Complicated Suicide Versus Autoeroticism?: A Case Involving Multiple Drugs and a Porta-Potty

A rare case of complicated suicide: Self-immolation and subsequent stab heart injury due to fall into a glass door

Complicated suicides can be defined as incidents where death is caused by a subsequent trauma rather than the primary injury. Deaths which occur as a complication of the suicidal act are very rare with few reports in the literature. We present the case of a 60-year-old man who was found at his home while still alive. His body was burning and he was lying on his back impaled by shards of glass that had come from a broken glass door. An ambulance was called but the man died before arrival at hospital. The autopsy showed stab heart and lung injuries in thorax and an abdominal stab trauma which resulted in the protrusion of the small intestine. Homicide was excluded and the sequence of events was reconstructed to reveal a complicated suicide intended to result from self-immolation but which resulted in a fall against a glass door which in turn resulted in shards of glass piercing his body and a fatal stab wound to the heart.

Complex and complicated suicides in Friuli (1993-2017)

Complex suicides involve more than one suicide method. According to the intention of the victim, they are classified as 'planned' when the use of more than one suicide technique has been previously devised by the victim and 'unplanned' when the first method turns out to be too painful or insufficient to cause death, and the individual then resorts to other means of suicide. Complicated suicide, on the other hand, is a term that was introduced by Töro and Pollak, in which a failed act of suicide is followed by traumatisation, which has a fatal outcome. This type of death must be distinguished from complex suicides. From a sample of 1160 fatalities (837 males) between 1993 and 2017, we identified 20 (1.72%) cases of complex suicide and three (0.26%) cases of complicated suicide. We considered age, sex, psychiatric history, previous suicide attempts, suicide methods and eventual secondary traumatisation. We also compared planned and unplanned complex suicides. The results show a higher number of planned complex suicides (16 vs. 4), a prevalence of males (n = 17) and adults (median age = 48 years, range 21-74 range). Plastic bag suffocation and gas inhalation (n = 8) were the most commonly used methods. Firearms (n = 4) were used exclusively by males in planned complex suicides. Wrist and forearm cuts (n = 5) were found in four unplanned and one planned complex suicides, and all of the cases with known previous suicidal attempts (n = 3) involved planned complex suicides. Complicated suicides concerned three male victims in two failed attempts of hanging and an unforeseen carbon monoxide intoxication following a non-fatal gunshot to the mouth, confirming the rarity of these fatalities.

In vitro bioaccessibility of metals from tape tea - A low-cost emerging drug

BACKGROUND

An in vitro physiologically relevant test based on the standard Unified Bioaccessibility Method (UBM) combined with inductively coupled plasma mass spectrometry was performed in this study to ascertain the elemental bioaccessibility pools of tape tea as emerging low-cost abuse drug under fasted conditions.

METHODS

Elemental quantification in tape tea and body fluid extracts was performed by an inductively coupled plasma quadrupole mass spectrometer - ICP-MS, and for sample preparation of the bioaccessibility extracts prior to ICP-MS analysis, a microwave-assisted acid decomposition was applied by using a microwave oven. The Unified Bioaccessibility Method (UBM) was considered for investigation of elemental bioaccessibility in tape tea, required a full set of organic compounds, salts, and enzymes.

RESULTS

Considering total element evaluation through ICP-MS, Co, Ni, Mn, and Zn are found at the highest concentrations in the sample, namely 415 ± 36, 202 ± 55, 1389 ± 225 and 2397 ± 197 μg L^-1, respectively. Regarding the oral bioaccessibility test, after both gastric and gastrointestinal extractions Co, Ni, and Mn are fully bioaccessible while for Zn the bioaccessibility is ca. 66 %.

CONCLUSION

According to the first results in the literature proposed for these samples, the bioaccessibility results indicate an increment in day-to-day total element concentration and depending on the concentration of each element that an individual consumes in its usual diet, the total concentration can exceed the TDI. There are several possible toxic effects caused by the excess of Co, Ni and Mn, which might be expected by their high total concentrations.

Autoerotic Deaths in Hamburg, Germany: Autoerotic accident or death from internal cause in an autoerotic setting? A retrospective study from 2004-2018

INTRODUCTION

Autoerotic deaths are rare events. The death scene is often bizarre and the death unexpected, thus often requiring forensic autopsies. Our analysis will provide an overview of the expected range of causes and manners of death in cases of autoerotic deaths.

METHODS

A retrospective analysis was carried out on all scientific and forensic autopsies and postmortem examinations performed at the Department of Legal Medicine in Hamburg, Germany, over the period of 2004-2018.

RESULTS

25 cases of autoerotic fatalities were identified over this 15-year-period or one to two cases per year, respectively. Autopsies were carried out on 23 of these cases. 16 (64%) of the cases involved autoerotic accidents and 7 (28%) from internal causes of death during an autoerotic act. Two cases had not undergone an autopsy. On average, those who were involved in autoerotic accidents had been younger in age (average age: 37 years) than the individuals who died from internal disease (average age: 61 years). Only one woman was involved. The most common cause of death in autoerotic accidents was strangulation (hanging: 8 cases, ligature strangulation: 1 case), followed by smothering of the respiratory tract (4 cases). Fatal intoxication was diagnosed in three of the cases. Fatalities with natural cause of death solely involved cardiovascular causes of death.

CONCLUSIONS

Autoerotic deaths involved a wide range of natural and non-natural causes of death. The reconstruction of such unusual cases and detection of non-natural fatalities requires thorough investigation of the scene of death as well as a postmortem external and internal examination including a chemical toxicological and blood alcohol analysis.

A burned body with a gunshot wound in the mouth and a suicide note: A complex or complicated suicide?

The body of a 53-year-old man was found in a burning car. The ignition key was in start position and the accelerator pedal was held down by his right foot. Autopsy revealed a gunshot entrance wound in the hard palate, a bullet track through the anterior cranial fossa and a projectile lodged in the left frontal lobe. The brain stem was free of lesions and any signs of secondary brain injury, such as brain oedema and intracranial haemorrhage, were not significant. Soot deposits and thermal injury to the mucosa were observed in the airways below the glottis and carboxyhaemoglobin (COHb) saturation was 40%. A single bullet case and a handgun were recovered next to the driver's seat. Fire investigators identified the motor as the beginning of the burning: therefore, the conclusion was that the car had caught fire due to overheating of the engine. Differential diagnosis between complex and complicated suicide was essential. The cause of death was identified as carbon monoxide intoxication, and the injuries to the brain were not felt to be immediately fatal. The case has been classified as a complicated suicide. There are no other published cases of a complicated suicide involving exposure to fire or the use of firearms.

Open Availability of Patient Medical Photographs in Google Images Search Results: Cross-Sectional Study of Transgender Research

Background

This paper focuses on the collision of three factors: a growing emphasis on sharing research through open access publication, an increasing awareness of big data and its potential uses, and an engaged public interested in the privacy and confidentiality of their personal health information. One conceptual space where this collision is brought into sharp relief is with the open availability of patient medical photographs from peer-reviewed journal articles in the search results of online image databases such as Google Images.

Objective

The aim of this study was to assess the availability of patient medical photographs from published journal articles in Google Images search results and the factors impacting this availability.

Methods

We conducted a cross-sectional study using data from an evidence map of research with transgender, gender non-binary, and other gender diverse (trans) participants. For the original evidence map, a comprehensive search of 15 academic databases was developed in collaboration with a health sciences librarian. Initial search results produced 25,230 references after duplicates were removed. Eligibility criteria were established to include empirical research of any design that included trans participants or their personal information and that was published in English in peer-reviewed journals. We identified all articles published between 2008 and 2015 with medical photographs of trans participants. For each reference, images were individually numbered in order to track the total number of medical photographs. We used odds ratios (OR) to assess the association between availability of the clinical photograph on Google Images and the following factors: whether the article was openly available online (open access, Researchgate.net, or Academia.edu), whether the article included genital images, if the photographs were published in color, and whether the photographs were located on the journal article landing page.

Results

We identified 94 articles with medical photographs of trans participants, including a total of 605 photographs. Of the 94 publications, 35 (37%) included at least one medical photograph that was found on Google Images. The ability to locate the article freely online contributes to the availability of at least one image from the article on Google Images (OR 2.99, 95% CI 1.20-7.45).

Conclusions

This is the first study to document the existence of medical photographs from peer-reviewed journals appearing in Google Images search results. Almost all of the images we searched for included sensitive photographs of patient genitals, chests, or breasts. Given that it is unlikely that patients consented to sharing their personal health information in these ways, this constitutes a risk to patient privacy. Based on the impact of current practices, revisions to informed consent policies and guidelines are required.