Delhi is the second largest city of the world both in terms of population and area, as well as being the capital of India. Every year, thousands of people from different states throng to the capital in search of a job in order to earn a living. When these people die and their bodies are found without any identifying documentation, it is very difficult for the police to establish their identities. These bodies are labelled as unidentified/unclaimed or unknown, and are sent for usually sent for medicolegal autopsy. Invariably, skeletonised bodies are also recovered, which are also subjected to medicolegal autopsy. Female foeticide is another social problem, and whenever such foetuses are disposed of illegally, they are also grouped under this category and brought for medicolegal autopsy. We undertook a five-year retrospective analysis (for the period 2010–2014) of all such cases brought for medicolegal autopsy at our centre, which caters only for the south and south-east districts of Delhi. A total of 7964 cases were brought for medicolegal autopsy, of which unknown cases accounted for about 16%. About 25–30 foetuses and skeletonised bodies were brought each year that was studied. The manner of death was certified as natural in about 71% of cases, with predominant pathology in the lungs. There was a clear predominance of males over females, with the 31- to 50-year age group accounting for half of all cases. There was an increase in the number of deaths during months of extreme temperatures. The average time between the recovery of a body by the police and the post-mortem was about seven days. These findings raise many questions, including the failure of governmental policies, police investigating agencies and social menace. The creation of a national missing-persons database as well as a DNA databank is needed to aid in the identification of unidentified/unclaimed and unknown bodies.
Sections 47 and 48 of the Mental Health Act 1983 allow prisoners to be transferred from prison to an appropriate health-care setting in order to be treated. There is an awareness that delays exist when transferring prisoners to hospital. However, literature regarding the delay in returning these patients from hospital is limited. The admissions from prison to a Psychiatric Intensive Care Unit (PICU) in South West London were compared to non-offenders on the PICU in order to compare the average length of stay for both groups and the time taken for the discharge from PICU once felt clinically appropriate. The study also compared demographic profiles, reason for admissions, psychiatric diagnosis and index offences. Over six years, there were 18 admissions from prison to a PICU. The control group comprised 37 non-offenders admitted to the same PICU. On average the prison group took longer to be deemed clinically ready for discharge and, even once clinically ready, then took longer to be discharged. The average length of stay in PICU was 77.83 days for prisoners, and 16.46 days for non-offenders. All 55 admissions were between 1 January 2008 and 31 December 2014. The offender pathway and the difference in the length of stay between prisoners and non-offenders in a PICU warrants further exploration. Possible recommendations to reduce the length of stay of prisoners include improved information sharing between prisons and hospital, and clearer guidelines regarding the level of security required.
The purpose of this study was to evaluate which DNA extraction method yields the highest quantity of DNA from chewing gum. In this study, several popular extraction methods were tested, including Chelex-100, phenol-chloroform-isoamyl alcohol (PCIA), DNA IQ, PrepFiler, and QIAamp Investigator, and the quantity of DNA recovered from chewing gum was determined using real-time polymerase chain reaction with Quantifiler. Chewed gum control samples were submitted by anonymous healthy adult donors, and discarded environmental chewing gum samples simulating forensic evidence were collected from outside public areas (e.g., campus bus stops, streets, and sidewalks). As expected, results indicate that all methods tested yielded sufficient amplifiable human DNA from chewing gum using the wet-swab method. The QIAamp performed best when DNA was extracted from whole pieces of control gum (142.7 ng on average), and the DNA IQ method performed best on the environmental whole gum samples (29.0 ng on average). On average, the QIAamp kit also recovered the most DNA from saliva swabs. The PCIA method demonstrated the highest yield with wet swabs of the environmental gum (26.4 ng of DNA on average). However, this method should be avoided with whole gum samples (no DNA yield) due to the action of the organic reagents in dissolving and softening the gum and inhibiting DNA recovery during the extraction.
We examined 169 deceased persons and 76 homicide–suicide cases reported in Japan’s Kanagawa Prefecture from 1999 to 2011. The relationships between homicide–suicide perpetrators and homicide victims; the numbers of victims; their age, sex, causes and places of death; motivation; and the presence or absence of a suicide note were extracted and examined. The relationship between homicide–suicide perpetrators and homicide victims was examined based on findings from the following: 24 married couples (31%), 22 parents and children aged ≥18 years (29%), 19 parents and children aged ≤17 years (25%), seven families (9%), two couples (3%) and two miscellaneous relationships (3%). The perpetrators comprised 39 men and 40 women, with a mean age of 51.6 years. The victims comprised 39 men and 51 women, with a mean age of 35.4 years. In our study, approximately half of the perpetrators were female, which differed greatly from the reports from Western countries, where most perpetrators were male. Homicide–suicides among married couples accounted for a higher proportion of overall homicide–suicide deaths in Western countries. In Japan, homicide–suicide occurred more frequently with parents and children. Cases in which a mother committed suicide after having killed her young children accounted for a high proportion of these deaths. Because these events occur so frequently in Japan, we recommend making particular efforts to reduce homicide–suicides among mothers and children.
The aims of this article are to consider the effects of hindsight bias on findings of negligence in medico-legal litigation and of the potential of the original Bolam direction to eliminate bias from the decision-making process. The Bolam test may have been expanded beyond its appropriate scope in the past, but these excesses have now largely been undone. It will be shown that Bolam still has an important role to play in tort cases. By considering breach of duty cases in which the Bolitho ‘gloss’ has been applied, attention is drawn to the potential dangers of disregarding practices within the medical profession.
The study presents a retrospective analysis of 64 cases of death resulting from ingestion of corrosive substances. The cases represented approximately 0.4% of all autopsies conducted and 13.6% of all fatal poisonings studied during the 10-year period from January 2005 to December 2014 at the Department of Forensic Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi. The data was analyzed with regard to age, sex, nature and source of corrosive substance used, survival period, cause and manner of death. Males (64.06%) outnumbered females (35.94%), with a male-to-female ratio of 1.78:1. The most common age group involved was 21–30 years (35.94%). Sulfuric acid (68.75%) presented as the most common corrosive substance ingested. Household cleaning substances (39.06%) were identified as a common source of such type of corrosive substance, but the exact source could not be identified in 56.26% of cases. In the majority of cases (46.88%) death was due to perforation peritonitis. Most of the victims (54.69%) succumbed to their injuries within a day of ingestion. In 87.5% of cases, the corrosive substance was consumed for suicidal purposes. A strict regulatory framework is required for the production, distribution, storage and use of corrosive substances. Preventive guidelines and creating awareness among the masses will go a long way towards curbing such unfortunate incidents.
Suicide rates and associated risk factors are known to change over time. The periodic evaluation of suicides in a particular locality may identify specific issues that may help in prevention efforts. The profile of 146 consecutive cases with suicide, open and narrative verdicts between January 2004 and July 2011 in Wolverhampton was studied in order to explore associated factors. Specific information about methods, mental health issues and stressors was collected. There was considerable variation in suicides in different wards of the city, with higher occurrences in inner-city areas. Male suicides were three times more common, and they were significantly younger than in female suicides. Common methods were hanging (52.7%) and poisoning (21.9%) involving a wide range of drugs. Life events were reported in 52.1% suicides, most frequently relational problems (28.1%), followed by physical illness and bereavement. Mental-health factors were associated with 63.0% of suicides, predominantly depression (45.9%) and alcohol and drug abuse (6.8%). The majority of the suicide victims (63.0%) were not in contact with mental-health services, including: most men (68.8%), young suicides up to age 34 (78.6%), the elderly (69.2%) and Asians (70.0%). A considerable proportion of these suicides had mental-health issues, mainly depression (42.4%) and alcohol or drug abuse (6.5%). Significantly more of them (69.6% vs. 22.2%) had stressors compared with suicides known to mental-health services. The findings of the study highlighted risk factors that may help prioritising intervention initiatives. It appears that local suicide audits may complement national information on suicide in designing appropriate local suicide-prevention strategies.
The puzzle of a mysterious death in the Middle Ages has been hypothesized in terms of contemporary forensic legal and scientific methods. That al-Hasan ibn-‘Ali died in 669 aged just 45 has been forensically analyzed based on written sources that dictate eyewitness accounts of historical events. The report of the contemporaneous poisoning of another individual who resided under the same household as al-Hasan’s and experienced similar, yet non-lethal, symptoms has served as the beginning of the analysis. In light of ancient (medieval) documents and through using mineralogical, medical, and chemical facts, it has been hypothesized that mineral calomel (mercury(I) chloride, Hg2Cl2) from a certain region in the Byzantine Empire (present-day western Turkey) was the substance primarily responsible for the murder of al-Hasan.
Lip prints can provide vital information that may be useful for the purposes of forensic investigations. The current study was undertaken with the aims of determining the distribution and predominant lip-print patterns in a Central Indian (Marathi) population and evaluating whether any sex differences exist. The study subjects were 400 healthy consenting volunteers – 200 males and 200 females – aged 18–25 years, from the Marathi community. A simpler and more convenient method of data collection – digital photography – was used. The central (most motile) 1 cm2 portion of both upper and lower lips was analysed digitally. As per Suzuki and Tsuchihashi’s classification, overall, Type IV (27.5%) and Type III (6.25%) were found to be the most and least prevalent patterns, respectively. The Type II (32%) lip-print pattern was found to be most predominant in males, while Type IV (32.5%) was found to be most commonly occurring in females. Statistically significant differences (p < .01) were observed between lip-print pattern types in males and females.
Respecting patients’ rights is an essential component in health care. Passing a regulation is not a guarantee for the protection of patients’ rights. This article aimed to assess patients’ awareness of the contents of the Patient’s Bill of Rights in Iran and to determine if they had received a service compatible with their rights charter.
This is a descriptive study in 202 hospitalised patients. A questionnaire was used, and associations between variables were examined using Pearson’s correlation test. The significance level was p < .05.
The patients’ ages ranged from 18 to 87 years of age, 33% were male and 79% were married. Patients’ knowledge was lowest regarding the need for consent for the treatment process and was highest regarding the patient’s right to know the expertise of the treatment team. The mean of patients’ knowledge was 77.56%. As for patients’ exercising their rights, the highest score belonged to the patient’s right for attending doctors and treatment team’s confidentiality; the lowest score belonged to the right to receive necessary information about probable complications, other treatment options and participation in the final selection of treatment method. The mean score of patient satisfaction was 8.06 (out of 11). There was no significant relationship with their education level or the number of admissions.
Health-care professionals can provide care based on patients’ rights, and their knowledge of patients’ rights needs to be evaluated. Educational programmes, leaflets, booklets and posters can be helpful in this regard. In addition, professional organisations and the Ministry of Health need to be more sensitive to this issue.
A few studies have demonstrated an inverse relationship between the general population and suicide rates and antidepressant prescribing rates. Correlations between general population suicide rates and prescribing rates of other psychotropic drugs have also been observed. There have not been any studies during the last decade.
The relationship between adult suicide rates and prescription rates of psychotropic drugs by the broad British National Formulary (BNF) categories, for individual psychotropic drug groups within the BNF categories (e.g. selective serotonin reuptake inhibitors) and for individual psychotropic drugs was examined over a 12-year period (1995–2006) was examined using Spearman’s rank correlation. All data were ascertained from the archives of the Office for National Statistics.
There was an absence of significant correlations between adult suicides rates and rates of prescriptions of psychotropic drugs in the broad BNF categories, individual psychotropic drug groups and individual psychotropic drugs.
The findings may be due to methodological errors. Should the findings be accurate, then the following approaches require consideration to reduce suicide rates further: (i) development of strategies to ensure continued prescription of psychotropic drugs at the current level; (ii) development of strategies to improve non-pharmacological measures, including improved mental health services provision for adults, improved assessment of suicide risk, increased availability of psychosocial interventions and restricting the availability of methods of suicide; and (iii) development of strategies to implement improvement in distal risk (e.g. societal socio-economic status) and protective (e.g. societal educational attainment) factors for suicide at a societal level.
It might be expected that follow-up telephone communication with next of kin relating to coronial autopsies would be distressing, particularly when made months or even years after the death. However, our experience has indicated that this is not the case in the majority of calls.
Unintentional carbon monoxide poisonings and fatalities lead to many toxicity cases. Given the unusual physical properties of carbon monoxide—in that the gas is odorless and invisible—unorganized and erroneous methods in obtaining engineering evidence as required during the discovery process often occurs. Such evidence gathering spans domains that include building construction, appliance installation, industrial hygiene, mechanical engineering, combustion and physics. In this paper, we attempt to place a systematic framework that is relevant to key aspects in engineering evidence gathering for unintentional carbon monoxide poisoning cases. Such a framework aims to increase awareness of this process and relevant issues to help guide legal counsel and expert witnesses.
The Mental Health (Care and Treatment) (Scotland) Act 2003 introduced the right for patients in high-security psychiatric care to appeal against detention in conditions of excessive security. A previous study examined the first 100 patients to appeal under this provision. In this study we compare them with the next cohort of 110 patients to lodge an appeal, finding, contrary to expectations, no change in patient characteristics or the outcome of their appeals. The clinical, legal and demographic features of successful and unsuccessful appellants, who made up 38% and 27% of the 110 patients, respectively, were also compared. Those patients with the support of their responsible medical officer and those already included on a transfer list had a significantly better chance of success (p = 0.00). It was also found that a history of excessive alcohol consumption was associated with successful appeals (p = 0.002). A diagnosis of learning disability was associated with unsuccessful appeals (p = 0.018), though the sub-sample was very small. These findings are important given the forthcoming extension of this right of appeal to other levels of security.
Bloodstain pattern analysis (BPA) is the forensic application of the interpretation of distinct patterns which blood exhibits during a bloodletting incident, providing key evidence with its ability to map the sequence of events. Here, we explore the use of equine blood and investigate its suitability within the field of BPA. Blood is a complex fluid, and finding a suitable safe substitute to human blood that encompasses all of its characteristics has been the focus of many investigations. Animal blood has been concluded as the closest and therefore the most suitable alternate. However, it seems that currently only porcine blood is most prominently utilised.
In this study, equine blood was investigated, using two different anti-clotting methods, where blood impacts were explored over a typical range of varying impact velocities upon a selection of commonly encountered surfaces. Key BPA parameters, such as the diameters of the resulting bloodstains, number of spines and area of origin were measured, which were subsequently applied into previously derived BPA equations.
We find that defibrinated equine blood is a suitable alternative and offers the same conclusive outcomes to human blood. This gives bloodstain pattern investigators and researchers an additional choice of blood which can be of benefit when certain bloods are difficult to attain or when the activity involves the usage of a large quantity of blood. Additionally we explore the effect on BPA of aged blood, which revealed a significant decrease in stain diameter of up to 12.78 % when blood has been left for 57 days. A shelf life of no more than 12 days is recommended when blood is refrigerated at 4℃.
As a new field in our country, forensic psychiatry needs strategies for management and rehabilitation programmes.
The aim of this study was to evaluate the sociodemographic characteristics of psychiatrically diagnosed inpatients who were hospitalised in the three years from January 2009 to December 2011 and the prevalence of such diagnoses. The specific objectives of this study were to use our results to identify rehabilitation programmes for the treatment of patients and to identify the specific training needs of mental-health professionals.
In this retrospective study, we collected data about the sociodemographics and violent behaviour of all forensic inpatients who underwent court-ordered psychiatric forensic evaluation and assessment. We reviewed and studied the documented diagnoses based on the following criteria and sources: the ICD-10 criteria for mental disorders, the Structured Clinical Interview (SCID), recidivism rates, criminal data, court records and other hetero-anamnesis data. The data were analysed using a descriptive approach.
The subjects were referred for forensic psychiatric evaluation, diagnosis and treatment either directly from prison (23.2%) or from the court (76.8%). The majority of the offenders (85.7%) were currently on trial, and charges of physically threatening others were more common than charges of domestic violence or murder. The prevalence of psychiatric diagnosis was 94.6%, and the most common diagnosis was psychosis (69.1%). Drug abuse and personality disorders, including high-risk behaviours, were also common. The overall relapse rate for aggressive behaviour was 48.9%.
Rehabilitation programmes for treatment and management are needed that specifically focus on psychotic disorders, severe personality disorders and drug abuse.
On 28 August 2012, the European Court of Human Rights (ECHR) issued a judgment regarding the requirements for the legitimate access of couples to assisted reproductive techniques (ART) and to pre-implantation genetic diagnosis (PGD). This judgment concerns the case of an Italian couple who found out after their first child was born with cystic fibrosis that they were healthy carriers of the disease. When the woman became pregnant again in 2010 and underwent fetal screening, it was found that the unborn child also had cystic fibrosis, whereupon she had the pregnancy terminated on medical grounds. In order to have the embryo genetically screened prior to implantation under the procedure of PGD, the couple sought to use in vitro fertilisation to have another child. Since article 1 of the Italian law strictly limits access to ART to sterile/infertile couples or those in which the man has a sexually transmissible disease, the couple appealed to the European court, raising the question of the violation of articles 8 and 14 of the European Convention on Human Rights. The applicants lodged a complaint that they were not allowed legitimate access to ART and to PGD to select an embryo not affected by the disease. The European Court affirmed that the prohibition imposed by Italian law violated article 8 of the European Convention on Human Rights. Focusing on important regulatory and legal differences among EU Nations in providing ART treatments and PGD, we derived some important similarities and differences.
Front-line clinician general practitioners may be required to assist in the administration of mental health legislation. Limited training has been an issue previously identified. This study aims to ascertain levels of training, knowledge and confidence of general practitioners in Scotland in relation to the mental health act. An anonymous online survey of all general practitioners in one Scottish health board was completed.
Eighty general practitioners in Forth Valley responded to the survey; 55% had never received any previous training in the mental health act. The majority rated knowledge of the act as fair (50%) and confidence in using the act as poor (44%). No relationship was found between previous training and current knowledge or confidence. Previous practical use of the act was associated with better current knowledge (p = 0.0074) and confidence in using the act (p = 0.0005). Of the respondents, 99% were keen to pursue further training in the act.
Further practical training for general practitioners in the use of the mental health act is required to improve knowledge and confidence in this important area.
The study comprised lip morphometry of 600 North Indian adults (300 males and 300 females). The aim of the study was to create base data of various linear and vertical measurements of the upper and lower lips and width of the mouth. This standard may serve as a guideline for sexual dimorphism as well as for restoration or enhancement of esthetic and plastic surgery for the lips in the north Indian population, which will enable the surgeon to offer a better cosmetic result. Prior informed written consent from all the subjects was obtained. The exclusion and inclusion criteria for the subjects were predefined. The analysis shows the sexual dimorphism in most parameters of lips being greater in males. The results were compared with the available data for north white Americans, Malays, Malaysian Indians, Italians, western Indians and Caucasians. In the population under study, the measurements differ in all dimensions with Malays, Italians and Caucasians and show resemblance to the Malaysian Indians. Knowledge of the proportion between the upper and lower lips helps in surgical correction of the region. This study highlights the applied significance of observations of the present study to forensic, namely racial and sex dimorphic, criteria of identification.
In neuropsychological studies of executive functioning in domestic violence offenders, the different investigations conducted have only studied differences within this group or in relation to control groups of non-offenders. To minimize the limitations in relation to comparison groups, the purpose of this study was to compare executive functioning in domestic violence offenders in relation to different groups of offenders (i.e. sexual, violent and non-violent) and a control group of non-offenders, with all groups matched on socio-demographic and clinical characteristics. Executive functioning was tested of all participants with the Trail Making Test (direct and derived scores). Compared with the control group, the domestic violence offenders and sex offenders exhibited the poorest performance on the Trail Making Test part B (time) and on the B-A derived index; whereas, the violent offenders group (i.e. convicted of assault, wounding, homicide etc.) showed a high number of errors in part B. These findings suggest that domestic violence offenders exhibit similar performance on the TMT as sex offenders, where both have poorer cognitive flexibility and executive control. Other violent offenders exhibited different patterns of difficulty on this test (e.g. more impulsivity responses). Executive functioning may be a central psychological process that could help explain the interrelations between domestic and sexual aggression, and could be a relevant construct for common treatment of domestic batterers and sex offenders.
Fetal laceration is a recognized complication of caesarean delivery. The aim of this study was to investigate the incidence, type, location, risk factors and long-term consequences of accidental fetal incised wounds during caesarean delivery. During a five-year period, we observed 25 cases of fetal lacerations caused by the scalpel during hysterotomy. In 20 of these cases, we observed these lesions as consultants for the Neonatologic Care Unit; the other five cases came under our care after an insurance claim for damages against the gynaecologist. All the infants had a lesion located to the head. In only 5 of the 25 cases the lesion was reported in the operative summary, and only 16 of the 25 mothers had signed an informed consent before surgery. With regard to the 20 cases diagnosed at the Neonatologic Care Unit, the lesion was closed using single stitches in nine cases, and with biological glue in 11 cases. Concerning the five cases that underwent legal proceedings against the gynaecologist, a clinical examination was performed by an expert in Public Health and Social Security in collaboration with a paediatric surgeon to evaluate the degree of biological damage. In all five cases, the result of the legal challenge was monetary compensation for the physical and moral damage caused by the gynaecologists to the patients and their parents. Accidental fetal lesions may occur during caesarean delivery; the incidence is significantly higher during emergency caesarean delivery compared to elective procedures. Patients should sign an informed consent in which they should be informed about the risk of the occurrence of fetal lacerations during caesarean delivery in order to avoid legal complications.
The investigation and classification of deaths in England and Wales relies upon the application by medical practitioners of diverse reporting standards set locally by coroners and thereafter upon the effectively unconstrained decision process of those same coroners. The author has conducted extensive comparative analysis of Ministry of Justice data on reports to the coroner and their inquest and verdict returns alongside Office of National Statistics data pertaining to the numbers of registered deaths in equivalent local jurisdictions. Here, he analyses 10 jurisdictions characterised by almost identical inquest return numbers in 2011. Substantial variation was found in reporting rates to the coroner and in the profile of inquest verdicts. The range of deaths reported varied from 34% to 62% of all registered deaths. Likewise only 2 of the 10 jurisdictions shared the same ranking of proportions in which the six common verdicts were reached. Individual jurisdictions tended to be consistent over time in their use of verdicts. In all cases, proportionately more male deaths were reported to the coroner. Coroners generally seemed prima facie to be ‘gendered’ in their approach to verdicts; that is, they were consistently more likely to favour a particular verdict when dealing with a death, according to the sex of the deceased. The extent to which coroners seemed gendered varied widely. While similar services such as the criminal courts or the Crown Prosecution Service are subject to extensive national guidance in an attempt to constrain idiosyncratic decision making, there seems no reason why this should apply less to the process of death investigation and classification. Further analysis of coroners’ local practices and their determinants seems necessary.
For many physicians, retinal haemorrhages (RHs) in infants and young children remain highly diagnostic of non-accidental (abusive) head trauma. Because clinicians have applied indirect ophthalmoscopy selectively to cases of suspected child abuse, the association between RH and other conditions such as infection, coagulopathy and accidental trauma has encountered habitual bias, creating the potential for iatrogenic misdiagnosis of child abuse. We present an autopsy case series of four children, aged three years old or younger, in whom RHs were detected by post-mortem monocular indirect ophthalmoscopy after the patients had died from infections. We discuss the laterality, number, type and location of RHs in these cases, and summarize proposed mechanisms of RH formation in fatalities from paediatric infection. We demonstrate that many of the ophthalmological findings that have been considered diagnostic of abusive head trauma can also occur in association with infective processes.
The identification of a patterned skin or scalp mark at autopsy can provide key forensic evidence in identifying an injury that may have been left by an assailant’s footwear. It is also important to consider whether such a mark could alternatively have been left by the deceased coming into forceful contact with a hard surface at the scene of an incident, for example by falling. This study was designed to demonstrate how variable surfaces are within paved urban areas, including those which might leave marks resembling footwear patterns, and to evaluate whether dental putty impression lifting is a practical and effective adjunct to photography in assessing patterned surfaces. Eighteen ‘scenes’ of approximately 50 m2 were assessed for different hard surfaces by photography and by the production of dental putty impression lifts. The number of hard surfaces varied between 4 and 12 per scene, with 90% (122/135) of all hard surfaces deemed likely to leave distinct marking on skin with forceful contact and 46% (62/135) a defined/regular mark potentially similar to a footwear injury (mean = 3.4 per scene). Dental putty proved to be an excellent tool in characterising hard surfaces, producing firm but slightly flexible lifts that can be used in combination with a commercially available inkless footwear impression kit to generate transparencies that help facilitate detailed comparison work. Whenever a potential footwear mark is identified at autopsy, a systematic examination of all hard surfaces at the scene is mandatory, and this process will be significantly strengthened by the use of dental putty.
A psychiatric patient prisoner is certified and treated involuntarily under the Saskatchewan Mental Health Services Act at the Regional Psychiatric Center if he/she is mentally ill, incapable of making treatment decision and is likely to cause harm to self or others. This retrospective study examined the treatment of certified patients during a 12-year period (1996 to 2007). A total of 112 patients were treated using 263 certifications during 163 separate hospital admissions. Fifty of all the certified patients (44.6%) required more than one certification, and out of these, 72% required another certification within three months of the first certification. Among those certified, schizophrenia and related psychosis (65.2%, n = 73), substance use disorder (50%, n = 56) and antisocial personality disorder (58%, n = 65) were the most common discharge diagnoses and antipsychotics, the most frequent discharge medications. Global Assessment of Functioning score of patients improved significantly (p < .05) from 43.6 at admission to 50.4 at discharge. This functional improvement may suggest a beneficial use of certification by keeping patients in treatment. This benefit may be enhanced if the statutory duration of certification can be increased to account for the length of time required for the adequate resolution of symptoms and to reduce the need for repeat certification.
Estimation of age is one of the most significant tasks in forensic practice. Amino acid racemization is considered one of the most reliable and accurate methods of age estimation and aspartic acid shows a high racemization reaction rate. The present study has investigated the application of aspartic acid racemization in age estimation in a Kuwaiti population using root dentin from a total of 89 upper first premolar teeth. The D/L ratio of aspartic acid was obtained by HPLC technique in a test group of 50 subjects and a linear regression line was established between aspartic acid racemization and age. The correlation coefficient (r) was 0.97, and the standard error of estimation was ±1.26 years. The racemization age "t" of each subject was calculated by applying the following formula: ln [(1 + D/L)/(1 – D/L)] = 0.003181 t + (–0.01591). When the proposed formula "estimated age t = ln [(1 + D/L)/(1 – D/L)] + 0.01591/0.003181" was applied to a validation group of 39 subjects, the range of error was less than one year in 82.1% of the cases and the standard error of estimation was ±1.12. The current work has established a reasonably significant correlation of the D-/L-aspartic acid ratio with age, and proposed an apparently reliable formula for calculating the age in Kuwaiti populations through aspartic acid racemization. Further research is required to find out whether similar findings are applicable to other ethnic populations.
Compensation of diethylstilbestrol exposure depends on the judicial system. In France, girls having been exposed to diethylstilbestrol are currently being compensated, and each exposure victim is being evaluated. Fifty-nine expert evaluations were studied to determine the causal relation between exposure to diethylstilbestrol and the pathologies attributable to diethylstilbestrol.
The following were taken into consideration: age at the first signs of the pathology; age of the sufferer at the time of evaluation; the pathologies grouped into five categories: fertility disorders – cancers – mishaps during pregnancy – psychosomatic complaints – pathologies of "3rd generation DES victims"; submission of proof of DES exposure; the degree of causality determined (direct, indirect, ruled out).
61% of the cases related to fertility disorders, 28.8% to cancer pathologies (clear-cell adenocarcinoma), 18.6% to mishaps during pregnancy, 8.5% to disorders resulting from preterm delivery, and 3.4% to psychosomatic disorders. Some cases involved a combination of two types of complaints. Indirect causality was determined in 47.1% of the cases involving primary sterility, in 66.7% involving secondary sterility, and in 5 out of 6 cases of total sterility. There is direct causality between in utero diethylstilbestrol exposure and vaginal or cervical clear cell adenocarcinoma. Causality is indirect in the case of disorders linked to prematurity in third generation victims.
Causality was determined by the experts on the basis of scientific criteria which attribute the presenting pathologies to diethylstilbestrol exposure. When other risk factors come into play, or when exposure is indirect (third generation), this causality is diminished.
Homeless and unclaimed dead bodies are a social as well as legal stigma on a country's development index. In addition, homeless people are exposed to increased incidence of diseases, accidents and mortality. Lucknow city, a city situated in the heart of the great Gangetic plain in the northern region of India, is surrounded by rural towns and villages and has seen tremendous growth in the past few years; with this the problem of migrants and homelessness has also increased. This has resulted in a spectrum of problems relating to law and order, including frequent incidences of unclaimed dead bodies, both due to natural and unnatural causes. Few studies on this subject have been published in India.
Observational retrospective study.
Data were collected from the files of the Department of Forensic Medicine & Toxicology between 2008 and 2012.
A total of 20877 autopsy cases were registered, out of which 3169 (15.17%) were unclaimed bodies. The majority of cases belonged to males (2218, 69.99%) as compared to females (951, 30.01%). Most unclaimed bodies were in the age group of 41–60 years (47.24%) and the least affected age group was 1–20 years (265, 8.36%). The most common manner of death was accident (1098, 34.64%), followed by suicide (1062, 33.51%), natural (927, 29.25%) and homicides (82, 2.59%). The most common cause of natural death in both males and females was chronic lung disease. Railway and road traffic accidents accounted for 516 (68.25%) accidental deaths in males, whereas in females they accounted for 301(88.01%). The most common mode of suicide among males was by poisoning (391, 48.81%), while poisoning (149, 57.08), hanging (78, 29.88%) and drowning (23, 8.81%) were the main modes of suicide in females reported in our study. Majority of the cases of deaths were reported during rainy season (2209, 69.70%).
This autopsy-based study tries to highlight the situation of picture of homeless deaths in Lucknow and the problems faced by the law enforcing authorities. More research is needed to identify the health-related problems of such people and possible contributory factors to mortality.
The ability to obtain an autosomal short tandem repeat (STR) profile of the semen donor from the reproductive tract of a living victim rapidly diminishes as the post-coital interval increases. This is of concern where victims of sexual assault provide vaginal samples several days after the incident. In order to overcome the technological impediments inherent in autosomal DNA typing with extended interval samples, we previously employed the use of Y chromosome STR profiling which, by targeting only male DNA, can eliminate masking of the male profile (by the victim’s alleles) or critical polymerase chain reaction reagent titration (due to excessive female DNA). Thus employing Y-STR profiling and additional enhancement strategies, we reported the ability to recover Y-STR profiles from samples collected 5 to 6 days after intercourse. However, the reproductive biology literature indicates that spermatozoa are found in the human cervix up to 7 to 10 days post coitus. Thus, even with improved extraction and profiling techniques, we failed to routinely recover profiles from samples collected ≥6 days after intercourse. The aim of the present work was to develop additional strategies to permit the recovery of male donor DNA profiles from ≥6 post-coital samples. Using nested polymerase chain reaction and DNA concentration procedures that together maximize the recovery and targeting of male DNA, we demonstrate the ability to obtain semen donor Y-STR profiles in extended interval post-coital samples collected 6 to 9 days after intercourse. This approaches the recognized time limits of sperm residence in the cervico-vaginal canal as described in the clinical literature.
The use of medical chaperones during clinical examinations is important whether one practises as a specialist, nurse, medical student or generalist. Chaperone use in general practice remains largely unknown in most countries across the world and, what is known is limited to a handful of countries. Their use in Australian general practice remains unknown.
To explore the attitudes and practices of a cohort of general practitioners in urban Melbourne regarding the use of chaperones in their daily clinical practice.
Self-administered postal questionnaire to pilot group of general practitioners in urban Melbourne, Australia. Main outcome measures: Frequency of chaperone use; views on chaperone use itself; preferred choice for the role of chaperone; main reasons for using chaperones.
The majority (95% respondents) had never or occasionally used a chaperone. The use of chaperones correlated with general practitioner gender – male general practitioners were more likely to use a chaperone. General practitioners preferred choice as chaperone was the practice nurse. There was no association found between chaperone use and the respondents’ age, practice size or the availability of a practice nurse. The most highly rated influence by general practitioners for using a chaperone was because of anticipated patient embarrassment and/or distress.
This is the first step in understanding attitudes and experiences of general practitioners in general practice in Australia. The results of a larger, national study would provide further insight into this important issue taking into account the realities of general practice in Australia and relationship between general practitioners and patients.
Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes.
We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001–2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient’s death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of leges artis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor’s decision, whether to prosecute or not.
Following the death of a British National on foreign soil, a primary investigation is conducted by the authorities of that country; HM Coroner and the United Kingdom police have no jurisdiction to conduct investigations abroad. Upon repatriation of a body, the legal investigation in the UK remains largely unchanged since the publication of the "harmonisation of medico-legal autopsy rules" (1999) and the passing of the Coroners and Justice Act (2009). We identified 44 cases within a 10-year period. An invasive autopsy had been performed abroad in 25 cases; an autopsy report was received prior to UK autopsy in one case. Seven cases showed incomplete evisceration; the absence of part or whole organs was recorded in 11 cases. Toxicology was performed abroad in five cases. Recurring technical difficulties related chiefly to embalming, including difficulty with dissection and noxious fumes. When an autopsy had been performed abroad, the time to UK inquest was prolonged by an average of seven months. A verdict of unlawful killing was returned in nine cases. The discussion expands on these issues, and attempts to offer reasoned explanation where possible. Two cases are used as exemplars to highlight difficulties to both the pathologist and Coroner. This casework remains rare but the potential problems include: absence of tissue; lack of information; technical difficulties; and a disproportionately high number of unlawful killings, making clear the need for experience and caution when making the post mortem examination.
Estimation of age from microscopic examination of human bone utilizes bone remodeling. This allows regression equation to be determined in a specific population based on the variation in osteon turnover in different population. The aim of this study was to provide age estimation for Malaysian males. Ground undecalcified cross sections were prepared from long limb bones of 50 deceased males aged between 21 and 78 years. Ten microstructural parameters were measured and subjected to multivariate regression analysis. Results showed that osteon count had the highest correlation with age (R = 0.43), and age was estimated to be within 10.94 years of the true value in 98% of males. Cross-validation of the equation on 50 individuals showed close correspondence of true ages with estimated ages. Further studies are needed to validate and expand these results.
High rates of psychotic disorder among special populations of homicide offenders, females, youth and the mentally disordered, have received much investigation. Personality disorder, especially antisocial personality disorder, augments the relative risk ratio of violence, especially in combination with substance use disorder. Few studies of these correlates of violence and especially homicide have been reported in low- and medium-income countries (LMIC). Using the structured clinical interview for DSM diagnosis (SCID), personality disorders were identified in a cross sectional study involving 546 homicide offenders in Jimma prison, Ethiopia. Predictors of personality disorder were determined using multivariate analysis of various demographic and clinical variables, for example, age, psychiatric history and substance use. Out of the 316 offenders who completed the SCID, only 16% fulfilled DSM IV criteria for personality disorder. The rationale for killing, self-defence, anger and revenge (52% of offenders), planning involved in offending (50%) and reasonably high level of relationship functioning (57% married) were different from most data from the high-income countries. Diagnostically relevant cultural factors in LMIC, not in play in high-income countries, may explain the differences in personality disorders similar to other mental disorders and the underlying mediators of homicide.
The main aim of this study was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. Data were collected on 4405 male and female victims of unnatural deaths aged 50 years or more from the total number of 21,235 autopsies performed in King George’s Medical University, Lucknow, India over a 5-year period, from 2008 to 2012. There were 3165 male victims and 1240 female victims. Unnatural deaths were higher in rural (64%) than in urban (37%) areas. Accidental deaths were the most common manner of unnatural deaths (59%), followed by suicidal deaths (34%) and homicidal deaths (7%). Traumas were the most common cause of unnatural death (77.3%), followed by undetermined causes (16.6%) and toxicological causes (6.1%). The most common causes of traumatic deaths were blunt head injuries (34%) followed by stab in the chest (6%), burn (16%), blunt injuries in abdomen and chest (10%), firearm injuries in the head and trunk (9%), strangulation (3%), stab in the abdomen (4%), smothering (4%), cut throat (3%), throttling (1%) and hanging (10%). Carbamate poisoning was the most common cause of toxicological deaths (44%) followed by organophosphorous poisoning (33%), ethyl alcohol poisoning (12%), barbiturate poisoning (3%) and zinc phosphide poisoning (8%).
Markers of skin wound vitality and the research methodology used for their determination are still matters of debate in forensic pathology. Cathepsin-D, a lysosomal enzyme, is the most expressed cathepsin in human skin, and although it seems to have the necessary requirements to be utilized as a vitality marker, past research has provided no definitive and clear response on its potential usefulness. Immunohistochemistry with monoclonal antibodies and image analysis has been employed to detect and quantify the expression of Cathepsin-D in human skin wounds. We analyzed skin fragments obtained from 20 living individuals (group A) and 20 persons deceased from natural causes (group B). For each case, five skin fragments were withdrawn at 0', 5', 10', 30', and 90' after abdominal incision. Once the samples were formalin-fixed and paraffin-embedded, we analyzed the expression of Cathepsin-D through the quantification of the immunohistochemistry signal by image analysis. Immunoreactivity was displayed in Pixels of positive area measured by image analysis and converted in micrometer squares. The average levels of Cathepsin-D were higher in group B than in group A, except in three cases which showed a lower expression, with a statistically significant difference of Cathepsin-D expression between the two groups (p < 0.0001). Group B showed unvaried levels among the progressive samples and group A revealed an increasing predominant trend at 30'. Due to the high levels of expression of Cathepsin-D found in the post-mortem injuries, our study definitively excludes any usefulness of immunohistochemistry quantification of this enzyme in the differentiation between vital and post-mortem injuries.
Estimating time since death (TSD) with fair accuracy from postmortem changes still remains an important but difficult task to be performed by every autopsy surgeon in medicolegal scenario. The aim of the present study was to estimate TSD from electrolyte analysis of postmortem vitreous humour collected from samples under semi-arid climate. Vitreous humour was collected from 210 dead bodies brought to University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, during the period of November 2010 to April 2012. The vitreous samples were analysed for sodium, potassium, calcium, chloride and glucose. The results showed a significant positive relationship between TSD and potassium (r = 0.841, p = 0.000) and a weak negative relationship between TSD and sodium (r = –0.137, p = 0.048) and glucose (r = –0.241, p = 0.000), whereas no significant relationship could be established between TSD and calcium (r = 0.055, p = 0.429) and chloride (r = 0.075, p = 0.11).
A recent English study demonstrated high rates of kitchen knife use in homicides by mentally disordered offenders subject to independent inquiries. Everyone accused of homicide in Scotland undergoes psychiatric examination; all such evaluations in a Scottish region between 2006 and 2011 were systematically analysed to identify homicide characteristics. It was hypothesised that kitchen knives would be the commonest sharp instruments used, and would be associated with unplanned domestic homicide against known victims, with no independent association with mental disorder. Kitchen knives were used in 32 of 55 homicides: 94% of 34 sharp object homicides (p < 0.05). No independent association was found between kitchen knife use and planning, location, relationship, intoxication or mental disorder. Kitchen knife use in homicide appears to be a significant public health issue, and not only in the mentally disordered population. Research is recommended into kitchen knife use in non-fatal violence, and weapon control in populations at increased risk of knife violence.
The objective of this study was to clarify the relationship between injury severity in bicyclists involved in traffic accidents and patient outcome or type of vehicle involved in order to propose effective measures to prevent fatal bicycle injuries. Hospital records were reviewed for all patients from 2007 to 2010 who had been involved in a traffic accident while riding a bicycle and were subsequently transferred to the Shock Trauma Center of Dokkyo Medical University Koshigaya Hospital. Patient outcomes and type of vehicle that caused the injury were examined. The mechanism of injury, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) of the patient were determined. A total of 115 patients’ records were reviewed. The mean patient age was 47.1 ± 27.4 years. The average ISS was 23.9, with an average maximum AIS (MAIS) score of 3.7. The ISS, MAIS score, head AIS score, and chest AIS score were well correlated with patient outcome. The head AIS score was significantly higher in patients who had died (mean of 4.4); however, the ISS, MAIS score, and head AIS score did not differ significantly according to the type of vehicle involved in the accident. The mean head AIS scores were as high as 2.4 or more for accidents involving any type of vehicle. This study provides useful information for forensic pathologists who suspect head injuries in bicyclists involved in traffic accidents. To effectively reduce bicyclist fatalities from traffic accidents, helmet use should be required for all bicyclists.
As most developing countries, including Nigeria, grapple with economic crisis, poor human capital development and high levels of income inequality, violent crimes – especially homicides – continue to be a cause for concern. We studied the pathology and demographic distribution of homicides in Rivers State of Nigeria expecting that the findings would be useful in formulating preventive strategies. Reports of homicide autopsies in the state for 11 years were retrospectively scrutinized for age, gender, type of weapon, site of injury, circumstances, mechanisms and causes of death. The data were analyzed using SPSS version 17. Homicides constituted 50.5% of the medicolegal autopsies. Although the overall male:female ratio was 12.4 : 1, there was variation with weapon. Deaths by firearm had the highest male:female ratio of 24.6 : 1. The mean and peak ages were 29.2 ± 11.4 and 21–30 years, respectively, while the range was 1 to 96 years. Firearms were the most common weapons, at 68.9%, hemorrhagic shock and head injuries at 61.5% and 28.2% respectively were the most common mechanisms and causes of death. Armed robbery incidents were the most common circumstances, while the head was the most common site of injury at 48.8%. The homicide rate is high in our environment and most homicides are committed during armed robberies using firearms. Improving medical care and providing emergency medical services will reduce cases of deaths from homicides, most of which occur due to manageable hemorrhagic shock. Increasing the drive towards controlling illegal arms acquisition and possession will reduce the present carnage in the state.
As mental health services have an important role in prevention of suicides, the relationship between Care Quality Commission performance ratings of mental health trusts and the local suicide rates were examined with the null hypothesis that there will be no relationship between them. Data on suicide rates for men and women aged 16–65 for each district covered by a mental health trust were ascertained from the Office of National Statistics for the year 2009. Data on performance ratings of mental health trusts for the same year were obtained from the Care Quality Commission Report.
There was no significant relationship between suicide rates in the districts covered by 60 mental health trusts in England and Wales and their performance ratings.
The negative findings suggest that the performance rating of mental health trusts do not influence local suicide rates.
Analysis of non-human DNA in forensic science, first reported about two decades ago, is now commonplace. Results have been used as evidence in court in a variety of cases ranging from abduction and murder to patent infringement and dog attack. DNA from diverse species, including commonly encountered pets such as dogs and cats, to plants, viruses and bacteria has been used and the sheer potential offered by such analyses has been proven. In this review, using case examples throughout, we detail the considerable literature in this field.
The aim of our study was to determine the frequency and nature of testicular and paratesticular lesions in forensic autopsies. A retrospective study was carried out on 495 adult male cases that underwent forensic autopsy from January 2008 to December 2011 in our Department. For each case, the following parameters were reported: age, body mass index, nature of testicular and paratesticular lesions, associated lesions in external genitalia, testicle weight, cause of death, manner of death, resuscitation attempts and prior medical history. Mean age of the studied population was 47.8 years (range 18–96). Mean body mass index was 25.3 kg/m2 (range 15–46.2). Testicular lesions and/or paratesticular were found in 16.4% of the cases (n = 81). The most frequent lesions were, respectively, testicular atrophy (n = 38) and trauma (n = 28). In three cases showing traumatic lesions, associated traumatic lesions were found in external genitalia. Most frequent cause of death was blunt trauma (19.9% of the cases). Manner of death most frequently associated with testicular trauma was, respectively, road traffic accident (n = 11) and suicidal fall (n = 6). Mean testicular weight was, respectively, 17.9 g for the right and 20.8 g for the left (range 2–38). Atrophy was associated with testicular weight less than 10 g. A significant association between testicular atrophy and age was found, the risk of atrophy increasing quite linearly with age. No significant statistical link between prior medical history and testicular pathology was found. There was also no influence of body mass index. Resuscitation attempts were not statistically associated with testicular traumatic lesions.
Diabetic foot is a complex and challenging pathological state, characterized by high complexity of management, morbidity and mortality. The elderly present peculiar problems which interfere on one hand with the patient's compliance and on the other with their diagnostic-therapeutic management. Difficult clinical management may result in medico-legal problems, with criminal and civil consequences. In this context, the authors present a review of the literature, analysing aspects concerning the diagnosis and treatment of diabetic foot in the elderly which may turn out to be a source of professional responsibility. Analysis of these aspects provides an opportunity to discuss elements important not only for clinicians and medical workers but also experts (judges, lawyers, medico-legal experts) who must evaluate hypotheses of professional responsibility concerning diabetic foot in the elderly.
Informal and involuntary (compulsorily detained) patients are the two broad categories of patients in psychiatric hospitals today. In Rabone v Pennine Care NHS Trust the Supreme Court made, among other things, a distinction between the two types of patients. This article contributes to the literature by adding to that distinction. It looks at the evolution of the term, ‘informal patient’, gives an account of Rabone case and then deals with the comparison between the two types of patients.
Ethical and legal dilemmas frequently arise in paediatric practice. Given the nature of the speciality, these issues are relevant to both the medical and legal professions. To this end, senior figures from the medical and legal professions in the Northern region have met on a regular basis in order to discuss anonymised case material. We report on the proceedings of the seventh such meeting. Six cases are described and key points arising from the subsequent discussion are presented.
The current analytical technology for the determination of New Psychoactive Substances in biological samples is still largely inadequate, because the immunoassays are unsuitable for the detection of most of these compounds and the use of traditional gas chromatography–mass spectrometry techniques is hampered by the lack of chromatographic standards and mass fragmentation patterns. Taking advantage of the molecular recognition capability of high-resolution mass spectrometry, the present work aimed to apply liquid chromatography-quadrupole-time of flight mass spectrometry for the rapid identification of New Psychoactive Substances in the hair, a peculiar tissue which "keeps memory" of the recent history of drug intake of the subject. All the samples were screened for the presence of 50 different New Psychoactive Substances (synthetic cannabinoids, cathinones and phenethylamines), substances that had been reported officially by the National Early Warning System in the period 2009–2011. Among the 435 samples analyzed, 8 were found "positive" for the following compounds: JWH-018, JWH-073, JWH-081, JWH-250, JWH-122, in a broad range of concentrations (0.010–1.28 ng/mg). Results strongly support the use of hair analysis to monitor the diffusion of new psychoactive drugs in the community.
An upsurge in gun violence in recent times in our environment necessitated this study, which aims to document the patterns of fatal gunshot injuries with the hope of finding a solution to this problem. The study was a retrospective analysis of cases of fatal gunshot injuries on which autopsies were carried out over the 5-year period from January 1998 to December 2002 at Police Medical Services, Benin City – a Nigerian ancient town located in the South-South zone of the country. Most cases of medico-legal death in Benin City and environs are referred to the Police Pathologist at the center for autopsy. A total of 210 cases representing 27.2% of all medico-legal deaths during the study period were reviewed. Males were far more affected than females (M:F = 10.7:1). The intent for the fatal gunshots was murder (88.5%), excusable homicide (4.8%), accident (4.3%) and suicide (0.5%). In 1.9% of the deaths, the circumstances were not clear. Armed robbers, thugs and assassins accounted for 88.1% of the fatal shots, while the Police accounted for 9.0%. The trunk was affected much more than the head, neck and limbs. There is a need to improve security in the country and reduce poverty. Illegal firearms should also be removed from circulation. An improvement in emergency health services will reduce deaths from gunshots.
Sudden or unexpected deaths can occur from violence, poisoning, as well as from natural causes. In spite of gastrointestinal diseases being one of the important causes for sudden natural death, only limited studies have been conducted into the pattern of sudden deaths due to gastrointestinal causes. As a result, a 10-year (January 2001 to December 2010) retrospective study was conducted in the Department of Forensic Medicine, M.S. Ramaiah Medical College, Bangalore, South India. Data were collected from the post-mortem register maintained in the department and the relevant reports were reviewed. Descriptive statistics for qualitative type of data was summarized using frequency and percentage. A total of 7520 deaths were reported. This included a total of 291 sudden natural deaths, out of which 62 cases (21.3%) were due to gastrointestinal causes. Maximum number of cases (nine cases – 15.6%) occurred in the year 2009. Of the 62 cases, 87% were males and 13% were females. The age of the deceased ranged from seven to 78 years and maximum numbers of cases were in the age group of 30–39 years (25.8%). Out of 28 cases (45.1%) of cirrhosis, 19 died due to variceal bleeding and the rest due to hepatic failure. Perforations resulted in death in 29% of cases due to peritonitis.
This is the first paper to group together most of adult laryngeal anomalies or malformations which may be misinterpreted by the forensic pathologist and taken for a proof of violence.
A review of the literature, to list the main pitfalls, to explain their nature and their origins.
We found two main categories, the congenital defects and the acquired anomalies.
The laryngeal region is complex. The pathologist must keep in mind anatomical variations or malformations, but also sequelae of old injuries and iatrogenic lesions. The survey, the patient’s clinical history, the findings of the whole autopsy and, if necessary, histology may help to interpret a laryngeal anomaly.