Pattern of sudden cardiac deaths.

BACKGROUND AND OBJECTIVE: Sudden cardiac death can be defined as a sudden, unexpected death caused by loss of heart function. Notwithstanding major developments in the diagnosis and treatment of heart disease, it remains the major contributing factor for deaths. This considers the pattern of sudden cardiac deaths.Methodology: This prospective study was conducted on all cases subjected to medico-legal autopsy in the forensic medicine department at a tertiary care hospital for a period of 18 months. All sudden cardiac deaths satisfying the WHO criteria were included. Unknown cases and bodies in advanced stage of decomposition were excluded. RESULTS: Sudden cardiac deaths accounted for 55% (82 cases) of 149 cases of sudden natural deaths and 6.5% of total autopsies conducted. The age group most commonly affected by sudden cardiac death ranged from 31 to 50 years. The majority of the cadavers had 90-95% degree of stenosis of left anterior descending artery, 70-80% of right coronary artery and 60-70% left circumflex artery. Coronary insufficiency was the major cause for sudden cardiac deaths with a total of 53 (64.63%) cases. CONCLUSION: Sudden cardiac deaths accounted for 6.5% of all the autopsies conducted and males outnumbered females with M:F ratio of 10.7:1, with mean age of 44.5 ± 12.63 years. The largest number - 60.97% - were aged between 31 and 50 years. Coronary insufficiency accounted for 64.63% of sudden cardiac deaths.

A Study on Postmortem Wound Dating by Gross and Histopathological Examination of Abrasions.

INTRODUCTION: Abrasions are the most common blunt force injuries. The precise dating of injury is extremely important in forensic medicine practice. As we know, the wound healing occurs in well-orchestrated sequence, consisting of inflammation, proliferation, and maturation.A study of occurrence of such phases will help in understanding the sequence of events in wound healing. In this context, this study of wound dating from gross and microscopic level was taken. MATERIALS AND METHODS: Postmortem study of wound dating by gross and histopathological examination of abrasions was carried out in the Department of Forensic Medicine, in M.S. Ramaiah Medical College. A total of 101 abrasions were correlated to time frame the occurrence of different gross changes and microscopic changes that follow the blunt trauma. Abrasions ranging from 0 hour to a maximum of 45 days were studied. RESULTS: The gross changes of abrasions were in correlation with the microscopic changes; however, the role of the comorbid conditions is significant because the results showed variations with respect to healing process. CONCLUSIONS: This study signifies that, if naked eye examination is studied along with histopathological examination, the reliability and accuracy of dating of wound increase. Whenever accurate determination of age is required, the autopsy surgeon can subject the samples for histopathological examination and correlate before opining the age of injury.

Glue sniffing.

Inhalant abuse refers to the inhalation of volatile substances for their euphoric effects. Glues and adhesives have been abused inhalants for decades and so the term "glue sniffing" attached to the habit. These days many substances used are not adhesives and the most accurate title of "solvent abuse" has been given to this widespread and dangerous habit. The various methods of inhalational abuse include huffing, bagging, dusting, glading, and sniffing. We report one such case of a 22-year-old male who was found in an unresponsive state at his residence with a plastic cover around his head and empty tubes of "Fevibond" glue beside him. He died on the way to hospital. At autopsy, conjunctival and visceral congestion were found with pulmonary edema and petechiae over visceral pericardium. The viscera were analyzed, and the presence of toluene in his liver and blood was reported.

Pattern of unnatural deaths among children: An autopsy study.

This study was conducted at the M. S. Ramaiah Medical College, Bangalore, between October 2007 and September 2009 to analyse the age and sex distribution of unnatural deaths in children, patterns and manner of death. Detailed information regarding the circumstances of death was sought from the relatives, friends and police. The scene of occurrence was visited, and photographs of the scene of occurrence were examined in relevant cases. Unnatural deaths in children constituted 6.62% of the total autopsies conducted. The majority of childhood deaths were in the age group of 15-18 years of both sexes constituting 46.88%. Males constituted 55.22% of cases. Suicide accounted for 40.63% of the cases. Most children committed suicide by hanging (82.05%). The main reason was academic failure and some of the cases were accidental (48.96%). Road traffic accidents accounted for 26.04% of the cases, where most children were pedestrians (56%). Drowning accounted for 15.63% of the cases. Most of the children drowned while playing near ponds (83.33%). Homicide accounted for 9.36% of the cases - either killed by their mother as part of a pedicide-suicide event or by the father, and in two cases the children were sexually abused before being killed.

A death due to ecstasy - a case report.

Drug addicts face the dangers of accidental overdose, fatal intoxication, reduced tolerance and carelessness in consuming drugs. There is an increasing use of designer drugs in many cities. The body of a 29 year-old male, an event manager by profession with an alleged history of consumption of ecstasy tablets, was subjected to autopsy. The cause of death was found to be disseminated intravascular coagulation consequent upon consumption of methylenedioxymethamphetamine. This was based on the brief history, autopsy features and a chemical analysis report. This case is discussed with the background of the existing literature about the interplay of the actions of methylenedioxymethamphetamine, the hyperthermia that would result from physical exertion as in dancing in rave parties leading to hyponatremia and the causes of disseminated intravascular coagulation.

Gastrointestinal hemorrhage in aluminum phosphide poisoning.

Poisoning, both accidental and intentional, is a significant contributor to the mortality and morbidity throughout the world. The commonest pesticide poisoning is organophosphates followed by phosphides. Ingestion of phosphides can induce severe gastrointestinal irritation leading to hemorrhage and ulcerations. Gastrointestinal hemorrhages and ulcerations beyond the duodenum have not been reported in the literature. Here, we report a case of severe hemorrhages and ulcerations in stomach, duodenum, jejunum, and ileum observed in a 45-year-old male who had consumed five tablets of Celphos(®) (each 3 g with 56% aluminum phosphide and 44% Ammonium carbonate) to commit suicide. He started vomiting after consumption, and the vomitus was blood-tinged. Once the treatment was instituted, he was stable for a day and thereafter his condition gradually deteriorated. He died on the 4th day of hospitalization, and autopsy revealed features of multiorgan failure and extensive gastrointestinal hemorrhages.

Aortic dissection complicated with haemothorax - an autopsy report.

In a forensic setting, haemothorax is usually seen in cases of trauma. The main non-traumatic cause for haemothorax is an intrathoracic rupture of an acute aortic dissection or an aortic aneurysm that is almost always fatal. Here we present one such case of sudden natural death caused by rupture of an acute aortic dissection. The deceased was a middle-aged, unidentified male who was subjected to autopsy at the Department of Forensic Medicine, M.S. Ramaiah Medical College, after having been brought in dead to the hospital. It is a type III DeBakey dissection as it originates in the descending aorta and it is quite unusual that a rare retrograde extension was also observed.

Fatal head injury: a sequelae to electric shock - a case report.

Deaths due to electric shock are increasing despite stringent laws and preventive measures. These shocks are a leading cause of death amongst construction workers. In about 20% of the cases, no visible injury due to electricity can be seen. In some cases, non-electrical injuries are present and at times there are no eyewitnesses to provide a detailed account of events. In such circumstances, examination of scene of death, autopsy and accident reconstruction with the help of an electrical expert are all necessary to determine the cause of death. Here, we report one such case where a mason working on the second floor of a building under construction sustained an electrical injury, following which he was thrown to the ground sustaining a fatal traumatic injury. After careful consideration, his death was attributed to the head injury.

Atypical fatal entry wound to the thigh--a case report.

Stab wounds encountered in medico-legal practice are caused by sharp or blunt pointed weapons such as a kitchen knife, dagger, screwdriver, iron rod, etc. Atypical entry wounds may result from elasticity of skin, relative movement of the victim or the offending weapon or both. These are often described in the literature. We report an unusual incised stab injury of the thigh where a single atypical entry wound resulted in injury to the femoral vessels. The precise causation of such a peculiar entry wound cannot be explained, though it can be considered within the dynamic processes involved between victim, assailant and the offending weapon. It is recorded because of its academic curiosity.

Sudden death due to coronary artery insufficiency as a result of massive cardiomegaly--a case report.

Forensic pathologists encounter a wide range of deaths due to natural causes. Natural deaths can be sudden and unexpected, occurring in apparently healthy people. All such cases have to be investigated and a medico-legal autopsy should be conducted to ascertain the cause of death, and to rule out any criminal cause of death. Here, we report a case of a 46-year-old male who collapsed at his workplace and died. There was no history of significant natural disease. The case was investigated due to the suddenness of his death and absence of a history of significant medical illness. An autopsy revealed that the death was due to coronary artery insufficiency as a result of massive cardiomegaly, although there was absence of significant occlusion of the coronary arteries.

Death due to coronary artery insufficiency following blunt trauma to the chest.

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36-year-old male following blunt chest trauma sustained during alleged assault by his neighbor.

Secondary combined suicide pact.

This article reports a combined suicide pact, where in a young couple; a 26 year old male and a 20 year old female committed suicide by using two methods. The couple had resorted to hanging and self-immolation to prevent failure of single method alone. In secondary combined suicides, several other methods of suicide are tried after the first method chosen has failed. It is primary combined suicide only when two or more methods are used simultaneously. Both types of combined suicide by one individual is well reported in the literature whereas the same by two persons together is rare. In this report, the deceased were disappointed lovers, poor and the family members were against their marriage. The investigation of scene, methods employed to commit suicide, autopsy findings and the interview with their relatives altogether suggested that it was a secondary combined suicide pact.

Death due to isolated jejunal tear following blunt abdominal trauma.

Small intestinal injury following blunt abdominal trauma has been widely reported. Isolated jejunal tear which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Here, we report a case of isolated jejunal tear in a 24-year-old male truck driver. He was admitted to a tertiary care hospital in a South Indian Metropolitan city with complaints of acute abdominal pain and tiredness following alleged accidental blunt trauma sustained to abdomen due to steering wheel impact. An isolated jejunal tear and adjacent mesenteric contusion and tear were missed by the treating physician even after preliminary investigations, and thus, the conservative management was instituted. The condition deteriorated gradually, and he succumbed to death. The autopsy revealed transverse tear of jejunum almost involving whole of its circumference on the antimesenteric border and peritonitis. Proper use of radio-diagnostic techniques and timely undertaken explorative laparotomy would have saved the life.

Sudden death in Marfan syndrome.

Marfan syndrome is an autosomal dominant genetic disorder of the connective tissue. The most serious complications of this syndrome are defects of the heart valves and aorta. Aneurysms of thoracic aorta are known to develop in Marfan syndrome. Other causes for development of aneurysms of the thoracic aorta are trauma, infections, valve and arch anomalies, genetic disorders, and atherosclerosis. These aneurysms upon rupture may lead to sudden deaths. They are usually detected during routine screening or follow-up of such persons suffering from Marfan syndrome and upon death will be certified by the treating physician. Thus, an autopsy surgeon rarely comes across such deaths. One such case of sudden death due to cardiac tamponade consequent upon rupture of dissecting aortic aneurysm in a 33-year-old male who complained of throbbing pains in the chest, radiating to back, became breathless, cyanotic and died on the way to hospital is being presented here.

Fatal case of retropharyngeal abscess associated with Pott's disease.

Retropharyngeal abscess is a rare, deep seated infection of the neck that usually affects young children. Chronic retropharyngeal abscess is rare and results from tuberculosis of the spine. Such swelling in the neck gradually increases in size and is detected during the routine radiological screening for symptoms like pain, dysphagia, fever, dyspnoea, progressive inspiratory stridor (from laryngeal obstruction), neck hyperextension etc, but rarely leads to sudden death due to airway obstruction. Thus the forensic pathologist rarely comes across such type of cases. Present case concerns obstruction of upper airway by a large retropharyngeal cold abscess leading to death in a 13-year-old female child from a lower socio-economic family. The possible explanation for the progression and fatal outcome of such abscesses associated with the Pott's disease is being discussed in the light of available literature.

Sudden death due to massive hemoptysis secondary to pulmonary tuberculosis--a case report.

Forensic pathologists deal not only with criminal, accidental and suicidal deaths, but also with a wide range of deaths from natural causes. Natural deaths at times can be sudden, unexpected and unattended by the relatives or friends or eye witnesses. In such cases, even though there is no criminal element in their causation, the case has to be investigated and medico-legal autopsy has to be conducted to know the exact cause of death, thus putting an end to the allegations raised. A 55-year-old male was found dead lying in his room in a pool of blood without any obvious injuries under suspicious circumstances with disturbed furniture in his room. The case was investigated due to suspicious circumstances of his death and absence of history of significant medical illness. The autopsy revealed the death was due to asphyxiation as a result of massive hemoptysis secondary to fibro-cavitatory tuberculosis.

Study of defence injuries in homicidal deaths - An autopsy study.

In order to determine specific patterns and distribution of defence injuries, this study was conducted on 121 homicidal deaths which showed defence injuries in 40 (33%) cases. Of these 40 victims, 72.5% were males and 27.5% were females. Maximum numbers of victims were in the age group of 20-29 years. In 70% of cases, more than one assailant was involved. It was found that in 77.5% cases, sharp weapons were alone used, whereas, in 10% and 12.5% of victims, blunt weapons and multiple (sharp and blunt) weapons, respectively, were used. Fatal wounds were seen most commonly on the head and neck region. In 42.5% of cases, defence injuries were seen on the right side only, whereas in 27.5% of cases both sides were involved. Victim's right forearm and hand were more commonly involved because these are nearest to the perpetrator and consistent with the preponderance of right-handed individuals in the population.