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The prevalence of traditional risk factors in the young with coronary artery atherosclerosis
ABSTRACTS
complications of endocarditis due to Staphylococcus lugdunensis. This coagulase negative bacterium is an uncommon cause of endocarditis with only 50 cases reported in the literature.1 In this case, S. lugdunensis was isolated from cultures of vegetations found on the native aortic and mitral valves. The autopsy also showed septic emboli in the kidney and spleen. The patient presented 19 days before death to his general practitioner and the local emergency department with back pain and fevers. The clinical differential diagnosis included pyelonephritis, kidney stone and musculoskeletal pain. He was initially treated with oral antibiotics. However, following serological and radiological investigations, it was concluded that the symptoms were due to lumbar spinal facet joint degeneration and nerve root impingement. Clinical and forensic features are discussed in the context of reported cases of S. lugdunensis infection. Reference 1. Renzulli, A, Della Corte, A, Torella M, et al. Mitral and aortic valve endocarditis due to Staphylococcus lugdunensis. Tex Heart Inst J 2000; 27: 67–9.
THE PREVALENCE OF TRADITIONAL RISK FACTORS IN THE YOUNG WITH CORONARY ARTERY ATHEROSCLEROSIS Christina Shin, Joanna Glengarry Department of Forensic Pathology, Auckland City Hospital, New Zealand Background: Coronary artery atherosclerosis (CAA) in the young is largely associated with traditional risk factors in the literature. However, other potential contributory factors such as familial hypercholesterolaemia (FH) should be a consideration, particularly in the absence of these risk factors. Aim: To determine the prevalence of traditional risk factors in young individuals with CAA in the autopsy setting. Methods: A database search was performed at this department. Reports from all full autopsies performed in-house between January 2007 and June 2016 on individuals 35 years or younger were retrieved retrospectively, and those with significant (at least moderate CAA) were identified. Demographic information, the cause of death, and the presence of traditional risk factors (obesity, smoking, hypercholesterolaemia/hyperlipidaemia, hypertension, diabetes mellitus and family history) were obtained. Results: Of a total of 1522 deceased, 78 cases (5%) demonstrated significant CAA. One or more traditional risk factors were known to be present or established at autopsy in 55 cases (79%). Conclusion: Traditional risk factors are present in the majority of cases of CAA in the young. Up to 29% of young individuals have no known cause for CAA and other causes such as FH should be considered, although documentation was limited and likely overestimates this group. References Bagnall RD, Weintraub RG, Ingles J, et al. A prospective study of sudden cardiac death among children and young adults. N Engl J Med 2016; 374: 2441–52. Navas-Nacher EL, Colangelo L, Beam C, et al. Risk factors for coronary heart disease in men 18 to 39 years of age. Ann Intern Med 2001; 134: 433–9. Leadbeatter S, Williams DW, Stansbie D. Incidence of familial hypercholesterolaemia in premature deaths due to coronary heart disease. Am J Forensic Med Pathol 1987; 8: 280–2.
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INVESTIGATION INTO THE POTENTIAL FOR POSTMORTEM FORMATION OF CARBOXYHAEMOGLOBIN IN BODIES RETRIEVED FROM FIRES Claire Sully1, Stewart Walker1, Neil Langlois2 1 School of Chemical and Physical Sciences, Flinders University, Adelaide, and 2Forensic Science South Australia, Adelaide, SA, Australia The forensic investigation of deceased retrieved from a fire includes determining if death occurred before or during the event. A blood carboxyhaemoglobin level above 10% is considered indicative of respiration during a fire. Previous spectroscopic studies revealed oxygen can passively diffuse into skin and reoxygenate haemoglobin.1 It was therefore questioned if carbon monoxide could also dermally diffuse and elevate post-mortem blood carboxyhaemoglobin levels, falsely insinuating an individual had been alive and respired during a fire. The aims of this project focused on determining if carbon monoxide could passively diffuse into the body post-mortem and elevate blood carboxyhaemoglobin levels. Following acceptance of notification by Ethics committees, stillborn piglets were exposed to 1% or 10% carbon monoxide. Spectrophotometry revealed carbon monoxide diffused into the dermal layers of skin. Carboxyhaemoglobin was quantified in blood from the heart and chest cavity. Samples from intact bodies were not affected, suggesting skin is a reasonable carbon monoxide barrier. Piglets with cavity breaches replicating extensive injuries, exposed to carbon monoxide demonstrated cavity carboxyhaemoglobin levels above 10%. These results identified when physical breaches are present in a body elevation in post-mortem carboxyhaemoglobin can occur that could be interpreted as an individual having been alive during a fire event. Reference 1. Watchman H, Walker GS, Randeberg LL, et al. Re-oxygenation of post-mortem lividity by passive diffusion through the skin at low temperature. Forensic Sci Med Pathol, 2011; 7: 333–5. HYPOTHALAMIC GENE EXPRESSION IS REGULATED BY DNA METHYLATION LINKING PARENTAL DIET DURING PREGNANCY TO OFFSPRING’S RISK OF OBESITY IN PSAMMOMYS OBESUS I. Khurana1,5, A. Kaspi1,5, M. Ziemann1, T. Block1, T. Connor2, B. Spolding2, A. Cooper2, P. Zimmet1, A. El-Osta1,3,4, K. Walder2 1 Epigenetics in Human Health and Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, 2Metabolic Research Unit, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Waurn Ponds, 3 Department of Pathology, The University of Melbourne, Parkville, 4Faculty of Medicine, Monash University, Melbourne, Australia; and 5these authors contributed equally to this work Background: The rise of obesity represents a major global public health issue.1 Recent studies imply that parental diet influences foetal development and future risk of metabolic syndrome in offspring.2 The hypothalamus controls energy balance by regulating endocrine signals. We hypothesise that offspring susceptibility to obesity is mediated by changes in DNA methylation that occurs during hypothalamic programming in utero, which persist
complications of endocarditis due to Staphylococcus lugdunensis. This coagulase negative bacterium is an uncommon cause of endocarditis with only 50 cases reported in the literature.1 In this case, S. lugdunensis was isolated from cultures of vegetations found on the native aortic and mitral valves. The autopsy also showed septic emboli in the kidney and spleen. The patient presented 19 days before death to his general practitioner and the local emergency department with back pain and fevers. The clinical differential diagnosis included pyelonephritis, kidney stone and musculoskeletal pain. He was initially treated with oral antibiotics. However, following serological and radiological investigations, it was concluded that the symptoms were due to lumbar spinal facet joint degeneration and nerve root impingement. Clinical and forensic features are discussed in the context of reported cases of S. lugdunensis infection. Reference 1. Renzulli, A, Della Corte, A, Torella M, et al. Mitral and aortic valve endocarditis due to Staphylococcus lugdunensis. Tex Heart Inst J 2000; 27: 67–9.
THE PREVALENCE OF TRADITIONAL RISK FACTORS IN THE YOUNG WITH CORONARY ARTERY ATHEROSCLEROSIS Christina Shin, Joanna Glengarry Department of Forensic Pathology, Auckland City Hospital, New Zealand Background: Coronary artery atherosclerosis (CAA) in the young is largely associated with traditional risk factors in the literature. However, other potential contributory factors such as familial hypercholesterolaemia (FH) should be a consideration, particularly in the absence of these risk factors. Aim: To determine the prevalence of traditional risk factors in young individuals with CAA in the autopsy setting. Methods: A database search was performed at this department. Reports from all full autopsies performed in-house between January 2007 and June 2016 on individuals 35 years or younger were retrieved retrospectively, and those with significant (at least moderate CAA) were identified. Demographic information, the cause of death, and the presence of traditional risk factors (obesity, smoking, hypercholesterolaemia/hyperlipidaemia, hypertension, diabetes mellitus and family history) were obtained. Results: Of a total of 1522 deceased, 78 cases (5%) demonstrated significant CAA. One or more traditional risk factors were known to be present or established at autopsy in 55 cases (79%). Conclusion: Traditional risk factors are present in the majority of cases of CAA in the young. Up to 29% of young individuals have no known cause for CAA and other causes such as FH should be considered, although documentation was limited and likely overestimates this group. References Bagnall RD, Weintraub RG, Ingles J, et al. A prospective study of sudden cardiac death among children and young adults. N Engl J Med 2016; 374: 2441–52. Navas-Nacher EL, Colangelo L, Beam C, et al. Risk factors for coronary heart disease in men 18 to 39 years of age. Ann Intern Med 2001; 134: 433–9. Leadbeatter S, Williams DW, Stansbie D. Incidence of familial hypercholesterolaemia in premature deaths due to coronary heart disease. Am J Forensic Med Pathol 1987; 8: 280–2.
S103
INVESTIGATION INTO THE POTENTIAL FOR POSTMORTEM FORMATION OF CARBOXYHAEMOGLOBIN IN BODIES RETRIEVED FROM FIRES Claire Sully1, Stewart Walker1, Neil Langlois2 1 School of Chemical and Physical Sciences, Flinders University, Adelaide, and 2Forensic Science South Australia, Adelaide, SA, Australia The forensic investigation of deceased retrieved from a fire includes determining if death occurred before or during the event. A blood carboxyhaemoglobin level above 10% is considered indicative of respiration during a fire. Previous spectroscopic studies revealed oxygen can passively diffuse into skin and reoxygenate haemoglobin.1 It was therefore questioned if carbon monoxide could also dermally diffuse and elevate post-mortem blood carboxyhaemoglobin levels, falsely insinuating an individual had been alive and respired during a fire. The aims of this project focused on determining if carbon monoxide could passively diffuse into the body post-mortem and elevate blood carboxyhaemoglobin levels. Following acceptance of notification by Ethics committees, stillborn piglets were exposed to 1% or 10% carbon monoxide. Spectrophotometry revealed carbon monoxide diffused into the dermal layers of skin. Carboxyhaemoglobin was quantified in blood from the heart and chest cavity. Samples from intact bodies were not affected, suggesting skin is a reasonable carbon monoxide barrier. Piglets with cavity breaches replicating extensive injuries, exposed to carbon monoxide demonstrated cavity carboxyhaemoglobin levels above 10%. These results identified when physical breaches are present in a body elevation in post-mortem carboxyhaemoglobin can occur that could be interpreted as an individual having been alive during a fire event. Reference 1. Watchman H, Walker GS, Randeberg LL, et al. Re-oxygenation of post-mortem lividity by passive diffusion through the skin at low temperature. Forensic Sci Med Pathol, 2011; 7: 333–5. HYPOTHALAMIC GENE EXPRESSION IS REGULATED BY DNA METHYLATION LINKING PARENTAL DIET DURING PREGNANCY TO OFFSPRING’S RISK OF OBESITY IN PSAMMOMYS OBESUS I. Khurana1,5, A. Kaspi1,5, M. Ziemann1, T. Block1, T. Connor2, B. Spolding2, A. Cooper2, P. Zimmet1, A. El-Osta1,3,4, K. Walder2 1 Epigenetics in Human Health and Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, 2Metabolic Research Unit, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Waurn Ponds, 3 Department of Pathology, The University of Melbourne, Parkville, 4Faculty of Medicine, Monash University, Melbourne, Australia; and 5these authors contributed equally to this work Background: The rise of obesity represents a major global public health issue.1 Recent studies imply that parental diet influences foetal development and future risk of metabolic syndrome in offspring.2 The hypothalamus controls energy balance by regulating endocrine signals. We hypothesise that offspring susceptibility to obesity is mediated by changes in DNA methylation that occurs during hypothalamic programming in utero, which persist