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Dul-Amnuay A. Case Study of Autopsy Findings in a Population of Post-COVID-19 Vaccination in Thailand. Am J Forensic Med Pathol 2024; 45:45-50. [PMID: 38127652 DOI: 10.1097/paf.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ABSTRACT Thailand began offering the coronavirus disease 2019 (COVID-19) vaccine nationwide in February 2021, with 1,885 deaths reported by the end of the year. Therefore, it is essential to assess the correlation between vaccination and cause of death from autopsy. This study included 34 autopsies of a deceased within 30 days after COVID-19 vaccination performed in Bangkok under the postmortem inquest service area of Bhumibol Adulyadej Hospital. The autopsies were performed by forensic pathologists. Moreover, detailed information about the deceased was collected, including age, sex, medical records, vaccination history, scene investigation reports, autopsy reports, cause of death, and a probable causal relationship between vaccination and cause of death. There were 24 males (70.59%), and the average age of the deceased was 52.76 years. Of all individuals, 28 (82.36%), 4 (11.76%), and 2 (5.88%) were vaccinated with AstraZeneca, Sinopharm, and SinoVac, respectively. The most common cause of death was ischemic heart disease (n = 17). None of the deceased patients had a causal relationship to the vaccine. Deaths were due to natural causes, as no definitive link between vaccination and cause of death was established in the study.
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Navlani LL, Verma A, Meshram R, Vaibhav V, Parate SV. Challenges in Diagnosing Sudden Death Caused by Acute Hemorrhagic Pancreatitis: An Autopsy-Based Case Report. Cureus 2023; 15:e49500. [PMID: 38152772 PMCID: PMC10752382 DOI: 10.7759/cureus.49500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Forensic pathologists frequently encounter cases of sudden natural death. Most sudden natural deaths are attributed to cardiac causes. Acute pancreatitis, especially hemorrhagic pancreatitis, is an infrequent yet critical contributor to sudden death. The role of a forensic pathologist is imperative in such cases to find out the cause of the sudden death and to either confirm or refute any allegations. In this context, we describe a case of a 34-year-old male who experienced sudden death due to acute hemorrhagic pancreatitis, highlighting the need for a detailed autopsy, pathophysiological insights, and diagnostic challenges.
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Affiliation(s)
- Lakhan Lal Navlani
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Arushi Verma
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Raviprakash Meshram
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Vikas Vaibhav
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Shailesh V Parate
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
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Almohammadi AA, Aljafri OH, Esawi HH, Alzhrani AA, Alharbi MS. The Etiology and Epidemiological Features of Acute Pancreatitis in Saudi Arabia: A Systematic Review. Cureus 2023; 15:e46511. [PMID: 37927657 PMCID: PMC10625166 DOI: 10.7759/cureus.46511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
We aimed to identify the etiology of acute pancreatitis (AP) and its most common causes with its epidemiological features among the Saudi population in 2023 in different regions. In this systematic review, we assessed the etiology and epidemiological features of acute pancreatitis in Saudi Arabia following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines. Inclusion criteria were studies conducted in Saudi Arabia, published in English, and involving participants aged 18 years or older. PubMed and Google Scholar were searched in March 2023 for English articles published between 1985 and 2023 using specific keywords. Two reviewers screened titles, abstracts, and full-text articles for eligibility, with disagreements resolved by a third reviewer. Data on study characteristics, participant demographics, and etiological factors were extracted using a standardized form. Descriptive analysis summarized the etiology of acute pancreatitis in Saudi Arabia based on the extracted data. Out of the 58 studies retrieved for screening, 10 studies were included in the final systematic review, and most of them were done in the Riyadh region. The sum of the sample size was 1,695 participants. In Saudi Arabia, the most prevalent cause of acute pancreatitis is biliary stones. The average mortality rate of acute pancreatitis in reported studies is 2.2%. In conclusion, biliary and idiopathic causes are the most frequent etiologies of AP in some different regions of Saudi Arabia, acute peripancreatic fluid collections and pancreatic pseudocysts are the two most commonly reported complications associated with AP, and the mortality rate of AP in Saudi Arabia may be higher compared to developed countries.
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Affiliation(s)
- Ahmed A Almohammadi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Owais H Aljafri
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Hossam H Esawi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Anas A Alzhrani
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Muteb S Alharbi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
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Bashir B, Ho JH, Downie P, Hamilton P, Ferns G, Datta D, Cegla J, Wierzbicki AS, Dawson C, Jenkinson F, Delaney H, Mansfield M, Teoh Y, Miedzybrodzka Z, Haso H, Durrington PN, Soran H. Severe Hypertriglyceridaemia and Chylomicronaemia Syndrome-Causes, Clinical Presentation, and Therapeutic Options. Metabolites 2023; 13:metabo13050621. [PMID: 37233662 DOI: 10.3390/metabo13050621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
We have reviewed the genetic basis of chylomicronaemia, the difference between monogenic and polygenic hypertriglyceridaemia, its effects on pancreatic, cardiovascular, and microvascular complications, and current and potential future pharmacotherapies. Severe hypertriglyceridaemia (TG > 10 mmol/L or 1000 mg/dL) is rare with a prevalence of <1%. It has a complex genetic basis. In some individuals, the inheritance of a single rare variant with a large effect size leads to severe hypertriglyceridaemia and fasting chylomicronaemia of monogenic origin, termed as familial chylomicronaemia syndrome (FCS). Alternatively, the accumulation of multiple low-effect variants causes polygenic hypertriglyceridaemia, which increases the tendency to develop fasting chylomicronaemia in presence of acquired factors, termed as multifactorial chylomicronaemia syndrome (MCS). FCS is an autosomal recessive disease characterized by a pathogenic variant of the lipoprotein lipase (LPL) gene or one of its regulators. The risk of pancreatic complications and associated morbidity and mortality are higher in FCS than in MCS. FCS has a more favourable cardiometabolic profile and a low prevalence of atherosclerotic cardiovascular disease (ASCVD) compared to MCS. The cornerstone of the management of severe hypertriglyceridaemia is a very-low-fat diet. FCS does not respond to traditional lipid-lowering therapies. Several novel pharmacotherapeutic agents are in various phases of development. Data on the correlation between genotype and phenotype in FCS are scarce. Further research to investigate the impact of individual gene variants on the natural history of the disease, and its link with ASCVD, microvascular disease, and acute or recurrent pancreatitis, is warranted. Volanesorsen reduces triglyceride concentration and frequency of pancreatitis effectively in patients with FCS and MCS. Several other therapeutic agents are in development. Understanding the natural history of FCS and MCS is necessary to rationalise healthcare resources and decide when to deploy these high-cost low-volume therapeutic agents.
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Affiliation(s)
- Bilal Bashir
- Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Department of Endocrinology, Diabetes & Metabolism, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Jan H Ho
- Department of Endocrinology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Paul Downie
- Department of Laboratory Medicine, Salisbury NHS Foundation Trust, Salisbury SP2 8BJ, UK
| | - Paul Hamilton
- Centre for Medical Education, Queen's University Belfast, Belfast BT7 1NN, UK
- Department of Clinical Biochemistry, Belfast Health and Social Care Trust, Belfast BT13 1FD, UK
| | - Gordon Ferns
- Brighton and Sussex Medical School, Brighton BN1 9PH, UK
| | - Dev Datta
- Lipid Unit, University Hospital Llandough, Cardiff CF64 2XX, UK
| | - Jaimini Cegla
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London SW7 2BX, UK
| | - Anthony S Wierzbicki
- Department of Metabolic Medicine and Chemical Pathology, Guy's and St. Thomas' Hospitals, London SE1 7EH, UK
| | - Charlotte Dawson
- Department of Metabolic Medicine, Queen Elizabeth Hospital NHS Foundation Trust, Birmingham PE30 4ET, UK
| | - Fiona Jenkinson
- Clinical Biochemistry and Metabolic Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Hannah Delaney
- Department of Clinical Chemistry, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Michael Mansfield
- Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - Yee Teoh
- Department of Chemical Pathology & Metabolic Medicine, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - Zosia Miedzybrodzka
- Department of Medical Genetics, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Haya Haso
- School of Medicine, University of Kurdistan Hewler, Erbil 44001, Iraq
| | - Paul N Durrington
- Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Handrean Soran
- Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Department of Endocrinology, Diabetes & Metabolism, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Hong XX, Wang HY, Yang JM, Lin BF, Min QQ, Liang YZ, Huang PD, Zhong ZY, Guo SJ, Huang B, Xu YF. Systemic injury caused by taurocholate‑induced severe acute pancreatitis in rats. Exp Ther Med 2022; 24:468. [PMID: 35747153 PMCID: PMC9204573 DOI: 10.3892/etm.2022.11395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/13/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Xin-Xin Hong
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Hong-Yan Wang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Jiong-Ming Yang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Bao-Fu Lin
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Qin-Qin Min
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Yi-Zhong Liang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Pei-Di Huang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Zi-You Zhong
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Shao-Ju Guo
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Bin Huang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
| | - Yi-Fei Xu
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, P.R. China
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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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Ben Abderrahim S, Gharbaoui M, Békir O, Hamdoun M, Allouche M. Sudden death related to the gastrointestinal system in Tunisia: A 13 year autopsy study. J Forensic Sci 2021; 67:596-604. [PMID: 34897679 DOI: 10.1111/1556-4029.14953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 12/20/2022]
Abstract
Sudden gastrointestinal (GI) death is an unexpected death due to digestive system causes mainly found after autopsy. The literature is rich in articles that studied sudden death due to cardiac causes while sudden GI deaths remain less well-documented. We retrospectively investigated all cases of gastrointestinal death at the Department of Forensic Medicine in Tunis, over 13 years (January 1, 2006 to December 31, 2018). Two hundred and eight cases were collected. The mean age of our series was 51.06 ± 20.99 years. No history of digestive disorders was reported in 78.4%, and no family history of sudden death was found in any cases. A male predominance was found in most epidemiological characteristics of the sample with a significant statistical rate in some features. Non-specific abdominal pain was the most described symptom (n = 92). Perforation of GI tract was the common mechanism involved in the death of 55 cases, of which 44 were related to ulcer perforation. These ulcer perforations were statistically more reported in smokers and people suffering from schizophrenia. Intestinal obstruction was the second commonest cause of death, mainly found in the elderly. Sudden death in children was most frequently caused by acute intussusception. This study highlights that systematic study of sudden death due to GI causes might provide opportunities to identify avenues for overall health improvement.
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Affiliation(s)
- Sarra Ben Abderrahim
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Olfa Békir
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Moncef Hamdoun
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
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Sessa F, Esposito M, Messina G, Di Mizio G, Di Nunno N, Salerno M. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Healthcare (Basel) 2021; 9:870. [PMID: 34356248 PMCID: PMC8307931 DOI: 10.3390/healthcare9070870] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022] Open
Abstract
The medico-legal term "sudden death (SD)" refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Economy and Sociology, Campus “S. Venuta”, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
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Abstract
Gallstone disease is the most common gastrointestinal disease in developed countries and is present in up to 15% of the population. Owing to the increased risk factors for gallstones in pregnancy, it is the second most common non-obstetric emergency, affecting up to 12% of pregnant women with a risk of recurrence. Up to 3% of pregnant women in America require a cholecystectomy in the first year after delivery. Gallstone disease has a high risk of developing associated complications, and maternal mortality can be up to 37% if the patient develops gallstone pancreatitis. Endoscopic retrograde cholangiopancreatography and cholecystectomy can be performed safely in the second trimester when benefits outweigh the risks. However, if the patient is able to be managed conservatively, then a cholecystectomy should be performed in the postnatal period to avoid further recurrences and complications. Despite this, there is currently no national UK guidance on how to manage gallstones and related diseases during pregnancy.
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Affiliation(s)
- Ecf Hess
- Department of Obstetrics & Gynaecology, Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK
| | - R P Thumbadoo
- Department of General Surgery, Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK
| | - Ecp Thorne
- Department of Emergency Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - K McNamee
- Department of Obstetrics & Gynaecology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
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