Adele Oyarzun
Adele Oyarzun
Bachelor of Biomedical Science (Honours)
I’d encourage anyone considering Honours to do it. My supervisors were really supportive, and it was inspiring and exciting to be working in a forensic science environment. I learnt a lot, and I think it presents so many opportunities.
Adele Oyarzun’s Honours project has been making a buzz at one of Americia’s largest Pathology conference in the USA – USCAP – where it’s been discussed in several lectures, with fantastic feedback. It’s not something she ever anticipated when she began her study with our Department of Forensic Medicine in early 2022.
Adele had always been interested in science and technology, and upon completion of her Monash Bachelor of Biomedical Science, contacted our Forensic Medicine team to see what further study opportunities were available.
“Honours seemed like a great way to learn research by actually doing it, and to brush up on soft skills that would improve my job-readiness, like communication and teamwork. My year certainly proved that true!”
Under the supervision of Professor Richard Bassed and Associate Professor Sarah Parsons, she embarked on a project to fill a gap in knowledge around myocarditis as a cause of death, versus as inflammation in the heart at autopsy.
Myocarditis is an inflammatory disease of the heart, characterised by infiltration of inflammatory cells in the heart, sometimes with injury of heart muscle cells. It carries a huge global disease burden, but accurate figures are hard to come by because it’s difficult to diagnose, and there is wide variability in the diagnostic criteria used.
“From the complexity of cardiac biopsies, to the cost of cardiac MRI, and the variations among use of immunohistochemistry and biomarkers as set out by various peak bodies, it’s incredibly challenging,” she says. “And it’s complicated by other conditions with physical changes that mimic those seen in myocarditis.”
In her literature review, Adele found only a single study that compared lethal vs. incidental myocarditis findings at point of death. Ultimately, the determination of death by myocarditis is strongly reliant on the judgement of the Pathologist performing the autopsy, and is therefore subject to variability between practitioners.
Having established a strongly defined gap in medical knowledge, Adele formulated a research question and project that would contribute to narrowing that gap. She sought to investigate the differences in the amount of inflammation between cases where myocarditis was deemed the cause of death, compared to cases where myocardial inflammation was incidentally present at autopsy.
She sourced autopsy records from the Victorian Institute of Forensic Medicine (VIFM) database, between the years 2011 and 2021. Fifty-one cases had myocarditis listed as the cause of death, but only 41 were included in Adele’s study after excluding some for complicating diagnostic factors or missing histopathology slides.
Finding cases with incidental myocarditis was more challenging. “We used the cause of death terms ‘multi-drug toxicity’ and ‘unascertained’ as our starting point,” she explains. “We chose the first because although some drugs can cause myocarditis, incidental inflammatory infiltrate is also seen in these cases. Unascertained was useful because if myocardial inflammation was present, it wasn’t sufficient to be considered the cause of death.
“Once we reviewed these files to only include those with findings of myocarditis in the notes, it yielded 48 cases, which worked very well with the sample size in our ‘cause of death’ group.”
Adele began an exhaustive extraction of relevant data from the autopsy reports, including patient baseline characteristics and notes around the circumstances of death, and a detailed analysis of histopathology slides taken at the time of autopsy, to evaluate inflammation severity and distribution, and the degree of cellular death.
“We found that infective symptoms prior to death were a predictor of fatal myocarditis, and interestingly, cardiac symptoms alone were not more likely to be seen in the myocarditis group. That said, the symptoms prior to death weren’t available for 61 per cent of those in the incidental group, so more research needs to be done there to confirm its utility as a predictor.
“Other potentially useful findings include the fact that hospitalisation prior to death was more likely to occur among those with fatal myocarditis. Fatal cases also had a significantly higher inflammatory index compared to incidental cases, and were more likely to have myocyte necrosis and a diffuse pattern of inflammation.”
Both her literature review and primary study findings have now been published, and Adele is now working as a Research Assistant with the Department of Forensic Medicine, where she’s applying all the skills she learnt.
“I’m glad my research has made a difference – I’ve learnt that most scientific discovery is accumulation of small breakthroughs in knowledge like this.
“I’d encourage anyone considering Honours to do it. My supervisors were really supportive, and it was inspiring and exciting to be working in a forensic science environment. I learnt a lot, and I think it presents so many opportunities.”