1.1.6: Classroom Evidence Board by Pradipta Majumder

Anna Garcia

snfreedland — 2017-09-29 15:04:06 UTC

Recently in the hospital, but no longer taking antibiotics prescribed to her (source: Lucy Leffingwell)
Had been experiencing back pain radiating towards her sides
Age: 38 years
Race: Hispanic
Weight: 165 lbs
Height: 5'4"
Has type 1 diabetes
Has sickle cell anemia
Has been prescribed hydroxyurea and vasotec (an ACE inhibitor)
Has left ventiruclar hypertrophy
Type B blood

Alex Garcia

snfreedland — 2017-09-29 15:05:44 UTC

Alex is Anna’s former husband.
Alex and Anna went through a nasty divorce last year. As soon as the divorce was finalized, Alex quickly remarried a much younger woman.
Alex and his new wife are currently expecting a baby.
Alex is rumored to be having financial difficulties and is still the beneficiary on Anna’s life insurance plan.
Alex last saw Anna last night when he went to her house to discuss some paperwork
Alex has the sickle cell trait
Type A blood

Lucy Leffingwell

snfreedland — 2017-09-29 15:07:53 UTC

Anna’s best friend and co-owner of a local bakery.
Business has been doing very well lately, but Anna and Lucy have been arguing over whether or not to expand the business and create a sugar-free line of products. Lucy really wants to expand, but Anna refuses.
Last saw Anna at work yesterday. Anna left work a little early because she said she had something to take care of.
Lucy has been debating whether or not to buy Anna out of her half of the business. The conflict with their business arrangement has caused a lot of strife in their friendship.
Type AB blood

Doug Greene

pnmajumder — 2017-09-29 15:09:31 UTC

Doug last saw Anna when she was walking her dog at 6:30am yesterday morning.
Doug reports that Anna usually walks her dog every morning, but that recently she’s been skipping the morning walk. He stated that Anna lives alone, has no family that lives close by, and her closest companion is her dog.
Doug and Anna recently were involved romantically, but Anna abruptly ended the relationship last week.
Type AB blood

Erica Piedmont

pnmajumder — 2017-09-29 15:13:26 UTC

Erica is the new wife of Alex Garcia.
Reported that Erica was seen sitting in a car parked on the street in front of Anna’s house the day before her death.
Erica and Alex were seen at a local diner recently having a heated argument.
Type B blood

Blood evidence

pnmajumder — 2017-09-29 15:17:54 UTC

Based on blood typing and DNA analysis, the blood from the crime scene is Anna's

Crime Scene Sketch

snfreedland — 2017-09-29 15:19:27 UTC

Hair evidence

pnmajumder — 2017-09-29 15:20:55 UTC

The hair at the crime scene matches the hair of Lucy Leffingwell

Fingerprint evidence

pnmajumder — 2017-09-29 15:21:08 UTC

The fingerprint at the crime scene matches that of Alex Garcia

Shoeprint evidence

pnmajumder — 2017-09-29 15:21:26 UTC

The shoe print from the crime scene matches with a show that both Anna Garcia and Erica Piedmont own. Investigation shows that the print from the scene belongs to one of the two females.

Drug evidence

pnmajumder — 2017-09-29 15:21:37 UTC

There was a whitish powdery drug in a capsule found at the crime scene. Since this substance reacted the same way to three indicators as aspirin did, it would be safe to say that this unknown substance is aspirin.

Time of death

pnmajumder — 2017-09-29 15:21:47 UTC

Aprox. 7:00 am

blood spatter analysis

pnmajumder — 2017-09-29 15:22:01 UTC

evidence from the crime scene shows that the blood fell at a 90 degree angle onto the floor at around 80 centimeters in the air, indicating that she was probably bending down.

Theory

pnmajumder — 2017-10-02 01:41:11 UTC

Due to Anna's diabetes, there was evidence of atherosclerosis and occlusion in the right coronary artery. This caused her heart to work harder leading to concentric left ventricular hypertrophy. The stent in her left anterior descending coronary artery proved ineffective, leading to a blood clot, ergo leading to a heart attack. With the heart working in overtime, parts of her body did not receive enough oxygen. During her heart attack, she threw up and knocked over a lamp in an effort to remain upright.

DNA evidence

pnmajumder — 2017-10-11 15:06:50 UTC

DNA analysis using gel electrophoresis shows that the blood at the crime scene was Anna Garcia's

Overall Autopsy

snfreedland — 2017-10-25 15:19:17 UTC

Toxicology

No evidence of alcohol-- BAC 0.015
Trace amounts of asprin
No evidence of overdose of any sort of drugs

General Appearance

No evidence of post-mortem tampering
Rigor mortis is generalized

Clothing and Valuables

One ring on the right ring finger
Clothes are not torn but are stained with blood
Small amount of vomit on the shoulder area of the blouse

Possible Causes of Death

snfreedland — 2018-03-23 15:15:55 UTC

- Suffocation
- Kidney failure
- Ketoacidosis
- Lack of oxygen
- Blood clot: stroke, heart attack, kidney failure, accute chest syndrome
- Heart failure

Diabetes

snfreedland — 2018-04-04 14:53:47 UTC

Autopsy:

Her blood toxicology report showed that her blood glucose level was 280 mg/dL (normal range 70-125 mg/dL). It also showed that her A1C was 11% (normal range 4-6%, or <7% if diabetic).
Her stomach toxicology showed she had no evidence of toxins or poisons in her stomach, just 125 mL of partially digested food.
Her urine toxicology showed that there were ketones in the urine, meaning her body was beginning to break down fat. The microalbumin test also revealed significant protein in the urine.
Her internal examination of the gastrointestinal system shows that everything appears normal. The mucosa and esophagus wall show no signs of damage, as well as the gastric mucosa, the mucosa of the jejunum, the duodenum, and the ileum (the 3 parts of the small intestine). The mucosa of the large intestine, colon, and rectum appear normal as well.
Her internal head and neck examination show that the lens of the right eye appear cloudy, the blood vessels in both eyes are swollen, abnormal blood vessels are present on the left retina, and vision was most likely impaired. Her oral cavity also revealed significant plaque buildup on the teeth as well as several receding gums. 4-5 unfilled dental cavities were visible.
Her internal trunk examination shows that the left kidney appears pale and shows the beginning signs of necrosis, while her right kidney appears normal.

Some notable things form the medical History document (Anna's age is 14 years old) include:

Anna reports fatigue and the inability to complete her normal activities without needing rest
No matter how much she drinks, she still feels thirsty
Frequent urination
Recent weight loss, even though no factors were changed
Family history of high cholesterol and heart disease
She mentions an occasional tingling sensation in her feet and lower legs, though no signs of edema
CBC results are normal
Her routine urinalysis shows glucose in the urine

Due to her high blood sugar levels and her not returning to base level, as well as her insulin levels being low, it has been concluded that Anna Garcia had type 1 diabetes.
Possible causes of death:
Kidney failure
Ketoacidosious
Burst blood vessels possibly leading to a blood clot, ergo stroke or heart attack

Sickle cell

snfreedland — 2018-04-04 15:03:31 UTC

Autopsy:

Her external examination showed that the nails on her fingers were blue or gray in color
Her toxicology report showed she had trace amounts of Hydroxurea in her blood, which is used to treat sickle cell disease
Her hematocrit showed that Anna Garcia had an extremely low red blood cell count
Finally, Microscopic analysis showed that a good portion of her blood cells were sickled

Some notable things form the medical History document (Anna's age is a little over a year old) include:

Temperature is at 101.4°F (high)
Respiration rate is at 40 bpm (high)
Pulse is at 175 bpm (high)
she appears to be lethargic and in a lot of pain
she has pale skin
Her Gastro-Intestinal exam showed she had a bright red diaper rash and an experience of diarrhea for the past two days
there is welling in her hands and feet and she appears to have a large abdomen (indicative of splenic sequestration)
her hematocrit showed she had only a 20% red blood cell count, which is very low

Due to her low RBC count, elevated respiration rate, and swelling in hands and feet, it's very safe to say that Anna Garcia has sickle cell anemia, and can't efficiently get oxygen because of it. She could start exercising or living in hotter areas, since both of those cause veins to grow, causing easier blood flow, which would in turn allow oxygen to get to areas of the body easier

Possible causes of death:
asphyxiation (due to low oxygen)
heart attack (sickled cells cause blockage in arteries and veins)
stroke (ditto)
kidney failure (ditto)
Acute chest syndrome (ditto)

Heart Disease

pnmajumder — 2018-04-06 00:52:30 UTC

Autopsy:

Her external heart and lung examination reveal that the lungs appear normal with no infiltrates. Anna also has a pacemaker
Her internal cardiovascular system revealed concentric left ventricular hypertrophy, evidence of mild mitral valve prolapse, as well as a stent present in the left anterior descending coronary artery. However, scar tissue and clots partially occlude the lumen of the vessel. The right coronary artery is 80% occluded. Narrowing is noted in the renal and cerebral arteries; provides evidence of atherosclerosis.There is also evidence of mild peripheral vascular disease in the left leg.

Some notable things form the medical History document (Anna's age is 37 year old) include:

Anna's systolic blood pressure placed her as stage one hypertensive(140/72)
She's a non-smoker
Her diet is high in calories and fat, and she drinks three glasses of wine each day
She used to be an athlete, but has not kept up with formalized excercise
Anna takes a daily aspirin and does a Yoga home video as needed to help her deal with the stress of her illness and work
She is bradycardic-- average resting heart rate ranging from 38-45 over the course of one day
No signs of edema in her feet or lower legs, but mentions an occasional tingling in her right calf
Blood pressure values averaged 142/85 over the course of the work up (slightly high)
Slight heart murmur detected
waist circumference-- 35 inches (very large)
Patient experienced drastic increases in blood pressure white completing a treadmill stress test, as well as a few PVCs. One run of ventricular tachycardia was noted, along with mitral regurgitation
She was only able to walk for two minutes before the test was concluded-- max speed 1.7 mph at an elevation of 10%, and max blood pressure of 190/110 (dangerously high)
Angiogram revealed a blockage in the left anterior descending coronary artery. Angioplasy recommended
An echocardiogram reveals the left ventricle was slightly enlarged but still within normal limits. Slight mitral valve regurgitation was noted

Due to her high systolic pressure, Anna can be diagnosed as stage one hypertensive. It is recommended that she reduces sodium in her diet, limits her alcohol, and use some sort of ACE inhibitor to help reduce blood pressure and dilate blood vessels.

Possible causes of death:
Kidney failure (renal artery blockage)
Stroke (cerebral artery blockage)
Cardiac arrest (mostly occluded right coronary artery, mild mitral valve prolapse, left ventricular hypertrophy)
Ishemic heart disease (left ventricular hypertrophy, mild mitral valve prolapse)

Manner of Death

snfreedland — 2018-04-09 14:51:29 UTC

Natural because there was no sign that someone else was in the house when she died. Also, based on her medical history, she had lots of diseases and complications that could have led to her death

5.1.1 medical history

pnmajumder — 2018-05-08 15:07:58 UTC

5 days before her death, Anna was admitted to the hospital due to a sickle cell chrisis, where she was confined to a bed, connected to a urinary catheter.
after a few days, it was discovered that she got a urinary tract infection.
Tests performed:
colony morphology

she was found positive for a bacterial infection

gram staining

there were small colonies with wavy, irregular margins found

biochemical test

it was found that Anna was infected with serratia marcenscens

cause of death theory:
the UTI may have (if no antibiotics were not administered) spread an infection in her kidney, causing the kidney to spread the disease to the blood, causing sepsis

Cause of Death

snfreedland — 2018-05-18 15:34:50 UTC

Anna died from sudden death due to prolonged Q-T syndrome, which causes erratic heart palpitations.The Q-T was exasperated by 711.75 (1.5 pounds) grams of aspirin that she consumed in total over the span of 6 years, which caused her irregular heart rhythm to be amplified.This paired with her low potassium and magnesium levels caused a malfunctioning heart. Her high troponin levels also indicated that her heart was extensively damaged, which further weakens her heart.

Post-mortem Analysis

pnmajumder — 2018-05-21 14:56:43 UTC

Toxicological evidence Showed that Anna had consumed macrolides and fluoroquinolones. this isn't a traditional medicine to give, and it ended up that Anna had accidentally consumed a drug meant to treat her dog's skin condition. due to eating an incorrect medicine, her qt syndrome was exasperated, and she died.