Indian Journal of Forensic Medicine and Pathology

The cases of crime against the elderly are on rise across India. Among the various manifestations of intrafamilial violence, parricide-homicide is the most horrific. Though studies of parricide are reported in western countries, only few cases have been reported in the literature in India.The etiology is multifactorial in both the offenders and the elders, with psychiatric disorders being reported as most common cause. We present here a case of homicidal death of an elderly woman by her grandson as a result of long-standing conflict over money or property. Early behavior management of the aggressive offender with an efforts to strengthen and respectfor family relationships would hinder the incidence of such cases.

Keywords: Parricide; Homicide; Elder; Head Injury.
 

Postpartum hypo-pituitarism is also termed as Sheehan’s Syndrome. Heavy bleeding during or after delivery leading to further necrosis of the pituitary gland are all characteristic seen in Sheehan’s Syndrome. It is commonly associated with hypo-volemic shock. The presentation of Sheehan’s Syndrome most commonly include amenorrhoea, hypoglycaemia, hypothyroidism along with agalactorrhea, also psychiatric manifestations like commonly as psychosis are seen though they are not uncommon to be seen. In developed countries owing to advances in services of obstetric care the occurrence of Sheehan’s Syndrome is seen relatively rare and is overall gradually decreasing worldwide. However, it can still be considered as common and relatively frequent seen in underdeveloped and developing countries. The diagnosis of Sheehan’s Syndrome is commonly late as it evolves slowly, reporting of psychoses are quite rarely seen in cases of Sheehan’s Syndrome. Herein in our study we discuss a case of 37 year old woman, diagnosis was psychotic disorder along with Sheehans Syndrome, diagnosed years later, with etiological aspects, follow-ups period and the details treatment with thyroxine, glucocorticoids which has shown a tremendous results with complete remission after attaining euthyroid and eucortisolemic state.

Keywords: Thyroxine; Psychosis; Sheehan’s Syndrome; Post-Partum Hypo-Pituitarism.

Sexual violence is the most common form of violence and is becoming a global problem. The cases registered under sections 376, 366A, 363, 354, 377 IPC and POCSO act are brought for examination for the evidence of signs of sexual intercourse and age estimation. The present study aims to find out the profile of sexual offences at Chamarajanagar, Karnataka and to describe the characteristics of survivors and accused of sexual assault. A standardized proforma specially designed for this purpose was used and filled in each case after detailed interviews. Data entry was made in excel after cleaning and coding it was transferred into SPSS software and the data was analyzed. Total 58 cases brought to hospital included 30 (51.7%) survivors and 28 (48.3%) accused. Maximum number of survivors educated up to school. Unmarried accused were maximum cases. In majority of cases the incident had occurred between evening & mid night time. Majority of the sexual assault cases occurred in the accused house. Majority of the survivors were examined after 48 hours. In majority of cases accused were close friends of the victims. The manner of offence in majority of the rape cases were of consensual type.

Keywords: Sexual Violence; Sexual Assault; Rape; Expert Evidence.
 

Introduction: Granulomatous lesion in the bone marrowis not a common finding and can be attributed to a variety of conditions ranging from infections to malignancies to drugs. Though tuberculosis is the most common etiology, bone marrow granulomas can be associated with a number of infections and other non infective conditions. The incidence of bone marrow granulomas has been increasing over the years due to the increasing surge of HIV infection. Aims: This study basically aims to study the prevalence of bone marrow granulomas, to identify the various causes and to study the pattern of granulomas in different conditions. Materials & Methods: This is a retrospective analysis of 100 cases of bone marrow granulomas conducted in the Clinical Laboratory of Kasturba hospital for a period of four and a half years from January 2009 to May 2013.The clinical details were collected from medical records and bone marrow biopsy slides were retrieved and studied. Results: Out of the 100 cases, 66% cases were diagnosed as tuberculosis. 17% cases were due to other infections like Typhoid fever (5%), Brucellosis (4%), Scrub typhus (2%), Hansen’s disease (1%), Cryptococcosis (2%) and HIV infection itself without any other opportunistic infections (3%). Malignancies accounted for 9% cases, Sarcoidosis (1%) and in 7% cases a definitive diagnosis was not reached. Among the 66 cases of tuberculosis, 40 (60%) cases were immunodeficient due to HIV infection. HIV positive cases predominantly showed single (52%), ill defined granulomas (73%), with caseation necrosis (52%), while HIV negative cases predominantly showed single (54%), small (50%), well defined or ill defined granulomas with plump epithelioid cells (58%) and Langhans giant cells (42%). Conclusion: There can be varied etiology for bone marrow granulomas with tuberculosis being the most common cause.The morphology and pattern of granulomas can aid in the diagnosis of the condition hence study of bone marrow for granulomas should be considered as an important diagnostic tool in such conditions.

Keywords: Bone Marrow; Granuloma; Tuberculosis; HIV; Drugs; Morphology.

Background: Head is the vital part of the body. So any injury to head may be fatal in the form of neurogenic shock, fracture or intracranial haemorrhage which is caused by mostly blunt object and some time it may be due to firearm injury. Aims: To study the epidemiological aspect of fatal head injuries. Material and Method: In this study 150 cases of fatal head injuries 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. Most of them are in the form any form of skull fracture or intracranial haemorrhage. Conclusion: Most of the fatal head injuries are of fracture of the skull followed by any of intracranial haemorrhage which were due to any form of road traffic accident.

Keywords: Neurogenic Shock; Intracranial Haemorrhage; Cranium.
 

Objectives: To detect the salivary stains, in particular, any improvement in the ability to target an area of DNA analysis. To evaluate the efficacy in detection of salivary stains between UV light, fluorescent and Raman spectroscopy. Study Design: Prospective randomised study. Place & Duration of Study: Department of Oral & Maxillofacial Pathology, Sri Rajiv Gandhi College of Dental Sciences & Hospital; Forensic science laboratory, Bangalore Test Centre & Indian institute of Science, Bangalore, Karnataka; between August 2013 to December 2014. Patients & Methods: Dried salivary stain samples from 20 volunteers were collected and exposed to ultraviolet-light spectrophotometer, Fluorescent spectroscopy and Raman spectroscopy. Water was used as a control sample and Tryptophan, to assess the presence of saliva from the collected samples. Results: A total number of 20 volunteers dried salivary stain samples were taken. The absorption spectra of the saliva samples revealed the excited wavelength of 240 to 248 nm coinciding with the excited wavelength of tryptophan in case of ultraviolet spectroscopy; the excited wavelength was 280 to 288 nm coinciding with the excited wavelength of tryptophan with less concentration of saliva in case of fluorescent spectroscopy; and in case of Raman spectroscopy, saliva was not detected instead the diluted content of KCL solution was only noted. Conclusions: Ultraviolet light spectrophotometer and fluorescent spectroscopy are a rapid and non-invasive technique for the detection of dried salivary stain, in which the sensitivity and accuracy is best with the fluorescent spectroscopy.

Keywords: Spectroscopy; Saliva; Forensic Science; Salivary Amylase; Light Source.
 

Background: Burns are a global public health problem, accounting for an estimated 265,000 deaths annually. Most of these happen in low- and middle-income countries and nearly half happen in the WHO South-East Asia region. Burn injuries involve both developing and developed nation. Goldman describes burns as “the silent epidemic”. Material & Methods: A Prospective study was conducted from Jan 2013 to December 2013 in which 87 autopsy cases of burn deaths were taken out of 976 autopsies conducted in the mortuary of Raichur institute of medical sciences, Raichur. Results: The maximum incidences of burn deaths in married females were in 21-30 years age group (40.3%). Majority of the victims were educated below 10th (55.3%). The most common place of death was kitchen (71.3%) and the most common manner of death was accidental (51.8%). Conclusion: Burns represent an extreme stressful experience and are complex devastating conditions. Public awareness should be increased regarding the social problem and importance should be given to education which can be achieved by different medias of mass communication.

Keywords: Burns; Married Women; Manner of Death.
 

Homicide is the most serious crime, as old as civilization and reported as early as in the Bible. The present prospective observational study was conducted at Forensic Medicine department of B J Govt. Medical College on 207 cases of alleged homicides brought for postmortem examination. The incidence of homicidal deaths was 1.76% with male preponderance and male to female victim ratio 3.9:1. Age group 21-30 years (36%) was the most commonly affected age group. Majority cases (55.55%) occurred during night and majority (36.71%) of the deaths occurred in summer season. Most common motive for killing was revenge (31.88%). Blunt injuries were commonest followed by sharp injuries, while hard and blunt weapon (53.14%) was the weapon of choice in majority. Head, neck and face region of body was most commonly affected in (49.4%) cases while
brain (48.47%) was the most common internal organ/structures involved. Head injury (32.85%) was commonest cause of death followed by shock and haemorrhage due to injuries and asphyxial deaths.

Keywords: Homicide; Homicidal Deaths.

Introduction: Over the past 30 years, Beck’s Suicide Intent Scale (SIS) has been the prevailing psychometric scale for assessing suicide intent in suicide attempters. In recent studies showed a positive relationship between SIS scores. Since the proportion of older people in population is rising worldwide, indeed the increase in developing countries like India is even greater than the developed countries. Material & Methods: The present autopsy has been carried out in the Department of Forensic Medicine, Bangalore Medical College and Research Institute, Bangalore. All the cases aged 60 years and above brought to the department for medico-legal autopsy with alleged history of suicide were selected. Detailed information regarding the deceased particulars including suicidal scale I as in, presumptive stressful life events as in and the circumstances of death were collected from the relatives and police. Results: Previous suicidal attempt was present in 11% of the victims. Most had history of bad physical health prior to death in suicide victims. 68% had Family h/o suicide in elderly suicides. 21% of victims had CVS disorder, 12% diabetes. 80% of victims had low suicide intention. Total number of stressful life events experienced by study population was very high- 5.29±1.05 and 5.05±1.04 for males and females respectively. The mean stressful life event score for life time in study population was also high- 357.37±62.62 and 365.53±86.46 in males and females respectively. Conclusions: Total number of stressful life events experienced by study population was very high -5.29±1.05 and 5.05±1.04 for males and females respectively. The mean stressful life event score for life time in study population was also high- 357.37±62.62 and 365.53±86.46 in males and females respectively.

Keywords: Suicide Intent Scale (SIS); Elderly Suicide; Stressful Life Events.

Background: Pattern of unnatural deaths is a reflection of the socio-economic status and mental health of the society. Objective of the study was to determine the pattern and cause of unnatural deaths and to find the association of causes with socio-demographic factors in a rural tertiary care hospital. Material and Methods: Retrospective record based study was conducted from the records of previous 2 years and 342 subjects were finally included. Institutional ethical clearance was obtained prior to the start of the study. Structured proforma was used to collect data related to cause and pattern of unnatural deaths. Data was analysed using SPSS 17 version software. p value <0.05 was considered as statistically significant. Results: Majority 52.04% were in the age group 41 to 60 years, 67.26% of them were females, 67.83% were from rural background and lower socioeconomic status (42.1%). Most common cause of unnatural death was head injury (35.08%), followed by poisoning (21.05%), burns in 13.45%, drowning in 9.94%, Hanging in 8.77% and other in 11.69% Conclusion: Head injury and poisoning were the  most common cause for unnatural deaths and age, sex, locality and socioeconomic status determine the pattern of unnatural deaths.
Keywords: Unnatural Deaths; Retrospective Study; Socio Demographic Factors; Head Injury; Poisoning.
 

Context: Thyroid swelling is a relatively common problem encountered in clinical practice throughout the world. Early detection of thyroid neoplasm is the fundamental basis of thyroid screening. A quest for ease, simple and accurate diagnostic tool that would differentiate between benign and malignant lesion has facilitated fine needle aspiration cytology (FNAC) as the first line tool in the initial thyroid evaluation. Aims: The study was aimed at classifying thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology and to compare the diagnostic efficacy of fine needle aspiration cytology by correlating with gold standard histopathology. Settings and Design: This prospective cross-sectional study was conducted over a period of two years in a tertiary hospital, Kerala. Methods and Material: A total of 710 patients were included in the study. FNAC was performed and Staining was performed with Haematoxylin & Eosin (H&E), Papanicolaou and May-Grünwald Giemsa Stains. Diagnosis was made based on TBSRTC. Excision biopsies were fixed in 10% formalin. Statistical Analysis used: IBM Statistical Package for the Social Sciences Software version 21 was used to perform Pearson Chi-square test and Fischer Exact. Results: In this study 592 (83.4%) cases of non-neoplastic lesions, 111 (15.6%) cases of neoplastic lesions and seven cases were found unsatisfactory for diagnosis. FNAC showed high sensitivity and specificity in diagnosing neoplastic thyroid lesions and it showed high level of significance in diagnosing papillary thyroid carcinoma. Conclusions: FNAC is an excellent diagnostic tool in the management of thyroid lesions since it provides rapid diagnosis with high accuracy rate. 
Keywords: Bethesda System; Neoplasm; Histopathology; Papillary Thyroid Carcinoma.