First Confirmed SARS-CoV-2 Related Deceased in Ethiopia on Post-mortem Examination and the Context Confronted in Limited Forensic Pathology Centre: case report.

A 55-year-old male was found dead in the church of Kefa Zone, Southern Nation and Nationality People Region, the local area of Ethiopia about 500 km away from the only available national forensic centre in Addis Ababa, Ethiopia. He had no medical history of comorbidity or medicine prescribed previously as well as no contact history with COVID-19 cases. Also, no travel history to Addis Ababa, which has an epicenter of COVID- 19 high burden cases, and no living individuals reported cases of COVID-19 patients in local residence of the deceased. The National COVID-19 emergency operating team already decided to do postmortem surveillance and collect nasopharyngeal or oropharyngeal swabs for SARS-CoV-2 on all the dead bodies submitted to the mortuary for postmortem examination. For this case and other cases on that day postmortem nasopharyngeal swabs collected and sent for RT-PCR COVID19. Test confirmed COVID-19 positive for this deceased one day after the body handed over to family and transported back to residence of the deceased. The external post-mortem examination revealed an emaciated middle-age adult male with rigor mortis on lower extremity and non- blanching livor mortis on the back of the body. There was no evidence of recent injury. On internal examination pleural adhesions were present on anterior and posterior aspect of left lung. The left lung extensively necrotized, collapsed and weighs about 280grams. Right lung was dark red in color, consolidated, weighs 450 grams, patchy petechial hemorrhages on the pleural surface. No viscera preserved for microbiology, virology, histopathology, or immunohistochemistry tests as these facilities are not available in our set up. With the pandemic impact of SARS-COV-2, a range of issues unfolds, also during autopsies, as we report the first Ethiopian case of fatal SARS-COV-2 pneumonia confirmed on post-mortem examination.

LIVOR MORTIS NA PRÁTICA MÉDICO-LEGAL

Livor mortis is perhaps the less explored cadaverous phenomenon in Legal Medicin. Well explored, lividity can bring important contributions concerning the reality of death, the diagnosis of the cause of death, the chronothanatognosis and other aspects related to the expertise of death. The livores of hypostasis require better study.

Rigor mortis and livor mortis in a living patient: A fatal case of acute total occlusion of the infrarenal abdominal aorta following renal surgery

A 63-year-old woman underwent a nephrectomy on the right side for renal cancer. Postoperatively she developed abdominal and lower back pain, which was treated with an injection of analgesics in an epidural catheter. The following morning it was discovered that the patient had cold legs with pallor and no palpable femoral pulse. Rigor mortis and livor mortis were diagnosed in both legs, even though the patient was still alive and awake. Doppler ultrasound examination revealed the absence of blood flow in the lower part of the abdominal aorta and distally. A cross disciplinary conference including specialists in urology, orthopaedics, vascular surgery, anaesthesiology, internal medicine, and intensive care concluded that no lifesaving treatment was possible, and the patient died the following day. A forensic autopsy revealed severe atherosclerosis with thrombosis and dissection of the abdominal aorta. This case clearly demonstrates that a vascular emergency should be considered when patients complain about pain in the lower back, abdomen or limbs. Clinicians should be especially aware of symptoms of tissue death that can be masked by epidural analgesia.

Pengaruh Kadar Hemoglobin Terhadap Lebam Mayat (Livor Mortis)

Abstact: Death can be identified by using advanced signs of death as follows: postmortem lividity (livor mortis), rigor mortis, decomposition, mummification, and adipocere. Postmortem lividity occurs right after clinical signs of death. Erythrocytes will accumulate to the lowest area of the body due to gravity, fill the veins and venules, and then form reddish purple spots called lividity. This study aimed to find the effect of hemoglobin level on colors indicating postmortem lividity and the time when the lividity vanishes due to pressure. This study used a cross-sectional design and was carried out at Prof. Dr. R. D. Kandou Hospital Manado from October to December 2015. In this study, pressure was given to the livor mortis of the deceased patients. Hemoglobin levels were obtained from the medical records. The results showed that there was a statistically significant effect of hemoglobin levels on the vanishing time of livor mortis (p<0.05, p=0.040), meanwhile there was no significant effect of hemoglobin levels on the colors indicating livor mortis (constant). Additional samples with more accurate instrument for measuring the differences in colors and periodical documentation with videos are recommended for further studies. Keywords: hemoglobin postmortem lividity (livor mortis) Abstrak: Kematian dapat dikenal pada seseorang melalui adanya tanda-tanda kematian lanjut berupa lebam mayat, kaku mayat, pembusukan, mumifikasi dan adiposera. Lebam mayat (livor mortis) terjadi setelah kematian klinis. Eritrosit akan menempati tempat terbawah akibat gaya gravitasi, mengisi vena dan venula, membentuk bercak warna merah ungu (livide) pada bagian terbawah tubuh. Penelitian ini bertujuan untuk melihat pengaruh kadar hemoglobin terhadap warna lebam mayat dan hilangnya (detik) ketika diberi penekanan. Jenis penelitian potong lintang. Penelitian dilakukan di RSUP Prof. Dr. R. D. Kandou Manado pada bulan Oktober – Desember 2015 dengan mengamati dan menekan lebam mayat pasien meninggal. Data rekam medis pasien ditelusuri untuk melihat kadar hemoglobin. Hasil penelitian menunjukkan terdapat pengaruh kadar hemoglobin terhadap hilangnya lebam mayat pada penekanan (p<0,05 atau p=0,040) dan tidak ada pengaruh kadar hemoglobin terhadap warna lebam mayat (livor mortis) = konstan. Disarankan untuk penelitian selanjutnya agar menggunakan sampel yang lebih banyak dengan penggunaan alat ukur warna maupun alat ukur untuk melakukan penekanan serta melakukan dokumentasi foto ataupun video secara berkala.Kata kunci: hemoglobin, lebam mayat (livor mortis)

Livor mortis pada keracunan insektisida golongan organofosfat di kelinci

The objective of this study is to compare the time livor mortis formed, fixed, and colored on the control group and treated group. This was a true experimental study with a post-test only control group design. This study was conducted at the Forensic Laboratory Prof. Dr. R. D. Kandou Hospital Manado from September to December 2015. Samples were 10 rabbits (Oryctolagus cuniculus) of 1250-2100 g, divided into two groups, the control group and the treated group. The treated group was exposed to diazinon as many as 3 ml in one treatment. Data were analyzed by using univariat analysis, subsequently tested using Independent t-Test. The results showed that there was no significant difference (p>0.05) on the time livor mortis formed and fixed between the control group and the treated group. There is a slight color difference of the livor mortis between control group (bluish-violet/purple) and treated group (purplish-red). Conclusion: There was no significant difference on the time of livor mortis formed and fixed between rabbits with and without organophosphate intoxication. There was a slight difference in color of livor mortis between rabbits with organophosphate intoxication (purplish-red) and the ones without intoxication (bluish-violet/purple).Keywords: livor mortis, intoxication, organophosphate, rabbitsAbstrak: Penelitian ini bertujuan untuk membandingkan waktu terbentuk, waktu menetap dan warna livor mortis pada kelompok kontrol dan kelompok perlakuan. Jenis penelitian eksperimen murni (true experimental desain) dengan rancangan penelitian post test only control group design. Penelitian dilakukan di Laboratorium Forensik RSUP Prof. Dr. dr. R. D. Kandou Manado pada bulan September – Desember 2015. Sampel terdiri dari 10 ekor kelinci (Oryctolagus cuniculus) dengan berat badan 1250-2100g yang dibagi menjadi kelompok kontrol dan perlakuan. Kelompok perlakuan dilakukan pemaparan diazinon sebanyak 3 ml dalam satu kali pemberian. Data dianalisis dengan analisis univariat kemudian diuji dengan Independent t-Test. Hasil penelitian menunjukkan tidak terdapat perbedaan bermakna (p>0,05) waktu terbentuk dan waktu menetap livor mortis antara kelompok kontrol dan kelompok perlakuan. Terdapat sedikit perbedaan warna livor mortis antara kelompok kontrol (biru keunguan) dan kelompok perlakuan (ungu kemerahan/livide). Simpulan: Tidak terdapat perbedaan bermakna waktu terbentuk dan waktu menetap livor mortis antara kelinci dengan dan tanpa keracunan organofosfat. Terdapat sedikit perbedaan warna livor mortis antara kelinci dengan keracunan organofosfat (ungu kemerahan/livide) dan yang tanpa keracunan (biru keunguan).Kata kunci: livor mortis, keracunan, organofosfat, kelinci

Nem tudo que parece ser, é lesão: aspectos anatômicos, não lesões, artefatos, lesões sem significado clínico e alterações post mortem encontrados na necropsia de suínos domésticos e selvagens (Sus scrofa)

A interpretação das alterações encontradas na necropsia é uma etapa importante para o sucesso do diagnóstico final. Este trabalho tem como objetivo descrever e ilustrar os aspectos anatômicos, não lesões, artefatos, lesões sem significado clínico e alterações post mortem encontradas em suínos domésticos e selvagens. Além disso, também se recomenda técnicas de colheita de tecidos para o diagnóstico de doenças que acometem essa espécie. Os principais aspectos anatômicos e não lesões descritos são fímbrias linguais, quadrilátero esofágico, toro pilórico e demarcação do padrão lobular do fígado (sistema gastrintestinal); tonsilas do palato mole, tecido linfoide associado ao estômago, placas de Peyer do intestino delgado e dobras da margem do baço (sistema hematopoiético); mediastino proeminente do testículo e aréolas da placenta (sistema reprodutor); atelectasia pulmonar e apêndice decidual (feto); e glândulas carpais (sistema tegumentar). Os artefatos de eutanásia abordados são petéquias na superfície do pulmão e rim, falsa anemia por sangria, hemorragia subdural por concussão cerebral, pseudo-infartos do baço e aspecto cerebriforme do intestino delgado. As lesões de pouco significado clínico descritas são cistos renais, linfonodos com pigmento de ferro, papilomas e hemangiomas no escroto, ossos no mesentério e hiperemia da mucosa gástrica. As alterações post mortem comumente encontradas são livor mortis, músculos pálidos, pseudomelanose e líquido serosanguinolento nas cavidades torácica e abdominal em fetos.