Morphological Patterns of Traumatic Head Injury in Medicolegal Autopsies at Muhimbili National Hospital, Dar ESSalaam Tanzania

Introduction: Head injury is predicted to surpass many diseases as a major cause of death and disability by the year 2020. There is a limited documentations on morphological patterns of traumatic Head Injury and its prevalence specifically in Medical legal Autopsy in Tanzania population. The aim of this study was to determine the morphological patterns of Traumatic Head Injury (TBI) in Medical legal autopsies seen at Muhimbili National Hospital (MNH). Subjects and Methods : This was a hospital based cross -sectional study conducted at MNH mortuary. The postmortem examination was performed under Virchow method on 170 cases of TBI in which morphological patterns of TBI was recorded. Proportional of TBI frequencies on various morphological patterns in medical legal autopsies were recorded. Association between cause of death and etiology of TBI were established by Fisher - exact test.Results:The proportion of TBI among the medico - legal autopsy at MNH was 38.5%. All cases of TBI had scalp abrasion, and the majority had linear fra cture 67(39.3%) and the commonest the parietal bone was commonly affected 85(55.6%). In closed TBI, majority had subarachnoid hemorrhage130 (84.9%). All cases of T BI had brain edema, with one coincidental finding of metastatic adenocarcinoma. A total of 42 cases of TBI had brain herniation, 51 brain laceration and 52, had brain contusion. The association between etiology of injury, wearing helmets among motor cycle user and cause of death was statistically significance (p<0.05). Conclusion:The higher pro portion of TBI among medicolegal autopsies at MNH reflects the burden of head injury in our settings.

Embolismo graso fulminante por lipoinyección glútea. Reporte de un caso con enfoque Médico Legal / Fulminant fat embolism due to gluteal lipoinjection. Report of a case with a Medical Legal approach

Resumen La liposucción es uno de los procedimientos estéticos que se realizan con mayor frecuencia a nivel mundial, con una baja incidencia de complicaciones y una mortalidad de 20 por cada 100 000 procedimientos y cuando se realiza en conjunto con una lipoinyección glútea la principal causa de muerte el embolismo graso. Se presenta el caso de una femenina de 32 años, sin patologías crónicas conocidas, la cual se asistió a un centro médico para que le realizaran una liposucción con lipoinyección glútea y falleció casi al finalizar la cirugía; en la autopsia Médico Legal se observó la presencia de material de aspecto adiposo en el tronco principal de la arteria pulmonar y en sus ramificaciones, en las cuales se obstruía por completo el lumen, mediante un estudio histopatológico se confirmó el diagnostico de embolismo graso, el cual se estableció como causa de muerte. Se realizó una revisión de la literatura sobre embolismo graso asociado a liposucción con lipoinyección glútea.

Abstract Liposuction is one of the most frequently performed cosmetic procedures worldwide, with a low incidence of complications and a mortality of 20 per 100 000 procedures, and when it is performed in conjunction with gluteal lipoinjection, the main cause of death is fat embolism. This article presents a case of a 32-year-old female, with no known chronic pathologies, who was attended at a medical center to undergo liposuction with gluteal lipoinjection and died almost at the end of the surgery; In the Medico-Legal autopsy, the presence of adipose-like material was observed in the main trunk of the pulmonary artery and in its ramifications, in which the lumen was completely obstructed, a histopathological study confirmed the diagnosis of fat embolism, which was established as the cause of death. A review of the literature about fat embolism associated with liposuction with gluteal lipoinjection was made.

Muerte súbita por miocarditis aguda asociada al virus influenza tipo B. Reporte de un caso / Sudden death due to acute myocarditis associated with influenza type B virus. Case report

Resumen La miocarditis es una inflamación del miocardio causada principalmente por infecciones virales, dentro de las cuales se encuentra el virus Influenza tipo B. Su presentación clínica varía desde individuos asintomáticos o con síntomas leves e inespecíficos a una miocarditis fulminante e incluso muerte súbita. La principal consecuencia a largo plazo es una miocardiopatía dilatada con insuficiencia cardiaca. Se presenta el caso de una femenina de 17 años, sin patologías crónicas conocidas, la cual presentó un cuadro viral de dos días de evolución y luego falleció de manera súbita; en la autopsia médico legal se documentó mediante estudios histopatológicos una miocarditis linfocítica aguda y por medio de la técnica de reacción en cadena de la polimerasa (PCR) de un frotis traqueal se evidenció la presencia del virus influenza tipo B. Se realizó una revisión de la literatura sobre miocarditis principalmente miocarditis viral causada por el virus Influenza B.

Abstract Myocarditis is an inflammatory disease of the heart muscle. Viral infections are the most frequent cause of myocarditis, incluided Influenza B virus. The clinical presentation of acute miocarditis is highly variable, ranging from subclinical disease to fulminant heart failure and sometimes with sudden death. The major long term consequence is dilated cardiomyopathy with chronic heart failure. We present a case of a 17 years old woman who presented with viral symptoms for two days and then died suddenly; in the medico-legal autopsy, an acute lymphocytic myocarditis was documented through histopathological studies and the presence of influenza type B virus was evidenced by means of the polymerase chain reaction (PCR) technique of a tracheal smear. A review of the literature on myocarditis, mainly viral miocarditis caused by the Influenza B virus, was made.

Métodos histoquímicos e inmunohistoquímicos para la estimación del Intervalo postmortem en tejidos humanos: una revisión / Histochemical and immunohistochemical methods for the postmortem interval estimation in human tissues: a review

El intervalo postmortem (IPM) es un importante desafío a resolver en patología forense, y consiste en poder determinar el tiempo transcurrido desde la muerte hasta el momento de la autopsia. Dada la poca confiablidad de algunos métodos por la gran influencia de factores externos, la Histoquímica (HQ) y la Inmunohistoquímica (IHQ), entre otros, han recibido considerable atención por sus niveles de objetividad en la investigación forense. Se presenta una revisión con búsqueda sistemática de estudios experimentales que apliquen métodos HQs e IHQs para la estimación del IPM sobre material cadavérico humano. Se identificaron 1053 artículos de los cuales 12 cumplieron con los criterios, a los que se agregaron 4 mediante una búsqueda manual (n=16 artículos). Alemania fue el país con más publicaciones destacando con 8 artículos. Las técnicas HQs de AgNORs, TRAP y PAS fueron utilizadas en 5 estudios (glándulas sudoríparas, piel, hígado, médula ósea y mucosa labial), mientras que las IHQs fueron empleadas con diferentes grupos antigénicos en 12 estudios (páncreas, cerebro, pulmón, tiroides, hígado, glándulas pituitarias, glándulas sudoríparas y mucosa gingival). Las estimaciones del IPM fueron posibles con márgenes entre 2-3 h. hasta los 20 días dependiendo de la técnica. El análisis de tejidos provenientes de cavidad oral asegura una vía no invasiva, de fácil acceso y bajo resguardo natural a la influencia de factores ambientales. Si bien no existe un método único que permita de manera confiable estas estimaciones, la introducción de nuevas técnicas permitiría evitar la producción de errores.

The postmortem interval (IPM) is an important challenge to be solved in forensic pathology, and it consists in determine the time elapsed since death until the autopsy. Given the low reliability of some methods due to the great influence of external factors, Histochemistry (HQ) and Immunohistochemistry (IHQ), among others, have received considerable attention for their levels of objectivity in forensic investigation. A scoping review of experimental studies that apply HQs and IHQs methods to estimate the MPI on human cadaveric material is presented. We identified 1053 articles, of which 12 met the criteria; we added 4 articles through a manual search (n = 16 articles). Germany was the most productive country, with 8 articles. HQ techniques of AgNORs, TRAP and PAS were used in 5 studies (on sweat glands, skin, liver, bone marrow and labial mucosa), while IHQs techniques were used with different antigenic groups in 12 studies (on pancreas, brain, lung, thyroid, liver, pituitary glands, sweat glands and gingival mucosa). IPM estimates were possible with margins between 2-3 hours up to 20 days depending on the technique. The analysis of oral tissues ensures a non-invasive route, easily accessible and under natural protection to the influence of environmental factors. Although there is no single method that reliably allows these estimates, the introduction of new techniques would prevent the production of errors.

Gross and Histopathological Findings in Fatalities Caused by Pulmonary Disease: An Autopsy Study

Respiratory pathologies are some of the common causes of deaths and it has been reported that in almost 1/3rd cases of sudden deaths the primary pathology may be attributable to pulmonary pathology. One of the important aspect of respiratory pathologies is that they can progress rapidly over a short period of time and in many cases these pathologies may prove to be fatal. In such cases gross and histopathological examination of lung tissue can give valuable insights into the cause of death. We conducted this prospective study to study the pathological findings in the lungs of such cases. Methods: The present study was conducted in the department of forensic medicine and toxicology of a tertiary care medical college situated in an urban area. The duration of study was 2 years. All cases of natural deaths brought for medico-legal autopsy were included in this study on the basis of a predefined inclusion and exclusion criteria. Virchow’s technique for dissection was followed in all the cases. The demographic details, gross and histopathological examination of lungs was done and findings were noted. Statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: The study consisted of a total 54 patients out of which there were 34 males and 20 females with a M:F ratio of 1:0.58. The most common affected age group was found to be between 30-40 years (22.22%). The mean age of males and females were found to be comparable with no statistically significant difference (P>0.05). Most people died within 3-7 days from time of admission (25.92%). Pneumonia was found to be leading cause of deaths in lung pathology which contributed to 74.7% cases. On gross pathology consolidation and pulmonary edema were most common findings whereas on gross as well as histopathological examination. Conclusion: Gross and histopathological examination of lung tissue in individuals dying due to natural causes can give valuable insights into the cause of death.

Profi le of medicolegal autopsies in Pekanbaru, Indonesia 2007-2011

Medicolegal autopsy should be carried out for all unnatural deaths to ascertain facts pertaining to death. A retrospective 5-year study was carried out by the Forensic Medicine and Medicolegal Department, Faculty of Medicine, University of Riau to describe the profi le of medicolegal autopsies in Pekanbaru, Indonesia. There were 613 unnatural deaths and 73 (11.9 %) medicolegal autopsies recorded between 2007 and 2011. The number of unnatural deaths showed a decreasing trend whereas the number of medicolegal autopsies increased over the years. The percentage of unnatural deaths subjected to medicolegal autopsy varied between 2.2 % and 23.1 % per year. Of the 73 medicolegal autopsy subjects, 68.5% (n = 50) were male and 31.5% (n = 23) females. The ages of victims ranged from newborn babies to 72 years, with a median of 28 years. 61.6 % of cases were in the 20-39 years age-group. Sixty (82.2 %) had unnatural deaths. The leading cause of death was blunt force (30.1%) and sharp force (20.5 %). Homicide was the predominant manner of death. Our study highlights that the main interest of the police in requesting a medicolegal autopsy is for investigation of homicide. Recognizing that autopsy has an important role in the investigation of unnatural deaths, further studies should be carried out to understand the factors that impact on the low percentage of medicolegal autopsies in unnatural deaths, so that solutions may be found for the future.

The medico-legal autopsy -It‟s religious and social attitudes.

An autopsy is a post-mortem assessment or examination of a body. It is performed by a physician trained in the specialty and authorized by law. The approach of the forensic pathologist to the investigation of a death is different from that of the hospital pathologist. Several health care areas are dependent on people's willingness to dispose of their body or parts thereof after death, and the issue of procedures involving corpse‟s entails important and, to some extent, growing problems. At this time there were still strong religious and social objections to the autopsy. There are also difficulties in providing corpses for anatomy education. The reasons behind these problems are probably manifold; some would be connected with the attitudes of people in general. This short review paper describe briefly only of its practical aspect of medicolegal autopsy with a brief historical review on its “Religious and Social Attitudes”.

An Analysis of Medicolegal Autopsies in Cheju National University, School of Medicine, 1998-1999 / 대한법의학회지

The aim of this study was to reveal the current status of forensic practice in Cheju. The range of subjects was limited to deaths autopsied in Cheju National University during the years of 1998 through 1999. All subjects were reviewed with respect to age, sex, cause of death and manner of death. The total number of deaths was 100, of these 85 cases were males and 15 were females. In age distribution, the age group of 30-39 occupied the highest proportion(25.0%). According to the manner of death, the cases of violent deaths were 78, natural deaths 20, and unknown cases 2. For the violent deaths, the percentage of accidental death was 30.8 and homicide 25.6, suicide 18.0, undetermined cases 25.6. According to the cause of death, asphyxia was the most common (35%), followed by injury(31%) and disease(20%). Among 35 deaths of asphyxia, 24(68.8%) were deaths due to drowning. Medicolegal scene investigation was done in 16 cases. Two cases remained as deaths of unknown cause because of severe decomposition

Pathological study on 18 cases of forensic re-autopsy and histopathological re-examination / 中国法医学杂志

Eighteen cases of forensic re autopsy and histopathological re examination were analyzed retrospectively. The manner and the impression of original autopsy,times of autopsy,the reason and manner of forensic re autopsy,the interval betwwen the original autopsy and the re autopsy as well as the last conclusions were analyzed.It was found that the forensic re autopsy always occured in cases of medical disputes(3 cases,16 7%) and death related to the police investigation(4 cases,22 2%).Only external examination and incomplete forensic autopsy were done originally in 13 out of 18 cases(72 2%).The conclusions of re autopsy were completely different from that of the original autopsy in 5 cases.Attension must be paid and prevention measures for re autopsy must be adopted were also discussed.