Auckloo Marie Belle Kathrina Mendoza, Davies Bronwen Beth
Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
J Forensic Leg Med. 2019 Apr;63:18-25. doi: 10.1016/j.jflm.2019.02.005. Epub 2019 Feb 21.
In South Africa, violence-related injury and mortality contributes highly to the nation's burden of injury. Drug abuse, which is also reported to be rife across the county, has been associated with violence, resulting injury, and death. While post-mortem toxicological investigations are comprehensive and routine in violent fatalities internationally; this is not currently the case in South Africa.
To conduct a post-mortem toxicological investigation on a cohort of violent fatalities in the West-Metropole of Cape Town, Western Cape.
The study included a prospective toxicological analysis and a retrospective review of the corresponding blood alcohol results on a small cohort of victims of violent death (whether homicidal, non-overdose suicidal, or accidental) admitted to the Salt River State Mortuary in Cape Town. Biological specimens were collected from the victims following informed consent from the next-of-kin, and a targeted screening approach using liquid chromatography coupled to tandem mass spectrometry was used for the qualitative toxicology analysis. At the Forensic Chemistry National Laboratory, blood alcohol testing was conducted using a headspace gas chromatography with flame ionisation detector according to national standards. Data was analysed with regards to demographics, circumstances of death, and toxicological results.
Consent was obtained for 104 violent death cases, autopsied between August-October 2015, most were male victims of homicide (n = 92, 88%). Volatiles analysis for ethanol was performed on 98% of cases, with 41% testing positive (>0.01 g/100 mL). Other drugs of abuse were detected in 63 (61%) cases and more than one substance were present in 51 (49%) cases. The most commonly detected substances were combinations of methamphetamine, diphenhydramine, and methaqualone.
A high prevalence of drugs of abuse was identified in a cohort of victims of violent death. Objective drug trends observed were consistent with national self-reported rehabilitation centre data and research on self-reported drug user. This study was limited by the sampling strategy, including challenges associated with obtaining consent and the rapid turnover of violent fatalities. Despite this - and to the authors' knowledge - this study provided the first prospective post-mortem toxicological investigation into violent death in South Africa. Contextually, it highlights the need for routine and comprehensive toxicology in these cases to strengthen research and service provision, so as to better understand the role of drugs in violent death.
在南非，与暴力相关的伤害和死亡率在该国的伤害负担中占比很高。据报道，药物滥用在全国也很普遍，它与暴力、由此导致的伤害和死亡有关。虽然在国际上，尸检毒理学调查在暴力死亡案件中是全面且常规的；但目前在南非并非如此。
对西开普省开普敦西都市的一组暴力死亡案例进行尸检毒理学调查。
该研究包括对一小群暴力死亡受害者（无论是他杀、非过量自杀还是意外死亡）进行前瞻性毒理学分析和对相应血液酒精检测结果的回顾性审查，这些受害者被送往开普敦盐河州立停尸房。在获得受害者近亲的知情同意后，从受害者身上采集生物样本，并采用液相色谱 - 串联质谱联用的靶向筛查方法进行定性毒理学分析。在法医化学国家实验室，根据国家标准，使用顶空气相色谱 - 火焰离子化检测器进行血液酒精检测。对人口统计学、死亡情况和毒理学结果进行了数据分析。
获得了104例暴力死亡案例的同意，这些案例于2015年8月至10月进行了尸检，大多数是男性他杀受害者（n = 92，88%）。98%的案例进行了乙醇的挥发性分析，其中41%检测呈阳性（>0.01 g/100 mL）。在63例（61%）案例中检测到了其他滥用药物，51例（49%）案例中存在不止一种物质。最常检测到的物质是甲基苯丙胺、苯海拉明和甲喹酮的组合。
在一组暴力死亡受害者中发现了很高的药物滥用率。观察到的客观药物趋势与国家自我报告的康复中心数据以及对自我报告吸毒者的研究一致。本研究受到抽样策略的限制，包括在获得同意方面的挑战以及暴力死亡案例的快速周转。尽管如此——据作者所知——本研究提供了南非首次对暴力死亡进行的前瞻性尸检毒理学调查。从背景来看，它强调了在这些案例中进行常规和全面毒理学检测的必要性，以加强研究和服务提供，从而更好地理解药物在暴力死亡中的作用。
