas Chromatography-Mass Spectrometry system. From these analyses, 101 cases out of 136 provided positive results (74.3%). Main substances detected were cocaine, diazepam, morphine, and ethanol. The most representative profiles of individuals that emerged from this study were: a Caucasian male, age 41-50, that died for cocaine acute intoxication or was killed; a Caucasian male or female with a range-of-age of 31-50 deceased for simple suicide caused by acute intoxication or by complex suicide caused by acute intoxication and suffocation; and finally, a Caucasian male with a range-of-age 21-40 that died in a car accident without any toxicological evidence. From the results, acute intoxication at the time of death was confirmed in 54 cases and in 57 cases the toxicological analyses helped in the determination of the cause and manner of death. From this study, the importance of toxicological data among forensic sciences is confirmed.
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Affiliation(s)
- Domenico Di Candia
- Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La SaluteUniversità Degli Studi Di MilanoMilanItaly
| | - Gaia Giordano
- Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La SaluteUniversità Degli Studi Di MilanoMilanItaly
| | - Michele Boracchi
- Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La SaluteUniversità Degli Studi Di MilanoMilanItaly
| | - Riccardo Zoja
- Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La SaluteUniversità Degli Studi Di MilanoMilanItaly
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Suicidal Behavior and Its Relationship with Postmortem Forensic Toxicological Findings. TOXICS 2022; 10:toxics10060319. [PMID: 35736927 PMCID: PMC9229491 DOI: 10.3390/toxics10060319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Suicide affects all sociodemographic levels, age groups, and populations worldwide. The factors that can increase the risk of suicidal tendencies are widely studied. The aim of this study was to analyze the types and combinations of toxics found in fatal suicide victims with different suicide mechanisms. A total of 355 autopsies were retrospectively studied, and 26 toxics were determined and related to mechanisms of suicide. Hanging (55%), drug overdose (22.7%), and jumping from a height (17.8%) were most represented suicide mechanisms with positive toxicology. Hanging was the most represented in men (50.3%; p = 0.019), while jumping from a height was more represented in women (29.7%, p = 0.028). Drugs of abuse were the most frequent toxics found in men (55.5%; p < 0.001), while medicines were the most frequent type found in women (70.3%, p < 0.001). Alcohol, nordiazepam, cocaine, and venlafaxine were the most consumed toxics. Benzodiazepines and venlafaxine were found in suicides involving drug overdose, hanging, and jumping from a height. In conclusion, most suicides were associated with drug abuse in men. Hanging was more represented in men and jumping from a height in women. Alcohol was present in combination with other toxics and medicines. The toxicological analysis is fundamental to understanding consumption patterns and establishing strategies and protocols for detecting and preventing suicide.
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Xiao L, Ye Y, Wang Y, Dai X, Fang S, Wei Y, Zheng Y, Wu H, Fu Y, Liao L. A 9-year retrospective study of poisoning-related deaths in Southwest China (Sichuan). Forensic Sci Int 2020; 318:110558. [PMID: 33208234 DOI: 10.1016/j.forsciint.2020.110558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Abstract
Poisoning is an increasing and significant burden that causes morbidity and mortality worldwide. In this retrospective study, poisoning-related cases that occurred in 19 cities and prefectures in Sichuan, Southwest China, between 2010 and 2018 were collected from the West China Forensic Medical Center of Sichuan and Public Security Bureaus. A total of 782 poisoning-related deaths were recorded, and their demographic characteristics, season of death, type of poison, and manner and cause of death were analysed. Of these cases, the victims were predominantly male (65.3%), and the 21∼50-year-old age group included the most victims (63.2%). The rural incidence was 71%. The most common poisoning agent was pesticide (40%), followed by toxic gases (32%), and there were cases of poisoning by poisonous animals and plants that are not common in other regions of China. The predominant manner of poisoning death was accident (50%), followed by suicide (38.3%) and homicide (5.0%). In this study, relevant information on poisoning-related cases was collected and compared with the poisoning data from other areas of China and foreign countries to provide guidance for the formulation of public health policies in Sichuan, Southwest China.
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Affiliation(s)
- Li Xiao
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yi Ye
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yanjun Wang
- Criminal Investigation Bureau, The Department of Public Security of Sichuan, Chengdu, China
| | - Xinhua Dai
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Shiyong Fang
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Ying Wei
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yuzi Zheng
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Hao Wu
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yinqiang Fu
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Linchuan Liao
- Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China.
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