Browsing by Author "Liebenberg, Linda"

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    Confirmation of cardiomegaly from the cardiothoracic ratio post-mortem Lodox® imaging
    (2018) Hofler, Rosemarie Ursula; Heyns, Marise; Liebenberg, Linda
    In post-mortem forensic radiology the cardiothoracic ratio (CTR) is seen as the most reliable and easiest method for the detection of an enlarged heart, where the maximum transverse diameter of the heart is divided by the maximum transverse diameter of the internal thoracic cage and if the result is greater than or equal to the 50 % threshold, the heart is deemed to be enlarged. This threshold is widely accepted and used in both clinical practice and in medicolegal post-mortem investigations. The primary aim of the study was to investigate the accuracy and reliability of this CTR threshold measured from the radiographs produced specifically by the Lodox Xmplar-dr scanner situated at the Forensic Pathology Service (FPS) Laboratory in Salt River, Cape Town, Western Cape. A secondary aim was to typify the observed enlarged heart, whether it was due to ventricle dilation or ventricle wall thickening leading to a diagnosis of cardiomegaly. The study was divided into a retrospective component which investigated past use of the CTR (%) in autopsy reports with regards to the cause of death/chief findings, at the Salt River FPS laboratory using the Division of Forensic Medicine and Toxicology, UCT, Office autopsies database, between years 2014 to 2016. The prospective component evaluated the reliability and accuracy of the CTR measured from conventional radiography produced by the Lodox scanner by comparing the diagnosis obtained from the CTR calculated from the Lodox images with the recorded heart weights. This CTR was also then compared to the CTR calculated with the heart in-situ in the pericardial sac to determine how accurate the radiograph produced from the Lodox scanner is for diagnosing an enlarged heart. The results showed a significant difference between the CTR calculated from the Lodox images versus the CTR calculated from the in-situ measurements, with the CTR from the Lodox images being better at detecting enlarged hearts, at 76 %, whereas the CTR calculated in-situ was better for detecting normal heart weights, at 84 %. Increasing the 50 % threshold would increase the specificity, thereby increasing the number of correctly identified normal heart weights as well as enlarged hearts, therefore a CTR threshold of 52 % (0.52) is recommended for the Lodox scanner for diagnosing an enlarged heart. When typifying the observed enlarged hearts the lack of mid-ventricular wall thickening together with the wall thinning suggests that the main cause of the CTR being over it 50 % threshold is dilation. It is important to note that in some of the cases the heart weight was still within the normal heart weight range.
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    Firearm fatalities examined at Salt River medico-legal laboratory in 1999 and their investigative outcome by 2004
    (2004) Liebenberg, Linda; Lourens, Denise
    The Republic of South Africa has OIle of the most liberal and human rights based constitutions wor1dWlde, with a very idealistic vision of individual freedom, alleviation of poverty access to education and health care and safety Many of the ideals are In direct redress of the previous regime, where only select strata of the populace had easy access to what are now constitutional rights for all.
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    Firearm fatalities examined at Salt River Medico-Legal Laboratory in 2009 and their investigative outcome by 2014
    (2016) Wichers, Ansie; Liebenberg, Linda; Heyns, Marise
    South Africa has a very long history of gun violence, particularly politically motivated. The politically motivated gun violence did subside after 1994, however there was an increase in criminal gun violence. In 2004 Dr Liebenberg from the University of Cape Town conducted a study on the victimology and investigative outcomes of firearm deaths of 1999 in the Salt River Medico - Legal Laboratory drainage area. There were some compelling results, including a remarkably low conviction rate of 7.21%. In 2000 new legislation was enacted, which is the Firearms Control Act (1) of 2000 and from 2001 to 2005 there was a 13.6% decrease in firearm homicides which was consistent after the introduction of the new act, likely due to the decrease in the number of firearms in circulation. Because of the changes in firearm legislation and reported crime rates, it was decided to conduct a follow - up study one decade later, looking at the investigative outcomes of firearm deaths to see whether the decreased contribution of firearms in homicides and crime made an impact on the investigative and judicial process of the Salt River Medico - Legal Laboratory cases. In 2009 there were 281 firearm deaths investigated at Salt River Medico - Legal Laboratory as opposed to 532 in 1999. In 1999, 89.29% of firearm deaths were due to homicide as opposed to 86.12% in 2009. In 1999 the majority of firearm homicide victims were Black and Coloured males between the ages of 21 and 30 years, this is similar to what is seen in 2009, however there were fewer Coloured victims in 2009. In both years homicides occurred more often on weekends, at night time. In 1999 there were peaks in May and then from October through to December. In 2009 however, the peaks were in March, May and August. One might thin k that with such a large decrease in the number of firearm deaths (not considering other crime trends), the criminal justice system might have fewer cases to investigate and prosecute and that the investigative outcomes (particularly conviction rate) of th ese cases might improve. Even though there was a significant drop in the number of firearm deaths in 2009, there has been no improvement in the conviction rate, with 2009 having a rate of 5.69%. The number of cases still being investigated was also similar at 104 cases (37.01%) for 2009 versus 182 cases (34.54%) for 1999. In 2009 only 58 (20.64%) cases completed the judicial process by 2014, which includes the 16 cases (5.69%) that ended in a guilty verdict, 18 (6.41%) cases where a suspect was acquitted (not guilty) and also 24 (8.54%) cases that were withdrawn in court. Of the 281 cases for 2009, 10 (3.56%) were still in court, which was significantly less than the 59 (11.20%) cases in 1999. From 2009 there were 87 cases that reached an impasse (30.96%) by 2014, as opposed to the 114 (21.63%) cases from 1999 by 2004, which is a statistically significant difference.
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    An investigation into the use of a commonly available fabric dye as a routine stain for tissue samples to be used as a first line, low cost, diagnostic adjunct for the diagnosis of anaphylactic death at autopsy, in a resource-challenged environment
    (2016) Burgers, Peter; Liebenberg, Linda
    A retrospective study of deaths attributable to anaphylaxis at the Salt River Forensic Pathology Laboratory was undertaken, with a view to determine if eosinophilia was present in tissue samples of the spleen, in accordance with previously published research. Suitable cases of non-anaphylactic death were used as controls. Use was made of two commonly available fabric dyes as alternative stains to the traditional Haematoxylin -Eosin ["H&E"].
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    Retrospective analysis of deaths in the Table Mountain National Park 2000-2011
    (2015) Maistry, Sairita; Liebenberg, Linda
    Background: The TMNP is one of the more famous of Cape Town's tourist attractions. Stretching across the Peninsula, this conservation site is home to rare indigenous flora and fauna, biodiverse habitats and the spectacular Table Mountain. Despite its seemingly safe infrastructure, there have been media reports of accidents and deaths that have occurred in the TMNP and on Table Mountain. Aim: To determine the number and types of fatalities in the TMNP from 2000-2011. Method: The Salt River Forensic Pathology Laboratory is a state mortuary which serves the Cape Peninsula. Included in its drainage area is the TMNP. Approximately 3000 medico legal investigations are performed per annum, the details of which are stored in databases at the SRFPL and at the Division of Forensic Medicine at the University of Cape Town. These and archival records were retrospectively searched for all deaths that occurred in the National Park between 2000 and 2011. The collected information was categorised and analysed according to the demographic profile of victims, cause and manner of death, blood alcohol levels and activities prior to death. Results: Between 2000 and 2011, there were 98 confirmed deaths in the TMNP. The deaths occurred mostly during the South African summer months and on Fridays and Sundays (weekends). The victims were predominantly Caucasian (59%) and male (90 %) with a mean age of 39.4 years. The majority of victims were local, while 15 % were foreign, European and tourists. Overall accidents contributed to 53% of all unnatural deaths with victims predominantly sustaining head injuries and polytrauma which occurred from falls (71%) during mountain recreational activities. 24% of victims who fell tested positive for alcohol (>0.01g/100ml). Body mass index (BMI) calculations of the 98 victims revealed that 53% had BMI above 25. A p re -existing medical condition (predominantly cardiac) was the cause of the natural deaths. 26 A significant finding of the study was that 22% of deaths were due to suicides that took place on or surrounding Table Mountain. Suicides occurred commonly during summer with Fridays and Mondays being the common suicide days. The victims, all men, in the age range of 30-39 years (mean age of 39 years) were predominantly Caucasian (68%) and used hanging (45%) and jumping (27%) off the mountain as the two most preferred methods of death. 22% of suicide victims tested positive for alcohol at time of death. Conclusion: The TMNP is one of South Africa's most popular tourist attractions, due largely in part to the presence of Table Mountain. A retrospective study of deaths that occurred within the Park and on the mountain range over a 12-year period identified a predominantly Caucasian male victim demographic and found that head and polytrauma sustained from falls while participating in mountain associated activities as the leading cause of death. A significant finding was the high percentage (22%) of suicide deaths that took place. This study has helped to identify Table Mountain as a possible local suicide hotspot and points to a need for TMNP authorities to include in their safety protocols, strategies for suicide prevention. Larger collaborative studies are recommended as this would significantly impact on public health through the improvement of Park and mountain safety.
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    Retrospective review of paediatrics patients involved in pedestrian vehicle accidents in greater cape Town
    (2020) Moller, Izelle; Liebenberg, Linda; Heathfield, Laura
    Pedestrian vehicle injuries are a growing public health threat worldwide. In South Africa, pedestrian accidents are the leading cause of injury related deaths in children younger than 15 years. There is international and national research looking at various aspects of pedestrian vehicle accidents. Previous studies have highlighted the general distribution of injuries sustained in paediatric pedestrian accidents. However, the specific types of injuries sustained by children pedestrians in different age groups have not been widely researched. We conducted a retrospective review of children involved in road traffic accidents as pedestrians in the greater Cape Town area from 2011 to 2015. The study population included patients below the age of 13 years that were admitted to Red Cross Children's Hospital (RCCH), as well as those subjects that died and presented to the Forensic Pathology Laboratory in Salt River also known as Salt River Mortuary (SRM). The age group 0-12 years was selected because RCCH is a referral paediatric hospital that only admits children under the age of 13 years. Data obtained from the study population were analysed according to age, gender, time, date (day of week and month) and area of accident, as well as injuries sustained. Cases were grouped according to age in order to analyse and compare changes in injury patterns for different groups. Age groups 0-4 years, 5-9 years and 10-12 years were selected. Further comparison of the injuries sustained was made between children admitted to RCCH (survivors) and subjects admitted to SRM (deceased). During the 5-year period 552 children were admitted to RCCH and 109 cases were admitted to SRM with 2:1 male to female predominance in both study groups. In our study, the group with the highest number/percentage of deaths was children aged 0 – 4 years, which contrasts with previous research. Most of the accidents (75-80%) occurred in lower socioeconomic areas. Significantly more head injuries occurred in children who died from their injuries than those who survived (96% versus 18%) (p < 0.0001). Out of the children who demised, 27% had spinal injuries, 61% had chest injuries and 43% had abdominal injuries, all of which were significantly higher than children who survived (p < 0.0001 for each). Upper limb injuries were equal between the two groups (12% vs 13%) and lower limb injuries were more common in the survivors (46% vs 24%). These results are the first to be documented in Cape Town and provide insight into the nature of injuries sustained by children involved in pedestrian vehicle accidents.