Academic Forensic Pathology最新文献

Introduction: Of the 170 000 death certificates filled out annually in the Netherlands, approximately a quarter is completed by a hospital physician. From a legal and statistical point of view, it is important that the legally required forms, that is the certificate of death (CD), the medical certificate of cause of death (MCCD), and the envelope of the MCCD used for medical secrecy reasons are filled out correctly (ie, according to law) and accurately (ie, cause of death in line with medical files).

Materials and methods: For this study, 517 CDs and MCCDs were collected from three hospitals over a 5-month period. The CDs and MCCDs were analyzed to determine to what extent they met the formal (correctly, according to law) and material (accuracy of the cause of death as compared to medical file information) requirements.

Results: In only 34 cases (6.7%) the hospital physicians fulfilled the formal requirements for completing both forms and the envelope of the MCCD. Sixteen cases were issued as natural deaths, although they were unnatural deaths. In 55 cases (11%) a phenomenon associated with death such as "no circulation" or "no breathing" was recorded as cause of death. Only 23 cases (4.5%) met the requirements of an accurate cause of death and correct completion of forms and envelope.

Discussion: Hospital physicians rarely met the formal requirements when filling out the forms and corresponding envelope. Furthermore, the accuracy of the reported cause of death reveals potential for improvement.

Conclusion: Correctness and accuracy in these forms are important not only from a legally administrative and criminal law point of view, but also for the robustness of public health epidemiology and the related funding of prevention of the established causes of death.

Gossypibomas, or retained surgical sponges, are rare and potentially life-threatening complications in modern medicine. They are most commonly the result of emergency abdominal or gynecological surgeries but can occur in any surgery where sponges are used intraoperatively. They can remain in the body for years following surgery and pose a risk for migration and subsequent complications. This case describes an abdominal gossypiboma in a 90-year-old woman, first identified more than a decade after a salpingo-oophorectomy. Migration into her colon eventually caused bowel obstruction and resulted in death. Intentional underreporting of gossypibomas is a major problem that limits knowledge of the condition and hinders their prevention.

We report the case of a 10-month-old male infant diagnosed with Wiskott-Aldrich syndrome, who was brought to our medico-legal postmortem center after being declared dead. The external examination and autopsy findings, considering both pathological and medico-legal aspects, are discussed in light of the limited literature on this subject. This case highlights the importance of differentiating natural lesions from traumatic and accidental causes.

Background: Students find it difficult to retain knowledge given during lectures. Tests should be given frequently to increase retention of information. An open book examination is one where the students can give answers using their textbooks. The aim of this study was to evaluate the effectiveness of 'Exam Derived Learning' in the form of an 'Online Open Book Examination' as a revision tool in the subject of Forensic Medicine among second-year MBBS students at All India Institute of Medical Sciences, Hyderabad. Materials and methods: An online open book examination was conducted in the form of pretested and validated MCQs after the regular interactive lecture classes on the topic of drowning but before the revision exercise on the same. Feedback from the students was taken on an online open book examination via pretested and validated Likert-scale-type perceptions. The median score of the online open book test was calculated. The perceptions of students' toward online open book examination were assessed via the median score. Results: The median score of the online open book test was nine out of 10, 34.7% of the students secured full marks, and 97.4% of the students secured more than 50% of the score. Students gave favorable feedback for the online open book examination. Conclusion: Open-book tests must be practiced as one of the assessment modules in medical education to enhance retention of knowledge and encourage critical thinking.

Accidental femur fractures in older adults are a public health concern with a considerably high rate of mortality and morbidity. We performed a retrospective review of all deaths reported to the Connecticut Office of Chief Medical Examiner (OCME) over a 5-year period that involved a femur fracture resulting from a ground-level fall. Data on cause of death, contributing conditions, age, ethnicity, sex, comorbidities, and interval between surgery and death were extracted. There were 470 deaths caused by a hip fracture due to a ground-level fall. The majority were woman (n = 312 or 66.1%) and White (n = 435 or 95.8%). The median age of the study population was 89 years (interquartile range [IQR] = 83-94). The locations of the falls were predominantly in homes (59.8%) or skilled nursing facilities (SNFs) (26.8%). Complications following surgery occurred with 259 (87.2%) of the 297 patients who underwent surgical repair. Contributing conditions to death occurred in 76.1% of patients (n = 359), with the most common being heart disease, dementia, chronic obstructive pulmonary, and diabetes mellitus (DM). The median survival interval after injury was 9 days (IQR = 4-21 days). The Area Deprivation Index (ADI) was not associated with sex, race, medical conditions determined to have contributed to death, whether the patient underwent surgery, or with any surgical complication. This study demonstrates the important role of medicolegal death investigation in producing accurate death certifications that can inform stakeholders about risk factors and comorbidities that may enhance the overall management of hip fractures in an ageing population.

Road traffic accidents cause 22 deaths daily in India. Lacerations are tears or splits in skin, mucus membranes, muscles, or organs when stretched beyond their limit of elasticity. Open wounds are the second most common wounds in road traffic accidents. Attention is drawn to open wounds due to the surface discontinuity. We are reporting this case because, during the autopsy, it was crucial to examine beneath the seemingly normal skin to determine the cause of death. There was no breach in vascular integrity or bony fractures or tears to narrow down the differentials. Here we discuss a case in which a 26-year-old healthy male died from a closed degloving injury. The autopsy helped in diagnosing a Morel Lavallée lesion. The patient suffered a closed injury to his left lower limb and abdomen after being struck by a heavy motor vehicle. He underwent immediate fasciotomy and exploratory laparoscopy within 10 h of admission but unfortunately did not survive. We review the current literature and the autopsy findings, providing a comparative glimpse of the differentials that can aid in its diagnosis, even in clinical set-ups. Emergency caregivers need to consider this entity as a differential diagnosis even when the skin shows no disintegrity. This will save time in the golden hour and it could potentially save a life.

Introduction: Did George Floyd die from Officer Chauvin's knee triggering reflex cardioinhibition an instantaneous neurogenic cardiac arrest (INCA)? Objectives: This study was conducted to assess the findings necessary to conclude what constitutes an INCA death and apply them to the George Floyd case. Methods: We performed an intensive iterative search of the literature for such deaths. Results: The carotid sinus responds to neck pressure causing a neurogenic reflex mediated through the vagal nerve that causes cardioinhibition. This reflex may result in syncope, which occurs predominantly in young females and older males. Seven deaths occurred from carotid sinus massage, causing ventricular fibrillation. Twenty-seven purported INCA deaths were reported based on a history of near-instantaneous collapse, absence of evidence of vital reaction at death, or hemorrhage in "reflex zones." INCA deaths must be distinguished from those from emotional stress resulting in sympathetic action, rather than parasympathetic action. We found that the reported INCA deaths occur in young and old adults with and without underlying cardiac pathology. Conclusion: The death of George Floyd is unlikely to have been from a rare lethal neck reflex mechanism; other causes and mechanisms of death can explain his death. He did not die instantaneously of neck pressure but prolonged neck pressure. The initial cardiac rhythm was pulseless electrical rhythm, not a ventricular arrhythmia. Neither absence of vital reaction nor hemorrhage in a reflex zone was found at autopsy. We conclude that George Floyd did not die of INCA from pressure on his neck.

Angioedema is non-dependent, non-pitting edema at a variety of sites. Its forms can be divided into histamine-mediated and bradykinin-mediated types. Histamine-mediated forms can present similarly to anaphylaxis with urticaria and itching, while bradykinin-mediated angioedema is slower in onset, presents with greater facial oropharyngeal involvement, and has a higher risk of progression. Bradykinin-mediated angioedema is of particular importance as it will not respond to the usual medications used in histamine-mediated anaphylaxis (steroids, antihistamines, epinephrine, etc). In this report, we present two cases of angioedema-induced death with coexisting COVID-19 infections in two male decedents. The associated gross autopsy, histology, and laboratory values will be discussed in detail. This article will highlight the importance of early detection and adequate treatment for the type of angioedema being evaluated as well as a discussion regarding the relationship between COVID-19 and angioedema.

We present the case of a 71-year-old diabetic woman, suffering from chronic renal failure and with a history of hemodialysis for 6 years, who suddenly died. The autopsy showed a tamponade hemopericardium and a perforation of the left atrio-ventricular wall by an abscess of the mitral annulus. A severe picture of calcification of the mitral annulus calcification also emerged. Histology confirmed the abscess, highlighting the presence of peri-abscess endocarditis. Post-mortem microbiological investigations identified the presence of Staphylococcus epidermidis. The case was considered of interest, since the onset of an abscess of the mitral annulus is an infrequent occurrence and it is an even rarer event if it occurs on native heart valves and in the absence of associated finding of valve vegetation. Finally, the lethal evolution can also be considered rare since although theoretically the cardiac rupture from an abscess is a possible event that leads to death, to date no case has yet been reported.

Sexual child homicide is a very high impact event. We report an instance where an 11-year-old boy was noticed by his grandmother hanging from the silver wired drying line which they are using for hanging the clothes in the house. Examination of the crime scene, autopsy findings, toxicological and DNA analysis confirmed the manner of death as sexual child homicide in a chronically abused child. A 28-year-old male perpetrator confessed to raping and murdering the boy, with DNA evidence and the perpetrator's confession providing strong legal proof. This case underscores the importance of post-mortem examinations in determining the exact manner of death and calling for vigilance in cases of suspected abuse.