Comparison of unbiased stereological estimation of total number of cresyl violet stained neurons and parvalbumin positive neurons in the adult human spiral ganglion.

Estimation of total number of neurons in the spiral ganglion (SG) at various ages and their functional status is important as these neurons are constantly exposed to noise and other environmental factors that may lead to neuronal loss with aging due to excitotoxic damage. Parvalbumin (PV) is a calcium-binding protein (CBP), found in highly metabolically active neurons. It helps in buffering cytosolic calcium, which is essential for neurotransmitter release. The neurons in the adult human SG express PV more strongly than other CBPs like calbindin and calretinin. These CBPs can be used as signatures to recognise neurons. In the present study, we quantified the number of neurons expressing PV by unbiased stereology and compared it to the number of neurons stained by cresyl violet (CV), which is a Nissl stain, in the adult human SG. Five adult human cadaveric temporal bones were obtained from the forensic science mortuary, after due clearance from the institute ethics committee. Independent CV stained and PV immunostained sections were used to estimate the total number of neurons (optical fractionator), with StereoInvestigator (SI) software. The estimated total number of SG neurons was 27,485±3251 and 26,705±1823 in the PV and CV stained sections, respectively. There was no significant difference between the estimates (p=0.552). Therefore, CV staining is simpler and more cost effective when estimating neuronal number. Although PV stains spiral ganglion neurons (SGNs) with a greater intensity and provides a functional status, its tedious protocol limits its use for quantification.

Fatal ovarian hyperstimulation syndrome in an anonymous egg donor.

Ovarian hyperstimulation syndrome is a rare, but potentially life-threatening iatrogenic disorder arising from ovulation induction or ovarian hyperstimulation for assisted reproduction techniques. We report a case of a 26-year-old multiparous woman, an anonymous egg donor, who died a few hours after undergoing a procedure to donate eggs at an in vitro fertilization clinic. Her husband alleged that medical negligence had led to her death. The autopsy confirmed death due to ovarian hyperstimulation syndrome. We know of no previous descriptions of fatal ovarian hyperstimulation syndrome in an anonymous egg donor in medico-legal literature.

Mortality among homeless women who remain unclaimed after death: An insight.

BACKGROUND: Some homeless people remain unclaimed after death. Although women constitute a minor proportion among the homeless, they represent a more vulnerable section. We reviewed the major autopsy characteristics and causes of death among women whose bodies remained unclaimed after death. METHODS: We analysed the autopsy records and inquest papers of unclaimed bodies of women for the period 2006-12 at the Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi. RESULTS: Most women whose bodies were unclaimed were 21 to 60 years old with a mean age of 45 years. Natural events (53.5%), largely attributable to acute/chronic lung diseases, were identified as the most common cause of death. Accidental deaths were predominant among the unnatural causes. Most bodies of women were found on the footpath besides the road (56.1%). CONCLUSION: The problems of physical/sexual abuse, acute chest infections and road traffic accidents are all aggravated in the situation of homelessness. More affordable shelters are needed to preferentially accommodate women. Also, awareness about the existing medical facilities needs to be increased.

Estimation of post-mortem interval: A comparison between cerebrospinal fluid and vitreous humour chemistry.

Accurate estimation of post-mortem interval is of great importance in medico-legal autopsy cases. The present study is intended to compare the accuracy of estimating post-mortem interval from biochemical parameters of vitreous humour and cerebrospinal fluid (CSF). Both the fluids were collected from 100 medico-legal autopsies with known time of death and analysed for potassium, glucose, sodium, calcium, urea and creatinine. The current study found that vitreous humour is a better fluid in comparison to CSF for estimation of post-mortem interval. It is also observed that among the statistically significant parameters in both the fluids, level of potassium and sodium in vitreous humour are giving more accurate results in comparison to their corresponding parameters in CSF while accuracy of glucose is more or less same in both the fluid. Nevertheless potassium concentration in vitreous humour is a single best time honoured parameter to estimate post-mortem interval.

Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Blunt Trauma Abdomen-A Prospective Study.

Focused assessment with sonography for trauma (FAST) is a limited ultrasound examination, primarily aimed at the identification of the presence of free intraperitoneal or pericardial fluid. In the context of blunt trauma abdomen (BTA), free fluid is usually due to hemorrhage, bowel contents, or both; contributes towards the timely diagnosis of potentially life-threatening hemorrhage; and is a decision-making tool to help determine the need for further evaluation or operative intervention. Fifty patients with blunt trauma abdomen were evaluated prospectively with FAST. The findings of FAST were compared with contrast-enhanced computed tomography (CECT), laparotomy, and autopsy. Any free fluid in the abdomen was presumed to be hemoperitoneum. Sonographic findings of intra-abdominal free fluid were confirmed by CECT, laparotomy, or autopsy wherever indicated. In comparing with CECT scan, FAST had a sensitivity, specificity, and accuracy of 77.27, 100, and 79.16 %, respectively, in the detection of free fluid. When compared with surgical findings, it had a sensitivity, specificity, and accuracy of 94.44, 50, and 90 %, respectively. The sensitivity of FAST was 75 % in determining free fluid in patients who died when compared with autopsy findings. Overall sensitivity, specificity, and accuracy of FAST were 80.43, 75 and 80 %, respectively, for the detection of free fluid in the abdomen. From this study, we can safely conclude that FAST is a rapid, reliable, and feasible investigation in patients with BTA, and it can be performed easily, safely, and quickly in the emergency room with a reasonable sensitivity, specificity, and accuracy. It helps in the initial triage of patients for assessing the need for urgent surgery.

Suicide pact by drowning with bound wrists: a case of medico-legal importance.

Suicide pacts are uncommon and mainly committed by male-female pairs in a consortial relationship. The victims frequently choose methods such as hanging, poisoning, using a firearm, etc; however, a case of a suicide pact by drowning is rare in forensic literature. We report a case where a male and a female, both young adults, in a relationship of adopted "brother of convenience" were found drowned in a river. The victims were bound together at their wrists which helped with our conclusion this was a suicide pact. The medico-legal importance of wrist binding in drowning cases is also discussed in this article.

Ice pick death: a case report and discussion of the injury pattern.

Death due to ice pick injury rarely reported in forensic literature. We report death of a 16-year old male, who was allegedly assaulted on chest, back and thigh by his school-mate, with an ice pick. The accused had got the ice pick from his father's ice shop to attack the victim. The multiple stabs to the chest region had perforated the lung and penetrated the heart chambers. The victim succumbed to death on the way to hospital and medico-legal autopsy was conducted. The injuries inflicted by the ice pick are highlighted and its pattern is discussed in this article, owing to the peculiar nature of the wounds produced by the ice-pick.

Cut wrists, electrocution and subsequent drowning in a water drum: an unusual combination of methods in complex suicide.

A 25-year-old male was found dead in a water drum inside the bathroom of his house one morning. Autopsy revealed a fatal right wrist cut, superficial cuts on middle phalanx of left index finger and features of ante mortem drowning. Investigation revealed the victim was an alcoholic and was depressed due to financial problems. On the previous night, under the influence of alcohol, he first tried to commit suicide by cutting wrist with razor blades, but death was not immediate. He then attempted electrocuting himself by touching a live wire, inside the bathroom, which failed and finally he drowned in a water drum. The victim had left a message, written with his blood on the floor of the room, reflecting his suicidal intentions. In complex suicide, many bizarre methods are used, but this combination of methods is unusual and not found in available forensic literature.

Postmortem examination in cases of custodial death in India.

Death in custody causes one of the most embarrassing situation for the law enforcement agencies and medicolegal experts. The doctors has to follow the guidelines given by National Human Rights Commission while conducting postmortem examination in such cases and many a times doctors have been blamed for giving a biased opinion under influence to protect the interests of police and jail officials. This paper discusses postmortem examination in cases of custodial deaths and incidence of custodial death in India as well as other parts of the world. The cases of custodial deaths for which autopsy was conducted at AIIMS has also been discussed.

Skeleton used for anatomical study brought for medico-legal autopsy: a case report.

Knowledge of human anatomy is essential for all those practising medicine. The human skeleton is invariably used to study the anatomy of body structures. For this, many human skeletons are obtained from the market by students and teachers and are kept at home or in hostel rooms. However, after use the skeleton has to be disposed off properly. In the present case, a human skeleton used for study purposes was thrown away in garbage and someone informed the police about presence of skeletal remains in the garbage. The case was registered by the police and the skeletal remains were brought for medico-legal autopsy.

The Abbreviated Injury Scale and its correlation with preventable traumatic accidental deaths: a study from South Delhi.

Anatomic trauma scoring systems are fundamental to trauma research. The Abbreviated Injury Scale (AIS) and its derivative, the Injury Severity Score (ISS), are the most frequently used scales. In a prospective study, 400 autopsies of road traffic accident victims performed between January 2002 and December 2003 were coded according to the AIS and ISS methods. All the cases were classified into different injury groups according to the Injury Severity Scale. Fifty-eight cases (14.5%) were assigned an ISS value of <25; 244 (61%) cases were valued between 25-49; 38 cases (9.5%) were valued between 50-74 and 60 (15%) cases had a value of 75. On analysis of medical care, in cases with ISS<50, about 96% of the victims did not receive optimal care quickly enough with a lack of pre-hospital resuscitation measures and lengthy transportation time to hospital being of major importance.

Study on arsenic level in public water supply of Delhi using hydride generator accessory coupled with atomic absorption spectrophotometer.

Exposure to arsenic has been associated with several health hazards. Worldwide the main reason for chronic human intoxication with arsenic is intake of contaminated drinking water. Air acetylene type of atomic absorption spectrophotometer in combination with hydride generator accessory was used to analyze arsenic level in 25 water samples collected from 25 booster pumping stations and 313 water samples collected from tap water supply of 62 areas of Delhi. Results were analyzed using SPSS and Barlett's Chi Square Test. Mean arsenic level detected in water samples collected from booster pumping stations was 0.00976 ppm (Range 0.000-0.017 ppm, Standard Deviation 0.006 and Standard error of Mean 0.00118). Maximum arsenic level (0.017 ppm) was found in water samples of booster pumping stations of Mehrauli, Punjabi Bagh and Ramjas Road. Mean arsenic level detected in samples collected from tap water supply was 0.013 ppm (Range 0-0.0430 ppm, Standard Deviation 0.00911 and Standard error of Mean 0.000515). In water samples of 42 areas arsenic level detected was exceeding WHO/EPA permissible limit of 0.01 ppm (10 ppb). The mean arsenic level detected in water samples of booster pumping station was within WHO/EPA permissible limit while mean arsenic level detected in tap water samples was marginally higher. Mixing of ground water and contamination through broken or leaking channel could be the possible reason of higher arsenic level in tap water. Continuous monitoring of quality of drinking water is required particularly in view of water contamination caused by industrial waste and uncontrolled ground water extraction.

2. Haemorrhoids leading to post-mortem artefact: a case report.

Any change produced, or feature introduced, in a body after death which is accidentally or physiologically unrelated to the natural state of the body is termed as an artefact. Since artefacts may lead to misinterpretation of post-mortem findings, it is important to rule them out. Artefacts may be produced for a variety of reasons. We present a case report where a young male in his late twenties committed suicide by hanging. He was suffering from haemorrhoids. Because of his posture, there was post-mortem bleeding, which was interpreted by the police as bleeding due to the self-cutting of his veins. Hence, we felt the need to report this case.

Suicide by a transvestite or sexual asphyxia? A case report.

Autoerotic asphyxial activity may at times result in unexpected death. Although the majority of deaths that occur during autoerotic asphyxial episodes are accidental, the possibility of suicide must always be entertained. In the case presented here, a 22-year-old married male was found hanging by his neck in his bedroom, which was locked from the inside. He was suspended by a 'lungi' (male wrap-around cloth) from the ceiling fan hook in his room, with his feet touching the ground. He was dressed in a brassiere, panties, and silver anklets. There was no evidence of previous perverse behaviour, and investigation disclosed no evidence of previous autoerotic sexual activity, homosexual behaviour, drug abuse or suicidal ideation.

An unusual suicide with a safety razor blade--a case report.

A 29-year-old male was found dead lying in a pool of blood inside a community toilet locked from inside. The individual is alleged to have committed suicide by cutting his throat with a safety razor blade, which was found at the scene by the investigating police authority. The deceased, as per his relatives, was suffering from depression for the last few days.

Study on arsenic level in ground water of Delhi using hydride generator accessory coupled with atomic absorption spectrophotometer.

Surveillance of drinking water is essentially a health measure intended to protect the public from water borne diseases. Hydride generator accessory coupled with atomic absorption spectrophotometer was used to analyze arsenic level in 49 ground water samples collected from different areas of Delhi. Arsenic level in ground water samples was in the range of 0.0170 to 0.100 ppm (Mean-0.0431, Standard Deviation-0.0136, Std. error of Mean-0.00194) with minimum concentration at Raney Well No. 7 (0.0170 ppm) and maximum at Kotla Mubarak Pur (0.100 ppm). Arsenic containing sediments and percolation of chemicals into soil as the result of dumping of garbage rich in chemicals into open landfills could be the possible source of arsenic in ground water of Delhi. Extensive survey and continuous monitoring is required to be made to assess the magnitude of problem and earlier intervention.

Decapitation in road traffic accident--a case report.

A 20-year-old girl along with four of her friends, all in their early 20s, met with a fatal accident in the early hours of the day. Their car was hit by a speeding truck at a crossing. All the occupants of the car sustained multiple injuries and died on the spot. The girl was decapitated in the accident. Her head was recovered outside the mangled remains of the vehicle and the rest of the body was extracted from the co-driver's seat of the damaged vehicle.

Confidential communications in medical care.

Since the legal consequences taking in consideration of Indian evidence Act 1857 of an unwarranted release of confidential information are uncertain and even the consequences may be serious, it is necessary that a physician be most cautious when divulging any information about a patient. Although there are exceptions to the proposition that all confidential information acquired from a patient should be kept secret, the basic rule to remember is that confidential information should not be revealed without obtaining the patient's consent unless law of the land like provision in criminal procedure code of India requires the physician to report the information, to any person or insurance company. Whenever a physician believes it is necessary to reveal a professional secret to protect the welfare of a patient, a third person, or the community, he should exercise caution in the method of disclosure. The following suggestions have been made to guide physicians under these circumstances: 1. Assure yourself that the person informed is sometime entitled to the information, such as the patient's parent or guardian. 2. Do not give information by telephone if you do not recognize the voice of the person making the request. 3. Avoid the use of telegrams or letters to communicate medical information of patient. 4. If you are in doubt about your right to release the information consult your legal council. 5. A person in police custody as an undertrial prisoner has the right not to permit the doctor who has examined him, to disclose the nature of his illness to any person. If a person is convicted, he has no right and the doctor can disclose the result to the authorities. 6. Never release the treatment history without written consent from patient or its legal heirs to any insurance company.