Indian Journal of Forensic Medicine and Pathology

  Aims: Plasma cell leukemia (PCL) is a rare disorder which develops spontaneously (primary PCL) or evolves in patients with multiple myeloma (secondary PCL). It is defined by the presence of 2 × 109/L peripheral blood plasma cells and plasmacytosis accounting for more than 20 % of the differential white cell count1. This study aims to analyze the clinical, morphologic and immunophenotypic profile of cases of Plasma cell leukemia and determine the significance of peripheral blood smear, bone marrow aspiration, serum protein electrophoresis and flow cytometry in the diagnosis. Methods: All cases diagnosed as Plasma cell leukemia during the period January 2012 to January 2015 were included in this study. Giemsa ( MGG­ May Grunwald Giemsa) stained smears of peripheral blood smears and bone marrow aspiration were examined. Serum protein electrophoresis (SPE) and immunophenotyping by flow cytometry were also subsequently done.Results: There were five cases of PCL diagnosed during this period which included four males and one female. Conclusion: Plasma cell leukemia is an aggressive disease. Peripheral blood smear examination, bone marrow aspiration, serum protein electrophoresis and immunophenotyping (flow cytometric analysis) are very useful in the diagnosis of PCL.

Keywords: Plasma Cell Leukemia; Peripheral Blood Smear; Bone Marrow Aspiration; Serum Protein Electrophoresis; Immunophenotyping. 

 Anomalous origin of the left coronary artery from the pulmonary trunk also known as Garland­ landWhite syndrome is a rare congenital anomaly. The usual clinical course is severe left sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. Arrhythmias or sudden cardiac death in adult life may be the first clinical presentation in patients with this anomaly. 

Keywords: Coronary Artery; Pulmonary Trunk; Congenital Anomaly.

  Head injuries or Craniocerebral injuries occupy a significant place due to high morbidity and mortality in developing countries like India. With severe paucity of trained man power, investigative facilities and rehabilitative services, traumatic brain injuries place considerable burden on care givers in different situations. Head injury is the most common emergency encountered in trauma units and casualty departments. The present study was undertaken on 100 victims died due to head injury to find their age & sex distribution, timing of head injury, survival period, types of skull fractures & types of intracranial haemorrhage. The highest incidence was seen in age group of 21­30 years and males clearly outnumbered females. In the present study, most of the incidents occurred between 6 PM to 12 midnight. Maximum number of victims died on spot. Linear fracture was the commonest type of skull fracture & combination of subdural haemorrhage with  subarachnoid haemorrhage was the commonest intracranial haemorrhage. 

Keywords: Head Injury; Skull Fractures; Intracranial Haemorrhages.   

  During the past few years, dramatic changes have occurred in the pattern of drug abuse and crime pattern. Significant increase is noticed in the number of drug abusers and emergence of money and muscle power centres who are the member of dominant and governing class these groups or centres acts as drug providers.All Medical students of PDVVPF’s Medical Collge Ahmednagar. All participants will be educated about study undertaken and importance of reply given by them . Acceptance of participation in the study will be taken as consent. All medical students of either sex will be included. Available research indicates that, traditionally, the actual rate of drug use in medical school has been similar, if not lower, than that of an equivalent nonmedical school population for many drugs.

Keywords: Medical Students.; Substance Abuse;Medical Institutions; High Risk Population.

  Suicide is nothing but self­killing which is a growing problem in developing as well as developed countries. Developing countries are suffering with suicide by agricultural poison whereas in developed countries it is by drugs. To analyze the situation of suicides by insecticide in males the present study is conducted in Hyderabad in department of forensic medicine, osmania medical college, hyderabad. Total of 132male cases of suicide by insecticides are observed.In this most of the deaths are in the age group of 41­50 years withfanancial health related problems. The decreasing order of insecticides to commit suicide areorganophospharus, organochlorins, carbamate.

Keywords: Suicide; Insecticide; Male. 

  For medicolegal studies, examination of human skeleton has obviously an utmost importance for the identification purpose. The experts are always facing a problem in identifying whether skeleton remains are of human being or not as well in estimating correct age, sex and stature of the specimen available. Sternum as an individual parameter for the determination of sex was first studied in 1788 by Wenzel. Sternal index, also known as manubrio­corpus index is an important and frequently studied parameter from this point of view. The present study is an attempt to know the reliability of sternal index in the differentiation of sex. The study of 100 cases was conducted at mortuary of P.D.U. Hospital and Medical College, Rajkot during the period of 6th January 2010 to 20th August, 2011. The materials for the study consist of sternum bones obtained from the cadavers brought for the post­mortem examination, after taking necessary consent from the relatives and police. Mean sternal index in males was 52.39 mm with SD of 7.70 while that of female cases was 60.12 mm with SD of 8.63. Sternal index in both sex had overlapping zone in the range of 39.33­73.51 mm. Observations of all male cases were falling in this range while 6.90% of female cases were falling outside this range. 

Keywords:dentification; Sternum; Sternal Index.  

  Introduction: To study the spectrum of histopathological changes in liver with an emphasis on the rare incidental lesions of liver in autopsies. Methods: A retrospective study of medicolegal autopsies for six years was conducted in the Department of Pathology, JSS Medical College, Mysuru, Karnataka. The gross and microscopic findings of liver specimens were taken into consideration to establish the presence of liver diseases and also to find out the types of liver diseases in relation to the age and sex of the cases. Results: The present study consists of a series of 284 autopsy cases from JSS Hospital, Mysuru, conducted over a period of six years. A total of 121 liver specimens sent were studied, out of which 16(13.2%) were normal and 8(6.6%) were autolysed. Histopathological lesions were seen in 97(80.1%) liver specimens, out of which 46(47.4%) showed fatty change, 9(9.3%) cases showed chronic venous congestion along with 8(8.2%) cases of cirrhosis, 3(3.1%) cases of hepatitis and 8( 8.2%) cases of interesting fortuitous findings comprising of Dubin Johnson syndrome, von Meyenburg complex, large bile duct obstruction, metastatic deposits of carcinoma of cervix, neuroendocrine tumor, vaso­occlusive  sickle cell crisis, amebic liver abscess and tuberculosis with coexistent fatty change. Conclusion: Fatty change of liver was the commonest incidental pathologic finding of liver with the commonest age group for liver disease being 41­60 years. This study has contributed a handful of findings to the pool of rare liver lesions in pathology emphasising the indispensible contribution of autopsy to the knowledge of pathology.

Keywords: Autopsy; Dubin Johnson Syndrome; Incidental; Vaso Occlusive Sickle Cell Crisis; Von Meyenberg Complex. 

Background: Deaths due to road traffic accidents are one of the common forms of unnatural death and its history is as old as the invention of the wheel. Two wheeler riders are more vulnerable to sustain injuries as the external shell of the vehicle is absent to protect them as compared to light motor and heavy motor vehicles. Lost balance during two wheeler accidents further increases the risk of injury. Study Design: It’s a cross sectional Prospective study. Place of Study: At Mortuary of Department of Forensic Medicine, Gandhi Medical College Secunderabad. aterial and Method: The present study was done in mortuary of Department of Forensic Medicine, Gandhi Medical College Secunderabad. The collected data was entered in Microsoft Excel. Coding of the variables was done. SPSS version 11.5 was used for analysis. bservation and Discussion: Deaths due to accidents which were subjected to post mortem examination at Gandhi Medical College, Secunderabad are 1710 over a period of year. Among them deaths due to two wheeler accidents were 576 (33.68%). Males deaths are more and they accounted to 515 (89.41%) and females 61 (10.59%). 287 males (49.83%) and 4 females (0.69%) were riding the vehicle, male to female ratio is 8.44: 1. Deaths in the age group of 21 to 30 years  tolled as many as 164 lives (28.47%). Late night accidents (i.e. from 9 pm to 3 am) are commonly seen in the present study, 129 persons (22.40%) died on the spot, and another 124 person (21.53%) could survive up to more than 6 hours, but died within 24 hours of the accident. Maximum number of two wheeler accidents during late evening is because the traffic density ishigh during this time and is coupled with the poor infrastructure and  fall in traffic discipline. onclusion: A total of 576 victims of two­wheeler road traffic accident in this part ofworld were studied. The study highlights the need of compulsory implementation of helmet  wearing for motorcyclist and necessitates the need for taking urgent steps for establishing ambulance services and provision of pre­hospital care & trauma services to reduce mortality and morbidity. 

Keywords: Road Traffic Accidents; Motorcyclist; Autopsy; Injury.

Background: Poison information centers are those, which provide immediate round the clock toxicity assessment and treatment recommendations for the effective management of poisoning cases. Objectives: The objectives of study to evaluate the needs of poison control center and Analytical services in this area. Material and Methods: Data was collected by Self­ Administered structured questionnaire,Individual interviews, and group discussions in the department. The received data was analyzed according to establish the poison control center in the region. esults: A total 683 cases of Poisoning were intentional and 233 cases were unintentional in 2008 and 2009. Out total 916 cases only 450 cases admitted in the hospital. Out of that only 225 cases were diagnosed by using different methods, about 43% cases were diagnosed by history, 32% by clinical symptoms, 16% by detailed physical examination and 9% by laboratory investigation. Remaining 225 case faced problem in diagnosis due to various reasons like in 62% case it is dueto lack of analytical facilities, 21% cases due to no definite group of symptoms and 17% cases due to signs and symptoms mimic with some diseases. Conclusion: The management of poisoning cases requires cooperation between analytical toxicology laboratory services and the physicians (clinical toxicology) dealing with the poisoning cases. 

Keywords: Poisoning; Poison Control Centers; Analytical Services; Antidotes. 

  Background: Identification is the major load in every department of forensic medicine. Stature of an individual is primary data of identification. Identification of an individual from dismembered body parts will help in solving crime as well as in various mass disasters like earth quake, floods and bomb explosion. Objective: In this study an attempt is made to estimate stature from hand length. Study Design: This is cross sectional descriptive study. Material and Method: Stature and Hand length are taken from 100 randomly selected students of M. P. Shah Medical College Jamnagar, out of them 50 were male and 50 were female. They aged between 18­ 26 years. Result: Correlation coefficient and simple linear regression equations are derived to estimate stature from hand length. Hand length in both the sexes exhibit strong and statistically significant relationship.

 Keywords: Identification; Stature; Hand Length. 

There is no statistical data to establish variation in epiphyseal fusion in Boys in central India population. This significant oversight can lead to exclusion of persons of interest in a forensic investigation. Epiphyseal fusion of proximal end of humerus in ninety males were analysed on radiological basis to assess the range of variation of epiphyseal fusion at each age. In the study the X ray films of the subjects were divided into three groups on the basis of degree of fusion. Firstly, those which were showing No Epiphyseal Fusion (N), secondly those showing Partial Union (PC), and thirdly those showing Complete Fusion (C). Observations made were compared with the previous studies. 

Keywords: Epiphyseal Union; Shoulder Joint; Proximal End of Humerus. 

Sudden death is a major cause of mortality in adults and older individuals and the medicolegal autopsy in such cases is common to rule out any unnatural cause. This autopsy based study was undertaken to analyze the presenting complaints of the patients at the time of hospitalization and to calculate the survival time, so the appropriate treatment can be offered to the patients to reduce the morbidity and mortality. It was a prospective, longitudinal cohort study done in cases of sudden deaths, which were brought to us for autopsy examination during the one year period. In our study sudden unconsciousness (32.59%) were the most common presentation of the victims in casualty, followed by uneasiness (22.76%) and acute chest pain (17.4%). At the time of the onset of symptoms, the majority of the victims (41.96%) were engaged in their daily routine work followed by the victims who were resting (37.50%). The cases were also analyzed according to the duration of survival of the victim after the onset of symptoms and we found that the 53.55% victims died almost immediately within one hour of the appearance of symptoms and brought dead to the hospital while 18.75% victims could survive a duration of 1­6 hours followed by the victims who survived 6­24 hours (13.40%) after the onset of symptoms. This study highlights the importance of identification of the victims of sudden cardiac arrest by recognizing their presenting complaints and immediate and timely providing basic and advanced life support with rapid transportation can reduce the mortality and morbidity. 

Keywords: Cardiac Death; Sudden Death; Presenting Complaints; Autopsy; Natural Death.

Forensic Medicine and Toxicology is an indispensable part of medical education. It deals not only with medico­legal autopsy, but also enlightens medical ethics in medical students. Medical Council of India has reduced the strength of qualified teaching staff required for under­graduate teaching which has deteriorated the quality and importance of subject in giving justice to medical education as well as criminal justice. The arising public cognizance about medical field, conduct of medical professionals and changing doctor­patient relationship has affected medical practice. The present study is aimed to assess the knowledge and attitude of medical interns and post­graduate students of Padmashree Dr Vithalrao Vikhe Patil Foundation’s Medical College, Ahmednagar towards ethical and legal aspects of medical practice. This is cross sectional, questionnaire based study conducted at Padmashree Dr Vithalrao Vikhe Patil Foundation’s Medical College, Ahmednagar from 1st January 2016 to 30th June 2016. Total 101 students volunteered for this study. It was found that most of the students failed to answer questions about negligence, autopsy, viscera preservation and duration of keeping medico­legal records. Hence, one month internship should be mandatory in Forensic Medicine and Toxicology and Forensic Medicine teaching staff should be restored to boost up knowledge of students about their ethical and medicolegal responsibilities during practice of medicine. 

Keywords: Consent; Medico­Legal Knowledge; Medical Negligence; Record Keeping. 

  Aims and objective: An effort was made to formulate a linear regression equation for prediction of personal height from the length of an ulna bone. Material and Methods: The present study was carried out on 326 (males 166 and females160) medical and paramedical students of PDVVPF’s medical college, Ahmednagar, Maharashtra (age 18 to 25 years). The parameters measured are height and the length of right and left ulna. Observations: They were recorded in tabulated form and analysed statistically for mean, standard deviation, standard error, correlation coefficient ( r), regression constant (a), regression coefficient (b) and standard error of estimation to formulate the linear regression formula. Results: The correlation coefficient (r) for male was 0.76 ( p < 0.01) and 0.74 (p<0.01) for right and left ulna. The correlation coefficient (r) for female was 0.67 (p<0.01) and 0.66 (p<0.01) for right and left ulna. Considering both sex together it was 0.84 (p<0.01) for right and left ulna. The mean ulna length is higher in males than females. Conclusion: here is a definite correlation between length of ulna and height of an individual. The regression formula proposed in study will be useful for clinicians, anatomist, anthropologist and forensic experts. 

Keywords: Linear Regression; Height; Ulna; Correlation Coefficient (r).

  Estimation of height from measurement of various body parts is of particular interest to many anthropologists, anatomist and forensic scientist for its importance in medico­legal cases. Our aim was to investigate the relationship between personal stature and footlength & to derive a regression formula to predict the height of an individual using foot length. The present study was conducted on 200 apparently healthy students (100 males and 100 females)studying in various places of Middle Gujarat Region between 18 ­25 years of ages. All these measurements were done by using standard anthropometric instruments and standard anthropometric techniques. Data was analysed separately for male and female. Estimation of stature using regression analysis using foot length gives the correlation coefficient for both sexes. It is concluded that linear regression analysis is goodfor estimating accurate stature. 

Keywords: Stature; Foot Length; Regression Analysis; Correlation Coefficient.

  Background: Motor vehicle crashes are a major cause of fatality all over the world. By 2020 motor vehicle injury is projected to become the third leading contributor to the global burden of disease in the world. Motor cyclists are about 25 times more likely than car occupants to die in Road Traffic Accidents. Aim and Objective: To Compare the scalp injuries with cranial and cerebral injuries, i.e., to know how many percent of cases of scalp injuries are associated with skull and brain injuries. Study Design: Cross sectional Prospective. Place of Study: Osmania General Hospital Mortuary Hyderabad. Duration of Study: From 2010 to 2012. Material and Method: The subjects for the study were all cases of head injury due to blunt trauma whether admitted to the hospital or not, brought for medico legal autopsy during this period. Information was gathered from the relatives of the deceased or accompanying persons, police personnel, police inquest, hospital records and postmortem findings. Observation and Discussion: n 400 cases of head injury cases, 82% of victims are males and 18% victims arefemales, 88 cases remained unidentified i.e., a whipping 22 % of 400 cases. In Age group  of 31­40, almost 70% of the fatalities of the 75 cases fell in under 35 year age group. The incidence in vehicular accidents is 208 of which 170 are males and 38 females. The majority of the vehicles driven by the victims were motor cycles 123 cases. 364 of the 400 cases (91%) scalp injuries co­ xisted along with bony and cerebral injuries. It is mentioned that external injuries may or may not be present in all cases of head injury. The view that wounds of the scalp due to blunt force must be looked upon as potentially serious no matter how they are produced.Scalp injuries are usually the result of direct impact but may not be apparent in inflicted head injuries. Conclusion: he subject of “scalp injury and cranio­cerebral trauma” has assumed paramount importance in recent times owing to the enormous mechanization of various aspects of life. By compiling the records of these traumas at national levelor international level can underline risk factors involved in these accidents, will be extremely helpful in the policy building and making the decisions for health promotion and health building at national or international level.

Keywords: Scalp Injury; Cranio­Cerebral Trauma; Road Traffic Accidents.

  Context: Poisoning is the commonest method adopted in India to commit suicide. Pesticide poisoning is an important cause of morbidity and mortality in many countries in the world. ims: resent study was undertaken to evaluate the pattern of poisoning deaths in Rajkot region of Gujarat. Methods and Material: Present Retrospective study was conducted from 1st January, 2012 to 31st December, 2014 at department of forensic medicine, PDU govt. medical college, Rajkot. During that period total 7434 autopsies were conducted, out of them 739 cases of fatal poisoning and animal envenomation were selected for study. Statistical Analysis Used: Microsoft excel. Results: Average incidence rate of death due to poisoning is around 10% in Rajkot region. Organophospharus poisoning (35.99%) was most common followed by Aluminium phosphide poisoning (31.39%) and these findings were observed in individual age group and in male. Incidence rate is higher in male (61.7%) as compared to female (38.3%). Highest numbers of cases were found in age group of 21­30 years (29.63%). Conclusions: rganophosphorus insecticide was the prime culprit among all poisons. Trends of this  region were revealed and result was comparable with previous studies done in same region. 

Keywords: Poisoning; Organophosphorus; Fatal; Rajkot; Retrospective.

  Background: Determination of sex from a small fragment of skeletal remains of human has been frequently a challenge with which a forensic expert comes across in his day to day life. Because of showing sexual dimorphism, hip bone remains to be a favourable part of skeleton for this purpose. Since long it has been proven that hip bone shows racial differences also. Materials and Methods: This study was conducted on a set of 41 hip bones, of which 24 belonged to male and 17 belonged to a female. Length of pubic and ischial part was measured and then iscio­pubic index was calculated with the help of formula given by Washburn (1949). Results: Ischio­ Pubic Index was found to be 76.72 ± 0.13(Range 65.71­96.08) in males & 85.87 ± 2.40 (Range 73.48­98.42) in females. Ischiopubic index remained in between 73.34 to 80.10 in male and between 78.27 and 93.47 in female with confidence limit of 99%. Conclusion: Our study results and it’s comparison with results of other workers shows that hip bone not shows only dimorphism but it’s metric values are population specific also. 

Keywords: Hip Bone; Sex Determination; Pubis; Ischium; Ischio­Pubic Index.