Sudden Death Due to Cardiac Tamponade Secondary to Myocardial Infarction Ventricular Wall Rupture.

Sudden deaths due to natural causes are commonly seen in forensic practice, most of which are attributed to cardiovascular diseases. Cardiac tamponade (CT) is one of the causes of sudden cardiac death, with a fatal outcome usually detected at autopsy. While both trauma and non-traumatic causes are responsible for CT, it is a known complication of acute myocardial infarction leading to cardiac rupture that involves the ventricular wall, septum, and papillary muscles. We report the case of a 50-year-old male who collapsed suddenly and was declared dead in the Trauma and Emergency Unit of the hospital before admission. Autopsy findings revealed 250 mL of blood and a 206 g blood clot in the pericardial cavity with a vertical tear on the posterolateral surface of the left ventricle with focal hemorrhagic myocardium consistent with acute myocardial infarction. The cause of death was CT as a result of myocardial rupture due to acute myocardial infarction. The gross and histopathological findings were diagnostic and revealed thrombosis of the left circumflex artery, transmural myocardial infarction, and ruptured myocardium of the left ventricle.

Importance of Crime Scene Visits by a Forensic Medicine Expert: A Survey-Based Study.

Background This study is intended to compare the Indian system of inquests, which is conducted by nonscientific people like police and magistrate (who are compulsorily neither qualified in science nor in law), and the medical examiner system of the USA which is done by doctors specialized in forensic medicine/pathology. Aims The goal of this study was to see if bringing in a medical examiner system makes a difference in determining the cause, manner, and time of death as compared to the current system of conducting inquests and autopsies by two different agencies, namely, the police and forensic medicine experts. Material and methods In the present study, a peculiar case (in which the police were clueless and the autopsy surgeon was confused during the autopsy) was chosen for getting an expert opinion from 50 forensic medicine experts from different parts of the country in which police were not clear regarding cause, manner and time of death, but later after a crime scene visit by forensic medicine experts who had conducted the autopsy, it was clarified. Opinion regarding the cause, manner, and time since death was taken from 50 medico-legal experts in two steps. In the first step, only the autopsy finding and history obtained from police were provided and in the second step, additional information obtained from the crime scene visit by forensic medicine experts was provided. The sampling method was purposive sampling. Result In the cause of death, Cohen's Kappa coefficient was 0.30% (z-statistic = 3.87, p-value = 0.0001), indicating a significantly low agreement between the first and second steps by the experts, as their decision changed after getting the evidence of the crime scene visit. In the manner of death, Cohen's Kappa coefficient was 0.06% (z-statistic = 0.66, p-value = 0.2540) indicating a very low agreement between the first and second opinions by the experts as their decision regarding the suspected manner of death changed drastically after getting the evidence of crime scene. In the time since death, Cohen's Kappa coefficient was 0.5531% (z-statistic = 7.25, p-value = 0.0001), which also indicates significant difference. Conclusion Therefore, in this study, the usefulness of the medical examiner system in the Indian setting has been proved beyond doubt expecting drastic improvement in criminal investigation by introducing the medical examiner system in India.

Phylogenetic analysis of Indian serotype Asia1 foot-and-mouth-disease virus isolates revealed emergence and reemergence of different genetic lineages.

Foot-and-mouth-disease virus (FMDV) serotype Asia1 causes significant number of disease outbreaks in India. Indian Asia1 virus isolates were shown to be genetically heterogeneous and of the two lineages (lineage B and lineage C) described in India, lineage C caused majority of the outbreaks. Emergence of a novel divergent lineage (lineage D) within lineage C has been described in 2001. In the present report, the complete VP1 genomic region of 41 FMDV Asia1 field isolates collected between 2003 and 2008 was sequenced. Phylogenetic analysis revealed reemergence of lineage C since 2005 following exclusive dominance of lineage D in the period between 2002 and 2004. At many positions lineage specific signature residues were identified. The antigenic relationship of the field isolates with the currently used vaccine strain IND63/72 was also determined, which reflects antigenic stability of serotype Asia1 in-spite of genetic heterogeneity.

Assessment of suitability of two serotype A candidate vaccine strains for inclusion in FMD vaccine in India.

The recent type A foot and mouth disease virus field isolates recovered in India are shown to be antigenically quite divergent from the in-use vaccine strain (IND 17/82), warranting the selection of a suitable vaccine strain which can cover this diversity in antigenic spectrum. In earlier studies employing neutralization test with anti-146S rabbit sera raised against eight candidate vaccine strains, IND 81/00 and IND 40/00 belonging to genotype VII were found to offer the best antigenic coverage. In order to assess the credibility of IND 81/00 and IND 40/00 as vaccine strains, 17 recent isolates received during 2005-2006 and representative isolates from older genotypes were subjected to two-dimensional micro-neutralization assay using bovine convalescent serum (against IND 81/00 and IND 40/00) and bovine vaccinate serum (against IND 40/00). From the results it is evident that both the isolates IND 81/00 (antigenic relationship 'r-value' >0.40 with 86% of isolates) and IND 40/00 ('r-value' >0.40 with 78% of isolates) show nearly equal antigenic relatedness with the recent field viruses and hence both of these are effective vaccine candidates in present context. Though very limited in its extent, these useful data obtained with antisera raised in homologous host system are logical extension of the on going quest for the appropriate vaccine strain and circumvents species disparities in the immune recognition of epitopes.