Indian Journal of Forensic Medicine and Pathology

Amniotic fluid embolism (AFE), an exceptional, disastrous, complication of pregnancy may occur in association with aspiration of gastric contents, one of its clinical mimics. Histologic confirmation of particulate components of amniotic fluid such as fetal squamous cells, lanugo hair, mucin and debris in pulmonary microvasculature is the foundation of diagnosis and presence of partially digested vegetative material with acute inflammatory changes in terminal bronchioles is a telltale sign of aspiration of particulate gastric content. We report a case of amniotic fluid embolism with aspiration of gastric contents in a 32 year preeclamptic, anemic patient that occurred after induction and augmentation of labor with a vaginal administration of misoprostol and artificial rupture of fetal membranes respectively. These episodes culminated in death of mother and female fetus during labor.

Keywords: Amniotic Fluid Embolism; Maternal Mortality; Aspiration; Gastric Contents. 

The deaths due to of fatal pressure over neck in hanging are distinguished by a very thin line from ligature strangulations and may lead to complexity and controversy during the further course of investigation if the findings are not interpreted properly at the autopsy stage. We report a case of an individual who was allegedly found hanging with no suicide note being recovered but during autopsy significant hemorrhage was seen in the Sternocleidomastoid and other Strap muscles, an uncommon autopsy finding in a case of hanging. After examining the ligature mark and other autopsy findings the case concluded to be of hanging only. The authors intend to highlight that an autopsy surgeon should not rush to the conclusion just because of one aberrant finding which is not usually seen in a particular manner. The case should be examined in totality considering the other findings and only then the cause and manner of death should be opined.

Keywords: Sternocleidomastoid Hemorrhage; Strap Muscles Hemorrhage; Hanging; Strangulation.

Grievous hurt as defined in Section 320 Indian Penal Code (IPC) has 8 clauses. Out of these the eighth clause is one, interpretation of which confounds most individuals, doctors and judiciary. A doctor may be tasked with opining whether a hurt is grievous or not based on the eighth clause. A clear understanding of law with application of medical science helps the doctor to opine clearly thereby helping the law enforcers in administration of justice. The lack of proper documentation or clear opinion on the other hand hinders justice and can result in judgements where the medical evidence is not correctly inferred by the judiciary. This article highlights the eighth clause of grievous hurt, its interpretation by courts and the precautions that should be followed by the medical man in interpreting and opining grievous hurt as per eighth clause.

Keywords: Grievous Hurt; Endangering Life; Severe Bodily Pain; Ordinary Pursuits of Life.

Organ Transplantation is one of our greatest scientific achievements, a miracle we have come to take for granted due to tremendous advances in medicine. However, the act of harvesting the organs of a deceased individual, though scientifically established, also involves a race against time to prevent ischemia and the ever present possibility of malpractice. Thus the social and legal aspects of organ donation seem to be as, if not more, complicated than the surgical and immunological aspects of transplantation itself. Indian law has various provisions to facilitate organ transplantation; however, rate of deceased donor organ transplantation is just 0.5 per million populations (PMP). In contrast, Spain is a leader in Organ Donation, with rate of 34.4 deceased donations PMP. In this article we aim to study the laws in both countries, and the possibility of adopting some of the policies implemented by Spain, so as to increase the number of donations in India.

Keywords: Organ Donation Law; Spain; India; Comparison.

Background: A breach in a duty in respect to reasonable care and skill which result in injury to patient is now count as a failure to provide service to patient. Such act can result in a lawsuit against the doctor (service provider), under the Consumer Protection Act (CPA). Material and Methods: A present cross-sectional questionnaires study was undertaken to study awareness of Consumer Protection Act amongst intern working at M. P. Shah Govt. Medical Collage, Jamnagar during October – December 2016. Results: Out of total 110, males were 62 (56.36%) and females were 48(43.63%) with mean awareness score about CPA were 9.85 ± 3.95 and 10.16 ± 4.01 respectively with p value was 0.357 (not significant). Conclusion: CPA awareness was found to be low among both male and female interns. Therefore, medical professionals need to update their knowledge and understanding on CPA and its amendments to be on a legally safer side.

Keywords: Consumer Protection Act; Medical Indemnity Insurance; Negligence.

Background: Maternal mortality rate is recognized as a social indicator and is dependent upon the general socioeconomic status, nutrition level and the level of maternal healthcare in the community. Aims: The present study was undertaken with a view to determine factors causing maternal deaths, to recognize cause of death and to discuss the utility of autopsy record as a useful and adjunct data source for ascertainment of maternal deaths and to study the cases that were subjected to pathological autopsy. Material and Methods: This was a retrospective study. The maternal autopsy data during the period 2009 to 2014 were analyzed. Clinical data was also obtained from the case record. The maternal death cases related only to pregnancy were included in the study. Paraffin sections were reviewed. Autopsy findings were correlated with clinical details and investigation in each case to establish an accurate cause of death. Results: 33 pregnancies related maternal death cases were studied. The age ranging from 15 -26 years. Cases belonged to lower socio-econmic status. Haemorrhages were the predominant cause of maternal mortality. 70% of maternal deaths were occurred within the first 24 hour of hospital admission. Multigravidity was seen in 60% cases of maternal deaths. Conclusion: Maternal death is the index of health care in community. Forensic pathologist plays a crucial role in identifying the cause of maternal death. Findings of such studies and the RCH guidelines will improve the maternal care and helps to reduce the maternal mortality rate.

Keywords: Maternal Mortality; Autopsy; Haemorrhages; Forensic Pathologist; Maternal Death.

Homicide is one of the heinous crimes executed by human beings. It may be a consequence of argument between acquaintances, robbery, sexual assault, financial conflict, property disputes, infidelity and other causes and results in innumerable deaths reverberating across every levels of society. In this study we have analysed data of autopsied homicidal deaths between January 2015 to December 2016. We found that males were common victims (56.52% cases) and the age group of 21-30 years was most commonly affected. We have found an increasing trend of homicide in this area. Most cases homicides were executed by sharp weapons followed by blunt.

Keywords: Homicide; Rural; Method.

Background: Injury and death from the passage of electric current through the body is common in both industrial and domestic circumstances. The study has been conducted to find out the incidence of electrocution deaths in tertiary center, common source of electrocution and the study of the pattern of injuries sustained by the victims. Histopathological study of skin lesions and other organs of the electrically injured victims are received for microscopic examination. Methods and Material: In the present study, 30 cases of electrocution have been considered. Case details including history are retrieved from records during the period of 2011 to 2016 and have been analyzed. The findings are recorded in proforma and evaluated histomorphologically. Results: 30 cases (6.6%) of electrocution deaths, all are males. The highest numbers of autopsy cases are observed in the age group of 21-30 years, followed by 31-40 years. Most of the victims are electrocuted at work places and very few victims electrocuted in their houses. The most common causative agent is high voltage electricity (93.3%) followed by the home appliances (6.7%). 90% of the cases died on the spot. All the electrocution deaths in the present series are accidental cases and no homicidal or suicidal cases observed. Conclusions: The risk of getting electrocuted from the haphazardly installed electric wires without proper maintenance in most parts of the place is indeed a matter of concern. The spread of awareness and adoption of safety measures are important factors required for prevention of fatal electrocution and the study is to look for the consistency in the frequency of these histopathological findings.

Keywords: Accidental; Electrocution; Entry Wound; Exit Wound; High Tension Wire; Skin Lesions; Myocardial Fibers.

Background: In this modern era of scientific development and industrial progress, craniocerebral trauma is the leading cause of morbidity, mortality and achieved status as a ‘global health epidemic’. Skull fracture is a important component of craniocerebral injury. Fracture pattern, type, extent, and position are important in assessing the sustained injury. The skull fractures, offer varying diagnostic and medico- legal problems to the medical jurists as well as to the clinicians. So in present study more emphasis was given on study of skull fractures. Materials & Methods: A prospective cross sectional study was carried out during period from 1st June 2011 to 15th October 2012 in the department of FMT of Rural Medical College, Loni. In present study 100 fatal cases of craniocerebral injury were studied. During medicolegal post-mortem examination, detailed external as well as internal examination was conducted in each case and injuries were examined in details. Skull fracture was noted in terms of type, location, number, extension & associated complications. In this way collected data was analysed & presented in this paper. Results: In the present study we found skull fractures in 71 cases out of 100 cases. Linear type of skull fracture was found in 40 cases. In 34 (47.88%) cases both the vault as well as base was involved. In case of vault fracture, occipital bone was commonest location (8 cases). It was noted that the commonest site of basal fractures was the combination of anterior, middle and posterior cranial fossa accounted for 15 cases. Conclusions: Majority of fatal cases of head injury shows skull fracture. Combined involvement of vault and base was seen in most of the cases. Linear fracture was the commonest type of fracture observed. In vault fracture, occipital region was commonly involved & fronto-parieto-temporal. In base fracture, combination of anterior, middle & posterior cranial fossa was the commonest combination observed.

Keywords: Craniocerebral Injury; Skull Fracture; Medicolegal Problem. 

Context: Estimation of time since death has always remained an important requirement in medico legal as well as civil cases. In last few years researchers have studied various chemical tests to estimate the time since death. Body fluids which are available for such chemical examination are whole blood, serum, cerebrospinal fluid, aqueous humour and vitreous humour. Amongst all these available body fluids, the vitreous humour has been largely utilized and vitreous potassium concentration has become most widely used method to predict the time since death. Aims: To find the correlation between vitreous potassium, vitreous sodium and time since death. Settings and Design: The present study is prospective study done at B J Govt. Medical College during October 2012 to October 2014. Material and Methods: 207 cases brought for postmortem examination during study period were selected after applying inclusion and exclusion criteria. Statistical Analysis: Statistical analysis was done using SPSS software to find coefficient of correlation, regression equation and ANOVA test was applied to study the significance. Observation and Results: The statistical analysis showed that there is no any significant correlation between time since death and vitreous sodium. However analysis showed a highly significant positive linear correlation between time since death and vitreous potassium concentration with regression equation as, y = 0.2115 (x) + 8.9122 with coefficient of correlation of + 0.8024. The rise was found up to 46 hours after death. The present study also showed that 95% confidence limit of over ± 17.14 hours limits the usefulness of this method in estimating time since death. Conclusion: The vitreous potassium is a very useful indicator for determination of time since death. However one should keep check on sampling errors and method of analysis, as it can make difference in the final results.

Keyword: Vitreous Potassium; Sodium; Time Since Death; Correlation. 

Finger print is the cheapest and user friendly tool of identification. It’s correlation with blood group is medicolegally important to trace the victim and accused for detection of crime. In this study thumb prints of 100 medical students of GMC, Latur were taken and correlated with their blood groups. In the study blood group B (39%) was the commonest ABO group, Rh + ve (92%) was commonest Rh system. Amongst the finger print patterns- Loops were most common (64%), whorls were second commonest (31%), the study suggests an association between finger print patterns and blood groups. Blood group B showed more Loops (28%) and blood group A (9%) showed more whorls. Our aim is to help investigating agencies by providing a clue in crime detection by fixing probable culprit. We can find out probable blood group of accused if we find chanced finger print and vice-versa.

Keywords: Finger Print; Unique Identity; Blood Group; Clue for Fixing Probable Culprit.

Background: Pancytopenia means decrease in all three cell lines .It is the striking feature of many illnesses ranging from megaloblastic anaemia to leukaemias. The underlying pathology of pancytopenia will determine the management and prognosis. Objective: To identify the various etiologies of Pancytopenia. Materials and Methods: The present study was undertaken at BRIMS Bidar. Results: 100 cases were studied, 57 males and 43 females with age ranging from 3 yrs to 90 yrs .Most of the cases presented with generalized weakness, followed by pallor, hepatosplenomegaly and bleeding manifestations. Conclusion: The present study were helpful in understanding the various causes of diseases process with bone marrow aspiration done in few of the pancytopenic patients along with support of biochemical investigations which were helpful in planning further investigations and management.

Keywords: Pancytopenia; Bone Marrow Aspiration; Megaloblastic Anaemia; Leukaemia.

Background: Stature of a person is one of the vital parts of identification. Assessment of height from different parts of the body by anthropometric study of skeleton is an area of interest to anatomist, anthropologist and forensic experts. Objective: This study aims to find the relationship between stature and forearm lengths and set regression equations for estimation of stature from radius and ulna length for Telangana population. Study Design: Descriptive cross sectional study. Material and Method: In the present study, stature and per cutaneous Forearm length measurements of 164 college students of ages 19- 27 years were done. The data for the present work was collected from the various senior secondary schools and colleges of Karimnagar area of Karimnagar District of Telangana State of India. Observation and Discussion: In the present study, regression equations have been formulated with the standard error of estimate (SEE) ranging from ±5.1892 cm to ± 5.5292 cm. For females the standard error of the estimation is observed in Left Ulna length (SEE = ± 5.1311 cm) and the Left radial length (SEE = ± 5.1092cm). For Males the standard error of the estimation is observed in Left Ulna Length (SEE = ± 5.5292 cm) and the Right radial length (SEE = ± 5.4395 cm). Conclusion: The Multiple regression equations provide slightly better results than the linear regression equations. The results in the present study indicate that the length of forearm can be efficiently used for stature estimation.

Keywords: Per-Cutaneous Forearm Length; Forensic Anthropology; Stature; Multiple Regression Analysis.

Background: Burn has tremendous importance in medico legal point of view as it is one of common cause of unnatural death and a major health problem in India. Setting of fire to self (self-immolation) in public is done to attract the attention of government and media regarding political affairs, personal problem. Sometimes people resort criminal act like murder, rape and for concealing the fact they want to burn the body of crime. Most often circumstance of burn is mysterious, obscurity and even untruthful statement. Materials used: Only those cases of burn which are ante-mortem and are confirmed to be so, after autopsy. Observation: The highest incidence occurred in the age group of 21-30 years (44%). About 70% of thermal burn incidence occurred in the kitchen. Most of the burn injuries are accidental in nature (70.67%). In suicidal and alleged homicidal majority of them are female. Major cases of accident burn are due to burst of kerosene stove (92%). Abdomen was frequently involved followed by extremities. Scalp hair, eye brow and eye lashes are involved in nearly 100% cases of suicidal and alleged homicidal burn but in accidental cases scalp hair is involved in (83.01%) and eye brows, eye lashes in 79.99% cases. Blackening of skin (20%), Heat rupture (0.67%) and pugilistic attitude was found in (3.33%) of cases. Soot in trachea is found in 20% of cases, Glottis edema in 2%, generalized congestion in 94.66% and generalized pallor in 5.34% cases. Conclusion: Awareness should be made to avoid such deaths. The extreme method of suicide can be avoided by proper counseling. 

Keywords: Ante-Mortem Burn; Awareness; Education; Manner of Death.

Introduction: Tuberculosis is the most common health problem caused by Mycobacterium, a non-motile, non spore forming aerobic acid fast bacilli. It is of two types, pulmonary and extrapulmonary. Extrapulmonary tuberculosis is the isolated occurrence of tuberculosis in any part of the body other than lungs like lymph nodes, neck, bones and serous membranes. We have undertaken this study to evaluate the clinicomorphological features of extrapulmonary tuberculosis. Materials and Methods: A prospective study was done in the Department of Pathology, Narayana Medical College, Nellore, for 2 years from 2014 to 2016. Extrapulmonary tuberculosis was identified constituting 125 cases (11%) of the total cases. Clinical data was recorded and the biopsy specimens were processed in our department and the data was analysed. Results: Cervical lymph node was the most common site involved by extrapulmonary tuberculosis in our study. The most common age group involved was 20-30 years with loss of weight being the most common presenting feature in these cases. Most of the cases were negative for AFB in both sputum and culture. Histopathological examination which is the gold standard for diagnosis proved to be positive in 72% of the cases. Conclusion: Our study on extrapulmonary tuberculosis has been done to review the various clinico-morphological aspects of the disease. Cervical lymph nodes were the most common site involved, 60 cases (18.3%) followed next by the osteoarticular system, 19 cases (18.3%).

Keywords: Extrapulmonary; Lymph node; Tuberculosis. 

 The role of Forensic anthropology to derive alternative and newer modes of identification is increasing every day. Estimation of stature is one of the important initial steps during forensic analysis of human skeletal remains. The aim of the present study was to derive a linear regression formula for estimating stature of adult Indian males from the length of the sternum. The study included 100 male & female sternums of Indian origin dissected from cadavers during medico-legal autopsies. Regression equation derived for both sexes collectively was “Stature=94.228 + 4.474 × (Combined Length of manubrium and body of sternum)”, with Standard Error=3.901cm and strength of association=0.858. This preliminary study concludes that the length of the sternum can be used as a tool for stature estimation in adult Indian males.

Keywords: Forensic Anthropology; Stature Estimation; Sternal Length; Linear Regression.

Background: Establishment of sex is an important aspect of forensic medicine. Previously conducted studies have shown that differences exist between male and female index and ring finger ratios. Aim: The purpose of the present study is to evaluate sexual dimorphism of index and ring finger in adolescents in the western part of the Indian population. Material and Method: The study was carried out on a cross sectional sample of 103 adolescents; out of which 50 of the respondents were males and the remaining 53 were females. Data on age, sex, and handedness was collected through a structured paper questionnaire as primary data collection and the anthropometric measurements as secondary data collection. Result: The result of the present study shows that the mean age of male population is 13.74 years while the mean age of female population is 14.91 years. Statistically significant difference (p < 0.05) between index and ring finger ratios in male and female are observed. Conclusion: The present study suggests that the ratio of less than 0.99 suggests male sex while a ratio of 0.99 or more suggests female sex. The findings of present study can be utilized to establish sex especially in circumstances where body was mutilated or only remains were brought or in cases of mass disaster.

Keywords: Identification; Sex Difference; Index Finger; Ring Finger; Anthropometry.

 Whenever unknown or decomposed or mutilated dead bodiesor isolated body parts or skeletal remains are found, first step of police investigation is to establish identity of deceased. Determination of stature from dismembered body parts can play vital role for identification of person. Present study was done to derive regression formula and multiplication factor to estimate stature from facial dimensions for population in and around Rajkot region of Gujarat. Total 100male cases and 100 female cases randomly selected from cadavers brought for post-mortem examination at mortuary of P. D. U. Govt. Medical College and Hospital, Rajkot. Stature was measured with measuring tape and Facial dimensions were measured by Spreading caliper after breaking Rigor mortis, if developed.Collected data were statistically analysed using software like Epi info 7 and Microsoft excel. Mean stature as well as mean Facial dimensions were significantly higher for male than for female (p<0.05). Regression formula and multiplication factor derived in present study are useful to estimate stature from Facial dimensions for population in and around Rajkot region of Gujarat.

Keywords: Identification; Stature; Facial Height; Facial Breadth.

 Background: The Indian National Crime Records Bureau (NCRB) reports that there were about 8083 dowry death cases registered in India in 2013. India reports the highest total number of dowry deaths with 8,391 such deaths reported in 2010, 1.4 deaths per 100,000 women. Aim and Objective: To know the recent pattern regarding unnatural deaths among newly married females so that effective preventive measure can be taken. Study Design: Cross sectional Prospective. Place of Study: Osmania General Hospital Mortuary Hyderabad. Duration of Study: From Nov 2010 to Aug 2012. Material and Method: The present study was conducted in Department of Forensic Medicine and Toxicology, Osmania general hospital. A total number of 296 autopsied cases of married woman within 7years of marital life were studied, brought by polices of various police stations in Hyderabad city, and the inquest, were conducted by the Executive Magistrate. Observation and Discussion: Dowry death is most common in the age group of 21- 30 years; no age group is an exception to harassment for dowry that finally leads to death of the individual. Hindu females comprised of an alarmingly large group 87%, while the number of deaths in other religion groups the Muslim (12%) and in Christian community is almost negligible. 60.1% in-laws of husband and husband are responsible for killing or forcing the victim to end her life. majority of deaths are due to burns (59.8%), followed by deaths due to hanging (23%), whereas poisoning(11.1%) and other injuries accounts for lowest incidence of deaths(6.1%) 89.2% are found to be suicidal, where as 10.8% are homicidal. Even though the Government of India has passed the Dowry Prohibition Act in 1961 1, till today this social evil was not totally eradicated from our society and has become a major issue of unnatural female deaths. Conclusion: This social curse has to be attacked by a multipronged and organized approach by police, women welfare organizations, reputed public servants, and judiciary and by awarding deterrent punishment to all offenders. In our opinion, a rational and practical approach on the above mentioned matter will certainly be helpful.

Keywords: Dowry Deaths; Autopsy; Domestic Violence.

  Age estimation is one of the prime factors employed to establish identity. It is possible to arrive at a close estimation of age in children by studying the eruption pattern of the deciduous and permanent teeth. Subjects from different ethnic and socioeconomic groups present different stages of maturation, with remarkable genetic variations in the order of appearance of tooth. Hence there is a need to study the chronology and sequence of tooth eruption for the different populations [2]. In the present study, students from three different schools, belonging to different socioeconomic status were examined to present a new data on the timing and sequence of eruption permanent tooth. A total of 2925 students were selected for the study after ascertaining their exact age from the records. The mean age of eruption of permanent maxillary teeth is as follows: First molar (6.9 ± 0.7 years), Central incisor (7.8 ± 0.8 years), Lateral incisor (8.8 ± 0.8 years), First premolar (10.7 ± 1.0 years), Second premolar (11.5 ± 0.9 years), Canine (11.6 ± 0.9 years) and Second molar (12 ± 0.8 years). The mean age of eruption of permanent mandibular teeth is as follows: First molar (6.3 ± 0.8 years), Central incisor (7.5 ± 0.8 years), Lateral incisor (7.9 ± 0.7 years), Canine (10.8±0.8years),First premolar(11.1 ± 0.5 years), Second premolar (11.8 ± 0.8 years) and Second molar (11.9 ± 0.7 years). The mandibular teeth tended to erupt earlier than the corresponding maxillary teeth in both sexes except the premolars.

Keywords: Age; Children; Eruption; Mandibular; Maxillary; Permanent Teeth.

 Case scenario method is a powerful student-centred teaching strategy that can impart students with critical thinking, communication, and interpersonal skills and allows students to develop a collaborative, team based approach to their education. A cross sectional study was conducted on 3rd semester students (n=100) at Forensic Medicine department, Hamdard Institute of Medical Sciences & Research, Jamia Hamdard for period of 4 months to use case scenario based (CSB) learning approach as a tool to improve students understanding of applied aspects of Forensic Medicine and encouraging them to actively participate in teaching learning processModules were prepared for case based teaching methodologies on four topics of Forensic Medicine namely medico-legal autopsy, mechanical injury, Thanatology and crime scene investigation.At the end of study program feedback evaluation of the program was done using questionnaire containing items pertaining to student’s satisfaction and participation based on Likert’s 5 rank scales. The assessment was done using MCQ’s and OSPE. More than 75 % of the students reported improvement in learning and engagement due to more active participation, were more organized in learning approach, increased analytical skills and problem solving ability and improved communication skills, collaborative skills by case scenario based (CSB) learning approach.

Keywords: Case Scenario Based Learning; Forensic Medicine; Students Learning.

 Background: The profile of medicolegal autopsy cases is important in order to know the death statistics in a region due to unnatural causes and also help to address the demographic needs according to the mortality statistics specific to that area. Material and Methods: The present study is a retrospective study of autopsies performed at the tertiary care centre, S Nijalingappa Medical College, Bagalkot, Karnataka India. Data collected from department of medical records and department of forensic medicine from January 2016 to December 2017 comprising 64 cases. Results: Out of 64 cases maximum number of the postmortem were in the age group of 21–30 years, majority of victims were males (61%), in identified bodies 88% were Hindu, 8% Muslim, 4 % were others. In our study 57.5% were rural residents and only 34.5% were urban. In 8% cases religion and residential status could not be determined. Death due to burn injuries and its complications formed majority of cases (37.5%) in our study followed by RTA (22%) and poisoning (15.5%). Conclusions: In our hospital based study of medicolegal autopsy cases- majority were in 3rd decade of life, males constituted more in number as compared to female, rural residents were more in number, Hindus being majority in number formed bulk of cases, burns, RTA and poisoning were seen as leading cause of death in medicolegal autopsies.

Keywords: Autopsy; Natural Deaths; Unnatural Deaths; Road Traffic Injuries; Burns; Hanging.