Epidemiological and clinical-pathological aspects of fasciolosis in livers of cattle slaughtered in southern Brazil / Aspectos epidemiológicos e clínico-patológicos de fasciolose em fígados de bovinos abatidos no sul do Brasil

Infection by Fasciola hepatica is an important cause of economic loss in cattle raised in Brazil and others countries. In slaughterhouses, the losses are mainly associated with condemnation of livers; however, it is believed that these losses can extend to diminished carcass yield and productivity throughout the life of the animals. Three slaughterhouses with a daily routine of approximately 15-20 cattle slaughters were monitored from July 2016 to November 2017. After sample collection, weighing, and liver assessment, statistical studies were conducted to determine disease prevalence and measurement of economic losses caused by fasciolosis through condemnation of the organ of choice of the parasite. Of the 210 livers assessed, 79 (37.6%) were condemned because of presence of F. hepatica, 87 (41.4%) were considered appropriate for human consumption, and 44 (20.9%) were considered inappropriate because of some other macroscopic lesions. The aim of this study was to estimate the prevalence of fasciolosis, correlate epidemiological and clinical-pathological aspects, and estimate the economic losses caused by the disease. It is estimated that the losses in southwestern Rio Grande do Sul state could reach R$ 36,943,532.60 (37.6%; 95% CI = 30,753,525.80 - 43,526,55.65) or US$ 11,437,626.20 (37.6%; 95% CI = 9,521,215.40 - 13,475,713.80) only because of condemnation of livers.(AU)

A infecção por Fasciola hepatica é uma importante causa de prejuízos econômicos para o setor pecuário no Brasil e em outros países. Em frigoríficos, as perdas estão relacionadas principalmente a condenação dos fígados, porém acredita-se que esses prejuízos possam se estender a perdas no rendimento de carcaça e durante a vida produtiva do animal. Durante o período de julho de 2016 a novembro de 2017 foram realizados acompanhamentos periódicos mensais em três frigoríficos, os quais, possuem uma rotina diária de aproximadamente 15-20 abates. Após a coleta de dados, pesagem e avaliação dos fígados foram realizados estudos estatísticos para determinação da prevalência e mensuração dos prejuízos econômicos causados por fasciolose pela condenação do órgão de eleição do parasito. Dos 210 fígados avaliados, 79 (37,6%) foram condenados devido a presença de F. hepatica, 87 (41,4%) foram considerados próprios para consumo humano e 44 (20,9%) impróprios por alguma outra alteração macroscópica. O objetivo deste estudo foi estimar a prevalência da fasciolose, e associar os aspectos epidemiológicos e clinico patológicos, além de estimar os prejuízos econômicos causados pela doença. Estima-se que as perdas na mesorregião Sudeste Rio-grandense possam chegar à R$ 36.943.532,60 (37,6%; IC.95% = 30.753.525,80-43.526.55,65) ou US$ 11.437.626,20 (37,6%; IC.95% = 9.521.215,40-13.475.713,80) somente devido a condenação de fígados.(AU)

A proposal for writing a better death certificate

Guidelines for writing death certificates have recently been released in various forms. However, the educational efforts of medical doctors do not seem to have led to significant improvements in the accuracy of death certificates. A death certificate can be considered as the process through which an individual's treatment sequence, and even life, is completed and summarized. Additionally, the decision about how to fill out a death certificate affects the amount of death compensation, the necessity of a legal investigation, and has implications for health care planning. However, the death certificate form used in Korea requires background knowledge of not only medicine, but also the legal system, which has placed a considerable burden on physicians in clinical practice. In addition to the continuous educational efforts of the community of physicians, other members of society should show appropriate appreciation and attention for the death investigation system. In the development of the system, the unique characteristics of the healthcare environment in Korea should be considered.

Amniotic Fluid Embolism.

Amniotic Fluid Embolism (AFE) is a potentially fatal rare obstetric complication. In this paper, the death of a 30-year old apparently healthy parturient due to AFE is reported. She underwent Lower Segment Caesarean Section (LSCS) under spinal anaesthesia but after about half an hour of the operative procedure, she developed features of Acute Respiratory Distress Syndrome (ARDS) and shock, and died within five hours of the onset of the symptoms. The sudden death of an apparently healthy parturient may lead to medical negligence claims by the relatives. In developing countries, it still remains a post-mortem diagnosis and in the present case, histopathological examination findings helped in coming to a conclusive opinion of AFE.

Post mortem study of congenital anomalies of the sternum bone.

Introduction: The sternum is one of the skeleton parts with frequent variation in appearances on images or autopsy series. Method:Present study was carried out during the year 2010 and 2011 at Department of Forensic Medicine, P. D. U. Government Medical College, Rajkot. The study was carried out to find out congenital anomalies of sternum bone recovered from the cadavers during post mortem examination. Result: Total 114 sternum bones were studied out of which 24 were having congenital anomalies either in the body of sternum or in xiphoid process. No any abnormality is found in manubrium. Sternal foramen is found in 10 cases and it is the most common form of congenital anomaly of sternum. Other anomalies are xiphoid foramen in 7 cases, fissured 4th segment in 5 cases and bifid xiphoid is found in 2 cases. Misinterpretation of autopsy findings has been a major concern to forensic pathologists. This article documents the occurrence of relatively rare congenital anomalies which may be misleading and may result in serious erroneous conclusions, particularly when evaluating skeletonised human remains. Conclusion: Presence of these anomalies and their antemortem records in the form of previous x rays make important data for the identification of skeletonised remains.

Second autopsy: The Indian scenario.

A Medico-legal autopsy is conducted to ascertain the cause of death, time of death, identification of the deceased, etc. in unnatural and/or suspicious deaths. However, the very purpose for which an autopsy is conducted may either not be served or appear to be poorly served in many a cases. In such times, another autopsy is requested and conducted on an already autopsied body commonly known as second autopsy. Rules are still unclear & varying for medico legal autopsy at different places resulting in unwarranted issues. This has resulted in a surge seen in cases of second autopsy or re-postmortem examination. With no rules governing the conduct of even a second autopsy and the sorry state of medico-legal autopsies as such in India, a lot of issues, wanted and unwanted, creep up while conduct of a second autopsy. An effort is made to draw attention towards the issues associated with the conduct of a second autopsy in India and few suggestions proposed to overcome those difficulties.

Linfadenite caseosa em ovinos deslanados abatidos em um frigorífico da Paraíba / Caseous lymphadenitis in slaughtered hair sheep in northeastern Brazil

Este trabalho teve como objetivo determinar a prevalência e distribuição de lesões da linfadenite caseosa em ovinos deslanados abatidos no município de Mulungu, Paraíba. Dos 1466 ovinos abatidos, 236 (15,9%) apresentaram lesões macroscópicas semelhantes à linfadenite caseosa. A prevalência foi maior em fêmeas, 17.9% (135/754) que em machos, 13,8% (101/732). As principais lesões estavam localizadas nos linfonodos pré-escapulares em 36,3% (97/268) dos ovinos, nos parotídeos em 22,4% (60/268) e no pré-crural em 20,9% (56/268). Somente 70 (26,1%) de um total de 268 lesões foram detectadas no exame ante mortem. Foram encontradas lesões em todos os lotes provenientes de diversos municípios da Paraíba, Pernambuco e Bahia. Das 51 amostras em que foi feito o cultivo bacteriológico, em 74,5% (43/51) foi isolado Corynebacterium pseudotuberculosis. Em 7,8% (4/51) foi isolado Staphylococcus aureus, em 2% (1/51) Escherichiacoli e 5,9% (3/51) amostras foram negativas. No exame histológico, em 11 linfonodos havia lesões da linfadenite caseosa caracterizadas por área de necrose central formada por lamelas concêntricas, com presença de grandes colônias bacterianas e focos de mineralização, rodeada por uma faixa de infiltrado inflamatório com macrófagos epitelióides e poucos neutrófilos. Na camada adjacente observaram-se linfócitos e plasmócitos e toda a lesão era delimitada por tecido conjuntivo fibroso. Nas outras 32 amostras foram observadas a maioria, mas não todas as lesões características da doença. Em 21 amostras foram encontradas células gigantes. As lesões histológicas dos linfonodos que foi isolado S. aureus foram semelhantes as da linfadenite caseosa. Conclui-se que as lesões histológicas de linfadenite caseosa são características, mas não patognomônicas, pois podem ser confundidas com lesões causadas por outros organismos piógenos e com tuberculose; portanto o isolamento bacteriológico é imprescindível para o diagnóstico definitivo da linfadenite caseosa.

The objective of this paper is to report the prevalence and distribution of lesions of caseous lymphadenitis (CL) in hair sheep slaughtered in an abattoir in the state of Paraíba, northeastern Brazil. From 1,466 sheep slaughtered, 236 (15.9%) had gross lesions similar to that of CL. The prevalence was higher in females, 17.9% (135/754), than in males, 13.8% (101/732). Ninety seven (36.3%) out of 268 lesions were localized in the prescapular lymph node, 22.4% (60/268) in the parotideal, and 20.9% (56/268) in the prefemoral. Only 70 (26.1%) out of 268 lesions suggestive of CL were detected during ante mortem examination. Caseous lymphadenitis-like lesions were observed in all flocks examined from different municipalities in the states of Paraíba, Pernambuco and Bahia. Cultures and histologic examination were performed in samples from 51 lesions. Corynebacterium pseudotuberculosis was isolated in 74.5% (43/51) samples, Staphylococcus aureus in 7.8% (4/51) samples, Escherichia coli in 2% (1/51), and in 5.9% (3/51) samples cultures were negative. Histologic findings in 11 lymph nodes showed all characteristic lesions of caseous lymphadenitis: central area of necrosis formed by concentric lamellae, with large bacterial colonies and mineralization, surrounded by an inflammatory exudate with epithelioid macrophages and few neutrophils; lymphocytes and plasma cells were observed in the next layer, and fibrous tissue was surrounding the whole lesion. Lesions in the other 32 lymph nodes showed most, but not all lesions characteristic of the disease. Giant cells were observed in 21 lymph nodes. Histologic lesions in lymph nodes from which S. aureus was isolated were similar as those of CL. These findings suggest that CL lesions are characteristic, but not pathognogmonic, because they can be confused with lesions caused by other pyogenic bacteria or tuberculosis; therefore bacteriologic examination is necessary for the diagnosis of the disease.

Res ipsa loquitor in post mortem examination.

The doctrine of Res ipsa loquitor means that “facts or thing speaks for itself”. It signifies that further details are unnecessary; the facts of the case are self-evident. This doctrine is applied when there is gross medical negligence on the part of treating doctor. It is often being presented when the damage resulted from teamwork where the doctor and some other persons were involved. In such circumstances, the doctor himself being ignorant about the cause of damage and the person actually responsible may find it difficult to prove his innocence, though he may actually be innocent. I am presenting here a case report of year 2008, which is a new type of example of Res Ipsa Loquitor in which an expert opinion was given by a board of medical doctors about medical negligence as per orders of Hon’ High Court on the basis of documents forwarded by Police.