Browsing by Author "Martin, Lorna"

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    Comparison of sars-cov-2 rapid tests and formal serological testing on deceased persons in Cape Town Metro
    (2022) Carlisle, Tayna; Heathfield, Laura; Martin, Lorna
    The COVID-19 disease was declared a global pandemic in 2020 and since, it is unclear how many people have truly been infected. Additionally, there is a paucity of research into post mortem antibody testing. An antibody screening tool that is suitable for use in the mortuary setting would go a long way to better document previous COVID-19 infections in deceased persons for surveillance purposes, which would add value to public health systems. This pilot study aimed to explore the use of the Sure Screen COVID- 19 IgG/IgM Rapid Test Cassette in a deceased population, and to compare it to the gold- standard antibody tests in South Africa, to determine the most suitable form of antibody testing for post-mortem samples. Thirty cases, with suspected COVID-19 infection in their lifetime, were recruited from Salt River and Tygerberg mortuaries following informed consent from next-of-kin. Positive COVID-19 PCR (PCP) test confirmation for SARS-CoV-2 was located for 19 of the participants. Blood was collected at autopsy into serum separator tubes which, were found to separate better when centrifuged immediately after sample collection. Sure Screen testing was carried out alongside Roche Diagnostics Elecsys Anti-SARS-CoV-2 and Abbott Architect SARS-CoV-2 IgG Assay. For the confirmed PCP cases, Elecsys' sensitivity was the highest at 94.74%, followed by Sure Screen IgG (78.95%). There was only one case with PCP confirmation with a negative Elecsys result and, in this instance, there was a longer interval between death and autopsy (8 days). No variables relating to time intervals between PCP, death and antibody testing were found to significantly influence the antibody test results. Overall Roche's Elecsys performed the best on our cohort of post-mortem serum samples, followed by Sure Screen, and lastly, Abbott's Architect assay. Based on these results alone, the Sure Screen test demonstrates potential as a screening tool in the mortuary setting, which should be followed up with Roche's Elecsys assay for diagnostic confirmation. However, it is recommended that the sample size be expanded to add weight to this preliminary conclusion.
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    Cooling rates of dummies under various degrees of air humidity, wind speed and air temperature
    (2013) Mfolozi, Sipho; Martin, Lorna
    Henssge observed that even a slight but permanent air movement accelerates cooling of a naked body significantly. However in those experimental studies the rate of air movement was not quantified. Today Henssge’s Nomogram method of thermometric thanatochronometry (mathematic estimation of the post-mortem interval using body temperature measurements) is used the world over and utilises various corrective factors for naked and clothed bodies in still/moving air. The purpose of this research was to correlate measured air flow rates (wind speed) and measured relative air humidity levels (RH) with post-mortem cooling rate in order to formulate appropriate corrective factors to be used with Henssge’s Nomogram. The effect of air flow rates and air humidity on the post-mortem cooling curve was studied within a range of air temperatures using gel-based models (Cooling Dummies) as substitutes for human bodies.
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    Death by electrocution: a retrospective analysis of three medico-legal mortuaries in the eThekwini district of KwaZulu Natal from 2006 to 2016.
    (2023) Awath- Behari, Anez; Martin, Lorna
    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.
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    Exploring the Medico-legal death scene investigation of sudden unexpected death of infants admitted to Salt River mortuary, Cape Town, South Africa
    (2018) Bennett, Tracy; Heathfield, Laura; Martin, Lorna
    A death scene investigation (DSI) forms an integral part of the inquiry into death, particularly for sudden unexpected death of infants (SUDI). Global guidelines exist for DSI, however, it is unclear how many countries adhere to them, and to what extent they are followed. Therefore, a systematic literature review was undertaken to assess the scope of SUDI DSI performed internationally. It was found that national protocols have been established in some countries, and have shown value in guiding medico-legal examinations. Further, South Africa did not routinely perform DSI for SUDI cases, nor was there a protocol. This was largely attributed to the burden of SUDI cases as well as the lack of resources. Therefore, this study aimed to suggest realistic and feasible ways to improve DSI for local SUDI cases. This research study consisted of three phases: 1) A twoyear review of medico-legal case files from SUDI cases investigated at Salt River Mortuary; 2) The prospective observation of DSI for ten SUDI cases, using a semi-structured checklist; and 3) he distribution and analysis of a survey regarding SUDI DSI to all registered, qualified forensic pathologists in South Africa. The results showed that the SUDI death scenes were assessed in 59.2% of cases at Salt River Mortuary, with inconsistent levels of documentation or photography. Death scenes were never investigated in cases where the infant was pronounced dead on arrival at a medical facility. In both scene observations (n=10) and retrospective analysis (n=454) only one case incorporated a re-enactment, but the majority of infants were moved prior to DSI. The findings support the need for a standardised approach to DSI, coupled with specialised training for staff. Based on the available resources, this should focus on the establishment of guidelines pertaining to photography, handling medicine and scene reconstruction, as well as accurate use of relevant documentation.
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    Forensic human identification: Generating Y-STR data for the South African population
    (2018) Reid, Kate Megan; Heathfield, Laura; Martin, Lorna
    Salt River Mortuary (SRM), Cape Town, investigates ~3500 cases of unnatural death annually, with an apparent burden of unclaimed bodies. A retrospective review was first undertaken to assess the number of these individuals who remained unidentified. Medicolegal records were examined (2010-2017), and ~9% of cases remained unidentified each year. DNA analysis was performed in 23.5% of cases. At the time of this study, unidentified bodies were in storage for up to two years, pending pauper burial. DNA profiling assists forensic human identification, and the analysis of markers on the Y-chromosome has particular importance in kinship analysis. To evaluate the statistical probability of DNA profiles matching between samples, reference data from the background population is required. Such data for the Y-chromosome is lacking for some populations groups in South Africa (SA). As such this study aimed to generate Y-chromosome data relevant to SA. Second to this, the obtainability of DNA profiles from unidentified decedents at SRM, prior to pauper burial, was investigated. Biological samples were obtained from 653 SA individuals (living: n=480; deceased: n=173) belonging to four major population groups. Following internal validation, samples were processed using the Promega PowerPlex® Y23 System. A cohort-representative subset of DNA profiles were also generated using the forensically validated Next Generation Sequencing (NGS) assay on the MiSeq FGx™ system, to assess concordance. Statistical analysis was performed using Arlequin and STATA packages. Full DNA profiles (i.e. haplotypes) were obtained from 626 samples (African: n=183; Coloured: n=170; Indian/Asian: n=111; White: n=162), with 599 haplotypes being unique to a single individual. Following optimisation, haplotypes were obtained from >99% and 85% of living and deceased individuals, respectively. Haplotypes were generated from numerous individuals stored for over one year, and DNA profile quality was not associated with time between death declaration and sample collection. NGS results confirmed the presence of one micro-variant and resolved allele-calling in five instances where the capillary electrophoresis assay was incorrect. Thus, concordance was observed in 98% of loci reviewed. Overall, haplotypes were successfully obtained for four different SA population groups, including refrigerated decedents, even 887 days after death declaration. This demonstrates that DNA profiling can be successful for decedents and efforts should be made to store DNA profiles for the possibility of familial searching and identification, even after burial. Identification of the multitude of unclaimed bodies at forensic facilities nationwide holds immense value for living family members, and provides closure for the acceptance of death and life thereafter.
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    Medicine and the Arts Week 6 - Dicing with death
    (2015-01-21) Martin, Lorna
    Warning: this video contains images from a real autopsy procedure. Lorna Martin, a forensic pathologist, talks about the forensic scientist’s work with human corpses and describes in some detail the standard procedure for dissecting and documenting a corpse. This is the fifth video in Week 6 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 6 - In dialogue about the corpse
    (2015-01-21) Levine, Susan; Posel, Deborah; Smith, Kathryn; Martin, Lorna
    In this video, Susan Levine reflects on how each of the three speakers in previous videos used their different perspectives to address the topic of death and the corpse and poses additional questions to them. Lorna is asked about her interaction with the families of the deceased. Deborah is asked to elaborate on the concept of 'discipline'. Kathryn is asked how her work interfaces with art presentation and representation. This is the sixth video in Week 6 of the Medicine and the Arts Massive Open Online Course.