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  1. New Insight into the Origin of the Red/Near-Infrared Intense Fluorescence of a Crystalline 2-Hydroxychalcone Derivative: A Comprehensive Picture from the Excited-State Femtosecond Dynamics
    Zahid NI, Mahmood MS, Subramanian B, Mohd Said S, Abou-Zied OK
    J Phys Chem Lett, 2017 Nov 16;8(22):5603-5608.
    PMID: 29094952 DOI: 10.1021/acs.jpclett.7b02601
    Fluorescence upconversion and transient absorption techniques are used to explain the source of the intense red/near-infrared emission of crystalline 4-dimethylamino-2'-hydroxychalcone. We found that the initially excited enol form undergoes tautomerization in 3 ps to form the keto tautomer. The latter is stable in the ground state as a consequence of J-type aggregation in the crystal packing and is manifested in an absorption peak at 550 nm that spectrally overlaps with the short-lived enol emission, leading to self-reabsorption and adding a factor to the complete depletion of the enol emission. Relaxation of the keto tautomer takes place in the form of intense fluorescence (600-750 nm) with 1.7 ns lifetime. The different spectroscopy in solution is due to vibrational cooling (300 fs), followed by solvation dynamics (5 ps in methanol) and twisting of the hydroxyphenyl ring (16 ps), before relaxation of the enol tautomer in the form of weak green fluorescence with 350 ps lifetime.
  2. Fulltext A dynamic forensic medicine approach: Management of the dead during COVID-19 outbreak in Malaysia
    Khoo LS, Hasmi AH, Mahmood MS, Ibrahim MA
    Forensic Sci Int Rep, 2021 Nov;4:100245.
    PMID: 38620858 DOI: 10.1016/j.fsir.2021.100245
    It has been a difficult year ahead since the announcement of COVID-19 as a pandemic by the Director General of the World Health Organization (WHO). Many countries including Malaysia have struggled to take urgent and aggressive measures to advise, detect, screen, test, isolate and treat their citizens in order to fight against the virus. All countries must strike a balance between protecting health, minimizing economic and social disruption and at the same time, preserving human rights which includes managing the dead with dignity and respect. The National Institute of Forensic Medicine (IPFN) Malaysia has been proactively engaging the various agencies involved in a concerted effort to ensure smooth flow in the management of the dead for all COVID-19 and non-COVID-19 cases since the beginning of the outbreak in February 2020. This is in accordance with all existing guidelines and regulations vis-a-vis infection prevention and control in the country. However, new situations that arise during the pandemic are always challenging and dynamic. The COVID-19 crisis has uncovered a plethora of issues surrounding the margin of the Forensic Medicine fraternity. Therefore, this article highlights various emerging issues encountered by the IPFN and how they are resolved through good leadership to guide and direct operations and activities during the exponential rise of COVID-19 infection in Malaysia. In the provision of the management of the dead, it is of utmost importance to note that the humanitarian aspect needs to be emphasized even in times of an outbreak to give closure to the family and the opportunity to mourn their loved ones.
  3. Human tuberculosis brain promotes neuronal apoptosis but not in astrocytes with high expression of vascular endothelial growth factor
    Othman FN, Muthuraju S, Noor SSM, Abdullah S, Mohd Yusoff AA, Tharakan J, et al.
    Tuberculosis (Edinb), 2018 09;112:45-51.
    PMID: 30205968 DOI: 10.1016/j.tube.2018.07.007
    The present study aimed to investigate the involvement of the angiogenic marker vascular endothelia growth factor (VEGF) and apoptotic markers of Bcl-2 and Bax in the neurons and astrocytes in the brain infected by Mycobacterium tuberculosis. The immunohistochemistry staining was performed to analyze the expression of the VEGF, Bcl-2 and Bax in the astrocytes and neurons. The expression of VEGF was high in neurons and astrocytes in both the infected brain and control tissues with no difference of angiogenic activity (p = 0.40). Higher Bcl-2 expression was seen in astrocytes of infected brain tissues compared to the control tissues (p = 0.004) promoted a higher anti-apoptotic activity in astrocytes. The neurons expressed strong Bax expression in the infected brain tissues compared to the control tissues (p 
  4. Fulltext Clostridial aortitis causing ruptured dissecting aneurysm in a young adult female
    Subramaniam K, Hasmi AH, Mahmood MS
    Malays J Pathol, 2014 Dec;36(3):213-6.
    PMID: 25500522 MyJurnal
    Ruptured dissecting aortic aneurysm more commonly occur in men in the 40 to 70 age group, and most commonly is associated with atherosclerosis. Uncommon causes are previous heart surgery, connective tissue disorders and aortitis. Despite its rarity, Clostridium spp aortitis progresses very rapidly with a mortality rate of approximately 79% in adults, typically occurring within 48 hours of infection. We present a case of sudden death due to clostridial aortitis causing ruptured aortic dissection in an apparently healthy adult female, 7 weeks post-spontaneous vaginal delivery. This case highlights the pathology of aortic dissection and cystic media necrosis as presentations of clostridium spp infection in young female adult.
  5. Fulltext MH17: the Malaysian experience
    Khoo LS, Hasmi AH, Abdul Ghani Aziz SA, Ibrahim MA, Mahmood MS
    Malays J Pathol, 2016 Apr;38(1):1-10.
    PMID: 27126658 MyJurnal
    A disaster is a natural or man-made (or technological) hazard resulting in an event of substantial extent causing significant physical damage or destruction, loss of life, or drastic change to the environment. It is a phenomenon that can cause damage to life and property and destroy the economic, social and cultural life of the people; and overwhelms the capacity of the community to cope with the event. The recent tragic aviation accidents in 2014 involving Malaysia Airlines flights MH370 and MH17 shocked the world in an unprecedented manner. This paper focuses on the Malaysian experience in the MH17 mission in Ukraine as well as the first ever international Disaster Victim Identification (DVI) operation for the Malaysian DVI team. The DVI operations in Hilversum, the Netherlands were well described in stages. The Netherlands' Landelijk Team Forensische Opsporing as the lead DVI team in Hilversum operated systematically, ensuring the success of the whole mission. This paper discusses the lessons learned by the Malaysian team on proper DVI structure, inter- and intra-agency cooperation, facilities planning and set up, logistics and health and safety aspects, as well as effective communication and collaboration with other international delegates. Several issues and challenges faced by the Malaysian team were also documented. In addition, the authors shared views, opinions and recommendations for a more comprehensive DVI operation in the future.
  6. Fulltext Application of facial recognition technology on identification of the dead during large scale disasters
    Khoo LS, Mahmood MS
    Forensic science international. Synergy, 2020;2:238-239.
    PMID: 32885161 DOI: 10.1016/j.fsisyn.2020.07.001
  7. Sudden cardiac death in a young adult man due to spontaneous coronary artery dissection
    Subramaniam K, Siew SF, Mahmood MS
    Malays J Pathol, 2019 Apr;41(1):51-54.
    PMID: 31025638
    Spontaneous coronary artery dissection is a rare event and commonly associated with pregnancy and female gender. This condition can reduce or completely obstruct the blood flow to the heart, causing a myocardial ischaemia, abnormalities in heart rhythm or sudden death. We present a case of a 28-year-old Indian male with no previous medical illness who complained sudden onset of chest pain prior to his death. Autopsy revealed a left anterior descending coronary artery dissection associated with plaque rupture. The anterior wall of left ventricle showed contraction band necrosis. There was also atheroma present in the right coronary artery which was insignificant. Histologically, dissection was associated with atherosclerosis. There was no evidence of vasculitis. The cause of death was given as coronary artery dissection due to coronary artery atherosclerosis.
  8. Sudden death due to infective endocarditis caused by Streptococcus constellatus: A case report
    Zamasry MS, Hilmi Z, Mohd Yusof MYP, Razali HSA, Nawawi H, Mahmood MS
    Trop Biomed, 2019 Dec 01;36(4):845-849.
    PMID: 33597456
    Infective endocarditis (IE) is a relatively uncommon disease, but has been challenging to diagnose over the years. With the increasing incidence, variety of causative agents and the resistance of microorganisms towards antibiotics, there is still an occurrence of sudden death due to undiagnosed IE. The most common microorganism causing IE is Staphylococcus aureus. However, there is increasing prevalence of other microorganisms causing IE. This case report highlights a case of sudden death due to IE caused by a rare pathogen, Streptococcus constellatus which belongs to the Streptococcus anginosus group (Milleri group). A study noted the crude incidence of IE in 6 world regions ranged between 1.5 and 11.6 cases per 100,000 people. To date, there has been no previous report on sudden death due to IE caused by Streptococcus constellatus in Malaysia, neither in the forensic nor clinical setting. This case report underlined the characteristics and pathological features of this microorganism. The increasing incidence and variety of causative organisms in IE are important public health issues. It is vital for future studies to examine the risk factors of IE related to Streptococcus constellatus, to enhance better understanding, insight and awareness regarding the course of this disease. This in turn may facilitate preventive measures to avoid morbidity and mortality from this condition.
  9. Reprint of: Cling film plastic wrap: An innovation for dead body packaging, preservation and transportation by first responders as a replacement for cadaver body bag in large scale disasters
    Khoo LS, Lai PS, Saidin MH, Noor Z, Mahmood MS
    Forensic Sci Int, 2018 Jul;288:242-255.
    PMID: 29783180 DOI: 10.1016/j.forsciint.2018.04.017
    Cadaver body bags are the conventional method to contain a human body or human remains, which includes the use for storage and transportation of the deceased at any crime scene or disaster scene. During disasters, most often than not, the first responders including the police will be equipped with cadaver body bags to do scene processing of human remains and collection of personal belongings at the disaster site. However, in an unanticipated large scale disasters involving hundreds and thousands of fatalities, cadaver body bags supplies may be scarce. The authors have therefore innovated the cling film plastic wrap as an alternative for the cadaver body bag used at the disaster site. The plastic wrap was tested on six different experimental subjects, i.e. both adult and child mannequins; body parts of the mannequin figure (arm and hand); a human adult subject and an unknown dead body. The strengths of the cling film plastic wrap are discussed in comparison with the cadaver body bag in the aspects of costing, weight, duration of the wrap, water and body fluid resistant properties, visibility and other advantages. An average savings of more than 5000% are noted for both adult body wrap and child body wrap compared to the cadaver body wrap. This simply means that the authors can either wrap 25 adult dead bodies or 80 children dead bodies with the cost of 1 cadaver body bag. The cling film plastic wrap has proven to have significant innovation impact for dead body management particularly by the first responders in large scale disasters. With proper handling of dead bodies, first responders can manage the dead with dignity and respect in an overwhelmed situation to facilitate the humanitarian victim identification process later.
  10. The clandestine multiple graves in Malaysia: The first mass identification operation of human skeletal remains
    Mohd Noor MS, Khoo LS, Zamaliana Alias WZ, Hasmi AH, Ibrahim MA, Mahmood MS
    Forensic Sci Int, 2017 Sep;278:410.e1-410.e9.
    PMID: 28698062 DOI: 10.1016/j.forsciint.2017.05.014
    The first ever mass identification operation of skeletal remains conducted for the clandestine graves in Malaysia consisted of 165 individuals unearthed from 28 human trafficking transit camps located in Wang Kelian, along the Thai-Malaysia border. A DVI response was triggered in which expert teams comprising of pathologists, anthropologists, odontologists, radiologists and DNA experts were gathered at the identified operation centre. The Department of Forensic Medicine, Hospital Sultanah Bahiyah, Alor Star, Kedah, located approximately 75km away from Wang Kelian, was temporarily converted into a victim identification centre (VIC) as it is the nearest available forensic facility to the mass grave site. The mortuary operation was conducted over a period of 3 months from June to September 2015, and was divided into two phases; phase 1 involving the postmortem examination of the remains of 116 suspected individuals and for phase 2 the remains of 49 suspected individuals. The fact that the graves were of unknown individuals afforded the mass identification operation a sufficient duration of 2 weeks as preparatory phase enabling procedurals and daily victim identification workflow to be established, and the setting up of a temporary body storage for the designated mortuary. The temporary body storage has proven to be a significant factor in enabling the successful conclusion of the VIC operation to the final phase of temporary controlled burials. Recognition from two international observers, Mr. Andréas Patiño Umaña, from the International Committee of Red Cross (ICRC) and Prof. Noel Woodford from Victoria Institute of Forensic Medicine (VIFM) had proven the mortuary operation was in compliance to the international quality and standards. The overall victim identification and mortuary operation identified a number of significant challenges, in particular the management of commingled human remains as well as the compilation of postmortem data in the absence of antemortem data for future reconciliation. CF Index in this DVI operation is 9%, indicating the primary identifications in this operation were effective. Limitations and further improvements of the mass identification operation will be discussed. This paper details the planning, preparations and management of the mass identification operation on the exhumed human remains which was also a forensic humanitarian service for the dead with dignity and respect.
  11. Fulltext The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body
    Hasmi AH, Khoo LS, Koo ZP, Suriani MUA, Hamdan AN, Yaro SWM, et al.
    Forensic Sci Med Pathol, 2020 09;16(3):477-480.
    PMID: 32500339 DOI: 10.1007/s12024-020-00270-z
    During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.
  12. Methanol related death in National Institute of Forensic Medicine, Hospital Kuala Lumpur: A case series
    Chng KL, Lai PS, Siew SF, Md Yaro SW, Mahmood MS
    Malays J Pathol, 2020 Apr;42(1):99-105.
    PMID: 32342937
    INTRODUCTION: Methanol is a widely available chemical with a range of uses including as solvent, as a fuel, in chemical synthesis and anti-freeze preparations. Most of the cases are accidental exposures to drinking beverages contaminated with methanol.

    MATERIALS AND METHODS: In mid-September 2018, there was a single outbreak of methanol poisoning in Malaysia especially involving the state of Federal Territory Kuala Lumpur and Selangor. There were 33 reported deaths suspected due to methanol poisoning in this current outbreak where 11 of them were brought in to the Institute of Forensic Medicine (NIFM), Kuala Lumpur. The last outbreak was in the year 2013 with 29 deaths reported out of 44 cases.

    RESULTS: There were 3 cases (27.2%) died in hospital and the remaining 8 cases (72.8%) were found dead at home and were later brought in dead to the hospital. A full autopsy was carried out for each case. Autopsy findings, as well as lab results pertaining to cases that survived and directly brought in dead, were of a different spectrum.

    CONCLUSION: Methanol related deaths are almost always as a result of greed. The running truism is 'methanol poisoning is a result of deliberate addition/adulteration with industrial methanol'. Prevention of the illegal production of methanol and methylated spirits should be established to curb this matter in the future.

  13. Fulltext Durability of cling film plastic wrap usage on dead body towards human decomposition changes
    Khoo LS, Mahmood MS
    Forensic science international. Synergy, 2020;2:72-75.
    PMID: 32412001 DOI: 10.1016/j.fsisyn.2020.01.003
    This study explores the practicability and usability of the cling film plastic wrap on the dead body with decomposition changes, whereby the feasibility of wrapping the remains to ensure the containment of the decomposition fluid within the cling film plastic wrap. Unknown and unclaimed dead bodies were used. Wrapping and preservation of human remains using the cling film plastic wrap could be the best operational practices for first responders rather than leaving bodies exposed on the disaster site, when the supplies of the cadaver body bags are inadequate. Thinking out of the box, the conventional way of using cadaver body bags to the cling film plastic wrap forms a new perspective in managing the dead and facilitating the human identification needs. New inventive idea of adopting the cling film plastic wrap as means of protecting the dignity of the dead person, could be the way forward in humanitarian forensic action.
  14. Fulltext Management of the dead during COVID-19 outbreak in Malaysia
    Khoo LS, Hasmi AH, Ibrahim MA, Mahmood MS
    Forensic Sci Med Pathol, 2020 09;16(3):463-470.
    PMID: 32519316 DOI: 10.1007/s12024-020-00269-6
    The emergence of a novel human coronavirus, SARS-CoV-2, causing severe respiratory tract infections in humans, is affecting all countries of the world and has become a global health concern. Since the virus was first identified in December 2019, the number of deaths have been propagating exponentially, causing countries across the world, including Malaysia, to increase emergency measures to combat the virus. Due to the fact that the COVID-19 pandemic does not discriminate its victims, it is of paramount importance to construct a plan for management of the dead for all suspected or confirmed COVID-19 cases, including the unidentified deceased, as an essential portion of the humanitarian forensic action approach. This document provides an overview on ways to maximize the local collective capacity from various government agencies to manage the dead based on the prevailing regulations and legislation in the country, in preparation for possible large scale deaths from this pandemic. The National Institute of Forensic Medicine Malaysia has improvised procedures and guidelines for management of the dead within the existing regulations in order to achieve a balance between medicolegal requirements and the safety of personnel managing the bodies of the deceased with suspected or confirmed COVID-19 infection; at the site of death, during transport, during postmortem procedures, storage and preparation before and during burial or cremation as well as environmental cleaning and disinfection, involving various agencies in the country. A form of temporary controlled burial is as an option to allow the reinvestigation of a decedent to help formally identify victims of the pandemic such as undocumented migrants or refugees who were previously not identified. Due to the different legal requirements and mortality rates between countries, there is no one-size-fits-all approach to the management of the dead. Whenever possible, every opportunity and assistance must be given to families to mourn their loved ones, even in times of crisis or an outbreak, in order to sustain an appropriate level of dignity and respect.
  15. The first case of C4-Blast related death in Malaysia: A multidisciplinary approach illustrated with emphasis on conjoint anthropologic and radiologic expertise in forensic identification of skeletal remains
    Wong YL, Khoo LS, Ibrahim MA, Mohamad Noor MH, Mahmood MS
    J Forensic Leg Med, 2021 Oct;83:102253.
    PMID: 34543893 DOI: 10.1016/j.jflm.2021.102253
    BACKGROUND: Blast related deaths are often shrouded by diagnostic and medicolegal complexities requiring multidisciplinary expertise in order to gauge accurate identification of the victims and document scientific investigations comprehensively. In the advent of more sophisticated technology, anthropologic methods can now be applied into post mortem imaging interpretation. The traditional imaging roles of characterizing osseous fragmentation, detecting and localizing foreign bodies can be expanded to simulate and support physical anthropologic examination to assist in documentation for court proceedings.

    CASE PRESENTATION: An assemblage of unidentified, incomplete, highly fragmented skeletal remains were found scattered on a bare area of land in a forest. There was evidence of an explosion given the pattern of scattered evidentiary material of explosive and ballistic nature. Laboratory analysis of white powder found within the explosive material confirmed the presence of high impact C4-explosive trace containing cyclotrimethylene trinitramin [Royal Demolition Explosive (RDX)] & pentaerythritol tetranitrate (PETN). It took meticulous multidisciplinary efforts to confirm the identity of the victim that was marred by the severe fragmentation and skeletalization of the remains. The initial radiologic interpretation focused more on identification of foreign bodies and supporting documentation of fragmentation. With the current availability of post computed tomography (PMCT) in our center, we reexamined the value and potential of PMXR and PMCT as an adjunctive tool for biological profiling.

    CONCLUSION: This was the first case of C4-blast related death reported in Malaysia. The multidisciplinary approach in efforts to identify the victim may serve as a guide in managing, coordinating and maximizing the expertise of different forensic specialists, with emphasis on anthropologic and radiologic collaboration.

  16. Oryong 501 sinking incident in the Bering Sea-International DVI cooperation in the Asia Pacific
    Chung NE, Castilani A, Tierra WE, Beh P, Mahmood MS
    Forensic Sci Int, 2017 Sep;278:367-373.
    PMID: 28806635 DOI: 10.1016/j.forsciint.2017.07.030
    On December 1st, 2014, the sinking of Oryong 501 occurred in the Bering Sea off the east coast of Russia. A total of 60 crew members, including 35 Indonesians, 13 Filipinos, 11 South Koreans and 1 Russian inspector were on board out of which only seven survived. Through an international rescue operation, the dead bodies of 27 were found and the remaining 26 crew are still missing. After transferring the dead bodies to the Busan Harbor in South Korea, the operation to identify the deceased began involving DVI teams from three countries: Korea, Indonesia and the Philippines. When a deep sea fishing boat sinks, it is very difficult to obtain antemortem data of the crew who had been on board for a long time. This is especially so if the crews are multinational. Further, the accuracy of the antemortem data provided by the families may be questionable, and the provided data is often not standardized. Despite the fact that the antemortem data were received in different formats, the identification process for the bodies of the 27 crew from the Oryong sinking was quickly completed through the cooperation among the three DVI teams. This case is an excellent example of how efficiently a DVI operation can be conducted in the Asia Pacific region. Issues raised during this operation should enable even better preparation for similar events in the future.
  17. Cling film plastic wrap: An innovation for dead body packaging, preservation and transportation by first responders as a replacement for cadaver body bag in large scale disasters
    Khoo LS, Lai PS, Saidin MH, Noor Z, Mahmood MS
    Forensic Sci Int, 2018 Apr;285:50-57.
    PMID: 29433011 DOI: 10.1016/j.forsciint.2018.01.018
    Cadaver body bags are the conventional method to contain a human body or human remains, which includes the use for storage and transportation of the deceased at any crime scene or disaster scene. During disasters, most often than not, the first responders including the police will be equipped with cadaver body bags to do scene processing of human remains and collection of personal belongings at the disaster site. However, in an unanticipated large scale disasters involving hundreds and thousands of fatalities, cadaver body bags supplies may be scarce. The authors have therefore innovated the cling film plastic wrap as an alternative for the cadaver body bag used at the disaster site. The plastic wrap was tested on six different experimental subjects, i.e. both adult and child mannequins; body parts of the mannequin figure (arm and hand); a human adult subject and an unknown dead body. The strengths of the cling film plastic wrap are discussed in comparison with the cadaver body bag in the aspects of costing, weight, duration of the wrap, water and body fluid resistant properties, visibility and other advantages. An average savings of more than 5000% are noted for both adult body wrap and child body wrap compared to the cadaver body wrap. This simply means that the authors can either wrap 25 adult dead bodies or 80 children dead bodies with the cost of 1 cadaver body bag. The cling film plastic wrap has proven to have significant innovation impact for dead body management particularly by the first responders in large scale disasters. With proper handling of dead bodies, first responders can manage the dead with dignity and respect in an overwhelmed situation to facilitate the humanitarian victim identification process later.
  18. Fulltext Postmortem CT scan in intoxication cases: A necessity or just an indulgence
    Soon LP, Subramaniam K, Madon NF, Mohamad Noor MH, Chainchel Singh MK, Mahmood MS
    Indian J Radiol Imaging, 2019 10 30;29(3):305-309.
    PMID: 31741600 DOI: 10.4103/ijri.IJRI_2_19
    Introduction: The aim of this study is to correlate urinary bladder distension and pulmonary edema on postmortem computed tomography (CT) scans with toxicology results in postmortem cases.

    Methods and Results: The study population was the postmortem cases of Asian population ranging from 16 to 75 years old in which blood and/or urine samples sent for alcohol and/or drug of abuse (DoA) analysis in year 2016 at our centre. Out of 434 cases, 54 from each group of positive and negative alcohol and/or DoA. Postmortem findings of lungs and postmortem CT scan urinary bladder volume (UBV) were recorded. Statistical significant correlation was obtained between urinary bladder distension on postmortem CT scan and cases with positive alcohol detection. However, the sensitivity was relatively low at 51.7%, whereas the specificity was 75% at the cut-off point. Low sensitivity and specificity at around 52.7% were obtained for pulmonary edema related to alcohol/DoA. This showed that UBV alone or pulmonary edema alone was not really a good indicator for alcohol or DoA intoxication. However, combination of both indicators provided higher sensitivity (73.3%) although specificity was lowered to 53.8%.

    Conclusion: The findings of postmortem CT scan bladder distension and pulmonary edema could possibly identify intoxication cases but not conclusive.

  19. Fatal injuries among motorcyclists in Klang Valley, Malaysia
    Ramli R, Oxley J, Noor FM, Abdullah NK, Mahmood MS, Tajuddin AK, et al.
    J Forensic Leg Med, 2014 Aug;26:39-45.
    PMID: 25066171 DOI: 10.1016/j.jflm.2014.06.007
    Motorcycle fatalities constitute the majority of road traffic deaths in Malaysia. The aims of this study were to describe the pattern of fatal injuries among Klang Valley fatal motorcyclists and to describe the factors associated with fatal (vs non-fatal) injuries.
  20. Pattern of suicides in 2009: data from the National Suicide Registry Malaysia
    Ali NH, Zainun KA, Bahar N, Haniff J, Hamid AM, Bujang MA, et al.
    Asia Pac Psychiatry, 2014 Jun;6(2):217-25.
    PMID: 23857761 DOI: 10.1111/j.1758-5872.2012.00227.x
    The National Suicide Registry Malaysia (NSRM) is a nationwide system that captures data on completed suicides in Malaysia from all forensic departments under the purview of the Ministry of Health Malaysia.
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