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  1. Rahimi R, Omar E, Md Noor S
    Malays J Pathol, 2015 Apr;37(1):57-61.
    PMID: 25890616 MyJurnal
    Charred human remains were found in the smoking ambers of a dying fire in an oil palm plantation in Selangor, Malaysia in the midnight of January 28, 2013. Investigations showed that palm fronds and rubber tires were used to light and sustain the blaze. At least four to five tires were estimated to be used based on the residual burnt metal wires at the site. The remains were brought to the Department of Forensic Medicine, Hospital Sungai Buloh, Selangor for post-mortem examination. Pre-autopsy imaging showed a fractured skull with presence of a bullet in the head. The body belonged to a male with unrecognizable facial features, pugilistic attitude, and reduced body size caused by fire damage with sparing of the posterior surface. A large fracture was present at the skull vault. An entry gunshot wound was observed on the left side of the body of mandible, which was associated with base of skull fracture. Heat-related fractures were also noted on the right side of the frontal bone. A projectile was retrieved from the right side of the occipital lobe. Further examination showed presence of soot and hyperaemic larynx, trachea, main bronchi, and oesophagus. Black spots measuring 1 to 2 mm were present on the surface and parenchyma of the heart, liver, pancreas and kidneys. Histopathology examination showed black particles within the vessels in the affected organs. We report this rare finding in a charred body and present a discussion based on published literature on this issue.
  2. 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.
  3. Ivorra T, Khorri SM, Rahimi R, Hoe CC
    Trop Biomed, 2023 Mar 01;40(1):1-6.
    PMID: 37355997 DOI: 10.47665/tb.40.1.003
    The estimation of the postmortem interval (PMI) is an essential information in death investigations. It is necessary to know the developmental data of the most important necrophagous insect species in every geographical area. Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae) is one of the most common species associated with human body decomposition, especially in the tropics, so a precise knowledge of its life cycle is crucial. However, despite its ubiquity, developmental data in a range of tropical temperatures is scarce. For this reason, the aim of this study is to provide the developmental data of the blowfly, C. megacephala, in a range of tropical temperatures and to apply these data in forensic entomology. Four temperatures were examined (i.e., 27.0°C 29.5°C, 32.0°C and 34.5°C) and the time of developments from egg to adult were recorded. To build the growth curves, five larvae per day were measured with a digital caliper. Accumulated degree-days were calculated and the isomorphen diagram for this species was plotted. As we predicted, the results showed that the life cycle of this species was affected by the increasing temperature. The implications of these new data for determining the minimum PMI in forensic entomology were discussed.
  4. Rahimi R, Omar E, Tuan Soh TS, Mohd Nawi SFA, Md Noor S
    Malays J Pathol, 2018 Aug;40(2):169-173.
    PMID: 30173235 MyJurnal
    INTRODUCTION: Leptospirosis is a zoonotic disease caused by spirochaete of the genus Leptospira. Human infection occurs after exposure to water or soil contaminated by urine from an infected animal. Most patients manifest as self-limited systemic illness. However 10% of patients manifest as severe disease associated with high fatality. The disease affects mostly men, cases involving pregnant women are uncommon. We presented a case of leptospirosis in a pregnant woman leading to mortality of both mother and foetus.

    CASE REPORT: A 28-year-old woman at 18 weeks of gestation, had shortness of breath and collapsed. She was brought unconscious to the emergency department and died shortly after arrival. A week prior to this, she had presented to the same hospital with pain on both thighs. Examination of the patient and ultrasound of the foetus revealed normal findings. Post mortem examination revealed hepatosplenomegaly and congested lungs; no jaundice, meningeal inflammation or cardiac abnormalities was evident. Histopathology examination of the lungs revealed pulmonary haemorrhages and oedema. Multiple infarcts were seen in the spleen and the kidneys showed foci of acute tubular necrosis. Laboratory investigations revealed Leptospira IgM antibody and PCR for leptospira were positive. This case illustrates the subtleness of clinical presentation of leptospirosis. The diagnosis was obscure even at post-mortem and was only suspected following histopathological examination, leading to further investigations.

    CONCLUSION: Leptospirosis may have a subtle presentation and a high index of suspicion for this infection is required for early identification of the disease.

  5. Rahimi R, Dahili ND, Anuar Zainun K, Mohd Kasim NA, Md Noor S
    Malays J Pathol, 2018 Aug;40(2):143-148.
    PMID: 30173231 MyJurnal
    INTRODUCTION: Cardiac-related diseases contributed approximately 50-60% of sudden natural death cases. This study aimed to describe the cardiac troponin T (cTnT) findings in post mortem subjects irrespective of the cause and manner of death, and the possible use of post mortem serum cTnT as a modality in investigating sudden natural death.

    METHODS: The study samples comprised 140 subjects aged 18 to 50 years old, natural and unnatural causes of sudden death brought to the Department of Forensic Medicine, Hospital Sungai Buloh (HSgB) and Hospital Sultanah Aminah Johor Bahru (HSAJB) for a period of 12 months. The subjects were categorised into 5 groups: cardiovascular disease (CVD), sudden unexplained death (SUD), thoracic trauma (TT), non-thoracic trauma (NTT) and other diseases (OD).

    RESULTS: Median troponin concentration in cases of CVD, SUD, TT, NTT, and OD were 0.51 μg/L, 0.17 μg/L, 0.62 μg/L, 0.90 μg/L and 0.51 μg/L respectively. We found no significant difference of troponin T level in different causes of death (p ≥ 0.05). NTT has the highest median troponin concentration with 0.90 μg/L, SUD possessed the lowest median concentration with 0.17 μg/L.

    CONCLUSION: Troponin T is neither specific nor useful as cardiac biomarker for post mortem sample. Therefore, it may not be a useful diagnostic tool at autopsy.

  6. Rahimi R, Omar E, Tuan Soh TS, Mohd Nawi SFA, Md Noor S
    Malays J Pathol, 2017 Aug;39(2):167-170.
    PMID: 28866699 MyJurnal
    BACKGROUND: Hand, foot and mouth disease (HFMD) is caused by enteroviruses such as Coxsackie virus A16 (CVA16) and Enterovirus 71 (EV71). The diagnostic hallmarks are oral ulcers and maculo-papular or vesicular rash on the hands and feet. Severe form of this disease can lead to death due to neurological and cardiopulmonary complications. This case report aims to describe a fatal case of HFMD with minimal oral and skin manifestations.
    CASE REPORT: A four-year-old girl was brought to a hospital after suddenly becoming unresponsive at home. She had a history of fever and lethargy for three days prior to her demise. The patient, and f ive other children in her neighbourhood had been diagnosed to have HFMD at a local health clinic; the other children had recovered without complications.
    RESULTS: Autopsy revealed a few punctate, sub-epidermal vesicles measuring 1 to 2 mm on the palm of her right hand and sole of the right foot, visible only with a magnifying glass. Internal examination revealed prominent nodularity at the oro- and hypopharynxes. The lungs were markedly congested and oedematous. Histopathology of the lung showed marked oedema and haemorrhage with mild pneumonic changes. Oedema with increase in macroglia and astrocytic proliferation were seen in the cerebral tissue, but no lymphocytic infiltration was evident. Enterovirus EV71 was detected by polymerase chain reaction in samples from the lung, cerebrospinal fluid and serum. The cause of death was given as HFMD complicated by pneumonia.
    CONCLUSION: Fatal HFMD may have minimal signs. A complete history, careful physical examination and relevant investigations lead to a diagnosis at post mortem examination. Awareness of the subtle signs and rapid deterioration associated with a fatal case of HFMD is a challenge to clinicians who encounter these cases.
  7. 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.
  8. Rahimi R, Ali N, Md Noor S, Mahmood MS, Zainun KA
    Malays J Pathol, 2015 Dec;37(3):259-63.
    PMID: 26712672 MyJurnal
    Suicidal feelings and a sense of hopelessness have been regarded as part of the ageing process more so in the context of being elderly and having physical difficulties. As older adults are the fastest growing population in the world, suicides among this population is also expected to increase. The authors retrospectively reviewed all cases recorded by the National Suicide Registry Malaysia (NSRM) for the year 2009. Suicide in victims 65 years and older totaled 23 in number and accounted for 7.1% of all suicides. All the cases were autopsied. The case records were retrospectively analyzed with respect to age, gender, ethnicity and method of death. Comparisons were also made between males and females, levels of education, presence of stressor and life events antecedent to suicide. The ages of these suicide victims ranged from 65 to 94 years. Men comprised almost 70% of the cases. The average age of the victim was 73 years. Hanging was the most common method of suicide, accounting for 56.5% of the cases. Other methods included jumping from height (13.1%), exposure to unspecified chemicals (13.1% ), jumping/lying before moving object (4.3%), exposure to pesticides (4.3%) and injuring oneself using sharp object (4.3%). Death of a loved one, legal problems, financial problems and physical illness were the stressors identified contributing to the suicide act.
  9. Kaur M, Rahimi R, Razali F, Mohd Noor N, Omar E, Abdul Manaf Z, et al.
    Malays J Pathol, 2019 Aug;41(2):177-183.
    PMID: 31427553
    INTRODUCTION: Coronary artery disease (CAD) is a known cause of major cardiovascular events and calcium score (CS) has been developed as a marker of coronary atherosclerosis. Yet, the relationship between post mortem computed tomography (PMCT) CS with histologically observed calcification and the severity of coronary artery stenosis has not been widely explored and is still unclear. This study aims to determine the association between coronary artery PMCT CS with histologically observed calcification and degree of stenosis of coronary arteries in post-mortem cases.

    MATERIALS & METHODS: This was a cross-sectional study involving 101 subjects recruited from the National Institute of Forensic Medicine (IPFN) Hospital Kuala Lumpur (HKL) over a period of 15 months, from December 2012 until April 2014. PMCT CS of the coronary arteries was calculated using Agatston-Janowitz score. Histological presence of calcification was observed and the degree of stenosis was calculated using an image analysis technique.

    RESULTS: PMCT CS increased with increasing severity of stenosis (p<0.001). PMCT CS showed a positive correlation with the presence of calcification (r=-0.82, p<0.001).

    CONCLUSION: Calcium score is strongly associated with coronary artery calcification and the degree of luminal stenosis in post mortem subjects. Thus, PMCT may be useful as a non-invasive tool in diagnosing CAD in the event that an autopsy is not possible.

  10. Heo CC, Rahimi R, Mengual X, M Isa MS, Zainal S, Khofar PN, et al.
    J Forensic Sci, 2020 Jan;65(1):276-282.
    PMID: 31305956 DOI: 10.1111/1556-4029.14128
    A body of an unknown adult female was found within a shallow burial ground in Malaysia whereas the skull was exposed and visible on the ground. During autopsy examination, nine insect larvae were recovered from the interior of the human skull and subsequently preserved in 70% ethanol. The larvae were greyish in appearance, each with a posterior elongated breathing tube. A week after the autopsy, more larvae were collected at the burial site, and some of them were reared into adults. Adult specimens and larvae from the skull and from the burial site were sequenced to obtain DNA barcodes. Results showed all adult flies reared from the burial site, as well as the larvae collected from the skull were identified as Eristalinus arvorum (Fabricius, 1787) (Diptera: Syrphidae). Here, we report the colonization of E. arvorum larvae on a human corpse for the first time.
  11. Singh S, Yong SK, Rahimi R, Singh MKC, Low VL, Pittino R, et al.
    Trop Biomed, 2023 Sep 01;40(3):370-374.
    PMID: 37897172 DOI: 10.47665/tb.40.3.015
    Beetles (Coleoptera) are known to constitute forensic evidence in medico-legal investigations as their presence can be used to date human remains in almost all decomposition stages. Many forensic studies focus on the successional colonization pattern of flies (Diptera); however, beetles have not so far been studied extensively for this aspect. A beetle of the genus Afromorgus Scholtz, 1986, A. chinensis (Boheman, 1858) (Scarabaeoidea: Trogidae), was found beneath a late decaying rabbit carcass at Paya Indah Wetland, Dengkil, Malaysia, for the first time. Both genus and species are already known to occur in Malaysia from literature.
  12. Ivorra T, Rahimi R, Goh TG, Azmiera N, Nur-Aliah NA, Low VL, et al.
    Int J Legal Med, 2024 Mar;138(2):677-683.
    PMID: 37211557 DOI: 10.1007/s00414-023-03023-z
    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.
  13. Rahimi R, Singh MKC, Noor NM, Omar E, Noor SM, Mahmood MS, et al.
    J Atheroscler Thromb, 2018 May 01;25(5):405-409.
    PMID: 29118310 DOI: 10.5551/jat.39107
    AIMS: The present study aimed to determine the epidemiological aspects of medico-legal autopsies and manifestation of coronary atherosclerosis.

    METHODS: This was a cross sectional study involving 222 cases recruited from National Institute of Forensic Medicine (NIFM) Hospital Kuala Lumpur (HKL) and Department of Forensic Medicine Hospital Sungai Buloh (HSgB) for a period of 15 months, from December 2012 to April 2014. Sociodemographic and autopsy findings, including the cause and manner of death were documented.

    RESULTS: Male and female subjects aged 18-70 years were recruited. Males contributed to 86% of the total subjects and comprised 61% of young adults. Road traffic accidents were the primary cause of death, contributing almost 50% of the subjects. One third of the cases comprised of death due to natural causes, wherein almost 75% of the subjects within this category succumbed to sudden cardiac death. Coronary artery disease (CAD) contributed to 60% of the sudden cardiac death (SCD). Single and double-vessel diseases were the most common pattern of atherosclerosis. In almost 80% of CAD cases, atherosclerosis affected the left anterior descending artery (LAD).

    CONCLUSION: Cardiovascular diseases were the most significant natural cause of sudden death with a staggering figure of 75%. CAD was the single most commonly encountered pathology within the SCD. Most cases presented with single and double-vessel diseases, observed in all subjects, as well as the young adult population.

  14. Rahimi R, Mohd Kasim NA, Zainun KA, Mohamad A' Azizan NA, Mansor MA, Ahmad Kamal NS, et al.
    Malays J Pathol, 2020 Apr;42(1):65-70.
    PMID: 32342932
    INTRODUCTION: Homicide is the act of killing one human being by another, encompassing death as a result of criminal act including justifiable homicide such as judicial killing and self-defence. This study aimed to ascertain the epidemiology and patterns of injury of homicide victims.

    MATERIALS AND METHODS: We reviewed records of medico-legal autopsy cases performed at the Department of Forensic Medicine, Hospital Sungai Buloh, for a period of five years, from January 2012 until December 2016. Subjects' demographic data such as age, gender, nationality, ethnicity and cause of death were recorded.

    RESULTS: A total of 122 homicide cases were documented. 90% of the victims were 18 to 65 years old. Males contributed 80% of the subjects. An alarming 42% of the subjects comprised of non-Malaysians. Indonesian subjects contributed one-third of the non-citizen category, followed by Bangladeshis at 20.4%. Other nationalities were Burmese, Nepalese, Pakistani, Vietnamese and unspecified. Among Malaysians, 50% of the subjects were Indians, followed by Malay (31.5%) and Chinese (17.8%). Sharp and blunt force traumas were the most common injuries found, contributing 33% and 32% respectively. Asphyxiation and firearm injuries recorded an almost similar frequency, contributing 25% in combination. Other patterns included combined sharp and blunt objects (4.9%) and burns (3%).

    CONCLUSIONS: A large number of immigrants in the country have significantly increased the forensic casework. Sharp and blunt objects continue to be the weapon of choice due to its easy accessibility. As domestic violence including fatal spousal and child abuse continue to rise, in-depth study in the area is warranted.

  15. Md Noor J, Hawari R, Mokhtar MF, Yussof SJ, Chew N, Norzan NA, et al.
    Int J Emerg Med, 2020 Feb 07;13(1):6.
    PMID: 32028888 DOI: 10.1186/s12245-020-0264-5
    INTRODUCTION: Methanol poisoning usually occurs in a cluster and initial diagnosis can be challenging. Mortality is high without immediate interventions. This paper describes a methanol poisoning outbreak and difficulties in managing a large number of patients with limited resources.

    METHODOLOGY: A retrospective analysis of a methanol poisoning outbreak in September 2018 was performed, describing patients who presented to a major tertiary referral centre.

    RESULT: A total of 31 patients were received over the period of 9 days. Thirty of them were males with a mean age of 32 years old. They were mostly foreigners. From the 31 patients, 19.3% were dead on arrival, 3.2% died in the emergency department and 38.7% survived and discharged. The overall mortality rate was 61.3%. Out of the 12 patients who survived, two patients had toxic optic neuropathy, and one patient had uveitis. The rest of the survivors did not have any long-term complications. Osmolar gap and lactate had strong correlations with patient's mortality. Serum pH, bicarbonate, lactate, potassium, anion gap, osmolar gap and measured serum osmolarity between the alive and dead patients were significant. Post-mortem findings of the brain were unremarkable.

    CONCLUSION: The mortality rate was higher, and the morbidity includes permanent visual impairment and severe neurological sequelae. Language barrier, severity of illness, late presentation, unavailability of intravenous ethanol and fomipezole and delayed dialysis may have been the contributing factors. Patient was managed based on clinical presentation. Laboratory parameters showed difference in median between group that survived and succumbed for pH, serum bicarbonate, lactate, potassium and osmolar and anion gap. Management of methanol toxicity outbreak in resource-limited area will benefit from a well-designed guideline that is adaptable to the locality.

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