Indian Journal of Forensic Medicine and Pathology

A retrospective analysis of clinical profile of the patients positive for antiphospholipid antibodies (150) that are lupus anticoagulant (83) and anticardiolipin antibodies (57) was carried out from January 2015 to December 2016 in Kasturba Medical College, Manipal. The diagnosis of lupus anticoagulants was based on prolongation of dRVVT, its absence of correction with normal plasma and correction by phospholipids. The presence of antiardiolipin antibodies was based on the technique ELISA (uolmmun). Out of 150 patients positive for antiphospholipid antibodies, the mean age of presentation was 38 years, more commonly seen in the women. The frequency of thrombosis in patients positive for lupus anticoagulants was 55.5% (46), more commonly of venous origin and in the lower limbs. The frequency of patients with lupus anticoagulants presenting with abortion was 26 (31.3%), immune thrombocytopenic purpura, was 80% (67), valvular heart disease was 5 (6%), 35 (42.1%) patients had secondary LA due to autoimmune diseases like SLE, Sjogerns, APS. Anticardiolipin antibodies were present in 57 patients, more common in women. Thrombosis was seen in 28 (49%) patients, more of venous origin and in the lower limbs. Other clinical manifestations were abortions seen in 8 (9%) patients, immune thrombocytopenic purpura seen in 18 (32.5%) patients, valvular heart diseases seen in 8 (14%) of the patients and autoimmune diseases seen in 31.3% of the patients. Patients positive for both lupus anticoagulant and anticardiolipin antibodies (10) had a higher rate of thrombosis around 60%, more commonly of venous origin and had higher associations with autoimmune diseases (80%).

Keywords: Lupus anticoagulants; Anticardiolipin antibodies; SLE.

This paper in a brief overview of the “fingerprint history” in Hungary, from the medieval naive usage through the scientifically sound personal identification till the recent situation. This conference paper was presented in Bratislava, 18th of October, 2018, at the celebration of 100 years old Slovak Police (100 ROKOV ÄŒESKOSLOVENSKEJ ŠTÁTNOSTI, PRÁVNICTVA A BEZPEÄŒNOSTI).

Keywords: Dactiloscopy; Friction ridge; Fingerprint; History; Hungary; Medieval; Habsburg; Gendarmery.

Introduction: Methods used for homicide varies enormously such as use of fire arm, use of Sharp weapons and by other means like Strangulation, smothering, poisoning, burning etc. However, employing multiple methods by a single assailant for killing one victim is rarely reported in standard Indian literature. Case Details: This case report describes the death of a 31 year old married female, who was killed by employing different methods of mechanical asphyxia. Multiple nail scratch abrasions were present on her cheek and neck. Internal examination showed haemorrhagic infiltration in the muscles of neck and contusion of the inner wall of upper respiratory tract. There was also presence of Sub-dural & Sub-arachnoid haemorrhage and multiple bilateral rib fractures, along with blunt trauma injuries on both her thighs. This case highlights the possibility of involvement of a single person only, in the homicide of a healthy adult female by the application of different asphyxial methods together. Conclusion: The autopsy findings helped the autopsy surgeon in reconstructing the sequence of events and the manner in which the act was carried out. All these criminal offences were done by one single assailant who compressed her mouth and nose with the left hand, squeezed her neck with right hand and pressed her thorax with knees. The autopsy findings and probable sequence of events helped the police to establish the crime by suspected assailant. This case emphasizes importance of forensic reconstruction in helping the judiciary.

Keywords: Homicide; Smothering; Manual Strangulation; Traumatic asphyxia; Forensic Reconstruction.

Introduction: Hanging is an important cause of homicidal and suicidal injury in adults, but in adolescents, it is usually accidental, leading to death because of asphyxia as a result of partial or complete hanging. Though rarely observed in children less than 12 years of age, suicide by hanging is a common cause of unnatural death in adolescents, and there are several recent examples. The most common suicidal methods among adolescents are hanging, the use of firearm, jumping from height, drowning and poisoning. Case Details: The authors describe three incidents in a metropolitan city, where an adolescent was brought to hospital after being found hanging in his/her own residence by their parents. In the first case, the victim was a 16 year old girl, who was found hanging from ceiling fan using her dupatta. In the second case, a 14 year old girl allegedly committed suicide by hanging herself after her parents had rebuked him regarding his academic performance. In the third case, a 13 year old boy allegedly hanged himself while trying to emulate the suicidal hanging shown in a crime thriller series. The authors discuss the suicide notes found in these cases and also the post-mortem examination findings in each case. Conclusion: The authors try to analyze factors associated with death due to hanging in adolescents and also identify areas of intervention for preventing such deaths. The predisposing and precipitating factors in these cases observed were love affair related strife, examination related pressure and emulating television stunts. This case series highlights the importance of crime scene reconstruction to evaluate manner of death in obscure cases.

Keywords: Adolescents; Suicide note; Hanging; Accidental; Ligature material; Autopsy.

Background: Exposure to toxic metals in the prenatal period may have a negative impact on birth weight and placental weight (BW/PW). Low birth weight is an important etiological factor for chronic diseases in advanced ages. The levels of essential elements are also important for healthy progress of pregnancy, but abnormal levels may be harmful, such as excessive zinc (Zn) in the body increases BW/PW. Placental tissue directly provides information to clinician about maternal and foetal exposure. Aims: To investigate the impact of cadmium (Cd), lead (Pb) and zinc (Zn) levels on birth weight. Methods: This study involved the measurement of metal levels in 150 participants by inductively coupled plasma mass spectrometry (ICP-MS). Results: There were positive significant correlations with BW/PW ratio and gestational age (r=0.205, p = 0.012), number of births (r=0.182, p = 0.025), birth weight (r=0.505, p<0.001), and birth size (r=0.296, p < 0.001). Maternal blood Cd levels positively correlated with placental weight (r=0.256, p=0.002) and negatively correlated with BW/PW ratio (r=-0.188 p = 0.021). Foetal placenta Pb levels were positively correlated with BW/PW ratio (r=0.198, p=0.015). Differences between maternal and foetal placenta Zn levels were found to be statistically significant (23.90 ± 3.26 and 25.50 ± 4.69, respectively, p < 0.001). Furthermore, Zn maternal levels of healthy births were found to be statistically different (p = 0.014) when compared with pregnancies with curettages and stillbirths. Conclusion: The findings are consistent with the hypothesis that increased Pb and Cd levels in pregnancy results in a low birth weight and these effects cannot be reversed by Zn, the levels of which are positive related with healthy births. Environmental heavy metal exposure in pregnancy should be routinely examined for baby health.

Keywords: Prenatal Care; Stillbirth; Heavy Metals; Zinc supplementation; Birth Weight.

Background: Forensic Medicine and Toxicology is an important subject in medical curriculum as it deals mainly with legal aspects of medical practice and postmortem examination. Aim and objective: To assess Medicolegal knowledge and attitude about postmortem examination among Postgraduate residents. Materials and methods: A cross-sectional, questionnaire based study was conducted from June 2018 to March 2019. The questionnaire based on application of basic and clinical medicolegal knowledge of Forensic medicine and toxicology required during Postmortem Examination (Autopsy) was designed and distributed to Postgraduate residents of Dr. Vitthalrao Vikhe Patil Foundation’s Medical College, Ahmednagar (M.S). Their responses were collected and analyzed statistically for number and percentage. Results: Total 54 Postgraduate residents were participated in study. Postgraduate residents have passed their MBBS from different government and private Medical colleges from Maharashtra state. It was shocking to know that only 7 (13%) resident were having knowledge regarding, who have the authority to decide whether Medicolegal Autopsy should be carried out or not. It was surprising and disgusting that not a single Postgraduate residents have knowledge about which organs should be preserved for routine viscera preservation for chemical analysis. We found that only 3 (5.6%) resident were having knowledge about preservatives required for chemical analysis. Only 12 (22.2%) were aware that, death in police custody essentially requires two postmortem surgeons and videography. Conclusion: This study was an honest attempt to assess knowledge and awareness about Postmortem examination. We observed that a knowledge about Postmortem examination is very poor among the Postgraduate (PG) residents who have passed their MBBS from different government and private Medical colleges from Maharashtra state. Their knowledge should be improved by implementing Competency based curriculum.

Keywords: Postmortem Examination; Autopsy; Medicolegal Knowledge; Forensic Medicine.

Background: Accident in rail track is one of the important segment in death investigation. Among the rail track accidents, death due to decapitation is one of the complex segment. Decapitation or beheading is an imminently fatal entity. There are possibilities that decapitation in rail track might be either accidental or homicidal or suicidal. Materials and Methods: The present cross sectional retrospective study of death due to railway decapitation cases had been carried out in the Dept. of Forensic Medicine at Late Shri Lakhiram Agrawal Memorial Govt. Medical College, Raigarh, Chhattisgarh. In this study autopsy records of all railway track decapitation death cases, which were autopsied at K.G.H. mortuary, Raigarh during the period of 04 years (2015–2019) were included for research purpose. Results and Observations: In our study decapitation injuries were 1.07% of total autopsy and 18.18% of total train accident cases. Males were predominant over females. Victims of age group 21–50 were maximum in number i.e 70.83%. Accidental decapitation was found in most of the cases i.e. 66.67%. Conclusion: Decapitation in railway track fatalities are not uncommon. Decapitation injuries are mostly accidental in nature, but suicidal and homicidal death cases have also been reported, so the pattern of injuries in railway decapitation injuries should be assessed cautiously by autopsy surgeons and final opinion should be formed only after considering all circumstantial evidences

Keywords: Rail track; Death investigation; Decapitation; Accidental; Homicidal; Suicidal.

Background: Due to wide spread uses in clinical sitting of different image modalities for example as ultrasound (US), CT scan (CT), and magnetic resonance image (MRI), lead to discover of many hidden liver lesions in previously un able to diagnosed. Imaging is a critical decision making tool in the diagnosis of liver lesion, because it will discriminate in high degree between malignant and benign in a lot of cases. Material and Methods: A crosssectional study were enrolled 67 patients with solid liver lesion whose admitted to Al-Hilla teaching Hospital between November 2018 and June 2019 with suspicion of solid live r lesion by ultrasound image or CT scan. Results: Sixtyseven patients (85 lesion) were included in this study. These patients aged between 25–70 years with mean age 52 ± 11 years. Study included 36 men (53.7%) and 31 women (46.3%). Male to female ratio 1.1:1. ADC values of 85 solid liver lesions were included in the study, an average of 1.2 lesion/patient. ADC range were 0.42–2.78 (10–3 mm2 /s) and ADC mean 1.2 ± 0.51(10-3 mm2 /s). The mean ADC and range for benign lesion was 1.7 ± 0.11 (0.72–2.78) and for malignant lesion was 0.61 ± 0.09 (0.42–1.68). Which is statistically significant difference between these value (p = 0.001). Conclusion: We concludes that quantitative assessment of solid liver lesion by DWI had best result in differentiate from benign and malignant lesion. The benign liver lesions had high ADC value than malignant lesion.

Keywords: MRI; Malignant; Ultra sound (US); Solid liver.

Aim of the study: The study aims to find the effect of low level laser therapy on the diabetic peripheral neuropathy patients. To evaluate the effect of low level laser therapy on the diabetic peripheral neuropathy patients. Background of the study: Diabetic peripheral neuropathy is the nerve damage caused by chronically high blood sugar and it leads to numbness, loss of sensation and sometimes pain in the feet,legs or hands. Diabetic Peripheral Neuropathy is a result of injury to the vasa nervosum, axons and atrophy of the axons leading to tissue damage. Methodology: Thiswas an experimental study of comparative of pre and post type. 14 patients are selectedselected from the A.C.S College and hospital and they divided into two groups. Group A received low level laser therapy Group B received interferential therapy. Pre and post test measurements taken using Pressure - Mono Filament Method, Vibration – Tuning Fork (128 Hz), Mc GillPain.

Keywords: Diabetic; Laser; Neuropathy.

Society free of crime is unimaginable. The incidence of sexual assault cases as well as reporting of such cases is on the rise after the 2012 Delhi gang rape case. The present study was conducted on 35 survivors of alleged sexual assault with the objectives to reveal their “socio demographic profile & medico legal consequences”. The current study shows in most cases the accused were known to the victim. The victims may or may not have detectable physical injuries. There was great time lapse between the occurrence of the incident and reporting to police. In some cases even in consensual relationship complain of sexual assault comes into play when breach of trust results. This study may help to increase public awareness, which can increase reporting of incidents and to frame appropriate measures to diminish such events in society.

Keywords: Sexual assault; Rape; POCSO act; Survivor.

Introduction/Context: Neoplasms of skin appendages are infrequently encountered in practice. Histopathology is the gold standard investigation for the final diagnosis. Aim of the Study: Approach to the diagnosis of skin adnexal tumors on the basis of histomorphological patterns and cell morphology. Materials and Methods: The present study is a retrospective study done in the department of pathology. All cases are collected from 2004–2018, total of 14 years retrospective study. Inclusion Criteria: All skin biopsy diagnosed as skin adnexal tumors. Exclusion Criteria: Inflammatory condition, inadequate biopsy, Cyst and tumor like lesions. Results: Total 90 cases of skin adnexal tumors were included in the present study. Out of 90 cases, 42 (47%) are male patients and 48 (53%) are female. According to histomorphological pattern, 78% have solid patterns, 17% have solid and cystic, and rest are cystic. As per cell morphology, basaloid cells forms predominant in skin adnexal tumors with 50% of cases. Discussion: In the present study, a new concept of histomorphological pattern is included, which is rarely studied. The histomorphological pattern is classified into solid, solid and cystic and predominant cystic pattern. Solid pattern constitutes 78% of adnexal tumors. It is predominantly seen in eccrine gland tumors like Eccrine spiradenoma, Eccrine hidradenoma. Cystic pattern is seen in 5% of adnexal tumors. It is seen in pilar tumors like pilomatrixom a,trichoepithelioma. Solid and cystic pattern is seen in 17% of adnexal tumors. It is seen in both eccrine, apocrine and pilar tumors. Conclusion: Hence, combining the histomorphological pattern and cellular morphology helps pathologist to diagnose with ease.

Keywords: Adnexal tumors; Basaloid; Clear cells; Solid pattern.

Background: Forensic Odontology is the study of teeth, in the interest of justice, which deals with proper handling and examination of dental evidence and with the proper evaluation and presentation of dental findings. At times, skull or facial remains only are brought for examination as well as identification in medico legal practice. Aims and Objectives: To establish the relationship of the stature of person with odontometric parameters like Inter Canine width and Inter Premolar width of maxillary arch as well to obtain a linear regression formula for stature estimation. Study Design: Cross Sectional Study. Place of Study: Study was conducted in the department of Forensic Medicine, Government Medical College Mahbubnagar State Telangana. Materials and Methods: The present study consists of a cross-sectional sample of 192 subjects (96 males and 96 females) aged from 19 to 26 years. Stature was measured using the stadio-meter, Maxillary Intercanine distance was measured as horizontal distance between the cusps tips of maxillary right canine to the cusp tip of left canine. Maxillary Interpremolar distance was measured as the horizontal distance between the buccal cusp tips of maxillary first premolar from right side to maxillary first premolar from left side. Observation and Discussion: Regression equation of Male stature on IC Length Stature = 100.758 + 1.8286* IC Length, Regression equation of Male stature on IP Length. Stature = 128.2966 + 1.0063* IP Length, Stature is dependent on IC Length & IP Length. Stature = 85.088 + 1.6186* IC Length +0.5702* IP Length the Regression equation of Male stature on IC length and IP length is significant with p value of 0.000088. Regression equation of Female stature on IC Length, Stature = 37.4967 + 3.3692* IC Length, Regression equation of Female stature on IP Length. Stature = 99.5668 + 1.4598* IP Length, Regression equation of Female stature on IC Length and IP Length, Stature = 29.5967 + 3.1706* IC Length + 0.3847* IP Length. Conclusion: It can be concluded that Intercanine and Interpremolar distance has a positive correlation and can be used successfully to estimate stature of the individual.

Keywords: Forensic Odontology; Stature estimation; Regression equation.

Thermal burns and related injuries are a major cause of death and disability affecting the entire world and more so to the developing countries like India. All the cases were analysed to find out different epidemiological factors, precipitating factors, circumstances, manner and cause of such deaths in southern region of the state. Majority of the victims (66.89%) were females and belonged to the age group of 11–40 years (77%). Majority of the victims (67.54%) were married, among which 57.36% deaths occurred within 7 years of marriage. 78.81% victims were from rural area. Maximum (82.11%) incidents took place in indoor between 6 PM and 9 PM (25.16%). Most of the cases were due to flame (91.39%) and bursting of kerosene pressure stove (19.21%) which was the most common source of fire. Extremities were involved in 98.57% cases. In 36.42% cases > 90% total body surface area is involved. Most of the victim (65.56%) died within 1 week when > 50% of TBSA is involved. Septicaemia was the leading cause of death (35.76%). Septicemia (27.15%) and Neurogenic shock (27.8%) were major contributors when > 50% TBSA involved. Maximum numbers of deaths (67.54%) were accidental in nature. > 90% of TBSA is burnt found in 48.18% of suicide cases and in 68.18% of homicide cases. Nearly one-fourth (24.44%) of dowry death cases were due to burns.

Keywords: Thermal burns; Flame; Kerosene; Septicaemia; Accidental; Dowry deaths.

World becomes more digitally sophisticated with the present technological environment. Being a part of e-world, we depend upon internet for various purposes. Earlier days, internet was used for research purpose and communication purposes alone. Today, it got extension into the fields like e-business, e-commerce, e-governance and social networking. The increased reliance on cyber space has paved way for a rapid growth in cybercrimes. As the cybercrime rate is day by day, the need for cyber awareness, laws and its applications gather great momentum. This paper tries to find out awareness of Information Technology among the youth of medical undergraduates in Pune. The paper is entitled as “Awareness about Cybercrime among medical undergraduates”. Researchers also investigate youth’s awareness on various sections, familiarity with cybercrimes, cybercrimes offenders and victimized youth. The study found that youth of Pune have a basic level of understanding on Information Technology.

Keywords: Cyberspace; Cybercrime; Cyberattacks; Cyber Law; Information Technology.

Introduction: Acute myocardial infarction is a most common cause of sudden death. Microscopic evidence of infarction is seen in H & E stained section only if person survived for a minimum period of 6 hours after fatal ischemic attack. So for visualisation of infarct of lesser age TTC test can be used. It is a gross staining procedure which can reveal infarct of within 5–6 hrs. age Aim of this study to incorporate this test in study protocol of sudden cardiac death with aim of visualising infarct rather than giving indirect evidence. Objective: To study usefulness of TTC stain as indicator of early myocardial infarction in Autopsy cases. Materials and Methods: The present study was conducted in MGM Medical College Indore on 210 Post-mortem autopsy cases of death due to suspected myocardial infarction. Heart obtained from autopsy cases subjected to gross examination of all three coronary vessels. After cleaning heart, complete transverse slices of ventricular myocardium subjected to TTC macro test. Knife cut slice is dipped in 1% solution of TTC for 20–30 minute. Result: Out of 210 cases brought for post-mortem examination with history of suspected cardiac attack on which TTC stain applied over heart 60 cases were found to show TTC staining reaction. In these cases, it was infracted area show pale to pink and normal areas as bright red. Discussion: Due to the absence of gross and microscopic changes before 6–8 hrs. of post MI survival time, there was a majar hurdle in estabilishing the cause of death by light microscopy in cases of early death due to myocardial infarction. Since biochemical alteration occur following injury to any tissue form pathological changes. After myocardial infarction due to leakage of multiple dehydrogenases enzymes infarcted area did not react with TTC and remain pale and normal myocardial enzyme react with TTC and form Formazone which was bold colour.

Keywords: Sudden cardiac death; Myocardial infarction; TTC Macro test.

Review of 28 research articles on the cerebrospinal fluid levels of neurotransmitter metabolites involving 1942 psychiatric patients found a strong evidence of involvement of serotonin system in suicidal behavior. All the individuals who attempted suicide, especially those using violent methods, had lower levels of CSF 5-hydroxyindoleacetic acid (5-HIAA) as compared to those in the controls. The Meta-analysis attempts to draw more reliable conclusion than did each individual study alone.

Keywords: Cerebrospinal fluid; Neurotransmitter metabolites; 5-HIAA.

Background: Myocardial Infarction is the irreversible necrosis of the heart muscle secondary to prolonged ischemia. The incidence of coronary heart disease has markedly increased in India over the past few years. Objective was to study the histopathological spectrum of myocardial infarction in autopsy specimens that play a major role as cause of death. Aims: To study histomorphological changes in myocardial infarction, to determine its age-sex distribution, etiology & complications. Materials and Methods: This work is a retrospective study of ovarian germ cell tumors carried out in department of pathology at tertiary healthcare center. All cases of germ cell tumors during the period from August 2017 to July 2018 were retrieved from the record files and analyzed. The tissues were routinely fixed with 10% formal in, and the slides were stained with hematoxylin and eosin stain and also with special stains whenever required. Results: Commonest age group was 40–49 years with significant number of cases below 30 years of age. Males are more commonly affected than females. Coronary atherosclerosis was most common etiology. Left anterior descending artery causing anterior wall MI was most common morphological finding. Ventricular aneurysm is the most common complication. Conclusion: Myocardial infarction due to atherosclerosis is the commonest finding in death cases subjected to medico legal autopsies.

Keywords: Myocardial Infarction; Coronary Atherosclerosis; Autopsy.

Introduction: Head injury is a leading public health problem causing loss of life and limb particularly among young population throughout the world and our country is not an exception to this. Now-a-days, the term “head injury” has been replaced by the new term “traumatic brain injury (TBI).” The incidence of head injury is rising day by day worldwide because of inadequate traffic education, increased mechanization, and less implementation of road safety rules. Materials and Methods: The present study was undertaken on fatal head injury cases of road traffic accidents autopsied at Al-Ameen Medical College and District Hospital, Bijapur. The aim of this study was to describe in detail all the autopsy findings in head injury due to RTA. Results: Two-wheelers was the most commonly involved vehicle 114 (63.4%) cases. Next in the order was Pedestrians 47 (26.2%). In 54.9% victims facial injury was seen. Abrasion was seen in 61 (33.9%) victims (Isolated or in combination with other injures). In majority of the victims, contusion of the scalp was seen -137 (76.1%) (Isolated or in combination with other injures). Laceration was seen in 24 (13.3%) victims. In this study 166 (92.2%) had skull fracture. Fracture of vault and base together was seen in 121 (67.2%) Fracture of base alone was seen in 31 (17.2%) and in combination with vault constitute 152 (84.4%). In majority of victim comminuted fracture was seen 112 (70.0%). Conclusion: From this study it is definite that head is one of the most accessible, vital and vulnerable part of the body in road traffic accidents and so good things to avoid accident or to protect from accident, wear helmet and avoid alcohol during driving. Following road safety rules is atmost important to avoid accidents and head injury related to accident.

Keywords: Head Injury; Road Traffic Accident; PM Examination; Fracture of Skull.