The Role of Pathological Examination of the Liver in Medicolegal Autopsy: A Tertiary Care Center Study From North India.

BACKGROUND: The pathological examination of a medicolegal autopsy is a great learning opportunity for a pathologist as well as for a forensic expert, where the cause of death remains unknown. Liver disease epidemiology differs from one geographic area to another. MATERIAL AND METHODS: This was a prospective observational study with 100 medicolegal autopsy cases over a one-year period conducted in the Department of Forensic Medicine and Toxicology (FMT) and Pathology. Representative tissue from the liver was collected in 10% neutral buffered formalin and sent for histopathological examination. RESULTS: The mean age of the cases was 41.98 ± 15.39 years, and ages ranged from 20 to 90 years with male preponderance. The most common histopathology and gross findings noted were mild to moderate chronic hepatitis (CH) (54%) and fatty change (36%), respectively. There was a significant association (p ≤ 0.05) between histopathology and gross findings, cause, and manner of death. CONCLUSION: Gross and histopathological examination of the liver in a medicolegal autopsy has a significant role in ascertaining the cause and manner of death.

Icy Intrigue: A Case Report of an Unusual Encounter With an Ice Pick Injury.

An ice pick is rarely observed as a weapon of offense in homicide or suicide. The severity of injuries produced by an ice pick ranges from circular contused abrasions to punctured wounds with clean-cut margins. We present a case of a self-inflicted ice pick injury to the chest autopsied at the AIIMS Rishikesh morgue. During this study, we noticed and analyzed the unusual presentation of injury by an ice pick, contrary to the injuries generally observed in ice pick cases. We highlight a peculiar case of a homicidal ice pick injury observed during the autopsy. The presentation deviated from typical patterns, with the weapon penetrating the victim's body in an unconventional manner. The findings challenge traditional assumptions regarding ice pick injuries and underscore the importance of comprehensive forensic analysis. Understanding and documenting atypical presentations of such injuries can aid forensic experts in accurately determining the cause and manner of death, facilitating the pursuit of justice in criminal investigations.

A Preliminary Study of Organ Weight After Histological Exclusion of Abnormality During Autopsy in the Adult Population of Uttarakhand, India.

Organomegaly can be a strong predictor of an underlying pathological condition. There are many standard tables available in various texts listing the normal organ weight range, yet there is a lack of a standard table that is accepted globally. The main reason behind this is variation in organ weight due to socioeconomic status, geographical variation, and racial and stature variation among different global populations. The Western population has different stature compared to our population, that is, residents of Uttarakhand, India. Different studies tabulated organ weights in different regions of the world and correlated with different bodily parameters such as sex, race, stature, BMI, etc, which have shown a significant variation. There are different sets of data available that cannot be accepted universally due to regional variation. Most of the studies done in various parts of the world do not specify the condition of the organ, whether it was normal at the time of study or not. The methods of dissection of organs were also not explained in different studies. In this study, a total of eight organs were weighed from 137 autopsies conducted at the mortuary of the All India Institute of Medical Sciences Rishikesh over a period of 1.5 years. It was found that the average brain weighed in males was 1313.2 gm (±127.7 gm) and among females, it was 1218.0 gm (±122.82 gm). The weight of the heart was 310.1 gm (±83.97 gm) in males and 241.2 gm (±71.42 gm) in females. Right and left lungs weighed 499.4 gm (±207.5 gm)/407.5 gm (±128.66 gm) and 459.6 gm (±179.19 gm)/369.4 gm (±144.17 gm) among males and females, respectively. The liver weight was 1477.0 gm (±370.52 gm) in males and 1309.0 gm (±274.18 gm) among females. Spleen weighed 154.0 gm (±74.63 gm) in males and 156.0 gm (±65.0 gm) in females. The right and left kidneys weighed 125.9 gm (±37.92 gm)/108.1 gm (±28.80 gm) and 126.3 gm (±31.26 gm)/106.6 gm (±22.4 gm) among males and females, respectively. In our study, we have done a histological examination to rule out any pathological condition before including the weight of the organs in the study. The present study is to derive a standard organ weight among the inhabitants of Uttarakhand, India, and to look for a variation in organ weight among different studies done in the past in different regions of the world.

Methanol Poisoning: An Autopsy-Based Study at the Tertiary Care Center of Uttarakhand, India.

Aims and objective This study describes postmortem and histopathological findings to understand the internal progression of methanol poisoning. The study also aims to examine clinical, biochemical, and histological changes seen with methanol poisoning. Materials and methods The study describes the methanol poisoning tragedy that occurred in February 2019 in the Haridwar district of Uttarakhand. Ninety-one patients were admitted to the hospital, four were brought dead, four died within a few hours of admission (designated as early deaths), and four died between 10 and 45 days of hospitalization (designated as late deaths). A medicolegal autopsy was performed on all 12 deaths. Gross external and internal findings were noted, and routine viscera and blood were preserved and sent to Uttarakhand's Forensic Science Laboratory (FSL) to estimate methyl alcohol. A section of the optic nerve was taken from the optic chiasma for histopathological examination. Data were collected retrospectively from records. All data were tabulated and analyzed using Microsoft Excel version 2019. The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences (AIIMS), Rishikesh (249201), Uttarakhand, India. Results Methanol poisoning is a health-associated disaster in many regions of India. Autopsy, including histopathological examination, could elicit the adverse effects of methanol on different organs. Their mean age was 37.7 years (range 21-70), and 67% (n = 8) of all victims were in the age range of 30-50 years. The average methyl alcohol level reported among hospital deaths and brought dead was 116.08 mg/dl and 224.6 mg/dl, respectively. A blurred vision had been their most common complaint, identified in 75% (n = 6), followed by vomiting and abdominal pain, while 50% (n = 4) had features of respiratory insufficiency. Mean pH and bicarbonate levels among hospital deaths were 6.61 mmol/l and 6.18 mmol/l, respectively. An autopsy revealed signs of hypoxia in all cases. Internal organs were congested. Severe metabolic acidosis leading to the respiratory failure was the cause of death in early deaths. Cerebral and pulmonary edema consequent upon septicemic shock was the cause of late deaths. A case with the most extended survival duration showed cerebral edema with intracerebral hemorrhage. Cirrhotic liver, along with features of renal failure, was an additional internal finding in late deaths. Optic nerve histopathology showed no demyelination or axonal necrosis; however, mild edematous changes were evident. Conclusions Methanol poisoning is one of the manmade disasters in the developing world. There are various adverse effects of different organs and organ systems inside the body. Timely intervention and diagnosis can save several lives. The organ-directed meticulous autopsy can help autopsy surgeons in establishing the diagnosis and thus help the judiciary in delivering justice to the sufferers.

A Comprehensive Review of Pathological Examination in Forensic Medicine: Past, Present, and Future.

Pathological examination (PE) encompasses a gross or macroscopy and histopathological or microscopic examination. It is prudent in finding the cause of death (COD) in clinical and medicolegal autopsies. There are various auxiliary techniques in the form of clinical history, communication, specialized training, and protocols for consolidation of the PE results. After a thorough search of the literature in PubMed with relevant keywords along with further analysis of the results, it emerged that even with the modernization of forensic medicine, a PE is unbeatable in detecting the COD. It has various useful aspects, apart from regular finding the COD, such as in student teaching, epidemiology of disease, audit tool, and quality assurance. There are also limitations of PE, which should be dealt with great caution. Hence, limitations must be understood by a forensic expert as well as a pathologist. In this review, all factors that are related to PE in any manner are discussed in detail, and the scope for improving the quality of PE to be relevant in the present scenario is reviewed. It is a comprehensive reassessment of the literature review that also casts light on the future along with a critical analysis of the facts that deal with PE.

Fatal wild leopard attack injuries in Uttarakhand, India.

Leopard attacks on human beings is common in Uttarakhand which is an area of national conservation. The objective of this study is to examine the pattern of injuries and circumstances to encourage ways of reducing such conflicts. There were eight deaths from leopard attacks brought for autopsy to the mortuary between January 2019 and August 2020. Incidents occurred mostly in a forest close to human settlements. One tourist was among the male victims, the remainder of whom were women carrying out household duties near the forest. Leopard attack injuries present in the head and neck were ante-mortem, with abdomen, buttocks and limbs post-mortem. People living at the border of protected areas need alternative means of support to enable them to avoid using forest resources, tourists must be warned to avoid wandering in the area.