Estimation of age from microscopic examination of human bone utilizes bone remodeling. This allows 2 regression equation to be determined in a specific population based on the variation in osteon turnover in different populations. The aim of this study was to provide age estimation for Malaysian males. Ground undecalcified cross sections were prepared from long limb bones of 50 deceased males aged between 21 and 78 years. Ten microstructural parameters were measured and subjected to multivariate regression analysis. Results showed that osteon count had the highest correlation with age (R = 0.43), and age was estimated to be within 10.94 years of the true value in 98% of males. Cross validation of the equation on 50 individuals showed close correspondence of true ages with estimated ages. Further studies are needed to validate and expand these results.
In 1994, the Government of India enacted the Transplantation of Human Organs Act (THOA) to prevent commercial dealings in human organs. However, a greater number of scandals involving medical practitioners and others in the kidney trade has surfaced periodically in every state in India. The present regulatory system has failed mainly due to the misuse of Section 9(3) of the THOA, which approves the consent given by a live unrelated donor for the removal of organs for the reason of affection or attachment towards the recipient or for any other special reason. Currently in India, approximately 3500-4000 kidney transplants and 150-200 liver transplants are performed annually. However, the availability of organs from brain-dead persons is very low. As a result, live related or unrelated donors form the main source of organ transplantation. Therefore, physicians and policy-makers should re-examine the value of introducing regulated incentive-based organ donation to increase the supply of organs for transplantation and to end unlawful financial transaction.
Lightning is a powerful natural electrostatic discharge produced during a thunderstorm. The electric current passing through the discharge channels is direct with a potential of 1000 million volts or more. Lightning can kill or injure a person by a direct strike, a side-flash, or conduction through another object. Lightning can cause a variety of injuries in the skin and the cardiovascular, neurological and ophthalmic systems. Filigree burn of lightning is a superficial burn and very rare. Two cases of death from lightning which have this rare finding are reported and discussed.
The main aim of this study was to determine the causes and epidemiological aspects of paediatric death. Data was collected on 143 cases of paediatric death from a total of 2,895 autopsies performed in University Malaya Medical Centre (UMMC), Kuala Lumpur, over a five-year period from 2000 to 2004. There were 78 males and 65 females. The largest number of cases (32.9%) were stillborn. The highest proportion of cases (30.1%) were Chinese. The majority of cases of paediatric death were non-traumatic (74.8%) of which intrauterine death (IUD) was the most common (32.9%). Amongst the traumatic deaths (25.2%), accidental injury (23.8%) was observed in the majority of cases.
Susuk, or charm needles, are small, metallic needles inserted under the skin, considered to enhance beauty, health and luck. This hidden secret of inserting susuk is a traditional superstitious ritual, widely practiced among women of Southeast Asia. Here, we present an interesting case of incidental radiographic finding of the concealed art of susuk, which was exposed on a panoramic radiograph taken on a routine basis as a part of diagnostic work up at our centre. An orthopantomogram revealed bilateral metallic foreign bodies in the maxillo-facial region. Anamnestic data affirmed the practice of the body art of susuk. The charm needles were present in the orofacial region without the patient experiencing any pathological signs or symptoms.
An 18-year-old construction worker suddenly collapsed while handling a power-actuated nail gun and died shortly after. A neat, almost circular puncture wound was found on the front of his left chest. No fire-arm residues were detected on the surrounding skin. The police stated that it was an accidental injury, at a construction site, where a nail fired from a nail gun by the deceased had deflected off the wall and struck him on the front of the chest. Since the entry wound appeared to be a neat hole, and that too on the front of the left chest overlying the heart area, there was reluctance on the part of the pathologist to accept it as an accidental injury due to a ricochet. A visit to the scene, interrogation of witnesses, examination of the alleged tool and post-mortem X-ray of the deceased were undertaken prior to autopsy. A bent nail was found in the heart. The scene visit and the subsequent autopsy revealed that the nail took a roughly circular flightpath after it had struck the wall, all the while travelling with its pointed end directed forward. Within the body too, the nail maintained the same path. Various medicolegal issues are discussed pertaining to nail-gun injuries. The importance of a visit to the scene, examination of the alleged tool, interrogation of witnesses and the X-ray of the body, all prior to autopsy, are emphasized. The conclusion was: accidental death due to the unusual ricochet of a nail.
Deaths due to plastic bag suffocation or plastic bag asphyxia are not reported in Malaysia. In the West many suicides by plastic bag asphyxia, particularly in the elderly and those who are chronically and terminally ill, have been reported. Accidental deaths too are not uncommon in the West, both among small children who play with shopping bags and adolescents who are solvent abusers. Another well-known but not so common form of accidental death from plastic bag asphyxia is sexual asphyxia, which is mostly seen among adult males. Homicide by plastic bag asphyxia too is reported in the West and the victims are invariably infants or adults who are frail or terminally ill and who cannot struggle. Two deaths due to plastic bag asphyxia are presented. Both the autopsies were performed at the University Hospital Mortuary, Kuala Lumpur. Both victims were 50-year old married Chinese males. One death was diagnosed as suicide and the other as sexual asphyxia. Sexual asphyxia is generally believed to be a problem associated exclusively with the West. Specific autopsy findings are often absent in deaths due to plastic bag asphyxia and therefore such deaths could be missed when some interested parties have altered the scene and most importantly have removed the plastic bag. A visit to the scene of death is invariably useful.
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 magnitude of the diagnostic benefit conferred by performing histopathological examinations after medico-legal/forensic autopsies remains debatable. We have tried to address this issue by reviewing a series of histopathology referrals concerning medico-legal autopsies in real-world routine practice. We present an audit of the consultations provided to forensics by clinical pathologists at our institute between 2015 and 2018. Over this period, 493 post-mortem examinations were performed by forensic pathologists. Of these cases, 52 (11%) were referred for histopathology. Gross assessment was requested in 22/52 (42%) cases. Histopathology examination was performed on single organs in 15/52 (29%) cases, primarily on the lung and heart, whereas parenchymatous multi-organ analysis was carried out in 14/52 (27%) cases. Bone-marrow sampling was studied in 4/52 (8%) cases. Immunohistochemistry was needed in 16/52 (31%) cases, special stains in 9/52 (21%) cases and molecular analysis in 4/52 (8%) cases. Focusing on technical processes, standard methodology on pre-analytical procedures was changed in 10/52 (19%) cases in order to answer specific diagnostic questions. We showed that although most of the time the diagnosis is clear by the end of dissection on the basis of the macroscopic findings, histopathology can provide, modify or confirm the cause of death in many medico-legal/forensic cases. Therefore, it is desirable that forensic pathologists and clinical pathologists establish robust working relationships in a cooperative environment. We conclude that it is important to implement guidelines based on real-world routine practice in order to identify cases where histopathology can provide useful contributions, which in our experience applied to 11% of forensic cases.