Indian Journal of Forensic Medicine and Pathology

Deaths in swimming pools are commonly attributed to drowning. There are other mechanisms also by which an individual can sustain injuries which can lead to an untimely death. We present a case of young male who sustained cervical spine injuries while diving in a swimming pool and died due to its complications. There is no separate registry or data in India compiling the number of swimming pool accidents and various injuries that are sustained by the patient. The authors aim to increase the public awareness regarding these hidden dangers with swimming pool activities which can cost permanent disability or even a life. This is not only a personal loss but a loss to the Community and Nation.

Keywords: Cervical Spine Injury; Drowning; Swimming Pool Accidents; Metallic Cervical Spine Implant; Septicaemia; Quadriparesis.

Autopsy examination of 100% burn is one of the most critical case that is encountered in medico-legal practice. At the same time burden to fix the identity of the victim lies on the autopsy surgeon in such cases. To exonerate any false positive or false negative inference, the concerned autopsy surgeon must be very cautious during examination. Preservation of articles during autopsy is very essential to avoid future disputes.

Keywords: Burn; Medico-Legal Practice; Autopsy; Identity; Articles.

 

Violent unnatural deaths is a major menace of the society in India. The worst are those of HomicideSuicides. Homicide followed by the suicide is a relatively rare act in which the perpetrator kills another person and subsequently commits suicide. The motives and circumstances that provoke the perpetrator to commit the crime may vary. This article by an integrated approach intend to describe the victimperpetrator relationship, motivating factors and the cause of death of such cases of homicide-suicide reported in India which are documented in the literature.

Keywords: Homicide; Suicide; Dyadic Deaths; Perpetrator; Cause of Death.

After cardiovascular disease, renal failure is a frequent cause of morbidity and mortality in the population worldwide. Humans are exposed to numerous plant toxins that cause deterioration of renal function with noticeable histopathological changes. Despite of extensive studies in past, recently only few articles have reported with an integrated approach to their nephrotoxic effects. In this article, we present plants which are involved in nephrotoxicity.

Keywords: Plant; Poisoning; Nephrotoxicity; Renal failure; Acute tubular necrosis.

 

Context: India is a country with highest rates of mortalities and morbidities resulting from snake bite. There is a concept that four snake species namely Naja naja, Bungarus caeruleus, Daboia russelii, Echis carinatus, together called the ‘The Big 4 snakes of medical importance’ are solely responsible for morbidities and mortalities. Indian antivenom is effective against aforementioned species only.

Aims: Aim of the study was to compare the clinical and laboratory variables in patients bitten by hump-nosed pit viper (Hypnale hypnale) and other vipers.

Settings and Design: Study was conducted in Kozhikode Government Medical College, located in Northern Kerala. It was a descriptive study on various clinical and laboratory parameters.

Methods and Material: Study was conducted comparing various clinical and laboratory
parameters in among patients bitten by Daboia russelii and Hypnale Hypnale.

Statistical analysis used: Analysis was done using EPIINFO and SPSS software. Comparisons between viper bites were done by the chisquare test.

Results: Analysis proved that except for parotid swelling, which was seen only among Daboia russelii bitten patients, there were no statistically significant difference among the various parameters studied, including mortality rate.

Conclusions: Our study emphasizes the urgent need for anti snake venom effective in Hypnale Hypnale envenomations.

Keywords: Hump Nosed Pit Viper; Indian Anti Snake Venom; Russell’s Viper.

 

Background: Identity of an individual is an imperative aspect in any kind of investigating procedure. There are numerous ways and means to do so in human beings (alive or dead), when a human body is in its entirety, but very few when only a part of it is available. In such cases, complete identification becomes unlikely and partial identification assumes importance to proceed into further investigations. There are various data available for identification. The height (stature) of an individual is one of them. There is scanty information regarding stature estimation by multiplication factor using head length in SouthIndian population.

Material and methods: The present study is a crosssectional study includes 200 south Indian student population of S. Nijalingappa Medical College, Bagalkot.

Aims and objectives: To correlate head length with stature, and to derive multiplication factor that can be applied for estimation of stature in South Indian population.

Results: The average stature in the present study is 172.44 cm for males and 159.49 cm for females and the average head length from Nasion to Inion is 18.18 cm for males and 16.77 for females and from Glabella to Inion is 18.69 cm for males and 17.28 cm for females.

Conclusions: There is a positive correlation between the head length with that of stature. The estimation of stature by derived multiplication factors are equally valid and can be used upon the South Indian population with fair degree of accuracy.

Keywords: Stature; Head Length; Multiplication Factor; South Indians; Anthropology.

 

Objective: To study the association of Dermatoglyphics with Ischemic Heart Disease and it can be also helpful in identification of persons in court of law.

Study design: Descriptive study. 

Place and duration of study: Data was collected for the study which was conducted at Al-Ameen Medical College & Hospital, Bijapur, Karnataka from April 2017 to June 2017.

Materials and methods: Finger prints were collected from the subjects after obtaining their informed consent in the month of 1 April, 2017 to 15 June, 2017. A total of 100 IHD diagnosed patients were selected from the OPD of Al-Ameen Medical College & Hospital and data were analyzed. The finger prints of both the hands were recorded on a plain white paper with a stamp ink pad by rolling method and each finger print was assigned by their Name, Age, and Sex.

Results: A total of one hundred patients were selected for this study which were all known case of Coronary Heart disease patients. Out of these one hundred patients the majority of the patients were belonging to whorl pattern of finger prints i.e., 90 (57%) where as the number of patients belonging to Loop pattern was 40 (29%) pattern of Arch and composite was same i.e., 10 (7%) each, and so these various types of fingerprint patterns can be used for genetic correlation and screening.

Conclusion: Majority of the patients was belonging to whorl pattern of finger prints followed by patients belonging to Loop pattern and the least patterns were Arch and composite. Each fingerprint is unique hence it can also be very effectively used as an evidence for identification in the court of law.

Keywords: Dermatoglyphics; Ischemic Heart Disease; Whorl; Loop; Arch; Court of Laws; Identification.

Introduction: Hanging is one of the most common mode of suicide in Asian countries as well as countries worldwide. Survival period in hanging does not follow a fixed pattern and fatality varies from few seconds to few minutes depending upon various factors such as duration of suspension, type of ligature material, force applied for compression of neck, position of the person etc. Victims usually fail to resist pressure and succumb to death speedily almost within few minutes. However in a few reported cases patient has survived for certain period after immediate and prompt resuscitative measures, but died at a later stage which can specifically be called as delayed or near hanging death. More than 25-30% of suicidal death cases due to hanging are reported in India and the data is expanding every year. We have studied certain number of cases in which people of young adult groups succumbed to death following consequent complications after rescued hanging.

Aims & Objectives: The present study is conducted to analyse the cases of delayed death in hanging and their comparison with other cases of hanging as well as preventive aspects in such cases.

Materials and methods: Total Nos. of delayed death in hanging were 07 during 2016 and 2017, among 131 cases of death due to hanging autopsied, which were brought to mortuary of KGH, Raigarh (C.G.), during the period of January 2016 to December 2017.

Observations & Results: In our study, Male: Female= 1:6, Partial: Complete Hanging= 1:6, Age group-16-36 years, Cause of death= H.I.E followed by pulmonary oedema, Survival period= 24-48 hrs, in one case victim survived around seven days. Soft & Hard materials were used for the purpose of hanging.

Conclusion: Predominant cause behind death is HIE and pulmonary oedema. Overcoming critical period can reduce morbidity and mortality.

Keywords: Rescued Hanging; Delayed Death; Near Death; Suicide; HIE.

Congenital malformations are most common cause of perinatal death. Antenatal imaging studies can easily detect the problem, and can give an idea of diagnosis. However autopsy still plays a pivotal role in confirming the diagnosis and identifying actual cause of fetal loss.

Materials And Methods: This is a descriptive, cross-sectional study on 101 fetuses, over a period of 2 years from October 2014 to September 2016 referred to the Department of Pathology, Dr PSIMS & RF; which were an outcome of spontaneous abortions, intrauterine deaths, still births and of therapeutic abortions due to anomalies. This study is to determine overall incidence and distribution of various congenital anomalies and data was analyzed statistically.

Results: Total 101 consecutive perinatal autopsy were performed, 31 (30.6%) fetuses showing congenital anomalies with female (16.8%) predominance and M:F ratio 1:1.2. Common congenital anomalies were observed in this study included central nervous system defects - anencephaly and meningomyelocele being common. Other systemic anomalies are genitourinary system, gastrointestinal system, respiratory and musculoskeletol system were seen. Multiple syndromes such as Prune-belle, Meckel- gruber were observed in this study.

Keywords: Perinatal Autopsy; Congenital Anomalies.

Eagle syndrome represents symptoms manifested by compression of regional structures by elongation of the styloid process or ossification of the stylohyoid membrane. The aim of the study is to assess the distribution of SP length and its correlation with side asymmetry. Present study was conducted in collaboration with department of Anatomy and department of Forensic Medicine at Jaipur National University Institute for Medical Sciences and research Center, Jaipur. A total of 38 dry skulls held by the Department of Anatomy were analyzed. The measures were synthesized in one mean measure. Descriptive statistics involved the calculation of central tendency and dispersion measures for each side of the styloid process and for each anatomic position. The length of the SP ranged from 5 mm to 43 mm and from 10 mm to 46 mm, based on the lateral view of the left and right styloid, respectively. From the posterior view, the values for the left and right sides of the skulls, respectively, ranged from 10 mm o 54 mm and from 15mm to 58 mm. This morpho-metric data of the styloid process is important to the physicians, neurosurgeons, otorhino-laryngologist and dentists for accurate diagnosis and treatment of dysphagia and chronic neck pain. The mere presence of an elongated styloid process does not automatically confirm a case of Eagle syndrome. The knowledge of SP variability apart from its anatomic value is of special interest for clinicians when managing atypical pain in the head and neck area as well as for forensic medicine and medico legal cases.

Keywords: Eagle’s Syndrome; Styloid Process; Elongated Styloid Process.

 

Context: The death due to burns may be instantaneous i.e. on the spot, or the victims may escape the immediate death and may die after one day of survival. All these deaths occurring after one day of survival will be considered as delayed deaths.

Aims: To study the profile of burn victims and to study the causes and manner of death among them. 

Settings and design: Department of Forensic Medicine and Toxicology, Gandhi Medical College and Hospital Secunderabad, Telangana, India.

Methods and material: One hundred deaths which had occurred due to burns after one day of infliction are selected from May 2009 to September 2009 in Gandhi Hospital Secunderabad. The entire data was analyzed and the cross sectional statistics were prepared by highlighting the causes and complications of delayed death due to burns.

Statistical analysis: The data was analyzed using proportions and presented as charts and tables.

Results: The male and female deaths were 36% & 64% respectively with highest number of cases among the age group 21-30 years (male and female 25.9% & 74.1% respectively). Maximum deaths were due to septicemia as the complication leading to the death i.e. 36% of total death (male and female 36.1% & 63.9% respectively). The highest death rate is between 3-7 days after the infliction of burns (Total 49%, with males & females 17%, 32% respectively), followed by 24-72 hours (29%)

Conclusion: Septicemia is the main complication in delayed deaths and the proportion is more in females compared to that of the males. The most common causes of burns are accidents and suicides. Dowry deaths & marital issues are more common in females where as financial and ill health issues are more common in males.

Keywords: Septicemia; Delayed Deaths; Complications; Dowry; Marital Issues.

Context: Cardiovascular diseases are an important cause of morbidity and mortality in both developing and developed countries. The prevalence of coronary artery disease has doubled in Indians during the past three to four decades. Hence, the study was undertaken to evaluate the prevalence of various heart diseases in this region of western Maharashtra.

Aim: The aim was to assess the pattern and prevalence of atherosclerosis involving the coronary arteries and to study the gross and microscopic features of various lesions affecting the valves, myocardium, endocardium and pericardium.

Design: This was a prospective analytical study.

Material and methods: The study included 250 complete heart specimens of medicolegal autopsy cases received from August 2012 to July 2014. Thorough gross examination of atria, ventricles and valves was done followed by examination of the coronary arteries and representative tissue bits were submitted for microscopy.

Results: Atherosclerosis was the most common lesion involving 123 cases with 48 cases of triple vessel disease. Ischemic heart disease was seen in 62 cases, 60 being associated with atherosclerosis. Fourteen cases of left ventricular hypertrophy, nine cases of valvular heart disease, three cases each of cardiomyopathy and disseminated intravascular coagulation, two cases of acute leukemia and one case each of papillary fibroelastoma, amyloidosis, ventricular septal defect and sickle cell anaemia were observed.

Conclusion: Present study emphasizes the role of atherosclerosis in ischemic heart disease. Amyloidosis and rare tumors like papillary fibroelastoma of the heart can be accurately diagnosed on histopathology underscoring the usefullness of an autopsy based study.
Keywords: Atherosclerosis; Ischemic Heart Disease; Valvular Heart Disease.

Background: Violent asphyxial deaths are one of the important causes of death nowadays. Hanging is one of the preferred mode of committing suicide. Pattern of suicidal death is a reflection of the prevailing social set up and mental health status of region.

Material & Methods: A Prospective study was conducted from Jan 2013 to December 2013 in which 106 autopsy cases of hanging deaths were taken out of 976 autopsies conducted in the mortuary of Raichur institute of medical sciences, Raichur. 

Results: The maximum incidences of hanging deaths were in 21- 30 years age group (37.7%). Majority of the victims were married (67.9%). The most common place of hanging was closed space (93.3%). On external examination the ligature mark was at or above the thyroid cartilage in all the cases with no fracture of thyroid cartilage or hyoid bone.

Conclusion: Hanging is the most commonly observed mechanical asphyxial death. The cause of death profile is an important set of public health information and forms the cornerstone of the health information system

Keywords: Hanging; Asphyxial Deaths; Ligature Mark.

 

Introduction: Tooth morphometrics show variations across gender, phenotypes, race, age and populations. These variations are evolutionarily determined but maybe modified by environmental factors such as socioeconomic conditions, nutrition, childhood health, maternal effects such as gestation and systemic conditions. Despite strong genetic contribution, the tooth may fail to reach its maximum potential size due to the role of environmental influences. A relation between tooth size and body size would compound the notion that teeth size, though dependent on genetic contribution, are not insulated from external influences. Previously attempts to corelate tooth size and body size by other authors have shown differing results. There is also a dearth of information regarding the same on deciduous dentition. Hence this study aims to corelate Body Mass Index (BMI) and clinical crown length (CL), mesiodistal width (MDW) and buccolingual width (BLW) of primary maxillary canines and first molars, among Chennai children.

Materials and methods: A cross-sectional study was conducted among 100 school going children, of both genders, in the age group of 3-6 years. Weight and height were calculated by metric standards and BMI was obtained. The participants were grouped as healthy, underweight and overweight. The different groups were measured intraorally, with a digital Vernier caliper for crown lengths, mesiodistal and buccolingual widths of primary upper canines and molars. Data was statistically analyzed.

Results: Total of 49,22,18 belong to healthy, underweight and overweight. Comparison of the mean (SD) of CL, MDW, BLW of upper primary canine and first molar among participants of different body size using one-way ANOVA test was found to be statistically significant (P<0.05).

Conclusion: A positive correlation exists a between body mass index and tooth metrics. Evident deciduous crown size variations of individuals of different BMI belonging to the same population should be taken into consideration while studying population comparisons of different odontometric standards.

Keywords: Morphometrics, Body Mass Index, Crown length, Mesiodistal width, Buccolingual width

 

Introduction: Deaths due to road traffic accident are one of the common forms of unnatural death and its history is old as the invention of the wheel. The head is the most prominent of the exposed parts of human body by virtue of its situation, choice in great majority of situations involving blunt trauma which may be accidental, suicidal or homicidal.

Materials & methods: The present study was undertaken on fatal head injury cases of road traffic accidents brought by the police to the mortuary of Al-Ameen Medical College and District Hospital, Bijapur for medico-legal autopsy between Oct 2003 Sep 2005, a total of 180 cases were studied.

Results: In the present stud of 180 cases, 150 (83.3%) were males and 30 (16.7%) females. Male, female ratio of 5:1 was observed. The maximum number of cases, 53 cases (29.5%) were seen in the age group of 21-30 years. The next in frequency was 25 cases (25.0%) seen in the age group of 31-40 years between 71-80 years 2 cases (1.1%) were seen. Most of the accident (20.0%) ccurred between 3pm to 6pm and between 9am to 12noon and 6pm to 9pm 27 (15.0%) cases occurred. In 2 (1.1%) cases the time of accident was not known. In the study most of the victims 137 (76.1%) died on the spot. The maximum time of survival was up to 6 hrs. Lorry and Truck was the commonest offending vehicle. Next in order was bus and unknown case was 7 (3.9%).

Conclusions: The male preponderance may be due males are more exposed to outdoor activities traveling. The reason for young adults most affected because they are the prime breads earners of the family, remains outdoor. The reason for the peak incidence of the accidents at 3-6hrs is multifold and includes hurry to reach home from place of work timed people after hectic work, rush traffic hours, in-adequate traffic control and fatigue to drive. Most victims died on the spot, this may be due to the severity of injuries sustained, lack of knowledge of first aid, delay in shifting the patient to trauma center etc.

Key words: Road Traffic accident, Head injury, Autopsy, Demographics.

 

Background: Out of three vital organ two (Heart and Lung ) are in the thoracic cavity. So injuries to chest cavity are mostly fatal in the form of haemorrhagic shock or neurogenic shock. Blunt or sharp objects may causes these type of injuries.

Aims: To study the epidemiological aspect of fatal blunt chest injuries.

Material And Method: In this study 120 cases of chest injuries by blunt objects are studied for their various aspect.

Results: Most cases are of road traffic accident (RTA). Most of them are young male between 20-40 years of age. Though majority of them died within in 1hrs, on the spot or on the way. Nature of injuries are correlated with the history and incident. Involvement od lung shows multiple rib fractures. Heart, major vessels and diaphragm were also involved in significant number of cases.

Conclusion: Most of the fatal blunt chest injuries were of road traffic accidents majority of them have lungs and ribs injuries and emorrhagic shock is the cause of death in almost all cases.

Keywords: RTA; Fracture; Spot Death; Haemorrhagic Shock.

 

Background: The rising trend of medico-legal cases reporting to our hospital emphasizes the need to have physicians who are trained in Forensic Medicine to equip them to deal with such situations. In an era of escalating crime, litigation and eroding doctor-patient relationship, ignorance of the law could lead to pitfalls in practice. Hence, the present study was conducted to evaluate the knowledge of our interns on handling routine medico-legal cases in the wards and Casualty.

Material and Methods: A total of 109 interns posted in various departments of the institute during the period from May 2016 to April 2018 participated in this research. Data was collected in the form of a self-administered questionnaire comprising close-ended multiple choice questions related to the topic of the study. It was then analyzed using SPSS version 11 by descriptive analysis.

Results: The majority of participants were able to identify a medico-legal case and classify an injury as simple or grievous. However, there was uncertainty regarding giving opinion in a case of drunkenness and custody of forensic samples in poisoning.

Conclusion: Overall, interns had good knowledge of handling medico-legal cases. The knowledge gaps identified through this study on particular topics have to be revised at regular intervals during internship and residency.

Keywords: Medico-Legal; Forensic Medicine; Interns; Wards; Casualty.

The study was conducted in HAH Centenary Hospital of Hamdard Institute of Medical Science & Research New Delhi, India. It is retrospective study so the cases entered in Medico legal case register during the period January 1st 2014 to 31st December 2014 were considered. Patients with alleged history of road traffic accidents were included in the study. Road Traffic Accidents (RTA) are in increasing trend now a day’s throughout the world causing great burden of morbidity and mortality among people. The present study is conducted to know the pattern of injuries, age, sex and time of incidence in patients of RTAs.

Keywords: RTA; Injuries; Vehicle.

 

Introduction: Occupational health hazards faced by this large and growing number of people depend on the region and its economic standing.

Aim: To study occupational health status of workers, causes and patterns of occupational injuries.

Materials and methods: It is a cross-sectional study in total of 100 workers who were examined at different construction sites and hazards were noted.

Results: It is being observed that most of the construction workers belong to the age group of 20-30 yrs. Male gender dominates construction workers. Distribution of the workers in different categories observed in this study was bricklayers 40% plumber 20%, painters 20%, stone cutters 6%, cleaners 6%, carpenters 4%, heavy machine operator 2%, truck driver 2%. The total injuries abrasions (56) contributed more. Site of injuries is categorized as upper extremities in 41 workers, lower 19 cases. Most of the injuries are afflicted in the evening hours followed by morning and afternoon. Accidents and the injuries occurred predominantly in the overtime’. Use of PPE was only in 4 cases and other 49 cases observed never used the PPE. 9 workers could get an immediate medical attention where 44 others could get first aid. 11 workers lost their daily wages and 42 others escaped from the loss of salary. The loss of daily wages ranged from 1 day to 5 days and the average of it being of daily wage loss per person.

Conclusions: There is need that the employers address all the potential risk factors at the workplace and educate employees on safe work practices and risk awareness.

Keywords: Occupational Health Hazards; Personal Protective Equipment; Occupational Injuries.