BACKGROUND: Men in the United States undergoing renal replacement therapy are more likely than women to receive a kidney transplant. However, the ability to pay may, in part, be responsible for this finding.
OBJECTIVE: To compare adult male and female transplantation rates in a setting in which equal access to medical treatment is assumed.
METHODS: Using data from the Canadian Organ Replacement Register, the rate of first transplantations was computed for the 20, 131 men and the 13,458 women aged 20 years or older who initiated renal replacement therapy between January 1, 1981, and December 31, 1996. Poisson regression analysis was used to estimate the male-female transplantation rate ratio, adjusting for age, race, province, calendar period, underlying disease leading to renal failure, and dialytic modality. Actuarial survival methods were used to compare transplantation probability for covariable-matched cohorts of men and women.
RESULTS: Men experienced 20% greater covariable-adjusted kidney transplantation rates relative to women (rate ratio, 1.20; 95% confidence interval, 1.13-1.27). The sex disparity was stronger for cadaveric transplants (rate ratio, 1.23) compared with those from living donors (rate ratio, 1.10). The 5-year probability of receiving a transplant was 47% for men and 39% for women within covariable-matched cohorts (P
In a forensic acarology study, conducted in a secondary forest of Forensic Science Simulation Site, Universiti Kebangsaan
Malaysia (UKM) in Bangi, Selangor, six carcasses consisted of three monkeys and three rabbits were placed individually
in steel enclosures and observed for 35 days. The carcasses, the soil beneath them and pitfall traps were checked daily
for insects and mites. A species of mesostigmatid mite, Macrocheles scutatiformis was discovered and this is a first time
reported in Malaysia. There are about 94.0% of Macrocheles present inside the cages of the monkey and rabbit carcasses.
Most mites in this study were collected from soil beneath the carcasses, on a dung beetle and a Chrysomya rufifacies
larva. Our findings showed that M. scutatiformis have a potential role in forensic investigation involving dead animals
perhaps corpses especially during the dry stage of decomposition.
Dorsal plating is commonly used in proximal phalanx fractures but it bears the risk of interfering with the extensor apparatus. In this study, dorsal and lateral plating fixation methods are compared to assess biomechanical differences using conventional 1.5mm non-locking plates and novel 1.3mm lateral locking plates.
Background and Objectives: Hip fractures constitute the most debilitating complication of osteoporosis with steadily increasing incidences in the aging population. Their intramedullary nailing can be challenging because of poor anchorage in the osteoporotic femoral head. Cement augmentation of Proximal Femoral Nail Antirotation (PFNA) blades demonstrated promising results by enhancing cut-out resistance in proximal femoral fractures. The aim of this study was to assess the impact of augmentation on the fixation strength of TFN-ADVANCEDTM Proximal Femoral Nailing System (TFNA) blades and screws within the femoral head and compare its effect when they are implanted in centre or anteroposterior off-centre position. Materials and Methods: Eight groups were formed out of 96 polyurethane low-density foam specimens simulating isolated femoral heads with poor bone quality. The specimens in each group were implanted with either non-augmented or cement-augmented TFNA blades or screws in centre or anteroposterior off-centre positions, 7 mm anterior or posterior. Mechanical testing was performed under progressively increasing cyclic loading until failure, in setup simulating an unstable pertrochanteric fracture with a lack of posteromedial support and load sharing at the fracture gap. Varus-valgus and head rotation angles were monitored. A varus collapse of 5° or 10° head rotation was defined as a clinically relevant failure. Results: Failure load (N) for specimens with augmented TFNA head elements (screw/blade centre: 3799 ± 326/3228 ± 478; screw/blade off-centre: 2680 ± 182/2591 ± 244) was significantly higher compared with respective non-augmented specimens (screw/blade centre: 1593 ± 120/1489 ± 41; screw/blade off-centre: 515 ± 73/1018 ± 48), p < 0.001. For both non-augmented and augmented specimens failure load in the centre position was significantly higher compared with the respective off-centre positions, regardless of the head element type, p < 0.001. Augmented off-centre TFNA head elements had significantly higher failure load compared with non-augmented centrally placed implants, p < 0.001. Conclusions: Cement augmentation clearly enhances the fixation stability of TFNA blades and screws. Non-augmented blades outperformed screws in the anteroposterior off-centre position. Positioning of TFNA blades in the femoral head is more forgiving than TFNA screws in terms of failure load.
The pancreas is a soft lobulated gland situated transversely across the upper part of the posterior abdominal wall. Its parts include the head, neck, body and tail. Annular pancreas is a rare condition where the head of the pancreas surrounds the second part of the duodenum like a ring.
The rate of organ donations from deceased donors in Malaysia is among the lowest in the world. This may be because of the passivity among health professionals in approaching families of potential donors. A questionnaire-based study was conducted amongst health professionals in two tertiary hospitals in Kuala Lumpur, Malaysia. Four hundred and sixty-two questionnaires were completed. 93.3% of health professionals acknowledged a need for organ transplantation in Malaysia. 47.8% were willing to donate their organs (with ethnic and religious differences). Factors which may be influencing the shortage of organs from deceased donors include: nonrecognition of brainstem death (38.5%), no knowledge on how to contact the Organ Transplant Coordinator (82.3%), and never approaching families of a potential donor (63.9%). There was a general attitude of passivity in approaching families of potential donors and activating transplant teams among many of the health professionals. A misunderstanding of brainstem death and its definition hinder identification of a potential donor. Continuing medical education and highlighting the role of the Organ Transplant Coordinator, as well as increasing awareness of the public through religion and the media were identified as essential in improving the rate of organ donations from deceased donors in Malaysia.
Human pluripotent stem cells (hPSCs) derived from either blastocyst stage embryos (hESCs) or reprogrammed somatic cells (iPSCs) can provide an abundant source of human neuronal lineages that were previously sourced from human cadavers, abortuses, and discarded surgical waste. In addition to the well-known potential therapeutic application of these cells in regenerative medicine, these are also various promising nontherapeutic applications in toxicological and pharmacological screening of neuroactive compounds, as well as for in vitro modeling of neurodegenerative and neurodevelopmental disorders. Compared to alternative research models based on laboratory animals and immortalized cancer-derived human neural cell lines, neuronal cells differentiated from hPSCs possess the advantages of species specificity together with genetic and physiological normality, which could more closely recapitulate in vivo conditions within the human central nervous system. This review critically examines the various potential nontherapeutic applications of hPSC-derived neuronal lineages and gives a brief overview of differentiation protocols utilized to generate these cells from hESCs and iPSCs.
The stages of decomposition and the faunal succession on rabbit carcasses in three different habitats, namely jungle, rural, and highland areas, were studied. Three New Zealand White rabbit (Oryctolagus cuniculus) carcasses weighing ∼2 kg were sampled daily until the decomposition process was completed. Representative specimens of adult flies, larvae, pupa, and mites were collected from the carcasses and processed in the laboratory. There were differences in decomposition rate and faunal succession between the carcasses. The fastest rate of decomposition was recorded in rural area, and the slowest rate of decomposition was recorded in highland area. The carcasses exhibited the same pattern of colonization by adult flies, but the dominant species of larvae and adult flies on each carcass in specific habitats were different. The primary species of flies recorded in jungle were Chrysomya megacephala F., Chrysomya rufifacies (Macquart), Chrysomya chani Kurahashi, Chrysomya villenuevi Patton, Chrysomya nigripes Aubertin, Chrysomya pinguis (Walker), Hemipyrellia ligurriens (Wiedemann), Hemipyrellia tagaliana (Bigot), Hypopyiopsis fumipennis (Walker), Hypopygiopsis violacea (Macquart), and Hydrotaea spinigera Stein represented by both adults and larvae. Musca domestica L., Atherigona sp., Lioproctia pattoni (Senior-White), Lioproctia saprianovae Pape & Bänziger, and Seniorwhitea princeps (Wiedemann) were represented by adults only. The biodiversity of flies in the rural area were C. megacephala, C. rufifacies, H. ligurriens, Fannia canicularis L., Hydrotaea chalcogaster (Wiedemann), and Hyd. spinigera represented by both adults and larvae, meanwhile M. domestica, Atherigona sp., Boettcherisca peregrina (Robineau-Desvoidy), Parasarcophaga taenionota Wiedemann, Parasarcophaga scopariiformis Senior-White, and S. princeps were represented by adults only. The species of flies collected in the highland area were Lucilia porphyrina (Walker), C. megacephala, C. rufifacies, C. villenuevi, C. pinguis, H. ligurriens, Hyd. spinigera, Hyd. chalcogaster, F. canicularis, and Boettcherisca highlandica Kurahashi & Tan represented by both adults and larvae, whereas C. nigripes, Chrysomya thanomthini Kurahashi & Tumrasvin, M. domestica, Atherigona sp., Parasarcophaga albiceps Meigen, P. taenionota, Sepsidae, Phoridae, and Millichidae were represented by adults only. Faunal succession followed the sequence of dominant flies, i.e., Calliphoridae, Sarcophagidae, Muscidae, Sepsidae, and lastly Stratiomyidae for jungle, or Sepsidae for rural and highland studies. Mites, from suborders Mesostigmata, Prostigmata, Astigmatina, and Oribatida, were also recovered throughout decomposition, which could be used for future implementation in forensic investigations. The data obtained from this study could provide more accurate indicators for local forensic scientists in solving criminal cases especially on the determination of time and primary location of death.
INTRODUCTION: Psychoda sp. is often collected from patchy habitats such as sewers, drains and decomposing organic matters. The discovery of Psychoda sp. in forensic studies indicated that it might have noteworthy value in assisting death investigations.
PURPOSE: This study reports on the first finding of Psychoda larvae collected from decomposing rabbit carcasses placed in Cameron Highlands, Pahang, Malaysia.
METHODS: The larvae were first observed on rabbit carcasses and were collected using tweezers and carefully preserved in 70% ethanol. They were subsequently mounted on microscopy slides using Hoyer's medium and identified as Psychoda sp. morphologically. The identification was also confirmed through a DNA barcoding analysis.
RESULTS: Psychoda sp. larvae were collected on day-10 post-mortem where the rabbit carcasses were at the advanced decay stage of decomposition. The cytochrome c oxidase I (COI) gene sequences of the larvae had 90% similarity with the Psychoda spp. in the database.
CONCLUSION: The finding of these larvae on carrion may provide additional valuable insights into forensic entomology and may assist in death investigations.
This study was designed to mimic homicide or suicide cases using gasoline. Six adult long-tailed macaque (Macaca fascicularis), weighing between 2.5 to 4.0 kg, were equally divided into control and test groups. The control group was sacrificed by a lethal dose of phenobarbital intracardiac while test group was force fed with two doses of gasoline LD50 (37.7 ml/kg) after sedation with phenobarbital. All carcasses were then placed in a decomposition site to observe the decomposition and invasion process of cadaveric fauna on the carcasses. A total of five decomposition stages were recognized during this study. This study was performed during July 2007. Fresh stage of control and test carcasses occurred between 0 to 15 and 0 to 39 hours of exposure, respectively. The subsequent decomposition stages also exhibited the similar pattern whereby the decomposition process of control carcasses were faster than tested one. The first larvae were found on control carcasses after 9 hours of death while the test group carcasses had only their first blowfly eggs after 15 hours of exposure. Blow flies, Achoetandrus rufifacies and Chrysomya megacephala were the most dominant invader of both carcasses throughout the decaying process. Diptera collected from control carcasses comprised of scuttle fly, Megaselia scalaris and flesh fly, sarcophagid. We concluded that the presence of gasoline and its odor on the carcass had delayed the arrival of insect to the carcasses, thereby slowing down the decomposition process in the carcass by 6 hours.
This is the first record of phoretic histiostomatid mites found on a forensically important blow fly species, Chrysomya villeneuvi (Diptera: Calliphoridae), collected from decomposing rabbit carcasses placed in Bukit Lagong Forest Reserve, Sungai Buloh and MARDI Cameron Highlands, Malaysia. The blow flies frequenting around the carcasses were first captured using an insect net. After pinning, they were examined under a stereomicroscope and mites phoretic on their body were carefully removed and preserved in 70% ethanol. Mites were cleared in lactic acid before mounting on slides using Hoyer's medium and identified under a compound microscope. The flies and their mites were identified as C. villeneuvi and deutonymphs of Histiostoma spp. (Astigmata: Histiostomatidae), respectively. This insectmite association may be useful to provide insights regarding the minimum post-mortem interval and the location of death in forensic entomological investigations.
The immature stages of necrophagous insects such as Diptera and Coleoptera play a vital ecological role in carrion decomposition. These invertebrates reduce the necromass significantly through consumption and recycle nutrients into organic forms which are readily being used by autotrophs or served as an abiotic storage in the soil ecosystem. Fly and beetle larvae are frequently encountered decomposers on ephemeral resource patches; however, lepidopterans associated with carrion decomposition is seldom reported. Here, we report colonization of Monopis sp. (Tineidae) and an unknown species of Psychidae on a rat carcass, and a Lithosiini caterpillar (Arctiidae) on a rabbit carcass in Peninsular Malaysia for the first time. The feeding behaviour and their potential forensic implications are discussed.
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.
A partially skeletonized human corpse was found in bushes in Selangor, Malaysia in June 2020. Entomological evidence was collected during the autopsy and sent to the Department of Medical Microbiology and Parasitology, Faculty of Medicine, Universiti Teknologi MARA (UiTM) for minimum postmortem interval (PMImin) analysis. Standard protocols were applied when processing preserved and live insect specimens of both larval and pupal stages. Entomological evidence revealed that the corpse was colonized by Chrysomya nigripes Aubertin, 1932 (Diptera: Calliphoridae) and Diamesus osculans (Vigors, 1825) (Coleoptera: Silphidae). Chrysomya nigripes was chosen as the PMImin indicator as this fly species is an earlier colonizer compared to D. osculans beetle larvae which their presence is the indicative of late stage of decomposition. For the present case, the pupae of C. nigripes were the oldest insect evidence collected and based on the available developmental data, the estimated minimum PMI was established between 9 and 12 days. It is noteworthy to highlight that this is the first record of D. osculans colonization on a human corpse.
Considering that crimes against animals such as illegal killing and cruelty have been alarmingly increasing and since burning is one of the common ways for disposing cadavers, ability to estimate minimum postmortem interval (PMI) using entomological data merits consideration. Chrysomya megacephala and Chrysomya rufifacies are common necrophagous species recovered from cadavers in many countries including Malaysia. Specific studies focusing on the oviposition and developmental patterns of both species on cadavers manifesting different levels of burn as described by the Crow-Glassman Scale (CGS) remain scarce. In four replicates, rabbit carcasses were burned to CGS levels #1, #2 and #3 by varying the amount of petrol used and duration of burning. Oviposition by C. megacephala and C. rufifacies was delayed by one day in the case of carcasses burned to the CGS level #3 (p<0.05) when compared with that of controls. Such delay in oviposition was not observed in the CGS level #1 and #2 carcasses. No significant differences (p>0.05) in the duration of development were found between control and burned carcasses. These findings deserve consideration while estimating minimum PMI since burning as a mean for disposing animal and human cadavers is gaining popularity.
Forensic entomological specimens received by the Unit of Medical Entomology, IMR., from hospitals and the police in Malaysia in the last 3 decades (1972 - 2002) are reviewed. A total of 448 specimens were received. From these, 538 identifications were made with the following results: Eighteen species of cyclorrphaga flies were identified consisting of Chrysomya megacephala (Fabricius) 215 cases (47.99%), Ch. rufifacies (Masquart) 132 (29.46%), Ch. villeneuvi Patton 10 (2.23%), Ch. nigripes Aubertin 7 (1.56%), Ch. bezziana Villeneuve 4 (0.89%), Ch. pinguis (Walker) 1 (0.22%), Chrysomya sp. 47 (10.49%), Sarcophaga sp. 28 (6.25%), Lucilia sp. 21 (4.69%), Hermetia sp. 15 (3.35%), He. illucens (Linnaeus) 1 (0.22%), Hemipyrellia ligurriens (Wiedemann) 3 (0.67%), Hemipyrellia sp. 2 (0.45%), Ophyra spinigera 1 (0.22%), Ophyra sp. 6 (1.34%), Calliphora sp. 24 (5.36%), Synthesiomyia nudiseta (Wulp) 1 (0.22%) and Eristalis sp. 1 (0.22%). Other non - fly insect specimens are Pthirus pubis (Linnaeus) (Pubic louse) 2 (0.45%) and Coleoptera (Beetles) 1 (0.22%). Ch. megacephala and Ch. rufifacies were the commonest species found in cadavers from different ecological habitats. Sy. nudiseta is an uncommon species, thus far found only on cadavers from indoors. Sy. nudiseta is reported for the second time in Peninsular Malaysia. A total of 329 cases (73.44%) had a single fly infestation, 109 cases (24.33%) had double fly infestation and 10 cases (2.23%) had triple fly infestation. Five cases (1.12%) had eggs and 3 cases (0.67%) had larval stages that were not identifiable. No arthropods were retrieved from cadavers in 8 cases (1.79%). In conclusion, although large number of fly species were found on human cadavers, the predominant species are still those of Chrysomya.
Variations in the origin of axillary artery branches are common. But, distinctly abnormal course of its posterior circumflex humeral branch is rare. We are reporting a case of posterior circumflex humeral artery (PCHA) originating from the axillary artery, passing through lower triangular space to reach the scapular region where it accompanied the axillary nerve and posterior circumflex humeral vein to pass around surgical neck of humerus, deep to the fibers of deltoid. Other variations observed in this specimen were the radial collateral artery arising from the PCHA, middle collateral artery arising directly from the brachial artery and absence of profunda brachii artery. PCHA forming a hair pin loop, traversing through lower triangular space instead of quadrangular space taking a long course is being reported for the first time. Further, the clinical and surgical importance of this case especially in relation with quadrangular space syndrome and relevant literature is discussed.
This study was carried out in an oil palm plantation in Tanjung Sepat, Selangor in September 2007 by using pigs (Sus scrofa L.) as a carcass model in a forensic entomological research. A 2.5 month old pig (10 kg) which died naturally was hanged on a palm tree to observe the insect succession and decomposition stages. Observation was made for 16 days; one afternoon visit per day and all climatological data were recorded. On the first day, adult muscids of Ophyra spinigera Stein and Musca domestica L. were observed, however no blowfly (Calliphoridae) activities were sighted. Fly eggs wer seen on the second day on both sides of the face, inside nostrils and genitourinary area. Adults of Chrysomya megacephala Fabricius and Chrysomya rufifacies (Macquart) congregated on the head and anal areas. Adult flies and maggots (first and second instars) were observed in the mouth and anus of the pig on the third day of hanging. Adult yellow jackets (Vespidae) and spiders (Arachnida) were found preying on some adult flies. Rove beetles (Staphilinidae) were also discovered on the pig carcass. Only a few ants (Formicidae) were sighted. Maggot masses were found in eye orbits, neck, and genital organs on the fourth day of hanging and some maggots were seen falling down to the ground. The dominant maggot species identified on this day was Ch. megacephala. On the sixth day, the head, neck, and anus were in the stage of active decay. Maggots of Ch. rufifacies were abundant on the seventh day and was the dominant species. On day eight the carcass fell onto the ground. Chrysomya rufifacies maggots were found underneath the pig carcass and they started to migrate and pupated under the soil. On the tenth day, third instar Op. spinigera maggots were found under the carcass. The rate of carcass decomposition slowed down and became stable from tenth day onwards to the sixteenth day of decomposition. Thereafter, most of the remaining parts of the body remained dried and devoid of any insects.