Bed sharing deaths in infancy - SIDS or asphyxia?

Letter to the editorRoger W. Byar

Toxicological screening and DNA sequencing detects contamination and adulteration in regulated herbal medicines and supplements for diet, weight loss and cardiovascular health

Use of herbal medicines and supplements by consumers to prevent or treat disease, particularly chronic conditions continues to grow, leading to increased awareness of the minimal regulation standards in many countries. Fraudulent, adulterated and contaminated herbal and traditional medicines and dietary supplements are a risk to consumer health, with adverse effects and events including overdose, drug-herb interactions and hospitalisation. The scope of the risk has been difficult to determine, prompting calls for new approaches, such as the combination of DNA metabarcoding and mass spectrometry used in this study. Here we show that nearly 50% of products tested had contamination issues, in terms of DNA, chemical composition or both. Two samples were clear cases of pharmaceutical adulteration, including a combination of paracetamol and chlorpheniramine in one product and trace amounts of buclizine, a drug no longer in use in Australia, in another. Other issues include the undeclared presence of stimulants such as caffeine, synephrine or ephedrine. DNA data highlighted potential allergy concerns (nuts, wheat), presence of potential toxins (Neem oil) and animal ingredients (reindeer, frog, shrew), and possible substitution of bird cartilage in place of shark. Only 21% of the tested products were able to have at least one ingredient corroborated by DNA sequencing. This study demonstrates that, despite current monitoring approaches, contaminated and adulterated products are still reaching the consumer. We suggest that a better solution is stronger pre-market evaluation, using techniques such as that outlined in this study

Toxicological screening and DNA sequencing detects contamination and adulteration in regulated herbal medicines and supplements for diet, weight loss and cardiovascular health

Use of herbal medicines and supplements by consumers to prevent or treat disease, particularly chronic conditions continues to grow, leading to increased awareness of the minimal regulation standards in many countries. Fraudulent, adulterated and contaminated herbal and traditional medicines and dietary supplements are a risk to consumer health, with adverse effects and events including overdose, drug-herb interactions and hospitalisation. The scope of the risk has been difficult to determine, prompting calls for new approaches, such as the combination of DNA metabarcoding and mass spectrometry used in this study. Here we show that nearly 50% of products tested had contamination issues, in terms of DNA, chemical composition or both. Two samples were clear cases of pharmaceutical adulteration, including a combination of paracetamol and chlorpheniramine in one product and trace amounts of buclizine, a drug no longer in use in Australia, in another. Other issues include the undeclared presence of stimulants such as caffeine, synephrine or ephedrine. DNA data highlighted potential allergy concerns (nuts, wheat), presence of potential toxins (Neem oil) and animal ingredients (reindeer, frog, shrew), and possible substitution of bird cartilage in place of shark. Only 21% of the tested products were able to have at least one ingredient corroborated by DNA sequencing. This study demonstrates that, despite current monitoring approaches, contaminated and adulterated products are still reaching the consumer. We suggest that a better solution is stronger pre-market evaluation, using techniques such as that outlined in this study

Frailty syndrome - medicolegal considerations

Abstract not availableRoger W. Byar

Curtain cords and accidental childhood hanging

Letter to the EditorRoger W Byar

Infant deaths associated with baby slings

Letter to the editorRoger W Byard and John D Gilber

Acute fatal upper airway obstruction from an occult cavernous hemangioma of the larynx

A 42-year-old previously well man collapsed while holding his throat. Resuscitation was unsuccessful, and at autopsy, the most significant findings were limited to the larynx, pharynx, and anterior mediastinum where there were multinodular dark blue tumors. Within the larynx, the lower border of the tumor was well demarcated, not extending beyond the vocal cords. A separate large polypoidal tumor mass was attached to the right aryepiglottic fold by a thin fibrous stalk. Histologic examination revealed numerous large, thin-walled cavernous-type vascular spaces typical of a multifocal cavernous hemangioma. Death was due to asphyxiation from obstruction of the upper airways by a cavernous hemangioma of the larynx. Adult laryngeal hemangiomas are rare and are usually supraglottic. This case demonstrates that pedunculated laryngeal cavernous hemangiomas may remain occult until the initiation of an obstructive episode with sudden collapse and death. In such instances, the diagnosis must rely upon an autopsy examination.Liina Kiho, and Roger W. Byar

Patterned postmortem ant abrasions outlining clothing and body position after death

Abstract not availableRoger W. Byard, Karen J. Heat

Need for a working classification system for sudden and unexpected infant deaths

Rachel Y. Moon and Roger W. Byar

Suizidales erhangen mit anogenitalen mutilationen

Abstract published in English and German English title: Suicidal hanging with anogenital mutilationThe case of a 51-year-old man found hanging in a cell in an institution for the criminally insane is reported. The decedent was hanging from a cord attached to a wall fixture. Addittional findings were of several superficial incised wounds at the base of the scrotum and a broom handle inserted into the rectum that had passed into the peritoneal cavity without causing any major vascular or internal organ injuries. The finding of the anogenital injuries raised suspicions of a sexual or sadistic homicide or of sexual asphyxia. Careful evaluation of the death scene and the autopsy findings, however, indicated that death had been caused by hanging and that the manner was suicide. = Suizidales Erhängen erfolgt meist an einem abgelegenen oder als sicher empfundenen Ort. In der Regel hängt der Verstorbene an einer um seinen Hals gelegten Schlinge. Am Ort des Geschehens finden sich häufig Hinweise darauf, auf welche Weise sich das Opfer erhängt hat, und Verletzungen sind in der Regel auf den Hals beschränkt. Gelegentlich zeigen sich während der Autopsie eines Erhängten Anzeichen für selbst beigebrachte Verstümmelungen, auch wenn zwischen diesen Verhaltensweisen eher selten Überlappungen bestehen [9]. Im Folgenden wird der Fall eines Erhängten mit anogenitalen Mutilationen vorgestellt, und diagnostische Schwierigkeiten werden besprochen.R.W. Byar