Sudden cardiac death associated with non-atherosclerotic cardiac conditions: a case series Dena Mohamed Naguib Abdel Moawed, Hanan Hosny Hassan, Elham E. Megahed, Budoor Mohammed Almusaifer, Dalia Samy Sabet, et al. Egyptian Journal of Forensic Sciences, 2026 Background Sudden Cardiac Death (SCD) remains a significant and challenging forensic pathology concern, often occurring in seemingly healthy individuals. While the atherosclerotic coronary artery disease is the predominant cause, a substantial proportion of SCD cases, particularly in younger individuals, are attributed to non-atherosclerotic conditions, including structural cardiac pathologies or non-structural causes like channelopathies. Although non-atherosclerotic cardiac diseases constitute a substantial part of SCD cases, they remain an important challenge in the forensic clinical practice with limited description in the literature. Therefore, the aim of this study was to describe the pathological findings of some representative non-atherosclerotic SCD cases encountered during the forensic autopsy and to highlight their diagnostic challenges. Cases presentation We present four distinct cases of non-atherosclerotic sudden cardiac death encountered in our practice: Hypertrophic cardiomyopathy presented with the classic features, including severe myocardial hypertrophy, disarray, and intramural coronary artery; right atrial thrombosis associated with markedly thickened mitral valve and cardiomegaly; mitral valve replacement with prosthetic valve vegetation as a complication of infective endocarditis; and "high take-off" origin of the left coronary artery without significant atherosclerosis. Conclusion This case series underscores the diverse range of non-atherosclerotic cardiac pathologies associated with sudden death. A meticulous and systematic forensic autopsy, encompassing gross and microscopic examination of the heart, is paramount in identifying these often subtle yet lethal conditions, thereby aiding in accurate cause of death determination.
Post-infarction cardiac tamponade causing sudden death: an autopsy series highlighting right ventricular free-wall rupture Sahar Issa, Ghadeer M. M. Abdelaal, Dalia AlSaif, Omar Ba Adheem, Zainab Al-Ruwai, et al. Egyptian Journal of Forensic Sciences, 2026 Background Cardiac tamponade is a rapidly fatal condition caused by the accumulation of fluid or blood within the pericardial sac, resulting in impaired cardiac filling and hemodynamic collapse. Myocardial rupture following acute myocardial infarction (MI) is a rare but catastrophic cause of sudden cardiac death and is often diagnosed only at autopsy. Case presentations Three cases of sudden death due to cardiac tamponade secondary to myocardial rupture were examined. Autopsy revealed hemopericardium associated with ventricular free-wall rupture in the setting of recent transmural MI. Although left ventricular rupture was the predominant finding, one case showed the uncommon occurrence of right ventricular free-wall rupture. Histopathological examination confirmed the timing and extent of infarction in all cases. Conclusion These cases highlight myocardial rupture as a critical and often fatal complication of acute MI. Careful postmortem examination, including detailed assessment of both ventricles and histopathological analysis, is essential for accurate diagnosis. Recognition of this complication has important implications for both forensic practice and clinical awareness.
Genetic variants associated with sudden cardiac death in the young: a systematic review Ghadeer M. M. Abdelaal, Shaimaa A. Shehata, Shrouk Mohamed Ali, Dena Mohamed Naguib Abdel Moawed Egyptian Journal of Forensic Sciences, 2025 Background Sudden cardiac death (SCD) in young individuals is a devastating event with significant genetic contributions. This systematic review comprehensively assesses the association between genetic variants and increased SCD risk in individuals under 35 years. A systematic search of PubMed, Scopus, and Web of Science databases was conducted following PRISMA guidelines using relevant keywords. Main body The review identified 21 studies. Most studies reported a higher proportion of males. Reviewed studies demonstrated a significant association between specific genetic variants and increased SCD risk. Common variants associated with SCD included those in genes encoding cardiac ion channels (e.g., SCN5A, KCNQ1, KCNH2, RYR2), calmodulin (CALM2), sarcomeric proteins (TNN, MYH7, TNNI3, MYBPC3), and desmosomal proteins (PKP2, DSC2). These variants encompass various types, including single nucleotide polymorphisms (SNPs), indels, splicing variants, and copy number variations, with missense mutations being the most prevalent. Such variants can disrupt cardiac electrical and structural integrity, leading to life-threatening arrhythmias. These variants are frequently implicated in inherited cardiac conditions such as hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome. Furthermore, multifactorial genetic contributions to SCD in the young were identified in the context of arrhythmias associated with sudden infant death syndrome, mitral valve prolapse, congenital heart defects, and epilepsy, underscoring a shared genetic basis. While the prevalence and clinical significance of these variants varied across studies, their consistent association with SCD highlights the critical role of genetic factors in SCD pathogenesis. Conclusions This review provides evidence that specific genetic variants are associated with an increased risk of SCD in young individuals. These findings highlight the importance of genetic screening and early intervention in individuals with a family history of SCD or risk factors for inherited cardiac conditions. Further research is needed to refine risk prediction models and develop effective prevention and management strategies for SCD in this population.
Association of designer drug use and sudden cardiac death: a systematic review Shrouk Mohamed Ali, Ghadeer M. M. Abdelaal, Dena Mohamed Naguib Abdel Moawed, Shaimaa A. Shehata Egyptian Journal of Forensic Sciences, 2025 Background Sudden death (SD) is defined as a non-violent, unexpected death occurring within 24 h of symptom onset, with no clear alternative explanation. It affects all age groups and can stem from both toxicological and non-toxicological causes. Among the toxicological contributors, the use of new designer drugs has emerged as a leading cause of death. This systematic review aims to estimate the prevalence of SD associated with new designer drugs, explore the pharmacological mechanisms underlying their effects, and identify the pathophysiological processes that lead to sudden death. The ultimate goal is to support the development of evidence-based risk mitigation strategies. Main body A total of 28 studies published between 2012 and 2024 were included. The majority of cases involved young adult males. The most commonly reported substances were synthetic cannabinoids (nine published articles) and synthetic opioids (eight published articles), followed by other categories such as synthetic cathinones and synthetic new psychoactive substances. Outcomes measured across studies included toxicological findings and postmortem reports. Conclusions The current evidence suggests that certain populations—especially young males—are at heightened risk for SD associated with designer drug use. Further research is essential to improve risk stratification and guide the development of preventive and clinical response strategies.
Postmortem redistribution of drugs: a literature review Ghadeer M. M. Abdelaal, Nagah I. Hegazy, Rasha L. Etewa, Ghada E. A. Elmesallamy Forensic Science Medicine and Pathology, 2024 Postmortem drug analysis is crucial in identifying the potential cause and manner of death. However, it is threatened by a significant phenomenon called postmortem redistribution (PMR), which refers to the alterations in drug levels occurring after death. This review aims to describe the PMR phenomenon, the mechanisms involved in the PMR of drugs, the various methods used to predict it, and various artifacts of postmortem drug concentrations. Several mechanisms, including passive diffusion from solid organs that act as drug reservoirs to the surrounding tissues, cadaveric changes after death (e.g., cell death, blood coagulation, hypostasis, and movements), and the putrefactive process, can result in artifacts of postmortem drug concentrations. The drug’s chemical and pharmacokinetic properties (such as acidic/basic properties, lipophilicity, protein binding, high volume of distribution, and residual metabolic activity) are additional factors. Several markers, including cardiac blood-to-peripheral blood ratio (C/P), liver-to-peripheral blood ratio (L/P), amino acid markers such as methionine, quantitative structure–activity relationship (QSAR) approach, and F factor, have been proposed for interpreting the liability of drugs to PMR. Several artifacts may affect the reliability of postmortem drug analysis. Peripheral blood is preferred for postmortem drug sample collection. Numerous laboratories evaluate the redistribution potential of drugs after death using the C/P concentration ratio. Nevertheless, the L/P concentration ratio is proposed to be a more reliable marker for PMR determination.
Electric field-directed migration of mesenchymal stem cells enhances their therapeutic potential on cisplatin-induced acute nephrotoxicity in rats Shaimaa A. Abdelrahman, Nermin Raafat, Ghadeer M. M. Abdelaal, Sara M. Abdel Aal Naunyn Schmiedeberg S Archives of Pharmacology, 2023 Cisplatin is widely used as an anti-neoplastic agent but is limited by its nephrotoxicity. The use of mesenchymal stem cells (MSCs) for the management of acute kidney injury (AKI) represents a new era in treatment but effective homing of administered cells is needed. This study aimed to investigate the effect of bone marrow-derived mesenchymal stem cells (BM-MSCs) on cisplatin-induced AKI in rats after directed migration by electric field (EF). Forty-eight adult male albino rats were equally classified into four groups: control, cisplatin-treated, cisplatin plus BM-MSCs, and cisplatin plus BM-MSCs exposed to EF. Serum levels of IL-10 and TNF-α were measured by ELISA. Quantitative real-time PCR analysis for gene expression of Bcl2, Bax, caspase-3, and caspase-8 was measured. Hematoxylin and eosin (H&E) staining, periodic acid Schiff staining, and immunohistochemical analysis were also done. MSC-treated groups showed improvement of kidney function; increased serum levels of IL-10 and decreased levels of TNF-α; and increased mRNA expression of Bcl2 and decreased expression of Bax, caspase-3, and caspase-8 proteins comparable to the cisplatin-injured group. EF application increased MSCs homing with significant decrease in serum urea level and caspase-3 gene expression together with significant increase in Bcl2 expression than occurred in the MSCs group. Restoration of normal kidney histomorphology with significant decrease in immunohistochemical expression of caspase-3 protein was observed in the BM-MSCs plus EF group compared to the BM-MSCs group. EF stimulation enhanced the MSCs homing and improved their therapeutic potential on acute cisplatin nephrotoxicity.
Sudden cardiac death associated with non-atherosclerotic cardiac conditions: a case series DMN Abdel Moawed, HH Hassan, EE Megahed, BM Almusaifer, ... Egyptian Journal of Forensic Sciences 16 (1), 44 , 2026 2026
Post-infarction cardiac tamponade causing sudden death: an autopsy series highlighting right ventricular free-wall rupture S Issa, GMM Abdelaal, D AlSaif, O Ba Adheem, Z Al-Ruwai, ... Egyptian Journal of Forensic Sciences 16 (1), 40 , 2026 2026
Ancestry estimation: Methodological evolution and forensic implications MM Ahmed, GMM Abdelaal Forensic Science, Medicine and Pathology, 1-22 , 2026 2026
Evaluating the Effect of Early Postmortem Interval on Hepatic Diazepam Concentration Detection in Male Albino Rats SUE Ibrahim, NAA Ibrahim, GMM Abdelaal, MTA Abaza Zagazig University Medical Journal , 2026 2026
Forensic DNA phenotyping: the need for proportionate regulation and judicial clarity in law enforcement GMM Abdelaal, SK Pal Egyptian Journal of Forensic Sciences 16 (1), 36 , 2026 2026
Forensic implications of glyphosate-induced thyroid and hematological toxicity: protective role of coenzyme Q10 in a rat model NM Ibrahim, EE Megahed, MA Gobran, BA Ibrahim, NA Zaitoun, ... Egyptian Journal of Forensic Sciences 16 (1), 10 , 2026 2026
CAREER SPOTLIGHT: A. Prof. Ghadeer Abdelaal GMM Abdelaal IACFT Journal (ISSN: 3088-6600) 3, 24-25 , 2025 2025
Cardiac Tamponade as a Cause of Sudden Death: Autopsy-based Case Studies and Clinicopathological Correlation S Issa, GMM Abdelaal, D AlSaif, OB Adheem, Z Al-Ruwai, BM Almusaifer, ... 2025
Association of designer drug use and sudden cardiac death: A systematic review SM Ali, GMM Abdelaal, DMN Abdel Moawed, SA Shehata Egyptian Journal of Forensic Sciences 15 (1), 46 , 2025 2025 Citations: 2
Genetic variants associated with sudden cardiac death in the young: a systematic review GMM Abdelaal, SA Shehata, SM Ali, DMNA Moawed Egyptian Journal of Forensic Sciences 15 , 2025 2025 Citations: 5
Developmental Neurotoxicity: Updates in Testing Strategies GMM Abdelaal 3rd Saudi Conference on Forensic Medical Sciences (SCFMS 2024) , 2024 2024
Forensic Perspective of Injuries with Particular Focus on Incised Wounds AAM Said, GMM Abdelaal, BHF Omran, SEY Elreffaey Zagazig University Medical Journal 30 (5), 1550-1555 , 2024 2024 Citations: 4
Date Rape Drugs Detection GMM Abdelaal 2nd Global Pharma and Drug Delivery Summit 2, 19 , 2024 2024
Ameliorative effect of taurine on nandrolone decanoate induced toxicity on brain, heart and testis in adult male albino rats E Megahed, D Abdel Moawed, SM Abdel Aal, SR Mohamed, A Talaat, ... Zagazig Journal of Forensic Medicine and Toxicology 22 (1), 55-84 , 2024 2024 Citations: 9
Postmortem redistribution of drugs: a literature review Ghadeer M. M. Abdelaal, Nagah I. Hegazy, Rasha L. Etewa, Ghada E. A. Elmesallamy Forensic Science, Medicine and Pathology 20, 1483–1490 , 2024 2024 Citations: 49
Postmortem Redistribution of Opioids GMM Abdelaal Euro-Global Congress on Advanced Therapeutics in Pain Medicine and Pain … , 2023 2023
Addictive Substances: Postmortem Analytical Challenges GMM Abdelaal Global Congress on Advances in Addiction Medicine and Psychiatry: Novelty in … , 2023 2023
Histological and biochemical evaluation of the effects of silver nanoparticles (AgNps) versus titanium dioxide nanoparticles (TiO 2 NPs) on rat parotid gland SMAM Aal, MZZ Mohammed, AAA Abdelrahman, W Samy, GMM Abdelaal, ... ULTRASTRUCTURAL PATHOLOGY 47 (4), 339-363 , 2023 2023
Histological and biochemical evaluation of the effects of silver nanoparticles (AgNps) versus titanium dioxide nanoparticles (TiO 2 NPs) on rat parotid gland SM Abdel Aal, MZ Mohammed, AA Abdelrahman, W Samy, ... Ultrastructural Pathology 47 (4), 339-363 , 2023 2023 Citations: 4
Neurocriminology and A.I. Neuroprediction GMM Abdelaal International Congress on Future Neurology and Advances in Research and … , 2023 2023
MOST CITED SCHOLAR PUBLICATIONS
Postmortem redistribution of drugs: a literature review Ghadeer M. M. Abdelaal, Nagah I. Hegazy, Rasha L. Etewa, Ghada E. A. Elmesallamy Forensic Science, Medicine and Pathology 20, 1483–1490 , 2024 2024 Citations: 49
Electric field-directed migration of mesenchymal stem cells enhances their therapeutic potential on cisplatin-induced acute nephrotoxicity in rats Shaimaa A Abdelrahman, , Nermin Raafat, Ghadeer M M Abdelaal, Sara M Abdel Aal Naunyn-Schmiedeberg's Archives of Pharmacology , 2023 2023 Citations: 12
Ameliorative effect of taurine on nandrolone decanoate induced toxicity on brain, heart and testis in adult male albino rats E Megahed, D Abdel Moawed, SM Abdel Aal, SR Mohamed, A Talaat, ... Zagazig Journal of Forensic Medicine and Toxicology 22 (1), 55-84 , 2024 2024 Citations: 9
Adult Sex Discrimination Using Metric Measurements of Hand Digital Radiographs in Egyptian Population G Abdelaal, E Abdallah, AA Alshamy, EE Megahed Forensic Medicine and Anatomy Research 10 (2), 27-43 , 2022 2022 Citations: 6
Genetic variants associated with sudden cardiac death in the young: a systematic review GMM Abdelaal, SA Shehata, SM Ali, DMNA Moawed Egyptian Journal of Forensic Sciences 15 , 2025 2025 Citations: 5
Forensic Perspective of Injuries with Particular Focus on Incised Wounds AAM Said, GMM Abdelaal, BHF Omran, SEY Elreffaey Zagazig University Medical Journal 30 (5), 1550-1555 , 2024 2024 Citations: 4
Histological and biochemical evaluation of the effects of silver nanoparticles (AgNps) versus titanium dioxide nanoparticles (TiO 2 NPs) on rat parotid gland SM Abdel Aal, MZ Mohammed, AA Abdelrahman, W Samy, ... Ultrastructural Pathology 47 (4), 339-363 , 2023 2023 Citations: 4
Updates in Chemical Analysis of Drugs of Abuse GMM Abdelaal Zagazig Journal of Forensic Medicine and Toxicology , 2021 2021 Citations: 4
Brief Overview of Sex Identification from the Sternum EMA Abdualhadi, NI Hegazy, GMM Abdelaal NeuroQuantology 20 (10), 12060-12067 , 2022 2022 Citations: 3
EARLY PHASE POSTMORTEM REDISTRIBUTION OF LIDOCAINE AND MIDAZOLAM IN ADULT ALBINO RATS GMM Abdelaal, NI Hegazy, GE Elmesallamy, RL Etewa Egyptian Society of Clinical Toxicology Journal 7 (1), 1-23 , 2019 2019 Citations: 3
Association of designer drug use and sudden cardiac death: A systematic review SM Ali, GMM Abdelaal, DMN Abdel Moawed, SA Shehata Egyptian Journal of Forensic Sciences 15 (1), 46 , 2025 2025 Citations: 2
Study of Sex Estimation of the Sternum by Multi-Slice Computed Tomography and Digital X-ray in Libyan Population E Abdualhadi, NI Hegazy, GMM Abdelaal The Egyptian Journal of Hospital Medicine 90 (2), 3167-3174 , 2023 2023 Citations: 2
Advances in Illicit Drug Portable Analytical Devices at Points of Care GMM Abdelaal Perspective of Recent Advances in Medical Research 12, 28-40 , 2023 2023 Citations: 1
Protective Effects of Tomato Lycopene and Zingiber officinale Extracts on Gentamicin-induced Nephrotoxicity in Adult Albino Rats (Comparative study) GMM Abdelaal, laila ME Sabik, RL Etewa, WI Soliman Zagazig Journal of Forensic Medicine and Toxicology 16 (1), 29-49 , 2018 2018 Citations: 1
Sudden cardiac death associated with non-atherosclerotic cardiac conditions: a case series DMN Abdel Moawed, HH Hassan, EE Megahed, BM Almusaifer, ... Egyptian Journal of Forensic Sciences 16 (1), 44 , 2026 2026
Post-infarction cardiac tamponade causing sudden death: an autopsy series highlighting right ventricular free-wall rupture S Issa, GMM Abdelaal, D AlSaif, O Ba Adheem, Z Al-Ruwai, ... Egyptian Journal of Forensic Sciences 16 (1), 40 , 2026 2026
Ancestry estimation: Methodological evolution and forensic implications MM Ahmed, GMM Abdelaal Forensic Science, Medicine and Pathology, 1-22 , 2026 2026
Evaluating the Effect of Early Postmortem Interval on Hepatic Diazepam Concentration Detection in Male Albino Rats SUE Ibrahim, NAA Ibrahim, GMM Abdelaal, MTA Abaza Zagazig University Medical Journal , 2026 2026
Forensic DNA phenotyping: the need for proportionate regulation and judicial clarity in law enforcement GMM Abdelaal, SK Pal Egyptian Journal of Forensic Sciences 16 (1), 36 , 2026 2026
Forensic implications of glyphosate-induced thyroid and hematological toxicity: protective role of coenzyme Q10 in a rat model NM Ibrahim, EE Megahed, MA Gobran, BA Ibrahim, NA Zaitoun, ... Egyptian Journal of Forensic Sciences 16 (1), 10 , 2026 2026