搜索结果：The Malaysian journal of pathology

Odontogenic keratocyst (OKC) is among the commonest odontogenic cysts known for its local invasiveness and high recurrence rate following treatment. The study on OKC among the Malaysian population is limited in recent years. The aim of this study is to evaluate the latest demographic and clinicopathological profile of OKC cases in the Faculty of Dentistry, Universiti Malaya (UM). The demographic and clinicopathological data of 147 OKC cases were extracted from the archive of the institution from 2003 to 2022. Descriptive statistics, Pearson Chi-square test and Fisher's Exact Test were employed for the statistical analysis. OKC affected younger age groups with peak incidence in the third decade of life followed by the second decade of life. An almost equal distribution among males and females was observed. Predominance of OKC was seen within the Chinese ethnicity. The mandible was the commonest site of occurrence. Recurrence was observed in 11.1% of the cases where most of them were treated by enucleation only. Majority of the cysts were predominantly lined by parakeratinized stratified squamous epithelium (94.6%) with corrugated surface (89.8%). Presence of epithelial island (16.3%), satellite cyst (15.6%), dystrophic calcification (10%) and atypia (7.5%) were also observed. Significant association (p<0.05) were seen in syndromic OKC involving both jaws, multilocular radiolucency in mandible and presence of satellite cysts in OKC involving both jaws. This study provides the latest demographic and clinicopathological profiles of OKC from this institution. This data could add value for current chairside assessment and treatment planning of OKC.

Lysosomal storage disorders (LSD) are storage disorders involving the malfunction of degradation enzymes in the lysosome. This study aimed to calculate the birth prevalence and carrier frequency of LSDs in the Malaysian population, to compare our results with previously reported epidemiologic data from other populations, and to describe the mutation spectrum in Malaysia. Between 2008 and 2017, 2.1% (92/4338) of suspected patients were diagnosed with LSD. The prevalence of LSD and carrier frequency in Malaysia were 0.43 per 100,000 live births and 1 in 241, respectively. The combined prevalence of mucopolysaccharidoses (MPS) and its carrier frequency were 0.34 per 100,000 live births and 1 in 271, respectively. Among this MPS group, MPS II presented the highest calculated birth prevalence of 0.45 per 100,000 male live births with a carrier frequency of 1 in 236. Within the group of sphingolipidoses, the combined prevalence was 0.13 per 100,000 live births with a carrier frequency of 1 in 439. Fabry disease was the most common disorder with a calculated prevalence of 0.52 per 100,000 male live births and a carrier frequency of 1 in 220 followed by metachromatic leukodystrophy (MLD) (0.2 per 100,000 live birth and carrier frequency 1 in 352). MLD is more common among people of Iban ethnicity with a prevalence of 14.33 per 100,00 live births and a carrier frequency of 1 in 42. Pompe and mucolipidosis type II are the less common subtypes of LSD with a prevalence of 0.06 per 100,000 live births and a carrier frequency of 1 in 651 and 0.04 per 100,000 live births with carrier frequency of 1 in 747, respectively. Overall, although the prevalence of LSD in Malaysia may be underestimated, the prevalence of MPS is consistent with reports done in other Asian countries.

To investigate the major causes of neonatal deaths in Malaysian neonatal intensive care units (NICUs). This retrospective observational study analysed prospectively collected data of neonates (gestation &#x2265;22 weeks, birthweight &#x2265;500g) admitted to 44 NICUs in the years 2015-2020 in the Malaysian National Neonatal Registry. Causes of death were reported using the modified Wigglesworth classification. Out of 759,435 neonates, 1.2% (n=9470) died. Most (72.3%) were early neonatal deaths (0-7days of life), 17.5% were late neonatal deaths (8-28 days of life), and 10.2% were post-neonatal deaths (>28 days of life). Inborn extremely preterm (EPT, <28 weeks gestation) neonates had the highest death rates (427.5/1000 livebirths) and term neonates (1.7/1000 livebirths) had the lowest. Congenital malformations accounted for 33.0% of deaths; the majority were of gestation &#x2265;28 weeks. Trisomy 18 (n=542), trisomy 13 (n=397), cardiovascular (CVS) malformations (n=371) and neurological malformations including neuro-tube defects (NTD) (n=252) were the four most common types of malformations. The three most common causes of non-malformation deaths were EPT (n=1424), sepsis (n=867, affecting all gestations), and hypoxic-ischaemic encephalopathy (HIE) in term neonates with/without multiorgan failure (n=570). Less than one-third of EPT neonates who died received respiratory support at birth. Most (85.3%) sepsis death was late-onset sepsis (&#x2265;72 hours of age). Only 27.8% term neonates dying from HIE received adequate therapeutic hypothermia. Extreme prematurity, nosocomial sepsis, HIE in term neonates, chromosomal abnormalities due to trisomy 18 and trisomy 13, ductal-dependent CVS malformations, and NTD were the six most common causes of neonatal deaths in Malaysian NICUs.

In Malaysia, acute coronary syndrome is the leading cause of hospitalisation. Identification of patients with low 30-day risk of major adverse cardiac event (MACE) may facilitate an early and safe discharge from overcrowding emergency departments (ED). This study aimed to determine the diagnostic accuracy of high-sensitivity-cardiac-troponin-I (hs-cTnI) for ruling out 30-day MACE among chest pain patients in ED. A prospective observational study using an Accelerated Diagnostic Protocol (ADP) which included Thrombolysis-in-Myocardial-Infarction (TIMI) score, electrocardiogram, and 0- and 3-hour hs-cTnI. TIMI = 0 and &#x2264;1 was used in ADP-1 and ADP-2, respectively. 20 (10%) and 64 (32%) of 201 patients were low-risk, whereby none of whom developed MACE in ADP-1 and ADP-2, respectively. Using the overall hs-cTnI cut-off, ADP-1 had a Sensitivity (Sn) of 100% [95% Confidence Interval (CI)] (51.7 to 100), Specificity (Sp) of 10.2% (6.5 to 15.6), Negative Predictive Value (NPV) of 100% (80.0 to 100) and Positive Predictive Value (PPV) 3.3% (1.4 to 7.4). ADP-2 yielded a Sn of 100% (51.7 to 100), Sp of 32.8% (26.4 to 40.0), NPV of 100% (92.9 to 100) and PPV of 4.4% (1.8 to 9.7). Using gender-specific hs-cTnI cut-off, either that of Abbott or a Malaysian population, yielded similar diagnostic accuracy; except the former produced slightly higher Sp of 75.4% (68.7-81.1). Using either the overall or gender-specific cut-offs, both protocols yielded 100% diagnostic accuracy for ruling out MACE which may enable a safe early discharge of up to 32% of chest pain patients in ED.

Leptospirosis is an emerging infectious disease exemplified by frequent outbreaks worldwide with more than one million cases and 50,000 deaths annually. A high number of cases have been reported in Southeast Asia, including Malaysia. This study aims to identify the relationship between climatic patterns and leptospirosis cases in Malaysia from 2013 to 2021. The climatic data comprising temperature, humidity, and rainfall from 2013 to 2021 were obtained from the Malaysian Meteorological Department. Data was collected from five states in Malaysia: Kelantan, Perak, Selangor, Negeri Sembilan, and Sarawak. A Spearman correlation test was used to determine the relationship between the climatic pattern and Leptospirosis cases. In general, Leptospirosis cases fluctuated, with a maximum number of 8291 cases in 2015 and the lowest number being 1761 cases in 2021. The rainfall (mm) exhibited a fluctuating pattern from 2013 to 2021, with the highest total rainfall of 1938.5 mm in 2017. Temperature patterns varied from 2013 to 2021 with the highest temperature recorded was 27.60 degrees Celsius (&#xb0;C) in 2016. The humidity increased steadily from 2017 to 2021, with the highest humidity recorded at 83.7% in 2020. A significant relationship was identified between the rainfall (mm) and Leptospirosis cases (p<0.05). The findings imply that the amount of rainfall has a significant relationship with leptospirosis cases and the highest cases of leptospirosis of 8291 cases, occurred in the year 2015 with a temperature of 27.3&#xb0;C, a humidity of 82.4 %, and a total rainfall of 1559.1mm.

Currently, digital pathology is a profound transformation in the field of pathology. Numerous artificial intelligence (AI) algorithms have demonstrated significant potential for the improvement of diagnostic efficiency, morphometric analysis of biomarkers, and diagnostic screening. However, the application of AI in pathology is a matter of considerable worry among pathologists. Within this article, we provided a concise overview of the process of digital pathology and deep learning in diagnostic pathology. Additionally, we explored the advantages and uses, obstacles and constraints, and future potential of artificial intelligence in diagnostic pathology. The implementation of innovative AI-based methods in pathology laboratory processes will enhance the effectiveness of disease diagnosis, as the collaboration between pathologists and AI systems has demonstrated superior performance compared to both the individual pathologist and the system. Nevertheless, pathologists continue to be crucial in the finalisation of the diagnosis.

Ameloblastoma is a benign but locally aggressive odontogenic tumour broadly divided into conventional, unicystic, peripheral, adenoid and metastasising types. The first three entities compose the majority and especially the conventional type which has different histopathological subtypes such as follicular, plexiform, acanthomatous, granular cell, basal cell and desmoplastic have been described. We report the largest series of ameloblastoma in a single study to analyse the demographic characteristics according to histopathological subtypes of ameloblastoma. 1,312 cases of ameloblastoma reported from two centres in Sri Lanka and Malaysia were analysed according to age, site and histopathological subtype. Of the total of 1,312 cases, the mean age for conventional ameloblastoma (excluding desmolastic subtype) was 36.82&#xb1;16.57. It was 46.3&#xb1;15.21 for categorisewhile peripheral and unicystic ameloblastoma occurred at 40.77&#xb1;16.35 and 31.00&#xb1;17.37, respectively. Ninety percent of the cases were in the mandible (p=0.00001) with significant predilection for the right side. Unicystic and plexiform subtypes were mostly seen in the 11-20 age group while the desmoplastic subtype was seen in the 51-60 age group. The commonesthistological subtype was follicular subtype and acanthomatous changes were observed predominately in combination with follicular subtype. Majority of the acanthomatous subtype was observed inposterior mandible (p=0.00001). The frequency of luminal (243) and mural (246) subtypes werealmost similar. This study provides a comprehensive demographic detail of differenthistological subtypes of ameloblastoma using the largest sample in the literature. The present findingswill be helpful in classification and understanding of different subtypes of the tumours.

Haemophilus influenzae (HI) is a significant pathogen responsible for respiratory and invasive infections globally. Following the introduction of the Haemophilus influenzae serotype B (Hib) vaccine in Malaysia in 2002, cases of Hib-related diseases declined sharply. Still, the prevalence of nontypeable Haemophilus influenzae (NTHi) emerged as a public health concern. This study investigates epidemiological and demographic patterns of HI infections in Malaysia's southern region. Clinical isolates of HI were recovered during routine diagnostic testing and analysed from June 2023 to December 2024. All isolates were identified using conventional laboratory methods, biochemical assays, and Matrix-Assisted Laser Desorption/Ionisation Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Confirmatory serotyping was outsourced to the National Public Health Laboratory in Sungai Buloh, Selangor. Epidemiological trends were assessed based on demographics, sample types, and seasonal variations. A total of 281 samples were analysed. NTHi accounted for 96.5% of isolates, with sputum as the dominant sample type (56.4%). Infants and elderly individuals constitute the most vulnerable groups. Peaks in sample submissions correlated with monsoon seasons. Foreign nationals had disproportionately higher mortality rates, reflecting challenges in vaccination access. The study underscores the dominance of NTHi infections in post-Hib vaccination settings in Malaysia. Seasonal trends and demographic disparities emphasise the need for tailored public health interventions and infrastructure strengthening to reduce the burden of HI infections.

International guidelines recommend having a positive anti-nuclear antibody (ANA) and clinical suspicion of systemic autoimmune rheumatic diseases (SARD) when requesting ANA subserologies. Compliance with these guidelines by physicians has been questioned in different parts of the world. To analyse the requesting pattern of ANA and anti-extractable nuclear antigens (ENA) simultaneously in the University of Malaya Medical Centre (UMMC). This is a retrospective descriptive study involving 1529 adult patients who had their ANA and ANA subserologies requested simultaneously by clinicians. The ANA, anti-ENA screening (ENASc) and anti-ENA specific (ENASp) results were retrieved. Their case records on their relevant diagnosis and follow-up tests were reviewed. Among the 1,529 samples, 536 (35%) patients were positive, and 993 (65%) patients were negative for ANA by indirect immunofluorescence assay (IIF). In the ANA positive group, 109 (20%) were positive and 46 (9%) were borderline for ENASc. Of those ENASc positive patients, only 47 patients were requested for ENASp. Forty-one (87.2%) were positive for ENASp, In the ANA negative group, 111 (11%) were positive and 66 (7%) were borderline for ENASc. The majority of the ENASc positive (86, 77%) or borderline (63, 95%) had not been requested for ENASp in this group. Of those who had ENASp tests done (28), 19 (76%) were positive and 3 were borderline positive for ENASp. A total of 223 patients were diagnosed with SARD, out of which 147 had SARD in the ANA positive group (66%), with systemic lupus erythematosus being identified as the commonest SARD. A total of 76 patients were diagnosed with SARD in the ANA negative group (34%), with rheumatoid arthritis being identified as the commonest SARD. A large number of ENASc negative results are obtained concurrently with ANA negative results, suggesting clinicians do not comply with international guidelines when requesting ENA tests. This survey strongly suggests implementing measures in hospitals to comply with international recommendations on ENA testing.

Breast cancer remains a significant health concern, particularly in Malaysia, where it stands as the most prevalent cancer among women. The BRCA, implicated in inherited breast cancer syndromes, has garnered considerable attention due to its role in tumorigenesis. Utilising next-generation sequencing and bioinformatic tools, researchers have compiled a comprehensive database of BRCA variants specific to the Malaysian population. This article reviews the distribution of these variants across different ethnic groups in Malaysia and explores their implications for biosensor development. By leveraging this database, researchers aim to construct biorecognition elements for electrochemical biosensors, enabling affordable and accessible genetic screening for breast cancer mutations. The article underscores the importance of adhering to technical standards and considering ethnic diversity in selecting biorecognition elements. Ultimately, the integration of Malaysian BRCA variants into biosensor technology holds promise for enhancing early detection and improving clinical management of breast cancer in the Malaysian population.

Fatal falls from heights rank as the second leading cause of unnatural deaths, following road traffic accidents. Victims exhibit distinct injury patterns influenced by multiple factors. Therefore, this study aimed to assess the pattern of fatal injuries resulting from falls from height in medicolegal autopsies. We reviewed 340 autopsies records conducted at the Universiti Kebangsaan Malaysia Medical Centre for ten years from 2010 to 2019. Statistical analysis was performed on socio-demographic data, cause and manner of death, fall height, primary impact, toxicological analysis, and psychiatric illness. A total of 340 cases comprising 246 males and 94 females, representing 175 Chinese, 106 non-Malaysians, 28 Malays, 27 Indians, and two Bumiputeras Sabahan/Sarawakian. Their ages ranged from 5 months to 86 years old. The findings revealed that most deceased were males aged between 19 and 40. The primary locations of falls were reported within the home (77.9%) and workplace (16.8%). In cases of falls from significant heights, multiple injuries were the leading cause of death (71.4%), with 68.3% of these incidents classified as suicides. Head injuries were prevalent in falls from lower elevations (42.3%), particularly in accidental scenarios (34.9%). In 80% of cases, toxicological analysis yielded negative results, with alcohol being the most frequently detected substance (30.9%). This study revealed that most injuries were linked to suicide. Hence, it is crucial to implement preventive measures to raise awareness among the public and mitigate similar incidents in the future.

Peripheral T-cell lymphomas are rare, aggressive malignancies with significant diagnostic challenges due to their heterogeneity. This retrospective study analysed 43 nodal Peripheral T-cell lymphomas cases diagnosed between 2019 and 2024 at the Blood Transfusion Hematology Hospital in Southern Vietnam and reclassified them using the World Health Organization 2022 classification. Nodal T-follicular helper cell lymphoma, angioimmunoblastic type, emerged as the most prevalent subtype (51.2%), markedly exceeding rates reported in Western (32.5%) and East Asian studies (36.2%). Despite the higher prevalence of Epstein-Barr Virus in Vietnam, the proportion of Epstein-Barr Virus positive in Peripheral T-cell lymphomas was not elevated (20%), suggesting additional genetic or environmental factors influencing lymphoma pathogenesis. These findings underscore the critical role of updated diagnostic standards and the utility of advanced markers in improving Peripheral T-cell lymphomas classification. This study provides rare insights into Peripheral T-cell lymphomas pathology in Vietnam, contributing valuable data to the global understanding of these rare lymphomas.

Legionella pneumophila, a microorganism that thrives in both natural freshwater and man-made water systems, is a significant pathogen that causes Legionnaires' disease, a potentially fatal form of pneumonia. This study aimed to investigate the distribution of L. pneumophila sequence types (ST) within the water supply system of the Klang Valley Integrated Transit System (KVITS) in Malaysia. Sequence-Based Typing (SBT) was used to determine the sequence type of the L. pneumophila isolates by amplifying seven different loci (flaA, pilE, asd, mip, mompS, proA, and neuA), as per the European Working Group for Legionella Infections (protocol version 5.0). L. pneumophila was isolated from five out of 80 samples (6.3%). These isolates comprised five distinct sequence types: ST1, ST22, ST2210, ST3017, and ST3029. Three isolates typed as ST1, ST22 and ST2210 belong to serogroup 1. Phylogenetic analysis suggested multiple sources of contamination. This study suggests the need for a comprehensive water management plan for KVITS, including routine testing and risk assessments, to reduce the risk of Legionnaires' disease outbreaks.

This consensus aims to develop a standardised guideline for human epidermal growth factor-2 (HER2) immunohistochemistry interpretation and reporting in Malaysia to support optimal therapeutic decision-making and research compatibility. An expert committee comprising pathologists and oncologists from public, private, and academic institutions convened to review existing international recommendations and taking into the consideration of local healthcare resource variations. The committee aims to harmonise reporting terminology in the reporting of HER2 testing, with emphasis on HER2-low and HER2-ultralow categories. A standardised HER2 reporting is crucial to ensure Malaysian patients benefit equitably from emerging HER2-targeted therapies. We hope this guideline could prepare the national pathology community in leading the evolving landscape of breast cancer management.

Podocyte infolding glomerulopathy (PIG) is a rare glomerular disorder characterised by the infolding of podocytes into the glomerular basement membrane (GBM) with the presence of intramembranous cytoplasmic microspherules or microtubules. Most patients with PIG presented with nephrotic or subnephrotic proteinuria accompanied with microscopic haematuria. The condition is often associated with autoimmune diseases. Recently, two cases of PIG were reported in Malaysia for the first time involving two female patients aged 25 and 36 years. The first patient had a history of systemic lupus erythematosus (SLE), peripheral neuropathy, anti-nuclear matrix protein 2 (NXP2)-positive antibody, autoimmune hypothyroidism, and primary ovarian failure. She presented with persistent nephrotic range proteinuria and haematuria. Meanwhile, the second patient with history of SLE presented at rheumatology clinic with bilateral pedal oedema, frothy urine, and haematuria. The electron microscopy (EM) analysis of the first patient revealed widespread and extensive invagination of podocyte cytoplasmic processes into the GBM, forming subepithelial clusters of microspherules and microtubules and separated by an intervening basement membrane. Likewise, extensive infolding of podocyte cytoplasmic processes into the GBM were found in the second case, and the intervening basement membrane separated the microspherules and microtubules. These findings confirmed the diagnosis of PIG, and the patients were treated with Prednisolone, maintaining normal creatinine level during follow-up. In summary, PIG is a rare and new glomerular disease which has been known to be associated with connective tissue diseases, predominantly affecting young individuals with a favourable clinical outcome.

In bladder cancer, the presence of lamina propria invasion (pT1) poses a significant clinical challenge due to varied tumour behaviours and risk of disease progression. Efforts to substage pT1 urothelial carcinoma (UC) using diverse systems have been made, but challenges persist in accurately predicting disease progression. This study introduces a novel risk stratification approach focusing on pT1b UC cases based on the spatial relationship between invasive carcinoma and the muscularis propria (MP) in transurethral resection of bladder (TURB) specimens. Retrospective analysis of pathology reports from 2017 to 2023 identified pT1 cases in TURB specimens, subcategorised using a 2-tiered approach. Exclusions were applied based on specific criteria, leading to a final cohort of 24 patients. We evaluated the tumour diameter and proximity to the MP from a "Tumour-MP (T-M) angle" perspective. A novel pT1b risk stratification method focusing on the T-M angle to differentiate low- and high-risk groups was developed, in which pT1b low-risk is defined as a T-M angle less than 180 degrees, and pT1b high-risk is defined as a T-M angle greater than 180 degrees. In this study of 24 pT1b UC cases, 16 were categorised as pT1b low-risk and 8 as pT1b high-risk. Notably, the high-risk group showed a higher upstaging rate to advanced tumour stages (&#x2265;pT2) in radical cystectomy (RC) specimens compared to the low-risk group (88% vs. 56%, p = 0.015). This new risk stratification method presents promise in guiding early aggressive treatment decisions, though larger prospective studies are essential for further validation and clinical integration.

Globally, non-albicans Candida (NAC) species have emerged as a notable cause of both healthcare-associated and opportunistic infections. Compared with Candida albicans, NAC species are more likely to cause infections fraught with antifungal resistance issues and higher mortality rates. The objectives of this study were to identify the various Candida species causing candidaemia in a Malaysian general hospital and to ascertain their antifungal susceptibility profiles. This 15-month cross-sectional study involved the peripheral blood of patients diagnosed with candidaemia. Conclusive species identification was achieved through matrix-assisted laser desorption ionisation-time-of-flight mass spectrometry (MALDI-TOF MS) while antifungal susceptibility was performed using the colourimetric broth microdilution method. A total of 118 non-duplicate Candida isolates were analysed during the study period. Out of this total, 47 (39.8%) were C. albicans, 25 (21.2%) were Candida parapsilosis complex, 24 (20.3%) were Candida tropicalis, 19 (16.1%) were Nakaseomyces glabratus and three (2.6%) were Pichia kudriavzevii. Collectively, the NAC species outnumbered C. albicans (60.2% vs. 39.8%). The overall minimal inhibitory concentration at which &#x2265;90% of isolates were inhibited (MIC90) for NAC species was 32 &#xb5;g/mL for fluconazole, 1 &#xb5;g/mL for amphotericin B and between 1 to 2 &#xb5;g/mL for the echinocandins. Despite C. albicans being the single most frequently isolated species from patients with candidaemia, more than half of candidaemia cases in our centre were caused by NAC species. Generally, although these NAC species were not fluconazole-susceptible, amphotericin B and echinocandins may still be utilised against them.

Sudden unexpected death (SUD) in a healthy young adult presents a challenging scenario that forensic pathologists often encounter. Although they are rare, thyroid diseases such as hyperthyroidism, hypothyroidism, and lymphocytic thyroiditis can contribute to SUD. Comprehensive investigations, including thyroid histological evaluation, are critical to identify underlying causes. This report discusses a rare case of lymphocytic thyroiditis in a young male who died unexpectedly, highlighting the forensic value of thyroid pathology in SUD cases. A 25-year-old Bangladeshi male, with no known comorbidities, was found unresponsive in bed and was brought to the hospital, where resuscitation efforts in the emergency department were unsuccessful. He had no complaints of health issues in the past two weeks before his death. There was no family history of SUD. Externally, there was no evidence of injury or systemic disease. Gross examination of vital organs, including the heart and brain, was unremarkable. A cricothyroidotomy incision partially obscured the thyroid gland. However, histological analysis revealed lymphocytic infiltration, follicular destruction in the thyroid glands, and fibrosis in the sinoatrial (SA) node. Extensive toxicological tests were negative and no thyroid function tests or molecular autopsy were performed. Lymphocytic thyroiditis should be considered in SUD cases, even with unremarkable gross findings or nonspecific clinical history. Routine microscopic thyroid examination could reveal subtle yet significant conditions contributing to SUD. Establishing standardised autopsy guidelines focusing on thorough thyroid assessment may improve post-mortem diagnostics and enhance the understanding of thyroid pathology in SUD.

In Malaysia, aviation accidents fall under the jurisdiction of the Air Accident Investigation Bureau (AAIB) and are subject to statutory investigation. The primary aim of these investigations is to reconstruct crash events, determine root causes, and recommend safety improvements, including modifications to aircraft design, to enhance survivability and prevent future incidents. Aviation pathology plays a crucial role in this process by confirming victim identities, establishing causes of death, contributing to crash sequence reconstruction, and ensuring a comprehensive analysis of human factors. This review examines key aspects of aviation pathology, including injury mechanisms and patterns, the forensic autopsy approach for aviation fatalities, and the correlation between injury findings and crash dynamics. Understanding these elements is essential for improving aviation safety and refining investigative methodologies.