Response to the letter, Williams syndrome: was intubation rather than anaesthetic drug choice a cause of cardiac arrest?

No Abstract

Drowning in Pretoria, South Africa : a 10-year review

Drowning is classified as the 3rd leading cause of accidental deaths worldwide and is deemed to be a preventable cause of death. Bodies retrieved from a water medium pose several challenges to the forensic pathologist with the diagnosis of drowning being primarily one of exclusion. The aim of this study was to do a retrospective descriptive case audit of bodies retrieved from water and immersion related deaths, which were investigated at the Pretoria Medico-Legal Laboratory (PMLL) over a 10 year period (January 2002 through December 2011). A total of 346 cases were identified for inclusion into this study. In 6% (20) of these cases, the death was not related to drowning; in 14% (48) no clear cause of death could be ascertained and in 278 cases (80%) the cause of death was considered to have been due to drowning. Infants (under 1 year, of age) constituted 41 (15%) of the cases; toddlers (aged 1e2 years) comprised 52 (19%) cases; children (aged 2e13 years) 49 (18%) cases; adolescents (aged 13e18 years) comprised 10 (3%) cases; adults (above 18, years) made up 126 (45%) of the cases. The majority of the drownings, occurred in swimming pools [125 cases (38%)]. In infants 23 (56%) of, drownings occurred in swimming pools followed by buckets [7 cases (17%)]. Sixty-nine per cent of toddler drownings (36 cases) occurred in swimming, pools. In the adult population, 40 (32%) of cases occurred in pools and 35 cases (28%) in rivers. Positive blood alcohol results were recorded in 48, (42%) out of 113 cases where the test was requested, 40 (35%) of these, cases higher than 0.05 g per 100 ml. This study suggests that many drowning deaths in Pretoria may be preventable by introducing greater public awareness of the risks and instituting relatively simple, protective measures.http://www.elsevier.com/locate/jflm2017-01-31hb201

Osseus metaplasia in chronic renal allograft rejection

The formation of heterotopic bone tissue outside the skeleton, known as osseous metaplasia, is a well-known phenomenon, but only a handful of cases describe this in renal allografts. We report the case of a 26-year-old female who was admitted to hospital for repair of an arteriovenous fistula of the right arm. Following her demise, the incidental finding of osseous metaplasia in the allograft kidney was made at autopsy. The pathophysiology, histology and possible clinical significance of the lesion are described

The forensic autopsy as a teaching tool: Attitudes and perceptions of undergraduate medical students at the University of Pretoria, South Africa

BACKGROUND. Numerous articles have been published on the use of autopsies in training medical students in anatomy and different branches of pathology. Some authors have described the emotional response of students who attend such postmortem sessions. Forensic pathology is an important subdivision of pathology. In some countries undergraduate medical students are expected to attend postmortem examinations on persons who died from traumatic causes. OBJECTIVE. To determine the attitudes and perceptions of 5th-year medical students with regard to forensic postmortem examinations at the University of Pretoria, South Africa. METHODS. A questionnaire was voluntarily completed by medical students on the last day of the practical rotation. RESULTS. The overall rating of the practical rotation was 82%. The strengths, weaknesses, opportunities and threats (SWOT) analysis indicated the following as strengths: record keeping, legislation review and traumatology description; as weaknesses: emotional trauma and nightmares; as opportunities: the attendance of autopsies; and as threats: physical dangers. CONCLUSION. The current study was similar to international studies with regard to students’ emotional response to attending autopsies. The autopsy remains a valuable teaching tool for undergraduate students. Emotional support is currently available for all students to assist them in overcoming their fear of attending forensic autopsy sessions.http://www.ajhpe.org.zaam2016Education InnovationForensic Medicin

Deaths due to police action and deaths in custody : A persistent problem in Pretoria, South Africa

In 2013, South Africa had the second highest rate of imprisonment in Africa. During the apartheid era, a substantial number of deaths in custody involved political detainees. However, two decades after the abolition of apartheid there continues to be a high number of deaths in custody and deaths due to police action. There is no internationally standardised classification for deaths which take place in custody and/or due to police action. For purposes of this study, we divided these cases broadly into two categories: firstly, deaths which took place as a result of police action as well as deaths of persons held in police custody, and secondly, deaths of inmates of correctional service facilities. We conducted a retrospective descriptive case audit at the Pretoria Medico-Legal Laboratory (PMLL) of all cases admitted as deaths as a result of police action, deaths in police custody and deaths in correctional service facilities during the five year period from January 2007 through December 2011. A total of 93 cases were identified, which included 48 deaths due to police action, 28 deaths in police custody and 17 deaths in correctional service custody. The majority of these deaths were due to gunshot wounds (n=48) – all due to police action. Hangings accounted for 17 cases, and the majority of these occurred in police holding cells. This study highlights the relatively large numbers of firearm fatalities related to police action. In contrast to similar studies elsewhere, we identified no deaths associated with illicit drug intoxication or due to phenomena such as excited delirium. We argue that there is a need for objective, impartial and competent medico-legal investigation into deaths of this nature

Performance of autopsies in South Africa : selected legal and ethical perspectives : in South Africa, academic and/or anatomical pathology autopsies are conducted in terms of the Human Tissue Act (Act 65 of 1983)

No abstract available.http://www.cmej.org.za/index.php/cme

"Death at the wheel" due to tuberculosis of the myocardium : a case report

According to the WorldHealth Organization, an estimated 9 million people contracted tuberculosis (TB) with approximately 25% of TB cases being from Africa. TB was reported as the number one cause of natural death for the period 2011–2013 in South Africa. The first reported case of myocardial TB was in 1664 by Maurocordat and the first reported case of sudden cardiac death due to TB was made in 1977.We present a case report of myocardial TB in an apparently healthy, 35-year-old male who died suddenly while driving his car. The problems associated with the diagnosis of TB of the myocardium and an overview of the relevant literature is provided.http://www.journals.elsevier.com/cardiovascular-pathology2017-07-31hb2016Forensic Medicin

Sharp force fatalities at the Pretoria Medico-Legal Laboratory, 2012-2013

BACKGROUND : South Africa’s crude death rate was recorded as the highest in the world in 2014. In 2013, 47 murders occurred daily nationwide, and it was confirmed that sharp force fatalities were frequent events. The aim of our study was to review the fatalities of persons admitted to the Pretoria Medico-Legal Laboratory over a two-year period. Understanding the magnitude of the problem, identifying the most commonly injured area and the mechanism of death in cases where the patient died in hospital could aid in the clinical management of some of these cases in order to reduce mortality. METHOD : A retrospective descriptive case audit was conducted at the Pretoria Medico-Legal Laboratory from January 2012 through to December 2013. RESULTS : A total of 173 applicable cases were included. These comprised 5% of the annual case load. Most of the injured persons were male (84%) and aged 21–30 years (50%). Only 27 (16%) decedents were hospitalised and 12 (44%) survived for ≥ 1 day. The most predominantly injured area on the body was the thoracic area (65% of cases). Positive alcohol concentration in the blood was reported in 109 (66%) cases (a range of 0.01 g/100ml to 0.35 g/100ml). Exsanguination was the leading mechanism of death (85% of cases). CONCLUSION : Compared with various international regions, an exceptionally higher percentage of these fatalities occur in Pretoria, South Africa. Most stab wounds penetrated the body’s thoracic region, consequently perforating the heart and lungs, resulting in immediate death. The proportion of hospital fatalities of patients who sustained abdominal and extremity injuries, and who had already survived ≥ 1 day, was a worrying finding into which further research is required. It is surprising that these patients mostly succumbed to blood loss.http://www.sajs.org.za/index.php/sajsam2016Forensic Medicin

Fatal head injuries in children under the age of 5 years in Pretoria

The incidence of fatal injuries in children has been reported to be highest among children aged 1 to 4 years. Major causes of head injury include road traffic accidents, falls, and intentional or inflicted injury (such as nonaccidental injury syndrome). This study reviewed the profile of children (under 5 years of age) who had been admitted to a large urban medicolegal mortuary (in Pretoria, the capital city of South Africa), after having suffered fatal head injuries. This study was conducted over a 5-year period (fromJanuary 2004 through December 2008), and a total of 107 cases were identified for inclusion. These cases constituted nearly a fifth of admissions in this age group. The male-to-female ratio was 56%:44%, and the peak age of injury was less than 1 year. Most head injuries were sustained in road traffic accidents (70%) followed by falls (10%) and other types of blunt force injuries (9%). Only 1 case of nonaccidental injury syndrome (child abuse) was found. The great majority of deaths were deemed to have been accidental in nature (91%) with 6 (6%) homicides. Urgent review pertaining to the use of child restraint devices and the safety of pedestrians is required, and the institution of childhood injury registers could aid in reducing childhood fatalities in South Africa.http://journals.lww.com/amjforensicmedicine/pages/default.aspx2015-09-30hb201

Drugged driving in South Africa: An urgent need for review and reform

Driving under the influence is a major threat to road safety in South Africa. Various psychoactive substances (both licit and illicit) have the potential to adversely affect driving performance and increase the probability of a road traffic accident. While it is common practice in South Africa to test drivers for alcohol levels, testing for additional impairing substances (including drugs of abuse) is rarely performed. In terms of current South African legislation, only driving under the influence of alcohol and a ‘drug having a “narcotic” effect’ is prohibited. This excludes several impairing psychoactive drugs which are not classified as narcotic substances. The aim of this article is to highlight issues and/or limitations surrounding drugged driving and to propose appropriate considerations for revision of the National Road Traffic Act. We also recommend revising existing legislation to include a comprehensive statutory definition and detailed provisions for drug testing to deter impaired driving