Suicide by a construction nail fired from a pistol.

Penetrating head injury to accomplish suicide by a non-ammunition-related projectile discharged from a nail-gun is a very rare entity. The authors describe even much rarer, and the first reported case of a suicide penetrating head injury by a construction nail discharged from a blank cartridge of a pistol. The absence of beveling and muzzle impression, the non-ejection of the discharged cartridge, and the exit of just the tip of the nail from the other side of wound were the atypical features in this firearm fatality sustained at a contact-range. The entry wound prototypes like abrasion and grease collar, and blackening were absent. An improvisation to insert a construction nail into the chamber of firearm, for utilization as a projectile was another unique highlight here. The deceased was a construction builder. Being debt-ridden, he probably could not manage to purchase even one live cartridge for his licensee pistol to bring suicidal ideation to culmination.

Death of a child due to venom toxicity following multiple honey bee stings: A case report.

Most bee stings are not life-threatening. Bee venom often causes local, mild allergic reactions in people, but even a single bee sting may induce a fatal anaphylactic reaction. Usually, anaphylactic reaction is the cause of death, but, when a child suffers multiple stings (more than 30), direct toxicity of venom can also be fatal. A three-year-old male child was brought to the hospital with pain, swelling and redness at the sting sites. He had more than 35 stings at various sites over his face, on his tongue and over his body. He died 10 hours after the incidence of the honey bee stings and was maintaining oxygen saturation until the terminal stage of his life. At autopsy, the honey bee sting sites showed redness, swelling and a small effusion of blood surrounding the stinger tracks. On the tongue two stingers were found in situ. Facial puffiness and eyelid swelling, along with congested organs, were also found, but features suggestive of anaphylactic death like airway oedema, mucous plug or cyanosis were absent. Hospital treatment records show that blood pressure remained low with tachycardia despite treatment. Having regard for all the evidence it was concluded that death was due to multiple honey bee stings that caused direct venom toxicity.

Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community.

AIMS: Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK. MATERIALS AND METHODS: All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported. RESULTS: Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01). CONCLUSION: Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.

IGF-1 stabilizes goat sperm mitochondrial transmembrane potential and reduces dna fragmentation.

BACKGROUND: Antioxidant present in sperm cells protects them from oxidative damage. However, sperm are more susceptible to peroxidative damages due to the loss of these enzymes during cryopreservation and their survival and fertility may be compromised. Insulin like growth factor-1 (IGF-1) has an antioxidant effect and could maintain sperm motility. OBJECTIVE: To improve seminal parameters, mitochondrial membrane potential (MMP), oxidative status and DNA integrity of buck semen after freeze-thawing by fortification of goat semen diluent with various concentrations of IGF-1. MATERIALS AND METHODS: Fifty ejaculates were collected and were extended with tris- citric acid- fructose diluent with 10% egg yolk and 6% glycerol with sperm concentrations of 1×108 mL-1. Post-cryopreserved sperm were assessed for motility and a range of other functional parameters. RESULTS: In post-thaw semen sperm motility, live sperm count, acrosome integrity, hypo-osmotic swelling positive spermatozoa, malondialdehyde (MDA), protein carbonyl content (PCC), TUNEL positive sperm differed significantly (P<0.05) with the various concentrations of IGF-1 used. Sperm functional parameters post-thawing were significantly (P<0.05) better in 250 ng/mL IGF-1. IGF-1 protects against lipid peroxidation by lowering MDA and PCC production, thus reducing the harmful effect of reactive oxygen species. The kidding percentage using the artificial insemination technique was significantly higher ( i.e., 40%) in the group supplemented with 250 ng/mL of IGF-1 than in the non-supplemented group (i.e., 30%). CONCLUSION: IGF-1 may be used to improve post-thaw semen quality and fertility as measured by actual kidding rate. Doi.org/10.54680/fr23610110312.

Patho-mechanical comparative morpho-characterization of contre-coup injuries of liver by cadaveric experimental simulation for medico-legal and forensic implications.

BACKGROUND: Liver is the most common organ to get injured in cases of blunt force trauma to the abdomen (BFTA). It is the 2nd commonest organ after brain to sustain injuries out of all the trauma related fatalities. However, the literature about contre-coup injuries to the liver due to BFTA is scarce in-spite of the high mortality rates seen out of injury to this particular organ. PURPOSE: The authors intended to systematize the characteristic morphogenesis of the contre-coup injuries of the liver on the basis of the patho-mechanics involved in various types of BFTA. METHODOLOGY: One hundred and sixty three cases of BFTA were identified, and interpretation was attempted for the contre-coup rupture of the liver seen in twenty out of all the trauma related fatalities that presented for post-mortem examination during the study period. However, the mechanics of the pattern of the rupture injuries to the liver were indiscernible. This motivated the authors to conduct the comparative characterization of injuries to the liver by experimental simulation of BFTA after necessary permission via inflicting pre-calculated forces on unclaimed cadavers. RESULTS: The patterns of contre-coup rupture/s of liver were established in all the twenty out of one sixty-three cases of BFTA. The rupture depicted patterns of injury in the situations of - 1) strong hits with a limited surface trauma, 2) very strong hits with a generalized surface trauma, 3) and collision with a solid surface resulting due to fall onto the side of the abdomen. The causative mechanism discerned was deformation of the liver, followed by its parenchymal rupture due to the shear and strain types of force/s consequent upon tissue compression. The minimum force and energy of impact required for the liver to rupture was estimated to be 2000 N and 141.5 J. CONCLUSION: This series of the simulation experiments revealed two variants of liver rupture in the contre-coup impact zone. The pattern of injury was maintained in cases, those studied at post-mortem examinations, but the relief ruptures were found to vary depending upon the overall mechanics of the traumatic forces involved in the simulation experiments performed on the cadavers. The anti-shock ruptures were formed during shock trauma, and shockproof ruptures were not seen in cases of underlying compressive forces. The morphogenetic characterization of the relief rupture surface of the liver was also delineated in relation to its surface orientation to the spine on the basis of the terms "large" and "very large" depicting the quantum of force/s delivered out of an impact or blow.

Establishment of effective and safe recipient preparation for germ-cell transplantation with intra-testicular busulfan treatment in pre-pubertal Barbari goats.

The busulfan, an alkylating agent, suppresses endogenous spermatogenesis in recipient testes. However, considering a wide variation in the effects of busulfan among animal species, its dosage and route of infusion need optimization to prepare effective and safe recipients. Thus, the current study aimed to create a suitable recipient goat model for germ cell (Gc) transplantation through a single intra-testicular (i.t.) busulfan infusion under ultrasonographic (USG) guidance. As observed through the infusion of trypan blue under USG guidance into mediastinum testis (MT) of pre-pubertal Barbari bucks, 3-5 mL of trypan blue solution could fill almost 80% of seminiferous tubules. Thereafter, in Experiment-1, the effect of different busulfan doses (mg/kg) i.e. 0 [negative control, Group (Gr) 1; 0 mg/kg-MT], 1 (Gr 2; 1 mg/kg-MT), 2 (Gr 3; 2 mg/kg-MT), and 3 (Gr 4; 3 mg/kg-MT) were studied. Further, in Experiment-2, sterilizing effects of busulfan infusion through two different routes [MT or cavum vaginale (CV)] were compared. Following i.t. busulfan treatment, no adverse physiological effects or body weight loss were detected. The histological analyses demonstrate a dose-dependent depletion of Gc with almost complete loss of Gc and spermatogenic activities in Gr 3 and 4, and extensive fibrosis in Gr 4. A considerable suppression of spermatogenesis marked with devoid of endogenous spermatogonial population and absence of significant (P > 0.05) effect on key hematological variables were observed in 2 mg/kg-MT Gr. These findings coupled with the results of significant (P < 0.05) down-regulation of marker genes of undifferentiated spermatogonia (THY-1 and PLZF), Gc pluripotency (UCHL-1, OCT-4, and DDX-4), and adhesion (E-cadherin and ß-integrin); up-regulation of apoptotic genes (ID - 4 and BCL-6), and unchanged expression of Sertoli cell marker (vimentin), confirmed the safe and efficient depletion of endogenous Gc in 2 mg/kg-MT Gr. Furthermore, the effect of busulfan infusion on scrotal-testicular biometry, endocrine variables (plasma cortisol and testosterone), and Gc removal was more evident when busulfan was infused into MT than into CV. Overall, the results demonstrated that 2.0 mg/kg is an optimal single dose of busulfan when infused into the MT under USG guidance for the preparation of pre-pubertal recipient bucks. Overall, this study provides a basis to prepare suitable recipients through providing an available niche for efficient Gc transplantation in goats.

Diagnosis of urogenital tuberculosis by multiplex-nested PCR targeting mpt64 (Rv1980c) and IS6110: comparison with multiplex PCR and GeneXpert® MTB/RIF.

A multiplex-nested PCR (M-nested PCR) targeting mpt64 (Rv1980c) + IS6110 was designed to detect Mycobacterium tuberculosis (Mtb) DNA within urine (n = 35), endometrial biopsies (n = 22) and menstrual blood (n = 3) of male/female UGTB patients, and results were compared with M-PCR using the same targets. Detection limit of the purified Mtb DNA was found to be 1 fg by M-nested PCR, which was 106 -fold lower than M-PCR. Moreover, sensitivities of 100% and 81·8% were obtained in confirmed (n = 5) and clinically suspected UGTB (n = 55) cases, respectively, by M-nested PCR, with a specificity of 97·1% (n = 70). Sensitivities attained by M-nested PCR were significantly higher (p < 0·05) than M-PCR in both clinically suspected and total UGTB (n = 60) cases. To confirm the true PCR-negative results, an internal amplification control, that is, human ß-globin gene (hbb) was incorporated in the M-nested PCR/M-PCR assays, wherein all the clinical specimens (positive/negative for mpt64/IS6110) were found to be positive for hbb. Some UGTB specimens (n = 35) were also subjected to GeneXpert® MTB/RIF assay that revealed a significantly lower (p < 0·001) sensitivity (17·1 vs 88·6%) than M-nested PCR, although high specificity (100%) was attained with GeneXpert. After validating the results in a higher number of UGTB specimens, our M-nested PCR may be translated into an attractive diagnostic kit.

Baclofen (fun drug) and ethanol combined poisoning in humans: A histopathology and morphometry model.

BACKGROUND: - This study intends to address the scarcity of data regarding the pathogenesis of Baclofen poisoning in humans, which has seen a recent increase, worldwide, especially amongst the young people. Another reason for the conduction of this study was lack of the substantial data about the histo-pathological findings of lungs, in synergistic toxicity of Baclofen with Ethanol, in-spite of it being very common in humans, and both being respiratory depressant with similar mechanism of action. PURPOSE: - The authors aimed to understand the pathogenesis of fatal poisonings in humans due to Baclofen in combination with Ethanol via an animal research model. The enhancement of the overall scientific literature by extending research along the lines of the handful studies available in this regard was another adjunct goal of the study. MATERIAL AND METHODS: Fifteen Wistar rats were divided into control and test group of five and ten subjects respectively. The test group was further divided into two sub-groups of five each, with Baclofen administered to one, and it in conjunction with Ethanol to the other, in lowest dosages adjusted for the humans. Rats in both the groups were euthanized by dislocation of the cervical vertebrae for the histopathology examination. RESULTS: Capillary and venous plethora, hemorrhages in the inter-alveolar septi, hemorrhages into the alveoli and sludging was seen in the 1st sub-group. The plethora of venules, capillaries and arterioles, with sludging by the WBC (white blood corpuscle) infiltrates was seen in the 2nd sub-group. Desquamation of the ciliated epithelium and edematous thickening of the intra-alveolar septi, along with features suggestive of the peri-vascular edema was seen in the 2nd sub-group. The morphometric analysis of the micro vessels showed a significantly higher value of the arteriolar diameter in the 2nd sub-group, in comparison to 1st, but the venular diameter in the two sub-groups did not differ to any extent.

Forensic pathological characteristics of explosion trauma in confined space terrorist mass fatalities classified with a 3-dimensional model.

BACKGROUND: Explosion fatalities are the severest type of violent crimes. These involve the use of explosive devices in terrorist like activities in confined spaces in civilian or military settings, with mass number of people present all around. A stark dearth of literature for the forensic interpretation of such catastrophes is astonishing. PURPOSE: Characterization of the pattern of the multitude of injuries in explosions in confined spaces as guide for investigations and growth of literature on this entity. METHODOLOGY: A review of the archives of the forensic examinations of mass fatalities due to an explosion in a metro car was undertaken. It was combined with the reconstruction of the events by developing a three-dimensional model of this incident that involved seventeen fatalities. RESULTS: All the decedents showed differential pattern of fatal injuries under the influence of damaging explosion factors (DEFs). The causative forces were characterized as gas-detonation (in all the cases), damaging effect by shock waves (59% of the cases), and impact of fragmentation and collision of the body (thrown off) with nearby objects. Traumatic effect due to shrapnel as well as blunt force was noted in 82% of the cases. Gross destruction of head due to combined effect of gas-detonation and fragmentation was seen in 29% of the cases. CONCLUSION: An interpretation of the nature and pattern of injuries in confined space explosions can help to estimate the location of deceased/s with respect to the epicenter and the type of DEFs.

Forensic diagnostics of the range of rifled firearm calculated by back spatter over clothing.

BACKGROUND: Numerous studies have been conducted by using sophisticated methodologies for the deduction of range in cases of firearm injuries. However, the stark dearth of literature for similar purpose by just simple analysis of blood traces on items of clothing is astonishing. PURPOSE: This study was done to determine the relationship between range of a rifled firearm and blood traces on the clothing of victims in firearm injuries. METHODOLOGY: Simulation experiments were performed by firing test shots in closed shooting range by using a Glock 17 pistol (9 mm luger) into pieces of clothing soaked with sheep blood. A total of 132 shots were fired. The morphologies and amount of blood spatter formed over a range varying from 5 cm to 100 cm (shooting angle-90°) were studied. RESULTS: An inverse relationship was found to exist between morphology of blood traces produced on the target and the distance of the shot fired. The misting and micro-blood spatters were recorded at a range of 5-60 cm. The distance from which shots were fired carried significant impact on the appearance and density of the spray and the blood spatter. CONCLUSIONS: The results provide a scientifically determined, statistically valid and simple equation formula in the most cost effective and easy manner for the deduction of range by mere examination of clothing in cases of firearm injuries. The requirements of the sacrifice of animals, and/or extrapolation of the results to humans by conducting experiments using hypothetical targets were also obviated in this study.

TULP1 related retinal dystrophy: report of rare and novel variants with a previously undescribed phenotype in two cases.

PURPOSE: To report on two rare and one novel TULP1 pathogenic variants in two patients associated with a previously uncharacterized phenotype of retinal degeneration. METHODS: Case report. RESULTS: A 4 year-old and a 19 year-old female presented with reduced vision and bilateral bull's eye maculopathy. In both patients, a unique pattern of perivascular retinal degeneration was noted. Electroretinography was consistent with a cone-rod dystrophy. Sequence analysis identified pathogenic variants in the TULP1 gene c.1087 G > A, p.(Gly363Arg); c.1568 G > A, p.(Cys523Tyr); and c.821delA, p.(Lys274ArgfsTer36). CONCLUSION: Patients with TULP1-related retinal dystrophy can have a distinctive retinopathy with a unique pattern of macular degeneration and periarteriolar vascular pigmentation.

Gaslighting in alleged assault ascertained as Munchausen syndrome transcending to malingering in highly counterintuitive self inflicted acid burns.

A factitious disorder leading to the self-infliction of highly counter-intuitive burns was diagnosed in a middle-aged female. The injuries were otherwise alleged to have been sustained by assault inflicted upon her by an unknown person. The case was diagnosed by medico-legal interpretation of injuries, in spite of a highly deceptive and concocted history by the patient and her husband. The entity was unique in being associated with magnificent primary, secondary and tertiary gains. The exploitation of the morbid sequel to malinger by the patient, and the involvement of the husband for the prolongation of the illness of his wife for financial gains as gaslighting was highly unusual. The self-infliction of injuries over hands is seen in factitious disorder. However, a combination of a guarded self-immersion of the hands and feet in a corrosive by an illiterate female, followed by malingering to earn livelihood is unprecedented in factitious disorders. The delayed presentation which required amputation of all the limbs to save the life of the patient is a glaring highlight of this case.

Forensic medical characteristics of firearm exit wounds in cases with armour protection.

BACKGROUND: The very limited literature about the characteristic morphology of the firearm ammunition wounds in the body armored victims led authors to conduct an experimental study to understand this issue of great forensic and medico-legal importance. PURPOSE: An autopsy of a male sniper was fraught with a challenge to differentiate between a firearm ammunition entry and exit wound. He was wearing body armour when shot at during a hostage rescue operation. The study was conducted to standardize the findings and answer the queries in such cases of forearms with inherent legal implications. METHODOLOGY: The modifying effect of the clothing and the armour on the firearm injuries in humans was studied by test firings on animal (pig) cadaver tissues, which has closest simulation to the human body tissues. These firings were preceded by X-ray fluorescence, and followed by stereoscopic and spectroscopic examinations. All the events were recorded by the high-resolution video camera shoots. RESULTS: An extensive cavitation in the form of a cone shaped crater, and a tissue defect with precipitated edges and patching of the epidermal layers indicated a firearm entry and exit wound, respectively, in victims wearing body armour at the time of the firearm injury.

Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study.

BACKGROUND: Benefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. METHODS: A 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. RESULTS: Seven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. CONCLUSION: Structured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.

Computer assisted three-dimensional reconstruction of scene in firearm homicide.

Worldwide advances in computer techniques are not yet recognised in the practice of forensic medicine. A promising application is their use in making a three-dimensional reconstruction of the crime scene. This study analyses this technique in a homicide by firearm. Queries regarding the direction and number of shots, position of the victim inside the car when shot at and presence of the accused at the crime scene were answered by a scientific model. Similar reconstruction of the scene, nailing the accused in a heinous crime, has not previously been reported as a study or a case. The paper anticipates impetus to the growth of literature in criminology and forensic sciences. It will also expedite the delivery of justice based on scientific evidence in controversial causes of death.

Expression of the developmental important candidate genes in oocytes, embryos, embryonic stem cells, cumulus cells, and fibroblast cells of buffalo (Bubalus bubalis).

The present study was undertaken to study the expression of the developmental important gene transcripts in immature oocytes, mature oocytes, different stages of IVF produced embryos, embryonic stem (ES), cumulus (BCC), fetal fibroblast (BFF), newborn fibroblast (NBF) and adult fibroblast (BAF) cells of buffalo by semi-quantitative RT-PCR. The expression of GLUT1, HSP70.1, POL A Polymerase, GDF9, BMP15, and SURVIVIN transcripts was found in immature oocytes, mature oocytes, 2-cell, 4-cell, 8-16 cell, morula, and the blastocyst. Interestingly, the CX43 expression was found in oocytes, embryos, and other cell types, but it was not detected in the blastocyst. However, the IFNT expression was found in the blastocyst only, but not in other cells. The buffalo ES cells showed the expression of intracellular and cell surface markers (NANOG, OCT4, SOX2, FOXD3, SSEA-3, SSEA-4, TRA-1-60, and TRA-1-81) and alkaline phosphatase activity. Two ES cell lines (S-line and M-line-II) were continued to survive up to 98th passages (~630 days) and 97th passages (~624 days), respectively. It was interesting to note that GLUT1, CX43, HSP70.1, POL A Polymerase, GDF9, BMP15, and SURVIVIN transcripts (except the IFNT) were expressed in buffalo ES, BCC, BFF, NBF and BAF cells. This is the first preliminary report that the buffalo ES, BCC, BFF, NBF, and BAF cells expressed the several developmental important candidate genes. It is concluded that the expression of the major developmental important genes was not only expressed in the oocytes and embryos but also expressed in the ES, BCC, BFF, NBF, and BAF cells of buffalo.

Parthenogenetic activation of buffalo (Bubalus bubalis) oocytes: comparison of different activation reagents and different media on their developmental competence and quantitative expression of developmentally regulated genes.

This study was carried out to compare the efficacy of different methods to activate buffalo A + B and C + D quality oocytes parthenogenetically and to study the in vitro developmental competence of oocytes and expression of some important genes at the different developmental stages of parthenotes. The percentage of A + B oocytes (62.16 ± 5.06%, range 53.8-71.3%) was significantly higher (P < 0.001) compared with that of C + D oocytes (37.8 ± 5.00%, range 28.6-46.1%) retrieved from slaughterhouse buffalo ovaries. Among all combinations, ethanol activation followed by culture in research vitro cleave medium gave the highest cleavage and blastocyst yields for both A + B and C + D grade oocytes. Total cell numbers, inner cell mass/trophectoderm ratio and apoptotic index of A + B group blastocysts were significantly different (P < 0.05) from their C + D counterpart. To determine the status of expression patterns of developmentally regulated genes, the expression of cumulus-oocyte complexes, fertilization, developmental competence and apoptotic-related genes were also studied in parthenogenetically produced buffalo embryos at different stages, and indicated that the differential expression patterns of the above genes had a role in early embryonic development.

Infant death resulting from sharing a cot with a 10-year-old boy.

An infant may die from unintentional suffocation if their exhausted, or inebriated or sedated mothers fall asleep while breast feeding or just sharing a bed and roll over on to them. The mother wakes up to find the baby dead in the morning. Diagnosis is complex due to minuscule autopsy findings and denial by parents about overlaying although it was accidental. Unusually, in this case, the baby was "over layed" by a young male child from the same family. The female baby was found listless next morning by her mother and died after three months of treatment. Death circumstances, non-sudden outcome, and unusual circumstances of overlaying the baby.