Profile of Mortal Injuries in Vehicular Accidents: An Autopsy-Based Study.

Background It is crucial to analyze the trends of fatal injuries among pedestrians, passengers, motorcycle riders, and drivers of three- and four-wheelers in traffic accidents. Objective To ascertain the trend of fatal injuries to the head, chest, and abdomen across different victim categories in vehicular accidents. Materials and methods An autopsy-based prospective study was carried out in the mortuary of a rural tertiary care hospital. A total of 108 fatal cases of vehicular accidents were taken into consideration. All natural and unnatural deaths, other than those stemming from vehicle crashes, were excluded from this study; only the victims of fatal vehicular accidents were included. Results Males outnumbered female victims by 8.8:1. The age range of 41-60 years was the most affected (38.9%). The greatest number of victims (17, or 15.8%) were male motorcycle riders in the range of 21-40 years. Most vehicular mishaps (61; 56.5%) occurred during the evening. The most frequent injury pattern reported was head injuries (53.4%). Conclusions Motorcycle riders constituted the most severely injured victim category in a vehicular accident. Most mishaps occurred in the dark because of inadequate lighting or bad road conditions in rural areas. Furthermore, the most frequently occurring type of injury was an injury to the head, which may be an outcome of riders' lack of compliance with the mandatory helmet-use policy.

Assessing the Need for Clinical Forensic Medicine Training in the Medical Undergraduate Curriculum.

OBJECTIVE: This study was conducted to assess the need for clinical forensic medicine (CFM) training (hands-on and bedside) in medical undergraduate students and to determine the utility of skill-based teaching methodology in CFM. METHOD: A cross-sectional study was carried out in the Government Medical College, where we used the mixed model approach (qualitative and quantitative component) to access the approach of three groups containing 50 participants each from (1) resident doctors/interns, (2) faculty, (3) casualty medical officers, toward skill-based teaching of CFM. A structured pretested questionnaire was administered to all study participants. The questionnaire was based on their perception regarding the legal problems faced during clinical practice and their attitude toward the need for CFM. It was followed by a focus group discussion (FGD) arranged separately for each group of 10 participants. Each FGD session lasts for 40 minutes with a moderator and recorder. RESULT: Present MBBS (Bachelor of Medicine & Bachelor of Surgery) curriculum teaches CFM very early is strongly agreed by 20 (40%) of the faculty, four (8%) of interns, and three (6%) of medical officers. 40 (80%) of interns, 43 (86%) of medical officers, and 40 (80%) of faculty necessitate hands-on training in CFM in the MBBS curriculum. Forensic medicine specialists should handle clinical medico-legal cases (MLCs), as agreed by 50 (100%) faculty, 46 (98%) interns, and 47 (94%) medical officers. CONCLUSION: Hands-on training in CFM is needed for a better practical approach for doctors toward handling MLCs. Hands-on training should be introduced in the second-year MBBS curriculum, and their clinical aspects should be taught simultaneously with clinical subjects till the internship.

Mines of cytokine: A treasure trove in pulpal and periapical diseases.

Pulpitis is a special disease of dental pulp. It causes localized inflammation, due to various inflammatory mediators such as cytokines and chemokines. These inflammatory mediators are responsible for various reparative and resorptive processes in the dental pulp. The balance between these processes ultimately determines the viability of the tooth. Due to the important properties of various inflammatory markers, the correlation of cytokinin gene expression in various stages of inflammation becomes necessary to focus on. Several studies in the past have focused on the importance of such correlation to help in diagnostic applications. The nature of these inflammatory mediators can help us in diagnostic evaluation. Several attempts have been made to focus on these associations so that it can assist in making clinical decisions effectively. The data available are vast but are the most neglected topic. This review article briefly outlines and summarizes the importance of various inflammatory mediators such as cytokinin and chemokines in various pathways of pulpal and periapical inflammation in explanatory and diagrammatic forms. Knowledge gained about pulpal inflammatory response may aid in understanding the molecular level of inflammatory pulpal and periapical diseases, which shall modify our future diagnostic modalities. Several medicaments are used in the treatment of minimal to advanced dental caries which leads to periapical infections. Thorough understanding of these medicaments can resolve secondary infection and can improve the prognosis of the treated tooth.

Custody-related deaths in Maharashtra state of India - Analysis of autopsies performed at a medical Teaching Institute during the period 2000-2018.

INTRODUCTION: Custody-related death is an internationally key sensitive issue with respect to Human Rights. The causes of death and associated factors in this vulnerable population vary according to country and region. The present study attempted to analyze the different causes of custody-related deaths and associated factors and identify the areas of intervention for prevention of such deaths. MATERIAL AND METHODS: This retrospective study was conducted using files of custody-related deaths in the Department of Forensic Medicine of Shri V. N. Government Medical College, Yavatmal, Maharashtra State (India). A total of 108 cases were autopsied by the Department during the period of 2000-2018. We used a pre-formed proforma to extract data from files of these cases; the data obtained tabulated and coded in to charts, following which they were analyzed in detail. RESULTS: Male preponderance (105) was observed, with there only being 3 female cases (Male: Female ratio 1:0.028). The most common age group among deaths in police custody/action was 31-40 years whereas; age group of 41-50 years was most common among prisoners. A majority of deaths occurred due to natural causes (69.44%); among these, 89.33% were prisoners, with cardiac causes being the most common. Many individuals died due to cardiac causes were brought dead at tertiary care hospital. Suicides were a common cause of unnatural deaths among individuals in police custody/action. The majority of victims committed suicide in police custody did so by hanging. All cases of suicide by insecticide poisoning were observed in police action, and hanging was the only cause of suicide in prison. Blunt force injuries were frequent cause of homicide in police custody, which were result of force used by police during interrogation. CONCLUSION: Lack of knowledge regarding the causes of death and careless attitude towards the suicidal behavior and, the health and welfare of detainees are avoidable reasons for custody-related deaths.

Unique fatality due to claw injuries in a tiger attack: a case report.

This paper describes a unique case of a fatal tiger attack in the wild. In the present case, a tiger fatally mauled a 34-year-old female with its claws, instead of the usual mechanism of killing by the bite injury to the neck. The autopsy revealed multiple fatal and non-fatal injuries caused by the tiger claws. The characteristic injuries due to the tooth impacts were absent as the teeth of the offending tiger were either fallen or non-functional. To the best of our knowledge, probably this rare case would be the first reported human fatality due to the tiger claw injuries in the world. The purpose of the present article is to highlight the fatal injuries due to the tiger claws, as the claw-induced fatal injuries in a tiger attack are not reported in the medico-legal literature. Moreover, this report would be an illustrative one for differentiation between the fatal injuries due to the claws and tooth impacts in a tiger attack. Furthermore, the present report establishes the importance of the tiger claws as a source of fatal injuries in a tiger attack.

Quantitative analysis of injury characteristics in victims of interpersonal violence: an emergency department perspective.

Violence runs into the fabric of society. In recent years, violence has been identified as an important health problem in industrialised societies. In the present study, conducted to analyze injury characteristics, 813 victims of interpersonal violence presenting to emergency department at a Government Medical College and Hospital from a major city in Central India were interviewed and examined over a period of one year. Central to the quantitative analysis of the data collected was the extraction of specific injury characteristics from the sample population. The group included 606 men and 207 females, most of them were resident of urban areas, aged between 11 and 30 years. Most of attacks occurred at nights, with minimal seasonal variation. Males were more commonly attacked outdoors by a single stranger male while females were mostly attacked indoors by spouse. Blunt trauma was more commonly seen in females as compared to males. Head neck and face region was the most preferred anatomical site by the assailants. Hard and blunt weapons were used more commonly at homes (184 of 269 incidents) than at streets (301 of 561 incidents). Sharp edged and pointed weapons were most commonly used at streets. Firearms were rarely used. Occurrence of physical assaults in this region more or less follows the pattern seen in other parts of the world with local and socio-cultural differences that need to be further delved into and considered during the planning and implementation of injury prevention programs.

Fatal tiger attack: a case report with emphasis on typical tiger injuries characterized by partially resembling stab-like wounds.

Fatalities due to attacks by tigers on humans are uncommon and are rarely described in the medico-legal literature. We herein present a forensic investigation in a unique case of a fatal tiger attack in the wild on a 35 year old female in India by an Indian Bengal tiger (Panthera tigris tigris). The attack resulted in two pairs of puncture wounds over the nape area with occult cervical spine injuries resulting from transfixing of spine due to the tiger canines; multiple puncture wounds, numerous scratches and abrasions consistent with the tiger claw injuries and injury to the right jugulocarotid vessels. This case outlines the characteristic injury pattern from such an attack along with the multiple sources of the tiger injuries. The analysis of these injuries might reveal the motivation behind the attack and the big cat species involved in the attack. A tiger injury is sometimes compared with a stab injury, as the patterned injuries due to a tiger bite are characterized by multiple penetrating, stab-like wounds. So, a special attention is paid toward establishment of the cause of death from bites by the animal teeth under unknown circumstances of trauma and to exclude the possibility of a homicide beyond reasonable doubt in such cases.

Age estimation from physiological changes of teeth by Gustafson's method.

Age determination is crucial in medicolegal cases. Various factors are considered for determination of age, out of which teeth are the most durable structures in human body which are better preserved even in the acidic soil. In many archaeological sites and forensic cases, teeth are the only available human remains for the identification and age determination purpose. We conducted this study to know the changes in teeth with advancement of age. In our study, 80 cases in the age group of 26-70 years were studied, out of which 58 were men and 22 women. The six physiological changes in teeth, viz. attrition, periodontosis, secondary dentin deposition, root translucency, cementum apposition and root resorption, were studied with each parameter having score ranging from 0 to 3. Total score was calculated by adding the scores of all the six physiological factors. The regression analysis was done by plotting the total score allotted against the actual age of the person. This regression line was used to derive the regression formula which came out as y = 3.71x + 16.03 and from this, age of the person was calculated. The average age difference between known and estimated age in this study was found to be ±4.43 years.

Traumatic asphyxial deaths in car crush: Report of 3 autopsy cases.

Traumatic asphyxia is a rare syndrome due to compression of thorax, abdomen or both. The diagnosis of traumatic asphyxia is based on typical findings consisting of cervico-facial congestion with swelling, multiple petechial hemorrhages in skin and conjunctiva with a history of traumatic compression. The authors report three cases of traumatic asphyxia in car crash to illustrate few unusual findings along with the typical autopsy findings. All three cases showed the typical findings of traumatic asphyxia. Regarding unusual findings, blisters containing hemorrhagic fluid were observed in two cases over areas subjected to traumatic compression. One case showed the peculiar skin pattern in the form of absent congestion corresponding to the tight-fitting strap of banyan. Subcutaneous emphysema was noted in two cases in presence of intact visceral pleura. These unusual findings could be used as additional markers of traumatic asphyxia in conjunction with characteristic features to support the diagnosis of traumatic asphyxia.

Orthopantomographic evaluation of canine and first premolar using Demirjian's stages in central India: new approach to forensic age estimation.

Teeth development is widely used for age estimation in forensic science. The aims of this study were as follows: first, to establish Indian data on canine and first premolar development for age estimation and second, to investigate population differences in teeth development. Orthopantomograms of 340 Indian children aged between 5 and 14 years were analyzed. Demirjian's stages were recorded for the developmental evaluation of canine and first premolar and for further descriptive statistical analysis. A two-way ANOVA was performed to test the significance of difference in teeth development by sex and stage. A one-way ANOVA was performed to investigate population differences in teeth development. Results showed statistically significant differences in teeth development by sex and stage. Accordingly, teeth development was earlier in girls. No statistically significant differences were observed in timings of Demirjian's stages among different populations. In conclusion, the findings of this study could be used for age estimation of Indian children.