Indian Journal of Forensic Medicine and Pathology

Background: Trauma is a leading cause of death in South Africa. Penetrating injuries are the cause of a high number of these traumatic deaths.
Objective: To study the incidence of deaths related top enetrating injury in the Mthatha region of South Africa.
Method: A record review was undertaken of all medico-legal autopsies performed from 1996 to 2015 at Mthatha Forensic Pathology Laboratory.
Results: Between 1996 and 2015 autopsies were performed on 22952 victims of unnatural death. Of these, 8 368 (36.45%) were killed by penetrating injuries. Anaverage of 62 deaths per 100 000 of the population were caused per year by penetrating trauma. The ratio between males and females affected was 6.7:1 in this study. Most victims of penetrating injuries (37.38%) were young people between the ages of 21 and 30.
Conclusion: The high incidence of death caused b ypenetrating injuryin the Transkei subregion of South Africa (1996–2015) indicates that the situation needs urgent intervention to save lives.

Adenomyoepithelial adenosis of breast is a very rare type of adenosis. The proliferation of epithelial and myoepithelial cells of breast together can result in spectrum of lesions ranging from Adenomyoepithelioma, adenomyoepithelial adenosis and adenomyo epithelial carcinoma. Adenomyoepithelial adenosis can transform into adenocarcinoma of breast and myoepithelial carcinoma. The diagnosis, differentiation and follow up is mandatory with wide local excision of the lesion with tumour free margins as it can recur, become malignant and metastasise rarely with inadequate excision. Here we report a case of adenomyoepithelial
adenosis of the breast in a 30 years old female.
Keywords: Breast; Adenomyoepithelioma; Adenomyoepithelial adenosis; Malignant transformation.

Drowning is a type of violent asphyxial death. Deaths due to drowning are usually suicidal and accidental in manner, but homicidal drowning is not uncommon. But it is very difficult for autopsy surgeon to give cause of death when deceased found dead in water with ligature
mark on the neck and other injuries on the body. A dead body of an unknown male, aged around 35–40 years was brought to mortuary of BLDE hospital Vijaypur for medico-legal post mortem examination with alleged history of accidental drowning. The case was registered u/s 174(C) CrPc. Post mortem examination revealed cause of death as head injury sustained by blunt trauma. The ligature mark present on the neck was opined as postmortem in nature. The viscera preserved revealed alcohol. Manner of death was opined as homicidal in nature.
Keywords; Drowning; Ligature mark; Postmortem examination; Homicidal.
 

Background: Man has been trying to have safe environment from time immemorial. Most of his time he is leading in the house because of availability of better comforts compared to his occupational environment. If the domestic environment is not safe he will be prone to
various types of accidents. The same domestic conditions are not suitable to all the age groups. Global domestic accidents are in the increasing trend and one of the important causes of higher
mortality. For prevention of domestic accidents, one should know the reasons for accidents. The present study is to know causes of domestic accidents in different age groups.
Materials and Methods: The present study is a longitudinal study conducted from 2004 to 2007 in Forensic Department of Gandhi Medical College. This is made on the dead bodies subjected
to postpartum examinations in the mortuary. A sample size of 100 subjects was taken through simple random method from reported cases due to domestic deaths. Data collected by using first information report, hospital records and postmortem examination report. Laboratory
support was obtained in ambiguous postpartum reports. The entry of data a format was designed with pretesting of adequate sample. Data analyzed using excel.
Result and Observations: In the present study 100 subjects were taken. Among the study subjects 59% are males and 41 females. 41% of domestic accidents are in children. Significant deaths are from illiterate and from low income groups. Most of the deaths reported from day wage earners and from manual labors. Injuries due to falls, burns and poisoning are the major causes observed in the present study. Three fourth of deaths occurred during day time. In old people deaths occurred in wash rooms due to falling.
Conclusion and Recommendations: Injuries are the leading causes of deaths in all age groups. Injuries, burns, poisoning, drowning, electrocution, poisonous animal bites, and asphyxia are seen as causes of death. Creating awareness on domestic accidents and preventive measures will play an important role.
Keywords: Domestic accidents; Asphyxia, Electrocution, Injuries.

Background and Aims: Breast cancer with morphological classification has limitation with similar clinical and histological features behave differently regarding prognosis and therapy response. Hence the molecular classification has been introduced to predict the clinical
outcome. The aim of this study were to classify breast cancer into various molecular subtypes using surrogate IHC biomarkers such as ER, PR, Her2/neu and to find the correlation of each subtype with clinicopathological features.
Materials and Methods: A total one hundred and twelve cases were enrolled in the study. The surgical specimens were evaluated histopathologycally; Suitable block was subjected for immunostain (ER, PR and Her2/neu). Based on their expression status molecular phenotyping was done.
Statistical Analysis Used: All the data were analysed with chi square test by SPSS Statistics Version 23.0. Armonk, NY: IBM Corp software.
Results: The mean age of the patient was 51.11 ± 12 years. Most common histological type was invasive ductal carcinoma, no special type (84.8%). Tumor size with <5 cm (68%) and left laterality (60%) being the most prevalent. Majority of cases were in Grade II and pT2 category. Molecular subtypes had following distribution: Basal like and luminal B were accounted 30% each, while luminal A and Her2/neu enriched were 20% each respectively. There was an association between tumour grade with molecular subtypes and ER, PR receptor expression status with significant p-value.
Conclusions: Incorporation of molecular subtyping into traditional histopathological reporting help in better therapeutic management and increases prognostic accuracy. In the current study Basal like presented in advanced stage of their disease.
Keywords: Invasive ductal carcinoma; Luminal subtypes; Prognostic markers.

Background: Head and neck swellings are the commonest clinical findings affecting all the age groups. FNAC is of great value in early diagnosis and differentiation of wide plethora of infective, benign and malignant lesions, in head and neck region. Prior cytodiagnosis by FNAC helps in delineating the heterogenous lesions occurring in head and neck region which serves as an aid in the evaluation and planning of necessary management.
Objectives of the study: To study the cytomorphological features and classify various head & neck lesions. To evaluate the role of FNAC in head and neck lesions. To study diagnostic accuracy of FNAC by histopathological correlation wherever available.
Materials and Methods: A prospective study was conducted from January 2016 to December 2018. FNA was performed on 1568 cases of head and neck lesions and cytomorphological features were studied. These cytomorphological features were correlated with concomitted
histopathologic diagnosis, wherever available. Data analysis was done by Statistical Package for the Social Sciences software version 22.0 and presented in terms of proportions or percentage. Chi-square test was used to see the association between the different variables. A p-value of < 0.05 was considered as significant.
Results: There were 1568 FNAC cases enrolled, out of which lymph node lesions (n = 703) were the most commonest lesions followed by thyroid gland, miscellaneous group and salivary gland. Reactive hyperplasia of lymph nodes, nodular goiter, epidermal cyst and pleomorphic adenoma were the predominant diagnoses of lymphnodes, thyroid gland, miscellaneous group and salivary gland respectively. Histopathological correlation was available in 348 cases and showed sensitivity of 80.76%, specificity of 100%, positive predictive value of 100% and negative predictive value of 98.4%. The diagnostic accuracy of FNAC was 98.55%. The association between FNAC diagnoses and histopathological diagnoses were considered to be statistically significant.
Conclusion: FNAC is a valuable preliminary diagnostic tool for assessing head and neck lesions and serves as a guide for diagnosis, therapeutic and better management of various cases.
Keywords: Fine needle aspiration cytology; Histopathology; Lymph node; Thyroid; Salivary
gland.
 

Knowledge of profile of poisoning of a particular area and of particular time period is very important as it will help the health providers and policy-makers to plan & equip accordingly. Demographic profile of the patients and type of poisons consumed depends upon the
availability of substances locally, their socioeconomic and cultural backgrounds. The present study was conducted at Annapoorna Medical College and Hospital, Salem, Tamilnadu in the year 2019. Data regarding age, sex, religion, occupation, locality (urban/rural), marital status & type of poison was collected in Pre-structured Proforma from two 3 yrs periods, 2007–2009 and 2016–2018. The variables from the two periods were compared to find out whether there were any changes. In the present study, the sex ratio, F:M changed from 1:1.6 to 1:1, there was increase in number of female cases in the later phase. With respect to age, there was almost doubling in number of cases in the age group of 11–20 yrs, from 26 cases (17.3%) to 54 cases
(31.8%). Poisoning due to insecticides had decreased significantly in the later phase, from 99 cases (66.7%) to 43 cases (25.3%), whereas, there was increase in poisoning due to herbicides from 9 cases (6%) to 37 cases (21.8%), poisoning due to rat killers increased from 17 cases
(11.33%) to 42 cases (24%) and household poisons from 3 cases (2%) to 13 cases (7.6%).
Keywords: Acute poisoning; Trends; Poisoning agents; Salem.

Introduction: Skull is more represented and reported to forensic experts for the identification of a person. Stature is an important biological profile to help to confirm the absolute identification
of a person. The judicial authority still consider stature estimation to confirm the identity. Even though many studies are available from the long bones, the challenge arises when long bones are not available and the formulae derived from these were limited applicable to fragmentary
skeletal remain. Hence, we have undertaken the study, for the estimation of stature from the length of cranial sutures.
Methodology: The study conducted at the tertiary health care institute in South India. This is a prospective observational study and includes 210 cases out of 229 autopsy cases conducted from December 2016 to December 2018. Out of 210 cases males were 160 (76.19%) and females were 50 (23.81%).
Result: The age of cases was ranging from 21 years to 60 years and their mean stature was 162.953 cm. The correlation coefficient (Pearson’s correlation, R) of total samples for coronal suture length (CSL) and sagittal suture length (SSL) were 0.326 and 0.308 respectively with the stature of deceased (STAD). The results showed, the cranial sutures are weakly correlated with stature in males and the linear regression equation could not be derived for males. The coronal
suture showed the moderate correlation with stature in females (R = 0.300) and the regression equation derived. The coronal and sagittal sutures showed a moderate correlation with stature in total samples and regression equations derived.
Conclusion: The formulae derived are limited to the South Indian population and applicable only when the sex is not identifiable or other long bones are not available. This study was helpful when the skull, head, and vault with cranial suture were available as a fragmentary bone.
Keywords: Coronal suture; Cranial suture; Linear regression; Sagittal suture; Stature.

Introduction: The role of umbilical cord abnormalities has seldom received attention as a cause of intrauterine fetal demise (IUFD). Umbilical cord anomalies are of various types ranging from clinically inconsequential anomalies to those which can result in fetal demise. There can be numerical abnormalities or non-numerical abnormalities or both within the same cord. In this study, we attempted to focus on the abnormalities of the umbilical cord.

Aim of the study: To study the various types of abnormalities in umbilical cords in fetal autopsy specimens.
Materials and Methods: This was a prospective study done in the department of Pathology at Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, India, over a period of six years. A total of 83 fetal autopsy specimens were received and studied grossly and microscopically. Autopsies were performed as per standard protocol and included complete anthropometry, external examination, gross and microscopic evaluation of different organs and placenta. Both numerical and non-numerical abnormalities were recorded.
Observations and Results: There were total 83 fetal autopsy specimens with umbilical cords. Primigravida accounted for 53% cases. MTP accounted for 45.7% cases and 54.2% cases were intrauterine deaths. Numerical abnormality of umbilical cord vessels was seen in 16.8% cases and all had single or multiple developmental anomalies. There were 20.4% cases of cord having normal or abnormal number of vessels along with additional other abnormalities. There were 18% cases with numerically normal vessels but with other abnormalities. The commonest numerical abnormality was of two vessels; single umbilical artery and single vein. Hypercoiling of cord and stenosis of cord were the common non-numerical abnormalities.
Conclusion: Ultrasound examination is recommended in all antenatal cases and definite guidelines are required for reporting cord abnormalities on ultrasound. In cases of MTP and/or IUD, a complete autopsy study should be done to detect cord anomalies. Irrespective of pregnancy outcome, examination of all umbilical cords from the labour room or operation theater will be helpful in determining whether further evaluation of the neonates is required or not.
Key Words: Cord abnormalities; Cord accidents; Fetal autopsy; Ultrasound of umbilical
cords.

Aim: To establish the uniqueness of lip prints for personal identification & to find the reference of the technique in family inheritance.
Objective: Use & reliability of lip prints in personal identification and family inheritance.
Hypothesis: Not applicable observational study.
Material and Method: The research will be conducted on around 100 students (50 males and 50 females) in Dr. Vitthalrao Vikhe Patil Foundation’s medical college. The people with congenital lesions, lip surgery or hypersensitivity to lipsticks will be excluded. The method of making lip prints will be noninvasive using simple materials like dark colored lipsticks, cellotapes and a magnifying glass.
Result: The uniqueness of lip prints as personal identification tool is proved by statistically analysing the data obtained from all the lip types some evidences of family inheritance can also be proven.
Conclusion: The inference of the study is lip prints are unique and permanent for an individual. Also lip prints have different patterns based on the grooves. Hence Cheiloscopy can be deterministic tool in personal identification
Keywords: Cheilosocpy; Identity; Crime.

Context: Renal diseases are responsible for a great deal of morbidity and mortality. The autopsy study throws immense light on pathogenesis of disease, reveals hazardous effects of violence on various organs and lastly often reveals the cause of death.
Aims: To study the histomorphological spectrum of renal lesions in autopsies and an attempt is made to establish the cause of death.
Design: Observational type of study.
Materials and Methods: A prospective study was conducted from July 2016 to June 2018 in the department of pathology. A total of 210 kidneys of adult medico legal autopsies performed during the period were included in our study. The stained microscopic sections were examined by two histopathologists independently.
Statistical Analysis: Descriptive analysis using IBM SPSS Statistics for Windows, Version 22.0.
Results: The age ranged from 4 to 80 years. Majority of the cases were in the age group of 21–30 years with a mean age of 33.40 years and the M:F ratio was 1.8:1. Out of 210 cases, 103 cases (49.1%) showed tubulo-interstitial and vascular lesions, 92 cases (43.81%) showed near
normal histology of kidney and 15 cases (7.1%) showed glomerular lesions.
Conclusions: The tubulo-interstitial lesions were more common than glomerular lesions in medicolegal autopsies. The incidental finding in this study highlights the importance of gross and microscopy examination of each organ in detail from each autopsy irrespective of the cause of death.
Keywords: Autopsy; Histomorphology; Renal lesions.

Road traffic accidents are one of the major causes of morbidity & mortality especially in developing countries including India. Craniocerebral injuries are the most common injuries found in fatal road traffic accidents. The objective of our study was to analyze the pattern
of craniocerebral injuries in these types of fatal accidents. The study was conducted at the Department of Forensic Medicine, Government Medical College, Kota during January 2017 to December 2018. During this period 290 victims of fatal road traffic accident were autopsied.
In the present study the male ratio was more compared to female. Most of the victims in the present study belonged to the age group of 21 to 30 years. Mechanized two wheelers were the commonest off ending vehicle. Most of the death occurred in the winter season. Most common
intracranial hemorrhage was Subdural hemorrhage with combination and fracture of vault was the commonest fracture found.
Keywords: Accident; Craniocerebral injuries; Intracranial Hemorrhage.

Background: Ligamentum flavum (LF) when thickens can contribute to spinal canal stenosis and nerve roots compression.
Objective: To Assess the relationship of Ligamentum flavum with age, sex and side
Patients and Method: This was a cross-sectional study conducted at MRI unit in AlHilla teaching hospital. Included 60 patients aged 20–80 years with low back pain and/or radiculopathy. Patients with a history of previous lumbar surgery or radiotherapy, congenital anomalies, scoliosis, spondylolisthesis, cardiac pacemakers, aneurysms, clips and metallic implants and joint replacements were excluded.
Results: The mean LF thickness at left side was 3.50 ± 0.6 mm in males and 3.72 ± 0.69 mm in females. In right side the values were not much different where the mean LF thickness in males and females was 3.30 ± 0.64 and 3.52 ± 0.66, respectively. Female had thicker LF than male but the difference did not reach the statistical significance.
It had been found that the mean LF thickness in both sides increased with advancing age, (p < 0.05). According to the level, it had been significantly found that in both sides the LF was thicker at the L4–L5 level than other two levels, and no statistically significant differences had been found between both sides when compared at each level
Conclusion: Advanced age and female gender were found to be independently raise the risk of LF thickness, The study suggest that LF measurement should be interpreted in conjunction with patients’ variables specially age and gender.
Keywords: Ligamentum flavum (LF); Magnetic Resonance Imaging (MRI).

Background: Personal Identification with the help of radiographic examination of Skull is a potentially useful method in cases where fragments of skull persist with no likelihood of identification. Frontal sinus Nasal bone, piriform aperture and Nasal septum show racial and
geographical variations and their shape can be used as one of the classic indicators of sexual dimorphism. The purpose of this study was to evaluate and classify the variations in the pattern of frontal sinus and nasal septum, the dimensions, size and the shape of the piriform aperture and their sexual dimorphism.
Material and methods: Postero-anterior cephalometric radiograph of 180 healthy individuals aged 20-70 years were traced for the morphology of frontal sinus and piriform aperture, pattern of nasal bone, nasal septum pattern using various classification systems.
Results: The most predominant pattern of frontal sinus seen in the study sample was the left dominant asymmetry 56.1% and the least predominant was symmetry 3.9%. The mean height of frontal sinus on right side in males was greater than in females and was statistically significant. The most predominant pattern of nasal bone was Type A (56.7%) and least predominant was Type C 2.8%. The most predominant pattern of nasal septum in males and females was found
to be straight 62.2% and 63.3% respectively and rare type 1.1%. The proportions of pattern of nasal septum were not statistically different among males and females. The mean height and mean area of the piriform aperture was found to be greater in males as compared to females which was statistically significant (p < 0.05).
Conclusion: The frontal sinus, nasal bone, nasal septum and piriform aperture can be useful aids for forensic identification.
Keywords: Frontal sinus; Nasal bone; Nasal septum; Piroform aperture, Forensic; Posteroanterior cephalometric radiograph.

Background: Stature estimation plays a crucial role in medico legal cases in identification of unknown bodies and in skeletal remains. A strong relationship exists between stature and various dimensions of different body parts for estimation of stature in forensic investigation.
Aim and objective: To estimate stature from per-cutaneous Tibial length measurements in people of Nellore district State Andhra Pradesh South India.
Type of Study: Descriptive cross sectional study with analytical and comparative components.
Place of Study: Department of forensic medicine and Toxicology Narayana Medical College, Nellore District of Andhra Pradesh State.
Material and Method: Stature: using the stadio-meter, the subject was made to stand barefoot in the standard standing position on its baseboard. For Tibial Length, Top point was the medial most point on the upper border of medial condyle of tibia and the lower point was tip of medial malleolus of the tibia, distance between these two points was measured by using spreading caliper to determine Per-cutaneous Tibial Length.
Observation and Discussion: The regression formulae derived for male was Height (y) = 87.38 + 1.92 * PCTL (x) and for females it was Height (y) = 62.93 + 2.45 * PCTL (x). Our study regression equations provided greater reliability in estimated stature and we derived regression formula. Kaore et al. reported in his study and commented that the regression formulae are more dependable than multiplication factor for stature estimation.
Conclusion: We conclude that the regression equations presented here can be used to estimate ante-mortem stature, with reasonable accuracy, of unknown mutilated or dismembered human lower limb remains from per-cutaneous lengths of tibia and fibula in medico-legal cases, particularly from Nellore district of State Andhra Pradesh.
Keywords: Per-cutaneous Tibial Length; Regression; Stature.

Background: Stature estimation provides relevant data for personal identi cation, in the events of murders, accidents or natural disasters, which results in highly decomposed, fragmentary and mutilated human remains.
Aim and Objective: To determine body stature of both sexes using arm span and find the relationship between stature and arm span.
Place of Study: The present study was carried out in the department of Forensic Medicine and Toxicology at Kamineni Institute of Medical Sciences and Research Center, Nalgonda District of State Telangana.
Type of Study: Descriptive cross sectional study with analytical and comparative components
Material and Method: Arm span length was measured using a calibrated steel tape to the nearest millimeter in bare feet on a level flat surface with peer backs and buttocks, heel against the wall giving the support.
Observation and Discussion: observation among study subjects n = 150, where 85 (56.7%) were males and 65 (43.3%) were girls. Height and arm span in boys (164.7 ± 10.92 cm and 162.38 ± 8.02 cm respectively) was significantly (p < 0.000) more than girls (157.1 ± 9.1 cm and 156.8 ± 6.5 cm respectively). Height to Arm span ration HAR of boys and girls according to age of the subjects are shown and overall mean Height to Arm span ration was 0.9961 ± 0.0183. In the present study the correlation between stature and arm span showed a strong positive correlation (r = 0.8651, p < 0.000). This result is an support to the widely accepted positive correlation between height and arm span in adults.
Conclusion: Using regression equation for estimation of stature is more acceptable, and result of this study and regression equations may be considered in clinical practice and in medico legal cases for estimation of stature from arm span in south Indian population of Nalgonda
District of Telangana.
Keywords: Stature; Arm Span; Regression equations.

Background: Forensic Pathology remains a mainstay in diagnosing all forms of fetal death including stillborn and it is an indispensable tool in the process of evaluating the underlying cause of death. Diabetes mellitus (DM) being a common clinical condition with hyperglycemic
state, it has a major impact on the growing fetus during gestation causing several morbidities including still birth. Histopathological evaluation of the systemic organs yields adequate information of the etiopathogenesis for the cause of death thereby aiding clinicians to proceed with further management and counselling to the parents
Methodology: The study was conducted between 2012 to 2020 covering 25 cases. The cases were categorized into 2 groups like Diabetes in Pregnancy (Type 1 & Type 2 DM) and Gestational Diabetes Mellitus (GDM). Complete clinical data including diabetic profile were
documented. Routine fetal autopsy procedure was performed and the major systemic organs involved in metabolism like Liver, kidney, pancreas and lungs were weighed and analyzed for histomorphological changes.
Results: The study analyzed 25 cases which showed 5 cases each in Type 1 & Type 2 DM and 10 cases in GDM. Renal changes in fetuses were prominent in GDM compared to other groups. Histomorphological changes in the form degenerative features in liver, pancreas and lungs
were more in common in GDM
Conclusion: Gestational Diabetes mellitus stays as a rampant condition leading to major cause for still birth compared to Type 1 & 2 DM. It had been evident that GDM is not an homogenous set of disease and a subset of conditions especially pre-existing but left undiagnosed could be a potential risk for growing fetal malformations with subsequent organ failure and stillbirth
Keywords: Fetal autopsy; Diabetes mellitus; Histomorphology; Still birth.

Introduction: Forensic ergonomics plays a vital role in understanding the vital relationship between legal problems and injuries. Core stability has an important role to play for an efficient functioning of both the upper and lower limb along with the task of stabilizing the trunk and
maintaining proper posture, through a coordinated and integrated manner. The inadequacy of the core poses a risk for the development of low back pain and dysfunction as a result of poor ergonomic posture.
The reason has been attributed to an altered neuromuscular balance leading to an imbalance of the endurance of the trunk muscles.
Aim: To study the relation between flexor muscle endurance and non specific low back pain.
Materials and Method: 6 subjects (3 males and 3 females) were selected on the basis of Oswestry disability index (ODI) questionnaire score of the age group of 22–45 years with a non specific  origin of low back pain. The flexor muscle endurance times were noted using the McGill’s flexor endurance test for each of them. A Pearson’s correlation coefficient was then calculated and significance of the testwas determined.
Results: The study revealed a Pearson’s correlation coefficient r = 0.622, and a t-test value p-0.001, implying a significant result.
Conclusion: It can be concluded that there is a moderate correlation between flexor muscle endurance and non specific low back pain with a revelatory result and it can be utilized for clinical use, such as work ergonomics in an efficacious manner.
Keywords: Core stability; Endurance; McGill test; Low back pain; Synergistic movements, Altered coordination; Forensic ergonomics.