Challenges in Implementing DVI Best Practice Guidelines Due to the Brumadinho Disaster

The broke of a tailings dam from Vale S.A. destroyed a gigantic area killing 270 persons in Brumadinho/Brazil. Organizing activities after a mass disaster is a complex process that requires the involvement of many people and resources in the laboratory. To DNA identification of the victims, a daunting work had to be made by DNA laboratory staff in a collaborative effort with many partners. Efforts to implement good practice guidelines in Disaster Victim Identification (DVI) have revealed several important aspects that need to change in the forensic DNA laboratory. This article highlights the challenges of implementing DVI best practice guidelines in resource-poor settings, but with professionals from different sectors engaged in the same goal of briefly identifying victims and helping families and society.

Opinions of Students on the Contribution of the DIVA 3D Virtual Dissection Table to the Teaching of Anatomy at the Faculty of Medicine and Odontostomatology of Bamako

Objective: Study the contribution of the DIVA 3D dissection table in the teaching of anatomy at the Faculty of Medicine and Odontology of Bamako. Material and Methods: This was a qualitative study carried out from November 1 to December 30, 2023 at the clinical and morphological anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako. Included in this study were students who participated in practical and tutorial sessions. The variables studied during this study were: the previous performance of dissection on a cadaver by the students, the opinion of the students on dissection on a cadaver, the replacement of dissection on a cadaver by virtual dissection in the absence of a body, the level student satisfaction. Results: We surveyed 130 participants. The average age was 22 ± 0.2 years with extremes of 17 and 29 years. 95.3% of participants were students. According to 66.7% of participants, virtual dissection is a good palliative in the absence of a corpse. 95.3% of participants found using the virtual dissection table easy with an average of 7.88 ± 1.4. The overall assessment was well rated by 99.3% of participants. Conclusion: According to the results of this study, the virtual dissection table should be improved by integrating commented videos. The use of the DIVA 3D virtual dissection table during practical and tutorial sessions is well appreciated by the students. We believe that the teaching of anatomy using 3D digital technology should be included in the study programs of the Faculty of Medicine and Odontostomatology.

Impact of Multifidus Muscle Morphometry on the Clinical Evolution of Chronic Low Back Pain

Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm3 ± 39, after physiotherapy it was 203 mm3 ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.

An Anatomical and Radiological Study of Origins of the Arteries Forming the Celiac Trunk: Clinical and Embryological Implications

The blood supply to the most of abdominal organs is provided by the branches of CT. The SMA supply caecum, ascends colon, all of the small bowels except the upper part of duodenum. Knowledge of variable anatomy of celiac axis and SMA may be useful in planning and executing radiological interventions such as celiacography and chemoembolization of hepatic and pancreatic tumors. In this study, the uncommon or low percentage cases of CT and SMA are presented in the light of clinical and embryological information. The celiac axises of a total of 30 adult corpses were examined. Dissections of abdominal region were performed in detail according to Cunningham’s manual. Angiographic images of 100 consecutive adult patients who underwent celiac MDCT angiography were evaluated. During autopsies, an incomplete celiac trunk or bifurcation of celiac trunk associated with the hepatomesenteric and gastrosplenic trunks (0.7%) and a celiacomesenteric trunk associated with high origin superior mesenteric artery and gastrosplenic trunk were detected (0.7%). During MDCT angiography, a case of total absence of celiac trunk associated with a hepatosplenomesenteric trunk (0.7%) and also a case of total absence of celiac trunk alone were observed (0.7%). The persistence or unusual development of ventral splanchnic arteries (VSAs) or ventral longitudinal anastomosis may result in variations or the unusual trunks related to celiac axis and SMA. The anomalous trunks of the CT may be result of either the persistence of some parts of the VSAs or ventral longitudinal anastomose that normally disappear or disappearance of parts that normally persist. The prevalence of unusual trunks of celiac axis and SMA in this study is quite low in literature. These abnormal vessels pose problems for surgeons and radiologists. Such vascular anomalies may cause clinical complications following surgical and radiological procedures such as resection of tumor of the pancreatic head, lymphadenectomy, coeliacography, aortic replacement with reimplantation of the trunk and coembolization of pancreatic and liver tumors.

Manner of Death and Fentanyl Related Drug Overdose Trends in Marion County, Indiana, US from 2018 to 2021

The purpose of this research was to investigate the manner of deaths in Marion County, throughout the years of 2018 to 2021 to see if there were any correlative increases in homicide, suicide, natural, accidental, or drug overdose related deaths. We surveyed the incidence of all deaths that occurred from 2018 through 2021 which came through the Marion County Coroner’s Office, Indiana. The data was then divided into two halves. According to the data, the leading manner of death in the first half and second half was accidental. This study revealed a total of 8732 cases: 3817 of them were observed to be accidental, 3092 natural, 956 homicide, 689 suicide, and 178 were undetermined. There were initially 318 drug overdose related deaths in 2018 and they increased to 2163 by 2021. In 2018, the number of deaths due to fentanyl related overdoses increased from 195 to 799 in 2021. This research will contribute to the forensic science field by providing information about the manner of death and fentanyl trends in Marion County over the last four years.

Influence of compound aescine gel on ultrastructure of vein infused mannitol and its mechanism

Purpose: When hypertonic solution 20% mannitol solution was injected into vein, inflammatory mediators and Mitogen-activated protein kinases activated by mannitol can directly induce the fading of vascular endothelial cell, which leads to phlebitis. The study aims to observe the influences of reparil-gel N coated at the proximal parts of the puncture point and basing on this along with infusing heated mannitol to veins to the injure and ultrastructure of veins which were infused the 20% mannitol solution by indwelling needle in vein. Methodology: There are 15 adult New Zealand rabbits. We randomly divided 24 ear veins of 12 adult New Zealand rabbits into Control group, Gelatum group, Gel heated group and injected 20% mannitol solution by vein detained needle in three groups. In Gelatum group, we coated the proximal end of the puncture point with a thin layer of compound aescine gel. Based on Gelatum group, we heated 20% mannitol solution to 35oC-37oC in Gel heated group. Then we observed the intravenous parts and took the veins of each group out to observe their morphology and ultrastructural after the second day of transfusion. 6 ear veins of the rest 3 rabbits as Health group weren’t given any interventions, the veins were taken out to observe their morphology. Results: Comparison between Gelatum group and Gelatum heated group on vascular dilatation, Infiltration of inflammatory cell and Formation of thrombus had no significance, P> 0.05, while the case was different for the comparison on injury of vascular wall, perivascular edema and perivascular hemorrhage, P< 0.05). The statistical significance exists between control group and Gelatum group and Gel heated group, P< 0.05. It was observed under the electron microscope that, in control group, the membrane of endothelial cell peeled off and the mitochondria swelled and vacuolized. In Gelatum group, the membrane of endothelial cell was defective, the parts of the mitochondria were fuzzy, intercellular substance was slightly edematous. In Gel heated group, the mitochondria were clear and intercellular substance slightly swelled. It could be found that the function of phagocyte was complete. Conclusions: Compound aescine gel can prevent phlebitis or reduce the incidence of phlebitis. The combined intervention of coating with a thin layer of compound aescine gel and heating mannitol solution can produce better effect.

Sleeping on an Anti-Wrinkle Pillow Reduces Facial Wrinkles: Results from an Anatomical Study

Background: A special pillow was designed to redistribute mechanical stress during sleeping in order to slow down the formation of facial skin wrinkles. Objective: To investigate whether sleeping on a specially designed pillow reduces facial skin wrinkles. Participants and Methods: A 28-day pilot study was carried out in which fifteen healthy female volunteers aged 23 - 55 years (mean age 35. 6 ± 8.5) slept on an antiwrinkle pillow. Evaluation of facial wrinkles was conducted before commencing the study (T0), following at 14 days (T14), and at 28 days (T28) when the study ended. Wrinkle density was assessed by computerized analysis of 2D images of participants’ faces. Results: A statistically significant decrease in wrinkle density was detected while smiling around both eyes, around the right eye in a relaxed facial expression, on average in all observed facial areas, around the left periorbital area in participants who predominantly slept on their left side of the body, but not on the frontal area. Limitations: A 3D camera could be used to better visualize and analyze wrinkle density. Conclusions: Sleeping on the specially designed pillow reduces facial wrinkles.

The Configuration of the Femoral Arterial Bifurcation’s Influence on Its Atherogenesis

Several theories point to the influence of the geometry of femoral arterial bifurcation in the formation and evolution of atherosclerosis plaques at the level of common, superficial and deep femoral arteries. The objective of this study is to correlate the degrees of calcifications of the femoral tripod with different morphological parameters, namely conicity, tortuosity, proximal and distal diameters of the arteries and angles between the common femoral artery (CFA) and the superficial femoral artery (SFA) and the profound femoral artery (PFA) and the superficial femoral artery. The results showed that only the tortuosity of the common femoral artery influences the formation of atherosclerosis plaque. These results allow us to predict the degree of calcification of the femoral tripod based on the tortuosity of the common femoral artery.

Peri-implantitis and periodontitis: Use of bacteriological test in dental practice

Peri-implantitis has been defined as an inflamematory condition involving dental implants, surrounding mucosa and bone, which lose supporting bone. Although high success rates for endosseous implants have been reported, failures occur, and some implants are lost or removed. At least 10% of the failures have been suggested to be the result of peri-implantitis. One of the major causes of the peri-implantitis is the bacterial colonization of implant surfaces but additional risk factors such as periodontitis, poor oral hygiene, tobacco consumption, prepost operative therapies and genetic susceptibility should be considered. In the present study a real-time PCR bases assay was designed to detect and quantify red complex species, then used to investigate 307 periodontal pocket samples from 127 periodontitis patients and 180 controls. Results demonstrated a significant higher prevalence of red complex species and increased amount of Porphyromonas gingivalis and Treponema denticolain periodontal pocket of periodontitis. Since a higher risk of peri-implantitis occurs in periodontally affected patients, detection and treatment of bacteria is a fundamental objective to ensure dental implant survival.

Mutation Analysis of STR Locus on 23 Autosomes in Hainan Population

[Objective] To analyze the mutation signature and regularity of STR locus on 23 autosomes in paternity testing cases in Hainan. [Methods] A total of 2715 paternity testing cases accepted by the Forensic Medical Identification Centre of our hospital from 2017 to 2020 derived from counties and cities in Hainan Province were collected, the cases containing gene mutations were selected, the mutation rate and details of each locus were counted, and the mutation regu-larity of 23 STR loci was analyzed. [Results] Of the 2715 cases identified as “support”, 1487 were triplet cases and 1640 were dyad cases, totaling 4614 meioses;There were 50 gene mutation events (including 17 triplet mutations and 33 dyad mutations), with an average mutation rate of 0.0047% and a cumulative mutation rate of 1.0837%. A total of 19 of the 23 STR loci were mutated, with a mutation rate of 0.1301% at the D12S391 locus and 0.0217% at five loci, TPOX, D1S1656, D2S441, D22S1045, and PentaD, while no muta-tion events were found at four loci, D19S433, TH01, D13S317, and D7S820. Of the 50 mutation events, 47 were one-step mutations, 1 was two-step, and 2 were three-step. There were 35 paternal mutations (13 triplets and 22 dyads), 6 maternal mutations (4 triplets and 2 dyads), and 9 indeterminate pater-nal/maternal mutations, with a paternal to maternal mutation ratio of 5.83:1. [Conclusion] The mutation rate of D12S391 locus is the highest, and the muta-tion rate of TPOX, D1S1656, D2S441, D22S1045 and PentaD loci is the lowest in Hainan population, and paternal mutations are more than maternal muta-tions. In the paternity test, if 1 - 3 STR loci do not conform to the genetic law, especially when the mutant locus is homozygous or the next of kin is identi-fied, it is necessary to use other kits to review and increase the number of loci or use the second-generation sequencing technology to confirm, carefully de-termine the mutation and ensure the accuracy of the identification conclusion.

Aka Canturk Oral Autopsy Method for the Dental Identification of Fetus and Infant Cases

Forensic research requires the application of reliable identification methods for unidentified individuals, among which the dental analysis has prime importance. The most significant source of dental evidence is oral autopsy applications, which consist of an examination and evidence collection from the oral cavity of a deceased individual. Oral autopsies show variations depending on the age of the person due to rigor mortis. The oral autopsy of a child may require an easier operation than adults, and thus, the procedures are usually simpler for fetus or infant cases. The aim of this study is to propose the theoretical and experimental aspects of an oral autopsy protocol for a special age group of fetus or infant cases, which is a method for extracting tooth germs in their developmental stages for identification purposes and entitled by the authors’ names as the “Aka-Canturk Oral Autopsy Method”.

Assessment of Total Incapacity for Work or Incapacity in the Criminal Sense in Case of Penetrating Wounds of the Neck

Penetrating wounds of the neck are often life-threatening. The victims are exposed to vascular and laryngotracheal lesions. The purpose of this work is to report the various aspects of the management of penetrating wounds in our context and to make the medico-legal assessment of incapacity in the criminal sense or total incapacity for work. This is a retrospective study (2002-2014) on thirty-nine (39) cases of penetrating neck wounds, received at the ENT departments of the Aristide Le Dantec and Fann University Hospital Centers. Patients were predominantly male, representing 94% of cases with an average age of 27 years. Seventy (70%) of the accidents occurred in the region of Dakar. In 42% of cases, the circumstance of occurrence was a fight or an assault. The weapon used in most cases by the aggressor was a cutter or a knife. The average waiting time was 37 hours with extremes of 02 and 216 hours. Surgically, all patients had been examined under general anesthesia. In terms of lesions, 37 cases had profound cervical muscle injuries, i.e. 94%. There were 17 vascular lesions (43%). The medico-legal distribution of patients showed that among them, 10% had a total incapacity to work exceeding 21 days. The determination of total incapacity for work is an important medical procedure that requires capability and experience. The doctor must not fall into the trap of the confusion between the TIW on the criminal level and the TIW on the civil level. He must limit medically and should not make judgments.

Regressive Changes of the Myocardial Sleeves in Elderly Victims of Sudden Bathtub Death

In Japan, most sudden deaths occurring during bathing happen in the winter, and predominantly to elderly people. One can infer a relation to physical conditions that are specific to aging. Atrial fibrillation, an arrhythmia, increases with age. This study examined histological changes in the pulmonary vein myocardial sleeves of sudden bathtub death victims and compared them with those of control individuals. We investigated 35 sudden deaths that occurred during bathing and 34 accidental deaths or deaths caused by diseases unrelated to cardiopathies. Pulmonary veins were excised cross-sectionally from the hilar side to the venoatrial junction. Then they were stained with hematoxylin and eosin, resorcin-fuchsin van Gieson, and Congo-red stains. Amyloid deposits in the pulmonary vein myocardial sleeves, as well as the range and severity of scarring, were graded microscopically on a scale of 0-3. In the sudden bathtub death victims, severe scarring was found in the myocardial sleeves of the four pulmonary veins (mean score, 2.0), which was significantly different (p < 0.05) from the control subjects (mean score, 1.4). Cardiomegaly was found in 28 out of the autopsied individuals. In subjects with cardiomegaly, the mean value of pulmonary vein myocardial sleeve scarring was 2.1. In subjects without cardiomegaly, the mean value was 1.8. Comparison revealed that cardiomegaly was associated significantly with scarring progression and degeneration of the myocardial sleeves. Scarring of the pulmonary vein myocardial sleeves was more advanced in victims of sudden bathtub death than in controls without heart disease. Elderly people with scarring of the pulmonary vein myocardial sleeves are likely to develop degenerative variations in their intra-atrial excitation conduction. These results demonstrate that taking hot baths might induce supraventricular arrhythmias such as atrial fibrillation.

Multiple tendons of the additional belly of flexor pollicis longus in the carpal tunnel: Embryological perspective and their clinical significance

Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the carpal tunnel cannot be overlooked during the radiological and surgical procedures in this region. Herein, we report a rare case of additional muscle belly of flexor pollicis longus. The additional muscle belly after a short course divided into three tendons. All three tendons entered the carpal tunnel along with flexor pollicis longus, passing deep to the flexor retinaculum. Within the carpal tunnel, two of these tendons fused and terminated by merging with the undersurface of the flexor retinaculum. The third tendon terminated by joining the flexor digitorum superficialis tendon for the index finger, in the palm. An additional slip of the first lumbrical muscle took origin from the third tendon of the additional muscle belly of flexor pollicis longus. Further, the embryological basis and clinical significance of current case is discussed.

Sexual Dimorphism in Adult Human Mandible of North Indian Origin

Background: In forensic science the identification of a human is based on three important factors: Age, Sex and Stature. Bones are an important tool for it and among human bones the pelvis and the skull are the most reliable source for sex determination. In the absence of complete pelvis, mandi-ble becomes the important source for sex determination since mandible is the most durable and movable part of skull that can resist postmortem changes. The present study is conducted to assess the accuracy and role of few metric and morphological parameters in determination of the sex of dry adult human mandible of North Indian origin. Material & Methods: The Study is conducted on 50 dry intact human adult mandibles of North Indian origin. The metric parameters i.e. bigonial breadth, bicondylar breadth are measured with a Vernier Calliper by two observers. Non-metric parameters being observed are the morphological features like gonion flaring, muscular markings and shape of angle of symphysis menti. Result & Conclusion: It is concluded that bigonial breadth and bicondylar breadth exhibit the sexual dimorphism. Morphological Parameters: Gonion flaring, muscular markings and shape of angle of symphysis menti also demonstrate the sexual dimorphism. These parameters taken together may determine the sex of adult human mandibles. The present study shows that the mandible is an important tool in the determination of gender with high accuracy.

Entrapment of the Median Nerve by a Muscular Branch of the Brachial Artery: A Case Report

Variations in the arterial pattern of the upper limbs are commonly encountered in routine dissection. In-depth information of the vascular structure of the upper extremities is not only important for diagnostic interventions and surgical approaches, but has medico-legal implications. We report the unusual variation of an additional muscular branch of the brachial artery entrapping the median nerve in the middle of the arm. This anomaly was present in both upper extremities of an adult male Indo-Malaysian cadaver. The abnormality reported here might result in neurovascular compression symptoms in the upper limbs. Knowledge of the vascular dissimilarity of the brachial artery and its division, and possible neurovascular entrapment is important to surgeons and medical practitioners for anticipating nerve compression and for confirmation via motor and sensory examination.

Sonographic Evaluation of Normal Anatomy of Fetal Central Nervous System in Mid-Trimester

The central nervous system is a common site for congenital anomalies. Neural tube defects (NTDs) such as anencephaly, encephalocele and spina bifida are among the most common central nervous system congenital anomalies. They result from failure of closure of the neural tube during embryonic development. The neural tube formation starts during the fourth week (22 - 23 days) after fertilization and fuses approximately between the days 25th and 27th. Most of NTDs result from genetic factors and environmental factors which are poorly understood. Diagnostic sonography can show a detailed visualization of the fetal intracranial anatomy such as the cerebral hemispheres, midbrain, thalami, and lateral ventricles. They also can measure the ratio between lateral ventricular and cerebral hemispheric width. It might show as well, the ratio between gestation, the rapid growth of the cerebral hemispheres and the expansion of the cerebral ventricles. The ultrasound during pregnancy plays a prominent and influential role in the prenatal evaluation of the central nervous system. It gives an excellent window for viewing and evaluating the fetal central nervous system during the second trimester through the lateral ventricles and transthalamic view, thus effectively contributing in the diagnosis and treatment of its congenital anomalies.

Study of the relationship between sphenoid sinus volume and protrusions in the sphenoid sinus

The relationship between the volume of sphenoid sinus (SS) and the prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusions in the SS was studied by using high-resolution CT imaging. The ICA and ON protrusions in SS were observed in randomly selected normal head CT scanning images from 350 adult subjects. Ac-cording to the incidence of ICA protrusion, three groups were divided into no ICA protrusion (70.75%), unilateral protrusion (8.68%) and bi-lateral protrusions (20.57%). The ON protrusion accounted for 16% in 350 subjects and accom-panied absolutely with ICA protrusion, but ICA protrusion appeared without accompanying with ON protrusion. The SS volume depended upon the protrusions in it and showed statistical dif-ferences, without ICA protrusion, the smallest size (11.16 ± 1.60) cm3;the unilateral protrusion, medium size (14.20 ± 1.80) cm3 and the bilateral protrusion, the largest size (25.03 ± 2.21) cm3. By observing 3D reconstructed models of ON and SS, we found ON was adjacent to SS (46%) and to posterior ethmoid sinuses (44%). The current study indicates that SS volume is varied with numbers of the protrusions and that ON location varies with the pneumatization of SS. Our results provide an anatomical basis to the surgeries for SS and its surrounding structures.

Impact of Therapeutic Electrical Stimulation of Sacral Surface Considering Individual Anatomical Sacral Variations on Early Recovery Urinary Continence after Radical Prostatectomy

Objectives: To investigate the effect of electrical stimulation of different anatomical variations of sacral surface on early recovery of urinary continence after radical prostatectomy. Methods: Twenty of 53 consecutive patients who underwent prostatectomy by a single surgeon were enrolled in this study. Ten patients were prospectively randomized to two groups;five patients in Sacral foramena stimulation group received postoperative surface electrical stimulation of sacral foramina area while five patients in control group did not received any electrical stimulation. Selection of remaining ten patients depended on sacral hiatus anatomical variations, assessed by plan X-rays. Of the ten patients, five patients with sacral hiatus subtotals were grouped under SHS1 while 5 patients with sacral hiatus totals were grouped as SHS2. Electrical stimulation for each group began 7 days after catheter removal, thrice a week for 8 weeks. Each of the 24 treatment sessions for each group composed of 20 minutes for sacral electrical stimulation. Continence was evaluated at baseline, 4 and 8 weeks using the 24-hour pad test and according to the incontinence section of the International Continence Society questionnaire. Results: After 2 weeks of treatment, the mean leakage weight was comparable between SFS group and SHS1 group while it was significantly lowered in SHS2 as compared to SFS and SHS1 groups. Comparing mean leakage weight at 8 weeks revealed further significant reduction in SHS2 group than in SFS and SHS1 groups. Moreover, percentage of continent patients was highest in SHS2 group after 8 weeks of treatment followed by SHS1, SFS and control respectively. Conclusions: Electrical stimulation of sacral hiatus surface area may provide better stimulation for sacral nerve than sacral foramena surface area and appears to be effective treatment for early recovery of urinary continence after radical prostatectomy.

Medicolegal autopsies in children: Experience of a department of Legal Medicine in Brazil

Purposes: The purpose of this study was to determine the pattern of mortality in children’s Federal District. Knowledge of the epidemiology of injuries is essential for planning, implementation and evaluation of preventive measures. Methods: We analyzed the forensic examination documents of all children under 12 years sent to the IML-DF, during 2010. The data analyzed included age, gender, cause of death (i.e.natural or external), mechanism of death (traffic accident, asphyxia, firearm injuries, poisoning, heat injuries) and the medical cause of death. Results: A large number of children (n = 123 total;n = 71 males, n = 52 females) were examined in the IML-DF, Brasília, Brazil. Mean age was 37.96 months, with a median of 12 months, and 21% of children were younger than 1 month. There were 62 cases (33 males and 29 female) classified as natural deaths. The average age for natural deaths was 18.72 months. Most cases of natural death occurred in the first year of life (n = 50), being prevalent in the first month of life (n = 24). Among the 62 cases analyzed, six were stillborns, 13 suffered intrauterine fetal distress (e.g. placental insufficiency, prematurity and meconium aspiration), 36 had lung problems (e.g. Acute respiratory distress syndrome (ARDS), bronchopneumonia, pulmonary hemorrhage, interstitial pneumonitis and infant respiratory distress syndrome (IRDS)), five had neurologicalproblems (e.g. hydrocephalus, hydranencephaly,convulsive seizures and meningitis) and two had undetermined cause of death. There were also isolated cases of heart disease, leukemia, diabetic ketoacidosis, peritonitis causedby acute appendicitisand amniotic bandsyndrome. There were 61 cases of deaths from external causes, as a consequence of the following: blunt instrument, firearm, physical agent (i.e.heat), physicochemical agent (i.e.asphyxia) and chemical agent (i.e.poisoning). Conclusions: The profile of deaths from external causesin this developing country follows a trend similar to trends reported in the literature for other developing countries. The majority of deaths are accidental, with traffic accidents being the most frequent cause, followed by asphyxia (i.e.aspiration of gastric contents and drownings). Sporadic cases of poisoning, injuries from firearms, accidents and fires also occur.