Browsing by Author "Kirk, Gavin"

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    Investigating post-mortem redistribution of drugs in a cohort of suspected unnatural deaths in Cape Town South Africa
    (2024) Clegg, Liza; Kirk, Gavin; Hlela, Marie Belle Kathrina Mendoza
    Introduction: The interpretation of post-mortem toxicological analysis results is complex, specifically, due to the phenomenon of post-mortem redistribution (PMR). The later needs to be taken into consideration when determining if, and to what extent a drug contributed to death. Additionally, case specific features also play a role and therefore no specific drug concentration can be deemed ‘fatal'. The accumulation of drugs in specific body areas before and around death creates drug reservoirs, influencing redistribution after death. However, patterns like concentration ratios between cardiac and peripheral blood aid in understanding PMR tendencies of specific drugs. By contributing data to the larger knowledge pool, we can better understand how different drugs behave in the post-mortem seeing, thereby assisting toxicologists and pathologists to come to a rational conclusion regarding the post-mortem toxicological results on a case-by-case basis. Methods: This study is the first of its kind in South Africa, aiming to investigate the extent of PMR of common drugs of use and misuse. To this end, paired admission femoral blood and autopsy femoral and cardiac blood samples were tested on a quantitative LC-MS/MS panel of 31 commonly misused drugs. Results: A total of 109 suspected unnatural cases admitted to the mortuary were included, of which 61 (56%) yielded positive toxicology results. The data was analysed using SPSS Version 28. The most common analytes detected were acetaminophen (n=13; 21.3%), 11-nor-9-carboxy-Δ⁹- tetrahydrocannabinol (THC-COOH) (n=20; 37.8%), amphetamine (n=30; 49.2%), methaqualone (n=33; 54.1%) and methamphetamine (n=33; 54.1%). Males represented the majority of cases in the cohort and the mean age of individuals testing positive was 33 years (SD: 10 years). Cardiac/peripheral (C/P) ratios were calculated and significant pairwise differences with Bonferroni correction were found for amphetamine, methamphetamine and nor-carboxy-tetrahydrocannabinol, corresponding with current literature. Additionally, where the literature was previously lacking data on the PMR of methaqualone, this study suggested that it is less likely to undergo PMR.
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    Post-mortem organ weights at a South African mortuary
    (2019) Peddle, Laura; Kirk, Gavin
    Background Weighing of organs is a necessary part of every autopsy and provides objective evidence of pathology, especially in forensic cases where histology is not always taken. Reference ranges must be locally applicable, accurate, and regularly defined. Aims The primary aim was generation of post-mortem organ weight reference ranges for use in South African mortuaries. Secondary aims were analysing factors influencing organ weights, and comparison of data to those from international populations. Methods A retrospective study was conducted using autopsy reports from the Salt River medico-legal mortuary in Cape Town, South Africa between 2013 and 2016. Disproportionate randomized stratified sampling was used to obtain sufficient cases from males and females; White, Coloured, and African racial groups; and decedents both older and younger than 50 years. Observations from 1262 decedents >18 years old dying traumatic on-scene deaths were recorded, excluding organs with macroscopic evidence of disease or destructive injury. The organs considered were the brain, heart, both lungs, liver, spleen, and both kidneys, and the variables collected were sex, race, age, height and body weight. This study was approved by the University of Cape Town Human Research Ethics Committee. Results Sampled decedents are described and excluded organs accounted for. Descriptive statistics are presented for each of the stratified subsamples. After assumption testing, multiple linear regression models are built, including interaction terms. Factors influencing organ weights are discussed and results compared to selected studies. Ideal organ weight reference ranges are proposed, based on 95% inclusion data from decedents aged 18-35 years with normal body mass indices. A smartphone application is offered, which calculates prediction intervals for individual decedents based on the multiple linear regression models. Conclusion This is the first study on post-mortem organ weights in South Africa, and despite limitations it provides useful locally derived population estimates.
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    Pregnancy related maternal deaths at Salt River Forensic Pathology Laboratory: a 5 year retrospective study of the epidemiological data and spectrum of pathology and disease in all pregnancy related deaths at Salt River Pathology Laboratory irrespect
    (2014) Khan, Akmal; Kirk, Gavin
    Death of women whilst pregnant and in the post-partum period is a huge burden of disease in South Africa. All confidential enquiries and research into pregnancy related deaths in South Africa have focused on examining the cases based on the WHO definition of maternal death and have excluded deaths from incidental or accidental causes. Pregnancy related deaths due to suicide, homicide and accidental causes have predominantly only been studied in first world countries. There is minimal data available for developing countries like South Africa.