Vol 6, No 2 (2020)

Aim. For the purpose of ensuring the reliability of national mortality statistics, the present regulations set out to generalize current information on the preparation of primary medical documentation on the basis of requirements for filing death certificates, ICD-10 rules and recommendations by the Russian Ministry of Health.

Material and methods. Existing requirements for filing death certificates, ICD-10 rules updated by WHO in 1996–2019 and recommendations by the Russian Ministry of Health were analysed.

Results. The preparation of primary medical documentation, formulation of the concluding clinical, pathological, anatomical and forensic post-mortem diagnosis, issuance of death certificates, selection and coding of the primary cause of death should be carried out in accordance with the unified ICD-10 rules. Postmortem diagnosis should correspond to Volume 3 of ICD-10.

Due to the pandemic of a new coronavirus infection, referred to as COVID-19, in 2019, WHO introduced changes to the ICD-10. COVID-19 was included in ICD-10 chapter XXII and received the codes of U07.1 and U07.2. COVID-19-accosiated deaths were divided into those where COVID-19 is determined to be the primary cause of death and those where COVID-19 falls into the category “other” causes.

COVID-19 with fatal complications is most frequently selected as the primary cause of death in acute conditions, with concurrent chronic diseases (cancer, diabetes, chronic forms of ischemic and cerebrovascular diseases, etc.) being indicated as “other” causes of death in Part II of the death certificate. In the presence of trauma, poisoning, bleeding and conditions requiring emergency medical care, these conditions are selected as the primary cause of death, with COVID-19 being recorded in part II of the certificate.

Conclusion. To provide reliable statistical information about mortality rates, executive authorities require the primary medical documentation filed in strict accordance with established rules. 

Autopsy data from 80 patients who died of the COVID-19 infection were analysed. Using macro- and microscopic studies, specific features of pathological processes in various organs were identified. The obtained experimental data, along with information from literature sources, allowed conclusions to be drawn about the mechanisms of damaging internal organs and body systems, as well as assumptions to be made about individual links in the pathogenesis of COVID-19. The thanatogenesis of the disease and the main causes of death are discussed, including acute cardiopulmonary failure, acute renal failure, pulmonary thromboembolism, shock involving multiple organ failure and sepsis. The critical importance of autopsy is emphasized, which provides valuable information on the morphological substrate for this infection closely associated with possible clinical manifestations.

Child abuse in Japan has become a social problem, with yearly increases in the number of consultations at child consultation centers. Of the four classifications of child abuse (physical abuse, neglect, sexual abuse, and emotional abuse), Japan has seen a particular increase in emotional abuse. Capturing evidence of child abuse is difficult. Generally, photographs are used as evidence, but the photography requires instructions. Three studies are introduced with alternate methods to enable bruising to be used as evidence of child abuse. First, spectrophotometry is used to digitize the color of skin, and provide scientific evidence of the co-existence of old and fresh bruises. Second, the diagnostic equipment of ultrasonography is used to evaluate the depth and thickness of subcutaneous hemorrhages that are due to bruising and which decrease over time after the bruising had occurred. Ultrasonic diagnosis can evaluate both the depth and thickness of such subcutaneous hemorrhages and illustrate the healing process. Third, forensic light source was used, which effectively uses violet light to enhance the visibility of bruises over time, even after old bruises become yellowish and can be hard to differentiate with the naked eye. These methods are useful for visualizing bruises and for capturing the evidence of child abuse. The methods are currently under study, but application in a clinical setting is expected.

The author describes the complex of Dimedrol-induced morphofunctional changes in the internal organs in animal models that possesses a diagnostic potential in forensic cases of fatal poisoning with this drug.

Aim. Studying and specification of the complex morphofunctional pathology of the internal organs in animal models under oral administration of toxic doses of Dimedrol, with the perspective of improving accuracy of forensic diagnosis of antihistamine poisoning with clinical data.

Materials and methods. Studies were conducted on white mongrel rats of both sexes and 180–220 g weight. Poisoning was modelled with pharmacopoeial Dimedrol containing 99.9 % of the active substance.

Results. Morphofunctional criteria are proposed for the differential diagnosis of antihistamine poisoning on the basis of characteristic changes in the microcirculatory bed and histological structure of the internal organs in experimental animals. Putative recommendations are formulated in the forensic diagnosis of death caused by antihistamine poisoning.

Conclusion. The obtained results indicate that the general toxic effect is complemented by pronounced vascular lesions in the genesis of death in cases of antihistamine poisoning at high doses of the administered drug. 

Postmortem computer tomography (CT) came into practice of forensic medicine in the 1990s and has later been complemented with magnetic resonance imaging (MRI). A pioneer virtual autopsy was conducted in Germany in 1983. In the Czech Republic, this examination was first performed in 1993.

A typical examination requires about 30 min, with the most resource-demanding stage being the image data rendering. CT was shown to better capture skeletal structures, while MRI contrasting is superior in terms of visualising soft tissues. In the Czech Republic, CT-based virtopsy is legislated mandatory to document deaths inflicted by gunshots, road traffic and aviation accidents, high falls, occupational and explosive-related injuries, thermal and mechanical traumas, strangulation, drowning as well as to examine unidentified or decomposing bodies, deceased children and adolescents aged under 18.

CT scanning prior to conventional autopsy provides a forensic expert with guidance to reveal pathologies non-invasively in particular regions that are difficult to dissect or access. The advantage of virtopsy is the objective acquisition of data that can be re-examined, reinterpreted or juxtaposed with the results of conventional autopsy and easily recovered for possible further expertise. 

Dieulafoy’s disease is a genetically determined lesion manifested in a developmental malformation of the vessels in the submucosal layer of the stomach with arrosion of an abnormally large artery. Dieulafoy’s ulcer is relatively uncommon and causes 0.4–1 % of all acute gastric bleedings, twice as often in men than in women. With the advent of endoscopy, its mortality rate decreased from 80 to 20 %. At the macroscopic scale, Dieulafoy’s arrosion is oval or star-shaped, with the mucous membrane “raised” above the bleeding vessel in the form of a polyp. In 80 % of the cases, the haemorrhage occurs at a 5–6 cm distance from the oesophageal-gastric anastomosis, most commonly in the lesser curvature. Microscopically, the wall of the arrosed artery is affected by proliferation and sclerosis of the intima, degeneration of the middle layer and disappearance of elastic fibres. This article describes a case from forensic practice that may be of interest to doctors of various specialities. During autopsy of citizen F., his stomach was found to contain two litres of black-brown clotted blood. Examination of the gastric mucosa revealed a lesion in the lesser curvature 5 cm below the oesophageal aperture with characteristic histological markers of Dieulafoy’s disease. Accordingly, death of citizen F. was caused by a massive gastric haemorrhage of a mucosal lesion developed in progression of Dieulafoy’s disease. This case highlights the risks associated with this pathology, as a massive gastric bleeding without proper timely surgery is potentially lethal.

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