Anatomical tracheal parameters in premature neonates with birth body weight less than 1000 g for effective and safe administration of surfactant

Objective. To evaluate anatomical tracheal parameters of fetus and premature infant for clarifying the permissible and safe depth of insertion and «thin catheter» diameter during minimally invasive administration of surfactant.Material and methods. Autopsy examination of fetuses and newborns with extremely low birth weight, who died during their first 168 hours of life. The study describes only 26 cases, respiratory system malformations are excluded. The authors measured the distance from the glottis to the bifurcation, the perimeter of the trachea under the ligaments, in the middle part and at the level of the bifurcation with the calculation of the trachea diameter.Results. The average body weight was 684.6 ± 160.8 g, gestational age varied from 21 to 33 weeks and averaged 25 weeks. The distance from the glottis to the bifurcation was 34.31 ± 5.28 mm, and the diameter in the upper, middle and lower thirds was 3.53 ± 0.64 mm, 3.41 ± 0.63 and 3.69 ± 0.78 mm respectivelyApplication of the results: registration of these indicators when choosing a catheter for minimally invasive administration of a surfactant and the depth of its introduction into the trachea in newborns with extremely low body weight will help to avoid such complications, as one-lung administration of surfactant and its regurgitation from the trachea during the procedure, thereby increasing the efficiency and safety of the methodConclusion. The length and diameter of trachea in neonates with extremely low birth weight in the early neonatal period depend on anthropometric values and gestational age at birth, mean length is 34.31±5.28 mm.

Fatal Moans and Bones in Crohn’s

Introduction/Objective Heterotopic mesenteric ossification (HMO) is a rare, reactive condition involving abnormal bone formation within the mesentery. While its etiology is uncertain, reports suggest two possible inciting events - either metaplasia from trauma and/or inflammation or dislodgment of bone fragments from other sites during abdominal surgery. With less than 50 reported cases, there is much unknown about this disease process. Herein, we present a rare, fatal case. Methods/Case Report A 43-year-old man with a history significant for Crohn’s disease status-post multiple abdominal surgeries and with resultant chronic abdominal pain was found unresponsive at home by family with an unknown downtime. He was taken to the local hospital where he was admitted to the Intensive Care Unit. Given a poor prognosis, family transitioned him to comfort care measures and he died shortly thereafter. Autopsy examination revealed a thin man with an ostomy and severe abdominal scarring. Internally, there were multiple aberrant bone fragments within the mesentery which neither perforated the bowel nor caused obstruction and which microscopically appeared to be mature and benign. Ancillary studies were significant severe dehydration. Follow-up conversation with his family revealed that due to debilitating abdominal pain, the decedent had significantly decreased his oral intake and had stopped taking medications to control his high output ostomy. Given the autopsy and investigative findings his death was certified as a natural death caused by dehydration due to complications of Crohn’s disease. Conclusion This is the first reported case of HMO occurring in inflammatory bowel disease. Awareness of this condition is important for clinicians as it can alter management of these patients. Early review and recognition from radiologists and pathologists can potentially improve the morbidity and mortality of this group.

Study to Assess the Autopsy in Relation with Age and Gender in Tertiary Care Hospital of Hyderabad, Sindh, Pakistan

Objective: To assess the autopsy in relation with age and gender in tertiary care hospital of Hyderabad, Sindh, Pakistan. Study Design: Retrospective, observational and non-interventional study Place and Duration of Study: Medicolegal Department of Liaquat University of Medical and Health Sciences Hyderabad from 1st January 2017 to 31st December 2018. Methodology: Three hundred and eighty-one patients were enrolled. Results: According to cause of death, 88 (23.10%) were died due to road traffic accident, firearm injury 73 (19.16%) and asphaxial death 70 (18.37%), assault 65 (17.06%), poisoning 37 (9.71%), electric shock 30 (7.87%) and undetermined 18 (4.72%) respectively. Conclusion: The relatable factors such as age and gender with the suicidal cases in results of autopsy examination which plays the most relevant role in the medical practices even after the advancement of diagnostic technologies. Key words: Assess, Autopsy, Age, Gender, Tertiary care hospital

Forensic Osteology and Identification

Every human corpse is unique. There are different religions in different parts of the world which adopt a variety of ways to dispose of corpses. Dead bodies can be found unattended, dug up, mutilated by the perpetrators of crimes, and eaten by wild animals in lonely unattended places. In these situations, forensic anthropologists or anatomists are consulted by the state authorities to help them to provide justice to the deceased person. The first and foremost scientific information desired by authorities is identification of the corpse, cause of death of the human body and weapon used, if applicable. Identification can be done by studying the bones of the human corpse during autopsy examination and if unknown skeletal remains are all that is available, examination of each bone is required. Forensic anthropologists or pathologists are asked to identify race, sex and age as important parameters of the identification. In this chapter, we will enumerate various parameters for identification. We will discuss race, age and sex from various bones as part of forensic oesteology.

Demographic and autopsy characteristics of drowning deaths in a major autopsy center of Gandaki province of Nepal

Background: Autopsy examination is mandatory in all unnatural deaths as per law of Nepal and thus all deaths due to drowning are undergone medico legal autopsy. This study aims to analyze the demographic and autopsy characteristics of drowning deaths in cases brought for medico legal autopsy at a major autopsy center of Gandaki province of Nepal. Methods: This study was conducted based on review of database in a period of two years among 53 corpses of drowning related deaths. The demographic data and relevant information from the inquest and autopsy report of such cases were collected and presented. Result: The commonest age group involved in drowning deaths was <20 years, attributing to 22 (41.5%) cases, and with males (41, 77.4%) more common than females. Suicidal drowning (34, 64.2%) was the commonest manner. Maximum (19, 35.8%) deaths occurred in the rainy season and on lakes (34, 64.1%). Conclusion: Drowning deaths were more common among males of young age groups. Most of the drownings occurred during the rainy season, lakes were the common sites of drowning, and the commonest manner was suicidal.

Legionnaires’ disease arising with hirsutism: case report of an extremely confusing event

Background Legionella bacteria is a common cause of pneumonia, but the infection may affect several organs in the most serious cases. A systemic involvement ab initio could be non-specific, leading to a diagnostic misinterpretation. Case presentation A 33-year-old woman had been complaining of mental confusion, restlessness, aggressiveness, and, subsequently, hirsutism. After 3 weeks, the patient developed pneumonia and died during the hospitalization. The autopsy examination revealed a multi-organ necrotizing exudative disease involving the lung, the heart and the brain. The microbiological tests of tracheal aspirate were positive for Legionella pneumophila serotype 1. Conclusion The Legionella infection may show a proteiform clinical course and an extra-pulmonary manifestation may be the first sign of the disease. Herein, we report a case of Legionella infection in a young female, presenting with non-specific neurological symptoms and hirsutism at onset, misdiagnosed as a metabolic disease.

Severe Dementia Predicts Weight Loss by the Time of Death

Background: Body mass index (BMI) in midlife is associated with dementia. However, the association between BMI and late-life obesity is controversial. Few studies have investigated the association between BMI and cognitive performance near the time of death using data from autopsy examination. We aimed to investigate the association between BMI and dementia in deceased individuals who underwent a full-body autopsy examination.Methods: Weight and height were measured before the autopsy exam. Cognitive function before death was investigated using the Clinical Dementia Rating (CDR) scale. The cross-sectional association between BMI and dementia was investigated using linear regression models adjusted for sociodemographic and clinical variables.Results: We included 1,090 individuals (mean age 69.5 ± 13.5 years old, 46% women). Most participants (56%) had a normal BMI (18.5–24.9 kg/m2), and the prevalence of dementia was 16%. Twenty-four percent of the sample had cancer, including 76 cases diagnosed only by the autopsy examination. Moderate and severe dementia were associated with lower BMI compared with participants with normal cognition in fully adjusted models (moderate: β = −1.92, 95% CI = −3.77 to −0.06, p = 0.042; severe: β = −2.91, 95% CI = −3.97 to −1.86, p &lt; 0.001).Conclusion: BMI was associated with moderate and severe dementia in late life, but we did not find associations of BMI with less advanced dementia stages.

An Update on Virtopsy- A Modern Forensic Investigation Tool

Virtopsy is a virtual alternative to a traditional autopsy, conducted with scanning and imaging technology. In developed countries Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are now being evaluated as complementary means for determination of cause of death. This paper explores the latest development and implication of virtopsy from ethical, clinical and technical point of view. Published literature in different journals with strict inclusion and exclusion criteria were extensively reviewed through use of general and Meta search engines to elucidate the applications and implications of virtual autopsy. The modern high-resolution imaging has been used as a well described aid in the setting of post-mortem investigations. Virtopsy introduces a new era in autopsy examination. It utilizes the technological innovation of modern imaging system to obtain best results and three Dimensional (3D) images of the body in multiple plains without mutilation of the human body. Now a days virtopsy is very much acceptable procedure to the forensic society. In western worlds virtopsy is likely to replace conventional autopsies in future. We can also try to implement this modern system in our country. KYAMC Journal.2021;12(1): 48-52