Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance

Sessa, Francesco; Esposito, Massimiliano; Messina, Antonietta; Mizio, Giulio Di; Nunno, Nunzio Di; Salerno, Monica

doi:10.3390/healthcare9070870

Cited by 35 publications

(47 citation statements)

References 159 publications

(165 reference statements)

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“…These new genetic techniques not only improve the accuracy of forensic determination of AASs as the cause of death but could help the scientific community to understand some of the aspects related to AASs abuse that are still unknown. A recent review confirmed the pivotal role of genetic investigation in the case of SCD [60]. Moreover, several recent studies reported the importance of research in the field of new molecular biomarkers such as miRNAs [23,91].…”

Section: Discussionmentioning

confidence: 74%

“…Tseng et al [59] conducted a study about out-of-hospital cardiac arrest (OHCA) and sudden cardiac death (SCD). To verify if the out-of-hospital deaths were due to cardiac causes, autopsy with histological and toxicological investigations were performed, as it was recently suggested to ascertain the exact cause of death in suspected SCD [60]. A multidisciplinary commission judged the final cause.…”

Section: Discussionmentioning

confidence: 99%

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Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review

et al. 2021

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Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders; AASs are among the most used drugs for improving physical performance, as well as for aesthetic purposes. The use of AASs by professional and recreational athletes is increasing worldwide. This review focused on deaths related to AAS abuse and to investigation of the autopsy results and histopathological findings using a rigorous methodology protocol covering: a complete autopsy, histological analysis, and a broad toxicological investigation. Moreover, we aimed to define an investigative diagnostic protocol supporting forensic pathologists during the post-mortem investigation of AAS abusers. This review was conducted using PubMed Central and Google Scholar databases to find articles published between 1 January 1968 and 30 June 2021, using the following key terms: “(anabolic-androgenic steroids) AND (autopsy); (anabolic-androgenic steroids) AND (forensic)”. A total of 939 articles were screened and 926 did not meet the inclusion criteria. In conclusion, 14 articles were included in this systematic review, reporting 137 fatal cases of AAS abuse in total. The histopathologic studies showed myocardial damage characterized by myocyte hypertrophy, focal myocyte damage with myofibrillar loss, interstitial fibrosis, mostly subepicardial, and small vessel disease. Indeed, in AAS-related cases, autopsy plays a pivotal role in the study of AAS adverse effects and organ damage related to their use or abuse. This systematic review aimed to define a specific workflow in death cases related to AASs, suggesting important future insights to better clarify sudden deaths related to AASs, such as the use of miRNAs. The forensic community needs a unified approach in cases of suspected death related to the use of AASs. There are several occasions to apply this workflow, for example in cases of death of bodybuilders and of young people who die in gymnasiums or during sports activities.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review

et al. 2021

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“…In this case, 3D CNN algorithms can automatically evaluate not only hard-tissue structures and search for inapparent damage that could have been responsible for a sudden death incident [91,130].…”

Section: Overview Of Used Artificial Intelligence For Forensic Age and Sex Determinationmentioning

confidence: 99%

“…Observer defines the points, and their interobserver error are the main weakness of cephalometric analysis (Figure 6). Anthropometry in Forensic Medicine and Forensic Science is frequently used for sex and biological age determination and other purposes [129][130][131].…”

Section: Artificial Intelligence Implementation In 3d Cephalometric Landmark Identificationmentioning

confidence: 99%

Use of Advanced Artificial Intelligence in Forensic Medicine, Forensic Anthropology and Clinical Anatomy

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Three-dimensional convolutional neural networks (3D CNN) of artificial intelligence (AI) are potent in image processing and recognition using deep learning to perform generative and descriptive tasks. Compared to its predecessor, the advantage of CNN is that it automatically detects the important features without any human supervision. 3D CNN is used to extract features in three dimensions where input is a 3D volume or a sequence of 2D pictures, e.g., slices in a cone-beam computer tomography scan (CBCT). The main aim was to bridge interdisciplinary cooperation between forensic medical experts and deep learning engineers, emphasizing activating clinical forensic experts in the field with possibly basic knowledge of advanced artificial intelligence techniques with interest in its implementation in their efforts to advance forensic research further. This paper introduces a novel workflow of 3D CNN analysis of full-head CBCT scans. Authors explore the current and design customized 3D CNN application methods for particular forensic research in five perspectives: (1) sex determination, (2) biological age estimation, (3) 3D cephalometric landmark annotation, (4) growth vectors prediction, (5) facial soft-tissue estimation from the skull and vice versa. In conclusion, 3D CNN application can be a watershed moment in forensic medicine, leading to unprecedented improvement of forensic analysis workflows based on 3D neural networks.

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“…One explanation could be that they are the ones that are more easily obtained even on the black market or through a friend, for example, at school or university. In addition, the easy administration (oral or inhalation) also contributes to ease of consumption [1,6,8,12]. The main reasons for the increase of smart drug use/abuse were: improvement of cognitive functions, reduction of stress, increase in free time, and increase in school and work performance [2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Smart drugs and neuroenhancement: what do we know?

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et al. 2021

Front. Biosci. (Landmark Ed)

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Introduction: Smart drugs are among the most common drugs used by students. It is estimated that they are second in incidence after cannabis. Although they are usually used for diseases such as attention deficit hyperactivity disorder (ADHD) and dementia, in most cases the use of smart drugs is illegal and without a prescription. Methodological issues: A systematic review was conducted according to PRISMA guidelines. SCOPUS, Medline (using PubMed as a search engine), Embase, Web of Sciences, and Google Scholar were used as search engines from January 1, 1980 to June 1, 2021 to evaluate the association between smart drugs and neuro-enhancement. A total of 4715 articles were collected. Of these, 295 duplicates were removed. A total of 4380 articles did not meet the inclusion criteria. In conclusion, 48 articles were included in the present systematic review. Results: Most of the studies were survey studies, 1 was a prospective longitudinal study, 1 was a crossover study, and 1 was an experimental study in an animal model (rats). The largest group of consumers was school or university students. The most frequent reasons for us-ing smart drugs were: better concentration, neuro enhancement, stress reduction, time optimization, increased wake time, increased free time, and curiosity. There are conflicting opinions, in fact, regarding their actual functioning and benefit, it is not known whether the benefits reported by consumers are due to the drugs, the placebo effect or a combination of these. The real prevalence is underestimated: it is important that the scientific community focus on this issue with further studies on animal models to validate their efficacy.

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Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance

Cited by 35 publications

References 159 publications

Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review

Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review

Use of Advanced Artificial Intelligence in Forensic Medicine, Forensic Anthropology and Clinical Anatomy

Smart drugs and neuroenhancement: what do we know?

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