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Potter R.N.,Armed Forces Medical Examiner System | Cantrell J.A.,Armed Forces Medical Examiner System | Mallak C.T.,Armed Forces Medical Examiner System | Gaydos J.C.,Armed Forces Health Surveillance Center
Emerging Infectious Diseases | Year: 2012

Adenoviruses are frequent causes of respiratory disease in the US military population. A successful immunization program against adenovirus types 4 and 7 was terminated in 1999. Review of records in the Mortality Surveillance Division, Armed Forces Medical Examiner System, identifi ed 8 deaths attributed to adenovirus infections in service members during 1999-2010.


Smith A.B.,Armed Forces Institute of Pathology | Smith A.B.,Uniformed Services University of the Health Sciences | Lattin Jr. G.E.,Armed Forces Institute of Pathology | Lattin Jr. G.E.,Uniformed Services University of the Health Sciences | And 3 more authors.
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: Postmortem imaging with CT or MR is emerging as an effective technique to augment forensic autopsy. Expected findings on postmortem imaging of the brain may mimic pathologic processes in the living brain, leading to potential misdiagnosis. The purpose of this study is to describe the array of CT findings that can be expected to be present within the brain after death. MATERIALS AND METHODS: A retrospective review was performed using an anonymized data base of 33 postmortem head CTs with no evidence of trauma to the face or scalp. Head CTs were assessed for 1) loss of gray-white differentiation, 2) effacement of the ventricles and cisterns, 3) postmortem intravascular blood distribution, 4) presence of intracranial or intravascular air, and 5) an irregular appearance of the falx. Imaging findings were correlated with autopsy findings. RESULTS: Visualization of the basal ganglia was noted in 30 (91%) subjects, and the cortical ribbon was appreciated in 14 (42%). The ventricles and cisterns were effaced in 19 (58%) cases. An "expected postmortem blood distribution" was seen in 27 (82%) instances. Intravascular air was present in 14 cases (42%). A "lumpy" falx was present in 20 cases (61%). In 4 cases of subdural or subarachnoid hemorrhage noted on autopsy, but not on CT, retrospective review confirmed that a true discrepancy between the radiology and pathology findings persisted. CONCLUSIONS: Recognition of expected postmortem patterns is required before pathology can be accurately diagnosed. A limitation of CT virtual autopsy is the possibility of missing small blood collections.


PubMed | U.S. Air force, Armed forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, San Antonio Military Medical Center and Armed Forces Medical Examiner System
Type: Journal Article | Journal: British journal of sports medicine | Year: 2016

Sudden cardiac death associated with physical exertion (SCD/E) is a complicated pathophysiological event. This study aims to calculate the incidence rate of SCD/E in the US military population from 2005 to 2010, to characterise the demographic and cardiovascular risk profiles of decedents, and to evaluate aetiologies of and circumstances surrounding the deaths.Perimortem and other relevant data were collected from the Armed Forces Medical Examiners Tracking System, Armed Forces Health Longitudinal Technology Application, and Defense Medical Epidemiology Database for decedents meeting SCD/E case definition. Incidence rates were calculated and compared using negative binomial regression.The incidence of SCD/E in the Active Component (ie, full-time active duty) US military from 2005 to 2010 was 1.63 per 100000 person-years (py): 0.98 and 3.84 per 100000 py in those aged <35 and 35years, respectively. Atherosclerotic cardiovascular disease was the leading cause of death overall (55%) and in the 35-year age group (78%), whereas the leading cause of death in the <35-year age group (31%) could not be precisely determined and was termed idiopathic SCD/E (iSCD/E). SCD/E was more common in males than females (incidence rate ratio (IRR) = 5.28, 95% CI 2.16 to 12.93) and more common in blacks than whites (IRR=2.60, 95% CI 1.81 to 3.72). All female cases were black.From 2005 to 2010, the incidence of SCD/E in US military members aged <35years was similar to most reported corresponding civilian SCD rates. However, the leading cause of death was iSCD/E and not cardiomyopathy. Improved surveillance and age-based prevention strategies may reduce these rates.


PubMed | Office of the Armed Forces Medical Examiner, Armed Forces Medical Examiner System and U.S. Navy
Type: Journal Article | Journal: Journal of analytical toxicology | Year: 2016

It is reasonable to expect the presence of multiple drugs to present a complicated picture of toxicity. We report a fatal case involving a young man who purchased illicit drugs and knowingly consumed them. After consuming these drugs and going to sleep in his friends car, he was found unresponsive the next morning with no signs of physical violence. Drugs found in the peripheral blood at autopsy were oxymorphone, methylone and ethanol at concentrations of 0.106, 0.50 and 130 mg/dL, respectively. The levels of oxymorphone and methylone in peripheral blood were comparable to those observed in other reported fatalities. Cocaine and benzoylecgonine were detected in the urine but not in the blood. Measureable concentrations were also observed for oxymorphone and methylone in urine, liver, kidney and bile. The physical findings at autopsy included pulmonary edema. This is the only reported fatal case involving this combination of drugs encountered in our laboratory.


PubMed | Broward County Medical Examiner and Trauma Services and Armed Forces Medical Examiner System
Type: Journal Article | Journal: Journal of analytical toxicology | Year: 2016

An accidental death associated with the use of the designer drug, 2-(4-chloro-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25C-NBOMe), is reported. A 23-year-old Caucasian male experienced severe respiratory distress and died after being subdued by military law enforcement. At autopsy, remarkable findings upon internal examination included mild to moderate coronary atherosclerosis, biventricular dilation, mild right ventricular hypertrophy and bilateral pulmonary edema and congestion. The decedents blood contained no drugs, ethanol or other volatile compounds. Pseudoephedrine, nicotine and cotinine were detected in his urine. A LC-QTOF designer drug screen, employing a basic solid-phase extraction, was used to isolate 25C-NBOMe, 25C-NBOH and 2C-C from both blood and urine specimens. Quantitative analysis was performed by LC-MS-MS operating in multiple reaction monitoring mode. 25C-NBOMe and 2C-C were present in the blood (2.07 and 0.12 ng/mL) and in the urine (27.43 ng/mL and 0.38 ng/mL), respectively. 25C-NBOMe concentrations were determined by standard addition in the brain (19.10 ng/g), spleen (27.13 ng/g), lung (25.21 ng/g), liver (15.20 ng/g), kidney (25.06 ng/g) and gastric contents (30.24 g total in 100 mL submitted). On the basis of decedent case history, autopsy and toxicological findings, the medical examiner ruled the cause of death as 25C-NBOMe toxicity temporally associated with excited delirium and forcible restraint. The manner of death was ruled accidental.


Malik-wolf B.,Armed Forces Medical Examiner System | Vorce S.,Armed Forces Medical Examiner System | Holler J.,Armed Forces Medical Examiner System | Bosy T.,Armed Forces Medical Examiner System
Journal of Analytical Toxicology | Year: 2014

This study examined the potential of abalone β-glucuronidase as a viable and cost effective alternative to current hydrolysis procedures using acid, Helix pomatia β-glucuronidase and Escherichia coli β-glucuronidase. Abalone β-glucuronidase successfully hydrolyzed oxazepam-glucuronide and lorazepam-glucuronide within 5% of the spiked control concentration. Benzodiazepines present in authentic urine specimens were within 20% of the concentrations obtained with the current hydrolysis procedure using H. pomatia β-glucuronidase. JWH 018 N-(5-hydroxypentyl) β-d-glucuronide was hydrolyzed within 10% of the control concentration. Authentic urine specimens showed improved glucuronide cleavage using abalone β-glucuronidase with up to an 85% increase of drug concentration, compared with the results obtained using E. coli β-glucuronidase. The JWH 018 and JWH 073 carboxylic acid metabolites also showed increased drug concentrations of up to 24%. Abalone β-glucuronidase was able to completely hydrolyze a morphine-3-glucuronide control, but only 82% of total morphine was hydrolyzed in authentic urine specimens compared with acid hydrolysis results. Hydrolysis of codeine and hydromorphone varied between specimens, suggesting that abalone β-glucuronidase may not be as efficient in hydrolyzing the glucuronide linkages in opioid compounds compared with acid hydrolysis. Abalone β-glucuronidase demonstrates effectiveness as a low cost option for enzyme hydrolysis of benzodiazepines and synthetic cannabinoids. © The Author [2014]. Published by Oxford University Press. All rights reserved.


Trofimovich L.,National Center for Telehealth and Technology | Reger M.A.,National Center for Telehealth and Technology | Luxton D.D.,National Center for Telehealth and Technology | Oetjen-Gerdes L.A.,Armed Forces Medical Examiner System
Suicide and Life-Threatening Behavior | Year: 2013

Suicide risk based on occupational cohorts within the U.S. military was investigated. Rates of suicide based on military occupational categories were computed for the Department of Defense (DoD) active component population between 2001 and 2010. The combined infantry, gun crews, and seamanship specialist group was at increased risk of suicide compared to the overall military population even when adjusted for gender, age, and deployment history. The results provide useful information that can help inform the DoD's suicide prevention mission. Data limitations and recommended areas for future research are discussed. © 2013 The American Association of Suicidology.


PubMed | Armed Forces Medical Examiner System
Type: Journal Article | Journal: Journal of analytical toxicology | Year: 2016

Screening for emerging drugs of abuse, specifically synthetic cathinones and synthetic cannabinoids, is difficult for high-throughput laboratories as immunoassay kits are often unavailable. Consequently, most laboratories employ liquid chromatography-tandem mass spectrometry (LC-MS-MS) screening, which can be complex and time consuming as these techniques may require involved sample preparation and lengthy analysis times. The increasing demand for novel psychoactive substance testing necessitates alternative screening methods that are sensitive, fast and versatile. The RapidFire tandem mass spectrometry system (RF-MS-MS) provides a rapid and highly specific screen for these emerging drugs of abuse with minimal sample preparation and an instrumental analysis time of <14 s per sample. Presented here are two RF-MS-MS screening methods used to analyze 28 emerging drugs of abuse, 14 synthetic cannabinoids and 14 synthetic cathinones, in urine with run times of 9 and 12.6 s, respectively. Sample preparation and hydrolysis were performed in a 96-well plate with one multiple reaction monitoring transition used for the identification of each compound. Eighteen thousand urine specimens were screened by liquid-liquid extraction followed by LC-MS-MS analysis, and the results were compared with those obtained using the RF-MS-MS screening method. The analytical data illustrate the advantages of the RF-MS-MS methods.


PubMed | Armed Forces Medical Examiner System
Type: Journal Article | Journal: Journal of analytical toxicology | Year: 2016

Synthetic cannabinoids emerged on the designer drug market in recent years due to their ability to produce cannabis-like effects without the risk of detection by traditional drug testing techniques such as immunoassay and gas chromatography-mass spectrometry. As government agencies work to schedule existing synthetic cannabinoids, new, unregulated and structurally diverse compounds continue to be developed and sold. Synthetic cannabinoids undergo extensive metabolic conversion. Consequently, both blood and urine specimens may play an important role in the forensic analysis of synthetic cannabinoids. It has been observed that structurally similar synthetic cannabinoids follow common metabolic pathways, which often produce metabolites with similar metabolic transformations. Presented are two validated quantitative methods for extracting and identifying 15 parent synthetic cannabinoids in blood, 17 synthetic cannabinoid metabolites in urine and the qualitative identification of 2 additional parent compounds. The linear range for most synthetic cannabinoid compounds monitored was 0.1-10 ng/mL with the limit of detection between 0.01 and 0.5 ng/mL. Selectivity, specificity, accuracy, precision, recovery and matrix effect were also examined and determined to be acceptable for each compound. The validated methods were used to analyze a compilation of synthetic cannabinoid investigative cases where both blood and urine specimens were submitted. The study suggests a strong correlation between the metabolites detected in urine and the parent compounds found in blood.


Vorce S.P.,Armed Forces Medical Examiner System | Knittel J.L.,Armed Forces Medical Examiner System | Holler J.M.,Armed Forces Medical Examiner System | Magluilo J.,Armed Forces Medical Examiner System | And 3 more authors.
Journal of Analytical Toxicology | Year: 2014

A case is presented of a 19-year-old white male who was found dead in bed by a friend. While no anatomic cause of death was observed at autopsy, toxicological analysis of his blood identified AH-7921, a synthetic opioid. AH-7921 was isolated by liquid-liquid extraction into n-butyl chloride from alkalinized samples. Extracts were analyzed and quantified by gas chromatography mass spectrometry in selected ion monitoring mode. The heart blood had an AH-7921 concentration of 3.9 mg/L and the peripheral blood concentration was 9.1 mg/L. In addition to the blood, all submitted postmortem specimens including urine, liver, kidney, spleen, heart, lung, brain, bile and stomach content were quantified. The following concentrations of AH-7921 were reported: 6.0 mg/L in urine, 26 mg/kg in liver, 7.2 mg/kg in kidney, 8.0 mg/kg in spleen, 5.1 mg/kg in heart, 21 mg/kg in lung, 7.7 mg/kg in brain, 17 mg/L in bile and 120 mg/125 mL in the stomach content. The medical examiner reported that the cause of death was opioid intoxication and the manner of death was accident. © The Author [2014]. Published by Oxford University Press. All rights reserved.

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