دانلود رایگان مقاله انگلیسی مطالعات جامع بافتشناسی و ایمنی سنجی قانونی در مرگ و میر در زندان - هینداوی 2017

In-custody deaths have several causes, and these include homicide, suicide, natural death from chronic diseases, and unexplained death possibly related to acute stress, asphyxia, excited delirium, and drug intoxication. In some instances, these deaths are attributed to undefined accidents and natural causes even though there is no obvious natural cause apparent after investigation. Understanding these deaths requires a comprehensive investigation, including documentation of circumstances surrounding the death, review of past medical history, drug and toxicology screens, and a forensic autopsy. These autopsies may not always clearly explain the death and reveal only nonspecific terminal events, such as pulmonary edema or cerebral edema. There are useful histologic and biochemical signatures which identify asphyxia, stress cardiomyopathy, and excited delirium. Identifying these causes of death requires semiquantitative morphologic and biochemical studies. We have reviewed recent Bureau of Justice Statistics on in-custody death, case series, and morphological and biochemical studies relevant to asphyxia, stress cardiomyopathy, and excited delirium and have summarized this information. We suggest that regional centers should manage the investigation of these deaths to provide more comprehensive studies and to enhance the expertise of forensic pathologists who would routinely manage potentially complex and difficult cases.

4. Discussion

This literature review indicates that in-custody or in-prison deaths occur frequently. The causes for these deaths include natural causes secondary to underlying chronic diseases, homicide, suicide, accidents, and unexplained death. The causes of death depend in part on the type of inmate population under review. Inmates in prison tend to be older and die from natural causes; inmates in jail are younger, often have been in custody for only a few days, and frequently commit suicide [10]. One study reported a remarkably high suicide rate as an explanation for in-custody deaths. Regardless of the underlying cause, all deaths need investigation and explanation to the possible extent. These investigations are relatively straightforward when there is significant external and internal trauma and when there are underlying chronic diseases, such as coronary atherosclerosis resulting in acute myocardial infarction. However, some cases with death secondary to natural causes probably do not have underlying chronic disease and some deaths are unexplained or accidental. These latter cases require more extensive investigation. Histologic studies of myocardium and the identification of contraction bands and calmodulin can provide information about stress cardiomyopathy, and histologic studies of the lung with overinflation of alveolar spaces can provide information about asphyxia. Postmortem molecular studies can help identify stress cardiomyopathy (calmodulin), AMI (CCC9/SRT1), asphyxia (aggregates of surfactant protein A), and excited delirium (increased levels of heat shock protein 70). Both the presence and absence of these morphological and biochemical changes can guide the forensic evaluation of these deaths. Maeda and colleagues have reviewed the use of mRNA transcripts in molecular pathology and suggested that quantitative analysis of mRNA can support and reinforce morphological evidence [62].