Indian Journal of Forensic Medicine and Pathology

India leads the world in the number of registered medical institutions and produces the largest number of medical doctors in the world. Not with standing this, India struggles the concerns of cadaver shortage, patient unavailability (in hospitals), lack of medical equipment’s/ instruments, shortage of medical personnel and medicines which is largely due to the malfunctioning of Indian Regulatory bodies and flawed Educational, Healthcare and Judiciary policies. Few authors have written on the prevailing deficiencies in the Indian policies especially the ‘Anatomy Acts’ but failed to correlate them with the ‘Indian Judiciary Regulations’ and provide radical solutions to ensure an uninterrupted supply of cadavers to medical institutions for academic and research purpose. The objective of our article is to review the policies and acts enacted by the Indian Educational, Healthcare and Judiciary policies pertaining to the disposal of unclaimed dead bodies both, prior to COVID-19 and during COVID -19 pandemic period.

Keywords: Unclaimed bodies; COVID-19 pandemic; Anatomy acts; Health care policies; Judiciary policies; Cadaver shortage; Medical education; Medical ethics; Regulatory bodies.

Introduction: Drowningis the 3rd leading cause of unintentional injury death, accounting for 7% of all injury-related deaths. The global burden and death from drowning is found in all economies and regions. In this study we aim to find out the demographic profile of drowning among cases brought for autopsy in the Department of FMT, RIMS, Ranchi. Material and Method: This Observational study was carried out in the Department of Forensic Medicine and Toxicology, Rajendra Institute of Medical Sciences, Ranchi, during the period from January 2019 to December 2019, wherein a total of 3342 autopsies were conducted out of which 109 cases were of Drowning. Results: Drowning was found to occur more commonly in rural areas (58.7%). Males are more prone to drowning (75.2%). Most common age group involved was found to be 31–40 years. Lakes were the most common place of occurrence (38.5%). Incidence of married females (66.7%) was slightly greater than married males (63.4%). Drowning was found to be most commonly accidental in nature (35.8%). Familial and financial problems (26.6%) along with depression (26.6%) accounted for most of the cases of drowning.

Keywords: Drowning; Lakes; Accidental; Familial problems; Depression.

Context: A comparison of PTEN and p53 expression in endometrial hyperplasia and carcinoma. Aims: To study the histomorphology and expression of PTEN and p53 markers in endometrial hyperplasia and carcinoma in histopathology samples. Settings and Design: This is a comparative study done on 40 cases of endometrial hyperplasia and 20 cases of endometrial carcinoma. Methods and Material: This is a 2 year study done on 40 cases of endometrial hyperplasia and 20 cases of endometrial carcinoma in a tertiary care hospital. Endometrial biopsies and resected specimens of uterus received at pathology department were grossed, processed and were stained by hematoxylin and eosin and examined by the pathologist. The expression of PTEN and p53 markers was evaluated on the diagnosed samples. Results: Out of 36 cases of endometrial hyperplasia without atypia, 4 atypical hyperplasias and 20 endometrioid carcinomas, loss of PTEN expression was found to be 16.7%, 25% and 80% respectively, whereas expression of p53 was found to be 5.6%, 75% and 90% respectively in the same cases. Conclusions: The loss of PTEN expression or positive expression of p53 in hyperplasias may be used as an early indicator of progression to carcinoma. The altered expressions of these markers are initiated in few cases of hyperplasia, which may progress to atypical hyperplasia, a premalignant lesion and ultimately develop into carcinoma.

Keywords: Endometrial hyperplasia; PTEN; p53; Endometrioid carcinomas; Immunohistochemistry.

Background: Chronic kidney disease has increased rapidly in the world, especially in developing countries like India,due to increase in Diabetes mellitus, Hypertension etc.Besides, symptomatology in such patients, laboratory parameters like Hematological, Biochemical etc are important in establishing diagnosis in such patients. Often, importance is paid to Biochemical parameters and Hematological parameters are neglected.Hematological parameters play a pivotal role in prognosis of these patients. Aim: The main aim of this study is to assess the hematological parameters in patients of Chronic Kidney disease and to assess their effect post dialysis. Materials and Methods: This is a cross sectional study done on 64 patients of chronic kidney disease and on maintenance of dialysis. The study was carried out in Hematology section of Central Laboratory, Mahatma Gandhi Medical College and Research Institute,Pondicherry from January to July 2020. Results: Out of 64 patients of Chronic Kidney disease, 47 (73.4%) patients were males and 17 (26.5%) patients were females. Majority of the patients were from the age group 41–60 years (76.5%), followed by the age group 21–40 years (18.7%). The major cause of Chronic Kidney disease was patients suffering from both Diabetes mellitus and hypertension accounting to 63 %, followed by Diabetes mellitus alone 25% and Hypertension alone 12%. (Graph 1) The hematological parameters before and after dialysis were anaemia, otherwise other parameters were within normal limits. The peripheral smear examination of all these patients, out of which 52(81.2%) patients showed Normocytic Normochromic anaemia and 12 (18.7%) patients showed (Graph 2) Microcytic hypochromic anaemia. Peripheral smear examination of Normocytic Normochromic anaemic patients showed evidence of hemolysis post dialysis in 28 patients. 12 patients showed fragmented red blood cells(schistocytes) alone, 7 patients showed microspherocytes alone and 9 patients showed both fragmented red blood cells and microspherocytes. Peripheral smear picture was more or less similar pre and post dialysis,except the parameters improved after the dialysis. Conclusion: Chronic kidney disease is a serious health ailment, which requires careful monitoring of all the parameters, not merely the kidney function tests, but also the hematological parameters, which affect the prognosis of the condition of the patient.

Keywords: Hematological parameters; Chronic kidney disease; Anaemia.

Introduction: The purpose of this study was to evaluate the diagnostic role of postmortem pericardial fluid cardiac troponins in cases of sudden cardiac death and to determine its significance. Methods: This study included totally 30 cases, of which 23 were cases of sudden cardiac death and 7 were control cases. In the following cases, along with age, gender, as well as circumstance of death, level of cardiac troponin I In pericardial fluid, cytological analysis of the fluid as well as post mortem findings of the coronary arteries were all analyzed. Levels of troponin I were assessed with the help of a rapid card test which worked on the principle of sandwich immunoassay. It detects a minimum amount of 0.5ng/ml of cTnI in samples. Results: In the 30 cases among which the study was conducted, the mean age was 44 years of age, with the majority of the cases lying between the ages of 41–50 (37%). It was also found that the majority of them were males (86.7%) as compared to females (13.3%). The mean time interval between death and sample testing came up to 11 hours, with the majority of the cases being between 16–20 hours time interval (37%). On correlation of rapid card test results and gross post mortem findings, the test showed a sensitivity of 86.7% and specificity of 20%. Conclusion: From statistical analysis it could be inferred that the frequency of MI was more in males than females, and in the age group of 41–50. The rapid card test had an appreciable sensitivity, but the specificity inferred there could be various situations in which there could be elevated troponins in pericardial fluid. This infers that while a case of myocardial infarction has a higher chance of showing elevated levels of cardiac troponin in pericardial fluid, a case of sudden death can not be reliably diagnosed as AMI on the basis of elevated troponins alone. There must be correlation between clinical, histopathological and cardiac marker findings.

Keywords: Myocardial infarction; Pericardial fluid; Cardiac troponin; Post mortem.

Introduction: Autopsy studies aid to the knowledge of pathology by unveiling some of rare lesions which are a source of learning from a pathologist’s perspective. Perinatal autopsies form an integral part in providing a clue to ascertain the cause of perinatal deaths and to study the congenital anomalies. Kidneys being important organs in maintaining the homeostasis, are affected by a variety of lesions like congenital anomalies, neoplasms and infections apart from being secondarily involved by diabetes, poisoning and other systemic diseases. Aims and objectives: 1. To determine the spectrum of histopathological findings of kidney in medicolegal autopsies. 2. To study the congenital anomalies and other lesions of kidney in perinatal autopsies. Materials and Methods: A retrospective study of medicolegal cases (269) and perinatal autopsies (100) for six years were included. The gross and microscopic findings of the specimens were taken into consideration. Results: Acute tubular necrosis (ATN) (51.16%) was the commonest histopathologic finding with the next common being changes secondary to diabetic nephropathy (16.27%). Others include hydronephrosis (13.9%), pyelonephritis (9.3%), multilocular cystic renal cell carcinoma (MCRCC), adult polycystic kidney disease (ADPKD), a case of coexisting pulmonary tuberculosis with liver cirrhosis and renal cell carcinoma (RCC) and a case of tumor to tumor metastasis. Perinatal autopsies showed cystic renal dysplasia, renal agenesis, autosomal recessive polycystic kidney disease (ARPKD) and a hybrid lesion. Conclusion: This study highlights the various incidental findings in medicolegal autopsies, which are imperative in academic and research purposes. Despite the growing complexity and dependence on newer diagnostic methodologies, the traditional role of histopathology in autopsy remains the gold standard.

Keywords: Autopsy; Cystic renal dysplasia; Hybrid lesion; Renal cell carcinoma; Tumor to tumor metastasis.

Foetal sex determination and sex-selective abortions by medical professionals has grown today into a thousand crore industry. In the Pre-Natal Diagnostic Technique (Regulation and Misuse) Act, 1994 amendment was done and titled as Pre-Conception and Pre-Natal Diagnostic Technique (Prohibition of sex selection) Act (PC-PNDT ACT) 2003 for improvement in technology-related sex determination regulation. Aims and Objectives: 1. To find out awareness about PCPNDT Act among the married women in the community and to determine their sociodemographic factors influencing this awareness. 2. To assess the reasons for gender Based family composition and violation of laws. Materials and Methods: A hospital-based observational study was carried out among the married women in the reproductive age group attending Dr. Vithalrao Vikhe Patil Memorial Hospital in Ahmednagar District. The 100 study participants were administered a preformed questionnaire of about ten questions on the PCPNDT Act. The data obtained was analyzed and expressed in percentage, and statistical analysis was done. Results: The majority of the participants (81%) were aware of the act amended by the Government for the prevention of female feticide. A large number of participants (60%) would prefer to know the sex of their unborn child, and also 9% of them would terminate the pregnancy if the sex was revealed to be a female. A large number of participants (85%) were aware that there is punishment for both doctors who facilitate and patients who seek pre-natal sex determination. Conclusion: The study found that most of the participants were aware of the possibility and techniques of pre-natal sex determination. More than half of the participants were aware of the law enacted by the Government. Still, they should be educated about the importance of maintaining the falling sex ratio and prevention of female feticide.

Keywords: Pre-Conception; Pre-Natal; Female feticide.

Introduction: Liver biopsy is an important diagnostic tool that assists determination of specific diagnoses and directs therapeutic decisions in patients with acute and chronic liver diseases. It can also be used to estimate the degree of liver damage to grade and stage hepatitis B and C, and to determine the best treatment for the damage or disease. Material and Method: A two year prospective study was conducted on 78 liver biopsies in the Department of Pathology, M.S. Ramaiah Medical College and Hospital from January 2018 to January 2020. The sections were examined and the histopathological findings were recorded. Immunohistochemistry (IHC) was performed by using markerssuch as CK7, CK20, CDX2, CEA, Hep par 1, TTF-1, synaptophysin, chromogranin and AFP for increased diagnostic accuracy. Results: In this study, age ranged from 3 months to 80 years. Mean age was 42.5 years. Out of 78 cases, 51 cases were males, 27 were females. Liver biopsy revealed that chronic hepatitis and metastasis were the commonest findings constituting 14.1% each. Hepatocellular carcinoma (HCC) and cirrhosis constituted 11.53% and 10.25% of total cases, respectively. Conclusion: Liver biopsy continues to play an important role in modern clinical practice and remains the gold standard for the diagnosis of majority of the hepatic diseases. Histopathological examination of liver biopsy specimen is an essential, safe and reliable tool for the diagnosis, accurate assessment of severity and follow up of the various hepatic lesions.

Keywords: Histomorphological analysis; Hepatic lesions; Liver biopsy.

Medical Certification of Cause of Death- MCCD, plays an important role in deciding the direction of public health programs, provide a feedback system for future implementation of health policies, health planning and management of epidemiological studies, vital statistics, medico-legal investigations, census studies, health research, assessment of effectiveness of public health programs. As Covid- 19 produces so much confusion into the mind of treating doctor as how to give cause of death in MCCD. Certification and classification and coding of death related to Covid-19 is essential for smooth contact tracing afterwards. Our study focused on the analysis of MCCD proformas filled up by residents and faculty members and common mistakes committed while filling it while treating the Covid patient at isolation wards. This is a retrospective, cross sectional study carried out at Covid-19 dedicated hospital associated with a Medical College situated in Rajasthan. The period of this study is three month of early Covid-19 pandemic time from 1st April 2020 to 30th June 2020, in which a total of 199 deaths were reported. We could study a total of 152 certificates (76.38%) out of total 199 deaths as in rest of cases, the MCCD was not attached as deceased was brought dead to hospital. The analytical result of study revealed some major errors like immediate cause of death was Covid-19 positive with cardiovascular arrest. The conclusion of our study highlights an urgent need for imparting extra efforts towards awareness, importance to undergraduates as well as postgraduate training. Also emphasis training of senior and junior faculty with other treating doctors. Suggestions to government for impose strict rules over clinician so that they know the importance of MCCD in pandemic time also.

Keywords: Brought dead; MCCD; Covid-19; Certification; Pandemic.

 Context: Papulosquamous lesions of skin are the most frequently seen conditions encountered by both dermatologists and pathologists. These conditions have a similar clinical picture; hence a definite histopathological diagnosis can solve the overlapping clinical features of various papulosquamous lesions of skin. Aims: To study the histopathological features of various subcategories of papulosquamous skin lesions and to assess the correlation between clinical diagnosis provided and the histopathological diagnosis obtained. Settings and Design: The study is done in a Tertiary care hospital which includes 150 skin biopsies received from Department of Dermatology. Methods and Material: The skin biopsy specimens were subjected to formalin fixation and paraffin embedding followed by staining with hematoxylin and eosin. The histopathological features of various papulosquamous lesions were analysed and clinicopathological correlation was done for the 150 cases of skin biopsies which were clinically suspected/ diagnosed as papulosquamous skin lesions. Statistical analysis used: Universal sampling done and this is a clinico-histopathological correlative study done for a period of 18 months. Results: Out of the 150 skin biopsies of papulosquamous lesions, psoriasis turned out to be the most common lesion. The papulosquamous skin lesions were commonly seen in males. 28% cases were of psoriasis vulgaris and 25% cases were of Lichen planus occupying the top two commonest papulosquamous skin lesions and a positive correlation with histopathological diagnosis turned out to be 76%. Conclusions: The complexity in diagnosing papulosquamous lesions due to features of clinical overlap can be overcome by the histopathological examination and findings which helps to diagnose the various subcategories of papulosquamous skin lesions.

Keywords: Papulosquamous lesions; Psoriasis; Lichen planus.

Background: Perinatal autopsy is an important tool to look out for various congenital malformations and its impact on perinatal morbidity and mortality. Though radiological intervention has reduced the incidence, perinatal autopsy is essential for confirmation of diagnosis and to look out for additional information. Objectives: To emphasize the importance of perinatal autopsy in diagnosing and confirmation of congenital malformations and to compare it with prenatal clinical findings. Materials and Methods: The present study comprises 100 consecutive perinatal autopsies after approval from the Institutional Ethics Committee. Prior consent from parents were taken and autopsy was done using standard protocols. Prenatal radiological findings were compared with the autopsy findings wherever available. Results: Out of 100 perinatal autopsies studied, 45 cases shows congenital anomalies, which included 26 males, 13 females and 6 cases with ambiguous genitalia. Among the 45 cases, 21 were therapeutic terminations, 15 still births and 09 cases of Intrauterine Deaths. The most common timing of therapeutic termination encountered was between 12–20 weeks. Out of 45 cases, anomalies were present in 16 cases of central nervous system (CNS), 5 of lung, 4 from kidney, 2 of heart, 7 cases of syndromes, 5 cases with multisystem involvement and 5 cases of miscellaneous group. Conclusion: Perinatal autopsy is essential to confirm congenital malformations and to look for additional findings. Also, it helps to counsel the parents to prevent such complications in future pregnancy.

Keywords: Fetal autopsy; Still birth; Sirenomelia; Meningomyeloencephalocele.

Background: A series of systemized techniques of measuring quantitatively the dimensions of human body and skeleton is called as Anthropometry and it is often viewed as traditionally the basic tool for biological anthropology and it has a long traditional use in forensic sciences and its findings has increased its use in medical sciences specifically in speciality of Forensic Medicine. Aim and objective: To find out correlation between Index and Ring finger length with stature of the individual and to devise a linear regression equation to determine stature from Index and Ring finger length. 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. The length of the Index and ring fingers was measured fromproximal crease to the tip. Observation and Discussion: The Mean±SD age of study samples was 21.41 ± 2.1years. There was no significant difference between themean age of the two genders (P>0.001). Accordingly the Mean±SD height was 164.62 ± 8.56cm intotal cases, 168.12 ± 7.6 cm in males, and 161.1 ± 8.01cm in females, which differed significantly (P<0.0001).The Mean±SD lengths of index and ring fingers were6.55 ± 0.48 cm and 6.6 ± 0.51 cm in total samples,6.72 ± 0.52 cm and 6.78 ± 0.55 cm in males, and6.37 ± 0.37 cm and 6.42 ± 0.38 cm in females, respectively. Conclusion: In our study there exists a significant and positive correlation between stature and Index and ring finger length between both the sexes indicating strong and reliable relationship between the parameters.

Keywords: Index and ring finger length; Regression equation; Stature.

 Objective: To find out the relation between sciatic notch index of adult human male and female from specimens present in the museum and inventory. Methodology: All bony specimens for study were taken from the museum of Forensic Medicine Department and Anatomy Department of Medical College, Kolkata and also from the inventory of Kolkata Police Morgue, based on the exclusion and inclusion criteria. They are arranged systematically by putting a unique number code against each specimen and measurements are taken of dimensions of sciatic notch using the standard measuring tools and following standard anthropometric methods. Results: Z test is done. n= 104, F=56 and M=48. For males and for females the mean Depth of sciatic notch is found to be 3.81 and 2.98 respectively.(Table 2) The mean Width of the same in males and females are found to be 3.48 and 4.23 respectively. SN Index of males and females are found to be 103.93 and 146.02 respectively.(Table 3) Conclusion: The differences are found to be statistically significant from the specimens taken for study. As such sciatic notch index in adults may be considered to be a dependable anthropometric entity for sexing of human pelvis, particularly in mutilated and fragmented skeletal parts.

Keywords: Sciatic notch index; Adult human pelvis; Sexual dimorphism; Variability.

Background: Respiratory pathology is the commonest autopsy finding and areresponsible for a great deal of morbidity and mortality. Adult respiratory diseases in the developing world are of increasing concern. 1 This study was undertaken to detect the pulmonary pathology findings in adult autopsy cases as there is limited availability of data. Aim: The aim of present study is to analyse the spectrum of pulmonary lesions in adult autopsy and to correlate the pulmonary pathology with the cause of death given as final autopsy diagnosis. Design: Observational type of study. Material and Methods: This is a prospective and retrospective study wasconducted inTertiary Care hospital, Kalaburagi over a period of 3years from July 2016 to June 2019.A total of 218 lungs of adult autopsies were performed. Autolysed specimens of lungs are excluded from the study. Results: A total of 218 lungs of adult autopsies were performed.All cases showed one or other histopathological lesions in lung.The various pulmonary lesions were classified as pulmonary infection 49 cases (22.2%), COPD 29 cases (13.3%) and pulmonary vascular diseases 140 cases (63.9%). The pulmonary vascular diseases encountered were (CVC) Chronic Venous Congestion (Fig. 4A) (05 Cases, 2.3%), Pulmonary Edema (Fig 2 A,B) (47 cases, 21.5%), Pulmonary Hemorrhage. With Congestion (Fig 3A) (83 Cases, 38%), Acute respiratory distress syndrome (ARDS) (Fig 3B) (04 Cases, 1.8%), Pulmonary Embolism (Fig 5B) (01 Case, 0.45%). Pulmonary haemorrhage with congestion was more frequent in cases of road traffic accident and burns. Chronic obstructive pulmonary disease includes emphysema (Fig 4B) (29 cases, 13.3%).The pulmonary infections encountered were Lobar pneumonia (Fig 1A) (40 cases, 18.3%), Interstitial Pneumonia 04 cases (1.8%), Bronchopneumonia (Fig 1B) (2cases, 0.9%) and 01 cases (0.4%) each of foreign body aspiration pneumonia (Fig 9) ,Lung abscess and Tuberculosis (Fig 5A) respectively. The age ranged from 20 to 80 years. Majority of the cases were in the age group of 30–39 years. 70 cases (32.1%) with M:F Ratio 1.9 :1. The incidental findings in this study are each case of foreign body aspiration pneumonia and Tuberculosis. Conclusion: In this study highlights various lesions in lungs which were confirmed by histopathological examination, which were either incidental or direct cause of death. Irrespective of cause of death, autopsy study is essential to evaluate diseases or injury that may be present and to determine the cause and manner of death.

Keywords: Adult autopsy; Pulmonary pathology; Pneumonia; Histopathological examination.

Background: Railway accidents that take human lives and economic toll are mostly underreported and go unnoticed and the victims of such incidences are poorly paid as well. Therefore it is important to pay due attention to the deaths of the Railway and devise effective policies to provide fair treatment to the victims of these incidents and also to make efforts to minimize them. Aims: To assess and judge the exact magnitude of morbidity and mortality and trends in fatal railway injuries. Materials and methods: This Retrospective study carried out at the mortuary of the teaching hospital on the incidence of railway deaths the material comprised of 298 victims who died exclusively of railway injuries. Results: In our Institute, medicolegal autopsies constitute 35% of the total autopsies. Autopsies in cases of Railways constitute around 10% of the total medicolegal autopsies. Most of the victims were in the age group of 21 to 30 years, males contributed to 70% and females 30%, but still, then female, alcohol was detected in the body in 13% of cases, distribution of the external injuries showed that there are commonest in the head region(73%),More than one reason was involved in the majority of cases. Conclusion: It is suggested that a set of preventive measures for a multipronged strategy to minimize railroad deaths.

Introduction: Tuberculosis is an age old disease and India has the highest disease burden. With the rise in HIV cases, the incidence of extrapulmonary tuberculosis has further increased. Both TB and EPTB remains a major health problem. Aim: To study the histopathological spectrum of EPTB with respect to its site, age and sex distribution. Material and Methods: This study is a retrospective study carried over a period of two years. We included 86 cases of EPTB from the departmental registry. The clinical details and the histopathological findings were noted. Results: We studied 86 cases of EPTB. Male: female ratio being 0.75. The most common age group was 21-30 years, followed by 31-40 years. Majority of cases involved the lymphoreticular system and the soft tissue. Rare sites included tonsil, thyroid, liver and kidney. Conclusion: Incidence of EPTB is on the rise as it mimics various other disease processes and may account for disease burden. Knowledge of the various EPTB sites in essential and should be kept as a differential diagnosis in histopathological reporting.

Keywords: Tuberculosis; Extrapulmonary; Infection; Histopathology.

Background: Sharp instrument injury is a preventable public health problem in South Africa. The Transkei region is not only different geopolitically from the rest of South Africa, but also in terms of injury patterns. It experiences a high rate of injuries, which is generally underestimated and underreported. Objective: To study the incidence of stab injury related deaths in the Transkei sub-region of South Africa over a period of 23 years (1993-2015). Method: A record review from 1993 to 2015 was undertaken of 24 419 medico-legal autopsies performed at Mthatha Forensic Pathology Laboratory. Results: Between 1993 and 2015 autopsies were performed on 26 855 victims of unnatural death, of these, 5 205 (19.38%) were victims of stab injury, which ranked second among all causes of unnatural death in the Transkei sub-region of South Africa. The average death rate as a result of stab injury was 33.1 per 100 000 of the population annually. Males outnumbered females (ratio 9.7:1). Most stabbings (2118 - 40.92%) occurring in the study period of 23 years were recorded among young adults between 21 and 30 years of age. Conclusion: The stab injury death rate is increasing in the Transkei sub-region of South Africa. The situation needs urgent intervention to save lives.

Keywords: Stab injury; Sharp penetrating objects; Homicide; Murder.