A comparative analysis of the findings of postmortem computed tomography scan and traditional autopsy in traumatic deaths: Is technology mutually complementing or exclusive?

Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95 of the deceased were males. The mean age of the corpses was 35 years (range 1667 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA

Histological and morphometric analysis of dilated cardiomyopathy with special reference to collagen IV expression

Introduction: Collagen distribution alterations are well known in dilated cardiomyopathy. There are also changes in microvasculature along with other histomorphorphological features. Aims and Objectives: To study the histomorphological features of DCM along with their quantitative correlation with LVEF. Alterations in collagen IV distribution pattern and microvasculature in DCM were also evaluated. Materials and Methods: The present study includes 34 right ventricular endomyocardial biopsies, 7 explanted native hearts and 41 autopsy control hearts. Sections were taken from lower half of right interventricular septum and stained for H and E, Masson trichrome and immunohistochemistry for CD34, SMA and Collagen IV to study the histological features, pattern of fibrosis, capillary and arteriolar distribution and collagen IV expression respectively. Morphometric analysis was carried out in all cases and controls using Image analysis software Image pro plus 7 and correlated with left ventricular ejection fraction. Results: The histomorphological changes of DCM include myocyte hypertrophy, nucleomegaly, and interstitial fibrosis. Interfiber fibrosis was the commonest. There was evidence of myocarditis, ischemic change and vessel wall alterations. Considerable alteration in Collagen IV distribution was observed with reduction in intensity and proportion of staining around myocytes quantified using Allred scoring against uniform pericellular staining in controls. Morphometric analysis revealed significant increase in nuclear area, myocyte width, percentage of fibrosis and reduction in capillary myocyte ratio in cases as compared to controls. There was no significant difference in arteriolar density. No significant association was observed between morphometric parameters and LVEF. Conclusion: Histomorphological changes in DCM are non-specific. Quantitation of histological parameters cannot be used to predict the disease progression as there was no significant correlation with LVEF. There is appreciable alteration in Collagen IV distribution in DCM owing to extracellular matrix alterations

Hospital Acquired Infections: Preventable Cause of Mortality in Spinal Cord Injury Patients

Background: There is an alarming rate of morbidity and mortality observed in the trauma victims who suffer spinal cord injuries (SCI). Such patients are admitted immediately and stay for longer periods of time and thus are at risk of acquiring nosocomial infections. Aims: The aim of this study is to analyze the primary cause of mortality in SCI patients. Design: Retrospective study. Materials and Methods: We conducted a retrospective 4 year analysis of the postmortem data of 341 patients who died after sustaining SCI at a tertiary care apex trauma center of India. Epidemiological data of patients including the type of trauma, duration of hospital stay, cause of death and microbiological data were recorded. Results: On autopsy, out of 341 patients, the main cause of death in the SCI patients was ascertained to be infection/septicemia in 180 (52.7%) patients, the rest 161 (47.2%) died due to severe primary injury. Respiratory tract infections (36.4%) were predominant followed by urinary tract infections (32.2%), blood stream infections (22.2%), wound infections (7.1%) and meningitis reported in only 5 (2.1%) cases. Acinetobacter sp (40%) was the predominant organism isolated, followed by Pseudomonas sp (16.3%), Klebsiella sp (15.1%), Candida sp (7.8%), Escherichia coli (6.9%), Staphylococcus aureus (6.9%), Proteus sp (3.3%), Enterobacter sp and Burkholderia sp (two cases each) and Stenotrophomonas sp (one case). A high level of multidrug resistance was observed. Conclusions: Hospital acquired infections (HAI) are leading cause of loss of young lives in trauma patients; hence efforts should be made to prevent HAIs