Drug use is a major burden in Cape Town, South Africa, and at times may be fatal. Individuals suspected to have demised from drug intoxication are referred for medico-legal investigation, in order for cause of death to be determined. Sometimes, it remains ambiguous as to whether the drug intoxication was suicidal or accidental, even after a full post-mortem examination. Literature has shown that molecular analysis of genetic variants in genes encoding for drug metabolising enzymes may provide insight into the manner of death. At Cape Town’s Salt River Mortuary, numerous toxicological-related cases yield ambiguous results, which may potentially be resolved with molecular analyses. However, no optimised molecular assay to sequence drug metabolising enzymes currently exists in a local context. The aim of this project was to design and optimise a molecular-based assay to sequence the drug metabolising enzyme, CYP2D6. Subsequent to primer design, exons in CYP2D6 were amplified and sequenced. The optimised assay was then applied to DNA from two decedents suspected to have demised from drug intoxication. Following a toxicological drug screen, certain drugs metabolised by CYP2D6 were reported. The assay revealed genetic variants within CYP2D6; both individuals were heterozygous for 138insT, rendering one allele in each individual defective. While one decedent also exhibited variants with normal and unknown haplotypes, the other decedent was homozygous for *17 (decreased functionality), overall making the former an intermediate (altered) or extensive (normal) metaboliser and the latter, an intermediate metaboliser of specific drugs. Quantitative toxicological results were unavailable; consequently, the contribution of the metabolism phenotype on death in these cases could not be established. However, the genetic variants, combined with the presence of these drugs in each case, suggests altered drug metabolism, which should be investigated further and interpreted within each case context. These findings would also be beneficial to the decedents’ living relatives, who may also carry these variants. Overall, this study demonstrates the value of molecular analyses in forensic investigations of toxicological-related fatalities, and lays the foundation for additional future research, particularly since the molecular assay has now been successfully optimised.

Background: Electrocution is a well-documented cause of unnatural death globally. Identification of demographic and spatial trends in developed countries has assisted in highlighting contributing factors and identifying areas at risk. This information and the appropriate institution of changes have proven worthwhile in reducing fatalities internationally. Less developed countries have shown increasing trends in electrocution fatalities related to rural-urban migration and growing electricity demand. Additional challenges plaguing such countries include illegal electricity connections and load shedding. The association of such issues to electrocution deaths have been sparsely explored. There remains a paucity of information regarding electrocution fatalities in South Africa and Africa as a whole. A general trend of increasing electrocution fatalities referred for medico-legal autopsy was observed at three medico-legal mortuaries in the eThekwini district of Kwa Zulu Natal, South Africa, from 2006 to 2016. Objectives This study aimed to analyse the epidemiology, characteristics and trends of deaths resulting from electrocutions. Methods. A retrospective descriptive study was conducted. Fatal non-lightning electrocutions autopsied at three medico-legal mortuaries in the eThekwini district over an 11year period, from 1st January 2006 to 31st December 2016, were analysed. Data sources included clinician notes, emergency services documentation, scene scripts including South African Police Services(SAPS) 180 form completed by SAPS representatives, postmortem and histology reports, toxicology reports from Forensic Toxicology unit, contemporaneous notes, postmortem death registers, daily listings of postmortem case allocations and electronic postmortem databases. Data were collated and categorised on an Excel spreadsheet and then analysed on statistical package STATA 13 (Stata Corp, TX, USA). 12 Results: There were 512 non-lightning electrocution fatalities from 1 st January 2006 to 31st December 2016. The trend of electrocutions indicates a general increase in cases from 2006, reaching a peak in 2013 followed by a gradual decrease until 2016. Most fatal electrocutions occurred in domestic environments amongst males in the third and fourth decade of life. However, a bimodal distribution showed a considerable number of electrocutions under 10 years of age, predominantly amongst females. The largest number of electrocutions were admitted to the chief medico-legal mortuary servicing the metro, Gale Street mortuary (43,95%). However, the highest concentration of cases was observed in Tongaat, a suburb on the outskirts of the metro. This contributed to the highest prevalence of electrocution cases (1,25% of all electrocution cases) being admitted to the Phoenix medico-legal mortuary, which serves predominantly Northern eThekwini, including Tongaat, and which lies on the fringe of the metro. Deaths from electrocution tend to occur mainly during the midday period, during the weekends, and commonly during the summer months. Injuries associated with fatal electrocutions in all age groups studied generally affected the extremities and predominantly involved the upper limbs. Blood alcohol concentrations were established in just over a quarter of cases and were mostly negative. Conclusion: Electrocution is an easily preventable unnatural death that remains poorly documented and analysed, especially in developing countries, with a paucity of studies in South Africa. Preventative measures and protocols cannot be generalised amongst populations. An appreciation of the demographic and temporal trends of electrocutions is crucial in order to institute preventative policy.

No description available.

No description available.

Background: In the South African mining sector, cardiorespiratory autopsy examinations are conducted on deceased mineworkers to determine eligibility for compensation, irrespective of the cause of death. An autopsy examination is a right under the Occupational Diseases in Mines and Works Act, Act No. 78 of 1973 (ODMWA) except for mineworkers who received maximum compensation awarded for occupational lung diseases in second degree category during life. Compensation awards to the deceased mineworkers’ dependants can contribute to short- or medium-term poverty alleviation. In spite of the possible benefits, ODMWA autopsy utilisation by black mineworkers’ families is incomplete. Increased utilisation has the potential to assist in alleviating poverty. It is imperative to understand what contributes to autopsy utilisation or non-utilisation by black mineworkers, as this will guide public health policy intervention regarding ODMWA autopsy. Aims: The study set out to quantify the monetary contribution of ODMWA autopsy to mineworkers’ families, to estimate the loss of potential financial benefits due to autopsy non-utilisation; define the characteristics of those deceased mineworkers who did not use the autopsy service (to tentatively formulate reasons for not using autopsy); and to describe the barriers and enablers that contribute to ODMWA autopsy utilisation. Methods: The study was primarily qualitative; however quantitave investigations were undertaken using data from the National Institute for Occupational Health (NIOH), the Medical Bureau for Occupational Diseases (MBOD), and The Employment Bureau of Africa (TEBA). First, a descriptive study was undertaken to determine autopsy utilisation and establish the amount of compensation paid to dependants of deceased mineworkers over a ten-year period (2001- 2010) following autopsy examination; and to estimate the loss of financial benefits from autopsy non-utilisation. Also, the characteristics of those deceased ii mineworkers recorded by MBOD in 2001-2008 but who did not undergo autopsy examination were investigated using data in the subjects’ MBOD files. The characteristics investigated included previous submissions to MBOD or date of last submission; age of the deceased at death and place and date of death; labour history, the last date of work; cause of death and medical information. Second, in-depth interviews on perceptions of autopsy were carried out with participants. The key participants were former and in-service mineworkers, relatives and widows of deceased mineworkers and others (traditional healers, occupational health practitioners, community and organised labour leaders). These categories of participants were selected because of the particular perspective that they were likely to bring to the study. A semistructured questionnaire was used to guide the in-depth interviews. All interview data were transcribed into English. Key ideas generated were noted at the end of each interview. The notes were examined for overall depth and meaning. The notes for each respondent were uploaded in their groups onto 2003 MAXqda PC (2003) and coded into segments and grouped into categories. Emerging themes were identified using a conceptual framework and meaning interpreted. Results Autopsy utilisation: 71% of in-service mineworkers over the 10-year period were employed by mines affiliated with TEBA. Using the annual TEBA-reported deaths as the denominator and ODMWA autopsies as the numerator, it was estimated that during 2000-2010, autopsy utilisation by black miners who died in service ranged from 30-46%. It is argued that these figures were an over-estimate as they did not include former mineworkers or in-service mineworkers working for TEBA non-affiliated mines. The results suggest that the majority of autopsy examinations were of TEBA registered mineworkers. Following autopsy examinations over ten years, 311 deceased mineworkers not compensated in life were certified by MBOD to suffer occupational lung disease in the first degree and 2 426 in the second degree categories respectively following autopsy examination. Autopsy non-utilisation: From the TEBA recorded deaths and ODMWA autopsies performed by NIOH, there were 15 064 mineworkers who did not undergo autopsy examination during 2001-2012. It is estimated that 355 mineworkers would have been certified in the first degree category, and 2 769 in the second degree category had they come to autopsy. Contribution of ODMWA autopsy to compensation: Each family of the 311 deceased mineworkers certified with occupational lung disease in the first degree category would have received an average lump sum payment of $8 750. Similarly each family of the 2 426 mineworkers certified with occupational lung disease in the second degree category would have received an average lump sum payment of $12 907 Additionally, each family of the 59 cases upgraded from first to second degree category following autopsy examination would have received an average lump sum payment of $5 250. If assumptions were made that Stewart (2007)’s findings on financial spending on basic needs such as food person per family of seven members were similar to that of mineworkers compensated following ODMWA autopsy; households that received $8 750 in compensation would have had sufficient money to buy food for 29-47 months. Similarly those who received $12 907.79 and $5 250 could have managed to buy food for 49-80 and 20-33 months respectively. Characteristics of deceased mineworkers: Tentative reasons of no autopsy examination were dying at home, recent MBOD submission, age of the mineworker, previous and current TB infection certified by MBOD. Ninety six percent of them died at home and four percent died in district public hospitals. Sixty four percent were recently submitted to MBOD and of these mineworkers, 70% had pulmonary tuberculosis. The majority were fairly young i.e. 52% died before the age of 50 years and a further 12% before the age of 60 years. Barriers and enablers of ODMWA autopsy: Barriers and enablers of ODMWA autopsy consent and utilisation were found to be diverse, complex, and multifaceted such that a multipronged intervention strategy would be required to increase utilisation. The barriers and enablers of ODMWA autopsy were in individual/family; socio-cultural and institutional perspectives. The respondents could rationalise their acceptance or rejection of autopsy within their own individual cultural or religious belief system and these varied according to the individual’s experiences, family beliefs and societal practices. Enablers regarding consent to ODMWA autopsy were dissociation of the body from the soul, matrilineal relations to the deceased mineworker, communication with ancestors while the mineworker was healthy, deaths described as bad by participants. Key to autopsy consent facilitation was the mineworkers communicating their acceptance of ODMWA autopsy examination to their families and by communicating this intention to their ancestors -where this was consistent with their belief system. Foremost among the barriers to ODMWA autopsy utilisation was the requirement of formal consent within a biomedical framework, which clashed with certain socio-cultural beliefs. These cultural barriers were associated with patriarchal relations to the deceased mineworkers, beliefs that being buried without cardiorespiratory organs was synonymous to burying an empty box, health workers’ attitudes, mistrust, commodification of body parts, community traditional norms and practices and unequal power relations on decision making which led to exclusion of potential beneficiaries (widows and children). Conclusion: The study documented that a large number of in-service black mineworkers did not utilise ODMWA autopsy in spite of the potential financial benefits demonstrated. Additionally, former mineworkers who did not utilise autopsy were under fifty years of age, died of PTB within twelve months of leaving mines at their homes. The study found cultural beliefs that were barriers to autopsy utilisation, but also those that may enable these barriers to be overcome. The finding that the cultural beliefs were not static or uniform suggested that increasing autopsy consent would require comprehensive communication and awareness intervention strategies aimed at individual, family and community levels. The intervention strategies should not be once-off, but long-term and should address the cultural beliefs. The enablers of autopsy utilisation could be used in the awareness messages. Further research is required to investigate the attitude of health care providers (nurses, traditional healers, medical practitioners etc) to ODMWA autopsy utilisation, investigate the process of decentralising the autopsy examination and the impact this will have on appeals, standardisation and resources; and to examine the legal framework which would make ODMWA autopsy permissible without the current consent requirements, possibly under similar conditions to forensic medicine. Revising consent requirements is important to alleviate the conflict felt by spouses, mineworkers and relatives who have to satisfy cultural imperatives which are at odds with giving consent to permanent removal of cardiorespiratory organs. ODMWA should remain in place until exposures resulting in occupational lung diseases have been reduced to non-disease-causing levels or no new occupational diseases are found at autopsy. The enablers and barriers to ODMWA autopsy found in this study may be generalisable to similar socio-cultural environments outside South Africa.

Diss. Uppsala : Uppsala universitet, 2007.

The abandonment of neonates in locations where discovery and survival is not intended is a global concern. These cases comprise non-viable foetuses and stillbirths (natural deaths), as well as abandoned live births (unnatural deaths); the latter having possible legal consequences. To describe the profile of abandoned neonates and obtain a global perspective of the post-mortem investigation in such cases, a systematic review of the literature on abandoned foetuses, concealed births and neonaticide was conducted. This revealed a paucity of research on the subject; only one published South African study and less than 30 studies from other parts of the world were obtained. While guidelines were available, a standard protocol for conducting the medico-legal investigation on abandoned neonates did not exist and the necessary extent of the investigation was debated. Furthermore, seemingly higher rates of abandoned neonates were observed in South Africa compared to elsewhere in the world, warranting investigation of these cases in a local setting. In an attempt to add to the data concerning abandoned neonates in South Africa, a case file review was carried out on abandoned live births, stillbirths and non-viable foetuses at Salt River Mortuary between 1 January 2012 and 31 December 2016 (n=249). Despite the majority of the cases being natural deaths, the cause of death frequently remained 'undetermined’ in these cases, often due to the presence of decomposition. Histological analyses were only performed in a small fraction of undetermined cases. Furthermore, the hypothesis that the prosecution rate of abandoned live births is extremely low was supported by this study, with only one case prosecuted in the 5- year period. For the remainder of the cases, the court status was given as either 'under investigation’ (47.8%) or 'case closed’ (47.8%). In the majority of the instances, the case was closed due to the unknown identity of the biological mother; however, DNA analyses were not performed in all of these cases. Overall, the data highlighted the need for the development and implementation of standard protocols, to ensure that cause of death and identification of the neonate can be established as far as possible.

In South Africa, there is a burden of unidentified deceased individuals in forensic mortuaries. When human remains are severely compromised, hard tissues may provide the only DNA source for identification. The QIAamp® DNA Investigator Kit is used in forensic laboratories worldwide, including in South Africa, to extract DNA for identification purposes. However, in local forensic casework, the DNA recovered from teeth is often of insufficient quantity and quality for generating a DNA profile. The phenol-chloroform DNA extraction method has demonstrated improved, yet inconsistent results, when used on hard tissues. Therefore, this study assessed DNA recovery from 52 human control teeth from three deceased individuals, using an optimised phenol-chloroform method. This method involved an overnight demineralisation, two additions of phenol/chloroform/isoamyl alcohol (25:24:1) and an ethanol precipitation, as used by the Australian Federal Police. Quantitative PCR (Quantifiler™ Trio DNA Quantification Kit) and DNA profiling (PowerPlex® ESI 16 System) were then used to assess DNA quantity and quality. Results were compared to those obtained from the same teeth but extracted using the QIAamp® DNA Investigator Kit. The phenol-chloroform method recovered DNA with significantly higher yields (p = 0.0454) and significantly less degradation (p < 0.0001). Despite this improvement, there was no significant difference in DNA profiling success. This study also did a preliminary analysis of other factors affecting results and suggested that premolars might be the best tooth type with regards to DNA quantity, quality and profiling. Furthermore, dental disease and jawbone had a significant impact on results from teeth. Lastly, the phenol-chloroform method was applied to six teeth from a marine decomposition case to assess its performance in a local forensic setting. DNA metrics were particularly poor in this casework example, highlighting how different forensic and control environments are and the need for further optimisation. Overall, this study supports the use of the phenol-chloroform method and has provided a preliminary suggestion of the best tooth type, jawbone and tooth condition for DNA analysis for forensic human identification.

Insects play an essential role in the resolution of medico-legal investigations. For various insects, like necrophagous flies, it is vital for their survival to find and inhabit a food source such as a decomposing body. This makes it possible to use these insects as evidence in medico-legal investigations. A crucial part of any medico-legal investigation is estimating the time that has elapsed since death, otherwise known as the post-mortem interval (PMI). The age of the oldest insects can provide the most precise estimation of the PMI. Flies undergo different stages of development. All the immature stages can be utilized as evidence at death scenes. Out of all the immature stages, pupae represent the oldest specimens, which makes them valuable in establishing a minimum time since death. Identification and aging of pupae is currently a challenging process since they all look similar in appearance. Few studies have been done on pupae for PMI estimation. This study aims to identify reliable morphological markers to aid in a more accurate age estimation of Lucilia sericata during the pupal stage. A total of 145 pupae were collected and examined for external morphological changes over time. Five pupae were collected at each time point. A total of six external morphological characteristics of the puparium and twenty external morphological characteristics of the pupae were initially examined. These characteristics were linked to age in accumulated degree hours (ADH), with the aim of creating a timeline that can aid in the estimation of pupal age. The pupal ADH ranges from the youngest being 6550 ADH and the oldest being 11300 ADH. The timelines identified several characteristics that develop during the early or late stages of development. Multiple linear regression analysis was performed to assess characteristics which were useful for estimating the age of the pupae (ADH) and develop a regression equation based on the data collected. The regression analysis identified 10 characteristics that are the most significant in aging pupae. They were the colour and shape of the labellum, leg length, leg width at full length, thoracic setae, facial setae, abdominal macrosetae, palp shape, genal setae and labrum colour. Some of these characteristics like the leg length and width and abdominal macrosetae did provide important time-breaks on their respective timelines. However, the development and the pigmentation of the compound eye also provided valuable time-breaks it's timeline.

Violence-related injuries are a major cause of mortality in the Western Cape (South Africa). Previous research has demonstrated an association between violent mortalities and drug use. Furthermore, long-term drug use has been shown to alter behaviour that may lead to violence. Hence, this study aimed to investigate the effect of long-term drug use on violence-related mortalities. Due to the drug retention properties of hair, it is the gold standard for demonstrating the historical pattern of drug use. Hair samples were collected from 92 violent death cases admitted to Salt River Mortuary (South Africa). A qualitative toxicological analysis was performed in 90 hair samples using a SCIEX X500R QTOF. Variables pertaining to the colour and length of the hairs were recorded. The majority of the hair samples were black (n=79), while others were black and white (n=5), greyish (n=3), light grey and reddish brown (n=1) and strong brown hair (n=1). Various toxicologically relevant substances were detected in 74 cases (82.2 %) in which a total of 54 different substances were detected in hair samples. Acetaminophen was the most prominent licit substance (47%) detected, followed by caffeine (18.9%) and diphenhydramine (12%). Methamphetamine was the most common illicit detected substance (54%), followed by methaqualone (43%). Segmented hair samples showed historical use in 81.2 % of cases. These results show that hair can be used as a supplementary sample during toxicological investigation in violent fatalities in the local context.