Forensic Pathology Service Research Articles

Opioid-related deaths in Northern Ontario in the early COVID-19 pandemic period.

In the first year of pandemic measures, opioid-related deaths across Ontario's (ON) 34 public health units (PHUs) increased by 60%. Death rates for all seven Northern ON PHUs were above the provincial average. This study describes and compares factors surrounding opioid-related deaths before and after pandemic measures were introduced, for Northern ON compared to the rest of ON. Aggregate data were provided for Northern ON and the rest of the province by the Office of the Chief Coroner/Ontario Forensic Pathology Services. Opioid-related deaths were cohorted by date of death for the year before and after pandemic measures were introduced on March 16, 2020. Chi-square tests were used to compare between cohorts and geographies to determine significant differences for each variable, and for dichotomized levels within variables. P-values < 0.05 were considered statistically significant a priori. In Northern ON, the number of opioid-related deaths approximately doubled from the pre-pandemic cohort (n = 185) to the early pandemic cohort (n = 365). Compared to the rest of ON, higher proportions of deaths occurred in Northern ON among individuals who lived and died in private residences, among women (although the majority of decedents were male) and among individuals employed in mining, quarrying, and oil and gas industries. Compared to the pre-pandemic year, in Northern ON, higher proportions of opioid-related deaths involved fentanyl and stimulants as direct contributors, and the majority involved evidence of inhaled drugs. Differences between the circumstances of death in Northern ON andin the rest of ON suggest opportunities to tailor interventions.

Cardiac arrhythmia and epilepsy genetic variants in sudden unexpected death in epilepsy.

Sudden Unexpected Death in Epilepsy (SUDEP) is the leading epilepsy-related cause of death, affecting approximately 1 per 1,000 individuals with epilepsy per year. Genetic variants that affect autonomic function, such as genes associated with cardiac arrhythmias, may predispose people with epilepsy to greater risk of both sudden cardiac death and SUDEP. Advances in next generation sequencing allow for the exploration of gene variants as potential biomarkers. Genetic testing for the presence of cardiac arrhythmia and epilepsy gene variants was performed via genetic panels in 39 cases of SUDEP identified via autopsy by the Ontario Forensic Pathology Service. Variants were summarized by in-silico evidence for pathogenicity from 4 algorithms (SIFT, PolyPhen-2, PROVEAN, Mutation Taster) and allele frequencies in the general population (GnomAD). A maximum credible population allele frequency of 0.00004 was calculated based on epilepsy prevalence and SUDEP incidence to assess whether a variant was compatible with a pathogenic interpretation. Median age at the time of death was 33.3 years (range: 2, 60). Fifty-nine percent (n=23) were male. Gene panels detected 62 unique variants in 45 genes: 19 on the arrhythmia panel and 26 on the epilepsy panel. At least one variant was identified in 28 (72%) of decedents. Missense mutations comprised 57 (92%) of the observed variants. At least three in silico models predicted 12 (46%) cardiac arrhythmia panel missense variants and 20 (65%) epilepsy panel missense variants were pathogenic. Population allele frequencies were <0.00004 for 11 (42%) of the cardiac variants and 10 (32%) of the epilepsy variants. Together, these metrics identified 13 SUDEP variants of interest. Nearly three-quarters of decedents in this SUDEP cohort carried variants in comprehensive epilepsy or cardiac arrhythmia gene panels, with more than a third having variants in both panels. The proportion of decedents with cardiac variants aligns with recent studies of the disproportionate cardiac burden the epilepsy community faces compared to the general population and suggests a possible cardiac contribution to epilepsy mortality. These results identified 13 priority targets for future functional studies of these genes potential role in sudden death and demonstrates the necessity for further exploration of potential genetic contributions to SUDEP.

A qualitative exploration of forensic pathology service staff perceptions of the implementation barriers and facilitators of manual- and electronic injury mortality surveillance system methods in South Africa

BackgroundInjury mortality surveillance systems are critical to monitor changes in a population’s injury outcomes so that relevant injury prevention responses may be adopted. This is particularly the case in South Africa, where the injury burden is nearly twice the global rate. Regular evaluations of surveillance systems are pivotal to strengthening surveillance capacity, performance, and cost effectiveness. The National Injury Mortality Surveillance System (NIMSS) is an injury mortality surveillance system that is currently focused in Mpumalanga and utilises manual and electronic web-based systems for data collection. This study explored Forensic Pathology Service (FPS) staff perceptions of the implementation barriers and facilitators of manual- and electronic injury mortality surveillance system methods.MethodsA qualitative study was employed using purposive sampling. Forty-seven participants, aged 29 to 59 years comprising 31 males and 16 females were recruited across 21 FPS facilities that serve the province. The formative evaluation occurred over the November 2019 to November 2022 period. Twelve focus group discussions were thematically analysed to determine emerging themes and patterns related to the use of the system using the WHO surveillance system guidelines as a framework.ResultsThe key themes concerning the barriers and facilitators were located along WHO attributes of simplicity, acceptability, timeliness, flexibility, data quality and stability. Distinctions between the manual and e-surveillance systems were drawn upon across the attributes highlighting their experience with the system, user preference, and its contextual relevance. With Mpumalanga predominantly rural, internet connectivity was a common issue, with most participants consequently showing a preference for the manual system, even though the electronic system’s automated internal validation process was of benefit. The data quality however remained similar for both methods. With program stability and flexibility, the manual system proved more beneficial as the dataset was reported to be easily transferrable across computer devices.ConclusionObtaining FPS perceptions of their experiences with the system methodologies are pertinent for the enhancement of injury surveillance systems so to improve prospective engagements with the systems. This will facilitate timely and accurate injury mortality information which is vital to inform public policy, and injury control and prevention responses.

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.

Investigating blood alcohol concentrations in injury-related deaths before and during the COVID-19 National lockdown in Western Cape, South Africa: A cross-sectional retrospective review.

Alcohol is a significant contributor to injury-related morbidity and mortality in South Africa (SA). During the COVID-19 global pandemic, restrictions to movement and to the legal access of alcohol* were introduced in SA. This study aimed to investigate the effect of alcohol bans during the COVID-19 lockdown periods on injury-related mortality and the blood alcohol concentrations (BAC) in these deaths. A retrospective, cross-sectional analysis of injury-related deaths in Western Cape (WC) province, SA, between 1 January 2019 to 31 December 2020 was conducted. Cases where BAC testing was performed were further examined according to the periods of lockdown (AL5-1) and alcohol restrictions. A total of 16,027 injury-related cases were admitted to Forensic Pathology Service mortuaries in the WC over the two-year period. An average decrease of 15.7% injury-related deaths in 2020 compared to 2019 was noted, as well as a 47.7% decrease in injury-related deaths during hard lockdown (April -May 2020) compared to the same period in 2019. In the injury-related deaths, 12,077 (75.4%) had blood specimens collected for BAC testing. In 5,078 (42.0%) of submitted cases, a positive BAC (≥0.01g/100 mL) was reported. No significant difference was observed in the mean positive BAC between 2019 and 2020, however in April and May 2020, the mean BACs observed (0.13 g/100 mL) was less than that in 2019 (0.18 g/100 mL). A high number of positive BACs in the 12-17-year age group (±23.4%) was observed. There was a clear decrease in injury-related deaths in the WC during the COVID-19-related lockdown periods that coincided with the alcohol ban and restriction of movement and an increase following relaxation of restrictions on alcohol sales and movement. The data illustrated that mean BACs were similar between all periods of alcohol restriction compared to 2019, apart from hard lockdown in April-May, 2020. This coincided with a smaller mortuary intake during the level 5 and 4 lockdown periods. Keywords: Alcohol; blood alcohol concentration; COVID-19; injury; lockdown; South Africa; violent death; Western Cape * Alcohol refers to ethanol.

The Goudge Inquiry and Forensic Pathology in Canada.

This article analyses the effects of The Inquiry into Pediatric Forensic Pathology in Ontario, commonly known as the Goudge Inquiry, and its effects upon forensic pathology in Canada. The Goudge Inquiry was a Government of Ontario public inquiry that examined the delivery of pediatric forensic pathology services to the Ontario Coroner's Office and the Canadian criminal justice system. The inquiry was conducted by Mr. Justice Goudge, a court of Appeal Judge and made substantial recommendations of improving forensic pathology in a Coroner system and its role in delivering evidence to the criminal justice system. This article reviews the inquiry and discusses the effect of the inquiry on the development of forensic pathology in Canada and academic literature about the inquiry. The Inquiry has had important effects on the role of all expert witnesses in the courts and is the most substantial examination of forensic pathology by any judicial inquiry. The Goudge Inquiry has been considered a significant success, being described as transformative.

Ethanol and illicit drugs acute use and abuse as risk factors for suicide: A case–control study based on forensic autopsies in the Basque Country, Spain

IntroductionAbuse/dependence and acute use of ethanol and illicit drug are considered risk factors for suicide. The risk is also influenced by demographic conditions and/or psychiatric comorbidity. The aim of the study was to test the association between presence of ethanol, illicit substances and prescribed drugs in suicide decedents and controls. Materials and methodsCase–control study of autopsies performed in the Biscay Forensic Pathology Service, Basque Country, Spain from 01/01/2010 to 30/06/2021 in subjects between 15 and 55 years old. Suicide deaths (n=481) with completed autopsy were evaluated. Concurrent natural deaths were chosen as controls (n=330). The risk for suicide according to demographic, toxicological and psychiatric variables was analyzed using logistic regression. ResultsEthanol was present in 21% and illicit drugs, mainly cannabis, cocaine and amphetamine, in 27% of suicide deaths. Illicit drugs were more frequent among males. In 63% of suicide cases, prescribed psychotropic drugs were detected.In a multivariate analysis, the main risk factors for suicide were psychiatric diagnosis of illicit drug abuse/dependence (OR=5.56, 95% CI 2.74–11.30) or another mental disease as mood or psychotic disorders (OR=13.05, 95% CI 8.79–19.37). Acute presence of ethanol (OR=4.22, 95% CI 2.52–7.08), recent use of cocaine (OR=2.52, 95% CI 1.05–6.07) and age <35 years (OR=2.50, 95% CI 1.62–3.87) were also associated with suicide deaths. ConclusionsThe presence of drugs of abuse in suicide deaths of people ≤55 years old is high. Recent use of ethanol and cocaine is significantly associated with an increased suicide risk. Specific prevention strategies against exposition to substances of abuse should be promoted, especially in psychiatric patients.

Epidemiological changes and causes of sudden unexpected death in infancy: A 30-year population-based study in Basque Country

IntroductionSudden unexpected deaths in infancy (SUDI) represents a serious public health problem. The objective of this work is to analyze its epidemiological and clinical-pathological characteristics. MethodRetrospective population study of SUDI in Bizkaia between 1991-2020. Data from the Mortality Registry and Forensic Pathology Service were examined. Results1,109 deaths in children under one year were recorded. A forensic autopsy was performed in 107: 61 cases of sudden infant death syndrome (SIDS) and 23 SUDI of explained cause. In other 10 cases SIDS was coded as cause of death without forensic autopsy. The incidence of SIDS was 0.26/1,000/year and decreased from 0.74 (1991-1995 five-year period) to 0.07 (2011-15 and 2016-20 periods). The percentage of SIDS in relation to total mortality decreased from 11.2 to 2.5%. In SIDS, category IB from San Diego (67%) and infants between 1 and 4 months (63%) predominated. An “unsafe sleep environment” was detected in 6 SIDS. 56.5% of the explained SUDI were infectious. Of the 84 autopsied SUDI cases, 70% had no pre-existing disease and 15% were premature and/or low birth weight infants. In 32% there were prodromal symptoms, mainly respiratory tract infection. Microscopic findings suggestive of respiratory infection were diagnosed in 10 SIDS. ConclusionsThe incidence of SIDS in Bizkaia is low and has decreased notably in the last 30 years. Prodromal symptoms and histopathological signs suggestive of infection are relatively common. Forensic studies provide relevant data, although prospective multidisciplinary and multicenter research would be desirable.

How much does a forensic autopsy cost in Spain?

Introduction and objectivesThe autopsy is considered the gold standard in death investigation. Performing an autopsy requires human and material resources that must be programmed in order to meet the demands of the judicial system. However, as far as we know, the cost of forensic autopsy in Spain has not been determined. Thus, the aim of this study was to estimate the cost of a standard autopsy in order to organise Forensic Pathology Services more efficiently.Material and methodsA micro-cost analysis was carried out. The nominal group technique was applied using a panel of 10 forensic experts in order to identify and quantify the resources associated with a forensic autopsy.ResultsThe results showed that analysis and studies are the most important item in the total cost (54.7%), followed by staff (20.5%), preservation of body (14%), single-use products (7%), equipment and stock (1.6%), cleaning and disinfection (1.5%), facilities maintenance (0.5%) and IT (0.2%).ConclusionsThe total cost of a standard autopsy was €1501.45, which is lower than the European average. This study is the first in Spain to calculate the unit price of a forensic autopsy by means of micro-cost analysis. This may help to address the way forensic pathology centres are organised at different levels of complexity.

Post mortem computed tomography is highly sensitive for pyelonephritis. A radiologic-pathologic correlation series.

Pyelonephritis is a potentially lethal disease occasionally encountered in the forensic setting. Post mortem computed tomography (PMCT) is an important investigative tool for the forensic pathologist. In particular, it may be used to document and screen disease prior to traditional autopsy methods. While the sensitivity and specificity of computed tomography for pyelonephritis is well studied in the antemortem clinical setting, the test characteristics of PMCT are not yet described in the forensic pathology literature. A series of all cases of fatal pyelonephritis identified at the Ontario Forensic Pathology Service, over the course of 1year was studied. Radiologic, clinical and pathologic findings were reviewed. A fulsome autopsy, including histopathologic examination, was considered the gold standard for sensitivity and specificity calculations. A control group consisting of 16 cases without pyelonephritis (ex: opiate toxicity) in which both PMCT and histologic data were available by way of comparison. Sixteen cases of pyelonephritis were identified. Post mortem computed tomographical signs of pyelonephritis included asymmetric renal enlargement, perinephric fat stranding, and ectopic renal air. The most (57%) individually sensitive of these findings was perinephric fat stranding but sensitivity increased to 100% if any of the three signs were present. The control group analysis revealed the specificity of air asymmetry (81%), asymmetric renal enlargement (81%), and fat stranding (69%). PMCT findings may rule in a diagnosis of pyelonephritis, and should prompt the pathologist to grossly and microscopically examine the kidneys.

Evolución epidemiológica y causas de muerte súbita en lactantes: estudio poblacional desde 1991 a 2020 en Bizkaia

IntroductionSudden unexpected deaths in infancy (SUDI) represents a serious public health problem. The objective of this work is to analyze its epidemiological and clinical-pathological characteristics. MethodRetrospective population study of SUDI in Bizkaia between 1991–2020. Data from the Mortality Registry and Forensic Pathology Service were examined. Results1,109 deaths in children under one year were recorded. A forensic autopsy was performed in 107: 61 cases of sudden infant death syndrome (SIDS) and 23 SUDI of explained cause. In other 10 cases SIDS was coded as cause of death without forensic autopsy. The incidence of SIDS was 0.26/1000/year and decreased from 0.74 (1991–1995 five-year period) to 0.07 (2011–15 and 2016–20 periods). The percentage of SIDS in relation to total mortality decreased from 11.2 to 2.5%. In SIDS, category IB from San Diego (67%) and infants between 1 and 4 months (63%) predominated. An “unsafe sleep environment” was detected in 6 SIDS. 56.5% of the explained SUDI were infectious. Of the 84 autopsied SUDI cases, 70% had no pre-existing disease and 15% were premature and/or low birth weight infants. In 32% there were prodromal symptoms, mainly respiratory tract infection. Microscopic findings suggestive of respiratory infection were diagnosed in 10 SIDS. ConclusionsThe incidence of SIDS in Bizkaia is low and has decreased notably in the last 30 years. Prodromal symptoms and histopathological signs suggestive of infection are relatively common. Forensic studies provide relevant data, although prospective multidisciplinary and multicenter research would be desirable.

Human Decedent Identification Unit: identifying the deceased at a South African medico-legal mortuary.

The Johannesburg Forensic Pathology Services medico-legal mortuary perform postmortem examinations on all cases of unnatural deaths in the greater Johannesburg metropolitan area, in South Africa. Unidentified decedents can comprise up to 10.0% of the total number of annual admissions at this medico-legal mortuary. To address the identification of the deceased, the Human Decedent Identification Unit (ID Unit) was created to perform secondary examinations for identification purposes. The aim of this study was to report on the identification methods and success rate of the ID Unit. Over a period of 31 months (January 2018–July 2020), unidentified decedents comprised 8.1% (n = 693) of all cases at the Johannesburg mortuary. The ID Unit processed 385 (55.6%) unidentified individuals during this period, who were mostly adult (100%), Black (94.5%), males (91.7%). DNA samples were successfully collected from most cases in the form of hair (96.4%; n = 371), blood (92.2%; n = 355), and nail samples (90.1%; n = 347). Fingerprints retrieved in 65.5% of cases (n = 252). Ultimately, 87 persons (22.6%) were positively identified. Fingerprinting was the most successful method of identification (98.9% of cases; n = 86). One positive identification was facilitated through DNA analysis. The nationalities of the positively identified decedents were from South Africa (52.9%; n = 46), Zimbabwe (5.7%), Uganda (1.1%), Mozambique (1.1%), Malawi (1.1%), South Sudan (1.1%), and undisclosed in 36.8% of cases. Through the collaborative efforts of all the agencies involved, the impact of the work of this ID Unit is vast—not only for South African authorities but most importantly for the decedents and their families.

Traumatic Diaphragmatic Injuries at Medicolegal Autopsy: A 1-Year Prospective Study.

Traumatic diaphragmatic injuries (TDIs) are relatively rare. The forensic literature pertaining to TDIs consists mainly of case studies, suggesting little attention to these injuries during autopsies and research. This prospective study was conducted at the Ga-Rankuwa Forensic Pathology Services mortuary over a 1-year period. We included all cases who had a full medicolegal autopsy, as prescribed by the relevant South African legislation (Inquest Act 58 of 1959). All diaphragms were examined by a forensic medical practitioner performing the autopsy. Nine hundred ninety-nine cases were analyzed; of these, 71 cases with TDIs were identified. The incidence of TDI was, therefore, determined to be 7.11%. A total of 60.56% involved the right hemidiaphragm, 19.72% the left hemidiaphragm, and 19.72% were present bilaterally. A total of 85.92% were present in men and 14.08% in women. Blunt force trauma comprised 33.80%, and penetrative trauma 61.97%. Most were associated with severe injuries. A total of 12.68% had organ herniation through the defects present. Our study revealed that TDIs were more common than initially reported. The right side was more often involved in our study than in other studies. Diaphragmatic injuries were observed in 21.46% of all penetrative trauma cases received in a year.

Forensic human identification: retrospective investigation of anthropological assessments in the Western Cape, South Africa.

The identification of unknown persons, particularly those who are decomposed or burnt, is a global challenge. Forensic Anthropology Cape Town (FACT) is a service provider that assists the South African state with the identification of human remains. However, empirical data pertaining to anthropologically analysed forensic cases in the Western Cape Province of South Africa are lacking. Therefore, anthropological data pertaining to the forensic cases submitted to FACT between 2006 and 2018 from Forensic Pathology Services were retrospectively reviewed (n = 172). This study also sought to assess demographic, traumatic and pathological factors that impacted successful identification. Most decedents were male (67%) and older than 35years (54%). While ante-mortem trauma was observed in 41% of decedents, the lack of medical records on ante-mortem injuries hindered the use of this information for identification. Positive identifications were reached for 37% of decedents, and of these, anthropological estimations were correct in 98% of cases for sex, 84% of cases for age at death and 100% of cases for stature. Considering globally accepted accuracies of 70-80%, these estimations were considered highly accurate, suggesting the anthropological methods used are suited to the population. However, 63% of cases remained unidentified, and this study showed that skeletal completeness and pathological conditions were the main factors that hindered demographic estimations. Lastly, not all unidentified bodies in the province were referred to FACT; given the highly accurate estimations, these data advocate for the routine, if not mandatory, use of forensic anthropology services for skeletonised remains in South Africa, with the overall purpose of positively impacting human identification. To improve identification rates globally, these data highlight the value of retrospective and region-specific studies to identify strengths and weaknesses in the system.

Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures

BackgroundThe effects of the COVID-19 pandemic on non-natural manners of death in Ontario is not known. Understanding the indirect consequences of the pandemic and related public health measures (i.e. lockdown) fills a vital need to inform best practice in public health and guide policy decisions.MethodsThe Office of the Chief Coroner and the Ontario Forensic Pathology Service (OCC-OFPS) investigate sudden and unexpected deaths in the province of Ontario. The number of homicides, suicides, and accidental deaths (non-natural deaths=77,655) were extracted from the centralized Coroner's Information System database (total deaths=197,966), across four provincially defined stages of lockdown related to the COVID-19 pandemic (March 17 to December 31, 2020), and crude rates (per 100,000 people) were compared to the previous eleven years.FindingsThere was no major change to the rate of homicides during 2020 compared to 2009-2019 (RR 1⋅1, 95% CI 0⋅95-1⋅2; p=0⋅19; estimated annual effect=21 more deaths in 2020). The rate of suicides also did not show an overall major change in 2020 (RR 1⋅02, 95% CI 0⋅96-1⋅1; p=0⋅50; estimated annual effect=27 more deaths in 2020). However, during the first stage of lockdown (Stage 0), there was a decrease in the rate of suicides compared to all combinations of recent years from 2013 onwards (RRs 0⋅82-0⋅86, combined 95% CI 0⋅69-0⋅99; max p=0⋅039; estimated effect of 30 less deaths in Stage 0). There was an excess of over 1,500 accidental drug-related deaths that occurred during 2020 (RR 2⋅5, 95% CI 2⋅4-2⋅7; p<0⋅001). This finding held up to ‘interrupted time series’ robustness testing, indicating that 2020 had substantially more drug-related deaths, even when accounting for the linear increasing trend over time. Although motor vehicle collision associated fatalities appeared to decrease slightly in 2020 (RR 0⋅89, 95% CI 0⋅81-0⋅96; p=0⋅0039; estimated annual effect of 78 less deaths), we could not conclude any lockdown-associated effect, particularly when compared to 2019 (RR 0⋅26, 95% CI 0⋅75-1⋅1; p=0⋅26).InterpretationIn Ontario, the short-term effects of the COVID-19 pandemic did not greatly increase homicide or suicide rates, nor decrease motor vehicle collision fatality rates; however, the longer-term impact of the pandemic remains to be elucidated and ongoing vigilance is warranted in the event that other trends emerge. Accidental drug-related fatalities substantially increased during all stages of the lockdown, marking an urgent need for consideration in policy. These results highlight the vital role of death investigation systems in providing high quality and timely data to inform public health recommendations.FundingNone.

Firsthand Experience in Graduating Three Cohorts of Forensic Pathologists Trained With Competency by Design (CBD) Curriculum.

The University of Toronto experienced graduating three cohorts of forensic pathologists trained with Competency by Design (CBD) curriculum. We achieved this as a result of multiyear development of Entrustable Professional Activities (EPAs), Required Training Experience (RTEs), and Specialty Competency Requirements (SCRs) by the Royal College of Physicians and Surgeons of Canada's Forensic Pathology Speciality Committee, the Ontario Forensic Pathology Service, and the University of Toronto. Our academic year is comprised of 13 blocks. We divided the 13-block period into 4 stages to map all the EPAs and RTEs. The first stage, Transition to Discipline, is 1 block, the second stage, Foundation of Discipline, consists of 3 blocks; the third stage, Core of Discipline, consists of 6 blocks, and the final fourth stage, Transition to Practice, consists of 3 blocks. Board-certified faculty members in Forensic Pathology with more than five years of experience supervised the trainees. We graduated 5 Canadian and 4 international trainees at the end of the third cycle of CBD-based training program. Using the Royal College Speciality Committee blueprint, the University of Toronto started in 2016 planning the CBD curriculum in the forensic pathology training program. By the end of June 2021, we graduated nine trainees from our CBD-based Forensic Pathology training program. We are training the fourth cohort, and they will be graduating at the end of June 2022. This article aims to share our firsthand experiencing in CBD training in forensic pathology.

An Experience on Facts about Teaching Forensic Medicine to Undergraduate Medical Students in South Africa

South Africa is struggling with an enormous amount of forensic pathology services because there is an extreme pressure on forensic pathologists to deal with the high number of medicolegal autopsies in the country. There are only five dozen forensic pathologists in South Africa who have to handle at least 80 000 autopsies per year. Medical officers, who have only received training as undergraduates in medical school, are expected to conduct these autopsies. Therefore, undergraduate teaching and training must be strong enough so that these young graduates can handle cases without any compromise in the quality of the outcome.This report is going to highlight the necessity of teaching forensic medicine at undergraduate level in South African medical schools. It will also discuss the shortcomings in medical school teaching programmes.

PCR based method for sex estimation from bone samples of unidentified South African fetal remains

Fragmentary bone in disaster victim identification is reliant on a robust and objective method. Current methods employing traditional phenotypic analysis for sex estimation of forensic fetal remains are limited and often not possible due to the lack of distinctive cranial and pelvic traits. Thus, a molecular sex estimation method optimized for bone samples would enhance current techniques. Sternal rib samples were dissected from unclaimed perinatal decedents, presenting at varied stages of decomposition and unconfirmed circumstances of death, who were admitted to the Johannesburg Forensic Pathology Service (JFPS) and included in the Johannesburg Forensic Paediatric Collection (JFPC). A molecular protocol was designed and optimized using genomic DNA from SW480 cells and five individuals of unknown provenance and known sex (estimated during medicolegal autopsy) by targeting the X-linked G6PD and Y-linked SRY genes. The sex estimated at autopsy was confirmed using the optimized protocol. Nine (9) unidentified individuals were included and assigned sex based on the method described. The development of a sex typing protocol targeting the G6PD and SRY loci provides a new PCR method for sex estimation of human remains from 25 mg of bone fragment.

Doctrine of ‘resipsa loquitur’ in surgical management of head injury in Transkei region, South Africa: Case Report

Background: Poor people accept death as ‘God’s wish’, sing a ritual song and bury their loved ones without pointing a finger at anyone or asking how their loved ones died. Medical errors cause several deaths, but most of the time this goes unnoticed, because many affected by it are poor and illiterate. Objective:To highlight the problem of fatal surgical errors in the management of head injury of patients in the Transkei region of South Africa. Case Histories: The case reports of the autopsies that discussed are intended to highlight the gross surgical negligence of medical professionals. In the first case, burr-holes were made to release intracranial pressure, but a piece of glass, which was the primary cause of increased intracranial pressure, was left in the cranium. In the second case, an inexperienced operating surgeon pushed the drill deep into the cortex of the brain while making burr-holes. The third case report describes a head injury suffered by an alcohol-intoxicated patient. The head injury was inflicted at a police station. This article presents histories, post-mortem findings, causes and mechanisms of death, as well as discusses acts of commission and omission. Conclusion: A high level of fatalities is caused by ‘acts of commission and omission’ in respect of head injury of patients in the Transkei region of South Africa. This matter needs regular auditing through forensic pathology services.

Mob justice fatalities in South Africa: a forensic mortuary study.

Mob justice fatalities are a gross violation of human rights as they represent extra-legal punishment. There is a paucity of research relating to the demographics of at-risk groups, nature of injuries and the impact to the Forensic Pathology Service at national and provincial levels. This was a retrospective study over 10years (1 April 2006 to 31 March 2016) at Germiston Forensic Pathology Service Medico-legal Mortuary. The objectives were to describe the demographics of the victims of fatal mob justice, describe the trends of the number of fatalities and causes of death over time, assess hospitalization frequency, describe the nature and location of injuries sustained, and to report on ancillary investigations performed. A total of 354 cases were analyzed. All victims were Black (100%), with 99.4% of the sample group being male. The largest proportion was aged between 21-30years (49.2%) with the majority having South African citizenship (68.9%). The majority of deaths were due to blunt force injuries (92.4%) with blunt force head injury being the most prevalent (79.9%). Half of the victims died on the scene (50.6%; n = 175). Hospitalization occurred in 49.4% (n = 175) of cases, of which, 56.3% died within 24h of hospital admittance. Ancillary tests were ordered in 22.6% of cases. Adequate resources should be distributed to appropriate departments to engage with and monitor communities in high incidence areas to curb these killings.