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We depict an uncommon presentation of rubber toy ingestion which remained impacted in the esophagus for months, gradually eroding the mucosa, and ultimately causing a traumatic acquired tracheoesophageal fistula.

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Lower abdominal pain is a common complaint for patients presenting for evaluation in the emergency department. Among other life-threatening complications, acute appendicitis needs to be ruled out in the case of right-lower quadrant pain (RLQ). Sigmoid perforation caused by an ingested foreign body is an uncommon cause of RLQ pain. This report presents the case of an otherwise healthy, 29-year-old male who presented to the emergency department with RLQ pain. His initial evaluation raised concern for acute appendicitis. However, during his exploratory laparoscopy, he was found to have a perforated sigmoid colon due to a skewer stick; the patient had no recollection of having ingested any foreign body. This paper highlights the importance of considering the possibility of sigmoid perforation by an ingested foreign body as a possible cause of RLQ pain. The article also reviews the most common causes of ingested foreign bodies, their potential complications and management.

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Objective: To analyze the characteristics of deliberate drug ingestion in adolescents and its related influencing factors. Method: This was a retrospective study. A total of 158 cases of deliberate drug ingestion as observation group and 160 cases of other diseases in adolescents as control group were treated in the Emergency Department of Baoding Hospital of Beijing Children's Hospital Affiliated to Capital Medical University from January 2020 to December 2022. The clinical characteristics of adolescents who engaged in deliberate drug ingestion were analyzed, and various factors that could potentially influence deliberate drug ingestion in adolescents were subjected to both univariate and multivariate analysis. Result: There was a progressive increase in the number of patients presenting with mental health issues year by year. Univariate analysis showed that family type, guardian's education level, place of residence, whether they were only children, parents' knowledge of medication, awareness of medication safety, depression/anxiety, negative life events, and social support were risk factors for deliberate drug ingestion in adolescents (all p<0.05). Logistic regression analysis showed that family type, parents' knowledge of medication, awareness of medication safety, whether they were depressed/anxious, negative life events, and social support were independent risk factors for deliberate drug ingestion in adolescents (p<0.05). Conclusion: The incidence of deliberate drug ingestion in adolescents is increasing year by year, and their behavior is influenced by multiple factors. Interventions should be targeted at controllable influencing factors to prevent or reduce deliberate drug ingestion in adolescents.

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BACKGROUND: Ingestion and aspiration of orthodontic devices are rare occurrences, typically associated with components such as expansion keys, archwire segments, dislodged fixed appliances (including brackets, buccal tubes, and bands), as well as fractured metal or plastic appliances. This article describes the clinical diagnosis and treatment process of a case of accidental ingestion of a fractured piece of orthodontic aligner. CASE PRESENTATION: A 31-year-old female under orthodontic treatment by aligners accidentally ingested a fractured piece of the aligner. The special difficulty of this case is that the transparent orthodontic aligner has a low radiopacity. At the beginning, no foreign body was found in the commonly used soft tissue window, causing difficulty in its location until greyscale was adjusted to lung window. The 2-centimeter fractured piece was taken out under anesthesia and endoscopic surgery. CONCLUSION: Materials with low radiopacity should be read with a lower grayscale range. Fractured orthodontic appliances with low retention force should not continue to be worn until consultation with attending doctor.

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Seabirds have become biovectors of plastic pollutants between marine and terrestrial ecosystems, and transport of plastics to their nesting sites becomes relevant due to increasing levels of pollution. To determine the pathways by which plastic reaches their colonies, we analysed the abundance of plastics at the nesting sites of five seabird species (Humboldt penguin Spheniscus humboldti, Peruvian booby Sula variegata, kelp gull Larus dominicanus, grey gull Leucophaeus modestus, Markham's storm-petrel Hydrobates markhami) nesting in northern Chile. Seabirds were primarily grouped according to their nesting behaviour, but two species foraging in contrasting habitats (kelp gull and Markham's storm-petrel) were also compared directly. The abundance, type, and polymer of macro-, meso- and microplastics were analysed in the soil of colonies and control sites, and microplastic ingestion was evaluated for selected species. Densities of plastics in colonies of surface-nesting seabirds ranged from 0 to 21.4 items m-2 (mainly plastic bags and thin films), and 0.002 to 19.7 items m-2 (mainly hard fragments) in colonies of burrow-nesting seabirds. Mean microplastic loads in the stomachs of seabirds were between 3.7 ± 4.2 plastic items individual-1. Overall, the abundances of plastic items in all seabird colonies were low, suggesting a limited transfer of plastics from sea to land. For kelp gulls, the results indicate transfer of macroplastic items to colonies, reaching the colony via regurgitates, with landfills considered as the main plastic source. Our results suggest that contrasting nesting behaviour and foraging habitats among species can explain differential plastic accumulation in seabird colonies, but also other factors, such as wind, contribute to the accumulation of plastic debris in colonies. Proper management of sanitary landfills are key to reduce plastic contamination of coastal seabirds and their colonies.

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Microplastics have become ubiquitous in the global marine environment, posing substantial influences on marine organism health, food web function and marine ecosystem structure. Protozoan grazers are known for their ability to improve the biochemical constituents of poor-quality algae for subsequent use by higher trophic levels. However, the effects of microplastics on the trophic upgrading of protozoan grazers remain unknown. To address this knowledge gap, the ciliate Euplotes vannus and the heterotrophic dinoflagellate Oxyrrhis marina were exposed to microplastic particles (5 µm) for four days with various concentrations (1-20 mg/L). Both O. marina and E. vannus ingested microplastics. At the exposure level of 20 mg/L, the ingestion rate, growth rate, biovolume, and carbon biomass of E. vannus were significantly decreased by 28.18 %, 32.01 %, 30.46 %, and 82.27 %, respectively, while such effects were not observed for O. marina. The contents of highly unsaturated fatty acids in O. marina and E. vannus on a mixed diet of microplastic particles and green algae significantly reduced by 8.66 % and 41.49 % relative to feeding only on green algae, respectively. Besides, we also observed an increase in the composition of C18:3 (ω-3) and C20:3 (ω-3) concurrence with a significant decrease in C16:0 and C18:0 in E. vannus after 96 h exposure at 20 mg/L. These results indicate that microplastics can weaken trophic upgrading of the nutritional quality by protozoan grazers, which may consequently alter the function of food webs.

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Individual coral polyps contain three distinct components-the surface mucus layer, tissue, and skeleton; each component may exhibit varying extent of microplastic (MP) accumulation and serve as a short- or long-term repository for these pollutants. However, the literature on MP accumulation in wild corals, particularly with respect to the different components, is limited. In this study, we investigated the adhesion and accumulation of MPs in four coral species, including both large (Lobophyllia sp. and Platygyra sinensis) and small (Pocillopora cf. damicornis and Porites lutea) polyp corals collected from Si Chang Island in the upper Gulf of Thailand. The results revealed that MP accumulation varied significantly among the four coral species and their components. Specifically, P. cf. damicornis exhibited the highest degree of accumulation (2.28 ±â€¯0.34 particles g-1 w.w.) [Tukey's honestly significant difference (HSD) test, p < 0.05], particularly in their skeleton (52.63 %) and with a notable presence of high-density MPs (Fisher's extract test, p < 0.05). The most common MP morphotype was fragment, accounting for 75.29 % of the total MPs found in the coral. Notably, the majority of MPs were black, white, or blue, accounting for 36.20 %, 15.52 %, and 11.49 % of the samples, respectively. The predominant size range of MP particles was 101-200 µm. Nylon, polyacetylene, and polyethylene terephthalate (PET) were the prevalent polymer types, accounting for 20.11 %, 14.37 %, and 9.77 % of the identified samples, respectively. In the large polyp corals, while MP shapes, colors, and sizes exhibited consistent patterns, remarkable differences were noted in the polymer types across the three components. The findings of this study improve the understanding of MP accumulation and its fate in coral reef ecosystems, underscoring the need for further investigation into MP-accumulation patterns in reef-building corals worldwide.

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Microplastics (MPs) are becoming increasingly common in freshwater ecosystems. Rotifers may involuntarily ingest MPs through non-selective filtration, thus causing non-real satiety, leading to adverse effects on their demography. Here, we evaluated the acute and chronic effects of MPs (30 µm) on two successive generations of Brachionus calyciflorus s.s. at 20 and 25 °C. Demographic variables and ingestion rates were compared in the absence and presence of microplastics (550 spheres mL-1). For the life table experiments, cohorts of twenty neonates were introduced into 20 mL medium with four replicates per treatment. Ingestion rates of the rotifer were tested at both test temperatures in the absence and presence of the microplastics in 20 mL containers with 1 ind. mL-1 per container. The rotifer population growth rates ranged from 0.55 to 1.05 d-1 depending on the treatment. MPs decreased the fecundity by 20-24 %. The average lifespan of rotifers exposed to MPs in the F0 generation was lower than that in the F1 generation at both temperatures, indicating that pre-exposure of mothers may offer some protection to the offspring. The population growth rate was higher at 25 °C. The ingestion rates were significantly lower in the presence of the microplastics. Our observations indicated that this strain of B. calyciflorus was better adapted to 20 °C; microplastics and higher test temperature resulted in a pronounced changes in the demographic variables of the rotifer.

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During the current opioid epidemic, the number of children with illicit toxic ingestions is increasing. Children presenting with altered mental status and neurologic, particularly cerebellar symptoms of unclear etiology, should be considered to undergo brain imaging as well as toxicology screening to not miss the possible complication of acute toxic leukoencephalopathy. We report the case of an eight-year-old child who presented with somnolence and respiratory depression of unclear etiology, responding profoundly to naloxone, quickly raising concern for drug ingestion. The toxicology screen was positive for fentanyl, cocaine metabolites, caffeine, and diphenhydramine, but not available until day 3 of the hospital stay. In the interim, head CT and brain MRI findings revealed concerning bilateral cerebellar hypodensities, suggestive of opioid-induced leukoencephalopathy. This condition has been described as potentially malignant and fatal, but very few cases of this pathology have been described in children so far. Fortunately, all neurological symptoms in our patient, including altered mental status, respiratory depression, atactic gait, blurry vision, and lower extremity pain, completely resolved within five days of presentation and the patient seemingly underwent a full clinical recovery without residual symptoms. Awareness and prompt recognition of acute toxic leukoencephalopathy in children presenting with altered mental status or neurological symptoms of unclear etiology is of utmost importance to prevent deterioration and optimize treatment, especially during times of a worsening opioid epidemic in our country.

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Marine plastic pollution is well described by bioindicator species in temperate and polar regions but remains understudied in tropical oceans. We addressed this gap by evaluating the seabird Barau's petrel as bioindicator of plastic pollution in the South-West Indian Ocean. We conducted a multifaceted approach including necropsies of birds to quantify plastic ingestion; GPS tracking of breeding adults to identify their foraging areas; manta trawling of plastic debris to measure plastic pollution at sea and modelling of plastic dispersal. We developed a spatial risk index of seabird exposure to plastic ingestion. Seventy-one percent of the analysed birds had ingested plastic. GPS tracking coupled with manta trawling and dispersal modelling show that adults consistently foraged at places with high level of plastic concentration. The highest ingestion risk occurred in the northwest of Reunion Island and at latitude 30°S. Our findings confirm that Barau's petrel is a reliable bioindicator of plastic pollution in the region.

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A large Argentine tegu (Salvator merianae) presented with anorexia. Initial radiographs revealed a metallic foreign body in the stomach. The tegu vomited and became inactive two days later. A follow-up radiograph revealed the persistence of the foreign body in the same region. The foreign body was identified as a cluster of multiple magnets resembling neodymium magnets reported missing by the owner. An emergent laparotomy was performed due to gastrointestinal perforations caused by the multiple magnets. The surgical intervention revealed perforations in the walls of the stomach and small intestine and progressing acute peritonitis. Three magnets were extracted from the abdominal cavity and the tegu showed recovery. At 200 days postoperatively, the tegu continued to demonstrate good appetite and energy levels.

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The ingestion of magnets used in toys and household products is a common problem in children and can have potentially devastating health consequences. The attraction between multiple magnets across intestinal walls can lead to bowel obstruction, fistula formation, necrosis, and perforation of the involved segments. Multiple magnets attached to each other within the intestinal lumen can also pass spontaneously. Clinical and radiological findings help guide the clinician in deciding whether to intervene surgically or follow an expectant management plan. We report the radiological finding of a "signet ring" on a plain abdominal X-ray that was associated with the surgical finding of fistula formation in two patients, who had clinically benign exams after magnet ingestion. This finding on plain abdominal X-rays should warrant operative exploration in children after magnet ingestion.

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Multiple toxic exposures are increasing nowadays. In cases of acute poisoning involving multiple agents, there is a potential for additional toxicity that goes beyond the effects and toxicity of each drug. Very scarce studies have investigated the problem of multiple toxic exposures where the information on drug-drug interactions (DDIs) originates from clinical experience, which is inconclusive and cannot be generalized to patients. Therefore, the current study aimed to explore the influence of co-ingestion on the clinical presentation of exposed patients and to identify the common associated DDIs and their effect on poisoning outcomes, including the need for mechanical ventilation (MV), intensive care unit (ICU) utilization, and prolonged hospital stay. The current study is a retrospective cross-sectional study that was conducted using medical records of 169 adult patients admitted to a poison control center and diagnosed with acute drug poisoning. Of them, 40.8 % were exposed to multiple drugs. The total number of drugs reported in the current study was 320 preparations, with an average of 1.9 drugs per patient. There were about 726 potential DDIs; more than half of these interactions were significant (n = 486). Antidepressants and psychotropics showed the highest total number of DDIs. Patients with multiple ingestion were significantly older and this pattern of exposure was more frequent among suicidal attempters, substance abusers, cardiac patients, and patients diagnosed with neurological and psychological problems. Moreover, patients with multiple ingestions showed severe presentations indicated by higher grades of Poison Severity Score and lower Glasgow Coma Scale. Multiple ingestion was associated with higher liability for MV, ICU admission, and prolonged length of hospital stay (p < 0.001). There was a significant moderate direct correlation between the number of drugs consumed and the number of resulting DDIs (r = 0.542, p < 0.001). There was a significant direct correlation between the occurrence of significant chronic/chronic drug interactions from one side and the history of substance abuse (r = 0.596, p = 0.041) and psychological illness (r = 0.662, p = 0.019) from the other side. Moreover, significant acute/acute drug interactions were correlated with being male (r = 0.969, p < 0.001) of older age (r = 0.672, p = 0.024). Similarly, significant acute/chronic drug interactions were moderately correlated with being a male (r = 0.692, p = 0.013). The presence of epilepsy and psychological problems were the main significant predictors of multiple acute toxic exposures. Among the patients exposed acutely to more than one agent who were on long-term treatment, exposure to three drugs or more could significantly predict the need for MV with excellent area under the curve (AUC) of 0.896 and 77.0 % accuracy. Moreover, and it was a fair predictor of ICU admission (AUC = 0.625), with an 88.9 % ability to exclude patients unlikely to need ICU admission. Particular attention should be paid to the patients at risk of potential DDIs. When prescribing drugs, the minimum number of drugs with the lowest effective doses, and minimal potential DDIs should be prioritized.

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BACKGROUND:  Physicians often focus on possible cardiac causes in patients presenting with chest pain. However, this case highlights a patient who presented with chest pain caused by ingestion of a foreign body after an uneventful meal eaten an hour prior to presentation. The fishbone was discovered after imaging. The article aims to raise awareness regarding the potential origins of chest pain, highlighting that it may stem from non-cardiac conditions. METHODS:  The methodology employed in this study involved conducting a case study that meticulously examined the repercussions and management strategies associated with foreign body ingestion. RESULTS:  The case report delineates the scenario of a 27-year-old male patient who inadvertently ingested a fishbone during a routine meal. It details the swift decline in clinical status, the meticulous diagnostic procedures employed, the subsequent management strategies implemented and the ultimate discharge of the patient in a stable condition. CONCLUSION:  This case highlights the importance of comprehensive history taking and considering a wide range of causes of chest pain when evaluating a patient. The foreign body ingested with the resulting cardiac complications could have been fatal if not promptly diagnosed.Contribution: This study contributed to advancing awareness surrounding foreign body ingestion, shedding light on potential complications and offering valuable insights into effective management strategies.

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The use of pyrethroids in aquaculture has been an important component of achieving a thriving salmon farming industry in Chile. While the residual presence of such substances is known to depend on environmental conditions, most ecotoxicological studies to date have not considered environmental context. Here, we conducted oceanographic monitoring combined with experiments aiming to estimate the effects of two pyrethroids on the feeding rates of larvae of farmed mussels, Mytilus chilensis. In additional experiments, mussel spats were exposed to both pyrethroids, but under contrasting temperature/pH so as to mimic winter and summer conditions. Experiments mimicking spring conditions revealed that both pyrethroid substances affected the feeding of mussel larvae as a function of concentration. Conversely, significant impact of pyrethroids on adults were not observed with regard to temperature and pH, but a significant impact of low temperature/low pH condition on ingestion rates was confirmed. Given the current status of increasing ocean acidification, the results of this study are expected to provide useful information with regard to achieving sustainable mussel aquaculture, especially considering both activities occur in similar geographic areas, and the expansion of salmon farming areas is ongoing in Chile.

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Elephant ear plants are popular ornamental plants renowned for their large foliage. These plants have been implicated in various inadvertent and deliberate ingestions. The leaves and roots of these plants contain raphides, which are needle-shaped calcium oxalate crystals. Ingestion of these crystals results in a localized inflammatory response, typically manifesting as irritation, edema, hypersalivation, and dysphagia. Herein, we describe a case of an older gentleman who presented to our institution following intentional ingestion of the leaves and roots of an elephant ear plant. This report describes the clinical manifestations secondary to the toxicities related to the ingestion of this plant and displays the successful conservative management approach employed following multiple diagnostic studies.

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Background: Due to the copious disposal of plastics, marine ecosystems receive a large part of this waste. Microplastics (MPs) are solid particles smaller than 5 millimeters in size. Among the plastic polymers, polystyrene (PS) is one of the most commonly used and discarded. Due to its density being greater than that of water, it accumulates in marine sediments, potentially affecting benthic communities. This study investigated the ingestion of MP and their effect on the meiofauna community of a sandy beach. Meiofauna are an important trophic link between the basal and higher trophic levels of sedimentary food webs and may therefore be substantially involved in trophic transfer of MP and their associated compounds. Methods: We incubated microcosms without addition of MP (controls) and treatments contaminated with PS MP (1-µm) in marine sediments at three nominal concentrations (103, 105, 107particles/mL), for nine days, and sampled for meiofauna with collections every three days. At each sampling time, meiofauna were collected, quantified and identified to higher-taxon level, and ingestion of MP was quantified under an epifluorescence microscope. Results: Except for Tardigrada, all meiofauna taxa (Nematoda, turbellarians, Copepoda, Nauplii, Acari and Gastrotricha) ingested MP. Absorption was strongly dose dependent, being highest at 107 particles/mL, very low at 105 particles/mL and non-demonstrable at 103 particles/mL. Nematodes accumulated MP mainly in the intestine; MP abundance in the intestine increased with increasing incubation time. The total meiofauna density and species richness were significantly lower at the lowest MP concentration, while at the highest concentration these parameters were very similar to the control. In contrast, Shannon-Wiener diversity and evenness were greater in treatments with low MP concentration. However, these results should be interpreted with caution because of the low meiofauna abundances at the lower two MP concentrations. Conclusion: At the highest MP concentration, abundance, taxonomic diversity and community structure of a beach meiofauna community were not significantly affected, suggesting that MP effects on meiofauna are at most subtle. However, lower MP concentrations did cause substantial declines in abundance and diversity, in line with previous studies at the population and community level. While we can only speculate on the underlying mechanism(s) of this counterintuitive response, results suggest that further research is needed to better understand MP effects on marine benthic communities.

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Morgagni hernia (MH), also known as a retrosternal or parasternal hernia, is a rare type of congenital diaphragmatic hernia (CDH) characterized by a defect in the anterior diaphragm. Patients with late-diagnosed MH typically present with vague gastrointestinal or respiratory symptoms. In some instances, MH is incidentally identified through chest X-rays performed for other reasons, such as foreign body ingestion, as illustrated in our presented case. We present a case of a delayed congenital diaphragmatic hernia of the Morgagni type in a two-year-old boy with a history of foreign body ingestion and severe abdominal pain. Diagnostic imaging, including chest radiograph and computed tomography (CT) scan, confirmed the diaphragmatic defect. Surgical repair, performed laparoscopically, resulted in an uncomplicated postoperative course and a favorable long-term outcome.

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Key Clinical Message: It is important to note that prevention of button battery ingestion is the most effective way to reduce its incidence and complications. This is unachievable without providing educational plans for parents. Moreover, triage nurses and first-line staff who take the history of patients and physicians should take the history to evaluate the risk of battery ingestion. Plain radiographs can be helpful in this matter, as the presence of "Hallow" and "Steep" signs in the anteroposterior and lateral views, respectively, can help. Abstract: Foreign body ingestion is a relatively common occurrence in pediatrics, especially among children 1-3 years of age. Although most cases are benign and managed conservatively, those with high-risk subjects such as button batterie can bring about fatal conditions in the minority of cases. In the present study, the history, diagnostic, and therapeutic procedures of a 13-month-old baby with the final diagnosis of button battery ingestion are presented. The parents ignored the symptoms, suspecting that it was a viral infection. The evaluations showed that a battery was lodged in the middle part of the thoracic esophagus, which was removed by an urgent endoscopic procedure. The patient was under observation and on a nothing-by-mouth diet for a week, receiving nutritional fluid with a nasogastric tube. The necrosis, which was obvious after the removal of the battery, was healing in the second control esophagogastroduodenoscopy performed 1 week after the procedure. The stricture was minimal, and no need for dilation was diagnosed. This case report underscores the importance of a timely diagnosis and removal of these cases. This case underscores the importance of the timely presentation of these cases to health care and the risk of delayed removal, such as necrosis, forming fistula, and perforation of the esophagus. The delay can cause necrosis, fistula, and perforation and might lead to irreversible severe complications and even death.

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Background: Nowadays it is estimated that worldwide more than 700 000 people die by suicide every year and a greater amount attempt this practice. Suicide is the fourth cause of death among 15-29 years old people. Sodium Hypochlorite (NaOCl) is used in household and com-mercial bleaches and due to its easy availability, accidental exposure to or intentional ingestion of NaOCl occurs frequently. In most cases health effects are only transient but if the subject ingests a large amount of this substance, this can generate severe consequences as oesophageal or stomach lesions and electrolytic imbalance. In the present study we analyse a rare case of suicide by fatal ingestion of bleach. Case Report: Case of a caucasic 47 years old woman with a background of several suicide attempts by exogenous substance ingestion that was found death alone in her apartment. The purpose of our investigation was identifying the cause of death. A rigorous and multidisciplinary methodological approach was adopted, including an accurate judicial inspection of the environment, an anamnestic collection, an autoptic procedure completed by macro and microscopic examinations of internal organs and a toxicological examination of biological fluids. Furthermore, a literature overview of similar cases was carried out. The resulting evidence demonstrates that woman's death occurred after a massive bleach ingestion. Conclusions: This case report highlights the importance of forensic methodology in investigating the ingestion of exogenous substances. Crime scene investigation, a detailed post-mortem examination, toxicology and a complete histopathological study are mandatory to solve the enigma.

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