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Article ; Online: Letter From the Guest Editor.

Kepron, Charis

Academic forensic pathology

2018 Volume 8, Issue 3, Page(s) x–xi

Language	English
Publishing date	2018-08-31
Publishing country	United States
Document type	Editorial
ISSN	1925-3621
ISSN (online)	1925-3621
DOI	10.1177/1925362118797773
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Article ; Online: Postmortem survey of haemoglobin A1c, non-alcoholic steatohepatitis and liver fibrosis within a general population.

Klaric, Kristina-Ana / Parai, Jacqueline Louise / Kepron, Charis Anthea / Walker, Alfredo Eugene / Milroy, Christopher Mark

Journal of clinical pathology

2022 Volume 76, Issue 9, Page(s) 606–611

Abstract: Aims: Non-alcoholic steatohepatitis (NASH), fatty liver disease and fibrosis are associated with diabetes mellitus and obesity. Previous autopsy series have reported prevalence of fatty liver disease to be 11%-24%. Recent studies, using imaging and ... ...

Abstract	Aims: Non-alcoholic steatohepatitis (NASH), fatty liver disease and fibrosis are associated with diabetes mellitus and obesity. Previous autopsy series have reported prevalence of fatty liver disease to be 11%-24%. Recent studies, using imaging and serology, suggest a prevalence of 20%-35%, NASH of 5% and advanced fibrosis of 2%-3%. We examined the prevalence of NASH and liver fibrosis in a general autopsy population. Methods: A cross-sectional study of consecutive, adult, medicolegal autopsies over a 1-year period was conducted. Liver sections were scored for fibrosis, inflammation and steatosis using a modified NASH scoring system. Stepwise logistic regression was used to identify associations between NASH or moderate/severe fibrosis and several clinicopathological parameters, including postmortem haemoglobin A1c (HbA1c). Results: Of 376 cases, 86 (22.9%) were classified as NASH. Prevalence of diabetes mellitus, body mass index (BMI) and postmortem HbA1c were significantly higher in NASH cases (39.5%, 32.3 kg/m Conclusions: NASH and advanced fibrosis were higher in our general adult autopsy population compared with previously published estimates. This is a large series with histological evaluation showing that HbA1c >7.0% is independently associated with NASH and advanced fibrosis.
MeSH term(s)	Adult ; Humans ; Glycated Hemoglobin ; Autopsy ; Cross-Sectional Studies ; Non-alcoholic Fatty Liver Disease/epidemiology ; Non-alcoholic Fatty Liver Disease/pathology ; Liver Cirrhosis/pathology ; Liver/pathology ; Diabetes Mellitus/epidemiology
Chemical Substances	Glycated Hemoglobin
Language	English
Publishing date	2022-05-09
Publishing country	England
Document type	Journal Article
ZDB-ID	80261-x
ISSN	1472-4146 ; 0021-9746
ISSN (online)	1472-4146
ISSN	0021-9746
DOI	10.1136/jclinpath-2021-207998
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Article ; Online: Ten Percent of SIDS Cases are Murder - or are They?

Milroy, Christopher M / Kepron, Charis

Academic forensic pathology

2017 Volume 7, Issue 2, Page(s) 163–170

Abstract: Sudden infant death syndrome (SIDS) has been used as a cause of death for over four decades. It has allowed deaths of infants to be registered as natural. Within this group of deaths, a certain number have been recognized to be homicides from inflicted ... ...

Abstract	Sudden infant death syndrome (SIDS) has been used as a cause of death for over four decades. It has allowed deaths of infants to be registered as natural. Within this group of deaths, a certain number have been recognized to be homicides from inflicted smothering rather than being natural or accidental deaths. Research has been conducted using confidential inquires to determine how frequent homicide is in cases called SIDS. This paper traces the history of quoted rates of homicide. Early work suggested the figure was between 2-10% of all SIDS cases, though other workers have suggested figures as high as 20-40%. With the fall in the rate of infant deaths following the "Back to Sleep" campaigns, these figures have been reevaluated. If the higher figures were correct that 20-40% of SIDS were homicides, the fall in infant deaths would be expected to be less than it has been. Current data suggests a much lower figure than 10% of current cases, with much lower overall rates of infant deaths. As well as 10% of SIDS cases having been stated to be homicides, a related question is whether multiple deaths classified as SIDS are really homicides. The paper discusses the maxim that one death is a tragedy, two is suspicious, and three deaths indicate homicide. The paper also looks at court cases and the approach that has been made in prosecutions of sudden unexpected death in infancy as multiple murder.
Language	English
Publishing date	2017-06-01
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1925-3621
ISSN (online)	1925-3621
DOI	10.23907/2017.018
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Article ; Online: Histologic Changes In Recreational Drug Misuse.

Milroy, Christopher M / Kepron, Charis / Parai, Jacqueline L

Academic forensic pathology

2018 Volume 8, Issue 3, Page(s) 653–691

Abstract: Use of recreational drugs is associated with a number of histologic changes. These may be related to the method of administration or due to systemic effects of the drugs. This paper reviews the histopathological features seen following recreational drug ... ...

Abstract	Use of recreational drugs is associated with a number of histologic changes. These may be related to the method of administration or due to systemic effects of the drugs. This paper reviews the histopathological features seen following recreational drug use. With injection, there may be local effects from abscess formation and systemic effects may result in amyloidosis. Injections have been associated with necrotizing fasciitis, anthrax, and clostridial infections. Systemic effects include infective endocarditis, with the risk of embolization, and abscesses may be seen in organs in the absence of infective endocarditis. Viral complications of injection include hepatitis and human immunodeficiency virus (HIV) infection. Injecting crushed tablets can result in intravascular granulomata in the lungs. Smoking drugs is associated with intraalveolar changes, including blackand brown-pigmented macrophages in crack cocaine and cannabis smoking, respectively. Snorting may result in intraalveolar granulomata forming when crush tablets are used and there may be systemic granulomata. Stimulants are associated with cardiovascular and cerebrovascular pathology, including contraction band necrosis and myocardial fibrosis, as well as coronary artery dissection. Stimulants may cause hyperpyrexia and rhabdomyolysis, which may be associated with changes in multiple organs including myoglobin casts in the kidney. Opioids cause respiratory depression and this can be associated with inhalational pneumonia and hypoxia in other organs if there is resuscitation and a period of survival. Ketamine use has been associated with changes in the urothelium and the liver. This paper reviews histology changes that may be seen in drug-related deaths using illustrative cases.
Language	English
Publishing date	2018-08-31
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1925-3621
ISSN (online)	1925-3621
DOI	10.1177/1925362118797740
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Article ; Online: Rickets or abuse? A histologic comparison of rickets and child abuse-related fractures.

Kepron, Charis / Pollanen, Michael S

Forensic science, medicine, and pathology

2015 Volume 11, Issue 1, Page(s) 78–87

Abstract: Purpose: The bone changes of vitamin D deficiency rickets have been invoked as an alternate explanation for child-abuse related fractures identified through medical imaging. The lack of modern histopathologic comparisons between these two entities ... ...

Abstract	Purpose: The bone changes of vitamin D deficiency rickets have been invoked as an alternate explanation for child-abuse related fractures identified through medical imaging. The lack of modern histopathologic comparisons between these two entities limits the abilities of the forensic pathologist to address this differential diagnosis, both in their autopsy reports and on the witness stand. Methods: We report a comparison of the histologic appearance of the bones in a two year old child with vitamin D deficiency rickets with fractures occurring in three young children with child abuse. Results: In the case of rickets, there was marked architectural disorganization of endochondral ossification at the costochondral junctions and growth plates of long bones. The child abuse-related fractures showed osteochondral callus at different stages of healing, either centered on a discrete fracture line or at metaphyses (e.g. classical metaphyseal lesions). In many instances, the healing fractures disrupted the line of endochondral ossification. In none of the child abuse-related fractures was there any similarity to the histologic appearance of rickets. Conclusion: The maturation disturbance in the growth plate that occurs in rickets is a distinctive entity that cannot be confused histologically with healing fractures, including the classical metaphyseal lesion.
MeSH term(s)	Autopsy ; Biopsy ; Bone Remodeling ; Bone and Bones/diagnostic imaging ; Bone and Bones/pathology ; Cause of Death ; Child Abuse ; Child, Preschool ; Diagnosis, Differential ; Fatal Outcome ; Female ; Forensic Pathology/methods ; Fracture Healing ; Fractures, Bone/diagnostic imaging ; Fractures, Bone/etiology ; Fractures, Bone/pathology ; Humans ; Infant ; Male ; Predictive Value of Tests ; Radiography ; Rickets/complications ; Rickets/diagnostic imaging ; Rickets/pathology ; Risk Factors
Language	English
Publishing date	2015-03
Publishing country	United States
Document type	Case Reports ; Comparative Study ; Journal Article
ZDB-ID	2195904-3
ISSN	1556-2891 ; 1547-769X
ISSN (online)	1556-2891
ISSN	1547-769X
DOI	10.1007/s12024-014-9639-3
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Article ; Online: Are There Hallmarks of Child Abuse? I. Osseous Injuries.

Walker, Alfredo / Kepron, Charis / Milroy, Christopher M

Academic forensic pathology

2016 Volume 6, Issue 4, Page(s) 568–590

Abstract: Fractures are commonly found in cases regarded as child abuse. The most commonly encountered fractures are to the ribs and the metaphyses. This paper examines the specificity of the classical metaphyseal lesion (CML) and rib fractures as hallmarks of ... ...

Abstract	Fractures are commonly found in cases regarded as child abuse. The most commonly encountered fractures are to the ribs and the metaphyses. This paper examines the specificity of the classical metaphyseal lesion (CML) and rib fractures as hallmarks of child abuse. Recently, vitamin D deficiency (rickets) has been proposed as an alternative cause for the appearances typically described in CML. The literature in this area is examined. Rib fractures have also been highly associated with child abuse, particularly posterior rib fractures. As well as metabolic bone disease, resuscitation has been examined as a cause of rib fractures in young children. The current literature remains strongly supportive of rib fractures and metaphyseal fractures being indicators of child abuse.
Language	English
Publishing date	2016-12-01
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1925-3621
ISSN (online)	1925-3621
DOI	10.23907/2016.056
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Article ; Online: Are There Hallmarks of Child Abuse? II. Non-Osseous Injuries.

Kepron, Charis / Walker, Alfredo / Milroy, Christopher M

Academic forensic pathology

2016 Volume 6, Issue 4, Page(s) 591–607

Abstract: Certain conditions have been considered hallmarks of child abuse. Such pathognomonic conditions have led to an inevitable diagnosis of inflicted injury. Forensic pathologists are faced with complex analyses and decisions related to what is and what is ... ...

Abstract	Certain conditions have been considered hallmarks of child abuse. Such pathognomonic conditions have led to an inevitable diagnosis of inflicted injury. Forensic pathologists are faced with complex analyses and decisions related to what is and what is not child abuse. In this review, we examine the literature on the specificity of five conditions that have been linked to inflicted injury to varying degrees of certainty. The conditions examined include tears of the labial frena (frenula), cigarette burns, pulmonary hemorrhage and intraalveolar hemosiderin-laden macrophages as markers of upper airway obstruction, intraabdominal injuries, and anogenital injuries and postmortem changes. Analysis of the literature indicates that frena tears are not uniquely an inflicted injury. Cigarette burns are highly indicative of child abuse, though isolated cigarette burns may be accidental. Pulmonary hemorrhage is seen more commonly in cases with a history suggestive of upper airway obstruction, but is not diagnostic in an individual case. Hemosiderin-laden macrophages may be seen in cases with inflicted injuries and in natural deaths. Abdominal injuries may be seen in accidents and from resuscitation, though panreatico-duodenal complex injuries in children under five years of age are not reported to be seen in falls or resuscitation. The understanding of anogenital injuries is increasing, but misunderstanding of postmortem changes has led to miscarriages of justice.
Language	English
Publishing date	2016-12-01
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1925-3621
ISSN (online)	1925-3621
DOI	10.23907/2016.057
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Article ; Online: Forensic Investigation of Methadone Concentrations in Deceased Breastfed Infants.

Madadi, Parvaz / Kelly, Lauren E / Ross, Colin J / Kepron, Charis / Edwards, James N / Koren, Gideon

Journal of forensic sciences

2016 Volume 61, Issue 2, Page(s) 576–580

Abstract: There is a paucity of data to aid in assessing whether postmortem methadone findings in breastfed infants are clinically and/or toxicologically significant. Two cases are reported in which methadone was detected in deceased neonates whose mothers were ... ...

Abstract	There is a paucity of data to aid in assessing whether postmortem methadone findings in breastfed infants are clinically and/or toxicologically significant. Two cases are reported in which methadone was detected in deceased neonates whose mothers were enrolled in methadone maintenance programs and were breastfeeding. In addition to a complete autopsy and toxicological testing for alcohol, prescription medications, and drugs of abuse, pharmacogenetic analysis was performed for variants in genes related to methadone metabolism and response. In both cases, the postmortem methadone concentration measured in neonatal heart blood was higher than the maximum serum methadone concentration reported in living breastfed infants whose mothers were receiving methadone. However, additional analysis of antemortem blood indicated postmortem redistribution of methadone. Pharmacogenetic results were suggestive of a potential predisposition to methadone toxicity based on studies in adults; the significance of these findings in breastfed neonates requires further research. The medical cause of death was unascertained in both cases.
MeSH term(s)	ATP Binding Cassette Transporter, Sub-Family B/genetics ; Breast Feeding ; Chromatography, Liquid ; Cytochrome P-450 CYP2B6/genetics ; Fatal Outcome ; Female ; Forensic Toxicology ; Heterozygote ; Homozygote ; Humans ; Infant, Newborn ; Male ; Methadone/analysis ; Milk, Human/chemistry ; Narcotics/analysis ; Opiate Substitution Treatment ; Polymorphism, Single Nucleotide ; Tandem Mass Spectrometry
Chemical Substances	ABCB1 protein, human ; ATP Binding Cassette Transporter, Sub-Family B ; Narcotics ; Cytochrome P-450 CYP2B6 (EC 1.14.14.1) ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	219216-0
ISSN	1556-4029 ; 0022-1198
ISSN (online)	1556-4029
ISSN	0022-1198
DOI	10.1111/1556-4029.12972
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Article ; Online: Sickle cell trait mimicking multiple inflicted injuries in a 5-year-old boy.

Kepron, Charis / Somers, Gino R / Pollanen, Michael S

Journal of forensic sciences

2009 Volume 54, Issue 5, Page(s) 1141–1145

Abstract: Sickle cell disease (SCD) and sickle cell trait (SCT) can be associated with sudden unexpected death in the pediatric population, usually due to pulmonary complications occurring within the acute chest syndrome (ACS). Musculoskeletal complications can ... ...

Abstract	Sickle cell disease (SCD) and sickle cell trait (SCT) can be associated with sudden unexpected death in the pediatric population, usually due to pulmonary complications occurring within the acute chest syndrome (ACS). Musculoskeletal complications can occur and are classically limited to bone infarcts. The occurrence of bone pathology centered upon the epiphyseal growth plate in SCD/SCT is extremely rare, and multiple such injuries in a single patient have not been previously reported. Herein, we describe a case of sudden unexpected death in a 5-year-old child with undiagnosed SCT due to the ACS, with widespread epiphyseal and periosteal bone lesions mimicking multiple inflicted injuries at autopsy. This case highlights the importance of clinicopathological correlation and is the first to describe SCT pathology as a mimic of nonaccidental injury.
MeSH term(s)	Acute Chest Syndrome/etiology ; Bone and Bones/pathology ; Child, Preschool ; Death, Sudden/etiology ; Diagnosis, Differential ; Epiphyses/pathology ; Forensic Pathology ; Hematoma/pathology ; Hemorrhage/pathology ; Humans ; Lung/pathology ; Male ; Multiple Trauma/diagnosis ; Periosteum/pathology ; Pleural Effusion/pathology ; Primary Myelofibrosis/pathology ; Respiratory Aspiration/pathology ; Sickle Cell Trait/diagnosis
Language	English
Publishing date	2009-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	219216-0
ISSN	1556-4029 ; 0022-1198
ISSN (online)	1556-4029
ISSN	0022-1198
DOI	10.1111/j.1556-4029.2009.01098.x
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Article ; Online: Periampullary carcinoid of the ampulla of Vater presenting as an intraductal papillary mucinous tumour of the pancreas: a sheep in wolf's clothing.

Kepron, Charis / Kapila, Varun / Hanna, Sherif / Khalifa, Mahmoud A

Canadian journal of surgery. Journal canadien de chirurgie

2008 Volume 51, Issue 3, Page(s) E67–8

MeSH term(s)	Adenocarcinoma, Mucinous/diagnosis ; Ampulla of Vater ; Carcinoma, Pancreatic Ductal/diagnosis ; Common Bile Duct Neoplasms/diagnosis ; Common Bile Duct Neoplasms/pathology ; Common Bile Duct Neoplasms/surgery ; Dilatation, Pathologic ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Ducts/diagnostic imaging ; Pancreatic Ducts/pathology ; Tomography, X-Ray Computed
Language	English
Publishing date	2008-08-06
Publishing country	Canada
Document type	Case Reports ; Journal Article
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
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