Journal of Forensic Medicine

Midazolam has long been employed for sedation and analgesia purposes in medical surgeries. However, this case re-evaluation reports a rare death case by overdosed midazolam to demonstrate a complex murder plot in Dalian, China. Specifically, this research project analyses and re-evaluates the original investigation report, the original autopsy report and the examiners’ findings. Based on the case analysis, the pathological examination indicates that a high concentration of midazolam (9.73 μg/ml) was tested in six needle mark areas (on the left arm and left/right buttock areas). The concentrations were determined and confirmed by LC/MS and GC/MS. This rare case strongly suggests that overdosed midazolam can be intravenously administered as a means of criminal homicide. This case was considered to be the first case reported by the forensic medicine community in China, which might indicate that overdosed midazolam may indicate a new means of killing in years to come. This research project may suggest three practical implications from a forensic pathological perspective. First, this analysis serves as a warning to the medical community that midazolam may have a dangerous side effect, if improperly administered. Second, several reports have indicated that overdosed midazolam can cause deaths. Finally, there has been a real case reported in China where overdosed midazolam was used to kill in a murder case with a concentration of midazolam (9.73 μg/ml) found in muscular areas (the needle marks) by the autopsy findings.

Head injuries is a worldwide problem. It is defined as insult to the head region and include fractures of the skull and facial bone. intracranial injuries and injuries to a special sense. The important factor that determines the outcome is terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intracranial haemorrhage. The study concluded a total of 206 cases with criminal head injury. All cases were from Minia Govern rate, Egypt. Age was ranged from 11 to 80 years old. In the current study the cases were with a definite head injury. Cases examined for age, sex, residence, type and site of fracture, treatment and complication. Cases were divided into 2 groups first group was patients with head injury and stay alive (non-fatal group) second group was patients with head injury and died at once after trauma or on their way to the hospital or after admission to the hospital (fatal group). Complete medical examination was done to the first group and complete autopsy was done to the second group, cross tabulations of the two groups for each variable were statistically analysed such variables include age, residence, sex, type of trauma, effect of trauma, treatment and complications. Chi square test was done to compare categorical variables with a P value < 0.05 is considered significant, ANOVA test was done to compare the age variable between the 2 examined groups. SPSS version 16 was used for statistical analysis, firearm injuries were the major cause of such criminal assault followed by injuries due to blunt trauma among fatal cases meanwhile blunt trauma was the common type of such criminal assault among non-fatal cases. Chance of survival following blunt trauma to the head is far greater as shown in the present study, light weapons are not sufficient to inflict fatal head injury, there was significant difference between both sex regarding fatality and outcome of head injuries, increasing age associated with poor outcome, the incidence of head injuries was very high in rural areas compared with urban areas and the mortality rate in rural areas was very high due to lack of facilities and all cases were referred to contral hospitals, the comminuted skull fracture was the commonest fatal type, the extradural and subdural haemorrhage were more common among the non-fatal cases and subarachnoid haemorrhage was more common among fatal cases.