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Repatriation of human remains following death in international travellers

Connolly R, Prendiville R, Cusack D, Flaherty G

J Travel Med, 2017 Mar 01;24(2).
PMID: 28395093 DOI: 10.1093/jtm/taw082

Background: Death during international travel and the repatriation of human remains to one's home country is a distressing and expensive process. Much organization is required involving close liaison between various agencies.
Methods: A review of the literature was conducted using the PubMed database. Search terms included: 'repatriation of remains', 'death', 'abroad', 'tourism', 'travel', 'travellers', 'travelling' and 'repatriation'. Additional articles were obtained from grey literature sources and reference lists.
Results: The local national embassy, travel insurance broker and tour operator are important sources of information to facilitate the repatriation of the deceased traveller. Formal identification of the deceased's remains is required and a funeral director must be appointed. Following this, the coroner in the country or jurisdiction receiving the repatriated remains will require a number of documents prior to providing clearance for burial. Costs involved in repatriating remains must be borne by the family of the deceased although travel insurance may help defray some of the costs. If the death is secondary to an infectious disease, cremation at the site of death is preferred. No standardized procedure is in place to deal with the remains of a migrant's body at present and these remains are often not repatriated to their country of origin.
Conclusions: Repatriation of human remains is a difficult task which is emotionally challenging for the bereaving family and friends. As a travel medicine practitioner, it is prudent to discuss all eventualities, including the risk of death, during the pre-travel consultation. Awareness of the procedures involved in this process may ease the burden on the grieving family at a difficult time.

Matched MeSH terms: Body Remains*
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.

Matched MeSH terms: Body Remains*
Test of Sex Estimation Equations on Carpal Bones in a Northeastern Thai Population

Laowatthanaphong S, Das S, Phatsara M, Tuamsuk P, Mahakkanukrauh P

Clin Ter, 2016 Mar-Apr;167(2):29-32.
PMID: 27212569 DOI: 10.7417/CT.2016.1917

Sex assessment is an essential step in person identification, both in forensic and anthropological contexts. Many parts of skeletal remains such as skull, pelvis and long bones have been proven to be useful in determining sex. However, literature has shown that short bones such as carpal bones are also sexually dimorphic. In the last few years, there was an unpublished study using lunate, scaphoid and hamate from bone collection in Northern Thailand to create 6 discriminant equations to assess sex. The objective of this study was to investigate the application of those equations in the sample from other parts of Thailand.

Matched MeSH terms: Body Remains
Can stature be estimated from tooth crown dimensions? A study in a sample of South-East Asians

Hossain MZ, Munawar KM, Rahim ZH, Bakri MM

Arch Oral Biol, 2016 Apr;64:85-91.
PMID: 26803673 DOI: 10.1016/j.archoralbio.2016.01.001

Stature estimation is an important step during medico-legal and forensic examination. Difficulty arises when highly decomposed and mutilated dead bodies with fragmentary remains are brought for forensic identification like in mass disaster or airplane crash. The body remains could be just a jaw with some teeth. The objective of this study was to explore if the stature of an individual can be determined from the tooth crown dimensions.

Matched MeSH terms: Body Remains
Accuracy of Kvaal's radiographic and translucent dentinal root techniques of extracted teeth in Malay adults for dental age estimation

Ramli UIS, Muhd US, Mohd Yusof MYP

J Forensic Odontostomatol, 2021 Aug 30;2(39):38-44.
PMID: 34419944

The use of teeth to estimate the age of unknown bodies provides much help especially in skeletal remains with no soft tissues left for identification. However, dental age estimation utilizing degenerative changes in teeth like dentinal translucency is often hampered with large margin of error. This study aims to compare the accuracy of Kvaal's radiographic method (intraoral periapical radiograph) with modified Bang-Ramm dentinal root translucency method in estimating dental age in Malay adults. One-hundred teeth of maxillary and mandibular incisors and canine were collected following dental extraction. Date of birth, date of extraction, gender and ethnicity were documented prior to extraction. All teeth were assessed using two methods of dental age estimation: 1) The equation from Kvaal's radiographic method and 2) Formula from modified Bang-Ramm dentinal root translucency method. The results from the age estimation were compared to the chronological age of the persons from whom the teeth were extracted. The average dental age estimated using both methods significantly correlated with the chronological age for both men and women. Overestimation and underestimation with mean absolute error up to 13 years and 15 years was observed in modified Bang-Ramm and Kvaal, respectively. The estimated age calculated from both methods also showed increasing standard deviation as the patient gets older. From the obtained results it is reasonable to conclude that modified Bang-Ramm method gives better accuracy for dental age estimation in Malay adults.

Matched MeSH terms: Body Remains
Fulltext A Taphonomic Study of Crocodylus porosus (Crocodylidae) and Tomistoma schlegelii (Gavialidae) Remains from Western Sarawak, Malaysian Borneo: Applications for Public Education

Ruhana Hassan, Nur Fatimah Mohd Azizi, Muhammad Amirul Arib Md Adzhar, Mohd Izwan Zulaini Abdul Gani, Rambli Ahmad, Charles Leh Moi Ung

Trends in Undergraduate Research, 2018;1(1):0-0.
MyJurnal

This study documented details of the dentitions, skulls and other skeletal remains of Crocodylus porosus and Tomistoma schlegelii, from western part of Sarawak, Malaysian Borneo. The remains of both reptiles were exhumed, followed by standard cleaning procedures and then detail morphological assessments were carried out accordingly. Both species show similar structure of vertebral columns, but T. schlegelii has the following unique structures: a long and narrower snout, D-shaped eye sockets, long and sharp pointed protruding quadratojugal bones, straight maxillae and dentary, a smooth surfaced skull, elongated triangular suborbital fenestrae, round shaped internal nares and visible supraoccipital from a dorsal view. C. porosus has heterodont dentition with blunt-pointed and irregular size of teeth whereas T. schlegelii has almost homodont dentition with sharp and similar size teeth. This is the first collection of teeth, skulls and other skeletal remains of both species obtained from Sarawak, and the materials have been used regularly to educate the public through science exhibitions, hoping they will spark the interests of young budding scientists to be involved in wildlife taphonomic studies in the future.

Matched MeSH terms: Body Remains
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.

Matched MeSH terms: Body Remains
Fulltext A new method for sex estimation from maxillary suture length in a Thai population

Sinthubua A, Ruengdit S, Das S, Mahakkanukrauh P

Anat Cell Biol, 2017 Dec;50(4):261-264.
PMID: 29354297 DOI: 10.5115/acb.2017.50.4.261

Sex estimation is one of the crucial procedures in the biological profile identification of human skeletal remains. Knowing sex of unknown case can lead to accurate and appropriate methods for predicting age, stature, ancestry, or even personal identification. Skull is one of the most reliable one among other skeletons and it is usually retained for both archaeological and forensic contexts. Although many morphological features and metric measurements of skull have been studied for sexing, but to the best of our knowledge is no study on maxillary suture length for sex estimation. Therefore, this study aims to develop a new sex estimation method for a Thai population by determining three maxillary suture lengths: anterior, transverse, and posterior maxillary suture, by computerizing amount of pixel obtained from photographs of these sutures. The present study was conducted on 190 Thai bone samples of which 96 were males and 94 were females. Independent t test revealed statistically significant difference (P<0.01) between males and females in all maxillary suture measurements. Equations derived from prediction model, which required three maxillary suture lengths gave 76.8421% accuracy from the leave-one-out cross validation in estimating sex percentage accuracies in predicting sex from these equations, which were relatively moderate. This study provides a novel and objective sex estimation method for Thais. It suggests that maxillary suture length can be applied for sex estimation. The new computerized technique will contribute basis knowledge and method for sex estimation, especially when only base of skull is available in forensic circumstance.

Matched MeSH terms: Body Remains
Reporting beetles in a mummified human corpse in Malaysia: Necrobia rufipes (Fabricius, 1781) (Coleoptera: Cleridae) and Dermestes maculatus De Geer, 1774 (Coleoptera: Dermestidae)

Ivorra T, Rahimi R, Zaini NA, Heo CC

Leg Med (Tokyo), 2023 May;62:102238.
PMID: 36913819 DOI: 10.1016/j.legalmed.2023.102238

This case study reports on two unrecorded Coleopteran species found together on a human corpse in Malaysia. The mummified human remains were discovered in a house in Selangor, Malaysia. The pathologist confirmed that the death was due to a traumatic chest injury. Maggots, beetles, and fly pupal casings were found mainly on the front part of the body. Empty puparia of Diptera were collected during the autopsy and identified later as the muscid Synthesiomyia nudiseta (van der Wulp, 1883) (Diptera: Muscidae). Also, the insect evidence received included larvae and pupae of Megaselia sp. (Diptera: Phoridae). According to the insect development data, the minimum postmortem period was estimated by the time to reach the pupal developmental stage (in days). The entomological evidence included the first record of Dermestes maculatus De Geer, 1774 (Coleoptera: Dermestidae) and Necrobia rufipes (Fabricius, 1781) (Coleoptera: Cleridae), which have not previously been recorded on human remains in Malaysia.

Matched MeSH terms: Body Remains
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.

Matched MeSH terms: Body Remains*
Stature Estimation from Lower Limb Anthropometry using Linear Regression Analysis: A Study on the Malaysian Population

Abu Bakar SN, Aspalilah A, AbdelNasser I, Nurliza A, Hairuliza MJ, Swarhib M, et al.

Clin Ter, 2017 Mar-Apr;168(2):e84-e87.
PMID: 28383619 DOI: 10.7417/CT.2017.1988

INTRODUCTION: Stature is one of the characteristics that could be used to identify human, besides age, sex and racial affiliation. This is useful when the body found is either dismembered, mutilated or even decomposed, and helps in narrowing down the missing person's identity.

AIM: The main aim of the present study was to construct regression functions for stature estimation by using lower limb bones in the Malaysian population.

MATERIALS AND METHODS: The sample comprised 87 adult individuals (81 males, 6 females) aged between 20 to 79 years. The parameters such as thigh length, lower leg length, leg length, foot length, foot height and foot breadth were measured. They were measured by a ruler and measuring tape. Statistical analysis involved independent t-test to analyse the difference between lower limbs in male and female. The Pearson's correlation test was used to analyse correlations between lower limb parameters and stature, and the linear regressions were used to form equations. The paired t-test was used to compare between actual stature and estimated stature by using the equations formed.

RESULTS: Using independent t-test, there was a significant difference (p< 0.05) in the measurement between males and females with regard to leg length, thigh length, lower leg length, foot length and foot breadth. The thigh length, leg length and foot length were observed to have strong correlations with stature with p= 0.75, p= 0.81 and p= 0.69, respectively. Linear regressions were formulated for stature estimation. Paired t-test showed no significant difference between actual stature and estimated stature.

CONCLUSIONS: It is concluded that regression functions can be used to estimate stature to identify skeletal remains in the Malaysia population.

Matched MeSH terms: Body Remains
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.

Matched MeSH terms: Body Remains
Fulltext Eight Weeks of Cosmos caudatus (Ulam Raja) Supplementation Improves Glycemic Status in Patients with Type 2 Diabetes: A Randomized Controlled Trial

Cheng SH, Ismail A, Anthony J, Ng OC, Hamid AA, Barakatun-Nisak MY

Evid Based Complement Alternat Med, 2015;2015:405615.
PMID: 26713097 DOI: 10.1155/2015/405615

Objectives. Optimizing glycemic control is crucial to prevent type 2 diabetes related complications. Cosmos caudatus is reported to have promising effect in improving plasma blood glucose in an animal model. However, its impact on human remains ambiguous. This study was carried out to evaluate the effectiveness of C. caudatus on glycemic status in patients with type 2 diabetes. Materials and Methods. In this randomized controlled trial with two-arm parallel-group design, a total of 101 subjects with type 2 diabetes were randomly allocated to diabetic-ulam or diabetic controls for eight weeks. Subjects in diabetic-ulam group consumed 15 g of C. caudatus daily for eight weeks while diabetic controls abstained from taking C. caudatus. Both groups received the standard lifestyle advice. Results. After 8 weeks of supplementation, C. caudatus significantly reduced serum insulin (-1.16 versus +3.91), reduced HOMA-IR (-1.09 versus +1.34), and increased QUICKI (+0.05 versus -0.03) in diabetic-ulam group compared with the diabetic controls. HbA1C level was improved although it is not statistically significant (-0.76% versus -0.37%). C. caudatus was safe to consume. Conclusions. C. caudatus supplementation significantly improves insulin resistance and insulin sensitivity in patients with type 2 diabetes.

Matched MeSH terms: Body Remains
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.

Matched MeSH terms: Body Remains*
Underwater DVI: Simple fingerprint technique for positive identification

Khoo LS, Hasmi AH, Mahmood MS, Vanezis P

Forensic Sci Int, 2016 Sep;266:e4-e9.
PMID: 27567043 DOI: 10.1016/j.forsciint.2016.08.019

An underwater disaster can be declared when a maritime accident occurred or when an aircraft is plunged into water area, be it ocean, sea or river. Nevertheless, handling of human remains in an underwater recovery operation is often a difficult and demanding task as working conditions may be challenging with poor to no visibility, location of remains at considerable depths and associated hazards from surrounding water. A case of the recent helicopter crash, into a famous river in Sarawak, domiciled by huge crocodiles, is discussed in this paper. Search and recovery team as well as the combat divers from the Special Elite Troop Commando, known as VAT 69, were deployed to the scene to perform the underwater recovery to search for all the victims on board involving five Malaysians with a pilot of Philippines nationality. This paper highlights the limitations and challenges faced during the underwater search and recovery. All the bodies recovered were in moderate decomposition stage with crushed injuries and mutilated face and body. A simple and conventional fingerprint technique were used to record the fingerprint. The prints impressions were later photographed using a smartphone and transferred back to the RMP headquarters in Kuala Lumpur for fingerprint match by using WhatsApp Messenger, a phone application. All the first five victims were identified within an average of 10min. The last victim recovered was the pilot. For foreign nationals, the Immigration Department of Malaysia will record the prints of both index fingers only. The lifting of the fingerprint of the last victim was the most challenging in which only one index finger left that can be used for comparison. A few techniques were attempted using the black printer's ink, glass and tape techniques for the last victim. Subsequently, images of the prints impression were taken using the same smartphone with additional macro lens attached to it to enhance the resolution. The images were transferred to the RMP headquarters through WhatsApp Messenger. The prints were confirmed to be the pilot 20min later.

Matched MeSH terms: Body Remains
Fulltext Study of sexual dimorphism of Malaysian crania: an important step in identification of the skeletal remains

Ibrahim A, Alias A, Nor FM, Swarhib M, Abu Bakar SN, Das S

Anat Cell Biol, 2017 Jun;50(2):86-92.
PMID: 28713610 DOI: 10.5115/acb.2017.50.2.86

Sex determination is one of the main steps in the identification of human skeletal remains. It constitutes an initial step in personal identification from the skeletal remains. The aim of the present study was to provide the population-specific sex discriminating osteometric standards to aid human identification. The present study was conducted on 87 (174 sides) slices of crania using postmortem computed tomography in 45 males and 42 females, aged between 18 and 75 years. About 22 parameters of crania were measured using Osirix software 3-D Volume Rendering. Results showed that all parameters were significantly higher in males than in females except for orbital height of the left eye by independent t test (P<0.01). By discriminant analysis, the classification accuracy was 85.1%, and by regression, the classification accuracy ranged from 78.2% to 86.2%. In conclusion, cranium can be used to distinguish between males and females in the Malaysian population. The results of the present study can be used as a forensic tool for identification of unknown crania.

Matched MeSH terms: Body Remains
Sex estimation of Malaysian sub-adults using craniometrics: A computed tomography study

Syed Mohd Hamdan SN, Rahmat RA, Abdul Razak F, Abd Kadir KA, Mohd Faizal Abdullah ER, Ibrahim N

Leg Med (Tokyo), 2023 Sep;64:102275.
PMID: 37229938 DOI: 10.1016/j.legalmed.2023.102275

Sex estimation is crucial in biological profiling of skeletal human remains. Methods used for sex estimation in adults are less effective for sub-adults due to varied cranium patterns during the growth period. Hence, this study aimed to develop a sex estimation model for Malaysian sub-adults using craniometric measurements obtained through multi-slice computed tomography (MSCT). A total of 521 cranial MSCT dataset of sub-adult Malaysians (279 males, 242 females; 0-20 years old) were collected. Mimics software version 21.0 (Materialise, Leuven, Belgium) was used to construct three-dimensional (3D) models. A plane-to-plane (PTP) protocol was utilised to measure 14 selected craniometric parameters. Discriminant function analysis (DFA) and binary logistic regression (BLR) were used to statistically analyze the data. In this study, low level of sexual dimorphism was observed in cranium below 6 years old. The level was then increased with age. For sample validation data, the accuracy of DFA and BLR in estimating sex improved with age from 61.6% to 90.3%. All age groups except 0-2 and 3-6 showed high accuracy percentage (≥75%) when tested using DFA and BLR. DFA and BLR can be utilised to estimate sex for Malaysian sub-adult using MSCT craniometric measurements. However, BLR showed higher accuracy than DFA in sex estimation of sub-adults.

Matched MeSH terms: Body Remains

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