Complete Autopsy Research Articles

A Research Study on Histopathological Changes that are Seen in Lungs of Victims Who Died of Drowning

Drowning is considered to be the leading cause of death in water and the third most common cause of accidental death worldwide, with the highest drowning rates in developing countries. The WHO defines drowning as the process of experiencing respiratory impairment from submersion/immersion in liquid. For forensic experts, death in water is a multifaceted issue presenting a challenge to them. Since all the circumstances from natural death to homicide are possible in the water, critical examination and interpretation of all abnormal findings found during autopsy are of great importance.Drowning is a diagnosis of exclusion, based on ruling out all other causes of death via complete autopsy and toxicology. Drowning causes hypoxemia, loss of consciousness, apnea and ultimately cardiac arrest. Fluid aspiration results in lung injury and acute respiratory distress syndrome. Acute Respiratory Failure is the main component of drowning pathophysiology. Near drowning results in multiple complications including aspiration pneumonia which is often life-threatening. Hence the histopathological changes in the lungs provide good corroborative evidence of death due to drowning. Nevertheless, for the examined drowning signs, no high diagnostic certainty could be observed. However, these findings can increase their diagnostic value if forensic doctors take influencing factors into consideration.From the central record section of the Department of Forensic Medicine, Siddhartha Medical College, Vijayawada, Andhra Pradesh, about 80 medicolegal postmortem reports of death due to drowning in undecomposed bodies were selected in which one whole lung was sent for histopathological examination during the past two years i.e, 2020 - 2022. Parameters like Age, Sex and Marital Status were also studied. Histopathological examination of drowned lungs showed that congestion was seen in 92% of cases, oedema in 96% cases, dilatation of alveoli in 86% of cases, thinning of septa was seen in 84% of cases rupture of alveoli seen in 64% of cases and hemorrhage is seen in 46% of cases. Mostly males are affected and drowning deaths are seen more in 26 – 40 years age group. The histopathological investigations must be performed on all the organs of non-putrefied bodies with the aim of making the difference between death by drowning and other causes of death. The lung examinations can show over-distension of the alveoli, thinning of the alveolar septa and compression with narrowing of the capillary network.

Sudden unexpected postnatal collapse and BUB1B mutation: first forensic case report

Sudden unexpected postnatal collapse (SUPC) is a sudden collapse of the clinical conditions of a full-term or near-term newborn, within the first 7 days of life, that requires resuscitation with positive ventilation and who either dies, has hypoxic-ischemic encephalopathy, or requires intensive care. The incidence of SUPC is very low, and most often presents a negative prognosis. The BUB1B gene is a mitotic checkpoint of serine/threonine kinase B that encodes a protein crucial for maintaining the correct number of chromosomes during cell division. Mutations in the BUB1B gene are linked to mosaic variegated aneuploidy syndrome 1 (MVA1), a rare autosomal recessive disorder characterized by diffuse mosaic aneuploidies involving several chromosomes and tissues. This paper discusses a case of a newborn who had a spontaneous delivery. After 2 h and 10 min, the infant showed generalized hypotonia and cyanosis, and his doctors performed orotracheal intubation, cardiac massage, pharmacological hemodynamic therapy, mechanical ventilation, antibiotic therapy, and hypothermic treatment. The newborn was discharged after 5 months with the diagnosis of hypoxic-ischemic encephalopathy. Suspecting an SUPC, a complete genetic analysis was performed demonstrating a compound heterozygous mutations in the BUB1B gene. The newborn died at 6 months of life, 1 month after discharge. A complete autopsy was performed, determining that the cause of death was due to sepsis starting from a brocopneumonic process, with outcomes of hypoxic-ischemic encephalopathy (HIE). In this scenario, it is not possible to demonstrate the causal effect of this mutation, considering that it could play a causal or concausal role in the onset of SUPC. Further research based on multicenter studies, as well as on animal models, could be very useful to clarify the pathological effect of this mutation.

The Comparison between the Effect of Probiotics and Antibiotics against Enterotoxin A Produced by Staphylococcus aureus Microbial and Histopathological Study

Abstract Background: Staphylococcus aureus is a significant pathogen that causes nosocomial infections as well as community-acquired diseases; the spectrum of S. aureus infections ranges from pimples and furuncles to toxic shock syndrome and sepsis. Probiotics, which are defined as “live microorganisms that, when taken in suitable proportions, impart a health benefit on the host beyond basic nourishment,” have attracted increasing public and scientific interest in recent years; probiotics are crucial for preserving the integrity of the gut mucosal barrier and preventing the expansion of potentially harmful bacteria. Objectives: The aim of this study was to evaluate the efficiency of probiotics to protect against the Staphylococcal enterotoxin A (SEA) of S. aureus on different organs of rats comparing with the effect of antibiotics. Materials and Methods: Twenty-five isolates were obtained from a variety of clinical locations. The gene sea was detected by using specific primer, 20 rats were used in this study and randomly divided into 5 groups. A complete necropsy was performed for all the animals. Results: The results of the sea gene showed that 16 out of 25 isolates harbored this gene. And the photomicrograph of liver and intestine, after treatment by probiotics (bacteria and yeast), revealed normal hepatocytes and newly formed villi with mild thickness and intact a muscular layer, respectively. At the same time, after treatment with antibiotics, the results showed remarkable reversible changes of hepatic architecture, areas of hepatocytes with normal arrangements and reversible changes, and these were represented by a significant villi length and the areas of necrosis in a muscular layer in liver and intestine, respectively. Conclusion: The conclusion revealed, probiotics of both types (bacteria and yeast) showed curable effect in the organs under study that were altered by SEA and gave efficient effect as much as antibiotics, and also suggested the usage of probiotics instead of antibiotics for better health.

Serologic, Virologic and Pathologic Features of Cats with Naturally Occurring Feline Infectious Peritonitis Enrolled in Antiviral Clinical Trials.

Feline infectious peritonitis (FIP) is a multisystemic, generally lethal immuno-inflammatory disease of domestic cats caused by an infection with a genetic variant of feline coronavirus, referred to as the FIP virus (FIPV). We leveraged data from four different antiviral clinical trials performed at the University of California, Davis. Collectively, a total of 60 client-owned domestic cats, each with a confirmed diagnosis of naturally occurring FIP, were treated with a variety of antiviral compounds. The tested therapies included the antiviral compounds GS-441524, remdesivir, molnupiravir and allogeneic feline mesenchymal stem/stroma cell transfusions. Four client-owned cats with FIP did not meet the inclusion criteria for the trials and were not treated with antiviral therapies; these cats were included in the data set as untreated FIP control cats. ELISA and Western blot assays were performed using feline serum/plasma or ascites effusions obtained from a subset of the FIP cats. Normalized tissue/effusion viral loads were determined in 34 cats by a quantitative RT-PCR of nucleic acids isolated from either effusions or abdominal lymph node tissue. Twenty-one cats were PCR "serotyped" (genotyped) and had the S1/S2 region of the coronaviral spike gene amplified, cloned and sequenced from effusions or abdominal lymph node tissue. In total, 3 untreated control cats and 14 (23.3%) of the 60 antiviral-treated cats died or were euthanized during (13) or after the completion of (1) antiviral treatment. Of these 17 cats, 13 had complete necropsies performed (10 cats treated with antivirals and 3 untreated control cats). We found that anticoronaviral serologic responses were persistent and robust throughout the treatment period, primarily the IgG isotype, and focused on the viral structural Nucleocapsid and Membrane proteins. Coronavirus serologic patterns were similar for the effusions and serum/plasma of cats with FIP and in cats entering remission or that died. Viral RNA was readily detectable in the majority of the cats in either abdominal lymph node tissue or ascites effusions, and all of the viral isolates were determined to be serotype I FIPV. Viral nucleic acids in cats treated with antiviral compounds became undetectable in ascites or abdominal lymph node tissue by 11 days post-treatment using a sensitive quantitative RT-PCR assay. The most common pathologic lesions identified in the necropsied cats were hepatitis, abdominal effusion (ascites), serositis, pancreatitis, lymphadenitis, icterus and perivasculitis. In cats treated with antiviral compounds, gross and histological lesions characteristic of FIP persisted for several weeks, while the viral antigen became progressively less detectable.

Problematika Penegakan Hukum Kasus Pembunuhan Berencana di Indonesia: Studi Kasus Pembunuhan Berencana Kopi Sianida oleh Jessica Wongso terhadap Mirna Salihin

This research was conducted to look at the problems of law enforcement in Indonesia in the case of the premeditated murder of Wayan Mirna Salihin. Whether the judge's decision has provided justice that is as fair as possible to the victim and perpetrator, the evidence presented at the trial does not comply with procedures in accordance with the Criminal Code, the emergence of the films Ice Cold Murder, Coffee and Jessica Wongso has made the public less confident in the law in Indonesia. It is necessary to examine the role of the forensic autopsy in uncovering this case, the discovery of cyanide in Mirna's stomach, which is very strong evidence to prove that the cause of Mirna's death was poisoning by her friend Jessica Wongso. Research methods used used in this research is normative legal research, research using a problem approach, namely judicial case study by approaching the Mirna Salihin premeditated murder case, by examining the judge's decision which resulted in Jessica Wongso being convicted, by conducting this research uncovering the irregularities that occurred in This murder case creates a conflict of interest that cannot be resolved. Jessica Kumala Wongso has been convicted of violating Article 340 of the Criminal Code, namely premeditated murder. In the results of the examination, experts said that a complete autopsy must be carried out for human deaths due to poison. The expert concluded that the cause of WAYAN MIRNA SALIHIN's death was cyanide, especially since 0.2 mg/liter of cyanide was found in the stomach. The judge's decision regarding the premeditated murder of Mirna Salihin did not have any valid and strong evidence at all, starting from the testimony of witnesses who did not there was someone who saw Jessica put poison in the coffee that Mirna was drinking, then the expert's testimony in the examination was not perfect, one of which was that the autopsy did not comply with proper procedures, as well as evidence, such as CCTV which was not original and contrary to regulations. KAPOLRI No. 10 of 2009, as well as the defendant's statement that it never occurred to him to kill his own friend.

Forensic Autopsy of Multiple Stab Wound

Introduction: Stabbing is the predominant form of homicidal violence globally, resulting in both physical impairment and death. A stab wound is the result of a forceful push from a sharp or blunt pointed object, resulting in a wound that is deeper than it is length. Case presentation: We present a case of a man who was found dead after being stabbed with a sharp weapon by his partner in a public area, with an open wound on the left chest. A forensic expert identified the body at Dr. Soetomo General Hospital, Surabaya, Indonesia. On external examination, we found 23 open wounds on several anatomical regions. Vital injuries include an open wound on the right side of the neck and the back of both sides of the chest. In an internal examination, we found both lungs looked shrunken, and blood was found in the right and left chest cavities. The stab wound to the right back penetrated the right lower lung and right liver lobe. The stab wound to the left back penetrated the lower left lung. Conclusion: A complete autopsy is vital to determine the cause, mechanism, and manner of death and to reconstruct the events before death.

Fraser syndrome with limb reduction defect: a rare and unique anatomic variation.

Fraser syndrome, named after George Fraser, is an autosomal recessive disorder showing a highly variable interfamilial phenotypic variation, with malformations ranging from minor symptoms to lethal anomalies like renal agenesis, incompatible with survival. Limb reduction defects have not been reported to be associated with it. A 21-year-old primigravida presented to the antenatal outpatient department with a level two targeted anomaly scan report suggestive of severe oligohydramnios with suspected renal agenesis. The cranial vault bones were compressed, and orbital globes and lenses could not be visualized. Renal agenesis was confirmed due to sleeping adrenals sign, non-visualization of the urinary bladder, and Doppler of renal arteries. A detailed examination of the fetal head in the sagittal section showed the absence of an eye globe and lens, arousing suspicion of Fraser syndrome. After pregnancy termination, a complete fetal autopsy was done to look for any additional findings. Patients who have a syndromic mix of acrofacial and urogenital abnormalities with or without cryptophthalmos should be evaluated for Fraser syndrome, which can be diagnosed by clinical examination and perinatal autopsy.

Diet-induced nephrocalcinosis in aquarium-raised juvenile spotted wolffish Anarhichas minor.

Wolffish are regularly housed in aquaria, but little data on their husbandry and health is available for caretakers. High occurrence rates of nephrocalcinosis and urolithiasis have been observed in Atlantic Anarhichas lupus and spotted A. minor wolffish housed at 2 Canadian zoological institutions. To explore the effect of diet on nephrocalcinosis and urolithiasis development, a 16 mo prospective study was conducted. A total of 32 juvenile spotted wolffish were randomly assigned to one of 4 experimental groups fed exclusively with the following diet: (1) Skretting® Europa 18 pellets; (2) Mazuri® LS Aquatic Carni-Blend Diet Formula; (3) vitamin-supplemented fish-based diet, and (4) vitamin-supplemented invertebrate-based diet. Urinalysis, radiographs, and complete necropsies were performed at the end of the study. None of the wolffish developed uroliths during the study period. All specimens fed with the fish-based and invertebrate-based diets developed nephrocalcinosis, whereas this condition was seen in 12.5 and 0% of the fish in the Skretting® and Mazuri® groups, respectively. Affected wolffish often presented with oxalate crystalluria and increased radiodensity of the posterior kidneys. Urinalysis and radiographic study were considered useful in the antemortem diagnosis of nephrocalcinosis. None of the previously published risk factors for the development of nephrocalcinosis in fish were supported by the results of this study. However, nutritional analyses of the 4 diets suggest that high dietary levels of gelatin or vitamin C or low levels of vitamin E could be potential risk factors for the development of nephrocalcinosis in spotted wolffish and thus warrant further study.

A Health Status Update of Myocastor coypus in Northern Italy.

Myocastor coypus is a pest animal present in Africa, Europe, North America and Asia that causes agricultural and ecological damages. Moreover, it has to be considered as a potential risk for public health. Forty-four coypus from the "Parco Naturale La Mandria" (Piedmont region, Northwest Italy) have been analysed. A complete necropsy and a whole histological evaluation of the liver, kidney and lung have been carried out on all the animals. Moreover, the positivity to Hepatitis E Virus (HEV), Encephalomyocarditis virus (EMCV), Francisella spp., Toxoplasma gondii and Neospora caninum have been investigated. None of the animal were positive for HEV, EMCV, Francisella spp. or Neospora caninum. Two animals tested positive for Toxoplasma gondii. A high presence of histological lesions has been identified in different organs, suggesting that lesions could be induced by different pathogens. As previously reported, coypu can act as a host for several pathogens, including important agents for human and animal health, and surveillance is necessary to fully understand the biological role and the importance of coypu as a disease reservoir in our country.

Maternal Mortality Resulting from Signet-ring Cell Carcinoma of the Sigmoid Colon Presenting as Bilateral Krukenberg Tumours: A Case Report

Krukenberg Tumours (KTs) during pregnancy are extremely rare, difficult to diagnose, and have a grave prognosis. Authors hereby, report an autopsy case of a 23-year-old primigravida at 29 weeks of gestation who presented at a tertiary care centre with preterm labour. She complained of severe abdominal pain, backache, and vaginal leakage for the past two days. Physical examination revealed an oedematous abdominal wall and a gravid uterus measuring 34 weeks, as the tumours could not be palpated separately. She underwent a normal vaginal delivery and delivered a live female foetus weighing 1.6 kg. However, she developed septicaemia and, on the fifth postnatal day, progressed to loss of consciousness and subsequently died. A complete autopsy was performed. Her past medical history indicated that at 20 weeks of gestation, bilateral ovarian masses were detected and biopsied. The biopsy revealed high-grade metastatic adenocarcinomas that were positive for CK20 and Epithelial Membrane Antigen (EMA) but negative for CK7, Alpha fetoprotein (AFP) and CD10, suggesting a primary tumour in the gastrointestinal tract. The autopsy revealed a signet-ring cell carcinoma of the sigmoid colon, along with bilateral large KTs and peritoneal metastasis.

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil.

To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. Training was provided to medical pathologists on MIA. A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance. A protocol was developed to perform minimally invasive autopsies (MIAs) in Death Verification Services (SVO), capable of expanding the system's capacity to identify a greater number of deaths suspected to be due to arboviruses. The experience suggests that in-service trained health professionals are able to perform MIA, and that use of this technique in SVOs has been shown to be capable of increasing the system's sensitivity in detecting deaths of interest to public health. Trained professionals will be able to collect biological material in hospitals, through MIA, in cases of interest for health surveillance and when family members do not allow a complete conventional autopsy to be performed.

A Retrospective Cross-sectional Analysis of Renal Complications in Association with Cancer: Insights from 120 Autopsies

Introduction: Kidney diseases frequently complicate cancer and its treatment, contributing to both morbidity and mortality. Malignancies can give rise to various kidney issues, such as glomerulonephritis and Chronic Kidney Disease (CKD). This association operates bidirectionally, with patients experiencing the development of renal diseases due to cancer, and CKD predisposing to cancer. Furthermore, nephrotoxicity induced by chemotherapy can result in Acute Tubular Injury (ATI) and necrosis, imposing limitations on its application. Aim: To evaluate the spectrum of renal pathology in autopsies of malignancies. Materials and Methods: This was a retrospective crosssectional study of complete autopsies of all cases of malignancies performed in the Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. The study was carried out over a 5-year period from January 2015 to December 2019. Analysis of cases with respect to demographics, type of primary malignancy, gross and microscopic features, and the final cause of death was conducted. These findings were meticulously tabulated, with frequencies and percentages calculated for each category. Results: A total of 4392 autopsies were conducted throughout the study period, with 120 of them revealing the presence of malignancies. A total of 38 (31.6%) malignancies were diagnosed for the first time at autopsy. The commonest renal findings on gross were scars (superficial and deep) seen in 40 (33.33%), followed by cortical cysts in 25 (20.83%), granular contracted kidney in 15 (12.50%), mass lesions in 7 (5.83%), abscesses in 7 (5.83%), and swollen, oedematous kidneys in 6 (5%) autopsies. The most frequent renal pathology on microscopy were infective lesions seen in 43 (35.83%), Acute Tubular Necrosis (ATN) in 32 (26.66%), ATI in 30 (25%), followed by malignancies- primary and secondary in 11 (9.16%), tubular casts in 6 (5%), etc. Rare findings included membranous glomerulonephritis and Tumour Lysis Syndrome (TLS) (Acute urate nephropathy) in 1 (0.83%) each. The TLS case had classic histomorphological features of TLS, apart from laboratory parameters. Extensive deposits of uric acid crystals were seen obstructing the tubules as well as some of the glomeruli on microscopy. Conclusion: In one-third of the cases, the malignancy was exclusively discovered during the autopsy. The study revealed a diverse array of lesions, encompassing pyelonephritis, ATN, primary and metastatic renal tumours, cast nephropathy, membranous glomerulonephritis, and TLS. One-fifth of the cases had end-stage renal disease (advanced renal disease). A significant number of the cases exhibited tumour masses within the kidneys. One-fifth of the cases had renal pathology contributing to the final cause of death, further highlighting the association between malignancies and renal pathology

Postmortem Alteration of Purine Metabolism in Coronary Artery Disease.

A new approach for assisting in the diagnosis of coronary artery disease (CAD) as a cause of death is essential in cases where complete autopsy examinations are not feasible. The purine pathway has been associated with CAD patients, but the understanding of this pathway in postmortem changes needs to be explored. This study investigated the levels of blood purine metabolites in CAD after death. Heart blood samples (n = 60) were collected and divided into CAD (n = 23) and control groups (n = 37). Purine metabolites were measured via proton nuclear magnetic resonance. Guanosine triphosphate (GTP), nicotinamide adenine dinucleotide (NAD), and xanthine levels significantly decreased (p < 0.05); conversely, adenine and deoxyribose 5-phosphate levels significantly increased (p < 0.05) in the CAD group compared to the control group. Decreasing xanthine levels may serve as a marker for predicting the cause of death in CAD (AUC = 0.7). Our findings suggest that the purine pathway was interrupted by physiological processes after death, causing the metabolism of the deceased to differ from that of the living. Additionally, xanthine levels should be studied further to better understand their relationship with CAD and used as a biomarker for CAD diagnosis under decomposition and skeletonization settings.

Abstract 13310: TTN Variants and Arrhythmic Risk Among Countywide Sudden Deaths: From the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study

Background: Titin, encoded by TTN , is a sarcomeric protein necessary for normal cardiac and skeletal muscle function. Truncating variants in the A-band are a frequent cause of isolated and familial dilated cardiomyopathy (DCM) in living cohorts. Whether variants outside of the A-band confer arrhythmic risk remains unclear. We investigated the yield and distribution of TTN variants in a postmortem study of presumed sudden cardiac deaths (pSCDs) in San Francisco County. Methods: From 2/1/2011 to 12/31/2017, the Postmortem Systematic Investigation of Sudden Cardiac Death study performed complete autopsies on 889 incident deaths (age 16-90) meeting World Health Organization criteria for SCD (pSCD). Using clinical records, autopsy findings, and family history, we performed deep phenotyping to adjudicate underlying arrhythmic “SAD” (potentially rescuable with defibrillation) or non-arrhythmic “non-SAD” (tamponade, overdose, etc.) cause of pSCD. We performed clinical whole exome testing on cases with next of kin consent. Results: Of the 322 pSCDs tested (196 SAD, 126 non-SAD), we detected 5 truncating/splice variants located in non-A-band regions (p=0.03 vs. none found in the A-band) in 4 cases, all SAD. No truncating/splice variants were detected in 47 cases with autopsy evidence of DCM (cardiomegaly and short axis &gt; 3.5cm). Overall, 89 cases had at least 1 TTN variant of uncertain significance (VUS): 61 (68.5%) SADs and 28 (31.5%) non-SADs, with a trend towards more TTN VUSs among SADs (p =0.10). A total of 110 VUSs were found: 10 (9.1%) in the Z-disc, 38 (34.5%) in the I-band, 50 (45.5%) in the A-band, and 12 (10.9%) in the M-band. TTN VUSs clustered similarly throughout the gene in SADs and non-SADs. Conclusion: In this 7-year postmortem genetic study of unselected countywide sudden deaths using autopsy to adjudicate arrhythmic cause, we found TTN truncating/splice variants in non-A-band regions were associated with SAD and a trend toward association with SAD among TTN VUS carriers. In contrast to living cohorts with diagnosed DCM, no cases meeting autopsy criteria for DCM had a truncating/splice variant. Since non-survivors (i.e., SCDs) are underrepresented in DCM cohorts, our results suggest a potential role for non-A band TTN variants in arrhythmic risk.

The importance of fetal autopsy: An institutional review and development of best practices for reporting size and estimating gestational age at demise.

Fetal and neonatal autopsy offers critical insight into disease processes and clinical decision-making in reproductive medicine. Elucidating the cause of death and gaining a deeper understanding of the entities leading to fetal demise aids in anticipatory guidance for physicians and patients. Accurate assessment of growth and dating of fetuses is an important aspect of classifying pathology in the fetal and neonatal population. This study aims to optimize the autopsy approach to sizing and dating discrepancies, in addition to exploring the current trends in causes of stillbirth, with respect to placental, fetal/neonatal, and maternal factors, and rates of cases that remain undetermined after autopsy. A single-institution retrospective review of autopsy reports from mid-2008 through 2021 revealed 243 complete perinatal autopsy examinations. Placental cause of demise was identified in 46% of cases. Cause of demise was undetermined in 22% of cases. Evaluation of a subset of cases exposed minimal to no reporting of size and/or dating discrepancies in almost half of cases with undetermined cause of death. "Best practice" suggestions for sizing and dating fetuses/neonates in the postmortem period have been developed to aid in delivering clear, consistent reports. Because fetal and neonatal autopsy is an invaluable tool for understanding the factors that contribute to stillbirth, it is important to use appropriate sizing and dating methods and consistent language to deliver proper patient education and clinical guidance.

Fatal upper aerodigestive tract obstruction in an East Asian finless porpoise (Neophocaena asiaeorientalis sunameri): findings in post-mortem computed tomography.

The present case report aims to outline the post-mortem findings of an East Asian finless porpoise with upper aerodigestive tract obstruction using different post-mortem computed tomography (PMCT) visualization techniques and discusses the potential cause of death of this individual. A dead-stranded adult male East Asian finless porpoise was recovered from the Northern coast of Jeju Island, Republic of Korea. The carcass was frozen in Jeju National University within 2h upon first reported. The PMCT examinations were performed at 120 kVp, 200 mAs with a section thickness of 1mm. The scan field of view (sFOV) was set to 400mm. Four image rendering techniques, including multi-planar reconstruction, three-dimensional volume rendering, perspective volume rendering, and minimum intensity projection technique, were used to aid the diagnosis of upper aerodigestive tract obstruction in the stranded finless porpoise. Conventional necropsy was performed to provide a complete necropsy report. Using PMCT, a Sebastidae of 24cm measured length was found to be lodged in the left pharyngeal food channel and esophagus of the finless porpoise. Hard rays of the pectoral fin of the lodged fish have impaled the esophageal mucosa. Fishing gear was found to embed at the dorsal side of the lodged fish. The trachea was compressed ventrally and the arytenoepiglottic tube opening has been narrowed, which may precipitate to the finless porpoise difficult breathing. Pulmonary hyperinflation, pulmonary edema, pneumothorax, pneumopericardium, and pneumorrhachis were observed. This case report represents the first documentation of potential radiological indicators of upper aerodigestive tract obstruction in the East Asian finless porpoise using PMCT. Spatial location of the lodged item could be rendered in situ as the time of death. It has demonstrated that PMCT could provide objective measurements to adjunct the necropsy findings in diagnosis of fatal aerodigestive tract obstruction in stranded cetaceans.

Determination of causes of adult deaths using minimally invasive tissue sampling in Gandaki province of Nepal: a multicenter hospital-based study

BackgroundMinimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death.MethodsA multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death.ResultsAmong a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p < 0.001).ConclusionsMITS was useful in establishing the cause of death in the majority of adult deaths and the most common cause was infectious disease. Our findings suggest that MITS can be a valuable and alternative tool for mortality surveillance in low-resource settings, where complete diagnostic autopsies are less accepted or less prioritized.

External challenges for specialists dealing with forensic autopsies.

In addition to poor infrastructure, and human resource constraints, forensic medicine specialists in developing countries face many external challenges. We aimed to investigate the prevalence, type, and source of external challenges confronting them including sex, age, religion, deceased's place of residence and the number of accompanying relatives. This cross-sectional, observational study was conducted between August 2020 and July 2022 at the Mortuary of AIIMS, Bhubaneswar with the approval of the ethical committee. Of note, forensic medicine specialists faced external challenges in about one in five cases (20.5%). Most demands were to either minimise the autopsy procedure (n = 65) or to conduct the autopsy at inappropriate times (n = 58). The demands to minimise the autopsy procedure were significantly associated with the deceased's age (p = 0.046), religion (p = 0.010), socioeconomic class (p = 0.020) and manner of death (p = 0.019). Our study found that forensic medicine specialists in India face significant external challenges. Avoiding unnecessary complete autopsies, implementing night autopsies, and embracing minimally invasive autopsies are recommended to mitigate these challenges.

Estudio poblacional forense de la muerte súbita inexplicada en la epilepsia en niños y jóvenes durante el periodo 1991-2021

IntroductionSudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in young epileptic patients. The objective of the work is to analyze its frequency and clinical-pathological characteristics as a cause of sudden death in epileptics under 35 years of age. MethodsRetrospective population study of all SUDEP in people aged 1–35 years in Bizkaia (period 1991–2021) and Seville (2004–2021) investigated in the Forensic Pathology Services (FPS). In each case, a complete autopsy was carried out with histopathological and toxicological studies, and review of clinical and circumstantial data. Data from the Mortality Registry for deaths by epilepsy were examined. Results101 deaths due to epilepsy were registered in the Mortality Registries and 46 SUDEP cases in the FPS, representing 6% of forensic sudden deaths in this age population. A high frequency of post-traumatic epilepsy cases (n = 5), brain abnormalities (n = 5) or epilepsy associated to developmental disorders (n = 4) or mental retardation (n = 3) was observed. The toxicological analysis was positive in 75%, highlighting the presence of antiepileptic drugs (n = 26). Illegal drugs were detected in 5 young people, mainly cocaine (n = 3). Death was unwitnessed in most subjects (85%) and occurred at night (n = 63%) while sleeping. ConclusionsSUDEP in children and young people is infrequent, however it is an important cause of mortality in epileptics. Although the mechanisms are not well understood, it is recommended to strengthen the medical control of epilepsy in youth, mainly in patients with post-traumatic or post-surgical epilepsy or in those who have associated developmental disorders or mental retardation.

Ependymal cyst in the caudal cranial fossa of a young Belgian Malinois dog with abnormal cerebrospinal fluid findings

Abstract Fluid-filled cavities within the brain are well-recognized in human and veterinary medicine. Congenital or acquired brain cystic lesions could be isolated or associated with other diseases. Clinical signs related to cysts depend on their size and the mass effect they exert on surrounding neuroanatomical structures. We present a case of a 5-month-old Belgian Malinois dog with cervical pain and right head tilt. The dog had a normal haematochemical profile and negative infectious disease tests. A contrast enhancement Computed Tomography scan revealed the presence of a thin-walled cystic lesion in the caudal cranial fossa at the level of the right pontine-cerebellar junction. A cerebrospinal fluid tap was performed by lumbar puncture, revealing a monocytic pleocytosis. After initial improvement following corticosteroid and antibiotic therapy, clinical signs worsened, and the dog underwent a second clinical evaluation and magnetic resonance imaging examination. After euthanasia a complete postmortem examination was performed. Histological and immunohistochemical findings were suggestive of an ependymal cyst.