Significance of Contusion at the Vocal Cord and Perivocal Cord Area in Cases of Non-intubated Death.

Every finding during a neck autopsy may be essential for accurately diagnosing and explaining the mechanism of death. In this prospective study in the Department of Forensic Medicine and Toxicology of Jordan University Hospital, 17 out of 95 neck autopsies revealed contusions of the laryngeal mucosa in the vocal or perivocal area. These contusions were found to be associated with various causes of death, including mechanical asphyxia (such as throttling, ligature strangulation, hanging, smothering, choking, plastic bag asphyxia, gagging, and inhalation of blood) and other causes (such as atypical drowning, carbon monoxide poisoning, head injury due to a road traffic accident, burns, electrocution, and brain edema). This study provides insight into the mechanisms of this important lesion and may contribute to a better understanding of the cause of death.

Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic for more than 2 years. Autopsy examination is an invaluable tool to understand the pathogenesis of emerging infections and their consequent mortalities. The aim of the current study was to present the lung and heart pathological findings of COVID-19-positive autopsies performed in Jordan. METHODS: The study involved medicolegal cases, where the cause of death was unclear and autopsy examination was mandated by law. We included the clinical and pathologic findings of routine gross and microscopic examination of cases that were positive for COVID-19 at time of death. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed through molecular detection by real-time polymerase chain reaction, serologic testing for IgM and electron microscope examination of lung samples. RESULTS: Seventeen autopsies were included, with male predominance (76.5%), Jordanians (70.6%), and 50 years as the mean age at time of death. Nine out of 16 cases (56.3%) had co-morbidities, with one case lacking such data. Histologic examination of lung tissue revealed diffuse alveolar damage in 13/17 cases (76.5%), and pulmonary microthrombi in 8/17 cases (47.1%). Microscopic cardiac findings were scarcely detected. Two patients died as a direct result of acute cardiac disease with limited pulmonary findings. CONCLUSIONS: The detection of SARS-CoV-2 in postmortem examination can be an incidental or contributory finding which highlights the value of autopsy examination to determine the exact cause of death in controversial cases.

Medico-legal importance of necrotizing fasciitis.

Despite the rarity of necrotizing fasciitis (NF), it is a relatively common cause of death in many lawsuits. Families seek financial compensation or legal charges against those they believe to be involved in the death, usually physicians who did not identify the infection soon enough. This paper explores six cases in forensic pathology practice where NF posed a unique medico-legal dilemma.

Age threshold for proper definition of premature coronary artery disease in males.

BACKGROUND: There is no universally accepted definition for the cut point age before which atherosclerosis is considered "premature." This is a retrospective study aimed to utilize the medico legal autopsy information for finding a proper definition of the age threshold of premature atherosclerosis in males. OBJECTIVES: This work aimed to utilize autopsy reports data that were issued at Jordan University Hospital to evaluate age-related differences in the distribution of coronary atherosclerotic and myocardial lesions and the determination of the age threshold at which such differences became apparent in male deaths. Such a threshold might provide a proper definition for premature atherosclerosis and premature sudden atherosclerotic cardiac death. At the same time, the meaning of a reference age for mature atherosclerotic death incidents could be elucidated. METHODS: A total of 1139 male autopsy reports with sudden coronary atherosclerotic death were reviewed. RESULTS: There is an overall decreasing trend in the prevalence of coronary thrombosis with age, where the prevalence of coronary thrombosis was more common in younger age groups and constitutes 59.9% of cases in the age groups less than 45 years in comparison to 42.7% of cases in the ages more than 65 years. The same trend was noticed for the prevalence of cases without evident myocardial fibrosis. On the other hand, the trend was increasing for stenosis without apparent thrombosis and for myocardial fibrosis. In spite of that, the detailed pattern of the prevalence of these pathologies with age did not show a steady, and a continuous change through the whole spanned age groups. Instead, two distinct phases were observed, the first phase represents the cases less than 49 years of age and the second phase represents the cases more than the age of 54 and the age group between 50/54 is what we called the "turn-interval." CONCLUSION: sThe "turn-interval" was considered as the scientific basis to define the age threshold that differentiates the premature atherosclerotic coronary diseases. Accordingly, it was proposed that male premature coronary artery diseases constituted the cases suffering from the heart attack, or died as a result of cardiac attacks below the age of 49, and the mature disease that affects people who is older than 54 years old.

Role of forensic medicine in evaluating non-fatal physical violence against women by their husbands in Jordan.

OBJECTIVE: Intimate partner violence against women is a major health problem in most nations, but to date, there has been little awareness of the extent or seriousness of this issue in Jordan. Forensic medical practitioners play a significant role in diagnosing, evaluating and reporting these cases. The Jordanian judicial system is dependent on forensic reports. This study aims to assess the role of forensic medicine in evaluating the physical injuries sustained by women who are abused by their husbands. METHOD: A retrospective review of 158 forensic reports of Jordanian women alleging assault by their husbands and who were seen at Jordan University Hospital over the period 2010-2015. RESULTS: Of the 158 women who presented, 87 had multiple injuries. The majority of injuries were soft tissue injuries, but others included fractures, tympanic membrane perforation, burns and neck contusions. Twelve women were pregnant at the time of the assessment. The period of incapacity caused by these injuries (an important factor for the Jordanian judicial system) was between 1 and 14 days. CONCLUSION: Intimate partner violence can present with a range of injuries from relatively minor to potentially disabling or life threatening. Forensic medicine has a role in documenting and evaluating these injuries and advising the judicial system in these cases. These are all key elements in increasing the awareness of the nature and extent of this behavior and its impact on women (and men) and the wider society.

The prevalence of alcohol and psychotropic drugs in fatalities of road-traffic accidents in Jordan during 2008-2014.

OBJECTIVE: Several studies confirmed alcohol and psychotropic drug consumption as important risk factors underlying fatal accidents. This paper presents updated toxicological findings in the fatalities of road traffic accidents of Amman district, in order to have an overall picture of the occurrence of these substances in these victims in Jordan. METHOD: Over a seven-year period (2008-2014), 2743, autopsies were conducted at Jordan University Hospital in which the sum of n = 311 (11.38%) were victims of road traffic accidents. Blood samples from these victims were collected. Toxicology screening for psychotropic drugs and alcohol was conducted on these samples, and the results were analyzed according to age, sex and victim's status. RESULTS: This study revealed that Alcohol and psychotropic drugs were positive in 36.5%, (n = 58) of the cases, and for alcohol alone (n = 13, 37.1%). The majority of the victims were pedestrians (n = 155, 49.8%). Additionally, 29.6% (n = 92) of the cases were of ages 19-29. Detected psychotropic drugs were benzodiazepines, barbiturates. None of the collected specimens were positive for illicit cocaine, amphetamines or cannabis. CONCLUSIONS: The results from this study proved the existence of alcohol and psychotropic drugs in the victims of road traffic accidents; Indicating an association between the uses of these substances in accident involvement. Though having some limitations, other conclusions require further data collection, cooperation with related parties in Jordan, and utilizing simple extended toxicological screens.

Prevalence of blood-borne viral infections among autopsy cases in Jordan.

Background: Morgues are high risk areas for the spread of infection from cadavers to staff during the post-mortem examination. Infection can spread from corpses to workers by airborne transmission, by direct contact, or through needle and sharp object injuries. Objective: Knowledge about the prevalence of these infections on autopsy is essential to determine the risk of transmission and to further enforce safety measures. Methods: This is a descriptive study. All autopsies performed in the Department of Forensic Medicine at Jordan University Hospital during the study period were tested for the serology of human immunodeficiency, hepatitis B and C viruses. Positive tests were confirmed by nucleic acid testing. Results: A total of 242 autopsies were tested. Age ranged from 3 days to 94 years (median 75.5 years, mean 45.3 years (21.9 ±  SD)). There were 172 (71%) males. The cause of death was considered natural in 137 (56.6%) cases, accidental in 89 (36.8%), homicide in nine (3.7%), suicide in four (1.7%), and unknown in three (1.2%) cases. Hepatitis B surface antigen was positive in five (2.1%) cases. Hepatitis C virus antibody was positive in five (2.1%) cases and the hepatitis C virus polymerase chain reaction was positive in two (0.8%) cases. HIV antibody was not detected in any of the cases. The infection status of cases was not associated with age, sex, nationality, or cause of death. Conclusion: The study findings indicated that there is a low prevalence of virus-infected autopsies in Jordan. However, the risk of transmission remains a potential threat and therefore the necessary precautions should always be taken during autopsy.

Development of an accessible self-assessment tool for research ethics committees in developing countries.

In response to increased research being performed in developing countries, many research ethics committees (RECs) have been established, but the quality of their ethics review systems remains unknown. Evaluating the performance of an REC remains a challenging task. Absent an accreditation process, a self-assessment mechanism would provide RECs a way to review their policies and processes against recognized international standards. We describe a self-assessment tool that was developed and reviewed by REC members and researchers from the Middle East. This tool reflects pragmatic aspects of human subjects protection, is based on international standards, is straightforward in its completion, and its items are relevant to the administrative processes that exist in many RECs in the developing world.