Browsing by Author "Maistry, Sairita"

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    Ethical considerations in forensic genetics research on tissue samples collected post-mortem in Cape Town, South Africa
    (BioMed Central, 2017-11-29) Heathfield, Laura J; Maistry, Sairita; Martin, Lorna J; Ramesar, Raj; de Vries, Jantina
    Background: The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. Main body: This article discusses some of the ethical challenges that were encountered in these research projects. Among these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. Conclusion: It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa.
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    The importance of a protocol in the recovery and handling of burned human remains in a forensic context
    (2016) Schwab, Petra; Friedling, Louise J; Maistry, Sairita
    Fire-related fatalities pose many investigative challenges, in part due to their fragility. This can be managed with the creation of protocols, specific to the environment in which they are implemented. Currently, no protocol for the recovery and handling of fire-related fatalities exists in Cape Town, South Africa. Additionally, the challenges, risk factors, and resources present at forensic scenes in the area have not been documented. From April to December of 2015, fire-related death scenes were attended with Salt River Forensic Pathology Laboratory, which serves the West Metropole of Cape Town. Details of the fatal fire scenes were noted, including the challenges faced, and the settings in which the fires occurred. Emphasis was placed on methodologies used to recover, handle, and transport remains, and the availability and utilisation of resources. The affect these methodologies had on the condition of the remains between scene and autopsy was assessed. In total 32 fire-related death scenes were attended, with 48 decedents recovered. Males predominated (64.6%), and the majority were young adults (75%). Accidental deaths were most prevalent (79.2%), however a fire-related suicide and homicides highlighted the importance of thorough investigation. Informal housing constituted 68.8% of the fatal fire scenes and presented unique scene constraints, including no direct road access at 50% of these scenes. Investigative limitations included: inadequate interagency communication, resulting in a lack of collateral information available at autopsy; deficient scene and contextual documentation; non-standardised recovery methodologies; insufficient availability and utilisation of resources (including safety equipment); and no specialised personnel (e.g. forensic pathologists/ anthropologists) conducting scene recovery. The majority of cases (60.4%) were further fragmented or fractured by time of autopsy, illustrating the necessity for improvement of current methodologies and the importance of the involvement of forensic anthropologists in recovery of fragmentary remains.
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    The prevalence of infection related death at Salt River Mortuary for the years 2013 and 2014
    (2017) Kruger, Maria Magdalena; Heathfield, Laura; Martin, Lorna J; Maistry, Sairita
    Infection related death is of major concern world-wide. This is especially true in developing countries where there is a high burden of disease. In some cases infections may present atypically and death occurs without a diagnosis in life. Many countries, including South Africa, classify these deaths as sudden unexpected or unexplained, which, under the Inquests Acts, necessitates a medico-legal autopsy. In order to understand the mechanisms underlying such deaths, a systematic review of the literature was undertaken on sudden death due to infection. Data from published research and reports identified many pathogens associated with sudden or unexplained death in infants and older individuals. However it remains important to understand locally relevant pathogens. In addition, many risk factors have been identified in different age groups but it is not known what risk factors are prevalent in a local setting and if these correspond to international trends. In order to contribute to local data a case file review was undertaken of infection related deaths at Salt River Mortuary between 1 January 2013 and 31 December 2014 (n=809). Deaths due to respiratory infections were the leading cause of death across all ages and in both sexes. It is not known to what degree this is a true reflection of the cause of death as the extent of autopsy, ancillary investigations and availability of ante-mortem clinical information varied widely. There has been a call for standardised protocols for the post-mortem investigation of these deaths and the data analysed reiterated this need. Many of the modifiable risk factors for infant death identified in the literature review were also identified in the Western Cape Metropole area, with the exception of sleeping position: side sleeping, as opposed to prone sleeping, was identified as the distinctive risk factor. In older individuals tuberculosis was identified as either the cause of death or a major contributor to comorbid conditions, which highlights the importance of further surveillance of vulnerable individuals. These data have provided insight into the extent of infection related death and associated risk factors in a local context. A standardised protocol for the investigation of these deaths across mortuaries would enable more accurate data to be collected which in turn could be fed back into the healthcare system.
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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.