Postmortem diagnosis of diabetes mellitus: comparative study of the diagnostic value of commonly used parameters

In medico-legal practice, undiagnosed diabetes has been suggested as a possible cause of death in otherwise unexplained deaths, and the postmortem diagnosis of diabetes mellitus can be of utmost importance for confirming death from metabolic derangement, or if medical malpractice is suspected. The aim of the present work was to study and compare the usefulness of some markers to diagnose diabetes during postmortem examination, and to ascertain their sensitivity and specificity. The study was conducted on vitreous humor and blood samples collected from 68 cadavers during postmortem examination. Based on medical records, cases were classified into two groups [31 cases with previous diagnosis of diabetes mellitus, and 37 cases without such diagnosis]. Collected samples were analyzed for fructosamine in blood; glycated hemoglobin; fructosamine, glucose and lactate [to determine glucose plus lactate] in vitreous humor. The results obtained in the present study indicate that the measurement of glycated proteins [fructosamine] in vitreous and serum, glycated hemoglobin, and the combined glucose and lactate levels in vitreous humor are useful indicators for diagnosis of diabetes mellitus in postmortem settings. The differences among the discriminatory potentials of the studied parameters were not statistically significant [as determined by comparing the areas under the receiver operating characteristic -ROC- curve]. The diagnostic potential of any of the studied parameters surpasses that of glucose levels in vitreous humor

Cardiac troponins in sudden death

In the present study, serum and pericardial fluid samples were obtained from three groups of deaths: Acute myocardial infarction, other cardiac related deaths and a control group of deaths. Significantly higher serum concentrations of both cardiac troponins T and I were found in deaths due to pathologically established acute myocardial infarction. Similar significant difference was also found as regards serum troponin T levels between other cardiac related and control deaths. There were no significant differences in pericardial fluid concentrations of either marker among the studied groups. Cardiopulmonary resuscitation had no significant effects on the concentrations of both cardiac markers