Doble mecanismo de estrangulación. A propósito de un caso / Double mechanism of strangulation. Apropos of a case

RESUMEN Las asfixias mecánicas son aquellas que resultan del impedimento mecánico a la penetración del aire en las vías respiratorias, suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina y a su modo de actuar. La estrangulación puede definirse como la constricción del cuello mediante la aplicación de una fuerza activa, ajena al peso del cuerpo, que actúa por intermedio de un lazo, las manos, el antebrazo o cualquier otra estructura rígida. En la estrangulación antebraquial, la constricción del cuello se lleva a cabo normalmente rodeando al individuo con el brazo y el antebrazo. Cuando el mecanismo de la compresión del cuello es lateral, no se afectan las vías aéreas, la compresión de las arterias carótidas hace que se produzca una isquemia cerebral y pérdida de conocimiento en 10-15 segundos. El mecanismo de muerte en estos casos será la anoxia cefálica. Si la compresión del cuello es anterior, actúa ocluyendo las vías aéreas, la presión sobre los cartílagos tiroides y cricoides puede producir fracturas y el mecanismo de muerte será la obstrucción respiratoria. El presente trabajo constituyó un caso poco común de estrangulación, donde se utilizó un mecanismo combinado que llevó al occiso al deceso final. Para la realización de la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, el examen del exterior y el interior del cadáver (AU).

ABSTRACT Mechanical asphyxias are those resulting from the mechanical obstruction of the air penetration in the airways. They are usually classified according to the nature of the mechanical mean producing it and the way it performs. Strangulation may be defined as neck constriction through the application of an active force not proper to the body weight, acting by means of a knot, hands, forearm or any stiff structure. In ante brachial strangulation, neck constriction is normally performed surrounding the individual with the arm and forearm. When the neck constriction mechanism is lateral, the airways are not affected: carotid arteries constriction produces a brain stroke and loss of consciousness in 10-15 s. The death mechanism in these cases will be cephalic anoxia. If the neck compression is anterior, it occludes the airways; the pressure on thyroidal and cricoid cartilages may produce fractures and death mechanism will be respiratory obstruction. The current work deals with an uncommon strangulation case, where a combined mechanism led the person to the final decease. For the case discussion the authors took into account the elements of the place, and the examination of the exterior and the inside of the corpse (AU).

Ahorcamiento con soga. Presentación de un caso atípico / Hanging with rope. Presentation of an atypical case

RESUMEN Las asfixias mecánicas son aquellas que resultan de un impedimento mecánico a la penetración del aire en las vías respiratorias. Suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina, y a su modo de actuar. El ahorcamiento no es más que la constricción del cuello, ejercida por un lazo sujeto a un punto fijo, sobre el cual ejerce tracción el propio peso del cuerpo. La muerte, según las circunstancias del caso, puede ocurrir por un mecanismo asfíctico, circulatorio, inhibitorio o por lesión medular (caso raro de presentación). El presente trabajo constituyó un caso atípico de ahorcamiento. El ciudadano que resultó fallecido, al dejarse caer bruscamente del balcón de su vivienda, con el dogal en el cuello (soga) y quedar pendiendo el cuerpo, ocasionó un traumatismo raquimedular severo; lo que trajo como consecuencia que se produjera una fractura de la 3ra vértebra cervical, y una contusión medular que lo llevó a la muerte de forma instantánea por el shock medular ocasionado. Para la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, y el examen del cadáver externa e internamente.

ABSTRACT Mechanical asphyxias are those resulting from a mechanical interruption of air penetration to the respiratory tract. They are usually classified according to the nature of the mechanical mean originating them and the way they perform. Hanging is no more that the neck constriction, executed by a lace attached to a fixed point, on which the proper weight of the body applies traction. Death, according to the circumstances of the case, may occur by an asphyxiating, circulatory, inhibitory mechanism or by medullar lesion (a rare case of presentation). The current work reports a case of atypical hanging. The person who died, when abruptly jumped down the balcony of his house with the rope around the neck and the body was left pending, suffered a severe spinomedullar trauma, causing a fracture of the 3rd cervical vertebra, and a medullar contusion causing an instantaneous death due to the medullar shock. To discuss the case, the authors took into account elements of the location where it took place, and the external and internal examination of the body.

Utilización de signos inespecíficos en el diagnóstico de asfixia por sumersión. Caso y revisión bibliográfica / Use of nonspecific signs in the diagnosis of asphyxia by submersion. Case and Bibliographic review

Las asfixias por sumersión representan un enorme reto para los médicos no solo por la dificultad para llegar a un diagnóstico definitivo de la causa de muerte, sino por la dificultad para determinar las circunstancias en las que se han producido; cuando el cadáver además está en putrefacción, representan un verdadero desafío; por lo que en algunos de estos casos, los forenses se auxilian de hallazgos inespecíficos para establecer la causa de muerte. Presentamos el caso de un menor de edad que se encontró en las riveras de un río, con antropofagia cadavérica extensa y en estado de putrefacción, la causa de muerte se concluyó utilizando algunos hallazgos inespecíficos como indicadores de asfixia por sumersión. Se analizó la validez de utilizar estos signos como indicadores asfícticos...(AU)

Muerte inesperada del lactante: Análisis de 591 casos / Sudden infant death: 591 cases analysis

Antecedentes: la muerte inesperada del lactante (MIL) sin asistencia, ya sea en domicilio o a su arribo al hospital conlleva a un impedimento en la firma del certificado de defunción y al necesario peritaje forense a los efectos de descartar las causas no naturales. Conocer la causa de muerte es de suma importancia no sólo para las autoridades sanitarias sino para los Pediatras a afectos actuar sobre los factores implicados. Objetivos: el objetivo de esta revisión es analizar las patologías encontradas y las circunstancias que rodearon a la muerte en los casos MIL, a los efectos de identificar factores de riesgo. Métodos: se incluyeron en este estudio 591 menores de un año fallecidos en forma súbita e inesperada, en domicilio o a su arribo a un centro asistencial, ingresados al Programa MIL, entre octubre de 1998 y diciembre de 2015, con intervalo libre 2002-2006. No todos los fallecidos en dicho período en iguales circunstancias fueron enviados para su estudio. Se reunió historia clínica, circunstancias de la muerte y la familia fue entrevistada. Los casos fueron analizados por el grupo interdisciplinario. Se clasificó como: Muerte Explicable cuando se encuentra una causa y Muerte Indeterminada cuando no se encuentra una causa. Estas últimas están constituidas por Síndrome de Muerte Súbita del Lactante (SMSL) y las Zonas Grises (ZG). Se agruparon como ZG aquellos casos en los que no había una causa que con certeza explicara la muerte, pero había factores predisponentes que pudieron causarla o favorecerla. Estas ZG fueron distribuidas en 6 categorías. Para clasificar como SMSL el grupo exige la ausencia de colecho, de decúbito prono, de almohada y de otros entornos factibles de causar sofocación. Resultados: se estudiaron 591 casos. Se identificó una causa de muerte en 339 casos (57.4%). En 252 la muerte fue indeterminada (42.6%). Se encontró infección respiratoria en 29% de los casos (50% de las muertes explicables); anomalía cardíaca en 15%; diarrea con deshidratación en 4.5%; sofocación accidental en 3%; se identificó una causa violenta en 1.5%. Hubo variación entre los dos períodos (1998-2001 y 2007-2015). De los casos indeterminados, 242 correspondieron ZG y 10 a SMSL. En 91% de las ZG menores de 4 meses de edad que tienen el dato evaluable, hubo un entorno de sueño inseguro. El colecho se observó en 72%, principalmente múltiple o asociado a decúbito prono u otros factores de riesgo. En neonatos, el 81% de las ZG evaluables, tuvo un factor de riesgo asociado a las condiciones de sueño. Conclusiones: se identificaron patologías sobre las que es posible actuar desde la prevención (infecciones respiratorias, diagnóstico prenatal de cardiopatías). En los casos indeterminados, se identificaron factores de riesgo modificables desde el primer nivel de atención con la implementación de campañas educativas y recomendaciones sobre sueño seguro dirigidas a la comunidad.

Background: sudden unexpected death in infancy (SUDI) carries an impediment to sign the death certificate. A legal autopsy is mandatory to exclude unnatural death. To know the cause of death in infancy is relevant to health authorities and paediatrics. Objectives: to investigate the pathologies and risk factors in the cases of SUDI studied. Methods: autopsies between October 1998 and December 2015 were analysed. There was a free interval (2002 to 2006). It does not include every case of SUDI in the local population. The clinical records were gathered, the circumstances of death investigated and the family was interviewed. The cases were discussed in a multidisciplinary team. The cases were classified as Explained Death or Undetermined. The undetermined deaths were classified either as Gray Zone (GZ) or SIDS cases. Six categories were considered in GZ. To consider a case as SIDS, a safe sleep environment is required; that means no co-sleeping, no prone sleeping and no pillows use that could eventually cause suffocation. Cases were coded as GZ when a clear cause of death was not identified, but abnormalities were found that could have predisposed or contributed to death. GZ were divided in 6 categories. Results: 591 cases were examined. A cause of death was identified in 339 cases (57.4%). In 252 cases, it was undetermined (42.6%). A respiratory infection was found in 29% of the autopsies (50% of the explained deaths). A cardiac anomaly was found in 15%; dehydration secondary to diarrhoea in 4.5%; suffocation in 3%; a violent cause was identified in 1.5%. There were variations between both periods (1998-2001 and 2007-2015). 252 deaths remained unexplained after the autopsy (42.6%), these were the undetermined cases. 242 were classified as Gray Zone (GZ) and 10 as SIDS cases. 91% of the evaluable GZ cases <4 months old had an unsafe sleeping environment. Co-sleeping was observed in 72% of the evaluable <4 month cases; it was mainly multiple or associated with prone sleeping position. In newborns, 81% of the evaluable ZG cases had a sleep related risk factor. Conclusions: The study improved allowed to identify pathologies amenable to intervention and prevention (respiratory infections, prenatal diagnosis of congenital heart disease). Sleep related risk factors were identified, amenable to prevention through community education programs.

Prevalencia puntual de consumo de sustancias en individuos que cometen suicidio por asfixia secundario a ahorcamiento en Santiago, 2014-2015 / Point prevalence of consumption of substances in individuals who commit suicide for asphyxia by hanging in Santiago, 2014-2015

Introducción: El trastorno por consumo de sustancias se ha asociado a suicidio, el que constituye la segunda causa de muerte en individuos entre 15 y 29 años. Dentro de los mecanismos más comunes de suicidio, se encuentra la asfixia por ahorcamiento. Objetivo: Determinar la prevalencia puntual de consumo de sustancias en individuos que ingresaron al Servicio Médico Legal (SML) de Avenida La Paz #1.012, Independencia, Santiago de Chile por suicidio secundario a asfixia por ahorcamiento durante 2014-2015. Materiales y métodos: Estudio de corte transversal en individuos que ingresaron al SML entre los años 2014-2015, cuya causa de muerte correspondiera a suicidio por asfixia por ahorcamiento y que tuvieran registros de: sexo, edad, alcoholemia y examen toxicológico. Se utilizó una plantilla Excel® 2011, determinándose estadística descriptiva y análisis porcentual. Resultados: Durante los años 2014-2015, ingresaron 8.321 individuos al SML, de los cuales se seleccionaron aleatoriamente 1.218 individuos. De dicha muestra, un 11,58% correspondió a muertes secundarias a asfixia por ahorcamiento. De éstos un 74,47% eran varones. El rango etario más frecuente correspondió a los 40-49 años. Un 49,65 % tenía alcoholemia positiva en sangre y un 58,87 % examen toxicológico positivo, siendo lo más frecuente la asociación de dos o más sustancias al momento del suicidio (39,72 %). Discusión: Se observan resultados similares en relación a edad, sexo en comparación a estudios similares, no así cuando se comparan las sustancias consumidas, donde hubo mayor prevalencia de cocaína. La prevalencia de consumo de sustancias en casos de suicidios consumados es de un 58,86%.

Introduction: The disorder for consumption of substances has been associated to suicide, this constitute the second cause of death in individuals between 15 and 29 years old. Among the most common mechanisms of suicide we found asphyxia by hanging. Objective: Determine the point prevalence in the consume of substances of individuals that were admitted in the Medical Legal Service (MLS) of Avenida La Paz #1.012, Independencia, Santiago de Chile, for secondary suicide asphyxia by hanging during 2014-2015. Materials and methods: Cross-sectional study in individuals admitted in MLS between 2014-2015, whose cause of death corresponded to suicide due asphyxia by hanging wich had registers of: sex, age, blood alcohol test and toxicological exam. A 2011 Excel® template was used, determining descriptive statistics and percentage analysis. Results: During the years 2014-2015, 8.321 were admitted in MLS, of which 1.218 were randomly selected. Of this sample, 11.58 % corresponded to secondary death to asphyxia by hanging. Of these, 74.47 % were male. The most frequent age range corresponds to 40-49 years. 46.65 % hadethanol in blood and 58.87 % positive toxicological test, being the most frequent the association of two or more substances at the moment of the suicide (39.72 %). Discussion: Similar results are observed in relation to age, sex compared to similar studies, but not when comparing substances consumed, where there was a higher prevalence of cocaine. The prevalence of substances consumed in cases of completed suicides is 58.86%.

Retrospective forensic analysis of 483 solved homicide cases in Suzhou city / 法医学杂志

OBJECTIVE@#To summarize the solved homicide cases taking place in Suzhou city and to find out the characteristics and commonness of them in order to analyze the key points of investigation at the scene.@*METHODS@#The data of 483 solved homicide cases occurring from January 2006 to March 2010 in the city were analyzed.@*RESULTS@#Most cases involved 1 victim and 1 suspect, with young male adults dominated. Most of them were non-local residents. The majority of suspects were intentional by passion due to quarrel and dispute. The most common weapons were sharp instruments generally carried by the suspects. Mechanical asphyxia and mechanical injury were the two most common causes of death in these cases.@*CONCLUSION@#The social characteristics of suspects, criminal motivation, injury instruments, distribution of injuries, cause of death, and manner of death in Suzhou showed similar general characteristics as the experience for detecting homicide cases in the future.

Effect of Prophylactic Phenobarbital on Seizures; Encephalopathy and Mortality in Neonates with Perinatal Asphyxia

Background. Seizures after an asphyxial insult may result in brain damage in neonates. Prophylactic phenobarbital may reduce seizures.Objective. To determine the effect of prophylactic phenobarbital on seizures; death and neurological outcome at hospital discharge.Methods. Neonates with base deficit 16 mmol/l and Apgar score at 5 minutes 7 or requiring resuscitation for 5 minutes at the time of birth were randomised to prophylactic phenobarbital 40 mg/kg (n=50) or placebo (controls) (n=44) within the first 6 hours of life. They were monitored for clinical seizures; hypoxic ischaemic encephalopathy (HIE) and mortality.Results. Seizures developed in 30.0 of the phenobarbital group as opposed to 47.7 of the control group (relative risk 0.63; 95 confidence interval -0.37 - 1.06; p=0.083). The proportions of patients who had died and/or had HIE II or III at time of discharge from hospital were similar in the two groups (42.0 v. 45.5). There were no differences in mortality between the two groups (14.0 v. 15.9). Conclusion. In infants with asphyxia; prophylactic phenobarbital does not reduce the incidence of seizures; HIE and mortality

Rape, sodomy and murder of a minor girl.

In this short case of article on typical sexual assault, a 14 year old minor girl was killed and found in a ditch of a jungle nearby her house. The minor girl has died as a consequence of barbarous act of sexual assault, sustained bruises on labia, recent hymnal tears, and tears around anus with signs of ligature strangulation besides the generalized signs of asphyxia. The wearing garments were found torn at places with the presence of stains of mad and sand particles. The laboratory findings confirm presence of spermatozoa. The presence of marks of violence on the genitals of the child, when an early examination is made is the strong evidence that the sexual assault has been committed. The psychiatric analysis of all the accused of this kind of cases should be made mandatory for better assessment of the cases besides an active legislative and judicial actions, comprehensive quick approaches of investigative officers and healthcare providers.

Study of hanging cases in Ahmedabad Region.

In spite of advancement in medical facilities, the natural end of life is inevitable. But for some persons, the death is destined earlier in an un-natural way. A few choose to make their own way by committing suicide. The major reasons are personnel problems, stress of life, family problems and financial problems. There are many methods for committing suicide like poisoning, hanging, self-immolation, drowning etc. Hanging provides painless death so it is one of the commonly adopted methods for suicide. However, in a few instances false allegations are made claiming that the ligature mark over neck is of strangulation rather than hanging. Vice versa cases are also likely. In such cases, the post-mortem findings are very helpful to differentiate between the two. Present prospective study was carried out at the mortuary of Civil Hospital, Ahmedabad over 2 years period ranging from December 2008 to November 2010 with a view to study to incidence, ligature materials, and post-mortem findings in hanging cases. The place of hanging, manner of death and reason for death were also studied in the study.

Landslide fatalities: A study of six cases.

A mountain collapsed on National Highway-53(NH-53) on 6th July 2011 around 2:30 p.m. A minibus which was carrying Security Personnel of Manipur Rifles (MR) and Indian Reserved Battalion (IRB) was hit by the landslide. Six occupants died on the spot and seven were injured. The cases were registered under U.D. Case no. 5/2011/G-SPM-PS and were brought to the RIMS Morgue the next day for Post Mortem Examination (PME). On PME, the victims showed general features of blunt force injuries with gross deformation and one case showed clogging of the whole respiratory tract with soil debris of the landslide. The victims died almost immediately on the spot due to vital organs injuries except in one case where it was due to traumatic asphyxia. Landslides occur frequently in these National Highways due to the hilly terrain and the perpetual rains, such major fatalities have never occurred before. Therefore the cases are reported here to analyze the types of injuries sustained, the causes of death and to discuss precautionary measures for prevention of further mishaps. This will also serve as an eye-opener to the magnitude of severity such a natural disaster.

Asphyxial deaths at District Hospital, Tumkur A retrospective study.

Asphyxial death forms one of the modes of death which may be suicidal, homicidal or accidental in nature. A retrospective study of autopsies conducted between years 2006 - 2010 is an attempt to know the incidence of asphyxial deaths at district hospital, Tumkur. During this period there were 2288 deaths, out of which 438 deaths were of asphyxial deaths. The most common form of asphyxial death was hanging followed by drowning. The incidences of asphyxial deaths were more in males than females in the ratio of 1.4:1. These cases were studied to know age and sex distribution of the victims. In this study, we found that among asphyxial deaths hanging were more 268 (61.18%) followed by drowning 140 (31.96%), strangulation 19 (4.33%) and others respectively. Appropriate education, influencing the media in their portrayal of suicidal news, reporting method, involvement of young generations in encouraging activities may reduce the rate of suicidal death by hanging in future.

A suicidal hanging with unusual findings at crime scene.

A 42 year old male, was found hanging by a plastic rope in his unbolted bed room. The rope was found attached to two suspension points (one end attached to the window panel and the other side to the ceiling knob) and the middle part of it used for the binding of neck. There was no knot present in the ligature as the right hand was found holding the ligature loop for the purpose of constriction of neck .A towel was found covering the head and underneath the ligature material on the neck used for padding. Blood stain was present on the floor below the suspended body which oozed out from the haemorrhoids. He was holding the cloth, wore in lower half of the body up to the mid thigh label, which appreciated by the authors as cadaveric spasm that developed in his flexor muscles of left hand. Detailed autopsy, crime scene examination and police investigation supported the manner of death as suicidal.

Pattern of ligature mark in cases of compressed neck in Rajkot region: a prospective study.

Ligature mark may be the only evidence available in cases of asphyxial deaths due to either hanging or strangulation. A through examination of the ligature mark and analysis of the information provided by it is therefore, a must to arrive at the most probable cause of death and differentiate between hanging and the ligature strangulation. A prospective study was conducted at the Department of Forensic Medicine, P.D.U. Medical College & Hospital, Rajkot from January 2008 to December 2008. During that period out of 2159 cases, 90 cases of hanging and 7 cases of ligature strangulation were selected for the present study. We found that deaths due to hanging constituted 4.17% of the total unnatural deaths subjected to medicolegal autopsy; young adults of the age group 21 to 30 years accounted for the maximum cases 40% and the male: female ratio was 2:1. Chunni (34.44%) was the most common ligature material used. The mark was obliquely placed (100% cases) above thyroid cartilage (80% cases). In all the cases of ligature strangulation the mark was transverse and below the level of thyroid cartilage.

Newer trends in hanging death.

A total of 105 cases of deaths due to hanging were studied in a span of 5 years time. This present study throws some light on the emerging trends that Hanging is increasingly being adopted by a relatively younger age group who are mostly illiterate and of poor socio-economic status. Hanging being viewed as giving swift painless death and without much expenses and without arousing much suspicion, this mode is increasingly adopted to commit suicide. Dribbling saliva mark, which was a hallmark of Ante-mortem hanging, is increasingly seen in less number of cases. No incidence of fracture of Hyoid bone being seen in this study, due to the fact that most cases were of lower age group and also may be due to most of the victims adopting soft ligatures and low suspension points. Transverse tears in the Carotid arteries were not seen here and on subjecting to Histo-pathological study, we could detect disruption of intimal layer of Carotid artery. Effect of pressure on layers of skin were seen on Histo-pathological study showing vital reaction changes useful for labelling Ante-mortem hanging.

Nomenclature for knot position in hanging A study of 200 cases.

Hanging is one of the common methods of committing suicide world wide. Position of the knot, in hanging cases is important as it determines the post-mortem findings of the head and face and can also be used to predict the expected autopsy findings. Although hanging has been described in forensic literature since ages, there has been no proper scientific nomenclature for classifying the position of knot in hanging cases. This paper describes a new nomenclature of exact knot position on the neck based on commonly used anatomical landmarks with self explanatory terms of classification, so that it can be understood and used by the autopsy surgeons and the pathologists with ease. In the present study 200 cases of hanging were studied retrospectively and position of knot is classified according to a newly described nomenclature. The new nomenclature classifies the position of knot into 6 major classes each of which are further subdivided into 3 subcategories thus making 18 different positions on each side of neck. The most common position of knot was found at occipitomastoid region (32%) and the least common position being at mental region (2%).

[Quality of life in burn disfigurement individuals as life in suffocation - a qualitative study]

Nowadays with improving the taking care of the burnt patients, mortality rate decreased. With the increased survival of these patients, the number of the survivors with complications increased. Among these consequences, disfigurement is the most important ones. So recently, psychosocial problems of burnt patients and their rehabilitation have been deeply paid attention to. Therefore, a qualitative study was conducted so as to obtain information concerning quality of life with burn disfigurement after being discharged from the hospital, in order to devise psycho-social support programs based on this evidence. This article reports part of a greater qualitative study. Purposive sampling and theoretical sampling was used to selecting the participants. The main data collecting tool was in-depth interviews. Thirty-four individual in-depth interviews were performed with 22 participants. The interviews were analyzed by the content analysis method and constant comparative method. After analyzing, for quality of life with burn disfigurement theme's "life in suffocation" with three core category "ruin lives", "to get tired" and "slavery disfigurement" appeared. Despite the severity of suffocation for different people was different, but it was for all participants. The evidences indicate quality of life with disfigurement even in people who few years living with problem, in a way that is inappropriate and uncomfortable as life is suffocating. Hence there exists a need to devise a proper supportive plan to enhance quality of life for these people

Pattern of neck findings in suicidal hanging A study in Manipur.

Deaths due to hanging are common among suicides. In a study on 84 cases of suicidal hanging brought for autopsy to the mortuary of the Regional Institute of Medical Sciences, Imphal during 2004 to 2008, it was observed that 77.38% of the cases were males and 22.62% were females. The highest number of victims was in the age range of 21-40 years. 73.81% of the cases committed suicide indoors and 57.14% of them used ropes as ligature material. 85.75% of the victims had fixed knots with a single turn and 10.71% had slip knots. Complete atypical hanging constituted 88.10% of the cases. 23.81% of the cases had tear of the carotid artery and 3.57% had hyoid fractures. None of the cases had cricoid or trachea fractures. The neck findings vary depending upon the composition, multiplicity and tightness of the ligature material used, the suspension time, type of hanging, etc. Hence, the possible findings in a suspected case of hanging must be always anticipated so as to avoid any erroneous opinion.

Diatoms: Role in drowning.

Drowning is a form of asphyxia due to aspiration of fluid into air passages caused by submersion in water or other fluid and is mostly accidental. The main question in case of a body recovered from water is whether the individual was alive at the time he entered water. If a body is found in water is does not necessarily mean, that this person has drowned.Deaths by drowning are difficult to determine and are often diagnosed by eliminating all other potential causes of death. Diatoms found inside the body of a drowned victim may serve as corroborative evidence in the diagnosis of cause of death. It can be ascertained whether the drowning is ante-mortem or post-mortem. The diatom test stands as the only direct screening test for drowning. The present case is one such example wherein the presence of diatoms has helped in arriving at a decision of ante mortem drowning, thereby emphasising its significance.

Traumatic asphyxial deaths due to an uncontrolled crowd at railway station: Two case reports.

Deaths in stampede accidents are not new in India. Majority of causalities occurred as a result of traumatic asphyxia in such cases. Traumatic asphyxia is a rare syndrome first described over 150 years ago by Olivier. It is caused by sudden compressive chest trauma and is associated with craniocervical cyanosis, facial edema and petechiae, sub-conjunctival hemorrhage, and neurological symptoms. Although minor incidents of jostling are common at railway stations, but deaths occurring consequent to stampede by an uncontrollable crowd is not very common. A stampede occurred at New Delhi railway station which results in death of two persons and injuring many. The autopsy findings along with circumstantial evidence, results in arriving of conclusion that these deaths occurs as a consequence of traumatic asphyxia. Various clinical features of this condition are described in the literature, a brief review of which is given in this article. In the conclusion few preventive measures are also suggested so that in future such tragedies can be averted.