The Importance of BHB Testing on the Post-Mortem Diagnosis of Ketoacidosis

Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed. Therefore, this study aims at evaluating the effects of BHB analysis on the number of deaths by DKA (diabetes ketoacidosis), AKA (alcoholic ketoacidosis), HHS (hyperosmolar hyperglycaemic state), hypothermia, diabetes, alcoholism, and acidosis NOS (not otherwise specified). All 2900 deaths from 2013 through 2019 in which BHB was analysed at the National Board of Forensic Medicine, and 1069 DKA, AKA, HHS, hypothermia, diabetes, alcoholism, and acidosis cases without BHB analysis were included. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. The number of BHB analyses/year increased from 13 to 1417. AKA increased from three to 66 and acidosis from one to 20. The deaths from alcoholism, DKA, and hypothermia remained stable. It is unclear why death from alcoholism remained stable while AKA increased. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change.

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Homicide with post mortem dismemberment of the victim with previous amputation of right lower limb: Case report and review of the literature

Medico-Legal Journal ◽

10.1177/0025817218775575 ◽

2018 ◽

Vol 86 (4) ◽

pp. 213-215 ◽

Cited By ~ 2

Author(s):

S Zerbo ◽

A Lanzarone ◽

P Procaccianti ◽

E Ventura Spagnolo ◽

A Argo

Keyword(s):

Case Report ◽

Cause Of Death ◽

Forensic Medicine ◽

Lower Limb ◽

Brain Injuries ◽

Cranial Vault ◽

Post Mortem ◽

Review Of The Literature ◽

Blunt Force ◽

Different Types

The dismemberment of a corpse is comparatively rare in forensic medicine and usually performed with different types of sharp tools. The victim is always the victim of a homicide. Dismemberment usually occurs where the killing took place without prior planning by the perpetrator. We report a case of homicide with post mortem mutilation of the victim’s body with previous amputation of right lower limb in which the perpetrator was not identified. At autopsy, several fractures were detected on the cranial vault, and the cause of death was due to skull and brain injuries from multiple blunt force traumas.

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First utilization of BioFire FilmArray® Respiratory Panel 2 Plus in post-mortem diagnosis of Influenza A H1N1

Microbiologia Medica ◽

10.4081/mm.2019.8311 ◽

2019 ◽

Vol 34 (2) ◽

Author(s):

Francesco D'Aleo ◽

Valentina Gatto ◽

Mattia Chisari ◽

Daniela Marcuccio ◽

Maria Cuzzola ◽

...

Keyword(s):

Case Report ◽

Cause Of Death ◽

Forensic Pathology ◽

Influenza A ◽

Legal Medicine ◽

Post Mortem ◽

Influenza A H1n1 ◽

Microbiological Testing

Post-mortem microbiology is an important tool in legal medicine and forensic pathology; this case report shows the importance of microbiological testing to establish the cause of death in infection suspected death. We refer a case of fatal Influenza A (H1N1) diagnosed only after dead with post-mortem microbiology tool.

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Post-mortem Peyer’s patches: Their potential application in forensic medicine

Immunopharmacology and Immunotoxicology ◽

10.1080/08923970902902437 ◽

2009 ◽

Vol 00 (00) ◽

pp. 090513010017019-7

Author(s):

Biagio Solarino ◽

Giancarlo Di Vella ◽

Thea Magrone ◽

Felicita Jirillo ◽

Angela Tafaro ◽

...

Keyword(s):

Forensic Medicine ◽

Potential Application ◽

Peyer's Patches ◽

Peyer’S Patches ◽

Post Mortem

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Molecular clocks in ancient proteins: Do they reflect the age at death even after millennia?

International Journal of Legal Medicine ◽

10.1007/s00414-021-02522-1 ◽

2021 ◽

Author(s):

Nina Sophia Mahlke ◽

Silvia Renhart ◽

Dorothea Talaa ◽

Alexandra Reckert ◽

Stefanie Ritz-Timme

Keyword(s):

Protein Degradation ◽

Forensic Medicine ◽

Molecular Clocks ◽

Post Mortem ◽

Age At Death ◽

Morphological Examination ◽

Dental Tissues ◽

Ancient Proteins ◽

Age Estimates ◽

Age At Death Estimation

AbstractAge at death estimation in cases of human skeletal finds is an important task in forensic medicine as well as in anthropology. In forensic medicine, methods based on “molecular clocks” in dental tissues and bone play an increasing role. The question, whether these methods are applicable also in cases with post-depositional intervals far beyond the forensically relevant period, was investigated for two “protein clocks”, the accumulation of D-aspartic acid (D-Asp) and the accumulation of pentosidine (Pen) in dentine. Eight teeth of skeletons from different burial sites in Austria and with post-depositional intervals between c. 1216 and c. 8775 years were analysed. The results of age at death estimation based on D-Asp and Pen in dentine were compared to that derived from a classical morphological examination. Age at death estimation based on D-Asp resulted consistently in false high values. This finding can be explained by a post-mortem accumulation of D-Asp that may be enhanced by protein degradation. In contrast, the Pen-based age estimates fitted well with the morphological age diagnoses. The described effect of post-mortem protein degradation is negligible in forensically relevant time horizons, but not for post-depositional intervals of thousands of years. That means that the “D-Asp clock” loses its functionality with increasing post-depositional intervals, whereas Pen seems to be very stable. The “Pen-clock” may have the potential to become an interesting supplement to the existing repertoire of methods even in cases with extremely long post-depositional intervals. Further investigations have to test this hypothesis.

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Consultation between forensic and clinical pathologists for histopathology examination after forensic autopsy

Medicine Science and the Law ◽

10.1177/0025802420965763 ◽

2021 ◽

Vol 61 (1_suppl) ◽

pp. 25-35

Author(s):

Vito Cirielli ◽

Federica Bortolotti ◽

Luca Cima ◽

Zeno De Battisti ◽

Giovanna Del Balzo ◽

...

Keyword(s):

Bone Marrow ◽

Cause Of Death ◽

Molecular Analysis ◽

Real World ◽

Routine Practice ◽

Working Relationships ◽

Post Mortem ◽

Macroscopic Findings ◽

Diagnostic Benefit ◽

Histopathology Examination

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.

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Mors Gaudet Succurrere Vitae. The Role of Clinical Autopsy in Preventing Litigation Related to the Management of Liver and Digestive Disorders

Diagnostics ◽

10.3390/diagnostics11081436 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1436

Author(s):

Stefano D’Errico ◽

Martina Zanon ◽

Michela Peruch ◽

Monica Concato ◽

Martina Padovano ◽

...

Keyword(s):

Risk Management ◽

Clinical Diagnosis ◽

Cause Of Death ◽

Clinical Performance ◽

Improve Patient Safety ◽

Methodological Approach ◽

Post Mortem ◽

Accurate Analysis ◽

Hepatic Diseases

Over the last 50 years, the number of clinical autopsies has decreased, but their role in assessing cause of death and clinical performance is still acknowledged. Few publications have studied their role in malpractice claim prevention. The paper aims to highlight the role of clinical autopsy in preventing errors and improve healthcare quality. A retrospective study was conducted on 28 clinical autopsies performed between 2015 and 2021 on patients dead unexpectedly after procedures for the diagnosis and treatment of digestive and hepatic diseases. After an accurate analysis of medical records and consultation with healthcare professionals, all cases were subjected to autopsy and histopathology. The data obtained were analyzed and shared with the risk-management team to identify pitfalls and preventive strategies. Post-mortem evaluations confirmed the clinical diagnosis only in six cases (21.4%). Discordances were observed in 10 cases (35.7%). In the remaining 12 cases (42.9%) the clinical diagnosis was labeled as “unknown” and post-mortem examinations made it possible to document the cause of death. Post-mortem examinations can concretely enrich hospital prevention systems and improve patient safety. The methodological approach outlined certainly demonstrates that, even in the risk-management field, “mors gaudet succurrere vitae” (“death delights in helping life”).

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Intra-individual alterations of serum markers routinely used in forensic pathology depending on increasing post-mortem interval

Scientific Reports ◽

10.1038/s41598-018-31252-5 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 8

Author(s):

Lina Woydt ◽

Michael Bernhard ◽

Holger Kirsten ◽

Ralph Burkhardt ◽

Niels Hammer ◽

...

Keyword(s):

Forensic Pathology ◽

Serum Markers ◽

Post Mortem ◽

Post Mortem Interval

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Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

International Journal of Legal Medicine ◽

10.1007/s00414-019-02219-6 ◽

2019 ◽

Vol 134 (4) ◽

pp. 1457-1463

Author(s):

M. E. M. Vester ◽

R. R. van Rijn ◽

W. L. J. M. Duijst ◽

L. F. M. Beenen ◽

M. Clerkx ◽

...

Keyword(s):

Computed Tomography ◽

Cause Of Death ◽

Medical Records ◽

Clinical Findings ◽

Added Value ◽

Post Mortem ◽

Additional Information ◽

Organ Failures ◽

Total Body ◽

Underlying Diseases

Abstract Purpose The aim of this study was to investigate whether post-mortem computed tomography (PMCT) provides additional information regarding the cause of death and underlying diseases in a general practitioners’ (GP), out-of-hospital population. Methods and materials Bodies donated to our anatomy department between January 2014 and January 2018, who consecutively underwent a total body PMCT and had given permission for retrieval of their medical records during life, were included. PMCT scans were assessed by a radiologist and compared with the cause of death as stated in the medical records. Discrepancies were analyzed with an adjusted Goldman classification. Results Ninety-three out of the 274 scanned donors during the inclusion period had given consent for the retrieval of their medical records, of which 79 GP’s responded to the request thereof (31 men, 48 women, average age 72.8 years, range 36–99). PMCT identified 49 (62%) cases of cancer, 10 (12.7%) cardiovascular diseases, 8 (10.1%) severe organ failures, 5 (6.3%) cases with signs of pneumonia, 2 (2.5%) other causes, and 7 (8.9%) cases without an (underlying) definitive cause of death. Eleven major discrepancies on the Goldman classification scale, with possible relevance to survival between PMCT and GP records, were identified. Conclusion PMCT can have added value for the detection of additional findings regarding the cause of death in an out-of-hospital, GP’s population, especially to identify or exclude major (previously non-diagnosed) underlying diseases.

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