Nomogram based Postmortem-interval estimation compared with the Actual death-interval in Tropical environmental conditions.

BACKGROUND: Estimating an accurate postmortem interval (PMI) is essential for death investigators to confirm the offence timing and suspects' alibis. Compared to traditional methods, the Nomogram-based method is claimed to estimate nearly accurate PMI, but most of such studies are based on the Western population. Adequate data for bodies exposed to tropical climate of India and the Indian subcontinent are not available. AIM: To assess the accuracy and goodness-of-fit of Nomogram based PMI estimation in bodies exposed to Indian climatic conditions after death. MATERIAL AND METHODS: This is a 3-year-long study on 200 bodies with known death times. The exact PMI was recorded from direct sources: family members, police and hospital records. Before autopsy, the ambient temperature, body weight, length, and rectal temperature were measured, and the details of clothing, sex, and age, were used on a nomogram to calculate the PMI (tN). One-way ANOVA correlation and Mann-Whitney U test were used to compare the variables. Linear regression analysis was used to establish the relationship between the rectal temperature (Tr) and nomogram estimated PMI (tN) and the known PMI(t). The consistency and agreement between the tN and t were measured using Intra-class correlation coefficient (ICC). Bland-Altman (BA) plot was used to compare the level of agreement between direct(t) and nomograms method PMIs. RESULTS: Nomogram-based PMI estimation showed a statistically significant strong relationship with rectal temperature (R 0.77, R2 0.74, adjusted R2 0.76, t-stat 25.83 p < 0.000) and exhibited a relatively consistent agreement with the known death interval (ICC 0.935). Regressing the tN over t showed that the nomogram method can predict PMI with 95 % accuracy. The BA plot between Direct and Nomogram methods exhibited a consistent agreement in PMI estimation though the limits of agreement (LoA) were wide: range 39.09-121.18 min. CONCLUSION: The accuracy and reliability of the Nomogram method in PMI estimation is high and recommended for the South Indian population. However, the presence of systematic differences between tN and t can't be ruled out due to wider LoA in BA plot. Hence, these findings highlight the need for further investigation and potential refinement of the PMI estimation methods to enhance accuracy and reduce discrepancies.

e-Thrombosis: occupation-specific hazard in electronic information and technology professionals.

There are many known risk factors for the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE). However, a recently observed risk factor is prolonged sitting (or immobility) for occupational dispensation. Some occupations, especially electronic information technology (IT) professionals, computer gamers, programmers, etc., are amenable to prolonged sitting periods for their work. Such a trend significantly increased in the corporate world during the covid pandemic restrictions and work-from-home policy of the IT companies. We have reported a case of the sudden death of an IT professional due to DVT and PTE. There is a conspicuous indication of the association between prolonged sitting hours and the development of DVT and PTE. This is also known as e-thrombosis. The prolonged seated immobility thromboembolic syndrome is a recently observed phenomenon in professionals having prolonged seated working styles. This paper is a case-based review of all tenets, i.e., clinical presentation, autopsy pathology, and preventive measures of the prolonged seated immobility thromboembolism associated with a sedentary working style.

Fatal necrotizing fasciitis in illegal abortion and the negligence tort.

The present paper is a case-based review on rare complications of illegal abortion, i.e., necrotizing fasciitis missed early by the treating gynecologists which landed up into a negligence tort against the physicians. The common complications of the abortion like incomplete abortion, haemorrhage, sepsis, etc. are usually handled successfully by the gynecologists; however, early detection often missed when a rare complication like necrotising fasciitis occurs. Eventually leading to litigations in case of death of the patient. The newer techniques have reduced the complications in medically terminated pregnancies (MTP); however, the deaths due to illegal abortions carried out by the clandestine abortion practitioners (CAP) poses a challenge, especially in rural areas. A 30-year-old woman went for an illegal abortion from a CAP to avoid social stigma. She developed sepsis & necrotising fasciitis (NF) of right lower limb due to intra-vaginal use of abortifacient herbs prescribed by the CAP. She was succumbed to the complications of necrotising fasciitis allegedly due to delayed diagnosis by the gynecologists. This led to a negligence tort filed by her family members against the treating gynecologists. The prudent medicolegal and medical steps are discussed here, that could have prevented such sequel.

Paraphenylenediamine Containing Hair Dye: An Emerging Household Poisoning.

Paraphenylenediamine poisoning is among one of the emerging causes of poisoning in Asian countries, because it is a constituent of hair dye formulations and is easily available in market at low cost. Hair dyes are rampantly used in Asian households compared with the western world. Locally, hair dye constituents may have allergic adverse effects, and acute systemic poisoning presents with characteristic angioedema, upper airway obstruction, rhabdomyolysis, methemoglobinemia, myoglobinuria, and acute renal failure. This study reports about the death of a 24-year-old Indian housewife who committed suicide by taking hair dye emulsion. She had an argument with her husband, and because of fit of rage, took a bowlful (80 mL) of hair dye emulsion kept prepared for the use by husband. She developed angioedema, cervical swelling, and rhabdomyolysis and died of acute renal failure within 24 hours. Toxicological analysis of viscera and blood revealed varying levels of paraphenylenediamine. Histopathological samples of kidney showed features of acute tubular necrosis and myoglobin casts in renal tubules. The aim of the study is to create awareness about the adverse effects of the hair dye, its poisoning outcome, and possible preventive measures.

Occupational death due to bilateral carotid artery occlusion - a medico-legal case report.

Occupational deaths are work-related deaths and usually occur in the work place of an individual. A case of occupational death in a female factory worker has been described, where the saree she was wearing accidentally got entangled in the moving belt and caused ligature strangulation. She was unconscious throughout indicating bilateral occlusion of the carotids and died a day after the incident. The authors have described the correlation between the distribution of the injuries on the body and the manner a saree is worn. Investigation of the workplace revealed that the place where she was standing was located between two machines, and the space was inadequate for normal movement. Some suggestions have been offered which may decrease the incidences of occupational ligature strangulation due to entanglement of dress materials in the moving machineries.

Impulsive frotteurism: a case report.

Frotteurism is a perverted sexual behaviour wherein the person tends to rub or bring about physical contact between his genitals and an unrelated female or male to derive sexual pleasure. Moreover, frotteurism is a common phenomenon among the general population which usually goes unnoticed or overlooked. Nevertheless, public frottage has legal implications in almost all countries over the world. But, when frotteurism manifests on the backdrop of psychiatric illness or as a developmental abnormality then it is worth discussing what the legal liability would be. The present case report is based on hypersexual frotteuristic behaviour manifested on the background of a concealed psychiatric illness, featuring depression and obsessive compulsive disease. The hypersexual behaviour manifested in the form of masturbation with features of frotteurism and subsequent development of depression. Nevertheless, compulsive manifestation of frotteuristic behaviour and subsequent development of morbid depression is rare. This paper describes a 12-year-old boy having unrestrained impulsive frotteurism with his peers, school mates and with his younger brother. He was conscious of the fact and feeling guilty of what he was doing but unable to restrain himself. It was followed by the development of symptoms of depression which was treated with Sertraline. Concurrent psychiatric counseling and rehabilitation measures were taken too. There was complete remission of the symptoms 6 months after the onset of treatment and without relapse thereafter. The paper discusses the differential diagnosis and management of hypersexual behaviour.

High-voltage suicidal electrocution with multiple exit wounds.

Poisoning, hanging, and burning are the usual methods adopted by people to commit suicide. Suicide by electrocution and that too high voltage is one of the rarest methods adopted for the purpose. We report the case of a young man who committed suicide by climbing up a 25-ft-high electric pole. The deceased was a regular alcoholic and was under severe depression for a long time because of his personal problems. He survived for more than 2 days after the incident. His serum urea and creatinine levels were elevated, so were the creatine kinase total and creatine kinase-MB level. The method adopted and the findings make this case a rare scientific report. Moreover, to the best of our knowledge, this is the first reported case in an English scientific literature of a high-voltage suicidal electrocution with multiple exit wounds. The circumstances surrounding the manner of electrocution and the features of electric injuries are presented and discussed.