Masters Degrees (Forensic Medicine)

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Correlation of post mortem LODOX digital radiological images with histopathological findings at autopsy : a prospective autopsy study at the Tygerberg Forensic Pathology Service Facility
(Stellenbosch : Stellenbosch University, 2015-04) Quarrie, Karisha Claudia; Burger, Elsie Helena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Forensic Medicine.
ENGLISH ABSTRACT: Background: The LODOX Statscan is a whole-body digital X-ray scanning device which was adapted for medical usage. The LODOX has an established role in the field of Forensic Pathology where it shows high sensitivity and specificity for the detection of skeletal pathology and foreign bodies. The role of the scanner in the detection of soft tissue pathology in the lungs of adults has not been reported and this study aims to review the radio-pathological correlation and the applicability of LODOX as a viable screening tool in the detection of lung pathology in post mortem cases. Methods: We prospectively reviewed cases which were referred for medico-legal autopsy between November 2012 and March 2013 to the Tygerberg Forensic Pathology Service mortuary, Cape Town, South Africa. All cases meeting the prescribed inclusion criteria underwent LODOX scanning as well as macroscopic and microscopic evaluation of the lungs as permitted by the Inquests Act 58 of 1959. The macroscopic and microscopic variables were considered the “gold standard” when compared with the results of the LODOX. The sensitivity, specificity, positive and negative predictive values were assessed. Results: One hundred and fifty nine cases (159) were included in the study. The most common radiographic patterns reported were the presence of ground glass opacities and consolidation. Overall, low to moderate sensitivity of these LODOX patterns in the prediction of pneumonic microscopic pathology (oedema, acute and chronic inflammation and features of diffuse alveolar damage) was noted. These values were lower than that reported for pneumonia using conventional X-rays. Additionally, these LODOX patterns have a high probability of representing oedema or autolytic/decomposition change. Pneumothorax was the most common pleural pathology detected on LODOX, but autopsy correlation could not be performed. Poor to no correlation was noted with the variables of cavity, malignant tumour, and bronchiectasis, but the prevalence of these conditions in our cohort was low. In general, LODOX predictions were better at excluding pathology which was not present rather than confirming pathology which was present. Conclusions: The LODOX offers excellent evidentiary value in the demonstration of a pneumothorax but currently has limited value as a “stand alone” test in the field of Forensic Pathology. However the continued use of the LODOX as an adjunct examination, as well as prospective study of its applicability, is advised.
A critical review of sudden unexpected deaths at Tygerberg Hospital Forensic Pathology Laboratory over a one-year period in 2016
(Stellenbosch : Stellenbosch University, 2021-03) Roman, Jill; Verster, J.; Dempers, J. J.; Osman, Muhammad; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology: Forensic Medicine.
Background In South Africa, admissions of sudden and unexpected deaths to large Forensic Pathology Laboratories (FPL) for medicolegal post-mortem examination are generally on the increase. Research in this field is useful to identify disease patterns and to reduce unnecessary admissions to forensic pathology services. Objectives Our main aim was to determine the recent epidemiological profile of sudden and unexpected deaths admitted to Tygerberg FPL from 1 January to 31 December in 2016, compared to a past similar study that evaluated similar data of 2001 to 2005. A secondary objective was to ascertain the contribution of respiratory disease. Method A retrospective study was conducted. Anonymized data were obtained from post-mortem case files for analysis and comparison, using an electronic Open Data Kit application, Red Cap electronic database and Windows Excel for secure storage, and Statistical Package for Social Sciences for biostatistical analyses. Results The total number of cases that were admitted to Tygerberg FPL in 2016 for medicolegal post-mortem examination were 3766. The past epidemiological study at the same facility evaluating the data of 2001 to 2005, showed an annual average of approximately 2700 admissions. Admissions of more than 1000 above the previous annual average was thus demonstrated. Of the 3766 admissions in 2016, a sum of 770 cases comprised the study population of sudden and unexpected deaths, of which 539 (70%) were adults and 231(30%) children. All cases that were known to have an unnatural cause of death upon admission were excluded A younger average age of 34 years and continued male predominance was demonstrated in the study population. The manner of death was presumably natural in 496 (64.4%) cases, unnatural in 60 (7.8%) cases and undetermined in 214 (27.8%) cases. In the population of minors (<18 years of age), presumed natural deaths accounted for 145/231 (62.8%) cases. Diseases of the respiratory and cardiovascular systems continued to be the leading natural causes of death in the overall study population. Pneumonia was the most prevalent cause of death in the population of minors (<18 years of age) and ischaemic heart disease in adults. Lower socio-economic status areas were more significantly affected. Conclusion Regular epidemiologic studies of sudden and unexpected deaths are needed in Cape Town’s Eastern Metropole for disease prevention and health promotion. Training of medical professionals and the South African Police Services is vital to better understand what a sudden and unexpected death is and when medico-legal referral is warranted. [370 words]
A descriptive analysis of unnatural deaths in the elderly population admitted to the Tygerberg Forensic Pathology Laboratory in South Africa from 2013 to 2017
(Stellenbosch : Stellenbosch University, 2023-03) Mostert, Lambert Jacobus; Afonso, Estevao Bernardo; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Division of Forensic Medicine.
ENGLISH SUMMARY: Background: The elderly population is globally increasing. Frailty and associated comorbidities make this population group prone to accidents and vulnerable to injury. Considering a high level of violent unnatural deaths in South Africa, not much research has been done on unnatural deaths in the elderly population. Objectives: The purpose of our study was to describe the causes of unnatural deaths in the elderly population. Methods: A retrospective descriptive study was conducted on all unnatural cases aged 65 years and older, admitted to Tygerberg Forensic Pathology Laboratory, serving the eastern part of Cape Town Metropolitan region. The study included 400 cases of elderly unnatural deaths from 2013 to 2017. Results: The most common cause of death in the elderly was found to be falls (29.8%), followed by transport-related injuries (20%) and procedure-related deaths (15.3%). Accidents were found to be the most common manner of unnatural death (61%), followed by suicides (10.8%) and homicides (9.5%). A significantly larger proportion of the suicide cases were male (n=37 in males; n=6 in females). Conclusions: Accidental deaths, in particular fall-related incidents, were the main cause for mortality in the study population. Further assessment regarding the circumstances of the accidents in the elderly is necessary to determine whether preventative strategies may lessen this burden in our ageing population. Procedure-related deaths were also highlighted as an area of concern requiring an integrated approach to assessment and standardisation of the classification of the manner of these deaths.
Femicide in the Eastern Metropole of Cape Town : A 5-year retrospective analysis
(Stellenbosch : Stellenbosch University, 2022-11) Wilscott-Davids, Candice; Afonso, Steven; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Division of Forensic Medicine.
ENGLISH ABSTRACT: Background: Violence against woman continues to be a global health problem with formicide being its most severe form, especially in a country with one of the world's highest homicide rates. Aim: To evaluate the female homicide cases at the Tygerberg Forensic Pathology Laboratory, identifying the demographic profile of victims, leading causes of death, patterns of injury and prevalence of sexual violence.
An investigation into the patterns and trends of injuries in community assault cases at the Tygerberg Forensic Pathology Facility over a 10-year period from 1 January 2003 to 31 December 2012
(Stellenbosch : Stellenbosch University, 2015-04) Herbst, Celeste Ingrid; Wadee, S. A.; Tiemensma, M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Forensic Medicine.
ENGLISH ABSTRACT: Background: An increase in autopsied cases of community assault fatalities has been observed at the Tygerberg Forensic Pathology Services Facility. A paucity of information exists as to the incidence and prevalence of these cases in a South African context. Objectives: To determine the patterns and trends of injuries sustained in so-called community assault fatalities. Methods: A retrospective and descriptive study was conducted. Fatal community assault cases admitted to the Tygerberg Forensic Pathology Facility over a ten year period, from 1 January 2003 to 31 December 2012 were reviewed. Data was collected from autopsy/post mortem examination reports, contemporaneous notes, attached hospital records, SAPS- 180 form (completed by South African Police Services representative) and other Forensic Pathology Services (FPS) documentation. Results: A total of 424 cases of fatal community assault were admitted during the study period with an annual increase between 2004 and 2008 and a second peak from 2010 to 2012. The cause of death in majority of cases was due to multiple injuries (42%) with blunt force trauma forming the basis of most of the injuries sustained. The most prevalent areas where these assaults occurred was Khayelitsha (166 cases) and Harare (84 cases) - one of the sub-sections in Khayelitsha. Male subjects were predominantly assaulted with only one female fatality recorded. Conclusion: Adequate policing in prevalent areas is essential, to address the unnecessary loss of life and additional burden on the criminal justice system and health care services.
An investigation into the profile and temporal evolution of firearm-related fatalities at Tygerberg Forensic Pathology Service Laboratory
(Stellenbosch : Stellenbosch University, 2023-03) Uren, Grace Amy; Dempers, Jacobus Johannes; Verster, Janette; Prinsloo, Megan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Division of Forensic Medicine.
ENGLISH SUMMARY: Firearm-related violence and fatalities are a significant public health and safety concern, especially in the South African City of Cape Town Metropole. Access and availability of firearms have been identified as key factors influencing this burden of firearm violence in Cape Town. Limited published data exist regarding firearm-related fatalities in the Eastern, Northern, Tygerberg, and Khayelitsha health sub-districts of the City of Cape Town Eastern Metropole serviced by the Tygerberg Mortuary. This study aimed to provide insight into the profile and severity of the pathological characteristics of firearm-related fatality cases admitted to the Tygerberg Forensic Pathology Laboratory for medicolegal postmortem examination observed in three time periods (2001, 2009, and 2017), from which patients were randomly selected. A retrospective descriptive study was conducted by evaluating autopsy case files of individuals admitted to the Tygerberg Forensic Pathology Laboratory after sustaining fatal firearm-related injuries. A total of 420 firearm-related fatality cases were included within the three distinct years, 2001 (n=125), 2009 (n=75), and 2017 (n=220), with most of these fatalities evident in young adult males. The majority of firearm-related incidents occurred in sub-economic areas and during night-time. A significant increase in the number of gunshots and individually fatal gunshot wounds sustained in victims from 2001 to 2017 (p=0.001) and 2009 to 2017 (p=0.002) was evident. The pathological severity of firearm-injury fatalities has increased and adds to the immense workload of an already overburdened facility. Interventions are required to decrease the illegal sale and distribution of firearms and stricter enforcement of gun-control legislation.
Opname van opinie van regslui ten opsigte van doeltreffendheid van geregtelike post mortems in die Wes-Kaap
(Stellenbosch : Stellenbosch University, 2001) Pienaar, J. P.; Brouwer, I. G.; Barnes, J.; Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Pathology. Forensic Medicine.
ENGLISH ABSTRACT: The main purpose in doing forensic post mortems is to supply information to the judicial system. Medical personnel involved in doing post mortems seldom get feedback regarding efficiency. Numerous allegations have been made regarding the work of district surgeons in terms of forensic post mortems, often suggesting that the work is substandard. In South Africa district surgeons do post mortems mostly in the rural areas, and training centre personnel do forensic post mortems in urban areas. Training centre personnel include specialized forensic pathologists, registrars and medical officers working in the Departments of Forensic Medicine, affiliated to universities. The South African Police Service mostly manages government mortuaries. The South African forensic medico-legal system is unique, and does not correspond in with the four main systems used worldwide. Research was done by sending 200 questionnaires to a representative group from the legal fraternity of the Western Cape (including judges / magistrates, state prosecutors, private lawyers) and also the South African Police Service investigating officers. The judiciary, as the users of the information generated through forensic post mortems, are therefore in a suitable position to determine the efficacy of forensic post mortem. The questionnaire was structured to determine the general perception, as well as comments, regarding 9 different aspects involved with doing forensic post mortems. These include the thoroughness and completeness of reports, standard of academic knowledge, efficacy of verbal testimony in court, length of time in releasing the report, general attitude, efficacy of sketches and diagrams, efficacy of photography, sufficient taking of toxicology samples and sufficient utilization of special laboratory investigations. The last question was an open question to allow for general comments and anecdotes. For each aspect it was also determined whether there was a difference in efficacy noted between the two groups. The effect of this, if any, on the judicial criminal justice system was also assessed. A different questionnaire was sent out to all forensic pathologists in the Western Cape. The standard of work of the district surgeons was hereby assessed. General comment regarding academic knowledge, and findings at post mortem made by district surgeons was assessed. The pathologists were also questioned regarding the general attitude of district surgeons, and imput were asked regarding continued medical education programs. An area for general comment was also supplied. The main findings were as follows: a. The legal fraternity in the Western Cape is generally satisfied with the efficiency of forensic post mortems, except the use of laboratory investigations and also the length of time to release reports. b. The legal fraternity could determine a difference in the efficiency of post mortems done by district surgeons and training centre personnel. Training centre personnel were generally regarded as more effective. c. The difference between the two groups, due to ineffective district surgeon post mortems, had a negative effect on the criminal justice system. The following recommendations were made: a. Training centre personnel: Serious consideration should be given to appointing qualified forensic pathologists in the rural areas. Training centre personnel should also be more involved in training the district surgeons. b. District surgeons: The training, re-training and continued medical education of district surgeons in the Western Cape should be prioritized. The service conditions should also be reviewed. c. Administrative: Audit of post mortem reports. The efficiency regarding court appearances should be audited through the Department of Justice. Administrative power will be necessary to oversee the above-mentioned recommendations.
A retrospective review of railway-associated deaths in the Cape Town Metro East region over a two-year period.
(Stellenbosch : Stellenbosch University, 2021-03) Okkers, Heidi Lee; Afonso, Estevao; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology: Forensic Medicine.
Background: Railway travel is an integral part of the daily transport of people and cargo worldwide, and no less so in South Africa. Generally considered safer than road transport, rail travel is still associated with risk and railway-related deaths attract significant media attention. There is limited local research into the epidemiology and pathology of these deaths. An improved understanding of these cases will assist in preventative strategies to minimise fatalities. Objectives: The aim of this study was to investigate railway-associated fatalities in the Cape Town Metro East region over two years, from 2016 to 2017. The objectives were to obtain a demographic profile of victims, characterise injury patterns, identify the temporal and geographical distribution of deaths and, where possible, the causes of death. Methods: A retrospective descriptive review of all railway-associated fatalities admitted to the Tygerberg Forensic Pathology Laboratory between 1 January 2016 and 31 December 2017 was performed. Data were collected from autopsy reports and available contemporaneous notes for each case, including South African Police documents and hospital notes, where relevant. Results: There were 104 cases of railway-associated deaths during the two-year period under study. Males accounted for 87 cases, while there were only 17 female victims. The mean age of all cases was 34.8 years. Most incidents occurred between the morning hours of 8 am and 10 am and in the evening from 7 pm to 10 pm, and a midweek peak of 62.5% of cases were reported as pedestrians who were struck whilst crossing the railway tracks. Khayelitsha was the suburb where the highest number of cases were recorded. Multiple blunt force injuries as the terminal cause of death accounted for 81.7% of cases. One case of electrocution and one of downing were reported. Two cases of alleged assault were recorded. Head injuries accounted for 91 cases with only five decapitations. Transection of the thorax occurred in eight cases and multiple rib fractures were also recorded. Multiple organs were disrupted and the upper limbs on the right were predominantly injured. 17 victims had blood alcohol levels above the legal limit of 0.05 g/100ml. Conclusion: More than half of the cases died as a result of multiple traumatic injuries after crossing the railway tracks as pedestrians. This study emphasizes the importance of adequate contemporaneous documentation of the cases. The background information and scene investigation play a significant role in determining factors assisting in the determination of the cause and manner of death. Optimal security can aid in the decline of unnecessary railway incidents and death. It is recommended that the investigation of railway-associated fatalities become a priority to prevent circumstances in which these cases occur.
Sudden and unexpected deaths in adults : an investigation of cases reported to Tygerberg Forensic Pathology Services from January 2001 - December 2005
(Stellenbosch : University of Stellenbosch, 2010-12) Tiemensma, Marianne; Burger, Elsie Helena; University of Stellenbosch. Faculty of Health Sciences. Dept. of Pathology. Forensic Medicine.
ENGLISH ABSTRACT: Background - The workload of the forensic pathologist and Forensic Pathology Services staff is increased by the referral of potentially unnecessary natural cases to the Forensic Pathology Services. The primary aims of the medico-legal autopsy are limited to establishing a cause of death in presumed unnatural cases, and to exclude criminality or negligence. Objective – To determine the final outcomes of forensic post-mortem examinations in “sudden and unexpected” adult deaths over a 5 year period. Methods - An observational, retrospective, descriptive study was conducted. ”Sudden and unexpected” adult deaths referred to Tygerberg Forensic Pathology Services between 1 January 2001 and 31 December 2005 were reviewed. Data was collected from the autopsy reports, contemporaneous notes and hospital records. Findings – A total of 816 adult cases of sudden and unexpected death were referred to Tygerberg Forensic Pathology Services over the 5 year period studied. Complete autopsies had been performed in 74% (601/816) of cases. The presumed manner of death was natural in 79 % of cases, and an increase in the number of natural cases autopsied per year was noted over the 5-year study period. Diseases of the cardiovascular, respiratory and central nervous systems were responsible for the majority of natural deaths. Infectious diseases were responsible for most deaths in the youngest age group studied (18-29 years). Acute alcohol poisoning was responsible for the deaths of 35 (6%) cases, with an average blood alcohol concentration of 0.38g/100mL in these cases. Eight deaths were drug-/substance related. Waiting times for blood alcohol and toxicology results increased over the 5-year study period. No cause of death was found in 10.6% of cases. Conclusions -The questionnaire and interviewing structure could possibly be improved in order to obtain better pre-autopsy information and to reduce the number of “unnecessary” medicolegal autopsies, thereby reducing the burden of cost on the Forensic Pathology Services.

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