Ligature mark on the face - forensic implications.

In deaths due to hanging and strangulation, the position, course and direction of the ligature mark, the kind of knot used and injuries to the neck structures help in deducing the cause and manner of death. Two cases of suicidal hanging are reported where the unusual positioning of ligature and presence of the ligature mark on the face raise doubts concerning the circumstances of death. The presence of a ligature mark on the face is an unusual and rarely reported phenomenon that can have serious medico-legal implications.

An unusual site for a snakebite.

Snakebites are an important cause of death in rural and suburban India. Most of these deaths occur due to envenomation. The incidence of snake bite is highest in developing countries with the most common site of such bites in the lower limbs. Here, we present a case where a 12-year-old boy had been bitten on his face which is an unusual site and as a consequence the treating doctor failed to make the correct diagnosis promptly and the boy died.

Sudden unexpected death due to strangulated inguinal hernia.

Sudden unwitnessed, unexpected deaths when the bodies are found in public places require a complete and meticulous medicolegal autopsy to ascertain the cause and manner of death to avoid further unnecessary investigations by the legal authorities. Such deaths attributed to gastrointestinal causes at autopsy are relatively uncommon. We report a case of sudden unexpected death due to strangulated inguinal hernia in a 60-year-old man. The body was discovered in a public area near a place of worship. The present case illustrates a potentially preventable sudden unexpected death due to a surgically correctable gastrointestinal condition. In the present case, the individual feared being hospitalised for treatment of his scrotal swelling with potential surgery and the eventual loss of daily income. In our opinion, such apprehensions may have delayed the potentially life-saving hospital surgical intervention in the individual.

Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India.

BACKGROUND: Depression is found to be common among patients with diabetes and it is associated with poor outcomes in disease control. This study was carried out to find out the proportion and determinants associated with depression among patients with established type 2 diabetes mellitus (T2DM) in various tertiary care hospitals in Mangalore city of south India. MATERIALS AND METHODS: This study was conducted in one government and three private tertiary care hospitals in Mangalore in December 2010. All consenting patients with confirmed diagnosis of T2DM were interviewed and screened for depression by administering the 9-item PRIME-MD Patient Health Questionnaire (PHQ-9). RESULTS: Of the 230 T2DM patients, 119 (51.7%) were males. The mean age of all participants was 53.61 ± 10.7 years. The median duration of T2DM was found to be 12.1 ± 7.35 years. Among the participants, 71 (30.9%) met the criteria for moderate depression, 33 (14.3%) for severe depression, and the remaining 126 (54.8%) had no clinically significant depression. Only 26 (11.3%) patients were already aware that they were depressed, of whom just 3 had taken medical consultation. Among the risk factors, depression was found to be significantly associated with older age, female gender, low socioeconomic status, unskilled and retired employment status, having complications due to T2DM or comorbidities like hypertension and coronary artery disease, being overweight and being on insulin syringe injections. CONCLUSION: This study found a high proportion of depression among patients with T2DM. Therefore the care of individuals with diabetes mellitus (DM) should include the screening and possible treatment of depression in order to achieve and sustain treatment goals.

Mortality among homeless and unclaimed bodies in Mangalore city - An insight.

Homelessness is a social as well as legal stigma on a Country's development index. In addition homeless people are exposed to increased incidence of diseases and accidents. Mangalore city, a bustling city located in Southern costal region of India, has seen tremendous growth in the past few years; with this the problem of migrants and homeless has also increased. This has invited a spectrum of problems relating to law and order including frequent incidences of unclaimed dead bodies, both due to natural and unnatural causes. This autopsy based study tries to highlight the situation of picture of homeless deaths in Mangalore and the problems faced by the Law enforcing authorities.

Sex estimation from foramen magnum dimensions in an Indian population.

Identification of skeletal remains is vital in forensic investigations. The need for methods to estimate sex from cranial fragments becomes apparent when only a part of skull is brought for identification. The present research is an attempt to study the sexual dimorphism of the anteroposterior diameter, transverse diameter and area of foramen magnum in a population of costal Karnataka region using statistical considerations. Ninety adult dry skulls of known sex (50 male and 40 female) were included in the study. Morphometric analysis of foramen magnum was conducted using vernier calipers and the area of foramen magnum was calculated. The anteroposterior diameter, transverse diameter and area of foramen magnum are found to be significantly larger in males than females. Binary Logistic Regression (BLR) analysis was performed to derive models for estimation of sex from the different measurements of foramen magnum and Receiver Operating Characteristic (ROC) curve was drawn for the predicted probabilities obtained from BLR analysis. The predictability of foramen magnum measurements in sexing of crania was 65.4% for transverse diameter and 86.5% for the anteroposterior diameter. For the area of foramen magnum that was calculated using the formula derived by Radinsky and Teixeria, the predicted probabilities were observed to be 81.6% and 82.2% respectively. When anteroposterior and transverse diameter were used together in BLR analysis the predictability of sex increased to 88%. However, considering the overlapping in the male and female values for the foramen magnum measurements it is suggested that its application in sex estimation should be restricted to cases where only a fragment of base of the skull is brought for examination. In such cases, the anteroposterior diameter and area of the foramen magnum can be employed as better tools for sexing the skulls than the transverse diameter of the foramen magnum.

Adenomyomatous polyp of the uterus: Report of an autopsy case and review of the literature.

Adenomyomatous polyps of the endometrium are a rare subtype of endometrial polyps. In addition to the usual features of endometrial polyps, they also contain a smooth muscle component. Grossly they appear no different than ordinary endometrial polyps. In the case reported herein, a 23-year-old nulliparous female was killed in a traffic accident. In the course of the medicolegal autopsy, a small pedunculated growth was identified in the fundus of the endometrial cavity. Histologically the mass consisted of endometrial glands intimately mixed with smooth muscle and thick walled blood vessels, consistent with an adenomyomatous polyp. There was no history of tamoxifen use in this individual. To our knowledge this is the first report of post-mortem diagnosis of an adenomyomatous polyp. Furthermore, this is the first report of an individual with this diagnosis younger than the fourth decade. In the medicolegal setting, forensic pathologists are constantly faced with entities that, while they may not have caused death, may serve to educate practitioners about rare lesions. This individual's finding serves as one of those entities. This case reiterates the importance of the autopsy as not only the answer to an individual's death, but as an avenue for the discovery of entities that may have relevance to those who are still living.

Double non coronary aortic sinuses: an autopsy case finding showing the arterial variation / Senos aórticos dobles, no coronarios: un caso de autopsia que demuestra la variación arterial

We report a case of variant origin of the right coronary artery from the left posterior aortic sinus. This was observed routinely during a medico legal autopsy of a 58 year old male who died in a road traffic accident. Initially it was believed that the right coronary artery was absent since there was no obvious right coronary artery ostium from the anterior aortic sinus. However it was found later that the right coronary ostium was present just beside the left coronary ostium in the left posterior aortic sinus and the right coronary artery was arising from the left posterior aortic sinus. The right coronary artery had an intramural course between the aorta and pulmonary trunk, which is considered as very dangerous and life threatening. We believe that the present case report will be enlightening to the cardiologist and cardiothoracic surgeon. It is also true that the conduction of medico legal autopsies of coronary arteries is important for the medico legal resolution.

Se presenta un caso de variación de origen de la arteria coronaria derecha desde el seno aórtico posterior izquierdo. Esto se observó de forma rutinaria durante una autopsia médico-legal de un hombre de 58 años que murió en un accidente de tránsito. Inicialmente se creía que la arteria coronaria derecha estaba ausente ya que no había un ostium observable desde el seno aórtico anterior. Sin embargo, se descubrió más tarde que el ostium de la arteria coronaria derecha estaba presente justo al lado del ostium de la arteria coronaria izquierda en el seno aórtico posterior izquierdo y la arteria coronaria derecha se originaba del seno aórtico posterior izquierdo. La arteria coronaria derecha presentó un recorrido intramural entre la aorta y el tronco pulmonar, que se considera como muy peligroso y potencialmente mortal. Creemos que el presente trabajo será esclarecedor para el cardiólogo y el cirujano cardiotorácico. También consideramos que el conocimiento de la anatomía de las arterias coronarias es importante durante el desarrollo de la autopsia médico-legal para lograr alcanzar una correcta resolución del proceso medicolegal.

Sudden death due to dysembryoplastic neuroepithelial tumor.

Sudden death in adults from presumably natural causes occurs more frequently than is commonly thought. Numerically they constitute a significant fraction of the total mortality of which central nervous system causes account for 15 percent of the cases. The neoplasms of neuroepithelial origin account for 3 percent of these cases. We are presenting a case of 40 year old woman, who suddenly developed vomiting, abdominal pain and rapidly deteriorating vitals over a period of 20 h and breathing last on the way to the hospital. A cystic swelling of the right frontal lobe was present at autopsy, histopathological examination of the swelling revealed to be Dysembryoplastic Neuroepithelial Tumour (DNT). DNT is a rare neurological tumor characterized by presence of neurons, astrocytes and oligodendrocytes presenting with complex partial seizures. It frequently affects the frontal and temporal lobes of adolescents and young adults.

Sudden death due to pulmonary aspergillosis.

Sudden death due to respiratory pathology is not uncommon and tuberculosis with its complications is well known to cause death. We report a case of a male, train passenger, who started coughing out blood and died on reaching the hospital. Medicolegal autopsy confirmed the sudden unexpected death to be due to pulmonary aspergillosis in the person with past medical history of tuberculosis.