The eye in forensic practice: In the dead.

Post-mortem examination of the eye provides valuable forensic information yet is often overlooked. This brief review focuses on determining the cause/manner of death and post-mortem interval. External eye findings like corneal haziness and tache noire, combined with post-mortem changes in the iris, lens, retina and vitreous humour, can help estimate time since death. Ocular biometrics (iris/retinal scans) may facilitate identification. Age-related ocular changes can provide insights. The eye offers clues into personality (corneal tattooing, trichotillomania) and cause of death (petechiae in strangulation, retinal haemorrhages in abusive head trauma). Ocular trauma and underlying eye disease may be evident. Toxicology of vitreous humour can detect drugs/poisons. As a window into systemic disease and age-related changes, the eye aids pathology interpretations and, accordingly, post-mortem examinations have value. Ocular findings should not be overlooked in forensic examinations as they provide distinct information in determining cause/manner of death and post-mortem interval.

Anemia Awareness Program in a Suburban Middle School: A Pilot Study Promoting Students as Public Health Advocates in Their Community.

INTRODUCTION: Almost a quarter of the people on earth are anemic, and most of them reside in regions of sub-Saharan Africa and South Asia. Anemia in children is linked with impaired cognitive and motor development and affects the future earning capacity. The most common cause of anemia is iron deficiency. The Indian Government has initiated multiple programs for the eradication of anemia. The prevalence of anemia has not decreased despite the improvements in the country's economy. It increased from 58.7% in 2015-16 to 67.1% in 2019-21 in children and from 50.4% in 2015-16 to 52.2% in 2019-21 in pregnant women. Maternal education, socioeconomic status, and number of children in the family are some factors that influence the prevalence of anemia. As these factors cannot be improved in a short time, we aimed to increase awareness about this issue by targeting school students from rural/semi-urban backgrounds. METHODS: This pilot study aimed at promoting school students as public health advocates in their community. Anemia Awareness Program was conducted in a local middle school in the suburban area, which was attended by 153 class eight students (72 female). Pre- and post-test questionnaires comprising 20 multiple-choice/true-false type questions were used. Pre- and post-test scores were obtained. The second part of the study was the identification of students with anemia. Blood hemoglobin levels of 127 students (58 female) were measured from venous blood samples. The students were also asked to inform their friends/relatives about anemia and to send people with symptoms of anemia to the free two-day Anemia Awareness Camp organized by the Medical College Hospital for check-ups. RESULTS: The mean post-test score (15.68/20) was much higher than the pretest score (2.99/20). Thirty-eight (25 female) out of 127 students had mild/moderate microcytic hypochromic anemia, suggesting iron deficiency. Thirty-two persons visited the free health camp to receive information from the students, of whom four had normal hemoglobin levels. CONCLUSION: This pilot study showed that physician-conducted anemia awareness programs are relatively low-cost methods to spread information among the general population in India.

The eye in forensic practice: In the living.

Eye examination plays an important role when living individuals are forensically investigated. The iris colour, retinal scans and other biometric features may be used for identification purposes while visual impairments may have legal implications in employment, driving and accidents. Ocular manifestations provide clues regarding substance abuse, poisoning and toxicity, and evidence of trauma, abuse or disease can be revealed along with psychological traits and lifestyle. Thus, the eye is a valuable tool in forensic investigations of living subjects, providing identifying characteristics along with health information. This review focuses on the medico-legal aspects of the eye's contribution when the living are subjected to forensic examination.

An Unusual Origin of the Left Vertebral Artery: A Case Report.

The present paper describes a 53-year-old male who presented to the emergency department with a history of sudden chest pain followed by unconsciousness at home. The autopsy revealed the left vertebral artery (LVA)'s aberrant origin from the aortic arch between the left common carotid artery and subclavian artery in a male deceased during a medicolegal autopsy. The aortic origin of the vertebral artery is an unusual branching pattern. Knowledge about the vertebral artery's normal and variant arterial anatomy is essential for patients who undergo various surgical or interventional procedures. In the sudden death of cardiac origin, its anatomy and morphology also hold crucial value. Typically, the LVA arises from the first part of the left subclavian artery (LSA).

Knowledge, Attitude and Practices (KAP) of Medical Professionals on Euthanasia: A Study From a Tertiary Care Centre in India.

INTRODUCTION: Euthanasia or mercy killing has remained as a matter of extensive debate and ethical conflicts in the scientific literature. Discussions on this theme have got legal, religious, political and philosophical ramifications. AIM OF THE STUDY: The present study aimed to assess the knowledge, attitude and practices of medical professionals in a tertiary care hospital. METHODS: After taking prior approval from the institutional ethics committee a structured questionnaire was prepared and distributed among 200 consenting medical professionals in a tertiary care centre in the North-Western region of India. RESULTS: 50% of the respondents said that they were sure of the existing regulation on euthanasia in India. When gender differences were considered a significant difference (p=0.0147) was found between the two sexes regarding the alternate decision maker for deciding euthanasia. It was observed that there was a significant difference(p=0.0055) between those with the age more than 30 years and aged less than 30 years regarding the type of euthanasia that is justifiable. DISCUSSION: In the present study, the percentage of doctors favouring euthanasia is higher than compared in previous studies. The view of euthanasia is highly variable in different studies. Even though passive euthanasia has been legalised recently, there is an apprehension that it might be misused.

Complex Suicide: A Case Series.

ABSTRACT: Suicide is a common manner of death typically carried out via a specific mechanism. When a suicidal act is committed using more than one method, it is called a complex suicide. A complex suicide can be divided into planned and unplanned. We present three cases of complex suicide in which multiple methods were used and a previous history of self-harm was present. This case series highlights the significance of a detailed medicolegal death investigation, including interviews with relatives and other witnesses, and a thorough forensic autopsy/toxicological analysis to ascertain the cause and manner of death.

Case Report: Medicolegal evaluation in a pediatric case of fatal scald injury from rural Nepal.

Thermal injuries in young children involving the buttocks, perineum, and lower limbs raise suspicion of child abuse. Determining the manner of death and ruling out homicide in a fatal case of scalding remains a challenge for forensic practitioners. In the present article, the medicolegal evaluation in a case of fatal scald injury involving a two-year-old child from rural Nepal is discussed. Young children sustaining serious injuries from scalds is a grave social concern. Such young lives need to be protected from scald injuries whether accidental or purposeful. Differences in injury patterns on the basis of their distribution and their characteristics are important to determine the manner of death in such cases.

Sudden death due to non-traumatic rupture of splenic artery aneurysm.

INTRODUCTION: Splenic artery aneurysm is a rare form of vascular pathology that carries a high risk of mortality once it gets ruptured. It has a prevalence of 1% and occurs due to thinning and dilatation of the arterial wall. CASE: We describe a case of a 35-year-old policeman who died suddenly. At medico-legal autopsy, intraperitoneal clotted blood about 1000 g and liquid blood about 3000 ml were seen. On further exploration, ruptured splenic artery aneurysm about 2.0 cm in diameter became visible near the hilum. CONCLUSION: Rare cases typically present as sudden and unexpected death with intraperitoneal bleed and may be confused with blunt trauma abdomen. Therefore, splenic artery aneurysm is an appropriate differential diagnosis for sudden deaths and intraperitoneal bleeding, respectively.

Fatal transorbital-intracranial penetrating injury- A case report.

Transorbital injuries are rare and may lead to fatal craniocerebral damage. Ocular penetrating injuries account for 24% of all penetrating head injuries in adults, while this percentage goes up to 45% in children. Any penetrating injury through the eyes may enter the intracranial cavity and might prove fatal to the victim owing to cerebral tissue damage and complex management. The dead bodies of three victims were found by the side of the river with multiple injuries to their eyes. Further examination revealed that they had sustained multiple transorbital-intracranial injuries. In such cases, identifying injury patterns is vital so that cause and manner of death can be determined precisely. A thorough postmortem examination can help identify the alleged weapon involved in the act and may clear the doubts concerned with the manner of death.

Filigree burns of a lightning strike: A case series.

Lightning is the discharge of an electric charge forming in the atmosphere between the earth and clouds which travels downward in a branching pattern. It is estimated that there are some 1800 active thunderstorms at any given moment. Lightning may injure or kill a person by a direct strike, a side-flash or conduction through another object. Agricultural workers are at risk in developing and underdeveloped countries, as are those engaging in sporting activities elsewhere. Fatalities resulting from lightning strikes may not show specific symptoms at autopsy, but there may be symptoms of burns on clothes and body and fernlike marks specific to lightning strikes on their bodies. Other signs are acute kidney failure, cardiac arrhythmias and deaths, and while internal organs may show oedema, congestion, etc, this is not in itself sufficient to establish causation. When diagnosing death from a lightning strike, it is essential to examine the deceased's clothes, their external body and carry out a crime scene investigation. We report a series of three cases of death from a lightning strike in previously healthy men engaged in their daily activities.

Sudden death due to ruptured oesophageal varices - autopsy-based case report.

Acute haemorrhage from ruptured oesophageal varices is a serious consequence of portal hypertension in cirrhotic patients. It represents a medical emergency with a high morbidity and mortality rate. Studies over the years have shown a direct link with chronic alcoholism in the development of such complications. Although the gastrointestinal system accounts for a few numbers of sudden deaths, bleeding through ruptured varices represent a life-threatening condition. The role of forensic pathologist is vital in dealing with sudden deaths. Here, we report a case of a 46-year-old man who died suddenly following the rupture of oesophageal varices.

Metallization at the Exit Wound-An Unusual Finding in Fatal Electrocution.

Electrocution injuries represent a severe occupational hazard. Those at work usually ignore the importance of safety training and safe practices while the electric source is nearby the work area. Death due to electrocution can occur with or without any electric mark on the body. Limbs are the commoner site for electric entry and exit wounds. Various uncommon sites for electric exit wounds have also been reported in the literature. We report a rare case of fatal electrocution, where a 28-year-old male carpenter sustained electric injuries at the worksite. Multiple exit wounds were present over the back of the chest, an uncommon site for the exit wounds, and notably, both entry and exit wounds showed evidence of metallization. The present case emphasizes on the significance of death scene investigations in the reconstruction of events and need for complete autopsy supplemented with chemical and histopathological examination of the electric wounds.

Dying from haemorrhagic cardiac tamponade - a case series.

Cardiac tamponade is a condition produced by the rapid accumulation of pericardial fluid, which restricts the filling of the heart. Often the forensic pathologist comes across different naturally occurring sudden deaths. Cardiovascular causes are the most common. Death due to cardiac tamponade can cause sudden cardiac death. Acute cardiac tamponade is almost invariably fatal, unless the pressure is relieved by removing the pericardial fluid, either by needle pericardiocentesis or surgical procedures. Cardiac tamponade is more commonly associated with cases of trauma, operative procedures, secondary to myocardial infarction or intra pericardial rupture of great vessels. Previous literature showed an association of cardiac tamponade with many other pathological conditions such as malignancy, central venous catheterisation, open heart surgery, dissecting aneurysm of the aorta, myocardial abscess, infective endocarditis, etc. We report a series of three cases where cardiac tamponade was given as the cause of death on autopsy secondary to post-myocardial infarction wall rupture.

Filicide-suicide: An unusual variant of dyadic death.

Dyadic suicides may be committed simultaneously or one after another by two or more people who may or may not have made a prior pact. The perpetrator is usually male and their victims female, and generally their intimate partners, with children less commonly involved. Another distinct type of homicide-suicide is the killing of children by a parent (filicide-suicide). The terms 'maternal filicide' or 'paternal filicide' are used respectively when the perpetrator is the mother or the father of the victim. We report a rare case of maternal filicide, where the mother drowned her three children and then herself in the same water tank. The case highlights the extreme stress put on a mother of girls in a patriarchal society where there is an overriding expectation and wish for sons. The resulting pressure on this mother for her 'failure' caused her to take her own and her children's lives.

Estimation of stature from sternum - Exploring the quadratic models.

Identification of the dead is significant in examination of unknown, decomposed and mutilated human remains. Establishing the biological profile is the central issue in such a scenario, and stature estimation remains one of the important criteria in this regard. The present study was undertaken to estimate stature from different parts of the sternum. A sample of 100 sterna was obtained from individuals during the medicolegal autopsies. Length of the deceased and various measurements of the sternum were measured. Student's t-test was performed to find the sex differences in stature and sternal measurements included in the study. Correlation between stature and sternal measurements were analysed using Karl Pearson's correlation, and linear and quadratic regression models were derived. All the measurements were found to be significantly larger in males than females. Stature correlated best with the combined length of sternum, among males (R = 0.894), females (R = 0.859), and for the total sample (R = 0.891). The study showed that the models derived for stature estimation from combined length of sternum are likely to give the most accurate estimates of stature in forensic case work when compared to manubrium and mesosternum. Accuracy of stature estimation further increased with quadratic models derived for the mesosternum among males and combined length of sternum among males and females when compared to linear regression models. Future studies in different geographical locations and a larger sample size are proposed to confirm the study observations.