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Abnormal Muscularization of Intra-acinar Pulmonary Arteries in Two Cases Presenting as Sudden Infant Death

Zainun K, Hope K, Nicholson AG, Cohen MC

Pediatr Dev Pathol, 2017 Jan-Feb;20(1):49-53.
PMID: 28276303 DOI: 10.1177/1093526616689311

Abnormal muscularization of acinar arteries is the hallmark of persistent pulmonary hypertension of newborn (PPHN), an uncommon disease with high rate of morbidity and mortality. PPHN presents with signs of respiratory distress immediately following birth. We herein report 2 cases presenting as a witnessed sudden unexpected death in the late neonatal period, preceded by respiratory deterioration and in whom the presence of abnormal muscularization of the acinar pulmonary arteries was reminiscent of PPHN. The significance of this report is twofold: to increase the awareness among pediatricians and pathologists of this feature that can present in some cases of Sudden Unexpected Death in Infancy/Sudden Infant Death Syndrome, and to highlight the importance of performing a thorough autopsy in order to identify the abnormality.

Matched MeSH terms: Autopsy
Demethylases of H3 lysine 27 (H3K27) expression in urothelial carcinoma (UC) of the urinary bladder

Anthony R, Rajandram R, Yap NY, Mun KS, Samberkar PN, Kuppusamy S

Malays J Pathol, 2023 Aug;45(2):261-269.
PMID: 37658535

BACKGROUND: Ubiquitously Transcribed Tetracopeptide Repeat on X Chromosome (UTX) and Jumonji Domain-Containing Protein 3 (JMJD3) are histone H3 lysine 27 (H3K27) demethylases that are found to play tumour suppressor or oncogenic roles in many cancers. However, their roles in urothelial carcinoma (UC) have not been well studied.
OBJECTIVE: This study investigated UTX and JMJD3 protein expression patterns in UC and assess their clinical significance.
PATIENTS AND METHODS: Immunohistochemistry (IHC) method was performed on formalin-fixed paraffin-embedded (FFPE) of UC tissues and compared to the normal bladder tissues from the autopsy specimen. The staining intensity of FFPE tissues were captured with the nuclear and overall positive pixels quantified using Aperio ImageScope software.
RESULTS: JMJD3 protein uptake was present in both nucleus and cytoplasm but UTX protein was predominantly seen in the cytoplasm of UC tissue. UTX was under expressed whereas JMJD3 was over expressed in UC compared to normal bladder. UTX and JMJD3 were not related to clinical stage and grade. However, significant association between JMJD3 expression and invasiveness of tumour (p<0.05) was noted, especially in MIBC group (88.9%). UTX and JMJD3 did not yield any significance as prognostic factors for diseasespecific survival.
CONCLUSIONS: Low expression of UTX protein in UC may indicate possible loss of its tumour suppressor activity and higher JMJD3 protein expression may indicate oncogenic activity. Hence, JMJD3 protein could be a potential diagnostic biomarker in detecting bladder UC of higher stages. Further investigation needed to study the dysregulation of this protein expression with associated gene expression.

Matched MeSH terms: Autopsy
Effectiveness of bone cleaning process using chemical and entomology approaches: time and cost

Lai PS, Khoo LS, Mohd Hilmi S, Ahmad Hafizam H, Mohd Shah M, Nurliza A, et al.

Malays J Pathol, 2015 Aug;37(2):123-35.
PMID: 26277669 MyJurnal

Skeletal examination is an important aspect of forensic pathology practice, requiring effective bone cleaning with minimal artefact. This study was conducted to compare between chemical and entomology methods of bone cleaning. Ten subjects between 20 and 40 years old who underwent uncomplicated medico-legal autopsies at the Institute of Forensic Medicine Malaysia were randomly chosen for this descriptive cross sectional study. The sternum bone was divided into 4 parts, each part subjected to a different cleaning method, being two chemical approaches i.e. laundry detergent and a combination of 6% hydrogen peroxide and powder sodium bicarbonate and two entomology approaches using 2nd instar maggots of Chrysomyia rufifacies and Ophyra spinigera. A scoring system for grading the outcome of cleaning was used. The effectiveness of the methods was evaluated based on average weight reduction per day and median number of days to achieve the average score of less than 1.5 within 12 days of the bone cleaning process. Using maggots was the most time-effective and costeffective method, achieving an average weight reduction of 1.4 gm per day, a median of 11.3 days to achieve the desired score and an average cost of MYR 4.10 per case to reach the desired score within 12 days. This conclusion was supported by blind validation by forensic specialists achieving a 77.8% preference for maggots. Emission scanning electron microscopy evaluation also revealed that maggots especially Chrysomyia rufifacies preserved the original condition of the bones better allowing improved elucidation of bone injuries in future real cases.

Matched MeSH terms: Autopsy/methods*
Fulltext Cause-specific mortality estimates for Malaysia in 2013: results from a national sample verification study using medical record review and verbal autopsy

Omar A, Ganapathy SS, Anuar MFM, Khoo YY, Jeevananthan C, Maria Awaluddin S, et al.

BMC Public Health, 2019 Jan 24;19(1):110.
PMID: 30678685 DOI: 10.1186/s12889-018-6384-7

BACKGROUND: Mortality indicators are essential for monitoring population health. Although Malaysia has a functional death registration system, the quality of information on causes of death still needs improvement, since approximately 30% of deaths are classified to poorly defined causes. This study was conducted to verify registered causes in a sample of deaths in 2013 and utilise the findings to estimate cause-specific mortality indicators for Malaysia in 2013.

METHODS: This is a cross-sectional study involving a nationally representative sample of 14,497 deaths distributed across 19 districts. Registered causes of deaths were verified using standard medical record review protocols for hospital deaths, and locally adapted international standard verbal autopsy procedures for deaths outside hospitals. The findings were used to measure the validity and reliability of the registration data, as well as to establish plausible cause-specific mortality fractions for hospital and non-hospital deaths, which were subsequently used as the basis for estimating national cause-specific mortality indicators.

RESULTS: The overall response rate for the study was 67%. Verified causes of 5041 hospital deaths and 3724 deaths outside hospitals were used to derive national mortality estimates for 2013 by age, sex and cause. The study was able to reclassify most of the ill-defined deaths to a specific cause. The leading causes of deaths for males were Ischaemic Heart Disease (15.4%), Cerebrovascular diseases (13.7%), Chronic Obstructive Pulmonary Disease (8.5%) and Road Traffic Accident (8.0%). Among females, the leading causes were Cerebrovascular diseases (18.3%), Ischaemic Heart Disease (12.7%), Lower Respiratory Infections (11.5%) and Diabetes Mellitus (7.2%).

CONCLUSIONS: Investigation of registered causes of death using verbal autopsy and medical record review yielded adequate information to enable estimation of cause-specific mortality indicators in Malaysia. Strengthening the national mortality statistics system must be made a priority as it is a core data source for policy and evaluation of the public health and healthcare sectors in Malaysia.

Matched MeSH terms: Autopsy/methods*
Fulltext An occurrence of Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) from a human corpse in a high-rise building in Malaysia: a case report

Syamsa RA, Ahmad FM, Zuha RM, Khairul AZ, Marwi MA, Shahrom AW, et al.

Trop Biomed, 2012 Mar;29(1):107-12.
PMID: 22543610 MyJurnal

This is the first report of Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) on a human corpse discovered in a high-rise building in Malaysia. On 5 March 2008, a decomposing body of an adult female was found on the top floor of a thirteen-story building in Kuala Lumpur, Malaysia. Her body was colonized by S. nudiseta larvae, which were normally associated with corpses found indoors at ground level. The post-mortem interval (PMI) was estimated at approximately 5 to 9 days. This case is significant as it demonstrates that this species can locate a dead body even in a high-rise building. Further findings of fly distribution especially in high-rise buildings should be reported to assist entomologists in PMI analysis.

Matched MeSH terms: Autopsy/methods*
Acute pulmonary thromboembolism in a case of fatal child abuse

Rahimi R, Zulkifli ZF, Omar E, Ismail H, Md Noor S

Malays J Pathol, 2017 Apr;39(1):83-87.
PMID: 28413210 MyJurnal

Child abuse is a worldwide problem. The four major types of abuse include physical abuse, child neglect, psychological maltreatment and sexual violence. We describe a fatal case of child abuse which presented with numerous old and recent soft tissue injuries all over the body. The injuries on the legs have immobilized the victim for quite some time, giving rise to deep vein thrombosis, leading to death as a result of acute pulmonary thromboembolism. This case demonstrates presence of both elements of abuse and neglect in one victim. As this category of crime involves a helpless child, we would also like to reiterate that the community has an obligation to prevent such tragedies and educating the public to recognize the signs and symptoms of abuse would be of utmost important. Ultimately, the community must also be responsible for reporting such offences and the act of silence is akin to condoning a crime witnessed.

Matched MeSH terms: Autopsy/methods
Fulltext Classification of forensic autopsy reports through conceptual graph-based document representation model

Mujtaba G, Shuib L, Raj RG, Rajandram R, Shaikh K, Al-Garadi MA

J Biomed Inform, 2018 06;82:88-105.
PMID: 29738820 DOI: 10.1016/j.jbi.2018.04.013

Text categorization has been used extensively in recent years to classify plain-text clinical reports. This study employs text categorization techniques for the classification of open narrative forensic autopsy reports. One of the key steps in text classification is document representation. In document representation, a clinical report is transformed into a format that is suitable for classification. The traditional document representation technique for text categorization is the bag-of-words (BoW) technique. In this study, the traditional BoW technique is ineffective in classifying forensic autopsy reports because it merely extracts frequent but discriminative features from clinical reports. Moreover, this technique fails to capture word inversion, as well as word-level synonymy and polysemy, when classifying autopsy reports. Hence, the BoW technique suffers from low accuracy and low robustness unless it is improved with contextual and application-specific information. To overcome the aforementioned limitations of the BoW technique, this research aims to develop an effective conceptual graph-based document representation (CGDR) technique to classify 1500 forensic autopsy reports from four (4) manners of death (MoD) and sixteen (16) causes of death (CoD). Term-based and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) based conceptual features were extracted and represented through graphs. These features were then used to train a two-level text classifier. The first level classifier was responsible for predicting MoD. In addition, the second level classifier was responsible for predicting CoD using the proposed conceptual graph-based document representation technique. To demonstrate the significance of the proposed technique, its results were compared with those of six (6) state-of-the-art document representation techniques. Lastly, this study compared the effects of one-level classification and two-level classification on the experimental results. The experimental results indicated that the CGDR technique achieved 12% to 15% improvement in accuracy compared with fully automated document representation baseline techniques. Moreover, two-level classification obtained better results compared with one-level classification. The promising results of the proposed conceptual graph-based document representation technique suggest that pathologists can adopt the proposed system as their basis for second opinion, thereby supporting them in effectively determining CoD.

Matched MeSH terms: Autopsy/methods*
Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus histopathology

Chainchel Singh MK, Abdul Rashid SN, Abdul Hamid S, Mahmood MS, Feng SS, Mohd Nawawi H, et al.

Forensic Sci Int, 2020 Mar;308:110171.
PMID: 32032870 DOI: 10.1016/j.forsciint.2020.110171

BACKGROUND: Post-mortem Computed Tomography (PMCT) allows non-invasive or minimally invasive detection of findings that may or may not be visible during conventional autopsy, however, it does not allow the investigator to draw any conclusions regarding patency of the vessel's lumen. To address this deficiency, Post-mortem Computed Tomography Angiography (PMCTA) utilizing different contrast media and techniques have been introduced with various studies looking at the correlation between PMCTA, autopsy (gross) findings and coronary artery histology in diagnosing coronary artery disease.
OBJECTIVES: The aim of this study is to investigate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis using water-based contrast media introduced though the vessels of the neck, compared to the gold standard of diagnosis i.e. gross and histological evaluation of the coronary artery.
METHOD: This was a cross sectional study of 158 arterial sections involving 37 subjects recruited from the National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur (HKL). An unenhanced PMCT was performed followed by PMCTA using water-based contrast media introduced though the vessels of the neck. Coronary artery stenosis was determined using multiplanar reconstructionD while the degree of stenosis was determined by calculating the percentage of luminal diameter divided by the diameter of the vessel internal elastic.
RESULTS: The analysis of PMCTA and histopathology examinations revealed a sensitivity of 61.5%, specificity of 91.7%; positive predictive value (PPV) of 40.0% and negative predictive value (NPV) of 96.4%.
CONCLUSION: PMCTA utilizing water-based contrast introduced though the vessels of the neck yielded similar results as other methods and techniques of PMCTA. We would therefore conclude that PMCTA utilizing this technique could be used to assess the degree of calcification and the presence of significant stenosis.

Matched MeSH terms: Autopsy/methods*
Postmortem abdominal radiographic findings in feline cadavers

Heng HG, Teoh WT, Sheikh-Omar AR

Vet Radiol Ultrasound, 2008 2 7;49(1):26-9.
PMID: 18251290

Postmortem radiographic examinations of animals are commonly performed in judicial investigations to rule out gunshot and fractures. However, there was no available data on radiographic postmortem changes of animals. Forty-one sets of abdominal radiographs of feline cadavers made within 12 h of death were evaluated for postmortem changes. Intravascular gas was detected in 11 of 41 (27%) cadavers. The most common site of intravascular gas was the liver. Intravascular gas was also present in the aorta, femoral artery, celiac and cranial mesenteric arteries, and caudal superficial epigastric artery. Intrasplenic gas was detected in two cadavers. Only two cadavers had distended small intestine. One cadaver had pneumatosis coli. The changes detected were most likely due to putrefaction.

Matched MeSH terms: Autopsy/veterinary
Delayed hanging death: a case report

Kumar V

J Pak Med Assoc, 2007 Jan;57(1):39-41.
PMID: 17319420
Matched MeSH terms: Autopsy
Confidentiality and death

Ong BB, Kaur S

Malays J Pathol, 1997 Dec;19(2):111-4.
PMID: 10879250

The duty of confidentiality in the normal doctor-patient relationship is well recognized. However, the duty of confidentiality between the pathologist who performs the autopsy and the requesting authorities and the next-of-kin is not as clearly spelt out. This article discusses the problems faced by the pathologist with regards to hospital and medico-legal autopsies in Malaysia. A proposed ethical guideline is included on how to deal with peculiar issues regarding confidentiality and the pathologist.

Matched MeSH terms: Autopsy
Sudden maternal deaths from amniotic fluid embolism

Nadesan K, Jayalakshmi P

Ceylon Med J, 1997 Dec;42(4):185-9.
PMID: 9476404

Sudden maternal death from amniotic fluid embolism is a rare but serious complication which usually occurs during late pregnancy, often during labour or shortly after, with more than 80% mortality. Such a death causes immense stress to both the relatives and the attending doctors as it is sudden and unexpected. Three such deaths are discussed here. Traditionally, it was believed that this complication usually occurred in prolonged and difficult labour, but there is evidence contrary to this, and it is not possible to predict when and where this fatal complication will occur. Current views and various pathophysiologic mechanisms leading to the fatal outcome are also discussed.

Matched MeSH terms: Autopsy
Mycobacterium tuberculosis complex in wildlife: Review of current applications of antemortem and postmortem diagnosis

Lekko YM, Ooi PT, Omar S, Mazlan M, Ramanoon SZ, Jasni S, et al.

Vet World, 2020 Sep;13(9):1822-1836.
PMID: 33132593 DOI: 10.14202/vetworld.2020.1822-1836

Tuberculosis (TB) is a chronic inflammatory and zoonotic disease caused by Mycobacterium tuberculosis complex (MTBC) members, which affects various domestic animals, wildlife, and humans. Some wild animals serve as reservoir hosts in the transmission and epidemiology of the disease. Therefore, the monitoring and surveillance of both wild and domestic hosts are critical for prevention and control strategies. For TB diagnosis, the single intradermal tuberculin test or the single comparative intradermal tuberculin test, and the gamma-interferon test, which is regarded as an ancillary test, are used. Postmortem examination can identify granulomatous lesions compatible with a diagnosis of TB. In contrast, smears of the lesions can be stained for acid-fast bacilli, and samples of the affected organs can be subjected to histopathological analyses. Culture is the gold standard test for isolating mycobacterial bacilli because it has high sensitivity and specificity compared with other methods. Serology for antibody detection allows the testing of many samples simply, rapidly, and inexpensively, and the protocol can be standardized in different laboratories. Molecular biological analyses are also applicable to trace the epidemiology of the disease. In conclusion, reviewing the various techniques used in MTBC diagnosis can help establish guidelines for researchers when choosing a particular diagnostic method depending on the situation at hand, be it disease outbreaks in wildlife or for epidemiological studies. This is because a good understanding of various diagnostic techniques will aid in monitoring and managing emerging pandemic threats of infectious diseases from wildlife and also preventing the potential spread of zoonotic TB to livestock and humans. This review aimed to provide up-to-date information on different techniques used for diagnosing TB at the interfaces between wildlife, livestock, and humans.

Matched MeSH terms: Autopsy
On poisoning by sodium cyanide

Willimott SG

Journal of the Malaya Branch of the British Medical Association, 1941;4:438-44.

Matched MeSH terms: Autopsy
Tumour of the brain in a boy, secondary to a primary carcinoma of the liver, with unusual features

Balasingham T, Sreenivasan BR

Journal of the Malaya Branch of the British Medical Association, 1938;2:98-100.

Matched MeSH terms: Autopsy
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.

Matched MeSH terms: Autopsy
Estimation of body height from spinal length measurements using post-mortem computed tomographic images

Zyoud TYT, Abdul Rashid SN, Suppiah S, Mahmud R, Kabeer A, Abd Manaf R, et al.

Malays J Pathol, 2020 Dec;42(3):423-431.
PMID: 33361724

INTRODUCTION: Post-mortem computed tomography (PMCT) provides information that helps in the determination of the cause of death and corpse identification of disaster victims. One of the methods for corpse identification includes assessment of the body stature. There is a lack of post-mortem imaging studies that focus on the anthropometric assessment of corpses. Our aim was to identify the relationship between cadaveric spine length and autopsy length (AL) among and autopsy length (AL) among a Malaysian population and derive a regression formula for the estimation of corpse body height using PMCT.
MATERIALS AND METHODS: We retrospectively assessed 107 cadavers that had undergone conventional autopsy and PMCT. We made 5 measurements from the PMCT that included cervical length (CL), thoracic length (TL), lumbosacral length (LS), total column length of the spine, excluding the sacrum and coccyx (TCL), and ellipse line measurement of the whole spine, excluding the sacrum and coccyx (EL). We compared these anthropometric PMCT measurements with AL and correlated them using linear regression analysis.
RESULTS: The results showed a significant linear relationship existed between TL and LS with AL, which was higher in comparison with the other parameters than the rest of the spine parameters. The linear regression formula derived was: 48.163 + 2.458 (TL) + 2.246 (LS).
CONCLUSIONS: The linear regression formula derived from PMCT spine length parameters particularly thoracic and lumbar spine gave a finer correlation with autopsy body length and can be used for accurate estimation of cadaveric height. To the best of our knowledge, this is the first ever linear regression formula for cadaveric height assessment using only post mortem CT spine length measurements.

Matched MeSH terms: Autopsy
Letter: Liver fluke in a Malaysian Orang Asli (Aborigine)

Prathap K

Trans R Soc Trop Med Hyg, 1973;67(6):881-2.
PMID: 4788767
Matched MeSH terms: Autopsy
Letter: First case of schistosomiasis in Malaysia

Murugasu R, Dissanaike AS

Trans R Soc Trop Med Hyg, 1973;67(6):880.
PMID: 4788765
Matched MeSH terms: Autopsy
Practical methods in resuscitation of multiple trauma victims

Delilkan AE

Med J Malaysia, 1973 Sep;28(1):29-31.
PMID: 4273779
Matched MeSH terms: Autopsy

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