The prevalence of reported domestic violence or intimate partner violence has greatly increased, with approximately 1.5 million women violently assaulted annually in the United States by an intimate partner. Strangulation is often seen in violence against women, including domestic violence cases. Strangulation is defined as "a form of asphyxia characterized by closure of the blood vessels or air passages of the neck as a result of external pressure on the neck." This is a 10-year case review of 102 living victims of strangulation who underwent medicolegal evaluation at the Clinical Forensic Medicine Program at a State Medical Examiner's Office serving Southern Indiana and all of Kentucky. The majority of victims (79%) were strangled by an intimate partner, and manual strangulation was the most common method (83%). A total of 38 victims (38%) described a history of domestic violence, and the same number lost consciousness while being strangled. Nine (9%) women were pregnant at the time of the attack, while 13 (13%) had a history of being sexually abused in addition to being strangled. A paucity of cases involved only strangulation, as most of the victims were subjected to myriad forms of blunt force trauma which included not only the head and neck but also other bodily regions. This is a unique presentation of strangulation of living persons as most evidence of strangulation in the forensic literature has been derived from postmortem examinations of the victims. This comprehensive study discussing the examination of a living strangulation victim offers valuable insight into the mechanism and the physical findings involved in the strangulation process.

Nursing home residents comprise a large and rapidly growing segment of the national population. Despite this fact, the majority of deaths occurring in nursing homes are not investigated because of the significant medical illnesses suffered by most residents. Herein, we report a series of unnatural deaths in nursing home residents, including two homicides and seven accidental deaths. In four of the deaths, there was an attempted concealment of the cause and manner of death. Fearing criminal or civil proceedings, nursing home personnel may attempt to conceal homicidal or accidental deaths in nursing home residents. Because of the serious, chronic illnesses suffered by these patients, attending physicians are often willing to sign death certificates without personally investigating the circumstances surrounding the patient's demise. The authors contend that unnatural deaths of nursing home patients are significantly underreported. Attending physicians and death investigators should be urged to investigate more fully sudden deaths in nursing home patients.

No abstract

Acephate is a commercial organophosphate pesticide formerly used in households and now used primarily for agriculture. Poisoning symptoms include salivation, lacrimation, urination, defecation, gastrointestinal illness, and emesis. In addition to these classic symptoms, neurodegeneration can result from increased and continued exposure of organophosphates. This 55-year-old woman presented with organophosphate-induced delayed neuropathy in the form of quadriplegia due to the commonly used pesticide acephate. She was exposed to this pesticide through multiple sprayings in her work office with underrecognized poisoning symptoms. She presented to her primary care physician with neuropathic pain and paralysis in her arm following the sprayings and eventual complete paralysis. The patient lived for 2 years following her toxic exposure and quadriplegia. A complete autopsy after her death confirmed a transverse myelitis in her spinal cord. We conclude that in susceptible individuals, acephate in excessive amounts can produce severe delayed neurotoxicity as demonstrated in animal studies.