Author Archives: churchc

Journal of Clinical Microbiology – Early edition articles – 25 March 2015

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OPEN ACCESS ARTICLE

Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death

Radiographics. 2014 May-Jun;34(3):830-46. doi: 10.1148/rg.343115169

Whole-body postmortem computed tomographic (CT) angiography is a promising new development in forensic radiology that has the potential to improve vascular and soft-tissue imaging beyond levels currently achievable with unenhanced postmortem CT. Postmortem access to the vascular system and injection of contrast medium are different from those steps in clinical (antemortem) radiology. Because there is no circulation in a corpse that could transport or dilute a contrast medium, the injection must be performed by using a roller pump to fill the vasculature (arterial and venous) with a mixture of a water-soluble iodized contrast medium and polyethylene glycol. In contrast to a classic autopsy, postmortem CT angiography is a minimally invasive procedure. It allows the diagnosis of vascular lesions without the disruption or destruction of anatomic structures, which could result in a loss of evidence in a criminal investigation. Furthermore, postmortem CT angiography facilitates the display of vascular pathologic conditions in areas that are not typically covered with autopsy alone, such as the craniocervical junction and the small pelvis. Therefore, postmortem CT angiography adds substantial value to the classic forensic autopsy; cross-sectional data can be reevaluated objectively at any time and are fully reproducible as counterexpertise, which is as useful in the fields of forensic medicine and pathology as in clinical research. Familiarity with the capabilities of postmortem CT angiography may help radiologists working with forensic cases improve their diagnostic performance.

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Computer-assisted virtual autopsy using surgical navigation techniques

AJR Am J Roentgenol. 2015 Jan;204(1):W58-62. doi: 10.2214/AJR.13.11957

OBJECTIVE; Virtual autopsy methods, such as postmortem CT and MRI, are increasingly being used in forensic medicine. Forensic investigators with little to no training in diagnostic radiology and medical laypeople such as state’s attorneys often find it difficult to understand the anatomic orientation of axial postmortem CT images. We present a computer-assisted system that permits postmortem CT datasets to be quickly and intuitively resliced in real time at the body to narrow the gap between radiologic imaging and autopsy.

CONCLUSION:

Our system is a potentially valuable tool for planning autopsies, showing findings to medical laypeople, and teaching CT anatomy, thus further closing the gap between radiology and forensic pathology.

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Hepatitis C enhanced surveillance: results from a southeastern Sydney pilot program

Public Health Research & Practice 2015; 25 (2): e2521520;  http://dx.doi.org/10.17061/phrp2521520

Aim: Hepatitis C virus (HCV) is a potentially serious bloodborne virus, which persists in the majority of those infected. Long-term sequelae include liver cirrhosis, liver cancer and premature death. Early identification of newly acquired infection is important for protection of public health. Routine surveillance based on laboratory notification of HCV infection is not sufficient to differentiate between newly acquired and chronic infections. Enhanced surveillance systems have been trialled globally in a number of settings. This pilot program aimed to increase identification of newly acquired HCV cases in southeastern Sydney residents and to ascertain the likely mode of transmission.

Methods: All HCV notifications in southeastern Sydney residents with specimen dates from 1 July to 31 December 2012 were included in a pilot program. Demographic data, Australian Indigenous identification and previous laboratory results were collected from electronic medical records, where available. Enhanced surveillance forms were sent to referring doctors to seek information about clinical symptoms and previous hepatitis C pathology. Data were collated to assess, according to Australian national case definitions, whether cases were newly acquired or not, or were unable to be determined on the available information.

Results: There were 104 notifications of HCV infection during the surveillance period. Forms were sent to 100 requesting doctors, with 72 forms returned. Six newly acquired cases were identified, a rate of 8%, compared with 1–3% classified by routine surveillance. Twenty cases (28%) were not newly acquired and the status of 46 (64%) was unable to be determined. Of the six newly acquired cases, sexual transmission was deemed to be the likely route of exposure for four cases, and injecting drug use for the remaining two.

Conclusions: Enhanced surveillance increased the rate of identification of newly acquired infections. However, the process was labour-intensive and the status of most cases was unable to be determined. Since identification of newly acquired cases has an important public health benefit in understanding factors in disease transmission, other approaches should be examined.

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Researchers find promising new biomarkers for concussion

(Brown University 25 March 2015) A panel of four readily detectable blood proteins can accurately indicate concussion, even helping distinguishing it from other injuries, according to a new study. Researchers at Brown University and Lifespan found the panel by employing the unusual strategy of looking at the body’s inflammatory response to trauma, which might also be a therapeutic target.

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Blood-based biomarkers could enable simple, accurate TB tests for diagnosis and monitoring

(Emory Health Sciences 30 March 2015) Researchers have identified blood-based biomarkers in patients with active tuberculosis that could lead to new blood-based diagnostics and tools for monitoring treatment response and cure.

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Mobile DNA sequencer shows potential for disease surveillance

(BioMed Central 25 March 2015) A pocket-sized device that can rapidly determine the sequence of an organism’s DNA has shown its potential in disease detection, according to a study published in the open access, open data journal GigaScience.

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