Research Articles (Forensic Medicine)

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A 10-year review of fatal community assault cases at a regional forensic pathology facility in Cape Town, South Africa
(Health and Medical Publishing Group, 2015) Herbst, Celeste Ingrid; Tiemensma, Marianne; Wadee, Shabir Ahmed
Background. An increase in autopsied community assault (CA) fatalities was observed at the Tygerberg Forensic Pathology Services (FPS), Cape Town, South Africa (SA). There is a paucity of information on the incidence and prevalence of these cases in SA. Objectives. To determine the patterns and trends of injuries sustained in so-called CA fatalities. Methods. A retrospective and descriptive study was conducted. Fatal CA cases admitted to the Tygerberg FPS over the 10-year period 1 January 2003 - 31 December 2012 were reviewed. Data were collected from autopsy/postmortem reports, contemporaneous notes, attached hospital records, the South African Police Services (SAPS) 180 form (completed by the SAPS representative) and other FPS documentation. Results. A total of 424 cases of fatal CA were seen during the study period, with an annual increase between 2003 and 2007 and a second peak in 2012. The cause of death in most cases was multiple injuries (42.0%), with blunt-force trauma being the basis of most injuries sustained. The area with the greatest burden of injury was the township of Mfuleni (73 CA deaths per 100 000 population). There was a predominance of males, with only one female fatality recorded. Conclusion. Adequate policing in prevalent areas is essential to address unnecessary loss of life and the burden imposed by these cases on the criminal justice system and healthcare services.
Aircraft fatality investigation as a function of a comprehensive health service
(Health & Medical Publishing Group, 1977-07-20) Schwar, T. G.
[No abstract available]
Death certificates : let’s get it right!
(Health and Medical Publishing Group (HMPG), 2009-09) Pieterse, Desiree; Groenewald, Pam; Bradshaw, Debbie; Burger, Elsie H.; Rohde, Jon; Reagon, Gavin
Errors in the completion of the death notification form
(Health and Medical Publishing Group (HMPG), 2007-11) Burger, Elsie Helena; Van der Merwe, Lize; Volmink, Jimmy
Objectives. To determine the frequency of errors in the cause of death sequence and to assess the completeness of information recorded on death notification forms (DNFs). Design. A population-based descriptive study. Setting. All residents of two residential areas in the Cape Town metropole who died during the period 1 June 2003 to 31 May 2004. Methods. We examined DNFs for pre-specified major and minor errors, assessed potential predictors of major errors using multivariate analysis, and assessed the DNFs for completeness in terms of particulars of the deceased, the informant and the health professional certifying death. Results. 844 DNFs were evaluated. Errors were found in 91.7% (95% CI 89.7 - 93.4%) of DNFs, and 43.4% (95% CI 40.1 - 46.7%) had at least one major error, most commonly an illogical cause of death sequence. Factors that seemed to affect the frequency of major errors were the number of lines of the cause of death sequence that had been completed, the age, gender and area of residence of the deceased, and the type of facility where the DNF had been completed. Varying levels of completeness were found for different items of information with some questions such as the education, occupation, usual business and smoking history of deceased being largely ignored by health professionals. Conclusion. An unacceptably high proportion of DNFs in the greater Cape Town area contain errors sufficiently serious to affect the accuracy of cause of death coding. This has far-reaching implications for the reliability of mortality data in South Africa. Educational, managerial and administrative interventions are urgently needed to improve the standard of DNF completion.
Establishing the College of Pathologists of East, Central and Southern Africa – The Regional East Central and Southern Africa College of Pathology
(2020-06-03) Sayed, Shahin; Mutasa, Rudo; Kaaya, Ephata
The scarcity of pathologists in sub-Saharan Africa is a well established fact that is attributable to few training programmes in the region; this is further compounded by the lack of harmonised curricula, training and exams within and without member countries. Description of the intervention: Through the Association of Pathologists of East, Central and Southern Africa, the College of Pathologists of East, Central and Southern Africa (COPECSA) was formed with the clear-cut goal of establishing a regional and internationally recognised college to support and inform good quality medical and laboratory practice by promoting leadership, mentorship and excellence in the safe practice of pathology through training, exams, accreditation, advocacy and professional development for health. Lessons learnt: Since its inception in 2010, COPECSA has conferred fellowships to 120 practising pathologists in the East, Central and Southern Africa in partnership with international organisations; the college has been awarded five competitive grants and conducted several quality improvement workshops. Recommendations: This paper describes the journey that COPECSA has made towards standardising the practice and training of pathology in the East Central and Southern Africa region.
Medical certification of death in South Africa – moving forward
(Health & Medical Publishing Group, 2015) Burger, Elsie Helena; Groenewald, Pam; Rossouw, Anastasia; Bradshaw, Debbie
Despite improvements to the Death Notification Form (DNF) used in South Africa (SA), the quality of cause-of-death information remains suboptimal. To address these inadequacies, the government ran a train-the-trainer programme on completion of the DNF, targeting doctors in public sector hospitals. Training materials were developed and workshops were held in all provinces. This article reflects on the lessons learnt from the training and highlights issues that need to be addressed to improve medical certification and cause-of-death data in SA. The DNF should be completed truthfully and accurately, and confidentiality of the information on the form should be maintained. The underlying cause of death should be entered on the lowest completed line in the cause-of-death section, and if appropriate, HIV should be entered here. Exclusion clauses for HIV in life insurance policies with Association of Savings and Investments South Africa companies were scrapped in 2005. Interactive workshops provide a good learning environment, but are logistically challenging. More use should be made of online training resources, particularly with continuing professional development accreditation and helpline support. In addition, training in the completion of the DNF should become part of the curriculum in all medical schools, and part of the orientation of interns and community service doctors in all facilities.
Medical mistakes-a student's perspective
(Health and Medical Publishing Group (HMPG), 2011-12) Van Schalkwyk, Gerrit; Moodley, Keymanthri
‘Only one rule in medical ethics need concern you – that action on your part which best conserves the interests of your patient.’ Martin H Fischer. Although Fischer’s premise seems perfectly reasonable, the alarming public perception that medical mistakes are commonplace suggests that even this ‘one rule’ is not being followed to the extent that patients are confident that their best interests will be preserved. This article aims to explore this concept from the perspective of a medical student. Rather than offer a comprehensive review of the topic, the focus will be on some rather unusual and possibly controversial views, which aim to highlight the unique constraints and difficulties of the medical profession.
Shaken baby syndrome : a South African medico-legal perspective
(North-West University, 2014) Le Roux-Kemp, A.; Burger, E.
Shaken Baby Syndrome refers to the violent and repetitive shaking of an infant, and is a form of abusive head trauma. It was first described in 1974, and has since been the topic of intensive study and discussion. The syndrome has classically been diagnosed with a triad of injuries, namely subdural haemorrhage, retinal haemorrhage and encephalopathy (brain abnormalities). However, recent publications have led to some doubt regarding the causation and diagnostic significance of the triad. It is now generally accepted that other conditions, even natural diseases, may cause the findings listed in the so-called "triad". To date, no reported case law is available on Shaken Baby Syndrome in South Africa; therefore this article focuses on cases in the United States and United Kingdom to delineate some of the issues associated with litigating the condition. This includes the obligation of expert witnesses to give independent, factual evidence about their areas of expertise. It is recommended that medical and legal professionals involved in cases of alleged child abuse should collect as much information as possible about the context of the case. Confessions by parents or caregivers should be treated with circumspection. Awareness campaigns should be aimed at informing the public of the dangers of shaking an infant. And with regards to Shaken Baby Syndrome an increased focus on evidence-based medicine is necessary to dissipate the uncertainty around the condition.
Sudden and unexpected deaths in an adult population, Cape Town, South Africa, 2001-2005
(Health and Medical Publishing Group (HMPG), 2012-02) Tiemensma, Marianne; Burger, Elsie Helena
Background. According to the regulations of the National Health Act, all 'sudden and unexpected' deaths in South Africa should be referred to Forensic Pathology Services (FPS) for further investigation. Objectives. We aimed to determine the final outcomes of forensic postmortem examinations in 'sudden and unexpected' adult deaths referred to Tygerberg FPS between 2001 and 2005. Methods. The study was a retrospective descriptive study. Demographic and autopsy data from adult cases of 'sudden and unexpected deaths' referred to Tygerberg FPS were collected and analysed. Results. Some 816 adult cases of 'sudden' deaths were studied. The presumed manner of death was natural in 645 (79.0%) cases, unnatural in 99 (12.2%), and undetermined in 72 (8.8%). Diseases of the cardiovascular, respiratory and central nervous systems accounted for the majority of natural deaths. Infectious diseases accounted for most deaths in the youngest age group studied (18 - 29 years); however, ischaemic heart disease was the most prevalent cause of death in the total study population. Conclusions. This study highlighted the lack of useful preautopsy information and therefore the performance of 'unnecessary' medicolegal autopsies in a resource-limited country. Clinicians could ease the burden by giving useful information when referring cases to FPS. Feedback should be given to family members, especially where the cause of death may have an impact on surviving family members.
Sudden death on an aeroplane
(Health and Medical Publishing Group (HMPG), 2010-03) Tiemensma, M.; Buys, Philip; Wadee, S. A.
Objective. To determine the leading causes of perinatal deaths and to evaluate any changes, with the inclusion of placental histology. Method. At perinatal mortality meetings, primary and final causes of death were assigned for the period 1 July 2006 - 30 June 2007. All singleton babies born to women residing in the metropolitan area serviced by Tygerberg Hospital were included in the prospective descriptive study. Results. The total number of singleton births was 10 396. The total of perinatally related losses (TPRL) rate was 26.2 per 1 000 births. The leading primary obstetric causes of death were: infections (47 - 17.3%), spontaneous preterm labour (PTL) (41 - 15.1%), antepartum haemorrhage (APH) (40 - 14.7%), intra-uterine growth restriction (IUGR) (40 - 14.7%), fetal abnormality (31 - 11.4%), hypertensive disorders (25 - 9.2%), unexplained intra-uterine deaths (IUD) (20 - 7.4%), intrapartum hypoxia (12 - 4.4%) and maternal disease (9 - 3.3%). A total of 162 placentas were sent for histology; 58 reports changed the primary cause of death. Conclusion. The TPRL rate for singleton pregnancies was 26.2 per 1 000 births for the study period. The TPRL rates in 1986 and 1993 were 36.7 and 30.5 per 1 000 deliveries. Infection is now the leading primary cause of death, followed by spontaneous PTL, APH and IUGR. During the previous two study periods, APH was the leading primary cause of death, followed by spontaneous PTL. Unexplained IUDs ranked third in 1986, fourth in 1993 and seventh in this study because of the availability of placental histology. Placental histology reports changed 21.3% of the primary causes of death.
Tuberculosis and phrenic nerve destruction
(Health and Medical Publishing Group (HMPG), 2007-08) Dempers, Johan J.; Bezuidenhout, Juanita; Schneider, Johann W.; Janse van Rensburg, Michele
ENGLISH ABSTRACT: Phrenic nerve palsy (PNP) is often associated with Mycobacterium tuberculosis-related expansile pneumonia, possibly because of nerve entrapment by healing fibrosis. Mohan and Jayaswal1 postulated that pressure on the left phrenic nerve by an enlarged hilar lymph node caused unilateral diaphragmatic paralysis in a 6-year-old boy who developed PNP during the course of pulmonary tuberculosis (PTB). Gie et al. described 6 childhood cases of PTB complicated by unilateral PNP. The children did not recover on antituberculosis drugs and steroids, or in 1 case, after surgical decompression. Therefore the theory of glandular compression alone does not adequately account for PNP as a complication of PTB. Our case, in which the fate of the phrenic nerve was confirmed, provides strong evidence that destruction of the phrenic nerve by the tuberculous inflammatory process is involved in the pathogenesis of diaphragmatic paralysis, which may influence the clinical management of these children.
Vasectomy under local anaesthesia performed free of charge as a family planning service : complications and results
(Health and Medical Publishing Group (HMPG), 2009-04) Trollip, G. S.; Fisher, M.; Naidoo, A.; Theron, P. D.; Heyns, C. F.
Objective. To evaluate the safety and efficacy of vasectomy performed under local anaesthesia by junior doctors at a secondary level hospital as part of a free family planning service. Method. Men requesting vasectomy were counselled and given written instructions to use alternative contraception until two semen analyses 3 and 4 months after vasectomy had confirmed azoospermia. Bilateral vasectomy was performed as an outpatient procedure under local anaesthesia by junior urology registrars. Statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, Fisher's exact or Spearman's rank correlation tests as appropriate. Results. Between January 2004 and December 2005, 479 men underwent vasectomy at Karl Bremer Hospital, Western Cape, South Africa; their average age was 36.1 (range 21 - 66) years, they had a median of 2 (range 0 - 10) children, and only 19% had 4 or more children. The average operation time was 15.5 (range 5 - 53) minutes. Complications occurred in 12.9%; these were pain (7.3%), swelling (5.4%), haematoma (1.3%), sepsis (1%), difficulty locating the vas (1%), vasovagal episode (0.6%), bleeding (0.6%), wound rupture (0.4%) and dysuria (0.2%) (some men had more than one complication). Of the men 63.3% returned for one semen analysis and 17.5% for a second. The vasectomy failure rate ranged from 0.4% (sperm persisting >365 days after vasectomy) to 2.3% (sperm seen >180 days after vasectomy and/or in the second semen specimen). No pregnancies were reported. The complication (5.6%) and failure rates (0%) were lowest for the registrar who had performed the smallest number of vasectomies and whose average operation time was longest. Comparing the first one-third of procedures performed by each of the doctors with the last one-third, there was a significant decrease in average operating times but not in complication rates. Conclusions. Vasectomy can be performed safely and effectively by junior doctors as an outpatient procedure under local anaesthesia, and should be actively promoted in South Africa as a safe and effective form of male contraception.

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