Profile of Mortal Injuries in Vehicular Accidents: An Autopsy-Based Study.

Background It is crucial to analyze the trends of fatal injuries among pedestrians, passengers, motorcycle riders, and drivers of three- and four-wheelers in traffic accidents. Objective To ascertain the trend of fatal injuries to the head, chest, and abdomen across different victim categories in vehicular accidents. Materials and methods An autopsy-based prospective study was carried out in the mortuary of a rural tertiary care hospital. A total of 108 fatal cases of vehicular accidents were taken into consideration. All natural and unnatural deaths, other than those stemming from vehicle crashes, were excluded from this study; only the victims of fatal vehicular accidents were included. Results Males outnumbered female victims by 8.8:1. The age range of 41-60 years was the most affected (38.9%). The greatest number of victims (17, or 15.8%) were male motorcycle riders in the range of 21-40 years. Most vehicular mishaps (61; 56.5%) occurred during the evening. The most frequent injury pattern reported was head injuries (53.4%). Conclusions Motorcycle riders constituted the most severely injured victim category in a vehicular accident. Most mishaps occurred in the dark because of inadequate lighting or bad road conditions in rural areas. Furthermore, the most frequently occurring type of injury was an injury to the head, which may be an outcome of riders' lack of compliance with the mandatory helmet-use policy.

Postmortem Burns to Conceal Homicidal Deaths: an Eight-Year Study.

Burned corpses are of medicolegal importance as circumstances may suggest means that are used for committing or concealing homicidal death or death occurring due to accidental causes. Postmortem burns, which may include homicidal burns (torch murder) or burns used to conceal the crime, are committed with the motive of identity destruction, transposing the cause and manner of death and destruction of evidence. The present study aimed to analyse the cases of postmortem burns in the context of the cause of death, manner of death and circumstances pertaining to death. This is a retrospective study performed in the Government Medical College δ Hospital, Aurangabad (MH), India, between 1 January 2009 - 31 December 2016. Cases involving burn injuries were examined in detail by autopsy reports, toxicological analyses, crime scene investigation and police records submitted at the Institute's office. A careful examination of vitality signs of burns, soot deposition in the lower respiratory tract and the presence of other fatal injuries was performed for each case. Cases exposed to fire before death were all excluded. Similarly, bodies being charred to such an extent to prevent distinguishing the vitality of burns were also excluded. Postmortem burns were recorded in 13 cases (0.46%) of deceased bodies to cover homicides. Females were reported to be more commonly involved and more in a household environment. Head injury was the most common cause of death, followed by death due to asphyxia due to any means. The findings of the present study reinforce the fact that burning cannot always effectively destroy the evidence, hindering the perpetrator from covering up the crime. Apart from the evidence at autopsy, a transdisciplinary approach must be initiated with detailed crime scene investigation, toxicology, ascertaining the cause of death with analyses of fatal injuries and contributory data for identification of the deceased.

Sudden death of a post-partum female with anomalous origin of the coronary artery with bicuspid aortic valve.

Modern techniques have enabled routine diagnosis of congenital cardiac defects, notwithstanding, there will be some that remain undiagnosed and asymptomatic until adulthood. But this is rarely the case with the patent foramen ovale, with the anomalous aortic origin of the left main coronary artery and bicuspid aortic valve. This case describes the sudden death of a female in her post-partum period due to cardiac tamponade following a ruptured aneurysm of the coronary artery at its origin at the sinus of Valsalva. Autopsy shows patent foramen ovale findings and anomalous aortic origin of coronary artery (AAOCA) and bicuspid aortic valve. The association of AAOCA with bicuspid aortic valve and patent foramen ovale is rare.

Burns vs. toxic epidermal necrolysis: A medico-legal dilemma.

Toxic epidermal necrolysis is a rapidly progressive exfoliating dermatosis which simulates second degree burns. The authors describe a fatal case reported as due to burns. Around 95% of the deceased's total body surface area was affected, with epidermolysis over face, chest, abdomen, limbs and associated with mucosal involvement. Histopathological findings revealed epidermal necrolysis and confirmed the autopsy suspicion. Because of its sudden onset and rapid progression, toxic epidermal necrolysis often arises suspicion of burns by investigators. We emphasise the differentiating features between toxic epidermal necrolysis and burns and its implications.

Fatal Iron Toxicity in an Adult: Clinical Profile and Review.

Acute iron toxicity is usually seen in children with accidental ingestion of iron-containing syrups. However, the literature on acute iron toxicity with suicidal intent in adults is scant. We report an instance wherein an adult committed suicide by ingestion of multiple iron tablets. Delay in treatment was there due to misdiagnosis of the intoxicating agent. She developed fulminant hepatic failure with rapid clinical deterioration. Despite aggressive supportive management, the patient succumbed to the toxic doses of iron. Clinical course and postmortem features are discussed with a review of the literature.

Suicide by self-disembowelment in prison.

Self-inflicted abdominal injuries are uncommon. Fatal self-inflicted abdominal injury is a rare occurrence, especially as a custodial death. A prisoner under-trial for attempted suicide was in judicial custody and was found unconscious in a pool of blood in the bathroom with cut open abdomen and exposed coils of intestine. The bathroom was found locked from inside and had to be forcibly opened. In spite of immediate hospitalisation and appropriate emergency surgical treatment, he succumbed on the same day. As the person had previously made several futile attempts to commit suicide and was in fact under trial for the crime of attempted suicide (section 309 of Indian Penal Code), the prison authorities had already taken good precautions to prevent access to any type of weapon, instrument, or material that could rekindle the thought of another attempt. In spite of all this, he successfully committed suicide with an apparently innocuous object, a disposable razor. This case is reported for the rarity of occurrence of this type of suicide, and it highlights the importance of utmost precautions to be taken in dealing with prisoners having suicidal tendencies.

Serial murder: An unusual stereotype.

Serial murders attract attention from the media, mental health experts, academia, and the general public. We present a case of serial murders that took place in a limited area and which caused public anxiety and anguish in central India. All the victims were homeless beggars, who were bludgeoned to death (crush injury). Individual murders were initially investigated by different police stations; fortunately, since they sent all the bodies to a common autopsy centre, a forensic pathologist was able to link all the cases, the first person to do so. This emphasises the need for sharing information among police stations and autopsy centres.

Quenching tank: Accidental drowning in hot quenching oil.

We describe an unusual case of drowning in fluid other than water in an industrial setting. A 26-year-old man was working in an industry which performs surface treatment of mechanical steel parts with quenching oil. He fell into the quenching oil (which was hot due to immersion of red hot metal parts), and as he was working alone in the particular section, there was a fatal outcome. A medico-legal autopsy was performed. The causes of death were found to be multiple, with the association of drowning, extensive superficial burns and asphyxia due to laryngeal oedema. To our knowledge, it is the first report of drowning in hot quenching oil, and only nine previous observations of drowning in industrial environments have been reported in the international literature. Even though rare, these kinds of accidental deaths can be prevented in dangerous industries with proper precautions and strict adherence to standard operating procedures.

Non-vehicular homicides masquerading as road traffic accidents.

Interfering with or planting evidence to disguise the cause of a death is not uncommon in forensic practice. Homicides staged as road accidents are, however, rarely encountered by crime scene investigators. We report two homicides which were presented as road traffic accidents. Case 1: Dead body of a 35-year-old male was brought for autopsy with history of road traffic accident. Primary police inquiry suggested that the victim was knocked down by a speeding four-wheeler, while walking by the side of a high way with his friends. On postmortem examination the deceased's death was found due to homicidal smothering staged as a road traffic accident. Case 2: Dead body of 40-year-old male was brought for autopsy with history of road traffic accident. It was an unwitnessed crush by a speeding four-wheeler. However, on postmortem examination, the deceased was found to have died from homicidal multiple stab wounds with his death staged as a road traffic accident. Importance of meticulous autopsy to determine accurately the cause of death is emphasized.

Prospects of poisoning - a multi facet study.

Aim of the study is to find out demographic profile, clinical characteristics and analysis of poison in clinical set up. The study carried out in Sri Aurobindo Medical College and PG Institute Indore, Madhya Pradesh. Total 75 cases of poisoning were studied for demographic profile, vitals (BP, pulse, heart rate, pupils, etc.), clinical features (such as vomiting, salivation, consciousness, etc.), type of poison and its analysis. Results: Poisoning was more common in cases between 15 and 25 years of age, in males than in females and in Hindu religion. Poisoning cases were predominantly from rural areas and in married people. Majority of cases were discharged after proper treatment and counseling. Altered vitals and clinical features were found in most of the cases. Organophosphate and aluminum phosphide compound were evaluated in most of the cases. Conclusions: Preventive measures should be applied through educating people, proper counseling, promoting poison information centers, and introducing separate toxicological units in hospitals.

Course of Near-hanging Victims Succumbed to Death: A Seven Year Study.

INTRODUCTION: Near hanging refers to victims who survive a hanging injury following attempted hanging, long enough to reach hospital. Delayed deaths in near hanging patients are mostly due to complication of hanging. The purpose of this study was to evaluate the demographics, mortality patterns and cause of delayed deaths in near hanging victims. MATERIALS AND METHODS: In this study autopsy files over a seven year period from 2007 to 2013 were reviewed, and data of near hanging deaths (attempted hanging cases who succumbed to death and subjected for medicolegal autopsy) was extracted. Records of 14,000 autopsies was reviewed, and 10 deceased having died delayed deaths after near hanging episode were identified. In each case, the patients' details, including gender, age, type of suspension, type of ligature material used for hanging and subsequent hanging mark produced were reviewed using autopsy reports and photographs taken during autopsy. RESULTS: Demographic and pathological aspects of the each case discussed to throw light on autopsy findings in victims who died following near hanging. Complete suspension was present in 3 cases, while partial suspension was present in 7 cases. Survivals in delayed death after near hanging episode have ranged from 9 h to 72 d. Hypoxic encephalopathy was the most common cause of death, followed by pneumonia. CONCLUSION: Most of the near hanging patients did succumb to hypoxic encephalopathy; however, consolidation of lungs (pneumonia) was the next common cause of death reflecting need for aggressive oxygen therapy and selective resuscitation should be performed in all such cases.

Indiscriminate disposal of museum specimens--a case report.

The human body and its parts and organs are invariably used in medical teaching institutions for academic purposes. Legal provisions for the preservation of such specimens are made in anatomy Acts across the country. However, after they have been used, the specimens are not disposed of in a proper manner. This is a public menace and forces the authorities concerned to carry out unnecessary investigations. We report a case in which the bodies of two foetuses that were brought for medico-legal autopsy were later found to be formalin-preserved "museum specimens" that had been used for anatomical study. We wish to emphasise the need for guidelines for the proper disposal of anatomical museum specimens.

Survival of a victim of Isadora Duncan syndrome: a case report.

Incidents of accidental strangulation by uncovered (open-spoked) wheels of vehicles are not uncommon but survival following such incidents is quite a rare phenomenon. The possibility of death from strangulation by a scarf getting caught in the wheel spokes of a vehicle was brought to the public's attention when the world famous dancer Isadora Duncan died on 14 September 1929. Cycle-powered rickshaws, bicycles and bullock-carts remain common forms of transport in India. However, the uncovered spokes of the vehicle wheel can trap the dupatta/chunni/odhani (long scarf worn around neck) worn by Indian women. A number of cases of fatal accidental strangulation have been described by different authors involving vehicles like cycle-powered rickshaws, bicycles and bullock-carts, with very few cases of reported survivors. Here we report a case of accidental strangulation involving a young girl with the dupatta getting caught in moving wheel of a bullock-cart, in which the victim survived in spite of severe injury to neck structures.

Pseudo-precipitate labour: myth or reality.

Spontaneous deliveries into toilet bowls always carry a special forensic significance. Forensic pathologist has to differentiate between a genuine precipitate labour and concealed birth or a neonaticide. Circumstances are challenging when a nullipara claims misapprehended precipitate labour. We report a similar case where a primigravidous unmarried girl delivered in a lavatory pan misjudging labour pains as that of bowel evacuation. Detailed obstetric history, postnatal maternal behaviour and visit to scene of incidence resolved the unnecessary charges of neonaticide on the embarrassed mother.

Myocardial infarction and concurrent chest injuries: two case reports.

Two cases of sudden death due to myocardial infarction which were associated external injuries on the chest are discussed here. Injuries were in the form of abraded contusions on the anterior part of chest. Both the cases were declared dead on arrival to the casualty section (Accident and Emergencies Department). In these cases, mention of injuries was not made in the inquest report. In both the cases, suspicion of foul play or the trauma induced myocardial infarction were ruled out by inquiring into the incidents by the autopsy surgeon. The cases highlight the importance of detailed history by the autopsy surgeon in cases of sudden death with associated injuries on the front of the chest.