Introduction Age determination is a major component of identification in forensic practice, and the skull is often the only available remain in mass disaster scenarios. The ossification stage of cranial sutures serves as a valuable tool in age assessment. The lambdoid suture is unique due to its anatomical location and biomechanical influences. With the advent of newer imaging techniques, antemortem age estimation has become increasingly feasible. Materials and Methods A retrospective cross-sectional study was conducted on computed tomography findings from 126 subjects (52 females, 74 males) aged 18-96 years. The minimum sample size was calculated based on previously reported correlation coefficients (r ≈ 0.5) in studies by Rawat et al and Wilkinson et al, assuming a moderate effect size, 5% alpha error, and 80% power, yielding a required sample size of 123. Suture fusion stages were analyzed at 7 points (L1-L7) using Frederic staging and Key scoring systems. Both ectocranial and cross-sectional closure patterns were assessed. Subjects with a history of cranial surgery, trauma, bone pathology, or congenital craniofacial anomalies were excluded. Results A statistically significant positive correlation between age and stage of suture closure was observed, particularly at L1, L3, L6, and L7 ( P < .01). Weaker statistically significant correlations were observed at L2 and L5. Spearman's correlation analysis demonstrated a positive association between external and cross-sectional fusion stages. Conclusion A positive correlation exists between chronological age and lambdoid suture fusion. However, reliance on a single suture is insufficient for accurate age estimation.
Introduction Diabetic ketoacidosis (DKA) is a well-known complication in diabetic patients, especially those who rely on insulin to maintain physiologic blood glucose levels, and allow for normal cellular uptake of glucose. While an uncommon cerebrovascular complication of DKA, there have been reported cases of subarachnoid hemorrhage (SAH) occurring in episodes of DKA. DKA is more prevalent in patients with insulin-dependent diabetes mellitus, particularly in younger patients under the age of 50. Methods A medicolegal autopsy was performed on a 19-year-old woman with a history of type 1 diabetes mellitus as well as prior episodes of DKA, who was found unresponsive in bed and did not survive resuscitation. Results The cause of death was found to be DKA on a background of elevated vitreous glucose and post-mortem serum β-hydroxybutyrate. Additionally, a mild recent SAH was found on post-mortem internal examination. Two aneurysms were identified in both the right ascending communicating artery (RACA) and right middle cerebral artery, and the SAH was found to originate from the RACA. There were other findings supportive of DKA, such as gastric erosions, pale kidney cortices, and fatty changes in the liver. Discussion DKA is a fatal complication of untreated diabetes mellitus, and the risk of mortality and morbidity increases with subsequent episodes. Diabetes can also predispose an individual to vasculopathies such as aneurysm formation, and subsequent SAH may be identified on post-mortem exam. While the SAH may not be the immediate cause of death, it is a rare finding in post-mortem examination of diabetic decedents, and the risk of aneurysm rupture may be the result of derangements such as increased intracranial pressure during DKA.
‘Macro-cautery’ refers to large-scale thermal coagulation, carbonization and vaporization of biological tissues produced by high-voltage electrical current, resulting in destruction of soft tissue architecture to the extent that body parts may be partially or completely ‘burned away’. In this case, giving the appearance of ‘Near-Capitation’. Electrical burns are some of the most severe injuries, carrying a high risk of both morbidity and mortality. They can cause extensive damage to vital organs, with the extent of injury depending on factors such as the voltage involved, the body's resistance and the duration of contact. In the present case, the deceased fell from a height of approximately 100 feet from a high-voltage electric transmission line with impact over the neck. Following this, the neck of the victim was severed with the depth of wound up to the vertebral column. It appeared similar to a chop wound injury to the investigating agencies. The aim of presenting this unique case is to discuss the role of fall from height in injuries sustained due to high-voltage electric current and to aid the practicing forensic pathologist in identifying the cause of injury sustained as electric injury may simulate mechanical injury. The authors have discussed the chain of events, pattern and distribution of injuries sustained and opined on the cause of death when a high-voltage current passes through the human body after falling from a height which may simulate mechanical trauma.
The sting of Vespa tropica is well known for causing a strong, allergic, self-limited local reaction, which usually resolves within few days. Unfortunately, in sensitized individuals, it can induce a fatal reaction. A 39-year-old Indian male sustained 4 V. tropica stings. He developed a local allergic reaction and breathing difficulty, but deteriorated rapidly and died within 24 h. Blood investigations revealed an increase in acute inflammatory cells, prolonged coagulation time, and deranged liver and kidney function tests. At autopsy, 4 sting puncture wounds with associated local allergic reactions were identified, and the internal organs were congested. Histopathological examination showed findings consistent with myocardial coagulative necrosis with lymphohistiocytic inflammatory infiltration, renal failure, hepatic injury, pulmonary hemorrhages with interstitial edema. V. tropica venom contains hyaluronidase, phospholipase, dipeptidyl peptidase-IV, antigen 5, and albumin-like proteins. These molecules are capable of inducing local inflammatory reactions, hemolysis, and multi-organ failure. This case report presents a fatality caused by 4 V. tropica stings, with detailed clinical, autopsy, and histopathological observations. These findings may be helpful in the clinical management of patients presenting with potentially lethal V. tropica stings.
