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-A healthy and strict diet would have allowed Anna's digestive system to have the necessary nutrients in order to live a healthier life and balance her cholesterol and blood.
-Limiting her intake of alcohol would have minimized the risk of cardiovascular problems. Plus, alcohol causes the liver to have inflammation and the immune system to weaken.
-An active lifestyle would have allowed Anna's heart rate elevate to healthy levels, blood pressure to be good. also, her cardiovascular system would have functioned well and minimize the risk of strokes

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The cause of death can now be determined as an ischemic stroke. An ischemic stroke can happen when there is an obstruction in a blood vessel that is supplying blood to the brain. There are many factors that could have contributed to her death. Anna's familial hypercholesterolemia state at age 37 contained high levels of cholesterol which would have formed plaques. This could have caused a stroke. The spleen and coronary artery show signs of occlusion which could have resulted from buildup in the blood caused by sickle cell anemia. Her sedentary state and high intake of calories and fats made her blood pressure and cholesterol high. This makes her susceptible to a stroke or state of dismay The digestive and urinary system were affected in the manner that she had high blood pressure and high blood sugar which may cause blood clots, Thebacteria Anna contracted, weakens the immune system and creates difficulty to breathe. The way Anna Garcia took three glasses of wine made her have the possibility of having a rise in blood pressure and resulting in heart faiilure or a stroke. Also the side that Anna's face landed on showed signs of numbness and a consistent external abrasion (6.1.2 Autopsy Report). And igns of hemorrhage and necrosis, as well as enlarged spleen, show signs of possible rupture caused by a blood clot.

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-Anna was admitted into the hospital due to sickle cell crisis where the pain in her legs was so bad she required a urinary catheter. Anna experienced a bacterial infection (E. Coli) due to the catheter.
-the morphology of

cellular colonies grown in cultures: wavy, convex/raised, red/pink, and small. These

characteristics completely match with only one bacteria, Serratia marcescens

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angiogram test, scans revealed a blockage in her left anterior descending coronary artery. Along with angiogram, stenting is suggested.
-family has history of heart attaks
-she eats unhealthy and does not excerise

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Anna Has FH which means she has always had high cholesterol.
Her dad didnt have it but her mom did and she was unlucky.
-Genotype for familial hypercholesterolemia: Ff

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Total Cholesterol – 389 mg/dL HIgh
LDL – 243 mg/dL HIGH
HDL – 60 mg/dL HIGH
Triglycerides – 145 mg/dL
Fasting blood sugar – 85 mg/dL
Hemoglobin A1c – 7.1%

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-reveals that Anna had an angioplasty performed due to her EKG changes. The angioplasty scans revealed a blockage in the left anterior descending coronary artery.
-is tachycardic; average resting heart rate ranged from 90-105 over the course of the day.
-blood pressure stage 1
- Hypertensive crisis (emergency needed)
Possible cause of death: heart disease.

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Evidence of statins, equivalent to 40mg/day. NOTE: A prescription bottle for Vasotec, an ACE inhibitor, was found at the scene, although there is no evidence of this drug in the blood. The decedent most likely had not taken this medication for at least 3-4 days.
Blood glucose level 280 mg/dL (normal range 70-125 mg/dL)

-Statins are used to lower choletesterol levels.
-Examination of the heart revealed concentric left ventricular hypertrophy. There is also evidence of mild mitral valve prolapse (this means that the mitral valve does not close properly).
-Possible cuases of death:
High blood sugar contributed to blood vessel clogging (atherosclerosis) which could have lead to a stroke.

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-had to go to the doctors a lot to treat her pain due to sickle cell disease.
-took medications everyday
-had chest pains, leg pain.
-Doctor  did a Transcranial Doppler to see if Anna had any  problems with blood in her brain.
-started taking hydroxyeau at 17
-thevround ball part of her bone is all rough and jagged. The doctor says that basically, the bone is dying (causing her joints to collapse) because the main artery that supplies the blood to the bone has been blocked again and again by the sickle cells.
-if pregnant could pass the disease on to her baby

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Diagnosed with sickle cell anemia at a young age

Severe anemia

Splenic sequestration (sickling in the splenic vein resulting in a collection of a large amount of blood in the spleen).

Above average heart rate

Test Results:

Red Blood Cell Count reduced levels

White Blood Cell Count increased levels

Lower than normal hematocrit

Blood oxygen lower than normal levels

37 year old Hispanic woman with both Type 1 diabetes and sickle cell disease

incidents of self-resolved chest pain

Unhealthy lifestyle

family history of early heart disease as well as uncontrolled hypertension

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-Age: 38 years old
-Height: 64 in
Weight: 165lbs
-Race: Hispanic
-Sex: Female

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My theory, as of right now, is that Anna Garcia's cause of death was natural/accident. Anna Garcia could have been having some diabetic problems also when she entered the house, she could have been nauseous and sick, which explains the vomit. A common way people treat diabetes is with aspirin, which was found in Anna Garcia's body. Poor blood circulation also be caused buy diabetes. Since Anna was found with trace amounts of aspirin in her system she most likely tried to inject aspirin into her leg (the poor blood circulation can cause cramping), that would explain the syringe and medicine on the ground. The nausea could have caused Anna Garcia to fall, and hit her head on the chair/table, and become unconscious. Without immediate medical aid, Anna's lack of blood flow could have stopped the oxygen getting to her brain, and killed her.

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-After being cut by restriction enzymes, DNA fragments remain mixed in solution and are undistinguishable from one another. The fragments need to be separated in order to be compared when we put them through the agarose gel.
-Since DNA has a negative charge,  we separated the DNA fragments by applying an electric current to the gel. This means that the DNA will migrate toward the positive pole when it is placed in an electric field.
-DNA analysis concluded that it was Anna Garcia's DNA, therefore we can exclude Alex Garcia.

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Scenario #1 (Anna, age 16)
-felt dizzy
-trembling and clammy by end of soccer game.
-felt weak and her vision was blurry.
-passed out and she had a brief seizure in the ambulance.
Scenario #2 (Anna, age 25)
-had to go to the bathroom quite often
-drank tons of water throughout the day, but attributed her thirst to the heat and humidity.
-felt like she was getting the flu.
-she was confused and disoriented and was beginning to speak incoherently
Scenario #3 (Anna, age 29)
-felt a bit dizzy. She immediately drank a juice box that was in her purse and she soon felt back to normal.

-Excessive thirst and increased urination are common diabetes signs and symptoms. When you have diabetes, excess glucose builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess glucose.When your kidneys can't keep up, the excess glucose is excreted into your urine, which makes you dehydrated. This will usually leave you feeling thirsty. So she was drinking more to quench her thirst so she was urinating a lot.

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-Temperature:98.7 °F
-Age: 14
-Blood Pressure: 110/72
-Pulse: 75 bpm
-Weight:103 lb
-Respiratory Rate:22 bpm
-Glucose in urine
-Excessive thirst and urination

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Laboratory Results

Toxicology

1. Blood

No evidence of alcohol.

No evidence of non-prescription drugs or overdose of prescription drugs.

Blood glucose level 280 mg/dL HIGH

A1C - 11%

2. Urine

No evidence of non-prescription drugs or overdose of prescription drugs.

Microalbumin test reveals significant protein in the urine.

Ketones in urine.

-The day before she died she was eating a lot of sugary foods which correlates to her glucose levels to be high.
-Possible causes of death: diabetic coma because of the high blood sugar, where she passed out hitting her head on the table

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Laboratory Results

Toxicology:

1. Blood

No evidence of alcohol.

No evidence of non-prescription drugs or overdose of prescription drugs.

Blood glucose level 280 mg/dL (normal range 70-125 mg/dL)

2. Stomach Contents

No evidence of toxins or poisons.

125 mL of partially digested food present.

Internal Examination:

Gastrointestinal System

The mucosa and wall of the esophagus are intact and gray-pink, without lesions or injuries. The gastric (stomach) mucosa is intact and pink without injury. The mucosa of the three parts of the small intestine, the duodenum, the jejunum, and the ileum, and the mucosa of the large intestine, the colon and rectum, appears normal. Approximately 125 ml of partially digested semisolid food is found in the stomach.

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Physical Examination Results

External Examination

Nails on fingers blue/gray in color.

Laboratory Results

Toxicology

1. Blood

Hydroxyurea, trace amounts – used to treat Sickle Cell Anemia.

-Hydroxyurea was the medication Anna was using to treat Sickle Cell Anemia. This medication helps with the painful episodes that come with the disease.
-It raises the level of HbF and the hemoglobin level.
-Blood cells were sickle shaped becasue of Sickle Cell Anemia which can cause blood clots and lead to strokes.

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1. Lucy Leffingwell: Anna's best friends. Co-owner of bakery with Anna. Recently Lucy and Anna have been arguing over business (Lucy considering buying Anna out of her share of the business)
2. Erica Piedmont: New wife of Alex Garcia. Seen sitting in a parked car on the street of Anna's house on the night of her death. Alex and Erica seen having a heated argument at a local diner recently
3. Doug Greene: Anna's neighbor and friend. Called the police. Last saw Anna walking her dog at 6:30 am yesterday morning. Involved w/ Anna romantically (ended abruptly last week)
4. Alex Garcia: Anna's former ex husband (nasty divorce last year)
Alex's wife is Erica Piedmont (expecting a baby)Has financial difficulties (beneficiary on Anna's health insurance plan)

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-Anna has too many calories per day.
- She is under in her vegetable intake, her fruit intake, her protein foods, and under in her Vitamins and magnesium intake, as well as her fiber.
-She is over in her refined grain intake and empty calories, as well as her sodium intake.
-Despite her being Diabetic, Anna did not eat that well and was not getting enough nutrients or enough of good foods.
-Starch: positive
-Protein: positive
-Glucose: positive
-Lipids: negative

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Anna Garcia was found dead on the morning of August 25 but she had actually died at approximately 7:00 am on the same day. (4 hours)

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-Anna has no insulin in her body which means she has Type 1 Diabetes.
- Anna's glucose tolerance test showed that her glucose level goes above the baseline and takes a while to come back down so we can conclude that she is diabetic.

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-Hot 92 degree F morning
-call came in at 9:45 am from Doug Greene who was worried about his neighbor Anna Garcia (dog had been barking for two hours).
-Doug last saw Anna on August 24 at 6:30 am walking her dog (wearing a sweater even though they were in a heat wave).
-EMT arrived on seen at 9:56 am.
Anna Garcia found lying face down in the 10ft by 11ft entryway.

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The diameter of the largest blood spatter found at the crime scene measured in at 17 mm, meaning the blood droplet fell from a height of 70 cm (almost the exact height of the cart found at the crime scene that had blood smears on it).  Maybe she hit her head on the cart and fell?

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1. Unknown Substance: Aspirin
2. Blood Type: B
3. Hair: Anna Garcia's
4. Fingerprint: Alex Garcia's
5. Shoe print: Anna Garcia's

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Anna's overall diet was not good for a diabetic person. She was under her vegetable and fruit intake. As well as not getting enough good fats and too many unhealthy fats. She was overeating and eating too many sugary foods that were not giving her proper nutrients. The day before she died she ate terribly:
Sunday – August 12 th

Breakfast

1 cup Cheerios

½ cup skim milk

½ cup blueberries

Lunch

1 cup low-fat strawberry yogurt

6 Ritz crackers

1 cup canned, low-sodium vegetable soup

1 12 oz can cola

Snack

1 single serving bag potato chips

Dinner

2 slices thick crust pepperoni pizza (14" pizza)

2 cups tossed salad

4 tbsp. Caesar dressing

Dessert

1 cup vanilla ice cream with ½ cup mini marshmallows

5 Oreo cookies

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1. General Appearance: No evidence of post-mortem tampering and rigor-mortis is generalized.
2. Clothing and Valuables: One ring on the right ring finger. Clothes stained with blood but not torn. Small amount of vomit is present on shoulder of blouse.
3. Extremities: Symmetrical and without abnormalities. Ankles are swollen and signs of fluid are positive. Fingernails are graying (low oxygen). Bone break in her shoulder.
4. Trunk:  Abdomen is sticking out/bloated. NO visible sign of trauma.
5. Head and Neck: Injury to the right temple, open wound where post-mortem bruising is evident.
6. Toxicology: No evidence of alcohol. Trace amounts of acetylsalicylic acid present. No evidence of overdose of drugs.
7. Manner of Death: Accident or Naural.
8. Possible Causes of Death: Infectious disease, allergic reaction to drugs,  Cardiovascular disease, head injury.