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

comparative-study on enzymatic changes in the serum and synovial fluid at early post-mortem period

In this study, postmortem blood and synovial fluid samples were taken from 50 cadavers, from Zeinhom's mortuary. Their medico-legal reports were revised thoroughly to obtain the precise time of death. Serum and synovial fluid samples were analyzed and the levels of the following enzymes were estimated. Alkaline phosphatase [Alk. Ph], Aspartate aminotransferase [AST] Alanine aminotransferse [ALT] and Lactate dehydrogenaze [LDH]. Postmortem serum and synovial fluid samples were grouped according to postmortem interval [the time of samples withdrawal in the first twelve hours ostmortem]. This study showed that the values of Alk. Ph. AST, ALT and LDH increased progressively until 12 hours P.M. It was observed that, there was no significant difference between the mean enzyme levels in the serum and synovial fluid. It is suggested that the mean enzyme levels in the synovial fluid can be used to predict their levels in the serum with much reliability. Moreover, synovial fluid can be easily obtained and does not generate cosmetic problems. It is concluded that synovial fluid analysis can provide useful information in autopsy cases in which suitable blood or urine specimens can not be obtained