A death due to faulty airbag system-case report.

Injuries due to automobile safety devices have been reported and we report a rare fatality due to a defective airbag system. A compact hybrid car driven by a 37-year-old male at moderate speed had crashed through an unprotected manhole. The car had moved around 200 m before it came to a halt. The passers-by had noticed that the driver was unconscious, partly leaning forward with an inflated airbag. He was pronounced dead on admission. The car had sustained minor indentation on front bumper. Autopsy revealed a circular perforated laceration on the neck associated with completely transected right carotid artery and partially transected jugular vein. There was a 2 × 2-cm cylindrical metal object lodged at C4-C5 vertebrae level, and the remaining part of this was retrieved during scene investigation and identified as a part of a metal canister in the inflator component of the airbag system. There was a perforation in the airbag which was similar in size to the retrieved foreign body. The cause of death was ascertained as hemorrhagic shock due to bleeding from ruptured neck vessels caused by primary shrapnel projected from the faulty airbag system. Following the incident, the manufacturers replaced faulty airbag systems in similar models. If abnormally fatal injuries are observed, a scene visit along with automotive expert opinion would provide valuable insight into the incident. Such information would alert the general public on regular screening of safety measures and prompt manufacturers to recall faulty products.

Acute hemorrhagic pancreatitis following influenza infection: a case report.

BACKGROUND: Acute hemorrhagic pancreatitis is a life-threatening condition leading to shock and multiorgan failure. Although prevalent in the general population, the incidence during pregnancy is low, with a high maternal and fetal mortality rate. The highest incidence is in the third trimester/early postpartum period. Infectious etiology for acute hemorrhagic pancreatitis is rare with only a handful of cases following influenza infection being documented in the literature. CASE PRESENTATION: A 29-year-old Sinhalese pregnant lady in the third trimester presented with an upper respiratory tract infection and abdominal pain, for which she was managed with oral antibiotics. An elective caesarean section was done at 37 weeks gestation due to a past section. On postoperative day 3 she developed a fever with difficulty in breathing. Despite treatment, she succumbed to death on the sixth postoperative day. The autopsy revealed extensive fat necrosis with saponification. The pancreas was necrosed and hemorrhagic. The lungs showed features of adult respiratory distress syndrome and necrosis was observed in the liver and kidneys. Polymerase chain reaction of lungs detected influenza A virus (subtype H3). CONCLUSION: Although rare, acute hemorrhagic pancreatitis from an infectious etiology carries risk of morbidity and mortality. Therefore, a high level of clinical suspicion must be upheld among clinicians to minimize adverse outcomes.

Usefulness of virtual autopsy in diagnosing pathologies in the paediatric population: A systematic review.

Objective: Virtual autopsy is a non-invasive/minimally invasive method for conducting an autopsy, with the assistance of imaging techniques. We aim to review the benefits of virtual autopsy in detecting pathologies in the paediatric population. Method: The procedure adhered to Institute of Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Seven databases including MEDLINE and SCOPUS were searched for articles published 2010-2020 worldwide in English. A narrative synthesis of the findings of included studies was carried out to discuss and summarize the results of the review. Results: From 686 studies on paediatric deaths, 23 met selection/quality criteria. Virtual autopsy was better than conventional autopsy in detecting skeletal lesions and bullet trajectory, thus a crucial tool in the investigation of traumatic and firearm deaths. Virtual autopsy was superior to conventional autopsy in identifying the point of bleeding in postoperative deaths and objectively quantifying air/fluid in body cavities. Virtual autopsy was a useful adjunct for detecting pulmonary thrombo-embolism, foreign body aspiration, drowning and metastatic malignancies. The use of non-contrast imaging in investigating natural paediatric deaths did not offer more information than conventional autopsy. Misinterpretation of normal post-mortem changes as pathological findings was another disadvantage of virtual autopsy leading to erroneous conclusions. But accuracy may be improved with contrast enhancement and post-mortem magnetic resonance imaging. Conclusion: Virtual autopsy is a crucial tool in the investigation of traumatic and firearm deaths in the paediatric population. Virtual autopsy will be useful as an adjunct to conventional autopsy in asphyxial deaths, stillbirths and decomposed bodies. Virtual autopsy has limited value in differentiating antemortem and post-mortem changes with the added risk of misinterpretations, therefore should be used with caution in natural deaths.

Pulmonary artery dissection-A review of 150 cases.

Pulmonary artery dissection (PAD) is considered to be a rare condition with a very high mortality. Since a comprehensive review on PAD has not yet been done, we analysed all the available reports on PAD. In this analysis and review we searched the databases; Medline, PubMed Central, Directory of Open Access Journals, Google Scholar using the search term "Pulmonary Artery Dissection" with no language restrictions. In the 150 cases of PAD reported from 1842 to June 2018, the average age at diagnosis was 44.8 years with a male to female ratio of 1.1:1. Diagnosis was made in 49.3% of the males in the third and fourth decades, and 55.4% of the females in the fifth and sixth decades. The primary underlying causes were pulmonary hypertension and heart diseases, both congenital (mainly PDA) and acquired. The commonest clinical presentations were dyspnoea and chest pain. The best investigation of diagnosis was CT scan. The pulmonary trunk was the site of dissection in 72.5%. Surgical treatment, or medical management followed by surgery, had the best success rates. The overall survival rate which was 10.9% up to the year 2000, increased to 59.3% thereafter. If PAD was diagnosed ante-mortem, 70.5% survived. Haemopericardium / cardiac tamponade was seen at autopsy in 84.2%. PAD is not as rare, nor as fatal as believed, and with a high index of suspicion and appropriate investigations, an early diagnosis of PAD can be made and successful treatment instituted.