Cranial Vault Suture Obliteration in Relation to Age: An Autopsy-Based Observational Study.

BACKGROUND: Age is one of the most critical identifiers for both living and dead. Forensic professionals in medical and legal matters are often presented with dismembered, disfigured, putrefied, or skeletal remains for analysis. In such situations, it is essential to identify individuals and estimate their ages. The skull is typically the well-preserved part of the body in such situations. If an aged person needs their age officially established for employment, superannuation, pension settlements, senior citizen benefits, etc., they may turn to medical professionals for help in making that determination. It has always been controversial to use cranial suture obliteration as a reference for age. Different geographical locations have been shown to have vastly different patterns of cranial suture closure. Therefore, this study was conceptualized to assess cranial vault suture obliteration in relation to age in the Meo population. This study was conducted to determine whether obliteration of cranial sutures can be taken into account for the estimation of age in elderly in this region and its reliability along with the influence of other factors such as sex and right and left side differences. MATERIALS AND METHODS: A total of 100 cases of more than 20 years of age brought for medicolegal autopsy were analyzed. The coronal, sagittal, and lambdoid sutures were studied ectocranially and endocranially. The degree of obliteration of sutures was scored ectocranially as well as endocranially. Data were analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Descriptive statistics were evaluated for continuous data in terms of mean and standard deviation, and categorical data were presented by frequency and percentages. An independent t-test was applied to find out the mean difference between the right and left sides of suture closure for ectocranial and endocranial surfaces. The Spearman rank correlation test was carried out to find out the relationship between the age and score of suture closure both ectocranially and endocranially. RESULT: Ectocranially and endocranially, the overall sagittal suture obliterates early followed by coronal sutures and then lambdoid sutures. On comparing the mean ectocranial and mean endocranial scores of 100 subjects by applying an independent t-test, a highly significant difference was observed in all three sutures. On correlating ectocranial sutures and endocranial sutures and age at death in all the cases through sagittal, right and left coronal, and lambdoid by applying the Spearman rank correlation coefficient, a highly significant correlation was found in all the subjects combined (p-value 0.000). However, no significant correlation (p-value >0.05) was found in ectocranial and endocranial sagittal sutures in individual age groups. CONCLUSION: We concluded that obliteration on the endocranial surface is more reliable than on the ectocranial surface. No statistically significant difference exists on the obliteration of sutures on the right and left sides of coronal and lambdoid sutures. The lapsed union was evident in all three sutures ectocranially. Endocranial suture obliteration can be used as a corroborative tool for age estimation.

Analysis of Changes in Electrolytes Level in Serum After Death and Its Correlation With Postmortem Interval.

Background Apropos estimation of postmortem interval is an important and difficult task for forensic pathologists. In routine practice, postmortem interval is deduced by conventional or physical methods such as early and late postmortem changes, which are subjective methods and prone to errors. Estimating time since death by thanatochemistry is a more objective method as compared to routine conventional or physical methods. The present study is an attempt to analyze the changes in electrolytes level in serum after death and its correlation with postmortem interval. Materials and methods Blood samples were taken from the deceased who were brought for a medicolegal autopsy. The concentration of electrolytes, mainly sodium, potassium, calcium, and phosphate, was evaluated in the serum. The deceased were grouped on the basis of time since death. Log-transferred regression analysis was done to establish the correlation of the concentration of electrolytes with time since death and regression formulas were derived for each parameter. Results Sodium concentration in serum showed a negative correlation with time since death. Potassium, calcium, and phosphate showed a positive correlation with time since death. No statistically significant difference exists in the concentration of electrolytes between males and females. No significant difference was observed in the electrolytes concentration between the age groups. Conclusion Considering the findings of this study, we infer that the concentration of electrolytes, primarily sodium, potassium, and phosphates, in the blood can be used to approximate the amount of time that has passed since death. Nonetheless, until 48 hours after death, electrolyte levels in the blood can be considered for the calculation of the postmortem interval.

Infective Endocarditis From Pseudomonas aeruginosa and Group C Streptococcus.

Endocarditis is a condition that is usually caused by an infection or inflammation of the endocardium. The disease is commonly seen among intravenous drug abusers, patients with intravenous catheters, and those who undergo cardiovascular and invasive dental procedures. Multiple different pathogens can cause endocarditis (bacterial, fungal, and viral) depending upon the patient's risk factors, epidemiology, and bacteria that are prevalent/endemic to the region. We present the case of a woman who had a history of polysubstance abuse, having presented to the hospital on multiple occasions with bacteremia with a previous admission for endocarditis, who developed a multi-bacterial infection at this presentation involving Pseudomonas aeruginosa and group C Streptococcus, which affected both the right and left side of the heart. In this paper, we reviewed common presentations of endocarditis caused by either bacteria, as well as recommendations for medical or surgical management of the condition.

Prognosis of sexual dimorphism with unfused hyoid bone: Artificial intelligence informed decision making with discriminant analysis.

Depending on the metric and non-metric skeletal features of various bones, forensic experts proposed diverse sex identification methods. The main focus of the present study is to calculate sexual dimorphism in human unfused or disarticulated hyoid bone and compared it with studies conducted by different researchers. For this study, 293 unfused hyoid bones were accumulated and investigated from 173 male and 120 female cadavers of the northwest Indian population from the age of 15 to 80 years. Initially, discriminant analysis was performed on the dataset to predict sex and to get an idea for the crucial variables for sexual dimorphism. Later, significant variables predicted by the discriminant analysis were used for machine learning approaches to improve accuracy for sex determination. The standard scaler method is used for pre-processing of the data before machine learning analysis and to prevent overfitting and underfitting, 70 % of the whole dataset was utilized in the training of the model and the remaining data were used for testing the model. According to the discriminant analysis, body length (BL) and body height (BH) were found to be highly significant for the sex determination and predicted sex with 75.1 % accuracy. However, implementation of machine learning approaches such as the XG Boost classifier increased the accuracy to 83 % with sensitivity, and specificity scores of 0.81 and 0.84, respectively. Moreover, the ROC-AUC score achieved by the XG Boost classifier is 0.89; indicating machine learning investigation can improve the sex determination accuracy up to the appropriate standard.

Invasive therapy versus conservative therapy for patients with stable coronary artery disease: An updated meta-analysis.

BACKGROUND: Heart disease remains the leading cause of death in the United States. Although there are clear indications for revascularization in patients with acute coronary syndromes, there is debate regarding the benefits of revascularization in stable ischemic heart disease. We sought to perform a comprehensive meta-analysis to assess the role of revascularization compared to conservative medical therapy alone in patients with stable ischemic heart disease. HYPOTHESIS: There is no significant difference in all-cause mortality or cardiovascular mortality between invasive and medical arms. METHODS: We performed a systematic literature search from January 2000 to June 2020. Our literature search yielded seven randomized controlled trials. We analyzed a total of 12 013 patients (6109 in revascularization arm and 5904 in conservative medical therapy arm). Primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac events (MACE) (death, myocardial infarction [MI], or stroke), cardiovascular mortality, MI, and stroke. Additional subgroup analysis for all-cause mortality was performed comparing percutaneous coronary intervention (PCI) with bare metal stent versus conservative therapy; and PCI with drug eluting stent versus conservative therapy. RESULTS: There was no statistically significant difference in primary outcome of all-cause mortality between either arm (odds ratio [OR] = 0.95; 95% CI [confidence interval], 0.83 to 1.08; p = .84). There were statistically significant lower rates of MACE (death, MI or stroke) in the revascularization arm when compared to conservative arm. CONCLUSIONS: Our analysis did not show any survival advantage of an initial invasive strategy over conservative medical therapy in patients with stable coronary artery disease (CAD).

Diagnostic Utility of Conventional Radiography in Head Injury.

BACKGROUND: Head injury is the frequent cause of morbidity and mortality and frequently encountered in emergency department. Radiological examination of the skull is an indispensable part in the management of patients suffering from head trauma. AIM: To determine the accuracy of X-ray in detecting skull fractures, comparing the same with autopsy and CT evaluation. MATERIALS AND METHODS: The medico-legal cases that died of traumatic head injury and brought for autopsy over a period of two years were included in the study. Only those cases were selected who had underwent both X-ray and CT evaluation prior to death. RESULTS: When compared with autopsy, X-ray missed 19.1% of fractures while 11.9% fractures missed in contrast to CT scan. CONCLUSION: Skull X-ray is of little benefit when a CT scan is obtained. It has no added advantage over CT scan. Whenever there is facility of CT scan is available, the patient of head injury should not underwent X-ray as it can only delay the diagnosis of an associated intracranial injury and exposes the already traumatised patient to harmful radiations.

Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims.

BACKGROUND: Emergency departments rely on CT scans to manage trauma victims, especially for head injuries. Although the detection of an undisplaced fracture on a CT scan of the head without significant intracranial findings may be insignificant for a clinician, such cases are of paramount importance for medico-legal purposes because they help ascertain the nature, manner, and cause of the head injury. AIMS: The study was conducted with the objective of knowing the sensitivity and specificity of ante-mortem CT scan findings indicating the presence or absence of skull fractures. METHODS: Findings were confirmed during post-mortem examination of the subjects who had died during management but who had not had any surgical intervention. A comparative study of ante-mortem CT scan and autopsy findings with respect to fracture in traumatic head injuries was undertaken on 60 deceased individuals brought in for medico-legal post-mortem examination over a period of two years. RESULTS: Considering the autopsy findings as the gold standard, we have concluded that 14.6 per cent of the fractures were missed on CT scan findings compared to fractures found during autopsy. The sensitivity of CT scan for skull fractures was found to be 85.4 per cent and specificity was 100 per cent. Kappa was 0.787, which shows good agreement with p<0.001, which was highly significant. CONCLUSION: In developing countries, images are interpreted in the axial plane only on a CT scan of the head, which may be due to a lack of financial and human resources. For better delineation of fractures, the use of techniques like multi-detector CT with sagittal and coronal reformations should be considered in the routine interpretation of a CT scan of the head.