Morphometric analysis of the foramen magnum in sex estimation: An additional 3DCT study from Nepal on a larger sample.

Background: Estimation of sex of the skeletal remains plays a vital part in the identification of an individual. This study is focused on the morphometric measurements of the foramen magnum region and examining the accuracy of sexual dimorphism in the Nepalese population. Methods: Measurements were obtained from 3D computed tomography (CT) scan of 261 Nepalese adult cranial bases with known age and sex. Length and breadth of the foramen magnum, length and breadth of right and left occipital condyles and maximum and minimum intercondylar distance were measured on the base of the skull CT images. Results: The mean values for all parameters were higher in males than females except for the maximum intercondylar distance. Sex prediction done with discriminant function analysis could classify the skull with an overall accuracy of 70.5%-71%. Conclusions: It can be concluded from the results that the morphometric study of the foramen magnum is less reliable for sex estimation in the Nepalese population.

Characteristic Features of Ear and Ear-Prints in Forensic Identification.

INTRODUCTION AND OBJECTIVES: The human external ear is a morphologically perplexing structure with wide variations in its features across individuals. Advances in forensic science have established the use of morphological features and prints of different parts of the human body in establishing the identity of an individual. The present study aims to establish such an identification process by examining the use of comparative analysis of ear prints and ear photographs. METHODOLOGY: The study examined the morphological features of ear prints of 140 participants (71 males and 69 females) ranging in age from 18 to 25 years (with a mean age of 20.22 ±â€Š1.77 years), recruited from a North Indian population. Prints of both the ears were recorded, using the inking method. The morphological features of the ear prints were compared with the photographs of the ear for their uniqueness and individualization using likelihood ratios. RESULTS: The degree ofantihelix curvature demonstrated the highest correlation (98.57%) between the morphological features visible on the ear and the expressions of these features in an ear print. The impression of earlobes, Darwin tubercle, crus of the helix, and shape of the external ear showed accuracy between 70% and 90%, whereas correlations below 70% accuracy were recorded for the other features. The likelihood ratios for 12 parameters were reported to be more than 10x, representing that the identification made using these parameters was > 10 times more likely to be true identification as compared to false positives. Moreover, 5 parameters were found to show high sensitivity, with values greater than 3 standard deviations (0.997), with an additional 9 parameters found to have good sensitivity at values greater than 2 standard deviations (<0.95). Similarly, 2 parameters were found to show high specificity, with values greater than 3 standard deviations (0.997), with an additional 18 parameters found to have good sensitivity at values greater than 2 standard deviations (<0.95). CONCLUSIONS: Elevated features of the ear, such as helix, antihelix, antitragus, tragus, and inter-tragic notch; particularly the degree of antihelix curvature, are more easily impressed and identifiable on an ear print. The results support that ear prints may provide important clues to assist in establishing the identity of an individual if several morphological features are evaluated concurrently.

Sex estimation from fingerprint ridge density. A review of literature.

Identification has always been very vital in forensic casework. Fingerprint patterns are population-specific and individualistic, that makes fingerprinting an important biological trait in human biology and forensics. Fingerprint is an impression of the friction ridges of the finger-ball, where friction ridges are raised portions of the epidermis. Skin on human fingertips contains ridges and valleys which together forms distinctive patterns. These patterns are fully developed in intra-uterine life and remain unaltered until the death of the individual. Injuries such as cuts, burns and bruises can temporarily damage quality of fingerprints but when fully healed, the patterns are restored. The number of ridges present in a unit area on a fingerprint is called the Fingerprint Ridge Density (FPRD). The epidermal ridge density can be determined by examining two parameters - ridge width and distance between the ridges. The thickness of the epidermal ridges varies between individuals and between the sexes. The present review of literature focuses on the sexual dimorphism on the basis of the FPRD and its possible use in forensic examinations. Most of the studies pertaining to the estimation of sex from the FPRD have been conducted in the last two decades when Mark A. Acree in 1999, devised a method of estimation of sex on Caucasian and African-American descent. The present analysis evaluates the studies found in the PubMed database conducted after Acree, 1999. The estimation of sex from the FPRD is based upon the fact that the females have a fine detailing of ridges and consequently more ridges are covered in a unit space in the fingerprints of females as compared to males. The paper also highlights -recent advancements and future perspectives in the area of FPRD. (www.actabiomedica.it).

Workplace safety concerns in medico-legal death investigations related to COVID-19.

The personnel involved in the management of COVID-19 affected dead bodies, including law enforcement personnel at the scene of crime, personnel involved in transportation of the dead bodies, forensic practitioners, autopsy pathologists, mortuary personnel, as well as the family members of the dead, etc. are at risk of exposure to SARS-CoV-2 infection. Post-mortem examination is a high-risk procedure, considering that it involves aerosol generating procedures, and exposure to body fluids. The safety of the forensic practitioners and support staff in the management of suspected or confirmed COVID-19 deaths hence, is of extreme importance, especially in the absence of pre-autopsy testing for COVID-19 and due to non-availability of adequate first-hand medical history of the deceased. This communication aims to highlight the current practices and advises certain guidelines in ensuring occupational health and safety in view of these risks in medico-legal death investigations.

Dignity and rights of the dead and their families: A compromise in the time of coronavirus disease 2019.

The biological aspects and economic impact of coronavirus disease 2019 have been extensively discussed in the literature. However the social, cultural and legal aspects of the pandemic, especially regarding the dignity and rights of the deceased and their families - have so far received little attention. This communication discusses restrictions and violations of the rights of the deceased and their families and their privileges to carry out funerary practices and rituals during the pandemic caused by the novel severe acute respiratory syndrome coronavirus 2.

Post-mortem ultrasonography: a safer alternative to autopsies in COVID-19 deaths.

Ultrasonography is known to have many applications in the diagnoses of diseases, as well as in guiding medical practitioners through precise medical procedures. However, its use as a post-mortem radiographic modality has been limited. Post-mortem ultrasonographic techniques are considered to be a safer alternative to high-risk post-mortem procedures, especially in infectious diseases. The present communication discusses the possibilities of using ultrasonography in post-mortem examinations in times of the ongoing COVID-19 pandemic to minimize the associated risk of SARS-CoV-2 infection of those working in mortuaries during full-body dissection in traditional autopsies. Post-mortem ultrasonography can be useful in reducing the extent of autopsies, thus decreasing the risk of exposure of forensic personnel.

When sexual offence is an unexpected diagnosis - exploration of medical, legal and social aspects in Nepalese scenario.

In Nepal, following allegations of sexual assault, the survivor is taken by the police to a Government Hospital for medical examination and sample collection. To provide an integrated service to survivors of gender-based violence, a One-Stop Crisis Management Centre (OCMC) is established in many Government Hospitals. However, paediatric survivors of sexual abuse frequently seek initial care at the emergency department, as most present with a medical complaint rather than for sexual abuse. It is therefore important to train emergency physicians with the skills required to identify the features and diagnose a case of sexual assault. We present a case where the diagnosis of sexual assault of a child was an incidental finding and discuss the challenges faced in dealing with such cases in non-OCMC Hospital.

Medico-legal encounters of 2015 Nepal earthquake - Path traversed and the road ahead.

The Gorkha Earthquake hit the region on 25th of April 2015, at 12:58, with the epicentre approximately 80 km N-NW of Kathmandu, recording 7.8 Mw on the Richter Scale. The disaster left almost 9000 individuals dead. The search and recovery as well as the subsequent Disaster Victim Identification (DVI) operations left much to be desired. The entire DVI operations consisted of examination of 365 bodies and collection of 15 blood/hair samples and 60 bone/tooth samples. This resulted in the scientific identification of eight individuals and visual recognition of 357. The scientific basis of identification of more than 8000 individuals, remains a question. The Disaster Response was hampered by miscommunication, incoordination and mismanagement on the part of all stakeholders and could have led to misidentification as well as missed identification. This demonstrates the importance of systematic management of dead bodies in mass casualty events to ensure dignity and respect of the deceased as well as family members. The helplessness felt by technical experts was compounded by the general lack of political will and the pressure on the law enforcement for quick disposal, irrespective of the available standards and protocols. Therefore, DVI operations can only be assumed to be a disaster in the making, when faced with lack of political will, lack of strict adherence to international standards as well as lack of determination from all stakeholders. Such a response from authorities is usually driven by panic following mass fatalities especially in disasters of great magnitude, like this one. The article discusses the challenges faced by the technical experts in the field and describes the advancements as well as recommendations for further improving the DVI operations in a resource-stricken country.

Sex Predictability by Using Mandibular Canine Index.

BACKGROUND: Canines are known for their higher resistance to trauma and pathological alterations when compared to other teeth. Among all the teeth, canines show highest sexual dimorphism. METHODS: This descriptive cross-sectional study was commenced from January 2019 to April 2019 after the ethical approval from Institutional Review Committee. The maximum mesio-distal widths of right and left mandibular canines and mandibular inter-canine arch width were measured on the cast with the help of a divider and digital vernier callipers. Mandibular canine index was calculated by dividing the mesio-distal width of each mandibular canine with inter-canine arch width. Data was entered and analyzed using Statistical Package for the Social Sciences version 21. RESULTS: Sex predictability by using mandibular canine index in the present study showed poor sex predictability (57.5% - 62.5%). CONCLUSIONS: Sex determination should be done by other methods and mandibular canine index should be used cautiously in Nepalese population.

Searching for Kin Amidst Tragedy-Disaster Victim Identification Operations for US Bangla Flight 211.

The nature of air disasters includes factors that exacerbate challenges in the identification process. Of the 49 deceased in the US Bangla air crash in Kathmandu, Nepal, four were intact, 11 presented with burn injuries, another 11 presented with partial charring, and 23 were completely charred. Personal belongings were useful in the identification phases for all types of victims. Fingerprints were obtainable and useful in intact victims and victims with less severe burn injuries; medical and surgical information was useful in bodies with burn injuries; finally, dental findings were useful in cases of extensive charring. Other useful methods in the process included marks of identification, physical features, and exclusion. In certain resource-limited settings, especially in closed population disasters, where scientific identification (DNA, dental records, etc.) is not currently available, personal belongings, clothing, and physical findings analyzed by an identification team using a structured organization may be cautiously used as the primary means of identification.

When Protocols Become Fairy Tales and Gods Remain Buried Under: Excerpts From the Diary of Forensic Experts at Ground Zero During the Mega Quake That Hit Nepal.

More than a year has passed since the mega quake hit Nepal. Although a lot is written about the lacunae in disaster preparedness, lessons learnt, and public health concerns after the aftermath, nothing much has been written about the fate of the deceased. Although saving takes priority after a disaster, the management of dead bodies also requires immediate attention because the process of identification becomes more difficult and expensive as time passes. This article shares the firsthand experiences of forensic experts at ground zero during the quake that may be useful to forensic experts responsible for handling such situations worldwide.

Craniometric analysis for estimation of stature in Nepalese population--A study on an autopsy sample.

Establishing the identity of the deceased becomes essential when highly decomposed bodies, mutilated body parts or skeletal remains are recovered from mass fatality sites. In these situations, estimation of stature along with other parameters such as age, sex and race/ethnicity becomes important to establish the biological profile of the deceased. Following the Maoist insurgency in Nepal, there have been numerous discoveries of unidentified human remains in mass graves or otherwise. No systemic studies and anthropological data on the Nepalese population however, is available posing problems in anthropologic evaluation of the remains. The sample of the present study consisted of 200 autopsied cases (148 males and 52 female adult cadavers). During the autopsy, the scalp was reflected after giving a coronal incision extending from one mastoid to the other exposing the cranium in each case. Maximum cranial length (MCL), maximum cranial breadth (MCB), bi-zygomatic breadth (BZB), minimum frontal breadth (MFB) and length of parietal chord (PC) were then measured. Stature was measured as the length of the body from head to heel in centimeters with the heel, buttocks, back of the shoulders and the head in contact with the autopsy table. Linear and stepwise multiple regression models were derived for estimation of stature from cranial measurements. Univariate, bivariate and multivariate regression models show statistically significant correlation between stature and the cranial measurements. The present study opines that the stature estimation from cranial dimensions using multivariate linear regression models is more accurate than those of the univariate and bivariate regression models. This study presents a rare data from Nepalese population that show typical Asian features and thus, is significant from anthropologic and genetic point of view. The study observations further contribute a baseline data bank for forensic pathologists and specialists.