Medical Autopsy Research Articles

Decedents Found in Bathtubs.

We investigated deaths in bathtubs for criteria to assist in death certification. We reviewed 252 deaths in which the person was found dead in a bathtub/shower at home. We extracted cause, manner, age, clad or unclad, water in the bathtub, water running, and face submersion. Of the 252 deaths, heart disease was the leading cause of death (129), followed by intoxication (47), trauma (22), drowning (28), and other diseases (26). The manners of death were 155 natural, 64 accident, 30 suicide, and 3 homicides. All drowning fatalities involved the decedent having their face submerged. Intoxication and natural deaths had submersion of the face in 15% and 12% of deaths, respectively. For nondrowning causes of death, the majority were without face submersion. For natural deaths, the predominant circumstance was the individual discovered unclad with water in the bathtub and the face not submerged. Conversely, for suicides, the majority were found clad without water. A comprehensive investigation incorporating a scene examination, gathering of the medical and psychosocial history, and typically an autopsy is needed to certify the cause and manner of death. Face submersion alone is not diagnostic of a drowning and must be interpreted with the medical history and autopsy findings.

Case of Bone Morphogenetic Protein Receptor Type 2 (BMPR2) Mutation Complicated by Pulmonary Hypertension Encountered at Autopsy

Abstract Introduction/Objective Bone morphogenetic protein receptor type 2 is a protein encoded by the BMPR2 gene which regulates cell division and apoptosis. BMPR2 mutations result in monoclonal plexiform lesions of proliferating endothelial cells in pulmonary arterioles, which leads to elevated pulmonary artery pressures, right ventricular failure, and death. Here, we present the case of a 12-year-old male with a known history of pulmonary hypertension secondary to BMPR2 mutation referred for medical autopsy after suffering cardiac arrest and passing away. Methods/Case Report This 12-year-old male was diagnosed with pulmonary hypertension in December 2022 after suffering a syncopal episode while running at recess. Genetic testing was obtained, and he was found to have a BMPR2 mutation. His father was tested and also harbored this mutation, but did not clinically have pulmonary hypertension. The decedent was initiated on ambrisentan, tadalafil, and spironolactone, but continued to present to the Emergency Department periodically for syncopal episodes. In April 2024, he presented to the Medical University of South Carolina in cardiac arrest which began while playing outside. A complete autopsy was performed, including gross and microscopic examination of tissues and postmortem vitreous electrolyte analysis. Gross examination revealed the decedent’s heart was enlarged to 350 grams (normal mean for age = 181 grams). Both cardiac ventricles were dilated and the right ventricle was markedly hypertrophic with a thickness of 1.2 cm. Microscopic sections are pending but will presumptively show significant cardiac myocyte hypertrophy and pulmonary arteriole thickening. Cause of death is pending certification but is presumed to be sudden cardiac death resulting from BMPR2 mutation- related pulmonary hypertension. Results (if a Case Study enter NA) NA Conclusion This case highlights a common genetic presentation of pulmonary arterial hypertension, with approximately 80% of familial cases of pulmonary arterial hypertension harboring BMPR2 mutations. Further research should be done to investigate treatment options and management of this genetic presentation.

The power of hybridization capture - Illustrated using an expanded gene panel on 100 post mortem samples, focusing on sudden unexplained death

Sudden unexpected death (SUD) is an unexpected event that in many cases are caused by diseases with an underlying genetic background. Forensic molecular autopsy is an approach that has gained wide-spread attention, in part explained by the rapid progress of DNA sequencing techniques. The approach leverages genetic data in combination with medical autopsy findings in post-mortem samples to explore a potential underlying genetic cause of death.Traditional forensic approaches to molecular autopsy focus on a small panel of genes, say <200 genes, with strong association to heart conditions whereas clinical genetics tend to capture entire exomes while subsequently selecting targeted panels bioinformatically. The drop in price and the increased throughput has promoted wider exome sequencing as a viable method to discover genetic variants. We explore a targeted gene panel consisting of 2422 genes, selected based on their broad association to sudden unexplained death. A hybridization capture approach from Twist Bioscience based on double stranded DNA probes was used to target exons of the included genes. We selected and sequenced a total of 98 post-mortem samples from historical forensic autopsy cases where the cause of death could not be unambiguously determined based on medical findings and that had a previous negative molecular autopsy.In the current study, we focus on the performance of the hybridization capture technology on a 2422 gene panel and explore metrics related to sequencing success using a mid-end NextSeq 550 as well as a MiSeq FGx platform. With the latter we demonstrate that our sequence data benefits from 2×300bp sequencing increasing coverage, in particular, for difficult regions where shadow coverage, i.e. regions outside the probes, are utilized. The results further illustrate a highly uniform capture across the panel of genes (mean fold80=1.5), in turn minimizing excessive sequencing costs to reach sufficient coverage, i.e. 20X.We outline a stepwise procedure to select genes associated with SUD through virtual bioinformatical panels extracting tier of genes with increasing strength of association to SUD. We propose some prioritization strategies to filter variants with highest potential and show that the number of high priority genetic variant requiring manual inspections is few (0-3 for all tiers of genes) when all filters are applied.

The last days of Daniel Webster: A detailed analysis of his cause of death.

Daniel Webster (1782-1852) was one of the most impactful United States political figures of the early and mid-nineteenth century. He served in Congress and as the Secretary of State for three Presidents. He died in October of 1852 and his autopsy appeared in the medical literature. Historians have reported that his cause of death was either related to a traumatic head injury he sustained in May of 1852 or from complications of alcoholic cirrhosis. In this manuscript, we will review Webster's medical history and autopsy to determine his cause of death.

Imaging analysis of pneumonic plague infection in Xizang, China: a case report and literature review

BackgroundPlague is an acute infectious disease caused by the Yersinia pestis. Historically, it has been a major pandemic with high mortality rates, known as the “Black Death” in the 14th century, which resulted in millions of deaths in Europe. With increasing economic prosperity, more and more people are traveling to Xizang. However, this trend also hides significant safety hazards. Currently, there are few recent reports on plague, especially those with imaging manifestations available. In this study, we report the detailed clinical and radiological data of the patient with pneumonic plague in Xizang, China, in 2023.Case presentationWe report a case of pneumonic plague in Xizang, which occurred in a herdsman living in an area where dead marmots were found. The patient presented with symptoms such as fever, hemoptysis, dyspnea and coma. Chest computed tomography (CT) scans showed multiple nodules distributed in the central regions of lung lobes, consolidation distributed in secondary pulmonary lobules, and had a gravity-dependent distribution pattern. These imaging findings were consistent with pulmonary hemorrhage and diffuse alveolar damage. Despite emergency treatment, the patient died within 48 h of admission. Through retrospective medical history investigation, laboratory examination and autopsy, the final diagnosis was confirmed as pneumonic plague.ConclusionPneumonic plague is the most deadly infectious disease, and its pathological features mainly include damage to the alveoli, pulmonary hemorrhage, and pulmonary edema. Corresponding to CT, it manifests as acute and rapidly progressing pneumonia, alveolar damage, and pulmonary hemorrhage. The value of this article lies in the completeness and typicality of the imaging data, vivid hand-drawn illustrations of transmission pathways, and comprehensive literature review, all of which serve to enhance public understanding of plague and play an important warning role.

Pathomorphological and gender-age aspects of echinococosis of the liver

Background. Echinococcosis is a chronic parasitic disease that belongs to zooanthropohelminthosis and is characterized by the development of solitary or multiple cystic formations in the liver, lungs, brain and other organs. Today, the incidence is increasing dramatically in non-endemic countries, and the spread of the disease is largely linked to global population migration. Purpose – To analyze the pathomorphological and sex-age characteristics of operated patients with echinococcosis of the liver for the period 2011–2021. Materials and Methods. Medical documentation and autopsy material of all cases of surgical intervention in patients with liver echinococcosis at the pathology department of the State Institution «Zaycev V.T. Institute of general and urgent surgery of the National Academy of Medical Sciences of Ukraine» for the period 2011–2021. Sex-age characteristics of patients with echinococcosis were studied. A pathomorphological study of the postoperative material was carried out, taking into account the size and type of cysts, and the location of their formation. The preparations were stained with hematoxylin and eosin and by the Van Gieson method. Results. During the period 2011–2021, 36 operated patients with echinococcosis were recorded. Liver echinococcosis was mostly detected in men – 52.8% (р ≤ 0.05), the average age of patients was 46.9 ± 3.1 years. Among the operated, the percentage of people under 50 was 69.4%, with a predominance of men (52%). In the case of primary and recurrent echinococcosis of the liver, single cysts were found in most patients, namely in 26 (72.2%) with predominant localization in the right lobe (88.5%). Multiple cysts were found in 10 patients (27.8%); lesions of the right lobe of the liver – 70.0%, left – 10.0%, both lobes – 20.0%. It was established that the average diameter of echinococcal cysts was 13.8 ± 2.5 cm, individual cysts reached 17 cm. The thickness of all layers of the cyst wall was 1.3 ± 0.3 cm. The outer acellular layer of the cyst wall was 0.8 ± 0.1 cm. In most cases (61.1%, p ≤ 0.05), the parasite was alive, as evidenced by the clear, colorless cyst fluid with the presence of single daughter cysts with a diameter of 0.1 to 2 cm, which had the same macro- and microscopic characteristics as the mother cyst structure The color of the entire membrane of the parasite was white-pink. Conclusions. Over a 10-year period, 36 patients operated on for echinococcosis of the liver were recorded, the majority of cases were men (52.8%, p ≤ 0.05). The average age of the patients was 46.9 ± 3.1 years and ranged from 26 to 69 years. Among those operated on, the percentage of people under 50 was 69.4%, with a predominance of males in the gender structure. In the case of primary and recurrent echinococcosis of the liver, single cysts were found in most patients, namely in 26 (72.2%) with predominant localization in the right lobe (88.5%). Multiple cysts were found in 10 patients (27.8%); lesions of the right lobe of the liver – 70.0%, left – 10.0%, both lobes – 20.0%. The average diameter of echinococcal cysts was 13.8 ± 2.5 cm, individual cysts reached 17 cm. The thickness of all layers of the cyst wall was 1.3 ± 0.3 cm. The outer acellular layer of the cyst wall was 0.8 ± 0.1 cm In most cases, the parasite was alive (61.1%, p ≤ 0.05).

A Narrative Review on the Clinical Relevance of Imaging the Circumventricular Brain Organs and Performing Their Anatomical and Histopathological Examination in Acute and Postacute COVID-19.

Autopsy followed by histopathological examination is foundational in clinical and forensic medicine for discovering and understanding pathological changes in disease, their underlying processes, and cause of death. Imaging technology has become increasingly important for advancing clinical research and practice, given its noninvasive, in vivo and ex vivo applicability. Medical and forensic autopsy can benefit greatly from advances in imaging technology that lead toward minimally invasive, whole-brain virtual autopsy. Brain autopsy followed by histopathological examination is still the hallmark for understanding disease and a fundamental modus operandi in forensic pathology and forensic medicine, despite the fact that its practice has become progressively less frequent in medical settings. This situation is especially relevant with respect to new diseases such as COVID-19 caused by the SARS-CoV-2 virus, for which our neuroanatomical knowledge is sparse. In this narrative review, we show that ad hoc clinical autopsies and histopathological analyses combined with neuroimaging of the principal circumventricular organs are critical to gaining insight into the reconstruction of the pathophysiological mechanisms and the explanation of cause of death (ie, atrium mortis) related to the cardiovascular effects of SARS-CoV-2 infection in forensic and clinical medicine.

Этико-философские аспекты цифровой танатологии

Modern man’s digital being has changed his attitude towards the most important cultural existentials, including the problem of death, which was sacred in previous eras. The article analyzes the characteristics of digital thanatology and raises the philosophical questions about the modes of digital afterlife. From an ethical and legal point of view, the article draws attention to the need to legally restrict the circulation on the Internet of the content depicting the bodies or parts of the bodies of military personnel killed in combat zones. The article analyzes moral and ethical nuances of new socio-cultural practices: selfies with the dead; streaming from funerals, creation of digital cemeteries and sharing of medical autopsy videos on Internet platforms. The author proposes the inclusuion of “Digital Ethics” course in the university curriculum on Ethics in order to prevent the devaluation of the problem of death under the influence of digitalization.

Diagnostic yield of postmortem brain examination following premortem brain biopsy for neoplastic and nonneoplastic disease.

Medical autopsies have decreased in frequency due in part to advances in radiological techniques and increased availability of molecular and other ancillary testing. However, premortem diagnosis of CNS disease remains challenging; while ∼90% of brain tumor biopsies are diagnostic, only 20%-70% of biopsies for presumed nonneoplastic disease result in a specific diagnosis. The added benefits of performing an autopsy following surgical brain biopsy are not well defined. A retrospective analysis was performed of patients who underwent brain biopsy and autopsy at Brigham and Women's Hospital from 2003 to 2022. A total of 135 cases were identified, including 95 (70%) patients with primary CNS neoplasms, 16 (12%) with metastatic tumors, and 24 (18%) with nonneoplastic neurological disease. Diagnostic concordance between biopsy and autopsy diagnosis was excellent both for primary CNS neoplasms (98%) and metastatic tumors (94%). Conversely, patients with nonneoplastic disease received definitive premortem diagnoses in 7/24 (29%) cases. Five (21%) additional patients received conclusive diagnoses following autopsy; 8 (33%) received a more specific differential diagnosis compared to the biopsy. Overall, autopsy confirmed premortem diagnoses or provided new diagnostic information in 131/135 (97%) cases, highlighting the value in performing postmortem brain examination in patients with both neoplastic and nonneoplastic diseases.

THYROID CRISIS AS THE CAUSE OF SUDDEN DEATH: AN AUTOPSY FINDING

Sudden death can occur due to previously known or undiagnosed thyroid diseases. This case reports the death of a 21-year-old woman with symptoms suggestive of thyroid crisis. The victim’s family suspected foul play based on physical findings on the body. However, police investigation and autopsy results revealed a history of pre-existing thyroid disease. The autopsy findings showed enlargement of the thyroid gland and lung edema. Forensic histology also revealed chronic inflammation in the thyroid gland and bleeding in the lung tissue. In conclusion, the victim’s death was attributed to poorly controlled hyperthyroidism which leads to thyroid crisis. This case highlights the importance of proper management and treatment of thyroid diseases, as well as knowledge of physical signs related to postmortem changes. In this context, the case does not fulfill criminal elements but is more related to the pre-existing health condition of the victim. Therefore, a comprehensive analysis is conducted, considering the available information, including the victim’s medical history, witness testimonies, autopsy findings, and other relevant evidence. The investigation of this case holds broad significance, not only in the medical and forensic aspects but also in terms of legal and justice implications.

Do Not Turn a Blind Eye on Forensic Biochemistry: Using Vitreous Electrolytes to Reveal Renal Insufficiency as Cause of Death.

In both medical and forensic autopsy, the kidneys may be overlooked grossly and histologically. As both acute and chronic kidney dysfunction have major implications on morbidity and mortality, it is essential to consider the kidneys as a pathologic source for both immediate and proximate cause of death. For decades, vitreous humor has been used as a measure of postmortem electrolyte analysis to help understand ionic disturbances carried over from the antemortem period. Renal insufficiency from both acute and chronic kidney dysfunction can be ascertained from vitreous investigations and should be a consideration for cause of death. Here, we present 4 cases in which vitreous analysis was used to determine the cause of death. In highlighting these cases, we support the use of biochemical testing in autopsy while demonstrating how it can help elucidate an often overlooked means of mortality. Importantly, it can help with the formulation of clinicopathologic correlations between antemortem and postmortem findings.

Unveiling Opinions: Exploring the Public’s View on Clinical Autopsies

Background: Clinical autopsy is an invaluable tool useful to identify causes of death and to uncover unknown and unexpected diseases which aids in raising awareness of common and rare diseases in a community. Clinical autopsy is essential to study pattern of morbid diseases that aids in formation of effective healthcare policies. Aim: To investigate the views of the general public on clinical autopsies in order to determine general conceptions and misconceptions that may aid in further a discussion and investigations. Methodology: This prospective cross-sectional study was conducted at Department of Forensic Medicine, Dow International Medical College, Dow University of Health Sciences Karachi Pakistan from October 2022 till March 2023. Data was collected from 300 participants using a 15-item questionnaire distributed to general population from various parts of Karachi selected by convenient sampling. Results: 46% were aware of term clinical/medical autopsy. 77% acknowledged medical and social role of clinical autopsies. Less than 50% could differentiate between clinical and medico legal autopsy. 50% are of the opinion that autopsy should not be conducted in natural deaths. 55% and 64% of the participants were of the opinion that clinical autopsy can improve future lives of people and provide diagnostic and curative strategies respectively. Participants of the study were unsure about the Islamic perspective of autopsy. 57% agreed to give consent for autopsy in society’s best interest. Conclusion: The large majority is uncertain about autopsy given their religious and personal views but it also reveals many acknowledge its possible utility in medicine and in bereavement process. Therefore, despite lack of research and public discourse, it provides us with data that may encourage and aid further research and discussion about acceptance of autopsy as a viable diagnostic tool. Keywords: Autopsy, Clinical autopsy, Medical autopsy, Pakistan

Carbon monoxide related deaths: A Verona case series. When cooperation becomes compulsory

IntroductionCarbon monoxide (CO) poisoning is a significant concern in forensic medicine, as it often presents unique challenges in terms of diagnosis, investigation, and determination of the cause of death. CO is a colourless, odourless, and tasteless gas that can be lethal when inhaled in high concentrations. It binds strongly to haemoglobin, forming carboxyhaemoglobin (COHb), which reduces the oxygen-carrying capacity of the blood, leading to tissue hypoxia and ultimately death. Materials and methodsCircumstantial data, medical history information, autopsy findings, and toxicological analysis results related to 24 CO poisoning cases at the Institute of Legal Medicine in Verona were collected and analysed. The data were examined in an integrated manner to identify correlations and common patterns. A comparison was also made with the data available in the literature. ResultsThe male gender was confirmed to be the most frequently involved. COHb levels were found to be less than 50% in 6 cases. Three individuals had concurrent cardiovascular pathologies, while 11 subjects tested positive for various substances, including alcohol, benzodiazepines, and morphine. In most cases, the manner of fatal intoxication was accidental, although 6 suicides and 1 homicide are reported. ConclusionsThe Verona case series demonstrates that deaths due to CO poisoning require a multidisciplinary approach. The integration of diverse expertise is essential for assessing the manner of death. This approach enables a comprehensive evaluation of the available data, aids in distinguishing between accidental, suicidal, and homicidal deaths, and ensures accurate and reliable forensic conclusions.

Evaluating the performance of ChatGPT in writing autopsy clinicopathological correlations

Abstract ChatGPT is a chatbot launched by OpenAI in November 2022 that has generated excitement due to its utility in several technical fields including medicine. The application has gained media attention due to concerns of academic plagiarism, including its use by students for writing projects. In scientific writing, a preprint in bioarxiv reports human reviewers failing to identify a portion of ChatGPT generated abstracts. Several articles published in early 2023 list ChatGPT as a coauthor, generating debate. In medicine, Gilson et al found ChatGPT crossed the 60% threshold for the NBME Free Step-1 dataset. Patel and Lam wrote a commentary examining the value of ChatGPT in writing discharge summaries. A literature review in PubMed yielded articles further examining the utility of ChatGPT in scientific writing, however none looking at its use in pathology report writing was found. To examine this, we investigated the capabilities of ChatGPT in writing autopsy clinicopathologic reports. The February 13 version of ChatGPT was used to generate autopsy clinicopathologic correlations using prompts with the same patient demographic, same medical history of hypertension and coronary disease, and varying autopsy findings. These findings include cardiac infarct, saddle emboli, basilar artery thrombus, liver cyst, and leukoplakia. A prompt with no significant autopsy findings was also included. The prompts note a lack of imaging, labs, and toxicology. The generated responses were examined and compared. ChatGPT generated multi-sentence responses incorporating patient information, history, and major autopsy findings per prompt, ranging in length from 8 to 14 sentences. Each output varied in style, with some responses including sections for gross and microscopic findings, while others only consisting of clinicopathologic correlation. Each response was generated between 42 seconds to 1 minute. The application generated plausible correlations between the medical histories and autopsy findings. ChatGPT correlated the findings to the patient’s supplied history in prompts with a cardiovascular autopsy finding. For the liver cyst, ChatGPT linked cyst formation to portal hypertension. For leukoplakia, ChatGPT suggested the presence of an upper GI cancer with cardiovascular history also likely contributing to death. For the prompt without significant findings, ChatGPT noted that the autopsy was inconclusive. ChatGPT debuted with an increasing amount of media attention due to its capability of producing natural language responses and surprising knowledge within multiple technical fields. ChatGPT is currently being used in academic writing at multiple levels within multiple fields. In medicine, ChatGPT has done well in multiple USMLE question banks. This study found that ChatGPT generated coherent clinicopathologic correlations commensurate to the amount of information supplied in the initial prompt. While useful as an initial framework, human review is still necessary to refine the response to make a more coherent report and to review made-up findings and dubious correlations.

Morphology of the mural and commissural atrioventricular junction of the mitral valve

ObjectiveThis study investigates mitral annular disjunctions (MAD) in the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures.MethodsWe examined 224 adult human hearts (21.9% females, 47.9±17.6 years)...

Report of the 23rd nationwide follow-up survey of primary liver cancer in Japan (2014-2015).

For the 23rd Nationwide Follow-up Survey of Primary Liver Cancer in Japan, data from 20889 newly registered patients and 42274 previously registered follow-up patients were compiled from 516 institutions over a 2-year period from January 1, 2014 to December 31, 2015. Basic statistics compiled for patients newly registered in the 23rd survey were cause of death, past medical history, clinical diagnosis, imaging diagnosis, treatment-related factors, pathological diagnosis, recurrence status, and autopsy findings. Compared with the previous 22nd survey, the population of patients with hepatocellular carcinoma (HCC) was older at the time of clinical diagnosis, had more female patients, had more patients with non-B non-C HCC, had smaller tumor diameter, and was more frequently treated with hepatectomy. Cumulative survival rates were calculated for HCC, intrahepatic cholangiocarcinoma, and combined hepatocellular cholangiocarcinoma (combined HCC and intrahepatic cholangiocarcinoma) by treatment type and background characteristics for patients newly registered between 2004 and 2015 whose final outcome was survival or death. The median overall survival and cumulative survival rates for HCC were calculated by dividing patients by combinations of background factors (number of tumors, tumor diameter, Child-Pugh grade, or albumin-bilirubin grade) and by treatment type (hepatectomy, radiofrequency ablation therapy, transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, and systemic therapy). The same values were also calculated according to registration date by dividing patients newly registered between 1978 and 2015 into five time period groups. The data obtained from this nationwide follow-up survey are expected to contribute to advancing clinical research and treatment of primary liver cancer in the world.

Cause of death and the autopsy rate in an elderly population

Autopsyrates are declining, while major discrepancies between autopsies and clinical diagnoses remain. Still, little is known about the impact of suspected underlying diseases, for example, a diagnosis of cancer, on the autopsy rate. The aim of this study was to investigate the relation between the clinical cause of death, a history of cancer, and the medical autopsy rate using data from the Netherlands Cohort Study on Diet and Cancer (NLCS), a large prospective cohort study with a long follow-up. The NLCS is a prospective study initiated in 1986 and includes 120,852 persons (58,279 males and 62,573 females), 55–69 years of age at the time of enrollment. The NLCS was linked with the Dutch Nationwide Pathology Databank (PALGA), the Dutch Population Register (GBA), the Netherlands Cancer Registry, and the causes of death registry (Statistics Netherlands). If applicable, the 95% confidence intervals were calculated. During the follow-up of the NLCS, 59,760 deaths were recorded by linkage with the GBA from 1991 until 2009. Of these, a medical autopsy was performed on 3736 deceased according to linkage with PALGA, resulting in an overall autopsy rate of 6.3%. Major variations in the autopsy rate were observed according to the cause of death. The autopsy rate increased according to the number of contributing causes of death. Lastly, a diagnosis of cancer affected the autopsy rate. The clinical cause of death and a history of cancer both influenced the medical autopsy rate in a large national cohort. The insight this study provides may help clinicians and pathologists counteracting the further downfall of the medical autopsy.

Incidence, causes, and risk factors of stillbirth in an Amazonian context: Saint Laurent du Maroni maternity ward 2016–2021

We aimed to describe the epidemiology of intrauterine fetal deaths in multiethnic western French Guiana and to assess its main causes and risk factors. A retrospective descriptive study was conducted based on data from January 2016 to December 2021. All information on stillbirth with a gestational age ≥20 weeks in the Western French Guiana Hospital Center was extracted. Terminations of pregnancy were excluded. We focused on medical history, clinical investigation, biological findings, placental histology, and autopsy examination to elucidate the cause of death. We used the Initial Cause of Fetal Death (INCODE) classification system for assessment. Univariable and multivariable logistic regression analyses were performed. Overall, 331 fetuses in 318 stillbirth deliveries were reviewed and compared to live births that occurred during the same period. The rate of fetal death varied between 1.3 % and 2.1 %, with an average of 1.8 % over the 6-year period. Poor antenatal care (104/318, 32.7 %), obesity ≥30kg/m2 (88/318, 31.7 %), and preeclampsia (59/318, 18.5 %) were the main risk factors associated with fetal death in this group. Four hypertensive crises were reported. According to the INCODE classification, the main causes of fetal death were obstetric complications (112/331, 33.8 %), particularly intrapartum fetal death with labor-associated asphyxia under 26 weeks (64/112, 57.1 %), and placental abruption (29/112, 25.9 %). Maternal-fetal infections were common, particularly mosquito-borne diseases (e.g., Zika virus, dengue, and malaria), re-emerging infectious agents such as syphilis, and severe maternal infections (8/331, 2.4 %). 19.3 % of fetal deaths (64/331) remained unexplained. Change in lifestyle as well as social deprivation and isolation adversely affect pregnancy in western French Guiana, in the context of a poor health care system that is similar to what is found in the Amazonian basin. Particular attention must be paid to emerging infectious agents in pregnant women and travelers returning from the Amazon region.

Prediction of criminal profiles based on forensic medical investigations in Banda Aceh, Indonesia

Background: Criminal profiles are also often referred to as psychological profiles or engagement profiles. Profile means a description the term profile to be discussed when discussing techniques and determining the possible characteristics of the debate about the results of research on crime itself. The following paper aims to present the case in predicting criminal profiles in Banda Aceh Indonesia based on forensic medical investigations. Case presentation: The victim is a male 16-year-old which is conducted a forensic medical examination. The result of forensic medical autopsy findings is the destruction of face-forming bones and skull fractures in the victim. According to the autopsy finding, the doctor concluded that the violence was carried out by someone who is powerful. The doctor states that the alleged criminal's profile consists of someone close to the victim, someone likely to be male, and someone who engaged in violence by using blunt objects. The police investigator is an Indonesian National Police in Banda Aceh district who has done the interview. The discussion with police investigators was conducted to predict the alleged perpetrator's profile. Based on the doctor's statement, the police conducted an investigation looking for the suspect, and the doctor's prediction was correct about the criminal profile of the perpetrator. During the trial, the panel of judges stated that the perpetrators used blunt objects to attack the victim. Conclusion: There is an association between the results of forensic medical examination, police investigations and facts at the trial in predicting the profiles of criminals.

Affecting Factors of Prostate Volume in Forensic Autopsied Decedents.

Because decedents undergoing forensic autopsies would have behaved normally before death, prostate volume according to age group can be confirmed with forensic autopsy materials. The objectives of this study were to first confirm the current prostate volume by age and then determine diseases that can influence prostate volume using forensic autopsy materials. Prostate specimens were collected from forensic autopsies performed at Shiga University of Medical Science, Japan, between January 2015 and December 2019. Overall, 207 decedents were included in the study. Prostate volume was measured by the Archimedes' principle. Concomitant diseases were determined by the past medical histories and autopsy results. The mean crude prostate volume was 29.1 ± 10.3 mL (range, 2.8-88.0 mL). The crude prostate volume increased with age. The mean corrected prostate volume (divided by body surface area) was significantly higher in patients with atherosclerosis than in those without. However, multiple regression analysis revealed that only age influenced the corrected prostate volume. Age was the only significant influencing factor for prostate volume. We propose applying age estimation using prostate volume for forensic medicine purposes. Because prostate volume was not influenced by concomitant disease, it would be valuable to estimate the decedent's age using the prostate volume.