Distribution & diagnostic efficacy of cardiac markers CK-MB & LDH in pericardial fluid for postmortem diagnosis of ischemic heart disease.

The aim of the present study is to evaluate the diagnostic efficacy of biochemical markers creatine kinase-MB (CK-MB) and LDH in pericardial fluid for postmortem diagnosis of ischemic heart disease (IHD). We studied 119 medico-legal autopsies selected during a period of 2 years. Subjects were assigned into diagnostic groups upon final cause of death as follows: (1) sudden cardiac death due to IHD's (n = 52), (2) violent asphyxia (n = 24); (3) polytraumatic deaths (n = 20); (4) natural deaths excluding cardiac causes (n = 23). Pericardial fluid samples were tested for estimating enzyme levels. Histological examination was performed with hematoxylin and eosin (H&E) stain on myocardial tissue samples. We observed highest levels of CK-MB & LDH in deaths due to IHD's. Kruskal-Wallis test revels significant differences in activities of CK-MB (P = 0.0001) and LDH (P = 0.0065) amongst all diagnostic groups. Mann-Whitney test showed highly significant (P < 0.0001) levels of CK-MB in group 1 as compared to other diagnostic groups. However, LDH levels were non-discriminatory (P = 0.0827) between cases of IHD's and cases of other natural deaths. CK-MB levels were statistically non-significant between cases divided as myocardial infarction (MI) and severe coronary artery disease in group 1, hence its role for postmortem detection of MI is somewhat limiting. However, sensitivity and negative predictive values of its cut off level obtained in cases of IHD's are nearly equal to diagnostic efficacy in clinical settings. Hence, it can be useful additional diagnostic tool for autopsy diagnosis of IHD's. Whereas, LDH is not useful for postmortem diagnosis in these cases.

Decomposed bodies--still an unrewarding autopsy?

One of the classic mistakes in forensic pathology is to regard the autopsy of decomposed body as unrewarding. The present study was undertaken with a view to debunk this myth and to determine the characteristic pattern in decomposed bodies brought for medicolegal autopsy. From a total of 4997 medicolegal deaths reported at an Apex Medical Centre, Yeotmal, a rural district of Maharashtra over seven year study period, only 180 cases were decomposed, representing 3.6% of the total medicolegal autopsies with the rate of 1.5 decomposed body/100,000 population per year. Male (79.4%) predominance was seen in decomposed bodies with male female ratio of 3.9:1. Most of the victims were between the ages of 31 and 60 years with peak at 31-40 years (26.7%) followed by 41-50 years (19.4%). Older age above 60 years was found in 8.6% cases. Married (64.4%) outnumbered unmarried ones in decomposition. Most of the decomposed bodies were complete (83.9%) and identified (75%). But when the body was incomplete/mutilated or skeletonised then 57.7% of the deceased remains unidentified. The cause and manner of death was ascertained in 85.6% and 81.1% cases respectively. Drowning (35.6%) was the commonest cause of death in decomposed bodies with suicide (52.8%) as the commonest manner of death. Decomposed bodies were commonly recovered from open places (43.9%), followed by water sources (43.3%) and enclosed place (12.2%). Most of the decomposed bodies were retrieved from well (49 cases) followed by barren land (27 cases) and forest (17 cases). 83.8% of the decomposed bodies were recovered before 72 h and only in 16.2% cases the time since death was more than 72 h, mostly recovered from barren land, forest and river. Most of the decomposed bodies were found in summer season (42.8%) with peak in the month of May. Despite technical difficulties in handling the body and artefactual alteration of the tissue, the decomposed body may still reveal cause and manner of death in significant number of cases.