Forensic Research Progress on Postural Asphyxia / 法医学杂志

In recent years, the increase in the number of cases of postural asphyxia has gradually attracted the attention and discussion of forensic scientists domestically and internationally, but a systematic, comprehensive and recognized expert consensus and identification standard has not been established at home and abroad. This paper reviews the case characteristics, occurrence, mechanism of death, and identification criteria of postural asphyxia, to provide reference for future research.

Application of Correspondence Analysis in the Analysis of Accidental Death of Chinese Residents / 法医学杂志

Objective To study the preference relation between residence, sex, age and causes of accidental death of Chinese residents. Methods In this study, 72 residence-sex-age groups and 8 causes of accidental death were qualitatively and quantitatively analyzed by correspondence analysis using the official statistical yearbook issued from 2014 to 2018, and the preference values were calculated. Results Among the 576 pairs of correspondences between the residence-sex-age groups and causes of accidental death, 352 pairs （61.11%） showed a preference relation （preference value>0）. In terms of residence and sex, accidental death preference among Chinese residents was higher in rural areas than in urban areas, and males were higher than females. In terms of the causes of accidental death, the overall risk of accidental mechanical asphyxia and motor vehicle accidents was the highest among all age groups of Chinese residents. In terms of age, with the increase of age, the preference value of accidental death of Chinese residents showed a trend of first increasing and then decreasing. The comparative analysis results of the preference values of various causes of accidental death in different age groups showed that motor vehicle traffic accidents, accidental poisoning, death by crush and electric shock were more likely to occur in the working age group between 20 and 59 years old, accidental fall and fire were more likely to occur in the elderly group over 80 years old, and drowning and accidental mechanical asphyxia were more likely to occur in the minor group between 1 and 19 years old. Conclusion There are different preference relations between residence-sex-age groups and causes of accidental death in China. Therefore, effective control strategies and measures should be formulated for Chinese residents with preference for accidental death.

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.

Hematoma sofocante, su fisiopatología / Suffocating hematoma, its pathophysiology

Se revisan la fisiopatología y los mecanismos que producen la sofocación en el hematoma cervical y se determina que el único tratamiento con posibilidades de éxito vital es el inmediato drenaje del hematoma.

In this article are reviewed the physiopathology and the mechanisms that causes suffocation in the cervical hematoma. It is determined that the only treatment with possibilities of vital success is the immediate drainage of the hematoma.

Estrangulamento acidental em crianças por fechamento automático de vidro de carro / Accidental strangulation in children by the automatic closing of a car window

RESUMO Entre as principais causas de morte em nosso meio, situam-se acidentes automobilísticos, afogamento e queimaduras acidentais. O estrangulamento é uma injúria potencialmente fatal, além de importante causa de homicídio e suicídio em adultos e adolescentes. Em crianças, sua ocorrência é usualmente acidental. No entanto, nos últimos anos, vários casos de estrangulamento acidental em crianças ao redor do mundo têm sido reportados. Paciente masculino de 2 anos de idade foi vítima de estrangulamento em vidro do carro. Admitido na unidade de terapia intensiva pediátrica com Escala de Coma de Glasgow de 8, piora progressiva da disfunção respiratória e torpor. Paciente apresentou quadro de Síndrome da Angústia Respiratória Aguda, edema agudo de pulmão e choque. Foi manejado com ventilação mecânica protetora, drogas vosoativas e antibioticoterapia. Recebeu alta da unidade de terapia intensiva sem sequelas neurológicas ou pulmonares. Após 12 dias de internação, teve hospitalar alta para casa em ótimo estado. A incidência de estrangulamento por vidro de automóvel é rara, mas de alta morbimortalidade, devido ao mecanismo de asfixia ocasionado. Felizmente, os automóveis mais modernos dispõem de dispositivos que interrompem o fechamento automático dos vidros se for encontrada alguma resistência. No entanto, visto a gravidade das complicações de pacientes vítimas de estrangulamento, é significativamente relevante o manejo intensivo neuroventilatório e hemodinâmico das patologias envolvidas, para redução da morbimortalidade, assim como é necessário implementar novas campanhas para educação dos pais e cuidadores das crianças, visando evitar acidentes facilmente preveníveis e otimizar os mecanismos de segurança nos automóveis com vidros elétricos.

ABSTRACT Among the main causes of death in our country are car accidents, drowning and accidental burns. Strangulation is a potentially fatal injury and an important cause of homicide and suicide among adults and adolescents. In children, its occurrence is usually accidental. However, in recent years, several cases of accidental strangulation in children around the world have been reported. A 2-year-old male patient was strangled in a car window. The patient was admitted to the pediatric intensive care unit with a Glasgow Coma Scale score of 8 and presented with progressive worsening of respiratory dysfunction and torpor. The patient also presented acute respiratory distress syndrome, acute pulmonary edema and shock. He was managed with protective mechanical ventilation, vasoactive drugs and antibiotic therapy. He was discharged from the intensive care unit without neurological or pulmonary sequelae. After 12 days of hospitalization, he was discharged from the hospital, and his state was very good. The incidence of automobile window strangulation is rare but of high morbidity and mortality due to the resulting choking mechanism. Fortunately, newer cars have devices that stop the automatic closing of the windows if resistance is encountered. However, considering the severity of complications strangulated patients experience, the intensive neuro-ventilatory and hemodynamic management of the pathologies involved is important to reduce morbidity and mortality, as is the need to implement new campaigns for the education of parents and caregivers of children, aiming to avoid easily preventable accidents and to optimize safety mechanisms in cars with electric windows.

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.

Suicide pact by hanging: A case report.

Suicides are more likely to occur during periods of socioeconomic, family and individual crisis. A suicide pact is an agreement between two people to end their lives. Most suicides are solitary and private; but few results from a pact between 2 people to die together. It is predominantly made by male-female partners and by less violent methods. Suicide pact between people of the same gender is an unusual event. We discussed a case of a suicide pact where a 19-year-old male and a 20-year-old male who were friends committed suicide by hanging because of drug addiction and poverty. Two young adult male made a pact to commit suicide by hanging themselves from a ceiling hook. It is unique case in this regard. Suicide pact is also very interesting from the perspective of medical examiners. They need to make comprehensive postmortem examination to finally conclude the proper cause and the manner of death.

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.

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.

Analysis of 27 death cases of the abandoned babies in Shanghai / 法医学杂志

OBJECTIVE@#To analyze and summarize the characteristics of the death cases of the abandoned babies in Shanghai, and to explore the main points and features in forensic investigation.@*METHODS@#Twenty-seven death cases of the abandoned babies were selected from 2007 to 2011 in the Institute of Forensic Science of Shanghai Public Security Bureau. The cases were retrospectively analyzed in the respects of scene of abandonment, cause of death and manner of death, etc.@*RESULTS@#Among the death cases of the abandoned babies in Shanghai, most of the infants were alive with young unmarried mothers. The main cause of death was mechanical asphyxia, and homicide occurred more commonly.@*CONCLUSION@#It is significantly difficult to determine the cause and manner of death in such cases, needing to be a comprehensive analysis on the case background, the investigation of scene and the examination of injury, etc.

Female infanticide.

Killing infant girls is something most of us cannot imagine. As shocking and disturbing as this behavior is, however, we must look at in within its cultural context. In some Indian communities there is a preference for male children. This attitude is rooted in a complex set of social, cultural and economic factors. Daughters will require a sizable financial dowry in order to marry. This dowry system, lack of economic independence, social customs and traditions has relegated the female to a secondary status. Because daughters leave their families of origin, they are often regarded as temporary members of their families and a drain on its wealth. There is an expression in India that ―bringing up a daughter is like watering a neighbor‘s plant‖. In most of such cases of female infanticide the perpetrator is the mother of the infant. Here we are highlighting a case where a new born female was suspected to have been brutally killed by her parent.

Suicidal hanging: A prospective study.

The objective of this study was to focus on various factors associated with suicide by hanging at Chennai, India; with a view to identify the areas of intervention. A prospective study was carried out on 65 cases of death due to suicide by hanging which was received by the Institute of Forensic Medicine, Madras Medical College, Chennai, India, during the period of August 2008- July 2009. In the present study, 84.7%% of the cases were below the age of 40years, time of hanging in 50.8% of the cases was 3am-12noon, place of hanging in 95.5% of the cases was their residence, 92.3% were living with their family and 69.2% were married. Most frequent precipitating factors were marital unhappiness (33.8%), problems associated with organic disease (18.5%) and dowry harassment (16.8%). To reduce the incidence of suicides by hanging, there is urgent need to focus on these factors.

Positional asphyxia: An opinion of exclusion.

The process of normal respiration depends upon three vital components i.e. a patent airway, an intact surface for gas exchange and a normally working ventilatory apparatus. The positional asphyxia has been defined as asphyxia caused due to unusual position of the body which interferes with the breathing and thus pulmonary ventilation. We are reporting a case of an adult female, who under the influence of alcohol positioned herself in such a way which led her to death due to positional asphyxia. The internal and external findings were non-specific. Therefore the exclusion criteria were used to conclude that the death was due to positional asphyxia. The cases of positional asphyxia are difficult to diagnose because of the absence of any specific external findings. The internal findings found in such cases are also non-specific and can be found in any case of an asphyxial death.

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.

Bride burning: a heinous crime.

“Dowry” is defined as meaning money, or other thing estimated in terms of money, demanded from the wife or her parents or her relatives by the husband or his parents or other relatives, where such a demand is not properly referable to any legally recognized claim and is relatable only to the wife’s having married into the husband’s family. Dowry death, a heinous crime is gradually engulfing and polluting the entire society. Newly married young women are the victims who adopted the way of suicide to end their lives by burning, hanging, poisoning or drowning. A 23 years old married female had died in her kitchen under suspicious circumstances within one year of her marriage life by burning with some inflammable material on dated 22/12/2009. The post-mortem examination revealed that death was due to asphyxia as a result of pressure over neck. 98% of dermo-epidermal burn present over body was post mortem in nature. Manner of death was homicidal. A medico legal aspect of the case is discussed in this article.

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.