Indian Journal of Forensic Medicine and Pathology

Background: Traumatic and violent deaths are the most prominent public health problem in
South Africa. The number of such deaths is under-estimated and under-reported in rural and
poor parts of South Africa, where the majority of the population resides.
Objective: To study the incidence of traumatic and/or violent death in the Mthatha region of
South Africa.
Method: A record review was undertaken from 1993 to 2015 of 24 419 medico-legal autopsies
performed at Mthatha Forensic Pathology Laboratory.
Results: Between 1996 and 2015 autopsies were performed on 26972 victims of unnatural
death of these, 18703 (69.3%) followed traumatic deaths. The average traumatic and violent
death rate is 135 per 100000 of the population annually. There has been a steady decline in the
death rate from 156/100000 of the population in 1996 to 123.6/100000 in 2015. Most (32.7%)
victims were between 21 and 30 years old. Males outnumbered females at a ratio of 4:1in
respect of traumatic and violent deaths in this region of Transkei in the study period.
Conclusion: The incidence of traumatic and/or violent deaths in the Transkei sub-region of
South Africa is high. The situation needs urgent intervention to save lives.
Keywords: Trauma; Injury; Wound; Unnatural; Death.
 

Background: Traumatic and violent deaths are the most prominent public health problem in South Africa. The number of such deaths is under-estimated and under-reported in rural and poor parts of South Africa, where the majority of the population resides.   Objective: To study the incidence of traumatic and/or violent death in the Mthatha region of South Africa. Method: A record review was undertaken from 1993 to 2015 of 24 419 medico-legal autopsies performed at Mthatha Forensic Pathology Laboratory. Results: Between 1996 and 2015 autopsies were performed on 26972 victims of unnatural death of these, 18703 (69.3%) followed traumatic deaths. The average traumatic and violent death rate is 135 per 100000 of the population annually. There has been a steady decline in the death rate from 156/100000 of the population in 1996 to 123.6/100000 in 2015. Most (32.7%) victims were between 21 and 30 years old. Males outnumbered females at a ratio of 4:1in respect of traumatic and violent deaths in this region of Transkei in the study period. Conclusion: The incidence of traumatic and/or violent deaths in the Transkei sub-region of South Africa is high. The situation needs urgent intervention to save lives.
Keywords: Trauma; Injury; Wound; Unnatural; Death

Background: Medical education in Indian Colleges is still mostly dependant on traditional
lecture classes along with practical classes for the Undergraduate students. Teaching methods
that enhance student engagement and encourage self directed learning can be effective in
delivering core knowledge and explaining difficult concepts, leading to increased learning.
The present study was conducted to understand the Indian Medical Graduates’ perspective
on different teaching methods practised and different attributes of a good medical teacher,
involved in teaching Forensic Medicine and Toxicology.
Method: This observational, cross-sectional, prospective, questionnaire based study was
done among 240 MBBS students of 5th semester in FMT Department, NRSMCH, Kolkata. The
study tool was a pre-designed, pre-tested and validated questionnaire with twelve questions
about different teaching methods practised in department and also involving attributes of a
medical educator.
Results: 71.3% teachers had good communication skills whereas 89.6% faculties were
approachable and helpful. Students preferred one-to-one interactions, group discussions
and tutorials over normal traditional lectures. Most of the students liked a combination of
blackboard teaching and audio-visual aided teaching over their individual use during lecture
classes. Good communication skill, good sense of humour, thorough knowledge of subject and
politeness emerged as the most important traits of a teacher.
Conclusion: An adaptable, approachable teacher who interacts with the students always
wins their hearts. All future doctors are society’s assets and thus a Forensic Medicine and
Toxicology teacher should be efficient and careful enough to ensure that the students imbibe
basic medicolegal knowledge.
Keywords: Lecture class; One-to-one interaction; Demonstration class; Medical Educator;
Communication skill; Medicolegal knowledge.
 

Cervical spine fracture is commonly reported trauma due to fall in elderly. This articlepresents a case of hyperextension injury of neck in an elder subsequent to slip and fall in an unusual prone position, and stress the importance of complete autopsy examination, death scene photographs and toxicological analysis in such cases.

Keywords: Neck injuries; Spinal injuries; Neck dissection; Accidental fall; Autopsy.
 

To inflict injury upon one’s own genitals is not easy and most of the times it is associated with psychotic disorders. In the absence of any psychiatric disorder the reason could be religious, cultural or suffering from gender identity disorder. Here I present case of married male, aged
35 years suffering from gender identity disorder who has strong belief that it would have been much better for him if he was female. He has dislike for his own genitalia. Sexual conflict with his wife led to genital mutilation by him to remove testes. Great majority of cases does not seek any medical help being from rural background, illiterate and unavailability of medical access at the local places. Psychological counselling and medical assistance at appropriate time would have helped him.

Keywords: Genitals; Gender identity disorder; Mutilation.
 

Acute upper airway obstruction may occur due to swelling of the thyroid gland. In such cases the onset of symptom is gradual as compared to fatal compression of neck and rarely causes sudden death. The authors report a case of death due to acute airway obstruction by complications of thyroid gland enlargement. The patients with a large goiter/ thyroid neck swelling, even asymptomatic, should be counseled about the impending complications by the treating doctor. The authors aim to add to Medical literature that acute airway obstruction due to natural causes may also be a cause of sudden death. Forensic Pathologists should consider this diagnosis in cases of sudden death with signs of asphyxia so as to prevent any misdiagnosis of violent asphyxial deaths.

Keywords: Acute Airway obstruction; Asphyxial deaths; Fatal thyroid enlargement; Adenomatous goiter.
 

Back Ground: Domestic violence is one of the common evils of society and it is a worldwide phenomenon. It is more common in underdeveloped countries. Wide variations in domestic
violence are observed in rural and urban slums. Present study to know in depth the reasons for DV. It is more common in the age group of 12 to 50 years. Objectives: 1. To study various types of domestic violence. 2. To know the nature and periodicity of violence. 3. To understand the triggering points and underlying factors. 4. To compare the results of the study with regional and national statistics.

Methodology: The present study is a longitudinal study conducted in a slum area of Hyderabad, TS from April to September 2018. A pre-designed questionnaire was prepared and tested in a slum area and after necessary correction it was administered to women in the study
area. 100 women included in the study after taking oral/written consent based on educational status. Demographic and socio-economic factors were included in addition to factors pertaining to domestic violence in designing format.

Results: Statistics on 100 women showed 90% of them were from nuclear family and only 10% from joint family lack of elders support was the preliminary cause, 35% did not have any educational qualifications, 60% of the women were depended on their spouses, 55% were unemployed, 60%of the women were harassed by their husband 20% by their father and remaining 10% by their sons, the type of assault was verbal abuse, paranoid behavior, suspicious nature. Frequency was daily in 75% of women, 5% weekly and the triggering factor
being Dowry in 22%, Birth of a girl child in the family 14% and 64 % were suffering harassment from paranoid husbands.90% of them had suffered from the social stigma of revealing to their close people and were silent sufferers.

Keywords: Domestic violence; Trigger points.
 

A retrospective study of post mortem examinations conducted between years 2014–2018 at Rural Tertiary Care Hospital, Ambajogai, Dist. Beed was carried out to know the incidence of asphyxial deaths with respect to age, sex, month, diurnal variations and type of Asphyxial
death. Out of total 2168 autopsies conducted during that period, 350 deaths were asphyxial deaths, which constitute 16.14% deaths. Most commonly involved age group was 21–30 years (92 cases i.e. 26.28%), followed by 31–40 years (69 cases i.e. 19.71%). The incidence of asphyxial death was more in males than females with the ratio of 2.09:1. Maximum cases were noted in the month of January (44 cases i.e. 12.57%), followed by May (35 cases i.e. 10.00%). Maximum deaths were in the morning hours (131 cases i.e. 37.42%), followed by afternoon (113 cases i.e. 32.28%) cases. In this study, we found that among all asphyxial deaths, Hanging was most common (228 cases i.e. 65.14%) followed by drowning (89 cases i.e. 25.42%) and strangulation
(11 cases i.e. 03.14%) respectively.

Keywords: Mode of death; Asphyxia; Hanging; Drowning.
 

Background: In Legal investigations like in crimes resulting in fatalities or when unknown ,skeletal human remains are being recovered by investigating agencies, it is the forensic pathologist who is often asked to give his opinion regarding personal identification for the deceased. Stature is considered to be one of the most valuable parameter to determine the physical identity of an individual.

Aim and objective: To find out correlation between Head length and Head breadth with stature of the individual and to devise a linear regression equation to determine stature from Head length and Head Breadth.

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: Present study comprised of total 300 young and healthy subjects in the age range 18–25 years, of Nellore region of south India. The subjects were studied for the following parameters: Stature, maximum head length and head breadth.. The measurements
were tabulated and statistically analyzed.

Observation and Discussion: The Mean height of males was 166.3±5.92 and that of females is154.9±5.53. Mean Head Length and Head Breath in males are 18.62±0.55, 13.62±0.52 and that
in females are 17.77±0.44, 13.22±0.27. The Pearson correlation of stature with head length andhead breadth in male is r = 0.315, r = 0.227 which is significant with p-value is 0.00043, 0.0026
and that in females are r = 0.276, 0.148 is significant with p-value is 0.00032, 0.03536 and in combined (Male and Female) r = 0.619, r = 0.431 is significant with p-value is 0.000001, 0.000001.
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 remains from Head Length and Head Breadth in medico-legal cases, particularly from Nellore district of State Andhra Pradesh.

Keywords: Head length; Head Breadth; Regression equation; Stature.
 

Background: The presence of a spinal lesion whether symptomatic or not, presents adiagnostic challenge and is always a cause for concern. In Indian population common spinal pathologies include tuberculosis and malignancy. We aim to study the spectrum of vertebral and paravertebral lesions, analyse with regard to age, sex, site, pathological diagnosis and
evaluate diagnostic utility of percutaneous image guided biopsy.

Methods: This was an Institutional Ethics Board approved retrospective study conducted in the Department of Pathology on vertebral and paravertebral biopsy specimens received from January 2014 to September 2019.

Results: A total of 152 cases of vertebral and paravertebral lesions were reviewed with age range of 2–80 years and majority of 42 cases among 61–70 years age group. Male predominance with male to female ratio of 1.62:1 was noted. Out of 152 cases, a majority of 62 cases were in lumbar region followed by 59 cases in thoracic region. Paravertebral involvement was noted in 24 cases. Among the 152 cases, 55 cases (36.2%) were non-neoplastic lesions, 84 cases (55.3%) were neoplastic. Among neoplastic lesions secondary deposits (60%) were common followed by primary malignancy (27%) and benign tumours (13%). Most common among, metastasis was Adenocarcinoma; primary malignancy was multiple myeloma; and benign tumour wasschwannoma. Tuberculosis was seen in 17 cases and majority involving the thoracic segments.

Conclusion: CT guided biopsy is a valuable tool for evaluation of vertebral and paravertebral lesions. Metastatic lesions were common followed by multiple myeloma and schwanoma. Tuberculosis was second common among non neoplastic lesions.
 

Keywords: Image guided biopsy; Vertebral lesions.
 

Background: Autopsy is crucial to identify asymptomatic and often undiagnosed lesions.Renal diseases have high morbidity and mortality and the information provided by morphological evaluation of renal autopsy specimens is crucial to prevent renal disease that tends to be asymptomatic. Hence this study was undertaken to analyze the morphological features of kidney lesions in autopsy specimens.

Materials and methods: The study was conducted on renal specimens from routine autopsies, over duration of five years, at a south Indian tertiary health care center. The specimens were evaluated morphologically and histological sections were interpreted and classified into glomerular lesions, nonglomerular lesions and normal findings.

Results: A total of 570 specimens from 285 autopsies, with mean age of 38.8 years and male: female ratio of 3.4:1, were included in the study. The major cause of death was cardiorespiratory failure (36.4%). Normal histology was identified in 63.5% of the kidneys. Tubulointerstitial,
glomerular, cystic, vascular and neoplastic lesions were identified in 22.8%, 5.6%, 3.9%, 3.5% and 0.4% of the kidneys, respectively.
Conclusion: The frequency of renal lesions encountered in autopsies was 36.5%. Nonglomerular lesions outnumbered gomerular lesions with male predominance. The commonest tubulointerstitial lesion was acute tubular necrosis. Chronic glomerulonephritis, benign nephrosclerosis and simple renal cysts were the major glomerular, vascular and cystic
lesions identified, respectively. Thus, through autopsy, varied preventable renal lesions that tend to be asymptomatic can be discovered and this data is indispensible for further assessment
of the disease trends.

Keywords: Autopsy; Glomerular lesions; Nonglomerular lesions; Renal lesions; Renal specimens.
 

Background: It is necessary to establish a biological profile of an individual by estimation of age, race, sex and stature to determine the individuality of an individual. It is considered as Big Four parameters in Anthropology.

Aim and Objective: To obtain a specific regression equation for stature estimation from middle finger length among male and female population of Nellore district of state Andhra Pradesh

Type of Study: Descriptive cross sectional study with analytical and comparative components.

Place of Study: At Narayana Medical College, Chinthareddy Palem, Nellore State Andhra Pradesh by the Department of forensic medicine and Toxicology.

Material and Method: The measurement was taken in standing position with stabilizationof hand on table. The caliper was horizontally placed along the ventral surface of the hand.The fixed part of the outer jaw of the caliper was applied to the proximal crease of middle
finger and the mobile part of the caliper was approximated to the tip of the middle finger and measurement was taken and the measurement was obtained up to one decimal place.

Result and Discussion: The mean middle finger length of 8.031 (SD±0.542)cm on right side as compared to 8.036 (SD±0.536)cm on left side indicate that the descriptive parameters are more on left side as compared to right side in males. Similarly in females also the mean middle finger length of 7.578 (SD±0.427) cm on right side and 7.586 (SD±0.428) cm on left side indicates the same thing that the parameters are more on left side. Our observation are in accordance to findings of a study conducted by Rahule et. al. in Indian population where good correlation existed between right middle finger length and stature in males and females and higher correlation coefficient in females than males similar to our study.

Conclusion: Middle finger length provides good reliability in Stature estimation, by deriving the population specific linear regression equations; as well the study reveals that the middle
finger length can be used successfully to predict stature in the population of Nellore region of Andhra Pradesh state.

Keywords: Middle Finger Length; Stature; Regression
 

Background: Age is one of the prime factors employed to establish the identity of an individual and the use of teeth for this purpose has been considered reliable. The measurement of reduction in pulpal width with advancing age due to secondary dentin deposition can been used as indicators of age.

Aim: To estimate the age of patients using pulpal width of permanent maxillary central incisors and to assess reliability of estimated age based on pulpal width of permanent maxillary central incisors with that of chronological age.

Materials and methods: 240 subjects aged between 20–50 years,with equal gender distribution were included in the study. Digital intraoral periapical radiography (Charge- coupled device sensor) of maxillary central incisors with paralleling angle technique were made for all study
subjects and pulpal cavity width was measured at Cemento-enamel junction (CEJ) , midpoint between CEJ and midroot level, midroot level using Planmeca Romexis software. Regression analysis was carried out to obtain the estimated age using pulpal width.

Results: The mean estimated age showed no statistical difference from the chronological age in both males and females (p>0.05).

Conclusion: Pulp width serves as a good indicator for age estimation in forensic odontology.

Keywords: Age estimation; chronological age; Maxillary Central Incisors; pulpal width; digital radiography; forensic odontology.
 

Introduction and Background: Diabetes mellitus is a chronic endocrine disorder. Diabetic foot is most common complication observed in patients with diabetes mellitus which may leads to debilitating disability like gangrene, non healing sepsis and amputation. Clinically diabetic
foot occurs due to diabetic neuropathy or ishchemic or combined neuro-ischemic.
Aim and Objectives: This study was conducted with aim to evaluate the problem of diabetic foot among type 1 and type 2 diabetic mellitus patients and to increase the awareness regarding practice of proper preventive measures among them. Objectives were to find out prevalence of diabetic foot among type 1 and type 2 diabetes mellitus patients and to evaluate practice of proper preventive measures to prevent diabetic foot among them. Materials And Methods: A cross sectional study conducted among diagnosed patients of type 1
and type 2 diabetes mellitus visiting at Dhiraj Hospital, SBKSMIRC, SVDU, Vadodara between January 2017 to April 2017. Total 98 patients were studied as per inclusion and exclusion criteria. Participants were examined clinically for neuropathy and ischemic features in both
feet for diagnosis of diabetic foot, while questionnaire based interview done for evaluation of practice of preventive measures among them. Data was compiled and statistically analyzed.

Observations and Results: Prevalence of diabetic foot was found 32.8% in male and 30% infemale diabetic patients. Prevalence of diabetic foot was 86.4% in type 1 diabetes mellitus patients and 15.8% in type 2 diabetis mellitus patients. 58.6% of patients with diabetic foot were practicing good care and preventive measures while practice of preventive care was found irregular in 41.4% of patients with diabetic foot. Medico-legal examination for disability related to diabetic foot and neuropathy is to be done as per Government of India guidelines under theRights of Persons with Disabilities Act and Rules.

Conslusion: Diabetic mellitus is a chronic incurable disorder till date. Common complications of diabetes mellitus like diabetic foot and diabetic foot ulcer needs proper preventive care and management. So that morbidity and disability can be prevented in patients with diabetes
mellitus.

Keywords: Diabetic foot; Diabetes mellitus; Disability; Preventive care.
 

The accurate assessment of age-at-death from skeletal remains is a key factor in both forensic anthropology and bioarchaeology. Several methods of determining age at death are currently employed that utilize the age specific changes of several anatomical regions of the skeleton.
However, as skeletal remains are often incomplete, it is useful to develop new methods based on previously unevaluated anatomy. This makes it more likely that sets of incomplete skeletal remains may include some feature that can be used to determine age-at death.
The purpose of this study was to develop standards for estimating age at death, using bone microstructure, that are applicable to a South Indian population. The sample consisted of 67 individuals (59 males and 8 females) of known age and sex. The sample was removed 5 cm
lateral from the costo-chondral junction of the fourth riband slides were prepared according to standard histological methodology. It was found that the number of Non-Haversian canals tend to reduce with age in a linear fashion which is also seen in the previous studies with coefficient of determination being 0.6703. Then the regression equation was calculated for estimating age using the number nonhaversian canal Y = –10.3637X + 70.37784 with standard error of estimate being ± 9.14 years.
 

Keywords: Non-Haversian canal; Rib; Age estimation; Vascular channels
 

Illegal abortion is a serious and preventable public health problem affecting women of reproductive age. Despite the implementation of a law legalising abortion in 1996 in South Africa, a high number of illegal abortions are still being carried out. The objective of this study
the trend of illegal abortion in the Transkei sub-region of South Africa (1996–2014). This is a retrospective record review, a descriptive study on criminal abortion. All aborted foetuses brought for medico-legal examination at the Mthatha Forensic Pathology Laboratory between
1996 and 2014 were recorded in the post-mortem register. In total 4986 unnatural deaths among females were recorded, which accounted for 21.51% of all unnatural deaths in this region from 1996 to 2014. Abortus material or products of conception ranked ninth in the list of autopsiedcases of unnatural deaths; these numbered 208(4.17%) of all autopsied non-natural deaths. The average number of foetal deaths were 10.94 (5.2%) each year. This was highest (17.31%) in 2010, and lowest (0.48%) in 1997 in this study.There is an increasing trend ofillegal abortion in the Transkei sub-region of South Africa. Government must pay attention to the issue of illegal abortion in this region.

Keywords: Illegal Abortion; Foetuses; Death
 

Estimation of the postmortem interval (PMI) is a very essential task for forensic experts,especially in criminal cases. The PMI is the time passed since the death of an individual and refers to the stages of autolysis. The current study was designed to estimate PMI by determination of
the oxidative markers, RNA integrity, GAPDH mRNA level in the brain of adult male albino rats and the autolytic ultrastructure changes of the cerebrum at time of death (0 hour), and then on 1st, 2nd, 4th, and 6th hours postmortem (hpm). Thirty-five male albino Wistar rats were
included in the present study (Seven rats for each time). The results revealed a significant timedependent malondialdehyde elevation with a decrease the antioxidant CAT, SOD, and GSH started from the 1st till the 6th hpm. On the other hand, the brain tissue GAPDH-mRNA gene
expression level showed a significant decrease at the 1st and the 6th hpm. The ultrastructure changes showed significant autolytic changes in the nerve cell, the nerve axon, and the blood vessels starting from the 1st till the 6th hpm. In conclusion, oxidative markers and ultrastructure
examination of the brain tissue especially cerebrum could be helpful for determination the early postmortem interval time.

Keywords: Postmortem; Oxidant/Antioxidant status; Molecular; Ultrastructure; Brain