Kerokan is a traditional Indonesian treatment involving abrading the skin over various parts of the body with a blunt object such as a coin or a piece of ginger which may create suspicious injuries. Here, the case of a 30-year-old woman who had undergone kerokan therapy is reported. She was complaining of retro-sternal pain and epigastric discomfort and subsequently became markedly short of breath and died. The observation of injuries predominantly located around the neck initiated a police investigation and forensic autopsy. Scattered abrasions, blisters and bruises were present on the forehead, the bridge of the nose extending to the ala, the upper and anterior aspect of the chin and the sternal notch, with discrete fresh and scabbed abrasions around the neck, over the sternum and on the backs of both hands. There were, however, no facial or conjunctival petechiae and no bruising of the underlying strap muscles, or fractures of the hyoid bone or thyroid cartilage. Histology revealed that myocarditis was the cause of death. Traditional practices may cause unusual bruises, abrasions, blisters and burns that may raise suspicion of inflicted injury from an assault. Knowledge of the manifestations of socio-ethnic practices such as kerokan is important in the evaluation of trauma in specific cultural groups.
The prevalence of ischaemic heart disease with associated cardiomegaly and other chronic diseases such as diabetes mellitus has increased in Malaysia in recent years. As the contribution to mortality from ischaemic heart disease/cardiomegaly in different ethnic populations is unclear, a three year (January 2013-December 2015) retrospective study of autopsy cases was undertaken at the Department of Forensic Pathology, University Malaya Medical Centre. There were 80 cases with lethal ischaemic heart diseases/cardiomegaly. The age range was 30-69 years (mean 50.19 years) with a male to female ratio of 39:01. The most vulnerable age was 50-59 years accounting for 38.75% of cases. Malays accounted for 15% of cases, Indians for 32.5% and Chinese for 36.25%. Although in 35 cases (43.75%) there was a history suggestive of ischaemic heart disease, the remaining 45 cases (56.25%) were apparently healthy until the terminal collapse. It appears that Indian males in the 50-59 year age range are most at risk for lethal cardiac events in this population, most often with no preceding symptoms or signs. The study demonstrates the value of studying subpopulations for disease risk rather than relying on accrued general population data.