Heart attack encroaching fourth decade: autopsy study of western Maharashtra

Background: Indians are known to have the highest coronary artery disease (CAD) rates, and the conventional risk factors fail to explain this increased risk. At present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). Methods: An autopsy study of 6 years: January 2015 to December 2020 which included heart specimens affected by MI from medicolegal autopsies received in histopathology section. The received heart specimens were fixed in 10% formalin and processed as per routine histotechniques with H&E stain and slides prepared were studied under light microscopy. Results: Maximum number of myocardial infarction cases 21 (23.5%) were seen in the age group of 41-50. Commonest histopathological pattern noted was Healed myocardial infarction 38 (42.6%), followed by acute myocardial infarction (AMI) 29 (32.5%) then acute with healed myocardial infarction (AHMI) 22 (24.7%). Conclusions: Atherosclerosis being the most common cause of MI but frequency of non-atherosclerotic myocardial infarction is rising in 4th decade which is a matter of concern. The study of human atherosclerotic lesion is an extremely difficult task in a living subject and an autopsy study is the best possible way to work on it.

Death due to sickle cell anaemia, an autopsy diagnosis: a study at a tertiary care hospital.

Background: Sickle cell disease (SCD) is the generic term for the group of inherited haemoglobinopathies caused by the occurrence of Haemoglobin S (HbS) in the homozygous or heterozygous form in combination of Hbs with another abnormal haemoglobin such as HbSC or beta-thalassaemias (HbS-thal). Sickle cell syndromes are remarkable for their clinical heterogeneity, including their presentations as sudden and unexpected deaths due to a sickle cell crisis. Less numbers of deaths are reported due to this cause because of ignorance of autopsy surgeon in considering this disease as a cause of death despite of its high prevalence. While doing autopsy in cases of deaths with no apparent cause and physical over activity medical officer must keep in mind the possibility of death due to vaso-occlusive crisis in sickle cell disease. Methods: The study covers a period of one year (January 2013 - December 2013) and it is a study of cases of autopsy carried out in a tertiary care hospital of South Gujarat. Results: A total of 607 cases examined, out of which sickled red blood cells were detected in 17 cases. The respective records were reviewed. Out of 17 cases, 13 cases were male and 4 cases were females. The youngest person was 15 years female and oldest was 70 years male. Conclusion: Sickle cell crisis is one of the causes of sudden unexplained deaths. The present study highlights the role of autopsy in such cases. Community awareness and marriage counseling programs are also helpful in preventing sickle cell disease.

Medicolegal Review of Deaths Related to Propofol Administration: Analysis of 36 Autopsied Cases / 대한법의학회지

Propofol is a widely used anesthetic in anesthesia and sedation. Recent cases of propofol-induced death have been associated with adverse effects, abuse, or intoxication. However, there are few forensic reports of propofol-associated death. We reviewed and analyzed 36 cases of death related to propofol administration recorded by the National Forensic Service in 2000-2011. The number of women was 28 (77.8%). Subjects in their 20s and 30s accounted for 61.1% of cases. Cause included medical accidents, 16 (44.4%); suicides, 2 (5.6%); and undetermined, 18 (50%; suicide/accident). Of the 16 medical accidents, 8 were internal medicine cases (conscious sedation endoscopy), 3 surgical cases, 3 plastic surgery cases, 1 urology case, and 1 obstetrics and gynecology case. In 20 cases of suicide or undetermined (suicide/accident), the victims were nurses (9 cases), doctors (4 cases), hospital administrators (2 cases), homemakers (2 cases), bar hostesses (2 cases) and an office worker (1 case). The doctor included 2 plastic surgeons, an internist, and a resident anesthesiologist. The autopsy findings were nonspecific; congested parenchymal organs (34 cases), pulmonary edema (8 cases), cerebral edema (2 cases), pulmonary and cerebral edema (2 cases), putrefaction (2 cases), mucosal petechiae in the interior of the larynx (1 case), and cerebral ischemic necrosis and pneumonia (1 case). The blood propofol concentrations ranged between 0.007 mg/L (cardiopulmonary resuscitation) or 0.23 mg/L (no cardiopulmonary resuscitation) and 4.38 mg/L in medical accident cases, and from 0.12 mg/L to 108.3 mg/L in suicide or undetermined (suicide/accident) cases. Other drugs were detected in 17 cases and alcohol was detected in only 2 cases. Blood concentrations in cases of medical accident were lower than in cases of undetermined cause.

Incidence of suicides by poisoning with a popular indian brand of hair dye.

Hair dyes are being used extensively by the general populace in India, and several brands are available in the market. There are increasing reports of suicidal ingestion of hair dye from various parts of the country because of easy availability and high lethality. This autopsy study was conducted with reference to deaths resulting from suicidal exposure to one of the most popular brands of permanent hair dye (Super Vasmol 33) in this part of the country, in order to understand the incidence and implications. Results revealed a female preponderance, with the most common age group affected being 20–30 years.

Incidence of poisoning deaths in and around Belgaum, Karnataka: A retrospective autopsy survey.

A five-year retrospective study was undertaken to ascertain the incidence of poisoning deaths in and around Belgaum district of Karnataka state, which were autopsied at KLE's Prabhakar Kore Hospital and Research Centre, Belgaum, a referral hospital catering to the needs of the general public within a radius of 100 km. Out of 600 autopsies conducted, 150 were deaths due to poisoning. The commonest age group of affected victims was 21 to 30 years. Males outnumbered females in a ratio of 2.2:1. The most commonly used poison was an organophosphorus compound. Most victims died within 1 to 6 hours of admission to the hospital. Most of the cases were suicidal in nature.