Cardiac troponin T as a postmortem biomarker for acute myocardial infarction.

The diagnosis of acute myocardial infarction (AMI), especially within the first hours after onset of ischemia, poses a challenge to the forensic pathologist. During this time, the infarction is generally not visible macroscopically nor with routine histology. Whilst cardiac Troponin T (cTnT) is a well-established biomarker for AMI clinically, its use as a postmortem diagnostic tool is less conclusive, warranting further investigation. The aim of this study was to investigate the sensitivity and specificity of cTnT as a postmortem diagnostic marker of AMI and the impact of postmortem interval (PMI) and cardiopulmonary resuscitation (CPR) on cTnT-concentrations. Samples from 64 subjects, 15 AMI cases and 49 controls, were collected at the Department of Forensic Medicine in Stockholm and analyzed for cTnT: one femoral blood sample was taken at arrival of the body to the morgue, and again during autopsy. Pericardial fluid (PCF) was only collected during autopsy. Sensitivity and specificity for serum cTnT were calculated to be 86.7 %/67.3 % and for pericardial fluid 86.7 %/44.9 %. cTnT samples taken during autopsy were generally higher than samples taken upon arrival to the morgue. A CPR-dependent elevation in serum cTnT was noted (P = .005). With a cut off at 56 n/L, serum cTnT can be used to rule out AMI. The postmortem interval and CPR must be taken into consideration when interpreting postmortem cTnT.

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.

Talking Dead. New burials from Tron Bon Lei (Alor Island, Indonesia) inform on the evolution of mortuary practices from the terminal Pleistocene to the Holocene in Southeast Asia.

Burial elaborations are a human behaviour that, in recent contexts can inform on social diversification, belief systems, and the introduction of new practices resulting from migration or cultural transmission. The study of mortuary practices in Mainland and Island Southeast Asia has revealed complex and diverse treatments of the deceased. This paper contributes to this topic with the description of three new burials excavated in Tron Bon Lei (Alor Island, Indonesia) dated to 7.5, 10, and 12 kya cal BP. In addition to the bioskeletal profiles and palaeohealth observations, we propose the adoption of archaeothanatological methods to characterise burial types in the region. Through the analysis of skeletal element representation, body position, articulation, and grave associations, we provide an example of a holistic approach to mortuary treatments in the Lesser Sunda Islands. Our results provide significant new data for understanding the evolution and diversification of burial practices in Southeast Asia, contributing to a growing body of literature describing prehistoric socio-cultural behaviour in this region.

Fatal work-related injuries in the Genoa district (North-Western Italy): Forensic analysis of the 10-year period between 2011 and 2020.

According to the ILO (International Labor Organization), an occupational accident is that which occurs in the course of work and results in either a fatal or non-fatal injury. Occupational-related deaths are increasingly a concerning issue, also worldwide, with severe social repercussions: it is clear that when a person loses their life, it has a permanent impact on all their family, as well as incurring direct and indirect costs for employers, workers and the community at large. The aim of the present retrospective-observational study is to investigate, from an autoptic and forensic point of view, the characteristics of occupational-related deaths of victims received between the 10-year period of 2011-2020 by the Municipal Morgue of Genoa, which forms part of the Institute of Forensic and Legal Medicine, for the purpose of providing a Forensic and Coroner's overview of this important phenomenon. The study comprises of a list of 47 people who died as a result of an occupational injury: 46 males and 1 female. It was observed that workers in the construction and steel manufacturing industries were in the category most at risk of fatal accidents (40.5%). In 41 cases (87.2%), death was related to major mechanical trauma, from falling from a height (42.5%) objects falling directly onto the victim (38.3%) and lastly, from pedestrian road accidents (6.4%). Fatal head traumas with endocranial haemorrhage accounted for deaths in 23 of all the cases studied (63.4%). As shown in our study, death in the workplace is still today having to be considered as an important social issue and it is still necessary to improve the workers' knowledge of the related hazards and risks involved at work, together with preventative procedures. An in-depth analysis of such risks in the workplace, as well as the monitoring and training of workers is fundamental if we are to achieve an overall improvement in working conditions.

Decomposition variability between the scene and autopsy examination and implications for post-mortem interval estimations.

Forensic experts rely on scene and/or autopsy photographs to estimate the post-mortem interval (PMI) when an in-situ assessment of decomposition is unfeasible. The degree of decomposition may vary between the scene and autopsy, which importantly could affect estimations of the unknown PMI in forensic casework. This study aimed to investigate decomposition variability between the scene and autopsy and assess the subsequent effect on the accuracy of PMI estimations. Scene and autopsy photographs from 94 cases with known PMI were used from the Allegheny County Office of the Medical Examiner in Pittsburgh, United States. The total decomposition scoring (TDS) method measured the overall decomposition level, and 28 markers of decomposition were recorded as a percentage of the total body surface area (TBSA). In 60% of cases the TDS had increased at autopsy causing significant overestimations of the autopsy PMI and 86% of decomposition markers varied between the scene and autopsy. Decomposition progressed during mortuary time lags (MTL) of 3-44 h, where bodies were stored in a pre-autopsy refrigerator at 4 °C, suggesting that refrigeration may not always delay decomposition. This research also assisted in validating photographs as a proxy for real-time decomposition assessments. While the autopsy photographs conferred higher quality than the scene photographs, the scene photographs produced more accurate PMI estimations. Forensic experts should exhibit caution when estimating the PMI from autopsy photographs alone, as they may not accurately reflect scene decomposition. To prevent misinterpretation of the PMI estimation, both scene and autopsy photographs should always be requested.

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 10 years (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 21-30 years (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 24 h 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.

Evaluation of Physical Risk during Necropsy and Morgue Activities as Risk Management Strategy.

Physical risk assessments allow us to understand work-related critical issues, thus representing a useful tool in risk management strategies. In particular, our study focuses on the identification of already known and emerging physical risks related to necropsy and morgue activities, as well as crime scene investigations. The aim of our study is, therefore, to identify objective elements in order to quantify exposure to such risk factors among healthcare professionals and working personnel. For the research of potentially at-risk activities, data from the Morgue of Policlinico Umberto I Hospital in Rome were used. The scientific literature has been reviewed in order to assess the risks associated with morgue activity. Measurements were performed on previously scheduled days, in collaboration with the activities of different research units. The identified areas of risk were: microclimate; exposure to noise and vibrations; postural and biomechanical aspects of necropsy activities. The obtained results make it possible to detect interindividual variability in exposure to many of the aforementioned risk factors. In particular, the assessment of microclimate did not show significant results. On the contrary, exposure to vibrations and biomechanical aspects of load handling have shown potential risk profiles. For this reason, both profiles have been identified as possible action targets for risk management strategies.

Funeral and Mortuary Operators: The Role of Stigma, Incivility, Work Meaningfulness and Work-Family Relation to Explain Occupational Burnout.

The funeral and mortuary sector, including funeral homes, cemeteries and crematoria, is a largely neglected sector in regard to the study of occupational factors that can affect the quality of working life. The present study aimed at overcoming this gap by investigating job demands and resources that may affect burnout levels. Data were collected through a self-report questionnaire involving funeral industry employees (N = 229) from cemetery, morgues, crematoria and funeral agencies in a Northern Italian region. The survey was cross-sectional and non-randomized. Results reveal that among job demands, stigma consciousness, supervisor incivility and work-to-family negative spillover significantly affect levels of burnout, whereas meaningfulness of work and family-to-work positive spillover may represent relevant resources to counter the onset of burnout. The results of this study contribute to new insights into the psychosocial working conditions that affect occupational wellbeing among the funeral industry sector by also giving insight into how to promote resources to prevent burnout.

High HIV prevalence among decedents received by two high-volume mortuaries in Kisumu, western Kenya, 2019.

BACKGROUND: Accurate data on HIV-related mortality are necessary to evaluate the impact of HIV interventions. In low- and middle-income countries (LMIC), mortality data obtained through civil registration are often of poor quality. Though not commonly conducted, mortuary surveillance is a potential complementary source of data on HIV-associated mortality. METHODS: During April-July 2019, we assessed HIV prevalence, the attributable fraction among the exposed, and the population attributable fraction among decedents received by two high-volume mortuaries in Kisumu County, Kenya, where HIV prevalence in the adult population was estimated at 18% in 2019 with high ART coverage (76%). Stillbirths were excluded. The two mortuaries receive 70% of deaths notified to the Kisumu East civil death registry; this registry captures 45% of deaths notified in Kisumu County. We conducted hospital chart reviews to determine the HIV status of decedents. Decedents without documented HIV status, including those dead on arrival, were tested using HIV antibody tests or polymerase chain reaction (PCR) consistent with national HIV testing guidelines. Decedents aged less than 15 years were defined as children. We estimated annual county deaths by applying weights that incorporated the study period, coverage of deaths, and mortality rates observed in the study. RESULTS: The two mortuaries received a total of 1,004 decedents during the study period, of which 95.1% (955/1004) were available for study; 89.1% (851/955) of available decedents were enrolled of whom 99.4% (846/851) had their HIV status available from medical records and post-mortem testing. The overall population-based, age- and sex-adjusted mortality rate was 12.4 per 1,000 population. The unadjusted HIV prevalence among decedents was 28.5% (95% confidence interval (CI): 25.5-31.6). The age- and sex-adjusted mortality rate in the HIV-infected population (40.7/1000 population) was four times higher than in the HIV-uninfected population (10.2/1000 population). Overall, the attributable fraction among the HIV-exposed was 0.71 (95% CI: 0.66-0.76) while the HIV population attributable fraction was 0.17 (95% CI: 0.14-0.20). In children the attributable fraction among the exposed and population attributable fraction were 0.92 (95% CI: 0.89-0.94) and 0.11 (95% CI: 0.08-0.15), respectively. CONCLUSIONS: Over one quarter (28.5%) of decedents received by high-volume mortuaries in western Kenya were HIV-positive; overall, HIV was considered the cause of death in 17% of the population (19% of adults and 11% of children). Despite substantial scale-up of HIV services, HIV disease remains a leading cause of death in western Kenya. Despite progress, increased efforts remain necessary to prevent and treat HIV infection and disease.

Directiva sanitaria para el manejo de cadáveres por COVID-19 y modificatoria según RM 171-2020-MINSA

Death Due To Electrocution- An Autopsy Based Study at Chattogram Medical College Morgue House.

As we less frequently encounter cases of death due to electrocution, less attention is given to them. These all have significant impact on morbidity and mortality of the common people of different ages. This autopsy based retrospective study (from January 2014 to December 2016) was carried out by the history of the case, inquest report and by doing thorough autopsy of each of the cases at Chattogram Medical College Mortuary, Bangladesh. Fifty (50) cases of electrocution accounted for 1.23% of the total 4020 autopsies. Male victims i.e. 43(86%) outnumbered the females 7(14%). The majorly affected age group was 21-30 (24 cases) followed by 31-40 years (13 cases) and 41-50 years (5 cases). The commonest place of occurrence was on the street side in 33 cases (66%) followed by home 17 (34%). High tension wire i.e. in 28 cases (56%) were the main causative agents followed by home appliances 16 (32%) and water pump 6 (12%). In relation to distribution of entry and exit wounds, we observed evidence of both entry and exit wounds in 32 cases (64%) followed by no entry or exit wounds in 11 (22%) and entry wounds only in 7 (14%). As per this study, entry wounds were present in the upper limbs in 34 cases (68%) followed by head-neck (7 cases) and lower limbs (3 cases). We also observed maximum exit wounds were in the lower limbs i.e. in 36 cases (72%) followed by upper limbs (5 cases) and chest-abdomen (2 cases). Considering manner of death, we observed all the cases of electrocution i.e. 50 cases (100%) were of accidental. Electrocution accounts for a smaller proportion of all unnatural deaths which could be prevented by adequate awareness and adopting safety measures.

The Extent of Aspergillosis in Critically Ill Patients With Severe Influenza Pneumonia: A Multicenter Cohort Study.

OBJECTIVES: To determine the frequency and prognosis of invasive pulmonary aspergillosis in critically ill patients with severe influenza pneumonia. DESIGN: Retrospective multicenter cohort study. SETTING: Five French ICUs. PATIENTS: Patients with influenza admitted to ICU between 2009 and 2018. MEASUREMENTS AND MAIN RESULTS: Of the 524 patients admitted for severe influenza diagnosed with a positive airway reverse-transcriptase polymerase chain reaction test, 450 (86%) required mechanical ventilation. A lower respiratory tract sample yielded with Aspergillus (Asp+) in 28 patients (5.3%). Ten patients (1.9%) were diagnosed with putative or proven invasive pulmonary aspergillosis, based on the validated AspICU algorithm. A multivariate model was built to identify independent risk factors for Aspergillus-positive pulmonary culture. Factors independently associated with Aspergillus-positive culture were liver cirrhosis (odds ratio = 6.7 [2.1-19.4]; p < 0.01), hematologic malignancy (odds ratio = 3.3 [1.2-8.5]; p = 0.02), Influenza A(H1N1)pdm09 subtype (odds ratio = 3.9 [1.6-9.1]; p < 0.01), and vasopressor requirement (odds ratio = 4.1 [1.6-12.7]; p < 0.01). In-hospital mortality of Asp+ patients was 36% versus 21% in patients without Aspergillus-positive pulmonary culture (p = 0.09). CONCLUSIONS: In this large retrospective multicenter cohort of critically ill patients, putative invasive pulmonary aspergillosis according to AspICU algorithm was a relatively rare complication of influenza. Patients at higher risk of Aspergillus pulmonary colonization included those with liver cirrhosis, hematologic malignancy, H1N1pdm09 influenza A virus, and requiring vasopressors. Our results provide additional data on the controversial association between severe influenza and invasive pulmonary aspergillosis. Reaching a consensual definition of invasive pulmonary aspergillosis becomes mandatory and confers further prospective research.

Arco aórtico: ramas y variaciones de diámetro interno en cadáveres frescos / Aortic arch: Branches and internal diameter variations in fresh corpses

Resumen Introducción: El conocimiento del patrón de las estructuras que emergen del arco aórtico es importante para las intervenciones en el cuello y la cabeza. Las variantes anatómicas y el área interna de estos vasos son cruciales para el enfoque de terapias endovasculares más seguras. Objetivo: Mostrar las variantes anatómicas y el área de los vasos que tiene dicha variación. Materiales y métodos: Se seleccionaron cuatrocientos cadáveres frescos, del Instituto Nacional de Medicina Legal y Ciencias Forenses de Medellín, con edades comprendidas entre los 18 y 40 años, sin lesiones en el tórax o el cuello, a los cuales se les evaluaron sus arcos aórticos. Todas las variantes se fijaron mediante registro fotográfico y las medidas se tomaron con un calibrador Mitutoyo. Conclusión: Este es el segundo trabajo sobre el tema llevado a cabo en Colombia y el primero en usar cadáveres frescos que se incorporaron en la medida que cumplían los criterios de inclusión.

Abstract Introduction: The knowledge of the pattern of the structures that emerge from the aortic arch is important for neck and head interventions mainly. The presence of anatomical variants and the internal area of these vessels is of great importance for the approach of safer endovascular therapies. Objective: To show the anatomical variants present and the area of the vessels that present such variation. Materials and methods: Four hundred fresh cadavers, aged between 18 and 40 years, without chest or neck injuries, were selected to evaluate their aortic arches, in the National Institute of Legal Medicine and Forensic Sciences of the city of Medellin, Colombia. All the variants were fixed photographically and the measurements taken with Mitutoyo calibrator. Conclusion: This is the second work on the subject carried out in our country and the first one using fresh cadavers and in a random way.

An Autopsy Based Study on Socio-economical Pattern of Organophosphorus Poisoning Cases Recorded from Sir Salimullah Medical College Morgue.

Poisoning is one of the commonest methods employed for committing suicide, especially in Developing countries like Bangladesh. In this retrospective study, a total of 114 organophosphorus poisoningcases autopsied at Sir Salimullah Medical College morgue, Dhaka, Bangladesh, were analyzed during the period from January 2016 to December 2017. Male predominance was noted accounting for 75% of total cases compared to females 25% cases. Most common age group involved was 21-30 years 31% followed by 31-40 years 22% belonging to lower socioeconomic status. Suicide was the commonest manner of death in majority of cases. The reason may be the increasing stress in the family and economic constraints. Accidental deaths due to occupational exposure or inhalation of OPC compounds are reported but in these cases mortality rate is less than that suicidal poisoning. To reduce poisoning cases proper emphasis should be given for safe use of pesticides and consciousness should becreated among the population about poisonous compounds.

Risk factors and associated outcomes of hospital readmission in COPD: A systematic review.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of unplanned readmission. There is need to identify risk factors for, and strategies to prevent readmission in patients with COPD. AIM: To systematically review and summarise the prevalence, risk factors and outcomes associated with rehospitalisation due to COPD exacerbation. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Five databases were searched for relevant studies. RESULTS: Fifty-seven studies from 30 countries met the inclusion criteria. The prevalence of COPD-related readmission varied from 2.6 to 82.2% at 30 days, 11.8-44.8% at 31-90 days, 17.9-63.0% at 6 months, and 25.0-87.0% at 12 months post-discharge. There were differences in the reported factors associated with readmissions, which may reflect variations in the local context, such as the availability of community-based services to care for exacerbations of COPD. Hospitalisation in the previous year prior to index admission was the key predictor of COPD-related readmission. Comorbidities (in particular asthma), living in a deprived area and living in or discharge to a nursing home were also associated with readmission. Relative to those without readmissions, readmitted patients had higher in-hospital mortality rates, shorter long-term survival, poorer quality of life, longer hospital stay, increased recurrence of subsequent readmissions, and accounted for greater healthcare costs. CONCLUSIONS: Hospitalisation in the previous year was the principal risk factor for COPD-related readmissions. Variation in the prevalence and the reported factors associated with COPD-related readmission indicate that risk factors cannot be generalised, and interventions should be tailored to the local healthcare environment.

A rapidly deployed, interactive, online visualization system to support fatality management during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE: To create an online visualization to support fatality management in North Carolina. MATERIALS AND METHODS: A web application aggregates online datasets for coronavirus disease 2019 (COVID-19) infection rates and morgue utilization. The data are visualized through an interactive, online dashboard. RESULTS: The web application was shared with state and local public health officials across North Carolina. Users could adjust interactive maps and other statistical charts to view live reports of metrics at multiple aggregation levels (eg, county or region). The application also provides access to detailed tabular data for individual facilities. DISCUSSION: Stakeholders found this tool helpful for providing situational awareness of capacity, hotspots, and utilization fluctuations. Timely reporting of facility and county data were key, and future work can help streamline the data collection process. There is potential to generalize the technology to other use cases. CONCLUSIONS: This dashboard facilitates fatality management by visualizing county and regional aggregate statistics in North Carolina.

Characteristics of women's death by violence according to necropsies carried out in the Callao morgue. / Características de la muerte de mujeres por violencia según las necropsias realizadas en la morgue del Callao.

The objective was to describe the characteristics of women's deaths by violence according to autopsies performed at the Callao morgue from 2016 to 2018. The forensic records of 83 women were reviewed and it was found that women's deaths by violence occurred most often in adulthood. Traffic accidents were found to be the most common cause. The most frequent location of the fatal injury was in the head segment. Most of the corpse removal took place on the public road. The district with the most cases was Callao. It is important that the authorities commit to creating, installing and following an action plan to prevent women's deaths by violence in Callao.

El objetivo fue describir las características de la muerte de mujeres por violencia según las necropsias realizadas en la morgue del Callao desde el 2016 al 2018. Se revisaron los registros forenses de 83 mujeres y se encontró que la muerte de mujeres por violencia ocurrió con mayor frecuencia en la etapa adulta, el suceso de tránsito fue el agente causante más implicado, la lesión mortal se ubicó mayormente en el segmento cabeza, se realizaron más levantamientos de cadáveres en la vía pública y el distrito con más casos fue el Callao. Es importante que las autoridades se comprometan a crear, instalar y seguir un plan de acción para prevenir la muerte de mujeres por violencia en el Callao.