ORCID Profile
0000-0003-1974-9313
Current Organisations
The University of Newcastle
,
NSW Department of Forensic Medicine
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Publisher: Springer Science and Business Media LLC
Date: 29-10-2009
Publisher: SAGE Publications
Date: 14-03-2017
Abstract: Air embolism (AE) is considered a rare event and can be either iatrogenic or traumatic. Various post-mortem methods to detect AE exist, of which radiology is preferred. The presence of air in the heart can be demonstrated using special dissection techniques where the heart is opened under water or by needle puncture from a water-filled syringe. Three cases of blunt-force head injury are presented herein, with AE being diagnosed by conventional radiography using a Lodox Statscan® full-body digital X-ray machine in all cases. This case series demonstrates that AE due to blunt-force trauma to the head and sinuses might be under-recognised in the forensic post-mortem setting. It also highlights the importance of radiology in diagnosing AE post-mortem, especially where the results of post-mortem techniques might be unsatisfactory.
Publisher: South African Medical Association NPC
Date: 29-03-2016
Publisher: Medpharm Publications
Date: 03-09-2015
Publisher: SAGE Publications
Date: 2010
DOI: 10.4137/CMC.S5676
Abstract: Sudden and unexpected death in the young is a common and worldwide problem. Sudden, unexpected death in infancy (SUDI), clinically unexpected death in an infant between one week and one year of age, affects around 1 in 1000 infants. Autopsy will reveal a specific cause of death in only one third of cases. This has led to various ancillary examinations in an effort to increase the diagnostic yield of the autopsy. In this case report it is suggested that another diagnostic modality, that of the post-mortem echocardiogram might be a worthwhile concept to explore.
Publisher: Springer Science and Business Media LLC
Date: 12-01-2016
DOI: 10.1007/S12024-015-9737-X
Abstract: In South Africa bee stings are most commonly caused by either Apis mellifera capensis or A. mellifera scutellata, indigenous species which are notoriously aggressive when compared to European honey bees. According to Statistics South Africa, 109 deaths were documented for the period 2001-2011 as having been caused by hornets, wasps, and bees (ICD10-X26). This appears to be a small number but, as was reported in Australia, these statistics might be inaccurate due to either over- or underreporting of cases. We report 3 cases of fatalities due to bee stings, including one with postmortem features of diffuse intravascular coagulopathy. A brief overview of the venom of the honey bee, reactions following a bee sting and possible mechanisms of death are presented. Confirming the diagnosis in these cases may be very problematic for the forensic pathologist, as in many cases minimal history is available and both external and internal examination could fail to reveal any specific signs of bee sting or other obvious morphologic abnormalities. Thus, there is a need for reliable confirmatory or supportive diagnostic tests.
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.FORSCIINT.2014.09.009
Abstract: The misuse of alcohol has a particularly detrimental effect and is one of the most significant public health problems in South Africa and it also has an impact on the criminal justice system with evidence of association between high levels of alcohol and risk-taking behaviour, committing crimes, or being a victim of crime. A global trend has been set worldwide with alcohol being one of the most common drugs found in post mortem specimens and especially with regard to cases admitted for medico-legal autopsies. The influence of alcohol on the cause of death is either a contributory or an underlying factor in a substantial number of violent deaths. We retrospectively reviewed 1455 cases, in which alcohol was taken, of 2344 medico-legal autopsies done in 2009. We found that 47% of the cases tested positive for alcohol, with the reported blood alcohol concentrations varying from 0.01 to 0.95g per 100ml (mean=0.16±0.11g per 100ml) with the highest proportion being in the 0.10-0.19g per 100ml range. A breakdown of the results showed that road traffic accidents, assaults and firearm-related deaths predominated the alcohol-positive cases. The results showed that there was a definite correlation between alcohol consumption and the incidence of other that natural deaths.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Academy of Science of South Africa
Date: 15-05-2019
DOI: 10.17159/2413-3108/2019/V0N67A4951
Abstract: Driving under the influence is a major threat to road safety in South Africa. Various psychoactive substances (both licit and illicit) have the potential to adversely affect driving performance and increase the probability of a road traffic accident. While it is common practice in South Africa to test drivers for alcohol levels, testing for additional impairing substances (including drugs of abuse) is rarely performed. In terms of current South African legislation, only driving under the influence of alcohol and a ‘drug having a “narcotic” effect’ is prohibited. This excludes several impairing psychoactive drugs which are not classified as narcotic substances. The aim of this article is to highlight issues and/or limitations surrounding drugged driving and to propose appropriate considerations for revision of the National Road Traffic Act. We also recommend revising existing legislation to include a comprehensive statutory definition and detailed provisions for drug testing to deter impaired driving.
Publisher: Academy of Science of South Africa
Date: 28-09-2020
DOI: 10.17159/2413-3108/2020/I69A5289
Abstract: In 2013, South Africa had the second highest rate of imprisonment in Africa. During the apartheid era, a substantial number of deaths in custody involved political detainees. However, two decades after the abolition of apartheid there continues to be a high number of deaths in custody and deaths due to police action. There is no internationally standardised classification for deaths which take place in custody and/or due to police action. For purposes of this study, we ided these cases broadly into two categories: firstly, deaths which took place as a result of police action as well as deaths of persons held in police custody, and secondly, deaths of inmates of correctional service facilities. We conducted a retrospective descriptive case audit at the Pretoria Medico-Legal Laboratory (PMLL) of all cases admitted as deaths as a result of police action, deaths in police custody and deaths in correctional service facilities during the five year period from January 2007 through December 2011. A total of 93 cases were identified, which included 48 deaths due to police action, 28 deaths in police custody and 17 deaths in correctional service custody. The majority of these deaths were due to gunshot wounds (n=48), and all of these occured due to police action. Hangings accounted for 17 cases, the majority of which happened in police holding cells. The study highlights the relatively large numbers of firearm fatalities related to police action. In contrast to similar studies elsewhere, we found no deaths due to phenomena such as excited delirium or deaths associated with illicit drug intoxication. We conclude that there is a need for objective, impartial and competent medico-legal investigation into deaths of this nature.
Publisher: South African Medical Association NPC
Date: 06-09-2016
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JFLM.2015.10.010
Abstract: Drowning is classified as the 3rd leading cause of accidental deaths worldwide and is deemed to be a preventable cause of death. Bodies retrieved from a water medium pose several challenges to the forensic pathologist with the diagnosis of drowning being primarily one of exclusion. The aim of this study was to do a retrospective descriptive case audit of bodies retrieved from water and immersion related deaths, which were investigated at the Pretoria Medico-Legal Laboratory (PMLL) over a 10 year period (January 2002 through December 2011). A total of 346 cases were identified for inclusion into this study. In 6% (20) of these cases, the death was not related to drowning in 14% (48) no clear cause of death could be ascertained and in 278 cases (80%) the cause of death was considered to have been due to drowning. Infants (under 1 year, of age) constituted 41 (15%) of the cases toddlers (aged 1-2 years) comprised 52 (19%) cases children (aged 2-13 years) 49 (18%) cases adolescents (aged 13-18 years) comprised 10 (3%) cases adults (above 18, years) made up 126 (45%) of the cases. The majority of the drownings, occurred in swimming pools [125 cases (38%)]. In infants 23 (56%) of, drownings occurred in swimming pools followed by buckets [7 cases (17%)]. Sixty-nine per cent of toddler drownings (36 cases) occurred in swimming, pools. In the adult population, 40 (32%) of cases occurred in pools and 35 cases (28%) in rivers. Positive blood alcohol results were recorded in 48, (42%) out of 113 cases where the test was requested, 40 (35%) of these, cases higher than 0.05 g per 100 ml. This study suggests that many drowning deaths in Pretoria may be preventable by introducing greater public awareness of the risks and instituting relatively simple, protective measures.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2016
Publisher: University of Adelaide Press
Date: 2018
DOI: 10.20851/SIDS-17
Publisher: Academy of Science of South Africa
Date: 15-05-2019
DOI: 10.17159/2413-3108/2019/I67A4951
Abstract: Driving under the influence is a major threat to road safety in South Africa. Various psychoactive substances (both licit and illicit) have the potential to adversely affect driving performance and increase the probability of a road traffic accident. While it is common practice in South Africa to test drivers for alcohol levels, testing for additional impairing substances (including drugs of abuse) is rarely performed. In terms of current South African legislation, only driving under the influence of alcohol and a ‘drug having a “narcotic” effect’ is prohibited. This excludes several impairing psychoactive drugs which are not classified as narcotic substances. The aim of this article is to highlight issues and/or limitations surrounding drugged driving and to propose appropriate considerations for revision of the National Road Traffic Act. We also recommend revising existing legislation to include a comprehensive statutory definition and detailed provisions for drug testing to deter impaired driving.
Publisher: Springer Science and Business Media LLC
Date: 22-07-2010
DOI: 10.1007/S12024-010-9184-7
Abstract: Sudden Infant Death Syndrome (SIDS) has been reported to be the leading cause of death in infants under 1 year of age in many countries. Unfortunately, a paucity of published research data exists in South Africa, with regard to the incidence of and investigation into the circumstances surrounding Sudden Unexplained Deaths in Infants (SUDI) and/or SIDS. Currently, even though most academic centers conform to a protocol consistent with internationally accepted standards, there exists no nationally accepted infant death investigation protocol in South Africa. It is the aim of this study to review the current practice of infant death investigation in two representative but geographically and demographically distinct centers. Retrospective case audit over a five-year period (2000-2004) was conducted at two large medico-legal mortuaries in Pretoria (Gauteng) and Tygerberg (Cape Town). Case files on all infants younger than 1 year of age were reviewed. The outcome measures included number of deaths, demographic details and the nature and final outcome of the post mortem examinations. A total of 512 cases were identified as possible SIDS cases and of these, 171 was classified as SIDS. The study showed marked inter-case and inter- isional variation in terms of the investigation of infant deaths at the two institutions. It is envisaged that this study will focus attention on the current lack of usable data regarding sudden/unexplained/unexpected infant deaths in South Africa, and aid in the formulation and implementation of a practical (yet internationally accountable) infant death investigation protocol, which could facilitate comparisons with other countries and initiate further structured research in this field.
Publisher: Springer Science and Business Media LLC
Date: 23-04-2016
Publisher: Medpharm Publications
Date: 02-01-2015
Publisher: South African Medical Association NPC
Date: 27-03-2016
Publisher: Academy of Science of South Africa
Date: 26-09-2016
DOI: 10.17159/2413-3108/2016/I57A442
Abstract: The reliability and accuracy of blood alcohol concentration (BAC) results presented in South African courts of law in respect of possible driving under the influence (DUI) cases, have in recent years been subjected to intense scrutiny and severe criticism. Research has shown that multiple factors may negatively impact on the reliability of results obtained from the analysis of such s les - including inappropriate or non-standardised s le management after acquisition thereof. In particular, long delays between s le acquisition and the analysis thereof may compromise the validity of results. Such delays may also negatively affect the outcome of both criminal and civil legal proceedings in possible DUI cases. A retrospective descriptive study was conducted on records from the Pretoria Forensic Chemistry Laboratory (PFCL) regarding the relevant dates pertaining to blood s les from deceased persons which were received for analysis. These parameters included the date of s le acquisition at medico-legal mortuaries, delays in submission of s les to the laboratory and date of actual analysis. In addition, the expiration dates of s le collection kits were recorded. Our results show that numerous expired kits were utilised and that there was an average delay of approximately five months between s le acquisition and laboratory analysis thereof. This delay period varied greatly but appears to correlate with geographical distance of the medico-legal mortuary from the PFCL. In order to optimise and facilitate the administration of justice in both criminal and civil cases of alleged DUI, these shortcomings should be urgently addressed. It is argued that the implementation of prescribed measures and standard operating procedures in s le management, together with other interventions such as accreditation of laboratories and improved resourcing of medico-legal and toxicology laboratories, is urgently required.
Publisher: South African Medical Association NPC
Date: 07-09-2016
Publisher: South African Medical Association NPC
Date: 08-03-2016
Publisher: Academy of Science of South Africa
Date: 26-09-2016
DOI: 10.17159/2413-3108/2016/V0N57A442
Abstract: The reliability and accuracy of blood alcohol concentration (BAC) results presented in South African courts of law in respect of possible driving under the influence (DUI) cases, have in recent years been subjected to intense scrutiny and severe criticism. Research has shown that multiple factors may negatively impact on the reliability of results obtained from the analysis of such s les - including inappropriate or non-standardised s le management after acquisition thereof. In particular, long delays between s le acquisition and the analysis thereof may compromise the validity of results. Such delays may also negatively affect the outcome of both criminal and civil legal proceedings in possible DUI cases. A retrospective descriptive study was conducted on records from the Pretoria Forensic Chemistry Laboratory (PFCL) regarding the relevant dates pertaining to blood s les from deceased persons which were received for analysis. These parameters included the date of s le acquisition at medico-legal mortuaries, delays in submission of s les to the laboratory and date of actual analysis. In addition, the expiration dates of s le collection kits were recorded. Our results show that numerous expired kits were utilised and that there was an average delay of approximately five months between s le acquisition and laboratory analysis thereof. This delay period varied greatly but appears to correlate with geographical distance of the medico-legal mortuary from the PFCL. In order to optimise and facilitate the administration of justice in both criminal and civil cases of alleged DUI, these shortcomings should be urgently addressed. It is argued that the implementation of prescribed measures and standard operating procedures in s le management, together with other interventions such as accreditation of laboratories and improved resourcing of medico-legal and toxicology laboratories, is urgently required.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
Publisher: Springer Science and Business Media LLC
Date: 03-05-2015
DOI: 10.1007/S00414-015-1198-Y
Abstract: There is a dearth of literature on the extent of fetal or newborn abandonment or "dumping" and the medico-legal investigation procedures these cases require. This is despite the fact that these occurrences are a worldwide phenomenon and by definition involve criminal law concerns such as illegal abortion, concealment of birth, murder, or neonaticide, depending on the country concerned. This article contributes to current literature in both respects and provides a retrospective case audit for the period 2004-2008 pertaining to all abandoned newborns and fetuses admitted to the Pretoria Medico-Legal Laboratory (PMLL) in South Africa. Demographic details, scope, and nature of the medico-legal investigation as well as formulation of cause of death were recorded. A total of 289 cases were identified for inclusion in this study, 57% of which were considered to have been non-viable fetuses, while 45 of the viable fetuses were deemed to have been stillborn. These instances involve the crimes of concealment of birth and at times illegal abortion, yet prosecution of these cases are relatively unheard of. Signs of live birth were identified in 38 of the cases in the study. Of these infants, 9 were deemed to have died from injuries they have sustained, and in a further 9 cases, no anatomical cause of death could be identified. Homicidal cases should be brought in cases where death ensued as a result of abandonment however, it is not known how many cases were prosecuted. A comparatively large number of cases were found to have been admitted to the Pretoria Medico-Legal Laboratory. This is alarming because South African abortion laws are liberal and services are free at point of access in the public health care sector. A substantial percentage of cases of abandoned infants were found to have shown signs of life after birth implying a homicidal manner of death or death by abandonment, but it seems these cases are merely shelved.
Publisher: Springer Science and Business Media LLC
Date: 06-04-2013
DOI: 10.1007/S12024-013-9427-5
Abstract: South Africa manifests a socio-economic dichotomy that shows features of both a developed and developing country. As a result of this, areas exist where a lack of resources and expertise prevents the implementation of a highly standardized protocol for the investigation of sudden and unexpected deaths in infants (SUDI). Although the medico-legal mortuaries attached to academic centers have the capacity to implement standardized protocols, a previous study conducted at two large medico-legal mortuaries indicated otherwise. This study also revealed that the exact number and incidence of sudden infant death syndrome (SIDS) cases was unknown. These findings prompted a multicenter study of the medico-legal investigation procedures and outcomes in five academic centers in South Africa. A retrospective case audit was conducted for a 5-year period (2005-2009) at medico-legal laboratories attached to universities in Bloemfontein, Cape Town-Tygerberg, Durban, Johannesburg, and Pretoria. The total case load as well as the total number of infants younger than 1 year of age admitted to these mortuaries was documented. The case files on all infants younger than 1 year of age who were admitted as sudden and unexpected or unexplained deaths were included in the study population. Data collected on the target population included demographic details, the nature and scope of the post-mortem examinations, as well as the final outcome (cause of death). A total case load of 80,399 cases were admitted to the mortuaries over the 5 year period with a total of 3,295 (6.5 %) infants. In the infant group, 591 (0.7 %) died from non-natural causes and 2,704 (3.3 %) cases of sudden, unexpected and/or unexplained deaths in infants were admitted and included in the detailed case analysis study. One hundred and ninety-nine babies were between 0 and 7 days of age and 210 babies between 8 and 30 days. The remaining 2,295 infants were between 1 month and 12 months of age. Death scene investigation was done in a total of 14 (0.5 %) cases. Discrepancies were present in the extent of the macroscopic post-mortem examinations, as well as the type and extent of the ancillary investigations performed. The investigations were completed in 2,583 of the cases. The majority of these infants died from natural disease processes [1,976 infants (76.5 %)]. Bronchopneumonia was the leading cause of natural deaths at all the mortuaries [674 cases (26.1 %)]. SIDS was diagnosed in only 224 cases (8.7 %) and in 383 (14.8 %) cases, where a full post-mortem examination with ancillary investigations was conducted the cause of death was recorded as "unascertained." This study indicated that the admission criteria (to medico-legal mortuaries) and the investigative process rotocols in cases of SUDI differ greatly among 5 of the largest academic medical institutions in South Africa. Establishing and implementing standardized admission criteria (to medico-legal mortuaries) and implementing uniform investigative and autopsy protocols would appear to be an essential prerequisite to gain better understanding of the mystery of SIDS in South Africa.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2016
Publisher: Academy of Science of South Africa
Date: 2020
Publisher: South African Medical Association NPC
Date: 25-04-2014
DOI: 10.7196/SAJCH.664
Publisher: AOSIS
Date: 23-06-2022
Abstract: Background: Formalin-fixed paraffin-embedded (FFPE) tissue archives in hospitals, biobanks, and others offer a vast collection of extensive, readily available specimens for molecular testing. Unfortunately, the use of tissue s les for molecular diagnostic applications is challenging thus, the forensic pathology FFPE tissue archives in Africa have been a largely unexploited genetic resource, with the usability of DNA obtainable from these s les being unknown.Intervention: The study, conducted from January 2015 to August 2016, determined the usefulness of FFPE tissue as a reliable source of genetic material for successful post-mortem molecular applications and diagnostics. Formalin-fixed paraffin-embedded tissue s les were collected and archived from autopsies conducted over 13 years in the forensic medicine department of the University of Pretoria (Pretoria, South Africa). Deoxyribonucleic acid from FFPE tissue s les and control blood s les was lified by high-resolution melt real-time polymerase chain reaction before sequencing. The procurement parameters and fixation times were compared with the quantity and quality of the extracted DNA and the efficiency of its subsequent molecular applications.Lessons learnt: This study has shown that FFPE s les are still usable in molecular forensics, despite inadequate s le preparation, and offer immense value to forensic molecular diagnostics.Recommendations: FFPE s les fixed in formalin for more than 24 h should still be used in molecular diagnostics or research, as long as the primer design targets licons not exceeding 300 base pairs.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.FORSCIINT.2015.02.005
Abstract: In a country notorious for violent crime, it seems that South African medico-legal laboratories make minimal application of technology in the death investigation process and little attention is given to trace evidence. Non-destructive, non-invasive, portable and cost-effective tools are required. This study was conducted at the Pretoria Medico-Legal Laboratory. The surface area of the bodies and clothing of victims of fatal interpersonal violence were examined using a torch, magnifying l , portable digital microscope and alternate light source to gauge their potential for trace evidence detection. Most studies apply these and similar tools to inert surfaces, with few focusing on their application to human skin. There was a statistically significant difference in the detection of many of the evidence types between the naked-eye observation of the pathologists and the technologies. The different imaging technologies were compared as to their cost, evidence detection ability and ease of use. The most common evidence types discovered on the bodies and clothing of victims of fatal interpersonal violence, as well as the propensity of each tool to detect these, was evaluated in order to devise the best option for incorporation into the Pretoria Medico-Legal Laboratory routine. The digital microscope performed best overall followed by the magnifying l , torch and the Polilight(®). This study aimed to justify the investment of more time, effort and funding into trace evidence recovery in the South African mortuary environment.
Publisher: South African Medical Association NPC
Date: 08-05-2016
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.CARPATH.2016.03.003
Abstract: According to the World Health Organization, an estimated 9 million people contracted tuberculosis (TB) with approximately 25% of TB cases being from Africa. TB was reported as the number one cause of natural death for the period 2011-2013 in South Africa. The first reported case of myocardial TB was in 1664 by Maurocordat and the first reported case of sudden cardiac death due to TB was made in 1977. We present a case report of myocardial TB in an apparently healthy, 35-year-old male who died suddenly while driving his car. The problems associated with the diagnosis of TB of the myocardium and an overview of the relevant literature is provided.
Publisher: SAGE Publications
Date: 2011
DOI: 10.4137/CMC.S6507
Abstract: Left ventricular noncompaction has been classified as a primary cardiomyopathy with a genetic origin. This condition is morphologically characterized by a thickened, two-layered myocardium with numerous prominent trabeculations and deep, intertrabecular recesses. Recently, it has become clear that these pathological characteristics extend across a continuum with left ventricular hypertrabeculation at one end of the spectrum. The histological findings include areas of interstitial fibrosis. We present a case of left ventricular hypertrabeculation which presented as sudden infant death syndrome. Histologically areas of subendocardial fibrosis was prominent and we propose that this entity may be a hidden cause of arrhythmic death in some infants presenting as sudden infant death syndrome., with areas of subendocardial fibrosis as possible arrhythmogenic foci.
Publisher: SAGE Publications
Date: 2010
DOI: 10.4137/CMC.S5933
Abstract: Left ventricular noncompaction/hypertrabeculation is a condition which is characterized by a highly trabeculated, “spongy” myocardium. It can present at any age with heart failure, arrhythmia and/or thromboembolic events. A wide variety of mutations have been found to be a cause of hypertrabeculation and it is possible that there is a continuum of hypertrophic cardiomyopathy, dilated cardiomyopathy and hypertrabeculation/noncompaction. We present a case of left ventricular hypertrabeculation which presented as sudden infant death syndrome and we propose that this entity may be a hidden cause of arrhythmic death in some infants presenting as sudden infant death syndrome.
No related grants have been discovered for Lorraine du Toit-Prinsloo.