Hanging is one of the most common methods of suicide worldwide, accounting for more than 50% of the population regardless of gender. In addition to being a method of suicide, hanging may also occur postmortem as an attempt to conceal a crime. Therefore, it is important to carefully examine the body and search for typical signs of this type of mechanical asphyxia, as well as for specific pathologic indicators confirming the exact cause, mechanism, and manner of death. The presented case report shows that a concealed homicide must be considered in every hanging victim, which requires a thorough investigation of the scene of death, which could give crucial information about the circumstances, with further important autopsy examination of the body externally and internally, and additional toxicological and histological examination, helping coroners to resolve the case and confirm the exact cause, manner, and mechanism of death.
A Registered medical practitioner is qualified to manage all the cases of poisoning and substance abuse after passing their graduate medical education. The qualification of managing poisoning cases comes from Toxicology taught to them under the subject "Forensic Medicine and Toxicology". At tertiary care centres, the post-graduates in Internal Medicine manage poisoning and substance abuse cases under emergency care based on the knowledge they received during their undergraduate studies. However, the Teacher who taught the subject is practically not involved in managing such patients, i.e. preaching without practice. This results in a gross deficiency in the quality of care for poisoning cases. To overcome this, we propose one centre as a Toxicology unit at every tertiary care centre, corroborating Medicine, Forensic Medicine, Pharmacology, Psychiatry and various other disciplines dealing with all the aspects of Substance abuse and Poisons. With the help of this unit, we can run a single centre catering to the management of poisoning and substance abuse patients, their mental health, diagnostic centres for drugs and poisons, drugs and poison information centre (DPC) including drugs de-addiction and treatment centre (DDAC), an integrated rehabilitation centre for addicts (IRCA), Outreach and Drop-in centres (ODIC), De-addiction drug pharmacy and various training courses to the health care professionals.
Introduction: India continues to grapple with a notable imbalance between the demand for and their actual availability of transplant organs, despite of concerted efforts in creating public awareness through mass campaigns and policy driven initiatives. While biomedical solution to this problem asks for more efforts for cadaveric or living donors as a viable way for addressing this challenge, the persistence shortage indicate existence of deeper and complex interrelationship between medical and socio cultural factors. Aim: This paper critically examines the socio-cultural factors influencing the reluctance to organ donation among youth in Delhi, the capital city of India. Material and Methods: Using online surveys and telephonic interviews this study has identified four thematic frameworks that converge together and shape the youth reluctance regarding organ donation. Result: By examining the ways in which youth today navigate in between the complex moral framework and societal values, this paper reframes the organ donation refusal not as a simple irrational act of the youth but as a conscious and contextually grounded act of resistance that are often been shaped by their cultural norms and institutional structure. Conclusion: Organ donation reluctance among the youth must be viewed as a culturally embedded decision-making process rather than a lack of awareness, calling for approaches that engage with the socio-cultural realities of contemporary youth.
Aim This study was conducted to assess the knowledge and attitude towards end-of-life care and advance directives amongst medical students and postgraduates of Saveetha Medical College and Hospital which is located in the city of Chennai, India. Methodology A cross-sectional questionnaire based observational study was conducted taking 369 medical students including interns and 83 postgraduates of Saveetha Medical College and Hospital as participants. A structured, pre-tested and validated questionnaire was prepared containing 18 questions related to end of life care and advance directives which was provided to the participants via google forms after obtaining informed consent. In addition, sociodemographic parameters such as sex, religion, phase of study and health insurance were obtained. Results Out of the 1077 individuals surveyed, majority of the respondents were females (61.1%). Most of the respondents were Hindus (67.1%), followed by Christians (19.1%) and Muslims (13.8%). Only 39.5% of the population had health insurance coverage. 96.2% of the participants in the study were unaware of Advance Directives (AD) or its legalization in India. None of them had created an AD, with the lack of promotion in medical education being cited as the primary reason by 94% of respondents. 31.4% of the population found the existence of AD reasonable, 75.8% of them were uncertain about whether it should be mandatory for all citizens of India. 80.2% were oblivious that adhering to Do Not Resuscitate (DNR) orders without an AD is illegal in India, while 61.1% were uncertain whether passive euthanasia and DNR are components of an AD in India. More than 90% of the population lacked awareness regarding the legal age for drafting an AD or the involvement of a Surrogate in its preparation. Nobody was familiar with the process of preparing an AD or the modifications to SC. Conclusion This study highlights insufficient awareness concerning Advance Directives (AD). However, attitudes toward AD preparation and End-of-Life care discussions appear to be mixed.
Background-Acetic acid is a common corrosive acid available as a household product and is used in several industries, including rubber, food, and leather goods. Its use as vinegar (5-10 % acetic acid), a tabletop condiment, is common. However, its use in suicides is limited because of its pungent smell and taste. It is thus rare to encounter such cases by the forensic pathologists and clinicians. We here present two cases of suicidal poisonings by vinegar in a setting made convenient by their easy accessibility. The present case also highlights that the unregulated cheese curd (chenna) industry workers are the likely candidates for such cases. Case presentation- We present two cases where the deceased was brought forward for the autopsy examination following a verbal declaration by the near and dear of vinegar intake. Both cases were working in the food industry to prepare curd cheese. The cases had erosions in the stomach with reflex pylorospam. The first case succumbed to multi organ failure resulting from systemic toxicity of the acid, while the second case died before receiving any medical attention because of asphyxia resulting from laryngeal edema. Conclusion- The amount of the ingested corrosive and grading of the mucosal necrosis determines the prognosis of the acetic acid ingestion. The present case report suggests that appropriate policy needs to be made for the preservation and accountability of these chemicals in industrial settings to prevent such mishaps in the future.
We investigated the suitability of dental age estimation surveys based on modified Chaillet and Demirjian's method using artificial multilayer perceptron neural network (ANN) for Malaysian Malays and Chinese juveniles. A total of 199 dental panoramic tomographs of Malays and Chinese ranging in age from 5.00 to 17.99 years old were evaluated. The difference between chronological age (CA) and dental age from the maturity score (DA) was computed, as well as the mean and standard deviation. Comparison of the estimated DA with CA showed that DA for Malays was significantly overestimated by 0.42 +/- 0.91 years (paired t-test, p < 0.05) and for Chinese was marginally overestimated by 0.02 +/- 0.68 years (paired t-test, p >= 0.05). This shows that DA estimation by using the modified survey of ANN does not differ significantly from CA for the Chinese but for Malays (especially females) a difference was noted.
Background: Medical education had to adapt to the challenges posed by the COVID-19 pandemic and shifted towards online platforms. However, this has been fraught with challenges. Objective: To compare traditional classroom teaching and online teaching and assessments in Forensic Medicine and Toxicology for undergraduate medical students. Methods: Total of 98 undergraduate medical students gave their anonymous feedback about Google Forms and Microsoft Forms for assessments and using Microsoft Teams for learning Forensic Medicine and Toxicology. Results: One-third of the students felt online classes were more convenient than traditional classes. Half the students thought that online classes didn't facilitate good teacher-student interaction. 39.8% of the students felt that technical difficulties during the online classes negatively affected their learning. 56.2% of the students believe that online practical classes cannot replace traditional practical classes. 74.5% of the students believed that feedback provided by the Forensic Medicine faculty helped them improve their academic performance. 68.4% of the students preferred traditional classes but would like it to be combined with some online learning. According to the teachers, viva conducted via video calls was the most authentic form of assessment. Conclusion: Technical issues may prevent medical educators and undergraduate medical students from completely embracing online teaching. The benefits of online teaching like convenience and versatility of options will likely see it being used in teaching medical students long after the pandemic is over. To make the teaching program more robust, feedback should be taken from the students regarding the teaching session, materials, and engagement methods.
The present short communication is based on the United States patent titled "Grossing Workstation with Electronic Scale". Autopsy is an essential part of medicolegal death investigation. Different novel tools are proposed and implemented to decrease the invasive nature of the traditional autopsy. The present proposal of a grossing workstation uses technology to primarily enhance the practice of autopsy. The proposed device comprising of camera, electronic scale (for measurements and weight), computer device to store data, screen to show and connect the case number to the specimen and time of the examination is used. The proposed grossing station decreases the need for extra personnel and photographers and decreases the chances of exposure to biohazards.
Background: With the increment in critical care over the last few decades, the outcome and prognosis of patients has significantly improved in many aspects. Cardiopulmonary resuscitation has been a setting stone in these endeavors. However, in many clinical cases reviving patients is not in their best interest, especially when the treatment is determined to be futile. The introduction of do-not-resuscitate (DNR) orders in critical care helps to avoid unnecessary patient suffering. Methods: We aimed to demonstrate the rates of DNR orders in King Fand Hospital of the University in the Eastern Province of Saudi Arabia and to highlight the related determinants. Two hundred and nineteen intensive care unit (ICU) admissions from August 2016 to December 2018 were analyzed. Age, gender, nationality, and diagnostic categories were all compared with the DNR rates in both surgical and medical ICUs. Results and Conclusions: This study highlights the determinants influencing the rates of DNR orders in a public teaching hospital in the Eastern Province of Saudi Arabia. DNR order was issued for 9.6% patients out of 219 adult patients in both ICUs. Oncological conditions were shown to be significantly associated with higher DNR rates, which can be attributed to advanced stages of disease and metastasis. Our research was conducted in a single-center university-affiliated public teaching hospital. Further, prospective multi-centered studies are urged to capture a more comprehensive view of DNR determinants and patients' characteristics in this region.
Forensic entomology has proven its importance in estimating the post mortem interval (PMI) of a carcass in criminal investigations. The PMI estimation is based on life cycle and succession pattern of insects, which is influenced by the environmental conditions and access to the carcass. The present study has been carried out in the West Himalayan region of India, to study the effect of season (Summer, Monsoon, winter) and altitude (ranging from 440 m to 2140 m), and to form a database of insect faunal succession on decaying rabbit carcasses. The insect fauna attracted to the carcasses comprised a total of 12 species belonging to two orders. Out of which only four species i.e. L. cuprina, S. haemorrhoidalis, C. vicina and C. vomitoria were found to be of forensic importance in estimating PMI, as they oviposit and subsequently completed their life cycles on the carcass. It has also been observed that altitude and seasonal variation affects the arrival time, oviposition, life cycles of insects and consequently alters the estimation of PMI significantly.
Background: Deaths due to heat stroke have surged in recent years in Japan. While the long-term sequelae of heat stroke in its survivors are well understood, our previous studies suggest that heat exposure may cause fatal organ damage before the systemic inflammatory response is triggered. In this study we aimed to provide a comprehensive analysis of cytokines and other signaling factors in sera and myocardial tissues in a rat model of heat stress. Methods: Male Wistar rats were anesthetized and subjected to heat stress (37.0 degrees C, 100% humidity; n = 8) to induce heat stroke (Heat group, n = 4) or normal temperatures (Control group, n = 4) for 90 min, followed by collection of blood sera and heart tissue samples. A multiplex assay system was used to analyze serum markers. Heart tissue was subjected to multiplex RNA sequencing and gene cascade analysis, and combined with iTRAQ (isobaric tags for relative and absolute quantitation) protein pathway analysis. Results: There were significantly higher levels of five interleukins (IL- 1 alpha, IL-2, IL-6, IL-17A, IL-18), fractalkine, interferon-.-inducible protein-10, leptin, tumor necrosis factor a, and vascular endothelial growth factor, and significantly lower levels of LIX and RANTES, in the sera of the Heat group compared with the Control group. From the 2,741 genes that showed a significant difference in myocardial mRNA expression between the groups, we identified 48 transcription factors and 34 binding regions. Pathway analysis identified the involvement of key node proteins including protein kinase C isoforms, calmodulin-dependent protein kinase II, and protein interacting with C-kinase (PICK1). Conclusion: This model of heat stress in rats triggered changes in the mRNA and protein levels of many genes involved in cardiac function, primarily affecting the activity of ion channels and mitogen-activated protein kinase.
Diatom test is widely used for ascertaining the place of drowning as well as the manner of drowning i.e. ante or post mortem drowning. In this paper, we report Diatomological mapping of eight waterbodies of Himachal Pradesh across Una, Bilaspur, Mandl, Kullu, Sirmaur and Kinnuar districts during across all the seasons using SEM, which would be helpful in the correct identification of diatoms in drowning cases. Diatoms from water samples were extracted using acid digestion and analyzed using Scanning electron microscopy. The results of present study have generated database of diatom diversity in context to different seasons i.e. Summer, Autumn, Winter and Spring seasons. It has been found that majority of diatoms was observed in the Spring season due to favorable environmental conditions while the adverse effect of light and temperature in the winter season declines the growth of diatom flora. It has been concluded that during the morphological examination of diatoms, sometimes the finer details of diatoms frustules such as their valve number, striae number, raphe details cannot be examined by LM even at higher magnification. SEM is required to examine them and correct identification of diatoms can be done up to the species level.
Background: Estimation of age in individuals has received considerable at tention in forensic literature. Laccasagne in 1889 was the first to use changes in teeth of adult to estimate age. The appl icat ion of radiography in forensic sciences was introduced in 1896, just few months after the discovery of X- ray by Reontgen. Dental radiography has been employed in age estimation since 1982. Teeth are considered to be best tool for age estimation, because teeth may be preserved long after all other tissues, even bone have disintegrated. In 1995, Kvaal et al developed a new method of dental age est imat ion based on relat ionship between age and the pulp size. Objective: To evaluate the reliability of Kvaal's method in dental age estimation. Methods: Electronic search of scientific papers was carried out in Pubmed Advanced, Science direct, Cochrane, Ingenta connect databases using specific keywords. Conclusion: Review of the articles suggest that Kvaal's method can be considered as one of the radiological methods of age estimation in adults and the results of the included studies showed the difference between chronological age and estimated age is higher.
A medicolegal autopsy provides critical evidence to the cause and manner of death, demography of victim, and nature of the crime committed. This task however becomes increasingly difficult if the bodies are decomposed or skeletonized, exposed to scavengers or different environmental conditions, that may introduce a variety of alterations in the physical remains. The main objective of the postmortem examination in such cases is to diagnose skeletal wounds along with an accurate interpretation of their mechanism; as this evidence may be the only clue to a potential homicide. Thereby, the whole skeletal analysis is focused towards discovery of acute injuries and to differentiate them, simultaneously, from the postmortem modifications, as a misdiagnosis may initiate an unnecessary or even fake criminal investigation. Furthermore, in criminal circumstances, especially involving clandestine situations, it is not uncommon for a corpse to remain undiscovered for an indefinite time period thereby causing loss of medicolegally significant findings. The present case deals with the mummified and skeletonized body of a young male, which was purportedly found within an under-construction building that was almost in ruins and located at an abandoned place. The autopsy discovered multiple depressed fractures over the skull, signifying lethal blows given to the head. A detailed analysis was further performed by maceration and processing of the skull through which a sound understanding of the mechanisms involved in blunt cranial trauma could be gained. The autopsy, in conjunction with the crime scene details, helped in uncovering the story of a homicide which was later corroborated with police investigations, as the alleged weapons along with the whole story came to the light of forensic doctors. The mechanism and manner of injuries along with the possible cause( s) of death are explained.
The keyhole lesion has been classically related to a tangential and superficial bullet strike to the cranium. A case of homicidal perforating gunshot wound to the head is described that showed an entrance keyhole defect over the left parietal bone while the corresponding exit defect was present over the ipsilateral sphenoid region. The lesion comprised of a roundish defect with internal beveling and a wedge-semicircular defect with external beveling that upon first inspection was present as a partly detached bone plug under the scalp and easily movable in a hinge-like manner. An autopsy reconstruction of the bullet track suggested an atypical and nontangential strike over the cranium, causing through and through perforation of brain. An intact full metal jacket bullet was recovered from the scene. The traditional explanation of the keyhole lesion following a tangential strike has sometimes created difficulties in wound interpretation in the past. In the present case, the possible mode of the keyhole formation from a non-tangential strike is explained that may help the pathologist in ascertaining the shot direction, in case confusion arises during the autopsy. An appropriate observation can further help in avoiding a legal bearing that may possibly arise in the future.
As countries become more developed, there will be a need for more sophisticated dental treatment provided which may bring about adverse outcomes. To protect oneself against any financial loss or any legal liability, dental practitioners have to acquire an insurance policy. This research is to determine the different benefits provided by the professional indemnity insurers. The objectives were to gather the type of cases of complaints made, to ascertain the different insurers involved in providing indemnity insurance, the various treatments covered. An interview was done with four insurer's representative and the data obtained were analysed based on the premium rates and increments, compensation limits, additional limit reinstatement, retroactive and run off covers, limit of claims made, locum dentists' cover, institutional coverage and any additional benefits according to each insurance policy. The findings indicated insurers have a lower premium rate for a reasonable compensation; another with a higher premium with a comprehensive dental insurance coverage which manages from the clinic to any court settlements. There is one to cater for those wishing an insurance based Shariah principles and another which not only covers indemnity but also any damage to clinic and any adverse action by any of the employees.
Background: Chronic lead poisoning manifestations is often non-specific and may mimic neurologic diseases, gastrointestinal problems, and hematologic disorders. When there is no history of lead exposure, it may be misdiagnosed. Trying to search occult exposure is very important and poisoning could be diagnosed by a simple test of blood lead level.Methods: Here we describe a case of lead poisoning with presentation of acute generalized muscle weakness who was admitted with primary diagnosis of Botulism. We also reviewed the literatures on this topic.Results: The primary diagnosis was food poisoning in further investigation, it revealed that his job is recovering of electronic piece of old computers for about 20 years. Based on recurrent uncontrollable abdominal pain, constipation, generalized weakness, associated with hypochromic microcytic anemia, a highly suspicious to chronic lead toxicity was considered. Patient's blood lead level was 149 mu gr/dL (normal:2-25).Conclusions: Detailed clinical investigation is the first step for identifying rare presentations of lead poisoning cases. The health hazards of lead poisoning are rising due to lack of education regarding the dangers of working with lead. With improving national health policies, we can prevent this chronic and subtle poisoning.
