A 15-year review of lightning deaths in Germany-with a focus on pathognomonic findings.

Lethal accidents caused by lightning are divided into observed and unobserved events. Pathognomonic or characteristic findings are often overlooked during external postmortem examination. Classical mistakes may be made which may often lead to an incorrect diagnosis. An analysis of 270 fatalities was performed on a historical collection of the Committee for Lightning Conductor Construction for the United Economic Area e. V. (ABBW) on lethal accidents due to lightning that occurred in Germany for the period 1951-1965. Furthermore, a selective literature research was carried out. The aim of the study was to analyze the death scene, the clothing, and the victim. The authors focused on chief findings which were relevant to the correct diagnosis of "death by lightning." Both Lichtenberg figures and singed body hair were considered pathognomonic for a lightning strike. The question arose as to whether Lichtenberg figures, for example, represented the finding that most often led to the correct diagnosis. Of the 270 lightning-struck victims from the case collection, 129 (47.8%) had singed body hair and 25 (9.3%) had Lichtenberg figures. A comparison of the frequency of the two reported findings, singed body hair versus Lichtenberg figures, has only been performed in the literature for case numbers below 40. This study is the first evaluation of a relatively large number of lethal accidents due to lightning. Singed body hair was reported more frequently in lightning-struck victims than Lichtenberg figures. This study showed that singed body hair is probably more diagnostically important than Lichtenberg figures.

The Effect of the COVID-19 Pandemic on Suicide Trends in Pretoria, South Africa.

ABSTRACT: Suicide is one of the worldwide leading causes of unnatural death. Pretoria is a capital city of South Africa and is the fourth most populated city in South Africa. Between 16 and 22 suicide cases are recorded daily in South Africa.Case files from the Pretoria Medico-Legal Laboratory were reviewed between 1 January 2015 to 31 December 2021, which spanned the COVID-19 pandemic. All cases of possible and probable suicides were included. One-way analysis of variance and Pearson chi2 tests were conducted to determine statistical significance in the observed trends.A total of 1820 possible and probable suicide cases were identified. The year following the outbreak of the COVID-19 pandemic accounted for the largest number of suicides. White males were the most heavily represented population, followed by Black males. Hanging was the most common method for males, whereas poisoning via ingestion and/or overdose was more commonly used by females.Suicides in Pretoria have increased since previous studies from 9.74% and 10.2% to 13.32%. Methods used have changed among various population groups over the past two decades. This paper examined changes in suicide trends in Pretoria compared to previous studies and highlighted correlations between suicide trends and COVID-19 lockdown measures.

The "hypopigmented" bitemark: a clinical and histologic appraisal.

So-called "hypopigmented" bitemark patterns, commonly seen but not limited to dark skinned individuals, can be of value in forensic investigations. The process of aging bitemarks observed on skin is controversial and without guidelines. This report analyzes tissue obtained from the site of a hypopigmented bitemark using special histochemical stains for the identification of melanin pigment, and a panel of immunohistochemical markers to aid in the aging process. Histologic evaluation clearly showed that cellular changes in the hypopigmented area were indicative of wound healing that had taken place over a period of time. This validates the hypothesis that a hypopigmented bitemark is an indication of a wound inflicted some days previously. These findings have value in forensic investigations, particularly in cases of suspected long-term physical abuse.

An Atypical Asphyxial Death: A Case Study.

ABSTRACT: An atypical asphyxial death is presented. The deceased was found wrapped like a mummy with multiple layers of plastic and adhesive tape, lying face down on the floor of his home. The death scene was in the lounge area of a large, poorly-kempt, free-standing house. No obvious evidence of illicit drugs or other medications were identified. There was no pornographic material or other paraphernalia of a sexual nature in proximity to the body. According to the brother, the deceased had attempted similar incidents like this in the past, where someone was available to release him.Because of the similar behaviour in the past, the background psychiatric history, and statements from the girlfriend and relatives, the authors propose that this represents an atypical asphyxia death.

Pulmonary Aspiration of Brain Matter in a Motor Vehicle Fatality: A Case Study.

ABSTRACT: We present the case of an adult man who was involved in a motor vehicle accident as a driver. Histological examination of the lung tissue showed the presence of brain tissue within the lumens of the bronchi and bronchioles. Aspiration of brain matter is a rare phenomenon, with only 1 case described in the literature. The finding of brain tissue within the bronchi and terminal bronchioles supports the scenario of a period of agonal respiration with consequent cerebral aspiration. This article adds to the limited literature, distinguishing antemortem or agonal aspiration from postmortem passive movement.

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

INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

A Fatal Case of Rickettsiosis From South Africa.

ABSTRACT: We present a case of fatal Rickettsiosis from South Africa.

Black Mamba Death: Venom Versus Antivenom?

We present the case of a male adult who was admitted to an emergency department after having sustained envenomation from a black mamba (Dendroaspis polylepis). According to the available history, a single fang hooked his right index finger, post venom extraction. After administering antivenom in the accident and emergency department, further vials were transfused in the intensive care unit. An urticarial rash was noted, which was thought to be related to the antivenom. The victim remained in a coma for 3 days, after which he was declared dead. A medicolegal postmortem examination was performed 4 days after death because of logistical reasons. The complexities of differentiating acute envenomation from black mamba versus early acute reactions to polyvalent antivenom administration are highlighted in this case study.

A Fire Extinguisher Death: The Macklin Effect.

We present the case of an adult white man found dead in a psychiatric institution with fine white powder (monoammonium phosphate) deposited over the entire face after he insufflated the contents of a dry chemical fire extinguisher. Fine white powder was present within the mouth and sinuses and lined the upper airways. On opening the thoracic cavity, approximately 500 g of fine white powder was present within the right thoracic cavity. The esophagus was ruptured. Traumatic emphysema of the posterior sternum wall was present (pneumomediastinum). The ethmoid bones were fractured by the barotrauma. On polarization of the lung tissue, birefringent material was noted deposited along the bronchovascular sheaths and in a subpleural distribution. Death was probably due to a combination of barotrauma and asphyxia.This case study provides strong evidence in support of the etiology and pathophysiology of the Macklin effect. It also provides for the first visual evidence of the phenomenon.

Case Report: Lightning-Induced Pneumomediastinum.

We present the case of a 41-year-old woman who was fatally injured during a witnessed lightning strike event and in whom autopsy revealed the unusual keraunopathological finding of overt pneumomediastinum. The possible pathophysiological mechanism(s) of causation of this phenomenon are discussed, with specific reference also to the "Macklin" effect and the role of blast overpressures associated with lightning strike. It is suggested that the latter may lead to sudden alveolar rupture, with subsequent rapid tracking of air along bronchovascular sheaths in a centripetal manner toward the hilum of the lung and thus into the mediastinum. A review of the blast literature suggests that this victim would have been exposed to a blast pressure wave of approximately 29-psi (200 kPa) to 72-psi (500 kPa) magnitude.

Bone marrow embolism to the lung in electrocution: two case reports.

Bone marrow embolism in electrocution was first described in the literature by Rappaport et al (Am J Pathol. 1951;27(3):407-433) in 1951. Two case studies demonstrating this phenomenon are reported here, one involving high-voltage exposure with associated skeletal injuries and the other involving domestic current and without evidence of skeletal injury. Both cases demonstrated bone marrow embolism on histologic examination of the lungs. The purposes of this article are to reiterate the existence of this unusual phenomenon and to consider possible pathogenetic mechanisms.

The individualisation of a dog bite mark: a case study highlighting the bite mark analysis, with emphasis on differences between dog and human bite marks.

A person who keeps or controls a dog in his own interest is liable "without fault" should that dog cause harm to any person. By owning a dog, man welcomes into his home a beast that preserves much of its primordial self, and is capable of inflicting a fatal bite wound. The courts may require the forensic expert to identify which specific dog caused the damage or fatal bite in an effort to establish the owner/controller of the animal. Very little has been published on the individualisation of dog bite marks, the procedures to be followed when confronted with usable bite marks and the range of analysis techniques available. The authors advocate a multidisciplinary approach, and utilise a case study to demonstrate the protocol to be followed when analysing a dog bite mark. The paper also highlights differences between human and dog inflicted bites. The authors warn against over interpretation of poor quality bite marks and a final conclusion of absolute certainty.

Secondary missile injury from lightning strike.

A 48-year-old-woman was struck dead by lightning on October 24, 2010, in Pretoria, South Africa. The cause of death was due to direct lightning strike. Examination showed secondary missile injury on her legs. This secondary missile (shrapnel) injury was caused by the lightning striking the concrete pavement next to her. Small pieces of concrete were located embedded within the shrapnel wounds. This case report represents the first documented case of secondary missile formation (shrapnel injury) due to lightning strike in the literature.

Does a sixth mechanism exist to explain lightning injuries?: investigating a possible new injury mechanism to determine the cause of injuries related to close lightning flashes.

Five mechanisms have been described in the literature regarding lightning injury mechanisms. A sixth mechanism is proposed in this article, namely, lightning barotrauma. A simple laboratory experiment was conducted using ordnance gelatin for ballistic studies. Lightning was simulated in a high-voltage laboratory using an 8/20-microsecond current impulse generator and discharged through ballistic gel. Temporary and permanent cavity formations were confirmed. The cavities formed were directly proportional to the currents used. Findings suggest that a sixth mechanism of lightning injury, namely, barotrauma, should be considered.