Rationale
Transient myopericarditis has been recognised as an uncommon and usually mild adverse event predominantly linked to mRNA-based COVID-19 vaccines. These have mostly occurred in young males ...after the second dose of mRNA COVID-19 vaccines.
Objectives
Fulminant necrotising eosinophilic myocarditis triggered by a variety of drugs or vaccines is an extremely rare hypersensitivity reaction carrying a substantial mortality risk. Early recognition of this medical emergency may facilitate urgent hospital admission for investigation and treatment. Timely intervention can lead to complete cardiac recovery, but the non-specific clinical features and rarity make early diagnosis challenging.
Findings
The clinical and pathological observations from a case of fatal fulminant necrotising myocarditis in a 57-year-old woman, following the first dose of the Pfizer-BioNTech vaccine, are described. Other causes have been discounted with reasonable certainty.
Conclusion
These extremely rare vaccine-related adverse events are much less common than the risk of myocarditis and other lethal complications from COVID-19 infection. The benefits of vaccination far exceed the risks of COVID-19 infection.
Postmortem computed tomography (PMCT) is a relatively recent advancement in forensic pathology practice that has been increasingly used as an ancillary investigation and screening tool. One area of ...clinical CT imaging that has garnered a lot of research interest recently is the area of “artificial intelligence” (AI), such as in screening and computer‐assisted diagnostics. This feasibility study investigated the application of convolutional neural network, a form of deep learning AI, to PMCT head imaging in differentiating fatal head injury from controls. PMCT images of a transverse section of the head at the level of the frontal sinus from 25 cases of fatal head injury were combined with 25 nonhead‐injury controls and divided into training and testing datasets. A convolutional neural network was constructed using Keras and was trained against the training data before being assessed against the testing dataset. The results of this study demonstrated an accuracy of between 70% and 92.5%, with difficulties in recognizing subarachnoid hemorrhage and in distinguishing congested vessels and prominent falx from head injury. These results are promising for potential applications as a screening tool or in computer‐assisted diagnostics in the future.
Weighing of organs is a standard requirement in post-mortem examination. Ideally, the lungs should be weighed intact to prevent pulmonary fluids loss. However, there are instances where the lungs are ...weighted fully or partially dissected. Although suggested to be 'appreciable', the amount of pulmonary fluid loss from dissecting the lung is not quantified. To quantify the amount of pulmonary fluid loss from dissecting the lung at post-mortem, this study compared 40 pairs of lungs weighed intact and dissected using two different dissection methods. The result of our study showed that the amount of pulmonary fluid loss may vary from different dissection methods and correlates positively (weakly to moderately) with intact lung weight. However, the average pulmonary fluid loss from dissection was <20 g (<3% of the intact lung weight) and was considered neither clinically significant nor 'appreciable'.
Diagnosing traumatic brain injury (TBI) from body fluids in cases where there are no obvious external signs of impact would be useful for emergency physicians and forensic pathologists alike. None of ...the previous attempts has so far succeeded in establishing a single biomarker to reliably detect TBI with regards to the sensitivity: specificity ratio in a post mortem setting. This study investigated a combination of body fluid biomarkers (obtained post mortem), which may be a step towards increasing the accuracy of biochemical TBI detection. In this study, serum and cerebrospinal fluid (CSF) samples from 30 acute lethal TBI cases and 70 controls without a TBI-related cause of death were evaluated for the following eight TBI-related biomarkers: brain-derived neurotrophic factor (BDNF), ferritin, glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6), lactate dehydrogenase, neutrophil gelatinase-associated lipocalin (NGAL), neuron-specific enolase and S100 calcium-binding protein B. Correlations among the individual TBI biomarkers were assessed, and a specificity-accentuated threshold value analysis was conducted for all biomarkers. Based on these values, a decision tree modelling approach was performed to assess the most accurate biomarker combination to detect acute lethal TBIs. The results showed that 92.45% of acute lethal TBIs were able to be diagnosed using a combination of IL-6 and GFAP in CSF. The probability of detecting an acute lethal TBI was moderately increased by GFAP alone and considerably increased by the remaining biomarkers. BDNF and NGAL were almost perfectly correlated (
= 0.002; R
= 0.944). This study provides evidence that acute lethal TBIs can be detected to a high degree of statistical accuracy using forensic biochemistry. The high inter-individual correlations of biomarkers may help to estimate the CSF concentration of an unknown biomarker, using extrapolation techniques.
Using post-mortem vitreous humour (VH) electrolyte in estimating the post-mortem interval (PMI) is not well studied in the infant population. We hypothesize that VH can be useful in estimating PMI in ...shorter PMI. This 5-year retrospective study investigated the changes in VH electrolytes (Na
+
, Cl
−
and K
+
) with respect to shorter PMI. This study examined PMI <48 hours and stratified the PMI into two groups (i.e. <24 hours and 24-48 hours). The electrolyte levels were compared and linear regression analysis was performed between the two groups. Our result showed that K
+
increases with PMI and is a relatively good estimator (compared to adults) for PMI especially when PMI was <24 hours. Na
+
and Cl
−
showed some evidence that they decrease with PMI but have no use in estimating PMI. The results from this study suggested K
+
is useful in estimating PMI but limited to only when the PMI is <24 hours.
Many previous studies have investigated the use of post-mortem biochemistry to estimate the post-mortem interval (PMI). Vitreous humour (VH) potassium and sodium/chloride levels are well recognized ...to increase and decrease, respectively, in the post-mortem period but have limited ability in estimating PMI. Cerebrospinal fluid (CSF) is described to have different post-mortem biochemical properties than VH, but is not well studied in relation to estimating PMI. This exploratory study examined 20 paired cases of VH and CSF to investigate their use in estimating PMI. Linear univariate analysis showed Na
+
, Cl
−
and K
+
in VH and CSF share similar trends, but only K
+
in VH and CSF collected via lumbar puncture (LP) showed a significant regression coefficient (p < 0.01). In subsequent linear multivariate analysis, the coefficient for K
+
in VH remained positive and significant but not for K
+
in CSF. Only minor improvement was observed in the multivariate analysis. Our study showed changes in analytes in VH and CSF follow similar trends. K
+
in VH is most accurate in estimating the PMI, with no significant improvement in accuracy when K
+
in CSF is combined. Thus, the role of CSF electrolytes in estimating PMI may be very limited.
Cardiopulmonary resuscitation (CPR) can create a range of unusual lesions and injuries, which may complicate forensic evaluation. Although potentially sinister findings, neck injury and conjunctival ...petechiae may also be seen in patients who have undergone CPR. We report a case of an individual with subcutaneous bruising and hemorrhage in the deep structures of the neck and florid conjunctival petechiae at autopsy that can be explained by cardiopulmonary resuscitation and meningococcal sepsis.
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