Intentional or unintentional caffeine abuse due to excessive intake of beverages or energy drinks containing caffeine is relatively frequent. However, death due to caffeine intoxication is rare and case reports of fatalities from caffeine toxicity are relatively infrequent. In this report, we describe an autopsy case involving a 31 year-old man who intentionally took a large amount of caffeine tablets in the form of a weight loss supplement as part of a suicide plan. Caffeine femoral blood concentration (170 mg/l) was within the toxic and potentially lethal ranges reported in the literature in similar cases. Postmortem biochemistry results suggested depressed glomerular filtration rate and pre-renal failure at the time of death but failed to reveal myoglobinuria, glycosuria, ketonuria or ketonemia. Based on the absence of pathological findings at autopsy and the high blood caffeine level, death was attributed to acute caffeine toxicity. The case emphasizes the usefulness of performing exhaustive toxicology and searching for all potentially relevant information in order to formulate appropriate hypotheses concerning the cause and manner of death.
SP-A is the most prevalent protein component of pulmonary surfactant which is essential to maintain alveolar stability. SP-A can be detected by immunohistochemistry and in such form it has been previously reported as a useful tool to distinguish aspyxial deaths from other hypoxic cases. The present immunohistochemical study shows the SP-A staining distribution among a selected forensic material to evaluate the effect of fluid accumulation in the lung interstitium and alveoli commonly related to pulmonary edema. A total of 48 cases were examined histologically and immuno-histochemically based on the presence/absence of pulmonary edema and survival time: 10 cases of acute cardiac deaths (ACDs) in which death occurred rapidly, in a few minutes from the beginning of the symptoms and without signs of pulmonary edema, 18 cases of drowning (12 in saltwater and 6 cases in freshwater), 20 cases of narcotic deaths (6 by cocaine and 14 by opiates) with gross pulmonary edema. The results suggest that edema fluid can produce some kind of molecular alterations of SP-A affecting immunostaining expression. The results show also that SP-A immunostaining patterns alone do not meet the requirements for general diagnostic use and cannot differentiate among fatalities. The SP-A expression needs to be preferably associated with the presence and intensity of histological signs according to suspected cause of death as well as type and amount of edema fluid commonly related to cardiac and/or respiratory failure (cardiogenic and non-cardiogenic pulmonary edema).
The body-alarm reaction results from the activation of hypothalamic-pituitary-adrenal axis, which can lead to physio-psychological phenomena such as an exclusion/occlusion of the sense of hearing. One hypothesis to explain this alteration consists in a hydromechanical dysfunction of the internal ear attributable to antidiuretic hormone. In this study, we evaluated the perception of acoustic stimuli administered in stressful conditions in 14 phobic patients and in 20 healthy subjects, in order to assess the influence of stress on perceiving capabilities. We also measured the concentration of salivary cortisol and IL-1β and neurovegetative parameters to objectivise and quantify the physiological reactions. Our results show a worse perception of the frequencies of the human voice under stress; these findings could have a dual value: in the legal field, concerning criminal liability, and on the operative context, regarding the efficiency of verbal communication among law enforcement officers in situations inducing intense emotional stress.
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