Sudden unexpected death in the young (SUDY) is the unanticipated demise of individuals aged between 1 and 40 years. In South Africa, these deaths are referred for forensic investigation. The primary aim of this study was to retrospectively investigate the frequency of known risk factors in SUDY cases admitted to Salt River Mortuary in Cape Town and explore differences between males and females. There were 1 088 SUDY cases identified with 0.9% (10/1 088) missing files. Reviewed cases were n=1 078, 62.6% (675/1 078) males, and 37.4% (403/1 078) females; 83.5% (901/1 078) adults and 16.4% (177/1 078) children, accounting for 5.6% of total admissions between 1 January 2010 and 31 December 2015. Despite the predominance of males, significantly more females (61.8%) were obese (p < 0.05). At least one primary medical condition was present in 53.7% of cases, with the leading conditions being tuberculosis (11.9 % of adult males), epilepsy (11.7% of adult males; 10.3% of female children), HIV (10.7% of adult females) and asthma (11.1% of male children). In the subset of the study population where information was available, before death, 74% of individuals were reported to have experienced prodromal symptoms; 37.6% of males and 32.4% of females did not seek medical intervention following symptoms. Information regarding a family history of sudden death was known in 237/1078 cases. In 3.2% of these cases, a family history of sudden death was reported. Significantly more males than females reported the use of tobacco, alcohol, and other illicit drugs (p < 0.05). More females were unemployed (p < 0.05). Interventions based on lifestyle modification, social support, pharmacologic needs, and awareness should be targeted at individuals with the above profiles, especially those with a family history of sudden death, as they may be high-risk groups. Findings from this study contribute new and relevant local reference data for SUDY risk profiles of males and females admitted to Salt River Mortuary.

Carbon monoxide (CO) is a gas that exerts its toxicity on humans, when inhaled, by bonding with haemoglobin (Hb) to produce carboxyhaemoglobin (COHb). This results in tissue hypoxia which can be fatal at high blood saturation levels. Carboxyhaemoglobin may be measured using a Radiometer ABL825 FLEX analyser, a spectrophotometric instrument that applies a technique called CO-oximetry to measure Hb derivatives such as COHb and methaemoglobin (MetHb). The latter is an oxidised form of Hb that can cause or contribute to mortality at high concentrations. Methaemoglobin is notorious for its instability in vitro. This study, therefore, sought to determine handling conditions best suited for the stability of MetHb in post-mortem blood such that the ABL825 FLEX analyser may be used for the simultaneous measurement of COHb and MetHb. To this end, blood samples collected from 15 cases of potential CO poisoning at Salt River Mortuary were aliquoted into red (no additive)-, green (containing lithium heparin)-, and purple (containing ethylenediaminetetraacetic acid)-top tubes. The samples were stored at 4°C or –80°C and retrieved from storage on days 0, 1, 4, 7, 14, and 30, for analysis. While COHb remained stable in all storage conditions over a 30-day period, this was not true for MetHb. When samples were stored at 4°C, a rapid increase followed by a gradual decline was observed for MetHb in all the tube types investigated. The MetHb content was at its lowest after two weeks of storage, which was consistent with COHb levels at the same time period and temperature. At –80°C, continuous increase of MetHb was observed, with the samples stored in green-top tubes showing the least amount of overall change from the reference (day zero) values. The study provided useful data regarding the stability of MetHb under the considered storage conditions, the investigators concluded that refrigerating blood samples in either red-, purple-, or green-top tube was suitable for the accurate simultaneous determination of both COHb and MetHb, if the analytes are measured immediately after collection or after two weeks of storage. Given that the nature of post-mortem forensic casework is such that suitable blood specimens are not always available for toxicological analyses, for the second aim of the study, the researchers sought to investigate the suitability of thoracic cavity fluid as an alternative specimen for the measurement of COHb. For this aim, thoracic cavity fluid collected into green-top tubes from the aforementioned cases was analysed immediately after collection. The results were compared to those obtained from the analysis of blood collected into green-top tubes and analysed on day zero (before storage). The statistical analyses used for this assessment indicated that thoracic cavity fluid would be a suitable alternative to blood for the measurement of COHb using the ABL825 FLEX analyser.

South Africa has one of the highest prevalences of drug misuse and abuse in Africa. Salt River Mortuary (Cape Town, South Africa), along with other national Forensic Pathology Service providers, receives many cases of suspected drug-related deaths. In some cases, the traditional autopsy – when viewed together with the decedent's history – is not able to indicate whether a drug-related death is accidental or suicidal in relation to altered drug metabolism. Literature has shown that this can be investigated by sequencing gene(s) encoding the implicated metabolising enzyme(s) in a postmortem genetic analysis. However, as such an analysis would normally be performed following the obtainment of postmortem toxicological results, it is imperative to investigate whether blood samples retrieved back from a toxicology laboratory would be sufficient for the said genetic analysis, despite the handling involved in the process of toxicological investigation. To this end, blood samples from 30 deceased individuals in which drug use/abuse may have contributed to death, were collected into two red-top tubes (plain), two grey-top tubes (containing sodium fluoride and potassium oxalate) and one EDTAcontaining purple-top tube (control). DNA was immediately extracted from one of each colour tube, while the duplicate red-top and grey-top tubes first underwent a process of toxicological analyses, and then underwent DNA extraction. The concentration, degradation, purity, contamination, and quality of DNA were assessed using real-time PCR, spectrophotometry, forensic DNA profiling, and Sanger sequencing. In contrast to the grey-top tubes, the results showed that the red-top tubes were most suitable for the aforementioned genetic analysis. Overall, the study not only demonstrated that postmortem genetic analysis using samples retrieved from a toxicology laboratory is possible in the local context, but also provided guidelines around the pre-analytical phase of the analysis. These results illustrate the opportunity to investigate these toxicogenetic avenues further, particularly in future expansion of services currently provided at Salt River Mortuary, which may provide families more information about circumstances of their relative’s death.