Browsing by Author "Davies, Bronwen"
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- ItemOpen AccessAssessment of the suitability of blood samples collected for toxicological analysis for subsequent genetic analysis: A follow-up study one year later(2018) Musiyandaka, Fungisai Lorraine; Heathfield, Laura; Davies, BronwenDrug usage, both of a recreational or pharmaceutical nature, is common, however the abuse of such substances is an international problem. In the Western cape, South Africa, the burden of drug-related fatalities is high compared to the rest of the country. The provincial Forensic Pathology Service may encounter cases where drug-related fatalities are unclear whether death was accidental or suicidal, or drug toxicity is inconsistent with the medical/social history. This may be due to genetic alterations with drug metabolism and it has been suggested that genetic analyses may be the next step in these cases. However, toxicology results from the National Forensic Chemistry Laboratory in the Western Cape may be delayed by months to years, meaning that upon interpretation of toxicology results, there is no chance to obtain another blood sample from the deceased individual for genetic analysis. It was therefore important to determine the suitability of blood samples collected and handled in toxicology environments for subsequent genetic tests. Previously, blood samples from 30 post-mortem cases were collected into two red-top (no additives), two grey-top (sodium fluoride/potassium oxalate) and one purple-top (EDTA) tubes. Samples from one red-top and one grey-top tube underwent toxicological analysis, followed by DNA analysis, while the remaining tubes (controls) underwent DNA analysis immediately. All samples were then stored for approximately one year, prior to this study. The DNA analysis was repeated on all blood samples (n = 150) and results were assessed in terms of storage time and tube type. DNA was not significantly degraded in any of the samples; however, DNA from red-top tubes had significantly lower concentrations compared to that from grey-top tubes (p < 0.001), regardless of whether the sample had undergone toxicological analysis. The very low yields of DNA from red-top tubes posed substantial challenges for PCR-based analysis, resulting in poor quality Sanger sequencing results. Some DNA from grey-top tubes, passed the quality assessments and hence further work is required to provide an informed decision on which tube type is better suited for genetic analyses.
- ItemOpen AccessAssessment of the suitability of blood samples collected for toxicology for subsequent genetic analysis: A follow-up study after five years(2023) Grobbelaar, Jana; Davies, Bronwen; Pearce BrendonTherapeutic and recreational drug use is a common occurrence across the world. However, substance use may sometimes result in adverse drug reactions and death even when typically non-fatal drug doses are administered. This phenomenon may be caused by variants in the genes encoding drug-metabolising enzymes, which leads to altered drug metabolism and at times, toxicity. Cause or manner of death may not be apparent in these cases, even after conducting a standard autopsy and ancillary toxicological and histological investigations. A molecular autopsy may then be performed to identify an underlying genetic cause. Genetic testing is however not routinely conducted in forensic mortuaries, and historic backlogs within the National Forensic Chemistry Laboratories may delay the processing of toxicology samples by months or even years. As such, specimens that have undergone toxicological testing and were stored long-term are sometimes the only samples available to conduct subsequent molecular autopsies, should it be necessary for the cause of death determination. This study therefore aimed to assess whether blood specimens that were used for toxicological analyses could provide suitable DNA for downstream genetic analyses after an extended storage period of five years. In 2017, DNA was analysed from blood samples collected into vials containing sodium fluoride/potassium oxalate preservatives or vials without preservatives (grey and red top tubes, respectively). A subset of these vials underwent preparation for toxicological analyses at the time, prior to DNA extraction, while the remaining tubes underwent DNA extraction immediately and were stored in a molecular laboratory as controls. DNA analysis was then repeated one year later in a separate study, as well as five years later as part of the current study. DNA quantity and quality scores were significantly lower in red top tubes compared to grey top tubes, and toxicological processing did not significantly influence results. DNA concentration and quality also significantly decreased over time for all sample types. PCR amplification and Sanger sequencing results were mostly poor for red top tubes, but grey top tubes showed overall improvements in sequence quality. However, all DNA analysis results generally improved when DNA was extracted using a modified salting out method. Based on these results, it is suggested that forensic laboratories that often experience delays in sample processing should perform molecular autopsies using blood stored in sodium fluoride/potassium oxalate preservative coupled with a salting out DNA extraction method.
- ItemOpen AccessComplementary and alternate medicines: a forensic analysis of the potential adulteration of over-the-counter anorectics and "lifestyle" medicines in South Africa(2017) Catterson, Sandra Lynne; Davies, Bronwen; Smith, Peter; Aukloo, Kathrina MendozaBackground: Complementary and Alternate Medicines (CAMs) in South Africa are not yet subjected to the same rigorous testing required for allopathic (prescription) medication, yet they are freely available as over-the-counter medicines. Past research has shown the presence of a banned drug, sibutramine in natural anorectics and a schedule 6 prescription drug, sildenafil, found in natural erectile dysfunction preparations. Methods: Initially, 26 exhibits (18 erectile dysfunction medicines and 8 anorectics) were screened for active pharmaceutical ingredients using high performance liquid chromatography tandem mass spectrometry. An AB SCIEX 3200 TRAP® linear ion-trap quadrupole mass spectrometer was used to detect and subsequently quantitate these active pharmaceutical ingredients using a targeted multiple reaction monitoring mode. Samples were extracted with 50% v/v methanol in water. A method for the quantitation of sildenafil was subsequently partially validated. The intra- and inter-assay precisions were evaluated and the linearity of the method was investigated in the range of 20 ng/mL to 2000 ng/mL. The method was then successfully applied to a random selection of CAMs. A random sample (n=61) of erectile dysfunction CAMs were selected for quantitation from two different clusters. Cluster 1 comprised of supermarkets and cluster 2 of pharmacies. Results: The validation method for sildenafil showed that the limit of detection was 1.09 ng/mL and the limit of quantitation was 20 ng/mL. The correlation co-efficient and bias were less than 20%. Initial screening of the 26 exhibits indicated that sildenafil was present in 12 of the 18 samples tested and sibutramine in 6 of the 8 anorectics. Of the later 61 exhibits tested, 43 tested positive for sildenafil. The mass of sildenafil per sample ranged from 1.09 ng/mL to 123.7 mg/sample. Conclusion: The lack of label content, regulation and legislation exposes the consumer to the risk of consuming an active pharmaceutical ingredient which may very likely have an adverse effect on their health. There is a need to raise public awareness to the potential dangers of unregulated CAMs, encourage doctors to become more aware of their patients' consumption of CAMs and to motivate the Medicines Control Council to follow through with their deadlines for the regulation of CAMs.
- ItemOpen AccessThe influence of Methylphenidate on the development of the forensically significant blow fly Chrysomya chloropyga (Diptera: Calliphoridae) in the Western Cape Province(2016) Visser, Hartwig; Heyns, Marise; Davies, BronwenForensic entomologists rely on insect development and successional data to estimate the post-mortem interval (PMI). Ante-mortem drug use prior to an individual's death may result in drug transmission to feeding insects and subsequent alteration of their development, thereby altering PMI estimates. This study investigated the influence of Ritalin (methylphenidate hydrochloride) (MPH) on the development of Chrysomya chloropyga. C. chloropyga larvae were reared on pig liver treated with MPH and exhibited a trend of expedited larval development and prolonged pupal development. Conservatively, the results suggest that MPH may expedite the larval stage by up to 17 hours and prolong the pupal stage by up to 16 hours. These preliminary findings suggest that, at the concentration investigated, MPH may alter the duration of C. chloropyga developmental stages, and consequently PMI estimates if MPH is not detected or its effects not considered. Furthermore, MPH was detected in both frozen and ethanol preserved specimens. MPH could still be detected from treated larvae, after 3.5 days incubation at ~30°C. This may suggest an improved stability of MPH in insects. Moreover, detection of MPH from ethanol preserved specimens suggests the qualitative toxicological utility of specimens maintained in this preservation liquid, despite stability and self-extraction concerns. These are the first entomotoxicological data on MPH generated for blow flies local to the Western Cape, South Africa.
- ItemOpen AccessInvestigating blood alcohol concentrations in injury-related deaths before and during the covid-19 national lockdown in Western Cape, South Africa: a cross-sectional retrospective review(2022) Bachan, Varushka; Molefe, Itumeleng; Davies, BronwenIn South Africa, alcohol is a significant contributor to the burden of injury-related morbidity and mortality. Our understanding of its impact in injury-related mortality in the country is limited. The COVID-19 lockdown period in South Africa introduced restrictions that limited the legal access to the sale and on-site consumption of alcohol and presented a unique opportunity for examination of the impact of such restrictions on injury-related mortality. This study aimed to examine the relationship between blood alcohol concentrations (BAC) and injury-related deaths and to investigate the effect of the COVID-19 lockdown periods and alcohol restrictions on injury-related mortality and post-mortem BAC levels. A retrospective cross-sectional analysis of BACs in all injury-related death cases admitted to mortuaries in the Western Cape (WC) province between 1 January 2019 to 31 December 2020 (inclusive) was conducted. Descriptive and inferential statistics were performed using STATA 13 (StataCorp, TX, USA), to investigate BACs in injury deaths before and during the COVID19 lockdown periods in South Africa. A total of 16,027 injury-related cases were admitted to forensic mortuaries in the WC province in the study period out of a total of 21,797 cases, with significantly fewer cases admitted in 2020 during the first two COVID-19 lockdown periods compared to the same period in 2019 (p< 0.001). Samples were collected for BAC levels in 12,077 (75.4%) of injury-related cases and were most frequently requested in suspected homicide cases (85.2% of 8190). A positive BAC (≥0.01 g/100 mL) was found in 5,078 (42.2%) of the study sample. No significant difference was observed in the mean positive BAC between 2019 (0.18±0.1%) and 2020 (0.17±0.09%), except in the months of level 5 lockdown between April and May 2020, when there was a decrease in the mean positive BAC to 0.13g/dL in 2020 compared to 0.18g/dL for the same period in 2019. There was a 47.7% reduction in injury-related cases seen year on year in the WC during the period of level 5 lockdown and full alcohol restriction in 2020 compared to 2019 however trauma cases increased later in 2020 during full alcohol restrictions. The data presented in this study shows a decrease in injury-related deaths in the WC during the lockdown periods that coincided with alcohol bans and an increase following relaxation of restrictions on movement and alcohol sales. The data shows that the mean concentrations were similar between all periods of alcohol restriction compared to 2019, however, there were significantly fewer individuals with positive BACs in 2020 during complete alcohol sales restrictions than in 2019. This did, however, coincide with a smaller mortuary intake during the level 5 lockdown. The findings of fewer injury-related deaths and fewer positive BACs during lockdown periods coinciding with complete alcohol sales restrictions in 2020 should be taken into consideration to inform future decisions on alcohol control policy in the country.
- ItemOpen AccessInvestigating pesticide-related deaths admitted to Salt River mortuary in Cape Town, South Africa: a retrospective, descriptive analysis(2022) Peter, Molatelo; Davies, BronwenPesticide-related poisonings place a burden on the public health system in low- and middleincome countries. Notification of pesticide poisonings and deaths is a legal requirement in South Africa, however, our understanding of the prevalence and type of pesticides involved in poisoning cases remains limited. This is further complicated by the emergence of ‘street pesticides', which are unlabelled and illegally sold toxic pesticides. It is important to understand the role of these and other pesticides in local poisonings, and mortuary data provides an important resource to be able to investigate pesticide-related mortality specifically. This study aimed to build on previous research conducted at the Salt River mortuary (SRM) by expanding and updating our understanding of pesticide-related fatalities within the West Metropole of Cape Town. A retrospective, cross-sectional review of all unnatural death cases admitted to the SRM between January 2016 and December 2019 (inclusive) was conducted so as to identify pesticide-related deaths for further investigation. A total of 15 761 cases were admitted to SRM over the 4-year study period (mean: 3941 cases per annum). From this total, 92 cases (0.58%) were identified as pesticide related. Most decedents were male (59.8%), with the cohort's mean age being 26.2 years (range: 2 months to 66 years). The majority of cases were suicides (60.8%), and terbufos (an organophosphate) was detected in 50 cases (54.3%). Pesticiderelated fatalities were found to predominately occur in lower socio-economic areas. According to the data adults and adolescents are most at risk of being exposed to the harmful effects of these harmful compounds. Using a holistic approach to investigating pesticide-related fatalities could provide important clues that assist in gaining a better understanding of the factors that influence pesticide-related incidents. Combined efforts from healthcare practitioners and forensic investigators could help inform policy-makers on ways to minimise the use or distribution of pesticide compounds.
- ItemOpen AccessInvestigating the effectiveness and efficiency of forensic pathology practice in Western Cape, South Africa(2017) De Jong, Jacqui Anne; Davies, Bronwen; Martin, Lorna JIntroduction: In South Africa (SA), the forensic sector faces significant challenges including how to meet increasing public expectations for high quality, reliable and valid scientific and medico legal results, whilst dealing with increasing caseloads and restricted resources in a developing country. Internationally, lean six-sigma and/or business-based frameworks have been developed to define, measure and analyse the efficiency, effectiveness and output of forensic laboratories, so as to assess performance to meet such challenges. Aim: This pilot project aimed to investigate the effectiveness and efficiency of forensic pathology practice at Salt River Mortuary (SRM) by applying lean six sigma principles (define, measure, analyse and improve) and FORESIGHT metric analyses to retrospective case and staffing data, as well as prospective observational analyses. Methods: A retrospective analysis of cases admitted to Salt River Mortuary in 2015 was conducted to define and measure a snapshot of forensic pathology practice in Cape Town. In addition, observations of autopsy processes were conducted to identify bottlenecks in the system and provide suggestions for improvement. Results: An analysis of post-mortem report turn-around for 3567 cases admitted to SRM in 2015 showed that approximately 10% of cases were closed (cause of death was determined) on the day of the post-mortem, 65% within 14 days and 80% closed within a 30 day period. Certain requested ancillary investigations delayed the finalisation of cause of death; for example, only 8.33% of carbon monoxide testing and 30.31% of histological examinations were completed within the year. A process map outlining autopsy practices at SRM was generated through observational data, which also identified key bottlenecks in the process (e.g.: equipment issues). Preliminary financial data suggested that it cost on average R16 155.03 per case. Staff data demonstrated a lack of pathologists compared to other staff categories and high case load requirements. Discussion: This pilot study investigates the utilization of metrics and strategic frameworks to assess forensic pathology processes in Cape Town. This study offers a cross-sectional insight into financial performance, efficiency and effectiveness of post-mortem investigations at SRM, highlighting bottlenecks and inefficiencies, and providing suggestions for improvement. The findings will assist in forming a basis for future work into the development of a framework for monitoring performance and progress, and developing benchmark standards for the death investigation system in South Africa
- ItemOpen AccessInvestigating the role of alcohol in road traffic collision fatalities in Western Cape, South Africa(2020) Malomane, Rixongile; Davies, Bronwen; Mole, CalvinRoad traffic collisions (RTCs) are a major contributor to unnatural death worldwide, but especially in low-to-middle-income countries (LMICs) where motorised transport has rapidly expanded. A literature review into RTCs and alcohol indicated that it is well recognised that alcohol intoxication is a key risk factor in RTCs and road traffic fatalities (RTFs). It also indicated that literature concerning the role of alcohol intoxication in RTFs in South Africa is limited. Hence, this study aimed to investigate alcohol in RTF victims in five of the major mortuaries (Salt River, Tygerberg, Paarl, Worcester and George) in the Western Cape Province between 1 January 2016 and 31 December 2017. Cases were extracted from the Western Cape Forensic Pathology Service (FPS) internal database, which included demographic and crash information, together with blood alcohol concentration (BAC) results. In total, 2079 cases over the two years were included in the study, with most cases admitted in the metropole of Cape Town (Salt River: n=838, Tygerberg: n=693). The proportion of unnatural deaths were greater outside the metropole (George, Worcester and Paarl) compared to the metropole (Salt River and Tygerberg) areas. The majority of fatalities were male individuals (male to female ratio of 3.52:1), with the average age of 35.2 ± 17.2 years. Most victims were pedestrians (n = 1106; 53.7%) and dark wet roads, and highways were noted as risk factors in RTFs. Blood was submitted for alcohol analysis in 1432 (68.9%) cases, and results were available for 1314 (91.8%) cases. Of the available results, 709 cases (54%) were positive for alcohol (BAC of ≥ 0.01g/100 mL). Of the positive cases, most had a BAC between 0.15 and 0.29 g/100mL and the overall average BAC was 0.20 g/100 mL. Pedestrians and drivers had the highest median BACs, and almost a third of all the positive BAC results were from pedestrian deaths. The findings of this dissertation can contribute to the growing research on alcohol and injury in South Africa, especially as it relates to RTFs. Insight into vulnerable populations within the province is highlighted, together with key risk factors associated with RTFs, as well as safety measures that may be targeted for improvement, especially with regards to driving and walking on the roads while intoxicated.
- ItemOpen AccessInvestigating the use of CO-oximetry for simultaneous measurement of carboxyhaemoglobin and methaemoglobin in post-mortem blood(2022) Muleya, Jane Mahlatse; Vuko, Loyiso; Mader, Jade; Davies, BronwenCarbon 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.
- ItemOpen AccessPost-mortem Molecular Investigation: exploring genetic variation in CYP2D6 in deceased individuals at Salt River Mortuary(2018) Vincent, Devin Michael; Heathfield, Laura; Davies, BronwenDrug 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.
- ItemOpen AccessPost-mortem toxicogenetics: determining the suitable of blood samples collected for routine toxicological analyses for use in subsequent genetic analyses(2018) Vuko, Loyiso Abongile Marvin; Davies, Bronwen; Heathfield, Laura; Auckloo, KathrinaSouth 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.
- ItemOpen AccessPost-mortem toxicological analysis of hair in violent fatalities: an investigation into long-term drug exposure(2022) Mnisi, Precious Zemvelo; Davies, Bronwen; Vuko, LoyisoViolence-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.
- ItemOpen AccessA post-mortem toxicological investigation: Understanding the role of drugs of abuse in violent fatalities in Cape Town, South Africa(2016) Auckloo, Marie Belle Kathrina Mendoza; Davies, Bronwen; Smith, Peter JViolence and resulting injuries are critical health burdens worldwide, accounting for the death of millions of individuals annually. The literature reports an association between drug use and violence, providing data indicating that the use of psychoactive substances increases the risk of morbidity and mortality due to violent acts. South Africa has a long history of violence, with one of the highest rates of recorded violence- and injury-related deaths in the world. This is complicated by an increase in illicit substance use and abuse, particularly in the Cape Town Metropole, located within the Western Cape Province. The use of toxicological findings from victims of violent death (homicides, suicides, and accidents) to examine community-specific drug-related violence is slowly increasing in different parts of the world. In South Africa, however, monitoring drug trends in violent fatalities using toxicological analysis is uncommon, and hence drug toxicology of violent-related fatalities is limited. Divided into three contextual sections, this research study focuses on the post-mortem toxicology of violent deaths in a South African setting. The first section provides a general idea of the research problem and an initial development of the investigation process. The second section provides a theoretical basis for performing routine toxicological analyses in deaths due to violence, reports important research work conducted in the field worldwide, and emphasizes the need to monitor toxicological data derived from violent fatalities in Cape Town, South Africa. The last section, in the form of a manuscript, presents the overall research study including the methodology, outcomes, and concluding findings in a concise and illustrative manner. The primary aim of this pilot study was to investigate the prevalence and characteristics of illicit substances in violent fatalities (homicides, suicides, and accidents) of the Salt River mortuary in Cape Town, South Africa. The objectives were to conduct a comprehensive drug toxicology analysis to generate qualitative and comparative data from the aforementioned cases. In addition, this study investigated the dynamics between psychoactive substance use and violent deaths in terms of toxicological trends, and the demographics and circumstances of death of the victim. Lastly, the author discusses potential qualitative associations between illicit substances and violence-related deaths in a South African setting, and provide suggestions for future toxicological analyses in these fatalities.
- ItemOpen AccessRetrospective analysis of suspected pesticide-related fatalities admitted to Salt River Mortuary in the West Metropole of Cape Town, Republic of South Africa(2018) Patience, Meryl; Davies, Bronwen; Rother, AndreaIntroduction: Pesticides offer great benefits in the agricultural sector, but exposure may pose both acute and chronic health risks to humans. In developing countries, morbidity and mortality rates related to pesticide exposure are high and in certain areas (such as in rural, lower socioeconomic and/or agricultural-dependent communities), pesticides may be stored in and around homes, which may increase the risk of accidental exposure as well as intentional poisoning. In Cape Town, South Africa, this public health issue is exacerbated by the informal selling of street pesticides. These are pesticides that usually comprise of a mixture of these chemicals, sold unregistered as liquids or granules in bottles or packages without clear identification labels, for domestic use. While cheap and widely available in informal settlements; these pesticide formulations are not regulated and extremely toxic. Data illustrating the extent and nature of fatalities related to acute and chronic pesticide exposure in Cape Town, particularly as related to street pesticides, is limited. This dissertation provides an overview of the literature associated with pesticide toxicity and related mortality, paying particular attention to available South African research. This is followed by a study investigating pesticide deaths at Salt-River Mortuary over a period of five years. Aim: The aim of this study was to determine the prevalence and characteristics of deaths associated with suspected acute pesticide toxicity, to broaden the spectrum of knowledge concerning pesticide-related deaths in Cape Town, South Africa. Methods: A retrospective analysis of cases admitted to Salt River Mortuary (SRM) from 2011 to 2015 (inclusive) was conducted. Demographic, autopsy, investigative and toxicological data (where available) were collected from post-mortem and other investigative reports. Results: Of the total of 16,453 cases admitted to SRM over a five-year period from January 2011 until December 2015, 104 (0.63%) were deemed to be acutely pesticide-related based on available autopsy data. There was an equal number of male (n=52; 50%) and female (n=52; 50%) victims. Most deaths (n=74; 71%) occurred at medical centres following exposure, and Terbufos was found to be the common pesticide detected analytically (n=42, 61%) in toxicology reports available (76%). Results revealed that (60%) of acute pesticide toxicity cases were suspected suicides, while (6%) of cases were suspected accidents and (3%) cases were suspected homicides, while the remainder were still undetermined pending toxicological investigations. Conclusion: A history of ingestion, autopsy findings and toxicological results (if available) assisted in identification of these cases, most of which came from lower socio-economic communities. While the number of overall cases is low, it is evident that these deaths are a public health burden, and may be preventable through improved notification and policy development. Challenges with this study involved the inability to distinguish mortality associated with chronic pesticide exposure, the lack of toxicological results available, limited scene investigation information to identify street pesticide contributions, and that the study was limited to one mortuary in Western Cape. An extension of this research to other mortuaries in Western Cape as well as collaborative work with community and public health sectors on availability and toxicity of street pesticides will assist in strategic intervention methods and policy reform to reduce accidental and suicidal mortality associated with acute pesticide exposure.
- ItemOpen AccessToxicological Findings in Fatal Road Traffic Accidents in Cape Town: A Pilot Study(2019) Shongwe, Nondumiso Khetsiwe Ntombi; Davies, Bronwen; Auckloo, KathrinaIntroduction: Road traffic accidents (RTAs) and associated morbidity and mortality are a global public health burden. Literature reports on an association between drugs and/or alcohol intoxication and traffic collisions. In South Africa (SA), where drug use and abuse are prevalent, annual RTAs rates are higher than the average global burden. Toxicological analyses in cases of RTA fatalities are not performed routinely in SA (apart from alcohol analysis), thus understanding the burden of other drug impairment on road traffic deaths is limited. Aim: A prospective toxicological analysis was performed in a cohort of road traffic fatality cases (drivers, passengers, pedestrians, motorcyclists and cyclists) from Salt River Mortuary in Cape Town, SA. The objectives were to perform drug screening in these cases to preliminary investigate detected substances as well as to evaluate the demographics and circumstances of death of the aforementioned cases. Methods: A systematic review was first performed to investigate the prevalence of drugs in internationally reported RTA fatalities. For the prospective study, post-mortem specimens including blood, vitreous humor, urine and bile were collected from cases in which next-of-kin consent was obtained. All samples were analysed using liquid chromatography-quadrupole time-of -flight mass spectrometry (LC/QTOF-MS). Results: Thirty cases were analysed over 3 months, of which most were male, pedestrians and between the age group of 31-40 years. The most prevalent cause of death was multiple blunt force injuries to the body. Single vehicle crashes were predominant particularly among the pedestrians and motorcyclists whereas drivers were mostly involved in multiple vehicle crashes. Substances (other than ethanol) were detected in 90% (n=27) of the cases. A broad range of drug groups were detected, and the most prevalent specific legal substances were caffeine (66.7%) and nicotinamide (53.3%) and illegal substances were methaqualone (10.0%) and methamphetamine (6.67%). Multiple cases indicated the detection of impairing substances even if consumed therapeutically, such as codeine, chlorpheniramine, diphenhydramine and zopiclone. Discussion: This study was the first to the author’s knowledge to report on prospective toxicological findings in road traffic accident cases in Cape Town. Although this was a pilot study, the results were in line with findings from other international studies, together with findings of prominent abused drugs within Western Cape (e.g. methaqualone and methamphetamine). While this study made no inferences of drug intoxication to cause of death, it has set a basis for future research in this topic and the development of a standardised protocol for the routine analyses of such cases in SA.